Medical Handbook 2014 by AIM Media Indiana

2014

Medical Handbook A PUBLICATION OF

2014 MEDICAL HANDBOOK

Mike Parrott Radiation Physicist

Dr Rahul Dewan Radiation Oncologist

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Contents Travel can be good for your health. . . . . . . . . . 6

Fats in food. . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Bursitis and tendinitis. . . . . . . . . . . . . . . . . . . . 8

Acid reflux. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Breast cancer. . . . . . . . . . . . . . . . . . . . . . . . . . 10

Prostate cancer . . . . . . . . . . . . . . . . . . . . . . . . 36

Investing in health care. . . . . . . . . . . . . . . . . . 12

Colds and flu . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Premature births . . . . . . . . . . . . . . . . . . . . . . . 16

First aid kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Childhood obesity. . . . . . . . . . . . . . . . . . . . . . . 18

Colonoscopies . . . . . . . . . . . . . . . . . . . . . . . . . 42

Sorting out ads for drugs. . . . . . . . . . . . . . . . . 22 Sugar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Alzheimer’s. . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Medication safety. . . . . . . . . . . . . . . . . . . . . . . 30

©2014 by Home News Enterprises All rights reserved. Reproduction of stories, photographs and advertisements without permission is prohibited. Stock images provided by © Thinkstock. 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.

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Travel as a health regimen By Josh Noel Chicago Tribune

The report doesn’t undertake any added science but simply synthesizes previous studies, and the involvement of an insurance company might be cause for skepticism, but a recently issued white paper reaches a conclusion always worth repeating: Travel is good for you. The benefits are both mental and physical, the result of “physical activity, cognitive stimulation and social engagement,” according to the study, commissioned by the U.S. Travel Association, the Global Commission on Aging and the Transamerica Center for Retirement Studies. The report quotes previous studies concluding that women who vacation twice a year have a significantly reduced chance of heart attacks or coronary death. Similarly, “men who did not take an annual vacation were shown to have a 20 percent higher risk of death and about a 30 percent greater risk of death from heart disease,” the report says. Even accounting for the obvious

2014 MEDICAL HANDBOOK

likelihood that people who can afford travel also have access to better health care, researchers have concluded that “vacationing is a restorative behavior with an independent positive effect on health.” Paul Nussbaum, a clinical neuropsychologist and adjunct professor of neurological surgery at the University of Pittsburgh, said the mental benefits are clear and can help stave off such diseases as Alzheimer’s. “When you expose your brain to an environment that’s novel and complex or new and difficult, the brain literally reacts,” he explained. Those new and challenging situations cause the brain to sprout dendrites — dangling extensions — which Nussbaum said grow the brain’s capacity. “Your brain literally begins to look like a jungle,” Nussbaum said. Brain growth certainly isn’t confined to travel — it can just as well be had by playing tennis, picking up a new hobby or going to the symphony — but travel is an ideal method. “Travel by definition is drop-

ping your brain into a place that’s novel and complex,” he said. “You’re stunned a little bit, and your brain reacts by being engaged, and you begin to process on a deep level.” Even the stress that comes with travel and being thrown out of routines can be helpful. “Some stress, some anxiety is good because it positions the brain to be more attentive and more engaged,” he said. Engaging the brain through travel doesn’t need to be as dramatic as climbing a mountain in Asia or strolling the rainy streets of a medieval European capital; it can be as simple as a weekend road trip or going home from work by a different route. “You just don’t want to be rote and passive,” Nussbaum said. And travel’s benefits are the proverbial gift that keeps on giving. “Travel sticks with us and brings back positive memories and experiences,” he said. “You have the ability to go back there in your brain.” Even if it’s just a deliberate trip around the neighborhood.

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Chiropractic can help ease tendinitis and bursitis By Dr. Mandy Wyant Next to low back and neck pain, tendinitis and bursitis are among the most common conditions treated by chiropractors. The most frequent locations for bursitis are the shoulder and hip, while for tendinitis it’s the shoulder and knee. Bursitis of the shoulder and

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hip commonly cause a throbbing or aching at night in the affected joint region. This can cause difficulty in finding a comfortable sleep position. Bursitis is often worse with increased activity, so hip bursitis, for example is classically worse with prolonged walking or running.

Bursitis can be diagnosed easily, but to truly heal the problem you must identify the cause. While antiinflammatories or other pharmaceutical measures may help with the pain, they do not address the causative biomechanical agent. There is almost always a change in the mechanics of the joint

When people hear “rotator cuff” they can get very worried. But the most common rotator cuff condition is a very treatable and mild form of tendinitis.

2014 MEDICAL HANDBOOK

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that has caused inflammation to build up over time. For this reason the causative muscle tension and/or joint problem must be fixed in order to keep the bursitis from recurring. Tendinitis is also very common and can affect any muscle tendon in the body, though it’s most commonly seen in the rotator cuff, I.T. band and patellar tendon. When people hear “rotator cuff” they can get very worried. But the most common rotator cuff condition is a very treatable and mild form of tendinitis. Rotator cuff tendinitis commonly presents as limited shoulder range of motion — especially with reaching out to the side or behind the body. Treating this condition involves work in the office on restoring normal mobility to the shoulder girdle musculature in conjunction with therapies

to help with the pain caused by inflammation. A good home stretching routine must also be established. In people under 55, the most common cause of knee pain is tendinitis in either the patellar tendon or I.T. band tendon. Patellar tendinitis (aka runner’s knee) is commonly felt as a general ache around the kneecap or directly below the kneecap, especially with activity.

Once identified, this condition is very easy to manage and treat with a combination of work both in and out of the office. I.T. band tendinitis is felt at the outside of the knee and sometimes up into the outside of the hip and thigh. This tendon can cause pain when the leg is fully straightened, or it can throb at night. Through a combination of muscle stripping techniques, ultrasound and home stretching/ strengthening recommendations, most patients can get back to 100 percent quickly. If you’re suffering from a nagging ache or pain, remember, most of these problems won’t go away unless you make them go away. Dr. Mandy Wyant is a chiropractor with Family Chiropractic and Wellness in Columbus.

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That was then; this is now Breast cancer risk: better knowledge and science today By Deana Tuell

For women like me — women who lost young mothers to breast cancer back in the early ’80s, years seemed to go by as we mapped out breast cancer risks without much new information surfacing. But today, we are learning and seeing more. For Americans, one in eight women will develop breast cancer in her lifetime. Some of these women have a strong family history of breast cancer that is passed down through the family genes. This is known as hereditary or familial breast cancer. We can look at the BRCA1 and BRCA2 genes now to get a clear picture of which are genetically linked. But 80 percent of breast cancers are sporadic, meaning they just happen, without a true genetic link. But now we have additional DNA testing available to help predict when we might see a sporadic breast cancer. It’s important that all women know their clinical risk for breast cancer. Factors include a woman’s age, how old she was when she started her periods and how old she was when she first gave birth to a child. By knowing all these things and putting together a risk profile, we can tell a woman her likely chances of developing breast cancer over five years and her lifetime. We can also use genetic testing to

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look for a link to breast cancer. We can now use both to get the clearest risk assessment for breast cancer that we’ve ever been able to do. Looking separately at clinical risk factors and genetic testing helps us put the pieces together, but looking at everything together truly gives women a clearer, brighter picture. We know that finding a genetic link to breast cancer will enable a woman to have full preventive health care options for managing risk with things like preventive mastectomies with breast reconstruction, medications or intensive screening. A woman chooses what’s right for her life and family. We know, too, that those sporadic breast cancers found early have a very high survival rate — better now than in the early ’80s. As a woman gets older, she goes through many changes that can affect her risk of developing breast cancer. We know that estrogen in a woman’s body — necessary for normal growth, childbearing, controlling menstrual periods, and heart and bone health over her lifetime, also can contribute to breast cancer risk. The lifetime production of estrogen can lead to increased risk. Breast cancer risks increase every year as a woman ages. Breast cancer absolutely occurs in younger women, but the women most

at risk of the disease are those over 40. All women 40 and older should be participating in yearly screening mammography. Medicine and science have shown us new factors that may be associated with breast cancer. We know that women should watch their weight and exercise regularly while limiting their alcohol intake to decrease the breast cancer risk. In 2014, the hope is very real. We know so much. We have digital screening mammography allowing us to see much better than with analog films. We have breast MRI that allows better views for women with dense breast tissue or to see a cancer more clearly and to look for additional disease. We have breast ultrasound, clinical breast exams by physicians, breast self-exams and better diagnostic mammography. All this, paired with chemoprevention (medications that reduce breast cancer risk) and more knowledge about diet/exercise, smoking cessation and reducing/eliminating alcohol intake, makes for the best breast health plan ever. Deana Tuell is manager and breast health navigator at Columbus Regional Health’s Breast Health Center.

Those sporadic breast cancers found early have a very high survival rate — better now than in the early ’80s.

2014 MEDICAL HANDBOOK

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What’s the next investment after your 401(k) and kid’s college fund? Health care

By Ken Sweet AP Markets Writer

You already can invest your retirement money and your kid’s college savings on Wall Street. Next on the list: your health care. A growing number of employees are required by companies to set up special savings accounts to cover part of their medical bills. Over time, they are also encouraged to invest a portion of it in stocks, bonds or a mutual fund, just like they do with a 401(k) or IRA. Americans now have $18 billion in Health Savings Accounts, a type of plan that allows them to save pre-tax dollars for future medical expenses, according to the Employee Benefit Research Institute, a non-partisan group that studies worker benefits. That’s up more than 40 percent from a year ago. The amount of money in HSAs is expected to double by the end of 2015, according to consulting firm Devenir. “They have nowhere to go but up,” says Paul Fronstin, a researcher at EBRI. An HSA is similar to the better-known Flexible Spending Account. Like in an FSA, an employee puts pre-tax dollars into a special account to use toward medical expenses not covered by insurance, from dental check-ups to prescription drug co-pays. But the similarities end there. Unlike an FSA, HSAs do not have a “use it or lose it” rule, so the money carries over year to year. A majority of companies who offer HSAs also contribute to the account, more than $1,000 a year for families, according to EBRI. HSAs are also portable. An employee can take their HSA to their next job or save the money for future use. The accounts can also provide significant tax advantages when used correctly. For workers, HSAs offer flexibility, although they are not appropriate for everyone. see INVEST on page 14

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INVEST continued from page 12 For employers the accounts can provide savings. The plans have been shown to slow the rise in health care costs, or even lower them. For Wall Street, HSA’s are another way to make money. Why? The savings in HSAs can be invested once they hit a certain threshold, typically $2,000. Nearly all HSA accounts are used in combination with a type of health insurance known as a high-deductible health plan, or HDHP. These plans are also sometimes known as a “Consumer Driven Health Plan.” As their name implies, HDHPs have high deductibles, often $1,200 or greater for a single person, or $2,400 for a family. HDHPs provide coverage for medical emergencies, leaving the day-to-day health care costs to the employee. HSAs can be used along with a HDHP to help offset those day-to-day costs.

Triple tax advantage When used correctly, HSAs can also provide a triple tax advantage, something even a 401(k) or IRA cannot do. The money put into an HSA is not subject to federal income tax and if the money is invested, any growth is tax-free as well. Any money used toward eligible medical expenses can be tax-free too. If your employer hasn’t offered an HDHP plan yet, it’s only a matter of time. By next year, 80 percent of all large employers will offer a HDHP, according to 2013 employer survey by Towers Watson. The vast majority of those HDHP plans will include an HSA, according to the survey. “Companies are becoming more interested in offering medical benefits that put a lot of the ownership on the employee,” says Elizabeth Ryan, head of Wells Fargo’s Health Benefit Services. A 2011 study by the non-partisan RAND Corporation showed that families who were enrolled in a these types of plans reduced their health care spending by 14 percent.

2014 MEDICAL HANDBOOK

However, families also spent less on preventative care. “The whole idea of these accountbased plans is that when people have skin in the game they’ll make super-wise decisions regarding their health care spending,” says Amelia Haviland, who co-authored the study and is an associate professor in statistics and health policy at Carnegie Mellon University.

Banks like HSAs Banks have embraced HSAs, and banking industry experts say the plans could become a big business for Wall Street, just as 401(k)s did. Banks earn money just by opening the accounts for employees and charging fees on the debit cards tied to them. They also earn a fee, typically 1 percent, for managing the mutual funds where people invest HSA money. Of the $18 billion Americans have set aside in HSAs, $2.3 billion will be invested this year, according to Devenir. The amount invested five years ago was just a tenth of that, $200 million. Devenir’s President and CoFounder Erik Remjeske estimates that HSAs have generated revenue of about $200 million for the industry in the past year, including all the fees from investing to administration. Wells Fargo has been offering HSAs since they were created 10 years ago as part of the 2003 Medicare overhaul. Wells Fargo’s Ryan says the bank handles more than $1 billion in assets in HSAs, spread across 400,000 accounts. While most of Wells business is handling HSAs for employers, there is a growing business of individuals opening the plans, Ryan says. “They may have purchased insurance on their own, and they may already be banking with Wells Fargo, so it’s a natural progression because they have other financial products with us,” she says. Of the people who have an HSA, 56 percent are below the age of 45, according to a 2012 survey by JPMorgan Chase, which also

offers HSA plans. Only two percent of JPMorgan’s customers over 65 have an HSA. Their overall use remains small. Industry observers say HSAs have two large hurdles to overcome: Most people find HSA-HDHP plans confusing or believe the plans don’t offer enough coverage, and HSAs can only be used with high-deductible health plans, restricting their use. If you get an HSA, it should not be used the same way as an FSA, experts say. FSAs are designed to be used up each year. While it’s OK to spend a part of your HSA, the long-term goal should be saving for future medical expenses.

Not for the chronically ill Experts warn that HSAs are not a good choice for individuals who are chronically ill because those people will burn through the money, eliminating a chance to invest it. Once the HSA reaches the $2,000 threshold, it can be invested. However, it’s important to invest HSA savings more conservatively than in an IRA or 401(k), experts say. Medical expenses can come up unexpectedly and you may need the money quickly. Unlike a FSA, HSAs carry over year to year, so any money put in is yours to keep. If you reach 65 years old and find yourself with too much money in an HSA, you can start using it for non-medical expenses. However, you’ll lose the tax-free withdrawal benefit and will have to pay income tax on it. Keep at least a portion of an HSA equal to your health care plan’s deductible in cash or a money market fund, experts say. That way, if the stock market falls, at least the amount needed to cover your deductible won’t be at risk. “Know that what you’re investing is part of your family’s health insurance,” says Carnegie Mellon’s Haviland. “You don’t want to gamble.”

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Pediatrics

Amber Allen, MD

Premature births could be helped by simple steps

By Lee Bowman Scripps Howard News Service

More than 15 million of the babies born around the world each year come too soon, with tremendous cost in lives lost and disabled — and medical expense. Yet research shows many early infants, even in developed nations like the U.S., could benefit from wider use of some simple caregiving methods. Research found that of 15.1 million preemies (born at less than 37 weeks’ gestation in 2012), 13 million survived beyond the first week of life, and the deaths of 1 million were due to complications of prematurity. More than a million who survived faced some degree of disability. The research was published in a group of papers in the journal Pediatric Research. In the United States, 450,000 babies were born early, nearly one out of nine births — numbers in line with countries like the Congo and Bangladesh — and the most of any industrialized country. And that’s an improvement. The preterm birth rate in 2012 was 11.5 percent, down from 12.5 percent in 2006. More than 80 percent of babies

2014 MEDICAL HANDBOOK

born earlier than 37 weeks in wealthy nations survive, often after long stays in intensive care, but many are likely to have long-term physical and intellectual disabilities; in low-income nations, death is twice as likely as disability among preterm infants. The Institute of Medicine has estimated that preterm birth in the U.S. costs more than $26 billion a year. Early babies often face health problems ranging from breathing difficulties, jaundice and vision loss to cerebral palsy and developmental delays. Dr. Joy Lawn, a neonatologist and epidemiologist at the London School of Hygiene and Tropical Medicine and leader of the research team, said most newborn deaths could be prevented without intensive care. “Some inexpensive methods that have shown very good improvement are not being used in many countries with a high pre-term burden. Whether babies are born in the U.S. or Ethiopia, they should all get the same good care,’’ Lawn said in a phone interview. For instance, two injections of a steroid used to treat asthma, given to mothers in preterm labor, can speed

along development of a baby’s lungs and reduce the risk of breathing distress when they’re born. The treatment costs about $1. Or keeping preemies warm and with skin-to-skin contact to mom’s chest — a technique called Kangaroo Mother Care — helps reduce the risk of illness and fosters breast-feeding. “This works as well in a neonatal care unit as it does in the developing world, but not many hospitals in nations like the U.S. will promote it,’’ Lawn said. The researchers estimate as many as 75 percent of preterm babies who die would survive if the two interventions were commonly used. The research also showed that worldwide, boys are about 14 percent more likely to be born preterm than girls, in large part because women pregnant with boys are more likely to have placental problems, high blood pressure and high protein levels in their urine that are associated with early birth. Lawn said more research is needed to understand all the causes of early birth, but “we also need to make better use of what we already know.”

2014 MEDICAL HANDBOOK

Solution to childhood obesity begins with family By Jennifer Willhite

Baby fat is harmless. Right? Not so fast. “There’s a lot of denial or lack of awareness about childhood obesity among most people,” said Dr. Jennifer Hartwell of Columbus Pediatrics. “I think that parents don’t fully appreciate how being overweight or obese affects their child.” Not only is an obese child at risk for serious health issues, including high blood pressure, elevated cholesterol levels, joint problems and early puberty, but also low selfesteem and poor body image. “These issues can certainly continue into adulthood and affect a person for his entire life,” Hartwell said. “Even if he’s able to lose the weight as an adult, he may continue to struggle with his relationships with food and eating.” According to Hartwell, childhood obesity is very common. An average of 30 percent of children are considered either overweight or obese, and there is not much of a line separating the two.

Annual checkups During annual checkups with a pediatrician, a child’s weight and height are recorded and compared to a standard growth chart to determine if he is on track for his age and height. Those numbers are then used to measure his body fat, known as body mass index (BMI). “If a child is in or below the 85th percentile for his age, his weight is normal,” Hartwell said. “If he’s somewhere between the 85th and 95th percentiles he’s considered overweight. And if his BMI is greater than 95 he is considered obese.” Attributing your child’s plumpness to “baby fat” can

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be risky. Although there’s no definitive data that confirms or discounts baby fat as a myth, being overweight at as young as 2 years old may be indicative of future weight issues, Hartwell said. Determining if a child’s weight problem is genetic or environmental can be tricky. If genetics are suspected, screening labs are performed to check the child’s hormone balance and metabolic health, such as thyroid function, Hartwell said. If everything checks out, environment and lifestyle become the focus. Simply waiting for your child’s weight to level out isn’t realistic. Depending on where he is on a growth chart, he has to stop gaining weight at some point because his height can’t keep up, Hartwell said. So how do you combat childhood obesity? The same way you fight obesity as an adult.

Focus on the family meal. And that means everyone is invested in preparing the meal and sitting down at the table together. — Molly Marshall, registered dietitian

2014 MEDICAL HANDBOOK

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If you are consuming more calories than you’re burning off, you’re going to gain weight, Hartwell said. The key is for the child to consume a healthy diet and get plenty of exercise and for the parents not to push weight loss. Advocating dieting at a young age can irreparably harm a child’s relationship with food and eating — and his body image. “Pushing dieting can encourage eating disorders,” Hartwell said. “The key is to maintain weight as they grow or decrease the amount of weight gain.”

Promote healthy eating When promoting healthy eating habits in young children, it helps to have a structured meal and snack schedule, said Molly Marshall, registered dietitian with Reach Healthy Communities at Columbus Regional Health. “Focus on the family meal,” she said. “And that means everyone is invested in preparing the meal and sitting down at the table together.” Also, avoid giving food as a reward. “Sometimes we feed our kids to appease and distract them,” Marshall said. “Food is to cure our bodies, not give us something to do.” Children rarely have better eating habits than their parents, she said. So it’s important for parents to set the example. When introducing new, healthy foods, it

can take a child up to 15 times of seeing a food before he will try it. “Exposing them to the food without pressure is more likely to work than forcing them to try it,” she said. A sedentary lifestyle can get you into trouble at any age. Incorporate at least one hour of physical activity into your family’s daily schedule, Marshall said. Most importantly, make these positive changes together. “Don’t single out an overweight child,” she said. “It’s a family affair.”

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WITH LESS PAIN even includes orthopedic your family.surgical Led bytreatments, an expert, Our advanced forward-thinking orthopedic team,onyour care as well as the emphasis we place wellness will personalized and to and berehabilitation, havewell-coordinated earned national make your transition an World active Report life go recognition from U.S. back Newstoand faster andBlue moreCross smoothly. and from & Blue Shield. Our advanced orthopedic surgical treatments, as well as the emphasis we place on wellness and rehabilitation, have earned national recognition from U.S. News and World Report and from Blue Cross & Blue Shield. 4Do you have joint pain? Watch our online education seminar to learn how we can help at crh.org/joint 4For more information about our Joint & Spine Center call 812-376-5806. 4Do you have joint pain? Watch our online education seminar to learn how we can help at crh.org/joint 4For more information about our Joint & Spine Center call 812-376-5806.

2014 MEDICAL HANDBOOK

May help; may cause sudden death By Lindsay Morgeson

“Talk to your doctor to see if this medication is right for you.” Rarely can you sit though an entire TV episode without hearing this phrase at least once. The question is normally asked after reading off an entire list of horrific side effects (including sudden death) that may happen while taking the medication. So why would you even want to take that drug? And why is a prescription medication being advertised in the middle of the big game?

2014 MEDICAL HANDBOOK

Advertising medication to the public, or direct-to-consumer (DTC) advertising, is legal in only two countries: the U.S.A. and New Zealand. In the rest of the world, drug manufacturers can only advertise to health care professionals. While there are not strict rules regarding the content of the commercials, the Food and Drug Administration states that the “prescription drug information provided by drug firms is truthful, balanced and accurately communicated.” Typically

the drug manufacturers interpret the “balance” rule to mean that the time of the commercial should be split 50:50 – so in a 60-second commercial, 30 seconds focus on the benefits and 30 seconds will be the risks. The side effects (or risks) may only occur in a very small percentage of patients, but legally they have to tell you that it could happen. “Am I supposed to tell my doctor what drugs I want to take?” Medication advertising can be both a blessing and a curse. Over the

years it has been praised for reducing the stigma associated with some medical conditions and offering a speaking point for patients to discuss with their doctors. Conditions such as depression, erectile dysfunction and urinary incontinence have now become more frequently recognized and appropriately treated. The downside to this is the millions of dollars spent on advertising and patients potentially being on more costly medications to treat a condition. Most of the medications that are now generic, and inherently cheaper, are typically not advertised.

“

When selecting an optimal medication for a patient, there may be a perfectly acceptable medication that is a fraction of the cost of the new, advertised one. “But I don’t want to make a doctor’s appointment just to ask about a medication.” The most common place people turn to for quick information is, of course, the Internet. It’s full of all kinds of information, but unfortunately, there is not a miracle website that can answer if a medication is appropriate for you. If you have questions about medications or treatments, pharmacists

are the most easily accessible (and free) health care professionals to ask. They can provide you with accurate medication information and legitimate resources on where to find further information. Just like any business, there are busy times (lunchtime and evenings), but pharmacists are there to make sure you get the most appropriate, personalized treatment. So the next time you see a medication commercial, you will have a better idea if that drug could be right for you. Lindsay Morgeson is a staff pharmacist with Columbus Regional Health.

When selecting an optimal medication for a patient, there may be a perfectly acceptable medication that is a fraction of the cost of the new, advertised one.

”

2014 MEDICAL HANDBOOK

Steps to fend off the lure of sugar

By Jen Mulson The Gazette (Colorado Springs, Colo.)

My name is Jennifer, and I’m a sugarholic. As of this writing, I have four days clean and sober from the white stuff. However, I probably should admit that there are three Brachs Peppermint Christmas Nougats lurking in my pocket that I’m dying to have with a hot cup of coffee. I turned to an expert for help. Cassandra Green is a certified holistic health counselor who just happens to co-own and teach at Cambio Yoga in Colorado Springs, Colo. She’s teaching a four-part “Kick Sugar to the Curb”

workshop, starting at the best time of year — after our post-holiday feasting extravaganza. Letting go of the white stuff can be a challenge, my fellow sweet-toothed friends, but it’s a worthy battle. “Every time you spike your blood sugar, it creates inflammation in the body, and that’s the root of all disease,” Green said. “It’s closely linked to cancer, heart disease and all degenerative diseases.”

The more she eats, the more she craves

I always observe that sugar operates as crack in my body — the more I eat, the more I want. Your body gets accustomed to having it, Green said, which instigates a large release of insulin to deal with it.

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“What goes up must come down,” she said. “You go through a cycle of high blood sugar and insulin is released, then blood sugar plummets and you crave sugar again. And sugar releases dopamine. People can be addicted to it just like drugs.” She’s not lying. Here are her recommendations: l Eat five mini meals a day to keep the blood sugar level steady. Make sure to consume whole foods and not processed foods, as those tend to unwind as sugar in the body, Green said. Try almonds and a piece of fruit as a midmorning snack. A healthy fat and carbohydrate, such as an apple, can help keep you from feeling hungry. Once the blood sugar is stabilized, the body is less likely to crave sugar. “The body is mourning that sugar,” she said. “But once it’s stabilized, the body can react more diplomatically. You can have huge change in personality due to blood sugar. You can manage stuff in life a lot better

(when blood sugar stabilizes).” l Take a multi-vitamin and a fish oil pill, which contain micronutrients and healthy fat. Due to the Standard American Diet (appropriately called SAD), many folks don’t get the proper nutrition their bodies require, which can lead to sugar cravings. l Fats can help combat cravings, so have some nuts or a piece of cheese. One also can mistake hunger for thirst so stay hydrated. Cinnamon is also a handy spice to have as it can help control blood sugar. Green recommends a baked apple with walnuts for dessert. (I can attest that this is a delicious alternative.) l Stick with it. By Day 5 of a sugar cleanse, the cravings will dissipate. Be wary of that cup of coffee, too, she said. Caffeine can trigger sugar cravings. (It’s like she’s reading my mind.) “It’s psychological. We’re used to having cheesecake and a cup of coffee,” she said. “For a lot of us, the caffeine is a natural metabolism speeder,

and it prompts you to have more sweets than you normally would. Caffeine and sugar go hand in hand.” Of course, moderation in all things, right? Eat well 80 percent to 90 percent of the time, depending on your activity level, and treat yourself every once in a while, according to an article on livestrong.com. So maybe I’ll have one of those tempting treats in my pocket, after a nice big bowl of kale. And then I’ll brush my teeth, which my mama advised me to do long ago. She also fought the sugar demons, mostly over a carton of ice cream after dinner every night. She was right, though — a minty mouth does help stop a sugar binge in its tracks. “If we look back before processed food was readily available, we see that people died over time, from infectious disease,” Green said. “They didn’t have a lot of degenerative diseases. Now we see we’re dying of degenerative diseases. They’re starting out on a cellular level.”

• Acute illness Walk-ins without an appointment 7:30 a.m. - 9:30 a.m., Monday through Friday Anyone with an acute illness can walk in during these hours and be treated without an appointment.

• Our Nurse Practitioner, Sue Thomas is available for same day appointments, Monday through Friday. • Lab work and immunizations between 7 a.m. - 11 a.m., 1 p.m. - 4 p.m., Monday through Friday, without an appointment. The Physicians of Columbus Adult Medicine will continue to provide care for Dr. Young’s patients.

Katrina McGillivray, D.O.

Sue Thomas, Nurse Practitioner

Located on the Hospital Campus 2326 18th Street, Suite 210, Columbus, IN www.columbusadultmedicine.com www.columbusgynecology.com

(812) 372-8426 New Patients Welcome

Helen Kinsey, M.D.

Cynthia Mason, M.D.

2014 MEDICAL HANDBOOK

Diabetes management … Aye aye, Captain! By Lucina Kessler

You will often hear me using the metaphor of being “in a boat” when I work with people with diabetes. We clarify roles early as I claim my place as crew member and your position as captain. This theme of conversation “you being captain” runs with all the certified diabetes educators at Columbus Regional Health’s Outpatient Diabetes Services, at Volunteers in Medicine clinics and with the Health Coach program. As part of your support team, we partner in your care, recognizing that you are driving. What facts do we know as we embark on our journey? • Managing diabetes is hard. • Self-management is critical to success. You are making decisions for yourself 8,760 hours per year, a small percentage with your

2014 MEDICAL HANDBOOK

health care team. • Knowledge is your compass. Diabetes self-management education becomes critical to driving the boat, making decisions and going in the right direction. • Behavior change is hard for everyone. • 95 percent of people who lose weight gain it back. • 50 percent of people prescribed medication for chronic conditions do not take them; 30 percent of people do not even get the first script filled. • How many people actually stick with activity programs? I’m guilty. • The American Association of Diabetes Educators helps guide the practice of diabetes educators/ coaches with seven self-care behavior categories: • Healthful eating. • Being active.

• Monitoring. • Taking medication. • Risk reduction. • Healthy coping. • Problem solving. • Setting SMART (Specific, Measureable, Attainable, Realistic, Timely) goals works. Working with your educator/coach to develop an individualized plan will help you sail on the right path to healthy diabetes care. • Keeping regular appointments with your primary provider will improve your numbers. • People who get routine labs have better values; follow your doctor’s wisdom on this one. • Support predicts success • Numerous studies show that social support is a powerful predictor of diabetes self-efficacy (you believe you can), adherence (you do

it) and positive health outcomes (we all see results). In my years as a diabetes educator, support has been the strongest predictor for success. You are amazing for what you have to navigate in a day and in a lifetime. Veering off course is part of the journey; we expect it, but we get back on course. Each person’s perception of support may vary depending on life experiences, culture, values and beliefs. Listening to your story (getting in your boat) is the first step to supporting you. Ongoing support is the key. I and the other CDEs are grateful for the lessons we have learned from our captains. It was your stories that led to the free classes in 2009 and the coaching project in 2012. Your voice will continue to change how we support and manage diabetes.

• Diabetes awareness session — 5:30 to 6:30 p.m., May 8, Aug. 14 and Nov. 13 at Mill Race Center. • Healthy Living with Chronic Conditions — six-week course at Mill Race Center. • Other local resources, call 211.

Individual sessions Your primary care provider may refer you to the health coach in her office (if one is available) or to Outpatient Diabetes Services at CRH (376-5500) for an appointment to see a certified diabetes educator. This will depend on your need. If you have not had previous diabetes core information or it has been over two years, we do recommend starting with the group information session on the second Thursday of each month at Mill Race Center.

Group sessions • Diabetes group information session — 3 to 5 p.m. second Thursday of each month at Mill Race Center.

Lucina Kessler is a diabetes clinical nurse specialist at Columbus Regional Health.

“

In my years as a diabetes educator, support has been the strongest predictor for success.

”

Rehabili tation and Med ical services open to the com munity!

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www.indianamasonichome.org | 690 State Street | Franklin, Indiana 46131 2014 MEDICAL HANDBOOK

Early diagnosis important for slowing Alzheimer’s disease By Yuko Yamato

Alzheimer’s disease is a condition of the brain that gradually interferes with memory and other thinking abilities, such as wordfinding, reasoning and understanding spatial relations. The condition is irreversible and begins to affect one’s abilities to carry out everyday tasks, such as handling money, keeping up with medicines and driving safely. Dementia is the umbrella term used to describe gradual loss of thinking abilities that may or may not be accompanied by changes in

2014 MEDICAL HANDBOOK

behavior, personality and emotion. While dementia can be caused by many conditions, Alzheimer’s disease is the most common cause among older adults in the United States. While estimates vary, as many as 5.1 million Americans may have Alzheimer’s disease.

Onset of brain damage

Scientists have been working to identify how the disease process begins and now believe that damage to the brain begins long before people show symptoms of Alzheimer’s disease. Abnormal deposits of proteins begin to form

amyloid plaques and tangled bundles of fibers (called neurofibrillary tangles), and connections between nerve cells begin to deteriorate. As the disease progresses, neurofibrillary tangles and plaques spread throughout the brain, leading to greater decline in thinking abilities. In addition, scientists are now aware that one’s genetics, environmental influences and lifestyle choices also can contribute to the development of Alzheimer’s disease. For instance, one form of the apolipoprotein E (APOE) gene

appears to increase one’s risk of developing Alzheimer’s disease. However, not everyone with it develops Alzheimer’s disease, and some people who do not carry the form of APOE gene can develop the disease. Studies also suggest engaging in mentally, socially and physically stimulating activities may help reduce the risk of Alzheimer’s disease.

Diagnosing the disease To diagnose Alzheimer’s disease, doctors may carry out various medical tests (such as blood tests) and perform brain scans, such as magnetic resonance imaging (MRI) and computed tomography (CT) to eliminate other possible causes of thinking difficulties, such as stroke, brain tumor and Parkinson’s disease. Doctors may also recommend neuropsychological testing

to objectively look for cognitive indications of the disease. Neuropsychological testing can measure one’s abilities not only in memory, but also in attention, language, reasoning and motor functioning, among others, helping doctors diagnose more accurately. Early and accurate diagnosis is important for many reasons. Available medications for Alzheimer’s disease cannot cure the disease; however, starting such treatment early on in the disease process can help preserve one’s thinking abilities. Slowing the progression of the disease may also help people maintain their independence longer. Early diagnosis will also allow families to make appropriate plans for the future, arrange resources and services, and most importantly, develop support systems. Caring for a loved one with Alzheimer’s disease can be a chal-

lenging experience for families in terms of emotional demands, physical demands and financial costs. To avoid neglecting their own needs, caregivers are strongly encouraged to participate in a support group to find comfort in knowing they are not alone. Support groups also provide a safe atmosphere, in which caregivers can express their concerns and receive support from those who may be going through a similar experience. For more information about support groups in the area or about Alzheimer’s disease, contact Alzheimer’s Association Greater Indiana Chapter at 800-272-3900.

Yuko Yamato is a clinical neuropsychologist at Columbus Regional Health

Frank R. Kolisek, MD

Orthopaedic Surgery • Hip and Knee Joint Replacement Specialist No referral needed, unless required by your insurance company.

Practice Focus

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Locations/Hospitals

OrthoIndy South 1260 Innovation Pkwy., Suite 100 Greenwood, IN 46143 Indiana Orthopaedic Hospital Community Hospital South

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Becker’s Orthopaedic Review: 125 National Top Knee Surgeons, 2012 Becker’s Becker’s Orthopaedic Review: 70 National Outstanding Hip Surgeons and Specialists, 2011 Becker’s Arthritis Foundation of Indiana Honoree of the Year, 2010 Arthritis Indianapolis Monthly Top Doctors Orthopaedic Surgery, 2010, 2011, 2012 and 2013 Indianapolis Top Doctors Orthopaedic Surgery, US News & World Report, 2011 and 2012 Top

To schedule an appointment directly with Dr. Kolisek, please call (317) 884-5160.

FrankKolisekMD.com 2014 MEDICAL HANDBOOK

By Stacey Wessel

Medication safety: Know what you’re taking

Do you keep a list of your current medications with you at all times? Carrying an updated medication list with you can be instrumental to your safety if an emergency arises. Nobody plans for the unexpected to happen. When a medical emergency arises, you can be better prepared by having an updated medication list in your wallet or available on your smartphone. The key information that everyone should have on their medication list includes the medication name, strength, how much, how often and why you take it. For example: Medication name(s) Metoprolol tartrate (Lopressor) Strength of the medication 50 mg How much you take One half tablet How often you take it Every day with breakfast and at bedtime Why you take it To lower blood pressure Having an updated medication list is not only for emergencies but is needed anytime you see a health care practitioner. How many times have you gone to your

2014 MEDICAL HANDBOOK

eye doctor’s appointment or dentist and they ask what medications you are taking? Yes, even your dentist wants to know what medications you take before you have your teeth cleaned. Medication incidents are one of the leading causes of hospital admissions throughout the nation. Some common reasons that cause admissions include drug interactions, confusion about dosage changes, doubling up on medication because they didn’t remember if they already took their pill that morning or not, and even mistakenly setting up their pillbox organizer with two tablets instead of one. All of these scenarios can lead to a medication incident that results in a trip to the hospital or physician’s office. Having a medication list that you can reference and easily update can reduce some of these inadvertent medication incidents. Always remember to update your medication list before you leave the physician’s office. Don’t wait until you get home to do it, as most of us will forget about it. You can even ask your physician’s office to print a new list for you before you leave. Better yet, keep the list on your smartphone and avoid the paper trail. Smartphones are another way to keep your medica-

“

Having an updated medication list is not only for emergencies but is needed anytime you see a health care practitioner.

tion list updated and with you at all times. There are numerous apps for storing medication lists available to download, and some can even remind you when it’s time to take the next dose of your medication. Search online for “medication apps” to find a wide variety of programs and then wisely research your options before you download.

More medication safety tips Use one pharmacy. If not pos-

sible, make sure your primary pharmacy has a copy of your complete medication list so it can scan for drug interactions. Safely discard all out-ofdate medicine. Start, stop or change medicines only with your doctor’s approval. Know each of your medications and what they are used for. If you have any questions, ask your doctor or pharmacist. Select another person who can

”

also learn what medications you take. Let them know where you keep your current medication list or provide one for them. Use a medicine container system, such as a daily pillbox, to organize multiple medications.

Stacey Wessel is a registered pharmacist and medication safety specialist at Columbus Regional Health.

Hometown healthcare. Exceptional care. Right here in our community. We all have a common goal: BEAT BREAST CANCER.

Specializing in Breast Healthcare Dr. Michael Dorenbusch Breast Surgeon

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2325 18th Street, Suite 220 • Columbus, IN 47201 • sisurgery.com 2014 MEDICAL HANDBOOK

‘Does this mean we can drink whole milk?’

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Making sense of changing dietary fat recommendations By Patti Wade

Some saturated fatty acids do not raise cholesterol. But many saturated fatty acids do raise cholesterol.

2014 MEDICAL HANDBOOK

”

It seems that every month a new study is heralded suggesting that we can now eat a formerly forbidden food. Or a food we thought would cure all turns out to be nothing more than a mere food. When studies seem contradictory and recommendations turn around 180 degrees, it is hard to know what to eat. It is also hard to trust the distinguished organizations that make the recommendations. To help understand how we got where we are, it is beneficial to look at how scientists and nutritionists determine dietary guidelines. It often starts with the realization that a certain group of people has a lower occurrence of a particular disease. For example, the observation was made in the 1960s of a very low incidence of heart disease in native Alaskans. This group was protected from heart disease despite consumption of large amounts of fat and very few fruits and vegetables. Looking at what foods the protected group consumed that were different from the foods eaten by groups with higher incidences of the disease, recommendations can be made based on associations. We do not necessarily understand the cause and ef-

fect relationship. In this case, scientists understood that fatty fish contain some beneficial oils and made recommendations to include these in our diets. In continuing to try to determine dietary influences on heart disease, scientists looked at fat consumption patterns of different groups of people, the incidence of heart disease and levels of blood cholesterol, which was felt to be the blood level indicator for risk of heart disease. Looking both at fat structure and the factors above, they determined that health is impacted by differences in fat saturation. Nutritionists felt comfortable recommending reductions in total fat and saturated fats (firm fats primarily from animal sources) and replacing saturated fat with polyunsaturated and monounsaturated fats (liquid fats, primarily oils from vegetables, nuts and seeds). As the research has continued, scientists have become aware that fats contain blends of different fatty

acids (components of fats). The structure of fatty acids that make up a fat dictates the fat’s role in our bodies. Some polyunsaturated fatty acids help our blood vessels to open up and some promote blood vessel tightening. Some saturated fatty acids raise blood cholesterol levels, and some do not impact blood cholesterol. The role of a particular fat changes based on interactions with other compounds in the body. Some fatty acids compete with others for enzyme activity, which means that the presence of one will impact the effectiveness of another. Because of the very complex interactions and roles of fatty acids, a study may report on one aspect of the entire picture and contradict what we have been told previously. For example, there was a recent report that full-fat dairy products are no longer found to raise blood cholesterol. Full fat dairy products contain primarily saturated fatty acids. Some saturated

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fatty acids do not raise cholesterol. But many saturated fatty acids do raise cholesterol. At this stage in dietary fat research, organizations such as the American Heart Association, the Institute of Medicine, the Academy of Nutrition and Dietetics and the World Health Organization do not have enough conclusive data to recommend a turn-around on full-fat dairy products. In January, the Academy of Nutrition and Dietetics posted the current guidelines for fat intake for healthy adults: regular consumption of fatty fish, nuts and seeds, lean meats and poultry, low-fat dairy products, vegetables, fruits, whole grains and legumes.

Patti Wade is a registered dietitian and manager of food services at Columbus Regional Health.

Douglas Y. Roese, M.D.

Jason W. Christie, M.D.

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2014 MEDICAL HANDBOOK

Several treatments recommended for gastroesophageal reflux disease By Dr. Geoffrey S. Raymer

Gastroesophageal reflux, or acid reflux, occurs when a portion of the contents of the stomach wash up into the esophagus. This is a normal occurrence in healthy people of all ages and is usually very brief and undetected. Gastroesophageal reflux disease or GERD, however, occurs when a person feels symptoms related to these events. Symptoms can vary from one person to another and may include such things as heartburn, nausea, vomiting, chest pain, hoarseness, difficulty with or painful swallowing, or even symptoms of asthma. Contents washing from the stomach into the esophagus can certainly be bothersome when symptoms like these are present. Because this material is acidic, it can also cause damage to the esophagus if there is frequent reflux activity or if the esophagus is not able to clear away the refluxed material quickly. People who experience heartburn or any of the other symptoms listed above at least two or three times per week are likely to have GERD.

2014 MEDICAL HANDBOOK

Heartburn The most common symptom, heartburn, is thought to affect approximately 10 million adults in the United States daily. This is typically described as a burning sensation in the center of the chest, behind the breastbone, which sometimes spreads to the throat. On occasion, there can be an accompanying acidic taste in the mouth. GERD can also be present even without the typical symptom of heartburn. Less common symptoms include stomach pain, usually in the upper central portion of the abdomen just below the rib cage; difficulty swallowing or a sense that food gets stuck after swallowing; painful swallowing; hoarseness; persistent sore throat; chronic cough; new onset or nighttime symptoms of asthma; regurgitation of fluid or food into the mouth; a sense of a constant lump in the throat; worsening dental disease; recurrent pneumonias or sinus infections; or waking from sleep with a choking sensation. The presence of any of these symp-

toms should be reported to a physician right away. Typically, the diagnosis of GERD is made based on the presence of symptoms and the response to therapy. Sometimes symptoms will respond to certain lifestyle modifications. In other situations, the treating physician may prescribe a medication to alleviate symptoms. In some cases, the treating physician may recommend further evaluation to exclude more serious conditions. This can include referral to a gastroenterologist, a physician with specialty training in the health and function of the digestive system. A gastroenterologistâ&#x20AC;&#x2122;s training includes the ability to use specialized techniques to evaluate the esophagus for any damage related to reflux. These can include techniques for measuring the acid that refluxes into the stomach; testing the function of the esophagus, including how well it is able to clear acid; and the performance of scope tests, or endoscopy, to directly visualize the lining of the esophagus.

“

Most GERD can be easily and successfully treated without serious complications. However, there are several complications that can arise ... particularly if it is not adequately treated.

Complications Most GERD can be easily and successfully treated without serious complications. However, there are several complications that can arise from GERD, particularly if it is not adequately treated. These can include ulcers of the esophagus, strictures or narrowing of the esophagus due to scarring from the effects of the acid, or lung problems such as asthma or pneumonias if the reflux is severe enough that acid affects the vocal cords or airways.

Long-standing GERD in some individuals can lead to a condition called Barrett’s esophagus. This occurs when the normal cells that line the esophagus are replaced by a different cell type in response to acid injury. These abnormal cells have a small risk of transforming into cancer cells. Barrett’s esophagus is a major risk factor for cancer of the esophagus. Fortunately, only a small percentage of people with GERD will ever develop Barrett’s esophagus and an even smaller percentage will progress to

”

esophageal cancer. A gastroenterologist can assess the symptoms of GERD and make recommendations as appropriate for lifestyle modification, medication or further testing to allow for relief of GERD-related symptoms and to help maintain the long-term health of the digestive system.

Dr. Geoffrey S. Raymer is a physician with Southeastern Indiana Gastroenterology and is medical director of endoscopy at Columbus Regional Hospital.

Local Expertise and Experience You Can Trust.

Specializing In

Screening Colonoscopy Colon Cancer Prevention Acid Reflux Difficulty Swallowing Other Digestive & Intestinal Disorders Liver Diseases and Hepatitis C

Steven Pletcher, MD • Geoﬀrey Raymer, MD Lora Fathauer, DNP, NP-C

2630 22nd Street, Columbus • (812) 372-8680 • www.columbusgastro.com 2014 MEDICAL HANDBOOK

Patients with prostate cancer have many options By Howard Cohen The Miami Herald

at Mill Race Center

812-372-6415

900 Lindsey Street • Columbus, IN 47201

admin@justfriendscolumbus.com • www.justfriendscolumbus.com Continuous activities • Flexible scheduling (as needed basis) Nursing & social work support • Financial assistance available VA, Medicaid Waiver, CHOICE and private pay

“Here when you need us” 36

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The detection and treatment of prostate cancer is getting high tech. New sophisticated screenings, better tests for evaluating biopsied tissue and use of MRI-ultrasound fusion to accurately map prostate cancer are the latest advancements in detecting and treating the disease. “These are the things that are new and exciting,” said Dr. Dipen Parekh, professor and chairman of the department of urology and director of robotic surgery at the University of Miami Miller School of Medicine. “If you do get a diagnosis of prostate cancer, if you seek out treatment with the right people, and you are in the right hands, you should expect an excellent future course.” In addition, robotic-assisted laparoscopic prostatetectomy continues to advance as a surgical tool, along with radiation therapy or brachytherapy, which uses radioactive seeds to kill cancer cells. Still others undergo a radical prostatectomy, the removal of a cancerous prostate and its surrounding tissue. Pre- and post-surgical pelvic floor physical therapy, a series of exercises under the guidance of a therapist, can also strengthen pelvic areas to end incontinence, said Louise Gleason, a physical therapist with South Miami Hospital’s Pelvic Floor Center. And, for those for whom prostate cancer has become too advanced and who are not candidates for surgery, Provenge, a restorative treatment of cellular immunotherapy, made from a patient’s own immune cells, can stimulate a patient’s immune system to identify and target prostate cancer cells,

thus prolonging life, said Dr. Michael Cusnir, an oncologist at Mount Sinai Medical Center in Miami Beach, Fla.

Guidelines Guidelines for screenings of the prostate, a walnut-sized portion of a man’s reproductive system that wraps around the urethra, the tube that carries urine out of the body, have changed since May 2013. “Instead of every man over 40 getting a PSA (prostate-specific antigen blood test), now it’s more focused on screening for patients with a high risk for prostate cancer, those who have a family history, or who are African American,” said Parekh. MRI-ultrasound fusion, adopted early by the University of Miami’s Sylvester Comprehensive Cancer Center, can result in more accurate prostate biopsies than ultrasound alone or digital rectal exams. The American Cancer Society recommends that at age 50, men who

are at an average risk of prostate cancer have a discussion about the risks and potential benefits of a screening with their doctor. The screening discussion can start at 45 for men at higher risk of developing prostate cancer, which, according to the American Cancer Society, will impact one out of seven men in the United States — though only one out of 36 will die from the disease. Most older men who have been diagnosed with prostate cancer will die from other causes before succumbing to the cancer. At-risk men would include African Americans, who have a higher instance of prostate cancer compared with their white and Hispanic counterparts, or men who have an immediate relative such as a father, brother or son who was diagnosed with prostate cancer before age 65. Those who have had more than one immediate relative with the disease at an early age should begin

PROSTATE CANCER SYMPTOMS Cancer Treatment Centers of America has identified the following symptoms related to prostate cancer: l Burning or pain during urination l Difficulty urinating, or trouble starting and stopping flow, or decreased flow or velocity l More frequent urges to urinate at night l Loss of bladder control l Blood in urine or semen l Erectile dysfunction l Painful ejaculation l Swelling in legs or pelvic area

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We almost train the patient’s own immune system to recognize the cancer cells and fight them on their own. — Dr. Michael Cusnir, an oncologist

discussions with their doctors even earlier, at age 40. Prostate cancer is the second most common cause of cancer death in men, behind lung cancer and ahead of colon cancer. About 233,000 new cases of prostate cancer will be diagnosed nationwide in 2014, and 29,480 men will eventually die from it, according to the American Cancer Society. The upshot: More than 2.5 million men in the United States who have been diagnosed with prostate cancer at some

point — the average age at the time of diagnosis is 66 — are still alive. Active surveillance, or monitoring the disease with doctor and patient working in tandem, can also improve quality of life. Robotic surgery, guided by infrared vision, is a preferred treatment because blood loss is minimized as is the risk of damaging blood vessels and nerve bundles that are responsible for blood flow to the penis that allows a man to achieve an erection. The image-guided surgery is also

”

less traumatic. Most patients go home within a day or two with a catheter, for about a week, to help drain the bladder until the sutures heal. Normal continence resumes for 95 percent of patients within the first six months.

Physical Therapy For patients who need help dealing with issues of incontinence, which can occur before or after prostate cancer surgery, or from an enlarged prostate as a man gets older, thera-

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peutic exercises can be a remedy. The Pelvic Floor Center at South Miami Hospital focuses on a ring of bones that includes the sacrum at the bottom of the spinal column and the pelvic bone on either side. At the base of that bone structure lie muscles that hang like a hammock from the tailbone to the pubic bone, supporting the pelvis. These muscles are voluntarily controlled, like the biceps or triceps, and are used to control the passage of waste from the body. “I gear my physical therapy toward the muscles and bones of the pelvis to see if we can help patients restore that function after whatever procedure they have,” Gleason said. “When these muscles are weak, or not working properly, they can’t close that urethra to hold that urine back and that’s where I come in. I assign people exercises based on the strength they already have so as to maximize their improvement,” she said. In general, it takes about a month

Dr. Charles Rau

before a patient will see real strengthening, Gleason said. Typical sessions run once a week for about six to eight weeks with home exercises suggested afterward. A simple exercise might go like this: Recline on the floor with knees bent, a hand on the belly, another on a leg. Tighten up around the anal area as if holding back gas. Release and repeat. “The first goal is to isolate the pelvic floor and be able to recognize when they are using it,” Gleason said. “From there, you can begin to exercise because you are using the correct muscle.” Still other therapies can utilize electrodes placed on the skin to measure activity in the muscles to train the muscles to contract and strengthen. If the incontinence or sexual dysfunction is muscular related, these exercise combinations can be effective, Gleason said.

Immunotherapy In some cases, prostate cancer has advanced beyond surgical solutions. Provenge, a therapeutic class of cellular immunotherapies, is not curative. But this non-surgical alternative to prostate cancer treatment can improve the survival rate of patients for months or years. Patients’ cells are collected, infused with an antigen that helps activate the patient’s T-cells to help fight the cancer cells, and then placed back into the patient’s body intravenously. “Almost like a blood transfusion,” explains Mount Sinai’s Cusnir. “We almost train the patient’s own immune system to recognize the cancer cells and fight them on their own.” The process is repeated three times in two-week intervals. “We’re still looking for a big change,” Cusnir said about the treatment of prostate cancer, “but at least we keep improving survival.”

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Tips on preventing colds and flu

By Drs. Kay Judge and Maxine Barish-Wreden The Sacramento Bee

If you get too busy, you can get overstretched and sleepdeprived, and at higher risk for illness, including colds and flu. Before you get to that stage, you should put in place some practices that will leave your immune system operating at peak performance. There are a number of supplements and botanicals that can help to reduce your risk of getting sick. They include: l Zinc is important for a healthy immune system, and the elderly in particular are often zinc-deficient. Be sure to eat zinc-rich foods, including oysters, beef, liver, poultry, crab and pork. Zinc is not well absorbed from multivitamins, so if you need extra zinc, take it as a separate supplement. The RDA is 11 milligrams per day for men and 8 milligrams for women, though some people need more. l Probiotics may help to prevent colds or reduce the duration of symptoms. They seem to work by stimulating immune function. Try lactobacillus rhamnosus GG or a mixed probiotic containing lactobacilli and bifidobacteria. The optimal dose is uncertain, but usually about 10 billion colony forming units per day for kids and 25 billion CFU for adults. l North American ginseng (also known as panax quin-

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quefolius) may reduce the risk of developing colds or influenza if taken for three to four months during the winter months. It may also reduce the severity and length of illness if you do get sick. The dose is approximately 200 milligrams twice daily. l Some data suggest that vitamin C may reduce the incidence of colds, especially in people exposed to extreme stress, physical exertion, or cold weather; their incidence of colds was reduced by 50 percent when they took vitamin C. Vitamin C is considered to be a safe supplement especially if taken in moderate doses, such as 250 to 500 milligrams twice daily. l Green tea may have antiviral effects; preliminary research suggests that it may help to prevent colds and flu. Drink three to five cups per day. And if you do get sick, here are a few things that can help to reduce the severity or length of your symptoms: l Zinc lozenges may also help to stop a cold; they must be started within 24 hours of the onset of symptoms. Look for zinc acetate lozenges that contain 13 to 25 milligrams of zinc per lozenge; other formulations of zinc are not as effective. Dissolve a lozenge in the mouth every two hours until you have consumed at least 75 milligrams total per day; stop after seven to 10 days. l Elderberry may help to reduce symptoms of the flu by boosting the ability of the immune system to fight off the infection; it is active against both influenza A and B and may even be effective for swine flu. Extract of elderberry can shorten the duration of the flu by at least 50 percent and also reduce fever and muscle aches. The dose is 1 tablespoon four times daily for three to five days. l The herb andrographis may also help to reduce the severity and duration of upper respiratory infections. Kan Jang is the Swedish andographis product that has been studied the most; it is often combined with Siberian ginseng (Eleutherococcus). It needs to be started within 48 hours of symptom onset. The dose is two capsules three times daily for five days. l Echinacea may help to reduce the length and severity of the common cold, though not all species are effective; Echinacea purpurea is the one that seems to be the best. It should be started at the onset of symptoms and continued for seven to 10 days. l Fresh garlic may help to thwart a cold — eat one raw clove of chopped garlic every hour at the first onset of symptoms. Stop after you’ve eaten six to eight cloves, or if you get GI distress (or if you start to smell like a garlic factory!). l Honey is an effective cough suppressor and can also ease a sore throat; take one or two teaspoons, either by itself or in some warm herbal tea. It can also be used safely in children over the age of 1. l Licorice is recommended by the German Commission E for inflammation of the upper respiratory tract. It fights viruses, helps to loosen secretions, and can soothe a sore throat. l Chicken soup seems to reduce inflammation, and if you throw in some mushrooms, onions and garlic, you’ll be supporting your immune system, as well.

The basics in a first aid kit If you’ve ever had to turn the bathroom cabinet upside down to find a BandAid when you need it, get organized. Make a first aid kit and keep it handy. Include these items and others you know you will use: l Gauze in pads or a roll. l Adhesive tape. l Cold pack. l Disposable gloves. l Band-Aids in assorted sizes. l Hand cleaner. l Small flashlight with working batteries. l Alcohol. l Scissors. l Tweezers. l Triangular bandage. l Syrup of ipecac. l Antiseptic ointment. — American Red Cross

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Common questions about colonoscopies

By Anita Norris

Why should you consider a colonoscopy? Because the procedure saves lives. A common and safe medical screening, a colonoscopy can help prevent colon cancer by detecting precancerous polyps. By removing these growths before they develop into full-blown cancer, the patient’s life can be extended and overall health improved. In general, most doctors recommend beginning colon screenings at the age of 50. However, if you possess risk factors – such as a member of your direct family who had colon cancer or polyps – it would be wise to start even earlier. You may think you don’t need a colonoscopy because you’re not experiencing any pain, bleeding or other symptoms. But colon cancer is insidious. Many patients do not experience significant symptoms until the disease is well advanced. By detecting it at the precancerous stage, polyps can be re-

moved in a relatively simple and low-risk surgery. Once colon cancer is advanced, however, it may require removing a portion of the colon, resulting in significant life changes. A sigmoidoscopy is another type of colon screening procedure. It is performed in a doctor’s office without sedation. However, it sees only about one-third of the colon. Colon cancer can occur anywhere in the large intestine. A colonoscopy is a more involved procedure that uses sedation to make the patient more comfortable. It views the entire colon, using IV sedation, with the dosage tailored to the patient’s needs. The prep involves drinking Miralax mixed with Gatorade (or another liquid). Few patients complain about the colonoscopy prep or procedure. X-rays can be used to detect colon polyps, but only the largest variety. In order to have a detailed view of the

entire colon so the surgeon can know what growths to remove, a colonoscopy is necessary. The day prior to a colonoscopy, a clear liquid diet is required. But otherwise most patients are able to follow a typical lifestyle, including going to work. Most colonoscopy patients can return to work or regular activities the day after the procedure, requiring only a single day away from their normal schedules. Risks associated with colonoscopy are extremely small, with the same minor chance of complications that comes with any type of surgery. Our doctors recommend having a screening once every 10 years, or more frequently if higher risk factors are involved. You don’t need a referral from a family practitioner; our doctors can evaluate whether you need a colonoscopy. Many insurance companies cover them. Anita Norris is a nurse practitioner with Southern Indiana Surgery.

A Reminder About the Importance of Screening Colonoscopy Affecting both men and women, colorectal cancer is the second leading cancer. When detected early, the five-year survival rate is 90 percent. If you are over the age of 50, schedule your colonoscopy with our experienced surgeons today. Along with receiving valuable lifestyle education, screening colonoscopy could be the first step in preventing colon cancer.

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