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Flu vaccine gets a shot of innovation in design, delivery 8 You’re NOT so vain bariatric weight loss surgery has more to do with long-term health than looks 10 How to get healthier by employing the buddy system with your pet 12 Roll out relief!  $¿VK\1HZ<HDU¶V  resolution

On The Cover: Tracy Bontrager, bariatric information specialist at IU Health Team Bariatrics,poses inside the offices for the clinic. page 8

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Until 2003, there was only the flu shot. A needle into the arm delivered vaccine, and a couple of weeks later your immune system was primed to fight off the top three strains of influenza likely to be floating around that winter and early spring. But over the past several years, flu vaccine developers and manufacturers have been doing a lot of tinkering. They’ve come up with at least seven different types of vaccine and/or delivery modes. There are options for people who haven’t been able to get vaccinated because of egg allergy; for those who hate needles; for those who hate needles injected into muscle and for older people with balky immune systems who might need a stronger dose to gain protection; and new lines of vaccines that protect against an extra strain of flu virus. In all, manufacturers have told the federal Centers for Disease Control and Prevention they expect to produce at least 135 million flu vaccine doses for distribution in the U.S. this season, with more than 73 million doses already delivered to doctors’ offices, clinics, pharmacies, hospitals and other outlets. Last year, the flu season got an early start in October. Many officials fear the same pattern may repeat this fall, prompting an early “get a flu shot” campaign that rivals the Christmas promotions by some retail chains. The CDC and other public health advocates recommend flu vaccination for anyone 6 months or older (younger babies immune systems aren’t geared up enough to get it). Last year, an estimated 56 percent of children and 42 percent of adults got flu vaccine. Children younger than 9 getting a flu shot the first time need two doses. “We have more types of vaccine available than ever before and there are one or more options that are right for everyone,’’ Dr. William Schaffner, an infectious disease specialist at Vanderbilt University and past

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Scripps Howard Columnist Lee Bowman president of the National Foundation for Infectious Diseases, said at a Sept. 26 briefing sponsored by the foundation. All flu vaccines will include strains of H1N1 and H3N2 and a strain of influenza B. The three-strain or “trivalent” vaccine represents the bulk of vaccine stocks available this season. Some lines are made using virus grown in eggs and can be given to anyone 6 months and older; others are grown in cell culture and approved only for patients 18 and older. The four-strain, or quadrivalent, vaccine is the big innovation for this year, protecting against a second B-type influenza that mainly sickens young children. It’s available as a shot and as a nasal spray, which is limited to use on healthy people ages 2 to 49. Vaccination experts expect the four-strain dose will replace the three-strain version in all products within two to five years, but the CDC says it will make up less than a quarter of vaccine supplies this year. Quadrivalent vaccines will cost a third to half more, according to some prices in government contracts and trade reports. For instance, one manufacturer’s price per dose to the CDC is $12.03 for the four-strain, $8.08 for the standard three-strain version. Another three-strain version can be delivered with barely a tingle by an array of tiny, short microneedles into the skin, rather than by a single needle into muscle. And for people sensitive to eggs — roughly 1 percent of adults and 4 percent of children — there’s a new egg-free three-strain formula. The vaccine is cultured in caterpillar cells. Fall 2013


There’s also a high dose vaccine intended for people 65 and older, whose immune systems are less responsive and who may need a bigger virus challenge for flu protection. Although the four-strain vaccines clearly cover more ground, CDC officials say that all FDA-approved vaccines offer good protection and that no strong evidence suggests one type is superior. “There are lots of open questions, and each year is different,’’ said Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases. Because individual immune systems differ and flu vaccines may not perfectly match the virus going around, no vaccine can guarantee you won’t get sick. But even if you do, the illness is likely to be shorter and milder than without a flu shot. To find flu vaccines in your area, the CDC offers this locator link: http://www.flu.gov/ stay-connected/vaccinelocator_2011.html. Contact Scripps Health and Science writer Lee Bowman at BowmanL@shns.com.

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SAM HOUSEHOLDER I THE GOSHEN NEWS Tracy Bontrager, bariatric information specialist at IU Health Team Bariatrics, poses inside the offices for the clinic.

You’re T O N So Vain Bariatric weight loss surgery has more to do with long-term health than looks By SHERRY VAN ARSDALL SHERRY.VANARSDALL@GOSHENNEWS.COM

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GOSHEN — There are people of all levels in life who seek the option of bariatric weight-loss surgery. “They feel frustrated and don’t know who to see or where to turn,” said Tracy Bontrager, bariatric information specialist with Team:Bariatrics at IU Health Goshen Physicians. “These are people who have tried every diet you can imagine and nothing is working for them. They feel they have nowhere to turn and may even feel embarrassed. They may have reached rock bottom and are now ready for a change.” Individuals dealing with significant health issues from being obese, including high blood pressure, diabetes, heart disease, stroke, depression, sleep apnea and osteoarthritis, could benefit from the procedure, Bontrager explained. “People with diabetes and on insulin (or oral diabetes drugs) can still be eligible for bariatric surgery,” Bontrager said. “There is data available to support the facts that after weight-loss surgery, up to 80 percent of patients can have their diabetes resolved.” Bontrager shook her head when talking about weight and diseases in the same sentence. “So many diseases are weight-related. If people Fall 2013


could lose weight, those diseases could be resolved,” Bontrager said. “If weight loss is their last resort, it could be resolved. It’s just not about looks (weight-loss surgery).” Eligibility for surgery One of the guidelines in determining eligibility for the surgery is a person’s body mass index (BMI), Bontrager said. BMI measures how much body fat a person carries by taking into account their weight, as well as their height.

“So many diseases are weight-related. If people could lose weight, those diseases could be resolved.” “If a person has a BMI greater than 40, they are a good candidate,” Bontrager said. At the Women’s Expo held Oct. 5 in Goshen at the Retreat Women’s Health Center, Lois Widmer and Julia LeCount, both of Goshen, had body composition assessments as part of the free health screenings and assessments offered during the event. Jeff Norment, a certified personal trainer with Team:Bariatrics, told Widmer her BMI number was under 40 — which is good — and shared some suggestions for better fitness. The two friends were glad to know their BMI numbers made them ineligible for the weight-loss Fall 2013

surgery, and they appreciated receiving information for making better choices for healthier lifestyles. Health-care coverage The cost factor, with health insurance companies providing coverage for more people having the surgery, has changed for several reasons. The improvements made with the latest technology and doctors sharing their successes have helped, Bontrager explained. “Most of the insurances cover 75 to 85 percent of the weight-loss surgery,” Bontrager said. “It was viewed as an elective surgery in the beginning. Doctors have perfected the surgery over time and helped share their expertise in the right ways to perform surgery.” The latest bariatric surgery options available at Team:Bariatrics include laparoscopic gastric bypass Roux-en-Y (RNY); laparoscopic adjustable gastric banding; and laparoscopic sleeve gastrectomy. Bontrager added that the lapband (adjustable gastric banding and sleeve gastrectomy) are deemed outpatient procedures and minimally invasive to a person’s body. And as with any type of surgery, there can be complicatons. “They can be back to full regular activity within three weeks,” she said.

“She’s observed more women opt to have the surgery than men,” she said. “I think it’s an interesting business.” The staff at Team:Bariatrics works together with the patients as they strive to lose their weight and dealing with the highs and lows of weight loss. “It’s a tool but it won’t fix you. You can gain the weight back,” Bontrager said. “There are many different reasons for having the surgery, but a person has to have a goal to finish and do well. They need to be doing it for intrinsic reasons and not something external. They need to do it for the right reasons.” A person shouldn’t consider bariatric surgery a short-term process. “It’s long-term,” Bontrager said. “It’s a passion and a person has to be ready to focus with that passion. It’s a dramatic change with the surgery.” Sometimes a patient has a hard time accepting the “new” person, and change their self-image of being overweight even though they’ve lost weight. “The mental challenge,” Bontrager said, “is sometimes larger than the physical challenge.”

Changing lives Bontrager enjoys her job and watching people’s lives transformed. ECL Health & Wellness

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BY S A L LY A

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A DEEP-TISSUE MASSAGE HELPS TO RELIEVE MUSCLE SORENESS AND JOINT STRESS, BUT IT DOES COME WITH A PRICE TAG. THIS IS NOT TO SUGGEST YOU ELIMINATE MASSAGES, BUT TO SHARE WITH YOU AN INEXPENSIVE TECHNIQUE, USING A FOAM ROLLER THAT WILL RELEASE MUSCLE TIGHTNESS, TO GET YOU THROUGH UNTIL YOUR NEXT MASSAGE APPOINTMENT.

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The foam roller not only stretches muscles and tendons, but also breaks down soft-tissue adhesions and scar tissue that can limit everyday movement. The now-popular foam rollers were originally associated with elite athletes and physical therapists, but have since graduated into gyms, Pilates studios, yoga classes and the home.

trolled by putting more or less body weight on the rollers. Foam rollers are cylinder-shaped, highdensity foam that come in varying lengths, shapes and firmness. The cost ranges from $12 to $40, and they may be found online or at most any sportinggoods store.

You will be using your own body weight by lying on the roller and moving back and forth on selected areas you want to target; pressure may be con-

* Hamstring (back of thighs) and calves: Sitting, place roller under back of thighs. With hands on floor behind you, lift buttocks slightly off floor. Slowly roll back and forth from buttocks to back of knees. For calf muscles, place roller under calves. Lift hips slightly, using hands for support,

EXERCISES

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and roll from below knee to ankle. * Quadriceps (front of thighs): Place roller under front of thighs, with lower arms resting on floor, head in alignment with spine, eyes facing downward. Contract abdominals to prevent the lower back from sagging. Using arms, roll back and forth from bottom of hip to top of knee. * Back and chest: This is an awesome stretch for posture. Lie on a long foam roller, shoulders and hips in alignment and spine straight, knees bent and feet on floor to prevent stressing

lower back, head supported by foam roller. Place a pillow or small towel under your head if you need more support. Allowing arms to fall to the sides, palms up, will stretch the chest. Taking deep breaths, relax for several minutes. Be aware that lying on a foam roller should never be painful. A good alternative for stretching exercises would be half rollers, as one side of the roller has a solid base. HOW TO USE FOAM ROLLERS:

1. Always warm up muscles before beginning. 2. Place roller under soft-tissue area you want to target to release tension. 3. Always roll on soft tissue.

Avoid rolling over bones or joints. 4.To roll with less pressure when working the lower body, sit near end of roller and roll with one leg. 5. Gently, roll back and forth over targeted area five to 10 times. 6. When you find a noticeably tight area, hold that position a few seconds, until it begins to soften. 7. If an area is too painful for direct pressure, work the area around it. 8. Drink water when finished. 9. If you have any chronic pain or cardiovascular issues, check with your physician before beginning a foam-roller workout. Č? ÍĽÍ     ÇĄ         

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Metro News Service Do you think that all New Yearâ&#x20AC;&#x2122;s resoluWLRQVDUHDELWÂżVK\" Perhaps youâ&#x20AC;&#x2122;re suspicious of the fads that appear each -DQXDU\RIIHULQJXVWKHODWHVWLQÂżWQHVV and diet trends that promise a slimmer you in the year to come. This year, instead of focusing on weight loss, why not resolve to try a tried and true resolution that will mean truly better overall health for you and your family â&#x20AC;&#x201C;- eating well with foods like True Northâ&#x20AC;&#x2122;s Omega-3 rich Atlantic salmon from the Gulf of Maine, where the salmon is the freshest? 2012 should be the year for paying more attention to overall health and well-being. Atlantic salmon is one of the most healthy and nutritious food choices available and is a great addition to any New Yearâ&#x20AC;&#x2122;s resolution that is aimed at living healthier. Itâ&#x20AC;&#x2122;s an excellent source of protein and loaded with vitamins and minerals, and is also one of the best sources of natural Omega-3 fatty acids. Omega-3 polyunsaturated fats are often known as â&#x20AC;&#x153;the good fatsâ&#x20AC;? and are 14

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considered essential because we need them to live a healthy life but we have to get them from external sources like seafood. The American Heart Association recommends that people include at OHDVWWZRVHUYLQJVRIÂżVKSDUWLFXODUO\ IDWW\ÂżVKVXFKDV$WODQWLFVDOPRQSHU week in their diets in part because of QXPHURXVKHDOWKEHQHÂżWVDVVRFLDWHGZLWK Omega-3s. As a great source of Omega-3 DHA and EPA essential fatty acids, Atlantic salmon helps the bodyâ&#x20AC;&#x2122;s heart health â&#x20AC;&#x201D; helping prevent heart disease and stroke, reducing the risk of cancer, lowering cholesterol; and may assist in brain health â&#x20AC;&#x201D; maintaining healthy brain activity and reducing the chance of developing Alzheimerâ&#x20AC;&#x2122;s disease in adults, and enhancing brain development and promoting learning in children. Studies have also shown Omega-3s may prevent depression, schizophrenia and memory loss, along with just generally increasing our daily energy levels and acting as an DQWLLQĂ&#x20AC;DPPDWRU\

Atlantic salmon leads the way, surpassing all other seafood, including wild salmon, in Omega-3 DHA and EPA amounts per serving. Not only that, but itâ&#x20AC;&#x2122;s an excellent source of protein and lower than beef or chicken in saturated fats. Itâ&#x20AC;&#x2122;s easy to start adding more Atlantic salmon to your diet and you can start out simply with basic recipes like True Northâ&#x20AC;&#x2122;s Salmon with Soy-Honey and Wasabi Sauce. Salmon isnâ&#x20AC;&#x2122;t complicated to cook, and when you combine the great taste with the knowledge that itâ&#x20AC;&#x2122;s VRJRRGIRU\RX\RXÂśOOÂżQG\RXUVHOISUHparing it more often. A great way to work salmon in to your new yearâ&#x20AC;&#x2122;s meal plan is to start slowly by swapping out one of your guilty pleasure meals â&#x20AC;&#x201D; something you know isnâ&#x20AC;&#x2122;t very good for you â&#x20AC;&#x201D; with a quick delicious meal of Atlantic salmon from the Gulf of Maine, where the salmon is the freshest. Youâ&#x20AC;&#x2122;ll feel better about the choice youâ&#x20AC;&#x2122;ve made and your body and mind will thank you. Fall 2013


Salmon with Soy-Honey and Wasabi Sauce 4 Servings Ingredients

4 5-6 oz (150-180 g) Heritage Salmon Portions

For salmon 1/2 cup (125 ml) mirin (Japanese sweet rice wine) 2 tablespoons (30 ml) soy sauce 1/4 cup (65 ml) rice vinegar 1 tablespoon (15 ml) finely grated, peeled fresh ginger

For sauce 2 tablespoons (30 ml) soy sauce 1/4 cup (65 ml) honey 1 tablespoons (15 ml) fresh lime juice 2 teaspoons (10 ml) wasabi powder 1 tablespoons (15 ml) water

Directions 1. Stir together mirin, soy sauce, vinegar, and ginger in a shallow dish. Add fish and marinate, covered, at room temperature for 10 minutes. 2. Boil soy sauce, honey, and lime juice in a small saucepan, stirring frequently, until thickened, about 4 minutes. 3. Stir together wasabi powder and water in a small bowl. 4. Preheat broiler, and cook fish on oiled rack, 5 to 7 inches from heat, until fish is just cooked through, about 6 minutes. Remove from heat and drizzle with sauces. 5. Serve with wild rice and steamed asparagus. Whether grilled, baked or poached, True North Atlantic salmon provides some of the essential nutrients and fatty acids needed for good health -- and it tastes delicious too. SIDEBAR: Healthy eating tips * Bake, broil or grill your salmon instead of pan-frying it. * Limit the amount of oil you use. * Flavour your salmon with seasonings like dill, lemon or pepper instead of butter or oil. * If you do use oil, make it olive oil. Research suggests that, like salmon, this monounsaturated fat lowers the risk of heart disease. * Pair your salmon with a healthy side dish like steamed broccoli, carrots or vegetable stir-fry. Not only will these colorful veggies look good, theyâ&#x20AC;&#x2122;re good for you too.

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