Inactive (722)

Segment Number 2
Audio File allina_health/1546ah1b.mp3
Doctors Van Sloun, Nancy
Featured Speaker Nancy Van Sloun, MD – Integrative Medicine
Guest Bio Nancy Van Sloun is an integrative medicine doctor at Penny George™ Institute for Health and Healing – WestHealth. Outside the clinic, Dr. Van Sloun tries to follow the advice she gives her patients. She enjoys taking walks with her dog or human companions, finding and cooking new recipes, and spending time with her family on the Gunflint Trail.

Learn more about Nancy Van Sloun
Transcription Melanie Cole (Host): If you’re trying to cut meat from your diet or simply trying to get more protein, there are plenty of meatless options. Vegans and vegetarians do it every day. My guest today is Dr. Nancy Van Sloun. She is an integrative medicine doctor at Penny George Institute for Healthy and Healing - West Health. Welcome to the show, Dr. Van Sloun. Are there a lot of plant foods that contain protein? Is this true or false?

Dr. Van Sloun (Guest): That is actually true. I learned something I didn’t know recently which is that all plants contain some protein. My family was having a dinner time conversation and we were wondering how much protein is in vegetables. Although it’s small amounts--it’s not as much as in some other foods; actually, all plant foods contain some protein.

Melanie: Wow, so people are consuming proteins without even realizing it. Where might they be getting those?

Dr. Van Sloun:   It includes vegetables, which I don’t think we think about. If you are having a sweet potato or broccoli, or cauliflower, there is some protein in those foods. There is also protein in different plant based foods which I think we’re more aware of. Some of the sources that have more protein that are plant-based are going to be things like nuts and seeds, legumes, beans and soy foods. There is also protein in foods that aren’t plant-based and aren’t meat and that includes our dairy products – cheese, milk and yogurt and also eggs.

Melanie: If you eat meat, does that give you enough protein for your daily diet?

Dr. Van Sloun:   For most people, absolutely it gives them enough protein. Our diet is very meat based as Americans; whereas, in fact, for the healthiest diet, meat should be at the top of the pyramid. A lot of people wonder if they are getting enough protein but when they’ve done dietary surveys, Americans actually probably are consuming more protein than they need with their meat based diet.

Melanie: Is there a way to get protein and fiber in the same meal, in the same food?

Dr. Van Sloun:   Absolutely and I think that’s where some of our plant-based proteins really are something that can provide us with more nutrition than a meat-based protein because a lot of the plant-based protein sources are high in fiber. So, things like fruits and vegetables that have small amounts of protein are high in fiber but, in addition, our legumes and our beans – like kidney beans, garbanzo beans--are high fiber. They feed our intestinal micro biota and our intestinal bacteria which we are learning more and more how much they play a role in health. Legumes are also high in magnesium which plays a role in a lot of different body processes. If you are adding these sources of plant-based proteins, you are getting things in your diet that are very health promoting that you’re not going to get in a more meat-based diet.

Melanie: Is there such a thing as getting too much protein?

Dr. Van Sloun:    People can get too much protein. I don’t think it’s something we think about very often but there are guidelines as far as what is too much and that’s getting over 35% of your calories from protein. People who are using a protein powder where they’re supplementing a lot with that and they don’t pay attention to how much protein is in that powder that might be a situation where people could get too much. We know that can put more stress on the kidneys. It’s also known that with very meat-based diets that will increase the excretion of calcium in the urine which is something that can lead to lower bone density. If I’m seeing somebody with osteoporosis and low bone density, we talk about a plant based diet versus a meat based diet. It is probably going to be healthier for issues like bone density in addition to a lot of other health issues.

Melanie:   How can people keep track of the protein that they’re eating? Give us some general guidelines for how much you should be getting a day.

Dr. Van Sloun:    Protein is a little tricky because we can’t just say half your plate should be protein like we do with fruits and vegetables because different foods have different amounts of proteins. If you’re eating meat, one thing to think about with meat and fish is that a three ounce size is a serving. With meat, that is going to be the size of a standard computer mouse; with fish, that is going to be the size of a check book. For guidelines of how much, that varies by weight. The guideline is sort of a cumbersome calculation of 0.8 grams of protein per kilogram of body weight. That means that a 200-pound man is going to need 73 grams of protein a day, whereas a 130-pound woman would need 47 grams. It can vary by body weight. In addition, if you are a vegetarian or vegan, you’re not getting any meat-based protein. The requirement goes up to 1 gram of protein per kilogram. That’s because the vegetable-based proteins are less bioavailable or less easily used by the body. So, you need a little more protein if you don’t have any meat in your diet at all.

Melanie:   Give us a little of some of the plant-based foods that are maybe not some of the vegetables that you’ve mentioned that vegetarians typically look to for their proteins.

Dr. Van Sloun:    If somebody is vegetarian, often they’ll eat some soy-based foods. As an example, a half cup of tofu has 10 grams of protein. For a woman, that’s almost a quarter of daily protein needs. They will look at legumes, things like lentils and different kinds of beans. With that, a half a cup is around 8 grams of protein. They will look at nuts, nut butters. If they are not vegan, eggs might be included. Things like cheese and yogurt also have protein, so they can be protein sources for a vegetarian also if they have dairy.

Melanie: Dr. Van Sloun, what do you tell people when they say, “I want a diet and I’m looking at these very heavy protein diets like the Atkins Diet” which eliminates carbohydrates? What do you tell them?

Dr. Van Sloun:    You really have to individualize that for the person to some degree. For general advice, what I tell people is at each meal, you want to think about having a healthy carbohydrate, a healthy protein and a healthy fat. That healthy carbohydrate really shouldn’t be things like white bread and bagels and things like that but it should be more whole grain. Actually, a whole grain like barley or boiling wheat berries or things like that; or, it can come from the more carbohydrate rich vegetables. It could be a sweet potato or it could be peas or it could be corn. Having some healthy carbohydrate, some healthy fat and some healthy protein at each meal. In general, as a country, when we demonize one of those three macronutrients, we tend to get off on diets that get to be more restrictive and for most people, there is not one of those macronutrients that is so bad that they shouldn’t have any of it.

Melanie:   What if someone is told they need to cut down on their proteins? Then, what do you advise them to cut back on besides the meat? What are some of the hidden sources?

Dr. Van Sloun:    With people who are getting too much protein, I would think about how much meat is in their diet because that is probably going to be the biggest source for most people. Then, it would be if they are getting food or products that are supplemented with protein, really looking at how much they are getting. If they are putting a protein powder in their smoothie every morning, how much protein is actually in that? How much are they using, to get a better handle on that? In addition, if they are supplementing with other products – bars, or things like that that are billed as having a lot of protein in them. Assessing how much protein is in those sources also.

Melanie:   In just the last few minutes, give us your best advice, sort of a Protein 101, Dr. Van Sloun, about what you want people to know about how much they need every day and where do you recommend the best sources of protein are?

Dr. Van Sloun:    Again, the guidelines for how much they need is going to be weight based but it’s going to be around 45 – 60 grams for the average weight, man or woman--somewhere in there. They can use that 0.8 gram per kilo calculation. From my perspective, I encourage people to think more of the plant-based proteins and work on including those in their diet just because they come along with all of these other things that are so important for health, including healthy fats and fiber and antioxidants. I try to encourage them to think of meat more as an ingredient in a meal instead of the main part of the meal and to explore with having some meals that don’t have any meat. Pick a day where their evening meal is not going to contain any meat. That can be a fun time to try different cuisines, different recipes and different flavors and really start to broaden a person’s diet.

Melanie: That’s great advice. Thank you so much for being with us. You’re listening to The WELLcast with Allina Health. For more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Internal Notes Nutr
Hosts Melanie Cole, MS

What Do I Eat? Post-Baby Nutrition For Mom

Additional Info

Segment Number 1
Audio File allina_health/1546ah1a.mp3
Doctors Christofferson, Melanie
Featured Speaker Melanie Christofferson, DO – Ob/Gyn
Guest Bio Dr. Melanie Christofferson is an obstetrician and gynecologist at Allina Health Cambridge Clinic. Her professional interests are in preventive medicine and health maintenance, general obstetrics and high risk pregnancy, abnormal bleeding and minimally-invasive and robotic surgery. Dr. Christofferson, originally from El Paso, Texas, has wanted to be a physician since she was a little girl.

Learn more about Dr. Melanie Christofferson
Transcription Melanie Cole (Host): The post-partum period can be an exciting and challenging time for new parents, but with all of the adjustments and a new baby in the home, women can sometimes feel unsure and insecure about their bodies and what they should be eating. They’re trying to lose that baby weight and nursing at the same time. It can be a very confusing time. My guest today is Dr. Melanie Christofferson. She’s an obstetrician/gynecologist who practices in Cambridge Minnesota at the Allina Health Cambridge Clinic and Medical Center. Welcome to the show, Dr. Christofferson. Tell us first, as women, while we are nursing a new baby, what do you think is the best advice to lose that baby weight and eat healthy at the same time?

Dr. Melanie Christofferson (Guest): That’s a tough question. I think the post-partum period, like you said, is pretty hard for new moms and there’s a lot going on. I think it’s important to focus on good nutrition and exercise immediately post-partum. You’re not trying to lose that baby weight all at once. It’s going to be a gradual loss just like you gained weight over those nine months. You’ve got to give your body time to lose weight the healthy way.

Melanie: Are there some foods that you want women to stay away from while there are nursing?

Dr. Christofferson: While they are nursing they can eat most foods just like they did before pregnancy. So, stinky cheeses are okay. You’re not going to pass any bacteria through the breast milk. One thing that you do need to watch for is your seafood or fish consumption. Like we know, seafood has mercury and then it also has some industrial pollutants that are called “polychlorinated biphenyls”--just PCB’s for short. Those are both secreted into mom’s breast milk and they can have a harmful effect on the baby’s neurologic development. Of course, there’s a flip side. So, fish and seafood both have significant health benefits for mom and baby and Omega 3 fatty acids have been associated with favorable neurologic development outcomes for infants, so I don’t want moms to steer clear of them completely. They just need to watch out for how much they’re eating. You can eat about two servings a week of the low mercury fish; that includes chunk light tuna, tilapia and shrimp. I just want moms to steer clear of the fish known to have high mercury levels such as sword fish, king mackerel. If moms have a question, the Minnesota Department of Health has a great website where they can look up more information and it even includes details about fish caught locally. So, if you are going fishing for a weekend and want to eat what you caught, they will give you guidelines as to how much is safe and how often you can eat it.

Melanie: What about alcohol and coffee? Beverages?

Dr. Christofferson: Coffee is definitely okay. New breast feeding moms can have one or two cups a day. If you’re drinking more than one cup, spread it out throughout the day. Just like in pregnancy, you kind of need to monitor your consumption because caffeine can be secreted into the breast milk and over time, it can make its way to baby. Really, moms should just kind of take a watchful eye as to how it’s affecting their baby. Make sure baby isn’t getting real irritable and is sleeping well. If she notices that baby is having any problems, maybe it’s a good idea to cut back. As far as wine goes, moms who aren’t breast feeding don’t need to worry but those moms who are really need to watch their intake. Unfortunately, alcohol is secreted into the breast milk in small amounts. So, one drink or less per day has not been proven to have any adverse effects for baby. The American Academy of Pediatrics Committee on Drugs actually considers it to be compatible; however, they note that large quantities can cause drowsiness, weakness and can even impact the baby’s growth and weight gain. So, if you are really concerned about its effects on baby, you can plan ahead. Just breast feed right before drinking and then pump and dump for about 2-3 hours after drinking. That’s the average amount of time it will take the alcohol to clear mom’s system after one serving. Once that’s out of mom’s system, she can resume feeding like normal.

Melanie: What about supplementation, Dr. Christofferson? If women should only eat fish twice a week and they have to be careful about certain other things, what about taking a multivitamin or fish oil? Can they continue with their supplements while they’re nursing?

Dr. Christofferson: For the most part, supplements are a great idea, especially if they are concerned that they are not getting the well-rounded, balanced diet, which can be hard when you’re sleep deprived and just getting by. Supplements are a good idea – the pre-natal. If you lost a lot of blood at the time of delivery, your provider might mention that he or she wants you to start an iron supplement. Omega 3 supplements are generally safe. Sometimes mercury is in those supplements, so just be careful about that one.

Melanie: We see in the magazines so many celebrities who’ve lost their baby weight in two weeks and, of course, they may be working with a trainer six hours a day or eating just like a bird. What do you say to people when they ask you that same question?

Dr. Christofferson: Well, really, post-partum weight change is variable from person to person. Like you said, those celebrities have trainers. They are working out for hours on end. They have chefs who are preparing these diets that are very limited on calories. That probably isn’t realistic for the average mom and it probably isn’t even healthy. I would tell her to be patient. During the first six months post-partum, she could expect to lose about a quarter of a pound up to just under two pounds per month depending on her diet and her level of physical activity. Really, it’s important to focus on gradual healthy change rather than very, very fast weight loss.

Melanie: Give us your best advice on losing that pregnancy weight and even restarting an exercise program because you have to be careful for those first few weeks, depending on how you delivered.

Dr. Christofferson: Right. I would kind of listen to your body. Don’t overdo it. You don’t need to jump back into a vigorous exercise route immediately. Eating well balanced meals, making sure you’re getting adequate healthy proteins, lean fats, lots of fruits and veggies just because you want to make sure you’re getting all those minerals and vitamins you need and, if you’re not, taking those supplements. Moms who are breastfeeding are going to be burning more calories and so they need about 300-330 extra calories a day. About 170, additionally, will come from mom’s tissue stores. So, that’s going to help her lose a little bit of the weight. Once she gets through that immediate post-partum period, she can start picking up her activity as tolerated. Even as her baby gets a little bit older, try things such as the mommy work out videos. You can find lots of those online. Those are nice because they let mom work out with baby. She doesn’t need to find healthcare and it’s kind of a neat bonding time.

Melanie: What do you tell people, Dr. Christofferson, about the stress of having a new baby and sometimes women use food as comfort trying to stay awake or getting up in the middle of the night and what do you tell them about stress eating?

Dr. Christofferson: Stress eating is very common and it’s easy to confuse being exhausted or being dehydrated with feeling hungry. Oftentimes, mom will report they crave sweets; they crave fatty foods. It’s really, really important to watch what you’re eating. I would recommend having healthy snacks on hand--things that you can easily grab that don’t require a lot of preparation but that aren’t going to allow you to indulge in the things that are less healthy. Don’t deprive yourself completely but make sure, for the most part, you are snacking healthily.

Melanie: So, give us an example of snacking healthily and what you want people to be doing so that it is a gradual weight loss but yet still really good for the baby and for nursing.

Dr. Christofferson: Sure. I would recommend moms picking those little nut packs or you can make your own with almonds, walnuts--things that are healthy. You can do the little pre-packaged veggies or get a thing of carrots and dip it in whatever your dip of choice is. Just make sure you’re not getting more dip than carrot. Veggies, fruits, anything you think of as healthy when you’re not actually eating a meal and try to keep your meals healthy, three times a day.

Melanie: In just the last minute, Dr. Christofferson, give your best advice to women post-partum for foods and post-partum nutrition to help them lose the baby weight even possibly fight off depression, help them with their stress. Just give us your best advice.

Dr. Christofferson: My best advice to new moms and their post-partum nutrition weight loss would be to give yourself time to appreciate your body and give it the tender loving care that it needs. It provided you your beautiful baby and this is the time to focus on being healthy, eating a balanced diet, exercising regularly and achieving healthy, gradual weight loss. Don’t have unrealistic expectations. Also, exercise. It’s a natural mood booster. It’s going to be wonderful to get outside and ward off those baby blues. Walking is a wonderful way to do light activity that you can start almost immediately post-partum. Really, who doesn’t need a pick me up every now and then and that extra exercise might be what it takes.

Melanie: Thank you so much. It’s great information. You’re listening to The WELLCast with Allina Health. For more information, you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

How To Support A Child Who Has Autism

Additional Info

Segment Number 5
Audio File allina_health/1545ah1e.mp3
Doctors Mateffy, LeeAnn
Featured Speaker LeeAnn Mateffy, -Lead Pediatric Occupational Therapist, MS, OTR/L, Courage Kenny Kids
Guest Bio LeeAnn Mateffy, of New Brighton, Minn., is a pediatric occupational therapist with professional interests in sensory integration, therapeutic listening, interactive metronome (IM), teens, pre-driving skills, SOS and feeding. She says the best part of her job is working with families and their children.
She said at a young age she became interested in occupational therapy because she saw them making cookies and doing crafts which looked like more fun than what they were doing in physical therapy.

Learn more about LeeAnn Mateffy
Transcription Melanie Cole (Host): Children diagnosed with autism face special challenges and it’s important that parents know how to address these challenges so that they can get early intervention for their children. My guest today is LeeAnn Mattify. She is the lead pediatric occupational therapist at Allina Courage Kenny Kids. Welcome to the show, LeeAnn. What challenges do kids with autism face and how can rehabilitation therapy help them?

LeeAnn Mattefy (Guest): Melanie, as you know we have lots of children who are diagnosed with autism. The latest figures that I have looked at from the CDC state that about one in 68 kids are diagnosed with autism or autism spectrum disorder. These kids are very smart. About half of them are average intelligence to above average intelligence. Autism is diagnosed in five times as many boys as it is in girls. A physician will diagnose your child with autism by looking at their behavior and what kind of developmental milestones your child has either made or hasn’t made. There is no easy blood test for diagnosing autism. It is a development disorder and the kids on the spectrum have lots of challenges with things like interpreting sensory information, with talking, with social skills, with communicating, with playing, with imitating other kids playing, with doing their own daily cares and with gross motor skills and fine motor skills.

Melanie: What differences might they have from their brother or sister that their brother or sister would notice and be unsure about?

LeeAnn: We’re all wired differently neurologically and that’s great. It’s not good. It’s not bad. It’s just different. You would see the sibling with autism processes information a little bit differently. I am an occupational therapist, or an OT, and I really look at sensory processing and motor skills for kids. Most of us might have a sensory challenge or two that we deal with – maybe you don’t like things that are very noisy so you like things a little quieter; Maybe you don’t like wearing socks because of that little line that you can feel in the sock; or maybe you can’t study or do what you need to do if it’s too noisy. Kids with autism, the sensory challenges are just really increased. It’s to the point that the noise is so loud that maybe they withdraw or they melt down. Other kids have a hard time with fine motor skills. Maybe writing is tough; maybe things like fastening your zipper or buttoning buttons is really hard. Handwriting can be really tough. Maybe I would work with your child to teach them how to keyboard to do homework assignments, text or email friends. Sometimes, I’ll encourage kids to learn to use one of those “texts to speech” programs like Dragon Naturally Speaking. I also work with speech therapists and they really look at things like social and language skills with kids. Maybe one of the things they really work hard on is keeping kids stay engaged when they play. Sometimes it is challenging to follow a kid’s lead in play, even though that is what we are really trying to do. So, maybe you work with whatever the kid is really interested in – maybe Thomas the Train – and you try to help the kid play with the train but not just get stuck in some kind of a repetitive action like watching the wheel spin and spin. Kids learn from play and if you’re just spinning something you’re not going to learn a lot from that. Maybe a speech therapist would work with a kid to help them understand words that you speak and also help others understand what this child is saying. If kids can’t communicate or can’t understand what you’re saying, sometimes they develop behaviors that are really undesirable. So, instead of the child being able to tell you that you’re bugging them or they want you to go away, they are just going to hit you instead. That’s where they might get into trouble and you may need a therapist involved. Physical therapists also work with kids on the spectrum. They work a lot on gross motor skills. Most of the kids on the spectrum can walk but then, they might be a little uncoordinated or a little clumsy or their balance isn’t quite adequate enough. Things like running and kicking a soccer ball, riding a bike – all the things that typical kids do are really hard to do for these kids. They need a little extra boost, a little extra help from a physical therapist. You think about how complicated playing soccer is. You have to be able to watch the ball. You have to run. You’re moving quickly. The ball’s moving quickly. You need to run up to the ball. You need to kick it and you need to kick it to a team mate or kick it between the goal lines so that you can do what you need to do. Those are a lot of the things that an OT, a speech therapist and a physical therapist would work on with your child with autism.

Melanie: How early can you start to identify some of the red flags and what should parents be looking out for so that they can seek early intervention?

LeeAnn: What we’ve really learned these last few years is that early intervention with kids on the spectrum has really helped them have better outcomes. Most parents will tell you that they could tell that something was something different with their child by the child’s first birthday. A lot of the research has shown that physicians can diagnose kids with autism by their second birthday and their diagnosis is reliable, it’s valid, it’s stable, it doesn’t change. Once you, as a parent, understand how your child reacts to the world, you can work with the therapist to help develop goals so that you can make your child succeed. Once you see some developmental or behavior issues, you would take your child to the doctor. The physician might diagnose your child being on the autism spectrum and then, usually, they would make a referral to therapy. As a therapist I talk to the parents and evaluate the child’s strengths and challenges. What kinds of things do we need to work on? What kinds of goals sound reasonable and realistic so that we can make the child more successful? In therapy, once children meet some of the short-term or long-term goals, then we would look at stopping therapy and discharging a child. They could start therapy again once the parents maybe see a change or there is some kind of a transition that is tough for kids to be able to move through successfully. As an OT, I work with kids on self-regulation. Most kids by the age of ten are able to self-regulate, they have some coping skills and they can feel like they know when they need to do something different so they don’t have a meltdown. Kids on the spectrum, this is a hard thing for them to realize so maybe that would be when I would work with a child again. As kids get older, we might look at different things. Maybe could they be a successful car driver? Do they want to volunteer? Do they want to get a job? Can we help make some recommendations for how they can be successful with those types of things as they age?

Melanie: You have to do therapy sometimes at different points as they age and when they are getting just a little bit older. What would you have to do with them – things that change in school, things that change in their family situation – and how do you work with them then?

LeeAnn: That’s right. We work with kids that we call the therapy “episodic.” That’s where we’ll work on some goals with the child and the parents and once they meet those goals, we discharge them and then we’ll get involved again. There are other different points in a child’s life where we might get involved. Maybe there’s a new baby in the family. Maybe the child is starting preschool or maybe they are going from elementary school to junior high – changing schools, having to go to different lockers. Maybe the family is planning a vacation where this child has never flown in a plane before. Maybe the child needs to learn to ride a bike or as they get older and they get invited to birthday parties or have sleep overs. Entering high school can be a tough one with kids going through puberty. Graduating from high school – at that time, kids might want to start volunteering, they start looking for their first job. All of these little transitions are times when therapy might be appropriate to jump in again and work with your child and you, as parents, to help manage these new things and provide a safe place to practice and try new ways of doing things.

Melanie: In just that last few minutes, LeeAnn, give your best tips for families when their children are somewhere on the autism spectrum, give your best advice, your best tips for working with these kids and what they can do at home on a daily basis to help their children thrive.

LeeAnn: It seems like the kids that do the best have a really structured home environment. The parents are great at using things like picture schedules so the child knows what to expect. First, we’re going to get up and have breakfast and then we’re going to brush our teeth. So, maybe there are pictures of having breakfast and brushing teeth. It also helps with transitions from one thing to another. Another thing at home that is helpful is to have a defined space for the child so they can go and veg-out and get away from some of the stressors but still have it be a safe environment. Sometimes at school, kids do better if they have a little defined workspace so things aren’t so confusing. Maybe we’ll use some colored tape and put it on the floor around the child’s desk area so that they know this is your work area; this is where you need to get your stuff done. As I said before, I can’t really stress enough how picture cues are really helpful. You can tell a child what to do but that is kind of fleeting. If you use a picture schedule, it seems that it just helps them organize their day. If you can figure out what kind of triggers do children have, especially sensory-wise, that make them melt down? Maybe the lights are too bright. So, can you turn down lights? Have natural lights. Have a child use sunglasses. Do noises bother them? Maybe they wear headphones or earplugs or bring them to an area that’s more quiet. Help the kids work on social scenarios. If they are going to be with a friend, how do you do greetings? You would practice that. As a parent, just plan for the transitions. Transitions can be tough for any kid. If you can anticipate some of these transitions and get some help if you think that is something that your child will need. The therapist will help you determine what would be best for your child. Remember to love your child. They are fun. Be patient and understanding like you would with any of your other children.

Melanie: Thank you so much, LeeAnn. It’s great and very important information. You’re listening to The WELLcast with Allina Health. For more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Help with the ACA: Programs that Address the High Cost of Care

The ACA plans all seem to come with high out-of-pocket costs. Are there resources for people who still can't afford care?

Additional Info

Segment Number 3
Audio File health_radio/1545ml1c.mp3
Featured Speaker Marianne Eterno, President of Government Relations for GTL
Guest Bio Marianne Eterno began her insurance career in 1987 at the former Golden Rule Insurance Company in Indianapolis, Indiana, and moved to Chicago in 1992, when she accepted a position with Celtic Insurance Company.

Marianne came to Guarantee Trust Life Insurance Company (GTL) in 1996, as a compliance and government relations consultant, and formally joined the company in 1997. As Assistant Vice President of Government Relations, she represents GTL in both the state and federal arenas, drives coalition development for the company, and serves as the company's media and public relations spokesperson.

In addition to sitting on committees for every major insurance trade association, Marianne serves on the Board of Directors of RetireSafe, a 400,000 member grassroots advocacy organization for senior citizens and as the Executive Director for the Council for Affordable Health Insurance.
Hosts Melanie Cole, MS

"But I Hate Milk:" Strong Bones Without The Dairy

Additional Info

Segment Number 4
Audio File allina_health/1545ah1d.mp3
Doctors Guetzko, Jaclyn
Featured Speaker Jaclyn Guetzko, DNP -Internal Medicine
Guest Bio Jaclyn Guetzko is an adult-gerontological certified nurse practitioner practicing at Allina Health Bloomington Clinic. Her professional interests include chronic disease management and preventive care. She completed her doctor of nursing practice in 2015.

Learn more about Jaclyn Guetzko
Transcription Melanie Cole (Host): Our bones are at their strongest around age 30 and they slowly lose density as we age. This is a natural part of getting older. However, if there was something you could do to prevent a disease, wouldn’t you? Conversations about healthy, strong bones usually involve drinking milk but what if you’re not a milk drinker or if you’re lactose intolerant? My guest today is Jaclyn Guetzko. She is a certified nurse practitioner practicing at Allina Health Bloomington Clinic. Welcome to the show, Jacqueline. Let’s talk about osteoporosis and bone density. Explain a little bit about women and what happens to our bones as we age.

Jaclyn Guetzko (Guest): Women are at increased risk for osteoporosis because we tend to have thinner and smaller bones then men. Also, as we begin to reach menopause and age, estrogen, the hormone that we know protects bones, dramatically decreases as a woman begins to approach and reach menopause. This is a major contributor to why we lose bone density and why women are more prone to osteoporosis. Those who are at the higher risk are Asian and white women. But, men and women of all ethnicities can get osteoporosis.

Melanie: Are there some people that are just going to have this problem? Is there a genetic or hereditary component to it or is there something that you can do to prevent it?

Jaclyn: Prevention is key. You’re never too old or too young to take care of your bones and prevent bone loss. There are a lot of good habits that we can incorporate into our daily life that can help decrease our chances of getting bone loss and osteoporosis. I tell my patients to obtain a diet that is rich in calcium. Get enough calcium and vitamin D as part of a well-balanced diet – rich in fruits, vegetables, protein and low-fat dairy products can help keep our bones healthy. I also like to really impress on patients to engage in a regular exercise program, especially high impact exercises because these are the exercises that help keep the bones strong. These are things like dancing, jogging, hiking or climbing stairs. If you are not somebody who can do high impact exercises, low impact exercises are a good, safe alternative and are also good for bone health. These are things like using an elliptical machine, a stair step machine, or even a treadmill. Other things that we can do to decrease our change of getting osteoporosis are to avoid smoking and limit alcohol intake, which can both lead to bone loss.

Melanie: Would somebody know if they are suffering this osteopenia (softening) or osteoporosis (bone loss)? Would they know or is this something that you want us to get tested for on a regular basis and have that bone density test?

Jaclyn: There’s really no signs or symptoms of osteoporosis or osteopenia, which is the early stages of osteoporosis. We don’t recommend screening or bone density scans until you are about 65 years old, because once bones have weakened from osteoporosis you might start seeing symptoms like height loss over time or a stooped posture. A significant sign of osteoporosis is a bone fracture that would occur much more easily than one would expect given their injuries.

Melanie: People hear you say calcium and foods rich in calcium and everybody right away thinks about milk. It’s got Vitamin D and calcium, both good for the bones. When we’re thinking about milk, some people can’t. They’re lactose intolerant or they have a milk allergy. So, what do we do if you can’t ingest dairy products?

Jaclyn: Yes. Milk products and low-fat dairy are great choices but if you don’t like milk or you avoid lactose products, there are other good food choices. Foods that are a great source of Vitamin D are things like fish, especially canned sardines or salmon with bones are high in calcium. Fatty fish, like salmon or tuna, is a great source of Vitamin D. Other good choices to get adequate calcium and Vitamin D are things like fruits and vegetables. Specifically, dark green vegetables like your kale, your broccolis, Chinese cabbage, mustard greens or turnips are good sources of calcium. Some foods are often fortified with calcium and Vitamin D. These are foods that have calcium and Vitamin D added to them. You can see this often times on the box when you are looking at foods at the grocery store. Certain brands of juices, brands of breakfast foods, soy milk, rice milk, snacks or bread sometimes are fortified with both calcium and Vitamin D.

Melanie: How do you know if you’re getting enough Vitamin D and/or calcium? Do you recommend supplementation? Vitamin D supplements or Cal-tabs or one of the calcium supplements?

Jaclyn: Our bodies need Vitamin D in order to absorb calcium. So, they do go hand in hand. I do recommend calcium supplements to those that think that their food sources are deficient or they’re not getting enough calcium in their diet. Women aged 50 and younger should be getting about 1000 milligrams of calcium per day and about 400-800 International Units of Vitamin D. Those 51 and older should be getting about 1200 milligrams of calcium per day and 800-1000 International Units of Vitamin D per day. This is your total daily calcium and Vitamin D. You can get this from food sources or you can get it from supplements. It is important to get into the habit of reading food labels to check the nutrition facts for the daily values of calcium and Vitamin D. It’s usually listed as a percentage on the side of the box. If a nutrition label states that it has 25% of the daily value of calcium, this means that you are getting 250 milligrams of calcium. This is a good way to count how much calcium you’re getting and if you’re noticing a shortage at the end of your days, go ahead and supplement. But, there is no benefit to taking additional calcium and there is also a small chance of developing kidney stones if you’re taking too much calcium. In terms of Vitamin D, it can be pretty hard to get Vitamin D from our food sources alone. We can get Vitamin D from the sunlight in terms of UVD rays, but if you live in an area like where I live in Minnesota, where sun exposure is very small, especially in the wintertime, it can be hard to get Vitamin D, or it can be almost absent. And also we tell all of our patients to us SPF 30 or higher and this blocks the UVD rays making it almost to get Vitamin D from the sun. Same as calcium, you want to check the food labels to make sure you’re getting enough Vitamin D in your total daily servings, but many people do need to take a Vitamin D supplement to get enough Vitamin D for bone health. Before taking a supplement, if you’re already taking a multivitamin, go ahead and check and see the content of the Vitamin D, especially since vitamin supplements are already in a multivitamin.

Melanie: So, in just the last few minutes, Jaclyn, speak about prevention regarding osteoporosis and really what the listeners can do starting today to help them build strong, healthy bones.

Jaclyn: This is one of my favorite things to talk about. Prevention is key in building strong and healthy bones. In addition to getting adequate Vitamin D and calcium, I really push for patients to get regular exercise. My best advice is to really stay physically active because this can help you build strong bones and slow your bone loss and it also keeps us healthy. Exercising can benefit our bones no matter when we begin and if you initiate a regular exercise program when you’re young and continue to exercise throughout your life, you’ll really gain the most bone health benefits. I recommend combining strength training with weight bearing exercises, like your walking, your jogging, your dancing. Strength training through weights in our upper body can help strengthen bones in the upper extremities and upper spine. The weight bearing exercises like our walking and jogging can help improve the bone health in our lower extremities, hips and lower spine.

Melanie: Thank you so much. It’s absolutely great information. You’re listening to The WELLcast with Allina Health. For more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Meningitis: Are You At Risk?

Additional Info

Segment Number 3
Audio File allina_health/1545ah1c.mp3
Doctors Martin, Catherine (Kate)
Featured Speaker Catherine (Kate) Martin, RN, CNP
Guest Bio Catherine Martin is a certified nurse practitioner at Allina Health Blaine Clinic. Her advice to patients is to find balance in their lives, something she practices in her own life through mentoring and photography.

Learn more about Catherine Martin
Transcription Melanie Cole (Host): Meningitis can be a very serious disease. Outbreaks of bacterial meningitis at colleges have grabbed the headlines because otherwise healthy, young adults can quickly become ill and even die from this contagious illness. My guest today is Catherine Martin. She's a Certified Nurse Practitioner at Allina Health Blaine Clinic. Welcome to the show, Kate. First tell us what meningitis is and what causes it?

Catherine Martin (Guest): Well, thank you. Well, first you've got to know the anatomy. The meninges are kind of a clear covering that lie over the brain and your spinal cord. They're the last protection, kind of, of the central nervous system to the outside world. There a few different types of things that can cause those to be inflamed: viruses, bacteria and a couple of other forms, which results in meningitis.

Melanie: So, people hear about bacterial meningitis. They hear about viral meningitis. What's the difference?

Catherine: Well, viral meningitis tends to be a little less serious and have more significant outcomes, however, it is still a significant illness. People usually recover without specific treatment as far as a viral illness. We just kind of support them as needed. The viral meningitis is not preventable with a vaccine. However, fortunately, the most common forms of bacterial meningitis, which are the most serious, do have a vaccine to help our bodies fight against that disease.

Melanie: So, if somebody gets the vaccine, is this vaccine 99%, 100% preventable for meningitis?

Catherine: I couldn’t give you an exact number but it's a very high percentage rate of persons who have received the vaccine. Their body creates antibodies which are like little soldiers that are kind of on board, ready to go if you come in contact with the bacteria. So, it just kind of pounces on it.

Melanie: How would someone who hasn't been vaccinated get meningitis?

Catherine: Well, it's not just kind of spread through casual contact or through the air. You get it, usually, with close or prolonged contact with an infected person. It can also be exchanged by respiratory secretions. So, kissing, sharing drinks, eating off the same utensils. Keeping in mind that the disease can incubate in a person, meaning they're not showing any signs of the illness for 2 – 10 days before they develop symptoms and about 3 days after someone who is exposed to the bacteria contracts it, they can start spreading it without any symptoms.

Melanie: What are the symptoms of bacterial meningitis? They can be confused with the flu and it's quite scary, if some of these happen.

Catherine: You're absolutely right. It is a flu-like illness at first. But, there are a few things that are very specific to a meningitis: sudden high fever, a severe headache and a stiff neck. Those will be kind of earlier in the illness. If you wait to seek treatment, you may start developing seizures or even get kind of an altered mental status--become a little bit confused.

Melanie: So, now, what do you do if somebody's experiencing these symptoms? If you have a teenager or college-aged kid and they've got a stiff neck and their fever jumps up and they've got a really bad headache, do you call 911 or do you take them to the doctor?

Catherine: I would get them to the closest emergency room. If they're not having any seizures or altered mental status, I think you can get them to the closest emergency room. I wouldn't take them into the clinic, because we'll just end up sending them to the emergency room from there. If they're lethargic and not very responsive and confused, I would definitely not hesitate to call 911 and have them bring them to the hospital for you.

Melanie: How is it treated?

Catherine: Bacterial meningitis can be treated with antibiotics. It's very important to start the treatment early on in the illness. You have a better success rate and a more likelihood of treating it with that. However, there can be long-term complications for patients that do survive the illness, as far as losing fingertips, toes and other chronic issues.

Melanie: Who is most at risk for bacterial meningitis, Kate?

Catherine: The population that's most at risk for dying from meningitis is infants and the elderly. However, you see the most common cases in anyone under 20.

Melanie: So now, tell us a little bit about the vaccine. We know that before our kids go to college is one time that it's very important that this vaccine be given.

Catherine: Yes. This one's for the meningococcus and it is given at, usually, age 12 and then repeated again at age 15. That will kind of protect against the most specific and more serious meningococcal disease that often we see the outbreak on college campuses. You know, a couple of kids wake up, they don't feel great and either they're in the ICU that evening or even possibly passed away from it.

Melanie: Is there anyone who shouldn't be getting the vaccine?

Catherine: Usually, people who have decreased immune systems should not be having the vaccine; anyone who's had a severe allergic reaction to a previous dose and anyone who has a significant allergy such as eggs. Usually, we avoid this one in children under 6 weeks old and anyone with a moderate or severe acute illness with or without a fever. We usually avoid vaccinating them.

Melanie: Now, tell us a little bit about vaccines in general and the pneumococcal vaccine and maybe even traveling--people that need vaccines for different reasons.

Catherine: Okay. Basically, the CDC recommends the meningococcal vaccine for all children 11-18 or certain younger high risk children. Usually, the first dose is at 12 and 16, like I said before, and that's for the one that we try to prevent you against when you go to college. Anyone who has been exposed to a diagnosed case of meningitis should be vaccinated. Anyone traveling or living where meningitis is common, so such as in South Sahara and military recruits. The HIB vaccine and the pneumococcal vaccines are what we give to little children but we're also giving that pneumococcal vaccine to geriatric patients as well. So, 65 and older. The HIB vaccine and the pneumococcal, which is the PCV13, is given at 2, 4, and 6 months old in infants and children. And, again, that is the time when they are the most vulnerable for that which is why we try not to delay that vaccine schedule and that's the Haemophilus influenza B again and then the strep pneumonia bacteria.

Melanie: Are you seeing more bacterial meningitis because some people are altering their vaccine schedules? Do you think, in just your opinion, that there might be more of an outbreak in meningitis than we've seen in a while?

Catherine: Well, I think vaccinating, in general, the less we do it, the more outbreaks we'll see in any disease that is vaccine preventable.

Melanie: Tell us in just the last few minutes, Kate, some final advice--best advice--for those that are at risk, such as college students and the meningitis vaccine and the disease itself.

Catherine: Okay. The biggest thing is to practice good personal hygiene. You learn it in school. The best thing you can possibly do is really good handwashing. You want to wash for at least 20 seconds getting the front of the hands, the back of the hands, between the fingers and under the fingernails. Don't share personal items: lipstick, Chapstick, food, glasses, water bottles, eating utensils and don't share towels. And, again, keeping in mind a person with meningitis can remain contagious for up to 24 hours after they have started treatment or be contagious for several days before they even develop symptoms.

Melanie: Thank you so much. It's really great advice and such important information. Thank you so much, Kate. You're listening to The WELLCast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Winter Workouts: Stay Active During The “Snuggle” Months

Additional Info

Segment Number 2
Audio File allina_health/1545ah1b.mp3
Doctors Arndt, Marc
Featured Speaker Marc Arndt, MA, -Exercise Physiologist
Guest Bio Marc Arndt is an exercise physiologist at the LiveWell Fitness Center. Arndt has been a personal trainer for 13 years and received his Cancer Exercise Trainer Certification and Personal Trainer Certification from the American College of Sports Medicine.

Learn more about Marc Arndt
Transcription Melanie Cole (Host): During the months between the holidays and spring, we feel like we want to snuggle indoors and we may find our activity levels decrease during this time. My guest today is Marc Arndt. He's an exercise physiologist with Penny George Institute for Health and Healing. Welcome to the show, Marc. Tell us a little bit about some of the first best bits of advice you would give somebody as we head into the cold winter months about not letting that activity level drop down.

Marc Arndt (Guest): Just stay motivated and keep active as much as you can and do anything possible to keep yourself moving throughout the day.

Melanie: So, people ask what does that mean, “Keep ourselves moving.” Is just taking a short walk considered that? Is parking a little further? What do you want them to do every single day and how much of it do they need to do?

Marc: Well, ultimately, we always consider 10,000 steps as a very healthy, active lifestyle and that's what we're always aiming for. So, ways that we can manage to do that is exactly like you said: parking a little bit further away from the shopping centers; going for a walk once we're in the shopping centers opposed to just shopping right away and getting back out; doing anything that we can possibly do to go and keep more active.

Melanie: If people do want to take a walk outside or if they're a runner – and you see those runners in the wintertime – and think, “Ah!” with the ice and the cold. What would you like people to know about exercising outdoors in the cold?

Marc: You can exercise outdoors in Minnesota, anytime throughout the year. There's never a cold enough day to say that you would have to stay inside. If you're going to exercise outside, we always recommend that you're doing that during the warmest part of the day. Typically, during the winter, that's going to be around that 10:00 in the morning until 3:00 – 4:00 in the afternoon when the sun is out. Even if the sun's not out, that's still probably your warmest time. Also, make sure that we're dressing in layers. Make sure that you're able to, as you're starting to warm up and start to sweat, that you're able to start taking some layers off so you don't have any other health issues that may arise with that.

Melanie: What about play? People often don't consider play as part of an exercise regime but sledding and snowshoeing and skiing all get your cardiovascular activity levels up. What about play?

Marc: Play is very important because just like any time when we're exercising during the summer, anything that’s going to go and give you a change of routine – you mentioned sledding. Sledding is a great way to go and change up that routine – keep you moving, keep you healthy when you're outside. Most people don't realize how much activity they're actually getting in when they're sledding because they figure that all that they're doing is going up and down a hill. Well, you know what? When you're climbing those hills, that makes a huge difference. When we're cross country skiing, we're staying more than active, typically, for that because we're typically going out for about, I would say the shortest time, normally, is going to be about a mile but, most of the time, when we're cross country skiing, that's typically going to be about a 3 -5 mile jaunt. Snowshoeing is another great way to go and stay active – very physically demanding with snowshoeing depending on how deep the snow is as well.

Melanie: What about injury and reducing the rate of injury? If our muscles are cold and we're exercising outside, are we more at risk for injury like pulling a muscle or slipping and falling on the ice?

Marc: I'd say we are probably more apt to be injury prone during the winter because there are more elements to it. Like you mentioned, slipping on ice or falling down, our muscles are going to get tight very quickly when we're outside. But, if we're able to stay moving and motivated as we're doing our activity, we're typically not going to get too tight or the muscles aren't going to tighten up too much. There's a lot of gear that's built around helping us not slip and slide on the ice if we're outside doing activities.

Melanie: Marc, one thing people don't typically think about – we hear about hydration during those hot summer months but during the cold months, it's just as important, isn't it?

Marc: Yes, it is. Typically, most people realize during the summer that they're sweating a lot more whether they're really engaged in exercise or not. Even just normal general activities when they're out in the summer, they're sweating, typically. However, during the winter, we're just as apt to sweat but it goes and evaporates much quicker off of our skin and, therefore, we don't notice that sweating part of it. So, we want to make sure that we're staying hydrated just like we do during the summer months. We want to make sure we're hydrating during the winter months as well.

Melanie: At the beginning of the segment, you mentioned staying motivated. But, it's darker earlier at night, and it's cold. You feel like you don't want to get out from under the blanket. Give us some advice on staying motivated to exercise and why that's so important.

Marc: Staying motivated can be just an internal peace, many people do have that internal drive to stay active and so forth throughout the winter. If you're not one of those people where it's as easy to do, I always typically tell some of my patients and so forth that they should go and try to find a group of people, whether it be neighbors or something like that, that they can go and go out for a walk with, or maybe they go to a shopping center and they just wander throughout the area before they actually do some shopping or just use the wide aisles and so forth so that they can go and walk through and get their activity. Like I mentioned, 10,000 steps isn't all that difficult to get typically from most individuals, but we do need to stay motivated to get there.

Melanie: What about for people who just really don't want to go outside? You mentioned mall walking, and going inside. Is that the time to join a gym or possibly investigate getting home equipment?

Marc: Exactly. We would want to go and start looking at the advantages and disadvantages to having the stuff there at our own house, especially if you're one of those that once they come home from work, or once they come home say, “I don't want to go back outside.” That would be a great place to go and start looking. What's the cost going to be for some dumbbells or resistance bands? And, maybe something small like a bike or something small of that nature that we can go and put inside our house. If you're working and you think, “You know what? I can stop on my way home from work before I get home to do my exercise, what's that gym membership going to cost at that point?” And make sure that you're asking all the important questions when you get there to the gym. See if there's any—you now, what your term limits are. Is it a full year that you have to pay whether it's during the summer, or not during the summer? See if you can put things on hold. If there are any medical issues that do arise or anything like that, we definitely do want to make sure that you're using your money wisely.

Melanie: So, in just the last few minutes, Marc, give your best advice to help people turn those snuggle months of winter into opportunities for maybe a new exercise routine.

Marc: Some of the fun things that I like to do is, if nothing else, try something brand new to you. Go out and try some snowshoeing. I know in Minnesota, we have all the snow in the world out there, but typically, we don't see that many people out snowshoeing. So, try something new, whether it just be once or twice throughout the winter but it just goes and breaks up that monotony of walking all the time or maybe you are constantly are cross-country skiing. Snowshoeing is a great adjunct to go and throw in. Using other devices like the Fitbits that are a big, hot issue right now. Using those to go and track what you're getting for a number of steps or just using a simple pedometer, something that you can track your numbers. And use logs, to go on logs. “How many steps am I doing?” That's one of the nice things about the Fitbit is it will a lot of the time sync to your computer or sync to your telephone--to your smartphones and so forth--and you can go and track all of that information.

Melanie: That's great advice to keep a log, to keep a journal, use a Fitbit because there are so many apps and bits of advice out there now that really can help people get motivated. It's such great information. Thank you so much, Marc, for being with us. You're listening to The WELLCast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

St Joe’s Cardiology – Mindfulness In Today’s World

Additional Info

Segment Number 3
Audio File st_joes/1545sj1c.mp3
Doctors Deron, Scott
Featured Speaker Scott Deron, DO, FACC
Guest Bio Dr. Deron is a Board Certified Cardiologist and a Fellow of the American College of Cardiology. He earned his medical degree at Philadelphia College of Osteopathic Medicine. Later he completed two Cardiology Fellowships at Albert Einstein Medical Center in Philadelphia and has participated in numerous research studies in Cardiology.

Learn more about Dr. Deron
Transcription Bill Klaproth (Host): We live in such a fast-paced world, it’s tough sometimes to slow down and enjoy the moments that can make each day truly special. When you are mindful of today, not only does that make life more enjoyable but it also does your heart health a world of good. Paying attention to what makes your heart soar and what brings it down is very important. With us today is Dr. Scott Deron, a board certified cardiologist and a fellow of the American College of Cardiology. He is also the service leader in cardiology at St. Joe’s. Dr. Deron, thank you so much for being on with us today. I’m so excited about this topic. So, if we could just jump right in: how is heart health and mindfulness connected?

Dr. Scott Deron (Guest): Excellent question, Bill. Thank you, by the way, for having me. In 2004, the INTERHEART Study was published in The Lancelot. This looked at a large amount of patients scattered across 52 countries and looked at nine modifiable risk factors. Things that are literally under our direct control in terms of our life and found that approaching 90% of all risk of progressive heart disease is linked to the decisions we make on a daily basis. This was a very compelling report indicating that the disease, that is right up there with cancer, that takes our population out well before normal life expectancy, is literally under our direct control. So the question that ran in my mind is, why is it that folks make the decisions that the population makes on a daily basis? And, what is the real root cause analysis of those decisions? That led me to look at my patient population, which was certainly mirroring that of this very large study, and I began to look at some of these issues. It led me to Boston to spend some time at Mind Body Medicine Institute at Harvard and understanding some of these underpinnings of why it is that we make the decisions we make. Some of the physiologic changes that happen with stress are well-categorized. We know that the near-miss car accident being that turning on of our sympathetic nervous system where our mouths go dry and our heart pounds and sometimes aches. That is a very vivid example. But, taking the extreme of the near-miss car accident and looking at it on a daily basis, there is a lot of those almost mini accidents that happen throughout our day and really how we react to them largely determines our physiologic response in terms of adrenalin, the effects of adrenalin on our blood pressure and so forth. It began a new part of my interest in population medicine and how we can really do our due diligence in the medical community in terms of getting the population healthier. This led to looking at some things that had been brought about through University of Massachusetts, some of the work by Jon Kabat-Zinn in mindfulness based stress reduction. He, I would regard as the father of mindfulness in the United States. He started approximately 35 years ago and really has a terrific program. It’s really through his work it ignited an interest and passion in me about all of those things that patients can do in their lives that minimize the effect of the stress that we deal with on a daily basis.

Bill: So, this discovery of mindfulness and its link to heart health – obviously, it sounds like it’s starting to become accepted in the mainstream medical industry. What can we do to be more mindful, to slow down to take that pressure and stress off of our hearts and our bodies?

Dr. Deron: That’s an excellent question, Bill. If you will, for a moment, we live our lives somewhere vacillating between a potentially painful past and fretting about the future. We are pulled backwards by that painful past and we are pulled forward by that concern we have about what’s going to happen. When we do that, we are actually pulled away from the one thing we truly have and that is that present moment. That is the only thing we can really hold in our hand because the future is a question mark. You can’t hold the past in your hand. One of the things that mindfulness-based interventions do is to simply ask us to slow down, to breathe. There are seven tenants to mindfulness-based stress reduction that come to the forefront. One of those things that I ask my patients to do is something simple. It’s to come up with a worry tree. A worry tree is a tree near where they live. They can take the problems they forage throughout their day, take that necklace off, put it on the tree, go into their homes and leave their problems outside. This little parable type exercise is something that can help people realize that they don’t necessarily have to live with their problems. The mind is a wonderful tool, but we need to put it down once in a while. Sometimes this idea of sort of putting your problems over there allows us to simply relax and be. We mutate into becoming human “doings” as opposed to human “beings”. When we simply understand that and do these really simple relaxing type exercises, we can get to a healthier place.

Bill: So breathe, leave your worries outside on the worry tree. Can you, very quickly, give us a few more steps? Those are really good.

Dr. Deron: Sure. There’s four senses that I like people to concentrate on. A sense of perspective; a sense of humor; a sense of wonder about the natural environment and a sense of purpose. I think when we ask ourselves to simply write down some of these things on paper where the one perspective is 100 years from now – you, me, and most everyone we know will be gone. Are the problems I’m really shouldering that important that it should take the fabric of my life in such a way that I need to run to go eat something to calm my stress? Am I going to go to substances or casual relationships that don’t really serve any good long-term purpose to cope with my stress? I think some of the things like understanding that sense of perspective; simply breathing; getting into a quiet place for five minutes. Breathe in, breathe out and tell yourself those words. Simply doing that on a daily basis just for five minutes can have a rather profound effect on our health.

Bill: So, a sense of humor, a sense of wonder, a sense of perspective – all great advice. Do you see a day where you would prescribe meditation over medication?

Dr. Deron: I think the best pill is no pill unless there is robust science that the person taking that pill is going to get some benefit from that. I think when we sense that there is something missing inside, namely our connection with the present moment, we try and fill that void. We try and self-heal ourselves with the easy things and certainly the most easy thing is food. If you think about it, when we are born, we’re absolutely helpless and we are fed four, six, seven times a day. When we are fed we are often kissed, hugged and sung to – loved absolutely unconditionally. That doesn’t happen to us frequently during the day much in this very busy lifestyle, but every time we eat we harken back to that. So, yes, I think meditation over medication associated with physical activity – a simple walking program – our brains produce beta endorphin and that gives us a strong sense of peace and well-being. I prescribe pedometers and literally write out a prescription for 10,000 steps a day. These are very healthy ways that work well with pills when we need them, but ideally before pills. Meditation over medication unless there is robust science for the medicine.

Bill: You know, this sounds so easy. “Okay. I’m going to have a sense of humor, a sense of wonder, perspective and I’m going to leave my worries on the worry tree.” I think it’s probably more difficult to concentrate and commit to that every day. It sounds easy but I think in reality when we are so busy and so hectic that it is hard to do that. Can you give us any tips to try to give us some thoughts on how we can commit to this and how we can really make this effective in our lives?

Dr. Deron: Bill, you are spot on. It is like miniature golf or darts. If you and I went and did those things today, we would be as good as they are, but if we worked at it for 10 or 15 minutes a day for the next month we’re going to be better at those things. It’s like any learned skill. It does take some practice, but it takes commitment. The commitment does need to come from within and, unfortunately, I think our modern medical system has been driven by the prescription or the procedure more often than it should be. It is sometimes easier to recommend those things then it is to actually getting the person to heal from within by doing some of these basic things. It’s a commitment to self. National Public Radio has brought back in the This I Believe, a segment that Edward R. Murrow did some years ago. I think if we all sit down and asked ourselves, “This I believe,” what are those things? I think the ability for us to heal from within complimented by pills and procedures when we need them, is a healthy way to go. But, it takes that quiet conversation with yourself about whether this life is worth it and, obviously, it certainly is. For many, it’s just too busy to simply have that quiet conversation with ourselves but our health absolutely requires it.

Bill: So, if you want this to work for you, that’s great advice. You’ve got to have that quiet conversation. You’ve got to commit to self and you’ve got to practice it. Dr. Deron, thank you so much. I could talk to you about this for a half hour, but, unfortunately, we don’t have that much time. Thank you so much for your time today, we really appreciate it. For more information visit StJoesHealing.org. That’s StJoesHealing.org. This is St. Joe’s Radio. I’m Bill Klaproth. Thanks for listening.
Hosts Bill Kaproth

Orthopedics – Knees Got You Buckled Down?

Additional Info

Segment Number 2
Audio File st_joes/1545sj1b.mp3
Doctors Brooks, Jacob
Featured Speaker Jacob Brooks, DO
Guest Bio Dr. Brooks' specialty is Orthopedic Surgery. His Residency was at Pinnacle Heath Hospitals. He is a member of American Osteopathic Board of Orthopedic Surgery.
Transcription Bill Klaproth (Host): Everyone has a bit of knee pain now and then but, at what point should you go see your doctor or orthopedic surgeon? Dr. Jacob Brooks from Down East Orthopedics Associates, which is associated with St. Joseph's Hospital, is with us today. His specialty is orthopedic surgery and he's on the American Osteopathic Board of Orthopedic Surgery. Dr. Brooks, welcome to St. Joe's Radio. Thanks for being on with us. Are most knee issues wear and tear problems or are they more related to injury?

Dr. Jacob Brooks (Guest): That's a great question. So, I usually break down knee-related pain into two categories: the acute kind of injury where you have a specific time or incident where you remember the knee pain initiating and then, you have a second form of knee pain which is that chronic, indolent, progressive discomfort that's more related to a degenerative process typically within the knee. Those kind of classifiers are our two main sources of discomfort, whether being acute soft tissue injury or rather a chronic, progressive osteoarthritic condition, more or less arthritis in the knee.

Bill: Which one is the most common out of the two that you see?

Dr. Brooks: Really, we can break that down almost into two kinds of subcategories of age related issues. Typically, younger, active patients tend to sustain more of the inflammatory conditions in the knee or acute injuries such as a meniscal tear or a ligament tear. We've all heard of anterior cruciate ligament tears or medial lateral collateral ligament tears. So, this helps the younger patient kind of deal with those more activity related injuries whereas, the natural progression of the condition of the knee is that you can develop a more chronic inflammatory condition of osteoarthritis which would give you more of a persistent discomfort into the knee.

Bill: So, with each of these, whether it be the acute injury or the chronic discomfort, when is it time for someone to go see a doctor?

Dr. Brooks: So, when you have an acute injury to the knee, things that would be cues that you shouldn't be waiting for this to kind of go away would be persistent mechanical symptoms of clicking, popping, giving way, feelings of instability, swelling that is persistent and that limits ability for you to be able to perform the activities of daily living or your occupation. And then, discomfort that usually lasts more than 2 or 3 days at a time where the pain is so uncomfortable that it really prevents you from being able to do your ADLs. The other thing would be that if you are unable to bear weight at all onto the knee, then that would be a reason that prevents you from being able to walk, that you would need to seek medical attention sooner rather than later.

Bill: Can people treat this with aspirin, then, for the people that's not an acute injury? You said if the pain persists for 2-3 days. Is aspirin a good form of medication to try to deal with knee pain?

Dr. Brooks: Yes. The kind of typical pneumonic of RICE, would be: rest--avoiding the type of activities that tend to bother it and then, icing it in the acute phase to try and reduce some of the inflammation and the swelling in and around the knee. And then, your typical anti-inflammatory medication, whether it be an aspirin or an Aleve or an Ibuprofen or typical NSAIDs that you can take for a short period of time to help reduce that acute inflammatory process that's going on in the knee, which can give you some relief.

Bill: So, someone comes to see you and they have chronic knee pain or they know they injured it somewhere. What is a typical diagnosis like?

Dr. Brooks: So, for a person that has an acute injury, or they say, “Doc, I was kneeling down to work in my garden and I felt a snap in my knee. I felt that click and that clicking and popping have been persistent since that time”, those tend to be a meniscal tear. What that is, is one of the shock absorbing cartilages in your knee which can become friable with age, which predisposes you to tearing them. Or, as you hear about young athletes with a twisting mechanism and then, they have an acute pop or an incident where the knee gave way followed by swelling and difficulty with ambulation because of the pain, and the mechanical symptoms of clicking, popping and giving way. That's one source of acute pain into the knee. Another one would be a ligament tear, such as an anterior cruciate ligament or an ACL tear. Again, more common with a specific mechanism, a twisting or a pivot mechanism, specifically with some sports-related activity: soccer, football or even downhill skiing, can predispose you to one of the ligament injuries which would require potentially surgical intervention.

Bill: So, can you quickly tell me, what are the general treatment options for each: the acute injury and then, the wear and tear discomfort type of an injury?

Dr. Brooks: Yes. In the acute phase, our preference would be to treat you symptomatically with typical anti-inflammatories, rest, avoidance of the activity and then, for a lot of people, a short period of physical therapy to work on both the range of motion, the strengthening, the rebalancing of the knee, to help both with the ligaments and stability of the knee. So that would be the acute phase. And when those fail to give you any improvement, there are injections with corticosteroids or hyaluronic acid, which would be an option for more the degenerative conditions in the knee or for acute injuries that tend to be plaguing people that don't resolve after a short period of time.

Bill: Speaking to you about knees, I just started to think that we all take our knees for granted. This may be a silly question but how do we keep our knees in shape? Is there a way to practice good knee health?

Dr. Brooks: That's a great question and one that I hear from a lot of patients in the office day to day. For a lot of people it's counterintuitive. We know that the cartilage or the covering of the bone and the joint that is prone to wear and tear with age is fed through the synovial fluid of the lining of the knee. The best way that that happens is through diffusion. There is no direct supply of blood to that cartilage. The nutrients get to that cartilage through moving the knee. So, I tell people, you know, keep it moving. If you don't use it, you lose it and that's very true when it comes to knee health. We want people to stay active. We want them to maintain a healthy weight, which reduces the amount of wear and tear on that cartilage and to maintain regular exercise and cardiovascular activity because that helps bathe the cartilage and maintain the health of the knee.

Bill: Great advice. Let me ask you this, for someone that has a knee problem that the RICE doesn't work or medication doesn't work and it's time for surgery. What does someone need to know about that?

Dr. Brooks: So there multiple reasons that you can require surgery. It's part of your workup when we'd see you in the office. We want to get x-rays to be able to better demonstrate to you the condition of your bone, the location of the bone, the morphology of the bone. If surgery is anticipated to needing to be taken place, we can do additional advanced imaging such as MRIs, where we're able to more definitively demonstrate to you the tears in the cartilage and so that we can preoperatively plan for fixation through surgery.

Bill: So, someone does have surgery. Has this become kind of common now and what is the recovery time for somebody that does have to have surgery on their knee?

Dr. Brooks: So, for arthroscopic procedures which would be for typical meniscal tears or ACL tears in the knee, those would be through two very small incisions in the anterior aspect of the knee. Through that, we're able to use a very specialized small camera that allows us to directly visualize both the injury as well as the surrounding tissue and cartilage within the knee through a second, again, small incision about a centimeter. We're able to work through that incision to be able to surgically repair and/or remove torn cartilage to be able to provide surgical fixation. These are advances that have allowed us to do the procedure very minimally invasive, which allows people to get up and get back to their occupation, their recreation or just living their day to day life with a minimum amount of recovery with the goal of being able to restore the function and the pain-free motion into the knee.

Bill: And, as we wrap up, Dr. Brooks, what is your best advice for someone dealing with knee pain?

Dr. Brooks: So, for patients that are dealing with pain that is more than the day to day discomfort that is associated with either an overuse or you are doing your occupation or your favorite recreational activity and that pain tends to be persistent, then my recommendation is that there's always a reason or a cause for that. With the help of a trained orthopedic surgeon, through one of these physicians, we're able to better identify that so that we can, hopefully, non-surgically provide you with solutions for this and then, if necessary, provide you with surgical interventions to get you back to the quality of life that you're used to living with a minimal amount of recovery.

Bill: Dr. Brooks, that's great advice. Thank you so much for your time today. We really appreciate it. For more information, visit StJoesHealing.org. That's StJoesHealing.org. This is St. Joe's Radio. I'm Bill Klaproth. Thanks for listening.
Hosts Bill Klaproth

Got Gas? Help is Here for That Gas and Bloating!

Additional Info

Segment Number 1
Audio File st_joes/1545sj1a.mp3
Doctors Chopra, Angeli
Featured Speaker Angeli Chopra, MD
Guest Bio Angeli Chopra, MD served her residency at the University of Alberta, Edmonton, Alberta, Canada. She completed a Gastroenterology fellowship at the University of Alberta, and a fellowship in Hepatology (study of the liver and related organs) at the University of Calgary, Alberta, Canada.

Learn more about Angeli Chopra MD
Transcription Bill Klaproth (Host): So, do you get gassy now and then? Feel bloated? Do you know what causes that? Well, if you want to know what causes that, we have the person here for you. Dr. Angelique Chopra is a gastroenterologist at St. Joseph Hospital and she is going to clue us in on all the answers. Dr. Chopra, thanks so much for being on with us today. So, can we just jump right on in to it? What causes that gas and that bloated feeling?

Dr. Angeli Chopra (Guest): Well, you know, there are two primary sources of gas. There's gas that ingested—so, that's mainly air that's swallowed; and gas that's produced by bacteria in the colon. So, swallowed air actually is a major source of gas in the stomach. Now, it's important to know that it is normal to swallow a small amount of air when you're swallowing your saliva but, if you chew foods or gulp liquids very rapidly, chew gum or smoke quite often, you may swallow a little more air than normal. It's also important to know that gas production can occur because of bacteria in the colon. Now, the colon is actually a home for billions of harmless bacteria and some of these actually support normal health of the bowel. But, certain foods have carbohydrates which are not completely digested and these bacteria might try to digest them causing more gas. For example, foods like cabbage, Brussels sprouts and broccoli have carbohydrates which are poorly digested and they may actually cause more gas and flatulence.

Bill: So chewing – normal chewing and swallowing -- you're going to get air down into your stomach. Right? So, is a way to combat that to chew your food better if we take this piece by piece?

Dr. Chopra: Exactly. You want to make sure that you chew food carefully and just a lot slower than normal. Try not to gulp down liquids. It's also important to watch your diet and see which foods are causing trouble as well. So, I tell people to keep a little bit of a food diary. There are foods, like we were saying, which have carbohydrates, specifically like lactose and sometimes fructans which are not completely digested. Also, make sure that you minimize chewing gum and smoking, especially if bloating and belching are big problems.

Bill: So, if you keep a food diary and if you're getting gassy or bloated and you subtract certain foods, that's a way to find out what could be causing it. Correct?

Dr. Chopra: That’s correct. I tell patients especially that are more aware of their gas--and that's an important thing to realize as well. A normal, healthy individual does produce 1 to 3 pints of gas a day and this can be passed 14 to 20 times a day. People that do feel more gassy or bloated or belchy don't necessarily produce more gas but they might be more aware of it. So, writing down what to eat and avoiding artificial sweeteners and soda--all of these things will help individuals feel better.

Bill: Are there other management options for someone with gas?

Dr. Chopra: Yes, I always tell patients to try some over the counter things which are available, for example, Beano. Beano is an over the counter preparation that helps to break down certain complex carbohydrates. For example, beans and vegetables like Brussels sprouts, broccoli and cabbage. I also tell people to try Simethicone. Simethicone is marketed as Maalox or Gas-Ex. What this does is, it causes gas bubbles to break up and it's widely used to relieve gas. I've also tried Pepto-Bismol for my patients. Again, it's available over the counter. This is going to help with that bloated feeling and it will actually reduce the odor of unpleasant smelling gas which can be, unfortunately, embarrassing.

Bill: So, the steps that you just talked about--which is great information--if that doesn't work is it time to see a doctor, then?

Dr. Chopra: You know, you definitely want to keep on eye on these symptoms because it is important to realize that certain medical conditions can cause you to make excessive amounts of gas. I tell people to watch out for symptoms such as: diarrhea that's lasting more than 5 days; unexplained weight loss; blood in your bowel movements; a loss of appetite; unexplained fever; throwing up for greater than 48 hours and also, iron deficiency anemia that doesn't have a good explanation. So, these are things that should alert patients as well as primary care providers to get in touch with their gastroenterologist.

Bill: So, having a little bit of gas that's normal?

Dr. Chopra: Exactly. Like I was saying, we all produce 200 ml or up to 3 pints a day. You want to keep an eye on it. Burping occasionally, or before or after meals is also normal. To a large extent, the amount of gas produced by the body depends on diet and these individual factors that we've talked about.

Bill: Are there some common myths about gas or bloating that you can talk about?

Dr. Chopra: So, I think one of the myths is that it's always worrisome. Again, you want to watch out for the alarm symptoms. In fact, bloating is probably one of the most common complaints that we hear of at a doctor's office. So, like I said, it may just be that you're more aware of it. But, it's also important to realize that certain medical conditions can lead to this. For example, if you do notice trouble with foods like wheat or pasta, you may, in fact, have a gluten intolerance, but, rather than cutting it out of your diet completely, get the testing done for it. The blood tests are fairly accurate and, therefore, you're not losing out on nutrients that you might commonly miss in your diet. Another one is dairy. So, people altogether start avoiding dairy, but I say, again, keep track of what you're eating and how it makes you feel. Whole foods like oatmeal, do have more sugar, so they may cause problems but your doctor may be able to do some breath, blood tests and even stool tests for you to confirm that.

Bill: I see these IBS commercials on TV. You see the women and their midriffs and they're talking about the gassing and the bloating and rumbling tummies. Can you talk about IBS and how that is connected with gas and bloating?

Dr. Chopra: Sure. So Irritable Bowel Syndrome or IBS, this is a condition, a chronic GI disorder, which can cause belly pain and problems with bowel movements. Some people have frequent, watery bowel movements. Other people don't have enough bowel movements and some people can switch back and forth. Other than diarrhea and constipation, people can, in fact, complain of gas and bloating, or filling too quickly when eating or even nausea. It's important to recognize that a lot of the times, when these individuals are thoroughly worked up through scopes, upper and lower, there's no organic disease found but the symptoms can be very real. There's not a specific test for it but if you tell your doctor or nurse your symptoms, they can usually figure it out. At times, they do need to run a few tests to make sure that there's nothing else going on than IBS. I tell people, again, “What can you do to feel better?” Start a diary, keep track of what you ate each day and how you feel. Stop eating foods that are making your symptoms worse or cause you to be gassier. I tell people, “If you have constipation, eat more fiber.” You can do this by eating fruits, or vegetables, take fiber pills or even powders. It's very important to exercise. So, try to do something active for 20 to 60 minutes 3 to 5 times a day.

Bill: So, it sounds like a normal course of staying well, eating well and exercising, helps with gas and bloating as well?

Dr. Chopra: That's right.

Bill: On that commercial--it's a commercial for yogurt. Does yogurt help?

Dr. Chopra: Probiotics, just like your intestine, are billions of harmless bacteria. Some of these are definitely required to support the normal health of the bowel. Some trials have shown that they do help with non-specific stomach pain as well as bloating and gas. You can get the naturally cultured yogurts. You can get them in pills as well. I often try to tell patients to give them a try and they may help, especially with things like fiber, to reduce some of your symptoms.

Bill: So, somebody that does have chronic gas and bloating, it sounds like there are steps, there are ways, there are treatments, to relieve the symptoms. Somebody doesn't have to live a life of being gassy. Is that correct?

Dr. Chopra: That's right. It's always important to remember to watch how much air you're swallowing, watch what foods are making you feel worse and also watch out for those alarm symptoms. The other thing I just want to quickly mention for gas, bloating as well as Irritable Bowel Syndrome, is the Fodmaps Diet. So, this is available and you can have a look at it on the internet. It's comprised of foods which are rich in fructose, lactose, and fructans. And all of these foods have three common properties: they're not always absorbed; they do increase the amount of fluid in the intestine and they're rapidly fermented by bacteria. So, the ingestion of some of these foods may cause more pain and bloating. Reducing their intake may help reduce symptoms such as IBS symptoms. It's surprising how much food can make a difference.

Bill: Great information, Dr. Chopra. You're a wealth of info. Thank you so much for your time today. We really appreciate it .For more information you can always visit StJoesHealing.org. That's StJoesHealing.org. This is St. Joe's Radio. I'm Bill Klaproth. Thanks for listening.
Hosts Bill Klaproth

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