HealthWatch Magazine: Jan 2013

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Table of

Contents DATE WITH A DOCTOR . . . . . . . . . . . . . . . . .

Who We Are Publisher • Tim Bogenschutz Advertising • Sam Swanson Editor • Sarah Nelson Katzenberger Cover Design • Jan Finger

Contributing Writers Jodie Tweed, Jenny Holmes, Sheila Helmberger

Healthwatch is a quarterly publication of the Brainerd Dispatch.

Read HealthWatch online at www. brainerddispatch.com

For advertising opportunities call Sam Swanson at 218-855-5841.

Email your comments to sarah.nelsonkatzenberger@brainerddispatch.com or write to: Sarah Nelson Katzenberger Brainerd Dispatch P.O. Box 974 Brainerd, MN 56401

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By Sheila Helmberger

Everything you need to know about medical screenings and immunizations

A LITTLE TOO SWEET? . . . . . . . . . . . . . . . . . . 6

Associated Press

Brain study shows frutcose may spur overeating

HOW TO SAVE A LIFE . . . . . . . . . . . . . . . . . . . 8 Cuyuna Regional Medical Center works to change cardiac arrest outcomes

By Sarah Nelson Katzenberger

BABY BOOM . . . . . . . . . . . . . . . . . . . . . . . .12 ICU nurses deliver comfort care — and their babies two at a time

By Jodie Tweed

DO YOU KNOW THE DRILL? . . . . . . . . . . . . .14 Your medical chart could include exercise minutes

Associated Press

FEELING SAD? . . . . . . . . . . . . . . . . . . . . . 16 Seasonal Affective Disorder common in the dark winter months

By Jessi Pierce

FLU? MALARIA? . . . . . . . . . . . . . . . . . . . . .18 Disease forecasters look to the sky

Associated Press

HEALTHY LIVING THROUGH LIFELONG LEARNING. . .

CLC and Essentia Health partner to make life-long learners of lakes area seniors

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By Jenny Homes

STAND ALONE EMERGENCY ROOMS . . . . . . . 20 Hospitals expand with independent ERs

Associated Press

FLU VIRUS WIDESPREAD THROUGHT U.S. . . . 21 Experts recommend flu shot for everyone over six-months-old

Associated Press

On the cover Cuyuna Regional Medical Center ambulance team members (left to right), EMT Mike Seitzer, and paramedics Ryan Franz and Corey Nelson, demonstrated the use of the LUCAS 2 device. The LUCAS 2 is used to provide chest compressions to a patient who has suffered out of hospital cardiac arrrest.

Steve Kohls • steve.kohls@brainerddispatch.com

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By SHEILA HELMBERGER Contributing Writer

Recommended immunizations for birth to 24 years

A date with the doctor Everything you need to know about medical screenings and immunizations.

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Whether you use one of the new electronic methods or still rely on the old faithful post-it-on-the-wall calenold dar you’ve probably started to document important dates that lie in the year ahead. You’ve probably already noted all of those weddings, birthdays, anniversaries and vacations that are planned for 2013.

But there are a few other important ones you shouldn’t forget.

Did you include any reminders to add routine health care exams for your family? What about needed immunizations?

Depending on the ages of the members of your household it might be time to pencil in some trips to the clinic, or reminders for some general screenings and routine check-ups that are easy to forget about otherwise.

This year the flu is making daily news headlines both for its popular occurrence and its severity. If you haven’t had one yet, an appointment for a flu shot might be the first one you need to make.

Dr. Marcy Byrns, Internal Medicine at Essentia Health-St. Joseph’s Medical Center in Brainerd, said just because you took a pass last fall, if you’re having second thoughts it isn’t too late.

“You will still get some benefit from a late flu season immunization,” she said.

“Even if you didn’t get it yet this year, you should and especially because this is such a vigorous flu season.”

Dr. Byrnes said another immunization you might want to update is your

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• Associated Press

tetanus shot.

If you haven’t had one in a while, it’s another preventive measure that can pay off right away, especially if you are around young children or infants. The immunization now includes protection from whooping cough, which is showing up in record numbers recently as well, and although it might not be severe for adults, it can be deadly if you pass it on to young children or babies.

So, if you’re otherwise healthy, who needs to see a doctor and when?

Children. Visits to a physician are recommended for children the first week of birth and again at two, four, six, nine, 12 and 15 months of age. Height and weight will be documented at these visits as well as vision and hearing screenings to make sure their growth is on track.

Various necessary immunizations are administered at each visit also (see box).

Children should be added to the family calendar for doctor visits again at two, three, four, five and six years old as well as at eight, 10, 12, 14, 16 and 18 years of age.

Adults. Even adults need periodic screenings. The visits can be valuable for assessing general health conditions and early diagnosis of things that may require additional treatment.

From 19 until age 39, men should visit a doctor at least every five years and women should plan to visit every three to five years. Your blood pressure will be checked and assessments will be made for other health risks.

Adult women should expect to have

a clinical breast exam every three years and continue to schedule an annual mammogram. The latest recommendations suggest that women should schedule visits for a pap test and pelvic exam every three years (after three years of normal test results in a five year period) after age 21 or three years after they first become sexually active.

Blood pressure readings should be checked every two years for all adult men and women if the readings are less than 120/80 and annually if readings are higher than 120-139/80-89. It’s important to have your cholesterol checked at least every five years and update any adult immunizations that might be needed including chicken pox, tetanus and Hepatitis B. Colon cancer screenings for both men and women begin at age 50 and men should also start to have PSA levels checked as well as prostate exams.

Women, as always, should continue to visit the doctor for annual clinical breast exams and mammograms.

Adults over 65, both men and women, should make appointments for a complete physical every one to two years.

Just to make sure you’re ahead of the game, make a note for next fall to get the flu shot for next year’s season. Visits to the doctor might not be a popular day on the calendar, but they can help make it possible to enjoy all of those weddings, birthdays, anniversaries and vacations.

• Diphtheria, tetanus, pertussis, hepatitis B and poliovirus (DTaPHepB-IPV): 2, 4 and 6 months.

•Haemophilus influenza type B (Hib): 2 and 4 months.

• Pneumococcal conjugate (PCV13): 2, 4, 6 and 12 months.

• Rotavirus (Rv): 2, 4 and 6 months.

• Measles, mumps, rubella, varicella (chickenpox) (MMRV): 12-15 months • Hepatitis A: 12-15months and 1823 months • Diphtheria, tetanus, pertussis, haemophilus influenza type B (DTaP-Hib): 15 months • Influenza: every year for ages 6 months and older Recommended immunizations 2 -6 years • Diphtheria, tetanus, pertussis (DTaP): 5 years • Poliovirus (IPV): 5 years • Measles, mumps, rubella, varicella (chickenpox) (MMRV): 5 years • Influenza: every year Recommended Immunizations 7 to 12 years • Tetanus, diphtheria, pertussis (Tdap) at age 12 • Meningococcal conjugate (MCV) at age 12 Recommended Immunizations 13 to 18 years • Meningococcal conjugate (MCV) at age 16 • Human papillomavirus (HPV): females only Information provided by Essentia Health.

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A little too sweet?

Brain image study shows

Fructose may spur overeating

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AP Medical Writers

This is your brain on sugar — for real. Scientists have have used imaging tests to show for the first time that fructose, fructose, a sugar that saturates the American diet, can trigger brain changes that may lead to overeating.

After drinking a fructose beverage, the brain doesn’t register the feeling of being full as it does when simple glucose is consumed, researchers found.

It’s a small study and does not prove that fructose or its relative, high-fructose corn syrup, can cause obesity, but experts say it adds evidence they may play a role. These sugars often are added to processed foods and beverages, and consumption has risen dramatically since the 1970s along with obesity. A third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

All sugars are not equal — even though they contain the same amount of calories — because they are metabolized differently in the body. Table sugar is sucrose, which is half fructose, half glucose.

High-fructose corn syrup is 55 percent fructose and 45 percent glucose. Some nutrition experts say this sweetener may pose special risks, but others and the industry reject that claim. And doctors say we eat too much sugar in all forms.

For the study, scientists used magnetic resonance imaging, or MRI, scans to track blood flow in the brain in 20 young, normal-weight people before and

• Associated Press

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• Associated Press

after they had drinks containing glucose or fructose in two sessions several weeks apart.

Scans showed that drinking glucose “turns off or suppresses the activity of areas of the brain that are critical for reward and desire for food,” said one study leader, Yale University endocrinologist Dr. Robert Sherwin. With fructose, “we don’t see those changes,” he said. “As a result, the desire to eat continues — it isn’t turned off.”

What’s convincing, said Dr. Jonathan Purnell, an endocrinologist at Oregon Health & Science University, is that the imaging results mirrored how hungry the people said they felt, as well as what earlier studies found in animals. “It implies that fructose, at least with regards to promoting food intake and weight gain, is a bad actor compared to glucose,” said Purnell.

He wrote a commentary that appears with the federally funded study in Wednesday’s Journal of the American Medical Association.

Researchers now are testing obese people to see if they react the same way to fructose and glucose as the normal-weight people in this study did.

What to do? Cook more at home and limit processed foods containing fructose and high-fructose corn syrup, Purnell suggested. “Try to avoid the sugar-sweetened beverages.

It doesn’t mean you can’t ever have them,” but control their size and how often they are consumed, he said.

A second study in the journal suggests that only severe obesity carries a high death risk — and that a few extra pounds might even provide a survival advantage.

However, independent experts say the methods are too flawed to make those claims.

The study comes from a federal researcher who drew controversy in 2005 with a report that found thin and normal-weight people had a slightly higher risk of death than those who were overweight.

Many experts criticized that work, saying the re-

searcher — Katherine Flegal of the Centers for Disease Control and Prevention — painted a misleading picture by including smokers and people with health problems ranging from cancer to heart disease. Those people tend to weigh less and therefore make pudgy people look healthy by comparison.

Flegal’s new analysis bolsters her original one, by assessing nearly 100 other studies covering almost 2.9 million people around the world. She again concludes that very obese people had the highest risk of death but that overweight people had a 6 percent lower mortality rate than thinner people.

She also concludes that mildly obese people had a death risk similar to that of normal-weight people.

Critics again have focused on her methods.

This time, she included people too thin to fit what some consider to be normal weight, which could have taken in people emaciated by cancer or other diseases, as well as smokers with elevated risks of heart disease and cancer.

The problems created by the study’s inclusion of smokers and people with pre-existing illness “cannot be ignored,” said Susan Gapstur, vice president of epidemiology for the American Cancer Society.

Flegal defended her work. She noted that she used standard categories for weight classes. She said statistical adjustments were made for smokers, who were included to give a more real-world sample. She also said study participants were not in hospitals or hospices, making it unlikely that large numbers of sick people skewed the results.

“We still have to learn about obesity, including how best to measure it,” Flegal’s boss, CDC Director Dr. Thomas Frieden, said in a written statement.

“However, it’s clear that being obese is not healthy - it increases the risk of diabetes, heart disease, cancer, and many other health problems.

Small, sustainable increases in physical activity and improvements in nutrition can lead to significant health improvements.”

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How to

By SARAH NELSON KATZENBERGER Heathwatch Editor

save a life

Cuyuna Regional Medical Center works to change cardiac arrest outcomes

S

Sometimes it’s a simple change that makes all the difference.

When the American Heart Association reconsidered sidered their stance on how to administer cardiopulmonary resuscitation (CPR) and who is qualified to do it, things changed for victims of cardiac arrest.

Up until April 2008, the standard procedure for administering CPR involved both chest compressions and mouth-to-mouth resuscitation — something that Dr. Mark Gujer, Medical Director of Ambulance, at Cuyuna Regional Medical Cen-

ter (CRMC) in Crosby, said could be a preventative barrier when it comes to people actually administering CPR. “You see some go down across the lobby and it’s not likely you’re going to run over there and start mouth-to-mouth,” Gujer said.

When it comes to CPR, Gujer said the rules have changed — and that’s a good thing.

In 2008, the American Heart Association released an advisory notice after scientific and medical research showed that hands-only CPR was more effective in saving lives when it comes

to out-of-hospital cardiac arrest.

“This will save more lives,” Gujer said.

When cardiac arrest occurs, a person’s heart stops contracting resulting in a loss of blood circulation to vital organs. When blood stops circulating, so does oxygen. Gujer explained that, physiologically, chest compressions help manually move blood — and oxygen — throughout the body and sustain blood pressure while a victim suffers cardiac arrest. Essentially chest compressions force the heart to do its job even while it is incapacitated.

When a person administering CPR stops chest compressions to administer mouth-tomouth, blood pressure plummets, against constricting the flow of oxygen throughout the body. Rebuilding the blood pressure needed to circulate oxygen requires additional chest compressions.

“It makes more sense not to let them breathe,” Gujer said. The ambulance team at Cuyuna Regional Medical Center is making a concerted effort to increase the number of survivors when it comes to cardiac arrest cases suffered out of hospital.

CRMC’s Director of Ambulance, Rob Almendinger and Gujer attended a medical conference in 2011 that led them to ask themselves if a rural EMS system, like CRMC’s, is capable of achieving the same successful rates as an urban system in regards to the survival rate of out of hospital cardiac arrests.

“When we came back from the conference and really looked at our data, CRMC had had 14 out-of-hospital arrests and zero saves. So we thought, ‘Let’s see where this goes,’” Almendinger said.

See CPR, Page 9

Steve Kohls • steve.kohls@brainerddispatch.com

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From left, EMT Mike Seitzer and paramedics Ryan Franz and Corey Nelson demonstrate the use of the LUCAS 2, a device used by the Cuyuna Regional Medical Center’s ambulance team to administer chest compressions to indviduals who have suffered out-ofhospital cardiac arrest.

“We can train as much as we want, but we will never be successful without public intervention. If they’re not doing CPR when we get there we don’t have a chance.”

-ROB ALMENDINGER, CRMC AMBULANCE DIRECTOR

Steve Kohls • steve.kohls@brainerddispatch.com

CPR, From Page 8 Almendinger and Gujer looked at what the most successful systems do differently and found ways to improve their own system.

The ambulance service has adjusted their CPR and Advanced Cardiovascular Life Support (ACLS) requirements from a two year training review to an annual requirement.

Rob Almendinger (left) and Dr. Mark Gujer head Cuyuna Regional Medical Center’s ambulance service. The pair said in increaser in paramedic and EMT training and well as public intervention is the key to positive outcome when it comes to treating out-of-hospital cardiac arrest.

“It’s made a big difference,” Almendinger said CRMC Ambulance also requires their EMT and paramedic staff members to complete a quarterly competency course on cardiac arrest management.

Almendinger said the focus of the competency requirement is to minimize the interruptions in chest compressions.

The team uses a new chest compression called the LUCAS 2. The portable electronically powered device administers what Guyer calls, “perfect compressions.” It can be strapped over the chest of a victim within a few seconds, minimizing the number of interrupts between chest compressions and allowing the responding EMTs and paramedics to See CPR, Page 10

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“There was a day when BLS (basic life support) meant nothing — it was just put them on a stretcher and go...

And that wasn’t all that long ago.”

- DR. MARK GUJER

CPR, From Page 9 focus on the victims vital statistics.

“There was a day when BLS (basic life support) meant nothing — it was just put them on a stretcher and go,” Gujer said.

“And that wasn’t all that long ago.”

In addition to providing better training for EMT and paramedic team members, Gujer and Almendinger found that providing better CPR education to the community increases the chances that a person who suffers out-of-hospital cardiac arrest will receive hand-only CPR immediately, ultimately providing them a better survival outlook.

“We can train as much as we want, but we will never be successful without public intervention,” Almendinger said. “If they’re not doing CPR when we get there we don’t have a chance.”

Almendinger said the CRMC ambulance team’s efforts have included public CPR training sessions. Since October 2011, the team has trained more than 1,000 individuals in CRMC’s service area in hands-only CPR. “As long as they can physically compress the mannequin, we teach them,” Almendinger said. “Anyone that invites us to go, we go.”

The efforts are working.

Almendinger said data from October

2011 through October 2012 shows of 14 out of hospital arrests, 7 achieved a return to spontaneous circulation (ROSC) — three of which walked out the hospital under their own power.

“It will be interesting to see this another year or two down the road,” Almendinger said.

Gujer said that even with the positive numbers, the efforts continue to improve.

“We’ve watched this project evolve,” he said.

Gujer and Almendinger continue to attend conferences looking for ways to better their methods. “Every time we bring something back to tweak our system,” Almendinger said.

Gujer and Almendinger agreed that the most important thing people can do is learn to administer hand-only CPR and teach five other people to do the same.

“We want to see this go viral,” said Gujer, adding that if there’s one thing that needs to be remembered when administering hands-only CPR: “You can’t push too hard.”

SARAH NELSON KATZENBERGER may be reached at sarah.nelsonkatzenberger@brainerddispatch.com or 855-5879.

The NEW CPR In case you find yourself in a situation where an adult or a teen has collapsed, three simple steps can save a life: 1. Call 911.

2. Put the heel of one hand into the center of the victim’s chest and your other hand over top.

3. Push hard and fast until emergency help arrives.

The American Heart Association says to push at a rate of about 100 beats per minute — or to the tune of Stayin’ Alive.

For more information visit the American Heart Association’s CPR website at www.heart.org/HandsOnlyCPR

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Steve Kohls • steve.kohls@brainerddispatch.com

The LUCAS 2 (above) is a portable electronically powered device administers perfect compressions on a victim that has suffered cardiac arrest and requires Cardiopulmonary Resuscitation (CPR).

The LUCAS 2 can be strapped over the chest of a victim within a few seconds, minimizing the number of interrupts between chest compressions and allowing the responding EMTs and paramedics to focus on the victims vital statistics.

CRMC partners with Allina Health and George Family Foundation in Healthy Communities Partnership

Cuyuna Regional Medical Center has joined the Healthy Communities Partnership, a three-year, $6.5 million program to experiment with different health improvement methods in 13 communities throughout Minnesota and western Wisconsin. The Healthy Communities Partnership includes the George Family Foundation, Allina Health, and ten other health organizations.

“We are grateful for this grassroots opportunity to engage our residents to identify ways to achieve sustainable improvements in community wellness and take ownership of their health. The Healthy Communities Partnership gives us the flexibility to develop initiatives and enhance wellness in a way that fits the specific needs of our community.

With 12 other communities being a part of this, we are excited to contribute to something that has the potential to make a positive impact on our entire state,” said John Solheim, Cuyuna Regional Medical Center’s CEO. Other healthcare providers and communities joining Cuyuna Regional Medical Center in the Healthy Communities Partnership are: Riverwood Healthcare Center, Aitkin; Baldwin Area

Medical Center, Baldwin, Wis.; Buffalo Hospital, Buffalo; Cambridge Medical Center, Cambridge; District One Hospital, Faribault; Grand Itasca Clinic and Hospital, Grand Rapids; Regina Medical Center, Hastings; Hutchinson Area Health Center, Hutchinson; FirstLight Health System, Mora; River Falls Area Hospital, River Falls, Wis.; Ridgeview Medical Center, Waconia; and Rice Memorial Hospital, Willmar.

The program is managed by the Penny George Institute for Health and Healing, the part of Allina Health that is responsible for health promotion and wellness. George, also co-founder of the George Family Foundation, says integrative medicine will be woven into the fabric of local health services.

“This program recognizes that at least 40 percent of deaths in the U.S. are attributed to four behaviors: unhealthy eating, inadequate exercise, smoking and hazardous drinking, and about 95 percent of the population lives with an identifiable risk factor,” said Courtney Baechler, MD, vice president of the Penny George Institute for Health and Healing, the part of Allina Health.

Communities customize the program to fit their specific needs and

resources, but some components are consistent, including: —Each community will hold baseline screenings. Each participant and community will know their “health score.”

—Participants will use an online tool called The Family Health Manager and allow researchers access to anonymous data.

—An inventory of local resources will identify and fill gaps in local wellness programming, such as smoking cessation classes.

—A wellness care guide will work with each participant on a health improvement plan that combines medical and non-medical approaches.

—Participants will be rescreened each year.

In the first phase of the program, participating partners will hold the baseline health screenings. Then, based on results and the inventory of local resources, community interventions to enhance wellness programming will be developed. Over the duration of the program, the goal is to improve health screening scores and build a sustainable framework of health and wellness support.

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HOSPITAL BABY BOOM

By JODIE TWEED Contributing Writer

Essentia Health ICU nurses deliver comfort, care –

and their babies

I

If you or a loved one

have ever been critically ill, you understand the difficult job that the dedicated nurses on the third-floor Intensive Care Unit at Essentia Health-St. Joseph’s Medical Center in Brainerd face during each 12-hour nursing shift.

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at a time

The nursing staff provides around-the-clock complete care for some of the sickest patients in the hospital. Not only can it be physically and emotionally demanding work, but every minute – and every decision – is a matter of life and death.

ICU nurses also provide comfort and support for the families who are forced to helplessly watch their loved ones struggle to live.

In the midst of so much sadness, worry and grief, there is life.

Something special has been happening in this thirdfloor unit. Patients and their families have even taken notice, providing them with a bit of sunshine in an otherwise emotionally-charged environment.

Three ICU nurses, all friends and colleagues, have recently given birth or are pregnant with twins. For several weeks, all three of them were pregnant with twins at the same time while working in the same unit.

Brenda Jentsch, a Registered Nurse in the Intensive Care and Telemetry units for the past 10 years, recently gave birth to her second set of twins. She and her husband, Mike, have twins, Michael and Emma, 5; a singleton, Joseph, 3; and twins Anna and Thomas, 5 months, born July 26. Jera Powell, a Registered Nurse in both the ICU and Telemetry unit for the past five years, gave birth Nov. 26 to twin boys, Noah and Logan. She and her husband, Jeremy, also have a 4-year-old daughter, Gabriella.

Jackie Sullivan, also an ICU Registered Nurse for the past five years, is pregnant with twin girls and due March 16. She and her husband, Eric, are excited to meet their girls, who are fraternal twins.

First Jentsch announced she was pregnant again with twins, then Powell. By the time it was Sullivan’s turn to share her news, she said she was afraid to tell her supervisor. But, she said, everyone, including her boss, was happy for her double blessing.

Jackie Sullivan (left), Brenda Jentsch and Jera Powell are Registered Nurses in the Intensive Care Unit at Essentia Health-St. Joseph’s Medical Center in Brainerd.

They are all expecting or recently had twins. Sullivan is pregnant and due March 16 with twin girls; Jentsch is shown with her twins, Anna (left) and Thomas, 5 months, twins Emma and Michael (top left), 5, and son Joseph, 3; while Powell is with her twins, Noah (left) and Logan, and daughter, Gabriella, 4.

Steve Kohls • steve.kohls@brainerddispatch.com

12

Life is a juggling act for Brenda Jentsch, who has five children, including two sets of twins. But the Essentia Health registered nurse has become adept at multi-tasking. She is shown at her Baxter home holding her 5-month-old twins, Anna and Thomas, while her 5-year-old twins, Michael and Emma, are gripping onto her. Joseph, 3, her middle son, is on the couch.

Steve Kohls • steve.kohls@brainerddispatch.com

Jentsch returned to work during Powell’s last weekend of work before her maternity leave. Powell will be returning to the ICU from her maternity leave around the time that Sullivan will be starting her leave.

Not only did the timing work out well, but all three nurses experienced normal, healthy twin pregnancies. Jentsch and Powell delivered their sets of twins – where else? – on the hospital’s third floor Family Birthplace Unit.

Both women had C-sections; Dr. Pamela Rice delivered the Jentsch twins while Dr. Hal Leland delivered Powell’s twin boys. Sullivan also plans to deliver her twin girls at Essentia Health. Her doctor is Dr. Alicia Prahm.

“I felt more comfortable, knowing I knew the staff, and if anything went wrong, I knew I’d be just fine,” Jentsch said, of delivering her babies at Essentia.

Powell said she’d never before had surgery until her C-section, so she was apprehensive about that. It helped calm her fears because she knew the medical staff in the operating room.

The three sets of twins aren’t the only babies in the unit. Two of their co-workers also have newborn babies, though they were born as singles.

“Everyone says they’re not com-

ing to our floor and drinking the water,” Sullivan said.

Powell and Sullivan said it’s been nice to get pregnancy, breastfeeding and parenting advice from Jentsch, who has five children ages 5 and younger.

Jentsch said her three “must haves” as a mother of two sets of twins is “coffee, a supportive husband and a large-capacity washer and dryer.”

“When I see you doing it, I know I can do it,” Powell told Jentsch with a smile.

Jentsch’s 5-month-olds are already sleeping through the night.

She said she has learned that a schedule is important, especially with five children. She always carries some sort of snack in her purse when they are on the go.

“Deep breaths are always good, too,” Jentsch said with a good-natured laugh. “Just enjoy it. They are more fun than work.”

“I’m going to miss being pregnant,” Sullivan said as she cradled a sleeping Thomas Jentsch in her arms. “I love feeling them kick.”

“You’re a natural, Jackie,” Jentsch told her.

Jodie Tweed, a former longtime Brainerd Dispatch reporter and HealthWatch editor, is a stay-at-home mom and freelance writer. She and her husband live in Pequot Lakes with their three daughters.

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By LINDSEY TANNER AP Medical Writer

Your medical chart could include

exercise minutes C CHICAGO (AP) — Roll up a sleeve for the blood pressure cuff. Stick out a wrist for

the pulse-taking. Lift your tongue for the thermometer. Report how many minutes you are active or getting exercise.

Wait, what?

If the last item isn’t part of the usual drill at your doctor’s office, a movement is afoot to change that. One recent national survey indicated only a third of Americans said their doctors asked about or prescribed physical activity.

Kaiser Permanente, one of the nation’s largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit, and some other medical systems are doing it, too.

Here’s how it works: During any routine check of vital

14

signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it’s among the first things the doctor sees.

“All we ask our physicians to do is to make a comment on it, like, ‘Hey, good job,’ or ‘I noticed today that your blood pressure is too high and you’re not doing any exercise. There’s a connection there. We really need to start you walking 30 minutes a day,’” said Dr. Robert Sallis, a Kaiser family doctor. He hatched the vital sign idea as part of a larger initiative by doctors groups.

He said Kaiser doctors generally prescribe exercise first,

Running club members train in Pasadena, Calif.

Dr. Robert Sallis says some patients may not be aware that research shows physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. As recently as November 2012, a government-led study concluded that people who routinely exercise live longer than others, even if they’re overweight.

• Associated Press

It’s a challenge

to make instead of medication, and for many patients who follow through that’s often all it takes.

It’s a challenge to make progress. A study looking at the first year of Kaiser’s effort showed more than a third of patients said they never exercise.

Sallis said some patients may not be aware that research shows physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. As recently as November a government-led study concluded that people who routinely exercise live longer than others, even if they’re overweight.

Zendi Solano, who works for Kaiser as a research assistant in Pasadena, Calif., says she always knew exercise was a good thing.

But until about a year ago, when her Kaiser doctor started routinely measuring it, she “really didn’t take it seriously.”

She was obese, and in a family of diabetics, had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

Solano, 34, decided to take up running and after a couple of months she was doing three miles.

Then she began training for a half marathon — and ran that 13-mile race in May in less than three hours. She formed a running club with co-workers and now runs several miles a week. She also started eating smaller portions and buying more fruits and vegetables.

She is still overweight but has lost 30 pounds and her blood sugar is normal.

Her doctor praised the improvement at her last physical in June and Solano says the routine exercise checks are “a great reminder.”

Kaiser began the program about three years ago after 2008 government guidelines recommended at

progress. least 2 1/2 hours of moderately vigorous exercise each week. That includes brisk walking, cycling, lawnmowing — anything that gets you breathing a little harder than normal for at least 10 minutes at a time.

A recently published study of nearly 2 million people in Kaiser’s southern California network found that less than a third met physical activity guidelines during the program’s first year ending in March 2011. That’s worse than results from national studies.

But promoters of the vital signs effort think Kaiser’s numbers are more realistic because people are more likely to tell their own doctors the truth.

Dr. Elizabeth Joy of Salt Lake City has created a nearly identical program and she expects 300 physicians in her Intermountain Healthcare network to be involved early this year.

“There are some real opportunities there to kind of shift patients’ expectations about the value of physical activity on health,” Joy said.

NorthShore University HealthSystem in Chicago’s northern suburbs plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

Dr. Carrie Jaworski, a NorthShore family and sports medicine specialist, already asks patients about exercise. She said some of her diabetic patients have been able to cut back on their medicines after getting active.

Dr. William Dietz, an obesity expert who retired last year from the Centers for Disease Control and Prevention, said measuring a patient’s exercise regardless of method is essential, but that “naming it as a vital sign kind of elevates it.”

Figuring out how to get people to be more active is the important next step, he said, and could have a big effect in reducing medical costs.

15

By JESSI PIERCE Contributing Writer

Feeling SAD?

Seasonal Affective Disorder common in the dark winter months

I

t can be known as the dark days of winter. Sunrise and sunset leave the Brainerd lakes area with just 8-9 hours of daylight between December and March and often times can lead to an overall glum feeling.

But that glum feeling is not just an emotional sad day – sometimes it can be something much more.

Seasonal Affective Disorder (SAD) is a type of depression that is recognized in climates where sunlight decreases during the winter season.

According to Dr. Mark Holub, an on-staff psychiatric specialist at Lakewood Health in Staples, depression is the most common behavioral condition treated at Lakewood and the most treatable. And in the months following holiday spending, snow and an increase in darkness, Holub said that is when the number of patients with SAD really rises.

“SAD has both biological, psychological and emotional components in it,” said Holub, who has been with Lakewood Health for five years. “As a physician, we focus on the biological part aspect.

“In the winter, the low amount of light, especially in our area, the human brain releases more melatonin in response to the low light, giving people those symptoms of wanting to sleep all day, eating abnormally and usually low energy. In the spring and summer patients diagnosed with SAD tend to do pretty well and are not in a depressive state, but when they wake up for work and it’s dark and they come home and it’s nearly dark, that low light increases those symptoms, usually worse in January, February and March.”

Playing into the biological symptoms are also the social aspects of depression. According to Dr. Corrie Brown, a clinical therapist at Lake-

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wood Health, due to the often frigid climate and darkness, she sees patients also missing that social interaction in the winter months that is often necessary for human’s emotional and behavioral state.

“People tend to isolate themselves more in the winter months,” said Brown who has been at Lakewood Health nearly five years. “They aren’t getting that regular social interaction or going to their regular activities maybe due to weather or road conditions.

“At the same time we see them then not eating well or getting their exercise, walking to the mailbox to get their mail and that often times can lead to a depressive state.”

Jessi Pierce • jessi.pierce@brainerddispatch.com So how do you treat SAD? Dr. Mark Holub (R), an on-staff psychiatric speacialist at Lakewood Health in Staples chats about Holub said first and foremost Seasonal Affective Depression (SAD) with collegue and clinical therapist at Lakewood Health, Dr. Corrie people who suspect something is Brown. SADis a commonly found in patients in the winter months where sunlight is minimal and is a off and think they might be suf- very treatable form of depression. fering from SAD should visit their primary physician. Holub said Holub said that the lights can be overnight (accepting that a person that other things could be leading purchased online or at most stores has depression) and it requires a to the symptoms that they are feel- like Target or Walmart. He stressed lifestyle change. But once patients ing like thyroid disease and a doc- that patients shouldn’t go over- come to terms they find that it retor should first rule those out before board with the treatment. Excessive ally is easily managed along with considering SAD use often times results in insomnia diet and exercise.”

Holub said for those who are and interfering with normal sleep And no matter the depth of deexperiencing those symptoms and regiman. pression, whether it’s a year, a it is SAD, antidepressants are very In addition to medications and month or a few weeks, Brown addaffective. Another unique treatment treatments, Brown said she practic- ed that it is something that is easily Holub said studies have shown to es a lifestyle change as well to fur- fixed. work is a 10,000 lux light therapy, ther help patients overcome their “The rate of recovery is so high where patients dose themselves depressive state. from depression that what we are with light for 30-45 minutes first “From my approach, I teach skills passionate about doing is removing thing in the morning. on managing the diagnosis of SAD those barriers and stigma that is as“What this does, is it tricks the and removing those barriers for a sociated with it,” said Brown. “We brain into thinking that it’s bright behavioral change,” she said. “One are working so hard to treat it besunshine,” he said. “However it is of the biggest things is when people cause it is so treatable and we have something that needs to be very deny that they have a problem with these services in the lakes area for measured and isn’t an instance depressing. They have to learn how people suffering.” where more is better. I usually rec- to first deal with being diagnosed JESSI PIERCE, staff writer, may be reached ommend patients get up an hour and then adjust and manage that at 855-5859 or jessi.pierce@brainerddispatch. com. Follow her on Twitter at www.twitter.com/ earlier and use the light during that accordingly. time.”

“It’s not something that happens jessi_pierce (@jessi_pierce).

Too many tests?

Routine checks getting second look

W

WASHINGTON (AP) — of the top 5 overused ASSOCIATED PRESS Recent headlines offered a tests and treatments fresh example of how the from different spehealth care system subcialties. Consumer jects people to too many medical Reports will publish a layman’s transtests — this time research showing lation, to help people with these awkmillions of older women don’t need ward discussions. their bones checked for osteoporosis For now, some recent publications nearly so often. offer this guidance: Chances are you’ve heard that —No annual EKGs or other carmany expert groups say cancer diac screening for low-risk patients screening is overused, too, from mam- with no heart disease symptoms. mograms given too early or too often That’s been a recommendation of the to prostate cancer tests that may not U.S. Preventive Services Task Force save lives. It’s not just cancer. Now for years. Simple blood pressure and some of the nuts-and-bolts tests given cholesterol checks are considered far during checkups or hospital visits are more valuable. getting a second look, too — things —Discuss how often you need a like routine EKGs to check heart bone-density scan for osteoporosis. health, or chest X-rays before elective An initial test is recommended at 65, surgery. Next under the microscope and Medicare pays for a repeat every may be women’s dreaded yearly pel- two years. vic exams.

—Women under 65 need that first The worry: If given too often, these bone scan only if they have risk factests can waste time and money, and tors such as smoking or prior broken sometimes even do harm if false bones, say the two new overtesting alarms spur unneeded follow-up lists. care.

—Most people with low back pain It begs the question: Just what for less than six weeks shouldn’t get should be part of my doctor’s visit?

X-rays or other scans, Weinberger’s If you’re 65 or older, Medicare of- group stresses. fers a list of screenings to print out —Even those all-important cholesand discuss during the new annual terol tests seldom are needed every wellness visit, a benefit that began year, unless yours is high, according last year. As of November, more than to the college of physicians. Other1.9 million seniors had taken advan- wise, guidelines generally advise evtage of the free checkup. ery five years.

For younger adults, figuring out —Pap smears for a routine cervical what’s necessary and what’s overkill cancer check are only needed once is tougher. Whatever your age, some every three years by most women. So major campaigns are under way to why must they return to the doctor help. They’re compiling lists of tests every year to get a pelvic exam (mithat your doctor might be ordering nus the Pap)? For no good reason, the more out of habit, or fear of lawsuits, Centers for Disease Control and Prethan based on scientific evidence that vention reported last month. Pelvic they are really needed. exams aren’t a good screening tool “Too often, we order tests without for ovarian cancer, and shouldn’t be stopping to think about how (if at all) required to get birth control pills, the the result will help the patient,” wrote report says.

Dr. Christine Laine. She’s editor of AnA close relationship with a primanals of Internal Medicine, which this ry care doctor who knows you well month published a list of 37 scenarios enough to personalize care maxiwhere testing is overused. mizes your chances of getting only Medical groups have long urged the tests you really need — without patients not to be shy and to ask why wondering if it’s all just about saving they need a particular test, what its money, says Dr. Glen Stream of the pros and cons are, and what would American Academy of Family Physihappen if they skip it. This spring, a cians. campaign called Choosing Wisely “The issue is truly about what is promises to provide more specific best for patients,” he says. advice. The group will publish a list

17

Flu? Malaria?

NEW YORK (AP) — Only a 10 percent chance of showers today, but a 70 percent chance of flu next month.

That’s the kind of forecasting health scientists are trying to move toward, as they increasingly include weather data in their attempts to predict disease outbreaks.

In one recent study, two scientists reported they could predict — more than seven weeks in advance — when flu season was going to peak in New York City. Theirs was just the latest in a growing wave of computer models that factor in rainfall, temperature or other weather conditions to forecast disease.

Health officials are excited by this kind of work and the idea that it could be used to fine-tune vaccination campaigns or other disease prevention efforts.

At the same time, experts note that outbreaks are influenced as much, or more, by human behavior and other factors as by the weather. Some argue weather-based outbreak predictions still have a long way to go. And when government health officials warned in early December that flu season seemed to be off to an early start, they said there was no evidence it was driven by the weather.

This disease-forecasting concept is not new: Scientists have been working on mathematical models to predict outbreaks for decades and have long factored in the weather. They have known, for example, that temperature and rainfall affect the breeding of mosquitoes that carry malaria, West Nile virus and other dangerous diseases.

Recent improvements in weather-tracking have helped, including satellite technology and more sophisticated computer data processing.

As a result, “in the last five years or so, there’s been quite an improvement and acceleration” in weather-focused disease modeling, said Ira Longini, a University of Florida biostatistician who’s worked on outbreak prediction projects.

Some models have been labeled successes.

In the United States, researchers at Johns Hopkins University and the University of New Mexico tried to predict outbreaks of hantavirus in the late 1990s. They used rain and snow data and other information to study patterns of plant growth that attract rodents. People catch the disease from the droppings of infected rodents.

“We predicted what would happen later that year,” said Gregory Glass, a Johns Hopkins researcher who worked on the project.

18

ASSOCIATED PRESS

Disease forecasters look to the sky More recently, in east Africa, satellites have been used to predict rainfall by measuring sea-surface temperatures and cloud density. That’s been used to generate “risk maps” for Rift Valley fever — a virus that spreads from animals to people and in severe cases can cause blindness or death. Researchers have said the system in some cases has given two to six weeks advance warning.

Last year, other researchers using satellite data in east Africa said they found that a small change in average temperature was a warning sign cholera cases would double within four months.

“We are getting very close to developing a viable forecasting system” against cholera that can help health officials in African countries ramp up emergency vaccinations and other efforts, said a statement by one of the authors, Rita Reyburn of the International Vaccine Institute in Seoul, South Korea.

Some diseases are hard to forecast, such as West Nile virus. Last year, the U.S. suffered one of its worst years since the virus arrived in 1999.

There were more than 2,600 serious illnesses and nearly 240 deaths.

Officials said the mild winter, early spring and very hot summer helped spur mosquito breeding and the spread of the virus. But the danger wasn’t spread uniformly. In Texas, the Dallas area was particularly hard-hit, while other places, including some with similar weather patterns and the same type of mosquitoes, were not as affected.

“Why Dallas, and not areas with similar ecological conditions? We don’t really know,” said Roger Nasci of the Centers for Disease Control and Prevention. He is chief of the CDC branch that tracks insect-borne viruses.

Some think flu lends itself to outbreak forecasting — there’s already a predictability to the annual winter flu season. But that’s been tricky, too.

Seasonal flu reports come from doctors’ offices, but those show the disease when it’s already spreading. Some researchers have studied tweets on Twitter and searches on Google, but their work has offered a jump of only a week or two on traditional methods.

In the study of New York City flu cases published last month in the Proceedings of the National Academy of Sciences, the authors said they could forecast, by up to seven weeks, the peak of flu season.

They designed a model based on weather and flu data from past years, 2003-09. In part, their

design was based on earlier studies that found flu virus spreads better when the air is dry and turns colder. They made calculations based on humidity readings and on Google Flu Trends, which tracks how many people are searching each day for information on flu-related topics (often because they’re beginning to feel ill).

Using that model, they hope to try real-time predictions as early as next year, said Jeffrey Shaman of Columbia University, who led the work.

“It’s certainly exciting,” said Lyn Finelli, the CDC’s flu surveillance chief. She said the CDC supports Shaman’s work, but agency officials are eager to see follow-up studies showing the model can predict flu trends in places different from New York, like Miami.

Despite the optimism by some, Dr. Edward Ryan, a Harvard University professor of immunology and infectious diseases, is cautious about weather-based prediction models. “I’m not sure any of them are ready for prime time,” he said.

• Associated Press

Healthy living through lifelong learning

By JENNY HOLMES Contributing Writer

Central Lakes College and Essential Health partner to create lifelong learners of Lakes area seniors

A

A growing number of Lakes area adults, aged 50 and greater, have returned to college over the past several months – but not for the reasons you may think.

Roughly one year ago, Central Lakes College, Brainerd Campus introduced The Center for Lifelong Learning; an opportunity for aging adults and retired individuals to participate in classes, workshops and presentations with topics geared specifically toward issues affecting them as they enter a new phase in their lives.

Bill Brekken has served as the Director for The Center for Lifelong Learning since its inception and says even in its infancy, The Center has been wellreceived by individuals in the area looking to pursue interests and lifelong learning opportunities.

“We’re proud of the success we’ve had,” Brekken said. “In our first year alone, we’ve offered 37 programs with over 900 participants. In this coming year, we are excited as we continue to add programming and partnerships to enhance opportunities for our community.”

A program committee for The Center for Lifelong Learning meets regularly to review potential topics, brainstorm instructors or presenters, and work with CLC to schedule events that appeal to their target audience. Arla Johnson serves on the program committee and has emphasized a need for regularlyscheduled, health-related topics for aging adults.

“Life experiences have taught me the importance of healthy living,” Johnson said. “Many of the adults participating in our program are in a transition phase in their lives – including empty nesters, retirees, and even those facing serious health issues.”

Collaboration is key when it comes to providing quality offerings, Brekken noted. Through a special partnership with the Lakes Area Memory Awareness Advocates, a workshop was offered in 2012 entitled “Living Well with Alzheimer’s,” and focused on the aspect of the caregiver.

“The one thing where I see The Center really meeting a need, is that of assisting caregivers,” Brekken added. “That’s really where my heart has been touched. I’ve seen what they face and have to deal with on a daily basis. If we can provide programming for healthy living and staying healthy, that is vital.”

The Center for Lifelong Learning also works with Essentia Health and other entities in the health care field to present timely and relevant topics for participants. From Alzheimer’s to arthritis and eating to eye disease, The Center is always interested in relevant topics in health care and other fields of interest.

The Center for Lifelong Learning is also hosting several sessions in the coming months on health-related topics, including joint health, fitness after 50, and the importance of laughter to a healthy lifestyle.

“We’re always looking for topics and presenters,” Brekken said. “In our area, we have such a diverse population of individuals with such a varied knowledge base and experiences. We welcome suggestions, proposals, pre-

senters, and participants. The Center for Lifelong Learning is completely community-driven and designed to help individuals navigate the transitions life takes at various stages. We are all about discovering ways to give back to our community.”

Johnson agreed from a standpoint of a passion for educating others on improving or maintaining health at a pivotal point in their lives.

“We want to meet everyone where they’re at and equip them with the tools and resources to help them make the most quality decisions facing their health care and lifestyles.”

19

ASSOCIATED PRESS

Stand alone emergency rooms

“ ” This is another

tool that hospitals can use to

grow...It’s a way to get patients

into the doors of your system.”

20

Hospitals expand with indepentent ERs

C

CHICAGO (AP) — One recent evening after office hours, Dr. James Magee got a phone call about a patient, a woman in her 40s. She complained of tingling on one side of her body, in her arm and leg.

Could it be a stroke?

Magee told the woman’s husband to rush her to the free-standing emergency room downstairs from his office in the Chicago suburb of Homer Glen. He told the man: “This is not something that can afford to wait.”

The convenience of 24-hour emergency care may be coming to more Illinois communities as hospitals make plans to build stand-alone ERs up to 50 miles from their flagship facilities.

For hospital executives, it’s a way to expand turf, compete for patients and prepare for an aging population and more Americans gaining insurance under the federal health overhaul law. For families who live far from a hospital, stand-alone emergency rooms provide the comfort of knowing trained doctors and nurses are nearby and ready to handle most health crises.

But for the health care system as a

whole, the trend could raise costs, particularly if more patients use emergency rooms for non-emergency problems instead going to an urgent care clinic or primary care provider.

While hospitals and insurance companies contest the question of costs, Illinois is poised for a possible miniature boom in miniature ERs. The state now has five stand-alone emergency rooms. In the Chicago suburb of Frankfort, two hospitals are competing to build another after state lawmakers last year extended a sunset date for new licenses.

Fewer than 300 hospitals in the U.S. have free-standing emergency departments, nearly double what it was in 2005, according to an American Hospital Association survey.

Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians, said he expects demand for emergency care to increase as President Barack Obama’s health care law expands the number of people with insurance starting in 2014.

“Urgent care centers will probably expand. And hospitals may see fit to open

more free-standing emergency departments,” Rosenau said.

Urgent care centers can handle problems that aren’t life-threatening, such as sprains, cuts, insect bites and simple broken bones. They usually are open late and on weekends.

In contrast, free-standing emergency centers are staffed around the clock. They can handle many life-threatening emergencies, although patients who need surgery and other complex procedures are transferred to full-service hospitals. They generally are equipped with imaging tools such as CT scanners and MRI machines.

Blue Cross and Blue Shield of Illinois spokesman Michael Deering said freestanding ERs “demand significantly higher reimbursement rates from insurers than an urgent care clinic or a retail clinic because they bill for costly facility fees that urgent and retail clinics do not.” Deering is worried patients will be confused about where they should seek care.

Hospital leaders counter that patients usually know when they need an ER and when they need urgent care.

The Illinois health planning board will See STAND ALONE, Page 21

STAND ALONE, From Page 20 decide which hospital system — if any — will get a permit for the Frankfort facility.

Hospitals nearby are worried a competing ER would siphon away nurses and contribute to a staffing shortage.

Hospitals nationally have been using freestanding ERs to attract patients in prosperous suburbs with growing, well-insured populations, said Emily Carrier, co-author of a 2012 study on hospital expansion and a senior health researcher at the nonpartisan Center for Studying Health System Change in Washington, D.C. Free-standing emergency rooms cost less to build than full-service hospitals, she said, but hospitals can charge the same rates and transfer patients into their main hospitals.

“This is another tool that hospitals can use to grow. You can locate a free-standing emergency department in a community where you’d like to have a presence,” Carrier said.

“It’s a way to get patients into the doors of your system.”

Another study found that most free-standing ERs are in urban areas, even though they originally were conceived as a solution for rural areas with no hospitals narby.

Illinois law says each free-standing emergency department must be in a city with a population of no more 50,000. It must be

staffed 24 hours a day by at least one boardcertified emergency doctor. It must have an ambulance that can take patients to a full-service hospital if necessary. It must be owned by a hospital system and can’t be marketed as a hospital emergency department.

Riverside Medical Center in Kankakee and Silver Cross Hospital in New Lenox are competing to build the Frankfort center.

Both systems have noted the area’s population growth. Silver Cross operates the existing Homer Glen free-standing ER. “How we deliver health care keeps evolving and this is one more evolution in how we deliver health care closer to patients,” said Maggie Frogge, senior vice president of corporate strategy for Riverside Medical Center.

Magee, the Homer Glen doctor who is a member of the Silver Cross medical staff, said the patient with the possible stroke turned out to be suffering from something less life-threatening.

“We’re still in the process of sorting that out,” he said. He added that he’s grateful the stand-alone ER was available.

“That’s the kind of convenience that is good for me as a physician.”

• Associated Press

Flu virus widespread throughtout U.S.

Experts recommend flu shot for everyone over six-months-old NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an “epidemic” threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it’s not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there’s a hint that the flu season may already have peaked in some spots, like in the South.

Still, officials there and

elsewhere are bracing for more sickness In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

“Everybody’s been sick. It’s miserable,” said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it’s not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven’t gotten this year’s vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have

been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, “you may have to call a couple places,” said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

The vaccine is no guarantee, though, that you won’t get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don’t get the vaccine. That’s in line with other years.

The flu’s early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as “stomach flu.”

Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor.

They may be given antiviral drugs or other medications to ease symptoms.

21 • Associated Press

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