Happy Memories of the Holiday Season
	Happy Memories of the Holiday Season I’ve been spending a lot of time thinking about the holiday season lately for obvious reasons -- it’s fast approaching. My thoughts have centered on how grateful I am for my family, but also I think about families who may not be together this year due to war or other circumstances. I know it’s all a part of life, but it’s a difficult part for many people, and I often think about that. Thoughts, so many thoughts go through our heads each day. I’ve heard that in an average day we have around 60,000 thoughts. Hopefully most of those thoughts are happy ones. They may not all be. But memories, memories can play a big role in turning our minds to happy thoughts. A happy memory I’d like to share is from my early adult years. I was probably about 22 years old, married, without children, lucky enough to be living less than 5 miles from the home I was raised in. My mom and dad were still alive, my entire family was close enough to home to make it there for the holidays, and I looked forward to spending the day with them like a little kid looked forward to Santa coming. I was a nurse working at St. Joseph Hospital (now Portage) in the Operating Room. I was on call for emergency surgeries that Christmas day. Those were the days before beepers, so as I left my home at noon time to go to my parents’ home for Christmas dinner and presents, I called the hospital to let them know where I’d be that day. As I walked into my parents’ home 15 minutes later to the smell of turkey baking, Christmas carols playing, and my entire family waiting patiently for us to get there so that the present-unwrapping could begin, the telephone rang. Yes, it was for me. As I looked around the dining room, the table was set so beautifully -- as usual with my mom’s best dishes and linen. I had to report to work immediately for an emergency appendectomy. As I told the operator I would be right there the tears began to fall. Yes, I was an adult, but at 22 still so disappointed that I had to leave. I quickly got over the disappointment as I concentrated on the young woman who was having abdominal pain and truly needed our care that Christmas afternoon. I wasn’t surprised to see that the appendix had ruptured and the time required for me to be there doubled as I realized I would be cleaning up after what we then referred to as a “dirty case”. By then I had resigned myself to the fact that it was ok. I was happy that I was able to spend the day at the hospital with people who really needed us. Six hours later I drove back to my parents’ house to pick up my husband and head home. To my surprise the table was still set, the presents were still wrapped and everyone was still there waiting for me to return “home”. The tears fell again, but this time not because I was disappointed, but because I was so grateful for this family. “What took you so long? Let’s eat and open these presents!” I couldn’t believe they had waited for me! What a precious memory. To this day, I smile every time I think about it. No relationship has been correlated between money and happiness for any family living above poverty wages, suggesting that once basic needs are taken care of, happiness cannot be bought at any price. Researchers consider happiness to depend less on our actual circumstances and more on how we choose to respond to our circumstances. How happy you are depends on how you approach life. This holiday season, may our lives be filled with health, happiness, and peace. And may your joy in the present moment create happy memories of the holiday season to savor forever. Wanda Kolb, RNC, MPA, is the administrator and co-owner of Aspirus Keweenaw Home Health & Hospice.
	Fitness Resolution
	Now that the holidays are coming to a close most of us begin thinking of our New Year’s Resolutions. Many of our resolutions have something to do with eating right and exercise. So we start out in January with great enthusiasm. After all the goodies of the holidays we are ready to eat our 5 fruits a day and lots of salads. We even join the gym or get out to ski. But as the weeks go by the strict regimen we set for ourselves may get boring or hard to fit into our busy schedules. The kids need to be run to hockey, basketball or some other event. We find ourselves grabbing a hot dog at the arena or driving thru a fast food restaurant on the way home for the evening. And exercise....we are definitely too tired for that! So how do we change our lifestyles to fit exercise into our busy schedules? Remember that you don’t need a large block of time to exercise. You can break 30 minutes into 10 minute spurts of exercise. Take a walk while your kids get dressed for the hockey game. If this is your time to chat with the other parents, take them with you. It’s much easier to keep to an exercise program if you have a partner. If the weather is bad, walk around the arena, the hallways of the school, or the mall. Be sure to warm up for 1-2 minutes, then walk at a medium to high intensity and cool down for 1 minute. Stretching at the beginning and end of the workout is also very important. There are many organized programs in our area. There are gyms, aerobic classes, water aerobics, martial arts, tennis and skiing lessons to mention a few. You will enjoy the social aspect of these classes as well as having someone motivate you. Get a partner to join with you. It’s harder to skip class if someone is counting on you. If you are not into organized programs and look at a workout as your time to think or solve problems, you can cross country ski at any time of the day or evening. This area has great, excellently groomed trails. The ski hills are also another option or just walk out the door and join a friend for a brisk walk in our winter wonderland. Snowshoeing is also a great calorie burner and there are now local trails. Sometimes just taking the first step out the door or the phone call to join a class is the hardest. But once that first step is taken you will enjoy what you are doing. Some days you may not feel like working out, you’re tired, under the weather or whatever. You don’t have to always work out at a high intensity, but you’ll find some movement will make you feel more energized and definitely boost your mood. There are so many benefits to exercising as you can read about at www.guideline.gov . They include prevention and treatment of coronary heart disease, hypertension, stroke, obesity, type 2 and type 1 diabetes, osteoporosis, osteoarthritis, rheumatoid arthritis, low back problems, asthma, COPD, mental health, cessation of smoking and sleep disorders. After reading this you will realize you can’t afford NOT to exercise. Just remember to warm up and stretch before and after you work out and drink plenty of water. Get your doctor’s approval if you have been sedentary Make a commitment, find a partner, try something new, take that first step. You won’t regret it. Colleen Rowe is employed by Aspirus Keweenaw Home Health & Hospice as a Patient Account Specialist. She is also a certified aerobic and water aerobic instructor and currently teaches classes in the Calumet area. She enjoys cross country skiing and snowshoeing, scuba diving, kayaking, camping and boating.
	Seasonal Affective Disorder
	The change in seasons is upon us, both in our external physical environment and in our internal emotional landscape. The rhythm of life changes as the days grow shorter, the sun’s warmth is fleeting, and the snow and winds bear down for the coming winter. Soon it will be time to hit the downhill slopes and cross country trails, snowshoe in the backwoods, and start up the snow machine. Anticipation of change is in the air. George Santayana reminds us, “To be interested in the changing seasons is a happier state of mind than to be hopelessly in love with spring.” While the changes in the temperature and upcoming snowfalls are easy to talk about, other aspects of the changing seasons are more difficult to express. Some aspects of winter visit increased stress on those in our community. In the Keweenaw we are particularly hard hit by decreased sunshine during the 6 months of winter. In our climate, we average only 185 days of sunshine per year. While 6% of the U.S. population (14,000,000) deal with Seasonal Affective Disorder (SAD) as a result of decreased daylight and subsequent impact on brain chemistry, those who live in harsher climates like the Copper Country are at even greater risk. The research continues to substantiate the experience of those who suffer from symptoms of depression during the winter months. SAD, a form of depression that occurs in relation to the seasons, is marked by decreased energy, oversleeping while still not feeling refreshed, feelings of guilt, anxiety, sadness, poor concentration, overeating with “comfort foods,” lethargy, and overall lack of vitality and interest in hobbies. Physical symptoms may even include lowered resistance to infection. Those not normally affected by depression are still vulnerable, with the symptoms appearing on a wide spectrum from mild to severe. SAD is differentiated from depression by a pattern of onset in the fall or winter months with full remission in the spring and summer months. People who manage depression on a year-round basis are vulnerable to worsening of symptoms during the change of seasons and are prompted to be more vigilant and proactive in self-care and seeking help when needed. SAD is diagnosed when symptoms are severe enough to disrupt work and family life, and cause considerable distress in everyday functioning. An estimated 10% of the U.S. population experience mild symptoms, what is sometimes referred to as the “winter blahs” or “cabin fever.” If you begin to notice the symptoms described here, discuss them with your health care professional. A myriad of strategies are available to manage the symptoms, including mindfulness with diet, exercise, and planning for activities that promote enjoyment of the whole person, body, mind, and spirit. Mild symptoms may be relieved through a daily hour’s walk in the sunlight. For those more severely affected, and/or physically limited in winter walking, phototherapy, or bright light therapy, may bring relief. Used 45 minutes daily, this treatment has shown to lessen or alleviate symptoms in some cases. Lights are available at area pharmacies, including KMMC and The Apothecary, as well as many on-line distributors. Contemplating the feelings associated with the change in seasons is helpful. People with a history of depression may experience anxiety and fear that the cycle of depression will worsen and become unmanageable. Descriptions of depression include, “a long dark tunnel I couldn’t find my way out of,” “exhaustion,” “shame and fear of telling anyone,” “blaming myself because I couldn’t fix this on my own.” The rhythms of the seasons are making themselves heard. If you find that winter brings unwanted changes in your mood and daily functioning, talk to someone. Depression can be frightening and isolating, but worse yet, it is often an unnecessarily kept secret. SAD and depression are treatable. Symptoms can be resolved through new coping skills, insight as to the connection between thoughts-feelings-depression, and in some cases treatment with an anti-depressant. Don’t keep it a secret.
	Self - Care For the Caregiver
	Sarah Baratono LMSW, ACSW - Keweenaw Home Nursing & Hospice Providing care to a loved one may be some of the most satisfying, yet most difficult work you ever are called on to do. Caregiving is an expression of love for someone who is important to you. However when in the role of caregiver, you may feel tied down, lonely, depressed, and mentally and physically exhausted. Caregiving not only involves the task of providing the care, which is difficult enough. It also involves the task of coping, or figuring out a way to keep your head above water. It requires a commitment to caring for yourself physically and mentally not only to enable you to continue to provide care but, just as importantly, to provide quality to your own life. You need to experience joy and not always feel tied down to the caregiving role. As a caregiver, you sometimes become so involved in the day-to-day efforts to keep things going, you may forget to let others know you need additional assistance with providing care for you loved one. Caregiving is a physical challenge. You may not be eating properly. Your sleep may be interrupted. You need to be aware of your body’s needs, particularly food, sleep and exercise. You need food because your body needs fuel in order to perform. Sleep is important as a lack of sleep can contribute to exhaustion and depression. Exercise is very important as it is a guaranteed stress reducer. Caregiving is also a mental challenge. You must cope with so many different feelings and thoughts you may feel overwhelmed. Often you may feel anger and resentment towards your loved one for being sick. Or jealousy at always having you own needs be second to those of your loved one. Realize that these feelings are neither good nor bad, they are just feelings. We are all human and we cannot help but become overwhelmed in difficult situations. It is how you deal with your feelings that is important. Anger or frustration may be the emotions that cause you to seek additional assistance in caregiving. You need to take care of yourself. Doing this is not being selfish. Caring for yourself is for your survival. You deserve to be living a full life even though you are providing care for a loved one. Take time to relax each day, read a book, go for a walk, take a bath, visit with a friend on the telephone. Ask family members for help. When they ask if there is anything they can do to help, your answer needs to be yes. Then tell them just what assistance you need. Natural supports in you life such a family members and friends can be a great source for respite care. While providing care for your loved one you still need to have time away to go to lunch with a friend, attend a church service, a musical performance or a sporting event. The time away will make you a stronger, healthier caregiver. We are fortunate in our area to have several respite care options through local service agencies. This respite care can be affordable and even without cost if you qualify financially. Attend a caregiver support group where you can share and hear stories that may be similar to your situation. Support groups offer emotional support from others experiencing the same difficulties you may be facing. To be a really good caregiver you have to be a really good self-care giver. You need to learn how to ask for help and how to accept help. If you are in need of additional information to assist you in your caregiving journey, contact Aspirus Keweenaw Home Health & Hospice at 337-5700.
	We are Making Strides Against Breast Cancer
	As you know, October is National Breast Cancer Awareness Month, the American Cancer Society is making significant progress in the fight against the disease. Since 1991, breast cancer death rates have declined more than 20%due to widespread awareness of the importance of early detection, greater use of mammography, and better treatments. Breast cancer research has yielded treatments like Herceptin and Tamoxifen - two drugs that lower breast cancer recurrence rates. Aggressive awareness campaigns have led to greater awareness of the need for early detection and greater use of mammography, and tireless advocacy efforts have ensured quality standards for mammography facilities nationawide. Help Continue to Make Strides Against Breast Cancer Join or donate to Making Strides Against Breast Cancer, the American Cancer society's premier community event to raise awareness and dollars to fight breast cancer. While the news in breast cancer is encouraging for the general population breast cancer survival rates are much lower among low-income uninsured, and underinsured women. Help the American Canmcer Society work to eliminate disparities in breast cancer by ensuring that income doesn't determine whether a woman has access to life-saving mammogram. Every day,elected official make important decisions that affect the cancer community. Join the efforts to encourage lawmakers to make cancer a priority. Make a donation to support cancer research, education advocacy, and service. Find out how to reduce your risk for breast cancer.
	cancer.org
	I Can't Take It Anymore! Or can I?
	We can all benefit by reducing stress in our lives. Stress can cause mental, social and physical manifestations including exhaustion, loss of/increased appetite, and headaches, crying, sleeplessness, oversleeping and more. I recently had the opportunity to listen to a sound message from Vicki Conte, Outreach Coordinator from the Wisconsin Parkinson Association. Her message was simple; life presents us with many problems, some of which are out of our control. Accepting certain basic principles of life may help us to manage stress more effectively. The following seven points are taken from Vicki’s talk and writings. 1.Life Is Not Always Fair. There will always be injustices in life. What can you do about it? Work to correct things if you can, but if you can’t, be realistic. Tell yourself that’s the way it is. 2.Some People Will Never Like You. You can be kind, good-natured and friendly and still meet people who dislike you. Knowing that there are people who cannot be won over frees you from an unrealistic goal of getting everyone to like you. 3.You Can’t Change People. People are the way they are. If they do change, it will be their choice and will occur over time. Accepting this will allow you to accept people as they are, and that’s a good basis for a less stressful relationship with them. 4.Life Is A Constant Struggle. Many people believe that once they get through this major difficulty it will be smooth sailing. Not so. Life is a series of problems, but if you see them as opportunities to learn and grow they won’t be nearly as stressful. 5.Things Are Bound To Change. Trying to hold on to the status quo is particularly stressful these days when the world is changing so rapidly. Nothing is forever. Accept the reality that things are bound to change and that change can be good! 6.Getting Older is Inevitable. Many people act as though getting older were a curse, but wrinkles, paunchy tummies and graying hair are a fact of life. Getting older is not only inevitable but it is a process that can truly be enjoyed. 7.The Past Cannot and Will Not Be Changed. There is simply no amount of time, energy, thought or effort that can be put into our pasts to change them. The very best we can do is take from the past what can benefit our life now and let go of the rest. In addition to accepting things beyond our control, there are many ways to help manage stress. Here are a few ideas that you may want to consider. Learn how to best relax yourself. This may mean meditation, breathing exercises, prayer, reading or whatever works for you. Set realistic goals for yourself so you do not become overwhelmed – reduce the number of tasks in your life and selectively deal with tasks in some priority. Don’t sweat the small stuff. Get enough sleep. Do something for others to get your mind off your self. Work off stress with physical activity. Try to be positive. Tell yourself that you can cope rather than how horrible everything is going to be. And lastly the lesson I’ve learned from my dad and other wise relatives and friends: Be grateful for what life provides.
	Know Your Blood Sugar Numbers.......
	Know Your Blood Sugar Numbers. . . Tests to Measure Blood Sugar Control About 30 to 50 % of people with diabetes do not even know they have it. A simple blood test can tell you what your blood sugar is. Testing your blood sugar is the only way to know whether it is too high, too low, or just right. The Finger-Stick Test: For Testing Blood Sugar Using a Blood Glucose Meter A finger-stick test is a simple test using a blood glucose meter to check changes in your blood sugar. The finger-stick test tells you what your blood sugar is at the time you test it. Finger-stick testing using a blood glucose meter helps you see how food, physical activity, and diabetes medicine affect your blood sugar. The readings you get from these tests can help you manage your blood sugar day by day or even hour by hour. Keep a record of your test results and review it with your health care provider. Finger-Stick Testing Blood Sugar Goal Ideal goals for most people with diabetes when finger-stick testing using a blood glucose meter are: Before Meals -- 80-120 mg/dl At Bedtime -- 100-140 mg/dl Your blood sugar goals may be different from these ideal goals. Ask your health care provider what goals are best for you. The Hemoglobin A1c Test: The Best Test for Diabetics for Blood Sugar Control The hemoglobin A1c test is a simple lab test that shows the average amount of sugar that has been in your blood over the last 3 months. Your health care provider does the test by taking a small sample of your blood and sending it to a lab. The hemoglobin A1c test shows if your blood sugar is close to normal or too high. It is the best test for your health care provider to tell if your blood sugar is under control. The hemoglobin A1c goal for people with diabetes is less than 7 percent. A change in your treatment plan is almost always needed if your test result is over 8 percent. The Benefits of Controlling Your Blood Sugar for Life Taking control of your blood sugar level has many benefits. Keeping your blood sugar (also called blood glucose) levels in the normal range can make a big difference now and in the future. In the SHORT RUN, you will: •Feel better. •Stay healthy. •Have more energy. •Prevent the signs and symptoms of high blood sugar such as: feeling very thirsty and tired; urinating often; losing a lot of weight; having blurred vision; and having cuts or bruises that are slow to heal. In the LONG RUN, you will: •Lower your chances of having diabetes problems such as eye disease, kidney disease, and nerve damage. •Enjoy a better quality of life. An Action Plan for Blood Sugar Control There are many steps you can take to control your diabetes for life. Follow this four-part action plan to get your blood sugar under control: 1. Know your blood sugar numbers. Get a complete picture of your blood sugar control with the finger-stick test using a blood glucose meter and the hemoglobin A1c test. 2. Reach your blood sugar goal. Make healthy lifestyle choices with the help of your health care provider. 3. Develop an eating program that work for you to keep your blood sugar under control. Create a food plan to stick with your self-care goals and manage setbacks. 4. Participate in an exercise activity that you enjoy. Exercise can help keep your body in good condition and improve your blood sugar levels. For more information: National Institute of Diabetes…
	www.niddk.nih.gov
	Cooking For One
	COOKING FOR ONE It’s dinnertime and you’re hungry – but the idea of cooking just for you leaves you less than enthused. Perhaps you are a senior adult, and find it difficult to spend a lot of time on your feet in the kitchen preparing meals. You may be looking for quick, easy, nutritious meal ideas to help keep you healthy. Let’s talk about “quick” meal ideas first, in particular, breakfast menu ideas. Microwave cooking is probably the quickest cooking method, but the toaster or toaster oven can be very handy, also. For a quick breakfast, instant hot cereal can be made in the microwave or on the stove. Frozen waffles can be made in the toaster. Other “one minute” breakfast ideas that require no cooking are, peanut butter on whole wheat toast, ready-to-eat cereal topped with sliced banana, or yogurt topped with berries. Plan a variety of these breakfast ideas during the week, and breakfast will not become boring! Lunch and dinner meal planning and preparation require more thought and more time in the kitchen. Finding simple recipes with a small number of ingredients are important, along with serving only 1 – 2 portions. If you are willing to try some of the individual frozen entrees (such as meatloaf, spaghetti) available in the grocery store, these frozen entrees can be used on those days when you really don’t feel like spending much time in the kitchen. Add a cooked vegetable or baked potato, and you have a great meal. You can also prepare one-dish meals, such as stews, casseroles, and skillet meats. Cooking an entire meal in the oven can give you a meal in minutes, actually in about 50 minutes! In a small baking dish, bake one-two pieces of chicken sprinkled with Italian salad dressing before popping into a 400 degree oven for 40-50 minutes. In another small baking dish sprayed with vegetable oil, place a sliced red or white potato. Toss with a light sprinkle of seasoned salt and a few teaspoons of water, cover loosely with foil, and bake at 400 degrees for 40 minutes or until tender. Next, it is time for you to relax while the food cooks in the oven. Add a dinner roll and tossed salad, plus your favorite canned fruit for dessert (or a bowl of ice cream), and you have a complete, nutritious meal. Don’t forget to pour a glass of milk, and then enjoy your dinner! Perhaps at a certain meal, you don’t want to cook or don’t have time to cook; a healthy snack may tide you over until you can spend some time in the kitchen later in the day. Nutritious snack ideas include cottage cheese and peaches, tuna salad on crackers along with a piece of fresh or canned fruit, or cheese, crackers and grapes. Menu planning can be fun. Start by writing down all of your favorite foods, whether they are meats, vegetables, breads, fruits, or desserts. Think of what you eat at your favorite restaurants, or what foods you love at the church social. Write all these foods down, and then start mixing and matching these foods into menus. Eating lunch one or more times a week at the local Senior Center is another great way to add variety to your weekly meals. Plus, you not only eat a nutritious meal, but have the added benefit of visiting with lots of people. Just because you are cooking for yourself doesn’t mean you shouldn’t eat well. Happy cooking! Kathy Setula, R.D., is a registered dietitian, and is contracting with Aspirus Keweenaw Home Health & HOspice to do community nutrition presentations.
	Caregiving: Recognizing Burnout
	Caregiving: Recognizing Burnout Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude- from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need or if they try to do more than they are able- either physically or financially. Caregivers who are “ burned out” may experience fatigue, stress, anxiety, and depression. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved one. Symptoms of caregiver burnout can include withdrawal from friends, family or love ones, loss of interest in activities previously enjoyed, feeling blue, irritable, hopeless and helpless. There may be changes in appetite, weight, or both. Changes in sleeping pattern, getting sick more often, feelings of wanting to hurt yourself or the person you are caring for,emotional and physical exhaustion. Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical and spiritual health. The demands on a caregiver’s body, mind, and emotions can easily seem overwhelming, leading to fatigue and hopelessness - ultimately, burnout. Other factors that can lead to caregiver burnout include role confusion which sometimes is difficult for a person to separate her role as caregiver from her role as spouse, child or friend. Caregivers become frustrated because lack of money, resources and skills to effectively plan, manage and organize their loved one’s care. Some caregivers place unreasonable burdens upon themselves, in part because they see providing care as their exclusive responsibility. Family members can place unreasonable demands on the caregiver and disregard their own responsibilities and place burdens on the person identified as primary caregiver. Thus many caregivers do not recognize when they are suffering from burnout and eventually get to the point where they cannot function effectively and may even become sick themselves. There are several steps you can take to help prevent caregiver burnout. First find someone you trust such as a friend, co-worker, or neighbor and talk about your feelings and frustrations. Set goals and accept that you may need help with caregiving, and turn to others for help with tasks. Be realistic about your loved one’s disease or illness and acknowledge that there may come a time when you will no longer be able to care for them at home alone. Take advantage of a hospice program volunteer to provide respite time. Set aside time for yourself, even if it’s just an hour or two. Remember, taking care of yourself is not a luxury. It is an absolute necessity for caregivers. Seek out professionals who are trained to help you deal with physical and emotional issues. Know your limits and be honest with yourself about your personal situation. Recognize and accept your potential for caregiver burnout. Educate yourself. The more you know about the illness, the more effective you will be in caring for the person with the illness. Develop tools to lighten up and think positive. Humor is a great tool to use with everyday stress! Stay healthy by eating right and getting plenty of exercise and rest. Accept your feelings. Negative feelings such as frustration or anger about your responsibilities or the person for whom you are caring is normal. It does not mean you are a bad person or a bad caregiver. If you detect burnout or want more information, contact a caregiver support group, or a home health service in your area. Karen Kezele is the Volunteer Coordinator at Aspirus Keweenaw Home Health & Hospice.
	To D or not to D? A Look at Vitamin D Supplements
	To D or Not to D? A look at supplementing with Vitamin D. Back in December, with the holidays just around the corner it was easy to blame my increasing fatigue and muscle aches on the stress of the busiest time of year. Unfortunately, when the holidays were over my symptoms didn’t get any better; in fact, they were getting worse. It was getting harder to climb out of bed in the morning and I was having a lot of headaches. I decided I had better see my doctor and hopefully she could help me figure out what was going on. I made my appointment and after talking with the doctor for just a short time she suggested I have a blood test to check my vitamin d level. At the time I wasn’t taking any supplements, just a multivitamin daily. I try to eat a balanced diet so I assumed my level would be normal. Unfortunately it wasn’t, and I soon found out why. We can’t produce vitamin D on our own and unlike many other vitamins and minerals, vitamin D isn’t found in sufficient quantity in many of the foods that we eat. The best way to get it is from exposure to the sun. As we yoopers all know, we can go for many, many days without seeing a glimpse of the sun! When we do get lucky enough to see it we are often covered from head to toe to keep from freezing, so our skin isn’t able synthesize enough vitamin d from this limited exposure. Older people are particularly at risk of vitamin D deficiency because they generally tend to spend less time outdoors in the sunshine. Those who are homebound or live in nursing homes are also at greater risk. During the 1930’s the United States government implemented a program to add vitamin D to milk in order to combat widespread rickets. Caused primarily by vitamin D deficiency, rickets is a weakening or softening of bones. Rickets was a common health problem up until then but since the fortification of milk with vitamin D it is now quite rare. The US milk supply is fortified with vitamin D but products made with milk such as cheese and ice cream are not. People who are lactose intolerant, as I am, must look to other sources of vitamin D in their diet such as salt water fish or fortified cereals. Many scientists and doctors are finding links between vitamin D deficiency and chronic diseases including cancer. It’s been known for years that vitamin D is essential for bone formation, growth and repair but research studies are now showing its importance in cell differentiation and growth. This is a key factor in maintaining a healthy immune system. There is also evidence to suggest that low vitamin D levels play a role in depression, especially seasonal affective disorder, SAD. High doses of vitamin d have proven to be an effective remedy for treating some of the symptoms of SAD. I think we can all relate to how our mood lifts when we see the sun after many dark winter days. Vitamin D is called a vitamin but it is actually a component of a powerful hormone called calcitriol. This active form of vitamin D, or D3, increases the absorption of calcium and phosphorus which are important components of bone structure. Vitamin D is found in other forms in our body so when looking at supplements it’s best to talk to your doctor about which one to take. Fortunately it’s getting toward the time of year when we are starting to see the sun more and everyone’s eager to get out and play. If you’ve been wondering about adding a vitamin D supplement to your diet I urge you to talk with your doctor about which one and how much to take. I’m so glad that I did. Becky Swykert,RN is a Staff Nurse at AKHH&H
	Keep Safe - Know Your Limits
	Keep Safe–Know Your Limits With summer comes all the exciting summer sports. Lake Superior is in a liquid form again and offers numerous possibilities for kayaking, boating , swimming, scuba diving and more. It’s great to try a new sport and sometimes our enthusiasm gets us in over our heads, literally. I know this from experience both as a kayaker and scuba diver. Some of the experiences I have had make me shudder as I think back and realize what the results could have been. But I still continue to enjoy these sports, with a little more insight and respect for our great Lake Superior and trust of my partner. Scuba diving is a great confidence builder. It teaches you how important it is to trust in your partner, but to be independent and not panic when your buddy is not where he should be. This may happen when someone gets excited and scoots to look at something just as you are looking the other way or having trouble with a piece of equipment. This shouldn’t happen, but does. Don’t panic, assess the situation, look for your partner’s bubbles and if need be make a safe, controlled assent to the surface. Your buddy should know the plan. An important part of a dive is the pre-planning and equipment check between you and your partner. Communication is key. Let your dive buddy know what you are thinking and expecting from the dive and check in with each other during the dive. Don’t feel bad about not making or aborting a dive if you just don’t feel comfortable, even if your partner must give up a dive. Diving in this situation only makes for a very uncomfortable and unsafe dive. Besides, this is supposed to be a fun sport. Before the first dive of the year, review the skills you learned in class. Be sure your equipment is in proper working order and get reacquainted with it. Discuss diving with your dive buddy. Plan your dive adventures. I remember a quote from my dive book, “There are old divers and there are bold divers, but there are no old, bold divers.” Well, there are some. Some can’t walk without a cane, some are lucky and only remember the close calls they’ve had. Some have lost wives, friends and dive partners or given up diving due to fear or physical reasons. So stay within YOUR limits, enjoy the sport and keep safe! Get the proper training to expand your limits. Diving will be more enjoyable and safe if you do. Whether your favorite water activity is kayaking, canoeing, swimming or diving, staying within your limits, being trained properly, having the correct safety equipment will make any sport more safe and enjoyable. Remember, Lake Superior is cold and can be unforgiving. Be prepared with life jackets and the proper survival suits and safety equipment. Take a boater safety course, kayaking, scuba, swimming class to make your time in the water more enjoyable. Get out there and enjoy our great lakes and woods. Have a wonderful summer adventure. Be Safe. Colleen Rowe is a Patient Account Specialist at AKHH&H
	Take Practical Steps to Prevent Falls
	Take Practical Steps to Prevent Falls Did you know that after the age of 65 our odds of falling increase considerably? Fortunately most falls aren’t serious. Still, falls are a leading cause of injury among older adults, and research shows that many of these injuries can lead to serious disability and even death. As we age we change physically. These changes, along with various medical conditions, and some medications, can be the cause of a serious and disabling fall. For example an elderly person with severe osteoporosis who experiences dizziness is extremely vulnerable to a fall that may cause serious injury. The dizziness may be an effect of a medication, or it may be caused by an eye or ear disorder. Whatever the cause, the combination of a fall and porous bones can be disabling. Here are some practical steps to take to prevent falls. MEET WITH YOUR DOCTOR. Together you can take a comprehensive look at your environment, health, and medications. Bring a complete list of all medications you are using. Review your fall history. Describe changes in your general health such as eye and ear changes, any dizziness, joint pain, shortness of breath or numbness that affect how you walk. Your doctor may evaluate your muscle strength, balance, and the way you walk. He may wean you off of certain medications. He may prescribe an assistive device for walking and some physical or occupational therapy. KEEP ACTIVE. Get regular physical activity. Consider walking, water exercises or tai chi, all of which improve strength, flexibility, balance, and coordination. Hanging clothes, push-mowing the lawn, gardening, and active hobbies are simple and enjoyable ways to maintain these abilities. Be sure to follow your doctor’s advice. WEAR GOOD SHOES. Evaluate your footwear. High-heels, floppy slippers, shoes with slippery soles, or walking in your stocking feet can cause you to slip or stumble and fall. Buy properly fitting, sturdy shoes with thin nonskid soles. Avoid shoes with extra thick extreme nonskid soles. REMOVE HOME HAZARDS. Take a look around you. Your home may be filled with booby traps. Clutter can get in your way. Try some of these safety tips: Remove newspapers, boxes, phone and electrical cords from pathways. Move magazine racks, coffee tables and plant stands from high traffic areas. Secure loose rugs using tacks, double-faced tape, or a slip-resistant backing. Repair loose floorboards, tiles and carpeting. Store dishes, food, clothing and other necessities within easy reach. Immediately clean spills of any kind. Use nonskid floor wax. Use non-slip mats in your tub or shower. LET THERE BE LIGHT. As you age, your ability to perceive color contrasts, depth, and motion changes. Keep your home brightly lit to avoid tripping on objects that are hard to see. Place night lights in your bedroom, bathroom, and hallways. Consider installing illuminating switches and switches at the top and bottom of stairwells. Then use these switches. Turn on the lights! USE ASSISTIVE DEVICES. Your doctor might recommend that you use a walker or a cane to keep you steady. Be sure to use these correctly or they can become the cause of a fall. Also consider installing grab bars inside and just outside of your tub or shower. Other helpful devices are a raised toilet seat with armrests, a plastic shower bench, a hand-held shower nozzle, handrails on both sides of your stairwells, and non-slip treads on wooden steps. BE MINDFUL AND VIGILANT. Pay attention to how you do things. For example, when you are preparing to sit down on a chair, turn all the way around. Back up to the chair until you feel the edge of the sitting surface with the backs of your legs. Reach with both hands for the arms or surface of the chair as you lower yourself down slowly with control. Sitting haphazardly half on/half off of the edge of a chair is a common cause of falls. There are many things we can do to prevent a potentially disabling fall. We can be mindful and vigilant for those we love as they grow older. We can help them to attain safety as they age by encouraging these steps on their behalf. Let’s all work together to reduce the causes of serious and disabling falls in our older population. By: Dorothy Riutta, Physical Therapist Aspirus Keweenaw Home Health & Hospice
	Why Balance Is Important
	Why Balance Is Important Aging successfully and living in your own home as long as possible is dependent upon maintaining a high level of balance and mobility. Good balance is the foundation for all the physical activities we do around the house and out of doors. Throughout most of our lives we give little thought to balance. The multiple systems that contribute to balance all work “behind the scenes” to keep us steady and safe. About the only time balance is brought into the conscious realm is when we miss a step coming down the stairs, slip on the ice or trip over the edge of the carpet. When the multiple systems that contribute to balance are working well this awareness of loosing our balance lasts less than a second, we regain our balance; avoid falling and move on with our day. Having not given much thought to balance throughout our lives we might be tempted to assume balance is a simple thing. In fact it is very complex requiring many structures, systems, mental processes of our body to be healthy and work together with split second timing and coordination. “Balance can be defined as the process by which we control the body’s center of mass (COM) with respect to the base of support, whether this base of support is stationary or moving.” (From: Fall Proof by Debra J. Rose) In other words, keeping our body upright when the environment around us and surface below us may be moving or changing. The multiple systems used to maintain balance involve three major components: sensory systems, motor systems and cognitive systems. The control center for our balance is our brain. In here our cognitive system resides. It receives information from our environment via the sensory system, interprets it and sends out instructions via the motor system to our muscles, which keep us steady as we stand in place or move. The sensory system is made up of our vision, vestibular (inner ear) and the somatosensory system, which is made up of our sense of touch, pressure, and the actions/positions of our joints and muscles. The motor system is primarily our muscles. Acting on sensory information arising from the environment our brain sends signals to our muscles to tighten and keep us steady and or to move to avoid a fall. In order to perform its task well, the cognitive system must be able to act quickly, know when a challenge to our balance is threatening our safety and requires a dramatic response like taking a quick step or a minimal response like tightening our ankles or bending forward at the waist and hips. The cognitive system stores past experiences in memory. For example, if you slipped on the ice and fell last winter the stored memory of this will change how you anticipate and approach an icy patch this winter. Normal aging leads to changes to many systems contributing to balance and mobility. Even without a major disease we lose some flexibility of our joints and muscles. Strength can decrease and the number of sensory nerves sending vital information to our brain decreases. These normal effects of aging can be made worse by diseases such as a stroke, Parkinson’s, low blood pressure, diabetes, Alzheimer’s etc. However, our bodies are amazingly adaptive and despite our age or health problems can change and modify. While changes are inevitable with normal aging there are things we can do to help improve or maintain balance which is so necessary for our safety and ability to live independently. Always remember the old saying, “If you don’t use it you’ll lose it.” This statement pertains to all systems of our body, including our brain. Balance can be improved or maintained by staying as active as possible. Walking is the most important activity you can do. If you can’t get outside easily or safely then walk laps around the inside of your home. Marching in place is also helpful. Obtain some weights and develop a strengthening program for your arms and legs. Of course, if you have a disease or injury and it has become unsafe or difficult for you to get up and move or exercise then a physical therapy referral to assess your needs and develop a safe and effective program may be needed. By: Colin Munn, Physical Therapist Aspirus Keweenaw Home Health & Hospice
	Assisting the Body to Heal Wounds
	WOUND MANAGEMENT The evolving and revolutionary change in wound care has resulted in many new advancements and treatments. In 1650 B.C., the Egyptians created the first adhesive bandage using gum and linen strips to draw wounds together. In 1000 B.C., the jaws of ants were used and stretched across wounds to help draw the edges together. In 1600 A.D., wound care became focused on maintaining a dry environment, using dressing materials made from cotton, paper, feathers and dust. Then, in 1962, George Winter Ph.D., of University of London, questioned if allowing wounds to dry out was the best method of healing. He conducted a study by creating partial thickness wounds on the backs of pigs. Portions of the wounds were allowed to dry out and form scabs, while others were covered by polymer film. The wounds covered by polymer film healed twice as quickly as wounds exposed to air. We now know that moist wound healing is essential to promote healing. There are numerous new wound products and dressings that not only promote moist healing, but also help to prevent contamination and trauma, absorb drainage and manage pain. Vacuum – assisted therapy and dressings with antimicrobial properties or growth factors are examples of some wound care products available today. Maggot therapy for debridement of wounds is becoming more common. A wound is defined as a break in the skin. A wound may result from an accident, surgery, and exposure to heat, sun or chemicals. It can range from a minor wound to a more involved wound with deep tunneling, such as a pressure ulcer (which is caused by unrelieved pressure over bony areas on the body). Catagories of wounds include surgical, stasis (venous) ulcers, arterial ulcers, traumatic wounds, diabetic ulcers, and pressure ulcers. Each wound requires different treatment options and strategies. For example, most surgical wounds are healed with sutures or staples, and heal without problems or complications, whereas a diabetic ulcer may take weeks to months to heal. Wounds are also classified as being acute or chronic. Acute wounds heal quickly and in a timely manner, whereas chronic wounds have delayed wound healing possibly with complications. Some common complications of wound healing include infection, hemorrhage, (bleeding), dehiscence (separation of skin and tissue layers), and fistula formation. Other factors that can affect wound healing include age (older adults are more prone to wound development and decreased healing), nutrition, oxygenation, certain medications, smoking (significantly reduces the amount of oxygen in bloodstream), and acute and chronic diseases. Wounds can be very painful as well as costly and difficult to treat. Pain management is an important aspect of wound care management. Care providers need to assess the patient’s present pain management and its effectiveness. Along with pain management, the financial, psychological and social implications related to wounds needs to be addressed. Patients with chronic wounds may face significant life changes and challenges. Skilled home care and Hospice nurses and Physical Therapists play an important role in effective prevention and wound management. The home care nurse/PT, works with the patient’s doctor in planning the overall wound care treatment to promote optimal wound healing. Whereas the goal in home care is healing, the goal in Hospice may be focused more on comfort, and preventing further wound deterioration. Prevention of wounds is always at the forefront in the home setting. Skilled nurses and therapists can provide the patient and caregivers with the resources and education needed to help in prevention of skin breakdown and wound development. Wound assessment includes assessing the “whole patient”, not just the wound. Wound assessment provides a baseline by which the patient’s plan of care is made. This includes reviewing wound treatments and its effectiveness, assessing healing potential and performing risk assessment for potential problems. It also includes assessing environmental, nutritional factors, and promoting wound healing by controlling or eliminating causative factors. The wound care nurse can make recommendations for treatments and equipment to promote or improve wound healing. Wound care continues to change dramatically with new technological advancements, and new wound care products becoming available or improved upon almost daily. Wound care management can be performed by a nurse or therapist in the home, hospital, out-patient clinic, or in a nursing home. Cindy Griffin, BSN, WCC and Jean Makinen, RN, WCC Certified Wound Care Specialists at Aspirus Keweenaw Home Health & Hospice.
	If I Can Do It, So Can YOU!
	If I Can Do It, So Can You! Isn’t “obesity” an awful word? Certainly they can’t be talking about me when they use that word! Yes, I used to have difficulty stepping up the curb. And so what if I looked for a table rather than a booth at the restaurant, and for a chair that didn’t have arms. It was just more comfortable, that’s all. Sitting on low couches, forget it! And at the Rosza Center, just why didn’t they make those seats more comfortable? I had to pull in my shoulders and it was actually painful to squeeze my butt into that seat. On an airplane I had to sit sideways so as not to crowd the person next to me. And wearing seatbelts in planes and cars was miserable. Come to think of it, I couldn’t keep up with anyone walking – that would take the wind out of me, not to mention the pain it caused in my feet. And stairs were actually frightening! My energy level and physical agility were not quite like my friends; in fact, turning over in bed was major physical activity. None of this hit my consciousness until I had to go to extra-wide shoes! I always prided myself on having small hands and feet. What happened? Here I am a senior citizen and now I have “fat feet”. I can’t tolerate that! I remember the day my doctor asked me, “How can I stress enough the importance of losing weight?” Physicians want patients with weight concerns to seek medical advice because they know they need help, but at the same time they don’t want to turn them away. They know that diabetes, high blood pressure, acid reflux, heart disease, gall bladder disease, lung disease, depression, sleep apnea, arthritic joint disease, and over-active bladder are direct results of being over-weight. Was my inability to lose weight a lack of will power? I always thought “food is love”. In our culture, we tend to celebrate everything with food! Just how did this happen to me? Power eating, binge eating, boredom, lack of self esteem – (I’m not sure which came first, the low self esteem or the weight) – or just lack of knowledge about the right way to eat? Maybe all of the above. So the challenge was on. And believe me, it was a challenge! With the help of a couple of doctors, a surgical procedure, and much learning on healthy lifestyle changes, I knew what I had to do and I was up for the challenge. For me, portion control was an important part of the change. Label reading began with looking at the serving size. Sure, one serving of pop is only 100 calories, but most bottles of pop are 2 ½ servings – if you drink the whole bottle, it’s like eating 16 teaspoons of sugar!! A balanced diet with a variety of foods in small portions helps maintain a healthy weight, prevents chronic disease, and energizes us to meet life’s demands. Drinking water is also important. Yes, eight whole glasses a day. It’s amazing how that decreases the appetite. And like it or not, exercise must be a part of the plan – just walking will do fine. I can remember thinking, “I can’t walk any distance.” Well, I started small and slow and before I knew it, the distance got greater and the pace got faster. I was really surprised that the more I did the more energy I had. Energy actually begets energy! And now, a year later and 140 pounds lighter, I can sit in that booth and I don’t mind putting on a seat belt, even with a winter coat on! I still may not be able to walk fast, but at least I’m not dying of shortness of breath trying. When I use a mirror to see the back of my hair, I have to look twice because that double chin isn’t there. Is that really me? Not bad at all! So the bottom line REALLY is, “If I can do it, so can you!” Judy Karvakko, RN, is a staff nurse at Aspirus Keweenaw Home Health and Hospice.