Our kidneys are incredibly high-tech filters. They are constantly monitoring and working to keep our bodies as healthy as possible. Kidneys filter our blood and keep the things we need, like water, sugar, proteins and electrolytes, and discard the things we don’t need, like urea, ammonia and drug metabolites, which make up our urine. Kidneys are high-tech filters because they do so much in addition to filtering. Kidneys regulate blood pressure, make sure our bodies aren’t too acidic or alkaline, and release certain hormones that tell bone marrow to make red blood cells and activate vitamin D, which helps the body absorb calcium.

Kidneys are amazing but in some people, they break down. When kidneys gradually lose their function, a patient is diagnosed with kidney disease. When kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes build up in the body. An estimated 30 million people, or 15 percent of U.S. adults, are estimated to have kidney disease. Nearly half of the 30 million people with severely reduced kidney function aren’t aware of having the disease. This is because kidneys are incredibly efficient organs. They are able to work at their normal capability with significant kidney damage, so no symptoms typically arise until the damage is critical. The only way to find out for sure if you have kidney disease is through specific blood and urine tests.

A number of factors contribute to kidney disease. If you have a few or many of the following conditions, visit your doctor to be tested for kidney disease. Symptoms for the disease rarely show, so testing is imperative. Conditions such as diabetes, high blood pressure, cardiovascular disease and obesity increase the risk of kidney disease. Smoking, a family history of kidney disease, abnormal kidney structure and old age are other potential causes.

There are always measures one can take to prevent kidney disease or lower the risk of increasing kidney damage. Controlling blood pressure and blood sugar, making lifestyle changes, such as eating healthy, maintaining a healthy weight and not smoking, are ways to reduce the risk. Also, make sure to follow the instructions on over-the-counter medications. Taking too many of certain pain relievers can damage your kidneys. Prevention and management are the biggest steps you can take to living a happy, peaceful and healthy life. Start today.

About the author

Dr. Talal Khan has been with Freeman Kidney Center for more than three years. He earned his medical degree at Rawalpindi Medical College, Rawalpindi, Pakistan, completed his residency in internal medicine at State University of New York, Buffalo, N.Y., and completed his fellowship in nephrology at Drexel University, Philadelphia, Pa. Dr. Khan is board certified in internal medicine, hypertension and nephrology.

The words “coach class syndrome” may sound relatively harmless, but heart specialists have a more serious name for it – deep vein thrombosis (DVT). It happens when blood clots form in the body’s deep veins, particularly in the legs, and left untreated, it can be fatal.

DVT can develop after long plane rides with particularly cramped seating and leg room. Other factors, such as low cabin pressure, low humidity and dehydration, can also contribute to developing DVT during a long flight. People with a history of cardiovascular disease or stroke and those who have had previous blood clots are at risk for DVT. However, the condition can also affect healthy, athletic people, and you don’t have to fly to get it.

Despite the name coach class syndrome, DVT can also affect those on the ground. Women who are pregnant or taking hormonal birth control can be at risk due to increased estrogen levels, which can cause blood to clot more easily. Staying stationary for extended periods of time can also increase risk of DVT because the veins deep in the legs require muscle movement to force blood back to the lungs and heart.

Once a blood clot has formed in a deep vein, a new problem can arise – the clot can break off, traveling through the bloodstream to obstruct a vessel in the lungs, creating a pulmonary embolism. According to the Centers for Disease Control and Prevention, 900,000 Americans develop DVT each year and up to 100,000 of them die from complications like pulmonary embolisms.

In the past, standard treatment included an extended hospital stay for anticoagulant and blood thinner drug therapy. During this therapy, patients walked a tightrope – too little medicine could lead to catastrophic clotting, but too much could cause life-threatening major bleeding.

Today, cardiovascular surgeons and cardiologists, can use a tiny catheter to remove the blood clot faster and more safely than they could with past treatment methods. During the procedure, the surgeon inserts a specially designed catheter into the vein and through the clot. Once the blood clot is isolated, clot-busting drugs are delivered, and high intensity vibrations break up the clot. The surgeon then removes the catheter with any remnants of medication, allowing the blood to again circulate through the vein. The entire procedure takes less than two hours.

Even if you are at risk for DVT, you can take steps to prevent it. As with many health conditions, getting regular exercise, maintaining a healthy weight and lowering your blood pressure can lower your risk. When traveling, try to get up and move at least once every four hours. If you are stuck in your seat, work your leg muscles by stretching your legs or flexing your feet. Staying hydrated and wearing compression stockings can also help.

Contact your doctor if you are concerned about your risk for DVT or if you have symptoms of DVT, such as leg swelling or pain, warm skin on your leg, red or discolored skin on your leg or tired legs. If you experience sharp chest pain, shortness of breath, sudden coughing or severe lightheadedness, seek immediate medical attention because these could be signs of a pulmonary embolism.

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About the author

Raymond Vetsch, MD, is a cardiothoracic and vascular surgeon at Freeman Health System. Vetsch joined Freeman Heart & Vascular Institute in Joplin in 1998. He is a nationally recognized surgeon of human heart valve transplants, and he specializes in complex and innovative valve procedures. To learn more about cardiovascular health, visit freemanhealth.com/heart or freemanhealth.com/heart-assessment.

While diabetes affects more than 30 million people in the U.S., another 84 million people have prediabetes, a condition that produces higher than normal blood sugar levels because the body no longer processes blood sugar properly. No signs or symptoms present themselves, but those with prediabetes have a good chance of progressing into type 2 diabetes.

The process of moving sugars from the bloodstream and into cells starts working improperly when an individual has prediabetes, much the way it does with type 2 diabetes. When sugar enters the bloodstream after eating, the pancreas secretes insulin, which helps your body’s cells take in sugar. With prediabetes, not enough insulin is made and high amounts of sugar remain in the bloodstream, causing high blood sugar.

Factors that increase the risk of developing prediabetes include dietary patterns, weight, inactivity, age, family history, sleep problems and age. Regular exercise and healthy eating habits can significantly help prevent or delay prediabetes, as well as progression to type 2 diabetes.

Managing weight and keeping the body healthy is essential to preventing prediabetes. A 40-minute brisk walk five times a week is an easy way to get some non-vigorous exercise. A standard meal should consist of 50 percent fruits and vegetables, 30 percent grains/starches and 20 percent protein. A variety of foods ensures necessary nutrients are entering the body. Liquids such as coffee, tea and water should be consumed regularly throughout the day to remain hydrated. Eating the correct portion sizes also helps to regulate and maintain weight. These amounts should be consumed every day:

• Fruits – 1½ to 2½ cups
• Vegetables – 2 to 3½ cups
• Grains – 5 to 10 ounces
• Protein – 5 to 7 ounces
• Dairy – 3 cups
• Oils – 5 to 8 teaspoons
• Solid fats and added sugars – small amounts

Exercising and eating right are the foundation of a healthy lifestyle. Doing so can be difficult, but dedication, taking precautions for safety and education can help prevent and manage prediabetes.

March 27, 2018, is American Diabetes Association Alert Day®, a one-day “wake-up” call for individuals to take a look at their risk for developing diabetes. Freeman Health System encourages people to take the one-minute type 2 diabetes risk test. The test can be found at diabetes.org/alertday.

About Susan Pittman

Susan Pittman, RD, LD, CDE, leads the Freeman Health System Diabetes Education team. Certified through the National Certification Board of Diabetes Educators, she provides nutritional counseling to patients with diabetes and those at-risk of developing the disease. For more information, call Diabetes Education at 417.347.5700.

Modern technology harnesses the power of the internet to access a wealth of information instantly, almost anywhere. Freeman Health System recognizes the importance of providing accurate health information, and has positioned itself as the source for information you can trust. We help you take advantage of technology by offering free access to our mobile-friendly health resource libraries, where you can find condition-specific information, whenever you need it.

Have you ever wanted to test your knowledge about stroke or understand how to determine your body mass index? Where would you look for information about treating obesity – would you ask a friend, read a magazine or consult your healthcare provider? While these can be a good starting place, your success in developing a healthy lifestyle depends on your ability to find accurate information and how well you understand and apply what you learn.

Current offerings include BARIATRIC and DIABETES libraries, as well as other tools found in the Health Resources section at freemanhealth.com. Our website enables you to learn in an interactive environment, and content is arranged with you in mind, so information is easy to find. Articles, quizzes and videos are available to teach you about each condition, helping you to make well-informed decisions about your health.

Quality of life requires good health and possibly a little luck. Learning about health helps you develop a healthy lifestyle and puts you in control. Turn to Freeman as your source for trusted, accurate health information. If you need a place to start, explore our website, take advantage of our free online risk assessments and use them on a regular basis. Try keeping BMI and blood pressure readings in a journal to track your risk of diabetes and stroke. And most of all, take time to enjoy life, eat healthy, get some exercise, celebrate successes, nurture friendships, keep learning and let Freeman help you become the best version of you that you can be – you deserve it.

Your health is important to you. Do you know if you are at risk for future health problems? Knowing your risk of a disease can help you take the right steps to prevent or manage it.

Freeman Health System provides several free Online Health Risk Assessments to help you have a better understanding of your risk for disease. Freeman offers assessments for breast cancer, diabetes, stroke, heart problems and weight-loss surgery. Assessments can be downloaded and printed to your physician.

Breast Cancer Risk Assessment

The Breast Cancer Risk Assessment is a quick, seven-question assessment. In 2018, an estimated 266,120 new cases of invasive breast cancer are expected to be diagnosed in American women and 2,550 new cases in American men. If you answer yes to any of the questions, you may be at an increased risk of breast cancer. Please call Wes & Jan Houser Women’s Pavilion at 417.347.7777 to schedule an in depth high-risk assessment.

Diabetes Risk Assessment

According to Centers for Disease Control and Prevention (CDC), 30.3 million American adults have diabetes, 7.2 million of those adults are undiagnosed. Many factors, such as family history and diet, play into a person’s risk of diabetes. The Freeman Diabetes Risk Assessment can help you learn your eight-year risk of developing diabetes. Once the assessment is completed, you’ll receive a personalized report outlining information about your health. Contact Freeman Diabetes Education at 417.347.5700 for more information.

Stroke Risk Assessment

Stroke is the fifth leading cause of death in the United States. The Freeman Stroke Risk Assessment can help you learn about your stroke risk, risk factors associated with stroke and steps to take to reduce the risk. Once you complete the assessment, you’ll receive a personalized report outlining information about your health.

Heart Health Assessment

Every 44 seconds someone suffers a heart attack. Equipped with the right tools you can control factors that lead to heart disease, which include monitoring cholesterol and blood pressure, quitting smoking and managing stress. The assessment takes 10 – 15 minutes to complete. For more information contact Freeman Heart & Vascular Institute at 417.347.5000.

Weight-loss Surgery Assessment

Discover if weight-loss surgery may be an option for you. The Weight-Loss Surgery Assessment helps determine your weight category and if you should lose weight. Additionally, it identifies your weight-related issues and conditions. For more information about Freeman Bariatric Center, call Janice at 417.347.1266.

All Freeman Online Health Assessments can be found here. An assessment is intended for informational purposes only. Please contact your healthcare provider if you believe you are at risk of a disease.

About the Author

Shelby Allen, RN, BSN, has led the Freeman Prevention & Wellness team for more than 20 years.  The team consists of Freeman Screen Team, Freeman WellBalance, and wellness programming to area schools and businesses.  She is a nurse and certified wellness director, bringing prevention and detection to the community.  For more information, call Freeman Prevention & Wellness at 417.347.5646. 

Many people are lucky enough to move freely throughout their lives – walking through their home, exercising, playing with children, all normal activities they often don’t need to think twice about. For those with spasticity, those normal activities are much more difficult. Spasticity is a movement disorder caused by an imbalance between signals that inhibit or stimulate the spinal cord. This results in muscles that are tight and make movement difficult – it can also cause involuntary movements and even fixed range of motion. Spasticity affects 1 million people in the United States, often adults and children with conditions such as multiple sclerosis, cerebral palsy, stroke, spinal cord injuries or brain injuries. 

Spasticity is nearly always bothersome and sometimes painful. Daily movements can become nearly impossible and muscle spasms can disrupt sleep. With little movement and poor sleeping conditions, spasticity begins to affect the overall physical and mental health of an individual. 

The first line of defense for spasticity is regularly stretching, exercising and rehabilitation. When spasticity affects only a few muscles, injections of botulinum toxin (BT) have been found helpful.

BT, commonly known as brand name Botox®, is a medication derived from a neurotoxin made by bacteria. This toxin is purified and can be used safely to treat spasticity in different muscle groups. BT works by blocking a nerve impulse. Usually, the brain sends messages to the muscles so they can contract and move, but BT impedes part of that process. It blocks the chemical signal between nerves and muscles, which carries the message from the brain and activates muscles. Since BT blocks these chemicals, the muscle doesn’t spasm. This provides relief from pain and muscle stiffness. 

BT is given as an injection into the muscle during an outpatient visit. There are no activity restrictions after a patient receives an injection, but the effect isn’t usually felt until a few days after the injection. Relief from spasticity symptoms by BT generally lasts between two and six months, so most injections are repeated every three months. To maximize the benefits of BT, physicians also recommend supplemental physical or occupational therapy

Using BT for spasticity has a number of benefits. It is usually effective in relaxing the injected muscles, provides a stable effect for several months, is usually well tolerated and improves range of motion. BT also shows a significantly improved gait pattern in patients, greater ease in stretching and tolerance of braces, and also a possible delay of surgery. 

For those suffering with spasticity and trying to take part in normal, everyday activities, BT is an option to help you get there.

Dr. Amanda Price earned her medical degree at Boston University School of Medicine and started as a physiatrist at Freeman NeuroSpine in September 2017. A physiatrist is a physician who reduces pain and restores function lost due to illness or injury and treats a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. Dr. Price is part of a team that specializes in spinal care services for patients. For specialized spinal care services, call 417.347.7200.

Having highly trained and educated nurses is a priority at Freeman Health System. The Nursing Education Fund is available to eligible Freeman nurses who want to further their nursing education. Money from the fund can be used for advancing a degree, a specialty certification (which can help an RN achieve a higher level in TAPP), healthcare projects or conferences that may be too expensive to attend without assistance. 

In 2017, I received funds to assist with my pursuit of a Master's Degree in Nursing – Neonatal Nurse Practitioner at the University of Missouri, Kansas City. I used the funds to help pay for tuition and reduce the amount of student loans I needed – and I could use the funds as I saw fit. 

Donating to the fund helps promote the profession of nursing. Nursing has developed from a technical trade to a body of science that is based in research, theory and the art of healing. Nurses are a vital piece in the healthcare system, providing quality, safe care with skills in bedside care, informatics, quality improvement, administration, education and community health services –  just to name a few. For the profession to grow, we as nurses need to invest in ourselves, and the Nursing Education Fund helps us do that. We hope you consider making a contribution today.

To learn more about giving options, visit freemanhealth.com/give-to-freeman.

Obstructive Sleep Apnea (OSA) can do more to your body than just wake you up in the middle of the night. OSA is the most common sleep-related breathing disorder. It is caused by repetitive episodes of apnea – repeated breaks in airflow. While men are more commonly affected by this disorder, women suffering from OSA are at a higher risk of heart failure[1]. Studies have found a link between OSA and heart-related problems such as hypertension, coronary heart disease, cardiac arrhythmia and heart failure.

Hypertension and OSA commonly go hand-in-hand with one another. Hypertension – high blood pressure – develops over many years and can worsen if you do not get enough sleep. OSA can keep you from getting enough rest to help keep your blood pressure down to healthy levels.

More severe cases of OSA have been linked to coronary heart disease, and in a few instances, heart failure. Coronary heart disease occurs when the coronary arteries begin to narrow, which restricts the amount of blood that reaches the heart. OSA can keep you from being healthy in your day-to-day life by keeping you from getting enough sleep to feel energized, which leads to exercising less and eating unhealthy foods more. These issues can compound on one another until heart failure occurs.

How can you tell if you’re affected by OSA? A few of the symptoms of OSA are:

• Excessive daytime sleepiness
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Morning headache
• High blood pressure

The current universal treatment for OSA is the continuous positive airway pressure machine, more commonly referred to as CPAP. The CPAP eliminates apnea and the hemodynamic – change in flow of blood to organs and tissue – changes during sleep. Long-term CPAP treatment positively affects blood flow throughout the body and daytime blood pressure levels.[2] According to the American Academy of Sleep Medicine, treatment for OSA has resulted in an improvement in quality of life with 54 percent seeing improved respiratory function, 49 percent report improved mental health, 41 percent of patients seeing an improvement in blood pressure and 31 percent seeing improved HbA1c – average blood glucose – levels.

Many people view OSA as a sleeping disorder than can keep you or your loved ones awake at night. However, OSA is much more than that, and the results can be much more damaging.

About the author

Jason Maxfield, MD, is a board-certified sleep medicine specialist and an American Academy of Sleep Medicine diplomate. Dr. Maxfield has worked at Freeman for four years and is the Medical Director of Freeman Sleep Center. To learn more about sleep disorders, visit freemanhealth.com/sleepmedicine or call 417.347.8688 to make an appointment.

[1] Mehra, Reena. “Obstructive Sleep Apnea and Cardiovascular Disease in Adults.” UpToDate, 19 Dec. 2017, uptodate.com/contents/obstructive-sleep-apnea-and-cardiovascular-disease-in-adults.

[2] Lattimore, Dee L. “Obstructive Sleep Apnea and Cardiovascular Disease.” Egyptian Journal of Medical Human Genetics, Elsevier, 3 May 2003, sciencedirect.com/science/article/pii/S0735109703001840.

The beginning of summer means warm weather, more daylight, swimming pools and sneezing. With summer in full swing, allergy sufferers all over the country are feeling the effects of allergy season. Allergies occur when your immune system reacts to a foreign substance such as pollen, pet dander or a synthetic chemical. Everyday tasks such as running errands, doing yard work and going for a walk can become exhausting due to high pollen counts, dander and other factors that trigger allergies.

Many people try to ignore their allergies and instead choose to “tough it out.” However, it could come to a point where your allergies become unbearable or even life threatening, and a visit to the doctor’s office is needed. Not addressing the allergy typically leads to watery eyes and runny noses, but more severe cases can lead to anaphylaxis – a severe allergic reaction.  

The first step to ridding yourself of the woes of allergies is to get tested. Allergy testing is used to find out what substance, or allergen, may trigger an allergic response in a person. The two most common types of allergy testing used are skin testing and a serum-specific IgE (immunoglobulin) antibody test. Once the allergy has been identified, the proper course of treatment can be issued.

Just as there are various kinds of allergies, there are various ways to treat them – and while there is no cure for allergies, symptom management through treatment is possible. These treatment options include:

• Antihistamines – to treat the “itchy,” “sneezy,” “allergic” component of allergies
• Anti-inflammatories – to treat the swelling, inflammatory component of allergies
• Environmental modification – making changes in flooring, air conditioning or humidity
• Allergy desensitization – used to gradually expose the patient to increasing doses of the allergen to eventually “desensitize” them to the allergen
• Allergy injections (immunotherapy) – generally used for indoor/outdoor environmental allergens
• Sublingual tablets – a new treatment option that can be used for some indoor/outdoor environmental allergens
• Drug desensitization – used in the case of drug allergy
• Sublingual immunotherapy

Don’t let your allergies keep you from enjoying your summer. With so many different treatment options, no one has to suffer through another summer full of scratchy throats and watery eyes.

About the Author

Nathan Box, DO, FAOCO, is an allergy specialist at Freeman Ear, Nose & Throat Center and is board certified by the American Osteopathic Board of Otolaryngology-Head and Neck Surgery. To learn more about allergies and treatment options, visit freemanhealth.com/allergy or call 417.347.8405 to make an appointment.