As life's events unfold, the inevitable aches and pains associated with injury, illness, and age eventually set in and affect our quality of life. Experiencing pain is expected, but living with pain is not necessary and in most cases physical therapy can significantly reduce or relieve pain.

One of the most common pain complaints we hear is related to low-back pain (LBP), which accounts for 2.5 to 3 percent of all physician visits in the United States. It is responsible for an estimated $85 billion in healthcare costs nationally.

Most patients with LBP are seen by their primary physician and often time will be referred to undergo diagnostic tests, such as x-rays and MRIs to help determine the root cause of the pain. These tests more often help identify pathology such as degenerative discs, bulging discs, herniated discs, spurs and arthritis.

Pain associated with such conditions is a more complex experience than what images and pictures of your body can portray. Referrals from your primary provider to physical therapists, who are specifically trained to treat low-back pain with interventions such as manipulation, exercise, and most importantly education about pain and a patient's unique pain experience, will help develop and execute a treatment plan that will address the cause of the pain.

At Portage Health, we develop an independent management program for our patients that are not solely dependent on medications. Although medications can help to control pain, the key objective is regaining pain-free movement as quickly as possible without dependence on medication. A physical therapist, working in concert with your primary physician, will work to find a long-term solution to your pain problems.

Another important component to therapy is timing and the introduction of physical therapy as an integral part of the treatment plan has been shown to be a crucial element in a patient's recovery from low-back pain. Delaying physical therapy goes against current research as several studies have shown reduced costs and improved outcomes with early physical therapy.

In people who receive physical therapy within 30 days after initial physician visit for acute low-back pain, there is decreased likelihood of injections or surgery compared to patients who waited longer to get physical therapy. Also, the use of frequent office visits regarding LBP is significantly lower among people who receive physical therapy within 30 days. That means less money out of your pocket to pay for co-pays.

No matter what influences you to seek physical therapy, early access to physical therapy referrals is the best and most direct way to achieve your goal. We take pride in knowing that our patients receive evidence-based, quality care focused on patient values. We strive for the best clinical outcomes, and we empower patients to have active, pain-free lifestyles. Our focus is to get you back to doing the things that are most important to you, and we can get you there faster.

Mallory Rojewski has her doctoral degree in physical therapy from Grand Valley State University, and serves Copper Country residents out of the Portage Health Rehab office in Calumet.

Dr. Carl Smoot is board certified in internal medicine, pulmonary disease and sleep medicine. He sees patients at the Portage Health Sleep Disorders Center in Hancock. Learn more about him at portagehealth.org/smoot, or about the Sleep Disorders Center at portagehealth.org/sleep.

An average person sleeps about a third of the day, roughly six to 10 hours. That time is actually the most important part of the day, as it determines mental and physical health for the remainder of the day.

Sleep determines your alertness, school or work performance, growth, muscle strength and repair, personality, ability to interact with others, control of diabetes and cholesterol, and the development of vascular disease. That list, while lengthy, is only a glimpse into the effect sleep has on your life.

The control of sleep has been determined by changes in our brain’s development over millions of years. Basically, humans are programed to wake with bright light (sunlight in the morning), and begin to get sleepier as the light fades in the evening. Any change from this can cause sleep disturbance. Shift workers prove that. Especially something like the “Southern Swing Shift,” which includes rotating between days, nights and afternoons. Studies have shown that shift workers like that live much shorter lives than those who do not work rotating shifts.

Sleep over a range from teenage to old age is 7.5 to 9.5 hours per night. There are people that sleep less, and others who need more sleep to feel rested. Being rested means a person is continuing to be alert in the most boring of situations.

The best way to take control of your sleep is to set the wake time in the morning the same every day. Waking up within a half hour of the same time every day will help you feel more rested than ever. That includes weekends, and even nights when you went to bed later than usual. This applies to adults, teens and children. Many parents feel that they are doing their children and teens a favor by allowing them to sleep in during the summer and on weekends, but that is definitely a mistake. This allows sleep to lose cycling control. This can have a profound effect on school performance.

One of the reasons for this is because the lowest point in a person’s body temperature during a 24-hour day cycle is about an hour prior to wake. This point sets the timing of all hormone secretion except that of the thyroid. Disturbances of sleep cycling can cause short stature, lack of energy, poor healing of connective tissue (muscle, ligaments, tendons, etc.), mental illness, poor job or school performance, etc.

Many sleep specialists think that most, if not all, problems associated with fibromyalgia can be due to abnormal sleep cycling. Mainly from a lack of deep sleep, which is when our bodies secrete growth hormones. Lack of adequate sleep can make weight control and blood sugar control much more difficult as well.

Total sleep and control of sleep cycling and timing are important aspects of your health. This should be discussed with your primary care provider at every visit. If there is a significant problem, then a consultation with a sleep specialist should be considered. The difference sleep can have in your life is profound, and could be just the thing you need to help turn your mental or physical health around.

 

As January approaches, most people intend to begin the New Year with many well-intended resolutions. This year, we ask you to commit to making your health a priority and focus on just one or two lifestyle changes that will truly influence the quality of life experienced by you and your family.

At Portage Health, we've made our resolution to be focused on combating obesity. Studies have shown that nearly 35 percent of our population is obese. This is the result of inactivity, poor diet, other chronic health concerns and an overall lack of awareness of how to eat properly, get adequate exercise and rest and prepare healthy and delicious foods while still maintaining your budget.

We recognize that lifestyle change takes commitment and hard work. We also know that unless we all work to make this necessary lifestyle choice - for ourselves and our loved ones - the alternative and consequences of such choices simply aren't good.

Portage Health is here for you with many resources to help evaluate your current health status, develop a plan of action that will empower you to reach your goals and to support you as you make changes in how you choose to live your life. The reality is this is not about exercise. It is about living a healthier and more fulfilling life. For some, that means simply toning muscle and better developing core strength in order to perform everyday activities easier, and with less pain. Others may have significant weight loss goals. No matter what you want to achieve, we are here to help you reach your goals.

The Portage Health Fitness Center offers much more than just gym memberships, we offer everything from group exercise classes to kettlebell training; indoor cycling to cycle fusion; and many aerobic workouts including zumba, yogalates, mat pilates, core combo and many others. Classes are affordable and convenient. Plus, your first class is always free.

To help you discover what will work best for you, the fitness center is offering free Introductory classes in January. Join us Mondays, at 6:45 p.m. to learn how to use the following equipment with good form.

• Jan. 7 - Indoor Cycling
• Jan. 14 - Kettlebells  
• Jan. 21 - Bosu/Stability Ball
• Jan. 28 - TRX Suspension/Resistance Bands

Classes will be led by one of our three full-time certified personal trainers: Emily Kunnen, Susan Rosemurgy and Amanda Altobelli. Each trainer is dedicated to helping you achieve your fitness goals, whatever they may be. One-on-one packages along with buddy training are available at affordable prices.

The only question that you need to answer is, if not now, when!?

For a detailed list of classes or to schedule a time to discuss your health goals with one of our trainers, visit portagehealth.org/FitnessClasses or call 483-1776.

The outbreak is due to a product that has not been used in the Upper Peninsula of Michigan, according to the WUPHD.

Information from the CDC

Please follow the following link to the Center for Disease Control and Prevention for more information and details about the Multi-State Meningitis Outbreak:
http://www.cdc.gov/hai/outbreaks/meningitis.html 

TV6 coverage of the issue in relation to the Upper Peninsula

See uppermichigansource.com for the full story:

A press release from the Western Upper Peninsula Health Department

Proper wound care is an important health concern, but often is overlooked or dismissed by patients.

One rule to abide by is that by the 30-day mark of an open sore on your body, it should be visibly healing. If it's not, at this point, it's no longer an open sore. It has become a chronic wound.

This is an upsettingly common problem, and is especially prevalent and dangerous among diabetics. In some situations, ulcers can become limb- or life-threatening.

At the Portage Health Advanced Wound Care Center we often see people who have been ignoring or dealing with such sores for months upon months without professional guidance.

They're toughing it out, hoping for the best.

As a professional in the field, I can tell you that is not a good idea.

In many situations, giving it more time will cause nothing but more problems. Some of these problems are serious.

If a wound worsens to extreme levels, a patient may develop an infection that leads to amputation. Three out of four lower-body extremity amputations to diabetic patients began as non-healing ulcers.

It can get worse. Some ulcers have five-year mortality rates as high as 55 percent.

That mortality rate is worse than colon cancer, which has a five-year rate just under 50 percent. Colon cancer is considered one of the more dangerous forms of cancer.

Health care is often about being proactive, and an open sore that isn't healing is no different. Getting treatment early on can make all the difference.

Our team will provide a comprehensive assessment of the problem. We have physical therapists and physical therapist assistants who have extensive wound care-specific certification, training and experience, diabetes and lymphedema experts and access to Dr. Jonathon Brueggeman, a podiatrist with specific interest, education and experience in wound care.

After assessing the issue, our staff provides specialized tests, treatments and dressings that will promote healing, and see patients through the entire healing process.

Much of what we do with patients is educate them on the situation they're in. After an initial meeting, our team will continue to work with a patient until they've improved. If needed, we can provide surgical options.

At the advanced wound care center, our goal is to help patients get back to the life they were living before the open sore became a chronic wound. The best way for a patient to fully heal is to be proactive. At 30 days, call your family doctor. Talk to them openly about the symptoms you're dealing with and work toward moving on with your life.

Editor's note: Dr. Wade Liston, DO, is the medical director of the Portage Health Advance Wound Care Center in Portage Health's main location in Hancock. On Sept. 13, Liston was the expert presenter at the "Wild on Wounds" annual educational conference in Las Vegas. Learn more at portagehealth.org/liston.

What choices have you made today that will contribute positively to your health? Were you physically active today? Did you fuel your body wisely? Did you get ample sleep last night? Did you avoid harmful substances, wear your seatbelt or helmet, and wash your hands regularly? Although we don’t often realize it, many minor decisions that we make throughout each day produce our personal lifestyle. Personal lifestyle, research shows, has a significant impact on our health and quality of life.

Of course, no one expects that you pick the healthy choice every time, but if you are truly committed to living a healthier lifestyle, you must create a plan of attack to make the healthier choice more often. This might not always be easy – change is often difficult. If you aren’t currently living a balanced and healthy lifestyle, this isn’t going to just come naturally starting tomorrow. It’s going to take some serious willpower to make those healthier decisions.

Traditionally health care organizations have focused on a reactive approach. Hospitals have been a beacon of trust and hope in an emergency; health care professionals save lives and help manage chronic conditions. In this capacity, these care providers will be here for years to come. But now, Portage Health and many forward-thinking providers across the world are focusing on a more proactive approach. If we each take the steps to take care of ourselves now, we may not be limited by the chronic disease or have to take the chance of surviving an emergency in the future.

Portage Health is working hard to make sure we are supporting this proactive approach in both community members and staff members. Our employee wellness program, which was created in 2009, provides tools and encouragement to assist staff members in making more of the healthy choices and less of the not-so-healthy choices. We’ve taken several steps to ensure our work environment is conducive to better decision making. Staff members support each other and challenge each other to reach health goals.

Of those staff members who had goals to make improvements, more than 40 percent of them improved blood pressure, more than 30 percent improved blood glucose and more than 20 percent lowered body mass index. That was just last year. More importantly, many participants report that they are feeling better and more confident, while having the ability to do things they couldn’t do before. These improvements are made possible by individuals making lifestyle changes and addressing issues with a primary care provider when necessary.

The American Heart Association has deemed us a Fit Friendly Company at the platinum level. In 2011, less than 350 companies nationwide were awarded this prestigious, most distinctive achievement. This is an affirmation that we’re doing something right as we work right here under our own roof to improve the health of our community.

Employee wellness has been gaining attention throughout the years, but more so in recent times as healthcare costs continue to escalate, as well as national rates of obesity and chronic disease. It’s clear that we need to take action to make those day-to-day healthier decisions. We need to choose to live healthier lifestyles. Start making your plan for a healthier life today, and avoid more serious problems tomorrow.

Editor’s note: Joni Erkkila is the wellness coordinator at Portage Health, the only “Platinum Level” Fit Friendly company in the Upper Peninsula.

While spring seems synonymous with allergies, several irritants arrive in the fall and take their toll on allergy sufferers. But several steps can help curb symptoms.

Ragweed, pigweed, plantain, sheep sorrel, sagebrush, and other weeds produce enormous amounts of the pollen that plagues allergy sufferers. Molds and late-blooming trees can also cause allergies in the fall.

Parts of the country with a wet summer season can experience more weed pollen and mold growth fueled by the moisture.

Allergy symptoms typically begin in early childhood, and often peak between the ages of 20 to 40.

The likelihood that a person will have an allergic reaction depends on a variety of factors, including family history. Many sufferers don't consult with a doctor about managing their allergies, and allergy symptoms are often confused with colds.

Allergic reactions are often mild but some, such as asthma, could be life threatening.

The more common milder symptoms include a runny nose, itchy eyes, sneezing, wheezing, a sore throat, nasal congestion, and coughing.

Skin irritations and breathing problems can also develop. Over time, even mild symptoms can cause sinus headaches, fatigue, insomnia and problems with concentration and work performance. They can also increase the risk of ear infections and sinusitis.

To help prevent allergies or make them less severe, it's useful to get a test to determine exactly what you're allergic to and take steps to avoid contact with it as much as possible.

Stay indoors helps. Keep your windows closed, wash your bedding regularly, and wash your hair and shower before going to bed. It's also a good idea generally to keep your house as clean as possible.

Talk to your provider about the options for treatment. There are a number of drug treatments available both over-the-counter and by prescription, including nasal steroids, antihistamines and decongestants. It's important to start taking the medications before you develop symptoms. If you still don't get relief, ask whether allergy shots might be another approach.

What makes heatstroke more severe and potentially life threatening is that the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control, are lost. The main sign of heatstroke is a markedly elevated body temperature — generally greater than 104 F — with changes in mental status ranging from personality changes to confusion and coma. Skin may be hot and dry, although in heatstroke caused by exertion, the skin is usually moist.

Other signs and symptoms may include:

• Rapid heartbeat 
• Rapid and shallow breathing 
• Elevated or lowered blood pressure 
• Cessation of sweating 
• Irritability, confusion or unconsciousness 
• Fainting, which may be the first sign in older adults

If you suspect heatstroke: 

• Move the person out of the sun and into a shady or air-conditioned space. 
• Dial 911 or call for emergency medical assistance. 
• Cool the person by covering him or her with damp sheets or by spraying with cool water. Direct air onto the person with a fan or newspaper.  

October has been designated National Breast Cancer Awareness Month, and healthcare providers across the country are promoting early detection as the single most important factor in fighting and surviving the disease. The American Cancer Society recommends that women begin to conduct monthly self-breast examinations at age 20, and have a clinical breast exam by their healthcare provider each year. In addition, women should begin annual mammograms at age 40.

If you are still menstruating, you should schedule your mammograms for the week after your menstrual cycle begins, when the breasts are generally less tender. On the day of the mammogram, don’t use any deodorant, lotions or powders.

During the mammogram, two flat surfaces will compress each of your breasts, one at a time, for a few seconds. Compression is necessary to get the best pictures.

Sometimes, forgetting to do your self-exam and schedule your mammogram can be a barrier to good prevention. Some women find that scheduling a mammogram around their birthday or anniversary is helpful, and perform their monthly exam on the last day of their period.

Try checking your breasts for changes in the shower. After toweling off, look for common signs of breast cancer in the mirror. Look for a change in breast size or shape. Check for changes in the color of your breast as well as skin changes like scaly, itchy areas, dimpling and puckering. Report any change from normal to your healthcare provider right away.

While some people experience clear physical changes and warning signs of breast cancer, most women do not. That is why screening is so important, as mammography has been shown to detect cancers too small to be detected by feel.

Breast cancer. Don’t let fear from those two little words scare you from protecting your breast health with monthly self-exams and yearly mammography for women older than 40.

• Enhance physical fitness
• Enhance ability to learn and perform skilled movements
• Increase mental and physical relaxation
• Enhance development of body awareness
• Reduce risk of injury to joints, muscles and tendons
• Reduce muscular soreness
• Increase suppleness due to stimulation of the production of chemicals which lubricate connective tissues
• Reduce severity of painful menstruation in females.

Unfortunately, even those who stretch do not always stretch properly and hence do not reap some or all of these benefits. Some of the most common mistakes made while stretching are:

• Improper warm-up
• Inadequate rest between workouts
• Overstretching
• Performing the wrong exercises
• Performing exercises in the wrong (or sub-optimal sequence)

There are several elements to a good stretch. Ideally, a particular stretch should work only the muscles you are trying to stretch. In general, the fewer muscles you try to stretch at once, the better. By isolating the muscle you are stretching, you experience resistance from fewer muscle groups, which gives you greater control over the stretch and allows you to more easily change its intensity.

Another important aspect of stretching is leverage. Having leverage during a stretch means having sufficient control over how intense the stretch becomes, and how fast. If you have good leverage, you have greater control.

Remember not to stretch too far beyond the point of comfort. If you begin to feel pain during a stretch, chances are you are overdoing it.

Stretch often. Stay flexible.

	“I’ve got a lot more zip now,” says restaurant owner Greg Budweg.

For Greg Budweg, the quest for great sleep began with a picture in a magazine. While waiting to see his doctor a few years ago, the Hubbell man flipped to a photo of a woman sleeping soundly.

Greg ripped out the picture and showed it to Dr. Joseph DellaValla.

“I want to sleep like this, doc,” he said. Greg spent his nights tossing and turning. “I’d wake up more tired than I was when I went to bed,” he said.

Greg worked with Dr. DellaValla and the team at the Portage Health Sleep Disorders Center to achieve his goal of healthy sleep.

An overnight sleep study confirmed that Greg was one of the 40 million Americans who have a sleep disorder. Obstructive sleep apnea (OSA), which causes temporary stoppages in breathing, was robbing Greg of the rest he needed, sapping his energy and jeopardizing his health.

OSA and other sleep disorders, including snoring and insomnia, can contribute not only to sleepless nights, but also pose serious risks to physical and mental health, said Dr. DellaValla. He is one of just three physicians in the Upper Peninsula who has earned board certification in Sleep Medicine.

In the short term, people with OSA frequently are sleepy during the day, Dr. DellaValla said. This makes for poor quality of life, and has been shown to dramatically increase the risk for car crashes. In the long term, OSA has been associated with an increase in high blood pressure, diabetes, depression, stroke, heart attack and sudden death.

Greg began using a CPAP machine, a device that regulates his breathing while he sleeps. The change in the quality of his sleep – and in his life -- has been gradual, but profound. Sleeping well has boosted Greg’s energy level at home and at work at Jim’s Pizza, the restaurant he owns in Hancock.

“Getting enough sleep makes a big difference,” he said.

In 2006, Greg was one of the Sleep Disorders Center’s first patients. In 2008, the growing center moved into a brand-new location in Hancock. The state-of-the-art facility offers amenities that you won’t find at any other sleep lab in the western Upper Peninsula, including private rooms furnished with Sleep Number adjustable beds and plasma televisions.

Greg said that he would encourage anyone who has trouble sleeping to get checked out at the Sleep Disorders Center.

“Slowly but surely,” he said, “you’re going to feel a lot better.”

In the last year or so, new research has reinforced the relationship between sleep and good health. Several groups have recently published their results regarding how obstructive sleep apnea (OSA), a common disorder where recurrent pauses in breathing interrupt our sleep, impacts our long-term health prospects. One group analyzed all available data on the proposed connection between OSA and automobile accidents. They confirmed that drivers with untreated OSA are roughly three times more likely to cause an accident compared with drivers without the disorder.

Keeping their eyes on the big picture, three independent groups published data on OSA and risk of death from any cause. Taken together, the three groups followed more than 8,000 patients. Severe obstructive sleep apnea was found to be an independent risk factor for death in all three studies.

Insomnia also gets a lot of attention from medical researchers. Over the past several years, research has connected inadequate sleep to both weight gain and the development of diabetes. New research now suggests that insomniacs who get too few hours of sleep each night have an increased risk of developing high blood pressure, a major cause of heart disease and stroke.

Car crashes, high blood pressure, death? Scary stuff! The good news is getting a good night's sleep doesn't have to be impossible. We can make some important changes on our own. One less cup of coffee or one less television program can make a big difference. Keeping a regular sleep schedule, even on weekends and holidays, can also help. Tobacco, whether smoked or chewed, can keep us awake and should be avoided before bed. If you can't fix things on your own, your doctor can help. Your doctor might tweak your sleep habits, recommend a medication or ask you to see a sleep doctor.

When it comes to obstructive sleep apnea, patients usually need an overnight sleep test (called a polysomnograph) to figure out if they have it. Signs you're at risk include loud snoring, feeling tired or sleepy despite a normal night's sleep and being told you stop breathing while you sleep.

Recent research has only reinforced the relationship between sleep and wellness. Sleep well and stay healthy!

Heart disease, cancer and stroke have become the leading causes ofillness and death in adults of both genders, but heart disease and stroke affect men at an earlier age than women. Health maintenance strategies for men also focus on prevention and screening for prostate and testicular cancer.

Many health problems men experience can be prevented by developing healthier lifestyles. A good diet and regular physical activity have been proven to reduce the risk of high blood pressure, diabetes, heart attack, stroke, colon cancer, depression and memory loss. Walking 30 minutes daily five times a week is a simple and effective start to living longer and healthier.

Use of tobacco products greatly increases the risk of stroke, heart attack, and emphysema. Men who use tobacco have much higher rates of various cancers including lung, mouth, throat, stomach, and bladder. Prostate cancer rates may be higher in smokers, also.

Alcohol abuse increases the risk of accidental trauma and contributes to health problems includingliver disease, cancer of the esophagus and stomach, and damage to the nervous system. Regular consumption of more than two alcoholic drinks daily may indicate problem drinking.

Unfortunately, some medical problems are unpreventable, so screenings are an important part of health maintenance. Just as women perform regular monthly breast self-exams, men should examine their testicles monthly between age 15 and 35 and advise their physician if they notice anything out of the ordinary or causes them concern. Men who have a father or brother with prostate cancer are at increased risk and should consider having their prostate examined by a doctor and having blood drawn for a PSA (prostate specific antigen) test beginning around age 45 to 50. Colon cancer screening should begin at age 50 and include a rectal examination and colonoscopy every ten years until age 75 for most men.

Screening for high blood pressure, diabetes, and high cholesterol should begin in middle age. Earlier screening for diabetes and hypertension is recommended for men in their thirties if they have risk factors of obesity or a family history.

Those bean-shaped, fist-sized organs are located near the middle of the back, just below the rib cage, on both sides of the spine. They are made up of millions of nephrons; tiny filtering units that can clean 200 quarts of blood and produce about two quarts of urine per day.

Within the nephrons are the glomeruli (tiny blood vessels) that are intertwined with tubules (tiny urine-collecting tubes). These very tiny structures are where the complicated filtering actually takes place. The glomeruli must keep normal proteins and cells in the blood, but allow the wastes and extra fluids to pass into the tubules and enter the urinary system.

The wastes are the results of normal cell function and the food and medications we consume. If the glomeruli are unable to remove all of the wastes, they build up in our blood and damage our bodies.

Do you know how well your kidneys are functioning? Most people do not. Kidney disease is a silent disease, causing no noticeable symptoms until it is quite advanced.
Fortunately, there are ways of detecting kidney disease that should be performed routinely, especially for people with conditions such as diabetes, that put them at higher risk for its development.

Kidney Function Tests

eGFR is the acronym for estimated glomerular filtration rate. It is a calculation of how well those little glomeruli are able to filter the blood. In the laboratory, a person's blood is tested for creatinine levels. Creatinine is a waste product created by normal breakdown of muscle cells. A patient’s age, sex and race are taken into consideration when calculating the eGFR. This number estimates how well the glomeruli are clearing wastes from the body.

Chronic Kidney Disease

eGFR is our best indicator of how well the kidneys are working. An eGFR of 90 or higher is considered normal. If the eGFR stays below 60 for three months or longer, a person is considered to have chronic kidney disease (CKD).

eGFR 30-59: This stage of CKD is considered moderate. At this stage, hormones and minerals are thrown out of balance, causing anemia and weak bones.

eGFR 15-29: This is considered severe, and serious consideration must be given to treating the complications of CKD. A patient's doctor may refer a patient to a nephrologist (kidney specialist) who can discuss treatment options.

eGFR < 15: At this point, the kidneys can no longer filter well enough to maintain life. Dialysis or a kidney transplant must be done.

Dialysis consists of being hooked up to a machine that cleans the blood for about four hours a day, three days a week for the rest of a person's life. If a patient travels for work or pleasure, the schedule must be maintained. The patient must arrange ahead of time to travel somewhere where there is a dialysis center.

Prevention — Our Best Medicine 

Hypertension: Hypertension (high blood pressure) damages the blood vessels in the kidneys. Keeping blood pressure under control helps to preserve kidney function. A patient with hypertension may be prescribed medication to lower the blood pressure and help protect the kidneys.

Keep blood glucose under tight control: Research has shown that keeping average glucose levels below 150mg/dL (A1C less than 7 percent) can result in a 50 percent decrease in the development and progression of CKD.

Points To Remember

• Get regular screenings
• Control blood pressure
• Control blood glucose
• Know your numbers

Chronic Kidney Disease (CKD) is stealthy. It provides us with no obvious warning signs. It takes us by surprise. Diabetes is the leading cause of CKD, accounting for about 44 percent of kidney failure in the United States.

Services provided by home health agencies can be divided according to their specialty area:

High-tech pharmacy services include:

• Infusion Therapy
• Ventilator management
• Diagnostic Services (lab/x-ray)

Skilled professional home health agency services include:

• Nursing provided by a registered nurse (RN) or a nurse practitioner.
• Licensed practical nurse (LPN)
• Physical therapy
• Occupational therapy
• Speech therapy
• Medical Social Work

Paraprofessional services include:

• Home Health Aides
• Personal Care Assistants
• Physical Therapy Assistants
• Certified Occupational Therapy Assistants (COTA)

Home services include:

• Homemaker and housekeeping services
• Live-in services
• Hourly or shift coverage
• Home companions

According to Tammy Carroll, director of Portage Health Home Care and Home Services, there are several things to consider when choosing a home health agency for you or your loved one.

1. Is the home health agency Medicare-certified?
   Medicare establishes minimum requirements for home health agencies to provide care to those withMedicare benefits. Many health insurers require Medicare certification for an agency to provide care to their members. Departments of public health review home health agencies regularly to insure adherence to these requirements.
2. Does the home health agency use its own employees or do they rely on contract staff? Home health agencies employ full-time and part-time professional staff. Home health agencies often cannot find adequate nursing, rehabilitation, or home health aide staff to meet all of their patients' needs. Many agencies contract with other providers or staffing agencies.
   You should choose a home health agency that can provide the majority of your care with its own staff. Inconsistent staffing can be disruptive for patients. If contract staff is used, ask what role the agency has in hiring and supervising contract employees.
3. What are the home health agency’s hiring standards for professional and paraprofessional staff? Each home health agency establishes hiring standards according to the type of services the employee provides. Some of these requirements include:
   • Verification of professional licensure for clinical staff, minimum educational requirements and prior home health experience
   • Verification of paraprofessional staff's certification by an approved board, and annual competency skills assessment testing
   • Criminal Offense Record Inquiries checks
   • Annual in-servicing and continuing education for all employees
4. What is the home health agency’s process for scheduling visits? Home health agencies take into account overall agency needs as well as the needs of the individual patients when scheduling visits. Circumstances such as holidays, illnesses and weekends force agencies to prioritize staffing. Often, staff members arrange to visit at a certain time, but emergencies come up that delay or postpone a visit. It's important that patients and families remain open to the possibility of changes in visit schedules. It is equally important that patients notify the agency if they are not going to be home for a scheduled visit.
5. What payment sources do home health agencies accept? Home health agencies accept payment for services from a variety of sources. If the agency isMedicare-certified, skilled home health services will be covered according to Medicare rules. MostMedicare-certified home health agencies also accept payment from Medicaid or state-sponsored health insurance. Individual insurers and managed care plans contract with selected agencies that meet their requirements and cover home health services according to their benefits.
6. How does the home health agency coordinate care with my physicians and other health care providers?
   Communication is key to achieving your healthcare goals. Agency nurses and therapists should monitor your care and regularly report progress or changes to your physician. Agencies should immediately contact your physician if there is a sudden change in your health and if there is a need to change any treatments. At a minimum, the agency must verify the doctor's orders every 60 days.
7. Does the home health agency make nurses available for emergencies?
   During regular office hours, an agency may be able to provide an urgent home visit to assist with non-life threatening emergencies. When offices are closed, agencies still generally make a nurse available for urgent situations. The nurse may not be available to make a visit, but will answer calls and advise patients and families over the phone. Some agencies employ an answering service to inform the nurse on call.
8. How do I voice my concerns with the agency?
   Home health agencies strive to provide high-quality care. However, you may encounter problems during the course of your relationship with the agency. If a patient or family member feels that the care received was inadequate, they should inform the agency. Many agencies request that patients complete a satisfaction survey once services have ended.
   You should play an active role in selecting the agency that will be providing care to you or your loved one. Educating yourself about the requirements and services offered by agencies is the best way to make the most informed decisions. Knowing which agencies meet your individual needs enhances the likelihood of a successful recovery.
   Locally, Portage Health Home Care and Home Services provide expert home health care. When your family or loved one needs care at home, call (906) 483-1160 or (800) 573-5001 (toll free) for reliable, caring service.

Wearing a helmet is the most important — and simplest — safety measure you can take to protect yourself against serious injury while riding your bicycle.

Here are some tips to make sure your helmet fits properly:

• The helmet should be level on your head.
• When you look up, the front rim of the helmet should be barely visible to your eye.
• The Y of the side straps should meet just below your ear.
• The chin straps should be snug against your chin, so that when you open your mouth very wide, the helmet pulls down a little bit.
• Move the helmet from side to side and front to back. You should feel the skin around your eyebrows move slightly with the helmet. If it doesn’t, the fit pads are probably too thin in the front or the back, or the helmet may be too large.
• If the helmet has a rear stabilizer, make it snug under the bulge on the rear of your head.
• Put your palm on the front of the helmet and push up and back. If it moves more than an inch forward, more fitting is required.
• Shake your head around. If the helmet dislodges, work on the strap adjustments.
• Make sure your helmet is comfortable! Try on several different helmets so that you can choose the one that fits you best.

Once you’ve got your helmet strapped on, keep an eye out for the Portage Health Helmet Incentive Team. We’re cruising the Keweenaw this summer, keeping an eye out for kids who are wearing their helmets properly while biking, rollerblading and skateboarding.

Happy riding!

Symptoms

If you have had a concussion, you may have any of the following symptoms: 

• Headache
• Confusion
• Memory loss (amnesia)
• Loss of consciousness
• Sleepiness
• Nausea or vomiting
• Trouble concentrating
• Dizziness
• Weakness
• Seizures
• Loss of balance

These symptoms, called post-concussive syndrome, can last for several days or weeks after the injury.

How is a concussion diagnosed?

Your healthcare provider will examine you and find out what happened. Your evaluation includes a neurologic examination, testing your strength, balance, reflexes, and memory. Additional tests may be ordered such as an X-ray called a computed tomography (CT) scan, a magnetic resource image (MRI) to make sure there is no damage to your brain, or specialized brain function tests and possibly spinal X-rays.

What treatments are available for concussions?

The treatment for a concussion is rest. Headache may be treated with a pain reliever. Nausea may be treated with a medication. If you have a concussion, you need to be watched by a friend of relative for 8 to 12 hours. Your provider may want you to be awakened and checked every 2 to 4 hours. If you experience any of the following, you should proceed to the emergency room.

Prevention

In collision and contact sports, it is important to wear appropriate headgear and mouth pieces that are fitted properly. In sports such as football, it is important to use proper blocking and tackling techniques and not to use your head for initial contact. In sports such as bicycling or rollerblading, it is important to wear a helmet.

Prior to returning to your activities, you should seek approval from your medical provider. Concussions can be severe. Receiving a second blow to the head before the first injury is fully healed can be fatal, even if the second injury seems minor.