Focus on what you have

[wide][/wide]As a student in high school at Onteora several years ago, Nicole Chartrand participated in several sports and took classes in anatomy and physiology, English, history, and health.

She also spent part of each day at Kingston and Benedictine hospitals touring the facilities and becoming well versed in American standards of health care. She witnessed both a live birth and an autopsy.

Shadowing Dr. Richard McNally, medical director of pathology, convinced her she wanted to work with patients rather than in the lab, and it prepared her for her participation in the rigorous New Visions program the following year. In that program, she helped out at local health-care agencies.

This background turned out to be excellent preparation for the four months she spent in Rwanda last year as a junior at Houghton College. The basic standards Chartrand had become used to were lacking in Rwanda, particularly in the impoverished countryside, where she spent a month and a half at a health-care clinic in a small village.

“Wow, these people do not have the resources we have in the States,” she said. “It was hard knowing that while you could possibly save a life in the States, in Rwanda these people were going to die.”

Chartrand, one of 20 students in Rwanda in the highly competitive Go Ed semester-study-abroad program and one of three focused on health care, spent two and a half months taking classes in the capital of Kigali. While the hospitals in Kigali lacked equipment such as machines for CAT scans or MRIs, they were relatively sophisticated compared to the facilities in the clinic in the village of Rwamagana, about an hour’s drive north, where Chartrand was based for the remainder of her time.

The standard of health care in the countryside was abysmally low, with people relying on traditional medicine in many cases based on superstition. For example, practitioners won’t touch somebody having a seizure because they believe the person is possessed by devils, she said. “They wouldn’t let me go near them, either, so I couldn’t treat them. You have to respect the cultural differences.”

Lack of medicine for malaria resulted in many deaths, she said.

People were vulnerable to illness because they didn’t practice basic sanitation, Chartrand’s group discovered when they conducted a survey of conditions in a small village in the north of the country. The survey revealed that people had to walk a great distance to get water — sometimes as long as ten hours — which they then transported in large cans. Though the water might be contaminated with pathogens, nobody boiled it before drinking. (The community health-care workers Chartrand accompanied tried to educate the villagers about such basic practices, distributing picture books showing people boiling water, washing hands, and performing other health-protecting tasks.)

In the Rwamagana clinic, Chartrand assisted in the “little surgery” (as the French term translates). Some of her patients were soldiers getting circumcisions to reduce the risk of AIDS. Others were people receiving treatment for old wounds suffered during the genocide, such as festering machete wounds.

A group of children was once brought in who had been injured from an unexploded grenade they had discovered that had gone off. “They came in gaping in shock,” Chartrand recalled. “It was really sad. I treated four of them, and they were all saved. When the child who was only four years old started to cry, we said, we’re good. When they don’t cry, it’s a bad sign.”

The great distance people have to walk to the hospital to get care was another challenge. “Africans are very reserved,” she said, “They don’t complain about things, and you know if they’re coming to the hospital something is very wrong.”

 

A heart for people

Chartrand was able to communicate with some Rwandans in French, a language spoken only by those who attended school — which many people can’t afford. She picked up some words in Kinyarwanda, despite its status as the world’s fifth most difficult language. Residing in a nursing school near the clinic, she became friends with the students in the school. One was a young woman who after suffering from debilitating symptoms was moved to the capital and a few weeks after died.

Chartrand said the disease from which she was suffering was never identified, but was probably cancer. “She was only 21, and when her disease began, they didn’t have the tests to diagnose it or the chemotherapy to treat it,” she said. “It was a very hard experience.”

Chartrand returned to the U.S. in May, and later in the year transferred to SUNY-New Paltz, where she is now a senior majoring in molecular and cellular biology. After graduating this December, she plans to apply to medical school. In the meantime she expects to work as an emergency medical technician, having obtained her EMT certification through BOCES last summer.

Chartrand described her experience in Rwanda as invaluable. “It’s given me a heart for people,” she said. “I definitely want to go back, whether it’s Rwanda or some other place hurting for health-care practitioners.” She’s committed to community-based health care, whether abroad or in this country.

“I learned that people will trust you more if you have a relationship with them,” she said. “That’s just as important as what you are doing for them medically.”

Living in Africa also was valuable in testing her values, she added. “Going outside your comfort zone really teaches you what you believe in and why — doing something that’s right, rather than because it’s something everyone else does in your culture.”

She took away many lessons from the Rwandans. “Amidst all the poverty and pain, there’s still so much joy,” she said. “It’s an inexplicable joy, which we don’t see here in the States. We have access to anything we want, yet still we’re so unhappy.”

Learning to appreciate the little things was a big thing she learned. “I’m so appreciative of going to college and being able to afford it,” she said. “It’s such a luxury. Or walking or living in a place where I don’t have to be scared my house is going to get bombed. Even though they [The Rwandans] have so little, they focus on what they have, not on what they don’t have.”

 

Race you to the top

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[/wide]Me, competitive? Don’t be ridiculous. Now get out of my way.”

There’s a reason I’ve avoided joining a gym for all these years. I managed to put it completely out of my mind during my years away, but one week with my old friends the Nautilus machines and pedaling, walking and running to nowhere has brought it back. I am a competitive maniac.

I don’t like to think of myself that way. I avoided team sports as a young person and as a parent I favored cooperative games, hoping to teach my children the value of working together toward a goal.

Sadly, they preferred cutthroat games of Chutes and Ladders, crowing as one of them stood atop a ladder watching the other slide back to “Start.” It didn’t get better as they got older; they can get into a fist fight over a game of Monopoly. I refuse to play any more because I do not consider games blood sport.

That’s apparently true only up to a point.

The first inkling I had was when I did my orientation on the weight-lifting machines.

“Start very slowly,” I was told. “You recently hurt your back, so you have to take it easy.”

A little voice in my head, a voice I hadn’t heard for years whispered, ‘Make the weights heavier.’

I looked around and didn’t see any bad trainers whispering behind me, so I shook it off and wrote down the weights the sane trainer suggested.

My first day on my own at the gym found me following a wiry little woman who looked to be 90 years old. She was hoisting those weights while hardly breaking a sweat. I followed her on each machine and discovered that all of her weights were set at least fifty pounds heavier than mine.

You can lift as much as she can!, whispered my evil little internal voice. Go for it.

Common sense won out, for the most part. But where did that voice come from?

Fast forward to the treadmill. I hate treadmills. They’re boring. And, I discover, they bring out the worst in me.

I was on a machine beside a woman ten years young than me, at least. She was in good shape, too. Her feet beat out a steady thump, thump, thump rhythm and she glistened with a well-earned sweat. I found myself peeking at the setting on her machine, looking to see what her pace was. I matched it. And then, god help me, I sped it up so if we were walking beside each other on the road, I’d have left her behind.

Ha!, cried my inner voice triumphantly.

What kind of sick puppy would compete with people working out at a gym? Woof. That would be me.

It happened again on my last visit. I was beside an extraordinarily sweaty man who was on the treadmill (yes, the treadmill again) alternating between jogging and a brisk walk. So I kept pace with him. And when he slowed down from his jog to a walk, I jogged for just a little longer. When we walked, I raised the incline on my machine so it was just a little harder.

I didn’t say anything, of course. I’m not that far gone. But I knew. And I knew that I knew and that was very, very worrisome.

I saw a woman doing some amazing exercises for the lower back and abdominal obliques. I had to try. And I suspect I am drawn to it because it looks so damned hard. It is.

This is not good. First, this goes against the image I have of myself.

I’m not competitive. I like games where everyone wins.

That’s apparently true unless I’m in a gym.

I’m not alone. I see people looking around at the people working out near them, then watch them pick up their pace. I see people pushing themselves so hard that they’re either punishing themselves, or trying to show up the rest of us. Even in the gentle stretch class, people are looking around to see if they can’t be just a little more flexible, a little more relaxed than the guy on the next mat.

I didn’t expect a gym membership to be an opportunity to analyze myself, but this is what it’s become. My long walks by myself allowed me to avoid confronting my inner crazy competitive person. I avoided her for so long that I actually forgot she existed. But it’s winter, I’m out of shape and I’m going to have to learn what she wants and how to keep her under control. Or I’m going to be a completely unhinged woman with an incredible physique.

 

The female heart

[wide][/wide]Quick – what’s the number-one killer of women in the U.S.?

Did you say cancer?

The fact is that coronary disease kills more American women every year than any other illness. According to the American Heart Association, 7.2 million women have heart disease. The risk starts to soar after menopause. One in four women over the age of 65 has heart disease. The rate is one in eight among women from 45 to 54. And it’s rising.

But women’s heart disease isn’t the same as men’s. Dr. Amparo Villablanca, a California cardiologist, said the blame can’t be put solely on hormones. We’re facing what she said doctors are calling the “diabesity” epidemic. We’re all getting fatter – and that leads to diabetes. Half the people who are diagnosed with diabetes are also discovered to have heart disease.

“The key is knowing your risks,” Villablanca said. “Know your genetic risks, know your numbers for blood pressure and cholesterol, know your body-mass index. And get them under control. Deaths from heart attacks are going down thanks to efforts to make more people aware of the risk factors. But the rates aren’t going down as fast for young women because they may not know they’re at risk for heart disease.”

That’s information that Dr. Ramin Manshadi, a cardiologist in Stockton, California, hopes to spread in his new book “The Wisdom of Heart Health.” He said the medical establishment was now beginning to understand that women’s heart attacks are very different from men’s. They are often “silent” heart attacks, and they are more likely to be fatal.

“Women do not have the classic chest pain that we equate with heart attack,” wrote Manshadi. “A heart attack, for a woman, may produce profuse sweating, or sudden fatigue that lasts for hours, or palpitations, or light-headedness. The pain might radiate to the center of the chest or even between the shoulder blades. They may not recognize these as symptoms of a heart attack, and it’s possible that a primary doctor might not recognize them, either.”

Those symptoms sound like they could easily be mistaken for symptoms of menopause. That’s why knowing your numbers, as Villablanca calls it, is so important. “If you know you’re at risk for heart disease, you will know that you can’t just ignore these symptoms or tell yourself they’re probably nothing. You know you have to consult with your doctor.”

Dr. Manshadi said women’s hormones were responsible for differences in the way coronary disease manifests. Before menopause, plaque buildup for women tends to erode arteries rather than rupture them as is more common for men and older women. And blockages tend to be more diffuse, making the surgical use of a stent to open blockages useless for many women.

“I’m hoping this book helps make women aware of their risks and makes them more educated about heart disease in general,” said Manashadi, “as they are often the ones who are responsible for health care decisions for their families.” He said he planned to donate the proceeds from the book to purchase defibrilliators for public schools throughout California.

Diet has a lot to do with reducing risk of heart disease. Dr. Dean Ornish proved back in the Eighties that a strict vegan diet combined with exercise and meditation to relieve stress could dramatically reverse existing heart disease. Since his groundbreaking 1982 diet book, “Stress, Diet and Your Heart,” the American diet has become less, rather than more, healthy. Dinner from a box was once advertised as a once-a-week break for a busy homemaker. It’s now the usual fare.

Sandra Lee, better known in New York for her relationship with governor Andrew Cuomo and nationally known for a show called “Semi-Homemade,” is the queen of the I-don’t-have-time-to-cook philosophy. A recipe for Creamy Chicken Noodle Soup on her website calls for a store-roasted chicken and two cans of cream of mushroom soup. Lee’s cooking technique, which favors speed and convenience, utilizes prepackaged foods loaded with sugar, sodium and preservatives.

TV food guru Paula Deen’s deep-fried, butter-soaked style of cooking has left her diabetic. Not exactly the healthy role model we’re looking for.

“Dr. Ornish paved the way,” said Vicki Koenig, a licensed nutritionist in New Paltz. “But there are a lot of ways to address our eating habits, lose weight, and reduce the risk of heart disease.” Koenig argued. She has had dramatic success with overweight clients by combining coaching with low-glycemic meal replacements. “I’ve been doing this a long time,” Koenig said, “and since starting to work with my clients using pre-packaged, pre-portioned meals, I’ve seen an 80% success rate. It’s a teachable moment.”

Dr. Ellis Lader, a cardiologist at MidValley Cardiology in Kingston, said that meal replacements, those pre-packaged you-can’t-get-this-wrong entrees, are successful for patients who have to lose weight and have to lose it now. But they present a challenge once the weight is off. They don’t come with a system to transition off the product and back to the dizzying choices in the local grocery store. That means you need a nutritionist.

Or you can drive to Albany. “Dr. Paul Lemanski [an Albany cardiologist who used to have a practice in Kingston] has a great program,” Lader said. “It gets the weight off, then teaches you how to keep it off.”

CardioFit, Lemanski’s program, utilizes Medifast meals to get the weight off, and also educates patients about the importance of exercise. It teaches them to reduce stress and stop smoking, and even offers cooking classes.

You can also learn to make healthier meals a little closer to home.

Roni Shapiro recently opened Healthy Gourmet To Go in Saugerties after years of offering vegan meals to area clients.

“I’ve worked with many clients with heart disease and hypertension,” said Shapiro. “I am convinced that the most important thing you can do for your heart is switch to a plant-based diet. Dairy and animal protein are full of saturated fat that clogs arteries. I’ve seen a plant-based diet work and I’ve seen people’s health improve. It’s easier to switch than it’s ever been. You can go to any regular grocery store and find meat substitutes.” You can also contact Shapiro at [email protected] to find out about heart healthy cooking classes.

Lader said current science points to a Mediterranean diet as the best for heart health, but he said more research is needed.

Exercise matters, too. “Thirty minutes of aerobic exercise a day. Walking’s plenty,” Lader said. “Jog if you’re up to it, but you don’t have to. Some resistance training. That lowers your blood pressure, lowers your blood sugar, lowers your bad cholesterol, and raises your good cholesterol. Just use common sense. If you have chest discomfort – stop!”

Particularly for women, chest discomfort could indicate another issue – one that your doctor may not consider. “It’s called Syndrome X or Small-Vessel Disease,” said Lader. “It is a narrowing of the little vessels, ones too small to see in most tests. But we can measure the reduction in the blood flow during exertion. It causes chest discomfort. We see it most often in women, particularly diabetic women.”

Lader said routine tests for heart disease won’t find Syndrome X, and some doctors will dismiss a woman’s symptoms if they don’t know about it. “It responds well to angina medication and calls for the same changes in lifestyle that other heart disease patients need to make,” said the local cardiologist. “Lose weight, get cholesterol and blood pressure under control, exercise.”

 

The local American Heart Association heart walks are scheduled for this month. On Saturday, March 10 the Dutchess County walk will take place at Vassar College in Poughkeepsie. On Saturday, March 24 the Ulster County walk will take place at Dietz Stadium in Kingston. Registration for both events will be at 8:30 a.m., and both walks will begin at ten o’clock.

 

No time to lose

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Mark Bedell, Town of Shandaken EMS, sits with a Lifenet wireless device in an ambulance.
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Door-to-balloon time (D2B) makes the difference between death and survival from a heart attack.

There are two kinds of heart attacks: one in which an artery to the heart is partially blocked, and the other in which an artery is completely blocked. The second kind, of course, is more imminently life-threatening. Time becomes of the essence. If medical personnel can get a balloon-tipped tube to open the artery up quickly, the data shows, the patient stands a good chance of survival.

To speed up the process, local ambulances have recently been equipped with Lifenet systems that enable paramedics to hook up a heart-attack patient to an electrocardiogram (ECG) monitor and transmit the readings directly to the hospital through the Internet. Physicians can make decisions about the patient’s care while the ambulance is en route, so hospital staff can be ready to leap into action upon the patient’s arrival. Based on the ECG, paramedics can also get advice from doctors about interim treatment while the patient is still on the way to the hospital.

The American Heart Association estimates that close to 400,000 people a year in the U.S. experience the more serious type of heart attack, known as STEMI (ST-segment elevation myocardial infarction). Part of an ECG reading is the ST-segment, which is elevated in situations where a coronary artery is fully blocked. The ECG is a critical part of diagnosis, and paramedics are trained in its use.

Studies show that patient outcomes significantly improve and hospital stays are shorter (Journal of the American College of Cardiology, 2006) when door-to-balloon time is 90 minutes or less. Local emergency crews are just beginning to use the Lifenet system to pare down their D2B time.

The system was purchased by HealthAlliance of the Hudson Valley through a grant from the federal government’s Hospital Emergency Preparedness Program at a cost of $49,025, explained Richard Parrish, EMS coordinator at HealthAlliance. The Lifenet system includes a base receiving station in the Kingston Hospital emergency room and modems for the Ulster County’s six ambulance services, Woodstock Rescue, Shandaken Ambulance, New Paltz Rescue, Ellenville Rescue, Mobile Life Support Services, and Diaz Ambulance.

Transmission of ECG data requires cell service, which is not yet active in Shandaken. At the February 6 Shandaken town board meeting, the town’s ambulance service administrator, captain Richard W. Muellerleile, asked that residents notify the service if they own a Verizon network extender, which enables connection to cell service. Ambulance staff hopes to compile a confidential list of extender locations so they can get information from the cardiac monitor while still in the ambulance instead of waiting until they reach wireless network access closer to Kingston.

A network extender plugs into an existing high-speed Internet connection to communicate with the wireless network. The various brands listed on Amazon.com are priced between $100 and $200.

Kingston Hospital is among the quarter of hospitals in the United States equipped to treat patients with percutaneous coronary intervention (PCI), the preferred type of treatment for STEMI, according to the American Heart Association. PCI is a group of medical procedures that use a mechanical means to treat patients with partially or completely restricted blood flow through an artery of the heart.

Balloon angioplasty, for example, involves insertion of a tube into an artery in the groin. The tube is threaded to a trouble spot in the coronary artery, where a balloon attached to the tip of the tube is then inflated, compressing the blockage and widening the artery to restore blood flow to the heart muscle.

Another PCI procedure involves use of a stent, a wire mesh tube that is inserted to open an artery and prevent re-blockage.

A catheterization lab at Kingston Hospital enables staff to perform cardiac catheterization, a procedure to examine blood flow to the heart and test how well the heart is pumping.

Prescription addiction

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A recent edition of the Journal of The American Medical Association (JAMA) described a report issued by the Centers for Disease Control, in a splendidly titled tome called the Morbidity and Mortality Weekly Report. Subtle sirens of alarm were sounded. The rate of unintentional drug-overdose deaths in the United States has risen over 600% between 1997 and 2007.

The report was not discussing heroin, meth or crack. It was warning doctors about prescribed analgesics. Drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007. That’s enough for everyone in this country to take a standard five-milligram dose every four hours for three weeks.

According to the report, “Prescription drug abuse is the fastest-growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.” The numbers are astounding. “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report non-medical uses of opioid analgesics.”

Did someone say there was a war on drugs? From the CDC’s analysis, it seems the medical industry has been exempt: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”

Allow me to share two stories behind these statistics. One is about a patient of mine whose name has been omitted here, and the other involves my own personal experiences after a back injury.

The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheelchair) and injured her shoulder. After MRIs and doctor visits that lasted months, it was finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.

That was 15 years ago. Her dosage increased dramatically over the years, as did her anxiety, her depression. Finally she was able to experience the abandonment she had so feared. Her marriage fell apart. She became so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.

I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians please to reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer has been a uniform “no.”

Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?

A few years ago, I fell (hard) and twisted my back. I was more embarrassed than in pain. “Oh, I’ll be fine,” I said. “It’s fine.”

Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. An urgent-care facility told me it must have been a muscle sprain because there was nothing on the x-ray. I was urged (I mean this literally) to take painkillers. I said, “No, thank you.”

The doctor on staff looked at me cross-eyed and said, “What do you mean, No, thank you?”

I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?” He reluctantly gave in and wrote the prescription, telling me “You’re going to be sorry.”

The pain was not going away as quickly as I’d hoped, but I had seen what Vicodin could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that last two months, I finally went for an MRI, where they found the bulging disc that was impinging on my sciatic nerve.

I found a physical therapist who was a hands-on genius. She relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the iliopsoas, particularly psoas major, the muscle that connects the hip to the spine. As she worked, I felt miraculous and immediate joy.

I was still in pain and not as limber as I used to be, but my condition was moving in the right direction. And I was willing to work hard to get better. Then the insurance company insisted on a new doctor, who looked over my chart and said, “You’re going to need Vicodin.”

I said, “No.”

Once again, that same look: “What do you mean, No?”

I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”

“Because you’re at maximum improvement. You can get the drugs but not the therapy.”

It was my turn to look at him cross-eyed. Much to the amusement of the nurse in the room with us, I said, “Are you crazy? Who are you working for?”

“This is medical standard now.”

“What about your oath?”

“I’m sorry.”

I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin.

I had to pay for my own physical training and take responsibility for my own recovery. It was not easy. But it was infinitely better than what I’d seen with my patients: people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic the patients were sometimes mistakenly diagnosed as bipolar instead of addicted. Rather than getting them off the vicodin, they were given ever-increasing doses of medication that eventually made reaching — or treating — them impossible.

This war on drugs we’re waging? Maybe it should start in the doctor’s office. It seems to be up to us patients. I don’t see the pharmaceutical companies leading the battle.

 

Judith Acosta is a classically trained homeopath, a licensed psychotherapist and a crisis counselor. A resident of New Paltz, she has written several books and is a regular contributor to The Huffington Post, The Journal of Emergency Medical Services and other publications. She may be reached at www.wordsaremedicine or www.thenextosama.com.