During National Suicide Prevention Awareness Month in September, it is important to remember lives lost to suicide, as well as to provide information about available resources for individuals who may be struggling with severe depression.

According to the American Association of Suicidology, a suicide attempt is made every 30 seconds in the United States. That means that every 12.3 minutes someone takes his/her life, accounting for 117 individuals each day or 42,773 suicide deaths annually. In southwest Missouri (Barton, Jasper, Newton and McDonald counties), 49 lives were tragically lost to suicide in 2014. That same year, Missouri ranked 17th in the nation in the number of suicides; statistics show that 1,017 Missouri citizens took their lives in 2014.

Missouri loses more lives to suicide than auto accidents, yet the topic is seldom discussed. Suicide is a heavy subject for those contemplating self-injury. Stigma attached to mental illness causes individuals to be ashamed of their thoughts and feelings. Individuals suffering remain silent about their thoughts, and those around them dare not ask if they are ok.

When suicidal individuals end their life, to end their pain, they pass their pain on to loved ones left behind; leaving them to make sense of the loss and navigate the tragedy. Research shows that approximately 18 people are impacted by each death. In our own community, at least 882 people have experienced this horrific loss and life disruption. Although suicidal thoughts can affect anyone regardless of age, gender, religious beliefs and/or background, tragedy can be avoided if the person struggling reaches out to a trained mental health professional. Mental health professionals can provide effective ways to help cope or survive the crisis. The best thing a person can do to help someone struggling with a possible life-threatening depression is to become educated about the warning signs of suicide and know what community resources are available.

Warning signs can include withdrawing from life, displaying extreme mood swings, sleeping too little or too much, increasing use of alcohol or drugs, feeling hopeless with no reason to live, feeling trapped, having unbearable emotional pain and wanting to die or kill oneself. If you recognize these warning signs in yourself, a friend, a co-worker or a loved one, be the change needed to break the code of silence. Talk directly and openly about your concerns. Help the individual get professional counseling treatment to avoid another life lost to suicide.

Ozark Center Crisis Services operates a free 24-hour hotline staffed by highly-trained mental health professionals. Crisis services are available by telephone at 417.347.7720 or 800.247.0661, as well as by text message at 720.7.TXTOZK. The National Suicide Prevention Lifeline is also available 24 hours per day at 800.273.8255. For a list of all services offered by Ozark Center, visit ozarkcenter.com. Help is readily available for anyone needing guidance or assistance.

To learn more about warning signs of suicide and how you can help someone, Ozark Center is holding a FREE community training workshop Saturday, September 10, 2016, at Freeman Business Center, 3220 McClelland Boulevard, Joplin. The sessions begin at 1:00 pm and end at 3:00 pm, with a balloon release to honor community members lost to suicide. Workshop sessions are open for adults and youths (grades 5–12). Fun activities for children younger than 5th grade will be provided. Reserve your spot by calling 417.347.7720.

When it comes to using and managing your medications, it is important to play an active role in your own healthcare. Because health risks accompany all medications, talk to your doctor or pharmacist about your medicines. According to the U.S. Food and Drug Administration (FDA), a drug is approved and considered safe enough when the benefits outweigh the known risks. To reduce risks and receive the most benefits, especially when taking multiple medications, the FDA encourages you to practice SAFER:

• Speak up
• Ask questions
• Find the facts
• Evaluate the choices
• Read the label and follow directions

Speak up during your doctor appointments. It is important for the healthcare team to know your medical history along with the medicines and treatments used. If possible, you should prepare and provide a written list of your medications and treatments to your doctor. It is also a good idea to keep a copy for yourself. The list should include any prescription medicines, over-the-counter medicines, dietary supplements and vitamins, as well as any allergies or problems you have experienced with a particular medicine or ingredient. You should also include any issues that may affect your use of medicine, such as trouble swallowing or trouble remembering to take your meds or if you are currently pregnant or trying to become pregnant.

Ask questions regarding your medications. Take notes on drug risks and usage during your doctor appointments or when picking up your prescription at your pharmacy. If you do not understand, always ask.

Find the facts about a prescription or over-the-counter drug by learning and understanding as much as possible. This may include brand or generic drug name, active/inactive ingredients, uses, side effects, directions or storage instructions, to name a few.

Evaluate your choices by weighing the benefits and risks you have learned about the medication. It is important to weigh the helpful effects versus the possible unwanted effects. Speak with your healthcare team when making these decisions.

Read the label and follow directions of both prescription and over-the-counter medicines. Before leaving the pharmacy with your prescription, double-check you have the correct medication, know the right dosage and know how to use it. When purchasing an over-the-counter medicine, read the label carefully. If you have questions or problems, contact your pharmacist or your doctor. Lastly, follow directions on the label and directions from your doctor and pharmacist to ensure you receive all the benefits while keeping risks low. Save the packing insert information, if available.

Managing your medications can be overwhelming, but it is possible. Practice SAFER, always talk to your doctor and pharmacist, and always play an active role in your own healthcare.  

Greg Cobble, RPh, earned his pharmaceutical degree from Southwestern Oklahoma State University in Weatherford, Oklahoma. He currently serves as the pharmacist-in-charge at QuickMeds Pharmacy^® at Freeman Hospital West and Freeman Outpatient Pharmacy Coordinator.

November is Palliative Care Month. What is palliative care? Palliative care provides relief to a patient with a serious illness through symptom and pain management. The goal of palliative care is to provide improved comfort to patients and families while maintaining the highest possible quality of life – even if a cure cannot be reached. The Freeman Health System palliative care team also supports patients and families with emotional and spiritual needs.

Palliative care at Freeman is provided by a specially trained team of registered nurses, Megan Spiering, Katie Adams, Patricia Johnson and me, and a palliative care physician, Dr. Christopher Black. Together, we educate patients and families about an illness or disease and strive to minimize symptoms while providing compassionate care and emotional support – encouraging the patient to live a meaningful life. Communication with patients and families is key. Through meetings and consultations, we hope the patient and family make timely, informed decisions. 

“One of the toughest yet most-rewarding times in palliative care is having a tough conversation with a patient and his or her family,” said Dr. Black. “Regardless of how difficult it is, when everyone comes to the same conclusion, we can focus on relieving a lot of pain and suffering for everyone involved.”

Some may assume palliative care is only used for patients with a terminal illness or end-of-life care, but it involves much more. After I joined Freeman in 2004, our team initiated and implemented the palliative care program. Since then, it has grown and become a valuable resource to many patients and their families, and we hope that continues. Working with many physicians and co-workers, we encourage palliative care to begin in the earlier stages of an illness – when patients often do not understand the options or possibilities for improvements. Palliative care provides understanding and yields a better and smoother transition for all in the future.

Not only do we work to relieve pain and suffering, we also work to reduce stress on patients, families and caregivers. The palliative care team serves as a resource to many others in the healthcare system, such as social workers, chaplains, nutritionists, rehabilitation specialists and so forth. We assist in coordination of complicated care plans across many departments to better clarify goals and priorities, helping with the understanding of treatment options and offering support, counseling and any other resources necessary. Providing comfort and guidance during all facets of an illness is what we do – this is how we provide care.

For more information on Freeman Palliative Care services, please visit freemanhealth.com/palliative-care or call 417.347.4094.

Gwynn Caruthers, RN, CHPN, earned her nursing degree from Pittsburg State University in Pittsburg, Kansas. She is not only a registered nurse but is also a Certified Hospice and Palliative Nurse. Gwynn joined Freeman Health System in 2004 after moving from Broken Arrow, Oklahoma. She started the palliative care program at Freeman – now serving as the Palliative Care Program Coordinator. Gwynn was named the Missouri Rural Health Champion for 2015 by Missouri Department of Health and Senior Services for her work with palliative care.

Keeping blood sugar controlled on a normal day can seem difficult and even stressful. Add the extra anxiety of holiday planning, travel arrangements, work schedules, holiday parties and gift-giving, and suddenly blood sugar maintenance feels even harder. Stress alone can raise blood sugar levels – and that’s without those sweet holiday treats! Find a sense of calm and good cheer this season with the following helpful tips:

1. Adjust expectations

No one is perfect. Expecting to eat perfectly, take medicine perfectly and have perfect blood sugar may lead to frustration and disappointment. Relax a little and understand that everyone makes mistakes. Instead of giving in to disappointment, accept grace and move forward – even if it feels like taking two steps forward, one step back most of the time. Remember to celebrate every success!

2. Take one day at a time

Staying healthy over the long term, requires making daily choices to stay healthy. Unhealthy choices add up over time and any short-term satisfaction gained from unhealthy choices can lead to long-term regret. Break that cycle before it starts and find alternatives to stay satisfied. Instead of reaching for the sweets or comfort food in times of stress, find something that feeds the soul instead – like a conversation with a friend, or a good book and a cup of hot tea (unsweetened or with a sugar-free sweetener, of course).  

3. Plan ahead

Before encountering those tricky holiday potluck parties or tempting cookie platters, think proactively. Planning ahead can help reduce stress when facing those tough situations. Pack a healthy snack to share instead of sugary or high-carb treats. Eat before the party or special event. Limit indulgences and take medicine appropriately. Decide beforehand what to tell people who ask about these lifestyle changes. Consider all the options and always keep positive goals in mind. If the plan includes indulging a little, prepare for what may happen in the event of a blood sugar spike.

4. Find support

Keeping blood sugar controlled and making healthy choices can be difficult. Support groups offer the opportunity to confide in others with similar challenges and struggles. Sometimes disappointment can lead to anxiety and even depression, making it difficult to eat well and take medications consistently. Speak to a mental health counselor who can listen and provide help.

About the author

Bethany Doak, RN, is a Certified Diabetes Educator for Freeman Diabetes Education. Having lived with type 1 diabetes since the age of 5, Bethany’s diagnosis inspires her every day to help others live well and take control of their health. Freeman offers a monthly Type 2 Diabetes Support Group and a quarterly Type 1 Diabetes Support Group for those living with diabetes, their families and friends. For more information on diabetes care, visit freemanhealth.com/diabetes.

Varicose veins are the seemingly unsightly, swollen, twisted and bulging veins found on the legs. They are caused by blood pooling up in the vein when a defective or damaged valve no longer pushes blood back up to the heart. Developing these veins may be more than just a cosmetic issue.

Here's why. Pain, swelling and leg fatigue can readily discourage an active lifestyle. Severe cases can even cause chronic infections and skin ulcerations. Gender, family history, age, pregnancy, obesity and prolonged standing all contribute to this condition.

For many seniors, varicose veins are an unfortunate rite of passage. Nearly 50% of all Americans over the age of 50 and 2 in 3 women over 60 suffer from them, but it’s a common problem at any age. I have treated patients younger than 20 and older than 90.

Hippocrates and the ancient Egyptians wrote about the condition, and until the 21st century, the only surgical treatment was stripping the greater saphenous vein (the primary leg vein). This was a painful, even barbaric procedure requiring a general anesthetic and weeks of recovery. Understandably, most patients avoided this treatment. I still see many patients who have suffered for decades, believing that vein stripping was their only alternative. These same patients are delighted to discover that medical technology has finally caught up with the treatment of varicose veins. Now, we are able to offer a minimally-invasive procedure that treats the condition in minutes.

Breakthroughs in catheter technology, the same type as used for heart interventions, provide physicians with a safe and effective solution in treating varicose veins. Using a local anesthetic, the doctor threads a catheter, about the thickness of a spaghetti noodle, into the vein, heating it from within and sealing it off. The catheter is pulled through the vein using radiofrequency energy (RFE) or laser to heat the vein walls, causing them to collapse inward. Once the vein is sealed, the body automatically re-routes blood through healthier vessels, thus restoring normal circulation. Varicosity symptoms quickly dissipate and the sealed vein is absorbed by the body.

Considered a medical necessity, not cosmetic surgery, this procedure is generally covered by Medicare and most insurers, thus clearing away the final barrier to longtime varicose vein sufferers seeking treatment. We are seeing many new patients.

No longer considered unmanly, we are treating more men than ever before. We’ve seen a rush of interest from active seniors well into their 80s. Many of these have middle-aged children who’ve undergone the treatment, and upon seeing the results, want the treatment for themselves. I’ve had patients tell me they are wearing shorts for the first time in 40 years!

Studies have found volunteering leads to improved physical and mental health because it provides a sense of purpose and accomplishment. Volunteering can be a very rewarding experience. If you ask Freeman volunteers why they volunteer, you may get a variety of reasons. Some of the reasons I have heard from our volunteers include:

“I enjoy the new friends I have made.”

“It brings me joy, and I feel good about myself.”

“I work in a positive atmosphere.”

“I love the challenge of learning something new.”

“It gives me a sense of pride, knowing I am helping others as well as giving back to my community.”

“It gets me out of the house, and Freeman offers great benefits to their volunteers.”

To get started, simply call me at 417.347.4603 or send an email to ldmcintosh@freemanhealth.com. You are welcomed to job shadow in a couple of areas before deciding which area fits you best. We work to get you on a day and time slot that works best for you. Some of the areas available to volunteer are ICU, surgery check-in desk, information desk, Freeman Gift Gallery, Freeman Cancer Institute, and Freeman Heart & Vascular Institute. We can accommodate a busy schedule – most Freeman volunteers work one 4-hour shift a week, so volunteering doesn’t have to be a big time commitment. We also offer an easy process for taking time off.

We hope this opportunity is just what you are looking for, and we are anxious to hear from you!

As we begin a new year, we often reflect on the things we didn’t accomplish last year and set a resolution or goal for the coming year. “The start is what stops most people” is true for many of us. We want to reach our goals and make positive changes in our lives, but often don’t know where to begin.

The first step in setting a health-related goal is to determine why you want to develop healthier lifestyle habits. Maybe the reason is that you have a strong family history of heart disease or stroke, or maybe you are a parent and want to be in the best possible health so you can care for your family. Once you have established the why, then you can follow the goal setting process to reach your objectives.

Goals should be SMART: Specific, Measurable, Action-based, Realistic and Time-oriented. Try these tips to set SMART goals:

• Set three-month and weekly goals based on your wellness vision.
• Focus on one goal at a time.
• Create a plan that is flexible, fun and appropriate for you.
• Start a journal and include goals, desires, barriers, obstacles, excuses and solutions.
• Plan for obstacles and determine how you will overcome them.
• Reward yourself for reaching the small goals to help you stay motivated for the long-term results.
• Remember small steps become lifestyle changes. Take it one step at a time and don’t be afraid to get started.

The moment you announce your pregnancy, advice begins to pour in. It can be hard to decide which advice to take to heart. Old wives tales are often the most entertaining – some examples include, “Carry low and the baby is a boy,” “Heartburn causes the baby to have a lot of hair,” “If you dream of a fist, you are pregnant,” and “Sleeping with your arm above your head causes the umbilical cord to wrap around the neck.” Of course, none of these are true, but some of these myths can cause women to limit their activities or keep them from staying as healthy as possible.

Myth: Exercise in pregnancy should be avoided.
Fact: Nothing is further from the truth. This subject has been studied and exercise is safe in pregnancy. The rule of thumb is in a normal healthy pregnancy, the exercise that you did before becoming pregnant can usually can be continued throughout the pregnancy, with modifications as the pregnancy progresses. Staying active is good for your flexibility and strength. Exercise also helps with basic aches and pains of pregnancy and labor. Always talk with your doctor first, but in most cases, exercise is encouraged.

Myth: Flu vaccine is not safe in pregnancy.
Fact: I highly encourage you to get vaccinated against influenza while pregnant. The vaccine does not cause influenza or any of the symptoms. Pregnant patients with the flu are more likely to have complications with respiratory distress and pneumonia – these complications can be avoided by getting vaccinated.

Myth: Sex in pregnancy is not safe.
Fact: Intercourse can cause contractions and uncomfortable pain, but typically does not increase risk of infection or preterm labor. As long as you are not in a high-risk relationship or having unprotected intercourse with a new partner, then the risk of infection is very low. Sexually transmitted diseases can cause pregnancy complications to both you and your unborn child if severe. If unsure, talk with your doctor.

Myth: Hair dye is not an option.
Fact: There is very little, if any, hair dye that is absorbed into the blood stream when you dye your hair. The smell of hair products may not agree with you in pregnancy, so make sure to dye your hair in a ventilated area.

Myth: Pregnant women are eating for two.
Fact: Unfortunately, it’s a myth that women are eating for two. You only need about 200-300 more calories per day when you are pregnant. Healthy eating and a healthy weight not only affects your pregnancy, but it may affect your child’s future. There is some research that suggests babies of obese moms are more likely to be overweight as an adult. Additionally, the more weigh you gain in pregnancy, the harder it is to lose after. Splurge now and then for those pregnancy cravings, but keep your diet balanced to keep you and your baby healthy.

Myth: Caffeine is off-limits.
Fact: You don’t have to be caffeine-free in pregnancy! There is a threshold of 300 milligrams of caffeine, which may contribute to miscarriage. If you have high blood pressure, heart problems or anxiety, caffeine may worsen those issues. Overall, a little caffeine is safe if you just can’t let it go completely. Read the labels and know how much you are really drinking or eating daily.

Myth #7: Flying is not allowed.
Fact: Whether you’re planning a trip or travelling for work, you are safe to fly. It’s safe to walk through airport body scanners, but if you want to play it safe, feel free to ask for an alternative method of screening. Just know if you are running late for your plane, a trip through the scanner will not harm your baby.

Myth: Fish is off-limits during pregnancy.
Fact: I encourage my patients to eat fish while pregnant – omega-3 fatty acids, found in fish, are chock-full of health benefits and helpful for brain development. Before consuming, just ensure that the fish or shellfish is cooked. Please note that large fish, such as swordfish, mackerel, shark, tilefish, are high in mercury must be limited. You’ll also need to avoid sushi, unless it is cooked.

Myth: Cocoa butter helps prevent stretch marks.
Fact: I hate to tell you this, but stretch marks are a genetic issue. Some women just don’t have stretch marks. We don’t like them, but unfortunately, that is just the way it is. Using a moisturizer is helpful as the skin stretches, but it won’t prevent stretch marks.

Myth: Hot dogs and lunch meat are not permitted.
Fact: You can eat hot dogs and lunch meat, but be sure they are well-cooked/heated through and that they’re not a mainstay in your diet.

Myth: Sleeping on your back is off-limits.
Sleeping on your left side does optimize the blood flow to your uterus (and to you), but this is not an absolute. If you wake up on your back or any side, no harm done. Sleep how you are comfortable; both you and your baby will be just fine.

There are many other very entertaining myths out there – but, before you change your life, starve yourself, don’t leave your house during an eclipse, or never raise your arms above your head, talk with your doctor! Enjoy your pregnancy and know that within reason, most day-to-day activity is just fine.

I believe the most under-prescribed thing in medicine is exercise. I suspect the reason is because it is not something simple to do – it is not a prescription that can be written, nor is it a pill that can be taken. Exercise involves dedication, hard work and prioritization in your life schedule to make sure you have time to do it.

Exercise has clearly been found to prolong people's lives and to combat disease when disease arises. People who exercise live at a different level as they age into their 40s, 50s and 60s than those who do not. Multiple studies have shown that exercise, even to a moderate degree, combats heart disease and cancer, and prevents diabetes and obesity. Additionally, it has a significant effect on people’s cognitive function and overall well-being as they age.

So the questions are, “How much should I exercise?” “How should I exercise?” and “When should I exercise?” First of all, you must make exercise a priority. It must be as important as everything else in your life and a schedule must be set up that you are going to stick to on a regular basis so that excuses are not made. Otherwise, days and weeks can go by without exercising.

It’s important to try to exercise at least four days a week, 30-40 minutes at a time. If you want to get into really good shape, then my recommendation is for six days a week. The exercise should be a mix of both aerobic exercise, such as treadmill, bike, or walking, and some strength training, which is not quite as important, but is important for overall core strength and muscle development.

The intensity of the workout is also important. If you go to work out and only get your heart rate up to 40-50% of what it should be, you are not going to get the benefit that you will get at 85% of maximum predicted heart rate. A heart rate monitor and careful guidance from your physician is critical to make sure that you push your workout, particularly the aerobic side, to the point where you are going to get benefit and you are not just wasting your time. Therefore, I would recommend four to five days a week, 30-40 minutes of aerobic workout, with a heart rate at 85% of maximum predicted heart rate. Also include one to two days a week of muscle-training for overall strength and core strength.

If you can dedicate yourself to this type of workout, the benefits from a health standpoint and a heart standpoint are huge. It takes discipline and time, and the value is far worth what you put into it!

Many mothers worry about having enough breast milk when they return to work and want to get started pumping right away. Don’t worry – feeding your baby as often as he or she wants will help build your milk supply the first few weeks. Below are a few common questions many mothers ask when needing to start pumping for work.

What kind of pump should I get?
A double electric pump will help remove more milk than a single pump or manual pump. Many insurance companies reimburse for the purchase of a pump when you are away from your baby.

How soon should I start pumping to prepare for returning to work?
Start pumping one or two weeks before returning to work. Gradually add pump times when you would normally be pumping at breaks during your work day.

How often do I need to pump?
Usually, three times in an eight-hour period is sufficient to provide milk when away from your baby. Feeding more often at home can decrease the amount of milk needed when away as well. Decrease the time away from your baby by feeding just before leaving and as soon as you return. For further information on calculating your estimated pumping frequency, we recommend this online tool to calculate your magic number.

How do I get my milk to “let down” when I am stressed at work?
Bringing pictures of baby or something that reminds you of your baby will help. Massaging your breasts before pumping will also help release the milk. It is also a good practice to manually express after pumping to ensure the breasts are well drained.

How should I store my breast milk?
Breast milk can last six months in the refrigerator’s freezer and twelve months in a deep freezer. If the milk will be used the next day, storing in the refrigerator is fine. It can last as long as four to six days at refrigerator temperature. For long-term storage, it is best to store your breast milk in individual servings in BPA-free containers in the freezer. Store in the back of the freezer to avoid temperature fluctuations.

Questions?
Please feel free to contact Freeman Lactation Services with any questions or problems. Our services are free and open to everyone – including women who did not deliver their babies at Freeman. Our phone number is 417.347.1067. We are available for outpatient consultations by appointment as well.