Health & Wellness Summer 2012

summer 2012

FOOT CARETIPSpage 28

+ LOTS MORE

food allergiespage 8

HEALTH FREE!HEALTHwellness a guide to healthy living in the Helena area

CoreExercisepage 22

HEALTH & wellness2 sunday, august 19, 2012

1 MEDICAL PARK DRIVE HELENA, MT 59601406-442-6356 | 406-442-6352, FAXwww.helenaultrasound.com

* We are Southwest Montana's leader in diagnostic medical ultrasound for 20 years.

* We have state-of-the-art equipment including incredible 3D/4D capability which is amazing for doing pregnancy ultrasounds and other imaging.

* We also provide other ultrasound exams such as carotid, venous, gallbladder, kidneys, breast, pelvic, thyroid along with OB exams.

* We only employ highly skilled, registered sonographers to conduct exams.

* Our staff is friendly, warm, and professional. We treat you right!

YOU DO HAVE A CHOICE

who performs your ultrasound; ask yourdoctor or health care provider to refer youto Sound Health Imaging.

Sound Health Imaging Staff. L to R: Theresa, Melissa, Katlin, Audrey, Terri, Jennifer, Taylor, Dawn

Advanced Medicine Close to Home

St. Peter’s Cancer Treatment Center is recognized as offering high-quality cancer care by The Commission on Cancer of the American College of Surgeons. Only 1 in 4 cancer programs in the United States receives this special approval.

OncologistTom Weiner, M.D.

www.stpetes.orgwww.stpetes.org

HEALTH & wellness sunday, august 19, 2012 3

St Petes 20205929Advanced Medicine Close to Home

St. Peter’s Cancer Treatment Center is recognized as offering high-quality cancer care by The Commission on Cancer of the American College of Surgeons. Only 1 in 4 cancer programs in the United States receives this special approval.

OncologistTom Weiner, M.D.

www.stpetes.orgwww.stpetes.org


health & wellness guide is published four times a year by the Independent Record

317 Cruse Avenue, Helena, MT 59601 | 406-447-4003

contentsSave Your Skin ........................................................6Food Allergies .........................................................8Mediterranean Inspired Quinoa Salad .......................9Fall Prevention .......................................................10Wisdom Teeth .......................................................12Medical Identity Theft Rising ...................................15New School Year Resolutions ................................16Sleep Smarts ........................................................17Are Your Ears Ready for Hunting Season? ..............18Are Your Favorite Foods Making You Fat, Sick,

Tired, & Crazy? ...................................................19Grinding Your Teeth ...............................................20Core Exercise is the Answer...................................22Women’s Health Institute ........................................25Choosing the Right Assisted Living Facility ..............26Women’s Health Clues...........................................27Foot Care Tips .......................................................28Did You Know?......................................................30Advertiser Index .....................................................30

You have a choice when it comes to Healthcare in your

home!

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406-586-0022

ButteFrontier Home Health

406-723-8933

KalispellFrontier Hospice

406-755-4923

in Helena406-443-4140 • 800 Front Street

in Helenai H l

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he message is out in the media: skin cancer is on the rise and you can help prevent or detect it! From printed materials to television, films and the internet

we really cannot escape the message of early detection and prevention.

After hearing Dermatology professor Albert Rosenthal, M.D., speak at a Dermatology Nurses’ meeting: “Early and continued sun protection…combined with early skin cancer detection and treatment, is the only effective means of combating this potentially deadly disease,” I became a champion for skin cancer screening as a tool to aid in early detection.

The American Academy of Dermatology suggests checking your birthday suit on your birthday and more frequently as recommended by your dermatology care provider. This self exam allows you to note if you see any changes: look for the ABCs warning signs of melanoma: moles that are new or changing with A-asymmetry, B-border, C- color, D-diameter, E-evolving. Also check all spots that are sore or non-healing, that persist and are easily irritated or open. They do not need to be dark.

Scheduling an annual full skin exam may save your life. Early detection and treatment of non melanoma skin cancers (squamous cell carcinoma and basal cell carcinoma) have a cure rate of 95 percent. Even melanoma, the most aggressive of the common skin cancers, when detected early, has a high cure rate. During the exam alert your provider to any change you or a family member has noticed. Your observations are

important. If you have a family or personal history of skin cancer, if you have spent a lot of time in the sun or have used indoor tanning, or have many moles or pigmented spots please schedule an annual full skin exam. If needed your dermatology care provider can remove part or all of a growth and check it for skin cancer or other disease.

by Karrie Fairbrother, R.N.St. Peter’s Nurse Educator

T

Your skin is the body’s largest organ. Be your own advocate for your skin’s health by being Sun AWARE:

Avoid UV Exposure

Wear sun protecti ve clothing and sun glasses

Apply sunscreen and reapply

Routi nely Check your skin and have an annual full skin exam

Educate others

AW A RE

SAVE Your SkinSAVE Your Skin

Bringing Quality Medical Imaging Back to HelenaLocally and Privately Owned

Helena Imaging Center NOW OPEN

Dennis Palmer, M.D.Randy Sibbitt, M.D.

Hassan Massouh, M.D.Christopher Lindsay, M.D.

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The only entirely Board Certifi ed and Fellowship trained radiology group in town. Radiology group with 20 years in the Helena community. The only place in Helena using Hologic mammography. Prompt, quality interpretations faxed to your provider. Online access to results for easy communication between doctors and patients.

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Dennis Palmer, M.D.Randy Sibbitt, M.D.

Hassan Massouh, M.D.Christopher Lindsay, M.D.

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The only entirely Board Certifi ed and Fellowship trained radiology group in town. Radiology group with 20 years in the Helena community. The only place in Helena using Hologic mammography. Prompt, quality interpretations faxed to your provider. Online access to results for easy communication between doctors and patients.

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State of the art mammography, Digital x-ray, Ultrasound, Bone densitometry, Low-dose multidetector CT


by Deborah Jones, RD, LN Director of Nutrition Services at St Peter’s Hospital Montana’s Delegate to the Academy of Nutrition and Dietetics

Guess Whose Food Allergies

Are Coming To Dinner?

re you planning a barbeque or picnic with family and friends which includes guests with food allergies? All great hosts and hostesses

want all their guests to enjoy the party. (A trip to the local Emergency Room due to anaphylaxis is a party dampener!) The most common food allergens are: cow’s milk, eggs, fish, peanuts, shellfish, soy, tree nuts and wheat.

A great party without incident can be had bydoing the following:■ Tell your guests what’s on the menu

■ Ask your guests if they have any food allergies that would necessitate a change to the menu.

■ Keep the menu simple. Fewer ingredients mean less chance of unexpected allergic reaction.

■ Make the food yourself. Prepackaged foods are convenient but may contain allergens hidden in the food, e.g., pre-made marinades and salad dressing many times contain allergens of wheat, soy and sesame.

■ Keep it clean. Prepare, dish, transport and serve allergy free dishes separately from dishes with allergen containing ingredients. Bring hand wipes and use condiment packets rather than shared jars to avoid cross-contamination. Use a clean tablecloth to cover the table where allergens may be left from a previous use.

■ Have the allergic guest bring his or her own items and allow them to grill on the clean grill first before other foods go on the grill.

■ Check out the website for the American Academy of Allergy, Asthma and Immunology (http://www.aaaai.org) for allergy safe recipes and other allergy information.

■ With a bit of careful planning and preparation you can have a great summer event that all your guests can enjoy! Following is a salad that does not include any of the common food allergens.

A


Eliza Wiley

1. Bring water to boil, add quinoa. Reduce heat to medium low, cover, and simmer until the quinoa is tender and the water has been absorbed, 15-20 minutes. Transfer quinoa to large bowl.

2. Gently stir into the quinoa the onion, pepper, olives, feta cheese and parsley.

3. Combine the salt, minced garlic, lemon juice balsamic vinegar and olive oil and drizzle over the salad. Stir until evenly mixed. Serve immediately or refrigerate and serve chilled.

Nutrition Analysis for Serving– Calories-187, Fat-11.5 gm, Cholesterol-8 mg, Sodium-270 mg, Carbohydrate-19 gm, Fiber- 2 gm, Protein-3 gm

Mediterranean Inspired Quinoa Salad – Serves 8

2 cups of water

1 cup uncooked quinoa, rinsed and drained (gluten free wheat free grain)

1 large yellow onion diced

1 large red bell pepper, diced

½ cup kalamata olives

½ cup crumbled feta cheese (traditionally made from sheep’s milk

¼ cup chopped parsley

¼ teaspoon salt

2 cloves garlic, minced

2/3 cup fresh lemon juice

1 Tbsp balsamic vinegar

¼ cup extra virgin olive oil

Pr

ince

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Pez

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ames

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et me start off with a story, a story about how I fell. I was doing a house call for a client who has some balance issues. Towards the

end of our treatment, I was educating him on the importance of proper foot ware. When I left I walked down their uneven dirt driveway to get to my car. As I walked down the driveway, my shoes slid out from underneath me and I was thrown to the ground. I sat there for a minute or so, making sure I didn’t injure myself. After I realized I was ok, I got up and dusted myself off and looked around in embarrassment to see if anybody saw me. My pride was a little bruised but otherwise I was ok. Later that day I got to thinking about why I had fell. The road seemed harmless enough. Being a physical therapist that deals with this everyday, I realized I wasn’t practicing what I preached. I sat on my couch at home and picked up my leather Doc martin shoes and examined their soles. I might as well have been wearing banana peel slippers on a hockey rink.

One out of every three people 65 years and over fall each year. You may be someone or know someone this has happened to. There are many factors involved in why we fall however they can be distilled down to three basic reasons:

1. HEALTH ISSUES: One of the problems with living is that our health gets a little worse as time goes on. High blood pressure, diabetes, hearing and vision loss are just a few conditions that can lead to the physical inability to balance like we did in the past. When I read the side effects of just about every medication, I see dizziness listed there. The more medications we are on, the more prone we are to lose

L

FALL PREVENTION

is better than the alternativeby Dr. Adam Eslahpazir, D.P.T. Gold Leaf Physical Therapy

Doctors of Physical Therapy

900 North Montana Avenue, Suite A5

442 — 4325 www.goldleafpt.com

Helena owned and operated

Dr. Alissa Eslahpazir, DPT Dr. Adam Eslahpazir, DPT


pole. Everybody uses them on the trail. This is a simple tool that can increase your balance. Simply understanding what we are capable of can also make the difference between balance success and failure.

After my fall, I went to the store to look for a new pair of shoes. Instead of buying what caught my eye, which was how I usually bought shoes, I started looking at the soles. I discovered there are some nice shoes with great soles. I went back to my clients’ house in my new shoes. I went in their house and chatted for a few minutes before treatment. After his treatment, the client looked me in the eye and said, “nice shoes!” I said, “Thanks!” As I walked out down the stretch of road that had thrown me earlier, I thought to myself, “Did they see me fall last week?” ■

our balance, especially blood pressure medications. Simple strengthening and balance exercises can go a long way to improve balance. A great resource is your physical therapist. They have extensive training to address these issues. Consulting your physician or pharmacist about your medications is another great way to avoid dizziness issues.

2. UNSAFE LIVING AREA: Clutter. Can’t live with it? Can’t live without it? Areas with less clutter reduce the risk of falling. Strategically placed furniture can also help. Rearrange furniture to better suit your needs. When furniture is readily available for support or out of the way for walking devices, this can make a big difference in avoiding falls. Night-lights are great. Many falls happen at night when going to the bathroom. Don’t be afraid to talk to your friends about your falls or balance. Often times they have similar stories that have novel solutions that we didn’t think of.

3. MISUNDERSTANDING OF RISK IN BALANCE: Most of us probably have an understanding of risk that was better off for our 20’s. The last time I was at my parents’ house, my dad got up on a swivel chair to change a light bulb while I watched in nail biting silence. Several months later, I found myself doing the same thing. I looked down at my wife who sat there in nail biting silence and remembered my mom always saying, “The apple doesn’t fall far from the tree.” Use solid stepladders to change light bulbs or to get to high areas. Use shoes that give you support and have grip. Hate the canes? Try a hiking

SteppingÊ OnÊAre you 60 years or older and worried about falling?

Call 447-1680 for a free course to prevent falls.


In general, dental and medical professionals agree that wisdom teeth should be removed in the following instances:

■ infections and/or periodontal disease;

■ cavities that cannot be restored;

■ pathologies such as cysts, and tumors, and

■ damage to neighboring teeth.

Wisdom teeth that are completely erupted and functional, painless, cavity-free, in a hygienic environment with healthy gum tissue, and are disease-free may not require extraction. They do, however, require regular, professional cleaning, annual check-ups and periodic radiographs to

monitor for any changes.

Wisdom Teeth Growth by Age

Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.

What Happens During Surgery?

If your dentist or healthcare professional recommends that your wisdom teeth be removed, you will most likely be referred to an oral and maxillofacial surgeon for the procedure. Before surgery, your oral surgeon will discuss the procedure with you and tell you what to expect. This is a good time to ask questions. Also talk to your surgeon about any concerns you have. Be sure to let your doctor know about any illness you have and medications you are taking.

There are several conditions that affect how easy it will be to remove a wisdom tooth. These conditions include how the tooth is positioned and the stage of root development. If the wisdom teeth are impacted the surgery might be more complicated.

Most of the time third molars can be removed with little or no pain. Usually they can be extracted at the oral and maxillofacial surgery office. Patients are given either local anesthesia, intravenous sedation or general anesthesia. Your surgeon will recommend the anesthetic option that is right for you.

isdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They come in between the ages of 17 and 25, a time of life that has

been called the “Age of Wisdom.”

What is an Impacted Tooth?When a tooth is unable to fully enter the mouth, it is said to be “impacted.” In general, impacted teeth are unable to break through the gums because there is not enough room. Nine out of ten people have at least one impacted wisdom tooth.

How serious is an impacted wisdom tooth?If left in the mouth, impacted wisdom teeth may damage neighboring teeth, or become infected. Because the third molar area of the mouth is difficult to clean, it is a site that invites the bacteria that leads to gum disease. Furthermore oral bacteria may travel from your mouth through the bloodstream, where it may lead to possible systemic infections and illnesses that affect the heart, kidneys and other organs.

Research has shown that once periodontal disease is established in the third molar areas, the problem is persistent and progressive, but may improve following extraction of the teeth.

In some cases a fluid-filled cyst or tumor may form around the base of the untreated wisdom tooth. As the cyst grows it may lead to more serious problems as it hollows out the jaw and damages surrounding nerves, teeth and other structures.

Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.

Must the tooth come out if it hasn’t caused any problems?

Many people believe that as long as they are not in pain, they do not have to worry about their wisdom teeth. However, pain free does not mean disease or problem free. In fact, wisdom teeth that come in normally may still be prone to disease, according to a study by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation. AAOMS strongly recommends that third molars be evaluated by an oral and maxillofacial surgeon by the time a patient is a young adult in order to assess the presence of third molars, disease status, and to suggest management options ranging from removal to a monitored retention plan to ensure optimal patient-specific outcomes.

Wisdom Teethby Montana Oral Surgery & Dental Implant

W (A) INFECTION

(B) DAMAGE TO NEIGHBORING TEETH

(C) CYST

12 YEARS

14 YEARS

17 YEARS

25 YEARS


What Happens after Surgery?Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your Oral and Maxillofacial Surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.

What if I decide to keep my wisdom teeth?If after discussing your situation with your family dentist or oral and maxillofacial surgeon, you decide to keep your wisdom teeth, be sure to take particular care in cleaning and flossing your teeth, especially the molars. Your third molars must be professionally examined regularly and x-rays of your wisdom teeth should be taken every year to make sure that the health of your teeth and gum tissue does not change. ■

All providers accepting

new patients

Dr. FritzDr. KeefeDr. Riggin

Dr. PalciskoDr. Augustine

1122 N Montana Ave 449-5563 www.helenapediatricclinic.comHOURS: Mon.-Fri. 8am-6pm Sat. 8am-12pm


Montana Oral Surgery 20205990

65 Medical Park Drive | Helena, Montana 59601 | 406.204.4377 | www.MontanaOralSurgery.com

Have your child’s wisdom teeth checked by Dr. Jason Flesichmann, Helena’s Board Certified Oral & Maxillofacial Surgeon.

*Bring in this ad for a free wisdom tooth consultation for your child up to age 21!

If only all their problems were this easy to deal with...

Impacted wisdom teeth often cause problems, even if your child doesn’t experience any discomfort.

HEALTH & wellness sunday, august 19, 2012 1565 Medical Park Drive | Helena, Montana 59601 | 406.204.4377 | www.MontanaOralSurgery.com

Have your child’s wisdom teeth checked by Dr. Jason Flesichmann, Helena’s Board Certified Oral & Maxillofacial Surgeon.

*Bring in this ad for a free wisdom tooth consultation for your child up to age 21!

If only all their problems were this easy to deal with...

Impacted wisdom teeth often cause problems, even if your child doesn’t experience any discomfort.

Two million Americans fall victim to medical identity theft each year, according to a study by the Ponemon Institute, commissioned by Experian’s ProtectMyID.

While medical identity theft costs victims an average of $22,346, the potential impact can be far greater - medical identity theft could cost some victims their health, or even their lives.

Medical identity theft involves the theft of personal information - such as your name, Social Security number or Medicare number – to obtain medical care, purchase drugs or submit false claims to Medicare. The crime can damage a victim's credit rating and even be life-threatening if it causes incorrect information to appear in a victim’s personal medical records, warns the U.S. Department of Health and Human Service’s Office of the Inspector General (OIG).

According to the study, while more Americans now understand just what medical identity theft is, few are taking the key steps that could help prevent it. Only 57 percent of survey respondents check their medical records for accuracy, and nearly one in five (18 percent) say they don’t care about the accuracy of their medical records.

“There are specific things that people can and should do to protect themselves from medical identity theft,” says Ken Chaplin, senior vice president of ProtectMyID. “People have to be vigilant with their personal information and avoid letting their guard down, even with family and friends.”

The Federal Trade Commission recommends you take these steps to help prevent medical identity theft:n Before you share medical information with anyone, verify who you're talking to. Never provide information over the phone or through the mail unless you initiated the contact and you're confident you’re dealing with a legitimate organization. Be aware that medical identity thieves often try to scam consumers by posing as representatives of insurance companies, doctor's offices, pharmacies and even government agencies.

n Protect your information. Keep paper copies of medical or insurance records and forms in a secure, locked file or drawer. When managing your health or insurance accounts online, be wary of any site that asks you to share sensitive information like your Social Security number, insurance account number or details of your medical conditions. Look for the hallmarks that a website is secure, including a web address (URL) that begins with “https” (the “s” stands for “secure”) and a lock symbol in the lower right-hand corner of the page.

n Picking through trash is a common ploy of identity thieves. Shred your discarded health insurance forms, bills and medical

records before disposing of them. Destroy the labels on your prescription pill bottles and packages before throwing them away.

The OIG also offers tips for medical identity theft protection, including: n Treat your Medicare and Social Security numbers and cards as carefully as you would your credit cards.

n Be wary of anyone who asks for your Medicare number in exchange for “free” medical equipment or services. If what they’re offering is really free, they shouldn't need your numbers.

n Never let anyone use your Medicare ID card. The Ponemon survey found that a growing number of survey respondents (5 percent more in 2012 than in 2011) have allowed a family member to use their personal identification to obtain medical services, including treatment, healthcare products or pharmaceuticals. Doing so is against the law, and may afford unscrupulous individuals the chance to use that information for unauthorized purposes.

According to the Ponemon survey, it takes, on average, about a year to resolve an instance of medical identity theft, and a quarter of the survey respondents said it took more than two years. As with a serious medical issue, resolution can be made more challenging depending on how long the problem is allowed to fester.

Take an active role in protecting your medical information from identity thieves. Check your medical records regularly and keep an eye on all your financial and credit accounts. Products like ProtectMyID can help. A comprehensive identity theft detection, protection and resolution product, it can help you prevent the damages caused by identity theft.

“Medical identity theft hits consumers both medically and financially,” says Dr. Larry Ponemon, chairman and founder of the Ponemon Institute. “For three years in a row, our findings have consistently shown that medical identity theft crime continues to increase in terms of prevalence and costs to the victim.” n

Medical identity theft rising: Steps to protect yourself by ARA Content


Avisitor to the Helena Family YMCA recently was complaining of chest pains during a workout. He went to the doctor who proceeded to put 2 stents

in his arteries. This gentleman is in excellent shape, and maintains a very sensible diet. So, why the chest pains and health concerns? As we’ve all heard, heredity has a lot to do with our health.

Many people end up paying the price later in life for their lifestyle choices early in life. Or, more specifically, for the choices their parents made. Today we often chose the quick or easy choice for meals, instead of the better or healthy choice. While many restaurants have a menu devoted to healthier foods, that is not always what a youngster wants.

With a new school season upon us, we can also start some new resolutions. Here are some ideas (simple and even inexpensive!) for meals for your kiddos:

BREAkFAST: milk, banana, whole grain cereal (I saw a

New SCHOOl YEAR Resolutions

mom at the store last week and each pre-school child had a box of chocolate-flavored, high-sugar cereal. Wow).

luNCH: turkey sandwich, carrot sticks, pear slices, milk.

SuppER: whole grain spaghetti and sauce, garden salad, orange slices, milk.

SNACkS: apple slices, peanut butter, or blueberries and yogurt.

Too busy to pack a lunch or breakfast for the youngsters? Just remember that children who eat breakfast score better on school achievement tests. Eating breakfast can help prevent childhood obesity, and children who eat school meals eat more fruits and vegetables. Even though we’re at the end of summer vacation, it’s important to note that when kids eat healthy meals during the summer months, they are more likely to do better in class when they go back to school in the fall.

Diet is one part of the solution … the other part is physical activity. Children who are physically active during the day feel better about themselves and do better in school. Children need at least an hour of physical activity each day to stay healthy and fit. There’s not enough time during the school day to get it all in. Physical activity can teach life skills such as teamwork, patience and motivation to help youth reach higher goals. Being physically active also increases self esteem.

Parents should remember that today’s suggestions aren’t cutting edge or innovative. Make sure that you encourage your children to join a team or afterschool activity – the Helena Family YMCA has programs year-round for children of all ages. Involve your children in the planning and preparation of healthy meals. Eat more meals together as a family. Give our children appropriate serving sizes of food to eat. And most important, turn off the television and take a family activity break or go for a walk. Limit television, computer, video games and movies to 2 hours or less per day.

A little bit of effort today with your children can prevent a multitude of problems later in life – even if they end up exercising and eating right while in their 50s! n

by David Smith, CEOHelena Family YMCA

VISIT US AT HELENAYMCA.ORG

HELENA FAMILY YMCA

FEEL GREATChoose the membership thatmakes a difference


FALL PREVENTION

is better than the alternative

Does your list of school supplies include sleep? Studies say it should, especially for teens.

Only 8 percent of American teenagers are getting the required nine or more hours of sleep needed, according to the National Sleep Foundation. In fact, a recent study published in the “Journal of Adolescent Health” found that more than 60 percent of high school students get less than seven hours of sleep per night. The situation does not improve in college, either. A 2010 study conducted at the University of St. Thomas in Minnesota revealed, not surprisingly, that 70 percent of college students get less than the 8 recommended hours of sleep.

While most people have, at times, battled sleep issues, poor sleep habits plague college campuses. Let’s face it - most college kids do not place a premium on a good night’s rest. In addition to sleep falling low on the priority list, most students are sleeping on cheap dorm mattresses and worn out pillows – which can affect sleep quality.

Perhaps reminding your student that there is a proven relationship between healthy sleep habits and academic success might help encourage healthier habits. In 2010, a University of Minnesota study found a significant positive correlation between the amount of sleep per night and GPA. Additionally, as the average number of days per week a student got less than five hours of sleep increased, GPA decreased.

Once a pattern of bad sleep has developed, is it possible for teens and college students to “reset” their internal clocks? Researchers at the American Academy of Sleep Medicine say it is. Suggest that your students try following these tips, a little bit at a time, over several weeks:

n Try your best to avoid caffeine, smoking, alcohol, heavy exercise and heavy snacking (pizza included) at least three hours before bedtime.

n Don’t pull all-nighters or cram for exams late at night. Specifically schedule studying for when you're most alert so your performance won't be affected.

n Be as consistent as possible with your sleep habits, ideally aiming to go to bed at the same time each evening and get at least eight hours of sleep per night.

n Wake up at the same time every morning and head outside. Sunlight helps reset circadian rhythms, the body’s internal biological process that rotates around a 24-hour schedule.

n Turn off your cell phone and laptop at night. Besides being a distraction, exposure to light can suppress the production of melatonin, a hormone that aids sleep.

n Make sure your bedroom is set up for sleep. If you are a light sleeper or your dorm is noisy, try wearing earplugs or noise-cancelling headphones. Keep the room cool and dark. Make your bed as comfortable as possible. Consider investing in a foam mattress pad and a quality pillow. For example, for around $100, you can purchase a mattress topper and a waterbase pillow, both of which greatly improve head, neck and back support while you sleep.

“While you most likely cannot control the amount of sleep your teens or college-aged kids receive, at least you can make sure that once they are in bed, the sleep they do get is of the best quality,” explains Maurice Bard, founder and CEO of Mediflow Inc., a company that makes waterbase bed pillows. “One simple way to accomplish this is to make sure your teens are sleeping on the right pillow - one that adjusts to properly support their head and neck throughout the night.”

Countless studies have shown that people who get the right amount of sleep are physically and emotionally healthier - which is of course is something we all want for our children. Getting better grades is just the icing on the cake. n

Sleep smarts: Sleep is an important part of back-to-school preparation by ARA Content


Gunshot exposure with any type of weapon, be it pistols, shotguns, or long guns does damage to the inner ear. The

loud burst of sound rattles the ear drum, the tiny bones in the middle ear and sends a large sound wave to the inner ear that contains thousands of tiny hair-like structures responsible for sending electrical impulses to the brain for understanding.

So how loud is a gun shot? Well to give you and idea, a whisper is about 25 decibels (dB), a lawn mower is 90 dB and a live rock concert can be up to 130 dB. A gunshot depends on what type of weapon you are firing, but can range from 120 dB and can get up to 180 dB.

Even one shot from a gun can cause irreversible damage to the ear; luckily it is rare that this happens. But you should always use your hearing protection. There are a variety of options available, including disposable foam plugs, over the ear muffs, custom molded plugs, and electronic protection. Some of these options allow for hearing what is going on around you or even enhancing the sounds around you, while others block out most of the sound around you. With that being said there is an option for every budget and ear. Call Comprehensive Hearing Services at 406-443-8838 for hour noise consultation to see what is available and what would keep your ears protected. ■

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Hidden food allergy symptoms might be frequent colds, flu, stuffiness, headaches, insomnia, bloating, indigestion, addictions, anxiety, depression, fatigue, joint pain, high blood pressure, cholesterol and sugar problems including difficult weight loss.

Clinics see many allergic reactions on a delayed and low-grade basis when people are sensitive to foods they eat daily. Doctors often don’t know that it's a hidden food allergy that’s causing all the problems.

Roger Deutsch, co-author of Your Hidden Food Allergies Are Making You Fat, is no stranger to allergies. -- He has suffered for years until now.

"I grew up in the Northeast and I suffered very extensively from serious allergy problems," says Deutsch. "I asked my doctor what caused allergies and she said, 'No one knows' -- so I felt a bit discouraged and decided to set out on my own to try and figure out how to solve my health problems."

"It didn't take too long to figure out that food and nutrition have the most to do with everything regarding health, including serious food sensitivity. I found a drastic, phenomenal improvement in my own condition when I began to control my diet."

A strong food sensitivity also known as a food intolerance, delayed food allergy or a hidden food allergy is not the same thing as a true food allergy.

A true food allergy causes a rapid, violent onset of symptoms. "It's meant to be that way," says Deutsch. "This is an evolutionary carryover from our defenses against parasites, so the body's reaction is to give it everything it's got... and when this occurs with food, it can be life-threatening."

A food intolerance, on the other hand, is mediated by a different branch of the immune system," says Deutsch. "It's called the innate immune system as opposed to the specific immune system and it's the same branch of the immune system that works as a first line of defense against bacteria.” The symptom onset is very different but equally destructive.

Recently, 98 percent of the participants in a well-designed Baylor Institute study who avoided their most inflammation causing trigger foods, lost tons of weight. Also, they quickly reduced their percentage body fat while gaining significant lean muscle tissue without any dieting.

Since hidden food allergies involve different chemical pathways, they require different tests for detection which are expensive and don’t provide treatment outside of a traditional allergy food elimination diet.

Now, a revolutionary new Star Wars like BioLaser system can scan you for hundreds of allergens and hidden food sensitivities in just a few minutes. It also tests for more than 100,000 environmental irritants and emotional imbalances that can cause serious health problems masquerading as many common diseases.

Next, the ASA Computer develops an electronic energy rebalancing program customized for you. Then the information is delivered by a “Smart” BioLaser to your body’s trigger points to help reduce your debilitating sensitivies. In just thirteen sessions, lasting about 15 minutes, you can get your life back to start enjoying renewed vitality and accelerated weight loss!

This remarkable science of homeopathy has been developed in Europe over the last 200 years. Recently, American researchers have used modern computerized technology to develop the FDA Safe, BioLaser energy balancing system that is only available right now at the Peak Wellness Clinic, 1111 N. Rodney in Helena, MT.

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Are your favorite foods making you fat, sick, tired and crazy?

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Rudy Rivera, MD & Robert Deutsch

Present this ad when you visit our clinic and receive a 25% credit on BioLaser balancing!


ave you ever awoken up at night and noticed yourself grinding your teeth? Do the muscles surrounding your jaw joint ever feel stressed or tense? Do

you suffer from chronic head and neck muscle pain or headaches? Does your jaw joint ever click, pop, or lock? If so you are not alone. Millions of people in the US suffer from the same problems. Some of these problems are classified as TMD (tempo-mandibular dysfunction), while others simply cause muscle discomfort or excess tooth wear.

The TMJ’s (tempo-mandibular joints) are often referred to as your jaw joints. They are very strong and stable joints, but they are complicated because they are bilateral (on both sides of your body) and connected to each other. Your bottom jaw is attached to the base of your skull through the TMJ’s, and it is connected only by soft tissues (muscles, ligaments, and a cartilage disc). Because of its complicated and dynamic nature, the TMJ frequently gets out of alignment and chronically searches for a stable position. This misalignment is what often times leads to clenching and grinding. The grinding often occurs at night and patients are regularly unaware of their habit. Lifestyle stress may also be an additive reason in causing a patient to clench and grind, but it is not the primary causative factor. There are many signs and symptoms associated with chronic TMD such as headaches, sore muscles, and wear patterns on teeth.

A dental bite splint is a non-invasive custom made removable dental appliance which is typically worn at night. There are many benefits to a bite splint. Primarily, a splint “deprograms” the muscles surrounding your jaw joint and it sets up an environment for relaxation and healing. Many patients, after only a short time wearing a splint, will find that their head and neck muscles feel more relaxed and are less painful. This is a great way to manage sore muscles in a non-invasive way, as well as potentially alleviating some chronic jaw joint associated headaches.

Another great advantage to a bite splint is that it protects your teeth from the detrimental effects of chronic clenching and grinding. Many patients are surprised when we as dentists tell them they have fractured a tooth, or possibly they have ground away an expensive crown. Or maybe, through grinding, they have lost natural tooth structure which is a sacred structure that cannot be regrown. Once it’s gone, it’s gone and must be replaced by a dentist. A bite splint helps preserve this natural tooth structure by placing a protective barrier over the teeth during the most common times of grinding. Bite splints can also be used in a preventative way in an attempt to avoid some dental emergencies such as fractured or cracked teeth, which may be related to clenching and grinding.

A dental bite splint is a very valuable and often times underutilized puzzle piece in the management of patients and their oral health. Ask your dental health care provider for more information on chronic clenching and grinding, and whether a bite splint would be a good tool to help improve your overall dental health. ■

H

Grinding your Teeth: A Common Problem

THE DENTAL MANAGEMENT OF

CHRONIC CLENCHING AND GRINDING.by Dr. Brandon N. Kiesling, DMD

Associated Dental Care of Helenawww.helena-dentist.com


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ext time you are in a large group of people, take a look around. I think you will be surprised at

the number of people who stand, walk or move as if they have back pain. Next, notice your own posture, the way you walk, how you get up from a chair or out of bed. Many of us compensate for back pain by making adjustments in the way we move (such as using our arms to help us sit or stand), or rely on a steady diet of over the counter pain medications. While these “fixes” address the immediate discomfort, they do nothing to solve the underlying problems. In fact, they may further harm the natural mechanical functioning of your body by putting undue stress on other joints.

A better approach to back care is to participate in a regular exercise program that addresses core strength. The “core” is a term used to describe the abdominal and back muscles. Most people have heard that back strength is connected with abdominal strength and that is quite true. Creating a solid foundation of core strength is the best possible way to prevent back injury and eliminate chronic pain.

Core strength is a combination of actual muscle strengthening, correction of alignment and posture, and the adoption of healthy habits. Learning to take your back and posture into consideration when doing the simplest tasks (picking up that bag of groceries or bending over the sink while brushing your teeth) or the most challenging (playing 18 holes of golf or doing some intense gardening) should be as much a habit as getting dressed

in the morning. A good core class will teach you which muscles to use, how to move correctly and what moves to avoid.

There are many classes focusing on core strength. They are not all pilates classes. Some are high energy, some not. Some classes use intentionally unstable equipment (such as stability balls or BOSU’s) to encourage use of the abdominal and back muscles for balance. Some pilates classes are done on a yoga mat and some use specialized equipment such as the “reformer” to help the practitioner use resistance to strengthen their muscles.

Each person needs to find a class that suits their needs and their temperament. There is not one class or one technique that is right for everyone. I chose pilates.

I worked at a high stress desk job, “hunched” over a computer, for nearly 26 years. During that time, I participated in various forms of exercise and thank goodness for that! However, by the time I retired, I was convinced that my knees

were shot and that chronic back pain was just part of life. I also had headaches most every day. That was when I took my first pilates class. I immediately understood that this was an unusual approach to exercise: intense yet gentle, calming and yet energizing. And while I had heard that pilates was a way to exercise the “core”, surprisingly, the class worked my entire body.

My own experience with pilates has convinced me that core-strengthening exercises are the basis of an overall healthier body. Correct posture and alignment allow for deeper breathing, the proper positioning of internal

organs, and the relief on various joints overworked by inappropriate use. The exercises are thoughtful and careful, with modifications available to meet the needs of an injured back. In my case, my back pain and headaches disappeared over time. Additionally, my leg muscles strengthened, which relieved the stress on my knees.

The typical mat pilates class runs 45 – 60 minutes. Participants begin warming up the back and neck using slow flexing and extending movements. Once the back and neck

are sufficiently warmed up, exercises will focus on each muscle group, or a combination of muscles. Exercises are done prone, on the back, side, seated and sometimes standing positions. Classes generally include a segment devoted to hip strength and mobility.

Many people experience a sense of tranquility or calm after a pilates class. Most likely, this is due to the deep,

Core strength is a combination of actual muscle strengthening,

correction of alignment and posture, and the adoption of healthy habits.

How to stop chronic pain, de-stress and build a better body? CORE EXERCISE IS THE ANSWER!

Nby Leslie Smith, Core Commitment


intentional breathing done with the exercises. Frequently, people comment that these feelings last for several hours after class. This de-stressing is a wonderful side benefit to the strength building exercise session.

Another bonus of a core workout is how the body trims itself by the concentrated muscle work. Pilates is known for “creating long, lean muscles”, or for making

the student “feel taller when I left than I was when I came in”. Many serious pilates students develop beautifully muscled legs, similar to a dancer’s.

But maybe you’re not interested in beautiful legs or feeling taller. Maybe you just want to stop having chronic pain. It’s time for you to find a core exercise program that you can stick with. Learn it, create healthy habits for your back, and change

your life for the better.

Leslie Smith is an exercise instructor at Broadwater Athletic Club, where she teaches pilates and other core-based classes, dance and QiGong Movement. She is also the owner of Core Commitment, where she teaches pilates and QiGong Movement in downtown Helena.

We offer Pilates and Qigong Classes in Downtown Helena!

Get to the CORE of YOUR fi tness Needs!

For more information: Leslie Smith 406-422-0682 www.corecommitment.nett

Tuesdays: Pilates 11:15 - 12:00 Wednesdays:QiGong Movement - 10:15-11:00 Pilates - 11:15 - 12:00 First Christian Church, Benton @ Power$4.00/class (discount with purchase of punch card)

Starting Sept 1 all classeswill start 15 min later.

QiGong-10:30amPilates-11:30am


BH-20211347

Don' t miss St. Peter' s 11th annual

Monday, October 1Helena Civic Center

Featuring actress Morgan Fairchild speaking about Heart Health and Stroke

Visit us on Facebook and enter to win a chance to be one of a select number of friends to attend a special reception with Morgan Fairchild. www.facebook.com/stpetershelena

Morning Blood Draw at the Hospital, 6:30 - 9:30 a.m.

Check cholesterol, blood sugar, thyroid and colon ($35)Fast for 12 hours before drawCollect results at evening event Schedule an appointment at stpetes.org/FWO12 or 444-2128

Order your FREE tickets online at www.stpetes.org/FWO12 by September 16

Tickets are also available by calling 447-2599.

Wellness Expo before Presentation, 4:30-7:30 p.m.

Health fair boothsDemonstrationsHealthy refreshmentsFree screeningsDoor prizes!

Wellness


St. Peter’s Women’s Health Institute (WHI)

by Kari Parmer, MSN, RN, Breast Care Navigator, and Dr. Maria Braman

t. Peter’s Women’s Health Institute (WHI) offers a team approach to women’s health care. Medical professionals partner with women to make their choices simpler and

keep them more informed.

The WHI was designed as a collaborative organization comprised of St. Peter’s Hospital and aligned members of its medical staff dedicated to developing and promoting coordinated, multi-disciplinary clinical programs tied to important women’s health issues. There are currently two sponsored programs within the WHI, the Breast Program and the Pelvic Relaxation and Urinary Incontinence (PRI) Program.

The Breast Program is accredited by the National Accreditation Program for Breast Centers. The Breast Care program involves a coordinated multi-disciplinary team approach to treatment options and care coordination. Integral to the program is ongoing quality monitoring that ensures that patient services, clinical pathways and outcomes are consistent with national standards. The seamless navigation of clinical care is assisted by Kari Parmer, the Nurse Navigator for the breast program. Parmer is also a leader in educating the community as well as individual women who have breast health questions or concerns. She guides women through their clinical and diagnostic evaluation of any breast abnormalities or concerns. In the event of a breast cancer diagnosis, Parmer assists patients in understanding recommendations

made by their physicians. She also helps patients navigate the health care system and connect them to resources to aid in their journey.

The PRI program was established to address the unmet medical needs of approximately 45% of post menopausal women who experience incontinence conditions. St. Peter’s wants women to know they don’t have to live with this discomfort and difficulty. There are numerous options that include noninvasive as well as surgical treatments. The PRI program at St. Peter’s is equipped to assist in finding the right option.

For information about St. Peter’s WHI programs, please contact the Nurse Navigator at 406-495-6780. ■

S

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BH-20211347

Don' t miss St. Peter' s 11th annual

Monday, October 1Helena Civic Center

Featuring actress Morgan Fairchild speaking about Heart Health and Stroke

Visit us on Facebook and enter to win a chance to be one of a select number of friends to attend a special reception with Morgan Fairchild. www.facebook.com/stpetershelena

Morning Blood Draw at the Hospital, 6:30 - 9:30 a.m.

Check cholesterol, blood sugar, thyroid and colon ($35)Fast for 12 hours before drawCollect results at evening event Schedule an appointment at stpetes.org/FWO12 or 444-2128

Order your FREE tickets online at www.stpetes.org/FWO12 by September 16

Tickets are also available by calling 447-2599.

Wellness Expo before Presentation, 4:30-7:30 p.m.

Health fair boothsDemonstrationsHealthy refreshmentsFree screeningsDoor prizes!

Wellness


Assisted living is often the answer when people are having more and more difficulty with everyday activities like dressing, showering, fixing meals and

getting around. Making the decision to leave your home can be difficult for the person and often the family, but you can make the transition easier by taking time to find the place that is the right fit and being honest about your needs and concerns.

Assisted living is an option for seniors who want or need help with some of the activities of daily living—things like cooking meals, getting to the bathroom in the middle of the night, keeping house, and traveling to appointments. It is also different from nursing home care where one needs round the clock medical care and assistance.

Facilities also vary about what they allow and provide which can make a big difference in making the place feel more like home, and help keep costs down. It is important to look around at the different assisted living facilities in your area to determine what they offer. You should consider many issues that help the place feel more like home and cater to having visitors.

Making a checklist can be a great tool in assessing the different places. Other than asking about their license and what services are allowed under the license you may want to ask if their license has ever been revoked. If so, when and why? As services do vary among the facilities, here are some important and personal questions to ask: What is their monthly rate? Is there a waiting list? If so, how long is the wait? Do they have private rooms that include bathrooms? Can they handle dual occupancy for couples? Are pets allowed to be kept by the resident?

If so, what types of pets? Do they have an area where the residents can get outside and walk around safely? Do they offer free TV service? Do they have a courtesy phone? What is the ratio for attendants to residents? Do they have a beauty shop? If so, what is the cost? Are utilities paid as part of the monthly rate (water, electrical garbage)? Do they offer transportation and is it free? Do they have daily laundry and housekeeping service? What social activities are offered and is there a cost? Ask to see their daily menu and ask if they offer meal options. Are meal guests allowed? If so, what is the cost?

The question about the ratio of attendants to resident is important in explaining the number of residents being cared for at any given time per staff attendants. A higher number of residents under the eye of fewer attendants can become a big deal at critical times. There may be more questions you want to ask depending on your lifestyle and needs. Write those questions down and make sure you ask all of the questions to each facility so you are not surprised by something later.If you would like a sample Assisted Living Facility Checklist, visit: www.mhmt.org

Preparation on the front end and fully understanding the differences between the assisted living facilities can be the difference for both the individual and family when taking the first step in easing this transition. n

by Shelley McLendon RN, Administrator, Masonic Home of Montana

Asking Questions in Choosing the Right Assisted Living Facility FOR YOU OR YOUR FAMILY MEMBER

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orth American women may want to take health advice from women in other areas of

the world. As it turns out, international women may have the secrets to living longer and avoiding medical conditions that seem to plague women in the U.S. and Canada. Here's how women across the globe are living longer, healthier lives.

■ pRACTICE pORTION CONTROlAlthough you've probably heard it before, reducing the amount that you eat can have its benefits, including weight loss. Many people remark how the French dine on cheese and butter and still manage to stay skinny. That is because they are eating in moderation, not making an entire meal out of two pounds of cheese. Smaller portions and maintaining an active lifestyle are two ways that many French women stay slim and healthy.

■ GO HEART-HEAlTHYThe "Mediterranean Diet" has been touted in recent years. Women in Italy and Greece set a good example by serving foods that are rich in heart-healthy antioxidants and good fats.

Nuts, whole grains, fish and olives are hearty and heart-healthy foods. Mediterranean cultures also use wine to improve heart health, help prevent cancer and slow the progression of neurological diseases, like Parkinson's and Alzheimer's. ■ STAY ACTIvE IN YOuR COMMuNITYJapanese culture emphasizes family connections and maintaining an extensive support system. The Japanese stay active into older adulthood, which could be why the island region of Okinawa is known for having the highest concentration of centenarians in the world. According to research, Okinawans, when compared to Americans, have an 80 percent lower rate of many cancers, including ovarian and breast cancer.

■ EAT lOCAllY Northern Europeans tend to eat farm-to-table, which means consuming things that they or their neighbors have grown and raised. Foods that are rich in omega-3 fatty acids, such as fish, in combination with native vegetables and

berries help keep obesity statistics very low. Scandinavians also eat game birds and elk, which produce meat that tends to be leaner than the types of farm-raised livestock North Americans rely on.

Adopting the healthy habits of others across the globe can help North American women live longer, healthier and more productive lives. n

N

Eating foods found in Mediterranean diets improves health.

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Just a few decades ago, the phrase “granny shoes” implied a tragic lack of coolness, and that the wearer had allowed comfort to trump style in their slow shuffle toward getting

old. Those days are definitely gone.

Today’s baby boomers and seniors are stepping out in everything from frisky flip-flops and hot heels to righteous running shoes and powerful hiking boots. Footwear is no longer dictated by age, but rather by the activity level and fashion sense of the wearer.

Still, like everything else about our bodies, our feet change with age. Because of this, the steps we take to keep them healthy have to adjust accordingly.

“While staying active is a great way to preserve overall health and can positively impact foot health, aging can naturally increase the risk of certain foot ailments,” says Joseph Caporusso, DPM, a podiatrist and president of the American

Podiatric Medical Association (APMA). "It's important to know the symptoms of age-related foot ailments and take steps to minimize their impact on your overall health."

APMA offers some information on common foot ailments to watch for as you age:

Arthritis While many health issues can cause arthritis, and it can affect people of any age, those older than 50 are most prone to it. The feet are more susceptible to this painful inflammation of the cartilage and lining of the joints because each foot has 33 joints – all of which help bear the weight of the entire body every day. Arthritic feet can lead to a loss of mobility if the condition is not diagnosed and treated.

The causes of arthritis can range from heredity to injuries to bacterial or viral infections that affect the joints. Arthritis may take several forms, so if you’re experiencing foot pain, it’s best

Foot care tips to keep boomers moving by ARA Content


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to have it diagnosed by a podiatrist. Symptoms that indicate it”s time to see the doctor include:

n Swelling in one or more jointsn Recurring pain or tenderness in any jointn Redness or heat in jointsn Loss of mobility in a jointn Stiffness in the early morningn Skin changes such as rashes or growths

Arthritis can be treated, but early diagnosis is important. Treatment options may include physical therapy, exercise or medication.

DiAbetesFoot-related complications are common among the nearly 26 million Americans who have diabetes. Proper diet, exercise, medical care and careful home management can help people with diabetes avoid the most serious complications of the disease, including amputation.

In addition to regular checkups with their podiatrist, people with diabetes can reduce their risk of complications with some basic foot care, including:

n Inspecting their feet daily.n Choosing thick, soft socks without seams that could rub or cause blisters.n Exercising daily.n Having new shoes properly measured and fitted.n Avoiding going barefoot.n Seeing a podiatrist for treatment of calluses, corns or warts, rather than trying to treat these conditions themselves.

high blooD pressureHypertension can be related to a buildup of plaque in the blood vessels, a condition which can lead to decreased

circulation in the legs and feet. Poor circulation can lead to the development of open wounds on the skin. Symptoms of poor circulation in the feet and legs include cramping, sores that take a long time to heal, changes in the color or temperature of the feet, and loss of hair on the feet and legs.

heel pAinOne of the most common foot complaints, heel pain can be caused by walking gait abnormalities, an injury, wearing poorly constructed footwear over the long term, or being overweight.

Heel pain is often very treatable. A podiatrist can examine the heel, and may take X-rays to rule out bone problems as the source of the pain. Treatment may include anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices.

To minimize risks of developing heel pain, wear shoes that fit well and have shock-absorbent soles, rigid shanks and supportive heel counters. Wear the proper type of shoe for the activity you'll be doing. Warm up before exercising, and pace yourself while participating in athletic activities. n

“Foot pain does notneed to be aninevitable part ofgrowing older,” Caporusso says.

“Wearing the right type of footwear for your needs, and paying attention to foot health can help keep boomers moving into their senior years.”


American Diabetes Association ........................... 21

Anderson Orthotics & Prosthetics ........................ 25

Associated Dental Care ....................................... 21

Benefis Bariatric institute ...................................... 5

Comprehensive Hearing Services ........................ 18

Core Commitment ............................................... 22

Elkhorn Health & Rehabilitation ........................... 28

For Women Only–St. Peter’s Hospital ................... 24

Frontier Home Health & Hospice ........................... 4

Gold Leaf Physical Therapy ................................. 10

Helena Dermatology & Laser Clinic ..................... 21

Helena Eye Clinic .................................................. 9

Helena Imaging Center ......................................... 7

Helena Pediatric Clinic ........................................ 13

Helena Surgi Center ............................................ 31

Lewis & Clark City-County Health Department..... 29

Masonic Home of Montana ................................. 26

Medical Weight Management .............................. 27

Montana Oral Surgery/Dental Implant Center ...... 14

Peak Allergy Clinic .............................................. 19

Shodair Children’s Hospital ................................. 21

Sound Health Imaging ........................................... 2

St. Peter’s Cancer Treatment Center ...................... 3

The Real Food Market & Deli ........................... Back

Touchmark ......................................................... 28

YMCA Helena ...................................................... 16

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