TV SPOT Catch the Around Cheyenne 60
second television advertisement.
2:08 PM August 12th, 2009 JUVENILE SYSTEM UPDATE: Part 2 of 3 Ronn Jeffrey, Municipal Court Judge, summarized the concept of the JPB as a multi-disciplinary group of people working together to plan a system for handling kids in the system...READ >>
2:54 PM July 8th, 2009 JUVENILE SYSTEM UPDATE: Part 1 of 3 After several discussions, the Laramie County Commissioners and Cheyenne City Council collaborated to approve the Laramie County Community Juvenile Services Joint Powers Board Agreement...READ >>
1:03 PM July 15th, 2009 AROUND CHEYENNE SURVEY Your opinion matters to us. Please take the time to fill out a brief survey and either mail or email it to us so that we may better serve you. TAKE >>
2:40 PM July 8th, 2009 ROTATING HEADER UPDATE You can now click on the rotating magazine cover images to open up the issues! Please note some of the past issues only contain the front cover.
3:11 PM June 12th, 2009 NEW WEBSITE Around Cheyenne has a new website! Please check back often as we continue to fill and update it with magazine content.
HEALTH: Heart-Healthy Eating: Variety and Spice By Dr. Gerrie Gardner,
Cardiologist, Cheyenne Cardiology Associates
One of the hardest things you may face after experiencing a heart attack or other health crisis is to make lifestyle changes. Altering what you eat can be one of the toughest.
Perhaps you can relate to the following:
If I can’t eat cookies, ice cream, or steak, what’s the point?
I don’t like fruits or vegetables.
No salt? No way!
Let me assure you, eating heart healthy doesn’t have to be depressing and tasteless. Instead, look at it as a chance to bring more variety—and spice—into your life.
Try something new - First, you should be eating a variety of whole grains, fruits, vegetables, nuts, seeds, and no-fat or low-fat dairy foods each day. Lean protein is also part of a balanced diet. Challenge yourself and others in your family to try one new heart-healthy food each week and to come up with different ways of preparing these foods.
For instance, every year in July, Cheyenne Regional Medical Center hosts a chili cook-off for employees. As part of the cook-off’s Iron Chef Competition, contestants must incorporate something unusual and healthy into their entries. Fish, sweet potatoes, and plantains (a member of the banana family) have been used with great success.
You might also try visiting a farmers’ market. At the market, you can select from a variety of locally or regionally grown fruits and vegetables. Plus, you are getting fresh air and exercise as part of your shopping experience. Another benefit is that many vendors will let you sample their foods before buying them. Prickly pear cactus (with the spines removed) is one of the more unusual items that you can find at one of the markets here in Cheyenne. Prepare the young pads by peeling their skin, dicing and adding them to salads. Why not give it a try?
What if you eat on the go? Or just don’t enjoy cooking? Heart-healthy recipes that cater to busy people are available online and in bookstores. Just be careful you aren’t taking short cuts with quality or short-changing your nutrition. Strive to use fresh ingredients and avoid recipes that rely heavily on canned products or boxed and pre-packaged foods. These can be high in sodium and other undesirable preservatives.
Eating raw fruits and vegetables is another simple option that will reduce your time in the kitchen and benefit your heart and overall health. Karla, a clinical dietitian at Cheyenne Regional, recommends freezing grapes—an especially nice treat during hot summer or fall days and one that is especially popular with kids and grandkids. Another idea is to use fruit as a dessert. Fruit satisfies most people’s cravings for sweets but without the high calorie and fat content found in packaged desserts.
For those of you who enjoy red meat - The American Heart Association (AHA) does allow for eating red meat—three to four ounces up to three times a week. Select lean cuts such as sirloin over rib eye, for instance. You can also eat pork or lamb up to two times per week. Again, go for the lean cuts (loin chops rather than ribs), and keep portion sizes at three to four ounces which is similar in size to a deck of playing cards.
Try buffalo or game meat - Many grocery outlets now offer buffalo, which is a lower-fat alternative to beef. Another good, low-fat source of animal protein is game meat. Elk, deer, antelope, and other wild game typically graze on low-fat fuels such as native grasses and shrubs and are on the move, which means their meat isn’t mottled with high concentrations of artery-clogging fat.
More animal proteins - Poultry and fish are other healthy sources of animal protein. Salmon, for instance, is flavorful and a good source of omega 3 fatty acids—a substance which makes your blood less likely to form clots that may trigger heart attacks. As with red meat, keep your portion sizes moderate, and keep in mind that the AHA recommends eating fatty fish at least twice per week.
Beans, beans – A heart-healthy diet should also include dried beans, which offer protein, fiber, vitamins and minerals. These days, you can find a variety of beans at local grocery stores: lentils, Anasazi, Adzuki, black, garbanzo, pintos, black, Lima, navy, red, kidney, northern and more. Many outlets also offer beans packaged with spices to add flavor. Be sure to avoid packaging with salt, though, which can contribute to hypertension and other fluid imbalances.
Poultry, fish, peas, nuts and seeds – Other healthy sources of vegetable protein are nuts and seeds. (Almonds are cited by the Mayo Clinic as one of the “10 great health foods for eating well.” Just don’t get too carried away—nuts and seeds are high in calories. The other nine great health foods cited by the Mayo Clinic are blueberries, apples, broccoli, red beans, salmon, spinach, sweet potatoes, vegetable juice and wheat germ. For more details, visit the website www.mayoclinic.com/health/health-foods/NU00632)
Don’t forget dairy - Milk, yogurt, sour cream and cottage cheese are a vital part of a balanced, heart healthy diet. Be sure to eat low or no-fat dairy products. Also, avoid the hard cheeses—they tend to be loaded with trans fat, a contributor to heart disease.
Good rule of thumb – A good rule of thumb to follow when eating a heart-healthy meal is for your plate to be divided as follows:
Fruits and vegetables – 50%
Grains – 25% (at least three servings of whole grains/day)
Protein (animal or vegetable) – 25%
Watch that plate size, too. Too much of even a good thing—including fruits, vegetables, grains and lean protein—can increase your calorie count and add unwanted pounds.
Stuck for ideas? Cheyenne Regional’s Cardiac Rehabilitation program offers a cookbook filled with tried and true recipes that taste delicious, are easy to prepare and are good for you. For more information or to order a copy, call (307) 633-7060. Cookbooks are $15 apiece.
If you are computer savvy, I also recommend you look into MyPyramid.gov – a U.S. Department of Agriculture website that offers personalized eating plans and interactive tools to help you plan your calorie requirements and food choices.
Did you know that it is not normal to feel tired all the time? Some people feel just as tired when they wake up as when they went to bed. They can not stay awake during a movie or during a telephone conversation or worse yet, at a stop light. They fall asleep when ever they slow down. Have you ever heard of someone snoring so loudly that they wake themselves up gasping for breath? This is most commonly associated with sleep apnea. This is a sleep disorder were the airway closes off during sleep. Another common sleep disorder is insomnia. This is the opposite of waking up during sleep. This is when you can’t fall asleep or don’t stay asleep for very long. These people are tired because they can’t sleep. A third area of problems is restless leg syndrome (RLS) and periodic leg movement disorder (PLMD). This occurs when the legs move voluntarily or involuntarily. All these sleep disorders should be evaluated by a physician trained in sleep disorders. Dr. Lazaro Bravo, Dr. Tara Taylor, Dr. Andrea Thornton and Dr. Sodienye Tetenta are specialized in sleep medicine and they can help you. They are local physicians who can follow up on your sleep needs.
Approximately 18 million Americans suffer from sleep apnea. Sleep apnea is when you stop breathing. The body recognizes this and wakes up just enough to take a large breath. This person usually snores very loudly, the upper airway starts to close off until the body wakes up to take a breath and this pattern repeats up to hundreds of times per night. This helps to explain why these people are so tired all the time. Their body is never getting a full night of sleep. They do not realize that their body is waking up just enough to breath and thus they never reach the rapid eye movement (REM) stage of sleep for the recommended lengths of time. That is why people who suffer from sleep apnea fall asleep when performing little or no activity. Recently there was an article in USA TODAY about drowsy drivers. According to Carol Ash, medical director of a sleep program at Somerset Medical Center in Somerville, NJ, “sleep deprivation has the same impact has intoxication. Your judgment becomes impaired, whether you realize it or not. We’re starting to understand that drowsy driving is the same as driving intoxicated.” Sleep apnea is a very serious condition that can be treated. If you can answer yes to any of the following questions, you need an evaluation for sleep apnea. Please see your physician or make an appointment at Mountain Falls Clinic.
Do you snore?
Do you choke or gasp for breath while you sleep?
Has anyone told you that you stop breathing during sleep?
Do you feel tired or fatigued after you sleep?
Has your weight changed in the last 5 years?
Have you ever nodded off or fallen asleep while driving a vehicle?
Can’t fall asleep? Maybe you have Insomnia. This is a sleeping disorder described by not being able to fall asleep or stay asleep. These people are tired because they truly are not sleeping. According to the U.S. Department of Health and Human Services in year 2007, approximately 64 million Americans suffer from insomnia on regular basis each year. This is 1.4 times more common in women then in men. There are different degrees and types of insomnia. Transient insomnia lasts from days to weeks. Acute insomnia last from three weeks to 6 months and chronic insomnia last for years. If this sounds like you, you may want to consult with your physician or the Wyoming Sleep Disorders Center. A local physician with special training in sleep disorders is available to evaluate you.
Another common sleeping problem is called restless leg syndrome (RLS). This is described by different people as being a tingling feeling, jumping sensation, tightening that occurs in both legs. The sensation occurs mostly at night or when sitting for long durations of time. To relieve this sensation, different people state they walk, take a hot bath, or stretch their leg muscles. The National Institute of Neurological Disorders and Stroke say that RLS affects as many as 12 million Americans. If left untreated, RLS can lead to exhaustion. There is treatment for RLS. Very similar to RLS is periodic limb movement disorder (PLMD). This is involuntary leg twitching or jerking movements during sleep that typically occur every 10 to 60 seconds. Usually this is diagnosed by the bed partner or during a sleep study. Does your bed partner kick you all night long? If so, they need to have a sleep consultation and a sleep study by the Wyoming Sleep Disorders Center.
The Wyoming Sleep Disorders Center is equipped to help diagnose all sleep disorders. The sleep rooms are state of the art with the finest furnishing. You will feel like you are visiting a relative with a home like atmosphere. All of the sleep rooms have a private restroom and most have a shower to help aid in the convenience of getting ready for work after sleeping in the sleep center. On the way out the door, you can help yourself to a continental breakfast. The Wyoming Sleep Disorders Center believes that better sleep leads to a better life.
Sleep is an essential part of the body’s needs. There are many diseases and symptoms associated with poor sleep. The Wyoming Sleep Disorder Center located at 4620 Grandview Avenue, Suite 201 (behind Avanti’s Italian Restaurant) is here to help you.
HEALTH: Tough Times Mean Tighter Pants for Stress Eaters By Megan K. Scott, AP Writer
NEW YORK (AP) — Leslie Fuller tried to stick to her shopping list on a recent grocery run. Instead, she found herself venturing down the candy aisle, throwing bags of Hershey’s Miniatures and M&M’s into her cart.
“I should just put them down on the seat and sit on them,” said Fuller, a paralegal in Las Vegas. “That’s where they’re going to go — on my behind. I eat them because it makes me feel better.”
Tough times means tighter belts, and for many people tighter pants as they turn to fatty, sugary comfort food to deal with recession-related stress.
Fuller, 51, recently lost her house to foreclosure through no fault of her own. She lost some of her husband’s income because of a pay cut. She lost her savings, which the couple used for moving expenses. And she recently put one of her dogs to sleep and is having foot surgery next month.
“To say that my life is stressful is an understatement,” said Fuller, who wants to lose 30 pounds. “I see a light at the end of the tunnel. I just don’t know how far it is.”
Denise Lamothe, an emotional eating expert and clinical psychologist in Exeter, N.H., said research indicates that more than half the population eats more when feeling stressed. She’s seeing patients who were losing weight before financial trouble hit but are now eating more.
“As the economy has faltered, people have become more and more anxious, more and more fearful,” said Lamothe, author of “The Taming of the Chew.” ‘’The more intense feelings become, the more people will turn to sugar, fat and salt, because that’s where they can get some relief.”
Such food is also cheaper per calorie than fruits and vegetables, said Linda Hlivka, co-author of “Stress Eater Diet.” McDonald’s, with its value menu, has benefited from the economic slump while sit-down competitors report steep declines.
With so many people out of work, it becomes easy to snack all day to fill the time, said Leslie Seppinni, a psychotherapist in Beverly Hills, Calif, adding that women are more likely than men to binge due to stress.
Suzanne Brumfield, 38, of Groton, Conn., found that out when she was unemployed for about six months last year. She reached for Little Debbie Oatmeal Creme Pies and Drake’s Funny Bones cakes because of boredom and mounting frustration from applying for countless jobs. She gained 30 pounds and ended up 100 pounds overweight.
Brumfield, who is married and has three stepchildren, has since found a job as an office manager, but she’s making less.
“I never really got anything positive out of it,” said Brumfield, who is now on Nutrisystem and has lost 30 pounds. “I never got the, ‘That satisfied a craving. I’m good now.’ It was, ‘I cannot believe I ate another one of those.’”
Stress eating generally follows a lifelong pattern, and most people will stress eat from time to time, depending on how bad the stress is and how long it lasts.
While there are lots of stressors that people will face throughout their lives, whether it’s the death of a loved one or divorce, financial worries are a huge trigger for overeating, said Hlivka. Not being able to pay bills, find work or support a family, watching retirement savings shrink. All hit home on a daily basis, she said.
“It doesn’t seem to go away, and for those people that are looking for jobs and can’t find jobs, their survival is at risk,” Hlivka said.
Jan Anderegg, 48, a mom of five in Guttenberg, Iowa, said at one time she was eating five or six boxes of candy a day to cope with money worries. She and her husband’s farm suffered a hit last year because of the rising costs of corn and hay, and they continue to field calls from bill collectors.
But Anderegg has lost 60 pounds since December. Instead of eating, she now writes short stories and logs on to the free health and weight loss Web site SparkPeople.com for support.
She keeps one box of candy in the house so she doesn’t go overboard. And she also eats more fruits and vegetables, drinks more water and watches portions.
“I wish I could say I felt it was under control,” Anderegg said about her stress eating. “I think it’s going to be an ongoing struggle for the rest of my life.”
Experts recommend stress eaters acknowledge the stress, and substitute eating from boredom, depression or anxiety with exercise or a hobby. But it’s important to get a handle on it. For most people, the extra calories will add up to extra pounds.
“It’s a mindless satisfaction that seems harmless in the moment,” said Seppinni. “But obviously has larger repercussions later, no pun intended.”
Over the decades, and especially in the last few years, great changes have occurred to improve the quality of all aspects of skilled care. Advances such as the incorporation of physical, occupational and speech therapy into health care programs and the invention of new methods of care, such as restorative programs, ensure that as our community’s needs change and our ability to provide the care needed will evolve as well.
On the forefront of modern health care is the desire to improve patients’ quality of life and return them, after a debilitating situation, to their former level of independence. One progressive branch of medicine, rehabilitation therapy, has been particularly instrumental in meeting these two goals. Physical, occupational and speech therapists specialize in helping individuals of all ages and ability levels to gain or regain important life skills.
At Life Care Center of Cheyenne, we are seriously committed to incorporating rehab into our patients’ and residents’ care plans, and we’re helping our therapy team to improve the lives of those we serve. This is why we now employ more than 20 therapists in order to give our patients thorough, one-on-one attention. Many of these 20 therapists have received special certifications to use new and state-of-the-art technologies to be even more effective.
We are currently, and have been, implementing an advanced rehab-to-home program, “Ready…Set…Go!” This program was created to ensure that when patients return home, they do so safely. Once a need for therapy is determined, our facility’s interdisciplinary team of therapists, skilled nursing specialists and other health care professionals provide careful evaluations of each person’s needs and create a specialized program, consisting of therapies and clinical treatments, to restore him or her to maximum functioning ability.
To achieve this goal of a successful return home, our program ensures that each patient is able to care for him or her self before returning home. As a part of our program, patients are asked to properly perform daily tasks, such as cooking and folding clothes, under supervision in our facility’s activities of daily living suite. This suite is a special area within the therapy gym that is constructed to resemble an actual home; it even includes working appliances. This innovation allows individuals to actually practice daily activities in a safe environment so that they feel confident returning home. The goal-focused nature of this program often leads to better outcomes and a speedier recovery.
In addition to rehab therapy, our restorative care program focuses on restoring quality of life to our patients and residents, whether they are planning to return home or stay with us long-term.
To better understand how restorative care can make a big difference in our residents’ quality of life, consider the situation of Suzy, a favorite lady in our restorative care family.
At first, Suzy just participated in our restorative dining program. She always had a smile on her face, and she would often encourage the other residents. Through specific care from our restorative staff, she was soon able to improve her eating skills and rejoin her friends in the main dining room. Then, after completing rehabilitation with our therapy department, she continued to work through some movement problems with our restorative staff. Suzy benefited greatly from group exercise and ambulatory training to help her move about more freely.
Individuals needing both rehabilitation and skilled nursing services can discover quality care that will meet their needs at Life Care Center of Cheyenne. We offer our skilled nursing care, rehabilitation services, and sub acute/intermediate care programs in a compassionate, home-like atmosphere. We also provide daily activities and exceptional dining services. Residents’ and patients’ families are invited to visit regularly and be as much a part of their loved one’s life as they so desire.
For more information about the ever growing and changing programs available to meet your needs, feel free to contact our facility’s admissions and marketing team at 307-778-8997. Life Care Center of Cheyenne, a Life Care Centers of America facility, is one of 220 facilities of its kind across the nation and is located at 1330 Prairie Avenue in Cheyenne. We encourage you stop by for a tour or to volunteer with our residents. You can also visit us online at www.LCCA.com.
CHEYENNE REGIONAL MEDICAL CENTER: Cheyenne Regional Promotes Safety, Awareness of Traumatic Injury Prevention
Any parent familiar with car seats also knows the frustration of installing a car seat. It’s not an easy task.
There’s also no denying the importance of safety. That’s something Cheyenne Regional Medical Center recognizes through its support of Safe Kids Wyoming. Safe Kids is a partnership between Cheyenne Regional and the Wyoming Department of Health. Both have contributed to its funding support since its inception in 2000. Statewide, the program promotes safety in cars, on bikes, at ski hills, at home, and in other ways.
“Safe Kids Wyoming is community-based. This approach works best in teaching injury prevention and in keeping people out of the hospital,” explained Stephanie Heitsch, Safe Kids Wyoming injury prevention coordinator. “Basing the program at Cheyenne Regional also shows the hospital’s support for injury prevention and keeping our community and state safe.”
In 2008, Safe Kids programming saved Laramie County residents approximately $600,000 in healthcare-related costs, said Heitsch. The savings statewide is estimated to be nearly $2.5 million for 2008.
Safe Kids coalitions are present in a total of 15 communities across Wyoming. Because communities have different needs, each local coalition can select its safety focus. The focus in Cheyenne and Laramie County is on bike helmets and child safety seats.
“Part of the reason for this emphasis is that head injuries resulting from bike accidents can alter the quality of life in dramatic ways,” noted Heitsch. “Properly installing and using child safety seats is also vital in keeping young children from being harmed,” she added.
Another reason for the child safety seat focus in Laramie County, and across Wyoming, is that child safety seat installation has become a tricky business with the ever-changing advances in car seats.
“Many of our residents don’t realize this, but we train students on how to install safety seats properly and become nationally certified car seat technicians,” Heitsch says. “It’s a week-long course, funded by the Wyoming Department of Transportation (WYDOT) Highway Safety Office.”
To help parents and caregivers, Safe Kids Laramie County offers safety seat education with a certified car seat technician on Tuesdays and Thursdays, by appointment.
Cheyenne Regional also offers new parents with no car seat choices on how they can obtain a car seat through the program.
In addition, local parents receiving assistance in the form of food stamps or other benefits can receive a low-cost car seat and be educated on the proper way to install it by a certified technician through the local Safe Kids car seat inspection station.
New dad, Dale Rogstad first installed his newborn’s car seat behind the driver’s seat, not realizing this was not the safest position for the car seat. A visit to a local volunteer fire station and a trained car seat technician showed him otherwise. The seat was moved to his sedan’s middle back seat, and he was given more instruction on installation.
“I wasn’t very confident going into it,” Rogstad says. “I think it’s because I heard so much about how hard it is to do it right.”
Today, he drives around town with his wife and 5-month-old son, confident in their safety.
About the time kids outgrow safety seats (usually any child under the age of 9 in Wyoming), they’re also pretty comfortable on a bike.
WYDOT supports Safe Kids with a safety helmet program in Laramie County. Aimed at elementary school children, kids are taught how their brain works and why they need to protect it. Helmets are available for a low cost to kids who don’t have one at home.
The safety trend seems to be here to stay.
“Kids are more receptive to it, and parents are becoming safer, too,” Heitsch explained. “At Super Day in June, we had at least five families looking for helmets for small children riding in pull behind carriers.”
To learn more about these programs or to get help with safety seat installation, call Safe Kids Laramie County at 307-633-7527.
CHEYENNE REGIONAL MEDICAL CENTER: Home Away from Home Program O ffers Relief for Travel-weary Guests, Patients
A health event brings stress all its own, but when travel is involved, the stress easily doubles. This is something Cheryl Heaton of Yuma, Colo., knows well.
Her husband, Bill Heaton, experienced a triple bypass in 2007. They could have gone to a Denver hospital, but they chose Cheyenne Regional Medical Center, a three-hour drive from their home.
Amid all the stress and upheaval of travel, it was heartwarming for the Heatons to learn of Cheyenne Regional Medical Center’s Home Away from Home program. Located at the hospital’s east campus, the program has provided low-cost guest rooms for patients and patients’ families since 1996. In that time, more than 26,659 families have used the nine guest rooms, says Home Away From Home Director Roberta Hurless.
“I just can’t say enough about it,” said Cheryl Heaton. “It’s very convenient for me. You just can’t beat the cost, either.”
For $25 a night, guests have a comfortable bed and access to a kitchenette stocked with donated TV dinners, snacks and drinks. A washer, dryer and toiletries are available, too. While no one is turned away if they can’t afford to pay, those who can pay are grateful for the substantial savings on lodging.
“People don’t always understand the stress patients and their families are going through at the time of a health crisis,” explained Hurless. “They’re facing very challenging decisions. So having a place to stay near the hospital and near a loved one being treated is comforting, convenient and often more affordable.”
The Home Away program is led by Hurless, who works part-time as director, and it’s staffed by hospital volunteers working 9 a.m.-1 p.m. and 1-5 p.m. on weekdays and on call on weekends. Cheyenne Regional provides the rooms for the program, but funding comes from the hospital’s volunteer program. “We absolutely rely on donations of supplies and volunteers to make this program a success,” said Hurless.
“They give you so much, those volunteers,” Cheryl Heaton explained. “They’re just so wonderful up there, so thoughtful and they do anything they can for you.”
The program was so meaningful to the Heatons, they’ve solicited donations for the Cheyenne program in their hometown, located about 140 miles northeast of Denver. With support from Hurless, the Heatons also helped clear the way for patients from the Veterans Administration Hospital and their visitors to use Cheyenne Regional’s Home Away lodging. Bill Heaton, who served for more than 20 years in the Marine Corps, has also been a patient at the VA Hospital in Cheyenne. Now Cheryl rests a bit easier when they’re in Cheyenne for checkups or procedures at Cheyenne Regional or the VA Hospital.
“We chose Cheyenne because we wanted a smaller, less-busy hospital,” she explained. “They have so many specialists there, we knew we should go there [for Bill’s healthcare].”
On any given night, it’s not unusual for the Home Away program to host guests from Nebraska and Colorado, as well as other countries.
“Unfortunately, with Interstate 80 right here, we do see a number of crashes,” Hurless explained. “Sometimes people need a place to stay while the person they were traveling with is treated. Sometimes they just need a place to stay before they can head home after recovering.”
Some guests have made the drive to take advantage of Cheyenne Regional’s cancer treatment facilities. They then use the Home Away program to rest before they drive home.
“People are extremely grateful because there is a place for them to stay,” Hurless added. “The volunteers and guests often have shared similar experiences. We know we’re doing good things here for patients and families.”
Want to help? Donations of single-serve snack foods are always welcome, as are microwaveable meals, cans of tuna, frozen burritos, boxes of macaroni and cheese, breakfast bars and toiletries. Milk, hot cocoa, tea and coffee always are appreciated. Bath robes are another item commonly requested by guests. A $25 cash donation can help a struggling family cover the cost of the stay. For more information on giving, call Roberta Hurless, 9 a.m.-1 p.m. weekdays, at 633-7212 or 633-7061.
MENTAL HEALTH: Anxiety Disorders By James P. Nelson
Webster’s defines anxiety as “1.a.Unease and distress about future uncertainties. b. A cause of uneasiness. 2.a. Intense fear or dread lacking a clearly defined cause or specific threat. 3. Eagerness or earnestness, often accompanied by uneasiness.”
For about 40 million American adults age 18 years and older, anxiety is not an occasional experience associated with a stressful event (a classroom presentation or a blind date); it’s a way of life. In order to qualify as a disorder in the psychiatric sense, anxiety must persist for at least six months. Anxiety disorders commonly occur along with other mental or physical illnesses and can get worse if they are not treated. Those with anxiety disorders may treat themselves with alcohol or drugs, but substance abuse may make anxiety worse or keep the disorder from being recognized for what it is, and delay treatment.
One sufferer described it this way:
“My wife calls me a worrier. I can’t ever seem to stop and relax. If I have to sit down for any length of time, I become extremely uncomfortable. I can’t stop thinking about all the little things that need to be dealt with like the details at work, how my son’s doing in football, my daughter’s boyfriend, my wife’s car might break down.”
“I have trouble getting to sleep at night, thoughts just racing in my head. I can’t concentrate at work because I’m worrying about what’s going on at home. When I get home, I can’t stop worrying about what’s happening at work. I get so tied up in knots that I sometimes get dizzy and nauseous. I’m afraid I might give myself a stroke.”
There are many types of anxiety disorders, each with its own particular symptoms. Here are some common examples, provided by the National Institutes of Mental Health.
Generalized Anxiety Disorder (GAD)
People with generalized anxiety disorder (GAD) experience constant worry and tension which is out of proportion to the situation. They anticipate the worst in all cases, are pessimistic, and worry excessively about health, money, family problems, or difficulties at work. Just the thought of getting out of bed and starting the day produces anxiety.
The Diagnostic and Statistical Manual of the American Psychiatric Society – Fourth Edition, Revised (DSM-IVR) states that GAD can be diagnosed when a person worries excessively about a variety of everyday problems for at least six months. People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.
Post-traumatic stress disorder (PTSD) develops after a person experiences a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or even strangers.
PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.
People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult.
PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a mugging or a kidnapping. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again
Obsessive-Compulsive Disorder (OCD)
People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.
For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.
Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.
Treatment
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference. Before treatment begins, a qualified mental health professional must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
Anxiety disorders can be effectively treated. If you, or someone close to you seems to have an anxiety disorder, get in touch with a mental health professional and make an appointment. This isn’t something you have to live with indefinitely. Get help.
Editor’s Note: This is the final article in a series of articles about a mood disorder called Bipolar Disorder. There is much misunderstanding about this mental health problem, and we hear a lot about it these days, so we advise anyone who thinks they may know someone with Bipolar Disorder to consult a licensed and qualified mental health professional who has experience diagnosing and treating it. As always, this article is for informational purposes only and is not intended as diagnosis or treatment.
Alyx (name change for privacy purposes) is having trouble with mood swings. For years, she wasn’t even aware that she had a mood disorder; she just thought everyone felt like she did. She experienced short periods of extraordinary emotional well-being during which life seemed great. Everything went extremely well all the time. She was hopeful, optimistic, and cheerful. She could go for long periods with only three or four hours of sleep a night, sometimes staying up all night long without apparent fatigue. Her new co-workers told her she had a great attitude, always seeing the sunny side of every issue.
But it didn’t last. Gradually, things returned to normal, a mix of good and bad, with no real extremes. Life seemed in balance. Alyx gradually began to see the difference between her overly optimistic attitude and what was really going on. She gradually became bored with work, bored with her boyfriend, and bored with life.
Soon after, the depression hit. Alyx just couldn’t seem to muster any energy for daily tasks. She felt sad, even hopeless much of the time. She had trouble sleeping, and the more sleepless nights she experienced, the more tired she felt. Eventually, she lost her appetite and had trouble concentrating at work. She was cautioned by her boss that she wasn’t getting her work done as quickly or as thoroughly as usual. She became sad and her body often ached for no apparent reason. She would come home from work each evening and feel exhausted; she would just go to bed without eating or interacting with her family. She was often tearful but couldn’t put her finger on exactly why she was upset.
After feeling like this for a few weeks, things gradually began to improve again. After two to three months, she was again beginning to feel like nothing could ever go wrong again, life was perfect again, and she was on top of the world.
This cycle repeated itself for most of Alyx’s late adolescent and early adult life. During one of her depressive episodes, her best friend insisted that she get counseling. Alyx was diagnosed with depression and was prescribed an anti-depressant. This resulted in the rapid onset of manic episodes. After several months of constant euphoria, she stopped taking the anti-depressant and began drinking.
After two DUI’s she was court ordered into treatment and her substance abuse counselor diagnosed her with Cyclothymia. The consulting psychiatrist agreed and prescribed a mood stabilizing medication.
Today, Alyx’s mood swings have leveled off, and she is having a happy and successful life. It is likely that Alyx will have to continue taking mood stabilizing medications for the foreseeable future, a fact that bothered her at first. After years of experiencing the uncontrollable mood swings and other negative consequences of Cyclothymia, she feels it is a small price to pay in order to lead a more stable life.
Cyclothymia is often overlooked or misdiagnosed due to the fact that the mood swings are not as severe or long-lasting as with bipolar disorder. People with Cyclothymia don’t completely lose contact with reality, as people with bipolar sometimes do. When you have Cyclothymia, you typically continue to function in your daily life, just not as efficiently. People affected by Cyclothymia often try to tough it out, not knowing that there are effective treatments available. Still others feel that acknowledging any sort of emotional illness is weak and a sign of a flawed character or a personal failing. The truth is, it’s a problem of brain chemistry and can be effectively treated medically.
Few people would reject medical treatment for an ailment like a migraine, but many still believe that mental illness is somehow different, imaginary, or too scary to confront. This is simple ignorance with no place in modern culture. If you think that you or someone in your family may have a bipolar disorder, or if the symptoms described here seem familiar, contact a qualified mental health practitioner for a diagnostic appointment. If you are currently being treated for a mental health condition, do not change your treatment or stop taking your medications without consulting your doctor.
Editor’s Note: This is the second in a series of articles about a mood disorder called Bipolar Disorder. There is much misunderstanding about this mental health problem, and we hear a lot about it these days, so we advise anyone who thinks they may know someone with Bipolar Disorder to consult a licensed and qualified mental health professional who has experience diagnosing and treating it. As always, this article is for informational purposes only and is not intended as diagnosis or treatment.
Last month, I talked about bipolar disorder, which is not a single illness, but really a complex of similar but distinct types of mental illness. I concentrated on identifying the symptoms of bipolar I, and in this article we will discuss bipolar II.
According to the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), bipolar II disorder (also known as bipolar 2 disorder or bipolar type 2) is “characterized by one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.” The key difference between bipolar I and bipolar II is that bipolar II has hypomanic, but not manic episodes. Also, those with bipolar II do not experience psychotic episodes. Hypomanic (meaning “sub-manic”, or “below manic”) looks like a manic episode, but is less intense. Hypomanic behavior looks like driven, high energy, restless, scattered activity.
Characteristics of hypomania include:
Grandiosity (heightened self esteem)
Excess energy (decreased need for sleep)
Pressured speech
Racing thoughts
Distractibility
Tendency to engage in high risk behaviors (such as spending sprees or sexual promiscuity)
Many people who exhibit hypomanic behavior just seem like over-achievers, until they notice that there is little actual achievement. The level of energy is not consistent with the actual output, and there is often a lack of sound judgment.
To people with bipolar II, hypomania feels good. It feels wonderful to have that much energy, to feel so good about one’s self. The sky’s the limit! This can make engaging in treatment, which usually involves some form of mood stabilizing medication coupled with some often radical changes in personal routine, difficult and unappealing. Often, the depressive episode is brought on by the negative consequences of a hypomanic episode. The bills come due and there’s no money to pay them. The sexually transmitted disease or the broken marriage becomes too high a price to pay. At that point, treatment seems more appealing.
A primary obstacle to long-term recovery is that a hypomanic episode feels so good. By comparison, life without it feels dull and boring. As a response, some people who are actually being successfully treated stop taking their medications. Others mistake their short-term success for a cure and stop taking their meds because they feel fine.
I once had a client who was progressing well with treatment. After over a year of stability, she got bored, went off her meds, altered her daily routine, and began experiencing symptoms. During hypomanic episodes, she would happily clean the house, fix and freeze enough meals to last a month, detail both cars, join clubs, and volunteer for election campaigns.
Then, when she ran out of energy, she would become overwhelmed and depressed, and go to bed for a week, dropping her unrealistic obligations, and disappointing those to whom she had committed time and resources. This sudden change frightening her family and during depressive episodes, she became irritable, hypercritical, and controlling with her husband and kids. She was sad and cried for hours at a time, for no apparent reason. She heightened the effect of depression by drinking heavily. When she resumed therapy, she returned to a more stable state of living.
Frequently, people seek treatment when they are in a depressive episode, and during their diagnostic interview, fail to mention that they also have manic or hypomanic episodes. Therefore, the most frequent problem in diagnosing and treating bipolar disorder is to assume that the depression is all there is, and treat it with an anti-depressant. Sometimes this works, but sometimes it makes the problem worse. It is extremely important to seek diagnosis and treatment from someone who has as much experience as possible with bipolar 2.
What can make bipolar disorder so difficult to diagnose is that some people have what is called a “mixed episode” which means that they have both manic or hypomanic and depressive symptoms at the same time. They can also cycle so rapidly between hypomania and depression that it can be very confusing to determine which is being experienced on any given day.
If you think that you or someone in your family may have a bipolar disorder, contact a qualified mental health practitioner for a diagnostic appointment. If you are currently being treated for a mental health condition, do not change your treatment or stop taking your medications without consulting your doctor.
Next month, the last installment in the Bipolar Series: Cyclothymia.
Editor’s Note: This is the first in a series of articles about a mood disorder called Bipolar Disorder. There is much misunderstanding about this mental health problem and we hear a lot about it these days, so we advise anyone who thinks they may know someone with Bipolar Disorder to consult a licensed and qualified mental health professional who has experience diagnosing and treating it.
We hear a lot these days about Bipolar Disorder, often with confusing references and conflicting descriptions of symptoms. Hopefully, what follows here will clear up some of the myths and present the reader with an idea of what it is and how to get help if you know someone who you think may have it.
Bipolar Disorder is what is known in psychiatric terms as a Mood Disorder, implying that it shows itself most often in the appearance of difficulty managing one’s feelings. There are many kinds of Mood Disorders, so not all people who have mood problems have Bipolar Disorder. Also, all of us have difficulty managing our moods from time to time, and this is normal. Just because someone we know is cranky occasionally doesn’t mean he or she has a Mood Disorder.
Labeling people as having Bipolar Disorder has become very popular lately, a label that is often abused by non-professionals in order to sanction friends, family members and co-workers who displease. This practice should be viewed cautiously, as it has no basis in fact. As always, if you think you or someone in your family has this disorder, consult a licensed and qualified mental health professional immediately.
Bipolar Disorder is actually very rare, occurring in only two percent or less of the general population, and is equally as likely in either males or females. Most people who show symptoms first do so in their teens or early 20’s, and those who have the disorder are slightly more likely to have had a parent, aunt or uncle who also experienced Bipolar Disorder. This is not to be confused with the normal mood swings typical of adolescents. Just because your teenager changes from happy to sad in response to the social pressures of school, or changes his or her mind about their favorite food or best friend, doesn’t mean they are Bipolar.
There are several different kinds of Bipolar Disorders, sorted into two major classifications in the Diagnostic and Statistical manual of the American Psychiatric Association, version IV-TR (DSM IV-TR) as; Bipolar I, and Bipolar II.
Bipolar I symptoms include a manic episode, usually followed by a major depressive or a mixed episode.
A manic episode is defined by the DSM IV-TR as three or more of the following symptoms which last more than one week:
“Inflated self esteem or grandiosity,” otherwise known as extreme arrogance and/or believing you’re better at everything than anyone else.
“Decreased need for sleep.”
“Pressured speech,” which means speaking rapidly and with great feeling as though unable to stop.
“Racing thoughts and/or flight of ideas,” meaning having great difficulty focusing during a conversation, quickly shifting from one thought or idea to another, or being unable finishing simple tasks.
“Distractibility,” like being unable to make lunch and eat it, or cleaning the house, or showering and getting dressed without shifting to doing something else.
“Psycho-motor agitation/increased goal directed activity,” such as excessive shopping, compulsive sexual behavior, gambling, or other addictive behaviors.
“Excessive involvement in high risk behaviors,” such as taking up hang gliding, bungee jumping, tight-rope walking, sky diving, street racing, etc.
A Major Depressive Episode is defined as a depressed (sad) mood lasting two or more weeks, loss of interest or pleasure in normally pleasurable events and activities, possibly accompanied by such symptoms as:
Being unable to sleep normally, or sleeping much more than normal.
Marked and sudden change in appetite or sudden weight loss or weight gain of 10 pounds or more.
Decreased energy level.
Feelings of guilt or worthlessness.
Difficulty concentrating on work or school, difficulty making normal decisions.
Thoughts of death or suicide.
A Mixed Episode is defined as both manic and depressive episodes within a week, with symptoms strong enough that the person can’t function, sees or hears voices, is unable to separate what’s real from imaginary, and needs to be hospitalized for their own safety or the safety of others.
Typically, these symptoms are extreme, and obviously noticeable as a departure from what would be considered normal behavior. Herein lies the difficulty; “normal” is a highly subjective thing and is not really a useful concept in describing human behavior. For people who have had Bipolar Disorder for a long time and gone undiagnosed, these behavior shifts may seem “normal”. This is why it is always a good idea to see a qualified mental health professional for an evaluation to determine whether you or someone in your family may have bipolar disorder.
MEN'S HEALTH: Exercise By Robert M. Monger, M.D. F.A.C.P.
I’m a big believer in exercise, and I think it helps you in lots of ways. Only about half of people in the United States exercise regularly, however, and about one in four doesn’t exercise at all.
How much should you exercise? The current recommendation is that you should exercise at least 30 minutes per day at least five days per week, and that you should do different kinds of exercise on a regular basis including aerobic exercise, resistance training, and stretching exercise.
Aerobic exercise involves activities that get your heart beating faster than usual such as walking or riding a bicycle. Swimming and water exercise classes are excellent if you have arthritis. Whichever exercise you choose to do, it should be something you enjoy, and it should be convenient. If you try forcing yourself to do some kind of exercise you hate, or if you join a gym but have to drive across town to get there, you won’t be exercising for very long before you give it up.
There are no specific heart rate recommendations for aerobic exercise. Generally speaking you should be able to carry on a conversation during moderate exercise, and if you are too out of breath to have a conversation, you are working too hard.
Resistance training is exercise designed to increase your muscle strength, such as weight lifting, and it’s recommended you do resistance training at least twice per week with at least 48 hours of rest between sessions. It is important to start with light weights when you are a beginner and to use proper technique. If you are a member of a gym, a trainer can help you get started and show you how to use the machines.
Stretching exercises are movement designed to improve flexibility and prevent injury. Many coaches recommend that you stretch before and after any exercise session.
What can exercise do for you? For one thing, the overall risk of dying is decreased in people who exercise regularly. Exercise also helps with weight management and helps decrease blood pressure, blood sugar, and cholesterol. There is some evidence that regular exercise can prevent certain kinds of cancer as well as dementia.
But perhaps the best reason to exercise is that regular exercise makes you feel better. People who exercise generally report that they have more energy during the day and sleep better at night, than people who don’t exercise. Exercise also helps with stress reduction and depression.
What about testing before starting an exercise program? Most people don’t need any special testing, but if you have concerns you should check with your doctor. People with diabetes or risk factors for heart disease such as high blood pressure or high cholesterol may need an exercise stress test before starting an exercise program.
How do you get started? If you currently do not get much exercise, start by exercising a few minutes at a low intensity such as walking. Try to do something most days of the week, even if it’s just for a few minutes. Then once you’ve established the habit of regular exercise, you can slowly increase the intensity. Your exercise sessions don’t need to be continuous to be beneficial;you should try to exercise for 30 minutes per day, but it can be broken up into three 10 minute sessions.
Ideally a good exercise program involves “cross training,” which basically means doing different exercises on different days. The idea is if you do the same exercise every day, you wind up over-using certain parts of your body and under-using other parts, which can lead to over-use injuries. So, try walking one day, then lifting weights the next day, then swimming then next day, riding a bicycle the next day, etc.
Another tip is to exercise with someone else on a regular basis. If you know your friend is going to be waiting for you at the gym, you’re a lot more likely to get there yourself.
There are certain warning signs to watch for when exercising. If you develop pain or pressure in your chest, arms or neck, nausea or vomiting during or after exercise, lightheadedness during exercise, or inability to catch your breath, you should stop exercising and contact your doctor immediately.
Find something you like to do and go do it. Regular exercise will improve your health, and you’ll look and feel better!
MEN'S HEALTH: Finding Medical Information on the Internet By Robert M. Monger, M.D. F.A.C.P.
The Internet is an amazing resource for finding all kinds of medical information.
The problem with the Internet is that it can be difficult to sort out reliable information from junk science. Even worse, many sites are run by people trying to sell you something, and the information found on those sites is really just a commercial to try to get you to enter in your credit card number.
How do you sort out good information from bad? The following is a list of sites that I’ve found to be reliable and that I can recommend to people who want to find medical information online.
For authoritative articles and in-depth research on health related topics, direct your web browser to http://gowyldnet. This site will get you started with both free medical information sites such as Pubmed and Medline Plus, as well as library-licensed full text articles in EBSCOhost’s Health Source: Consumer Edition database and alternative medicine information in Alt Healthwatch. The Wyoming Libraries provide these resources through funding from the Wyoming State Legislature, and all you need to access them is your library card and PIN.
If you check the Medical Library Association website (www.mlanet.org) there is a list of over 100 medical websites that they consider reliable, including a “top ten list” of what they consider to be the most useful medical websites. Included in their top ten lists are sites sponsored by the American Academy for Family Physicians (www.familydoctor), the National Cancer Institute (www.cancer.gov), and a children’s health site sponsored by the Nemours Foundation (www.kidshealth.org).
Harvard Medical School has a website (www.healthharvard.edu) that has links to several different newsletters, including a men’s health newsletter. They also publish a “Guide to Men’s Health” that is available through their website.
The Mayo Clinic Medical School also has a website (www.mayoclinic.com) that has extensive medical information written for the general public and also offers books and newsletters.
Are you going to be traveling outside the country? The Centers for Disease Control (www.cdc.gov) has a website that provides up-to-date recommendations for immunizations for each country. They also have extensive information about diseases you might run into here in the Unites States, including Swine Flu.
There are many patient advocacy groups that can be accessed through the Internet. These groups generally provide information and education, and organize support groups (both in person and virtual). A patient advocacy organization exists for almost every medical condition you may have heard of (and for lots of conditions you’ve never heard of), and a good way to find the one you’re interested is through the Healthfinders website (www.healthfinder.gov).
Several other good sites are the National Library of Medicine (www.nlm.nih.gov), the National Institutes of Health (www.nih.gov), and for information about HIV/AIDS the University of California San Francisco school of Medicine site (www.hivinsite.ucsf.edu).
What if you come across a website that seems reliable, but you’re not totally sure? A website developed by a university in England (www.judgehealth.org.uk) has guidelines you can use to judge the quality of medical websites, so that you can decide for yourself if a website is worth your time.
Be cautious about for-profit medical websites. Some websites are supported by advertisements for drugs or medical devices and the information found there can be very biased. A few for-profit sites such as WebMD (webmd.com) are reliable, but generally you should most likely be skeptical. Considering that there are so many great not-for-profit sites available, you can probably find all the information you need without having to view ads to get the it.
Did you hear something in the news that caught your attention and want more information? A website called Medical News Today (www.medicalnewstoday.com) offers coverage of the top medical news stories being covered by the popular press. WebMD offers similar news summaries.
Finally, once you’ve found information online, how to you share it with your doctor? Lots of doctors hate it when a patient says, “I read on the Internet…” One way to approach your doctor is to mention the name of the reliable website at which you looked. If you start your sentence, “I read on the Mayo Clinic Website that….” your doctor is much more likely to pay attention.
The Internet is a wonderful resource for finding medical information if you know where to look. Try to use sites that are sponsored by well known institutions and medical schools, and stay away from sites trying to sell you something, and you’ll find a world of great information.
MEN'S HEALTH: Preparing to Go to the Doctor By Robert M. Monger, M.D. F.A.C.P.
Many people are not fully prepared for doctor’s visits and therefore waste precious time gathering information. Before you go to see your doctor there are a few things you can do to make the most of your appointment.
Doctors often have 15 minutes or less to spend with you during an office visit, and the more time a doctor needs to spend gathering information about you, the less time they have to spend on your actual medical problems. By preparing ahead of time, you can get the most out of your visit.
First, know what medications you are taking. The best prepared patients I see have a list of their medications that they bring with them. It’s important to know not only the name of the medications you take but also the dose. For example, know the milligrams, how many times per day you take each pill, and how long you’ve been taking them.
Some medications can be taken for more than one reason, and so it is also important to know why you’re talking each pill. Remember to include any vitamins and herbal medications that you take; they can be just as important as prescription drugs. It can also be helpful to know what medications you’ve tried in the past, and also to know to what medications you are allergic.
How do you remember all this? Write it down! Make a list of all your medications, including both prescription and over-the counter, to hand to the doctor when you arrive at the office. If you’re not sure about your prescriptions, then take all your pill bottles, put them in a bag, and bring them with you to your appointment. Your doctor can go through them with you and help sort them out.
Also, it’s helpful to know what medication refills you need and if your insurance company will pay for a 30-day supply or if you can get a 90-day supply. Lots of times patients leave the office with the wrong prescription and then have to call to get it changed.
Another way to maximize your time with your doctor is to have a written copy of your past medical history to hand to the doctor so that you don’t have to spend your time trying to remember every time you’ve been in the hospital or when you were diagnosed with a certain condition.
Keeping track of your prescriptions is a good example. The best way to do this is to have a written summary of your medical history to hand to your doctor. This should be no more than one or two pages, and include a list of your previous operations and hospitalizations (including when and where they occurred) as well as any medical conditions that you have, such as high blood pressure or diabetes, and when you were diagnosed.
How do you keep track of all this information? One way is to keep a list of your medical history and medications on a home computer. Once you have all the information listed the first time, it’s relatively easy to update as things change. You can simply print it out each time you go to the doctor.
I also encourage patients to keep copies of all of their previous medical records. Doctors’ offices generally keep your records for seven to ten years after your last visit. After that the records are destroyed and the information is lost forever.
You can obtain copies of your records from a doctor’s office or hospital by sending a letter requesting them. The information in any of your medical records is yours to keep, although you may be asked to pay a small copying fee.
You should try to get copies of as many of your medical records as you can and then keep a master file of all of your records at home. Talk with your doctor and ask if they would like any of your previous records. If they do, you can bring them in for the office to copy, but make sure to keep a copy for yourself. Your records may be important to your children or grandchildren someday as well.
In the future, much of this information may be stored online. Google Health, for example, is a relatively new service that offers free online storage of your medical records. Google claims that your information will be secure on their site, and they have tools to help you collect your medical records. If you are computer savvy, it may be something to look into.
Finally, another tip for maximizing your time with your doctor is to make a list of all the questions you want to ask so that you don’t forget anything. You can pull out your list before the doctor leaves the room and make sure everything gets answered.
Unfortunately, when patients don’t know what medications they take and have a difficult time remembering their medical history, doctors spend almost the entire office visits trying to gather information. This leaves very little time for the doctor to actually focus on your current medical problems or answer your questions.
Getting organized before your visit will help you get the most of your appointment with your doctor!
MEN'S HEALTH: Wear Your Sun Screen! By James P. Nelson MA, LPC
According to the Skin Cancer Foundation, the federal government has determined that ultraviolet radiation, both from the sun and from tanning beds can cause skin cancer. “Therefore, along with other sun safety strategies, sunscreens that absorb or block UVR serve as an important protective function.”
The US Environmental Protection Agency (EPA) estimates that the sun causes 90 percent of non-melanoma skin cancers and 65 percent of melanomas. Each year, there are an estimated million or more new cases of skin cancers. “The incidence of invasive melanoma, the most serious form of skin cancer, is estimated to be 59,940 [cases] this year, with deaths estimated to be 8,100,” according to the American Cancer Society.
There have been recent reports casting doubt on the effectiveness of some sunscreens, even calling some of them dangerous. The latest report comes from the Environmental Working Group, which claims that in an investigation of nearly 1,000 sunscreen products, four out of five offer inadequate protection from the sun, or contain ingredients that may pose a health risk.
Dermatologists who reviewed the group’s research say the biggest problem is that it lacks scientific rigor. In particular, they are critical of a sunscreen rating system that they say is “arbitrary and without basis in any accepted scientific standard.”
“What they are doing is developing their own system for evaluating things,” said Dr. Warwick L. Morison, professor of dermatology at Johns Hopkins and chairman of the Skin Cancer Foundation’s photobiology committee, which tests sunscreens for safety and effectiveness. “Using this scale to say a sunscreen offers good protection or bad protection is junk science.”
Sonya Lunder, a senior analyst with the Environmental Working Group, disagrees, saying, “The database and rating system were based on an extensive review of the medical literature on sunscreens.” Of nearly 1,000 sunscreens reviewed, the group recommends only 143 brands. Most are lesser-known brands with titanium and zinc oxide, which are effective blockers of ultraviolet radiation, but are less popular with consumers because they can leave a white residue.
This tells us what to look for in an effective sun screen. Unfortunately, many people make mistakes when it comes to wearing sunscreen. According to the American Cancer Society, properly applying sunscreen and following manufacturer instructions are key to maximum protection. The following are some common mistakes when using sunscreen:
Applying sunscreen after going outdoors. Sunscreen needs to be applied 15 to 30 minutes before going outside to give it time to be absorbed into the skin. Follow manufacturer’s instructions for absorption time.
Not applying enough sunscreen. The application estimate is about one ounce for an adult. Keep in mind that all body parts that will be exposed to the sun need to be protected. Commonly neglected areas include the face, ears, neck and feet.
Not reapplying after swimming. Sunscreen not labeled “waterproof” or “water resistant” does come off while in the water. Even waterproof and water-resistant sunscreen provide protection for only a limited amount of time. Check the label for how often to reapply it.
Not reapplying sunscreen at all. Many people have the misconception that one application of sunscreen will provide all-day protection. Not true. Sunscreen needs to be reapplied generally every two hours or after exercise or water activity. Check the label for specific instructions.
Using sunscreen only when it is sunny. Sunscreen needs to be used in the sun and in the shade. Harmful UV rays can still affect people when it’s cloudy.
Most of us spend more time outdoors in the summer. The intensity of the sun’s rays is greater in the summer. So, wear your sunscreen. If used correctly, it works!
PHARMACY TALK: How to Manage Fever in Infants and Children By Kristin Brauneis, PharmD Candidate
and Amy L. Stump, PharmD, BCPS
Fever is the body’s way of fighting off a bacterial or viral infection. Fevers are usually not dangerous in children and infants over three months of age. Symptoms of fever include being irritable or fussy, not as talkative or active, and feeling warm or hot. Treating a fever will not treat the infection, but will help make the child feel more comfortable by alleviating symptoms.
How can I tell if my child has a fever?
Take your child’s temperature. A temperature above 99.50F (37.50C) orally, 100.40F (38.00C) rectally, 98.60F (37.00 C) axillary (armpit), or 100.00F (37.80C) taken from the ear is considered a fever. If a child has a slightly elevated temperature but is still active and drinking fluids, treatment is generally not necessary.
How should I treat a fever?
Tylenol (acetaminophen) and Motrin or Advil (ibuprofen) are the drugs of choice to alleviate fever in children and are typically safe with few side effects when used at the recommended doses. Aspirin should never be used in children due to its increased risk of Reye’s syndrome. Reye’s syndrome is a serious disease of the liver that causes nausea, vomiting, and low blood sugar.
Tylenol and ibuprofen may be given to infants and children at a weight based dose (which is preferred), or an age based dose. Dosing instructions are indicated on the product box or can be obtained from a primary care provider or pharmacist. Tylenol can be used for children less than 3 months old. Ibuprofen should only be used in children older than six months.
What are the different types of Tylenol and ibuprofen available?
Tylenol is available in a variety of formulations including solution drops (infant drops), elixir (ethanol free), liquid, chewable tablet, disintegrating tablet, caplet, gelcap, geltab, and extra strength. It is important to be aware of the dosages in different formulations. Infant drops are more concentrated compared with children’s suspension. Tylenol suppositories are available but have fallen out of favor due to potential for toxicity. Ibuprofen is available as suspension drops, liquid suspension, chewable tablet, caplet, liquid filled capsule, and regular tablet. Ibuprofen infant suspension drops are also more concentrated than the children’s suspension.
Is it okay to give Tylenol or ibuprofen with food?
Tylenol or ibuprofen may be given with food to decrease stomach upset.
What is the best way to administer Tylenol or ibuprofen?
A medication syringe, dropper, or cup with dosage markers should be used to administer the medication. Tableware or measuring teaspoons can vary between 2 mL (about half a teaspoon) and 10 mL (two teaspoons) which may result in significant under or over dosing.
What if the fever lasts more than 24 hours or the child gets worse?
Call your primary care provider immediately. Also call if the child has vomiting, diarrhea, sore throat, or pain. If a child is less than 3 months old, contact your primary care provider regardless of how long the fever has lasted. Tylenol or ibuprofen should not be used for more than 10 days without contacting your primary care provider.
Can I give other medications with Tylenol or ibuprofen?
Some medications may enhance the toxic effects of Tylenol; it is important to ask your doctor before administering Tylenol with the following medications: Phenobarbital, rifampin (Rifadin®), isoniazid or carbamazepine (Tegretol®). Avoid Tylenol or ibuprofen with ethanol containing products found in adult preparations such as Nyquil®, Robitussin®, or Vicks®. Do not give Tylenol or ibuprofen if your child is already receiving a cough and cold medication that contains Tylenol or ibuprofen.
What are some other things I can do to comfort my child?
If a child is shivering, keep them warm. If not shivering, keep a cool washcloth on their forehead or sponge them in lukewarm water, and give plenty of hydrating fluids to replace electrolytes. Hydrating fluids include Pedialyte®, Enfalyte®, Equalyte®, Oralyte®, and Pediatric Electrolyte®.
Important Notice:The information provided in this column does not constitute formal medical advice. A general article can not account for the individual differences that each person has. Always check with your own doctor or pharmacist to see if the information in this article is appropriate for you. The information contained in this column applies to general medical practice and may not reflect current medical developments. Reading this column does not mean that you have established a pharmacist-patient relationship with Amy Stump, PharmD.
PHARMACY TALK: Keeping Cool and Safe During Summer Heat By Greg Sarchet, PharmD Candidate
and Amy L. Stump, PharmD, BCPS
As the pleasant temperatures we have been experiencing give way to the hot days of summer, it is important to review the effects of extreme heat on the body. During heat stroke the body temperature can quickly rise up to 106 degrees or higher. If not treated, heat stroke can cause death or disability. Some signs of heat stroke are red-hot skin, fast heart rate, headache, dizziness, nausea, or confusion. Usually with heat stroke the body doesn’t sweat. Heat exhaustion is not as bad as heat stroke. Signs to look for with heat exhaustion are weakness, fainting, tiredness, dizziness, headache, fast heart beat, and muscle cramping. People suffering from heat exhaustion will usually be sweating a lot.
If you notice these signs in yourself or someone around you, move inside or to a shady area. If the problem seems to be heat stroke, call 911 for help. If the signs seem more like those of heat exhaustion, try to cool off, get a drink or something cold, take a cold shower, and rest. If the symptoms are still there after one hour call 911.
Now that we have learned about heat stroke and heat exhaustion here are a few tips on how to avoid them:
Drink plenty of fluid during hot weather. Try to drink about two glasses of water every hour to replace what is lost by sweating. If your doctor has put you on a low fluid diet be sure to check with them to see how much water you will need to replace what you lose.
Wear loose, light-colored clothes when going outside. Also, cover up with a wide-brimmed hat and sunglasses to give your skin as much protection as possible. Covered skin is cooler skin during hot weather.
Try to plan your outdoor activities during the coolest part of the day. Usually mornings or evening are best because the temperature isn’t as hot. When outside working or playing, pace yourself and take breaks often. Don’t do as much work as you are used to doing during cooler times.
Remember to keep an eye on those who are the highest risk of heat exposure, the young, the elderly, people with long term diseases, and the disabled. Check on neighbors and friends to make sure they are safe.
Finally, use common sense. Never leave children, elderly or pets in unattended vehicles. Keep parked cars locked so that playing children aren’t tempted to hide inside them. The temperature inside a parked vehicle can reach 20 degrees hotter than the outside air temperature within just a few minutes, even with the windows cracked.
By following just a few simple tips during hot weather, you can protect yourself and those around you so everyone can have a safe and cool summer.
Important Notice:
The information provided in this column does not constitute formal medical advice. A general article can not account for the individual differences each person has. Always check with your own doctor or pharmacist to see if the information in this article is appropriate for you. The information contained in this column applies to general medical practice and may not reflect current medical developments. Reading this column does not mean that you have established a pharmacist-patient relationship with Amy Stump, PharmD.
PHARMACY TALK: Save Money in the Future by Becoming
Familiar with Medicare Part D Today By Greg Sarchet, PharmD Candidate
and Amy L. Stump, PharmD, BCPS
Medicare Part D is a prescription drug benefit plan that began in 2006. The plan was developed to provide prescription insurance to Medicare beneficiaries.
Q: Who is eligible for Medicare Part D?
A: People who are eligible to receive Medicare Part A or are enrolled in Medicare Part B are entitled to receive Medicare Part D benefits. Individuals may sign up for the plan three months before the month they turn 65 until three months after they turn 65. If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If a person elects not to sign up when they become eligible, the next opportunity for them to sign up for Medicare part D benefits will be from November 15 to December 15 of that year. Penalties are given to individuals who don’t sign up when they are first eligible. The penalty will increase the cost of the prescription insurance in the future.
Q: How do I choose a plan?
A: The most important part in picking a drug plan is finding one that covers the medications that you take. A formulary is a list of drugs that each plan will cover. When choosing a Medicare Part D plan a good place to start is determining which plan has all your drugs covered on their formulary. If you can’t find a plan that covers all your medications, then try to find a plan that will pay for your most expensive medications.
Q: How much will my drug coverage cost me?
A: Your cost for Medicare prescription drug coverage will vary depending on which drugs you use and which Medicare plan you join. Payments you may make in a Medicare plan include monthly premiums, yearly deductibles, and co-payments. Monthly premiums are a monthly fee that can vary by drug plan. This fee is the same amount every month. A deductible is an amount you have to pay out of pocket before your drug coverage will “kick in.” A co-payment is set amount that you pay every time you pick up a prescription. This amount can be a percentage of the cost of the medication or a set dollar amount.
Q: What is the donut hole and catastrophic coverage?
A: The donut hole is also known as the coverage gap. During this time you have to pay 100 percent of your prescription costs. The catastrophic coverage is a safety net for people who have very high prescription drug costs.
Q: Where can I get more information?
A: A good place to start would be www.medicare.gov. This website has a lot of good information as well as tools to help you pick which Medicare part D plan would work best for you. A great local resource to take advantage of is Loisjean Hallberg with Wyoming Senior Citizens INC. You can contact Loisjean at ljchey@wyoming.com or by phone at (307) 634-1010.
Even if you don’t use a lot of prescription drugs now, you should still consider joining a Medicare Part D plan. No one plans on becoming ill or needing medications. If you join now you may protect yourself from unexpected prescription drug costs in the future.
Important Notice:
The information provided in this column does not constitute formal medical advice. A general article can not account for the individual differences that each person has. Always check with your own doctor or pharmacist to see if the information in this article is appropriate for you. The information contained in this column applies to general medical practice and may not reflect current medical developments. Reading this column does not mean that you have established a pharmacist-patient relationship with Amy Stump, PharmD.
PHARMACY TALK: Brain Attack By Greg Sarchet, PharmD Candidate
and Amy L. Stump, PharmD, BCPS
Most people are familiar with what a heart attack is and why it is important. Unfortunately not as many people are aware of an equally dangerous attack that can occur on your brain. This “brain attack” is called a stroke.
Q: What is a stroke? A: A stroke is the loss of blood flow to an area of brain. When this happens oxygen is not able to reach the brain and brain cells begin to die. When brain cells die, abilities which are controlled by that part of the brain are lost.
Q: How do I recognize if someone is having a stroke? A: The National Stroke Association has developed a simple way to increase recognition and response to stroke symptoms. If you or someone around you has a stroke just remember to Act FAST.
F = FACE Ask the person to smile. Does one side of the face droop? A = ARM Ask the person to raise both arms. Does one arm drift downward? S = SPEECH Ask the person to repeat a simple phrase. Does the speech sound slurred or strange? T = TIME If you observe any of these signs, it’s time to call 9-1-1.
Q: Why is being able to recognize a stroke important?
A: Stroke is the third leading cause of death in America behind heart disease and cancer. You only get one brain but the good news is you can prevent a stroke from occurring; up to eighty percent of strokes are preventable. Stroke is the number one cause of adult disability. Abilities lost could include memory, movement, and speech. Two-thirds of people who survive a stroke will be left with some type of disability. The severity of a stroke depends on where the brain was damaged and how severe the damage is.
Q: How do mini strokes differ from a stroke?
A: Sometimes transient ischemic attacks (TIAs) are referred to as a “mini stroke.” A TIA is a brief episode of stroke symptoms lasting less than 24 hours. TIAs do not cause brain damage; however, they are a sign of an upcoming stroke so they should not be ignored. Contact your health care provider immediately if you think you have had a TIAs.
Q: Why is it important that a stroke victim seek medical attention immediately?
A: There is a life-saving treatment you can receive if you have had a stroke. This treatment can also decrease the severity of a stroke survivor’s disabilities. Unfortunately, only five percent of stroke patients receive this treatment.
Q: Why are so few patients receiving this treatment?
A: In order to qualify for treatment you must receive the medication three hours after the onset of stroke symptoms. If you delay getting to the hospital, or do not know when you started having stroke symptoms, you will not be a candidate for treatment.
Knowing what to do in a crisis can save your life! For more information go to www.stroke.org.
Important Notice:
The information provided in this column does not constitute formal medical advice. A general article can not account for the individual differences each person has. Always check with your own doctor or pharmacist to see if the information in this article is appropriate for you. The information contained in this column applies to general medical practice and may not reflect current medical developments. Reading this column does not mean that you have established a pharmacist-patient relationship with Amy Stump, PharmD.
Often known as the “sunshine vitamin” because it is produced in the skin following exposure to the UVB rays of sunlight, the science of molecular biology is having a hard time keeping up with Vitamin D. An average of one scientific paper per day is being published about the functions and benefits of Vitamin D, and yet, we have probably just scratched the surface of this natural wonder.
First of all, “vitamin” D is a “secosteroid transcriptional activator,” which places it closer to the function of a pro-hormone or hormone. In supplements and fortified foods, there are two commonly available forms of the vitamin: D2 and D3. Vitamin D3 (cholecalciferol) appears to be as much as three times more effective than D2, so Vitamin D3 is the form that is generally recommended. Vitamin D interacts with over 900 types of tissues throughout the body that contain vitamin D receptors. One of the earliest recognized actions of vitamin D was its ability increase the intestinal absorption of calcium for the maintenance of healthy bones. A deficiency of vitamin D produces a disease known as rickets, causing the bones to become so soft that they can sometimes bend. When rickets was recognized, the vitamin D supplementation of dairy products was initiated to help prevent this condition. Vitamin D, (1,000 IU daily) along with calcium (1,500 mg daily) is also important in the prevention of osteoporosis in older Americans.
In the northern latitudes, vitamin D cannot be produced adequately in the skin during the late fall, winter, and early spring months, so almost everyone north of Los Angeles becomes vitamin D deficient during those seasons without supplementation. Vitamin D appears to benefit the immune system. We have long known that illness such as influenza and colds strike with greater frequency during the fall, winter, and early spring months. Some researchers now suggest that the seasonal distribution of these illnesses may be tied to lower vitamin D levels in these seasons. Recent discoveries about vitamin D’s mechanism of action in combating infections has led Science News to suggest that vitamin D is the “antibiotic vitamin” due its powerful effects on immunity. Vitamin D induces the production of antimicrobial polypeptides, which inhibit both bacterial and viral infections, while at the same time decreasing acute inflammation such as the cytokine storm. Cytokine storm is one of the mechanisms causing influenza deaths, especially in the young and healthy, so a decrease in this risk is a very striking and potentially important benefit of vitamin D. Adequate levels of vitamin D have also been related to a decreased risk of tuberculosis and other respiratory infections as well as a decreased risk of asthma in children.
Foods that contain vitamin D include mainly oily fish, but also egg yolks and fortified dairy products. This is why grandparents were probably given cod liver oil supplements to help keep them healthy. With the possible exception of oily fish, most foods do not supply nearly what the skin makes during exposure to about 15-20 minutes of midday sunshine, which can be several thousand units of vitamin D. Sunscreen incidentally blocks these UVB rays, so the widespread use of sunscreen, although recommended to prevent skin cancer, is possibly associated with lower vitamin D levels in the general population. The American Journal of the Medical Sciences published in July of 2009 a report that vitamin D deficiency is associated with an increased risk of cardiovascular diseases, including hypertension, heart failure, and ischemic heart disease. All people, but especially those with more melanin pigment in their skin, have a difficult time producing enough vitamin D in the northern latitudes due to the weaker sunshine. Because these cardiovascular diseases are all disproportionately higher in African Americans living in North America, researchers are now suggesting that persons with darker skin tones pay special attention to their vitamin D levels. In addition to cardiovascular diseases, a number of studies have suggested that vitamin D deficiency contributes to an increased risk for diabetes mellitus or insulin resistance.
Emerging research has suggested that vitamin D is also critical for a healthy pregnancy and a healthy baby. In an article entitled “Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes” jointly published this year by the Department of Neonatology and Nutrition, Saint-Vincent de Paul Hospital, Paris, France, and Department of Pediatrics, Baylor College of Medicine, the following was discussed and supported. “It appears that vitamin D insufficiency during pregnancy is potentially associated with increased risks of preeclampsia, insulin resistance, and gestational diabetes. Furthermore, experimental data also anticipate that vitamin D sufficiency is critical for fetal development, and especially for fetal brain development and immunological functions. Vitamins D deficiency during pregnancy may, therefore, not only impair maternal skeletal preservation and fetal skeletal formation, but may also be vital to the fetal ‘‘imprinting” that may affect chronic disease susceptibility soon after birth as well as later in life.”
Another pregnancy related outcome recently linked to poor vitamin D status is an increased risk of cesarean delivery. In a case-controlled study published in 2009, women with low levels of vitamin D were almost four times as likely to have a cesarean than women with high vitamin D levels. This finding may be explained by poor uterine muscular performance, as poor muscle performance is a generally recognized symptom of vitamin D deficiency. The amount of Vitamin D supplementation necessary for an optimal pregnancy is debated, but certainly adding 1,000 IU daily in addition to a prenatal multivitamin seems safe and reasonable.
This article has just scratched the surface of emerging vitamin D research. I would like to encourage all to discuss vitamin D with health care providers, and consider adding 1,000 IU of vitamin D daily to current regimen. Parents and grandparents knew something important when they told children to play outside in order get some fresh air and sunshine.
WOMEN'S HEALTH: What Beautiful Babies By Sharon K. Eskam, M.D., F.A.C.O.G.
Expectant parents usually look forward to an ultrasound examination in pregnancy as one of the high points of prenatal care and rightly so. Even though the main objective of an ultrasound survey is to evaluate the fetal anatomy from a medical perspective, one of the great benefits of this examination is to give parents an exciting preview of their baby. There is also good evidence that this enhances prenatal bonding with the baby, not only for the parents, but also for other family members.
However there is some confusion as to the different types of ultrasounds and the reasons for the examination. Any unexpected problem (such as bleeding) may prompt an ultrasound examination at any point but at around 22 weeks gestational age, a fetal anatomical survey is often performed. This is usually done in 2D (two-dimensional) format, as this format gives the most information about the internal anatomy such as the brain, heart, kidneys, bones, and other internal structures.
This example is a side view of a baby in 2D ultrasound. The facial profile and bone structure of the forehead and mid-face is visible. On different planes many of the internal structures of the head and body can be visualized.
In contrast, this is a 3D (three dimensional) view of a baby at a similar gestational age. This image demonstrates the skin surface and is much more comparable to how the baby would look visually if the uterus was equipped with a viewing window.
While the 2D exam gives physicians the most vital information about the internal structure of the baby, similar to the information obtained by a CT or ultrasound scan in an adult, the 3D pictures are often more visually appealing to the parents.
Often on 3D and 4D examinations, parents may get a feeling for not only the baby’s appearance, but also its personality, thus enhancing the bonding experience. 4D is simply 3D in motion, as thus is not expressed any differently than 3D on still pictures.
We at Cheyenne Ob-Gyn strongly believe that every parent deserves a high quality ultrasound that depicts the recommended views of the baby’s internal anatomy. We also make every reasonable effort to provide a high quality 3D keepsake ultrasound portrait of the baby to all of our patients. Cheyenne Ob-Gyn is currently the only Ob-Gyn office within the State of Wyoming that is AIUM (American Institute of Ultrasound in Medicine) accredited for the performance of ultrasound in both obstetrics and gynecology.
Visit the website at www.AIUM.org for more detailed information as to the significance of this program. We are always happy to accept new patients, and also provide ultrasound as a consultation service to Family Practice and other physicians throughout the State of Wyoming. Appointments or consultations may be scheduled by calling 634-5216.
WOMEN'S HEALTH: Herbal & Other Products, Which Should be Avoided in Pregnancy By Sharon K. Eskam, M.D., F.A.C.O.G.
Pregnancy is a very special and wonderful time in the life of any woman, but is also a time that demands extra care and thoughtfulness. Pregnant women may sometimes assume that a product is safe to consume in pregnancy because it is considered an herbal product, or because it is available without a prescription. Nothing could actually be farther from the truth.
There are over 500 plants which have the ability to cause miscarriage or other pregnancy complications, and about 50 of these are commonly used today in the United States. There are others which are frequent ingredients in Chinese or other traditional medicinal herbal products. A few of these products are safe in small amounts but may cause problems when used incorrectly or in large amounts. Among the products which may cause miscarriage or birth defects are the following: Rue, Tansy, Mugwort, Golden seal, Pennyroyal, Feverfew, Gentian, and Cascara Sagrada. Other plants, which are quite toxic and related to miscarriage, may still have other legitimate medicinal uses outside of pregnancy, such as Cohosh (black and blue), Angelica, Hyssop, Squaw vine, and Motherwort.
Certain herbal products may increase uterine contractions and therefore may cause pregnancy complications including premature labor. Products in this category include Mistletoe, Cohosh (both black and blue), Cotton root bark, and Goldenseal. Products used as laxatives also possibly have this effect and should be likewise avoided. Aloes, Castor oil, Senna, and Barberry fall into this classification. Herbal products that may increase blood pressure include Licorice, Ephedra, Mandrake, and Sanguinaria. Products that can have other negative effects in pregnancy include Dong Quai, Horsetail, and Ginseng.
Not only is the list fairly extensive and by no means complete in this short article, but there are also common products that are quite safe when ingested in small qualities, but may become toxic when ingested in very large amounts. This group includes certain spices such as basil, oregano, ginger, and marjoram. As food seasonings or flavorings these plants are quite benign, but ingestion in excessive amounts may cause pregnancy related complications.
We may easily forget that coffee and tea are actually herbal products containing the stimulant caffeine as their use is so prevalent that it is generally not considered medicinal. Consumption of these products in pregnancy is generally considered safe, although large quantities (six to eight cups daily) may be related to increased rates of miscarriage. Massive consumption of caffeine in the second and third trimester of pregnancy may also be related to fetal heart rate abnormalities or hyperactivity in the baby.
Tobacco is another herbal product that unfortunately is commonly used by many pregnant women. The main toxic ingredient in tobacco is nicotine, although more than 70 carcinogenic and dangerous substances have been isolated from cigarette smoke including carbon monoxide, arsenic, cadmium, and lead. In Wyoming the rate of tobacco use is about 20 percent in pregnancy, higher than the national average and sadly prevalent in younger mothers. Tobacco use is known to increase problems in pregnancy such as ectopic (tubal) pregnancy, placental problems, premature delivery, and small birth weight babies. Recent evidence suggests that women who smoke at conception have a significantly increased risk of certain birth defects, such as limb abnormalities in their babies including missing or extra fingers.
Another consideration worthy of concern is that herbal products are not regulated by the FDA, and are commonly imported from foreign countries which may have different health standards, such as China. In recent years, some imported herbal products have been found to be contaminated by toxins such as mercury and lead, which are detrimental to the developing fetal brain.
Non-prescription products, such as aspirin and cold products, may or may not be safe in pregnancy depending upon certain circumstances. In the case of Aspirin, use is generally discouraged in pregnancy, as it affects blood clotting causing a slightly increased risk of hemorrhage. Conversely, Aspirin is sometimes used therapeutically in women who are at increased risk for clotting or pre-eclamptic disorders in pregnancy. Tylenol (acetaminophen) is generally considered safe when used according to package directions, although overdose can cause severe and dangerous liver damage. Motrin (Ibuprofen) is generally discouraged in pregnancy as use in the later stages of pregnancy may cause constriction of an important fetal blood vessel resulting in potential danger for the baby.
Pregnancy should be a safe, happy, and as worry free as possible time for any mother-to-be. The safest course of action for a pregnant woman or a woman considering pregnancy is to always check with a health care provider before ingesting any substance that she is uncertain about the safety of during pregnancy. At Cheyenne Ob-Gyn, we are the pregnancy experts. We are always happy to answer questions, and we are always just a phone call away at 634-5216.
WOMEN'S HEALTH: What You Need to Know About H1N1 (Swine) In fluenza By Sharon K. Eskam, M.D
I am writing this article in early May, as the novel H1N1 influenza strain is currently at a WHO pandemic level 5 of 6 even though it seems to be producing relatively mild disease in the United States. By the time you read this article in June, the situation could be totally different, but some basic things about influenza will remain the same.
The initial news coverage at the end of April was all doom, gloom, with warnings of an imminent global pandemic. This week, even as the disease silently spreads, the news is almost mute. The news media seems to swing between the extremes of panic and total denial, neither of which is a rational approach, and neither provides useful information necessary for people to diminish their risk.
We see seasonal flu every year in the fall and winter, and approximately 20,000 Americans each year die from complications related to it. The case fatality rate (CF) is around 0.1 percent, and aside from the annual flu shot campaign, it is mostly unnoticed.
To understand pandemic influenza a small history lesson is necessary. In 1918 there was another novel influenza virus, to which most of humanity had never before been exposed. This virus first surfaced in March of 1918 and went relatively unnoticed, with a case fatality rate similar to seasonal influenza. It was a form of H1N1 that had probably come from swine, but had developed the ability to efficiently infect humans. It returned with a vengeance in the fall and winter of 1918 with an increase in its case fatality rate of roughly 10 fold or 2-3 percent. It killed more people than WWI, an estimated 50 million people worldwide. Many of its victims were young and otherwise healthy individuals in the prime of their lives, and without the underlying health problems of most influenza victims. It was a nightmare.
In April of 2009, another novel H1N1 virus that was a type of swine influenza surfaced and appeared to infect humans fairly efficiently. It (as of the time of this writing anyway) does not appear to be particularly lethal, and its case fatality rate is currently being compared to that of seasonal influenza. There is a good chance that by the time you are reading this H1N1 is already receding into the background and many people are forgetting about it. If that is the case, we are in a perfect situation to prepare for fall and winter if the virus mutates into a more dangerous form and returns. Viruses have a nasty habit of doing just that, and there are some very dangerous genes in the environment. H5N1 (avian influenza) for example, has a case fatality rate of 60-70 percent. H1N1 has the potential ability to provide a bridge within swine, for the mixing of human influenzas and avian influenzas. No one knows if this will happen, but any mixing with H5N1 is a frightening prospect. While currently this particular H1N1 is sensitive to Tamiflu and Relenza, most H1N1 is not, and this current positive cannot be counted on to persist.
Influenza viruses thrive in cold, dry environments. They do poorly in warm and humid conditions. One study shows that there is low transmission if the temperature is above 68 degrees F and the relative humidity is greater than 80 percent. Decreasing transmission this winter may be as simple as humidifiers in classrooms. The surgical masks people were seen wearing in Mexico City do little to protect the wearer, as influenza viruses are small enough to pass through these masks, but may protect others from the wearer if they cough or sneeze. Most people infect themselves by touching a contaminated surface and then touching their nose, mouth or eyes. Influenza viruses can stay alive on hard surfaces, such as desk counter tops, and even money for about a day. Teach your children not to touch their faces or eat unless they have cleaned their hands well, either by a hand sanitizer or by a simple soap and water washing for at least 15 seconds. (Fifteen seconds is roughly the time it takes to sing the “Happy Birthday” song, which most children know well.)
UV light kills influenza viruses as does Lysol, 70 percent alcohol, and Clorox. The increased UV light and temperature may be the reasons that influenza subsides in the summer, but it may also be related to vitamin D. Vitamin D, which is important to the immune system, is made by skin exposure to UVB light. In the northern hemisphere fall and winter, the UVB light is not sufficient to make vitamin D. Most people subsequently become deficient unless they supplement vitamin D. This is especially true for people with darker skin, as the melanin skin pigment blocks the UVB light. There is some evidence that 1,000 Units of vitamin D supplementation daily in adults may help to decrease the risk of infections including influenza, and that population wide vitamin D deficiency in the winter and spring is the reason that the common cold is associated with those “cold” seasons.
While we may have an effective vaccine this fall, we may also be without one, as vaccines take months to develop, and viruses mutate quickly and many times unpredictably. There is also the lesson of the 1976 swine flu in which only one person died of swine flu in the entire United States, but 25 died from the vaccine. Over 400 people also developed a debilitating neurological complication called Guillain Barre Syndrome, making this a classic case of the “cure” being worse than the disease.
International pharmaceutical giant, Baxter Pharmaceuticals has reportedly received a contract from the WHO to begin producing a vaccine for the current H1N1 along with collaborator, Sanofi Pasteur-Aventis. There were interesting reports concerning Baxter earlier this year. (Google: “Baxter” and “H5N1” together for more information on this and draw your own conclusions.) Incidentally, if you think involuntary quarantine or detention for refusing a vaccine is impossible, look up MSEHPA (Model State Emergency Health Powers Act) PDF and read pages 27-29 very carefully. The Wyoming legislature passed a version of this act in 2003 tacked on to a transportation bill, WY S.F. 11, which was signed into law by the Governor on March 3, 2003.
If virulent influenza surfaces this fall, a few simple steps taken now can lessen its impact. Social distancing means avoiding crowds and situations where infection is likely including shopping trips to replenish various supplies. In such a situation having a good supply of canned and non-perishable food, water and basic medical supplies could be very important. It has been estimated that 70 percent of American households could not survive for one month if confined to their homes without basic infrastructure. While that sounds frightening, it is actually quite preventable with a little simple planning. Tap water may be placed in rinsed soda bottles or juice bottles (not milk containers) and made safe for later drinking by adding two drops of household Clorox per liter or eight drops per gallon. Canned goods are often on sale during the late summer as crops are harvested. Flashlights, candles, matches, and batteries are always good to have on hand.
The lesson of the suffering in New Orleans post Katrina should be a warning against relying upon FEMA or other federal agencies if a worst-case scenario occurs. We in Wyoming have a history of self-reliance and meeting challenges. Hopefully we won’t see a virulent H1N1 or any of its cousins this fall, but if we do, we are better served by being “prepared and not scared.”
