Health ’89

HEALTH CHECK EXHIBITORS 1989

Adolescent Primary Care Coalition

Dallas Chapter of Medical Assistants

American Association of Retired Persons

American Cancer Society

American College of Surgeons -North Texas Chapter

American Diabetes Association

American Lung Association

American Orthopedic foot & Ankle Society

Arthritis Foundation -North Texas Chapter

Baylor College of Dentistry

Baylor Health Care System

Baylor University Medical Center

Brookhaven Psychiatric Pavilion

Children’s Medical Center of Dallas

The Coalition for Organ & Tissue Donor Awareness of the Dallas/fort Worth Metroplex

Dallas Academy of Otolaryngology

Dallas Council on Alcoholism and Drug Abuse (United Way Affiliate)

Dallas County Dental Society

Dallas County Health Department

Dallas County Pharmaceutical Society

Dallas Dietetic Association

Dallas Fire Department -Emergency Medical Service

Dallas Lighthouse for the Blind, Inc.

Dallas Medical &. Surgical Clinic

Dallas/Fort Worth Ob-Gyn Society

D/FW Council Against Health Fraud

Doctors Hospital

Granville C Morton Hospital at Wadley Institutes

Green Oaks, A Psychiatric Hospital

HCA Medical Center of Plano

Home Health Services of Dallas, Inc.

Hope Cottage

Humana Hospital -Medical City Dallas

Humana Senior Association

JDF Diabetes Research Foundation

Kaiser Permanente

Lions District 2 X 1 Blood Bank

Lions Sight and Tissue Foundation

Lupus Foundation of America, Inc. -Dallas Chapter

Memorial Hospital of Garland

Mental Health Association

Methodist Medical Center

North Texas Chapter Multiple Sclerosis Society

Sudden Infant Death Syndrome and Information and Counseling Project

Parkland Memorial Hospital

Planned Parenthood of Greater Dallas

Presbyterian Hospital of Dallas

Presbyterian Village North Retirement Community

RHD Memorial Medical Center

Richardson Medical Center

St. Paul Medical Center

Texas Society of Psychiatric Physicians

Texas Society to Prevent Blindness

The Blood Center at Wadley

The Edna Gladney Center

Mended Hearts Chapter 30

U.T. Southwestern Medical Center

Timberlawn Psychiatric Hospital, Inc.

Tremont Retirement Community

United Ostomy Association -Dallas Area Chapter

Dallas Veterans Administration Medical Center

Telesis HealthCare & Retirement

La Posada -Servicios Internacionales

Trinity Hypertension cm. Diagnostic Research Center

The Meadowgreen, ACS1 Co.

Dallas County Emergency Nurses Association

Dallas Association of Hearing Aids Specialists

Dallas Autism Society

Doctors Nursing Center

The Cedars Hospital

The Dallas Association for Parent Education. Inc.

Dallas Diagnostic Association

Charter Surburban Hospital

Sanus/65 -Medicare Health Plan

CareFlite G.A.F.



(As of December 30, 1988, the preceding health organizations are participating in Health Check 1989.)

by Anne Eby

Chicken-fried steak, mashed potatoes, cream gravy, hot rolls and butter. Probably some of the best words a Texan could hear and some of the worst things he could consume; that is, if he’s not careful. When Surgeon General Koop issued his report on nutrition and health last summer, he cited dietary fat as a leading cause of major disease in Americans. Because that is something you can control, the 1989 Health Check supplement focuses on nutrition, particularly fats and cholesterol.

Good nutrition is common sense. The diet recommended by the American Heart Association is much like the one recommended by the American Cancer Society, the American Diabetes Association and Weight Watchers. In essence, a little attention to your daily diet now may help prevent a myriad of health problems later on.

So what is Health Check?

It is a fair sponsored by the DCMS Auxiliary and the physicians of your community to help raise awareness of health issues and trends. Health Check offers free screenings and information, thanks to the coordinated efforts of area hospitals, health agencies and supporting organizations. The fair demonstrates the vast number of health resources which are available in the Dallas community.

While Health Check is not a diagnostic exam, a problem could be found through the screening process. If so, please see your own physician for help. If you do not have one, call the Physician Referral Service of the Dallas County Medical Society at (214) 948-3622.

PRFVFNTIVF CARDIOLOGY: EATING FOR THE FUTURE

See your 3-year-old munching on potato chips in front of the television. Would you believe his dietary habits already put him at risk for coronary heart disease? Here comes your 16-year-old eating a fast lunch out of a bag. Would you be surprised to know he may already have high cholesterol?

With more than half of the U.S. adult population having a cholesterol count that is higher than “desirable,” families are beginning to take a good look at their kids. And the team in the Preventive Cardiology Center at Children’s Medical Center in Dallas is helping them to do that.

The program is designed to evaluate risks, treat existing problems and establish healthy habits. They’re focusing on those who need it most, those who already have one or more risk factors working against them. Risks such as artherosclerosis (clogged arteries), early coronary disease or heart attack in a family member, high blood pressure, high blood cholesterol, diabetes, obesity and stroke.

Using a “multi-prong” approach, five team members work with each family to develop a healthy lifestyle and eliminate some of the risks associ-ated with heart disease. They conduct a physical exam and exercise test to determine general health. A separate lifestyle evaluation notes everything from exercise routines and caffeine intake to television habits and fast food stops. Once the diet and nutrition plan are established, another team member helps the family make the necessary emotional and lifestyle transitions.

“It takes courage for a family to admit early death or a heart attack is in the future,” said Sarah Blumenschein, MD, director of the Pediatric Cardiology Program at Children’s. “But ar-therosclerosis is a silent killer,” she said, “and that’s why it’s important to know your family history.”

Oftentimes, parents will bring their kids to the Center shortly after a death in the family – a time when mortality comes home to roost.

Most of the time a parent has high cholesterol, too, so it becomes a family project. According to the Center’s research coordinator, Evelyn Torres, RN, “All of the families have some family history; it may not be apparent, but maybe a grandparent or someone had coronary problems.”

Children’s Preventive Cardiology Center has seen about 65 families since its door opened one year ago. And the majority of those families have been recommended by a family physician. The initial process includes self-assessment and evaluation of the family’s lifestyle. The first appointment at the Center is with all five team members so the family can meet with each one individually. During that time, team members pinpoint three or four points that the family should begin working on. These points might include fat-modification in the diet; eating out two times per week instead of five; and focusing the family’s reward system away from food.

“Typically, parents reward children with food, and we’re trying to get them away from that,” said Cherie Hughes, psychologist at Children’s and behavioral counselor for the program. Hughes suggests parents offer more “social” rewards. She explained that adolescents would probably enjoy a trip to the movies; smaller children on the other hand, would want ’things’ such as a new box of crayons.

After the initial visit, “team meetings” are scheduled at three-month intervals to track the progress.

Clinic Coordinator Paula Dimmitt said the majority of the families respond well to the lifestyle changes. And while it would seem adults have a tough time adjusting, it’s actually teens who have it the roughest. Peer pressure is most evident at that age, and according to Hughes, teens tend to feel immortal also.

“Kids are kids. You can put most anything in their diet, and they’ll eat it. Others will say, ’I don’t like it,’” said Janet Litteral, a registered dietician who is the program’s dietary counselor. Therefore, moms are getting into creative cooking and hiding oat bran in cookies and meatballs, she added.

“A young child doesn’t have much control over what’s eaten,” Litteral said. Therefore, modifications for a healthy diet must begin with the parents. “Some will roll their eyes, but they hear us: start early and keep the reforms universal,” she said.

The team is careful not to alienate any of the family members to make them feel “different” in their social groups. That’s why they offer advice on eating out, fixing sack lunches and even modifying family recipes for heart healthy eating.

Dr. Blumenschein said the satisfac-tion comes when they see a family so pleased with themselves for adapting a healthier lifestyle. And it’s even greater to see how a child’s entire ego and self-perception can improve just because he knows he is better off.

A KEY TO IMMORTALITY

“Well, look at this,” she teased as she picked up his key ring from the desk. “I always knew you wanted to live forever, but I never dreamed you had a Key to Immortality.”

“Yeah,” he grinned, “It’s my chance to live forever – hut through other people.”

“What does that mean?”

“It means that when I die, if my organs and tissues are acceptable, they can be donated to people who need them.”

“Oh, I see,” she nodded. “I was! thinking of getting one of those stickers for my driver’s license. Is that the same thing?”

“It’s the same idea, but the key is more visible.”

So visible, in fact, that some 8,000 Americans are carrying a Key to Immortality right now. And since its introduction last April, an additional 32,000 prospective donors also have requested one.

“The response has been incredible,” said Kim Bufkin, education and community relations coordinator of Transplant Resources and Services Center, The University of Texas Southwestern Medical Center of Dallas. “One organ and tissue donor can help more than 50 people. Isn’t that a great statistic?”

Transplant surgery has come a long way in 34 years. It is now possible to transplant about 25 different tissues and organs, and according to Bufkin, more than 5,500 patient applications were filled out in Dallas in 1987 alone.

The Key to Immortality was the brainchild of the Dallas/fort Worth Coalition on Organ and Tissue Donor Awareness. Composed of area procurement agencies and transplant hospitals, the Coalition began in 1984 as a sponsor for National Donor Awareness Week. In the four years since, it has continued to provide public education campaigns on the importance of organ donation for transplantation and research.

The idea of a key was originally conceived by Dallas businessman Stanley Marcus and designed by Bud Mantz of the Center’s community advisory board. With the infinity sign on its top, the Key hangs at an odd angle on a ring, and the phone number of Transplant Services is visible to emergency personnel. Every second counts when trying to procure organs for transplantation. For an operation to be successful, the heart, liver and kidneys must be removed immediately after brain death; corneas must be removed within six hours; and bone and cartilage must be removed within 24 hours.

“We still will only do a procurement with the consent of the next of kin,” Bufkin said, adding that the families rarely say no.

On January 1, 1988, Texas became the 31st state to implement “Routine Inquiry” legislation which mandates that hospitals present the opportunity of donation to all next of kin of potential medically suitable donors at the time of death. This legislation responds to the needs for transplantable donations of organs and tissues.

All too often, relatives don’t remember that their loved one wanted to be a donor until after it’s too late. But the Key helps ensure that such an opportunity won’t be missed. It says, “It’s OK to ask.”

Transplant Services Center began originally in 1971 as the Skin Transplant Center for Burns. Within six years, it had become the Lions Sight and Tissue Foundation. By 1979, its services also included musco-skeletal tissue for orthopedic transplantation. Therefore, in 1984, the bank became Transplant Resources and Services Center, a name which more clearly defines its role in the University and in the community.

UT’s Transplant Services Center receives thank-you letters almost daily, Bufkin said. Letters come from recipients, grateful for a second chance, and they come from families, grateful for the opportunity to have their loved ones live on through someone else.

Every day in the United States more than 12,000 people wait for a transplant and the benefits are great. Kidney transplants relieve people from regular dialysis. Those with severe liver disease will die without a liver transplant. Pancreatic transplantation frees insulin dependent diabetics from daily injections and helps fight possible loss of limb, sight or life.

Corneas, the clear part of the eye, can be transplanted to restore sight to the blind. A thin layer of skin can be donated and used as a vital covering for bum victims. Bone grafts, the most frequently used tissue, play an important role in restoring mobility, avoiding amputations and returning orthopedic patients to lives free of pain. And further, a transplant operation can restore life to those suffering from fatal heart and lung disease.

According to the Uniform Anatomical Gift Act, anyone may become a donor when he or she dies. Minors may donate organs and tissue with a parent’s or guardian’s consent.

For those considering organ and tissue donation, the decision is a personal one. It may be helpful to talk with family members, friends, a physician and/or member of the clergy. Afterwards, tell others about your decision; the Key will alert medical personnel, but only your next of kin can ensure that your wishes are carried out.

Bufkin concluded, “When we don’t allow an individual and his family the opportunity to make that kind of deci-sion then We’ve made it for them.”

OSTEOPOROSIS:A HIDDEN CRIPPLER

My curiosity got the best of me during my tour of the Dallas Osteoporosis Center.

“What exactly does this machine do?” I asked Dr. Sydney Bonnick, Center director, as we approached the alcove off the main hallway.

Before I knew it, I was in a hospital gown, climbing up on a long padded :table.

Once I lay down, she made sure my i spine was flat on the table; and she positioned the arm of the dual energy x-ray absorptiometry, or DPX, over my belly button.

“It will complete about 150 passes,” she explained.

I watched the computer screen across the room and saw my own spinal vertebrae being drawn line by line, in x-ray fashion, from the bottom up.

Seven minutes later, I held that same picture in my hand. Dr. Bonnick showed how the density of my bone registered on paper – shaded areas represented higher bone mass, heavy lines defined bone edges. She said my bones appeared to be in good health and showed no signs of the deteriora-tion characteristic of osteoporosis.

Not yet, anyway. ..

A crippling, disfiguring disease of the bone, osteoporosis affects 10 to 30 million women in America. It is caused by a loss of bone mass, due primarily to calcium deficiency. Dr. Bonnick told me that the first three decades of our lives are spent building bone mass. By mid-30s, both men and women experience a slight and gradual loss of that bone. But women lose six times more rapidly than men after menopause when estrogen levels decrease rapidly. And most men are not at as great a risk because they tend to have more bone mass to begin with and do not suffer the same quick hormone decline.

It’s normal for bone loss to occur, Dr, Bonnick said. “But you want to give your body more to start from before you start losing,” she added.

It begins with bone breakdown. The body contains two types of bone: dense, solid cortical bone associated with the hard bones of one’s arms and legs; or porous, honeycombed tra-becular bone which makes up the center portion of a bone. Every bone has both types, but the proportions differ. For example, spinal vertebrae are mostly trabecular bone. Because this porous bone is usually the first to weaken, early osteoporosis often shows up in the spine.

That’s where the dual energy x-ray absorptiometry comes in. The DPX is a low energy scan which looks at bone structure. A safe procedure, the DPX uses about 1/50 the amount of radiation used for a normal chest x-ray. It enables a physician to view the lumbar vertebrae in the spine, the area just below the last rib.

Furthermore, it’s this kind of technology that has physicians like Dr. Bonnick so excited about advances in osteoporosis. “It has revolutionized the field because it has finally given researchers and clinicians the ability to develop effective means of therapy and prevention,” she said. Borrowing an analogy from a fellow physician, Dr. Bonnick added that before this technology came about, it was like trying to treat high blood pressure and never being able to take a blood pressure reading.

“There is no reason in the world any woman should ever develop osteoporosis,” Dr. Bonnick said. And once you are aware of that, “prevention is just common sense health talk,” she said.

First on her list is nutrition, particularly calcium, a key ingredient for hone health. It is also essential for muscle contraction, blood clotting, brain and nerve functioning. A negative calcium balance causes the body to pull calcium from the bone into the bloodstream to use it for other purposes.

“By age 15, 80% of women are calcium deficient,” Dr. Bonnick says. While a normal diet contains around 450 milligrams (mg) of calcium, the U.S. Recommended Daily Allowance is 1,000 mg.

Dairy products are probably the most concentrated source of calcium, with milk and cottage cheese front-runners in that category. However, 12 oz. of the product yields only 320 mg of calcium, a fraction of the U.S. RDA. And most people are not apt to eat a cup and a half of cottage cheese with a meal. On the other hand, foods such as lean beef, carrots, and breads contain less than 50 mg each per serving.

For non-milk drinkers, Dr. Bonnick recommends a brand of orange juice, Citrus Hill Plus Calcium, because it is fortified with almost as much calcium as milk.

Women need to get their daily allowance of calcium some how, some way, Dr. Bonnick says, naming calcium supplements as another option. However, in choosing supplements, stick with major name brands, such as OsCal or Citrical. Her reasoning: calcium supplements are viewed by the Food and Drug Administration as food additives, and therefore, not closely regulated for content and effectiveness.

Number two on Dr. Bonnick’s osteoporosis prevention list is exercise, particularly weight-bearing exercise, as it is important in achieving and maintaining bone mass. “Stressing the bone or ’loading the bone’ gives the bone reason to strengthen itself,” Dr. Bonnick said. Therefore, she recommends activities such as walking, jogging, dancing and biking.

But if osteoporosis already is evident, Dr. Bonnick said a physician can prescribe therapies to help an individual re-match her original fracture thresh-hold. If a woman is experiencing post-menopausal bone loss because of a loss of estrogen, she probably won’t be able to prevent further loss with calcium supplements. Estrogen deficient osteoporosis needs to be treated with estrogen through replacement therapy. Calcium deficient osteoporosis needs to be treated with calcium so that the body will not pull needed minerals from the bones.

Another treatment for osteoporosis, a slow-release form of sodium flouride, has been developed by researchers at The University of Texas Southwestern Medical Center at Dallas. Although sodium flouride has long been recognized for its ability to strengthen teeth and build bone, until recently, it had not been applied specifically for the treatment of bone loss associated with osteoporosis. The compound entered Phase II of the Food and Drug Administration’s clinical trials in July 1987.

Because any therapy can take from one-and-a-half to two years to respond, Dr. Bonnick says osteoporosis is easier to prevent than treat, considering the current state of the art and the expanding elderly population.

Ten billion dollars is spent annually on treatment,” she said. “Why not spend $10 billion on prevention instead? You can’t put a dollar sign on pain, suffering and loss of productivity.”

ANSWERS

1. False-Because they are prepared from whole milk or cream, most cheeses are also high in saturated fat and cholesterol. Ounce for ounce,meat, poultry and most cheeses have about the same amount of cholesterol, but cheese tends to have still more saturated fat. Therefore, when selecting these dairy products, remember that natural and processed hard cheeses are highest in saturated fat; low-fat and imitation cheeses may have less saturated fat. Low-fat cheeses such as cottage cheese, farmer’s cheese and skim milk mozzarella cheese are your best choice.



2. False – Hydrogenation is a process which changes a polyunsaturated (a”good” fat) to a saturated fat (a “bad” fat), thereby helping to raise blood cholesterol levels. This process is often used by manufacturers to prolong the shelf life of some products; polyunsaturated fats, which are usually liquid at room temperature, do not stay fresh for long periods of time. Hydrogena-tion is most commonly found in commercially baked crackers, cookies and some margarines. Therefore, substitute with such things as bagels, fresh fruit and high fiber cereals.



3. False – Oftentimes, frozen dinners contain too much fat. The rule of thumb is to select dinners with 300 calories or less and less than 10 grams of fat. This ensures that less than 30% of the calories are from fat. How do you figure it? Look at the label and follow this simple equation: Multiply the number of grams of fat by nine (one gram of fat has nine calories) and divide that by the total number of calories. Then multiply the remainder by 100 to get a percentage for your answer. For example, a Chicken Prima-vera frozen dinner has 270 calories and 9 grams of fat. Nine grams of fat X 9 = 81 “fat” calories; 81÷270 calories = .3; .3 X 100 = 30% of calories from fat. This is a healthy frozen dinner. An item called the “Fat Finder” is an easy reference, plastic wheel which matches grams of fat with total calories to show the percentage of fat in a product. Its 4″ diameter size makes it convenient for quick calculation at the grocery store. “Fat Finders” are available from most nutrition and diet counselors.



4. False – Calories aren’t as big a concern for weight loss as is total intake of saturated fat. If all nine hundred calories are consumed in an icecream sundae with chocolate and whipped cream, your body will notburn these calories from fat as efficiently as calories from complex carbohydrates. Therefore, approximately 60% of your total day’s calories should be from complex carbohydrates (i.e. starches, fruits and vegetables) and 30% or less coming from fat.



5. False – Don’t be misled by product advertising. While some foods donot contain cholesterol, they can be high in saturated fat which can increase blood cholesterol levels. Instead, look at the total fat content. Choose more monounsaturated fats, such as olive and canola oils and polyunsaturated fats, such as safflower and corn oils, and soft tub or liquid margarine.



6. False – A few of the plant oils -coconut oil, cocoa butter, palm oil andpalm kernel oil – are high in saturatedfat and can actually raise bloodcholesterol levels. Therefore, stay withoils such as safflower, com and olive.Coconut and palm oils are found inmany commercially baked goods suchas cookies and crackers and nondairyproducts such as whipped topping, coffee creamers, and some cake mixes.They are also found in many preparedsnacks. Coconut oil is used in commercially prepared popcorn to give it adelicious aroma. Yet, look at that oil inits natural state – a hard, white, waxysubstance – and that popcorn soonloses its appeal.



7. False – Although shrimp is highin cholesterol, it is low in saturated fatand calories. Some research indicatesthat a diet high in fat is a main determinant in raising blood cholesterollevels. Since shrimp is very low inoverall fat content it can be includedin a low cholesterol meal plan.



8. False – Many granola and so-called natural cereals are loaded withfat and sugar. Coconut oil and palm oilare often key ingredients used in theseproducts to extend shelf life and contribute to the flavor of these cereals.



9. False – Don’t despair. Oat branmay be used in a variety of recipes, including meatballs, muffins andcookies. Up to 40 grams per day offiber, particularly the soluble formfound in beans, oat products and fruitscontributes to overall lowering of bloodcholesterol levels.