HEALTH S O U T H W E S T U TA H P U B L I C H E A LT H F O U N D AT I O N | FA L L 2 019 MEASLES RETURNS
GET OFF THE COUCH
NUTRITION MY THS
PG. 4
PG. 30
PG. 14
UTAH BEST OF STATE 2017, 2018, 2019
WELCOME LETTER
SWUPHD LOCATIONS (Southwest Utah Public Health Department)
B E AV E R 75 W 1175 N Beaver, Utah 84713 435-438-2482
GARFIELD 601 E Center Panguitch, Utah 84759 435-676-8800
IRON 260 E DL Sargent DR. Cedar City, Utah 84721 435-586-2437
Welcome to the 22nd issue of HEALTH Magazine, published by the Southwest Utah Public Health Department’s non-profit Foundation. This issue of HEALTH includes articles about hand washing, measles, tuberculosis, suicide prevention, emergency management, even a technique for falling asleep quickly that originated with soldiers on the battlefield.
We promote healthy living by protecting your health and preventing disease.
HEALTH Magazine won Utah’s Best of State medal for two years in a row (20172018) in the Community Development Publication category. This year we won Best of State in Literary Arts Design. We’ve appreciated the feedback many of our readers have shared with us. Let us know which articles you find helpful or motivational - or give us any comments or feedback - by emailing us at info@ swuhealth.org.
We continue to provide programs that promote healthy living by protecting your health and preventing disease and injury. We also have the goal of providing reliable health information to the communities we serve, and this magazine is a valuable part of that effort. Sincerely,
KANE 445 North Main Kanab, Utah 84741 435-644-2537
WA S H I N G TO N 620 S 400 E St. George, Utah 84770 435-673-3528
HEALTH MAGAZINE | SPRING 2019
David W. Blodgett, MD, MPH SWUPHD Director & Health Officer
MAGAZINE STAFF DIRECTOR/HEALTH OFFICER: David W. Blodgett MD, MP PUBLISHING DIRECTOR: Jeff Shumway EDITOR: David Heaton DESIGN & ARTWORK: Kindal Ridd QUESTIONS OR COMMENTS?
EMAIL INFO@SWUHEALTH.ORG
INSIDE PREVENT 4. MEASLES
By David W. Blodgett, MD, MPH
8. THE WHITE PLAGUE
By Danielle G. Timothy RN, BSN
10. SAVE A LIFE 12. TARGET 21
By Mori Kessler
PROMOTE 14. NUTRITION MYTHS
By Mallory Spendlove RDN, CD
16. NALOXONE
By Mikelle Lloyd
18. HAND WASHING
By Kindal Ridd
20. SLEEP LIKE A SOLDIER
By Michael Grothaus
PROTECT 22. WHERE THERE'S SMOKE
By Mike Gale
24. SAY NO TO BACKFLOW
By Josh Poulson
26. MEET YOUR LOCAL EMERGENCY MANAGER
By Paulette Valentine
30. FLU SHOOTOUT DATES
SWUHEALTH.ORG | PAGE 3
PART I THE RETURN OF
BY DAVID W. BLODGET T, MD, MPH
ou’ve likely heard about the measles outbreaks going on across the country this year. Although Utah has been spared, as of August 22nd there have been 1,215 cases of measles in 30 states in 2019. This is by far the highest count since 1992 and since the disease was declared eradicated from America in 2000. Given the history of measles in our country, and the continuing toll it takes worldwide, it is unfortunate to see measles making a comeback in our country. The vast majority of these measles cases have been in unvaccinated patients. In the decade before a vaccine became available in 1963, nearly all children got measles by the time they were 15 years of age. It is estimated that 3 to 4 million people in the United States were infected each year; of these cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain). It might help to put it this way: • About 1 in 5 people in the U.S. who get measles will be hospitalized. • 1 out of every 1,000 people with measles will develop brain swelling, which could lead to brain damage. • 1 to 3 out of 1,000 people with measles will die, even with the best care. • Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop 7 to 10 years after measles infection.
Some people think of measles as just a little rash and fever that clears up in a few days, but measles can cause serious health complications, especially in children younger than 5 years of age. There is no way to tell in advance the severity of the symptoms your child will experience. Some of the more common measles symptoms include: • High fever (may spike to more than 104° F) • Conjunctivitis (red, watery eyes) • Rash (3-5 days after symptoms • Cough begin) • Koplik spots (white spots in the mouth) • Runny nose (coryza)
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Measles might be the most infectious of all known diseases. Measles spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, up to 9 out of 10 people around him or her will also become infected if they are not protected. You can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left. Infected people can spread measles to others even before knowing they have it. Measles is still common in many parts of the world. Each year, an estimated 10 million people get measles, and about 110,000 of them die from it. Exposure to measles can happen when travelling to an area where measles is still active, or when an infected person comes to this country - which happened when visitors to Disneyland spread the disease in 2015.
Because measles is so easily spread, the best protection against measles is getting immunized through vaccination. The MMR (measles/mumps/rubella) vaccine provides long-lasting protection against all strains of measles. It is estimated that one dose provides protection to 93% of those immunized, while two doses provide 97% protection. The immunity from measles produced by the MMR vaccine is so robust that there isn’t a need to receive a booster dose later on. Generally, children should get their first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. If your family is traveling overseas, the recommendations are a little different: if your baby is 6 through 11 months old, he or she should receive 1 dose of MMR vaccine before leaving. If your child is 12 months of age or older, he or she will need 2 doses of MMR vaccine (separated by at least 28 days) before departure. It is critical for all international travelers to be protected against measles, regardless of their destination. There are two reasons to get immunized with any vaccine. The first is to protect the person being vaccinated. The second reason is to protect those who can’t get vaccinated or don’t develop immunity if they are vaccinated. In the case of measles, children less than a year old do not respond as well to the vaccine, yet they are the ones most likely to have the worst complications if infected by the disease. When enough people are vaccinated in a population, the disease will stop circulating, thus protecting those who are under-immunized or not able to be vaccinated. It is a concept called “herd immunity”, and it’s the reason that a disease that kills so many worldwide is now rare in the United States. Let’s keep it that way; please make sure you and those you love are up to date on measles vaccinations!
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PART II
VOICES FROM THE PAST BY DAVID W. BLODGET T, MD, MPH
TWO WELL-KNOWN WRITERS LEAVE US THEIR VERY PERSONAL EXPERIENCES WITH MEASLES
In his collection of essays, The Turning-Point of My Life (published in 1906), Mark Twain recalls how his deliberate measles infection during an 1845 outbreak brought him to death’s door: “The summer came, and brought with it an epidemic of measles. For a time a child died almost every day. The village was paralyzed with fright, distress, despair. Children that were not smitten with the disease were imprisoned in their homes to save them from the infection. In the homes there were no cheerful faces, there was no music, there was no singing but of solemn hymns, no voice but of prayer, no romping was allowed, no noise, no laughter, the family moved spectrally about on tiptoe, in a ghostly hush. I was a prisoner. My soul was steeped in this awful dreariness--and in fear. At some time or other every day and every night a sudden shiver shook me to the marrow, and I said to myself, "There, I've got it, and I shall die!" Life on these miserable terms was not worth living, and at last I made up my mind to get the disease and have it over, one way or the other. I escaped from the house and went to the house of a neighbor where a playmate of mine was very ill with the malady. When the chance offered I crept into his room and got into bed with him. I was discovered by his mother and sent back into captivity. But I had the disease; they could not take that from me. I came near to dying. The whole village was interested, and anxious, and sent for news of me every day; and not only once a day, but several times. Everybody believed I would die; but on the fourteenth day a change came for the worse and they were disappointed.” HEALTH MAGAZINE | FALL 2019
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Beloved children’s author Roald Dahl, creator of Willy Wonka, Matilda, and James and the Giant Peach, wrote the following open letter, entitled Measles: A Dangerous Illness, for publication in 1986 in memory of his daughter, Olivia: "Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything. "Are you feeling all right?" I asked her. "I feel all sleepy," she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her. On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it. It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk. In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out. Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die. LET THAT SINK IN. Every year around 20 children will die in Britain from measles. So what about the risks that your children will run from being immunised? They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation. So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised. The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible. Incidentally, I dedicated two of my books to Olivia, the first was 'James and the Giant Peach'. That was when she was still alive. The second was 'The BFG', dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.” www.roalddahl.com © The Roald Dahl Story Company Limited, used with permission SWUHEALTH.ORG | PAGE 7
THE WHITE
THE STORY OF TUBERCULOSIS BY DANIELLE G. TIMOTHY RN, BSN
EPIDEMIOLOGIST & TB CONTROL NURSE
n elderly patient was admitted to the hospital for weakness and fatigue. She had previously been diagnosed with anemia but was otherwise thought to be in good health. A bone marrow aspiration was performed which was inconclusive.
The woman was discharged but over the next two and a half years was readmitted several times with complaints of fever and chills, genitourinary bleeding, and coughing for several weeks’ duration. She received multiple blood transfusions, and an x-ray was presumed to be clear other than old scarring.
Eventually the patient’s persistent fever rose from 102 to 105 degrees, and another bone marrow aspiration was done before she was allowed to go home to await the results. Soon the test cultures returned, which showed the
growth of Myobacterium tuberculosis, but the doctors believed a diagnosis of tuberculosis was unlikely. It was too late anyway; two weeks later, on November 7th, 1962, Eleanor Roosevelt died at the age of 78.
Mrs. Roosevelt’s autopsy revealed that tuberculosis had spread throughout her body - to her lungs, liver, kidney, even the bone marrow. Her cause of death was listed as miliary tuberculosis, a rare form of the disease. Tuberculosis, also known as TB, is a bacteria that usually attacks the lungs, although it can infect any part of the body. It is spread through the air from one person to another through coughing, sneezing, singing, or talking.
TB has taken a toll on human life and health since ancient times. It was known as “con-
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sumption” or the “white plague” into the years. Between 3.1% and 5.0% of the U.S. 1800s until Dr. Robert Koch announced population has LTBI. the discovery of Mycobacterium tuberculosis, the bacteria now known as TB, Active TB usually affects the lungs and causwhich was causing the deaths of one out es symptoms that include chills, fever, night of every seven people in the U.S. and sweats, chest pain, fatigue, weight loss, and chronic coughing that may produce sputum Europe at this or blood. Active time. Today, tuTB patients may berculosis affects PEOPLE WHO WORK OR be contagious and nearly 2 billion require treatment. LIVE IN FACILITIES people worldBoth active and lawide, and there LIKE HOSPITALS, tent TB can usualwere 1.3 million ly be detected with TB-related deaths HOMELESS SHELTERS, medical testing. reported in 2017. NURSING HOMES, OR People most at In 1885, New risk for developCORRECTIONAL York physician ing active TB inEdward Trudeau FACILITIES clude those who built the first are immunocomTB sanitarium, SHOULD GET promised, homewhere patients less, injection drug PERIODIC were prescribed users, or were rethe same healthy TB TESTING. cently infected with eating and outTB bacteria. Close door recreation contacts with people infected with TB are that he believed had cured him of the also at greater risk, along with anyone who same disease several years earlier. By works in facilities like hospitals, homeless 1925, the U.S. had 536 sanatoriums with shelters, nursing homes, or correctional faapproximately 673,000 beds. cilities. People who work in those condiToday, both latent and active TB are tions are often required to get periodic TB treated over several months with drugs testing. that include isoniazid, rifampin, ethambutol, and pyrazinamide. There is cur- The Centers for Disease Control (CDC) rently no vaccine for TB available in the reports that in 2018, a total of 9,029 new tuberculosis cases were confirmed in the U.S. United States, the lowest ever reported in A person can have latent TB infection the United States. Currently, one of our na(LTBI) and not have symptoms or be tional goals is to eradicate TB, which will contagious. However, 10% of those require expanded detection and treatment with LTBI who don’t get treatment will among LTBI high-risk populations. Tuberdevelop active TB, which occurs when culosis also remains a global problem and the infection overcomes the immune its elimination will depend on international system, a process that can take weeks to cooperation.
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SAVE A
BY GUEST COLUMNIST (NAME WITHHELD)
t seemed like just another busy day as a wife, mother of five, and a small business owner. It all changed when I got this text. At the time I was in my van, frustrated and honking. I was late to an appointment and my teenage daughter was in the house taking her sweet time. I had no idea my teenage son was in our basement planning to end his life; he was just waiting for me to drive away. My irritation increased as I waited in the van, then I glanced down at my phone as the text came in. Shock and horror filled me as I read
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it. “Am I too late?,” I thought as I frantically ran back into our house looking for my son. I found him downstairs and embraced him, asking if he was okay. The weird thing was, he seemed alright on the surface.
overwhelmed me. My mind then shifted to the message from the unknown number. Who was this that had saved my son’s life with a text?
I later learned that the young man responsible for saving my son applied proven suicide prevention principles, Soon his friends arrived and our whether he knew it or not. family surrounded him with love and support. Through tears, he Those principles are known as explained the darkness he felt and “QPR”, which stands for Question, how he planned to end his life. My Persuade, and Refer. Just like peohusband and I rushed him to the ple trained in CPR and the Heimlich emergency room, knowing this was Maneuver save thousands of lives each year, people trained in QPR serious. learn how to recognize the warning We later learned how important it signs of a suicide crisis and what was to seek professional help since steps to take to get help. Each year he had not only thought of suicide, thousands of Americans, like this but how he would carry it out. young man, are saving the life of a friend, family member, colleague, or The mental health experts at Dixie neighbor. Regional Medical Center were stellar. They assessed his condition and After getting help at the ER, we arhelped stabilize him. I held him ranged to have our son meet regularin the emergency room and reas- ly with a psychiatrist and a therapist. sured him we needed him with us. He is working through the challenges As I held him, thoughts flooded my that brought him down; it turns out mind: what if I had driven away? he was being bullied. I will be forevWhat if I had not looked at that er grateful for that young man who text? How would our family, our texted me. For our family, he will neighborhood, and our community always be a hero because he took achave been impacted? My thoughts tion... and saved a life.
SUICIDE PREVENTION RESOURCES Anyone can get trained in QPR. Contact the Southwest Utah Behavioral Health Center at 435-634-5638 or mgriffin@sbhcutah.org to find out about upcoming trainings, or schedule a training for your business, club, church group, school, or community event. If you are considering suicide, or want help intervening with a loved one, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). For an online chat option, visit suicidepreventionlifeline.org. You can also download the SafeUT app to get help for yourself or someone else.
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THE EFFORT TO RAISE THE SMOKING/VAPING AGE NATIONWIDE BY MORI KESSLER
GUEST COLUMNIST
hile Utah passed a law earlier this year raising the legal smoking age to 21 over the next two years, a Utah congressman and senator have joined others seeking to impose the same age restriction on the national level. U.S. Rep. Chris Stewart and Sen. Mitt Romney have both come out in support of the “Tobacco to 21 Act” which will raise the legal age for buying tobacco products to 21 nationwide. “Combating tobacco use by children has been a priority of mine since first taking office,” Stewart said in a statement issued April 30. “I truly believe that it is an epidemic among our youth. I am confident that this bill will significantly reduce underage tobacco usage and ultimately save lives.” While targeting tobacco products, both the Utah law and proposed federal legislation also include electronic cigarettes and associated products. The Office of the Surgeon General describes tobacco use among youth ages 12 through 17 as an “epidemic” with over 600,000 middle school students and 3 million high school students across the nation estimated to smoke cigarettes. According to data referenced by Stewart’s office, each day more than 2,000 youth under 18 smoke their first cigarette. For those who become teenage
smokers, the habit opens them up to a possible premature death from a tobacco-related illness if efforts aren’t made to end underage smoking. “Increasing the minimum legal sale age will help prevent young people from starting down a path that often leads to addiction, disease, and premature death,” according to a statement from Stewart’s office. Romney officially joined what has since become known as the “Tobacco 21” bandwagon May 8th. “What we know is that tobacco damages the human body,” the senator said in a statement. “What we know is that tobacco kills people. We know the people that are hooked on tobacco end up taking home less pay every week because of the cost of tobacco. We also know that tobacco use is costing our nation billions upon billions of dollars—a loss of life, a loss of funds.” It makes sense to find ways to help prevent youth from getting hooked on tobacco, Romney said, yet added some young people don’t always have the best perspective or experience when it comes to making decisions that can have long-term impacts. “For that reason, it makes all the sense in the world to make it illegal for young people to purchase these products, so that we can help them during a time
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when their judgment is not as clear as it might be,” he said. “Older people typically have figured out that tobacco products make no sense at all,” In relation to vaping, the Southwest Utah Health Department issued a statement in February that 37% of Washington County 12th graders have reported using e-cigarette products. “Vape products disproportionately harm youth,” Kye Nordfelt, SWUPHD health promotion director said in the February statement. “While some may argue that e-cigarettes are intended only for adults and can be an effective tool to stop smoking, studies show that twice as many teens than adults vape in southwest Utah. Their popularity is leading toward another generation of nicotine addicts.” An estimated 95% of adult smokers started before they were 21, he said, and that it is a push of the health department to attempt to delay tobacco use among the youth. This is primarily due to brain chemistry, as nicotine from cigarettes can impact a still developing brain to become “wired for addiction,” he said. “This policy sends a clear message to our youth,” Nordfelt said. “It’s just not allowed until you’re older.” Through its Washington County Youth Coalition, the health department has been very vocal about
fighting youth smoking and vape use. Through the coalition the health department was able to get the Washington County Commission to ban smoking at the Washington County Regional Park fairgrounds in 2017. The health department also pushed for a ban on area cities approving the opening of new tobacco specialty shops. St. George and other cities have done this, including Washington City which issued the ban early last year. “In my home state, the legislature figured this out, was one of the first states in the nation to say we’re going to raise the smoking age to 21, and they did so because they saw what was happening with vaping,” Romney said. “Vaping has doubled in young people in my state. This is the same trend we’re seeing across the country. This is one step we can take. There are more steps that we need to take but this is a critical step. It will save lives, it will improve the health of our citizens. It will also save billions of dollars. Let’s get this done.” Mori Kessler is Senior Reporter for St. George News Original version, titled “Stewart, Romney support effort to raise smoking, vaping age to 21 nationwide” published in St. George News (www.stgeorgeutah.com) on 5-15-19. Edited for length, used with permission.
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NUTRITION
BY MALLORY SPENDLOVE RDN, CD
SWUPHD PROJECT COORDINATOR
hether it’s authors or experts, friends or family, it seems everyone has an opinion on food, whether it’s what food groups are better than others or which ones should be avoided altogether. Much of the information is conflicting, and often not scientifically sound. In fact, one recent study showed that up to 90% of the nutrition information shared on social media is not true. Here are six common nutrition myths I’ve seen as a registered dietitian nutritionist: MYTH 1: EATING HEALTHY IS “ALL OR NOTHING” In nutrition, there is no such thing as perfection. Think about the last time you told yourself you couldn’t eat something you were craving. What happened? Did you end up wanting it more and eating more than you planned? When you restrict foods, there is an increased risk of binge eating and feeling out of control.
Next time you are craving a food you “can’t have,” consider eating a little bit, enjoy it, and move on with your day. You are human, and there is no perfect way of eating. What you eat on a consistent basis is much more important than what you eat occasionally. MYTH 2: THERE ARE "GOOD" AND "BAD" FOODS The “good” or “bad” labels we give foods are often arbitrary and can change based on where we get the information from. We read or hear that something is bad for us, then take it as fact and avoid it. Most diets tell us food is either good or bad, leading us to pass judgment on ourHEALTH MAGAZINE |FALL 2019
selves over food as if eating was a moral issue. Think about the last time you said "I've been so good today" or "I'm a terrible person” based on what or how much you ate. Relating our food choices to self worth stirs up feelings of guilt and shame. Letting go of this belief can help you feel better and be kinder to yourself. Drinking enough water does not make you a better person, it just helps your body function. MYTH 3: CARBOHYDRATES ARE BAD FOR YOU Have you heard this one, or its counterpart that says sugar is bad for you? There are many fad diets right now that demonize carbohydrates and sugar. Avoiding carbohydrates is unnecessary and can be harmful. Carbohydrates are the body's preferred energy source. There are three main components of carbohydrates: starches, sugars, and fiber. Starch and fiber are essential parts of our diet. We need the vitamins and minerals found in starch. Fiber keeps our gut healthy, along with lowering the risk of type 2 diabetes and
PROMOTE
heart disease. Fiber is only found in carbohydrates from plant foods.
Sugar can be found naturally in some foods or added during the manufacturing process. The recommended daily limit of added sugar is 10% of daily calories, not including natural sugars found in fruit or dairy products. MYTH 4: ALL FAT IS BAD FOR YOU Like carbohydrates, we need fat in our diet. Our bodies use dietary fat to use fat soluble vitamins. These vitamins include Vitamin A, D, E and K. Unsaturated fat is the most beneficial to our bodies. It comes from plants and is liquid at room temperature. Avocados, olive oil, nuts, seeds, and fish are great sources of unsaturated fat.
Saturated fat is solid at room temperature and is typically found in animal products. Saturated fat is non-essential and the recommended daily intake is less than 10% of our daily calories. Foods with trans-fat are the exception and should be avoided completely. Trans-fat or partially hydrogenated oils increase the risk of developing heart disease. MYTH 5: FRESH IS ALWAYS BETTER THAN FROZEN Many believe that fresh fruits and vegetables are always the best option, which might be true when they’re in season. Otherwise, frozen can be a great option.
Processing of frozen vegetables and fruits actually occurs at their peak ripeness, when the fruits and vegetables have the most nutrients and taste the best. There is minimal processing for most frozen fruits and vegetables. Look for bags that do not include ingredients besides the fruit or vegetable to avoid unnecessary added sugar. MYTH 6: DIETS PROMOTED BY CELEBRITIES ARE GOOD FOR YOU Just because a diet is popular doesn’t mean it’s safe, proven, or effective in the long term. Don’t trust your health choices to someone based solely on their celebrity status . Look at a diet critically to see if it restricts food groups or identifies foods as “good” or “bad”. If so, avoid it. These diets are tempting because they promise a quick fix. Often they can’t deliver on their promises, and can even put your health in jeopardy. If you want to lose weight or create healthy habits, check with your doctor or a dietitian. These qualified health professionals can help you find a plan that works for you. The Southwest Utah Public Health Department offers a class on creating healthy habits in person and online. Register at SWUHEALTH.ORG/DIABETES.
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REVERSING OPIOID OVERDOSES WITH
BY: MIKELLE LLOYD
hat is harm reduction? It’s a practice meant to reduce the risk associated with a behavior. A basic example of harm reduction is wearing a seatbelt. When you are in a moving vehicle, there’s a certain inherent risk of harm. Wearing a seatbelt is a harm reduction practice that can prevent death and minimize injury if an accident happens. Wearing a seatbelt does not HEALTH MAGAZINE |FALL 2019
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mean a driver is seeking out an accident, simply that they are prepared if one occurs.
Naloxone is an example of harm reduction for opioid use. Naloxone is a drug that reverses an opioid overdose by bonding to receptors in the brain and repelling opioids off of those receptors. Naloxone can now be obtained from a pharmacy without a prescription and can be given as a nasal spray or an intramuscular injection.
Ben Martinez, a Peer Recovery Coach with Utah Support Advocates for Recovery Awareness (USARA), explains, “Harm reduction services do not enable drug use across the board. Naloxone only enables people to breathe again. You cannot recover if you are dead; Naloxone gives someone another chance to recover from a substance use disorder.” Ben says the people he knows who have been brought back from an overdose because someone administered Naloxone are now tax-paying community members who contribute to society. “They help other people get into recovery, they own businesses, they own houses, they are engaged in the community. They are brothers, sisters, moms, dads, and valuable people to society.”
To those who are struggling with opioid dependency or addiction, Mr. Martinez says, “You are not alone - this community cannot heal until we talk about opioid abuse. Recovering from opioid use disorder is not a singular and randomly occurring event; it is an ongoing process that requires support and understanding. It’s on people in recovery to speak out more. It’s on the community to not put shame and stigma on past drug use when a person is in recovery.”
As a person in long-term recovery from substance abuse, Mr. Martinez has a message for those who have a loved one struggling with opioid use disorder: “You are not alone! There may be shame among family members, but you didn’t fail as a parent, you didn’t fail as a spouse, you didn’t fail as a human being. This disease touches every aspect of our society.” Reaching out to a loved one who is struggling - and recognizing that this person is not their true self when they are misusing opioids - is an important step in creating an environment for successful recovery. OPIOIDS include drugs prescribed for pain. Brand names include OxyContin, Percocet, Vicodin, Percodan, Lortab, Demerol, and generic codeine and fentanyl. NALOXONE is a drug available without prescription to caregivers, emergency responders, or potential bystanders that can be administered without legal liability. If given in a timely manner, Naloxone can reverse the effects of an opioid overdose and prevent death if followed by emergency care. Visit utahnaloxone.org for a list of pharmacies that offer Naloxone, education resources, and referrals for treatment.
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egular hand washing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. Many diseases are spread by not washing germ-covered hands, then infecting yourself by touching your eyes, nose, or mouth. You can also spread germs when you touch other surfaces with unwashed hands. HOW TO WASH YOUR HANDS:
WHEN TO WASH YOUR HANDS:
• Wet your hands with clean, running water, turn off the tap, and apply soap.
• Before, during, and after preparing food • Before eating food • Before and after caring for someone who is sick • Before and after treating a cut or wound • After using the toilet • After changing diapers or cleaning up a child who has used the toilet • After blowing your nose, coughing, or sneezing • After touching an animal, animal feed, or animal waste • After handling pet food or pet treats
• Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. • Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice. • Rinse your hands well under clean, running water. • Dry your hands using a clean towel or air dry them.
Hand washing is quick, simple, and keeps us all from getting sick. Hand washing is a win for everyone, except the germs! (Source: Centers for Disease Control)
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You don’t have to be a superhero to protect your body from germs.
Or a hazmat suit!
2019 ©kindalridd for swuhealth
You don’t need a helmet…
Or a suit of armor...
Just wash your hands! SWUHEALTH.ORG | PAGE 19
SLEEP LIKE A
BY MICHAEL GROTHAUS
GUEST COLUMNIST
f you often find yourself having trouble falling asleep, you’re not alone. The American Sleep Association (ASA) says that 50 million to 70 million U.S. adults have a sleep disorder. Among that group, insomnia is the most common. The ASA says that 30% of adults have reported short-term, insomnia-like symptoms, and 10% of American adults deal with chronic insomnia.
sleep cost U.S. businesses a staggering $411 billion in lost productivity every year.
The recommended amount of sleep an adult needs is between seven and nine hours each night. But for many, finding this time isn’t the problem–it’s falling asleep once your head hits the pillow. I’m one of those people who occasionally has this problem, and in the past have tried everything from meditation to A major study of 440,000 adults showed that 35% of medication. But for the last four weeks, I tried someus get fewer than seven hours of sleep a night. That thing different–and it’s something worth trying if you means there are millions of people at risk of facing have sleep problems. serious health problems that lack of sleep can cause, including obesity, heart disease, and diabetes. But it’s Recently, an old method used by the U.S. Army to not just health problems these people have to deal help soldiers fall to sleep in less than ideal conditions (like battlefields) has resurfaced. The Independent with. says the technique was first described in a book from Lack of sleep is a big problem for your productiv- 1981 called Relax and Win: Championship Perfority–and for the company that employs you. A 2015 mance by Lloyd Bud Winter. Harvard study showed the average worker loses the equivalent of 11 days of productivity every year due In the book, Winter describes the technique designed to sleep issues. And a 2017 study found that poor by the U.S. Army to make sure soldiers didn’t make
HEALTH MAGAZINE |FALL 2019
PROMOTE
mistakes due to grogginess. The technique apparently tried it–but that was for people who tried it for six sends you off to sleep within two minutes. weeks. That’s why I wasn’t too bummed when I tried this technique every night in the first week and nothHERE’S THE QUICK SLEEP TECHNIQUE ing happened. So four weeks ago, I tried it. The technique mainly involves muscle relaxation, breathing, and visualization But then something changed starting at around the ninth night. And honestly, I can’t be sure if it was due tricks anyone can do. Here’s how it works: to the technique itself or the sheer boredom caused 1. Sit on the edge of your bed. Make sure only your by trying to calm my body into a lump-like state. bedside light is on, your phone is silenced, and I relaxed my muscles and visualized swinging in a your alarm is set for the morning. velvety hammock. And the next thing I knew, it was 2. Now relax your facial muscles. First tighten them around 3 a.m., and I woke up, awkwardly splayed up in a wincing motion, and then slowly let your over my bed, with my feet still touching the floor and muscles naturally loosen. And let your tongue fall the bedside light still on. I was deeply tired and only woke enough to swing my legs into bed and turn off any which way in your mouth. 3. Once your face feels like deflated putty, let gravity the lamp. pull your shoulders naturally toward the ground. But the event gave me hope, and the next night I did Let your arms dangle too, one side at a time. it again. This time I didn’t pass out right away, but 4. While doing this, breathe in and out, listening to felt a great release come over my body after my hamthe sound of your breath. With each breath, let mock visualization, and I crawled into bed and turned your chest relax further and then let gravity relax out the light. Next thing I remember is waking eight hours later, feeling rested. your thighs and lower legs. 5. Once your body feels like nothing more than So I can confidently say this decades-old technique a loosely formed lump of clay, try to clear your worked for me. Mind you, it didn’t work every night. mind for 10 seconds. If thoughts come naturally, Some nights during that second week I didn’t get that let them pass–just keep your body loose and limp. “release” after my visualization. But as the weeks After a few more seconds you mind should feel went on, the trick seemed to work more often than not. And it seemed to work more effectively when I clearer. 6. Now picture one of the following two scenarios: visualized myself in a velvety hammock instead of in you lying in a canoe in a calm lake with clear blue a canoe, so it helps to switch up visualizations to see skies above you; or you in a velvet hammock, gen- what works best. tly swaying in a pitch-black room. If you happen So should you try it? There’s no reason not to, based to be a person who isn’t great at visualization, you on my experience. By the fourth week, it was workcan instead chant the mantra, “Don’t think, don’t ing more often than not. One thing I know for sure is think, don’t think” for 10 seconds instead. that trying this is better than taking an Ambien–and And that’s it. At the end of these steps, which should doesn’t take much more time than swallowing a pill. take about two minutes, lie down and turn out the So go ahead and give it a try. Then sleep on it. You bedside light. Ideally, you’ll drift off to sleep within might be surprised by the results. a few minutes.
HOW THE TECHNIQUE WORKED FOR ME
Originally published under the title “What happened when
When I began the technique I was heartened that the I tried the US Army's tactic to fall asleep in two minutes" Army found that it worked for 96% of people who on FastCompany.com (10-26-18). Used with permission.
SWUHEALTH.ORG | PAGE 21
WHERE THERE'S
BY MIKE GALE
REGIONAL HEALTHCARE COORDINATOR, AEMT
IN THE OUTDOORS
The Environmental Protection Agency (EPA) reports that smoke, whether from burning wood or other sources, can be detrimental to your health. All fires create or release tiny particles along with other toxic air pollutants. Particles smaller than 2.5 microns (or PM2.5) can travel deep into the respiratory system and irritate the lungs, cause inflammation, trigger asthma attacks, and increase the risk of heart attacks and strokes. Smoke can also exacerbate respiratory diseases such as chronic obstructive pulmonary disease (COPD) and emphysema. The elderly, children and teenagers, pregnant women, and anyone with existing cardiopulmonary disease are the most vulnerable. When burning wood, whether in a campfire or wood stove, The EPA recommends using dry, well-seasoned wood to reduce the amount of smoke. Staying upwind and limiting the amount of time you are around smoke are also ways to minimize your exposure. During wildfire season it can be difficult to avoid smoky conditions. The Centers for Disease Control (CDC) recommends the following steps to protect yourself when wildfire smoke is in the air: • Check local air quality reports and health warnings, along with local visibility guides. • Stay indoors and keep indoor air as clean as possible. • Keep windows and doors shut as much as possible. If you use an air conditioner close the fresh-air intake during smoky conditions and make sure the filter is clean. • Avoid activities that increase indoor pollution such as burning candles, incense, using fireplaces or gas stoves. • Consider using a High Efficiency Particulate Air (HEPA) filter to reduce the amount of indoor pollution.
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• When outside, do not rely on simple dust masks for protection such as paper comfort masks. An N95 or higher rated mask may provide better protection but it is important to learn how to properly select and check its fit for it to be effective. Follow the directions included with the respirator. • Temporarily relocate from smoky areas or, when prompted by officials, evacuate the area. • Cleaning up after a fire can also expose you to harmful contaminants. Use appropriate Personal Protective Equipment (PPE) such as an N95 respirator, gloves, shoes, and long pants and shirt. • Follow the advice of your doctor or healthcare provider.
elevation changes such as vaulted ceilings or at the end of stairwells, in every bedroom, as well as outside each sleeping area. Having a fire extinguisher in the kitchen and garage is also recommended. If you don’t have smoke detectors or you’re unsure if you have enough, there is the American Red Cross Home Fire Campaign. They can install up to three smoke detectors in your home for free. They can provide bed shaking devices for those with hearing impairments. Experts say you have less than 2 minutes to evacuate during a home fire, so having functioning smoke detectors and practicing evacuation is essential. To learn more about fire preparedness, visit www.ready.gov/home-fires
As always, prevention is the best medicine. Prevent wildfires from starting and protect your property from wildfire. Follow local fire restrictions and create defensible space around your home. Many people in the Southwest Utah region live in areas that fire managers consider “Wildland- Urban Interface”, so it’s essential to clear brush, weeds, tree limbs, and anything else that could burn from around your home. Contact your local fire warden or emergency manager to learn more about how to create defensible space.
IN THE HOME
Did you know that in house fires, it’s not usually the heat or the fire itself that kills its victims? According to the National Fire Protection Agency, most fire deaths are the result of smoke inhalation. Smoke from structure fires is very hot, dense, and toxic. It makes it very difficult for people to breath or even see well enough to exit their own home. People can die within feet of their own door or a window because they can’t see where the exits are and are overcome by smoke. This is why it’s important to have functioning smoke detectors in your home that are tested regularly. The earlier you know there’s a fire, the more time you have to get out. There should be a smoke detector on every floor of your home, anywhere there are SWUHEALTH.ORG | PAGE 23
SAY NO TO
CROSS CONNECTION AND BACKFLOW PREVENTION BY JOSH POULSON
GUEST AUTHOR
e all play a role in keeping our drinking water safe, whether we get water from our city, a small subdivision that shares a well, or a private well.
Without preventive measures, there is potential for water from cross-connections (like your dishwasher, pool, pressure booster pump, sprinklers, or animal water trough) to be sucked up the spout and through the pipes in your home - even all the way into the water lines that service your neighborhood. This can happen when there is backflow due to low water pressure or a break in the water lines. That’s why plumbing codes require backflow prevention devices in homes and businesses. These devices are vital in keeping the drinking water supply safe for you and your neighbors.
ent if you live in an older home. You can ask your local utilities manager or water operator if they have a record of the installation, or they may do an inspection to make sure that you have one.
You should also make sure that a hose bib vacuum breaker is installed on the threads of any outdoor tap, allowing you to hook up a hose to water the grass or animals and wash your car while protecting against back-siphonage. The hose bib vacuum breaker is designed to discharge water pressure that is left over in the hose once the water supply is turned off or when pressure in the garden hose becomes greater than the pressure in the water pipes. At those times a spring-loaded valve closes to the water supply from your house and opens to the outside air to prevent water or other materiJust in case, you can check to see if al from being sucked back into your your house had a backflow preventer house plumbing. installed when it was built. They should have been included in all new- Recently a local pest control company er construction but may not be pres- used the garden hose from a home -
HEALTH MAGAZINE | FALL 2019
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which didn’t have a vacuum breaker at the faucet - to add water to their pesticide tank. At some point the water line lost pressure, resulting in pesticide from the tank getting sucked up into the home.
Even if backflow prevention devices are installed in your home and outside faucets, play it safe by keeping an air gap between the end of the hose and sources of potential contamination, including pools and animal water basins.
The residents had to have their water lines flushed for many hours and have If you have considered installing a boosttesting done er pump beto make cause of low sure that no water prespesticide sure, talk remained. with your Fortunately local water there was company to a backflow find a differprevention ent solution. device proBooster tecting the pumps inconnection to the street water line, or the crease the risk of backflow problems and whole neighborhood would have been ex- some companies may not allow them. posed to pesticides in the drinking water. All of the water companies in our district Other problems can occur when private are required by the state to have a cross-conindividuals hook up their sprinkling sys- nection control plan which details their tem to the drinking or irrigation water prevention and monitoring efforts. If you lines without proper approval and back- have concerns about cross-connections flow prevention devices, or they remove you can call your water company and ask the backflow preventer at the water meter to speak with the person who is trained in hoping to increase their water pressure. backflow prevention. They are invested in These cross-connections open up the po- keeping our drinking water safe, although tential for dirty water and foreign material we all play a role in keeping contaminated to flow back into the public drinking wa- water out of our home and community water lines. ter systems.
We all play a role in keeping contaminated water out of our home and community water systems.
SWUHEALTH.ORG | PAGE 25
PART I
MEET YOUR LOCAL EMERGENCY
BY PAULET TE VALENTINE
SWUPHD EMERGENCY PREPAREDNESS DIRECTOR
mergency management is sometimes thought of as only an administrative function, charged with creating and maintaining plans for community disaster response. This is an important role of an emergency manager, but there is much more they do for the counties they serve. Emergency managers strive to promote safer, less vulnerable communities that have the capacity to cope with any natural or man-made threat. That includes updating and practicing plans to prepare for, respond to, and recover from the most likely scenarios for their specific county. In Southwest Utah those could include wildfires, floods, earthquakes, and pandemics, among other hazards that could impact the safety or health of the public. Emergency Managers are familiar with all aspects of preparedness, from individuals and families to neighborhoods and cities. They maintain working relationships with other agencies on the local, state, and national levels and are able to create unity among them when brought together to handle large-scale events. Let’s meet the emergency managers of Southwest Utah:
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DENISE DASTRUP Denise has served as Garfield County’s emergency manager for five years since being appointed by the sheriff. She enjoys living in a small community where everyone pulls together in a crisis. The 2017 Brian Head Fire was such an event, when 72,000 acres of forest land was burned. She was part of the daily emergency brief-ings held by the federal fire management team and offered whatever support was needed, which included compiling reports and community messaging. A year later, heavy rain showers in the burn area created a flash flood in the Panguitch City watershed, damaging one of the spring collection boxes used for city water. Mud and contaminated debris entered the main water system, leaving Panguitch without clean water for nearly a week. Denise issued a “No Use” notice until city workers were able to flush the storage tanks, then put a boil order in place for several days until the water system was safe. She kept everyone up to date through social media and other methods. The water needs of Garfield Memorial Hospital presented a challenge that was met with a portable purification system brought in by the Southwest Utah Public Health Department, allowing the facility to remain open and operational. Denise understands the difference that communication and information makes for community resilience during a crisis. She encourages Garfield County citizens to register for local emergency alerts by visiting: public.alertsense.com/signup/?regionid=1388
SWUHEALTH.ORG | PAGE 27
PART II
MEET YOUR LOCAL EMERGENCY
LES WHITNEY Les Whitney has served as the Director of Emergency Services in Beaver County for 20 years. He began his career in emergency response as a firefighter in 1974 and became a fire chief in 1985.
The largest fire Les has encountered ended up being the largest wildfire in Utah’s history, which started with a lightning strike near Milford, Utah on July 6, 2007. The fire burned 363,052 acres (567 square miles) over eight days, closing large stretches of Interstate 15. For Les and many of the veteran firefighters involved, this was the fastest moving fire they had ever seen. Ten truckers had to abandon their cargo trailers on the side of the road. Smoke caused numerous wrecks on I-15, including a multi-car pileup, requiring additional resources from a public safety system that was already stretched thin. A fatality occurred when an individual exited a vehicle and was hit by another driver who could not see through the smoke. Two motorcyclists were also killed because of low visibility. Les organized and coordinated local resources during the Milford Flat Fire to protect the lives and property of Beaver County citizens. Les gets the most satisfaction from his job as emergency manager when he is training and working with first responders and community members to prepare for a variety of disasters and threats. His goal is for all residents to be prepared to not only take care of themselves, but be able to help others as well in any emergency.
GEORGE COLSON Although he may seem new to Iron County, George is actually an alumnus of Southern Utah University. He served 25 years in the army and worked with an FBI weapons of mass destruction team as a state liaison out of the Miami Field Office. George was with the Broward County Sheriff’s Department before moving back to Utah where he joined the American Red Cross. He was hired as Iron County’s emergency manager last year (2018).
George has been deployed to scores of large-scale emergencies - mostly major storms - across the nation. Now he enjoys having only one county to worry about. Disasters are not unheard of here, like the Brian Head fire in 2017 (which George was involved with as a member of the Red Cross), but he is concerned about anyone having the mindset of “it will never happen here”.
George wants the citizens of Iron County to be at least minimally prepared and willing to help others so they can come together as a community to recover and rebuild from whatever may come their way. As far as his role when a disaster strikes, he says "It’s like being a conductor in the orchestra; I don’t have to know how to play every instrument, just how to help them work in unison with each other to accomplish something amazing." HEALTH MAGAZINE | FALL 2019
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JASON WHIPPLE A lifelong resident of Washington County, Jason Whipple spent 21 years working as a police officer and firefighter for the city of St. George before becoming Director of the Emergency Response Training Center at Dixie Applied Technology College. He then moved into emergency management for the county in 2017 and became the Washington County Emergency Services Director this year. Jason’s involvement in large-scale emergencies includes fieldwork in 2005 when the Santa Clara River overflowed its banks, causing dozens of homes to flood or collapse into the river and taking one life. No one expected the level of devastation caused by the flooding. In December 2010, after seven days of continuous rain, The Virgin and Santa Clara rivers were both running rapid and high, and conditions began to resemble those from five years earlier. As the emergency manager for St. George City, Jason joined other agencies at the county’s Emergency Operations Center, where they worked tirelessly to keep people and property safe. Resources were activated to control water flow and support those stranded by high water levels. Jason encourages citizens of Washington County to become better prepared by having a family plan based on what your needs would be in a disaster. He says everyone should take the opportunity to participate in local trainings, preparedness fairs, and registering for the Washington County Alert System at 911register.com.
ALAN ALLDREDGE Alan’s service in many emergency response roles, including search and rescue, fire department, sheriff ’s deputy, and EMT, made for a good fit when he was offered the position of emergency manager for Kane County 13 years ago. A resident of Kanab for 32 years, he also serves as Chief Deputy for the Sheriff ’s Office. Alan’s most challenging situation occurred in 2005, when a fatal landslide occurred along Kanab Creek, burying a 10-year-old boy. As fire chief and incident commander for response, Alan coordinated the recovery efforts offered by emergency response agencies and the many community members who showed up to help. His role included managing resources and ensuring everyone’s safety during the operation. It took two days of intense round-the-clock work until they were able to retrieve the little boy’s body, a tragic ending to a community’s labor of love. One of Alan’s priorities is encouraging people to be self-reliant. His hope is for the people of Kane County to take personal responsibility in preparing themselves and their families for any emergency or disaster that may occur. He sees flooding as the greatest threat to the region’s residents and continues his efforts to prevent and prepare for such events in the future.
SWUHEALTH.ORG | PAGE 29
SHOOTOUT ST. GEORGE
Tuesday, September 17, 2019 8am-1pm - Drive-thru in Red Cliffs Mall Parking lot (18+) 1-6pm - Red Cliffs Mall Center Court (all ages)
B E AV E R
Wednesday, September 18, 2019 12-4pm - Drive through(18+) - Walk-in(all ages) - EMS Shed
CEDAR CITY
Saturday, September 21, 2019 9am-12pm - All Ages - Cedar City Hospital Health Fair
*KANAB
Saturday, October 12, 2019 9am-1pm - All Ages - Kane County Health Fair @ Middle School
PA N G U I T C H
Friday, October 18, 2019 11am-2pm - Drive through(18+) - Walk-in(all ages) - Fire Station
GET YOUR FLU SHOT WHILE HELPING US PRACTICE OUR COMMUNITY EMERGENCY RESPONSE PLAN! To SAVE TIME visit SWUHEALTH.ORG/FLU to print consent form. Fill out and bring with you! Also, wear a SHORT-SLEEVED shirt. $20 (cash, check, or credit) or NO CHARGE with proof of the following insurances: Aetna, Cigna, DMBA, Educators Mutual, Healthy Premier, Medicare, Motiv Health, PEHP, Select Health, Tall Tree Administrators, United Health *FREE for all Kane County Residents! However, to assist with costs, insurance cards will be accepted.
HEALTH MAGAZINE | FALL 2019
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ASK YOUR DOCTOR IF GETTING OFF THE
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