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Fighting diabetes starts at the dinner table John Kelleher jkelleher@havredailynews.com

Courtesy photo Suzy Wiken, left, and Celeste Elliot, registered dietitians at Northern Montana Hospital, show off a display of healthy foods that can be used in fighting the effects of diabetes.

After people find out they have diabetes, one of their first stops is to see Suzy Wiken and Celeste Elliot, the registered dietitians at Northern Montana Hospital. Wiken and Elliot find people are sometimes angry, upset or confused and always concerned. "They are concerned about their feet, their eyesight," said Elliot. Diabetics then learn about the lifestyle changes they can make to bring their disease under control. The dietitians explain to them what diabetes is doing to their bodies, and what people can do to mitigate the effects of the disease. The hospital’s program is approved by the American Diabetes Association and serves people in Hill, Blaine and Liberty counties, except for the Rocky Boy's and Fort Belknap Indian reservations, which have their own programs. For starters, diabetics learn how they can change their diets to lose weight and keep the number of carbohydrates in their food down, the dieticians said. Fewer fats and more fruits and vegeta-

bles help them out, they said. And they can learn how to be more active. Walking and running is helpful, and swimming is great. “I always suggest swimming with gusto,” Elliot said. That is hard because hours for swimming are somewhat limited in Havre, but it provides exercise, tones important muscles and burns energy, they said. Some people have a hard time doing traditional exercises, Elliot said, because they have joint problems in their lower bodies, and swimming is easier. People are sometimes relieved to find out they have more control over their disease than they thought, she said. There is internal resistance to a better diet, especially with men patients. “Typical guys like to eat, and they like to eat what they want,” said Elliot. Often people can bring their blood sugar levels down considerably by diet and exercise, Wiken said. Changing to different types of juices or eating whole wheat bread instead of white bread can help, they said, Eating out is a problem because restaurants often provide large servings of food, when diabetics are encouraged to eat in

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The Northern Alumni Association completed a major remodeling of some of the lower floors in the 1980s and have worked on many other projects to maintain the building. The building housed several offices for the college, including the Alumni Association and the Foundation until 2008. But failure of electrical, plumbing and heating systems in the building led to those offices being moved. The proposal for Bullhook to lease and renovate the building was drafted and submitted while the university was led by an interim chancellor, former provost Joe Callahan, who came out of retirement to serve at the university’s helm while the search was conducted that ended with the hiring of Chancellor Jim Limbaugh. The proposal also was submitted while S h e i l a S t e a r n s wa s t h e M o n ta n a Commissioner of Higher Education. B e fo re H R SA awa rd e d t h e g ra n t , Limbaugh took over at Northern and Stearns retired, with her position filled by Clayton Christian. After HRSA awarded the grant to Bullhook, Limbaugh and Christian said the proposal did not fit the plans of the university. In statements and interviews in June, university system representatives including Christian said converting the building for use by a non-university entity did not meet the plans and goals of the university. The building will be repaired and renovated for student and academic use at the university, which will be done within the university system budget resources, they said.

Finding a new location The health center staff then switched gears, immediately starting the search for alternate locations. The one approved in September by HRSA takes up a quarterblock across from City Hall, in a space now occupied by an empty lot, the Brandon Building and the building that formerly housed Heberly Engineering. Smith said, with the location approved by HRSA, work is now ongoing to finalize the

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purchase of and build in the new location. She said the health center staff members are working with the Montana Community Development Foundation to find funding to purchase the real estate. Once that is done, the Brandon Building will be moved and the Heberly Building torn down, she said. The staff members were interviewing architectural and engineering firms last week, with a firm to do the actual designs expected to be selected soon. The firm will be heavily involved in selecting the contractors, with the intent to hire as locally as possible, Smith said. Smith said the staff members of the health center, and local residents, will be involved in deciding what the final design of the new health center should look like.

Expanding care and services

Constructing a new facility has two main purposes — creating a “medical home model” with services offered under one roof, and expanding the space in which to provide those services. When the center staff members announced the grant in May, they said the health center now has some 3,500 patients. The new facility is expected to allow that to nearly double, to some 6,500. The expansion also will allow increased staff. In May, the center employed 29 people, and the plans were to expand the number of medical and behavioral health care positions in the operation. Smith said part of that already is under way. A new doctor was scheduled to come on board Oct. 8, with expansion of services planned — possibly including some weekend and night-time clinics. When the new facility is open, that doctor will begin to work full time with the health center. Smith said the health center also will continue to work with other local health care providers, as well as continuing to work with programs at Montana State UniversityNorthern.

Havre Daily News/File photo Bullhook Community Health Center opens for business in 2007 in its 13th Street location.

Havre Daily News/Lindsay Brown An empty lot, the Brandon Building and former Heberly Engineering building now occupy the space on 5th Avenue and 4th Street where the new Bullhook Community Health Center will be erected.


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Plans for new Bullhook clinic location moving forward Tim Leeds tleeds@havredailynews.com After a three-month regrouping, the board and staff of the Hill County community health center are continuing to move forward with the construction of a new location and centralized services for the center. “We are working on the purchase of the land. Hopefully, we will have those all completed by around (Wednesday, Oct. 10) … ,” Cindy Smith, executive director of Bullhook Community Health Center said Oct. 1. “Once they can break ground next spring, it will be probably a year’s process so it will be probably the spring … in 2014 before we can move in.” The Human Resources and Services Administration of the U.S. Department of Health and Human Services notified the center staff May 1 that it had awarded Bullhook $4,957,921 to lease, renovate and repair Donaldson Hall on the Montana State University-Northern campus and put all of its services there. The administration of the university system later stopped that plan, saying putting the clinic on campus did not meet their longrange plans for the building and the rest of Northern’s campus. Bullhook’s staff then put in applications with alternate possible locations, and HRSA announced Sept. 10 it had approved building

a new clinic north of the Havre City Hall complex on 5th Avenue and 4th Street.

Working to expand health care services Bullhook got its start when a county health consortium, formed in 2003 to identify areas where improvements in health care were needed, found that services to low-income people and people without insurance were in short supply in the region. The Bullhook Clinic was created under a federal planning grant in 2005, as a part of the Hill County Health Department. The clinic provided — and the health center continues to provide — medical services to patients, including on a sliding-fee scale based on the patient’s income. During period of cuts to programs in the federal government, the clinic staff was notified in 2006 that the second year of its federal grant had been cut. The clinic reorganized, cutting six nonmedical members of its staff, cancelling its outreach, reducing wages and combining job duties within remaining positions. That December, the clinic applied for new funding through a Federal New Access Community Health Center Grant to reform as a free-standing operation. In July 2007, the clinic reopened as an independent nonprofit organization, the

Bullhook Community Health Center. At almost the same time, the group was working on finding ways to add dental care to its services. The consortium that had recommended the creation of Bullhook also found that many in the area had difficulty finding dental care due to a shortage of providers and lack of services where people can use programs like Medicaid and the state Childrens Health Insurance Program, now part of Healthy Kids Montana. Bullhook applied for state grants authorized by the 2007 Legislature to help communities expand their dental care. Bullhook was passed over in the first round, but in September 2008 received a $185,000 two-year grant. Bullhook has continued to expand its services, and offers addiction counseling services as well as housing programs like the Montana Asthma Project and the Montana Medicaid Health Improvement Program.

Consolidating a location But the locations for those services are split, and the space for them is crowded. After splitting from the county, Bullhook moved into a space just east of Northern Montana Hospital, which it leases from Northern Montana Medical Group. Once it successfully started the dental

clinic, it leased space in the Atrium Mall, where those services still are housed. The addiction counseling and other services are housed in the building with the main clinic, on 13th Street. One of the goals of applying for the HRSA grant, through funds for community health centers which Sen. Max Baucus, D-Mont., worked to include in the Patient Protection and Affordable Care Act, the national health care reform bill, was to bring all of the services together in a convenient location.

Trying to save a historic building and improve health care The original application to HRSA proposed using the grant to renovate Donaldson Hall on the Montana State UniversityNorthern campus and use that building to house the health center. Donaldson, the first completely new building erected on Northern’s campus, opened in 1936 as a women’s dormitory. Donaldson was retired as a residence hall in 1971. The lower floors were rented to the Havre school district at that time, and Donaldson saw limited use as a dormitory or temporary housing space in the 1980s and 1990s with regular dormitories operated in other buildings.

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smaller proportions. It is also hard to count calories, fat or carbohydrates, but new smartphone applications enable people to find out that kind of information while they are ordering food. Some chain restaurants are beginning to post calorie or carb information on the menu, Wiken said. The United States is going through a diabetes epidemic, they said, and the Hi-Line is no exception. Many risk factors contribute to diabetes, they said — diet, lack of exercise or heredity. But there is one major factor: Obesity. “I think 99 percent of the people I see are obese — or were,” Wiken said. There is a belief that the effects of diabetes get worse as years go on, they said. But proper treatment makes that way less likely,

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they said. They are beginning to see people more often who are pre-diabetic, they said. These are people who are on their way to contracting diabetes. Often referred by doctors, the treatment for pre-diabetes is often the same: More exercise, better diets and sometimes medication. Losing weight and stopping smoking is usually the best thing that pre-diabetics can do. Often if pre-diabetics lose weight and eat better, they can be taken off medication, they said.

Finding out about diabetes People find out they are diabetics in a variety of ways, they said.

Sometimes doctors realize the symptoms and perform tests. Sometimes people begin to realize they are tired all the time, and they realize that diabetes may be the problems. One of the very few good things about the diabetes outbreak is that more people have blood-sugar-testing equipment, they said. The test involves lancing a finger to get a small drop of blood. The glucose meter can tell how much sugar they have in their blood system at the time. People often have their friends test their blood sugar. Sometimes, that is how people realize they have pre-disables.

Type 1 diabetes While most of the increase is in Type 2 diabetes, Type 1 diabetes remains a problem, they said.

www.havredailynews.com Type 1 is usually diagnosed in young people. It is caused by a shutdown or severe limitation of the liver function. Insulin is used to treat Type 1. People can usually treat themselves by i n j e c t i o n o r m o r e f r e q u e n t l y by pump. The pump injects insulin into the body throughout the day, and people can inject more before eating meals.

Get checked out While there are problems with diabetes, diabetics can live good lives if they are treated early and follow their doctor's advice, they said. The key is early detection, they said. If people have any of the side-effects, such as being tired all of the time, get checked out right away.

Making healthy food and drink choices American Diabetes Association Knowing what to eat can be confusing. Everywhere you turn, there is news about what is or isn't good for you. Some basic principles have weathered the fad diets and have stood the test of time. Here are a few tips on making healthful food choices for you and your entire family. You may also be interested in our book, Healthy Calendar Diabetic Cooking. Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals. Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce. Include dried beans — like kidney or pinto beans — and lentils into your meals. Include fish in your meals two or three times a week. Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey. Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese. Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats. Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and fullfat ice cream. Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

For More Information The book “What Do I Eat Now? A Stepby-Step Guide to Eating Right With Type 2 Diabetes” is a great resource to keep in your kitchen as a handy reference guide when it comes time to preparing meals. Also the

Diabetes Association have a registered dietitian ready to answer your nutrition questions. To keep in touch with the American Diabetes Association: Sign up for the the latest news on diabetes research, food and fitness, and opportunities to support the American Diabetes Association.

What Can I Drink? Food often takes center stage when it comes to diabetes. But don’t forget that the beverages you drink can also have an effect on your weight and blood glucose! We recommend choosing zero-calorie or very low-calorie drinks most of the time. This includes: • Water • Unsweetened teas • Coffee • Diet soda • Other low-calorie drinks and mixes You can also try flavoring your water with a squeeze of lemon or lime juice for a light, refreshing drink with some flavor. All of these drinks provide minimal calories and carbohydrates.

What to Avoid Avoid sugary drinks like regular soda, fruit punch, fruit drinks, energy drinks, sweet tea, and other sugary drinks. These will raise blood glucose and can provide several hundred calories in just one serving. See for yourself: One 12-ounce can of regular soda has about 150 calories and 40 grams of carbohydrate. This is the same amount of carbohydrate in 10 teaspoons of sugar. One cup of fruit punch and other sugary fruit drinks have about 100 calories — or more — and 30 grams of carbohydrate.

Tired of Water?

As you can see, you have many other options. Most diet drinks (like diet soda or diet tea) have zero grams of carbohydrate per

Diabetes and salt One key way of treating diabetes is to cut back on consuming sodium. Here are some additional tips that can help you cut back on sodium throughout your day: • Take the time to check labels at the grocery store. Check the amount of sodium in a serving and compare it to other similar items. This may sound time-consuming, but next time you shop for groceries, you’ll know what best options are and exactly where to find them. • Limit the amount of salt that you add when cooking. Instead, stock your spice cabinet with salt-free seasonings and spices. Look for recipes that don’t call for added salt. Fresh herbs, citrus juices, vinegars, and garlic are all low-sodium ways to add flavor to your food. Here are some examples: • Squeeze fresh lemon juice on steamed vegetables, broiled fish, rice, or pasta. You may want to try squeezing fresh lime juice on Spanish dishes. • Try salt- or sodium-free lemon pepper or mesquite seasoning on chicken. • Add cooked onion and garlic to liven up meats and vegetables. • Add fresh herbs to salads, pasta, or rice dishes to enhance flavor instead of adding salt or high-sodium condiments. • Marinate vegetables or cook them with balsamic vinegar. Refrain from using the salt shaker at the table. Try your food without salting it first — it may be better than you think. You’ll get a true taste of the natural flavors in the food you cook. If you need to, remove the salt shaker from the table all together. Keep the pepper out if you want to add a kick to your meal. Be aware that sometimes fat-free and reduced fat items have more sodium in them. It is usually added to give these products more flavor. Check the nutrition labels on these items so you know what you are getting. serving, so they will not raise blood glucose on their own. These diet drinks are sweetened with artificial sweeteners instead of added sugars. Removing the added sugars and replacing them with artificial sweeteners removes most of the calories and carbohydrates. One good thing about low-calorie drinks and drink mixes is that they are available in several flavors. They may be a good alternative to regular lemonade, iced tea, fruit punch, etc. These drink mixes are also usually sweetened with low-calorie sweeteners. They are very low in calories — about 5-10 per 8-ounce portion — and have less than 5 grams of carbohydrate per serving.

Milk and Juice Low-fat milk and 100 percent juice with no sugar added are also healthy drink choices. These drinks provide more calories and

carbohydrates than the other recommended choices, but they also provide us with important vitamins and minerals. Just remember to control portion size when you drink them, because the calories and carbohydrates can add up when you have too much. Choose low-fat 1 percent or skim milk, and make sure that you count it in your meal plan. One cup of skim milk provides about 12 grams of carbohydrate and 80 calories. If you choose to drink juice, be sure the label says it is 100 percent juice with no sugar added. Juice provides a lot of carbohydrates in a small portion, so be sure to count it in your meal plan. Usually 4-6 ounces — not even a full cup — contains 15 grams of carbohydrate and 50 or more calories. If you like to have juice in the morning but don’t want the carbohydrate from fruit juice, try low-sodium vegetable juice. At just 50 calories and 10 grams of carbohydrate in 1 cup, it is a great alternative.


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Dental health ■ Continued from page 11 A dentist will check your teeth for signs of decay that can result from decreased salivary flow. A physician will test for any underlying disease or conditions that may be causing your dry mouth. Having a dry mouth is not itself serious but taking care of your teeth and gums and regular dental visits are important when living with dry mouth. Without the cleansing effects of saliva, tooth decay and other oral health problems become more common. Patients using oral inhalers for asthma often develop oral candidiasis, an oral fungal infection, and are encouraged to rinse their mouths with water after using the inhaler. Tell your dentist what medications you are taking and any other information about your health that may help identify the cause of your dry mouth.

60 and older

Havre Daily News/Lindsay Brown A sign at Liberty County Hospital reads Tobacco Free Campus. Many hospitals have adopted similar health-conscious policies.

Just 60 years ago, it was an assumption that as we age we would lose our natural teeth. But, that’s not the case for today’s older adults who are keeping their natural teeth longer than ever before. A healthy mouth and teeth help you look good, eat delicious and nutritious foods, and speak clearly and confidently. Being mouth healthy is essential for good quality of life. Maintaining good oral health habits now is especially important because unhealthy bacteria in the mouth not only can harm your teeth and gums but may be associated

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with serious medical conditions. Research has shown that infections in the mouth may be associated with heart disease, stroke, diabetes, pneumonia and other health problems that are common in older adults. It really only takes a few simple steps,  brushing and  flossing daily, visiting your dentist regularly and eating nutritious foods.

Brush and floss daily Brushing and flossing your teeth is just as important for you as it is for your grandchildren. Even though it may have been years since you’ve had a cavity, your risk of cavities increases with age. One of the reasons is dry mouth—a common side effect of many prescription medications. Brush your teeth twice a day with fluoride toothpaste. Choose a toothbrush with soft bristles and a small head to get to those hard-to-reach areas. Replace your toothbrush every three or four months, or sooner if the bristles becomes frayed. If you have arthritis or other condition that limits movement, try an electric toothbrush. Clean between teeth daily with floss. If floss is too difficult to work with, try a floss pick or tiny brushes made specifically to clean between teeth.

Clean dentures daily Bacteria stick to your teeth and also to full or partial dentures. If you wear dentures, remember to clean them on a daily basis with cleaners made specifically for dentures. Do not use toothpastes for natural teeth or household cleaners, which are too

abrasive and can damage dentures, which can be expensive to replace. Take your dentures out of your mouth for at least four hours every 24 hours to keep the lining of your mouth healthy. It’s best to remove your full or partial dentures at night. Your dentist will provide you with instructions about how long your dentures should be worn each day.

Visit a dentist regularly Get regular dental checkups at least once a year — do not wait until you have pain. Why? As you age, the nerves inside your teeth become smaller and less sensitive. By the time you feel pain from a cavity, it may be too late and you may lose your tooth. There are also more serious conditions that

www.havredailynews.com your dentist will look for, like oral cancer and gum disease, which do not always cause pain until the advanced stages of the disease. By then, it’s more difficult and costly to treat. When you go to your dentist for a checkup bring the following information: • List of medications, including vitamins, herbal remedies, and over-the-counter medications • List of medical conditions and allergies • Information and phone numbers of all health care providers, doctors, and your previous dentist • Information about your emergency contacts, someone who can help make decisions on your behalf in the case of a medical emergency • Dental insurance or Medicaid cards.


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Early detection starts with you Many factors might predispose a woman to breast cancer: age, diet, weight, smoking, and other lifestyle habits. But there is one clear correlation: simply being a woman means being at risk. This year, over 200,000 women will be diagnosed, but there is good news. When it is found early, the five-year survival rate is 98 percent; it is still high, at 90 percent, for all women with breast cancer. The importance of early detection is at the heart of National Breast Cancer Awareness Month, sponsored by a network of government and non-profit breast cancer advocacy groups. The National Breast Cancer Foundation recommends setting up an individualized early detection plan. The three main tools for early detection are the breast self-exam, the clinical exam, and the mammogram. Depending on a woman’s age and family history, the frequency of each of these can be adapted to optimize her chances of detecting breast cancer at the early, localized stage. The self-exam is recommended for women of all ages: get to know the normal contours and density of your own breasts by running a soapy hand over them in the shower. The soap reduces friction and allows the hand to feel variations in texture. Often, variations and patterns of lumpiness are part of the normal make-up of a woman’s breasts. If anything changes in the breast or in the underarm area, however, see a physician and ask for a clinical exam of the area. For women aged 20 to 39, it is advisable to have a clinical examination of the breasts every three years. After 40, it should be done once a year. Mammograms are recommended on a yearly basis for women over 40.

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Three Ways to Help Provide Comfort

For Those Suffering From Breast Cancer (Family Features) Breast cancer affects millions of women, which in turn affects their families and their friends. You don't have to have breast cancer in order to help raise awareness of it and provide comfort. There are things you can do to take on this disease and make a difference in your own life and in the lives of others while providing much-needed comfort and support. Team Up with Friends Multiply your impact on breast cancer awareness by getting a group of friends together to take action: * Host a Fundraising Party. Put together a girls' night out or a potluck dinner party, and challenge guests to bring donations to support breast cancer research. * Get Moving. Sign up as a group to participate in a walk or run event that raises awareness or funds. * Volunteer Together. Check out local breast cancer awareness events and find ways your group of friends can serve together. If there isn't a local event, sponsor one of your own. Visit www.NationalBreast-

Early detection means doing regular self-exams so you know which bumps and irregularities are normal for your breasts.

Cancer.org to find out how. Give Comfort to Others You can personalize and send free virtual Comfort Packages to friends and family via a digital tool on the Hanes Facebook page. For each package sent, Hanes will donate $1 to the National Breast Cancer Foundation, Inc. (up to $25,000) to promote early cancer detection and provide mammograms for those in need. The Comfort Package is fully customizable with photos, videos, recipes, T-shirt designs, music and messages. Sending a Comfort Package is one of many gestures that can brighten someone's day and help provide support and comfort to a loved one. As a longtime supporter of breast cancer awareness, Hanes has made cash and in-kind donations totaling $1 million since 2009 and is donating up to $125,000 to NBCF this year. Learn more at www.Facebook. com/Hanes or www.HanesPink.com. Buy and Wear Pink Products The next time you are at the grocery store or the mall, think about purchasing the pink version of your favorite items. Your purchase can help raise money as well as awareness for the cause. In addition, wearing your favorite pink items is a stylish way to show support and demonstrate your commitment. Consider wearing pink once a week in October to feel connected to the cause.

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Some successes in anti-smoking program Bullhook dental clinic — care at a reasonable cost But more work needs to be done John Kelleher jkelleher@havredailynews.com There is good news and bad news on the front to reduce the incidence of tobacco use on the Hi-Line. The good news: It appears the number of people smoking has decreased. More people are quitting. Fewer people are starting the habit. The bad news: Lot of people are still addicted and are having a hard time quitting. But then there is some more good news: The HELP Committee sponsors a program that helps people in the difficult task of quitting smoking and educating non-smokers about the wisdom of not starting. “All indications are that … the rate of tobacco use has declined,” said Jay Schuschke, a prevention specialist for t h e N o r t h M o n t a n a To b a c c o - F r e e Coalition. “People are becoming successful in overcoming the addiction,” he said. Smokers find it difficult to quit on their first try, he said.

“We are trying to impress on people that just because they didn’t succeed on their first try, they are not failures,” he said. Instead, he said, people should look at it as the first step in a long effort to quit. “Overcoming the addiction can be so difficult,” he said. “Some people find it more difficult than others,” he said. “For a lot of people, it takes more than one effort. “Our advice is to keep trying,” he said. S c h u s c h ke s a i d o n e b i g a d va n ta ge Montana smokers have in their efforts to quit is the Montana To b a c c o Q u i t L i n e, o f t e n c a l l e d j u s t t h e Q ui t L i ne. “Studies show that chances of success are better if you use Quit Line or work with a physician,” he said. Quit Line operates out of National Jewish Health Center in Utah. It operates with a live person seven days a week, and even if you call in the middle of the night, yo u c a n a t l e a s t ge t a n a n s we r i n g machine. Schuschke said staffers who answer the phone can help people figure out just what is the best method if quitting. Use of pills, gum, a patch and several other methods are available. Usually, the Quit Line can provide assistance in obtaining and paying, at least for several weeks, for some of the medications

John Kelleher jkelleher@havredailynews.com In 2009, Bullhook Community Health Center opened a dental clinic to add to its other health care services. Cindy Smith, Bullhook's executive director, saw first-hand the need for such a dental clinic. When she worked at the Hill County Health Department, she knew of parents who pulled their children's decayed teeth out — without benefit of anesthesia —   because they couldn't afford dental care. "That's how desperate they were," she said. Most local dentists don't take Medicaid patients, she said, so low-income people had to leave town to get care.

Now, she said, Great Falls dentists aren't taking new patients, so if there were no Bullhook clinic, people may have to go as far as Helena for any kind of complex dental care. For routine care, "we had to send people to Malta" before the clinic opened, she said. Since the dental clinic opened, she added, people are receiving good care at a reasonable cost. Bullhook dental clinic, located at Atrium Mall, is served by two dentists and two hygienists. It was funded by a grant and later expanded with money from the federal stimulus program. Many of the dentists are working under a Health Services Corp. program that allows them to work off college loans by providing services in under-served areas such as Havre.

About 2,000 people a year visit the dental clinic, she said. “We get lots of different folks,” she said. "Close to 30 or 40 percent of the people are on Medicaid," she said. There is a sliding-fee scale for the patients, she said. The less money they make, the more the fee for service is reduced. Some people are covered by dental insurance, she said. Smith was surprised by how many people lived with chipped teeth, cavities and other problems, she said. Getting good dental care enables people to live pain-free, look better and avoid other health issues related to poor dental health. The better appearance has helped many people feel better about themselves and feel confident to apply for jobs. In addition to routine cleanings, complete

examinations and root canals, dentists can help lay the groundwork to get dentures if that is what is needed. The dentists then refer patients to professionals who can fit the dentures. Through dental screenings of all patients, they sometimes are the first to realize that people have diabetes or high blood pressure. People with such medical problems are referred to Bullhook’s medical clinic for further evaluation. Due to another grant the clinic has received, staffers are able to visit schools and do screenings of young people’s teeth, she said. Parents are notified of the children’s problems, she said, and are told of the services Bullhook offers. The clinic has some money available to help these young people pay for the work they need, she said.

Dental health is important at any age American Dental Association

Adults Under 40 used to help people break the habit, he said. People under 18 cannot use the patch, he said, since the patch has not won approval for use by young people. The Quit Line can assist people to quit smoking, but the process is still not easy, he said. That’s why education aimed at stopping people from starting in the first place is seen as the best tool, he said. Anti-smoking groups are making strides in lowering the rates, he said, but it is very hard. Young people often follow the lead of role models, he said. Fewer role models are smoking today, he said. In Hollywood, for years, film stars were smoking on the big screen. Product placement ads purchased by tobacco companies meant people smoked — and the name was mentioned in the script. Today, more often, people don’t smoke unless the theme calls for it. “(The TV show) ‘Madmen,’ it is based in the 1960s,” he said. “They are smoking because in the ’60s, everybody smoked.” Hollywood has slowly heeded the calls to have actors who are more responsive to the needs of young people. “More kids are learning the risk of addiction,” he said. Young people today are better informed than people in earlier generations. “When I was young, we felt we were immortal,” he said. Young people used to feel they could break the addiction once they grew up, he recalled. When they got older, they fo u n d o u t i t wa s h a r d e r t h a n t h ey thought.

The changing picture Montana has been in the forefront of some programs aimed at curtailing cigarette smoking, Schuschke said. But he’s afraid of some backslides. Before most states took action, Montana banned indoor smoking, including in restaurants. Finally, the law prohibited smoking in bars and casinos, he recalled. He said he heard from many people who worked as wait staff at bars and casinos who were happy they no longer had smokefilled workplaces. “They had a choice of working with second-hand smoke or getting out of the business,” he said. Secondhand smoke is a big killer, he said.

The future of the program Anti-smoking activists are pleased with the successes they have seen, he said, and want to continue their work. But they are worried about continued funding for projects such as the Quit Line. Ten years ago, Schuschke said, Montana voters approved a plan that would give the anti-smoking efforts one-third of the money the state got from a massive settlement the states received from a lawsuit against the tobacco companies. The 2010 Montana Legislature reduced that to one-sixth of the money, he said, and some people want to cut that further. “It’s important that people know, no tax money is going for this project,” he said.

Some people think tooth decay is just for children, but did you know you are at risk your whole life? Untreated dental disease can lead to serious health problems such as infection, damage to bone or nerve and tooth loss. Dental infections that are left untreated can even spread to other parts of the body and, in very rare cases, can be life threatening.

Dental disease is preventable The good news is that dental disease is preventable. You can practice preventive dentistry on yourself by adopting these healthy habits: Always remember to brush your teeth twice a day, floss between teeth once a day, eat a balanced diet and limit between-meal snacks. And don't forget to schedule regular dental visits. By following a healthy dental routine and making smart food choices, you can lower your risk for tooth decay.

Brushing Brushing your teeth is the cornerstone of any good oral hygiene routine. To keep your teeth and gums healthy, always be sure to brush your teeth twice a day with a softbristled brush. The size and shape of your brush should fit your mouth allowing you to reach all areas easily. Also, don’t forget to replace your toothbrush every three or four months or sooner if the bristles are frayed. A worn toothbrush won’t do a good job of cleaning your teeth. Finally, make sure to use an ADA-accepted fluoride toothpaste. It makes no difference whether you choose a manual or powered toothbrush — just make sure to brush twice a day, every day.

Flossing Flossing goes hand-in-hand with brushing. By flossing once a day, you help to remove plaque from between your teeth in areas where the toothbrush can't reach. This is extremely important because plaque that is not removed by brushing and flossing can eventually harden into calculus or tartar. Once tartar has formed, it can only be removed by a professional cleaning.

Gum Disease Gum disease is an inflammation of the tissues that hold your teeth in place. If it is severe, it can destroy the tissue and bone, leading to tooth loss. Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. When plaque is not removed it can harden into calculus — tartar. When tartar forms above and below the gumline, it becomes harder to brush and clean well between teeth. That buildup of plaque and tartar can harbor bacteria that lead to gum disease. The first stage of gum disease is called gingivitis, which is the only stage that is reversible. If not treated, gingivitis may lead to a more serious, destructive form of gum or periodontal disease called periodontitis. It is possible to have periodontal disease and have no warning signs. That is one reason why regular dental checkups and periodonta l exa m i n a t i o n s a re s o i m p o r ta n t . Treatment methods depend upon the type of disease and how far the condition has progressed. Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or recurring. Brush twice a day, clean between your teeth daily, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.

Teeth Grinding

Teeth grinding, also called bruxism, often occurs unconsciously while you sleep. It can

cause serious damage to your teeth and jaw. Although it is often considered to be stressrelated, teeth grinding can also be caused by sleep disorders. Your dentist’s choice of treatment will depend on the cause of your grinding, but you may be fitted with a mouthguard to protect your teeth while you sleep.

TMJ The temporomandibular joints, or TMJ, are among the more complex joints in your body. Any problem that prevents the TMJ from working properly may result in a painful disorder, also referred to as TMJ disorders or sometimes TMD. The exact cause of a TMJ disorder is often unclear, but possible causes can include arthritis, dislocation, injury and/or problems related to alignment or teeth grinding from stress. Symptoms can include: • Pain in or around the ear • Tenderness of the jaw • Clicking or popping noises when opening the mouth If you’re regularly experiencing facial or jaw pain, see your dentist. Exercise, muscle relaxants or physical therapy may help.

Root Canals Sometimes a cavity is just too deep to be fixed and may require a root canal. Root canal procedures are used to treat problems of the tooth's soft core, otherwise known as dental pulp. The pulp contains the blood vessels and the nerves of the tooth, which run like a thread down into the root. The pulp tissue can die when it’s infected or injured. If you don't remove it, your tooth gets infected and you could lose it. During a root canal treatment, the dentist removes the pulp, and the root canal is cleaned and sealed off to protect it. Your dentist may then place a crown over the tooth to help make it stronger and protect it.

Sensitive teeth If hot or cold foods make you wince, you may have a common dental problem — sensitive teeth. Sensitivity in your teeth can happen for several reasons, including: • Tooth decay — cavities • Fractured teeth • Worn fillings • Gum disease • Worn tooth enamel • Exposed tooth root

Missing Teeth Did you know that the average adult between the ages of 20 and 64 has three or more decayed or missing teeth? If you are missing one or more teeth, there are plenty of reasons to correct the problem. For one thing, a large space between your teeth may affect how you speak or eat. Even if it’s not noticeable, a missing molar can affect how you chew. Remaining teeth may shift and in some cases, bone loss can occur around a missing tooth. With today’s advances, you don’t have to suffer from missing teeth. Here are some options to replace a lost tooth or teeth. Talk to your dentist about which option is best for you: • Bridges. Anchored to your adjacent teeth, these can be removable or fixed, depending on your mouth, your dentist’s recommendation and your needs. • Dentures. An option if you’ve lost all or most of your teeth. • Implants. Most similar to a natural tooth.

Dry mouth Everyone’s mouth can be dry sometimes, but if you feel like your mouth is always dry, i t m ay b e t i m e to s e e k t re a t m e n t . Medications and certain health conditions can lead to dry mouth.

■ Continued on page 13


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2012

October 2012

HEALTH GUIDE

www.havredailynews.com

How well do you know the flu? Kim Bowker Clinical coordinator Bullhook Community Health Center Yes, the flu season is already upon us. It is time to take out and dust off all of those old excuses you use every year for why you won’t be getting your flu shot. But first, before we go over your excuses, let me go over with you what influenza or the flu actually is so we are all talking about the same thing when we mention flu. When the medical profession talks about influenza and the flu, they aren’t talking about “stomach flu,” where you end up in the bathroom most of the time you are sick. In the medical world, the flu is not just a bad cold like some think when they hear the word flu. Influenza — flu — is far more dangerous than a bad cold. The flu is a highly contagious respiratory illness caused by the influenza virus. Nationally 36,000 people die from the flu each year and more than 200,000 are hospitalized from flu complications. During most influenza seasons, 5 percent to 20 percent of the nation’s population is infected with influenza with an annual estimated cost to society of up to $12 million or more during severe epidemics. Symptoms of the flu include: High fever, headache, extreme fatigue, dry cough, sore throat, runny or stuffy nose, muscle aches and sometimes nausea, Unlike a cold, where your symptoms usually gradually come on, the flu generally comes on suddenly and you can almost state the day and hour you got sick. Individuals

are able to infect others beginning one day before getting the symptoms and up to seven days after getting sick. That means you can give someone the flu before you even know you have it. The peak of flu season in the United States is usually anywhere from November through March. The flu can slowly start showing itself and working toward that peak as early as September and, in Montana especially, last until April or May some years. Now that you “know” the flu fairly well, let me introduce you to the flu vaccine. Flu vaccines have been used since 1945, so they aren’t just the new kid on the block still in the experimental stage. The influenza vaccine is very safe, effective and has few side effects. Vaccine is available for ages 6 months old and up. Those hospitalized the most for the flu are young children and the elderly. Since babies aren’t able to get a shot until six months old, it is important for those around a new baby to get immunized to protect the baby. The same is true for the elderly. They are able to get a flu shot, but their percentage rate of being fully immunized goes down as they get older, so those around them need to receive their flu shot to protect the elderly. The flu vaccine is usually given in the fall; although, because of our late flu season in Montana, even December and January are not too late for your yearly flu shot. It is important to get the shot every year since the strain of what “flu bug” is the most common around the world changes from year to

year, so the vaccine is changed sometimes from year to year. Back to those old excuses you have for not getting your yearly flu shot: “The shot can give you the flu” … Fact: Flu vaccines — except the flu nasal spray — are made from killed influenza viruses so cannot give you the flu. “I’m not worried about a case of the flu” … Fact: Even if the flu doesn’t lay you up or put you in the hospital, you could infect someone else who does get serious symptoms and need hospitalization. “I am afraid of or don’t like needles” … Fact: The benefit of the vaccine and avoiding a very long lasting, painful bout of flu

far outweighs the discomfort of the injection. “I don’t have time to get my flu shot” … Fact: You don’t have time to get sick and laid up in bed with the flu. There are many more reasons people have to not get their flu shot, but the fact is that if you won’t go get the shot and do it for yourself, then please go get the shot to protect someone else from getting the flu from you. I hope you will be able to put away your old excuses for good and get out and get your flu shot this year. And while you are at it … you might as well make it an annual event. Here is wishing you a healthy flu season.

Emergency warning signs for the flu The Centers for Disease Control and Prevention lists the following as signs of severe complications of the flu: children: • Fast breathing or trouble breathing • Bluish skin color • Not drinking enough fluids • Not waking up or not interacting ��� Being so irritable that the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough • Fever with a rash

In addition to the signs above, people should get medical help right away for any infant who has any of these signs: • Being unable to eat • Having trouble breathing • Having no tears when crying • Having significantly fewer wet diapers than normal In

HEALTH GUIDE

October 2012

www.havredailynews.com

The dangers of secondhand smoke

Eric Reed /AP Images for American Lung Association Sarah Chalke, actress and national spokesperson for the Faces of Influenza campaign, received her flu shot to help protect herself and her young son, Charlie, from this serious disease.

In

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adults: • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms that improve but then return with fever and worse cough.

Montan Tobacco Quit Line Secondhand smoke — the smoke that comes from a lighted tobacco product or from a person who is smoking tobacco — contains more than 4,000 chemicals. Of these chemicals, 11 are known cancer-causing poisons and 250 are known toxins. The 2006 U.S. Surgeon General’s Report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, available online at: http://www.surgeongeneral.gov/library/ secondhandsmoke, concluded that there is no risk-free level of secondhand smoke, and the only way to protect people from the dangers of secondhand smoke is to eliminate the smoke exposure. The U.S. Centers for Disease Control and the U.S. Surgeon General have created a guide, titled “Secondhand Smoke: What it Means to You” at http://www.surgeongeneral.gov/library/secondhandsmoke/secondhandsmoke.pdf, that summarizes the 2006 Surgeon General’s Report and explains how people can take action to improve their health. The CDC and Surgeon General have also created a factsheet, titled “Secondhand Smoke is Toxic and Poisonous” at http:// www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet9.html, outlining the dangerous chemical components in secondhand smoke. A minimum of 38,000 and up to 65,000 deaths occur each year in the U.S. as a result of diseases caused by exposure to secondhand smoke. Thousands of other people in the U.S. suffer from conditions caused by or made worse by secondhand smoke. As many as 175 Montanans die annually from exposure to secondhand tobacco smoke. With the passage of Montana’s Clean Indoor Air Act in 2005 and full implementation in October 2009 all workplaces and public places are now required to be smokefree. People of all ages and backgrounds can be affected by secondhand smoke. But vulnerable populations, such as senior citizens and children, are at increased risk from

health problems such as heart attack in seniors and slow lung growth in children. The U.S. Centers for Disease Control recommends anyone with heart-related diseases avoid any exposure to secondhand smoke. Exposure to secondhand smoke increases the risk of health problems such as: • Heart disease, heart attacks and increased heart rate • Bronchitis and pneumonia • Burning eyes and throat • Ear Infections • Nose bleeds • Increased blood pressure • Frequency and severity of asthma • Headaches • Sudden Infant Death Syndrome (SIDS) • Low birth weight and pre-term babies • Lung cancer • Emphysema Why are Smokefree Living Environments so Important? Secondhand smoke knows no boundaries. While 85 percent of Montana households control their exposure by not permitting smoking inside the home, residents in multi-unit housing cannot control their exposure to secondhand tobacco smoke if their neighbors are smoking. Smokefree policies ensure that residents in multi-unit housing households are not exposed. According to the 2008 Montana Adult Tobacco Survey: • Approximately 18 percent of Montanans rent their home. • Among renters, an estimated 48,000 live in an apartment or duplex and over onethird (36 percent) of respondents living in multi-unit housing also had children 17 years or younger living with them. Less than 20 percent of Montanans living in multi-unit housing are protected by a smokefree policy set by their landlord. Of Montana multi-unit renters who do not have a smokefree policy in their building or complex, the majority — 85 percent — were

Montana Tobacco Quit Line services can help Montana Tobacco Quit Line • A free telephone service for all Montanans — 1-800-QUIT-NOW • A free personalized quit plan • Free cessation coaching personalized quit plan • Five free pro-active cessation coaching sessions • Four free weeks of nicotine replacement therapy (gum, patches or lozenges) if appropriate, for cigarette or smokeless tobacco users • Chantix at a reduced cost, $50 co-pay per month for three months • Bupropion at reduced cost, $5 co-pay per month for three months • Free educational materials for health care providers as well as friends and families of tobacco users • A fax referral system for health care providers who have patients that want to

quit using tobacco (see provider link) • Trained staff that offers culturally appropriate services for American Indians Montana Quit Line hours • Monday through Thursday, 7 a.m. to 9 p.m. • Friday, 7 a.m. to 7 p.m. • Saturday and Sunday, 8 a.m. to 4:30 p.m. There is a 24-hour voicemail, so people can leave messages at any time. Provider Resources • A quick and easy reference for providers about the steps that their patents, as well as the provider, can take in order for the patient to receive Free NRT (gum, patches, lozenges) and reduced cost Chantix or buproprion from the Montana Tobacco Quit Line.

in favor of their landlords adopting a smokefree policy. Low-income Montanans with rent-assisted housing are at particular risk since their housing options may be limited. Ventilation and air purifiers cannot end the harm caused by exposure to secondhand smoke. The American Society of Heating, Re f r i ge ra t i n g , a n d A i r C o n d i t i o n i n g Engineers has commented on the need to eliminate smoking rather than try to venti-

late it stating that “the only means of effectively eliminating health risk associated with indoor exposure is to ban smoking activity.” Exposure to secondhand smoke in multiunit housing complexes poses a public health problem because the smoke from one unit can enter other units. The only way to eliminate this exposure to secondhand smoke in multi-unit housing complexes is to have a comprehensive smokefree policy.

Frequently asked questions Can adolescents call the Quit Line? Yes, adolescents are welcome to call the Quit Line. The FDA has not approved NRT for persons under 18 so they are not eligible for that benefit. • Is the number of calls limited to five per individual? No, the individual may have as many calls as needed to quit and stay quit. The research indicates that five sessions is the optimal number for telephone cessation counseling. Individuals who relapse are also encouraged to call the Quit Line. Studies show that individuals will quit several times before they stay quit. • How does the Nicotine Replacement Therapy — NRT — get to the individual? Two weeks of NRT — gum, patches or lozenges — is mailed directly to the individual. • Who provides the services of the Quit Line? National Jewish Health in Denver, ranked the nation's No. 1 respiratory hospital by U.S. News & World Report, operates the Montana Tobacco Quit Line. National Jewish also operates the Colorado and Ohio Tobacco Quit Lines, as well as the UCare Tobacco Cessation Line in Minnesota and the nationwide LungLine.


8

2012

October 2012

HEALTH GUIDE

www.havredailynews.com

Time to prepare for influenza with a flu shot Vaccination recommended for all people 6 months and older Tim Leeds tleeds@havredailynews.com

AP Photo/Mel Evans George Eberhardt, 107, of Chester, N.J., is given his annual flu shot Oct. 18, 2011, by nurse Bettie Donnelly in Mendham, N.J. Babies and toddlers were more likely to get the flu vaccine last year than people over 65.

With the flu season about to come into full swing, medical experts again are urging people to avoid the potentially deadly illnesses with a simple precaution — get vaccinated. Vaccinations are available at numerous locations in the area, including Bullhook Community Health Center, the Hill County Health Department, most clinics and doctors’ offices, and many local pharmacies, as well as through some programs sponsored by some local businesses. The Hill County Health Department and Bullhook Community Health Center already have held several flu-shot clinics in Havre and along the Hi-Line, with more being scheduled as the season progresses. Flu shots also are available on a walk-in basis, although only on Tuesday’s at the county health department. People can call the health department at 265-5481, ext. 266, Bullhook at 265-4541 and the Northern Montana Medical Group clinic at 265-7831, or local pharmacies or their family medical provider for more information about getting a shot. The issue was in the spotlight in 2009, with the discovery of the new H1N1 influenza, commonly called Swine Flu. As it was a novel virus, a separate vaccination was necessary to protect from that strain, along with the standard vaccination for seasonal flu. Since then, one vaccination includes the H1N1 virus. The Centers for Disease Control and Prevention now recommend — starting in the 2010 flu season — that anyone older than 6 months receive an influenza vaccination, with some groups with a higher risk of complications — such as people with chronic problems including asthma, diabetes and chronic lung disease; pregnant women; and people 65 years and older — having a higher priority for the need for vaccinations. Children younger than 2 also are at a higher risk of severe complications if they contract influenza. While the vaccine is not approved in use for children younger than 6 months, people who care for children that young also are recommended to get a shot. This year’s vaccine covers three strains of the virus including the H1N1 virus. Vaccinations typically are available through shots or a nasal inhalant.

Preventing the flu

The best way to reduce the chances of

contracting influenza is to receive a vaccination. That not only reduces the chance of the person vaccinated coming down with the flu, it also reduces the chance of people spreading the illness to others in the community. The flu season typically begins in October and can run through May. Along with vaccination, common sense and good hygiene also reduces the chance of getting — or spreading — influenza. Many medical experts say flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose. Covering coughs and sneezes with a sleeve or disposable tissue, regularly washing hands with soap and water — for 10 seconds to 15 seconds each time — or hand sanitizer if that is not available, and regularly sanitizing items touched by people such as door knobs, telephones or computer keyboards helps reduce the chance of flu spreading. While vaccination is considered the most effective way to prevent people from contracting the flu, it is not foolproof — vaccinated people can still catch the illness. The severity of the illness and likelihood of severe complications typically is reduced with vaccination, however. Vaccinations in previous years do not guarantee avoiding the illness in following years, especially as the flu virus often changes from year to year. The strength of protection wanes as the year progresses, as well, with the rate of the decline varying depending on several factors in each individual. Annual vaccinations are recommended.

Signs of the flu

Influenza, although caused by different viruses, has many symptoms similar to the common cold. Symptoms include fever — although not all people suffering from the flu have a fever — or feeling feverish or having chills; coughing; sore throat; runny or stuffy nose; muscle or body aches and headaches; feeling severely tired; and, in some cases, vomiting or diarrhea, although this is more common in children. The CDC reports that many people use the term “stomach flu” to describe illnesses with nausea, vomiting or diarrhea. These symptoms can be caused by many different viruses, bacteria or even parasites. While vomiting, diarrhea, and being nauseous or “sick to your stomach” can sometimes be related to the flu — more commonly in children than adults — these problems are rarely the main symptoms of influenza. The flu is a respiratory disease and not a stomach or intestinal disease. While most people who get influenza will recover in a few days to less than two weeks, some people will develop complications,

9

2012

HEALTH GUIDE

October 2012

some of which can be life-threatening and result in death. Pneumonia, bronchitis, and sinus and ear infections are three possible of complications from flu. The flu also can make chronic health problems worse, such as causing people with asthma to suffer asthma attacks, and people with chronic congestive heart failure may have worsening of this condition due to the illness.

If you contract the flu The main recommendation for people who come down with the flu is to stay home, rest and avoid contact with people to prevent spreading the disease. People who think they may have developed the flu should contact their health care provider. The CDC urges people to avoid going to the emergency room, which should only be used for people who are very sick. Only people who have the emergency warning signs of flu sick-

ness should go to the emergency room. People showing flu symptoms who are at high risk of flu complications or are concerned about their illness, call their health care provider for advice. People who go to the emergency room and are not sick with the flu may catch it from people who do have it, the CDC webpage adds. Medicines to help control the flu are available through prescription. People with symptoms of the flu are urged to stay home, rest and drink plenty of fluids such as water and juice. The CDC recommends that anyone with flu symptoms stay at home for at least 24 hours after the fever is gone, without using a fever-reducing medicine, except to get medical care or other necessities. People with the flu who must leave home, for example to get medical care, are urged to wear a facemask or cover coughs and sneezes with a tissue The CDC recommends that people stay home for at least 24 hours after their fever is gone except to get medical care or for other

Symptoms of the flu Listed below are typical symptoms exhibited by someone who has contracted influenza: • Fever or feeling feverish/chills. • It's important to note that not everyone with flu will have a fever. • Cough • Sore throat • Runny or stuffy nose • Muscle or body aches • Headaches • Fatigue, tiredness • Some people may have vomiting and diarrhea, though this is more common in children than adults.

Who Should Get Vaccinated This Season? Everyone who is at least 6 months of age should get a flu vaccine this season. It’s especially important for some people to get vaccinated. Those people include the following: • People who are at high risk of developing serious complications like pneumonia if they get sick with the flu. • People who have certain medical conditions including asthma, diabetes and chronic lung disease. • Pregnant women. • People 65 years and older • People who live with or care for others who are high risk of developing serious complications. This includes: • Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease.

Who Should Not Be Vaccinated? There are some people who should not get a flu vaccine without first consulting a physician. These include: • People who have a severe allergy to chicken eggs. • People who have had a severe reaction to an influenza vaccination. • Children younger than 6 months of age. • People who have a moderate-to-severe illness with a fever should wait until they recover to get vaccinated. • People with a history of Guillain–Barré Syndrome — a severe paralytic illness, also called GBS — that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Those individuals should tell their doctor if they ever had Guillain-Barré Syndrome, and the doctor will help decide whether the vaccine is recommended.

things they must do which no one else can do for them. The fever should be gone without the use of a fever-reducing medicine, such as Tylenol. People with the flu are urged to stay

www.havredailynews.com home from work, school, travel, shopping, social events and public gatherings. Online: Centers for Disease Control and Prevention influenza pages: http://www.cdc. gov/flu/index.htm


8

2012

October 2012

HEALTH GUIDE

www.havredailynews.com

Time to prepare for influenza with a flu shot Vaccination recommended for all people 6 months and older Tim Leeds tleeds@havredailynews.com

AP Photo/Mel Evans George Eberhardt, 107, of Chester, N.J., is given his annual flu shot Oct. 18, 2011, by nurse Bettie Donnelly in Mendham, N.J. Babies and toddlers were more likely to get the flu vaccine last year than people over 65.

With the flu season about to come into full swing, medical experts again are urging people to avoid the potentially deadly illnesses with a simple precaution — get vaccinated. Vaccinations are available at numerous locations in the area, including Bullhook Community Health Center, the Hill County Health Department, most clinics and doctors’ offices, and many local pharmacies, as well as through some programs sponsored by some local businesses. The Hill County Health Department and Bullhook Community Health Center already have held several flu-shot clinics in Havre and along the Hi-Line, with more being scheduled as the season progresses. Flu shots also are available on a walk-in basis, although only on Tuesday’s at the county health department. People can call the health department at 265-5481, ext. 266, Bullhook at 265-4541 and the Northern Montana Medical Group clinic at 265-7831, or local pharmacies or their family medical provider for more information about getting a shot. The issue was in the spotlight in 2009, with the discovery of the new H1N1 influenza, commonly called Swine Flu. As it was a novel virus, a separate vaccination was necessary to protect from that strain, along with the standard vaccination for seasonal flu. Since then, one vaccination includes the H1N1 virus. The Centers for Disease Control and Prevention now recommend — starting in the 2010 flu season — that anyone older than 6 months receive an influenza vaccination, with some groups with a higher risk of complications — such as people with chronic problems including asthma, diabetes and chronic lung disease; pregnant women; and people 65 years and older — having a higher priority for the need for vaccinations. Children younger than 2 also are at a higher risk of severe complications if they contract influenza. While the vaccine is not approved in use for children younger than 6 months, people who care for children that young also are recommended to get a shot. This year’s vaccine covers three strains of the virus including the H1N1 virus. Vaccinations typically are available through shots or a nasal inhalant.

Preventing the flu

The best way to reduce the chances of

contracting influenza is to receive a vaccination. That not only reduces the chance of the person vaccinated coming down with the flu, it also reduces the chance of people spreading the illness to others in the community. The flu season typically begins in October and can run through May. Along with vaccination, common sense and good hygiene also reduces the chance of getting — or spreading — influenza. Many medical experts say flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose. Covering coughs and sneezes with a sleeve or disposable tissue, regularly washing hands with soap and water — for 10 seconds to 15 seconds each time — or hand sanitizer if that is not available, and regularly sanitizing items touched by people such as door knobs, telephones or computer keyboards helps reduce the chance of flu spreading. While vaccination is considered the most effective way to prevent people from contracting the flu, it is not foolproof — vaccinated people can still catch the illness. The severity of the illness and likelihood of severe complications typically is reduced with vaccination, however. Vaccinations in previous years do not guarantee avoiding the illness in following years, especially as the flu virus often changes from year to year. The strength of protection wanes as the year progresses, as well, with the rate of the decline varying depending on several factors in each individual. Annual vaccinations are recommended.

Signs of the flu

Influenza, although caused by different viruses, has many symptoms similar to the common cold. Symptoms include fever — although not all people suffering from the flu have a fever — or feeling feverish or having chills; coughing; sore throat; runny or stuffy nose; muscle or body aches and headaches; feeling severely tired; and, in some cases, vomiting or diarrhea, although this is more common in children. The CDC reports that many people use the term “stomach flu” to describe illnesses with nausea, vomiting or diarrhea. These symptoms can be caused by many different viruses, bacteria or even parasites. While vomiting, diarrhea, and being nauseous or “sick to your stomach” can sometimes be related to the flu — more commonly in children than adults — these problems are rarely the main symptoms of influenza. The flu is a respiratory disease and not a stomach or intestinal disease. While most people who get influenza will recover in a few days to less than two weeks, some people will develop complications,

9

2012

HEALTH GUIDE

October 2012

some of which can be life-threatening and result in death. Pneumonia, bronchitis, and sinus and ear infections are three possible of complications from flu. The flu also can make chronic health problems worse, such as causing people with asthma to suffer asthma attacks, and people with chronic congestive heart failure may have worsening of this condition due to the illness.

If you contract the flu The main recommendation for people who come down with the flu is to stay home, rest and avoid contact with people to prevent spreading the disease. People who think they may have developed the flu should contact their health care provider. The CDC urges people to avoid going to the emergency room, which should only be used for people who are very sick. Only people who have the emergency warning signs of flu sick-

ness should go to the emergency room. People showing flu symptoms who are at high risk of flu complications or are concerned about their illness, call their health care provider for advice. People who go to the emergency room and are not sick with the flu may catch it from people who do have it, the CDC webpage adds. Medicines to help control the flu are available through prescription. People with symptoms of the flu are urged to stay home, rest and drink plenty of fluids such as water and juice. The CDC recommends that anyone with flu symptoms stay at home for at least 24 hours after the fever is gone, without using a fever-reducing medicine, except to get medical care or other necessities. People with the flu who must leave home, for example to get medical care, are urged to wear a facemask or cover coughs and sneezes with a tissue The CDC recommends that people stay home for at least 24 hours after their fever is gone except to get medical care or for other

Symptoms of the flu Listed below are typical symptoms exhibited by someone who has contracted influenza: • Fever or feeling feverish/chills. • It's important to note that not everyone with flu will have a fever. • Cough • Sore throat • Runny or stuffy nose • Muscle or body aches • Headaches • Fatigue, tiredness • Some people may have vomiting and diarrhea, though this is more common in children than adults.

Who Should Get Vaccinated This Season? Everyone who is at least 6 months of age should get a flu vaccine this season. It’s especially important for some people to get vaccinated. Those people include the following: • People who are at high risk of developing serious complications like pneumonia if they get sick with the flu. • People who have certain medical conditions including asthma, diabetes and chronic lung disease. • Pregnant women. • People 65 years and older • People who live with or care for others who are high risk of developing serious complications. This includes: • Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease.

Who Should Not Be Vaccinated? There are some people who should not get a flu vaccine without first consulting a physician. These include: • People who have a severe allergy to chicken eggs. • People who have had a severe reaction to an influenza vaccination. • Children younger than 6 months of age. • People who have a moderate-to-severe illness with a fever should wait until they recover to get vaccinated. • People with a history of Guillain–Barré Syndrome — a severe paralytic illness, also called GBS — that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Those individuals should tell their doctor if they ever had Guillain-Barré Syndrome, and the doctor will help decide whether the vaccine is recommended.

things they must do which no one else can do for them. The fever should be gone without the use of a fever-reducing medicine, such as Tylenol. People with the flu are urged to stay

www.havredailynews.com home from work, school, travel, shopping, social events and public gatherings. Online: Centers for Disease Control and Prevention influenza pages: http://www.cdc. gov/flu/index.htm


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How well do you know the flu? Kim Bowker Clinical coordinator Bullhook Community Health Center Yes, the flu season is already upon us. It is time to take out and dust off all of those old excuses you use every year for why you won’t be getting your flu shot. But first, before we go over your excuses, let me go over with you what influenza or the flu actually is so we are all talking about the same thing when we mention flu. When the medical profession talks about influenza and the flu, they aren’t talking about “stomach flu,” where you end up in the bathroom most of the time you are sick. In the medical world, the flu is not just a bad cold like some think when they hear the word flu. Influenza — flu — is far more dangerous than a bad cold. The flu is a highly contagious respiratory illness caused by the influenza virus. Nationally 36,000 people die from the flu each year and more than 200,000 are hospitalized from flu complications. During most influenza seasons, 5 percent to 20 percent of the nation’s population is infected with influenza with an annual estimated cost to society of up to $12 million or more during severe epidemics. Symptoms of the flu include: High fever, headache, extreme fatigue, dry cough, sore throat, runny or stuffy nose, muscle aches and sometimes nausea, Unlike a cold, where your symptoms usually gradually come on, the flu generally comes on suddenly and you can almost state the day and hour you got sick. Individuals

are able to infect others beginning one day before getting the symptoms and up to seven days after getting sick. That means you can give someone the flu before you even know you have it. The peak of flu season in the United States is usually anywhere from November through March. The flu can slowly start showing itself and working toward that peak as early as September and, in Montana especially, last until April or May some years. Now that you “know” the flu fairly well, let me introduce you to the flu vaccine. Flu vaccines have been used since 1945, so they aren’t just the new kid on the block still in the experimental stage. The influenza vaccine is very safe, effective and has few side effects. Vaccine is available for ages 6 months old and up. Those hospitalized the most for the flu are young children and the elderly. Since babies aren’t able to get a shot until six months old, it is important for those around a new baby to get immunized to protect the baby. The same is true for the elderly. They are able to get a flu shot, but their percentage rate of being fully immunized goes down as they get older, so those around them need to receive their flu shot to protect the elderly. The flu vaccine is usually given in the fall; although, because of our late flu season in Montana, even December and January are not too late for your yearly flu shot. It is important to get the shot every year since the strain of what “flu bug” is the most common around the world changes from year to

year, so the vaccine is changed sometimes from year to year. Back to those old excuses you have for not getting your yearly flu shot: “The shot can give you the flu” … Fact: Flu vaccines — except the flu nasal spray — are made from killed influenza viruses so cannot give you the flu. “I’m not worried about a case of the flu” … Fact: Even if the flu doesn’t lay you up or put you in the hospital, you could infect someone else who does get serious symptoms and need hospitalization. “I am afraid of or don’t like needles” … Fact: The benefit of the vaccine and avoiding a very long lasting, painful bout of flu

far outweighs the discomfort of the injection. “I don’t have time to get my flu shot” … Fact: You don’t have time to get sick and laid up in bed with the flu. There are many more reasons people have to not get their flu shot, but the fact is that if you won’t go get the shot and do it for yourself, then please go get the shot to protect someone else from getting the flu from you. I hope you will be able to put away your old excuses for good and get out and get your flu shot this year. And while you are at it … you might as well make it an annual event. Here is wishing you a healthy flu season.

Emergency warning signs for the flu The Centers for Disease Control and Prevention lists the following as signs of severe complications of the flu: children: • Fast breathing or trouble breathing • Bluish skin color • Not drinking enough fluids • Not waking up or not interacting • Being so irritable that the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough • Fever with a rash

In addition to the signs above, people should get medical help right away for any infant who has any of these signs: • Being unable to eat • Having trouble breathing • Having no tears when crying • Having significantly fewer wet diapers than normal In

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The dangers of secondhand smoke

Eric Reed /AP Images for American Lung Association Sarah Chalke, actress and national spokesperson for the Faces of Influenza campaign, received her flu shot to help protect herself and her young son, Charlie, from this serious disease.

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adults: • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms that improve but then return with fever and worse cough.

Montan Tobacco Quit Line Secondhand smoke — the smoke that comes from a lighted tobacco product or from a person who is smoking tobacco — contains more than 4,000 chemicals. Of these chemicals, 11 are known cancer-causing poisons and 250 are known toxins. The 2006 U.S. Surgeon General’s Report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, available online at: http://www.surgeongeneral.gov/library/ secondhandsmoke, concluded that there is no risk-free level of secondhand smoke, and the only way to protect people from the dangers of secondhand smoke is to eliminate the smoke exposure. The U.S. Centers for Disease Control and the U.S. Surgeon General have created a guide, titled “Secondhand Smoke: What it Means to You” at http://www.surgeongeneral.gov/library/secondhandsmoke/secondhandsmoke.pdf, that summarizes the 2006 Surgeon General’s Report and explains how people can take action to improve their health. The CDC and Surgeon General have also created a factsheet, titled “Secondhand Smoke is Toxic and Poisonous” at http:// www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet9.html, outlining the dangerous chemical components in secondhand smoke. A minimum of 38,000 and up to 65,000 deaths occur each year in the U.S. as a result of diseases caused by exposure to secondhand smoke. Thousands of other people in the U.S. suffer from conditions caused by or made worse by secondhand smoke. As many as 175 Montanans die annually from exposure to secondhand tobacco smoke. With the passage of Montana’s Clean Indoor Air Act in 2005 and full implementation in October 2009 all workplaces and public places are now required to be smokefree. People of all ages and backgrounds can be affected by secondhand smoke. But vulnerable populations, such as senior citizens and children, are at increased risk from

health problems such as heart attack in seniors and slow lung growth in children. The U.S. Centers for Disease Control recommends anyone with heart-related diseases avoid any exposure to secondhand smoke. Exposure to secondhand smoke increases the risk of health problems such as: • Heart disease, heart attacks and increased heart rate • Bronchitis and pneumonia • Burning eyes and throat • Ear Infections • Nose bleeds • Increased blood pressure • Frequency and severity of asthma • Headaches • Sudden Infant Death Syndrome (SIDS) • Low birth weight and pre-term babies • Lung cancer • Emphysema Why are Smokefree Living Environments so Important? Secondhand smoke knows no boundaries. While 85 percent of Montana households control their exposure by not permitting smoking inside the home, residents in multi-unit housing cannot control their exposure to secondhand tobacco smoke if their neighbors are smoking. Smokefree policies ensure that residents in multi-unit housing households are not exposed. According to the 2008 Montana Adult Tobacco Survey: • Approximately 18 percent of Montanans rent their home. • Among renters, an estimated 48,000 live in an apartment or duplex and over onethird (36 percent) of respondents living in multi-unit housing also had children 17 years or younger living with them. Less than 20 percent of Montanans living in multi-unit housing are protected by a smokefree policy set by their landlord. Of Montana multi-unit renters who do not have a smokefree policy in their building or complex, the majority — 85 percent — were

Montana Tobacco Quit Line services can help Montana Tobacco Quit Line • A free telephone service for all Montanans — 1-800-QUIT-NOW • A free personalized quit plan • Free cessation coaching personalized quit plan • Five free pro-active cessation coaching sessions • Four free weeks of nicotine replacement therapy (gum, patches or lozenges) if appropriate, for cigarette or smokeless tobacco users • Chantix at a reduced cost, $50 co-pay per month for three months • Bupropion at reduced cost, $5 co-pay per month for three months • Free educational materials for health care providers as well as friends and families of tobacco users • A fax referral system for health care providers who have patients that want to

quit using tobacco (see provider link) • Trained staff that offers culturally appropriate services for American Indians Montana Quit Line hours • Monday through Thursday, 7 a.m. to 9 p.m. • Friday, 7 a.m. to 7 p.m. • Saturday and Sunday, 8 a.m. to 4:30 p.m. There is a 24-hour voicemail, so people can leave messages at any time. Provider Resources • A quick and easy reference for providers about the steps that their patents, as well as the provider, can take in order for the patient to receive Free NRT (gum, patches, lozenges) and reduced cost Chantix or buproprion from the Montana Tobacco Quit Line.

in favor of their landlords adopting a smokefree policy. Low-income Montanans with rent-assisted housing are at particular risk since their housing options may be limited. Ventilation and air purifiers cannot end the harm caused by exposure to secondhand smoke. The American Society of Heating, Re f r i ge ra t i n g , a n d A i r C o n d i t i o n i n g Engineers has commented on the need to eliminate smoking rather than try to venti-

late it stating that “the only means of effectively eliminating health risk associated with indoor exposure is to ban smoking activity.” Exposure to secondhand smoke in multiunit housing complexes poses a public health problem because the smoke from one unit can enter other units. The only way to eliminate this exposure to secondhand smoke in multi-unit housing complexes is to have a comprehensive smokefree policy.

Frequently asked questions Can adolescents call the Quit Line? Yes, adolescents are welcome to call the Quit Line. The FDA has not approved NRT for persons under 18 so they are not eligible for that benefit. • Is the number of calls limited to five per individual? No, the individual may have as many calls as needed to quit and stay quit. The research indicates that five sessions is the optimal number for telephone cessation counseling. Individuals who relapse are also encouraged to call the Quit Line. Studies show that individuals will quit several times before they stay quit. • How does the Nicotine Replacement Therapy — NRT — get to the individual? Two weeks of NRT — gum, patches or lozenges — is mailed directly to the individual. • Who provides the services of the Quit Line? National Jewish Health in Denver, ranked the nation's No. 1 respiratory hospital by U.S. News & World Report, operates the Montana Tobacco Quit Line. National Jewish also operates the Colorado and Ohio Tobacco Quit Lines, as well as the UCare Tobacco Cessation Line in Minnesota and the nationwide LungLine.


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Some successes in anti-smoking program Bullhook dental clinic — care at a reasonable cost But more work needs to be done John Kelleher jkelleher@havredailynews.com There is good news and bad news on the front to reduce the incidence of tobacco use on the Hi-Line. The good news: It appears the number of people smoking has decreased. More people are quitting. Fewer people are starting the habit. The bad news: Lot of people are still addicted and are having a hard time quitting. But then there is some more good news: The HELP Committee sponsors a program that helps people in the difficult task of quitting smoking and educating non-smokers about the wisdom of not starting. “All indications are that … the rate of tobacco use has declined,” said Jay Schuschke, a prevention specialist for t h e N o r t h M o n t a n a To b a c c o - F r e e Coalition. “People are becoming successful in overcoming the addiction,” he said. Smokers find it difficult to quit on their first try, he said.

“We are trying to impress on people that just because they didn’t succeed on their first try, they are not failures,” he said. Instead, he said, people should look at it as the first step in a long effort to quit. “Overcoming the addiction can be so difficult,” he said. “Some people find it more difficult than others,” he said. “For a lot of people, it takes more than one effort. “Our advice is to keep trying,” he said. S c h u s c h ke s a i d o n e b i g a d va n ta ge Montana smokers have in their efforts to quit is the Montana To b a c c o Q u i t L i n e, o f t e n c a l l e d j u s t t h e Q ui t L i ne. “Studies show that chances of success are better if you use Quit Line or work with a physician,” he said. Quit Line operates out of National Jewish Health Center in Utah. It operates with a live person seven days a week, and even if you call in the middle of the night, yo u c a n a t l e a s t ge t a n a n s we r i n g machine. Schuschke said staffers who answer the phone can help people figure out just what is the best method if quitting. Use of pills, gum, a patch and several other methods are available. Usually, the Quit Line can provide assistance in obtaining and paying, at least for several weeks, for some of the medications

John Kelleher jkelleher@havredailynews.com In 2009, Bullhook Community Health Center opened a dental clinic to add to its other health care services. Cindy Smith, Bullhook's executive director, saw first-hand the need for such a dental clinic. When she worked at the Hill County Health Department, she knew of parents who pulled their children's decayed teeth out — without benefit of anesthesia —   because they couldn't afford dental care. "That's how desperate they were," she said. Most local dentists don't take Medicaid patients, she said, so low-income people had to leave town to get care.

Now, she said, Great Falls dentists aren't taking new patients, so if there were no Bullhook clinic, people may have to go as far as Helena for any kind of complex dental care. For routine care, "we had to send people to Malta" before the clinic opened, she said. Since the dental clinic opened, she added, people are receiving good care at a reasonable cost. Bullhook dental clinic, located at Atrium Mall, is served by two dentists and two hygienists. It was funded by a grant and later expanded with money from the federal stimulus program. Many of the dentists are working under a Health Services Corp. program that allows them to work off college loans by providing services in under-served areas such as Havre.

About 2,000 people a year visit the dental clinic, she said. “We get lots of different folks,” she said. "Close to 30 or 40 percent of the people are on Medicaid," she said. There is a sliding-fee scale for the patients, she said. The less money they make, the more the fee for service is reduced. Some people are covered by dental insurance, she said. Smith was surprised by how many people lived with chipped teeth, cavities and other problems, she said. Getting good dental care enables people to live pain-free, look better and avoid other health issues related to poor dental health. The better appearance has helped many people feel better about themselves and feel confident to apply for jobs. In addition to routine cleanings, complete

examinations and root canals, dentists can help lay the groundwork to get dentures if that is what is needed. The dentists then refer patients to professionals who can fit the dentures. Through dental screenings of all patients, they sometimes are the first to realize that people have diabetes or high blood pressure. People with such medical problems are referred to Bullhook’s medical clinic for further evaluation. Due to another grant the clinic has received, staffers are able to visit schools and do screenings of young people’s teeth, she said. Parents are notified of the children’s problems, she said, and are told of the services Bullhook offers. The clinic has some money available to help these young people pay for the work they need, she said.

Dental health is important at any age American Dental Association

Adults Under 40 used to help people break the habit, he said. People under 18 cannot use the patch, he said, since the patch has not won approval for use by young people. The Quit Line can assist people to quit smoking, but the process is still not easy, he said. That’s why education aimed at stopping people from starting in the first place is seen as the best tool, he said. Anti-smoking groups are making strides in lowering the rates, he said, but it is very hard. Young people often follow the lead of role models, he said. Fewer role models are smoking today, he said. In Hollywood, for years, film stars were smoking on the big screen. Product placement ads purchased by tobacco companies meant people smoked — and the name was mentioned in the script. Today, more often, people don’t smoke unless the theme calls for it. “(The TV show) ‘Madmen,’ it is based in the 1960s,” he said. “They are smoking because in the ’60s, everybody smoked.” Hollywood has slowly heeded the calls to have actors who are more responsive to the needs of young people. “More kids are learning the risk of addiction,” he said. Young people today are better informed than people in earlier generations. “When I was young, we felt we were immortal,” he said. Young people used to feel they could break the addiction once they grew up, he recalled. When they got older, they fo u n d o u t i t wa s h a r d e r t h a n t h ey thought.

The changing picture Montana has been in the forefront of some programs aimed at curtailing cigarette smoking, Schuschke said. But he’s afraid of some backslides. Before most states took action, Montana banned indoor smoking, including in restaurants. Finally, the law prohibited smoking in bars and casinos, he recalled. He said he heard from many people who worked as wait staff at bars and casinos who were happy they no longer had smokefilled workplaces. “They had a choice of working with second-hand smoke or getting out of the business,” he said. Secondhand smoke is a big killer, he said.

The future of the program Anti-smoking activists are pleased with the successes they have seen, he said, and want to continue their work. But they are worried about continued funding for projects such as the Quit Line. Ten years ago, Schuschke said, Montana voters approved a plan that would give the anti-smoking efforts one-third of the money the state got from a massive settlement the states received from a lawsuit against the tobacco companies. The 2010 Montana Legislature reduced that to one-sixth of the money, he said, and some people want to cut that further. “It’s important that people know, no tax money is going for this project,” he said.

Some people think tooth decay is just for children, but did you know you are at risk your whole life? Untreated dental disease can lead to serious health problems such as infection, damage to bone or nerve and tooth loss. Dental infections that are left untreated can even spread to other parts of the body and, in very rare cases, can be life threatening.

Dental disease is preventable The good news is that dental disease is preventable. You can practice preventive dentistry on yourself by adopting these healthy habits: Always remember to brush your teeth twice a day, floss between teeth once a day, eat a balanced diet and limit between-meal snacks. And don't forget to schedule regular dental visits. By following a healthy dental routine and making smart food choices, you can lower your risk for tooth decay.

Brushing Brushing your teeth is the cornerstone of any good oral hygiene routine. To keep your teeth and gums healthy, always be sure to brush your teeth twice a day with a softbristled brush. The size and shape of your brush should fit your mouth allowing you to reach all areas easily. Also, don’t forget to replace your toothbrush every three or four months or sooner if the bristles are frayed. A worn toothbrush won’t do a good job of cleaning your teeth. Finally, make sure to use an ADA-accepted fluoride toothpaste. It makes no difference whether you choose a manual or powered toothbrush — just make sure to brush twice a day, every day.

Flossing Flossing goes hand-in-hand with brushing. By flossing once a day, you help to remove plaque from between your teeth in areas where the toothbrush can't reach. This is extremely important because plaque that is not removed by brushing and flossing can eventually harden into calculus or tartar. Once tartar has formed, it can only be removed by a professional cleaning.

Gum Disease Gum disease is an inflammation of the tissues that hold your teeth in place. If it is severe, it can destroy the tissue and bone, leading to tooth loss. Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. When plaque is not removed it can harden into calculus — tartar. When tartar forms above and below the gumline, it becomes harder to brush and clean well between teeth. That buildup of plaque and tartar can harbor bacteria that lead to gum disease. The first stage of gum disease is called gingivitis, which is the only stage that is reversible. If not treated, gingivitis may lead to a more serious, destructive form of gum or periodontal disease called periodontitis. It is possible to have periodontal disease and have no warning signs. That is one reason why regular dental checkups and periodonta l exa m i n a t i o n s a re s o i m p o r ta n t . Treatment methods depend upon the type of disease and how far the condition has progressed. Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or recurring. Brush twice a day, clean between your teeth daily, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.

Teeth Grinding

Teeth grinding, also called bruxism, often occurs unconsciously while you sleep. It can

cause serious damage to your teeth and jaw. Although it is often considered to be stressrelated, teeth grinding can also be caused by sleep disorders. Your dentist’s choice of treatment will depend on the cause of your grinding, but you may be fitted with a mouthguard to protect your teeth while you sleep.

TMJ The temporomandibular joints, or TMJ, are among the more complex joints in your body. Any problem that prevents the TMJ from working properly may result in a painful disorder, also referred to as TMJ disorders or sometimes TMD. The exact cause of a TMJ disorder is often unclear, but possible causes can include arthritis, dislocation, injury and/or problems related to alignment or teeth grinding from stress. Symptoms can include: • Pain in or around the ear • Tenderness of the jaw • Clicking or popping noises when opening the mouth If you’re regularly experiencing facial or jaw pain, see your dentist. Exercise, muscle relaxants or physical therapy may help.

Root Canals Sometimes a cavity is just too deep to be fixed and may require a root canal. Root canal procedures are used to treat problems of the tooth's soft core, otherwise known as dental pulp. The pulp contains the blood vessels and the nerves of the tooth, which run like a thread down into the root. The pulp tissue can die when it’s infected or injured. If you don't remove it, your tooth gets infected and you could lose it. During a root canal treatment, the dentist removes the pulp, and the root canal is cleaned and sealed off to protect it. Your dentist may then place a crown over the tooth to help make it stronger and protect it.

Sensitive teeth If hot or cold foods make you wince, you may have a common dental problem — sensitive teeth. Sensitivity in your teeth can happen for several reasons, including: • Tooth decay — cavities • Fractured teeth • Worn fillings • Gum disease • Worn tooth enamel • Exposed tooth root

Missing Teeth Did you know that the average adult between the ages of 20 and 64 has three or more decayed or missing teeth? If you are missing one or more teeth, there are plenty of reasons to correct the problem. For one thing, a large space between your teeth may affect how you speak or eat. Even if it’s not noticeable, a missing molar can affect how you chew. Remaining teeth may shift and in some cases, bone loss can occur around a missing tooth. With today’s advances, you don’t have to suffer from missing teeth. Here are some options to replace a lost tooth or teeth. Talk to your dentist about which option is best for you: • Bridges. Anchored to your adjacent teeth, these can be removable or fixed, depending on your mouth, your dentist’s recommendation and your needs. • Dentures. An option if you’ve lost all or most of your teeth. • Implants. Most similar to a natural tooth.

Dry mouth Everyone’s mouth can be dry sometimes, but if you feel like your mouth is always dry, i t m ay b e t i m e to s e e k t re a t m e n t . Medications and certain health conditions can lead to dry mouth.

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Early detection starts with you Many factors might predispose a woman to breast cancer: age, diet, weight, smoking, and other lifestyle habits. But there is one clear correlation: simply being a woman means being at risk. This year, over 200,000 women will be diagnosed, but there is good news. When it is found early, the five-year survival rate is 98 percent; it is still high, at 90 percent, for all women with breast cancer. The importance of early detection is at the heart of National Breast Cancer Awareness Month, sponsored by a network of government and non-profit breast cancer advocacy groups. The National Breast Cancer Foundation recommends setting up an individualized early detection plan. The three main tools for early detection are the breast self-exam, the clinical exam, and the mammogram. Depending on a woman’s age and family history, the frequency of each of these can be adapted to optimize her chances of detecting breast cancer at the early, localized stage. The self-exam is recommended for women of all ages: get to know the normal contours and density of your own breasts by running a soapy hand over them in the shower. The soap reduces friction and allows the hand to feel variations in texture. Often, variations and patterns of lumpiness are part of the normal make-up of a woman’s breasts. If anything changes in the breast or in the underarm area, however, see a physician and ask for a clinical exam of the area. For women aged 20 to 39, it is advisable to have a clinical examination of the breasts every three years. After 40, it should be done once a year. Mammograms are recommended on a yearly basis for women over 40.

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Three Ways to Help Provide Comfort

For Those Suffering From Breast Cancer (Family Features) Breast cancer affects millions of women, which in turn affects their families and their friends. You don't have to have breast cancer in order to help raise awareness of it and provide comfort. There are things you can do to take on this disease and make a difference in your own life and in the lives of others while providing much-needed comfort and support. Team Up with Friends Multiply your impact on breast cancer awareness by getting a group of friends together to take action: * Host a Fundraising Party. Put together a girls' night out or a potluck dinner party, and challenge guests to bring donations to support breast cancer research. * Get Moving. Sign up as a group to participate in a walk or run event that raises awareness or funds. * Volunteer Together. Check out local breast cancer awareness events and find ways your group of friends can serve together. If there isn't a local event, sponsor one of your own. Visit www.NationalBreast-

Early detection means doing regular self-exams so you know which bumps and irregularities are normal for your breasts.

Cancer.org to find out how. Give Comfort to Others You can personalize and send free virtual Comfort Packages to friends and family via a digital tool on the Hanes Facebook page. For each package sent, Hanes will donate $1 to the National Breast Cancer Foundation, Inc. (up to $25,000) to promote early cancer detection and provide mammograms for those in need. The Comfort Package is fully customizable with photos, videos, recipes, T-shirt designs, music and messages. Sending a Comfort Package is one of many gestures that can brighten someone's day and help provide support and comfort to a loved one. As a longtime supporter of breast cancer awareness, Hanes has made cash and in-kind donations totaling $1 million since 2009 and is donating up to $125,000 to NBCF this year. Learn more at www.Facebook. com/Hanes or www.HanesPink.com. Buy and Wear Pink Products The next time you are at the grocery store or the mall, think about purchasing the pink version of your favorite items. Your purchase can help raise money as well as awareness for the cause. In addition, wearing your favorite pink items is a stylish way to show support and demonstrate your commitment. Consider wearing pink once a week in October to feel connected to the cause.

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Dental health ■ Continued from page 11 A dentist will check your teeth for signs of decay that can result from decreased salivary flow. A physician will test for any underlying disease or conditions that may be causing your dry mouth. Having a dry mouth is not itself serious but taking care of your teeth and gums and regular dental visits are important when living with dry mouth. Without the cleansing effects of saliva, tooth decay and other oral health problems become more common. Patients using oral inhalers for asthma often develop oral candidiasis, an oral fungal infection, and are encouraged to rinse their mouths with water after using the inhaler. Tell your dentist what medications you are taking and any other information about your health that may help identify the cause of your dry mouth.

60 and older

Havre Daily News/Lindsay Brown A sign at Liberty County Hospital reads Tobacco Free Campus. Many hospitals have adopted similar health-conscious policies.

Just 60 years ago, it was an assumption that as we age we would lose our natural teeth. But, that’s not the case for today’s older adults who are keeping their natural teeth longer than ever before. A healthy mouth and teeth help you look good, eat delicious and nutritious foods, and speak clearly and confidently. Being mouth healthy is essential for good quality of life. Maintaining good oral health habits now is especially important because unhealthy bacteria in the mouth not only can harm your teeth and gums but may be associated

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with serious medical conditions. Research has shown that infections in the mouth may be associated with heart disease, stroke, diabetes, pneumonia and other health problems that are common in older adults. It really only takes a few simple steps,  brushing and  flossing daily, visiting your dentist regularly and eating nutritious foods.

Brush and floss daily Brushing and flossing your teeth is just as important for you as it is for your grandchildren. Even though it may have been years since you’ve had a cavity, your risk of cavities increases with age. One of the reasons is dry mouth—a common side effect of many prescription medications. Brush your teeth twice a day with fluoride toothpaste. Choose a toothbrush with soft bristles and a small head to get to those hard-to-reach areas. Replace your toothbrush every three or four months, or sooner if the bristles becomes frayed. If you have arthritis or other condition that limits movement, try an electric toothbrush. Clean between teeth daily with floss. If floss is too difficult to work with, try a floss pick or tiny brushes made specifically to clean between teeth.

Clean dentures daily Bacteria stick to your teeth and also to full or partial dentures. If you wear dentures, remember to clean them on a daily basis with cleaners made specifically for dentures. Do not use toothpastes for natural teeth or household cleaners, which are too

abrasive and can damage dentures, which can be expensive to replace. Take your dentures out of your mouth for at least four hours every 24 hours to keep the lining of your mouth healthy. It’s best to remove your full or partial dentures at night. Your dentist will provide you with instructions about how long your dentures should be worn each day.

Visit a dentist regularly Get regular dental checkups at least once a year — do not wait until you have pain. Why? As you age, the nerves inside your teeth become smaller and less sensitive. By the time you feel pain from a cavity, it may be too late and you may lose your tooth. There are also more serious conditions that

www.havredailynews.com your dentist will look for, like oral cancer and gum disease, which do not always cause pain until the advanced stages of the disease. By then, it’s more difficult and costly to treat. When you go to your dentist for a checkup bring the following information: • List of medications, including vitamins, herbal remedies, and over-the-counter medications • List of medical conditions and allergies • Information and phone numbers of all health care providers, doctors, and your previous dentist • Information about your emergency contacts, someone who can help make decisions on your behalf in the case of a medical emergency • Dental insurance or Medicaid cards.


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Plans for new Bullhook clinic location moving forward Tim Leeds tleeds@havredailynews.com After a three-month regrouping, the board and staff of the Hill County community health center are continuing to move forward with the construction of a new location and centralized services for the center. “We are working on the purchase of the land. Hopefully, we will have those all completed by around (Wednesday, Oct. 10) … ,” Cindy Smith, executive director of Bullhook Community Health Center said Oct. 1. “Once they can break ground next spring, it will be probably a year’s process so it will be probably the spring … in 2014 before we can move in.” The Human Resources and Services Administration of the U.S. Department of Health and Human Services notified the center staff May 1 that it had awarded Bullhook $4,957,921 to lease, renovate and repair Donaldson Hall on the Montana State University-Northern campus and put all of its services there. The administration of the university system later stopped that plan, saying putting the clinic on campus did not meet their longrange plans for the building and the rest of Northern’s campus. Bullhook’s staff then put in applications with alternate possible locations, and HRSA announced Sept. 10 it had approved building

a new clinic north of the Havre City Hall complex on 5th Avenue and 4th Street.

Working to expand health care services Bullhook got its start when a county health consortium, formed in 2003 to identify areas where improvements in health care were needed, found that services to low-income people and people without insurance were in short supply in the region. The Bullhook Clinic was created under a federal planning grant in 2005, as a part of the Hill County Health Department. The clinic provided — and the health center continues to provide — medical services to patients, including on a sliding-fee scale based on the patient’s income. During period of cuts to programs in the federal government, the clinic staff was notified in 2006 that the second year of its federal grant had been cut. The clinic reorganized, cutting six nonmedical members of its staff, cancelling its outreach, reducing wages and combining job duties within remaining positions. That December, the clinic applied for new funding through a Federal New Access Community Health Center Grant to reform as a free-standing operation. In July 2007, the clinic reopened as an independent nonprofit organization, the

Bullhook Community Health Center. At almost the same time, the group was working on finding ways to add dental care to its services. The consortium that had recommended the creation of Bullhook also found that many in the area had difficulty finding dental care due to a shortage of providers and lack of services where people can use programs like Medicaid and the state Childrens Health Insurance Program, now part of Healthy Kids Montana. Bullhook applied for state grants authorized by the 2007 Legislature to help communities expand their dental care. Bullhook was passed over in the first round, but in September 2008 received a $185,000 two-year grant. Bullhook has continued to expand its services, and offers addiction counseling services as well as housing programs like the Montana Asthma Project and the Montana Medicaid Health Improvement Program.

Consolidating a location But the locations for those services are split, and the space for them is crowded. After splitting from the county, Bullhook moved into a space just east of Northern Montana Hospital, which it leases from Northern Montana Medical Group. Once it successfully started the dental

clinic, it leased space in the Atrium Mall, where those services still are housed. The addiction counseling and other services are housed in the building with the main clinic, on 13th Street. One of the goals of applying for the HRSA grant, through funds for community health centers which Sen. Max Baucus, D-Mont., worked to include in the Patient Protection and Affordable Care Act, the national health care reform bill, was to bring all of the services together in a convenient location.

Trying to save a historic building and improve health care The original application to HRSA proposed using the grant to renovate Donaldson Hall on the Montana State UniversityNorthern campus and use that building to house the health center. Donaldson, the first completely new building erected on Northern’s campus, opened in 1936 as a women’s dormitory. Donaldson was retired as a residence hall in 1971. The lower floors were rented to the Havre school district at that time, and Donaldson saw limited use as a dormitory or temporary housing space in the 1980s and 1990s with regular dormitories operated in other buildings.

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smaller proportions. It is also hard to count calories, fat or carbohydrates, but new smartphone applications enable people to find out that kind of information while they are ordering food. Some chain restaurants are beginning to post calorie or carb information on the menu, Wiken said. The United States is going through a diabetes epidemic, they said, and the Hi-Line is no exception. Many risk factors contribute to diabetes, they said — diet, lack of exercise or heredity. But there is one major factor: Obesity. “I think 99 percent of the people I see are obese — or were,” Wiken said. There is a belief that the effects of diabetes get worse as years go on, they said. But proper treatment makes that way less likely,

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they said. They are beginning to see people more often who are pre-diabetic, they said. These are people who are on their way to contracting diabetes. Often referred by doctors, the treatment for pre-diabetes is often the same: More exercise, better diets and sometimes medication. Losing weight and stopping smoking is usually the best thing that pre-diabetics can do. Often if pre-diabetics lose weight and eat better, they can be taken off medication, they said.

Finding out about diabetes People find out they are diabetics in a variety of ways, they said.

Sometimes doctors realize the symptoms and perform tests. Sometimes people begin to realize they are tired all the time, and they realize that diabetes may be the problems. One of the very few good things about the diabetes outbreak is that more people have blood-sugar-testing equipment, they said. The test involves lancing a finger to get a small drop of blood. The glucose meter can tell how much sugar they have in their blood system at the time. People often have their friends test their blood sugar. Sometimes, that is how people realize they have pre-disables.

Type 1 diabetes While most of the increase is in Type 2 diabetes, Type 1 diabetes remains a problem, they said.

www.havredailynews.com Type 1 is usually diagnosed in young people. It is caused by a shutdown or severe limitation of the liver function. Insulin is used to treat Type 1. People can usually treat themselves by i n j e c t i o n o r m o r e f r e q u e n t l y by pump. The pump injects insulin into the body throughout the day, and people can inject more before eating meals.

Get checked out While there are problems with diabetes, diabetics can live good lives if they are treated early and follow their doctor's advice, they said. The key is early detection, they said. If people have any of the side-effects, such as being tired all of the time, get checked out right away.

Making healthy food and drink choices American Diabetes Association Knowing what to eat can be confusing. Everywhere you turn, there is news about what is or isn't good for you. Some basic principles have weathered the fad diets and have stood the test of time. Here are a few tips on making healthful food choices for you and your entire family. You may also be interested in our book, Healthy Calendar Diabetic Cooking. Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals. Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce. Include dried beans — like kidney or pinto beans — and lentils into your meals. Include fish in your meals two or three times a week. Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey. Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese. Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats. Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and fullfat ice cream. Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

For More Information The book “What Do I Eat Now? A Stepby-Step Guide to Eating Right With Type 2 Diabetes” is a great resource to keep in your kitchen as a handy reference guide when it comes time to preparing meals. Also the

Diabetes Association have a registered dietitian ready to answer your nutrition questions. To keep in touch with the American Diabetes Association: Sign up for the the latest news on diabetes research, food and fitness, and opportunities to support the American Diabetes Association.

What Can I Drink? Food often takes center stage when it comes to diabetes. But don’t forget that the beverages you drink can also have an effect on your weight and blood glucose! We recommend choosing zero-calorie or very low-calorie drinks most of the time. This includes: • Water • Unsweetened teas • Coffee • Diet soda • Other low-calorie drinks and mixes You can also try flavoring your water with a squeeze of lemon or lime juice for a light, refreshing drink with some flavor. All of these drinks provide minimal calories and carbohydrates.

What to Avoid Avoid sugary drinks like regular soda, fruit punch, fruit drinks, energy drinks, sweet tea, and other sugary drinks. These will raise blood glucose and can provide several hundred calories in just one serving. See for yourself: One 12-ounce can of regular soda has about 150 calories and 40 grams of carbohydrate. This is the same amount of carbohydrate in 10 teaspoons of sugar. One cup of fruit punch and other sugary fruit drinks have about 100 calories — or more — and 30 grams of carbohydrate.

Tired of Water?

As you can see, you have many other options. Most diet drinks (like diet soda or diet tea) have zero grams of carbohydrate per

Diabetes and salt One key way of treating diabetes is to cut back on consuming sodium. Here are some additional tips that can help you cut back on sodium throughout your day: • Take the time to check labels at the grocery store. Check the amount of sodium in a serving and compare it to other similar items. This may sound time-consuming, but next time you shop for groceries, you’ll know what best options are and exactly where to find them. • Limit the amount of salt that you add when cooking. Instead, stock your spice cabinet with salt-free seasonings and spices. Look for recipes that don’t call for added salt. Fresh herbs, citrus juices, vinegars, and garlic are all low-sodium ways to add flavor to your food. Here are some examples: • Squeeze fresh lemon juice on steamed vegetables, broiled fish, rice, or pasta. You may want to try squeezing fresh lime juice on Spanish dishes. • Try salt- or sodium-free lemon pepper or mesquite seasoning on chicken. • Add cooked onion and garlic to liven up meats and vegetables. • Add fresh herbs to salads, pasta, or rice dishes to enhance flavor instead of adding salt or high-sodium condiments. • Marinate vegetables or cook them with balsamic vinegar. Refrain from using the salt shaker at the table. Try your food without salting it first — it may be better than you think. You’ll get a true taste of the natural flavors in the food you cook. If you need to, remove the salt shaker from the table all together. Keep the pepper out if you want to add a kick to your meal. Be aware that sometimes fat-free and reduced fat items have more sodium in them. It is usually added to give these products more flavor. Check the nutrition labels on these items so you know what you are getting. serving, so they will not raise blood glucose on their own. These diet drinks are sweetened with artificial sweeteners instead of added sugars. Removing the added sugars and replacing them with artificial sweeteners removes most of the calories and carbohydrates. One good thing about low-calorie drinks and drink mixes is that they are available in several flavors. They may be a good alternative to regular lemonade, iced tea, fruit punch, etc. These drink mixes are also usually sweetened with low-calorie sweeteners. They are very low in calories — about 5-10 per 8-ounce portion — and have less than 5 grams of carbohydrate per serving.

Milk and Juice Low-fat milk and 100 percent juice with no sugar added are also healthy drink choices. These drinks provide more calories and

carbohydrates than the other recommended choices, but they also provide us with important vitamins and minerals. Just remember to control portion size when you drink them, because the calories and carbohydrates can add up when you have too much. Choose low-fat 1 percent or skim milk, and make sure that you count it in your meal plan. One cup of skim milk provides about 12 grams of carbohydrate and 80 calories. If you choose to drink juice, be sure the label says it is 100 percent juice with no sugar added. Juice provides a lot of carbohydrates in a small portion, so be sure to count it in your meal plan. Usually 4-6 ounces — not even a full cup — contains 15 grams of carbohydrate and 50 or more calories. If you like to have juice in the morning but don’t want the carbohydrate from fruit juice, try low-sodium vegetable juice. At just 50 calories and 10 grams of carbohydrate in 1 cup, it is a great alternative.


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Fighting diabetes starts at the dinner table John Kelleher jkelleher@havredailynews.com

Courtesy photo Suzy Wiken, left, and Celeste Elliot, registered dietitians at Northern Montana Hospital, show off a display of healthy foods that can be used in fighting the effects of diabetes.

After people find out they have diabetes, one of their first stops is to see Suzy Wiken and Celeste Elliot, the registered dietitians at Northern Montana Hospital. Wiken and Elliot find people are sometimes angry, upset or confused and always concerned. "They are concerned about their feet, their eyesight," said Elliot. Diabetics then learn about the lifestyle changes they can make to bring their disease under control. The dietitians explain to them what diabetes is doing to their bodies, and what people can do to mitigate the effects of the disease. The hospital’s program is approved by the American Diabetes Association and serves people in Hill, Blaine and Liberty counties, except for the Rocky Boy's and Fort Belknap Indian reservations, which have their own programs. For starters, diabetics learn how they can change their diets to lose weight and keep the number of carbohydrates in their food down, the dieticians said. Fewer fats and more fruits and vegeta-

bles help them out, they said. And they can learn how to be more active. Walking and running is helpful, and swimming is great. “I always suggest swimming with gusto,” Elliot said. That is hard because hours for swimming are somewhat limited in Havre, but it provides exercise, tones important muscles and burns energy, they said. Some people have a hard time doing traditional exercises, Elliot said, because they have joint problems in their lower bodies, and swimming is easier. People are sometimes relieved to find out they have more control over their disease than they thought, she said. There is internal resistance to a better diet, especially with men patients. “Typical guys like to eat, and they like to eat what they want,” said Elliot. Often people can bring their blood sugar levels down considerably by diet and exercise, Wiken said. Changing to different types of juices or eating whole wheat bread instead of white bread can help, they said, Eating out is a problem because restaurants often provide large servings of food, when diabetics are encouraged to eat in

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The Northern Alumni Association completed a major remodeling of some of the lower floors in the 1980s and have worked on many other projects to maintain the building. The building housed several offices for the college, including the Alumni Association and the Foundation until 2008. But failure of electrical, plumbing and heating systems in the building led to those offices being moved. The proposal for Bullhook to lease and renovate the building was drafted and submitted while the university was led by an interim chancellor, former provost Joe Callahan, who came out of retirement to serve at the university’s helm while the search was conducted that ended with the hiring of Chancellor Jim Limbaugh. The proposal also was submitted while S h e i l a S t e a r n s wa s t h e M o n ta n a Commissioner of Higher Education. B e fo re H R SA awa rd e d t h e g ra n t , Limbaugh took over at Northern and Stearns retired, with her position filled by Clayton Christian. After HRSA awarded the grant to Bullhook, Limbaugh and Christian said the proposal did not fit the plans of the university. In statements and interviews in June, university system representatives including Christian said converting the building for use by a non-university entity did not meet the plans and goals of the university. The building will be repaired and renovated for student and academic use at the university, which will be done within the university system budget resources, they said.

Finding a new location The health center staff then switched gears, immediately starting the search for alternate locations. The one approved in September by HRSA takes up a quarterblock across from City Hall, in a space now occupied by an empty lot, the Brandon Building and the building that formerly housed Heberly Engineering. Smith said, with the location approved by HRSA, work is now ongoing to finalize the

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purchase of and build in the new location. She said the health center staff members are working with the Montana Community Development Foundation to find funding to purchase the real estate. Once that is done, the Brandon Building will be moved and the Heberly Building torn down, she said. The staff members were interviewing architectural and engineering firms last week, with a firm to do the actual designs expected to be selected soon. The firm will be heavily involved in selecting the contractors, with the intent to hire as locally as possible, Smith said. Smith said the staff members of the health center, and local residents, will be involved in deciding what the final design of the new health center should look like.

Expanding care and services

Constructing a new facility has two main purposes — creating a “medical home model” with services offered under one roof, and expanding the space in which to provide those services. When the center staff members announced the grant in May, they said the health center now has some 3,500 patients. The new facility is expected to allow that to nearly double, to some 6,500. The expansion also will allow increased staff. In May, the center employed 29 people, and the plans were to expand the number of medical and behavioral health care positions in the operation. Smith said part of that already is under way. A new doctor was scheduled to come on board Oct. 8, with expansion of services planned — possibly including some weekend and night-time clinics. When the new facility is open, that doctor will begin to work full time with the health center. Smith said the health center also will continue to work with other local health care providers, as well as continuing to work with programs at Montana State UniversityNorthern.

Havre Daily News/File photo Bullhook Community Health Center opens for business in 2007 in its 13th Street location.

Havre Daily News/Lindsay Brown An empty lot, the Brandon Building and former Heberly Engineering building now occupy the space on 5th Avenue and 4th Street where the new Bullhook Community Health Center will be erected.


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