nah now winter 2016

VOLUME 1, ISSUE 3/WINTER 2016

FLAGSTAFF MEDICAL CENTER • VERDE VALLEY MEDICAL CENTER • SEDONA CAMPUS

5 tips for sticking with your fitness goals

Expert in the house: How to avoid winter

depression

8 ways to keep your skin healthy in winter

Healthy tofu lasagna

ALSO INSIDE:Losing to win:NAH Bariatric Surgical Weight Loss Clinic helps patients make major lifestyle changes

Northern Arizona Healthcare NOW!

Communications Department1200 N. Beaver St.

Flagstaff, AZ [email protected]

Richard A. Smith, Ed.D.Vice President of NAH

Development & Communications

Trista MacVittieDirector of NAH Communications

Editorial and productionContributors:

Kerry Bennett, M.A.Angela Lyons, M.B.A., C.Ph.T.

Sean OpenshawSophia Papa, M.A.

Sarah Sabalos-Gruber, M.Ed.

Designer:Trevor Roberson

Photographer:John Burcham

Northern Arizona Healthcare provides healthcare services through Flagstaff Medical

Center, Verde Valley Medical Center, Northern Arizona Healthcare Medical Group – Flagstaff, Verde Valley Medical Clinic, Cancer Centers of Northern Arizona Healthcare, EntireCare

Rehab & Sports Medicine, Fit Kids of Arizona, Guardian Air, Heart & Vascular Center of Northern Arizona,

Northern Arizona Homecare, Northern Arizona Hospice and Valley View Care.

To learn more about Northern Arizona Healthcare, visit NAHealth.com.

This publication in no way seeks to serve as a substitute for professional medical care.

Consult your physician before undertaking any form of medical treatment or adopting any exercise program or

dietary guidelines.

Copyright© 2016 Northern Arizona Healthcare.All rights reserved.

Printed on recycled paper.

Northern Arizona Healthcare Board of Directors

Chair – Charles MarrVice Chair – Alice Gagnaire, R.N.

Treasurer –Wayne FoxSecretary – Shawn Orme Andrew Aldridge, M.D.

Rick CranmerJames DormanWilliam JeffersRichard Kruse

Kenneth Salce, M.D.Ray Selna

Guadalupe Woodson, F.N.P. Rob Thames, NAH President and CEO

AdministrationRob Thames

NAH President/CEOMarilynn Black

Vice President of Systems Integration and Chief Information Officer

Ann BolloneVice President of NAH Human Resources

Mark Carroll, M.D.Vice President and Chief Medical Officer,

Flagstaff Medical CenterChris Clarke, R.N.

Vice President of NAH Physician GroupAmy Gottschalk, M.D.

Vice President of NAH Quality and Chief Medical Officer, Verde Valley Medical Center

Susanne Maiden, R.N.NAH Interim Administrator and Chief Nursing

Officer, Verde Valley Medical CenterRick Peterson

Vice President of NAH Professional & Support ServicesRichard (Rick) Smith, Ed.D.

Vice President of NAH Development & CommunicationsFlo Spyrow

Executive Vice President and Chief Administrative Officer, Flagstaff Medical Center

Jeffrey TreasureExecutive Vice President and Chief Financial Officer

Katy Wilkens, R.N.Vice President and Chief Nursing Officer

VOLUME 1, ISSUE 3, WINTER 2016

Charles Marr

On the cover: Gastric bypass surgery patient Dawn Mosher, who has lost 142 pounds since April 2015, jokes with NAH Patient Advocate Betsy Fritz. Fritz has guided Mosher throughout the process of having the surgery and making the lifestyle changes needed to successfully lose weight and keep it off.

Northern Arizona Healthcare was formed in 1995 when Flagstaff Medical Center and Verde Valley Medical Center partnered to build the VVMC – Sedona Campus. In the last 20 years, however, FMC and VVMC continued to operate primarily as two separate medical centers. In October 2015, that changed when three governing boards consolidated into one, uniting all services as a system. Today, as the chair of Northern Arizona Healthcare Board of Directors, I am proud to be part of the NAH family of more than 3,400 doctors, nurses and other healthcare professionals who serve 700,000 people across 50,000 square miles. Our team touches the lives of so many as their primary provider of care or the partner of other healthcare organizations in our region. Because NAH is nonprofit, I believe it is our mandate to continually invest in the facilities, technology and expertise that enable us to provide quality healthcare to the communities we serve. I have been fortunate to see many important improvements taking place at NAH over the last five years. I am looking forward with great anticipation to the new developments taking place across the organization in 2016, including: • A project expanding our obstetrics medical and surgical capacity at Flagstaff Medical Center.• The opening of the new headquarters of Guardian Air in Flagstaff.• The new outpatient center in Camp Verde. On behalf of NAH, I want to wish everyone a happy, healthy new year.

Charles MarrChairNorthern Arizona Healthcare Board of Directors

Cover storyLosing to Win: NAH Bariatric Surgical Weight Loss Clinic helps patients make major lifestyle changes

n recognition of February, American Heart Month, Northern Arizona Healthcare is sponsoring an online health risk assessment. Beginning Feb. 1, the 10-minute assessment will be available on our website at NAHealth.com. After answering a series of questions about your health and

lifestyle, you will receive a report estimating your risk of developing heart disease; what you are doing well; and actions you can take to lower your risk.

9 Nutrition in Northern Arizona

10 Foundations for health

12 Health by the numbers

14 Expert in the house

15 Resolutions for a healthier new year

4

February is American Heart Month: Take our online heart disease health risk assessment

I

In this issue…

Inside NOW

VOLUME 1, ISSUE 3 / WINTER 2016

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9

NAH Bariatric Surgical Weight Loss Clinic helps patients make major lifestyle changes

by Sarah Sabalos-Gruber, M.Ed. NAH Communications

In her office at Northern Arizona Healthcare’s Bariatric Surgical Weight Loss Clinic in Flagstaff, Patient Advocate Betsy Fritz keeps a thick, beautifully-decorated album. Open it, and stories and photos pour out – the words and images of people whose weight stopped them from walking normally; fitting into ordinary clothes; or even sitting comfortably at a desk.

The album also features another, very different set of stories and photos. Here, people describe running outdoors, swimming in the ocean and playing with their grandchildren. Looking into the camera, they hold up – triumphantly – pairs of jeans that could wrap around their bodies twice.

It’s only when you look closer that you realize these stories and photos are of the same people – before they began their weight-loss journeys, and afterward. Some you can recognize only by their eyes.

Northern Arizona Healthcare • 5

The album Patient Advocate Betsy Fritz keeps at the Bariatric Surgical Weight Loss Clinic features the success stories of patients like Jacob Garcia, who lost 130 pounds through the support of the clinic’s expert team of physicians, nurses, dietitians and therapists.

Top of page: Gastric bypass surgery patient Dawn Mosher has four children, and lovessurprising them with all the activities in whichshe is now able to participate.

6 Northern Arizona Healthcare •

Program gives patients their lives backDawn Mosher, 50, who lives in Prescott, is one of these

people. “Gastric bypass surgery gave me my life back,” she said. “I was

386 pounds, had two small kids, and my health was deteriorating – diabetes, asthma, high cholesterol, narcolepsy and gout. My pulmonologist said my lung function was the lowest he had ever seen in a patient. I was expecting to die any day, but I decided I wanted to live to see my kids grow up.”

Although her weight loss is ongoing, Mosher has lost 142 pounds since April 2015, and no longer suffers from any obesity-related illnesses. She did, however, learn she had colon cancer after undergoing a colonoscopy required by the bariatric program. She received treatment and is now cancer-free.

“If I hadn’t jumped through all the hoops of the bariatric program and undergone all the medical checkups, I wouldn’t even have known I had it,” she said. “So if I hadn’t died of obesity-related causes, I might easily have died of colon cancer.”

Mosher, who now has four children – all adopted – loves surprising them with the things she can do.

“My kids had no idea I used to be a baseball player,” she said, “but now I can play with them and actually jump up in the air to try and catch the ball instead of telling them, ‘Just throw it at me.’ I got to go on a roller coaster for the first time in 20 years – my kids had no idea I liked roller coasters, because it wasn’t safe for me to ride them before. And they’re eating healthier these days, too – they’re off soda because we don’t keep it in the house.

“Our family fitness goal is the Whiskey Row Marathon next spring – we may have to walk it, but we’ll be there.”

The last resort – and the first choice Since the Bariatric Surgical Weight Loss Clinic opened in 2004,

it has been both the last resort and the first choice for more than a thousand people like Dawn. A last resort, because these patients – each overweight by at least 100 pounds – had tried dozens of diets and exercise programs; and the first choice, because of its distinction as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery. The program is staffed by a team that supports each patient during every step of his or her comprehensive lifestyle overhaul, both before and after the procedure.

Patricia Olm, M.D., who clears patients for surgery, helps them un-derstand the program isn’t just about an operation – it’s about making big changes in daily living, including diet, exercise sleep habits and stress reduction. Patients are also required to explore any emotional and psychological issues that may have contributed to their obesity.

“Bariatric surgery is only one tool to help facilitate weight loss and chronic disease management,” Olm said. “Ongoing lifestyle manage-ment is critical.”

•Laparoscopicgastricband(Lap-Band® surgery):Abandisplacedaroundtheupper partofyourstomachtocreateasmallpouch. Thebandlimitstheamountoffoodyoucan eatbymakingyoufeelfullaftereating smallamountsoffood.•Laparoscopicsleevegastrectomy:About 75percentofthestomachisremoved,leaving anarrowgastric“tube”or“sleeve.” Nointestinesareremovedorbypassed.•Laparoscopicgastricbypass:Alargesection ofthestomachisstapledoff,creatingatiny pouch,whichisthenconnectedtothesmall intestine.Thispouchcanonlyaccommodate afewouncesoffoodatatime,andthe reconnectedintestinecausesthefoodtobypass partoftheintestinesosomeofthecalorieswill notbeabsorbed.

Typesofbariatricsurgery

Patient Dawn Mosher and Patient Advocate Betsy Fritz from the NAH Bariatric Surgical Weight Loss Clinic, which has been distinguished as a Center of Excellence by the American Society of Metabolic and Bariatric Surgery.

“Gastric bypass surgery gave me my life back,” patient Dawn Mosher said. “I was 386 pounds, had two small kids, and my health was deteriorating – diabetes, asthma, high cholesterol, narcolepsy and gout. My pulmonologist said my lung function was the lowest he had ever seen in a patient. I was expecting to die any day, but I decided I wanted to live to see my kids grow up.”


Whatisobesity?According to the Arizona Department of Health Services and the World Health Organization:

• Obesity is fat accumulation that may impair health. The World Health Organization defines obesity as a body mass index, or BMI, greater than or equal to 30. This is not the case for athletes, who often have high BMIs as a result of greater muscle mass. • BMI is a weight-for-height index in which your weight in kilograms is divided by the square of your height in meters. An easier way to calculate your BMI: go to the National Institutes of Health website and use the calculator provided at nhlbi.nih.gov/health/ educational/lose_wt/BMI/bmicalc.htm• Nearly two out of three adults in Arizona are either overweight, defined as a BMI of 25 to 29, or obese, defined as a BMI of 30 or greater.• Being overweight or obese increases the risk of cancer, arthritis, joint problems, gall bladder disease, liver disease, kidney disease, heart disease, diabetes, hernia, lung problems and infertility, among other conditions.• Thirty-nine percent of adults aged 18 and older were overweight in 2014, and 13 percent were obese.• Most of the world’s population lives in countries where obesity kills more people than malnourishment.• Obesity-related healthcare costs the U.S. $147 billion annually.• Obesity is preventable, and most obesity-related health problems are reversible.

To learn more, visit azdhs.gov/topics/index.php# obesity-prevention-home and who.int/mediacentre/ actsheets/fs311/en/.

Readytolearnmore?Ourfreeinformationsessionsareheldfrom6to7p.m.

thesecondTuesdayofeachmonthattheDoubleTreebyHilton,1175W.Route66inFlagstaff.Check-inbeginsat5:30p.m.Nopre-registrationisnecessary.Tolearnmore,call928-214-3737.Additionally,sessionscanbebroadcastlivetoyourpersonalcomputer.Formoreinformation,call928-773-2222andchoosetheoption“GeneralSurgery.”

Pound by pound – the long, careful process of losing weight

Fritz, who leads a free information session offered to inter-ested patients, meets many patients who are suffering from hernias or facing knee or hip replacement surgery – and their doctors have suggested weight loss as a means to relieve the attendant pain.

“From the night they attend the information session to the day of surgery and afterward, I help guide everyone through the process,” Fritz said. “As patient advocate, I’m a bit like a midwife.”

Surgeon Robert Berger, M.D., who has performed 500 bariatric procedures, also compares the long, careful process to giving birth.

“If you got pregnant one day and had the baby the next day, you probably wouldn’t be ready,” he said.

Surgeon Andrew Aldridge, M.D., performs minimally invasive bariatric surgery using sophisticated robotic equipment.

Surgeon Andrew Aldridge, M.D., performs minimally invasive bariatric surgery using sophisticated robotic equipment.


Starting the weight-loss journeyFor most patients, the journey follows this pattern:

1. Attend a free information session to learn about the program. Sessions meet from 6 to 7 p.m. the second Tuesday of each month at the DoubleTree by Hilton, 1175 W. Route 66 in Flagstaff.

2. Meet with Patient Advocate Betsy Fritz at the clinic, 1050 N. San Francisco St., Suite B, for more specific information, including insurance coverage.

3. Join the support group for pre-operative patients, which meets from 3:30 to 5 p.m. or from 6 to 7:30 p.m. on the first Wednesday of each month at the clinic. The meeting is televised to Verde Valley Medical Center in Cottonwood and to Little Colorado Medical Center in Winslow.

4. Attend an initial appointment with a bariatric surgeon – Andrew Aldridge, M.D., Robert Berger, M.D. or Brian Coates, D.O. – to determine which surgical option is best for you.

5. Go to all pre-op appointments and checkups, including a mental health assessment. Appointments may take place at the Bariatric Surgical Weight Loss Clinic or at Flagstaff Medical Center, 1200 N. Beaver St.

6. Undergo surgery at Flagstaff Medical Center.

7. Stay at FMC as an inpatient for one or two nights during recovery.

8. Return to the clinic for post-op follow-up appointments.

9. Attend regular support group meetings at the clinic.

Didyouknow?•Bariatricsisthebranchofmedicinefocusedon thecauses,preventionandtreatmentofobesity.

•TheteamofsurgeonsoperatingatNAHcurrently averages127surgeriesperyear;since2004,they haveperformed1,198surgeries.

•Theaveragebariatricsurgerypatientresearches hisorheroptionsonlineforyears.

•Theaveragebariatricsurgerypatientlosesabout 70percentofhisorherexcessweightduringthe yearfollowingtheprocedure.

•AccordingtotheAmericanSocietyforMetabolic andBariatricSurgery,bariatricsurgerycan reducetheriskofdyingfromcancerbyasmuch as60percent;fromheartdiseasebymorethan 50percent;andfromdiabetesbymorethan 90percent.

•“Thankyouforhelpingmegetmylifeback.”•“Goingtothebariatricclinicprobablysavedmylife…you areallapartofmynew‘bariatricfamily’andIoweallof youmymostsincerethanks.Iamanewperson!”•“Mylifehasneverbeensofulfilling,andIcontinuetofocus onlifelongchangewithmynewstomach,andlivingalong andhappylifeformyfamily.”•“It’ssomucheasiertogetdownandupoffthefloorwithmy 9-month-oldgranddaughter.Mykneedoesn’thurtany more…andIammoreoptimisticabouteverything.”

Whatourpatientssayabouttheprogram

Questionstoaskyourselfbeforeyouchoosebariatricsurgery•HaveIdoneeverythingelseinmypowertolosethis weight,andhaveIkeptadetailedlogofmyefforts– bothformyselfandforhealthinsurancereasons?

•HaveIaddressedalltheemotionalandpsychological issuescontributingtomyweight?

•AmIreadytocommittolong-termlifestylechanges intermsofnutritionandactivitylevelinorderto maintaintheweightIwillhavelostaftersurgery?•AmIableandwillingtoacceptthephysicalrisks ofsurgery?

—PsychologistJohnB.Martin,Ph.D.,whoworkswithpatientsinthebariatricsprogram

The team of surgeons operating at NAH currently averages 127 surgeries per year; since 2004, they have performed 1,198 surgeries.


Nutrition in Northern Arizona

his lasagna recipe, which serves 12, is courtesy of Colleen Lingley, R.D.N., a clinical dietitian based at Northern Arizona Healthcare’s

Bariatric Surgical Weight Loss Clinic. She uses organic soy and wheat products due to pesticide concerns and the widespread genetic modification of both plants.

This recipe is a favorite among bariatric patients because, in addition to being healthy, tasty and easy to prepare, it contains no meat, which is difficult for them to digest. However, you can substitute ground beef, pork or turkey for the tofu if you desire, as well as experiment with your favorite spices.

THealthy tofu lasagna Ingredients:

• ½ (12-ounce) package uncooked organic lasagna noodles• 12-ounce package organic firm tofu, crumbled• 16-ounce package frozen spinach, defrosted and squeezed fairly dry• 2 eggs• ¼ teaspoon black pepper• ¼ teaspoon ground nutmeg• 2 tablespoons milk• 1 cup spaghetti sauce• 1 tablespoon dried parsley• 2 cups shredded mozzarella cheese, divided• ¼ cup shredded Parmesan cheese

Directions:1. Preheat oven to 350 degrees.2. Bring a large pot of water to a boil. Add lasagna and cook for 8 to 10 minutes or until firm; drain.3. In a medium bowl, combine tofu, spinach, eggs, pepper, nutmeg, milk, spaghetti sauce, parsley and 1 cup of the mozzarella cheese. Spread a layer of this mixture in the bottom of a 9-inch by 13-inch baking dish.4. Layer lasagna noodles with the sauce mixture, ending with sauce. Sprinkle with remaining mozzarella and Parmesan cheese. 5. Bake in preheated oven for 25 to 35 minutes.

Colleen Lingley, R.D.N.


Nutrition profile for one serving (1/12 of casserole):Calories: 155Fat: 6.5 gramsTotal Carbohydrates: 12.5 gramsSugar: 1.5 gramsProtein: 11.5 gramsSodium: 148 milligrams

Foundations for healthNAH Foundation special events

Interested in giving?Contact Jennifer Hidinger in Flagstaff at 928-773-2426 or Stephanie Giesbrecht in Cottonwood at 928-639-6100 to find out how.


• April 2: Loven Family Run at Blazin’ M Ranch in Cottonwood to benefit Valley View Care

• May 14: Copper Ball at Hilton Sedona Resort at Bell Rock to benefit the Cancer Centers of Northern Arizona Healthcare

• June 20: Chicks with Sticks Women’s Golf Tournament at Pine Canyon Golf Club in Flagstaff to benefit breast cancer education and research

• July 16: Pepsi-Cola Taylor House Century Ride at Flagstaff Medical Center to benefit The Taylor House

• Aug. 6: Machine Solutions Run & Walk for Kids at Fort Tuthill in Flagstaff to benefit the Children’s Health Center

• Aug. 25: Holes for Heart Care Golf Tournament at Pine Canyon Golf Club in Flagstaff to benefit the Heart & Vascular Center of Northern Arizona

• Dec. 3: Turquoise Ball at the High Country Conference Center in Flagstaff to benefit NAH’s area of greatest need

Need more information? Please call the NAH Foundation special events team at 877-527-5291.

Upcoming events: Recent events: The 55th annual Turquoise Ball on Dec. 5 was the most successful ball to date. The event raised a record amount of funding for the Cancer Centers of Northern Arizona Healthcare, which will be used to purchase a much-needed van to transport patients.

2 • 0 • 1 • 6

PEPSI-COLATAYLOR HOUSECENTURY RIDE2015


There are many different ways to contribute to Northern Arizona Healthcare’s future. Although cash contributions are needed and always appreciated, there are several creative and flexible options that offer a variety of tax advantages and other benefits, even during your lifetime.

Features and benefits

• You can request your gift be placed toward an immediate NAH need

• You can change the terms of the trust at any time

• Flexibility to provide for family needs first• Increases the opportunity for an endowed gift

• Flexibility to provide for family needs first• Increases the opportunity for an endowed gift

• You can leave your heirs less costly bequests and make a major gift to NAH

• You can leave your heirs less costly bequests and make a major gift to NAH

• Annual payments will be made to you at a guaranteed return for life• Your gift will benefit NAH now

• You will receive a steady income• You will receive income and estate tax benefits• Your gift will benefit NAH in the future

• You will receive a steady income• You will receive income and estate tax benefits• Your gift will benefit NAH in the future

• Your gift will benefit NAH now• You will receive current gift and estate tax benefits• Your assets will be returned to your estate at the end of the term

Gift type

Outright gift

Living trust

Will bequest

Life insurance gift

Retirement plan gift

Real estate gift

Charitable gift annuity

Charitable remainder annuity trust

Charitable remainder unitrust

Charitable lead trust

Definition

A gift of cash, personal property or securities

A trust you set up to take effect during your lifetime

A gift wherein you name NAH in your will

A gift of a life insurance policy wherein NAH is named the beneficiary

A gift that names NAH as remainder beneficiary after your death

A gift of real property

A contract wherein NAH agrees to pay you back a percentage of your gift annually

A trust that pays a fixed income to you before NAH receives the remainder

A trust that pays a variable income to you before NAH receives the remainder

A trust that pays income to NAH before you or your heirs receive the remainder

Tax advantages

• You can take an income tax deduction for the whole value of the gift• There is no capital gains tax due on the appreciated property or security

• Possible savings in your estate taxes if you name NAH as the beneficiary of the trust remainder

• Estate tax deduction for the value of your bequest

• Income tax deduction for the value of the gift • Potential estate tax advantages

• Avoids high income tax on the plan • Potential estate tax advantages

• Income tax deduction for the charitable value of the gift with no capital gains tax due

• Charitable income tax deduction in the year the gift is made• Ongoing tax-favored payments• Tax deductions can be carried forward for 5 years if necessary• Income tax deduction for the charitable value of the gift with no capital gains tax due• Potential reduction in estate tax liability

• Charitable income tax deduction may be available• Avoids capital gains tax • Ongoing tax-favored payments• Income tax deduction for the charitable value of the gift with no capital gains tax due• Potential reduction in estate tax liability

• Charitable income tax deduction on present value of remainder• Income tax deduction for the charitable value of the gift with no capital gains tax due• Potential reduction in estate tax liability

• Gift tax deduction• Flexibility of transfer of assets to an heir• Flexibility to manage current tax liabilities

Many ways to give to Northern Arizona Healthcare

Healthy blasts for winter 2016

Health by the numbers


Trixy Petsche, L.P.N. Joyce Richards, D.O.


habits for a happier tummy in 2016The holiday season is notorious for causing stomach and digestive troubles, due to the aftermath of cookie- and alcohol-laden parties. Trixy Petsche, L.P.N., a licensed practical nurse with Verde Valley Medical Clinic – Gastroenterology, and gastroenterologist Joyce Richards, D.O., offer the following tips to finish out the winter in a balanced way:

1. Drink plenty of plain fluids – water and caffeine-free tea help rinse out your digestive system. A glass of water every morning is like gold to your body.

2. Stop, or at least cut down, on your soda intake.

3. Add some dried fruit to your diet to replace all those desserts and add some extra fiber – aim for 20 grams a day.

4. Your tummy responds well to good exercise habits – try a winter sport like skiing, snowboarding or snowshoeing. If you can’t face the cold outdoors, try a workout DVD in the warm comfort of your home.

5. Express your gratitude for all the good things in your life this year! Feeling grateful is strong medicine for your whole body.

6. Avoid eating within two hours of bedtime.

To make an appointment at Verde Valley Medical Clinic – Gastroenterology in Cottonwood, call 928-649-7913.

64 positive approaches to chronic illness

ccording to the Centers for Disease Control and Prevention, about half of all

adults have one or more chronic health conditions – and one in four adults have two or more. For many people, chronic illness is a fact of life – but it doesn’t have to define your life.

The start of a new year is a great time to re-examine and improve the ways you approach and manage a chronic illness or condition. James Arthur, M.D., a primary care physician at Verde Valley Medical Clinic – Primary Care in Cottonwood, suggests the following:

1. Learn as much as possible about your condition. Educating yourself about what is wrong, and how to make it better, gives you a stronger sense of control and cuts down on worry. It’s also a great way to get the most out of your medical treatment.

2. Seek medical care from providers you can talk freely with. Ask them all your questions – even the scary and embarrassing ones. Make sure you understand the pros and cons of all your treatment and pain-management options.

3. Avoid depression and isolation by building and maintaining a solid support system of family and friends. If you are low on either, find a support group with others who understand how you are feeling.

4. Keep doing the things you like to do, whenever and however you can. This helps you stay connected with other people, and boosts your self-confidence, independence and sense of community.

The seven most common chronic diseases in the U.S. are:1. Heart disease2. Cancer3. Stroke4. Diabetes5. Arthritis6. Obesity7. Respiratory illness To make an appointment with Dr. Arthur in Cottonwood, call 928-634-5551.

A

The surface area of the small intestine is approximately 2,700 square feet – about the size of a tennis court.

James Arthur, M.D.

Julie Polzin, N.P.-C.

R

8 ways to keep your skin healthy in winter

ough, dry skin,

a common problem year-round in Arizona, can be at its worst during the cold, windy winter months. Julie Polzin, N.P., a nurse practitioner with Northern Arizona Healthcare Medical Group – Flagstaff, shares some winter skin care tips to help keep skin well hydrated and healthy.

1. Add moisture to skin with olive or coconut oil. Olive oil, a natural, hypoallergenic way to moisturize, contains antioxidants, including vitamins E and A for repair and renewal. Coconut oil has antiseptic properties and free-radical fighting antioxidants. To make your own moisturizer, mix three parts coconut oil to one part olive oil with a few drops of lavender oil. You can also mix liquefied coconut oil (it’s solid at room temperature,

liquid when warmed) or olive oil with an equal amount of a creamy, fragrance-free moisturizer and apply directly to skin. It’s best to apply right after bathing while your skin is moist, in order to lock in hydration.

2. Take warm showers and baths. While hot water is relaxing, it snatches moisture from the skin. You can also add a few drops of olive oil to your bath water for its moisturizing benefits.

3. Dress appropriately and keep covered to protect as much of your skin as possible.

4. Unprotected facial skin dries easily, so avoid products containing alcohol and apply moisturizer at least once

per day. Washing your face each week with Greek yogurt can be beneficial, because the lactic acid it contains acts as gentle non-abrasive skin exfoliator. Exfoliation helps boost the generation of new, moist cells in your skin.

5. Drink plenty of water. It’s as important to stay hydrated in the winter as it is in the summer.

6. Consider adding more citrus fruits, green veggies, fish oil, flax, olive oil, avocado and sardines

to your diet. Foods like these, rich in vitamin C and Omega-3 fatty acids, will benefit your skin.

7. Don’t forget to apply sunscreen, no matter how cold or overcast the day is. The sun is still there, even if you can’t see it.

8. Limit your use of soap, which can be drying to skin. Use mild soap only, as needed.

To make an appointment with Northern Arizona Healthcare Medical Group – Flagstaff, call 928-913-8800.


5 tips for sticking with your fitness goals in the New Year

Regular gym-goers call them “resolutionaries” – people who resolve to start a new, revolutionary fitness program on Jan. 1, only

to fade out before Valentine’s Day due to injury or discouragement at not seeing results quickly enough. Bryan Taylor, M.S., C.S.C.S., C.E.P., an exercise physiologist at the Cardiac Rehabilitation Center located at Flagstaff Medical Center, offers the following tips to keep you on track well into 2016.

1. Build from the ground up. Your first exercise day doesn’t have to be a triathlon. Doing too much too soon can lead to dropping out of exercise completely. The American Heart Association and the American College of Sports Medicine recommend 30 minutes of moderate-intensity cardiovascular exercise, such as brisk walking, five times a week – a total of 150 minutes – for general and heart health. You don’t have to do all 30 minutes of exercise at once.

2. Set realistic goals. Nothing is more motivating than achieving

your goals – that’s why they need to be achievable. Set small, short-term goals that help you reach a larger goal. Once you get there, reward yourself for all your hard work! Then, refine and set new goals.

3. Do what you enjoy. If you hate doing something, you likely won’t keep doing it. If you love to run, run – but if you don’t, try bicycling or something else that suits you better. Also, your workout doesn’t have to be the same every time, so switch it up and try new things! A well-rounded plan includes cardio, strength and flexibility, and will keep the heart, lungs and muscles strong.

4. Pack a workout bag and put it by the door. Set yourself up for success by putting a workout bag by your door at night, so you can grab it on your way out in the morning. You might also set a workout reminder on your phone; or have a friend text you with a friendly reminder to go to the gym or hit the trails later. Or you could try exercising first thing in the morning – no one ever regretted an a.m. workout!

5. Build in accountability. Even with the best intentions, we don’t always do what we plan to do if no one is there to hold us to it. Social support is key to permanent change, so find a reliable exercise buddy or join a workout group where you feel encouraged – and where they miss you if you don’t show up!

For more information on the health-related benefits of exercise and exercise recommendations, visit the American Heart Association at heart.org and the American College of Sports Medicine at acsm.org.

Bryan Taylor, M.S., C.S.C.S., C.E.P.


Q&A: How to combat depressive disorders with seasonal pattern

Expert in the house

uring the winter months, people tend to become more sedentary − outside activities popular during summer and

fall become more challenging as temperatures drop. Staying active during the winter, however, is necessary for physical and mental health.

We asked licensed professional counselor Kim Alexander, L.P.C., clinical manager of counseling and therapy services for Northern Arizona Healthcare’s Behavioral Health Services at Flagstaff Medical Center, to explain depressive disorders with seasonal pattern and how to avoid them.

Q: What are depressive disorders with seasonal pattern – and are they just the winter blues? A: They are two different things. “Winter blues” is a general term used to describe the “blahs” some people feel during winter. These mild symptoms, related to light deficiency and cold temperatures, can include decreases in energy, enthusiasm and productivity. This is not necessarily a problem unless it significantly interferes with an individual’s ability to function in the home, school or work environment.

Once referred to as seasonal affective disorder, or SAD, depressive disorders with seasonal pattern are major depressive episodes beginning in the fall or winter and ending in the spring. The American Psychiatric Association no longer regards this as a separate disorder from major depression. This subtype of major depression comes and goes based on the seasons.

Q: What are the signs and symptoms of depressive disorders with seasonal pattern?A: They must meet four criteria:• Depressive episodes occur at particular times of the year.• Remissions of mania or hypomania occur at a characteristic time of year. Mania is a state of heightened energy and euphoria with a significant elevation of mood involving significant impairment of judgment or insight, while hypomania is a milder form of mania involving mood and energy elevation with mild impairment of judgment and insight. • Patterns last for two years with no non-seasonal major depressive episodes during that same period.• Seasonal depressive episodes outnumber other depressive episodes throughout the patient’s lifetime. Additional characteristics include changes in energy levels, sleeping too much, or hypersomnia, overeating, weight gain and carbohydrate cravings.

Q: Does depressive disorder with a seasonal pattern only affect people during the winter?A: No, it can occur in the spring or early summer. However, it is less common during those seasons.

Q: What are some tips to avoid seasonal depression? A: Get outside and go for a walk during a break or during lunch; make your environment sunny and bright; sit close to windows while at home or in the office; get regular exercise for at least 30 minutes three times a week; stay social by continuing to interact with family and friends − even if you do not feel up to doing so − and practice stress management. Yoga, meditation and massage therapy may also be useful. Finally, take a trip to a warmer climate during winter months, if possible.

Q: If I am suffering from depressive disorders with seasonal pattern, what should I do? How is it treated?A: Seek professional help from your doctor or mental health provider. Light therapy, also known as phototherapy, is often helpful in preventing and treating episodes. Psychotherapy is also beneficial. For severe symptoms, medication can be helpful.

Q: What are the consequences of not treating seasonal depression?A: Consequences may include social withdrawal; school or work difficulties; suicidal thoughts or behaviors; and substance abuse.

To make an appointment with NAH Behavioral Health Services’ outpatient therapy clinic in Flagstaff, call 928-213-6400.

Dby Sophia Papa, M.A. NAH Communications

Kim Alexander, L.P.C.

Resolutions for a healthier new year

Don’t break the chain“I’m committing to doing

something every day with the goal to ‘Never break the chain,’” NAH Website Management Coordinator Sean Openshaw said. “Not only does exercising consistently help improve my overall fitness, I find it keeps other things top of mind, like nutrition, hydration, sleep and, of course, more exercise. Consistency is such a critical aspect of fitness.”

“Don’t break the chain” is a productivity life hack used by Jerry Seinfeld, which is available online at lifehacker.com/281626/jerry-seinfelds-productivity-secret. Openshaw creates a calendar to track his progress, with the goal of achieving a checkmark, or X, each day of the year. The core idea is to build the longest chain of X’s possible. The length of the chain serves as encouragement not to break it.

“If the goal is to exercise 30 minutes every day,” Openshaw said, “you can set criteria such as, ‘Any activity that lasts 30 consecutive minutes and results in improved health and wellness.’ But you have to validate the activity beforehand. You can’t think back on the day and justify a checkmark because you walked quickly between meetings for about 30 minutes total.”

According to Openshaw, activities that count include running, biking, lifting, cycling, yoga and walking. Stretching, meditation and massage also count, as do planning, researching and managing goals.

One caveat: You can create rules that let you off the hook but still earn you a checkmark, such as allowable skip days when you are ill or injured; have a family emergency; or truly make an effort to complete 30 minutes but are unable to.

Openshaw once weighed 250 pounds and smoked two packs a day before having his last cigarette in 1995. He has kept the 75 pounds off by using the ‘break the chain’ technique. In the process, he racked up three Ironman triathlon races, six half-Ironman races and an untold number of running and bike races.

Stick to specific, attainable goals“I like to set specific, attainable goals as my resolutions,” said

NAH Emergency Services Liaison Emily Ross. For 2016, she has committed to:

• Spending at least an hour per week volunteering in the community.• Attending at least one seminar or workshop during the year

unrelated to her work, and one indirectly related to her work.

• Becoming a pen pal.• Taking one trip per month to help complete her goal of

section-hiking the Arizona Trail.• Finishing her kitchen renovation so she can have friends

over for dinner at least once a month.• Incorporating her partner into one of her daily workouts

per week, preferably outdoors.

Get out of bed on time – you snooze; you lose“I resolve not to hit ‘snooze’ in the winter mornings when

it is still pitch black,” NAH Foundation Specialist Stephanie Giesbrecht said. “As noted by our great Sleep Lab staff, hitting ‘snooze’ confuses your body’s natural rhythm, and the more you hit ‘snooze,’ the more confused your body becomes.

“Also, the nine-minute snooze allows your body to just get into the beginning of a sleep cycle when it is interrupted again. This fragmented sleep can set you up to feel groggy for several hours after finally getting out of bed. And I need every minute I can get in the morning to keep from running late. Being late causes me to be stressed and miss details, which stresses me out more – which is certainly not worth the additional nine minutes of ‘non-sleep.’”

We asked our colleagues at NAH to share their resolutions for 2016

by Kerry Bennett, M.A. NAH Communications


Openshaw once weighed 250 pounds and smoked two packs a day before having his last cigarette in 1995.

Stephanie Giesbrecht Sean Openshaw

NAHealth.com

nah now winter 2016

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