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January 2011

HEALTH

PERSPECTIVE A Tale of Two Cancers

A S p e c i a l S u p p l e m e n t t o T h e Va l l e y N e w s and Clarinda Herald-Journal

National Radon Awareness Month WHAT YOU SHOULD KNOW ABOUT MRSA Cholesterol: Friend or Foe

2 October 2010

HEALTH PERSPECTIVE

The Valley News/Herald-Journal

November 2010

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Americans need to improve qaulity of diets

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Healthy, Happy New Year! Now is a great time to improve your nutrition habits.

Nearly one-third of the calories in a typical American’s diet come from soft drinks, sweets, salty snack foods, alcohol and fruit-flavored drinks.

Most Americans need to improve the quality of their diets. When researchers ask the average American what vegetables they eat, the top four vegetables consumed in the US are French fries, iceberg lettuce, potato chips and catsup. There is much room for improvement in both choosing a healthier diet and controlling the obesity crisis.

One of the areas which can improve our health is to be aware of the subtle eating cues that surround us every day.

Researchers have shown that people don’t overeat because they are hungry. People overeat because of a multitude of factors, including the influence of family and friends, the size of food packages and plates, the way foods are described on the labels and packages, food smells and even whether the eater is distracted while eating. This area of information has been dubbed “Mindless Eating”.

People eat more of a food when it is visible and convenient.

So, put the candy dish out of sight and out of reach, and you’ll eat less candy.

You can use this information to make healthy foods (carrots) visible and convenient, and you’ll improve your diet by eating more vegetables. So put a dish of

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raw vegetables out on the counter and make snacking on something healthy easier.

The bigger the bowl, the more you’ll eat. People by human nature, fill their plate. So, use smaller bowls, smaller plates, and smaller glasses. You’ll have your portion and you’ll be satisfied. Did you ever think about Grandma’s china?

It’s smaller, and a generation ago, people were smaller. Maybe there’s a correlation there…. So, fill your big bowl with raw veggies for snacking, and get a smaller bowl for ice cream.

Drinking sugary beverages also are adding to the obesity crisis. People who drink one or more sugared sodas are 27% more likely to be overweight than those who do not drink sugary soda. Sugary sodas (and coffee drinks and sports or energy drinks) add lots of calories, but liquid calories don’t “register” in our brains as filling us up. All those beverage calories can go down quite mindlessly. When you chew solid calories, you’re more likely to feel “full”. So don’t drink your calories.

There is a definite relationship between the diet you consume and your health.

When it comes to our waist size, bigger is not better. So to downsize your waist, downsize your plate. Start eating more of the healthy foods and less of the high fat high sugar foods. When you fill your (smaller) dinner plate, visual your plate.

Half should be vegetables. One-quarter should be whole grains, one quarter lean protein. All foods can be included in your diet, just be mindful of your portions by choosing smaller dishes.

The Valley News/Herald-Journal

HEALTH PERSPECTIVE

January 2011 3

Faith, Family, & Friends: A Tale of Two Cancers Two Page County natives share their battles with cancer and how stem cell transplants saved their lives

By BOB ESCHLIMAN Staff Writer

At first glance and casual observation, there isn’t a lot Chuck Offenburger and Marilyn Lee have in common. Sure, they’re both from Shenandoah, but unless you really get to know their individual stories, there’s no way to know just how much they share.

Lee was working as a nurse at Shenandoah Medical Center in January of 2007 when she was diagnosed with mantle-cell lymphoma, one of the rarest forms of

Dr. Katarzyna Jamieson, middle, was one of the two physicians who directly supervised Chuck’s care. The other was Dr. Thomas Carter, who was in charge the first half of Chuck’s stay. Both are colleagues of Dr. Roger Gingrich, the transplant unit chief, who consulted regularly with Drs. Jamieson and Carter.

non-Hodgkins lymphoma. This form of cancer develops as a tumor of the mantle cells that surround the reproducing centers of the lymph nodes.

It’s so rare, only 15,000 people

in the United States are thought to have it. But, it’s even more rare in women. And, oncologists have had a difficult time understanding its biology, which makes it very difficult to treat, and almost

impossible to receive a “fully cured” prognosis.

“I had some chemo and radiation treatments, and they seemed to work,” she said. “In January of 2010, I was told I was officially in remission. But, they told me there was a possibility of it coming back.”

It did.

In May of last year, Lee was rediagnosed with mantle-cell lymphoma, but in a different location on her body. Her doctors at Hematology & Oncology Consultants in Omaha used a different kind of chemotherapy, as well as radiation treatments.

“The doctors gave my husband and me a list of options. At the bottom of the list was stem cell transplant. In June, when we realized the chemo wasn’t working, my oncologist — Dr. [James R.] Commer — asked if it would be OK to begin the paperwork for a stem cell transplant. When we

found out the radiation was working, it was recommended we should have the transplant.”

In the meantime, Offenburger was beginning to deal with his own second round of cancer diagnosis. He had previously been diagnosed with non-Hodgkins follicular lymphoma — a B-cell form of lymphoma that starts in the lymph nodes and slowly progresses into the blood, bone marrow, and internal organs — in July of 2009.

Because it is slow-progressing and painless, the disease can reach a very late stage before it is detected. But, it is easily treatable, and, after some mild chemotherapy, the cancer was under control.

“In March of 2010, Carla was diagnosed with a tumor on the lower side of her left jaw, and in April they did a needle biopsy that confirmed it was cancer. She see CANCERS, Page 4

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HEALTH PERSPECTIVE

4 January 2011

CANCER

Continued from Page 3 had surgery in May, followed by some follow-up radiation in June and July,” he said. “Two days after she finished her radiation treatments, I had a huge pain in my lower back. And, a couple days after that, we found a small growth near my tailbone.”

Offenburger’s new case of cancer was diagnosed as large-cell lymphoma — which occurs when the DNA of an immunity cell, or lymphocyte, is damaged — a far more aggressive form of cancer that spreads quickly throughout the lymph system, the blood, and internal organs, such as the liver and spleen. This new case, known as a “second cancer,” is not all that uncommon among cancer survivors.

“The first round of cancer, it was pretty easily controlled with chemo or radiation, so we fully expected to get it under control, followed by some regular maintenance treatment,” he said. “I was told there was a likelihood of

recurrence, but much later. They said, if it did, lymphoma had a history of becoming more aggressive when it comes back.”

The large-cell lymphoma is, indeed, far more aggressive, and much more dangerous for the patient. Based on past patients, and with Offenburger’s own pattern with cancer, his doctors felt regular chemotherapy treatments were not likely to stop the cancer, so they recommended a stem cell transplant.

Stem cell therapies have only been in the public consciousness for a handful of years, but the specialist Offenburger saw at the University of Iowa Hospitals and Clinics, Dr. Roger Gingrich, has been specializing in the technology and its benefits for cancer patients for more than 30 years.

He said a lot of science has taken the stem cell therapies from their infancy to more wide-spread use.

“The issue we confronted in the late-1970s was, ‘How do you successfully cure cancers that are resistant to chemo doses that are safe for the patient without per-

The Valley News/Herald-Journal

manently damaging the bone marrow?’” he said. “The bone marrow produces all of the blood cells for the body, but with chemo, we’re knocking out or significantly diminishing that function, at least temporarily.”

At the time, it was thought that available chemotherapy treatments could be increased to a level that would kill the cancer, but at the same time, would cause irreparable damage to the patient’s bone marrow. One thought to circumvent permanent damage to the bone marrow was to take out living bone marrow stem cells from the patient, preserve them, give the patient a high-dosage chemotherapy treatment, then re-inject the stem cells back into the patient’s blood to help the bone marrow heal.

“There’s a fair bit of technology that had to go into that. We had to figure out how to freeze the stem cells… then we had to figure out how to store them for days or Patients in the stem cell transplant unit are encouraged to stay active, taking weeks,” Gingrich said. “Once that along IV poles and walking the long hallway – 17 laps are said to make a mile. all was set in place, and we had Chuck Offenburger did that daily, and he also did spins on an exercycle outside see CANCERS, Page 5

his room and exercises recommended by the staff physical therapist Melanie House.

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HEALTH PERSPECTIVE

The Valley News/Herald-Journal

CANCER

Continued from Page 4 the science worked out, we had to address the question, ‘What if the bone marrow is contaminated with cancer?’”

Gingrich said transplant genes were identified by scientists in the 1960s, but that science needed to work out the finer points for finding matches. As technology has improved, the ability to find the right matches has become far more successful.

Initially, donations were limited to within the same family, with successful matches found in only one-third to one-fourth of all cases. But, eventually, the University of Iowa Hospitals and Clinics successfully developed the first unrelated-donor registry, which today features 12-13 million people from around the world who have been tested and can be matched as a potential bone marrow donor.

The first large-case series of stem cell transplants took place in 1978 and 1979 in Seattle, Wash. One hundred patients, all with advanced acute cases of leukemia comprised the sample group. Of them, only nine survived to live an extended period of time cancer free.

It was the proof-of-principal researchers needed, however, to move the treatment

forward.

“Now that some had been treated successfully, we asked ourselves, ‘How can we do better?’ We wanted to be able to predict who would do poorly, and move the transplant earlier in their cancer fight,” he said. “So, we went from success rates in the high-single digits to 10 percent, to rates in the 60-70 percent range in adults, and even higher in kids.”

Offenburger said his team of oncologists looked at several factors to determine if he would be a good candidate for a stem cell transplant. They included: age, general health, overall attitude, and will to live. He also said doctors looked at how much treatment they felt he would be able to tolerate.

“Lucky enough, my bone marrow was clean. They tested me last August and determined I could be my own donor, so they proceeded with the transplant,” he said. “In late October, they hooked me up to two I.V.’s — one left and one right — to pull the stem cells out. They took 4.4 million stem cells out of my body.”

Although her treatments took place at Emmanuel Hospital in Omaha, Lee said her transplant experience was virtually identical to Offenburger’s. She said she also had “clean” bone marrow, which allowed her to be her own donor of stem

cells for the transplant.

Once the stem cells were harvested and properly frozen for storage, both began what Offenburger referred to as “big guns chemo,” in which the dosage of chemotherapy medicines was ratcheted up in an effort to “go for the cure.” The reaction to this kind of treatment can vary greatly.

“I had no immediate side effects, and I tolerated the chemo really well,” he said.

“It wasn’t until the second full week in the hospital that I started feeling the full effect.

I wasn’t nauseated, but I did have trouble eating anything but soft food.”

“I had my chemo in Red Oak, and I was getting a triple dose of what I had normally received for chemotherapy. I did pretty well to begin with, but I eventually lost my appetite and started to have other side effects,” Lee said. “I got tired, because my blood counts were down, but eating was the hardest part. It all looks good, but it just doesn’t taste as good.”

Offenburger said the thought of chewing up a big piece of meat, or having a cup of coffee, just wasn’t appealing to him for a span of about seven to 10 days — personal records for both. Staying as active as possible helped, he added.

“I never had a day where I was completely laid out. I had my laptop com-

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puter and high-speed Internet, so I kept up with some news and writing projects I was working on,” he said. “I also would walk in the hallway three times a day. Seventeen laps was a mile, so I would break it up into thirds. And, I would ride an exercise bike for 15 minutes twice a day.”

Lee said the Three F’s — faith, family and friends — helped her get through the experience. She said, even while she was in isolation as her body rebuilt its immune system, her husband visited her frequently in the hospital. She also had both of her sons in the room at the time of her stem cell transplant.

Offenburger agreed about the importance of the Three F’s. His chemo and transplant took place right around the Thanksgiving holiday. And, despite the discomfort and lack of appetite, he said he had one of the best Thanksgiving holidays of his life.

He said his family had its own Thanksgiving gathering early, before he went to hospital. While in the hospital, however, he experienced a tradition in which the nurses brought in a full-blown Thanksgiving dinner for the patients, their families, and the other nurses on staff that day.

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HEALTH PERSPECTIVE

CANCER

Continued from Page 5 “It was the first day I could eat a full plate of food. I had some pumpkin pie, and it tasted like Heaven. That night, we got a phone call that we had a new granddaughter,” he said. “How much more thankful could you be? One, you’re off to good health; two, the hospital just gave you a wonderful Thanksgiving meal; and, three, you have a new granddaughter.”

Both Lee and Offenburger offered some words of advice, both for those who have recently been diagnosed with cancer, and for those who are about to undergo stem cell transplant therapy.

“If you’re diagnosed with cancer, as many people will, don’t freak out,” Offenburger said.

“You probably will, at least temporarily, but so many of us still have that 1980s view of what being a cancer patient was like.

That can still happen, but for most of us, it’s a totally different experience today.”

Nurses Linda Lampson (left) and Luanne Link used a set of IV’s in each of my arms on Tuesday morning, Nov. 2, at the DeGowin Blood Center at the University of Iowa Hospitals and Clinics in Iowa City. They did the five-hour “stem cells harvest,” drawing Chuck’s blood from his left arm, circulating it through a machine that separated out stem cells, then infusing his blood back into his right arm.

He said cancer isn’t the death sentence it used to be, and it can be controlled, so those who have been diagnosed should never give up. The medications involved have improved so much, he added, and are no longer completely disabling.

“Even if you exhaust all of the drugs available, don’t give up,” he said. “There could be a new one next week.”

Offenburger added that stem cell transplants aren’t for everyone. He said the patient needs to be “spiritually fit” with a “sense

of a higher power and your spiritual place in the universe.”

“I took great comfort in prayers that came my way,” he added.

“You just have to put it in God’s hands, and ask Him, ‘Please, help me.’ I got instant relief just by doing that.”

“You spend a lot of time alone while you’re there, so be prepared to be comfortable with just yourself,” Lee said. “Stem cell transplants aren’t fun, but they’re certainly doable. Just don’t plan to jump right back into your routine… I look at the challenges others faced, and realize I’m so blessed to have this option. If it’s offered to you, take advantage of it.”

The Future: Stem Cell Transplants Dr. Roger Gingrich of University of Iowa Hospitals and Clinics has been a pioneer in the field of stem cell transplant therapy for more than 30 years. He said, in the future, there are three main areas where researchers will continue to work on the science behind stem cell transplants.

The Valley News/Herald-Journal First, he said the development of antibiotics has been a huge area of success. He said researchers will continue to work to find drugs that are safer, with fewer side effects, will being stronger. The development of more oral medications will allow for faster transfer of patients to their home setting.

Second, he said there will be more work to expand the number of possible donors for cancer patients whose bone marrow is infected with cancer cells. He added the development of banks for cord blood — blood taken from a child’s umbilical cord after birth — rich in stem cells would give rise to their use for adults.

Finally, he said researchers will work to develop better methods of prediction to determine who will need a stem cell transplant earlier in their treatment process to make cancer treatment more successful and less costly. He said waiting to perform the transplant results in patients that are “beat up,” and cancers that are more resistant to chemotherapy.

The Valley News/Herald-Journal

HEALTH PERSPECTIVE

January 2011 7

Radon: The silent killer . . .

Naturally occurring deposits in soil can release radioactive gas

By BOB ESCHLIMAN Staff Writer

If you live in Iowa, there’s a very good chance you have a killer in your home. And, while this killer is both silent and invisible, there are measures you can take to protect yourself and your family from its deathly grip.

Radon, a naturally occurring, odorless, and colorless gas, is the second-leading cause of lung cancer deaths in the United States behind cigarette smoking.

The U.S. Environmental Protection Agency estimates between 15,000 and

20,000 lung cancer deaths this year will be the result of radon poisoning, prompting the agency to declare January as National Radon Action Month.

“I highly recommend people get their homes tested. Once you know the level of radon in your home, you will know what more needs to be done,” Iowa state radon officer Rick Welke said. “But, there are some people out there who don’t test because they don’t want to know. But, if there was a carcinogen floating in the air of my home, I’d want to know about it and take care of it.”

Radon is created by the degradation of uranium deposits in the soil. As the uranium atoms shed electrons to reach an inert or

stable state, it sheds radium, which in turn degrades into radon. The gas itself also breaks down into “radon daughters,” which are the actual cause of lung cancer.

As a gas, radon is able to

pass through certain types of porous soil and rocks, as well as water. It enters the home through cracks in the basement and foundation.

Once it is trapped inside the home, and undergoes its degradation into “radon

daughters,” the most dangerous part of the process begins.

RD’s, as they are called by radon specialists, will freely attach themselves to dust particles in the air, which can then be inhaled directly into the lungs, causing cancer.

“Iowa has a lot of radon because of its geology.

When the glaciers were descending, they left behind ground up uranium and radium, which eventually decayed into radon,” Welke said. “Radon, as a gas is easily sucked into the low-pressure environment of a home’s basement. It only has a three-day halflife, but when it decays, it releases alpha particles.”

When alpha particles strike the DNA of a cell, they can strip off pieces, or

cause damage to the DNA sequence. This in turn causes cancer to develop in the cells of the affected area.

When this happens in the lungs, it leads to lung cancer.

The level of radon in a home can be detected with a simple test kit that can be picked up through county departments of public health, through the Iowa Air Coalition in Cedar Rapids, or from any hardware or home improvement store. The cost of a test can range from $6 to $19, depending upon the type of test purchased.

Testing just once is never enough, though, because radon levels can fluctuate over time.

“You should really test the air in your home every see RADON, Page 9

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The Valley News/Herald-Journal

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The Valley News/Herald-Journal

January 2011 9

Radon Data for Southwest Iowa County Adair Audubon Cass Fremont Guthrie Harrison Mills Montgomery Page Pottawatamie Shelby Taylor Southwest Iowa

RADON

Continued from Page 7 three or four years, if you don’t already have a mitigation system,” Welke said.

“For homes with mitigation systems, as long as the sys-

Population 7,350 6,032 13,758 7,345 10,833 15,328 15,002 10,796 15,260 90,224 11,957 6,344 210,229

Avg. pCi/L 8.5 9.5 8.9 10.3 9.7 7.1 7.8 8.1 9.8 5.8 9.4 5.5 7.4

tem is working, you shouldn’t have a problem.”

Radon tests measure the level of radiation in the air in units called picocuries per liter, or pCi/L. The EPA rates any home with radon levels below 2 pCi/L as being relatively safe. Those

Low (<2 pCi/L) 1,029 1,146 1,926 661 1,408 2,912 3,150 2,051 2,136 22,556 1,913 2,030 42,920

with radon levels of more than 2, but less than 4 pCi/L, are considered to be at moderate risk.

The average radon level for a home in Iowa is 5.6 pCi/L. The average for the 12-county area of Southwest Iowa is 7.4

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% 14% 19% 14% 9% 13% 19% 21% 19% 14% 25% 16% 32% 20%

Med (2-4 pCi/L) 1,029 664 2,201 1,616 2,383 2,759 2,700 1,619 2,136 18,947 1,196 1,523 38,773

pCi/L. In Page County, the average level per household is 9.8 pCi/L, second only to the 10.3 average reading in Fremont County.

Although those are averages per household, the levels in individual homes can vary greatly.

“The EPA’s action level is 4 picocuries per liter. At that point, they highly recommend homeowners go through the mitigation process to remove the radon from their homes,” Welke said. “But, I’ve seen test results for homes in Iowa that tested at 200 to 2,000, depending on where they were built.”

Radon mitigation can cost

% 14% 11% 16% 22% 22% 18% 18% 15% 14% 21% 10% 24% 18%

High (>4 pCi/L) 5,292 4,222 9,631 5,068 7,041 9,657 9,151 7,125 10,987 48,721 8,848 2,791 128,535

several hundred dollars for a single home, but is almost always 100 percent effective in reducing radon levels to below 2 pCi/L. When installed in new homes, however, radon-resistant construction practices can reduce the level of radon to the same as outdoor air.

“It’s always easier to mitigate radon in new homes, but it’s even easier if it’s already built into the home,” Welke said.

“The goal of a radon mitigation system is to move the air, suck it up and out, and emit the air above the roof line of the home. And, they have backups and safety features to let you know that they’re working.”

% 72% 70% 70% 69% 65% 63% 61% 66% 72% 54% 74% 44% 61%

A number of counties across Iowa have enacted building codes that require radon-resistant construction practices in all new homes.

However, there is no statewide building code, and the Iowa Department of Public Health, for which Welke works, has been hesitant toward suggesting a statewide mandate for radon-resistant construction.

“The department can’t make law. So, it’s up to the cities and counties to decide what kind of building regulations they want,” he said.

“In Iowa, we believe strongly in home rule, where local officials make their own rules and laws.”

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HEALTH PERSPECTIVE

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Family meals equals family health. . .

Clarinda Regional Health Center Dietitian

Does your family eat together at mealtime at least a few times a week? Family meals tend to contain healthier portion sizes, more fruits and vegetables, fewer snacks, and fewer fried foods. And they do far more than put healthful food on the table. Children, who eat family meals perform better in school, tend to be happier, less stressed, have positive peer relations, and a decreased risk of suicide. As an added bonus, family meals also provide children with skills they can use later in life, such as social etiquette, table manners, and conversational skills. More mealtime at home was the single strongest factor in better achievement scores and fewer behavioral problems in children all ages. More meals at home also resulted in less obesity When you cook and serve meals at home, you have more control over the quality and quantity of your family’s food choices. Kids tend to mimic their parents’ attitudes about foods. Children won’t perceive healthy eating as important if it is not something that they see you doing. Eat and serve sensible portion sizes. Be open to trying new foods and new ways of cooking

foods.

In our haste to get meals prepared, we may forget that mealtime gives time to talk, listen and build family relationships. And it's a chance for parents to be good role models for healthful eating. Try to make it routine.

Set a regular family mealtime. Pick a time together.

Enjoy more table time, less cooking time. Make quick, simple meals (even a sandwich, fruit and milk) to give more table time together.

Turn off the TV. Focus mealtime on family talk.

Keep table talk positive. Everyone gets to talk and to listen.

Keep table time realistic – not so long that the pleasure goes away.

Keep meals simple and easy – a family meal together doesn’t have to be elaborate or include expensive ingredients. A simple meal, eaten with others while sharing conversation, is worth more than the most elaborately prepared dish. What I remember is how good it felt to gather around the table and share. Don’t let this simple concept become lost in the busy-ness of everyday life.

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HEALTH PERSPECTIVE

January 2011 11

What You Should Know about MRSA Bacteria with resistance to common antibiotics has been on the increase in recent years.

More and more we are hearing about MRSA. But what is it and why should we be concerned?

You can now have endoscopic carpal tunnel surgery at Shenandoah Medical Center. With just a small incision on your wrist, you experience less pain and less chance of infection. There is no splint to wear and no stitches to remove. This procedure allows you to use your hand right away. To learn more about minimally invasive surgery, contact Dr. Ray at the Shenandoah Medical Center.

What is MRSA? MRSA stands for methicillin-resistant Staphylococcus aureus. MRSA is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's a type of staph infection that is resistant to commonly used antibiotics such as penicillin, amoxicillin, and oxacillin.

Garden-variety staph are common bacteria that can live on our bodies. Plenty of healthy people carry staph without being infected by it. But staph can be a problem if it manages to get into the body, often through a cut. Once there, it can cause an infection. Usually, these infections are minor and don't need special treatment.

Most often, MRSA causes mild infections on the skin, causing sores or boils.

But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Although most MRSA infections aren't serious, some can be life-threatening.

MRSA is spread by contact. So you could get MRSA by touching another person who has it on their skin. Or you could get it by touching objects that have the bacteria on them or by living in crowded conditions. MRSA infections are common among people who have weak immune systems and are in hospitals, nursing homes,

Dr. Subir Ray is the only surgeon in this area who performs Endoscopic Carpal Tunnel Surgery.

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712-246-7486

and other heath care centers. Infections can appear around surgical wounds or invasive devices, like catheters or implanted feeding tubes.

CA-MRSA (Community-acquired MRSA) has now emerged as the most frequently identified drug-resistant pathogen in US hospitals. In the past 10 years, infections caused by this organism have emerged in the community. Outbreaks of community-associated (CA)-MRSA infections have been reported in correctional facilities, among athletic teams, and among military recruits. Basically, anywhere people interact in close proximity and have the potential to share towels and other articles.

Prevention Some of the best ways to keep from getting or spreading the infection include: Frequent and thorough hand washing.

Experts recommend washing your hands for as long as it takes to slowly recite the alphabet.

Covering cuts and scrapes with a clean bandage.

Do not touch other people's wounds or bandages.

Do not share personal items like towels or razors, and wipe down surfaces you come into contact with at the gym or in a locker room.

Persons coming to see their doctor or entering the hospital for a surgical procedure can be reassured that the doctors, nurses, and medical staff at Shenandoah Medical Center take great precautions to wash their hands and disinfect or sterilize surfaces and equipment to prevent the see MRSA, Page 12

12 January 2011

HEALTH PERSPECTIVE MRSA

Continued from Page 11 spread of bacteria and viruses to our patients.

Remember, antibiotics can cure bacterial infections but not viral infections. Most upper respiratory infections, like cough and cold illnesses, are caused by viruses and will not improve with the use of antibiotics.

You Can Help Taking an antibiotic for a viral infection will not cure the infection or make you feel better.

Just because an antibiotic is not prescribed doesn’t mean you are not sick. Ask what else can be done to help relieve symptoms and do not request an antibiotic when

The Valley News/Herald-Journal a healthcare provider determines one is not appropriate.

Only take antibiotics for a bacterial infection, such as strep throat, or as your doctor prescribes.

Take the antibiotic exactly as prescribed. Do not skip does. Complete the prescribed course of treatment, even if you start to feel better. Don’t save antibiotics for the next illness.

Take antibiotics prescribed only for you. Do not share or use leftover antibiotics. Antibiotics treat a specific infection.

Taking the wrong medicine can delay or correct treatment and allow bacteria to multiply.

Prevent infections through good hand hygiene and getting recommended vaccines.

Cholesterol –

Friend or Foe?

Enjoy Life Without

By CINDY EIVINS, MS, RD, LD Clarinda Regional Health Center Dietitian

Heartburn Imagine life without heartburn. Eat the foods you like with no medicines, no restrictions. Nissen fundoplication outpatient surgery gives permanent results. The gold standard for acid reflux surgery that has stood the test of time for over 100 years. Return home the same day and resume normal activities in a day or so.

Dr. Subir Ray MD, FACS: Specializing in Nissen Fundoplication Surgery for Acid Reflux 110127-38545

High cholesterol can affect anyone. It is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. By following a healthy eating plan you can reduce the three major risk factors for heart disease – high blood cholesterol, excess body weight and high blood pressure.

Your blood levels of cholesterol, LDL, HDL and triglycerides provide a good picture of your heart health. Cholesterol comes from two sources: your body and food. It is a waxy substance produced by the liver and supplied in the diet through animal products. Some cholesterol is needed to form cell membranes and make certain hormones. Too much cholesterol in the blood can lead to build up in the arteries.

LDL is the bad cholesterol that can build up and clog the walls of the arteries. HDL is the good cholesterol that helps remove cholesterol from the arteries. Triglycerides are a type of fat in the blood. High triglycerides can increase your risk for heart disease.

To lower cholesterol levels you can limit saturated fat, trans fat and dietary cholesterol, add foods containing soluble fiber

and soy protein. Saturated fat tends to come from animal sources and is usually solid at room temperature. Trans Fats are formed in manufacturing process by turning liquid fats to solid fats at room temperature. Although they are often mentioned together, cholesterol and fat are not the same. Fat helps to insulate the body’s organs and transports fat soluble vitamins.

Both are necessary but can be damaging to your heart if consumed in high amounts.

Low-fat foods are generally crisp, water; dry; or chewy –fruits, vegetables, dried beans and peas, skim and low-fat dairy, breads and cereals, turkey, chicken fish and other lean meats. High-fat foods are generally smooth, oily, thick in texture, creamy or greasy—like cheese, butter, margarine, salad dressings, French fries and luncheon meats. Choose high-fat foods less often.

Heart healthy eating would include eating more soluble fiber and two servings of fish a week. The soluble fiber in food like oats and dried beans and peas, can lower LDL cholesterol. The recommendation is eating 20-35gm of fiber daily. Fish and fish oil contain fatty acids that are good for the heart. People who consume two or three servings of fish a week have fewer heart attacks and strokes, plus lower blood pressure than people who eat none.

HEALTH PERSPECTIVE

The Valley News/Herald-Journal

January 2011 13

Nissen Fundoplication - Gold Standard Treatment for Acid Reflux Submitted By SHENANDOAH MEDICAL CENTER Acid Reflux, Heartburn, GERD, Hiatal Hernia . . . that burning sensation you get after eating. Whichever name you use, it’s not pleasant and may keep you from enjoying some of your favorite foods.

Your body naturally produces acids which are needed to properly digest your food. As long as they stay in your stomach everything is good. But if these acids are allowed to seep up into the esophagus, they will irritate the lining of the esophagus and cause a burning feeling inside.

Some foods seem to bring on heartburn more than other foods. People who smoke or are overweight have a greater tendency to experience heart-

burn. At some point, a hiatal hernia has developed.

Food travels from your mouth, through your esophagus and into your stomach.

The lower end of your esophagus, or sphincter, should allow food to pass only one way, and quickly

close up to keep food and acids in your stomach from going backwards, or refluxing, into your esophagus.

When the lower end of the esophagus doesn’t constrict enough to keep the acid in your stomach, you experience gastroesophageal

reflux disease or GERD. If a portion of your stomach slips through the enlarged opening you have a hiatal hernia. If GERD is left untreated, you are at increased risk of developing cancer of the esophagus.

You may experience tem-

porary relief from heartburn by avoiding foods that seem to trigger heartburn.

Quitting smoking and losing weight may give you some relief as well. Not eating for one to two hours before bedtime and elevating your bed to a 30 degree angle may help. Many people try over-the-counter medicines or prescription medications which simply reduce the amount of acid in your stomach which your body needs to digest the food you eat.

For permanent relief, a surgical procedure called nissen fundoplication is the answer. This surgery closes the hiatal hernia and wraps the top of the stomach around the outside of the esophagus a full 360 degrees, creating a new sphincter at the end of your esophagus which prevents food from creeping back

up. The added support prevents the reflux from happening. A partial wrap will not have the same results as one all the way around. The nissen fundoplication can be done on an outpatient basis. You return home the same day after surgery.

After a day or two on a liquid diet, you may begin to eat normally without avoiding your favorite foods.

You will be free of heartburn without having to take medication for the rest of your life.

Nissen fundoplication is the gold standard used for the treatment of acid reflux.

It has been performed for over 100 years and is not experimental. For more information about this procedure, you may call Dr. Subir Ray at the Shenandoah Medical Center at 712-246-7485.

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14 January 2011

HEALTH PERSPECTIVE

The Valley News/Herald-Journal

Swallowing Difficulty is a treatable condition

By TRAVIS MILLER Clarinda Regional Health Center Certified Speech/Language Pathologist

Dysphagia (dis-FAY-juh) is the clinical term for difficulty with swallowing function. There are a variety of diseases and disorders that can cause swallowing difficulty, such as Parkinsonism, Multiple sclerosis, COPD, and stroke to name a few. Typical signs and symptoms of dysphagia include: Coughing during or after eating/drinking, gurgly-sounding voice during or after eating/drinking, food/liquid spilling out of the mouth, recurring pneumonia or chest congestion, and weight loss.

How is dysphagia diagnosed?

The speech-language pathologist (SLP) evaluates the strength and coordination of the musculature used in the swallow process. The SLP further analyzes how the patient performs while swallowing foods/liquids of various con-

sistencies. The SLP may also conduct a Video-Fluoroscopic Swallow study, which allows the SLP to see the inner workings of the swallow process.

Treatment of dysphagia consists of: (1) Oral/motor exercises to increase strength and coordination of the swallow musculature, (2) Thermal stimulation to increase the sensitivity of the mouth and other swallow structures, (3) Positioning and strategies to allow the person to swallow more safely and effectively, and/or (4) Diet/liquid consistency modification.

Travis Miller, speech/language pathologist at Clarinda Regional Health Center, is available to evaluate and treat patients with dysphagia.

To schedule an appointment for an evaluation, please call Rehabilitation Services at (712) 542-8224. A physician’s referral is required prior to initiation of therapy.

A surgical solution for hearburn without incisions Now Being Performed At Clarinda Regional Health Center. . .

What may have seemed like science fiction, surgery without an incision, is now a reality that is making lives better for patients suffering from chronic acid reflux also known as gastroesophageal reflux disease (GERD). Dr. James Stone, Clarinda Regional Health Center surgeon is the first in Southwest Iowa, Northwest Missouri, and Southeast Nebraska to offer the TIF (transoral incisionless fundoplication) procedure for the treatment of GERD. “The TIF procedure with the EsophyX device can significantly improve quality of life for our patients.” said Dr. Stone. “Many patients take reflux medications which suppress acid production such as PPIs (proton pump inhibitors) to help relieve their heartburn symptoms and are still unable to eat the foods they want

or have to sleep sitting up to reduce nighttime reflux.

In addition recent studies have shown that long term use of PPIs can lead to inadequate absorption of minerals such as calcium leading to bone fractures. Studies have also shown that PPIs can

interact with other prescription medications reducing their efficacy. Clinical studies show that after the TIF procedure many patients are off their daily reflux medications and can eat and drink foods and beverages they avoided for many years.

Reflux no longer impacts their life like it previously did.”

In a healthy patient, there is a natural valve between the esophagus and the stomach that forms a physical barrier preventing stomach fluids from backwashing, or “refluxing,” up into the esophagus. “In a patient with chronic GERD, this valve has become dysfunctional,” explained Dr. Stone.

“The TIF procedure reconstructs the valve between the esophagus and the stomach to prevent reflux. It is based on the same well proven principles of conventional more invasive laparoscopic GERD surgery what’s known as Nissan fundoplication.

TIF’s advantage is that it is ‘surgery from within’ performed transorally (through the mouth).

Because the procedure is incisionless, there is reduced pain, no

visible scar and most patients can get back to their normal activities within a few days.”

The subject of acid reflux, heartburn and the TIF procedure was recently featured on the TV Show “The Doctors”. The segment of the show, along with additional video information about TIF is available on the Clarinda Regional Health Center website at www.clarindahealth.com.

“We are very excited to be able to offer our patients the same benefits as more invasive procedures with only minimal risk,” expressed Dr. Stone.

Please contact us at 542-8349 if you or someone you know suffers with chronic GERD and would like more information about how TIF can get you back to living without the pills and without heartburn.

HEALTH PERSPECTIVE

The Valley News/Herald-Journal

January 2011 15

Endoscopic carpal tunnel surgery Letâ&#x20AC;&#x2122;s your hands get back to work Submitted By SHENANDOAH MEDICAL CENTER Carpal Tunnel Syndrome (CTS) starts with a numbness or tingling in your hand and develops into a pain which can extend up your arm all the way to your shoulder. It is a result of a pinched nerve in the palm of your hand. It can strike during the day or wake you up at night. You might think your hand has simply

gone to sleep, so you try shaking it to make the tingling sensation or numbness go away and restore your circulation.

Carpal Tunnel Syndrome is often caused by repetitive motion.

Any activity that involves grasping, squeezing or clipping motions, such as using tools, using a computer, knitting or playing the piano, can lead to CTS. However, carpal tunnel can develop without repetitive

motion.

Avoiding treatment can possibly lead to irreversible damage. If you have CTS, the nerve that provides sensation to the hand and function to the thumb is being pinched. After a while, permanent injury to the nerve will result.

There is no treatment that can fully restore hand function and sensation once permanent damage is sustained.

With endoscopic surgery, a

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small incision, less than a half inch, is made in the wrist. An instrument is inserted underneath the skin as the surgeon watches a video monitor to guide the instruments. Little, strip bandages are all that is needed to close the incision, not stitches. Patients go home the same day and are able to use their hand right away.

Because only a small incision is made, compared to a large incision in the palm, patients experi-

ence less pain and less chance for infection. Patients do not wear any kind of splint afterwards and there are no stitches to remove.

There is no lengthy recovery time. Scarring is not a problem either.

Dr. Subir Ray is the only surgeon in this area who performs endoscopic carpal tunnel surgery.

For more information, you may call the Shenandoah Medical Center at 712-246-7486.

Weight Loss Is this the year for you?

By CINDY EIVINS, MS, RD, LD Clarinda Regional Health Center Dietitian

Another year and another round of resolutions is upon us. Is weight loss on your list? Staying realistic is the best road to successful long term weight loss. People donâ&#x20AC;&#x2122;t just overeat because they are hungry.

We eat for lots of reasons, influence of family and friends, the size of food packages and plates, the way foods are described on labels and packages, the colors of foods, the presence of candies the food smells, distractions while eating, whether food is stored in cupboards, and the containers in which food is served or stored. We make nearly 250 decisions about food every day, often without much thought. The danger of eating is when you are not aware of how much or when you are eat-

ing. It can lead to overconsumption of needless calories. Here are some tips that might help.

Be aware that some of the biggest traps are the convenience of food. We no longer have to feel hungry because food is available at every turn-from the office vending machine to the gas station and fast-food stop.

You never have to travel far to find food, even if you are not hungry. This might not be so bad but these foods are often calorie-dense, nutrient-poor foods. But convenience is not the only problem.

Large portion sizes are everywhere in restaurants and packaged foods. We need to pay close attention to the nutrition facts panel serving size. Individualsize bags of chips may contain 2 or more servings.

Be careful about eating without thinking when we think food purchases are cheap. We can buy anything

we want. If you feel like a big candy bar, you can buy it, but think about the calories.

What about eating and doing something else, like driving or watching TV? We are eating without thinking. If you have an endless supply of food and you are paying attention to something else, it is hard to stop eating. Make a rule that eating is done sitting down at the kitchen table.

One thing you can do to eat less is change your eating environment. Keep foods like fruits and vegetables, in convenient places and available, we will choose them more often than high calorie foods.

Weight loss takes vigilance of what you eat, how much you eat and when you eat. Weight loss is not about just eating; it is about everything in your day to day, year to year eating and exercise habits.

HEALTH PERSPECTIVE

16 January 2011

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