Western Wisconsin

Health News from Western Wisconsin

Put a little walk in your spring this year
Bone marrow transplant is close to home
High Dose Rate brachytherapy allows outpatient cancer treatment
Care tailored just for you ... Ministry Health Care’s Patient-Centered Medical Home
Join us for Miracle Fest

 

Put a little walk in your spring this year

Walking offers a win-win exercise plan, especially for women. Walking is a path to physical fitness that virtually anyone can follow. According to Vinay Sharma, MD, a family physician with Ministry Medical Group in Thorp. "Walking has been proven to lower the risk of a wide range of health problems, and it can help with weight control."

A pedometer can be a great incentive either for starting or jump starting a walking program. Clip a pedometer on your belt or waistband above the hip, and it will count the steps you take in a day.

Logging the number of steps you walk each day for a week will raise your awareness of just how much or how little exercise you really get. Most of us will probably find out that we get far less exercise than we think.

“The point is not to become demoralized about our sedentary lives, but to use the information to jump start our routine,” said Dr. Sharma. “One suggested target is 10,000 steps per day or about five miles – an activity level that reaps both health benefits and weight loss. This might sound like a lot, especially if your pedometer tells you you’re only covering 2,000 steps per day.”

Dr. Sharma suggests that people create a plan to increase their daily mileage. “Be realistic, especially if you’re overweight or not very fit,” said Dr. Sharma. “You might start by adding 2,000 steps, about a mile. If you walk it briskly, you can squeeze it into 15 minutes. At a slower pace, it will take you 20 minutes. Once you’re comfortable and consistent with that level, add another 2,000 steps. Keep adding until you reach 10,000 steps, or whatever goal you set for yourself.”

The beauty of walking is that you can break your target distance into a number of shorter, more manageable spurts. Perhaps you could walk one mile to and from work, take a 15-minute walk as part of your lunch break, and a 30-minute walk with your significant other or neighbor after dinner.

Adding miles to your daily routine is a way to lose weight and inches without dieting. A woman who weighs 145 pounds will use about 80 calories per mile walking at a 15-minute pace. If she adds four miles a day, that adds up to 320 calories. If she maintains those miles over 10 days, she’ll have used 3,200 calories, the equivalent of one pound. In a month, that will add up to three pounds; in 6 months, she could lose 18 pounds. No one is claiming that this is an effortless way to lose weight, but it is an attainable goal for most women.

There are countless studies that attest to the ability of walking to protect against many diseases that affect women including osteoporosis, breast cancer, heart disease and stroke.

A study of 18 postmenopausal women who participated in a 15-week walking program concluded that women walking a little less than two miles at least 5 days per week had significant improvement in bone mineral density. Preserving and increasing bone mineral density protects women from osteoporosis.

Data from the Women’s Health Initiative showed that women who walked briskly for one and a quarter to two and a half hours per week decreased their risk of breast cancer by 18 percent compared with the rate for inactive women.

More data from the Women’s Health Initiative study, which collected information from 73,743 women age 50 to 79 for 3.2 years, found that women who walked at least two and a half hours per week lowered their risk of heart disease, heart attack and stroke by one third compared with women who did not walk.

Women at the highest level of walking and vigorous exercise had the greatest benefit, a reduced risk of about two thirds compared with sedentary women.

Walking, as well as other forms of regular exercise, is also known to lower the risk of adult onset diabetes, improve symptoms of depression and relieve psychological and physical stress.

“There are countless reasons to walk and few compelling reasons not to,” said Dr. Sharma. “Walking can be done inside or out, alone or with friends, requires no special equipment or skills, and it can help keep our hearts, minds and bodies feeling and looking younger. Dare to take that first step. You might be surprised how quickly the next 10,000 will follow.”

Quick walking facts

  • Walking one 15-minute mile burns about 80 calories.
  • Walking two miles a day, five days a week can improve bone density.
  • Walking 15 to 30 minutes a day, five days a week can decrease breast cancer risk by 18 percent.
  • Walking 30 minutes a day, five days a week may lower the risk of heart disease, heart attack and stroke by 33 percent.
  • Walking lowers the risk of adult onset diabetes.
  • Walking improves symptoms of depression.
  • Walking relieves psychological and physical stress.
  • Walking 10,000 steps at moderate intensity, defined as breathing hard, but still able to speak a four-word sentence, but not being able to sing the same four words can improve cardio-respiratory fitness by 10 percent

Take 10,000 steps and keep counting

You may have a $2000 piece of exercise equipment in your basement as evidence of your good intentions. But if you’re truly interested in losing weight and becoming fitter, a better investment might be a $25 pedometer.

A pedometer is a little device that you can clip on your belt. The basic idea is to count your steps and take more of them.

The 10,000-step movement using pedometers started in Japan in the 1960s, but it’s been popularized in the United States, in part by Catrine Tudor-Locke, PhD, author of the book Manpo-kei: The Art and Science of Step Counting.

There’s nothing magic about 10,000 steps; there was no research to back that up as the appropriate number. It’s simply the Japanese term for pedometer–manpo-kei or “10-thousand-step-meter.”

According to Bill Hopkins, MD , a family physician with Ministry Medical Group in Stanley, “The idea is to exercise, and anything that motivates you to get moving is a plus. Many Americans exercise primarily to lose weight, and that in itself is a healthy goal. But the health benefits are well documented, protecting against heart disease, hypertension, type 2 diabetes, and many cancers.

“Of all exercise options, walking is the most popular, and it’s certainly the most accessible. Virtually anyone can do it.”

If you have the self-discipline to follow the U.S. Surgeon General’s guidelines and get out for a brisk 30- to 45-minute walk nearly every day, there is no reason to change that. If you can meet your exercise goals by having a treadmill in your basement, more power to you. Most Americans, however, are not so easily motivated, and that is the reason for the pedometer.

In one study, sedentary women who were instructed to walk 10,000 steps a day walked more and were more likely to meet their fitness goals than another group instructed to walk briskly 30 minutes most days of the week.

Both groups carried pedometers, but all pedometers in the 30-minute group were sealed until the study was over. Those in the 10,000-step group were able to monitor their total at any time, and they walked about 2,000 steps a day more than the group told to walk for 30 minutes a day.

“Wearing a pedometer to measure steps is sort of like using the scales to monitor weight,” Dr. Hopkins says. “Log your steps every day, and you will have a constant reminder of how active you’ve been. If you’re trying to add to your total, you may park at the far end of the parking lot or take the steps rather than the elevator.”

A popular weight loss book, The Step Diet by Drs. James O. Hill and John C. Peters recommends that you establish a baseline by wearing a pedometer for several days while performing daily activities, then add 2,000 or 3,000 steps to that baseline number while cutting your daily calories by 25 percent.

Every 2,000 steps will use up about 100 calories, so don’t expect dramatic weight loss unless you’re calorie counting as well. But if your pedometer is accurate, and you’re faithful to your plan, you are guaranteed to increase the number of calories you burn each day.

Any physical activity that promotes weight control and improves circulation has health benefits. Physical inactivity, combined with a poor diet, may account for as many as 16 percent of deaths in the United States.

Cardio-respiratory fitness is influenced by intensity, which can be increased gradually once the step count has been increased. The Canadian Health First study found that both a 10,000-step pedometer group and a group exercising for 39 minutes a day at moderate intensity improved their fitness level compared to a control group. However, the moderate intensity group increased their respiratory fitness by 10 percent compared to 4 percent for the 10,000-step group. “Once the daily step count is higher, then the addition of some briskness is recommended,” the author said.

Moderate intensity was defined as breathing hard, but still able to speak a four-word sentence. At the same time, you should be exercising hard enough that you could not “sing” a four-word sentence.

Intensity is measured by heart rate, but for most Americans the challenge is getting enough steps, day in and day out.

If you’re buying a step counter for yourself, you may want to spend a little more ($15 to $50) and get a pedometer capable of lasting a few million steps. If you’re buying for a class or large group, there are promotional devices of adequate quality that cost as little as $5.

Lower cost pedometers are not always very accurate. If you’re planning to make step counting a long-term commitment, it makes sense to buy an instrument that is nearly as dedicated as you are.

Take a walk to lower blood sugar

Exercise may be the single most important thing you can do to keep your blood sugar within normal ranges and prevent type 2 diabetes.

“Walking is an exercise that’s widely recommended, primarily because it’s low impact, moderately intense and something virtually anyone can do without special training or equipment,” said Stacey Gusman, DNP, a family nurse practitioner with Ministry Medical Group in Owen. Studies show it also may be the ideal exercise for controlling blood sugar.”

As diabetic patients know, it’s not the sugar you eat that’s a problem; it’s the uncontrolled sugar in the blood that leads to the serious complications of diabetes such as heart disease and kidney, eye and nerve problems.

“In a person without diabetes, nearly everything that’s eaten is turned into sugar (glucose) during the digestion process, and this sugar is then transported through the blood and taken into muscle cells to be used as energy,” said Gusman. “Exercise uses this stored energy, and regular exercise trains muscle cells to use glucose more efficiently.

“In type 1 diabetes, the pancreas becomes unable to produce insulin, a hormone necessary to unlock the body’s cells and allow glucose to enter. As a result, patients with type 1 diabetes have to take daily insulin injections regardless of anything else they do for treatment.”

People with type 2 diabetes may produce insulin but perhaps in smaller quantities, and their cells are likely to be resistant to the effects of insulin. For these patients, glucose-transporting molecules (GLUTs) may be even more important than insulin. GLUT-2 transporters attach themselves to glucose particles in the blood and carry them to the cell membrane. At this point, GLUT-4 transporters inside the cell come to the surface and usher the glucose molecules inside.

People with type 2 diabetes tend to have a shortage of these glucose transporters, but moderate exercise such as brisk walking takes on the role of GLUT-2s in transporting glucose to cells. And it also increases the production of GLUT-4 transporters inside the cell, allowing glucose to enter more efficiently.

How much walking is needed to get this kind of protection against the effects of high blood sugar. One study concluded that at least 38 minutes a day (or 4,400 steps) is required in order to lower hemoglobin adequately.

“Brisk walking is generally defined as 3.5 to 4 miles per hour, but if you’re not used to exercise, you may have to start at a substantially slower pace,” said Gusman. “To get aerobic benefits, your walking pace should get your heart rate elevated to 70 to 80 percent of your maximum heart rate. The maximum is generally defined as 220 minus your age.”

A vigorous arm swing will help get your heart rate up, but if you can’t comfortably handle a heart rate higher than 60 percent of your maximum heart rate, you can get a comparable benefit from 90 minutes of continuous walking. Walking uphill will produce a higher rate, but, according to one study, downhill walking may be more beneficial for control of blood sugar.

“Make sure you have good shoes that are comfortable, offer good support and have materials that breathe as you perspire,” said Gusman. “It’s important to avoid blisters, which can lead to ulcers if you already have diabetes.”

If you have diabetes, impaired glucose tolerance, or an increased risk of diabetes for any reason, there is good reason to get off the couch and get moving.

Choose the right shoes for walking

There was a time midway through the last century when one pair of generic “tennis shoes” or “sneakers” for each athlete in the family might have sufficed. Not so today.

“Every sport or activity has its own moves, requirements and challenges,” says Joel Kowski, DPM, a podiatrist with Ministry Our Lady of Victory Hospital. “The surface – hardwood, clay, grass, concrete or asphalt – also presents special needs.”

Dr. Kowski recommends using a walking shoe. The mechanics of walking are distinct from those of running. Whereas some runners require a relatively thick, rigid sole for stability and shock absorption, a walker needs a shoe that is flexible, particularly at the ball of the foot. The flared and elevated heel that is common with some running shoes is likely to be a hindrance with walking.

All walkers should be aware of their foot type – pronated, supinated or neutral.

  • People who pronate (roll their feet inward) need more of what are known as motion control shoes. They are generally inflexible with denser material on the inside to help correct for pronation.
  • People who supinate (roll outward) and those with high arches may need more flexibility and cushioning, particularly in the mid-sole area.
  • People who have a neutral foot, which has no motion control issues, need a stability shoe. It’s more flexible than a motion control shoe but provides greater support and durability than the cushioned shoe.

If you don’t know your foot type, a salesperson at a specialty athletic shoe store can help you by examining the wear on your old shoes.

A specialty store, with sales staff who can discuss your specific needs, is the best place to shop. Look-alike shoes, even of the same brand, sold at department chains are usually made for casual wear and do not have the materials and design needed for serious athletic use. Once you know a model number and size of a shoe that works for you, you may be able to find discounts online.

Buying a large box full of athletic shoes requires spending a large box full of money. The cost is small, however, compared to what you might spend at a podiatrist’s office to treat an injury.

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Bone marrow transplant is close to home

Bone marrow is the soft spongy tissue that lies within the hollow interior of long bones. It is found in the breast bone, skull, hips, ribs and spine. In adults, the marrow in large bones produces new blood cells – a critical function to sustaining life.

Bone marrow contains hematopoietic progenitor cells (HPC), stem cells, bone marrow cells, and peripheral blood stem cells, which are known as the “parent” cells that produce the body’s white blood cells, which fight infection; red blood cells, which carry oxygen to and remove waste products from organs and tissues; and platelets, which enable the blood to clot.

Cancers of the blood such as, multiple myeloma and lymphomas, as well as aplastic anemia, and some other immune deficiency diseases, cause defective blood cells and interfere with normal cell production.

Aggressive cancer treatment can also destroy normal cells found in the bone marrow. The ability to provide bone marrow transplants allows oncologists to treat these diseases with aggressive chemotherapy and / or radiation by replacing the diseased or damaged bone marrow after the chemotherapy / radiation treatment.

Ministry Saint Joseph’s Hospital’s autologous (from the patient) Hematopoietic Progenitor Cell (HPC) transplant procedure, commonly called stem cell or bone marrow transplant, uses the patient’s own bone marrow. Although HPC transplant offers potential cure or improved survival for these diseases, the treatment process is complex and requires a skilled and talented staff in the laboratory as well as on the nursing units.

Prior to receiving chemotherapy or other treatments, healthy bone marrow can be stimulated to produce more stem cells and push them out into the bloodstream where they are collected through a catheter in a vein. These healthy cells are reintroduced back into the body after treatment.

Ministry Saint Joseph’s Hospital is one of only four facilities in Wisconsin with the ability to perform this type of transplant. The Marshfield Clinic / Ministry Saint Joseph’s Hospital autologous HPC transplant program has received accreditation from the Foundation for the Accreditation of Cellular Therapy (FACT) and is one of a select group of cell transplant programs recognized for its overall excellence. FACT accreditation is only awarded to progenitor cell transplant programs that have demonstrated an outstanding level of patient care and medical and laboratory practices.

“FACT accreditation provides assurance to the patient and family seeking transplant that we have a quality program,” said Ione Miedema, RN, MSN, AOCN, Hematopoietic Progenitor Cell Transplant program manager. “It is a requirement to participate in clinical trials conducted by the National Cancer Institute / National Institutes of Health. It recognizes the ability of our physicians, nurses, collection staff and transfusion services staff in managing the health of the person undergoing transplant and demonstrates that we have a multidisciplinary program that can address just about any issue that may arise with the transplant patient.

In 2000, the Marshfield program was the first in Wisconsin to receive accreditation. It remains the only program in north central Wisconsin and is only one of 126 programs in the U.S for adult autologous transplant. The Marshfield Clinic / Ministry Saint Joseph’s Hospital hematopoietic progenitor cell transplantation program is an Eastern Cooperative Oncology Group approved Transplant Center which means it can participate in clinical trials that use HPC transplant for the treatment of cancer.

As part of the accreditation process, a FACT team reviewed records, treatment standards and other materials from Marshfield, and then conducted an on-site review.

To receive the accreditation, which is effective for 3 years, the Marshfield program had to meet FACT standards, which include:

  • Definition of an infrastructure required for all phases of the safe collection, processing, and administration of hematopoietic cells used for bone marrow
  • transplantation.
  • Requiring an ongoing assessment of these activities.
  • Requiring all clinical, collection and processing facilities to evaluate and report clinical outcomes.

Founded in 1996, FACT establishes standards for high quality patient care, medical and laboratory practice. It is a non-profit organization developed by the Center for International Blood & Marrow Transplant Research and the American Society of Blood and Marrow Transplantation for the purposes of voluntary inspection and accreditation in the field of hematopoietic cell therapy (bone marrow transplant).

In April 2003, the center met the criteria for accreditation by the American Association of Blood Banks for Hematopoietic Progenitor Cell collection and processing. The program is also a participating team with the International Marrow Transplant Registry. The Autologous Bone Marrow Transplant Program began in 1982, and in 1991, the Autologous Peripheral Blood Hematopoietic Progenitor Cell program was added.

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High Dose Rate brachytherapy allows outpatient cancer treatment

High Dose Rate (HDR) brachytherapy is an effective and more comfortable cancer treatment regimen that allows patients with certain cancers to be treated on an outpatient basis without an extended hospital stay.

During HDR treatment, high doses of radiation are delivered directly to the tumor through tiny hollow radioactive catheters (the size of a grain of rice) that are placed in the body next to the tumor. After treatment the radioactive source is removed.

There are fewer side effects and patients can often return to normal activity immediately. HDR uses the latest in computer technology and controls the radioactive source remotely.

“There are several advantages of high-dose rate brachytherapy,” said Warren Olds, MD,a Marshfield Clinic radiation oncologist on staff at Ministry Saint Joseph’s Hospital. “The treatment, which usually takes about 20 minutes, allows for more precise control over the amount of radiation that is concentrated directly to a tumor, and causes less potential damage to healthy tissue. That translates into a high level of success for certain types of cancers.”

The most common types of cancer that can benefit from HDR brachytherapy are gynecological, including cervical and endometrial cancers. Esophageal, lung and gallbladder cancers also occasionally can be treated. “For concentrated cancers, HDR is safer and more comfortable for the patient,” said Dr. Olds.

The HDR brachytherapy procedure is typically repeated over several treatments,” said Dr. Olds. “It can be given as the only treatment, or may be combined in a treatment plan with external radiation therapy. However, HDR is not suitable for cancers that have spread out for more than a few centimeters.”

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Care tailored just for you ... Ministry Health Care’s Patient-Centered Medical Home

It’s not a place. It’s a team of health care professionals that work together to coordinate care, which makes your health care more efficient and

  • saves you time
  • avoids duplicate testing
  • provides specialist and medication consultation
  • coordinates all your health care visits and results
  • creates a unified health care plan to treat your mind body and spirit

Three Ministry Medical Group clinics receive national medical home recognition

Ministry Medical Group clinics in Tomahawk, Stevens Point and Waupaca have received national recognition for their medical home models by the National Committee for Quality Assurance (NCQA) . They have received Level 3 Physician Practice Connections® - Patient-Centered Medical Home Recognition (PPC-PCMH™), the highest level that can be attained.

NCQA recognizes primary care practices that: function as patient-centered medical homes by providing a model of care where each patient is at the center of his or her care and has an ongoing relationship with a personal provider who leads a team that takes collective responsibility for patient care.

Ministry Medical Group launched three medical home pilot sites in 2011. Since then, many of their clinics have begun transitioning to medical homes. Ministry’s medical home teams consist of physicians partnered with advanced practice providers (APNPs or PAs), RN case managers who coordinate chronic disease management, patient service representatives, health care associates (CMAs or LPNs) and a behavioral health specialist.

“This certification is a significant milestone for us,” said Ronald Cortte, MD, Ministry Medical Group Family Practice. “Lots of hard work has been accomplished by our staff at each of our sites. Our common goal is to not only meet the requirements for certification but to exceed them as a part of our ongoing work in making the health care experience the best it can be for our patients.”

Some of the areas PPC-PCMH measure include patient tracking and registry functions; access and communication; care management; patient self-management support; electronic prescribing; test tracking; referral tracking; performance reporting and improvement, and advanced electronic communications.

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral health care organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs. There are nine PPC® standards, including 10 must-pass elements, which can result in one of three levels of recognition. Level three represents the highest level of recognition.

Ministry Health Care plans to have all of its primary care clinics recognized as Level 3 PPC-PCMH by October.

Please visit www.ministryhealth.org/medicalhome to learn more about patient-centered medical home.

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Join us for Miracle Fest

Thursday, April 25

Miracle Fest 2013 promises to be an evening filled with laughter and fun at the Wildwood Station in Marshfield, Wisconsin.

 

  • 5:30 p.m. Hors d’ oeuvres, cocktails and silent auction
  • 6:30 p.m. Program featuring a special miracle family, followed by the vocal auction
  • 7:45 p.m. Entertainment by comedian, Scott Novotny
  • 9 p.m. Announcement of silent auction and raffle winners

Early Bird Special Ticket price is $30 per person. After March 16, the ticket price is $35 per person.

For more information or to purchase a ticket, please call 715.389.3955.

The event will benefit the Child Life Program at Ministry Saint Joseph’s Children’s Hospital and Marshfield Clinic Children’s through Children’s Miracle Network.

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