HEALTH CARE October 2020
THE DAYS ARE GETTING DARKER
don’t let your spirits: how to handle SAD in 2020
YOUR RISK OF BREAST CANCER MAY BE IN YOUR GENES learn more on pg. 22 Meet Alaska’s Chief Medical Officer,
DR. ANNE ZINK
15 YEARS OF SERVICE!
2005 2020 Restoring health and hope to Alaskans with donated health care for 15 years! “If I hadn’t found APA, I wouldn’t have gotten my surgery or gotten my life back.” APA Patient A.M. “Anchorage Project Access gives people hope when they may have lost hope. Sometimes it takes a lot of humility to say, “I need help.” It’s been a real life changer for me personally.” APA Patient Y.C.
CELEBRATING 15 YEARS AS ALASKA’S HEALTH CARE SAFETY NET IN PARTNERSHIP WITH ANCHORAGE’S FINEST
physicians, dentists, advanced practitioners, surgery centers, hospitals, physical therapists, primary care clinics and allied health professionals providing critically needed donated medical and dental care to Alaskans without access to health care.
ANCHORAGE PROJECT ACCESS EXTENDS OUR DEEPEST APPRECIATION TO CHRISTIAN HEALTH ASSOCIATES, TO OUR SUPPORTERS THROUGHOUT THE COMMUNITY, AND TO OUR GENEROUS AND COMPASSIONATE VOLUNTEER PROVIDERS, BOARD MEMBERS, FUNDERS AND STAFF. Since its inception, Anchorage Project Access has coordinated over 650 physicians, dentists and allied health professionals who have provided over $49.3 million in donated health care to individuals with limited resources and without health insurance.
APA has enrolled over 5,000 patients, who, on average, have received 3 or more individual specialists donating care per patient
APA has scheduled over 18,000 patient appointments for donated health care
APA has provided over 6,000 assistance sessions helping Alaskans apply for health insurance
100% of all APA patients have established a primary care health home
“Wherever the art of Medicine is loved, there is also a love of humanity” Hippocrates Anchorage Project Access 2401 E. 42nd Ave Suite 104 Anchorage, AK 99508 907.743-6600 Anchorageprojectaccess.org
This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $935,785 with 82.9 percentage funded by HRSA/HHS and $160,000 amount and 17.1 percentage funded by nongovernment source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA/HHS, or the U.S. Government.
October 2020 | HEALTHCARE
To increase access to health care for low-income, uninsured individuals by coordinating a network of committed and compassionate volunteer providers.
Dr. Wynd Counts, MD
Dr. Wendy Cruz, MD
Dr. Kristina Eaton, MD Dr. Jessica Goldberger, MD Dr. Allison van Haastert, MD
Katie Ulmer – MSN, FNP Winifred Koehler – MN, WHNP Migel Hadley – MSN, FNP
Minimally Invasive and Robotic – Assisted Surgeries, Prenatal Care, Infertility, Gynecology, Contraception and Mona Lisa Touch Laser
2741 DeBarr Road, Suite C205 • Anchorage, Alaska 99508 (907) 279-2273 * Fax (907) 258-7705
www.wcakobgyn.com Preferred Providers with:
Blue Cross, Aetna, Tricare, Multiplan, Cigna, MODA, UHC
HEALTHCARE | October 2020
WAYS TO PROTECT YOUR HEART By Cynthia Sass, M.P.H., R.D., Premium Health News Sevice, www.diabeticlivingonline.com
Healthy habits can go a long way in protecting your heart. Adopting these 10 habits can help you lower your risk of heart disease, high blood pressure and high cholesterol — and they can help you feel great, to boot!
1. HIT THE SACK Getting enough sleep is an important part of a healthy lifestyle. If you regularly wake up unrefreshed despite a good night’s sleep, talk to your doctor about the possibility of a sleep disorder, which may increase your risk for heart disease.
2. PLAY A GAME. You don’t have to be good at tennis to enjoy burning around 400 calories per hour. According to the American Heart Association, physical activity helps you lose weight, which makes it easier for your heart to work efficiently. Set a date for racquetball, Frisbee, badminton, croquet, golf — you might not even notice you’re exercising.
3. GO NUTS. Squirrel away a handful of nuts or a packet of squeezable almond butter for a powerful snack that’s rich in hearthealthy omega-3s. Walnuts and almonds pack the biggest punch, but hazelnuts, pecans and pistachios can boost HDL (good) cholesterol levels, too. Or work nuts into your meals and snacks: chopped nuts add flavor as a salad topper, and spreads are perfect for apple or celery dipping.
reason to unravel the yarn? It’s hip to knit: look for a knitting group in your area, or start your own!
6. SHAKE THE SALT HABIT. Sodium increases blood pressure, which taxes the heart. Hide the table salt and control ingredients by cooking meals at home. The Dietary Guidelines for Americans recommend that adults consume no more than 2,300 milligrams of sodium per day and the American Heart Association recommends further restricting sodium to no more than 1,500 mg.
7. CONSIDER A MED. High blood pressure is the most significant factor for stroke risk. While eating right, losing weight and cutting back on salt can help, some people are genetically predisposed to hypertension. Ask your doc if a medication might help control yours.
8. MAINTAIN A HEALTHY WEIGHT. If you’re over your healthy weight, losing as little as 5 to 10 pounds may help lower your blood pressure.
9. EAT MORE FIBER.
One serving of nuts equals a small handful — 1.5 ounces — of whole nuts or 2 tablespoons of nut butter.
Foods rich in fiber may help lower your risk for heart disease, stroke, obesity and Type 2 diabetes. Look for heart-healthy and nutrient-dense recipes that incorporate whole grains, vegetables and fruit.
4. STOP SMOKING.
10. GET A DOG.
Smoking damages your heart and lungs, and tobacco use remains the most preventable cause of early death in the United States. Smokers are more likely to develop atherosclerosis — buildup of fatty substances in the arteries — which can lead to coronary heart disease and stroke. Quit smoking and you’ll have a higher tolerance for heart-healthy physical activity too.
5. CHILL OUT. Excessive stress can wreak havoc on your health, contributing to high blood pressure and making the heart work harder — potentially leading to a stroke. The AHA recommends sewing, knitting and crocheting among many stress management techniques. Need another
October 2020 | HEALTHCARE
Or volunteer at the Humane Society or ASPCA. The CDC cites that pets can decrease your blood pressure, cholesterol and triglyceride levels, adding to a hearthealthy lifestyle. Plus, petting an animal can lower stress hormones. Diabetic Living is a magazine and website with a mission to give people with diabetes (PWDs) and the people who love and care for them the information needed to make the best health decisions in their dayto-day diabetes care. Online at www.diabeticlivingonline.com.
lling o r n E for now y 4th ar Janu art! st
Become one at nightingale.edu
Feel at Home with Yourself
Tai Chi In-Person and Zoom Classes Slow Down Be Mindful
Yurt Health and Wellness, LLC firstname.lastname@example.org (907) 201 2136 Yurthealth.com HEALTHCARE | October 2020
Afraid of getting a mammogram? You’re not alone.
SPONSORED: Here’s everything you ever wanted to know about your first mammogram, from how long it takes to what it will feel like -- and why you shouldn’t put it off any longer. Presented by Providence Imaging Center As a radiologist with a specialty in breast imaging, Dr. Heather Tauschek looks at as many as 7,000 mammograms every year. But when she turned 40 and it came time for her own first mammogram, Tauschek admits: She was scared. That’s right. Even a doctor who reviews anywhere from 60 to 100 mammograms every single day was a little bit afraid to get one herself. “I have the world’s worst white coat syndrome,” Tauschek said. “My heart races. I get nervous.” It’s not unusual to be nervous about getting a mammogram. In fact, fear is one of the most common reasons women put off the routine screening. “It’s very commonly an emotional experience,” said Lauren Jager, the mammography supervisor at Providence Imaging Center. “That’s super normal. It’s kind of nerve wracking. You’re getting checked for cancer.” But a mammogram doesn’t need to be a scary experience. If you know what to expect, you’ll find it’s a lot less intimidating -- and a lot more pleasant -- than you imagined.
What happens at a mammogram? A screening mammogram starts out just like any other visit to the doctor, and these days, that means some extra measures to prevent the spread of COVID-19. Providence Imaging Center, where Jager works, is located inside Providence Alaska Medical Center. When you enter the hospital, you’ll have a quick screening with a temperature check and a few questions about your health. At the imaging center, you check in just as you would at your regular doctor’s office, after which you’ll go into an exam room, where you’ll undress completely from the waist up and change into a hospital gown. (You can also ask for a warm robe, Jager added.)
Equipment has been redesigned to compress differently and for shorter periods of time. Many patients are able to take advantage of SmartCurve paddles, new equipment that curves around the breast and makes the experience more comfortable. The position, configuration and equipment that work best will vary from patient to patient. “We’re making sure that each individual person gets the best exam for them,” Jager said. “One of the things about breasts is that nobody is shaped the same. We’re kind of making sure that each patient, all of their breast tissue has been imaged and imaged well.” Typically, the imaging technologist will take two images per breast: Topto-bottom and side-to-side. Sometimes they may need to get additional pictures, especially if your breast tissue is dense (which is common among younger women). If they’re having a hard time getting an image of the area behind your nipple, they may take some “nipple in profile” pictures as well. You’ll repeat the process on the other side, and then, as quickly as it started, your appointment will be over. “It’s super quick,” Jager said. “You’re pretty much in and out of here within 20 minutes. The radiologist looks at it later that day. Almost everybody leaves saying ‘That wasn’t bad at all.’”
How do you prepare for a mammogram? There are a few things you should know about your mammogram ahead of time. For one thing, if you menstruate, you may want to book your appointment for the week after your period, when your breasts will be least tender. If you think the compression might leave your breasts feeling sore, you might want to take some aspirin or ibuprofen before your visit. And when getting ready for your appointment, be sure not to apply deodorant or any creams, lotions or perfumes in the area of your armpits or chest. They can show up on your mammogram, which could lead to you being called back in unnecessarily. When Tauschek went in for her first screening, she recruited two friends to schedule mammograms at the same time so they could offer one another moral support. “There is an element of fear,” Tauschek said. “You don’t know what to expect. We live in Alaska, it’s cold, you have to disrobe. It’s just awkward.”
Once you’re ready, an imaging technologist like Jager will come in and go through a fairly detailed health history questionnaire, and then it’s time to capture some images.
One other important thing to know about your first mammogram: It is not uncommon to be asked to come back for additional images.
The mammography machine is large, and you’ll stand next to it and be asked to position your body so that your breast is in the best possible spot. A pair of large paddles will gently compress your breast, and you’ll be asked to hold your breath and stay very still while the images are being recorded.
Mammography is regulated by the Food and Drug Administration, so imaging clinics are required to track their statistics and ensure the safety and accuracy of their tests. Generally, Tauschek said, no more than 10 percent of patients should be called back for a diagnostic mammogram or ultrasound. Of every 10 patients who are called back, eight or nine will turn out to have nothing to worry about.
This is the part that makes some people nervous. And Jager said she understands; it’s a little weird to think of putting your breast between two pieces of plastic to be squeezed, even if it’s a gentle squeeze. “We do use compression,” Jager said. “That’s how we get the good pictures.” But while the screening feels awkward and possibly uncomfortable, it shouldn’t be painful. If it is, Jager said: Speak up. Often there are adjustments that can be made to help. “The technology has gotten so much better, even since I started doing mammograms about eight years ago,” Jager said. “Patients who haven’t come in in a few years always comment on how much better it is.”
“A lot of people freak out when they get called back, but the majority of people who do get called back don’t have anything wrong at all,” Tauschek said. It’s very common for first-time mammograms to require some follow-up because there aren’t any existing images to examine for comparison. Once you’ve had a few mammograms, there’s a record of what “normal” looks like for your breasts. “Sometimes breast cancers can be very subtle in imaging,” Tauschek said. “Having a comparative exam is really what tips you off that there’s been a change. Some things are easy to look at, but some can be really, really subtle.”
And what exactly is Tauschek looking for when she reviews those 6,000 to 7,000 mammograms every year? “One thing we look for is calcification,” Tauschek said. “It’s kind of like grains of sand or calcium like you would have in the shell of an egg. There are lots of benign causes of calcification, but there are other types of calcifications that are cancerous.” Tauschek also looks for “architectural distortion,” or a place where tissue starts to pull together in sort of a star shape, as well as subtle changes in breast tissue density. “They are looking for anything that looks like a mass,” Jager said. “They are looking for anything that looks asymmetric. There’s just a lot of different things -- (the radiologists) have the eagle eyes.”
When should you start getting mammograms? Over the past decade or so, there has been some debate about when and how often women should have screening mammograms. The American Cancer Society recommends women have the option to receive annual mammograms starting at age 40 and strongly recommends annual screenings from 45 to 54, with biannual mammograms starting at age 55. The American College of Radiology and the Society of Breast Imaging recommend annual mammograms beginning at age 40, and Tauschek concurs. “Screening mammograms, in countless studies over very large populations, have been shown to decrease breast cancer deaths and morbidity,” Tauschek said. According to the American Cancer Society, breast cancer death rates decreased by 39 percent between 1989 and 2015. The change is attributed both to improved treatment and to the advent of mammography, which came into widespread usage in the mid-1980s. And spotting cancer earlier can often mean less intensive treatment and better outcomes. Patients whose breast cancer is detected in the “localized” stage, before it has spread to any other areas of the body, have a 98.9 percent five-year survival rate, according to the National Cancer Institute. That drops to 85.7 percent among patients whose cancer has spread to their lymph nodes, and 28.1 percent among patients whose cancer has metastasized, or spread to other systems of the body. “By finding things earlier and when they’re smaller, you decrease the number of women that die from breast cancer,” Tauschek said. Don’t let financial concerns stand in your way, either. The Affordable Care Act requires that most health insurance plans cover annual or biannual mammograms with no copay starting at age 40, and the State of Alaska sponsors a program called Ladies First that helps provide nocost mammography and other preventive services based on income. Most importantly, Jager said, don’t let fear keep you from scheduling a screening mammogram, whether it’s fear of COVID, fear of the procedure, or fear of what you might learn. Hospitals and clinics have strong disease prevention controls in place, and when it comes to breast cancer, research indicates that early detection saves lives. “Breast cancer is not going to go away,” Jager said. “Mammography is still really important. I just really hope that people aren’t putting off this particular exam and seeing it as something that’s elective.” Providence Imaging Center is a full-service diagnostic imaging clinic located in Anchorage and Eagle River. Learn more about mammography and the importance of breast health screening at ProvImaging.com.
This story was produced by the creative services department of the Anchorage Daily News in collaboration with Providence Imaging Center. The ADN newsroom was not involved in its production.
October 2020 | HEALTHCARE
CAN EXERCISE HELP TREAT ANXIETY? By John J. Ratey, M.D., Premium Health News Service, Harvard Health Blog
Chances are good that you, or someone you know, is dealing with anxiety. One in five Americans over 18, and one in three teenagers 13 to 18, reported having a chronic anxiety disorder during the past year. And when I talk to college students, they’re not at all surprised that a whopping 63% of students felt tremendous anxiety during their freshman year, according to a report by the National College Health Association. The toll of anxiety can be high: It increases a person’s risk for other psychiatric disorders like depression, and it can contribute to diabetes and cardiovascular problems. One sobering study shows that people with anxiety tend to be more sedentary and do less intense forms of physical activity, if any. That’s ironic, because lacing up your sneakers and getting out and moving may be the single best nonmedical solution we have for preventing and treating anxiety. As a psychiatrist who studies the effects of exercise on the brain, I’ve not only seen the science, I’ve witnessed firsthand how physical activity affects my patients. Research shows aerobic exercise is especially helpful. A simple bike ride, dance class or even a brisk walk can be a powerful tool for those suffering from chronic anxiety. Activities like these also help people who are feeling overly nervous and anxious about an upcoming test, a big presentation or an important meeting.
Moving your body decreases muscle tension, lowering the body’s contribution to feeling anxious. Getting your heart rate up changes brain chemistry, increasing the availability of important anti-anxiety neurochemicals, including serotonin, gamma aminobutyric acid (GABA), brain-derived neurotrophic factor (BDNF), and endocannabinoids. Exercise activates frontal regions of the brain responsible for executive function, which helps control the amygdala, our reacting system to real or imagined threats to our survival. Exercising regularly builds up resources that bolster resilience against stormy emotions.
THE DETAILS So exactly how much exercise does one need to protect against episodes of anxiety and anxiety disorders? While pinpointing this is not easy, a recent meta-analysis in the journal Anxiety-Depression found that people with anxiety disorders who reported high-level physical activity were better protected against developing anxiety symptoms than those who reported low physical activity. Bottom line: when it comes to treating anxiety, more exercise is better. If you’re just starting out, don’t despair. Some research also shows that just a single bout of exercise can help ease anxiety when it strikes. Which type of exercise you choose may not matter greatly. Studies point to the effectiveness of everything from tai chi to high-intensity interval training. People experienced improvement no matter which types of activity they tried. Even general physical activity is helpful. The important thing is to try activities and keep doing them.
TO MAXIMIZE THE BENEFITS: • • • •
Choose something enjoyable so you will do it repeatedly, building resilience. Work toward getting your heart rate up. Work out with a friend or in a group to reap the added benefit of social support. If possible, exercise in nature or green space, which further lowers stress and anxiety.
While scientific studies are important, you don’t need to consult a chart, statistics or an expert to know how good you feel after working up a sweat. Remember those feelings and use them as motivation to do something physical every day. Time to get up and get moving!
HOW DOES EXERCISE HELP EASE ANXIETY? •
Engaging in exercise diverts you from the very thing you are anxious about.
John J. Ratey, M.D., is a contributor to Harvard Health Publishing. HEALTHCARE | October 2020
WEATHERING THE SEASONAL STRUGGLE TAKING CARE OF MENTAL HEALTH TAKES PRECEDENCE DURING A PANDEMIC WINTER
BY BAILEY BERG
t’s not uncommon to feel blue during the winter, especially in Alaska, where sunlight is scarce and the season is long. The culprit doctors often point to Seasonal Affective Disorder (SAD), a type of depression that’s related to the changing seasons. It can present itself in myriad ways, including: having low energy levels, problems sleeping, changes in appetite or weight, having difficulty concentrating, a sense of hopelessness, dark thoughts and beyond.
“This year, because of the coronavirus, we’ll probably have a tendency to stay in our homes and be more separated from people, which is going to exacerbate some of the symptoms we experience along with Seasonal Affective Disorder,” Buckingham said.
“People with Seasonal Affective Disorder experience these symptoms to an extent that it’s disruptive to their daily life,” said Sara Buckingham, Assistant Professor of Clinical-Community Psychology at University of Alaska Anchorage. “They might find it hard to go to work, have social relationships or interact with daily life. It starts to disrupt our functioning and that’s when we get worried about it.”
“I think the best thing people can be thinking about is how they generally cope and how can they modify their coping mechanisms for the moment that we’re in,” Buckingham said. “For a lot of us coping might look like going out with friends and talking at a restaurant, but that’s not as feasible right now, so how can we adapt that?”
While not a new concept, this year may be more challenging for 49th state residents. After everything that 2020 has piled on, ranging from social distancing to nationwide turmoil, SAD could prove to be a more substantial burden than usual. In a normal year, it can be challenging to be social when you’re in a funk. With mandates calling for business closures and keeping social circles small, this winter will likely be even more difficult to connect with others.
October 2020 | HEALTHCARE
While that may sound gloomy, there are things you can do to keep your spirits up. Albeit, you may need a bit more creativity to figure out what will work for you.
EXERCISE AND OTHER TYPES OF PHYSICAL ACTIVITY HELP RELIEVE STRESS AND ANXIETY, BOTH OF WHICH CAN INCREASE SAD SYMPTOMS. BEING MORE FIT CAN MAKE YOU FEEL BETTER ABOUT YOURSELF, TOO, WHICH CAN LIFT YOUR MOOD.
A few small things Buckingham said Alaskans can do to prevent or mitigate the effects of SAD include keeping a routine and pushing ourselves to engage in activities. “What ends up happening is if we stop engaging in activities, we start to feel worse and more sluggish,” Buckingham said. “And then we spiral down, so we stop doing even more activities because we feel tired and sluggish, which makes us more tired and sluggish and have a more depressed mood. So scheduling ourselves out and engaging in
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activities that are getting us moving, that’s going to be really important. Mayo Clinic echoes that, saying “exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.” Beyond being active and keeping a schedule, other things often credited for lessening the weight of SAD include maintaining a healthy diet, being well rested and preserving social connection with friends and family, even if it’s just talking over the phone or on a video conferencing platform. Because the waning light in the winter plays a big role in SAD, many experts recommend getting outside in the afternoon, while the sun is at its peak. If that’s not possible, some professionals say people can find light therapy boxes - sometimes known as “happy lights” and “SAD lamps” - helpful, as the lamps are intended to mimic natural outdoor light. The National Alliance of Mental Illness recommends even just 30-minutes of use - such as in the morning, while you get ready for your day - to increase your mood. Studies have shown that the daily light therapy can help improve the mood of 60 to 80 percent of people with SAD. However, Buckingham recommends talking with your medical professional about what kind of lamp would work best for you. There are a plethora of lights on the market, but often, she said, you get what you pay for.
If those coping mechanisms prove to not be enough and you still feel overwhelmed, Buckingham said that’s when it’s important to reach out to a mental health professional, as “those folks are trained to help people.” “I think it’s important to keep in mind, too, that people are incredibly resilient and this is something we go through every season,” Buckingham said. “It’s really important to figure out what works for you and to make sure that we’re reaching out for help when we need it.”
REFERENCES: • • •
https://www.mayoclinic.org/diseases-conditions/seasonalaffective-disorder/diagnosis-treatment/drc-20364722 https://www.nami.org/About-NAMI/NAMI-News/2013/ Less-Sunlight-Means-More-Blues-for-Some https://pubmed.ncbi.nlm.nih.gov/2679625/
HEALTHCARE | October 2020
Dr. Tony Nimeh Fairbanks Urology Dr. Tony Nimeh 907.331.0932
Fairbanks Urology Also servicing patients 907.331.0932 in Anchorage
Also servicing patients in Anchorage Start
References 1. Berry, et al., J Urol 1984; 2. Speakman et al., 2014 BJUI International; 3. AUA BPH Guidelines 2003, 2010, 2018 amended 2019; 4. Lokeshwar, Transl Androl Urol 2019; 5. Miano, Med Sci Monit 2008; 6. Mirakhur, Can Assoc Rad J 2017; 7. Woo, BJUI 2011; 8. McVary, J Urol References 2016; 9. Gilling, Can J Urol 2020; 10. Kadner, World J 1. Berry, et al., J Urol 1984; 2. Speakman et al., 2014 Urol 2020; 11. Roehrborn, et al., J Urology 2013; BJUI International; AUA BPH Guidelines 2003, 2010, 12. Naspro, Eur Urol3.2009; 13. Montorsi, J Urol 2008; 2018 amended 4. Lokeshwar, Transl etAndrol 14. McVary, J Sex2019; Med 2014; 15. Roehrborn, al.,CanUrol 2019; 5. Miano, Med Sci EU Monit J Urol 2017; 16. Sonksen Urol2008; 2015 6. Mirakhur, Can
of the prostate (PVP). Although symptom relief What Are the Symptoms of Enlarged the prostate (PVP). Although symptom relief What Are Symptoms of Enlarged may notofoccur immediately, these treatments Prostate and the When Should Men See a may not immediately, Prostate and When Should Men See a may provide the occur most symptom relief these of any treatments Urologist? procedure last a the longmost time. symptom However, these Over 70% of men in their 60s have an enlarged mayand provide relief of any Urologist? typicallyand require anesthesia, prostate, also commonly known as have Benign procedure last general a long time. 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Frequent needcannot to urinate both day andyour night Invasive Treatment Option? • A•sense that you completely empty • Weak or slow urinary stream Can You Describe An Available Minimally bladder I’m very excited to offer my patients a proven, • A sense that you cannoturination completely empty your Invasive Treatment Option? • Difficulty or delay in starting minimally invasive option to treat enlarged bladder • Urgent feeling of needing to urinate ® prostateI’m called UroLiftto verythe excited offer myThe patients System. UroLifta proven, • A•urinary stream that stops and starts Difficulty or delay in starting urination Systemminimally is the onlyinvasive leading enlarged option toprostate treat enlarged • Urgent feeling offrom needing urinate a ® Many men who suffer BPH to experience procedure that does notthe require heating, cutting, prostate called UroLift System. The UroLift 2 stops and starts 4-10 • A urinary stream that reduction in quality of life, or destruction of prostate tissue. so it’s important to see Here’s howprostate System is the only leading enlarged a Urologist if these persist. a urologistthat candoes use the System Many men whoproblems suffer from BPH experience a it works: procedure notUroLift require heating, cutting, device to lift and move the enlarged prostate 2 What Treatment Options AresoAvailable? reduction in quality of life, or destruction of prostate tissue.4-10 Here’s how it’s important to see tissue out of the way so it no longer blocks Treatment options for enlarged prostate range a Urologist if these problems persist. it works: a urologist can use the UroLift System the urethra (the passageway that urine flows from medications to surgery; some minimally device to lift and move the enlarged prostate through). Implants are placed to hold the tissue Whatprocedures Treatment Are in Available? invasive canOptions be performed a tissue out of way socurtain, it no longer blocks back, like tiebacks onthe a window leaving Treatment options for enlarged prostate range Urologist’s office. the urethra (the passageway that urine from medications to surgery; some minimally an unobstructed pathway for urine to flow more flows Medications can be helpful in relieving BPH easily. through). Implants are placed to hold the tissue invasive procedures can be performed in a symptoms for some men, however, patients must back, like tiebacks on a window curtain, leaving Urologist’s office. What are the Benefits of the continue taking them long-term to maintain the an ® unobstructed pathway for urine to flow more UroLift System? effects. An issue can withbe prescription is Medications helpful inmedications relieving BPH easily. The UroLift System is the only leading BPH thatsymptoms their effectiveness be however, inadequatepatients and for somemay men, must procedure shown not Benefits cause new of onset, What aretothe the they may cause dizziness, fatigue, and continue taking them long-term tosexual maintain thesustained erectile 3,11-14 ® or ejaculatory dysfunction. 3 UroLift System? dysfunction. effects. An issue with prescription medications Compared is BPH procedures, the only UroLift System Theto UroLift System is the leading BPH As that a result, men choose to be discontinue theirmany effectiveness may inadequate andtreatment has a strong safety profile with minimal medications for BPH. procedure shown to not cause new onset, 3 they may cause dizziness, fatigue, and sexual side effects. sustained erectile or ejaculatory dysfunction.3,11-14 3 Water vapor therapy uses water vapor, or steam, dysfunction. What to Expect After theprocedures, Procedure? Compared to BPH the UroLift System to remove prostate tissue. treatments, As a result, many menHeat-based choose to discontinue Patients usually go home the same day profile and with minimal treatment has a strong safety including water vapor therapy, are less invasive medications for BPH. typicallyside no catheter effects.3is required after the than surgical options and can be performed procedure. Patients can experience some light Water vapor therapyThese usestherapies water vapor, or steam, under local anesthesia. provide to Expect After pelvic the Procedure? blood inWhat the urine and short-term pain. to remove prostate Heat-based moderate symptom relieftissue. for some patients. treatments, Patients usually home the same day and Symptom improvement isgo demonstrated as early including water vapor therapy, are less invasive Surgical treatments that involve removal of as two typically weeks and may continue to improve up the to no catheter is required after than surgical options and can be performed 11 prostate tissue include transurethral resection three months. Patients can usually quickly return procedure. Patients can experience some light under local (TURP) anesthesia. These therapies provideto normal activity.15,16 of the prostate and photovaporization blood in the urine and short-term pelvic pain.
moderate symptom relief for some patients.
Surgical treatments that involve removal of prostate tissue include transurethral resection of the prostate (TURP) and photovaporization
Assoc Rad J 2017; 7. Woo, BJUI 2011; 8. McVary, J Urol 2016; Gilling, Results9.may vary.Can J Urol 2020; 10. Kadner, World J Indicated theRoehrborn, treatment ofetsymptoms of an 2013; enlarged prostate up to 100cc in men 45 years or older. Urol 2020;for11. al., J Urology As with any medical vary. Most common side effects are temporary 12. Naspro, Eur Urolprocedure, 2009; 13.individual Montorsi,results J Urolmay 2008; andMcVary, include pain burning with15. urination, blood in urine, pelvic pain, urgent need to urinate and/or 14. J Sexor Med 2014; Roehrborn, et the al.,Can control the urge.11 side effects, including bleeding and infection, may lead to a serious Jthe Urolinability 2017;to16. Sonksen EU UrolRare 2015 outcomes and may require intervention. Speak with your doctor to determine if you may be a candidate.
Results may vary. ©2020 NeoTract, Inc. All rights reserved. MAC00530-01 Rev B Indicated for the treatment of symptoms of an enlarged prostate up to 100cc in men 45 years or older. As with any medical procedure, individual results may vary. Most common side effects are temporary October 2020 | HEALTHCARE and include pain or burning with urination, blood in the urine, pelvic pain, urgent need to urinate and/or the inability to control the urge.11 Rare side effects, including bleeding and infection, may lead to a serious outcomes and may require intervention. Speak with your doctor to determine if you may be a candidate.
©2020 NeoTract, Inc. All rights reserved. MAC00530-01 Rev B
Symptom improvement is demonstrated as early as two weeks and may continue to improve up to three months.11 Patients can usually quickly return to normal activity.15,16
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DR. ANNE ZINK, ALASKA’S CMO BY BAILEY BERG
When Dr. Anne Zink, Chief Medical Officer for Alaska, is deciding how to proceed, she remembers what a former attending doctor told her: “Do what’s right for the patient and remember the rest is noise.” “It’s been my guiding professional principle,” Zink said. As a former emergency medicine physician, she sees her patients as the people of Alaska, people who she is tasked with making healthier. It’s a job that has become all the more important this year thanks to the coronavirus pandemic, bringing her into Alaskans homes via virtual town halls and response updates.
FROM FINE ART STUDENT TO CHIEF MEDICAL OFFICER Growing up in Colorado as the daughter of two physicians, Zink told herself she never wanted to be a doctor. However, after college, where she majored in organic chemistry and fine arts, she completed a fellowship in Nepal, Botswana and Antarctica. The experience changed how she saw the interface between science and people. While in Botswana, she saw first-hand how much HIV was affecting the community, presenting an “ah-ha” moment for her future career. “Where people lived, how they interacted, their cultural beliefs, tourism money, access to medications — all these play a huge role in people’s overall health and life,” Zink
2020 | HEALTHCARE
said. “And if you don’t have your health, it’s hard to have much of anything else. I really liked the clinical interactions there and was really inspired by this intersection between science and humanity that I saw in medicine. It was really then that I was like, ‘I think this is what I want to do, I think this is where I belong’.” She went on to study at Stanford Medical School, where she realized that she was more interested in rural and whole person medicine — as opposed to specialized medicine — and spent her residency at University of Utah, focusing on emergency medicine and looking at systems of care that think about the whole process, rather than individual medicine. When it was time to look for a job, her husband, an Alaskan she’d met while working as a summer mountaineering guide, asked if they could move back to the 49th state full-time for a few years. “I ended up taking a job at Mat-Su (Regional Medical Center), which was about as urban as he could live and about as rural as I could practice,” Zink said. “I quickly fell in love with both the people and the place, but I think more importantly, the medicine. I love the sense of the community taking care of each other’s health, rather than just the institute of medicine as a whole.” In that role, Zink became involved in the opioid epidemic and behavioral health care, after becoming frustrated with the purgatory patients would wait in to get care. In an effort to determine what social factors and broken health care system parts were making it hard for people to get the care they needed, she started the High Utilizer Mat-Su Program.
After 10 or so years at Mat-Su Regional Medical Center, Zink decided she needed a change; her family took a sabbatical year to travel and work abroad. While she was doing clinical work in Bhutan in January 2019, then-Chief Medical Officer Jay Butler was offered the position as the Deputy Director of Infectious Disease at the CDC. “We talked and he said, ‘I think you should consider this job’,” Zink said. After finishing her commitment abroad, she returned to Alaska and stepped into the role as CMO. “And it’s been quite a whirlwind year since,” Zink said.
THE NOT SO NORMAL DAY-TO-DAY In a normal year the role of a CMO is to oversee public health in its many forms, ranging from the divisions of Women and Children’s Health and Office of Substance Misuse, Addiction and Prevention to EMS and Disaster Response to the various labs and the Medical Examiner’s Office. “So essentially overseeing all public health and providing a clinical voice within the larger Department of Health and Social Services,” Zink explained. This isn’t a normal year, however. The coronavirus pandemic has affected all realms of health care and all Alaskans in a number of ways. “Initially it was a lot of scrambling parts,” Zink said of the early days of the pandemic. “Watching the cases for China super carefully, trying to get a sense of what this really looks like, trying to understand the disease and the process that we could test for and how contagious was it, what sort of role did asymptomatic spread play and the rest of it.” From there, it was more logistics based: how can we purchase PPE, how can we make sure tests happen and how can we get the public as informed as possible.
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“It was all-consuming for quite some time there,” Zink said. “But we’ve been trying to move out of that kind of emergency response as quickly as possible and as soon as cases started to go down, we quickly were trying to figure out how to get into a more regular pattern.” While every state and each department within are required to have a pandemic flu plan in preparation and ready to go at all times, it needed to be modified to fit the parameters of the particulars of COVID-19. For Alaska that looked like bringing on additional help, expanding labs — Alaska’s lab does around 3000 COVID tests a day, Zink said— creating a whole new IT and web system, contract tracing and figuring out how to work
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with different communities to make sure there was readily available testing. Beyond trying to maintain a hold on the pandemic, Zink said it’s also important to not drop the ball on the other work the state is doing. Right now Alaska is experiencing the highest rate of syphilis cases ever, as well as TB outbreaks. “We still need to make sure that we’re the ones who respond if there’s an earthquake or when there was a tsunami warning or if there’s a plane crash with multiple victims,” Zink said. “And also making sure chronic work continues. We see even more in this pandemic the importance of good weight control and minimizing heart disease and diabetes and hypertension. So making sure that’s all happening on a regular basis.” Something that Zink and her team will be stressing in the coming weeks and months is the importance of getting a flu vaccine and staying home if you’re feeling unwell. It’s a move that will help minimize the risk of hospitalization and death, not just for oneself, but others you may encounter in your day-to-day life. “We need people to winterize, overall,” Zink said, adding that includes not going to school or work if they feel symptomatic at all, getting tested at the beginning of any symptoms, making a plan for if you need to isolate and thinking about how to address physical and mental health.
instead of just response,” Zink said. Zink said a notable result in going through the pandemic is that a light has been shown on the inequities that exist within societies as a whole — something she hopes will be in more conversations about what a healthy community looks like going forward. “If someone doesn’t have a room to isolate in and they’re ill, it’s really hard to keep them from spreading it to others,” Zink said. “Or if they live in a community with no running water, it’s hard to wash your hands all the time. There’s been this dual response of both responding to the pandemic and trying to prevent the pandemic at the same time.” But even looking back at the last few months, Zink said she’s been wowed by how people across the spectrum have come together to problem-solve, and how science and technology have come together to support health. “I think about how much better we are at preparing for COVID patients now than we were in April, and I think about how much further we’ll be in six months,” Zink said. “We’re moving at lightning speed and it’s pretty impressive to watch. I believe we’re just going to get closer and closer to many more options and hopefully we will be able to build systems of resiliency and prevention through it to create communities of more health and more wellness.”
A GLIMMER IN THE DISTANCE While the coronavirus has been a game changer for everyone, Zink said she’s optimistic that as a society we’ll come out stronger post-COVID. “I love the idea of positive deviance and seeing things that are working well and continuing those,” Zink said. “I think with any great challenge in society it’s how we respond to it that matters more than anything else. I think we have an opportunity to really learn a lot from this pandemic and grow from it and respond in positive ways.” A greater support of telehealth, where communities in hard-to-reach places are granted better care than ever before, is something Zink foresees sticking around postpandemic. As telehealth allows more professionals to be on a call to support a patient, the care is more patientspecific, as opposed to location-specific. Zink also believes more people will recognize the importance of prevention and public health, entities that have been systemically underfunded for years and are part of the reason there are high health care costs. “We have got to find a way that connects us better and that we’re able to really invest more in intervention,
2020 | HEALTHCARE
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themselves sitting in an office with a doctor who knows nothing about them. This situation is often made worse when that young adult doesn’t know enough about their own medical history to get the doctor up to speed. Below are some actions parents and teens or young adults can take to make sure this transition goes as smoothly as possible. HELP TEENS BUILD SKILLS AND UNDERSTAND THEIR HEALTH NEEDS
TOO OLD FOR THE PEDIATRICIAN?
TIME TO SWITCH DOCTORS. By Claire McCarthy, M.D., Premium Health News Service, Harvard Health Blog
It happens to every young adult: At some point, they become too old for their pediatrician. When it happens depends both on the young adult and the pediatric practice. Some teens are ready for a change when they become legal adults at 18, tired of sitting with babies in the waiting room. Others want to stay with their pediatrician and do until the very last minute the pediatrician will let them. As for practices, some have firm rules about when patients need to move on, while others don’t, letting them stay until the early years of their 20s. Ideally, young adults will have a smooth transition from one health care provider to another: a full and clear hand-off of all the medical and other information needed. Unfortunately, it’s often not so smooth. Many young adults find themselves adrift without a doctor, which can be a problem for those with chronic health problems. And many others find
2020 | HEALTHCARE
• By the time your teen reaches high school age, and maybe before, give them time alone with their health care provider. This allows teens to practice self-advocacy and build necessary skills for talking about their health and health care needs. • If your teen has a chronic health problem, teach them about it. By the time they are 18, or preferably before, they should have a solid understanding of their condition and its implications. • If your teen takes regular medications, make sure they know the names, doses and what they are taking them for. Help them learn independence in taking their medications and also in calling for refills. Start this by high school. • Make sure your child knows all of their allergies. Many teens do not. WORK WITH YOUR PEDIATRICIAN AND HEALTH PLAN
Plan to start the transition to another doctor at least a year ahead of time — more in some circumstances, such as when a teen has a disability or sees specialists. • A teen with a disability may need your involvement in their life and health care past the age of 18. Talk to your doctor about whether or not guardianship would be a good idea. Aim to start this conversation by age 16, because the process can take some time. • Ask your pediatrician when patients need to leave the practice, so you know when you need to get started on the transition. It may take a while to find a doctor and get an appointment. So, start at least a year ahead of time.
• Check with your insurance company about options for primary care practices. Look up practices and practitioners online together. Find out what you can and get recommendations from people you trust — including your pediatrician! • If your teen sees specialists, get recommendations from them as to which specialists your teen might see as an adult. This is an important conversation to have as you look for primary care practices. It’s best if the new primary care practice is affiliated with the recommended specialist and their hospital.
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• You will need to get health records transferred from your pediatrician to the new practice. If your child is 18 or older, they will have to make this request, not you. Ideally, request all of the records, perhaps on a disc or thumb drive. What the new doctor needs most are the last few notes in the record — including the last physical, and the latest specialty notes — the vaccination record, and an updated medication and allergy list. • Make sure your teen knows their family medical history. Write down any medical problems in the family, particularly those of your teen’s parents, siblings, grandparents and other close relatives. It’s not something families often talk about, and it’s crucial information for your teen’s new doctor. • See if your pediatrician is willing to reach out to the new primary care provider to do a “warm handoff.” Most are willing and it could make all the difference, especially if there are any special health care needs. This may seem like a lot, but it’s really not. The key is to start early, and work at it throughout your child’s high school years. If you do, by the time they make the transition from a pediatrician to a new primary care doctor, everyone will be ready — not just your child, but also the new doctor, which puts your child in the best position possible as they take on life — and health care — on their own. Claire McCarthy, M.D., is senior faculty editor at Harvard Health Publishing.
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2020 | HEALTHCARE
What to do if you lose your health insurance during the coronavirus crisis By Deborah D. Gordon, Kiplinger’s Personal Finance, Premium Health News Service
You can’t control whether you lose your job and your benefits because of COVID-19. You can, however, take steps to protect yourself in case you wind up without health insurance during the global pandemic. Don’t panic. Take a breath. Collect yourself. And then make a plan.
1. IF YOU HAVE A SPOUSE WITH INSURANCE, TRY TO GET ON THEIR PLAN. If you have a spouse or partner with employer-sponsored insurance, you may be able to join if you lose your job or your benefits due to a furlough or other cuts. For those worried they could soon lose their jobs, have your spouse or partner contact their human resources department to see if you can join their plan. You probably won’t be able to get on that plan without a change in your benefit status, but get the details on how to make that change now so that you’ll be prepared.
2. EXPLORE COBRA. If you lose your job at any time, you may be legally entitled to buy into your employer’s health insurance plan for a period of time. The Consolidated Omnibus Budget Reconciliation Act, commonly known as COBRA, gives you the right to buy this coverage for as long as 18
months — longer if you’re approaching Medicare eligibility — provided you’re willing to pay for it. Because employees pay the full cost of health insurance premiums without any employer contribution, COBRA tends to be very expensive — prohibitively so for most people. On an annual basis, the average employersponsored insurance premium for family coverage was more than $20,000 in 2019 and more than $7,000 for an individual. Under COBRA, the employee pays the full premium and may be charged a small administrative fee. These costs may be especially hard to bear without income. However, if you have a chronic condition or already know you will need expensive care, it may be worth it. If your company has at least 20 employees, it is likely subject to COBRA rules. In that case, they are obligated to notify you about this option if they terminate your employment. In the meantime, you can proactively check with your human resources representatives to see if it is an option for you, and if so, what it would cost. If you are furloughed, you may be eligible for COBRA if you lose eligibility for the group health insurance plan. Your company will have to issue you COBRA documents in that case; make sure to get those so you can qualify.
3. CHECK OUT THE HEALTH INSURANCE MARKETPLACE. The Affordable Care Act (ACA) created health insurance marketplaces operated either by the states, the federal government or as a state-federal partnership. Everyone has access to one of these marketplaces where HEALTHCARE | October 2020
individuals can compare an assortment of plans with varying costs and coverage levels. Even the most basic marketplace plans offer comprehensive benefits and consumer protections. Though buyer beware: The lower the monthly premium, the higher the deductible and other cost-sharing components are likely to be. Typically, these marketplaces are only open during specific “open enrollment” periods, but a few states have opened up enrollment now to help uninsured residents get covered during this crisis. Other states may follow. Even if your state does not offer a special enrollment period, you may still be able to sign up. Life events like a marriage, a move or a job loss or change are typically deemed “qualifying events,” during which you can enroll outside of the open enrollment window. Losing your job or your benefits, including from a furlough that results in losing eligibility for the group insurance plan, is just the sort of life event for which these exceptions are designed. But don’t delay. Marketplace insurance usually takes effect on the first day of the following month or the one after that, depending on when you apply. Depending on your financial situation, you may qualify for free or subsidized insurance. Even if it’s just for a transitional period, these programs provide comprehensive coverage, often at reduced cost. Visit healthcare.gov or your state’s health insurance marketplace to learn more about your specific situation.
4. CONSIDER APPLYING FOR MEDICAID. Medicaid is the publicly funded health insurance program designed to cover the most vulnerable and low-income people. It operates as a federal-state partnership, with certain rules set at the federal level and specific administration handled at the state level. As a result, eligibility rules vary depending on where you live, how many people live in your household, what your income is, and whether you have any special conditions. Under the ACA, 37 states and the District of Columbia expanded their Medicaid programs to allow for greater flexibility in expanding coverage to more residents. Medicaid is highly regulated, with substantial consumer protections. It offers robust benefits at free or very low cost to enrollees. Depending on the state, eligibility may start retroactively as of the day you apply. Even if it takes time to determine if you’re eligible, if you ultimately are, you may be fully protected from health costs you are forced to incur in the meantime. Though some people hate the idea of getting help to pay for anything or of getting help from the government,
2020 | HEALTHCARE
this is not a moment to worry about stigma. If you need coverage, and you qualify for this program, take the opportunity to protect yourself financially.
5. ASK FOR HELP Health insurance has its own jargon, convoluted rules and bureaucratic hurdles. Trying to sort it out on your own at any time can be completely overwhelming. In a crisis when the world seems to be holding its breath waiting for catastrophe to strike, you’re probably not in the best position to navigate all on your own. The good news is you may not have to. Start with your company’s human resources; they may be able to help you transition off of their plan. You can also call the state or federal health insurance marketplace. Even if you have to wait on hold or encounter bureaucratic-style customer service, don’t give up. If you don’t get a clear answer or the help you need, call back another time or ask for a supervisor. There is always someone who can get to the bottom of your situation. It just may take some patience. Though federal funding was slashed for insurance navigators, nonprofit organizations still exist in many places to help consumers find health insurance options. Often operating locally or at the state level, helpers are out there. Start at the federal website and Google your way to help in your area. Look for nonprofit agencies whose mission is to help, rather than for-profit companies that may be trying to sell you less-than-robust insurance coverage. Hospitals and health centers often employ financial counselors whose jobs are to help patients find health insurance. These staff are often extremely well versed in the intricacies of insurance rules and options. Call the clinic or the hospital you would most likely go to for care if you get sick, and ask them for help finding and applying for coverage. More than 150 million Americans get their health benefits through an employer. COVID-19 may push that number way down. It is no time to be without health insurance. If you find yourself in that situation, remember that there are options. While you might be waiting for the worst to happen, get yourself prepared. Figure out where to turn if you need to get covered in a hurry. Then, stay home. And wash your hands.
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COMBATING BREAST CANCER THROUGH GENETICS
DEVELOPMENTS IN GENETIC TESTING MAY HELP POTENTIAL PATIENTS BY AMY NEWMAN
linical exams, mammograms, chemotherapy and radiation are the standards of care that immediately come to mind when people think of breast cancer detection and treatment.
But in recent years, genetic testing has begun to play an increasingly important role in the fight against breast cancer, helping medical providers identify patients, particularly women, with an increased risk and guiding the development of treatment and screening plans. “(Genetic testing) is used in understanding what caused the person to have cancer, planning both their treatment or screening after their cancer and, in at-risk individuals, to help them be proactive,” said Maggie Miller, a genetic counselor at Providence Cancer Center in Anchorage.
THE GENETIC BREAKDOWN
Genetic testing looks for mutations that increase a woman’s risk of developing breast cancer, particularly in the BRCA1 and BRCA2 genes. Although only 5% to 10% of breast cancers have an inherited component, Miller said, these two mutations comprise roughly half of those cases. While the presence of these mutations doesn’t mean that a breast cancer diagnosis is unavoidable, it does substantially increase the risk. According to the Susan G. Komen Foundation, women with a BRCA1 mutation have a 50% to 70% chance of developing breast cancer by age 70; that risk drops slightly for women with the BRCA2 mutation, down to 40% to 60%.
2020 | HEALTHCARE
Genetic testing isn’t reserved solely for women. Because men diagnosed with breast cancer have a higher likelihood of carrying a BRCA1 or 2 mutation — even higher than all women who receive the same diagnosis, Miller said — they are also referred to a genetic counselor. Knowing whether the mutation is present is important for more than developing treatment and screening protocols. “Men who inherit a BRCA mutation are at increased risk for prostate and pancreatic cancer, and can pass (the mutation) down to their daughters,” Miller explained.
TECHNOLOGY AND TESTING INCREASES
Several factors have influenced genetic testing’s enhanced role in breast cancer treatment, chief among them an improved understanding of the genetics behind breast cancer itself. “One of the big things that have changed, probably within the last year, is the American Society of Breast Surgeons now recommends that all women diagnosed with breast cancer be offered genetic testing, and not just those meeting a certain set of criteria,” explained Dr. Marilyn Sandford of Alaska Breast Care and Surgery in Anchorage. Before the revised 2019 guidelines, physicians recommended that women who were diagnosed with breast cancer and had other risk factors, including a family history of breast cancer, meet with a genetic counselor. Yet research showed that this recommendation missed identifying women who fell outside that defined group.
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(907) 777-1850 • afmanchorage.com “The study looked at women who had a family history, and then it looked at women with breast cancer who had no family history,” Sandford said. “And what the study showed was that with or without a family history, the likelihood that an abnormal gene would be found was substantially similar. So, family history was not shown to be a reliable way to distinguish who is at risk to get breast cancer.” Genetic testing has also become more financially accessible over the years, Miller said. In 2005, a genetic test cost $4,000; today, women can get a direct-to-consumer test, which the Food and Drug Administration approved in 2018, for as little as $250. Advancements in information technology have also made it easier for providers to identify and notify women with an increased breast cancer risk. “The imaging centers and medical providers have been gathering information about patients’ family history and personal health history forever, but I think this is an IT advancement that really allows us to capture those people and let them know that they have that risk,” Miller said. “It’s been really helpful because we can spend time with the patient talking about extra screening and how genetic counseling is going to help them manage their care.” And then there was the celebrity factor. In 2016, Oscarwinning actress Angelina Jolie underwent a preventative double mastectomy after testing positive for BRCA1, bringing the issue into the mainstream and causing many women to discuss the
idea of genetic testing with their providers. “I think Angelina Jolie was this incredible advocate for getting people to think about genetic testing,” Miller said. “The public awareness is incredibly higher.”
MANY WAYS TO MANAGE RISK
While genetic testing can identify the presence of a cancercausing mutation and provide additional insight into a woman’s breast cancer risk, it’s just one piece of a larger puzzle doctors and genetic counselors utilize to help guide a patient’s overall plan of care, from enhanced screening protocols to prevention and treatment options, Miller said. “There’s kind of a laundry list of options for screening and prevention of breast cancer,” Miller said. “So, early and increased frequency of mammograms, and the addition of breast MRI, has been shown to detect breast cancer earlier, and therefore reduces the stage at which it’s diagnosed.” Though enhanced screening is important for women identified as being at-risk, Sandford is quick to point out that managing risk involves more than frequent screenings. “That’s always a point I like to make about risk management,” she said. “All we do if we screen more intensely and more often is we find that breast cancer. With any discussion of labeling someone at high risk of breast cancer, there has to be a really good focus on prevention.” HEALTHCARE | October 2020
Chief among those prevention measures, with or without a diagnosis, are lifestyle changes. “We know that having a healthy lifestyle reduces the risk of cancer substantially,” Miller said. “A healthy lifestyle is physical activity, non-smoking, modest to zero alcohol use, a healthy diet and a healthy weight. All of those things sound so simple, but they’re actually really hard to practice and understand.” Depending on other risk factors, some women who test positive for a genetic mutation may opt for a bilateral mastectomy, “the most aggressive form of prevention,” Miller said. She estimated that roughly 60% to 70% of the women she counsels who test positive for a genetic mutation choose that option. The remainder, she said, pursue a combination of hormone suppression therapy and increased screening, as well as implementing recommended lifestyle changes. As more data on genetics and inherited cancers becomes available, Sandford expects genetic testing for all women to become the norm. “There’s a lot of moving pieces, and it’s evolving very quickly,” she said. Miller agreed. “It’s a lot more complicated than what we know, which makes us sound really primitive, but we are learning every day.” Our team consists of experienced providers with Alyeska Center for Facial Plastic Surgery & ENT, Geneva Woods ENT, and Anchorage Audiology Clinic who have joined together under one group — ENT Specialists of Alaska.
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2020 | HEALTHCARE
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HEALTHCARE | October 2020
Good news for those with Type 2 diabetes: HEALTHY LIFESTYLE MATTERS By Alyson Kelley-Hedgepeth, M.D., Harvard Health Blog, Premium Health News Service
Type 2 diabetes (T2D) is a metabolic disorder of insulin resistance — a reduced sensitivity to the action of insulin — which leads to high blood sugar, or hyperglycemia. Approximately 12% of American adults have T2D, and more than one-third of Americans have prediabetes, a precursor to T2D. This is a major public health concern, as T2D dramatically increases risk for heart disease, including heart attacks, atrial fibrillation and heart failure. The development and progression of T2D is affected by many factors. Some, such as a person’s race/ethnicity, age and gender cannot be modified. Others, including body weight, exercise and diet can be changed. Can lifestyle changes help reduce heart disease risk if you have diabetes? In 2010, the American Heart Association published “Life’s Simple 7,” which they defined as “seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health.” The Simple 7 touched on smoking status, physical activity, ideal body weight, intake of fresh fruits and vegetables, blood sugar, cholesterol levels and blood pressure. Subsequent studies found that people in optimal ranges for each of these factors had lower risks of heart disease compared to people in poor ranges. But given the significant increase in heart disease risk in those with T2D, it was not clear if the impact of these modifiable factors would hold true for the T2D population. Recent study suggests lifestyle changes do benefit T2D and prediabetes A study published in JAMA Cardiology looked at whether the ideal cardiovascular (CV) metrics covered in Life’s Simple 7 translate into improved CV health for those with T2D or prediabetes. The results were exciting, and consistent with other large population-based studies. Patients who had five or more ideal CV measures had no excess of CV events compared with people with normal blood sugar levels. CV events measured in the study included death, heart attack, stroke and heart failure.
2020 | HEALTHCARE
Each additional ideal health metric was associated with an additional 18% drop in CV event risk for people with T2D, and an additional 15% drop for those with prediabetes. This was a prospective, observational study, examining the association of risk factors only. It was not a randomized trial looking at an intervention. As a result, we cannot draw conclusions about cause and effect. Nonetheless, this is the first study to show a positive association between ideal lifestyle factors and CV health in people who are at high risk for CVD due to T2D. These results showcase the importance of our lifestyle choices, suggesting that meeting ideal health metrics can help reduce risk of CV events.
LIFE’S SIMPLE 7 So what are the lifestyle and metabolic health goals should you strive for, whether or not you have diabetes? 1. Manage blood pressure. 120/80 mm Hg or lower is best. 2. Control cholesterol. Aim for total cholesterol below 200 mg/dL. 3. Reduce blood sugar. Get your HbA1c (an average measure of blood sugar over the past three months) under 5.7% if you have prediabetes, or below 6.5% if you have T2D. 4. Get active. Your goal is 150 minutes per week of moderate-intensity activity or 75 minutes per week of vigorous activity. 5. Eat better. That means at least 4.5 cups of fruits and vegetables per day. 6. Lose weight. You want a body mass index (BMI) of less than 25. 7. Stop smoking. You’ll reap CV benefits, not to mention lowering your risk for cancer, COPD and much more.
Alyson Kelley-Hedgepeth, M.D., is a contributor to Harvard Health Publications.
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HEALTHCARE | October 2020
Alaska healthcare magazine published by the Anchorage Daily News..