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Health Perspective

January 2014

Copyright 2014 The Valley News & The Herald-Journal

PEANUT Allergies





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The growing concern over peanut allergies By TESS GRUBER NELSON


Staff Writer

s a parent, you try to pay attention to what goes in your child’s mouth when it comes to meals and snacks, and for most of us, that isn’t a life or death situation. However, for some parents of children with serious allergies, it is. Chris and Erin Cook of Shenandoah have a 4-year-old daughter, Avery, who is allergic to peanuts. This means that the entire family, and anyone that watches her, needs to be diligent as to what she ingests. Erin explained they found out Avery was allergic to peanuts when she was just over a year old and while at daycare. “They had given them peanut butter on crackers and she had barely even taken a bite when she broke out in hives and her eyes got bloodshot,” Erin recalled. “I didn’t even think it could be a peanut allergy.” It was a co-worker of Erin’s and another childcare provider at the daycare, who also has a son with a peanut allergy, that informed Erin that Avery could be allergic to peanuts. It was additionally fortunate both ladies were in the same room as Avery at the time. “I went and told the front desk of the daycare and then took her to the ER. They gave her Benedryl, and that was enough because she hadn’t ingested it,” Erin continued. Doctors recommended the Cooks take their daughter to an allergy specialist, where it was confirmed Avery was allergic to peanuts. “They said there is a 20 percent chance she’ll grow out of it,” said Erin. “We’re still hopeful.” Before they found out Avery was allergic, Chris and Erin said they didn’t know much about peanut allergies and hadn’t heard of too many people that had it. Since Avery is allergic to such a common household item, those who watch her have to be extra cautious of what she ingests – and it doesn’t just include her not eating peanuts in general, but items cooked in peanut oil, processed in peanut plants or foods that contain peanuts. And they have become very accustomed to reading labels on products. “It’s not just peanuts,” Chris said. “It’s so much more - more than you’d think.” “We have an Epipen we take with us when we travel, or when she stays with our parents. Turnbull (daycare) has an Epipen and they don’t serve anything with peanuts in it.” Erin said. “We’ve pretty much gotten used to it,” Chris said. Babysitters and Avery’s older sisters, Ellie and Morgan, are also aware Avery can’t have peanuts of any kind. Even Avery understands she can’t have peanuts. “The girls are really good about it, but it was an adjustment” Chris said. According to the Mayo Clinic, being allergic to nuts is one of the more common food allergies, especially among children. Many people who are allergic to peanuts are also allergic to other tree nuts, including walnuts, almonds and pecans. As with any allergen, reactions vary from person to person. Some may experience mild symptoms, such as light rashes or swelling, while others may have severe reactions, including anaphylactic shock, which is characterized by shortness of breath, a severe drop in blood pressure, constriction of airways, and potential heart failure. A peanut allergy occurs when your body mistakenly identifies peanut proteins as something that can be harmful. Just as your body might fight a cold, it releases chemicals from the immune system to fight off the peanut invader. The number of kids with peanut allergies has been increasing over the last 10-15 years, doubling in the last half-decade alone. It isn’t known why some people are prone to nut allergies while others are not. However, Michael C. Young, M.D., Assistant Clinical Professor of Pediatrics at Harvard Medical School and a practicing pediatrician at Children’s Hospital, has a few ideas. Nursing mothers and very young children are eating more peanuts, particularly in the form of peanut butter, than ever before, someThe Valley News (1/29) & Clarinda Herald-Journal (1/30)


thing that Young feels could be causing a higher incidence rate of peanut allergies. Young also theorizes that better hygiene may play a role, suggesting that because children have fewer infections (due to improved hygiene and routine immunizations),their immune systems are more likely to target other things, such as foods and environmental factors, resulting in allergies. Although peanut allergies are prevalent and can be dangerous, there is no reason to act rashly. Young notes that approximately 20 percent of children will outgrow their peanut allergies by the age of 6, and he advises that it is worth having a child retested as they get older to gauge if there have been any changes in the status of the peanut allergy. When dealing with peanut allergies, it is important to separate myths from facts.  Direct contact is the most common cause of a reaction. This results from eating peanuts or foods that contain peanuts. Cross-contamination,which occurs when peanuts unintentionally come into contact with other foods, is another common cause. see PEANUT, Page 4



Continued from Page 3

 Some people can have a reaction by touching peanuts with their skin. A rash may occur, but a very dangerous reaction will not result unless the peanuts enter the mouth or come into contact with the nose or eyes.  An allergic reaction can occur from inhalation of peanut dust, such as peanut flour or ground shells during processing. Aerosol cooking sprays that contain peanut oil also can produce a reaction. It is important to note that the smell of peanuts will not induce an allergic reaction.  Mount Sinai School of Medicine in New York found that peanut proteins can be detected in some people’s saliva after eating peanuts. A kiss could transfer some of the peanut allergens to another person.  Sometimes an allergy is not really an allergy, but rather an intolerance to a certain food. A food intolerance does not involve the immune system. A person with a food intolerance can eat small amounts of the food with only mild symptoms, such as indigestion, rather than a severe reaction with a true allergy. While being diligent in reading food labels and asking what ingredients are in prepared foods at restaurants is key for people with peanut allergies, so is avoiding potential skin contact. This means thoroughly washing areas where peanuts or peanut butter may have been and ensuring other children wash up after lunch. “It could be potentially the rest of her life she’ll have to deal with this,” Chris said. “We’re hopeful she’ll be in that 20 percent.” According to Spire Health Partners, more than 3 million people in the United States have a nut allergy, and one-third of them will suffer from a severe symptom if they ingest nuts.

Precautions allow people to enjoy a FLU FREE winter


Christmas carols and holiday cheer have been replaced with sniffling and sneezing as area residents contend with the effects of flu season. Since people typically spend more time indoors in close proximity to co-workers, family and friends during the winter

months, they are more susceptible to the flu. Dr. Autumn Morales at Clarinda Regional Health Center said flu season generally extends from December to February, but could begin as early as October and continue until April depending on winter weather conditions. “So far the flu season has been consistent with recent years, but we still may see a great deal more flu,” Morales said.

Therefore, there are some simple precautions people can take to protect themselves and their families from the flu. Morales said the best way to prevent the flu is to get a flu shot. Some people prefer to avoid getting a flu shot because they want to build up their natural immunities or they believe the shots can make them sick. However, most flu shots contain an inactive virus that will not make the recipient sick, and will only trigger the body’s immune system response to a foreign invader. It can take a couple of weeks for full immunity to develop, so it’s possible to still get sick even after a flu shot has been administered. Also, a flu shot does not guarantee recipients won’t get the flu. People can still get the flu after receiving a flu shot, as it may be another strain of the virus. Still, flu shots are largely effective. “Clarinda Regional Health Center is still offering flu shots for established patients through the walk-in clinic. Adults who are not patients can also visit the walk-in clinic, but we would like to have young children under the age of 12 to be examined before they receive a flu shot. You can also check with your local pharmacy to see if they are offering flu shots,” Morales said. Proper hand washing can also reduce the risk of flu and the spreading of other germs. Morales said a thorough hand washing with see FLU, Page 6

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Explaining the gluten-free diet By JOHN VANNOSTRAND Staff Writer

Dietary fads come and go, but the gluten-free movement is one nutritional trend that seems to have staying power. The gluten-free diet was once largely exclusive to sufferers of Celiac disease, a condition that damages the lining of the small intestine, preventing it from absorbing parts of food the body needs to stay healthy. That damage is the byproduct of the body’s reaction to gluten, a term used to describe proteins found in specific grains. But while the gluten-free diet remains a necessity for those who cannot tolerate gluten, nowadays even nonsufferers are embracing the gluten-free diet for a variety of reasons. “A gluten free diet is prescribed for someone with Celiac Disease, an autoimmune disorder caused by sensitivity Molly Gilmore to gluten, a protein found in wheat, rye, barley and sometimes oats,� said Molly Gilmore, dietitian at Clarinda Regional Health Center. One such reason is non-Celiac gluten sensitivity, or NCGS. Though NCGS is not as severe as Celiac disease, research has suggested that a gluten-free diet can relieve NCGS symptoms, which include abdominal pain and headaches. “According to the Celiac Support Association, approximately 1 in 133 people have celiac disease, although most are not diagnosed,� Gilmore said. Allergies are another reason some people may opt for a gluten-free diet. Unlike Celiac disease or NCGS, both of which are digestive system responses to gluten, wheat allergy is an immune-system response and, like other

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allergies, can be outgrown. But until a wheat allergy is outgrown, it’s best to avoid foods, including those with gluten, that might trigger an allergic reaction. “It is important to know that celiac disease is not a food allergy. True wheat allergies are actually very uncommon in both adults and children,� Gilmore said. “When these grains are consumed by someone with celiac disease, it can cause damage to the intestines and in some cases, triggers severe gastrointestinal distress, including vomiting and diarrhea.� While a gluten-free diet is a necessity for people with Celiac disease, NCGS or wheat allergies, according to Michell Nacouzi, MD, a primary care physician at Duke Primary Care Brier Creek, it may provide little health benefit to those without such conditions. But that doesn’t mean the popularity of the gluten-free diet is about to wane. Those without a preexisting medical condition who are considering a gluten-free diet anyway should know a few things about this diet before making such a drastic change. Gluten-free is not easy. Unlike eliminating sugary soft drinks or cutting back on fried foods, going cold turkey on gluten can be very difficult. Many people who adopt a gluten-free diet find it extremely challenging, as gluten proteins can be found in additives, making something as seemingly simple as reading labels a lot trickier than it looks. “Grains containing gluten include wheat, barley, rye, malt and oats. Some oats have been processed to be gluten-free and should be stated on the package,� Gilmore said. Though labels may not list gluten among a product’s ingredients, men and women must be aware of all additives that contain gluten proteins in order to avoid gluten entirely. And while supermarkets are stocking more gluten-free products, shopping for groceries while on a gluten-free diet can be tedious. Certain foods and drinks must be avoided. Though people considering a gluten-free diet are aware that such a diet requires some sacrifices, they may not know which see GLUTEN, Page 15



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should last between 15 and 30 seconds. â&#x20AC;&#x153;Usually if you can sing the happy birthday song that is a good timer,â&#x20AC;? she said. When those around you are sick, it is best to keep your distance, especially when those people have the flu. The Centers for Disease Control and Prevention state that people with the flu can spread it to others up to six feet away. Droplets of bodily fluids expelled during coughing, sneezing and even talking are the primary way flu viruses are spread. â&#x20AC;&#x153;If you see someone that is visibly ill do not approach them. On the flip side of that, if you are sick, stay home,â&#x20AC;? Morales said. â&#x20AC;&#x153;I would also recommend avoiding crowds especially if you have small children or have medical conditions that make you more susceptible to the flu.â&#x20AC;? People who smoke or have respiratory problems are at much greater risk of the flu. Smoking cigarettes and cigars can affect the immune system and also compromise the body in a number of different ways. Smoking can disable mechanisms in your breathing passageways that serve as natural repellants to the flu. These include the hairs on the lungs that brush away contaminants. Smoking also can create holes in the lining of lower air passages, and such holes can make people more susceptible to illness, including the flue. Smokers who get the flu typically find that the flu further complicates their ability to breathe. Women who are pregnant should also be especially cautious. According to Dr. Cameron Wolfe, an infectious disease specialist at Duke University Medical Center, women who are pregnant are at a higher risk of complications and even death from influenza. Doctors donâ&#x20AC;&#x2122;t fully understand why, but many feel that because the flu can compromise a womanâ&#x20AC;&#x2122;s ability to breathe well, this makes it difficult for oxygen to be passed on to the fetus. Pregnant women should speak with their obstetricians about the safety of the flu shot. Similarly, the flu can impact the ability of newborns and infants to breathe well. â&#x20AC;&#x153;My best recommendation is to stay at home as much as you can until the baby is at least four to six months old,â&#x20AC;? Morales said. Finally, people need to be sure they get plenty of rest and good food. Adequate sleep and a healthy diet can bolster the immune system. Itâ&#x20AC;&#x2122;s important to stay hydrated, eat fruits and vegetables rich in vitamin C and prioritize getting a good nightâ&#x20AC;&#x2122;s sleep each night.


Continued from Page 4


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How to reduce your risk for diabetes Staff Writer

Eat like you already have diabetes to reduce your risk for the disease. That’s the advice offered from Shenandoah Medical Center (SMC) dietician Kay Wing. “Managing diabetes is like flying an airplane. You need both wings to keep balanced. One wing represents physical activity, and the other wing is healthy eating. Both of those things have to come into play,” Wing said. Diabetes affects how the body uses glucose, the main type of sugar in blood. Glucose, which comes from the foods we eat, is the major source of energy needed to fuel the body’s functions. To use glucose, the body needs Kay Wing the hormone insulin. But in people with diabetes, the body either can’t make insulin or the insulin doesn’t work in the body like it should. The health expert is offering more advice on how to stay healthy: Know your number. Wing encourages people to have regular check-ups. “When diabetes is caught in the early stages, it’s like cancer – early detection can prevent complications. So, getting that regular blood test is important,” she said. A healthy lifestyle can help prevent or delay the onset of Type 2 diabetes, even



though some cases cannot be prevented. Lighten up. Wing offered this tip to determine diabetes risk: “People can look on a website and determine what their body mass index is. If it’s greater than 27 they might consider a weight loss of 10 to 20 pounds. Usually the overweight status needs to change a little bit to come from the pre-diabetes range into the normal range,” said Wing. Being overweight increases the risk for Type 2 diabetes and a scores of other health problems such as heart disease and stroke. That said, Wing discourages losing weight with a fad diet plan, “because they usually don’t teach you a moderate and healthy way of eating. The ones that provide all the food groups and just recommend a balance and fewer calories are the ones you want to choose,” Wing said. “I don’t put people on diets. I recommend people cut back by 100 calories a day. That can be as simple as substituting fruit for a brownie or chips. The thing that’s made the most difference in some of my gestational diabetes clients is eliminating sugary drinks,” Wing said. “Instead, drink flavored or unflavored water, coffee, or unsweetened tea. If your favorite food is a Snickers candy bar, then you tell yourself you’re never going to eat another one, it stresses out the body. Just eat them in moderation, in smaller portions – less often.” Factor in fiber. Adding more fiber to your diet is another way to prevent or delay the onset of type 2 diabetes. Many foods include fiber; that includes beans, fruits, nuts, and vegetables. “A cup of berries has about eight times the fiber of a piece of fudge,” Wing said,

adding that berries are a healthier choice also because the calories are less than fudge or salty foods. Fiber also makes the stomach feel fuller which reduces the likelihood of overeating. Fiber helps the body control its blood sugar levels and can lower the risk of heart disease. Increase fruit and vegetable intake; avoid refined carbohydrates. Diets high in refined carbohydrates have been shown to increase a person’s risk of diabetes, while additional studies have stated that diets rich in whole grains protect the body against diabetes. Get moving. Physical activity can be increased easily, said Wing. “Even for older adults, increased activity can be as simple as finding a route to walk around your house; walk during commer-

cials if you’re watching TV. Use soup cans as weights to move your arms around in different ways while you’re watching TV. Any extra activity helps,” Wing said. Type 1 diabetes can’t be prevented. No one knows for sure what causes type 1 diabetes – nor do they know with certainty who will get diabetes. But Wing said genetics or environmental triggers, like a serious illness, can prompt the gene to go into diabetes. “Type 2 has a strong genetic component, but can be delayed. If you live long enough, anything can happen; the 80 year olds who are getting diabetes could have had it at age 50, but kept it down with exercise,” she said. There’s no reliable way to predict who see DIABETES, Page 15



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Did You Know?

Diabetes is a chronic disease marked by high levels of blood glucose (sugar). These high blood glucose levels are a result of defects in insulin production or insulin action. There are two different types of diabetes: Type 1 Diabetes- autoimmune reaction in which the body no longer produces its own insulin. Usually strikes in childhood, adolescence or young adulthood and lasts a lifetime. People with type 1 diabetes have to take multiple insulin injections daily or use insulin pumps; they cannot take oral medications because their body does not produce any insulin. Type 2 Diabetes- the body makes insulin, but does not use it properly. Previously referred to as adult-onset diabetes because it was usually diagnosed in adulthood, but because of increased obesity it is being diagnosed more and more in children and young adults. According to Megan Roberts, RN and Diabetes Educator at Clarinda Regional Health Center, â&#x20AC;&#x153;the process of type 2 diabetes can be thought of like a lock and key. Insulin acts as a key to unlock our cells, allowing sugar to enter. When insulin does not work properly, cells cannot be unlocked, and in turn, blood sugars rise.â&#x20AC;? According to the ADA, nearly 26 million children and adults in the U.S. have diabetes. Another 79 million Americans have pre-diabetes and are at risk for developing Type 2 diabetes. The Iowa Department of Public Health reports that In Iowa alone, 42% of adults (950,000 Iowans) now have diabetes or pre-diabetes--- 7%-8% of have diagnosed diabetes(174,000); 4%-5% have undiagnosed diabetes(120,000); and 32% have pre-diabetes (670,000). The Center for Disease Control shows Page County is no exception- as of 2009, between 9â&#x20AC;&#x201D;11% of adults (about 1,500 people) have been diagnosed with diabetes. The ADA estimates the cost of diagnosed diabetes in the US is approximately $245 billion. Diabetes can create eye see DID YOU KNOW, Page 12

Keeping weight off once itâ&#x20AC;&#x2122;s gone Losing weight can be a life-changing event. For some men and women, the desire to lose weight is largely cosmetic, while others must lose weight for medical reasons. Regardless of the reason behind a personâ&#x20AC;&#x2122;s desire to lose weight, setting and achieving such a goal is an accomplishment to be proud of. As difficult as losing weight can be, men and women often find it even more difficult to keep that weight off once itâ&#x20AC;&#x2122;s gone. But maintaining a healthy weight does not have to be so difficult, especially when people can apply the same effort and discipline to keeping weight off that they did to losing weight. The following are a few additional tips to help men and women maintain a healthy weight. n Exercise daily. Exercise plays a significant role in many peopleâ&#x20AC;&#x2122;s weight-loss efforts, and men and women should continue to emphasize exercise as they work to maintain their weight loss. An exercise regimen that helped you lose weight can be just as effective as you work to keep that weight off. Aerobic and strength-training exercise can help men and women maintain a healthy weight while reducing their risk for various diseases, including heart disease. Strength training exercise can be especially important for men and women as they age, as such exercise helps maintain bone health and reduce the risk of osteoporosis. n Continue to monitor eating habits. Once the weight has been lost, that does not mean you can return to your pre-weight loss diet. After those

excess pounds have disappeared, continue to watch what you eat, avoiding foods that are high in fat and sugar. In addition, continue to control your food portions to avoid overindulging. Portion control can go a long way toward helping men and women keep weight off, and how much you eat should be considered nearly as important as what youâ&#x20AC;&#x2122;re eating. n Enlist the help of others. Many people enlist the help of family and friends as they attempt to lose weight. Immediate family members, in particular, tend to play a significant role in such efforts, acting as a daily support system and even, on occasion, serving as the â&#x20AC;&#x153;food policeâ&#x20AC;? when men and women veer off course of their healthy diets. Such support can be just as valuable as you work to maintain your weight loss. If you worked out on the buddy system on your way to losing weight, continue to do so. If your family adopted a healthy diet to help make things easier on you during your weight-loss efforts, continue to eat such healthy foods as a family, which can only pay dividends for everyone in the long run. n Expect some setbacks, but donâ&#x20AC;&#x2122;t accept them. Just like there were setbacks on your road to losing weight, there will be setbacks as you try to maintain that weight loss. Such setbacks are to be expected, but theyâ&#x20AC;&#x2122;re much easier to accept when youâ&#x20AC;&#x2122;re already at a healthy weight than they were when you were overweight. But when you accept setbacks and donâ&#x20AC;&#x2122;t work to avoid more, all that hard work losing weight could end up being for

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DID YOU KNOW Continued from Page 10

problems, affect foot health, oral health, hypertension, hearing loss, mental health and much more. Over the years, as awareness of Diabetes has come to national attention, so have many misinterpretations and ‘myths’ associated with Diabetes. Here are a few…  Myth: “Diabetes is not that serious of a disease, I feel fine.” Fact: Diabetes is a growing epidemic with a devastating physical, emotional and financial toll on our country. Diabetes causes more deaths per year than breast cancer and AIDs combined. 2 out of 3 people with Diabetes die from either heart disease or stroke.  Myth: “It’s possible to have ‘just a touch’ or ‘a little’ Diabetes.” Fact: There is no such thing as ‘just a touch or ‘a little’ Diabetes, you either have Diabetes or you don’t.  Myth: “You have to lose a lot of weight for your Diabetes to improve.” Fact: Losing just 7% of total body weight can offer significant health benefits- about 15 pounds if you weigh 200.  Myth: “I can’t eat sweets on a diabetic diet.” Fact: People with diabetes can still enjoy the foods they love. Portion sizes are important to keep blood sugars in check.  Myth: “Eating too much sugar causes diabetes.” Fact: Eating high-sugar foods is not directly linked to the development of diabetes. However, eating too many sugary foods can lead to weight gain, which does increase your chance for developing diabetes. Questions? Contact the Clarinda Regional Health Center Diabetes Education team: Megan Roberts, RN 712-542-8263 or Melisa Baier, RD, LD 712-542-8303

Why do we need fiber? Many food products boast added fiber on their packaging. Breads, cookies, beverages, and so much more contain extra fiber in response to the public’s growing desire to consume foods with high levels of dietary fiber, which medical professionals claim is an essential element to a healthy diet. Despite that publicity, many consumers remain in the dark about the role fiber plays in the body. ABOUT FIBER Many people are aware of the importance of including fiber in the diet, but few people understand the importance of dietary fiber. Fiber is an essentially indigestible substance that is found mainly in the outer layers of plants. Fiber will pass through the human digestive system virtually unchanged from when it was consumed and without being broken down into nutrients. Fiber is classified into two types: insoluble fiber, which will not dissolve in water, and soluble fiber, which can be dissolved. Insoluble fiber is typically found in whole grain products, dark leafy vegetables, green beans, wheat bran, corn bran, seeds, nuts, and skins of fruits and vegetables. Soluble fiber comes from foods like oats, nuts, fruits, and dried beans. FIBER AND DIGESTION Fiber is essential to digestion. The Harvard School of Medical Health advises people should get between 20 to 30 grams of fiber each day, though many people do not consume that much fiber. Fiber adds bulk in the digestive system, which helps soften stool and flush out the intestines. It assists in making bowel

movements more frequent, preventing constipation. A diet high in fiber helps reduce the risk for hemorrhoids and diverticular disease. FIBER AND WEIGHT LOSS While fiber is often associated with improving regularity, that is not its only role. Fiber, particularly soluble fiber, that can be slowly digested will prolong the digestive process, helping to keep the stomach fuller longer. Feeling full can help a person eat healthy portions. Fiberrich foods are also less calorie-dense. This means you can eat more and feel fuller without consuming tons of calories. Increasing fiber consumption may help men and women looking to lose weight.

FIBER AND BLOOD SUGAR The slow absorption of carbohydrates also regulates the absorption of sugar into the bloodstream. This can prevent sugar spikes that may be dangerous to those with diabetes. It also may be able to help reduce the risk of developing type 2 diabetes, according to a study published in the New England Journal of Medicine in May 2000. FIBER AND CHOLESTEROL Soluble fiber has been shown to help lower blood cholesterol concentrations by decreasing the absorption of cholesterol and bile acids in the small intestines. When less bile acid is absorbed, see FIBER, Page 14

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Workplace Wellness Everyone would like to be as healthy as they can be so that they can do the things they want to do. Today we are hearing buzz words such as wellness, lifestyle changes and personal accountability. Everyone seems to have a stake in our health and wellness as a community. This includes not only health care organizations and providers but also communities, schools, insurers, and employers. Clarinda Regional Health Center (CRHC) has been involved in promoting health and wellness for many years. Activities such as health fairs, health education, medical screenings, weight management programs, wellness newsletters, and community educational programs have helped the citizens of Clarinda and the surrounding area to maintain a healthy profile. CRHC expanded our efforts in this area with the implementation of a Workplace Wellness program that is offered to local employers. Along with the traditional health fairs and medical screening, a Wellness Coaching Program was added to the offering. CRHC has seven (7) Clinical Health Coaches that work with individuals in the workplace to assist them in setting personal health and wellness goals and helping them meet those goals. We help them set realistic achievable health goals, encourage participation in various activities from lunch ‘n’ learns, running or walking in 5/K or larger races, using our gym or the Lied Center group activities, getting a massage to name a few. One of the benefits that the employer receives is a healthier work force. CRHC also assists local and regional employers with their Occupational Health programs. This may include keeping immunization records up to date, managing workers compensation injuries and managing a Workplace Wellness Program. CRHC also works with the community as a whole by organizing Health Fairs for different businesses and an annual Community Health Fair with labs being done in April and the Health Fair and 5/K walk/run the first Saturday in May. During flu season we also organize flu clinics for different businesses to make it easier for their employees to get the flu vaccine. CRHC works with employers by providing pre-employment physical testing and drug and alcohol testing. CRHC has four employees trained to administer the Physical Capacity Profile® (PCP) test. The test matches physical abilities to the physical demands of a job. This helps employers reduce injuries by ensuring employees have the physical strength to safely perform their job responsibilities. It documents impairments that the employee brings with them to the workplace, per the American Medical Association Guidelines, and it provides pre-injury baseline measurements allowing treating professionals to expedite the rehabilitation process. Regardless of your definition of health and wellness, CRHC is dedicated to assisting all of our clients in achieving their health and wellness goals.

(712) 542-2176 or (800) 682-7920 %SSIE$AVISON$RIVEs#LARINDA )!

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Office Based Clinic Health Coach: CRHC Key to Exceptional Care During 2013, Clarinda Regional Health Center and Clarinda Medical Associates became the first health care provider in Page County to offer the services of a specially-trained health coach to patients dealing with chronic conditions. Over the past few years, the health professionals at Clarinda Medical Associates has seen the number of patients with a chronic grow and knew they wanted to partner with the patients to better manage the disease process. Primary care of the past was designed for acute episode care, rather than chronic and preventative care. The prevalence of chronic diseases is shaping the health care future of Iowa. People with chronic diseases such as hypertension, diabetes, COPD and others will benefit from a model of care that anticipates a patient’s needs. Chasing the problems of chronic disease has not proven to be effective in improving outcomes of patients with diabetes and hypertension. The focus of the present is on patient-centered medical care. This approach partners provider and patient. Patient centered care is all about empowerment of patients and collaboration of resources to teach patients about their chronic disease and self-management. Specialists, home health care, nursing homes, diabetic educators, dietitians, wellness experts, and others are brought into patient involvement by the primary care provider. A team approach helps patients learn about their disease and to take responsibility in achieving good health. Patient-centered medical care places an emphasis on respect of a patient’s preferences, needs, and values. This respect is what makes the patient the center of his medical care. Studies have shown that better outcomes are achieved when patients get regular assessments of how they are doing; receive evidenced-based clinical management, and are given ongoing support for self-management. Clarinda Medical Associates has added Jayne Cabeen, RN to this medical team. Jayne has taken the position of Clinic Health Coach. Jayne will communicate with patients directly and let them know what steps they need to take to improve their chronic disease. She is currently focusing on diabetic patients. Jayne uses physician-directed standards of care to encourage patients to be diligent in follow up of their disease. As a physician office based health coach, Jayne helps to manage the increasing number of patients with a chronic condition by following lab results, overseeing the disease registry and communicating with nurses and providers about what needs to happen with each patient in order to improve clinical outcomes. Jayne helps providers have a planned and productive visit. Jayne coordinates care across the care continuum, making referrals to other resources as needed. Jayne Cabeen will assist our patients in developing a plan, one step at a time to improve the outcome of their disease. Her constant follow up of our patients will go a long distance in assuring eventual success in the management of chronic disease patients. The entire medical staff and support team of nurses at Clarinda Medical Associates are excited about having this new resource. It is reassuring to know that by coordinating care and by working together as a team all CMA patients are being well taken care. Diabetes is a defined as a disease characterized by high blood sugar levels that result from defects in the body’s ability to produce and/or use insulin. It is estimated that 8.3% of the US population have diabetes. Co-Morbidities of hypertension and heart disease affect a predominance of diabetic patients. Untreated diabetes is the leading cause of blindness and kidney failure. More recently, health care experts have placed increased emphasis on healthy lifestyle choices and careful glucose monitoring. Routine follow up care to assess for change in treatment has become a standard of care in the diabetic patient. Changes in exercise and eating choices that lead to modest weight loss have proven to lower diabetes and heart risks, leading to a healthier and longer life.

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Continued from Page 12

the body must use stored cholesterol to make more, lowering blood cholesterol as a result. The American Heart Association reports greater reductions in low-density lipoprotein, or LDL, cholesterol among people who consume diets high in soluble fiber compared to diets low in saturated fat and cholesterol alone. HOW TO INCREASE FIBER CONSUMPTION While many products include added fiber, here are some of the best ways to increase the number of grams of fiber consumed on a daily basis. ď Ž Eat more bran, as bran has the highest fiber content of any food at about 25 to 45 percent. ď Ž Consume whole fruit instead of juice. Whole fruits have more fiber in them and fewer calories than juices. Eating fruit can help you to feel fuller longer. ď Ž Pass up on refined flours. Opt for whole grains whenever eating bread, cereal and baked goods. Try to aim for grains that have at least three grams of fiber per serving. ď Ž Increase your consumption of beans. Beans are relatively inexpensive, filling and tasty. Plus, they pack a great deal of fiber, protein and other important nutrients. ď Ž Take a fiber supplement if you feel you are not getting enough fiber in your daily diet. Gummy fiber chews can be tasty ways to get fiber. ď Ž Opt for fresh fruit and vegetables for snacks over processed foods.


Routine checkup schedule for women While there are many health screenings relevant to both men and women, there are also tests specific to each gender. Two of the more important routine screenings women should be aware of are regular mammograms and pap tests, which can both diagnose risk factors for certain types of cancer. MAMMOGRAM A mammogram consists of X-ray pictures of the breasts and is used to detect irregularities in breast tissue that may reveal the presence of cancerous tumors. Screenings also might detect microcalcifications that can sometimes indicate breast cancer as well. The Centers for Disease Control and Prevention says that 40,678 breast cancer deaths occurred in 2009 and that 26 out of every 100,000 females will die from breast cancer. Most organizations, including the National Cancer Institute, recommend that women age 40 and over have a mammogram done every one to two years to help catch cancer early, which improves a womanâ&#x20AC;&#x2122;s chance of survival. However, not every woman is routinely getting screened. In the United States, roughly 68 percent of women have gotten mammograms within the last two years, according to the CDC. Although mammograms require small doses of radiation, which can cause cancer, to take the images, the benefits nearly always outweigh the risks. It is recommended that women age 35 to 39 get a baseline mammogram so they have an image of the healthy breast to which future mammograms can be compared.

Women are advised to get routine examinations, including pap tests and mammograms.

PAP TESTS A pap test, also known as a pap smear, is a diagnostic tool that checks for cellular changes in the cervix. The cervix serves as a barrier point between the vagina and the uterus. The pap test is usually done in a gynecologistâ&#x20AC;&#x2122;s office, although family practitioners also may administer it in their own offices. The doctor will insert a speculum into the vagina to widen the passageway so he or she can see the cervix. He or she then will take a sample of cells from inside and outside the cervix and send them to a laboratory for testing. It is recommended that a woman refrain from sexual activity prior to her pap test. Itâ&#x20AC;&#x2122;s also best if a woman does not use any lubricants, cleansers or medications that are used intravaginally before the test. Also, she should not use tampons. In fact, those who have their menstrual period will want to reschedule the pap because it can be difficult for a doctor to get a good collection of cells for testing. The frequency of pap tests will be determined by the womanâ&#x20AC;&#x2122;s age, results

of prior pap tests, medical history, and history of the human papilloma virus, or HPV. Many women get annual pap tests starting at age 21 or when they first become sexually active. Those who have had normal results for at least three years in a row

may opt to get tested every two or three years. Women who are age 65 or older may be able to cease pap tests, but annual pelvic exams are still advised. For those who have had a hysterectomym which involves the removal of the uterus, pap tests are

still necessary. However, after a total hysterectomy (removal of the uterus and cervix), pap tests may stop. Pap tests are not always 100 percent accurate, however. False positive and false negative results can happen. The doctor may require a different type of test if a pap test comes back with a positive result. To remain healthy, women are advised to keep up with routine physicals and tests that can help diagnose cervical and breast cancer in their early stages. If lack of medical insurance is preventing a woman from being tested, she can contact the National Breast and Cervical Cancer Early Detection Program to find programs that offer free or low-cost pap tests to women in need.


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foods and beverages they will need to avoid until they have instituted the diet. For example, a gluten-free diet excludes any beverages that contain barley, meaning beer cannot be part of a gluten-free diet. Though many gluten-free beers are now on the market, beer afficionados may find such alternatives cannot compare to the real thing. Rye and wheat products also must be avoided, and these include products whose labels list bulgur, durum flour, farina, gra-

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during the manufacturing process when gluten-free foods come into contain with foods that contain gluten. Manufacturers typically include the phrase â&#x20AC;&#x153;may containâ&#x20AC;? on labels as a warning to consumers looking to avoid gluten and other ingredients. When labels include this phrase, thereâ&#x20AC;&#x2122;s a strong chance that cross-contamination has occurred, and such products should be avoided by men and women on gluten-free diets. â&#x20AC;&#x153;For people with celiac disease, the best treatment is to avoid gluten-containing foods for the rest of their lives,â&#x20AC;? Gilmore said. Cross-contamination also can occur when gluten-free foods are prepared on the same surfaces as foods containing gluten. For

example, toasting gluten-free bread in the same toaster as regular bread can easily lead to contamination. Preventing cross-contamination can be a difficult task, and that difficulty merits consideration by people who want to adopt a gluten-free diet. A gluten-free diet may lead to a vitamin and nutrient deficiency. Grains are often rich in vitamins, and avoiding grains as part of a gluten-free diet can deprive men and women of these vitamins, weakening their bodies as a result. When adopting a glutenfree diet, speak with a dietitian to ensure your diet has enough iron, calcium, fiber, thiamin, riboflavin, niacin, and folate. If the diet is lacking, you will need to make adjustments.


healthy eating plan. Wing encourages members of the community to plan on attending the SMCâ&#x20AC;&#x2122;s annual health fair on Saturday March 29. Wing has been serving as a dietician at SMC since 1975. Wing was instrumental in establishing the SMC Diabetes Self Management Program in September 2000. The program recently received an Education Recognition Certificate from the American Diabetes Association. Since starting the Self Management Education Program, this is the fourth time the ADA has awarded SMC the certificate. For more information, visit

Continued from Page 8

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will get Type 1 diabetes, said Wing, but blood tests can detect early signs of it. â&#x20AC;&#x153;We always want two numbers in the diabetic range before we give people a diagnosis of diabetes in case there was a stress on your body. Itâ&#x20AC;&#x2122;s like gestational diabetes â&#x20AC;&#x201C; the body is under a lot of stress. But when the woman delivers the baby, their body goes back to normal in 90 percent of the cases,â&#x20AC;? Wing said. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s such a complex disease â&#x20AC;&#x201C; seek out a health care professional for helpâ&#x20AC;Śespecially a registered dietitian for a

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ham flour, kamut, semolina, and spelt among their ingredients. Though there are now many gluten-free foods on the market, unless labels say gluten-free, the following are a handful of products that should be avoided: Breads, cakes and pies, cereals, croutons, French fries, pastas, salad dressings, soy sauce, soups Many doctors also recommend men and women on a gluten-free diet avoid oats, as they can easily be contaminated with wheat during the growing and processing stages of production. Be mindful of the dangers of cross-contamination. Cross-contamination can occur




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Health Perspective - January 2014  
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