Tag Archives: Jason Singer

‘It is more than a skin blemish’

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Adolescence is a tough time, and blemishes make it all the tougher. (Courtesy Spectrum Health Beat)

By Jason Singer, Spectrum Health Beat


It’s intuitive that acne causes depression, but a massive new study out of England shows just how devastating acne can weigh on people’s psyches.


Researchers, following nearly 2 million men and women in England over a 15-year period, found a 63 percent increase in clinical depression in the first year people had acne compared to those without acne.


Most people were younger than 19 at the start of the study, but they ranged in age from 7 to 50.


“This is not surprising,” said Adele Cadieux, PsyD, a pediatric psychologist with Spectrum Health Helen Devos Children’s Hospital. “Unfortunately acne begins when kids are much more focused on their physical appearance” than other qualities.


Acne is mostly unavoidable: About 85 percent of people will experience a breakout at some point, making it the most common skin condition in the U.S., according to the American Academy of Dermatology. Women are more likely to get acne, and more likely to suffer depression because of it.


There are ways, however, to reduce children and teens’ risk of suffering depression after an outbreak.

Recognize the signs

Acne is a skin condition in which hair follicles become plugged with oil and dead skin cells. This can cause whiteheads, blackheads or pimples on the face, forehead, back, chest and shoulders.


Many people think of acne as a relatively benign condition, but the study shows otherwise, researchers said.


“For these patients with acne, it is more than a skin blemish—it can impose significant mental health concerns and should be taken seriously,” Dr. Isabelle Vallerand, the lead researcher, noted in a statement.


Parents concerned about their children should look for possible signs of depression.


“If (kids) mention they might not want to go social or extracurricular activities, or their child’s behavior or grades start changing, or they seem more withdrawn,” those could be signs the child is struggling with something, Dr. Cadieux said.


“Whether the child identifies whether any of this is related to acne or not, it’s important to take that next step of trying to evaluate what’s contributing to these changes.”


The best way to find out answers: Ask questions, Dr. Cadieux said.


If kids seem reluctant to talk to their parents, take them to a pediatrician or encourage a special teacher, coach or religious figure to talk with them, she said. Sometimes children are more likely to open up to non-family members than they would a parent.

‘You’re on a stage and being judged’

An effective way to gird children and teenagers against depression is to focus on qualities other than physical appearance.


“One of the things that is really important for kids is to focus on aspects of their life that are going well,” Dr. Cadieux said. “Families can be very important in providing some of that feedback, whether it’s their personal qualities, their skills, really anything other than focusing on physical appearance.”


Fostering those other skills and qualities—getting them into music classes, sports leagues, coding or theater camps, depending on their interests—can also help them form an identity around those qualities rather than their physical appearance, doctors said.


If those efforts don’t work, counseling is an option.


The increase in risk of depression is the worst in the first year of acne, and lasts for five years, the study showed. Although still high, the increased risk of depression decreases each year after the first year of diagnosis.


After five years, the increased risk disappears, even if the acne persists. This also isn’t surprising, Dr. Cadieux said.


“As you get older, your maturity level changes,” she said. “In adolescence, you’re so focused on physical appearance, as if you’re on stage and being judged.


“But as you transition into adulthood, you begin to recognize your skills, abilities and successes—you can build your self-esteem on these and not focus as much on physical appearance. These can help reduce the risk of depression.”


Reprinted with permission from Spectrum Health Beat.




Avoid skiing injuries by training now

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By Jason Singer, Spectrum Health Beat


Although the slopes might not be ready just yet, it’s never too early to begin preparing your body for ski season.


Here’s a look at the most common injuries and the best ways to prevent them:

Head injuries

Falls account for 75 to 85 percent of ski injuries, according to the American College of Sports Medicine, and nearly all ski-related head injuries are the result of falling.


The best way not to fall is “making sure you’re in shape,” said Jason Lazor, DO, who specializes in sports medicine for Spectrum Health Medical Group Orthopedics. To do that, start preparing weeks or months before you actually get on the slopes.

The time to start prepping for skiing is yesterday. Prepare your core, muscles and joints for the rigors of skiing and you’re less likely to injure yourself. (Courtesy Spectrum Health Beat)

“You don’t really want to ski yourself into shape,” Dr. Lazor suggested. “When you’re skiing, you’re putting a lot of forces on the body. …The body can best handle those forces when you’ve done some prepping.”


Dr. Lazor recommends a combination of stretching, cardiovascular training like running, cycling and/or swimming, and resistance training focused on the lower extremities to best prepare for ski season. In terms of weight and resistance training, he suggests focusing on quads, hamstrings, abdomen and pelvic stabilizers.


Strong muscles and flexibility increase stability and muscle control, as well as decrease muscle fatigue, which all help to prevent serious falls.


“The more in-shape you are and the more body control you have, the better you can avoid accidents, and when accidents do happen, the better you can protect yourself,” Dr. Lazor said.


The other key for protecting your head is wearing a properly-fitted helmet. You’ll look great.

Sprains and fractures

Two other common injuries when skiing are sprains and fractures. Collisions with objects and other skiers account for between 11 and 20 percent of ski injuries, according to the American College of Sports Medicine, and are the primary cause of fractures.


Skiing “in control” is the best way to avoid those collisions, says Dr. Lazor. Almost every resort posts a Responsibility Code, which reminds skiers to keep an eye on the skiers in front of them, stop in safe and visible places, always look uphill while stopped, and other basic tips for avoiding collisions and ensuring safety.


It’s also important to know your limits, says Dr. Lazor, and not to ski on trails that are above your ability level.

Thumb and wrist injuries

About 30 to 40 percent of skiing injuries are to the upper extremities, according to the American College of Sports Medicine, and “the most vulnerable joint of the upper body is the thumb.”


Skier’s thumb, which is a tear in the ulnar collateral ligament of the thumb, happens when skiers fall on an outstretched hand while still gripping their ski poles.


The best way to avoid this injury—which can lead to pain and weakness when grasping objects—is to avoid falling (see above advice). A second helpful tip is to use ski poles with straps rather than fitted grips.


“(Straps) are associated with fewer injuries,” the American College of Sports Medicine reports.

When to see a doctor

“In general, if you’re questioning an injury, go seek out help,” Dr. Lazor advised.


Signs of serious head injuries are people acting outside their normal character, behaving more emotionally than normal, a sudden sensitivity to light and lingering headaches.


Another advantage to working out before winter arrives, Dr. Lazor said, is people who work out can tell the difference between general soreness following physical activity and pain from an injury. He frequently reminds people that the Orthopedic Urgent Care clinic stands at the ready to assist them as they encounter any sort of orthopedic injuries—on or off the slopes.


Dr. Lazor has a simple mantra for those wondering when to see a doctor: “When in doubt, get checked out.”


Reprinted with permission from Spectrum Health Beat.

‘A little bit of hope’

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Spravato may provide a dose of hope to people who struggle with treatment-resistant depression. (Courtesy Spectrum Health Beat)

By Jason Singer, Spectrum Health Beat


For the first time in decades, doctors have a new weapon to fight serious cases of depression.


Of the 16 million Americans adults living with depression, as many as four million have treatment-resistant depression, which means current treatments such as talk therapy, anti-depressants and electro-convulsive therapy have given them little or no relief.


But recently, the Food and Drug Administration approved ketamine, a fast-acting drug that differs significantly from Prozac, Paxil and other anti-depressants that have been on the market since the 1990s.


Even when antidepressants work, it often takes four to six weeks to kick in, while ketamine only takes several hours to begin showing positive effects, drug trials have shown. The approval is “welcomed news,” said David Franzblau, MD, a psychiatrist with Spectrum Health Medical Group.


“The prospects for ketamine as a long-term treatment remains to be seen,” said Dr. Franzblau, the site chief of the Spectrum Health Integrated Care Campus at East Beltline.


“Trials have shown that the duration of time before symptom-relief is generally much shorter compared to current antidepressants so it at least represents a promising bridge, if not a long-term treatment.”

A stubborn illness

Depression is a mood disorder that affects the way people feel and interferes with their ability to function at home and at work.


It can be associated with the loss of appetite, sleep disturbance, difficulty concentrating, memory impairment, and a loss of motivation and productivity, Dr. Franzblau said.


“Everybody experiences sadness and anxiety,” he said. “It’s the length of time and number of episodes, along with a constellation of other symptoms, that determine whether somebody has clinical depression.”


About one in 16 American adults suffer from clinical depression at any given moment.


“Depression is the most prevalent mental health disorder in the population,” Dr. Franzblau said. “I believe the adverse impacts of even the treatment-resistant variants can be substantially decreased, and thereby improve the quality of life (of all patients), with enough time and a systematic approach.”


The first step in combating depression is consulting with your primary care physician. First-line interventions that a mental health professional might recommend include counseling and medication.


Antidepressants regulate neurotransmitters like dopamine, serotonin and norepinephrine. But the results have been mixed, especially for the up to 33 percent of patients who have treatment-resistant depression.


One current intervention for treatment-resistant depression is electro-convulsive therapy. The benefits of electro-convulsive therapy “were observed accidentally,” Dr. Franzblau said, “like many scientific discoveries.”


The symptoms of depression among patients with epilepsy improved after a seizure.


“The brain is an electrical apparatus: brain activity, thinking, memory and mood regulation like arousal or anxiety, those are all electrical or electro-chemical events,” he said. “So ECT is basically inducing a seizure” in a controlled environment (often in an outpatient setting), helping severely depressed people who haven’t responded to medication.


There are misconceptions about the procedure, and suitable patients have to be chosen, but it can be effective in bringing about a recovery, Dr. Franzblau said. Sometimes one course of this treatment will suffice, or a patient may require periodic maintenance treatment.

From the club to the doctor’s office

Despite $12 billion a year spent on antidepressants globally, suicide rates have increased 25 percent nationally in the last two decades, and are rising in 49 of 50 states.


That’s why any new treatment is welcomed news.


Interest in ketamine—an anesthetic used frequently in hospitals and the battlefield—has grown steadily since the early 2000s.


In 2000, researches at Yale reported that doses of ketamine provided quick relief to seven people with depression.


In 2006, the National Institute of Mental Health documented 18 people with treatment-resistant depression who received the drug intravenously and reported their issues had disappeared almost immediately.


“What seems remarkable is that the drug also seems to help domains other than depression, like anxiety, suicidal thinking, and anhedonia”—the inability to feel pleasure, noted Dr. Carlos Zarate Jr, chief of the National Institute of Mental Health’s experimental therapeutics branch who led the 2006 study.


“It seems to have more broad effects, on many areas of mood,” shared in a New York Times article about ketamine.


Ketamine does have side effects. Ketamine was once a popular drug in the 1980s and 1990s known as Special K, and can cause hallucinations and psychotic episodes in people who are high risk for them. The drug also was less effective in drug trials for people over 65.


The drug maker, Janssen Pharmaceuticals, said the non-generic medication form esketamine, which will be marketed as Spravato, would have less dramatic side effects. Like with all new drugs, Dr. Franzblau said he’ll proceed cautiously because the benefits and costs become clear only after a medication has been used for some time.


“I anticipate I will use it,” he said. “I want to make sure that the benefits outweigh any complications and side effects.”


Esketamine will be administered as a nasal spray. Patients who receive it will have to be monitored for at least two hours, and won’t be allowed to drive on days they receive the drug.


The recommended course will be two days per week for four weeks.


In one drug trial, Janssen reported that those taking esketamine only relapsed into depression 25 percent of the time, as opposed to 45 percent with a placebo. All the people in the study had previously been diagnosed as having treatment-resistant depression, and had failed with other types of treatment.


“Clinical depression represents considerable suffering for the patient and their families,” Dr. Franzblau said. “At worse, it’s a lethal condition, as demonstrated by the rising suicides in our country. New treatments are needed and offer hope.”


Reprinted with permission from Spectrum Health Beat.


10 doctor-approved tips for runners

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Dr. Matthew Axtman, Spectrum Health Medical Group Orthopedics, is the medical lead for the annual River Bank Run, the largest 25K in the country (Chris Clark, Spectrum Health Beat)

By Jason Singer, Spectrum Health Beat

Photos by Chris Clark


Ready to lace up your running shoes?


Springtime usually heralds the beginning of another full season of 5Ks and roadside runners.


Whether you’re training for your first race, want to be more active, or seek to cut minutes off your run times, here are 10 tips from doctors in the know:

1. Set a goal

Setting a goal, along with a timeline to accomplish that goal, is key, said Matt Axtman, DO, a sports medicine specialist with Spectrum Health Medical Group.


Your goal may be running for 30 minutes straight without any walking by May 15, running a 5K in 25 minutes by July 1, or completing a marathon in five hours by September.


A specific goal is the first step toward a runner making strides.

2. Select a program

Photo by Chris Clark, Spectrum Health Beat

After setting a goal, selecting a program and schedule is the next major step.


“The Internet is a wealth of information,” Dr. Axtman said.


Whether it’s an 8-week plan to go from running to walking or beginner’s guides to running 5Ks or 10Ks, Google can help you find pretty much anything. Runner’s World, the popular international magazine and website, also offers a variety of plans for less than $10.

3. Cross training

On days when you’re not running, continue to do athletic activities, whether it’s lifting weights, hiking or other sports.


The most fit athletes are multi-sport athletes, Dr. Axtman said, citing Bo Jackson, a former professional football and baseball player, and Cal Ripken Jr., a baseball Hall-of-Famer known as “The Ironman” because he has the longest consecutive-games-played streak. Ripken was both a soccer and baseball player growing up.


“If you want to be an elite runner, it’s more than just running: It’s weight-lifting, it’s cross-training,” Dr. Axtman said. “We don’t like to see single-sport athletes, they tend to get overuse injuries and fatigue injuries.”

4. Listen to your body

“You’re going to have a normal soreness and achiness (after you run),” Dr. Axtman said. “That muscle fatigue is going to be there.”

Photo by Chris Clark, Spectrum Health Beat

But with rest and stretching, that should go away in no more than a few days, he said. If you have pain, apply ice to the affected area to reduce inflammation. If the pain lingers for more than a week, don’t push it.


And if rest doesn’t cure the pain, see a professional.


“Something that might not be a big deal initially, it could become a big deal and cause major problems if you don’t listen to your body and push it too hard,” Dr. Axtman said.

5. Proper shoes

Footwear is important, Dr. Axtman said. Having the wrong shoe can alter your gait, which can lead to more stress on the ankles, knees and lower back, and ultimately lead to injuries.


His advice? Get your foot and stride evaluated at a store that sells athletic footwear. They’ll help you select the proper shoe.“Also, pay attention to the mileage,” Dr. Axtman said. “Shoes typically last from 300-500 miles. After that, the soles start to wear out, the cushioning starts to wear out, which can alter your mechanics and lead to injury.”

6. Outdoors vs. Treadmill

All running is helpful, Dr. Axtman said.


When coming back from injury, treadmills are recommended because they have more cushioning and bounce, which leads to less impact on the body. But running on the road tends to be more difficult because there are hills and the surface material is less forgiving.


If you choose to run on a treadmill, change the incline to 2 percent, which will approximate the difficulties of running outdoors and keep you on track with your training schedule, he said.

7. Weight lifting

“You don’t need to do intense weight-lifting—you don’t need to be buff and Arnold Schwarzenegger-like,” Dr. Axtman said. “But you want to be strong, and that’ll help you run better times and run longer distances.”


Weight-lifting allows the body to perform at optimum levels.“It’s like driving in your car,” he said. “If alignment is off, your car is going to shake. And that’ll affect gas mileage (and) it’ll burn gasoline more quickly. If there’s one thing with your car, it affects all the other systems. Same with your body.


“When you’re running, you’re using core muscles to provide stability, along with your spine, and you use your shoulders and upper muscles to provide torque. It’s all important. It’ll all help you.”

8. Running partners

Unless you’re incredibly self-motivated, keeping to a training program can be difficult. Studies have shown, however, that running partners not only motivate you to show up to training sessions, but push you to run longer distances.

All running is helpful, Dr. Axtman said. When coming back from injury, treadmills are recommended because they have more cushioning and bounce, which leads to less impact on the body. (Chris Clark, Spectrum Health Beat)

“They make you accountable, so you’re more likely to show up and give 100 percent during your workout because you know that someone else is counting on you,” said Andrew Allden, who coaches women’s cross-country at the University of South Carolina, in an interview with Runner’s World.


And as another Runner’s World article once declared, “Partners make the best alarm clocks.”

9. Hydration

Knowing your “sweat rate” is important: Weigh yourself before and after a run, and calculate the difference and that’s your rate, Dr. Axtman said.


“And that’s typically how much water you can consume,” he said. “You don’t need to equal it, but get close.”


Water shouldn’t be chugged before running because that can cause sloshing, cramping and nausea while you run. It should be sipped in the hours before a run.


And for long-distance runners—say, more than two hours on the road, “we also recommend rehydrating with a sport drink or sport gel because you’re also losing sodium and minerals and want to replenish those,” Dr. Axtman said. “That’ll keep your body working optimally.”

10. Lifestyle changes

Training is wonderful, but significant barriers to serious improvement are diet and sleep habits.


“Altering your eating habits can take your weight down, which is going to put a lot less stress on joints,” says Dr. Axtman. Doctors recommend the Mediterranean diet, which is flexible and sustainable. The important thing is to eat whole foods instead of processed foods.


“If you buy it in a box, bag or can, it’s probably processed,” says Thomas Boyden, MD, a cardiologist with Spectrum Health Medical Group. “If you’re eating vegetables, fruits, whole grains, nuts, beans and still a little bit of animal, the evidence is strong (your health will improve quickly).”


And so will your running times, Dr. Axtman said.


Reprinted with permission from Spectrum Health Beat.

‘Know your farmer’

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By Jason Singer, Spectrum Health Beat

The egg section at the grocery store can be intimidating.

Should you buy brown or white? Organic? Free-range? And what do those words really mean?

From a health perspective, free-range and organic are “definitely better,” said Krista Gast, a Culinary Medicine dietitian with Spectrum Health Medical Group.

Organic is a certification from the USDA that means chickens eat feed grown without pesticides, synthetic fertilizers, fungicides or herbicides. They also can’t be given antibiotics or growth hormones.

Free range typically means uncaged, but the government does not regulate or have a definition for that label.

But even those descriptions have caveats. With organic, “there’s a question as to how well those guidelines are enforced,” Gast said.

And when buyers hear free-range, some may envision chickens running outdoors and eating healthy foods like grass, seeds and bugs.

But that’s not always the case, Gast said.

The only fool-proof method, she said, “is to know the farmer you’re buying from.”

Free-range vs. pasture-raised

Gast often buys her eggs at farm markets, she said.

Many small farmers can’t afford to get organic certification—which can cost thousands of dollars—but still raise their chickens in an organic, compassionate way that larger farms can’t always replicate.

“If it just says ‘free-range,’ maybe the chicken went outside for five minutes,” Gast said of large farms. “That’s not really what a lot of people are envisioning.

“It’s definitely better than caged, but there’s no standard: It’s a loose term,” Gast said. “Free-range means uncaged, but it can also be inside of large warehouses, where the chickens are packed in like sardines. They can’t walk around, can’t nest, can’t spread their wings, and generally don’t have access to the outdoors.

“If they’re raised in that way, with that stressful environment and have all these stress hormones coursing through their bodies, it affects their health. And if we eat it, it can get passed on to us.”

If you can’t get to a farm or farm market to see and hear how the chickens are being raised, look for an “American Humane Certified” label or a “pasture-raised” description on the egg cartons or farm’s website, she said.

“‘American Humane Certified’ means the chickens can access spacious areas, are given access to the outdoors, can run,” she said. “There’s a little more of standard and qualification to it.

“Pasture-raised chickens should have access to pasture space to perform natural behaviors. They should be able to peck for seeds and bugs, and that is kind of a hallmark of pasture-raised.”

As for brown versus white eggs, they just come from a different breed of chicken.

“The quality, nutrition and flavor are no different,” Gast said.

‘A great way to utilize eggs’

Eggs aren’t particularly healthy or unhealthy. They have a lot of cholesterol—185 grams per large egg—but the U.S. removed a cholesterol limit from its dietary recommendations in 2016, saying the limit was based on old, iffy science.

But for egg eaters, the difference between chickens raised in a healthy environment or a stressful environment is significant.

Chickens raised in a warehouse are “fed grains, or sometimes even other parts of chickens that had passed away,” Gast said. “This is kind of the ugly side of the business … and it isn’t heathy for us.”

But if a chicken is raised in a pasture, it eats grass, seeds, marine algae and other natural foods, and it becomes loaded with omega-3s.

Omega-3s are an essential fat that can lower blood pressure, lower the risk of heart disease and strokes, and help prevent arthritis and certain cancers, according to Harvard’s T.H. Chan School of Public Health, so choosing your eggs carefully can have positive effects.

“The benefits from anti-inflammatory foods in your diet, not only eggs, but plant sources like walnuts and other healthy sources of omega 3s, they quell that chronic inflammation in the body that puts us at risk for diabetes, heart disease, cancers and Alzheimer’s,” Gast said.

“Having that low level of chronic inflammation—(partly attributed to) processed foods, a lot of added sugars, saturated and trans fats—can lead to obesity and all kinds of other bad outcomes.”

A good way to tell if the chickens were allowed access to the outdoors is the color of the yolk, said Jim Cross, a certified executive chef and chef supervisor for Spectrum Health Butterworth Hospital.

Chicken eggs that were allowed to feed on seeds, grass, bugs and have an overall healthy diet have a much more richly colored yolk.

“Ducks eat a lot aquatic plants and bugs, so the yolks are a deeper, richer orange color,” Cross said. Healthy chickens produce similarly vibrant eggs.

In addition to choosing eggs from well-raised chickens, what you eat with the eggs determines the overall health value of the meal. Consumers should eat their eggs with vegetables like peppers, kale and spinach to increase their healthiness, as opposed to processed foods and those with saturated fats like bacon, ham or lots of cheese, Gast said.

Cross, whose kitchen prepares 4,000 meals per day, goes through about 1,600 eggs per week. He buys all his personal eggs from local farms whose chickens live healthy lives, and both Cross and the hospital buy eggs from farms that don’t clip their chickens’ beaks—a very painful and unnatural process, he said.

In Cross’s eyes, an underutilized way to eat an egg is using it to make egg-based sauces like hollandaise or creme anglaise.

And if you use those egg sauces on top of well-cooked vegetables or in desserts, you add an additional level of flavor and texture to the meal.

“I don’t think eggs are usually considered for sauces because people think of gravies or cream sauces,” Cross said. “It’s a shame, because it’s a great way to utilize eggs in a different way.”

Reprinted with permission from Spectrum Health Beat.

‘Bystanders are usually the first responders’

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By Jason Singer, Spectrum Health Beat

Photos by Chris Clark

In October 2017, a bullet shattered Paolo Bautista’s arm in a mass shooting at a country music concert in Las Vegas.

As the bullets rained down on concertgoers, Bautista’s quick-thinking sister stuffed her wound with a sock. A stranger pulled a belt tight above the hole. Doctors say this makeshift tourniquet saved Bautista’s life.

Fifty-eight people died in that incident.

As the number of mass shootings in America increases—there were 11 school shootings in the first three weeks of this year—advocates would like to see tourniquet kits made available in public spaces such as schools, shopping malls and arenas.

Doctors believe tourniquets could potentially save lives if they were more readily available in places where mass shootings can occur.

Photo by Chris Clark, Spectrum Health Beat

“In reality, bystanders are usually the first responders,” said Laura Maclam, injury prevention and outreach coordinator for trauma services at Spectrum Health Butterworth Hospital. “Whether it’s three minutes or six minutes or nine minutes that you’re waiting for the ambulance, if you can get care during that time, it can be the difference between life and death.”

Maclam is spearheading Butterworth Hospital’s Stop the Bleed campaign, part of a nationwide effort to increase the number of tourniquets in public spaces and teach citizens how to apply them.

“Just like we train people to administer CPR, we should be training people on how to stop bleeding,” Maclam said.

Past is present

Tourniquets are not a new invention.

As Alexander the Great marched through Asia and northeast Africa during the fourth century B.C., tourniquets were used to staunch the bleeding of wounded soldiers.

They were used by the ancient Romans under Julius Caesar and during the American Revolution under George Washington, and by nearly every army in between.

The most basic tourniquet is basically a tight cord or bandage placed above a wound, which compresses the limb and restricts blood flow. It prevents injured people from quickly bleeding to death.

But tourniquets fell out of favor after World War II, when medical experts blamed prolonged cutoff of blood flow for the number of amputations soldiers were suffering.

Transportation was much worse in those days, and it often took many hours—if not days—for wounded people to get treatment. That’s no longer the case.

The thinking began to change after a study found that 10 percent of combat deaths in the Vietnam War could have been prevented by tourniquets.

Photo by Chris Clark, Spectrum Health Beat

In the 1980s, the Israeli military adopted them. And by 2005, the American military had re-adopted them after a study at an Iraq hospital showed that 87 percent of patients who came in with a tourniquet survived. Among those who were good candidates for tourniquets but didn’t receive them, none survived.

“Tourniquets have come along way,” Maclam said. “When applied properly, they can cause quite a bit of pain, but they stop blood loss very effectively.”

If a tourniquet stays on many hours it could still lead to amputation, but that rarely happens, Maclam said. And even if it did, “loss of limb is better than loss of life.”

Life lessons 

The Stop the Bleed campaign began in 2012 after the Sandy Hook school shooting in which 20 children and six adults were massacred.

“There’s a research project called the Hartford Consensus that came together after Sandy Hook,” Maclam said. “What they realized: Potentially several of those lives could have been saved if some bleeding could have been controlled at the scene.”

The Obama administration heavily promoted the Stop the Bleed campaign. It recommended that tourniquet kits be added to locations where automatic external defibrillators are available—places such as stadiums, business offices, airports, airplanes, hospitals and shopping centers.

Maclam and Butterworth Hospital’s goal is to get tourniquet kits in as many places as possible in Michigan.

They’re providing free or low-cost training to any person or group who wants it. The Spectrum Health Foundation recently donated $10,000 to the campaign.

Maclam said anyone, including children as young as 11, should be taught the basics of how to stop bleeding in an emergency scenario.

Photo by Chris Clark, Spectrum Health Beat

“I think I could teach anyone,” she said. “It can be a little scary—some people don’t want to think about blood or an open would—but it’s just like teaching someone CPR or an AED. It’s a little upsetting, but it’s important.

In the last decade, 40 percent of mass shootings have occurred at education institutions, Maclam said. These types of large gathering places are prime for this sort of campaign.

“So, looking at universities, local schools, the arena, the places you think about where people gather—sporting events, malls, school buses, elementary schools, mass transit,” she said. “There’s a program out of Seattle—they have light rail there—and they taught all their employees. Any opportunity where people can gather, those are probably the best targets and the best places for installation and training.”

Beginning last year, Michigan passed a law requiring students to learn how to administer CPR and AED before graduating. Maclam believes tourniquet kits should be included in that curriculum.

“I think this will be included with that education moving forward,” she said. “In order to graduate, what a great thing to add.”

Reprinted with permission from Spectrum Health Beat.

Turning ‘a disability into an ability’

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Lauren Whitaker is a musician and a lung warrior. (Courtesy photo)

By Jason Singer, Spectrum Health Beat

 

Lauren Whitaker spent long stretches of her childhood in the hospital.

 

Minor colds turned into pneumonia. Even when she wasn’t hospitalized, “my parents basically ran a hospital at home,” she said. They treated her daily with lung exercises, breathing treatments and a special mechanical vest that helps move fluid through her respiratory system.

 

“I was kept away from kids, play dates, birthday parties,” Whitaker, 17, said. “And no preschool. They didn’t want me to be exposed to viruses. I was prone to getting sick often and for a long time. And it happened so much doctors were worried my lungs would become damaged.”

 

Whitaker was born with tracheomalacia, a condition in which the cartilage that keeps open the trachea, better known as the windpipe, is soft and frequently collapses.

 

The condition restricts airflow, which allows fluid to frequently build up in Whitaker’s respiratory system. And when Whitaker coughs, the trachea can close, which prevents the fluid from clearing out.

 

For every 100 children with asthma, about two or three have Whitaker’s condition, said John Schuen, MD, division chief of pediatric pulmonology and sleep medicine at Spectrum Health Helen DeVos Children’s Hospital.

 

There are no good surgical options, Whitaker was told. There are no long-term cures.

 

But after years of suffering—hospitalizations every four to six weeks, missing kindergarten, missing out on playdates with other children—Whitaker and her family found a remedy in an unlikely place.

 

The music room.

 

Whitaker learned to play the flute in fifth grade. She fell in love with it a couple years later. It has not only contained—and mostly solved—her medical issues, it has given her a life path.

 

“She’s really turned a disability into an ability, and it seems to be a tremendous ability,” Dr. Schuen said. “Now she’s on the cusp of launching a brilliant, brilliant career.”

‘Like beavers building a dam’

Dr. Schuen first met Whitaker at age 4. Her family had been struggling with her recurrent pneumonia.

 

“She was in and out of hospital, in and out of our office, in and out of her primary doctor’s office when we first met,” Dr. Schuen recalled. “This has been something that’s been ongoing ever since she was born.”

 

In a healthy person, Dr. Schuen said, the airways produce thin watery secretions, which are constantly moved and which provide defense against germs and trap inhaled particles such as dust and dirt. The secretions eventually move to the throat and mouth, where they’re coughed out or swallowed, thereby protecting the lungs.

 

“The airways are like tiny streams or streamlets that join up to bigger rivers, until they dump into Lake Michigan,” the doctor said. “That would be what’s normal.”

 

But with tracheomalacia, “it’s kind of like beavers building a dam in the middle of the river,” he said. “The water doesn’t move normally. It pools behind the beaver’s dam and it just stands there. It’s great for beavers trying to make a home, but not good for homeowners.”

 

The buildup of fluids in the respiratory system makes infections and bronchitis much more likely, he said.

 

Dr. Schuen had a suggestion: In addition to daily chest exercises and use of the vest, he recommended Whitaker learn a wind instrument. It could strengthen her lung function.

 

If the lung muscles were stronger and produced more air and pushed that air through Whitaker’s system more forcefully, she could more easily blow through that dam, reopening the river of air.

 

Whitaker and her parents took his advice.

 

In fourth grade, her school had a presentation about joining fifth-grade band. Whitaker jumped at the chance.

 

“Dr. Schuen said it would be a good thing for me to play an instrument,” she said. “He said the quality and quantity of life would be better with an instrument. But honestly, I just wanted to do it. Obviously there were health benefits, but I was like, ‘Oh, an instrument, that sounds cool!’”

 

She originally chose the clarinet, but couldn’t produce a sound. But she was one of only two children who could produce a sound on the flute, so she said, “Let’s do this one.”

 

By seventh grade she began taking it seriously, practicing more and more each day. And sure enough, her health slowly improved.

 

“I started getting less sick with colds,” she said. “It wouldn’t hit me nearly as hard. … When I get sick now, it’s just a minor cold, not 15 days in the hospital.”

Aiming for a career

Whitaker has turned her condition into a strength.

 

Before her senior year of high school, she enrolled at Interlochen Center for the Arts, a boarding school with an acclaimed music program.

 

“I went to their summer camp for one week and liked it so much I wanted to stay the whole year,” Whitaker said.

 

The flute program has only 14 students, half of them international. Only two are from Michigan. Most of the curriculum is arts-based. She takes two academic classes and the rest of her curriculum is courses like music theory, band, chamber music and orchestra.

 

She plays the flute as many as eight hours per day. She won two concerto competitions in 2017. And she was recently accepted into the prestigious New England Conservatory of Music in Boston.

 

She hopes to make a career as a flutist.

 

“We keep our fingers crossed,” said her mother, Laurie Whitaker. “It’s a very, very competitive field. But it’s really been neat. She got to play at DeVos (Performance Hall). She got to do a solo. It was quite an honor.

 

“It’s been a wonderful journey,” Laurie added. “Her health has been so great, partially because she’s playing a ton. When she gets sick, she picks up the flute and she feels like she can breathe better. And now she sails through colds and viruses like her peers. … I’m just so proud of her.”

 

Dr. Schuen called Whitaker’s story inspirational. The idea that a disability can be turned into an ability with the right mindset and commitment, he said, could resonate with a lot of patients.

 

“She’s turned a negative into a positive,” he said. “She could wind up going to Juilliard, Boston Conservatory, she could play with national or international fields.

 

“There are many people who have problems like Lauren. But she and her parents were, (1) proactive, and (2), very positive and innovative. When we made suggestions, they ran with it. … Lauren’s an incredible young woman. I’m really happy and excited for all of them.”

 

Learn more at the pediatric specialty care available at Helen DeVos Children’s Hospital, including the nationally-ranked pediatric pulmonology program.

 

Reprinted with permission from Spectrum Health Beat.

‘A brand new kid’

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By Jason Singer, Spectrum Health Beat

 

Christina Lundquist didn’t understand it.

 

Her son, Parker, was falling asleep in the car. He couldn’t stay awake during movies. He was failing his third-grade classes.

 

“His grades did not reflect what we saw his potential would be,” she said. “And I guess that’s kind of where I thought something was wrong.”

 

Parker’s school thought he might suffer from attention deficit disorder, better known as ADD, but Christina disagreed. She used to work in a hospital and the symptoms didn’t align with her understanding of ADD.

 

Christina and her husband, Phillip, paid for private testing.

 

“The psychologist doing the testing said, ‘His IQ did not come back as high as we were expecting. I’ve seen this in the other kids that have sleep apnea,’” Christina recalled.

 

The psychologist referred the family to John Schuen, MD, a pediatric pulmonologist with Spectrum Health’s Helen DeVos Children’s Hospital, for further testing. Sure enough, a sleep study showed Parker had sleep apnea.

 

Dr. Schuen recommended two things: surgically removing Parker’s uppermost tonsils, called adenoids, and putting Parker on a CPAP, a machine that helps certain patients sleep.

 

“His grades went from failing to straight A’s,” Christina said. “His brain was really shutting down from being so tired, so fatigued. …Within a week of being on CPAP, he was like a brand new kid.”

What is sleep apnea?

Sleep apnea is a disorder in which the patient’s breathing stops and starts throughout the night, which disrupts sleep. It affects children and adults in different ways: Children often experience behavioral issues, and adults often struggle with daytime fatigue.

 

“Clues that give parents a hint is kids’ snoring, gasping, pausing when they breathe, mouth-breathing, odd noises in the middle of sleep like coughing or choking … unusual noises like that,” Dr. Schuen said. “Sometimes there are morning headaches. When I say morning headaches, I mean they have headaches that wake them up in the middle of the night or upon waking up right away in the morning.”

 

There are two types of sleep apnea, Dr. Schuen said. Central sleep apnea is when the brain doesn’t tell the body to breathe.

 

The more common version, obstructive sleep apnea, is when the patient tries to breath, but something is blocking or obstructing the airwaves. Hence, the name.

 

About 10 percent of children struggle with persistent, nightly snoring, a sign of sleep apnea. About 3 to 5 percent have obstructive sleep apnea, Dr. Schuen said.

 

“When kids have obstructive sleep apnea, the most common reason behind the apnea is large tonsils and adenoids,” Dr. Schuen said. “Tonsils and adenoids look like golf balls in the back of your throat. The adenoids, (the uppermost tonsils), sit right above roof of your mouth. You can’t see them without special tools.”

 

Obesity, which leads to rings of fat in the throat or chest, can also cause obstructive apnea, Dr. Schuen said. But that didn’t apply to Parker.

 

When children exhibit possible symptoms of apnea, Dr. Schuen orders a sleep study.

 

“The study is this: We have specially designed rooms to help promote a good night’s sleep and let parents sleep next to the child in the same room,” Dr. Schuen said. “In the pediatric sleep laboratory, our sleep tech places different gizmos and gadgets on the infant or child or teen that let us assess what’s going on during sleep. During the course of the sleep study, we’ll measure an amazing amount of information: 16 different channels look at brain waves, the stage of sleep, how often they wake up, when they wake up, oxygen and carbon dioxide levels, and the sleep positions they’re in when possible apnea events occur.”

 

“And if they’re not breathing properly, we can determine the type of apnea and how often these events occur.”

 

Normal people tend to have four to six sleep cycles per night and will wake in between, Dr. Schuen said, but “you’re only awake a millisecond and don’t fully appreciate the fact that you’re awake—then, boom, back to sleep.”

 

But those with moderate sleep apnea can awake five times per hour, while severe sufferers can have 10 or more micro-arousals per hour.

 

“With apnea … particularly in kids, they might not always even awaken from sleep,” he said. “But because their oxygenation may suffer, their carbon dioxide levels may rise, or they may just shift their stage of sleep. It deprives them of good sleep.”

 

Sleep is closely tied to IQ and brain function. A recent study showed that kids who ate seafood slept better, and then performed nearly five points better on IQ tests.

 

During the daytime, kids who suffer from OSA may include “academic difficulties, problems paying attention, impulsivity and rarely, sleepiness,” Dr. Schuen said.

‘A dramatic improvement’

The sleep study showed Parker suffered from moderate to severe sleep apnea.

 

In July, Parker had his adenoids removed—“the typical solution,” Dr. Schuen said—but his apnea didn’t improve. Parker still struggled with focus issues and his behavior late in the day deteriorated.

 

Dr. Schuen ordered a second sleep study in September, which showed Parker still suffered from obstructive apnea.

 

He decided to put Parker on CPAP, a machine with a nasal mask that’s held in place by headgear. The mask is hooked up to a hose, which pushes air through the lungs and opens up the airways while the user sleeps.

 

The results for Parker were nearly instantaneous. Within a week, Christina said, Parker’s academic performance and attitude changed.

 

“He’s just a better child all the way around,” she said. “His behavior is better. He was acting out during that time, and that’s gone away. He was having some anger, especially toward the evening, and that has gone away. He’s sleeping all night long. Before he’d get up several times a night, but not anymore.

 

“And he can tell, if he goes somewhere and can’t use the CPAP, he comes home and says, ‘I need to wear the CPAP.’ He can tell the difference.”

 

Parker shared that he often fell asleep in class and couldn’t pay attention.

 

“I was so tired all the time,” he said. “Now I can stay focused longer. … I can concentrate for an hour now. It used to be 10 minutes.”

 

Parker loves extreme mountain biking with his father. He enjoys math and gym class. He can tell his body has changed with better sleep.

 

“I like gym because we get to run around and do fun stuff,” he said. “But I couldn’t really run as fast as everybody because I was so tired.”

 

Christina, who also suffers from sleep apnea, uses a CPAP machine just like her son. She notices similar improvements when wearing it.

 

“When I do wear it, I feel like I have more energy,” she said. “When I don’t wear it, I’m really cranky in the morning, even after a full night’s sleep.”

 

Parker says it’s a relief to no longer struggle in school.

 

“It made me feel really happy that I’m actually good at something,” he said. “Because I didn’t get much sleep, I couldn’t focus. It was messing me up.”

 

Learn more about the nationally-recognized pediatric pulmonology and sleep medicine program at Spectrum Health Helen DeVos Children’s Hospital.

 

Reprinted with permission from Spectrum Health Beat.