Medical Handbook 2012

2012

Medical Handbook

Dr. Anita Conte , Medical Oncologist

We

Dr. Michael Mak, Medical Oncologist

Dr. Rahul Dewan, Radiation Oncologist

of beating cancer as a team effort.

At Columbus Regional Health’s nationally accredited Cancer Center, we’ve created a continuous care model that allows you to be treated by a single team of doctors and healthcare experts throughout your entire treatment and recovery process for the best possible outcome. t First, our team of Pathologists, Radiologists and Surgeons use innovative technology to diagnose cancer early. t If a cancer diagnosis is made, a clinical team of Certified Radiation and Medical Oncologists, Cancer Nurse Navigators, a Radiation Physicist, Radiation Therapists and other experts come together to thoroughly plan your immediate treatment. t During every step of the way, your team provides you with the ongoing support and state-of-the-art care you need for a successful recovery.

When it comes to a successful treatment for cancer recovery, there’s no place that thinks like Columbus Regional Health.

Learn more about how we’re thinking beyond at crh.org/cancer Scan this QR code with your phone to learn more

Contents Working toward better sleep. . . . . . . . . . . . . . . . . . . . . 2

Post-cancer rehabilitation. . . . . . . . . . . . . . . . . . . . . . 30

Da Vinci Surgical System. . . . . . . . . . . . . . . . . . . . . . . . 6

Staying out of the ER. . . . . . . . . . . . . . . . . . . . . . . . . . 32

Annual physical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Infants and obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Protect your hearing. . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Adolescent health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Enemies of teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Food storage safety. . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Achilles heel spur. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Food and drugs don’t mix. . . . . . . . . . . . . . . . . . . . . . 39

Generic medications. . . . . . . . . . . . . . . . . . . . . . . . . . 16

When to weigh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Parkinson’s disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Health screenings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Colonoscopies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Work out without eating. . . . . . . . . . . . . . . . . . . . . . . . 24 Lowering diabetes risk. . . . . . . . . . . . . . . . . . . . . . . . . 26 Healthy bones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Comments should be sent to Doug Showalter, The Republic, 333 Second St., Columbus, IN 47201 or call 812-379-5625 or dshowalter@therepublic. com. Advertising information: Call 812-379-5652. ©2012 by Home News Enterprises All rights reserved. Reproduction of stories, photographs and advertisements without permission is prohibited. Publisher: Chuck Wells; Special Publications Editor: Doug Showalter; Copy Editor: Katharine Smith; Graphic Designer: Phillip Spalding. Stock images provided by © Thinkstock.

Do you experience discomfort, swelling and varicose veins?

?

PAD affects millions of Americans and is often underdiagnosed and treated.

PAD and venous disease can be identified using simple, non-invasive screening tests. Once identified, they can often be treated with a variety of minimally invasive techniques. We provide the latest in minimally invasive treatments including medical laser technology and radio frequency venous ablation.

Vascular Partners, LLC is committed to providing treatment for PAD and venous disease using a personalized patient-centered approach. If you think you are having symptoms of PAD or venous disease, our friendly staff is willing to answer any questions or concerns you might have.

John A. Fry

MD, FACC, FSCAI Coronary Angioplasty, Stent Implantation Cardiology

Matthew H. French MD, FACC, FSCAI Coronary Angioplasty, Stent Implantation, Cardiology Internal Medicine

4001 Goeller Blvd. Suite A | Columbus

812/342-2100 | 866/281-9202 | www.vascularpartners.com 2012 MEDICAL HANDBOOK

1

Work your way to a sound sleep

By Sally Anderson Tampa Bay Times How would you rate your sleeping habits? Hopefully, favorably, considering we spend about a third of our life sleeping and about half the population deals with sleep issues.

According to research, the average adult sleeps fewer than seven hours per night. Chronic sleep deprivation can negatively affect our immune system, making us more vulnerable to many health issues, and it certainly has a negative effect on our daily moods, performance capabilities and energy levels. Amazingly, it even has an impact on weight.

Michael Bruis, author of “Beauty Sleep” and the clinical director of the sleep division for Arrowhead Health in Glendale, Ariz., said two hormones — ghrelin and leptin — are key in this process.

Ghrelin is the hormone that tells you when to eat. When you are sleepdeprived, you have more ghrelin.

Leptin is the hormone that tells you to stop eating, and when you are sleep-deprived, you have less leptin.

You are eating more, plus your metabolism is slower when you are sleepdeprived, Bruis says.

Three common sleep myths Myth 1: You need eight hours of sleep.

Fact: Eight is not necessarily the magic number; it is just an average.

Seven to nine hours of sleep is generally recommended for both older and younger adults to function at their best.

2

2012 MEDICAL HANDBOOK

SHNS photos

The palm-tree pose Myth 2: Sleeping longer will help fatigue.

Fact: Oversleeping alters your sleep pattern, which can make for a difficult time to fall asleep the following night. If you are getting seven to nine hours of sleep and still feel

fatigued, you could have issues that need medical attention.

Myth 3: You don’t need naps.

Fact: A short nap, no longer than 10 to 30 minutes in early to midafternoon, can give you a boost of energy. However, naps late in the day

ARE YOU READY TO GET OUT AND ENJOY LIFE? OUR ORTHOPEDIC SPECIALISTS CAN HELP! Joint Replacement Spine & Neck Sports Medicine ACL Reconstruction Knee Surgery Shoulder Surgery Foot & Ankle Surgery Hand, Elbow & Wrist Surgery Scoliosis Osteoarthritis Fracture Care MRI & Dexa Scan

Find Us On

Thomas W. Marshall, M.D.

Larry D. Olson, M.D.

David D. Gallagher, M.D.

Darryl A. Tannenbaum, M.D.

John B. Chambers, M.D.

Douglas J. Federle, M.D.

Cary M. Guse, M.D.

Lisa R. Lanham, DPM

Four Convenient Locations in Columbus, Seymour, Greensburg and North Vernon.

812.376.9353 | 800.886.9353 | www.southerninortho.com 2012 MEDICAL HANDBOOK

3

can mess up your sleep cycle, making it more difficult to get to sleep at night.

Conditioning to fall asleep While there are many sleep issues that may need the attention of a physician, the most common causes for insomnia in older adults are poor daytime habits and a poor sleep environment. Here are some tips:  Let the sunshine in: Spend some time outside, particularly in the morning. Sunlight stimulates your body to produce melatonin, which is a natural hormone that helps regulate your sleep-wake cycle.  The sleep/exercise connection: Physical activity gives sound sleeping a big boost. However, timing is important, as exercising too close to bedtime could give you too much energy to sleep soundly. Do 20 to 30 minutes of cardio earlier in the day for the most sleep-enhancing benefit.  Eating habits: Avoid rich, heavy meals later in the evening. Fatty foods are harder to digest, making a lot of work for the stomach and, perhaps, an uncomfortable night’s sleep.  Sleep routine: A cool, dark and quiet room is best for sleeping.

Develop a nightly routine that relaxes you, such as reading, listening to music or soaking in a hot bath. Try to go to bed and get up at the same time every day. The regularity will help to set your sleep-wake clock, improving the quality of your sleep.  Don’t be a clock watcher: Cover the clock by your bed or turn it around so you can’t see what time it is when you wake up in the night. Clock watching can create stress and make it difficult to go back to sleep.  Manage stress: Deep breathing, meditation, progressive relaxation and performing easy stretches are 4

2012 MEDICAL HANDBOOK

Knee drop

Pretzel stretch stress-management tools that can help with the transition between being awake and ready for sleep.

It’s a stretch Stretching helps reduce muscle tension and gets you ready for a good night’s sleep:  Palm-tree pose This is a whole-body stretch.

Standing tall with feet together, clasp hands, palms facing outward. While inhaling, slowly stretch arms upward, palms now facing upward. Lift heels

off the floor, stretching body upwards as far as you can. Exhaling slowly, lower arms and heels.  Child’s pose This is a very relaxing yoga pose that stretches backs and hips.

Beginning on hands and knees, sit back into heels while stretching arms forward. Relax into the stretch. Move the straight arms to the right side and you will be stretching your left side.

Hold for a few seconds, then repeat on opposite side.  Knee drops This is a hip and lower-back stretch. Lying on your back, bend knees with feet flat on floor, relaxing arms to the sides. Keeping shoulder blades on the floor, drop knees to the right side, turning head to the left.

Take several deep breaths, repeating to opposite side.  Pretzel stretch This targets hips and outer thighs.

Sitting on floor with back straight, extend legs to the front. Cross left leg over right leg, placing foot flat on the floor. Turn upper body to the left, placing elbow of opposite arm to the outside of the bent knee. Hold 15 to 30 seconds; change legs and repeat.

2012 MEDICAL HANDBOOK

5

da Vinci Surgery

Da Vinci Surgical System can improve procedure results

By Karen Werskey Medical conditions that require surgical intervention are now being performed through leading edge technology. Thanks to the da Vinci Surgical System, patients at Schneck Medical Center in Seymour are experiencing major surgeries through incisions smaller than a staple, with less pain and a rapid recovery rate.

Common types of gynecologic conditions like fibroids (non-cancerous growths in the uterine wall), endometriosis (non-cancerous growths of the uterine lining) or prolapse (falling or slipping of the uterus) can cause chronic pain and heavy bleeding, as well as other disabling symptoms.

Women who experience these symptoms are often treated surgically 6

2012 MEDICAL HANDBOOK

by removal of the uterus, known as a hysterectomy.

Hysterectomy can sometimes be performed through the vagina.

However, when the uterus is large or if you have internal scarring from prior surgery or other conditions, abdominal hysterectomy is usually performed.

Traditionally, abdominal hysterectomies are performed with open surgery, which requires a wide incision below the navel. This procedure can be painful, involving heavy pain medications, risk of infection and significant blood loss and a large scar from the incision. After surgery, a long recovery is necessary.

As an alternative, there are innovative, less invasive surgical pro-

cedures. These procedures use the state-of-the-art da Vinci surgical system to help your doctor perform the most precise and least invasive procedures available today.

Colorectal procedures are usually performed via traditional open surgery, meaning a large open abdominal incision is made from the pubic bone to just below the breastbone. While open surgery can provide an effective treatment for colorectal cancer, it often involves significant trauma and a long recovery.

Laparoscopic surgery is a minimally invasive alternative to open surgery.

Traditional laparoscopic technique provides better satisfaction for the patient; however, it is more challenging for the surgeon due to the extensive

dissection required, limited articulation of laparoscopic instruments and counter-intuitive movements for the surgeon.

Surgical intervention, such as a da Vinci colectomy, can offer potential benefits such as excellent cancer control, low rate of complications, prompt return to a normal diet, short hospital stay, fast return of bowel function and a faster recovery.

More than 13,000 U.S. residents die from kidney cancer each year.

Fortunately, with early diagnosis and treatment, kidney cancer can have a survival rate of 60 percent.

The gold standard treatment for localized kidney cancer is surgery through an open approach, requiring a large incision. Conventional laparoscopy is less invasive but has limitations for the surgeon. But da Vinci surgery uses the best techniques

of open surgery and applies them to a robotic-assisted, minimally invasive approach, thus allowing your surgeon to perform a precise minimally invasive surgery. It may also provide your surgeon the means to preserve your kidney by removing just the tumor When diagnosed with prostate cancer, men have voiced three main concerns: getting rid of the cancer, maintaining urinary function and preserving sexual function. A da Vinci radical prostatectomy addresses all three concerns.

With the system, the surgeon has enhanced precision that filters any tremors of the hands while scaling the motions of the small instrument tips with more accurate movements.

High-definition 3-D vision and up to 10x magnification enable your doctor to see the cancer, healthy tissues and blood vessels at a level of detail

far greater than with open surgery or conventional laparoscopic surgery.

Obesity is a serious medical condition affecting about 400 million adults worldwide. Mounting evidence suggests surgery may be among the most effective treatments for obesity and related diseases.

The most commonly performed weight loss operations are Roux-en-Y gastric bypass, gastric sleeve and duodenal switch. All can be performed in an open or minimally invasive manner. If your doctor recommends bariatric surgery to treat obesity, you may be a candidate for a safe and effective minimally invasive procedure with the da Vinci surgical system.

Information: www.daVincisurgery. com.

Karen Werskey is da Vinci surgical robotics coordinator at Schneck Medical Center.

2012 MEDICAL HANDBOOK

7

8

2012 MEDICAL HANDBOOK

2012 MEDICAL HANDBOOK

9

annual physical important to reveal changes in health

By Jennifer Willhite Most of us adopt a passive role during a doctor’s visit. And an annual physical is no exception.

How do you get more involved?

How do you know what questions to ask? What exactly is the doctor looking for?

Let’s start at the beginning.

Typically, a physical exam, also known as a wellness exam, is catered to the individual.

In most cases, age determines what the exam will include in addition to the standard evaluation. Regardless of the patient’s age, physicians check to make sure he is up to date on his immunizations and preventive screenings and tests.

As you have probably experienced, the doctor checks your vital signs, including blood pressure, listens to your heart and lungs, and assesses your overall appearance and weight. The doctor may also conduct abdominal 10

2012 MEDICAL HANDBOOK

and neurological exams to check for signs of fluid retention, arterial and muscle health, and mental acuity.

According to Dr. Amanda Dornfeld, of Sandcrest Family Medicine, when the physician follows this formula, he is conducting what’s called a “review of systems.” He is looking for any changes or significant markers indicative of disease or the potential for disease.

So what is meant by significant changes?

“We want to be sure someone doesn’t have headaches, chest pain, shortness of breath, abdominal pain, change in their bowels, blood in their stool or diarrhea,” says Dornfeld.

“Any of those things would be important.”

Any out-of-the-ordinary changes, even subtle differences, can be your body’s way of letting you know something’s not right.

For instance, do you snore? Did

you know snoring could be a symptom of something more serious?

Associated with airway obstruction, snoring can be indicative of sleep apnea. Snoring, though seemingly annoying and innocuous, can be worth discussing with your doctor.

Physicians may order additional tests following the physical exam.

Depending on age and individual medical history, they may range from simple blood work to urinalysis or more extensive evaluations, such as a colonoscopy.

Although not considered part of a standard physical exam, blood panels, conducted to evaluate cholesterol and blood sugar levels, are recommended periodically. According to Dornfeld, blood work should be performed at least every five years, unless there are symptoms or another reason for concern, such as a family history of disease or risk factors like hypertension or obesity.

Gender-specific tests may also be involved. According to WebMD.com, annual physicals for men can entail testicular, prostate and hernia examinations. Each is performed to check for tenderness or other abnormalities that may indicate infection or disease.

Breast and pelvic examinations are part of a woman’s physical. Each is performed to determine if there are irregularities, such as lumps or tenderness. As part of the pelvic exam, additional screening, such as a Pap test, may be performed. How frequently breast and pelvic exams are ordered is dependent on the age and complete medical history of the patient.

In most cases, individuals have nothing to report during a physical.

However, an annual exam is a prime opportunity to speak with your doctor about any concerns you may have about your health.

“Definitely, an important part of a physical is talking about risk factors and trying to decrease risk factors or eliminate them,” Dornfeld says. “We always talk about smoking, exercise and weight.”

You, as the patient, are an active participant in your health care. Use your time with the doctor, even if it is once a year, to educate yourself and ask questions.

Not sure what to ask? Consider the following.  Ask about immunizations. Are you up-to-date? What about seasonal vaccinations?  Are you due for any screenings?

If so, which ones?  Are you taking medications? Do they need to be adjusted or changed?  Have you any concerns about your family’s medical history? Could you be at risk for chronic disease,

such as diabetes or cancer? Ask what preventive measures you can take.  How’s your weight? Ask your doctor for advice or recommendations for weight loss.  What about lifestyle changes?

Thinking of exercising? Where should you start?  Wanting to quit smoking? Ask for advice about quitting and support options.

Make the most of your physical exam. Prepare your questions ahead of time. If need be, write them down.

Even if you have no concerns, keeping your annual appointment is a good thing to ensure you keep communication open with your doctor.

“It is kind of a time to touch base,” Dornfeld says, “to make sure there’s nothing new going on that we need to evaluate.”

INDIANA HEART PHYSICIANS We have been dedicated to providing quality, cost effective care since 1987. Indiana Heart Physicians is the most experienced and respected cardiovascular physician group in South Central Indiana. Our services are offered at convenient locations, where we work in collaboration with primary care physicians and area hospitals to address our patients’ needs close to home.

We provide 24/7 emergency interventional cardiology coverage for the region.

Office Services:

Cardiac Consultation Echocardiogram Stress Echocardiogram Nuclear Stress Testing 12-Lead EKG Holter Monitor Event Monitor Service

Invasive Cardiology Procedures:

Pacemaker Implantation • Cardiac Catheterization Angioplasty • Stent Implantation • TEE

David Hamilton, M.D.

Kevin Preuss, M.D.

Melinda Hunnicutt, M.D.

Mark Hatfield, M.D.

Samantha James Schmidt, Svarczkopf, M.D. M.D.

Bobbie Robb, N.P.

Comprehensive Minimally Invasive Endovascular Procedures:

Minimally Invasive Treatment For Peripheral Vascular Disease

Electrophysiology:

Pacemakers/Defibrillators and Follow-up Arrhythmia Management

In the heart of the community, for the hearts of the community Columbus • Seymour • Greensburg • North Vernon For appointments call: 812-379-2020 or 1-800-537-9587

Brian Akrami, D.O.

2012 MEDICAL HANDBOOK

11

Protect your hearing by bettering your health

By Dr. Kasia Ostrzenska St. Petersburg Times Recently I was approached by a colleague with a new gizmo in hand — a hearing screener.

Much to my surprise, the quick test showed that I may have some hearing loss.

WHAT? As a primary care doctor (and quite a few years from the age group targeted in ads for hearing aids), I realized then just how little emphasis is placed on protecting our hearing at every age.

We are constantly reminded to protect ourselves from sun damage, to get regular eye exams, dental exams and other important screenings. But for some reason, hearing is pushed into the “once you can’t hear, come see me” category.

Look back at your life. How many concerts did you

attend without earplugs? How often do you pump up the volume when your favorite song plays?

Vacuum cleaners, lawn mowers, leaf blowers, motorcycles and countless other annoyances all contribute to

Hospice of South Central Indiana Comfort. Care. Compassion.

Hospice is hope. Hope for the best possible care during an advanced illness. Hospice is not a place, but a compassionate approach to care.

The goal of your community hospice is to help people with an advanced illness or condition to live life fully, maintain their dignity and keep control over their lives.

• Hospice of South Central Indiana is your not-for-profit community hospice serving southern Indiana for over 30 years.

• Hospice services are provided wherever the patient resides: home, assisted living facility, nursing home, hospital or Hospice Inpatient Facility.

• The Hospice Medicare/Medicaid Benefit covers care and services related to the advanced illness. Residents of south central Indiana are qualified for and deserving of hospice services.

• Hospice offers 24 hours per day, 7 days per week physiciandirected medical care, on-call nurse availability and referral information.

Your community hospice gives patients and families choices and puts them in charge of their care and of their lives. Hospice of South Central Indiana serves the following counties: Bartholomew, Brown, Clark, Dearborn, Decatur, Jackson, Jefferson, Jennings, Johnson, Ohio, Ripley, Rush, Scott, Shelby and Switzerland.

2626 E. 17th Street • Columbus, IN 47201 812-314.8000 • 1.800.841.4938 ext. 8000 12

2012 MEDICAL HANDBOOK

www.hospiceofsouthcentralindiana.org

the daily assault on our hearing.

Consider your job: Firefighters, police officers, construction workers and many others are at a much higher risk of developing hearing loss as a result of their noise exposure. Our children are exposed to loud sounds every day, and many parents, barraged by noise themselves, don’t give too much thought to the potential impact on those young ears.

How many of us have ever even invested a couple of bucks in a pair of earplugs?

Yet once hearing loss occurs, the cost of treatment is considerable. Most people don’t realize hearing aids often are not covered by insurance plans, and they can cost thousands of dollars.

They can take some time to get used to, and background noise often prevents patients from using them altogether. People with significant hearing loss may avoid social situations, becoming more withdrawn from friends and family, which leads to isolation and depression.

So do not neglect your hearing health. Protect your children early in life. Know your risk factors. Both vision and hearing are influenced by diet and lifestyle factors.

For example, diabetics have a higher risk of not only developing eye problems but also hearing loss.

Chronic use of alcohol, and medications such as very high doses of aspirin, ibuprofen, acetaminophen, certain antibiotics, some chemotherapy medications and progestin (used in hormone-replacement therapies), are all linked to potential hearing loss.

Noise, however, is the leading cause of hearing impairment. According to the National Institutes of Health, approximately 26 million Americans suffer from noiseinduced hearing loss.

So what can we do to optimize our hearing health?  First and foremost, follow the diet and exercise rules that benefit every aspect of health, including hearing.

There are some indications that antioxidants like vitamins A and C may fight free-radical damage, including to the auditory system. So eat lots of fresh fruits and veggies and take a good multivitamin for insurance.  Use earplugs as often as possible whenever exposed to loud noises.  Lower the volume on your iPods, stereos, TVs, cellphones and any other gadget.  Spread the word about hearing protection to your family and friends. Be noise-conscious and save your hearing.

2012 MEDICAL HANDBOOK

13

Soda pop and energy drinks are enemies of teeth

by Dr. Erica Bayoneto and Dr. Mark Gardner As specialists in pediatric dentistry, we lament that soda pop and energy drinks are job security for dentists.

These drinks have become substantial dietary sources of tooth decay, affecting people of all ages.

The problems with soda pop and energy drinks are twofold: first, the sugar content in these drinks is bad for your teeth, and second, the acid is extremely high.

Sugar is broken down into acidic byproducts, and in combination with the acids in soda pop and energy drinks, tooth enamel is softened and cavities are the result. Lots of them.

Dental caries, or tooth decay, is the most prevalent health care problem facing American infants, children and adolescents. It is five times more prevalent than asthma, which is the second most common health care problem, according to the Centers for Disease Control.

Frequent ingestion of sugars and other carbohydrates (e.g., fruit juices, acidic beverages) and prolonged contact of these substances with teeth are particular risk factors in the development of cavities.

A recent study indicated that 13 percent of children age 2 through 10 had diets high in consumption of carbonated soft drinks, and these children had a significantly higher tooth decay experience than did children with other fluid consumption patterns.

“Erica and I rarely have a day in our practice when we do not see one or two infants or toddlers with a severe form of tooth decay called ‘early childhood caries,’” Gardner said. “There is virtually always an associated consumption of these beverages with the development of this condition.”

Increased consumption of sweetened beverages and snack foods has also been linked to obesity. Childhood obesity has reached epidemic proportions worldwide and leads to many other associated health risks.

Many soft drinks also contain significant amounts of caffeine, which if consumed regularly may lead to increased or even habitual usage.

A study looking at the consumption of these drinks by teenage girls showed that girls who increased their con14

2012 MEDICAL HANDBOOK

submitted photo

sumption of soft drinks had a 40 percent decrease in their consumption of milk, which may contribute to a decrease in bone density, subsequent increase in fractures and future risk of osteoporosis.

Tooth decay has been reported at much higher levels in those children who attended schools that had vending machines with soda pop and energy drinks.

Many beverage and snack food products are targeted specifically and aggressively at the child and adolescent market. Vending machines containing these products are readily accessible to children and adolescents in schools.

An effort is under way to increase the healthy choices available in vending machines by replacing sugar-sweetened drinks with bottled water, candy bars with nutrition bars and potato chips with dried fruits and nuts.

Dental health is imperative to overall health. Bayoneto tells her patients to “brush your teeth two times a day with fluoride-containing toothpaste, floss at least once a day and be sure to visit your dentist every six months for a checkup.”

Gardner and Bayoneto agree that avoiding soda pop and energy drinks that have high sugar content and are very acidic is an important factor in maintaining good health and especially important in maintaining good dental health.

Dr. Erica Bayoneto and Dr. Mark Gardner are boardcertified specialists in pediatric dentistry with Children’s Dental Care in Columbus.

Treatments vary for Achilles tendon spurs

By Dr. Scott Benjamin According to Greek mythology, the hero Achilles had only one weakness — the tendon that now bears his name, located in the back of the heel. As Achilles could attest, any injury or dysfunction of this tendon would certainly be debilitating. Maybe Achilles’ problem was a spur in this area. Who knows? Homer’s “Iliad” offers no clues.

The Achilles tendon is a large, powerful tendon whose function is crucial to normal walking. One of the more common problems associated with this tendon is the formation of a large spur at the tendon’s insertion behind the heel. Along with spurring, there is usually calcification within the tendon as well. This combination of spur and calcification causes both mechanical pain from rubbing in the shoe and dysfunction of the tendon leading to problems pushing off the foot with normal walking.

Patients who present with this problem typically resort to the use of backless shoes or a heel lift or both to relieve pressure from the spur. They typically complain of an inability to walk normally due to pain.

Pain is worse with any increase in activity, and running or jumping usually becomes impossible. Pain is concentrated at the Achilles insertion point in the back of the heel but can spread upward into the tendon as well.

Diagnosis of this condition is very straightforward. A large “bump” of bone is noted at the back of the heel, with associated redness, swelling and pain with pressure over the area. The Achilles tendon is usually thickened at the insertion site from both inflammation and calcification in the tendon. A simple X-ray will confirm both spur and calcification in the tendon. An MRI to better image the tendon can be obtained if a tear is suspected, but in most cases is not necessary.

Conservative treatment options are fairly limited, but should always be attempted for initial treatment.

Treatments such as padding the heel counter in the back of the shoe or wearing backless shoes as mentioned earlier can sometimes eliminate spur pressure. There is also a special sock made with a gel pad to cushion the spur.

Injecting the Achilles insertion with cortisone and placing the patient in a cast boot for three to four weeks is another option, but should be used with caution be-

submitted photo

cause of risk of tendon rupture. In the presence of a large spur, however, conservative treatment is rarely curative.

Definitive treatment involves removing the spur surgically. This is not as simple as it sounds because a portion of the Achilles tendon must be released to access the spur in order to remove it. I always debride the tendon as well to remove calcification and improve function.

The technique I use involves splitting the Achilles tendon down the middle so only the middle portion of the tendon is released from the attachment site. This allows good exposure of the spur, which is removed entirely along with calcifications.

The tendon is then reattached with tiny anchors that embed into the back of the heel bone. The anchors increase stability of the tendon and allow earlier range of motion exercises and weight bearing.

Post operatively, I recommend four weeks of no weight bearing, followed by four more weeks of protected weight bearing in a walking cast boot. I initiate physical therapy at two weeks post operative, which is critical to a quicker return to normal activities.

Achilles spurs are a fairly common condition that can cause great disability and pain, so are very satisfying to treat. If this sounds like something you may have, make sure to see a physician trained in diagnosing and treating this condition.

Dr. Scott Benjamin is a podiatrist at Benjamin Podiatry.

2012 MEDICAL HANDBOOK

15

Pharmacists’ perspectives on generic medications

By Brianna Martin and Chris Soedel As the price of nearly everything is going up, you may wonder how you can save money on your prescription and over-the-counter (non-prescription) medications. One option is to have your new prescriptions filled with generic medications or switch your current prescriptions over to the generic. Generic medications may cost less than brand name products, but there are some things you need to know.

Generic drugs contain the same active ingredients as the brand-name drug. They are approved by the FDA

16

2012 MEDICAL HANDBOOK

only after meeting the same standards as the brand product. Companies have to prove that their generic works in the same way as the brand.

Their color, size, taste or markings may be different, but generics come in the same dosage form and strength as the original. They are also as safe and work just as well. The companies making generics must also meet the same manufacturing standards as those making the brand-name drugs.

The original company that researches, develops and makes a drug gives the medication a brand (or trade) name in addition to its generic (or chemical) name. Because manu-

facturers invest billions of dollars developing drugs, the drugs are given patents.

Most drug patents last for 20 years. While a medication has patent protection, the companies charge a higher price for the drug. Once the patent expires, other drug companies can begin to make and sell the generic version.

Sometimes, companies bargain with each other or fight in a court of law about patents and making a new generic medication. This can delay the release of a generic or give a company exclusive rights to make the new generic for a certain amount of time.

The first company approved by the FDA to make the new generic drug is given six months of market exclusivity to sell the drug. This means that they can make and sell the generic version of the drug for six months before any other company is allowed to sell its version of the generic drug.

During this six months, the price may fall by only about 10 percent. Once other companies enter the market, the price may fall by 80 percent to 85

percent.

Many doctors and pharmacists recommend staying with certain brand name medications or one generic company. Often these particular drugs require blood testing to make sure you are getting enough medication to be effective but that you also aren’t getting too much of the drug.

Some examples include blood thinners, thyroid medications and some seizure medications.

Some popular medications that may have generics available in 20122013 include:  Seroquel (quetiapine) for bipolar disorder, depression and schizophrenia.  Lexapro (escitalopram) for anxiety and depression.  Plavix (clopidogrel) for prevention of clotting in cardiac or stroke patients.  Actos (pioglitazone) for diabetes type 2.  Singulair (montekulast) for asthma and allergic rhinitis.

Using generic drugs in place of the brand-name products can leave you with more money in your wallet.

Your pharmacist can provide further advice.

Brianna Martin is a staff pharmacist at Columbus Regional Health, and Chris Soedel is clinical pharmacy coordinator.

World-Class Foot & Ankle Care

Without Leaving Columbus

Our team provides comprehensive medical and surgical care for all foot and ankle conditions.

From common problems to complex conditions, we will use the latest technology to help restore mobility and get you back on your feet.

DR. JOHN R. HLADIK, DPM, CWS

Fellow, American College of Foot & Ankle Surgeons Board certified, American Board of Podiatric Surgery Board certified, American Board of Wound Management Internship and residency, foot and ankle surgery– Mount Sinai Medical Center/Case Western Reserve University, Cleveland

DR. TYLER A. GROUT, DPM Board eligible, American Board of Podiatric Surgery Internship and residency, foot and ankle surgery– University of Pittsburgh Medical Center, Pittsburgh

C

LUMBUS , FOOT & ANKLE Inc.

RECONSTRUCTIVE SURGERY • ANKLE ARTHROSCOPY SMALL JOINT REPLACEMENT SURGERY DIABETIC LIMB PRESERVATION/WOUND CARE TREATMENT OF FAILED PREVIOUS SURGERY • SECOND AND THIRD OPINIONS

360 PLAZA DRIVE, SUITE B | COLUMBUS, IN | 812.372.6274 | COLUMBUSFOOTANKLE.COM 2012 MEDICAL HANDBOOK

17

associated Press

Parkinson’s patients participate in dance class therapy.

Parkinson’s disease affects quality of life

By Lydia Brown Parkinson’s disease (PD) is a progressive neurological disorder that affects movement. The hallmark symptoms are tremors, slowed movement, difficulty beginning a movement and muscle stiffness. PD occurs when cells that produce a chemical called dopamine deep in the brain 18

2012 MEDICAL HANDBOOK

gradually die off, which affects the movement pathway in the brain.

While Parkinson’s disease is not fatal in itself, it does affect quality of life and can lead to other health issues.

Currently, there is no cure for PD, but there are many treatments available that can reduce symptoms and slow the rate of progression.

No one knows exactly what causes Parkinson’s disease. Scientists believe it is caused by genetic and environmental factors. Some studies show that men have a slightly higher risk of developing PD than women.

Other risk factors include having a family history, exposure to pesticides, and consumption of well water and

certain metals. However, having one or more of these risk factors does not necessarily mean you will develop the disease.

While the risk of developing Parkinson’s increases with age, it is not just an “old person’s disease.”

Approximately 10 percent of people with PD are under 50, and some have been diagnosed as young as 18. About 1 million people in North America have Parkinson’s, and 50,000 new cases are diagnosed yearly.

There is no medical test available to conclusively diagnose PD. A neurologist or movement disorder specialist makes the diagnosis by assessing symptoms and ruling out other causes. Because of this, misdiagnoses are sometimes made, especially at the onset of the disease.

Early signs of PD can be subtle and sometimes written off as “getting old.”

Common initial sensations include aching, burning or tingling sensations, and numbness or coldness. Usually, issues begin on one side of the body, gradually spreading to both sides.

Not everyone with Parkinson’s experiences every symptom. Most experience mild cognitive deficits, such as having difficulty planning and following through on difficult tasks.

Some develop dementia as the disease progresses; this risk increases with age. Depression affects about half of people with PD. Other health issues associated with PD include impaired balance and a stooped posture. People with PD often have a “masked” facial expression. Speech, voice and swallowing problems can occur. Handwriting can become small and illegible. Fatigue and sleep disturbances are common.

Treatments for PD can be as

individual as its presentation.

Medications can relieve some of the movement symptoms and increase mobility. A type of neurosurgery called deep brain stimulation can help control motor issues in some people.

Exercise is becoming an increasingly popular and effective form of therapy, and exercise programs exist specifically for people with PD. Neurologists also recommend that people with PD keep their brains active. Speech therapists, occupational therapists and physical therapists can improve quality of life.

Columbus Regional Health sponsors a support group to provide resources and emotional support for patients and their families. Please call 376-5393 for more information.

Lydia Brown is a speech-language pathologist at Columbus Regional Health.

Serving children in this community for 38 years.

S

WE ARE ACCEPTING NEW PATIENTS. As a patient you will enjoy the highest quality of pediatric medicine.

Join our practice for newborn through early adult well exams, sports physicals, illnesses, school difficulties, or any parental concern that you may have. We provide care for many childhood problems as well as prevention, diagnosis and treatment of more serious conditions. Our phone nurses are Licensed RNs. Several Riley physicians satellite here. We participate in and file several insurances. VFC immunizations. A personal and friendly staff.

Walk-in hours Mon–Sat 7:30–9:00 a.m. (for established patients only) D ct Do Doctors on call 24/7 • We accept new Medicaid • Same day appointments for illnesses

1120 N. Marr Rd. • 812-376-9219 • www.columbuspeds.com 112 2012 MEDICAL HANDBOOK

19

Early diagnosis is how we At Columbus Regional Health’s Lung Institute, we’re thinking about the innovative care needed for the fight against lung cancer. • That’s why we have a talented team of specialists dedicated to diagnosing it early with Electromagnetic Navigation Bronchoscopy. • Dr. David Wilson, who performs more of these procedures than any other physician in the world, uses this technology to look deeper into narrow lung passages than traditional bronchoscopy, gathering a small tissue sample to biopsy.

• To confirm a diagnosis, our team of Pathologists reviews the tissue. • After diagnosis, our physicians partner with our Cancer Center to start a treatment plan early when the potential for a cure is highest.

When it comes to diagnosing and treating lung cancer, there’s no place that thinks like Columbus Regional Health.

20

2012 MEDICAL HANDBOOK

Dr. Pam Robertson, Clinical & Anatomic Pathologist

Dr. David Wilson, Pulmonary Medicine & Critical Care Physician

to beat lung cancer.

Learn more about how we’re thinking beyond at crh.org/lung Scan this QR code with your phone to learn more

2012 MEDICAL HANDBOOK

21

Recommendations for health screenings vary

By Jennifer Willhite It seems like recommendations for medical screenings and tests are constantly changing.

Trying to follow the latest recommendations from medical and governmental bodies can be frustrating at best. It is never too early to start having an annual physical, also known as a wellness exam, but not everyone needs a battery of tests every year.

So how do you know which guidelines to follow when it comes to preventive care?

“Sometimes new data emerges, and lots of people will have an opinion about what is considered good preventative care for men and women,” says Dr. David Porter of Sandcrest Family Medicine. “It is important for health care consumers to weigh the information and make good decisions for themselves in consultation with their medical provider.”

As we all quickly learn, with time, the human body begins to demonstrate signs of aging and wear. People generally start to experience more medical issues following their 50th birthday. However, risk factors play a prominent role in determining not only how we age, but what medical issues we may develop.

According to the American Academy of Family Physicians, risk factors are the prime determinant for whether preventive testing should be performed.

For instance, if you smoke you may be at risk for heart disease, diabetes or other chronic conditions; whereas, a nonsmoker may have a substan22

2012 MEDICAL HANDBOOK

tially lesser risk for the same illnesses.

Therefore your doctor may recommend regular testing. Being honest about lifestyle and risk factors is instrumental in guaranteeing the right preventive care for your situation.

Among the most debated preventive tests and screenings for women are mammography and Pap tests.

According to current guidelines, Porter says, women with no personal or familial history of breast cancer may not need to undergo annual mammograms.

The U.S. Preventative Services Task Force (USPSTF), an independent panel of primary care physicians, says women age 50 and older should be encouraged to get a mammogram every two years. Mammography testing for women under age 50 is strictly determined on an individual basis.

Similarly, Pap smears aren’t an

annual necessity for the majority of women. The USPSTF recommends women 21 and older undergo a Pap test every three years. Women who have had a hysterectomy, with removal of the cervix and have no history of cervical cancer are usually considered exempt from Pap tests.

“Most women don’t need Pap smears annually if they are at low risk,” Porter says. “The new recommendations reflect a two- to threeyear interval for most women. The risk factors are quite different for cervical cancer versus breast cancer.”

Prostate-specific antigen (PSA) testing is usually reserved for men age 50 and older, unless one carries a significant risk for prostate cancer. To increase early detection, annual testing is recommended. Men are encouraged to have a conversation about PSA testing with their health care provider

so they can make an informed decision about being tested. There is still much research and debate surrounding the benefits of PSA testing, especially for men 75 and older.

Colon cancer is a preventable disease. Porter says individuals 50 and older are encouraged to get a routine colonoscopy every 10 years. However, if there is a family history of colon cancer, screening may begin earlier.

Aside from colonoscopy, another method of colorectal cancer screening involves a fecal occult blood test, which may be conducted annually if a patient possesses an average to mod-

erate risk for colon cancer.

Regular cardiovascular testing is also recommended for men and women. Screening generally involves cholesterol and blood pressure tests to assess any potential risk factors to heart health, such as atherosclerosis, or hardening of the arteries, and hypertension, or high blood pressure.

Extensive cardiovascular testing is often reserved for those with substantial risk factors for coronary heart disease.

“Some things, such as cholesterol, aren’t necessary to check more than every three years, unless it is abnormal,” Porter says.

Assessing personal risk for treatable disease can be the key to early diagnosis and complication prevention.

According to the American Medical Association, patients should be proactive when it comes to their health care. The AMA encourages individuals to ask questions and be forthcoming about any concerns they may have.

During your next annual wellness exam, talk with your doctor about the importance of preventive testing, assessing risk factors and what you should know to make better, informed decisions about your health.

Colonoscopies are vital for cancer prevention

By Anita Norris About 50,000 Americans die every year due to colon cancer — making it the most deadly form of the disease after lung cancer. Screening of the colon, or colonoscopy, has been proven to help catch colon cancer earlier, thereby giving the patient a greater chance for survival and recovery.

Colon cancer is entirely preventable. Early detection of precancerous colon polyps allows them to be removed with minimally invasive surgery before they develop into fullblown colon cancer. Studies show the removal of polyps can reduce the risk of developing colon cancer by 90 percent.

For people of average risk for colon cancer, colon screenings are recommended beginning at age 50. But for those with a family member who has had colon cancer or colon polyps, colonoscopies should be started earlier than age 50.

A colonoscopy should be performed once every 10 years for people of average risk for colon cancer and more often for those who have had precancerous polyps removed in the past or have a family history of colon cancer.

Colon cancers are insidious. Many people affected by colon cancer experience no symptoms until the disease is advanced, at which point it may be difficult to treat. The removal of part of the colon is sometimes required in serious cases. Late-stage symptoms can include abdominal pain, diarrhea or constipation, bleeding from the rectum or a change in bowel movements.

Colonoscopies are superior to sigmoidoscopies, which are usually done in a doctor’s office without sedation and can only scan about one-third of the colon. Colon cancer can appear anywhere in the large intestine. A colonoscopy sees the complete large

intestine and is done with sedation, which makes the procedure more comfortable for the patients.

Colonoscopies are also preferable to X-rays, which can only detect large polyps. In order to remove colon polyps, a colonoscopy is necessary to pinpoint their exact location and size.

Polyps can be removed via the scope during the procedure.

Patients undergoing a colonoscopy have some food restrictions the day prior to screening. Generally they are able to work the day prior to the procedure and can return to work the day after the procedure. Most insurance plans cover colonoscopies.

Given the safe, effective and relatively painless nature of colonoscopies, the benefits of getting screenings to ensure a healthy colon become immediately clear.

Anita Norris is a nurse practitioner with Columbus-based Southern Indiana Surgery Inc. 2012 MEDICAL HANDBOOK

23

To burn more fat, skip eating before workout

By Maria Cheng AP Medical Writer LONDON — Running on empty may not be such a bad idea after all.

Though many athletes eat before training, some scientists say that if you really want to get rid of more fat, you should skip the pre-workout snack.

Several studies suggest exercising while your body is low on food may be a good way to trim excess fat. In a recent paper, European researchers found that cyclists who trained without eating burned significantly more fat than their counterparts who ate.

Muscles usually get their energy from carbohydrates, which is why athletes like Lance Armstrong and Michael Phelps scarf down enormous amounts of food before a race. But if you haven’t eaten before exercising, your body doesn’t have many carbohydrates in reserve.

That forces it to burn fat instead, scientists say.

“When you exercise (after fasting), your adrenalin is high and your insulin is low,” said Peter Hespel, a professor of exercise physiology at the University of Leuven in Belgium. “That ratio is favorable for your muscles to oxidize (break down) more fatty acids.” Hespel said that people who exercise without having eaten burn more fat than they would if they had grabbed a bite beforehand.

In a study published in April, researchers at the University of Birmingham and elsewhere assigned seven people to cycle three days a week, followed by an intense session an hour later without eating. Another seven people followed the same regime, without the instruction to fast.

Though members of the group that didn’t eat performed worse on the intensive training, they burned a higher proportion of fat to carbohydrates than the group that ate. The results were published by Medicine & Science in Sports & Exercise, the journal of the American College of 24

2012 MEDICAL HANDBOOK

associated press

While athletes like Lance Armstrong can consume all the pie they want during a race, skipping that pre-workout meal may be a good idea, according to scientists.

Sports Medicine.

In a 2008 study, Hespel and colleagues tested the effects on men who did endurance training without eating versus those who ate. In the athletes who hadn’t eaten, the researchers found a spike in the amount of proteins needed to process fat, meaning their bodies had been primed through fasting to burn more fat.

Hespel recommends people do this kind of training before breakfast, since eating carbohydrates interrupts the process of metabolizing fat for about six hours afterward.

Though he and colleagues have primarily studied the effects of exercising without eating in young, healthy people, he thinks the method

could also help people with problems like diabetes. Because exercising without eating produces muscles that are better at absorbing glucose — which is important for preventing diabetes — Hespel theorized the strategy would also help diabetics control their insulin levels.

Other experts said that even though people may burn more fat this way, it is mostly fat within the muscles that will be lost and won’t make a big difference to people trying to lose weight.

“When you exercise (without eating), fat is broken down more quickly in the muscle,” said Andrew Greenberg, director of the Obesity and Metabolism Laboratory at Tufts University.

“You may enhance how you burn the fat in the muscles, but it doesn’t affect your overall body fat,” he said. He said more intense exercise may prompt the body to burn more fatty acids in other regions of the body, but that a lot of training would be required to see a big difference.

For recreational athletes interested in maximizing their exercise regimen, some experts recommend a regular training session where you deliberately do not eat beforehand.

“Science is finally catching up with what smart runners have always known,” said Ron Maughan, a professor of sport, exercise and health sciences at Loughborough University in Britain. “If you have a long, hard run without breakfast once a week, that hard run will train you to burn fat,” he said. “And for the rest of the week, have plenty of carbohydrates so you can train hard.”

Maughan cautioned against doing too much exercise on an empty stomach. “That might help you get very good at burning fat, but you won’t be very good at whatever exercise it is you’re doing,” he said. “Without enough fuel, you won’t get the intensity of training you need to get improvements.”

Others were more skeptical and said people shouldn’t exercise without having at least a small snack first.

“I think it’s actually a pretty bad idea,” said Dr. Alexis Chiang Colvin, a sports medicine expert at Mount Sinai Hospital in New York who has worked with professional football and hockey teams.

“If your blood sugar is low, you could wind up getting dizzy and you might not be able to exercise as well as if you were well-nourished,” she said. Colvin recommended having something small like a banana before training. She also warned the strategy might make people more prone to injury and that eating was important so the body would have enough nutrients to recover from a bout of exercise.

Hespel acknowledged the method wasn’t for everybody and that aside from the pain of struggling through an exercise session while hungry, there are other potential pitfalls.

“When you postpone breakfast to exercise, it is possible you might eat more afterwards,” he said. “People exercising (without eating) need to respect all the normal strategies of weight control like not overeating.”

Daniel Kobbina, a personal trainer who also runs a martial arts school in London, said the method requires discipline — but it works.

“If you train on an empty stomach, you’ll see that six-pack a lot sooner,” he said.

Keeping you

to 100 Pregnancy Care Pediatrics Adults Well Care Sick Care Mental Health Counseling

HEALTHY is what we do.

Physicians Slade Crowder, MD Amanda Dornfeld, MD Jamie Hannah, MD Loren Hurst, MD Andrea Mernitz, MD David Porter, MD

Family Counselor Dan Boyer, MSW, LCSW Pregnancy Care Coordinator Heather Cowan, CMA

Nurse Practitioner Ann James, MSN, RN, CS

S A N DC R E S T F A M I L Y M E D I C I N E Columbus Regional Health

3203 Middle Road | Columbus, IN 812-373-2700 | 800-334-0077 www.sandcrest.org

2012 MEDICAL HANDBOOK

25

Lifestyle changes lower diabetes risk

By Monica Sopiarz and Kalin Clifford According to the American Diabetes Association, 79 million Americans are diagnosed with prediabetes.

Pre-diabetes is diagnosed when sugar levels are higher than normal but not high enough to be diagnosed as Type 2 diabetes. There are different blood tests that the doctor can use to diagnose pre-diabetes. One common test is the fasting plasma glucose (FPG) test, which requires a person to fast overnight.

A normal FPG level is less than 100 mg/dl. An FPG between 100 and 125 mg/dl indicates the person has pre-diabetes. A person is diagnosed with Type 2 diabetes if the FPG level rises to 126 mg/dl or above.

Another common test is the he-

26

2012 MEDICAL HANDBOOK

moglobin A1C test. This is a blood test that shows the average blood glucose level for the past two to three months. An A1C 5.6 percent or below is normal. A1C levels range between 5.7 percent and 6.4 percent in pre-diabetes. A person has Type 2 diabetes if the A1C is 6.5 percent or above. If your doctor diagnoses you with pre-diabetes, you should be tested every year after diagnosis of pre-diabetes.

Patients with pre-diabetes may or may not experience any symptoms.

Symptoms of elevated blood sugar include unusual thirst, frequent urination, extreme hunger and fatigue.

Risk factors for developing prediabetes and Type 2 diabetes include being overweight, age greater than 45 years, family history of diabetes, gestational diabetes, giving birth to a baby weighing more than 9 pounds and belonging to a certain ethnic group

(African-American, Latino, Asian American or Pacific Islander).

Having pre-diabetes is a risk factor for developing Type 2 diabetes, but with lifestyle modifications, one can lessen the risk. These lifestyle modifications include eating healthy foods, maintaining a healthy weight and including physical activity as part of one’s daily routine. It has been shown that losing 7 percent of body weight and exercising moderately for 30 minutes per day, five days a week can lower a person’s risk of developing Type 2 diabetes by 58 percent.

Dietary changes should begin with adding a healthy meal plan into your lifestyle. A healthy meal plan includes five to six servings of fruits and vegetables per day, lean meat, fish, nuts and seeds, moderate dairy intake and complex carbohydrates. These food

choices can help improve blood sugar control and lessen the risk of developing Type 2 diabetes.

In addition to making dietary changes, adding 150 minutes of physical activity per week will help improve blood sugar control and lessen the risk of developing Type 2 diabetes.

Any activity that increases your heart rate is physical activity. This can be formal exercise such as fast swimming, walking and biking and also everyday activities, such as walking, gardening and cleaning the house.

By making these small changes in your lifestyle, you can not only improve your blood sugar control and lessen the risk of developing Type 2 diabetes, you can also improve your overall health.

Monica Sopiarz and Kalin Clifford are Columbus Regional Health pharmacy residents.

This dental specialty treats diseases, injuries, and defects of the mouth and jaws (removal of teeth, implants, facial fractures, corrective jaw surgery).

COLUMBUS ORAL AND MAXILLOFACIAL SURGERY

R. Todd Bergman, D.D.S. Owen M. Forbes, D.D.S. Board Certified A.B.O.M.S.

2350 NORTHPARK COLUMBUS, IN 47203

812-372-7312 • 800-458-3768 2012 MEDICAL HANDBOOK

27

Fitness leads to healthier bones

By Dr. Darryl Tannenbaum Osteoporosis affects 10 million Americans, with an additional 20 million more at risk for the problem. It is characterized by low bone mass and a loss of bone tissue resulting in weak and fragile bones.

Although many believe it is a problem only in elderly women, half of osteoporosis-related fractures occur in women over the age of 50. Men are also at risk for osteoporosis, although the numbers are significantly less.

Our bones are a complex structure made up primarily of the minerals calcium and phosphate and a protein called collagen. Bones can become

brittle and susceptible to fracture if there is an insufficient combination of these minerals.

While the leading cause of osteoporosis in women is a lack of the hormone estrogen, vices such as alcohol, caffeine and cigarette smoking are risk factors as well.

Menopause brings lower levels of estrogen that leads to a decrease in the amount of collagen in bone and a decrease in bone density.

Unfortunately, the loss of bone density occurs over an extended period of years and is often not recognized until a fracture has resulted.

The disease is fairly advanced at

A

FAMILY

Our Medical Professionals: Dale E. Guse, MD Charles M. Hatcher, MD William F. Lustig, MD

D P

that time and is not immediately correctable. In addition to dietary and postmenopausal contributions, medications such as steroids and anticonvulsants are risk factors for osteoporosis.

So what can you do now? Hope begins with exercise. It has been demonstrated that women who stay fit suffer less from a decrease in bone mass and density. Furthermore, the negative effects of being a couch potato are accelerated as you age.

Physical activity benefits women immediately, regardless of the age you begin. In a manner similar to the way in which muscles increase in strength

Dermatology

P hysicians, Inc

Brian J. Niedbalski, MD Tracy L. Salinas, MD Philippa M.E. Shedd, MD Laura A. LaSell, CFNP

General, Surgical & Cosmetic Dermatology

• Acne & Rashes • Warts & Moles • Skin Cancers • Contact Dermatitis Adults • Adolescents • Children

Columbus Regional Health

Doctors Park | 372-8281 3201 Middle Road Columbus, IN W G NOPTIN CE EW TS C A N EN TI PA

Michael P. Sheehan, MD

Jack R. Marian T. Scherer, MD Bayne-Poorman, DO

360 C Plaza Drive, Columbus • 812-376-9686 dermatologyphysiciansinc.com 28

2012 MEDICAL HANDBOOK

associated press

Resistance training is recommended by doctors to help strengthen bones weakened by osteoporosis.

with exercise, bones become denser.

Bones adapt to increased stresses by becoming stronger and thicker.

Increased new stress (or exercise) leads to the production of new bone.

Exercise is also believed to positively influence the hormonal control of bone remodeling as well.

Two types of exercises are most beneficial for improving bone density: weight-bearing and resistance exercises. Weight-bearing exercises rely on your ability to work against gravity.

Studies have demonstrated that your body will increase bone production when your bones are supporting your weight during exercise.

In particular, fast walking, stair climbing, running and hiking support your weight and will increase the strength of your bones. Although biking and swimming are excellent for cardiovascular health, they are not

weight-bearing exercises and do not increase bone density.

Resistance exercises involving weight lifting also require muscles and bones to increase mass and result in improved bone density.

Are you already suffering from osteoporosis? It is important to consult with your family doctor regarding bone density testing before beginning an exercise program. Bone density testing is a painless procedure performed by your family doctor that is readily available and is usually covered by insurance.

Remember, exercise is something that not only makes your mind and heart feel good, but your bones will benefit greatly, too.

Dr. Darryl Tannenbaum is an orthopedic surgeon with Southern Indiana Orthopedics and medical director of the CRH Joint and Spine Center.

S OUTHERN I NDIANA OB/GYN P HYSICIAN ’ S P RACTICE O RGANIZATION , I NC .

George Albers, MD Board Certified

Dan Davis, MD Board Certified

Pam Spencer, NP SPECIALIZING IN: Laparoscopic hysterectomy • Endometrial ablation Surgical and non-surgical treatment for urinary incontinence C-Section • Tubal ligation Normal and high-risk obstetrical care including VBAC

2450 Northpark Suite A • Columbus • 812-376-3311 www.southernindianaobgyn.net 2012 MEDICAL HANDBOOK

29

After battling cancer, patients turn to rehabilitation

By CRH Rehabilitation Services staff When you are fighting cancer, there is a lot of information on the disease process, treatment options, side effects and expected outcomes.

What is harder to find is information about what to expect for your body and health after treatment is finished and where to get help for some common aftereffects.

Here is a short list of some conditions that may occur after cancer treatment and what help is available.

Full body rehabilitation Fighting cancer can take a toll on your entire body. Balance, endurance and strength can all be affected.

Physical and occupational therapy can help retrain and restore your body. You may have to learn new ways of doing some things.

An experienced therapist will identify ways for you to regain control over your body or help you retrain to overcome obstacles. Therapists can also help identify equipment needs, such as walkers, canes, shower chairs and other adaptive devices.

Scar adhesions Surgical scars can leave a residual reminder of any cancer surgeries.

These scars can occur both within your body or close to the top layers of your skin. Symptoms of scar adhesions include limited motion due to the scar adhesions or cording; pain and discomfort when moving; and the inability to tolerate clothing due to scar hypersensitivity.

A trained therapist can help “release” the scar to restore motion and lessen pain.

Brad’s has several styles and sizes of lift chairs, all from $597 to $897.

And we offer FAST delivery and warranty service!

• Continuous activities • Flexible scheduling (as needed basis) at Mill Race Center 812-372-6415 900 Lindsey Street Columbus, IN 47201 email: admin@ justfriendscolumbus.com

• Nursing & social work support • Quality of life enhanced by social interaction and therapeutic programs • VA, Medicaid Waiver, CHOICE and private pay

729 Washington St., Columbus, IN • www.bradshomefurnishings.com • Mon–Sat 9:30–6, Fri 9:30–8

30

2012 MEDICAL HANDBOOK

Lymphedema

Radiation injuries

Lymphedema is swelling in an arm, leg or other part of the body that occurs when the lymphatic system is not working properly. The lymphatic system helps remove excess fluid from the body. When it is not working properly, lymph fluid builds up and swelling occurs. Surgery, radiation and trauma to the lymphatic system can damage the lymphatic system and cause swelling.

While there is no cure for lymphedema, it can be treated. Treatment can reduce swelling, improve movement, reduce pain and improve your ability to perform daily activities.

Physical and occupational therapists can receive additional training to become certified for treating lymphedema.

Dr. Charles Rau

Radiation may cause injury to soft tissue and bone. Symptoms include painful tissue breakdown in the area of radiation. The most common sites of radiation injuries are the head, neck, genito-urinary area and bowel.

Depending on the area of radiation, this may present as a non-healing open wound in the radiated area; exposed bone and pain in the mouth; abnormal bleeding, pain and/or incontinence of the bladder or bowel.

The use of hyperbaric oxygen therapy has been one of the most studied and frequently reported successful treatments for delayed radiation injuries.

Healing body, healing mind From chemo brain to adjusting to a “new normal,” rehabilitation psychology can help therapeutically with the emotions that come along with cancer and survivorship.

Biofeedback can help someone relax from the heightened state of feelings when coping with cancer. Many survivors are looking for pain relief without having to take extra medications. A rehabilitation psychologist can help with that as well.

Managing the effects of cancer treatment doesn’t have to be as hard as fighting the cancer itself.

The therapy professionals of Columbus Regional Health’s Rehabilitation Center can help you rebuild your life.

Information: 376-5806.

Dr. David Rau

We have relocated our office to the CRH campus.

Accepting all insurances.

NEW PATIENTS WELCOME.

2326 18th Street, Columbus • (812) 378-7474 www.raufamilymed.com Monday-Thursday 7:00 am - 5:00 pm Friday 7:00 am - Noon 2012 MEDICAL HANDBOOK

31

Avoid the ER with advice from emergency room doctors

By Nancy Churnin The Dallas Morning News You can’t prevent every trip to the emergency room, but simple steps can keep you safe — or keep you alive when the worst happens.

Americans made more than 119 million visits to emergency rooms in 2006, according to the National Hospital Ambulatory Medical Care.

Among the most common causes cited by the Centers for Disease Control and Prevention are trauma, abdominal pain, chest pain, fever and acute upper respiratory infection.

To find out how to cope with those issues, we turned to experts.

To help you keep out of the ER, they say you should be getting ongoing care from a primary physician who may be able to catch small problems before they escalate. At the same time, they echo the position of the American College of Emergency Physicians: Don’t hesitate if you are experiencing bleeding you can’t stop, gaping wounds, breathing troubles, chest pain, extreme pain, vomiting that will not stop, extremely high fever or suicidal thoughts.

They note that the danger signs for children vary from those for adults; parents should consult with their pediatricians for symptoms that warrant an ER visit, such as any fever in a baby less than 3 months old.

When it comes to preventing and coping with the most common ER problems, here’s the advice we received from three emergency physicians, Dr. Matt Bush, Dr. Ketan Trivedi and Dr. Halim Hennes.

32

2012 MEDICAL HANDBOOK

First-aid essentials for home and car  The national Poison Control Center number, 800-222-1222, which will route you to your local poison control center.  Bandaging supplies (skin cleanser, antibacterial ointment, bandages, butterfly bandages for lacerations).  Tweezers (to remove splinters).  Aspirin (regular for fever and baby aspirin for chest pains).  Antihistamines for allergies.  Ibuprofen as an anti-inflammatory medication.  Acetaminophen as a fever reducer.  Ice pack for swelling.  Clean T-shirts for larger wounds or to use as a temporary tourniquet or sling; a safety pin can help secure the cloth over the shoulder.  Skin glue (for small cuts).  Check expiration dates on all medications regularly.

SOURCES: Dr. Matt Bush, Dr. Ketan Trivedi, Dr. Halim Hennes

Trauma Prevention: Use bike helmets, seat belts and motorcycle helmets when you ride. Watch children in grocery carts to make sure they don’t fall. Be wary of sharp objects. Practice safety measures around swimming pools.

Before heading to the ER: Immobilize broken arms and legs with a straight object wrapped alongside the bone with a bandage. Create a sling for an arm with a large cloth pinned with a safety pin over the shoulder.

Put an ice pack on any area that is swelling. Stop bleeding with pressure.

Apply gauze and wrap the bandage around the gauze.

Be aware that anyone taking blood thinners is at increased risk for excessive bleeding and should share that information with the ER staff.

Know the signs of concussion and get checked out immediately if the person shows signs of headache, nausea, confusion or slurred speech after hitting his head.

Use CPR immediately on someone who doesn’t have a pulse. Each second without oxygen can cause permanent damage to the organs.

Chest pain Prevention: Maintain a healthful lifestyle and don’t be a weekend warrior who exercises inconsistently. See your family practitioner regularly and be aware of your stroke and heart attack risk. Sweating and shortness of breath are red flags for a serious problem.

Before heading to the ER: Call 911 and go in an ambulance, where technicians can help if your condition worsens. Baby aspirin helps thin the

blood, which can avoid clots in most cases but can make things worse if the problem is aortic dissection, or bleeding of the main artery from the heart.

Abdominal pain Prevention: Make good food choices because abdominal pain can be caused by indigestion. If it is, overthe-counter stomach medication may offer relief.

Pain can also be caused by food poisoning, appendicitis, diverticulitis, inflammation or colitis. Expectant mothers should ask about a possible ectopic pregnancy. If a head injury is involved, let the ER staff know immediately, as this could be a sign of a fatal blood clot.

Before heading to the ER: If you’re vomiting, stay hydrated. Drink a halfounce of clear liquid every 15 minutes and continue as long as it stays down.

Take ibuprofen and aspirin for pain and fever as needed.

Respiratory difficulty Prevention: Be aware of triggers for breathing problems — smoke or allergies — and avoid them if possible. People with asthma and chronic obstructive pulmonary disease, or COPD, are at the greatest risk for respiratory difficulty. If you have signs of bronchitis, see your family practitioner before it leads to pneumonia.

Before heading to the ER: People with breathing conditions should use an inhaler and go to the doctor immediately for treatment. Stay calm, as hyperventilation can aggravate the problem.

High fever Prevention: Avoid germs by washing hands frequently and not sharing drinks or utensils. Cough into your sleeve rather than your hand. Use hand sanitizers. Check with your pri-

mary care physician to make sure you are up-to-date on vaccinations.

Before heading to the ER: Babies younger than 3 months, senior citizens, cancer patients undergoing chemotherapy, patients taking steroids and people with a weakened immune system should go to the hospital with any fever, says the American College of Emergency Physicians.

Danger signs for otherwise healthy people can be a fever of 104 degrees Fahrenheit or higher, a fever that lasts for more than four to five days, trouble breathing, a change in behavior, headache or neck stiffness. Be alert to exposure to bacterial or viral infections if the person is not vaccinated or has been recently exposed to possible parasites or bacteria in the water.

Bacteria can cause potentially fatal infectious diseases if they get into cuts and wounds. Wash open or infected areas well with soap and water and apply antibiotic ointment and bandages. Bring fever down with acetaminophen or ibuprofen and stay hydrated.

Is it an emergency?

Even ER doctors find themselves rushing to the hospital sometimes.

Trivedi was at a play with his wife and three children when the youngest, who was 2, started playing with his wife’s purse. “One minute she had a quarter in her hand and the next minute it disappeared,” he recalls. “I asked her, ‘Where is that quarter?’ and she pointed to her mouth.”

The American Academy of Family Physicians advises taking a child who has swallowed a battery or something sharp or metal like a coin to a doctor immediately. Even though most small objects will pass through the gut without causing problems, things can get stuck in a child’s windpipe that could prove dangerous even in the absence of obvious symptoms such as vomiting, gagging, drooling, not eating, stomach pain, coughing or wheezing.

Happily, the X-ray at the ER showed that the coin passed safely through his daughter’s system. But Trivedi doesn’t regret the trip.

“Better safe than sorry,” he says.

Special advice for parents  Don’t smoke. Secondhand smoke irritates the lungs of younger children and makes them more susceptible to infection. Even if you go outside to smoke, the smoke may still be in your clothes and in the car.  Keep the top of sippy cups and bottles clean. These are often overlooked germ collectors.  Toss the trampoline. They put children at risk for head, spine and limb injuries.  Don’t leave children alone in or near water for a second. Most accidents happen when caretakers run to the phone.  Lock up pills, poisons and choking hazards. A trip to the grandparents’ house can prove dangerous if medications and cleaners are left in a toddler’s reach. Choking is a common cause of injury and death in children under 5, according to HealthyChildren.org. Safety pins, toys, coins, broken balloons, batteries and small, smooth foods such as peanuts, raw vegetables and hot dogs can put a child at risk.

SOURCE: Dr. Halim Hennes 2012 MEDICAL HANDBOOK

33

Babies on obesity path?

New sign may offer answer

By Lindsey Tanner AP Medical Writer CHICAGO — Researchers say there’s a new way to tell if infants are likely to become obese later on: Check to see if they’ve passed two key milestones on doctors’ growth charts by age 2.

Babies who grew that quickly face double the risk of being obese at age 5, compared with peers who grew more slowly, their study found. Rapid growers were also more likely to be obese at age 10, and infants whose chart numbers climbed that much during their first 6 months faced the greatest risks.

That kind of rapid growth should be a red flag to doctors and a sign to parents that babies might be overfed or spending too much time in strollers and not enough crawling around, said pediatrician Dr. Elsie Taveras, the study’s lead author and an obesity researcher at Harvard Medical School.

Contrary to the idea that chubby babies are the picture of health, the study bolsters evidence that “bigger is not better” in infants, she said.

But skeptics say not so fast. Babies often grow in spurts and flagging the speediest growers could lead to putting infants on diets — a bad idea that could backfire in the long run, said Dr. Michelle Lampl, director of Emory University’s Center for the Study of Human Health.

“It reads like a very handy rule and sounds like it would be very useful — and that’s my concern,” Lampl said.

The guide would be easy to use to justify feeding infants less and to unfairly 34

2012 MEDICAL HANDBOOK

associated press

An infant’s growth is measured during a checkup. label them as fat. It could also prompt feeding patterns that could lead to obesity later, she said.

Lampl noted that many infants studied crossed at least two key points on growth charts, yet only 12 percent were obese at age 5 and slightly more at age 10. Nationally, about 10 percent of preschool-age children are obese, versus about 19 percent of those age 6 to 11.

Lampl and Edward Frongillo, an infant growth specialist at the University of South Carolina, voiced concern in an editorial accompanying

the study in the journal Archives of Pediatrics & Adolescent Medicine.

They argue that more research is needed to confirm whether the study’s recommendation is really a useful way to flag infants for obesity.

“The potential to do more harm than good is actually very high,” Frongillo said.

Taveras said the kind of rapid growth noted in the study should be used to raise awareness about potential risks but is not a reason to put babies on a diet.

The study involved 45,000 infants

and children younger than age 11 who had routine growth measurements during doctor checkups in the Boston area from 1980 through 2008.

Growth charts help pediatricians plot weight, length in babies and height in older kids in relation to other children their same age and sex. Pediatricians sometimes combine an infant’s measures to calculate weight-for-length — the equivalent of body-mass index, or BMI, a heightto-weight ratio used in older children and adults.

The charts are organized into percentiles. For example, infants at the 75th percentile for weight are heavier than 75 percent of their peers.

The study authors used seven major cutoffs on the charts — the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles — to calculate growth pace. An infant whose weight-

for-length jumped from the 19th percentile at 1 month to the 77th at 6 months crossed three major percentiles — the 25th, 50th and 75th — and would be at risk for obesity later in childhood, the authors said.

Larger infants were most at risk for obesity later on, but even smaller babies whose growth crossed at least two percentiles were at greater risk than those who grew more slowly.

About 40 percent of infants crossed at least two percentiles by age 6 months. An analysis of more than one-third of the study children found that 64 percent grew that rapidly by age 2.

Dr. Joanna Lewis, a pediatrician at Advocate Lutheran General Hospital in Park Ridge, Ill., said she supports the idea that infancy is not too young to start thinking about obesity.

Still, she emphasized that rapid

growth in infancy doesn’t mean babies are doomed to become obese. “It’s not a life sentence,” and there are steps parents can take to keep their babies at a healthy weight without restrictive diets, she said.

Lewis said many of her patients are large babies whose parents feed them juice or solid food despite guidelines recommending nothing but breast milk or formula in the first six months.

“The study reinforces what we try to tell parents already: Delay starting solids and don’t put juice in a bottle,” she said.

Lewis also advises parents that when starting infants on solid food, have the whole family sit down and eat together. Research has shown that obesity is less common in children raised in families that have frequent meals together at home.

From Our Home to Yours

Hickory Creek Nursing Home Provides

Qualified skilled nursing staff Medication management and administration Restorative nursing & care • Wound care management IV therapy • Pain management • Respiratory services Physical therapy • Speech therapy Occupational therapy Nutritionally balanced meals Assistance with dining Special diets • Between meal snacks Respite care for short stays Hospice care • Adult day care Assistance with daily care Daily social and recreational programs

John Alessi do, faafp

board certified family medicine mro/occupational health

Tania D. Frederick msn, fnp

board certified family medicine

Walk-ins and urgent care welcome

Accepting new patients 812-376-6136

Fax: 812-372-8728 • 5400 East 25th St., Columbus IN 47203

www.nashvillefamilymed.com 812.988.2223 • 103 Willow St., Suite B 2012 MEDICAL HANDBOOK

35

Shaping good health as teens outgrow pediatrician

By Lauran Neergaard AP Medical Writer WASHINGTON — Ever watched a teen skulk in the corner of a toddler-packed pediatrician’s waiting room, obviously wishing to be anywhere else?

Adolescents aren’t just big kids, and too many start falling through cracks in the health care system when they pass the stage of preschool shots and summer camp checkups — what a major new report calls missed opportunities to shape the next generation’s well-being.

The period between ages 10 and 19 is unique, bringing more rapid biological changes than perhaps any age other than infancy. Even though most of the nation’s 42 million adolescents seem to be thriving, it is a time of risk-taking and pushing boundaries in ways that can mean immediate consequences: car crashes, experimenting 36

2012 MEDICAL HANDBOOK

with alcohol or drugs, teen pregnancy, sexually transmitted disease.

And it’s also an age when many of the habits that determine good health during adulthood are set, or not.

“They are quite literally our future. If we don’t take good care of them, there’s a strong likelihood when they’re running the ship they’re not going to have a good time running the ship,” said Dr. Frank Biro of Cincinnati Children’s Hospital’s long-running adolescent medicine program.

Yet the system of care for tweens and teens is fragmented and poorly designed. Few doctors specialize in adolescents’ complex needs or provide comprehensive care that earns their trust, concludes a recent probe by the National Research Council and Institute of Medicine. Most at risk are the poor.

The result: The past decade has

brought declines in teen pregnancy and smoking but little other overarching progress. Tweens and teens increasingly are overweight; physical activity’s dropping; chronic diseases like asthma and diabetes are on the rise; and injuries, chiefly from car crashes, remain this age’s leading cause of death.

While 20-somethings tend to see primary care doctors the least, a gradual falloff begins in adolescence.

Only a fraction of tweens and teens have been screened for risky behavior so doctors can intervene before a problem arises, the report found.

Between 10 percent and 20 percent of adolescents annually experience a mental health disorder, such as depression or anxiety, with less access to that specialty care. Five million are uninsured, too often even left out of federal-state programs designed to provide health coverage to children.

Yet half of deaths among adults are due to health-related behaviors that often start during adolescence.

“A 10-year-old is probably the healthiest person in America,” notes Dr. Frederick Rivara of the University of Washington, a co-author of the new report. “Something happens between age 10 and age 25.”

Teens do tend to see a doctor, clinic or school-based care program somewhat regularly, if not because parents demand it, then for vaccinations or the 15-minute physical required by sports teams. But the report notes it can take at least 40 minutes to do a thorough adolescent checkup, including screening and counseling for risky behaviors — the kind that may prompt enough trust for the teen to return with a problem he doesn’t want mom to know about.

But with fewer than 500 doc-

tors certified as adolescent medicine specialists between 1996 and 2005 — some states have none — most families will need to hunt for a pediatrician or family physician with the communication and social skills and, perhaps more importantly, the true interest to engage a teen.

“Adolescents have so much energy. They see the world so differently than you or I,” says Biro, Cincinnati’s adolescent medicine chief, who wasn’t part of the report and says society’s stereotype of sex and drugs isn’t the typical teen.

The relationship starts with the doctor making clear that the adolescent has a right to patient confidentiality that grows with age, although he must work with the parents, too.

As Biro describes the balancing act: “As long as you’re not hurting yourself, another person or getting

Looking For Affordable Memory Care Options?

f

hurt by another person, I will hold that information confidential. ... If there’s a direct health risk that could involve their life, then I will share that.”

Then comes recognizing that the early teen years are when kids move from concrete thinking to more abstract thought — they begin to connect the dots, Biro explains. They may assume the doctor connected the dots the same way, meaning a girl who complains of stomach pain may not volunteer that she fears pregnancy.

“It’s not that they’re withholding information. They figure they’ve just told you everything you need to know because the rest of it you should be able to figure out,” Biro says. “I prove to them I am, indeed, about as smart as mud, and I have to ask them more probing questions.”

Benjamin Podiatry PC Dr. Scott Benjamin DPM

4001 Goeller Blvd., Suite B • Columbus (812) 378–5800 • www.benjaminpodiatry.com

Consider Keepsake Village of Columbus 24 HOUR LICENSED CARE • SECURE ENVIRONMENT • PRIVATE ROOMS AVAILABLE

Comprehensive Foot and Ankle Care Diabetic Foot Care Wound Care Board Certified in Foot Surgery Fellow American Board

STOP BY KEEPSAKE VILLAGE AND TAKE A TOUR!

of Podiatric Surgery Digital X-Rays Fracture Care

A Premier Memory Care Community

Over 18 Years’ Experience

372.0950

2546 Foxpointe Dr. • Columbus • www.KeepsakeofColumbus.com A Capital Senior Living Community

2012 MEDICAL HANDBOOK

37

Know how to store, reheat food safely

By Meredith Cohn The Baltimore Sun Many Americans make meals out of leftovers. And while everyone knows to refrigerate perishables, not everyone is taking all the proper steps to ensure the next-day food is safe, according to the Institute of Food Technologists, a nonprofit society of food science professionals from academia, government and industry.

The group definitely supports leftovers and even says some foods actually taste better the next day, such as those with spices, because the flavors have time to meld. But be mindful that bacteria can grow in food.

Here are some tips for managing the food properly:  Refrigeration: Of course food needs to be refrigerated. But people may not realize that you don’t need to cool cooked foods before putting them in modern refrigerators. They are built to cool dishes that are warm to the touch without breaking them, though you can save energy by chilling the food promptly after cooking.

You can put it in front of a fan, in an ice bath or divide it into smaller portions in shallow dishes. Just make sure you get the food in there within two hours of cooking or one hour on hot days.

Do make sure your refrigerator is set at 40 degrees or lower, but use an appliance thermometer rather than relying on the refrigerator displays.  Storing: The group recommends thin-walled metal, glass or plastic containers that are no more than two inches deep. Bags, foil and plastic are 38

2012 MEDICAL HANDBOOK

good for odd-shaped food.

Keep cooked meat for only three to four days. Uncooked meats, poultry and seafood will last only a day or two. Raw roasts, steak and chops can last three to five days. Casseroles, veggies and other side dishes will last three to five days also. Ditto for pie.  Freezing: This totally halts bacteria growth in most foods for months. Recommended storage times are more for nutritional value and quality. Uncooked meats can be stored eight to 12 months, while frozen cooked meats will lose flavor after three months. The freezer should be

at zero degrees.  Reheating: Use a thermometer to ensure proper temperature. Meats should be heated to 165 degrees in the center. Sauces, soups and gravies should be brought to a boil. Never reheat in a crock pot, slow cooker or chafing dish.

Steak and whole cuts of beef or lamb can be left a bit rare when reheated as long as they were initially cooked at a high temperature to sear the surface and kill bacteria. If you use a microwave, use a lower power setting to reheat without overcooking.

Some foods don’t mix with drugs, supplements

By Judy Hevrdejs Chicago Tribune Think of your stomach as one big test tube. Maybe you drop in a vitamin or herbal supplement each morning. Maybe a cholesterol-lowering statin or a blood-pressure drug.

Perhaps an infection-fighting antibiotic or allergy-relieving antihistamine.

And you wash it down with fruit juice or milk or coffee.

That may not always be a good thing because some foods and beverages — from chocolate and caffeine to dairy and alcohol — as well as dietary supplements (vitamins, herbals, etc.) and over-the-counter (OTC) drugs can interact with prescription drugs when they land in your gut. Those interactions may affect the ability of the drug to work as it should. Or that mix may cause unwanted side effects.

With some tetracyclines, for example, you may need to avoid dairy products at the time you take the drug. If you take digoxin for your heart, you may need to steer clear of St. John’s wort and large amounts of black licorice (that contains glycyrrhizin).

Take ACE Inhibitors to lower your blood pressure? Go easy on high potassium foods such as bananas, oranges and green leafy vegetables. And depending on the statin you’re taking — there are many different types in this class — you may need to avoid grapefruit.

Such drug, food and supplement interactions become especially important as the number of drugs taken

increases.

Shiew Mei Huang, acting director, office of clinical pharmacology at the Food and Drug Administration’s Center for Drug Evaluation and Research, cites a survey published in the Journal of the American Medical Association that found in the population 57 and older in the U.S., “at least 80 percent use at least one prescription drug. Half of them use OTC drugs. And some use dietary supplements.”

Says Huang, “What is important in that report is that almost 30 percent use more than five drugs. And among those who take a prescription drug, half of them take either OTC or dietary supplements.

“It is the dietary supplements we have to be very careful (about),” she adds, and doctors need to be told about them.

Hartmut Derendorf, a professor who heads the pharmaceutics department in the University of Florida’s College of Pharmacy in Gainesville, might agree about the role dietary supplements play.

“Sometimes they look alike and patients think they are medications like normal medications. But dietary supplements are not required to be investigated and tested with the same rigor,” he says.

Because your age, gender, medical history, etc., can affect how a drug interacts with other substances in your gut, “there are no general rules,” says Derendorf. “The key is for patients to be very open, to work with their pharmacist and physician and tell them about the use of supplements and also look for the specific food interactions that are known for the medication that they are using.”

That’s crucial because guidelines can change. The FDA regularly releases food-and-drug interaction consumer updates that are prompted by a variety of factors, Huang explains, including the recent grapefruit juicestatin update issued last February.

So what should you use to help the medicine go down? Stick to a plain glass of water, say experts.

Points to remember:  Keep a record of all drugs (prescription, over-the-counter), vitamins and herbal supplements that you take.

This FDA chart can help: www.fda. gov/drugs/resourcesforyou (type “my medicine record” in the search field).  Tell your doctor or pharmacist about all drugs (prescription, OTC) and supplements you take.  If a doctor prescribes a new drug, ask the doctor or pharmacist if there are food interactions.  Read drug information from the pharmacist; don’t discard.

2012 MEDICAL HANDBOOK

39

Your bathroom scale is a tool, not an inquisitor

By Lavinia Rodriguez Tampa Bay Times Should you weigh yourself every day? Once a week? Not at all? Advice about weighing can be confusing.

Some experts say weighing should be kept to a minimum so we don’t get obsessed about it; others say weighing daily can keep us from losing awareness so that we don’t cheat; and still others tell us to judge our weight by how our clothes fit, not the scale.

Most dieters believe that the more you weigh yourself, the more motivated you’ll be and the faster you’ll lose weight. But when the number on the scale is our primary focus, there’s less attention paid to the behaviors that result in weight loss.

With so much focus on weight, a bad day on the scale can make us want to give up and avoid weighing in — or even give up the diet and exercise behaviors that promote weight loss altogether. Less rigidity about weighing in leads to more success with weight management.

Viewing weighing in as a time to find out whether you’re a success or a failure is always a problem. Weighing in is only an opportunity to get information. It’s not even the most important information that you need.

If it were possible to get reliable and accurate information about the amount of fat you’ve lost, that would be useful. But household scales aren’t that sophisticated. Still, it’s possible to use a household scale in ways that make weighing productive.

Your weight varies because of many factors — how much you’ve eaten, 40

2012 MEDICAL HANDBOOK

the time of day when you weigh, how much water you may be retaining or how much muscle mass you may have gained or lost.

Several factors can help determine your best weighing schedule:  Objective attitude. The mind isn’t going to want to do anything that’s uncomfortable. So if you see the scale as your personal judge, the mind will resist. It’s important to approach the scale unemotionally. Weighing in is simply a tool, not a test. If you approach the scale with rules such as “I must lose weight today,” then you’re setting yourself up to fail.

You might say, “My weight is the same as yesterday. I’ve been losing, and I’m doing well with activity and nutrition. I’m going in the right direction.”

Or, “The scale shows my weight as 2 pounds higher than yesterday. I’m still doing well with my behaviors, so it must be something other than fat

gain. I’ll keep doing my job and let my body do its job.”

This may also be true: “I’ve been gaining weight consistently the past couple of weeks. I’m still exercising, and my nutrition is good. However, I’ve been eating out more. My body’s reflecting what I’m doing. I’ll cut back on eating out.”

All three examples show how weigh-ins can be used as tools, rather than as determiners of success or failure.  Realistic expectations. However fast or slow your weight loss is, there’s a logical reason. Rather than getting frustrated at the number on the scale, use it to help figure out whether your behaviors are on the right track.

Think of yourself as your body’s teammate. As long as you’re doing your part, your body will do its part, too — but on its schedule, not yours.

Weight-loss deadlines make little sense. Relax and do the work. The rewards will come.  Sensible goals: Your goals should be about behavior, not numbers on the scale. Goals dealing with activity level, nutrition and portion control deal more directly with fat loss than any number. Besides, it’s best to stay away from trying to guess what your “right” weight should be. Everyone is different physiologically, and it’s next to impossible to forecast what the best weight is for someone.

How often should you weigh?

Once you have a realistic attitude about the scale, you can choose to weigh daily, weekly, monthly or not at all. Discover what works for you.

What does surgery look like to you?

Schneck Medical Center is the only hospital in the area, and one of few in the world, with the da VinciÂŽ Si Surgical System. This state-of-the-art tool gives our experienced doctors greater mobility and a better look inside the surgical area.

With this next generation of minimally invasive technology, you’ll experience less pain and a faster recovery at Schneck.

See what your neighbors say about their robotic-assisted surgeries and learn more at schneckrobotics.org.