An Alana HealthCareTM PublicationFall 2010www.alanahealthcare.com

The Right FitYour Best Health: Rheumatoid Arthritis

Competitive bidding could be a losing proposition for some Medicare beneficiaries

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Dear Readers,

Welcome to Alana HealthCare’s latest edition of Wellness 360TM. We were so pleased with the outpouring of responses to and support for our inaugural edition that we have increased the size of our publication from 12 to 16 pages. With each issue, our goal is to deliver compelling articles on important topics in healthcare that are educational, informative, and empowering. We welcome your continued feedback and look forward to hearing about the kinds of articles our readers want to see in future editions.

In the months since our last edition Alana HealthCare has continued to flourish as we embark on many new and exciting endeavors. We are expanding our business into new specialty areas and opening new locations in our sustained effort to extend healthcare services from physicians’ facilities to our patients’ homes. In keeping pace with other healthcare organizations, we are also adapting to the reform initiatives while staying dedicated to our core principle of providing outstanding patient care.

This edition takes a closer look at the people and services that contribute to Alana HealthCare’s distinct patient-centered reputation. Our cover article, “The Right Fit,” focuses on how the field of orthotics and prosthetics is improving the lives of individuals through ever-evolving technology and acute patient care. In the article, readers will meet our O & P team and learn how the design and fit of our devices provide a better quality of life for our patients. This issue also introduces readers to Rocky Goodall, an Orthotist/Prosthetist and congenital bilateral amputee, discusses the coping strategies patients need following the news of diagnosis, talks about the ways rheumatoid arthritis is affected by the weather, and explains ways to prepare for the upcoming flu season.

We hope that you enjoy this issue of Wellness 360TM. Once again, we welcome your comments and invite you to tell us what you think by emailing us at feedback@alanahealthcare.com.

Thanks,

Jason Shiflet, President

Steven A. Schneider, Chief Executive Officer

Letter from the President

Table of Contents

Letter from the President ........................................... 2

Managing Life with a Chronic Health Condition ..... 3

The Right Fit .............................................................. 6

Getting to Know: Rocky Goodall ............................ 10

Food for Thought: Competitive bidding could be a losing proposition for some Medicare beneficiaries .............................................................. 12

Your Best Health: Rheumatoid Arthritis .................. 14

Did You Know: Fighting the Flu .............................. 15

Wellness 360°An Alana HealthCare™ Publication

Editor: Cory SchneiderGraphic Designer: Barbara MorrisContributors: Mike Gallagher, Daniel ReillyPublisher: Amy Massey

507 E. College StreetDickson, TN 37055Toll-free: (877) 796-9679Fax: (615) 375-1132www.alanahealthcare.com

Steven A. Schneider, CEOJason Shiflet, President

Wellness 360TM is published by Alana HealthCare. The information provided in this newsletter in no way replaces the information and advice provided by a health care professional. A doctor or nurseshould be contacted regarding the diagnosis and treatment of any medical condition. Websites and reference information are provided for your convenience only, and Alana HealthCare neither endorses nor supports the statements they contain in any way. Alana HealthCare does not verify the authenticity of these websites or the content they provide.

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Managing Life with a Chronic Health Condition

Balancing Life continued on page 4

Being diagnosed with a chronic health condition presents an extreme challenge for most people. Feelings of fear and

anxiety over the unknown can be almost paralyzing for some newly diagnosed individuals. These feelings, if not dealt with properly, can eventually consume a person and leave them focused on the new diagnoses and nothing else. Living with a chronic health condition is truly a balancing act for patients. It is crucial for patients to strive for that balance in their lives: finding a way to manage their illness in whatever way works for them, while also continuing on with their lives by enjoying time spent with family and friends and finding purpose in their work or hobbies.

I recently had the privilege to speak with Gary McClain, PhD, a recognized expert in understanding the emotional reactions to medical diagnosis. We spoke about maintaining that balance in one’s life when diagnosed with a chronic health condition. Dr. McClain is the founder of JustGotDiagnosed.com, a website for individuals recently diagnosed with chronic health conditions, their caregivers, and loved ones. He is also finishing a new book for nurses and clinicians entitled After the Diagnosis: How Patients React and How to Help Them Cope, which will publish in October 2010.

DR: How do individuals react after receiving an initial diagnosis of a chronic health condition?

GM: Initially some people experience shock and disbelief from the unexpected

news. Even those who knew they were having symptoms usually are holding out hope that the symptoms were not real, or that perhaps they were temporary and would resolve on their own. This initial state of shock can last anywhere from a few minutes to months for some patients.

Once patients get past the shock of the diagnosis, newly-diagnosed patients react to their diagnosis in a variety of ways. They move into a sense of denial and fear of the unknown which can sometimes lead to a lack of adherence

when taking medications or even skipping clinic and further testing appointments. For some, taking the medications and going to physician appointments makes the diagnosis too real at a time when they are not yet ready to deal with it. If this state of denial lasts for an extended period of time it can become very dangerous for the patients’ health and well-being.

Anger from the feeling of loss of control of one’s own life is another emotion that the newly-diagnosed often experience. It is common to ask the “Why me?” question and want to know what they did to deserve this perceived punishment. Additionally, individuals may experience a sense of grief and loss similar to losing a loved one. This is really a feeling of loss of innocence – the belief that nothing “bad” can happen –and questioning whether they have hope for the future. They may even experience an overall sense of helplessness in their lives at this point.

The sense of guilt stemming from feeling that patients brought the illness upon themselves, or guilt for someday becoming a physical or financial burden to loved ones is another emotion that patients may experience. Eventually most patients come to accept their diagnosis either on their own or with help from others. Patients come to a realization that their lives may not turn out exactly how they had planned, but they accept the new hand that has been dealt to them and choose to make the most of it.

By Daniel Reilly, PresidentComprehensive Health Education Services

Feelings of fear and anxiety over the unknown can be almost paralyzing.

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Balancing Life continued from page 3

DR: How can a person diagnosed with a chronic health condition achieve and maintain balance in his or her life?

GM: I often tell my clients to “Fake it until you make it!” It is helpful for patients to develop a sense of humor about the situation and find a safe place where they can be totally honest with themselves about their emotions. Patients should take action and make adjustments in their lives to plan and maintain structured lives, and to develop action plans that they adhere to even on days when they “don’t feel like it.” Building a network of friends, family and a support group (if possible) is helpful to achieving and maintaining a healthy realistic outlook. A big part of maintaining balance is for patients to know what they can realistically handle, and knowing when they need to ask for help. There is no shame in asking for help and a solid support network is there to provide it when needed. This is not easy for some, as it often involves giving up some control in life and admitting that they have limits. Asking for help for the things that can be tiring—such as house work, grocery shopping, or even running errands—can mean extra energy to truly enjoy the fun things in life. I also recommend that my patients try to reduce stress as much as possible through meditation and reflection. Use the times that your energy is low to reflect on where you are at in your journey and all that you have accomplished rather than being upset that your body does not have the energy to do the things you used to do.

DR: What can happen if patients do not maintain balance in their lives and focus too much on their chronic health conditions?

GM: First, patients must come to the realization that achieving balance in their lives is something that is totally up

to them. Everyone has his or her own process. How patients deal with the diagnosis is not up to their physician, caregivers, or loved ones. They need to want to take the lead in their healthcare. Just the initial diagnosis, alone, will oftentimes throw a patient “off balance”. If a patient is not able to reestablish and maintain some sort of balance in his life while living with a chronic health condition, he may become non-compliant with his medications and possibly even his medical appointments. This unfortunately may also lead to alienation of support from friends and family who may perceive him as giving up on his condition, and feel helpless as to how to reach out to him. Creating a negative self-image and having feelings of hopelessness and helplessness may also set in if balance is not achieved. This unfortunately can lead to a downward spiral for the patient that can take some work to overcome.

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Patients must feel free to be able to ask questions without fear of repercussions or embarrassment.

DR: Where can a person turn for support in dealing with a chronic health condition diagnosis?

GM: It is crucial for patients to establish and maintain good communication with their “team” at all levels. Patients must feel free to be able to ask questions without fear of repercussions or embarrassment. That level of trust is very important to maintaining communication.

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The fear seen in newly diagnosed patients often stems from fear of the unknown; that is why it is imperative that patients become informed as much as possible about their new diagnosis, the possible outcomes, and all available treatment options. There is a certain amount of control that patients are able to realize when they feel informed and empowered to manage the situation. This information can come from asking questions, doing research on their own, and by speaking with others who are living with the same diagnosis. Patients should be certain that information found online is from a reputable website that is not filled with bogus information just to sell them a miracle cure. Support from others can often be found through the Internet as well as by joining online support groups and chats about the condition. This also allows patients to maintain their anonymity when that is important to them. On a local level, patients can find support from counselors, clergy, and oftentimes good friends and family.

The following excerpt is from Gary McClain’s website, justgotdiagnosed.com. Visit his website to read more about each of the points.

Ten Steps to Becoming a Fighter

Patients who deal most effectively with a medical diagnosis are what I will call fighters. This doesn’t mean fighting in the sense of taking up arms. Being a fighter means being empowered in terms of understanding your diagnosis, the options for treatment, and what lifestyle adjustments need to be made in the near future, and beyond.

Being empowered is about arming yourself with rational thinking. However, Fighters have also acknowledged their feelings and continue to honor their own emotions. I would even say that dealing with the emotional aspects of a diagnosis opens the door to rational decision making.

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Fear may, realistically, never completely go away. The anger and disappointment at being diagnosed may flare up at times. But emotions like fear and anger, when they are acknowledged and experienced, may also give way to hope, optimism, and a renewed passion for life.

Here’s what you can do to develop some “muscle” in dealing with your diagnosis.

1. Find a safe place to express your feelings.

2. Confront the fear factor.

3. Beware of adopting the victim role, even if you think you deserve to.

4. Designate yourself as the primary decision-maker.

5. Get a second opinion and even a third.

6. Research your condition.

7. Think of your physician as a professional and not as your best friend.

8. Decide where you need support and then ask for it.

9. Do the numbers.

10. Create a vision for the future.

Just Diagnosed? First, allow yourself to be human.

Whether a medical diagnosis initially propels you into flight, freeze, or fight, don’t start out by fighting with yourself. Let yourself react honestly and fully. And then equip yourself with knowledge, support, and professionals whom you trust. After all, you’re in charge.

* Gary McClain, PhD is currently finishing a new book for nurses and clinicians entitled “After the Diagnosis: How Patients React and How to Help Them Cope” which will be out in October 2010.

Patients should be certain that information found online is from a reputable website that is not out filled with bogus information just to sell them a miracle cure.

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The Right FitOrthotics and Prosthetics is improving patients’ lives one uniquely designed brace or artificial limb at a time. Understanding those needs and how talented orthotists and prosthetists meet them may help to answer the questions you are afraid to ask the next time you meet an individual who has benefitted from the work of O & P.

By Cory Schneider

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o the outside observer, it may be difficult to tell when the average person is living with a

chronic condition. The symptoms of the disease or the discomfort that person may be feeling are often internal. But that is not always the case for people who have orthotics or prosthetic devices. When a person has an artificial limb or is wearing an orthopedic brace, that is a sign that they are dealing with a medical condition and it is easy to make an assumption about who they are, or worse, be frightened off by how they look.

A closer look at orthotics and prosthetics and the people that it serves reveals a field that aims to better the lives of its patients through ever-evolving technology and acute care that assesses and addresses the very unique and individual needs of each patient who requires either an orthopedic brace or prosthesis.

A Closer look

Orthotics and Prosthetics (O & P) is the evaluation, fabrication and custom fitting of artificial limbs and orthopedic braces. Orthotics is concerned with the manufacturing of devices that support or correct the function of a limb or the torso. Prosthetics are artificial extensions that replace missing body parts. Together, says Joe Tomlinson,

the Director of Orthotics and Prosthetics for Dickson Medical Equipment (DME), an Alana HealthCare Company, “O & P is about finding devices that alleviate pain and, ultimately, improve the quality of patients’ lives.”

Tomlinson oversees a staff of dedicated orthotists and prosthetists who work in consultation with physicians to meet patients’ needs. Orthoses, such as splints, braces, and inserts, are devices that help to support, align, prevent or correct musculoskeletal abnormalities or deformities of the human body. Patients who require orthotic braces include individuals who have sustained a physical impairment due to conditions such as a stroke, spinal cord injury, or a congenital abnormality (e.g., cerebral palsy or spina bifida). Even corrective shoe inserts can be counted as orthopedic devices. Orthotists may design braces for nearly any part of the body, including the knee, cervical collar, back, or ankle.

Rocky Goodall, an orthotist/prosthetist with the O & P Division of DME, says that one orthopedic device many people do not think about is the compression garment, made for mastectomy patients.

“Mastectomy patients experience swelling in their arms, and these garments can help increase circulation and decrease edema,” says Goodall. He adds that splints and boots for individuals who have sustained a foot or leg fracture are also orthopedic devices. Essentially, say Tomlinson and Goodall, many of the devices that ease pain stemming from a broad range of accidents, diseases, and other medical conditions fall into the domain of orthotics. Prosthetics, on the other hand, may be less confusing because, as Goodall explains, individuals who have benefitted from prosthetic limbs are increasingly less likely to cover up their news legs and arms. By definition, prostheses can be fixed or removable and are typically used to replace parts lost by injury (traumatic) or missing from birth (congenital) or to supplement defective body parts. According to Goodall, there are five major reasons for amputation and that a patient would therefore seek out a prosthetic limb. “Complications from vascular circulation problems is the number one cause of amputations,” he says. “Diabetes is second. From there, cancer, motor vehicle accidents, and congenital birth defects make up the bulk of other reasons patients come to us for prosthesis.”

www.alanahealthcare.com

The Right Fit continued on page 8

T

Orthotics and prosthetics ... aims to better the lives of its patients through ever-evolving technology and acute care.

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won’t. A lot of our patients have felt neglected in the past. Often, a larger company will do a prosthesis and never see a patient again. We’ll redo a leg, and redo it again, until we know that it’s right.”

Tomlinson says that DME orthotists and prosthetists know that their work is not completed once patients have their orthopedic

Once a patient has had a limb amputated and the site of amputation heals properly, his doctor may make the recommendation that he consult a service such as DME to start talking about an artificial limb. Prosthetists work with patients to create a limb that suits the patient’s needs and provides ultimate comfort. The end goal, says Goodall, is to find a seamless limb replacement. The ComforT Zone

According to Tomlinson, the philosophy that informs the way that DME’s orthotists and prosthetists work keeps in mind that patients come to them at crucial times when only support and careful attention—not added stress—are needed. Good orthotists and prosthetists, he explains, work to ensure a patient’s every comfort.

“People don’t have to be in pain constantly,” he says. “They can work closely with physicians, and in turn us, to explore options that may alleviate or control that pain, and to correct defects or deficiencies. They can live better lives.”

The DME staff echo these sentiments and explain that the patient-centered approach stems from a family-like atmosphere at the office.

“It all comes from the small company feel,” says J.R. McNeese, a certified orthotic fitter (COF). “We’re trying to build personal relationships with patients and give them services that larger companies

The Right Fit continued from page 8

Good orthotists and prosthetists ... work to ensure a patient’s every comfort.

9www.alanahealthcare.com

devices or prosthetic limbs.

“Follow-up is very important,” he says. “At a minimum, we will do a phone check-in, depending on the brace or prosthesis. When it’s more complicated, we will set up a meeting with patients or do at-home visits, if necessary. We have to make sure that everything is working properly and that patients

know how to use and take care of their braces or prostheses. Education is huge. But sometimes, they just need a simple adjustment and we’re here to do that, too.”

CAre in ACTion

Allie Newman, a DME patient from Clarksville, TN, says she has experienced the patient-centered approach first-hand and that it has

made a difference to her. Newman is a diabetic who had part of her right leg amputated in 2002. It took her some time to make her way to DME, but after a surgeon recommended the company, she worked with Goodall and says her whole attitude has changed.

“At first, I thought he couldn’t be as good, as nice, as he was,” she says. “But he kept fitting my leg until it was right. He would always do a little bit more than other companies did in the past. You can tell that [DME’s] always thinking about the people they’re working with.”

Fernando Lara, DME’s newest orthotist/prosthetist, says that he was struck by the openness of the office environment. Having worked in the business for over 26 years, he says it was a welcome change.

Goodall explains that the loyalty that DME’s staff has to its patients extends to each other. And this attitude is obvious, says Newman.

“An extra pat, an extra hug, they can do wonders,” she says. “I’m glad to be at a place that knows that.”

After an amputation has healed properly, your doctor may start talking to you about an artificial limb.

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By Cory Schneider

W hen Rocky Goodall was born two months premature in 1975, his doctors told his parents

that he only had 48 hours to live. Born a congenital bilateral amputee, Goodall was missing both of his legs below his knees. He was so small—only a few pounds—that he could be held in just one hand. The prognosis was grim, but the doctors were wrong. Goodall more than beat the odds and has since dedicated his life to helping others in similar situations do the same.

Goodall is a orthotist/prosthetist in the O & P Division of Dickson Medical Equipment, an Alana HeathCare Company, and the advice and know-how he imparts to patients comes firsthand and well-tested. He estimates that he has been through anywhere from 25-to-30 sets of prosthetic limbs.

“I used to break everything. Especially the feet,” he says. “I ran over a pair of legs once with a four wheeler. I jumped a fence one time to get to school. I was going fishing and I snapped a foot in half. I had to throw the foot over the fence and run to the car with no foot. I would turn my feet around at little league games.”

But with all of those mishaps came experience and a wealth of knowledge. Goodall shares his story with every patient he sees, and that story gets them through the initial pain and fear of losing a limb and learning to live with prosthesis.

That story, according to Goodall, is not a sad one. In fact, from an early age he showed signs of having every intention of overcoming any perceived disabilities. Physically, doctors explained that his legs never formed, though he did have what resembled boneless foot-like structures on the back of his legs that would eventually have to be removed. Mentally, Goodall acted as if he did have both legs fully intact. At 10 months, he tried to walk for the first time.

“I just kept falling down,” he recalls, with a laugh. “But they couldn’t stop me.”

His parents decided to get him prosthetic legs. Goodall became the youngest person at his facility to be fitted for a pair of prosthetic limbs. By the time he was a year old, he says you could not tell that he was not born with legs.

“I could get around with or without them,” he says. “I did everything: played sports, swam, played little league baseball. I’ve always been able to do everything.”

While his brothers and sisters grew up barely noticing the absence of Goodall’s legs, the same was not true of other kids at school. It was important, he says, to readjust his thinking about those kids’ stares.

“I realized they were amazed at what I was doing,” he says. “Sure, some people accepted it with no problem and some people freaked out. But I matured and realized they were all impressed in some way. I accepted it at a young age and I didn’t see myself as being any different.”

And Goodall has not missed a milestone. He got his driver’s license at 16—despite his parents’ fears. And he married and had four children to whom he has passed on the belief that anything is possible with will power and determination.

Ten years ago, Goodall became friendly with the man at the facility that made his legs and started working as a technician. Before that, he had no training in prosthetics, but quickly learned by doing. It was then that he realized his unique position to inspire and motivate other patients. If he could do it, be believed, so could they.

“There’s nothing better to me than helping other people through hard times. It’s like winning the lottery,” he says.

Rocky Goodall, BOCPO/L

Getting to Know...

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Goodall was officially certified in 2007 and became a practitioner. From there, he began managing offices, as well, and received his state licensure. He joined Dickson Medical Equipment in early 2009 and has not looked back since.

“It’s a great work situation,” he says. “We’re honest with each other and loyal. We have a nice thing going on.”

Goodall says the patients he works with want to know everything: from whether he experiences phantom limb pains to how he goes upstairs and how he drives.

“When they first come in, they think their lives are over,” he says. “Their lives are always going to be compromised, and they can’t accept that. But when they see someone like me, they have to accept it. Usually, those patients are missing just one leg, and I prove to them that life isn’t over. I tell them: ‘I have been through it, endured it, and overcome it.’”

Goodall advises his patients on the physical and emotional pitfalls of prosthesis. He notes that skincare is the single most important thing to keep in mind. He instructs patients in cleaning

the area that comes in contact with the prosthetic limb and caring for the liners he or she wears over that area. He tells them about his own painful experiences with ingrown hairs and the taxing recoveries from his many surgeries.

On the emotional side of things, Goodall explains that patients have to be prepared for meeting new people, and have to learn to anticipate and deal with the wide range of reactions their prosthetic limbs will garner.

“You see amputees all around, especially because of diabetes and vascular health problems,” he says. “Mostly, other people just want to know what the technology is, what the pumps are for. They’re curious, and we can help them stare less if we answer their questions.”

Goodall has noticed that more and more amputees are not covering up with long pants and shirts. He tells patients how his own children refer to his prosthetic limbs as “robot legs.” He maintains that how patients handle and ultimately live with their new circumstances lies in their own perceptions.

“The main thing to remember is that people aren’t staring at you to make fun,” he says. “They are staring because they’re amazed at what you can do.”

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In recent years, policymakers in Washington, D.C. have been trying to cut healthcare costs. These cuts have had a particular impact

on Medicare, the federal healthcare program for senior citizens and people with disabilities. The spending cuts and reforms have left many of the nation’s 46.5 million Medicare beneficiaries asking the same question: “What does this mean for me?”

For many of these Medicare beneficiaries and their families, what these cuts will likely mean is that it will be harder to obtain access to the home medical equipment and services they need to stay healthy and independent in their own homes. And, more importantly, they will have difficulty staying out of nursing homes or hospitals.

Even though spending on home medical equipment is less than two percent of the total Medicare budget, and even though reimbursement rates have been cut deeply and disproportionately over the years, Medicare continues to promote the reforms.

One of the most troubling recent changes is the Medicare competitive bidding program for home medical equipment and services, which includes oxygen therapy, wheelchairs, hospital beds, and other durable medical equipment used in homes.

The bidding program has the ability to eliminate many of the home medical equipment providers in the bid areas and eventually across the country as a result of “suicide bids” that create bid awards to low to provide the profitability necessary to provide quality care to patients that require home medical equipment and services. That became clear when the program was first implemented in 2008 in 10 areas around the country. Congress halted the program due to numerous problems and flaws, such as Medicare contract awards being given to unlicensed home medical providers and companies with little experience in providing certain types of home medical equipment. In reintroducing the bidding system, however, the Medicare program failed to make the changes needed to protect home care patients and providers.

Because Medicare is the primary payer for senior citizens and people with disabilities who use home medical equipment, Medicare can use economic pressure to force home care providers to submit to unsustainably low bids needed to “win” one of the few contracts being offered. The competitive bidding process may actually discourage competition in the home medical equipment and services sector, reduce access to care for patients, and possibly put many providers in financial jeopardy. Round one is complete in nine metropolitan statistical areas in the U.S., and will begin on January 1, 2011. The bidding for Round 2 of the program will begin in 2011 in

an additional 91 areas that represent the majority of the Medicare population and will take effect on January 1, 2012.

The question is whether this program will actually decrease costs over the long run. With the potential of fewer available providers, many patients will be forced into far more expensive post-acute care alternatives, such as hospitals or nursing homes. This will simply shift costs to other parts of the healthcare system.

When it comes to caring for patients in the home, there is no need for a tradeoff between quality and affordable care. Home care is both cost-effective and is often the preferred method of care by senior citizens and patients because it provides them with independence and allows the opportunity to be close to family and friends. The more that patients rely on quality healthcare equipment and services at home, the less the U.S. will have to spend on longer hospital stays, emergency room visits, and nursing home admissions.

Providers of home medical equipment and services across America have proposed fiscally responsible alternatives to the competitive bidding program. An increasing number of associations and independent medical equipment suppliers—including thousands of local providers of home care equipment

Competitive bidding could be a losing proposition for some Medicare beneficiaries

Food for Thought

By Mike GallagherVice President of Government Affairs, Alana HealthCare

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and services—support H.R. 3790, a bipartisan bill in Congress that would preserve access to home care and provide a cost-effective alternative to the Medicare competitive bidding program for durable medical equipment. So far, the bill has 254 cosponsors in the U.S. House of Representatives, with broad bipartisan support. Cosponsors include key House leaders who agree that there are concerns with this flawed program.

H.R. 3790 would replace the bidding program while ensuring that the projected cost savings of the program are met through a series of payment reductions for home medical equipment providers across the country. This important bipartisan bill will preserve

To find out more on the Medicare Competitive Bidding Program, or H.R. 3790 (the Bill to replace the Competitive Bidding program), visit the following websites:

• www.aahomecare.org• www.dmecompetitivebid.com• www.cms.gov/

DMEPOSCompetitiveBid

For more information, contact state homecare associations. To convey your position, concerns, or ask questions, consider contacting your local government representative.

You can contact your representative by calling the

US. Capitol Switchboard at (202) 224-3121. Keep

in mind that you may also be required to get in touch with the state and district

where you currently reside.

high-quality home care services and equipment for Medicare patients and prevent job losses and the needless closing of businesses across the country in the midst of an already difficult economic climate.

14 www.alanahealthcare.com

By Cory Schneider

As autumn approaches, it is important to remember that many medical conditions can be exacerbated by the

cooler temperatures. When it comes to Rheumatoid Arthritis, Dr. Dimitrios A. Pappas warns that informed patients have to separate fact from fiction. Pappas is an Assistant Professor of Medicine and Co-Director of the Rapid Arthritis Care and Evaluation (RACE) Center at Johns Hopkins School of Medicine. He spoke to Wellness 360 about the ins and outs of Rheumatoid Arthritis and his best advice for staying healthy year-round.

What is rheumatoid arthritis? Who has the condition? What are the symptoms? What are the treatments available for it?

Rheumatoid Arthritis (RA) is an immune-mediated inflammatory disease. This means the immune system attacks healthy tissue; in the case of RA, that tissue is the lining in the joints. About 1.3 million people in the United States have RA. It can occur in all races and at any age, though about two to three times more women than men have RA.

RA can cause pain, swelling, and eventually destruction of joints. Smaller joints like those in the hands, wrists, and feet are most often affected. There is no cure for rheumatoid arthritis but there are many medications available that can put the disease in “remission.” By remission we mean a state of no joint pain, inflammation, or destruction. Medications need to be taken for a long-term period or even for life to maintain this remission state. It is important for people with RA to work with a rheumatologist to find the right medication or combination of medications to control the disease. The goal of treatment is to preserve function by reducing inflammation, preventing joint damage, and relieving pain.

How is rheumatoid arthritis affected by the weather? What are some other triggers?

Interestingly, there is no scientific proof that either cold or hot weather changes how people with RA feel. Many patients do tell me that their arthritis gets worse in the summer, but just as many tell me their arthritis is worse in winter. A bigger trigger for changes in how people with RA feel is stress. Stress can include anything from an illness to chronic pain to a new job. Some have suggested that weather changes effect a change in the barometric pressure, which in turn can alter the “tension” of the joint capsule (the lining of the joint). There are nerve endings in this capsule, which may transmit this increased tension as a pain sensation.

What can patients diagnosed with rheumatoid arthritis do to stay healthy and feel well? What are some tips and best practices?

Like all of us, people with RA need a balanced diet and exercise. Exercise—including stretching, aerobics, and weight training—will keep joints functioning and improve overall health. Exercise can also help prevent or fight depression, reduce pain, and control weight.

In fact a healthy diet and regular exercise may be even more important for people with RA compared to people without RA. We consider RA to be a disease that may have an impact on many organ systems (different parts and organs of the body) such as the heart. RA has been associated with a higher risk for early heart disease and may predispose patients to heart attacks or strokes at an

earlier age. Thus everything that aids in keeping cholesterol levels low for people without RA is also applicable for patients with RA. Smoking should be discontinued for the same reason and weight loss, if needed, should be pursued.

What other things should RA patients keep in mind when trying to maintain their best health?

I believe it is very important for people to learn as much as they can about their disease. This allows them to act as a partner in their care and to make the most informed decisions about their treatment. Our website at Johns Hopkins Arthritis Center (http://www.hopkins-arthritis.org) can be a resource for patients who want to know more about their disease.

Your Best Health: Rheumatoid Arthritis

It’s that familiar time of year again. Yellow school buses are stopped at the corner to pick up children for school as their parents anxiously

wish them good luck and wave goodbye. The last of the summer heat is still being felt, but in just a short time the leaves will begin to change color. It’s almost the fall, and while this time of year brings with it many wonderful things, it also marks the beginning of flu season.

You can prevent the seasonal flu virus by taking the proper precautions, including getting the yearly flu vaccine. Yearly flu vaccination should begin in September or as soon as vaccine is available, and continue throughout January and oftentimes beyond. The timing and duration of flu seasons vary. While flu outbreaks can occur as early as October, they normally peak in January or later.

The seasonal flu vaccine normally protects against the three influenza viruses that research indicates will be most common during the upcoming season. The viruses in the vaccine change each year based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year. The 2010-2011 flu vaccine will protect against 2009 H1N1, in addition to two other influenza viruses. The flu vaccine is normally effective about 2 weeks after vaccination, at which time antibodies that provide protection against the flu virus infection develop in the body.

The CDC Says “Take 3” Actions To Fight The Flu:

1. Take time to get a flu vaccine. • The Centers for Disease

Control and Prevention (CDC) recommends a yearly flu vaccine as the first and most important step in protecting against flu viruses.

• Everyone six months of age and older should get vaccinated against the flu as soon as the 2010-2011 season vaccine is available.

• People at high risk of serious flu complications include young children, pregnant women, people with chronic health conditions like asthma, diabetes, heart and lung disease, and people 65 years and older.

• Vaccination of high-risk persons is especially important to decrease their risk of severe flu illness.

• Vaccination is important for healthcare workers, and other people who live with or care for high-risk people to keep from spreading flu.

• Children younger than six months are at high risk of serious flu illness, but are too young to be vaccinated. People who care for them should be vaccinated instead.

2. Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.

• Avoid touching your eyes, nose and mouth. Germs spread this way.

15www.alanahealthcare.com

Did You Know…

Fighting the Flu

Fighting the Flu continued on back cover

CorporATe heAdquArTers

Alana HealthCare, LLC507 East College StreetDickson, Tennessee 37055Telephone: (615) 375-1094Fax: (615) 375-1132Toll-free Phone: (877) 796-9679Toll-free Fax: (877) 471-2484www.alanahealthcare.com

subsidiAries

Alana HealthCare Pharmacy, LLC: 507 East College StreetDickson, Tennessee 37055Telephone: (615) 375-1094Toll-free Phone: (877) 796-9679Toll-free Fax: (877) 471-2484 DME Tennessee, LLC: DME of Dickson760 Hwy 46S Dickson, TN 37055Office: (615) 446-7444 Fax: (615) 446-7483

DME of Jackson117 North ConalcoJackson, TN 38305Office: (731) 660-5080 Fax: (731) 660-0025 DME of Union City1200 B South Bishop St.Union City, TN 38261Office: (731) 885-2122Fax: (731) 885-2177 DME of Dyersburg1083 Vendall St. Dyersburg, TN 38024Office: (731) 286-1000 Fax: (731) 286-1001

DME of Clarksville1817 Madison St. Suite 5Clarksville, TN 37040Office: (931) 503-1309Fax: (931) 503-1313 DME of Erin15C North Boone St.Erin, TN 37061Office: (877) 342-6107Fax: (931) 289-3947 DME Orthotics and Prosthetics127 Crestview Park Dr. Ste 104Dickson, TN 37055Office: (615) 740-0177 Fax: (615) 740-1154 DME Orthotics and Prosthetics1817 Madison St. Suite 5Clarksville, TN 37040Office: (931) 503-1309 Fax: (931) 503-1313

• Try to avoid close contact with sick people.

• If you are sick with a flu-like illness, the CDC recommends that you stay home for at least 24 hours after your fever is gone, except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)

• While sick, limit contact with others as much as possible to keep from infecting them.

3. Take antiviral drugs to treat your illness if your doctor prescribes them.

• Antiviral drugs are different from antibiotics. They are prescription medicines (pills, liquid, or an inhaled powder) and are not available over-the-counter.

• Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications.

• It’s very important that antiviral drugs be used early (within the first two days of symptoms) to treat people who are very sick (such as those who are hospitalized) or people who are sick with flu symptoms and who are at increased risk of severe flu illness, such as pregnant women, young children, people 65 and older, and people with certain chronic health conditions.

• Flu-like symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also experience vomiting and diarrhea. Keep in mind that it is possible to be infected with the flu and exhibit respiratory symptoms without a fever.

Information compiled from the Centers for Disease Control and Prevention. Visit them at http://www.CDC.gov.

– Amy Massey

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