THE GOOD LIVING MAGAZINE from SOUTHERN ILLINOIS HEALTHCARE AUGUST 2012 how painkillers differ TOP CANCER CARE CLOSE TO HOME SOOTHING SEDONA BREATHE EASY DESPITE ASTHMA MYSTERY MALADY , REVEALED BE SAFE FROM lyme
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how painkillers
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TOP CANCER CARE CLOSE TO HOME
SOOTHING SEDONA
BREATHE EASYDESPITE ASTHMA
MYSTERY MALADY, REVEALED
BE SAFE FROM lyme
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C2_SILL_SUMMER12.indd 2 7/19/12 4:35 PM
CONTENTS
AUGUST 2012
24269
FEATURES
LIFESTYLES / IS A LIVING WILL RIGHT FOR YOU?With it you can make your own choices for end-of-life care.
CLINICAL UPDATE / ‘I’M BACK’An outdoorsman beats prostate cancer thanks to robotic surgery.
HEALTHY LIVING / PAINKILLER RISKS: WHAT TO DO NOW Finding a safe strategy for relief
ESCAPES / SOOTHING SEDONAThere’s balm for the spirit in this stunning Southwest setting.
CLINICAL UPDATE / HEPATITIS: THE QUIET KILLERThis silent time bomb is ticking away at the lives of hundreds of southern Illinoisans.
BETTER CARE / THE MYSTERY DISEASEDon’t suffer in silence with the pain of fibromyalgia.
DEPARTMENTS
WELCOME LETTER
TAKING CHARGE / BREATHE EASYWe have your solution to asthma.
FOUNDATION FOCUS / HOPE IS HOMEVisit our facility for the latest technology in cancer treatment.
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FLASH / AUXILIARY DAY The community of Herrin honored the hospital’s Auxiliary by declaring a day in its honor.
TAKING CHARGE / LIFE GOES ON WITH CONGESTIVE HEART FAILURE Today’s treatments mean this condition needn’t be as limiting as it sounds.
PREVENTION / WHY WOMEN’S ‘ACHILLES HEEL’ IS IN THE KNEE The torn anterior cruciate ligament is the bane of the active woman—but you can reduce your risk.
STAYING WELL / THE ABC’S OFDIGESTIVE DISEASE Knowledge is power when it comes to tummy trouble.
YOUR BODY / COUNTING CALORIES A roundup of activities that do your body good
GLORIOUS FOOD / IMMORTAL OIL The fruit of the ancient olive tree yields one of nature’s most sublime creations.
SEASONAL HEALTH / LYME DISEASE Beware the disease spread by tick bites. It can be more than a nuisance if it’s not caught early.
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Welcome letter
Welcome to the august edition of Southern IllInoIS
health and life magazine.
in this issue, you will read about an initiative dear to the hearts of
many of our families, friends and neighbors—a comprehensive, free-
standing cancer center in our own backyard. for far too long, we have
watched our loved ones embark on the journey for treatment to places
far away from home. this takes an emotional, physical and financial
toll on the thousands of cancer patients who endure travel back and
forth each year; for many, that can mean 100 appointments in the
first 12 months alone. We want to change that and we need your help.
i hope the story of our hope is home campaign touches you. We
cannot do it alone.
in addition, we share innovative advances in da Vinci robotic surgery.
You will meet dr. srinivas Rajamahanty and an avid herrin angler
who bounced back from prostate surgery in time to hit our region’s
beautiful lakes last spring. dr. erica Kaufman shares her optimism
regarding fresh treatments for patients coping with hepatitis c. You will
hear from one woman who handles her adult asthma with inspiration
and ease with the help of her pulmonologist.
in each issue of Southern Illinois health and life magazine, we strive
to share relevant advances in modern medicine while highlighting the
physicians, specialists, nurses and other healthcare providers who dedi-
cate their lives to making us well. We couple this with a blend of healthy
lifestyle news and getaways that are good for body, mind and soul.
if you have any questions or input on something you would like to see
in our magazine, please let me know. i am always happy to hear from you.
sincerely,
here’s to
Rex P. BuddePResident andchief executiVe officeRsoutheRn illinois healthcaRe caRbondale, illinois
SIH STAFF
PResident and chief executiVe officeR Rex P. Budde
coRPoRate diRectoR ofmaRKeting and communication cHeRyl Benn
communications cooRdinatoR
RoSSlInd RIce
SouTHeRn IllInoIS HeAlTHcARe1239 East MainCarbondale, IL 62901(618) 457-5200
SIH cAll cenTeRPhysician referrals, information on classes and hospital services: Monday–Friday, 8 a.m. to 4:30 p.m. 1-866-SIH-2468 (1-866-744-2468)
WAInScoT STAFF
editoR in chiefRITA guARnA
aRt diRectoRSTePHen vITARBo
aRt assistantmegHAn BASHAW contRibuting editoR
TImoTHy kelley
Southern Illinois health & life is published by Wainscot media, 110 summit avenue, montvale, nJ 07645, in association with southern illinois healthcare. this is Volume 4, issue 1. © 2012 by southern illinois healthcare. all rights reserved.
material contained herein is intended for informational purposes only. if you have medical concerns, seek the guidance of a healthcare professional.
memorial hospital of carbondalest. Joseph memorial hospitalherrin hospitalcenter for medical artsminers memorial health centersih cancer institutelogan Primary care
the good living magazine from southern illinois healthcare you!
CEO_SIH_12.V3.REV1.indd 4 7/19/12 3:24 PM
1Do a little homework. End-of-life care is more complex than you may sus-pect. For example, “heroic measures” can mean dif-ferent things to different people. “If you have termi-nal cancer and don’t want aggressive treatment, does that mean doctors mustn’t insert a breathing tube for acute pneumonia?” asks Abby Woods, palliative care coordinator for South-ern Illinois Healthcare. Read up on end-of-life care (see box at right) and re-flect. Do you want all pain relieved even if doing so may hasten death? Per-haps you’d like all possible medical steps taken—a living will can say that too. And it can express wishes about hospice care, organ donation and the funeral.
2Discuss your wishes. Consult with the people who are closest to you—especially your intended proxy—and with your doc-tor and clergyperson.
3obtain a basic form. Southern Illinois Healthcare has a living will document it makes available to pa-tients. Sample documents that follow Illinois law may also be downloaded from the Illinois Department of Public Health website (www.idph.state.il.us/pub-lic/books/Livin.PDF) and www.illinoislegalaid.org.
4retain a lawyer if you choose. It isn’t required, but you may wish to have an at-torney complete your living will. His or her time will cost you from $100 to $500, says attorney Martin Shenkman, but you’ll save if you’ve used the forms to marshal ideas in advance.
5save your Document. In Illinois, two adults over the age of 18 must wit-ness living wills. These witnesses can’t be some-one responsible for your medical care or someone who will inherit from you. Keep one signed original at home where it’s close at hand (not in a bank’s safe deposit box). Give others to your doctor, your lawyer and your healthcare proxy.
with it you can make your own choices for end-of-life careif you could do something today that might save your loved
ones distress years from now, you’d do it, right?
You can, with modest cost and effort, but there’s a catch. It means thinking
about what may be uncomfortable to consider: your final days.
What you can do—even if you’re young and healthy—is create a living will.
It’s a legal document that records your wishes for medical care in case you
become terminally ill and unable to communicate. Often, medical technology
can extend life beyond the point where there is consciousness or the hope of
its return. But it can be heart-wrenching for a relative to have to decide that a
treatment should be withheld.
“Living wills can take a huge burden off the shoulders of family members
in making those terrible decisions,” says attorney Martin Shenkman, co-author
with his wife Patti Klein, M.D., of the book Living Wills and Healthcare Proxies. A
living will is one part of what’s called an advance directive; another part, equally
important, is a healthcare proxy directive, which names a trusted person to
make decisions in your stead.
is a living will right for you?
is it worth facing scary thoughts to create this tool? that’s up to you. however, consider this
haunting question: “what happens in the hospital when it’s 3 a.m. and someone has to decide?”
To FInD ouT MoREcheck amazon.com or another online book service for those volumes on living wills:
Living Wills and Healthcare Proxies, by martin shenkman and patti klein, m.d. law made easy press, 2004. How to Write Your Own Living Will, by edward a. haman. sphinx publishing, 2000. Planning for Uncertainty: A Guide to Living Wills and Other Advance Directives for Health Care, by
david John doukas, m.d., and william reichel, m.d. Johns hopkins university press, 1993.
LIfeStYLeS
s o u t h e r n i l l i n o i s h e a lt h & l i f e / 3
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an outdoorsman beats prostate cancer thanks to robotic surgery
clinical update
Dave Duncan of herrin haD a feeling that the Day would come, although he tried not to dwell on it. “i knew
the possibility was there, but i tried not to think about it,” he
says. “i believe there is no sense in getting worked up about
something you really can’t control. i’m sort of laid-back and
care-free, and i wanted to stay that way.”
even though he tried not to fret, “it” was still there: the
likelihood that he someday would be facing prostate cancer.
after all, his father had suffered from the disease and his
own primary care physician had him on a “watch list” for the
disease for almost 10 years. With a family history of the
disease and knowing that nearly a quarter million new cases of
‘I’m back’
prostate cancer will be diagnosed in the u.S. this year, duncan
had cause for concern.
He underwent a prostate exam twice a year. a test last
summer indicated a higher-than-normal pSa score, a measure
of prostate-specific antigen, which can indicate cancer. a
referral to a urologist for a biopsy led to the unwelcome but
not unexpected news: prostate cancer.
duncan was given several options for treatment.
“i could have undergone chemotherapy or radiation, had
stents put in or had it removed,” he recalls. “i know that those
people who have the treatments are not always sure that the
cancer is 100 percent gone. i knew if the prostate was taken out
it would be gone, so i decided that at age 60, i didn’t need it
anymore.”
He turned to urological surgeon Srinivas Rajamahanty, M.d.,
at the center for Medical arts in carbondale for the proce-
dure. even then, duncan had two choices for removal of his
prostate: traditional open surgery or an operation utilizing the
Dave Duncan, avid fisherman, at Crab Orchard Lake
for more informationto find out if da Vinci robotic surgery is for you, contact the sih call center at 866-744-2468 or Visit www.daVincisurgery.com
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Prostate_FF12.V3.REV1.indd 1 7/19/12 3:33 PM
an outdoorsman beats prostate cancer thanks to robotic surgery
da Vinci® surgical robot. Dr. Rajamahanty is the only physician
in southern Illinois using the da Vinci for urological surgeries
including prostatectomy. After consultation with the surgeon,
Duncan chose the robotic procedure.
“Dr. Rajamahanty and I talked one-on-one for an hour,”
he says. “He went through everything and really took his time
explaining things to me.”
The explanation included the benefits of robotic surgery
as well as the actual procedure itself.
“We compare everything to open surgery, but open surgery
for prostate removal means an incision from the belly button
to the pubic bone—about six inches—and long hospital stays and
recovery time,” Dr. Rajamahanty explains. “The da Vinci offers
a lot of advantages over that. It is a minimally invasive option, a
sort of laparoscopic surgery.”
“I knew the possIbIlIty was there, but I trIed not
to thInk about It.”He says with the procedure, the long incision is replaced
by several small incisions for a tiny camera as well as for
the instruments which are attached to arms of the robot. The
much smaller incisions mean much less blood loss for the
patient.
“The average blood loss in traditional open surgery is 500
milliliters or more, usually requiring a transfusion,” the
doctor says. “With the robot, blood loss is under 200 milliliters.”
Additionally, he says, post-operative recovery time is
minimal.
“We usually send patients home the next day and they
sometimes can return to work in just a few days.”
Dr. Rajamahanty says that in da Vinci surgery, the physi-
cian in many ways mimics a traditional open surgery, but he is
able to do more and do it more precisely.
“We don’t cut corners; we do the same steps, but it is
minimally invasive and the robot gives us degrees of freedom
that we as surgeons don’t have,” he adds. “The human hand
and wrist are limited in movement; the robot can do things
we just cannot do.”
He says another advantage of the da Vinci is that it offers
a better visual perspective on the surgery.
“There’s a ten-fold magnification of the surgery,” he says.
“It means you can be more precise.”
During surgery, Dr. Rajamahanty manipulates the robotic
arms and instruments via a three-dimensional console in the
operating room, much like operating an elaborate video
game system. Through the use of hand controls and pedals, he
is able to precisely manipulate the robotic arms and instru-
ments. He can even view the readings of instruments and
see ultrasounds and other medical images without moving
his head.
“The robot is more of an extension of the surgeon during
the procedure. It presents a stronger magnification of the
surgery field and offers better dexterity because it can rotate
in more ways than the human hand,” he explains. “Plus, it filters
your natural hand tremor to make movement more precise.”
All in all, with a skilled urological surgeon, the da Vinci
improves all aspects of the surgical experience.
“The robot does not replace your intuition as a surgeon or
your knowledge,” Dr. Rajamahanty continues. “It just helps
you and you can use it to your advantage for your patients.”
The advantages of da Vinci-assisted prostatectomy are
not limited to the short-term benefits of less pain and quicker
recovery. Many men are concerned about a return to intimacy,
which is not a problem, the doctor assures.
There are also pluses over the long run, Dr. Rajamahanty
says.“Because I am able to see so much closer, I can do a better
job of rejoining the bladder and urethra after the prostate
is removed. That means the patient has less chance of urinary
problems like incontinence later in his life,” he adds.
“Technology is becoming so much more advanced that
robotic prostate surgery is quickly becoming the standard of
care,” Dr. Rajamahanty says. “In my mind, there is no doubt
that the results of robotic surgery are better for the patient.”
Duncan says the surgery was definitely better for him.
“No surgery is easy, but this was the easiest choice,” he
says, adding it wasn’t long after his operation that he, an avid
outdoorsman, was back to hunting and fishing. In fact, just
a few weeks after surgery he was catching fish on the lakes and
rivers of Alabama.
“I would recommend this surgery,” he adds. “I’m back to
just like before.”
Srinivas Rajamahanty, M.D.
s o u t h e r n I l l I n o I s h e a lt h & l I F e / 5
Prostate_FF12.V3.REV1.indd 2 7/19/12 3:33 PM
Despite the confusing news reports, your Doctor can help you
plan a safe strategy for relief
healthy living
painkiller risks: what to do now
Must easing toDay’s pain Mean taking chances with
tomorrow’s health? no, the experts say—despite all that you’ve read
about risks. But if you suffer chronic discomfort from arthritis or
other ills, it may be time for a fresh conversation with your physician
about what pain-relief products are best for you.
Because of what we know about cardiac risk, says Scott Wright,
M.D., a cardiologist at the Mayo Clinic in Rochester, Minnesota,
“people should now think carefully about how to best manage their
long-term arthritic pain.”
Worries came to a head in September 2004, when the popular
prescription painkiller rofecoxib (brand name vioxx) was withdrawn
by its manufacturer because studies suggested that taking it for a
long time increased one’s risk of heart attack and stroke. Shortly
thereafter, the Food and Drug administration asked that a sister
medicine called valdecoxib (Bextra) be taken off the market because
of possible cardiovascular risk and the danger of potentially life-
threatening skin complications.
vioxx and Bextra are COX-2 inhibitors, a class of medications
that tend to constrict blood vessels, raise blood pressure and make
the platelets in the blood stickier. “Research data show that in
some situations patients’ risk of a cardiac event is 10 to 25 percent
higher if they’re on COX-2s long-term,” says Dr. Wright. the FDa
didn’t originally intend these medicines to be used indefinitely, he
adds, but “they’ve worked well for a large number of people—in-
cluding my own mother—and it’s human nature to want to stay
on them.” the FDa decided to require new “black box” label warn-
ing messages—its toughest kind—about cardiovascular risk for all
prescription nonsteroidal anti-inflammation drugs, or nSaiDs, a
larger category of medicines of which COX-2s are a subgroup.
and even for most non-prescription nSaiDs—familiar over-the-
counter products like ibuprofen (advil, Motrin), naproxen (aleve)
and ketoprofen (Orudis)—the agency requested that product
labeling include reminders about limiting dose and
duration and also provide more information about both cardio-
vascular and gastrointestinal risks.
So what’s a pain sufferer to do?
Consult your doctor, says John Chaney, a registered pharmacist
and pharmacy manager at herrin hospital. “a good rule of thumb
for any medication is to use the lowest prescribed dose in the
proper time frame for the shortest duration that gets the job done.
and remember that all medications—including over-the-counter
and herbal products—have potential risks.” Follow your physi-
cian’s advice if you’re going to be taking anything regularly for a
long period—including over-the-counter products, says Chaney.
Finally, it’s only fair to note that pain is subjective and not all
medications are perceived as equally effective. Some people
who have given up COX-2 inhibitors report that they’re not getting
quite the same level of pain relief from the medications they’re
now taking instead.
“remember that all medications—including
over-the-counter products—have risks.”
—pharMacist john chaney
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Don’t rule out gooD olD aspirin. this 19th-century miracle drug does pose a risk of gastrointestinal bleeding, but it’s also the one nsaiD for which the FDa is not request-ing new label information on cardiac risk—because it’s known to protect the heart. some people have levels of pain higher than the safe daily maximum of aspirin can han-dle, but for many the familiar tablet does double duty. “We recommend that most people take an aspirin every day to guard against heart disease,” says Dr. Wright. “it turns out aspirin may be much safer and better than we realized.”
4 Ways To sTay Safe
talk to your Doctor about your risk. your physician knows your medical history, and risks differ greatly from one individual to the next. “if you’re a 20-year-old with a knee injury who will be taking a pain reliever for a few weeks, the increased cardiac risk of a coX-2 inhibitor may not be worth worrying about,” says cardiologist scott Wright, M.D., of the Mayo clinic. “but if you’re a 60-year-old with diabetes, hypertension or a history of smoking or heart disease and you’ll need pain relief indefinitely, that’s dif-ferent.” if you take a blood-thinning medication such as warfarin (coumadin), you’ll likely be told to avoid aspirin, ibuprofen and naproxen.
consiDer a coMbination. if you rely on either celebrex or one of the older nsaiDs on an ongoing basis, says Dr. Wright, you may wish to guard against their gastro-intestinal risks by also taking a stomach-protecting medi-cine, perhaps a proton pump inhibitor such as omprazole (prilosec), lansoprazole (prevacid), esomeprazole (nexium), rabeprazole (aciphex) or pantoprazole (protonix).
iF inFlaMMation isn’t a concern, try acetamino-phen (tylenol). it’s gentle on the stomach and often works well against pain, but unlike nsaiDs does nothing against inflammation. it can be a good first line of defense if you have osteoarthritis, the kind that comes from thinning cartilage, but not if you have rheuma-toid arthritis, an inflammatory condition. in a study of people with osteoarthritis of the knee, 40 percent reported good-to-excellent relief with tylenol versus 60 percent with the riskier nsaiDs.
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S O U T H E R N I L L I N O I S H E A LT H & L I F E / 7
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For years doctors have known that traditional, inflammation-
fighting NSAIDs such as aspirin, naproxen and ibuprofen can
sometimes trigger peptic ulcers and bleeding in the stomach
lining. That’s because these medicines target a group of
enzymes called cyclooxygenase, or COX. COX enzymes pro-
duce the hormone prostaglandin, which stimulates inflammation.
But these enzymes also tend to protect the stomach lining,
and when their action is inhibited, so is that protection.
In 1990, scientists thought they’d found a better answer.
They discovered a new category of COX enzymes called
COX-2, which appear in cells only during the inflammatory
response. By targeting only the COX-2 enzymes, it was hoped,
a medication could achieve the welcome anti-inflammatory
effects without danger to the stomach lining.
Thus, in the late 1990s, COX-2 inhibitors were introduced.
Besides Vioxx and Bextra, they included celecoxib (Celebrex),
which is still available but now carries a new, FDA-mandated
warning about cardiovascular risk.
PAIN RELIEF MEDICATIONS: WHAT YOU NEED TO KNOWNO MEDICATION IS PERFECT, AND DIFFERENT ONES WILL BE RIGHT FOR DIFFERENT PEOPLE. HERE’S THE RUNDOWN ON FIVE COMMON PAIN RELIEVERS WITH THEIR ADVANTAGES AND DISADVANTAGES:
MEDICAL NAME TRADE NAME AVAILABLE OVER THE COUNTER?
NSAID? SAFE DAILY ADULT DOSAGE LIMIT
THE GOOD NEWS THE BAD NEWS
CELECOXIB Celebrex No Yes 200 milligrams It’s the one COX-2 inhibitor left, and many people have found this class ef-fective; probably little risk of stomach bleeding in short term
May increase risk of heart attack and stroke; evidence now shows there is risk to stomach in long-term use
ACETAMINOPHEN Tylenol Yes No 4,000 milligrams (8 Extra Strength Tylenol capsules or 6 Tylenol Arthritis Formula capsules)
A good fi rst choice. Safe for the stomach; poses fewer risks than most pain relievers
Does not act against infl ammation, the cause of some pain; large amounts can promote liver damage, especially if users consume alcohol
ASPIRIN Yes Yes 4,000 milligrams Inexpensive; has addi-tional benefi t of protect-ing the heart
My cause bleeding in stomach lining; must not be used for children with viral illness
IBUPROFEN Advil, Motrin, etc. Yes Yes 1,200 milligrams (over the counter) 2,400-3,200 milligrams (perscription)
Very effective for many individuals
May cause bleeding in stomach lining, kidney or liver problems, high blood pressure or congestive heart failure
NAXPROXEN Yes Yes 660 milligrams or 440 milligrams for seniors (over the counter) 1,000 milligrams (prescription)
Effective; less frequent dosing
My cause bleeding in stomach lining, kidney or liver problems, high blood pressure; may increase risk of cardio-vascular event
Aleve, Naprosyn, etc.
Today, however, even COX-2 inhibitors’ easy-on-the-
stomach reputation has come into question—at least for long-
term use. “Research data have shown that after a year these
medicines have a risk of GI bleeding that may be comparable
to other agents,” says cardiologist Scott Wright,
M.D., of the Mayo Clinic. Still, many people
insist that the COX-2 inhibitors provide
the best pain relief they’ve
found yet.
THE RISE AND FALL OF COX-2 INHIBITORS
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Take a deep breaTh. breaThe in, filling your lungs
with air. Now exhale. It is a very simple process, and the ability
to breathe without thought or effort is something we take it
for granted. Well, most of us take it for granted. All across southern
Illinois are thousands of people for whom taking a deep breath
is very difficult—if not impossible—because of asthma.
“In layman’s terms, asthma is an inflammatory disease of the
airways that you can develop at any age,” explains pulmonologist
Raymund Pineda, M.D. “The main symptoms are wheezing, short-
ness of breath and coughing.” The disease is most common in
young people, many of whom outgrow it. Asthma, however, also
can first appear later in life.
Dr. Pineda says the root cause of the disease is unknown, but
certain factors such as allergies, weather changes, exercise
and environmental components such as pollen, dust and smoke
can incite flare-ups and airway spasms, making breathing difficult
for sufferers.
Valerie Funk of Elkville knows what it’s like. “Before treat-
ment, if I was having an attack, it would be a really bad thing,” she
recalls. “I couldn’t catch my breath, and it felt like the walls were
closing in and I couldn’t escape. Even with deep breaths it was like
I couldn’t get any air.”
Funk, 35, has had asthma since she was a child.
“I feel it has prevented me from doing some things,” she says.
“My worry was always that I’d push too much. I stayed away from
sports just because of the asthma.”
Diagnosing asthma requires some detective work on the part of
physicians, says Fadi Adra, M.D.
“Typically, you see episodes of coughing, wheezing, tightness
in the chest and occasionally a family history of asthma,” he
says. “Sometimes it is difficult because people come in with just a
cough and no other symptoms. It can be challenging.”
Breathing tests are used by the physicians to confirm asthma.
Then they try to address the roots of the illness as well as the
symptoms.
“First we try to eliminate the causes of the asthma,” Dr. Adra
says, explaining that things such as smoking, pets and exposure
to certain chemicals may be partially to blame. “But most of the
time it is very difficult to eradicate the causes.”
Attention then turns to treatment.
“Treatment depends on the frequency of the attacks and their
severity,” Dr. Pineda explains. “We always start with a simple
inhaler, which is used as needed, and we see how that goes.”
He says the treatment of asthma is a “step-up” and “step-down”
approach, with medications including inhaled corticosteroids.
More serious asthma cases such as Funk’s are treated with Immu-
noglobulin E receptor antibodies—a weekly or bi-weekly injection.
“It has worked wonders for many patients,” he says.
“It has pretty much prevented all of the attacks,” adds Funk,
who has been receiving the injections for two years. “I am really
able to do more now.”
Before the shots, even after puffs from an inhaler, Funk some-
times needed emergency treatment for especially severe attacks.
Today, those are a memory. She’s even taken up a nationally
known intense workout regimen.
“Before treatment I wouldn’t have been able to push myself like
that,” she says. “It definitely has made a positive impact on the
quality of my life.”
Dr. Pineda says people with asthma can live perfect normal
lives by controlling the disease, and gaining control of asthma
is relatively simple. That’s something to help all of us breathe a
little easier.
breathe easyWe have your soluTion To asThma
TAkINg cHARgE
Need help coNtrolliNg your asthma?
Call the SIH Call Centerat 866-744-2468 for a list of pulmonologists serving southern illinois.
Raymund Pineda, M.D.
Valerie Funk
Fadi Adra, M.D.
s o u T h e r n i l l i n o i s h e a lT h & l i f e / 9
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Soothing
Sedona
there’s balm for the spirit in this stunning southwest setting
Without a doubt, the best travel experiences are transformative,
healing mind, body and spirit alike. We come home not merely
refreshed and recharged, but somehoW rejuvenated and changed for the better.
ph
oto
s:
sh
ut
te
rs
toC
K
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The gorgeous red hue of Sedona rocks comes from iron that has accumulated in sandstone over the millennia.
DIST.travel.V2.REV2.rg.indd 27 7/19/12 3:26 PM
If ever a destination dealt in transformation, it’s Sedona, Arizona. You
needn’t believe what they say about the spiritual energy of the place
to see that there’s something powerful about Sedona. Nor do you have
to visit an alternative healer, take a walk with a “coyote talker” or experi-
ence the sublime at one of Sedona’s spas (though you can do all these
things). The setting alone—with its soaring red rock buttes, sculpted
spires and stunning cliffs—is enough to work magic. Even down-to-
earth, grounded-in-reality types say they feel a special energy in Sedona.
Reports one recent visitor: “Something there really spoke to me.”
Over the past few decades, this once sleepy town and longtime
magnet for artists has evolved into a first-class resort community.
Besides fine lodging, dining and shopping, Sedona offers activities
and attractions that promise to soothe the souls not only of spiritual
seekers and nature lovers, but also of art and culture buffs, history and
archaeology fans, active adventurers and anyone else in need of renewal.
You can reach Sedona by flying into Phoenix, renting a car and
driving about two hours north. When you arrive, you’ll be in a bowl-
shaped valley that sits about 4,500 feet above sea level. First-time
visitors expecting a sandy desert landscape are surprised by the broad
swaths of pine forest surrounding Sedona. The green trees create
a striking contrast to red sandstone monoliths with names such as
Cathedral Rock, Bell Rock, Two Nuns and Elephant Rock.
If you’ve been to the Grand Canyon, Sedona’s red rock formations
will feel familiar. That’s because the rock layers of Sedona’s half-mile-
high cliffs are nearly identical to those found in the upper half of the
Grand Canyon. There is one key difference: In Sedona, rather than
looking down on the striated sandstone cliffs and monoliths, you’re
surrounded by them. That’s part of the power of the place.
Most days, the backdrop for this beauty is a vast, intensely blue sky
and a bright desert sun whose long rays cast a fiery orange glow on
the cliffs at sunrise and sunset. (Desert sun notwithstanding, Sedona’s
climate is comfortable year-round; it’s only in July and August that the
mercury regularly soars into the 90s, and even then nights are cool.)
Depending on where you stay in Sedona, you can step outside your
door, keep on walking and within 15 minutes find yourself high up on
one of those magnificent cliffs. But the best news is that you don’t have
to be especially fit to hit the hills, since there’s a wide choice of hiking
trails, from easy to difficult.
Even avid hikers will want to put aside their hiking gear for a jeep
tour of Sedona’s backcountry. These off-road tours bounce along
through rugged territory, exploring area canyons, following old
stagecoach routes, visiting ancient ruins and climbing to the top of the
2,000-foot-high Mogollon Rim.
The great outdoors in Sedona is so alluring that you may feel you
can never get enough. Fortunately, there are plenty of options for
exploring it, including guided horseback excursions, mountain biking
and sightseeing aloft by hot air balloon, helicopter or plane.
Or just hop in a car and drive. Among nearby sights worth a
visit are Chapel of the Holy Cross, an inspiring modern shrine built
right into the red rocks, scenic Boynton Canyon and Red Rock
Crossing, whose views of Oak Creek and Cathedral Rock have been
photographed so often they’ll seem familiar.
In Sedona, rather than lookIng down on the StrIated SandStone clIffS and monolIthS, you’re
Surrounded by them. that’S part of the power of the place.
Continued...
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Opposite, Cathedral Rock, whose spires stand 1,000 feet over the road below, is known as a vortex center and a place for blissful meditation. This page, the Chapel at Tlaquepaque evokes the feel of a quaint Mexican village with its Spanish tiled roof, hand-carved leather pews and stunning mural over the altar. It’s located in an arts and crafts village with unique galleries, shops and restaurants.
S O U T H E R N I L L I N O I S H E A LT H & L I F E / 13
DIST.travel.V2.REV2.rg.indd 29 7/19/12 3:26 PM
Hiking in Sedona is an exhilarating experience, with trails for every fitness level. Visitors can hire a spiritual guide to lead them to vortex areas. Opposite, low-slung adobe casitas sit amid cottonwood trees at the Enchantment Resort; pan-seared veal chop with Morel sauce from the menu of the resort’s Yavapai restaurant.
PH
OTO
S:
SH
UT
TE
RS
TOC
K
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You can even drive or take a tour from Sedona to the South Rim
of the Grand Canyon, just two and a half hours away. Or stay closer
to home and visit the former hillside mining town of Jerome.
One drive not to miss is Highway 89A as it winds up
16-mile-long Oak Creek Canyon. With sheer walls and unusual rock
formations, this stretch of road has been named one of the nation’s
most scenic drives. In summer, the creek is stocked with trout and
swimming holes beckon. Between late September and mid-October,
you’ll be treated to blazing autumn foliage. And no
matter when you visit, you can stop along the way
for a hike or a creek-side picnic.
Leave time to drive all the way to Oak Creek Vista
for a dramatic bird’s-eye view of the area. While there,
you can pick up locally crafted wares on sale by Native
American artisans. If you’re traveling with children—
or you’re kid-minded yourself—you’ll want to stop
at Slide Rock State Park, don your bathing suit and
splash your way down a natural water slide.
Nature is not Sedona’s only attraction. The region’s
human history is just as compelling. Numerous ruins
and rock art sites tell of ancient peoples who were
skilled in pottery, weaving and agriculture and who
traded with peoples throughout the Americas long
before Europeans came.
The most impressive of the sites is Montezuma Castle, about
25 miles south of Sedona. Constructed in the 12th century by the
Sinaguan people, this five-story, 20-room dwelling is built into the
sides of a high cliff. A few miles away is Montezuma Well, a huge
sinkhole that’s fed by underground springs that support a verdant
oasis. You can take tours of these and other sites that focus on the
archaeological, cultural and geological history.
Artistic types have long found that Sedona’s beauty fuels the
muse. In the 1920s, Hollywood discovered that red rock country
makes a dramatic film set, and numerous Westerns have been filmed
here since. The first well-known visual artist to “discover” Sedona
was surrealist painter and sculptor Max Ernst, who lived here in the
1950s, initiating an influx of artists that continues today.
Today, Sedona has a thriving art scene. Art lovers can spend
days perusing collections of Native American, Southwestern and
Western arts and crafts in more than 40 galleries, and the Sedona
Arts Center offers a full calendar of exhibitions,
plays and workshops. At Sedona Cultural Park,
concerts are held in an outdoor amphitheater.
As if nature didn’t provide enough in the way of
spectacular settings, visitors can also book a stay at
the luxurious Mii Amo spa, which takes its name
from the Native American word for journey. A world-
class destination in itself, it’s set within the grounds
of the luxurious 70-acre Enchantment Resort in
secluded Boynton Canyon. Lodgings here have
unmatched views of undulating red rock walls and
formations, contrasting with the deep green of trees.
For some, however, what makes Sedona most
compelling are not the visual delights, but a
handful of energy fields called vortexes that are
said to elicit profound healing and spiritual experiences. Never
scientifically proven, the vortexes are nonetheless the reason so
many seekers, mystics and healers find their way to this spot.
Perhaps they’re also why this area has long been considered sacred
by native peoples.
Find out for yourself by taking a vortex tour, or strike out on your
own for the vortex sites, many of which are located at Sedona’s most
dramatic rock formations. One way or the other, you’re bound to find
it a powerful—perhaps even transformative—experience.
Art lovers cAn spend
dAys perusing collections of nAtive AmericAn, southwestern And western
Arts And crAfts in more thAn 40 gAlleries.
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DIST.travel.V2.REV2.rg.indd 31 7/19/12 3:27 PM
foundation focus
ImagIne a place where IndIvIduals battlIng cancer
can go to receive the very latest in treatment. a place where
their physicians—regardless of specialty—are steps away from
each other, making consultations and collaboration easy. a place
where related services and support staff work together with
compassion and care to meet the needs of patients and their
families. a place that is comfortable, cheerful and, perhaps best of
all, close to home.
for decades such a place has been a wish for southern illinois
cancer patients and their medical providers, but the realization
of that dream is about to come true.
Planning and fundraising are under way for the southern illinois
Healthcare cancer center, a single comprehensive facility that will
provide state-of-the-art cancer care and treatment close to home.
“When we see an unmet need, we respond to it,” siH Presi-
dent/cEo Rex Budde explains. “that is the driving force behind
our latest and most aggressive undertaking: the creation of a new,
comprehensive cancer center for southern illinois. for too long,
cancer patients in our area have had the perception that they need
to travel long distances to get the care they required. this has
placed a burden on them, both financially and emotionally.”
the goal of the planned facility is to serve the entire region
from a convenient, easy-to-get-to location along the Route 13
corridor, keeping patients close to home, work, family and friends
and to the life they are accustomed to living. it will also improve
patient care by placing all of their providers and services under
one roof, says Jennifer Badiu, administrative director of the siH
cancer institute.
“We currently don’t have a central location to bring all of these
programs, services, physicians, teams and technology together,”
hope is home
Without support and gifts from the people of southern illinois, the Cancer Center will remain a
dream. But led by a volunteer committee that under- stands the needs and benefits of this project, the “hope
is home” Campaign is striving to raise $10 million for the new center. pledges can be fulfilled over a five-year
span and the facility will present a number of naming opportunities for donor recognition and for enduring
legacies. financial pledges or gifts of any size are welcome for hope is home, as are gifts of stocks, life
insurance, real estate or bequests. representatives of the campaign and the sih foundation are happy to
present ideas and options for giving.to become part of this exciting facility that will save
lives in southern illinois, call gene honn ([email protected]) at the sih foundation,
(618) 457-5200, extension 67843. You may also donate online by visiting www.sih.net/hopeishome.
16 / a u g u s t 2 0 1 2
CancerCenter_SIL12_V6.REV1.indd 16 7/19/12 3:23 PM
she adds. “Bringing all of those services to the patient in a
centrally located facility decreases their anxiety, improves
communication among the physicians and really speeds up the
care that is appropriate at the community level.”
Equally important will be the convenience for patients and
their loved ones.
“This center will not just offer technological expertise and
high-quality physicians and support staff,” says Carbondale-based
surgeon Marsha Ryan, M.D. “It also will be a place that is serene
and comforting and that allows patients not to have to travel, which
will be beneficial to them both emotionally and physically.”
Studies have shown that cancer patients make an average of
100 trips to medical facilities for treatment, tests and services in
the first year after a diagnosis. Often, for people in southern
Illinois, the distances can be great. Research has shown the treat-
ment of cancer is more likely to be successful when patients are
able to remain close to home, family and their normal routines.
Keeping life as normal as possible is a primary goal in all cancer
treatment, and the new Cancer Center will play a major role in
maintaining normalcy, said Mary Rosenow, M.D., medical director
of the SIH Cancer Institute.
“When a cancer diagnosis is made, there is a sudden and drastic
change in a person’s life,” she explained. “Priorities get rearranged,
there’s great concern about the future and then there is aggres-
sive treatment, all while the person is not feeling well and still
dealing with all of the issues related to family, jobs and financial
situations. It’s really difficult.”
The function of the Cancer Center will be patterned after SIH’s
own Breast Center, which treats hundreds of cases of breast
cancer each year in a team-based approach of diagnosis, treatment
and follow-up care.
“We want to take the highly successful model of centralized
care and expand it over other cancer diagnoses, and that will
require a real, live cancer center—with building, staff and provid-
ers,” says Dr. Ryan.
She adds that the center also will ensure that cancer treatment
remains on the cutting edge.
“I know that the new center will change the way that cancer
services are delivered in southern Illinois,” Dr. Ryan says. “And it
will do even more. The quality of each and every one of its
parts also will benefit patients with non-malignant illnesses, since
we will rally and recruit the best and brightest providers and staff.
Build it and almost everything else gets better as well.”
Officials estimate that the new center could treat up to 1,400
cancer patients annually. A specific location for the new center has
not yet been announced. It is estimated that total land acquisition,
site development and construction costs for the project will
approach $20 million. Southern Illinois Healthcare has committed
to about one-half of the total; fundraising for the balance is
underway through the SIH Foundation’s “Hope is Home” campaign.
To date, more than $2.4 million has been pledged by area com-
panies, organizations and individuals, including nearly $450,000
in pledges over the next five years from SIH employees, for the
46,000-square-foot facility and accompanying manicured grounds
and peaceful healing garden.
“The Cancer Center will not just promote high-quality care,”
says Dr. Ryan. “It will be a very visible legacy. It’s good for us, for
the community and all of our children.”
LEFT: Sujatha Rao, M.D., oncologist; Alberto Cuartas, M.D., oncologist; Marsha Ryan, M.D., surgeon and co-founder of the Breast Center; George Kao, M.D., radiation oncologist; BELOW: Dr. Ryan shares plans for the new Cancer Center during an unveiling dinner at the SIU Student Center ballrooms.
S O U T H E R N I L L I N O I S H E A LT H & L I F E / 17
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Herrin Hospital auxiliary Day
Celebrating a milestone
AuxiliAry DAy The community of Herrin honored
the hospital’s Auxiliary by declaring a day in its honor
on May 2, 2012, for its members’ outstanding service. The city proclamation coincided with
the Auxiliary’s $100,000 donation to the hospital’s new chest
pain unit—its third such donation in the past four years.
1 The proclamation 2 Auxiliary check presentation 3 Herrin
Mayor Vic ritter enjoys a laugh with the ladies while perched
on Auxiliary President Shirlene Carnaghi’s lap 4 Herrin Civic
Center billboard, one of several in the community, on Auxiliary Day
Flash_SIL12_v2.rg.REV1.indd 2 7/20/12 10:30 AM
Men’s HealtH ConferenCe7 SIH Marketing’s
Tracy Herron alongside NFL Hall
of Famer Jackie Smith, the keynote
speaker of this year’s Men’s Health
Conference at John A. Logan College
MHC HeALTHGrAdeS HealthGrades recognized Memorial Hospital of Carbondale with a 2012 Outstanding Patient experience award, which ranked Memorial in the top 10% nationally for patient satisfaction. 5 Pictured is SIH Service excellent Coordina-tor Jason Pigg with members of the emergency department staff. 6 Trophies from 2011 and 2012
obesity awareness walk 8 New Life Weight Loss Center’s Naresh Ahuja, M.d., bariatric surgeon, leads the walk around Bruce Park in energy. 9 Bariatric program coordinator Heather ruhe and SIH Manager of Community Benefits Amy Wright
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taking charge
Today’s TreaTmenTs mean This condiTion needn’T be as limiTing as iT sounds“congesTive hearT failure”—The
phrase has a scary ring, and indeed it’s a
serious diagnosis. But today it’s possible to
live comfortably for many years with this
condition.
“Patients with heart failure are living
longer these days, living better and living
with less stress,” says nabil al-Sharif, M.D.,
a cardiologist at Prairie cardiovascular in
carbondale. “they go fishing, they go walk-
ing—in many cases they have a very good
lifestyle. But they and their doctors share a
big responsibility to stay in touch and pre-
vent trouble before it happens.”
congestive heart failure occurs when the
heart muscle weakens and fails to pump as
well as it should, causing fluid to build up
in the lungs and other body tissues. the
symptoms can include fatigue, shortness
of breath, edema (swelling) in the legs and
ankles, abnormal weight gain (which may
be a sign that you’re retaining fluids), cough
(often worse when you’re lying down), dry
mouth or thirst. Five million americans live
with congestive heart failure, and there are
half a million new cases each year. it’s the
most frequently diagnosed condition in hos-
pitalized patients over age 65, and it costs
life goes on withcongestive heart failure
the nation more than $50 billion annually.
“the two main causes of congestive
heart failure are heart attacks and high
blood pressure,” says Dr. al-Sharif. “in the
long run they can cause the heart muscle
to weaken and fail to do its job of pumping
blood to the organs of the body.”
he describes the condition as “a progres-
sive disease that worsens over time. Patients
can become tired and short of breath with
less and less activity.” and he adds that
congestive heart failure can affect people at
almost any age. “i recently saw a patient who
was 28 years old,” says Dr. al-Sharif. “he
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HeartFailure_SS12_V1.rg.indd 24 7/19/12 3:29 PM
watch the water.Drink no more than half a gallon, or 64 ounces, of fluids in a 24-hour peri-od—less if you can. weigh yourself daily if you tend to retain fluids. If there’s a change of even 5 pounds within a week, call your doctor.
get actIve. If your doctor says it’s OK, take up walking or some other form of aerobic ex-ercise, which can improve the blood flow to the heart. “I tell my patients to plan on walking a mile a day,” says cardiologist Nabil al-Sharif, M.D. avoid repetitive weight lifting over 10 to 15 pounds, though.
SKIp the cOcKtaIlS.while Dr. al-Sharif says a single glass of wine is permissible, you should avoid any more significant alcohol intake if your heart is weakened and damaged.
lOSe weIght.every pound of fat has many miles of blood ves-sels, which your heart has to pump to—and if it’s forced to work too hard, trouble can result. los-ing the fat can improve heart-failure symptoms dramatically.
lIMIt Salt.restrict sodium to one-and-a-half grams (1,500 milligrams) in a day. check labels; anything more than 200 milligrams per serving is probably too much. also skip the salt in wa-ter when you boil rice or pasta.
12 3
45
developed the condition because he ignored
a heart-rhythm problem for 10 years.”
So if you’re experiencing fatigue, short-
ness of breath or heart-rhythm irregulari-
ties, it’s important to see your primary care
physician. “An echocardiogram—an ultra-
sound of the heart—can give us a good idea
about the pump mechanism and how weak
or strong it is,” the doctor says.
If an examination reveals is uncontrolled
blood pressure or arrhythmias, a history of
coronary artery disease or other reasons to
suspect difficulty, your doctor may refer you
to a cardiologist for a fuller evaluation and
possible treatment.
There are several medications that can
assist the heart in pumping more efficiently.
Diuretics such as hydrochlorothiazide can
help rid the body of excess fluid, and ACE
(angiotensin-converting enzyme) inhibitors
such as lisinopril help blood vessels relax
and open up. “ACE inhibitors are the corner-
stone of congestive heart failure treatment,”
says Dr. Al-Sharif. Beta blockers such as
metoprolol reduce blood pressure by block-
ing the effects of the hormone epinephrine,
and spironolactone controls a hormone
called aldosterone that raises blood pressure.
Artificial heart devices, heart transplants
and special kinds of pacemakers can also
improve the heart’s pumping ability and
greatly enhance the quality of life.
If your heart is still healthy, keep it that
way with sensible eating (emphasizing fruits,
vegetables and whole grains, and limiting
fats, salt and sugar), regular exercise and
regular physical exams and consultations
with your physician.
One more tip: When your doctor mea-
sures your blood pressure, take the reading
seriously, counsels Dr. Al-Sharif. “Many
patients will react to a high reading by saying
it’s ‘white-coat hypertension’—that is, an el-
evated reading brought on by feeling stressed
seeing the doctor—so they may neglect to
take any blood-pressure medication that has
been prescribed. Often they’re kidding them-
selves, and that can be dangerous.”
Are you At risk?
It’s possible to have congestive heart failure and not know it—which means it’s important to know both the risk fac-tors and the symptoms.
risk FACtors high blood pressure
prior heart attack
history of heart murmurs
enlarged heart (or family
history of enlarged heart)
Diabetes
syMPtoMs Shortness of breath, which
can develop even during light activities
coughing or difficulty breath-ing at night while lying down
weight pain with swelling in the legs and ankles from fluid retention
Fatigue and weakness
Dry mouth or thirstIf doctors learn about the condition early, they can often slow or stop the progression of the disease.
5 tiPs to heed iF you hAve Congestive heArt FAilure
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PREVENTION
THE TORN ANTERIOR CRUCIATE LIGAMENT IS THE BANE OF THE ACTIVE WOMAN—BUT YOU CAN REDUCE YOUR RISKEACH YEAR NEARLY 250,000 AMERICANS
injure the anterior cruciate ligament (ACL),
an injury that’s been called women athletes’
“Achilles heel”—even though it’s in the knee.
The ACL is a ligament that crosses your
knee joint, acting as a brace to stabilize knee
movement. ACL tears can happen when you
slow down suddenly, cut or pivot with your foot
planted or land from a jump, according to J.T.
Davis, M.D., an orthopedic surgeon and sports
medicine specialist at Orthopedic Institute
of Southern Illinois.
ACL injuries are more common in females
for two primary reasons, says the doctor: “Some
women are anatomically predisposed to ACL
injury due to smaller ligaments and less space
available for the ligament in the middle of the
knee. In addition, the biomechanics of jumping
and pivoting in women does not allow for as
much dynamic muscular support as that seen
in men and therefore puts more stress on the
ligament, making it more susceptible to tearing.”
You may have torn your ACL if you feel
or hear a pop in the knee, have pain and feel
your knee “giving out” when you put weight on
it. You should feel better after a few minutes,
but some knee swelling will probably occur.
“If it’s something where you can apply weight
and have at least some ability to walk, see your
primary care physician. Apply ice, elevate the
knee, use a compressive wrap and take a non-
steroidal anti-infl ammatory (such as ibuprofen
or naproxen) until you can see your physician,”
Dr. Davis says. However, if you are unable to
bear weight and the pain is unmanageable, a
trip to the emergency room makes good sense
to rule out a fracture.
The surgeon will listen to an account of
what happened and do a few hands-on tests to
see if the knee stays in proper position when
pressure is applied from different directions.
“The majority of my diagnoses are made with
a history and a physical examination,”says Dr.
Davis. “Swelling within the joint is a primary
sign I see in the acute stage following the injury.
Imaging always begins with a series of X-rays
to check for bone abnormalities and to make
sure there are no fractures. Ultimately, an MRI
(magnetic resonance image) scan helps me look
at the ACL and other soft-tissue structures in
the knee, which can include other ligaments
and the meniscus (the cartilage at the top of the
shinbone).”
People in their teens and twenties who
want to return to sports usually choose to have
arthroscopic surgery to repair cartilage damage
and reconstruct the ACL. The surgery corrects
the looseness and instability that limit knee
function after a tear. Dr. Davis rebuilds the
ligament by using tissue from either the patient
or a cadaver to substitute for the ligament. “I
put in a scaffold or a framework and the body
builds a new ACL around that framework.”
“The surgery has a success rate of over 90
percent,” says Dr. Davis. However, surgical
patients must commit to working hard in phys-
ical therapy afterwards. “Physical therapy is an
essential component to help the patient regain
motion and strength while not compromising
the surgery during the healing period.”
Physical therapy alone may suffi ce for older
patients who are willing to restrict their activi-
ties to be careful with their knees. If the injury
caused trauma to the meniscus and the patient
decides against ACL reconstruction, some stud-
ies suggest continued wear and tear on cartilage
can lead to arthritis, says Dr. Davis.
Post-surgical therapy helps control swell-
ing, regain range of motion and build muscle
strength. Exercises to improve stability and
balance and sports-specifi c training to move
properly on the court or fi eld also help.
REDUCE YOUR RISK OF ACL INJURY Maintain strength and fl exibility with year-round exercises geared to these goals, especially on the hamstring muscles. In sports, crouch when you turn and bend your knees when you land from a jump.
WOMEN’S ‘ACHILLES HEEL’: IT’S ACTUALLY THE KNEE
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Knowledge is power when it comes to tummy trouble
staying well
the abc’s ofdigestive disease
the symptoms aren’t fun to talK
about, but persistent diarrhea, constipa-
tion, bloating or abdominal pain can indi-
cate a disease of the lower digestive tract.
Here’s a quick primer on such maladies:
iRRitaBle BOwel synDROMe,
sometimes referred to as spastic colon,
affects about 15 percent of americans,
more than two-thirds of them women. it
causes abdominal cramps, gas, bloating
and constipation and/or diarrhea. if you
have iBs, you should identify the foods
that seem to cause problems so you can
avoid them—and find other sources for the
nutrients they provide.
though iBs isn’t life-threatening, you
should see your physician about it,
because it can mimic the symptoms of a
more serious condition he or she will want
to rule out. if diarrhea is predominant,
an anti-diarrheal product such as loperamide
(imodium) or bismuth (Pepto-Bismol)
or a colon-relaxing medicine called dicy-
clomine (Bentyl) may be appropriate. if
constipation is the main symptom, ask your
doctor about an over-the-counter remedy
called Miralax.
DiVeRtiCUlOsis is a common condi-
tion in which small pouches or bulges
called diverticula form in the digestive
tract. Many people with diverticulosis
feel no symptoms; others may have gas,
abdominal cramps, bloating, diarrhea
or constipation. if you have diverticulosis,
diet and exercise can help. Cut down
on high-fat foods and substitute foods
high in fiber. also, try to exercise for 30
minutes a day most days.
when inflammation or an infection
occurs in a diverticulum, that’s DiVeR-
tiCUlitis. it causes fever, nausea and
abrupt pain, usually in the lower left part
of the abdomen. treatments for diverticu-
litis include dietary restrictions, antibiotic
medications or—especially if it’s recur-
rent—surgery to remove the diseased por-
tion of the colon.
Finally, the inflammatory illnesses
CROHn’s Disease and UlCeRatiVe
COlitis each affect about half a million
people in the U.s., with men and women
equally at risk. Both diseases are marked by
very persistent and sometimes bloody diar-
rhea that can make it hazardous to stray
far from the bathroom. in each, the lining
of the digestive tract is inflamed, but
Crohn’s disease can occur anywhere in
the tract, while ulcerative colitis is typically
restricted to the colon and rectum. Both
conditions, unlike diverticulitis, increase
one’s risk of colon cancer. Doctors aren’t
sure what causes these diseases, but they
now know they’re not the result of stress
or suppressed emotions, as was once
thought. lifestyle changes and a number of
medications, including anti-inflammatory
drugs, immunosuppressants and antibiot-
ics, can ease symptoms for many patients.
But in about 25 to 40 percent of people
who have Crohn’s disease or ulcerative
colitis, surgery to remove all or part of the
colon and rectum is ultimately required.
“it’s usually hard to tell on your own
which of these conditions is affecting you,”
says Zahoor Makhdoom, M.D., a gastro-
enterologist in Carbondale, “so if you have
persistent bowel symptoms, see your family
physician or gastroenterologist.”
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clinical update
HepatitisThe quieT killerA time bomb is ticking AwAy in the lives of hundreds of southern illinoisAns, And most don’t even know it
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EvEn though thE disEasE is not a
frequent topic of conversation, it is one that
everyone should be concerned about says an
area infectious disease specialist.
“Are we seeing it here in southern Illi-
nois? Oh, my gosh, yes,” says Erica Kaufman,
M.D., at the Center for Medical Arts in Car-
bondale says. “When I came here, I thought
I’d see just a couple of cases of hepatitis C,
but unfortunately it’s the No. 1 consultation
I get; it’s a bigger issue than we all thought.”
Like hepatitis A and hepatitis B, the virus
called hepatitis C causes inflammation of
the liver. However, each variety of hepatitis
is unique in the way it spreads, the way it
affects the body and how it is treated. The
problem with hepatitis C is that the disease
can go unnoticed for years, all while attack-
ing the liver, potentially leading to serious
conditions including cirrhosis, liver failure
and even death.
“You can have it for years and not know
it; that’s pretty common,” Dr. Kaufman ex-
plains. “I would say most of my patients are
either in their 20s and just got it or they are
in their 50s and have had it for 30 years.”
She says hepatitis C is similar to high
blood pressure or high cholesterol in that
people do not realize they have the condition
until it is pointed out to them. Unfortunate-
ly, unlike the other disorders, hepatitis C isn’t
something that shows up in normal tests.
“The problem with hepatitis C is that it’s
not something that doctors routinely ask
about and it’s not something that patients
routinely ask to be tested for; women want
their mammograms and men want their
prostates checked and we all need choles-
terol tests, but nobody thinks about hepatitis
C,” she says, partially because of the way the
disease is contracted and spread.
“Hepatitis C is a blood-borne virus,”
explains Dr. Kaufman, who has more than
100 patients with the disease. “It’s not spread
through tears or saliva or skin contact or
breathing.”
Instead, hepatitis C is spread through
blood exposure. Dr. Kaufman says those at
risk include anyone who had a blood trans-
fusion prior to the mid-1990s (“when we
started screening the blood supply”), those
who have used intravenous drugs or snorted
cocaine and some people with tattoos.
“I would say anyone who had a blood
transfusion before 1992 or even once used
IV drugs—even if they think the needle
was clean—or who has a prison or home-
made tattoo should get tested,” she says,
adding that because of the high number of
blood capillaries in the nasal passages, any-
one who has ever tried cocaine should also
be tested.
Yet, she says, people are hesitant to get the
simple blood test either because they don’t
know about the disease or because they are
reluctant to face some of the earlier deci-
sions of their lives.
“I want people to think about their past.
If they ever—even once—had any one of
those exposures, including that one time you
tried IV drugs when you were 17, you need
to get tested,” she says. “I just feel that
there are a lot of people in general, but
especially in southern Illinois, who have
had those exposures and need to be checked
out. Yes, there is a psychological barrier to
getting tested. They don’t want to know. But
hepatitis C is curable. I can understand that
they want to live in ignorant bliss, but I also
see the devastation if they don’t get tested.”
That devastation is a deterioration of
the liver, leading to scarred or dead liver
cells. The progression can take decades, but
unchecked long enough, cirrhosis and liver
failure can result. Both can cause death.
Additionally, chronic inflammation may
lead to liver cancer. In fact, hepatitis C is the
leading cause of liver cancer and the No. 1
reason for liver transplants in the U.S.
The good news is that hepatitis C is
curable.
“You can very slowly reverse the deterio-
ration of the liver,” Dr. Kaufman explains.
“The liver is one of the only organs that
can regenerate. It actually can improve itself,
so we want to get rid of the virus so that
regeneration can happen.”
She says most hepatitis C can be treated
with an intense short-term regimen of medi-
cations, and new pharmaceuticals are in
development to battle the disease. While the
six to twelve months of treatment can be tough
with side effects and frequent doctors’ visits,
Dr. Kaufman says it is worth the struggle.
“If you suffer through it, you’ve got a
really good chance of beating the disease,”
she says. “My patients have done really,
really well.”
She adds that in addition to the medicine,
hepatitis C patients also need support and
understanding from family and friends, who
need to better understand the disease.
“There is a misconception and stigma
against hepatitis C and it’s all wrong,”
she adds. “These people are safe, productive
members of society. They are not lepers;
they are just people with a virus.”
Dr. Kaufman adds that her patients are
fighters, defeating the disease.
“They are so determined. In some cases
they’ve stood up to their past and to the dis-
ease and you get to see the real human spirit.
They’re going to keep going and they’re
going to beat it.”
Erica Kaufman, M.D.
“the liver is one of the only organs
that can regenerate. it actually can improve itself.”
—Erica kaufman, m.d.
attention, boomers:
in a new development, the government is proposing that all Baby Boomers be tested for hepatitis c. the centers for disease control and Prevention recently released draft recommendations that anyone born from 1945 to 1965 should get a one-time blood test to see if they have the liver-destroying virus. according to the cdc, Baby Boomers account for more than 2 million of the 3.2 million americans infected with the blood-borne virus. to find out more about testing, contact the sih call center at 866-744-2468.
s o u t h E r n i L L i n o i s h E a Lt h & L i f E / 2 5
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staying fit
counting cals
a roundup of activities
that do your body
soccer, casual1 hour
476 calories
good
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Dr. Erica Kaufman
88 calories
READING1 hour
156 calories
SHOPPING, GROCERIES, WITH CART1 hour
68 calories
KISSING 1 hour
204 calories
BALLROM DANCING 1 hour
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Don’t suffer in silence with the pain of fibromyalgia
better care
the mysterydisease
fibromyalgia is the roDney
Dangerfield of health problems: It gets no
respect. Its symptoms are quite tangible—
overall ache and pains, chronic fatigue,
sleeping problems, headaches, stiffness,
bowel irregularity and depression—but
there is no definitive diagnostic blood test or
imaging scan and no cure. treatments may
help, but only about half of those with
fibromyalgia find lasting relief. One thing
seems certain: doubting that this mystery
illness is “real” only adds to the woes of
those who have it.
Fibromyalgia is defined as a chronic
musculoskeletal condition marked by
sustained pain or tenderness in the body’s
fibrous tissues—muscles, ligaments and
tendons. Fortunately, it is not progressive,
crippling or fatal.
because there are no objective biomark-
ers to help physicians diagnose fibromyalgia,
they must first rule out other possible causes
of pain, such as lupus or rheumatoid arthri-
tis. according to the american college of
rheumatology, a clinical diagnosis is made
by examining the patient and identifying
“tender points”—areas over the extremities
and paraspinal region, often where tendons
are inserting into bone, that are tender to
the touch. current guidelines say that pain
in 11 of those 18 points signals fibromyalgia.
In fact, the National Fibromyalgia associa-
tion estimates that it takes an average of five
years for a fibromyalgia patient to receive
an accurate diagnosis.
treatment is targeted to the patient’s
symptoms. antidepressants, the mainstay of
treatment options, have been shown to help
some patients. Nonsteroidal anti-inflam-
matory agents (NSaIDs) such as ibuprofen
sometimes help ease the pain, but it’s not
clear why, as fibromyalgia is not an inflam-
matory condition. because stress is often
a contributing factor, seeing a psychologist
or other mental health professional may
help as well.
Many physicians refer their patients to
physiatrists like brent Newell, M.D., at the
rehabilitation Institute of chicago at
Herrin Hospital. a physiatrist specializes
in physical medicine and rehabilitation.
Dr. Newell works to increase function
and mobility and find ways to help his
patients’ get a good night’s sleep, something
often difficult for fibromyalgia sufferers.
“Sometimes, patients may need a sleep
study to diagnose problems,” he says. “Initial
treatment will sometimes involve medications
to address the sleep issues, and I really stress
the importance of exercise. In particular,
aerobic exercise is important. I tell them to
find something they enjoy like walking, biking,
aqua exercises, Zumba or Pilates and to gradu-
ally increase their activity. I don’t care if they
start with five minutes and work up from
there, but they need to do something that will
get their heart rate up,” says Dr. Newell.
Physical therapy can be helpful for people
who are significantly de-conditioned, the
doctor adds. “this is the challenge because
it hurts. It hurts to exercise but exercise is
helpful. You have to get patients to distin-
guish between good discomfort and pain,
which can be very difficult for individuals
with fibromyalgia.”
Patients may have more answers in the
future. New research suggests that the likely
mechanism for fibromyalgia is related
to the way pain signals are processed in the
brain, explains Dr. Newell. “We’re learning
that patients with fibromyalgia have areas of
their brains that are more active than those
without fibromyalgia.” to find out more,
visit www.fmaware.org.
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It’s a kInd of magIc, really: an elIxIr that enrIches
civilizations, enlivens cultures and enhances health. And has been doing so
for millennia. The olive tree is tenacious, a scrappy survivor—these trees
often live 700 years or more, making them seem immortal—that needs
minimal water and cultivation.
While the ancient Greeks didn’t necessarily fully appreciate the taste,
they did pour oil over their bodies, and they used the tree’s branches to
fashion crowns for Olympian athletes. In The Odyssey, Homer called
olive oil “liquid gold,” acknowledging its worth as an economic
engine for many Mediterranean countries. The Romans
also treasured it, and to this day, many different cultures
use it for important ceremonies—baptisms, blessings,
anointing the dead.
In homes around the world, olive oil elevates
domestic rituals. It delights the eye with a variety of
gorgeous shades, from green through gold,
and features taste notes from apple through
butter, grass, lemon, pepper, herbs
and more. Plus it moisturizes skin,
conditions hair and helps people
get a close shave.
Immortal oIl
PH
OTO
S:
SH
UT
TE
RS
TOC
K
the fruIt of the ancIent olIve tree yIelds one of nature’s most sublIme creatIons
3 0 / a u g u s t 2 0 1 2
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All that and it’s good for you too. Back in
the ’60s, scientists noted that few people living
in countries near the Mediterranean Sea were
afflicted with cardiovascular disease or cancer. They
theorized the reason was the abundance of heart-
healthy olive oil in their diets. Subsequent research
showed that olive oil contains unsaturated fats that
may help lower a person’s risk of heart disease,
“bad” cholesterol levels and blood sugar. Plus, it
boosts the HDL, or “good” cholesterol, which helps
combat heart disease. In addition, its high levels of
vitamin E and oleic acid support healthy bones.
Perhaps that’s why Americans have been having
a gastronomic love affair with olive oil. Between
1982 and 2001, U.S. consumption grew from 64
million pounds to 380 million pounds.
Still, health benefits aside, the truth is that the
thrill of olive oil is really in the eating. For those
whose palates have tasted only the bland, mass-
produced imported blends, you’re in for a wake-up
call: even the mildest artisanal oils are bursting with
flavor. And because there are more than 700 kinds of
olives, it’s impossible to say what the “best” olive oil
is, any more than one could choose the “best” wine.
As with wine, the fun is in the trying and tasting.
Nonethless, aficionados have given us a few solid
guidelines for selecting olive oils:
1 Olive oil should be stored out of light and
away from heat, lest it turn rancid. Don’t buy
unless the seller is displaying it according to those
guidelines.
2 As with most things, higher quality tends to
correlate with higher price.
3 Look for a harvest or best-by date on the label;
don’t purchase olive oil that is more than
two years old.
4 Know the differences between various grades of
oil (see sidebar below), so you can match your
purchase to its intended purpose: High quality for
skin moisturizing, for health and to drizzle over
bread or salad; light for baking; a cheap kind to use
if you happen to have an oil lamp.
To best understand olive oil, set up an informal
tasting. As with wine, pour a bit in a small wine
glass or other small container (experts use a round
glass that fits in the palm of the hand, the better
to warm up the oil). Swirl it around. Bring your
nose close to the glass and inhale deeply. Let your
mind free-associate to help you describe what you
smell—is it fresh-cut grass? Cinnamon? Avocado?
Nuts? Butter?
Then, take a good sip. Holding the oil in your
mouth, suck in air, then close your mouth and
breathe out through your nose. This is called
“retronasal perception” and will expose your palate
to an even wider range of flavor notes. You will also
pick up bitter notes—not surprising, as olive oil is
made from non-cured olives, which are naturally
bitter. Though an acquired taste, a bit of bitterness
is a good thing when it comes to olive oil. (A good
example is Cobrancosa from Portugal.)
When you swallow the oil, be aware of a
pungent, peppery sensation—a sort of chemical
irritation that’s present in all olive oils. It can range
from barely noticeable to intense.
Test two or three different kinds of oil if you
like, cleansing your palate between each with plain
or sparkling water, or a piece of neutral-tasting
bread. Choose oils in different price ranges. You
will likely be surprised by the wide variation
between them.
This remarkably versatile substance is key to
countless recipes, from salad and pasta dressings
to sauces and even cakes. Of course, it’s also the
basis for an excellent dipping experience—not only
of crusty bread, but of fresh mozzarella, bread,
ripe tomatoes, cubes of grilled chicken, roasted
vegetables and more. Take your pleasure, and enjoy!
Know the labelsCold-pressing is a chemical-free process using only pressure, which produces the highest- quality olive oil.Though the term lingers, most makers now achieve the same result by using centrifuges for the first press.
exTra-virgin is the highest quality of olive oil. Just 1 percent acid, it’s made from the first cold-pressing of the olives, which best preserves their nutrients.
virgin olive oil is also a first-press oil, with an acidity level of between 1 and 3 percent.
Fino olive oil is a blend of extra-virgin and virgin oils.
lighT olive oil is not lighter in fat. rather, it’s been processed until it’s lighter in color and essentially flavorless, making it a good choice for baking.
reFined olive oil (sometimes called “pure” olive oil) is low-quality olive oil that has been treated with charcoal and other filters. The term “olive oil” used alone refers to a blend of refined and virgin olive oil.
Olives are a fruit; olive oil is their “juice.” Like any fresh juice, it should be enjoyed as soon as possible after extraction.
s o U T h e r n i l l i n o i s h e a lT h & l i F e / 31
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Playing in grassy or wooded
areas? Try wearing a hat, long sleeves and
pants and tucking your pants legs into your
socks. That may help you avoid being one
of about 30,000 Americans diagnosed with
Lyme disease each year.
Bacteria in the spirochete family cause
the condition. Deer ticks primarily carry
the disease to animals and humans through
bites. Illinois had 135 cases in 2010, a
jump of nearly 300 percent from 10 years
ago, according to the Illinois Department
of Public Health. “It’s not as common in
our area as it is in Wisconsin and the New
England states; but for that reason, it’s
important to tell your physician if you have
travelled to these areas,” says Linda Bobo,
M.D., an infectious disease specialist at
Center for Medical Arts in Carbondale.
Lyme disease is tricky, because the time
from the tick bite to the first symptoms
may make cause and effect hard to con-
nect—and some patients may not even no-
tice a characteristic rash, sometimes in the
shape of a bull’s-eye. It can appear from
three to 30 days after a bite. Besides the
bull’s-eye, there can be a systemic illness
associated with Lyme disease. Symptoms
include fever, chills, headaches, fatigue,
muscle aches, joint pain and stiff neck and
can go on for months to years. “In these
more unusual cases, the living organism
is no longer present, therefore antibiotics
are not helpful,” adds Dr. Bobo. The doc-
tor adds that you can be simultaneously
infected with the more common bacteria
that cause tick-borne illness in Illinois, like
Rocky Mountain Spotted Fever, Ehrlichio-
sis and a few others.
If you’re bitten, removing the tick from
your skin properly can decrease your odds
of infection (see box at right). Says Dr.
Bobo: “Never mind those old wives’ tales
about burning the tick with a match or
smothering it with petroleum jelly. These
things are more irritating to the tick, mak-
ing it more likely to regurgitate—and that’s
how it transmits the disease.”
If identified early, Lyme disease can
be successfully treated in most cases
with a short course of antibiotics. When
it progresses to later stages, its effects
can include nervous system difficulties
such as facial paralysis, as well as arthritis,
lyme disease
Remove a tick the Right way
Using fine tweezers or a special tick
remover, grasp the tick gently at the
head as close to your skin as possible
and pull straight out.
save the tick to be identified by placing
it in a plastic bag or a jar of alcohol to kill it.
Clean the bite wound with disinfectant.
Then take the tick to your doctor to find
out if you need treatment.
as the outdooRs beckons, bewaRe of Lyme spRead by tick bites. this disease can be moRe than a nuisance if it’s not caught eaRLy
SEASoNAL HEALTH
meningitis and heart problems.
So take precautions. Besides long sleeves
and pants, wear light colors so you can see
a tick. Consider using insect repellants with
DEET on clothes and exposed skin (except
for face, hands or irritated areas). You can
also buy clothing infused with the insecti-
cide permethrin, which is good for 25 wash-
ings. And make your yard tick-unfriendly by
keeping grass mowed and leaves raked.
“Teach your kids not only to survey
themselves, but also to have others check
them carefully for ticks when they have
been outdoors,” advises Dr. Bobo. “It’s also
important for them to shower and wash
their hair immediately.”
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TO FIND A JOINT CAMP SURGEON, CALL
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With the Herrin Hospital Joint Camp method, your specially-trained orthopedic surgeon will lead a team of specialists centered around you and your care. Plus, you’ll enjoy the camaraderie of recovering with other joint replacement patients during therapy.
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C4_SILL_SUMMER12.indd 2 7/19/12 4:35 PM