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Anchorage family copes with son’s severe epilepsy INSIDE
Cantwell woman gets diagnosis after symptoms snowball Dr. Lee Ann Gee: Managing mental health in turbulent times Go tobacco-free with Great American Smokeout Dr. Charles Steiner: What you need to know about diabetes Department of Health and Social Services: Mask Up, Alaska!
November 2020 Vol. 1, No. 11
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November 2020 Vol. 1, No. 11
Alaska People Meet Sawyer Morin, who has Dravit syndrome, a rare form of epilepsy. It’s a major challenge for his family, but they’re determined not to miss out on life’s regular experiences.
About Alaska Pulse Alaska Pulse is a monthly magazine focusing on health in the Far North and distributed around Fairbanks and Anchorage. We’ll share stories from around the state about how people stay healthy. Learn from experts in different medical fields on ways to improve, or maybe just maintain, your health. We’ll hear personal stories about people’s triumphs over different health adversities. Alaska Pulse is a community publication, so every issue is sure to hold a variety of perspectives.
Alaska Pulse is a publication of the Fairbanks Daily News-Miner LLC. 200 N. Cushman St. Fairbanks AK 99707 Publisher Richard E. Harris
By Aliza Sherman Page 4
Kaeleen Mayo of Cantwell knew something was wrong, but it took years for her to get a diagnosis. By Kris Capps Page 16
Chuck Gray believes a lack of vitamin D after decades in Alaska may have contributed to his multiple sclerosis. Page 20
IN THIS ISSUE
Editor Rod Boyce editor@AlaskaPulse.com 459-7585
HEALTH SENSE: Dr. Lee Ann Gee: Managing mental health in turbulent times .......... 11
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HEALTH SENSE: Go tobacco-free with Great American Smokeout .................................... 12
HEALTH SENSE: Dr. Charles Steiner: What you need to know about diabetes ............. 22 HEALTH SENSE: Dr. Kim Driftmier: Spine care for Alaskans .................................................. 24 HEALTH SENSE: Quitting tobacco for a healthy heart ............................................................ 25 HEALTH SENSE: Dr. Brück Clift: Longing for longevity............................................................. 26 Department of Health and Social Services says “Mask Up, Alaska” ................................. 30 AlaskaPulse.com — November 2020
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braves the day 4
November 2020 — AlaskaPulse.com
Sawyer Morin, center, with his parents Sam and Sara Morin and older brother Salvador.
Family copes with son’s constant seizures from Dravet syndrome By Aliza Sherman
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hen Sawyer Morin was born in Anchorage, everything seemed to be on track. Then at four months, he had a seizure. “We were hoping it was a type of febrile seizure, a seizure with a fever, which is really common for children to have a febrile seizure but grow out of them by 5, 6 or 7 (years old),” says Sawyer’s mom, Sara Morin. She, along with her husband, Salvador — who goes by Sam — were suddenly confronted with a frightening episode that many new parents face. But the first seizure Sawyer suf-
fered would not be his last. In that first month, he had two seizures that came on when he was sick, followed by a seizure every month after. At 8 months old, he had a seizure that required doctors to put him into a coma to stop him from seizing. That seizure had lasted two and a half hours and no emergency medications could stop it. Sawyer came out of the coma a few hours later and was out of the hospital two days after that. By that time, Sawyer was having full and partial grand mal seizures, now referred to as tonic-clonic seizures. The Epilepsy Foundation defines a tonicclonic seizure as a convulsion that “usually begins on both sides of the brain but
can start on one side and spread to the whole brain. A person loses consciousness, muscles stiffen, and jerking movements are seen.” Tonic-clonic seizures typically last one to three minutes. A tonic-clonic seizure that lasts more than five minutes is considered a medical emergency. After his first induced coma, with new medications on board, Sawyer was seizure-free for a few months. The family was hopeful that the seizures were gone for good. The hope was soon shattered. At a year old, Sawyer began having new types of seizures. He was having absence seizures where he would stare off into space, drop seizures resulting in AlaskaPulse.com — November 2020
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Sawyer’s older brother Salvador loves superheroes and was nicknamed Super Sal. When Sawyer was born, he naturally became Super Sawyer, according to Sara Morin. Salvador is an advocate for Sawyer, spreading the word to his peers about epilepsy awareness. Right, the family was able to travel to Disneyland in 2019 to Epilepsy Awareness Day. 6
November 2020 — AlaskaPulse.com
Although Sawyer’s many daily seizures make careful preparation for outings necessary, Sara Morin says he is a generally happy child and she doesn’t want her boys to miss out on fun.
a sudden loss of muscle control causing him to fall to the ground, and myoclonic seizures that involved a rapid jerk of his muscles.
Getting a diagnosis
In 2018, at 15 months, Sawyer finally received a diagnosis: Dravet syndrome, originally called severe myoclonic epilepsy of infancy (SMEI). The Dravet Syndrome Foundation website explains that Dravet symptoms begin in infancy or early childhood and usually start with seizures that are “focal” — meaning in one area of the brain — or “generalized” throughout the entire brain, leading to convulsive seizures. Other seizure types can present in a child after 12 months of age and can vary greatly. Dravet syndrome is a rare disease and studies say the prevalence ranges between 1 in 20,000 and 1 in 40,000. According to the Dravet Syndrome Foundation, about 80% of those cases are caused by an SCN1A gene muta-
tion and is considered to be at the severe end of the epilepsy syndrome spectrum. There is currently no cure for Dravet. “It’s wonderful to get a diagnosis in so many ways because you know what direction to go (with medications). So we’re glad to have that diagnosis, but the diagnosis was extremely scary,” says Sara, adding, “One in five children don’t make it to 18 due to seizures.” Children with Dravet syndrome also have a high incidence of SUDEP or Sudden Unexpected Death in Epileptic Patients. “I can’t even tell you how long we cried, but we cried for days and months. 2018 was definitely Sawyer’s scariest year because we were still learning so much. He was in four comas that year,” says Sara. The Morin family traveled from Alaska to Seattle, where they met with Dr. Russell P. Saneto, DO, PhD, a pediatric epileptologist who specializes in hardto-treat epilepsies at Seattle Children’s
Hospital. They were able to get Sawyer off medication that wasn’t helping and weaned him off other medications.
Family life with Dravet syndrome
Sara recalls there were days when the family would travel back and forth by ambulance from home to the hospital. They’d get out of PICU, return home for eight hours, then a seizure wouldn’t stop, and they’d be right back in the hospital. Before Sawyer’s seizures became more frequent, Sara ran a home day care. She had to quit because Sawyer was in the hospital so often. The family was down to one income. Sawyer has to be watched around the clock. He is never unsupervised. A common cold puts him into a seizure. Every time he has a fever, he goes into a seizure. Sara lists some other things that can be a trigger. “Tired, hungry, those are two big triggers. Excitement. A burst of wind. Water AlaskaPulse.com — November 2020
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“I can’t even tell you how long we cried, but we cried for days and months. 2018 was definitely Sawyer’s scariest year because we were still learning so much. He was in four comas that year.”
— Sara Morin
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is a big trigger. Sunlight. Water — playing in any type of water. Water seems to be a very big trigger. A temperature change if he gets in a warm tub or gets in a cool pool. Also light reflecting off water.” Even a change in food texture, like taking a bite of something hot and not expecting it or a food texture change such as going from a bite of meat to mashed potato, particularly when he was younger, could trigger a seizure. Sara says it got to a point where she stopped looking for triggers because almost anything could be a trigger. In 2018, the Morin family living room was prepped like a mini ER with two pulse oximeters to measure his heart rate and oxygen levels, some supplemental oxygen, a manual resuscitator bag to force air into his lungs if he stops breathing, and a suction to clear his airway, if needed, when he seized. Siblings of children with Dravet syndrome can experience stress and other challenges, and Sara says Sawyer’s older brother, Salvador, has had to grow up quickly. “He helps me all day. He knows what to watch for with seizures. He is super compassionate and very loving towards his brother. Even when his brother can be a little stinker, he is just so helpful.” Sara says that when they have to call the paramedics, Salvador’s job is to get the door to make sure it is open and put Sara’s phone charger in her purse. He is also a big advocate for Sawyer, spreading the word about epilepsy awareness such as explaining to his peers on the playground why his brother has to wear a helmet — to protect his head if he falls down during a seizure. Salvador recently held his own fundraiser for Sawyer with Alaska artist Amanda Rose Warren’s participation. Salvador melted down crayons and Amanda sold his crayons, along with some of her illustrated stickers, on her website. Salvador’s nickname, since he was 2 years old, was Super Sal because of his love of superheroes. Sara says when Sawyer came along, it seemed fitting to give him the nickname Super Sawyer, particularly because he came after years of struggling with infertility and
miscarriages. The family even threw a superhero-themed baby shower and took newborn photos of Sawyer dressed like Batman — all of this before they knew about his epilepsy.
Managing Sawyer’s Dravet syndrome
Sawyer sleeps next to Sara so she can immediately feel if he stops breathing in the night. His heart has stopped before during a seizure. In the case of severe seizures that wouldn’t cease, Sawyer is given a “rescue medication” of a high dose of a diazepam, a powerful benzodiazepine, to flood his system and quickly help calm his brain and nerves. Sara explains that children with Dravet syndrome have “comorbidities,” which are diseases or medical conditions that coexist with the primary disease. Sawyer also has mobility and balance issues, so he sits in a wheelchair and wears a protective helmet. Sawyer tires quickly, has focus issues, and is developmentally behind. Sara said there will be many more comorbidities to come as Sawyer gets older on top of the multiple seizures every day. He con-
tinues to undergo occupational therapy, physical therapy and speech therapy. In March 2019, right after a major seizure that sent him into the PICU, Sawyer was prescribed what Sara describes as a game changer and a turning point: Epidiolex, the only FDAapproved pharmaceutical for epileptic seizure reduction containing cannabidiol or CBD, a chemical compound derived from the cannabis plant. Sawyer has not been put into a coma since starting on Epidiolex, and while not seizure-free, his seizures did reduce to 50 seizures or fewer a day for a while. He went three months without any tonic-clonic seizures and even his rescue meds — diazepam and phenobarbital, the next rescue med in his Seizure Action Plan — seemed to work more effectively. His seizures did eventually return, however. Also in 2019, the family began fundraising to learn more about getting a seizure dog for Sawyer, a promising support option for him. By November 2019, the family had raised enough money to be able to fly, after an appointment at Seattle Children’s, to Disneyland for Epilepsy Awareness Day. This was the
first time they were able to travel for something beyond medical visits. They used the trip as a fact-finding mission to interview the organizations that train seizure assistance dogs to figure out how to obtain one for Sawyer.
Sawyer at almost 4 years old
Through the Morin family’s fundraising efforts and the generosity of countless people in Anchorage and beyond, the Morins have been able to move forward with 4 Paws for Ability, a service dog organization that provides support for children worldwide. 4 Paws for Ability has only two training centers in the nation, one in Ohio and one in Anchorage. Sara says the process for training a seizure assistance dog specific to Sawyer’s needs involves a year of regular service dog training, and then, at about a year, the dog begins to learn skills related to a specific child. In less than two years, Sawyer will get his dog. Sara explains that once his dog is ready, every time Sawyer has a seizure, she will send what he is wearing at the time to 4 Paws for Ability with infor-
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mation about how long the seizure lasted and what it looked like. She will also send clothes from times when Sawyer is not having a seizure. By doing this, his dog will learn the scent of Sawyer’s seizures so it will be able to not only alert caregivers when Sawyer is seizing, but even pre-alert them, a highly specialized ability. As of this writing, Sawyer is still having 50 to 150 seizures daily and is on five seizure medicines twice a day. When his medicine changes, his seizures change. “We know our paramedics very, very well. They know that if we’re calling, once they get here we’re just loading up and going because we can’t stop the seizure,” Sara explains, adding, “We have two stations that respond — Station 9 or Station 12 — and they both know us quite well.” Even going to the Alaska State Fair last year took preparation. Upon arrival at the fairgrounds, Sara went to the EMT building to let them know about Sawyer’s condition and to let them know what they might need if Sawyer has a seizure that won’t stop. “I don’t want my kids, as much as possible, to miss out on fun,” says Sara. “Say we’re having fun — we may have a few seizures in there — but if we’re having a good day, we’re going to try to do it as best and as safe as we can.” On the horizon for Sawyer is an FDA-approved procedure called Vagus Nerve Stimulator (VNS) Implantation, a form of treatment for drug-resistant 10
November 2020 — AlaskaPulse.com
Resources Super Sawyer Facebook Page
https://www.facebook.com/Super-Sawyer-212745016129746/
Epilepsy Foundation
https://www.epilepsy.com/ A nationwide organization that provides community services, public education, federal and local advocacy, seizure first aid training, and research funding into new treatments and therapies.
Dravet Syndrome Foundation
https://www.dravetfoundation.org/ Raises funds for Dravet syndrome and related epilepsies; supports and funds research; increases awareness; and provides support to affected individuals and families.
Know SUDEP Now
http://knowsudepnow.org/ A partnership of the Cameron Boyce Foundation and the Epilepsy Foundation to create K(NO)W SUDEP NOW! to bring awareness and to end sudden unexpected death in epilepsy.
4 Paws for Ability
https://4pawsforability.org/ A service dog provider for children and adult children with caregiver guardianship who cannot live independently. epilepsy. The implant, like a “pacemaker for the brain,” stimulates the vagus nerve in a patient’s neck, delivering regular pulses that help prevent seizures and reduce the risk of sudden death from epilepsy. The vagus nerve controls involuntary body functions such as breathing and heart rate. If a seizure does occur, the implant delivers a more powerful jolt to help stop the seizure. The implant
can also be activated by his family, teachers, and caregivers using a special magnet in place of rescue medications. Throughout all of what Sawyer has experienced in his nearly four years, Sara says he remains a happy child, playful, dancing, and always smiling. He is, without a doubt, a superhero. Aliza Sherman is a freelance writer in Anchorage. Comments about this story? Email editor@AlaskaPulse. com
HEALTH SENSE
Managing mental health in turbulent times By Dr. Lee Ann Gee
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ith the rapidly evolving news and information of COVID-19, it’s easy to feel overwhelmed and unsure. For all of us who struggle with our mental health, the rapidly changing environment can magnify any challenges that we’ve been dealing with. It’s important to do what we can to tend to our emotional wellbeing as we navigate this period of time. If you’re finding that your anxiety or depression is feeling harder to manage, here are a few ways you can get through: “Headline Stress Disorder,” a term coined for the anxiety resulting from the 24-hour news cycle, can be ramped up when always-emerging information about COVID is readily available. If around-the-clock coverage is causing you distress, try disabling news push notifications on your phone and set aside one block of time a day to follow coverage rather than continuously checking in. When you do read coronavirusrelated news, for example, make sure you choose trusted sources such as the Centers for Disease Control (CDC), World Health Organization (WHO), or local health authorities. Guidelines for personal pandemic care include avoiding touching your face, washing your hands often for 20 seconds, covering your mouth when you cough or sneeze, avoiding contact with those who are unwell, and staying home if you’re feeling sick (except to get medical care). For more health guidelines, choose trusted organizations such as the CDC or WHO. Our self-care practices often go neglected in periods of high stress, but it’s important to stay on top of getting adequate sleep, eating nutritious food, and taking vitamins that can help keep stress levels down and your immune system strong. If gyms and other exercise locations are closed in your area, try one of the many fitness classes that can be streamed online. Be sure to stay in touch with your friends and family to let them know how you’re feeling or ask them to check in on you if you know that you tend to isolate when stressed. If constant discussion of coronavirus stresses you out, it’s OK to ask for some “COVID-19-free time.” If you feel that your anxiety or depression is interfering with daily functioning, seek out help from a medical professional. Remember that mental health is just as important as physical health and that help is available
when you want it. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship and should not be used as a substitute for professional diagnosis and treatment. Always consult your primary health physician before making any health care decisions or for guidance about a specific medical condition. If COVID-19 and social isolation are heightening your symptoms of depression, TMS Center of Alaska may be able to help. At TMS Center of Alaska, we specialize in TMS therapy — an FDA-cleared, non-invasive treatment for treatment-resistant depression and OCD without harmful side effects. To learn more or to schedule a TMS consultation, please contact us online or call or text us today at 877-2613391. Dr. Lee Ann Gee is a licensed and board certified general practice psychiatrist based at Achieve Medical/TMS Center of Alaska in Anchorage. She also practices in Fairbanks. For more information please visit info@tmscenterofalaska.com or call 833-872-5867.
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HEALTH SENSE
Great American Smokeout is a good place to start your tobacco-free life Alaska Department of Health and Social Services
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n Alaska, 2 out of 3 adults who smoke want to quit. The annual Great American Smokeout, scheduled for Nov. 19 this year, has helped many people start to quit tobacco use. The American Cancer Society supports the event every third Thursday of November. The Smokeout lasts for just one day, but it prepares people to plan and start quitting their tobacco use for good. “The pandemic has brought to light, perhaps more than ever, the
importance of staying healthy yearround and protecting our lungs,” said Christy Knight, program manager for Alaska’s tobacco prevention program. “We know that smoking weakens the immune system, which makes it harder for your body to fight viruses like COVID-19. On the Smokeout and every day of the year, our program has free resources like Alaska’s Tobacco Quit Line to help people stop using tobacco and feel better right away.” Tobacco is the leading preventable cause of death and disease in the United States as well as in Alaska. Each year, smoking is linked to an
ONLINE MENTAL HEALTH SUPPORT GROUPS Support for all Alaskans affected by mental illness: people living with mental illness and their families, friends, and loved ones. Share your experiences, discuss challenges, and receive support in a confidential environment. Join from your computer, tablet, or smartphone. No cost to participate. To learn more and view meeting schedule go to:
www.supportgroupscentral.com/NMAK To pre-register and access meetings: 1. Go to: www.supportgroupscentral.com/NMAK 2. Click on: “Not yet a Member?” 3. Create an account and return to the NMAK page 4. Register for an upcoming meeting under “Our Meeting Calendar” 5. Log on up to 15 minutes before the scheduled meeting time
For more information, email alaskanami@gmail.com 12
November 2020 — AlaskaPulse.com
For more information about NAMI call NAMI Fairbanks at 907-456-4704 or email fairbanksnami@gmail.com
estimated 700 deaths and $575 million in health care costs in Alaska. Smoking harms nearly every organ of the body, and breathing secondhand smoke can cause diseases and death. Every year in Alaska, tobacco causes more deaths than suicide, motor vehicle crashes, chronic liver disease and cirrhosis, homicide and HIV/AIDS combined, as stated in the Tobacco Prevention and Control’s Annual Report. Over the past 50 years, health care providers have learned more about the harmful effects of tobacco use in all forms.
In 1964, the U.S. surgeon general released the first report of the Surgeon General’s Advisory Committee on Smoking and Health. This report was the first of many to document the significant negative health effects caused by tobacco use. It sparked actions to ensure the health and safety of Americans through policies and health education efforts shown to prevent and reduce tobacco use. Since that time, cigarette use has significantly declined nationally and in Alaska. Between 1996 and 2017, the percentage of adult smokers in Alaska fell from 28% to 20%. Between 1995 and 2017, the percentage of Alaska high school students who smoked decreased from 37% to 10%. While there’s been a steady decline in cigarette use among Alaskans, e-cigarettes pose a new challenge. In the past decade, the number of teens using e-cigarettes has significantly increased. In 2018, the U.S. surgeon general called youth e-cigarette use an epidemic in the United States. In 2019, 1 out of 4 Alaska high school students currently used e-cigarettes, and about 1 out of 2 had ever tried them, according to the Youth Risk Behavior Survey. These vaping devices often have high nicotine concentrations, which is a concern for addiction in the developing teen brain. It is never too late to quit smoking. Improvements are immediate. Within just one hour after quitting, a person’s heart rate improves. Within one day, nicotine levels drop to zero and, after several days, carbon monoxide levels drop to the level of a nonsmoker. The benefits of quitting continue over the following months and years, including reduced risk for chronic disease such as cardiovascular disease, chronic obstructive pulmonary disease (COPD) and cancer, according to the Centers for Disease Control and Prevention. Quitting can be hard, but Alaskans
YOU DON’T HAVE TO STOP SMOKING IN ONE DAY. START WITH DAY ONE. Quitting smoking isn’t easy. It takes time. And a plan. You don’t have to stop smoking in one day. Start with day one. Let the Great American Smokeout® event on November 19 be your day to start your journey toward a smoke-free life. You’ll be joining thousands of people who smoke across the country in taking an important step toward a healthier life and reducing your cancer risk. Plus, the American Cancer Society can help you access the resources and support you need to quit. Quitting starts here.
Learn more at cancer.org/smokeout or call 1-800-227-2345.
©2019, American Cancer Society, Inc. No. 012990 Models used for illustrative purposes only.
don’t have to do it alone. That’s where the Great American Smokeout comes in: Individuals and communities come together to celebrate one day without tobacco use. Alaskans can contact local tobacco prevention organizations to find events in their communities Alaskans who want to quit tobacco or e-cigarette use can get help every day of the year. Alaska’s Tobacco Quit Line offers free support and services that are individually tailored to each adult’s needs. The Quit Line offers 24/7 access to trained coaches who provide ongoing support. People who enroll in the Quit Line also can receive free nicotine replacement therapy, such as nicotine
patches, lozenges and gum. Alaskans who participate in the Smokeout and decide to be free of tobacco can call 1-800-QUIT-NOW or text READY to 200-400 to set up a quit plan that is right for them. Alaska parents or guardians of teens who use tobacco, including e-cigarettes, can seek help by talking to their teen’s health care provider. Visit Alaska’s Tobacco Quit Line and log into Live Vape Free for more information about e-cigarettes and resources to help teens quit vaping. This site offers free, online learning experiences and resources to help parents learn about the different types of vapes youth use and how to have supportive conversations with teens about quitting. AlaskaPulse.com — November 2020
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HEALTH SENSE
No adult is ‘too young’ for a health care directive in this COVID world By Jo A. Kuchle
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here have been memes, TikToks, social media postings and news stories about the strangeness of 2020. Many are wishing and hoping that the year ends soon and without further calamity. The source of most of these postings is the coronavirus and its grim statistics. It has impacted many – including leaders – so thinking it could infect any one of us is certainly not beyond question. What would happen to us if the coronavirus – or any disease, for that matter – inflicted us that we could not make our own decisions regarding health care? A past national news story can help explain what could happen to us in this pandemic. In 2005, the national news media accounts of the Terri Schiavo became a hot topic around kitchen tables all over the country. Ms. Schiavo was the Florida woman at the center of a battle that pitted her husband against her parents regarding whether she should receive food and water by artificial means because she was in a persistent vegetative state. Everyone had an opinion either “for” the husband or “for” her parents. The key issue was this: What did Terri Schiavo want? Her husband said she did not want extraordinary measures, including food and water, and her parents said she did. No one knew for sure, but it seemed that everyone had an opinion. Her case was one of the most gut-wrenching cases of our time because it brings up an issue all of us could face. We find ourselves asking, “What if that were me?” Terri Schiavo generated a host of legal cases. The Florida Supreme Court heard several appeals. Congress got involved, as did the then-President George W. 14
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Bush. The U.S. Supreme Court denied a petition for certiorari and, as a result, eventually the feeding and hydration tube was removed and Ms. Schiavo died on March 31, 2005. While the opinions are many, there is one thing that everyone in the case agreed upon, and that is that there would be no case at all if Ms. Schiavo had completed a directive, “living will” or durable power of attorney setting forth her wishes. Since Jan. 1, 2005, Alaska has had the advance heath care directive. The directive is a written document that sets forth what a person wants to happen to them in the event of their incapacity. Every state has some version of a directive or a living will. A durable power of attorney appoints a person to take care of your personal affairs in the events you cannot. It is “durable,” meaning that it is still effective should you become incapacitated. In a coronavirus world, it makes sense to have a health care directive – particularly if you have strong beliefs about ventilators and alternative therapies. The new directive is quite comprehensive, and it is worth taking a look at. It is also a good idea to discuss these issues with your doctor and to make sure he/ she also has a copy of your directive. Alaska’s directive can be completed, and an attorney does not need to draft the form. The directive sets forth basic medical choices, including whether the person wants food and hydration, as well
as pain medication. The directive does not grant or determine financial powers. Most hospitals require a directive be on file before admission. The directive also names a person to make medical decisions on behalf of the incapacitated person. In Alaska, the directive needs to be witnessed by two disinterested people or signed before a notary. It is best to do both. The directive becomes effective when the principal (the person who signed the health care directive) lacks capacity and that decision is made by a primary physician. The power granted in the directive form can be made effective upon signature, but it remains in force if the principal lacks capacity, which is different than a standard power of attorney, which is revoked unless it is made “durable.” Being “durable” simply means that the validity of the document survives the principal’s incapacity. A directive can be revoked in any way that shows intent to revoke such as tearing, burning or writing “revoked.” Total destruction is the best way to revoke so that there is no question of what the principal wanted. The agent designation must be in writing or the principal must orally inform the supervising health care provider of his/her designated agent. It is always best for this to be in writing. Divorce, dissolution or legal separation revokes a spousal agency. If there is no directive, an adult may designate a surrogate by informing the health care provider, orally, who they want to serve. If that is not done, then the statute sets forth the priority of who can act — a spouse, adult child, parent, or adult sibling. If there is no one else, someone else who cared for the person may act. Obviously, there could be issues if there is more than one adult child, parent or sibling and,
Pixabay
of course, those people could disagree on what should be done. Moving down the list of priority, it is likely that at some point a medical provider will want the designated person to have court authority, most likely in the form or a guardianship, so that the medical provider knows that he/she is dealing with a person who has authority to act. The cost – both emotional and financial – can be avoided by a directive. A directive only becomes important when the principal is in a medical crisis and at that time, the last place family and friends want to be is in court. Anyone over the age of 18 should make a health care directive. Terri Schiavo was in her mid 20s when she had the health care crisis that led to her incapacity. In this pandemic, the coronavirus has impacted the young and old. Any competent adult can complete the form and should complete the form so that his/her wishes are in writing. In order to cover all of your needs in the event of incapacity, it is also a good idea to have appointed a trusted person as your attorney-in-fact in a written power of attorney so that he or she can take care of your financial and personal affairs during the period you cannot. The power of attorney can be made “durable” so that it is still effective should you become incapacitated. A copy of the statutory Alaska advance health care directive is available to be downloaded at www.alaskalaw.com. Go to “articles” and look for this article, and then click on the link in the article to look at the form. It is advisable that you discuss this form, which is straight out of the statute, with your own
attorney to make sure it fits your personal situation and that you complete it correctly. No one over the age of 18 is “too young” for an advance health care directive, and amid a pandemic, it is never too late to get a directive completed. Save yourself and your family heartache, headache and money. Get an advance health care directive so that your loved ones know what you want to happen should you face a debilitating illness. No American family should have to face the heartbreak that the Schiavo family faced nor that many have faced as a result of the global 2020 pandemic. Jo Kuchle is a shareholder at CSG Attorneys in Fairbanks. She has practiced in estate planning and probate for 33 years.
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Chasing a snowball Cantwell woman’s health woes kept growing, but it took years to get a diagnosis By Kris Capps Alaska Pulse
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ear and anger can easily take over when you know you are sick and doctors just can’t seem to pinpoint the problem. Kaeleen Mayo of Cantwell knows exactly how that feels. For years, the 41-year-old woman knew something was seriously wrong. She just couldn’t get the right diagnosis. She repeatedly entered medical facilities full of hope and repeatedly left dejected. Eventually, she decided to learn as 16
November 2020 — AlaskaPulse.com
much as she could about her symptoms so she could be a full partner in her health care. The more she researched, the more knowledgeable and selfconfident she became. She started asking more questions of doctors and soon became a more active participant in decisions about her treatment. It took years, but eventually doctors confirmed what she said she had discovered on her own. She suffers from Cushing’s disease. This is a rare and serious condition, affecting 10 million to 15 million people every year, most commonly adults
between the ages of 20 and 50. Women account for more than 70% of the cases, according to UCLA Health. What is Cushing’s disease? Cushing’s disease is an excess of the steroid hormone cortisol in the blood level caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH is a hormone produced by the normal pituitary gland. Symptoms include fullness and rounding of the face (called moon-face); added fat on the back of the neck; easy bruising of the skin; excessive weight
Kaeleen Mayo with her daughter Hailee in 2016, just before her Cushing’s disease symptoms became severe. Kaeleen Mayo.
Photo courtesy
“My Cushing’s is like a snowball rolling down a hill. It gets bigger and bigger and along the way picks up pieces of debris. My problem started out small and throughout the years it has gotten bigger and bigger.”
— Excerpt from Kaeleen Mayo’s diary
gain especially in the abdominal area while legs and arms remain thin; weakness and fatigue; wasting away of muscles; high blood pressure; vision loss and more. Kaeleen found doctors often treated her for individual symptoms, like high blood pressure or being overweight, but for a long time didn’t pull all of the symptoms together for a full picture. “You feel like you’re this nag,” she said. “In reality you just want to be validated for all the issues that you have. You want a diagnosis so you can get better.” She was diagnosed with thyroid cancer in 2013 and underwent treatment. Shortly after that, symptoms of Cush-
ing’s disease kicked in. “In 2014, I started going downhill,” she said. She developed acne, one of the symptoms of Cushing’s. “I’m 41,” she said. “I shouldn’t be having acne.” Vision started failing in one eye. During an MRI, specialists found a tumor on her pituitary gland but told her tests showed the tumor was not producing the harmful hormone. Years later, it was discovered that she just happened to present differently, meaning her symptoms were not textbook symptoms. In December 2019, a doctor finally
confirmed Cushing’s disease as her affliction — just as she had determined herself many years earlier. Surgery was scheduled for 2020 to remove the tumor and she was optimistic to be on the road to recovery. Unfortunately, surgeons had to abort midstream when her lung collapsed in the operating room. She needs to reschedule the procedure. “Now I’m petrified to have surgery,” she said. “But I have to, for my future. I have to get this tumor out and get Cushing’s under control.” “I want to be better to do things physically more and not feel so sick all the time,” she added. “I want to do things AlaskaPulse.com — November 2020
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Kaeleen Mayo before the effects of Cushing’s disease were evident.
“They assumed that all my problems were from being overweight. But my weight gain is a symptom of Cushing’s. ‘Snowball effect.’ After years and years of hearing that and feeling those feelings you start to believe it. You start to really feel bad about yourself. You wonder why you can’t lose weight, why you can’t feel better? It’s all my fault, I am a weak person. You feel like everyone else feels and perceives you that way. Which a lot of them do.”
— Excerpt from Kaeleen Mayo’s diary
“Even after being diagnosed with Cushing’s I still doubt things and I still blame myself even though I have a clinical reason for all of my problems and my appearance. I would say Cushing’s has affected me mentally and emotionally in a way that has been debilitating and life changing. “ “Nothing makes me more happy than when people want to learn about this disease and ask how it has affected me, my family and my life. It has been all-consuming and debilitating for so many years. Now that I finally have a diagnosis I feel somewhat free. I want everyone to know about Cushing’s, learn about it and hopefully perceive and be more compassionate with overweight people because you never know what is causing their issues.” 18
November 2020 — AlaskaPulse.com
Kaeleen Mayo outside her home in Cantwell this fall.
Kris Capps photo
with my family.”
Looking ahead
The years of suffering with these symptoms have taken a toll. As her symptoms grew worse, her personal life suffered. “My body has manifested into a Cushing’s body, and it’s not pleasant,” she said. “When people see me, they automatically pass judgment. They think that I am lazy and fat, and why doesn’t she just lose weight, etc. I know people think that and I can tell. “ Consequently, she doesn’t like to go out in public anymore. “I’m not going to fully blame Cushing’s disease for all my issues, but it is a huge reason for a lot of issues,” she
added. “My whole prime of life has been this sickness. It’s upsetting.” One thing she has learned is to never give up. “I’m not a doctor,” she said. “But I do know my body and there was so much more to this.” She is relieved to finally have a diagnosis. The struggle has turned now to effectively dealing with the disease. For her, part of healing involves sharing her story with others and educating them about Cushing’s disease. She doesn’t want anyone to go through the challenges she has faced. “If I can just help one person, or two, to spread the word, I would be happy,” she said. She still has other health issues not
related to Cushing’s disease. But first things first. She wants to get Cushing’s under control and then chip away at those other medical problems. “I’m going to ride the storm here and see where it takes me,” she said. Her advice to others who may find themselves in a similar situation: Find a support group. Check all your hormone levels, because you could be a patient without textbook symptoms. “Don’t feel bad to ask your doctor for tests,” she said. “They don’t know your body like you know your body.” “Knowledge is power,” she added. “Take control of your own health.” Contact staff writer Kris Capps at kcapps@ AlaskaPulse.com
AlaskaPulse.com — November 2020
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Chuck Gray has lived most of his life in Alaska and was a pilot until just two years ago. He was diagnosed with multiple sclerosis and says he believes many people in the north develop MS because of a lack of vitamin D.
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November 2020 — AlaskaPulse.com
Studies: Life in the far north may bring increased risk of MS By Chuck Gray
I
have had multiple sclerosis since diagnosed at age 52 in 1980. I am now 90 years old and have lived in Fairbanks since I was 15, beginning in 1943. I was born in Illinois. If I had known then what I know now, I do not believe I would have MS. It is now well established that low vitamin D is a major trigger for the disease. Factors for low vitamin D are how far north you live (environmental), family history (genetic) and diet. It has been known for a long time that people born and raised near the equator rarely have MS. The farther north you live, the better your chance of getting MS. A doctor in Fairbanks once told me there is “a lot” of MS in our community. Two friends of mine, one male and one female, have it. I believe most longtime residents of Fairbanks have low vitamin D levels unless they are on a supplement. So let’s consider what I have learned about the disease, such as taking a vitamin D supplement, and other interesting factors. MS is an autoimmune disease where the myelin insulation on the nerves is broken or destroyed and consequently the nerve connection between brain and muscles is lost. Current studies are geared to finding the cause of this destruction and possible repair. But for the most part, when a function is lost, it is permanent. Modifying drugs have been quick to come on the market in the last 20 years. There are about 20 now approved or in the pipeline. Most are injections; two are oral. None cure the disease but render
attacks less severe or lengthen the time between attacks. The MS Society of America is now supporting studies to see if vitamin D can be effective once MS as been diagnosed, in both types of MS. No MS drugs were available when I was diagnosed, and I have never taken any. Doctors now identify four types of MS, but they boil down to two basic types: relapsing-remitting and progressive. In the first type, you have an attack, maybe minor at first, then it goes away — maybe for years — but leaves you scarred (mine left for seven years). But it will appear again. This is why it is so difficult to determine if a diet or a new medicine is helpful. The second type, progressive, is usually more devastating because there are no remissions between attacks. And the first type can morph into the second. Most often the first attack happens between the ages 20 to 50. I was 52. My first diagnosis was somewhat subjective because MRI scans were not available then. MS is associated with plaque spots in the brain or brain stem that show on an MRI scan. My own progress was slower than some. Between 1959 and 1980 I can account for three or four definite events, each leaving my left side weaker. In 1999, at age 71, the MS specialist at Scripps Clinic in California reviewed my case and as an aside mentioned that he sees less MS activity in patients after age 70. It was about then that I heard of studies in England about vitamin D and began taking it. I have not had any definite attacks since; mostly just old age setting in. I retired from the Daily News-Miner in 1993 at age 65 and found the same year I did not have the stamina to hunt Dall sheep any longer. I flew an airplane until two years ago (with extra FAA medical surveillance). Life is still good. Vitamin D is actually a hormone. It naturally occurs when sunlight strikes your skin. Vitamin D regulates a lot of things in your body. Almost everyone knows that, along with calcium, it builds strong bones. It is also good for your
heart and may be important in preventing some kinds of cancers, according to the National Institutes of Health. But back to MS: There is a blood test for the amount of vitamin D in your system, called the 25-hydroxy test. Let’s look at some of the interesting facts that various studies have come up with. Remember I said that the farther north you go, the more MS? One study noted that Norway was an exception to this. The authors surmised that since Norway is a rather narrow country with a long coastline, the residents have access to and consequently eat a lot of fish (vitamin D). Or this one: A pair of Canadian researchers charted birthdates of 40,000 people with MS in Canada and other northern countries. Their graph showed it peaked in May as the worst month to be born in and a low point in November as the best month. The conclusion was that mothers who carried babies during winter months had lower vitamin D levels than those who were born after a summer of sunlight. Apparently mothers impart some permanent immunity to the baby. (I was born in May). Incidentally, women have about two times more MS than men. Presumably, men spent more time outdoors. All of this is to say that, if you live in the north country, it is wise to have your vitamin D checked with a blood test. A supplement may be prescribed if it’s too low. I wish I had known this when I was 20 or 30 years old. The vitamin D test is expensive and is probably why so few people have it done. Testing runs about $250 at a doctor’s office but as low as $25 to $40 at a Health Fair. I submit my story because I believe it is now possible to substantially reduce new cases of multiple sclerosis in Fairbanks and the north country if people will monitor and control their vitamin D levels. Chuck Gray has no medical training. His opinions are his only, based on his many years living with MS, consulting with doctors. His email address is cgray.ak@gmail.com.
AlaskaPulse.com — November 2020
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HEALTH SENSE
What everybody needs to know about diabetes By Dr. Charles Steiner Tanana Valley Clinic
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ovember is National Diabetes Month, a time when communities across the country join forces to raise awareness about Type 1 and Type 2 diabetes. According to the Centers for Disease Control and Prevention, more than 100 million U.S. adults are living with diabetes or prediabetes. For every two people with diagnosed diabetes, there is one person who has diabetes and does not know it. Of greater concern, the prevalence of diabetes is increasing at an alarming rate, causing many health experts to label it as an epidemic. Type 1 and Type 2 diabetes are different disorders, although both affect blood sugar control. Type 1 diabetes involves the ability of the pancreas to secrete insulin. It often has a genetic cause and is not generally related to lifestyle. Type 2 diabetes represents a gradual process when the body’s ability to manage carbohydrates, especially glucose, becomes gradually less effective over many years. This is called insulin resistance and is often related to being overweight or being under fit. Prediabetes is the time when insulin resistance goes up and before the blood sugars are high enough to be diagnosed as diabetes. Closer to home, the Alaska Department of Health and Social Services recently reported that diabetes is among Alaska’s leading causes of death. Its prevalence has risen from 3.8% in 2000 to 9.9% in 2018. More than 100,000 Alaska adults have been diagnosed with diabetes or prediabetes, with more likely at risk but not yet diagnosed. I am a family physician at the Tanana Valley Clinic and have been helping 22
November 2020 — AlaskaPulse.com
patients with diabetes for over 20 years. Below I address some of the most commonly asked questions about diabetes.
Q. What is diabetes? A. Diabetes is a chronic health condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin is the hormone primarily controlling blood glucose levels. An inability of the body to properly use insulin or the absence or insufficient production of insulin causes diabetes. Q. What is the difference between Type 1 and Type 2 diabetes? A. Type 1 diabetes, or insulindependent diabetes, occurs when the pancreas produces too little or no insulin. Although Type 1 diabetes usually appears during childhood or adolescence, it can also develop in adults. Type 2 diabetes occurs when cells resist the effects of insulin — also called insulin resistance. To compensate, the body increases the secretion of insulin. At some point it can no longer keep up and then secretion drops off to the point where it may no longer be produced. You can think of it as your pancreas working as hard as it can, but eventually it gets tired and is not able to produce the insulin it needs to anymore. About 90% of people have Type 2 diabetes and 8% of people have Type 1. Gestational diabetes, (where blood sugar
increases during pregnancy), accounts for the remainder. Q. How do you test for diabetes? A. One common test for diabetes is called a glycated hemoglobin (A1C) blood test, which measures average blood sugar for the past three months. The test does not require fasting. An A1C level of 6.5% or higher indicates that you have diabetes. An A1C between 5.7% and 6.4% indicates prediabetes. Below 5.7% is considered normal. Physicians recommend getting a baseline A1C test at age 45, or sooner if you are overweight, or have one or more risk factors for prediabetes or Type 2 diabetes. Risk factors include family history of diabetes, high blood pressure, polycystic ovary syndrome, are inactive, have a history of gestational diabetes or of having heavy babies (greater than 9 pound birthweight) or are a member of certain ethnic groups (Black, Hispanic, American Indian or Asian American). Q. What can I do to prevent diabetes? A. Type 1 diabetes is an autoimmune disorder and can be managed but not prevented. You can manage the disease by eating healthy, exercising and working with your doctor to identify treatment options. Insulin is the only currently available treatment of Type 1 diabetes. Researchers are working to fully understand what triggers the autoimmune disease and hope to learn more about ways to prevent, treat and cure the disease. Individuals with Type 2 diabetes have options to manage or prevent their disease. Prior to developing Type 2 diabetes, most people have prediabetes — their blood sugar is higher than normal but not high enough yet for a diabetes diagnosis. More than 88 million U.S.
adults have prediabetes, though over 80% of them don’t know it. Lifestyle changes such as losing weight, eating a healthy well-balanced diet that is low in processed and sweetened foods, and engaging in regular, moderate physical activity may reduce the progression of Type 2 diabetes by up to 70%. Q. What are the early signs of diabetes? A. Common signs of Type 1 and Type 2 diabetes may include: • Increased thirst • Frequent urination • Extreme hunger • Dry mouth • Itchy skin • Fatigue • Blurred vision • Unexplained rapid weight loss Q. I’ve been diagnosed with prediabetes, what does that mean? A. Prediabetes is a serious health condition where blood sugar levels are higher than normal but not high enough yet to be diagnosed as Type 2 diabetes. The good news is that if you have prediabetes, lifestyle changes can
help prevent or delay Type 2 diabetes and other serious health problems. Since prediabetes has no clear symptoms, it’s important to talk to your health care team about getting checked if you are over the age of 45, overweight, are physically active less than three times a week or have a close relative with Type 2 diabetes. Q. If I’m diagnosed with diabetes, how will it impact my life? A. Most people with diabetes live full lives. But, diabetes is a demanding disease and can impact your life in many ways. It is important to be active in your own diabetes care and self-management. In addition to working with your medical provider, is important to involve diabetes educators and dieticians. Diabetes is an emotionally stressful disorder, and mental and emotional counseling is often very helpful. Here are four tips for staying healthy and living well with diabetes. 1. Get active. Exercise is good for your heart. It lowers your blood pressure and helps your body’s muscles use insulin more effectively. If you keep fit,
you might need less medicine to control your blood sugar. 2. Eat well. Eating well is another key to managing diabetes. That means eating a wide variety of foods — protein, dairy, grains, and fruits and vegetables — every day. It also means watching your portion sizes, getting enough fiber, and avoiding an overload of fat, salt, alcohol and sugar. 3. Stay vigilant. It’s important to take your medications for diabetes and any other health problems even when you feel good. You may be asked to keep track of your blood sugar. Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away. 4. Work with your health care team. If you have questions about diabetes or experience any of the symptoms outlined above, please contact me or your primary care provider for more information. Dr. Charles Steiner is a board-certified physician in the Internal Medicine Department at Tanana Valley Clinic in Fairbanks. Dr. Steiner is one of the longest-serving physicians at TVC, specializes in family medicine and provides comprehensive Type 1 and Type 2 diabetes care and management.
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HEALTH SENSE
Spine care for the Alaskan By Dr. Kim Driftmier
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eople frequently ask me, “What can I do to improve my back/spine health?” Some people are looking to alleviate pain, while others are looking to prevent or delay future problems. Many people, 80% by some studies, will have back problems at some point in their life that require a trip to the doctor’s office. Genetics and age play a large role in spine health. While we cannot pick our parents nor delay our birthdays, there are a few things we can do to promote a healthy spine. Exercise, nutrition, vitamins, and awareness to prevent accidents are just a few. Keeping fit through regular exercise is paramount to maintaining a well-functioning spine. Cardiovascular workouts and weight training programs are both important. Even with the health benefits of exercise, it should be recognized that not all workout routines are created equally. Unfortunately, some exercise routines may either not help or could be causing damage to the spine. When beginning a new exercise regimen, it is advisable to take one or two sessions with a personal trainer or physical therapist to ensure that helpful activities are being done and that proper technique is being implemented. Additionally, it is also a good idea for those who are continuing a tried and true routine. You may be surprised when an outside eye lends advice to your workout routine. More and more, we are learning that inflammation caused by food can affect the body in many ways. This has certainly been evident in the research realms of heart health and cancer care. But science is also discovering that the foods we know to influence the heart also have similar influences on the musculoskeletal system. In general, foods that are good for your heart are likely to be good for your spine as well. Consuming whole grains and omega fatty acids while avoiding fried foods and refined
sugars can help ease joint and back pain. It seems that in Alaska everyone is aware of the need to supplement with dietary vitamin D. It helps keeps the bones strong, and this in turn benefits the spine. However, vitamin D is not the only chemical/hormonal influence on bone strength. As we age, hormone changes can lead to weakened bones. This is more apparent in women after menopause, but men are commonly affected as well. As such, asking your doctor about checking for osteoporosis is advisable even in the setting of lifelong vitamin D supplementation. Vitamin D and calcium play an important role in bone and spine health, but they are only one part of the picture. Occasionally, other medicines may be needed to keep your bones strong and healthy. Finally, accident prevention is also worth mentioning. Alaska is a place of great adventure, and our powerful toys help us to do that. But skiing, ATVs, boating, and camping can all pose threats to the health of the spine. Accidents can happen to anyone, and it is always best to be cautious. Ski within your limits, throttle back a bit on the ATV or snowmachine and bring a sleeping pad while out camping. Be kind to your spine, and it will return the favor. Ultimately, while genetics and age may play a big role, there are many things we can do to positively influence the health of our spines. Stay fit, eat well, see the doctor occasionally, and be careful when adventuring. Dr. Kim Driftmier is an orthopedic spine surgeon at McKinley Orthopedics, Sports Medicine & Spine, located in Fairbanks.
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November 2020 — AlaskaPulse.com
Make a “shout out” to a health care provider who’s had a positive impact on your life. Go to AlaskaPulse.com to tell us about it
HEALTH SENSE
Veteran Keith Montgomery enjoys hiking in places like Arctic Valley after quitting tobacco.
Quitting tobacco for a happy heart By Katie Yearley
Alaska VA Healthcare System
W
hen I was a kid, I spent many summers visiting my grandparents’ house in New Mexico. I have many memories from that time, but one of the strongest is my entire family sitting on the back porch and talking while enjoying the sunshine. In every one of these memories, my family smoked tobacco. This memory, of an enjoyable activity associated with smoking, is a common one. Dr. Jill Duke, licensed clinical psychologist, says this is part of what makes quitting smoking so difficult. “A person who is using tobacco has established a lot of habits,” says Duke, “Each of the times they’re using tobacco, they’re oftentimes engaged in another activity… those two things have now become linked.” Whether it is because you are having coffee or you are driving, once you start using tobacco regularly with those activities, you create a habit. Suddenly you cannot do one without the other. Duke helps head a Tobacco Cessation Group at Alaska VA Healthcare. In
these classes, she works with veterans to help them develop a plan for how they can ease off and quit tobacco, whether its cigarettes, cigars, vaping, or chewing. Much of the direction is behavioral changes, like different stress management choices and medication alternatives for nicotine. Army Veteran Keith Montgomery started the process of quitting after visiting Duke’s Tobacco Cessation Group. After talking through some of the steps, he decided to quit on Valentine’s Day in 2020. He chose that date because he wanted to start being good to his heart on “heart day.” Montgomery began using tobacco when he was around 10 years old. Back then, everyone smoked pretty heavily, Montgomery says. Once he set his quit date last Febru-
ary, Montgomery began a process of using nicotine patches, which he slowly reduced until he felt he did not need them anymore. After a month or so, he stopped using them completely. “I don’t have the desire to smoke right now and I don’t want to,” he says proudly, “I got back from Seattle last night and, you know, [being] on the plane was a big thing, because you couldn’t smoke.” When he does get cravings, Montgomery uses breathing techniques and meditation to get through the moment. Overall, he feels the smoke-free experience has been great for his respiratory system and thinks other veterans should look into the Tobacco Cessation Group. “What’ve they got to lose?” he says. The Tobacco Cessation Group is held virtually every Wednesday from 1-2:30 p.m. using VA Video Connect. The group offers support from providers and participants talk about strategies for quitting. Veterans can call 907-257-4854 to be scheduled and sent a link. Questions? Contact one of the group facilitators at 907-257-3727 or 907257-4854. Katie Yearley is a public affairs specialist at the Anchorage office of the Alaska VA Healthcare System in the Department of Veterans Affairs.
AlaskaPulse.com — November 2020
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HEALTH SENSE
The longing for longevity By Dr. Brück Clift
The average human lifespan is currently 72 years. Men average 69.8 Aging is driven by many factors. At the cellular level, aging is years, while women average 74.2 years, though women have much shorter caused by damage to DNA and alterations to how it is expressed, reproductive capability than men. Since ancient times there have always along with the accumulation of molecular wastes. DNA also been myths and legends about sources shortens every time a cell replicates, and the shortening end of of eternal youth. There have been healers, snake oil salesmen, true scienDNA, known as a telomere, acts as a molecular clock. tists and physicians who have claimed to improve life span, health span and fertility. Indeed, expectancy has increased ening end of DNA, known as a telomere, acts as a molecular dramatically since 1900, but we must beware of fraud. Even clock. Inflammation is associated with oxidative stress that now, and in the future, advances in the fields of organ transcan damage DNA and proteins, as can toxins. The body must plants, implantable devices, artificial limbs, and artificial efficiently repair, recycle and clear damaged proteins and cells intelligence have already begun to push the limit of available so that cellular waste products do not accumulate. therapies, but access to experimental treatments and the overInsulin plays a role in regulating blood sugar and causing all cost of certain types of interventions will create questions the body to store fat but has also been shown to act as a proabout access to care for ordinary diseases of aging. aging molecule in animals like worms, independent of blood To achieve life extension without health span expansion sugar. would be pointless. Ideally we want to be healthy for as long Animal models show that both insulin (which responds to as possible and then die quickly, avoiding the ravages of consumption of sugar) and a pathway called mTOR (which chronic disease. responds to consumption of protein) are implicated in aging What is the current research on what can be done to extend and can be targeted with drugs to increase life span. health span (and hopefully life span) right now? Are there any drug treatments that show promise? What are the most Calorie restriction and exercise important lifestyle changes we can make? These mechanisms largely explain why caloric restriction Aging is driven by many factors. At the cellular level, aging and fasting have been shown to reduce aging and increase is caused by damage to DNA and alterations to how it is longevity. Caloric restriction appears to slow the metabolism expressed, along with the accumulation of molecular wastes. DNA also shortens every time a cell replicates, and the short- and the associated accumulation of toxic byproducts, reducing cellular damage. It increases insulin response. Fasting seems to suppress inflammation and promote a state where the immune system repairs and recycles damaged molecules, activating the sirtuin pathway for DNA and protein repair. you My name is Karin Hadsell and I’ve been in business here in town for over 3 years. I s s e r d The benefits of exercise are widely known. Very large and e Just th st the time rent and sell evening gowns and wedding dresses. Need a dress for a one-time family convincing studies have shown no upper limit to the correlar ju need fo eed it! photo or event such as a prom? Don’t drive to Anchorage to spend $400 on a wear-ittion between cardiovascular fitness and mortality. Individuals you n once gown when you can rent a dress for a fraction of the price and return it.* who can run on a treadmill longer demonstrate significantly lower all-cause mortality. My social media manager (and a client), Kamaya Fenton (Miss Alaska Other studies have strongly correlated other factors, such as Teen Earth 2019) and I are hosting a charity fashion show for next year. the ability to do more than 40 pushups in males, with a signifDetails coming soon! icantly reduced risk of heart attack. In addition to maintaining 544 3rd Avenue, Suite A • Fairbanks, AK 99701 • 11am-6pm Tues-Sat the overall baseline functionality of the muscles, vasculature, 907-328-2933 • www.facebook.com/UntilMidnightAK/ and organs, exercise seems to be protective by stimulating the *Due to Covid dresses must be dry cleaned before returning. production of endogenous antioxidants such as superoxide
Until Midnight
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November 2020 — AlaskaPulse.com
Dr. Brück Clift and her 4-year-old son, Toby, during an outing on the Crevasse-Moraine Trails in Palmer.
dismutase and glutathione peroxidase, which demonstrate antioxidant activity far in excess of that which can be achieved with dietary supplementation. For this reason antioxidant supplementation has lost popularity in life extension research in recent years.
Food and supplements
Some specific foods and supplements have been shown to extend life and health span, mostly in animal models. While human trials are scant, food and
supplements are available to everyone without a prescription. Foods and supplements that positively affect the sirtuin pathway have shown promise to improve the effects of aging in animal models. Resveratrol (found in grape seed extract and red wine) and some other related polyphenols activate this pathway. Sirtuins require a coenzyme, NAD+ (nicotinamide adenine dinucleotide), which increases the activity of sirtuins. Unfortunately, NAD+ decreases in abundance as people age. Increasing
NAD+ concentrations in mice models through dietary supplementation has been shown to improve metrics of health and life span, like physical activity and life expectancy. NAD+ precursors include nicotinamide riboside (NR), nicotinamide mononucleotide (NMN), and niacin. Senolytics remove cells that have become senescent (or too old to function properly). These cells get in the body’s way and promote a toxic environment for the healthy cells. Fisetin is a flavonoid polyphenol that helps destroy AlaskaPulse.com — November 2020
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senescent cells. It is found in many common fruits and vegetables. Eating fruits and vegetables that are high in nutrients and antioxidants and relatively low in calories (when compared to grains and processed foods) reduces the effects of aging and decreases risk for inflammatory processes and cancer. Polyphenols found in green tea have also been demonstrated to have absorbable antioxidant activity and to act as senolytics. Curcumin (found in turmeric) and Crocin (found in saffron) may delay cellular senescence and reduce inflammation via antioxidant mechanisms. Curcumin is thought to reduce the risk of some cancers’ formation and metastases. Crocin decreases the effects of UVB light on DNA, thus has potential to reduce skin damage (photoaging). Supplementation with collagen may reduce wrinkles and skin changes associated with aging. I recommend getting most of these foods through diet rather than dietary supplements.
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Pharmaceuticals
A number of pharmaceutical drugs have shown promise in extending human health and life span. Metformin is a common first line Type 2 diabetes treatment that has been shown to decrease mortality and morbidity from diabetes and has shown protective effects in a variety of other conditions still being explored including cancers, kidney, cardiac, and Alzheimer’s disease, as well as in trials to treat aging and extend human life span. Metformin is a less-toxic derivative of the molecule discovered in the medicinal plant goat’s-rue. It has been around for decades, is available in generic form, and quite affordable. It acts by reducing blood sugar and inflammation as well as by improving lipid profile. It does not cause hypoglycemia because it acts in an insulin-independent manner. By reducing baseline blood glucose, it decreases insulin resistance, lowering insulin secretion. When taken with meals, it also reduces glucose absorption from the gut, preventing the absorption of
calories. Acarbose, which also reduces glucose absorption from the gut, and pioglitazone, which increases insulin sensitivity, are other medications prescribed for diabetes that have been implicated as having life-extending/anti-aging potential. SGLT2 inhibitors like Farxiga, Jardiance, and Invokana also reduce blood sugars, the risk for cardiovascular events and have been shown to be protective to the kidneys. These medications likely also act through some of the same mechanisms as caloric restriction.
Alcohol and tobacco
One cannot help but reflect on the similarities between aging and poisoning. Smoking cigarettes and drinking alcohol, eating preserved meats and using illicit drugs all promote aging because they are directly toxic both to tissues and at the molecular level. Alcohol alters lipid metabolism and promotes the deposit of fat in the liver. The polyphenols found in wine are linked
to increased life span, but the damage that may be done to liver, heart and pancreas will likely reduce life span and health span in the setting of heavy drinking. These polyphenols can be found in other foods and supplements that are not also toxic. The medical community generally recommends a maximum of seven alcoholic drinks in a week for women and 14 for men. In Britain, where alcohol usage is high, the NHS recommends taking at least one alcohol-free day weekly.
tem works best when sleeping. Six to eight hours of sleep a night is recommended for most adults. For some of us, our ability to sleep is diminished as we age. Daily exercise, time-restricted feeding, and supplementation with melatonin (a neuroprotective antioxidant that aids in sleep) at night and NAD+ precursors in the morning can all improve circadian rhythm and reinforce good sleep habits.
Sleep
Happiness and stress reduction are important to enjoying a long health span. To achieve this, I encourage nurturing social relationships. I also encourage goal-oriented behavior, being more efficient, self-disciplined, organized and
Getting enough sleep is critical. The body has a system called the glymphatic system that clears cellular wastes and recycles fluid in the brain, and this sys-
Stress reduction
deliberate in our actions. Seeking hobbies and educational pursuits. Risk for cardiovascular events and some cancers is increased with increased stress and misery. Being productive addresses anxiety and diminishes it directly. Boredom increases anxiety and reduces mental flexibility, potentially contributing to dementia. Exercise, in addition to the other benefits that it provides, decreases stress and produces natural endorphins that reduce pain and increase that overall satisfaction and sense of productivity that makes people feel good. Dr. BrĂźck Clift is a family medicine doctor whose practice is in Palmer.
AlaskaPulse.com — November 2020
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Mask up Alaska! E
arly in Alaska’s fight against the novel coronavirus, the Department of Health and Social Services launched a public information campaign called ‘Mask up, Alaska!’ urging residents to don masks or cloth facial coverings in an effort to decrease the spread of COVID-19. Doctors and health officials, including Alaska’s Chief Medical Officer Dr. Anne Zink, have confirmed over the last six months since the COVID-19 pandemic first arrived in Alaska that wearing a mask can greatly diminish the risk of spreading the virus through airborne droplets. Wearing a mask is important because with COVID-19, individuals can be contagious and spread the virus while showing no symptoms and may be unaware they are sick. “Individual actions make a difference. From helping each other through earthquakes to clearing snow from a neighbor’s driveway, Alaskans take care of each other and have a strong sense of community,” the campaign said. “Wearing a face mask is another way to show you care and to protect those who are more vulnerable to serious illness.” — Erin McGroarty Kevin Knox lives in Sitka. He is head coach of the local swim team and serves on the City and Borough of Sitka Assembly. Kevin says, “I wear my mask to protect my athletes, my family and my entire community. Living in an island town where an outbreak could spread very quickly and exhaust our limited resources, it is imperative that we do everything we can. I want to see our community continue to remain as open as possible and as a coach I want to ensure my swimmers can continue to workout, to care for their health and athletic ability as much as they can.”
Nikkie Corbett is the owner of Sew Yup’ik. She lives in Soldotna and was born and raised in Bethel. “I wear my mask because it’s easy.”
Amy Kruse makes masks for others and lives in Kasilof. She says, “Mask wearing can be difficult for many. We are doing our best to make masks that are extremely comfortable, colorful, fun, affordable and uniquely Alaskan. Alaskans are such amazing supporters of local artists! We are embracing the unique opportunity to express and protect oneself (and others) by sporting (wearing) artwork that you love.”
Michael and Jason Evans, brothers who live in Fairbanks, say this about masks: Jason, age 7: “Masks are good for your body so you won’t get coronavirus.” Michael, age 12: “Just wear the mask.”
Leah Dunn lives in Homer and attends Homer High School. Before school started in August, Leah made dozens of homemade cloth masks for teachers, school staff, students and friends.
Julie and Ken Flynn are retired and live in Anchorage (50+ year residents). Ken says, “I wear a mask because I think it’s the right thing to do. We believe in the science and that’s that.”
Gail Schubert is president and chief executive officer of Bering Straits Native Corporation (BSNC). Gail says she wears her mask “to do my part to keep others safe.”
Renee Daniels is lead mammographer at Bartlett Regional Hospital in Juneau. Renee says, “I wear a mask to protect myself and others from the virus. I made a Facebook page called Mask Pride where you can post a head shot of yourself with your favorite mask, tell us about where you wear your mask, what you like about it and why you wear it. Anything to spread the word, not the virus.”
Maura Jones is executive assistant to the chief executive officer at South Peninsula Hospital in Homer and part of the COVID-19 response for her community. Featured this #maskupalaska campaign are Lieutenant General David A. Krumm and Chief Master Sergeant David R. Wolfe.
Fritz and Susie Ward are siblings who live in Anchorage. Fritz says, “I wear a mask so no one gets the virus.” Susie says, “I want people to stay safe, and to make others feel comfortable around me.”
Dean Lukin from Kotzebue is a pilot, firefighter, emergency medical technician, hunter, father of four children and grandfather of one. He says, “I wear a mask to fly, to go to the grocery store and post office, and will continue to wear one because it’s respectful and because it protects you and me from possible exposure.”
Lt. Gen. David A. Krumm is the Commander, Alaskan Command, United States Northern Command; Commander, Eleventh Air Force, Pacific Air Forces; and Commander, North American Aerospace Defense Command Region, North American Aerospace Defense Command, Joint Base ElmendorfRichardson, Alaska. He is the senior military officer in Alaska.
Dr. Mimi Benjamin is the Hospitalist Medical Director at Bartlett Regional Hospital in Juneau. She says, “I wear a mask to protect my friends, family and community, even while fishing!”
Chief Master Sergeant David R. Wolfe is assigned as the Senior Enlisted Leader of the Alaskan NORAD Region, Alaskan Command, and the Command Chief Master Sergeant, Eleventh Air Force, Joint Base Elmendorf-Richardson, Alaska.
Make a “shout out” to a health care provider who’s had a positive impact on your life. Go to AlaskaPulse.com to tell us about it AlaskaPulse.com — November 2020
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