Health and wellness fall2013 by Fairbanks Daily News-Miner

November 2013

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F O C U S O N M E N T A L H E A LT H • Alaska's issues maintaining balance guilt post traumatic stress • Mental health vs. love anger mental illness head trauma on addiction memory loss greed job stress • Our state, rief grief low mood s.a.d. hate relationships by the numbers drugs pleasure fear loss of loved one • What the CDC post traumatic stress irritability says greed pain phobias job loss sex frustration mental health issues stress happiness

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KIDS: • Getting your child offline • Healthy parties at school • Schools and allergies • ADHD and your child

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Fairbanks Daily News-Miner

Wednesday, November 6, 2013

HEALTH & WELLNESS

TABLE OF CONTENTS • Issue focus: Mental health in Alaska …...................... 2 Mental health vs. mental illness ............ 4 Mental health basics …............................ 4 Mental wellness at college …................... 5 Fairbanks mental health services ........... 5 Other health topics: • Diet Probiotics may aid digestion ................... 6 Going gluten-free is vital for many ….... 8 Controlling acid reflux …......................... 9 The benefits of antioxidants ….............. 10 • General health Pick the workout that’s right for you … 12 Getting involved in your treatment ….. 13 A breast cancer screening option ......... 16 Techonology and strep throat ............... 17 App helps track the flu ........................... 18 Knowing Crohn’s disease ....................... 19 New devices help transplant patients . 20 Fitness norms not true for all .............. 24 • Kids ADHD diagnosing ................................. 23 Limiting your kids’ screen time …........ 28 Allergies and schools …......................... 29 A health party in the classroom …........ 31

Alaska plagued by problems related to mental health By Weston Morrow WMORROW@NEWSMINER.COM

very region has its own issues to deal with. In Alaska, those issues frequently manifest as mental health conditions. Mental health conditions cover a broad range of issues and experiences and can come about through many factors. In many cases, those factors can be exacerbated by Alaska’s nature. Its long, cold, dark winters can have a depressing effect on people, especially when multiplied by other concerns. Kate Burkhart is the director of the Alaska Mental Health Board, as well as the state Advisory Board on Alcohol and Drug Abuse and the state Suicide Prevention

The Alaska Department of Health and Social Services estimates nearly 13,000 children up to age 17 — 7.2 percent of the juvenile population — suffer from serious emotional disturbance. ISTOCK PHOTO Council. She said the state’s rural nature can contribute

to the prevalence of mental health conditions. Despite the extreme cold and the seemingly never ending dark, Burkhart said, the circumpolar environment can make the development of mental health conditions more likely, but can’t cause them itself. “It’s not a cause factor,” Burkhart said. “It’s a contributing factor.” The Alaska Department of Health and Social Services estimates more than 21,000 adults in Alaska — 4.6 percent of the adult population — suffer from serious mental illness. In addition to that, the department estimates nearly 13,000 children up to age 17 — 7.2 percent of the juvenile population — suffer from serious emotional dis-

turbance. Francine Harbour is the executive director of the Anchorage affiliate for the National Alliance on Mental Illness, an organization that helps connect those who suffer from mental health conditions to peers who have gone through similar experiences. Harbour dealt with her own mental health conditions. She is in recovery for bipolar disorder and post-traumatic stress disorder and said the key to dealing with mental health conditions often is early recognition and treatment. The biggest problems, she said, usually come about when the issue is left untreated too long. ALASKA » 3

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Roughly 50 percent of people with severe mental disorders are affected by substance abuse, according to the National Alliance on Mental Illness. ISTOCK PHOTO

ALASKA Continued from 2 “By the time you get to the acute treatment (hospitalization) level, it’s much harder to treat,” Harbour said. “Often, dollars are used for acute treatment, and by then, the illnesses have become so serious that they’re that much harder to treat successfully, whereas if you treat those illnesses at the early intervention stage, then there’s a much higher success rate for treatment.” Suicide is one particularly strong consequence of mental illness left untreated that resonates in the state of Alaska. The rate of suicide in Alaska, 20 per 100,000, is nearly twice that of the rate for the United States as a whole, 12 per 100,000. The suicide rate in Alaska has dropped slightly in recent years but has risen nationally. “That’s a pretty stark statistic. It’s horrifying. It goes to show, in my mind ... when these conditions go untreated,

people die,” Harbour said. “If we use even lesser dollars (than what we spend for acute treatment) for prevention and early intervention, we could keep things from getting so bad that people end up feeling like the only way they can get away from their symptoms is to kill themselves.” For many people who don’t have access or don’t desire to use preventative care, self-medication can worsen an already present mental health condition. Alcohol-induced deaths in Alaska in 2012 were nearly four times greater than the national figure. Roughly 50 percent of people with severe mental disorders are affected by substance abuse, according to the National Alliance on Mental Illness. “We do hear from people, especially in rural Alaska, that a lack of economic opportunity is something they feel is directly related to issues of substance abuse,” Burkhart said. Harbour said that for many people, the dual struggle to overcome a mental health condition while simultaneously

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Mental health vs. mental illness By Weston Morrow WMORROW@NEWSMINER.COM

or many people who have never dealt with mental illness — or even those who have — it often can be hard to understand what qualifies as a mental illness and what constitutes a mental health issue. The technical difference often is made between clinical and sub-clinical illnesses, said Francine Harbour, the executive director of the Anchorage affiliate of the National Alliance on Mental Illness. A clinical illness would be one that requires some form of treatment by a health professional, whereas a sub-clinical condition typically can be resolved in time without professional treatment. For instance, Harbour said, when a person goes through a break-up or bout of anxiety that might have a significant impact on a person’s life, but in some cases it might be considered sub-clinical by a health professional. “If it goes on long enough and

Contact staff writer Weston Morrow at 4597520. Follow him on Twitter: @FDNMschools.

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attempting to recover from addiction can be overwhelming. “They clear out the substance abuse disorder and they find out they’re not done,” Harbour said, “and sometimes the mental disorder is the harder to deal with.” In the past mental health and substance abuse were not linked in the mind of care providers, and people with substance abuse issues would often get turned away from mental health services. In recent years, providers have begun moving toward a more inclusive method of treatment, Burkhart said. Often people won’t seek help because they are afraid of being stigmatized, she said. Harbour said those who work in the mental health profession, especially those like herself, who have stood on the other side of treatment, are there to help.

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Some facts about mental health in Alaska from the Centers for Disease Control and Prevention’s 2011 report “Mental Illness Surveillance Among Adults in the United States.” • Prevalence of current depression among adults age 18 years and older (from 2006): 1,806 individuals, 6.7 percent of age group • Prevalence of serious psychological distress among adults age 18 years and older (2007): 2,329 individuals, 2.4 percent of age group • Mean number of mentally unhealthy days during past 30 days among adults age 18 years and older (2009 survey): 2,363 individuals, 2.5 percent of age group • Number of adults age 18 years and older who have ever received a diagnosis of depression in their lifetime (2006): 1,998 individuals, 17.4 percent of age group • Number of adults age 18 years and older who have ever received a diagnosis of anxiety in their lifetime (2006): 2,000 individuals, 12 percent of age group

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Mental health basics and indicators The following information comes directly from the U.S. Centers for Disease Control and Prevention (www. cdc.gov): The term mental health is commonly used in reference to mental illness. However, knowledge in the field has progressed to a level that appropriately differentiates the two. Although mental health and mental illness are related, they represent different psychological states. Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” It is estimated that only about 17 percent of U.S. adults are considered to be in a state of optimal mental health. There is emerging evidence that positive mental health is associated with improved health outcomes. Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof ) associ-

ated with distress and/or impaired functioning.” Depression is the most common type of mental illness, affecting more than 26 percent of the U.S. adult population. It has been estimated that by the year 2020, depression will be the second leading cause of disability throughout the world, trailing only ischemic heart disease. Evidence has shown that mental disorders, especially depressive disorders, are strongly related to the occurrence, successful treatment, and course of many chronic diseases including diabetes, cancer, cardiovascular disease, asthma, and obesity and many risk behaviors for chronic disease; such as, physical inactivity, smoking, excessive drinking and insufficient sleep.

Mental health indicators In the health care and public health arena, more emphasis and resources have been devoted to screening, diagnosis, and treatment of mental illness than mental health.

Little has been done to protect the mental health of those free of mental illness. Researchers suggest that there are indicators of mental health, representing three domains. These include the following: • Emotional well-being such as perceived life satisfaction, happiness, cheerfulness, peacefulness. • Psychological well-being such as self-acceptance, personal growth including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships. • Social well-being, including social acceptance, beliefs in the potential of people and society as a whole, personal self-worth and usefulness to society, sense of community. The former surgeon general notes that there are social determinants of mental health as there are social determinants of general health that need to be in place to support mental health. These include adequate housing, safe neighborhoods, equitable jobs and wages, quality education and equity in access to quality health care.

Wednesday, November 6, 2013

DISTINCTIONS Continued from 3 the depression and anxiety becomes debilitating in some way ... it can become clinical,” Harbour said. “The best thing would be to go and get some treatment for it.” Harbour said her preferred term to use is often that a person has a “mental health condition.” She finds that term is encompassing enough to include both clinical and sub-clinical issues. She has had her own mental health conditions to overcome. “I am in recovery from bipolar disorder and (post-traumatic stress disorder),” Harbour said. “That gives me that lived experience of mental illness so I am a peer to other people who are in the throws of coming to grips with mental illness.” The National Alliance on Mental Illness works to connect people dealing with mental health conditions to peer counselors who have gone through similar experiences in the past for counseling and sponsorship. Harbour said that, regrettably, a stigma often surrounds people with mental illness. “I rarely tell people I’m in recovery for bipolar disorder because it has a stigma,” Harbour said. “If you say a ‘mental health condition,’ it’s like saying ‘I have a cardiac condition.’ It makes the point that it’s a medical condition.” Contact staff writer Weston Morrow at 459-7520. Follow him on Twitter: @FDNMschools.

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Wednesday, November 6, 2013

HEALTH & WELLNESS

Fairbanks mental health services getting a fresh look Staff Report NEWSROOM@NEWSMINER.COM

airbanks mental health services have gone through an overhaul this fall, with the longtime care provider entering bankruptcy in September and a new organization stepping in to fill that void. Fairbanks Community Mental Health Services, which is an affiliate of Anchorage Community Mental Health Center, was launched Sept. 14. FCMHS was awarded the state grant to provide mental health funding following the closure of Fairbanks Community Behavioral Health Center. The new organization will provide local mental-health services until at least next July. FCMHS provides therapeutic services for both seriously mentally ill adults and severely emotionally disturbed children and youth in the Fairbanks area. One focus is case-management services to help

clients connect with community resources. Clients are also helped “to develop social networks, skills of daily living and social skills development,” according to the organization. Some services that were once offered for local mental-health clients are no longer being offered, particularly those that can’t be paid for by Medicaid or another revenue source. Services that are no longer provided include vocational training programs and a daytime adult drop-in center. Psychiatric service are being provided by prescriber who rotate between the facilities in Fairbanks and Anchorage. There is also a full-time nurse in Fairbanks who helps with medication and other health concerns. FCMHS also is working to provide ongoing care to clients of Fairbanks Community Behavioral Health Center. Former clients may call 452-1575 to speak with staff about the process. Contact the newsroom at 459-7572.

UAF Health and Counseling Center offers many services By Elika Roohi

MEDICAL INSIGHT Submitted by Contributing Community Author

Liz Bottasso Senior Services Director

Fairbanks Resource Agency 805 Airport Way (907) 451-0389 Reprint from FRA Wisdom November-December 2013

Message From Brain: Get Up and Move A simple message, get up and move, is receiving more attention regarding our brain health. Studies over the years have reported that physically active people tend not to smoke, are healthier eaters, have less brain shrinkage as they age and experience other benefits such as less stress and more patience in personal relationships. Some studies have even found a correlation between higher physical activity and fewer credit card purchases and financial stability. But wait, that’s not all. Exercise is good for your brain, specifically aerobic exercise. Brisk walking is perhaps the easiest aerobic activity for most of us. But other activities such as long distance running/jogging, swimming, dancing, cycling and even raking leaves will all get your heart beating faster. Aerobic activities should increase your heart beat (strive for between 60 and 85% maximum heart rate or an ability to talk comfortably but not be able to sing). According to the American Heart Association (AHA) and the American Stroke Association (ASA) moderate aerobic physical activity should cause you to feel warm, break a sweat and breathe heavily without causing you to gasp or feel a burning sensation in your muscles).

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GOOD FOR THE BODY, GOOD FOR THE BRAIN As our population ages and greater numbers experience Alzheimer’s and dementia related diseases, research into cause and treatment has increased. Organizations like AHA and ASA have long emphasized the importance of physical activity for a healthy body. Now scientific research is finding links between exercise and its impact on the health and function of the brain, in particular the hippocampus. Recent research from the University of Maryland School of Public Health reports “that exercise may improve cognitive function in those at risk for Alzheimer’s by improving the efficiency of brain activity associated with memory.” During the winter, the University of Alaska Fairbanks Health and Counseling Center helps students affected by seasonal affective disorder. ISTOCK PHOTO

all types of issues, from homework related stress to suicidal thoughts. They also do sessions for couples and groups. If there’s ever a crisis or traumatic event on campus, counselors give talks to students and provide additional counseling as needed. If students find them-

selves seeking help after hours, the center has a list of community resources available on their website, connecting students to various general health clinics, walk-in clinics and counseling centers in town. UAF » 6

EXERCISE AT ANY AGE MAKES A DIFFERENCE Many studies, including those at the Cooper Institute in Dallas and the University of Illinois at Urbana-Champaign, have reported that exercise at any age can make a difference in brain health. In a September issue of AARP Bulletin, Kirk Erickson, a lead author in a number of studies relative to aging, cognitive impairment and factors that promote healthy aging said, “It proves that exercising even in late adulthood, even if you’ve not been active before, is not futile. People need to know that dementia is not inevitable.” So get moving toward a healthier brain.

Our thanks to Liz Bottasso for contributing this column. The article is intended to be strictly informational.

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ollege life comes with its own set of problems. During the school year, the University of Alaska Fairbanks Health and Counseling Center sees around 1,500 students who come to take advantage of the many services offered by the center. Students at UAF taking nine or more credits pay a $105 fee that gets them access to medical visits to the health side of the center and six counseling sessions from the three counselors on staff. “The most important thing is that students know that we’re here for them,” said Betty Aldrich, the director of health and counseling at UAF. Counselors at the health center see students for

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Probiotics: Those active cultures may help digestion and the immune system Chandra Orr CREATORS.COM

hether it is yogurt that makes you go or pills with active cultures, companies claim that these beneficial bacteria help regulate digestion, boost the immune system and even reduce lactose intolerance. But, do we really need this stuff? Well, yes and no. The human body is home to some 100 trillion bacteria — that’s 10 times the number of cells in the human body — and among them are hundreds of strains of good bacteria. Most people enjoy a healthy colony of helpful microorganisms in their digestive tract, renewed through foods like cheese, yogurt, bananas and sauerkraut. “There should be more than 550 kinds (of good intestinal flora) in our gut totaling about 6 pounds,” said Nancy Parlette, a certified digestive health specialist with the

Wednesday, November 6, 2013

HEALTH & WELLNESS

“

There should be more than 550 kinds (of good intestinal flora) in our gut totaling about 6 pounds. They feed off the fiber in our foods and are a huge part of our immune system.” Nancy Parlette, a certified digestive health specialist with the Loomis Institute

Loomis Institute. “They feed off the fiber in our foods and are a huge part of our immune system.” It’s a naturally occurring symbiotic relationship. These beneficial bacteria aid in digestion by fermenting unused nutrients. They also destroy harmful bacteria, bolster the immune system and produce vitamins like biotin and vitamin K — and we’re not the only species that rely on microflora for proper health. Cows, for example, get the bulk of their nutrients from the microbes in their four-chambered

stomachs rather than from the food they eat directly. The bacteria ferment and digest cellulose in plants, and the cow absorbs the nutrient-rich byproducts. They also absorb the microbes themselves as they die off, which supply additional protein and energy. Green iguanas, too, rely on microorganisms to break down the fibrous plant material that comprises the bulk of their diet — and the species has developed a rather unsavory strategy to seed their systems. PROBIOTICS » 7

UAF Continued from 5 The Health and Counseling Center also provides alcohol and substance abuse evaluations. Underage students who are found drinking in dorms are required to take a class, where they are screened to make sure they are not at risk for any mental health issues. During the winter, the center helps students affected by seasonal affective disorder. Aldrich said the center sees a lot of out-of-state students who are particularly affected by the change in light during the winter. The center has SAD lights available to rent out to students in need. This semester, the Health and Counseling Center is rolling out a new prevention program. Head Counselor Tony Rousmaniere and Stacy Schmitt from University and Student Advancement have been working on a survey to email students that will help the counseling center identify students at risk by what answers are provided. The survey will include around 40 confidential questions about stress, depression, body image and medical history. The emails are being sent out on a rolling basis, so the center can keep up with the response and provide adequate support to students in need. Suicide rates have been increasing for college-age students during the past decade. Aldrich hopes the new program will offer more effective prevention at UAF. Elika Roohi is a senior in the journalism department at UAF.

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Wednesday, November 6, 2013

PROBIOTICS Continued from 6 Babies frequently nibble on the excrement of adult iguanas, which contains enough of the beneficial bacteria to jumpstart a colony. Thankfully, humans have more palatable options for bolstering good bacteria. Of late, grocery shelves are packed with all manner of foods and supplements intended to replenish our digestive systems. In time, a poor diet, stress and the use of certain medications can kill off beneficial bacteria in the gut. “We either starve them to death by not eating anything with fiber or we kill them off by taking all the pills or treatments like antibiotics, antacids, steroids, chemotherapy and radiation,” Parlette explained. Medical research has shown a strong correlation between healthy, active colonies of microflora and healthy bodies — there is even evidence to suggest that a daily probiotic supplement can alleviate chronic conditions like irritable bowel syndrome, Crohn’s disease and lactose intolerance. Research also shows a possible link between probiotics and a reduced risk of colon cancer, obesity, urinary tract infections, tooth decay, skin problems and allergies. “Probiotics have not classically been

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proven to help in many of the disorders of digestion. There have been no classic studies which compare them against a placebo with a measurable endpoint that proves probiotics are better than a placebo,” said Dr. Jorge E. Rodriguez, author of “The Acid Reflux Solution” and a frequent guest on the TV shows “The Doctors,” “Good Morning America” and “The View.”

“That being said, there are many meta analysis that show that probiotics may help treat H. pylori ulcers, diarrhea due to antibiotics, colon cancer and irritable bowel syndrome,” Rodriguez said. “I tell my patients to go ahead and take them along with accepted, proven medical therapy. It can’t hurt.” Different strains of probiotics offer

different benefits, so be sure to read the label carefully when choosing a supplement or supplemented food. The packaging should include the types of bacteria included and define the potency by billions of cells, which will determine how much you need to consume to reap the benefits. Parlette recommends a multi-strain, daily probiotic supplement that contains both lactobacillus for the small intestine and bifidobacterium for the large intestine. For daily maintenance, choose a regimen that contains 20 billion to 50 billion cells. Supplements typically offer more bacteria for the buck than supplemented foods like yogurt, cheese and cereal. The fine print in one yogurt commercial, for example, states that it must be eaten three times a day to get the full benefits, while most supplements found in the vitamin aisle pack all you need into one small pill. To get the most out of the supplements, cut back on sugar and white flour, which feed the harmful bacteria, Parlette said. Instead, focus on a diet rich in fruits, vegetables, whole grains and legumes, which contain the fiber to feed the beneficial bacteria. Also, eat plenty of naturally probiotic-rich foods like cottage cheese, bananas, artichokes, pickles, sourdough bread and miso soup.

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Why are so many people going gluten-free? By Chandra Orr CREATORS.COM

umans have been cultivating grains for more than 10,000 years, so why now are so many people going gluten-free? It may look like just another food fad, but for those with gluten sensitivity, the latest supermarket offerings could make life a lot easier. “Millions of people suffer everyday not knowing that what they are eating is making them sick,” Dr. Edward Conley said. “Doctors are not aggressive enough in diagnosis because they still feel that everyone who is sensitive to gluten must have celiac disease, and that is not true.” Celiac disease, or gluten intolerance, is a serious autoimmune disease in which a person can’t tolerate gluten, a protein found in wheat, rye, and barley. Symptoms can be quite severe — including intermittent diarrhea, abdominal pain, weight loss and

malnutrition — or so mild and nondescript as to be overlooked or misdiagnosed. Depression, anemia, muscle cramps, joint pain and skin rashes are all common. Gluten sensitivities, by contrast, are less severe and characterized by bloating, abdominal discomfort and diarrhea and they’re on the rise. In fact, it’s almost five times more common today than it was 50 years ago, according to a 2009 study conducted by the Mayo Clinic. And most people affected don’t even know they have it. “This is a very serious health issue,” Conley explained. “I have seen people who were told they were going to die from autoimmune disease and we were able to reduce the inflammation and damage by getting rid of gluten.” Gluten is most commonly associated with bread and pasta, but it also shows up in some very unlikely places. GLUTEN » 9

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GLUTEN Continued from 8 Lumped under monikers like “modified food starch” and “vegetable protein,” gluten can be hiding in cold cuts, salad dressings, spice blends, spaghetti sauce, beer — even chewing gum and pills. Luckily, the FDA now requires food manufacturers to list common allergens, including wheat, on all labels — and with the rise in gluten sensitivities, many companies are using a product’s gluten-free status as a top selling point. “Gluten-free products are beneficial only if you are gluten sensitive. The problem is that 95 percent of people who are gluten sensitive are never diagnosed because doctors don’t think of it,” Conley explained. “In my practice, I have seen tremendous destruction of health from the fact that someone is gluten sensitive and never knew that what was causing their abdominal pain or autoimmune disease

was due to what they were eating everyday,” he said. Not all gluten-free options are created equal, though. “A naturally gluten-free grain like quinoa is an excellent choice for a healthy, balanced diet,” said Cheryl McEvoy, director of communications for the National Foundation for Celiac Awareness. “Gluten-free cookies, on the other hand, may have the same or even more sugar, fat and sodium than their traditional wheat-based counterparts, so they’re not healthier for those who don’t have to avoid gluten,” McEvoy said. Even those without acute sensitivities are going gluten-free. Proponents claim that gluten-free diets significantly boost health and energy, aid in weight loss and help patients better cope with migraines, ADHD, autism and depression. Evidence also suggests that gluten can exacerbate chronic health problems like allergies, asthma, digestive disorders and autoimmune conditions. “I frequently recommend

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HEALTH & WELLNESS gluten free diets to my patients. It is not necessary for everyone, but you would be surprised at how many people feel so much better when they get rid of the gluten,” said Dr. Mary Ann Block, an osteopathic physician and medical director of The Block Center. “While we have been making and using grains for 10,000 years, the results still yield a food that is not real. It must be altered, manufactured to be eaten. It is better and healthier to eat foods the way they come and eating a shaft of wheat just doesn’t happen.” If you suspect you may have a gluten sensitivity, track your symptoms and speak with your doctor. They may advise a gluten-free diet. If your doctor suspects celiac disease, they will likely order a blood test to check for raised levels of specific antibodies that are produced in reaction to an allergen. However, these tests have varying degrees of reliability and may show false negatives, so an intestinal biopsy may be required.

Controlling acid reflux Identifying and treating causes of indigestion

some medication to take, and sometimes when I don’t take the medicine I can really tell the difference,” she said. Indigestion problems aren’t limited to seniors. John Lund, 24, also has acid reflux. A fit, athletic law enforcement profesDiane Schlindwein sional, he takes a specialist-preCREATORS.COM scribed medication every day. Lund said knowing his paternal ixty-four-year-old Kate grandfather died of esophageal Levin knows to avoid eating any tomato-based sauce cancer at age 55 makes taking products in the late afternoon or care of his acid reflux now, as a young man, especially importearly evening. “If I eat anything ant. with a red sauce — spaghetti, Levin and Lund are two of pizza, whatever it might be, I’ll the almost 125 million Amerhave indigestion all night and icans whose source of misery won’t be able to sleep.” begins with the consequences of Levin also sometimes suffers what they eat. There are several from a nagging cough that her doctor says is caused by acid REFLUX » 10 reflux. “My doctor has given me

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Features local columns and national news of the week for your well-being

Wednesday, November 6, 2013

kinds of acid reflux, explained Dr. Jamie Koufman, a pioneering laryngologist and director of the Voice Institute of New York. Koufman said a backup of the stomach contents into the throat causes laryngopharyngeal reflux, or LPR, the medical term for reflux in the throat. LPR is also known as airway reflux and silent reflux. Silent reflux describes when a person is unaware that the problem is actually acid reflux and may think they have postnasal drip, allergies or asthma. Koufman, who is also a professor of clinical otolaryngology at New York Eye and Ear Infirmary of the New York Medical College, has been studying the frightening 850 percent increase in reflux-related esophageal cancer and the acidification of the American diet since the 1970s. Koufman said the clues lie in the tissues of the larynx, or voice box, that show evidence of a digestive enzyme called pepsin. Pepsin is manufactured in the stomach, and the backflow of stomach acid and pepsin is corrosive. Symptoms of reflux are hoarseness, chronic throat-clearing, cough, choking episodes, trouble swallowing, a lumpin-the-throat sensation, postnasal drip, sinusitis, asthma, sore throat, heartburn and indigestion. Eating carefully is important, said Koufman, who is the co-author of the book “Dropping Acid: The Reflux Diet Cookbook & Cure.” The book is a crash course on acid reflux, which covers the history of the disease and helpful hints. Koufman recommends a two-week “acid detox.” For 14 days, avoid consuming any acidic foods, and fill your meals with fish, poultry, tofu, melons, bananas, oatmeal, whole-grain breads and cereals, mushrooms and greens. “Eat close to the earth — things like grain, poultry, fish,” she said. “Grains are good; almost all vegetables.” Avoid fried food, chocolate and soft drinks.

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Another New York-based physician, Dr. Nieca Goldberg, author of “Dr. Nieca Goldberg’s Complete Guide to Women’s Health,” also recommends avoiding peppermint, caffeinated drinks, citrus juices, tomato juice and fatty foods. Goldberg said that when she was younger she suffered with acid reflux in the form of a sharp pain in her chest as well as a “sick feeling.” “I was starting my practice, working on a research project and generally juggling several heavy balls simultaneously,” she writes in her book. “I was drinking a great deal of coffee. “I went to my doctor, who diagnosed acid reflux and suggested appropriate medication. I got better, but having the pain of acid reflux made me more aware of how frightening such chest pain can be.” She said gastrointestinal reflux disease, or GERD, is often cured with a combination of medications and lifestyle changes. Both Koufman and Goldberg recommend “closing the kitchen” after 8 p.m., as late-night meals and snacks provoke indigestion. “Eating earlier in the evening will allow the stomach to empty before you lie down to sleep,” Goldberg said. “Raise the head of the bed to keep the esophagus above the stomach,” Goldberg said. “People who sleep on their left sides seem to do better than on their right.”

Wednesday, November 6, 2013

ANTIOXIDANTS Continued from 10 diet obtains the maximum advantage from them. “To understand why antioxidants are important, you must first know what free radicals are,” said Stacey Whittle, a registered dietitian and cofounder of Healthy by Design Nutrition Specialists. “In regards to the human body, free radicals are unstable oxygen molecules that can damage our cells and organs. They are responsible for aging, tissue damage and possibly the cause of disease. The chemical reactions responsible for breathing and eating create free radicals.” Environmental causes of free radicals include stress, air pollution, processed foods, prescription and recreational drugs, smoking and industrial chemicals. She said one’s health is at risk when the amount of free radicals is greater than what the body can handle, causing aging and disease. “This sounds grim, but we aren’t helpless against free radicals,” Whittle said. The body makes numerous molecules that suppress free radicals, and the body also extracts free-radical fighters from food, she explained. These defenders,

Fairbanks Daily News-Miner

HEALTH & WELLNESS often called antioxidants, are phytochemicals (plant chemicals), vitamins, minerals and other nutrients. They can be found in most fruits and vegetables, but culinary herbs and medicinal herbs can also contain high levels of antioxidants. Whittle said the most commonly known antioxidants are: • Vitamin A and carotenoids: Found in brightly colored fruits and vegetables, such as apricots, broccoli, cantaloupe, carrots, collards, kale, sweet potatoes, tomatoes, etc. • Vitamin C: Found in fruits, such as oranges, tangerines and other citrus fruits, blueberries, strawberries, kiwi, tomatoes, bell peppers, green leafy vegetables and tomatoes. • Vitamin E: Found in nuts and seeds, whole grains and green leafy vegetables. • Selenium: Found in fish and shellfish, red meat, grains, eggs, chicken and garlic. • Coenzyme Q10 (CoQ10): Found in fish, meat, soybean oil, sesame oil and canola oil. Whittle said antioxidants came to public attention in the 1990s, when scientists began understanding that free radical damage was involved in the early stages of artery-clogging atherosclerosis and may contribute to cancer, vision loss and several other chronic conditions. Some studies showed that people with

low intakes of antioxidant-rich fruits and vegetables were at greater risk for developing these chronic conditions than were people who ate plenty of these foods. Clinical trials began testing the impact of single substances, especially beta-carotene and vitamin E, as deterrents against heart disease, cancer and other diseases. “We have to eat a variety of fruits, vegetables, grains, beans and nuts every day,” said Marion Alvarez, M.D., health coach and plant-based nutrition counselor. “There’s no need to take antioxidant supplements; just add a few of these to your diet every day”: • Beans • Blueberries • Artichokes • Raspberries • Apples • Pecans • Broccoli • Squash • Carrots • Green leafy vegetables • Whole grains • Cocoa beans • Green tea When incorporating antioxidants into one’s diet, “it is best to consume raw fruits and vegetables because most antioxidants can be affected when cooked at high temperatures,” Alvarez added.

Also, “it has been said that dairy can cancel out the antioxidants’ positive effects, so it’s better to avoid eating dairy with fruit and vegetables.” In addition to being an important part of a balanced diet for overall health and well being, antioxidants are available in a variety of beauty products marketed as anti-aging. Dermatologist Dr. Molly Griffin said the most effective ones are vitamin C, idebenone (she recommends the product Prevage) and the fruit extract Coffee Berry (she suggested the product Revaleskin). These help with “all the components of sun damage: tone, texture and discoloration in the skin,” Griffin said. So while antioxidants aid in disease prevention, they may also preserve and improve physical appearance. Alvarez said consuming antioxidants in food can also “prevent premature aging and increase collagen production, which helps skin to be firmer,” she said. “It also reverses sun damage and can reduce the appearance of wrinkles. The most important information I can give you about antioxidants is that it is best to consume them from fresh fruits and vegetables. There are a lot of supplements claiming to be as helpful, if not more, than the actual foods, but this has not been proven yet. Remember, eat healthy ... be happy!”

Dr. John Mayer, MD Board Certified General Surgery Colonoscopy Upper Intestinal Endoscopy Outpatient Hernia Repair Treatment of Reflux Breast Evaluation and Treatment Minor Surgery

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Office: 457-5050/Fax: 457-5034 • www.mayerclinic.net 1867 Airport Way, Suite 120B, Fairbanks Monday – Friday 8:30AM – 4:30 PM Saturday and Sunday – CLOSED

Fairbanks Daily News-Miner

HEALTH & WELLNESS

Wednesday, November 6, 2013

The best workout is the one you can do By Jack Newcombe CREATORS.COM

t was Christmas morning. Dressed in our pajamas, my wife, mother-in-law and I sipped coffee while we opened presents. As the fireplace crackled in the background, my mother-in-law picked up a present from her son. She opened it, and her face expressed a look of disappointment. She lifted her head and said, “It’s P90X.” My wife and I both turned to each other, trying to decipher what a P90X could possibly be. Luckily, my mother-in-law explained: “It’s a workout routine. Chris (her son) has been really into it, and it’s helped him get in shape.” My mother-inlaw then put the gift aside and grabbed a piece of candy from the coffee table. P90X (Power 90 Extreme) is a home exercise program. It is sold via infomercials and promises to deliver results in 90 days through an intense combination of various workouts. My brother-in-law got into it, saw results and thought his mother would enjoy the program just as much as he did. His intentions were good; he had seen his body improve,

Combining resistance training with cardio can give you the most efficient workout. CREATORS.COM PHOTO COURTESY OF ANICA WONG

liked the routine and wanted his mother to feel the same way. She obviously did

not. Unfortunately, not all workouts work out for everyone. People like what they like and oftentimes cannot really describe why. It is sort of like the Supreme Court’s description of pornography: “I know it when I see it.” Angela Leigh, a group fitness manager at the luxury gym Equinox, believes that “the ‘best’ workout depends on the person.” According to Leigh, “in general terms, anything that gets you sweating and moving in a challenging and safe way is good for you.” Essentially, the best workout is the one that you actually do, provided you are not in danger of injuring yourself and provided that it is actually a workout. Leigh explains more specifically, “Doing something that combines the three modalities of strength or resistance training, cardiovascular exercise and some sort of flexibility or stretching will give you a total body workout.” Leigh says the time spent working out could be a big inhibitor for some people. As a result, one needs to maximize that

WORKOUT » 13

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Check out our Health page in Monday’s paper!

time. According to Leigh, “if you can only do one workout a day, try to do all three modalities together.” After speaking with Leigh, it was clear to me that one modality in particular often is ignored: resistance training. Leigh thinks it should be a critical component of anyone’s routine. “Resistance training will benefit you, if done correctly, long term. Your metabolism feeds off of muscles.” Why doesn’t cardio have the same impact? Leigh explains: “Muscles are in charge of revving up your metabolism, (whereas) cardio ( just) maintains it. People will spend an hour straight on a cardio machine and think that they’ve burned 600 calories, but that is simply not true. Everyone should be mixing in resistance training. Three or four times a week is safe and beneficial.” Leigh also talks about common urban legends that lifting could negatively impact specific groups, such as women and runners. “There is a myth that lifting heavy weights gets you bulky, but it is just that, a myth. Eating bad food gets

Fairbanks Daily News-Miner

Wednesday, November 6, 2013

HEALTH & WELLNESS

It’s your body: Helm your own health care By Chelle Cordero CREATORS.COM

t is your body and your life. It is your right and your responsibility to take an active role in the management of your health care. Local health care providers are educated in the field of medicine, but they still need the important information and interaction that you, the patient/consumer, can offer in order to make concise and beneficial judgments and diagnoses. Your emotional attitude, including trust, toward the doctor and the treatment can have a crucial effect on your overall health. Some tips experts suggest to help you get the most from your health care treatment include: • Give information; don’t wait to be asked. You know best how you are feeling; tell your doctor. Bring a fully updated and current health history and a list of medications, including dosages and frequency. It is especially important to have this information on hand if you are seeing more than one doctor (i.e., specialists). Make sure you request all lab reports and X-rays be sent to each one of your attending physicians. “Doctors only have so much time to spend with their patients, and they’re not mind readers. I always bring a list of questions for my doctor, and I was surprised to learn most people don’t come as well-prepared,’’ New York politician Andy Spano said. When you are visiting a new doctor

WORKOUT Continued from 12

Aiysha N. Audil and John D. Shaw for the first time, make sure you make it easy for the doctor to “get to know you.” Prepare your family health history, as well as your own. Sometimes genetics play a significant part in health issues. Make note of any unusual and recent changes in your weight, activity level, mood and strength. • Ask questions. If you don’t ask questions, the doctor may assume you understand your treatment and options even if you don’t. Make a list of your concerns before your appointment so you don’t forget to speak to the doctor about anything that is bothering you. Bring along a friend or family member to sit in on your discussions, take notes and ask for brochures or other patient literature. BODY » 14

you’re intimidated about something, it is probably because your body really needs it.” P90X works for some people; yoga works for others. Ideally, you’re doing some combination of resistance training that raises your heart rate with a flexibility component. However, what is most important is that you do something. As long as you are working out safely and actually working out, keep doing whatever workout you enjoy doing. You could share your love of a routine with others, but they might not share your passion. At the same time, don’t be afraid to try new workouts, because your body loves new challenges. When it comes to working out, Christmas presents or pornography, you never know what you might like unless you try it.

MEDICAL INSIGHT Submitted by Contributing Community Authors

Gunnar Ebbesson LPCS MAC/Clinical Director

Olivia Foote UAF Graduate Student/Intern

Turning Point Counseling Services 315 5th Avenue 374-7776 www.turningpointcounselingsevices.com

Addiction is a Medical Illness That Responds to Medical Treatment Recently, death from prescription drug use overtook car accidents as the number one cause of accidental death in the US. The harmful effects of addiction are everywhere we look. Just pick up any newspaper, or look in almost any family tree. Addiction ravages our communities, families, and individuals regardless of socioeconomic status, ethnicity, or religion. Alcohol and drug abuse takes a heavy toll on Alaska’s economy. According to a report funded by several state boards, the total estimated costs attributable to alcohol and drug abuse was $1.2 billion in 2010. In another recent report on perceived health needs, Alaskans ranked alcohol and drug abuse as concerning them most. Traditionally, society has viewed addiction as a moral failing or an inadequacy in willpower. Science has revolutionized our understanding of this disorder, dramatically changing our concept of the disease of addiction. Today, substance use disorders are known to be a result of biological and environmental factors that affect an individual’s brain and result in abnormal behavior. Scientists have shown how addiction works in the brain by hijacking its reward and memory pathways, exerting powerful control over the part of the brain responsible for judgment and decision-making. Because scientists are now able to understand how addiction functions on a physiological level, we can now see more clearly that this is a disease process, medically treatable, just like any other medical illness. Despite current medical understanding of substance use disorders, a persistent stigma still exists that keeps people who suffer from it feeling shame and guilt for their illness. By talking about addiction as a medical condition, treatment and recovery no longer have to be in the shadows. This paves the way for people suffering from the effects of addiction to come forward with their problems and seek help. Moreover, community members in recovery would stand up and be heard saying that treatment does work, recovery is possible, and people who were once in the grips of addiction can become responsible, contributing members of society. By spreading awareness and educating our community on addiction as a disease, we will be able to lower the stigma of addiction. If you, or someone you know is struggling with the effects of drugs or alcohol, there are options available within our community. Please reach out. This is a treatable disease. No one should have to suffer in silent shame.

Our thanks to Gunnar Ebbesson & Olivia Foote, for contributing this column. The article is intended to be strictly informational.

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you bulky. One of my good friends is a marathon runner who does resistance training four or five times per week, and his running is better for it.” She clarifies by explaining that “you want a strong and heated engine. The more you feed it with sprints and challenges and constantly keep it guessing the more your body changes.” Despite her passion for the benefits of resistance training, Leigh underscores that any workout that is safe and challenging is a good one. “I am a firm believer that anything that gets you moving and sweating and (that makes you) feel successful (is) good.” Her only additional advice is to “spice it up. If

“

Communication, the interchange of factual information between patient and their physician, is not just very important; it is essential.”

Fairbanks Daily News-Miner

Wednesday, November 6, 2013

HEALTH & WELLNESS

Being informed and asking questions can help you get the most from your health care treatment.

BODY Continued from 13 • Follow up after the doctor’s visit. Call with questions or any changes to your condition. Schedule appointments for tests or specialists without delay. Make sure you understand what the tests are for, and call for your results if the doctor does not call you in an expected time period. Don’t be afraid to ask for a second opinion. If surgery or other treatments are recommended, be sure you understand what the hoped-for outcome is to be. “Communication, the interchange of factual information between patient and their physician, is not just very important; it is essential,” according to a paper by Aiysha N. Audil and John D. Shaw. Here are a few questions to ask your doctor. It is not a complete list and should be adjusted to your individual needs and the reason for your doctor’s visit. • Understand your diagnosis: What is wrong with me? What treatments are available to help me get better? Where can I get more information about my condition? • If you need a lab test, an X-ray or another kind of test, ask your doctor: How will the test be done? Will this test provide accurate results? What are the benefits and risks?

CREATORS. COM PHOTO COURTESY OF BIO IMAGES, UK CREATORS.COM

When and how will I receive the results? • If you receive a prescription for a new medicine: What is the name of the medicine? What is it supposed to do? When should I take the medicine, and

how much should I take? Does the medicine have any side effects? • If you need surgery: What kind of operation do I need? How invasive will this surgery be? What are the risks of the operation?

How long will it take to recover? What will happen if I don’t have the operation? Are there any alternatives to the operation? Where can I get a second opinion?

James R Miears D.D.S., P.C.

& Ronald M Teel D.D.S., P.C. 1919 Lathrop St. STE: 211, Fairbanks, Alaska 99701

Excellence in Dentistry.

www.smilefairbanks.com Phone: (907) 452-1866 • Fax: (907) 456-1267

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Wednesday, November 6, 2013

HEALTH & WELLNESS

Keeping Fairbanks Healthy

D I R E C T O R Y AESTHETIC TREATMENTS S. GAYLE KAIHOI, D.O. Midnight Sun Family Practice 475 Riverstone Way, #5 455-7123

BEHAVIORAL HEALTH SERVICES FAIRBANKS NATIVE ASSOCIATION 3100 South Cushman Street 452-6251

CLINICS CHIEF ANDREW ISAAC HEALTH CENTER 1717 Cowles 451-6682 FAIRBANKS PSYCHIATRIC AND NEUROLOGICAL CLINIC 1919 Lathrop Street, Suite 220 452-1739 INTERIOR COMMUNITY HEALTH CENTER 1606 23rd Ave. 455-4567 INTERIOR WOMEN’S HEALTH 1626 30th Avenue 479-7701 www.interiorwomenshealth.com TANANA VALLEY CLINIC Multiple Specialties Available 1001 Noble Street 459-3500 www.tvcclinic.com

COLONOSCOPY/ENDOSCOPY ARVA CHIU, M.D. ALASKA MEDICINE & ENDOSCOPY, LLC 452-2637 www.akmedicine.com

COUNSELING DELLIE DICKINSON, LPC 1716 University Avenue 460-2166 NORTH WIND BEHAVIORAL HEALTH 1867 Airport Way, Suite 215 456-1434 TURNING POINT COUNSELING 374-7776 turningpointcounselingservices.com

DENTISTRY, ORTHODONTICS DR. CHRISTOPHER HENRY Orthodontics 114 Minnie Street, Suite B 457-7878 www.alaskabraces.com

DENTISTRY JAMES R. MIEARS, D.D.S., P.C. RON M. TEEL, D.D.S. 1919 Lathrop Street, Suite 211 452-1866 www.smilefairbanks.com EVAN L. WHEELER 3691 Cameron Street, Suite 101 479-8123 www.evanwheelerdds.com

EAR, NOSE & THROAT EAR, NOSE & THROAT CLINIC Doctors Raugust, Tallan, Hammond and Kim 1919 Lathrop Street, Suite 103 456-7768 www.FairbanksENT.com

FAMILY PRACTICE S. GAYLE KAIHOI, D.O. Midnight Sun Family Practice 475 Riverstone Way, #5 455-7123

GENERAL SURGERY JOHN MAYER, M.D. Board Certified General Surgery 1867 Airport Way, Suite 120B 457-5050

HEARING SERVICES FAIRBANKS HEARING & BALANCE CENTER AT THE EAR, NOSE AND THROAT CLINIC 1919 Lathrop Street, Suite 103 456-7768 www.FairbanksENT.com

HOME HEALTH ACCESS ALASKA 526 Gaffney 479-7940

NEURO SURGERY ALASKA NEUROSCIENCE ASSOCIATES 751 Old Richardson Hwy, Suite 101 451-8737 • (866) 944-5967

OB/GYN PETER D. LAWRASON, M.D. Specializing in high & low risk 1919 Lathrop Street, Suite 219 452-1622 LAUREN BALDWIN OFFICE OF PETER D. LAWRASON, M.D. Certified Nurse Midwife 1919 Lathrop Street, Suite 219 452-1622 MARK MILES, M.D., FACOG UNIVERSITY WOMEN’S HEALTH 1875 University Avenue 374-6959

OPTICAL IMAGE OPTICAL 1867 Airport Way, Suite 100 452-2024

OPTOMETRY CHAD PERSONETT, O.D. CLEAR VISION OPTOMETRY 1867 Airport Way, Suite 150A 452-2131 MATTHEW RILEY, O.D. CLEAR VISION OPTOMETRY 1867 Airport Way, Suite 150A 452-2131 COLLEEN PERSONETT CLEAR VISION OPTOMETRY 1867 Airport Way, Suite 150A 452-2131

ORAL HEALTH ALASKA ORAL & FACIAL SURGERY DR. STEPHEN SUTLEY 1275 Sadler Way, Suite 202 452-4101 www.alaskasurgerycenter.com

ORTHOPEDIC SURGERY FAIRBANKS ORTHOPAEDIC Hand, Hip, Shoulder & Knee Surgery 1405 Kellum Street, Suite 101 374-4636 www.orthofairbanks.com

PAIN MANAGEMENT INTEGRATIVE PAIN CENTER OF ALASKA Dr. Nancy E. Cross and Staff 1275 Sadler Way, Suite 101 374-6602

PHYSICAL THERAPY NORTH POLE PHYSICAL THERAPY 157 Lewis Street, North Pole 488-4978 www.NorthPolePhysicalTherapy.com

VARICOSE VEINS LASER VEIN CENTER – DON IVES, MD Varicose Vein Treatment 1405 Kellum Street, Suite 300 452-8346 www.dynamiclegs.com

WALK-IN HEALTH CARE 1st CARE CENTER No Appointment Necessary 1101 Noble Street 458-2682 www.tvcclinic.com STEESE IMMEDIATE CARE 1275 Sadler Way, Suite 101 374-7911 www.steeseimmediatecare.com

YOUTH SERVICES BOYS & GIRLS HOME OF ALASKA 3101 Lathrop Street 459-4700

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Fairbanks Daily News-Miner

HEALTH & WELLNESS

Wednesday, November 6, 2013

Thermography offers breast cancer screening tool breast screening tool by the FDA since 1982 — an adjunct to mammography — but I’ll bet you’ve My first hint of the importance never heard of it. What a shame. of breast thermography came Thermography is a non-invafrom Dr. Christiane Northrup sive imaging technology that, during a PBS pledge drive several Northrup explained, picks up years ago. I don’t recall her exact anomalies in the breast better words, but I certainly remember and earlier than they show up on stopping in my tracks when I mammograms. heard them. And I’m so grateful How much earlier? Eight to 10 I did, because as I mentioned last years! No cancer-causing radiaweek, breast cancer doesn’t just tion! No painful squeezing of the run in my family, it gallops. breast! Unlike mammograms that Northrup is a well-known we now know are problematical authority on women’s health — for women with dense breasts, author of “Women’s Bodies, Wom- thermography works on all women’s Wisdom” and “The Wisdom en. And thermograms can detect of Menopause” — and on this par- abnormalities near or below the ticular day, she was doing her best armpit, where mammograms to convince viewers that mamnever go. mograms were underperforming Thermograms. Write it down, and over-diagnosing when it look it up, check it out. That’s came to detecting and preventing what I did after I first heard breast cancer ... and that there Northrup, and now I’ve had two was something else out there we of them in my home state of New should all know about. Mexico, where Dr. Kathryn Ater, That something else is state-of- D.O.M — a Doctor of Oriental the-art thermography. It’s been Medicine — has worked long and approved as a safe and effective hard since 2007 to develop her

By Marilynn Preston CREATORS.COM

expertise in interpreting thermograms. You can read more about her on her website thermographynewmexico.com, where she explains that while “breast thermography is not a replacement for mammography,” it is an essential tool to help women “take control of their own health.” I’m for that. Conventional breast-screen techniques (mammograms, ultrasound, MRIs) are structural, meaning they look for abnormal structures — masses or densities — in breast tissue that may or may not turn into a cancer. Thermography is a physiological test. It uses a thermal imaging camera to detect abnormal activity in the breast — increased heat, blood flow or changing vascular patterns. All of these are early indicators that something suspicious is happening in the breast tissue. “Pre-cancerous and cancerous masses need more nutrients than normal tissue in order to maintain their growth,” Ater explains. If

she sees a troubling hot spot in a woman’s thermogram, she helps her patients think through their options for follow-up. For some women, an ultrasound is the next best step, but most doctors and insurance companies will insist on a diagnostic mammogram first. Other women will take a wait-and-watch attitude. And still others will drastically change their lifestyle in ways that fosters breast health and can keep abnormalities from growing into malignancies. “This is why thermograms are so preventative,” says Ater, who has seen patients improve dramatically by following her breast health protocol. It’s too extensive to cover here but includes: a clean diet, stressing high-fiber, low sugar, non-processed foods; getting enough sleep; managing stress; exercising; and boosting lymph flow. And now for the bad news. Thermography is where acupuncture was 30 years ago. Mainstream medicine has billions

of dollars invested in standard screening techniques, and radiologists don’t study — and therefore don’t trust — breast thermography, which is why most insurance companies refuse to pick up the cost of a $200-$300 thermogram. Ater admits it is a “loose and unregulated” industry and finding an expert thermographer can be difficult. That’s why she lists three excellent sources for further study: DrNorthrup.com, Drmostovoy.com and Mercola. com. I don’t know if thermography will save my life, but it has certainly given me a new lease on life. I don’t like getting mammogams every year. All that radiation scares me. My annual thermograms focus on breast health, and I trust Ater to identify abnormalities before they develop into serious problems. So why has your mainstream doctor never mentioned thermography? That, dear reader, is a problem you can fix.

Access Alaska Support Group Schedule Support groups are made up of people with common interests and experiences. People who have been through, or are going through, a similar circumstance can do more than sympathize with you — they can relate to what you are going through and keep you from feeling like you are alone.

r u o Y k r a M ! r a d n e l a C

Head Injury Support 1st and 3rd Monday of each month, 5:30-7:00 p.m.

VIP (Visually Impaired Person) Support Group 1st Tuesday of each month, 1:30-3:00 p.m.

MS (Multiple Sclerosis) Support Group 2nd Wednesday of each month, 12:00-1:30 p.m.

Wall Buster Advocacy 2nd and 4th Monday of each month 2nd Monday, 12:30-2:00 p.m. 4th Monday, 5:30-7:00 p.m.

SATURDAY FEBRUARY 14, 2014 SAVE THE DATE Fairbanks Diabetes Expo

American Sign Language Lunch Bring your own lunch Every Tuesday, 11:00 a.m.-1:00 p.m.

Parent Advocacy 3rd Tuesday of each Month, 5:30–7:00 p.m.

www.accessalaska.org

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This message brought to you by

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diabetes.org/Alaska

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American Diabetes Month November 2013

For additional information and to confirm dates and times please call 479-7940

Wednesday, November 6, 2013

Fairbanks Daily News-Miner

HEALTH & WELLNESS

Technology takes on cases of strep throat By Lauran Neergaard AP MEDICAL WRITER

MEDICAL INSIGHT Submitted by

Odette Butler Executive Director

Breast Cancer Detection Center of Alaska 1905 Cowles Street, Fairbanks, Alaska 99701 (907) 479-3909 • www.bcdcofalaska.org

Can your wife, mother, daughter, or friend “live with a little cancer”? In 2009, the U.S. Preventive Services Task Force (USPSTF) updated their recommendation concerning routine mammography screenings, “to clarify their original and continued intent”. The updated recommendation advises women to begin biennial mammography screening at age 50. In addition, the task force advises against self-breast examination, stating that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits”. These recommendations led to substantial confusion regarding mammography guidelines for patients, as both the American Cancer Society and the Mayo Clinic recommend annual mammography screenings for women beginning at age 40 and encourage self-breast exams. In formulating its recommendations, the USPSTF considered the potential benefits and “harms” of routine mammography screenings. The Task Force considered potential harms to include: radiation exposure, pain during procedures, patient anxiety and other psychological responses, consequences of false-positive and false-negative test results, and over diagnosis of breast cancer. Dr. Carolyn Runowicz, a gynecologic oncologist and professor of obstetrics and gynecology, believes that the new guidelines have given many women the wrong message. “My patients can live with a little anxiety. They cannot live with a little cancer,” she said. According to national data, since the USPSTF has revised the language of its recommendations the number of women in their 40’s receiving routine mammograms has declined nearly 6%. In 2010, this resulted in 54,000 women between the ages of 40 and 49 not receiving their mammograms. Fairbanks is no exception. Facilities offering mammography services have experienced a decline in annual mammography screenings in recent years. In an analysis of 43,341 routine mammography screenings conducted between 2007 and 2010, Elizabeth Arleo, assistant professor of Radiology at New York-Presbyterian Hospital-Weill Cornell Medical College and her team concluded that 19% of the cancers found as a result of screening were in women in their 40s; 50% of these cancers being invasive. Additionally, an article published by the American Roentgen Ray Society indicates that following the American Cancer Society guidelines, annual screenings beginning at age 40, “saves 71% more lives than the USPTSF – recommended regimen of biennial screening” beginning at age 50. According to a 34-year study authored by Dr. Rebecca Johnson, medical director of a teen and young adult cancer program at Seattle Children’s Hospital and a breast cancer survivor, advanced breast cancer rates have increased among young women. Because annual screenings generally are not conducted until a woman has reached the age of 40, it is even more important to conduct self breast exams to detect any notable changes. Dr. Johnson stressed the urgency of patient and doctor education declaring “young women and their doctors need to understand that it can happen in young women . . . people shouldn’t just watch and wait”. Annual screening saves lives. Additionally, regular self-breast exams allow women to become familiar with their breasts, how they normally look and feel, so changes can be more easily detected. The benefits of annual screening and self-breast examination substantially exceed the potential “harms”. Please understand the urgency of these invaluable tools; the life that is saved could be yours.

Our thanks to Odette Butler for contributing this column. The article is intended to be strictly informational.

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WASHINGTON — Debating whether to seek a strep test for that sore throat? One day there could be an app for that: Researchers are developing a home scorecard that aims to prevent thousands of unnecessary trips to the doctor for this common complaint. More than 12 million people make doctors’ visits for a sore throat every year. Usually the culprit is a virus that they just have to wait out with a little TLC. In fact, the risk of strep throat is low enough for adults that doctors may skip testing them, deciding not to bother after running down a list of symptoms. That can leave patients wondering why they spent hours in the waiting room and had to pay the doctor’s bill. “If you could know that your risk was low enough that you wouldn’t even be tested, you might actually save yourself a visit,” said Dr. Andrew Fine, an emergency physician at Boston Children’s Hospital. The trick: Combine some of the symptoms that doctors look for with a bit of computer data to tell if strep throat is circulating in your geographical region. If the bug’s in your neighborhood, that increases the chances that you’ve caught it, said Dr. Kenneth Mandl, a Harvard professor and informatics specialist with Boston Children’s. As a first step, Fine and Mandl turned to the records of more than 70,000 sorethroat patients who got strep tests and had their symptoms recorded at CVS MinuteClinics in six states between 2006 and 2008. They determined those people’s risk of strep using the experimental scorecard approach and checked the computer model’s accuracy against the strep test results. Nationally, identifying those with less than a 10 percent chance of strep throat could save 230,000 doctor visits a year, the team reported Monday in the journal Annals of Internal Medicine. The method wasn’t perfect: It meant 8,500 strep cases would have been missed, or the diagnosis delayed, concluded the government-funded study. But Mandl said it’s unlikely that would lead to lasting harm as most of those infections would clear up on their own, or persisting pain eventually would send patients to the doctor. And he noted that the rapid strep tests that doctors use in their offices can miss cases, too. Much more research is needed to prove if the method would work in everyday life

and if a mobile app or a phone call to the doctor would be the best approach. The Boston team has begun the next step: Parents of kids who come to the hospital’s emergency room for a strep test are handed a digital tablet and asked to fill out the scorecard first. Researchers will see how the combination of symptoms and local infection trends compare with actual strep test results. Sore throats are a challenge. Strep throat, caused by bacteria named Group A streptococcus, is to blame for only about 10 percent of cases in adults, and 30 percent in children. It’s hard to tell who needs a strep test based on symptoms alone, cautioned Dr. Chris Van Beneden of the Centers for Disease Control and Prevention, which helped fund the new research. But what is clear: Doctors should be sure it’s strep before prescribing antibiotics because those bacteria-fighting drugs have no effect on viruses. Yet research published last month in the journal JAMA Internal Medicine found 60 percent of adults who sought care for a sore throat received antibiotics. Unneeded antibiotic use can spur development of drug-resistant germs. The Boston team looked at the flip side of the issue: Who could safely skip a strep check? Because strep is most common in children ages 5 to 15, doctors usually test youngsters with a sore throat for the bacteria. For anyone 15 or older, Mandl said doctors may skip a test depending on symptoms. While a cough and runny nose are more typical of a cold virus, strep symptoms might include a fever, enlarged lymph nodes, tonsils with swelling or pus and lack of a cough. So Fine and Mandl focused first on the over-15 crowd. Because feeling lymph nodes and peeking at tonsils could be difficult for the average layman, their scorecard posed easy questions: Is there a fever? Is there a cough? Then came the key: The scorecard automatically merged those symptoms with local trends in strep diagnosis. It’s a practice called biosurveillance. Already, hundreds of hospitals, clinics and health departments automatically report certain symptoms and diagnoses to the government. That lets officials track the spread of flu every year, for example — and some web sites now show flu activity by zip code so people can check if influenza has reached their community.

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Wednesday, November 6, 2013

Apps help users track the flu By Nora Krug THE WASHINGTON POST

he warnings have already begun: The flu season is on the horizon. If you want to know how close that horizon is to your front lawn, WebMD has a map that will tell you. Its cold and flu map — available this year through WebMD’s mobile site — can tell you the prevalence of flu in your neighborhood. Using a combination of geolocation data and symptom information reported by WebMD users, the map pinpoints sickness hot spots, labelling them mild, moderate or severe, right down to the Zip code. This map is not the only program of this sort — the Centers for Disease Control and Prevention offers similar information on its flu tracker site, as does Google’s flu trends site. But WebMD says its information, updated weekly, is more current than that used by the CDC, which “uses physicians’ reports after patients seek treat-

ment.” (The WebMD map is based on patient reports, which are arguably less reliable than doctor diagnoses.) Knowing that flu is on the rise in your area may not prevent you from catching it, but the WebMD site offers tips on how to stem the spread of infection, including setting up “sanitizer stations” and using paper towels, which it says are less likely to carry germs than those made of cloth. Better yet, get a flu shot now.

Hair regrowth Despite a recent report of a major breakthrough in lab-grown human hair, a cure for baldness remains elusive. Thankfully, men have options beyond toupees and hair plugs. The October issue of Men’s Health sorts through them, offering warnings and tips in a field with a reputation for quackery. Among them: Try to find the cause. Not all hair loss is a genetic

inevitability. There are also nutritional and hormonal factors, the magazine reports, and a dermatologist can help you find the root of the problem, so to speak. The article weighs the benefits of drugs such as Propecia (finasteride) and Rogaine (minoxidil). They may be FDA-approved, “but both are better at maintaining what you have than regrowing what you lost,” dermatologist George Cotsarelis said in the article. Be wary of shampoos that say your hair will look thicker: “Only one ingredient has been shown to truly preserve your pate. Ketoconazole, an antifungal used to fight dandruff, may save your mane by reducing” testosterone production in hair follicles. Of course, hair transplants are another option, but they can cost as much as $10,000, according to the article. And there’s also low-level light therapy, which is FDA-approved and can cost $3,000 but seems to work for some people.

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Crohn’s disease treatments available as young as 18 months, can be particularly hard to diagnose in children. An estimated two-thirds Crohn’s disease is a chronic to three-quarters of children with inflammatory condition of the Crohn’s disease will require one or gastrointestinal tract. It belongs more operations in their lifetime. to a group of conditions known as The causes of Crohn’s disease inflammatory bowel diseases, or are not well understood. Diet IBDs. Ten percent, or 140,000, of and stress may aggravate Crohn’s the estimated 1.4 million Amerdisease, but they do not cause icans who suffer from IBD are the disease on their own. Recent younger than 18. Crohn’s most research suggests hereditary, commonly affects the end of the genetics and even environmental small bowel (the ileum) and the factors contribute to its developbeginning of the colon, but it can ment. The principal drugs used also affect any part of the gastroto treat Crohn’s disease and colitis intestinal, or GI, tract, from the are 5-ASA agents (e.g. sulfasalamouth to the anus. Symptoms can zine or mesalamine) and corticovary, low energy and fatigue are steroids (e.g., prednisone). very common. The GI tract normally conCrohn’s disease may affect as tains harmless bacteria, many many as 700,000 Americans. of which aid in digestion. The Men and women are equally likely immune system usually attacks to be affected, and while the disand kills foreign invaders, such ease can occur at any age, Crohn’s as bacteria, viruses, fungi and is more prevalent among adolesother microorganisms. Under cents and young adults between normal circumstances, the harmthe ages of 15 and 35. IBD, which less bacteria in the intestines are has been detected in infants protected from such an attack. In

By Chelle Cordero CREATORS.COM

parents have IBD. The disease is most common among people of eastern European backgrounds, including Jews of European descent. In recent years, an increasing number of cases have been reported among African American populations. The environment in which you live also appears to play a role. Crohn’s is more common in developed countries rather than under-developed countries, in urban rather than rural areas, and in northern rather than southern climates. One mom in New York’s lower Hudson Valley, whose teenage daughter was recently diagnosed with Crohn’s, was directed to the Maria Fareri Children’s Hospital. She was directed to The Crohn’s and Colitis Foundation of America for both information and support. CCFA (http://www.ccfa.org) provides educational programs for patients, physicians, and the public and hundreds of active support groups. For requests for free bro-

people with IBD, these bacteria are mistaken for harmful invaders and the immune system mounts a response. Cells travel out of the blood to the intestines and produce inflammation (a normal immune system response). However, the inflammation does not subside, leading to chronic inflammation, ulceration, thickening of the intestinal wall, and eventually causing patient symptoms. There is no cure for Crohn’s disease; surgery may help control symptoms or treat complications, but relapses are common. Crohn’s tends to run in families, so if you or a close relative have the disease, your family members have a significantly increased chance of developing Crohn’s. Studies have shown that 5 to 20 percent of affected individuals have a first-degree relative — parent, child or sibling — with one of the diseases. The risk is greater with Crohn’s disease than ulcerative colitis. The risk is also substantially higher when both

chures about IBD and Crohn’s as well as information about CCFA, call 888-MY-GUT-PAIN. Your doctor can help you determine which hospitals are best equipped to deal with the disease. The most telltale symptoms of Crohn’s disease manifest due to inflammation of the GI tract or IBD. Symptoms related to inflammation of the GI tract: • Persistent diarrhea • Rectal bleeding • Urgent need to move bowels • Abdominal cramps and pain • Sensation of incomplete evacuation • Constipation (can lead to bowel obstruction) •General symptoms that may also be associated with IBD: • Fever • Loss of appetite • Weight loss • Fatigue • Night sweats • Loss of normal menstrual cycle

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Transplant patients survive thanks to new devices, drugs By Arthur Allen SPECIAL TO THE WASHINGTON POST

n 1983, when Orlando Felice was 28 years old, a summer virus caused his heart to fail. For three months, the Baltimore accountant lay teetering on the edge of death until surgeons found him a new heart, from a 16-year-old girl who had died in a motorcycle accident. Felice’s operation was the third heart transplant performed at Johns Hopkins Hospital. Since then, side effects from his anti-rejection drugs have caused Felice to undergo a kidney transplant and numerous skin cancer operations. On the most important score, however, Felice has beaten the odds: He’s had 30 years with a stranger’s heart beating in his chest, making him one of the longest-lived heart transplant patients. Contrast Felice’s story with that of 63-year-old Chris Einhorn. Three decades after Felice’s transplant, Einhorn was out drinking coffee at a Starbucks in Rockville, Md., when Johns Hopkins called to say her new heart was ready for her. That night, she underwent surgery, and she left the hospital nine

Implanted devices helped keep Chris Einhorn active for 17 months until she had heart transplant surgery in August. She was able to leave the hospital nine days after the operation. MARVIN JOSEPH/WASHINGTON POST ly good health when she received her transplant, because for the previous 17 months her native heart had been getting a boost from a left ventricular

days later. Soon she was on her feet and playing with her grandson. Felice and Einhorn are both success stories. But Einhorn was in relative-

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HEART » 21

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assist device, or LVAD — a machine that has transformed prospects for patients with serious congestive heart failure. Increasingly, such devices sustain people, including most notably former Vice President Dick Cheney, who probably would have died before they could receive a transplant. And the support the devices provide often allows patients to recover faster after they do get a new heart. Felice, without use of an LVAD, had to spend a month in the hospital after his transplant. As many as 500,000 people suffer heart failure in the United States each year. Yet the number of hearts available for transplant plateaued at around 2,500 in 1995. Medicine is getting better at transplanting hearts and the need for them is growing larger, but the number of organs available is static. So devices are filling some of that gap. “The whole field is being dominated today and tomorrow by LVAD and artificial hearts, and is becoming a problem of engineering, miniaturization and, believe it or not, batteries,” said cardiologist Michael Hess, who directs the

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HEART Continued from 20 Pauley Heart Center’s heart transplantation program — one of the world’s oldest — at the Medical College of Virginia in Richmond. “The next big breakthrough is going to come out of (engineering schools such as) MIT and not medicine.” He added: “We can now take someone near death’s door, put in a mechanical device, rehabilitate them over several months and improve their state of health, so that when they do have the transplant, they are in much better shape.” That was what happened to Cheney, who was indeed at death’s door, his heart and kidneys failing, in July 2010, when he was rushed into surgery to receive an LVAD. It restored his health to the point that he was able to receive a heart transplant 20 months later, at age 71. “I believed I was approaching the end of my days, but that didn’t frighten me,” Cheney writes in his memoir “Heart: An American Medical Odyssey,” which he published this month with his cardiologist Jonathan Reiner. “If this is dying, I remember thinking, it’s not all that bad.”

quickly. According to heart surgeons at three Washington area hospitals, more than half of the patients who received transplants at heart centers in this area last year had previously gotten an LVAD. In 2012, about 2,000 LVADS implantations were done — a tenfold increase over 2006 — and doctors say they expect the numbers to continue to sharply increase. A 2011 study suggested that 40,000 to 200,000 patients each year would benefit from either an LVAD or a heart transplant. Ventricular assist devices — in addition to LVADs, there are units that support the right ventricle, or both sides of the heart — allow doctors to give transplants to older, sicker patients. When Felice got his new heart, 50 was the absolute upper age limit for transplant recipients, said his cardiologist Edward Kasper. Now, the absolute limit is 75. Hearts are a scarce resource, and doctors are reluctant to put them into people who aren’t likely to live very long. Cheney, who had suffered five heart attacks and undergone many surgeries, was one of the oldest patients at Virginia’s Inova Fairfax Hospital ever to receive a new heart. “Mechanical circulatory support has been a real game-changer,” said Nelson Burton, chief of heart and lung surgery at Inova Fairfax. He said he implants twice as many LVADs as hearts these days, and “I’m sure that ratio will increase as the technology improves. We’ll be putting in more and more of them.” Patients in search of a new heart face an uncomfortable reality: Most hearts become available when young people die of head trauma, usually through homicide, suicide or car wreck. Medicine is getting better at keeping such patients alive, which decreases the number of hearts available for transplant. ••• Given this fact, the future points to a device industry making gadgets that guarantee longer lives without transplant. In 2012, 40 percent of LVAD recipients got their devices as “destination therapy,” meaning they are permanent implants. Already, many LVAD recipients don’t expect ever to receive a heart transplant. Some recipients of the HeartMate II have lived with it for eight years. The device theoretically could last in a patient for at least 17 years, according to Gary Burbach, chief executive of Thoratec, the Pleasanton, Calif., company that makes it. A small percentage of LVAD patients have had the devices removed after their native hearts recovered sufficient function following a period attached to the pump. HEART » 22

MEDICAL INSIGHT Submitted by Contributing Community Author

Dellie B. Dickinson, M.A. Licensed Professional Counselor

1716 University Avenue Fairbanks, Alaska 99709 (907) 460-2166

There’re 3 Sides to Every Story Most of us have heard the saying “There are two sides to every story”. Typically, however, within any given relationship there are three sides: yours, the other party’s and, somewhere in the middle, the reality of what really is. Too often we make the incorrect assumption that we know exactly what the other person meant, why they said what they did and the motive behind thier statement or behavior. We don’t consider that we may not have actually understood what they were trying to say and we are, therefore wrong in the motive we place on them. These seemingly small errors can have big consequences on relationships if one interprets another’s words or behaviors incorrectly and fails to challenge their own perception or interpretation. Consider this: what we believe about any given situation impacts how we feel about that situation. What we feel, in turn, impacts how we behave and how we behave impacts the relationship or the situation. It is crucial that we make sure we are interpreting the message or behavior correctly, and be willing to challenge our own beliefs regarding any given situation by checking it out with the other person. For example, you might simply say “I don’t understand. What did you mean by that?” or “That felt like criticism. Are you angry with me?” Maybe even, “You seem stressed today. Is everything ok?” This gives the other person the opportunity to clarify what they meant or how they’re feeling and you are able to challenge your own interpretation of the situation. Take, for instance, a husband and wife. She makes the statement “You are working too much. I never see you anymore!” What she is trying to communicate is “I miss you. I’ve been lonely without you”. What he hears is criticism, “You are not meeting my needs”. So, rather than responding as she had hoped with care and attention, he responds with anger and pulls away from her, as is consistent with his belief that she is being critical. This confuses the wife, as she was trying to move closer to him. She is hurt because his response does not match the message she sent him. When she senses him pulling away from her she feels rejected and believes he does not care how she feels. She attempts to pursue him, often resulting in the husband feeling attacked, which only causes him to withdraw even further. Based on this scenario, the husband did not react to the truth of the matter that his wife was lonely, but rather to his interpretation that she was being critical. She, on the other hand, did not consider that he may have felt criticized, but incorrectly assumed he was uncaring and selfish. Both interpreted the other’s comments and behaviors incorrectly and neither considered the possibility that they may be wrong in the motives they attatched to the other’s words and behaviors. Another way to think about this is that we do not respond to reality, but rather to our perception of reality. Again, how we interpret any given event determines how we respond to it. Public speaking, for instance, is a welcome opportunity for some. For others it is to be avoided at all cost. Or for some, running late for an appointment is “no big deal”. To others it is cause for significant disstress. There is the reality, “I have to speak in public”, or “I am running late”, and then there is our interpretation of that reality and what it means to us. The interpretation of that reality is what we react to, not the event itself. Healthy relationships require a certain humility and tentativeness about them; the willingness to say “It’s possible I misunderstood. Help me understand what you meant by that”. Being willing to challenge our own beliefs and hear how others experience us will go a long way in making others feel heard and cared for, while at the same time avoiding unneccessary pain and confusion within our daily relationships.

Our thanks to Dellie Dickinson for contributing this column. The article is intended to be strictly informational.

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••• Caring for the heart has many dimensions, including diet, drugs, stents and bypass surgery. But it used to be that transplantation was the only solution when a heart was beyond repair. The first transplant was done in 1967 by South African surgeon Christiaan Barnard, who had learned much of his technique at the Medical College of Virginia. Transplantation was rare — and post-transplant life expectancy was measured in months, not years — until the early 1980s, when the FDA approved cyclosporin, an immunosuppressant less damaging to the body than anti-rejection drugs used up to that point. In 1994, the FDA approved the first ventricular assist device, and in 2008 the agency approved the HeartMate II, the current leader in the LVAD market, as a bridge to keep patients healthy until transplantation. Another popular LVAD is made by Heartware International. The 10-ounce LVAD contains a finger-size pump that pushes blood through the heart. LVADs drive a flow of blood through the heart continuously rather than in pulses. As a result, the patient usually does not have a measurable heartbeat, because the device is doing most of the pumping that the heart once did. “At the hospital they liked to call us the zombies,” Einhorn said. Use of these devices has expanded

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HEART Continued from 21 Using the device has drawbacks, including an increased risk of infection and blood clots. Edward Baldwin, a 64-yearold retired Navy man living in Portsmouth, Va., received an LVAD at the VA hospital in Richmond in February 2012 after many years of heart trouble. But the device caused intestinal bleeding, he said, and he required blood transfusions every four or five days until he received a transplant five months later. Since then, Baldwin says, he has been doing better. At best, the device is burdensome. Patients must carry a sling holding a power module and eight pounds of batteries that require recharging after a maximum of 14 hours; the patient is hooked up to a wall power unit at night. To prepare for a shower, patients with LVADs must carefully wrap themselves in plastic to guard against infection from the electrical leads that pass through their abdomens.

Wednesday, November 6, 2013

HEALTH & WELLNESS

But a heart transplant also has medical and psychological costs. Chris Einhorn was happy to get rid of her LVAD gear when she got her heart transplant in August, but adjusting to someone else’s heart has had its ups and downs. Using the LVAD meant having to take a blood thinner but no immunosuppressants. Now she is on an antiviral drug required to prevent rejection of her new heart, as well as three types of immunosuppressants that cause tremor, indigestion and emotional swings. She had to be taken off a heart medicine that led to muscle spasms, and she is monitored daily to check her blood pressure, weight and signs of incipient diabetes, a frequent side effect of her high-dose steroid use. Einhorn, a well-informed and careful patient, said she’s been doing well on the post-transplant drugs but finds it’s a “mixed emotional bag” to be running on an organ that belonged to someone who died tragically. ••• For some patients, moving

from an implant to a transplant would require too large a tradeoff. Laura Huber of Aberdeen, S.D., received an LVAD in 2007 at age 26, after a virus or autoimmune reaction attacked her heart. She doesn’t want a transplant, at least for now. “The device won’t necessarily last forever,” said Huber, who works as a physical therapist in a cardiology ward. “But the risks of a transplant, based on how well I’ve been functioning for almost seven years — I don’t see enough benefit to it.” Huber’s heart, like those of many VAD patients, continues to function at a minimal level, and she feels there’s a glimmer of hope it will recover enough to have the device removed someday. Or perhaps, some years down the road, she can get an improved version of her current device. “I can’t swim or do contact sports. I can’t sit in a hot tub. But I play golf instead of basketball, and I don’t really feel limited physically,” she said. “I’m anxious about a transplant. I feel that my native parts give me a longer chance of survival, or at least of not rejecting a new organ.”

The HeartMate II was approved to keep patients healthy until transplantation, but the device theoretically could work for at least 17 years, according to the head of the company that makes it. THE WASHINGTON POST

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Diagnosing ADHD is anything but exact science By Amanda Mascarelli SPECIAL TO THE WASHINGTON POST

who are not so severely affected or who only partially fit the criteria, symptoms are often blurred, making it much more difficult to assess the disorder. “There is no line” that defines who does and does not have ADHD, said Lawrence Diller, a behavioral developmental pediatrician and an assistant clinical professor at the University of California at San Francisco. Except in the extreme, diagnosing ADHD is a “judgment call based on subjective opinion,” he said. ••• Schools play a major role in whether a child ends up with an ADHD diagnosis and is treated with stimulant medications. A large majority of referrals are generated by problems reported at school, Diller said, yet schools typically do not investigate the context of learning disorders and behavioral problems. “The whole system of diagnosis (of ADHD) is based primarily on symptoms of behavior only.” Many doctors and some schools rely on the Vanderbilt Assessment Scale, a questionnaire meant to flag symptoms of ADHD and identify other underlying conditions. It includes general statements — such as “Is distracted by extraneous stimuli” and “Is forgetful in daily activities” — and asks the person completing the form to rank how often each applies to the child throughout the day. But the test does not provide the necessary insights into a child’s home life — discipline patterns, inadequate learning environments, familial difficulties — Diller said. “If the behavior crosses the threshold on these forms, the parent is likely to be told the child has ADHD, even though there can be a host of other reasons why the kid is acting that way.” The child may also have other problems that have little to do with attention but result in ADHD-type behaviors. For instance, a child with an auditory processing problem — a disorder in which the ears and the brain are not properly coordinated — will hear oral ADHD » 24

MEDICAL INSIGHT Submitted by Contributing Community Author

S. Gayle Kaihoi, D.O. Midnight Sun Family Medicine, P.C. 475 Riverstone Way, #5 Fairbanks, Alaska 99709 Ph. (907) 455-7123 • Fax: (907) 455-7125

Medical Common Sense Emergency Departments across the country are overextended and burdened with individuals who routinely seek care at an ED for the coughs, colds, sore throats, tummy aches, fevers, and etc, that could be treated in a lower cost clinic setting. There will always be situations that require ambulance calls and visits to the ED, but common sense, preparation, and foresight, can go a long way to help reduce costly and unnecessary ED visits. To begin, find a Family Physician. This is a doctor who, most often, will be able to care for your entire family and who can refer to a specialist if needed. Ask for the Health Maintenance recommendations for a person of your age, your spouse or partner, and children, and keep up with these basic health care recommendations. If possible, take a Basic First Aid class, learn CPR, and have a First Aid reference in your home. Put together a First Aid Kit and be familiar with, and comfortable using, the items in it. Some basics include: a digital thermometer, bulb syringe, band-aid assortment, antiseptic wash, antibiotic ointment, scissors, tweezers, gauze packs, medical tape, butterfly bandages, bee sting kit if needed, anti-itch cream, liquid Benadryl, liquid non-aspirin and ibuprofen for children and tablets for adults, hot water bottle, ice packs. Ask your Provider what to do, and when to be seen, for fevers, aches and pains, sore throats, tummy aches, bumps and bruises. Ask for handouts on specific illnesses or instructions. Remember that many common respiratory illnesses are viruses and will resolve, with rest and fluids, within 7-14 days. If antibiotics are prescribed for a bacterial illness, take the entire prescription, don’t stop when you start feeling better. Medication is prescribed specifically for you; don’t “share” your medications with friends or family! If you have a disease or illness that requires ongoing medication and monitoring, learn about your illness! Ask questions and read about current care recommendations for your condition. Take medication if required, ask why it is required, how it treats your condition, and possible side affects. Don’t stop your medication without first talking to your Doctor. Many of the minor injuries and illnesses of day to day life can be cared for in a non-emergent setting. Be prepared and use common sense! It works! Our thanks to Dr. Gayle Kaihoi for contributing this column. The article is intended to be strictly informational.

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hen my son was in preschool, I did what many parents of excessively energetic and impulsive preschoolers have surely done: I worried whether his behavior might be a sign of attention-deficit hyperactivity disorder (ADHD). Then I sought input from two pediatricians and a family therapist. The experts thought that his behavior was developmentally normal but said it was still too early to tell for sure. They offered some tips on managing his behavior and creating more structure at home. One pediatrician worked with my son on self-calming techniques such as breathing deeply and pushing on pressure points in his hands. He also suggested an herbal supplement, Valerian Super Calm, for him to take with meals and advised us on dietary adjustments such as increasing my son’s intake of fatty acids. Studies have shown that a combination of omega-3 (found in foods such as walnuts, flaxseed and salmon) and omega-6 fatty acids (from food oils such as canola and flax) can reduce hyperactivity and other ADHD symptoms in some children. In the couple of years since trying these techniques, my son has outgrown most of those worrisome behaviors. I had just about written off the possibility of ADHD until a few weeks ago, when his kindergarten teacher mentioned that she was going to keep an eye on him for possible attention issues. Hearing that left me worried and heavy-hearted. Why is it still so hard to diagnose ADHD? And why is there so much emotional baggage associated with treating it? There are no firm numbers for the number of children with ADHD in the United States. The Centers for Disease Control and Prevention estimates that 9 percent of U.S. children ages 5 to 17 had received diagnoses of ADHD as of 2009. It is far more prevalent in boys than in girls. Among those given the diagnosis, a small minority suffers extreme symptoms, and in those cases, diagnosis is fairly straightforward. Children with extreme cases tend to have trouble staying engaged in tasks, even those that they enjoy, for any length of time and find it impossible to stay still, particularly in classroom settings. But for the vast majority of children

Why is it still so hard to diagnose ADHD? And why is there so much emotional baggage associated with treating it?

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One promising area of research has found that dopamine, a chemical messenger Continued from 23 in the brain commonly assoinstructions, but then ciated with motivation and those instructions might get reward, is reduced in adults scrambled. Instead of getting with ADHD. (Such studies out the blue notebook and have not been done in chilturning to Page 20, he or she dren since they require the may take out the wrong book use of small amounts of radioand look lost, stare out the activity, which is not recomwindow or bother a friend. mended for people younger “That will be reported on than 18.) the Vanderbilt as being disIn a 2009 study in the tractible and not completing Journal of the American tasks,” Diller said. Medical Association, a team Diller recommends that led by Nora Volkow, director parents first address of the National Institute on discipline and learning Drug Abuse, reported that issues before turning to decreased dopamine signalmedications, particularly ing in the ventral striatum, in children younger than 6. an area of the brain involved He shows parents how to be with reward and motivation, more immediate with setting was associated with attenlimits, such as using a timer tion problems in adults with to let kids know how long untreated ADHD. they can play or being clear The results suggest that about consequences (for low dopamine levels in the instance, if cleanup isn’t reward center might explain sufficient, toys are removed why many children and adults immediately for a brief period with ADHD struggle with a of time), and he recommends lack of motivation about cer“1-2-3 Magic,” a book that tain tasks. gives parents tools for effecIn a 2012 study in the Jourtive discipline. nal of Neuroscience, Volkow For “the kids who are in this and colleagues showed that gray zone, it can be difficult,” methylphenidate, a stimulant said Thomas Insel, director that is the active ingredient in of the National Institute of Concerta and Ritalin, restored Mental Health. “What we dopamine to normal levels usually say is to err on the side and significantly improved of trying to provide kids with inattention and hyperactivity structure and feedback. If that in adults. doesn’t help, then you think Notably, they found that about medication.” the dopamine messages were enhanced in the ventral ••• striatum following treatment. Researchers are beginning This showed that increased to understand the neural dopamine transmission in pathways that underlie the reward center of the brain ADHD, progress that is iden- was key to improving their tifying potential new stratepatients’ ADHD symptoms. gies for treatment. Even though stimulants

ADHD

Wednesday, November 6, 2013

HEALTH & WELLNESS have been proved safe and effective in children with ADHD, the decision to medicate is controversial and fraught with anxiety for many parents. “We just tend to fight against” treating a disorder whose diagnosis is based on behavioral symptoms, Insel said. He emphasizes that behavioral interventions should be tried first in those with moderate symptoms but says that medication can be remarkably helpful for children with the disorder. Deferring treatment for children who need help can have serious consequences, he notes; self-esteem begins to suffer because the children are constantly being corrected for not sitting still or paying attention. “The cost of not doing something about it becomes more severe,” Insel said. Even if your child is identified as having ADHD, it remains an open question whether he will outgrow the diagnosis. A 2013 study in the journal Pediatrics found that just 30 percent of people who had received such diagnoses as children still had symptoms as adults. But other research has shown that the number is as high as 65 percent. In our case, we plan to observe our son closely and stay in touch with the teacher, but we don’t yet have major concerns. He’s happy in school and progressing well. But as any parent surely understands, it can be nerve-racking to wait and see, especially when a child’s well-being is at stake.

Fitness norms: Guides but not gospel for all By Lenny Bernstein THE WASHINGTON POST

ow am I doing? That’s a natural question when it comes to health and fitness, especially for men and especially as we age. You want to know whether all your hard work is paying off, or how far you have to go to catch up. And if you’re just starting to work out, you’re interested in how much effort you need to invest to improve and maintain your health. Experts say there are reliable norms, advice that is solidly based on research and testing, but they recommend that you use the information with caution. “Age and gender-predicted standards always give you a template to work toward. It lets you know where you are in terms of your fitness level,” said Jonathan Myers, a clinical professor of medicine at Stanford University and a health research scientist at the Veterans Administration Palo Alto Health Care System. “The ‘but’ is that you benefit from exercise without getting too caught up in where you are relative to a standard, without getting too compulsive about measuring your heart rate.” If there’s one measure you should pay attention to as you get older, it’s your cardiovascular fitness. Here’s why: Numerous studies have proved that it is the single best predictor of mortality from any cause, not just diseases of the heart, lungs and circulatory

system. Cardiovascular fitness also improves quality of life — think fatigue, back pain or the inability to climb stairs or do yard work. Best of all, most of the benefits come when you switch from little or no exercise to a regular program. Or, as health experts put it, when you move out of the bottom two quintiles and into the middle. At the Cooper Clinic in Dallas, doctors have been collecting data from tens of thousands of patients they have pushed to exhaustion in treadmill tests since 1970, producing one of the largest databases of cardiovascular information in the United States. “We found that just 30 minutes of cardiovascular activity three to five times a week decreases chances of dying from any cause at all by 58 percent and increases longevity by six years,” said Tyler Cooper, chief executive officer of Cooper Aerobics Enterprises. Just moving from “poor” or “very poor” to “fair” on the Cooper scale conveyed most of that benefit, he said. In fact, cardiovascular fitness is such a reliable predictor of good health that in January, the American Heart Association proposed creation of a national registry of cardiorespiratory fitness data to establish norms and help physicians use them in treating diseases associated with obesity and sedentary lifestyle. A project to compile that information has been launched in a dozen health FITNESS » 28

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MEDICAL INSIGHT HEALTHY INSIGHT

Wednesday, November 6, 2013

FAIRBANKS PSYCHIATRIC & NEUROLOGICAL CLINIC A PROFESSIONAL CORPORATION

Submitted by Contributing Community Author

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New mothers expect the postpartum period to be a happy time, with the joyful homecoming of a newborn. However, up to 85% of new mothers experience some form of postpartum blues. The blues are characterized by: tearfulness, moodiness, irritability, and anxiety. These symptoms generally start two to four days postpartum and resolve within two weeks of delivery. Yet, not all women with postpartum blues see a resolution of their symptoms and some can develop postpartum depression.

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The diagnosis of postpartum depression can be challenging, as the list of symptoms are similar to natural postpartum feelings. Due to social stigma and self-imposed postpartum expectations, mothers are often hesitant to fully recognize the full extent of their lack of mental well-being. Failing to identify postpartum depression is the first barrier to effective treatment. An open discussion regarding social support, relationship stability, and maternal sentiment should be part of a routine postpartum office visit with the obstetrician. Once postpartum depression is identified, treatment should not be delayed. Treatment should incorporate approaches to all three contributing components to postpartum depression: biological, psychological and social. Biological factors can be addressed by promotion of adequate sleep, light therapy, and appropriate nutrition. Psychological factors are treated with individual and/or group therapy aimed at reducing stress and depression. Social factors can often be managed with marital therapy, or practical assistance by close friends and other family members.

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Family and friends play a vital role in identifying the signs and symptoms of postpartum depression in a new mother. If you are concerned about a loved one with a newborn, vocalize your concerns to her. Encourage her to seek help. Assist her in accessing appropriate medical care; her obstetrician is a great first contact who can appropriately assess her condition and intervene as necessary to treat postpartum depression. 17414695 11-6-13

Our thanks to Dr. Kerry Wappett for contributing this column. The article is intended to be strictly informational.

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Some of the characteristics of postpartum depression include: difficulty sleeping, feelings of guilt and worthlessness, fatigue, difficulty concentrating, depressed mood, a loss of interest in things that used to be engaging, weight changes, and difficulty bonding with their newborn. Up to 20% of new mothers experience postpartum depression, with even higher rates seen in women who have previously suffered from the condition.

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STEESE IMMEDIATE CARE STEESE IMMEDIATE CARE IS A GREAT ALTERNATIVE WHEN YOUR PRIMARY CARE PROVIDER IS NOT AVAILABLE

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Docs to parents: Limit kids’ texts, tweets, online By Lindsey Tanner AP MEDICAL WRITER

CHICAGO — Doctors 2 parents: Limit kids’ tweeting, texting & keep smartphones, laptops out of bedrooms. #goodluckwiththat. The recommendations are bound to prompt eye-rolling and LOLs from many teens, but an influential pediatricians group says parents need to know that unrestricted media use can have serious consequences. It’s been linked with violence, cyberbullying, school woes, obesity, lack of sleep and a host of other problems. It’s not a major cause of these troubles, but “many parents are clueless” about the profound impact media exposure can have on their children, said Dr. Victor Strasburger, lead author of the new American Academy of Pediatrics policy “This is the 21st century and they need to get with it,” said Strasburger, a University of New Mexico adolescent medicine specialist. The policy is aimed at all kids, including those who use smartphones, computers and other Internet-connected devices. It expands the academy’s longstanding recommendations on banning televisions from children’s and teens’ bedrooms and limiting entertainment screen time to no more than two hours daily.

Wednesday, November 6, 2013

HEALTH & WELLNESS

Mark Risinger, 16, checks his Facebook page on his computer as his mother, Amy Risinger, looks on at their home in Glenview, Ill. ASSOCIATED PRESS Under the new policy, those two hours include using the Internet for entertainment, including Facebook, Twitter, TV and movies; online homework is an exception. The policy statement cites a 2010 report that found U.S. children aged 8 to 18 spend an average of more than seven hours daily using some kind of entertainment media. Many kids now watch TV online and many send text messages from their bedrooms after “lights out,” including sexually explicit images by cellphone or Internet, yet few parents set rules about media use, the policy says. “I guarantee you that if you have a 14-year-old boy and he has an Internet connection in his bedroom, he is looking at

pornography,” Strasburger said. The policy notes that three-quarters of kids aged 12 to 17 own cellphones; nearly all teens send text messages, and many younger kids have phones giving them online access. Mark Risinger, 16, of Glenview, Ill., is allowed to use his smartphone and laptop in his room, and says he spends about four hours daily on the Internet doing homework, using Facebook and YouTube and watching movies. He said a two-hour Internet time limit “would be catastrophic” and that kids won’t follow the advice, “they’ll just find a way to get around it.” Strasburger said he realizes many kids will scoff at advice from pediatricians — or any adults.

FITNESS Continued from 24 centers across the country, and the Heart Association hopes to expand it. “Although (cardiorespiratory fitness) is recognized as an important marker of both functional ability and cardiovascular health, it is currently the only major risk factor that is not routinely and regularly assessed in either the general or specialized clinical setting,” the Heart Association wrote in its policy statement in the journal Circulation. Still, there are caveats. Normal heart rates can vary by as much as 20 beats per minute, and sometimes people grow overly concerned when their statistics don’t mirror the norm. “‘Normal’ has great variability — even maximal heart rate can be as much as +/- 20 bpm from prediction equations,” Benjamin D. Levine, a professor of medicine, cardiology and exercise science at the University of Texas Southwestern Medical Center in Dallas, wrote in an email. “The problem is when people deviate from ‘norms,’ they get worried.” Some fitness activities defy efforts to define what is normal. Experts agree that strength training is essential to ward off the roughly 1 percent annual loss of muscle mass that occurs after age 50 and that flexibility and balance exercises are nearly

“

as important. But it’s not easy to offer advice that is applicable to a widespread population. “It is difficult to set age-related norms for muscle strength because there are so many variables,” said Rosemary Lindle of Professional Fitness Consultants in Bowie, Md. Those include genetics and body size. Some people may have strong upper bodies but weaker lower bodies. And some tests may not be right for everyone, especially the elderly. “Not all these tests would be appropriate for every single individual,” said Jacque Ratliff, an exercise physiologist for the American Council on Exercise. “Not everybody is going to be able to run 1.5 miles.” The American College of Sports Medicine offers modified fitness tests for older people, including a sit-and-reach flexibility check that is done on a chair rather than on the floor, according to Barbara Bushman, a professor in the kinesiology department at Missouri State University. The takeaway, experts said, is to measure yourself against norms where appropriate, consult trainers or other professionals to help gauge your progress, but keep up a regular exercise program at all costs, especially as you grow older. “Exercise is the best medicine there is,” Cooper said. “It has an effect on everything in a positive way.”

‘Normal’ has great variability. ... The problem is when people deviate from ‘norms,’ they get worried.” Benjamin D. Levine, a professor of medicine, cardiology and exercise science at the University of Texas Southwestern Medical Center in Dallas

Fairbanks Family Wellness Dr. Alexandra Swenson, D.C. Services Offered:

Family Chiropractor, Pediatrics, Pregnancy, Athletics, Acute Care, Corrective Care, Wellness Care (Dr. Swenson accepts MediCare)

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Feds post food allergy guidelines for schools THE ASSOCIATED PRESS

ONLINE

The federal government is issuing its first guidelines to schools on how to protect children with food allergies. The voluntary guidelines call on schools to take such steps as restricting nuts, shellfish or other foods that can cause allergic reactions, and make sure emergency allergy medicine — like EpiPens — are available. About 15 states — and numerous individual schools or school districts — already have policies of their own. “The need is here” for a more comprehensive, standardized way for schools to deal with this issue, said Dr. Wayne Giles, who oversaw development of the advice for the Centers for Disease Control and Prevention. Food allergies are a growing concern. A recent CDC survey estimated that about 1 in 20 U.S. children have food allergies — a 50 percent increase from the late 1990s. Experts aren’t sure why cases are rising. Many food allergies are mild and something children grow out of. But severe cases may cause anaphylactic shock or even death from eating, say, a peanut. The guidelines released Wednesday ATLANTA —

CDC guidelines: www.cdc.gov/ healthyyouth/foodallergies

were required by a 2011 federal law. Peanuts, tree nuts, milk and shellfish are among the food that most often most trigger reactions. But experts say more than 170 foods are known to cause reactions. The new advice call for schools to do such things as: • Identify children with food allergies. • Have a plan to prevent exposures and manage any reactions. • Train teachers or others how to use medicines like epinephrine injectors, or have medical staff to do the job. • Plan parties or field trips free of foods that might cause a reaction; and designate someone to carry epinephrine. • Make sure classroom activities are inclusive. For example, don’t use Peanut M&M’s in a counting lesson, said John Lehr, chief executive of an advocacy group that worked on the guidelines, Food Allergy Research & Education (FARE). Carolyn Duff, president of the National Association of School Nurses, which

Tyler Edwards, 12, of Hendersonville, Tenn., carrues this epinephrine autoinjector with him because of his allergies. On Oct. 30, the federal government issued its first guidelines to schools on how to protect children with food allergies. ASSOCIATED PRESS worked on the guidelines, said many schools may not have policies on food

allergies. “And if they do, maybe the policies aren’t really comprehensive,” she said.

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ALASKA ORAL & FACIAL SURGERY CENTER, INC. STEESE MEDICAL CENTER

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Specially trained in a broad category of oral and facial surgical procedures including but not limited to: Dentoalveolar Surgical Procedures: • Removal of teeth including wisdom teeth • Bone and oral tissue grafting • Trauma, infections, pathology and reconstructive surgery

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Navigating often-unhealthy school parties Tips for healthful classroom parties

By Casey Seidenberg SPECIAL TO THE WASHINGTON POST

eople often ask me for my opinion on classroom parties: Should we let kids eat cake? It is a fantastic question and one that should be asked by all schools and parents. At first glance, yes, kids should eat cake. I wholeheartedly believe that cupcakes and ice cream should be enjoyed on occasion. And a child’s birthday is a milestone, fun for both child and parent to celebrate. The challenge begins when there are 25 kids in a class, which means almost one celebration per week if spread evenly throughout the year, which we know doesn’t happen. Then pile on the parties for Halloween, Christmas, Valentine’s Day and St. Patrick’s Day, plus the daily desserts that many schools offer. Kids are faced with a great deal of unhealthful food during a school day. The challenge persists when one school party includes pizza, a sugar-filled drink, popcorn, a cupcake and ice cream, as well as a goodie bag with candy. Offering so many treats as part of one celebration can contribute to an unhealthful eating habit: the belief that a party is an excuse for overconsumption. This is not a belief we want to instill in our kids. Food and alcohol often go together. The habit of overeating to celebrate can lead to alcohol overindulgence as kids get older and parties take on a different tone. When our kids are teenagers and win a sports championship, or when they are adults and receive a promotion, we hope they will understand that celebrating does not need to be focused just on food and drink. Teaching our children that a holiday or celebration is about spending time with friends, participating in a fun activity or being active together, instead of simply consuming food and drink, is an import-

By Casey Seidenberg SPECIAL TO THE WASHINGTON POST

Ideas for healthful classroom parties • Shift the focus from food to fun. • Limit parties to one junk-food item. • Have a scavenger hunt with nonfood items. • Provide extra recess. • Host craft and activity stations that don’t include decorating a cupcake or cookie. • Conduct games with nonfood prizes. • Have a dance party. • Read a book. • Restrict food dyes, high-fructose corn syrup, chemicals and additives. • Serve snacks with fun plates, napkins, cups or straws. • Use cookie cutters to make sandwiches and other snacks more interesting.

Smart party snacks

ant and a lifelong message they can carry through their teenage years and into adulthood. So definitely let kids eat cake, just in moderation — and without all of

the other stuff. Seidenberg is co-founder of Nourish Schools, a Washington, D.C.-based nutrition education company.

• Fruit smoothies (whip them up on-site) • Trail mix (parents bring the ingredients and kids make their own) • Bananas and strawberries with chocolate dip • Yogurt parfaits with granola and fruit • Angel food cake topped with fruit • Berries with whipped cream • Lower-sugar, lower-fat popcorn • Fruit kebabs • Mini cupcakes • Cupcakes without frosting Adapted from the Center for Science in the Public Interest (www.cspinet.org).

SATURDAY FEBRUARY 14, 2014

Evan L. Wheeler DDS

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