Medical Guide 2022

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2022 Annual Guide of Medical & Health Care Professionals

MEDICAL GUIDE 4

LOCAL CNA TRAINING PROGRAM WORKING TO FILL A NEED IN THE HEALTHCARE INDUSTRY

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HEART DISEASE AND DIABETES

12 BLOOD DONATION: GOOD FOR OTHERS, GOOD FOR YOU 16 CHOOSING PALLIATIVE CARE OPTIONS


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MEDICAL GUIDE 2022

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MEDICAL GUIDE 2022 TAILORED

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MEDICAL GUIDE 2022

Mat-Su CNA Training Program student Kobe Brown works during clinical studies. COURTESY OF MATSU CNA TRAINING PROGRAM

Local CNA training program working to fill a need in the healthcare industry BY JEREMIAH BARTZ

FRONTIERSMAN.COM

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growing need in the local healthcare industry led to the creation of a program that is now working to help fill the void.

The Mat-Su Certified Nurse Aide Training Program was approved by the Alaska Board of Nursing in late 2020, and is now producing nurse aides who are qualified to work for healthcare providers throughout the Valley. “The program started because of the need for healthcare workers here in the Mat-Su area,” program administrator Jesse Christensen said. “We’re trying to grow the workforce so the hospitals, nursing homes and the other providers aren’t running so short staffed and using traveling staff from out of state.” Christensen said there is a great need for CNA’s who can provide direct patient care, and assist nurses and staff at facilities across the region. “There’s a high demand,” Christensen said. There’s also the impact of the COVID-19

pandemic, during which similar programs were shut down. That extended the need. There are other avenues for CNA training, but they are connected to more traditional education programs. There are courses at Mat-Su Career and Technical High School and Mat-Su College, but those are geared toward secondary and postsecondary students. Alaska Job Corps has also had CNA programs in the past. But the Mat-Su CNA Training Program is different. “This one is for anybody,” Christensen said. Mat-Su CNA instructor and program coordinator Angie Thursby said the program has already drawn a wide range of students, ages 18 to 60. Thursby said, in just a matter of months, she has seen a variety of students that includes recent high school graduates to single moms to people with advanced degrees ready for a career change. continued on page 11

“The program started because of the need for healthcare workers here in the MatSu area,” program administrator Jesse Christensen said. “We’re trying to grow the workforce so the hospitals, nursing homes and the other providers aren’t running so short staffed and using traveling staff from out of state.”


MEDICAL GUIDE 2022

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MEDICAL GUIDE 2022

Heart disease and diabetes BY DR. SAMUEL ABBATE

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ardiovascular disease is the leading cause of death among persons with diabetes. Men with diabetes are 2 to 4 times more likely to die from a heart attack then men without diabetes. Women with diabetes are 5 to 8 times more likely to die from a heart attack than women without diabetes. Overall, cardiovascular disease is responsible for about 70% of all deaths in persons with diabetes. Strokes are responsible for 16% of all deaths in persons with diabetes. High blood glucose values worsen the adverse effects of high cholesterol levels. Persons with diabetes have 2 to 3 times that rate of cardiovascular disease than persons without diabetes that have the same cholesterol levels. The high glucose levels cause the cholesterol to be more likely to buildup in the walls of the blood vessels leading to heart attacks and strokes. Because of this, cholesterol levels are treated to lower levels in persons with

diabetes. If you are 40 or older and have diabetes, your cholesterol levels should be checked annually. High blood pressure is also common in persons with diabetes and should be closely monitored and carefully controlled. Of course, persons with diabetes should not smoke as this double the risk of cardiovascular events. The American Diabetes Association recommends that all adults with diabetes should have their 10-year risk of having a heart attack calculated. The American College of Cardiology has an online calculator you can use or ask your health care provider to use: https://tools.acc.org/ ASCVD-Risk-Estimator-Plus/#!/calculate/ estimate/ . Your provider will use the risk score to direct the goals of your therapy. In December 2008, the Food and Drug Administration (FDA) began requiring drug developers to submit data on long-

term cardiovascular outcomes trials on all new diabetes medicines. All new diabetes medicines must show that they do not cause an increase in cardiovascular disease. Members of two classes of drugs for the treatment of type 2 diabetes have actually shown to decrease cardiovascular deaths. Glucagon-like peptide 1 (GLP-1) receptor agonists agents are injectable drugs that effectively lower blood glucose values and promote limited weight loss. Liraglutide (brand name Victoza – daily dosing) and semaglutide (brand name Ozempic – once weekly dosing) have both been demonstrated to have beneficial effects on reducing cardiovascular events. The liraglutide study results were so good that the FDA approved with use of liraglutide to reduce the risk of heart attacks, strokes and cardiovascular deaths in persons with type 2 diabetes and existing cardiovascular disease. continued on page 7


MEDICAL GUIDE 2022

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Is “natural” thyroid hormone better? BY DR. SAMUEL ABBATE

hormones, they ARE thyroid hormones.

ypothyroidism is a common disorder effecting over 10 million Americans. It occurs when the thyroid gland loses its ability to produce an adequate amount of hormone to meet the body’s needs. Hypothyroidism is treated by replacing the thyroid hormone in pill form.

Is “natural” thyroid hormone better than “synthetic” thyroid hormone? No. There are three problems with DTH. First, because every thyroid gland contains different amounts of thyroid hormone, it is difficult to manufacture a consistent product. DTH producers have been shut down by the FDA on several occasions because the variance between batches of medication was considered to be too great. A person using DTH can get pills labeled as continuing the same dose of thyroid but actually receive highly varying amounts. Synthetic hormones do not have this problem.

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Desiccated thyroid hormone (DTH) has been commercially available since 1934. It is made by extracting thyroid hormone from the thyroid glands of pigs and cows. Because it comes from animals, it is referred to as being “natural.” Synthetic thyroid hormone (levothyroxine – T4 and Liothyronine – T3), is produced by pharmaceutical companies. These have been available since the early 1960s. While they are made using chemical reactions, they are atom-for-atom the same as the hormone your body makes and the hormone taken from animal sources. Synthetic is not “artificial.” Levothyroxine and Liothyronine are not chemical compounds that mimics thyroid

Second the ratio of T4 and T3 (the active forms of thyroid hormone in the blood) differs between humans and the animal sources of the DTH. In humans there is 1 molecule of T3 for every 14 molecules of T4. In pigs and cows there is 1 molecule of T3 for every 4 molecules of T4. So in humans T3 is 7% of the thyroid hormone produced whereas in DTH it is 20%. The higher percentage of T3 may lead to symptoms of excess thyroid hormone in patients. Levothyroxine is the T4 form of

continued from page 6 Sodium–glucose cotransporter 2 (SGLT2) inhibitors are oral medicines that lower blood glucose values by actively removing glucose from the body through the urine. Empagliflozin (brand name Jardiance) and Canagliflozin (brand name Invokana) both reduced cardiovascular events and hospitalizations for heart failure. Empagliflozin also has been shown to decrease cardiovascular mortality and all-cause mortality. SGLT2 medicines have also been shown to have beneficial effects on the kidneys in persons with diabetes. Ask your healthcare provider if one of these medicines might be appropriate to include in your treatment regimen. Guard your heart for life.

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thyroid hormone. Your body converts the T4 into T3 as it needs it. Therefore you are not at risk of excess T3 effects on the body. Finally, the ratio between the T4 and T3 in DTH is constant. Therefore increasing the dose of DTH raises both T4 and T3. Likewise, decreasing the dose will decrease both T4 and T3. Synthetic T4 (levothyroxine) and T3 (liothyronine) may be dosed separately allowing your provider to customize the amount you receive. Because it contains both T4 and T3, patients often feel better on DTH than typical synthetic hormone replacement. This is because many providers who use synthetic hormone only give the T4 form of the hormone. If you do not feel well on the levothyroxine alone, ask your provider about using both T4 and T3 or see an endocrinologist trained in the use of both forms of the hormone. Use of synthetic thyroid hormone can provide consistent relief from the symptoms of hypothyroidism. It provides your body with the exact hormones that it has lost the ability to make.


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MEDICAL GUIDE 2022

Valley business offering physical and occupational therapy for children BY JACOB MANN FRONTIERSMNA.COM

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Backcountry staff work with clients with varying diagnoses and implement a variety of treatment environments so that every child has the best possible chance at achieving their goals and independence.

ackcountry Therapeutics, LLC has been offering physical therapy and occupational therapy to Valley children since 2012. Their primary mission is to immerse their clients in fun and practical “It really uses functional and everyday activities that tailor to their unique needs and activities to help these kids… That was help them improve their overall health. my drive, to help these kids get every opportunity to succeed and have what every “I just wanted to create a business that other kid in their situation has across the wasn’t like other clinics,” Backcountry country,” Rapson said. Therapeutics owner Andrea Rapson said. Backcountry offers Occupational and Rapson started out by herself by visiting Physical therapy in the community to make kids in their homes and utilizing a small each child’s sessions more realistic and rented clinic/pool. Backcountry has since functional to the real-life experiences they grown to feature 13 therapists and their will encounter, whether it’s a trip to the own 9,600 square foot facility. park, a restaurant, or the local library. “Honestly, it’s pretty awesome. We always give it back to our families…We’ve been blessed to have really good therapists who’ve continued to work with these families and build relationships, and really made a difference… We’ve just grown into this really big family,” Rapson said.

It really uses functional and everyday activities to help these kids… That was my drive, to help these kids get every opportunity to succeed and have what every other kid in their situation has across the country, Backcountry offers pediatric occupational therapy and physical aquatic therapy in a 24-foot saline pool that’s four feet deep and offers a safe and fun environment for kids to grow and develop skills.

Backcountry Therapeutics uses horses as a part of their therapy. COURTESY PHOTOS

The pool is a part of Backcountry Therapeutics’ programs.

Backcountry offers in-home services for clients and/or families who are immunecompromised, are not able to secure safe and reasonable transportation to our facility, and children whose goals and/or needs are based in the home. Rapson said this service has been particularly helpful during the pandemic.

“It was definitely scary. I think a lot of it was just that unknown and that fear at first… I think it was definitely hard on everybody. We had a bunch of really great therapists and we really just committed to each other… It definitely made the bond Backcountry also offers equine-Assisted between all the therapists stronger. We Occupational and Physical therapy yearhad to completely change what we knew round with a heated barn in the winter so of therapy and learn a whole new way clients can work on functional life skills while of working with families and kids… The interacting with horses on a daily basis. families and therapists, there some of the Clients can work on motor development, toughest people I know, and we all kind of strength, coordination, confidence, sensory made it through together,” exploration, emotional and self-regulation coping skills, overall processing, and other For more information about Backcountry skills through this program. Therapeutics, visit alaskabct.com/services.


MEDICAL GUIDE 2022

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Heartreach Executive Director Joyce Moropoulos talks about the various programs. COURTESY PHOTOS

Heartreach marketing coordinator Julie Miller and her daughter Ashley work together each week to help local families.

Heartreach Center continues to support local families BY JACOB MANN

FRONTIERSMAN.COM

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eartreach Center Executive Director Joyce Moropoulos participated in a question and answer interview to discuss the latest developments their team of staff and volunteers are working on to support local families. Q: What is Heartreach all about? “We do a lot here. We help with unplanned pregnancies and we’re a family resource center. That in a nutshell covers a whole lot. You don’t have an unplanned pregnancy in a vacuum. There’s a whole lot of things that come into your life, and we deal with all those different life journeys and stories. We really want to offer hope for everybody that walks through our door.” Q: What sort of services and programs do you offer? “We have over 700 classes that we offer to parents. We livestream the classes. We have a library full of great, positive things. We have abortion recovery services. It really helps you deal with that trauma and kind of set things right in your life. We have a huge family program called Embracing

Parenthood. We livestream the classes… We also have a large group class called Love and Logic. We have a program called Step up Now to Healthy Relationships. It’s a threeday workshop we take to public schools.” Q: What are the latest developments you’d like to share? “We added STI and STD treatment just recently. It took a lot of time to get our ducks in a row for that. Alaska is number one in the nation per capita for the highest rate of gonorrhea and chlamydia. That’s not a great statistic for Alaska. We want to do something about it and put hope there. That’s free and of course, all of our services are free of charge to our clients, paid for by our donors, our Friends of Heartreach… We’re getting ready to get our medical mobile unit. It’s coming this spring. Because of COVID, we’ve been at a backup for automobiles. We were supposed to have it in the fall. That will be really wonderful for us to use for the communities that are north of us and south of us, the smaller areas that don’t get pregnancy services like that, like Sutton, Willow, and Talkeetna, and maybe even beyond. We’re talking about making a loop around those communities and offering

pregnancy tests. There will be ultrasounds, STD and STI testing, and treatments. We’re also on the cusp of getting into the abortion pill reversal network, and that’s through Heartbeat International. Once a woman starts a chemical abortion, there are two pills involved. If she takes the first pill and changes her mind, we can really help her out.” Q: What else does Heartreach offer? “We have a market that’s amazing. We are part of the national earn while you learn program. Parents can earn ‘parenting bucks’ by doing positive things for their children like reading to them, taking them to different activities, keeping them in school, and doing healthy things for themselves… They earn bucks and go spend them in our parent market. We go from infant to 5T. We have tons of diapers and our clients receive diapers every time they come… During COVID we have really done that. It’s been amazing. We did curbside delivery for a lot of people that weren’t our clients.” For more information about Heart Reach, visit heartreachalaska.com. Contact Mat-Su Valley Frontiersman reporter Jacob Mann at jacob.mann@frontiersman.com


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MEDICAL GUIDE 2022

Health care at the Pioneer Home It’s really just a matter of connecting almer Pioneer Home administrator elders to their Joshua Shaver participated in a families. We’re question and answer interview to still doing the discuss their efforts taking care of seniors Facetime visits throughout the pandemic. for elders that can’t get out and Q: What’s your general philosophy for are in quarantine. looking after senior residents? Really, we’re just “Our mission statement for the entire looking for every opportunity we can. Our Alaskan Pioneer Homes and for us is elders truly see our elders as family. They to provide elder Alaskans a home and bring their pets into the building to come to community, to celebrate life through its visit with them and do whatever they can to final breath. We’ve definitely been seeing bring joy to their lives.” that final breath portion of it. Eight of our residents have died of COVID... We’ve been Q: Would you say the recent outbreak in the midst of a major outbreak since the has shown how prevalent and serious end of August. We’re doing the best we can COVID is, especially for seniors? to take care of people and try to maintain “Extremely so. When you look at the numbers, staffing levels. The Delta variant has really the people that are most likely to get it and hit home hard… We just have to continue have serious consequences, including death, to keep taking care of residents. That’s our are elderly people. This Delta variant has primary mission here.” shown to be extremely infectious.” BY JACOB MANN

FRONTIERSMAN.COM

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Q: What have you been doing to keep Q: What are some of the reasons the morale up? COVID and its varieties are so “We’re making sure that all of our regular dangerous to seniors? activities are happening as much as possible… We’re just doing what we can to make sure that people still have those opportunities for interactions. We’re still having limited visitors and church services.

“When you’re hitting that stage of life, all of our body systems are not at peak efficiency. A lot of seniors are on medications that can make their immune systems not as effective.

The reason why it becomes more dangerous is because COVID symptoms are primarily respiratory… Your lungs are going to be working harder so it’s going to hit you harder.”

Q: What are some of the ways we as a community can keep our seniors safe? “I think the most important thing they can do is get vaccinated. It used to be that people would still function in their lives if they were feeling a little under the weather. With COVID and the Delta variant, now is not the time to tough it out when you’re having symptoms. If you’re not feeling well, you should just stay home.”

Q: What are some things seniors can do to stay healthy? “Just knowing how infectious it can be, even seniors that are vaccinated. I would recommend that seniors wear masks when they’re out in the community because you never know what’s jumping around. I also think it’s important to participate in whatever exercise you can. Just really focus on doing those things that are going to keep your lungs and your heart strong. Also, do things that help your mental health too. Participate in those activities that bring joy in your life.” For more information about the Alaska Veterans and Pioneer Home in Palmer or other locations around the state, visit alaska.gov.


MEDICAL GUIDE 2022

Vaccines for seniors BY DR. SAMUEL ABBATE

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ur immune system become weaker as we age. It is less capable of mounting a response when exposed to new infectious agents such as bacteria and viruses. It is also less capable to developing an immune response when vaccines are given. Therefore, aging causes us to be at increased risk for developing infectious diseases. Weaker immune systems also result in higher rates of hospitalization and death from infectious diseases in the elderly. The flu, pneumonia and shingles are known to be particularly problematic in older individuals.

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Clay McCormick and Callie Tomlinson work through the Mat-Su CNA Training Program. CLAY MCCORMICK  CALLIE TOMLINSON

Acute respiratory illnesses, including the flu and pneumonia cause over 56,000 deaths each year in persons 65 years and older. This makes these illnesses the eighth leading cause of death in senior citizens. They are also a frequent cause for hospitalizations. The flu, pneumonia and shingles are the three most expensive vaccinepreventable diseases in the United States. INFLUENZA: In persons over age 65 years, the flu is responsible for over 36,000 deaths and 200,000 hospitalizations each year. More than 90% of deaths due to the flu occur in this age group. Therefore the flu vaccine is recommended for all adults age 50 years and older. It is important to get the vaccine before the end of October so that it has enough time to be effective before the start of the flu season. Because aging immune systems need stronger stimulation than those of young people in order to mount and adequate response, special vaccines have been developed for the elderly. Flublok has 3 times the amount of antigen (the material that stimulates the immune system) then standard vaccines. Fluzone contains 4 time the amount of antigen. Make sure and request a high potency vaccine when you get your flu shot. PNEUMONIA: The pneumococcal bacteria causes pneumonia and other serious infections such as meningitis – an infection of the central nervous system. Death from this bacteria increases in persons over the age of 50 with most deaths occurring in persons over the age of 65 years. 1 in 20 older persons that gets pneumonia will die from it. Pneumococcal vaccine is up to 85% effective in preventing infection with this bacteria. Two vaccines are recommended. Pneumovax and Prevnar. Pneumovax gives protection against 23 different strains of pneumococcal bacteria and Prevnar protects against 13 strains. Pneumovax is recommended for all adults beginning at age 19 years. A second dose should be given at or after age 65 years. The second dose should be given at least 5 years after the first dose. For example, if you received your first dose of Pneumovax at age 62 years, then the second dose should not be given until you are 67 years old. Prevnar should be given 1 year after the pneumovax is administered. In immunocompromised individuals the doses may be given at a shorter interval so ask your provider about the timing that is best for you. Ask you provider about other vaccinations that are recommended for older adults. For a complete list of recommended vaccines please go to https://www.vaccines.gov/who_and_when/adults/seniors.

continued from page 4 Thursby also said the opportunity for success has been almost immediate upon completion. “Everyone so far who has come into the program has a job before they finish the program or at least a week or two after,” Thursby said. Thursby also said the potential salary ranges from about $17 per hour to $23 per hour depending on where they work. There are also bonuses for working nights and weekends. Potential employment includes hospitals, long term care facilities, assisted living and home health care. There is also financial aid available for prospective students. “Right now I don’t think I’ve had a single student pay out of pocket for their tuition or fees,” Thursby said. Mat-Su CNA is currently housed on the Maple Springs campus in Palmer. Thursby said Maple Springs offers to cover the cost of the program for a CNA student in exchange for the commitment of one year of employment. The Mat-Su Health Foundation also has a vocational scholarship available for those who have lived in the Valley for at least a year. Mat-Su CNA typically offers a six-week course that includes 80 hours of clinical instruction and 60 hours of classroom instruction. The Alaska Board of Nursing recently reduced the required number of hours from 140 to 75, which includes 16 hours of classroom instruction, which can be done online or in person. The remaining 59 hours are training at a long term care facility. That will go through at least Jan. 4, 2022. Those interested can email Thursby at matsucna@gmail.com or see mat-sucna.com Contact Frontiersman managing editor Jeremiah Bartz at editor@frontiersman.com


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MEDICAL GUIDE 2022

Blood donation: Good for others, good for you 7,000 units of platelets and 10,000 units of plasma are also needed each day in the U.S. Platelets may be used for up to 5 days very 3 seconds someone needs blood. One out of 10 people in the hospital will and plasma may be frozen for use for up to one year. Nothing is wasted. In response need blood during their stay. One pint to the need for blood and blood products, (also called a unit) of blood can save up to an estimated 6.8 million Americans donate three people’s lives. 4.5 million Americans lives’ are saved each year are saved because blood each year. These donors give 13.6 million units of life-giving blood. If you are of blood transfusions. not already a blood donor, please consider Blood donors help people of all ages. People joining these donors. that need transfusions of blood include accident and burn victims, heart surgery Good For Your Health: and organ transplant patients, and those First, when you give blood you will learn battling cancer. The average transfusion requires 3 to 4 units of blood so the need for your blood type. Many patients are curious about their blood type but your insurance blood is great. will not pay for your doctor to order a test to Donated blood is separated into three determine your blood type. So giving blood components: Red blood cells – these carry will educate you about your blood type. oxygen to the tissues in the body; PlateletsSecond, you may learn more about your these help clot the blood and stop bleeding; health status. Fourteen tests are run on Plasma – the fluid component of the blood. each unit of blood that is donated. Eleven Almost 36,000 units of red blood cells are of these tests are for infectious diseases. needed each day. Red blood cells can be for up to 42 days after they are donated. Nearly You will be informed if any of these tests is BY DR, .SAMUEL ABBATE

GOOD FOR OTHERS:

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abnormal so you can follow up with your provider to address them. Third, blood donors have a lower risk of heart attacks and strokes. One study in the Journal of the American Medical Association showed that amongst persons who donated blood twice each year had a lower rate of heart attacks and strokes. Another study from Finland showed an 88 percent decrease in the rate of heart attacks among people who donated blood once each year compared with those who did not give blood. Finally, blood donors have a lower risk of cancer. Regular blood donations are associated with lower risks of cancers including liver, lung, colon, and throat cancers. The lower rates of cancer are related to lower iron levels in the blood. Iron can act as an oxidizing agent in the blood causing tissue damage. Lower iron stores in the bodies of persons who gave blood twice each year resulted in a lower risk of cancer and mortality. Please consider giving blood today – someone’s life is depending on it.


MEDICAL GUIDE 2022

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Medical offices are still safe during the era of COVID BY JACOB MANN

FRONTIERSMAN.COM

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rising number of people are avoiding going to the hospital or doctor’s office in fear of contracting COVID-19. There have been numerous cases of individuals with serious conditions or medical emergencies who died for this reason. Capstone Clinic Medical Director Dr. Wade Erickson said the Valley has been no exception to this trend.

to avoid medical treatment facilities since they have proven mitigation protocols for preventing the spread of COVID-19 and adequate space for urgent care. He said that it’s safe to enter these facilities, and it’s important for people to keep up with their medical appointments and seek care when they need it. “At this point, I have no concerns about people who need care going to the hospital,” Erickson said. “If someone is in need of hospitalization or emergency care, they should feel welcome to receive it and expect to get good care in that environment at this time.”

“We see it every day. People are postponing their procedures, screenings, exams, physicals, things like that, both because they have concerns about going out and they have Caution is always recommended with all concerns about overwhelming the system matters around the pandemic. Erickson said presently,” Erickson said. that vaccination is the number one method of According to Erickson, there is no need protection.

“I feel the vaccine is safe and reduces hospitalization and death,” Erickson said. “My experience so far with folks who are dealing with COVID itself is too many of them are arriving at care late. At that point, they’re pretty sick. That’s a reactive strategy. A proactive strategy would be making sure their immune system is ideally managed and making sure that they’re vaccinated if they’re high risk,” Erickson said. In addition to vaccination, Erickson said that wearing masks in high-density areas, good health practices, and supplements can also reduce the risk of contraction or lessen the severity of COVID-19. For more information about COVID-19 in Alaska, visit covid19.alaska.gov.

FRONTIERSMAN FILE PHOTO

Dr. Wade Erickson speaks during a Mat-Su Borough Assembly.


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MEDICAL GUIDE 2022

What is health? A deeper look BY TERI PETRAM

the community and individual level.”

any components impact a person’s overall well-being. Where we live, learn, work, and play all play a part in the big picture. The environment we live in, access to education and healthy food, financial stability, and good relationships or connections in our homes and community all impact our health.

The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. In Ayurveda and Traditional Chinese Medicine, the definition of health goes one step further to include spiritual wellness.

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These factors combined to affect the wellbeing of any given individual. When we strive to live our healthiest lives, it helps to understand these factors and how they currently impact our minds, bodies, and health | helTH | noun the state of being free emotions… our overall well-being. from illness or injury: he was restored to health | [as modifier]: a health risk. When you look up the word health in a dictionary or google the definition, the standard answer will be similar to this:

This is the typical western definition of health to which we’ve all grown accustomed. If you don’t have a disease, illness, or injury, you are healthy. But… that definition is evolving to include a more comprehensive picture. Health is not limited to the results of blood tests or images scanned through x-rays and MRIs, but instead, it is determined by complex interactions between several factors collectively known as the social determinants of health (SDOH). SDOH affect a broad range of health risks and outcomes and include many parts of our lives such as our schools, workplaces, homes, and communities, access to social and economic opportunities, available resources offered to us, the safety in our homes and workplaces, healthy food and water, clean air, local emergency health services, access to jobs, access to education and the nature of our social interactions and relationships with others. When a person is deprived of their essential needs such as food, shelter, income, or home and neighborhood safety, their stress level increases. They may appear to be healthy for the moment, but over time prolonged stress takes a toll on overall health with hormonal imbalances, sleep deprivation, memory problems, and more. Family Nurse Practitioner Curtis Harvie says, “as a health care provider living in the community I serve, it is vital for me to address social determinants of health at

When a person comes to SCHC for healthcare, I not only look at their medical history, labs, and vital signs. I also want to know about their housing, food, financial security and support system, and education. I use this information to tailor a plan of care that involves our entire team at SCHC to optimize your health and the health of our community.

Communities with higher average incomes experience fewer illnesses and a longer life expectancy. Income affects other determinants of health, luch as food security and housing quality. Malnutrition isn’t just about being hungry – the lack of consistent, proper nutrition can lead to a host of physical problems and opens the door to disease. If there isn’t enough money to buy or rent a home in a safe neighborhood, people may be forced to choose a less secure area. An astounding amount of evidence shows that where you live actually affects your health, leading to the next discussion point – the physical environment.

Physical Environment The physical environment includes air and water, as well as homes, workplaces, schools, and surrounding communities. Whether these factors are high-quality or not certainly impacts your health. Having easy access to primary necessities such as affordable food, green spaces like parks, and health care options also lead to a more favorable outcome. Residents of neighborhoods with low crime rates are naturally encouraged to get out of the house and be more physically active, which is undoubtedly better for you than hanging out all day on the couch. On the other hand, neighborhoods with high crime rates are far more likely to affect you adversely, both directly and indirectly.

Those with greater access to transportation options not only save time but improve their mental health by reducing stress through comfort and convenience. Walkability also plays a considerable part in one’s health. If a neighborhood actively enables the ~ Curtis Harvie, Family Nurse Practitioner community to walk more, the need for motorized transportation lowers, Sunshine Community Health Center potentially reducing both local pollution and waistlines.

Income and Social Status

The amount and dependability of income often go hand in hand with social standing and can significantly affect our health. According to the U.S. Department of Health and Social Services, a person’s health improves as income increases.

The physical environment can either promote or damage a person’s health, so it is essential to consider this factor when assessing our health status and potential. continued on page15


MEDICAL GUIDE 2022

continued from page 14

Social Environment Added to the already lengthy list of individual factors affecting your health is the Social Environment. This includes interpersonal support networks as well as broader social systems and community groups. Quality support from family members, friends, and communities are associated with higher overall health for many reasons. Creating more cohesive communities can lead to greater feelings of empowerment, which leads to a higher level of personal responsibility for healthy behaviors. Social support enables us to deal with problems and difficult

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situations in our lives by providing emotional guidance, additional information and perspective, and other forms of assistance. As a rule, high-quality social networks encourage people to make life-changing choices for the better and maintain a healthy mental state. This is incredibly impactful for the underprivileged already struggling to overcome challenges that come with poverty.

Patient Advocacy Many health care facilities now offer advocacy services to help their patients navigate the healthcare system. They provide assistance completing paperwork and help identify and connect people with services that improve overall

well-being where that person lives, learns, works, and plays. For example, Patient Advocates at Sunshine Community Health Center help people with heating assistance grants, Medicaid, Medicare or Healthcare Marketplace enrollment, food stamps, senior benefits enrollment, farmers market coupons, and more.

Ask your healthcare provider about Patient Advocacy services and learn more about your community’s resources that can assist you with your whole health.

Awareness of health determinants allows leaders and healthcare facilities like Sunshine to address public health issues more effectively. Lori Proctor, a Patient Advocate We can all help improve at Sunshine Community everyone’s health by voicing Health Center, says, “As I community needs and working meet with patients and they together to change policies. By present their needs to me, understanding and addressing they are so grateful to learn social determinants, we can about available services that reduce health inequalities, often didn’t know existed. It enhancing all Alaskans’ is a privilege to walk patients welfare. through the paperwork and to Teri Petram is the Marketing help them receive an outcome Director at Sunshine that improves the quality of their life.” Community Health Center


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MEDICAL GUIDE 2022

Choosing palliative care options

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odern medicine works marvels, though some conditions remain a mystery. When afflicted with a condition that has no cure, individuals suffering illnesses or other ailments may need to look for ways to feel better. This is the basis behind palliative care.

life of patients, their caregivers and their extended families. However, only 14 percent of the estimated 40 million people across the globe who need palliative care currently receive it. Those with access to care can use these guidelines when selecting palliative care services.

The Mayo Clinic says palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of serious illnesses. Palliative care is not exclusively end-of-life care, but it can be. In fact, hospice care is a form of palliative care for terminally ill people. The American Board of Internal Medicine Foundation offers that palliative care may include emotional, spiritual and physical support. In addition to pain management, palliative care may help relieve symptoms such as shortness of breath, anxiety, fatigue, nausea, and depression.

• Start with your primary care physician to acquire the best care possible. He or she can put you on a path to building a palliative care team. • Have a list of questions at the ready. These can include asking about the criteria for palliative services. What treatments will you have to discontinue and what can be continued? What to do if diagnosis/prognosis changes? Which professionals will be on the palliative care team?

• Decide where care will take place. Some palliative services, such as end-of-life hospice care, may take place in a hospice According to The World Health Organization, center or in a special wing of a hospital. Other palliative services occur at home. palliative care improves the quality of

Specify where you want to be cared for so that you can choose the right program. • Determine if you can get assistance with advance directives. Some palliative care teams will work with volunteers in the legal and accounting fields to provide peace of mind. Chronic, life-threatening or serious illnesses may require individuals to document their plans while they’re still of sound mind. They also can spell out desires and goals for treatment, in addition to establishing a health care proxy when the future may make decisions challenging. • Interview and get to know potential palliative care providers. Assess more than an individual’s credentials. Choose people who are compassionate and exhibit genuine concern for your well-being. Palliative care is an important component of feeling well for as long as possible. It takes research and knowing what you want from care to find the best options.


MEDICAL GUIDE 2022

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Balance caregiving and working

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ven though thousands of trained professionals play vital roles in the care of the aging population, many of the unsung heroes of long-term care are the unpaid or informal caregivers who step in to provide assistance to someone they love. A 2019 study published in the journal Geriatric Nursing found approximately 16.6 percent of the United States population age 18 and older self-identify as informal caregivers who provide care for adults with health conditions and disabilities. Assistance needs range from “old age” care requirements for Alzheimer’s disease and related dementias to impaired mobility assistance. Furthermore, Assisting Hands Home Care says roughly six in 10 family caregivers also work full- or part-time. While it can be a noble effort to step in and provide care to a friend or family member, caregiving can be time-consuming and emotionally and physically demanding, particularly for those who also are balancing careers and families. The Centers for Disease Control and Prevention indicates that while some aspects of caregiving can be rewarding, caregivers may be at increased

risk for negative health consequences, such as depression and difficulty maintaining healthy lifestyles. These effects may be exacerbated by stresses at work. The challenges of managing caregiving and a career can be challenging, but it’s not impossible to perform both roles successfully. • Use company assistance or benefits. Some companies have policies in place that enable a person to handle certain aspects of caregiving more effectively. These can include unpaid Family and Medical Leave Act leave, employee assistance counseling programs, flex time, and even telecommuting capabilities to coordinate work around caregiving.

date about caregiving schedules, family appointments, work responsibilities, and other pertinent events. Seeing responsibilities spelled out can help all parties involved divide time accordingly. • Develop a safety net. Reach out to trusted friends or reliable neighbors who can step in during emergencies when work schedules cannot immediately be adjusted. • Practice self-care. Self-care is crucial to ensuring a person has the energy to provide quality care to a loved one as while simultaneously navigating his or her career. Take breaks as needed.

• Consider professional care services. Relying on a home care agency or a skilled nursing facility can be a solution when • Speak with your employer. Employees a person needs to simultaneously work should be honest with their human resources and care for a family member. Individuals departments or supervisors about their also can look into respite care, which is roles as caregivers. Honest communication a temporary care situation that enables can help the employers understand the informal caregivers to get a break for a set situations and perhaps find workarounds time. Respite care is offered through various that will satisfy all needs. assisted living facilities. • Get organized. Create a shareable family calendar so that everyone stays up-to-

Informal caregivers can explore various tips for balancing careers with caregiving.


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MEDICAL GUIDE 2022

How active seniors can protect their vision

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etirement may be seen as a time to slow down and enjoy some well-earned rest and relaxation, but today’s seniors clearly did not get the memo. Modern seniors look and act a lot different than traditional depictions of retirees.

In fact, there are many ways for active seniors to protect their vision so they can continue to get up and go without having to worry about losing their eyesight.

• Make your diet work for you. The AOA notes that a number of eye diseases can develop after an individual turns 60, and some of The shift in attitudes regarding aging is these conditions can be minimized with wise noticeable in the growth of active retirement lifestyle choices. For example, a healthy, communities, which are designed for aging nutrient-rich diet can protect vision over the men and women who want to engage in activities where no chairs are required. Active long haul. The National Council On Aging notes that studies have found that omega-3 seniors may not fit outdated stereotypes of fatty acids, which can be found in foods cardigan-clad grandparents shuffling about like spinach, kale and salmon, can reduce dusty retirement homes, but even the most individuals’ risk for age-related eye diseases. energetic retirees may still be vulnerable Seniors can speak with their physicians to age-related health complications. For about other ways to utilize diet to combat example, the American Optometric Association age-related vision problems. notes that men and women over the age of 60 may be vulnerable to age-related vision • Protect your eyes and look cool at the problems. A certain degree of vision loss same time. Active seniors spend lots is natural as men and women age, but that of time outdoors, and that may have an doesn’t mean active seniors have to sit idly by. adverse effect on their vision. The NCOA

notes that lengthy exposure to the sun’s ultraviolet rays can cause both short- and long-term eye damage. Thankfully, such issues are easily avoided if seniors wear sunglasses with UV protection when going outside. Brimmed hats also can protect the eyes from harmful UV rays. • Be mindful of screen time. Much has been made of how much screen time is healthy for young people. But seniors also are not immune to the potentially harmful effects of spending too much time staring at their phones and other devices. The NCOA recommends seniors employ the 20-20-20 rule in regard to screen usage. Every 20 minutes, look about 20 feet away for 20 seconds. This quick exercise can reduce eye strain. An active lifestyle benefits seniors in myriad ways. Seniors should take steps to protect their vision so they can continue to get up and go long after they retire.


MEDICAL GUIDE 2022

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Get kids on a healthy track

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hildhood obesity is a serious medical issue affecting children around the world, but notably in North America. While the issue has been around for decades, the Centers for Disease Control and Prevention says American children and teenagers have witnessed a significant increase in weight gain since the COVID-19 pandemic began.

Emphasize a fun activity with a focus on movement that produces shortness of breath, body warmth and sweat. These are indicators that the heart rate is really pumping.

Kids Health® by Nemours. These healthy foods should include at least five servings of fruits and vegetables a day, with an emphasis on vegetables.

Psychological Association found that 61 percent of respondents age 18 and older reported a median weight gain of 15 pounds during the pandemic. Teach children that weight • Limit screen time. Children loss is accomplished when • Use exercise as a reward and may be inclined to entertain more calories are burned than not a punishment. Make exercise themselves by heading for the something kids can look forward television, mobile phone or tablet consumed. Pay attention to portion sizes and explain how to. Reward a job well done on a first, especially after a yearbeverages like fruit juices can be test with extra time biking with plus of being stuck indoors. But sneaky sources of extra calories. friends or a hiking trip to a scenic parents can make a concerted Younger school-aged children national park,. Kids will be begin effort to limit kids’ screen time Children may need a little extra have been among the hardest to associate exercise with fun. in favor of more physically help getting fit, especially if hit during the pandemic. A study challenging pursuits. they gained weight during the • Offer a variety of foods. Kids published in September 2021 pandemic. Teaching healthy who eat a variety of foods are • Teach healthy eating habits. found the percentage of obese habits now can help kids enjoy more likely to get the nutrients A Harris Poll survey conducted children and teens increased to the body needs, according to on behalf of the American healthy futures. 22 percent compared with 19 percent before the pandemic. The CDC looked at the BMI of study subjects between March 1, 2020 and November 30, 2020. One of the study’s authors, Dr. Alyson Goodman of the CDC’s National Center for Chronic Disease Prevention and Health Promotion, described the results as “substantial and alarming.” Being less physically active, overweight and eating the wrong foods can start children on a path toward problems that once were only considered conditions of adulthood, namely hypertension, diabetes and high cholesterol, offers the Mayo Clinic. To reverse course, parents, guardians and educators can focus on helping children become more physically fit. The following are a few ways to do so. • Encourage participation in sports or other physical activities. Sports practices, games, competitions, and other activities may keep children moving for an hour or more several days per week. However, the American Academy of Pediatrics states that only 25 percent of children get the recommended 60 minutes of physical activity per day.


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MEDICAL GUIDE 2022

The differences between Crohn’s disease and colitis

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iving with inflammatory bowel conditions like ulcerative colitis and Crohn’s disease can be challenging. Many people experience situations where they feel like they don’t have control of their bodies and are limited in what they can do. Sometimes pain and other discomfort can affect how they live their lives. Managing conditions that affect the bowels takes patience and knowledge of the illnesses themselves. While they share certain characteristics, there are some differences between Crohn’s disease and colitis.

Crohn’s disease The Crohn’s & Colitis Foundation notes that Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. It was discovered by Dr. Burrill B. Crohn and his colleagues in 1932. Crohn’s is most often diagnosed in adolescents and adults between the ages of 20 and 30. The condition can affect any part of the gastrointestinal tract from the mouth to the anus, but most commonly affects the end of the small bowel known as the ileum and the beginning of the colon. While it can affect any part of the intestines, Crohn’s disease usually occurs in a pattern of “normal” areas of unaffected intestines between patches of diseased intestine.

Colitis Ulcerative colitis, or just simply colitis, differs from Crohn’s disease in that colitis only affects the large intestine. With ulcerative colitis, there are no healthy areas in between inflamed spots; the entire large intestine is inflamed.

Diagnosis Doctors will conduct various tests to determine where inflammation is present. A sigmoidoscopy examines the lower large intestines; a colonoscopy examines the entire large intestines; and a esophagogastroduodenoscopy checks the lining of the esophagus, stomach and duodenum. Sometimes an endoscopy will be used to look at the small intestines as well. Other testing can check the bile ducts in the liver and the pancreatic ducts. With these tests and a thorough assessment of symptoms, doctors can determine if a person has Crohn’s disease or ulcerative colitis. A balance of dietary changes and medication can help manage symptoms.

Common symptoms Since the symptoms of Crohn’s disease or ulcerative colitis can be similar, it may be difficult to know which illness is present without further testing. Here are some common symptoms, courtesy of WebMD. • Diarrhea

• Fever

• Belly cramps

• Weight loss

• Constipation

• Fatigue

• Urgent need to have a bowel movement

• Smaller appetite

• Rectal bleeding

• Irregular menstrual periods

• Feeling like a BM wasn’t complete

Symptoms may come and go between flare-ups.


MEDICAL GUIDE 2022

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Early warning signs of Alzheimer’s disease

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lzheimer’s disease is an insidious illness that slowly robs individuals of their memories, personalities and relationships. The Mayo Clinic says Alzheimer’s is a progressive neurological disorder that causes brain atrophy and cell death, which contributes to continuous decline in thinking, behavioral and social skills. This eventually affects a person’s ability to live independently. The most common form of dementia is Alzheimer’s disease, which is believed to affect approximately 5.8 million Americans age 65 and older. While there currently is no cure for Alzheimer’s disease and other dementias, there are strategies that can help mitigate symptoms. An ability to recognize dementia symptoms early can help millions take proactive steps to improve quality of life. Below are some early warning signs of Alzheimer’s disease, courtesy of

notable health organizations, including MJHS® Health System, the Alzheimer’s Association, Alzheimer’s New Zealand, and the Mayo Clinic. • Recent memory loss that affects daily life. While it is normal to forget where you left keys, names or even telephone numbers from time to time, a person with dementia may have difficulty remembering recent events or where they live. • Personality changes. Individuals may begin to show subtle differences in their personalities, including mood swings. For example, a person who is easygoing may become reluctant to interact with others. • Difficulty with familiar routes. A person with dementia may have regular difficulty driving familiar routes or finding the way home. • Trouble finding the right words. Finding words to converse freely can be difficult for people with Alzheimer’s. Such individuals

may experience particular difficulty finding the right words to express their thoughts or identify objects. • Disorientation with time. Someone with Alzheimer’s disease may be confused about the time of day and what is appropriate for that time. • Decreased or poor judgement. Individuals with dementia may make consistently poor decisions and may start paying less attention to their physical appearance. • Difficulty following a plan. A person with Alzheimer’s disease may have challenges solving problems, such as working with numbers, following a recipe or keeping track of finances. Early signs of dementia may be confused as normal age-related changes. However, when such signs present themselves, it is critical to speak with medical professionals to get a clear diagnosis.


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MEDICAL GUIDE 2022

Factors that increase the risk for preterm births

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risk factors for preterm births are defined as “modifiable” by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Modifiable risk factors can be changed to help women reduce their risk of giving birth before their pregnancies reach fullterm. One study sponsored by March of Dimes and published Despite the best efforts and in the Maternal and Child Health intentions of expecting parents Journal concluded that as many and their medical teams, preterm as one-quarter of all preterm births remain a significant issue births might be attributed to across the globe. According to modifiable risk factors. These the World Health Organization, factors included: about 11 percent of the world’s • abnormalities in the interval live births are preterm births. between pregnancies March of Dimes reports that the rate of preterm births in the • a woman’s body mass index United States is 9.8 percent, before pregnancy while the Canadian Institute for Health Information notes that • the amount of weight gained Canada’s preterm birth rate is during pregnancy roughly 8 percent. The Centers for Disease If those figures are alarming, it’s Control and Prevention notes that certain behavioral factors worth noting that many of the xpecting mothers often go to great lengths to protect their developing babies as they aspire to achieve a healthy, full-term pregnancy. That’s a notable and worthy goal, as the Association of Women’s Health, Obstetric and Neonatal Nurses notes that babies need a full 40 weeks to grow and develop.

also can increase a woman’s risk for premature birth. Such behaviors, including tobacco usage and alcohol consumption, are modifiable risk factors that women can control.

• Abnormalities of the reproductive organs, including a short cervix or a shortening of the cervix during the second trimester instead of the third trimester.

Though modifiable risk factors are within women’s control, they are not the only variables that can increase a woman’s risk for preterm births. The NICHHD notes that additional factors women cannot control or influence put them at high risk for preterm birth. These factors include:

March of Dimes notes that prematurity can cause problems, including developmental issues, for babies throughout their lives. However, the WHO has developed new guidelines for improving the outcomes of preterm births, and these interventions can improve the chances of survival and health outcomes for preterm infants.

• A history of delivering prematurely • Being pregnant with twins, triplets or more or the use of assisted reproductive technology to become pregnant. In fact, the American College of Obstetricians and Gynecologists notes that preterm birth is the most common complication of multiple pregnancy.

Pregnant women and women hoping to become pregnant can speak with their physicians about what they can do to increase the chances their pregnancies reach full-term. More information about preterm births is available at marchofdimes.org.


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