Healthy lifestyles 2015

SECTION

FLU SEASON UPDATE What are the symptoms?

How can it be prevented?

FROST BITE What temperature does it become dangerous?

How do you treat it?

REGULAR EXERCISE

DIETING FEATURE

How to exercise when it’s cold.

What programs are available in Mitchell?

What health benefits?

How many calories are in a healthy diet?

A special supplement to The Daily Republic and Advisor

2 Healthy Lifestyles 2015

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Healthy Lifestyles 2015

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Get the facts, not the flu Preparation and prevention for the influenza season The Daily Republic The Department of Health says the number of flu-related hospitalizations in South Dakota has doubled within a week.

It reported 245 hospitalizations on Jan. 9, up from 121 hospitalizations on the Jan. 2 report.

The number of confirmed flu cases jumped from 281 to 480 within a week. Those were the most recent numbers available at the time of this report Jay Gravholt, director of media relations at Avera Health, confirmed 134 positive tests in Mitchell since December. Twenty-one were admitted to the hospital.

Influenza caused 13 deaths in South Dakota (2014-2015 flu season), most recently a 2-year-old girl in Sioux Falls. According to the Associated Press, the total number of deaths increased considerably after the confirmation of only three deaths the week before.

Influenza, commonly known as “the flu,” is a contagious viral infection that affects the respiratory system, nose, throat and lungs. Influenza symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache,

chills and extreme fatigue. Those at high risk can develop complications like pneumonia due to influenza.

Who is at risk for influenza?

Dawn Tomac, director of quality and safety for Avera Health, says influenza can make anyone sick. High-risk patients can develop complications, including pneumonia and bronchitis, which can lead to hospitalization or death. For these high-risk patients, early antiviral treatment is essential, she said.

Those at high risk include children younger than 5 (especially those younger than 2), adults 65 years and older, pregnant women, American Indians and Alaskan natives.

According to the Centers for Disease Control and Prevention website, people with the following medical conditions are also at higher risk: asthma, neurological and neurodevelopmental conditions including disorders of the brain, spinal cord, peripheral nerve and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy or a spinal cord injury.

More high-risk medical conditions include chronic lung disease, heart disease, blood dis-

orders such as sickle cell disease, endocrine disorders such as diabetes, kidney disorders, liver disorders and metabolic disorders.

The CDC website says that a weakened immune system due to disease (HIV or AIDS) or medication also puts people at risk. Those taking medicines for chronic conditions and people younger than 19 who are receiving long-term aspirin therapy should be especially cautious.

Those with a body mass index of 40 or greater are also at higher risk for complications.

How the flu spreads and how to prevent it

“The best way to prevent influenza is vaccination,” Tomac said. “Yearly vaccination for anyone 6 months or older is the first step.”

It is also important to vaccinate those who are in close contact with high-risk people or family, especially those in contact with infants less than six months of age, she said.

Not only can the vaccine potentially make the severity of the sickness less intense, knowing what precautions can be taken can prevent the spread of disease.

Tomac said influenza spreads mainly by droplets made when a person with the illness

coughs, sneezes or speaks. The droplets land in the mouth or nose of those close by.

Generally, the proximity for exposure is less than 3 feet. The illness may also be contracted by touching contaminated surfaces and subsequently touching the eyes, nose and/or mouth.

A person sickened by influenza is contagious beginning day one prior to symptoms up to five to seven days after becoming sick.

“Some with poor immune systems such as very young children and those receiving chemotherapy could infect others for an even longer period of time,” Tomac said.

Tomac suggests the following ways to protect yourself and others during the flu season: cover your cough and sneezes with a tissue and dispose of it properly, stay away from people who are sick and wash your hands with soap and water or with an alcohol-based hand rub.

Avoid touching your eyes, nose and mouth.

Try to keep sick members of the household separate from others. Keep surfaces such as bathroom and kitchen counters disinfected,

See NOT THE FLU, Page 11 Cover by Ashley Schabacker/The Daily Republic & layout design by Jen Phillips/The Daily Republic.

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4 Healthy Lifestyles 2015

Coming soon to a workplace near you: ‘wellness or else’

By SHARON BEGLEY

Reuters NEW YORK — U.S. companies are increasingly penalizing workers who decline to join “wellness” programs, embracing an element of President Barack Obama’s health care law that has raised questions about fairness in the workplace.

Beginning in 2014, the law known as Obamacare raised the financial incentives that employers are allowed to offer workers for participating in workplace wellness programs and achieving results. The incentives, which big business lobbied for, can be either rewards or penalties — up to 30 percent of health insurance premiums, deductibles, and other costs, and even more if the programs target smoking.

Among the two-thirds of large companies using such incentives to encourage participation, almost a quarter are imposing financial penalties on those who opt-out, according to a survey by the National Business Group on Health and benefits consultant Towers Watson.

For some companies, however, just signing up for a wellness program isn’t enough. They’re linking financial incentives to specific goals

such as losing weight, reducing cholesterol, or keeping blood glucose under control. The number of businesses imposing such outcomesbased wellness plans is expected to double this year to 46 percent, the survey found.

“Wellness-or-else is the trend,” said workplace consultant Jon Robison of Salveo Partners.

Incentives typically take the form of cash payments or reductions in employee deductibles.

Penalties include higher premiums and lower company contributions for out-of-pocket health costs.

Financial incentives, many companies say, are critical to encouraging workers to participate in wellness programs, which executives believe will save money in the long run.

“Employers are carrying a major burden of health care in this country and are trying to do the right thing,” said Stephanie Pronk, a vice president at benefits consultant Aon Hewitt.

“They need to improve employees’ health so they can lead productive lives at home and at work, but also to control their health care costs.”

But there is almost no evidence that work-

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place wellness programs significantly reduce those costs. That’s why the financial penalties are so important to companies, critics and researchers say. They boost corporate profits by levying fines that outweigh any savings from wellness programs.

“There seems little question that you can make wellness programs save money with high enough penalties that essentially shift more health care costs to workers,” said health policy expert Larry Levitt of the Kaiser Family Foundation.

Four-Figure Penalties.

At Honeywell International, for instance, employees who decline company-specified medical screenings pay $500 more a year in premiums and lose out on a company contribution of $250 to $1,500 a year (depending on salary and spousal coverage) to defray out-ofpocket costs.

Kevin Covert, deputy general counsel for human resources, acknowledged it was too soon to tell if Honeywell’s wellness and incentive programs reduce medical spending. But it is clear that the company is benefiting financially from the penalties. Slightly more than 10 percent of the company’s U.S. employees, or

roughly 5,000, did not participate, resulting in savings of hundreds of thousands of dollars.

Last year, Honeywell was sued over its wellness program by the Equal Employment Opportunity Commission. The EEOC argued that requiring workers to answer personal questions in the health questionnaire - including if they ever feel depressed and whether they’ve been diagnosed with a long list of illnesses — can violate federal law if they involve disabilities, as these examples do. And, if answering is not voluntary.

“Financial incentives and disincentives may make the programs involuntary” and thus illegal, said Chris Kuczynski, an assistant legal counsel at the EEOC. Using the same argument, the EEOC also sued Wisconsin-based Orion Energy Systems, where an employee who declined to undergo screening by clinic workers the company hired was told she would have to pay the full $5,000 annual insurance premium.

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Some vendors that run workplace wellness for large employers promote their programs by promising to shift costs to “higher utilizers” of

See WELLNESS, Page 12

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Staying active in the cold Winter exercising important for physical, mental health

By ERIC MAYER

The Daily Republic Regular exercise is something every person needs.

In January at the start of a New Year, people make resolutions to start living healthier lifestyles, and exercising regularly plays a key role in a healthy lifestyle.

Thomas Gulledge, a fitness coordinator at the Mitchell Recreation Center, said exercising has numerous benefits.

“The biggest benefit of all is that you will feel better,” Gulledge said. “A lot of people have specific goals and they don’t even think about how they feel. You will wake up and enjoy life more.”

Anytime Fitness owner Emily Hohn agreed with Gulledge, saying exercising during the winter helps people enjoy summer activities.

“A lot of us are guilty of staying inside during the winter months,” Hohn said. “Staying active in the winter helps us prepare for the summer activities that come up sooner than we think about them.”

Planning ahead for summer activities is one way for people to stay active during the winter

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months, and Hohn said it’s never too early to think about staying in shape for those activities.

“Now is the time to be thinking and preparing for summer time activities,” Hohn said. “I have a staff that is familiar with helping people prepare for any activity, whether it’s a 5K run or slowpitch softball season. We can help prepare people for any activities they will participate in during the summer.”

Both Gulledge and Hohn agree that everyone needs some type of exercise, but finding regular ways to exercise — especially in the winter — can be tough.

Both fitness centers, along with many others in Mitchell and area communities, offer winter classes to help people of all fitness levels enjoy exercising.

Anytime Fitness in Mitchell has three personal trainers available for one-on-one training and group training. Anytime Fitness also offers three classes that are open for members and non-members of the fitness club. Classes include a bootcamp class, a shape-up for summer class and a women on weights class.

While the Mitchell Rec Center has fewer specific classes to join, Gulledge pointed out the center has something for everyone.

“We have everything. We have a pool, we have a hot tub, we have a steam room and two basketball gyms. We have a full weight room, treadmills, ellipticals and fitness on request,” Gulledge said. “The thing about the Rec is that we have everything here in one place. It’s our selling point that we can provide you with any type of exercise at the Mitchell Rec Center.”

The Mitchell Rec Center also has a five-week ladies bootcamp class, which is for females who train at any fitness level, from 5:30 to 6:30 p.m. on Mondays, Tuesdays and Thursdays.

“The goal is to get people moving again and pointing them in the right direction for exercises,” Gulledge said. “We make sure that the program uses the whole center and keeps every day fresh.”

Finding various ways to exercise is just as important as finding time to regularly exercise Gulledge said.

“A lot of people get pigeon-holed into one activity or exercise. They either like the treadmill or just the bike, so our programs help people change their exercise routine,” Gulledge said. “If you change up your workout, your body has to adapt.”

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ities, Gulledge said the benefits of exercise will increase.

“Your body will burn more calories and use more energy if you do different exercises and don’t let your body adapt to one certain activity,” Gulledge said. “If your body continually adapts to different exercises you will be better off in the long run.”

As the New Year brings resolutions for many people to exercise more, gym and fitness centers experience the flock of more people.

“With any gym, January is going to be one of the crazier months,” Hohn said. “We do haveresolutions and we want to help people step outside the box when it comes to exercising.”

6 Healthy Lifestyles 2015

Paying for pets Some owners spend whatever’s needed to maintain their pets’ health Forum News Service GRAND FORKS, N.D. — Last summer, when his 10-year-old chocolate Labrador, Molly, needed surgery for a torn ligament, Brandan Hasby of East Grand Forks, Minn., had second thoughts about whether or not to go ahead with it, he said.

The surgery would cost $3,500.

“But it comes down to quality of life,” he said. “She was a very healthy dog besides that.

She had no arthritis and no signs of dysplasia (hip problems). That made my decision easier.”

Hasby has owned Molly since she was 6 weeks old.

“She’s a member of the family,” he said. “I wasn’t ready to let her go yet.”

Originally, Molly was a hunting dog.

“That’s what I got her for,” he said.

Molly joined him in waterfowl hunting until about six years ago, when Hasby gave up the sport, he said. “She’s been my little partner.”

“I don’t know what I will do when the time comes (to put her down).”

It’s not uncommon for pet owners to fork out big bucks to preserve the health -- and lives -- of their animals, which many say are members of the family.

Shattered Leg Erica Sundby also thought twice about spending thousands of dollars on the family dog after an injury four years ago.

Erica and Alan Sundby’s dog, Remi, was almost a year old when he escaped from the fenced yard at the family’s Grand Forks home.

“He went for a joy run,” Erica Sundby said.

“He was hit by a car, we assume, as no one brought him back. He made it back home on his own.”

One of his hind legs was shattered, an injury that required “having plates and screws put in,” she said.

Remi, described by Sundby as “a mutt,” was a giveaway pup, she said. “He’s part border collie, springer spaniel and there’s some retriever in there, too.”

After consulting with a veterinarian, she was surprised to learn that surgery to fix Remi’s leg would cost about $3,500.

She admits to having second thoughts about spending that amount, she said. “My husband didn’t, though.”

“I’m more of a checkbook keeper than he is.”

Her husband, Alan, has a closer bond with Remi, she said. “He’s the master.”

She didn’t seriously balk at the expense, she explained.

“I wanted (Remi) to stick around, too. It was just a little shocking (to learn the cost).”

Since his accident, Remi has made a full recovery, she said. “And today, you’d never know that happened to him.”

“He’s still a very happy dog, but he won’t go to the vet very kindly anymore, after going through doggy surgery.”

Freak Accident Last summer, Boris, a 4-month-old Ragdoll kitten, got stuck upside down in the back wrung of a chair -- a freak accident that resulted in a broken femur bone in his back leg, said his owner, Rose Guzman of Gilby, N.D. She rushed him to a veterinarian in Grand Forks.

“He now has a plate, pins and rod,” she said.

Boris was ordered to have total rest, which meant no jumping for three weeks. Her husband, Doug, slept with Boris in the living for the first week after surgery “so he could take the funnel collar off him,” she said.

The kitten has made a full recovery.

“He now runs and plays,” Guzman said. “He comes when called and fetches like a dog.”

The vet bill ran about $2,200, “but we would do it all over again,” she said. “He is such a cuddler and loves everyone.”

Chiropractic, Acupuncture Last summer, Marsha Van Laere of rural Northwood, N.D., estimated that she and her husband, Todd, plunked down thousands of dollars for veterinary care for their 11-year-old black Labrador, Paige.

They also have another hunting dog, Rex, a 7-year-old chocolate Lab. They got both dogs as pups.

“We don’t have kids,” she said. “They’re our kids.”

When Paige was just over 1 year old, she needed surgery, costing $1,000, for a torn ligament.

“We had no second thoughts; she was just a year old,” Van Laere said. “We’d spent a pretty good penny just to buy her. We’re going to do what we can to take care of her.”

After the surgery, Paige “came back 100 per-

See PETS, Page 11

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Healthy Lifestyles 2015

7

Why is it so hard to get hospitals to hire more nurses?

By LYDIA DEPILLIS

The Washington Post WASHINGTON — On a freezing night in late December, Ann Mead shivered outside the gates of Medstar’s Washington Hospital Center, drawing only emotional warmth from the cluster of fellow nurses singing protest songs and receiving updates on contract negotiations that had stalled the previous month.

They were nearing the end of a grueling strike: A one-day action had lengthened to 10 days when the hospital said it couldn’t find replacement nurses for a shorter period. Ambulances and fire trucks honked in solidarity as they drove by.

Mead, 32, left her career in international relations to become a nurse only a year ago — but she’s already starting to feel burned out. That’s why she decided to take the financial hit of an extended unpaid vacation rather than break the strike: One of National Nurses United’s key bargaining objectives is to increase the number of nurses at the hospital, which would give her fewer patients at a time to deal with in the cardiac surgery unit where she works.

“I am incredibly exhausted after every shift

that I work, so mentally and physically exhausted,” said Mead, a slim blonde, hunching into her parka. “I feel like some days I think of everything I did that day, and I think, ‘I could’ve done this for this person, if I’d just had the time to get to it.’

And I have to convince myself that I did my best to prioritize what the most important things are for each person, because I couldn’t get to everybody.”

Why won’t the hospital hire more people?

It’s not because there aren’t enough nurses around — the much-talked-about “nursing shortage” has dissipated. RNs have put off retirement through the bad economy, and nursing schools have doubled their output of new graduates.

Washington Hospital Center received 6,316 applications last year,

and hired 7.5 percent of them.

“There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply,” said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania’s nursing school.

“All the shortage of care at the bedside has to do with how much hospitals want to pay nurses, and whether they want to use their resources on something else.”

That shortage of care at the bedside tends to be the worst in nursing homes, as well as in under-resourced rural facilities where it’s hard to attract anyone to work. But if Mead’s experience is any indication, staffing levels could be better at large urban institutions like Washington Hospital Center, too. And a growing body of research has tied more nurse attention to better patient outcomes, from lower rates of infection to shorter hospital stays — which ultimately save money and can help hospitals avoid costly lawsuits.

So, what’s the best way to get more nurses on duty? The debate has been simmering for decades and is likely to only get more intense as

See NURSES, Page 12

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8 Healthy Lifestyles 2015

Common sense helps avoid frostbite

By KELLA RODIEK The Daily Republic

Alcoholics and sportsmen make up to be the highest percentage of frostbite victims in South Dakota.

This statement was made by both Dr. Scott VanKeulen, Emergency Department medical director at Avera Queen of Peace Hospital in Mitchell, and Dr. Chris Carlisle, a 28-year emergency room physician at Sanford Health in Sioux Falls.

Frostbite, simplified, is considered tissue damage, caused by the cold, and usually on the extremities, according to VanKeulen. He explained that when tissue gets cold, the blood vessels in that area constrict, which decreases blood flow to the area and can cause freezing.

inside the vessels are made up of water, and that the water will start to crystallize, which can cause damage. He said this stage is still reversible, to a point, but damage to the nerves and blood vessels often causes blisters and a lingering sensitivity to cold conditions in the future.

If circumstances lead to the third and most severe stage of frostbite, there is no recovering, he said.

“A deep frostbite will freeze the entire tissue, including the nerves and muscles, to a point where the blood vessels rupture,” VanKeulen

said. “So then when you warm yourself up, the tissue is dead and it turns black and hard, which will either fall off, or need to be amputated.”

Identifying The Symptoms VanKeulen explained that often, being able to feel your hands or feet burning and aching is far preferable to not being able to feel anything.

“When it comes down to it, if they hurt, that’s a good sign,” he said. “That means the nerves are still functioning and so there’s a

Knowing The Stages VanKeulen said, as with burns, frostbite is categorized into stages of severity. Mild frostbite, called frostnip, is the burning or painful tingling that occurs at the onset of cold irritation. If you warm yourself up at this point, the body will correct the skin’s temperature and there is no real damage done, he said.

The second stage, a superficial frostbite, occurs when the cells inside your blood vessels actually begin to freeze due to decreased blood flow, VanKeulen said. He noted that the cells

chance you’re still in a more minor stage, but feeling nothing, that’s more concerning.”

If it has progressed, the skin takes on a doughy, white appearance caused from blood not being provided to the area. This skin, he said, won’t pink up when you warm yourself.

The tricky part, even for doctors such as VanKeulen, is that initially, the two more severe stages appear similar and it often takes several days to notice lasting changes.

Contributing Factors According to both doctors Carlisle and VanKeulen, the combination of cold and wet will greatly accelerate the process of frostbite compared to the cold alone.

“Our skin actually uses water to dissipate heat, and what’s bad about that is that, well, you don’t want that to happen when you’re cold,” VanKeulen said, noting that it doesn’t have to be below freezing for frostbite to occur.

He said that it largely depends on how wet or dry you are, your age and the amount of blood flow to the area. People with poor circulation, vascular disease or who are on blood pressure pills are at a disadvantage in this regard.

Carlisle added that variables in the weather, such as wind chill and humidity, can also increase risk.

Alcohol has been found to be one of the most

See FROSTBITE, Page 14

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Healthy Lifestyles 2015

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Diets about more than just weight loss Avera dietitian recommends finding balance to maintain healthy lifestyle

By BROOKE CERSOSIMO

The Daily Republic Dieting is a complex process that can become an easy part of daily life.

Many people who diet, primarily begin the process to lose weight. Yet, most find that dieting is much more than that it’s a path to a healthy lifestyle.

“Dietitians will recommend physical activity, along with a healthy diet in order to reap the benefits of following a healthy lifestyle,” Avera Queen of Peace registered dietitian Carri Lucas said in an email interview. “When combined with exercise, healthy eating can aid in better blood pressure control for people with hypertension, better blood sugar control for people with diabetes, better weight control for people who are wanting to lose a few pounds and much more.”

When dieting is done correctly, people can see and feel positive results.

But dieting can turn ugly, too. Lucas said there are some things to look out for when choosing a diet plan to follow “Some diets that hit the media often lead to unwanted stress and frustration when individuals are not able to follow the diet as expected,” she said. “Often times, as dietitians, we will see individuals who have done really well on one of these fad diets. But more often than not, they soon find that the diet does not fit well into their lifestyle and they may even gain more weight than they had originally lost. If a diet plan mentions cutting out or eliminating any whole food groups, it is likely not a healthy diet.”

She added this is the case in most circumstances unless the individual is cutting out specific food items, such as soda, ice cream, chocolate, etc.

Some popular diets are Weight Watchers, Nutrisystem, South Beach Diet and Ideal

Protein.

Lucas said different diets suggest several ways of losing weight, and suggested some basic tips on dieting.

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Along with these health choices, the inevitable food pyramid is still a model to follow.

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See DIET, Page 14

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10 Healthy Lifestyles 2015

The Lowdown | Links Between Hearing Loss and Other Medical Conditions By: The ReSound Blog The Official ReSound Blog

Diabetes

How many times have you seen articles in the news about one medical condition being connected to another? Hearing loss is no different.

Based on recent studies, here is a list of the most significant medical implications of hearing loss.

Sleep Apnea New research presented at the American Thoracic Society’s 2014 International Conference found that people with sleep apnea may have a greater risk of hearing loss. Potential reasons for this link may include adverse effects of sleep apnea on vascular supply to the cochlea via inflammation and vascular remodeling or noise trauma from snoring.

Smoking A recent study published in the Journal of the Association for Research in Otolaryngology, found that smokers were 15.1% more likely to develop hearing loss, while passive smokers were 28% more likely to develop hearing loss than non-smokers. The researchers are unable to determine the exact reasons for why smoking and passive smoking increase the risk of hearing loss, but speculate that it could be due to toxins in tobacco smoke or smoking-related cardiovascular disease causing microvascular changes.

A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. Also, of the 86 million adults in the U.S. who have prediabetes, the rate of hearing loss is 30% higher than in those with normal blood glucose. The reasons for how diabetes is related to hearing loss are unknown. It’s possible that the high blood glucose levels associated with diabetes cause damage to the small blood vessels in the inner ear, similar to the way in which diabetes can damage the eyes and the kidneys.

Dementia & Alzheimer’s Hearing loss may increase the risk of cognitive problems and dementia, according to a 2013 John Hopkins University Study. They also conducted a 2011 study focusing only on dementia, whereby they monitored the cognitive health of 639 people who were mentally sharp when the study began. The researchers tested the volunteers’ mental abilities regularly, following most for about 12 years, and some for as long as 18 years. The results were striking: The worse the initial hearing loss, the more likely the person was to develop dementia. Researchers say that there are plausible reasons for why hearing loss might lead to dementia — the brain’s hearing centers are very close to the regions where Alzheimer’s first starts.

Brain Shrinkage Although the brain becomes smaller with age,

the shrinkage seems to be fast-tracked in older adults with hearing loss, according to the results of a study by researchers from Johns Hopkins and the National Institute on Aging. The report revealed that those with impaired hearing lost more than an additional cubic centimeter of brain tissue each year compared with those with normal hearing. Those with impaired hearing also had significantly more shrinkage in particular regions, including the superior, middle and inferior temporal gyri, brain structures responsible for processing sound and speech. The study also gives some urgency to treating hearing loss rather than ignoring it, saying it should be treated before these brain structural changes take place.

Heart Disease

In a study published in The Laryngoscope, researchers found that audiogram patterns correlate strongly with cerebrovascular and peripheral arterial disease and may represent a screening test for those at risk. The authors of a study published in the American Journal of Audiology concluded that impaired cardiovascular health negatively affects both the peripheral and central auditory system.

Obesity Researchers at Brigham and Women’s Hospital (BWH) recently published study results demonstrating that a higher body mass index (BMI) and larger waist circumference are each associ-

Providing education to our community at a recent Lunch and Learn seminar. ated with higher risk of hearing loss in women.

The researchers found that when compared with women with BMI of less than 25, the risk for hearing loss was 17% higher for women with a BMI of 30 to 34, 22% higher for women with a BMI of 35 to 39, and 25% higher for women with a BMI of 40+.

Depression

Hearing-impaired adults are more likely to be depressed than those with excellent hearing – and than those who are fully deaf -according to a large U.S. survey. Higher rates of depression were most common in middle-aged women. More than 11% of people with some hearing problems scored as having moderate to severe depression, compared to 6% of people with good or excellent hearing.

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Healthy Lifestyles 2015

NOT THE FLU Continued from Page 3 and regularly clean toys by wiping them with a household disinfectant according to product directions. If a child puts a toy in his/her mouth, it should be disinfected and rinsed.

Do not share drinks or eating utensils with someone else, and avoid eating finger foods to keep your hands out of your mouth.

“People can stop spreading influenza by staying home when ill,” Tomac added. “People have a tendency to take fever-reducing medications such as acetaminophen or ibuprofen and return to school or work too early.”

The CDC recommends that those infected should stay home for at least 24 hours after the fever is gone unless medical care or necessities are needed. The fever should be gone without the use of fever-reducing medicine.

Tomac warns that if people are still coughing

PETS Continued from Page 6 cent,” she said. “We do a lot to keep her that way, though.”

They take Paige to a Casselton, N.D., veterinarian three or four times a year for chiropractic and acupuncture procedures.

“She’s a different dog when she comes out,” Van Laere said. “She’s one of the only dogs I know that’s excited to go to the vet.”

and have a runny nose, they may not be ready to be out of the home just yet. “Remember people will continue to be infectious for five to seven days after the onset of the symptoms.”

Policies at work and school should also be followed. At work, clean frequently touched items such as door knobs, keyboards, and phones. Keep an adequate supply of tissues, soap, sanitizer, and disposable wipes.

Additionally, do not visit high-risk people if you have respiratory symptoms. Do not visit long-term care facilities or hospitals, and avoid visiting homes with infants less than 6 months old.

are called trivalent vaccines. Quadrivalent vaccines are also available.

Trivalent flu vaccine protects against H1N1 (commonly called swine flu) and H3N2 (influenza a) viruses. Many other flu shots are available. Most are given with a needle and the intradermal trivalent can be injected into the skin rather than the muscle with a shorter needle. A quadrivalent nasal spray vaccine can be used by healthy people aged two to 49.

Flu vaccines are manufactured by growing the virus inside eggs or cultures.

Who is unable to receive the vaccine?

The following information comes from the Centers for Disease Control and Prevention website.

There are several flu vaccine options for the 2014-2015 flu season. Traditional vaccines are made to protect against three flu viruses. These

Children younger than 6 months are too young to get the influenza vaccination. The CDC website also states that people with severe, life-threatening allergies to the vaccine or any ingredient in the vaccine are prohibited from receiving the vaccine.

People older than 65 should not receive the high-dose vaccine. Those younger than 18 and older than 64 should not receive the

‘Spoiled Rotten’ The Van Laeres’ dogs “are both spoiled rotten,” she said. “They go everywhere with us.”

Last summer, Paige’s vet bills totaled nearly $1,000 for surgeries to remove a mass on her right side and a burst blood vessel in her ear.

“We invest quite a bit into our dogs to improve their lives ... I don’t know how many vet calls we’ve had.”

When Van Laere found a company online that produced magnetic blankets to ease pain in horses, and convinced it to make one for Paige,

“my husband thought I was the craziest person in the world,” she said.

The blanket has proven to be a great boon for both dogs, soothing muscle soreness after a long day of hunting.

“You can tell they’re not as stiff, not as sore,” Van Laere said. “They move more freely.”

The dogs may use the blankets for up to a week after they’ve been hunting, “depending on how much of a workout they’ve had,” she said.

“It helps them, too, in cold weather.”

“Paige loves hers. Rex just looks at me, like,

What options are available for vaccination?

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intradermal vaccine.

Overview of essentials information

• CDC recommends taking three actions to prevent influenza.

• Get vaccinated • Take everyday preventive actions to stop the spread of germs.

• Avoid close contact with those who are ill.

• If you are sick stay home.

• Cover your nose and mouth with tissue when you cough or sneeze.

• Wash your hands.

• Avoid touching your eyes, nose and mouth.

• Clean and disinfect surfaces and objects that may be contaminated with germs like influenza.

• Take influenza antiviral drugs if your doctor prescribes them.

‘Really?’ “ Rex has racked up his share of vet bills, too, including the cost of dental care after breaking off “one of his big canines,” she said.

“There was the Great Potato Incident of 2008,” Van Laere said, recalling the time Rex ate whole, raw potatoes -- a stunt that warranted a visit to the vet.

“I was worried about a blockage,” she said.

The vet recommended waiting for the potatoes to digest naturally.

12 Healthy Lifestyles 2015

WELLNESS Continued from Page 4 health care services, according to a recent analysis by Lorin Volk and Sabrina Corlette ofGeorgetown University Health Policy Institute — and by making workers “earn” contributions to their health care plans that were once automatic.

Consider Jill, who asked that her name not be used for fear of retaliation from the company. A few years ago, her employer, Lockheed Martin, provided hundreds of dollars per year to each worker to help defray insurance deductibles. Since it implemented its new wellness program, workers must now earn that contribution by, among other things, quitting smoking (something non-smokers can’t do)

NURSES Continued from Page 7 health-care reform extends coverage to more people, and creates new standards that hospitals have to meet.

National Nurses United, a powerful and combative union that has grown quickly through mergers and organizing new hospitals over the last decade, has a preferred solution: mandatory minimum nurse staffing ratios. In 2002, it pushed through a law that imposed ratios in California, NNU’s power base.

It’s hard to tell how much the law helped

and racking up steps on a company-supplied pedometer.

“Basically, if you don’t participate in these programs, you have to pay something like $1,000 out of pocket forhealthcare before insurance kicks in,” said Jill.

Companies insist the penalties are not intended to be money-makers, but to encourage workers to improve their health and thereby avoid serious, and expensive, illness.

As evidence of that, said Honeywell’s Covert, the company offers employees “easy ways to get out of” some of the wellness requirements, such as certifying that they do not smoke rather than submitting to a blood test.

Balancing The Wellness Books.

Why are companies so keen on such plans?

Most large employers are self-insured, meaning they pay medical claims out of revenue. As

a result, wellness penalties also accrue to the bottom line.

About 95 percent of large U.S. employers offer workplace wellness programs. The programs cost around $100 to $300 per worker per year, but generally save far less than that in medical costs. A 2013 analysis by the RAND think tank commissioned by Congress found that annual healthcare spending for program participants was $25 to $40 lower than for non-participants over five years.

Yet at most large companies that impose penalties for not participating in workplace wellness, the amount is $500 or more, according to a 2014 survey by the Kaiser foundation.

“For economic reasons, most employers would prefer collecting the penalties,” said Al Lewis, a wellness-outcomes consultant and co-author of the 2014 book “Surviving

Workplace Wellness.”

Lori, for instance, an employee at Pittsburghbased health insurer Highmark, is paying $4,200 a year more for her family benefits because she declined to answer a health questionnaire or submit to company-run screenings for smoking, blood glucose, cholesterol, and blood pressure.

She is concerned about the privacy of the online questionnaire, she said, and resents being told by her employer how to stay healthy.

Highmark vice president Anna Silberman, though, doesn’t see it that way. She said the premium reductions that participants get “are a very powerful incentive for driving behavior,” and that “people deserve to be rewarded for both effort and outcomes.”

patients. There’s pretty solid evidence linking understaffing to bad results, like hospital-acquired infections and increased mortality rates.

The evidence on the benefits of mandated nurse ratios is more mixed, with several reporting no significant changes to patient outcomes — although since the severity of illnesses and injuries in the California system increased at the same time, stasis may actually indicate that increased staffing helped prevent a corresponding increase in bad outcomes.

That’s why even experts who’ve spent years building the case that nurses are crucial to health outcomes — such as Lori Melichar, a labor economist at the Robert Wood Johnson

Foundation — aren’t willing to say that legislated minimums are the way to go. “It’s a complicated question already,” Melichar said.

“And when you layer on ‘Is this policy going to be effective,’ as a researcher and an economist, I can’t make that determination.” It seems clearer, however, that the California law is good for nurses. Over the first few years of implementation, patient loads decreased by an average of one whole person per nurse, which boosted nurse job satisfaction and lowered their rates of occupational injury.

That’s why NNU has pressed on, proposing mandatory nurse staffing ratios nationally through Congress and in more than a dozen

states and the District of Columbia. Faced with intense resistance from the hospital industry, none of the measures have passed. A few states have required hospitals to set up labor-management committees to negotiate over staffing levels, but NNU dismisses that as a fake solution. And at Washington Hospital Center, the idea that NNU will be able to get any language on staffing levels through contract negotiations seems more remote by the day.

“They want no conversation with the union or anybody about the way staffing goes,” said Stephen Frum, the union’s shop steward at

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Washington Hospital Center. “They want complete control.”

--To understand why hospital executives hate the mandatory minimums idea, listen to Washington Hospital Center’s nursing director, Sue Eckert, talk about running the facility on a snow day. On January 6, for example, Eckert got to work at 6:30 a.m. to deal with the chaos she knew she’d find when she arrived.

“Influenza is hitting beyond belief; our emergency room is packed,” she said on an afternoon break in the hospital’s administration suite. “The patients who are ready to leave aren’t leaving, because nobody can come pick them up. But everybody who had a surgical procedure got here on time.” Meanwhile, nurses are late, snarled in traffic, or calling in sick themselves.

Every four hours, Eckert got an email with a little box that described the census of nurses, doctors and technicians in each unit. To keep staffing levels adequate across the building, Eckert shifted people around to the areas of greatest need — leaving some temporarily with a less-than-ideal ratio. If the District had a law like California’s, Eckert said, that would’ve been illegal. “And I felt very comfortable that everything was safe,” Eckert said. “I would probably do it no matter what, but would possibly be

exposed to a violation.”

Eckert said she thinks that most of the time the hospital would meet California’s requirements — but she doesn’t want to have to make sure that the numbers don’t ever sink below its stipulated ratios. “I have such concern that people think a number is magic, and that number’s is going to fix the problem,” she said.

So, again, if nurses are available, and more nurses improve patient outcomes, why not just hire more nurses to avoid situations where you might have fewer people than you need?

“You could do that,” Eckert said. “And then the reality is, you have the cost.” The cost, of course, is increasingly relevant as the Affordable Care Act is requiring hospitals to be more efficient with their dollars — which they have historically done by cutting staff, not adding them.

As for Ann Mead’s distress: Eckert chalked that up to the fact that it’s her first year on the job, and first-years are always stressed out until they gain more experience. To try to mitigate that feeling, Washington Hospital Center has a nursing residence program, which is supposed to help newbies through the hardest stage. Over the past few years, the hospital has actually improved staffing, hiring more nurses and reducing the number of temporary nurses it used to hire from staffing agencies to fill gaps.

Turnover rates have declined, from a high of 20 percent three years ago to an industry-average 12.8 percent in 2014.

But Mead isn’t the only one feeling overburdened. A survey of nurses from last spring revealed that nurses were more concerned about staffing levels than almost any other aspect of their working conditions — especially on the general inpatient floors, where higher nurse staffing levels have more subtle benefits than in the intensive care units. And in the anonymous comments section, more than gripes about managers, the issue of staffing came up again and again.

“Employees frequently verbalize frustration and without much hope of change,” wrote one nurse, in a unit where 66 percent of respondents felt staffing levels were inadequate. “All clinical staff are stretched too thin.”

Another offered the kind of scenario that results from having not enough hands on deck: A nurse is in the middle of passing medications, when a patient at risk of falling calls to go to the bathroom. Since there aren’t enough nurses or technicians around to help, the unstable patient gets up to go by himself, exactly the kind of precarious situation that everyone is trying to avoid.

--So, if mandatory minimums aren’t going any further, what’s the way forward? The American Nursing Association supports flexible approaches, such as requiring hospitals to come up with adequate staffing plans for each unit, which allows them more freedom to adjust to sicker patients. Another partial remedy is transparency: Currently, hospitals

13

aren’t required to disclose staffing ratios at all, which makes it difficult to track whether they’re improving or to compare one hospital with another. If nurse-to-patient ratios became one of the public metrics that go into rankings and evaluations, perhaps hospitals would staff up to compete for patients.

NNU thinks that’s a fake solution, too. “The problem is that it assumes that the way people decide what hospital people will seek care in is based on some consumerist model, like buying a car,” said Ken Zinn, NNU’s national political director. “Sure, for some elective surgeries that’s the case. But mostly, it’s where does your doctor have privileges, or where does the ambulance take me.”

That may be true. But at the moment, NNU doesn’t appear to have a better option. And until things get better, Ann Mead isn’t sure how long she can stick around.

“I expected to be on my feet on my time; I expected it to be stressful because you’re caring for lives — obviously that’s a stressful thing in itself,” she said. “I did not expect it to be this intense, so often. What I did not expect was to not be listened to by my own hospital management, who are nurses themselves, to not regard what we’re saying we need.”

“I can do it for a while longer,” Mead finishes, as the crowd starts to disperse. “But it’s one of the main reasons I don’t think I can do it for that long.”

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FROSTBITE Continued from Page 8

significant factors contributing to frostbite.

Alcohol causes dehydration, which makes you unable to pump as much blood to your extremities, according to VanKeulen.

“It also makes people more sedentary, plus, under the influence, they don’t feel as much pain so they end up with more damage before they realize the discomfort,” he said.

He explained that it also causes blood dilation in the skin, causing people to feel warmer than they should.

Aside from alcohol, risk of injury is also increased due to a connection between frostbite and hypothermia, according to VanKeulen.

“With hypothermia, the whole core body temperature drops, so the body then puts all the blood flow from our extremities up into our

DIET Continued from Page 9 maintaining a healthy lifestyle,” she said.

The amount of calories a person should take in throughout a day is different for each individual.

Lucas added the caloric intake for a person is based on activity level, height, weight, goal weight, age and gender.

brain and heart to try to decrease the amount of exposure of the blood to the cold,” he said, “which leads to worse frostbite.”

PREVENTION STRATEGIES Carlisle said that at Sanford, they don’t see a particularly high number of cases of frostbite.

“Folks around here are pretty smart, but there are always hunters and sportsmen who are having way too much fun to come in and get out of the cold,” he said. “And I know because I am one, but you need to know your limits.”

He advises simply using common sense. He said that sometimes people have a mindset in which they think that if they are outside working and get cold, it can help to work harder or faster to increase blood flow, but that isn’t the case.

“Really the only thing to do is go inside and

warm the tissue.”

However, if you are going to warm up, VanKeulen said it is crucial to warm yourself fully and not expose yourself to the cold again before a complete recovery of warmth is made.

“If you’re out on a hunting trip, etc., the last thing you want to do is warm your feet up and then go out and freeze them again, because you’ll do much more damage the second time,” he said.

“There will actually be far less damage with a more extreme freeze the first time compared to refreezing.”

He said the body will send less blood to the area the second time, so the freeze will be quicker and more profound.

“Essentially, your body says ‘Screw this, we’re not doing that again. That did too much damage the first time.’ ” He evidenced this with examples of wartime

“

If a diet plan mentions cutting out or eliminating any whole food groups, it is likely not a healthy diet.

Avera dietitian, Carri Lucas

“Even when I recommend a diet based on these factors, it is still only a calculation,” Lucas said. “Typically during nutrition education, I will take a diet recall to determine what my client consumes on a daily basis. Then I assess

”

these records for anything that can be adjusted, substituted or eliminated from the diet to cut back on some additional unwanted calories.

I have found this to be the easiest, and most effective lifestyle modification.”

“trench foot,” saying that the higher-ranking soldiers who were allowed to sit closer to the fire at night to warm their feet often had worse cases of frostbite, and many lost their toes or feet because of the repeated warming and refreezing.

To warm yourself, the doctors recommend using water around 102 to 105 degrees — comfortable shower temperature — and warming yourself slowly.

VanKeulen cautioned not to get the water too warm.

“Don’t get it too hot, because your hands may not be able to feel it, and the last thing you want to do is burn them after you just froze them,” he said.

Warming yourself can be done at home, but once physical changes or damage is noticeable, a trip to the physician is advised, both experts said.

Ways to monitor caloric intake can be as easy as keeping track on a cell phone. Apps such as MyPlate Calorie Tracker or MyFitnessPal can be used to calculate how many calories a person takes in during a day.

Lucas said these apps help a person determine ways to cut back calories.

“Following this plan for two to three weeks and weigh yourself a couple of times each week to determine if you have lost any weight,” she said, adding losing one to two pounds per week is considered healthy weight loss.

Healthy Lifestyles 2015

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16 Healthy Lifestyles 2015