October is National Breast Cancer Awareness Month. In the United States, breast cancer is the second most common cancer diagnosed in women with nearly 200,000 cases projected to be diagnosed this year with over 40,000 of those cases being fatal. Breast cancer is the second most deadly cancer in American women. 1 in 8 of us will develop it if we live to age 85.

That's the bad news.

The good news is that breast cancer is being diagnosed earlier in the disease process allowing treatments to be more successful. Remember that even though breast cancer is thought of as a "women's disease," men can develop it too with about 1% of breast cancer cases diagnosed in males.

If breast cancer is caught early, the five-year survival rate is now about 90%. (Read this last sentence again so you remember how important it is to catch the cancer early.) Most breast cancers no longer require radical mastectomy. New treatments that are less invasive and disfiguring exist. Many lumps are found by women on self breast exam, by their partners, or on mammogram. Monthly self breast exam, at least annual clinical breast exam and appropriate and timely breast imaging are critical! If you are suspicious of any lesion, get the area assessed by your health care person. Delay costs lives!

The following signs can indicate breast cancer:

A lump in the breast or underarm that persists after your menstrual cycle; often the first apparent symptom of breast cancer, breast lumps are painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.

Swelling in the armpit.

Although lumps are usually painless, pain or tenderness in the breast can be a sign of breast cancer.

A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.

Any change in the size, contour, texture, or temperature of the breast; a reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.

A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration; scaling of the nipple is symptomatic of Paget's disease, a localized cancer.

Unusual discharge from the nipple that may be clear, bloody, or another color. It's usually caused by benign conditions but could be due to cancer in some cases.

A marble-like area under the skin.

An area that is distinctly different from any other area on either breast.

Early breast cancer is not detectable by touch.

We live in a society that places taboos then ironically peppers us with unhealthy images of what breasts are for and even how they "should" appear so a lot of people don't have a working definition of breast tissue. So what is a breast anyway?

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.

The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances. Breast tissue changes over the life span from more firm ductal tissue to tissue that is more elastic and fatty. This is normal aging of the breast despite what images are portrayed in the popular media.

For information on breast health, the Web is the best place to start. The Susan G. Komen Foundation is a great resource as is breasthealthonline.com and Mayo Clinic in addition to many others. The imperative here is that the subject of breast health should no longer be taboo and secretive but a freely discussed regular part of health maintenance. If you have been putting off getting a breast exam, pick up the phone right now to make an appointment with your health care person. If you have found a lump or other abnormality, make an appointment. Passivity yields disease; action elicits knowledge, reduces fear and anxiety and fosters health.

Make this the month that you take charge of your health care.

In God's Peace,

Traci

Sitting Shiva, Grief, Flu

Greetings and Shalom,

Last night at Abiding Hope, I was fortunate in that I got to attend the Wednesday night series about Loss and Grief. The group was awesome--we had the gamut of ages, genders, and educations. We watched a video by Pastor Rob Bell about how we, as Christians, can help others navigate through grief. The media was compelling; Pastor Bell's account of dealing with the death of a young man whom he had been close to was visceral, riveting, and truly heartbreaking. After watching the video, Laura led a group discussion about coping mechanisms for dealing with grief, how grief can manifest and what we can do to help others. Sitting shiva, the Jewish practice of being present and silent, intentionally, with the loved ones who are grieving a loved one. The practice is powerful but clearly unlike how most of us Americans live--action and goal oriented, schedules brimming with activity, electronic device cords unspooling from our ears. Intern Laura charged us with a homework assignment to write a letter to someone whom we loved and lost, knowing that God is sitting shiva with us. Let's just say it is a powerful, powerful experience and I highly recommend it for anyone struggling with grief.

On a completely different note, Dr. Dave Lieuwen spoke at AHA last Sunday about H1N1 flu as well as seasonal flu. Currently the recommendations by the CDC are that most people should have a seasonal flu shot and many should get an H1N1. Following are the most recent guidelines from the CDC.

Preventing Seasonal Flu: Get Vaccinated

The single best way to prevent seasonal flu is to get a seasonal flu vaccination each year.

There are two types of flu vaccines:

• A seasonal flu vaccine will not protect you against the new 2009 H1N1 flu. The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The seasonal flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.

• The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy* people 2-49 years of age who are not pregnant.

When to Get Vaccinated Against Seasonal Flu

Yearly seasonal flu vaccination will be administered for $25 at Abiding Hope between 0900 and 1200 on September 27.

Who Should Get Vaccinated Against Seasonal Flu?

• In general, anyone who wants to reduce their chances of getting seasonal flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons..
• People who should get a seasonal flu vaccination each year include:
• Children aged 6 months up to their 19th birthday
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:
• Health care workers
• Household contacts of persons at high risk for complications from the flu
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

Preventing Seasonal Flu: Get Vaccinated

The single best way to prevent seasonal flu is to get a seasonal flu vaccination each year.




There are two types of flu vaccines:

• A seasonal flu vaccine will not protect you against the new 2009 H1N1 flu. The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The seasonal flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.




• The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy* people 2-49 years of age who are not pregnant.




Please continue to keep up with flu updates by accessing the flu websites at the Colorado Department of Health and the CDC. NPR also has a really great video clip of how one single flu virus from a sneeze is inhaled and injected into one single cell of the host, which could be you. Check it out. Stay healthy.




God's Grace,




Traci Shahan

Good Grief: How to Cope with Loss

Shalom,

This week one of the offerings during AHA will be a presentation about grief: what it is, how it manifests, the subtypes of grief and how to cope. Since I have invested several hours in coalescing this material into a synopsis, I am copying some of the material and pasting it on this entry. I think you will find this information helpful.

What is Grief?

The unthinkable has happened: someone whom you loved, a relationship, a pet, a job, your social status, an ability or other situation that was an underpinning of your life is gone. No matter who or what is no longer in your life, you are wounded and have been left with a deep void while you adjust to your changed life circumstances. It feels like the pain will never end and that you may never feel joy again. Read on.

In short, grief is a normal response to loss, although it may not feel “normal” to the person in the midst of it. Grief is generally thought of as an emotional process but there are also physical, spiritual and mental aspects of grieving. No matter the definition, grief is painful and perplexing: we cry, sigh, lament, feel like we can’t go on, we tell our story over and over, we miss meals, we can’t balance our checkbooks, we get angry and exhausted. These are some typical ways that grief can manifest. There are no cardinal rules about how and when or why to grieve. Your grief is yours and unique to you like your thumbprints. Do not “should” yourself or others during the grieving process. Allow the bereaved to journey through the process as s/he sees fit. Though death and loss may make you and others uncomfortable, it is helpful to acknowledge its presence, power, process and passage. Above all, be gentle with yourself and others who are in the midst of journeying through grief, which at some point in life, will be all of us.

These Jumbled Feelings: Am I Crazy?

No, you're not going crazy. (The caveat here is that if you feel like or are thinking about hurting yourself, committing suicide or hurting another person, you should call 911 so that appropriate care can be accessed for you.) You are not alone in feeling like you are "losing it." Many bereaved people report a surreal feeling. This is nature’s safety net built into the grief cycle that allows you to detach from your day-to-day life. You will survive this, sanity intact, and eventually go on to reclaim your life and some degree of joy, despite your loss.

There are many ways in which grief can touch you-- physically, mentally, emotionally and spiritually. There is a wide range of "grief symptoms", and you may wonder what is norma and what is not. Rest assured that almost ANY symptom you might have, although it would be considered alarming otherwise, is perfectly normal during grieving.

When Will This End?

The healing journey will vary but time will ease the sting of the loss. Don’t try to control or minimize the time. The more willing that a person is to experience the unpleasant emotions, the more complete will be the healing. Many people report that grief symptoms generally wane within two years of the loss. But I like to say, “The only way out is through.” Although grief can feel overwhelming and unruly, and some people can feel “out of control,” the process of grieving is predictable. Most grief theorists use the rubric of the late Dr. Elisabeth Kubler-Ross to conceptualize the passage through grief.

Stages of Grief

Denial, Anger, Bargaining, Depression and Acceptance

The five stages, denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or in a prescribed order. Our hope is that with these stages comes the knowledge of grief ’s terrain, making us better equipped to cope with life and loss.

Coping Strategies

Give sorrow words; the grief that does not speak whispers the o'er-fraught heart and bids it break. ~William Shakespeare

Below are some proven strategies that may help you through a grief experience:

Be gentle with yourself and others. It takes a long time to heal. Some days will be better than others. It is normal for grief to wax and wane. Some days are best lived with the saying Start out slowly, then taper off.

Take care of your body; you'll need it later. Eat healthy, even though you might find it hard to eat at all right now. Get some stress vitamins and take one every day. Exercise.

Be an advocate for yourself. You have the right to grieve in your own way. Focus on yourself and your needs. Surround yourself with supportive loved ones.

Believe grief experts: it will pass.

Trust the grieving process.Go where it leads you.

Don't duck the system. It may be tempting to numb the pain of grief with alcohol or drugs, even prescription drugs. But everything will have to be faced and experienced sooner or later. Sooner is much better.

Look for the gifts, whether they are new friendships, learning to draw, or taking a real authentic look at your life.

Journal. There is no therapy like that of giving yourself a voice.

The grieving process creates change in your life that allows you to gradually acquiesce your need for the lost. Grief helps you come to terms with this, and to refocus your energies toward the future. Grief is never about "returning to normal". You will never be the same as you were before your loss. And so a part of grief is about finding a new life order for yourself. You will re-engage in life and find yourself planning for the future with some degree of joy in being alive

Respectfully submitted,

Traci Shahan

Health Education Lecture Series

Greetings in the name of the Risen Christ,

The health ministry team is busy preparing for Launch Weekend, September 12 and 13, during which the ministry will be formally introduced. We have all been working diligently on our lectures, workshops, and staffing the blood pressure clinic, which will be located in the narthex on Launch weekend. Our line-up for the Health Education Lecture Series includes topics as diverse as seasonal and H1N1 flu issues, bone health, spiritual health, family recovery from addictions, caring for aging parents, and cardiovascular health. These lectures will take place in the Seminar Room of the DTC starting on September 20 continuing through October 25 on Sundays at 0925. Please support the AH members and professionals who have devoted much time and effort to make this ministry successful. By the way, the ancient vocations of parish nursing and health ministries are experiencing a renaissance worldwide. It is the stated goal of the International Parish Nurse Resource Center to have a parish nurse available in each and every faith community. Abiding Hope is part of this vanguard!

Front Range Flu Shots will offer seasonal flu shots--H1N1 vaccines will NOT be offered--for $25 from 0900 to 1200 on 09/27, the same day as Dr. David Lieuwen speaks about influenza. It is critical that we all become informed and act to prevent transmission of flu thereby protecting our loved ones and our community. Remember that epidemiologists and public health officials predict that this flu season will be severe and that the current H1N1 flu pandemic will continue. Influenza can be a serious and fatal disease. (It's not "just a cold.") Learn NOW how to keep your family healthy.

Please hold the members of the health ministry in prayer. Our sole purpose is to foster health and harmony within and without the walls of Abiding Hope. As always we, as a team, would love to get your ideas and input about what topics are interesting to you. Please email them to tracis@abidinghopelutheran.org.

Peace,

Traci Shahan, RN, WHNP-BC, ND

Fall AHA Health Ministry Educational Series

Greetings,

This week marked the continuing evolution of the health ministry at Abiding Hope.  The pastoral staff has approved a seven-week lecture series about contemporary health issues, ranging from H1N1 (swine) and seasonal flu, to cardiovascular health, spiritual health, family recovery from substance abuse and women's health.  Lecturers will include physicians and nurses from our very own Abiding Hope community.  These professionals are committed to fostering our growing Health Ministry, so please support their efforts by attending the talks. Times for the lectures are scheduled during AHA from 9:25 to 10:05 in the Seminar Room of the DTC.   This seven-week lecture series begins on September 20 with Dave Lieuwen, MD speaking about seasonal and H1N1 flu.  It is very important this year for all of us to understand flu and to prepare and protect ourselves and each other accordingly.  Seasonal flu shots will be available for $25 from 9:00 a.m. to noon on September 27.  H1N1 shots will NOT be administered at Abiding Hope.

Part of the health ministry program involves visitations to parishioners who are immobile due to having had a stroke.  In meeting with one of these recovering people and her family this week, I realized that a review of basic information about stroke might be helpful.

First, what is a stroke?  There are two types of stroke, ischemic, which is caused by blood clots and cut off blood flow, and hemorrhagic stroke, which is caused by a blood vessel breaking. Both types of stroke can be serious and even fatal.

Second, what symptoms are suggestive of a stroke? 

Weakness or tingling in arms or legs. 

Severe headache.

Vision disturbances.

Problems speaking or understanding.

Loss of balance, impaired coordination or becoming dizzy.

Third, a mnemonic offered by the American Stoke Association to help identify onset of stroke is FAST.  

F stands for Face: look at the person's smile and facial symmetry. 

A stands for arms.  Look at the positioning of the arms and ask the person to raise both arms. If the arms are unable to held at the same height, this may signal a stroke.  

S reminds us to evaluate the person's speech.  Is it slurred?  Is the person able to repeat words or a brief sentence?  

T means time.  If the person has any of these symptoms, get help right away.  Call 911.  Time is critical in treatment of and outcome for stroke.

Fourth, knowing your risk factors for stroke is important.  For instance, do you have a family history or personal history of hypertension, cardiovascular disease or stroke?  Do you exercise every day?  Do you manage the stress that life presents you?  Do you eat a healthful, well-balanced diet that includes lean sources of protein, nuts, fruits, vegetables?  Does your health care provider recommend you take supplements or medications?  If so, do you follow the regimen carefully.

Stroke is a serious medical issue that is often a life threatening emergency.  Keep a list of medical resources and emergency phone numbers close by.  Don't doubt yourself or others.  If someone exhibits the above, seek help immediately.

God's grace,

Traci Shahan

The communication on this blog is intended only as a general information.  It is not intended to provide specific medical advice or to substitute for medical care and consultation.  This information is not intended to supersede regulations or law.

 

Osteoporosis

Osteoporosis: A Silent Disease

This week's blog subject is about osteoporosis, a metabolic disease that includes thinning of bones.  Lest you think that this disease is relegated only to those who are over age 80 or that you will never get it, think again.  This is a prominent disease facing most women and many men at some point in their lives, especially those over the age of fifty.  Fifty percent of women over the age of 50 will experience an osteoporotic fracture, although men are certainly not immune from the ravages of osteoporosis.  Currently the United States has 10,000,000 people diagnosed  with osteoporosis and that number is projected to increase to 14,000,000 by 2020. Put into context, these fractures affect more women than breast cancer, strokes and heart attacks combined, though osteoporosis is still underdiagnosed and undertreated (Miller, Baim, and Lewiecki, 2008).  These fractures should not be diminished in importance as, not only do they cost $20,000,000,000 (Yes, that is twenty billion dollars) per year in the United States alone, they contribute to decreased quality of life with pain, decreased mobility, loss of self esteem and death (Miller et al, 2008). We have done and continue to do a poor job in this country of identifying and treating osteoporosis.  This is not just your elderly aunt's problem.  A "hunchback" and broken hip are not normal parts of aging; they are part of a treatable metabolic disease that can be fatal.  Treated early with both pharmacologic and nonpharmacologic modalities, osteoporosis can be ameliorated.  Bone health is an issue about which we should all be proactive.  Read on for more information and to identify risk factors.

So who is at risk?

• Those with poor calcium intake, which includes nearly all Americans.
• Those with poor Vitamin D intake, which again includes many Americans.  If you have never had a serum Vitamin D level--a blood test--performed, request at your next physical that your doctor do so.  
• Those who ingest a lot of caffeine and sodas, once again including most Americans.  
• Those who regularly drink three or more alcoholic drinks per day.
• Those who passively or actively ingest tobacco.
• Those who use aluminum-based antacids frequently.
• Those who do not get consistent weight bearing exercise.
• Those with a family history of osteoporosis
• Those with a history of falls.
• Those with other medical conditions like cystic fibrosis, hypogonadal disease, diabetes, inflammatory bowel disase, celiac disease, autoimmune disorders, alcoholism, heart failure, and depression.
• Those who chronically use glucocorticoids, heparin, anticonvulsants, and those who have undergone chemotherapy.
• Women, especially those of Caucasian and Asian descent.

What test is used to diagnose osteoporosis and osteopenia, the condition that can lead to osteoporosis?

• The gold standard test is called a Dual-energy s-ray absorpitometry, DEXA for short.

should be tested? Per the osteoporosis foundation, the following guidelines should be observed.

• All women 65 and older and all men 70 and older
  
• younger postmeopausal women and men who have fracture risk
  
• adults who have experienced a fracture after age 50
  
• adults with condition or meds associated with low bone mass or bone loss
• postmenopausal women discontinuing estrogen
  
• anyone who might be considered for osteoporosis therapy or in whom evidence of bone loss exists.
• Anyone being monitored for response to therapy.
  

For more information, the National Osteoporosis Foundation has a superb website--www.nof.org.

Many therapies exist to help staunch the silent but deadly and far-reaching effects of this disease.

Peace to you during this beautiful summer season,

Traci Shahan

The Healing Power of Community

Greetings to you in the Risen Christ,

We live in a world rife with discord, broken relationships, and hopelessness. It doesn't take much digging to find negative input: media outlets chronicle disasters, crime and bad economic news. (To their credit every so often, they cover positive events but oftentimes those stories are buried in the sports segment or the weekend circular.) Even our associates can saddle us with messages that are negative. It is easy to become disenchanted, sad, burdened with worry to the point of hopelessness, hence the statistics on depression I cited in a previous blog. Even within, never mind without, the community of faith, life can seem like one big negative.

So if humanity is as flawed as the newspapers and internet suggest, what can we believe in? And why should we believe?

The short answer to the first question is because God said so. Reference the Revised Common Lectionary for this week, July 26, 2009. In 2 Kings 4:42-44, we are reminded of the power of first fruit giving. Through Elisha the prophet, the people were admonished that if they offered to God their first fruits--barley and grain--reminding them that the Lord said, "They shall eat and have some left." In other words, give and you shall receive. Ephesians 3:14-21 lyrically describes the love of Christ that surpasses knowledge." These verses tell us that we are rooted and grounded in Christ's love, which we can't comprehend completely. John 6:1-21 describes the event of the disciples rowing on the turbulent--read very scary--Sea of Galilee. Jesus told everyone to relax, to have faith and, as you know, they were all returned to land. Intact and whole. He led by example and modeled the peace of God when all appearances seemed to merit otherwise.

In a more immediate sense, here's why we should believe: not only does it feel better than fretting and awfulizing but it fosters health and wellness. Reference writings by Dean Ornish, MD, who objectively describes the enhancement of health by affiliating with a community of faith. Many other authors have described the same. The fact is that those who attend a faith-filled group regularly live longer, feel better and suffer less frequently from the ravages of the #1 reason for death in America: cardiovascular disease.

So the message of the blog this week is an old one related numerous times in scripture and within our current medical literature: we need to foster intentional relationships and authentic community. Believe in God's message of grace and redemption. Maybe even eliminate and reduce negative input. And always remember that the gifts of God are FREE!

In Peace,

Traci