Did you know eating a Mediterranean diet could prevent or even reverse metabolic syndrome, a cluster of risk factors for heart disease, high blood pressure and diabetes? (Courtesy Spectrum Health Beat)
We always hear about the latest fad diet, but don’t we often wonder what really works?
Where should we start? How should we start?
In an effort to develop positive eating habits, many of us have tried several diets over the years. More often than not, these diets provide only short-term solutions that leave us without a strong foundation to make significant, long-term behavioral changes.
The Mediterranean diet, however, isn’t a diet so much as it’s a way of living.
It’s a lifestyle.
Who?
Who should be interested in the Mediterranean diet? You, me and anyone who wants to cook and eat real, healthy, whole, unprocessed foods that bring your weight, health and life back to their prime.
We all know that eating the right fats, reading labels and watching carbs is beneficial, but what does that really mean? We go to the grocery store and we fill up our carts with products we either know, or think we know, are good for us. But are they really?
The Mediterranean diet offers many healthy options, no matter what your taste palate. It balances carbohydrates with grains, good fats and proteins, promoting optimal health and natural weight loss.
What?
The Mediterranean diet is not a “fad,” but a long-term solution: Eat low-glycemic-index foods to help you keep your metabolism steady, feel full longer and eat less.
Low-glycemic foods break down slowly, allowing you to feel satisfied and lose weight at the same time. Examples include: berries, citrus, apples, pears, vegetables, legumes, minimally processed grains, oatmeal, nuts, hummus, kidney beans and chickpeas.
With this type of meal plan, you can still fit in your favorite foods. It’s a way of cooking and eating that’s non-restrictive, so you don’t have to suffer through deprivation.
Based on the cuisine of Greece, Middle East, Southern Italy and Spain, the diet entails less consumption of red meat, sweets and saturated fats that are found in butter or high-fat dairy products.
It’s also a sustainable diet that you can live with. If you like to eat “real” foods, if you shop at farmers markets, or if you eat farm-to-table, the Mediterranean way could be the right plan for you.
It’s worth noting that U.S. News & World Report ranked the Mediterranean diet first place in the “plant-based diets,” according to Best Diets 2013 rankings.
Why?
How about, why not? How about cooking like a Greek islander, or learning a gourmet dish from Spain or Italy? Eating like a Greek is not only healthy, it’s delicious.
Mediterranean foods are rich in antioxidants and they have anti-inflammatory effects on the body. So you can live longer, with less disease.
When?
Realistically, we can follow it every day. And since it’s proven to help us live longer, healthier lives, we should.
By incorporating techniques that improve our eating behaviors—meal planning, food choice, and cooking prep—we can reap a lifetime of benefits.
Where?
In the kitchen, the heart of the home, and just about everywhere else. The Mediterranean diet fits a busy, healthy lifestyle, whether you’re learning the art of cooking at home or you’re working to educate yourself on healthy food choices when dining out.
Let’s not forget: How?
Great taste and zero calories aren’t the only benefits of infused water—it can also help flush toxins, improve skin and enhance mood. (Courtesy Spectrum Health Beat)
Here’s how to follow a low-glycemic diet such as the Mediterranean diet:
You do not need to memorize the glycemic index or count grams of carbohydrates in foods.
Choose fiber-rich, natural carbohydrates, including vegetables, fruits and legumes. Eat them along with a source of protein and a healthy fat.
Eat grain products in the least-processed state possible. Examples include stone ground whole wheat bread as opposed to white bread.
When you have a sugary treat, do it in moderation—and after a balanced meal.
Limit fruit juice and avoid sugary soda. Drink more water. If you don’t enjoy drinking water, try an infused water recipe to add a little excitement to H2O.
In the dark days of winter, we all start feeling caged in and sick of the cold.
It is normal to feel moody, irritable, anxious, sad, depressed, less motivated and even overwhelmed. Some days we would just rather stay in bed and hide from the world under the covers.
If you have the misfortune to suffer premenstrual syndrome, or premenstrual dysthymic disorder, the winter will seem even longer.
Many women suffer mild mood changes such as irritability during their monthly period, after the birth of a baby or around the time of menopause.
In a normal menstrual cycle, estrogen drops slowly before the period starts. Mood changes are tied to estrogen level changes and, as another cycle begins, estrogen rises and mood changes go away.
What are not as common are mood changes that affect relationships, work behavior or lifestyle habits such as use of alcohol. This happens to women who suffer from these premenstrual syndromes.
The way this works is our brain chemical balance is influenced by estrogen. We each are unique in our chemistry. Our brain chemical balance is a big part of our personality—how we cope, our sex drive, our behavior in general.
Banking with brain chemicals
A couple of brain chemicals to pay attention to are gamma-aminobutyric acid and serotonin.
Gamma-aminobutyric acid is the brain chemical that helps with concentration. Some brains do not make enough of it and this contributes to symptoms of attention deficit disorder.
Serotonin is the brain chemical many women depend on to feel normal. One way to think about serotonin is like money in the bank. Picture a bank balance sheet. We make serotonin during sleep.
Due to genetics, some women make more serotonin than others. Serotonin goes in the “deposit” column of your balance sheet. Serotonin is “spent” on each life event. Unresolved issues or emotional challenges like elder parent care or a difficult job situation “costs” more serotonin than, for example, being late for work or not having any clothes that fit.
When estrogen is low—right before a menstrual period—serotonin is spent more quickly. Something needs to happen to rebuild your balance.
A real life example
A patient of mine I’ll call Mary came to me at the urging of friends.
Mary’s behavior had changed significantly. At Mary’s appointment, we assessed the situation. Her periods were slightly irregular, but still came every month. She had been noticing more headaches, bloating and fatigue around the time of her period. Overall, she thought she was doing well but agreed her moods had been worse.
I asked her what had changed in her life. Mary confided that normally when she was in a bit of a bad mood, she could still “act happy.” Lately, however, she seemed unable to control what came out of her mouth. She worried about everything, particularly—and needlessly—about money or future plans.
Too many nights she could not sleep because her mind simply would not stop. Her weight and sex drive had changed for the worse. Mary simply did not feel connected and often felt sad and she did not know what to do about it.
We talked about how brain chemicals and estrogen are closely related. Because of her lower estrogen level right before periods, she spent her brain chemicals too fast. Also because of low estrogen, she couldn’t sleep well before a period, and therefore didn’t make enough brain chemicals.
Mary had fallen into a vicious cycle.
She hesitated to consider taking medication to help. I reminded her that women 75 years ago would have given anything for the medical options we have today. Women now do not have to suffer like in years past. Times have changed for the better.
Mary did choose to take advantage of medicine that raised her brain chemical serotonin. After three months, she felt like her normal self. She was more active, had started walking again every day and wanted to go out with her friends.
So pay attention, ladies: Bad moods can be a symptom of changing hormone levels, but they do not have to be suffered in silence. Please talk to your doctor and get help.
“You can pick the high-protein diet to lose weight, but what you want to think about is the long-term,” Dr. Holman said. “If you go back to normal dieting, you’d put all that weight right back on. I’d recommend picking a diet you can stick with that’s healthy.”
America is deluged with new diets from year to year—high-fat, low-carb, high-protein—but in the end it seems the basics are best: a plant-based diet with fruits and vegetables, whole grains, legumes, nuts, and lean meats and seafood.
Photo by Chris Clark
One diet in particular fits the bill: The Mediterranean.
“You’ll lose weight on it and you can also look at all the positive effects, even much later,” Dr. Holman said.
Ample evidence supports the benefits of a Mediterranean-style diet, including reduced risk of coronary heart disease, stroke and diabetes. Research also suggests that diet plays an outsized role in brain health, while a Mediterranean diet supplemented with olive or nuts is associated with improved cognitive function in older adults.
Calling it a Mediterranean “diet,” in fact, may be something of a misnomer.
“It’s not a diet—it’s not something you go on and quit,” said dietitian Jessica Corwin, a community nutrition educator at Spectrum Health Healthier Communities. “It’s a way of thinking about meals differently.”
Remember the old Clinton-era food pyramid, early 1990s or so? That majestic work of art featured bread, rice, cereal and pasta prominently at the bottom, recommending a carbtastic 6 to 11 servings per day.
Photo by Chris Clark
Some illustrations of the Mediterranean food pyramid, meanwhile, don’t even show food at the bottom. They feature families playing and people interacting.
Seriously.
“The very base of the pyramid is about having fun, living an active lifestyle, and enjoying your food,” Corwin said. “It’s a stark contrast to our culture’s habit of racing through a meal while standing, driving or watching TV.”
As for actual food, the diet places heavy emphasis on leafy greens, vegetables, fruit and whole grains, building out from there.
Said Corwin: “Those following a plant-based Mediterranean Diet plan their meals around the vegetables, rather than the meat. Instead of saying, ‘OK, Monday we’ll have beef with something else,’ the focus switches to, ‘We have a ton of leafy greens we need to use up tonight, so what should we do with that?’”
First add nuts, beans, legumes, seeds, herbs, spices and olive oil, then fish and seafood. Poultry, eggs, cheese and yogurt would come once every other day, or perhaps a few times per week, with red meat and desserts just once or twice a month.
High-protein diets can increase your health risks. Research has shown that people who regularly consume high-protein foods—red meat, in particular—are effectively increasing their lifetime risk of chronic disease.
“Red meat, animal protein, has been linked to increased cardiovascular disease, cancer and diabetes,” Dr. Holman said.
A person with kidney problems, meanwhile, may see their condition worsen on a high-protein diet.
“When you have tons of protein, it’s harder for the kidneys to process and clear it,” Dr. Holman said. “Super-high protein levels can affect your kidneys. Most of the time, healthy people are OK, but if you’re predisposed to problems with your kidneys it can cause you to retain fluid.”
A predictable side effect of the diet craze: People are protein-crazy.
Photo by Chris Clark
“Sometimes people don’t think they’re getting enough protein, but they are,” Dr. Holman said. “Most people overestimate how much protein they need.”
Smart dieting is the first step to positive lifestyle change, but don’t feel pressured to make dramatic changes immediately. Dr. Holman said he’ll first ask his patients to maintain a 24-hour food journal, carefully documenting the foods they typically eat in one day.
“You have to think about lifestyle change,” he said. “They’ll pick one or two things they can change. Sometimes it’s just as simple as cutting out soda. And most people don’t realize how healthy nuts are—they should switch to nuts as one of their snacks.”
The payoffs are real: Studies have shown people who adhere to a Mediterranean diet are about 30 percent less likely to develop cardiovascular disease, Dr. Holman said.
If supermarket circulars influence your grocery shopping, you could be saving money at the expense of your health.
That’s because studies show the offerings are often far from the healthiest food choices.
Researchers looked at a year’s worth of circulars from a small Midwestern grocery chain to see how the nutritional quality of sale items compared to that of the average American diet, which itself scores low.
They found that sales reflected a tendency to eat too much protein and not enough fruits and vegetables.
While 25 percent of sale items were for protein-based foods, only 8 percent were for vegetables and 7 percent for fruits. Worse still, less than 3 percent were for the most healthful dark green, red and orange vegetables.
So it’s important not to let these circulars dictate your eating habits.
Eating healthy doesn’t have to cost as much as you might think. The difference can be as little as $1.50 more per day. Interestingly, some studies have shown that even people who spend the most money on food don’t automatically select healthier choices.
Regardless of budget, the average family spends the biggest chunk of their food budget—about 35 percent—on items like snacks, treats and frozen dinners. That means shifting just some of your shopping dollars may be enough to boost your diet.
Once you’re at the store, carefully shop the perimeter—that’s where fresh foods are displayed—for items that didn’t make the circular.
Buy seasonally to save money, and choose whole foods—like a chicken you cut up yourself—and fruits and vegetables that you wash and slice since precut ones cost more.
Buy in bulk when it makes sense, if for example, canned beans and whole wheat pasta are on sale.
Make a shopping list in advance to avoid impulse buying, but be flexible so you can take advantage of unannounced sales.
For many women, a healthy lifestyle is not enough. They want some kind of treatment to help them feel better and get back to feeling like themselves. (Courtesy Spectrum Health Beat)
Too many women suffer needlessly from symptoms of hormone changes and menopause.
Women want to age with health and vitality, but often are taken by surprise with midlife body changes. It is unfortunate that not enough women know the facts about hormones and options for healthy aging.
We are fortunate these days because there are so many treatment options available.
There has been significant research to help us understand how to individualize these options for each woman depending on her preferences, medical history, stage of menopause and degree of symptoms.
Options abound
The foundation of treatment for the symptoms of menopause is a healthy lifestyle. This is defined by the SEEDS, or seven essential elements of daily success.
Following the SEEDS each day includes:
Eighty ounces of water
Seven hours of sleep
A healthy balance of healthy carbs, protein and fats with only one unhealthy carb treat
A multivitamin and vitamin D
Exercise and stretching
Fiber
Calm breathing and gratitude
For some women, this is enough to feel good through menopause. Twenty percent of women get through their transition with only minimal symptoms.
For many women, however, a healthy lifestyle is not enough. They feel so in the hole of symptoms that they want some kind of treatment to help them feel better and get back into good habits. This is when we talk about the most effective treatment for hot flashes, night sweats, pain with sex, sleep and mood disturbances and decreased sex drive.
Estrogen medication works quickly and is safe for many women. There are many fear-based untruths out there that keep women from using medication that can help them feel like themselves again.
A recent study of hormone use showed that the risk of blood clots has a higher association with oral estrogen use, not with transdermal—absorbed through the skin—estrogen therapy. And for oral estrogen use, the risk was higher with equine estrogen, also known as premarin, and not with the bioidentical, FDA-approved form of estrogen.
Now, for women who have taken premarin for years and do not want to stop, the risk of associated blood clots is mainly in the first year. Switching is possible, but for those women who choose not to, the advice would be to minimize other risks for blood clots by maintaining a healthy weight, staying hydrated, and taking a baby aspirin when on long car trips or plane rides. And always talk to your doctor about your risk.
Bottom line, be informed, make decisions based on facts, and get advice from doctors and other health care providers who are menopause certified. Every woman is different and what works for her or is safe for her may not apply to another.
Test your hormone knowledge
True or false? Hormones will make me fat.
False. Menopause is associated with belly fat, hormone medications are not. Studies show that hormone medication may help with sleep and reduce insulin resistance, so if women do the work to stay healthy, hormones can help maintain a healthy weight.
True or false? Estrogen causes breast cancer.
False. In the aforementioned study, women who were on estrogen because they had a hysterectomy had a lower risk of breast cancer. Estrogen does not cause cancer, but if a woman gets breast cancer, we do not give estrogen in the blood (via a patch or pill) because of concerns it could cause a recurrence. We might prescribe vaginal estrogen, but not systemic. The only women in the Women’s Health Initiative study with more breast cancer were older and on synthetic oral progesterone more than seven years. This study helps us understand safe ways to give hormones and which type.
True or false? Prescription medication is not bioidentical.
False. It is biochemically identical to the estrogen the ovary makes before menopause. We prescribe FDA-approved estrogen and progesterone, meaning it is the same every time you place a patch or take a pill. There is no batch-to-batch variability like in the compounded medications. Insurance will cover the FDA-approved medication.
Hormone guidelines to consider
If the below criteria describes you, hormones could be a safe option:
Less than 10 years from last period
No history of breast cancer
No vascular heart disease (heart attack, or high risk for heart attack)
No history of blood clot in the leg or lung
No prior stroke
No dementia
No metabolic syndrome (combo of high blood pressure, central obesity, high blood sugar, high cholesterol)
These are only guidelines. If there are any questions regarding risk, your provider will bring in partners from cardiology, diabetes, hematology, and cancer care to help guide decisions.
Inflammation is the body’s initial reaction to infection and injury. It can be classified as acute or chronic.
Acute inflammation is a short-term, physiologic response that can occur for minutes or days. It is caused by injury, infection or irritation.
Chronic inflammation is a long-term physiologic response that can occur over weeks, months or years. It’s caused by poor nutrition, obesity, viruses and chronic infection. This prolonged, continuous or chronic inflammation state is what can generate hormones and proteins that can damage your body’s healthy tissues and cells and increase your risk for cancer.
Follow these anti-inflammatory nutrition tips to help lower your risks:
Fill your plate with colorful fruits and vegetables: Five servings of fruits and 2.5 servings of vegetables per day can provide anti-inflammatory phytonutrients and fiber. Fiber can lower levels of C-reactive protein, which is a protein in the blood that signals inflammation. The American Institute for Cancer Research recommends adding plant foods to at least two-thirds of your plate. Make one-quarter of your plate whole grains and starchy vegetables, then make the other half non-starchy vegetables and fruits.
Limit red meat and processed meats: Keep pork, beef and lamb consumption to less than 18 ounces of cooked meat per week, and avoid processed meats, to decrease your cancer risk. Substitute these with other healthy sources of protein, such as beans, lentils, tofu, fish, poultry, low-fat dairy products, high-protein grains and non-processed soy protein.
Consume foods rich with omega-3 fatty acids: Eicosapentaenoic acid and docosahexaenoic acid from fish and alpha-linolenic acid from plant sources help protect your body from inflammation. Tuna, salmon, flaxseed, walnuts and avocado are high in omega-3 fatty acids.
Promote probiotics in your diet: Add a daily serving of cultured dairy foods like kefir, Greek yogurt and yogurt.
Eat fewer foods that are high in calories and low in nutrients: Foods with added sugars and fats can cause weight gain and prevent the intake of antioxidants, vitamins, minerals and phytochemicals.
How does body weight influence inflammation?
Stay physically active: Studies suggest that physical activity reduces inflammation and also helps you lose weight. The American Institute for Cancer Research suggests adding 30 minutes of daily activity, then slowly increasing it to 60 minutes or more of moderate activity or 30 minutes of vigorous activity.
Aim for a healthy BMI and waist circumference: Being overweight or obese can cause chronic inflammation. Fat cells release a variety of hormones, proteins, cytokines and growth factors that increase inflammation. Obesity increases the risk of numerous cancers—pancreatic, kidney, postmenopausal breast, colon, esophageal and endometrial. A healthy BMI is between 18.5 and 24.9. As BMI increases, cancer risk increases. A waist measurement of 31.5 inches or more for women and 37 inches or more for men can also increase your cancer risk.
Gut health has become a prominent focus in 21st-century health care.
The human body has more bacteria cells than human cells, and recent clinical research links an imbalance of bacteria in the gut microbiome (“good” vs “bad” bacteria) to almost every chronic disease—including obesity, diabetes, autoimmunity, depression, cancer, heart disease, fibromyalgia and asthma.
Research also reveals that people with lower amounts of “good” intestinal bacteria had increased fat tissue, insulin resistance, high cholesterol and general inflammation when compared with individuals who have a healthy gut microbiome.
In addition to the ecosystem inside the gut, the intestinal wall itself houses nearly 70 percent of the body’s immune system.
The lining of our intestinal wall is only one cell layer thick, and therefore very susceptible to damage. If that barrier breaks down, due to infection, medication, food allergens or toxins, the body’s immune system is compromised, which can also lead to chronic disease.
The gut also contains more neurotransmitters than the brain, and the two organs are highly connected.
If messages are altered for any reason in any direction—from the brain to the gut or the gut to the brain—you’ll experience health concerns.
At STR!VE, we talk with members about the link between gut health and chronic disease, and use evidence-based lifestyle management strategies as the first and primary method for prevention and treatment.
Lifestyle factors that can damage your gut microbiome
Processed foods and a nutrient-poor diet
Chronic stress
Overuse of medications such as steroids, anti-inflammatories, antibiotics and acid blockers
Actions you can take to improve your gut microbiome
Replace processed foods, sugars and refined carbohydrates with fiber-rich whole foods
Aim for 75 percent of your plate to be plant-based foods and vegetables
Eat fermented foods that contain good amounts of probiotics such as miso, kimchi, sauerkraut and tempeh
Consider a 30-day elimination diet to pinpoint trigger foods
She had been living with breathlessness for years. She even worked as a hospice nurse caring for patients who had stage 4 chronic obstructive pulmonary disease.
And still, Michelle Pekel found herself taken aback earlier this year when a doctor diagnosed her with COPD.
“Hearing the letters ‘COPD’ is a wakeup call—a call that I continually ignored for 35 years,” said Pekel, 50, of Fremont, Michigan.
An umbrella term for a group of lung diseases, including chronic bronchitis and emphysema, COPD is a progressive disease in which the blocked airways make it increasingly difficult to breathe.
According to the Centers for Disease Control and Prevention, more than 15 million people have COPD, although this number may be as high as 25 million because another 10 million people don’t know they have it.
Pekel found herself in that latter category of Americans.
“I’ve smoked a pack a day for 35 years and the symptoms didn’t seem like symptoms to me, as this was my everyday life,” Pekel said. “I always had a shortness of breath, chest tightness and constant coughing. … Although abnormal for a non-smoker, (it) was something that I came to terms with and became my norm.”
Not everyone who has these symptoms has COPD, and not everyone who has COPD has these symptoms, said Sally Wagoner, RN, a tobacco treatment specialist with Spectrum Health Gerber Memorial.
Over time, the symptoms can add up and get in the way of simple tasks. They can make everyday activities like cooking, climbing stairs or carrying a suitcase seem like a challenge.
Courtesy Spectrum Health Beat
As a hospice nurse who knows what stage 4 COPD looks like, Pekel wanted to avoid this fate.
“I have two children and I knew that I needed to quit for me to be in their lives,” she said. “My father died at the age of 59 from a massive heart attack and my mother died at 64 with cancer—and both were smokers.”
By her own account, Pekel had been a committed smoker, burning through a pack of cigarettes a day.
She smoked in the mornings, in the evenings, in the hours in between and even throughout her two pregnancies.
“I can’t imagine what I was polluting my children with,” Pekel said. “My daughter begged me to quit, but I didn’t hear her. Now all I can say is, don’t wait until it’s too late, until you get cancer, a stroke or a heart attack. So many diseases, all because of cigarettes.”
Wake-up call
Not until her own COPD diagnosis—and a little nudge from her pulmonologist at Spectrum Health Gerber Memorial—did Pekel decide she needed to take control.
She registered for the smoking cessation program that Wagoner leads.
“Quitting tobacco is the single most important thing you can do for your health,” Wagoner said. “The Quit for Good program at Spectrum Health Gerber Memorial encompasses all the tools and knowledge you need to be successful in one-on-one, group sessions or family quit programs.”
The program includes weekly meetings that can be adjusted to fit a person’s schedule.
“The weekly meetings are really needed to see higher success,” Wagoner said. “And we recommend eight sessions, which ensures accountability and continued success.”
Pekel said she has smoked her last cigarette.
And while she’s taking her newfound smoke-free lifestyle one day at a time, she credits the special program at Spectrum Health Gerber Memorial for giving her the resources and strength to kick cigarettes for good.
“Without the class, I don’t think that I would have been successful,” she said. “The plan was a huge piece of the puzzle, and my quitting this time was successful—and it wasn’t before.
“I’ve never gone this long before without a cigarette, after 35 years of smoking, never,” she said. “I am amazed at my progress and can see and feel the change. My daughter is 14 and used to complain how her clothes smelled of smoke, and second-hand smoke is real. Now my house smells better, my car, my clothes. It’s a nice bonus to have.”
The journey didn’t come easy.
Registering for the class turned out to be the easy part.
“I had to mentally prepare myself to go to the first session,” Pekel said. “I was very anxious for my first class. I have tried to quit countless times over the years and I would make it two weeks and would be back to smoking again. Nothing seemed to work for me.”
Wagoner helped Pekel begin her journey as a non-smoker by first explaining the effects of smoking and describing the 4,000 chemicals that reside in cigarette smoke—dangerous toxins like ammonia, carbon monoxide, arsenic and formaldehyde.
“You see the commercials and you hear about this all the time, but this was an eye-opener for me,” Pekel said. “I didn’t realize I was smoking such harsh chemicals and toxins and for so long. I couldn’t believe what I was willingly doing to my body. Then it made me also realize the effects that I was having on others around me.”
Pekel said she still had doubts she could quit after that first session in January.
Wagoner was encouraging and enthusiastic, but Pekel doubted she could win the mental war with herself.
Among all U.S. adults who smoked in 2015, about 7 in 10 reported they wanted to quit completely, according to the Centers for Disease Control and Prevention.
Wagoner’s early suggestion—taper off gradually to quit cigarettes—proved more difficult than expected because she couldn’t smoke just two cigarettes a day, Pekel said.
She eventually chose a nicotine replacement. Wagoner worked with physicians to find a replacement method that would work for Pekel.
“I was 15 years old when I first started smoking, and like a lot of smokers I’m anxious about what life would be like without cigarettes,” Pekel said. “Sally didn’t push me, but she did show me how you can live life without cigarettes, how to make a plan for quitting, what to do when I crave a cigarette.”
Easy does it
When the craving for cigarettes sneaks up on her, Pekel said she gets busy.
Photo by Taylor Ballek
She does something with her hands and focuses on an activity such as cleaning the cabinets, cupboards and closets. Her house is now constantly clean and much better-smelling without the cigarette smoke, she said.
“When someone is trying to quit tobacco, old routines and triggers can derail any progress,” Wagoner said. “So what we did was analyze Michelle’s routines, so we could break those up to avoid downfalls.
“For her, mornings were the worst times,” Wagoner said. “And she couldn’t give up her coffee, so we had her have her morning coffee at the kitchen table instead of in front of the TV or computer.”
Pekel said changing the routine meant cigarettes were no longer associated with those old habits.
“After meals was another huge trigger for me,” Pekel said. “And I’m happy to say that after 36 days, that trigger was no longer there. If I can do it after 35 years, anyone can do it.”
Another positive activity Pekel incorporated into her life was exercise.
Before she walked into Wagoner’s quit tobacco program, Pekel had never stepped foot inside Tamarac, the wellness facility west of downtown Fremont that houses an outpatient rehabilitation center, a skincare center and spa, a pool, a café and support programs like tobacco cessation and diabetes education.
There’s also a 12,500-square-foot gym with personal trainers and fitness trainers, as well as more than three dozen fitness classes.
“Now I’m working out at least three times a week,” Pekel said with a laugh. “Tamarac has so many resources, opportunities and support for people like me who want to turn over a new leaf and take our health back. Pound and Zumba are my go-to programs, and I go there three times a week.
“The first class after I quit smoking, I was short of breath within seconds,” she said. “And now after 30 days, I’ve noticed an improvement in my breathing and stamina in the class.”
Time and money
Getting healthy wasn’t the only benefit.
Pekel also saw a financial dividend from quitting cigarettes. Because she no longer smoked, she wasn’t spending $6 per pack, per day. That added up to $42 a week, or almost $170 a month.
The extra money was nice, Pekel said, although nothing beats waking up in the morning and being able to breathe deeply without any shortness of breath.
It’s a miraculous feeling to go through the day with more energy.
“It feels so good to have more energy and a better quality of life,” Pekel said. “The exercise is really helping me stay active and busy. I can enjoy my kids and my pets keep me active.
Photo by Taylor Ballek
Said Pekel: “Being diagnosed with COPD was a real wake-up call that made me think about the consequences if I continued down this path. What would happen to my children and my pets if I would die? It’s a reality that you need to come to terms with. Who would take care of my children? Provide for them? Love them as I do? Smoking isn’t worth it.”
Despite the progress she’s made, Pekel is also a realist.
She knows that after smoking for 35 years, she’ll never regain full function of her lungs.
“I’m 50 years old, but I know that by quitting I can slow the progression of COPD,” she said. “Don’t wait until you get sick. Stop polluting your lungs, pick up the phone and register for a tobacco quit class.
“Don’t get into the mindset that you have smoked too long, that you can’t quit,” she said. “You can and you will—and I’m proof of that.”
Ruth Hourani swept hair from the floor at Profile Salon on a recent Monday, locks of brown, gray, red—each strand a story.
Hourani, a volunteer at Profile Salon’s Beautiful You program, knows that story of picking up the pieces all too well. The cancer story.
Just a short time ago, Hourani sat in those salon chairs.
Once a month, the Grand Rapids, Michigan, salon treats cancer patients to complimentary manicures, pedicures, massages and hair services.
Hourani said she gained so much from the fellowship and pampering at Beautiful You that she wanted to give back. She now volunteers there.
But it’s been a long and frightening journey from then until now.
In March 2016, Hourani underwent a routine mammogram. She went in confident. After all, she performed regular breast exams.
Photo courtesy Ruth Hourani
But when she overheard the receptionist attempting to schedule a biopsy after the mammogram, she knew.
“They had me scheduled for an ultrasound then switched it to a biopsy,” Hourani said. “Right then I thought, ‘Uh-oh, this isn’t going to be good.’”
That was on a Friday. The following Monday, March 14, her phone rang. Results. Results she did not want to hear. She suffered from an aggressive cancer.
“My husband (Thom) put the phone on speaker because I knew I wouldn’t retain much,” Hourani said. “It was like the floor dropped right out of my world.”
“I went from a biopsy to being told to get ready for surgery within a week,” she said.
She had a lumpectomy on her left side on March 31. Doctors also removed two lymph nodes. They were clean, but due to the type of cancer, HER2, she had to undergo six chemo treatments, six weeks of radiation and a full year of preventative treatment called Herceptan.
She tried to keep life as normal as possible for her husband and two sons, Anthony, 21, and Thom, 18.
“My youngest son was a senior in high school and I wanted to make sure his last year was fun for him and it wasn’t all about Mom being sick,” she said. “When I look back, I don’t know how I did it. I was exhausted.”
Hourani threw up a denial defense at first—about the cancer diagnosis, about everything happening in her once-normal life.
“I lost my hair,” she said. “Two weeks from the first treatment they tell you you start losing it and they were dead on.”
Feeling beautiful again
Hourani enjoys sporting a sharp hair style. A friend of hers told her about the Beautiful You program.
“I was hesitant at first because I was so much in denial about what I was going through,” Hourani said. “I went there on one of their off days and had them shave my head. Your hair doesn’t fall out a piece at a time. It falls out in handfuls. If I had to do it over again I would shave my head right away. It was more traumatic to see it fall out.”
“They took me into a special room so I wouldn’t be out in public (for the head shaving),” Hourani said. “I felt very secluded and alone because it is a lonely journey. Unless you’re going through it, no one can understand how you’re feeling or really be there for you.”
Photo by Chris Clark, Spectrum Health Beat
Despite her hesitancy, when she started attending monthly Beautiful You sessions, she gained camaraderie, comfort and compassion.
“I thought I needed something to look forward to,” Hourani said. “I needed to be with people who were OK seeing me without hair. Friendships change throughout this type of journey because most people don’t know how to handle seeing you sick. Most people are used to seeing me very strong. I’m happy hiding my emotions. People had a hard time seeing me otherwise.”
When she walked into the salon, she felt sisterhood.
“Everyone is loving and caring,” she said. “You’re catered to—little things you wish other people would do, they did. If your body hurts, you can get a massage. If your head hurts, and your scalp is sensitive to everything, to have your head massaged just means the world to you.”
Sharing the beauty
She sat with like-minded sisters in salon chairs, bald sisters, sisters who shared emotional and physical pain, sisters who somehow understood the juggernaut in her journey.
She so much wanted to get from Point A to Point B, to slay the fears, to dry the tears. Her salon sisters understood that, too.
“I got to know a lot of the people,” she said. “I didn’t leave there without crying, because you could. You don’t feel beautiful when you’re going through cancer. You’re bloated from treatments and hormones. You gain a lot of weight. You just don’t feel at all attractive to anybody.”
Beautiful You offers wigs for those who wish to wear one. They offer sweet treats and coffees and fresh fruit.
Volunteers make purses and scarves and necklaces for the cancer clients.
“You come home with something so you feel like you were given a gift,” Hourani said.
Now, Hourani is repaying that gift. On her first day of volunteering, she brought in fabric purses that a friend of hers made. Hourani wants to start crocheting again so she can make items for the group, too.
But most of all, she wants to impart her gift of knowledge, of being a cancer survivor, of reaching back to a sister who is at Point A, and helping them to recognize there is indeed a real-life Point B somewhere in the not too distant future.
She wants to help them believe. To trust. To know.
“I’m hoping to be an advocate, to talk to the women about what they can expect,” Hourani said. “I hope that I can make people feel as good as I felt, and feel as beautiful as I felt when I was there.”
Photo by Chris Clark, Spectrum Health Beat
Hourani hugged the receptionists behind the desk, and talked with cancer patients getting pampered.
She wants to be a guiding hand, through her words.
“I would stay after my appointments just to talk to people and be upbeat with them knowing that it just stinks what you’re going through,” she said. “People will ask what you need and you don’t even know what to tell them. It’s almost as if these women just knew. When you walk in there, they know what you need—a massage, pedicure, manicure…They’ve got to see some pretty ugly feet without toenails (they fall out during chemo), but none of them look shocked.”
Hourani wants to reassure, just as other Beautiful You volunteers reassured her.
“They tell you you look beautiful,” she said. “Your family can tell you the same thing, but it comes differently from women who have been through it. They say, ‘We don’t care how you look. We want you to feel awesome today.’”
She misses the pampering, but now she tries to help others feel awesome.
“When you’re going through cancer, you feel as if you are dying, but you don’t want to feel that way,” she said. “It’s sad so many people have been touched by it. If I can help somebody else understand what they are going through after what I have been through, that right there is a blessing.”
Pam Westers, owner of Profile Salon, launched Beautiful You by Profile four years ago. The program started with less than 10 women three years ago and now pampers 60 to 80 cancer patients every Beautiful You Monday.
“It makes their whole month,” Westers said. “They look forward to this appointment because all their other appointments are hospitals and doctors. They love the relationships they make here. It’s almost like a support group when they’re here. It revitalizes them for the whole month.”
Despite the well-known dangers of smoking, the sizable benefits of quitting may be overlooked, a new study suggests.
“These findings underscore the benefits of quitting smoking within five years, which is a 38 percent lower risk of a heart attack, stroke or other forms of cardiovascular disease,” said study author Meredith Duncan, from Vanderbilt University Medical Center in Nashville.
“The bottom line is if you smoke, now is a very good time to quit,” Duncan said in an American Heart Association news release.
Her team also found that it takes more than 15 years from the time you quit until your cardiovascular disease risk returns to the level of those who never smoked—so the sooner you quit, the better.
Cigarette smoking in America is declining and leaving a growing population of former smokers. Earlier studies have hinted that the risk for heart disease lessens within a few years after quitting, but these studies haven’t looked closely at smoking history, including changes in smoking habits.
In this study, Duncan and her colleagues analyzed data on the lifetime smoking histories of nearly 8,700 people who took part in the Framingham Heart Study.
At the beginning of the study, none of the participants suffered from cardiovascular disease. Over 27 years, researchers compared the risk for heart disease among people who never smoked with those who quit.
They found that more than 70 percent of heart disease occurred in current or former smokers who smoked at least 20 pack-years—smoking one pack a day for 20 years.
But smokers who quit within the last five years cut their risk for cardiovascular disease by 38 percent, compared with people who continued to smoke. Moreover, it took 16 years after quitting for the risk of cardiovascular disease to return to the level of never smokers, the researchers found.
The findings were presented at the American Heart Association’s annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.
In 2013, after a five-year battle, Emmy Rickert lost her Aunt Jodi to breast cancer.
Two weeks later, at age 24, Rickert began fighting the same battle.
Rickert was still grieving the loss of her mom, who died of a brain aneurysm just two years prior. Seven months before her mom passed away, Emmy’s dad endured a heart transplant.
Two weeks after Aunt Jodi died, while Emmy worked as a legislative aide for a state senator in Lansing, Michigan, she felt a bruised area on her chest.
“I felt deeper and felt a lump,” Emmy said. “I was an active 24-year-old who exercised regularly. I wondered if I pulled a muscle or dropped something on it.”
Rickert visited her OB-GYN in Lansing.
“She said, ‘You’re 24, it’s probably nothing,” Rickert said. “’Let’s check back in a month.’”
Still tender from the loss of her aunt, she wanted to be sure. She pushed.
“I really credit my aunt with my life,” Rickert said. “I tell people to be their own health advocate, I really had to push my OB to get it checked further. I didn’t feel comfortable having just lost my aunt.”
Rickert talked her doctor into ordering an ultrasound.
“I remember going in thinking ‘whatever journey I’m about to start, help me to be strong enough for it,’” Rickert said. “I just didn’t have a good feeling about it.”
Cancer at 24
Shortly after the Friday morning ultrasound began, the technician stepped out and brought the radiologist in. He immediately ordered a core biopsy.
On Monday, while at her desk at work, she got the results.
“The radiologist called me and told me I had breast cancer,” Rickert said. “He seemed quite shaken. He said, ‘I’ve never had to call a 24-year-old to tell them they have breast cancer.”
I remembered back to when I was a child. Whenever I was sick and had to take medicine, (my mom would) say, ‘Alright, I’m sending the soldiers in to kill the bad guys.’ Every time I watched the chemo flow into my body, I thought of my mom and felt her there. I thought, ‘We’re sending the good guys in to kill the bad guys.’
Emmy Rickert Breast cancer survivor
The words rang in her ears. Just like in the movies. But this wasn’t fantasy. Instead, earth-shattering reality.
Photo by Chris Clark, Spectrum Health Beat
“My ears started ringing after I heard the word ‘cancer,’” she said. “I didn’t hear anything after. My world was spinning at that point. I didn’t understand why this was happening. I hadn’t prepared myself for those words ‘you have cancer.’ I don’t know if anyone can prepare themselves for that.”
Rickert’s mind whirled. She feared not only for her life, but she feared how she would tell her family about the diagnosis. They had already lost so much. So fast.
Right then, right there, she vowed to have the most optimistic and positive attitude possible.
“Having seen my family go through so much, I knew that was the answer,” she said.
Sharing the diagnosis with family
Rickert picked up her younger sister from Central Michigan University. They drove to their family home in Hersey, Michigan, near Reed City.
“I told them, ‘Listen, this is what’s going on,’” Rickert said. “I don’t know the specifics yet, but I’ve been diagnosed with breast cancer. I’m going to fight it and I’m not scared. I don’t want you to be, either.”
She soon learned the specifics. They weren’t comforting.
She had triple negative breast cancer, the most aggressive form of breast cancer. She needed surgery right away.
Because her young age and triple negative diagnosis threw up red flags, she underwent a mastectomy on her left breast.
“They came out and told me it had grown an entire centimeter in the two weeks from the ultrasound to surgery,” Rickert said. “But it had not spread to my lymph nodes yet. They said if I had waited even a matter of weeks, it would be a different story.”
Further testing revealed Rickert carries the BRCA2 gene mutation.
Following surgery, Rickert wanted to go home. Home to Hersey. Home to family. Home to friends.
Knowing there was a new Spectrum Health cancer center in Reed City—the Susan P. Wheatlake Regional Cancer Center, one of six Spectrum Health cancer centers, she teamed up with a Spectrum Health oncologist to fight the foe.
She always wanted to be a mom
But the recommended chemotherapy carried a risk she wasn’t willing to take—infertility.
“The No. 1 fear for me was not losing my hair or being sick during chemo, or even death,” she said. “It was not being a mother. Being a mother has always been my dream.”
She went to a fertility specialist in Grand Rapids, and froze her eggs before commencing chemotherapy.
That decision helped instill a deep resolve. Commitment deepened. She would win this fight. She had to win this fight. For her unborn children.
“That gave me so much hope,” Rickert said. “It gave me the gumption and will to say, ‘I’m going to be a mother now no matter what the fertility outcome is after chemo. That means I need to survive this because I’m going to be a mom.’ I went into it with a suit of armor, with hope and peace.”
Courtesy Emmy Rickert
Only after her eggs were frozen and safely tucked away did she begin chemotherapy. She felt fear as she watched the liquid drip into her veins.
But she also felt a presence. A presence she missed so very much. Her mom.
“Along this whole journey, I could really feel my mom there,” Rickert said. “I remembered back to when I was a child. Whenever I was sick and had to take medicine, she’d say, ‘Alright, I’m sending the soldiers in to kill the bad guys.’ Every time I watched the chemo flow into my body, I thought of my mom and felt her there. I thought, ‘We’re sending the good guys in to kill the bad guys.’ I think that outlook really made a difference for me.”
Unfortunately, chemotherapy made her sick. Very sick. Aunt Jodi did well through chemotherapy. Not so for her niece.
“I was in bed for weeks at a time,” Rickert said. “My dad and little sister would help me to the bathroom. But I was glad it was kicking my butt because I thought it might be kicking cancer’s butt as well.”
‘So much gratitude’
She’s grateful she made the decision to return home.
“Being close to my family and having that support system, being in my hometown and being at Spectrum also made a difference for me,” she said. “I had so many people rooting for me and lifting me up daily. There wasn’t time to feel down. I constantly was uplifted by my doctors and my townspeople, my family and friends.”
After she recovered from chemotherapy, Rickert decided she didn’t want to ever live through the same nightmare. She proactively had her right breast removed.
A year later, she married.
She and her husband, Kelly, conceived naturally. Their daughter, Grace, entered their lives on May 15, 2015.
“I can’t even begin to describe the joy we felt,” Rickert said. “I started to enjoy living. I felt so much gratitude that I survived. Seeing that miracle reminded me even more how precious and fragile life was.”
Having survived her own battle, she turned her energy outward.
“I started to do as many speaking engagements as I could, trying to help as many people diagnosed, or battling cancer, as I could,” she said. “I had gone through this for a reason, and that was to be a bright light for anyone going through this. I felt so driven to let people know there is life after cancer.”
And for the Rickert family, yet another life. Their son, Huck, was born in 2016.
Photo by Chris Clark, Spectrum Health Beat
The children were her light at the end of the tunnel, rainbows at the end of her storm. She calls them her little rainbow children.
But she knows storms can return. That’s why she’s not taking a single moment for granted. None of them.
“I know my cancer could return or something else could happen,” Rickert said. “Life is so precious, miraculous and fragile. I’m constantly being in the moment with my family. I’m helping others see that there is life past cancer and there is beauty in the battle because it makes you so much more aware of the fragility of life and the beauty of life.”
“Her courage and optimism in the face of adversity takes my breath away,” Dr. Smith said. “She is one in a long line of strong women who proudly carry on the legacy of Betty Ford with her candor, willingness to publicly speak of her personal journey, promote screening and early detection and, most of all, help all women take charge of their own destiny.”
Connie Gall, whose fibromyalgia led to her early retirement, has found a new sense of purpose in the adoption and care of older dogs. She’s pictured here with her dog Prince. (Courtesy Spectrum Health Beat)
What do actor Morgan Freeman and Irish singer-songwriter Sinead O’Connor have in common with Connie Gall, a retired college financial aid officer?
All three suffer from fibromyalgia, a chronic pain disorder with debilitating effects.
Gall, 59, has lived with fibromyalgia since 1990. Just four months after having back surgery that year, she was in a car accident that gave her severe whiplash.
The whiplash triggered a series of symptoms: migraines, widespread joint and muscle pain, TMJ trouble, restless legs, burning and cold skin sensations, sleep problems, fatigue, tinnitus and polyneuropathy.
Although Gall’s symptoms began 28 years ago, it wasn’t until 2004 that a rheumatologist connected the dots and diagnosed her with fibromyalgia.
Joshua Brinks, NP, is a family nurse practitioner who works in the Spectrum Health Medical Group East Grand Rapids Family Medicine office and specializes in working with fibromyalgia patients. He and Gall, one of his patients, would like to shed some light on fibromyalgia and debunk some of the common myths associated with it.
Myth No. 1: Fibromyalgia isn’t real, it’s all in your head.
Fact—Fibromyalgia is a central nervous system pain processing disorder.
“It’s a chronic pain syndrome,” Brinks said. “We don’t know what causes it and we don’t have a cure. And so for patients to actually have a name (for their disorder) and to know that … it’s not in their head is very comforting or relieving to them.”
Gall agrees. When she finally found a doctor who “could put a name on what was going on with me, it made me feel validated … and it all started to make sense,” she said. “It’s (your) central nervous system playing games with you.”
In the last decade, more and more health care providers have accepted and acknowledged the reality of fibromyalgia, Brinks said.
“That’s a big step,” he said.
The next challenge is getting more people to understand it.
“It’s hard to explain to people it’s something that’s going on in your brain—that it’s your central nervous system that is controlling how you feel pain,” Gall said.
Myth No. 2: Health care providers diagnose fibromyalgia when they can’t find a “real” diagnosis.
Fact—There are defined diagnostic criteria for fibromyalgia. If a patient meets these criteria and if other diseases are ruled out, the diagnosis is quite clear.
“I can diagnose it in a single visit,” Brinks said, giving two main diagnostic criteria:
Widespread pain above and below the waist on both sides of the body for three months or longer.
Eleven out of 18 classic tender points—again, above and below the waist on both sides of the body.
“There’s no blood test for it, although sometimes we do a blood test to rule out other things that can mimic it,” Brinks said.
Myth No. 3: If your muscles hurt so much, there must be something wrong with them.
Fact—The problem isn’t in the muscles themselves, but in the way the brain is interpreting signals.
“The fact is,” Brinks said, “they’ve done studies to look at the muscle fibers, they’ve looked at biopsies, pathology studies—they can’t find anything wrong here.”
So if you have fibromyalgia, you need to “retrain your brain into thinking that if (your) husband gives (you) a hug and that causes pain, it’s not actually causing harm to the tissue,” he said.
Myth No. 4: Fibromyalgia is a syndrome that affects only women.
These statistics match the patient demographics Brinks sees in his practice.
Myth No. 5: Fibromyalgia is rare.
Fact—Experts estimate that more than 5 million adults in the United States have it.
“It’s actually one of the most common pain disorders,” Brinks said.
Myth No. 6: Fibromyalgia is hopelessly untreatable.
Fact—Although fibromyalgia has no cure, several treatments can be helpful. Patients respond best if they keep a positive attitude and try various treatments to find what works for them. Brinks mentioned several:
Education
This is where treatment should start for every patient, said Brinks, who spends extra time helping newly diagnosed patients understand what he knows about fibromyalgia.
Gall advises people to find out as much as they can about their illness and its symptoms.
“One of the things that helped me was to really learn about it,” Gall said. “I found reading about it, understanding what all these things are, it made them less scary.”
Maximize sleep
Almost all patients with fibromyalgia experience non-restorative sleep.
“We don’t necessarily know why, but … the quality of their sleep is not good, so they wake up feeling tired,” Brinks said. The result: intensified pain.
Brinks tries to help patients develop good sleep behaviors and patterns. He also looks for underlying sleep disorders, such as obstructive sleep apnea, and works to treat them.
Low-impact aerobic exercise
Using an elliptical machine, swimming, riding a bike, going for a fast-paced walk—any of these exercises can improve a patient’s sleep and mood, and they can also reduce pain. “Initially it makes your pain a little worse, but then it gets better with time,” Brinks said. Activities like yoga and tai chi can help, too.
Cognitive behavioral therapy
Try a multidisciplinary approach to treatment, Brinks suggested. Working with a therapist or pain psychologist, some patients experience improvement through relaxation and breathing techniques or through guided imagery.
Drug therapy
Brinks often starts patients on a low dose of amitriptyline, which can help improve sleep and pain. He might also prescribe drugs that block the reuptake of serotonin and norepinephrine in the brain, which can help improve a patient’s mood and reduce pain. Some patients also find that anticonvulsant medicines help reduce pain.
The medications’ effectiveness can vary from patient to patient. “Sometimes it’s just one drug, sometimes it’s a combination,” Brinks said.
But narcotics are not in the mix: “Research has shown over and over again that narcotics do not help fibromyalgia,” he said.
Address underlying mood disorders
Treating anxiety and depression, which often go hand in hand with fibromyalgia, can ease the burden of living with the disorder.
Well-balanced diet
Gall is a firm believer in eating right.
“I don’t know what shape I’d be in if I didn’t eat so well,” she said. “If you let that slide, it’s like a domino effect.”
Overall, attitude makes a big difference for people with fibromyalgia, she said.
“I love life. I think this is a pretty cool place to be, and if you’re always talking to the people you run into about the latest thing your doctor has told you to do, that means you’re concentrating on your condition,” she said.
“Except for those days when I’m screaming through those stabbing pains or curled up like a ball with a migraine for three days, I’m going to try to do the rest of life with a smile on my face,” she said.
Brinks said people who have good attitudes and a willingness to try new things will experience better outcomes.
Three P’s
One strategy Brinks recommends is the “three P’s” approach:
Prioritize—“If you have a day off work and you have 12 errands you want to run, you need to shorten that list,” Brinks said. “What are the things that are most important?” If you take on too much, the stress can impact your sleep and “all of that is like the perfect storm for fibromyalgia to flare up,” he said.
Plan—Based on your priorities, think about how you should approach your tasks and what’s reasonable to expect of yourself.
Pace yourself—If you have three errands to run, don’t try to do all of them in the first two hours. Space them out, Brinks said. Gall told of a day when she didn’t pace herself as she prepared the house for a family gathering. She ended up in so much pain, she could hardly enjoy the party.
Above all, Brinks said, don’t let pain rule your life. Recognize there will be good days and bad, and remind your brain that your pain is “not life threatening—it’s annoying and frustrating, but it’s not going to cause terminal illness,” he said.
Still, it may bring about major life changes. For Gall, the pain and other symptoms of fibromyalgia became so bad she eventually had to retire early from a job she loved.
Looking to fill the void, she and her husband began adopting older dogs from animal shelters, giving them a safe home in their later years. The sense of purpose this gives her is a tremendous help, Gall said.
After decades with fibromyalgia, she’s found the best strategy is to face it with grit and resolve.
“Even if I have to do life in pain every day, ranging from a pain level 3 to a pain level 10, I don’t get to go back and do it again,” she said, “so I’m going to try to be as good at it as I can.”
Depression and anxiety are both common and potentially serious health issues.
In fact, approximately 10 percent of us suffer from one of these disorders, with anxiety being more common in women than in men.
The symptoms of anxiety and depression can go away and come back throughout life if left untreated, and many people find it difficult to admit they have anxiety or depression, thinking there isn’t a cure for what they are experiencing. Fortunately, this couldn’t be further from the truth.
A few months ago, a patient I’ll call Cindy came to see me for her annual visit. She started to talk about her life and how she was feeling down most of the time. She didn’t understand why she was feeling this way—everything seemed like it should be nearly perfect.
Cindy is married, has three great kids and a part-time job she enjoys. She also has a strong group of friends at church and her parents live nearby, so she really feels like she has a good life.
As I probed a bit further with questions, she admitted she had been feeling down for about three months and wondered if she would ever feel like her old self again.
Her kids are doing well, but they are becoming busier with sports, church and school. Of course, this meant that Cindy is becoming busier as well. Although she generally isn’t feeling stressed or anxious, she started noticing some changes in herself: doubting how well she could handle her busy life, losing interest in playing games with her kids, making excuses to avoid going out with friends, cooking less (something she once loved to do), losing interest in sex, and exercising less.
When I asked Cindy about her extended family, she said that her mom had suffered from depression during Cindy’s childhood, and she remembers her mom withdrawing and spending quite a bit of time in her bedroom.
Cindy felt that her mom didn’t really know her and was never supportive of anything she wanted to do. In fact, when Cindy wanted to join the cheer team in high school, her mom would not take her to practice, and never encouraged Cindy to practice on her own or exercise to stay in shape. In addition, her mom always seemed sad and unusually quiet, her dad worked long hours and was never home, and her brother kept to himself most of the time.
Cindy obviously didn’t have a perfect childhood. She once had big dreams of attending college, but those dreams never materialized. She hadn’t thought about her college dreams in a long time, but talking to me about her childhood stirred up some old memories.
On a positive note, Cindy doesn’t drink much alcohol, never smoked, and eats a fairly healthy diet. She also walks the dog around her neighborhood daily, but she didn’t follow an intense workout program. Although she feels OK with her weight, she admits that she would feel better if she lost a few pounds.
Cindy just wanted to know how she could feel better. I certainly understand Cindy’s frustrations, and I was anxious to figure out why she was feeling this way and help her develop a plan to move forward.
I talked with her about anxiety and depression. We first looked at common risk factors of both: genetics (family history), low self esteem, prior traumatic events, abuse or neglect, substance abuse and early onset of anxiety and depression.
Cindy obviously had at least one of these factors in her life. We also talked about other reasons people struggle with these issues.
Anxiety and depression can be related to life events (past and present), but they can also be caused by chemical imbalances in the brain. The analogy I use to explain our brain chemistry goes something like this: brain chemicals are like money in the bank—we only have so much to spend before we run out. We make brain chemicals when we sleep, and genetically (linked to many genes), some of us make more than others. We spend brain chemical on life events, which can cause our supply to get low.
For Cindy, life events (busy kids, busy husband, busy household) were causing her to use her supply of brain chemicals. She also had unresolved issues come to the surface: her kids getting to do things she never did in her childhood, her husband working long hours (just like her dad did), and thinking more about her earlier dreams of college. Add to all of this a little weight gain, and you can imagine the stress Cindy felt.
When we have unresolved issues on our minds (like Cindy did), they cost brain chemicals. Sometimes we may not even be aware of some of the things that are floating around in our head. So, when our friends ask us out for coffee or it is time to make dinner, we don’t have enough brain chemicals to propel us forward. We slowly start to shut down, and life starts to pass us by. Depression can set in and affect not only ourselves, but our family, friends and co-workers as well.
There are several common symptoms of depression that you can look out for, including feeling down most days, losing interest in usual things, sleeping too much or not enough, losing or gaining weight, feeling unable to concentrate or think clearly, and thinking you are not good enough.
If depression is left untreated, other issues can arise, such as anxiety, diabetes, heart disease and thyroid disease.
In order to help Cindy, I first ordered some lab work, which included her blood count, thyroid levels, body chemistry function, vitamin levels, and sugar levels. All came back normal. My hope was that we could work together to treat her symptoms.
Cindy felt a sense of relief just getting her worries off her chest, and she became hopeful when I told her she wasn’t crazy. Her experiences are normal, common and treatable.
I first recommended that she see a therapist who practiced Cognitive Behavioral Therapy to help her sort out issues from her past. I also suggested more exercise in her daily routine, even if it is in small amounts (like 10,000 steps per day).
And, finally, I recommended a short-term course of medicine from a group called SSRIs (Selective Serotonin Reuptake Inhibitors). These drugs increase the brain chemical levels so there is “more money in the bank” to help people like Cindy get back on track and stop the downward spiral.
Cindy came to see me two months later, and she felt much more like herself again—hooray!
She had seen her therapist several times and had started a very low dose of the medication. She also developed a meal and exercise plan that worked well. Her kids and husband had noticed, and commented that they had missed having fun with her and were happy to have her back.
Cindy started to think about her part-time job and maybe quitting so she could go back to school. She had coffee with a friend and realized how good it felt to stay connected and laugh again.
I have no doubt that Cindy will be fine, but she will always have to be aware of her feelings, or even ask a friend to check in with her if she notices any new symptoms Cindy might be displaying. Cindy will inevitably experience stressful events in her future (we all will), so she will always be at risk for starting a downward spiral at some point.
However, with treatment and awareness, she should live a happy, connected and fulfilled life.
Moooove over, Bessie. Cow’s milk has lots of competition.
You can fill your glass with a milk-like beverage made from hemp, coconut, cashews, macadamia nuts, oats, peas, flax, sunflower seeds or quinoa.
And the longtime favorites―soy, rice and almond milks―occupy more and more space on store shelves.
In the past few decades, the growth in milk alternatives has cut into Americans’ dairy milk consumption. Cow’s milk sales have dropped to half the level of the 1980s, according to the Dairy Reporter. Meanwhile, the milk alternatives market is expected to double by 2019.
With more options popping up, picking the right milk to pour on your cereal can be a bit overwhelming for consumers.
Making that choice depends on an individual’s health needs―and taste preference, says Kristi Veltkamp, MS, RD, a dietitian at Spectrum Health Blodgett Hospital.
“If you have allergies, that’s obviously a big driving force,” she says.
For those allergic to cow’s milk, nuts or soy, the growing alternatives market offers some welcome options.
Aside from allergies, nutritional goals should guide your choice, she says.
From the cow
When it comes to nutrition, the old standby rules.
“Cow’s milk by far has the most nutrition in it,” Veltkamp says. “It has protein in it. It has carbohydrates. It has fats. It has a good combination of all three macronutrients. …It’s also a good source of calcium. It has phosphorus and potassium.”
Nutritional guidelines call for whole milk for children from ages 1 to 2. Veltkamp recommends organic milk, free of growth hormones.
Consumers also should consider pastured or grass-fed cow’s milks, she adds, because in consuming an animal product, “you eat what it eats.”
Once children turn 2, they generally can switch to a lower fat milk.
Although adults have long been advised to drink low-fat milk to limit calorie and fat consumption, Veltkamp says recent research casts doubt on that practice. A 2016 study in the journal Circulation, for example, found people who consumed full-fat milk and dairy products had lower diabetes rates.
Sugars and protein
People opt for an alternative to cow’s milk for a variety of reasons―they may be lactose intolerant, allergic to milk or following a plant-based diet.
Typically, the plant-based alternatives are created by blending up the main ingredient with water and straining out the pieces.
“Then, they add a thickener. Otherwise, it would be very watery,” Veltkamp says, “Then they add vitamins. Essentially, it’s flavored water.”
Many plant-based milks “are a nice low-calorie option if you are trying to watch your calories or your carbs,” Veltkamp says.
But stick with an unsweetened version, she advises. The flavored versions of popular drinks, like soy and almond milk, can deliver more sugar and calories than cow’s milk.
And remember to check the nutrition facts. Rice milks typically are relatively high in carbs.
Milk produced by cows does contain lactose, a naturally occurring sugar. But that differs from the sugar added to sweetened milk alternatives.
“It is processed differently in the body,” Veltkamp says.
Most of the alternatives have little protein―just a gram or 2 per serving. For those looking for a higher protein content, soy milk and pea milk are good alternatives. They contain 7 or 8 grams of protein in a cup.
Calcium and cooking
Most of the plant-based milks are calcium fortified and deliver 30 to 50 percent of the recommended daily allowance for adults.
If lactose intolerance poses a problem, consumers can buy lactose-free milk.
“They add an enzyme called lactase, and it breaks down the lactose in milk,” Veltkamp says. “It’s kind of like it’s predigested.”
Despite the thinner consistency, Veltkamp says milk alternatives work well in recipes.
“I use almond milk in any recipe that calls for milk, and I don’t have any issues,” she says.
If you’ve experienced depression, it may help to know you aren’t alone.
More than 16 million people experience at least one major depressive episode at some point during the year, according to the National Institute of Mental Health.
The positive angle on this: We know of many things that can help fight depression, including therapy, exercise and medication.
Sometimes the treatment depends on the circumstances.
Depression after having a baby, known as postpartum depression, is more common than people may realize.
About 15 to 20 percent of women in the U.S. experience major depression after having a baby. This type of depression is different from the more common baby blues, which about 80 percent of new mothers will experience.
Baby blues pertains to hormonal changes from having a baby, as well as lack of sleep with a new baby and a new role that comes with new pressures and other circumstances.
Postpartum depression in moms, however, is more extreme and can interfere with a woman’s ability to care for herself and her family. Severe symptoms usually require treatment.
Over time, we have come to realize that postpartum depression can happen quite often. Many moms will suffer in silence, however, because they don’t know what signs to look for or they don’t know what to do about it even when they know what’s happening.
I should also point out that women can also suffer from depression during pregnancy, not just afterward. An estimated 14 to 23 percent of pregnant women will struggle with depression, according to the American College of Obstetricians and Gynecologists.
While it may seem reasonable to assume this depression results from a pregnant mom’s changes in hormones, this is only partly true.
Depression in pregnancy can also be triggered by an unplanned pregnancy, partner violence, a previous pregnancy loss, relationship issues and more.
Some of the symptoms to watch for:
Thoughts of death or suicide
Sleeping too little or too much
Sadness that won’t go away
Inability to concentrate
Loss of interest in things you once enjoyed
Anxiety beyond what might be considered a normal amount
Feelings of guilt
No desire to eat or eating all the time
Extra stress
Some of these symptoms are normal with pregnancy, so it’s important to remember that you need to watch for extremes.
Make sure you talk with your OB provider if you’re worried about depression or anxiety during pregnancy.
A study published earlier this year in JAMA Pediatrics found evidence suggesting that depression during pregnancy could result in poorer emotional and behavioral outcomes in children.
Of 101 pregnant moms surveyed for the study, 42 met the criteria for mild depression. Researchers then took MRIs of each baby’s brain at 1 month of age.
“Our study suggests that moderate levels of maternal depression and anxiety symptoms during pregnancy were associated with variations in the brain’s white matter microstructure or ‘wiring’ at one month of age,” said lead author Douglas Dean III, of the University of Wisconsin-Madison.
Up to 1 in 5 pregnant women experience depression and anxiety, according to the report, adding: “Mounting evidence links these conditions with poorer emotional and behavioral outcomes in children.”
Other studies, meanwhile, have found that untreated depression during pregnancy is linked to lower baby weight at birth.
Bottom line: If you are pregnant and feeling symptoms of depression or anxiety, please talk to your OB provider.
In one of our recent childbirth classes, a mom-to-be asked me for some advice on the best ways to bring her new baby into the home, since they have two dogs.
Now, my family doesn’t have inside animals at home, so I don’t have any personal experience.
But this struck me as a great question, and it led me to ask around and search online for some helpful tips. I found plenty of great information.
To start, you should assess your dogs—or even your cat, if that’s the case—to get a handle on their experiences and disposition around small children.
Has your pet ever been around small children before? How did the pet do?
One site I looked at recommended preparing your dog at least four months in advance for the arrival of the baby. You can do this by showing the pet the baby areas for play and sleep, the baby’s clothes, and so on.
When you’re one to two months from the delivery date, adjust the dog’s normal routine. You’ll have to do this anyway if you plan to have the dog sleep somewhere else, or if the dog’s access to certain areas will be limited because there’s a new baby in the house. It’s best to ready the dog in advance.
If you have time—and if your dog doesn’t already know these—teach the dog some basic commands like come, go, sit, stay and drop it. (That last one comes in handy with baby items.) It’s very important to teach the dog not to jump.
Prep your pup
One great way to prepare you dog for the arrival of a new baby in the home is to mimic—appropriately and respectfully—the potential behaviors of your baby. This can be done before your baby comes home, but also after.
Babies don’t know what they’re doing. If they see a dog, it’s inevitable they will pull its ears, fur, paws and nose.
The recommendation is to gently interact in a similar way with your dog—gently pull on the fur, for example—and give the dog a treat for behaving properly. Then, say something to your dog that you would have said if baby had been pulling on the dog’s fur.
For example: Give the dog’s paw a gentle tug, and then in a kind voice say, “What was that? Just baby!”
Continue this, appropriately, so your dog learns not to react. Your dog can learn how to properly respond to baby’s poking and prodding. Also, remember you’ll be teaching your baby what is OK and not OK with your pet.
Also, teach your dog that the nursery is off limits. (Remember, the American Academy of Pediatrics recommends your baby sleep in a crib or bassinet in your room for the first year if possible, or the first six months at a minimum.)
At the end of the day, your baby’s safety is more important than all else. If you suspect your pet can’t behave or can’t be properly trained to accommodate a new baby, you should find the pet a new great home.
Some other tips I found in online research:
When you’re still at the hospital with your new baby, give a family member something that has your new baby’s scent on it, such as a burp cloth or a blanket. Have the family member take that item back to the house so that your dog can smell it. This can acclimate the dog to the new baby’s scent.
Once you’ve left the hospital and you arrive home with your baby, try to enter the home first. You or a family member can hold the baby at a safe distance, possibly in another room or a quieter part of the house. Let your dog get used to your return and work through its excitement. Just keep your baby a safe distance from the dog until the animal settles down.
Have someone distract the dog with treats until everything settles down.
When you eventually do allow the dog to come over and see the baby, be relaxed. Allow the dog to smell baby’s feet first. Praise your dog for being gentle and have treats available.
Never leave your baby alone on the floor with your dog.
Tainted pet foods and treats may make more than your dog or cat sick, new data from the U.S. Food and Drug Administration suggests.
Harmful bacteria can also make owners ill if they handle contaminated pet products improperly, and bacteria such as salmonella can spread from pets to people, the agency said.
“Ultimately, we’re hoping to learn ways FDA can help minimize the incidence of foodborne illness associated with pet foods and treats,” Renate Reimschuessel, head of the FDA’s Veterinary Laboratory Investigation and Response Network, said in an agency news release.
To collect the new data, the FDA worked with 11 veterinary labs across the United States to investigate pet infections reported by pet owners. One of the main focuses was salmonella infections.
Of almost 3,000 dogs and cats tested so far, fewer than 100 have tested positive for salmonella, the agency found.
“Pet owners should know, though, that almost half of the dogs that tested positive for salmonella showed no symptoms,” Reimschuessel said.
And a dog with no signs of illness can still be carrying salmonella, which can spread to people, she added.
The dogs that have tested positive for salmonella were more likely to have eaten raw pet food, Reimschuessel said. Raw food is not heated or cooked, which might explain why there was a higher likelihood of contamination, officials said.
There are a number of things pet owners can do to protect themselves, including checking the FDA’s list of recalled pet products. Other measures include:
Feed pets in areas that are easily cleaned and sanitized
Wash hands carefully after handling pet foods
Earmark specific utensils for use only with pet foods
Wash counters and any other surfaces that come into contact with pet foods
Keep dry pet foods in a sealed container in a cool, dry place
Never buy pet food in dented cans or damaged packaging
Cats, dogs, birds and other pets can help people manage their mental disorders, a study says.
Researchers from the United Kingdom asked more than 50 adults with long-term mental conditions about the role pets play in their social networks.
Sixty percent placed pets in the central and most important circle—above family, friends and hobbies. Another 20 percent placed pets in the second circle.
Many said the constant presence and close proximity of their pets provide an immediate source of calm. For some, a pet helps distract them from symptoms and upsetting experiences such as hearing voices or suicidal thoughts.
“You just want to sink into a pit … the cats force me to sort of still be involved with the world,” one patient said.
Another patient said: “I’m not thinking of the voices, I’m just thinking of the birds singing.”
The findings were published in the journal BMC Psychiatry.
“The people we spoke to through the course of this study felt their pet played a range of positive roles, such as helping them to manage stigma associated with their mental health by providing acceptance without judgment,” said study lead author Helen Brooks, from the University of Manchester.
“Pets were also considered particularly useful during times of crisis,” Brooks said in a journal news release.
“Pets provided a unique form of validation through unconditional support, which [the patients] were often not receiving from other family or social relationships,” she said.
Despite this, pets weren’t considered in the individual care plans for any of the people in the study, Brooks said.
The results suggest pets should be considered a main source of support in the management of long-term mental health problems, Brooks and her colleagues concluded.
Through open discussion of what works best for individual patients, the mental health community might better involve people in their own mental health care, she said.
“March is the month God created to show people who don’t drink what a hangover is like.”
~ Garrison Keillor
A force with which to be reckoned
The construction industry is a virtually untapped source of high-demand, well-paying jobs for women. Women in Construction Week focuses on raising awareness of the opportunities available in construction and emphasizing the growing role of women in the industry. Read more here.
Listen to those pipes
The gift of song has always been Thomas Carpenter’s saving grace. His deep baritone-bass voice has opened doors many times, and he delights in singing at church, for Dégagé, nursing homes, Heartside Art Studio and Ministry, and other organizations that help the homeless. Read more here.
Boo!
It’s rare, but you can actually be scared to death. When a person is frightened or perceived to be in danger, the brain triggers a surge of adrenaline, which makes the heart beat faster and pushes the body instantly into “fight-or-flight” mode. It also affects the liver and pancreas, triggers perspiration and pushes blood toward major muscle groups. But don’t let that scare you. Read all about it here.
Fun fact:
It’s a thing
Spring fever isn’t just a saying — experts say the body’s makeup changes due to different diets, hormone production and temperature.
Feel yourself being pulled in a million directions and losing track of what’s really important? The meditative practice called mindfulness can help you get centered and re-focus on what’s meaningful to you.
And it doesn’t take time that’s already in short supply on your busy schedule. You can reap the benefits in less time than it takes for a coffee break.
Mindfulness shows you how to block out distractions and replace stress and other negative emotions with a sense of well-being. You accomplish this by focusing on the here-and-now — your present thoughts and feelings, not past concerns or future worries. You also learn to accept these thoughts and feelings without passing judgment on them, such as labeling them as good or bad, right or wrong.
Practicing mindfulness is easier than you might think. At the start of each day, you might take 10 minutes to do a few yoga stretches — yoga incorporates mindfulness because it teaches you to focus on your breathing as you move through poses.
Or spend 10 minutes at lunch or anytime during your workday to do a head-to-toe de-stress. Breathe in and out as you zero in on each part of your body, going from toes to the top of your head.
To unwind at night, consider more formal “guided” mindfulness, maybe with a podcast you can listen to through your smartphone. The UCLA Mindful Awareness Research Center offers free ones, starting at just 3 minutes long.
The answer is a very conditional “Yes.” But, experts say, it’s extraordinarily unlikely to happen.
“Those circumstances are extremely rare when that happens,” and pre-existing conditions are typically a factor, said Dr. Mark Estes, a cardiologist and professor of medicine at the University of Pittsburgh Medical Center.
When a person is frightened or perceived to be in danger, the brain triggers a surge of adrenaline, which makes the heart beat faster and pushes the body instantly into “fight-or-flight” mode. It also affects the liver and pancreas, triggers perspiration and pushes blood toward major muscle groups.
“It’s measured on how big the scare is,” said Dr. Vincent Bufalino, a cardiologist and president of Advocate Medical Group in Downers Grove, Ill. He said the more dangerous adrenaline surges come from the body’s response to a life-threatening situation or the stress of discovering the deceased body of a loved one.
“You can have a sudden cardiac-related event related to an adrenaline surge, but I think it would be a stretch to say you could get that from someone coming in a werewolf costume to your front door,” he said. “This is the kind of thing that you can’t prepare for. If it happens, it happens, and you hope your body doesn’t overreact to that event.”
People can typically get an adrenaline rush from skydiving or bungee jumping—even while watching a horror flick from the couch. More dangerous adrenaline surges come from life-or-death moments such as getting out of the way of an oncoming car or fleeing a tornado.
“Swings of emotion and roller coasters are OK for people who are young, who have a healthy heart,” Estes said. “But certainly, in people with pre-existing risk factors or pre-existing cardiovascular disease, you want to reduce the environments in which you might be suddenly stressed like this.”
People are able to prepare themselves when they get on an amusement park ride, so their risk isn’t the same as when they find themselves in life-threatening danger.
“The human mind and the human body do have the ability to prepare themselves for situations that can be anticipated that might be stressful and generally handle them much, much better,” Estes said. “It is the sudden, unexpected things which tend to cause a dramatic increase in heart rate and blood pressure and put people with pre-existing cardiovascular disease at risk.”
A possibly dangerous result of sudden stress may come from takotsubo cardiomyopathy, a weakening of the heart’s main pumping chamber that is typically caused by emotional or physical stress. The temporary condition affects women significantly more than men.
Also known as broken-heart syndrome, takotsubo cardiomyopathy is different from a heart attack in that arteries are not blocked but blood flow is negatively affected nonetheless.
“Adrenaline is a funny thing,” Bufalino said. “We can’t measure it. The precipitating events are diverse. Your response to an event might be different than mine.”
Occasional rushes from adrenaline can be good for you, sometimes leading to increased cognitive function. But prolonged stress and an abundance of stress hormones over time can have negative effects, such as high blood pressure or anxiety.
“It’s hard for us to be precise in saying, ‘This event led to a certain amount of adrenaline that led to a cardiac event.’ They’re sporadic at best,” Bufalino said.
And there’s little that can be done to prevent being frightened to death, he said, but being in good shape may help.
“Those folks who are used to dealing with adrenaline with exercise probably have a blunted response” because their higher cardiovascular fitness level may allow their body to better handle an adrenaline surge, Bufalino said. “I would speculate that aerobic exercise might be preventative or at least modify the body’s response (to adrenaline).”
One low-dose aspirin a day could help women avoid ovarian cancer or boost their survival should it develop, two new studies suggest.
In fact, daily low-dose aspirin—the type many older women already take to help their hearts—was tied to a 10 percent reduction in developing ovarian cancer. It was also tied to as much as a 30 percent improvement in survival for ovarian cancer patients, the researchers said.
“Clearly, both these studies offer evidence of the benefit of the use of these anti-inflammatory drugs, and an insight into how to better prevent and treat this deadly disease,” said Dr. Mitchell Kramer. He directs obstetrics and gynecology at Northwell Health’s Huntington Hospital in Huntington, N.Y.
Kramer wasn’t involved in the new studies, and said that “more study is certainly warranted.” Still, “recommending a daily low-dose 81 mg (milligram) aspirin might be more than an ounce of prevention, as well as help for those women who have already developed the disease,” he said.
Ovarian cancer is the fifth leading cancer killer of women, largely because it is too often detected too late.
According to the researchers, there’s increasing evidence that inflammation plays a role in the development of cancer and can worsen outcomes. Medications, such as aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)—including ibuprofen (Motrin, Advil) or naproxen (Aleve)—have already been shown to lower the risk of certain types of cancers, most notably colon cancer.
But do these drugs have a role to play against ovarian tumors?
To find out, researchers from the U.S. National Cancer Institute and the Moffitt Cancer Center in Tampa, Fla., pooled data from 13 studies from around the world. The studies included more than 750,000 women and asked them about their use of aspirin and NSAIDs. The researchers then tracked these women to see who developed ovarian cancer—more than 3,500 women did.
According to the report published July 18 in the Journal of the National Cancer Institute, taking daily aspirin reduced the risk of ovarian cancer by 10 percent.
“This study gives us a new perspective on whether aspirin and non-aspirin NSAIDs can impact cancer risk. Not only does it look at ovarian cancer, which hasn’t been studied before, our sample size is three-quarter of a million women who were followed for several decades,” Shelley Tworoger, senior study author and associate center director for population science at the Moffitt Cancer Center, said in a center news release.
“The results of the study support that aspirin can reduce ovarian cancer risk, but further studies will need to be performed before a recommendation of daily aspirin can be made,” Tworoger added.
In a second study, researchers from the University of Hawaii in Honolulu and the Moffitt Cancer Center used the Nurses’ Health Studies to collect data on nearly 1,000 women already diagnosed with ovarian cancer.
The investigators found that women who used aspirin and non-aspirin NSAIDs after being diagnosed with ovarian cancer experienced as much as a 30 percent improvement in survival.
The results of the study were published in the journal The Lancet Oncology.
“To our knowledge, this study contributes the first comprehensive assessment of use of several types of common analgesic medications, such as aspirin and non-aspirin NSAIDs, after diagnosis in relation to ovarian cancer survival,” said Melissa Merritt, an assistant research professor at the University of Hawaii Cancer Center.
“Our work demonstrates the importance of common medication in increasing survival rates of ovarian cancer, and this will encourage more studies to be conducted to confirm the results and broaden the discovery,” she explained in the news release.
Both studies relied on retrospective, observational data, so they were unable to confirm a cause-and-effect relationship, only an association.
Still, the evidence for an effect does seem to be there, said Dr. Adi Davidov, who directs gynecology at Staten Island University Hospital in New York City.
He called the results “intriguing,” and believes that “we can now add an NSAID to further reduce the risk of cancer.”
Kramer added that “since aspirin has anti-inflammatory properties and is a relatively well-tolerated medication with few side effects, seeking its benefits for this deadly disease makes a great deal of sense.
U.S. Food and Drug Administration approval of the Gardasil 9 human papillomavirus (HPV) vaccine has been expanded to include people ages 27 through 45, the agency said in a news release.
Gardasil 9, approved in 2014 for people ages 9 through 26, is the follow-up vaccine to the original Gardasil, which was approved in 2006 and is no longer sold in the United States. The updated vaccine is designed to prevent cancers and disease caused by nine HPV types.
Some 14 million Americans become infected with HPV each year, according to the U.S. Centers for Disease Control and Prevention. About 12,000 women are diagnosed annually with cervical cancer caused by the virus and 4,000 women die each year from the disease, the CDC reports.
“The Centers for Disease Control and Prevention has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90 percent of these cancers, or 31,200 cases every year,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research.
Gardasil 9 also is designed to prevent HPV-triggered cases of genital warts in men and women, and vulvar, vaginal and cervical precancerous lesions in women, the FDA says.
The most commonly reported side effects of the vaccine include injection-site pain, swelling, redness and headache.
Gardasil 9 is produced by a subsidiary of Merck & Co., based in Kenilworth, N.J.
Bob Bustance enjoys life in his hometown of Hastings, Michigan.
Depending on the season, he tends to his vegetable garden, hunts deer or goes snowmobiling.
But in September of 2017, as he harvested the last of his crops, he seemingly lost control of his bladder.
“I had to urinate frequently,” said Bustance, 58. “I had no control. It came out of nowhere.”
Bustance made an appointment with his family doctor. Her concern led to a referral to Christopher Brede, MD, a Spectrum Health Medical Group urologist.
“He went ahead and did his testing,” Bustance said. “Three days later, he called and told me I had prostate cancer. I was astonished.”
Dr. Brede said the routine screening showed Bustance had a rising PSA level, leading to a biopsy.
“The cancer was found to be localized at diagnosis,” Dr. Brede said.
After considering options presented by Dr. Brede, Bustance chose to have the cancer surgically removed. Dr. Brede performed a robotic prostatectomy.
But that wasn’t the end of Bustance’s cancer story.
Doctors discovered cancer lurking in his thyroid during a total body scan.
“It all hit at one time,” he said. “They took my prostate. Six weeks later they went in and took my thyroid.”
Photo by Chris Clark, Spectrum Health Beat
Bustance sensed the cancer double whammy could only mean one thing. His time was up. He visited a local funeral home and planned for what he thought to be his future.
“I thought I was going to die,” Bustance said. “I went ahead and made my funeral arrangements and bought a cemetery plot. It was like a tidal wave hitting you.”
Dr. Brede said he doesn’t think the two cancers were related.
“Prostate cancer is the most common non-skin cancer solid tumor in men, so it would not be that rare for an individual to have prostate cancer with another cancer,” he said. “His happened to be discovered concurrently. They ended up not being related.”
Bustance said a Spectrum Health nurse navigator helped answer questions and schedule appointments throughout the ordeal.
“He called me every week,” Bustance said. “He was a positive person. Everyone was so positive… Without those people at Spectrum, I would have never made it.”
In June, Bustance was able to return to his position as a supervisor for a metal stamping company.
“The company I work for has been awesome,” he said. “There’s no company in the world that will hold a man’s job for 10 months to make sure I had health insurance. A lot of people stepped up. It’s just amazing.”
Bustance continued to see Dr. Brede weekly after his surgery, then every three months and now, every six months. His PSA tests have been normal.
“I am so ecstatically happy,” he said at the time.
He and his partner of 35 years, Betty Negus, are resuming life.
Photo by Chris Clark, Spectrum Health Beat
“Robotic surgery is one of the most awesome experiences you could ever have,” he said. “They didn’t do an incision at all—just little holes with a couple of stitches. The recovery time to me was just remarkable. I got it done, went home and laid around for three or four days. The soreness just went away. By the time I went to see him a couple of weeks later, everything was healed up. No red marks. No nothing.”
Bustance said he’s still not 100 percent energy wise, but he can only imagine how he would feel if he had large incisions to contend with.
“Of all the surgeries a man could have, that’s the way to go because of the recovery time and not being split wide open,” he said. “Dr. Brede gave me options (treatment or removal). Cancer has been in my family for years. Being as young as I was, I looked at him and said, ‘I want it gone.’ Betty and I talked about it. I pretty much made up my mind I wanted it out.”
“It was very trying,” he said. “I had to stay positive. I had to surround myself with positive people. I live each day trying to be better than I was yesterday and it works. My eating habits have changed. Everything has changed.”
Bustance said he’s happy with his decision to have the prostate and thyroid cancer removed.
“I think I made a wise choice,” he said. “It’s a good feeling. I wake up every day very thankful. I wasn’t a religious person, but it really makes you think. It really does. It all came out for the best for me.”
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.”
Extreme cold has come to West Michigan and will be a regular visitor this winter.
Parents should take extra precautions when sending young children outdoors for any length of time, and that means learning the warning signs of hypothermia and frostbite.
Parents need to know how to prevent extreme cold weather exposure and be ready to respond appropriately to problems, said Jennifer Hoekstra, an injury prevention program coordinator with Spectrum Health Helen DeVos Children’s Hospital.
“Children don’t realize they can get in trouble quickly when they are out in temperatures close to or below zero,” she said.
Clothing
Problems arise when infants and children are not dressed properly, Hoekstra said. Make sure they’re dressed in several thin layers to stay warm and dry. Adequate outdoor clothing includes thermal long johns, turtlenecks, at least one shirt, pants, sweater, coat, warm socks, boots, gloves or mittens and a hat.
Hypothermia
Hypothermia develops when a child’s temperature falls below normal due to exposure. It often happens when children are outdoors in extremely cold weather without proper clothing or when their clothes get wet. If your child shivers and becomes lethargic and clumsy, hypothermia may be setting in. Your child’s speech also may become slurred.
Call 911 immediately if you suspect your child is hypothermic. Until help arrives, take children indoors, remove any wet clothing and wrap them in blankets or warm clothes.
Frostbite
Frostbite happens when the skin and outer tissues become frozen. This condition tends to happen on extremities like the fingers, toes, ears and nose. Watch for extremities that may become pale, gray and blistered. Children may complain that their skin burns or has become numb.
Here’s what to do if your children show signs of frostbite:
Bring children indoors and place the frostbitten parts of their bodies in warm water.
Apply warm washcloths to frostbitten noses, ears and lips.
Do not rub the frozen areas or use a heating pad.
After a few minutes, dry and cover children with clothing or blankets.
Give them something warm to drink.
If the numbness continues for more than a few minutes, call your doctor.
When the temperatures drop low, “the best advice is to keep your children inside and busy with indoor activities,” Hoekstra said. Same goes for your furbabies, too.
The Grand Rapids Ballet and Spectrum Health have enjoyed a harmonious relationship for the past five years, with sports medicine professionals and athletic trainers helping dancers achieve ultimate health and conditioning.
“Spectrum sent someone right over,” Houser said. “She really helped me out a lot because I had an important rehearsal that day.”
‘Piece me back together’
Houser said he’s grateful for the quick response, and grateful he could continue his love of “expressing emotion, physically.”
He’s on the mend.
“There was a bunch of stuff out of alignment,” he said. “It sent everything into spasm. It took a couple of weeks to get to a normal place. I think without that quick response, it would have taken much longer to heal.”
Even when there aren’t unexpected injuries, Spectrum Health athletic trainers Emilee Van Hoven and Allie Hoyt visit the ballet twice a week; Heather Pietrzak and Paige Bachelor visit the ballet three times a week. They work with dancers who are recovering from injury.
“It’s a bit reoccurring, so they all help piece me back together,” Houser said.
After six hours a day of dancing—for six, sometimes seven days a week—even the strongest and most fit bodies tire.
“They keep an eye on things that could turn into something major,” Houser said. “My hip hurts a little bit today. My ankle feels a bit jammed. Those little things can become chronic if you can’t be seen quickly. Them being here so frequently is incredibly helpful.”
Photo by Chris Clark, Spectrum Health Beat
Houser said Fridays are typically the hardest day because the aches and pains compound over the week.
“Even if you’re just getting your calves to relax a little, it helps,” he said.
Depending on the nature of the injury, the sports medicine team will sometimes do soft tissue work, sometimes mobilization.
“Sometimes they’ll give you exercises and tools we can use on our own to maintain certain things, like stretches,” Houser said. “Or they’ll tape us up to help keep things in place.”
Hand in hand
Phillip Adler, manager of the Spectrum Health Medical Group Sports Medicine program, approached the ballet about a partnership in 2011. Dr. Axtman had previously worked with the Atlanta Ballet and other dance groups.
“The expertise he had really made the ballet believe we had the experience to manage this unique area of sports and performing arts medicine,” Adler said. “I was the primary athletic trainer that would go down whenever the ballet needed anything.”
And so began Spectrum Health’s performing arts medicine partnership with the Grand Rapids Ballet.
By the second year of the collaboration, Adler brought on additional sports medicine staff to help in the endeavor. They covered not only rehearsals, but performances.
“I have worked with a lot of high-level athletes and NFL players, but I’ll be honest, ballet dancers are not nice to their bodies,” Adler said. “They have to go on point balanced on one leg, with the hip bent at 90 degrees for 15 or 20 seconds with maybe a partner. They’re working eight or more hours a day.”
Ballet companies typically don’t have injury prevention or strength and conditioning programs like many other professional sports teams do.
“I don’t think the vast majority of people realize what goes into putting on a ballet performance,” Adler said.
Photo by Chris Clark, Spectrum Health Beat
Adler said the partnership can help extend dancers’ careers.
“They have such a finite time to be a professional ballet performer,” Adler said. “How can we help them prevent injury or manage injury so that it prolongs their career? Not so long ago a surgery for a ballet dancer was career-ending. We’re making sure if those things come up, how do we maintain careers?”
Ferraro said he has noticed a huge decline in injuries since partnering with Spectrum Health.
“It’s been a huge benefit to us,” the ballet manager said. “The dancers have absolutely loved it.”
The athletic trainers often spot and prevent things before they become serious injuries.
“If somebody starts to feel an issue or something isn’t feeling right, they can let us know and the athletic trainers will come pretty much any day they’re needed,” Ferraro said, noting he’s grateful for the assistance.
“A lot of bigger ballet companies don’t even have this benefit,” he said. “It’s just a phenomenal relationship for us.”
Winter can sometimes lead to excessive screen time.
Kiddos may think it’s too cold, too snowy, or otherwise too gray to venture outside for play. So they resort to endless hours playing video games, messaging their friends, or binge-watching Spongebob Squarepants episodes.
This can be a bit of a problem.
The National Institute of Health defines screen time as activities done in front of a screen, such as playing video games, watching TV or working on a computer.
Screen time is an activity where you are sitting, using little energy and can be described as sedentary. This means that the activity burns little energy.
Why should we limit screen time?
It’s important to limit sedentary activity. To do this, it’s important to limit screen time.
Children who get too much screen time can have trouble sleeping at night and have a higher risk for anxiety, attention problems or depression. This can cause your child to have trouble paying attention and behaving while they’re at school.
These children are also at a higher risk of gaining too much weight, too quickly, thus leading to obesity.
What are the recommendations?
According to the American Academy of Pediatrics,
today’s children are spending an average of seven hours or more each
day on media, including cell phones, computers, video games, iPods and
tablets.
Children younger than 2 years old should have no screen time. Children older than 2 should have two hours or less. This includes all media combined.
Screen time for learning is still considered sedentary time and should still be monitored and limited.
How can I help my child?
There are many ways to work with your child to reduce screen
time. First, talk to them about why you’re monitoring screen time and
the health benefits of doing other activities.
Additionally, the American Academy of Pediatrics has made these recommendations:
Remove the TV or computer from your child’s bedroom.
Do not let your child eat while watching TV or using the computer.
Decide which programs to watch ahead of time. Then, turn off the TV when those programs are over.
Suggest other activities, such as family walks, bowling, roller skating or shooting hoops at the local gym.
Be a good role model as a parent. Decrease your own screen time to two hours a day.
Be careful with your ticker when temperatures plummet. (Courtesy Spectrum Health Beat)
By Health Beat Staff
Winter is here and isn’t leaving anytime soon.
That means it is time to take precautions when exercising or spending any length of time outside.
We asked Thomas Boyden, MD, a Spectrum Health Medical Group preventive cardiologist, for tips on keeping your heart healthy during this time of year.
“Individuals with a known heart condition or heart disease should be particularly careful when shoveling snow or breathing in cold air during the winter,” Dr. Boyden said.
Five tips for helping your heart stay healthy and warm this winter:
If you have any questions or concerns before engaging in outdoor winter activities, consult your physician first.
Wrap a scarf around your mouth and nose so the cold air is warmed before it reaches your lungs. This eases strain on both your heart and lungs.
Limit shoveling to the level of activity you are already used to. If you haven’t been active for months, don’t engage in this vigorous, weight-bearing activity. Too much exertion increases the risk of a heart-related episode.
If you feel any tightness or pain in your chest, stop shoveling or walking in the cold and seek medical attention.
Try to maintain your exercise routine throughout the winter by finding warm, indoor places to walk such as the mall, health club or senior center.
This advice isn’t just for people with a known heart condition, Dr.
Boyden said. A long, cold winter can be challenging for otherwise
healthy people as well.
Bundle up, stay active and be smart when it comes to winter heart health.
Has your spouse or a family member ever told you that you alternate between snoring and gasping for breath while you sleep?
For the sake of your heart, it may be time to seek a solution.
Researchers often identify a connection between obstructive sleep apnea and a number of cardiovascular problems.
Wael Berjaoui, MD, a pulmonologist with Spectrum Health Medical Group, describes sleep apnea as an interference of airflow during sleep. This potentially serious disorder is characterized by breathing that repeatedly stops and starts during sleep, and it’s usually associated with a reduction in blood oxygen saturation.
These episodes can prevent restful sleep, often waking a sleeper as he gasps for air.
But there’s also a hidden impact on the heart.
This condition can worsen coronary artery disease. Research has found that patients who have sleep apnea are more likely to have life-threatening outcomes when they have a heart attack.
“Imagine waking up and feeling like someone is trying to choke you. Of course your heart rate and blood pressure will increase,” Dr. Berjaoui said of the association between obstructive sleep apnea and the heart. “Your body thinks it is in distress.”
Research has shown that patients who undergo continuous positive airway pressure therapy will see a decrease in systolic blood pressure, Dr. Berjaoui said, which reduces the potential for progressive damage to arteries and veins, and in turn reduces the incidence of stroke, heart disease and heart failure.
Continuous positive airway pressure, or CPAP, is a treatment that uses mild air pressure, delivered through a lightweight mask, to keep the airways open during sleep.
CPAP treatment also can improve the health of people with heart rhythm problems, particularly those with an irregular heartbeat condition known as atrial fibrillation. Up to 80 percent of people with atrial fibrillation also may suffer from sleep apnea, Dr. Berjaoui said.
“It is much harder to control atrial fibrillation or cure it if you don’t treat the (apnea) first,” he continued. “It is important for patients who have cardiac conditions to be evaluated. …Even without all of the symptoms, a patient still could have sleep apnea and it can compromise their ability to effectively manage something like high blood pressure.”
If a patient requires more than two medications to control high blood pressure, for instance, there is at least a 7-in-10 chance the patient also suffers from sleep apnea, even if he doesn’t have the telltale symptoms of loud snoring or excessive daytime sleepiness.
And while there is an association between sleep apnea and cardiac conditions, Dr. Berjaoui pointed out it is not cause and effect.
The important takeaway: Sleep apnea can affect your ability to manage other conditions, including those affecting the heart.
Dr. Berjaoui said if you’re concerned about the impact of obstructive sleep apnea on your heart, you should talk to one of Spectrum Health’s sleep professionals. They can evaluate your sleep patterns in the sleep lab or in an at-home test.
Every year, many of the 75 percent of smokers who want to quit find motivation in getting a fresh start in the New Year.
Libby Stern, LMSW, TTS, knows that quitting smoking can be a challenge and, for many, it may take several attempts to finally succeed.
“A lot of times it’s like a practice approach,” she said. “It’s not uncommon to make six or seven attempts to quit.”
If you’re seriously thinking about kicking the habit once and for
all, here are a few things that Stern, a smoking cessation expert at Spectrum Health Healthier Communities, suggests will help you get off on the right foot and stay on your path.
Remember what the QUIT acronym stands for:
Quit date. Set a quit date within two to three
weeks. This gives you time to get used to the idea and to make
preparations without allowing so much time that you forget about it.
Having an important date allows you to attach additional meaning to your
quit.
Use medication. Talk with your health care provider
about using a medication to help you quit. There are prescription
options like Chantix and Zyban as well as over-the-counter options like
nicotine replacement patches, gum and lozenges. Figure out what you
think will work for you and prepare yourself. Some medications will need
to be started a week or two ahead of time.
Identify your social support. Find a quit buddy or
someone who will support you along the way. It makes a huge difference
to have someone you can talk to about your quit smoking journey and get
their support and encouragement.
Talk to an educator or counselor. Counseling and/or
formal education can help you to identify your personal triggers and
develop new coping skills. Combining counseling with medications
significantly improves the likelihood of success.
Develop a quit plan for yourself. Keep in mind that, when you quit smoking, you have to change more than the smoking.
Identify how you can change your routine to make quitting easier. For instance, if you always wake up, make your coffee and smoke while you read the paper or watch TV, change it up. Maybe you skip the coffee and paper and go straight for the shower and off to work instead, getting your coffee at work where there is no smoking.
If driving and smoking poses a challenge, get some coffee stirrers, cinnamon toothpicks, sugar-free licorice sticks or lollipops and have them in the car for those times when you have a craving. Changes in your routine can make it easier for you, especially in the beginning.
As a former smoker, Stern knows quitting is hard, but not impossible. Sometimes, students even tell her it was not as difficult as they expected.
Her message to anyone hoping to quit: “There are more former smokers today than smokers. You can be one, too.”
Planning is the key, so make sure you plan ahead for the expected and unexpected. Educate yourself and consider medications that may help.
Only you can decide when you’re ready to quit, but when you are, remember that there are many resources to help you. You can do this—there are more former smokers today than smokers. You can be one, too.
“I loved sugar, and I still do,” says Kelsey Haynes, a community relations specialist for Spectrum Health. (Photo by Taylor Ballek, Spectrum Health Beat)
No candy or cookies. No soda pop. No hazelnut syrup in your coffee.
The idea filled Kelsey Haynes with dread at first. A self-described “sugar addict,” she didn’t know how she could give up her sweet ways.
But three weeks into a sugar-free challenge, she likes the results. She’s lost a few pounds. She feels energized. She has broken her afternoon candy-jar habit.
“I loved sugar, and I still do,” she says. “I just don’t crave it. It’s changing my habits.”
Sugar-free challenges are popping up on the internet lately, urging folks to cut added sweeteners from their diets for a set period of time, as a growing number of health advocates identify added sugars as a prime culprit behind rising obesity and diabetes rates.
Haynes followed a suggestion from a New York Times columnist, who advised readers to try going a month without sugar.
Most sugar-free campaigns don’t target the sugars naturally found in fruit and dairy products.
They focus on the sweet stuff added to food to make our taste buds happy. Sugar lurks in some surprising places―bread, crackers, ketchup, breakfast cereal, salad dressing and pasta sauce―that don’t seem at all sweet.
Low-calorie artificial sweeteners are eliminated in the sugar-free challenge, as well, because they help fuel the sweet-tooth habit.
“A 30-day (no-added-sugar) challenge is not such a bad idea,” says Christy McFadden, MS, RDN, a dietitian and supervisor of medical nutrition therapy for Spectrum Health. “I think people can learn a lot about how much sugar is in the food that they are eating.”
Haynes meal preps her health lunches to bring to work. Picture above is her cauliflower rice recipe. (Photo by Taylor Ballek, Spectrum Health Beat)
The challenge requires people to read nutrition labels and discover the many ways sweeteners appear in prepared food. Instead of sugar, the ingredients might include honey, agave, nectar, molasses, cane juice or sucrose―all forms of added sweeteners.
“Fifty-seven things are actually sugar on a label,” McFadden says.
With sugar incorporated into so many foods, people can develop a preference for the sweet stuff without realizing it.
“We want to eat more of it or want to overeat in general,” she says. “When we go away from that for a while and make a conscious effort to avoid it, you can retrain your taste buds to prefer other foods or just not love sugar so much.”
The 10 percent guideline
Haynes, a community relations specialist for Spectrum Health, has long been interested in nutrition and fitness. She already read nutrition labels and had a good idea of the amount of sugar in food.
But she still struggled with a longing for sweets.
“When people would ask me what my favorite sugar was, my answer would be, ‘Yes,’” she says. “That sugar packet on the table―I would open it up and eat it.”
Eliminating added sugars helped her focus on more nutritious options.
“I still eat a decent amount of sugar in fruit form,” she says.
A typical morning smoothie consists of kale, ginger, chia seeds, kefir, a half-banana and an orange.
She also developed an efficient way to plan a week’s worth of meals and snacks―to keep her healthy eating plan on track. She keeps menus and matching grocery lists on file in her computer, so she can print up a list before she heads to the store.
McFadden says the focus on healthier foods is a key benefit of a short-term no-sugar challenge.
Haynes has long been interested in nutrition and fitness. With a serious sweet tooth, she wasn’t sure she could give up her sweet ways. But three weeks into a sugar-free challenge, she likes the results. (Photo by Taylor Ballek, Spectrum Health Beat)
“I think it does force you to make healthier choices for a while and be conscious of that, too,” she says.
Americans get 13 percent of their calories from added sugar. But they should keep it under 10 percent, according to federal dietary guidelines.
Going beyond that point could mean either consuming excess calories or not eating enough nutritious foods.
For those aiming to limit sugar intake, upcoming changes in food labels will help. By July 2017, the Food and Drug Administration will require manufacturers to list added sugars on the labels for most foods. The labels must state the amount of sugar in grams and as a percent of daily calories.
The ultimate goal of a no-sugar challenge should not be to avoid all types of sugar forever, McFadden says. It should be to develop a healthy diet―one that includes fruits, vegetables, whole grains and lean proteins.
“Milk, yogurt and fruit have a lot of natural sugars. It’s not a pure evil,” she says. “But they come with all these other nutrients. In soda pop, there’s nothing there except sugar.”
Photos (except where noted) by Chris Clark, Spectrum Health Beat
With the wind in her face and the reins in her hands, Shanna Ruffner guides Jag, her quarter horse, through corkscrew-like barrel racing drills at a farm near her Otsego, Michigan, home.
Ruffner, 39, has been steering horses through barrels since age 2.
She’s always felt freedom and exhilaration aboard a horse’s back. Until last year.
After many repetitive motions at work, she felt pain.
The pain in her hands started like a slow walk, waking her up at night about this time last year. By November, the sensation had galloped into her daily life, affecting just about everything she attempted to do.
Taking a toll
Ruffner has worked for years for General Motors in the Lansing Delta plant, assembling Traverse and Enclave vehicles.
“I do a lot with the main wiring harness for the motor, plugging in different things and bolting things to it,” Ruffner said. “I also torque down the strut, tie bar and hub on the front end and attach radiators to the undercarriage before it gets married to the body.”
It’s important work, but repetitive work. And it eventually took a toll on her.
“I started experiencing numbness in my fingers about a year ago,” she said. “It finally got to the point in November that I could no longer sleep because it was waking me up. My hands would completely go numb in the middle of the night. They would go numb and they would burn. It was just unbearable.”
It became increasingly more difficult to work, and also risky to ride.
“It made it difficult to ride a strong, powerful horse because my hands would go numb while I was riding,” Ruffner said. “I ride a very powerful gelding. It’s a good thing we have a good bond because if it were any other horse, I don’t think I’d be able to ride.”
Still, the pain sometimes outweighed the fun. It was a crushing blow for Ruffner, who followed in her dad’s hoofprints so many years ago.
Her dad, George, who died in 1996, rode competitively and taught his daughter all he knew about barrel racing.
Photo by Chris Clark, Spectrum Health Beat
As a child, Ruffner competed in Michigan, Indiana, Ohio and Texas.
But in the last year, she felt like her condition was holding her over the barrels.
“It made it hard to pull and made it hard to hang on,” she said. “It just didn’t feel quite right. I didn’t have as much control as I would have liked to have.”
A horse wasn’t the only thing that became difficult to steer. She experienced trouble driving a car.
Ruffner’s commute from Otsego to Lansing spans an hour and 15 minutes. About 10 minutes into her drive, her hands would go numb. And eventually, they’d be numb before she even turned on the ignition.
She enjoyed taking her sons, Trenton, 18, and Brady, 15, to the movie theater for family outings. But the numbness closed the curtain on those outings, too.
“I got to the point I didn’t want to go to the movie theater because I knew my hands would bother me by the time I got there,” she said.
‘It was simple’
Last spring, with pain and numbness continuing to canter, Ruffner saw a specialist in Lansing for a nerve test.
“They basically hooked up different electrodes to see how the nerves react,” she said. “The nerve testing came back that I needed surgery on both my hands.”
In June, she consulted with Peter Jebson, MD, a Spectrum Health Medical Group orthopedic hand and upper extremity surgeon.
“It was simple,” Ruffner said. “I felt a little pressure when they were cutting (the ligament), but as far as anything else goes, the worst part of it was the shot of the local (anesthetic) to numb my hand. It was a piece of cake.”
Ruffner needed only Tylenol to keep the pain at bay.
“It’s felt really good,” she said.
Photo by Chris Clark, Spectrum Health Beat
Dr. Jebson said he’s pleased with Ruffner’s progress.
“With carpal tunnel, you have pain, particularly at night,” he said. “You can have bothersome numbness and tingling and also functional loss. She had the entire constellation of symptoms. But she’s already experiencing 100 percent pain relief and 90 percent of the tingling has improved. She is doing very well and the incision looks good.”
Dr. Jebson said carpal tunnel release surgery has come a long way in recent years. It used to be performed in an operating room in a hospital or outpatient surgery facility, under general anesthesia, which is significantly more expensive. The new technique, developed in Canada, saves patients money, pain and healing time.
“It also used to be a larger incision,” he said. “The patient used to be casted or splinted after surgery. We’ve progressed to where we now do minimally invasive incisions.”
Dr. Jebson and his Spectrum Health Medical Group team of hand specialists—Drs. Kevin Chan, Randy Lovell and Levi Hinkelman—perform about 750 in-office hand surgeries each year, including carpal tunnel release, trigger finger, trigger thumb, De Quervain’s tendonitis release, simple tendon laceration repairs and ganglion cyst excisions.
Dr. Jebson estimates performing procedures in the office suite saves patients and health care insurers $2,000, “which is significant with the increasing shift of financial responsibility to patients with higher co-pays and deductibles,” he said.
“Not only does it save patients a significant amount of out-of-pocket expense because they’re not using anesthesia and they’re not at a surgical center, patients don’t have to go for any preoperative testing, which saves them a lot of time,” Dr. Jebson said. “And this doesn’t require IV antibiotics.”
Office-based surgery is also environmentally friendly, producing only one bag of waste for a day’s worth of surgeries versus one bag for every procedure.
“It’s a significant savings to society in general,” he said. “It’s a multiple win and provides true value for patients. It’s the future—it will be the standard of care in three to five years across the country. We’ve been doing it for four years now and happen to be a nationally recognized program.”
Ruffner is pleased—especially that she’ll be able to return to work soon.
“I’m a self-admitted workaholic,” she said. “Being home all the time is difficult for me.”
Photo by Chris Clark, Spectrum Health Beat
It may be a bit before she bounces back to barrel racing—her saddle weighs 19 pounds and she has a 5-pound weight restriction.
But she has plans beyond lifting saddles. She aims to have surgery on her left hand, too.
“By the time this journey is all said and done, I will have had surgery on both hands,” Ruffner said. “I want to get it done and over with and be pain-free and resume a normal life.”
She hopes to be running barrels again by mid-September, with both hands healed and weight restrictions lifted.
“It’s a rush,” she said of barrel racing. “I love the adrenaline. You get to go out and run as fast as you can around three barrels without hitting them on a 1,000-pound animal that has a mind of their own. They have a personality and temperament all their own. You learn the true meaning of teamwork. It’s one thing to be a team with another human. It’s entirely different to be a team with an animal.”
But Ruffner said she truly appreciates the teamwork with Dr. Jebson and other Spectrum Health staff, in getting her back to where she wants to be.
“Anybody that is fearful of having carpal tunnel release surgery done should know, the way Dr. Jebson does it, they shouldn’t be fearful,” Ruffner said. “Have the surgery and take care of it as opposed to waiting until your hands are completely numb all the time. This experience has been so easy.”
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.
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.
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.
Alyssa D’Agostino can endure a lot: a battle against breast cancer, then leukemia, then a relapse of leukemia.
But when she realized she would not be home for her daughter Gianna’s ninth birthday—that drove her to tears.
“We have to do something.”
Katie Celentino heard that message over and over again from staff members at the bone marrow transplant unit at Spectrum Health Butterworth Hospital, touched by D’Agostino’s sorrow.
And so they did. In 24 hours, they pulled together a purple unicorn party that left Gianna nearly speechless.
The little girl burst into the staff room for the party with a big “Oh!” as she whirled around, taking in the birthday banner, a unicorn drawing on the whiteboard, party hats and a table brimming with colorfully wrapped presents. Nurses and nurse technicians greeted her with a lively round of “Happy Birthday!”
D’Agostino sat beside her daughter, eyes sparkling above her yellow face mask. She wore her party attire, a green tinted wig and a headband decorated with a silver unicorn horn and peach flowers.
“This is so amazing,” she said. “I’m blown away big-time.”
Diagnosed with breast cancer in 2015, D’Agostino underwent surgery and chemotherapy and emerged a survivor.
Photo by Taylor Ballek, Spectrum Health Beat
In July 2017, she learned she had acute myeloid leukemia. It went into remission, but resurfaced in April 2018. Again, she was hospitalized as she began chemotherapy treatments.
In late August, she went to Butterworth Hospital, with plans to get the disease back into remission so she could undergo a bone marrow transplant.
Five straight months in a hospital: That has been her spring, summer and autumn.
She hoped she would be home for Gianna’s birthday. She had gifts and planned a surprise celebration with family. When she learned that would not happen, she said, “I was devastated.”
And then, she learned a party was in the works on the fifth floor of Butterworth Hospital.
Celentino, the nurse manager, said staff members eagerly joined together to make the day special. Nurses came in on their day off or stayed after their shifts ended. Nurse technician Courtney Fend used her artistic skills to create a birthday banner and unicorn drawing.
Sharing Gianna’s big day was deeply rewarding for the staff, Celentino said.
“We don’t always get to see these moments,” she said. “These are the things that matter to our patients. This is why they matter to us.”
A gift of happiness
Photo by Taylor Ballek, Spectrum Health Beat
Gianna, a third-grader at Chandler Woods Charter Academy in Belmont, Michigan, came to the party with her grandmother, Alice D’Agostino. She wore her Halloween costume—a purple and black outfit with a purple wig. She dressed as Mal from the Disney movie Descendants.
Her mom’s gift made the outfit complete. She gave Gianna a pair of black boots, just like Mal’s.
Gianna bubbled with enthusiasm as she opened her gifts: sparkly pencils and coloring books, fluffy unicorn pajamas, card games, glittery nail polish, hair chalk, a jewelry box and a kit for making her own jewelry.
She thanked everyone and went around the room giving hugs.
Gianna then sat beside her mom and they wrapped their arms around each other.
D’Agostino said the celebration exceeded all her expectations. And seeing her daughter’s happiness was a gift in itself.
“I just loved seeing her face light up,” she said. “When she’s happy, I’m happy. Doing something special for her just makes me feel good.”
