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HealthPerspective October 2013 Copyright 2013 The Valley News & The Herald-Journal

Fight against Breast Cancer Obamacare

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What is an internist

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Taking pills safely By ANUJ WADHWA, MD Internal Medicine CRHC

Sometimes it can seem as though every time you go to see your provider, you are given a new pill to take. If you are seeing more than one provider, or if you get admitted to the hospital, it can get really confusing. Here are a few tips to keep your medications straight, and to keep yourself safe from unwanted side-effects. 1) Tell your provider about all the pills you take, including over-the-counter and herbal medications. It may be best to bring the pill bottles with you every time you see your provider. 2) Be sure to mention any allergies, including what the reaction was. You must understand, though, that some effects from medicine, e.g. - nausea from antibiotics

may simply be a side effect, not an allergic reaction. It may be safer for you to take that antibiotic rather than a replacement which is not as effective. On the other hand, lip swelling from any medication is serious, and you should not take that medication or certain other related medications. 3) Let your provider know if you could be pregnant or are breast-feeding, so that they can select the safest medication for both you and the baby. 4) Educate yourself. Keep a list of the medications that you take and why you need to take them. Also, make sure that you understand how you should Anuj Wadhwa, MD take your pills - on an empty stomach, on a full stomach, before meals, first thing in

the morning or last thing at night. Know whether you can stop them on your own, and if so when. For example, most antibiotics should be taken for the prescribed duration even if you are feeling better, because a partially treated infection breeds resistance. Most painkillers, however, can be stopped or taken on an as-needed basis if your pain gets better. If you are prescribed a new medication, your prescriber or pharmacist can tell you about the common side-effects, and you can also read the printed information that comes with your prescription. 5) If you are not getting any better, you should go back to see your provider to check if they need to change the dose or switch to something else. A word of caution, though. Many medications, e.g. - painkillers for sprains or medicines for depression do not work instantaneously and do not work miracles. You should not suffer unnecessarily, but you should have realistic expectations.


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6) Do not take more of the medicines than prescribed. If one is good, two are not always better! In fact, two may have little benefits while increasing the side-effects to annoying, and even dangerous heights. 7) Do not take medicines prescribed for someone else. You may have a different medical issue, although your symptoms may be similar, and you may have other medical problems or you may be taking medicines that make it unwise for you to take that medicine, or you may need a different dose. 8) Store your medicines away from the reach of children. 9) Throw away medications past their expiry or medications that have been discontinued.

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Just what is an internist anyway? Internal Medicine CRHC

With several internists new in our area, people may be wondering just what has arrived. Our area has long had family physicians, doctors who provide care for patients “ f r o m critical to grave�, from birth through Steven Freeman, childhood MD and into advanced years. Internists focus on medical care for adults only. Internists are doctors of internal medicine. The term internal medicine is an old one, originating in Germany in the 1800s.

For many years internists were the “doctor’s doctor�, or “diagnosticians� who other doctors turned to for diagnosis and treatment of complex adult patients. Internal medicine is the mother specialty for the various medical subspecialties, such as cardiology, pulmonology, nephrology, and so on. To this day physicians who want to learn those subspecialties first go through training in the specialty of internal medicine, then sub-specialize from there. Now days, internists often describe themselves as “doctors for adults�. In fact, the American College of Physicians has used that as a motto. Much like pediatrics is the medical care of children, internal medicine is the medical care of adults. They serve as a “personal physician� or primary care physician to adults, providing medical care to adults all ages. They often ask

lots of questions, then examine patients and order tests to arrive at a diagnosis. They then prescribe medical treatment, or if needed refer a person for further evaluation, or for surgical or other treatment. They deal with a wide range of problems, varying from minor illnesses to complex webs of multiple medical problems. For patients with multiple problems and multiple subspecialists, they often serve to coordinate care amongst the various subspecialties. In the hospital and in the clinic they may not only manage multiple medical problems but also treat skin conditions, remove minor skin lesions, deal with mental health issues or substance abuse, deal with women’s health issues, or provide preventive medicine exams and advice. Internists spent 3 years in residency training after medical school to acquire these skills.


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Internists who choose to subspecialize will spend another 3 or more years in fellowship training to become oncologists, cardiologists, and so on. Internists bring more depth of knowledge about diagnosing and treating adults. There is a trade-off between depth of knowledge and breadth of knowledge. Some internists also trained in pediatrics. However, internists do not have the same breadth of knowledge as family physicians, and do not usually have training in pediatrics, and do not train in obstetrics or surgery. Those they defer to other physicians. Instead they provide care for their patients in the office, the hospital, and even in the nursing home, from young adulthood to advanced years, through the span of adult years and the various medical challenges that accompany them.



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Obamacare is the shorthand name for the Affordable Care Act, approved by Congress in 2010. Some provisions already have rolled out, but Oct. 1 marks a major new chapter: startup of the insurance marketplaces for purchase of individual policies. While the term “Obamacare� initially was used by opponents of the legislation, it has since been embraced by President Barack Obama. Often during the 2012 campaign, when health care policy was a key point of difference with Republican challenger Mitt Romney, the president said, “You want to call it Obamacare -- that’s OK, because I do care.�


A majority of business have already added many features of Obamacare. By STEVE JORDAN World-Herald staff writer

You’re one call away from a great Medicare Supplement plan from The Blues®.

Bob Wilson

staff, and most employers already have adopted the main features of Obamacare or have included them for years. “In the big scheme, I don’t see this dramatically impacting the way the employers are acting,” said Omaha attorney Craig

see Obamacare, Page 5

Brian Steinkuehler

Wilson Insurance Agency 110 N. Elm, Shenandoah, Iowa   s   Wellmark Medicare supplement insurance plans are not affiliated with any government agency. Wellmark Blue Cross and Blue Shield of Iowa is an independent Licensee of the Blue Cross and Blue Shield Association. © Wellmark, Inc., Des Moines, IA.


Kovarik, who advises businesses on health plans. For example, most employers have “open enrollment” periods each year where employees can sign up for coverage regardless of their health history. That meets the Affordable Care Act’s ban on re-

22P009-2010-IA (U 4/10)


employees. Otherwise, most employer plans are expected to be stable in 2014. Businesses for the most part will continue their long practice of offering health coverage to employees as a benefit intended to attract and keep good people on


Tuesday’s kickoff of the Obamacare marketplaces is aimed at less than 15 percent of Nebraska and Iowa residents -- people who couldn’t or didn’t want to buy health insurance before. That leaves the remaining 85 percent. This includes people covered by group plans through their employers. For most of them, the biggest change for 2014 will be familiar: costs rising in a range that six health plan experts in the region estimate at 6 percent to 15 percent. The increases are mostly because of higher medical prices and more use of medical services, the experts say, although the Affordable Care Act will contribute between 1 and 5 percentage points to the rise. Bret Sesker, a principal with Omaha benefits firm SilverStone Group, said he expects medical costs alone -- increased use and price inflation -- to rise between 8 percent and 11 percent for 2014. For employer groups, actual percentage increases will vary widely, from nearly zero to increases in the high teens, with at least part of the cost passed on to

jecting insurance applicants who have pre-existing medical conditions. The law also prohibits lifetime benefit caps and sets annual maximum out-of-pocket costs at $6,350 for an individual and $12,700 for a family. Many group policies already have lower limits on annual costs. And many businesses, in their attempts to curb cost increases over the years, have stressed wellness plans and smoking cessation -- the kinds of preventive measures emphasized in Obamacare. Aside from cost increases, the group policies that cover the average employee will contain similar benefits as in recent years, said Jerome Rewolinski, director of account management for Blue Cross Blue Shield of Nebraska. Even though the group plans aren’t required to have all of the “essential benefits” of the Obamacare marketplace policies, he said, many group plans already include most of the same benefits. “The key,” Rewolinski said, “is if you’re covered by a company plan today, you can still remain in that plan -- and in most cases you’ll be best served by having that employer coverage,” because

OBAMACARE Continued from Page 4

employers typically pay a big share of the cost. Among the law’s new features that do affect group insurance plans: a $63-a-year transitional reinsurance fee per covered person, a health insurance tax (estimated to increase premiums by as much as 2.5 percent annually) and a patient-centered outcomes research fee of $2 per covered person. The insurance tax won’t hit employers who don’t buy insurance but who instead pay their employees’ claims through a health plan administrator. That’s called a self-funded plan or self-insurance, and more businesses are considering it partly because of the new tax. The most important factor in group costs, said the experts interviewed, is not Obamacare but the claims experience of group members. Duncan Aviation of Lincoln is paying about $200,000 a year in fees from the Affordable Care Act, but employees will pay only a 2 percent increase in premiums next year, the same as this year. Medical claims have been flat, said Michael Cox, vice president of human resources. That 2 percent is just to “stay ahead� in case of unexpected

large claims in future years. Employees enrolled in Duncan’s high-deductible plan with health savings accounts have had no increase in premiums since the plan began three years ago. The company pays 75 percent of premiums for the health plans and hasn’t cut benefits in recent years. Cox credits more than a decade of Duncan’s emphasis on wellne ss, including on-site clinics at the 2,000-employee company’s two locations and financial incentives for people to take care of their health. “I think it’s a cumulative effect,� Cox said. “It’s not something in one year or two years or five years where you see huge dividends. It’s more of a long-term strategy. It’s part of the culture. People think about it.� Some employees of Royal Composites, an aircraft parts manufacturer from Minden, Neb., will benefit from the Affordable Care Act because they can use its marketplace instead of paying high rates through the state’s insurance pool for people with high-risk medical conditions. Phillip Gill, president and CEO, said he will double the company’s wellness budget in 2014 to try to control costs, but he expects another 10 percent increase. So far he doesn’t offer insurance for his 140 employees, instead reimbursing them

for policies they buy on their own. The law’s penalty for employers who don’t offer insurance has been delayed a year, and Gill is thinking about offering a group plan but is unsure. Meanwhile, he’s offering incentives to workers who take part in the wellness program. “That’s the only leverage we have, is people working to get a little bit healthier,� he said. “Stop smoking and quit eating sugar, and everybody would be in good shape -but that’s easier said than done. We’re trying to make it a positive thing.� Sesker, from SilverStone, said businesses that emphasize wellness can save on medical costs. “They can beat those claim trends,� he said. “It takes a while to really have an impact, but it’s worth the time and effort.� The Affordable Care Act includes some efforts to reduce health care costs. Any significant cost reductions are more likely to come from the health care industry itself, said Kim Lobato, senior vice president for AON Risk Services in Omaha. Payment methods for medical providers are changing to emphasize care of patients, for example. “There isn’t anything yet that has really impacted (medical) inflation,� Lobato said. “There’s a lot of cost-shifting that goes on,�


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with expenses being passed to employers and employees. Even so, he said, â&#x20AC;&#x153;Having group insurance is a heck of a lot easier for me as an employee than it is to navigate the exchange market and deal with insurance on my own. It is a real benefit to employees, and employees will recognize that in competitive hiring.â&#x20AC;? Omaha restaurant owner Greg Cutchall said heâ&#x20AC;&#x2122;s waiting for 2014 bids on his companyâ&#x20AC;&#x2122;s 70-member, self-insured health plan and likely will keep it in place, although he may ask some employees to test the marketplace. â&#x20AC;&#x153;It might make sense for a handful (to use the marketplace) but may not make sense for another group,â&#x20AC;? he said. â&#x20AC;&#x153;I donâ&#x20AC;&#x2122;t think anything there is a win-win.â&#x20AC;? Mark Whiting, principal with Mercer Health & Benefits of Kansas City, Mo., said some employers will try to blame the new law for all of the 2014 increases, and all are looking for ways to control health costs. â&#x20AC;&#x153;Employers are looking for home runs,â&#x20AC;? Whiting said, when the only real options are the occasional bunt, stolen base and sacrifice fly -- small steps that may bring costs down a little. â&#x20AC;&#x153;They want to know what to do to take out 7 to 10 percent of costs, but that doesnâ&#x20AC;&#x2122;t exist.â&#x20AC;?


YOUR HEALTH INSURANCE ROAD MAP On Oct. 1, people can begin enrolling for health coverage that is effective next year. By Jan. 1, 2014, most people must have health insurance or face a fine. (The mandate that employers with 50 or more workers provide affordable insurance or pay penalties won’t take effect until 2015.) Most of the roughly 260 million Americans with job-based, individual or government coverage probably have nothing to do now. But if you’re unsure, and among the nearly 49 million uninsured in America, this road map should help.

STEP 1 Determine whether you must buy coverage now.

Do some homework


No, if you have insurance through:

No, if you are:

>> Your employer >> Medicaid >> CHIP (Children’s Health Insurance Program) >> Tricare (for ser vice members, retirees and their families) >> A veteran’s health program >> Medicare >> Private insurance you bought that is at least the bronze coverage level (See below) >> A grandfathered plan from before enactment of Affordable Care Act

>> Part of a religious group opposed to accepted health insurance benefits >> An undocumented immigrant >> In prison >> Part of an Indian tribe >> Too poor to file a tax return ($10,000 single, $20,000 family) >> Or if the cost of available coverage coverage would exceed 8 percent of your income even with an employer contribution or tax credits

Get prepared.

to make sure you understand how insurance coverage works, including the definitions of such terms as premiums, deductibles, out-of-pocket maximums, co-payments and coinsurance. For help, see our glossar y on Page 5.

Gather basic information about your household income. To find out how much of a tax credit you’re eligible for, you’ll need income information, like the kind you get on your W-2, current pay stubs or tax return.

Set your budget. You’ll need to figure out the most you want to spend on health insurance each month and whether you’ll need to cut other expenses before you review the different types of health plans being offered.

STEP 3 Check to see if you qualify for tax credits to subsidize the cost of insurance.

You are likely eligible for the financial help if: >> Your annual household income is: individual $11,490 to $45,960 Couple $15,510 and $62,040 Family of four $23,550 to $94,200 >> You do not have access to insurance through an employer. >> You are not eligible for other coverage, including Medicaid, the Children’s Health Insurance Program, Medicare or military coverage.

If none of the above applies to you, continue on...

The different types of health coverage plans

You can get specifics on your tax credit by:

Through the marketplace, you’ll be able to choose a health plan that gives you the right balance of costs and coverage.

The marketplace plans will be divided into four categories, based on the portion of medical expenses they cover. >> BRONZE PLANS Insurance covers 60 percent of medical bills >> SILVER PLANS Coverage is 70 percent >> GOLD PLANS Coverage is 80 percent >> PLATINUM PLANS Coverage is 90 percent The policyholder will pay the remaining portion of the medical bills.

All plans must:

All the plans will provide the same 10 essential health benefits: >> Outpatient ser vices >> Emergency ser vices >> Hospitalization >> Maternity and newborn care >> Mental health and substance use disorder ser vices

>> Prescription drugs >> Rehabilitation ser vices and devices >> Laborator y ser vices >> Preventive and wellness care and chronic disease management >> Pediatric ser vices, including dental and vision care

>> Cover at least 60 percent of medical costs >> Limit annual out-of-pocket costs, such as co-payments and deductibles. >> Limit the amount that older plan members may be charged >> Outlaw annual benefit-spending limits >> Not allow rates to vary base on gender, occupation or medical claims histor y.

>> Going to your state’s online insurance marketplace and filling out a three-page form (11 pages for a family) giving your salar y and other information. This online step will tell you whether you qualify for a tax credit. >> The facts are “self-attesting ,” which means they won’t be checked until later.

STEP 4 Make a choice of insurance plans.

Make sure your doctors and preferred hospitals are in the plan you pick.

NOTE: Premiums can vary by age, smoking status and geographical region of each state.

You may have to check the plan's own website or call your doctor’s office.

The government will be checking whether you bought insurance. When you are ready to start

STEP 5 Buy the insurance.

You will be reading and hearing a lot about the new insurance options. The marketplaces are designed to be one-stop shops. Go online to do your comparison shopping , ask your questions and make your purchase. Or you can seek the assistance of a navigator, who will help you through the selection process. Turning to a local insurance broker also is an option.


Go to, the federal government’s Health Insurance Marketplace. If you live in Nebraska or Iowa, you’ll use this website to apply for coverage, compare plans and enroll. You’ll also find tips, worksheets and explanations that will help you with the task.

Need Help?

Seek out a navigator, people specially trained to work with you one-on-one to sor t through insurance choices and complete the application process in the marketplace. IN NEBRASKA >> Community Action of Nebraska >> The Ponca Tribe

IN IOWA >> Genesis Health System >> Visiting Nurse Ser vices of Iowa >> Planned Parenthood of the Heartland

OTHER SOURCES OF HELP >> OneWorld (South Omaha) >> Charles Drew Health Center (northeast Omaha) >> Enroll Nebraska (sponsored by AARP Nebraska, Nebraska Appleseed and Interchurch Ministries of Nebraska)

Companies selling insurance on the Nebraska and Iowa marketplaces: NEBRASKA >> Blue Cross Blue Shield of Nebraska >> CoOpor tunity Health >> Coventry Health Care >> Health Alliance Midwest

IOWA >> Avera Health Plans >> CoOpor tunity Health >> Coventry Health Care >> Gunderson Health Plan >> Health Alliance Midwest >> Sanford Health


Tax returns probably will have a box for you to list your insurer, which could be cross-check ed with the employer’s tax filing or your insurer’s information. If you lie or don’t buy insurance, you may get a letter asking you to pay a penalty. The IRS can’t garnish your wages to collect, but it can reduce your refund. Employers already list insurance benefits on your W-2 income tax form.

How the penalties breakdown 2014 2015 2016

Per adult

Per child

Per family

$95 $325 $695

$47.50 $162.50 347.50

$285 $975 $2,085

Or percent of income* 1 2 2.5

*whichever is greater


Call 800-318-2596, 24 hours a day, 7 days a week

Online Visit healthcare.go v; sign up for email or text updates; visit v; follow @healthcare.go v on Twitter

Español CuidadoDeSalud.go v

Video Using the marketplaces at marketplace.cms.go v/getofficialresources/multimedia/multimedia.html

SOURCES: healthcare.go v; McClatchy Newspapers; Kaiser Family Foundation; Blue Cross Blue Shield of Nebraska; World-Herald archive


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8 /

How does the American Cancer Society stand out in the fight against breast cancer? About the American Cancer Society The American Cancer Society combines an unyielding passion with nearly a century of experience to save lives and end suffering from cancer. As a global grassroots force of more than three million volunteers, we fight for every birthday threatened by every cancer in every community. We save lives by helping people stay well by showing them steps they can take to reduce their risk for cancer or detect it early; helping people get well by guiding them through every step of a cancer experience; by finding cures through investing in and conducting groundbreaking research; and by fighting back by working with legislators to pass laws to defeat cancer and by rallying communities worldwide to join the fight. Together with our millions of supporters, we are creating a world with less cancer and more birthdays. What Sets Us Apart in the Fight against Breast Cancer Breast cancer awareness is at an all-time high, which means more people are being exposed to information about the disease and, hopefully, more are following the American Cancer Societyâ&#x20AC;&#x2122;s recommended cancer screening guidelines to find breast cancer early and stay well. However, in todayâ&#x20AC;&#x2122;s increasingly â&#x20AC;&#x153;pinkâ&#x20AC;? society, it can be extremely difficult for people to differentiate among breast cancer-fighting organizations, determine the correct screening guidelines, and understand how money donated to the cause is making a difference. There are some organizations that support only breast cancer research. Unlike

these organizations, the American Cancer Society supports research to find cures for all types of cancer, because we know that discoveries in one area could help find answers in another. Much of the discovery research funded by the Society has the potential for having an impact on breast cancer with more than $200 million invested in that research since 1990. As the nationâ&#x20AC;&#x2122;s largest non-governmental funder of cancer research, investing more than $3.6 billion since 1946, we turn what we know about cancer into what we do about it. Thanks in part to this work, nearly 12 million cancer survivors (2.5 million of them breast cancer survivors) and countless others who have avoided the disease will celebrate another birthday this year. As the nationâ&#x20AC;&#x2122;s largest voluntary public health organization with the single most universally recognized cancer-fighting brand identity overall, the American Cancer Society is the longstanding leader in the fight against breast cancer. And together with our supporters, we are saving lives in many ways: Helping People Stay Well from Breast Cancer We know that finding breast cancer early, when it is easiest to treat, can mean the difference between life and death. So we provide screening guidelines, clinician education, and engage in efforts to increase public awareness about the importance of yearly mammograms. At, you and the women you care about can sign up to receive an email

that will remind you to schedule your yearly mammogram in the month of your choice. The American Cancer Society recommends that all women 40 and older get a mammogram every year, in addition to a breast exam by their doctor or nurse as part of their regular health checkups. Although there is no guaranteed way to prevent breast cancer at this time (which is why yearly mammograms are so important), there are steps you can take to reduce your breast cancer risk: â&#x20AC;˘ Maintain a healthy body weight throughout life. â&#x20AC;˘ Engage in moderate to vigorous regular physical activity (at least 45-60 minutes on five or more days of the week). ¡ Reduce the amount of alcohol you drink, if you drink at all, to no more than one drink per day for women (and no more than two drinks per day for men). ¡ If you are at high risk for breast cancer, talk with your doctor about your risk and what your options are to reduce your risk Helping Women and Men with Breast Cancer Focus on Getting Well Having cancer is hard. Finding help shouldnâ&#x20AC;&#x2122;t be. Thatâ&#x20AC;&#x2122;s why the American Cancer Society is in everyoneâ&#x20AC;&#x2122;s corner around the clock to guide them through every step of a breast cancer experience. The Society offers free programs and services in communities across the country to ensure that cancer patients and their loved ones do not

have to face cancer alone. Below are some of the support services we provide: â&#x20AC;˘ Transportation assistance to and from treatment â&#x20AC;˘ Free wigs and assistance with treatment-related physical side effects â&#x20AC;˘ Emotional support programs that connect newly diagnosed breast cancer patients with survivors â&#x20AC;˘ Cancer education classes â&#x20AC;˘ An online support network â&#x20AC;˘ Free lodging (in many communities) for those having to travel far for treatment We are committed to connecting people facing cancer with the information, day-today help, and emotional support they need in the communities where they live to help them focus on getting well. Finding Breast Cancerâ&#x20AC;&#x2122;s Causes and Cures The American Cancer Society invests more in breast cancer research â&#x20AC;&#x201C; to better understand, prevent, and treat the disease â&#x20AC;&#x201C; than in any other cancer site. We take pride in funding promising researchers early in their careers, and our track record is something we share with pride. Of the researchers chosen for Society funding throughout the years, 44 have gone on to win the Nobel Prize. Your support has allowed the American Cancer Society to play a role in nearly every major breast cancer research breakthrough in recent history, including: see BREAST CANCER, Page 11

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Facts about asthma By KRISTINE MERRILL, RT

Respiratory Therapy Manager CRHC ASTHMA TRUE OR FALSE 1) True or False? Asthma is â&#x20AC;&#x153;all in the mindâ&#x20AC;? False: Asthma is not a psychological condition. However emotional trigger can cause flare-ups. 2) True or False? You will â&#x20AC;&#x153;grow outâ&#x20AC;? of asthma False: you cannot outgrow asthma. In about 50% of children with asthma, the condition may become inactive in the teenage years. The symptoms however may recur at anytime

in adulthood.

3) True or False? Asthma can be cured, so it is not serious, and nobody dies from it. False: There is no cure for asthma, but the disease can be controlled in most patients with good medical care. The condition should be taken seriously since uncontrolled asthma may result in emergency hospitalization and possible death. 5) True or False? You can â&#x20AC;&#x153;catchâ&#x20AC;? asthma form someone else who has it. False: Asthma is not contagious 7) True or False? People with asthma should not ex-

ercise. False: Swimming is an optimal exercise for those with asthma. On the other hand, exercising in dry, cold air may be a trigger for asthma in some people. But this should not stop an asthmatic from exercising. Using your inhaler 20 mins before exercise is the best to prevent exercised induced asthma episodes. 8) True or False? Asthma does not require medical treatment. False: Asthma is best controlled by having and asthma management plan designed by your doctor that includes the medications used for quick relief and those used for controllers.

9) True or False? Medications used to treat asthma are habit-forming.

False: Asthma medications are not addictive. 10) True or False? Someone with asthma can provoke episodes anytime they want in order to get attention. False: Asthma attacks cannot be faked. Asthma is a lifelong disease. The more you know about asthma, the more it will be controlled. Ask your doctor about getting more asthma education. Or please feel free to call the respiratory staff at Clarinda Regional Health Center.


.UMEROUSSTUDIESSHOWTHAT,!3%24(%2!09 â&#x20AC;&#x153;Dignity in Lifeâ&#x20AC;? is our Mission. Ways we may serve you include CANHELPWITH We are â&#x20AC;&#x153;Families serving Familiesâ&#x20AC;?. Skilled care with therapists on staff s4ENDINOPATHIES s3PORTS)NJURIES We succeed by focusing our attention & energies For your rehabilitation needs. Stop in to see LOCAL On exceeding expectations with a Hospice services are also available. s#ARPAL4UNNEL3YNDROME s6ENOUS5LCERS video testimonies â&#x20AC;&#x153;Yes, I Canâ&#x20AC;? attitude. s0LANTER&ASCIITIS s"URNS regarding this amazing Stop by for a visit,The coffee is always on. s&IBROMYALGIA sand more! When you need us, new therapy! @V\OH]LUL^WSHUVW[PVUZI\[^OPJOVULPZYPNO[MVY Either short or long term `V\&0JHUOLSW`V\\UKLYZ[HUK`V\YVW[PVUZHUKZLSLJ[ â&#x20AC;&#x153;Life is Goodâ&#x20AC;? Our team of friendly faces Shenandoah Chiropractic [OLYPNO[WSHUMVY`V\HUK`V\YMHTPS` Will do the best for you at Stanton Care Center and Laser Clinic @V\OH]LUL^WSHUVW[PVUZI\[^OPJOVULPZYPNO[MVY @V\OH]LUL^WSHUVW[PVUZI\[^OPJOVULPZYPNO[MVY @V\OH]LUL^WSHUVW[PVUZI\[^OPJOVULPZYPNO[MVY 3&REMONT3TREET 3UITE" s3HENANDOAH )! (ALLAND!VENUEs3TANTON )OWA .P]LTLHJHSS[VKH` `V\&0JHUOLSW`V\\UKLYZ[HUK`V\YVW[PVUZHUKZLSLJ[ `V\&0JHUOLSW`V\\UKLYZ[HUK`V\YVW[PVUZHUKZLSLJ[ `V\&0JHUOLSW`V\\UKLYZ[HUK`V\YVW[PVUZHUKZLSLJ[ 712-829-2727 712-215-9165 0RUV^OLHS[OPUZ\YHUJL [OLYPNO[WSHUMVY`V\HUK`V\YMHTPS` [OLYPNO[WSHUMVY`V\HUK`V\YMHTPS` [OLYPNO[WSHUMVY`V\HUK`V\YMHTPS` *UHJ %XWW


Saturday Morning Clinic

Health insurance is changing.

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Greg Butt Farm Bureau Agent 100 E Stuart St Clarinda, IA 51632 712-542-3333


Give me a call today! I know health insurance.







BREAST CANCER Continued from Page 9

• • • •

Funding research into breast-conserving surgery, using lumpectomy plus radiation for treatment Establishing mammography as the gold standard to find breast cancer early Discovering lifesaving treatments such as Herceptin and Tamoxifen Discovering genes for inherited breast and colon cancer

• Confirming the knowledge that noses and lower the number of deaths from our nation’s lawmakers. Thanks in part to genetics, diet, lack of exercise, and breast cancer each year. donations made to ACS CAN at Making alcohol abuse can increase a person’s Strides Against Breast Cancer® events, cancer risk Fighting Back against Breast Cancer ACS CAN’s advocacy efforts are affecting • Discovering cancer-causing oncogenes American Cancer Society Making Strides many of the laws that govern what options and tumor-suppressor genes Against Breast Cancer events are held na- are available for people battling cancer. tionwide each year to celebrate people who Currently, breast cancer research proj- have battled breast cancer, educate people • ACS CAN has successfully lobbied ects are under way at institutions across the about ways to reduce their risk, and raise Congress for millions of dollars for the country, thanks in large part to the funds funds to support research and programs Centers for Disease Control and Prevention raised by Making Strides Against Breast to help people facing the disease. Making National Breast and Cervical Cancer Early Cancer® participants. With your continued Strides walks range in distance from three Detection Program, which helps low-inhelp, we can fund more critical research to five miles, and they are an opportunity come, uninsured, and underinsured women projects, one of which could result in a for families and friends of all ages to unite get access to critical screenings and followbreakthrough that would lead to fewer diag- and share their passion for fighting back up treatment. ACS CAN is currently workagainst breast cancer. ing to increase funding for the program so it can serve more eligible women. Additionally, we work with public offi• ACS CAN actively supports federal cials to enact policies to defeat breast can- legislation that would increase access to cer and rally communities, including par- treatment for breast cancer patients and the ticipants in Making Strides Against Breast quality of life for breast cancer survivors. Cancer® events, to join the fight. The • ACS CAN urges Congress to fund critAmerican Cancer Society, in collaboration ical research that has the potential to make with our nonprofit, nonpartisan advocacy progress in the prevention, treatment, and affiliate, the American Cancer Society Can- care of those diagnosed and living with cancer Action NetworkSM (ACS CAN), works cer. hard to keep breast cancer a top priority for

We’re here for you when common sense isn’t.

“Goggles – who needs goggles?” The ER at:

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