Get Healthy November December 2013 by The Times of NWI

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LIFE, HOPE AND M.S. Living with chronic disease

What Need

DONNA HALPERN, MS awareness advocate and survivor

PREVENTION ATTENTION Hearts, Breasts, Hormones, Brains and Bones

ALSO

TLC for Caregivers Cancers Not Killers Are Vitamins Good for You? Dr. LOVerA mILLer, hormone Therapist at Franciscan St. Anthony health NOVEMBER/DECEMBER 2013- michigan City. NWI.COM/GETHEALTHY

1 | PRODUCT

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Sports Injuries and Women An Update on STD Vaccine Chronic Anxiety is Not Funny SepTember/OCTOber 2013 NWI.COm/geTheALThy

Choose Methodist. Detect Lung Cancer at Earlier, More Curable Stages The Lung Care Center at Methodist Hospitals is Northwest Indianaâ&#x20AC;&#x2122;s multidisciplinary resource for patients with lung disease. It combines the experience and expertise of skilled pulmonologists, radiologists, thoracic surgeons, medical and radiation oncologists and pathologists, with the most advanced diagnostic and treatment technologies. Methodist offers Low-Dose CT Lung Screening for those at high risk of developing lung cancer or other lung diseases as defined by National Institute of Health criteria. The Lung Care Center also features the latest diagnostic technologies, including Northwest Indianaâ&#x20AC;&#x2122;s first Electromagnetic Navigation Bronchoscopy (ENB) and The Regionâ&#x20AC;&#x2122;s most advanced Endobronchial Ultrasound (EBUS) technology. This blend of latest diagnostic technologies and advanced treatment options with comprehensive rehabilitative services and supportive care will help you breathe easier.

lung care center Leading the Way to Better Health

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Choose Methodist. Breathe Easier. If you are a current or former smoker you may be a candidate for lung cancer screening using low-dose computed tomography (CT) technology. Recent research found that low-dose CT screening helped reduce mortality among those at high risk of developing lung cancer by 20%.

Call 219-757-7212 to learn more.

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How To o Choose the Right Retirement Community

veryone wants to live life to the fullest—to enjoy each season of life, and move into each season comfortably. As people age, transitions present new challenges and as a Continuing Care Retirement Community (CCRC), Hartsfield Village offers choices and options for everyone. “We provide a plan for your senior living needs now, and for your future,” says Kevin Orze, Director of Marketing and Sales. “It’s a plan that celebrates the full continuum of life and promotes successful aging.” The Continuing Care Retirement Community in Munster welcomes seniors into a community they can feel a part of, with a sense of neighborhood, a sense of being home. The staff is loyal and enthusiastic, adding more friendly faces to their neighborhood. Services for Hartsfield Village’s 300-plus residents are offered according to the resident’s needs and wants, and residents and families alike appreciate the dedicated staff. Orze points out that the time to begin establishing that neighborhood is before skilled nursing care is needed. While some seniors may live independently for their whole lives, others who may have a chronic illness or even simply longevity in the family, understand they may need more help as they age. The main thing is to plan for the future, and the future at Hartsfield Village as a Continuing Care Retirement Community can be secure and fulfilling. “Our goal is to keep our residents as independent as they possibly can be,” says Orze. “Some are here for many years and they’re active, but at some point, they may benefit from more assistance, which we provide. It’s comforting to have that continuity, so they maintain neighbors and friends and a lifestyle. Having a plan in place is much easier than trying to find another place and start all over.” Part of aging successfully is having the time for desired and enjoyable activities. There are no worries about cooking, cleaning, maintenance—all is taken care of so that seniors can take advantage of living well. At Hartsfield

Hartsfield Village Wii bowlers

QUICK TIPS

Start looking into options for senior living now, while you’re young and healthy.

Do your homework; the AARP Web site is helpful for definitions.

Set up appointments to visit different senior residential communities

Talk with residents and staff to see if they’re happy.

See what’s on the schedule, what kinds of activities are planned.

Nee d More INfo?

Tony V. MarTin, The TiMes

Village, in Northwest Indiana and just 22 miles from Chicago, residents live life the way they choose on a scenic 38-acre campus. They’re close to favorite stores, restaurants, cultural and leisure activities, and places of worship. Medical facilities nearby include one of the nation’s most respected healthcare organizations, Community Hospital, the sponsor of Hartsfield Village. Orze notes there are more options now available to seniors, including “stand alone“ living and memory care facilities. “Their services are fine, whether it’s an elegant setting or a minimal one—but they still present that issue of not offering a continuing care community” with all of the advantages. Hartsfield Village recognizes the full continuum of life. As a benefit of living in a CCRC, residents can seamlessly transition to a different level of care, if additional help becomes necessary. Hartsfield offers a plan for residents’ future living needs, so they can age in place. Rehabilitation becomes an essential aspect of recovery from illness, yet often seniors must go to separate rehabilitation facilities away from where they call home.

Making decisions in good time The changing economy has affected seniors, with the value of their homes and their retirement plans reduced. Many seniors have stayed in their homes longer than they intended to, and at some point may not be capable of independent living. Orze advises, “Don’t wait until they have a medical crisis, where decisions have to be made quickly. Then they may have waited so long they have lost an opportunity.” Seniors need to be actively involved in planning their future, making sure that future holds all the potential it can hold. Experts on aging successfully are often baby boomers, and most talk about how important it is to have satisfaction with their lives. While many people want to stay in their own home, their neighborhood may have changed; some neighbors aren’t there anymore. Maybe getting around has become limited because they don’t drive anymore, so their activities become limited, too. At Hartsfield Village, “We’ll have the kids of seniors here tell us, ‘We’ve called and we leave messages, because (Mom or Dad) is never home, always out doing

HARTSFIELD VILLAGE RETIREMENT COMMUNITY 10000 Columbia Ave. Munster, IN (219) 934-0750 hartsfieldvillage.com

something,’ and that’s great,” says Orze. “Age is not a number, it’s a state of mind. “I love what I do and the services we offer. You’ll often see a change in people’s attitudes when they come to see what Hartsfield Village is all about. They see how enthusiastic we are and it’s quite a pleasant surprise for them.” Seniors can start now, at whatever stage in life they are, to set up appointments to visit different senior residential facilities. “You really have to visit. You can’t make a major choice like this without seeing and understanding all your choices,” says Orze. Take a tour. Get a sense of whether residents seem happy and see what kinds of activities are scheduled. Talk to staff and residents, talk to friends. As a not-for-profit retirement community, any profits made are reinvested for the betterment of residents and their community. In general, residents of not-for-profits report a much higher level of satisfaction. No wonder Hartsfield’s motto is “Living Well, Living Wise.” november/december 2013 | GET HEALTHY | 1

November/December 2013

THE EVER-PRESENT DISEASE

BACKBONE OF HEALTH

Cancer comes in many forms, with a myriad of different symptoms and treatments. But new advances in technology and research have granted hope to some who suffer this disease.

The spine is the center of your body’s framework, and a complex vertebral column that includes bone, tissue and nerves. Learn how to care for your spine, reduce pain and relieve stress in this issue

HEALTHY PRODUCTS MOGO FLAVORED MOUTHGUARD Mouth guards are a staple for contact sports athletes, but what do most youth athletes do the moment the whistle blows to stop the action? They pull out their mouth guard out and when the action starts again they scramble to get the mouth guard back into their mouths. A large part of this scenario is because mouth guards don’t fit properly and they taste horrible. MoGo is the first flavored mouth guard on the market with technology that uses a players dental PROVIDED impressions to provides a custom fit mouth guard with unrivaled protection on the field. The MoGo mouth guard is worn by thousands of athletes across the country at the youth, high school, collegiate and professional level. Visit mogosport.com.

NEW PHYSICIANS JOIN FRANCISCAN MEDICAL SPECIALISTS

Dr. Arash Koochek has joined Franciscan Medical Specialists’ Department of Dermatology. He is board certified in dermatology and practices at the Franciscan Medical Specialists office in Dyer. He is accepting new general and cosmetic dermatology patients. He is fluent in English, Spanish and Persian (Farsi). Dr. Amjad Ali has joined the Franciscan Medical Specialists Department of Infectious Diseases. He is board certified in internal medicine and board eligible in infectious diseases. He is accepting new patients at the Franciscan Medical Specialists office in Hammond. Dr. Tapan Desai has joined Franciscan Medical Specialists’ Department of Pulmonary Medicine. He is board certified in internal medicine, pulmonary medicine and sleep medicine. He is accepting new patients at the Munster Medical Center. He is fluent in English and Gujurati. Dr. Amita Thakkar has joined Franciscan Medical Specialists Department of Rheumatology. She is board certified in internal medicine and board eligible in rheumatology. She has office hours at the Munster Medical Center and at the Franciscan Medical Specialists office in Schererville.

HOLIDAY CONCERT TICKETS ON SALE Tickets for the 19th annual LaPorte Hospital Foundation Holiday at the POPS are on sale. The philanthropic concert takes place Dec. 14 at the LaPorte Civic Auditorium, 1001 Ridge St. Main floor tables sell out quickly, so interested attendees are encouraged to purchase tickets atholidaypopslaporte.org as soon as possible. Proceeds benefit the foundation’s VNA Fund, which supports Indiana University Health LaPorte VNA Services and other philanthropic health care needs in the community. The concert features a variety of local talent including the LaPorte County Symphony Orchestra, directed by Philip Bauman. Entertainment will also be provided by guest artists including Shania Povlock, vocalist; Cripple Creek, vocal ensemble; Illumination, chorus; and Sarah Gartshore, vocalist.

SPO LAUNCHES “LIVE WELL BY SHARP” WELLNESS WATCH SPO (SPOM), a leading developer of biosensor and microprocessor technologies for use in portable monitoring devices, today announced through its partnership with MZB & Company Inc. (MZB), the launch of a new and innovative consumer wellness watch designed to measure the overall daily activity level of adults and children. The new wellness watch branded as “Live Well by SHARP” incorporates several innovative features that include patented LED display functionality and a time-piece which continuously measures the number of daily activities, recommended steps and calories burned against preset recommended goals. This can be especially helpful for those who wish to monitor their daily activity levels without the need to use or wear additional devices. Furthermore, the attractive design is aimed at encouraging people to wear the watch at all times. SOYFOODS: HEALTHY SOLUTIONS TO CHILDREN’S NUTRITION To meet growing demands for healthy, plant-based foods, schools nationwide are serving tofu, veggie burgers, soy crumbles, soymilk, soy yogurt and other soyfoods. In celebration of National School Lunch Week Oct. 14-18 , the Soyfoods Association of North America highlights the latest research confirming the healthfulness of soyfoods for children, and showcases schools offering soyfood options in their cafeterias. The bottom line for parents—children in the U.S. and across the world enjoy a variety of soyfoods daily and have grown and developed normally. School food service programs are increasingly taking advantage of the nutritional and economical value that soyfoods can provide their students. Soyfoods work within school meal requirements to offer a complete protein source that also supports fat and calorie reduction. Schools serve fortified soymilk in place of cow’s milk, edamame as a vegetable, and tofu, soy-based deli slices, soy nuts, crumbles, burgers, soy nut butter or nuggets as meat alternates. The menu options enjoy high acceptance.

survivor spotlight

THE LINE OF

DUTY

A SCHERERVILLE POLICE OFFICER FINDS PAIN RELIEF

or years, Jennifer Zukley lived with chronic pain in her left arm, elbow, shoulder, chest area and fingers. It wasn’t until she woke up one night paralyzed and in excruciating pain that she would learn it was all related to an underlying issue with her spine. Zukley, 47 and a Schererville police officer, had seen several doctors regarding her chronic pain prior to this incident. She was always prescribed medication, with no investigation into the cause. She was told it was tendonitis and nerve damage from previous injuries and car accidents she had been in throughout the years. “No one ever said the pain was from something in my spine. That was never introduced to me so I had no idea that was connected.” Zukley saw Gregory McComis, MD, an orthopedic surgeon and owner of North Point Orthopaedics (nportho.net) in Munster. The Schererville resident had a herniated rupture, which required a surgery called a discectomy, removal of the herniated disc. “From the time I entered that office until my surgery a week later, it was completely the most investigative, intensive care I’ve ever received in my life,” she says. “When they did the MRI, it looked like a career ending devastating injury. “(Dr. McComis) had the most compassionate look on his face and he said ‘We can fix this. You will return to work. You will have no more pain. It will be better than before.’ Everything he said was correct.” McComis says many of his patients have been previously misdiagnosed. In Zukley’s case, “This is something that had been going on for a long period of time. People thought she was having a heart attack, had shoulder

problems. She was misdiagnosed for several years.” He says some other physicians concentrate on only one part of the pain and miss other underlying problems. In Zukley’s case, it was a pinched nerve in her neck, he says. She was surprised by how pain free she was after she woke up from recovery. “Actually now I have a better life than I did before. I don’t have pain. When you have pain, it limits your outlook, limits your motivation, limits your attitude.” Zukley says she had learned to live with her chronic pain and planned to retire from the police force when she turned 50 but doesn’t feel like that now. “Being a police officer, it’s a very physically demanding job and you have to have all your faculties. You have to be able to work out, you have to have stamina,” she says. “I’m capable now. I have all the ability to continue with it. I don’t know what I would have done had I not met Dr. McComis.” McComis said he has great success with his minimally invasive, outpatient technique for the discectomy. “One of the hospital systems in the area has looked at the outcome of how patients do and I have the best outcomes for neck and back surgery of the surgeons who do that.” He is also in the top 1 percent of those outcomes in the country. He said this technique doesn’t injure the muscle and causes patients less swelling and thus, less pain. They go home the same day and their recovery is that much shorter. —Jennifer Pallay

HOW TO RECOGNIZE SPINAL PAIN ISSUES

the body shop

PHOTOS COURTESY OF COMMUNITY SPINE & PHYSICAL THERAPY

on your mind

Shaun Kondamuri, MD and managing director at Midwest Interventional Spine Specialists in Munster, has answers some common spine questions. He is board certified in interventional pain medicine, anesthesiology and internal medicine. Q:What are some warning signs that chronic pain is something more? A: Several warning signs come to mind. If the pain is worse when lying down or if it is associated with weight loss, it needs to be investigated for other causes such as tumors. If back pain occurs after an infection or in the setting of cancer in another part of the body we often think about infection like osteomyelitis developing in the bone or metastatic tumor spread to the spinal bones. If there is trouble urinating or trouble passing a bowel movement in the setting of back pain this can indicate a more serious nerve injury that could require more urgent surgery. Loss of sensation around the anus or sudden onset of sexual dysfunction is a potential emergency indicating a Cauda Equina Syndrome that may require immediate surgery to prevent incontinence and permanent paralysis. Commonly patients come with headaches and are thought to have migraines.They are treated for years with anti-migraine medications and only get a little better because the real problem is in their neck.When you treat the cervical problem the headaches are resolved. We commonly see this in whiplash injuries following car accidents for example. Q:What are some treatment options for chronic pain? A: Numerous treatment options exist. Nonsurgical options should be tried first because they are safer and reversible unlike surgery. Options include interventional pain management, which includes diagnostic injections to confirm where pain is coming from. Rehab can include physical therapy for improving range of motion, stretching, strengthening, and to aid in starting a self-directed daily or three to four times a week regular exercise program. Interventional pain management may help patients with severe chronic pain get through chiropractic therapy if chiropractic or physical therapy cannot be performed due to severe pain. Numerous minimally invasive treatments can be offered such as thermal destruction (radiofrequency ablation) of nerves that transmit pain or modifying the pain signal using treatments such as spinal cord stimulation. All of these treatments can provide quite effective pain relief in the right situations. Sometimes unfortunately, we have little we can offer some patients and the best we can do is palliate the pain with some medications such as antidepressants, anti-neuropathics, anti-convulsants, etc. because the pain cannot be resolved.

food & fitness

hands HELPING

Bone and Spine Health BUILDING BONE DENSITY AND STRENGTHENING THE SPINE THROUGH EXERCISE

our bones and spine both play an essential role in your body. They work together to provide the framework of your body, aid in movement and protect your major organs, among other tasks. Keeping your bones and spine healthy can help prevent pain and injury, as well as osteoporosis. T h e N a t i o n a l O s t e o p o ro s i s Foundation reports that nearly 9 million Americans suffer from osteoporosis, a disease characterized by weakened bones. An even higher number of Americans suffer from back pain, which affects 8 out of 10 people at some point in their lives, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. In order to prevent pain and injury and lower the risk of osteoporosis, maintaining proper strength and flexibility in the spine and bones Community Hospital Medical Office Building is essential, explains Helen Mitrakis, DPT, MPA, 801 MacArthur Blvd, Suite 405 Cert. MDT and supervisor of Community Spine Munster, Ind. & Physical Therapy in Munster. Dr. Mitrakis 219.836.5381; comhs.org recommends strengthening activities to increase communityspineandbrain.com bone density while also improving balance and posture. Lakeshore Bone She explains: “Increased bone density helps & Joint Institute prevent and decrease the risk of fractures, and 601 Gateway Blvd good balance and stability decrease your risk of Chesterton, Ind falls and sustaining fractures. 219.921.1444; lbji.com

Caregivers, those tending someone who is ill, disabled, emotionally vulnerable or aged, are often at high risk themselves. According to the National Alliance for Caregiving and AARP in a study updated in November 2012, currently about 65.7 million caregivers make up 29 percent of the U.S. adult population providing care. And those in what’s termed the Sandwich Generation often are juggling multiple demands—dealing with their parents as well as their children whether they’re under 18 and still at home or young adults struggling to find well paying jobs or the expense of college tuition. Add to that the stresses of everyday living, jobs and paying the bills and working and the combination can be detrimental. That’s what a study by the National Caregiver Alliance indicates. As an example of how caretaking can impact health, the study shows that the risk for a caregiving spouse between the ages of 66 and 96 experiencing mental or emotional strain is 63 percent higher than those of the same age who are not caretakers. The combination of loss, prolonged stress, physical demands of caregiving and biological vulnerabilities that come with age place people at risk for significant health problems as well as, possibly, an earlier death. According to Dr. Larry Brewerton, PhD, a professor of psychology at Indiana University Northwest who also has a part time private clinical practice, it isn’t only older caregivers who at risk. The Sandwich Generation also faces an increased risk for depression, chronic illness and a deterioration in their quality of life. Outlining some of the warning signs that a caregiver may need care too, Cynthia Fodness, MSN, CNS, Mental Health Nursing Instructor at the University of St. Francis and psychiatric consultant at St. Clare Clinic, includes, “Nervousness, grouchiness, constant fatigue, inability to sleep, lack of appetite or eating too much, can’t get the cared-for one off your mind, finding no happiness in everyday things, confusion, having no spare time or being too tired to enjoy it.”. It’s important to recognize these symptoms not only in ourselves but also with friends. “That’s when it’s important to talk to the person about it,” says Brewerton who warns against missing the signs of someone in distress. Sometimes our friends are in a caring profession and can’t just vent to us and so we need to find other ways to help. “If the person is a professional bound by patient confidentiality, encourage him or her to use resources available within his/her profession,” Fodness says. “But no matter what, Fodness recommends asking what you can do to help. “Don’t just say, let me know if I can do anything to help, Fodness recommends. “Offer specific help—bring food, take the person—with or

“Proper posture is important to prevent compression fractures of the spine, which are common with osteoporosis, and helps decrease the stress on the spine by maintaining proper body mechanics during our daily functional activities.” Examples of weight-bearing activities that strengthen the bones and spine include walking, stair climbing, hiking, dancing, jogging, racquet sports and Tai Chi. Resistance with bands or weights; water resistance with water weights, paddles or gloves; and gravity resistance such as yoga poses and push-ups also help build bone density and keep the spine healthy. Orthopedic Spine Surgeon Anton Thompkins, MD at Lakeshore Bone and Joint Institute in Chesterton says weight-bearing exercises— such as walking, step aerobics or anything that puts stress on the bones—help increase bone density. “According to Wolff’s law, bones heal under stress,” Dr. Thompkins explains. Weight-bearing exercises make your bones work against gravity and become stronger. Without gravity and the benefit of weight-bearing exercises, the bones become weaker, as seen in astronauts who have spent long periods of time in space. “As soon as you take weight off the bone, it will actually start being degraded or osteofied,” Dr. Thompkins adds. Strong core muscles, which include abdominal, back and pelvis muscles, are important to your spine’s health as they help support the spine. While maintaining a strong core is important, Dr. Mitrakis cautions against abdominal crunches or sit-ups for people with osteoporosis due to the increased risk of fracture. She recommends that abdomen strengthening activities should be done in a neutral spine position to help prevent fractures. —Ashley Boyer

without the cared-for one—out for coffee or a meal. Spend time with the cared-for one so the caregiver can have some time away.” Stress and poor planning often lead to poor dietary choices, and they can become chronic problems, says Cathie Claysen MS, RD, LD, School of Nursing, College of Health and Human Services at Indiana University Northwest. “It can help to keep a log of your food and exercise habits,” she says. “Then choose an area to improve, such as evening snacking in front of the television. Then formulate a plan to change your habit. This could be going for a walk after dinner, having a healthy snack prepared, or relaxing with a book instead. When you find a substitute that works for you, then repeat it until it becomes a habit.” Fodness also lists getting enough sleep, drinking fluids, avoiding excess caffeine and alcohol, exercising, spending time with friends and family, doing things that have been fun in the past and seek support from people in your life. Ask for things you need, and don’t take everything onto your shoulders— lots of people want to help but don’t want to intrude,” she says. “If you ask, they’ll help. See your doctor regularly and especially if you have signs of illness and seek counseling if things become overwhelming.” Support groups are also a good way to find support and help. Most communities offer a variety of groups, most of them free, such as Alzheimer’s Support Group as well as groups offering support for such diseases and issues as cancer, mentally ill children, grieving parents and more. Hospitals offer a range of groups and more information can often be found in local newspapers and on websites. “I forget who said it,” says Fodness, “but someone said, ‘It takes a whole village to raise a child.’ That’s so true. It’s also true that it takes more than a caregiver to care for someone who needs care. It takes the community, which includes family, friends and everyone else, to care for the one needing care, as well as the one giving it.” —Jane Ammeson

senior scope

Vitamins HEALTHY OR NOT? P

When it comes to vitamins, can there be too much of a good thing? • Depends upon our needs and what vitamins we’re taking, says Tim Petritis, a member of the marketing and education team at Baums Natural Foods with locations in Munster, Merrillville and St. John. • “We have two certified nutritionists at the store that can answer questions about vitamins,” he says. “Much of what we sell are formulas made by companies who have doctors and research scientists on staff who specialize exclusively in nutrition.”

etritis emphasizes knowing what you’re taking because more isn’t always necessarily better. “People will come in and say I’m taking this and this vitamin supplement, and I’ll ask them why they’re taking them and they don’t really know,” says Kim Kramer, RDN, LDN, Ingalls Wellness Dietitian, Kids Eat Right Crew Illinois Representative and the Illinois Academy of Nutrition and Dietetics Media Spokesperson. “Americans tend to believe that more is better, and that is definitely not the mentality to have when taking vitamins,” says Lori Granich, RD, a clinical dietitian at the Midwest Bariatric Institute in Dyer. “Some vitamins are merely excreted when the dosage is more than the body can store, but others can build up and cause toxicity.”

Large doses of supplements can also affect absorption or the body’s use of other nutrients says Cathie Claysen MS, RD, LD, School of Nursing, College of Health and Human Services at Indiana University Northwest. “They should be thought of as supplemental and not substitutes for a healthy diet,” she says. “When vitamins provide very high dosages, there can be serious side effects,” says Granich. “Too much Vitamin A, for example, can cause liver problems and osteoporosis. Depending on the vitamin, high dosages can cause anything from fatigue to kidney problems.” According to Claysen, large doses of calcium or magnesium from supplements can decrease iron absorption and zinc supplements can decrease calcium absorption. “Interference with vitamin absorption from foods has also been documented,” she says. “If people are eating healthy natural food, they should be getting the nutrients that they need,” says Kramer. “That would include whole grains which help move the food through the body to help prevent colorectal cancer as well as two and a half cups of vegetables and two cups of fruit a day. It’s also important to limit the consumption of processed meats, alcoholic beverages and sugar and to maintain a healthy weight for

cancer protection.” Kramer recommends eating three meals a day and not go four to five hours without eating anything. “We absorb nutrients best from a variety of nutrient dense foods like fruits, vegetables, legumes, low fat dairy and whole grains,” says Claysen. But eating well isn’t always possible with our hectic lifestyles, says Petritis. “Unfortunately, even if we ate a perfect diet, the soil is depleted and to extend the shelf life of foods, we would come up short,” he says. “Dietary supplements can include vitamins, minerals and even enzymes and are intended to help people reach their dietary needs,” says Granich. “The supplement industry has really skyrocketed...The biggest thing to remember is that supplements are not regulated in the same way our food is by the Food and Drug Administration.” There are supplements and there are supplements, says Petritis. “People need to read the labels and see if there artificial colors and fillers like talc which have been known to cause health problems,” he says. “Often people may think they are getting a bargain on drugstore vitamins but what they are getting are fillers, binders, low grade fish oils and synthetic nutrients. Many products are designed to sell, not work.” —Jane Ammeson

ask the expert

deep brain stimulation

DR. MANOJ RAO

Expert Care

CUTTING EDGE TREATMENT FOR PARKINSON’S

efore his deep brain stimulation procedure, Parkinson’s disease patient Frank Maver could not drive his car or get out of a chair without assistance. After the procedure he says, “my life has improved so much it’s unbelievable.” The deep brain stimulation, commonly compared to a pacemaker for the brain, and DaTscan, an imaging technique used to track dopamine in the brain, are two technologies local hospitals are using to benefit Parkinson’s patients. “It’s been hugely successful,” says Andrea DeLeo, a neurologist at Northwest Indiana Neurologic Associates and on staff at Community and St. Catherine hospitals. “The main focus is to give patients back the quality of life that they have been missing, and it really has been able to do that. Patients are driving again, able to go shopping, bathe themselves, feed themselves, many different things. It’s also improved the quality of their (family) relationships by the fact that they are not needing as much help.” Maver, who had the deep brain stimulation done this spring, is a 77-year-old Highland resident. About six years ago, he had trouble with one of his fingers while trying to cut meat. It got progressively worse, he says, and his Parkinson’s had progressed to stage 3 by the time he decided to try the deep brain stimulation therapy. “It took me about a year or more to decide if I wanted somebody to fish in my head, somebody to play with my brain,” Maver says. “I investigated and it was either be chair ridden or be able to walk. I had to do something.” He says he recommends the procedure to anyone considering it saying it’s worth it even just to be able to drive again. He says his doctors—Dr. DeLeo and Wayel Kaakaji—were amazing and that although it doesn’t

work for every patient, he and his family are happy it worked for him. Dr. DeLeo says they typically try to do the procedure while the Parkinson’s is in its early stages but it can be done with any patient based on symptoms. “It’s not an end stage salvage thing at all. It’s really not,” she says. “It’s really for the patient who wants to maintain an active lifestyle and isn’t actively controlled on medication and is requiring more and more medication to keep that level functioning.” Arif Dalvi, director of the Parkinson’s Disease Center at Methodist Hospitals’ Neuroscience Institute in Merrillville, says the center focuses on 21st century treatments of Parkinson’s, including the deep brain stimulation and DatScan technologies. About a year ago, the hospital started using DatScan, which can estimate what dopamine is doing in the brain. The new test is superior to imaging studies like MRI and CAT scan for diagnosis, says Dalvi, a Methodist Physician Group doctor. “The older studies just show the structure of the brain, not the chemical imbalance,” he says. In addition to the DatScan, the center also uses the Unified Parkinson’s Disease rating scale, developed by Columbia University, to diagnose and measure Parkinson’s. “It’s a very lengthy diagnosis and has a lot of implications short term and long term so we want to make sure we get the diagnosis right the first time around.” Treatments are individualized following a comprehensive program Dalvi developed with his 15 years experience in surgical and pharmaceutical

Dr. Manoj Rao, a leading physician at Urologic Specialists of Northwest Indiana, believes being informed about urologic health can save lives. His main office is in Merrillville at 400 W 84th Drive. He also has an office in Gary at the Methodist Northlake campus. He provides care and performs surgery at the following hospitals: St. Anthony’s in Crown Point, St. Mary’s in Hobart, Community Hospital in Munster, Pinnacle Hospital in Crown Point, and Methodist Northlake and Southlake campuses.

Q: How long have you been practicing in

After a deep brain stimulation procedure, Parkinson’s disease patient Frank Maver returns to see neurologist Andrea DeLeo, who adjusts the settings on his implant device to maximize results and diminish tremors and rigidity.

treatments for the disease. “We take a holistic approach,” he says. “Instead of just relying on medications alone, these patients come in for an extended visit. They are seen by a physical therapist to see how we can help with walking and balance. They are seen by a pharmacist to see if there are issues with drug interactions. They’re seen by a nutritionist so we can make sure there are no food interactions with their medications. And they are seen by me and measured by the scale. It’s an extensive two-hour visit that really gives us a sense of what this Parkinson’s disease patient is about and then we can tailor treatment for that particular patient.” For a more comprehensive overview of Parkinson’s, visit emedicine.medscape.com/article/1831191overview to read a chapter Dalvi co-authored. —Jennifer Pallay

NWI? Any concerning trends growing among your patients over the last few years? I recently began my career with the Urologic Specialists of Northwest Indiana. I have found in my time here that the people I have cared for are very kind, and the hospitals at which I work to be very supportive and dedicated to patient care. One concerning issue I have noticed is patients who attribute blood in their urine to a urinary tract infection and neglect to follow up with a urologist. This is a very concerning condition and many of these patients have underlying urological diseases such as kidney stones or cancer in the bladder or other parts of the urinary tract. I encourage any patients who see blood in their urine, especially in the absence of a urinary tract infection, to seek urological care. Q: How many cases of cancer do you treat

in a year? Any particular cancer showing up more often? Throughout the year, urological cancers are also quite common. In fact nearly 40 percent of all cancers encountered in men are treated by urologists. Prostate cancer is far and away the most common cancer in American men and is also the leading cause of cancer mortality. Fortunately, with advances in research, we have found many men are at low risk for metastatic disease and are unlikely to die from prostate cancer.

PROVIDED

Compiled by Times Staff

CORPORATE WELLNESS CLINIC OPENS IN VALPO

Porter Regional Hospital has opened a new Health At Work corporate occupational and wellness clinic at 809 LaPorte Ave. The clinic will be open from 7:30 a.m. to 4 p.m. Mondays through Fridays. The site will provide clinical and medical services to its corporate clients.

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Due to this, we offer alternatives to standard treatments such as active surveillance, where we can monitor PSA levels and perform repeat biopsies to monitor the cancer over time. Our group also offers Da Vinci robotic assisted laparoscopic surgery to treat urological cancers as well as benign conditions of the prostate, kidney and urinary tract.

penile prosthesis surgery can be performed with a short stay in the hospital and many men and their partners find this treatment to be very favorable. I am giving seminars at Methodist Hospital’s Southlake campus to further discuss men’s health issues in more detail and those interested can contact my office for more information.

Q: Besides kidney or urinary tract infections what other reasons can a patient come in and see you about? I have found many patients seeking care for men’s health issues, which seem to not be talked about much in public, such as vasectomy, low testosterone, infertility or erectile dysfunction. We perform vasectomy in the office with local anesthesia and offer multiple products for testosterone replacement including longer lasting testosterone pellets. Given that in vitro fertilization is very expensive and not always covered by insurance plans, I encourage couples who are unable to conceive after one year of trying to seek urological care.

Q: You completed your residency in Urology

Q: What are some options men have when

dealing with erectile dysfunction? For erectile dysfunction, many men are prescribed medications such as Viagra, Levitra or Cialis. Not all men are aware that other options exist for this condition. We offer treatments such as inflatable penile prostheses and other non-operative interventions for those who have a poor response to medications. The

at Loyola University Medical Center and did rotations at Children’s Memorial Hospital and the Hines VA Hospital. How did these particular rotations (Children’s and Hines) help prepare you for your career? The experience at the Hines VA Hospital is cherished by all of our residents. With appropriate supervision, we are able to provide top notch care for all urological conditions to veterans. Our VA was one of a select few in the country with the Da Vinci robot, providing the latest in technology to our veterans who deserve the best health care available. We also spent four months at Children’s Memorial Hospital, now the Lurie Children’s Hospital. The majority of our pediatric urology training is with the outstanding pediatric urologists at Loyola University—Doctors Hatch and Matoka. Loyola University Medical Center’s Department of Urology provided me with a wonderful, well-rounded training experience and I look forward to providing care to all patients in Northwest Indiana. —Trish Maley

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what’s new

survivor spotlight

the body shop

on your mind

food & fitness

senior scope

ask the expert

Flavored mouthguards, a SHARP wellness watch, and a new initiative for soy foods.

An officer of the law overcomes spinal challenges.

Exercises can increase bone density to strengthen your frame.

Doctors advise how to take care of the caregivers.

When it comes to vitamin supplements, how much is too much?

New technology gives Parkinson’s patients better lives.

Dr. Manoj Rao, urologist, discusses what you need to keep your insides healthy.

4 letter from the editor 2 | GET HEALTHY | nwi.com/gethealthy

6 health care advisory council

Taking the next step after cancer.

Survive and thrive. If you’ve fought with cancer, you know it can be exhausting. In fact, radiation, chemotherapy, and surgery can affect energy, endurance, balance, and strength. The Ingalls Survivorship program is helping cancer survivors achieve a happy, healthy, energetic life following their cancer treatment.

The Ingalls Survivorship program provides personalized guidelines, activities, and exercises documented to improve endurance, strength, and balance – and is staffed by 25 experienced clinicians, all certified in Survivorship Training and Rehabilitation (STAR) including nurses, nutritionists, physical therapists, psychologists, and others who can help you take the next step.

Ingalls is committed to helping you enjoy a rich, fulfilling life. So regardless of which hospital treated you for cancer, please contact the only hospital in the Chicago southland area to be certified in survivorship – Ingalls. Take the next step after cancer and truly thrive. Call us at 708.915.STAR (7827) www.Ingalls.org/CancerCare

We treat one kind of cancer. Yours.

november/december 2013 | GET HEALTHY | 3

letter from the editor volume 8 | issue 6

THE OMNIPRESENT DISEASE

ometimes it seems as though cancer is everywhere. Three out of my four grandparents died of cancer, and several other relatives have battled the disease over the years. I know I’m not the only one who has so many people in their life affected by cancer. For some, cancer takes a fairly swift and violent toll on the body. Like my grandmother, who was diagnosed with clear cell ovarian cancer in 1998 and passed away in 2001. And for others, cancer can be almost a liveable disease. Like my grandfather, who lived with testicular cancer for several years without any major problems. Cancer is common, but no two experiences are ever the same. And that’s why, even though I have had a lot of personal experience with cancer, it’s almost impossible for me to write about it. Because there are no words to describe exactly what happens when someone you love gets the diagnosis. Or what goes through your mind as you help them fight. But I do remember my grandma’s acceptance of her diagnosis. Instead of asking “why me?” and feeling hopeless, she would say, “Why not me?” She recognized that it

could happen to anyone. Through chemo and surgeries, she kept her positive outlook, and even found humor in her situation. As she lost her battle, she accepted that fact with the same level of equanimity as her diagnosis. We always hear about a “cure for cancer.” News reports predict that it will come within ten years, or fifteen. But just as no two experiences are the same, no two cancers are the same. It seems like irrational hope to expect a panacea for all cancers. And maybe it is. But even so, huge strides have been made, even in the last few years. New treatments for leukemia have turned one of the most terrifying diagnoses into something almost manageable. Other cancers can be treated for years as a chronic condition. And as almost everyone knows, the earlier the disease is diagnosed, the better chance the patient has of surviving. New ways to screen for cancer have made an early diagnosis more obtainable than ever. Cancer can happen to anyone. And though there may not be a cure for all cancer yet, the best thing anyone can do to protect themselves is to be prepared. Get screened. Talk to your doctor. KATHLEEN DORSEY MANAGING EDITOR

CHECK OUT NWI.COM/GETHEALTHY, WHERE YOU’LL FIND: Our comprehensive calendar of Well-Being Events • Fresh new articles and information every day Health advice from local and national experts • The place to sign up for our weekly email newsletter to receive advice and ideas on nutrition, fitness, mental health and health care

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Publisher — CHRIS WHITE Associate Publisher/Editor — PAT COLANDER Managing Editor — KATHLEEN DORSEY Associate Content Producer — TARA MCELMURRY Design Director — BEN CUNNINGHAM Designer — APRIL BURFORD Contributing Editors JANE AMMESON, LESLY BAILEY, ASHLEY BOYER, CHRISTINE BRYANT, TRISH MALEY, TARA MCELMURRY, JENNIFER PALLAY, PHILIP POTEMPA, CARRIE RODOVICH, ELOISE VALADEZ, SHARON BIGGS WALLER NICHE PUBLICATION SALES Account Executives MIKE CANE, ANDREA WALCZAK Advertising Operations Manager ERIC HORON Advertising Managers DEB ANSELM, CRAIG CHISM, DEEDEE WHITE, CHUCK SMITH Production Manager TOM KACIUS Published by Lee Enterprises The Times of Northwest Indiana Niche Productions Division 601 W 45th Ave, Munster, Indiana 46321 219.933.3200 2080 N Main St Crown Point, Indiana 46307 219.662.5300 1111 Glendale Blvd Valparaiso, Indiana 46383 219.462.5151 Copyright, Reprints and Permissions: You must have permission before reproducing material from Get Healthy magazine. Get Healthy magazine is published six times each year by Lee Enterprises, The Times of Northwest Indiana, Niche Division, 601 W 45th Ave, Munster, IN 46321. CORRECTION On the Sept/Oct issue cover, Dr. Lovera Miller’s workplace was incorrectly identified. Dr. Miller is now practicing at IU Health LaPorte. Get Healthy Magazine regrets the error.

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THE HEALTHCARE AND INSURANCE INDUSTRIES ARE NOT WHAT THEY USED TO BE

John Gorski Community Healthcare System

And that’s a good thing

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esearch abounds and the data that pours out touches every corner of the system. There is speculation about how healthy people will behave with more options for insurance, but no researcher has the ability to set-up a facsimile of what the environment will be without pre-conditions and with mandatory requirements with confidence. Or what kind of informed or misinformed choices will come from that structure. Medical insurances, at least in my world, kind of reminds me of choosing a cell phone plan in the old days. Remember when you used to have to predict how many minutes you thought you—and the rest of your family members—were going to talk on the phone during the next several months? Now when making my annual prognostication I tend to be incredibly optimistic or just as far gone in the opposite direction. Either way it affects cash flow adversely. But, I have gotten better about taking care of myself and that is partly due to the contagious nature of healthy behaviors. While everyone in my life, including me, still eats way too much pizza, we eat it less often. My 27-year-old daughter pushed me to get a phone app with vegetarian recipes that are simple and convenient for dinner. She also eats too much pizza, but it doesn’t matter that much when you ride a bike nine miles to and from work unless it’s pouring rain. Everyone is more conscientious about prevention, if only because their doctors and insurance companies are forcing the issue. And at the opposite end of the spectrum, new methods of diagnosis and treatment are hurtling forward at top speed. Chronic conditions that were once a life sentence to confinement are increasingly controllable. After targeted therapies, patients resume jobs, recreational activities and normal lives, picking up where they left off. Repairs are so commonplace that even major surgery that goes on for hours is no longer something to be feared but another milestone to be passed, that causes the patient to mend unhealthy habits sooner rather than later. Yes, dealing with health issues, diet, exercise, combinations of medications at certain intervals, remembering a complaint that may crop up from time to time, are all complicated. But none of these cause and effect relationships are impossible to learn. Not to mention having doctors and other healthcare professionals who actually listen to the answers you give to their hundred questions. Healthcare and its consequences have become more complicated, but that’s the expectation when individuals take on more responsibility for controlling and modifying behaviors that have enlarged outcomes for us and our families.

PAT COLANDER ASSOCIATE PUBLISHER AND EDITOR

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Jay Platt, DDS Oral Surgery and Dental Implant Center Debbie Banik Lakeshore Bone & Joint Institute John Doherty Doherty Therapeutic and Sports Medicine Dr. Alex Stemer Franciscan Medical Specialists Gregory P. McComis, MD North Point Orthopedics Nitin Khanna, MD, FAAQS Dwight Tyndall, MD, FAAQS Spine Care Specialists

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Carol Schuster, RN, MBA Franciscan Alliance Thomas J. Gryzbek Franciscan St. Margaret Health Jim Lipinski Franciscan Alliance James T. Callaghan III, MD, MBA Franciscan St. Anthony Health Michigan City Trish Weber, RN, MBA Franciscan St. Anthony Health Michigan City Jonathan Nalli Porter Hospital Ian McFadden Methodist Hospitals Denise Dillard Methodist Hospitals Haroon Naz Pinnacle Hospital Barbara H. Greene Franciscan Physicians Hospital Beverly DeLao Franciscan Hammond Clinic Rob Jensen Franciscan Hammond Clinic

MARKETING AND COMMUNITY RELATIONS Mylinda Cane Community Healthcare System Angela Moore St. Catherine Hospital Kelly Credit Porter Hospital Karen Keltner Porter Hospital Mary Fetsch St. Mary Medical Center Marie Forszt Community Hospital Joe Dejanovic Franciscan Alliance Ellen Sharpe Franciscan Alliance Sister M. Aline Shultz, OSF Franciscan Alliance Maria E. Ramos Franciscan Alliance

Dr. Nancy Trimboli Trimboli Chiropractic

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Colleen Zubeck Franciscan Medical Specialists Centers of Indiana

Anton Thompkins, MD Lakeshore Bone & Joint Institute

Michael Shepherd St. James Hospital and Health Centers

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what’s new Compiled by Times Staff

Local Health News

HEALTHY PRODUCTS

CORPORATE WELLNESS CLINIC OPENS IN VALPO

MOGO FLAVORED MOUTHGUARD Mouth guards are a staple for contact sports athletes, but what do most youth athletes do the moment the whistle blows to stop the action? They pull out their mouth guard out and when the action starts again they scramble to get the mouth guard back into their mouths. A large part of this scenario is because mouth guards don’t fit properly and they taste horrible. MoGo is the first flavored mouth guard on the market with technology that uses a players dental PROVIDED impressions to provides a custom fit mouth guard with unrivaled protection on the field. The MoGo mouth guard is worn by thousands of athletes across the country at the youth, high school, collegiate and professional level. Visit mogosport.com.

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PAID CONTENT

MICHAEL SENA’SYour PRO-FIT source for local health

news and information. BATTLING THE PHYSICAL AND EMOTIONAL EFFECTS OF A CANCER DIAGNOSIS

he used to take care of her body. She was actually quite thin when she was young. But then came the kids and the job changes and the smoking habit she couldn’t kick, and before she knew it, she was a woman in her 50’s facing the diagnosis of Stage 3 cervical cancer. But instead of giving up, she decided to get stronger. “At that point, she could have just ended up a broken person,” recalls Michael Sena of a client of his Pro-Fit training facility in Dyer. “And while it was tough on all of us to hear the news, the diagnosis forced her to look

at exercise and well-being in a whole new way. She made her body stronger to combat the disease, and she is now in remission. More importantly, though, her vibrancy for live is back to being alive and well. She is smiling from ear to ear these days.” Indeed, the importance of battling cancer both physically and mentally has long been documented. “It really becomes a three legged stool,” says Sena, who has worked within the health and fitness field for over 30 years. “It’s a balancing act between eating healthy to exercising properly to living positively.” Whether living at your best to help

avoid a future cancer diagnosis or facing an unfortunate diagnosis at this very moment, it’s of vital importance to use exercise to help strengthen your cells and balance the hormones which are released in the body. Believe it or not, studies show that less than 8 percent of adults living in the United States maintain an active lifestyle. “Everyone has dormant cancer cells that can come alive when the rest of our body is weakened,” explains Sena, who opened his Dyer facility in October of 2011. “Many believe that much of the illnesses we face, including cancer, could be combated if we all took better care of our bodies.”

A cancer diagnosis can also leave one feeling ‘down and out’, which can also be combated by the use of exercise in one’s daily life. “Statistically, it has been proven that depression can dissipate through exercise and the subsequent release of hormones within the body,” says Sena, who has been voted in as one of the “Top 100 Trainers in America” by Men’s Journal magazine. “I have had many clients over the years who had been taking anti-depressants for anxiety and depression who ended up either reducing their medication or coming off of them all together while staying consistent with healthy eating and regular exercise.”

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survivor spotlight

THE LINE OF

DUTY

A SCHERERVILLE POLICE OFFICER FINDS PAIN RELIEF

10 | GET HEALTHY | nwi.com/gethealthy

HOW TO RECOGNIZE SPINAL PAIN ISSUES Shaun Kondamuri, MD and managing director at Midwest Interventional Spine Specialists in Munster, has answers some common spine questions. He is board certified in interventional pain medicine, anesthesiology and internal medicine. Q:What are some warning signs that chronic pain is something more? A: Several warning signs come to mind. If the pain is worse when lying down or if it is associated with weight loss, it needs to be investigated for other causes such as tumors. If back pain occurs after an infection or in the setting of cancer in another part of the body we often think about infection like osteomyelitis developing in the bone or metastatic tumor spread to the spinal bones. If there is trouble urinating or trouble passing a bowel movement in the setting of back pain this can indicate a more serious nerve injury that could require more urgent surgery. Loss of sensation around the anus or sudden onset of sexual dysfunction is a potential emergency indicating a Cauda Equina Syndrome that may require immediate surgery to prevent incontinence and permanent paralysis. Commonly patients come with headaches and are thought to have migraines.They are treated for years with anti-migraine medications and only get a little better because the real problem is in their neck.When you treat the cervical problem the headaches are resolved. We commonly see this in whiplash injuries following car accidents for example. Q:What are some treatment options for chronic pain? A: Numerous treatment options exist. Nonsurgical options should be tried first because they are safer and reversible unlike surgery. Options include interventional pain management, which includes diagnostic injections to confirm where pain is coming from. Rehab can include physical therapy for improving range of motion, stretching, strengthening, and to aid in starting a self-directed daily or three to four times a week regular exercise program. Interventional pain management may help patients with severe chronic pain get through chiropractic therapy if chiropractic or physical therapy cannot be performed due to severe pain. Numerous minimally invasive treatments can be offered such as thermal destruction (radiofrequency ablation) of nerves that transmit pain or modifying the pain signal using treatments such as spinal cord stimulation. All of these treatments can provide quite effective pain relief in the right situations. Sometimes unfortunately, we have little we can offer some patients and the best we can do is palliate the pain with some medications such as antidepressants, anti-neuropathics, anti-convulsants, etc. because the pain cannot be resolved.

Should I have my wisdom teeth removed? When should I have them removed? These are a few questions that are commonly asked in our office. We would like to have the opportunity to see you for a consultation to determine if you will benefit from wisdom tooth removal. Consultations are always complimentary for wisdom teeth and dental implant patients. Dr. Platt has been serving Northwest Indiana for over 20 years with quality oral surgery care in Wisdom Teeth Removal, Dental Implants, Oral and Maxillofacial Surgery, Extractions, General and IV Sedations. Patient financing available

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Dr. Jay Platt and his staff work closely with you and your dentist to ensure your treatment exceeds your expectations. Choosing an oral surgeon is an important decision. Our team is composed of experienced professionals who are dedicated to your care. We are looking forward to fulfilling your dental needs.

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the body shop

PHOTOS COURTESY OF COMMUNITY SPINE & PHYSICAL THERAPY

Bone and Spine Health BUILDING BONE DENSITY AND STRENGTHENING THE SPINE THROUGH EXERCISE

our bones and spine both play an essential role in your body. They work together to provide the framework of your body, aid in movement and protect your major organs, among other tasks. Keeping your bones and spine healthy can help prevent pain and injury, as well as osteoporosis. The National Osteoporosis Foundation reports that nearly 9 million Americans suffer from osteoporosis, a disease characterized by weakened bones. An even higher number of Americans suffer from back pain, which affects 8 out of 10 people at some point in their lives, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. In order to prevent pain and injury and lower the risk of osteoporosis, maintaining proper strength and flexibility in the spine and Community Hospital Medical Office Building bones is essential, explains Helen Mitrakis, 801 MacArthur Blvd, Suite 405 DPT, MPA, Cert. MDT and supervisor of Munster, Ind. Community Spine & Physical Therapy 219.836.5381; comhs.org in Munster. Dr. Mitrakis recommends communityspineandbrain.com strengthening activities to increase bone density while also improving balance and posture. Lakeshore Bone She explains: “Increased bone density helps & Joint Institute prevent and decrease the risk of fractures, and 601 Gateway Blvd good balance and stability decrease your risk of Chesterton, Ind falls and sustaining fractures. 219.921.1444; lbji.com

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“Proper posture is important to prevent compression fractures of the spine, which are common with osteoporosis, and helps decrease the stress on the spine by maintaining proper body mechanics during our daily functional activities.” Examples of weight-bearing activities that strengthen the bones and spine include walking, stair climbing, hiking, dancing, jogging, racquet sports and Tai Chi. Resistance with bands or weights; water resistance with water weights, paddles or gloves; and gravity resistance such as yoga poses and push-ups also help build bone density and keep the spine healthy. Orthopedic Spine Surgeon Anton Thompkins, MD at Lakeshore Bone and Joint Institute in Chesterton says weight-bearing exercises—such as walking, step aerobics or anything that puts stress on the bones—help increase bone density. “According to Wolff’s law, bones heal under stress,” Dr. Thompkins explains. Weight-bearing exercises make your bones work against gravity and become stronger. Without gravity and the benefit of weight-bearing exercises, the bones become weaker, as seen in astronauts who have spent long periods of time in space. “As soon as you take weight off the bone, it will actually start being degraded or osteofied,” Dr. Thompkins adds. Strong core muscles, which include abdominal, back and pelvis muscles, are important to your spine’s health as they help support the spine. While maintaining a strong core is important, Dr. Mitrakis cautions against abdominal crunches or sit-ups for people with osteoporosis due to the increased risk of fracture. She recommends that abdomen strengthening activities should be done in a neutral spine position to help prevent fractures. —Ashley Boyer

SIMPLE EXERCISES YOU CAN DO AT HOME TO STRENGTHEN YOUR BONES AND SPINE Dr. Mitrakis offers the following exercises as examples of exercises that strengthen the spine and bones. This list is not exhaustive and she cautions that you should always consult a physician prior to starting any exercise program or regime. OVERHEAD UPPER EXTREMITY EXTENSION

Anchor a band to the top of a door. Grab the band from a high position and pull your arms down just past your hips. Hold your stomach in tight to support the spine.This strengthens the muscles of the back and the arms.

OVERHEAD PULL DOWN

Anchor a band to the top of a door. Grab the band from a high position and pull your arms down bending your elbows toward the ribs. Hold your stomach in tight.This strengthens the Latissimus Dorsi of the back, which helps support the spine.

FOAM ROLLER SNOW ANGELS Lying down on a foam roller with your knees bent, raise your arms overhead like you are going to make a snow angel. Hold your stomach in tight and try to keep your back flat against the roll.This strengthens the abdomen and helps stretch the spine and arms to maintain flexibility and prevent a kyphosis or forward bend of the spine.

FOAM ROLLER ADVANCED BRIDGE

Lie down on your back with your feet on a foam roller and tighten your stomach muscles as you lift your hips off the floor. Slowly straighten one leg. Do not let your hips drop or sag; try to keep them level. This may be done directly on the floor until you build your strength.This provides strength in the legs, pelvis and core muscles (abdomen and back).

BALL LUMBAR EXTENSION

Rest your abdomen on a ball with your legs stretched out straight and toes on the ground. Place your hands behind your head but make sure not to pull on your neck. You also may modify this and cross your arms over your chest. Slowly raise your shoulders back and away from the floor. This strengthens the muscles of the low back.

BALL PLANK

Place your forearms on a ball and keep your feet on the floor. Try to hold a plank position on the ball. Make sure your hips and spine stay level while you pull your stomach in tight. This may be modified by placing the forearms on the floor for increased stability until you build your strength. This provides weight bearing for the arms while strengthening the core muscles (abdomen and back).

BALL UPPER AND LOWER EXTREMITY EXTENSION

Rest your abdomen on a ball with both hands and feet on the ground. While you hold your stomach in tight and keep your spine aligned, slowly raise the opposite arm and leg. This can be modified by doing only the arms and only the legs until you build your strength and stability. This strengthens the muscles of the core (abdomen and back), upper back, arms and legs.

november/december 2013 | GET HEALTHY | 13

on your mind

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living with

CANCER From survivors to caretakers, relatives and friends, cancer affects everyone’s lives. With the help of new treatments and medical advances, some cancers are becoming easier to manage, while others can be detected earlier with new screening techniques. Learn how the future of cancer treatments is changing.

Patient A with cancer goes to a chemotherapy appointment, where a nurse gets an IV running with drugs that will kill cancer cells but also make the patient feel sick for awhile. • Patient B with cancer goes to the kitchen at home, takes a pill with some water, and goes about the business of the day. • What makes their treatment routines so different from each other?

atient A has an acute and likely curable kind of cancer. Patient B has a cancer determined to be incurable yet manageable with medication for an extended period of time—a chronic cancer. “Some cancers can kill quickly, and others grow so slowly that an elderly patient may very well die of old age and not from the cancer,” says Dr. Bharat Barai, medical director of Methodist Hospital Oncology Institute in Merrillville. “We always try to cure; in cases where we can’t cure, the next best thing is to try to convert it into a chronic disease.” Barai likens treating a chronic cancer to treating diabetes or high blood pressure: The condition exists but is controlled as much as possible with medication. Quality of life is an important factor in choosing treatment, says Dr. Erwin Robin, on staff at Community Hospital in Munster and St. Mary Medical Center in Hobart. “If the disease is curable, like testicular cancer, we use aggressive treatments. We probably won’t take short-term quality of life into consideration because we don’t want to compromise the curability of the disease. Dr. Bharat Barai “But there are many types of malignancies that we know from day one they won’t be cured; we hope for remission. If you know the patient will be around, for example eight years with a chronic malignancy, we want that to be a good quality of life time.” Traditional treatments include chemotherapy, radiation, bone marrow transplants and surgery, says Barai. But for a chronic cancer, treatment can be as simple as taking a pill every day, or radiation followed by medication. Both Robin and Barai emphasize there are many cancers today that can be cured, including certain kinds of leukemias, breast cancer, colon cancer and lung cancer. “Cancers that without treatment can kill in Dr. Erwin Robin

Lung Cancer Screenings

Save Lives

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Lung cancer survivor Jim Miller travels from Bridgeman, Michigan to see Oncologist Erwin Robin, MD at Community Hospital in Munster.

months, we have turned into chronic cancers,” says Barai. “Turning a cancer into a chronic cancer is not possible in every case, but more and more people are alive through treating as a chronic disease.” For patients with a chronic, non-curable disease, says Robin, “We try to keep them in remission for as long as possible, and while they’re in remission there is always the hope that a new thing will be discovered to turn it into a curable disease. I always like to tell patients that hopefully they’ll discover a cure. “In a research project at Community Hospitals I witnessed a breakthrough … using Receptin along with chemotherapy for Stage I and Stage II breast cancers. With Receptin there was an increase in cures by 20 percent.” In a patient with leukemia, pills were prescribed and “within a month or two I sent him to a research facility. He was there a month and came back to me with a normal blood count. Several months later he was in complete remission” and survived for several years after that.

Barai agrees there have been significant advances, with “much better survival for colon cancer and lung cancer, and now 85 percent of women diagnosed with breast cancer in 2013 should be living 5 years from now and beyond.” That’s a beacon of hope for patients with chronic cancers as well. And the patient’s outlook can affect the how well treatments work in the meantime. “A patient who is going to fight for life and keep a cheerful outlook; in most cases the quality of life will be 95 percent of normal,” says Barai. “But if the patient thinks about that other 5 percent, it can affect how they (take care of themselves).” “The attitude of the patient most definitely has an effect,” says Robin, who adds that patients with a positive outlook are more likely to be doing things that help overall health, such as making sure they have proper dietary intake. Definitely, a patient with a positive attitude is more likely to respond to treatment better. —Julie Dean Kessler

Low-Dose CT

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Adults with a past of heavy smoking may benefit from a lowdose CT scan screening of the lungs for early detection of lung cancer. This screening is available to individuals who meet the established high-risk criteria.

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november/december 2013 | GET HEALTHY | 17

LOCAL DOCTORS BATTLE

lung cancer

As doctors, Gaurav Kumar and Masood Ghouse are on the front lines of the war against lung cancer. • Although many patients win their battles with cancer each day, many more lose them. Last year, alone, more than 160,000 died from lung cancer—making it the leading cancer killer in both men and women in the United States.

t’s an uphill battle, says Dr. Ghouse, a Porter Regional Hospital oncologist who says it can be frustrating to see funding dollars and publicity focused on other cancers, even though lung cancer causes more deaths than the next three most common cancers combined (colon, breast and prostate). “A lot of people blame the victim,” he says, noting smoking is thought to cause up to 80 to 90 percent of lung cancer cases. “There should be a stronger push for more funding and awareness so we can have more research. We need to make advancements and have better control over this in the future.” A new clinical strategy for lung cancer, however, has shown promise—identifying the presence of cancer in someone who has not demonstrated any symptoms. About two years ago, the National Cancer Institute released results from a clinical trial in which at-risk smokers were screened with either a low dose computed tomography (CT) or standard chest x-ray. The study found that screening individuals with low dose CT scans could reduce lung cancer mortality by 20 percent compared to a

chest x-ray. Over the past year, organizations like the American Lung Association and American Cancer Society, have recommended low-dose CT screening for those who are at the highest risk—those who are current or former smokers aged 55 to 74 and who have a smoking history of at least 30 pack years, meaning a person smoked one pack a day for 30 years, two packs a day for 15 years and so on. These findings were significant, Dr. Kumar says, because by the time a patient displays symptoms of lung cancer, the disease has likely progressed or spread. “A lot more people used to die before the cancer would even be diagnosed,” says Dr. Kumar, who is on staff at St. Mary Medical Center. “We’re catching more cases now. I think our ability to catch and identify cancer is improving, and in time, in the next five to 10 years, we may see a decline in lung cancer incidents.” Several hospitals and specialist offices offer these low-dose CT scans—often for less than $100. It’s a small price to pay to potentially save one’s life, and may be covered by insurance companies, Dr. Ghouse says. He recommends starting first with a family physician, who can then refer the patient to a hospital that offers the service. “More insurance companies are agreeing to pay for it because it catches cancer early,” he says. Other technology advances in the region are helping physicians catch lung cancer early, something doctors say will help patients live longer and have

a better quality of life during treatment. Now, specialists are able to minimize radiation exposure to other parts of the body and provide local radiation only to the tumor site. Researchers also are developing ways to provide more individualized treatment for lung cancer. “We can run the genetics on the cells and look for specific mutations,” Dr. Kumar says. “Then based on those mutations, we can provide individualized care of therapy—providing specific drugs that will work better with those mutations.” Currently, survival rates for lung cancer vary depending on the type of cancer and how early it is diagnosed, but overall, the 5-year survival rate is just 15 percent. Dr. Ghouse says he hopes these new innovations, along with several other drug therapies

“

I think our ability to catch and identify cancer is improving, and in time, in the next five to 10 years, we may see a decline in lung cancer incidents. DR. GAURAV KUMAR, ST. MARY MEDICAL CENTER

ONLY “WOMEN’S BOUTIQUE” OWNED BY A REGISTERED NURSE

The Women’s Boutique of ABC Medical carries the following types of mastectomy and shape-reconstructive products: (inside ABC Medical Services)

Post operative drainage management garments up to size 3x Breast forms in foam, microbead, full silicone, lightweight silicone, composite, variable-fill, cooling available in various sizes, shapes and shades in stock Custom breast prosthesis and/or custom nipple/areola prosthesis available Silicone prosthetic nipple/areola; temporary tattoos available Scar reduction sheets in various sizes Extensive inventory of post-mastectomy bras in assorted styles, brands and colors, often new styles brought in quarterly up to size 50D in stock

Lymphedema sleeves, vests available in stock items or custom Compression vests for post- breast reconstruction, lymphedema or chest surgery Attractive compression short sleeve t-shirts, compression bras/shapewear by SassyBax Post-mastectomy swimsuits, swim prostheses and coverups Wigs, scarves, glitter caps, turbans, head coverings in assorted colors & styles Skin care products for post-radiation: nonmetallic deodorant, super moisturizing lotion, shampoo Moisture control sleepwear

We also carry a full line of Medical Supplies & Dressings - Wheelchairs, Commodes, Beds, Lifts, Arthritis Braces, Diabetic Shoes (Fitted by Pedorthist), Custom Shoes & Inserts, Gait Analysis, Back Pain Products, & Many More.

currently being developed, will extend the survival rate for those diagnosed with lung cancer, Dr. Ghouse says. “I think in the next four to five years, the way we approach lung cancer will be more advanced,” he says. —Christine Bryant

november/december 2013 | GET HEALTHY | 19

SKIN

Melanoma can be lethal if it goes undetected Samantha Amezcua of Munster says self-examining her skin for signs of melanoma has been incorporated into her daily routine for the last four years.

Samantha Amezcua

TONY V. MARTIN

I am looking at my moles on a daily/ weekly basis. I look for brand new moles, moles with dark black coloring, changes in existing moles with color and shape along with new lesions that appear red, squishy or dry,” says Amezcua. “I see my dermatologist every three months since my melanoma.” Both basal cell carcinoma and melanoma are hereditary in Amezcua’s family and in 2009, at age 30, Amezcua was diagnosed with melanoma. To date she has had 75 moles removed—55 of which were removed in the past 3 years. According to the Melanoma Research Foundation, melanoma is one of the fastest growing cancers in the United States and worldwide. Despite melanoma being a form of skin cancer, it can also develop on

other areas of your body such as scalp, mouth, nails or eyes. “While skin cancer historically occurs on the head and neck area 85 percent of the time, the important thing to be aware of is that they can occur anywhere on the body. Over the years, I have had patients referred from their gynecologists as well as podiatrists,” says Dr. Michael Malczewski of Cosmetic & Plastic Surgery of Northwest Indiana. “In my practice we see new cases of basal cell carcinoma of the skin daily, new cases of squamous cell carcinoma of the skin weekly, and new cases of melanoma, or its precursors, just about weekly as well. It has exhibited a more dramatic increase in incidence than any other cancer, and why it doesn’t get more press is beyond me.” Dr. Malczewski, who has been caring for melanoma patients since 1987, says he has treated melanoma in a patient as young as 8. “The prognosis for melanoma overall is actually quite good, but that hinges on early diagnosis,” says Dr. Malczewski. Dr. Mitchell Bressack, a dermatologist at Dermatology Center of Northwest Indiana and Malczewski agree that early diagnosis is contingent on thorough

self-examinations. “Self-exam is the most important thing, and, if someone sees a mole that they think is changing or is suspicious to them, they should see a dermatologist, regardless of age,” says Dr. Bressack. Joan Filipowski, a nurse at Franciscan Alliance, says when doing self-exams to remember that not all moles on your body go through a series of changes, only some of them. “The ones that do go through changes can become a basal cell carcinoma or a squamous cell carcinoma and others can become melanomas. Melanoma can also suddenly appear as a new dark spot on the skin,” says Filipowski. Dr. Malczewski says the key to early detection is patients being vigilant and doing monthly self-exams of their skin— nose to toes. “If you can look at a mole, freckle, red spot, lump, bump, etc. and say “this looks very different from a couple of months ago, that is relevant and warrants a trip to your doctor,” says Dr. Malczewski. Dr. Bressack says in addition to self-exams he stresses to his patients that protection from the sun is the best thing they can do to protect themselves from skin cancer. “In general, if an area is not covered by adequate clothing, it should have sunscreen applied to it,” says Dr. Bressack. Dr. Bressack says to determine if what you are wearing can protect you from the sun, hold the clothing up to the light. If you see light coming through it, it is not protecting you from the sun, and sunscreen should be applied beneath that piece of clothing. “By not wearing sunscreen the chances of having basal cell skin cancer is high and many people are not aware of that,” says Amezcua. “Speaking about melanoma and sharing my story is something I do with every opportunity possible. My hope is to encourage people to see a dermatologist, educate them on the dangers of not using daily sunscreen and help them see that skin cancer can happen to someone as young as I.” For support or information on melanoma visit melanoma.org. —Trish Maley

leukemia Although treatment for leukemia can be complicated and the cure success rate can vary based on a patient’s age and overall health, oncologists are hopeful that recent strides in treatment may have an impact on a countless number of patients. There are several types of leukemia, which is defined as an abnormal proliferation of white blood cells, says Dr. Bennett Caces, a hematologist oncologist on staff at Ingalls Memorial Hospital. The most common types of leukemia in adults are acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) and are treated in similar ways. “AML is still thought to be a disease of the older population, and incidents go up as we get older,” Dr. Caces says. “The median age of diagnosis is 66 years old.” Doctors say one of the major advances in leukemia research is understanding the composition of the disease, which makes it easier to determine a course of treatment. Looking at genetic markers helps classify the treatment into three categories that gauge treatment successes. “Before, we would lump all AML patients into a category with three or four subcategories,” Dr. Caces says. “Now we can categorize them as AML, but give them a good prognosis, intermediate and poor prognosis. This is important, because it helps physicians proceed with treatment.” For leukemia patients, the first step in treatment is induction chemotherapy, which is designed to help bring patients into remission. Dr. Caces says there is still room for improvement in the leukemia survival rates, but recent developments have given researchers, patients and oncologists hope that there might be new treatment options on the horizon. Chemotherapy has worked for decades because it kills cancer by attacking any cells in the body that divide quickly, Dr. Caces says. That’s why a chemotherapy patient loses their hair or gets diarrhea, because the hair and the lining of the gut have cells

that divide rapidly. But a new form of therapy—called targeted therapies—rely on chemical agents to target something specific on the cancer cell, which will help leave the normal, non-cancerous cells intact. Dr. Alan Tan, an oncologist with Premier Hematology Oncology Associates who is also a staff physician at St. Margaret Health, says chronic leukemia (CLL) patients are benefiting from a targeted therapy drug called ibrutinib. “It’s the closest thing to a miracle drug that we’ve seen in the last decade or so,” Dr. Tan says. “It’s not just a generic killer, it targets the pathway of the cancer.” Right now, treating leukemia with targeted therapies is being used in trial studies and in larger cancer centers, both oncologists say. “Right now, they’re being used together with chemotherapy,” Dr. Caces says. “Chemo is still a good part of treatment, overall. But some patients with AML, especially the elderly, could not ever tolerate a strong regimen of chemo, but they can get the targeted therapy on its own.” Dr. Caces says it is important for people to be willing to participate in clinical trials, not only because it could help with their own treatment, but it could also help improve treatment options for future generations. “Ultimately, the more we study these things, the more chances we have for improving the outcomes,” he says. “For these clinical trials to move forward, we need people willing to participate in the studies.” Dr. Tan agreed, and says that trials randomize patients to determine who gets standard care and who gets additional experimental drugs. “There more people we enroll into clinical trials, the more it benefits everyone else,” he says. “Especially with leukemia that is difficult to treat, and there is nothing else to offer as far as a good, curative therapy.” — Carrie Rodovich

november/december 2013 | GET HEALTHY | 21

new colon cancer detection methods

SCREENINGS

Bottom line, now more than ever, there is no excuse not to get screened for colon cancer, doctors say. • Colon cancer is the second leading cause of cancer-related deaths in the United States—expected to cause more than 50,000 deaths this year.

et colon cancer typically takes about 10 years for it to go from precancer to cancer stage— ample time for a screening to catch the cancer. “If everybody in the country over the age of 50 got screened for colon cancer, we would cut the death rate by 60 percent,” says Dr. Blase Polite, an assistant professor of medicine at the Center for Gastrointestinal Oncology at the University of Chicago. Put another way, if everybody over 50 got screened, more than 30,000 lives would be saved each year, he says. “This is a very preventable cancer and screening works,” he says. “No debate about it.” Yet many avoid a colon cancer screening, something doctors say is essential to surviving this type of cancer because it’s much more difficult to treat by the time symptoms appear. Often, doctors hear it’s because patients think of a colonoscopy as a less than pleasant experience. Dr. Polite, however, says as technology advances, more screening tests available continue to increase. “Everything from specialized stool sample analysis where we look for DNA changes that may signal a cancer to what are called virtual

22 | GET HEALTHY | nwi.com/gethealthy

colonoscopies where a CT scanner with special software is used instead of a scope to make a 3D reconstruction of the colon to look for polyps or cancer,” he says. Colonoscopies are getting more sophisticated as well, where doctors are testing using special sprays and lights to try and find precancers and cancers with higher accuracy than ever before. All of these technologies are available in the Northwest Indiana and Chicago areas at various medical practices and hospitals, he says. “We keep improving these technologies so that hopefully one day we can do away with the preparation to clean out the colon that many patients don’t like,” Dr. Polite says. In what Dr. Polite calls an era of genomic medicine, for the first time ever, doctors and researchers have sequenced the entire genome of colon cancers. “We now know many of the gene mutations that are driving this cancer,” he says. “This has already allowed us to develop many so called targeted drugs to go after these mutations and at places like the University of Chicago, we continue to test the next generation of these drugs so hopefully we will be able to cure more people with colon cancer even after it has spread to other parts of the body.” Dr. Rajeev Tummuru, a gastroenterologist at Porter Regional Hospital, says surgical treatments for colon cancer have advanced as well. Surgeons at Porter Regional are current with the latest surgical techniques, including laparoscopic colon surgery—a surgery that involves the use of several small incisions through which a specialized camera and instruments are inserted.

“This can result in a faster recovery time without a large incision,” Dr. Tummuru says. Also available in this region now is an endoscopic ultrasound—a technique that can help surgeons and oncologists with planning treatment. “Until now, this has not been available in the region, and patients needing this procedure have had to go to Chicago or Indianapolis,” he says. Dr. Mohamad Kassar, an oncologist at Munster Community Hospital, says one of the most exciting advancements he’s seen is in colon cancer therapy. “We used to use chemotherapy drugs, where we had one or two chemo drugs available,” he says. “But now we have multiple agents of chemo drugs and biological targeted therapy.” Doctors can now devise treatment plans based on a biological profile of the cancer. “We can actually obtain colon cancer profiles, and depending on the tumor characteristics, we can design an achievement plan,” he says. Doctors define a target in a higher concentration of the cancer cells, and then provide therapy that specifically targets that area. “This way, patients do not have the classic side effects of chemotherapy, and enjoy a better quality of life during treatment,” Dr. Kassar says. Even in the most advanced types of colon cancer, where the cancer has spread to other parts of the body, doctors are seeing longer expectancy rates in patients. “The average survival has improved dramatically in the last 10 years,” Dr. Kassar says. “It used to be 6 to 8 months. Now it’s 2 to 3 years.” —Christine Bryant

SPECIAL FEATURE

UP STRAIGHT

THE BEST IN SCOLIOSIS TREATMENTS

Scoliosis, which is a sideways curvature of the spine, can be a mysterious condition with a mind of its own. In its mildest form, it can correct itself over time, but in severe cases, it can require spinal surgery. While typically thought of as occurring in adolescents, this condition can also affect adults. Mohammad Shukairy, neurosurgeon on staff at Community Hospital and St. Mary’s Hospital, treats both adults and adolescents with scoliosis. His adolescent patients typically have already been diagnosed and are seeking evaluation for treatment. In the adult population, the cases often present with more of a general complaint such as back pain or discomfort and he is the one who diagnoses the condition. “Many times children and young adolescents present with scoliosis that is idiopathic, which means that it is something that we don’t have a cause for, we don’t understand why people get the curvature of the spine,” Dr. Shukairy says. “Adults often present with degenerative scoliosis. This occurs because of the aging process of the spine.” Dr. Shukairy, who is part of the Community Spine and Neurosurgery Institute in Munster, says adolescents with mild scoliosis can be treated conservatively, but if the curve is greater than 45 or 50 degrees surgery is often recommended. Dr. Shukairy says scoliosis is not uncommon in the young population. For adults, the risk tends to increase with advanced age. Still, he says, in the adult population, scoliosis does not have to be a debilitating problem. There are several lifestyle factors that can modified to prevent worsening of spinal problems. The main lifestyle modifications are to quit smoking, which advances the degeneration of the spine, and to pursue weight loss. Patients can also focus on exercises that increase the strength and posture of the spine—yoga and pilates and those types of exercises. Although it is ideal to catch adolescent scoliosis early, the disease can be “sneaky”

november/december 2013 | GET HEALTHY | 23

and difficult to diagnose, says Nancy Trimboli, a chiropractor and owner of Trimboli Chiropractic with offices in Munster and Cedar Lake. “The problem is that a lot of times by just looking at posture or looking for a rib hump, you don’t see (the scoliosis.)” The best way to see any curvature is through an X-ray, she says. Free scoliosis screenings via X-ray are offered at both of her offices. Less than 50 percent of those she screens have it, she says, and in the general population, it would be even less. Most parents who bring their children to be checked have a reason such as the child slouching, having a high shoulder or having a family history of scoliosis.

r. Trimboli, who has been practicing in Munster for 20 years, says the chiropractic approach is to correct pelvic unleveling. That can involve adjustments of the pelvis and sacrum, the foundation bone of the spine. Other times, her young patients have a short leg, which can be as short as 3/4 of an inch, she says. “They’ve been diagnosed with a spinal curvature and meanwhile, it’s the spine compensating for a short leg.” Because legs grow at different rates, they will Dr. Nancy sometimes take a “wait and Trimboli see” approach to see if the legs and spine even out. Older teens may need a lift in the shoe and monitoring of their leg length as they continue to grow. Once the scoliosis curve is at a certain point, doctors may recommend a brace, but Dr. Trimboli says the brace has its own set of physical and emotional challenges. “The jury is still out on whether the braces do any good at all,” she says. When the child wears the brace 23 hours a day, the supportive muscles of the spine get weaker and weaker. With chiropractic, there is a different approach, she says. “Just like anything else, try every available option that is noninvasive that works with your body’s own healing ability,” Dr. Trimboli says. “There’s always room for surgery later but you can’t undo that once it’s done. There are no guarantees on anything so try the most logical, easiest less invasive thing first.”

24 | GET HEALTHY | nwi.com/gethealthy

PHOTOS PROVIDED

Shown are X-rays from a 14-year-old male patient who had a 14-degree curve in his lumbar spine [left].Two months later, following chiropractic care, the curve was gone [right].

Dana Andric, whose children are Trimboli’s patients, learned about scoliosis the hard way this summer. While hugging her 13-year-old son, she felt an abnormality in his back. After having it checked, they learned he has a 48-degree curve, considered severe in the scoliosis field. He will most likely have to have surgery to correct it. Following his diagnosis, she tested her two other children and found that her 7-year-old daughter has a 28-degree curve and her 11-yearold son has an 18-degree curve “It really hit us shockingly. I diagnosed all my kids,” Andric says. Her son, even with his severe curve, never complained of back pain. She says they attributed his aches to normal growing pains. “I would really just tell people to explain to their kids to watch for anything that looks visually strange.” As children get older, they take care of their own bodies more. “We can’t see what lies underneath all that clothing. In puberty, a lot can go on.” “When I saw his X-ray, like a backwards S, I almost passed out. It was shocking to see when you never even knew that a problem existed.” Nitin Khanna is an orthopedic spine surgeon and founder of Spine Care Specialists in Munster, a division of Orthopedic Specialists of Northwest Indiana. He says scoliosis treatment has undergone what he would term “revolutionary” changes over the last 10 to 15 years. While early treatments were painful and debilitating, new advances have

made it possible for patients to recover quickly. Early treatments primarily focused on bracing and traction. The early surgical procedures involved a large incision with significant amount of blood loss. They would also put patients in body casts for multiple months. “It was arguably one of the most painful and debilitating operations that existed at its times with very mediocre results,” Dr. Khanna says. It was still done that way as recently as 15 years ago. Internal fixation allowed surgeons to use spinal metallic implants to help create structural support for the spine and help correct the curvature. Other advances include treating the spine from both the front and back with spinal instrumentation. “There were significant advances as both result in the ability to correct the curvature and maintain that new curvature for many patients for many years. But it was still the most painful and debilitating operation that existed.” It took up to one year to fully recover. With the advent of the minimally invasive surgical technique over the last five years, many of these Dr. Nitin Khanna issues are resolved. These procedures only disrupt the tissue in and around the problem, diseased or pathologic segment, Dr. Khanna says. This minimizes scar tissues, minimizes operative time, decreases blood loss, decreases the length of stay for patients and allows patients to resume their every day activities in the order of weeks as opposed to months. While the majority of scoliosis patients do not require surgery, Dr. Khanna advises seeking a decision from an expert whose entire career is dedicated to spinal treatment. “As time goes forward and we understand some more of the genetic links associated with scoliosis we may be able to intervene at an earlier stage to treat curves that predictably will be more severe in nature,” Dr. Khanna says. Dr. Khanna, who trained at Rush University Medical Center, says that today’s advances in scoliosis care are remarkable compared to what he saw in his training. “I’m very proud to have been part of the design team in developing some of these minimally invasive techniques,” he says. — Jennifer Pallay

Are you living with chronic back or leg pain? Patient Name

Miriam D.

Surgery Date

December 2012

Indications for Surgery Surgery Performed

“

Back and leg pain; spondylolisthesis with stenosis Minimally disruptive posterior lumbar interbody fusion (MAS® PLIF) at L4-L5

I had low back pain for so long I have lost track, but estimate about six years—worsening every

The NuVasive® MAS PLIF procedure is a minimally disruptive approach to traditional back surgery. MAS PLIF can result in a faster recovery and a reduced hospital stay compared to traditional spine procedures. To learn more about MAS PLIF, visit www.nuvasive.com.

year. Arthritis runs in my family and this just became part of my life. Little by little this pain robbed me of my active lifestyle, from downhill skiing, hiking, walking four miles three times a

Dr. Khanna and Dr. Tyndall of Spine Care Specialists perform the MAS PLIF procedure, in addition to other minimally disruptive techniques.

week, and gardening in my 1.5-acre yard. About three years ago, my pain reached a point that after standing and walking for three to four hours at work, I had severe pain radiating down my left leg. It persisted all day and so I went for my first MRI. The subject of surgery came up but I chose physical therapy and had three epidural steroid injections. I received partial relief with this and also by taking large doses of ibuprofen daily. Two years ago, my downward spiral started with a three-week trip to Italy, walking long distances on uneven stone walkways, sometimes with luggage. When I returned home,

Nitin Khanna, M.D., FAAOS Orthopaedic Spine Surgeon

I had pain that persisted all day and well into the night. My family doctor sent me for another MRI and back to the pain clinic for two more epidural injections. I had minimal relief, so I went to see Dr. Nitin Khanna. As you can imagine, I still did not want

Spine Care Specialists of Munster, IN offers the full spectrum of Spine Care solutions for patients suffering from painful conditions of the spine. They provide comprehensive diagnostic services, conservative treatment approaches, and the latest surgical options in the event that surgery is required. All surgeons are Board-certified and Fellowship-trained, and dedicated solely to the care of the spine.

back surgery. But I was so impressed with Dr. Khanna’s expertise, his compassion, and thoroughness

To schedule a consultation, please call 219.924.3300 or visit www.spinecarespecialists.com.

in going over every detail of my MRI. This was the first time I felt at ease about contemplating a lumbar fusion surgery. Denise, his nurse, did not miss a single detail in preparing me with pre-op and post-op information. I am now pain-free, walking miles again, and just returned from six days of hiking on some rugged trails in the Smoky Mountains.

Dwight Tyndall, M.D., FAAOS Orthopaedic Spine Surgeon

Thank you, Dr. Khanna and Denise, for your dedication and compassion. It has made a huge difference in my life!

”

As with any major surgical procedure, there are potential benefits and possible risks involved in orthopaedic surgery. Please consult your physician for a full list of potential complications and to determine if you are a candidate for the MAS PLIF procedure. © 2013. NuVasive, Inc. All rights reserved.

, NuVasive, Speed of Innovation, and MAS are registered trademarks of NuVasive, Inc.

13-NUVA-1207

november/december 2013 | GET HEALTHY | 25

MS AFFECTS

ENTIRE

FAMILY Fred and Donna Halpern

For the Halpern family, multiple sclerosis is a disease that has affected the entire family, not just its matriarch, Donna. • Donna Halpern was diagnosed with MS while she was in her late 20s, when it began as problems with her vision and her knees, says her husband, Fred Halpern. Fred Halpern, who owns Albert’s Jewelers, says after his wife was first diagnosed, she was able to lead a fairly normal life, and could golf, do housework and keep up with the family. But over the next 35 years, Donna Halpern, now 66, has undergone numerous treatments to stave off its progression through her nervous system. After a fall, it affected her back to the point she now needs to get around in a wheelchair. “It’s affected her bladder, her knees, her vision, her hearing. Over time, it has taken a lot of her motor skills away,” Fred Halpern says. “It’s a terrible disease.” Dr. Mridula Prasad, medical director for the Methodist Hospital MS Center, says multiple sclerosis is a chronic, often disabling disease that attacks the central nervous system, which includes the brain, spinal cord and optic nerves. It presents with symptoms of fatigue, numbness, temporary loss of vision in one eye, difficulty walking or balance issues, stiffness or muscle spasms, and bowel and bladder problems. Treatment has evolved over the years, and while there is no cure, Dr. Prasad says the symptoms can be managed and there are new medications and treatments available. “Before, symptoms were managed, but now we have disease modifying medications,” she says. “Dependent of the person and symptoms, more and more new medications are now available to manage and slow the progression of MS. With the push for research, many more new treatments are expected.” And while there is nothing anyone can do to prevent MS, it is important to catch the disease

early to help prevent disabilities. “The treatments are to maintain quality of life and control symptoms,” she says. Fred Halpern says he has made sure his wife has all the resources possible to fight the disease. “She gets drugs, infusions, whatever it takes to hopefully slow down the disease,” he says. “My girl has been through a lot of misery with this disease.” She also does aqua therapy in a pool, either here or in their Florida home during the winter. Through it all, however, she has faced the disease with a positive attitude and a strength and fortitude of character, he says. “She thinks there are people who have things worse than she has,” he says. “She has a good outlook, always looks on the sunny side of the street. She wants to live for her children and grandchildren.” But, he says, he knows many families aren’t as lucky as he is, and don’t have the best resources at their fingertips. Which is why the family, and his business, have been heavily involved in raising money for the National MS Society. Each year he holds an auction at his store, Albert’s Jewelers, to raise money for MS research. He also participates in numerous other fundraisers, and donates personally, as well. Last year, he donated between $150,000 and $200,000 between all his fund-raising efforts. “The help and support we get is unbelievable,” he says. “We have amazing teamwork, and companionship, everyone wants to do good and raise money for research.” This November, Fred Halpern and his son, Josh, are going to Colorado for a National MS Society Volunteer Hall of Fame banquet, where they have been nominated for an award for their fundraising and awareness efforts. “I would love to see a cure. I don’t know that it would ever help my wife, but it will help someone, some day,” he says. “We’re trying.” —Carrie Rodovich

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Fairmeadows continues to provide medical care in the comFort oF home

vital part of the Northwest Indiana medical community since 1975, the Fairmeadows Organization continues in its mission to deliver the highest quality home infusion and medical equipment services and products in order to enhance the quality of life and the independence of those who have come to rely upon them. “We are an even stronger and more patient oriented company,” says Pharmacist Dan Zurawski, RPH, the company’s president and founder. “Our pharmacists, Dan Zurawski, R.Ph. and Glenn Jabaay, PharmD, combined have more than 65 years experience in intraveneous infusion.” To accomplish their mission, Fairmeadows Home Infusion compounds sterile products for patients released from the hospital who are being cared for at home.

Northwest Indiana and the south suburbs of Chicago but also teaching hospitals in Chicago and Indianapolis,” he says. “Nurses rely upon us and know that we can take care of their patients.” Because of that Zurawski says they sometimes get calls from medical practitioners about patients who need their help but live outside of the service range. “For example, not too long ago we got a call from a hospital in Indy and we ended up serving a pediatric patient in Winamac, about 68 miles from here because they couldn’t find any other provider willing to serve the patient,” says Zurawski, a graduate of Purdue University’s pharmacy school. “In cases like that, we’re always willing to go out of our way to serve people.”

Home infusion is a growing need “Many times the patient only spends a day or so in the hospital or doesn’t even stay in the hospital, but is sent home for six weeks or so of antibiotic therapy,” says Zurawski. “Home infusion is cost effective. Instead of costing $3000 or more per day to stay in the hospital, it costs just a couple hundred dollars a day to stay at home which is covered by most insurances. Plus the patient has the comfort of being in their own home.” Noting that Fairmeadows complies with all federal and state standards for preparation of sterile products and are also accredited by the Accreditation Commission for Health Care (ACHC), Zurawski adds, “It’s very fulfilling to help people and to know you’re making a difference.”

“Home infusion is cost effective. Instead of costing $3000 or more per day to stay in the hospital, it costs just a couple hundred dollars a day to stay at home which is covered by most insurances. Plus the patient has the comfort of being in their own home.” Pharmacist Dan Zurawski, RPH Fairmeadows President and Founder “We have a whole array of different antibiotics available,” says Zurawski noting that some medicines are administered via an infusion pump and others by gravity. “Among the services our home infusion company provides

are antibiotics for many conditions such as osteomyelitis, a rare but serious bone infection and other therapies like total Parenteral Nutrition, which is feeding a person intravenously who can’t get nutrients through the usual process of eating and digestion.” Fairmeadows’s service area is about 35

to 40 miles from their Munster location which includes much of Northwest Indiana and the southern suburbs of Chicago as well as towns like Orland Park, Bourbonnais and Kankakee. “Over the years we’ve developed relationships with many of the hospitals and their case managers not only in

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