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Healthcare November 2012 Edition

Diabetes

Prevention

State-of-the-art Medical Technology Healthy Habits Exercise & More

Local Advancements in Cancer Care www.dardenpublishing.net

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Healthcare features

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Cover Story

Diabetes Prevention

Learn how you can reduce your risk for developing type 2 diabetes.

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Small Steps for your Health Experts tell us what to do to get to and stay at a

healthy weight and prevent type 2 diabetes.

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5 Things All People with Diabetes Need to Know

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How Did Diabetes become a National Epidemic? Q & A with Dr. Sheri Colberg-Ochs

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State-of-the-Art Cancer Care Locally, the latest advancements in cancer screenings

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and the latest diagnostic tools are available, including 64-slice CT scanners, PET scans, and MRI machines. The latest therapy options include focused-beam radiation and a Gamma Knife速 center, and there are plans for a new linear accelerator.

State-of-the-Art Technology Hampton Roads is home to at least two exceptional pieces of technology aiding in advanced cancer care: the Gamma Knife速 and proton beam therapy.

departments

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Nutrition and Wellness

Healthy Habits

Diabetes & Exercise

Healthcare in Hampton Roads

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From the Publisher

Hello Neighbors

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his edition is dedicated to my immediate family, friends and their family members and to everyone that may know someone struggling with diabetes or cancer. I hope the information provided will help us all understand the trauma and discipline required as we live with, or try to prevent these diseases. It was May 1982 when Mom called and said “help me take your father to the hospital”. When I arrived, his right leg was black from the knee to his toes. He died on May 10, 1982 at the age of 67 from complications of obesity, diabetes and a stroke. Born on a farm in Isle of Wight County with 9 siblings, he maintained a life believing that family values and hard work would endure the hardships life may bring. Although he grew his own fruits and vegetables for our family of 6, worked as a carpenter with extensive long hours, and tried to eat sensibly… he could not overcome his illness of diabetes. Today, my mother at the age of 92 is under diabetes medications; my older brother and I are border diabetics and I have several friends that have similar issues. My wife and I have also lost several of our closest friends to cancer. What did we do wrong? We all knew the risks of the diseases, yet somehow life’s traumas were too much to endure. Can you relate to this scenario? As an aging senior trying to maintain an active lifestyle, I wake up some mornings unable to rise and shine like I did 30 years ago. Without our support group of friends, it may be difficult to eat properly or maintain our habitual exercise programs. As baby boomers, it takes a daily conscious effort to keep our mind and muscles active, after all, we want to be able to enjoy every day for as long as we can. Sitting on the couch, watching TV is no way to avoid our pain. I have lost many friends in the blink of an eye. There are no guarantees in life…that we will wake up tomorrow to share and remember our life’s adventures with the love of our family and friends.

www.HRHealth.net www.MDNews.com

PUBLISHER

Paul Quillin Darden Copy Editor

Jackie Nelson Darden ART DIRECTOR

Sherril Schmitz CONTRIBUTING WRITERS

LeAnne Rains Benedetto Mark & Marti Carrier Brian Cole Paul Darden Natalie Miller Moore

©Copyright 2012 by Darden Publishing. The information herein has been obtained from sources believed to be reliable: however, Darden Publishing makes no warranty to the accuracy or reliability of this information.

Healthcare in Hampton Roads is our publication with a mission to spread the word about local health awards, accolades and quality of healthcare now available for people of all ages. I see it every day when I walk among the sick and listen to their stories of how our health professionals from Hampton Roads saved a life or recommended a new procedure that put bounce back in their step. In upcoming editions we will present national health concerns in a way that you can understand and hopefully share your new found knowledge with family and friends so we all can live longer, healthier lives with confidence that we are in good hands right here in Hampton Roads. NEXT UP: CARDIAC, OBESITY AND WEIGHT MANAGEMENT

Healthcare in Hampton Roads is a bi-annual publication with current distribution to area Chambers of Commerce, and a delivery program to selected health related businesses throughout Hampton Roads. To obtain a copy or to find a location nearest you, please contact: DARDEN PUBLISHING 931 A Shoal Creek Trail Chesapeake, Virginia 23320-9483

To Your Good Health!

(757) 389-5473 darden.publishing@cox.net www.dardenpublishing.net

Paul Q. Darden, Publisher

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You can reduce your risk for developing type 2 diabetes. In this article you will learn how you can take small steps to change your diet, increase your level of physical activity, and maintain a healthy weight. With these positive steps, you can stay healthier longer and reduce your risk of diabetes. Before people develop type 2 diabetes, they almost always have “prediabetes” — blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes. The good news is there are things you can do to prevent or delay the development of type 2 diabetes. While diabetes and prediabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others. Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing prediabetes.

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Diabetes Prevention from the American Diabetes Association


o high blood pressure o low HDL cholesterol and high triglycerides o a family history of diabetes o a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds o belonging to an ethnic or minority group at high risk for diabetes

Eating well to maintain a healthy weight is one of the most important things you can do to lower your risk for type 2 diabetes and heart disease. It can seem hard to make healthy food choices, particularly if you are on a budget and short on time. But there are some simple steps you can take to help you and your family eat healthier. Choose 2 or 3 of these suggestions to start today. Then come back another day and try a few more.

Build a Healthier Plate

There are three different tests your doctor can use to determine whether you have prediabetes: • The A1C test • The fasting plasma glucose test (FPG) • or the oral glucose tolerance test (OGTT). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes. If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). Both are also known as prediabetes.

• Use a grocery list when shopping for food to help you choose more fresh vegetables, fruits, and whole grains. • Instead of stressing out about the foods you’re trying not to eat, focus on the foods you need to eat more. Go to www.MyPyramid.gov, find out how many servings of veggies, fruits, and whole grains you need each day, and work on achieving those goals. You’ll be so busy (and so full!) “focusing on the positive” that you won’t even miss that hot fudge sundae. • Buy leaner meats (such as chicken, turkey, and lean cuts of pork or beef such as sirloin or chuck roast) and lower fat dairy products (like low-fat or skim milk and yogurt). • Buy whole grain breads and cereals. • Save money by buying less soda, sweets and chips or other snack foods. • Remember that special “dietetic” or “diabetic” foods often cost extra money and may not be much healthier than simply following the suggestions given here.

Shop Smart • Set aside some time to plan your weekly meals. You

Who Should Get Tested for Pre-Diabetes? • If you are overweight and age 45 or older, you should be checked for prediabetes during your next routine medical office visit. • If your weight is normal and you’re over age 45, you should ask your doctor during a routine office visit if testing is appropriate. • For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or prediabetes, including:

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might want to start with just a few days. It may seem like a hassle at first, but having a plan (and writing your grocery list with it in mind) can save you time, stress, and a lot of extra trips to the store. • Stock your pantry with plenty of healthy basics, including brown rice, whole grain pasta, crackers and cereals. • Remember that fresh fruits and vegetables are usually healthier than canned or frozen, but it is better to have canned or frozen fruits or vegetables than none at all! • When you run out, put the items on your grocery list so you’ll always have them on hand. • Shop only from your grocery list.


• Avoid aisles that contain foods high in calories but low in vitamins and minerals such as candy, cookies, chips and sodas. Also avoid buying items promoted at the front of the store, on the “end-cap” displays at the end of each aisle, or at the cash register. These foods are usually low in nutrition. • Never shop when you are hungry and might be tempted by a less healthy food.

• In restaurants, ask if meats can be grilled rather than fried, and request sauces and dressings on the side. Remember to choose fruit, salad, or other vegetables as side items, rather than French fries. Order a salad or soup to start and then share an entrée. Save money, and lots of calories, by skipping dessert. What else can you do to lower your risk for type 2 diabetes and heart disease? Stay active, don’t smoke, and lose weight, if needed. 

Eat Smart • To cut down on the sodium in canned vegetables, drain and rinse them before heating in fresh water. You can do the same to cut down on added sugar in canned fruits or better yet, buy them packed in juice (not syrup). • Try starting meals with a salad or a broth or tomato- based soup with lots of vegetables. This helps you eat more goodfor-you veggies while filling you up before you get to the higher fat and calorie courses. • Make healthy snack foods easy to find in your kitchen. For example, when you get home from work or school, put some fresh carrots, grapes, or pretzels out on the counter instead of a bag of chips.

New to diabetes?

Online resources from the American Diabetes Association • Visit www.diabetes.org/prediabetes to learn more about managing your prediabetes. • Learn about CheckUp America, the Association’s program to help people lower their risk for type 2 diabetes and heart disease, at www.checkupamerica.org. • For recipes and information about meal planning, see My Food Advisor™, an online tool, at www. diabetes.org/MyFoodAdvisor.

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Healthcare in Hampton Roads

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Small Steps for your Health There are many things the “experts” tell us to do to get to and stay at a healthy weight and prevent type 2 diabetes: Choose healthy foods, make healthy meals, be active 30 minutes a day. But where should you start?

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t’s not easy to do all of this every day living in today’s fastpaced and fast-food world. And it can be even harder if you have a lot of changes you want to make.It’s easier to make lifestyle changes one step at a time—over months and years. Think of each small step as one piece of your effort to change your habits. Making changes one step at a time gives you the best chance to reach and stay at a healthy weight and prevent type 2 diabetes. The good news is that making just a few small changes can have make a big impact on your weight and health. Learn how to make these changes step-by-step.

Goals Realistic

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r the nex s of fruit Eating: Fo t two piece

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I will ea each week, d one as an breakfast an at e n o — c). a day and specifi ack (realistic sn n o o rn afte es I go to a next five tim e Th : g all in Eat ill order a sm aurant, I w st re d o , fo fast hamburger and a single French fries fries and a large French ific). rather than tic and spec urger (realis b am h le b dou r the next active: Fo ly l ica ke a Phys eek, I will ta ays each w d r u d fo , an th mon (realistic k after lunch al w te u in 15 m specific).

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Is your health at risk? People around you may tell you that you have a problem with your weight or health. But what do you think? If you don’t believe you have a problem, you will probably not want to make changes. You may even resent or be angry at the people pushing you to change. If you do think you have a problem, you will probably succeed. Step number one: accept that you have habits you need to change.

Are you ready, willing, and able to change? To succeed at making lifestyle changes you need to answer YES to the question, “Are you ready, willing, and able to change?” The experts say that for people to change, making the change must be important to them. In other words, you must have good reasons to change. For example, maybe you want to live long enough to see your grandchildren grow up. You must have more 6

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reasons to change than reasons not to change. The experts also say that you must be confident—believe that you can change. To succeed, take what you want to do and break it down into small steps. Then think about a few things you are ready, willing, and able to change. Leave other habits that you don’t feel ready, willing, and able to change for another time.

What are you ready, willing, and able to change? To answer this next question, think about your current eating and activity habits. What foods do you buy? How active are you? Try to keep honest food records for a few days to get a true picture of what you eat. Based on your current habits, start with a few changes that are easy to tackle. Pick some changes that you want to do the most, and that will make the biggest impact. Perhaps choose one change in your eating habits and another in activity. Remember; don’t try to change everything at once. For example, maybe you tend to eat a bowl of ice cream every night while you watch TV. Can you switch that ice cream to a healthier snack? Maybe fruit or a small bowl of cereal? Or just a smaller portion of ice cream. And can you take a 15 minute break from the TV and go for a walk?

For each goal, think about four things: 1. How long will you try to reach this goal? Keep it short. 2. Is it easy to do in your regular daily life? Keep it realistic. 3. Is it limited in scope? Be specific. 4. How often will you do this?

Keep your goals realistic. Don’t try to do too much too quickly. Let’s look at three examples of realistic goals. 1. Eating: For the next month (how long), four days each week (how often) I will eat two pieces of fruit a day – one at breakfast and one as an afternoon snack. (realistic and specific). 2. Eating: The next five times (how long) I go to a fast food restaurant (how often), I will order a small French fries and a single hamburger, rather than large French fries and a double hamburger (realistic and specific).


3. Physically active: For the next month (how long), four days each week (how often) I will take a 15 minute walk after lunch (realistic and specific). Notice that the eating goals are not “I will eat more fruit” or “I will eat healthier.” The activity goal is not “I’ll walk more.” These goals aren’t specific like the examples above. Set 1 to 3 goals at a time. Write them down. Put them in a place where you will see them often -- on the refrigerator, your bathroom or bedroom mirror, or in your purse or wallet. Get more realistic tips on changing your eating habits or learn more about physical activity.

Did you succeed? The last step is to see how you did at making the change. Once the time you set is over, look at the goals you set. Ask yourself these questions: Did you succeed? Did you set your sights too high? Did something happen in your life to keep you from being successful? If you were successful, give yourself a BIG pat on the back. (Or maybe a trip to the movies!) Wait, you are not done! Making a change for two weeks or a month does not mean that it will stick for life. It’s so easy to slip back to your old ways. Practice the new habits faithfully. It will take months before they become your way of life. If you weren’t successful, try again. Revise your goals or choose easier ones. Make sure they contain the four parts of setting a goal that’s within reach. Make sure you want to make changes in this area and that you believe you can.

What is your next step? Start the lifestyle change cycle again. Choose some new goals to work on. Slowly, goal by goal, over time you’ll be eating healthier and being more active... and you’ll be at a healthier weight. You’ll also be on your road to preventing or delaying type 2 diabetes.

Healthcare in Hampton Roads

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The

Things All People with Diabetes Need to Know

By LeAnne Rains Benedetto

Do you want to know what annoys me most about having diabetes? The doctors and nurses telling me what to do and how I should feel usually do not have diabetes. I am certainly not wishing it on them. The doctors, nurses and nutritionists I work with care deeply about their patients and are dedicated to our care. But it’s hard to tell my doctor the insulin I am taking sometimes makes my ankles swell giving me “cankles” so I can’t wear my cute shoes with my cute skirt. Of course it’s vain. Of course taking my life-saving insulin so I can function is more important than concerns about a muffin-top hanging over my shoes. But I am certain if just one of the medical professionals treating me had this same problem, there would be a solution. Or at least we could have a discussion in which I don’t sound so ridiculous. Managing diabetes is all in the details. And only people with diabetes can truly understand the challenges that face them each day. So I have created a website where people with diabetes can have a candid conversation about what works and what does not in their daily lives. I was diagnosed with Type 1 diabetes on my birthday in 2009. I will be the first to tell you the journey since then has been messy. I don’t yet have it all figured out. But there are 5 things I can tell you I know for sure.

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BREAKFAST WILL SAVE YOU OR SINK YOU First of all, you are eating breakfast right? For people with diabetes breakfast is critical for blood sugar management. I have found if I get this meal wrong I am a mess for the rest of the day. I don’t care how healthy you make a pancake, bagel, waffle, cereal or oatmeal. I can never seem to take enough insulin to cover high-carb meals like this. And if I do get it right, I blow up like a balloon. I have to eat low-carb in the morning. That means a protein (eggs, soy burger, ham, unsweetened yogurt, cheese or hummus) and veggies (spinach, red or yellow peppers, broccoli, etc.). A spinach and feta cheese omelet, peppers dipped in hummus

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or plain yogurt and a few blueberries if I am in a rush are the options that keep my blood sugar steady all morning. I am speaking for myself here. If you have figured out a way to eat oatmeal without taking a boatload of insulin and putting on about 5 pounds overnight, please let me know!

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EXERCISE IS NOT OPTIONAL These are the words of Oprah’s fitness guru, Bob Greene. During a particularly horrifying Oprah show about the ravages of diabetes, Bob Greene told a group of prediabetic and diabetic church-ladies huffing and puffing on treadmills that their excuses about exercise were behind them. There was a lot of grimacing and eye rolling. But exercise is not optional. I know this from my own personal experience. I am a good diabetic when I am exercising and a bad diabetic when I am not. It’s just that simple. When I exercise I am forced to take my insulin on a more disciplined schedule (or I won’t have the energy to exercise). My mind is clearer, my eating is better (that whole energy thing again) and I have more internal strength to handle stress. The occasional neuropathy in my feet disappears completely, and my need for insulin is cut in half. If I go just 2 days without exercise my insulin needs shoot up immediately. I get up at 4:30 in the morning to make this happen before life gets in the way. Do what you have to do because exercise is not optional.

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PUT YOUR MONEY WHERE YOUR MOUTH IS Once you are diagnosed with diabetes you need to pay attention to your kidneys for fear of failure, your eyes for fear of going blind, your limbs for fear of losing them and your heart for fear of a stroke or heart attack. If that is not enough to worry about, let me tell you another critical part of your body that needs immediate attention. Your mouth! I ended up with undiagnosed and untreated dry mouth for more than a year. Now I am paying a terrible price. Make sure your dentist knows you have diabetes, make sure your dental care improves dramatically, (sometimes insurance will cover 2 cleanings a year) and make sure you are going to a dentist who understands what diabetes can do to your


gums and pearly whites. Just picturing false teeth fizzing in a glass near your sink should be a motivator.

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DON’T DRINK IT OR EAT IT IF YOU DON’T KNOW WHAT IS IN IT It’s the question all people with diabetes secretly, or openly, hate, “Should you be eating/drinking that?” Of course they should not ask it, especially in front of all those people at the buffet table. But truth be told, you probably should not be eating/drinking it. There are so many “landmines” out there for diabetics. The bottled ice tea that, are you kidding me, has 60 grams of sugar. The Thai sauce on those veggies with a hint of sweetness that sends my blood sugar to 500 within an hour. Now, I rarely eat anything without a thorough examination of the nutrition label. And when going out to eat I hit the restaurant website for nutrition facts to determine what I can and cannot eat or ask the establishment for those facts. Restaurants rely on sugar, fat and salt to make their food taste so yummy. That is a trio of trouble for people with diabetes.

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YOU CAN NEVER TAKE A DAY OFF DIABETES

Those are the words of the diabetes nutritionist stand-

ing at the foot of my hospital bed in November of 2011. I was in the hospital because I had let my diabetes get out of control. I was not exercising. I was not eating well. I was not sleeping well. Not the best combination when you are working to manage diabetes. Though the nutritionist was one of those non-diabetics telling me what to do, I could see the concern in her face. She knew where I was headed if things did not change. And she was sad for me. Of all the things I know for sure about diabetes, this is the thing that means the most. It guarantees you a longer and healthier life. For more information go to www.healthydiabetic.org.

Award-winning journalist LeAnne Rains Benedetto has reported and produced from newsrooms around the world. She is currently the owner/ operator of LeAnne Rains Productions, LLC, and the Creator, Executive Producer and Host of “The Healthy Diabetic”. LeAnne was diagnosed with Type 1 Diabetes in March of 2009. She lives in Virginia Beach, Virginia, with her husband, 2 daughters and son.

Healthcare in Hampton Roads

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How did Diabetes become a National Epidemic and what can we do to stop it? By LeAnne Rains Benedetto

Dr. Sheri Colberg-Ochs is the most impressive person with diabetes I know. When I was diagnosed with Type 1 diabetes in 2009, I went on a frantic Internet search for stories of hope. I found Sheri. Diagnosed with Type 1 at the age of 4, Dr. Colberg-Ochs is now an author of 8 books, she has a PhD in exercise physiology, she is a professor of exercise science at Old Dominion University in Norfolk, Virginia, and an adjunct professor of Internal Medicine at Eastern Virginia Medical School. I was looking for stories of people who had lived long, healthy lives with diabetes, and I found many of them in her wonderful and inspiring book, 50 Secrets of the Longest Living People with Diabetes. She took time out of her busy schedule to talk with me about the diabetes crisis in America and the simple lifestyle changes that could save and improve millions of lives.

Q: a:

Where does diabetes stand in terms of a crisis in the country right now?

Actually it’s quite dire. The latest statistics from the CDC in 2011 are that 25.8 million Americans have diabetes, both type 1 and type 2, and there are another 79 million people with prediabetes who are at very high risk for developing diabetes.

Q: a:

How did this happen?

I think there are a number of different factors that are coming into play with this rise in diabetes. One of them certainly is environmental. Another thing is the type of lifestyle we live. If you compare now with 20 years ago, you see that most of us are a lot less physically active. That is a key part in the rise in diabetes. Another is just the types of foods we are eating, most of us are eating on the run we are getting meals from take out places or fast food restaurants. And those meals have plenty of calories but they are very low in nutrition. And that lack of vitamins, minerals and essential nutrients may also be a factor that is triggering the rise in diabetes.

Q:

If you could wave a magic wand and change one or two behaviors that would dramatically impact diabetes what would they be?

a:

This is very simple. I would have people stand up more. You don’t really think about standing being a physical activity, but if you stand up for several hours your legs get tired you realize you have been physically active. That alone would help expend a lot of 10

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calories. I would also have everybody become more aware of the foods they are eating. Then maybe you can cut back a little bit on your portion. Little changes can have a big affect. Just to give you an example, lets say you are gaining weight slowly maybe 5 pounds a year. How many calories extra do you think you would have to eat to get there? Not many. Actually to gain 5 pounds of fat in a year you only have to consume about 50 calories extra a day. That is 5 peanut M & Ms. That’s 2 chocolate kisses. I mean that’s not much food to be off. If you do that for five years, you have gained 25 pounds. So lets say we can just tip the balance in the other direction. Now instead of gaining our extra 50 calories a day we are 50 calories lower a day. That means by the end of the year you will have actually lost 5 pounds without even thinking about it. So if you think about where can you cut back 50 calories a day, or where can you do 50 calories more of activity where can you fit that in? Is that taking the stairs instead of the elevator? Is that standing up an extra 2 hours a day? It’s really not that hard to tip the scale in the other direction.

Q:

There are so many medications for diabetes management and still it is such a struggle for so many people. Why?

a:

When you give some one a pill or insulin and say, “Here this is going to manage your diabetes,” it takes the personal responsibility away from you. That pill is only going to work when it is taken in conjunction with a healthy lifestyle. Honestly, a lot of the medications we use for the treatment of diabetes cause weight gain. If you’re trying to manage your weight, which is important when trying to manage diabetes, you are going to get discouraged. And this is for any type of diabetes. Because there are plenty of people out there with Type 1 diabetes who are gaining weight from taking too much insulin, who are developing symptoms of both Type 1 and Type 2 where they get very insulin resistant. Exercise helps lower the amount of insulin you would need to take or the amount of any medication you would need to take to get the same job done. It is the most effective way to enhance the action of insulin in your body, whether it’s injected or natural, and make that insulin work effectively. And it will work after each bout of exercise for up to one to two days. As you train regularly you are going to need less insulin or medication to manage your diabetes.

For more information, go to www.healthydiabetic.org.


State-of-the-Art

Cancer Care

By Natalie Miller Moore

There is an erroneous belief in the Hampton Roads area that if you are diagnosed with something serious, like cancer, you should immediately book a plane ticket and head for Johns Hopkins, the Mayo Clinic or Duke University Health System. Depending on the type of cancer you have, people might tell you to try MD Anderson in Houston or Dana-Farber in Boston. These are all exceptional hospitals. But many people in Hampton Roads may be surprised to see the innovative Hampton Roads and high quality care that’s right here in their backyards. is now home to the

largest proton beam

Locally, the latest advancements in cancer screenings and the latest diagnostic tools are available, including the world, located 64-slice CT scanners, PET scans, and at the Hampton MRI machines. The latest therapy options include focused-beam radiation University Proton and a Gamma Knife center, and there Therapy Institute. are plans for a new linear accelerator. Hampton Roads is now home to the largest proton beam therapy center in the world, located at the Hampton University Proton Therapy Institute. Additionally, clinical trials for chemotherapy are ongoing at sites all over Hampton Roads.

therapy center in

Charlie Hill experienced this in the past decade as he had to deal with cancer several times. His wife was diagnosed with lung cancer in 2001 and passed away in June 2002. Just weeks after her funeral, Charlie got the news that he had prostate cancer. “The lesson from my wife’s cancer was that we didn’t know early enough to prevent metastases,” he said. As a result, Hill embarked on a comprehensive search for information about prostate cancer. He got two local opinions and then went to Johns Hopkins for a third opinion. “At that time, I wanted the gold standard. I researched physicians and selected one who had done at least 200 procedures. I went to Baltimore for the surgery,” Hill said. Healthcare in Hampton Roads

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Hill had done his research, and at the time, what was most important to him were the statistics on who was most experienced in treating prostate cancer. His surgery was deemed successful. But in 2006, Hill had a reoccurrence. He continued to work with his local doctors, including a radiation oncologist from EVMS. Hill found that the cancer care he received locally was the same caliber as what he had traveled to receive. “I was not surprised that advanced care was here. It was just a matter of uncovering what’s here. I knew there were a few people here who had international reputations in urology and prostate cancer, including a doctor who was the president of the American Urological Association, a doctor who personally experienced prostate cancer. I think this further enhanced what can be done for prostate cancer in this area,” Hill said. “I think Hampton Roads should be a national destination for diagnosis and treatment of prostate cancer, but it’s not well understood locally or around the country. I did my research to know this, but lots don’t,” Hill said. Jaime Reigler, marketing specialist from Virginia Oncology Associates, agrees with Hill. “You can stay here and get the best treatment. As a community, it’s all here, care at home, in your backyard. VOA offers state of the art radiology, outpatient cancer care, and numerous clinical trials, including some phase one trials that are cutting-edge medicine. Leeanne Dalton, the Administrative Director of the Bon Secours Oncology Services, said although the perception is that cancer care can be better elsewhere, that option should really be reserved for specific circumstances. “You don’t have to travel to Mayo or Cleveland, unless that is something your provider decides for you. And I truly believe that our doctors are committed to making sure patients get the best care – it’s priority one. But in nine out of 10 cases, I think that patients will find what they need in the Hampton Roads area,” Dalton said. “We have some incredibly skilled expert surgeons, and a lot of them come out of those bigger programs. This area is attracting high-end surgeons, and we have cutting-edge technologies. There are some non-tangible benefits to being able to complete treatment close to home and maintain that hometown support network,” Dalton said. When Sherry Rousselle was diagnosed with breast cancer four years ago, at the age of 36, she was scared but confident in her health care team. “I think the resources here are incredible. I don’t see why

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you’d go somewhere else, unless it’s a rare type of cancer that’s never been treated here,” Rousselle said. She said her experience was well-coordinated and the people who worked with her at Riverside helped her find her way even though she was at times overwhelmed. “The Cancer Care Center is one place for everything,” Rousselle said. “I spent an hour with a nurse who goes over what to expect. And there was nutrition counseling, massage therapist, and counseling. I did all my treatment there. And if you are there for any reason and you have another question about what’s going on, they can help with anything. You can take yoga classes specifically for people going through chemo, learn how to apply makeup when you lose your eyebrows. There are classes all the time.” Rousselle, delighted to be 40 with no evidence of disease, said she’s had time to reflect on her experience. “In four years, I’ve had a lot of time to think. “Would I have done anything different? No, I wouldn’t have,” she said. Rousselle was treated by oncologist Dr. Kim W. Schlesinger, Director of the Breast Cancer Program at Riverside, who said one of her most important goals is “to meet the patient where they are.” That’s one of the benefits of a move toward integrated cancer care. Riverside, as well as other area hospitals, follows an integrated model of cancer care in order to serve patients more holistically. Sofia Mikac, the Integrative Oncology Manager for Peninsula Cancer Institute, named nearly a dozen services that patients can be connected with through the Institute. The center puts all the resources in one place – and you can see that it’s a bit different just from the waiting room. It has trays of cookies, jigsaw puzzles in progress on a table, and quilts decorating the walls. The way people greet each other, both staff and patients, rings of familiarity and caring. “We’re here to focus on the cure, and this is where it all comes together. The treatment of the patient and the family, we are on this journey together,” Mikac said. At the Cancer Institute, the cancer-care team works with patients on education, medication management, and side-effect management. But there are also have staff social workers, dieticians and therapists to assist with other important life issues. For example, social workers can arrange transportation for patients who need it. And access to a dietician means patients can get immediate help improving their diet, and have a resource for later when they may be having side effects that affect their diets. Among other services, the Institute provides massage therapy, stress reduction, yoga, instruction in self-meditation, and psychological counseling.

in Your Own Backyard

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Cancer Conferences All over Hampton Roads, teams of medical professionals are meeting to discuss cases in multi-disciplinary conferences. The surgeons, radiation oncologists, pathologists, radiologists, medical oncologists, dieticians, patient navigators, social workers, and medical residents gather to figure out the best way to proceed or follow up with a cancer case. This means that patients are getting input from a team of experts (effectively second, third, and fourth opinions) on their treatment plans. Sentara’s cancer conferences review most cases, including 100% of head and neck cancers, which, typically, are complicated. Cheri Hinshelwood, of Sentara Corporate Communications, explained that there are 20 cancer conferences covering eight different specialties across Sentara Healthcare, and that it’s a unique situation to be able to have specialty pathologists with experience in those specific cancer types reviewing cases. During the conference, doctors, med students, and staff discuss each case with a “here’s what we know, and here’s what we don’t” approach. They view CT scans, MRI results, pathology slides, video and photos of the patient case and ask each other for input. If there are any relevant factors, such as the patient skipping chemo treatments or dealing with homelessness, they add those to the discussion and brainstorm the best ways to manage that. The goal of the cancer conferences, and similar ones across Hampton Roads, is to assess patients prospectively. That means that a patient case gets scrutiny and attention in the beginning so that the best course of action can be decided. Marc Silverberg, a pathologist for Sentara, said that achieving 100% prospective – rather than retrospective –views on patient cases is “the Holy Grail.” Looking back on what could have been done isn’t nearly as helpful as getting each case in front of the team while there’s still time to treat the cancer. Sentara’s head and neck team is achieving that Holy Grail, reviewing all head and neck cancer cases at their conferences. Photo courtesy of Natalie Miller Moore

Photo courtesy of CHKD

“These are complementary therapies, not alternatives,” Mikac said. “Fear of the unknown, stress, pain, and anxiety are major issues for people dealing with cancer. And if we can help with those, we can help them more effectively complete treatment.” While receiving chemotherapy in the office, patients are made as comfortable as possible, with access to a movie library, and good company in the form of therapy dogs. They also have the talents of a music coordinator, who will put together a customized playlist for each patient — whether they want soothing classical music or energizing rock ‘n’ roll. Research has shown that listening to music can reduce pain and anxiety for patients. “We want our patients to call us whenever they have a question. They sometimes feel like it’s only CHKD tries to make cancer happening to them. We may be able to help, and we treatment as entertaining as possible for their young are available for questions anytime,” Mikac said. patients. The integrated model also includes referrals to even more resources, including those for family members, such as support groups and genetic counseling. These resources combine with advanced medicine to help patients beat cancer. “When I entered oncology, I wanted a field where I could get to know a patient over the longitude of care but one that also had a leading edge to it,” Schlesinger said. Hampton Roads is also lucky to have a resource for children who are diagnosed with cancer at CHKD, the Children’s Hospital of the King’s Daughters. The hospital, located in Norfolk, specializes in care for kids up to age 21. Much of the equipment is designed especially for children, such as the CAT scan with lower radiation settings to avoid giving an adult dose to a small child. The cancer center is also child-friendly – not just in the brightly colored décor – but also in the amenities provided for children who have to be there for cancer treatment. Amya Petrel, age 4, is receiving her chemotherapy via IV while playing video games on a banquette with her brother. Her parents, Carla and John, are nearby. They said Amya has spent a lot of time at CHKD in the past year, and was admitted for several months last year. Although it was a difficult time, they said being at CHKD made it a bit easier. “She was here for Halloween and they had their own trick-or-treating for her. And when it was Christmas she got gifts from the Ronald McDonald House. The nurses are so great. They’ve brought her stickers or nail polish because they know it will make her day,” John Petrel said. The family travels 60 miles each visit from Gloucester on the days that Amya has treatment, but they said it’s worth it. “If I had to be in a hospital, it would be here,” said Carla Petrel. Health care in Hampton Roads has proven to be both modern and patient-centric. Patient navigation of the health care system and integrated, one-stop-shop cancer centers are trends that continue to grow to meet the needs of cancer patients in this area. “No two cancers or cancer patients are the same,” Dalton said, “so it’s important to take the individual into account.” The hospital systems of Hampton Roads are making great strides in leading the way in cancer care. And that’s hopeful for everyone living in this region, whether their lives are touched by cancer or not. “I think people think of cancer as depressing and scary, but there is also an incredible amount of hope. Thinking about the patients’ courage keeps me going,” Schlesinger said.

Healthcare in Hampton Roads

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Photo courtesy of Hampton University Proton Therapy Institute

State-of-the-Art

Technology Comes to Hampton Roads

Hampton Roads is home to at least two exceptional pieces of technology aiding in advanced cancer care: the Gamma Knife® and proton beam therapy. Both these high-tech tools use radiation to kill tumors, a common way to treat cancer-related tumors. But the science behind them and the way they are used make them very different from conventional cancer treatments.

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Hampton University Proton Therapy Institute (HUPTI) is the largest and most advanced of the nine such centers in the United States. Proton therapy is the most precise form of radiation treatment, because it targets tumors while sparing surrounding healthy tissue, causing fewer side effects than traditional therapy. Use of proton therapy is growing, especially for pediatric cancers. Cynthia Keppel, the Scientific and Medical Director for HUPTI, explained how the protons are used and customized for the specific location, size, and shape of the tumor. “The protons are delivered by an external beam. It’s a subatomic particle and a very low dose. But if you use multiple beams aimed at the same area, the radiation is all deposited in one area, making it a high dose only in that spot,” she said. Proton therapy releases the majority of its destructive energy within a small range inside the tumor, depositing less dose upon entrance and no dose upon exit. This way, it is possible to deliver more radiation to the tumor without harming healthy tissue around it. Keppel said patients feel fewer side effects from this treatment. “Think of an X-ray where there’s an intersection of lines of radia-


Photo courtesy of Riverside Health System

great working relationships the neurosurtion. The intersection is where the highest geons have with other programs nationally. dose of radiation is, but it bathes the “Go ahead and get a second opinion, but rest of the body in X-rays. With proton also investigate treatment here,” he said. therapy, the dose is in the tumor, so the “We work with UVA, Johns Hopkins, and surrounding healthy tissue is unaffected,” teams nationally. We also get patients from she said. all over.” One of the major concerns, The Gamma Knife® at Riverside was inespecially with pediatric patients, is that the radiation from treating cancer today stalled in 2005, with the Synergy -S® the next could cause a secondary tumor down year. There are only 220 Gamma Knives® in the road. In fact, a Virginia Beach couple, the world and only a small number of neuSusan and Jim Ralston, started the Pediatrosurgeons trained to use them. Dr. Kersh is ric Proton Foundation to improve access one of them. to proton therapy after their 2-year-old The Gamma Knife® delivers focused son was diagnosed with cancer in 2007. and highly accurate beams of radiation to a They lauded the opening of a local specific area of the brain, as an alternative to proton-beam center. HUPTI treated its conventional brain surgery, which can be inKelly Spencer, medical physicist, demonstrates the Gamma first patient in August 2010, and is now vasive due to cutting open the skull to access Knife® equipment in the lab at Riverside. fully functional. the brain. “Radiation oncology is essentially “A center like this is really exciting. I applied nuclear physics. It uses 3D thinking, think it’s raising the whole profile of the Hampton Roads area,” Keppel and it’s precise to a sub-millimeter,” Kersh said. The process involves a lot said. She credits the vision and passion of Hampton University’s president, of measurements of the head, including calculating the size and shape of Dr. William Harvey, with making this project a reality. the tumors. Dr. Allan Thornton is a radiation oncologist at HUPTI and he has During the procedure, which takes one to two hours, 201 individual worked in Proton therapy for the last 20 years, including at the Harvard beams of cobalt radiation meet at a single focal point in the patient’s Cyclotron Laboratory and the Indiana University Cyclotron Facility. brain. The radiation hits the target directly, without damaging the surThat makes HUPTI the third center he’s worked at, out of the nine rounding tissue. The Gamma Knife® essentially kills the tumor. All that’s in the country. “I’m lucky to have an experienced staff at this unique left is a small scar, or nothing. resource,” Thornton said. Kersh likes to joke that the Gamma Knife® is the “uncutting edge” HUPTI is freestanding and not affiliated with any hospital systems of medicine. “The results are the same as surgery. The alternative is cut– making it a true community resource. “I see this as a regional center, ting open your head and spending two weeks in the ICU,” he said. The and there are a number of centers that send patients here. It’s a shared Gamma Knife® is a non-invasive alternative, and patients often resume resource, and I think that’s a different concept, but a good one,” he said. normal activities the next day. He said nearly 75% of patients come to HUPTI without being Besides brain tumors and lesions, the Gamma Knife® can be helpful referred by a doctor. Thornton thinks that shows patients are becomfor other neurologic conditions, such as temporal lobe epilepsy (where ing more involved in their care. Many times they’ve researched proton seizures originate from one point in the brain,) certain movement disortherapy on the Internet on their own. ders and obsessive-compulsive neuralgia (commonly known as OCD.) Referrals to the center don’t come just from the region or the East The Radiosurgery Center sees about 350 cases a year for 10-15 different Coast. Thornton said he’s had patients from all over the world call him, diseases, and, Kersh said, they’ve seen some incredible responses. and he’s currently treating patients from the United Arab Emirates, Russia The future of cancer care is looking brighter, as state-of-the-art techand India. nology continues to grow in this area. Recently, Bon Secours announced Another nationally known cancer resource here in Hampton Roads plans for a cancer center expansion at Maryview with a state-of-the-art is the Radiosurgery Center, a partnership between Riverside and the Varian TrueBeam linear accelerator, a radiation therapy unit, and addiUniversity of Virginia, which includes the Gamma Knife® and the tional equipment that is not currently available in Hampton Roads. Synergy- S® linear accelerator. The combination of technology is rare. According to Dr. Ron Kersh, head of the center, there are only eight facilities in the world with both. And one of them is located right here in Hampton Roads, on the Riverside campus in Newport News. HUPTI: http://www.hamptonproton.org/ “I’m not sure why this area has such an inferiority complex. We can Gamma Knife: http://www.riversideonline.com/rrmc/radiosurgery_ build submarines. Why not treat your brain cancer here, too? You don’t center/gamma-knife.cfm necessarily need to travel to get advanced health care,” Kersh said. Pediatric Proton Foundation: http://pediatricprotonfoundation.org/ One of Kersh’s other arguments for treating cancer locally is the Healthcare in Hampton Roads

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Nutrition and Wellness

Incorporate

Healthy Habits into Your Daily Routine

By Mark & Marti Carrier

Maintain a Healthy Weight for Optimal Health and Fitness

Exercise Regularly to Reduce Risk of Disease A healthy diet and regular exercise routine go hand-in-hand to help reduce your risk of diseases such as diabetes and allows you to live an overall healthy lifestyle. The ADA offers the following benefits to being active, as it relates to combating diabetes:2 • Improves Blood Glucose Management: Activity (Exercise) makes your body more sensitive to the insulin you make and it burns glucose (calories), both of which help to lower blood glucose levels. • Lowers Blood Pressure: Activity (Exercise) helps your heart pump stronger and slower. • Improves Blood Fats: Exercise provides heart healthy benefits such as raising good cholesterol (HDL), while lowering bad cholesterol (LDL) and triglycerides. • Exercise Promotes Weight Loss and Maintaining a Healthy Weight • Exercise Lowers Risk of Common Diseases Such as Heart Attack, Stroke, Some Cancers and Bone Loss • Exercise Increases Energy and Improves Quality of Sleep • Exercise Reduces Stress, Anxiety and Depression • Exercise Builds Stronger Bones and Muscles: Weight-bearing activities, such as walking, can make bones stronger. Strength-training activities, such as lifting light weights, using resistance bands can make muscles strong. 16

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There isn’t one magic number when it comes to determining a healthy body weight. Everyone’s ideal weight is unique to their specific body structure, muscle mass, water retention and overall health. To determine what your specific healthy weight range should be, consult your health care provider or a licensed nutritionist/dietitian. After you work with a professional to determine your healthy weight range, these providers can help you establish and adjust your weight loss or management goals to align with achieving overall health and fitness. In addition to adding regular workout sessions into your daily schedule that motivate, encourage and support living a healthy lifestyle, you also can begin incorporating more active habits into your normal daily routine. Starting today, try incorporating as many of the following approaches (suggested by ACS) as possible to support an active and healthy lifestyle. • Improves Blood Glucose Management: Activity (Exercise) makes your body more sensitive to the insulin you make and it burns glucose (calories), both of which help to lower blood glucose levels. • Use the stairs instead of the elevator. • Walk or bike to your destination. • Be active at lunch with your co-workers, family, or friends. • Take a 20-minute activity break at work to stretch, or take a quick walk. • Walk to visit co-workers instead of sending an e-mail message. • Go dancing with your spouse or friends. • Plan active vacations, rather than driving trips. • Wear a pedometer every day to increase your number of daily steps. • Join a sports or recreation team. • Use a stationary bicycle or treadmill while watching TV. • Plan your activity routine to slowly increase the days per week and minutes per session. 2 Before you begin any weight loss or exercise program, you should always seek the advice of an appropriate professional, which could range from your health care provider, licensed nutritionist, a certified personal trainer, etc., depending on the specifics of your situation. Through state-of-the-art techniques and science, Fitness Together combines strength training, cardio conditioning and nutritional guidance for a complete health and fitness solution that can help get you started toward making healthy, well-rounded food and exercise choices to support an active lifestyle. Visit our website at www.fitnesstogether. com/Norfolk or www.fitnesstogether.com/greatbridge and read testimonies from clients who have started their journey with becoming healthier. Call or come into our local studio today for more information on individual nutrition and exercise plans that can help you make your overall fitness goals and aspirations more attainable. Centers for Disease Control and Prevention, www.cdc.gov American Cancer Society, www.cancer.org

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Diabetes & As recently as 20 years ago, exercise for those diagnosed with diabetes was still not generally accepted. Today the advantages are clear but the rewards do come with risks. Diabetes is such a serious condition I’m going to clarify: While there is plenty of evidence that a professionally designed exercise program can be beneficial, there are many individual variables. Physician’s approval is essential. This column will present general, not specific individual, considerations.

F

ollowing physician’s approval, a full understanding of individual lifestyle and habits along with a professional screening assessment is necessary. There are four classifications of the metabolic syndrome diabetes. I’m going to focus on Type 1 and Type 2 ( these two represent 95% of all cases ). We all need insulin. It’s released by our pancreas to help cells control our glucose (blood sugar), fat and protein metabolism. This release is deficient in Type 1 diabetics, glucose builds up, and insulin must be injected daily to try to maintain normal glucose levels. Type 1 is diagnosed early in life (before age 30 and often in childhood), is not caused by nor controlled by lifestyle choices alone, represents approximately 5% of all cases, has an autoimmune factor, and is not associated with excessive body fat or obesity. The long term benefits of exercise are the same as for non-diabetics—improved cardiovascular fitness, additional lean muscle tissue to provide more energy and increased joint range of motion. Because there are many unpredictable blood glucose responses and many influential factors to monitor, exercise for the Type 1 diabetic can be problematic not only during but also pre and post exercise. For this reason, a clinical exercise environment is often preferable and in some cases, required. Type 2 Diabetes: The two primary risk factors are obesity and inactivity. These both reflect lifestyle choices. A predisposition called “family history” is a third risk factor. This is also a lifestyle choice although we don’t usually think of it that way. My point

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Nutrition and Wellness

Exercise is: If you set a good example with your lifestyle, there won’t be a “family history” to pass on to your children. Type 2 was formerly called “Adult-onset diabetes”. You probably remember the term. Why the change in terminology? Because so many of our inactive, junk food fed, overweight children are being diagnosed daily. In the U.S., Type 2 cases have tripled since 1970. Why? Poor nutritional habits and lack of daily physical activity for way too many adults and children. Excessive glucose intake from processed foods, sweets, baked goods, etc overloads the regulatory system and is stored as body fat. This overload then calls for abnormal insulin to combat it. As a result the body’s cells gradually shut down and just stop listening to these constant calls for more insulin. Enough! they say. The result is too much body fat and it is present in over 80% of all Type 2 diabetes diagnoses. What to do, what to do? Glad you asked. For prevention and for post diagnosis control, when combined with reformed nutritional habits, regular daily exercise is the most successful path to improvement of metabolism and glucose level control. This statement applies to the general population as well as the diabetic. The non-diabetic can theoretically lose body fat simply by increasing calorie burning activity to a level greater than the volume of calories consumed. The fundamental difference for the diabetic is that the body’s changes at the cellular level now make nutritional alterations necessary in quality, not just in quantity, to control the disease. So, good nutritional advice for everyone is crucial for diabetics. • Eat lots of small healthy meals/snacks to keep blood sugar from dipping and creating cravings. • Drink plenty of water. • Reduce or hopefully eliminate processed junk food. • Eat more fresh vegetables, fruit, beans, berries, tomatoes, sweet potatoes, omega 3 fish (salmon, tuna, mackerel, herring, halibut,…), nuts and learn to read “ingredients” to effectively identify whole grains. Eat better and exercise more. I know you’ve heard that before. THE GOAL is to avoid the long term complications of this disease which include: • Diabetes is the primary cause of blindness in the U.S. • Resistance to all infections is significantly reduced. Cuts and sores heal slowly.

By Brian Cole

• Much more prone to urinary tract infections, high blood pressure, strokes, heart disease and kidney failure. • Deterioration of the nervous system resulting in slowed reflexes, loss of sensation in the legs and feet, impotence and other related circulatory problems. In general, mild to moderate regular exercise activity is beneficial for all. The risk/reward should be determined through consultation with the physician and started only by those who have a clear understanding of the diligence necessary to monitor and implement controls. Because diabetes is often a progressive disease, constant reevaluation is required. While a team approach is surely helpful ( physician, nutritionist, qualified exercise specialist, pharmacist,…), the ultimate daily responsibility is with the most motivated of all: The individual who has been diagnosed with this potentially debilitating condition.

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