Healthy Living | Spring 2010

[ � ] SPRING Healthy Living | MARCH 2010 Skagit Publishing www.goskagit.com

By Gordon WeeksEditor

Nutritionist Bev Swanson invites you to take a look at your dinner plate and eval-uate what you see. “If it looks like a work of art, full colors and textures, you’re on the right track,” she said. If your meal

looks like a white, highly processed mass, you might want to consider at-tending one or two nutrition classes Swanson hosts at Island Hospital in Anacortes. “Basic Nutrition” is presented from 7-8:30 p.m. Monday, March 22, in the hos-pital’s conference rooms one through three. Attendees will learn about how vitamins and minerals help the body function, why bodies need soluble and insoluble fiber, how bodies process fat and the importance of hydration. The cost is $15. Swanson also presents “Your Guide to Choosing Healthy Foods” from 7-8:30 p.m. Monday, April 19, in the

hospital conference rooms one through three. Attendees will learn how to choose the most nutritious foods. The cost is $15. For a reservation for either or both classes, call 360-299-4204. Swanson has been offering nutrition advice in Skagit County for years. For nearly a decade, she was the nutrition educator at the Skagit Food Co-op in Mount Vernon, where she answered customer’s questions, wrote articles for the newslet-ter, conducted classes and developed healthy recipes for the deli. She also taught a nutrition class at Skagit Valley College. For the past nine years, Swanson has worked as a physical therapist at Island Hos-pital. She started teaching a belly dancing class two years ago at the hospital and last year debuted her nutrition class. Her classes evaluate the energy nutrients (fats, carbs, protein), stress the importance of soluble and nonsoluble fiber and indentify the “superstar” fruits and vegetables such as blueber-ries, cranberries and plums. “The crux of it is whole foods,” she said. “If it looks anything like it was when it

was growing, you’re on the right track.” Amongst other subjects, her “Choosing Healthy Foods” examines gluten-free choices, a current concern among many despite Swanson’s belief that “gluten has gotten a bad rap.” And she reminds us, “We are what we eat.” Other health classes at Island Hospital include: • “Essential Remedies: Nature’s Won-der Cleaners and Super Germ Killers”

from 6:30-8 p.m. March 15, $15.

• “Look Good ... Feel Better,” a free class that teaches beauty techniques to help restore appearance and

self-image during chemotherapy and

radiation treatments, from 1-3 p.m. March 15

or April 19. • “A Guide to Better

Sleep” from 3:15-4:30 p.m. March 17, free.

• “Women’s Safe Weight Training,” 8-11 a.m. March 24, $10. • “Baby Basics,” 6:30-9 p.m. April 15, $20, fee waived for those on DSHS medical. • “Infant and Child Safety,” 6:30-9 p.m. April 22, $20, fee waived for those on DSHS medical. Registration: 360-299-4204.

Learn to eat healthier at Anacortes classes at Island Hospital

““The crux of it is whole foods. If it

looks anything like it was when it was

growing, you’re on the right track.’’

Nutritionist Bev Swanson

www.goskagit.com Skagit Publishing MARCH 2010 | SPRING Healthy Living [ � ]


At the emergency department at Skagit Valley Hospital, doctors deal with every-thing “from death and dismember-ment to ‘I have a sliver,”’ said Emergency De-partment Medical Director Kirk Brownell, M.D. With the hospital’s new Quick Look program, the sliver sufferer no longer languishes so long in the waiting room. Launched Jan. 13, the program al-lows patients with minor injuries and illnesses to be seen more quickly by a physician assistant. The program was prompted by patient complaints and “the realization patients were waiting too long,” said Dr. Everett Worth, as-sistant director of the department. “If you’re the one with the sprained ankle, and you’ve been there an hour and a half, that’s a long time,” Worth said. Among the patients placed on the Quick Look track are those with coughs, cuts and bruises. The Quick Look procedures are executed between noon and 10 p.m. “That’s when we have our great-est volume and our greatest needs,” said Emergency Department Director Donna McCabe. Patient volume is a challenge for hospitals throughout the country, she said. Skagit Valley Hospital’s emergency department receives about 90 to 100 patients a day, said McCabe. About 20 to 30 have ailments that qualify them for the Quick Look procedures, and 16 to 18 percent are admitted to the hospital, she said. With the new Quick Look system, a patient arriving with a minor ailment

or injury gives the patient registration person their name and date of birth, and then are taken to a triage room so the physician can determine the

severity of the ailment. The rest of the registration process takes place at the bedside. Sometimes, the ailments aren’t so minor, and the patient is admitted.

The Quick Look process didn’t re-quire any additional hires. “We were able to refocus our staff-ing,” said McCabe. The emergency

department’s redesign in 2007 helps accommo-date the process, said Worth. Skagit Valley Hospital fol-lowed up on the new program by calling about 90 patients who were processed through

the Quick Look program. Almost all of them said it was their shortest visit to an emergency department, said Brownell.

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“If you’re the one with the sprained ankle, and you’ve been (in the emergency department waiting room) an hour and a half, that’s a long time.’’Dr. Everett Worth, assistant director of the emergency department, Skagit Valley Hospital

[ � ] SPRING Healthy Living | MARCH 2010 Skagit Publishing www.goskagit.com


Photo by Frank Varga

The first ankle replacement surgeries 30 years ago were failures, but years of innovation and testing have produced a model that allows recipients to walk, hike, even ski. The procedure is now available at Skagit Valley Medical Cen-ter in Mount Vernon, and Dr. Lance Ho is awaiting his first local ankle replace-ment patient. Total ankle replacement allows the

patient to move the foot up and down and side to side. “It’s a big surgery,” said Ho, who performed about 30 total ankle re-placements while training at a private practice in Oakland. Most patients were suffering from arthritis, while others needed the procedure because of normal wear or a trauma such as an ankle fracture, he said. The ideal patient for the procedure is someone older than 50, not too heavy

and not extremely active. Patients with poor leg circulation, diabetes or nerve conditions of the leg are not good candidates. Ho, who also sees patients Mondays at United General Hospital in Se-dro-Woolley, uses Scandinavian Total Ankle Replacement. The STAR ankle is made up of three parts. The first part covers the lower bone of the ankle joint, called the talus bone. The second part covers the bottom of the “shin” bone, or tibia, which runs from the bot-tom of the knee to the top of the ankle. Both of the parts that cover the bone are made of cobalt chromium alloy. The parts are coated in titanium in the places where they actually touch bone. The third piece — a mobile bearing made of medical grade plastic — is placed between the two metal parts. The plastic is designed to move as the ankle moves. The ankle procedure requires a cut along the front of the ankle to open the ankle joint. About 3/8 of an inch of bone is removed from the joint to make space for the replacement. The surgeon then shapes the bones of the ankle so the replacement fits in place. No bone cement is needed. Patients can walk on the ankle within a couple weeks, and complete recovery takes two or three months, Ho said. The replacements last 10 to 12 years, he said. The design is significant because of the small bones and joints involved in the ankle, and the amount of pressure ap-plied by the upright body. “There were probably over a hun-dred different types (of replacement models) out of Europe which failed because of the designs,” said Ho. But total replacement isn’t for ev-eryone. Ankle fusion “is still the gold standard for your active person with arthritis,” said Ho.

Total ankle replacement surgery new to Skagit County

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Tritt) and classical (Mozart). Other titles include “General Wellness” and “Ease Grief.” The new full-time social services worker is Pat Lundin. She helps new cancer patients with their insurance work, and refers them to community resources such as food banks and help paying utilities. “Every situation is dif-ferent,” Lundin said. “They’re under a tremendous strain when they come. They’ve lost their job. They’ve lost their insurance.” The challenge is “trying to find enough resources for people who are

the most in need,” she said. Lundin also offers emotional support for the family members of the cancer patients. “Caregiving is a hard job,” she said. “I think it’s one of the toughest jobs, do-ing it 24 hours a day. It’s very isolating; it takes a lot of skills.” The new dietitian is Meg Griswald, who started work last June and works

Mondays, Wednesdays and Fridays at the Sedro-Woolley center. Many patients arrive having lost a great deal of weight, and the goal is to regain and stabilize, she said. Many cancer patients suffer from nausea and can’t bear the smells of hot food, Griswald said. A key is eating small meals more often and offering cold foods, she said. She directs patients toward high protein foods and supple-ments and encourages high intakes of fluids. Some patients don’t have much help at home, so Griswald steers some toward Meals on Wheels deliveries or

helps write grocery lists. At the center’s appearance center, cosmetologists are available by ap-pointment to fit wigs on women who have lost their hair. The wigs are do-nated by the American Cancer Society. Caps and scarves also are available. The American Cancer Society hosts the “Look Better, Feel Better” classes at the center.

The new Breast Institute at the Skagit Valley Hospital Regional Cancer Care Center is funded by a $200,000 grant from the Safeway Foundation. Almost 100 new breast cancer patients are treated each year at the center. Dailly is the Institute’s first patient navigator. She serves as a liaison be-tween the patient and the physicians, scheduling appointments as needed with the radiologists, surgeon, medical oncologist and radiation oncologist. Making those appointments is Dail-ly’s first job after a woman is diagnosed with breast cancer. “Some people can actually be paralyzed by the news ... My first job is to reduce the anxiety,” she said. She also helps patients locate in-formation about the disease and the importance of nutrition, exercise and attitude in the outcome of the disease. She attends weekly meetings where five specialists - a medical oncologist, a surgeon, a radiation oncologist, a radiologist and a pathologist — review each case and determine the best treat-ment plan. “Everyone talks to each other,” said Dailly. “It’s a team. That’s the difference.” After the treatment, Dailly focuses the patient on survivorship. “It’s an on-going relationship of support and trust, and I’m also there to answer their ques-tions,” she said, adding, “Every woman is different. Every treatment is differ-ent. Every journey will be different.”

“It’s an ongoing relationship of support and trust, and I’m also there to answer their questions.’’’Dominique Dailly, patient navigator, The Breast Institute, Skagit Valley Hospital Regional Cancer Care Center

Seeking new way to treat pancreatic cancer, institute will inject vaccine directly into tumor By Lindy Washburn, The Record

A novel approach to treating inoper-able pancreatic cancer is under study at the Cancer Institute of New Jersey, using a vaccine injected directly into the tumor. Research with mice has shown that when a vaccine is administered in the usual way, via a limb, no immune response is created. But when the vac-cine is injected directly to the site of a cancerous tumor, the mice develop a system-wide immune response. The Phase I clinical trial will study the safety of this approach in humans, said

Edmund Lattime, one of the principal investigators and deputy director of the cancer institute. He is a professor of surgery there. “We will take patients with locally ad-vanced, inoperable pancreatic cancer,” he said. “We will use an endoscope that will go into the stomach. It will image the tumor and take a biopsy of the tu-mor, and then we will inject the vaccine into the tumor itself.” The vaccine to be used has already been tested for safety when injected into humans via an arm.

This trial is sponsored by the National Cancer Institute, which is providing the vaccine, known as PANVAC. More than 42,500 Americans a year are diagnosed with pancreatic cancer, which has a five-year survival rate of 5 percent. “There has not been a significant breakthrough in the treatment of pancreatic cancer since an upgrade in chemotherapy in the mid-1990s,” said Elizabeth Poplin, a medical oncologist at the Cancer Institute of New Jersey and the study’s lead researcher.

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[ 1� ] SPRING Healthy Living | MARCH 2010 Skagit Publishing www.goskagit.com

Relationship:No Anxiety? Not possible.

By Barton GoldsmithScripps Howard News Service

Many people think that they are supposed to live anxiety-free. Not so. Anxiety is part of the human condi-tion. We all experience it on almost a daily basis in one form or another, and in some ways it can be helpful. It’s important to realize that we grow most through meeting the challenges of difficult and painful experiences. Something that intimi-dated us, once overcome, contributes to our growth and confidence. Hey, don’t get me wrong: I’d love an anxiety-free existence, but where would any of us be without worry? It does keep us safe in a number of ways; we avoid stepping off cliffs because we know we can get hurt. Anxiety also serves us in smaller ways, letting us know that something isn’t quite right so that we can make appropriate adjustments. Those little signals in the back of your brain are a combination of anxiety and intuition trying to get your attention, to make sure you are heading in the right direc-tion. The trick here is to learn to use your anxiety in positive ways. The first step is to see what the payoff of an anxious moment (or interval) might be for you. Perhaps it’s telling you that this assignment isn’t quite right for you or that you really can’t afford that new flat-screen television. I think it’s wise to at least look at your feelings before you leap. The flip side of the coin is that excite-ment and anxiety feel exactly the same to our bodies. And it’s quite common for people to feel both excited and scared at the same time. Thrill rides at

amusement parks (and first dates) give you that excited/scared feeling. It’s perfectly normal -- and usually fun. A number of folks do suffer from generalized anxiety disorder (GAD) or panic attacks, and that’s a different story. Most of us don’t worry about normal daily activities on a regular ba-sis. If you do, and have been worrying like this for six months or more, you really need to get a checkup, a correct diagnosis and treatment, if necessary. At times, anxiety can shake you to your core. Your confidence evapo-rates, your ability to communicate is hampered and your thinking process is blinded by fear. Learning how to avoid it, control it and deal with it appro-priately is a set of skills that will serve you for the rest of your life. One of the best tools is to imagine

the worst, then imagine the best and finally imagine what is most likely to happen and hold on to that thought.When anxiety strikes, it helps to re-member that you have dealt with simi-lar events well, and that you have the tools to get through this one. Sit down (or pull over), take a few deep breaths and think through what’s worrying you. Chances are you already have the answers you need, and once you calm down a little, you will see them much more clearly.

(Dr. Barton Goldsmith, a marriage and family therapist in Westlake, Calif., is the author, most recently, of “Emo-tional Fitness at Work.” He also hosts “Emotional Fitness” on NPR. E-mail him at [email protected].)


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How to: Treat a FeverWith winter ending, many fevers are still likely to hit. Here’s advice from doctors on handling them:

Resist panic. A fever is a sign that your immune system is doing its job: fighting an infection. Consider going without medicine unless your temperature climbs rapidly or you’re very uncom-fortable. Many doctors recommend not using a fever-reducing medicine until a fever is 102 or higher.

Drink lots of fluids. Dehydration is a greater risk with a fever, especially if you also have vomiting or diarrhea. Water and herbal teas are good choices,

as are ice chips, ginger ale, fruit juices or Popsicles.

Eat if you are hungry. Don’t try to force down food if you don’t feel like it. If you’re not sure, try some soup — you’ll be getting extra fluids to boot.

Follow dosing instructions. This is especially important with young chil-dren. Note that babies younger than 3 months need to see a doctor before they get any medicine, and no children should take aspirin because of the risk of dangerous complications.

Stay as comfortable as possible. Wear

light, loose-fitting clothes — or more layers if you feel chilled — and keep the room cool. Also try a lukewarm bath or sponge off with a cool cloth; avoid cold water because shivering may increase body temperature.

Know when to call a doctor. General rules are fevers that are 104 degrees or higher, last longer than three days or go away and then return. Also call if you experience trouble breathing, convul-sions, confusion, stiff neck or severe vomiting or diarrhea. And always err on the side of caution if you or a child looks or acts very ill.

By Alison Johnson, Daily Press (Newport News, Va.)


Other common causes of sleep dis-turbances include too much caffeine or alcohol, too little exercise or exposure to bright light, and untreated medical conditions such as arthritis or depres-sion. How old your mattress is, how warm your room is at night, how much light comes in through your window — these can make a difference too. Try changing sleep habits and condi-tions before taking sleep medications, which can be habit-forming and have other unwanted side effects such as ex-cessive grogginess the next day, experts advise. But realize you may need short-term assistance from a counselor. “Implementing behavioral changes is very difficult for people to do without help,” said Dr. Cathy Alessi, a sleep expert at the Veterans Administra-tion Greater Los Angeles Healthcare System. Whether the need for sleep dimin-ishes with age is a topic of ongoing debate. Educational materials from the National Institutes of Health suggest that seniors need seven to nine hours of sleep a night, about the same as younger adults. But Scott Campbell, director of the laboratory of human chronobiology at Weill Cornell Medi-cal College in New York, says some research suggests otherwise. In a small experiment involving 50 people observed in a sleep laboratory, Campbell found that older adults slept about two hours less than people 30 or younger and almost a full hour less than people in middle age. The study was published in 2007 in the Journal of Sleep Research. Similarly, a 2008 report in Current Biology found that older adults (age 60 to 72) slept 7.5 hours a night on average, compared with nine hours a night for people age 18 to 32. What’s increasingly clear is that for the elderly, insufficient sleep is linked with medical concerns such as hypertension, depression, diabe-tes, heart disease and stroke. “If you have a sleep disorder, the chances of developing one of these conditions is heightened,” Bloom said. “And conversely, if you have one of these diseases, the chances of developing a sleep disorder are higher.”

For years, Eve Van Cauter, director of the sleep research laboratory at the University of Chicago, has been investi-gating this phenomenon. Her research shows that reduced sleep or perturbed sleep in healthy young adults increases stress levels, impairs a person’s ability to metabolize glucose, interferes with hormone levels and increases appetite. “Sleep affects the organism at every level,” Van Cauter said, speculating that these effects persist in older adults. Why would that be so? As people age, it appears that brain mechanisms promoting sleep deteriorate, Van Cau-ter said. Add to this the fact that older adults have more chronic illnesses, are less active and are less exposed to bright light that regulates their biologi-cal clocks, and the potential for sleep disturbances is magnified. And what about that daily nap that older men and women often take? Is it a good idea? Many U.S. sleep experts frown on naps, arguing that they can compromise nighttime slumber. But several small studies suggest that napping adds to the total amount of sleep older people get during a 24-hour period, potentially improving their alertness during the day and early evening. If you do nap, practice good habits: “Go to bed, close the curtains, turn off the ringer on the telephone, set an alarm so you sleep for 1.5 hours at most, and make sure you get up by about 4 p.m.,” said Timothy Monk, a professor of psychiatry at the Universi-ty of Pittsburgh Medical Center. “If you (do this), your nap shouldn’t interfere with your sleep at night.”

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TIPS FOR SLEEPING WELL• Develop a sleep ritual. Take a hot bath 90 minutes before bedtime or concentrate on relaxing 30 minutes before you get into bed.• Try to go to bed and awaken at the same time every day.• Make your bedroom restful and comfortable. • Limit noise and light.• Go to bed only if you feel sleepy.• Try to exercise every day. Exercise helps many people sleep better. But avoid heavy exercise within two hours of bedtime.• Cut down on substances such as caffeine, nicotine and alcohol, which can interfere with sleep, especially later in the day.• Use your bedroom only for sleep and sex.• Sleep only in your bedroom. Avoid napping or sleeping on couches or chairs.If you nap, do so in the early afternoon for a limited time. Some experts suggest 30 to 45 minutes; others say an hour or a bit longer is fine.• If you can’t fall asleep, leave your bedroom. Return only when you feel ready to go to sleep.• Ask your doctor if any of your medi-cations could be keeping you awake at night.

Sources: Evidence-based recommendations for assessment and management of sleep disorders in older persons, Journal of the American Geriatrics Society, 2009; Family-Doctor.org

[ 22 ] SPRING Healthy Living | MARCH 2010 Skagit Publishing www.goskagit.com

TV can make you fat, shorten your life

By Drs. Kay Judge and Maxine Barish-WreddenMcClatchy Newspapers

As a society, we are watching more television and doing less exercise than we should, with increasingly adverse effects on our health. The reasons our patients give us for their TV watching include: “I work hard and need TV to relax,” “Why should I give up something I like to do?” and “I am too tired to do anything else.” We often need reasons to change our habits, so here are some compelling data from recent studies on TV-watch-ing:

• Kids are spending more time with so-called “entertainment media.” A new study from the Kaiser Family Foundation revealed that American teens and younger children spend almost eight hours a day watching TV, playing video games or surfing the In-ternet. This has increased by more than an hour in just the past five years.

• TV watching may shorten your life. A study published this month in Circu-lation: Journal of the American Heart Association found that every hour per day on average spent in front of the television brings with it an 11 percent overall greater risk of premature death and an 18 percent greater risk of dying from cardiovascular disease.

• TV watching is linked to obesity and high cholesterol. Higher TV view-ing hours are associated with higher body mass index numbers, lower levels of fitness and higher blood cholesterol and triglyceride levels, according to a study published in 2008 in the Interna-tional Journal of Obesity.

• TV watching is linked to a bigger belly, flabby arms and a risk of heart disease. Decreasing the amount of TV watching might be effective as a first step in reducing atherosclerosis. Risk factors such as TV watching have an unfavorable association with the fol-lowing measurements: BMI, waist girth, waist-to-hip ratio, and sub-scapular and

triceps skin-fold thickness, according to the National Heart, Lung and Blood Institute’s Family Heart Study pub-lished in Atherosclerosis in 2000.

• Watching TV increases the risk of diabetes in men and women. The Nurses’ Health Study published in the Journal of the American Medi-cal Association in 2003 studied more than 50,000 women and noted that TV watching and other sedentary behav-iors led to an increased risk of obesity and Type 2 diabetes mellitus in women. So now that you are convinced that the boob tube is not all that good for your health, what can you do? A quick and easy first step is calculat-ing what you watch in a week, and the following week, cutting it down by 50 percent.

(Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program in Sacramento, Calif. Have a question related to alternative medicine? E-mail adrenalinesacbee.com.)

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Healthy Living | Spring 2010