Alaska
PULSE
September 2020 Vol. 1, No. 9
.COM
An Alzheimer’s journey ‘She wants to live in the moment’ INSIDE Dr. Tony Nimeh of Fairbanks: Testing for prostate cancer Meet Manley Hot Springs’ health aide Dr. Tucker Drury of Wasilla: Surgery and robotics go together Anchorage couple learns from an in-home CO scare Give a shout out to your favorite doc
A different kind of urology Dr. Herbert J. Wiser practices with the philosophy that your experience matters most. He’s someone you’d be comfortable being in a room with and talking to, whether for a routine checkup or a hard-to-have conversation. And that makes a big difference in urological care. It’s why our doctors asked him to join Tanana Valley Clinic. Listening, caring and compassion, that’s what makes our service a different kind of urology.
now open for appointments - Call Today! 1650 Cowles Street, 4th Floor, South Tower
Book an appointment: 907-458-2630
Learn more: www.foundationhealth.org
INSIDE Our mission
Helping Alaskans to live a healthy and satisfying life in the Last Frontier by hearing from their fellow Alaskans, from Alaska health experts and by sharing their own stories.
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
September 2020 Vol. 1, No. 9
I love my doc!
O
ur health care providers keep us going. Family medicine doctors. Pediatricians. Mental health professionals. Ophthalmologists. Surgeons. Dentists. Nurses. Emergency medical personnel. The list goes on. Where would we be without them? We probably all have our favorites and eagerly recommend them when a friend asks who we see. We’ll tell that friend about why we like that particular provider so much. Now you can tell others. Give a shout out through the Alaska Pulse to a medical pro who has fixed you up and helped keep you healthy in body or mind. I’ve got my longtime favorites, including Dr. Gina
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 Pender at Tanana Valley Clinic, Dr. Larry Coon at Eye Clinic of Fairbanks and my dentist, Dr. Evan Wheeler. And I’ll never forget Dr. Charlie Steiner, who came to my aid when I collapsed on a flight between Seattle and Fairbanks from food poisoning (not from the airline food, by the way). I bet you have your favorites, too. Now you can show them
how much you appreciate them by giving them a public “shout out” through the Alaska Pulse. Use the link on the home page of AlaskaPulse.com, and we’ll share your notes of appreciation. To my doctors, I say, “Thanks for all you do for me.” —Rod Boyce Editor, Alaska Pulse
IN THIS ISSUE An Anchorage couple’s Alzheimer’s journey............................................................................... 4
Publisher Richard E. Harris
HEALTH SENSE: Memory loss is not necessarily the first sign of dementia .................. 10
Editor Rod Boyce editor@AlaskaPulse.com 459-7585
Mobile mammography unit makes rounds across Alaska .................................................. 12
Advertising
HEALTH SENSE: Ayurveda: Ancient wisdom for modern times ........................................... 21
advertising@AlaskaPulse.com
459-7548
Design Julie Stricker jstricker@AlaskaPulse.com 459-7532
HEALTH SENSE: COVID-19 planning for families with children ......................................... 11 HEALTH SENSE: For troubled veterans, help is a phone call away ................................... 15 Fairbanks’ runner aims for a sub-4-hour marathon in all 50 states ............................... 16 HEALTH SENSE: Watch your step, falls can cause serious injuries .................................... 23 Health aide hopes to make a difference in Manley................................................................ 24 HEALTH SENSE: Prostate Cancer Awareness Month ................................................................ 26 HEALTH SENSE: Robotics assisted surgery for joint replacement ..................................... 28 Anchorage family finds out they had a silent killer in the house ................................... 30
AlaskaPulse.com — September 2020
3
Living with Alzheimer’s
An Anchorage couple’s shared path takes them to a new land By Aliza Sherman
“I
t’s like the game, Chutes and Ladders, but there are no ladders. You’re not climbing back up. It only goes down.” That’s how Michael Strahan describes what it is like when a loved one has Alzheimer’s disease. In 2016, Michael’s wife of more than 40 years, Linda, began exhibiting unusual symptoms. Michael recalls one night in their Anchorage home when he heard a noise
Linda and Michael Strahan in Costa Rica. Photos courtesy of Michael Strahan
4
September 2020 — AlaskaPulse.com
in the living room. He found Linda carrying a thermos of hot water. When he asked what she was doing, she said she was waiting for the kids to arrive for the day care she managed in their home. “It’s 12:30,” Michael responded. “A.M. or P.M.?” Linda asked. She didn’t seem to know the answer. Michael led his wife to a clock and asked her what time it was. She didn’t know. That incident got his attention.
AlaskaPulse.com — September 2020
5
Before the diagnosis
The couple met in Oregon and were married in 1977.
Michael is quick to marvel at his wife’s energy. She was a woman who had always been extremely active – easily walking 10 to 15 miles in a day – and highly engaged with her church and her community. The two of them met at a church leadership training program in Oregon where Linda had grown up and Michael had moved after high school. The couple fell in love, got married in 1977, and lived in Eugene, Oregon, for a while until they moved to Hawaii to work with some friends who were taking over a church. In 1985, they moved to Alaska, and Michael was hired right away by Alaska Airlines, where he worked for the next 33 years. In addition to working for the airline, he was also a registered hunting guide, and in 1996, he purchased the Alaska Outdoors Supersite commercial website from its previous owner after
MORE SPACE. MORE VARIETY.
MORE SAFETY MEASURES. FROM OUR HOME
TO YOURS
HAVE A GREAT SCHOOL YEAR!
working as a writer for the site. He and Linda ran the online business together while she also ran a day care in their home. The couple relished outdoor adventures in Alaska, and spent the years hunting, fishing, river rafting, and flying all over the state.
Receiving the diagnosis
Fast forward to 2016 when Michael, and even Linda’s friends and Michael’s sister, expressed concern about Linda’s state of mind. They were starting to observe Linda experiencing moments of extreme confusion or speaking aloud but not making sense. Linda went to Alaska Neurology for her first test – a MiniMental State Exam – to test her cognitive function and screen for cognitive loss. The test didn’t go well, and a number of possible diagnoses were discussed, including Creutzfeldt-Jakob Disease, an aggressive form of
ANCHORAGE
365-7384
MAT-SU
365-7384
South • East • West • Club for Women The Summit • Downtown • Eagle River Studio
Wasilla • Palmer
FAIRBANKS
458-1790
JUNEAU
364-4398
South • West
Valley • Downtown
6
September 2020 — AlaskaPulse.com
F606408-1
THEALASKACLUB.COM
After Linda Strahan began to behave erratically, she took a cognitive test at Alaska Neurology. Later, she traveled to the Mayo Clinic in Arizona for more tests. She was diagnosed with early onset Alzheimer’s.
dementia. The couple traveled to the Mayo Clinic in Arizona for additional tests, including an EEG, a CT scan and brain MRIs. Her official diagnosis was Young Onset Alzheimer’s, also referred to as early onset Alzheimer’s, an uncommon form of dementia that affects people under 65 years of age. Linda was in her mid-50s at the time. The news was devastating. Linda was instructed not to drive, which took away a major part of her work life – transporting the kids at her home-based day care to parks and other recreational spaces around Anchorage. In one diagnosis, her entire career of taking care of children in her home and at their church nursery came to a halt. The diagnosis dealt a major blow to Linda and Michael’s finances. “We had some money in savings, and we were floating on that,” Michael recalls, realizing that the savings would not last more than a year. Without Linda working, their income was cut in half. Michael ran all the numbers, and
they kept coming up short. They were homeowners, they owned two vehicles, and all he could see is they would start losing things – the vehicles, his job if he couldn’t get to work, then their house. “I could see the dominoes falling in front of us,” he says, and at the time he thought they weren’t going to make it. According to Michael, these were the financial considerations for Linda’s care: • In-home care – In the United States, they were looking at $200 to $250 per day for nonmedical, in-home assistance that included cooking, cleaning and companionship while he worked. • A care facility – As Linda’s condition progressed into the later stages of Alzheimer’s, the couple would be looking at about $8,000 per month.
Moving forward from diagnosis
As Michael looked at their finances, Linda began her treatment, which included a combination of medications that could only do so much to stave off her deteriorating condition. She began taking donepezil and memantine, two standard Alzheimer’s medications. She
also was prescribed escitalopram, an antidepressant, as depression can be a common offshoot as Alzheimer’s progresses. In speaking with friends, Michael knew he and Linda would have to make some major changes in their lives to accommodate her diagnosis and their finances. Some people suggested that he consider retiring early and moving to another state, or even country, where their money could go further. A major factor in picking a new place to live was that it had to have a quality health care system so Linda could get the ongoing treatment she would need. “We went online and thought, ‘Maybe we need to do something radical,’” says Michael, and the couple began looking at Costa Rica. Michael learned that Costa Rica had a good quality medical system with affordable prices set up by the Costa Rican government. In-home care in Costa Rica ran about $30 to $40 per day. A care facility would cost about $1,900 per month. The couple traveled to Costa Rica in AlaskaPulse.com — September 2020
7
During the decades they lived in Alaska, the Strahans spent as much time as they could exploring the state and getting outdoors as much as possible. Despite Linda’s diagnosis, Michael says the couple continues to explore, this time in Costa Rica. They are focusing on the positive and living in the moment. Michael credits their faith with helping them persevere.
8
September 2020 — AlaskaPulse.com
2018 as tourists, then settled in for 90 days, returning to Alaska to visit family and friends, then going back again to accumulate enough time in the country to gain residency status. Their days start with Michael helping Linda get dressed and fed, then they jump in their truck and go on drives. Some people have asked why he keeps taking her on adventures if she doesn’t remember any of it, but he says some people just don’t get it. “She doesn’t have to remember it. She wants to live in the moment,” he says.
The long goodbye
While he is already feeling an overwhelming sense of loss, Michael says that in some ways there are blessings that come with an Alzheimer’s diagnosis. If someone dies suddenly, he says, it can be really hard because there could be unfinished business that can’t be fixed after someone’s passing. With Alzheimer’s, there is some time to connect, reconnect, say what needs to be said. Michael and Linda spent much of the first two years after her diagnosis making the rounds to friends and family — “the long goodbye,” as Michael says he’s heard others call it. When they arrived in Costa Rica, Linda was solidly in Stage 5 of Alzheimer’s, according to the Global Deterioration Scale, developed by Dr. Barry Reisberg, director of the Fisher Alzheimer’s Disease Education and Research program at New York University Langone Health. Stage 5 is “moderate Alzheimer’s disease,” marked by early deficits in “basic activities of daily life” and an inability to recall major life and current events. By mid-2020, Linda was a little past the middle of Stage 6. At “moderately severe Alzheimer’s disease,” a person may find it challenging to dress or bathe or to carry out other basic activities of life, with heightened confusion and difficulty speaking. Michael points out that not everyone experiences all of the symptoms described in the literature about Alzheimer’s, and they don’t necessarily experience them all in the same order or the same periods of time. A person with Alzheimer’s can plateau in a stage for an unpredictable amount of time, then
RESOURCES 7 Stages of Alzheimer’s https://www.alzinfo.org/understand-alzheimers/ clinical-stages-of-alzheimers/ Teepa Snow/Positive Approach to Care – Support for caregivers https://teepasnow.com/ https://www.youtube.com/user/teepasnow Information on Alzheimer’s drugs https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/ in-depth/alzheimers/art-20048103 Michael Strahan’s Blog https://greyhavens237.blogspot.com undergo sudden rapid and significant deterioration. Through the challenges, Michael says his and Linda’s faith in God has been instrumental in helping them persevere through the last few years. After her diagnosis, Linda asked God for more time and was able to spend those first few years enjoying quality time with loved ones. “For a person of faith, there is an unshakable hope that this is not really an end in any sense that matters. It’s a beginning. Your entire life on Earth is but a grain of sand on the white shores
of eternity,” Michael writes on his blog, Grey Havens, named after the Elvish port city in “The Lord of the Rings” that was portrayed as a sanctuary. On his blog, he documents his and Linda’s experiences with Alzheimer’s. “You feel yourself completely surrounded by the love of God in ways you never experienced before, and somehow you know, between the waves of emotion, that it really is going to be okay.” Aliza Sherman is a freelance writer in Anchorage. Comments about this story? Email editor@AlaskaPulse. com
AlaskaPulse.com — September 2020
9
HEALTH SENSE
Memory loss is not necessarily the first sign of dementia By Gay Wellman
Alzheimer’s Resource of Alaska
W
e commonly assume that memory loss is the first sign one is developing dementia. But researchers are now suggesting that a different aspect of thinking called executive function may give the earliest indications that brain changes are forming that can lead to dementia. In a recent article in the Alzheimer’s Reading Room, author Carol Larkin explained new evidence suggesting that memory loss is not necessarily the first sign of developing dementia. Researchers confirm that memory loss starts showing up eight to 10 years before a diagnosis can be made. But now researchers are also suggesting that those thought processes termed “executive functions” begin to change 18 to 20 years before a
Alaska Pulse would like to
thank all our state’s medical professionals, our superheroes! Working tirelessly to
F606223-1
provide excellent care to the patients of their communities. Their time, attention, and expertise do not go unappreciated. We look to them for guidance and leadership and they deliver unwaveringly.
Thank you so much for all you do!
dementia diagnosis can be made. Ms. Larkin suggests that this is “because the screening tools we have today for deficits in that type of thinking just aren’t good enough to show those deficits in people who appear to be fine.” There are two areas in our brains that manage executive functions. The first is the frontal lobe, which is right where it sounds like it should be, in the front, behind our foreheads. The second is the temporal lobe, which is located on both sides of our head. None of the things these areas manage involves memory. Together, these areas control things like: • Reacting successfully to things in our environment • Making decisions • Controlling our emotions • Finding the correct word for the things we use • Understanding abstract concepts • Knowing the sequence for completing a task • Categorizing objects • Understanding and quickly processing spoken words • Attention span • Exercising sound judgment Most of us don’t associate problems in these areas with the possible development of dementia. We wait to worry until there are noticeable problems with memory. Ms. Larkin suggests that if we understood this that “perhaps families would ask their doctors to screen their loved ones earlier in the disease process, thus allowing for more time for preparation for what is to come.” Gay Wellman, R.N., is an education specialist at Alzheimer’s Resource of Alaska.
10
September 2020 — AlaskaPulse.com
HEALTH SENSE
Circle of Support COVID-19 planning for families with children By Laura Norton-Cruz
Y
ou’re feeling sick, it’s the middle of a pandemic, your 2-yearold is jumping on you, and your 6-year-old needs help with online school work. You’re scrambling to figure out where to get tested for COVID, how to keep your kids safe and fed, and how to manage it all if it gets any worse. Many parents have found themselves in difficult situations like this. While these are inevitably stressful times, having a plan can help reduce some of the burden of that stress. September is Preparedness Month, and parents and caregivers are having to prepare in so many new ways during this pandemic. The “Circle of Support” resource helps walk families through creating a plan for their children if the parents or caregivers get sick with COVID-19. Created by state and nonprofit partners, this helps you identify your Circle of Support (a group of people that you can call on to provide child care), what to include in your plan, when to activate your plan, and how to find help outside your circle from organizations, if needed. It includes step-by-step guidance on symptoms, testing, and isolation, as well as guidance on what to put into a “gobag” for your children and considerations of how to choose people for your Circle of Support.
What makes a COVID-19 plan different from many other emergency plans are the virus-specific considerations in choosing emergency caregivers. You want to avoid sending your children to an adult who might be at greater risk of complications from COVID-19, such as someone over age 60 or something with diabetes, heart conditions, obesity, conditions that compromise their immune system, or other concerns. This user-friendly, engaging plan, the worksheet that goes along with it, and the additional worksheet and resource list for children with disabilities are all designed to work for as many families as possible. The Circle of Support guide is inclusive of single-family households or households where one parent is deployed, households with elders present, households with breastfeeding infants, coparenting arrangements, and more. For public health guidance to be useful, it has to be inclusive and easy to use, no matter what your family looks like.
For this reason, the resource is available not only in English but also in Spanish, Samoan, Hmong, Somali, Tagalog, Russian and Korean. You can find it in each of these languages at: http://dhss.alaska. gov/dph/Epi/id/Pages/COVID-19/circleofsupport.aspx In addition, there are two videos in which real Alaska parents talk through how they use this plan for their families, which you can find on the Alaska DHS/ EM YouTube channel or in Spanish at https://youtu.be/dDcEWgqBRZ0 and in English at https://youtu.be/A3AkkotUxQs The COVID-19 pandemic is difficult on all of us, and families are stretched thin. Having a plan, having bags at the ready and checking in regularly with the people in your Circle of Support can help set your mind at ease that if you were to get sick, your children would be in safe, trustworthy hands. Laura Norton-Cruz is a public health specialist with the Alaska Department of Health and Social Services.
AlaskaPulse.com — September 2020
11
Odette Butler, executive director of the Breast Cancer Detection Center of Alaska stands outside the center’s mobile unit, which travels thousands of miles to serve rural Alaskans every year. Amanda Bohman photo
Fairbanks-based mobile mammography unit makes yearly rounds across Alaska By Amanda Bohman Alaska Pulse
T
ok, population 1,258, where Cindy Jernigan rents camping spots and cabins, has limited health care services. Jernigan typically takes care of her health needs while living Outside during the winter, she said. “I do not have medical insurance. Knock on wood, I stay healthy,” said the owner of Tok RV Village and Cabins. When the Breast Cancer Detection Center of Alaska’s mobile unit visited Tok last summer, Jernigan had a mammogram. It was convenient. Tok sits along the Alaska Highway 12
September 2020 — AlaskaPulse.com
93 miles from the Canadian border. To otherwise get a mammogram in Alaska, Jernigan would need to travel hundreds of miles. “It was so nice to be able to stay here in the community and have that done,” she said. “The results were sent to me, and it worked out perfectly. I think they provide a wonderful service to the smaller communities. I’m grateful. They take care of ladies that need this.” Breast cancer is the most common cancer among women in Alaska. Since 1986, the BCDC mobile detection program has served thousands of rural residents, traveling to communities from Dutch Harbor to Central.
Only about 20 communities in Alaska have mammography capabilities, according to the Centers for Disease Control and Prevention.
On the road with a mission
The mobile imaging technology has changed but the goal—saving lives— has persisted. Early detection is key, according to Odette Butler, executive director of the Breast Cancer Detection Center of Alaska. “The longer you wait, the harder it is to treat,” she said. The Breast Cancer Detection Center
operates one of two mobile mammography units in the state. All who seek a mammogram from the detection center, a nonprofit, are served, regardless of ability to pay. The center raises money to offset the expenses of serving people with limited resources, Butler said. The BCDC’s mission is to “increase awareness of the survivability of breast cancer and the benefits of early detection by delivering screening services and educational programs throughout the state of Alaska.” In a typical year, starting in April, the mobile detection unit hits the road, serving Gustavus, Yakutat, Ninilchik, Nenana, Skagway, Girdwood and more. In 2018, about 25 communities had mobile mammography service courtesy of the Fairbanks-based mobile detection unit. Mary Dinon, registered nurse case manager in Klawock, said mammography is unavailable on her small Southeast Alaska island. Without the mobile unit, residents must travel for mammograms. “It’s definitely a vital service. We are
“It was so nice to be able to stay here in the community and have that done. The results were sent to me, and it worked out perfectly. I think they provide a wonderful service to the smaller communities. I’m grateful. They take care of ladies that need this.” — Cindy Jernigan, Tok
kind of scrambling this year without it,” she said. The mobile unit had to cut back its 2020 schedule due to the COVID-19 pandemic. In a typical year, the unit logs more than 4,000 miles. Dinon said her patients are traveling to Ketchikan and Sitka for mammograms this year. “I really think they fill a niche here,” she said. Butler is hopeful that those who rely on the mobile unit are finding other
ways to get a mammogram this year. “We still tell our patients to get a mammogram every year,” she said. In 2018, 887 people received mammograms courtesy of the Breast Cancer Detection Center’s mobile unit. In 2019, the unit served fewer people, 498, after the Alaska Marine Highway strike and a broken generator in August. This year, 156 mammograms have been performed via the mobile unit since June. The detection center has COVID-19 protocols but the global
Improve Your Sleep. Improve Your Life. Veteran-Owned Business and AASM Accredited Sleep Lab WeSmall are open to keep you healthy CPAP / APAP / BI-LEVEL • Equipment • Masks & Accessories • Adjustments & Cleaning • Travel PAP Machines
TESTING • Clinic Sleep • Home Sleep • MSLT DOT • Pediatric
TELEMEDICINE CAPABILITY • Video Consults • Remote Home Sleep Testing • Remote Monitoring & Follow-up • Online Education
F601734-1
The Most Comprehensive Sleep Clinic in Fairbanks and Alaska.
Contact us for a free sleep apnea assessment: 907-374-3063 • info@alaskasleep.com • www.alaskasleep.com AlaskaPulse.com — September 2020 13
The Breast Cancer Detection Center’s Fairbanks-based mobile center is named “Nancy,” in honor of former Alaska first lady Nancy Murkowski, a BCDC founder.
Odette Butler talks about the mobile unit’s imaging machine. The unit’s setup cost about $650,000, bought with support from several charities. Amanda Bohman photos
pandemic has made travel logistics challenging, Butler said.
A rig named ‘Nancy’
The technology when the BCDC first began offering mobile services was a portable, folding imaging machine that was stuffed in a van or flown around rural Alaska in a crate. These days, the detection center is offering state-of-the-art imaging known as tomosynthesis, also known as 3D mammography, in a customized 34-foot Freightliner truck named “Nancy” in recognition of former Alaska first lady Nancy Murkowski, a founder of the BCDC who was inspired to improve access to mammography after a friend was diagnosed with breast cancer. The pink-splashed big rig is decked out with a Barbara Lavallee-inspired mural on its side, a waiting area with 14
September 2020 — AlaskaPulse.com
a flat screen television and an imaging machine worth more than a new fivebedroom house. The whole set-up cost $650,000, according to Butler, with support from the Waterfowl Foundation, a charity operated by the Murkowski family, the M.J. Murdock Charitable Trust and others. The mobile unit costs about $175,000 a year to operate. When it rolls into a community, it is eye-catching. Butler said many of the mammograms are pre-scheduled, but they do accept walks-ins. “Mammograms are important,” she said. “People need to get their mammograms.” The mobile unit has also served as a marketing tool for the detection center. The truck has appeared in the Fairbanks Golden Days Grande Parade and
other high-profile events. People can pay $1,000 to have the name of a breast cancer victim or survivor written on the side of the truck. Companies can have their logo added for $5,000. The truck inspires new supporters of the Breast Cancer Detection Center. “I have had guys come up to me when I drive it in the parade and say, ‘If you ever need somebody to drive this around, I will do it for you,’” Butler said. A commercial driver’s license is not required to operate the truck, which Butler said gets about 8 miles to a gallon of fuel. The Breast Cancer Detection Center was founded in Fairbanks 1976 and was the first to offer mammograms in Interior Alaska. Contact staff writer Amanda Bohman at 459-7545. Email her at abohman@AlaskaPulse.com
HEALTH SENSE
If you are a veteran in a mental health crisis and you are thinking about hurting yourself-or you know a veteran who is considering this— act now. You are not alone, and you can get help.
For troubled veterans, help is a phone call away By Katie Yearley
Alaska VA Healthcare System
I
n Alaska, we groan when we first see the signs of “termination dust” on the mountains. The days are growing colder, the nights longer. As we buckle down for subzero temperatures, we should also think about doing things for our mental health. Some veterans may feel socially isolated in Alaska. Many veterans still have trauma they are trying to deal with on their own. Navy veteran Joe Angelo has lived in Alaska for 37 years. He thinks it is important that veterans find support from others to help deal with their trauma. “If a veteran is living alone, he’s alone. So how do you fix that? Well, he would have to fix it by seeking social interaction,” says Angelo. You may feel you are alone and that you have problems you can never overcome. You may begin to think that suicide is your only option. You do not have to go through this alone. Rebeca Chace, suicide prevention coordinator, says that suicide prevention helps get veterans connected with many
resources to deal with thoughts about suicide. One resource is the Veterans Crisis Line number. You can dial 1-800273-TALK (8255), then press 1 or text 838255 to speak with a responder if you or someone you know is in crisis. The Veterans Crisis Line has over 600 responders and a 99% answer rate, making it the world’s largest crisis call center. You can also chat online with a responder at www.VeteransCrisisLine. net. Chace says it is completely confidential and that you decide how much information you want to share with the responder. The only time your information is shared is if you give the responders permission or would like care after your talk. If you are in danger of hurting yourself or other people, the responder will need to get more information from you to make sure you and others are safe
and to coordinate a dispatch of local emergency services. Another resource is Same-Day Access. Alaska VA Healthcare offers SameDay Access to veterans with urgent needs for mental health appointments. If you are in crisis you can use SameAccess to receive immediate care at one of our facilities or schedule an appointment. Chace says one of the best things you can do is to stay with a veteran until they get the assistance they need. “If they’re in immediate crisis, we need to stay with the veteran to make sure … there’s no intent … that we have a safety plan, that we have an appointment set up,” says Chace. If you are a veteran in a mental health crisis and you are thinking about hurting yourself — or if you know a veteran who is considering this — act now. You are not alone, and you can get help. You can reach Rebecca Chace at 907257-4846 for help and to get connected with additional suicide prevention resources like community partnerships and programs. 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 — September 2020
15
16
Jane Lanford is a strong supporter and active participant in Alaska International Senior Games. She wore this T-shirt at a marathon in Tennessee, the last marathon she ran2020 Outside before the coronavirus hit. Photo courtesy of September — AlaskaPulse.com Jane Lanford.
This homemade gift from a friend helps Jane Lanford keep track of how many marathons she has run. Lanford has seven to go: Iowa, Nebraska, Oklahoma, Ohio, West Virginia, Connecticut and New Hampshire. Photo courtesy of Jane Lanford
A mission of miles
Fairbanks runner aims for marathon in all 50 states and a future as a fitness trainer By Kris Capps Alaska pulse
J
ane Lanford went from being a self-described klutz growing up to an athlete who is very close to running sub-4-hour marathons in all 50 states. With only seven states left, this will be her crowning achievement after 40
years of running. This passion has also led her to a retirement career that she hopes will become her legacy — helping others stay fit and live healthier lives.
First race
Lanford, of Fairbanks, was 25 years old when, on a whim, she joined a
friend on a 3-mile run. Before that, she had never really considered running as fun or exercise. To her surprise, she kind of enjoyed it. “Then there was a little race of about 4 miles, so I entered it,” Lanford said. “I figured I didn’t have to tell anybody. It was fun. I was the second out of three women in the race.” It was that moment, however, that AlaskaPulse.com — September 2020
17
Left, Jane Lanford is a member of the 50sub4 Marathon Club. Members must run at least 10 marathons in under four hours to be eligible to join. Lanford has to run marathons in seven more states to complete her goal. Right, Jane Lanford’s personalized license plate. Kris Capps photos
ignited a passion for running that continues today. After serving two years in the Peace Corps in Micronesia and then moving to Saipan, an island in the northern Mariana Islands, she decided to get more serious about running. She was a journalist at the time. “It turned out there was an expat there from San Francisco,” she recalled. “He was a lawyer and an extremely good marathoner. “ His finish times were consistently 2 hours, 30 minutes for the 26.2- mile courses, she said. “I started running and he was happy to coach me and take me under his wing,” she said. They trained for the Guam Marathon, which would take place 120 miles away. They hoped she would do well. “I ended up in 3:35.57 and I was the women’s winner,” Lanford said. “It’s a pretty high bar for your first marathon. There were just over 100 finishers and 10 of us were women.” The poster from that 1981 race still hangs on her living room wall, along with memorabilia from many other marathons.
Wise Women Retreat
Plant Medicine Allies Retreat
September 18th-20th
October 9th-11th
A Weekend Of Soulful Sisterhood, Yoga, Visualization & Seasonal Ayurvedic Support.
Ritual And Ceremony To Ground, Center And Sustain During Times Of Change.
Black Rapids Lodge $350/person (Double Occupancy)
Black Rapids Lodge $350/person (Double Occupancy) All-Inclusive Co-Ed ~ All Welcome
Donna Lanni
•
IG: @donnalanni
•
FB: @wmyogaayurveda
•
This week will be a substance free weekend. No alcohol please. wmyogaayurveda.com
Contact 907-978-0915 or on social media for more details.
Donna Lanni • IG: @donnalanni • FB: @wmyogaayurveda • wmyogaayurveda.com
18
September 2020 — AlaskaPulse.com
F606356-1
All-Inclusive Women, and all who identify as women are welcome.
Since then, she has run at least one marathon every year. “I’ve been fortunate enough not to be injured and still able to do that kind of running,” she said. “Only in recent years have I really ramped up how many a year I’m doing.” The most marathons she has ever run in one year is nine. “I’m up to 114 marathons and six ultras,” she said. An ultra is any race longer than a 26.2-mile marathon. She even bounced back after a torn meniscus in her knee required surgery, costing her 13 months of running. Over the years, Lanford has entered the Equinox Marathon in Fairbanks 20 times. She placed in the top 5 women six times and holds the women’s records for age 50-54 and 55-59. She received the Spirit of the Equinox Award in 2000, which she treasures. She also has run the Boston Marathon three times. But amid all that success, she found herself searching for a new goal. “I decided to do all the marathons in Alaska,” she said. “I thought there were nine. I have since done 20 different ones. Some come and go, most are extremely tiny.” She was preparing to head to her 21st Alaska marathon. Running races, she discovered, was a great way to visit places like Kodiak and Dillingham and Prince of Wales Island. New races kept cropping up, so she never ran out of Alaska marathons. Then she heard about a couple of Alaskans who were not only running marathons in every state but running them in less than four hours. That’s a pace of about a 9-minute mile. “At the time, that was easy for me,” she said. But in order to be eligible to join the official Sub-4-Club, she had to run 10 marathons in less than four hours. She sat down and put together an Excel spreadsheet, which she still updates regularly. “It turned out I had exactly 10 states in 2011,” she said. “All under four hours, no problem.”
She evaluated her situation. “I’m already 56 years old and need 40 more states under four hours,” she recalled thinking. “I know it’s going to be a crunch.” She started searching for marathons that were on reasonably flat terrain and in cool weather, avoiding any race held in temperatures warmer than 60 degrees. “It’s been great,” she said. “I have found all kinds of friends to travel with me. I’ve visited parts of the country I hadn’t been to. It was just fascinating and fun getting to visit all these places. “I was knocking out the marathons pretty well and suddenly, I started getting older,” she noted. Her times were increasing to the 3 hour, 50 minute range. “I did a whole bunch of them in 2018-2019 in the 3:50s,” she said.
Above, Jane Lanford has three bedspreads made out of T-shirts from the many running races she has entered over the years. Left, she received a pair of Nike VaporFly shoes as one of her retirement gifts from Usibelli Coal Mine. The unique running shoes, she said, have shaved minutes off her finish time. Kris Capps photos
AlaskaPulse.com — September 2020
19
A Of all the awards she has received, these plaques honoring her volunteer work are her most prized. Kris Capps
photo
Jane Lanford finishes the Shelby Forest Loop Marathon, near Memphis, Tenn. in February 2020 with a time of 3:50.48. Photo courtesy of Jane Lanford
Then, she got a little help from technology. “Nike invented a new kind of shoe, the VaporFly, purported to take 4- to 5% off runners’ times,” she said. “That’s like a 10-minute advantage. I thought, that can’t be.” She had long ago switched careers and spent many years working as a certified public accountant. Retirement was pending from Usibelli Coal Mine and she strongly hinted the perfect retirement gift would be a pair of $250 Nike VaporFly shoes. She got them, wore them, and promptly shaved several minutes off her time. As she scanned the feet of other runners, she realized many of them were also wearing these same shoes. “I have been reborn now,” she said. “My times dropped to 3:50 and 3:51 instead of 3:58.” Alas, the coronavirus interrupted her marathon mission and she doesn’t know when the next marathon will happen. So she just tries to stay in shape for future marathons in Iowa, Nebraska, Oklahoma, Ohio, West Virginia, New Hampshire and Connecticut. 20
September 2020 — AlaskaPulse.com
“Two of them are repeats,” she said. “I ran over four hours in Iowa and West Virginia, so I’ve got to redo them.” As always, the biggest competition is herself, not the other runners, she said. But she does love the camaraderie of runners she has met over the years. “I have friends no matter where I go,” she said.
Social running
Lanford can’t really explain the passion she felt when she discovered running and the passion she continues to feel for running. “I seem to be blessed bio-mechanically for running,” she said. She confessed that she gets away with “pretty low mileage training,” running about 25 to 30 miles a week, year round. “Any good coach will tell you, that’s not enough,” she said. Yet, that is what seems to work for her. “In recent years, I just stay trained up because I’m doing them frequently. I’ll get a couple 20-milers in before the marathon, and fewer, shorter runs during the week, like 3- to 6-miles, and make sure I build up to longer and lon-
ger runs on the weekend.” She loves the social aspect of running. “I seek out people to run with,” she said. “I live on Murphy Dome and I make the trip into town just to meet somebody to run with if I can.” “I try to have a running buddy as much as I can,” she said. “Anymore, they’re faster than I am.”
Next goal
Lanford is 65 years old and she has finally settled on her next goal, a way to share her passion for running with others. She recently became a certified personal trainer, focusing on fitness. She’s not really sure yet what form this new path will take, but she hopes to work with older people. She is already a staunch supporter and participant in the Alaska International Senior Games. She is also a strong believer in volunteering and delivers Meals On Wheels to homebound seniors one morning every week. “I want to leave some kind of legacy, to convince people to have a little healthier life,” she said. “You’re never too old to try something new.” “I just hope I can inspire people to stay fit or try to stay fit,” she said. Reach staff writer Kris Capps at kcapps@AlaskaPulse. com
HEALTH SENSE
Ayurveda
Ancient wisdom for modern times By Donna Lanni
A
yurveda, the more than 5,000-year-old modality of health and wellness from India, is finding its way into Western lifestyle practices. Most people have heard of neti pots, tongue scraping and oil pulling as a daily morning ritual. Others openly discuss their “dosha” after taking quizzes in magazines or online. But what does this really mean? How can an ancient practice really help us in these very intense times? Ayurveda offers a multi-therapeutic approach of preventive modalities to bring the individual into balance with the natural rhythms of nature, the seasons, and with their own true natural expression of health. Ayurveda also takes the qualities of the mind into account and believes that the mind, body and spirit of an individual are all connected. It utilizes the concept that all living beings have within them a unique blend of the five Mahabuthas or elements: space, air, water, fire and earth. These elements blend to form three major dosha. Vata, (space and air), Pitta (fire and water) and Kapha (water and Earth) are seen as expressions of 20 qualities that describe all matter. For example, a Vata expresses the qualities of air and space (light, clear, cold, dry, mobile, rough and subtle), Pitta (sharp, hot oily, spreading, acidic light-brilliance), and Kapha (dense, heavy, cold-clammy, soft, dull). These qualities combine in unique proportions to make us who we are as individuals. Prakruti is your unique blend of elements as seen at the time of pre-pubescence and all “dosha” tests should be taken with the vision of yourself at this time. It offers a baseline glimpse of your pure innocent self. Vikruti is the expression of the dosha in the present moment and is often an indicator of how we have strayed from our natural state of being and what elements may be out of balance. How we stray from our best health takes on many forms. It is our belief in Ayurveda that we literally “are what we eat” and that anything we ingest (food, thoughts, energy) create the overall state of health in the moment and over time. Therefore, a diet filled with processed foods, too much caf-
feine, alcohol, frozen foods, GMOs, and foods with lower Prana (life force energy) can, over time, cause digestive stress and toxins (Ama), which can lead to illness. The grocery store isles are filled with medicines that reduce gas, acid, bloating, and constipation; all of these just manage the symptoms of a greater problem. Irregular schedules, too much screen time, chronic stress, unhealthy relationships and environmental toxins shift the elements as well. Alaska
PULSE Shout Out
Send a Message of Support and Gratitude
A
laska Pulse would like to thank all our state's medical professionals, our superheroes! Working tirelessly to provide excellent care to the patients of their communities. Their time, attention, and expertise do not go unappreciated. We look to them for guidance and leadership and they deliver unwaveringly.
Thank you so much for all you do! Our community medical professionals are our superheroes. Help us share messages of support to these amazing people. Send them a note of support, a funny joke, an uplifting story, or whatever you choose – we guarantee your message will make their day.
Visit www.AlaskaPulse.com/shout-out
and share your message.
AlaskaPulse.com — September 2020
21
W
Eating healthy fats such as ghee and vegetables such as root crops, avoiding alcohol, practicing gentle yoga and meditation and eating grounding garden herbs such as cumin, coriander and fennel all act to soothe and nourish the body, mind and spirit.
We are all sensitive to the change of seasons as this is the time where we catch colds more easily and notice shifts in eating and temperature. We have a life rhythm: the beginning, middle and end. And, women experience a monthly rhythm under the influence of the moon. Ayurveda seeks to help the individual find balance in all of the rhythms that affect us commonly and individually. So, as you see, everything from the exterior world becomes a part of you and has the potential to shift your individual elemental blend toward a state of disease. My teacher, Dr. Vasant Lad, says, “You are the world and the world is in you.� In Ayurveda, we strive for balance in the dosha, balance in digestion, balance in the seven tissues (immune, blood, muscle, fat, bone, nerve and reproduc22
September 2020 — AlaskaPulse.com
tive), the three waste products (sweat, urine, feces), and the five senses hearing, touch, sight, taste and smell). And that is a lot to balance right now! We have all had more screen time, more stress, and perhaps an increase in fear and loneliness due to COVID-19 and the unrest of the world. Calming the nervous system (Vata, air and space; Pitta, fire and water) by establishing a set morning and evening grounding routine (Kapha), eating healthy fats such as ghee and vegetables such as root crops, avoiding alcohol, practicing gentle yoga and meditation and eating grounding garden herbs such as cumin, coriander and fennel all act to soothe and nourish the body, mind and spirit. Although Ayurveda is not recognized by the AMA and cannot legally make medical claims, it is common knowl-
edge that COVID symptoms, in normal cases, act like the typical influenza virus, is transmitted through nasal and oral droplets, and sometimes present with loss of taste and smell. Paying particular attention to the cleaning of nasal passages through breath work (pranayama), rinsing the nose with water (neti), applying calming and moisturizing oil drops into the nose (nasya), scraping the tongue to remove toxins, and gargling with sesame or coconut oil (oil pulling), just seems common sense and costs very little. These morning practices also serve to calm, nourish and detoxify and are usually part of the daily Ayurvedic routine or dinacharya. In closing, Ayurveda is a very ancient practice that when applied can help us find balance in our changing world. Donna Lanni, E-RYT 500 Ayurvedic yoga specialist, is owner and founder of Wisdom Medicine Yoga & Ayurveda in Fairbanks.
HEALTH SENSE
Watch your step By Mike Swenson
Tanana Valley Clinic
M
oose hunting season. Colorful leaves. Frosty mornings. Three traditional signs of fall in the Interior. The changing season is beautiful for many but can be dangerous for older Alaskans who need to approach the colder weather with a bit more caution. According to the Centers for Disease Control and Prevention, one senior falls every second in the United States. While an accidental fall isn’t usually a medical emergency for younger individuals, as the body ages bones often become brittle and healing can take longer. Seemingly minor falls can result in serious injury in older adults. In addition to the injuries associated with the actual fall, fear of falling can also seriously affect an aging adult’s quality of life and, sadly, can keep a person from being active and independent. In 2019, the state of Alaska released a report on injury and deaths among older adults. The report concluded that falls are the No. 1 leading cause of serious injury requiring acute care and one of the leading causes of death among Alaska residents ages 55 and older. The rate of serious fall injury is higher among older women than men in Alaska. The report also identified substantial disparities in serious fall-related injury among older Alaska adults by race. Alaska Native adults experience approximately twice the rate of falls compared with older white adults and more than three times the rate of older adults of other races. Falls are typically caused by physical conditions that impair mobility or balance (e.g. decreased leg strength) or hazards in the environment (e.g. icy sidewalks). Several physical changes related to aging make older adults more susceptible to falling, including decreased
strength, reduced sense of balance, declining eyesight, loss of flexibility and decreased endurance. Environmental hazards occur when people do not notice a hazard or do not respond quickly enough after a hazard is noticed. Most falls occur when several causes interact. The good news about fall-related injuries is that many of them can be prevented. Here are 10 simple steps that older Alaskans can take to prevent falls: 1. Begin or maintain a regular exercise program. Weight training or resistance training may help strengthen weak legs and thus improve steadiness during walking. 2. Wear appropriate shoes. Shoes that have firm, nonslip soles, some ankle support, and flat heels are best. 3. Stand up slowly after sitting or lying down. This strategy can help prevent dizziness because it gives the body time to adjust to the change in position. 4. Ask your primary care provider to review your medicines. Older individuals should ask their primary care provider to review all prescription and nonprescription drugs being taken to see if any of the drugs could increase the risk of falling. If such drugs are being used, your doctor may be able to lower the dose or prescribe another drug. 5. Have your vision checked every year. Having the correct glasses and wearing them can help prevent falls. Treatment of glaucoma or cataracts, which limit vision, can also help. 6. Make your home safe. There are sev-
eral environmental improvements than can be considered to make your home safer, including improved lighting, clutter-free floors, grab bars in the bathroom, taped or removed throw rugs, nonslip mats and elevated toilet seats. 7. Keep your sidewalks clear. Walking slowly and carefully on slippery sidewalks can minimize falls. Applying de-icing material such as salt or gravel can also help keep sidewalks clear. 8. Use special care when getting in and out of vehicles. Getting in and out of cars or trucks can pose a special risk for older adults. To get out of your vehicle, remember “step down, not out” with both feet. This approach forces you to stand up or step flat-footed, reducing the chances of slipping. 9. Have your balance checked. Fairbanks Memorial Hospital’s Rehabilitation Services offers a free Balance Screening Program for anyone over the age of 55. The assessment tests strength/ flexibility, vision, mobility, cognition, sensory integration and balance. To learn more about the program, please call 907458-5670. Your primary care provider can also check your balance during your annual physical. 10. Prepare for an emergency. Make a plan for you and your loved ones for who will be called and how the call will be made in case of an emergency. In addition to an emergency plan, many older adults invest in an alert system that can assist in an emergency. The best treatment for fall-related injuries is prevention. As the weather begins to change, be aware of where you are stepping and stay steady on your feet. If you have questions, or need more information on preventing falls for you or a loved one, please contact your primary care provider. Mike Swenson is chief medical officer at Tanana Valley Clinic in Fairbanks.
AlaskaPulse.com — September 2020
23
Dale Keeling’s dog, Moose.
Health aide making a difference in Manley Tanana Chiefs Conference
D
uring his 27 years as a paramedic/fireman in his home state of Colorado, Dale Keeling thought he knew a lot about providing care to the ill and injured. Then he fell in love with an Alaska girl, followed her back to her hometown of Manley in Interior Alaska, and learned about the health aide career. “Her dad was a health aide in Manley in the ‘70s, and he talked to me a lot about the job ... I thought that with my background, the training would be pretty easy, and that being a health aide was not that dissimilar to being a paramedic,” he said. He was wrong. His experience certainly helped him in the training course, but he learned pretty quickly that as a health aide his base of knowledge was expected to be much wider. “My job as a paramedic was basically emergency medicine. But health aides do urgent care, chronic care, administer antibiotics, suture wounds and a lot of other things I never did as a paramedic,” he said. “We have to learn about the whole body in much greater depth than with my previous training. And the clinical exams we conduct with patients are much more thorough than anything I did before.”
Now you never have to miss an issue again. Have the Alaska Pulse delivered to you each month. Sign up Today for just $29.99 Call (907) 459-7566 or visit www.AlaskaPulse.com/mypulse 24
September 2020 — AlaskaPulse.com
F606432-1
Never m i an issuess !
Keeling says that one of the best parts of being a health aide is that he has the time to get to know people, which makes it easier to figure out the best way to help them get and stay well. “And it is a joy to see people out in the community a few days after I’ve worked with them in the clinic and have them come up to me and say they feel betDale Keeling was a paramedic for ter,” he said. “I feel 27 years in Colorado before moving like I truly make a to Manley and training to become a difference in the lives community health aide. of people, in the lives of my neighbors.” The most frustrating part of his job is one frequently mentioned by health care providers across the country: Dr. Google. Easy access to the internet is a blessing, but the information available is not always correct, and people can end up giving themselves the wrong diagnosis, which sometimes delays proper treatment. Keeling’s job also has become more complicated since the coronavirus pandemic. “There is more testing for people who travel. I have to make sure we have a good supply of things like masks. I have more reports to do and more meetings with other health care providers to make sure we are hearing the latest information about how to avoid the virus,” he said. It all takes more time and coordination. When he is not at his health aide job, Keeling is usually working at his second job: doing the many tasks involved in
trying to live a largely subsistence lifestyle. “My wife Katrina Andrulli and I are busy all the time. There is fishing, hunting, 10 cords of wood to put up every year, fixing things that break, maintaining a large garden, preserving food for the winter. I just bought a place with a sawmill, so I am learning all about that. It is never ending. Mind you, I am not complaining. I am blessed to be in such a gorgeous place, living a healthier lifestyle. I am 53 and I’m convinced that all the chores keep me young.” Dale Keeling’s supervisor, Ryan Clairmont, had only glowing things to say about him. “We are incredibly lucky to have a guy with the kind of skill set he has working as a health aide. He is a huge asset to Manley and to our program. He was recertified so that he can now teach the Basic Life Skills program, which incorporates CPR training, to our health aides. It is a pleasure working with him.”
Above, a new Tanana Chiefs Conference clinic in Manley opened this summer. Construction began in November after freeze up and Johnson River Enterprises worked through one of the coldest winters on record only to be delayed again by six weeks due to COVID. Left, Manley is the hometown of Keeling’s wife, Katrina Andrulli.
Tanana Chiefs Conference is a nonprofit health organization based in Fairbanks and serving more than three dozen communities of the Interior.
AlaskaPulse.com — September 2020
25
HEALTH SENSE
It’s Prostate Cancer Awareness Month. Here’s what you need to know By Aaron Marks Fairbanks Urology
A
aron Marks is a clinical care coordinator for Fairbanks Urology. Dr. Tony Nimeh is a urologist and men’s health expert at Fairbanks Urology. Aaron sat down with Dr. Nimeh to discuss Prostate Cancer Awareness Month. Aaron: We’re here with Dr. Tony Nimeh, and we’re discussing Prostate Cancer Awareness Month. Dr. Nimeh, we hear a lot about the PSA blood test for testing for prostate cancer. Is this a reliable test? Dr. Nimeh: The PSA is a very important test in prostate cancer detection. It is very reliable for some things, but it’s not very reliable for other things. Prostate-specific antigen, or PSA, is a protein produced by normal cells, as well as cancer cells, of the prostate gland. The PSA test measures the level of PSA in a man’s blood. The analogy for this test that I like to use with my patients is that the PSA is like oil for your car engine. The oil is supposed to be there. But if you park your car in front of the house and in the morning you find there’s oil all over the ground, that’s a problem and you need to figure out why there is a leak. Same thing with a prostate and the PSA. The PSA is inside the prostate. If we do a blood test and we find the PSA is elevated, that means there’s a leak. The PSA is leaking out of the prostate into the bloodstream, and we can measure an elevation in the PSA in your blood. We’re testing to see if there’s a leak in the prostate. 26
September 2020 — AlaskaPulse.com
Now with that being said, prostate cancer is not the only thing that can cause a leak. That’s why when you go see your doctor and they see an elevation in the PSA, they say, well, we need to investigate this further. So what else can cause the PSA to leak? Well, there’s a few different things. Sexual activity before the test can cause it. Also, any procedure on the urinary tract, or urinary tract infections. Plus any physical activity like horseback riding or snowmachining can make an impact. Aaron: So when should a man get a PSA test done? Dr. Nimeh: The PSA is a screening test for prostate cancer that is done at the age of 50. And it’s done annually from 50 until the age of 70. The reason why we call it a screening test is that we are trying to find the cancer before it becomes symptomatic. If we find the cancer before it becomes symptomatic, then we have a chance of catching the cancer early on and if we do that, then the chance of a cure is very high. If we wait until it starts to give off symptoms, such as affecting the organs or leave the prostate and goes to the bone which can create fractures, then
that means the prostate cancer has become quite advanced and it’s a lot more difficult to cure. We can still treat it, but we want to catch it before it becomes advanced. Aaron: If the PSA is elevated, how do we make sure it’s not from prostate cancer? Dr. Nimeh: Once we have an elevated PSA, we do a prostate biopsy. It takes about 15 minutes, and we send the biopsy off to a pathologist. If there is a cancer, it all depends on what type of cancer. Aaron: What happens if the prostate biopsy is positive? Dr. Nimeh: The American Urological Association has categorized prostate cancer into four categories: very low risk, low risk, medium risk, and high risk. Depending on where the patient is, we will recommend different courses of action. For example, for the very low risk category, we actually do not recommend any treatment at all. Of course, for the high risk category we do recommend treatment. Aaron: We hear a lot about chemotherapy. Is this used in the treatment of prostate cancer? Dr. Nimeh: Chemotherapy is rarely used in prostate cancer. It is effective with other types of cancer but not for prostate cancer. The different options for prostate cancer are active surveillance, hormone therapy, surgery, and radiation therapy. Chemotherapy is used only for very
advanced cases. If we are talking about active surveillance for low risk cancer, then all that means is that we are actively monitoring this cancer because we believe if we keep an eye on it, then the second it becomes more aggressive we still have a chance to completely cure it. If we diagnose a low risk cancer and we keep an eye on it for let’s say five years, and then five years later it becomes more aggressive and we intervene at that point, then we still have a chance of curing it. Aaron: But what have we gained by waiting for five years while the man is on active surveillance? Dr. Nimeh: Well, we gained that for five years that patient did not have to have therapy and did not have to suffer the side effects. Unfortunately, every therapy that we use in prostate cancer will have some sort of side effect. There’s always a downside. So by saying we’re going to implement active surveillance, then there was a five-year period where that man didn’t suffer any form of erectile dysfunction, incontinence, or any of the side effects that can come with it. If we fast forward and it’s five years later and this cancer is now moderate or high risk, there are two treatments: One is surgery. The second is radiation. Radiation usually comes with some sort of hormone therapy. The surgery involves removing the entire prostate. Aaron: What in your opinion is the best treatment? Dr. Nimeh: Again, that depends on the type of cancer and the age of the patient. For younger patients, we tend to recommend surgery. Older patients tend to go for radiation. Mostly because the surgery has a higher risk when the patient is older. Also if a younger patient has surgery and they have a recurrence, they can have radiation done later.
Doing surgery on tissue that has been through radiation is more difficult because the tissue doesn’t heal as well as tissue that has not been through radiation. Concerning radiation, there is a new technique to decrease the side effects of the radiation on the surrounding organs such as the bladder and the rectum. The radiation is focused on the prostate, and the rectum is at risk for receiving part of that radiation and will suffer from side effects. A new technique we’ve been doing is putting a gel called SpaceOAR gel, which is a spacer that creates a space between the prostate and the rectum. So now when the radiation is going to the prostate, there is less impact on the rectum. This is an advanced technique that we’re doing here in Fairbanks that will allow patients to have less side effects from the radiation. Aaron: Thank you so much Dr. Nimeh!
North WiNd Behavioral Caroline Atkinson
MA, LPC Licensed Professional Counselor
Cathy Johnson
RN, MSB, ANP Advanced Nurse Practitioner
Elizabeth Kraska
MA, LPC Licensed Professional Counselor
1867 airport Way Suite 215 FairBaNkS, alaSka
(907) 456-1434 Fax (907) 456-1481
North Wind Behavioral Health offers outpatient treatment Services include: individual, for anxiety, depression, PTSD, mood disorders, ADHD couples and family therapies and and other behavioral health challenges. medication management. Hours: Monday–Thursday 9:30 a.m. – 5 p.m. • Most Insurances Accepted • www.northwindbehavioral.com
AlaskaPulse.com — September 2020
27
HEALTH SENSE
Robotics-assisted technology improves precision and outcomes for Alaska’s joint replacement surgery patients By Dr. Tucker Drury
N
ot long ago, joint replacement surgery required a hospital stay. But medical advances in recent years have improved and streamlined the procedure, enabling many patients to have a knee or hip replaced in an outpatient facility and go home the same day. Now an innovation, robotics-assisted technology, makes that outpatient procedure even more precise, so patients spend less time in surgery and have a quicker recovery and a new joint that fits and performs better that ever. My partners and I at Surgery Center of Wasilla, a multi-specialty outpatient facility serving Alaska’s Mat-Su Valley, recently became the first ambulatory surgery center, or ASC, in Alaska to invest in robotics-assisted technology. We all had used the technology in the hospital, and we are especially excited to now bring it to our ASC. Why? Because it improves patient outcomes dramatically, and in addition to better accuracy, it helps us shorten the patients’ intraoperative experience. Surgery Center of Wasilla’s roboticsassisted system is very robust, with five surgeons currently using the technology. The system is built on years of data and experience and allows us, as surgeons, to build a customized preoperative plan for each patient. As a first step, the patient obtains a CAT scan of either their hip or their knee, preoperatively. We then take that three-dimensional model into a planning session where we really look at their unique anatomy, and if the 28
September 2020 — AlaskaPulse.com
patient has issues such as deformities from an arthritis pattern that has gone on for a long time, we can anticipate those problems. Once in the operating room, we again collect data points from the patient’s anatomy and reconcile what we see with our preoperative plan – so we have checks and balances. And then we engage the assistance of our system’s robotic arm as a tool to make the needed surgical cuts very precisely and with confidence that we’re doing everything in the best way possible to make this mechanical joint work really well – ideally, as well as the patient’s original joint. One of the questions I often get from patients is, “Is the robot going to do my whole surgery?” And the answer is no. As the surgeon, I still have to make the incision and treat the tissues with respect and provide really good exposure. But with the robotic arm, I have an advanced tool making me better, blending technology with my experience to create a great outcome for the patient. For patients, one significant advantage of the new system is fewer cuts and smaller incisions. Traditionally, total joint replacements used X-rays, two-dimensional technology, to create the preoperative plan for a patient. But oftentimes with that flat, traditional
As the surgeon, I still have to make the incision and treat the tissues with respect and provide really good exposure. But with the robotic arm, I have an advanced tool making me better, blending technology with my experience to create a great outcome for the patient. approach, you’d get into the operating room, make a cut and check it, and then you’d have to cut again, because while the plan was two dimensional, we’re dealing with a very complex, threedimensional joint. I have personally found that the new technology improves the plan so much that I cut less, reducing potential trauma to the patient. With the robot, we assess, plan, observe, and then we cut. And that is also what really shortens the intraoperative experience. In addition, the robot helps ensure the new joint is being put in proper alignment, which makes a big difference in its usability. Think of it like aligning a
set of new snow tires up here in Alaska: If we put them on crooked, the wear pattern is going to be inappropriate, and they won’t last as long. With roboticsassisted technology, I have a tool that can help me align the patient’s parts better to increase longevity. The robotics system we now have in place at Surgery Center of Wasilla comes from Stryker, a manufacturer with a long track record of success with hip and knee implant products. The Stryker Mako System lets us marry successful implants with the cutting-edge technology that helps us put them in with more precision and better outcomes for the patient. It’s humbling to admit, but I have carefully studied my results and have realized that using a tool like this makes me a better surgeon – the pieces get put in better with the assistance of this technology. My advice for patients who are candidates for joint replacement? Do the research, look up Stryker online, and take a look at the Stryker Mako robot. Outpatient total joint replacement has become the standard of care in the Lower 48, and demand is expected
to increase exponentially in the next decade. The reason is, for a patient who is healthy and motivated, the less time they spend in the hospital environment for a procedure like this, the better. This is especially true in today’s environment of the coronavirus. If you’re not in a hospital where you can be exposed to patients with other disease processes,
and if we can get you back to your home environment faster, where you’re with the people who love you and your own food and your own TV, that’s often a big win. Dr. Tucker Drury is a surgeon-owner at Surgery Center of Wasilla. He has completed more than 170 knee and 140 hip replacement surgeries using robotics-assisted technology.
AlaskaPulse.com — September 2020
29
CO
A silent killer in my house By Aliza Sherman
I
knew something was not right. Deep in my gut, I knew. I learned a hard lesson one winter about the importance of the air in my Anchorage home. I still struggle with the fact that I learned this lesson the hard way and a little too late. In September 2005, while I was pregnant with my daughter, my beloved dog Chewie — a black and tan, 10-pound Chihuahua — got sick. Very sick. The illness was completely unexpected because his most recent veterinary visit a few months earlier confirmed a clean bill of health. Now his vet didn’t know how to diagnose him other than to say he probably had a brain tumor. Chewie’s symptoms included: falling down, bumping into walls, walking in circles, and an inability to stand while 30
September 2020 — AlaskaPulse.com
eating at his dog bowl. Soon he began having mild seizures. The entire time he was sick, I had a nagging feeling that something wasn’t right. Yes, I was emotional because my dog was dying, but his decline seemed too sudden. I gave Chewie the medicine my vet prescribed and provided him with around-the-clock hospice care for three months. Caring for him was particularly challenging because I was several months pregnant and suffering from nausea, headaches and dizziness. Still, I woke up four or five times each night to respond to Chewie’s cries. I cradled him in my arms like a baby to soothe him. In December, the day after Chewie had an uncontrollable seizure during my birthday party, I was finally advised to put him to sleep. I didn’t know what else to do, so I complied.
Several weeks later, in January 2006, my second oldest Chihuahua, Ernie, fell ill. He exhibited the exact same symptoms as Chewie: dizziness, bumping into walls, falling down — everything but the seizures. The vet said that Ernie had a brain tumor. Another brain tumor? How could two unrelated dogs both get brain tumors? I questioned my vet but was only given possible next steps: testing, medication, and then the inevitable. This time, I watched Ernie closely to see if there was something going on around him that was making him sick. Was he eating a plant that was toxic? Was I using a cleaner that was poisoning him? That is when I noticed that his dizziness increased after he would lay down in front of a heating vent on the living
room floor. All three of my Chihuahuas spent the winters dozing in front of this vent for warmth to replace the sunlight they were missing. Could something be coming through the heating vent that was making him sick? Something like carbon monoxide? “It couldn’t be carbon monoxide,” my husband said, pointing to our top-ofthe-line detector plugged into the wall nearby. “See, it shows zero carbon monoxide.” I looked at the LCD display and the red zero but still wasn’t convinced. As an experiment, I shut off the furnace vent so that Ernie couldn’t breathe in any air coming up from that vent. Within a week, the worst of his symptoms were gone. I asked my vet about getting Ernie tested for carbon monoxide poisoning, but it involved first having to locate a laboratory that could administer the test. By the time I found one, the carbon monoxide was already out of his system.
Not the end of the trouble
In March, I went in for an unscheduled sonogram, something I asked for just to make sure everything was OK with my pregnancy, a bit paranoid after multiple losses. The sonogram technician examined me. “Do you smoke?” he asked. “No.” I replied honestly. “Are you around people who smoke?” “No.” “Do you light a fireplace in your home?” “No. Why are you asking me these questions?” I was beginning to get nervous. The technician explained that he saw blood pooling in my placenta. Apparently my placenta at 26 weeks looked like a placenta at the end of a pregnancy. He thought I was a chronic smoker because the blood lakes he described
could signify exposure to low levels of carbon monoxide — similar to the amount a smoker would take in. Carbon monoxide? But our carbon monoxide detectors in our house read zero. A few days later, I called a furnace company. The furnace guy spent about five minutes checking the house for carbon monoxide with a hand-held detector. Once again, the reading was zero. Then I told him about my dogs. He listened patiently, then looked at my pregnant belly. “My wife’s pregnant, too.” he said. He decided to stay a little longer and turned the furnace up a little higher. Within a few minutes, the numbers on his detector began to rise. “You have carbon monoxide in your house,” he said. He then went over to our carbon monoxide detectors — both upstairs and downstairs — to check “peak levels.” Check peak levels? This is when I learned that neither my husband nor I knew how to properly read our carbon monoxide detectors. The furnace guy showed me how to press one of the buttons on the face of the detector to see what numbers were registering that were below the level that would set off the detector alarms. Although the levels he found in our house were not enough to kill my husband or me, they were enough to kill a small pet. “Birds would be the first to go,” he said. “Then smaller animals.” “What about an infant?” I asked. “Yeah, maybe even an infant.” There was enough carbon monoxide in my house to make me nauseous and dizzy in my fifth month of pregnancy, enough to damage my placenta and possibly affect my unborn child.
A lesson in detectors
monoxide detectors go off ? The furnace guy explained that carbon monoxide detectors are not set to go off with lower levels of carbon monoxide, just the higher levels that could be deadly to humans. He said that even good detectors — as we had — should be checked for peak levels regularly to see if anything is registering. It turns out we had the best carbon monoxide detectors on the market but that we didn’t know how to read them. The next day we had a new furnace installed, the heating vent in the garage sealed off, and, just for good measure, I stopped parking my car in our attached garage for the rest of the winter. Our carbon monoxide detectors now read zero, and when I pressed the peak button each day, they still read zero. I still think of my poor dog, Chewie, suffering from carbon monoxide poisoning all that time while none of us knew what was going on. People try to comfort me by telling me that Chewie was a canary in a coal mine: His death was the first signal that something was wrong with the air in our home and possibly saved our baby. The lessons to be learned from this? Spare no expense when buying the carbon monoxide detectors, and, more importantly, learn how to read them properly. Any carbon monoxide registering in a home is unsafe, no matter how small. Get your furnace checked annually before each winter and serviced if you have a leak. If your furnace is old (ours was 21 years old and most models estimate a 20-year lifespan), invest in a new one. Sure, the extra expense will hurt a tight budget, but life is too precious not to invest in safety. And most of all? Trust your gut. Aliza Sherman is a freelance writer in Anchorage. Comments about this story? Email editor@AlaskaPulse. com.
But why didn’t my expensive carbon AlaskaPulse.com — September 2020
31
When you need care, we’re here for you 1st Care is your choice for immediate and after-hours care. We are able to manage a majority of your immediate care needs, including a full complement of lab testing and X-Ray services. We might not be able to fix your ego, but we can fix just about everything else. When you need care, we’re here for you.
8am - 8pm, 7 days/week for all your urgent health care needs 1101 Noble Street
907-458-2682
www.foundationhealth.org
