INSIDE The joys of swimming page 3
Patient centered medical home page 7
Are you ready to “age well?” By DaviD anDerson
I
was asked to write something about "Aging Well" and at first I was flattered, then realized I was asked because I am aging (aging well, I hope). First some data about aging. Many misunderstand "life expectancy." They look at statistics and see male life expectancy at 76, females at 81. That means for someone 74, like me, they think they will only live two more years so why try to do anything healthier or different? But that 76 number is from birth. True data shows once someone has reached 70, males will live on average another 14 years, females 16 years. So you'd better pay attention to what I have to suggest about aging well! Here are some more facts: In 1960, 720 people of 100,000 living died of heart attacks, strokes and artery problems. In 2011, only 265 of 100,000 living died of those causes, and it is an older population. The reason is primarily the better management of blood pressure, diabetes, cholesterol, diet, and less smoking. You can thank your Primary Care Physician for this, as that is what he/she works on all day long. The incidence of death from pneumonias, influenza and accidents also fell. Cancers had a small but significant drop, while emphysema deaths increased.
See Aging, page 10
Medical cannabis page 9
Water is the healthy choice for strong teeth By hazel whiteoak
W
e are not a third world country yet an epidemic of third world proportions is ravaging our nation. Dental disease endangers the overall health of millions of Americans. It’s associated with diabetes, respiratory, and heart disease and costs our health system billions of dollars. At particular risk are lowincome children, pregnant women,
seniors and people with disabilities. Children with dental decay are in danger of serious illness and often miss many school days due to pain. They fall behind academically, have low self-esteem and face worsened job prospects as adults compared with their more prosperous peers. Sadly, in some states, children have died. Every year, more than 2,000 lowincome children come to PDI Surgery
See Water, page 10 © Sonoma West Publishers | July 28, 2016
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Swimming can be a great way to stay fit S wimming is a low impact fitness routine that can be fun and can be effective for almost anyone, at any age. Dan Greaves, the Parkpoint Health Club Masters Swim Coach and Neptunes Swim Team Head Coach, answers common questions about getting started swimming and improving as you go. swimming for exercise is a popular option in warm weather. what should swimmers keep in mind? People should definitely wear sun screen and reapply often. Also make sure to drink lots of fluids since you can't tell how much you're sweating while exercising. are there a few simple things that people can do on their own if they are interested in improving their swimming technique? There a variety of things that people can do to improve their stroke. There are several videos available online that can help, they can take a few private lessons with a certified swim coach and join a masters swim group to help improve endurance and technique. what age is the best age for kids to start taking swim lessons? why? Kids should start becoming comfortable in the water as early as six months old and should learn to swim on their own as early as three years old. Water safety is a life saving skill and the importance of it cannot be stressed enough.
– Submitted by Parkpoint Health Club
Starting off right — Parkpoint Health Club Aquatics Director Lauren Ahlgren helping a child learn to swim.
Understanding diabetes is key to managing your blood sugar
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iabetes is the sixth-highest cause of death in the United States. High blood sugar untreated over long periods of time can cause many serious health problems including heart disease, stroke, kidney failure, blindness and gangrene. Glucose (sugar) is the fuel for our bodies and insulin allows this fuel to move from the bloodstream into the cells. Diabetes is a chronic health condition where the body is not able to produce enough insulin. Without adequate insulin, the cells are starved of the glucose needed to function and the sugar levels become increased causing
hyperglycemia. Your blood sugar level is a balance between the type of food you eat, how much food you eat, the amount of exercise you get and the amount of insulin in your body. Eating too much of the wrong kinds of food or not taking diabetes medicine on time can cause high blood sugar. Infections can cause high blood sugar even if you are taking your medicines correctly. Missing meals, not eating enough food, or taking too much diabetes medicine can lead to low blood sugar (hypoglycemia). Prediabetes is a medical condition where blood
LIVING WELL is published by SONOMA WEST PUBLISHERS, INC. as a supplement to the July 28, 2016 issues of The Healdsburg Tribune, The Windsor Times, Sonoma West Times & News and the Cloverdale Reveille. PUBLISHER Rollie Atkinson
BUSINESS MANAGER Anna Harsh
CIRCULATION Stephanie Caturegli
SALES MANAGER Paula Wise
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sugar levels are higher than normal, but not high enough to be called diabetes. Early treatment can return blood sugar levels to normal range. Small steps can make a big difference, such as walking briskly for at least 30 minutes a day, five days a week; Parking further from the store or taking the stairs; Eating less high calorie foods and eating more salads and vegetables; and switching from soda and juice to no-calorie water. Losing 7 percent of your body weight can lower your risk for Type 2 Diabetes by 58 percent. – Submitted by Healdsburg District Hospital
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Summer 2016
Finding your joy and your ‘happies’ in your retirement By ginny carroll
W
hatever else you do with your retirement, be sure you make plenty of time to do what makes you happy. Not so much to give you a sense of accomplishment, not so much to feed your ego – but simply to do things that give you joy. Make a list of all the things that make you happy. Post it somewhere you’ll see it every day, like your bathroom mirror. Add to it whenever something else occurs to you. Look at your list every day and as often as you can – every day, if possible – do at least one of those things. To get you started, we asked some of our elders what makes them happy. “Going to Trader Joe’s makes me happy,” said one. “Having a massage,” said another. “Talking to people,” said a third. “Giving to others,” “Nature,” “Learning something new,“ “Babies and toddlers,” and “Ice cream” were others – simple things, everyday things. You may be surprised when you see what comes up for you. And what doesn’t. If you find that some of your happy things are baffling to find (after all, you can’t just walk into a baby and toddler store and pick out a couple of ‘em, can you?), ask the staff at your senior center; they know how to find all sorts of things. In fact, your senior center may be the answer to finding some of your happies. Senior centers today are very different than they were 20 years ago. We who are seniors now used to think of such centers as kind of like a babysitting
Friends — The photo above was taken at a surprise party for Marty Modrich’s 90th birthday by the Cloverdale Senior Center. One of Marty’s happies is making birthday cards for others. For years she has kept a list of members’ birthdays, and she makes a card for everyone, every year. So members showered her with birthday cards on her own birthday. Pictured with Marty is her living rose and her friend, Mark Gandy.
service for old people. We dreaded the day we’d have to go. In fact, some of us vowed never to go to a senior center. Even now there are some seniors who sneak in to take part in the activities but don’t become members because it makes them feel old. Most senior centers today are hives of activity, offering a wealth of opportunities to find your happies. At the Cloverdale Senior Center, for example, you can learn sign language, Spanish and Tai Chi; you can join a tablet users group, a collage circle or a meditation circle; practice yoga at three different levels; increase your flexibility and balance with strength training, join discussion groups, explore your artistic talent (talent not required), with three kinds of art classes; and many more classes, plus frequent exciting events like cabaret evenings and presentations on subjects vital to you. New classes and activities are being added all the time. Here’s the thing: Retiring is an accomplishment in itself. Congratulations – you made it. It wasn’t easy, was it? But you’ve done your share, paid your dues, earned the right to put yourself first. It’s not selfish, it’s your time, your turn. You’ve found out that you are not going to discover a cure for cancer or the common cold, you’re not going to fly to the moon, become a famous opera star, or any of the other grandiose things you imagined as a kid. And you’ve accepted it. You’ve found out that life is not a destination – it’s a journey. In your case, it’s a journey successfully completed. Reap the benefits. – Ginny Carroll is a volunteer with the Cloverdale Senior Center
Water NOT Soda For healthy teeth and a healthy life
Together, We Make Kids Smile! LEARN MORE AT
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pdisurgerycenter.org ͻ (707) 837-8833
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‘Mothers Rising’ program offers support for pregnancy By sarah hollister
P
regnant women at West County Health Centers receive enhanced services through the Mothers Rising perinatal program. In addition to the standard prenatal care provided by our family practice physicians, West County Health Centers offers an array of comprehensive education on nutrition, mental health support, pregnancy and parenting education from the first pregnancy visit through the postpartum period. Integrated into the prenatal care is the opportunity to sit down with a nurse or health educator for one-on-one sessions focused on everything from pregnancy health and development to accessing valuable community resources. We realize that every factor in a woman’s life affects her pregnancy, so we take more time to give the support she needs. Each woman is empowered to tailor her visits to meet her individual needs and interests, with classes such as childbirth preparation, breastfeeding and newborn care, infant CPR and returning to work. Once the baby is born, the services continue with our nurse who is a board certified lactation consultant, providing regular home visits for the new mom and baby. The home visiting component is an important part of the woman’s care, especially when early challenges arise. Our nurse and physicians work closely to coordinate care as the primary care team for the family. In addition to the home visiting support, the new moms of West County Health Centers are encouraged to attend weekly drop-in groups for ongoing support and opportunities to meet and learn from other moms. There is a lactation clinic group for no-cost help and advice from our lactation consultant. Immediately following this group is a postpartum support group called the Mothering Workshop. This group has ongoing topics and activities with topics ranging from postpartum self-care to growing a healthy happy baby. The group support setting offers our mothers the social connection
Early and often — Perinatal care at community health centers like West County Health Centers focuses on a comprehensive approach to education and empowerment.
that is often lacking in the community. Often, mothers who start coming to the groups continue throughout their child’s infancy, and sometimes into toddlerhood. It is our goal to improve the outcome of every pregnancy, supporting each woman’s birth and transition into motherhood. We find that the outcomes for families are long lasting. Both babies and mothers benefit with better health outcomes and more confidence. Mothers
Rising is a program designed to offer moms the best care possible. We believe that both pregnant women and moms do better with one-on-one help and encouragement. Healthy pregnancies and successful breastfeeding lead to a healthy family, and ultimately a healthy community. – Sarah Hollister, PHN, RN, IBCLC, is the Comprehensive Perinatal Services Program Coordinator at West County Health Centers.
Understanding and managing cholesterol is key to a healthy heart
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holesterol is a naturally occurring hormone in your body that is created in your liver. The level of cholesterol in your blood is influenced by your diet. Foods high in saturated fats and cholesterol will increase your blood cholesterol level. Excess cholesterol can coat your blood vessels and is known as plaque. Over time this build up can narrow the vessels and is known as “hardening of the arteries.” The flow of blood is slowed, and this can cause heart disease. If a piece of the plaque breaks off, and becomes stuck in an artery feeding the brain this is what is known as a stroke. If a blood clot blocks an artery feeding the heart it is a heart attack. High cholesterol is a major risk factor for heart disease which is the number one cause of death in the United States. Each year, more than a million Americans have heart attacks and about half a million die from heart disease.
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How can you lower your cholesterol level? Reduce the amount of saturated fat and cholesterol in your diet. Read labels on processed foods and note the amount of saturated fat and cholesterol listed, choose wisely. Limit saturated fats and oils such as lard, bacon drippings, palm oil and coconut oil. Avoid trans fats or partially hydrogenated vegetable oils. Limit fatty meats such as bacon, sausage, steak, ribs, ground meat, hot dogs, corned beef, pastrami, processed meats such as bologna and organ meats such as livers and kidneys. Limit egg yolks. Limit milk products containing more than 1 percent milk fat. This includes cream, most cheeses, whipped topping and non-dairy creamers. Avoid fast foods such as hamburgers, French fries, fried chicken and tacos. Heart healthy foods to include in your diet can
help you control your cholesterol. They include: Vegetable oils such as olive or canola oil. Skinless chicken or turkey, lean beef, veal, pork, lamb and fish. Meatless main dishes such as beans, peas, pasta or rice. Being overweight can increase your cholesterol. Lowering your weight can help lower your cholesterol level. Regular physical activity will also help lower cholesterol levels and reduce your risk of heart disease. Adapted from information on the National Institutes of Health’s website For more information visit: American Heart Association www.heart.org – Submitted by Healdsburg District Hospital
Summer 2016
Dr. Steve Bromer and Jazmine Burden, CCMA with patient at the Sebastopol Community Health Center
Your support makes a huge difference in the lives of our patients here in our community.
WCHC Executive Director, Mary Szecsey
For over 40 years, West County Health Centers has provided comprehensive, quality and accessible health care services to the communities of western Sonoma County. We are a cohesive team of healthcare providers, support staff and volunteers dedicated to wellness, compassion, affordability and excellence of care.
Dr. Jason Cunningham and care team with a patient at the Sebastopol Community Health Center.
West County Health Centers provides medical, dental, and mental health care to the growing and diverse population of our community, particularly to medically vulnerable and underserved patients including seniors, children, teens, homeless people, low income families and many others who are in need.
LOCATIONS
Dr. Rhonda Berney with patients at Sebastopol Community Health Center.
Dr. Misty Zelk with a patient at the Gravenstein Community Health Center.
West County Health Centers envisions healthy communities building relationships & partnerships that support health & wellbeing for all people.
Sebastopol Community Health Center Gravenstein Community Health Center Russian River Health Center Occidental Area Health Center Forestville Wellness Center Forestville Teen Clinic Mental Health Services Russian River Dental Clinic ADMINISTRATIVE OFFICE PO Box 1449, Guerneville, CA . 707-869-5977
Living Well
www.wchealth.org 6
Patient centered care at community health centers Patients treated with respect, dignity and compassion
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Patient Centered Medical Home (PCMH) is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It is a place where patients are treated with respect, dignity and compassion, and it enables strong and trusting relationships with providers and staff. Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preferences, and that patients have the education and support they need to make decisions and participate in their own healthcare. coordinated: Patient care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and support services. comprehensive: A patient’s doctor and healthcare team is wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care and chronic care. committed to quality and safety: The healthcare organization and healthcare team is dedicated to improving the quality of care, ensuring that patients and families have what they need to make informed decisions about their health. accessible: Patients are able to access services around their schedule, with shorter waiting times, after hours care, 24/7 electronic or telephone access and strong communication through a patient portal which allows patients to schedule appointments, ask a question of their physician, view test results, immunization records or receive important information about their visits.
Community health centers can help — Your patient centered medical home has you covered.
Family centered: Medical professionals are family centered practitioners who recognize the vital role that families play in ensuring the health and well-being of infants, children, adolescents, and family members of all ages. Patient-centered and family centered care is an approach to health care that shapes policies, programs, facility design, and staff day-to-day interactions. It leads to better health outcomes, wiser allocation of resources and greater patient and family satisfaction. evidence Based: Evidence based medicine (EBM) is the explicit, judicious and reasonable use of the best modern evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the most up to date information that is grounded in clinical research. It is an approach which aims to increase the use of high-quality clinical research in clinical decision making. community health centers There are many excellent community health centers in Sonoma County that practice the patient centered medical home philosophy. In west Sonoma County, west
county health centers operate the Russian River Health Center, the Occidental Area Health Center, the Sebastopol Community Health Center, the Gravenstein Community Health Center, the Forestville Wellness Center, the Forestville Teen Clinic, the Russian River Dental Clinic and Mental Health Services. (See page 5 for a story about WCHCs unique Mothers Rising program.) In Cloverdale, alexander valley healthcare offers family medicine,
women’s health and obstetrics, general dentistry/oral health, behavioral and mental health services and Covered California Assistance at its medical and dental facilities. With medical and dental clinics in Healdsburg and Windsor, alliance Medical center offers medical and dental care, including a unique shared medical visit program – the goals of these visits are to educate patients in wellness practices, such as improved physical activity, nutrition, self-care and behavioral health to reduce the risk of heart disease and diabetes. Alliance also offers an in-house pharmacy. Patients who previously couldn’t fill their prescriptions due to cost, language barriers, or transportation now receive their medication when they need it. Patients can come directly to the pharmacy after their appointments and their prescription has already been filled. Most community health centers also offer special programs for teens, veterans and other groups that warrant special attention.
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Opinion: medical cannabis ought to be free from prohibitionists By JeFFrey hergenrather
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atients increasingly ask their physician for guidance in the prospect of using cannabis for medical problems. Pain is the primary complaint for patients seeking a cannabis consultation. This is primarily chronic pain of degenerative disease but includes neuropathic pain of diabetes, HIV, chemotherapy and all causes. Cannabinoids work well in neuropathic pain, where opioids tend to have limited benefits. Many patients benefit greatly with the addition of cannabinoids, even to the point of discontinuance of their pharmaceutical products. Auto-immune disorders such as multiple sclerosis, rheumatoid arthritis, Crohn’s disease, lupus erythematosis, ankylosing spondylitis, transplant rejection and others can be characterized as the body’s inability to adequately down regulate the immune response. Cannabinoids provide an immunomodulating effect for many with these diseases, resulting in reduction of pain and inflammation if not an arrest of the disease. Reports of cancer treatments and
cancer protective effects of cannabinoids abound in the past few years. In uncontrolled clinical observations many human cancers exhibit sensitivity to plant cannabinoids, though the response is variable over a wide range of doses. Specific tumor markers and imaging studies provide the best method of following the clinical response to cannabinoid therapy. As yet there are no specific tumor markers to reveal the sensitivity of
individual cancers to cannabinoids. Patients vary widely in their differences in tolerating cannabis. We know that there are fast and slow metabolizers of plant cannabinoids. We also know that there is as much as a fourfold difference in THC blood levels following the same dose of THC. This variability in the body’s handling of these molecules can be seen in the polymorphisms in these genes, perhaps offering an explanation for the wide range of patient tolerance in using cannabis as medicine. Rafael Mechoulam, the Israeli chemist who characterized and isolated THC over 50 years ago, speaks of cannabis as a treasure trove of compounds for medical uses. For the cannabis clinicians, endocannabinoid augmentation with plant cannabinoids safely and unequivocably benefits many disorders including seizures, autoimmune diseases, sleep, eating, mood disorders, glaucoma, autism and cell proliferation diseases. Cannabis dosing and questions of impairment for automobile driving remains a polarizing topic. Cannabis with alcohol is impairing
just as is alcohol alone, though unlike alcohol, cannabinoid blood levels don’t correlate with impairment unless you’re speaking of a neophyte users in which case a 5 ng/ml blood level is found to be impairing. For the experienced user, high blood levels of THC are found in safe drivers. As with any other medication, the patient needs to assess their own ability to drive safely before getting behind the wheel. With millions of people using cannabis as medicine, setting a low legal limit for driving will unfairly incriminate the medical cannabis user. There is an enormous amount of evidence for the safety and efficacy of cannabis as medicine. Phytocannabinoid safety and efficacy confound the federal government’s old and unfounded assertions of addiction and brain damage to the developing brain. Scientific investigation of these questions needs to be freed from the prohibitionists in federal bureaucracies to elucidate the risks and benefits of cannabis as medicine. – Jeffrey Hergenrather, MD is the president of the Society of Cannabis Clinicians.
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www.goodhearing.com Summer 2016
AGING From page one I love to discuss local ways to improve health. So how about red wine and diabetes? There actually was a study done in Israel where type 2 diabetics were given one glass of either water, white wine or red wine with their dinner. No other alcohol was consumed. The researchers were very happy to report a modest improvement in diabetic control for those given red wine. Of course, they were careful to add that too much wine or alcohol makes diabetes worse. Red wine has phenols, like resveratrol, and some studies have shown other health benefits, although controversy exists. And how about a local product that reduces the incidence of strokes by 41 percent? A well controlled study in France showed that regular users of extra virgin olive oil had 41 percent fewer strokes than non-users. The people who benefited used lots of olive
oil for cooking, salads and breads, and consumed very little other fats. Olive oil gets its benefit from antioxidants and monounsaturated fats, which are much healthier than polyunsaturated fats or trans fats. Of course, I recommend you use local olive oil producers, like Davero Olive Oil or Trattore/Dry Creek Olive Oil. California producers have to meet high standards for their extra virgin olive oil, whereas foreign producers, like the ones you see commonly and inexpensively in grocery stores, do not. Some of those products have been tested and do not even contain olive oil. So, how to “age well?� Keep your mind and body active, most of us should take a low dose daily aspirin, make sure your blood pressure numbers are good, your blood sugar and cholesterol numbers are good, your diet healthy, wear your seat belt and don’t smoke. And consume (limited) amounts of local wine, and (unlimited) amounts of local olive oil. – David Anderson, MD, is a retired physician, trying to age well at 74.
WATER From page one Center in Windsor with such severe dental decay that they require surgery under anesthesia. Their average age is three and the average number of teeth requiring treatment or extraction is 12. As many as 18 teeth requiring treatment is not unusual. A common cause of tooth decay in young kids is sippy cups filled with juice, soda or milk. For older kids and adults, it’s drinking sports drinks, juice or soda at lunch, at games and at home. By bathing the teeth in sugar and acid all day, there’s no opportunity for the mouth’s pH to rebalance. Twenty-five percent of kids start kindergarten with tooth decay, young adults with decayed teeth have difficulty getting jobs, and 31 percent of our seniors
A well controlled study in France showed that regular users of extra virgin olive oil had 41 percent fewer strokes than non-users.
have no teeth. Most shocking is the fact that dental disease is preventable. Regular visits to a dentist as soon as the first baby tooth appears, brushing and flossing twice a day (parent supervision is important until a child is seven years old), eating fresh fruits and vegetables – these are the basics for healthy teeth. We’re bombarded with commercials for beverages loaded with sugar that rot the teeth and are especially attractive to young children. There is one simple and costeffective solution to this problem: parents can protect their children from dental decay and the serious diseases that can result from it simply by making sugary drinks a rare and special treat, and encouraging them to drink water. – Submitted by Hazel Whiteoak, Pediatric Dental Initiative (PDI) in Windsor.
Bathing the teeth in sugar and acid all day, there’s no opportunity for the mouth’s pH to rebalance.
Center for
Women’s Health and Well-Being Treatment of Hormonal Imbalances and Sexual Health in Women rac tice tthat hat pprovides rovides ttreatment reatment ooff cclinical A ggynecology ynecolo g y ppractice linic al issues issues that that pprofoundly rofoundly aect ae c t w women’s omen’s personal p ers onal health, h ealth , well-being, well-b eing , aand nd iintimate ntimate rrelationships. el ati o ns h i p s .
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feel good...
we have you covered
Additional Providers:
Enrique Mendez-Gonzalez, MD Niranjana Parthasarathi, MD Robert Rutherford, MD Patricia Serio, MD Liz Lomax-Pile, FNP Ann Luke, FNP Lea Queen, PhD Cynthia Mattson, LCSW Lisa Planting, MFT Brad Chun, DDS
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Medical Site:
Alexander Valley Healthcare
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serving northern sonoma county and beyond 11
6 Tarman Drive Cloverdale Dental Site:
100 West Third Street Cloverdale
707.894.4229
www.alexandervalleyhealthcare.org Summer 2016
Quality Healthcare Close to Home Business owners and managers, do you have uninsured employees due to part time work or other factors? Do you have employees with uninsured family members? You can help provide high quality, low cost medical care for the people who work for you and for those they love by telling your employees and your Human Resources Director about Alliance Medical Center. Family Practice • Specialty Care • Pediatric Care Dental Care • Chronic Disease Care • Nutrition 1381 University Avenue, Healdsburg • 707-433-5494 8465 Old Redwood Highway, Windsor • 707-687-2498 www.alliancemed.org
Treat your family to the modern facilities and caring staff at a locally managed healthcare provider! Living Well
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