Bridging The Gap Between Patients And Providers
Volume 2, Issue 4 - Winter 2012 www.rsvphealth.com
Women’s Health
CHARLIE’S VOICE IS CHANGING
YOU HAVE MORE POWER THAN YOU THINK
VIRTUAL WORKOUT, REAL SWEAT; WORKING OUT WITH THE WII AND KINECT
Too much to do.
Too LiTTLe Time.
We can help!
As parents age, their needs change. You soon discover that your time is filled with “have to do” instead of “get to do.” Our services vary from doing chores to companionship to personal care. Let us be the caregiver, so you can spend your time being family.
Reclaim the time you spend with loved ones. Call today. 314.446.2519
LSSInHomeServices.org Home Health Private Duty Outreach Social Services Living Safe Technologies Hospice Care
Credits Publisher RSVP Health, LLC Executive Editors Benjamin A. Moss Rodney D. Gross, Ph.D.
RSVP Health is a focused group of individuals, interested in bringing consistent and understandable health care, health and wellness education and services. It is who we are that dictates what we do. What we do: Health Care Business Development Strategic Business Planning Executive Health Care Management Practice Management Policy and Procedures Protocols Speaking Engagements Health Care Reimbursements Patient Satisfaction Practice/Office Patient Flow Designs Patient and Senior Care Advocacy RSVP Health 888-415-8759 www.rsvphealth.com twitter.com/rsvphealth facebook.com/rsvphealth
Creative Director Production Manager Benjamin A. Moss Writers Rodney D. Gross, Ph.D. Dr. Charles Willey, M.D. Lola AuBuchon Gross Dr. Arturo C, Taca, FABAM, FABPN Jeff Browning Rita Martin Luke Smith For advertising information, please contact us at: RSVP Health 888-415-8759 info@rsvphealth.com
RSVP Health is provided for information and education purposes and is in no way to take the place of a health care professional’s advice. Please consult a health care professional with any health related questions. Not all information within is the opinion of RSVP Health. RSVP Health is not liable for any decisions made as a result of information received from the RSVP Health Magazine. www.rsvphealth.com
4 RSVP Health | www.rsvphealth.com
RSVP Health | Community Health Care and Wellness Resource Guide
All of us have our own particular journey that defines us one way or another and RSVP Health is no exception. Reflecting back on our first full year, we have grown from a little “niche” company to one that now has no borders or boundaries relating to subject matter. Those of you, who follow us via our Website, Facebook, Publication (online & print), Radio Show, etc, are whom we have to thank for our expanded journey and not to forget our clients who help make all of this possible. So many of you have contacted me personally and it is RSVP Health’s and my privilege to do what we can to answer your questions, direct you to other “experts” and most of all, being a resource for you. What better way to begin our journey in 2012, than to highlight and promote “Women’s Health and Wellness”. There is not a one of us that probably does not have at least one female that was or has been a part of our journey. I am lucky, I have had several, from my Mom, both of my Grandma’s, Aunts, Sister and finally the one that chose me for her continued journey, my wife Lola. A woman’s journey from the beginning of time until currently, is one filled with numerous obstacles, struggles, defining moments, accomplishments, etc. One of the unique things about women, is, that they are a woman. Their body and very essence varies dramatically than males. Among the many things that I listed two sentences before, is the health and wellness of women and how it itself has dramatically changed from the view of health care and medical institutions. Traditionally both men and women were treated the same for everything and thank goodness, that has changed. More and more research has been and is being conducted to the advancement and understanding of Women’s Health and Wellness. Additionally, many health and wellness awareness campaigns for women, traditionally, where only highlighted in certain time frames. It is the goal of RSVP Health, mine personally, that there not be just brief identifications (once or twice a year), and not be a time limit and or cut-off dates when we can or cannot discuss. Anyone’s health and wellness deserves all the attention one desires. That is one of the most unique things about RSVP Health and all its’ media outlets (Radio Shows, Article, Interviews, Publications, etc), there is no time limit. Many of our articles we wrote a year ago, two years ago, are still “fresh” and “relevant”. This is what separates RSVP Health from others, we do not just do “yard of the week” subjects. Thought and relevancy is the core of my “philosophy” and this result must be a common denominator with my clients.
The empowerment of women is not only around the direct subject of health and wellness, but as you will see in this issue, the evolution and awareness of women in the workplace, as business owners, serving in the military, etc. Inside these pages, you will also see statistics and articles devoted to the points I just made. As I mentioned above how many women have guided and been a part of my journey, this subject is very dear to me and should be to all. One of the struggles of doing a publication is how much can we squeeze into the final product. The good thing is that though many things did not make it into this publication, we will have them on our RSVP Health Website (www.rsvphealth.com) and that will consist of more articles and actual interviews. If you have a journey and or story that you would like to share, contact me at rodney@rsvphealth.com. As always, I would like to thank all health care & wellness entities and contributors that have participated in this guide and for seeing the importance to educate and communicate to you. In addition, I would like to thank all who make up RSVP Health LLC and their support on the importance of health care and wellness education, communication and awareness. In closing, RSVP Health LLC will continue striving to bring health care and wellness education, awareness and access to you with one goal in mind, your well-being. Our journeys, though unique to each one of us, will cross roads on some of these common subjects and together we will strengthen these junctures. Rodney D. Gross, Ph.D.
“Someone who just goes through the motions of life will never experience the notion of life.” -Dr. Rodney D. Gross, January 30th, 2012
RSVP Health | www.rsvphealth.com 5
Health coverage as individual as your family. Don’t put your family at risk by trying to get by without health care coverage. Get reliable benefits that match your busy life. We can help you choose a plan that makes good sense for your health, and your wallet.
Diana Harte
Authorized Independent Agent
314-727-5522 x107 dharte@mrctbp.com 230 S. Bemiston Ave., Ste 900 Clayton, MO 63105
Health. Join In. Diana Harte isHealth an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. 6 RSVP | www.rsvphealth.com
In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Life and Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Table of Contents | RSVP Health
You Have More Power Than You Think.
Forever Your Mom; the Ultimate Caregiver
Page 8
Page 16 Charlie’s Voice is Changing
Page 24 Exercise for Bone Health.
Page 62 Page 12 Winning at Losing
Page 28 Queen Of Hearts
Page 14 Understanding Your Health Coverage
Page 32 Osteoporosis: What You Need To Know
Page 19 Staying Two Steps Ahead: Why It’s So Important for Seniors to Plan for the Unthinkable
Page 35 For Seniors in the Workforce, Flexibility and Curiosity Are Key to Job Longevity.
Pages 20 Generations of Healthy Living
Page 36 The Ovaries
Page 50 Called to Serve: A Two-Step Plan for Becoming a First-Time Caregiver Page 56 Virtual Workouts, Real Sweat: Working out with the Wii and Kinect Ignore The Pain? - Page 52; Methamphetamine - Page 54; Living with Multiple Sclerosis - Page 58; Improving Your Baby’s Odds During Pregnancy - Page 66
RSVP Health | www.rsvphealth.com 7
You Have More Power Than You Think! Part 4 By Dr. Rodney Gross, Ph.D.
8 RSVP Health | www.rsvphealth.com
Common Procedures? Colposcopy Cryosurgery LEEP Procedure Hysteroscopy D&C Common Disorders? Autoimmune Disorders Gallstones Hypertension (High Blood Pressure) Migraines
Osteoporosis Urinary Tract Infections Become Your Own Health & Wellness Expert
Women’s Health and Wellness “Common Procedures & Disorders”
Per your request, Ladies and Girls, here are some procedures you may encounter and some of the most common disorders related to women. Now you will have the power in knowing some of the procedures utilized and disorders in Women’s Health & Wellness before you go to the doctor. Traditionally, no matter, race or sex, we went to the doctor and told what we needed. There is a difference in being told, than having it explained, where one could understand what is going to be happening to “their” body. Most of us do not know medical terms and procedures and what they mean and as I said above, this is something that all of you requested in large numbers. As always, I am so thankful the “You Have More Power Than You Think,” continues to empower many of you.
issues and I will reference which issue you can find further detail on our website under the media tab. I will use some of my own definitions and quote some of the others when needed, with the goal of all of us having a better and basic understanding of what procedure(s) and disorders you may encounter. As always, my definitions and highlights are very basic to empower one to ask questions, research the web, go to the library and or spend a day at the bookstore. Most of what I just said costs little to nothing in return for the knowledge you will receive. Your health and wellness is your “Return on Investment”.
I will attempt to put as many of the procedures and common disorders you requested and add some that I think is relevant to your well-being. I may have described some of them in previous
RSVP Health | www.rsvphealth.com 9
The Common Procedures? Below were “some” of the most requested ones that all of you asked.
The Common Disorders? Below were “some” of the most common disorders experienced by women, per your requests.
Colposcopy - If your cervix appears abnormal during your pelvic exam and Pap smear, your gynecologist may order this procedure. Normally about a 10- to 15-minute procedure that is painless and performed in the office, you are positioned on the examination table, as you would be for a pelvic exam. An acetic acid (such as common table vinegar) is placed on the cervix, and then your physician will use the Colposcope (an electric microscope) to view your cervix through a bright light on the end of the Colposcope.
Autoimmune Disorders - A condition when the immune system attacks the body’s own tissue. Autoimmune Disorders affect about 12 million Americans and 75% of them are women. The ones more common in women are:
Cryosurgery – if confirmation of abnormal cervical cells, this procedure may be performed. Performed in the doctor’s office with one positioned, as you would be for a pelvic exam, cryo probes are inserted and are placed to cover the cervical tissue that has the confirmed abnormal areas. Liquid nitrogen is flowed through the probes causing the probes to freeze and destroy the “superficial” abnormal tissue. The procedure may be done multiple times in one session and has a success rate of around 85%. D & C (Dilation and Curettage) – Performed in hospital settings using general anesthesia or a doctor’s office using a local anesthetic, D & C is one of the most common procedures involving women. A curette is used to scrape the uterine walls; loosening pieces are obtained and sent off to a lab for examination. A suction tube may also be utilized to obtain uterine lining. Hysteroscopy – A thin telescope instrument called a hysteroscope is inserted into the uterus and provides a way for your doctor to look inside the uterus. It may be performed in a hospital setting or doctor’s office with local, regional or general anesthesia. A Hysteroscopy may be diagnostic or operative. LEEP (Loop Electrosurgical Excision Procedure) – Once again, in the presence of abnormal cervical cells, this procedure allows your doctor to remove the abnormal tissue. Under local anesthesia, a thin wire loop electrode that is attached to an electrosurgical generator uses an electrical current that allows the loop to cut and scoop out the affected tissue. This procedure usually takes between 25-30 minutes.
10 RSVP Health | www.rsvphealth.com
Multiple Sclerosis Sjogren’s Syndrome Lupus Rheumatoid Arthritis (1.3 million Americans suffer from this, with roughly 66% of them being women) Gallstones – Are 3 – 4 times more common in women than men. Hypertension (High Blood Pressure) – Is more common in women than men are after age 50. Migraines – In the U.S., 6% of men suffer from them vs. 18% of women. Osteoporosis – By age 65, some women will lose half of their skeletal mass. Urinary Tract Infections - Especially affecting women and significant health problems for women, it includes Cystitis/Bladder Infection and Kidney Infections. Become Your Own Health and Wellness Expert There are abundant procedures and disorders throughout the women’s health and wellness world. I hope this helps give you a simplified and brief explanation of “some” of the procedures and disorders you requested and may encounter being a female. Never let health and wellness intimidate you in anyway. The individuals whom you seek out for your health and wellness should have the utmost professionalism. However, as I have witnessed throughout my years in the health and wellness profession, most of us forget to explain diagnosis, tests, procedures, disorders, etc and what they mean to our patients/customers. One last thing, even with all you may encounter, the one thing that is constant and most important is “Y.O.U. and “Y.O.U.R.” health and wellness! Empower yourself, ask questions, demand communication and know RSVP Health. You have more power than you think!
Health Care the Way It Ought to Be Remember the good old days when your family doctor really spent time with you? Wouldn’t it be great to have that same level of service now from your primary care physician as your healthcare needs increase? Dr. Charles Willey, MD As heard on RSVP Health radio & Bob Hardcastle’s Money Talk TV and radio
At Innovare Health Advocates, we practice “Old School” Internal Medicine that means we spend Quality Care all the time necessary to help you enjoy a healthier life. Speaks for Itself “Old School” medicine means you receive the most 91% of Patients Are up-to-date medical treatment available while getting all the time you deserve from our top medical team. Satisfied & Happy We are your coach and advocate, and wherever you with Our Healthcare go in the healthcare system, we’re with you every Practices* step of the way. We work closely with you to educate, motivate and lead you to better long term health. “Old School” means truly responsive Internal Medicine that delivers high quality patient care with specific attention to low cost for you. We appreciate the two Medicare Advantage plans in which we participate, Essence Healthcare and Gold Advantage, that truly enable Old School Internal Medicine. Ask for us when you call Essence 866-597-9560 or TTY:711 or Gold Advantage 800-533-0362 (both plans Mon-Fri from 9 am to 5 pm). The Innovare style of medicine is Healthcare the Way It Ought to Be. Come see us soon and experience the difference. Dr. Charles Willey, MD; Terry McQuaide, APRN-BC; Barbara Menke, APRN-BC; and Christine Grissum, APRN-BC
Call Dr. Charles Willey and the team at Innovare Health Advocates for an appointment. Our offices are in: South St. Louis County—314-843-4794 Jefferson County—636-931-5112 Visit us online at www.innovarehealth.com.
Patient Satisfaction Study RSVP Health | *Source:2009 www.rsvphealth.com 11 ©Copyright 2010 CJW Enterprises Inc.
Winning at losing | National Institute of Health
Getting your weight under control can help you avoid many health problems. While there are many ways to successfully lose weight, most people regain it over time. Ongoing research is now giving us insights into how to keep that weight off. Dr. Rena Wing of Brown Medical School and The Miriam Hospital spoke at NIH recently about the latest research in weight control. She explained how the National Weight Control Registry (NWCR), an effort funded in part by NIH, is helping researchers find out not only how
how to control their weight? Wing just completed an NIH-funded study called STOP-Regain to find out. She and her research team enrolled 314 people who’d recently lost at least 10% of their body weight. They were randomly divided into 3 groups. One group had meetings and weight-control lessons in person. A second group got their lessons over the Internet and met in on-line chat rooms. For comparison, the third group got only quarterly newsletters. The researchers devised a color-coded system for the in-person and Internet groups. People in the green zone (less than 2 pounds over their starting weight)
Winning at losing How to Keep that Weight Off National Institute of Health
people lose weight but how they can maintain their weight loss. The NWCR is a different kind of study. Rather than randomly putting people into groups and testing different methods, the researchers set up a registry that anyone can join if they’ve lost at least 30 pounds and kept it off at least a year. Those who enroll fill out questionnaires about how they lost weight, how they’re trying to keep it off and other aspects of their health. There are now over 6,000 people in the study. They’ve lost an average of about 70 pounds and have maintained their weight loss for an average of 5.7 years. Wing said that the methods people in the registry used to lose weight varied. They included cutting down on certain foods, eating less overall, liquid diets and many others. In contrast, there isn’t a whole lot of difference in how they maintain their weight. People who successfully control their weight, Wing explained, tend to eat a low-fat diet, watch their total calories and do a lot of physical activity. Can the lessons learned from the NWCR teach others 12 RSVP Health | www.rsvphealth.com
got gifts. Those 3-4 pounds above their starting weight were in the yellow zone, where they were encouraged to be careful and figure out why they were gaining weight. Those 5 or more pounds above were in the red zone; they got individual counseling to help them start losing again. The study confirmed that people who’ve recently lost weight are at high risk of regaining it. Almost 75% of those in the newsletter group had regained 5 pounds or more by the end of 18 months. The lessons and meetings, however—in person or by Internet—helped reduce the amount of weight people regained. Those who succeeded in keeping their weight off, Wing explained, got on the scale every day and took action immediately if they saw changes they didn’t like. “People in the [in-person and Internet] groups have learned to use that information from the scale to self-regulate their eating and exercise behaviors,” she said. There are several proven ways to lose weight. With a little change in your thinking, you can keep it off.
Winning at losing | National Institute of Health
Keeping Weight Off The National Weight Control Registry continues to give us clues about how to keep weight off: Keep eating fewer calories. Exercise regularly. Over 90% of those who’ve kept their weight off use physical activity as part of their weight control program. Eat a healthy breakfast. Weigh yourself daily. Plan for how to get back on track if your weight begins to creep up. Watch the fast food. People in the registry eat fast food less than once a week, and eat out no more than 3 times a week. Don’t be a couch potato. Almost 2 of every 3 people in the registry watch less than 10 hours of TV per week—much less than average. Try to exercise instead of eating while you watch. Stay consistent. Those who “go off their diet” on weekends, vacations or holidays have a harder time keeping weight off.
Keep Winning: Whole Body Vibration at Skaggzzz Sleep Institute. The Whole Body Vibration Machine is a platform that you stand on which produces vibrations offering a stimulus to the body. The energy is safely and effectively transferred to your body, stimulating every cell – your muscles, your bones and your soft tissue. The body reacts involuntarily with multiple muscle contractions in order to rebalance you on the plate. The quick movement of the platform also increases the “g” force of the body. As acceleration increases, your body will feel like it weighs more thus mimicking weight-bearing exercise. The result is less stress on the joints, ligaments and tendons when compared to regular resistance training Skagzzz Sleep Institute 1269 Doctors Dr. Farmington, MO 63640 573-760-1501 Find us on Facebook RSVP Health | www.rsvphealth.com 13
Understanding Your Health Coverage When I say the words “health coverage,” what’s your first reaction? Concern? Elation that you have it? Confusion? All of the above? It’s true that health coverage can be confusing, frustrating and overwhelming. However, by spending time understanding the intricacies of your health coverage, you ensure that you will receive the best healthcare “bang for your buck.”
Kathy Beaven
Authorized Agent Individual, Family and Small Business Licence number: PR34420 Anthem Blue Cross and Blue Shield 1831 Chestnut Street, St. Louis, MO 63103 (314)923-5532 - office (314)923-4746 - fax kathy.beaven@anthem.com www.kathybeaven-insurance.com
In Missouri (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Missouri is available at anthem.com.
14 RSVP Health | www.rsvphealth.com
Another benefit of understanding your plan is being able to act decisively and quickly should a medical emergency strike. During an emergency is not the time to research which hospitals you can be taken to for treatment. So just what are the key things to understand your health coverage? To help you, I’ve prepared a list of health coverage terms to look for while you read through your coverage. While there are differences between health coverage plans and providers, this terminology will likely apply to most, if not all, providers and plans. Cost-Sharing: With most health care coverage, you pay a monthly premium, then you share some of the cost of covered medical care with the company that provides your health care coverage. The level of cost-sharing you choose directly impacts your premium amount. The more you are willing to share in the costs, the lower your premium. With Anthem Blue Cross and Blue Shield you can choose your level of protection and the level of cost-sharing that works best for your health care needs and budget. Deductible: The amount you have to pay each calendar year for covered services before your health care plan starts paying. For some services, the plan will even begin to pay before the deductible is met. Usually, the higher a plan’s deductible, the lower the premium. In some cases, you may also have a separate deductible for certain services such as prescription drugs. Coinsurance: The percentage of the cost of covered services that you will be responsible for, after your annual deductible is met. With some plans, you have a choice of coinsurance levels. Much like your deductible, selecting a higher coinsurance typically lowers your monthly premium because it increases your share of the cost. Copayment: A specific dollar amount you have to pay for certain covered services. Out-Of-Pocket Maximum: The most that you would pay in a calendar year for deductible
and coinsurance for network covered services. Once you reach this maximum, the plan pays at 100% for most covered services for the rest of the calendar year. Formulary: A list of prescription drugs our health care plans cover. They include generic and preferred brand name drugs that have been rigorously reviewed and selected by a committee of practicing doctors and clinical pharmacists for their quality and effectiveness. We’ve negotiated lower prices on these formulary drugs, so you’ll save when your doctor prescribes medication from our formularies. There can be different formularies for different health care plans. Formulary lists can be found at www.anthem.com. Health Savings Account (HSA): A special bank account that can be set up by a member enrolled in a qualified HSA-compatible highdeductible health plan. Contributions to this account can be made with certain tax advantages and funds from the account can be used for qualified health care expenses. Network Discounts: With Anthem, you have access to some of the largest provider networks in the state. These network (or participating) providers have agreed to accept lower costs for their covered services to Anthem members — similar to volume discounts. These negotiated costs help reduce the overall cost of covered medical services, including your share of those costs. This is true whether you are paying the entire cost for covered services (such as while you are meeting your deductible), or whether we are sharing the cost. With over 10,500 doctors and more than 125 hospitals, chances are your provider already participates. Just visit a network provider to take advantage of the savings. With our PPO plans, you can always choose to receive services outside the network, but your share of the cost will be greater. For your convenience, I have created a page of questions you can use to help you review your current plan or to help when you are shopping for coverage. You can also use this page to record all the components of your plan so you have them in one place. I’m happy to forward this to you via email. Call me to today to learn how Anthem Blue Cross and Blue Shield can help you with your individual or business health care coverage needs.
We are LIVE on the air, 8:20 A.M. Friday Mornings on KREI, 800 AM. Listen live or hear the shows on RSVPHealth.com. Click on the media button for the most recent show, or select media > audio for the show archives.
Looking for answers on health care?
Check out rsvphealth.com Updated Articles Expert Answers to Health Care Questions Health Care News Audio and Video of Radio Show and Forums Connect to us through Facebook or Twitter. Facebook.com/rsvphealth Twitter.com/rsvphealth
6 RSVP Health | www.rsvphealth.com
RSVP Health | www.rsvphealth.com 15
16 RSVP Health | www.rsvphealth.com
Forever Your Mom; the Ultimate Caregiver By Dr. Rodney Gross
When we think back throughout our lives, no matter the subject, we usually go back to the earliest memories of our childhood and that usually involves our parent(s). When we think about things like the following examples: Who was the one to put a band-aid on a boo-boo? Who was the one to comfort you when you fell? Who was the one hold you after that shot in the doctor’s office? Who was the one that made us take that nasty tasting medicine? Who was the one who made you eat healthy things? Who made you bundle up before going outside to play so “you do not catch a cold”? Who made you go to the dentist “regularly”? Who made you brush your teeth? Who made you take a bath? The first person that comes into our minds for the vast majority of us is our mom. You can see by these examples why I think they are the “Ultimate Caregivers”. Merriam-Webster defines a caregiver as “a person who provides direct care (as for children, the disabled, or the chronically ill)”. If you ask me as being a child to the greatest mom of them all and working with thousands of “Caregivers” throughout my professional health care career, I feel very comfortable labeling mothers as the “Ultimate Caregivers”. Moms being moms, my point meaning they never quit worrying about you, they are forever a mom. No matter if you tell them repeatedly, it will not matter. Moms have and will forever be on the front line of their child(s) health and wellness. The above are a few examples to provide that testament. For as long as they are alive, no one in her mind can give or take better care of their child than they can. Therefore, that leads us to the question, “who” will take care of these “Ultimate Caregivers” when they need it? Moms are famously known to take care of everyone except herself. I am not saying they let themselves go completely; they usually do not make “their” health
the priority. Additionally, we need to understand some of the most concerning ailments that our moms may face, before we can figure out how and who will take care of her. Unfortunately, medical care for women in the past was very vague, and most conditions were treated as you would treat a male with the same conditions. Mom’s and Women’s Health is obviously very different from Men’s Health, the actual bodies are different. Seems like common sense to me. Instead of going into why the medical profession for years “lumped” all things as being equal, I will line out several examples of where women are very different. Obviously, there are the diseases and conditions of the breast (though men can have breast cancer), the female gynecological areas (Ovaries, Cervix, Uterus, etc) and hormones, just to name a few. However, a few diseases and conditions have some alarming statistics for women that we should be aware. More women die from Heart Disease each year than from Breast, Ovarian and Uterine Cancer combined. Heart Disease is the number one cause of death in women, killing more women than men (with Heart Disease) each year. Lung Cancer is the leading “cancer” cause of death in women, taking the lives of about 70,000 women each year. Colorectal Cancer is the third leading cause of “cancer” deaths in women, taking the lives of about 30,000 women each year. Autoimmune Diseases, collectively, are the eight leading cause of death for women under the age of 65. I am going to pick out Lung Cancer and elaborate. It is probably very easy to figure that the majority of women to include men who die from lung cancer, where smokers. A concern is the 20% of women you died, as a result of Lung Cancer, never touched a cigarette. Lynne Eldridge, M.D., makes a perfect and distinct statement in some of her research: “Once considered a “man’s disease”, lung cancer is no longer discriminatory. In 2005, the last year for which statistics are available, 82,271 women (vs. 107,416 men) were diagnosed with
RSVP Health | www.rsvphealth.com 17
Forever Your Mom; the Ultimate Caregiver | Dr. Rodney Gross
lung cancer and 69,078 women died (vs. 90,139 men). While lung cancer diagnosis decreased in men each year from 1991-2005, the incidence increased 0.5% each year in women. The reason is still not clear. It is unfortunate that despite obvious differences in our appearances, we tried to lump men and women together when talking about lung cancer. The causes, response to various treatments, survival rate and even symptoms to watch for differ. Lung cancer in women occurs at a slightly younger age and almost half of lung cancers in people (men & women) under 50 occur in women. The survival rate for lung cancer in women is higher than for men at “all stages” of the disease. Sadly, the overall 5-year survival rate is only 16% (vs. 12% for men).” I cannot speak and would not speak for Dr. Eldridge, but I think the agreement would be that there are many differences in how the medical community should view and treat diseases and conditions between women and men. Being a woman puts them at certain risks of disease and conditions that differ from men that traditional medicine/research in the past somewhat ignored. Take the time to make yourself aware and educated. We, as a child and a society, owe it to our moms to make sure they receive the best possible care, from the best possible “Caregivers”, to include ourselves. They did not discriminate in our health, nor should we in theirs. Most of us are caught up in a very hectic lifestyle nowadays (though no excuse) and take our moms for granted, figuring they will always be ok because that is how we remembered them being when we were young (never complaining, superhero-like, just always “ok/fine”). Their one weakness, if they have one, is they are human just like us. Remind them of the things you remember (like the ones I mentioned in the beginning), spend time with them and ask them about their health. Though you may do this, you may get the “don’t tell me what to do, you are not my mother” from them. Then and just then, you will know they are “Forever Your Mom; the Ultimate Caregiver”.
18 RSVP Health | www.rsvphealth.com
Staying Two Steps Ahead: Why It’s So Important for Seniors to Plan for the Unthinkable
“The greatest discovery is that our attitude, not our circumstances, determines our quality of life.” - William James The subject of providing additional care for aging loved ones is a topic many families are nervous to approach. But delaying the conversation only delays the help, and it is important to recognize that neither party is comfortable posing the question “What if?” One thing seems to hold true: neither party is comfortable initiating the conversation, and for obvious reasons. Seniors fear the loss of their independence and their families find it hard to see their loved ones begin to falter at tasks that used to be so easy. One thing is for sure; no one wants to lose their freedom. But planning for the future doesn’t have to mean giving up the things you want. By taking the initial step, you can show your children that you are willing to talk about the subject, and that you have your own opinions about what kind of care you would like to receive.
What is motivating you to take these actions now? Was there a specific event that made you think about it making these plans? How important is it to you to be physically independent and stay in your own home? What aspects of your life give it the most meaning? How will it be possible to continue to pursue those aspects should you move out of your current home? Ultimately it comes down to what William James expressed in the quote at the beginning of this
Staying Two Steps Ahead: Why It’s So Important for Seniors to Plan for the Unthinkable By Jeff Browning, LSS
“It’s important to start talking about the ‘what ifs’ early on, so caregivers are comfortable making decisions,” says Carol Melka, Director of Outreach Services for Lutheran Senior Services. “Unfortunately, many people don’t address these issues until a crisis occurs.”
article. These situations are never simple, and the circumstances may not be ideal, but it is up to us to take steps to ensure our future safety and happiness. Taking a little time to plan ahead can make the future less stressful and enable you to protect your independence.
A crisis often takes the form of a stroke, a fall, or other life-threatening occurrence. Strokes are especially problematic for seniors, as they can lead to communication disorders such as aphasia. If this happens, it can be difficult for seniors to express their wishes to their loved ones, and it can lead to feelings of loneliness and helplessness.
For more tips on how to talk to your aging loved ones about planning ahead for their future, call on the experts at Lutheran Senior Services (LSS). With a wide range of programs serving the St. Louis area, LSS is dedicated to helping seniors live life to the fullest, wherever they call home. To learn more, visit LSSLiving.org.
For this reason, it is important for older adults to take that (admittedly intimidating) first step and talk to their loved ones about their future plans for care. Here are some questions for seniors to consider when planning a discussion with their loved ones.
RSVP Health | www.rsvphealth.com 19
Generations of Healthy Living | With Rita Martin
A story of four women in three generations on how life and healthcare have changed. Mary Martin our matriarch, was born in 1932 in Ste. Genevieve county, Missouri the seventh of 15 children. She worked with her mother and sisters on their small farm tending chickens, gardening, canning and sewing. The heavier work was managed by her father and brothers. It wasn’t all work, but times were not easy. One of Mary’s brothers died at 14 months with Osteomyelitis, Mary herself had scarlet fever. The Martin family was raised on fried potatoes and beans during the week with beef or fried chicken only on the menu for Sunday dinners.
used for widening the blood vessels. Mary is the primary caregiver for her husband. It’s a labor of love. However, one where you must be sure you are also taking care of yourself. Mary does some light exercising in her home to maintain strength and agility. Tina is the only daughter of Mary and Archie. Life was simple country living between home in town and her grandparent’s family farm. She grew up camping, hunting, fishing, raising rabbits, eating wild game and farm vegetables. Playing in the barn and the creek where she learned how to swim are cherished memories. With her cousins and neighbors she played hopscotch, jump rope,
Healthy Generations Family interview of four women across three generations. With Rita Martin
She was married in 1952 to Archie Henderson. They raised their family of three children in Ste. Genevieve. The first child, Mark was born in 1954, with Guy 4 years later, then two years after that came Tina. Mary had the usual discomforts with pregnancies and only one real scare with Tina. The after birth kept trying to come before the baby. She made several trips to Perryville, the closest hospital at the time before they eventually induced labor. Ether was actually used with all her deliveries. Mary worked outside the home for awhile but was mostly busy at home raising her family. She had no significant health problems until kidney stones in 2009 that had to be removed and several broken bones during her adult life. In 2010 she was diagnosed with rheumatoid arthritis and in 2011 had a heart attack due to a clot. She was told she now has arterial defibrillation. Mary experienced menopause at age 46 with no hot flashes or problems to speak of. She currently only takes Coumadin to thin her blood and Imdur
20 RSVP Health | www.rsvphealth.com
jacks and Barbies. She noted that they were not as concerned with ticks and mosquitos back then as we are today. She married Wayne Meyer in 1978, and opened a beauty shop on their property. Her husband also ran a family business close to their home. They have four children, Damian, Nicole, Candace and Garrett. Unlike her mother, Tina did not experience much morning sickness, but was always tired when pregnant. She had no problems birthing her children until the fourth, which was a frank breach. The doctor was able to turn the baby enough for a natural birth and Tina endured this without medication. An overriding theme in the Meyer household was one of a healthy lifestyle. Through the years she worked with keeping her family on vitamins and supplements for their health. The family used to roll their eyes when the vitamins came out, but appreciated her style of caregiving when symptoms and illnesses were less frequent. Tina
Generations of Healthy Living | With Rita Martin
used to drink soda and eat junk food too when she was younger. But now she walks three miles most days. She lifts weights Monday, Wednesday and Friday and does stretching exercises on Tuesdays and Thursdays. It takes experiencing the difference yourself to become a believer in eating healthy and taking care of yourself. When problems occur with a family member’s well being, Tina studies and reads, not relying solely on medical professionals for all the answers. When a new health challenge, even if it’s one of aging, is presented to Tina, she does the research, educates herself about the condition or process and learns what she can do to prevent, reverse, or lessen adverse effects. Tina was also 46 when she experienced menopause. However, she had a much harder time than her mother. Hot flashes were a problem, but the insomnia was unbearable. She had blood testing showing all levels were normal including her hormones. It wasn’t just insufficient sleep keeping her up, she could not sleep at all. She was however able to devote this time to reading and her research led her to discover bioidentical hormones. There she found it would be necessary to find a compounding pharmacy that could combine the drugs needed and that they would know of local physicians using this treatment. Finding a pharmacist who was compounding then led her to a doctor in that vicinity. When visiting this doctor she was asked “What are you here for?” Tina told her she was interested in bioidentical hormones. The physician did not examine her, take her temp or blood pressure, just wrote the prescription and charged her $140 for the visit. Tina sought another opinion, going to Poplar Bluff to visit with Dr. Poppy Daniels. Tina had also been having stomach pains. Most doctors would have done upper and lower GIs that would have only shown if tumors were present. Dr. Poppy ordered stool profiles that showed a wheat allergy, low digestive enzymes & probiotics and that her cortisol was “through the roof”. She started with prescribed antibiotics; has been building up good flora in her digestive system and is now on bioidentical hormones including estrogen, testosterone, DHEA and progesterone. “Dr. Poppy is wonderful”, say Tina. She is sleeping
well and feels great. She said that as you get older things are suppose to get worse. But instead she feels better. Just in time, as she is a busy new grandmother of 4. Caden and Mikayla at 2 1/2, and Colten and Cora both arrived this fall. Nicky was the second child of Tina and Wayne’s children. She was told that she used to throw up after she was burped for the first five months, had a lot of ear infections and very colicky. At one time she had mono and also had strep each summer of her high school year, though her tonsils From L-R - Candace, Candace, are still in place. Since adulthood she has not had Candace, Candace strep throat again nor does she take any allergy medications though she was shown to have a slight allergy to eggs and hay mold. She now only takes vitamins. Nicky is an RN at Barnes Hospital in Cardio Thoracic ICU and her husband Kyle Schweiss, a teacher and football coach attended high school and college together and were married in 2006. She just gave birth to their second child a few weeks ago. Her two pregnancies were very different, the cravings, how her hair and nails were growing, how she felt during each term even though both were boys. Her favorite form of exercise is to swim laps at the YMCA and lifting weights to maintain strength. She is looking forward to getting back to this activity following her recovery from pregnancy. Biking is another activity she is interested in taking up with her coworkers who do about 20 miles after work. This will also be a great family activity later on once the boys are older. Growing up Candace, remembers her mother providing well balanced meals containing meat, vegetables with milk at each meal. In high school she became more aware of her diet and though she worked at a fast food restaurant, she worked at skipping the carbs. She remembers through her mother’s influence, swallowing spoonfuls of molasses after track practice to prevent nutrient depletion. She was not a fan at the time! However, she was healthy, but did have some stomach upsets most likely due to stress. She was a determined student, through her personal drive to finish at the top of her class.
RSVP Health | www.rsvphealth.com 21
Peace of mind right from the start. Different families need different health plans. Select from our plans designed to fit you and your family.
Get the quality health care coverage you need, without the expense you might expect. Anthem Blue Cross and Blue Shield has plans that provide protection at a rate that’s probably less than you expect.
VINCENT K. BLAIR
Authorized Independent Agency
(314) 961-7777
20 North Gore, Suite 100 Webster Groves, MO 63119 http://www.vincentkblair.com
Vincent K. Blair with Vincent K. Blair Agency is an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Health | www.rsvphealth.com and 22 BlueRSVP Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Generations of Healthy Living | With Rita Martin
Candace is an RN with SSM at St. Mary’s working with patients and Dr. Eapen, MD in his Cardiac care practice. She has always been conscious of the benefits of exercise due to family example and committed to it at a young age. More recently, her and Jerrad Martin, her husband of four years, have been training for a half marathon. Finding the time and getting the scheduled longer runs in are a bit of a challenge that takes commitment. The extra time spent together as a couple along with the running and scheduled massage therapy help with stress. Their meals contain a starch, salad and fish or chicken with an occasional red meat. While talking about pregnancies and babies the ladies got on the subject of SIDS, Sudden Infant Death Syndrome and how laying babies down to sleep has changed. Tina always laid her babies on their stomachs noting that one of her children often threw up in his sleep causing her to fear he might choke and aspirate. SIDS, was just not as highly publicized then as in more recent years. Now, parents are told never to leave their babies to sleep face down, for fear that they could smother in the bed clothing; more apt to have apnea events; or, re-breathe their exhaled air, possibly raising their levels of carbon dioxide. Stomach sleepers are also said to retain more body heat, possibly raising their temperatures which can be harmful to some babies. Nicky has been diligently keeping baby Colten on his back when putting him down
Healthy Connections
to sleep even though he prefers his stomach. This is not leading to very much sleep time for the new parents. But, they always lay their babies on their backs to sleep. With two health professionals in the family, they have seen many patients in the hospitals and clinics without adequate or any insurance coverage at all. Insurance for small business owners such as Tina and Wayne is very expensive and usually means a very high deductible. In recapping the ladies felt that the best you can do for your health is to keep informed about new developments, especially when you have an issue to overcome. Reading, researching, talking to healthcare professionals and discovering what will work for you is the best approach to take. This is proof that you have “More Power Than You Think” when it comes to your health. Research and educated on your health and your health care options including being proactive about the wellness of yourself and your family. For more information on biodentical hormone therapy see http://www.health.harvard.edu/ newsweek/What-are-bioidentical-hormones.htm You can view the latest information about SIDS at http://www.aap.org/pressroom/sids.pdf
Ten great free resources for health, health care and wellness research.
1. National Institute of Health www.nih.gov
6. Drugs.com www.drugs.com
11. AMA Doctor Finder http://www.ama-assn.org/aps/amahg.htm
2. Web MD www.webmd.com
7. Health Finder www.healthfinder.gov
12. Food and Drug Administration www.fda.gov
3. Mayo Clinic www.mayoclinic.com
8. MedHelp www.medhelp.org
13. Cleveland Clinic http://my.clevelandclinic.org/default.aspx
4. Medicine Net www.medicinenet.com
9. Medicine Plus www.medicineplus.gov
14. Family Doctor www.familydoctor.org
5. Health Grades www.healthgrades.com
10. eMedicine Health www.emedicinehealth.com
15. RSVP Health www.rsvphealth.com RSVP Health | www.rsvphealth.com 23
Charlie’s Voice is Changing By Rodney Gross Ph.D.
24 RSVP Health | www.rsvphealth.com
In 1976, a show many of us will remember, “Charlie’s Angels” aired on ABC until 1981. It was one of the first television shows to put women into roles traditionally written and played by men. The show usually started out with the three women sitting in the office waiting for those familiar words from Charlie, “Morning Angels” and they would reply, “Morning Charlie”. Charlie was their male boss and owner of the private investigation service and gave them their assignment. However, bringing a different mindset of having women fighting crime, catching the “bad” individuals and looking great at the same time, most of us remember television shows and commercials only depicting women as almost subordinates to a male and or their husband and in some cases their own kids. Basically, in an apron: cooking or cleaning for everyone else. Though there is nothing wrong with that at all, if someone chooses that, the “depiction” of women is becoming more realistic that concurs with current statistics. Current figures from the “U.S. Census” and “CIA World Fact Book” indicates in the United States: 158 million females vs. 153 million males Life expectancy for females is 81 vs. 75 for males There are twice as many females as males over age 85 and older 66% of women vs. 62% of men voted in the 2008 election Almost 80% of individuals in the Health Care & Social Services field are women In that same field, 52% of all ownership were women Total of 7.8 million businesses owned by women and another 4.6 million businesses where they were equal partners with males 70% of the Education (Teachers, Daycare, etc) field is made up by women In the Finance/Insurance field, woman make up 60% Active Duty military - 15% women Reservist - 25% women National Guard- 16% women Women Veterans - 1.8 million What is ironic is that a vast majority of these women highlighted above still do all the cooking, cleaning and taking care of the kids on top of those careers. They are the “ultimate multi-taskers”! I always think of my mother working at the local hospital full-time and still having the time and energy to take care of my sister, father and me. I still do not know how she or many mothers like her, accomplished it all.
Women owned 7.8 million nonfarm U.S. businesses operating in the fifty states and the District of Columbia. These womenowned firms accounted for 28.7 percent of all nonfarm businesses in the United States. Women-owned firms employed 7.6 million persons (6.4 percent of total employment) and generated $1.2 trillion in receipts US Census Bureau
Many of us now have the opportunity to work for, work with, and gain inspiration by, women. You do not have to look too far back in time when that was not the case. This world is a much better place if you ask me, in having this trend of women spreading their wings per say and if you do not believe that, look at some of the fields (Health Care, Education Social Service, etc) where they have been within in the past. Whether one chooses to stay at home or pursue a career, they now have a choice and a broad one at that. Women are on the forefront of government, science, health care, management, ownership, etc, and you will continue to see growth not only in the highlighted figures above, but in others as well. Therefore, the next time they make a current and or realistic show of the old “Charlie’s Angels”, the tables may be turned. Charlie, Charley, Charlee, Charleigh, may be on the other end of that conversation, but the voice will be a woman’s voice.
RSVP Health | www.rsvphealth.com 25
Sleep. Sleep is essential to good health. However, over 40 million Americans suffer from some type of sleep disorder that prevents them from having a good night’s sleep. Often, the symptoms of a sleep disorder go unrecognized and untreated. Without help, an individual’s quality of life can suffer, possibly leading to other medical conditions such as heart attack, stroke or an injury. Skaggzzz Sleep Institute is composed of registered sleep technologists with years of experience in the field of sleep disorders. Come see our Board Certified Specialists at no cost to discuss your sleep problems and see if a sleep test is the answer. Here are some sleep disorders and symptoms. SLEEP APNEA Sleep apnea is a serious medical disorder in which breathing is repeatedly obstructed for periods of time. Symptoms: Habitual snoring, daytime sleepiness and irritability.
NARCOLEPSY Narcolepsy is a disorder of the central nervous system that causes excessive daytime sleepiness, cataplexy (sudden muscle weakness) or sleep paralysis when falling asleep or awakening from sleep.
RESTLESS LEG SYNDROME Restless legs syndrome involves a “creepy crawly” sensation in the legs resulting in a frequent need to move the legs for comfort.
PERIODIC LIMB MOVEMENT DISORDER Periodic limb movement disorder is the rhythmic moving or kicking of the limbs while asleep.
INSOMNIA Insomnia is a condition characterized by difficulty falling asleep or maintaining sleep.
Skagzzz Sleep Institute 1269 Doctors Dr. Farmington, MO 63640 573-760-1501 Find us on Facebook
RSVP Health | www.rsvphealth.com 27
By Lola AuBuchon Gross
The matriarchs are the women who have been leading and caring for their families, tribes, and communities, since the dawn of time. These modern day matriarchs are continuing to provide the loving direction and strength that is essential to the balance of this world. As a woman myself, I realize we come from the heart, a loving place unafraid of showing and sharing our affection and emotions with others. Being the great communicators we are, we usually do not hold back on anything. However, when it comes to our health we seem to have this built in pain mechanism that leads us to “sometime push” ourselves beyond what we should. Our hearts can be our greatest strength or our greatest enemy. Yes, I am talking about the number one killer of women, heart disease. One of the most common misconceptions about heart disease is that it mostly affects middle-aged men. In actuality, 42.5 million women are living with some form of cardiovascular disease. There are more women dying of cardiovascular disease than men each year. We as women must realize that our heart health is just as important as our men’s health. Heart disease is the number one cause of death of American women, killing more than a third. In the US this year, alone five times as many women will die from heart attacks compared to breast cancer deaths.
28 RSVP Health | www.rsvphealth.com
Queen Of Hearts: By Lola AuBuchon Gross
What exactly is heart disease? The National Heart, Lung and Blood Institute define coronary heart disease as the main form of heart disease. This is a disorder of the blood vessels of the heart that could possibly lead to a heart attack. When an artery becomes blocked, it prevents oxygen and nutrients from getting to the heart, thus a heart attack occurs. Some other cardiovascular diseases are high blood pressure, stroke, rheumatic heart disease, and angina. Once you have heart disease you will have it for the rest of your life as there is no cure only prevention and management. What are the risk factors for heart disease? Before we can practice prevention, we need to know the risks. The National Institute of Health defines risk factors as conditions or habits that make a person more likely to develop a disease. Important heart disease risk factors that we can as women do something about are as follows: Smoking Being overweight Being physically inactive Diabetes High blood pressure High cholesterol Obviously, quitting smoking, losing weight, and being more physically active are lifestyle choices we can control. High blood pressure, high cholesterol, and diabetes our doctors make us aware of through various tests; that is where regular check- ups become essential. Knowing your blood pressure and cholesterol numbers, as well as blood sugar, may give you the inspiration to lose weight. By becoming more active and eating a heart healthy diet, the weight usually comes off thus lowering blood pressure and cholesterol. Those that lose the weight have also gotten their type 2 diabetes under control.
Being the good communicators that we are, we females need to start a dialogue with our doctors about heart health. Doctors usually as a routine do not bring up women’s heart disease, so it is important we start the conversation. Ask your doctor to assess your risk and be open and honest about your lifestyle choices. Your doctor will order the necessary tests and discuss the meaning of those numbers. Speak up if you do not understand and ask your doctor to devise a healthy plan of action against heart disease. Finally, if you find yourself in the unfortunate situation of feeling like you are having symptoms of a heart attack call 911 immediately. According to Women Heart (The National Coalition for Women with Heart Disease) the warning signs of a heart attack are: Discomfort, tightness, uncomfortable pressure, fullness, squeezing in the center of the chest lasting more than a few minutes, or comes and goes Crushing chest pain Pressure or pain that spreads to the shoulders, neck, upper back, jaw, or arms Dizziness or nausea Clammy sweats, heart flutters, or paleness Unexplained feelings of anxiety, fatigue or weakness-especially with exertion Stomach or abdominal pain Shortness of breath and difficulty breathing Armed with this knowledge, we now know it is ok to seek and demand treatment for our hearts. Remember this, even though we are the strong matriarchs, we have to take care of ourselves and listen to our bodies when we know something is wrong. By taking our own heart health seriously and demanding others to listen, we can all be the “Queen of Hearts”.
Risk factors that cannot be changed are: Having a family history of early heart disease Age 55 and older for women By having a mother or sister that had a heart attack before age 65, or a father or brother before age 55, you are more likely to develop heart disease. Even though women of all ages have a risk of heart disease, even 30 and 40 somethings, the risk increases with age. Age 55 and older women are the highest age group risk. Early onset of menopause is believed to be a contributing factor. Although these were the cards we were dealt, we can greatly lessen our chances by being extra diligent about knowledge and prevention.
Lola AuBuchon Gross
RSVP Health | www.rsvphealth.com 29
which on is the veteran? Both. ,W路V our job WR JLYH every vet WKH EHVW FDUH DQ\ZKHUH
ne
? OHDUQ PRUH DW www.womenshealth.va.gov
Get Healthy. Stay Healthy.
Osteoporosis: What you need to know
Most of us have heard of osteoporosis, but how much do you know about it? It affects not only older women – it can strike
disease, or already have it.1 Might you be one of them?
What is osteoporosis? The word “osteoporosis” means “porous bone.” Bone is living tissue, like your skin. Just as your skin cells die and are replaced by new cells, your body constantly breaks down old bone and replaces it with new bone tissue. As we age, existing bone cells are reabsorbed by our bodies more quickly than our bodies can replace it. The spaces within our bones grow larger, and the outer shell of our bones grows thinner. Our bones lose minerals, mass, and structure. For people with osteoporosis, the bones eventually weaken to the point that they break very easily.3,4 Between the ages of 20 and 30, most people acquire their peak skeletal mass.2,4 The greater a young adult’s bone mass, the more likely he or she will be to have a high bone mass as an older adult, and the longer it will take for bone loss to reach dangerous levels.2
32 RSVP Health | www.rsvphealth.com 01507ANMENABS 12/09 F0064969
Assess your risk
How do I know if I have osteoporosis?
White, Asian or Hispanic women who are post-menopausal are those who most often suffer from osteoporosis.2 Additional risk factors include having:
Osteoporosis is a symptomless disease, and many people do not know they have it until they break a bone. A stooped posture or loss of more than one to two inches of height is caused by spinal fractures, which can sometimes occur without pain. And hip fractures nearly always require major surgery and hospitalization. Nearly one in four hip fracture patients over age 50 dies
How much calcium do you need each day?
and only 15 percent of patients can walk across a room unaided six months after the fracture. Osteoporosis is the underlying cause of most of these fractures.1
• A small body frame and being thin • A family history of osteoporosis or broken bones • Early menopause • Broken bones as an adult • One’s ovaries removed before menopause • Periods of extended bed rest3 Some medications can also contribute to a loss of bone density, as well as medical conditions such as anorexia nervosa, rheumatoid arthritis, and low levels of estrogen (and testosterone, for men).1 While these factors are largely beyond your control, diet and lifestyle choices also play a large part in determining whether or not a person will develop osteoporosis. Smoking, heavy drinking, and an inactive lifestyle are bad for your bones, and a diet low in calcium and vitamin D, and high in sodium, your body to rebuild bone as it breaks down naturally.1
If you have risk factors for osteoporosis, your doctor may order a bone mineral density (BMD) test using a central dual energy X-ray absorptiometry, or DXA. The results will reveal whether you have low a fracture occurs, and bone density can predict the chances that you’ll have a fracture in the future.1 With this information, you and your doctor can decide what steps to take next.
Prevention and treatment If you have low bone density, your doctor may recommend a medicine that will slow your bone loss or help rebuild your bones. But if you have not already developed osteoporosis, your physician will recommend preventive measures including: • A diet rich in vitamin D and calcium, which can be found in lowfat or nonfat milk, cheese, yogurt and other dairy products; dark green leafy vegetables;
Ages
Amount mg/day
Birth to 6 months
210
6 months to 1 year
270
1 to 3 years
500
4 to 8 years
800
9 to 18 years
1,300
19 to 50 years
1,000
51 years and older
1,200
Source: Dietary Reference Intakes for Calcium, National Academy of Sciences, 1997
Resources For more information, visit the National Osteoporosis Foundation online at nof.org. There, you’ll determine your risk factors. To help your kids get the nutrition their bones need, check out bestbonesforever.gov, a site devoted to encouraging preventive behaviors among girls and teens. The parents section of the site contains recipes, a calcium calculator, printable grocery lists, and tips for convincing picky eaters to get the calcium and vitamin D they need.
with calcium, such as orange juice and cereal. See “How much calcium DO you need each day?” for recommendations on your daily calcium intake. • Regular weight-bearing exercise • Quitting smoking, if necessary, and limiting your alcohol and cola intake.2,4
Visit anthem.com for more ways to get healthy — and stay healthy. National Osteoporosis Foundation (2008): nof.org Centers for Disease Control and Prevention, Calcium and Bone Health,(December 3, 2008): cdc.gov 3 National Institute on Aging, Osteoporosis : The Bone Thief(August 6, 2009): nia.nih.gov 4 WebMD, Osteoporosis Health Center, (November 23, 2008): webmd.com 1 2
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Accidents Happen. And when they do, the best way to summon help is The Button, part of the personal emergency response system offered by Lutheran Senior Services. It’s safety, security, and peace of mind for people who live on their own. Call 314.446.2421 to learn more.
ÂŽ
Living Safe Technologies The Button. Plus More. 314.446.2421
g
TheButtonbyLSS.org
For Seniors in the Workforce, Flexibility and Curiosity Are Key to Job Longevity
The good news? We’re living longer! The not-sogood news? That could mean big changes in the business world, especially for aging members of the workforce. Over the past century, the average American’s life expectancy has jumped by more than a third. In 1911, a person could reasonably expect to live to 51.5 years old, but today, that number has leapt to 78.2, the largest, fastest increase to this figure in the history of the world. So what does that mean to society as a whole? That’s the question author Ted Fishman set out to answer in his new book, “Shock of Gray.” The answers he came up with predict a future shaped by its oldest inhabitants – and we as a culture will see major ramifications in areas from finance to the arts. “Shock of Gray” fleshes out ideas Fishman presented in his best-selling book, “China Inc.”, which tells how China has used its young and inexpensive workforce to become a global superpower. On the other end of the age spectrum, Fishman argues that seniors will affect the world’s economy in significant ways through globalization and immigration. After all, the trend toward longer life isn’t native to the United States. Across the world, life expectancy is 65 and older in more than 160 countries – indeed, in 2010, 7.6% of the world’s population topped the 65-year mark. This growing number will have a huge effect on how we live in the coming years as a global society. The increasing senior population brings with it a shift in the ratio of seniors to younger people. The question becomes, who will take care of the members of our aging population? In America in particular, the structure of the family has shifted and become decentralized, which means fewer family members left to care for aging relatives. As a result, the responsibility of taking care of family members has in large part been passed on to immigrants. This is a good thing, because immigration has helped keep the United States average age lower (and our seniors-to-youngerpeople ratio more even) than in most other countries. So what does this shift mean in the business world?
Much has been made in the media about the aging of the workforce. People are waiting longer to retire – partly out of financial necessity, partly out of an emotional need to keep busy. After all, advances in medicine have made it possible for people to work longer, so it is becoming increasingly common for people in their 60s and 70s to have steady jobs. More workers in the workforce can mean a devaluation of each employee’s value to their company. For older adults, that thought can be discouraging, but Fishman indicates that all is not lost. “You have to try to ensure that your labor isn’t devalued,” he writes. “You need to make sure that you have a good inventory of skills and a strong social network before you find yourself in an employment crisis.”
For Seniors in the Workforce, Flexibility and Curiosity Are Key to Job Longevity By Luke Smith, LSS
The keys to doing this: flexibility and a willingness to continue to learn. “We have a large group of workers who haven’t kept their skills current,” he says. “(These) people are encouraged to leave; they are bought out, made redundant or left in the cold when their jobs move.” For some seniors in the workforce, that could mean further schooling or on-the-job training, and it certainly means staying flexible in the face of major changes. But for a generation of Americans who are increasingly using their retirement years to embark on a second, third, fourth, or even fifth career path, flexibility is one thing that today’s seniors seem to have in spades. Retirement doesn’t look like it used to, and the residents living in Lutheran Senior Services senior living communities wouldn’t have it any other way. These continuing care retirement community are perfectly suited to an active lifestyle, whether that means continuing to work at the job you love or pursuing the hobbies and activities that you’ve always wanted to try. To find the location nearest you, visit LSSLiving.org. RSVP Health | www.rsvphealth.com 35
The Ovaries
36 RSVP Health | www.rsvphealth.com
The Ovaries | By National Institute of Health
The ovaries are part of a woman’s reproductive system. They are in the pelvis. Each ovary is about the size of an almond. The ovaries make the female hormones - estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus). When a woman goes through her “change of life” (menopause), her ovaries stop releasing eggs and make far lower levels of hormones.
Benign and Malignant Cysts An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue too. Most ovarian cysts are benign (not cancer). Most ovarian cysts go away with time. Sometimes, a doctor will find a cyst that does not go away or that gets larger. The doctor may order tests to make sure that the cyst is not cancer.
Understanding Cancer Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Ovarian Cancer Ovarian cancer can invade, shed, or spread to other organs:
Tumors can be benign or malignant:
Invade: A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus. Shed: Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
Benign tumors are not cancer: Benign tumors are rarely life-threatening. Generally, benign tumors can be removed. They usually do not grow back. Benign tumors do not invade the tissues around them. Cells from benign tumors do not spread to other parts of the body. Malignant tumors are cancer: Malignant tumors are generally more serious than benign tumors. They may be life-threatening. Malignant tumors often can be removed. But sometimes they grow back. Malignant tumors can invade and damage nearby tissues and organs. Cells from malignant tumors can spread to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the lymphatic system or bloodstream. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
Spread: Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if ovarian cancer spreads to the liver, the cancer cells in the liver are actually ovarian cancer cells. The disease is metastatic ovarian cancer, not liver cancer. For that reason, it is treated as ovarian cancer, not liver cancer. Doctors call the new tumor “distant” or metastatic disease. Risk Factors Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, we do know that women with certain risk factors may be more likely than others to develop ovarian cancer. A risk factor is something that may increase the chance of developing a disease. Studies have found the following risk factors for ovarian cancer: Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer. If several women in a family have ovarian or breast cancer, RSVP Health | www.rsvphealth.com 37
The Ovaries | By National Institute of Health
especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer. Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer. Age over 55: Most women are over age 55 when diagnosed with ovarian cancer. Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
Shortness of breath Feeling the need to urinate often Unusual vaginal bleeding (heavy periods, or bleeding after menopause) Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor. Diagnosis If you have a symptom that suggests ovarian cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have one or more of the following tests. Your doctor can explain more about each test:
Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
Physical exam: Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
Scientists have also studied whether taking certain fertility drugs, using talcum powder, or being obese are risk factors. It is not clear whether these are risk factors, but if they are, they are not strong risk factors.
Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer.
Having a risk factor does not mean that a woman will get ovarian cancer. Most women who have risk factors do not get ovarian cancer. On the other hand, women who do get the disease often have no known risk factors, except for growing older. Women who think they may be at risk of ovarian cancer should talk with their doctor. Symptoms Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include: Pressure or pain in the abdomen, pelvis, back, or legs A swollen or bloated abdomen Nausea, indigestion, gas, constipation, or diarrhea Feeling very tired all the time Less common symptoms include:
38 RSVP Health | www.rsvphealth.com
Blood tests: Your doctor may order blood tests. The lab may check the level of several substances, including CA125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman’s response to ovarian cancer treatment and for detecting its return after treatment. Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound). Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and
The Ovaries | By National Institute of Health
ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the “Treatment� section. Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread. A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells. Staging To plan the best treatment, your doctor needs to know the grade of the tumor (see Diagnosis) and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer. Your doctor may order tests to find out whether the cancer has spread: CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan. Chest x-ray: X-rays of the chest can show tumors or fluid. Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays. Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
These are the stages of ovarian cancer: Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen. Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen. Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver. Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs. Treatment Many women with ovarian cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. Knowing more about ovarian cancer helps many women cope. Shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what your doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to your doctor-to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details. Your doctor may refer you to a gynecologic oncologist, a surgeon who specializes in treating ovarian cancer. Or you may ask for a referral. Other types of doctors who help treat women with ovarian cancer include gynecologists, medical oncologists, and radiation oncologists. You may have a team of doctors and nurses. Getting a Second Opinion Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange RSVP Health | www.rsvphealth.com 39
The Ovaries | By National Institute of Health
to see another doctor. In most cases, a brief delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Sometimes women with ovarian cancer need treatment right away. There are a number of ways to find a doctor for a second opinion: Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team. NCI’s Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can assist you online through LiveHelp at http://www.cancer.gov/help. A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists. NCI provides a helpful fact sheet called “How To Find a Doctor or Treatment Facility If You Have Cancer.” Treatment Methods Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used. Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body: Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women with all stages of ovarian cancer. The section on “The Promise of Cancer Research” has more information about clinical trials. You may want to ask your doctor these questions before your treatment begins: What is the stage of my disease? Has the cancer spread from the ovaries? If so, to where? What are my treatment choices? Do you recommend intraperitoneal chemotherapy for me? Why? Would a clinical trial be appropriate for me? Will I need more than one kind of treatment? What are the expected benefits of each kind of treatment? What are the risks and possible side effects of each treatment? What can we do to control side effects? Will they go away after treatment ends? What can I do to prepare for treatment? Will I need to stay in the hospital? If so, for how long?
Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis. Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body. You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs. Because cancer treatments often damage healthy cells and tissues, 40 RSVP Health | www.rsvphealth.com
What is the treatment likely to cost? Will my insurance cover the cost? How will treatment affect my normal activities? Will treatment cause me to go through an early menopause? Will I be able to get pregnant and have children after treatment? How often should I have checkups after treatment?
The Ovaries | By National Institute of Health
Surgery The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
How will I feel after surgery? If I have pain, how will it be controlled? How long will I be in the hospital?
both ovaries and fallopian tubes (salpingo-oophorectomy) Will I have any long-term effects because of this surgery? the uterus (hysterectomy) Will the surgery affect my sex life? the omentum (the thin, fatty pad of tissue that covers the intestines) nearby lymph nodes
Chemotherapy Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.
samples of tissue from the pelvis and abdomen If the cancer has spread, the surgeon removes as much cancer as possible. This is called “debulking” surgery. If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed. You may be uncomfortable for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief. The time it takes to heal after surgery is different for each woman. You will spend several days in the hospital. It may be several weeks before you return to normal activities. If you haven’t gone through menopause yet, surgery may cause hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your doctor or nurse about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time. You may want to ask your doctor these questions about surgery: What kind of surgery do you recommend for me? Will lymph nodes and other tissues be removed? Why? How soon will I know the results from the pathology report? Who will explain them to me?
Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways: By vein (IV): The drugs can be given through a thin tube inserted into a vein. By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen. By mouth: Some drugs for ovarian cancer can be given by mouth. Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used. You may have your treatment in a clinic, at the doctor’s office, or at home. Some women may need to stay in the hospital during treatment. The side effects of chemotherapy depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly: Blood cells: These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team checks you for low levels of blood cells. If blood tests show low levels, your health care team can suggest medicines that can help your body make new blood cells. Cells in hair roots: Some drugs can cause hair loss. Your hair RSVP Health | www.rsvphealth.com 41
This picture is of the ovaries and nearby organs.
Ovaries Fallopian tubes
Uterus
Vagina
42 RSVP Health | www.rsvphealth.com
The Ovaries | By National Institute of Health
will grow back, but it may be somewhat different in color and texture. Cells that line the digestive tract: Some drugs can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines that help with these problems.
the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, or bloody stools. Also, your skin in the treated area may become red, dry, and tender. Although the side effects can be distressing, your doctor can usually treat or control them. Also, they gradually go away after treatment ends. NCI provides a booklet called Radiation Therapy and You.
Some drugs used to treat ovarian cancer can cause hearing loss, kidney damage, joint pain, and tingling or numbness in the hands or feet. Most of these side effects usually go away after treatment ends. You may find it helpful to read NCI’s booklet Chemotherapy and You. You may want to ask your doctor these questions about chemotherapy: When will treatment start? When will it end? How often will I have treatment?
Supportive Care Ovarian cancer and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life. Your health care team can help you with the following problems: Pain: Your doctor or a specialist in pain control can suggest ways to relieve or reduce pain. You may want to read the NCI booklet Pain Control. Swollen abdomen (from abnormal fluid buildup called ascites): The swelling can be uncomfortable. Your health care team can remove the fluid whenever it builds up.
Which drug or drugs will I have? How do the drugs work? Do you recommend both IV and IP (intraperitoneal) chemotherapy for me? Why? What are the expected benefits of the treatment? What are the risks of the treatment? What side effects might I have? Can I prevent or treat any of these side effects? How? How much will it cost? Will my health insurance pay for all of the treatment? Radiation Therapy Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the body. Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes. Side effects depend mainly on the amount of radiation given and
Blocked intestine: Cancer can block the intestine. Your doctor may be able to open the blockage with surgery. Swollen legs (from lymphedema): Swollen legs can be uncomfortable and hard to bend. You may find exercises, massages, or compression bandages helpful. Physical therapists trained to manage lymphedema can also help. Shortness of breath: Advanced cancer can cause fluid to collect around the lungs. The fluid can make it hard to breathe. Your health care team can remove the fluid whenever it builds up. Sadness: It is normal to feel sad after a diagnosis of a serious illness. Some people find it helpful to talk about their feelings. See the “Sources of Support” section for more information. You can get information about supportive care on NCI’s Web site at http://www.cancer.gov/cancertopics/coping and from NCI’s Cancer Information Service at 1-800-4-CANCER or LiveHelp (http://www.cancer.gov/help). Nutrition and Physical Activity It’s important for women with ovarian cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can. RSVP Health | www.rsvphealth.com 43
The Ovaries | By National Institute of Health
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems. Also, the NCI booklet Eating Hints has many useful ideas and recipes. Many women find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it. Follow-up Care You will need regular checkups after treatment for ovarian cancer. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remained somewhere in your body after treatment. Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include a pelvic exam, a CA125 test, other blood tests, and imaging exams. If you have any health problems between checkups, you should contact your doctor.
be harmful. And certain complementary approaches could be harmful even if used alone. You may find it helpful to read the NCI booklet Thinking About Complementary & Alternative Medicine: A Guide for People with Cancer. You also may request materials from the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. You can reach their clearinghouse at 1-888-644-6226 (voice) and 1-866-464-3615 (TTY). Also, you can visit their Web site at http://www.nccam.nih.gov. You may want to ask your doctor these questions before you decide to use complementary medicine: What benefits can I expect from this approach? What are its risks? Do the expected benefits outweigh the risks? What side effects should I watch for? Will the approach change the way my cancer treatment works? Could this be harmful? Is this approach under study in a clinical trial? How much will it cost? Will my health insurance pay for this approach? Can you refer me to a complementary medicine practitioner?
You may wish to read the NCI booklet Facing Forward: Life After Cancer Treatment. It answers questions about follow-up care and other concerns. It also suggests ways to talk with your doctor about making a plan of action for recovery and future health. Complementary Medicine It’s natural to want to help yourself feel better. Some people with cancer say that complementary medicine helps them feel better. An approach is called complementary medicine when it is used along with standard cancer treatment. Acupuncture, massage therapy, herbal products, vitamins or special diets, and meditation are examples of such approaches. Talk with your doctor if you are thinking about trying anything new. Things that seem safe, such as certain herbal teas, may change the way your cancer treatment works. These changes could 44 RSVP Health | www.rsvphealth.com
Sources of Support Learning you have ovarian cancer can change your life and the lives of those close to you. These changes can be hard to handle. It is normal for you, your family, and your friends to have many different and sometimes confusing feelings. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of your health care team can answer questions about treatment, working, and other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.
Your situation is unique. Your care should be too.
Each member of the LSS Hospice Care team believes wholeheartedly in touching lives and making a difference during a person’s remaining days. Each family we serve becomes our family, and by working together we make life and loss as bearable as possible. Ž
314.446.2539 < LSSHospiceCare.org
RSVP Health | www.rsvphealth.com 45
Bridging the Gap Between Patients and Providers.
This card is ready for use, simply cut along dotted line.
46 RSVP Health | www.rsvphealth.com
The Ovaries | By National Institute of Health
Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group. It is natural for you to be worried about the effects of ovarian cancer and its treatment on your sexuality. You may want to talk with your doctor about possible sexual side effects and whether these effects will be permanent. Whatever happens, it may be helpful for you and your partner to talk about your feelings and help one another find ways to share intimacy during and after treatment. For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer. NCI’s Information Specialists at 1-800-4-CANCER and at LiveHelp (http://www. cancer.gov/help) can help you locate programs, services, and publications. They can send you a list of organizations that offer services to women with cancer.
are studying whether certain drugs can help prevent ovarian cancer in women at high risk. Screening studies: Researchers are studying ways to find ovarian cancer in women who do not have symptoms. Treatment studies: Doctors are testing novel drugs and new combinations. They are studying biological therapies, such as monoclonal antibodies. Monoclonal antibodies can bind to cancer cells. They interfere with cancer cell growth and the spread of cancer. If you are interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It explains how clinical trials are carried out and explains their possible benefits and risks. NCI’s Web site includes a section on clinical trials at http:// www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of ovarian cancer. NCI’s Information Specialists at 1-800-4-CANCER or at LiveHelp at http://www.cancer.gov/help can answer questions and provide information about clinical trials.
The Promise of Cancer Research Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new and better ways to prevent, detect, and treat ovarian cancer. Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances, and researchers continue to search for more effective methods. Women who join clinical trials may be among the first to benefit if a new approach is effective. And even if the women in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about ovarian cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients. Researchers are conducting studies with women across the country: Prevention studies: For women who have a family history of ovarian cancer, the risk of developing the disease may be reduced by removing the ovaries before cancer is detected. This surgery is called prophylactic oophorectomy. Women who are at high risk of ovarian cancer are taking part in trials to study the benefits and harms of this surgery. Other doctors RSVP Health | www.rsvphealth.com 47
Taking Care of What Matters Most, even when it’s inconvenient.
COMPREHENSIVE • COMPASSIONATE • CONVENIENT COMPLETE • COST EFFECTIVE 573-747-1510
|
508 W. Pine St., Farmington, MO
| www.midwestconvenientcare.com
Midwest Health Group Commitment to Community Midwest Health Group is proud to announce our brand new lab. It is be a Quest and Labcorp draw station and offers: - PadNet testing for peripheral artery disease and or poor circulation. - Nerve testing to help diagnose disorders of the spine and carpal tunnel syndrome - Lung testing (pulmonary function testing [PFTâ&#x20AC;&#x2122;s]) - 24 hour glucose monitoring - Saturday hours 8:00 AM - 12:00 PM (noon) - Drive up location All of these tests and services can be provided no matter where your primary physician or provider is located and the results will be forwarded to them.
Dr. Paul Moniz D.O. and Dr. Guy Roberts D.O.
Midwest Health Group and Midwest Health Group Convenient Care is proud to spotlight our nurse practitioners: Midwest Health Group Josie Savage, N.P., Christina Klinesorge-Rariden, FNP, Gina Herberlie FNP and Missy Radosevich FNP Midwest Health Group Convenient Care Angelica Lappe FNP
573-747-1510 508 W. Pine St., Farmington, MO www.midwestconvenientcare.com
Called to Serve: A Two-Step Plan for Becoming a First-Time Caregiver By Jeff Browning, LSS
50 RSVP Health | www.rsvphealth.com
“It is one of the most beautiful compensations of life, that no man can sincerely try to help another without helping himself.” - Ralph Waldo Emerson Caregivers know exactly what Emerson was talking about. The role of caregiver is one that most people play at some point in their life. Whether that role includes simple daily chores like helping with the grocery shopping or laundry, or more involved activities like bathing and dressing, chances are you will we be called to serve someday. There are about 45 million unpaid caregivers in the United States today, and with the first baby boomers reaching retirement age, that number is going to increase. Becoming a caregiver can be a daunting endeavor; it means taking on the pressures of helping someone else live their life, and it comes on top of all the pressures we already have in our own lives. Juggling caregiving with work, a marriage, a family, and a social life can become incredibly stressful for caregivers. That stress can manifest itself in different ways for different people, including increased levels of irritability, mood swings, headaches, neck and back pain, overreacting, a sense of not being an able provider, and can even lead to more serious health problems and substance abuse.
Yenor suggests a more effective way to approach the situation may be as an information gatherer, not as a decision maker. “It empowers everyone when we make decisions together. It really helps older adults understand that they are not having their freedoms taken away.” Here are some questions for family members to discuss with their aging loved ones: Do you feel safe at home? What can we do to help you live at home safely, now that your abilities are changing? Would you be open to bringing a paid caregiver or service provider into your home? How do you feel about the prospect of moving into an assisted living community? A skilled nursing care center? If something should happen, do you have a will or a health care proxy? The second step – information gathering – is a little easier. There are a wide range of resources available in your community to help caregivers, from senior living communities to United Way-funded programs. One useful resource is your local Area Agency on Aging, which provides information on local services for seniors, including
Though it is challenging, caregiving can be rewarding in the long run. According to the National Women’s Health Information Center (NWHIC), about half of caregivers report that “they appreciate life more as a result of their caregiving experience,” and that “caregiving has made them feel “It is one of the most beautiful compensations of good about themselves.” So how do we try to foster life, that no man can sincerely try to help another those good feelings and minimize the bad? One effective way to begin alleviating some of the anxiety and pressure that comes with helping family and friends is to learn important pertinent information before a crisis situation occurs.
without helping himself.”
“The biggest struggle I see in families is the fear of the unknown,” says Sara Yenor, a licensed social worker and active living coordinator working for Lutheran Senior Services. “Caring for a loved one is often unknown territory for people until they are right in the middle of it. It may be a daughter or son making health care decisions for a parent, or a spouse who suddenly has to take care of the household finances for the first time in his or her life. This kind of change can cause many people to feel as though they have lost control.” The first step in planning for a safe future is beginning an honest conversation with the person you will be caring for. This step is often the hardest one to take for most people. Children are especially hesitant to discuss health issues with their parents, often because they don’t know what questions to ask or where to begin when they see their loved ones faltering with tasks they once performed on their own. “Many seniors are quick to say, ‘I don’t need help,’” says Yenor, “but it is important for potential caregivers to start talking about the ‘what ifs’ early so they are comfortable making decisions on behalf of their loved ones.”
- Ralph Waldo Emerson
transportation and housing. Another is the National Family Caregivers Association, which sends out weekly newsletters with advice for people helping aging loved ones. These resources can provide direction and establish some security in knowing what lies ahead and how to prepare for it. Unfortunately, many people wait until the moment a crisis happens to begin thinking about these questions. Elderly family members or friends may find themselves in a situation where they are unable to speak for themselves. That’s why it is necessary to take steps today to educate ourselves about our elders. Talking together helps caregivers truly understand their elders’ wishes and empower them to live life according to their own plan. For more tips on giving care to your aging loved ones, call on the experts at Lutheran Senior Services (LSS). With a wide range of programs serving the St. Louis area, LSS is dedicated to helping seniors live life to the fullest, wherever they call home. To learn more, visit LSSLiving.org.
RSVP Health | www.rsvphealth.com 51
Ignore the
Pain?
Two people fall and suffer seemingly similar injuries. Six months later, one has completely recovered but the other still has debilitating pain. How can different people seem to experience pain so differently? Through carefully controlled experiments using advanced brain imaging techniques, researchers are discovering that people’s brains can process the same pain signals from their bodies very differently. These insights are leading to surprising new strategies for controlling pain. Advances in pain research were the focus of the first annual symposium of the NIH Pain Consortium. NIH created the consortium to enhance pain research and promote collaboration among pain researchers across the many NIH institutes and centers involved with pain research. Scientists at the inaugural symposium described their investigations into the genes involved in pain, how nerves transmit pain signals from the body to the brain, and new medications and other therapies under development. Dr. Robert Coghill of Wake Forest University explained that there are significant differences in the way people experience pain. When people had the same level of heat applied to the backs of their legs, Coghill recounted, the intensity of pain they reported was “all over the place”—from someone who said it didn’t hurt at all to someone who said the pain was so intense they almost withdrew from the study. 52 RSVP Health | www.rsvphealth.com
Ignore the Pain? | National Institute of Health
Coghill’s team wanted to see whether these ratings represent a true difference in the way people experience pain or differences in how they explain what they feel. To answer this, they examined the brain activity of their subjects using an MRI (magnetic resonance imaging) machine while they applied different levels of heat. They found that those who reported feeling more pain had stronger and more frequent activation in a number of brain areas, particularly a region called the primary somatosensory cortex. These people were all getting a generally similar input delivered to their brains, but once the signal got into their brains, it seemed to be processed differently in different people. To see if they could manipulate that processing, the researchers trained people to associate different levels of painful stimulus with different tones. They then tested the impact of expectation by signaling a moderately painful stimulus but then delivering an intensely painful one. “When we look at their pain intensity ratings, they decrease significantly,” Coghill said. “The bigger the expectation people had that the pain was going to go down, the more the pain in fact went down. Changes in expectation accounted for 88% of the variability in the pain people said they felt.” What’s the possibility that the subjects were only telling researchers what they thought they wanted to hear? MRI showed that their brain activation matched what they were saying they felt. “These people really were experiencing less pain than they would normally when they were correctly expecting the stimulus,” Coghill said. Expectation has a widespread impact on how the brain processes pain. “The final word is always look on the bright side of life,” Dr. Coghill concluded. “Try to think positively. That can really change the way you experience pain.” Dr. M. Catherine Bushnell of McGill University said that researchers have known for years that people feel more pain when they’re focusing on it than when they’re paying attention to something else. The problem in manipulating attention, however, is that mood and emotions play such a large role. But maybe manipulating mood, she thought, can have an effect on pain. Odors have a strong emotional impact on people. By finding an odor someone likes and one they don’t, Bushnell’s group found that you can manipulate their mood. They went on to show that odor-induced mood affects how people rate pain when researchers apply heat to their arms.
“We found that, in fact, if you correlate the rating of pain unpleasantness with all these different factors…,” Bushnell said, “the only factor that predicts the ratings of pain unpleasantness is mood.” Brain-imaging experiments showed that odor had a widespread effect on pain processing that involved many areas of the brain. Like the people in Coghill’s experiments, those in Bushnell’s really were experiencing different levels of pain. Dr. Christopher DeCharms of Omneuron wanted to see if people could learn how to manipulate their brain activity themselves to affect how much pain they feel. It’s already known that stimulating certain brain regions electrically or with certain medications can have an impact on pain, DeCharms explained. “What if you can train the patient to cognitively modulate that same brain region without surgery or pharmacology?” he asked. He and his colleagues developed a way, using an advanced MRI machine, to acquire brain activity data in real time and then feed that information back to the patient. The subjects had a device on their non-dominant hand to generate a painful heat stimulus. A scrolling line graph or a graphic of a fire going up and down showed them in real time the activity in a brain region called the anterior cingulate cortex, an area involved in pain perception and regulation. The subjects successfully learned to manipulate activity not only in that region of the brain, DeCharms said, but also in other regions in the pain processing network as well. “Through the course of training, they showed greater and greater control over their pain perception,” DeCharms explained. “Control over brain and control over pain mirrored each other very closely.” The group next wanted to see if it was possible to use this approach on chronic pain. They performed a similar procedure in chronic pain patients from the Stanford Pain Management Center, except without applying any external pain. The subjects reported a substantial decrease in their chronic pain after just one session. They said they felt like they had a greater sense of control over their pain and that they felt they’d learned what they needed to do to control it. While the experiment had only 8 subjects, DeCharms says he is planning to test the technique with larger groups. However effective this particular method proves, one thing does seem indisputable: psychological factors like mood and attention can affect how much pain you feel.
RSVP Health | www.rsvphealth.com 53
METHAMPHETAMINE
Methamphetamine is a central nervous system stimulant drug that is similar in structure to amphetamine. Due to its high potential for abuse, methamphetamine is classified as a Schedule II drug and is available only through a prescription that cannot be refilled. Although methamphetamine can be prescribed by a doctor, its medical uses are limited, and the doses that are prescribed are much lower than those typically abused. Most of the methamphetamine abused in this country comes from foreign or domestic superlabs, although it can also be made in small, illegal laboratories, where its production endangers the people in the labs, neighbors, and the environment. How Is Methamphetamine Abused? Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intranasally (snorting the powder), by needle injection, or by smoking. How Does Methamphetamine Affect the Brain? Methamphetamine increases the release and blocks the reuptake of the brain chemical (or neurotransmitter) dopamine, leading to high levels of the chemical in the brain—a common mechanism of action for most drugs of abuse. Dopamine is involved in reward, motivation, the experience of pleasure, and motor function. Methamphetamine’s ability to release dopamine rapidly in reward regions of the brain produces the intense euphoria, or “rush,” that many users feel after snorting, smoking, or injecting the drug. Chronic methamphetamine abuse significantly changes how the brain functions. Noninvasive human brain imaging studies have shown alterations in the activity of the dopamine system that are associated with reduced motor skills and impaired verbal learning. 1 Recent studies in chronic methamphetamine abusers have also revealed severe structural and functional 54 RSVP Health | www.rsvphealth.com
changes in areas of the brain associated with emotion and memory,2,3 which may account for many of the emotional and cognitive problems observed in chronic methamphetamine abusers. Repeated methamphetamine abuse can also lead to addiction—a chronic, relapsing disease characterized by compulsive drug seeking and use, which is accompanied by chemical and molecular changes in the brain. Some of these changes persist long after methamphetamine abuse is stopped. Reversal of some of the changes, however, may be observed after sustained periods of abstinence (e.g., more than 1 year).4 What Other Adverse Effects Does Methamphetamine Have on Health? Taking even small amounts of methamphetamine can result in many of the same physical effects as those of other stimulants, such as cocaine or amphetamines, including increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and hyperthermia. Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems (“meth mouth”), anxiety, confusion, insomnia, mood disturbances, and violent behavior. Chronic methamphetamine abusers can also display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects crawling under the skin). Transmission of HIV and hepatitis B and C can be consequences of methamphetamine abuse. The intoxicating effects of methamphetamine, regardless of how it is taken, can also alter judgment and inhibition and can
lead people to engage in unsafe behaviors, including risky sexual behavior. Among abusers who inject the drug, HIV/AIDS and other infectious diseases can be spread through contaminated needles, syringes, and other injection equipment that is used by more than one person. Methamphetamine abuse may also worsen the progression of HIV/AIDS and its consequences. Studies of methamphetamine abusers who are HIV-positive indicate that HIV causes greater neuronal injury and cognitive impairment for individuals in this group compared with HIV-positive people who do not use the drug.5,6 What Treatment Options Exist? Currently, the most effective treatments for methamphetamine addiction are comprehensive cognitive-behavioral interventions. For example, the Matrix Model—a behavioral treatment approach that combines behavioral therapy, family education, individual counseling, 12-step support, drug testing, and encouragement for nondrug-related activities—has been shown to be effective in reducing methamphetamine abuse.7 Contingency management interventions, which provide tangible incentives in exchange for engaging in treatment and maintaining abstinence, have also been shown to be effective.8 There are no medications at this time approved to treat methamphetamine addiction; however, this is an active area of research for NIDA. How Widespread Is Methamphetamine Abuse? Monitoring the Future Survey* Methamphetamine use among teens appears to have dropped significantly in recent years, according to data revealed by the 2009 Monitoring the Future survey. The number of high-school seniors reporting past-year†† use is now only at 1.2 percent, which is the lowest since questions about methamphetamine were added to the survey in 1999; at that time, it was reported at 4.7 percent. Lifetime use among 8th-graders was reported at 1.6 percent in 2009, down significantly from 2.3 percent in 2008. In addition, the proportion of 10th-graders reporting that crystal methamphetamine was easy to obtain has dropped to 14 percent, down from 19.5 percent 5 years ago.
8th Grade
10th Grade
12th Grade
Lifetime**
1.6%
2.8%
2.4%
Past Year
1.0
1.6
1.2
Past Month
0.5
0.6
0.5
Methamphetamine Prevalence of Abuse Monitoring the Future Survey, 2009. National Survey on Drug Use and Health***
Arturo C. Taca, Jr., MD, FABAM Medical Director – The Institute of Neuro-Synergy (INSynergy) Founded by Arturo C. Taca, Jr., MD, FABAM, INSynergy was created in response for a dire need to provide effective and affordable treatment for motivated persons struggling with addictions. Dr. Taca brings to the Institute of Neuro-Synergy (INSynergy) a wealth of experience in addiction medicine. Dr. Taca is a Diplomate and Board Certified by the American Board of Addiction Medicine as well as the American Board of Psychiatry and Neurology. Dr. Taca has been the force behind setting the benchmark in addiction treatment locally. He has established medically assisted recovery programs locally and founded the very popular and highly effective Integrated Neuro-Science program protocol.
According to the 2008 National Survey on Drug Use and Health, the number of past-month methamphetamine users age 12 and older decreased by over half between 2006 and 2008. Current (past-month) users were numbered at 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008. Significant declines from 2002 and 2008 also were noted for lifetime and past-year use in this age group. From 2002 to 2008, past-month use of methamphetamine declined significantly among youths aged 12 to 17, from 0.3 percent to 0.1 percent, and young adults aged 18 to 25 also reported significant declines in past-month use, from 0.6 percent in 2002 to 0.2 percent in 2008. Other Information Resources For more information on the effects of methamphetamine abuse and addiction, visit www.drugabuse.gov/drugpages/methamphetamine.html. To find publicly funded treatment facilities by State, visit www.findtreatment. samhsa.gov. For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit www.whitehousedrugpolicy.gov/streetterms/ default.asp. * These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted by the University of Michigan’s Institute for Social Research. The study has tracked 12th-graders’ illicit drug abuse and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov. ** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey. *** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from NIDA at 877–643–2644. 1 Volkow ND, Chang L, Wang GJ, et al. Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. Am J Psychiatry 158(3):377–382, 2001. 2 London ED, Simon SL, Berman SM, et al. Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers. Arch Gen Psychiatry 61(1):73–84, 2004. 3 Thompson PM, Hayashi KM, Simon SL, et al. Structural abnormalities in the brains of human subjects who use methamphetamine. J Neurosci 24(26):6028–6036, 2004. 4 Wang GJ, Volkow ND, Chang L, et al. Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence. Am J Psychiatry 161(2):242–248, 2004. 5 Chang L, Ernst T, Speck O, Grob CS. Additive effects of HIV and chronic methamphetamine use on brain metabolite abnormalities. Am J Psychiatry 162(2):361–369, 2005. 6 Rippeth JD, Heaton RK, Carey CL, et al. Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc 10(1):1–14, 2004. 7 Rawson RA, Marinelli-Casey P, Anglin MD, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction 99(6):708–717, 2004. 8 Roll JM, Petry NM, Stitzer ML, et al. Contingency management for the treatment of methamphetamine use disorders. Am J Psychiatry 163(11):1993–1999, 2006.
Before this, he was the former Medical Director of Assisted Recovery Centers of America (ARCA) and led this program to develop higher standards in treating addictions. Before INSynergy, Dr. Taca completed his psychiatric residency training at St. Louis University where he was the Chief Resident of the Department of Psychiatry. He is currently a clinical instructor and continues to teach and supervise residents at the St. Louis University School of Medicine Department of Psychiatry and St. John’s Mercy Medical Center. Dr. Taca also was voted one of the Best Doctors of America in Psychiatry. This distinction is only offered to those physicians who have been selected by consensus of their peers to be included in Best Doctors. Only about 5% of all doctors in the U.S. are honored in this way by their colleagues as the result of a nationwide survey in which doctors cast more than one million votes
RSVP Health | www.rsvphealth.com 55
Virtual Workouts, Real Sweat: Working out with the Wii and Kinect By Luke Smith, LSS
Running. Swimming. Yoga. Video games? One of these things is not like the other, right? I would be willing to bet never in your life has anyone ever said to you, “You need to get in shape. Go play a video game.” Well, that may be getting ready to change. Everyone knows exercise is good for the body, no matter what your age is. Everyone also knows that exercising is a hard habit to get into and an incredibly easy habit to break. But in recent years, software companies have developed video game systems that give more than just the gamer’s thumbs a workout. They require you to get up and move around in order to play. The trick is to make working out so much fun that you don’t even realize you are working out. That’s one of the reasons why the Nintendo Wii has become the most popular video game device of all time. The Wii Sports game
56 RSVP Health | www.rsvphealth.com
Virtual Workouts, Real Sweat: Working out with the Wii and Kinect | By Luke Smith
that comes bundled with the system is easily the best selling video game ever, nearly doubling former record-holder Super Mario Brothers’ longstanding record. And why? Because playing gives you more than a way to kill time—it gives you a way to live better. The Wii’s wireless controller tracks your movements, making your character move on the screen. By simulating boxing, bowling, golf, and other sports, games like Wii Sports can really have you working up a sweat. And its low-impact exercises are a big draw for older adults who want to work on their range of motion, balance, and joint issues. So just how popular is the Wii Bowling among seniors? It’s harder nowadays to find a senior living community without a Wii hooked up to a big screen TV or projector. Wii bowling and golf leagues have popped up all over the country; in fact, in October 2009, a world record was set in Houston, Texas, by 600 seniors who came out for a Wii Bowling tournament. Most Wii games offer a real physical experience. For those ready to graduate from Wii Sports to something a little more intense can move on to Wii Fit. The game comes with a specially designed “balance board” that is used for many of the program’s minigames which include yoga, aerobics, cardio, strength, training, and balancing. And for those looking for a still more challenging routine, you might look into Microsoft’s Kinect for the XBOX 360. This brand new device has been called the next step up from the Wii. The big difference is there’s no controller other than your own body. A camera on the device tracks you as you move, making it an even more interactive experience. This development is great for virtual exercise because it frees you from external controllers. It tracks a greater range of motion, so the machine will know if you’re really doing those jumping jacks or just sitting on the couch waving your remote.
be a positive or a negative. Many games expect participants to jump or crouch, which can be problematic for seniors for the same reasons the Wii works so well – range of motion, balance, and joint issues. If you’re thinking about purchasing a Kinect, be sure to do your research on which games to purchase, or even consult your doctor to avoid real physical problems from your virtual workout. While this technology probably won’t replace the long walk or the bike ride, it’s a terrific backup option for colder months when some people might otherwise “hibernate” for the winter. And as it gets more and more popular, it’s getting easier and easier to find people to play with.
While this technology probably won’t replace the long walk or the bike ride, it’s a terrific backup option for colder months when some people might otherwise “hibernate” for the winter. Want to check out the Wii? At Lutheran Senior Services senior living communities, Wii bowling is just one of a whole range of fitness and wellness activities available to our residents. With locations throughout the greater St. Louis area, we’re dedicated to helping seniors live the active lifestyle that best suits them. That means a full and diverse activities calendar, and a community full of likeminded neighbors ready to participate with you. To find a location near you, visit LSSLiving. org.
Expecting a greater degree of physical activity can
RSVP Health | www.rsvphealth.com 57
Living with Multiple Sclerosis | By Rita Martin
Deana “Robyn” Pigg is a devoted daughter, wife and mother. She is the relative or friend that remembers all important occasions in your life and keeps you up on where folks have moved or how they are convalescing. She is also there for you when you need a hand or a shoulder to lean on. In February of 2007, Robyn’s right arm became numb. She thought it was possibly, a pinched nerve, so as a regular chiropractic patient, she went for an adjustment. Dr. Huck was unable to alleviate the numbness and felt she should see a neurologist for an MRI. Her primary care physician referred her to a neurologist for further testing. The neurologist did order several tests finding nothing conclusive.
symptoms such as numbness, weakness, visual loss, double vision and imbalance. Attacks of inflammation causing symptoms lasting more than 24 hours are called relapses or exacerbations. Some attacks will last only 1 day but many last a few weeks to several months. Generally, the myelin can be repaired so recovery can occur. If the inflammation is severe enough, the actual nerves may be cut. This may result in permanent disability. Robyn was admitted to the hospital on that Sunday. Hearing Multiple Sclerosis as her diagnosis was a big shock. She knew no one with the disease, which added to her stress and anxious feelings.
Living with Multiple Sclerosis The fight of Robyn Pigg By Rita Martin
On Friday March 2nd, her arm was still numb and then by Saturday, it was down her whole right side. When on Sunday the numbness was going up her left side, she knew there was something to worry about. This was about three weeks since the initial onset and her visit with Dr. Huck. On that Sunday, March 4th, her husband took her to Missouri Baptist Medical Center. By the end of the day a physician along with the emergency department did more testing including a lumbar puncture (spinal tap) and was able to confirm, Multiple Sclerosis. Multiple Sclerosis is a disease in which the brain, spinal cord and nerves to the eyes (optic nerves) can be attacked by your immune system. Specifically, the attack is directed at the coating of nerve cells called myelin. Myelin allows electrical signals to travel along nerves rapidly. When your immune cells attack myelin, these signals can be delayed or blocked. This prevents the nerve cells from “talking” to one another. The result of this inflammation against myelin can be neurological
58 RSVP Health | www.rsvphealth.com
She spent four days in the hospital. While there, she was treated with steroid infusions that took an hour to administer each day for four days. This helped to get her through the initial attack, easing some of the symptoms. However, the numbness in her right arm has never gone away. Robyn began a search for a MS specialist for further care. Through several sources, she heard of Barry Singer, M.D. of The MS Center for Innovations in Care at Missouri Baptist Medical Center. Dr. Singer is now Robynʼs neurologist. She sees him about every six months and is currently injecting an interferon medication three times a week under the skin. Interferon, which is a natural compound that our immune cells make to fight viruses can help “quiet down” inflammatory white blood cells and help block these cells from crossing the blood vessel walls into the brain and spinal cord. You can read more about interferon and other treatment options on Dr. Singerʼs web site, MS Living Well listed at the end of this article.
Living with Multiple Sclerosis | By Rita Martin
Exhaustion and weakness are the biggest problems Robyn faces. She tries to sleep eight hours or more each night and is aware that fifteen minutes of rest can help when she is over tired. One such time leading to her only real relapse Robyn’s employer needed someone for a short while on night shift that she volunteered to try. After ten days she was back on more steroid infusions. This she did as an outpatient, going to the local hospital each day. The different work schedule upset her sleep and daily routine. Though lack of sleep does not trigger relapses, lack of sleep makes coping with a relapse much harder. Increased fatigue is common with relapses. Her family is supportive, and understands the depth of fatigue and weakness she faces so they try to get her to slow down. However, Robyn has always been the “go to” and she is the first to step up. She is learning she can’t take on everything she would like to do in order to take proper care of herself.
vision. Dr. Singer diagnosed this as optic neuritis, a common symptom and often the first to present itself in a patient diagnosed with MS. It is a sudden loss of vision (partial or complete), or sudden blurred or “foggy” vision, with pain on movement of the affected eye. This condition often improves once the optic nerves have had time to heal. Dr. Singer made himself available for my questions and his website was most informative. He is passionate about helping his patients and is involved in the community to support and spark awareness. RSVP Health greatly appreciates his cooperation and information.
MS is recognized as a chronic, inflammatory and autoimmune disease of the central nervous system. It is among the most common causes of neurological disability
Robyn’s current insurance is covering everything. However, she will have a change in insurances this year and is hoping for the best. Fortunately, pharmaceutical companies that make MS medications have financial support programs even for those individuals without insurance. Robyn knows she would benefit from an MS support group but, at this time there is none in the St. Francois County area. Dr. Singer is highly involved himself in the National Multiple Sclerosis Society and the Gateway Chapter and puts patients in touch with help when needed. However, this would not replace having a friend close at hand going through similar trials and tribulations. On her own Robyn has found acquaintances, now friends with MS that she can touch base with to share the ups and downs. It is an important fact that those with MS need support both physically and mentally and should seek the needed support, so you are not in this alone.
in young adults and occurs at least twice as frequently in women as in men. If you are having symptoms of multiple sclerosis, discuss this with your healthcare provider. Like Robyn, you may need to seek a reputable neurologist to rule out other problems and order an MRI and lumbar puncture if needed. MS Center for Innovations in Care www.mslivingwell.org National MS Society Gateway Chapter nationalmssociety.org/chapters/MOS/index.aspx National MS Society www.nationalmssociety.org/ index.aspx
I recently attended an appointment with Robyn to better understand living with MS. She has started to have pain behind her eyes with peripheral
RSVP Health | www.rsvphealth.com 59
60 RSVP Health | www.rsvphealth.com
RSVP Health | www.rsvphealth.com 61
Exercise for Your Bone Health National Institute of Health
Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only does exercise improve your bone health, it also increases muscle strength, coordination, and balance, and it leads to better overall health. Why Exercise? Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.
62 RSVP Health | www.rsvphealth.com
Exercise for Your Bone Health | National Institute of Health
The Best Bone Building Exercise The best exercise for your bones is the weightbearing kind, which forces you to work against gravity. Some examples of weight-bearing exercises include weight training, walking, hiking, jogging, climbing stairs, tennis, and dancing. Examples of exercises that are not weight-bearing include swimming and bicycling. Although these activities help build and maintain strong muscles and have excellent cardiovascular benefits, they are not the best way to exercise your bones. Exercise Tips If you have health problems – such as heart trouble, high blood pressure, diabetes, or obesity – or if you are age 40 or older, check with your doctor before you begin a regular exercise program. According to the Surgeon General, the optimal goal is at least 30 minutes of physical activity on most days, preferably daily. Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. Stop exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session. If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis.
A Complete Osteoporosis Program Remember, exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss whether you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your bones strong. The National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center acknowledges the assistance of the National Osteoporosis Foundation in the preparation of this publication. For Your Information This publication contains information about medications used to treat the health condition discussed here. When this fact sheet was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
According to multiple Studies, weight or strength training over time can help prevent bone loss, and could actually help build new bone.
For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at: U.S. Food and Drug Administration Toll Free: 888–INFO–FDA (888–463–6332) Website: http://www.fda.gov/ For updates and questions about any statistics, please contact the Centers for Disease Control and Prevention’s National Center for Health Statistics toll free at 800–232–4636 or visit its Web site at www.cdc.gov/nchs.
RSVP Health | www.rsvphealth.com 63
our job
her
www.womenshealth.va.gov
Get Healthy. Stay Healthy.
Improving your baby’s odds during pregnancy Most people entering parenthood want nothing more than a happy, healthy baby. In the U.S., about 13% of babies are born too early.1 And, one in every 33 babies is born with some sort of birth defect.2 Healthy choices can help avoid premature labor and birth. You can give your baby the best odds by:
Eating a balanced diet.
Avoiding smoking, alcohol and drugs.
Watching for signs of premature labor.
While pregnant, make every calorie count for your baby.5 Try to avoid making hunger-driven choices by:
Planning ahead.
Bringing snacks with you.
Eating every three hours.
See the Resources section for a link to some great snack and meal ideas.
Prevent birth defects
2
Feed your body and your baby while pregnant A pregnant woman needs to eat between 100 and 300 extra calories each day. Recommended weight gain while pregnant is 25 to 35 pounds. Women who are pregnant with more than one baby or are underweight should gain more.3 Women who are overweight or obese should gain less.3 Not gaining the right amount of weight raises the chance of delivering a low birth weight baby, weighing about 5.5 pounds or less. Low birth weight is a major cause of infant death, and is linked to developmental, physical and psychological problems.4 Gaining too much weight raises the chance of gestational diabetes and high blood pressure. This can lead to early or complicated childbirth.4
66 RSVP Health | www.rsvphealth.com 19800ANMENABS 2/11 F0066565
Not all birth defects can be avoided, but you can lower your baby’s chances. Before you get pregnant:
Have a preconception exam, especially if you have any long-term health problems.
Make sure your shots are up to date.
Begin taking a daily multivitamin that has 400 micrograms of folic acid.
Get yourself to a healthy weight.
Quit smoking.
Once you become pregnant:
Get early and regular care before the baby is born.
Don’t change a cat’s litterbox, and avoid places where cats may have defecated.
Don’t eat undercooked meat.
Avoid touching rodents, including hamsters, mice and guinea pigs.
Don’t drink any alcohol.
Don’t take any prescription drugs, over-the-counter drugs or herbs, unless directed to do so by a health worker who knows you’re pregnant.
Avoid pesticides, and speak with your doctor about any chemicals you’re exposed to at work.
Know the signs of early labor More than one in every 10 babies born in the U.S. are born early.1 If your labor starts too soon, your doctor can give you drugs to slow or stop labor contractions, prevent infection and help your baby’s lungs mature faster.6 It’s important to know the signs of premature labor, so you can get help and better your baby’s chances. Warning signs of premature labor:7
Stomach tightness (contractions) every 10 minutes or more often. These contractions may not be painful.
Pelvic pressure; feeling as though your baby is pushing down
Low, dull backache
Menstrual-type cramps or pain
Stomach cramps with or without diarrhea
Late preterm deliveries8 Since the early 1990s, the number of late preterm babies, those born during 34 and 37 weeks of pregnancy,9 rose by up to 20% in some parts of the country.8 More frequent cesarean sections and induced deliveries explain most of the rise.8 These infants are developmentally and physiologically immature. They suffer from more health problems and higher death rates than infants born full-term.8,9 The risk of breathing problems, which are the leading reason late preterm babies are admitted to the neonatal intensive care unit, drops greatly with every week the pregnancy lasts. Increased risks are found even among babies born at 37 or 38 weeks.9 Sometimes health risks to the mother or baby call for an early birth. Your doctor will weigh the risks of delivering early against the risks to your health. Convenience should not play a role when creating a birth plan.
If you have even one sign of premature labor, call your doctor right away. They may want to check you at their office or the hospital. Or, they may ask you to rest on your left side or drink 2-3 glasses of water or juice to see if these signs of labor stop. If after an hour you still have signs of premature labor, call your doctor back or go to the hospital.7
Visit anthem.com for more ways to get healthy — and stay healthy.
Resources Visit pregnancyfoodguide.org for pregnancy wellness tips, recipes, and meal and snack ideas. For more information on birth defect prevention or treatment, visit the National Center on Birth Defects and Developmental Disabilities at cdc.gov/ncbddd. Or, visit the March of Dimes site at marchofdimes.com for information on healthy pregnancy.
Sources
1 Centers for Disease Control and Prevention, Birthweight and Gestation (December 22, 2009): cdc.gov 2 March of Dimes, Birth Defects (June 2010): marchofdimes.com 3 WebMD, Pregnancy and Weight Gain (February 10, 2010): webmd.com 4 Healthcommunities.com, Pregnancy and Nutrition Overview, Weight Gain During Pregnancy (accessed September 7, 2010): womenshealthchannel.com 5 American Egg Board, Pregnancy Food Guide (accessed September 7, 2010): pregnancyfoodguide.org 6 March of Dimes, Premature Birth Prevention and Treatment: Drugs for Use in Preterm Labor (July 2009): marchofdimes.com 7 March of Dimes, Premature Birth: Signs and Symptoms of Preterm Labor and What to Do (April 2008): marchofdimes.com 8 Centers for Disease Control and Prevention, Born a Bit Too Early: Recent Trends in Late Preterm Births (November 18, 2009): cdc.gov 9 National Institutes of Health, U.S. National Library of Medicine, MedlinePlus, Delivering Babies Even a Few Weeks Early Ups Respiratory Risks (July 27, 2010): nlm.nih.gov/medlineplus
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Inc. The Blue Cross and Blue Shield names and symbols RSVPCompanies, Health | www.rsvphealth.com 67 are registered marks of the Blue Cross and Blue Shield Association. 19800ANMENABS 2/11 F0066565
Educating you on how to be empowered in health care! Catch us LIVE every Friday at 8:20 A.M. on KREI 800 AM If you canâ&#x20AC;&#x2122;t get KREI, then listen to the latest episode by visiting rsvphealth.com/media
RADIO SHOW