HEALTHY LIVING

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Spring hikes on the Peninsula Living with multiple sclerosis Caring for children with autism Growing epidemic of sleep apnea

MARCH 2015

volume 11, issue 1

on the cover

Healthy Living Volume 11, Issue 1

■

March 2015

Published by the PeninSula Daily newS/ SeQuim Gazette advertising Department Ofﬁces: 305 w. First St., Port angeles, wa 98362 360-452-2345 ■ peninsuladailynews.com 147 w. washington St., Sequim, wa 98382 360-683-3311 ■ sequimgazette.com

John C. Brewer, publisher and editor Steve Perry, advertising director

Patricia Morrison Coate, Sara Farinelli and Brenda Hanrahan, editors

Over the hill hikers, from left, Walt Livingston, Bill Gottschalk, Paul howard and alma Seniuk enjoying a sunny February morning on the Sequim prairie in the Dungeness recreation area. Page 5

Articles and submissions We’re always on the lookout for article ideas to include in our quarterly Healthy Living publication. If you have an idea for a story, please let us know. Professionals in their field are invited to contribute informative and educational articles or columns for consideration in Healthy Living. Send articles, columns and photos (jpegs at 200 dpi minimum) to special sections editor Brenda Hanrahan at bhanrahan@peninsuladailynews.com. We cannot guarantee publication due to space and content considerations. If your submission is accepted, we reserve the right to edit submissions. Submitted articles are the opinions and beliefs of the contributing writer and in no way represent an endorsement by Healthy Living, Peninsula Daily News or Sequim Gazette.

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Trekking across the Peninsula Sara Farinelli, Peninsula Daily News

As the Peninsula Trails Coalition, or PTC, enters its 27th year, it can proudly point to the progress made on the Olympic Discovery Trail as the validation of its efforts. Many of us living in the region and many visiting, too, enjoy the trail without thinking of the vision and effort that have gone into creating it. The nonprofit PTC has resolutely pursued its dream of a multimodal trail across the North Olympic Peninsula for walkers/hikers, bicyclists and equestrians and has done this with an all-volunteer workforce.

Growing participation Now more than 50 percent complete, the trail continues to grow, and the PTC has come to recognize a need for the organization behind the trail to match the trail’s growth. Armed with a new strategic plan and logo, the PTC is working aggressively to inform the community about the work that remains to be done and to call on the community to participate. Even with 150 to 200 active volunteers on its roster, there is still a need for volunteers to serve on the board and on committees.

“We have a very broad and deep array of volunteer capabilities,” said Jeff Bohman, PTC board president. “But we’re also interested in finding a few people who can manage our membership database to integrate it with our website and social media.” In addition, Bohman cited the need for people to serve on the finance and fundraising, outreach Peninsula Trails Coalition and marketing, and membership recruitment and development committees as well as on the board. The organization is also looking for an archivist/ historian to document its history and volunteers to staff information booths at festivals and fairs in Jefferson and Clallam counties.

Traversing the peninsula When completed, the Olympic Discovery Trail will

stretch roughly 126 miles from Port Townsend on the northeastern tip of the Peninsula to LaPush on the Pacific coast. There are several exciting projects in the offing, including a short, but vital segment to the trail on restored shoreline at Discovery Bay slated for this summer. Also, a volunteer had an idea of an offshoot path circumnavigating William R. Fairchild International Airport in Port Angeles. Dubbed the “Pilot’s Loop,” it would divert trail users eastward along 18th Street to Lincoln Park as well as give airport workers a path for exercising. Ongoing discussions with other groups and landowners promise more diversions off the main line for trail users in the future. A prime example of a segment off the main line is the Adventure Route, 25 miles of challenging hilly, forested terrain, a third of which is on old logging roads. The route begins just west of the Elwha River bridge on state Highway 112 and runs to the north side of Lake Crescent, where it meets with the trail. A little further west on the lake’s northern shore, Clallam County and Olympic National Park officials are working together to upgrade the Spruce Railroad Trail with plans to incorporate it into the trail. As the trail continues to move forward on its trek across the peninsula, expect the Peninsula Trails Coalition to continue advocating vigorously for its growth and building coalitions with other stakeholders. For information about the Peninsula Trails Coalition, visit its website at www.peninsulatrailscoalition.org.

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Spring hikes on the Peninsula

This year, like 2014, may have an earlier snowmelt, so the flowers may be wet and muddy, but you can find trilliums, fawn lilies and, with careful searching, the elusive blooms of wild ginger. About a mile and a half from the lower trailhead, the story and photo by Susan Erzen, Klahhane Club member Lower Grey Wolf Trail goes past a riverside camp site and winds through blowdowns on a trail redesigned and maintained by an industrious Gray Wolves trail crew. Members of the Klahhane Club downhill segment. As the trail rises above the river, about 2.5 miles hike year-round on the beautiful North It’s about two miles from the visitor from the trailhead, fawn lilies, calypso orchids and Olympic Peninsula. center to the downhill and another half trilliums burst through the leaves. Chocolate lilies The upside of so little snow this mile to the junction with Switchback decorate a small knoll among the trees. winter is easier access for hikers to Trail. After crossing rickety wooden bridges, look beneath higher elevation trails (although some It’s a beautiful trail along a ridge but the large heart-shaped leaves of the wild ginger for its access roads for vehicles remain closed) not a place for hikers who are afraid of reddish brown flowers. and, of course, earlier spring blooms. heights. The trail goes down to another mossy river camp When scheduling spring hikes, club The intersection with Switchback and then follows the river to more campsites before members plan for both wildflowers and Trail offers three choices: go back the reaching a dead end where there once was a bridge. mud. way you came, go up 13 switchbacks to These hikes offer early spring flowers. For Pacific rhododendrons, Victor Pass, or hike down a half-mile to Even more dramatic bouquets of lupine, larkspur, Klahhanes head for the Tubal Cain the Switchback trailhead. arnicas, cinquefoils and Indian paintbrush await hikers Trail in mid- to late spring. Look for yellow chickweed who venture up the more difficult trails to Badger If timed right, the relatively flat monkeyflowers and white anemones Calypso orchid Valley, Buckhorn Pass, Marmot Pass and the Elwha to trail to the abandoned Tubal Cain near the bottom. Hurricane Hill in late spring through summer. mine will be lined with pink blossoms From there you must hitch a ride Wooded slopes, wildflowers and views across the beginning a short walk from the trailhead and back to the visitor center parking lot, unless you have valleys await you in the mountains this spring and, at continuing for about 2.5 miles. left a car at the end of the trail. Rhodies can also be found along the first mile of the Avalanche lilies also brighten the wooded areas from least this year, very little snow. Slab Camp Trail to Deer Park. Deer Park enroute to Grand Ridge. The Klahhane Club celebrates its centennial this spring. After 5.2 miles, hikers are treated to grass widow After two miles of undulating trail, the white An exhibit of artifacts from the club opened on March 1 at the flowers dotting the Deer Park meadows with their avalanche lilies spread out among the evergreens along Museum at the Carnegie, 207 S. Lincoln St., Port Angeles. Museum purple “eyes.” the path before the trail climbs out into sweeping views hours are 1- 4 p.m, Wednesday to Saturday. If you hike Sunrise Ridge from the north side of the across Grand Valley. For more information about the club and how to join, visit its Hurricane Ridge Visitors Center to Switchback Trail, Check the national park website www.nps.gov for website at klahhaneclub.org. you’ll pass carpets of avalanche lilies, especially on the trail conditions and when trails reopen for the season.

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Many more hills to go

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Over the Hill Hikers is a group of intrepid outdoor lovers who meet twice a week, rain or shine, to trek the beautiful forests and mountains of the Olympic Peninsula. Ranging from 60-something upwards of 90 years of age, participants come in all fitness levels. “I don’t mind going uphill, but I prefer the ones going up and down, Over the Hill Hikers, from left, Joyce Blankenship, Jean Dager,Phil Walt Livingston, Montel Livingston, Bill Gottschalk, Bharti up and down,” says hiker Dominiak, Desai, Chuck Bakeman, Alma Seniuk and Gail Larson on a recent hike. Alma Seniuk, gesturing Arnold, who has been hiking with the gentle slopes with her group for 17 years. arm. One sunny Wednesday in midOne of her favorite hikes is a February was too fine a day to spend segment of the Adventure Route adjunct of the Olympic Discovery Trail, on the logging trail as planned, so the assembled hikers were polled on an accessed via Joyce-Piedmont Road. The trail’s rolling hills are easier on alternate site. A sociable bunch, hikers often her knees. gather after the trek to have lunch at As year-round hikers, the group a restaurant. hikes remote back country trails from “I joined when I first moved here to summer through fall to beachfronts get to know the area and meet people. and lower elevations in the winter It’s been great for both,” Arnold said. through spring. Hikers begin assembling at 8:45 Hikes are usually 5 to 10 miles a.m. and leave promptly at 9 a.m. from round trip with a moderate elevation the Sequim Goodwill store parking lot gain. However, some trails may climb on Wednesdays and alternate between as much as a few thousand feet. While the group’s schedule is posted the Sequim location and the Haggen supermarket parking lot in Port online, it is flexible and adapts to Angeles on Fridays. weather and hiking conditions. For more information, call Arnold Hikes are almost never canceled at 360-417-3728 or Bill Gottschalk due to inclement weather. at 360-457-9546, or visit the group’s “I remember once it rained pretty website at www.olypen.com/richd. hard and we had to cancel,” said Jim

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Living with multiple sclerosis Story by Karen Griffths

Gotta go, gotta go, gotta go right now! Remember that 1990s commercial for pills to help control an overactive bladder? Ever since I was diagnosed with multiple sclerosis, I’ve dealt with an urgent need to empty my bladder ASAP. I’ve come to view it as a minor inconvenience compared with all the mayhem and destruction “The Beast” living within me has caused. “But you look so good!” Before I was diagnosed with MS, I don’t recall ever having those words spoken to me, but now I hear it all too frequently, and it actually irritates me. Why? Because if I look good on the outside, I should be feeling good on the inside, right? Wrong. On inside I feel like crap, all the time, 24 hours a day, seven days a week. When the subject of MS comes up, most people picture someone visibly crippled and wheelchair bound. While there are some days I walk with a pronounced limp, for the most part my symptoms — as well as the majority of those with MS — are not outwardly visible. Ten years ago I was happily working at the Peninsula Daily News as a special sections editor. One morning, I woke up feeling numb and tingly from the bottom of my feet to the top of my head, along with extremely tight muscles (which I later learned was called spasticity). My primary care physician in Sequim, Dr. Samantha Reiter, suspected MS and had MRIs done of my brain, stem and spine. When the scans showed numerous enhanced lesions, she referred me to Dr. Mariko Kita, a neurologist who specializes in MS at the Virginia Mason Neuroscience Institute in Seattle. She confirmed that I did, indeed, have MS. It’s estimated that more than 12,000 people have MS in the Pacific Northwest. MS is a neurodegenerative disease that causes the body’s own immune system to attack the nerve cells in the brain and spinal cord. To get there, it eats through the myelin sheath that

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resourCes National and State Organizations National Multiple Sclerosis Society offers free magazines and newsletters and emotional support. www.nationalmssociety.org Greater Northwest is the MS regional chapter. www.nationalmssociety.org/Chapters/WAS Local MS Support groups In Port Townsend, a well-established MS support group meets the first Tuesday of the month. Contact Stacie at slhoskins70@gmail.com. In Sequim, a recently started group meets the last Tuesday of the month. Contact Patty at Pheath1960@outlook.com. Multiple Sclerosis Roadshow, Saturday, May 30, 10 a.m. to 2 p.m., Red Lion Hotel in Port Angeles. Featured speakers include Swedish Multiple Sclerosis Center neurologists James Bowen, Pavle Repovic, Peiqing Qian, clinical psychologist Michelle Toshima and vocational counselor Shaheen Virani. To register contact the National Multiple Sclerosis Society at 1-800-344-4867 and press 1, or go online to MSNorthwest.org and click on “Calendar.”

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covers nerves in the body, causing the scar tissue that disrupts nerve pulse communication. Living well with MS sounds like an oxymoron. It’s important to note that everyone’s MS is different; symptoms might be similar or very different in frequency and intensity. I live with numbness and spasticity and chronic pain in my muscles, joints and nerves. The worst by far are the problems in my cognitive, or thinking and thought, processes. I often feel disconnected from the world, heavyheaded and as if a thick cloud has taken over my brain. I have trouble staying on task and am easily overwhelmed. I forget names, faces and have even gotten lost in downtown Sequim! I’ve gone through times of major depression and angst while learning to accept the limits MS has clobbered me with, and I still despise every single one. I love to work and be active, so when MS forces me to spend three days in bed, I get angry with myself, and dark thoughts of suicide waft through my brain. A mantra I learned long ago and try to live by is: “Tomorrow will be better.” Some days, I’m stuck in bed with sort of a semicomatose, semiparalyzed feeling. To help mitigate the frustration I feel with the amount of time I spend languishing in bed, Dr. Kita suggested I view my energy as a tank of gas. With MS, I will never have a full tank of gas, she said, but if I listen carefully to my body and try to pace myself, I might be able to keep my tank half-full. So far, I’ve never gotten my tank close to half-full. I’m doing good if I can keep it steady at a quarter-tank. I’ve gained much valuable help and education about living with the disease through the National Multiple Sclerosis Society, and it’s out of gratitude I will be participating in the Walk MS: Bainbridge Island 2015 event April 11. If you’d like to support my walk, visit my page at main.nationalmssociety.org/goto/KarenG. I’m happy to answer anyone’s questions about my

Peninsula Daily News/Sequim Gazette

Clallam County Respite Center

numbers rise. The center will also serve as a way station for individuals being released from the hospital but not completely ready to transition back into the community. “This will reduce hospital time and expense,” said Jensen. “A month ago, patients would have had to remain in the hospital for another week.”

Story by Sara Farinelli, Peninsula Daily News

An integral part of Peninsula Behavioral Health’s mental health crisis stabilization program, the Clallam County Respite Center opened Jan. 20 to assist residents experiencing acute psychiatric crises. By providing a local psychiatric crisis care facility, Peninsula Behavioral Health hoped to reduce the cost of expensive inpatient treatment for patients and their families and alleviate demands placed on the Olympic Medical Center emergency room, the Port Angeles and Sequim police departments and the Clallam County jail. “So far it is doing what we had hoped. It is keeping people out of psychiatric hospitals and reducing the time that people have to be boarded at OMC while awaiting a psychiatric bed,” said Peter Casey, executive director of Peninsula Behavioral Health.

Reducing the cost of care In the one-month period through the end of February, the center served 18 individuals. “Of those 18, I can say conservatively that eight would definitely have been psychiatrically hospitalized had we not had the respite center available,” said Brittney Jensen, crisis services supervisor. In the past, residents in need of mental health crisis stabilization care have had to be hospitalized as far away as Bellingham or Longview, and more than 36 percent had to be held for days at a time at Olympic Medical Center because psychiatric beds were not available. According to Jensen, hospitalization can cost from $10,000 to $20,000. Transportation to the hospital by

Growing demand The number of clients at Peninsula Behavioral Health has doubled since 2008, when their mission was expanded to include services for those with psychological problems. It now treats more than 4,000 patients in the Peninsula Behavioral Health Respite Center medical assistant Sherri community. In the past year alone, the client base has increased by 800 new Medicaid recipients as a result of Rodriguez and resident staff Tim Cella prepare lunch. the Affordable Care Act and Medicaid expansion. ambulance costs around $2,000. Last year, 111 people required hospitalization, and Now, patients can drive themselves or walk to the more than 50 percent were not clinic clients. respite center for voluntary treatment. Nonetheless, as required by Washington state law, With earlier intervention, staff anticipates that Peninsula Behavioral Health had to cover much of the fewer patients will reach the point where they require costs with state funds designated for people who are involuntary treatment. indigent but do not qualify for Medicaid. That particular state fund not only pays for crisis The Respite Center The respite center is in the former St. Vincent de Paul services and unfunded hospitalizations but also Thrift Store building at 112 E. Eighth St. in Port Angeles outpatient care for those without coverage. Since that funding source has been cut $300,000 across from the Peninsula Behavioral Health clinic. from last year’s amount, said Casey, it has become more Development coordinator Rebekah Miller pointed imperative to avoid hospitalization costs in order to out the center’s campus-like setting with psychiatric support staff available in the clinic or on call outside of have more money left for outpatient services. Even with an increase in staff, Peninsula Behavioral operating hours. Health has had to refer privately insured patients In fact, the clinic is a comprehensive treatment to other community resources. However, as Jensen facility with medical doctors, nurse practitioners and stressed, no one is turned away from crisis services. therapists all under the same roof. The six-bed, unlocked center is staffed round-thePeninsula Behavioral Health is a private, not-for-profit community clock with a medical assistant and resident staff. health center established in November 1971. Stays have averaged three to five days. It’s annual fund-raiser is May 1 at the Red Lion Hotel, 221 N. Lincoln St., To date, the most number of clients checked in at Port Angeles. This year, Daniel James Brown, author of The Boys in the Boat, one time has been four. will be the guest speaker. For information on this event or services offered However, as residents become more aware of the by the agency, visit www.peninsulabehavioral.org. service, Peninsula Behavioral Health expects to see the

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Caring for children with autism story by Sara Farinelli, Peninsula Daily News

A Centers for Disease Control and Prevention report released last year said as many as 1 in 68 children in the U.S. are born with an autism spectrum disorder, or ASD. Boys outnumber girls by roughly 5 to 1. ASD collectively refers to complex neurodevelopment disorders previously diagnosed separately as autism, pervasive developmental disorder not otherwise specified and Asperger syndrome. Distinguished by differences in how the brain functions, symptoms are impaired communication skills, obsessive and repetitive patterns of behavior and difficulties with social interaction.

“He had meltdowns that were unbelievable,” said Owen. “Our home was like a war zone.” When Arion started kindergarten, interaction with other children exasperated his condition. Suspecting ASD, his teacher encouraged Owen to have her son tested.

The services and programs maze Medical evaluations and educational evaluations are separate processes. Families with special-needs children need a medical Early signs diagnosis to access government services and programs. One of the earliest cues for ASD is delayed speech “Developmental Disabilities Administration is and language skills. something parents want to be connected with as soon “Jeremy says it’s like talking to an alien,” said as possible,” said Timothy Bruce, health and human stay-at-home mom Candy Bradshaw, referring to her services planner for the Clallam County Department of boyfriend’s comment about communication with their Health and Human Services. 5-year-old son, Austin. “Even if they don’t like the label, because they feel According to Bradshaw, Austin understands words their child is functioning high on the spectrum, it is a but has difficulty forming them into speech. His preferred key to opening doors for funding of services.” mode of communication is dragging family members The first step, said Bruce, is submitting the proper around the house and pointing to what he wants. paperwork to the Department of Social and Health Among later indicators, according to the National Services in Olympia to get the process going. Institutes of Neurological Disorders and Strokes, is an Due to a lack of support systems needed to make inability to make friends and play with others and an accurate diagnoses, children in our area are often not inflexible conformity to routine. diagnosed until the age of 4 or 5 years, according to Dr. Symptoms in mildly affected children can sometimes Joshua Jones at Peninsula Behavioral Health. be overlooked and late to diagnose. Parents must get a medical referral from their Joylena Owen’s son Arion has no language child’s doctor to Mary Bridge Children’s Hospital and impairment or learning disabilities. In fact, the 10-year- Health Center in Tacoma or Seattle Children’s Autism old reads at the college level and excels in his studies. Center for a comprehensive diagnostic evaluation Owen, a marketing representative at Peninsula performed by a multidisciplinary team of health care Daily News, faulted her parenting skills for his professionals. uncontrollable tantrums. Entering the school system is a whole other ballgame.

Special-needs children then need to be tested to determine eligibility for special education classes. “We don’t limit our programs to a specific diagnosis,” said Brianne Barrett, director of special education and federal programs for the Port Angeles School District. “Our main goal is to teach kids skills to make them as independent as possible so that they can access the curriculum at school. For us, every child is a generaleducation student first.” In Washington state, local school systems conduct year-round screenings to identify children with developmental delays from birth through age 21. Although children do not enter the school system earlier than age 3, if parents notice developmental delays, they can have their children tested for homebased early intervention programs. Health care professionals generally agree that the earlier the intervention, the better. Community support and advocacy Crystal Linn Middleton, co-founder of the Clallam County Autism & Developmentally Delayed Community support site on Facebook, urges parents and caregivers to advocate for their child. “Nobody pushes for your child’s needs,” said Middleton. “If you are not advocating for them, they’ll get the bare minimum because the need here is so great.” continued on Page 9 >>

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<< continued from Page 8

Middleton’s support group posts upcoming events and training and provides information on resources available. The closed group now has 89 members sharing experiences and seeking advice from others in similar situations. Human Services planner Bruce said government-administered services have improved greatly over the past four years with better communication among agencies and organizations and a “no wrong door” approach that works to connect inquiries with the appropriate office. Still, “getting from a to b to c” can be challenging, said Middleton, “Everything is a process, and you have to take it a step at a time. There’s no skipping.”

RESOURCES

Government Offices

Advocacy Groups

The Arc of Washington State, arcwa.org. Local affiliate of national community-based organization advocating for and serving people with intellectual and developmental disabilities and their families, 888-754-8798. Autism Now, autismnow.org. The National Autism Resource Center site offers a central point of quality resources and information. PAVE, wapave.org, Partnerships for Action, Voices for Empowerment; parent-directed organization that works with families, individuals with disabilities, professionals and community members in all walks of life and with all types of disabilities, 253-565-2266.

JONATHAN COLLIN, MD A comprehensive evaluation should be more than a 15-minute appointment and a few lab tests that generally reveal nothing.

State and Local Support Groups

Autism Society of Washington, www.autismsocietyofwa.org. ASW Port Angeles affiliate, contact ASW board member Kim Ortloff at 360-504-1148 or email info@autismsocietyofwa.org. Clallam County Autism & Developmental Disabilities Community, connect on Facebook. Information on spectrum services, developmental delays and sensory issues. FEAT of Washington, www.featwa.org, Washington state non-profit providing autism programs and services; also administers a statewide autism grant and family autism support hotline. Parents of Minors with Developmental Disabilities Support Group, connect on Facebook. Affiliated with Clallam Mosaic, www.clallammosaic.org; support and social activities for minor children with developmental differences and their families.

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360-417-2428. Jefferson County Public Health Community Health /Developmental Disabilities, 615 Sheridan St., Port Townsend, 360-385-9400

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March 2015

America’s growing epidemic Story by Dr. Michael McDonald, Olympic medical Sleep Center

While the media were focused on the potential epidemics of Ebola, H1N1 and measles, another more prevalent and life-threatening epidemic was developing throughout the United States. The epidemic is the growing number of young Americans who are becoming obese and developing obstructive sleep apnea. The Centers for Disease Control estimates that 35 percent of the population has reached the obesity level. Sixty-nine percent are either overweight or obese. Obesity is defined as a Body Mass Index, or BMI, of greater than 30. Most are aware of the health consequences of obesity. However, most are unaware that up to 85 percent of the obese population will develop sleep apnea. Obstructive sleep apnea is a disease affecting the ability to breathe when asleep. The problem is, simply, that the soft areas of the throat collapse upon inhalation. No new air will enter the lungs and the oxygen level in the blood will fall, often severely. Over a period of seconds, the body will recognize the problem and send “fight or flight” chemicals into the body to cause the patient to partially awaken and allow a full breath. This cycle may repeat many times an hour. The combination of obesity and sleep apnea lead to both short-term and long-term health problems. Some of the short-term issues are poor sleep quality and poorly restorative sleep, daytime sleepiness, reduced job performance, higher risk of accidents and reduced sex drive. Long-term consequences are high blood pressure,

fourfold increase risk of stroke or heart attack, Type 2 diabetes, irregular heart rhythms and twofold increase in risk of dementia. Though many of these risks may not affect the patient immediately, after years of untreated obesity and sleep apnea, health and life expectancy will be affected. Identifying those who are at risk is usually not difficult. You and your bed partner should answer the following questions together: • Do you snore? • Are you sleepy during the day or early evening? • Have you been observed to stop breathing or to gasp when asleep? • Are you being treated for high blood pressure? • Is your body mass index greater than 30? • Are you older than 50? • Is your neck size greater than 17 inches for men or

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16 inches for women? • Are you male? If you answered “yes” to three or more of these questions, you are at significant risk for sleep apnea. However, identifying those at risk can sometimes be difficult as some of the common symptoms are not present. Any one or two of the symptoms above may reflect the presence of severe sleep apnea. This is particularly true in the young population. Identifying your risk is the first step in treating sleep apnea and obesity. Making an appointment to see a sleep physician for an evaluation is the second step. Determining to follow-through with treatment is the third important step in treating apnea and obesity. Fortunately, very successful treatment is available for patients with sleep apnea. Depending on the severity of the apnea, treatment options include, dental sleep appliances, continuous positive airway pressure (CPAP) machines, surgery and weight loss. All are designed to hold the soft part of the airway open. Once you are on treatment for four weeks, the risks of sleep apnea are reduced dramatically. The sleep specialist will help to guide you to the most appropriate treatment plan. All health care organizations recommend early recognition, diagnosis and treatment of obstructive sleep apnea. There is strong evidence to support the fact that treated patients will live more active and healthy lives, and your health care costs over years will be reduced. To determine your BMI, go to www.webmd.com/ men/weight-loss-bmi. Dr. McDonald is a member of the American Academy of Sleep Medicine, the American Academy of Otololaryngology and the Oregon Academy of Otolaryngology and is affiliated with Swedish Sleep Center.

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Providing the highest quality home care to seniors and people with disabilities for more than 30 years • We are licensed by the state and accept insurance, private pay and DSHS. We serve all income levels. • Services range from housework to personal care including medication reminders, incontinent care, transportation, bathing, dressing, transfers and protective supervision.

Serving Clallam County since 1971, Peninsula Behavioral Health is the region’s primary resource for mental health services. Last year over 3,300 men, women, and children received psychiatric and psychological services from an expert staff including MDs, nurse practitioners (ARNPs), social workers, counselors, nurses, case managers, and other professionals.

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