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LL TEST EVENT WI NCE PAGE 4 BIG HURT ’ ENDURA ATHLETES RPAL ABOUT CA H UT TR ME PAGE 8 THE SYNDRO TUNNEL CE EN TIN INCON URINARYCOMMON PAGE 11 NOT UN
<< Georgia Heisterkamp, M.D., of Olympic Medical Center discusses options with a patient. In this edition of Healthy Living, she elaborates on the urgency — or lack thereof — for appendicitis surgery.
Articles & 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 (jpgs at 200 dpi minimum) to special sections editor Laura Lofgren at firstname.lastname@example.org. 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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Athletes will test themselves in Big Hurt 2017 STORY BY PENINSULA DAILY NEWS
Bring on the Hurt! Big Hurt — a four-leg test of endurance — is set for Saturday, Sept. 23 in Port Angeles. From the beauty of our inner harbor to the ruggedness of the foothills, this event promises to push participants to their physical limits while connecting the community and showcasing the outdoor diversity of the North Olympic Peninsula. Registration closes Friday, Sept. 22, at 11:59 p.m. Course and registration information can be found online at www.bighurtpa.com. Both individuals in the Iron Division and relay teams gather from far and wide to explore Port Angeles and its scenic surroundings via bike, kayak and foot. Participants will begin on mountain bikes at Foothills and ride 16.5 miles on logging roads, single-track trails and pavement before reaching the shores of the Waterfront Park, located at West Railroad Avenue and North Oak Street along the waterfront in downtown Port Angeles. From the beach, participants will kayak 3 miles in the inner harbor, embark on a 30-mile road bike journey to Freshwater Bay and endure a 10-kilometer (6.21-mile) run along the Olympic Discovery Trail. Although this year marks the third annual Big Hurt, the event is building from the original event that ran from 1997 to 2004. The race quickly grew in that time from 65 to nearly 600 participants and was widely
embraced by the communities of the North Olympic Peninsula, as well as visitors. “Big Hurt was an iconic local event when I first moved to Port Angeles in 2002, but before I got a chance to participate, the event ended,” said Lorrie Mittmann, Big Hurt co-organizer. “Over the years, many local athletes have described how great it was, and they mentioned to me that they would like to see it return; thus, when I got the opportunity to work with Tim [Tucker] and Scott [Tucker], I was energized because I knew we could do it and the community would support us,” Mittmann said. “What we are really excited about this year is that we are starting to see our out-of-area marketing bear fruit, with participants coming from British Columbia, Colo-
rado, and Oregon. Our local winner from last year moved to Florida but has decided to return to Port Angeles for the Big Hurt weekend for another try at the top spot.” The Big Hurt once again takes place the same weekend as the Downtown Association’s Arts and Draughts beer festival. Race co-organizer Tim Tucker said, “I am really happy that along with the re-start of Big Hurt, the downtown association in the second year created an amazing Arts and Draughts festival. This now allows anyone to come to Port Angeles and experience our outdoor beauty, burn some calories, and then spend the rest of the weekend sampling good food, good brew, and some small town hospitality. It just doesn’t get any better than that.” BIG HURT continued on 5 >>
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<< BIG HURT continued from 4
Coupled with ample community support, Mittmann, Tim Tucker and Scott Tucker are the primary forces behind the successful return of Big Hurt. This year’s title sponsors are and Peninsula Bottling and Unique Energy Drink. Participants ages 15 and older can race solo in the Iron Division or as a relay team made up of two to four racers. There are 50 spots open in each category. Teams can be formed for $220, or individuals can race for $85. Awards will be given for overall top three men and women in the Iron Division and top three overall teams. A portion of the proceeds from this year’s Big Hurt will be donated to PeninKeith Thorpe/Peninsula Daily News sula Trails Coalition — the nonprofit orgaKelley Burns, representing Sound Bikes and Kayaks, crosses the finish line to win the nization devoted to the construction, mainteam competition during the 2016 Big Hurt in Port Angeles. tenance and promotion of the Olympic Discovery and Olympic Adventure trails. Community members are encouraged to LEGS OF THE RACE hang out near the Exchange Zone to cheer Each leg of the race offers a different THE EXCHANGE ZONE — A GREAT on race participants. The best time to view challenge for participants and highlights PLACE TO WATCH THE RACE the final finish for both the individuals recreational opportunities available on the Big Hurt event central, or the Exchange and teams is from 2 p.m. to 4 p.m. In addi- Olympic Peninsula. Zone, is located at Waterfront Park. tion this year there will be a new selfie LEG 1 — The 16.5-mile mountain bike Hurricane Ridge Winter Sports Club, station with a pirate and a crab to take portion takes place in the foothills above Olympic Distributing and Station 51 Tap- your picture along with a live marimba Port Angeles on a combination of dirt loghouse will host a beer garden at the band and drummers to liven up the scene. ging, single-track and paved roads. Exchange Zone, which is open to the pub- Transitions between legs will take place LEG 2 — A 3-mile kayaking portion follic and for race participants. lows a triangle-shaped course in Port between 11 a.m. and 3:30 p.m.
Angeles Harbor that begins and ends at West End Park. LEG 3 — The 30-mile road bike travels west out of Port Angeles and crosses the Elwha River with visits to Freshwater Bay and the lower parts of Kelly Ridge on Dan Kelly and Eden Valley roads. It has a cumulative elevation gain of 2,100 feet. LEG 4 — The final leg is a 10K outand-back run on the Olympic Discovery Trail along the waterfront. It starts and finishes at the West End Park. The course is on a paved surface. During the race, the trail will remain open to the public. TEAMS Teams will be assigned one timing chip that will be included in and picked up with their race packets. This chip is associated with their racing number and cannot be switched with any other chip. The chip serves as a baton, being passed from one team member to the next during the event. There will be a “transition zone” established from the start and finish of each of the event legs with the exception of mountain biking, which will have a remote start line but will finish in the transition zone. All individuals and team members must be off the course by 5 p.m. To register for Big Hurt or to learn more visit www.big hurtpa.com or email olympicadventure firstname.lastname@example.org.
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OMC diabetes prevention program slated for 2018 Registration is now open for Olympic Medical Center’s upcoming Diabetes Prevention Program. Anyone with pre-diabetes is encouraged to consider attending the program. Attendees will learn to identify and adopt healthier lifestyle choices to improve overall health and prevent the onset of type 2 diabetes. Olympic Medical Center’s certified diabetes educator provides coaching, educational materials and resources, and facilitates peer support in a dynamic group setting. This group is facilitated by Vicki Everrett, RD, CDE, Diabetes Education Coordinator, Olympic Medical Center. The Port Angeles series begins Feb. 7, 2018. Classes will be held Wednesdays from 4 p.m. to 5 p.m. at 939 Caroline St. A cost of $160 covers 16 weekly group sessions, plus 16 follow-up group sessions and all materials. Topics might include: • Meal planning: carbohydrate counting, weight management, low-fat meals, dining out, and more • Medication and insulin instruction • Exercise guidelines • Goal-setting • Blood glucose monitoring • Risk management and complication prevention • Psychosocial support
“This program encouraged me to make better choices, focus on reading and understanding labels, and the importance of exercise.” – Donna H. “The camaraderie was really valuable. Tracking meals showed me how much I was eating. The program motivated me to join a regular class at the Y.” – Ruth M. — patient testimonials provided by Olympic Medical Center
• Insulin pump therapy Based on the Diabetes Prevention Program research study led by the National Institutes of Health and supported by the Centers for Disease Control and Prevention, this course has proven to be an effective motivator for positive lifestyle change among those at risk for type 2 diabetes. A referral is required from a physician for one to enter the program. For more information or to register, phone 360-4177125. For even more information, visit www.tinyurl.com/ OMC-Diabetes.
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Prediabetes increases your risk of:
BLOOD SUGAR LEVEL
STORY BY PENINSULA DAILY NEWS
Without weight loss and moderate physical activity 15–30% of people with TYPE 2 DIABETES
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REFERENCES Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2014. Knowler WC, BarrettConner E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403. As cited in March 22, 2013, MMWR. Tuomilehto J, Lindstom J, Eriksson J, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344:1343–1350.
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Tommy Arand cruises to the finish line during the 2015 Run for Healthy Families.
‘Run for Healthy Families’ set support to victims of domestic violence and sexual assault. This is a family friendly event. In recognition of domestic violence All runners and walkers, strollers, kids, awareness, Healthy Families of Clallam dogs on leashes are welcome. County will hold the fourth annual Run Child runners will receive a medal. for Healthy Families 5K/10K at 10 a.m. Register at www.tinyurl.com/HealthySaturday, Oct. 21. The race and silent vigil will take place Run-2017. Registration ends Thursday, Oct. 19, at 11:59 p.m. at the Port Angeles City Pier along the Healthy Families of Clallam County, a Waterfront Discovery trail. nonprofit, is a United Way of Clallam The race is an out-and-back, starting County partner agency. and ending at the pier. For more information, phone 360-452The cost is $25 for adult individuals and 3811, email email@example.com or visit $10 dollars for children younger than 18. www.healthyfam.org. There is special pricing for families of Healthy Families of Clallam County is three or more who register together: $45 located at 1210 E. Front St., Suite C, in for a family of three, $50 for a family of Port Angeles. four and $55 for a family of five or more. If you need help, phone the 24-hour CriAll proceeds support Healthy Families of Clallam County providing services and sis Line at 360-452-HELP.
STORY BY PENINSULA DAILY NEWS
Peninsula Daily News/Sequim Gazette
At your annual comprehensive eye exam, talk with your doctor about your eye health and your lifestyle and vision goals. If appropriate, your eye doctor can recommend a consultation with us.
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The truth about carpal tunnel syndrome that we refer to as “carpal tunnel syndrome.” The median nerve serves sensation to the thumb, index finger, long finger and half of the ring finger. It also provides the motor function to the muscles of the thumb, which allow us to oppose the fingertips in pinch.
STORY BY DR. REGINA M. MCGOVERN
Doctors have recognized carpal tunnel syndrome for more than 150 years, and it is now a common term thrown about in casual conversation. Everyone seems to know someone who has it or who has had treatment for it, yet there is lot of misunderstanding about what the condition is and when or what to do about it. WHAT IS CARPAL TUNNEL SYNDROME? Carpal tunnel syndrome is a well-recognized group of symptoms that occur when the nerve traveling through the carpal tunnel is injured by too much pressure. These symptoms are typically tingling or intermittent numbness, sometimes aching pain or sharp electric shock-like sensations. Occasionally, carpal tunnel syndrome can produce shoulder or neck pain. Often sufferers complain of burning pain in the hands or fingers, which wakes them from sleep. Many people find it difficult to explain their pain. Instead they frequently report, “I’ve got carpal tunnel.” But this complaint does not provide enough information to know what treatment is necessary. In fact, everyone has a carpal tunnel, or more likely two, so let’s talk about that first and foremost.
WHAT IS THE CARPAL TUNNEL? The carpal tunnel is the group of small bones of the wrist that form an arch, or a “tunnel.” This space is closed by a ligament and the structures confined by this space are the nine tendons that flex your fingers/thumb, plus the median nerve. Pressure on this nerve is what causes all the troubles
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WHAT CAUSES SOMEONE TO GET ‘THE SYNDROME’? The causes of someone getting carpal tunnel syndrome can be perplexing. Often it seems there is no rhyme or reason for why symptoms begin when they were not there last week or even last year. But the causes and contributors of carpal tunnel syndrome are many and varied. Pressure on the nerve in the tunnel can build slowly over time as one is aging. Diseases such as arthritis, obesity, thyroid problems and diabetes can be gradually causing more encroachment on the nerve as inflammation, fatty tissue or fluid in the carpal tunnel increases. The tendons themselves tend to thicken over time, taking up more room and leaving less space for the nerve. Carpal tunnel syndrome will sometimes run in families; a diminutive bone structure with a muscular build is a set-up for carpal tunnel syndrome. Alternatively, carpal tunnel syndrome can occur suddenly, associated with a fracture or other injury. CARPAL continued on 9 >>
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<< CARPAL continued from 8
DO SPECIFIC JOBS CAUSE CARPAL TUNNEL SYNDROME? Most people associate keyboard activity with the development of carpal tunnel syndrome. Although healthy body positions during long working hours is important to avoid nerve irritation and tendonitis, keyboarding per se is rarely the sole cause of carpal tunnel syndrome. However, manufacturing and heavy labor occupations that require repetitive, forceful grip and the use of vibrating tools has been proven to significantly contribute to the development of carpal tunnel syndrome.
or burning sensation. Weakness or the inability to continue uninterrupted activities during the day is frequent at this stage. Happily, surgery will typically resolve these symptoms immediately.
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YOUR SKIN IS AN IMPORTANT GAUGE OF YOUR OVERALL HEALTH. For more than 20 years, board-certified dermatologist Dr. Claire Haycox and Leah Layman, ARNP, have provided the most current skin care and treatment for every stage of life. From common skin sensitivities and acne treatments, to more complex concerns such as hair loss, lupus, psoriasis and skin cancer, Jefferson Healthcare’s expert dermatology team can help you understand what your skin is telling you.
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DOES SURGERY EVER FAIL TO WORK? Carpal tunnel release surgery is almost always successful; however, rumors of “failed” carpal tunnel surgery abound. There are three common reasons for this: 1. The persistent pain after surgery is not actually from carpal tunnel syndrome. For example, release of the carpal tunnel will not resolve pain from arthritis or tendonitis. If this was not made clear ARE THERE NONSURGICAL prior to surgery, the patient assumes that TREATMENTS? the surgery “failed.” Intermittent symptoms of carpal tunnel 2. Numbness in the hands persists syndrome are very common and do not because there is another source of nerve mean that surgery is needed. compression. Ergonomic adjustments, such as raising Frequently, this occurs at the elbow or the chair height or lowering the keyboard at the neck. A thorough exam and/or a can often resolve these transient symptoms. nerve conduction study (electrical test of More frequent changes in position or nerve function) can almost always identify activity can have the same effect. these other nerve injuries. For those with mild to moderate carpal 3. The patient waited too long to come tunnel syndrome, wearing a wrist splint to surgery. at night will often significantly improve or When long-standing pressure on the resolve symptoms of pain and intermitnerve has gone unchecked for too long, tent numbness. conduction through the nerve essentially Severe carpal tunnel syndrome, howstops and some of the muscles in the hand ever, is very unlikely to resolve without completely waste away, or atrophy. surgical intervention. Although a patient who has surgery at this stage will reliably get pain relief, senWHEN IS SURGERY NECESSARY? sation and muscle strength are not likely Most often, individuals come to a surto recover fully. geon when pain and discomfort insist. Because the nerve tends to send louder WHAT SHOULD I DO IF I AM messages as the injury progresses, this EXPERIENCING NUMBNESS AND tends to be when nerve injury is at least PAIN IN MY HANDS? moderately severe. First off, don’t assume that all pain and Often they have already been wearing numbness in the hands is carpal tunnel wrist splints at night, but this is no longer syndrome. preventing their fingers from going numb or waking them with a “pins and needles” CARPAL continued on 13 >>
Learn more about the skin you’re in: VISIT JeffersonHealthcare.org/dermatology CALL 360.344.1002
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APPENDECTOMY EXPECTATIONS: Surgery not always immediate STORY BY LAURA LOFGREN PENINSULA DAILY NEWS
SYMPTOMS OF APPENDICITIS
We’ve all heard stories of someone who has suffered from appendicitis. A tale usually begins with explanation of an excruciating pain in the right side of the stomach area, followed by a trip to the emergency room where doctors rush the patient immediately into surgery to have the offending appendix removed before it kills said patient. Whether these stories were meant to bring on terror to us as kids or not, they instilled something in the public that has become an expectation for anyone who suffers from appendicitis: surgery is immediate. THE CONDITION First, let’s define what the appendix is. According to the American College of Surgeons, the appendix is a small pouch that hangs from the large intestine where the small and large intestines join. If the appendix becomes blocked and swollen, bacteria can grow in the pouch. The blocked opening can be from an illness, thick mucus, hard stool or a tumor. When a blockage occurs, that’s when one can be diagnosed with appendicitis. Appendicitis is an inflammation of the appendix usually caused by a bacterial infection. The infection and swelling can decrease the blood supply to the wall of the appendix. This leads to tissue death, and the appendix can rupture, causing bacteria and stool to release into the abdomen. A ruptured appendix can lead to peritonitis, which is an infection of the entire abdomen. Appendicitis affects people between the ages of 5 and 90, but mostly commonly between the ages of 10 and 30. And while many might say the appendix is totally useless, Dr. Georgia Heisterkamp, of Olympic Medical Center in Port Angeles, stated, “It’s probably not useless, but it doesn’t have a significant function or role to our well-being. But we live just fine without our appendix,” she said. “Some people believe it may have a very small role in the immune system and fighting infection. The common age is 12 for appendicitis to occur. [The appendix] may harbor lymph node-like tissue and sometimes in children, they’ll development appendicitis after a viral infection.”
ing appendix, the common notion is they head to the emergency room and are admitted for an emergency appendectomy (the removal of the appendix) almost immediately. But, according to doctors around the country, including Heisterkamp, that expectation isn’t always the case. “Many patients can be safely medically managed for a brief period of time while awaiting surgery,” said Heisterkamp, who has performed hundreds of appendectomies. Cases of appendicitis are treated individually, so not every patient requires emergency surgery. Depending on the presentation of symptoms — most people with appendicitis show symptoms within 12 to 36 hours, according to Heisterkamp — doctors will hydrate a patient with fluids and start them on antibiotics before surgery. “We’ll start surgery several hours within admission [to the hospital],” she said. “There are still those times where we have to operate at 2 a.m. They may be septic (high fever, pre-shock), and they do need and operation right away.” But for some patients, they might not present or acknowledge symptoms for a THE EXPECTATION week or two, according to Heisterkamp. When someone thinks they have an ail“It’s quite a spectrum of the disease.”
• Stomach pain that usually starts around the navel and then moves to the lower right side of the abdomen • Loss of appetite • Low fever, usually below 100.3oF • Nausea and sometimes vomiting • Diarrhea or constipation Occasionally, a person might not know they have appendicitis until the appendix perforates, according to Heisterkamp. Another misconception is that the appendix “bursts.” Heisterkamp lamented that “burst” is an incorrect term for what happens to a sick appendix; an appendix perforates, allowing bacteria to slowly leak into the abdominal cavity. THE PROCEDURES Once a patient with appendicitis has been admitted to the hospital, nurses and doctors assess the severity of the condition and create a surgical or nonsurgical plan based on the individual experiencing pain. For some patients experiencing only some signs of appendicitis, the surgeon might treat them with antibiotics and watch for improvement. In uncomplicated appendicitis, antibiotics may be effective, but there is a higher chance of reoccurrence, according to the American College of Surgeons. As far as surgical treatment goes, there are two options: a laparoscopic appendectomy and an open appendectomy. Laparoscopic surgeries are the most common and involve one to three abdominal incisions. A tube, or a port, is inserted into one of the slits, and carbon dioxide gas
inflates the abdomen. A laparoscope is inserted through another port, and surgical instruments are placed in the other small opening and used to remove the appendix. According to Heisterkamp, laparoscopic surgery might not be possible for children, as the abdomen is too small. In an open appendectomy, the surgeon makes an incision that is usually about 2to 4-inches long in the lower right side of the abdomen. The appendix is then removed from the intestine. Sometimes a surgeon will begin with a laparoscopic technique and need to change to an open technique. This is done for the safety of the patient. As with any surgery, something can change during the procedure and cause the surgeon to change course unexpectedly. While some patients experiencing symptoms of appendicitis will need to be operated on immediately, there should be no expectation of immediate surgery going into an emergency room. Nurses, doctors and surgeons deal with individual patients as just that — individually. Of course there is a science behind diagnosing appendicitis, but not everyone’s treatment will be the same. The human body is full of possibilities, and it is the job of your surgeon to figure out the best course of action for you specifically. Peninsula Daily News/Sequim Gazette
A little leakage can mean bigger issues OTHER COMPLICATIONS Urinary incontinence can lead to other factors that impact one’s lifestyle. “If you experience significant incontinence, you can have issues associated with having to wear a pad all the time, similar to a diaper rash in babies, and oftentimes not want to go about your normal activities due to fear that you may have an accident,” Plamoottil said. Bensen added that social embarrassment and isolation are outcomes of urinary incontinence. Falls on the way to the bathroom at night or with urgency are also risk factors,” she said.
STORY BY LAURA LOFGREN PENINSULA DAILY NEWS
A little leak after a sneeze. An urgent need to run to the restroom after having a hearty laugh. A pause to your workout to change your skivvies. Urinary incontinence occurs when you least desire it. Defined as the involuntary leaking of urine, this condition affects both men and women, with it occurring more frequently in women. “My practice is about 75 percent female, and most of them have issues with incontinence,” said Dr. Carleen Bensen, a boardcertified urologist at Olympic Medical Center. TYPES OF URINARY INCONTINENCE Dr. Sheena Plamoottil, who specializes in obstetrics and gynecology at Olympic Medical Center in Port Angeles, said there are several different types of incontinence. The main two are stress incontinence and urge (or urgency) incontinence. “Stress incontinence occurs when there is involuntary leakage with increased pressure in the abdomen, such as when you cough, sneeze [or] jump,” Plamoottil said. “We can diagnose this one with a test in the office to see if you leak with coughing or sneezing. “Urge incontinence happens when you have a sudden urge or need to go to the bathroom and leak before you get there. We diagnose this more by symptoms. “Sometimes you can have mixed incontinence, which happens when you have components of both,” she said. Simple office testing doesn’t always result in a diagnosis, Plamoottil said, and more extensive testing is necessary. Bensen added that a urinalysis might be needed to rule out a urinary tract infection or blood in the urine. An ultrasound scan might be needed “to make sure the bladder is emptying completely,” Bensen said. “Then, [we] may do a test called urodynamics, where the bladder is filled with water and we check for increase in pressure and leakage.” RISK FACTORS Several influences could factor in to one being diagnosed with urinary incontinence. “Most incontinence is more prevalent as we age. There are some urge incontinences that can be caused by neurological disease, for example, that can effect younger people as well,” Plamoottil said. Depending on the type of urinary incontinence, factors can differ. “For stress incontinence: age, genetics, PENINSULA DAILY NEWS/SEQUIM GAZETTE
obesity, constipation [or] pregnancy,” Plamoottil said. “For urge incontinence: age, obesity [or] neurological function.” Some neurological functions, according to Bensen, include multiple sclerosis, spinal cord injuries, Parkinson’s disease and stroke. “Gravity and having children increase the risk,” Bensen added. In addition, she said, cigarette smoking and having weak pelvic floor muscles can increase the likelihood of urinary incontinence. Sexual activity, especially in women, also can play a role in urinary incontinence. “In men, an enlarged prostate can sometimes lead to urine leakage,” Bensen said. “Pelvic surgery and radiation can also
be a factor. Then, some people are just plain unlucky and an have overactive bladder just because,” she added. WHEN IT BECOMES SERIOUS If you’re suffering from minor or major leakage and it’s impacting your lifestyle, both Plamoottil and Bensen said it’s time for a doctor’s visit. “If someone is experiencing incontinence and it has been concerning them or disrupting their normal life, that’s when they should come in to the doctor,” Plamoottil said. “A lot of women, I’ve found, think that incontinence is ‘normal,’ so they deal with it. I like to tell them that though something is ‘normal,’ it may not be ‘optimal.’ ”
TREATMENTS As far as treatments go, those suffering from urinary incontinence have a few options, depending on the type of incontinence a doctor has diagnosed. “For stress incontinence, behavioral modification and exercises can help,” Plamoottil said. “I utilize our pelvic floor physical therapists often to help patients retrain their bladder and strengthen their pelvic floor. There are some pessaries [a plastic device inserted into the vagina] that can also help stress incontinence. We also have surgical options to help with stress incontinence using slings and bulking of the opening where you urinate from. “For urge incontinence, we usually treat that with the same conservative steps and then move to medicine if that does not remedy it. Individuals can practice good pelvic floor health by staying up on their Kegel exercises and try to maintain a normal weight. There also may be some foods and drinks that are more irritating to the bladder, like caffeine or carbonation that they can avoid,” she said. “Bicycling is excellent, as well as anything which strengthens the core,” Bensen added. “There is medication, surgery and exercise, as well as smoking cessation and weight loss,” she said. “For people who are overweight, if they will lose 10 percent of their body weight, there is a noticeable difference in their incontinence.” Whether it’s a trickle after a cough or a heavier flow from out of nowhere, there are ways to make urinary incontinence more manageable in day-to-day life. If incontinence is a concern, start implementing a more active lifestyle and eating healthier. When all preventive measures have been taken but incontinence still occurs, schedule a visit with your doctor to discuss further options.
Pack well for a hike in the wilderness STORY BY METROCREATIVE
September may enjoy the title of National Wilderness Month, but any time of year is a good time to enjoy the great outdoors. One of the ways to immerse oneself in nature is to enjoy a day hike or overnight backpacking excursion. Millions of people take to trails or create their own paths all across the world each and every year. Hiking is a great way to enjoy the beauty of nature, but it also has other benefits. The American Hiking Society notes that research has consistently shown that hiking as regular exercise can improve overall health and fitness. It also might lengthen and improve quality of life. Hiking as a form of low-impact walking can reduce risk for heart disease, hypertension, diabetes, obesity and anxiety. Preparing for a hike involves packing accordingly for the trip. These items should be brought along on hiking trips to ensure such excursions are comfortable, safe and successful. • Water: Bring along water whether you’re hiking in warm or cool temperatures. Water can be heavy, so some experienced hikers prefer to bring a filtration device or purifying tablets so they can rely on natural water sources for their drinks.
Pack accordingly for a hike outdoors, whether it’s a short excursion or an overnight campout. Let someone know where you plan on hiking before you head out. • Proper footwear: Trail shoes might be adequate for shorter hikes or when you are not carrying much gear; otherwise, opt for sturdy hiking boots with plenty of sole and ankle support. • Nutrition: Bring along lightweight
food to keep you well fed. Any number of situations, including difficult trails and getting lost, can prolong hiking trips. Nutritious snacks can help hikers maintain their energy levels. • Rain gear/extra clothing: Dressing in
layers and having a change of clothes enables you to adjust your attire according to the weather conditions. Wear waterrepellant materials that wick away sweat. • Sun protection: Sun protection includes sunscreen, sunglasses and a hat. • Illumination: Pack a headlamp or flashlight, and don’t forget the batteries. Light will help you navigate if you are out after sundown. Flashlights also can be used to signal others if you’re lost. • Navigational tools: A compass and map will help keep you on course. Remember, cellphones may not work in remote areas. • Fire starter: A night spent in the wilderness might not be on the itinerary, but chemical fire starters, matches or even dryer lint can help start fires in emergency situations. • Multipurpose tool: A multipurpose tool can be used to cut items, open cans and much more. • First aid kit: Don’t forget a prepackaged first aid kit to treat minor or major injuries. Taking a first aid course is also helpful. • Toilet paper: When nature calls in nature, a roll of toilet paper can make things much easier. • Emergency shelter: Tarps, tents or even reflective blankets can be put to use if a day trip needs to be turned into an overnight stay.
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Nip the nail-biting habit for your health The infection, called paronychia, causes redness, swelling and pain around the nail. Microorganisms can get into the skin Nail biting, also known as onychophagia, through tiny tears and abrasions that occur is a common habit that affects people of all while biting the nails and cuticles, according ages. Biting your nails usually stems from to The Mayo Clinic. stress or forms as a nervous habit. If the infection damages the nail bed, you Most research says that children and can end up affecting nail growth. teenagers make up the greatest number of Should you have warts on your hands or regular nail biters. fingers, they easily can be transferred to On the surface nail biting might seem like your lips and mouth through nail biting. a trivial thing in terms of affecting your Nail biting also can cause problems to health. your teeth. Although it can seem like biting your nails Prolonged nail biting might affect how the does nothing more than make the hands teeth form in children. It can interfere with look less attractive, there are actually other dental occlusion, or the manner in which the dangers to repeated nail biting that people upper and lower teeth come together to bite. prone to the habit should consider. Eventually teeth can shift out of position. Firstly, biting your nails can be an unsaniThe Academy of General Dentistry estitary behavior. mates that nail biting can result in thouThe fingers can pick up all measures of end up in your gastrointestinal system and sands of dollars of extra dental work. contaminants, and the nails can be an ideal can lead to infection. While biting your nails might seem like a location for bacteria to thrive because nails The nails also can harbor fecal matter and harmless habit, it actually can affect perare more difficult to keep clean than the sur- many other unsavory microscopic particles, sonal health in a number of ways. face of the hands. even parasites. Explore the different ways to keep from According to the American Academy of Biting your nails gives these tiny invaders biting your nails to improve the health of Dermatology, bacteria such as E. coli can live easy access to your body. beneath the tips of your nails. Nail biting also might lead to infections on your fingers, your teeth and the rest of your body. When you bite your nails, those bacteria the fingers around the nail bed. STORY BY METROCREATIVE
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Night-time splint wear can be tried when numbness alone is present. If this resolves the problem, no other treatment may be necessary. Symptoms that are bothersome and persistent should be evaluated by a medical provider. Physical exam and X-rays will often indicate what further treatment or referral is necessary. Regina M. McGovern, M.D., is a board-certified orthopedic durgeon with sub-specialty training and certificate of added qualification in hand and microvascular surgery. She completed her training at the Mayo Clinic and has been serving people on the North Olympic Peninsula since 2001. She has surgical privileges at Olympic Medical Center, Sequim Same Day Surgery, Jefferson Healthcare and Forks Hospital. She can be found at Strait Orthopedic Specialists, P.S., 832 Georgiana St., in Port Angeles. She can be reached at 360-4570804.
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Eateries earn award for safe food handling • The Galley • Timberhouse Restaurant
STORY BY PENINSULA DAILY NEWS
The 2016 Outstanding Achievement Awards were presented at the Aug. 17, Jefferson County Board of Health meeting to recognize 26 restaurants, full-service food establishments and their proprietors for demonstrating the highest standards of safe food handling during the past year. The 26 restaurants and proprietors worked hard in 2016 to maintain excellent food safety standards. Most of the recognized establishments work with complex menus, which adds to food safety challenges. Jefferson County Public Health (JCPH) and the Board of Health recognized them for their dedication to preventing illness, and encouraged the entire food industry to strive for the same honor.
Criteria for the award were developed by the JCPH Food Safety Round Table and Jefferson County Food Safety Staff and are based on food safety inspections conducted in the areas of personal hygiene, food temperature safety and prevention from contamination. All food workers must hold a current Washington State Food Worker Card.
Grilling food safely
One of the challenges of cooking over high, open heat is the difficulty in determining just how long to keep foods over the flame. Use these tips to make grilling Submitted photo 2016 OUTSTANDING ACHIEVEMENT Representatives from 10 of the 26 eateries who received awards are, from left, back row: easy and safe. AWARD WINNERS • Preheat and prepare the grill: Be Marcia Atwood, Kenna Eaton, Stephanie Boyle, Jeff Boyle and Stuart Whitford; middle • Belmont Catering sure to preheat the grill to between 400 row: Alice Yantz, Philippa Mills and Susan Porter; front row: Tracy Nichols, Elizabeth • Blue Heron School and 500 degrees Fahrenheit. Use a nonMays, Lisa Minnihan, Cleare Shields and Gabe Santiago. • Brinnon School District stick spray on the grates while the grill is • Brinnon Senior Supper Club • QFC Number 870 Deli, Port Hadlock heating. • Grant Street School • Chimacum Elementary School • QFC Number 106 Deli, Port • Jefferson County Jail • Buy a meat thermometer: By • Chimacum High School Townsend • Jefferson Mental Health (now called knowing internal temperatures in a few • Chimacum Middle School • Quilcene School Cafeteria Discovery Behavioral Healthcare) seconds, grillmasters can have juicy foods • Chimacum Primary School • Safeway #538 Grocery • Lanza’s that are cooked to the correct temperature • Discovery View Retirement Association • Tri-Area Community Center Senior • Mo Chili BBQ (Mobile Complex) so foodborne illnesses do not become a • Ferino’s Pizzeria Nutrition/Meal • Pippa’s Real Tea problem. • Food Co-op Deli • The Boiler Room • Port Townsend Senior Nutrition — Metrocreative 791948243
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Understanding, clearing up adult acne ute to adult acne. When stressed, the body releases certain horMany youngsters develop acne mones, most notably cortisol, to during adolescence. address the problem. Acne often disappears by the Skin experts say that testostime adolescents graduate high terone can accompany cortisol, school, but for some people, acne which can drive oil glands to prolingers into adulthood. duce more oil. The American Academy of DerStress can lead to more oily matology has said adults can get skin, which increases the likeliacne, which might persist as hood of breakouts. adults reach their 30s, 40s or 50s. Learning how to reduce stress Some people even develop acne can lead to clearer skin. for the first time as adults, a con• Hormonal changes: Fluctuadition known as adult-onset acne. tions in hormones are normal for Although both men and women. women can develop acne, women Estrogen and progesterone levtend to get adult acne more often els vary depending on the menthan men. strual cycle. Adult acne can be particularly The Johns Hopkins Departfrustrating for adults who had ment of Dermatology has said acne as children. that acne is prevalent before Understanding what’s behind one’s menstrual cycle and can the blemishes can help people get also occur during menopause the treatment they need to banwhen hormones are in flux again. ish breakouts. If acne is problematic, women • Stress: Stress might contrib- can speak with their doctors
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about hormone therapy or birth control pills to see if either option can alleviate the hormone fluctuations that contribute to acne. • Family history: Genes also might be to blame for adult acne, as some people might have a genetic predisposition to acne.
• Medication: Acne might be a side effect of certain medications. If medicine is triggering breakouts, women can discuss potential alternatives with their physicians. • Sugar: Some evidence suggests that sugar can contribute
to acne by raising insulin levels, which then triggers oil-releasing male hormones. Stick to foods that do not trigger a sugar (and insulin) spike. Australian researchers found that people who followed a lowglycemic index (GI) diet (which is low in refined carbohydrates such as those found in white bread) had a 22 percent decrease in acne lesions, compared with a control group that ate more highGI foods. • Salt: It’s not the greasy fries that cause acne, but it very well may be the salt on those fries. Some doctors suspect that sodium can cause issues with the skin because the iodine found in table salt and seafood can build up and make acne worse. If these options do not work, speak with a dermatologist about cleansing regimens and topical treatments that can help reduce acne breakouts.
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Tips to ﬁght fall allergies before they begin your allergies are under control, a new problem is brewing. In the blink of an You made it through a tough spring allergy season (itchy) eye, fall allergy seaand are now grasping onto son will be here. “Ragweed, the biggest the last bits of high temperallergy trigger in the fall, atures and fun in the sun. But just when you think usually starts releasing its
STORY BY BRANDPOINT
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pollen with cooler nights and warm days in mid- to late August. Ragweed season can last into September and October when the first frost hits,” said allergist Stephen Tilles, M.D., president of the American College of Allergy, Asthma and Immunology (ACAAI). “If you suffer from spring allergies, there’s a good chance you also suffer from fall allergies.” A single ragweed plant can release a million pollen grains in a day. Winds can carry these grains for up to 100 miles, which means no matter where you live, you’ll likely be affected if you’re allergic to ragweed. Add to this high levels of mold spores that are common in the fall, and it’s no wonder people end up sneezing and wheezing. Dr. Tilles said the key to winning the war on fall allergies is to start early while still in the heart of summer. Here are some tips from ACAAI to consider: OUNCE OF PREVENTION Take your fall allergy medications two weeks before symptoms usually begin, which can mean early or mid-August. Remember to continue your medication for two
weeks after the first frost. WAIT ON THE ‘FRESH AIR’ Keep your car and home windows closed. Use your air conditioning to regulate temperature. When you open windows, you allow ragweed and other allergens in, and they stick to surfaces. DRESS LIKE A SECRET AGENT If you do go outside, wear a hat and sunglasses to keep ragweed pollen out of your eyes. MASK OUT THE IRRITANTS After spending time outdoors, leave your shoes at
the door. Then shower, change and wash your clothes to remove the pollen. For summer and fall yard tasks, wear a NIOSH N95-rated filter mask. Only N95 masks filter out pollen due to its micro size. HAVE A HEART-TO-HEART WITH JUNIOR If your child is old enough, make sure they know what their triggers are before they head back to school. Teach them how to properly use any prescribed inhaler device or epinephrine auto injector. Update all prescriptions for the start of the school year.
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SCHOOL THE TEACHERS Help new teachers understand your child’s allergy triggers and how to address them. Share your child’s treatment plan with school staff, including any medication needed during school hours. If your child has a food allergy, let the teacher know they need two epinephrine auto injectors with them at all times. COACH THE COACHES If your child participates in athletic activities, make sure the coach or physical education teacher knows what to do in case of an asthma- or allergy-related event. GO STRAIGHT TO THE EXPERTS Board-certified allergists are trained to diagnose and treat your symptoms, and can create an individual action plan. If you think you or your child might be one of the more than 50 million Americans that suffer from allergies and asthma, visit www.acaai.org to find an allergist in your area and take the symptoms test.
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Shellﬁsh harvesters: Use the ‘Three Cs’ STORY BY PENINSULA DAILY NEWS
The Washington State Department of Health is urging recreational shellfish harvesters to take extra precautions and check, chill and cook — the “Three Cs” — through the end of September. The combination of hot weather, low tides and little rain have contributed to more than 10 reports of vibriosis illnesses from people who ate raw or undercooked oysters they collected themselves. Vibrio parahaemolyticus bacteria is found naturally in the environment and thrives in warm temperatures. “The shellfish industry follows special control measures during the summer months to keep people who choose to eat raw oysters from getting sick,” said Rick Porso, director of the Office of Environmental Health and Safety, in a news release. “For those who enjoy collecting and consuming their own shellfish, it’s important that they follow a few simple measures to stay healthy.” Before heading to the beach, people who
Falling Leaves, Falling Temperatures... Rainy Days, Slippery Steps.
1. CHECK 2. CHILL 3. COOK gather their own shellfish should check the DOH Shellfish Safety Map at www. tinyurl.com/WA-Shellfish to determine if any areas are closed. Shellfish gathered from open and approved areas should be harvested as the tide goes out, chilled as soon as possible and cooked at 145 degrees Fahrenheit for 15 seconds to destroy Vibrio bacteria. Vibriosis symptoms include diarrhea, abdominal cramps, nausea, vomiting, headache, fever and chills. The illness is usually mild or moderate and runs its course in two to three days.
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Time for a “tune-up” at Sequim Health & Rehab with our outpatient therapies. Slip and fall or take a tumble and injure yourself, Sequim Health & Rehab is ready to help you get back on your feet with our seven-day-a-week therapy department and outpatient therapy services.
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Gardening classes slated STORY BY PENINSULA DAILY NEWS
While it might seem like the prime growing season for veggies is over, there is still time to learn a few tricks of the trade as we enter into the autumnal season. WSU Master Gardeners will present “Advanced Growing Groceries” classes this fall. Class participants will dig deeper into vegetable gardening by exploring topics such as seed saving, building healthy soil, permaculture, winter and early spring gardening, pest management and much more. Attendees also will have opportunities to practice hands-on skills and have their specific questions answered by local gardeners.
Some fall lawn care tips STORY BY METROCREATIVE
If lawn and garden responsibilities dip considerably in winter, then fall is the last significant chance
before the new year that homeowners will have to address the landscaping around their homes. Homeowners who want
The seven-week class will take place Tuesday afternoons from 1 p.m. to 4 p.m. in the WSU Port Hadlock classroom, located at 121 Oak Bay Road. In addition, there will be a movie night and three Saturday afternoon field trips from 1 p.m. to 4 p.m. Classes begin Sept. 26 and run through Nov. 7. Class size is limited, so interested parties are encouraged to sign up early. The cost is $88, and scholarships are available. Download the 2017 GG Registration Form at www. extension.wsu.edu/jefferson/gardening-classes/ or sign-up through Brown Paper Tickets at 2017advancedgg.bpt.me. Questions? Contact at Bridget Gregg at wsujeffcomg@ gmail.com or 360-379-5610, ext. 210. their lawns to thrive yearround can take advantage of the welcoming weather of fall to address any existing or potential issues. • Keep mowing, but adjust how you mow. As fall transitions into winter,
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lower the blades so the grass is cut shorter while remaining mindful that no blade of grass should ever be trimmed by more than one-third. Lowering the blades will allow more sunlight to reach the grass in the months ahead. • Remove leaves as they fall. Leaves left to sit on the lawn may ultimately suffocate the grass by forming an impenetrable wall that deprives the lawn of sunlight and oxygen. The result is dead grass and possibly even fungal disease. • Aerate the turf. Aerating reduces soil compacting, facilitating the delivery of fertilizer and water to a lawn’s roots. It’s best to first have soil tested so you know which amendments to add after the ground has been aerated.
Brown Bag talks round out year STORY BY PENINSULA DAILY NEWS
The Clallam County WSU Master Gardeners are planning several more Brown Bag series to round out the year. These free Thursday presentations take place at noon in the county commissioners’ meeting room at the Clallam County Courthouse, 223 E. Fourth St., Port Angeles. SCHEDULE • Sept. 28: “Dwarf Fruit Tree Varieties” with Bruce Pape, master gardener • Oct. 12: “Bulbs” with RJan Danford, master gardener • Oct. 26: “Seed Saving” with Muriel Nesbitt, master gardener • Nov. 19: “Ducks in the Garden” with Selinda Barkhuis • Dec. 14: “Holiday Decor and Gifts from the Garden” with Tanya Unruh and Marilynn Elliott, master gardeners. For questions about the Master Gardener Brown Bag series, phone 360-565-2679, or visit www. extension.wsu.edu/clallam.
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How to enjoy an eco-friendly autumn game in the yard. Serve finger foods to cut down on the need for plastic or paper plates and flatware. Purchase a keg of beer from a local brewery to eliminate individual beer cans and bottles.
STORY BY METROCREATIVE
Autumn arrives with cool breezes, awe-inspiring foliage and the hint of holidays on the horizon. Fall is a favorite time of year for many people because the crisp weather motivates people of all ages to enjoy the great outdoors. Individuals conscious of their carbon footprints can use fall as a time to take inventory of their behaviors and make changes where necessary. The following are some steps to take right now that fit perfectly with the harvest season. SHOP AT A LOCAL FARM STAND Take advantage of the roadside stands that crop up this time of year, where you can find bushels of apples, pumpkins, gourds and late-summer vegetables. After a day of sightseeing, visit a farm stand for warm cider and freshly baked doughnuts. Buying local produce reduces reliance on foreignshipped foods and other products, while also cutting back on the fuel consumed to get foods from the farm to the table.
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esting table centerpieces. CREATE A COMPOSTING PILE Outdoor chores are easier in cool weather than they are when the mercury rises. Set aside a place in the yard for composting. A healthy compost pile should have roughly twothirds carbon (brown) materials and one-third nitrogen (green) materials, according to EarthEasy.com. Use those lawn clippings and raked leaves to make compost for spring plantings.
VISIT A CORN MAZE After corn has been harvested, farm owners often use their land for supplemental income. Corn mazes can be simple or complex depending on visitors’ ages. Engage in family bonding outside and turn off electronics in the process.
RECYCLE OLD CLOTHES TO DRESS A SCARECROW Clothing that is not worthy of donation can be transformed into a festive scarecrow just in time for Halloween hijinks. Fill out the body of the scarecrow with newspaper and then add some pieces of straw around the neck, hands and feet.
BAKE YOUR OWN PIE After a fun-filled day picking apples or late-season ber- HOST A FOOTBALL PARTY ries, head home and use Watch the game on telethose locally sourced fruits to whip up a delicious pie. vision or have a pickup
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USE NATURE TO DECORATE Skip plastic, mass-produced decorations and rely on nature to dress up your home. Fill vases with leaves and berries. Place small pumpkins on mantles, and enrich the landscape of your home with vibrantly hued mums and other cool-weather plants. Corn husks and stalks can add harvest flair to front porches. Twigs nestled and tied together can make inter-
Set out a nonalcoholic punch bowl so the kids can enjoy refreshments, too. Autumn can be a great time of year to embrace some eco-friendly practices. Take some time to enjoy this special season.
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