GREATER ST. LOUIS
Promoting Healthier Living in Your Community • Physical • Emotional • Nutritional
HealthyCells Premier Issue 2011
m a g a z i n e
Shriners Hospitals for Children® – St. Louis Changing the World Through Caring for Kids page 12
Hypertension: The Silent Killer page 15 The New Year Signals A Healthier Lifestyle for Many page 22 What to Look for When Researching Senior Care Options page 30
welcome letter Welcome to the Premier Issue of Healthy Cells Magazine St. Louis! You have opened this magazine because you care about your health. So do we! Every article in this publication will provide you with useful information pertaining to physical, nutritional and emotional health that you can refer to again and again. The majority of the articles will be written by local health professionals. In each issue look for: 1. The latest updates on nutrition and exercise, as well as perspectives on physical and emotional health. 2. Connections to respected local health care providers who can communicate their expertise to meet your needs.
“Our goal is to provide you with the information you need to live a healthier life.”
3. Valuable community resources, whether medical, business or non-profit, that can improve your life and the lives of future generations. It’s exciting for the St. Louis area to have its own edition of Healthy Cells Magazine. This great publication will join the family of Healthy Cells Magazines that include Peoria, Bloomington, Springfield/Decatur, the Quad Cities and Hattiesburg, Mississippi. Several other cities will soon have their own local health magazine as well. Healthy Cells Magazine was first published in March of 1999 in the greater Peoria area. Since that time it has grown due to the generosity of its readers, advertisers and the loyal medical community. You will find this FREE magazine in a wide range of locations throughout the greater St. Louis area. This copy is yours to keep or to pass along to someone who can use it. My thanks go to the advertisers in this magazine. They are committed to helping YOU live a healthy lifestyle. When you visit their businesses, please tell them you saw their ad in Healthy Cells Magazine. They will be delighted to serve you! Sincerely,
Mike Kelly, Owner Healthy Cells Magazine St. Louis
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 3
2011 Volume 1, Issue 1
Welcome Letter: Premier Issue
Medical Care: Concierge Medicine
Emotional: Behavioral Intervention Can Reduce Depression in Stroke Survivors
Nutritional: 3 – 2 – 1. . . Happy New You!
Physical: Fibromyalgia – Frequently Asked Questions
The Right Dose: Hypertension: The Silent Killer
Hospice Care: Ask the Tough Questions for End of Life Medical Decisions
18 20 22 24
Shriners Hospitals® — St. Louis Changing the World Through Caring for Kids
Orthopedics: Elbow Injuries Women’s Health: Helping Women with Pelvic Prolapse and Bladder Control Problems Stop Smoking: The New Year Signals a Healthier Lifestyle Body Health: Varicose Veins Can Have Serious Medical Implications
Healthy Skin: Tips to Weather Winter With Healthy Skin
Senior Health: Recognizing Symptoms of Dementia
Grief Recovery: Killer Cliches About Loss
Future Decisions: What to Look For When Researching Senior Care Options
Hearing Loss: Having Trouble Hearing? Listen to the Truth Behind Hearing Loss Myths
This Month’s Cover Story:
Brain Aerobics: Crossword, Go Figure, Try Squares
For information about this publication, contact Mike Kelly, owner at 314-558-0860, firstname.lastname@example.org Healthy Cells Magazine is a division of: 1711 W. Detweiller Dr., Peoria, IL 61615 Ph: 309-681-4418 Fax: 309-691-2187 email@example.com • www.healthycellsmagazine.com
Healthy Cells Magazine is intended to heighten awareness of health and fitness information and does not suggest diagnosis or treatment. This information is not a substitute for medical attention. See your healthcare professional for medical advice and treatment. The opinions, statements, and claims expressed by the columnists, advertisers, and contributors to Healthy Cells Magazine are not necessarily those of the editors or publisher. Healthy Cells Magazine is available FREE in high traffic locations throughout the Greater St. Louis area, including major grocery stores, hospitals, physicians’ offices, and health clubs. Healthy Cells Magazine is published monthly and welcomes contributions pertaining to healthier living. Limelight Communications, Inc. assumes no responsibility for their publication or return. Solicitations for articles shall pertain to physical, emotional, and nutritional health only. Mission: The objective of Healthy Cells Magazine is to promote a stronger health-conscious community by means of offering education and support through the cooperative efforts among esteemed health and fitness professionals in the greater St. Louis area.
I wish to thank all the advertisers for their support of Healthy Cells Magazine’s mission to bring positive health related information to our readers. Because of their generosity we are able to provide this publication FREE to you. – Mike Kelly
Concierge Medicine — Getting Back to Basics
By Tinna P. King, M.D.
ave you ever called a doctor’s office to schedule an appointment, only to find out that it would take several weeks or months to be seen? Spent an hour or more in the waiting room, waiting patiently for the doctor, only to have that doctor spend less than 10 minutes with you addressing your concerns? Felt like you were being shuffled through quickly after being given a prescription or treatment plan with unclear instructions? If you have, you are not alone. This is what our U.S. healthcare system has morphed into over the years, and it is not likely to improve under the recently passed healthcare legislation and impending shortage of physicians. Enter the concept of concierge medicine. Concierge medicine (also known as retainer-based or direct care medicine) involves a direct relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for this retainer, doctors provide enhanced care. Patients are able to be seen in a timely fashion and treatment plans are individualized, because these practices limit their sizes to between 100 -1000 patients rather than the typical 4000 in a standard primary care practice. Patients in this type of care setting are usually able to be scheduled within 24 - 48 hours, spend little if any time waiting in the waiting room, and enjoy the ability to have all of their health concerns addressed with their doctor without being rushed. Think this is a luxury that only the wealthy can afford? The following statistics may surprise you:
• Less than 5% of those seeking concierge physicians are actually top executives or business owners • Over 50% of concierge medicine patients make a combined household income of less than $100,000 per year • Individuals comprise approximately 50% of those seeking concierge care • Approximately 25% of all concierge physician searches are for couples with no children, and over 20% are for families with children
Most annual retainer fees for individuals cost less than a daily cup of designer latte when averaged out over the year, with far more beneficial health consequences. This data should be very encouraging to the public, as it dispels the myth that concierge care is merely healthcare for the rich. It is now accessible and very affordable for people across all ends of the healthcare spectrum, enabling virtually anyone to enjoy the benefits of immediate access to highquality personalized medical care. For more information, call Dr. King’s office at 314-994-9338 Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 5
A Brief Behavioral Intervention Can Reduce Depression in Stroke Survivors Information from The National Institute of Health
nurse-led behavioral intervention can reduce the incidence of depression in stroke survivors, according to the results of a study published in the recent issue of the journal Stroke. The intervention, called Living Well with Stroke (LWWS), provided individualized counseling sessions aimed at increasing pleasant social interactions and physical activity as a way to elevate mood, and was designed to be used alone or in conjunction with antidepressant medications. This study was funded by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH). A stroke occurs when the blood supply to a part of the brain becomes blocked or interrupted, leading to brain damage in the affected area. Stroke survivors can experience a range of aftereffects, including impaired mobility or paralysis, pain, speech and language problems, and altered cognition. As many as one-third of stroke survivors also develop post-stroke depression (PSD), which may include intense feelings of loss, anger, sadness, and/or hopelessness. Compared to stroke survivors without depression, those with PSD tend to have a poorer response to rehabilitation, a longer delay in returning to work, more social withdrawal, and increased use of health care services. They are also at higher risk for subsequent strokes, cardiac events, and death. While antidepressant medications have shown varying degrees of short-term efficacy for PSD patients, few studies have examined non-pharmacologic interventions or long-term outcomes. In a clinical trial involving over 100 stroke survivors who exhibited symptoms of PSD, Dr. Mitchell’s research team compared LWWS against usual post-stroke care. The study participants ranged in age from 25 to 88 years, and 59 percent were male. In addition, over 70 percent had experienced at least one episode of depression prior to their stroke, and 60 percent were taking an antidepressant medication at entry into the study. All participants received standard post-stroke information and continued to see their primary care provider for ongoing medical care. Those assigned to the LWWS program received nine counseling sessions over two months with a specially trained stroke rehabilitation nurse. In these sessions, the nurse taught the participants problem-solving skills and helped them develop realistic treatment goals. In addition, several sessions were devoted to improving mood by helping the
Page 6 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
participants identify and increase their participation in pleasant social events and physical activities, such as being with family, listening to music, reading, solving a puzzle, or learning something new. “In designing LWWS, we reasoned that changing the behaviors commonly associated with depression through an individualized counseling program would lead to a more effective and longer-lasting elevation of mood than is often seen with medications alone,” said Dr. Pamela Mitchell, the principal investigator of the study. “Individuals who have suffered a stroke often must make adaptations in their lives and learn to cope with new limitations, both physical and cognitive. Depression during the recovery period can interfere with their ability to fully engage in their treatment regimen or return to family and work,” noted Dr. Patricia A. Grady, the NINR Director. Depression scores in the LWWS group were significantly lower after treatment and at a one year follow-up compared to the control group. In addition, more participants in the LWWS group achieved remission — with scores no longer meeting the criteria for depression — compared to the control group both immediately after treatment (47 percent vs. 19 percent), and at a one-year follow-up (48 percent vs. 27 percent). At two years, depression scores continued to decrease and remission rates continued to increase for both groups, although the gap narrowed so that the differences were no longer statistically significant. For both the intervention and control groups, patients in remission at one year had significantly higher scores in perceived ability, recovery, and social participation than those who were not. “The success of LWWS shows the importance of including behavioral strategies in the care of stroke survivors. We believe our study is the first to report a clinically significant reduction in depression in these patients over a long term,” said Dr. Mitchell. “We also showed that achieving remission from depression by any means is an important treatment goal that could promote recovery and sociability.” “This study has the potential to add another tool for health care professionals to use in helping individuals cope following a stroke,” added Dr. Grady. “Also of note, the LWWS program included instruction to help family members and other informal caregivers identify resources and support services as a way to reduce their caregiving burden, an important aspect of comprehensive post-stroke care.” NINR supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. For more information about NINR, visit the Web site at www.ninr.nih.gov. The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov
“The success of LWWS shows the importance of including behavioral
strategies in the care of stroke survivors.”
Stroke Warning Signs • N UMBNESS OR WEAKNESS OF THE FACE, ARM OR LEG, ESPECIALLY ON ONE SIDE OF THE BODY • CONFUSION, TROUBLE SPEAKING OR UNDERSTANDING • TROUBLE SEEING IN ONE OR BOTH EYES • T ROUBLE WALKING, DIZZINESS, LOSS OF BALANCE OR COORDINATION • S EVERE HEADACHE WITH NO KNOWN CAUSE Immediately call 9-1-1 or your emergency response number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you’ll know when the first symptoms appeared. It’s very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke. tPA is the only FDA-approved medication for the treatment of stroke within three hours of stroke symptom onset. A TIA, or transient ischemic attack, is a “warning stroke” or “mini-stroke” that produces stroke-like symptoms but no lasting damage. Recognizing and treating TIAs may reduce your risk of a major stroke. The usual TIA symptoms are the same as those of stroke, only temporary. The short duration of these symptoms and lack of permanent brain injury is the main difference between TIA and stroke.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 7
Successfully Set and Achieve Your Weight Loss Goals
s the pumpkin pie, holiday cocktail and sugar cookie memories begin to fade, we’re reminded that the time has come to set or “re-set” our goals. Popular New Year’s resolutions — to lose weight and/or stay fit — resurface with a bang year after year. You’ve probably heard people say, “Those who lose weight eventually gain it back.” Don’t give up hope! Many people who successfully maintained a substantial weight loss for more than a year have done it on their own. Registered dietitian Tara Gidus, also known as the Diet Diva, knows it can be a struggle to set goals and stick to them. “Prime weight loss season is upon us, and the need for realistic, achievable and tasty ways to make healthy lifestyle changes is as important as ever,” said Gidus. “An exercise and healthy eating focus, along with a positive attitude and the right tools, can lead to a happier and healthier you — a new you.” Help yourself to successfully achieve your weight loss resolution with Gidus’ tips.
•T hink of You. Take “me” time to rest, relax, shop or exercise for stress relief. Stress hormones have been tied to weight gain. • Break It Down. Have an ultimate goal, and then break it into mini goals that are easily achievable. This makes the road to success seem easier and allows you to celebrate along the way. • Flavor It. Calorie moderation doesn’t have to mean boring. Use Hidden Valley Original Ranch Salad Dressing & Seasoning Mix to add a punch of flavor without compromising calories. It’s especially great to use in dips and other game day snacks.
Page 8 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
• Keep Track. People who keep track of what they eat can lose up to twice as much weight as people who don’t. Jotting down how much you ate and how you were feeling can also help you connect food to energy and mood. •G et Your Zzz. Snooze your way to weight loss. Getting enough sleep is critical to keep the hormones that control your appetite in check. •F lex Your Muscles. The more muscle mass you have the more calories you burn while you are sleeping. Stay fit by doing strength training twice a week. •D on’t Multitask. Turn off distractions like the TV and computer while eating or you could lose track of how much has gone in. Tune in to your body’s hunger and fullness cues to know when to eat and when to stop.
Weight Loss Profile People who have successfully achieved long-term weight loss tend to have common characteristics:
• Eat breakfast every day • Monitor their weight weekly • Watch less TV (i.e. less than 10 hours/week) • Daily exercise (i.e. 30 to 60 minutes/day)
For great eating ideas using Hidden Valley products, check out these recipes, or go to www.hiddenvalley.com.
Baked Chicken Tenders
Prep Time: 20 minutes Chill Time: 6 to 24 hours Cook Time: 16 to 18 minutes Makes 8 (3-ounce) servings 1 packet Hidden Valley Original Ranch Salad Dressing and Seasoning Mix, divided 2 cups non-fat Greek yogurt 11/2 cups low-fat buttermilk 1 package (20 ounces) fresh 99% fat free chicken tenders 1 cup whole wheat bread crumbs 1/3 cup sliced almonds 1 teaspoon garlic powder 1/4 teaspoon pepper olive oil cooking spray 1. Combine 1/2 packet Ranch Dressing and Seasoning Mix with yogurt; refrigerate. 2. Combine remaining Ranch Dressing and Seasoning Mix with buttermilk; refrigerate. 3. Rinse chicken and thoroughly pat dry on paper towels. 4. Combine chicken and buttermilk mixture together in a food storage zipper bag. 5. Refrigerate 6 to 24 hours. 6. Heat oven to 425°F. 7. In a food processor, combine breadcrumbs, almonds, garlic powder and pepper. 8. Coat chicken in breadcrumb mixture. 9. Set a wire rack on baking sheet and coat with cooking spray. 10. Lay chicken pieces on wire rack and spray with more cooking spray. 11. Bake 16 to 18 minutes until no longer pink (internal temp at least 170°F). 12. Use yogurt mixture as a dipping sauce.
Original Ranch Spinach Dip
Prep Time: 5 to 10 minutes Chill Time: At least 30 minutes Makes 12 (1/4-cup) servings 1/2 packet Hidden Valley Original Ranch Dips Mix 1 cup plain non-fat Greek yogurt 1 cup light sour cream 1 box (10 ounces) frozen chopped spinach, thawed and well-drained 1/3 cup chopped walnuts* 1. Combine Ranch Dips Mix, yogurt, sour cream, spinach, and walnuts. 2. Chill 30 minutes or until just before serving. 3. Serve with whole wheat crackers and raw vegetables. *Pecans or water chestnuts can be used in place of walnuts.
Cheesy Ranch Popcorn Prep Time: 5 minutes Cook Time: 3 1/2 minutes Makes 6 (2-cup) servings 1 bag (3 ounces) reduced-fat, low sodium butter-flavored microwave popcorn 1/4 pack Hidden Valley Original Ranch Salad Dressing and Seasoning Mix 3 sprays from olive oil mister 3 tablespoon grated Parmesan cheese 1. Pop popcorn according to package directions. Immediately open the bag and pour the popcorn into a large serving bowl. 2. Spray the popcorn with three sprays from the olive oil mister, toss with Ranch Salad Dressing and Seasoning Mix and then toss with the Parmesan cheese. Serve immediately.
Introducing Hidden Valley Salad Kits
Just add lettuce! The makers of Hidden Valley introduce Salad Kits — four prepackaged kits containing tasty ingredients sure to liven up everyday salads. To learn more about new Hidden Valley products, visit www.hiddenvalley.com. Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 9
Frequently Asked Questions Q: What is fibromyalgia? A: Fibromyalgia (fye-bro-mye-AL-ja) is a disorder that causes aches and pain all over the body. People with fibromyalgia also have “tender points” throughout their bodies. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs that hurt when pressure is put on them. Q: What causes fibromyalgia? A: The causes of fibromyalgia are not known. Researchers think a number of factors might be involved. Fibromyalgia can occur on its own, but has also been linked to:
• Having a family history of fibromyalgia • Being exposed to stressful or traumatic events, such as: • Car accidents • Injuries to the body caused by performing the same action over and over again (called “repetitive” injuries) • Infections or illnesses • Being sent to war Q: What can I do to try to feel better? A: Besides taking medicine prescribed by your doctor, there are many things you can do to lessen the impact of fibromyalgia on your life. These include:
Page 10 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
• Getting enough sleep. Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. Most adults need seven to eight hours of “restorative” sleep per night. Restorative sleep leaves you feeling well-rested and ready for your day to start when you wake up. It is hard for people with fibromyalgia to get a good night’s sleep. It is important to discuss any sleep problems with your doctor, who can recommend treatment for them. • Exercising. Although pain and fatigue may make exercise and daily activities difficult, it is crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do hard exercise should just begin to move more and become more active in routine daily activities. Then they can begin with walking (or other gentle
exercise) and build their endurance and intensity slowly. • M aking changes at work. Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make changes that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift. • Eating well. Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.
Q: Will fibromyalgia get better with time? A: Fibromyalgia is a chronic condition, meaning it lasts a long time — possibly a lifetime. However, it may be comforting to know that fibromyalgia is not a progressive disease. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time. For more information on fibromyalgia, call womenshealth.gov at 1-800-994-9662 or contact the following organizations: • National Institute of Arthritis and Musculoskeletal and Skin Diseases: (877) 226-4267 or (301) 495-4484, www.niams.nih.gov • A rthritis Foundation: (800) 283-7800, www.arthritis.org • N ational Fibromyalgia Association: (714) 921-0150, www.fmaware.org Reviewed by: Daniel Clauw, M.D. Director of the Chronic Pain and Fatigue Research Center University of Michigan All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women’s Health in the Department of Health and Human Services. Citation of the source is appreciated. Content last updated June 29, 2010. Ph. Number: (866) 725–4404 Web Address: www. fmpartnership.org
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 11
Shriners Hospitals for Children® – St. Louis
Changing the World Through Caring for Kids By Tammy Robbins, Director, Public and Community Relations patients with rare and complex disorders, providing elite experience in their treatment.” Widely published in medical journals, the physicians at Shriners Hospitals for Children® are often referred to as the “expert’s experts” and draw visiting physicians nationwide to St. Louis to observe their practices. This level of expertise makes it possible for the hospital to predictably provide definitive care in the treatment of infants, children, adolescents and young adults with often complex musculoskeletal deformities of the spine and upper and lower extremities. Many of the hospital’s physicians are both full-time faculty members of the Washington University School of Medicine and on the staff of St. Louis Children’s Hospital and/0or Barnes-Jewish Hospital. “Our medical staff is highly focused on teaching and research, and through that work, they’re dedicated to helping expand the worldwide body of medical knowledge and improving the quality of life for people around the world,” Dr. Schoenecker said. “And, as a result, Shriners Hospitals for Children® is able to provide in-hospital care for kids from around the world. “ It’s one way that Shriners Hospitals for Children® is changing the world through caring for kids. Erickson Hernandez is a good example of that effort.
“Our physicians are able to make decisions in the best medical interest of the child, fostering a creative and
ith a tightly-focused specialty and an environment promoting medical innovation, Shriners Hospitals for Children® St. Louis is one of the region’s top destinations for families seeking orthopaedic care for their children. Led by Chief of Staff Perry L. Schoenecker, M.D., the medical staff at Shriners Hospital represents some of the world’s elite doctors in their specialties. This local hospital is part of the Shriners Hospitals for Children® system: 22 pediatric specialty hospitals designed to provide comprehensive care for patients regardless of a family’s ability to pay. The system focuses on four specialties: orthopaedics, burns, spinal cord injury rehabilitation, and cleft lip and palate. The hospital in St. Louis focuses on orthopaedics only. “Our physicians are able to make decisions in the best medical interest of the child, fostering a creative and innovative health care culture,” said Dr. Schoenecker. “Because our mission is focused solely on pediatric orthopaedics, our doctors see a high percentage of Page 12 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
innovative health care culture.” Erickson’s story Four-year old Erickson Hernandez was born with a type of cleft hand that has never been documented, according to Shriners Hospitals for Children® orthopaedic surgeon Dr. Charles Goldfarb. “This is a one-in-a-lifetime case,” he said. “My partner, Dr. (Paul) Manske, who has been in practice for over 30 years, said he had never seen anything like it. There’s nothing in the medical literature about it.“ (Dr. Manske is the senior surgeon for upper extremities at Shriners Hospitals for Children®, and is editor of the Journal of Hand Surgery). Erickson, from western Guatemala, was born with three arms: one on the right, and two on his left side. The partially-formed arms on his left side performed two completely different and equally vital
functions. Goldfarb explained that Erickson’s upper arm had a good shoulder joint, and, importantly, a growth plate. The bottom arm was almost like the second half of the top arm, he said, with a normal humerus and two functioning fingers, but no shoulder or elbow joints to provide movement. “It’s very uncommon to see extra digits, let alone extra limbs,” Dr. Goldfarb said. “We’ve only seen one other documented case of a boy in China born with three arms, and that was in mainstream media, not in medical journals.” In that case, surgeons simply amputated the less functional of the two arms on one side. But Erickson’s situation was much different. Erickson used his two left arms in “beautiful combination,” by grabbing the bottom arm with his top arm, in order to grasp objects, said Kathy Corbett, who arranged for his care at Shriners Hospitals for Children® St. Louis. Corbett is the executive director for the St. Louis chapter of Healing the Children, a nonprofit, volunteer organization dedicated to securing donated medical and surgical care for children who are in need. “His mother kept him covered,” said Corbett. “He would have been ostracized in Guatemala. As it was, he got a lot of stares here in the United States, but people are much less sensitive to those kinds of things in Guatemala.” Goldfarb agreed. “This was a problem for him from a social point of view, but he made the best of a terrible situation. Which kids always do.” At first glance, the obvious treatment would have been to amputate one arm. However, upon seeing how the two left arms functioned together, Dr. Goldfarb was determined to save this function for Erickson. “The ideal situation for Erickson was to use the best parts of both arms,” Dr. Goldfarb said. “The fall-back situation would have been to excise the lower arm, because his upper arm has a good shoulder and growth plate. He would have then been able to use a prosthesis to help him use his upper arm. However, we were hoping for a home run,” he said.
nerves and vascular tissue from the bottom arm to the top, in order to provide function and feeling to the fingers of what was his lower arm, newly attached to the top arm. “I think his arm will allow him to do anything he wants to,” Dr. Goldfarb said. “His arm won’t be a limiting factor in his life.”
“We were excited to help him, but we had to be a little creative in our approach,” — Dr. Goldfarb added. Goldfarb, Manske and their team got that home run. The surgeons were able to join the humerus joints of the top and the bottom arm and fuse them together. Furthermore, they were able to “re-route” all the Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 13
Corbett agreed, and is ecstatic about the outcome. “He’s so proud. He wants to show it to everyone,” Corbett said. “Of course it’s not a perfect arm, but it makes him feel like any other little boy.” Erickson’s surgical team, which includes Drs. Goldfarb and Manske, as well as his occupational therapist, Valeri Calhoun, are now in the process of writing an article for publication in medical journals, in the hopes that this successful outcome will be able to help other children. In addition to the surgery Erickson had to transform his arm, Shriners Hospitals for Children® surgeons also performed a surgery to release a “tethering” in his spine, which could have caused him future paralysis, as well as a surgery to correct his scoliosis. He will return to the hospital periodically for several years to extend the growing rods in his spine. Research and Teaching The surgeries and help that Erickson has received from Shriners Hospitals for Children® will make a tremendous difference not only in his life, but in the lives of others as he’s able to return to his native country and grow up to be a contributing member of his community. It is the aim of Shriners Hospitals for Children® to do just that for children in United States, as well as throughout the world. It’s one way that the hospital is changing the world through caring for kids. The hospital system is also committed to conducting innovative research and outstanding medical education programs. Shriners Hospitals for Children® is not only a research hospital, but also a teaching hospital, which attracts the most innovative and advanced experts in the field of orthopaedics.
Page 14 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
System-wide more than 8,000 physicians have received residency education or postgraduate fellowship at Shriners Hospitals in the past 20 years. Dedication in teaching and researching means the hospital is helping to expand the world-wide body of medical knowledge and improving the quality of life for people around the globe. Eligibility Children up to age 18 are eligible for care at Shriners Hospitals for Children® - St. Louis, if they have an orthopaedic condition. Patients are accepted for care based solely on their medical needs. To refer a patient for care in St. Louis, please contact the hospital at 314-4323600 or 1-800-850-2960. Help Change the World As a 501 (c)(3) nonprofit organization, Shriners Hospitals for Children® relies on the generosity of others to continue its mission.
For more information on giving to the hospital, go to www.donate2shc.org, or contact us locally at 314-872-7807.
the right dose
Hypertension: The Silent Killer By Lynn Schmittgens, R.Ph.
igh blood pressure is a common, but serious, condition that can lead to coronary artery disease, heart failure, kidney failure, stroke and other health problems. Yet there are often no warning signs. It’s possible to have high blood pressure, also called hypertension, for years without knowing it. If your blood pressure (BP) is extremely high you may have unusually strong headaches, chest pain, difficulty breathing and poor exercise tolerance. Excess pressure over time can damage the heart and blood vessels without any noticeable symptoms, therefore it is important to screen for hypertension to prevent serious problems. A blood pressure reading is written as systolic pressure, which is the force of blood pushing against the walls of the arteries as the heart pumps blood, over diastolic pressure, which is the blood pressure between heartbeats. A normal blood pressure reading is 120/80, or “120 over 80”. Multiple high blood pressure readings over a prolonged period of time are especially worrisome if you have a close relative who has hypertension. Once diagnosed, your physician can help you define a plan for treating hypertension. Certain lifestyle changes can lower your BP:
help protect your kidneys. Some possible side effects include dry and persistent cough, headache and diarrhea. Angiotensin II Receptor Blockers (ARBs) block the action of Angiotensin II, which cause blood vessels to relax, thereby lowering your BP. Some possible side effects include fatigue, dizziness or fainting and muscle pain. Calcium Channel Blockers (CCBs) such as Diltiazem and Verapamil block calcium entering the muscle cells of the heart and blood vessels. This decreases BP by allowing the blood vessels to relax. Some possible side effects of these types of medicine include dizziness upon standing up as well as trouble breathing, heart rhythm problems and ankle swelling. Hypertension is a chronic condition that tends to worsen as we age. It is crucial to continue treatment even though there may be no overt symptoms of high blood pressure. If you experience any side effects make sure to discuss it with your healthcare provider. Your doctor may adjust the dosage or put you on another medication. Untreated high blood pressure is a time bomb and finding the right regimen for you is the key to staying healthy. Call The Medicine Shoppe Pharmacy® in Affton at 314-638-3535 to schedule your free blood pressure screening. For more information about hypertension visit the National Institutes of Health online at www.nih.gov.
• If you smoke, STOP. • Maintain a healthy weight. If you are overweight, even moderate weight loss will help. • Exercise (with your physicians okay). Start small and increase the time spent each day. A brisk 30 minute walk outdoors will improve mood and sleep as well as help decrease BP. • Eat appropriate amounts of food especially fresh fruits, vegetables and grains. • Minimize consumption of red meat, fried foods, salt and sweets. • Get adequate rest. In cases where lifestyle changes aren’t enough medication may be needed. There are many pharmaceutical options, and they are sometimes used together to control high blood pressure. Often the first step is a diuretic or water pill that helps decrease BP by reducing the fluid in your blood vessels. Some possible side effects include headache, weakness, joint or muscle pain and low potassium blood levels. If more help is needed to get your high blood pressure under control the doctor may prescribe a Beta-blocker (e.g. Atenolol, Metoprolol). These types of medicines cause your heart to beat slower and with less force, thereby decreasing your BP. Some possible side effects include fatigue, lightheadedness and drowsiness. Another option is an ACE inhibitor (e.g. Lisinopril), which prevents blood vessels from contracting to lower BP and also Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 15
Ask the Tough Questions for End of Life Medical Decisions
sking your doctor questions when faced with end of life medical decisions may have an impact on the quality of your life. Although it is important to trust your family doctor, you must not be afraid to ask questions. The time after a family member has been diagnosed with a terminal illness, or has been in a serious accident, is not when you want to be dealing with end of life issues. It is vital to know what your loved ones wishes are before any event occurs. In many cases critical decisions about life and death are made while everyone is under extreme stress. Turning to your doctor to guide you through this strenuous time is normal. Statistically, about one-quarter of Medicare dollars are spent during the last year of life, this statistic is unchanged from twenty years ago. It is only logical that health care costs would rise near death, because most people are sick before they die. Medical care is expensive. According to the Census Bureau, 83 percent of all the deaths occurring in the United States occur among persons covered by Medicare, even though persons age 65 and older represent just 13 percent of the population. If quality of life is more important to you than quantity, start asking questions. Do not assume that your family and physician know what your choices are. Talk to them before a situation arises. Most people think about the disposition of their assets. Somehow they avoid planning for the end of their life. If you do not share your ideas with your loved ones, other people take over during this vulnerable time. You want your loved ones to understand your desire to live or die with dignity. Take for example the following scenario; Mr. A is an 81 year old gentleman, married with 6 grandchildren. He plays golf twice a week, tinkers in his wood working shop, and is active in his church. He was recently admitted into the hospital with flu like symptoms. After several days the doctors are uncertain what is causing the symptoms. Mr. A is not getting better. He ends up in the Intensive Care Unit (ICU). His greatest fear is being a burden to his family and not being able to live an active life. Mr. A is chemically induced into a coma. While in the coma, he had a stroke and is then placed in a skilled nursing facility where he no longer can walk or talk. He is now unable to communicate his wishes to his family and physician. At this time the family can only follow the advice of the medical staff. This is a typical scenario. Medical staff is trained to take care of their patients. They are proficient in saving lives. New drugs, devices and tools that are being developed everyday in the medical field increase the chances of prolonging life. Most physicians are enthusiastic about new technology, they are eager to treat and cure their patients using this expertise. Communication during this fast paced time can be difficult. Sometimes the enthusiasm the medical staff has for technology overwhelms the patients and their families. The drive to save a life does not always take into consideration the quality of the patient’s life. The need to take every measure to save your loved one life may not be their true wishes. There is anecdotal as well as practical evidence that many loved ones regret all the medical testing and treatment provided during the last days of life. No one chooses to die in the ICU at the hospital or Page 16 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
in a skilled nursing facility. The majority of people want to die in the comfort of their own home surrounded by their loved ones, not strangers. So many factors influence end of life medical decisions. When thinking about your own death or that of someone you love, your attitudes and beliefs about suffering, pain, religion and persons you are leaving behind impact the decisions you make. Some of the choices you may be faced with are; 1. Curative Care; treatment and therapies provided to a patient with intent to improve symptoms and cure the patient’s medical problem. 2. Home Care; medically-related services for patients in a home setting rather than in a medical facility. Home health care may include skilled nursing in addition to speech, occupational and physical therapy. In many cases, it includes assistance with cooking and other household chores. It also includes monitoring the patient’s prescriptions. 3. Palliative Care; a comprehensive, specialized care provided by an interdisciplinary team to patients and families living with a lifethreatening or severe advanced illness expected to progress toward dying and where care is particularly focused on alleviating suffering and promoting quality of life. 4. Hospice Care; a type of care and a philosophy of care which focuses on the palliation of a terminally ill patient’s symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The care is rendered either on an inpatient basis or in the home setting for a terminally ill patient. Hospice care provides pain management and emotional support for the patient, family and caregivers. Hospice emphasizes the quality of life for their patients and allows them to die with dignity. These choices are not intended to provide all the information you need to make your medical decisions for your life’s end. It is essential to plan ahead. Educate yourself about your options. This is not to say that all measures should not be taken when someone becomes very ill or is severely injured. Do not be afraid to ask questions of your physician, medical experts, legal advisor and loved ones. Let them know what your wishes are before something catastrophic occurs. For more information, contact Alternative Hospice at one of our 3 locations: St. Louis and surrounding area at 636-3433839; DeSoto and surrounding area at 866266-3421; Cuba and surrounding area at 866-391-8548. You can also visit our website at www.alternativehospice.com.
Elbow Injuries By Jason D. Rabenold, M.D.
Why They Occur and How They are Treated
lbow injuries range from mild to debilitating and can happen to anyone. According to Jason Rabenold, M.D., a shoulder and elbow fellowship trained orthopedic surgeon at Mid County Orthopaedic Surgery and Sports Medicine, many elbow injuries are caused by overuse. “Athletes, people with occupations that require repetitive motions and active individuals are all at risk of injuring their elbows,” he says. Common elbow injuries The elbow joint is composed of bone, cartilage, ligaments and fluid. Muscles and tendons help create movement within the joint. Common elbow injuries include: Lateral Epicondylitis (tennis elbow) – the condition is characterized by pain that is centered where the forearm tendons meet the bony
Page 18 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
prominence on the outside of the elbow. Symptoms may include pain when the area is touched, a weak or painful grip and pain when the wrist is extended. A common cause of the condition is overuse. Medial Epicondylitis (golfer’s elbow) – the condition is characterized by pain that is centered on the inner side of the elbow where the forearm tendons meet the bony prominence on the inside of the elbow. Symptoms may include pain that extends along the forearm, stiffness, pain when making a fist and weakness in the hands and wrists. A common cause of the condition is overuse. Olecranon Bursitis – the condition occurs when fluid collects in a sac called a bursa, which is located behind the elbow. Symptoms may include pain, swelling behind the bursa and a limited range of motion. A common cause of the condition is trauma to the area.
Biceps Tendonitis – the condition occurs when the tendons that connect the biceps muscles to the lower arm become inflamed or irritated. Symptoms may include pain and tenderness and a snapping sound or sensation in the shoulder area. The most common causes of the condition are repetitive overhead activity and overdoing it in the weight room. Osteochondritis Dissecans – the condition is characterized by a loss of blood supply to an area of bone underneath the surJason D. Rabenold, M.D. face of a joint. Symptoms may include pain, a clicking sound when the joint is moved, decreased joint movement or a locking of the joint and swelling and tenderness of the skin over the joint. Common causes of the condition include trauma and stress to the area. Other common elbow injuries include sprains, strains, fractures, dislocations and arthritis. According to Dr. Rabenold, people should seek medical attention immediately after sustaining an elbow injury. “Any person who is experiencing pain should see a physician,” he says. “People with elbow injuries may experience pain and swelling. Athletes may notice a poorer performance, pain, numbness and tingling down to the hand or even instability of the elbow.” Diagnosis and treatment Elbow injuries are generally diagnosed through a physical exam, patient health history, X-ray and, if needed, CT and MRI scan. For most non-traumatic injuries, treatment begins with more conservative methods. “Treatments may include physical therapy, anti-inflammatory medication, bracing and injections,” says Dr. Rabenold. For traumatic injuries or injuries that require further care, surgery is an option. Some procedures are now able to be done arthroscopically (minimally invasively). “We are able to perform more procedures arthroscopically than ever before,” says Dr. Rabenold. “However, many injuries, especially traumatic injuries, require formal, open procedures and reconstruction of the anatomic structures.” Preventative measures can reduce injuries Dr. Rabenold suggests people can prevent elbow injuries by taking precautions when engaging in physical activities. “Wear elbow pads when performing high-risk activities and make sure coaches are educated on the proper amount of activity for their athletes,” he says. Jason D. Rabenold, M.D. is an orthopedic surgeon at Mid County Orthopaedic Surgery and Sports Medicine, a division of Signature Medical Group. Dr. Rabenold completed his shoulder and elbow fellowship at the University of Texas Health Science Center at San Antonio. He furthered his shoulder training with a traveling fellowship in Nice and Annecy, France. Prior to his shoulder training, Dr. Rabenold obtained his medical degree at State University of New York at Syracuse and completed his general orthopedic training at The University of Toledo Medical Center. To make an appointment with Dr. Rabenold call 314.983.4700. Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 19
Helping Women with Pelvic Prolapse and Bladder Control Problems Edward S. Levy, MD, FACOG, Urogynecology, Ob-Gyn, Female Pelvic Medicine and Reconstructive Surgery
What is Pelvic Organ Prolapse (POP)? Pelvic organ prolapse refers to a group of vaginal support problems that affect millions of women and can cause considerable discomfort. As women age, tissues that support the uterus, vagina, bladder, and rectum can accumulate damage and weakness that causes hernias or bulges to protrude from the vaginal opening. Often, the original damage occurs during childbirth, but does not manifest itself for many years. Other contributing factors include smoking, chronic coughing, straining or heavy lifting, and a family history of similar problems. Symptoms can include pelvic pressure or pain, difficulty urinating or having bowel movements, and a noticeable bulge protruding from the vagina. Many women suffer for years before seeking treatment. Why do some women leak urine? Loss of bladder control (urinary incontinence) is also very common and comes in different types. The most common complaint is leaking urine when coughing, laughing, sneezing, jumping, or doing any other activity that puts pressure on the pelvis. This is known as “stress incontinence.” Another type of leakage, “urge incontinence,” describes the symptom of having to urinate so badly that one cannot make it to the bathroom without leaking. This condition is also known as “overactive bladder” or OAB. Some women are unfortunate enough to have both types of incontinence. The same risk factors described above for pelvic organ prolapse also increase the risk for stress incontinence. Stress incontinence usually results from a loss of structural support between the urethra and upper wall of the vagina. In most cases, urge incontinence (OAB) has no known cause. Is help available for these problems? Does it really work? Yes and yes! After several generations of less than stellar treatments, we have finally developed highly successful and durable repairs for both pelvic prolapse and stress incontinence. Of course, not all patients require surgery. Mild stress incontinence can often be managed with pelvic muscle exercises or “Kegels”. Non-surgical treatment of prolapse usually involves the use of a vaginal insert called a “pessary”. Some women do very well with these vaginal devices that need to be removed and cleaned periodically. Some women find them uncomfortable or inconvenient to maintain. Surgical treatment of stress incontinence involves supporting the fallen urethra with an outpatient, thirty-minute vaginal operation called a “sling”. Postoperative discomfort is usually minimal and most patients Page 20 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
return to work and normal activities in a few days. Long-term success rates are above ninety percent and do not decline over time. Pelvic prolapse procedures are more complicated and sometimes take a few hours to complete. I specialize in a minimally-invasive vaginal approach that is very successful with an excellent safety profile. I am also involved in ongoing research to help demonstrate which procedures provide the best long-term results while maintaining very low risks. After these procedures, most patients spend a night in the hospital and resume a fairly normal schedule of activities in two weeks. Lifting, straining, and sexual activity are not allowed for at least six weeks after surgery. With the traditional surgical techniques, many women would have a recurrence of the same problems within months or years of their first surgery. However, with the modern techniques that I have used for the past several years, long-term success rates are above ninety percent and the results are much better than with old-fashioned techniques. Most patients are able to resume normal (and even improved) sexual activity within a few months of surgery. As a specialist in pelvic reconstructive surgery, I am excited to be working at a time when women with prolapse and incontinence have excellent opportunities to improve their lives with quality treatments that are safe and effective. For more information, please contact the office of Dr. Edward S. Levy, MD at Metropolitan Ob-Gyn and Urogynecology, 314-686-4990, 816 South Kirkwood Rd., Suite 100, Kirkwood, MO 63122.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 21
The New Year Signals a Healthier Lifestyle for Many Submitted by The Saint Louis County Department of Health
very year, millions of Americans commit themselves to a New Year’s resolution to improve their health. The Centers for Disease Control and Prevention reports that quitting smoking is the fourth most popular New Year’s resolution. The Saint Louis County Department of Health understands the health risks of tobacco and the benefits of a smoke-free environment. Last year, the health department was awarded a two-year, $7.6 million dollar grant under the Communities Putting Prevention to Work Program (CPPW) to directly address and improve the smoking rates in Saint Louis County. The program, funded by the American Recovery and Reconstruction Act and administered by the Centers for Disease Control and Prevention (CDC) in Atlanta is focused on “Changing Tobacco Norms in Saint Louis County.” With the new countywide smoke-free ordinance that went into effect on January 2nd, the local CPPW project is working to reduce secondhand smoke exposure, increase smoking cessation, and reduce smoking initiation among youth. Some of the strategies being considered include amending the county ordinance to cover all bars and casinos (some are exempt under existing law), promoting the adoption of campus-wide tobacco free schools, and limiting tobacco advertising and product displays in retail stores near schools, parks, and youth-centered events. Community partners, such as the Tobacco Free St. Louis Coalition, are working with the CPPW project to achieve these policy initiatives. “This project is about making Saint Louis County a healthy place to live, work, and play,” said Barry Freedman, CPPW Project Manager. The U. S. Surgeon General has stated that, “Smoking cessation (quitting smoking) is the single most important step that smokers can take to enhance the length and quality of their lives.”
Page 22 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
The CPPW project is also playing a major role in helping smokers kick the habit by providing onsite smoking cessation classes for St. Louis County companies with 50 or more workers. Freedman said he is very pleased with the strong, immediate response from companies interested in providing smoking cessation classes for their employees.
“This project is about making Saint Louis County a healthy place to live, work, and play”
Freedman said, “We started the classes last year in December with four companies and the numbers keep growing.” Freedman added that companies who are interested can still sign up for smoking cessation classes. All classes are being provided free of charge. Here are a few tips to help smokers quit: • Remove all cigarette related materials from your home, car and office. • Plan a new activity in place of smoking breaks. For example, take a brisk walk during the break. • Drink lots of water. • Take deep breaths since smoking urges can be intense during the first two weeks. • Delay reaching for a cigarette as long as you can because the urge will pass. Health educators also suggest switching and changing up activities. For example, coffee drinkers could switch to tea or juice. The Missouri Quitline is another great resource for smokers who are struggling to stay smoke free. The Quitline offers three levels of assistance including: information and consultation, one-on-one in-depth counseling, and intensive intervention. Participants must be Missouri residents and at least 18-years-old. For more information and help quitting smoking, please visit the Saint Louis County Department of Health’s website at www.stlouisco. com/doh, or call the Missouri Quitline at 1-800-QUIT-NOW (800-7848669) anytime between 7:00 a.m. and 11: 00 p.m.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 23
Varicose Veins Can Have Serious Medical Implications Insurance Covers Medically Necessary Treatments By Dr. Norman N. Bein, Vein Specialties
aricose veins are gnarled, enlarged veins. The word “varicose” comes from the Latin root “varix,” which means “twisted.” Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins in your lower body. For many people, varicose veins and spider veins — a common, mild and medically insignificant variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory system. Varicose veins are a common condition in the United States, affecting up to 15 percent of men and up to 25 percent of women. Treatment may involve self-help measures or procedures by your doctor to close or remove veins. When painful signs and symptoms do occur, they may include: • An achy or heavy feeling in your legs, and burning, throbbing, muscle cramping and swelling in your lower legs. Prolonged sitting or standing tends to make your legs feel worse. • Itching around one or more of your veins. • Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention. Varicose veins are dark purple or blue in color and may appear twisted and bulging — like cords Spider veins are similar to varicose veins, but they’re smaller. Spider veins are found closer to the skin’s surface and are often red or blue. Tiny one-way valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward. As you get older your veins can lose elasticity, causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose.
Risk factors These factors increase your risk of developing varicose veins: • Age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to malfunction. • Gender. Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins. • Genetics. If other family members had varicose veins, there’s a greater chance you will too. • Obesity. Being overweight puts added pressure on your veins. • Standing/Sitting for long periods of time. Your blood doesn’t flow as well if you’re in the same position for long periods. Page 24 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
In making a diagnosis, your doctor will examine your legs while you’re standing and will look for swelling. He or she may also ask you to describe the pain and aching in your legs. Finally, your doctor may perform an ultrasound test to see if the valves in your veins are functioning normally or if there’s any evidence of a blood clot. Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are the result of long-term “water logging” of these tissues, caused by increased pressure of blood within affected veins. Brownish pigmentation usually precedes the development of an ulcer For more information or to schedule an examination with Dr. Norman N. Bein, please call 314-993-8233, or toll free at (866) 626-VEIN (8346), 11456 Olive Blvd., Creve Coeur, MO 63141, or visit our website at www.VeinSpecialties.com.
Tips to Weather Winter With Healthy Skin
(ARA) - It may seem as though summer is the season for skin care woes, with all the sun, sand, sweat and pool chlorine you expose your skin to during the warm months. But the dry, cold winter weather can also affect skin health - unless you take some seasonal steps to protect your skin. Before you step out the door to walk to work, hit the slopes or just hang out with your kids at the park, keep in mind these winter skin care “dos” and “don’ts.” • Moisturize. You probably moisturize in the spring and summer, but winter weather calls for something different. Look for a moisturizer that’s oil-based, rather than water-based. The oil in the moisturizer will create a layer of protection for your skin, helping it retain more moisture. Choose healthy oils, such as mineral, almond or avocado. Moisturize every day, applying the moisturizer under your makeup as a base. • Continue to wear sunscreen. Winter sun may seem less intense than at other times of the year, but it’s still strong enough to damage unprotected skin. Snow glare can magnify the sun’s effects. Choose sunscreens with high SPF, that work for both UVA and UVB rays. And reapply sunscreen frequently if you’ll be outside for a while - just as you would in summer. • Wear gloves to protect the sensitive skin on your hands, and lip balm to keep your lips from becoming chapped. • Be aware of how the clothing you put on can affect your skin, especially during winter. If you already suffer from dry or sensitive skin, choosing laundry products that are dye and perfume free - like Tide Free & Gentle, Downy Free & Sensitive, Bounce Free & Sensitive and Tide Stain Release Free - can help reduce your skin’s exposure to these potential irritants. Tide Free & Gentle, Downy Free & Sensitive, and Bounce Free & Sensitive are all dermatologist-tested products that will clean and soften clothes just as well as other products.
“Avoid showering or bathing in very hot water. Very hot water can actually cause your skin to dry out, and so can lingering in water too long.” • Use a humidifier in your home, especially if your heat is forced air. More moisture in the air can help prevent your skin from drying out. What to avoid • Don’t walk around in wet socks, shoes or gloves. Being cold and wet can cause skin to itch, crack or even develop sores. If you’ll be out in the snow and there’s a chance your socks or gloves will get wet, take a spare pair of each to change into. • Postpone facial peels, and drop alcohol-based astringents or toners from your beauty routine. Winter air is harsh enough on your skin, without adding chemicals that can further dry it out. • Avoid showering or bathing in very hot water. And trim the time you’re in the shower or bath. Very hot water can actually cause your skin to dry out, and so can lingering in water too long. • Finally ... don’t lick your lips. While your instinctive reaction to lips that feel dry or chapped might be to lick them so they’ll stay moist, this actually dries lips. The saliva evaporates quickly from your warm lips and takes their internal moisture with it. Reach for lip balm instead.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 25
Recognizing Symptoms of Dementia
Page 26 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
By Lori J. Holmgren RN, MSN., Director, Visiting Angels – St. Louis South
he Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandma’s apple pie. Grandma always makes the traditional pie from her old family recipe. This year, however, the pie tasted a little on the salty side, perhaps a half cup full of salty. Though the family was disappointed over the pie, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with Grandma’s mental state? One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia? An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia. “Dementia causes many problems for the person who has it and for the person’s family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms. • Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question. • Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it. • Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want. • Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home. • Poor judgment. Even a person who doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather. • Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them. • Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later. • Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes. • Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful. • Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people.” Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible. What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some
“Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support.” medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed. In the beginning, family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged. Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way. “The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it’s a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive. The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support.” Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for. The National Care Planning Council (www.longtermcarelink.net) supports caregiving services throughout the country. Their website is a comprehensive resource for senior care and long term care planning. The book, “The 4 Steps of Long Term Care Planning” will guide you through 4 easy steps to create a plan for you or a loved one’s long term care. (www.longtermcarelink.net/a16four_Steps_boot.htm) For more information, contact one of the local Visiting Angels agencies near you. South County and Jefferson County, 314-8425589; Webster Groves and Kirkwood, 314-962-5700, or visit our website at www.VisitingAngels.com. Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 27
“Killer Cliches About Loss” Healthy Cells magazine is pleased to present the first in a series of feature articles on the subject of Grief ❣ Recovery®. The articles are written by Russell P. Friedman, Executive Director, and John W. James, Founder, of The Grief Recovery Institute. Russell and John are co-authors of WHEN CHILDREN GRIEVE - For Adults to Help Children Deal with Death, Divorce, Pet Loss, Moving, and Other Losses - Harper Collins, June, 2001 - & THE GRIEF RECOVERY HANDBOOK - The Action Program For Moving Beyond Death, Divorce, and Other Losses [Harper Perrenial, 1998]. The articles combine educational information with answers to commonly asked questions.
e have all been educated to acquire things. We have been taught how to get an education, get a job, buy a house, etc. There are colleges, universities, trade schools, and technical schools. You can take courses in virtually anything that might interest you. What education do we receive about dealing with loss? What school do you go to learn to deal with the conflicting feelings caused by significant emotional loss? Loss is so much more predictable and inevitable than gain, and yet we are woefully ill-prepared to deal with loss. One of the most damaging killer cliches about loss is time heals all wounds. When we present open lectures on the subject Page 28 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
of Grief ❣ Recovery ®, we often ask if anyone is still feeling pain, isolation, or loneliness as the result of the death of a loved one 20 or more years ago. There are always several hands raised in response to that question. Then we gently ask, “if time is going to heal, then 20 years still isn’t enough?” While recovery from loss does take some time, it need not take as much time as you have been led to believe. Recovery is totally individual. There is no absolute time frame. Sometimes in an attempt to conform to other people’s time frames, we do ourselves great harm. This idea leads us to another of the killer cliches — you should be over it by now.
It is bad enough that well-meaning, well-intentioned friends attack us with killer cliches, but then we start picking on ourselves. We start believing that we are defective or somehow deficient because we haven’t recovered yet. If we take just the two killer cliches we’ve mentioned so far, we can see that they have something in common. They both imply that a nonaction will have some therapeutic or recovery value. That by waiting, and letting some time pass, we will heal. Let’s add a third cliche to the batch — you have to keep busy. Many grievers follow this incorrect advice and work two or three jobs. They fill their time with endless tasks and chores. At the end of any given day, asked how they feel, invariably they report that their heart still feels broken; all they accomplished by staying busy was to get exhausted.
“Grief ❣ Recovery® allow you to have fond memories not turn painful and help you retake a happy and productive place in your own life.” Now, with only three basic killer cliches we can severely limit and restrict our ability to participate in effective recovery. It is not only that people around us tell us these cliches, in an attempt to help, but we ourselves learned and practiced these false beliefs for most of our lives. It is time for us to learn some new and helpful beliefs to assist us in grieving and completing relationships that have ended or changed. QUESTION: I have heard that it takes two years to get over the death of a loved one; five years to get over the death of a parent; and you never get over the death of a child. Is this true? ANSWER: Part of the problem is the phrase get over. It is more accurate to say that you would never forget a child who had died, any more than you would ever forget a parent or a loved one. Another part of the problem is one of those killer cliches we talked about, that time, of itself, is a recovery action. Although recovery from loss does take some time, it is the actions within time that lead to successful recovery. The primary goal of Grief ❣ Recovery® is to help you “grieve and complete” your relationship to the pain caused by the emotional changes caused by death, divorce, and other losses. Successful application of the principles and actions of Grief ❣ Recovery® allow you to have fond memories not turn painful and help you retake a happy and productive place in your own life. In addition, you regain the ability to begin new relationships, rather than attempting to replace or avoid past relationships. Next month: “Less Than Loved Ones — Hopes And Dreams” For information about programs and services, write to The Grief Recovery Institute, P.O. Box 6061-382 Sherman Oaks, CA 91413. Call  907-9600 or Fax:  907-9329. Please visit our website at: www.grief-recovery.com.
Alternative Hospice provides holistic end-of-life healthcare by integrating complementary care with conventional medicine. Our program offers support and guidance to the grieving and empowers patients, families and our community with information and education.
‘Teaching the Art of Living and Dying Well’ 866-266-3421 636-343-3839 866-391-8548 DeSoto
and surrounding area
and surrounding area
and surrounding area
Alternative Hospice stands ready to serve as your emotional and spiritual guardian angels during this difficult time.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 29
What to Look For When Researching Senior Care Options
f you are like most people, addressing the care options of your senior loved ones is a topic that you don’t want to address until the time comes when some tough decisions about the future of your loved one have to be made. Do yourself a favor; begin researching the living arrangements or care options that will meet your loved ones – and your needs – before that time comes. Even if you are aware of the different senior care and service options available to you, you probably don’t know where to start to differentiate between them, and what questions to ask to determine which one is the best choice for your situation. Fortunately the St.
Page 30 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
Louis area has a number of reputable senior care and service organizations that can assist you in making an informed decision. Senior care can include many living options such as independent living communities, assisted living, skilled nursing, and long-term care and rehab services. There are also a number of home and communitybased services, such as private duty nursing, home health care, outpatient therapy, adult day-care facilities, respite care, rehab and therapy, and hospice care. That’s a lot to digest. How do you know what’s right for you? By asking a few questions and doing a little homework. • Is anyone on staff able to complete an assessment to determine whether your loved one is able to live independently in their own apartment or would they be better served in an assisted living apartment? • How experienced are the certified nurse assistants who will be caring for your loved one in a skilled nursing community (nursing home)? • What kind of activity program does the community offer, and how often do they take their residents for day trips? • Are the residents of a skilled community sitting alone without any human contact, or does the staff stop and visit the residents as they go about their work? These are a mere sampling of the questions that you should consider — questions that do not address the more widely considered, yet important topics such as payment plans (including refundable entrance fees and insurance coverage), meal plans and other amenities available to the loved one. These days, your research will probably include a visit to the Internet. Many organizations will include meal menus and activity calendars
“Senior care can include many living options such as independent living communities, assisted living, skilled nursing, and long-term care and rehab services.” on their web sites. Some organizations have incorporated videos using real residents and family members to communicate the essence of the living experience on its site. Regardless of how you go forward with making your decision, just remember that there are plenty of people who can help differentiate between the different care options. Just try not to wait before starting the research process – when the time comes when your senior loved one is in need of care, you’ll be glad you didn’t. Bethesda Health Group is a not-for-profit, non-denominational senior care organization that has been serving the needs of St. Louis seniors since 1889. It is comprised of five independent living communities, three dedicated skilled nursing communities, and one community with independent senior living, assisted living, skilled nursing, long-term care and rehab services under one roof. It also offers the community a number of home and community-based services, such as Private Duty, Home Health, Outpatient Therapy, Adult Day Care services, Respite Care, Rehab & Therapy, and Hospice Care. Terri Glaze is the organization’s Community Care Coordinator and can be reached at 314-800-1911.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 31
Having Trouble Hearing? Listen to The Truth Behind Hearing Loss Myths
Page 32 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011
ure, you sometimes have to ask people to repeat themselves, and the volume knob on the car stereo is set much farther to the right than it used to be. But you can’t be experiencing hearing loss - you’re not a senior citizen. Hearing loss only affects the old, right? Not necessarily. “Only 40 percent of people with hearing loss are older than 64,” says Dr. Sergei Kochkin, executive director of the Better Hearing Institute in Washington, D.C. “The largest age group with hearing loss is people between 18 and 64 - about 19 million people compared to 14 million at retirement age. More than 1 million schoolage children have hearing problems, as well.” The idea that hearing loss only happens to the aged - and is an unavoidable circumstance of aging - is just one of many commonly believed myths about the issue. The truth is that hearing loss affects all age groups. If you want to avoid hearing loss, it pays to know the truth behind the myths and the basics of hearing loss prevention. Here are some common myths about hearing loss, and the truth behind the myths:
problems, the results may be suspect since most people with hearing problems hear pretty well in quiet environments - like a doctor’s office. Without special training on hearing loss, it may be difficult for your family doctor to even realize you have a hearing problem.
Myth: If I had hearing loss, my family doctor would have told me. Truth: Only 15 percent of doctors routinely screen for hearing loss during a physical exam. Even when a doctor does screen for hearing
Myth: Hearing aids are big and ugly. Wearing one will make me look old or disabled. Truth: Untreated hearing loss is far more noticeable than today’s hearing aids. If you miss the punch line of a joke, or respond inappropriately to a comment or question, people may wonder about your mental capacity. Hearing aid makers realize people are concerned about how they will look wearing a hearing aid. Today, you can find miniature hearing aids that fit totally within the ear canal or behind your ear, making them virtually invisible.
“The largest age group with hearing loss is people between 18 and 64 about 19 million people compared to 14 million at retirement age. More than 1 million school-age children have hearing problems, as well.”
Myth: Nothing can be done about my hearing loss. Truth: People with hearing loss in one ear, with a high-frequency hearing loss, or with nerve damage may have been told by their family doctor that nothing can be done to help. Modern technology has changed that. Now, nearly 95 percent of people with hearing loss can be helped, most with hearing aids. Myth: Only people with serious hearing loss need hearing aids. Truth: Your lifestyle, your need for refined hearing and the degree of your hearing loss will determine whether you need a hearing aid. If you’re in a profession that relies on your ability to discern the nuances of human conversation - such as a lawyer, teacher or group psychotherapist - even mild hearing loss can interfere with your life.
Myth: Hearing loss is an inevitable part of growing older and there’s nothing I can do to prevent it from happening to me. Truth: You can take steps to prevent hearing loss. Noise is one of the most common causes of hearing loss; 10 million Americans have already suffered irreversible damage to their hearing from noise. Yet a third of all hearing loss could be prevented with proper ear protection. Myth: I cannot afford hearing aids Truth: There is a wide price range in hearing aids on the market just like there is for other consumer products. In addition the BHI has identified close to 100 sources for financial help in their eGuide “Your Guide to Financial Assistance with Hearing Aids.” If you work in a high-risk profession, make sure your hearing is protected according to OSHA regulations, and wear hearing protection such as foam or silicone plugs or earmuffs. At home, lower the volume on the TV, radio, stereo and any device that uses earbuds or headphones. Wear ear protection while mowing the lawn or blowing leaves or snow. Buy quieter products (compare decibel ratings) and reduce the number of noisy appliances running at the same time in your home. Before taking a new medicine, be sure to ask the doctor about any possible side effects on your hearing. To learn more about hearing loss, treatment for hearing loss and hearing loss prevention, visit the Better Hearing Institute online at www. BetterHearing.org. Or take the BHI’s online hearing test at www.hearingcheck.org.
Premier Issue 2011 — Greater St. Louis Area — Healthy Cells Magazine — Page 33
ANSWERS Page 34 — Healthy Cells Magazine — Greater St. Louis Area — Premier Issue 2011