Healthy lifestyles
January 27, 2016 PERRY BACKUS – Ravalli Republic
2 - Ravalli Republic, Wednesday, January 27, 2016
Marcus Daly Hospital offers fitness program By MICHELLE McCONNAHA
flexibility, strength, endurance and balance at the Exercise is one of the main Marcus Daly Memorial resolutions that people set for Hospital’s “Fit and Well themselves at the start of a Exercise” program beginnew year. ning Feb. 16. The program According to Marcus Daly is also designed to improve Rehabilitation Department the performance of daily Head Pete Dunn, the benefits activities and to develop an of staying active include a at-home exercise program. better quality of life and indeInstructors and physical pendence. therapists Missy Frank and “Obviously there are physiLarry Ingvalson will lead ological benefits, as well as the class and customize the benefits in cardio, flexibility, exercise routines. endurance and improved Frank said she sees many balanced which reduces our people coming to the hospirisk for falls,” Dunn said. “As tal after falling. we age we lose that mobility, “We want to help prevent strength and flexibility that that,” Frank said. “In genputs us at a higher risk for eral, this time of year we falls.” MICHELLE MCCONNAHA – Ravalli Republic hear from patients that say Marcus Daly Rehabilitation Department Head Pete Dunn with physical therapists Missy Frank Dunn recommends checkthere’s not an area to walk and Larry Ingvalson promote safe exercise as a key to staying active. The new program, ‘Fit and ing with a primary care proaround and keep fit. They Well Exercise,’ begins Feb. 16. vide to be sure that exercise enjoy that in winter they is safe to do – whether attending the class, going to a gym on come here and use our space to exercise, and they get to meet working independently. people. We see them get stronger and walk better.” “Medication and various impairments can put people at risk, Frank and Ingvalson will teach how to be safe in exercising, how and we want to make sure people are safe,” Dunn said. to safely increase the intensity of exercise and how to prevent Learn how to exercise safely and effectively while increasing falls. Ravalli Republic
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“We’ve added core stability exercises and balancing exercises,” Frank said. “The core is all the muscles surrounding the abdomen and back – they play a very important role in stability. In our last class, we’ll have exercises on a mat table to strengthen back and abdominal muscles.” Frank said the class begins and ends with personal assessments. “We do two general assessments and look at their posture, balance and strength – we do walking tests and standing tests,” Frank said. “We do assessments at beginning of the class and at end to see their improvements.” Dunn said he watched the class last spring. “I love how customized the class is for each individual,” Dunn said. “They do the assessments, then modify the class for each individual. What is nice is it creates buy-in from participants. The goal isn’t to exercise for 12 classes; the goal is when you leave you have something you can do safely on your own.” At the end of the program, each participant receives a printout of modified, personalized exercises to take to another exercise class, a gym or home. Dunn said the program is designed for people age 50 to 83, however people of all ages would benefit.
“It can be catered to any ability, but it usually draws individuals that are less active,” Dunn said. “This isn’t in replacement of a gym membership, but it is a kick start to educate people on the benefits of exercise. It is coming from the skills of a therapist on ‘here’s how to exercise safely,’ the importance of balance and endurance and modifications specifically for them. They can do this anywhere – outside, in a gym or at home.” Dunn said the hospital has additional health programs and continues to ask the community for ideas to meet their needs. One new wellness program is for people who have completed their physical therapy but want more. “They may no longer need skilled therapy, but they haven’t returned to their previous level of function. And we do have a program for them after they graduated from skilled therapy,” Dunn said. “We are trying to encourage our community, no matter their abilities, to stay healthy. It is important to stay active.” “Fit and Well Exercise” will meet from noon to 1 p.m. Tuesdays and Thursdays for six weeks beginning Feb. 16 in the Marcus Daly Rehabilitation Center in Hamilton. The program costs $99. To register for the program, call 406-375-4570.
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4 - Ravalli Republic, Wednesday, January 27, 2016
Sapphire Community Health is open and accepting patients in Hamilton By Susan Reynolds Ravalli Republic
Sapphire Community Health is Ravalli County’s new community health center. So, what is a community health center (CHC)? The National Association of Community Health Centers states that “America’s Health Centers are special places, not just in the health care system, but in the fabric of the communities they serve.” A CHC is also known as a federally funded health center or a FQHC. It is a not-for-profit, patient directed, locally governed primary health care organization. Having a distinct FQHC designation allows Sapphire CHC to accept all patients regardless of their ability to pay. With a sliding fee, patients are able to access the health care they need and are not turned away based on their lack of income. Historically, health centers have been a vital source of health care for both the insured and uninsured.
Private insurances, Medicare and Medicaid are all acceptable forms of payment at Sapphire Community Health. Cost-effective quality care delivery is a central part of the CHC framework. A 2009 George Washington University Report showed that patients receiving care at a CHC spend, on average, $1,093 less annually compared to those who did not use a CHC for health services. Sapphire is one of just 17 CHCs in Montana. So far we have welcomed over 300 new patients since opening our doors in October. Our focus is on patient involvement in service, improved access to care, reduction in health disparities and effective management of chronic illness. Our providers seek to provide exceptional service and compassion to each and every patient. Sapphire Community Health invites you to experience our unique approach towards health and wellness. We encourage you to schedule your appointment today by calling 541-0032 or visit us on the web at www.sapphirechc.org.
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January is Cervical Health Awareness Month By LuAnn Burgmuller For
the
Ravalli Republic
Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 30 years, the cervical cancer death rate has gone down by more than 50 percent. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early − in its most curable stage. Another way to prevent cervical cancer is to get vaccinated against human papilloma virus (HPV), which causes most cases of cervical cancer. HPV infections can cause cervical cancer in women and penile cancer in men. HPV can also cause throat and mouth cancer, anal cancer, and genital warts in both men and women. You can help protect yourself and your child from these cancers with the HPV vaccine. The vaccine may be given between the ages of 9 and 26, but the optimal ages to vaccinate against HPV for both males and females is between 11-12 years old. Why is the HPV vaccine given at such an early age? For the vaccine to be the most effective, it should be given prior to exposure. Furthermore, studies also show that the body’s immune system responds more strongly to the vaccine at age 11 or 12 than if given later; thus earlier vaccination is providing better protection for your child. This is not to say that your preteen is ready to have sex. In fact, it’s just the opposite, but it’s important to get your child protected long before your child takes part in any sexual activity.
What if my child is older than 12 years old? If your older child hasn’t gotten the vaccine yet, talk to their doctor about getting it now. HPV vaccines can be given up to the age of 26. It takes six months to complete the 3-dose HPV vaccine series. What about boys? HPV vaccine is strongly recommended for boys too. This vaccine can help prevent boys from getting infected with the types of HPV that can cause genital warts and cancers of the mouth/throat, penis and anus. HPV vaccination of males reduces the spread of HPV to their current and future partners. Are HPV vaccines safe? HPV vaccines are very safe. Millions of people worldwide have already received HPV vaccines. When side effects occur, they are normally mild, such as pain, redness, or swelling in the arm at the injection site. Less common effects can be fever, an allergic reaction, headache, or fainting. Talk to your health care provider about the recommended immunizations for your child and yourself. Ravalli County Public Health is also happy to help parents review immunization records and administer needed vaccines. Most insurance will cover the cost of vaccines and the Vaccines for Children (VFC) program provides vaccines for children ages 18 years and younger who are uninsured, Medicaid-eligible, or American Indian/ Alaska Native. Questions or comments may be directed to LuAnn Burgmuller, RN, Director Ravalli County Public Health, 205 Bedford St, Hamilton MT (next to the museum), Open 8-5 M-F (closed noon to 1).
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Ravalli Republic, Wednesday, January 27, 2016 - 7
“Beep Testing” improves conditioning By STACIE DUCE Ravalli Republic
Most of us can roughly gauge our own fitness levels by the redness in our face and our breathlessness during physical activity. But local high school coaches use technology and beep tests for measurable results in evaluating the conditioning of prep sport athletes. Kiah Nisly is the head coach of Hamilton High’s girls’ soccer team and administered beep tests several times last season during conditioning exercises. “We had a beep test the first week of practice and could see pretty clearly who had sat on the couch all summer and who had been preparing for the season,” she said. “Mainly, we used the results as a benchmark and re-tested several more times during the season so the girls could mark their improvements and value our conditioning. We found that those who scored highest on the beep tests were also the ones who could play 90 minutes of soccer without any trouble.” Nisly and her assistants set cones on the field at 20 meters from the start line. They use an app on their smart phones to play a series of beeps that progressively get faster. The girls must make it to the cone and back before the next beep in order to advance to the next level. Each level has sublevels with the number of sublevels increasing for each level up to 20. Nisly said that for example, level one might have seven sub-levels while level 12 has 12 sub-levels allowing for precise measurements of improvement. “It not only tests their endurance but also their speed since the beeps increase in rate as time goes on,” she said. “It can be an intense workout and really challenges the girls. They not only test themselves but they compete against one another and encourage each other. If one is getting tired, I’ve often heard the girls say, ‘Come on, you can do one more with me.’” The sprint race becomes a “last man standing” game that can also pit the girls against one another in positive competition. “The most entertaining is when a freshman and a senior are the last two left,” Nisly said. “No upperclassman wants to lose to a freshman, so it really pushes them to do their best, especially when everyone else is cheering them on. And more often than not those seniors win.” The beep tests have been a standard tool of fitness for several decades for collegiate soccer coaches, but now are accessible enough for anyone to do on their own. “I tell the girls that college coaches won’t even consider them unless their beep tests are in the double digits,” Nisly said. “ Some college coaches use the results to decide who’s on the team, who starts and who can skip conditioning as a reward. For us, it was really exciting to see some of our high school girls reach those collegiate levels of fitness last season.” Mark Plakorus, head coach for the girl’s soccer team at the University of Montana said he uses a Man United test for similar conditioning exercises with his team and said, “The older you get the more important it is to monitor your training and fitness especially if you’re plan-
ning to play after high school. Fourteen on a beep test is generally a minimum requirement for collegiate soccer players but our national teams, those girls are machines and 14 is probably their easy warm-up. It’s not right to compare, but it gives you an idea of what it takes to play beyond.“ Erica Musberger is a fitness professional and volunteered as the conditioning coach for the Hamilton High School girl’s soccer team. “I feel that in many aspects of our lives, we have room for improvement and beep tests are a quick way to measure an athlete’s fitness ability and set goals to improve,” Musberger said. “Conditioning is so important because what you put into practice or on your own time is what you’re going to bring to the game. Your efforts show on the field on game day and set great fitness habits for the rest of your life.” The progressive beep test competition in Hamilton wasn’t only between the players and each other. Nisly and her husband, Joe Nisly, who coaches Stevensville High School’s girls’ basketball team, had an in-family challenge as well. “When Joe saw how great the beep tests were in improving our conditioning, he decided to incorporate it into his conditioning drills for basketball and he was pretty certain his Stevensville girls could score on the beep tests as well as my Hamilton girls,” Kiah said. “So it was a good challenge for us as coaches as well.”
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A child’s perspective on Childhood Type 1 diabetes By STACIE DUCE For
the
Ravalli Republic
If you ask a child when he or she was diagnosed with Type 1 diabetes, you’ll most likely learn the exact day and more details of the experience than you anticipated. “12-12-12,” said Andrew Searle, a 12-year-old who attends Hamilton Middle School. “That’s the day I went to the hospital. And actually, on the eleventh of December is when the nurse told me I had diabetes, but she was really rude about it and I was in shock. The next day is when I went to the hospital and was officially diagnosed by doctors, so that’s the day I say. I stayed in this really awesome hospital with really good food that I really enjoyed and ate more than I should before I realized the concept.” Searle also has a vivid memory of the events leading up to his diagnosis. “For awhile I was always thirsty and the day before I got really sick, our class was on a field trip to the Nutcracker,” he said. “I wasn’t allowed to get up and get out of my seat, but I had to pee like every 15 minutes so that was a terrible experience. It was a terrible field trip.” Ephraim Apedaile is a 10-year-old who also has a pancreas that failed him. “June 30, 2012,” he said. “It was a Sunday and we came home from church and I wasn’t feeling well. My dad checked my blood sugar and the monitor said it was high, which means it was over 500, so I went to see Brett (Dr. Heath). I just wasn’t feeling good and I was
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getting a drink almost every three minutes.” BreeAnne Weidow is also a student at Daly Elementary. She’s 8 and in the second grade. “I was 5,” she said. “I was sick and really sleepy and when I told my mom I needed a drink, I went to the couch instead and couldn’t wake up. She took me to the doctor and I stayed in the hospital for a couple of days. When they figured it out, I cried when I got my finger poked and when I got my shots I was scared. But now I’m used to it.” The U.S. Center for Disease Control estimates that more than 18,000 new cases of Type 1 diabetes are diagnosed among children each year. New technology like insulin pumps allow diabetic patients to receive medication continuously and adjust doses as needed. “I got my pump right before we moved to Montana about a year and a half ago,” Searle said. “I hated it at first because it was always on me but I finally got used to it and then I was happy because my thighs weren’t always black and blue from shots.” The CDC explains that children develop Type 1 diabetes when the beta cells in the pancreas that produce insulin are destroyed. The destruction of the beta cells limits the production of insulin, which lowers blood sugar. To survive, people with Type 1 diabetes must have insulin delivered by injection or pump. Type 1 diabetes accounts for only about 5 percent of all diagnosed cases of diabetes in adults in the United States. “In the beginning I was always going low because my pancreas was still working a little,” said Searle. “But now that my pancreas officially stopped giving me insulin, I go high and have to adjust.” Andrew’s mom, Sara Searle, said that as he’s growing and maturing, it’s been harder to monitor. “Just when we think we have it all figured out, his numbers spike again,” she said. “We’ve found that exercise really helps him maintain balance and the results last into the following day. We all know the benefits of exercise and eating right, but Andrew and I are kind of science geeks and we can see that it’s all real and measurable. What we eat really matters. And when we might say we’re a little dizzy and need to eat something, we really do. That’s your body talking and it’s important that we listen.” Searle reiterated that Type 1 diabetes can’t be cured by diet and exercise alone. “Most people think I can’t have sugar, but that’s a misunderstanding. You can, you just have to realize the risk,” he said. “Ideally, I can’t eat 10 chocolate cakes a day, but neither should anyone else for obvious reasons.” Searle’s dream is to apprentice in a bakery someday soon. “Just because I love cooking doesn’t mean I have to eat it, but I usually do,” he said. “It’s fun and I love to make things I haven’t ever eaten before.” For Christmas, Searle received mostly baking supplies like funnels, oven mitts and silicone baking sheets. “My dream is to make a whole lot of money when I’m an adult so I can retire early and make food all day and be a beekeeper,” he said. Weidow already spends a lot of time in a bakery since her mom
Ravalli Republic, Wednesday, January 27, 2016 - 9
works at Red Rooster Artisan Bakery in Hamilton. “It’s a little bit hard because all the stuff is very tasty but I don’t want to eat much junk food,” she said. All three children must monitor their blood sugar at least twice a day during school. “I come to the office before lunch at 11 and before afternoon snack at 2,” Weidow said. “If I’m over 250, it’s high and I have to correct it
stacie duce – Ravalli Republic
BreeAnne Weidow, one of several students who have Type 1 Diabetes and treat them with insulin pumps monitors her blood sugar levels several times each day in school.
on my pump.” Searle also checks his blood sugar in the school office at the middle school. “We actually have quite a few Type 1 diabetic children in the district,” said Heidi Apedaile, Ephraim’s mom who works as an emergency room nurse at Marcus Daly Memorial Hospital and has been employed as a school nurse in the past. Because Hamilton School District only has one full-time nurse who must travel between schools, the office staffs are trained and knowledgeable in helping students manage their diabetes and regulate blood sugar levels throughout the day. As for advice to other children who might be diagnosed with Type 1 diabetes, Apedaile said, “It’s a lot to take care of but you have to stay calm. If you panic, it’s a lot harder on you and everyone else. It’s sad, but you’ll get used to it.” “When you first get it, it’s kind of scary because of the shots, but when you get used to it and when you get a pump, it’s all better,” added Weidow. Searle offered a helpful anecdote. “Make sure you have enough test strips wherever you go,” he said. “Once, my family went on a trip to Lake Powell and we were about a three-hour boat ride from the marina when I realized I was out of strips. We were trying to calibrate what the sensor said and adjust when we actually met a diabetic girl on a hike who let me check my blood sugar on her machine. Eventually we ordered more test strips on Amazon and they delivered them right to our boat dock. Having diabetes is always an adventure, but it’s not like I’m 80 years old or anything.”
10 - Ravalli Republic, Wednesday, January 27, 2016
Highschool concussions are a growing concern
By MARGA LINCOLN Ravalli Republic
HELENA – Could the kickoff return in football games become obsolete – going the way of the fumblerooski? The risk of injury, particularly during kickoff and punt returns, came under scrutiny during a discussion of youth athlete concussions at a recent Education and Local Government Interim Committee meeting at the state Capitol. University of Montana researcher Valerie Moody reported on her project team’s assessment of the implementation of the Dylan Steigers Protection of Youth Athletes Act. The Montana Legislature passed the act in 2013 to promote the safety of youth athletes, requiring the removal of any youth athlete showing concussion symptoms from participation until cleared medically. It’s intended to protect school athletes. Among the key findings Moody reported in a conference call to the committee were: - Half of all schools don’t have access to a certified athletic trainer or school nurse. - A number of high concussion-risk sports are being offered to youth athletes that are not sanctioned or sponsored activities by schools or school districts. - Only 84 percent of the institutions responding had a concussion policy. - Although student athletes and their parents are receiving concussion education, they are not returning signed documents indicating
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they have received and read the information – thus putting the schools at risk of liability. - While coaches are completing annual concussion training, athletic trainers and officials are not always completing the training, or having it documented. - Parents are a significant barrier to implementing the act because they are not following protocols for when students can return to play or are “doctor shopping.” - An effective source of concussion education training is the National Federation of High School Sports website. Among the recommendations were: - There is a critical need for nurses and athletic trainers in Montana schools to provide comprehensive medical care to student athletes. - More resources are needed to implement concussion policies at schools. - The Montana High School Association should continue to be the vehicle for implementing the law. - The current law should also cover non-sanctioned sports that are high concussion risks. - The role of parents’ responsibility in the current law for reporting concussions to appropriate personnel should be examined. - To recognize that cognitive baseline testing is a useful tool, although unrealistic to require at this time. - The study recommended new language for the existing law to spell out annual training requirements for coaches, athletic trainers and officials, and to include non-sanctioned sports activities in the law. Mark Beckman, executive director of MHSA spoke in support of the study and said the 1,600 officials registered in the Montana Officials Association are suspended if they don’t do the concussion training. “I think we’re making huge strides” in reducing concussions, he said. Sen. Mary Sheehy Moe, D-Great Falls, asked about getting rid of football kickoff returns. Beckman and assistant director Brian Michelotti said they were looking at recommendations about that, as well as bunch kicks and onside kicks because of the higher risk of injury. Angela Wathan, chair of the Governor’s Traumatic Brain Injury Council, spoke in support of the Dylan Steigers Act, and in support of the guideline “when in doubt, sit them out.” The council also asked for more concussion training for health care providers and for traumatic brain injury protections for sports that are not sanctioned by schools, no matter the venue. Arianna Del Negro, a board member of the Brain Injury Alliance of Montana, spoke in support of the Dylan Steigers Act being carried out to its full potential and of Moody’s study. There are far-reaching implications for those suffering brain injury, she said, which can result in a lifetime of adverse impacts. Sen. Jill Cohenour, D-East Helena, requested that a bill draft come back to the committee and that future discussions include adding nonsanctioned sports to the legislation. Committee members also requested copies of a previous bill carried by Sen. Robyn Driscoll, D-Billings, that included language on non-sanctioned sports; and a fiscal analysis of cleaning up the language in the current Dylan Steigers Act to reflect some of Moody’s recommendations.
Ravalli Republic, Wednesday, January 27, 2016 - 11
A white smile to brighten your new year By Dominic Farrenkopf
the-counter products purchased at Ravalli Republic a store or products First impressions dispensed by a are lasting impresdental office. sions, and one sure “It is important way to make a good that if patients elect impression is with a to use the over-thebright, healthy smile. counter products, Dentist Jeremy they should still Anderson and his have a full dental staff at Victor Dental evaluation. This will Clinic are pleased to rule out any dental help people achieve health problems their healthy smile that may be presgoals. ent prior to starting “Discolored teeth any bleaching regican arise from a men,” Anderson multitude of factors, said. and understanding Choosing to have the cause is the first your dentist adminstep in the process ister a whitening to achieving a whiter DOMINIC FARRENKOPF – Ravalli Republic treatment presents smile,” Anderson said. Dr. Jeremy Anderson and the staff of Victor Dental Clinic show off their white smiles outside one of their four operatories. a unique case-by“Discoloration occurs case situation that from external surface requires custom-fit staining, decay, restorations, root canal treatment on the tooth or a bleach trays. dead tooth. These causes have different ways of being addressed “I prefer to make custom bleaching trays for patients. They then to produce the desired result of a white smile. The second step use them at home with gel dispensed from my office,” Anderson involves visiting with your dentist and having a full dental evaluasaid. “The bleaching gel dispensed from a dental office typically is tion.” going to have a stronger concentration than over-the-counter prodThe mission of Victor Dental Clinic is to provide excellent oral ucts, thus getting white teeth faster. Because the trays have a cushealth care by educating its patients and helping them make good tom fit, there is minimal irritation of the gum tissue. This method has decisions. a higher upfront cost due to fabricating the trays but, from that point Anderson offers this advice: It is very important to have a healthy on, the same trays can be used and only refills of the whitening gel mouth prior to starting any treatment to whiten teeth and, when need to be purchased.” your dentist evaluates you, you should discuss proper use of bleachAnderson started practicing in Victor in 2008 after graduating from ing material. the University of Iowa’s College of Dentistry. “The material itself can be very harmful to the gum tissue if used “Beauty is in the eye of the beholder,” he said. “Each person has inappropriately,” he said. “It is also important to discuss tooth sensi- a different goal in mind of what they want their smile to be. When tivity. Increased tooth sensitivity during bleaching is a very common they are able to achieve that goal, it can mean the world to them. side effect. After an evaluation by your dentist, he or she will be Confidence, self-esteem and just plain happiness can get a nice able to advise you on the best way to achieve the whitening result boost when you are able to show off your smile every day.” desired.” Several whitening options exist. Patients can choose from over-