HEALTH SENSE: Sara Patterson on advance health care directives

Consider an advance

health care directive

By Sara Patterson O ur entire lives we are taught to plan and prepare for our future: school, college, retirement, etc. One thing that we’re we are not taught to plan or prepare for is the end of life. Discussion about death and dying is a scary topic and therefore often avoided. Yet the best time to talk about and document your health care wishes and after-death preferences is while you are healthy and of sound mind. Starting the conversation now builds a foundation and normalizes the topic.

Advance care planning is not just about old age. At any age, a medical crisis, disease or severe injury could leave you unable to make your own health care decisions. Planning for health care in the future is essential. Do you have a plan? Have you thought about who would help guide your medical decisions if it meant life or death? What kind of medical treatments would you be willing or not willing to receive?

The process of working through these questions and talking about them is called advance care planning. Advance care planning explores the kinds of decisions that you will need to make. If you choose to formalize your choices, you would do so on a document called an Advance Health Care Directive, or AHCD.

We all have values and preferences that relate to health care. It’s important to think about these values and preferences, discuss them and write them down in an AHCD. Having an AHCD, also known as a living will, ensures your preferences are understood and respected in the case of a medical crisis, disease or severe injury.

There are two parts to an AHCD. Part one allows you to name a surrogate decisionmaker, called a health care agent, to be your voice and help guide your medical decisions in the event that you’re unable to do so yourself. After choosing this person, it’s important that you get their permission to ensure they’re willing to take on that role and responsibility, if ever needed. It’s also critical to have a conversation with them about your documented health care wishes in the AHCD, this way will have an opportunity to ask questions and verify their understanding.

Part two goes into detail about your preferences for medical treatment. If you are unable to speak, it’s likely you are very ill and need treatments to prevent you from dying. These treatments are called life-support or life-prolonging treatments. Life support treatments may include cardiopulmonary resuscitation, artificial ventilation (breathing machine), artificial nutrition/hydration (tube feeding), and dialysis. If you have questions about these treatments, consult your primary care doctor.

Life-support treatments may be used when it is expected that you will recover and the treatment would therefore be temporary. Some, more serious, situations might require treatment for the rest of your life such as a breathing machine.

The topic of death and dying cannot

be ignored when you face a serious or terminal illness. It suddenly becomes necessary to discuss health care options with your loved ones and health care providers. The hardest time to start an advance care plan conversation is when you are told your time is short.

Making decisions about unknown health care situations can be difficult, and there is no right or wrong answer. The best way to make your decisions is to base them on where you’re at in your health now and how the treatment would fit within your life goals, values and beliefs. You need to weigh the potential benefits (help) and burdens (harm) from the treatment as it relates to you. Discuss your particular illnesses and treatment options with your doctor and ask how they may help or harm you. Planning and making decisions about life-prolonging treatments can be emotionally difficult for you and your family. But it can also be comforting; if your loved ones ever need to make decisions on your behalf, they will know what you would want. They’ll have peace of mind, and you can feel confident that your wishes are known and understood. If you are ready to complete an AHCD or need assistance, Foundation Health Partners offers AHCD sessions, “Your Life – Your Design.” These sessions are free, they’re open to the public and they occur quarterly.

Three sessions remain this year: Friday, April 17; Wednesday, July 15; and Wednesday, Oct. 14. All sessions are from 1 p.m. to 2: 30 p.m. in the McGown Room at Fairbanks Memorial Hospital.

For more information about “Your Life – Your Design,” please contact Sara Patterson with Foundation Health Partners Palliative Care Department at 907-458- 5102.

Diana Wolf, who is teaching an online version of Principles of Genetics course in spring 2020, holds part of the home DNA testing kit that will be used in the class. Photos by JR Ancheta, UAF

High-tech home study

UAF hosts first online DNA sequencing class

Students in UAF’s Principles of Genetics course will test dietary supplements such as these to see if their ingredients match the advertised contents.

By Marissa Carl-Acosta T his spring the University of Alaska Fairbanks is providing the country’s first online class that enables students to do DNA sequencing in their home.

Principles of Genetics, a four-credit biology course, provides each student molecular genetics equipment and teach them how to sequence the contents of herbal dietary supplements to see if they actually contain the plant species listed on their labels. Based on the samples tested so far, many of them don’t.

“The results are fairly shocking,” said Diana Wolf, who has taught the course for 15 years and is now developing the online version. Principles of Genetics is part of UAF’s plan to offer a fully online biology degree soon.

Before deciding to provide online students with the equipment needed to prepare the samples themselves, Wolf tested online lab programs from other colleges.

“They were lame and they were frustrating,” she said, remembering one where she had to use her computer mouse to pick up a pipette graphic and put liquid in a tube. “It’s certainly not the same as doing it yourself, and it’s certainly not going to get students excited about doing science.”

The components of a home DNA test are displayed at a lab in UAF’s West Ridge Research Building.

Creating her one-of-a-kind education experience was not the easy choice. In addition to cost barriers, Wolf ’s challenge is replicating a one-on-one experience for students who are in different settings and working at different times. To bridge any gaps, Wolf will use video and make herself easily available to students.

Even though students are not in a lab setting, mastering good lab techniques will be critical their success in the online course. Step one, learning how to properly use a pipette, requires students to share video of themselves actually doing it.

Wolf will then offer feedback to students individually, ensuring they are ready to move on to the next step.

Wolf has also made videos of herself showcasing various lab techniques. She will offer live video sessions throughout the semester, which students can join to work on their labs or ask questions.

Wolf and the UAF Department of Biology and Wildlife are committed to serving students who need the flexibility of online courses. Wolf expects the online version of her course will appeal to a variety of students, including those who work full-time, live out of state, serve in the military, are preparing for medical school or are interested in their own biology.

“Lab work, such as DNA sequencing, is an extremely important part of genetics,” Wolf said. “And students are excited by the prospect of sequencing DNA on their own.”

Marissa Carl-Acosta is a communications specialist for the University of Alaska Fairbanks.

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Ninja mom

Fairbanks athlete was flying high until heart problems struck

By Kyrie Long Alaska Pulse Monthly

Christi Marie Hannah was well into training to run in multiple rigorous obstacle courses this year as a returning contestant on the “American Ninja Warrior” television show when she was unexpectedly diagnosed with ventricular tachycardia, a potentially deadly heart disorder.

Hannah is a single mother with three children who grew up in Fairbanks and now splits her year between Alaska and Iowa, her current home at this time of the year, where she coaches sports for kids and is a dental hygienist.

Hannah is the third Alaskan to be on the show, following Nick Hanson of Unalakleet and Nate DeHaan of Bethel.

The series, a spin-off of the Japanese television show “Sasuke,” has contestants compete in a timed obstacle course testing speed, strength and balance. The contestants with the most successful runs through the course move through multiple phases of the show, from city qualifiers, to city finals, to nationals, where the ultimate goal is to beat the “Mount Midoriyama” obstacle course in Las Vegas and become the next American Ninja Warrior.

Athletic fitness is paramount in the contest and working out has been a major part of Hannah’s life.

Top, Christi Hannah with her kids Emily, 11, Logan, 4, and Michael, 10. Above, a student named Trevor teaches Hannah some Alaska Native games, including the stick pull. Hannah does a handstand to show her Alaska pride. Photos courtesy of Christi Hannah

She would try to be in the gym at least two hours per day for four to five days per week. Even when she can’t make it, she and her children did workouts together at home. She began training for “American Ninja Warrior” while in Missouri in 2017 as a kind of half workout goal, half bet with her trainer. In 2018 she was a tester for the Minneapolis obstacle course, and in May 2019 she made her first run as a bona fide contestant, just before her 30th birthday. Hannah made it past the Seattle/ Tacoma qualifiers last year, placing fourth out of the top five women competitors, but didn’t make it past the city finals.

She kept on training. Then everything stopped.

A sudden change of plans “Two months ago I pretty much collapsed on a run,” Hannah said in an early January telephone conversation from her Iowa home. “I’m not a runner and I’m not going to pretend that I am, but it’s kind of my endurance. I force myself to do so many miles.”

At the time, she was in Iowa, and Hannah’s Apple Watch logged her heart rate at 195 beats per minute. The American Heart Association notes that the target heart rate for 30-year-olds exercising is 95-162 bpm, while the average maximum heart rate is 190 bpm.

“So on that run I was full force running and the ground started moving and just black came to my eyes and I just kind of melted to the ground.”

She curled up and told the people she was running with to give her a minute to regroup. She finished that run, but when she described her symptoms to a doctor, she was told to come in immediately. Doctors tested her for diabetes, asthma, low electrolytes and — despite Hannah being highly fit — they checked her heart. The electrocardiogram came back normal, but her doctor wanted more tests.

Hannah was given a heart monitor in mid-December and was told to do everything she could in the next 24 hours to make her heart do whatever it might have done when she collapsed.

So she went to the gym for two hours, where she decided to run to try to trigChristi Hannah’s heart is being monitored so doctors can try to understand what is causing her abnormal heart rhythms. Courtesy of Christi Hannah

What is ventricular tachycardia?

By Kyrie Long Alaska Pulse Monthly V entricular tachycardia is a type of abnormal heart rhythms that can endanger your health. Christi Marie Hannah, an “American Ninja Warrior” contestant, is in tremendous physical shape because of her training. But the electric signals that tell her heart when to pump don’t always fire correctly.

In explaining ventricular tachycardia, or V-tach, Dr. Romel Wrenn, a cardiologist with Fairbanks Memorial Hospital, started with cardiac arrhythmia.

Normally, when there are no issues with heart rhythm, the heart rate is between 60 and 70, according to Wrenn. The heart rhythm is set by the heart’s primary pacemaker — the sinus node. “It sends a signal to the atria and then down to the ventricle through this secondary pacemaker, the AV node, then it activates the pumping chambers — the ventricles,” he said.

In some cases, upper chambers may go out of rhythm because of some outlying areas of irritability. A person can develop atrial arrhythmia, where the atria, or upper chambers of the heart, beat out of sync or too fast, or a ventricular arrhythmia, where there is a focus in the ventricles, the lower heart chambers, that take over, according to Wrenn.

If an area in the main pumping chamber becomes irritable, it can start sending signals when it isn’t supposed to,

V-TACH » 25

ger the same response. It worked. Her doctors were monitoring her heart during the workout and called her to tell her to stop immediately and return to the hospital.

Ultimately it was an electrophysiology cardiologist who diagnosed Hannah with ventricular tachycardia. Something was very wrong in her heart’s electrical pathways.

Mixed signals Hannah’s doctors, using a process called cardiac ablation, wanted to fix her heart by destroying the part of it that wasn’t functioning properly.

When the day came for her procedure, everything went as planned — almost. She went to MercyOne hospital in Waterloo, Iowa, where doctors planned to insert a catheter in each of her femoral veins, located in the thigh, and then thread them up to her heart. The idea was to shock her heart so they could see which part of it was failing in order to destroy that tissue.

“It was interesting to see all of the little electrodes in my heart, just watching the video of it, you know, and seeing how he would control each one, setting them up and down and how they would need to go,” Hannah said.

Her doctor talked with her throughout the procedure, asking Hannah what she felt as the test proceeded.

They would shock her heart until it spiked and watch as her heart rate dropped and recovered.

At one point her heart rate rose above 280. Hannah said it felt as though someone was crushing her head but at the same time they were turning a knife in her chest. She could feel her heart spasming.

That was when they had to stop the process.

Hannah said her doctor came over and told her, “We have you at the most dangerous levels we can put you at and it’s not doing anything.”

Somehow, despite multiple readings on heart monitors while she was training, doctors didn’t find what they were looking for.

The next obstacle Going into the procedure, Hannah Christi Hannah coaches children and has maintained an optimistic mindset, despite her recent setbacks.

said she wasn’t afraid to die but was afraid to leave her children behind. She hasn’t talked about the subject with the kids she coaches at work beyond telling them she had to have an operation, but her own three children are a different story. Her oldest child, Emily, is 11, while the younger two, Michael and Logan, are 10 and 4. “With my own kids, they know quite a bit more about what’s going on, but I try to keep it pretty G-rated to where it’ll be OK. Kids are pretty smart,” Hannah said, after the ablation attempt.

The children have seen her on the worst days, when she has trouble getting up. “So for them, it’s definitely been scary for them.”

Although the ablation was inconclusive, it did bring some positivity. But it also brought some uncertainty.

Initially she was still planning to continue training following the ablation. She said there was some speculation during the procedure that, because of her rigorous training, her heart has the ability to recover from her episodes of ventricular tachycardia.

“There’s a good side of that, meaning that I won’t go into cardiac arrest,” she said. “They said that was surprising and that I can continue to train with my heart the way it is.”

The issue is figuring out what to do from here, though. It took some time for the catheter entrance sites to heal before she could go to the gym. Once they did, Hannah tried to work out again.

“I can’t do push ups consistently,” she said. “I can do 12 and my body was shaking so bad I couldn’t hold up. So I had to stop and usually I do 70 to 80 straight through.”

She hasn’t risked a workout again. “From the day that I tried, that was the only one I tried and that was scary enough for me that I’m just not going to push it.”

She said she’d like to try again, but she’s leery of doing anything at this point. Hannah says she can’t even stand at work for long periods of time.

Christi Hannah hangs from the door of the Fairbanks Rescue Mission.

V - TACH Continued from 23

thus starting an abnormal rhythm.

In Hannah’s case, her left ventricle is the one having trouble.

If the heart rate is above 100, doctors call it tachycardia, whether in the atria or the ventricles.

“If you take a normal person,” he said, “up to 4 percent of normal people can have bouts of ventricular tachycardia, where the ventricle becomes irritable and starts beating fast for up to, and in general, less than 30 seconds and we call that ‘non-sustained.’”

Non-sustained ventricular tachycardia, according to Wrenn, is generally not a problem unless someone has a weak heart. Most people can tolerate it, and in most cases doctors wouldn’t know about it unless people develop symptoms.

Generally, he noted, people notice the fluttering and become faint or notice their heart is beating fast.

Different complications can develop from V-tach. “The most common thing would be that if it’s sustained and if it’s fast enough, the person may have bouts of loss of consciousness,” Wrenn said. “If the heart is weak or in some cases, depending on how fast it’s going, it can lead to sudden cardiac death where the blood pressure drops and becomes so low that it goes from ventricular tachycardia, and this rhythm can worsen or degenerate into ventricular fibrillation, where the main pumping chamber isn’t pumping at all.”

Causes range from issues with medication causing low potassium or magnesium, to poor circulation, to genetic abnormalities. DR. ROMEL WRENN

Contact staff writer Kyrie Long at 459-7510. Email her at klong@AlaskaPulse. com.

Another ‘Ninja’ shot? As of right now, her next run on the “American Ninja Warrior” obstacle course is up in the air. She is supposed to compete in St. Louis in May.

If the heart trouble continues, she said the show’s producers probably won’t allow her to participate, but she doesn’t know yet.

“I’m still not giving up hope, if that says anything,” she said. “People keep asking if I’m still going to compete this spring and I’m like ‘Yep, I am.’”

The optimistic attitude is a bit of a theme for her.

She didn’t talk about what had been happening for months after the symptoms started. Then, one day in late December, Hannah made a post on her Facebook, telling people what had been going on. Ninja competitors posted many positive comments.

“Sometimes reality’s not the best part, but you can make a positive out of it,” Hannah said.

On Jan. 31 Hannah emailed an update for this story.

Her doctors had talked about trying to get her into the Mayo Clinic. In a testament to the drive of people who choose to run grueling obstacle courses time and time again, some of the ninjas she trained with for “American Ninja Warrior” work at the Mayo Clinic in Rochester, Minnesota, and contacted cardiologists themselves, asking the doctors there to look at her case.

She now has an appointment scheduled.

“It’s amazing when life comes full circle,” Hannah wrote.

Contact staff writer Kyrie Long at 459-7510. Email her at klong@AlaskaPulse.com.

Jody Tate, director of Gateway to Recovery, part of Fairbanks Native Association. Below is a view of the nurses’ station from the commons room. Photos courtesy of Fairbanks Native Association

No boundaries

FNA’s Gateway to Recovery saves lives

By Diana Campbell A ddiction has no boundaries. It can affect anyone: rich or poor, religious or atheist, mom or dad.

While many people can use alcohol without a problem or stop taking drugs without a struggle, there are some for whom alcohol and drugs becomes a real problem. That’s because the way their bodies interact with the misuse of alcohol or drugs can cause a physical dependence.

“There are physical changes in the brain,” said Brian Robb, the clinical director and physician assistant at Gateway to Recovery. “It’s an actual disease to overcome.”

Fairbanks Native Association’s Behavioral Health Department operates Gateway to Recovery, a 24-hour drug and alcohol withdrawal facility. Statistically, Alaska is third in the nation for substance and alcohol misuse. Gateway provides medication-assisted treatment for patients and is the only dedicated withdrawal center in Interior Alaska. “It saves lives,” said Steve Ginnis, executive director of Fairbanks Native Association. “Personally, I’m grateful for the help they have provided to hundreds of people suffering from addiction.”

Alcohol withdrawal help is the most

“Drugs and alcohol hijack that part of the brain that says you will do this or you will die. This is not a choice. It’s not a moral condition.”

— Brian Robb Gateway to Recovery

sought treatment at Gateway, which is important because unmanaged alcohol withdrawal can cause death. Opioid with- drawal also can cause death but to a lesser frequency than alcohol. The issue with opi- oid addiction is that people who try to kick it alone often go back to using, Robb said. Getting professional help for either gives people a better chance for recovery because of the nature of addiction. At Gateway, alcohol treatment can take three to five days. Opioid treatment can take three to 10 days.

People who are alcohol or substance dependent have substance use disorder, which medical professionals compare to chronic illnesses such as diabetes, hyper- tension, or asthma, according to a booklet by the U.S. Substance Abuse and Mental Health Services Administration.

The disorder is why it’s hard to stop using substances, even if the sufferer knows the use needs to stop.

“It’s a hijacker,” Robb said. “Drugs and alcohol hijack that part of the brain that says you will do this or you will die. This is not a choice. It’s not a moral condition.” Since 2005 Alaska has exceeded the per capita national average for alcohol con- sumption, according to an epidemiology report by the Alaska Department of Health and Social Services. Alaska is third highest state for excessive consumption, with Fair- banks having the highest excessive drink- ing rates in the state. About 23% of people here struggle with alcohol, above state and national averages.

Alcohol addiction is deadly. Being an alcoholic reduces lifespan by 30 years, Robb said. About 1 in 3 traffic accident fatali- ties in Alaska during 2012-2016 in Alaska were alcohol-related, according to the state report. One in five people who were hospi- talized because of an injury had suspected or proven alcohol use. Half of all adults

Top: A patient room, with a bathroom. The center has 10 beds. Center: A blood pressure monitor sits ready in the hallway. Patients are medically monitored while at Gateway. At left, sometimes patients come with only the clothes they’re wearing. The facility has a stock clothing closet. New socks are always welcome. Far left, Brian Robb, Gateway clinical director and physician assistant. All patients are medically screened to make sure they can go through withdrawal. Staff also check their vital statistics regularly.

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Gateway has a clothing closet with indoor and outdoor clothing and footwear.

have someone in their family who misuses alcohol, which could result in death, injuries, neglect and domestic violence, Robb said.

Drug misuse is just as dangerous. Drug-related deaths were five times greater for Alaskans ages 25 to 64 than any other age groups, according to the state report.

Yet treatment is hard to come by. Only 19% of 20.7 million nationwide who needed treatment were able to get it.

In Fairbanks, longer-term treatment facilities have an average 30-day wait. However, FNA’s Gateway to Recovery is open 24 hours a day with around-the-clock medical staff. Patients, both men and women, can be referred or can walk in.

The facility’s windows provide plenty of natural light. There are double and single rooms, for a total of 10 beds. The facility has a nurses’ station, a commons area, staff offices, a laundry room and a patient kitchen.

A patient will first be given an intake assessment by a nurse. Once admitted, patients are given a pair of scrubs to wear and assigned a bed. They are given food even if it’s not during a scheduled meal time.

Patients are checked every 30 minutes by staff. Appropriate medications are prescribed: benzodiazepines for alcohol withdrawal; and clonidine, Suboxone and medications for nausea, vomiting and anxiety for opioid withdrawal.

The stay is voluntary, said Jody Tate, Gateway to Recovery’s director.

“Our doors are not locked,” Tate said. “People have to want to be here.”

They often see the same people, which Tate takes to mean people see Gateway as a safe place to be.

Staff members don’t want the facility to be known as just a detox center. It’s more, said Robb, the clinical director and physician assistant.

“Gateway to Recovery is a good name for us, because we are a gateway,” he said. “This is very often the first step toward recovery.”