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COLUMN | WEST END HEALTHLINE

How to Find a Pest Control Company You Can Trust | 1.11

Practical Steps to Preventing Flu | 12.10

Patients by the Numbers

by GINA LOTZER

We patients can be just a bunch of numbers. There is our weight, height, temperature, blood pressure, pulse, cholesterol, hemoglobin, eyesight. I could go on and on. Lately, we are being given another number when we go to see the doctor — our BMI.

My first thought was “Oh great! Yet another number that will, no doubt, be too high!” But after hearing more about this number and learning more about BMI here at United Family Medicine, where I work as an administrative assistant, I have begun to realize that this particular number affects virtually all of the other numbers. By working on lowering my BMI I can reduce my blood pressure, cholesterol and pulse, not to mention that pesky weight number!

BMI stands for body mass index. This is a ratio of height and weight. When calculated, this number provides our percentage of body fat. This relatively new number replaces an older term used for years, “ideal weight.” Lowering this ratio means that the patient is exchanging fat for muscle, resulting in a leaner, healthier body. This results in all sorts of positive numbers at checkups. Having a lower BMI also reduces the risk of many chronic diseases, such as diabetes and heart disease, as well as joint problems associated with higher weights. The Centers for Disease Control estimates that 33% of adults in the U.S. are obese. At least I’m not alone.

One of the unfortunate aspects of BMI is that it is not too hard to wind up in the “obese” range. That’s where I land. It’s important for me to remember, however, that this is just a number, not a judgment. This information is given to me to do with what I will. I make the choice to change what I am doing to lower this number and thus become a healthier individual.

There is a push starting in this country to make BMI the fifth vital sign, along with body temperature, blood pressure, pulse and respiratory rate. The more we patients hear about our BMI at office visits, the more we will begin to accept hearing this number and taking it in the spirit in which it is given; that being the spirit of helpfulness and concern.

Let me tell you, it was not wonderful to hear that my BMI is in the obese range. It was an eye-opener and it grabbed my attention. In this New Year one of my resolutions is to lower my BMI number, not just to overweight, but to average (ah, to be average again!). I have always had an exceptionally low cholesterol number. Lately, however, this number has been slowly climbing. Funny, so has my BMI! Instead of concentrating on all the various numbers that result from my visit to my provider, I could just work on lowering one — my BMI, and I’ll hit the jackpot on those other numbers too.

So next time I am at my doctor’s office for a check-up, I won’t wince and then glare at my nurse or doctor. I’ll just say, “Thanks for the info.” And my next visit will be filled with wonderfully LOW numbers all around!

Above is an example of the numbers associated with BMI and the range from underweight to obese. Your provider or nurse can explain more about this number if you are interested in finding out more about it. Remember this is just one more piece of information to keep us strong and healthy.

Accessing the Wisdom of Winter, and Beating the Winter Blues

by Paula Coyne, MA
Licensed Psychologist at United Family Medicine

Can we use winter to enhance our health and vitality? How can we possibly enhance our well-being in the winter, in this time of cold and dark? Isn’t winter a hardship to be endured, a setback in our vitality? How can we tell if we have dipped into the Winter Blues, or a seasonal depression?

In the cycle of the seasons, winter’s wisdom calls us to become quieter, more introspective. This is a time for naturally sleeping more, yearning for comfort foods, releasing the past year of experiences but reflecting on the learnings, sharing stories with friends and family, and dreaming of what we want to create anew in the spring. When we lived closer to nature, as all people did over millennia, we kept to the rhythms of the sunrise and sunset. We slowed down during wintertime. Like the trees and the animals, we drew ourselves in and became reflective.

In our current lifestyle, we are expected to continue with all our usual high activity level; light switches turn on, we get up in the dark, stay up long after sunset, and our productivity is expected to continue on unchanged.

In the words of C. Geraghty, this isn’t a time to be literally asleep, but a time to become more dormant. “All of nature must at some point rest and fall fallow. Striving to resist the in turning of the season can be an exhausting and sometimes futile undertaking. During this season it is often wise to work with the environment instead of against it. Take stock, watch, gain power from the seed ideas and plans that you are germinating. One cannot live a meaningful life without taking time to ponder it first.

“To many, darkness either of day or the mind is frightening. An abyss, an unknown dark place of great depth, would seem a frightening prospect. But what if you did look there, in the place of lacking, what would you see or feel? What would it be like to sit with it, even for a few minutes a day, to wait for an image — anything that you could hold in your mind or write on paper? What would you find there — the name of a friend you would like to contact, an unresolved question to consider, or the knowing that there are more desirable paths that you would like to take in life? Perhaps this darkness is actually a fertile place, if we are willing to sit with it long enough to hear its secrets. In the darkness, the mystery of life can be fruitful.” [See about.com. C. Geraghty: “Winter Blues,” Health’s Disease and Conditions, updated 2007.]

But how about when one’s introspection and the slowing down of winter become unhealthy? Many of us have a touch of what could be called the Winter Blues. Up to 25% of people in the northern United States report some features of Seasonal Affective Disorder (SAD) — we are eight times more likely to experience SAD than people in the southern states. Only 2 or 3% of those with symptoms have severe enough problems to warrant treatment. It is more common among women, begins during young adult years and can continue throughout life. The symptoms start to show up in the fall, may intensify as the winter progresses, and lighten up in the spring as we return to longer periods of sunlight. In order to be diagnosed with SAD, the pattern needs to have been occurring for at least two years.

Symptoms of SAD
Feeling disinterested in doing things you usually enjoy.Craving starchy foods like potatoes and bread; gaining weight.Having trouble getting up in the morning, and wanting a nap.Feeling tired and slowed down much of the time.Decreased sexual desire and function.Trouble concentrating.Women may have worse than usual premenstrual symptoms.Feeling better in the spring may be excessive, bordering on mania.People with SAD can even have suicidal thoughts and feelings.Causes of SAD aren’t completely clear, but it is known that our exposure to light influences our serotonin levels, which fall to their lowest levels in the winter. Light also effects the natural circadian rhythms in the body. These rhythms regulate body functions such as mood, appetite, and sleep. Again, we are a part of nature and are influenced by its cycles more than we may be aware.

Diagnosis and Treatment of SAD
See your healthcare provider or a mental health professional if you have some of these symptoms and they are affecting your functioning, especially if there are any thoughts of suicide. The most effective treatment for SAD includes increasing exposure to sunlight or artificial light that is like sunlight. Medication and psychotherapy are also helpful.

Light therapy is sometimes an insured benefit; a light box is portable and can be used at home for about 30 minutes in the morning as you read. Some people buy special light bulbs and install them at home. Therapeutic light bulbs range in lux (a measure of light) from 2,500-10,000. The use of light needs to be monitored so one does not become manic! Using it later in the day, in the night, or to excess can interfere with sleep.

Prevention and Self Care

For all of us throughout winter, it is important to maintain our self care.
Get regular exposure to sunlight between fall and spring.
Get support; stay connected with family and friends.
Manage stress in healthy ways: Practice deep relaxed breathing each day, do some stretching at home, take walks, take up a hobby, make a point in engaging in pleasurable healthy activities each day. Watch a comedy, Laugh!
Avoid alcohol usage and other substances. DO NOT turn to caffeine to boost energy; this increases anxiety, irritability, reactivity, and interferes with sleep cycles.
Stop smoking.
Eat healthy meals three times a day, including leafy greens, fruit, protein. Drink water.
Keep a regular sleep schedule and aim for about eight hours per night.
Exercise: take walks, try out some yoga, use an exercise DVD, join the gym or visit West Seventh or Jewish Community Centers to use their facilities; Dance!
Wherever you are in your self care habits, make a beginning now to treat yourself better. Choose one or more of the above practices, and decide to take action to make some improvements in your self care. You deserve it!
Get immediate help if you have any thoughts or feelings about wanting to harm yourself or others. Ramsey County Crisis Line is available 24/7: 651 266-7900.
So find the beauty of this winter season, take some time for dreaming and reflection. And if you are finding any of the symptoms discussed above, take action now to make it a healthier and happier winter for you and your loved ones.

A Personal Perspective on Living with Bipolar Disorder

by John Lotzer

I was born into a wonderful family. As far as I can recall, none of my family members have ever been diagnosed with a mental illness, so they had no reason to believe that I would be afflicted by bipolar disorder. It was called “manic depression” back then, which is a terrible term that implies one is crazy. People attributed the ups and down to “moodiness.”

So, I thought I was moody back then, which was considered a character defect; a flaw in my being for which I was personally responsible. No one back then was aware of how to treat it. It made me feel ashamed of myself. Looking back, I realize that my symptoms started in the late 1960s when I was just a teenager. I was not diagnosed properly until I was 46, more than 30 years later. This caused me a lot of shame, and a lot of severe emotional pain that stayed with me for most of my life. My life seemed hopeless.

How did the doctors determine that I had bipolar disorder? They looked at the symptoms I was having that may have caused the condition. During a manic episode the person’s mood is elevated and he or she may have feelings of invincibility, or spend money compulsively and irrationally. While in a depressive episode one may feel sad or empty, lose interest in activities that used to be enjoyable, feel fatigued, and have feelings of worthlessness and thoughts of suicide. Then the doctor can determine the best treatment procedures.

Today we realize that bipolar is a chronic, permanent, and life threatening illness if it is not treated properly, made possible by advancements in medications and behavioral therapies. Although bipolar disorder is a disruptive, long-term condition, one can keep his or her moods in check by strictly following a treatment plan that includes medications and psychological counseling. Often, one’s condition may seem to be hopeless, yet it responds well to treatment so that one can structure a life worth living.

I don’t have to approve of my condition, but I must accept it because there is no permanent cure. Fortunately, much of the negative stigma associated with bipolar is disappearing. This reduces any shame that is improperly implied. Today, I don’t need to be ashamed of myself. My affliction with bipolar disorder does not mean that my very being is flawed. I am not a bad person.

As for my personal experience, medical and psychological science has literally saved my life more than once. In one particular instance, I called professionals from the mental health care center; they drove to my apartment, administered some aid, and brought me into the crisis center. I didn’t want to call that number but I’m glad I did. In another instance, someone called 911 in the moment of my distress and I was taken to the hospital that way. The first incident occurred when I lived in Minnesota and the second one while I lived in Atlanta. In each case I was given excellent and friendly care from highly professional medical personnel. In each case I was examined for my physical and psychological well being. Based on the results of the doctors’ examinations, a treatment plan was structured especially for me. It was then up to me to follow the instructions if I were to get healthy again.

Several times I didn’t have health insurance or money to pay the medical bills. In each occasion I was able to count on public organizations to pay the bill. In particular, when I returned to Minnesota, jobless and in need of care, I was able to find services at 1919 University, which offers the Ramsey County services on a sliding scale based on income. There I was assigned to a psychiatrist and a therapist who helped me with medications and counseling that I so desperately needed. Since I didn’t have a job I was able to get the services for free. Today I have a job and I am contributing to Ramsey County as a taxpayer.

Here are some Mental Health Services provided in Ramsey County. If you have symptoms like those I wrote about earlier, please call and begin to get help.
* United Family Medicine: 651-241-1000.
* Open Cities Health Center: 651-290-9200.
* West Side Community Health Services: 651-222-1816.
* Ramsey County Adult Mental Health Services: 651-266-7900.
* Ramsey County Children’s Mental Health Services: 651-774-7000.

I could go through all the symptoms and the specific medications and behavioral health treatments that are available, but I think I would like to say that following a treatment plan given you by a treatment team is of the utmost importance and can help you the most. The team can be a support group for you as well as those family members and friends who are close to you. Be sure to take advantage of what is out there. Do not change or discontinue taking meds when you start to feel better. I cannot express this enough!

May God bless you and keep you well.

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Living a Full Catastrophe Life in the West End

by Paula Coyne, MA
Licensed Psychologist at United Family Medicine

This Healthline is about living your life in the present moment, whatever it is, however it is, without judgment. With compassion even. That’s the kicker for all of us.

What is a full catastrophe life?
It’s yours and it’s mine. It’s the unemployment, homelessness, it’s physical pain, the loss of a loved one, fear of the unknown, health problems, losing a home, meeting change, loneliness; it’s aging, depression, anxiety, panic attacks, not being able to sleep at night — it’s the full spectrum of what we as humans can experience. And, luckily, it is the “good stuff,” too — the falling in love, having a real friend, the joy of a birth, the soft sun shining on your face, seeing your beloved child sleeping peacefully, having a full refrigerator of food for yourself and your family, seeing — really seeing — the beautiful fall colors against this October blue sky, having a paycheck, doing something that you love.
What helps us enjoy the good stuff more and suffer less with the painful experiences? The practice called “Mindfulness.” Mindfulness means noticing and accepting whatever we are experiencing, moment to moment, without judgment, with compassion. Mindfulness is the opposite of going on automatic pilot, letting that little mind voice in our head (yes, we all have that!) run us around, running over the top of our own experience, missing the beautiful little moments of our lives as well as creating more stress-increasing resistance to the tough experiences. Mindfulness has helped humans cope with stress for thousands of years, and over the past 30 or so it has been brought into hospitals and clinics around the world, because it works. It is great for dealing with chronic pain, or any human suffering. It takes practice, but we discover that as we release resistance and judgment toward the experiences inside and even outside of ourselves, we suffer less. We discover that as we learn to shine the light of loving kindness and compassion toward ourselves, it is easier to shine it on others.

Got Stress?
The magic tool of stress reduction, the conscious breath, was right there under our noses all along. We breathe about 20,000 times in a day. Most of those breaths are unconscious, automatic, and often shallow. But as we learn to breathe with awareness, everything starts to change. We move out of automatic reactivity into an experience of more presence within ourselves. We become aware of muscle tension that can be chronic, that exacerbates pain and triggers the fight-or-flight reaction. Noticing that tension, we can choose to soften it, to open to the full, natural, deeper and slower breathing we do when we feel safe. Practicing this, our nervous system can begin to heal from the effects of stress. We feel better, we become more able to respond rather than react to stressors. We sleep better, digest food better, find ourselves more willing to laugh, more able to enjoy even the little pleasures of life, even when we still have problems and pain. With the help of our breathing awareness, we can learn to “ride the waves” of our experiences, even waves of pain, with less resistance, less suffering, with more equanimity and compassion toward ourselves and others.

Jon Kabat-Zinn first brought the Mindfulness Based Stress Reduction (MBSR) program to the University of Massachusetts Medical Center 32 years ago. The practice of mindfulness has been shown through much research over these years to be very effective in reducing perceived stress and suffering among many thousands of participants facing challenging medical and or psychiatric health issues. The eight week program is now offered at hospitals and clinics the world over. It has “been on the cutting edge of mind-body and integrative medicine for three decades.” The MBSR program introduces the mind-body awareness practices of sitting and walking meditation, breathing, the body scan, mindful eating, and yoga. Participants explore the principles of mindfulness in their daily lives through homework assignments, in eight weekly two-and-a-half hour sessions, and in a one day silent retreat.

The psychologists at United Family Medicine (UFM), Maureen Gluek and Paula Coyne, both incorporate these principles and practices into their own lives and in their therapy sessions with patients. They hope to secure funding so that the eight week MBSR program can become available to patients and staff alike at United Family Medicine. In the meantime, the University of Minnesota’s Center for Spirituality and Healing currently offers it, as does River Garden Yoga in St. Paul.

Paula offers a weekly Stress Reduction Group for patients at UFM, and began teaching yoga and meditation at 6 a.m. on Wednesday mornings at River Garden Yoga in October. Maureen will soon be offering a weekly women’s therapy group at UFM that includes mindfulness practices.

Information: (1) United Family Medicine, 1026 West Seventh, 651-241-1000. (2) MBSR at the University, csh.umn.edu or 612-624-9459. (3) MBSR and Yoga at River Garden Yoga, 455 West Seventh: 651 270 6643 or rivergardenyoga.com.

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A Way Back from the Abyss | 10.11

by Gina L.

I was a 44-year-old divorced mother of two grown daughters when just before Christmas in 2002 I found myself, (once again), in a Chisago County holding cell. The second time in less than two years. I was pulled over earlier in the evening and charged with my second DWI. Once more I had to call my oldest daughter and ask her to pick me up from jail. This time I was looking at jail-time. Merry Christmas to me!

I felt that I could explain away getting pulled over once for driving while under the influence of alcohol or drugs, but I could not come up with a reason why I chose to drink and drive again. I was done! I was heart-sick at the way I acted when I drank and bone-tired of making plans to drink “responsibly” and having those plans fly out the window after the first drink. I needed help. I was bankrupt — financially (had filed for bankruptcy in 2001), morally and spiritually. (I thought God had turned away from me because of the things I had done.) This was something I had no idea how to fix. I called my cousin who had been sober for 25 years at that time. He gave me my first glimpse of hope. I then called the Employee Assistance number and they connected me with The Haven, an outpatient treatment facility close to where I lived, which was very helpful since I had lost my driver’s license completely for three months.

While I learned a lot about myself and my disease while in outpatient treatment, I feel that my recovery really began when I stepped through the doors to attend my first AA meeting and was given my first copy of the “Big Book” of Alcoholics Anonymous. At the Haven we were given the opportunity to hear from many people from various AA clubs in the city. More often than not I found myself nodding my head at their anecdotes and more importantly being surprised at how similar their stories were to my own. They shared how they felt growing up and how they felt when they drank and I was constantly saying to myself, “that’s exactly how I felt.” One of these “angels” became my sponsor.

When I opened the Big Book of Alcoholics Anonymous it was as if I finally received the rulebook for living. Here in the first 164 pages was a blueprint on how to live life on life’s terms, not my terms (my terms having put me in jail twice in less than two years). It always seemed to me from very early on that everyone else knew what to do and when to do it and how to act except for me. When I attended my first AA meeting it was like I had finally found the place where I fit in. I realize that not all people feel this way right at the start like I did, but as the saying goes, “please don’t leave before the miracle happens.” In the eight plus years of my sobriety I have seen many miracles happen, not just my own.

I am living the life now that I always hoped for. I have a peace and serenity that nothing can shatter as long as I remain spiritually fit and I stay that way by following the 12 suggestions in AA’s Big Book. I live and work in the West 7th community and I have attended several wonderful AA meetings in our community. There is nothing quite like the conversations between one alcoholic or drug addict and another.

There is a way out of the abyss that is alcohol and drug addiction. It takes one step, one leap of faith. Once you have taken that leap, please know that that there are millions of us – alcoholics and drug addicts – waiting to reach out and catch you in the arms of AA. Please contact St. Paul Alcoholics Anonymous Intergroup Office at 651-227-5502 or aastpaul.org. Peace

Dealing with Trauma: Ouch!

Although you may have never been chased by a lion, there is still a good chance that you have had trauma in your life. The good news is that the body knows how to give relief.

Trauma has been a part of our history for thousands of years. Whether it was physical trauma like falling and breaking a bone or emotional trauma like living through war, abuse or a natural disaster, our bodies are made to respond. If you think back to a time when you got injured or were frightened, you were feeling this response. There is an increase in our heart rate that you may feel as blood pumping fast; there is a quickening of your breathing, shorter and faster. Your eyes focused, your mind starts to think fast and specifically. These are all parts of the “readiness” response. Your body, when in trauma mode, gets ready to act.

There are also two protective mechanisms that make it easier for you to act. First, some chemicals get released that make you feel less pain, and second other chemicals get released that make you not remember as well. Amazing!

When I was a kid my friends and I had the great idea to rake all the neighbors’ leaves and then pile them next to my friend’s garage. We then began jumping into the leaves from the roof! I was a bit nervous when I was up top so I only half-heartedly jumped only to feel a quick pain and then kind of a numb feeling in my arm. As I sat on the back stairs, I felt something was not quite right. I had a sick feeling in my stomach and I could not lift my tiny headphones up with my arm. I calmly walked home to my parents to tell them I think I broke my arm. The rest was a bit of a blur when the pain got really bad and I started crying.

This story is a quick tour of acute physical trauma. My “readiness response” kicked in as well as the protective chemicals from pain and memory that helped me think through what to do and get help. Our bodies are so perfect that they can help us act in situations that can be life-threatening, both physically and emotionally.

The sad part of our body’s “readiness response” and protective chemicals is that they are only a temporary response. It gets us through the event or maybe through a series of events, but it is not obvious what happens with trauma over time.

What we do know is that our bodies store trauma and memory. Although it can be obvious — like distinct memory of a violent act — most often it is not as obvious. It can be a feeling of numbness or avoidance of certain sounds or situations, or it can simply be experiencing anxiety, stress, and agitation. You can think of these two things as a continuation of the “readiness response” and the protective chemicals. It is as if the readiness mode is chronic — in the form of agitation or anxiousness — as well as the “I need protection” mode — in the form of numbness, lack of feeling, or avoidance.

Time for another story. There is a test we can do on people’s shoulders to tell whether or not they had a bad shoulder injury. We simply have them lie back on the exam table with their arm off the table as we hold the arm and slowly move it back over the head. Patients who dislocated their shoulder will almost jump off the table, not in pain, but to make sure that you stop bending their arms. It is not something they think about, they just quick act to protect their shoulder. Patients who have not had their shoulder dislocated will just sit there and let you move their shoulder without a concern in the world. What is reassuring is that we can help the patients who had a previous injury. If we support and hold their shoulder as we bend their arm, they will sit there as if they never had the injury. The body knows when it is being supported and will not tell the person to move into protect mode.

There is similar support we can give to the physical and emotional body after trauma. Several types of medicine have found ways to help the body release from a chronic readiness mode and chronic protective state so it can return to its normal ‘happy as a clam’ state.

From the area of psychology, or counseling, there are forms of therapy that have been found helpful. From the arena of bodywork, there are exciting therapies like osteopathy and cranial sacral therapy. Many people have found these types of soft and gentle bodywork to be really helpful in releasing old trauma from the body. One particular book, “Waking the Tiger” by Peter Levine, does a good job of explaining in more detail how our bodies react to trauma with the readiness mode and protective chemicals. Finally, prayer and meditation are practices that can help relieve the effects of trauma. Get involved in your local spiritual community and ask for help in practicing prayer and meditation.

The message here is one of hope. Not only do our bodies know how to react to trauma as it is happening, but they were built to release the trauma when it is over — and although sometimes we need help in learning how to do this, there are many options available. If you feel like you or someone you know has trauma that seems stuck, even if it has been stuck for a while, do not give up. Search out your options. Ask your health provider if they are comfortable dealing with trauma or if they can recommend someone for you. Good luck, you will do great!

P.J. Lally is a fourth year medical student at the University of Minnesota currently serving the West Seventh community at United Family Medicine.

What is a Midlevel Provider?

by Cora Peine, PA-C

Physician Assistants (PAs) and Nurse Practitioners (NPs), also known as midlevel providers, have been part of the U.S. landscape of medical care for the past few decades. Both professions are important. We are in an era of unprecedented cost and inefficiency when it comes to medicine; PAs and NPs offer excellent care to patients while reducing the economic burden. You are likely to see PAs and NPs at your local clinic and hospital. It is important to understand their history, training, and credentials.

In the mid 1960s, the country was suffering from a shortage of general practitioners (GPs), specifically in rural areas. Additionally, there were many military medical corpsmen who were extensively trained and experienced, but had limited prospects for employment once they returned from the war in Vietnam. It was through these circumstances that the Physician Assistant and Nurse Practitioner professions were born. A few PA programs started in the Eastern U.S., an NP program opened in Colorado, and gradually the programs (and thus, the professions) spread across the United States. In the mid 1990s, Minnesota opened its own PA program at Augsburg College. NP programs have opened at several universities throughout Minnesota.

Across the United States today, there are more than 140 Physician Assistant programs and approximately 88,000 PAs, with more than 1,000 in Minnesota. Most PAs today graduate with a master’s degree, but may also have bachelor’s degrees or certificates of Physician Assistant Studies. The military has a PA program that offers a doctorate degree. Each PA graduates from a nationally accredited program, and there is only one accrediting agency. Therefore, regardless of the degree, the training that PAs receive is very uniform. The training is rigorous, two to three years long, and encompasses both classroom and clinical (hands-on) training. They receive education in dermatology, cardiology, pulmonology, otolaryngology (study of the ears, nose, and throat), gastroenterology, hematology, neurology, psychiatry, pediatrics, geriatrics and pharmacology.

Every Physician Assistant who practices in Minnesota must pass the Physician Assistant National Certifying Exam, a computer-based, multiple-choice test comprising questions that assess basic medical and surgical knowledge, and must take a recertifying test every six years. In addition, PAs in Minnesota must complete 50 hours of continuing education yearly. They are licensed and regulated by the Board of Medical Practice. You can find specific information about your personal PA online at docboard.org/mn/df/mndf.htm. This includes the date they were first licensed and when their license expires, where they practice, and any disciplinary action taken against them.

NPs are registered nurses who go on to further graduate education and earn a master’s or a doctorate degree. Throughout the United States, there are more than 155,000 nurse practitioners, 2,500 of whom practice in Minnesota. While Physician Assistants are always taught a family practice curriculum, Nurse Practitioners specialize in a variety of areas, including acute care, adult health, family health, gerontology health, neonatal health, oncology, pediatric/child health, psychiatric/mental health, and women’s health. They take a licensing exam based on their specialty and are required to complete annual continuing education requirements.

Nurse Practitioners are licensed by the Board of Nursing. You can find specific resources about your personal NP at the Minnesota Board of Nursing website, nursingboard.state.mn.us.

Nurse Practitioners and Physician Assistants both work in a variety of family practice, specialty and subspecialty practices. Their scope of practice is similar, and they often work together. They do many procedures, including mole removal, sutures and casting. They also write prescriptions, read x-rays and can institute 72-hour mental health holds.

For both NPs and PAs, coordination of care is very important. They believe that a care plan includes the patient, their family, their social circumstances, nursing staff, and appropriate consultants. This is why so much time is spent in the interview. They review your living circumstances, alcohol, drug and tobacco use history, occupation, family history, etc. It isn’t because they are nosy, but because these things have a huge effect on your medical condition and prognosis. It helps them to develop a care plan that works for the patient.

One very important difference between the professions is that Physician Assistants are not autonomous. They do not work alone. Everything that PAs do is guided by their supervising physician who delegates responsibilities to the PA. The PA can do whatever the supervising physician does, trusts his or her PA to do, and that the PA feels comfortable doing. This supervisory agreement means that there has to be an excellent relationship between the PA and the physician. It is why, although all PAs are trained in family practice, they can work in any specialty, hospital or clinic. Through their working relationship, the PA is trained by and is trusted by their supervising physician. While most Nurse Practitioners do have a relationship with a collaborating physician, it is not legally mandated.

There is a new healthcare buzzword: “Medical Home.” It means that, in order to get the best, most efficient and cost effective care, patients need to have a primary care clinic with a team of people who know them. If your medical provider knows you and your medical, social and family history, they can help you make decisions about your care. The goal is to make decisions that are in line with your values and needs. Someone who knows you well can help you make those decisions better. Unfortunately, as in the 1960s, there are not enough primary care physicians to fulfill the role of the medical home provider. More physicians are being trained in specialties, where they are undoubtedly also needed. Therefore, there continues to be a much needed place for Nurse Practitioners and Physician Assistants.

Physician, Buck Thyself Up | 7.11
by Tim Rumsey, MD

Enough about you patients. Let’s talk about me.

It’s been a rough six months. I woke up one morning last January and couldn’t see out of my right eye. Nothing. Even a warm shower didn’t help. You don’t have to be a doctor to know that’s bad. I had a spot on my lung and advised myself to “just watch it and repeat the chest x-ray in three months.” My bad teeth got worse. Then a hernia as big as a VW Beetle popped out.

I saw nice specialists, nice x-ray people, nice lab people. Nice anesthesia people (nice gowns you have to wear to the operating room). The front desk people were the nicest of all. Every one of them knew I was scared.

Bless you, patients. You know all about waiting and worrying and worrying and waiting.

Gerry Lauer, deceased, 89 year-old friend, patient, West Seventh clan leader, would receive me into his home on friendly visits with: “Doc, have a seat out here on the porch. Grab an old magazine. I’ll be right back in 45 minutes.” He always told me that “I’ll be right back” was the universal doctor’s lie. Gerry said he needed to bring “War and Peace” when he came to see me. And he’d nearly finish it in the waiting room.

My eye was fixed. Cataract. But I waited too long. My eye doctor told me I was a good doctor but a bad patient. My surgeon said I waited too long and that I would make a bad patient. Then I cancelled my hernia surgery …twice. Too busy. It’s still not done. (That VW needs to be towed away.) I haven’t even called the dentist yet.

I’ve had bowel changes, urine changes, midnight cravings (fulfilled) for chocolate covered glazed donuts with pink and white sprinkles. I’ve been humbled, I’ve been impatient, I’ve been put on hold and had appointments cancelled. I’ve gotten big bills. I’ve been afraid. But mostly I’ve grown to appreciate what you (we) patients go through.

A dictionary says that the noun “patient” means one who endures or suffers. A sick person, an invalid. One who is resigned, long suffering. Capable of accepting delay. A victim. A person who must undergo some action. All of the above.

Hey, everything I have is curable. I see people everyday that are really suffering and worrying. Brain tumors, end of the road cancers, pain that takes you down. Loneliness, depression, strokes, bad hearts, bad marriages, bad lives. Losing a child.

What I have is nothing. It’s time for me to buck up.

I’m going to be a better doctor. Really. I’ve been a patient.

How Can We Work Together for a Healthier Neighorhood?
By Kate Vickery, MD

If you live in West Seventh your life expectancy is on average seven years less than people who live in Eagan and other suburban areas. According to the Wilder and Blue Cross Blue Shield Foundation study “The unequal distribution of health in the Twin Cities,” health disparities present in other areas of the U.S. are also present here (wilder.org/download.0.html?report=2337).

Our neighborhood is home to a training program for family doctors — the United Family Medicine Residency. My residency classmates and I started the Healthy West 7th project, a partnership of United Family Medicine Residency, United Family Medicine, and many different neighborhood individuals and organizations. Our big goal is to make West Seventh a healthier place to live and work (and perhaps decrease that seven year gap). Our more immediate goal is to find ways to better involve the neighborhood in the health improvement projects the residents complete each year.

After completing the first part of our project, which involved talking to many people in the neighborhood (in surveys, small groups, and one-on-one), community members met early in May to hear our findings and discuss where we go from here. Eight main themes listed in order of priority by the votes of people at the recent meeting:

Basic Needs: The question of critical basic needs was present in all discussions. A steady job, affordable housing, and access to good quality medical care are at the foundation of good health. People we spoke to supported programs to promote job training, advocacy for affordable housing, and real health care reform.
Resource Coordination: People looking for services are often unaware that what they want is already available in the neighborhood. Suggestions included postings on bulletin boards, a resource guide, and a West Seventh Facebook page.
Nutrition: Many people know they need to eat healthier and lose weight, but they don’t know how to do it. Ideas included low cost cooking classes, more community vegetable gardens and local branches of the farmer’s market.
Community Building: Social networks are an important part of our physical and spiritual health. Staying connected to our families, friends, and neighbors was an important theme. Our neighborhood can help people avoid loneliness/isolation with discussion groups, senior-youth partnerships, neighborhood gatherings — perhaps with a unique West Seventh celebration to celebrate our cultural diversity, history, and more.
Activities for Youth: Children are the future and need to be busy and involved in healthy activities. Important needs include low cost childcare, more fitness opportunities in and outside of school, classes about healthy eating and a theater group. We heard about services our neighborhood already has in place for senior citizens too.
Fitness: People told us how they motivated themselves for fitness activities, often with the help of their close family or friends. West Seventh could promote fitness as a neighborhood including: walking clubs, low cost aerobics, yoga or other classes, sports teams, more biking/walking paths, building a neighborhood pool, and more.
Health Education: People are looking for more reliable information about health and wellness. Everything from questions about how to eat healthy, how vitamins are important, how to raise healthy kids, and how to make sense of all your medicines. People wanted to learn more about meditation, yoga, diabetes and heart disease.
Volunteerism: Many spoke of how important it is to share the talents we have. It makes us all feel good and it offers our best to others in need. We have great potential to help each other out in West Seventh. Suggestions included creating a barter system or volunteer time bank, communities (homeless, those in recovery from drug/alcohol addiction) offering to teach medical residents and others about their situations, and desire to interact more with Allina employees at United Hospital.

Our project generated a lot of enthusiasm for health improvement in our neighborhood. From here we plan to form a neighborhood council to oversee resident projects and connect them with all the great efforts already underway in West Seventh. We also found an energetic group who are interested in community health improvement on a larger scale and in exploring what we all might do together to help each other be healthier. One idea we discussed was using “The Blue Zones,” a book by Dan Buettner (bluezones.com) about communities in the world who live long, happy lives. This book inspired the town of Albert Lea to launch a campaign to make their town healthier. Maybe we could do the same in West Seventh.

If you want to be a part of a council to oversee resident projects or to be a part of a larger conversation about improving the health of West Seventh, please contact Kate Vickery at 651-241-1010 or kvickery@unitedfamilymedicine.org.

We have had a great amount of support and cooperation from many in the neighborhood and beyond. Special thanks to the Minnesota Academy of Family Physicians Foundation, Allina, United Family Medicine Residency and Clinic, the West 7th Community Center, Cooper’s Foods, Mississippi Market, SOKOL Czech and Slovak Society, the Little Bohemia Neighborhood Association and the St. Paul Jewish Community Center.

Rolfing® Structural Integration, A Primer (Part 2)

by Kelly Jones Hicks

Who Benefits from going through the Rolfing® process?
Rolfing SI is an individual endeavor, meaning there is no typical entrance into or experience of the Rolfing process. And the people who come to a Rolfing® session are as varied as their complaints. They include individuals with chronic health conditions like Temporomandibular joint disorder (TMJ), arthritis, congenital distresses, poor habits of posture and movement, as well as victims of accidents, emotional trauma and aging.

Parents bring their children to experience Rolfing when the children have physical constrictions, as well as emotional inhibitions. Mothers bring their newborns (even a one-day old), who have experienced stressful and sometimes desperately debilitating birth traumas and injuries.

Countless professional athletes and Olympians use Rolfing SI not only to enhance their performance, but also to assist them in maintaining healthy and resilient bodies. Numerous performers in the arts (opera, music, and dance) use the Rolfing process to enhance their performance and longevity as excellent performing artists.

Well-known pitcher for the Kansas City Royals, Bret Saberhagen, went through the Rolfing process. He suffered from the obvious arm and shoulder problems of a pitcher: muscle strain and tendinitis, which disabled him early in the season. In fact, he was so transformed that he went on to become a two-time Cy Young Award winner for best pitcher in the American League over the next years.

“You come into Rolfing because you have wear and tear on one part of your body or another, and after a while you have to readjust. It might not be where you are hurting. It could be somewhere else that’s affecting you. The spot where you feel pain isn’t necessarily where the pain is coming from. Rolfing isn’t a like a massage, where you sit down and it relaxes you, it’s going to feel good for the day. With a Rolfing session, you’re going to feel more intense work on your muscles. You might be sore for the rest of that day, but it’s going to help you out for a longer period of time.”

This is exactly right. Rolfing produces progressive change on the cellular level, such that the change is powerful, long lasting and sustainable over years. This differentiates Rolfing SI from most other methods of working with the physical body.

Dori G. was in her fifties when she broke her back in a car accident. The Harrington rods were surgically implanted at the Mayo Clinic caused her excruciating pain. Once she had the rods removed, her freedom of movement returned slightly but some pain remained. Through Rolfing® SI, she could stretch and move without any pain. “I went into Rolfing wanting something more than a Band-Aid approach. I was hoping for a miracle, and I got it.”

Accidents are unforeseeable traumas that demand immediate attention, and Rolfing Structural Integration can help. It can also help before an accident, before a lifetime of chronic repetition, injury and emotional trauma becomes established.

Briah has found that doing a Rolfing session on newborns and children is a wonderful gift for them, which helps induce better neuromuscular functioning, as well as confident and strong bodies. “Rolfing infants and children helps their healthy development and maturation by stimulating the integration of all body systems…” she said.

Adrian was just three weeks old when his parents brought him to Briah for a Rolfing session. He was born in a posterior position, face down, which caused stress on his head and neck. His first three weeks of life were stressful — difficult eating patterns and constant crying. After just two Rolfing sessions, his eating habits became regular and his tears were only used to signal hunger, fatigue and diaper changes.

Joey loves participating in sports. He runs track and feels some of his fast running is attributed to Rolfing SI. At age seven, his parents came to Briah with a diagnosis of ADD/ADHD. He had trouble focusing, was easily agitated and impatient, and he had low self-esteem. After the Rolfing process, Joey was less impatient, more tolerant and more cooperative. “He still remains a driven little boy — but there has been a shift in his personality.”

Briah is considered a pioneer in applying the principals of Rolfing Structural Integration on many types of animals such as dogs, cats, horses, birds of various kinds including eagles and owls; also a mountain lion, a moose, and many more domestic animals. As with her human clients, she seeks to assist them to reach their true potential. She also guides them through issues with pet rescue and trauma, as well as relief and rehabilitation from injury. In fact, she’s written the book on these subjects.

Due this spring, “Animal Healing: The Power of Rolfing® Structural Integration” will give you more reasons to include this therapeutic modality in your family’s health maintenance tool kit.

| 4.11
Kelly Jones Hicks

“Some individuals may experience their losing fight with gravity as a sharp pain in their back, others as the unflattering contour of their body, others as a constant fatigue, yet others as an unrelenting threatening environment. Those over 40 may call it old age. And yet all these signals may be pointing to a single problem, so prominent in their own structure, and in the structure of others, that it has been ignored; they are off balance. They are at war with gravity.” Ida P. Rolf

Photo: Briah Anson Rolfing a baby as mother looks on.

Healthy West 7th! Community Conversation
May 7, 1-3pm. West 7th Community Center.
After months of interviews, focus groups and research, the Healthy West 7th! Project presents their results and have a discussion about health in our neighborhood.

It’s amazing what a pair of hands can accomplish to relieve stress and pain in the body, especially if those hands belong to Briah Anson, MA, Certified Advanced Rolfer™. Briah’s goal is to become one of the world’s best Rolfers™. She is a devoted Buddhist practitioner, who meets each client with the intention of alleviating a vast array of physical, mental, and emotional issues, which they bring to her table every day.

Fortunately for those in the West Seventh neighborhood, Briah’s Rolfing® Structural Integration (SI) practice is located in the brick-red Banfil Office Court (557 West 7th, 651-228-9569). Briah has a remarkably exotic personal background and a nationally known, well-respected professional reputation in Rolfing® Structural Integration.

Her focus has always been an active exploration and best expression of the mind and body. During her 31 years of Rolfing® SI, Briah has given over 30,000 sessions of this transformative body work to people of all ages, from infants to seniors. Briah said, “Rolfing® Structural Integration effectively reorganizes the neuromuscular system. The results with children are dramatic.”

Her book, “Rolfing: Stories of Personal Empowerment” presents 85 profiles of individuals from infants to seniors (age 91), families, and even animals, who have experienced relief with Rolfing® SI.

What is Rolfing® Structural Integration (SI)? The Rolfing® technique was developed by Briah’s mentor, biochemist and physiologist, Ida P. Rolf, Ph.D. In a quest to alleviate her own health issues, Dr. Rolf sought help from the early founders in the fields of chiropractic, osteopathy, cranial osteopathy, homeopathy and other progressive modalities. She had severe curvature of the spine and was prediabetic, and the traditional medical field predicted she would end up in a wheelchair by age thirty. Her quest to find a solution to her own medical problems encouraged her on a deeper level to help others as well.

Dr. Rolf’s premise began with asking, “What kind of organism will develop if the body parts are appropriately related? What happens when soft tissues and related bone structures actually function in the positions in space which their architectural design suggests most appropriate and which contributes most effectively to establishing the vertical?”
“The vertical in man’s structure is the outcome of his proprioceptive sensory awareness of movement (derived from muscular, tendon, and articular sources), and his appreciation of the gravity pull of earth. Whether consciously or unconsciously he feels this pull and responds to it. This is a subtle concept: the intellectual formulation arises out of the sensory awareness.”

“How would these more vertical individuals compare with the random, less conscious humans who tread the surface of the earth today?” She continues, “Is it perhaps too far-fetched to wonder whether one of the tap roots of human aggression and its underlying fear may be the continuous sense of insecurity which random humans unconsciously feel with reference to their environment — the gravity field?”

Dr. Rolf’s intense curiosity and deliberate research endeavors revealed to her a key understanding of Rolfing®: “I complain that people do not seem to understand my basic goals, the fundamental purpose for which Rolfing® has been developed.”

She went on, “…I as an individual am not primarily interested in the relief of symptoms, either physical or mental. To hear Rolfees tell of their unbelievable wonderful symptom alleviation, it is hard not to accept this assessment as a goal. However, I am interested in human potential; and human potential neither includes nor excludes the palliation of symptoms.”

Editor’s note: Conclusion of this article and further information in our May issue.

Advanced Care Planning | 3.11 [IMAGE]

Andrea Westby, MD, and Luke Beckman MD, UFM Residents

We have now made it to March, and if any of you are like us, you are looking eagerly toward the first signs of spring, and have likely long forgotten your New Year’s resolutions. When the New Year begins, our culture dictates that we should also begin a “new year,” with the encouragement of New Year’s resolutions such as losing weight, drinking less alcohol, quitting smoking, and exercising more frequently. While these are admirable and important life changes that would improve our health and wellbeing, we would argue that these life changes need to be implemented in a more sustainable fashion, rather than a trendy start-time that may or may not wane by midyear.

Our challenge to you is to consider making a midyear resolution that is achievable and sustainable, and we would like to make a suggestion. For those of you who have been so far blessed with at least 65 years of life, we advocate that you consider creating a Health Care Directive. And for those of you who have not yet reached that era of your lives, consider having a conversation with those you know who are at least 65 years old about Advance Care Planning, and to begin thinking about what types of care you would want for yourself.

Andrea: I am sure that almost every healthcare provider has a patient story that comes to mind when discussing end-of-life decision-making, but I want to share a story about why I feel that Advance Care Planning and healthcare directives are so important. This story is about my own family. When I was in college, before I was even really in the medical field, I came home to spend Christmas break with my family. The evening before I arrived home, my mother had taken my grandmother to visit my grandfather in the nursing home where he was rehabilitating after a stroke. My grandmother had just recently moved into a senior living facility for a temporary stay after completing her initial chemotherapy treatment for a recurrence of non-Hodgkin’s lymphoma. This was one of those places that had a plaque on the door that the resident needed to flip over in the morning to let the staff know that they were awake and out of bed. That morning, my grandmother did not turn over her card, so the staff entered the room and found her still sitting in the chair from the night before.

She was rushed to the hospital about 45 miles away for intensive care. My mother and I met her ambulance in the emergency department, and the doctors there told us that she was probably septic from pneumonia, a lung infection that was likely worse because of her recent chemotherapy. She was very weak, and it was suggested that she have additional help to breathe, including endotracheal tube placement and ventilator. The physicians reported that it was possible that she would not need the breathing tube for a very long time if her body was able to fight the infection, but also that she may not be able to be weaned off the ventilator. My grandmother had discussed her wishes with my mother and grandfather in the past, and she had indicated that she did not want to be intubated or have CPR performed on her if they were needed to sustain her life. While my mother knew this, she struggled with the decision, but did give permission for them to try intubation for the time being. My grandfather, father, sisters, and uncle came to the hospital, and we ultimately decided that grandmother had made her wishes clear: that she would not want to live on a ventilator for any period of time at this point in her life. They took out the breathing tube, and we sat with her for the hours before she died, telling stories and letting her know how much we loved her. I am confident that this allowed my grandmother to die the death that she would have wanted.

Luke: With advances in medicine and technology we are now able to keep people alive longer, but not necessarily preserving quality of life. For some, living as long as possible is most important, and for others, providing comfort in the dying process is most important. Preferences about end of life care are very personal, but can be very difficult to discuss in many circumstances. Unfortunately, the person needing life-sustaining treatment is generally not able to express his/her desires while acutely sick, whether they are unconscious after a heart attack, confused after a stroke, or in a coma after a car accident. Discussing your preferences for end-of-life care with your loved ones and doctor(s) while you are still feeling well and can make decisions yourself will help everyone involved in decision-making in those terrible circumstances. Having those discussions increases the likelihood that you will receive the care that you want, and helps the family and loved ones with the difficult decision about when to let go. Going through a process of Advanced Care Planning can guide you and your loved ones through this sometimes difficult, but important discussion.

What is Advanced Care Planning?
Advanced Care Planning is a process of informing others of your values, preferences, and wishes related to your healthcare in case illness or injury prevents you from telling them yourself. The plan involves completing a document containing the following information:

Naming a Health Care Agent: This allows you to name another person to make healthcare decisions for you if you are not able to do so for yourself.
Health Care Directive: This gives more specific information to the healthcare agent and healthcare providers about what treatments you may want, including but not limited to cardiopulmonary resuscitation (CPR), ventilator support (breathing machine), tube feedings, IV fluids, and antibiotics.
Values History: This allows you to give more information about what makes life worth living, when life would no longer be worth living for you, how and where you would like to die, and spiritual or religious beliefs and traditions. This document should be signed by you and either a notary public or two witnesses, discussed with your healthcare agent, and given to your doctor. It is important to have the document available for healthcare providers at your institution in case of an emergency.

What if I change my mind about what I want? You can cancel your previous health care directive by:

Creating a revised version, and having it signed as above
Writing a statement saying that you want your directive cancelled, and sign as above
Telling two other people that you want your healthcare directive cancelled.

How do I go through Advanced Care Planning? There are several different ways to complete this process:

Contact your doctor’s office. They should have someone who can help guide you through the process, and give you some information and forms
Call the Office of the Ombudsman for Older Minnesotans at 1-800-657-3591, or 3. Go to caringinfo.org, to download and print state-specific forms and read more information. The Minnesota Health Care Directive is a highly respected resource in this area, developed at the University of Minnesota.

Thank you for allowing us to share our story with you, and we hope our story and this information provides you with the tools and information for you to begin having this conversation with your physician or your loved ones, or both. We believe that this is a lasting resolution that will provide you and your family peace of mind for years to come.

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La Clinica los Maynards | 2.11 [IMAGE]

by Jerry Montie, MD, Lead Physician of the Sibley Manor Clinic
Connie Walsh, Lead Patient Advocate, United Family Medicine

In the spring of 1995, West Seventh Community Center social worker Gail Martinson heard so many stories from Latino mothers at Sibley Manor about having to go to hospital emergency rooms for routine care, that she asked our UFM clinic for help. Connie Walsh floated the idea of an on-site medical clinic at Sibley Manor itself, and it happened.

For 15 years United Family Medicine has operated a small clinic within the Sibley Manor apartment complex. The clinic is staffed by UFMJ physicians and staff Wednesdays from 1:30 to 5:30 p.m. This clinic provides access to health care for Sibley Manor residents who are new Americans unaccustomed to receiving care in our health care system, and for those with transportation difficulties (cost, small children, language barriers).

Every week we have worked, along with a family medicine resident or medical student, to provide well-child care and immunizations, prenatal care, diabetes care, physical exams, and other urgent care needs. The services are provided in a cozy two bedroom apartment at the intersection of West Seventh and West Maynard Streets. Patients are greeted by friendly staff, in English or Spanish. For other languages we provide prearranged interpreter services. Regular patients report enjoying an intimacy not experienced in larger clinic systems. The level of warmth and trust experienced by patients has been the key to our success.

Assistance getting health care coverage or arranging to be on our clinic’s sliding fee scale is also offered. Sibley Manor opened in the 1950s. The 22-acre site has 550 apartments in 55 three-story buildings. Immigrants began arriving at Sibley Manor in the 1960s when Cubans fled communism and made their way to St. Paul. They were followed by Asians in the 1970s and 1980s, then Russians, Mexicans, and Africans.

Over the years we have appreciated help from volunteer student interpreters from Bethel University, Augsburg College and the University of Minnesota. Nurses from United Hospital also have given their time and expertise. Start-up funding in the early years came from the Allina Foundation and United Hospital, but now Sibley Manor is one of UFM’s formal service sites. Owner-manager Bob Julen of Sibley Manor has been an integral, supportive partner from the beginning.

At the Sibley Clinic, or “La Clinica los Maynards” as the original moms called it, we have diagnosed and treated childhood seizures, tuberculosis, diabetes, autism, and high-risk pregnancies. Onsite prenatal classes were also an early service. While our current lab is quite basic, we have learned that much care can be provided with good diagnostic skills and strong problem solving abilities, not necessarily requiring a lot of expensive testing. When more testing is needed we send patients to our main clinic (1026 West Seventh) or to United Hospital.

Beautiful stories abound. We saw one early family through three pregnancies. They have since purchased a house in the West Seventh community. Dad is fully employed and mom is in school. Connie and I have attended their children’s baptism and confirmation celebrations.

It has been our privilege to be part of a true community health collaborative at “La Clinica los Maynards.” This collaborative promotes healthy lifestyles and preventive care to groups that have traditionally lacked access to adequate care. It is a powerful partnership with the West 7th Community Center, an extraordinary learning experience for the family medicine residents of Allina, United Hospital, and our wonderful volunteers — but most importantly with Sibley Manor residents and owners.

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How to Find a Pest Control Company You Can Trust | 1.11 [IMAGE]

Bedbugs are migrating to public places like movie theaters and retail stores and then hitching rides home on unsuspecting consumers. Not only are bedbugs a growing problem, they are also a hard problem to get rid of. The BBB of Minnesota and North Dakota recommends doing your research to find a pest control company you can trust to get the job done efficiently. When hiring a pest control company, the BBB recommends that home and business owners consider the following: (a) Start with the BBB’s reports on exterminators; (b) Make sure the company has sufficient training and certifications. Ideally, the company will also be a member of a national or local trade association; (c) Be sure the company has liability insurance; (d) Make sure that you completely understand the extent of the infestation as well as the possible remedies and side effects of any chemicals used; (e) Read the fine print carefully. Pay close attention to any warrantees or termination fees if you’re entering into an extended contract for monitoring or future services. For more advice on hiring home maintenance professionals, visit bbb.org/us/consumer-tips-home.

Practical Steps to Preventing Flu [IMAGE]

| 12.10

Dr. Vinay Goyal's simple advice on prevention of flu remains important:

While you are still healthy and not showing any flu symptoms, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps not fully highlighted in most official communications can be practiced:

Frequent hand-washing.
“Hands-off-the-face” approach except to eat, bathe, etc.
Gargle twice a day with warm salt water. Use Listerine if you don’t trust salt. Simple gargling prevents proliferation. Don’t underestimate this simple, inexpensive and powerful preventative method.
Similar to gargling, clean your nostrils at least once every day with warm salt water. Not everybody may be good at using a Neti pot, but blowing the nose thoroughly once a day and swabbing both nostrils with cotton swabs dipped in warm salt water is very effective in bringing down viral population.
Boost your natural immunity with foods rich in Vitamin C, or Vitamin C tablets that contain zinc to boost absorption.
Drink as much warm liquid as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive.

Dr. Vinay Goyal is an intensivist (a specialist in managing Critical Care Units) and thyroid specialist with more than 20 years of clinical experience. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital and Tata Memorial. Presently, he heads the Nuclear Medicine Department and Thyroid Clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).