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HEALTH & Alzheimer’s risk can be reduced

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January 29, 2013

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Health & Wellness

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To your health! As the first month of 2013 comes to a close, all of us can resolve â&#x20AC;&#x201D; formally or informally â&#x20AC;&#x201D; to begin or continue healthy lifestyle choices. This special publication will help you do just that. Itâ&#x20AC;&#x2122;s designed to inform you of some of the many ways for you and your loved ones to make progress in being as healthy, happy and productive as possible. Health and wellness is more than just keeping up-to-date with health care. Itâ&#x20AC;&#x2122;s part of a joyful, fulfilling lifestyle. Our area has many ways for people to come together to share knowledge and support each other as they become stronger, happier and more productive. We hope you enjoy this special publication. Share it with family, friends and co-workers, and let us know what topics you would like to read about in the future! This guide can also be found online at kpcnews.com. -KPC Media Group

January 29, 2013

Water essential for healthy living AUBURN â&#x20AC;&#x201D;Many adults know the importance of drinking water. Since childhood, the virtues of drinking water have been extolled to them. Water is essential to life, but how much a person should drink each day, has fluctuated over the years. Water keeps the body healthy in a number of ways, but the body also loses water in a number of ways. For instance, the body loses water when a person breathes, sweats, urinates or has a bowel movement. To stay healthy and avoid dehydration, the body must replace this lost fluid. In addition to fending off dehydration, water helps the body flush out waste and maintain a healthy body temperature. It also reduces the risk of developing kidney stones or becoming constipated. According to the Centers for Disease Control and Prevention, water helps lubricate and cushion joints and protects the spinal cord and other sensitive tissues. Some situations, and living conditions require more water than usual. People who spend more time in hot climates need more water, just as in times of physical activity. In addition, the body needs more water when it suffers from certain ailments or conditions, including fever, diarrhea or vomitting.

Though many people feel drinking caffeinated beverages, including coffee and soda, dehydrate the body, experts say moderate caffeine consumption does not dehydrate the body. A 2000 study published in the Journal of the American College of Nutrition found that healthy people who consume moderate amounts of caffeine do not lose more fluid than people who abstain from caffeine. Over consumption of caffeinated beverages might prove problematic, but moderate consumption can provide the body with the fluids. It is rare that a person drinks too much water, and many people find they do not drink enough water by accident. One way to combat that is to bring a bottle of water with you wherever you go. Fill up the bottle before the beginning of the shift and keep it at your desk. To give yourself time to stretch throughout the day, get up during work and get a drink of water. While some may find water bland, adding a slice of lemon or lime gives it more flavor. OCTAVIA LEHMAN

Drinking healthy water To ensure the water you are drinking is See WATER page 5

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January 29, 2013

From page 4

BY GRACE HOUSHOLDER

graceh@kpcnews.net From walking to work site wellness, a volunteer group dedicated to increasing awareness of “healthy eating, active living” in Noble County made strides in 2012. According to a report issued earlier this year, some of the group’s accomplishments in 2012 were: • Promoting safe routes to schools — West Noble has implemented a common bus stop for students. This eliminates the bus stopping at multiple places and allows for children to walk safe distances to the bus stop. It also saves money on fuel. Some students who formerly rode the bus to school are now walking safely to school. • Access to healthy foods — West Noble implemented a red/yellow/green color system that allows students to readily identify vending foods that are a source of good nutrition. • Work site wellness — Activate Noble

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YMCA, Parkview Noble head group to promote wellness

WATER healthy, get it tested. Kathy Shuman, a technician at Astbury Water Technology, said that home owners with private wells are responsible for assuring water is safe. Astbury Water Technology is an Indianacertified drinking water lab. The organization conducts water tests to assure water is safe to drink. Astbury recommends yearly testing for total coliform bacteria and E. coli, as well as nitrates. Bacteria in water can cause gastroinstestinal illnesses. “Households with infants, pregnant women, nursing mothers, and elderly people should especially test for nitrates,” Shuman said. Nitrates typically get into water through fertilizers, septic and sewage treatment systems, and livestock operations, Shuman said. Any public water service providers that have a well, such as restaurants, churches and mobile home parks, are required to test their water regularly by the state of Indiana. Water companies also conduct other tests. For example, Astbury conducts tests on pool water for total coliform and E. coli bacteria and heterotrophic bacteria; beaches for excessive E. coli; and older homes with lead solder.

Health & Wellness

County has a team that provides free work place assessments for businesses. The team compiles a list of best practices and shares the information with interested companies. “The Activate Noble County team is interested in helping organizations to institute strategies for an improvement plan. This will help them move to the next level in their work place wellness offering,” said Casey Weimer, CEO of the Cole Center Family YMCA. For more information about instituting and improving work site wellness, contact Weimer at 347-9622 or ceo@coleymca.net. In 2009 Noble County was selected to be one of 21 communities nationwide to be a “Healthy Pioneer of Change.” Activate America: Pioneering Healthier Communities is a YMCA initiative that brings people together to create environments that help sustain healthy behaviors. The Centers for Disease Control and Prevention helps with funding.

Nationwide and locally, some of the goals are to help provide opportunities for kids to be physically active before, during and after the school day; create and/or promote walking/biking trails and sidewalks for community members to be active; work with employers to provide work places that support healthy eating and activity; and increase opportunities for residents to purchase and consume fresh fruits and vegetables through communitygardens, farmers markets, and other activities. Noble County’s team, led by officials from the Cole Center Family YMCA and Parkview Noble Hospital, includes Kendallville Mayor Suzanne Handshoe as well as numerous volunteer representatives of businesses and nonprofit agencies. More information is online at activatenoblecounty.com. The organization also has a Facebook page; type in “Activate Noble County.”

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January 29, 2013

Ways pets can improve personal health AUBURN —Rather than heading to a pharmacy for solutions to common ailments, people may be able to stop at the nearest pet store or animal shelter and find a furry remedy instead. Studies link positive health benefits to pet ownership. According to WebMD, one study found that 48 stockbrokers who adopted a pet experienced lower blood pressure readings in stressful situations than did people who did not own pets. Another study found that individuals suffering from serious diseases, such as cancer or AIDS, are far less likely to experience depression if they have a strong tie to a pet. Pets also have proven beneficial to seniors struggling with loneliness. Pets are not perfect; they can try someone’s patience at times, especially when a cat has used a sofa as a scratching post or when a dog that decided that it would be okay to eat the trash. Yet, for many pet owners the positives far outweigh the negatives. Here are some of the many ways that pet ownership can be good for health: • Fight depression: Many therapists have

prescribed pet therapy as a method for alleviating and recovering from depression. A pet is an unconditional friend and can provide a listening ear a person needs to talk through problems. Also, walking and taking care of a pet diverts the time that is normally spent on focusing on problems. • Improve physical activity levels: Heading to the gym is one way to get a workout, but spending an hour walking a dog or tossing a ball around a ball for a game of chase and fetch is another way to get the heart rate up. Many dog owners benefit from the exercise that goes along with daily walks. Some people choose to exercise with their pets, enjoying the companionship of physical activity. • Lower blood pressure: Petting a cat or a dog can lower blood pressure, as well a watching a fish swim around a tank. • Lower cholesterol: Owning a pet requires lifestyle changes, especially a dog. Owners see an increased level of physical activity. Pets also help reduce stress which may keep individuals from looking to unhealthy foods as sources of

OCTAVIA LEHMAN

Jedidiah Kreger, 7, of LaGrange, plays with his dog, Dandie ,at Pawsitively Paradise in Angola.

alleviating anxiety. • Reduce allergies: Children who grow up in homes with cats and dogs are less likely to develop common allergies and even asthma, research suggests. Children who live around two or more cats and dogs before their first birthday are less likely to have allergies,

according to a study published in the Journal of the American Medical Association. • ADHD therapy: Adults and children with attention deficit hyperactivity disorder benefit from working with a pet or having a pet as a companion. Playing with a pet is a great way to release energy and focus on tasks.

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Alzheimerâ&#x20AC;&#x2122;s risk can be reduced BY AARON ORGAN

aorgan@kpcnews.net While Alzheimerâ&#x20AC;&#x2122;s disease and other forms of dementias are not entirely preventable, there are ways in which you can reduce your risk, local officials say. Amanda Mainstone, the marketing director with Life Care Center of LaGrange, says that though Alzheimerâ&#x20AC;&#x2122;s disease is hereditary and thus it is unlikely it can be prevented, it can be slowed. Mainstone, as well as Provena Sacred Heart Home of Avilla dementia social worker Tricia Parks and Suzi Ogden, director at Cameron Woods Senior Living Community in Angola, all say that maintaining a healthy and active lifestyle is paramount to keep your brain and its abilities sharp. â&#x20AC;&#x153;One of the things that we do to try to keep people alert and oriented and engaged in their everyday activities is, we keep them busy doing things that involve the body and the mind,â&#x20AC;? said Ogden. â&#x20AC;&#x153;The more that you exercise your brain and the more that you work with your hands for hand-eye coordination, the longer you will be able to do all

of those things.â&#x20AC;? Cameron Woods, Provena Sacred Heart and Life Care Center all hold heaps of activities throughout each day that promote that active and stimulating lifestyle. Residents at Cameron Woods can engage in arts and crafts creating, jigsaw puzzles, dominoes, bingo and regular bridge and euchre games, as well as exercise equipment. Provena Sacred Heart, too, promotes physical exercise through its â&#x20AC;&#x153;restorative gymâ&#x20AC;? where residents can do arm and leg exercises or ride a stationary bike, or volley a balloon with a pool noodle or take walks around the grounds, Parks said. Mainstone said the games of memory or use of flash cards are also said to be effective in slowing down the impact of Alzheimerâ&#x20AC;&#x2122;s. Cameron Woods residents also keep and regularly play crossword puzzles and word scramble games, Ogden said. The Alzheimerâ&#x20AC;&#x2122;s Association suggests that crossword puzzles and similar mindSee ALZHEIMERâ&#x20AC;&#x2122;S page 8

PHOTO CONTRIBUTED

A Cameron Woods Senior Living resident shows off her Wii Bowling success. Cameron Woods includes Wii play in its efferts to stimulate the brain and reduce the risk of Alzheimerâ&#x20AC;&#x2122;s.

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January 29, 2013

ALZHEIMER’S From page 7

stimulation games strengthen brain called and could even create new nerve cells. But while those are all well-known activities, the star of Cameron Woods’ stimulation show is Wii night. Yes, Wii, the Nintendo gaming system that allows the player to control the games with a cordless remote with motions. Its popularity soared with younger generations, but the residents at Cameron Woods are reaping its benefits. “We have a crowd in there when we play Wii,” said Ogden. “They have to have a range of motion in order to do it, and it keeps them up and alert.” Provena Sacred Heart rounds it balanced treatment out with social activities, such as field trips or group discussions, that stimulate the mind through interaction. Parks added that diet also plays a role in reducing the risk of Alzheimer’s disease. A heart-healthy diet of red meats and plenty of fruits and vegetables can benefit the brain’s functions. Once the effects of Alzheimer’s set in, treatment can include medications. Also, though, Mainstone said Life Care Center of

PHOTO CONTRIBUTED

Cameron Woods residents braid fabrics, an activity designed to keep the mind and body invigorated and sharp to reduce the risk of Alzheimer’s.

LaGrange residents will bring in pictures that allow them, as the impact of Alzheimer’s progresses, to have a visual reminder of the subject of the picture, be it

a person, place or thing. At Cameron Woods, a strict schedule that guides a resident to know when to attend each activity or treatment has been

highly effective in allowing residents to carry on with a fruitful life. “They know what to do, when,” Odgen said. “That really helps and it’s important.”

Testing brain pacemakers to zap Alzheimer’s damage BY THE ASSOCIATED PRESS

WASHINGTON — It has the makings of a science fiction movie: Zap someone’s brain with mild jolts of electricity to try to stave off the creeping memory loss of Alzheimer’s disease. And it’s not easy. Holes are drilled into the patient’s skull so tiny wires can be implanted into just the right spot. A dramatic shift is beginning in the disappointing struggle to find something to slow the damage of this epidemic: The first U.S. experiments with “brain pacemakers” for Alzheimer’s are getting under way. Scientists are looking beyond drugs to implants in the hunt for much-needed new treatments. The research is in its infancy. Only a few dozen people with early stage Alzheimer’s will be implanted in a handful of hospitals. No one knows if it might work, and if it does, how long the effects

might last. Kathy Sanford was among the first to sign up. The Ohio woman’s early stage Alzheimer’s was gradually getting worse. She still lived independently, posting reminders to herself, but no longer could work. The usual medicines weren’t helping. Then doctors at Ohio State University explained the hope — that constant electrical stimulation of brain circuits involved in memory and thinking might keep those neural networks active for longer, essentially bypassing some of dementia’s damage. Sanford decided it was worth a shot. “The reason I’m doing it is, it’s really hard to not be able, sometimes, to remember,” Sanford, 57, said from her Lancaster, Ohio, home. Her father is blunter. “What’s our choice? To participate in a See TESTING page 9


©KPC Media Group Inc. • kpcnews.com

January 29, 2013

TESTING From page 8

program or sit here and watch her slowly deteriorate?” asked Joe Jester, 78. He drives his daughter to follow-up testing, hoping to spot improvement. A few months after the five-hour operation, the hair shaved for her brain surgery was growing back and Sanford said she felt good, with an occasional tingling that she attributes to the electrodes. A battery-powered generator near her collarbone powers them, sending the tiny shocks up her neck and into her brain. It’s too soon to know how she’ll fare; scientists will track her for two years. “This is an ongoing evaluation right now that we are optimistic about,” is how Ohio State neurosurgeon Dr. Ali Rezai cautiously puts it. More than 5 million Americans have Alzheimer’s or similar dementias, and that number is expected to rise rapidly as the baby boomers age. Today’s drugs only temporarily help some symptoms. Attempts to attack Alzheimer’s presumed cause, a brain-clogging gunk, so far haven’t

panned out. “We’re getting tired of not having other things work,” said Ohio State neurologist Dr. Douglas Scharre. The new approach is called deep brain stimulation, or DBS. While it won’t attack Alzheimer’s root cause either, “maybe we can make the brain work better,” he said. Implanting electrodes into the brain isn’t new. Between 85,000 and 100,000 people around the world have had DBS to block the tremors of Parkinson’s disease and other movement disorders. The continuous jolts quiet overactive nerve cells, with few side effects. Scientists also are testing whether stimulating other parts of the brain might help lift depression or curb appetite among the obese. It was in one of those experiments that Canadian researchers back in 2003 stumbled onto the Alzheimer’s possibility. They switched on the electrical jolts in the brain of an obese man and unlocked a flood of old memories. Continuing his DBS also improved his ability to learn. He didn’t have dementia, but the researchers wondered if they could spur memorymaking networks in someone who did.

But wait a minute. Alzheimer’s doesn’t just steal memories. It eventually robs sufferers of the ability to do the simplest of tasks. How could stimulating a brain so damaged do any good? A healthy brain is a connected brain. One circuit signals another to switch on and retrieve the memories needed to, say, drive a car or cook a meal. At least early in the disease, Alzheimer’s kills only certain spots. But the disease’s hallmark gunky plaques act as a roadblock, stopping the “on” switch so that healthy circuits farther away are deactivated, explained Dr. Andres Lozano, a neurosurgeon at Toronto Western Hospital whose research sparked the interest. So the plan was to put the electrodes into hubs where brain pathways for memory, behavior, concentration and other cognitive functions converge, to see if the jolts reactivate those silenced circuits, added Ohio State’s Rezai. “It’s like going through Grand Central Station and trying to affect all the trains going in and coming out,” he said. Lozano’s team found the first clue that

Health & Wellness

9

it’s possible by implanting six Alzheimer’s patients in Canada. After at least 12 months of continuous stimulation, brain scans showed a sign of more activity in areas targeted by Alzheimer’s. Suddenly, the neurons there began using more glucose, the fuel for brain cells. “It looked like a blackout before. We were able to turn the lights back on in those areas,” Lozano said. While most Alzheimer’s patients show clear declines in function every year, one Canadian man who has had the implants for four years hasn’t deteriorated, Lozano said, although he cautioned that there’s no way to know whether that’s due to the DBS. The evidence is preliminary and will take years of study to prove, but “this is an exciting novel approach,” said Dr. Laurie Ryan of the National Institutes of Health’s aging division, which is funding a followup study. In research under way now: • The Toronto researchers have teamed with four U.S. medical centers — Johns Hopkins University, the University of Pennsylvania, University of Florida and

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10

Health & Wellness

kpcnews.com • ©KPC Media Group Inc.

Indoor air quality important to healthy living

TESTING From page 9

Arizona’s Banner Health System — to try DBS in a part of the brain called the fornix, one of those memory hubs, in 40 patients. Half will have their electrodes turned on two weeks after the operation and the rest in a year, an attempt to spot any placebo effect from surgery. • At Ohio State, Rezai is implanting the electrodes into a different spot, the frontal lobes, that his own DBS work suggests could tap into cognition and behavior pathways. That study will enroll 10 participants including Sanford. Surgery back in October was Sanford’s first step. Then it was time to fine-tune how the electrodes fire. She took problemsolving tests while neurologist Scharre adjusted the voltage and frequency and watched her reactions. Sanford was cheered to see her test scores climb a bit during those adjustments. She said she knows there are no guarantees, but “if we can beat some of this stuff, or at least get a leading edge on it, I’m in for the whole deal.”

January 29, 2013

While many people may worry about contaminants that could be polluting outdoor air, indoor air quality also must not be overlooked. According to the Environmental Protection Agency, air inside the home can be two- to five-times more polluted than air outside the home. Sources of indoor air pollution include cigarette smoke, radon, carbon monoxide, lead-laden dust from old paints, dirt-filled carpet and household cleaners. The National Safety Council says Americans spend 90 percent of their time indoors, so poor air quality can greatly affect personal health. Research conducted by the Environmental Protection Agency found there are three elements in every home — dirt, dust and pollen; germs bacteria and viruses; and toxic gasses and odors. Health effects of dirt, dust and pollen include nose and throat irritation, runny nose, congestion, sneezing, cough and wheezing

and asthma flares. Possible effects of germs bacteria and viruses include sinusitis, upper respiratory infections, throat and ear infections, bronchitis and pneumonia. Possible health effects of toxic gases and odors include memory lapse, mild depression, lung dysfunction, blurred vision, headaches and lethargy. There are several steps that can be taken to improve he quality of indoor air. • Open the windows to let air circulate. It is important to change the air inside of the home several times a day to prevent the buildup of pollutants. Rachel Gibson, of Gibson’s Heating and Plumbing in Waterloo noted that as people focus on energy efficiency and seal their homes and office buildings, they create a closed-loop cycle of air where the air becomes trapped. “Outside, nature takes care of (air quality),” Gibson said. “Inside the building See AIR QUALITY page 11

METRO CREATIVE CONNECTION

Improving indoor air quality can help prevent sneezing, coughing and congestion.

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January 29, 2013

AIR QUALITY From page 10

you donâ&#x20AC;&#x2122;t have that.â&#x20AC;? â&#x20AC;˘ Change the filters on home heating and cooling systems as the manufacturer suggests. Gibson noted filters may need to be changed more frequently in older holes or homes with pets. Filtration will take care of dirt, dust and pollen, Gibson said. Air filtration will catch particles in the air and systems can range from being very basic to advanced. â&#x20AC;˘ Routinely clean exhaust vents in kitchens, bathrooms and laundry rooms. â&#x20AC;˘ Consider the installation of an air purification system or purchase in-room HEPA filters. Some air cleaners use ultraviolet light technology intended to destroy pollutants in indoor air. Ultraviolet light kills germs and acts the same as sunlight outside, Gibson said. Gibson pointed out one-room air cleaners will not take care of the air quality of the entire home or office. â&#x20AC;˘ Routinely clean pet bedding and groom animals to remove shedded fur. â&#x20AC;˘ Avoid the use of toxic cleaning products and open windows after doing any cleaning. â&#x20AC;˘ When possible, use natural pest control procedures. â&#x20AC;˘ Introduce more plants to the home, which naturally filter air. â&#x20AC;˘ Use detectors to test for radon and carbon monoxide in the home.

Health & Wellness

11

There are cheap ways to freshen up your home Most people want their living spaces to smell clean and fresh. While itâ&#x20AC;&#x2122;s important to make sure that bad smells arenâ&#x20AC;&#x2122;t a symptom of a worse problem, things such as pets, aromas from the kitchen, cigarette smoke, and other things can make a home smell bad. Here are inexpensive ways to remedy that. â&#x20AC;˘ Find the source of the bad smell and eliminate it. This could be a garbage pail sitting in the sun or sink disposal thatâ&#x20AC;&#x2122;s filled with food debris. â&#x20AC;˘ Use a chunk of cedar or sandalwood in drawers and closets for a fresh woodsy smell. â&#x20AC;˘ Simmer some cinnamon sticks and water in a pot on the stove.

â&#x20AC;˘ Dab a favorite essential oil onto a piece of fabric and stash it wherever you want a pleasant smell â&#x20AC;&#x201D; even in the car. â&#x20AC;˘ Toss a used dryer sheet in the linen closet to keep sheets and towels smelling freshly washed. â&#x20AC;˘ Grow herbs in a window box. When the breeze blows, the fresh smell of basil or rosemary will come into the home. â&#x20AC;˘ Keep fresh flowers or plants inside the home. Theyâ&#x20AC;&#x2122;ll filter the air and provide a pleasant aroma. â&#x20AC;˘ Use lemons to clean the sink and kitchen surfaces for a fresh, citrus smell. â&#x20AC;˘ Bake some cookies or another dessert for a wonderful aroma.

â&#x20AC;˘ Place a tray of fallen pine needles on a cookie sheet sprayed with a little water into a warm oven. The pine scent will fill the house. â&#x20AC;˘ Push cloves into an orange. Hang the clove-studded orange on a string and place in a corner. The orange clove scent will slowly fill the room. â&#x20AC;˘ Open up the windows and let fresh air in. â&#x20AC;˘ Soak cotton balls in vanilla and stash around the house. â&#x20AC;˘ Bathe and groom pets frequently. â&#x20AC;˘ Use a favorite-scented reed diffuser, which will lightly scent the house for weeks. â&#x20AC;˘ Keep a pot of water with potpourri on a wood-burning stove or radiator for a wonderful scent.

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Health & Wellness

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January 29, 2013

Help is available for sleep apnea BY MATT GETTS

mattg@kpcnews.net KENDALLVILLE â&#x20AC;&#x201D; For more than 40 years, health professionals have been helping people with sleeping conditions such as sleep apnea get a better nightâ&#x20AC;&#x2122;s rest. Sleep apnea, according to the health website WebMd.com, â&#x20AC;&#x153;is a serious sleep disorder that occurs when a personâ&#x20AC;&#x2122;s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain â&#x20AC;&#x201D; and the rest of the body â&#x20AC;&#x201D; may not get enough oxygen.â&#x20AC;? Starting in January, a test to determine if a person has sleep apnea has become available to be done at the personâ&#x20AC;&#x2122;s home. In the past, such testing was done exclusively at sleep centers such as those at Cameron Hospital in Angola, DeKalb Health in Auburn, Parkview Noble Hospital in Kendallville and Parkview LaGrange Hospital in LaGrange. These tests involved spending the night in the

hospital and wearing wires connected to monitors. Now, some people may be eligible to have these tests done in the comfort of their own homes, according to Parkview Noble polysomonographer technologist Weldon Cline. Cline has overseen four of the at-home studies. People who qualify go to the hospital and pick up special equipment that monitors such things as oxygen levels and how many times they stop breathing while they sleep. The equipment is taken home overnight, then is returned to the hospital where data can be read and interpreted. Because some people are reluctant to spend the night in the hospital for various reasons, including cost, more people could potentially be helped with that hurdle cleared. â&#x20AC;&#x153;Sooner or later, thatâ&#x20AC;&#x2122;s going to be the norm,â&#x20AC;? Cline said. â&#x20AC;&#x153;In the long run, I think itâ&#x20AC;&#x2122;s going to be very beneficial for people.â&#x20AC;? According to Cline, only people who have no other health problems are eligible

MATT GETTS

Weldon Cline, a registered polysomonographer technologist at Parkview Noble Hospital in Kendallville, sits in one of the rooms used for sleep studies at the hospital. The room includes a television and a private bathroom.

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for the at-home sleep study. People with heart conditions or high blood pressure, for example, may need to have the study done at the hospital where they can be more closely monitored. Sleep apnea involves a shrinking or obstructing of airways while a person sleeps. Symptoms, according to Cameron Hospitalâ&#x20AC;&#x2122;s website, can include snoring, feeling sleepy or tired during the day and sometimes waking up gasping for air in

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the middle of the night. Cline said people who have sleep apnea will always snore, but not everyone who snores necessarily has sleep apnea. People need to consult their family physician for a referral to order a sleep study. Sleep apnea is no laughing matter. â&#x20AC;&#x153;It puts a lot of wear, tear and stress on the entire cardiovascular system,â&#x20AC;? Cline See SLEEP APNEA page 13

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January 29, 2013

SLEEP APNEA From page 12

said. “It can be dangerous.” The treatment for sleep apnea involves a mask and a machine that forces air to keep the airways of the throat open during sleep. Most people are used to sleeping with the mask within a week, Cline said, though adjustment periods vary. Cline said there is roughly an even split between women and men who come to the hospital for sleep studies. He’s fitted people as young as their 20s for the breathing assistance equipment, called a CPAP.

“It’s really never too late,” Cline said. “I’ve done people who are in their 80s.” To fall into what the insurance companies calls a “normal” range, a person who has a sleep study can have their breathing stopped for fewer than five times per hour. These so-called sleep apnea events must last at least 10 seconds. Anyone who falls outside of this normal range may qualify through their insurance to get a CPAP. Many people tell him how wonderful it is to finally get a good night’s sleep, Cline said. But he doesn’t have to rely on the testimony of others. “I actually have sleep apnea, too,” Cline said. “I’ve been on CPAP for 10 years.”

Health & Wellness

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January 29, 2013

Women catch up to men on lung cancer risk BY MARILYNN MARCHIONE

The Associated Press Smoke like a man, die like a man. U.S. women who smoke today have a much greater risk of dying from lung cancer than they did decades ago, partly because they are starting younger and smoking more — that is, they are lighting up like men, new research shows. Women also have caught up with men in their risk of dying from smoking-related illnesses. Lung cancer risk leveled off in the 1980s for men but is still rising for women. “It’s a massive failure in prevention,” said one study leader, Dr. Michael Thun of the American Cancer Society. And it’s likely to repeat itself in places like China and Indonesia where smoking is growing, he said. About 1.3 billion people worldwide smoke. The research is in Thursday’s New England Journal of Medicine. It is one of the most comprehensive looks ever at long-term trends in the effects of smoking and includes the first generation of U.S. women who started early in life and continued for

decades, long enough for health effects to show up. The U.S. has more than 35 million smokers — about 20 percent of men and 18 percent of women. The percentage of people who smoke is far lower than it used to be; rates peaked around 1960 in men and two decades later in women. Researchers wanted to know if smoking is still as deadly as it was in the 1980s, given that cigarettes have changed (less tar), many smokers have quit, and treatments for many smoking-related diseases have improved. They also wanted to know more about smoking and women. The famous surgeon general’s report in 1964 said smoking could cause lung cancer in men, but evidence was lacking in women at the time since relatively few of them had smoked long enough. One study, led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto, looked at about 217,000 Americans in federal health surveys between 1997 and 2004. A second study, led by Thun, tracked smoking-related deaths through three periods

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— 1959-65, 1982-88 and 2000-10 — using seven large population health surveys covering more than 2.2 million people. Among the findings: • The risk of dying of lung cancer was more than 25 times higher for female smokers in recent years than for women who never smoked. In the 1960s, it was only three times higher. One reason: After World War II, women started taking up the habit at a younger age and began smoking more. • A person who never smoked was about twice as likely as a current smoker to live to age 80. For women, the chances of surviving that long were 70 percent for those who never smoked and 38 percent for smokers. In men, the numbers were 61 percent and 26 percent. • Smokers in the U.S. are three times more likely to die between ages 25 and 79 than non-smokers are. About 60 percent of those deaths are attributable to smoking. • Women are far less likely to quit smoking than men are. Among people 65 to 69, the ratio of former to current smokers is 4-to-1 for men and 2-to-1 for women. • Smoking shaves more than 10 years off the average life span, but quitting at any age buys time. Quitting by age 40 avoids nearly all the excess risk of death from smoking. Men and women who quit when they were 25 to 34 years old gained 10 years; stopping at ages 35 to 44 gained 9 years; at ages 45 to 54, six years; at ages 55 to 64, four years. • The risk of dying from other lung diseases such as emphysema and chronic bronchitis is rising in men and women, and the rise in men is a surprise because their lung cancer risk leveled off in 1980s. Changes in cigarettes since the 1960s are a “plausible explanation” for the rise in non-

cancer lung deaths, researchers write. Most smokers switched to cigarettes that were lower in tar and nicotine as measured by tests with machines, “but smokers inhaled more deeply to get the nicotine they were used to,” Thun said. Deeper inhalation is consistent with the kind of lung damage seen in the illnesses that are rising, he said. Scientists have made scant progress against lung cancer compared with other forms of the disease, and it remains the leading cause of cancer deaths worldwide. More than 160,000 people die of it in the U.S. each year. The federal government, the Canadian Institutes of Health Research, the Bill and Melinda Gates Foundation, the cancer society and several universities paid for the new studies. Thun testified against tobacco companies in class-action lawsuits challenging the supposed benefits of cigarettes with reduced tar and nicotine, but he donated his payment to the cancer society. Smoking needs more attention as a health hazard, Dr. Steven A. Schroeder of the University of California, San Francisco, wrote in a commentary in the journal. “More women die of lung cancer than of breast cancer. But there is no ‘race for the cure’ for lung cancer, no brown ribbon” or high-profile advocacy groups for lung cancer, he wrote. Kathy DeJoseph, 62, of suburban Atlanta, finally quit smoking after 40 years — to qualify for lung cancer surgery last year. “I tried everything that came along, I just never could do it,” even while having chemotherapy, she said. It’s a powerful addiction, she said: “I still every day have to resist wanting to go buy a pack.”

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Health & Wellness

15

Insurers prod doctors, hospitals to stop elective early deliveries BY KAISER HEALTH NEWS

Jenn McCorkle still regrets giving birth early. McCorkle was 37 weeks pregnant when her obstetrician scheduled her for a Caesarean section the following week, saying there was no reason to wait. But when her son, Maverick, was born in August 2008, his lungs were not fully developed; within hours, one of them collapsed. The infant spent the next 13 days in a neonatal intensive care unit (NICU), most of them hooked up to a ventilator. McCorkle wishes she had known what decadesâ&#x20AC;&#x2122; worth of studies have found: that inducing labor or performing Caesarean sections before 39 weeks of gestation for no medical reason significantly increases a newbornâ&#x20AC;&#x2122;s risk of complications and even death. While most babies delivered at 38 weeks do not end up in intensive care, research shows they are more likely to have feeding, breathing and developmental problems than those born at 39 or 40 weeks. Since 1979, the American College of Obstetricians and Gynecologists (ACOG) has recommended against deliveries or induced labor before 39 weeks unless there are medical reasons, such as the motherâ&#x20AC;&#x2122;s high blood pressure or diabetes or signs that the fetus may be in distress. Still, an estimated 10 to 15 percent of U.S. babies every year are delivered early without medical cause, according to the Department of Health and Human Services. â&#x20AC;&#x153;After 37 weeks, patients really push for it

because they are miserable and donâ&#x20AC;&#x2122;t want to be pregnant anymore,â&#x20AC;? said Alfred Khoury, director of maternal-fetal medicine at Inova Fairfax Hospital, which does not do such deliveries without medical cause. â&#x20AC;&#x153;Or they say, â&#x20AC;&#x2DC;My mother is hereâ&#x20AC;&#x2122; or â&#x20AC;&#x2DC;I have to be in a wedding.â&#x20AC;&#x2122; â&#x20AC;&#x153; In addition, physicians working in solo practices or in rural areas may prefer to schedule deliveries before 39 weeks to help manage their schedules, said Helain J. Landy, chairman of the department of obstetrics and gynecology at MedStar Georgetown University Hospital, which prohibits such deliveries. â&#x20AC;&#x153;The reality of caring for patients, or [doctorsâ&#x20AC;&#x2122;] day-to-day needs, may sometimes interfere with following the guidelines,â&#x20AC;? she said. Now, though, some government and private insurers are discouraging and in some cases penalizing doctors and hospitals for delivering babies early without cause. Their goal is to reduce care in NICUs, where the average charge is $76,000 per stay, and to avoid subsequent medical costs to treat such problems as jaundice, feeding problems and learning and developmental issues. Beginning Jan. 1, UnitedHealthcare, the nationâ&#x20AC;&#x2122;s largest private health insurer, began paying hospitals more money if they take steps to limit early deliveries without medical cause and show a drop in their rates. Starting in July, Medicare, which pays for thousands of births to disabled women every year, will require hospitals to report their rates of elective deliveries before 39 weeks.

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Hospitals may be penalized beginning in 2015 if their rates remain high. A few insurers are refusing to pay for such deliveries altogether. As of Jan. 1, the South Carolina Medicaid program and BlueCross BlueShield of South Carolina stopped reimbursing providers for performing early deliveries without medical cause. Together, the two insurers pay for 85 percent of births in the state. Texas implemented such a policy in 2011, and New York and New Mexico are considering similar actions, according to state officials.

â&#x20AC;&#x2DC;Wait A Minuteâ&#x20AC;&#x2122; Without prodding from the government or insurers, some hospitals have taken steps to curtail elective early deliveries.

In 2011, St. Joseph Medical Center in Houston stopped performing them after reviewing studies and hearing from the March of Dimes, a nonprofit that works to prevent birth defects and infant mortality. In that first year, NICU admission rates for babies born between 37 and 39 weeks dropped 25 percent, said Eugene C. Toy, an obstetrician who championed the effort. â&#x20AC;&#x153;When we saw their numbers, we said, â&#x20AC;&#x2DC;Wait a minute. Why isnâ&#x20AC;&#x2122;t everyone doing this?â&#x20AC;&#x2122; â&#x20AC;? said William Glomb, a neonatologist and medical director of Texas Medicaid. Texas subsequently became the first state to stop paying for such deliveries through its Medicaid program. A study undertaken by 27 hospitals owned by HCA Holdings, the nationâ&#x20AC;&#x2122;s largest forprofit hospital chain, found that educating See EARLY DELIVERIES page 16

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EARLY DELIVERIES From page 15

doctors about the risks was less effective in reducing rates of early deliveries than having medical staff prohibit the practice. Today, about 90 percent of the companyâ&#x20AC;&#x2122;s hospitals, including Reston Hospital Center, donâ&#x20AC;&#x2122;t allow it, said HCA spokesman Ed Fishbough. Some physician groups, however, resist being told how to practice. â&#x20AC;&#x153;We oppose the legislative control of medicine,â&#x20AC;? said Jeanne Conry, president-elect of ACOG. Conry says her organization has developed its own â&#x20AC;&#x153;clear, effective guidelinesâ&#x20AC;? laying out clinical markers for determining when early delivery might be appropriate. Even Toy, the St. Joseph obstetrician, opposes the Texas Medicaid policy inspired by the experiment at his hospital. When states or insurers get involved, Toy said, doctors may hesitate to deliver early even when there are clinical reasons to do so. â&#x20AC;&#x153;Outcomes are best when there is a doctorled process, rather than a legislative or payment mandate,â&#x20AC;? he said. The March of Dimes is also wary of using

financial rewards or penalties. â&#x20AC;&#x153;Payment is a really big hammer, and we want to have a comfort level with a policy so we donâ&#x20AC;&#x2122;t cause unintended consequences,â&#x20AC;? such as making doctors reluctant to perform early deliveries even when they are needed, said Cindy Pellegrini, a senior vice president at the nonprofit. Among other difficulties, she cited the challenge of determining a babyâ&#x20AC;&#x2122;s gestational age.

â&#x20AC;&#x2DC;Do The Right Thingâ&#x20AC;&#x2122; Some doctors applaud such steps, however, saying the are necessary to drive change. Amy Picklesimer, an obstetrician at South Carolinaâ&#x20AC;&#x2122;s Greenville Hospital System, said the tough stance taken by her stateâ&#x20AC;&#x2122;s Medicaid program and others â&#x20AC;&#x153;helps us all do the right thingâ&#x20AC;? and makes it easier to educate women. Early elective deliveries in South Carolina dropped from 9 percent to 4.6 percent of all births in 2012, after the state asked hospitals to change their policies. Overall, NICU stays fell 21 percent, said South Carolina Health and Human Services Director Tony Keck. To win support from doctors and hospitals, some states are trying incentives rather then penalties. Washington stateâ&#x20AC;&#x2122;s

January 29, 2013

Carol Wagner, senior vice president for patient safety at the Washington State Hospital Association, said payment incentives need to change so hospitals arenâ&#x20AC;&#x2122;t hurt if they crack down on the procedures. Educating expectant mothers is also key to reversing the trend. A 2009 survey of 650 women who had recently given birth found half considered it safe to deliver before 37 weeks. Before the birth of Maverick, McCorkle had no idea of the dangers that early deliveries can pose. (Her obstetrician did not respond to phone calls and e-mails seeking comment.) Today, the Pittsburgh-area mother is grateful that Maverick has grown into a healthy 4-year-old. And she takes every opportunity to urge expectant mothers to learn from her experience. â&#x20AC;&#x153;Wait as long as possible against having a C-section or being induced,â&#x20AC;? she said. â&#x20AC;&#x153;And donâ&#x20AC;&#x2122;t schedule it unless there is a medical reason.â&#x20AC;? Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Medicaid program last year began paying a 1 percent bonus to hospitals that met several quality targets, including reducing their early elective delivery rates. And in the past two years, Oregon, Louisiana and Michigan have asked hospitals to voluntarily stop such deliveries. Despite such efforts, though, only a third of hospitals report rates of elective early deliveries at or below the goal of 5 percent, according to data they submit to the Leapfrog Group, an employer group focused on patient safety. Many still have rates exceeding 15 percent, the 2011 data show. â&#x20AC;&#x153;Saying you wonâ&#x20AC;&#x2122;t pay for early elective deliveries is a very controversial thing to do, because hospitals donâ&#x20AC;&#x2122;t like it and some doctors donâ&#x20AC;&#x2122;t like it,â&#x20AC;? said Leapfrogâ&#x20AC;&#x2122;s chief executive, Leah Binder. Because complications are rare and neonatal care has become so good, obstetricians rarely see the negative effects of some early elective deliveries. â&#x20AC;&#x153;Most babies do so well that we have all got fairly complacent toward late preterm deliveries,â&#x20AC;? MedStar Georgetownâ&#x20AC;&#x2122;s Landy said. Another issue is that under current payment systems, hospitals profit from admissions to their neonatal intensive care units.

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Health & Wellness

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Teens reach out to help KPC COMMERCIAL peers with depression PRINTING $GLYLVLRQRI.3&0HGLD*URXS,QF

BY THE ASSOCIATED PRESS

INDIANAPOLIS â&#x20AC;&#x201D; At her worst, she felt isolated. Cutting her body was a way to feel alive â&#x20AC;&#x201D; even though there were days when she wished she were dead. â&#x20AC;&#x153;I believed I was worthless, unloved.â&#x20AC;? Sarah Wood, 17, hid her inner pain well. So well that the day after she was released from the hospital for the outer, physical pain, a classmate told her she had never looked happier. But it was a best friend â&#x20AC;&#x201D; someone who had known her since third grade â&#x20AC;&#x201D; who recognized the warning signs. Audrey Muston, 18, was the one who first sought help for Sarah. That was nearly six years ago. Now the two seniors at Lawrence North High School are weeding through college applications and counting down the days to graduation. Woodâ&#x20AC;&#x2122;s depression didnâ&#x20AC;&#x2122;t stem from a traumatic loss. Instead, it just appeared and enveloped her as she entered her teen years. â&#x20AC;&#x153;My family was there for me â&#x20AC;&#x201D; I have the greatest family in the world,â&#x20AC;? she told The

Indianapolis Star. â&#x20AC;&#x153;I know they felt guilt that they didnâ&#x20AC;&#x2122;t recognize things, but it was easy to hide it. â&#x20AC;&#x153;Depression is a mental illness. It can hurt anyone.â&#x20AC;? The memory still burns in the minds of Sarahâ&#x20AC;&#x2122;s parents, Jim and Karen Wood. â&#x20AC;&#x153;As any parent knows, it is very hard to see your child in pain,â&#x20AC;? Karen Wood said. â&#x20AC;&#x153;My husband and I were unaware of our daughterâ&#x20AC;&#x2122;s pain for months before she started to reach out for help. As soon as we did know, we wanted to fix everything as quickly as possible. We soon realized that we had to go through the pain and depression with her and live through the process of recovery.â&#x20AC;? A key part of Sarah Woodâ&#x20AC;&#x2122;s ongoing â&#x20AC;&#x153;recoveryâ&#x20AC;? is through a program she started three years ago with Muston. Together, the two have reached some 3,600 Lawrence Township middle school students struggling with depression, self-injury and thoughts of suicide. See TEENS page 18

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TEENS From page 17

Wood was one of five students across the country recently recognized with a Power of Children award by The Children’s Museum of Indianapolis. Each recipient was given a $2,000 grant toward his or her work. Recipients included a teen who helped military veterans find jobs and a young woman who helped East Coast schools recover from Hurricane Sandy. Although Wood’s efforts are directed toward middle school students, she’s also helped educate teachers, administrators and parents. “It goes beyond words to say how grateful we are that we still have our daughter and that she is using God-given talents to help others,” Karen Wood said. “We are very proud of Sarah and are confident that her story of finding hope will allow other families to be open with each other when help is needed.” Using the slogan: “Speak out. Get Help. There is Hope,” Wood and Muston produced a video where people of varying ages held up hand-painted signs that read, “We Support You,” ”You are Different” and “You are Loved.” The idea is to illustrate that depression spans all ages. And for teens, it’s often a taboo subject.

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When they relate their story, the two friends both stress how it felt to be in Wood’s shoes (the one battling depression) and how important Muston’s role was (to seek help for your friend). “Looking back she didn’t want to do anything like go to the movies,” Muston said. When Wood asked her friend how many pills she would need to kill herself, Muston immediately talked to her parents, expressing her concerns. She then sought the help of a school counselor. “I tried to hide everything,” Wood said, as she talked in a secluded room at Lawrence North and fidgeted with a three-ring binder. On the cover is a message in her handwriting: “Life is Worth Living.” She acknowledges there is “a lot of stigma” about mental illness. But she’s quick to point out that one of the challenges is that the people who survive the pain often don’t talk about it. That’s where she’s different. “I look back, and I’m thankful I went through it. I see it as a blessing, because it’s shaped who I am.” When the girls present their story to middle school health classes, they are accompanied by a mental health professional who answers questions and offers information about recognizing the warning signs of mental illness along with the crisis hotline number. “In the way that they talk about it, it’s more comfortable coming from your peers,”

AL LEAGUE

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THE HERALD

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EPUBLICAN

Scores •

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Olympics •

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Gold in relay is record 19th for Phelps

ts Evenpics AreaOlym • •

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In a Thursday, Jan. 10, photo, Sarah Wood, 17, left, and Audrey Muston, 18, walk the halls at Lawrence North High School in Indianapolis. Seniors Wood and Muston are reaching out to help middle school students identify and deal with depression through an awareness program. When Sarah was a freshman, she began talking to students about the struggles she had had with depression, self injury and thoughts of suicide.

said NaKaisha Tolbert-Banks, director of education and public affairs for Mental Health America of Greater Indianapolis. “I think early on in their journey, there was some resistance. People thought if you talk to kids about suicide, then the kids might attempt suicide. That’s like saying if you talk to your kids about sex, they’ll have sex,” Tolbert-Banks said. “That’s how it’s all changed over the years… . Sarah and Audrey understand the importance of this issue and the difference they’ve made. They’ve touched the lives of many students.”

And with just a few short months until graduation, the girls are already looking at the future of their program. Wood has plans to study psychology and work with adolescents; Muston is looking at a career in foreign language. Both hope that underclassmen and others at the school will keep the program moving forward. But if they don’t, Wood says she finds peace knowing some parents and students have called her or stopped her in the hall to say, “Thanks, you helped me or my son or daughter.

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