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Talking while the cuff is on can boost your blood pressure reading. So can a full bladder or crossing your legs. (For Spectrum Health Beat)

Mum’s the word the next time you have your blood pressure checked.

Talking while the cuff is on can boost your blood pressure reading. So can a full bladder or crossing your legs, the American Heart Association says.

“These simple things can make a difference in whether or not a person is classified as having high blood pressure that requires treatment,” said Dr. Michael Hochman, a member of the heart association’s blood pressure task force. He’s also an associate professor of clinical medicine at the University of Southern California.

Our Take

Blood pressure should be measured during every physical exam, and more often if you have abnormal readings.

An accurate reading is important. A reading of 120 over 80 is where prehypertension begins, and 140 over 90 is where hypertension begins for most healthy adults. When the top (systolic) number is between 120 and 139, and/or the bottom (diastolic) number is between 80 and 89, your reading is in the prehypertension range.

“Prehypertension is a warning sign,” said Thomas Boyden, MD, a cardiologist with Spectrum Health Medical Group. “It means that you’re at a greater risk of chronic high blood pressure. Depending on your blood pressure and risk factors for heart disease, you may only need to make a few lifestyle adjustments.”

Dr. Boyden, a heart disease prevention expert, said these small lifestyle changes can help delay progression to high blood pressure and the need for medications.

“Knowing how to measure blood pressure accurately at home, and recognizing mistakes in the physician’s office, can help you manage your pressure and avoid unnecessary medication changes,” Hochman said in a heart association news release.

Here, the heart association outlines seven common culprits that can alter your blood pressure reading.

  • Having a full bladder can add 10 to 15 points to a blood pressure reading. Always try to use the bathroom before getting a reading.
  • Poor support for your feet or back while seated can raise your blood pressure reading by 6 to 10 points. You should sit in a chair with your back supported and feet flat on the floor or a footstool.
  • Crossing your legs can add 2 to 8 points to your reading.
  • If your arm hangs by your side or you must hold it up while getting a reading, your blood pressure numbers may be 10 points higher than the actual figure. Your arm should be on a chair or counter so that the blood pressure cuff is level with your heart.
  • Having the cuff placed over clothing can add 5 to 50 points to your reading. The cuff should be on a bare arm.
    A too-small cuff can add 2 to 10 points to a reading.
  • Talking can add 10 points to your reading. Remain still and silent while your blood pressure is taken.
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El programa científico All of Us es un proyecto de los Institutos Nacionales de Salud (NIH, por sus siglas en inglés) que busca acelerar la investigación médica para lograr mejorar la salud de personas de todos los orígenes. (Chris Clark | Spectrum Health Beat)

A fines de los años cuarenta, justo después de que terminara la Segunda Guerra Mundial, Estados Unidos tuvo que enfrentarse a un enemigo mucho más mortal aun.

La enfermedad cardíaca.

En el universo de la posguerra, donde los avances en el conocimiento médico habían dominado ya a las muertes causadas por enfermedades infecciosas, la enfermedad cardiovascular emergió como la principal amenaza, reclamando al año más de la mitad de las muertes entre los adultos de EEUU.

En 1945, un año después de que terminara la guerra, la enfermedad cardíaca hipertensiva y un accidente cerebrovascular, cobraron la vida del presidente Franklin Roosevelt. Tres años más tarde, su sucesor, Harry Truman, reconoció la inminencia de la amenaza y firmó un decreto que destinaba 500 mil dólares para la realización de un estudio sobre enfermedades cardíacas a lo largo de 20 años.

Esa investigación profunda se tradujo en el estudio cardíaco de Framingham; mismo que reunió 5,200 hombres y mujeres que fueron sometidos a examinaciones periódicas, tomando en cuenta las mayores causas de las enfermedades cardiovasculares.

La investigación cumplió los 20 años, pero siguió. Incluso más allá de la fecha límite. Gradualmente se inscribió a los hijos y nietos del grupo inicial. Setenta años más tarde, Framingham continúa recabando datos.

El estudio ha servido y ha extendido su función en el fortalecimiento de la medicina moderna y la comprensión de las afecciones cardiovasculares, según Dave Chelsa, director de investigación operativa en el Biorepositorio Universal de Spectrum Health.

«No es muy grande, ni diverso, pero es valioso porque esas personas fueron seguidas a lo largo de sus vidas» dice Chelsa. «Sabemos lo que sabemos sobre la enfermedad cardiovascular generalmente como resultado de la intervención de ese pequeño grupo».

¿Por qué es importante esa pequeña reseña histórica? Es una perspectiva útil.

Los inicios de la investigación Framingham son humildes, pero se convirtió en un estudio multimillonario de más de 70 años, (más lo que se acumulen).  Se ha consolidado como un depósito importante del conocimiento médico.

Hoy, en esta época innovadora donde todo es tecnología, Estados Unidos busca extender el concepto de forma exponencial.

En vez de 5,200 participantes, se busca a un millón.

En vez de 500 mil, se invertirán 1,500 millones de dólares.

Y comienza con una década de estudio. Que además no limita su enfoque en la enfermedad cardíaca. En cambio se concentra en la salud general—buena, mala, todo cuenta. Se encuestan a todos los grupos raciales, sin distingos de género o condición socioeconómica.

Finalmente, se empaca toda esa información concedida de manera voluntaria—muestras de sangre, información del genoma, encuestas personales de salud—y combinada con tecnología de punta se criba y analiza para lograr perspectivas sobre condiciones de salud y bienestar en toda la nación.

De funcionar como se pretende, el programa científico All of Us, Framingham será, lo que la tienda de abarrotes de la esquina, es a Amazon.com.

Historias compartidas

El programa científico All of Us es un proyecto de los Institutos Nacionales de Salud (NIH, por sus siglas en inglés) que busca acelerar la investigación médica para lograr mejorar la salud de personas de todos los orígenes.

El sitio web del programa lo resume inteligentemente: es «una iniciativa de participantes comprometidos, fundamentada en datos duros que apoyan la investigación en la intersección de la ecología humana, conducta, genética, medio ambiente, Ciencia de datos, computación y mucho más; para producir nuevo conocimiento con el objetivo de desarrollar maneras más efectivas para tratar enfermedades».

Suena maravilloso y simple en un enunciado. Pero es colosal logísticamente hablando.

A diferencia de la mayoría de los estudios de investigación, mismos que se centran en una enfermedad especifica o una población objetivo, el programa científico All of Us no se limita a condiciones de salud o características personales, indica Chelsa.

Se concentra agudamente en acumular datos sanitarios e información genómica de personas  de todo tipo, para después procesar los datos y entender a profundidad qué conduce a la buena (o mala) salud.

Ahí es que cabemos TODOS.

Desde luego que no importa lo maravilloso que pueda ser su dispositivo electrónico, aun así se requiere de historias conmovedoras de la gente, si de llamar la atención se trata.

De modo que ahí hablamos de NOSOTROS.

«Los participantes y sus colaboradores, nos hace únicos» dice Chesla.

«Frecuentemente, las investigaciones tienen un enfoque de orientación a la enfermedad. Se tienen estudios que investigan un cáncer especifico, o un elemento cardiovascular muy particular».

En esos estudios, los investigadores buscan desarrollar nuevas tecnologías y tratamientos. En All of Us, según Chesla, los investigadores buscan compartir datos con otros investigadores—y los participantes del estudio.

Es un nivel de transparencia poco común, dice Chesla.

«No solo puede usted participar, también es bidireccional el flujo de la información y eso es verdaderamente lo que distingue este programa» anotó. «Como participante, usted puede ir a internet para consultar su portal, ver su información e incluso obtener nuevos datos sobre usted mismo».

En alcance y extensión, el proyecto es ciertamente inigualable.

«Realizar un estudio poblacional de esta naturaleza, donde todo mundo que vive en los Estados Unidos puede participar, y es agnóstico al estado de enfermedad o bienestar, simplemente es único» insiste Chesla.

El Oeste de Michigan es actualmente uno de los mercados pilotos, atendido por Spectrum Health. La inscripción está abierta a personas mayores de edad que viven en EEUU, y son o fueron pacientes de Spectrum Health.

La inscripción estará abierta para todos a finales de la primavera.

Las personas interesadas pueden inscribirse en cualquiera de nuestras siete ubicaciones, o bien pueden empezar esta jornada en la página de Spectrum Health All of Us. Ahí contestará una pequeña encuesta y después puede elegir la ubicación que le resulte más conveniente para dar las muestras de sangre y orina que se requieren.      

Medalla de honor

Steve Heacock, vicepresidente sénior de mercadotecnia y relaciones públicas en Spectrum Health, tuvo el honor de ser el primero en inscribirse en All of Us. Un empleado de Spectrum Health tomó su muestra de sangre en una de las ubicaciones donde se lleva a cabo la prueba y ahí contestó su encuesta».

«Eso es todo lo que hay que hacer» dijo. «Estamos en la primera etapa».

A Heacock le entusiasman los grandes resultados de este programa, y no necesariamente por lo que significa para él.

«Se trata en realidad de abonar a este gran esfuerzo, es un gran paso hacia adelante en ciencia e investigación» indicó, aludiendo a su participación como una medalla de honor.

«Contribuir a ese cuerpo de la ciencia que va a servir para la innovación es algo muy positivo» indicó.

Según Heacock, todos somos una pieza en algo más grande que nosotros mismos. Su participación en All of Us sería una pequeña pero valiosa contribución hacia ese gran propósito.

«Se da uno cuenta, ‘soy parte de una corriente continua’» dijo Heacock. «Es solo una vida, y una vida es importante y significativa, pero de pronto se desvanece entre todas las demás».

Pensémoslo así: recordamos a nuestros abuelos, y quizás a nuestros bisabuelos—pero,  ¿y los padres de los bisabuelos? ¿Y los de los tatarabuelos? A partir de ahí la historia se complica.

«Entonces, generación tras generación, seguimos avanzando» dice Heacock. «Pero no significa que han desaparecido. Es una corriente continua. Estas cosas del ADN lo comprueban, cuando se pueden investigar tiempos remotos. Es emocionante».

El programa científico All of Us está «informando esa corriente» indicó.

Incluso cuando los investigadores cumplan con su meta de un millón de personas inscritas—y participando en forma estrecha—tendrá que ser rápido y sencillo.

Según su descripción inicial, los arquitectos del proyecto lo diseñaron así.

«Yo no lo veo como un obstáculo a futuro de ninguna manera» dice Heacock. «Lo haré por el resto de mi vida. Es una encuesta anual que resulta fácil contestar si pone usted atención a sus asuntos médicos».

El compromiso es mínimo, si se trata de tiempo, dijo.

«No se tarda uno nada» indicó Heacock. «Se trata de que me permite acceso a mi información. También les permite el acceso a mi expediente médico, porque se necesita la perspectiva completa».

Lo mejor de todo, dijo Chesla, cada participante puede diseñar su propia trayectoria.

«Su nivel de participación podría ser, el primer día ‘yo di las muestras de sangre, y contesté la encuesta en línea, y ahora no estoy interesado en el tema porque tengo hijos’ o porque estoy enfermo o ese es simplemente el nivel de participación que deseo» indicó Chesla.

Usted entonces puede optar salir.

«Esto no significa que usted no podrá ver sus resultados» dijo Chesla. «Solo significa que usted no desea participar».

O bien, usted puede continuar y participar de lleno.

«Usted puede convertirse en el participante ejemplar que contesta la encuesta por diez años consecutivos y continua haciéndolo todos los años, porque eso permitiría la medición estadística de los investigadores» dijo Chesla. «He incluso puede ser seleccionada para un estudio transversal».

Uno de ellos incluye la provisión de los dispositivos portátiles Fitbit a 10 mil participantes.

«Los 10 mil participantes tendrán que regresar para que se les pruebe el dispositivo, después tendrán que aprender cómo usarlo y deberán asegurarse de tener el equipo adicional necesario en casa—WiFi, o una computadora para cargar la información» indicó Chesla.

El nivel de participación de las personas determina no solo el valor a la ciencia sino la proposición de valor que tiene para aquellas personas que participan.

«Entre más participen, mayor información» dijo Chesla. «No es un truco para engancharle. Al final del día, se trata de estudios que funcionen—entre más sabemos de un individuo en determinada población, mejor podemos analizar los datos para identificar temas en común o los hilos de su enfermedad y cofactores».

La campaña All of Us incluso ha creado una página de web donde los participantes pueden sugerir ideas novedosas para  el estudio de esos datos.

Es un estudio detallado

Los estudios de investigación médica típicamente encuestan cientos o acaso miles de personas—no decenas de miles, o en este caso, un millón.

Lo destacado de All of Us es la colección de datos de amplia escala para su análisis. Un estudio estadístico de esta magnitud permitirá a los investigadores a hacer predicciones detalladas sobre el impacto de ciertos tratamientos en cierto tipo de persona.

Para lograrlo, se consultan los datos de poblaciones clave, sin importar que tan grandioso o granular se tenga que ser. Un «enfoque no discriminatorio» que se nutre de la diversidad de los participantes puede brindar el más robusto de los muestreos. Indicó Chesla.

«Los Institutos Nacionales de Salud han sido muy específicos con su aplicación» añadió. El programa científico All of Us representara en exceso a las poblaciones que tradicionalmente están subrepresentadas en la investigación biomédica».

Quizás no sea sorpresa que los participantes originales del estudio de Framingham fueran principalmente blancos.

«Ochenta por ciento de ellos eran hombres caucásicos» dijo Chesla.

Las poblaciones rurales, urbanas, pobres y minoritarias han estado históricamente subrepresentadas en la investigación científica, dijo Chesla.

Lo último que quiere el NIH es atender a las mayorías sobre las que se tienen datos en abundancia.

Heacock enfatizó este punto.

«Piense en la experiencia de las comunidades de color, en cómo fueron tratadas y dónde están, y en la desconfianza que debe superarse» acotó Heacock. «La única forma en que esta ciencia va a ser aplicable en general es si todos participan. Si hacemos esto bien, estaremos en mejor condición».

Dijo Chesla: «Carecemos de diversidad, también en lo socioeconómico, porque las personas que no tienen seguro no participan en ensayos clínicos y, generalmente, Medicaid no cubre eso».

Y luego está el factor de la edad.

Dada la naturaleza, generalmente, reactiva de la medicina no hay tanta información médica sobre poblaciones menores de 65 años.

El programa científico All of Us proviene de la Iniciativa de Medicina de Precisión, una idea de la administración Obama para promover de forma proactiva la atención médica personalizada a las características y necesidades individuales.

Esto significa que todos nosotros, por definición, buscamos ser más diligentes e inclusivos.

«Todos son iguales en este programa» dijo Chesla. «Un joven de 18 años que es saludable y tiene conocimientos tecnológicos, se ha inscribe para permanecer en el programa durante 10 años, es tan ventajoso para la investigación como un hombre de 89 años que es modelo de salud y ha vivido 12 años más que el hombre o la mujer promedio en los Estados Unidos».

Igualmente, un hombre de 89 años luchando contra una serie de dolencias también es bienvenido.

« ¿Por qué algunas personas sucumben a una enfermedad y por qué algunas personas la superan?», preguntó Chesla. «Éstas son preguntas a las que no podemos respuesta actualmente».

Podemos ver de lado a lado, pero a nivel poblacional no podemos descifrar los indicadores que muestran cómo responderá alguien a tratamiento o cómo podemos involucrarlos cuando se encuentran bien, para así mantener el bienestar y cuidar verdaderamente la «salud» y no la «enfermedad».

En relación al tamaño, alcance, ambición y capacidad, el estudio científico All of Us no tiene precedentes en su objetivo de descubrir estos indicadores ocultos.

«Extienda este esfuerzo a un millón de personas, pero con intencionalidad en geografía, diversidad, o cómo sea que se desee medir—añada el elemento moderno de la tecnología—y el resultado será único y especial» concluyó Chesla: «Este es un programa de 1,500 millones  de dólares a lo largo de diez años con alcance de un millón de participantes».

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Health Beat | Spectrum Health by His Right Side Once Paralyzed By A .. - 2d ago

One evening, 9-year-old Fabian Vasquez competed in a wrestling match, pinning an opponent to the mat.

Just an hour later, at home, he suffered a headache that hurt so much it made him cry.

He got dizzy. He threw up. As his parents prepared to bring him to an emergency room, he dropped to the floor, paralyzed on the right side of his body.

A tangle of blood vessels in Fabian’s brain had suddenly begun to bleed. The results could have been catastrophic.

But two months later, Fabian walked into the neurosurgeon’s office at Spectrum Health, wearing sweats and sneakers, moving with the quick step of a boy eager to get the appointment over, so he could return home to play.

It was almost like there was an angel sitting on our shoulders.

Stacy Vasquez
Fabian’s mother

He showed off the surgery scar on the top of his skull, now partially covered with hair.

“They call me the million-dollar head,” he said with a grin.

“He’s doing really good. He’s pretty much got his whole right side back,” said his mother, Stacy Vasquez. “It was almost like there was an angel sitting on our shoulders.”

Seeing Fabian’s dramatic comeback is just as gratifying for Justin Singer, MD, the vascular neurosurgeon who operated on Fabian.

“For him to be back at school only two months afterward, and to be able to ride his bike and do his activities—things like that are why we go to medical school,” he said.

A bleed in his brain

Fabian, now 10 years old, is the youngest of four children, from from Hart, Michigan. An outdoors kid, he loves helping his dad, Heraldo Vasquez, who manages a large fruit and asparagus farm.

“Fabian is not a sit-down kind of kid,” Heraldo said. “He likes to work. He likes to ride snowmobiles. He likes to do anything active.”

And he loves wrestling. He started the sport at age 4.

Neither he or his parents knew that in his brain lay a tangle of arteries and veins called an arteriovenous malformation—or AVM. An AVM can exist for years without issue. But sometimes the area where the arteries and veins come together becomes weakened and it begins to bleed.

That’s what happened with Fabian. There was no sign of a problem until after his wrestling match on Jan. 13, 2018.

His parents rushed him to a nearby hospital. The staff contacted Spectrum Health Aero Med to transfer him to Helen DeVos Children’s Hospital in Grand Rapids, Michigan.

But the Aero Med helicopter could not make the trip on that snowy, winter day, so Fabian went by ambulance.

Artur Szymczak, MD, a pediatric neurosurgeon, determined he was stable when he arrived, but could not move the right side of his body. He ordered a CT scan, which identified a large hemorrhage on the left side of the brain, in an area that affects sensation and movement.

An angiogram showed there might be an AVM, but there was so much pressure and blood that the results were not definitive, said Dr. Singer, director of vascular surgery for Spectrum Health Medical Group.

Fabian’s parents struggled to see their son sedated, on a ventilator. Their little wrestler could not move his right arm or leg.

“We didn’t know if he was ever going to breathe on his own,” Stacy said. “He was such an active child. To see him like that was hard.”

Five days later, they performed another angiogram and identified the AVM. The next day, Dr. Singer performed surgery.

Almost immediately after surgery, he actually was able to move better.

Dr. Justin Singer
Vascular neurosurgeon

Before surgery, Fabian was alert and able to talk to his parents. He told them he was terrified of dying. He begged his mom and dad to accompany him to the operating room.

His mom, a nurse, tried to explain why they could not go with him. “We said, ‘It’s a clean place. Only the doctors can go in there.’ He said, ‘Then take a shower.’”

As Fabian went into the operating room, his family prayed.

In surgery, Dr. Singer removed the AVM, as well as the blood that had pooled in his brain.

“Almost immediately after surgery, he actually was able to move better,” he said. “And part of that was related to the fact that the motor fibers weren’t under so much pressure from the hemorrhage that was there.”

A 10th birthday party

Fabian quickly improved. Two days after surgery, he transferred to Mary Free Bed Rehabilitation Hospital for rehab.

And he met his goal to return home by his 10th birthday—Feb. 21. His dad threw a surprise party for him at the VFW Hall in Hart. More than 300 family and friends joined the celebration.

“We are happy to have him home,” Heraldo said.

On March 13―two months to the day of his brain bleed—Fabian arrived for his follow-up visit with Dr. Singer and physician assistant Olivia Rivera, PA-C.

He had already graduated from a wheelchair, walker and brace. He was back in school. He could ride his BMX bike again.

“It’s amazing,” his mom said. “I will feel forever grateful to Dr. Singer.”

He climbed on the exam table and lay face-down, propping his head on his arms, so Rivera could remove stitches from the incision.

“This better not hurt,” he said.

Fabian and his mother talked about a few signs of his illness that remain. Sometimes, he has trouble finding the word he wants to say. And his right foot drops a bit.

“I’m not as strong as I was,” Fabian said. “My right leg is not as strong.”

But he has already come a long way in a short period of time. The brain can continue to heal for a year after an injury from a hemorrhage, Dr. Singer said.

“He still has much time to heal and improve,” he said. “Kids are much more resilient than we are as adults.”

The location of Fabian’s AVM helped in his recovery. If it had occurred a little farther forward in the brain, it might have permanently injured parts of the body that control movement.

“He was potentially in a place where he could have been neurologically devastated the rest of his life and be paralyzed on that right side,” Dr. Singer said.

Fast action also helped. He praised Fabian’s parents for quickly seeking medical care when his symptoms occurred. He hopes it will set an example for others to follow.

“If something really unusual occurs for a loved one, or for you, people should get help quickly,” he said. “That’s when we can do something about it.”

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Health Beat | Spectrum Health by Getting A Move On Also Lowers Body .. - 2d ago
Federal health guidelines urge us to spend half an hour each day moving with enough vigor to boost the heart rate. But half the U.S. population fails to squeeze in time for it. (For Spectrum Health Beat)

Exercise can help prevent many chronic illnesses as well as make it easier to manage health conditions, from diabetes to joint pain.

In terms of prevention, aim for the recommended 150 minutes of exercise, like brisk walking or cycling, each week. Along with eating a healthy diet, this can cut your risk of diabetes by more than a third, plus increase your level of good cholesterol. Exercise also lowers body weight, blood pressure and triglycerides, thus reducing key risk factors for heart disease.

If you’re already managing a chronic illness, exercise may improve symptoms and reduce the amount of medication you need to take. It builds muscle, which helps you move more easily, and reduces stress, which can aggravate many health conditions. Back pain and arthritis improve with the right stretching and exercise plan. If you have diabetes, exercise can improve blood sugar control.

Our Take

To encourage us to make exercise a priority, Thomas Boyden, MD, a Spectrum Health Medical Group preventive cardiologist, details the many ways physical activity makes our lives better.

His top 10 reasons to exercise can provide a motivational boost to put down the smartphone and pick up the pace.

Routine exercise:

  • Lowers blood pressure
  • Lowers blood sugar
  • Helps control cholesterol
  • Builds bone strength
  • Helps prevent dementia
  • Fights depression, stress and anxiety
  • Improves balance
  • Reduces risk for heart attack and stroke
  • Aids weight control
  • Helps you sleep better

Exercise does not have to mean running a marathon, Dr. Boyden said. But it should involve activity more vigorous than a leisurely stroll.

Exercise’s health effects on:

  • Heart disease: Regular aerobic exercise and interval training in particular are heart-healthy, boosting cardiovascular fitness.
  • Back pain: Core exercises strengthen the muscles around your spine, creating better support for your spine.
  • Arthritis: Exercise enhances the muscles that support your joints, making movement easier; it also eases stiffness.
  • Diabetes: Exercise helps you use insulin more effectively and lower your blood sugar level.
  • Asthma: Exercise can help control attacks.

If you’re managing an illness and haven’t been active, talk to your doctor about what exercises are safe, any precautions to take, what kind of discomfort is normal, and what are signs to stop, like feeling dizzy, short of breath or chest pain.

Working with your doctor is especially important when you have diabetes. Because exercise can affect blood sugar, you’ll need to take precautions to prevent blood sugar from becoming too low during workouts.

In terms of intensity, start off slow—that means you should be able to talk, but not sing, when working out.

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Health Beat | Spectrum Health by A Little-known Condition During Pre.. - 3d ago
When Spectrum Health physician assistant Shana Strantz experienced itching on her palms and feet toward the end of her pregnancy, she quickly suspected cholestasis. (For Spectrum Health Beat)

Ever hear of cholestasis of pregnancy?

I recently talked with Shana Strantz, a physician assistant in the OB/GYN office at Spectrum Health Gerber Memorial, about her own experiences with cholestasis.

Strantz has an interesting story that pregnant moms may want to hear about.

As a physician assistant, she sees patients for prenatal care, postpartum care, annual female exams, contraception counseling and other gynecologic matters. While she doesn’t perform deliveries, she treats patients throughout their pregnancies and in the postpartum period.

But Strantz is also a new mom herself—she gave birth to a beautiful little girl, who is now 10 months old.

Her experiences during her pregnancy were somewhat unique.

She had a great pregnancy overall and she felt fortunate to avoid any nausea or vomiting. She had the normal fatigue and aches and pains one would expect with pregnancy.

She offered to talk to me about her experiences with cholestasis.

Q: What happened toward the end of your pregnancy? What symptoms did you experience?

At about 34 weeks gestation, I started to have very mild itching of the palms and soles of my feet, which seemed to be worse in the evening. Had I not worked in obstetrics and gynecology, it may have been easy to just disregard my symptoms and think nothing of it.

Fortunately, I know about cholestasis of pregnancy. I brought up my symptoms to my obstetrician, Melissa Bayne, DO, of Spectrum Health Gerber Memorial. She ordered the necessary blood work to check for cholestasis, which are bile acids and liver enzymes.

My labs were initially normal. I continued to have symptoms, so my labs were repeated a week later. My bile acids were elevated, double normal, and my liver enzymes started to rise.

She then started me on a medication to improve my symptoms, scheduled twice weekly non-stress tests to monitor my baby and scheduled for an induction between 36 to 37 weeks gestation.

From such a normal healthy pregnancy to all this, it was quite a shocker and quite overwhelming and scary.

Of course, I was also excited—hey, I got to meet my baby earlier than expected. However, I had the extra worry about the increased risk of stillbirth and the risks of induction. I went on to have a successful induction and a healthy baby girl!

Q: What should other pregnant women watch for?

Intrahepatic cholestasis of pregnancy is a transient liver condition that develops in pregnancy with symptoms onset typically in the late second trimester and third trimester.

Symptoms include generalized itching of the skin, most commonly of the palms of the hands and soles of the feet. Symptoms tend to be worse at night.

It typically does not have a rash associated with the itching. The symptoms can be treated with a medication, although the condition can increase the risk of stillbirth. As a result, frequent fetal monitoring and early induction between 36 to 37 weeks is recommended.

If you notice these symptoms, please talk to your OB provider for further evaluation.

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Health Beat | Spectrum Health by Gynecologists Are Uniquely Qualifie.. - 3d ago
Traditional risk factors for heart disease include high blood pressure, diabetes, high cholesterol and obesity. (For Spectrum Health Beat)

A well visit to her gynecologist can benefit a woman’s heart, two leading U.S. medical groups say.

“As the leading health care providers for women, OB/GYNs provide care that goes far beyond reproductive health and are in a unique position to screen, counsel and educate patients on heart health,” said Dr. Haywood Brown, immediate past president of the American College of Obstetricians and Gynecologists.

Our Take

Heart disease affects one-third of all women.

Did you know that it also happens to be the No. 1 killer of women and causes 17.5 million deaths per year? That’s the bad news.

The good news is that heart disease is preventable, or at least it can be delayed by many years. Heart attacks do not have to happen at such an alarming rate; in fact, they shouldn’t even happen at all.

Heart rehabilitation, lifestyle changes and medications can save lives by preventing heart attacks.

Diana Bitner, MD, NCMP, Spectrum Health Medical Group, is board certified in obstetrics and gynecology and shares these details and more in a recent blog post.

Read her blog post to learn more.

“OB/GYNs have a powerful opportunity to be the secret weapon in the fight against heart disease,” Brown added in an American College of Obstetricians and Gynecologists news release.

In a joint advisory, ACOG and the American Heart Association said annual well-woman exams by obstetrician-gynecologists should include a heart disease risk assessment. The advisory emphasizes the value of collaborative care between ob-gyn specialists and cardiologists.

Heart disease and stroke are the leading causes of death in American women. And about 90 percent of them have at least one heart disease and stroke risk factor.

“The annual ‘well woman’ visit provides a powerful opportunity to counsel patients about achieving and maintaining a heart-healthy lifestyle, which is a cornerstone of maintaining heart health,” said Dr. John Warner, president of the American Heart Association.

Traditional risk factors for heart disease—high blood pressure, diabetes, high cholesterol and obesity—affect both sexes, but some may affect women differently or be more significant.

The statement said OB/GYNs are uniquely qualified to identify and treat woman-specific conditions that may increase a woman’s risk of heart disease or stroke.

Certain pregnancy complications, for example, indicate a subsequent increase in the mother’s heart risk. They include pre-eclampsia, gestational diabetes, gestational high blood pressure, preterm delivery and low birth weight.

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Health Beat | Spectrum Health by Breast Cancer Survivor Mary Rottier.. - 4d ago

Mary Rottier had just weaned her youngest child in 2015 when she discovered a golf ball-sized lump in her right breast.

At first, she suspected a clogged milk duct.

A biopsy told a different story.

Rottier, of Hesperia, Michigan, had triple-negative breast cancer, which can be difficult to treat. The disease had also spread to her lymph nodes.

A child psychotherapist, she had just turned 40. She felt stunned.

“There is never a good time to have cancer, but it was especially tough with a young family,” said Rottier, whose children were a toddler and a kindergartner at the time of diagnosis.

To top it off, she had two counseling practices, including one in Georgia. Her husband, a commercial airline pilot, often had to travel out of town for work.

Rottier’s oncologist, Mark Campbell, MD, was based at the Spectrum Health Lemmen-Holton Cancer Pavilion in Grand Rapids, but Rottier choose Spectrum Health Gerber Memorial Cancer Center in Fremont for her treatment.

Convenience influenced her decision: Fremont is just a 15-minute drive from her home.

Her treatment began with chemotherapy to shrink the tumor, after which doctors performed a lumpectomy to remove the tumor itself. Radiation followed.

Her treatments ended in June 2016 and her cancer has been in remission ever since.

“(Gerber) was wonderful and convenient … I didn’t dread going there,” Rottier said. “It was as positive an experience as you can have going through something like that.”

A year before she became ill, Rottier joined the Gerber Memorial Patient and Family Advisory Council, a group focused on patient care and doing what is in the patients’ best interest. Now she is the council’s vice chair.

“It has been an amazing group to work with,” she said. “They helped with my own patient experience throughout my treatment.”

Bringing smiles

Shortly after her treatment ended, Rottier made a point to return to Gerber Memorial a few times each month with Jenga, a Shetland sheepdog, to visit with patients—many of whom had already been there during Rottier’s stay.

“It was really neat,” Rottier said. “It helped knowing I have a story, too.”

Jenga, now 14, is also a breast cancer survivor, and soon retiring. Rottier is actively training two other sheepdogs, Fisher and Cali, to take her place.

Cali, who is just 5 months old, has a personality like Jenga’s and promises to be an incredible therapy dog.

“I just love it,” Rottier said. “It’s just really about the people and bringing a smile to someone’s face.”

She has always embraced the idea of “giving back what God has given to me.”

During the past few years, she teamed up with a friend to create goody bags for cancer patients.

Rottier still faces her share of health scares and challenges, but she maintains a positive attitude and looks ever forward with confidence.

“When people hear the word cancer, it’s like doomsday,” she said. “But for me, in all honesty, getting cancer and having treatment changed my life in so many positive ways.

“Cancer didn’t destroy my life. It just helped it fall into place.”

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Health Beat | Spectrum Health by Someone Develops Dementia Every Thr.. - 4d ago
Maintaining a healthy social life and doing things you enjoy is important for everyone’s quality of life. (For Spectrum Health Beat)

When loved ones develop dementia, it’s hard to know how to make their lives better. But now researchers have pinpointed ways to help these folks live as well as possible.

“While many investigations focus on prevention and better treatments, it’s equally vital that we understand how we can optimize quality of life for the 50 million people worldwide who have dementia,” said researcher Linda Clare. She’s a professor at the University of Exeter in England.

Our Take

In 35 years as a doctor, Spectrum Health’s Iris Boettcher, MD, has seen positive changes in the realm of dementia treatment—new studies, valuable findings, useful advice.

Awareness, however, is one aspect that still needs some work.

“There is a lot of undiagnosed dementia,” she said. “People just attribute it to old age.”

“Once you have a diagnosis, you can then understand that it is a disease—as opposed to attributing it to people just being stubborn or writing it off as old age.”

Luckily, there’s more and more support in the community for people with dementia.

“Grand Rapids in particular has a campaign going on around becoming a dementia-friendly community,” Dr. Boettcher said.

That campaign, Rethinking Dementia, teaches people how to interact with those who have dementia.

“There are simple things you can do,” she said. “One is just recognizing that someone may be having trouble. There are opportunities for people to learn. You don’t have to be clinical—it’s just good citizenship, learning how to work with people who have dementia.”

In the study, her team reviewed 198 studies that included more than 37,000 people. The investigators found that poor mental or physical health, problems such as agitation or apathy, and unmet needs are associated with poor quality of life for people with dementia.

Factors associated with better quality of life included good relationships, social engagement, better daily functioning, good physical and mental health, and high-quality care.

“We now need to develop ways to put these findings into action to make a difference to people’s lives by supporting relationships, social engagement and everyday functioning, addressing poor physical and mental health, and ensuring high-quality care,” Clare said in an Exeter news release.

Gender, education, marital status, income, age and type of dementia were not associated with quality of life.

According to Doug Brown, chief policy and research officer at Alzheimer’s Society in the United Kingdom, “Maintaining a healthy social life and doing things you enjoy is important for everyone’s quality of life. As this Alzheimer’s Society-funded study highlights, people living with dementia are no exception,” he said.

“Someone develops dementia every three minutes, but too many are facing it alone and feel socially isolated—a factor that researchers pinpoint contributing to a lower quality of life,” Brown added.

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Health Beat | Spectrum Health by A Weekly Plan, In-season Produce An.. - 5d ago
You can save money on produce by purchasing it in season and preserving it for later, either by canning or freezing. (For Spectrum Health Beat)

Gas prices are going up again and food isn’t getting cheaper. That’s the outlook in American homes this year.

Amid a tight budget and high prices, what steps can you take to ensure you and your family eat healthy, great-tasting food?

Planning is the name of the game, Spectrum Health registered dietitian Kristi Veltkamp said.

“Lack of planning is the biggest deal-breaker,” Veltkamp said.

Does your after-school or after-work routine involve the question, “What’s for dinner?” Do you rummage through the refrigerator or pantry at the last minute, hoping to whip up something suitable for dinner?

It may be time to sit down and think carefully about how you’re spending your food money. It can help you avoid the desperate, late-evening runs to fast-food restaurants or pizza parlors—or pricey restaurants—and it’ll keep your wallet and your waistline in top shape.

Veltkamp’s 5 tips to keep your food budget under control: 1. Plan your meals  

This is the No. 1 solution to save money. Planning your meals ahead of time allows you to build according to your budget. It sets you up for success each week, Veltkamp said.

It’s not just about dinner, either. “You can pack your lunch so you don’t have to go out at work,” Veltkamp said. “And you can plan to use the leftovers.”

You should also aim for more vegetarian meals—they’re cheaper and healthier. “Meat tends to be the most expensive item,” Veltkamp said.

With a creative mind, you can find new and innovative ways to use items such as beans and rice, which are cheaper and preserve longer, she said. Tacos made from rotisserie chicken and all the fixings, for example, make for a quick, cheap and easy meal.

2. Get Crocking

If you plan your meals ahead at the start of each week, the Crock-Pot can prove to be a lifesaver not only in money but in time, too.

“When you’re doing the cooking yourself, you’ll save more money,” Veltkamp said.

The tacit message here: Stay away from restaurants as much as possible—they eat up your budget. (They also increase your salt intake.)

Generally, Crock-Pot meals can be healthy. “It depends on what you’re putting into it,” Veltkamp said. Canned goods are OK, but you should rinse them first to cut down on the sodium.

“One of the ways it saves on money is when you use more ingredients that haven’t been prepared—raw products like rice, potatoes, beans or even frozen veggies,” Veltkamp said.

3. Buy in season

Items that are local, fresh and in season should be on your list each week.

“They’re higher in nutrients and they haven’t been delivered across the globe,” Veltkamp said. “And if you buy a lot at once, they’re cheap. You can can them or freeze them and save them for later.”

This includes berries, greens, tomatoes and much more. Veltkamp said some people will toss their herbs in water and freeze them into cubes, then throw them into soups once they’re needed.

One tip: Buy in-season items fresh, then buy them mostly canned or frozen when they’re out of season. Some fresh produce can get pricey when it’s out of season.

4. Buy in bulk

Bulk food stores are sometimes hard to come by without a membership—Costco, Sams Club and the like.

But if you can manage to pick up some essential items in bulk, you can truly save a bundle.

What should you buy in bulk? “Things that aren’t going to spoil fast,” Veltkamp said. “Nuts, grains, rice, beans, flour—non-perishable items.”

5. Shun the junk

This is a big one. Junk foods may sometimes appear like the cheap way to go, but in the long run you’re only setting yourself up for trouble.

Junk foods—processed foods, sugary foods—offer empty calories that only leave you craving more.

“Your body doesn’t need the empty calories,” Veltkamp said. “If you eat healthy, you crave less.”

Healthy foods are simply more filling.

Think about it: A bag of chips is a few bucks, but there are many people who can sit down and make that bag disappear in one evening. A bag of apples may cost slightly more.

“But who sits down and eats a bag of apples?” Veltkamp said. One or two apples will satisfy hunger cravings and also deliver much-needed nutrition.

“Healthier foods tend to fill you up more and make you more satisfied,” Veltkamp said. “You don’t have the cravings you get with those processed foods.”

Bottom line: You’re eating less food and getting more nutrition.

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Health Beat | Spectrum Health by You Don’t Have To Eliminate T.. - 5d ago
Long-term exposure to small amounts of arsenic can increase the risk of bladder, lung and skin cancer, heart disease and diabetes. (For Spectrum Health Beat)

There’s a danger lurking in rice and you won’t find it by reading labels. It’s the chemical arsenic.

And the threat isn’t about immediate poisoning but rather that long-term exposure to small amounts can increase the risk of bladder, lung and skin cancer, heart disease and diabetes.

Arsenic naturally finds its way into our soil and water because it’s in the Earth’s crust, but it also accumulates from some pesticides and fertilizers.

Our Take

Chronic exposure to arsenic in small doses, often from food or other sources people are not aware of, is hard to detect and poses the greatest risk for babies, said William Bush, MD, pediatrician-in-chief of Spectrum Health Helen DeVos Children’s Hospital.

“Infants are in a rapid growth phase so they consume a much larger percentage of food relative to the size and weight of their body than a small child or adult does,” Dr. Bush said. “Any exposure to toxins, therefore, shows up in greater concentration.”

Many baby formulas are rice-based and parents often are counseled to use rice cereal as one of baby’s first sources of solid food. Reports have surfaced of high levels of arsenic in organic brown rice syrup, a sweetener used in juice and baby formula.

“If a mother can’t breast-feed, we suggest using dairy-based formula. For infants who can’t tolerate dairy, a soy-based formula,” Dr. Bush advised. “For babies ready to start on solid foods, oatmeal and other grains are good choices, along with pureed fruits and vegetables.”

Rice tends to absorb arsenic more readily than many other plants. Most unfortunate is that brown rice has the highest amounts because the arsenic accumulates in the otherwise healthful outer layers, which are removed to make white rice.

You don’t have to eliminate all rice from your diet, but choose it carefully, suggests the watchdog group Consumer Reports. Their testing found that arsenic levels differ depending on the types of rice and where they were cultivated.

Here are some tips to limit your rice intake:

  • Choose white basmati and brown basmati rice cultivated in California, India and Pakistan, and sushi rice cultivated in the United States.
  • Vary your whole grains to minimize arsenic exposure—try whole wheat, amaranth, buckwheat, millet, polenta and grits.
  • Carefully read the labels of all food products: Rice, rice flour or brown rice syrup are in everything from gluten-free foods to teething biscuits.

High concentrations of arsenic in rice-based foods given to babies and children have led to recommendations to not give them rice drinks and to limit the number of servings of rice cereal. According to Consumer Reports, just one serving of rice cakes has close to a child’s weekly limit, and one serving of rice cereal and rice pasta could put kids over the maximum amount.

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