2015
Medical Handbook
Contents Diabetic foot ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 E-cigarettes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Primary care providers. . . . . . . . . . . . . . . . . . . . . . . . . 6 Easy ways to improve health. . . . . . . . . . . . . . . . . . . . 8 Childhood immunizations. . . . . . . . . . . . . . . . . . . . . 10 Fibromyalgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Forest Path A home-like setting for up to ten residents with skilled nursing and therapy available.
Osteoporosis in men . . . . . . . . . . . . . . . . . . . . . . . . . 14 Managing migraines . . . . . . . . . . . . . . . . . . . . . . . . . 18 Juicing trend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Back pain treatments . . . . . . . . . . . . . . . . . . . . . . . . 24 Herbal supplements . . . . . . . . . . . . . . . . . . . . . . . . . 26
Not just a design, an approach to living. Call Today
for Additional Information!
Heart attack basics. . . . . . . . . . . . . . . . . . . . . . . . . . 28 First aid kits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Dine at home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
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. Š2015 by Home News Enterprises. All rights reserved. Reproduction of stories, photographs and advertisements without permission is prohibited. Stock images provided by Š Thinkstock.
Lutheran Community Home, Inc. 111 Church Ave., Seymour, IN 47274 www.LutheranCommHome.org
(812) 522-5927
2015 MEDICAL HANDBOOK
1
What is a diabetic foot ulcer? By Dr. John R. Hladik
Definition One of the most serious complications of diabetes is formation of a diabetic foot ulcer, an open wound (sore) located below the ankle in an individual with either Type 1 or Type 2 diabetes. One in six diabetic patients will develop a diabetic foot ulcer in their lifetime, and of those, one in four will require an amputation. Each year, approximately 85,000 lower extremity amputations are performed in the U.S. due to complications from diabetes. This number represents over half of all amputations performed in the U.S. each year.
has advanced tremendously. At the Wound Center at Columbus Regional Hospital, a team of diabetic foot and vascular specialist physicians, nurses, social workers, nutritionists, physical therapists and diabetic nurse educators is available to each diabetic foot ulcer patient. We use advanced treatments, including specialty wound care products, biological skin substitutes, total contact casting and hyperbaric oxygen therapy. Through our advanced treatment program, we are proud of our healing rate of greater than 80 percent of all diabetic foot ulcers healed in 16 weeks.
Causes
Hyperbaric Oxygen Therapy
Both Type 1 and Type 2 diabetes lead to neuropathy, the loss of feeling in the toes and feet due to nerve damage and impaired blood flow. Patients with neuropathy may be unable to feel blisters, ingrown toenails, calluses or sores on their feet. Unnoticed and untreated, such sores can worsen and invite infection. In addition, nerve damage from diabetes can lead to muscle damage. When the foot muscles fail to keep the bones in their proper position, the bones can become deformed and prominent. This causes increased chances of forming pressure points on the feet and, in turn, formation of more wounds.
Treatment All diabetic foot ulcers do not end up with the patient requiring an amputation. Treatment for these wounds
2
2015 MEDICAL HANDBOOK
The Wound Center at CRH has two hyperbaric oxygen chambers used to assist healing. A patient is placed in the chamber and allowed to breathe 100 percent oxygen under pressure to assist in sending more oxygen to the wound tissue and shorten healing times. The treatments are easy and very well tolerated.
Information If you have a non-healing diabetic foot ulcer or another type of wound and want more information on our program, contact the Wound Center at Columbus Regional Hospital at 812-367-5373. Dr. John R. Hladik is co-medical director of the Wound Center, Columbus Regional Health.
Walk confidently. Offering treatment for painful and unsightly veins.
Douglas Y. Roese, M.D.
Jason W. Christie, M.D.
Medical Director Vascular Surgeon
Vascular Surgeon
2325 18th St., Suite 220 • Columbus, IN 47201 • (812) 372-2245 • sisurgery.com/veins
“Now, I can.” Once a 320-pound stress eater, Earl Six is now a 5K
Runner.
You can too! Start your new life at our next FREE information session. Register at 812-418-3512 or visit ColumbusBariatrics.com. Walk-ins welcome!
Earl Six knows running a 5K isn’t easy. And being obese, he thought he’d never get the chance. But the Bariatric Center at Columbus Regional Health made the journey possible. He lost the weight ... and gained the courage. “The staff gives you that sense of comfort,” says Earl. Now, he can cross the finish line.
LOCATION:
2325 18th Street Suite 220 • Columbus For a full list of information sessions, please visit our website.
Get expert weight-loss counseling and care close to home for minimally-invasive gastric bypass, banding or sleeve procedures. Earl Six Greensburg, IN Lost 150 pounds Managed by
MedHnbk_2015.indd 1
2015 MEDICAL HANDBOOK
3
3/30/15 4:42 PM
Alternative tobacco products still cause for concern
T
By Stephanie Womack
here has been a lot of buzz surrounding alternative tobacco products lately, namely the electronic cigarette (or ecigarette) or Electronic Nicotine Delivery Systems (ENDS). E-cigarettes are devices that claim to contain no tobacco but are designed to look like conventional cigarettes. They are intended to be inhaled, known as vaping, similar to how a smoker uses conventional cigarettes. They produce an aerosol (called vapor by the industry) upon each inhalation that resembles the smoke produced by combustible tobacco products. Secondhand aerosol from e-cigarettes/ ENDS contains ultrafine particles and low levels of toxins known to cause cancer. The aerosol is made up of a high concentration of ultrafine particles, and the particle concentration is higher than in conventional tobacco cigarette smoke. Exposure to fine and ultrafine particles may exacerbate respiratory ailments like asthma and constrict arteries, which could trigger a heart attack. E-cigarettes/ENDS contain and emit propylene glycol, a chemical used as a base in e-liquids and solutions and is one of the primary components in the aerosol emitted. Even though propylene glycol is FDA approved for use in some products, the inhalation of vaporized nicotine in propylene glycol is not. Some studies show that heating propylene glycol changes its chemical composition, producing small amounts of propylene oxide, a known carcinogen. E-cigarettes/ENDS are being promoted as a less dangerous alternative to cigarettes or a smoking cessation aid; however e-cigarettes have not been approved as safe by the U.S. Food and Drug Administration. No independent research on the critically important question of safety or efficacy currently exists. The FDA has warned the public that e-cigarettes contain various toxic and carcinogenic chemicals. Recently the FDA proposed some provisions to regulate alternative tobacco products, which include prohibiting sales to children under 18, restricting vending machines to adult-only facilities, prohibiting free samples, requiring addiction warnings, requiring disclosure of ingredients, prohibiting the introduction of new or changed products without prior FDA review, prohibiting manufacturers from claiming a tobacco product is
4
2015 MEDICAL HANDBOOK
less harmful or will expose a consumer to fewer harmful substances without first providing the FDA with scientific evidence. Another concern is that some smokers are buying empty liquid cartridges and filling them themselves with solutions purchased online. The solutions are very concentrated, which creates a risk of overdosing or poisoning. Even with all the unknowns, data have shown that the number of high school students who reported using an e-cigarette has doubled in the past year. There have also been cases where the e-device has exploded and caused significant damage to the user. Also, the e-liquids used in these products can be poisonous if ingested directly. Stephanie Womack is tobacco program coordinator for Columbus Regional Health. For questions or more information regarding tobacco control in Bartholomew County or other products: 812-375-3194 or swomack@crh.org.
2015 MEDICAL HANDBOOK
5
Having a primary care provider is important for good health
A
By Dr. Slade Crowder
primary care provider, or PCP, is what most people mean when they say “my doctor.� Through care coordination, accessibility and continuity, PCPs help patients stay healthier while at the same time saving them money. This is why it is so important to have a PCP. PCPs work with nurses in their office to make sure patients are not just up to date on physicals, but also on other wellness services, such as vaccines and cancer screenings. For patients with conditions like diabetes, heart disease or high blood pressure, PCPs will ensure that recommended testing is being completed and at healthy levels. Working with electronic health records, PCPs are now looking for gaps in care that could lead to illness even when a patient is not in the office. One must be established with a PCP to benefit from this service. PCPs also strive to be readily available. At our office, we have walk-in hours six days per week for urgent appointments; we have a doctor available every night for emergency phone calls. During the day, we have a nurse phone line where licensed nurses can answer questions or quickly pass questions on to the PCP. Finally, we continue to see our patients when they are in the hospital.
6
2015 MEDICAL HANDBOOK
While PCPs strive to treat most conditions, at times referrals to specialists will be required. Then, a PCP will help you quickly find the right specialist, will help you understand recommendations and will help resolve any conflicting advice between specialists. Perhaps the most important aspect of having a PCP is continuity. I went into family medicine as I enjoy the relationships I build with my patients. These relationships help me better understand my patients and work with them to make the best choices for their health. Knowing someone is sensitive to medicine or someone usually prefers a more natural approach can help me give the most appropriate advice. A patient who comes in with a headache and upset stomach could easily end up with expensive testing, but knowing the person is currently under tremendous job stress, I may be able to see the true cause of the symptoms and avoid unnecessary tests and quickly get to helping relieve the symptoms. Having a PCP who knows you well is the surest way to get the best care possible. Dr. Slade Crowder is a member of the medical staff at Columbus Regional Health.
2015 MEDICAL HANDBOOK
7
Easy ways to improve health
I
By Rene Lynch n Los Angeles Times (TNS)
t’s easy to get overwhelmed when trying to embrace a more healthful lifestyle. What new diet book should you buy? Should you join a CrossFit gym? Do you need a tracker, and if so, which one? And — gulp! — how much is this all going to cost? It’s enough to make you plop back down on the couch and reach for the remote. Here are five ways to improve your health starting today that might even save you money in the long run.
1
Walk more. It’s the fastest, easiest way to get in some exercise. And taking a walk right after a meal is especially good for curbing glucose levels, which is helpful for anyone trying to rein in blood sugar. Don’t wait, though: Glucose hits its peak 30 to 60 minutes after a meal.
2
Protect yourself from the sun. Slather on sunscreen and don a wide-brimmed hat. Discuss your skin sensitivity with a doctor and find out if you need to take additional measures, such as longsleeved shirts, driving gloves and long pants.
3
Speaking of doctors: Stop the foot-dragging when it comes to scheduling your annual physical. Just do it.
4
Slash the sugar. No one is trying to take away all your ice cream. But how about a scoop or two once or twice a week instead of three heaping scoops every night? Find small, simple ways to trim the sugar out of your diet and you’ll trim your waistline.
5
Get more sleep. This should be welcome news. Research increasingly suggests that a run-yourself-ragged lifestyle leads to stress, and stress leads to weight gain (and a stubborn resistance to weight loss). So get more Zzzs.
8
2015 MEDICAL HANDBOOK
2015 MEDICAL HANDBOOK
9
Childhood immunizations have revolutionized health care
C
By Dr. Leesa McCauley
hildhood immunizations are a rite of passage for most. Vaccines originated in Britain in 1798, around the time of our nation’s founding, when smallpox vaccines were developed. Beyond clean water, the No. 1 health advance in history has been the development of immunizations against common viruses and some bacteria. Vaccinations have increased life expectancy around the world much more than antibiotics or heart surgery, for example. Vaccines provide immunity on two levels: individual and herd. Individual immunity is provided when a vaccine causes an immune response to a disease without actually causing the disease. The individual is then equipped to fight the disease if and when he encounters it in the community. Herd immunity is provided when the vast majority of a population is immunized and no one in the community comes in contact with the disease because it has been eliminated from the community by the vaccine. Parents often have questions about the recommended immunizations for their children, especially as several new immunizations have come about in the past few years. The first immunization given to a baby is part one of the hepatitis B series of three injections. It is given in the hospital within the first one to two days of birth. Then, a series of immunizations is given every two to three months for the first 18 months of life. The schedule followed in most primary care offices and the health department is the one developed by the Centers for Disease Control. It is very similar to the one developed by the World Health Organization, but is tailored to the needs of children in the U.S. Routine immunizations fight against hepatitis B, diphtheria, tetanus (lockjaw), pertussis (whooping cough), haemophilus influenza B, pneumococcus (strep pneumonia), polio, measles, mumps, rubella (German measles), rotavirus, varicella (chicken pox) and hepatitis A. Many immunizations are given in combination injections, and most are given in a series of three to four injections. At any well-child visit, the immunizations given might be hard for a parent to predict, but most doctors’ offices have developed a routine that ensures children get all their immunizations on time. Most children finish their infant immunizations by 18 months to 2 years of age. Another set of booster immunizations for diphtheria, tetanus, pertussis, measles, mumps, rubella, polio and varicella is given between the ages of 4 and 6, before chil-
10
2015 MEDICAL HANDBOOK
dren start school. At age 11 or 12, tetanus, diphtheria, pertussis and meningococcal (against bacterial meningitis caused by Neisseria meningitidis) immunizations are given, and a three-part human papilloma virus (the virus that causes cervical cancer) series is recommended. A meningitis booster is also given at age 16 to 18. Also, seasonal influenza immunizations are recommended for everyone over 6 months of age. Parents may have questions about how to prepare their baby for immunizations. Ideally it is important to create a calm environment for a baby, and if at all possible for the parent to remain calm. Some may be wondering if a baby should receive Tylenol before her shots. Studies have shown that pre-immunization Tylenol reduces the effectiveness of the vaccine because it blunts the baby’s immune response. It is OK to give a child Tylenol a few hours after the shot if she becomes fussy, seems sore at the vaccination site or develops a low grade temperature. The child’s physician should be informed if she develops a fever greater than 100.4 degrees F. Information on the CDC recommendations can be found at www.cdc.gov/vaccines/schedules. Information on individual immunizations can be found on Vaccine Information Statements developed by the CDC at www. cdc.gov/vaccines/hcp/vis/index.html. Information is also available from the CDC for catch-up schedules if your child is behind. Your primary care office should be able to make recommendations for your child’s immunization needs at any point. Childhood immunizations are covered by commercial and state insurance plans. Dr. Leesa McCauley is a primary care physician with Columbus Regional Health’s Sandcrest Family Medicine.
We are here for you.
Dr. Sutapa Nag, Pediatrics
Dr. Ryohei Otsuka, Family Medicine and Geriatrics
Julie Snyder, FNP Family Medicine
Dr. Sheri Cheng, Family Medicine
Treatment for Acute Health Issues Treatment for Chronic Health Issues Preventative Health & Wellness Services Women’s Health Services Well-Baby / Well-Child Exams Developmental & Behavior Care Sports Physicals Immunizations Diagnostic Lab Work
WindRose
Health Network - Hope
...leading you to better health!
163 Butner Drive | Hope, IN 47246 | 812-546-6000 | 812-546-0368 812-546-0368fax | Hours: M, T: 8-7 W-F: 8-5
Family Medicine Ryohei Otsuka, MD Sheri Cheng, MD Julie Snyder, FNP
www.windrosehealth.net
Pediatrics
Sutapa Nag, MD
Follow us on Facebook! 2015 MEDICAL HANDBOOK
11
Exercise is key to managing fibromyalgia
I
By Jennifer Willhite
n the fall of 2010, Columbus resident Monica Christian began having trouble at work. Christian, who worked in business management, had always kept her office neat and organized. Suddenly, it became a cluttered mess. She began experiencing memory problems, multitasking was nearly impossible and she was unable to stay focused. “It was like someone put their fingers in my brain and mixed stuff up,” the 42-year-old says. “My short-term memory was gone, and I was afraid I had dementia or early-onset Alzheimer’s disease.” She’d always had migraines, but as she started experiencing widespread burning pain, the migraines increased. “It was like someone lit a fuse, and it exploded,” she says. “The migraines picked up steam, and I went from having a couple each month to three a week.” Christian met with several doctors, and some wrote off her pain as being related to depression. It wasn’t until she met with a neurologist that it was determined she had fibromyalgia. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, fibromyalgia is defined as a disorder that causes tender spots of muscle pain and fatigue. Dr. Mazen Elyan, rheumatologist with the Franciscan Physician Network, says diagnosing fibromyalgia is gener-
12
2015 MEDICAL HANDBOOK
ally clinical and straightforward. But reaching a diagnosis can be an exclusionary process. “Fibromyalgia symptoms are typical,” he says. “But sometimes we run other tests to make sure there’s nothing else contributing to the pain.” Such was the case with Christian, who underwent several tests, including a lumbar puncture, and several rounds of blood work to rule out other diagnoses, such as multiple sclerosis, which can mimic fibromyalgia in symptom presentation. Christian says on what she calls “fibro days,” it’s like someone has pulled the plug on her gas tank and all her energy evaporates. There aren’t adequate words to describe the pain associated with a fibromyalgia attack, she says. What makes it worse is that the pain travels throughout the body, she says. “One that is troublesome for me is I get pain underneath my right arm,” she says. “It’s a searing, burning pain, and it’s maddening.” Many nights when her fibromyalgia flares, Christian must lie on top of the covers because the mere feel of a sheet on her skin is too much to bear.
“You don’t truly sleep with fibro,” she says. “I can sleep for eight hours, wake up and feel like I haven’t slept at all.” Elyan acknowledges fibromyalgia is often considered a controversial diagnosis, but the controversy stems from the limitations of medical knowledge and diagnostic tools used to detect the illness, he says. “It is a universally recognized condition that has been described for decades, so it’s not a new diagnosis per se,” he says. “There’s been a better description of the symptoms, which have become more recognized over time. We just don’t know what causes it.” Most frequently diagnosed in women who are in their 20s and 30s, fibromyalgia affects upward of 6 percent of the population, Elyan says. Fibromyalgia, which can present in varying degrees from mild to severe, can be a stand-alone diagnosis. However, it’s frequently a co-morbid condition, meaning, there’s another diagnosis present, such as a musculoskeletal disorder. Treatment for fibromyalgia is generally twofold, Elyan says. Individuals may be given prescription drugs to help manage pain, such as certain classes of antidepressants and anticonvulsants. The other aspect of treatment is exercise. Physical therapist Bobby Lassiter, with ATI Physical Therapy in Columbus, says most of the patients
he sees have a precursory diagnosis in addition to the fibromyalgia. Physical therapy options for fibromyalgia are individualized, he says. The goal is to increase blood flow through the muscles to facilitate long-term strength and flexibility, which can lessen fibromyalgia pain. “Depending on the degree of discomfort for the individual, we don’t necessarily call it massage, but we do soft tissue mobilization,” he says. “If a person can tolerate it, we can sometimes do it for short-term improvement in their pain. But based on research, the best long-term outcome for patients with fibromyalgia is exercise.” Lassiter says one of the main benefits of physical therapy is giving patients the tools and resources they need to manage their symptoms at home. Additional therapy options may also include acupuncture and hydrotherapy, he says. As part of her treatment, Christian takes a combination of Effexor, an antidepressant, and Neurontin, an anticonvulsant. For exercise, she walks and does yoga. She acknowledges it’s difficult, but says if you have fibromyalgia the best thing you can do is stay active. “When you hurt, you just want to sit still,” she says. “But you have to move. I don’t know that moving stops your bad fibromyalgia days, but it makes your good days better.”
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 2015 MEDICAL HANDBOOK
13
Osteoporosis in men is a silent disease
I
By Jennifer Grant
f you think you’re not at risk of getting osteoporosis because you’re a man, think again. While 80 percent of Americans with osteoporosis are women, men are at risk, too. Two million American men have osteoporosis, and another 3 million are at risk. It is estimated that after the age of 50, one in five men will break a bone due to osteoporosis.
What is osteoporosis?
Osteoporosis is a disease that makes your bones weak and more likely to break. Osteoporosis is called a silent disease because it often goes unnoticed until a bone fracture occurs. It develops less often in men than in women because men have larger bones and bone loss starts later in life and progresses more slowly. As life expectancy continues to rise, it is likely that the number of men diagnosed with osteoporosis will also increase.
Are you at risk?
• Did your mother or father have bone loss or broken bones? Osteoporosis can run in families. • If you are Caucasian or Asian, you have an increased risk of getting osteoporosis. • The use of certain medications such as corticosteroids, medications that depress the immune system, cancer treatments (especially for prostate cancer) and some seizure medications can increase your risk.
14
2015 MEDICAL HANDBOOK
• Are you a man over the age of 65? Men lose bone as they grow older. • Do you have a small frame or low body weight? • Some diseases such as diabetes, scoliosis, rheumatoid arthritis, malignancy and inflammatory bowel disease can increase your risk of developing osteoporosis.
Risks you can change • Is your diet low in calcium now or when you were a child? A diet low in calcium either in the past or present increases your risk of bone loss. • Do you exercise? Bones get weak without exercise. • Are you a heavy smoker? Smoking decreases your body’s ability to make new bone. • Do you drink more than two alcoholic beverages daily? Alcohol interferes with the body’s ability to make new bone. • Do you drink a lot of soda, coffee or other caffeinated drinks? Too much caffeine can keep your bones from getting enough calcium. • Low vitamin D levels.
How is osteoporosis diagnosed in men? Osteoporosis can be effectively treated if it is detected before you have lost too much bone. Your health care provider can diagnose and treat osteoporosis. Certain lab
tests and X-rays may be ordered to evaluate your bone health. A bone mineral density test may be ordered. This test can identify osteoporosis, determine your risk for broken bones and help monitor your response to treatment.
Prevention and treatment Prevention and early detection are best to limit bone loss. You should participate in weight-bearing exercise at least 30 minutes a minimum of three to four times a week. Weight-bearing exercise can include walking, yoga, running, tennis, weight training, use of resistance machines and aerobics. Swimming and bike riding are good activities but do not count as weight-bearing exercise. Getting enough calcium is important. Adult men age 19 through 50 should get 1,000 mg of calcium daily. After the age of 50, men need 1,200 to 1,500 mg of calcium daily. Calcium can be found in foods such as low fat milk and dairy products, fortified almond milk and lesser amounts in green leafy vegetables. Vitamin D helps your body absorb calcium from your diet. It is made in skin when it is exposed to direct sunlight. Vitamin D can also be found in lesser levels in foods such as egg yolks, fish, liver or fortified dairy products or orange juice. If you are at risk for or have been diagnosed with osteoporosis, your health care provider may prescribe supplements or medication to help prevent or slow bone loss.
While you cannot change your genetics, skeletal frame, sex, race or age, you can control other risk factors such as diet, exercise and lifestyle choices, including smoking and alcohol use, to improve your bone health. Your health care provider can help guide you through prevention and treatment of osteoporosis. Jennifer Grant is a certified orthopedic nurse with Columbus Regional Health’s Joint & Spine Program.
Frank R. Kolisek, MD
Orthopedic Surgery • Hip and Knee Joint Replacement Specialist
No referral needed, unless required by your insurance company.
Practice Focus
Locations
• Hip and Knee Arthritis Surgery OrthoIndy South • Partial Joint Resurfacing 1260 Innovation Pkwy., Ste. 100 • Total Joint Replacement Greenwood, IN 46143 • Computer Assisted Surgery • Soft Tissue Sparing Minimally Invasive Surgery
Awards
• Becker’s Orthopedic Review: 125 National Top Knee Surgeons, 2012 • Becker’s Orthopedic Review: 70 National Outstanding Hip Surgeons and Specialists, 2011 • Arthritis Foundation of Indiana Honoree of the Year, 2010 • Indianapolis Monthly Top Doctors Orthopedic Surgery, 2010, 2011, 2012, 2013 and 2014 • Top Doctors Orthopedic Surgery, US News & World Report, 2011 and 2012
To schedule an appointment, please call 317.884.5160.
FrankKolisekMD.com
2015 MEDICAL HANDBOOK
15
Break
Al • • • • •
16
2015 MEDICAL HANDBOOK
k Away From
llergy Season! Only Board Certified Allergists that live and practice in Columbus, since 1984. WE OFFER THE FOLLOWING: ADULT & PEDIATRIC CARE Skin testing to inhalants, foods, molds, pollens, weeds Patch testing Venom testing (bees, hornets, wasps, etc) Testing for asthma. Immunotheray
• Sick visits-often the same day • Sinus infections • Treatment for all types of asthma including exercise induced • Asthma action plans • Penicillin skin testing • Oral challenges
• Anaphylaxis • Immunodeficiency • Angioedema • Sublingual therapy for those who qualify
OUR DOCTORS ARE: ROBERT W PETRY MD NAMRATA SINGHAL MD CERTIFIED ASTHMA EDUCATOR ON STAFF
of Columbus 815 Schnier St, Columbus, IN 47201 •
812-378-3131 2015 MEDICAL HANDBOOK
17
Fotolia/TNS
Migraine studies yield fresh approaches to ward off pain
I
By Lisa Mulcahy n Los Angeles Times (TNS)
f you suffer from migraine headaches, you have plenty of company. More than 10 percent of the population is hurting right along with you, including 18 percent of women. Migraines are most common from the ages of 25 to 55. The good news: New research can help change your approach to managing your migraines. Here are five strategies to try. Worry can cause a headache, but a recent study from Yeshiva University in New York found that the relief experienced after a stressful situation can also bring on the pain. The cause may be a drop in stress hormones including cortisol, according to study co-author Dawn Buse, director of behavioral medicine at Montefiore Headache Center in New York City. Calming yourself the right way can cut your risk. “If the stress has already passed, it’s wise to use all of the factors that may protect against migraine, including sleep, proper nutrition, physical activity and exercise, and relaxation practices, which balance the nervous system,” Buse said in an interview. Those practices could include cognitive behavioral therapy, guided visual imagery or simply closing your eyes for 30 seconds to focus on your breathing.
18
2015 MEDICAL HANDBOOK
Speaking of relaxation, meditation may just be the ticket when it comes to minimizing a migraine’s effect, according to researchers at Wake Forest Baptist University in Winston-Salem, S.C. “Those in our study who took a two-hour instructive class in mindful meditation for eight weeks and meditated on their own five days a week for 35 to 40 minutes experienced migraines that were less severe and shorter,” said lead study author Dr. Rebecca Erwin Wells. Chronic migraine sufferers also reported 1.4 fewer migraines per month on average.
Tweet pain away University of Michigan researchers analyzed 21,741 tweets about migraine, 65 percent by people experiencing a headache at that time, and found that expressing feelings about the pain may provide symptom relief. “Neuroimaging studies have suggested that emotional and cognitive areas in the brain can modulate, in part, activity related to the perception of physical pain,” said study author Alexandre DaSilva. “Social media may provide relief for migraineurs that goes beyond the emotional.”
Don’t obsess over red wine Aged cheese. Chocolate. Wine. Caffeine. Most migraine sufferers are familiar with a long list of foods that may kick off a headache. “It’s key to remember, though, that migraines are caused in many people by compounding factors. If you experience a strong smell like perfume, flickering or flashing lights, less sleep and you eat a cold-cut sub with nitrates all in one day, yes, you may get a migraine, but if you ate that sub on a day when you didn’t experience those other triggers, you might be just fine,” said Dr. Fred Cutrer, a neurologist at the Mayo Clinic in Rochester, Minn., in an interview. If a migraine does strike, try eating bread or crackers to raise your blood sugar and potentially ease symptoms: “Personally, I find eating starchy food helps when I’m having a migraine,” Cutrer added.
Don’t overtreat Before your doctor sends you off for expensive imaging tests like a CT scan or refers you to a specialist, ask to talk about your migraines. A study by Beth Israel Deaconess Hospital researchers in Boston found that 12 million Americans annually are overtreated for headaches. Instead, study author John N. Mafi said, “Clinical guidelines for headache recommend that physicians counsel their patients on lifestyle modifications. Leading
an overall healthy lifestyle with a diet rich in fruits and vegetables as well as regular exercise can also help. Another important approach includes keeping a headache diary. Once patients can identify each of their own migraine triggers, they can take active steps to prevent them, thereby lessening the need for medications or visits to the doctor.”
We have been dedicated to providing quality, cost effective care since 1987. Southern Indiana Heart & Vascular 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
Comprehensive Minimally Invasive Endovascular Procedures:
Minimally Invasive Treatment For Peripheral Vascular Disease
David Hamilton, Melinda M.D. Hunnicutt, M.D.
Mark Hatfield, M.D.
Samantha Lucas, M.D.
Soo Park, M.D.
Nandu Gourineni, M.D.
Gabriel Improvola, M.D.
Bobbie Robb, N.P.
Diane Halstead, M.D.
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
Firas Ghanem, M.D.
2015 MEDICAL HANDBOOK
19
Jay L. Clendenin/Los Angeles Times/TNS
Time has not put the squeeze on juicing trend
A
By Mary Macvean n Los Angeles Times (TNS)
year ago, trendistas were snuggling up to juice bars to cleanse, reset, detox and glow a little. Today, things are only busier in the world of juice — and I don’t mean Minute Maid. Juicing just won’t go away. “The concept has settled into being just part of a healthy life, rather than a thing,” says Andrew Freeman of the AF&Co. restaurant consulting firm. But a “thing” it remains. Juice bars continue to open, where people are paying in the double digits (yes, you can pay $12 for a drink that’s not spiked with vodka) for a bottle of juice, albeit cold-pressed and organic in a range of pretty colors. Cold-pressed juice is even for sale in airports and at Trader Joe’s. “It’s amazing,” Dave Otto says one morning outside his pristine, tiny shop in Los Angeles. His business began in 1975 as the Beverly Hills Juice Club, an extension of his “quest for a perfect diet.” These days, he does 10 to 15 times the business he did then, he says. The cold-pressed juice market is estimated at $100 million a year. What gives? In a way, it’s the moral equivalent of an Egg McMuffin — fast and convenient — although the juice client would never venture into a fast-food shop.
20
2015 MEDICAL HANDBOOK
Today’s juice — cold-pressed between plates, meaning no heat is used — is a great answer for busy people, says Alexis Schulze, co-founder and chief visionary officer of the Nekter Juice Bar chain of 49 shops. “It’s accessible for people who try to get their fruits and vegetables in but who say, ‘I just don’t have time to sit down and eat a salad,’” she said over a glass of Toxin Flush, made with apple, ginger, lemon, parsley and spinach. Are we really that busy? Apparently so. Busy but also yearning, Otto says: “People are sick and tired of being sick and tired.” Amanda Chantal Bacon, founder of Moon Juice, says people are taking their health into their own hands because they feel disappointed by conventional food and medicine. “People have invested so much time and energy and hope in fat-free foods like SnackWells and $200 eye creams and pills to make you happy in your marriage. We gave it a really good effort,” she says, explaining that she became a juicer to guard her own health. With names for concoctions like Glow, Purity or Goodness Greens, who wouldn’t want to drink up? There are seasonal flavors, such as pumpkin spice and cranberry-cinnamon, and more exotic ones. Juice Served Here,
which has a handful of stores in the L.A. area, offers charcoal lemonade; Moon Juice sells Silver Strawberry with Mezotrace silver. And with the possibility of greater energy, glowing skin, a clearer mind, a detoxified gut and more, who could refuse? Most people eat so little plant food, says Joe Cross, author of “The Reboot With Joe Juice Diet, “is it any wonder that when they add these supercharged flood of nutrients that they feel better?” But it’s hard to prove that glowing skin, clearer thinking or resetting is the result of juicing. And there’s plenty of disagreement about the value of a 16-ounce juice, even one made from up to 2 pounds of produce, compared with the food itself. Lisa Sussman writes in her book “Cold Press Juice Bible” that the “jury is still out on whether your body can absorb the nutrients more easily in liquid form or if there’s any advantage in giving your digestive system a break from working on fiber.” Dana Hunnes, a senior dietitian at the Ronald Reagan UCLA Medical Center, says she’s asked often about juicing. “I think it’s healthier to eat the food and get the fiber and other things,” though she says there’s likely no harm in jump-starting an effort to eat healthfully with a oneday juice regimen.
While many juices contain kale or spinach and other vegetables and herbs, they often also contain apples and other sweeter produce. And that can mean a fair amount of sugar. To counter that, Sussman suggests juicing four servings of leafy or cruciferous vegetables for every one of fruit. (Of course, juicing at home takes a commitment ranging from $100 to $2,500 for the juicer.) “Successful long-term juicers learn to liquefy greens and vegetables on a daily basis and to juice sweet-tasting fruits and the sweetest root vegetables ... in moderation,” Eric Helms writes in “The Juice Generation,” which is also the name of his New York company. Whether organic cold-pressed juices are healthful depends in part on the context, says Tricia Psota, a nutritionist at the U.S. Department of Agriculture. If juice is an addition to your diet, the calories can add up (a 16-ounce bottle typically has about 200 calories). So can the dollars. On the other hand, if a juice replaces your usual midmorning doughnut, it’s hard to argue against it. Juice fans are not flinching, Freeman says. “They’re willing to pay for quality, to be in the know. We’ve come a long way from Tang.”
• 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 Practitioners, Carla Talley and Sue Thomas are 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.
Carla Talley, Nurse Practitioner
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.
2015 MEDICAL HANDBOOK
21
Probiotics are nature’s life support
R
By Ellen Kanner n Miami Herald (TNS) Your probiotic experience can be cheap, delicious and natural. Go for cultured whole foods, including kefir and kombucha, kimchi and sauerkraut, miso and natto — and yogurt. Once the simple, satisfying fermented milk from your favorite local ruminant (cow, goat or sheep), commercial yogurt is now an industry unto itself, with more than $7.4 billion in sales last year. There’s a wall of yogurt in every grocery store’s refrigerated section, including vegan yogurt containing probiotics and coconut (So Delicious, 6 ounces, $1.99) or soy (Stonyfield O’Soy, 6 ounces, $.99), but no dairy. The amount of probiotics varies from yogurt to yogurt, so check the label. Look for live active cultures of beneficial bacterial strains with tongue-twisting names including L. acidophilus, B. bifidum, L. bulgaricus and S. thermophilus. Another reason to check ingredients — with the exception of plain, unsweetened yogurt like Cabot (32 ounces, $3.79) or Whole Soy Co. (24 ounces, $3.79),
O
ight now — and all the time — your digestive tract is teeming with billions of bacteria. Some are good, some are potential troublemakers. Usually your body does a standup job of keeping it all in balance. But it never hurts to ask for help. That’s where probiotics come in. To unpack the name, pro is Greek for supporting, bios means life — probiotics support life. Probiotics rank among the good bacteria, promoting good digestion and protecting your gut. Research indicates they’re especially helpful with digestive issues or flagging immunity. You can buy pricy probiotic capsules (Ultimate Flora, $24.99, 30 capsules), which offers between 15 billion and 30 billion probiotics, and fortified foods like Bio-K+ probiotic-enriched cultures ($25.99, six 3.5-ounce jars), promising 50 billion probiotics per jar. However, much probiotic goodness gets lost in the processing and how your body absorbs fortified probiotic products is questionable.
p en
to the comm u
Rehabilitation Center and Skilled Nursing Care For more information call
Want to see what a 5 star facility, as rated by Medicare.gov looks like?
Call the Indiana Masonic Home for a tour and we will show you ours!
888-464-6077 • 317-736-6141 www.indianamasonichome.org | 690 State Street | Franklin, Indiana 46131 22
2015 MEDICAL HANDBOOK
ty! ni
Rehabilit ation, Medical Services & Memory Care
TNS photo
most yogurt, especially popular single serve cups, contains added color, flavoring, thickening agents and an egregious amount of sugar. So Delicious coconut yogurt contains 20 grams per serving, Dannon and Stonyfield O’Soy each has 26 grams. A handful of Hershey’s kisses, by comparison, has 23 grams. Beneath all that sugar lies something delicious, tangy and probiotic-rich. That’s how it’s made. Probiotic delivery is all but guaranteed with yogurt. Choose one that supports life simply and naturally.
Cranberry yogurt bread
Yogurt does more than provide probiotics. It makes this easy quick bread beautifully moist. Enjoy for breakfast or as a snack with fresh fruit or even with more yogurt. Makes 1 loaf, or about 10 servings. 4 tablespoons grape seed, canola or other neutral oil 1 cup berry yogurt, dairy or vegan (about 1 1/2 cartons of 6 ounce single-serve yogurt) 1/2 cup plus 1 tablespoon sugar 1 tablespoon fresh orange juice 1 teaspoon flax seed 2 cups unbleached all-purpose flour 1 tablespoon baking powder 1/2 teaspoon cinnamon 3/4 cup cranberries, fresh or frozen (if frozen, do not thaw) Grated rind of one orange
Heat oven to 350 degrees. Lightly oil a 9-by5-inch loaf pan. In a large bowl, stir together the oil, yogurt, 1/2 cup of sugar, orange juice and flax seed, whisking for a moment or two until mixture is incorporated and sugar is dissolved. Sift together flour, baking powder and cinnamon. Pour into yogurt mixture. Stir briefly, just till combined. Batter will be thick. Pour the cranberries, remaining tablespoon of sugar and grated orange rind in a food processor and pulse briefly, so the berries are coarsely chopped. Gently mix the chopped cranberries into the batter. Spoon mixture into the prepared loaf pan and bake for 50 to 60 minutes, or until bread is golden brown, smells berry sweet and an inserted tester comes out clean.
Expertise for your Digestion
Specializing In Colonoscopy Gastroesophageal Reflux Swallowing Disorders Digestive and Intestinal Diseases Liver Disease and Hepatitis C
Joining us in July, DR. PATRICK BARRETT Kinsie Fisher, MSN, NP-C Lora Fathauer, DNP, NP-C Geoffrey Raymer, MD Steven Pletcher, MD
2630 22nd Street, Columbus • (812) 372-8680 • www.columbusgastro.com 2015 MEDICAL HANDBOOK
23
Chris Roth, owner of Steel City Ballroom in Mount Lebanon, Pa., works on a salsa dance with Becky Stern. He is part of the University of Pittsburgh’s study of better ways to prevent lower back pain. | TNS photo
New back pain treatments keep patients on the move
A
By David Templeton n Pittsburgh Post-Gazette (TNS)
fter he had battled lower back pain for three months with hot showers, analgesic heat rubs and heating pads, it finally happened. Chris Roth awoke one morning barely able to move. This was a huge problem for Roth. As owner of Steel City Ballroom in a Pittsburgh suburb, he teaches the trademark hip-shaking and body-twisting steps of ballroom dancing. “I canceled my lessons,” said Roth, 44. “I’d had back pain but not like that. This was the most extreme pain. That’s when I couldn’t push through it.” Fortunately for Roth, Anthony Delitto was a student. The chairman of the University of Pittsburgh department of physical therapy in the School of Health and Rehabilitation Sciences offered to help.
24
2015 MEDICAL HANDBOOK
In his office, Delitto analyzed Roth’s posture and how he walked to figure out the potential source of his pain. Then he had him lie down on his back and cross his legs in a figure-four position. Then he pounced on him and rocked him back and forth a few times. They heard a pop. The pain vanished. The hip was realigned. Back to the ballroom. But Roth’s efforts to continue dancing throughout the pain actually represents a new approach to treating lower back pain. Don’t shut down. Remain active. Push through the pain so it doesn’t become chronic. To study that concept, Patient-Centered Outcomes Research Institute has awarded the University of Pittsburgh $14 million over five years to lead a national
trial to test whether a more aggressive European treatment can better prevent acute lower back pain from becoming a chronic condition in which the level of pain magnifies and is more difficult and expensive to treat. Participants in the trial include Intermountain Healthcare in Salt Lake City, Johns Hopkins Hospital and Health System in Baltimore, the Boston Medical Center and the Medical University of South Carolina. Delitto will lead the trial to test the European treatment against “usual care” in which the doctor decides on treatment. “Certain patients are more inclined to worry that when their back hurts they are further harming it, causing them to become inactive,” he said. “That can seriously impede recovery and cause further damage, leading to chronic back pain.” Lower back pain, especially with no signs of a fracture or muscle damage, makes it imperative that the person stay active, in shape and on the job. “Chronic lower back pain is clearly something we would like to avoid,” Delitto said. Intense lower back pain can stab like a knife when a person picks up a dropped pencil or lifts a child. Or it could be the swing of a golf club or a slip on the ice. But once it occurs, acute lower back pain can flash periodically throughout the day and continue for weeks, months and even longer. If it extends beyond six months, the pain could become chronic. About 10 percent of those experiencing lower back pain end up with a chronic condition. The annual health care cost of lower back pain in the United States is $86 billion, a Journal of the American Medical Association study reports, making it one of the costliest conditions in American medicine. The Patient-Centered Outcomes Research Institute is a nonprofit, nongovernmental organization created through the Affordable Care Act of 2010. Its mandate is to improve health care by helping patients, caregivers, clinicians, employers, insurers and policy makers make more informed health decisions. It funds projects that compare the costs and effectiveness of treatment options. In that context, the Pittsburgh-based trial will compare the “usual care” approach against the European strategy, which involves a primary care physician and a physical therapist. Cognitive behavior therapy can help the patient put back pain in perspective and persuade the patient to continue doing everyday activities. Called “Target,” the project will recruit 60 primary care clinics affiliated with the five medical centers including University of Pittsburgh Medical Center. Each randomly will be assigned to follow one of the two protocols. Delitto said the trial will include 2,640 patients with acute lower back pain experienced less than half the time and for less than six months. Researchers will evaluate them based on their response to pain and their predispo-
sition to avoiding pain out of fear of further injury. The team also will document the number of X-rays, surgeries and other related medical procedures each patient has experienced. A World Health Organization report on lower back pain says risk factors include “occupational posture, depressive moods, obesity, body height and age,” while noting that its causes and onsets “remain obscure and diagnosis difficult to make.” “Back pain is not a disease but a constellation of symptoms. In most cases, the origins remain unknown,” the report says. “What’s good for the heart is good for the back. You have to be active and engaging in life. Walking and exercise are important to health,” Delitto said. “We think we can improve outcomes in patients, so there is less a tendency of chronic lower back pain.” Timothy Carey, director of the Cecil G. Sheps Center for Health Services Research at University of North Carolina Chapel Hill, has conducted several back pain studies over the past 25 years. He said he’s familiar with the Pittsburgh project. “Chronic back pain is tremendously disabling, with high costs in terms of medical expenses and time off work, as well as the burden of chronic pain and reduced function by patients,” he said.
Caring for those you care for most.
• Extended respiratory care • Skilled and long term care • Respite care available
Willow Crossing
Health and Rehabilitation Center For a personlized tour Contact Julie Nugent • 812-379-9669
admissions@willow-crossing.com 2015 MEDICAL HANDBOOK
25
Many herbal supplements aren’t what the label says
B
By Mary Esch n Associated Press
ottles of Wal-Mart-brand echinacea, an herb said to ward off colds, were found to contain no echinacea at all. GNCbrand bottles of St. John’s wort, touted as a cure for depression, held rice, garlic and a tropical houseplant, but not a trace of the herb. In fact, DNA testing on hundreds of bottles of store-brand herbal supplements sold as treatments for problems ranging from memory loss to prostate trouble found that four out of five contained none of the herbs on the label. Instead, they were packed with cheap fillers such as wheat, rice, beans or houseplants. Based on the testing commissioned by his office, New York Attorney General Eric Schneiderman said he has sent letters to the four major store chains involved — GNC, Target, WalMart and Walgreens — demanding that they immediately stop selling adulterated or mislabeled dietary supplements. Schneiderman said the supplements pose serious risks. People who have allergies or are taking certain medications can suffer dangerous reactions from herbal concoctions that contain substances not listed on the label, he said. “This investigation makes one thing abundantly clear: The adage ‘buyer beware’ may be especially true for consumers of herbal supplements,” the attorney general said. The herbal supplement industry criticized the method used to analyze the samples and raised questions about the reliability of the findings. Wal-Mart’s vice president of health and wellness, Carmen Bauza, said testing by Wal-Mart suppliers hasn’t revealed any issues with the relevant products, but the company will comply with the attorney general’s request to stop selling them in New York. “We take this matter very seriously and will be conducting side-by-side analysis because we are 100 percent committed to providing our customers safe products,” Bauza said. Walgreens pledged to cooperate with the attorney general, who asked the store chains for detailed information on production and quality control.
26
2015 MEDICAL HANDBOOK
“We take these issues very seriously and as a precautionary measure, we are in the process of removing these products from our shelves as we review this matter further,” Walgreen spokesman James Graham said. GNC said it, too, will cooperate, but spokeswoman Laura Brophy said: “We stand by the quality, purity and potency of all ingredients listed on the labels of our private-label products.” Target said it can’t comment without reviewing the full report. Nutritionist David Schardt of the Center for Science in the Public Interest said the tests show that the supplement industry is in urgent need of reform, and until that happens, consumers should stop wasting their money.
A 2013 Canadian government study estimated there are 65,000 dietary supplements on the market, consumed by more than 150 million Americans. The nonprofit American Botanical Council estimated 2013 sales of herbal supplements in the U.S. at $6 billion. The Food and Drug Administration requires companies to verify their products are safe and properly labeled. But supplements are exempt from the FDA’s strict approval process for prescription drugs. Schneiderman said tests found no echinacea or any other plant material in bottles of Wal-Mart’s Spring Valley Echinacea. He said no ginseng was found in 20 tests of GNC’s Herbal Plus Ginseng, which is taken to boost energy. Other supplements tested included garlic, which is said to boost immunity and prevent heart disease; ginkgo biloba, often touted as a memory-booster; and saw palmetto, promoted as a prostate treatment. DNA tests found such substances as rice, beans, pine, citrus, asparagus, primrose, wheat, houseplant, wild carrot and unidentified non-plant material — none of which were mentioned on the label. The store chain with the poorest showing was WalMart, where only 4 percent of the products tested showed DNA from the plants listed on the labels.
The investigation looked at six herbal supplements sold at stores across the state. Testing was performed by an expert in DNA technology, James Schulte II of Clarkson University in Potsdam, New York. The DNA tests were done on three to four samples of each supplement purchased. Each sample was tested five times. Overall, 390 tests involving 78 samples were conducted. Steve Mister, president and CEO of the Council for Responsible Nutrition, a dietary supplement trade group, criticized the testing procedure and accused Schneiderman of engaging in a “self-serving publicity stunt under the guise of protecting public health.” “Processing during manufacturing of botanical supplements can remove or damage DNA,” Mister said. As a result, he said, DNA analysis “may be the wrong test for these kinds of products.” Michael McGuffin, president of the American Herbal Products Association, said identification of an herb through DNA testing must be confirmed through other means, such as chromatography or microscopy. But Arthur Grollman, a physician and pharmacology professor at Stony Brook University, called the study “a well-controlled, scientifically based documentation of the outrageous degree of adulteration in the herbal supplement industry.”
Dr. Charles Rau • Continuous activities • Flexible scheduling (as needed basis) at Mill Race Center 812-372-6415 900 Lindsey Street Columbus, IN 47201 email: admin@ justfriendscolumbus.com
Dr. David Rau
Located at the CRH campus. Accepting all insurances.
NEW PATIENTS WELCOME.
• Nursing & social work support • Quality of life enhanced by social interaction and therapeutic programs • VA, Medicaid Waiver, CHOICE and private pay
2326 18th Street, Columbus • (812) 378-7474 www.raufamilymed.com Monday-Thursday 7:00 am - 5:00 pm Friday 7:00 am - Noon 2015 MEDICAL HANDBOOK
27
Heart attack What is a heart attack?
The human heart is a muscle that pumps blood. Blood containing food and oxygen to meet the heart’s own needs comes from the coronary arteries. Fatty deposits, called plaque, made of cholesterol and other substances can build up in the walls of these vessels, a condition called atherosclerosis. Over time such deposits narrow the arteries and reduce or stop blood flow to the heart. This may cause chest pain called angina pectoris. When less blood flows to the heart, the heart muscle may be damaged. If a blood clot forms in a narrowed artery and completely blocks the blood flow, part of the heart may die. Doctors call this a heart attack or a coronary thrombosis, coronary occlusion or myocardial infarction. When a heart attack occurs, the dying part of the heart may trigger electrical activity that cause ventricular fibrillation. This is an uncoordinated twitching of the ventricles that replaces the smooth, measured contractions that pump blood to the body’s organs. Many times if trained medical professionals are immediately available, they can use electrical shock to start the heart beating again. If the heart can be kept beating, and the heart muscle isn’t too damaged, small blood vessels may gradually reroute blood around blocked arteries. This is how the heart compensates; it’s called collateral circulation. The key to surviving a heart attack is to recognize the warning signals, listed below, and get immediate medical attention. — American Heart Association
Blood flows to the heart Blood supply is blocked in coronary artery Heart area is damaged
ABCs of a heart attack
l Angina (chest pain) — back pain or deep aching and throbbing in the left or right bicep or forearm. l Breathlessness — or waking up having difficulty catching one’s breath. l Clammy perspiration. l Dizziness —Unexplained lightheadedness, even blackouts. l Edema — swelling, particularly of the ankles and/or lower legs. l Fluttering (or rapid) heartbeats. l Gastric upset (or nausea). l Heavy fullness — or pressure-like chest pain, radiating to left arm or shoulder.
Take action
If you experience heart attack symptoms, don’t delay. l Call 911. l Sit or lie down. l Chew, crush or swallow an aspirin followed by a drink of water, if possible. Taking aspirin immediately at the onset of heart attack symptoms may prevent the formation of additional small blood clots blocking blood flow through clogged arteries. If that happens, heart muscle damage may be prevented or delayed, buying time to get to the hospital.
Hearts can heal
A heart attack is like a quick blow to the heart. The heart can be “stunned” by the lack of blood and oxygen. But when the blocked artery can be opened quickly, the damaged muscle gains back more of its normal function. Soon after a heart attack, small arteries near the damaged area begin to expand. They bring in blood to the area around the blocked artery. This may help limit the amount of damage. Within a few weeks or months, damaged heart cells are replaced by scar tissue as the heart heals.
28
2015 MEDICAL HANDBOOK
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
John Alessi do, faafp
board certified family medicine mro/occupational health
George Albers, MD Board Certified
Dan Davis, MD
Tania D. Frederick msn, fnp
board certified family medicine
Walk-ins and urgent care welcome
www.nashvillefamilymed.com 812.988.2223 • 103 Willow St., Suite B
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 2015 MEDICAL HANDBOOK
29
Dinner at home is a main ingredient for healthy eating By Meredith Cohn n The Baltimore Sun (TNS)
P
eople who eschew takeout for home cooking eat healthier foods, whether they aim to or not, according to new research from the Johns Hopkins University. “When people cook most of their meals at home, they consume fewer carbohydrates, less sugar and less fat than those who cook less or not at all — even if they are not trying to lose weight,” said Julia A. Wolfson, the lead author of the study and a fellow at the Center for a Livable Future at Hopkins’ Bloomberg School of Public Health. The findings may be obvious to some, or at least reassuring to others, but they could have implications for the obesity epidemic facing adults and children in the United States if enough people are persuaded to cook their own meals. Wolfson, a trained chef, said some people don’t think they know how to cook or don’t think they have the
For the people you care about, trust the name that physicians and families have trusted for more than 40 years.
Skilled Nursing Care • Physical Therapy Home Health Aides • Homemakers Infusion Therapy • Medicaid Waiver/PA We accept Medicare, Medicaid, Most Private Insurance & Private Pay Visit us online for more info: www.interim-health.com
3200 500 N. National Rd. • Columbus, ININ 47201 W. Eads Parkway • Lawrenceburg,
812-799-1846 (812) 537-5546 or (877) 567-6041
Call for a Free In Home Assessment 30
2015 MEDICAL HANDBOOK
time. Others may not have ready access to healthy ingredients, such as fresh produce. Many people are just out of the habit. She said cooking at home doesn’t have to be fancy or expensive, and most people just need a kickstart, like a cooking class, menu advice or tips to navigate grocery aisles. For the study, published in the journal Public Health Nutrition, Wolfson and others analyzed data from a national survey of 9,000 adults about what they ate. The 8 percent who cooked only once a week or less consumed an average of 2,301 calories, 84 grams of fat and 135 grams of sugar a day. The 48 percent who cooked dinner six or seven nights a week consumed 2,164 calories, 81 grams of fat and 119 grams of sugar a day. Those who cooked at home tended to rely less on frozen food and were less likely to eat fast food when they dined out. People in African-American households cooked less often than those in white households, and people who worked full time away from home cooked less often. These results were no surprise to Susanna DeRocco, who helps individuals, families, schools and others get on track in the kitchen with advice and recipes through workshops and her website, HealthyBodiesHappyMinds. org. She said meals can be made even healthier with some thought. Most people just don’t know where to start and feel overwhelmed by the idea of cooking, she said. The certified health coach, nutritional counselor and mother advises people to start small and simple. Pick a day, like Sunday, find one or two easy recipes online, and go to the store. After getting comfortable
making a few meals, consider making a double batch and freezing half, or at least figuring out a second use for the leftovers. Maybe rice was part of a stir fry one night and covered in beans the next, she said. Or the pasta gets customized with slightly different toppings to please different tastes in the house. And, DeRocco said, do some food preparation in advance of the workweek, like chopping vegetables, so everything is ready to go — this may even be a money
saver as people use the produce they buy rather than throwing it away. “Most people I know struggle in the planning,” she said. “They’re coming home at 6 and opening the fridge or pantry and saying, ‘What am I going to do?’ That’s what you want to avoid. And you can, with a little planning.” Cooking at home is mostly about developing a habit, DeRocco said, and “not letting Pinterest or Martha Stewart intimidate you.” Lisa Manuel, a mother of 7-year-old Chloe and 9-year-old Burke, sought help from DeRocco about two years ago to develop that kind of routine, though she, her children and her husband all eat at different times and don’t all like the same things. “It felt like a 24-hour buffet,” she said. She was heartened to hear that just eating at home meant they were likely eating healthier than families that don’t, but she wanted to do better. Manuel now tries to feed the family some of the same things, or variations of them. She plans, shops and preps ingredients on the weekends and stows batches of food in the freezer. She acknowledges doing better for her kids than for herself. “I’m not as disciplined as I should be,” she said. “I need to sit down and eat a meal and not snack in be-
Back Pain, neck Pain, HeadacHes?
accepting new Patients
Dr. Mandy Dr. Justin Dr. Chelsea Wyant Beckner DeVillez
familychiropractic andwellness 1405 Washington Street • Columbus
812.373.3376
www.familychiropracticcolumbus.com 2015 MEDICAL HANDBOOK
31
Dinner at home continued from page 31
tween everyone else’s meals. … When I stick to it, I feel a lot better. When I’m off track, I can definitely tell.” To help meet its goal of reducing heart disease by 20 percent by 2020, the American Heart Association offers basic cooking classes with chef Tia Berry. She said the organization wanted to help people not only cook at home but make healthier choices about ingredients. Obesity has drastically increased across the nation over the past two decades, with more than a third of adults and 17 percent of children now in that category, according to U.S. Centers for Disease Control and Prevention data. That has contributed to an increase in rates of heart disease, stroke, diabetes and some types of cancer, and $147 billion in additional annual health spending. Berry said if people are trying to make lifestyle changes and cook at home, it would be easy to improve the nutritional value of the food. For example, make potato or other salads with a vinaigrette rather than a mayonnaise base, and don’t deep-fry anything. “We offer recipes that are easy and familiar, like fajitas, chili and salad, that are heart-healthy and not anything too complicated,” said Berry about the 10 Simple Cooking with Heart Kitchen classes the association offered in Baltimore. There are also recipes and tutorials on the organization’s website.
General & Surgical
Dermatology • Acne & Rashes • Warts & Moles • Skin Cancers • Contact Dermatitis
Adults • Adolescents • Children
Dr. Jack R. Scherer, Michael Sheehan, Laura Burdick, MD, FAAD MD, FAAD MD, FAAD
360 C. Plaza Drive, Columbus • 812-376-9686 dermdocinc.com 32
2015 MEDICAL HANDBOOK
“It’s not five-star restaurant food,” she said, “but it is things that people are comfortable with and are not as intimidated by.” She said most people eat the same things over and over, so it’s a matter of choosing a few healthy recipes and practicing. Cooking dinner at home regularly requires a lifestyle change, but, Berry added, “it doesn’t have to be complicated. You just need to pay attention to what you’re eating.”
Christopher E. Stevens, M.D. Board Certified in Otolaryngology
“Providing ALL your Ear, Nose, and Throat Needs in Pediatric and Adult” Specializing in: Diseases of the Ear, Nose, and Throat Head and Neck Cancers Sleep Disorders: snoring/ apnea Sinus Problems
Accepting New Patients
812-669-1490 Toll Free 855-368-3621 2345 Northpark Dr., Columbus, IN 47203
MYTH:
YOU HAVE TO TRAVEL FAR TO GET THE BEST CANCER CARE. REALITY:
SCHNECK OFFERS NATIONALLY RECOGNIZED CANCER CARE HERE IN SEYMOUR.
When Mary Anne Jordan was diagnosed with breast cancer, she didn’t consider being treated anywhere but Schneck. Why? Because she trusted our care. We caught her cancer early, performed a lumpectomy immediately and developed the advanced treatment that’s saving her life. This expertise is why our Cancer Center is nationally recognized for excellence by the Commission on Cancer. Today, Mary Anne is finishing chemotherapy and receiving the heartfelt care we’re known for. YOU HAVE A VOICE IN YOUR CARE. Tell your doctor you choose Schneck. Malcolm Baldrige National Quality Award Winner
SchneckCancerCenter.org
FACING CANCER. FACING DECISIONS. Many thoughts and fears go through your mind the minutes, hours and days after learning you have cancer. But the one thing you never have to question is where to go for answers. Our team of cancer specialists is now seeing patients, right here in downtown Columbus. And since your first decision about treatment is often the most important, we’ll get you in right away to discuss all your options so you can make the right decision for you and your family.
Franciscan Physician Network 123 2nd St. Columbus, IN
(855) 837-8831
Let us help remove all the waiting, wondering and uncertainty. Call today for an appointment! New patients will be seen within 48 hours – next day in most cases.
Inspiring Health FranciscanStFrancis.org/Columbus