Healthy Living | Spring 2010

Learn to eat healthier at Anacortes classes at Island Hospital

By Gordon Weeks Editor

hospital conference rooms one through was growing, you’re on the right track.” three. Attendees will learn how to Amongst other subjects, her “Choosing choose the most nutritious foods. The Healthy Foods” examines gluten-free Nutritionist cost is $15. For a reservation for either choices, a current concern among many despite Swanson’s belief that “gluten Bev Swanson or both classes, call 360-299-4204. has gotten a bad rap.” And she reminds invites you to Swanson has been offering nutrition us, “We are what we eat.” take a look at advice in Skagit County for years. For Other health classes at Island your dinner nearly a decade, she was the nutrition Hospital include: plate and eval- educator at the Skagit Food Co-op in • “Essential Remedies: Nature’s Wonuate what you Mount Vernon, where she answered der Cleaners and Super Germ Killers” see. “If it looks customer’s questions, wrote from 6:30-8 p.m. March like a work of articles for the newslet15, $15. art, full colors ter, conducted classes • “Look Good ... ““The crux of it is and textures, and developed healthy Feel Better,” a free whole foods. If it you’re on the recipes for the deli. She class that teaches right track,” also taught a nutrition looks anything like beauty techniques she said. class at Skagit Valley it was when it was to help restore If your meal College. appearance and growing, you’re on looks like a white, highly processed For the past nine self-image during the right track.’’ mass, you might want to consider atyears, Swanson has chemotherapy and tending one or two nutrition classes worked as a physical radiation treatments, Nutritionist Swanson hosts at Island Hospital in therapist at Island Hosfrom 1-3 p.m. March 15 Bev Swanson Anacortes. pital. She started teaching or April 19.

“Basic Nutrition” is presented from 7- a belly dancing class two • “A Guide to Better 8:30 p.m. Monday, March 22, in the hos- years ago at the hospital and Sleep” from 3:15-4:30 p.m. pital’s conference rooms one through last year debuted her nutrition March 17, free. three. Attendees will learn about how class.

• “Women’s Safe Weight Training,” vitamins and minerals help the body Her classes evaluate the energy 8-11 a.m. March 24, $10. function, why bodies need soluble and nutrients (fats, carbs, protein), stress the • “Baby Basics,” 6:30-9 p.m. April 15, $20, fee waived for those on DSHS insoluble fiber, how bodies process fat importance of soluble and nonsoluble medical. and the importance of hydration. The fiber and indentify the “superstar” • “Infant and Child Safety,” 6:30-9 cost is $15. fruits and vegetables such as blueberp.m. April 22, $20, fee waived for those Swanson also presents “Your Guide ries, cranberries and plums. to Choosing Healthy Foods” from “The crux of it is whole foods,” she said. on DSHS medical.

Registration: 360-299-4204.

7-8:30 p.m. Monday, April 19, in the “If it looks anything like it was when it

[ ] SPRING Healthy Living | MARCH 2010

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Quick Look program means shorter wait in SVH emergency department

By Gordon Weeks Editor

or injury gives the patient registration person their name and date of birth, and then are taken to a triage room so the physician can determine the

The Quick Look process didn’t require any additional hires.

“We were able to refocus our staffAt the emergency department at ing,” said McCabe. The emergency Skagit Valley department’s Hospital, doctors redesign in 2007 deal with everyhelps accommothing “from death date the process, and dismembersaid Worth. ment to ‘I have Skagit Valley a sliver,”’ said Hospital folEmergency Delowed up on the partment Medical new program by Dr. Everett Worth, assistant director of the emergency department, Director Kirk calling about 90 Skagit Valley Hospital Brownell, M.D. patients who were With the hospital’s processed through new Quick Look severity of the ailment. The rest of the the Quick Look program. Almost all program, the sliver sufferer no longer registration process takes place at the of them said it was their shortest visit languishes so long in the waiting room. bedside. Sometimes, the ailments aren’t to an emergency department, said Launched Jan. 13, the program also minor, and the patient is admitted.

Brownell. lows patients with minor injuries and illnesses to be seen more quickly by a physician assistant. The program was prompted by patient complaints and “the realization patients were waiting too long,” said Dr. Everett Worth, assistant director of the department.

“If you’re the one with the sprained ankle, and you’ve been there an hour and a half, that’s a long time,” Worth said.

Among the patients placed on the Quick Look track are those with coughs, cuts and bruises. The Quick Look procedures are executed between noon and 10 p.m.

“That’s when we have our greatest volume and our greatest needs,” said Emergency Department Director Donna McCabe. Patient volume is a Open daily challenge for hospitals throughout the in downtown country, she said.

Skagit Valley Hospital’s emergency Mount Vernon department receives about 90 to 100 patients a day, said McCabe. About 20 Your community to 30 have ailments that qualify them natural market for the Quick Look procedures, and since 1973 16 to 18 percent are admitted to the hospital, she said.

With the new Quick Look system, a patient arriving with a minor ailment

“If you’re the one with the sprained ankle, and you’ve been (in the emergency department waiting room) an hour and a half, that’s a long time.’’

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MARCH 2010 | SPRING Healthy Living [ ]

Total ankle replacement surgery new to Skagit County and not extremely active. Patients with poor leg circulation, diabetes or nerve conditions of the leg are not good candidates.

Ho, who also sees patients Mondays at United General Hospital in Sedro-Woolley, uses Scandinavian Total Ankle Replacement. The STAR ankle is made up of three parts. The first part covers the lower bone of the ankle joint, called the talus bone. The second part covers the bottom of the “shin” bone, or tibia, which runs from the bottom of the knee to the top of the ankle.

Both of the parts that cover the bone are made of cobalt chromium alloy.

The parts are coated in titanium in the places where they actually touch bone.

The third piece — a mobile bearing made of medical grade plastic — is placed between the two metal parts.

The plastic is designed to move as the ankle moves.

The ankle procedure requires a cut along the front of the ankle to open the ankle joint. About 3/8 of an inch of bone is removed from the joint to make space for the replacement. The surgeon then shapes the bones of the ankle so the replacement fits in place.

No bone cement is needed.

Patients can walk on the ankle Dr. Lance Ho sees orphopedic patients at Skagit Valley Medical Center and United within a couple weeks, and complete General Hospital in Sedro-Woolley recovery takes two or three months, Ho said. The replacements last 10 to 12

By Gordon Weeks patient to move the foot up and down years, he said.

Editor and side to side.

The design is significant because of the “It’s a big surgery,” said Ho, who small bones and joints involved in the Photo by Frank Varga performed about 30 total ankle reankle, and the amount of pressure apThe first ankle replacement surgeries placements while training at a private plied by the upright body.

30 years ago were failures, but years of practice in Oakland.

“There were probably over a huninnovation and testing have produced Most patients were suffering from dred different types (of replacement a model that allows recipients to walk, arthritis, while others needed the models) out of Europe which failed hike, even ski. The procedure is now procedure because of normal wear or because of the designs,” said Ho. available at Skagit Valley Medical Cen- a trauma such as an ankle fracture, he But total replacement isn’t for evter in Mount Vernon, and Dr. Lance Ho said. eryone. Ankle fusion “is still the gold is awaiting his first local ankle replaceThe ideal patient for the procedure standard for your active person with ment patient. is someone older than 50, not too heavy arthritis,” said Ho. Total ankle replacement allows the

[ ] SPRING Healthy Living | MARCH 2010

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Tritt) and classical (Mozart). Other titles include “General Wellness” and “Ease Grief.”

The new full-time social services worker is Pat Lundin. She helps new cancer patients with their insurance work, and refers them to community resources such as food banks and help paying utilities. “Every situation is different,” Lundin said. “They’re under a tremendous strain when they come.

They’ve lost their job. They’ve lost their insurance.”

The challenge is “trying to find enough resources for people who are

Mondays, Wednesdays and Fridays at the Sedro-Woolley center. Many patients arrive having lost a great deal of weight, and the goal is to regain and stabilize, she said.

Many cancer patients suffer from nausea and can’t bear the smells of hot food, Griswald said. A key is eating small meals more often and offering cold foods, she said. She directs patients toward high protein foods and supplements and encourages high intakes of fluids. Some patients don’t have much help at home, so Griswald steers some toward Meals on Wheels deliveries or

The new Breast Institute at the Skagit Valley Hospital Regional Cancer Care Center is funded by a $200,000 grant from the Safeway Foundation. Almost 100 new breast cancer patients are treated each year at the center.

Dailly is the Institute’s first patient navigator. She serves as a liaison between the patient and the physicians, scheduling appointments as needed with the radiologists, surgeon, medical oncologist and radiation oncologist.

Making those appointments is Dailly’s first job after a woman is diagnosed with breast cancer. “Some people can actually be paralyzed by the news ... My first job is to reduce the anxiety,” she said.

She also helps patients locate information about the disease and the importance of nutrition, exercise and attitude in the outcome of the disease.

She attends weekly meetings where Dominique Dailly, patient navigator, The Breast Institute, five specialists - a medical oncologist, Skagit Valley Hospital Regional Cancer Care Center a surgeon, a radiation oncologist, a radiologist and a pathologist — review each case and determine the best treatment plan. “Everyone talks to each the most in need,” she said. helps write grocery lists. other,” said Dailly. “It’s a team. That’s Lundin also offers emotional support At the center’s appearance center, the difference.” for the family members of the cancer cosmetologists are available by apAfter the treatment, Dailly focuses patients. pointment to fit wigs on women who the patient on survivorship. “It’s an on“Caregiving is a hard job,” she said. “I have lost their hair. The wigs are dogoing relationship of support and trust, think it’s one of the toughest jobs, donated by the American Cancer Society. and I’m also there to answer their quesing it 24 hours a day. It’s very isolating; Caps and scarves also are available. tions,” she said, adding, “Every woman it takes a lot of skills.”

The American Cancer Society hosts the is different. Every treatment is different. Every journey will be different.”

The new dietitian is Meg Griswald, “Look Better, Feel Better” classes at who started work last June and works the center.

“It’s an ongoing relationship of support and trust, and I’m also there to answer their questions.’’’

Seeking new way to treat pancreatic cancer, institute will inject vaccine directly into tumor By Lindy Washburn, The Record A novel approach to treating inoperable pancreatic cancer is under study at the Cancer Institute of New Jersey, using a vaccine injected directly into the tumor.

Research with mice has shown that when a vaccine is administered in the usual way, via a limb, no immune response is created. But when the vaccine is injected directly to the site of a cancerous tumor, the mice develop a system-wide immune response.

The Phase I clinical trial will study the safety of this approach in humans, said

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Edmund Lattime, one of the principal investigators and deputy director of the cancer institute. He is a professor of surgery there.

“We will take patients with locally advanced, inoperable pancreatic cancer,” he said. “We will use an endoscope that will go into the stomach. It will image the tumor and take a biopsy of the tumor, and then we will inject the vaccine into the tumor itself.”

The vaccine to be used has already been tested for safety when injected into humans via an arm.

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This trial is sponsored by the National Cancer Institute, which is providing the vaccine, known as PANVAC. More than 42,500 Americans a year are diagnosed with pancreatic cancer, which has a five-year survival rate of 5 percent.

“There has not been a significant breakthrough in the treatment of pancreatic cancer since an upgrade in chemotherapy in the mid-1990s,” said Elizabeth Poplin, a medical oncologist at the Cancer Institute of New Jersey and the study’s lead researcher.

MARCH 2010 | SPRING Healthy Living [ 13 ]

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Relationship: No Anxiety? Not possible.

By Barton Goldsmith Scripps Howard News Service Many people think that they are supposed to live anxiety-free. Not so.

Anxiety is part of the human condition. We all experience it on almost a daily basis in one form or another, and in some ways it can be helpful.

It’s important to realize that we grow most through meeting the challenges of difficult and painful experiences. Something that intimidated us, once overcome, contributes to our growth and confidence.

Hey, don’t get me wrong: I’d love an anxiety-free existence, but where would any of us be without worry?

It does keep us safe in a number of ways; we avoid stepping off cliffs because we know we can get hurt.

Anxiety also serves us in smaller ways, letting us know that something isn’t quite right so that we can make appropriate adjustments. Those little signals in the back of your brain are a combination of anxiety and intuition trying to get your attention, to make sure you are heading in the right direction.

The trick here is to learn to use your anxiety in positive ways. The first step is to see what the payoff of an anxious moment (or interval) might be for you. Perhaps it’s telling you that this assignment isn’t quite right for you or that you really can’t afford that new flat-screen television. I think it’s wise to at least look at your feelings before you leap.

The flip side of the coin is that excitement and anxiety feel exactly the same to our bodies. And it’s quite common for people to feel both excited and scared at the same time. Thrill rides at

amusement parks (and first dates) give you that excited/scared feeling. It’s perfectly normal -- and usually fun.

A number of folks do suffer from generalized anxiety disorder (GAD) or panic attacks, and that’s a different story. Most of us don’t worry about normal daily activities on a regular basis. If you do, and have been worrying like this for six months or more, you really need to get a checkup, a correct diagnosis and treatment, if necessary.

At times, anxiety can shake you to your core. Your confidence evaporates, your ability to communicate is hampered and your thinking process is blinded by fear. Learning how to avoid it, control it and deal with it appropriately is a set of skills that will serve you for the rest of your life.

One of the best tools is to imagine

[ 18 ] SPRING Healthy Living | MARCH 2010

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the worst, then imagine the best and finally imagine what is most likely to happen and hold on to that thought.

When anxiety strikes, it helps to remember that you have dealt with similar events well, and that you have the tools to get through this one. Sit down (or pull over), take a few deep breaths and think through what’s worrying you. Chances are you already have the answers you need, and once you calm down a little, you will see them much more clearly.

(Dr. Barton Goldsmith, a marriage and family therapist in Westlake, Calif., is the author, most recently, of “Emotional Fitness at Work.” He also hosts “Emotional Fitness” on NPR. E-mail him at barton@bartongoldsmith.com.)

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How to: Treat a Fever

By Alison Johnson, Daily Press (Newport News, Va.) With winter ending, many fevers are still likely to hit. Here’s advice from doctors on handling them: Resist panic. A fever is a sign that your immune system is doing its job: fighting an infection. Consider going without medicine unless your temperature climbs rapidly or you’re very uncomfortable. Many doctors recommend not using a fever-reducing medicine until a fever is 102 or higher.

as are ice chips, ginger ale, fruit juices or Popsicles.

Eat if you are hungry. Don’t try to force down food if you don’t feel like it. If you’re not sure, try some soup — you’ll be getting extra fluids to boot.

Follow dosing instructions. This is especially important with young children. Note that babies younger than 3 months need to see a doctor before they get any medicine, and no children should take aspirin because of the risk of dangerous complications.

Drink lots of fluids. Dehydration is a greater risk with a fever, especially if you also have vomiting or diarrhea.

Water and herbal teas are good choices, Stay as comfortable as possible. Wear

light, loose-fitting clothes — or more layers if you feel chilled — and keep the room cool. Also try a lukewarm bath or sponge off with a cool cloth; avoid cold water because shivering may increase body temperature.

Know when to call a doctor. General rules are fevers that are 104 degrees or higher, last longer than three days or go away and then return. Also call if you experience trouble breathing, convulsions, confusion, stiff neck or severe vomiting or diarrhea. And always err on the side of caution if you or a child looks or acts very ill.

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Other common causes of sleep disturbances include too much caffeine or alcohol, too little exercise or exposure to bright light, and untreated medical conditions such as arthritis or depression. How old your mattress is, how warm your room is at night, how much light comes in through your window — these can make a difference too.

Try changing sleep habits and conditions before taking sleep medications, which can be habit-forming and have other unwanted side effects such as excessive grogginess the next day, experts advise. But realize you may need shortterm assistance from a counselor.

“Implementing behavioral changes is very difficult for people to do without help,” said Dr. Cathy Alessi, a sleep expert at the Veterans Administration Greater Los Angeles Healthcare System.

Whether the need for sleep diminishes with age is a topic of ongoing debate. Educational materials from the National Institutes of Health suggest that seniors need seven to nine hours of sleep a night, about the same as younger adults. But Scott Campbell, director of the laboratory of human chronobiology at Weill Cornell Medical College in New York, says some research suggests otherwise.

In a small experiment involving 50 people observed in a sleep laboratory, Campbell found that older adults slept about two hours less than people 30 or younger and almost a full hour less than people in middle age. The study was published in 2007 in the Journal of Sleep Research. Similarly, a 2008 report in Current Biology found that older adults (age 60 to 72) slept 7.5 hours a night on average, compared with nine hours a night for people age 18 to 32.

What’s increasingly clear is that for the elderly, insufficient sleep is linked with medical concerns such as hypertension, depression, diabetes, heart disease and stroke. “If you have a sleep disorder, the chances of developing one of these conditions is heightened,” Bloom said. “And conversely, if you have one of these diseases, the chances of developing a sleep disorder are higher.”

For years, Eve Van Cauter, director of the sleep research laboratory at the University of Chicago, has been investigating this phenomenon. Her research shows that reduced sleep or perturbed sleep in healthy young adults increases stress levels, impairs a person’s ability to metabolize glucose, interferes with hormone levels and increases appetite.

“Sleep affects the organism at every level,” Van Cauter said, speculating that these effects persist in older adults.

Why would that be so? As people age, it appears that brain mechanisms promoting sleep deteriorate, Van Cauter said. Add to this the fact that older adults have more chronic illnesses, are less active and are less exposed to bright light that regulates their biological clocks, and the potential for sleep disturbances is magnified.

And what about that daily nap that older men and women often take? Is it a good idea?

Many U.S. sleep experts frown on naps, arguing that they can compromise nighttime slumber. But several small studies suggest that napping adds to the total amount of sleep older people get during a 24-hour period, potentially improving their alertness during the day and early evening.

If you do nap, practice good habits: “Go to bed, close the curtains, turn off the ringer on the telephone, set an alarm so you sleep for 1.5 hours at most, and make sure you get up by about 4 p.m.,” said Timothy Monk, a professor of psychiatry at the University of Pittsburgh Medical Center. “If you (do this), your nap shouldn’t interfere with your sleep at night.”

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TIPS FOR SLEEPING WELL • Develop a sleep ritual. Take a hot bath 90 minutes before bedtime or concentrate on relaxing 30 minutes before you get into bed.

• Try to go to bed and awaken at the same time every day.

• Make your bedroom restful and comfortable.

• Limit noise and light.

• Go to bed only if you feel sleepy.

• Try to exercise every day. Exercise helps many people sleep better. But avoid heavy exercise within two hours of bedtime.

• Cut down on substances such as caffeine, nicotine and alcohol, which can interfere with sleep, especially later in the day.

• Use your bedroom only for sleep and sex.

• Sleep only in your bedroom. Avoid napping or sleeping on couches or chairs.If you nap, do so in the early afternoon for a limited time. Some experts suggest 30 to 45 minutes; others say an hour or a bit longer is fine.

• If you can’t fall asleep, leave your bedroom. Return only when you feel ready to go to sleep.

• Ask your doctor if any of your medications could be keeping you awake at night.

Sources: Evidence-based recommendations for assessment and management of sleep disorders in older persons, Journal of the American Geriatrics Society, 2009; FamilyDoctor.org

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MARCH 2010 | SPRING Healthy Living [ 21 ]

TV can make you fat, shorten your life

By Drs. Kay Judge and Maxine Barish-Wredden McClatchy Newspapers As a society, we are watching more television and doing less exercise than we should, with increasingly adverse effects on our health.

The reasons our patients give us for their TV watching include: “I work hard and need TV to relax,” “Why should I give up something I like to do?” and “I am too tired to do anything else.”

We often need reasons to change our habits, so here are some compelling data from recent studies on TV-watching: • Kids are spending more time with so-called “entertainment media.” A new study from the Kaiser Family Foundation revealed that American teens and younger children spend almost eight hours a day watching TV, playing video games or surfing the Internet. This has increased by more than an hour in just the past five years.

[ 22 ] SPRING Healthy Living | MARCH 2010

• TV watching may shorten your life.

A study published this month in Circulation: Journal of the American Heart Association found that every hour per day on average spent in front of the television brings with it an 11 percent overall greater risk of premature death and an 18 percent greater risk of dying from cardiovascular disease.

• TV watching is linked to obesity and high cholesterol. Higher TV viewing hours are associated with higher body mass index numbers, lower levels of fitness and higher blood cholesterol and triglyceride levels, according to a study published in 2008 in the International Journal of Obesity.

• TV watching is linked to a bigger belly, flabby arms and a risk of heart disease. Decreasing the amount of TV watching might be effective as a first step in reducing atherosclerosis. Risk factors such as TV watching have an unfavorable association with the following measurements: BMI, waist girth, waist-to-hip ratio, and sub-scapular and

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triceps skin-fold thickness, according to the National Heart, Lung and Blood Institute’s Family Heart Study published in Atherosclerosis in 2000.

• Watching TV increases the risk of diabetes in men and women. The Nurses’ Health Study published in the Journal of the American Medical Association in 2003 studied more than 50,000 women and noted that TV watching and other sedentary behaviors led to an increased risk of obesity and Type 2 diabetes mellitus in women.

So now that you are convinced that the boob tube is not all that good for your health, what can you do?

A quick and easy first step is calculating what you watch in a week, and the following week, cutting it down by 50 percent.

(Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program in Sacramento, Calif. Have a question related to alternative medicine? E-mail adrenalinesacbee.com.)

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