DOWN SYNDROME - Valley Health Magazine

Table of ContentsDown Syndrome:Living • Growing • Learning17FEATURES:23273135395357COMPLEMENTARYLife After Breast CancerMENProstate CancerWOMENBio-Identical HormonesBEAUYVaginal Cosmetic SurgeryDENTALAirway DevelopmentSENIORAlzheimer’s DiseaseDIET & NUTRITIONSport & Energy DrinksOTHER:111213Non-ProfitMarjaree Mason CenterChampion of FitnessSam ShimaTechnologyCyberKnife15434762SpotlightHenry Aryan, M.D.Dental ProfilesHealth ProfilesHealthy Dining12Valley Health Magazine l

Non-ProfitMarjaree Mason CenterHISTORYThe Marjaree Mason Center opened itsdoors in 1979, less than a year after themurder of Marjaree Mason, a highlyactive member of the Fresno communitywho was killed by her ex-boyfriend.Marjaree’s murder caused a great dealof community outcry, and brought tolight the tremendous need for domesticviolence services in Fresno County. Inresponse and with the blessing ofMarjaree’s family, the Young Women’sChristian Association (YWCA) of Fresnofounded the Marjaree Mason Center(MMC) with the goal of serving victims ofdomestic violence in Fresno County.One of the oldest and most wellrespected nonprofits in Fresno County,MMC began as simply a small shelter anda hotline, but as the need for servicesbecame increasingly apparent, the organizationquickly expanded.Now in continuous operation for nearly30 years, and as a standalone domesticviolence service agency since 1998, MMCruns the only three domestic violenceshelters in Fresno County and providesa bevy of supportive services, includinglegal assistance, individual and grouptherapy, 24-hour hotline, victim advocacy,case management, parenting and life-skillsclasses, court accompaniment, safetyplanning, and much more. MMC providesmost of these services at no cost.MISSIONMMC’s mission is to provide, throughintervention and prevention services, asafe and supportive environment forindividuals exposed to family violence.Domestic violence exists in all culturesand crosses all economic barriers, and itremains a growing problem. Last year,Fresno Police responded to nearly 7,000domestic violence calls for assistance,and over the past 12 months, MMCshelters provided a safe haven to morevictims than in any year prior. MMC is theonly organization in the county specificallydedicated to helping these victims.Beyond helping victims, MMC alsostrives to prevent future abuse througheducation and outreach programs. MMCoutreach advocates perform presentationsfor schools, healthcare and educationpersonnel, law enforcement and courtofficials, church and community leaders,and other community stakeholders whomay be able to help victims of domesticviolence.VALLEY PRESENCEEvery year, MMC provides services tomore than 4,500 unduplicated victims ofdomestic violence in Fresno County. Ofthose victims, more than 1,000 receiveshelter, nearly 900 receive therapy, andabout 2,400 receive legal assistance.More than half of the victims housed atMMC shelters are children.Only with the support of generousdonors and grantors can MMC provideservices to such a large number ofpeople. Much of this support comesduring Domestic Violence AwarenessMonth when MMC hosts the annual TopTen Professional Women and Top BusinessAwards, a tremendous event thathonors women who’ve contributed totheir professions while serving as rolemodels in our community, as well as abusiness that has supported womenemployees while giving back to thecommunity.This year marks the 25th anniversary ofthe Top Ten Professional Women and TopBusiness Awards, and MMC is celebratingby inviting all of the previous Top TenAward winners to this year’s awardsluncheon on October 23rd. MMC anticipatesmore than 1,000 attendees at thisyear’s luncheon. If you would like to attendor sponsor this event, visit www.mmcenter.org/events for more information.VOLUNTEERMMC offers many volunteer opportunitiesfor people with or without domesticviolence training. Volunteers may runoutreach booths, be a part of the fostergrandparentprogram, operate the 24-hour crisis hotline, or perform otherduties.For more information on the MarjareeMason Center or its programs, call (559)237-4706 or visit www.mmcenter.org.Valley Health Magazine l 11

Medical ClipboardCHAMPION OFFITNESSSam Shima> By Krista DossettiIt wasn’t until high school that Sam Shima wasformally introduced to the sport of gymnastics. “Iwas 15 and I picked an elective course calledco-ed gym. I had no idea what it was.” Samopened the gym doors on his first day of class tosee people jumping and flipping all over theroom. It was love at first sight. He quickly signedup for the boy’s gymnastics team. “As a sophomore,I won a couple medals and got a tastefor it.” He started winning more first placetrophies, enjoying the articles about him in thelocal paper and the words of encouragementfrom customers at the Japanese restaurant heworked at on weekends. Sam went on to becomeTeam Captain as a senior and found even atseventeen that he took naturally to teaching andhelping his younger teammates. “I had no idea afree class I took in high school would be the startof a 30-year career.”After high school, Sam knew he wanted gymnastics andfitness to continue to be a part of his life, but as he says,most kids have three options: “Compete throughoutcollege, work for money, or focus on school.” Shima chose thelatter two out of necessity, and his mother’s wish that he get adegree. “She was very intent on my finishing,” Sam recalls, and in1979 he made his parents proud by graduating from the Universityof Washington with a degree in Philosophy. Although thismajor seems an unlikely choice for a fitness enthusiast, Samexplains how studying philosophy was like finding the “yin andyang” in his life. “(In philosophy) you have to study great thinkersof the past and logic and ethics—gymnastics is very disciplinedin body and somehow philosophy is disciplined in thought.Gymnastics gave me athleticism and philosophy gave me focus.”Sam ShimaAfter college, 25 year-old Sam decided to put his new focusinto practice and moved to Los Angeles to join the gym crazesweeping California in the early ‘80s. He began by volunteeringas an instructor at the YMCA where he met movie stars and justbefore the 1984 Summer Olympic Games in Los Angeles, goldmedalist Peter Vidmar and Coach Sakamoto of the U.S. men’sgymnastics team. Sam was inspired by the meetings, but was stillsearching for a way to turn his own passion for gymnastics intogold. “In real life, you have to work of a living,” and so Sam pickedup a job as an airline steward. He decided to go back to school inOrange County as well and completed an A.A. degree in RecreationStudies.Sam had been living in Los Angeles for nearly five years beforehe got his first chance to work in recreational fitness full-time.“Even then, there were statistics on rising childhood obesityavailable,” Sam says of his work with fitness oriented companiessuch as The Discovery Zone and Kid-A-Saurus. “The idea was,they can have pizza, but they have to be active first.” Samenjoyed his work with the two companies, but ultimately becamedissatisfied with the corporate model and lack of creative opportunity.According to Sam, when Kid-A-Saurus started losingPHOTO BY: Steve Collins12 l Valley Health Magazine

Technologymoney, he was laid off. Luckily, thebirthday cake supplier felt a little sorry forSam and invited him over to bake cookiesduring the holidays. It was a set-up.Besides the instant attraction he felt forhis future wife Diana, “When I found outshe had a gymnastics background…thatwas it.” He moved to Fresno just twomonths later and the pair was married inSeptember 1995.Now, Sam and Diana have a two yearolddaughter named Danielle who Samcalls, “the darling of our lives.” He hasalso finally found his fitness niche and ispreparing for the five-year anniversary ofhis own business, Gymnastics Beat. AtGymnastics Beat, Sam offers gymnasticsclasses ranging from Mommy & Me andkids classes to competitive Pep & Cheerand adult classes. “So much in life is findingbalance and I’m a natural teacher. Iwant to be a motivator.” Sam has foundthe best way to accomplish this is by usingthe old monkey-see, monkey-do method.“If you want them to climb the rope, youhave to do it first.” And he can. Sam stillprides himself on being able to keep upwith the kids. He can flip, jump, climb andplay with the best of them. Looking backon his own life and his simple beginningsin a free gym class, Sam has become passionateabout getting the word out aboutgymnastics. “Having a basic gymnasticselementary education will help kids succeedat other sports. Every sport—look atswimmers: they do a handstand and thenflip into the water. The fundamentals comefrom gymnastics.”While many gymnasts dream of goldmedals and award ceremonies, Sam Shimahad a different dream and has carved hisown path to achieving it. “I wasn’t an NCAAchampion or an Olympic Champion. Iwasn’t even close. But I make sure kids aregetting their exercise, that they’re gettingoff the couch, and hopefully I’m givingthem confidence.” Now that is what beinga true Champion of Fitness is all about.CYBERKNIFEPROCEDUREAvailable In The Valley> Provided by Community Regional Medical CenterCYBERKNIFE STEREOTACTIC RADIOSURGICAL SYSTEM was createdby Neurosurgeon John Adler at Stanford University. Radiosurgery iscoined “surgery” because the results are similar to the precision ofsurgical outcomes in compact tumors and is a viable option for patients whohave previously had radiation or cannot withstand surgery.CyberKnife’s combination of software, robotics and X-ray technology allowsit to target just the tumor, rather than an entire section of the body. As a result,significantly large doses of “tumor-killing” radiation can be applied without theside effects of damaging innocent tissue. The treatment can be condensed to1 to 5 outpatient sessions, rather than a typical multi-week course of low-doseradiation therapy. CyberKnife represents a significant advance in radiosurgerybecause its computerized tracking system allows CyberKnife to treat tumorsthroughout the entire body rather than being limited to the brain as with earliersystems.In 2001 the CyberKnife System received FDA clearance for treatment oftumors anywhere in the body that radiation was indicated. Today, CyberKnifeis used to treat tumors, lesions and conditions including tumors in theprostate, spine, pancreas, liver, lungs, brain, acoustic neuromas, trigeminalneuralgias and other intracranial conditions. CyberKnife is available in Fresnoat Community Regional Medical Center.To date, more than 40,000 patients worldwide have been treated by theCyberKnife System. Below is a testimonial of one such patient.SAM’S STORYMY WIFE AND I WERE ENJOYING ALIFE OF RETIREMENT, WORKING INTHE YARD, KEEPING THE ROSE BUSHESBLOOMING AND TRAVELING THECOUNTRY VISITING FAMILY, WHEN WEGOT THE NEWS ABOUT MY CANCER.There has never been any record ofcancer in my family, so when my doctortold me that I might have prostate cancerafter a routine physical, my wife and Iwere interested but not worried, sinceI had not experienced any symptoms. IValley Health Magazine l 13

Technology(continued from previous page)just thought I’d visit a urologist and he’dhave better news. I learned later thatmost men with prostate cancer don’thave any warning signs.I went in and had a blood test, andmy urologist detected an elevated PSAlevel (Prostate-Specific Antigen). It wasover level eight. My doctor told me thatmen with PSA levels within that rangehave about a one-in-four chance ofhaving prostate cancer.At that point, we discussed myoptions. My doctor said that my growthmight be very slow over the years andthat I might even outlive the cancerin my prostate and we could take the“watchful waiting” approach. That’swhen you keep a close eye on the cancerwithout treating it.I didn’t want to go on worrying aboutthe growth of the cancer over the years,and thought it would be best to haveit removed and have no further worriesabout how much it was growing. So wetalked about having surgery to removemy prostate. That was when he told meabout something I had never heard ofthat sounded interesting to me. It was anew treatment called CyberKnife.My oncologist thoroughly discussedthe CyberKnife procedure and thepossible ramifications and we decidedthat it was the best treatment for me.As he explained it, a computercontrolleddevice would deliver radiationdirectly to my tumor in high doseswhere more than 100 beams of radiationwould enter my body from differentangles. Since each beam is extremelysmall, the radiation wouldn’t damagethe healthy tissue or organs it passesthrough. But where the beams intersectat the target, the does is high enoughto destroy the cancer.Best of all, it wouldn’t involveany cutting, and to our surprise wewouldn’t have to travel out of town forthis high-tech surgery; we just had todrive downtown.My doctor and the CyberKnife teamplanned my treatment and how theradiation would be delivered and I hada scan to determine the size, shape andlocation of the tumor. Then they placedspecial markers around the cancer cellsto create a target area. They showedme the markers, little gold pellets aboutthe size of a small seed, that wouldbe implanted by my doctor and couldremain in my body permanently withoutdoing any harm.My wife and I love to travel, so wewere relieved to learn that the goldmarkers are not radioactive, so I havesince been able to pass through airportsecurity with no difficultly.After we planned my treatment Iwent back for the surgery. Each sessionlasted about an hour, and I would liein a custom-made “cradle” to help meremain still. I didn’t need anesthesiaand couldn’t feel a thing. In fact, I wasso comfortable that occasionally duringtreatment I would doze off.My doctor told me that since thetreatment was non-invasive, I couldexpect to return to my normal activitiesalmost immediately, and he was right. Ifelt no immediate ill effects, nor any ofthe other lasting side affects that youhear about like incontinence, impotenceor bowel problems. After the first coupleof treatments, my wife and I enjoyedlunch together and then drove home.After the last three treatments, I drovehome myself. There was no pain ordiscomfort, and no confusion that mightmake driving difficult.The only side affect to the surgerywas that I had to make frequent trips tothe bathroom. My doctor told me that mybody needs to eliminate the dead cancercells over a period of time and that was thereason for frequent trips to the restroom.But now, instead making trips to therestroom, my wife and I are travelingthe country. We have a tour scheduled,so you can see the treatments have notslowed us too much!I am so grateful for the staff andphysicians who gave me the support andencouragement when we discussed thevarious treatment options available. Weconcurred that CyberKnife was the besttreatment and I am happy to report thatas a result of my PSA level had droppedto a level 1 and my doctors say that itmay drop even further.14 l Valley Health Magazine

SpotlightHenry Aryan, M.D.> by Krista DossettiDr. Henry Aryan was born inHuntington Beach, CA. in 1973,when orange groves (not realityTV shows) were still the signature trademarkof the area. In what he describes asa “pretty normal childhood”, Dr. Aryangrew up doing the same things anddreaming of the same future as most ofhis peers. Nintendo and surfing were big.The Internet had given birth to the firstgeneration of self-proclaimed computergeeks. Jobs in that field were still easy tocome by, and Dr. Aryan thought he justmight get one. As a high-hurdle trackstandout in high school, Dr. Aryan wasable to attend UCLA on scholarship, andcould feasibly today be tinkering withmicrochips and blue screens. Luckily,he isn’t.After majoring in Cybernetics, a fieldof study that exposed him to business,computer systems, biology and neurology,Dr. Aryan describes the decision to goto medical school as something of amisnomer. “I knew it would be long, andthat didn’t scare me. I knew it wouldbe difficult, and that didn’t scare me. Idon’t know…there was no one moment.”Instead, his passion for medicine, andsurgery and the spine specifically, seemsto have developed over time. Besides,“The economy had down-turned,” and hisprospects to work in computer sciencesand engineering weren’t as abundant asthey had been when he began college;staying in school didn’t seem like such abad idea. He applied and was acceptedto the University of California Irvine MedicalSchool.IT WAS IN SAN FRANCISCO, WHILETREATING PATIENTS, THAT DR.ARYAN NOTICED A LARGE NUM-BER OF HIS PATIENTS WERE TRAV-ELING FROM FRESNO TO SANFRANCISCO TO RECEIVE TREAT-MENT. “AS A DOCTOR, FINDING APLACE TO PRACTICE WHERE YOUCAN FILL A NEED…IT’S A PERFECTMATCH.”He then moved to Northern Californiawith his wife, Hala. Dr. Aryan says she hassupported him 100%, all the way, evenwhen he came home one day afterdeciding on surgery (neurosurgery inparticular) and told her how much moreschooling would be necessary. As aUCLA graduate herself, and professionaljournalist, Hala and Dr. Aryan moved fromIrvine to San Diego where he completedhis residency at the University of CaliforniaSan Diego Medical School, and finallyto San Francisco, where Dr. Aryan finisheda combined fellowship in surgical andnon-surgical treatment of complex spinaldisorders in the Departments of Neurosurgery& Orthopaedics at the Universityof California San Francisco.It was in San Francisco, while treatingpatients, that Dr. Aryan noticed a largenumber of his patients were travelingfrom Fresno to San Francisco to receivetreatment. “As a doctor, finding a placeto practice where you can fill a need…it’sa perfect match.” So, after taking about ayear to plan their move to Fresno, Dr.Aryan and Hala hit the road again. Thistime, however, they were fortunatelytraveling a bit heavier, with their twochildren, Aya (now 4) and Laith (now 2) intow.Although he had been recruited andbegan work at Saint Agnes, within justa few months Dr. Aryan decided tojoin Sierra Pacific Orthopaedic Center(SPOC) and build his own private practice.Following his instinct in San Francisco, thatthere was a real need for his specialty ofneuro-spinal surgery in Fresno, his practicewas full in just a few months. And hisfamily had adjusted well to life in theValley, too. “All of the most importantthings are here. My family comes first, andI think there are really good schools here.It’s great for the children.”Aside from his private practice, Dr.Aryan travels once a year to Central andSouth America as part of InternationalNeurosurgery Children’s Association(INCA), of which he is a founding member.He is also the author of numerousresearch articles, maintains an academicappointment and surgery privileges atUCSF, and has co-authored two books,including 100 Questions & Answersabout Spine Disorders. He is currentlycompleting a book on Spinal Oncologywith the help of Hala, his willing editor.When asked how he maintains balance inhis life, a difficult accomplishment for anydoctor, Dr. Aryan simply says, “My familyis my hobby. And because my parentsweren’t doctors, I use them to keep me incheck. To remind me of how it shouldbe.” If your passionate about what youdo though, he adds, “it [balance] is thehardest thing to accomplish.”Valley Health Magazine l 15

“Are you sufferingfrom sexualdysfunction?”WILLIAM SCHIFF, M.D.A special message to men & womenWe Can Help!Sexual Dysfunction in men and women can take several formsand oftentimes not be the most obvious. It can dramatically impacta person’s quality of life in many ways including that with theirpartner. What is important to know is that there are now a myriadof treatment options available to both men, women and couplesthat can help restore their self confidence, well being and overallenjoyment of life and relationships.We at Urology Associates are dedicated to providing individualsand couples with the latest knowledge and technology to helpidentify the root causes of their sexual dysfunction and thenprovide effective treatment in a caring, understanding andsupportive environment.Urology Associatesof central california7014 N. Whitney Ave.Fresno, CA 93720559.321.2800www.urologyassociates.netResolution of this problem canonly start after you callUrology Associates to set anappointment for an evaluationPlease call us today at (559)321-2800

Down Syndrome:Living • Growing • LearningBy Michael J. Allshouse, D.O., F.A.C.S., F.A.A.P.Photo by: Michael L’Heureux

Down SyndromeThey are sleeping peacefully an extra copy of chromosome number 21now but the disarray of the in the cells that make up individuals withsheets and blankets on their this syndrome. Since that time much hasbeds is recent evidence of nocturnal been learned about the genetics of DS.We now know that most folks with DS havemayhem and motion. Perhaps theyan extra chromosome 21 in all cells of theirwere dreaming of swimming, baseballor breaking barriers.bodies, called trisomy 21. In about 2 to 4%only some of the cells have an extra 21.They will be up soon – pursuing those This type is known as mosaic trisomy 21. Aendeavors with great passion and energy. small number of people with DS have anThe breathing is quiet and unlabored extra part of the 21st chromosome thatthrough those cute little noses. When gets stuck on another one. This is calledclosed in sleep, the slightly slanted eyes translocation. The extra set of the hundredsof genes that live on chromosomelook normal, just like everything else.My wife says God gives them the special 21 results in the changes in the structure,look they have when awake so that when function and appearance of people withthey are around you can anticipate somethingdifferent may happen. Many times Down Syndrome is one of the mostDown Syndrome.that is true.common genetic disorders in humans. ItWHAT IS DOWN SYNDROME?occurs in about one out of every 800 toIn 1866 an English physician, John 1000 babies born in the US. It is seen in allLangdon Down, described the syndrome ethnic, social and economic groups. Therethat bears his name, Down Syndrome (DS). is an increased risk of having a baby withIt was almost a hundred years later that DS when the mother is older but overall,Jerome Lejeune, a French physician, first 80% of babies with DS are born to womendiscovered that the cause of DS is due to who are less than 35 years old. RecentKaryotype from a female with Down syndrome (47, XX, +21)1 2 3 4 56 7 8 9 10 11 1213 14 15 16 17 1819 20 21 22 Xgenetic evidence indicates that increasedpaternal age (- > 42 years old) may also bea risk factor. It is estimated that 88% of theextra chromosome 21 comes from themother, 8% from the father and the restmay be due to a defective chromosomeseparation after fertilization occurs. Ingeneral, the probability of recurrence ofDS for a couple with normal chromosomesis thought to be about 1%.SCREENING FOR DOWN SYNDROMEThere are several methods to screenfor DS. Many pregnant mothers havescreening blood tests, often known asa triple screen. Definitive testing ofteninvolves more invasive tests such assampling amniotic fluid, umbilical cordblood or part of the developing placentalunit to confirm the diagnosis. There arenewer methods to make the diagnosisfrom mother’s blood that will be readilyavailable in the future. High resolutionultrasound examinations can also giveclues to the diagnosis and may givepreliminary information about other congenitalanomalies that are associated withDS such as heart disease and intestinalobstructions. In some situations, the prenatalknowledge of the diagnosis can helpthe families learn more about DS and helpprepare for the new baby and any specialmedical and social needs. During childhood,ongoing screening for recognizedhealthcare problems is important. Thereare published health care guidelines forthe care of people with DS that areroutinely updated to maintain the mostcurrent and helpful recommendations forhealthcare providers. Accordingly, moreand more folks with DS are living long andproductive lives.DIAGNOSING DOWN SYNDROMEIn the time immediately after delivery,health care providers may suspect thediagnosis of DS based on some typicalphysical features. These include a flattenedfacial profile, upward slant to the eyes,short neck, low set or abnormal ear shape,whitish spots on the iris of the baby’s eyes(Brushfield spots), a single transversecrease of the palm of the hand, short,curved little fingers, and a widened spacebetween the first two toes. Sometimes18 l Valley Health Magazine

One of the most valuableaffirmations to new parentsof a baby with DS is to lovethat child like any other.the changes in a baby’s appearance fromthe birth process may make interpretationdifficult. To truly confirm the diagnosis atest of the baby’s chromosomes (a karyotype)must be done. This is usually accomplishedwith a blood test. The discovery ofthe diagnosis of DS can have profoundeffects on a family. This is especially truewhen the diagnosis was not expected orconfirmed by prenatal testing. Parents andother family members may experiencestrong emotions such as sadness, disappointment,anxiety and fear of the future.These types of feelings and reactions areunderstandable and normal. The mannerin which this information is presentedto families is vital to the process of acceptanceand adjustment to this new life andfamily adventure. Education of healthcareprofessionals and the assistance ofsupport groups like the Fresno Area DownSyndrome Society (FADSS) can be invaluableto the families with new babies whohave DS. While there are some importantmedical and surgical conditions associatedwith DS that must be investigated, newbornswith DS are babies first, who justhappen to have DS. One of the most valuableaffirmations to new parents of a babywith DS is to love that child like any other.ASSOCIATED MEDICAL DISORDERSDuring the first days of neonatal life,children with DS require screening forseveral associated disorders. This listincludes an ultrasound test of the heart(echocardiogram) to rule out congenitalheart disease, which affects 50% ofthese babies. Early screening for bloodand thyroid disorders is also essential.Screening is also done annually for blooddisorders and thyroid hormone levels.Some babies with DS have congenitalblockages of their digestive tract thatrequire immediate surgery. The mostcommon are known as esophageal orduodenal atresia and imperforate anus.An atresia is a physical blockage in thebaby’s digestive tract that prevents themfrom swallowing or digesting food. Imperforateanus is an anorectal malformation –quite simply, these babies have no openingto pass their bowel movements. Babieswith DS who do not have appropriateearly bowel movements may need tobe screened for a condition known asHirschsprung’s disease. Hirschsprung’s diseaseoccurs at a higher rate in babies withDown Syndrome compared to the generalpopulation. There is an absence of importantnerve cells in the rectum of babieswith Hirschsprung’s disease that preventsthe intestine from relaxing to pass thewaste material that is a bowel movement.It must be treated surgically and can belife threatening if complications arise.Screening exams for hearing and eyefunction are also crucial to the discoveryand correction of problems in these areas.IMMUNE FUNCTIONRoutine well-baby examinations andscreenings are important. Infants and childrenwith DS have some problems withtheir immune systems that make themprone to infections such as pneumoniaand ear infections. Ear infections are a bigdeal in babies with DS and require thecare of an Ear, Nose and Throat doctorearly to prevent hearing loss problemsValley Health Magazine l 19

Down Syndromedue to recurrent ear infections. Infants withDS appear to be more prone to sometypes of seizure disorders, especially infantilespasms, which may need treatment.Aside from an increased risk of childhoodleukemia, it has been clearly and scientificallyobserved that people with DS rarelyever get other types of cancer.MOBILITY & MOTOR FUNCTIONNewborns with DS have low muscletone known as “hypotonia”. This may impactthe oral motor skills that are neededfor breast or bottle-feeding. Assistance ofan infant feeding support specialist maybe helpful. Delayed achievement of somedevelopmental milestones is expected.Children with DS may not walk independentlyuntil age two or more. They maydisplay delayed fine motor skills such ashand and finger coordination.NUTRITION & EXERCISEGood nutrition and eating habits areimportant to develop at this time. Childrenand adults with DS have slow metabolicfunction and may be less inclined to exerciseregularly so, watching diet and caloricintake is essential to avoid obesity. It isrecommended to try and avoid the use offood as a behavior modifier, to reward orplacate. Involvement in exercise and sportingactivities is encouraged. Children withDS are not especially prone to athleticinjuries but there is a clear associationof DS with abnormalities of the uppercervical spine, known as Atlanto-axialinstability. Special x-ray studies are necessaryto diagnose this problem. These arerequired by Special Olympics for DSathletes to compete in certain events thatare considered high-risk. Constipation andacid reflux disease are frequently observedin children with DS and may require treatmentwith both diet and medication. Acondition known as Celiac disease hasalso been seen with increased frequency.This involves a reaction to a protein knownas gluten, which is in many products madefrom wheat. Current recommendations areto screen all young children for this problem.EAR, NOSE & THROATAlong with recurrent ear and upperrespiratory tract infections, children withDS have a significant risk for enlargementFRESNO AREADown Syndrome SocietyLocal/National Resource ListFresno AreaDown Syndrome Society4420 N. First StreetSuite 106Fresno, CA 93726(559) 228-0411www.fadss.netCentral ValleyRegional Center4615 N. MartyFresno, CA 93722-4186Fresno (559) 276-4300Merced (209) 723-4245Visalia (559) 738-2200www.cvrc.orgNationalDown Syndrome Society666 BroadwayNew York, NY 10012(800) 221-4602www.ndss.orgNational Associationof Down Syndrome(630) 325-9112www.nads.orgNationalDown Syndrome Congress(800) 233-6372www.ndsccenter.orgHealth Care Websitewww.ds-health.comChildren’s HospitalCentral California(559) 353-3000www.childrenscentralcal.orgBreak The Barriers8555 N. Cedar Ave.Fresno, CA 93720(559) 432-6292www.breakthebarriers.orgof the tonsils and adenoids. This may contributeto another potentially significantproblem known as obstructive sleep apnea.Airway obstruction and labored breathingduring sleep may cause severe disturbancesin behavior at home or school and shouldbe investigated. Special sleep studies mayneed to be done to assess this problem.MENTAL FUNCTIONPeople with DS are often classifiedas having moderate mental retardation.There is a wide range of severity of theintellectual disability in folks with DS.Clearly, they can benefit from earlyintervention programs to optimize theirindividual development. Behavior problemsmay arise in early childhood. If problemsare suspected, parents in partnership withtheir pediatrician may need to seek specialistevaluation and advice. Children withDS have the risk of an associated diagnosisof autism or autistic spectrum disorder.This may require special early interventionand school strategies to provide the childwith the best opportunity to succeed inschool and future life. Toilet training isoften delayed in these youngsters butcan almost always be achieved in time.Children with DS have different learningcapabilities. It is known that short-termmemory is deficient but patterns of behaviorcan clearly be established and childrenwith DS can learn to read and write. Manylater do well in secondary education andmay even learn to drive automobiles.COMMUNICATIONPeople with DS have a wide range oftalents and capabilities. One of the thingsthat often set a person with DS apart fromtypical peers is communication. There isoften disparity between what children withDS understand and what they can expressvia conventional methods of speech communication.They have delayed fine motordevelopment and speech acquisition.Because of the speech and communicationgap, hearing and vision preservation areessential. Because of delays in speakingskills or articulation, augmentative andalternative communication methods areoften very helpful. Children with DS canlearn sign language for instance. With thisconcept of “total communication” they20 l Valley Health Magazine

Down Syndromecan often get their message across beforethey can say it in sentences. Much like aparent works to help their child speak byrepetition, it is important for parents to bediligent with sign language and includethem in conversations beyond assessingsimple wants and needs.GROWING WITH DOWN SYNDROMEEarly in life the differences between infantsand young children with and withoutDS may be less notable. Over time, theintellectual, social and emotional gap maywiden. During adolescence, a person withDS may need different focus on educationalobjectives that are tailored to thatyoung person’s capabilities. Many youngadults with DS will learn and develop lifeskills that can allow them to live independentlyhowever, not every person with DSwill have that degree of development orthe intellectual capability to be independent.Educational and community programsmust recognize that sometimes“interdependent” living is a more realisticgoal for a person with DS. It is important forthese young people to have appropriateinformation and guidelines regarding lifeskills, personal hygiene and human sexuality.There are resources available to help inthese areas. Continued emphasis on gooddietary choices and exercise is important asis routine health care screening.Transitions can be very difficult foryoung adults with DS. It is not unusual foryoungsters and adults with DS to developvery structured and often inflexible patternsof behavior—from diet to the waythey dress. Change can be disproportionatelydisruptive and cause profoundbehavior disturbances. There is increasingrecognition of problems with depression,obsessive-compulsive disorders and avariety of other mood related disturbancesin adults with DS. Many can be treatedwith medication and lifestyle alterations.There is an observed association of DSwith early onset Alzheimer’s disease. Infact, ongoing studies are looking at usingmedications developed for Alzheimer’sdementia to treat patients with DS.GETTING HELPThe development of a support systemcan seem like a daunting task to new par-ents. Learning what services are availableto assist families with members who haveDown Syndrome is an important part ofthis process. Fortunately, our communityhas a wealth of services that can pointparents in the right direction to get thehelp they need for their family members.A great place to start is to find a goodfamily pediatrician who is familiar withthe health care guidelines for infants andchildren with Down Syndrome. Thereare also pediatric subspecialists to helpwith specific health needs. Programs suchas the Central Valley Regional Center andlocal early intervention programs can begreat starting points for services until thechild transitions to their school district.The Fresno Area Down Syndrome Society(FADSS) was founded to support thefamilies of the Fresno and Central Valleyarea whose lives are touched by DownSyndrome. FADSS provides parent andindividual support as well as educationalopportunities to learn about the spectrumof life with Down Syndrome. FADSSmaintains active ties with national organizationsto keep current and robust inthe support of our local families andfriends.REMARKABLE RESULTSSeveral decades ago it was conventionalwisdom to institutionalize babiesborn with DS and to not bring them intothe family fold, lest they destroy the fabricof the family. We now have a much clearerpicture of the remarkable potential ofpeople with DS and how much they mayenrich the lives of families and friendswho they encounter. Many children withDS are enrolled in a more inclusive schoolenvironment with success and with profoundimpact on the “typical” childrenthey rub elbows with at school. Manyacquire meaningful jobs and contribute tosociety in positive ways. The path to theirdevelopment and the end result are notalways ideal or predictable. It is, however,a path worth taking because the end resultis often quite delightful and the trip iscertainly anything but boring or routine.Sara, Ryan & Charlie AllshouseThree’s a Charm:Mike & Denise’s StoryNumerology is the study of numbers.Numerologists often try to discern patternsof significance or destiny in those numbersin relation to human existence. Commonfolk often place value or find meaning incertain numbers. Some of them are drivenby a sense of superstition or by what canbe called kismet, fate or destiny. One ofthe numbers that appears in a recurringrole of importance or significance is thenumber three. When we are ready to startsomething, it is often “one- two- three andGO!” There were Three Musketeers. Threecan be either company or a crowd. Somethings are three dimensional. Really goodteams “three-peat” and Three Dog Nightand Three Doors Down are pretty goodbands. Some pretty good sandwiches aretriple-deckers—buses too. And to top it alloff, there is the Holy Trinity.So, you might reasonably ask, whatdoes the number three have to do withthis story? An excellent question indeed…let’s take a closer look. Our family hastwo parents, five children and two dogs.Add all of those numbers up and divideby three. What do you get? Why, thenumber three of course. It also turns outthat the three youngest children in ourfamily - Charlie, Ryan and Sara – happento have Down Syndrome. Down SyndromeValley Health Magazine l 21

Down Syndromeis a common genetic condition that occurswhen a person has three copies of the 21 stchromosome in the cells that make up allparts of their bodies. The presence of extra21 st chromosome material results in somecharacteristics that define Down Syndrome.This includes levels of developmentaldelay and a variety of other traits that makepeople with Down Syndrome differentfrom those with normal chromosomes.This means that sometimes the Allshouseresidence is a three-ring circus.When our son, Charlie Allshouse wasconceived we already had two children –Tony and Victoria. It was actually discoveredthat Charlie had Down Syndrome on theresults of an amniocentesis test. The resultswere a big surprise to everyone involvedand it took some time to adjust to suchfamily-defining news – especially becauseeveryone predicted the test would be“normal.” There were tears and periodsof sadness that quickly became replacedby the quest to find out more about thisSyndrome and to prepare for Charlie’sarrival. By the time Charlie decided to enterthe outside world, our family was readyand waiting. Of course, Charlie decidedthat he had to be born by emergencyCaesarian section – one month early andwhile his Dad was driving from Fresno toSan Diego. OUCH! Charlie turned outto be pretty healthy at first but he wasn’tnearly as good of an eater as he is now.His Mom worried about feeding him, andtogether we were already worrying aboutwho would take care of him in the futurewhen we were no longer around. But welearned something important very early.Babies with Down Syndrome are verymuch like other babies. They need food,love, clean diapers and patience. Charliealso had a clubfoot and some other minorproblems but he looked pretty darngood overall. Our family became involvedwith the local Down Syndrome supportgroup and met many people whose liveshad been touched by Down Syndrome.We began to learn quite a lot about thiscondition. Charlie’s big brother and sisterwere very fond of Charlie but they knewthat he was different and required someextra time for certain things. As parents,we had to make special efforts to balancethe time and the love. Things were notalways easy and there were times ofsadness. Gradually, the sad days startedto fade and were outnumbered by far bygood ones. Our family continued to helpwith the local DS support group and assistother parents entering this strange newworld of parenthood and family dynamic.That is how Ryan Allshouse came to joinour clan.Ryan came to our family via adoption.He also came with red-orange hair,an indomitable spirit and a large holebetween the chambers of his heart.He was sickly at first – mainly due to hisheart condition. This was repaired by thecardiac team at Valley Children’s Hospitalin 1997. The last time we checked, he hasnot stopped since. Ryan’s genetic/ethnicheritage was of Irish ancestry via Australiangeographic relocation. His grandmotherlabeled Ryan as her “Irish Mixmaster”after several attempts at babysitting. Thatis probably a misnomer because there israrely ever “sitting” involved when Ryanis awake. We all felt that Ryan would be agrand addition to our family and a lifelongbrother/companion for Charlie. You’ll haveto ask Charlie what he thinks but Ryan hasbeen a wonderful addition and he is lovedby many people, and occasionally by hisolder sister Victoria.Sara was born less than a year afterRyan. She was several weeks early and hada blockage in her intestines that requiredurgent surgery as a newborn. Sara wasalso adopted into our family. The boy: girlratio was a bit skewed and Sara neededa home. Sara is spry, athletic and petite.She is all girl. She loves to dress up, wearsparkly items and fancy shoes. She andRyan are inseparable at home. She lovesfruit, making tea parties and supersonic jetaircraft and rocket ships.These are immediate impact children.They may tax us from time to time but theyalso excel at inspiration. Their big brotherTony was the Soroptomist award winnerin sixth grade; given to the youngsterwith the most humanitarian spirit. He alsocoaches developmentally delayed youngpeople in basketball and baseball. Victoriawonders if she will ever want to havechildren. She has seen the risks of doingso and, at least temporarily, prefers dogs.Denise Allshouse was inspired enough tofound the Fresno Area Down SyndromeSociety and get involved with Breakthe Barriers. She is involved with DownSyndrome support groups on a nationalThey all love music, French fries and, most ofthe time, life in general.They are great kids andwe love them like crazy.level. Mike Allshouse is a pediatric surgeonand member of the Down SyndromeMedical Interest Group. Denise and Mikehave a reputation for being very good withfamilies who have members with DownSyndrome – especially new families withnew babies. We have had really exceptionalprofessors. We just told you about them.These three children all have DownSyndrome but they are truly all quitedifferent in spite of being raised in thesame household. Charlie also has anautistic spectrum disorder that affects hisspeech and communication skills as wellas his patterns of life. Ryan is very smartand does well in school. He can read, addnumbers and write his name and manywords. The boys love to swim – even inthe dead of winter. Sara loves gymnasticsand dancing. They all love music, frenchfries and, most of the time, life in general.They are great kids and we love them likecrazy. Oh, by the way, when they start todo something wrong – and we catch them– we warn them by telling them to stopand then we count to three. They HATE itif we get to three!22 l Valley Health Magazine

Life After Breast Cancer:lymphatictherapyBy Julie Cash, C.L.T.As a patient you’ve been diagnosedwith “Cancer”. Your breasthas been cut into or removedby a skilled surgeon. You’ve had an exhaustingamount of doctor appointmentsand more than likely sat for hours connectedto a beeping machine that’spumping a life saving cocktail into yourveins. You’ve received free tattoos fromyour radiation oncologist and a lovelytan on one of your breasts (or chest wall).You’re finally ready to be released into“The World After Cancer Treatment.”You attempt to get on with your lifewhen suddenly your body doesn’t feellike the body you had before cancer.You’re fatigued and your chest ornew breast feels tight and pulls whenyou lift your arm over you head. Yourincisions from surgery feel tight. Yourarm used for chemotherapy hurts andhas no strength, and your other arm isbigger than your chemotherapy arm soyou’re afraid to use it.Any of the above sound familiar?These are common problems faced byindividuals recovering from breast cancertreatment. If you are experiencing oneor even a few of these symptoms, yourquality of life can be significantly diminishedcausing functional impairment,emotional and social repression anddifficulty in home and work environments.Post-Surgical ComplicationsAxillary Web SyndromePain coming from your underarm toyour elbow when lifting your arm overyour head causing limited range ofmotion may be Axillary Web Syndrome(AWS). Some patients describe it asfeeling like they have a guitar stringunder their arm. It is associated with theweb of tissue extending from the axilla(armpit) into the arm and sometimesinto the elbow and thumb. According tothe Department of Surgery Bio-Clinicalbreast care program at the Universityof Washington, more research is beingdone to see if there is a connectionbetween AWS and lymph nodes thathave been removed under the armduring surgery. This is performed todetermine the extent and progressionof the cancer. It helps the medical teamdecide which types of post-surgicaltreatment to recommend.Tissue Fibrosis & LymphedemaThe tightness in your chest wall or theaffected breast being larger and perkierthan the other may be due to Tissue Fibrosisfrom radiation. The changes that occurfrom radiation sometimes result in hardand leathery tissue, tightness across thechest or breast, or chest wall edema orlymphedema (accumulation of fluid in thelymph vessels). It is not uncommon toexperience edema in the armpit, aroundthe scapular region, along the chest wallor around and including a reconstructedbreast or implant. This usually causes painand discomfort. Indentations from the brawill be seen on an edematous breast.Tissue Fibrosis from radiation can alsocause constriction of fascia in the chestwall, causing the affected shoulder to pullforward limiting range of motion andproper posture in the shoulders. Therealso may be discolored areas of the skinValley Health Magazine l 23

ComplementaryAxillary webbing under armExample of lymphedemaafter radiation. These symptoms can bemanaged successfully with therapeuticintervention.Thanks to the sentinel node biopsy,we have seen a reduction but not an eliminationof lymphedema. In this procedure,a dye is injected into the affected breast.The dye is followed to the first node thatpicks it up. The sentinel node is the firstnode to be removed. If it is negative,usually there is no further dissection. Ifthe sentinel node is positive, additionalnodes will be removed causing greaterrisk for the onset of lymphedema. Insome people the swelling starts immediatelyafter surgery or radiation. Forothers it may not appear until many yearslater, or not at all. Not everyone who undergoessurgical removal of lymph nodesor radiation develops lymphedema. Thelymphatic system varies from person toperson. If lymphedema is left untreatedor ignored it can result in serious conditionssuch as Lymphangitis or Cellulitis. Ifthe swelling is significant enough, it can’tbe hidden. In fact, a swollen arm is farmore visible than the loss of a breast. Thedebate about the percentage of womenwho develop lymphedema continues, butno matter what the statistics say, if youhave lymphedema you need treatment.Band ExerciseLYPHEDEMA GLOSSARYAxillary Web Syndrome: A visible webof axillary skin overlying a palpablecord of tissue that is made taut andpainful by shoulder abduction or flexion.Tissue Fibrosis: A normal healingprocess that hardens tissue due toradiation interrupting the normal flowof the lymphatic system.Sclerosed Veins: Hardening of the VeinsLymphedema: Accumulation of lymphaticfluid causing swelling due to the dissectionor radiation of lymph nodes. Animpaired lymphatic system can also occurfrom injury, infection and genetic makeup.Lymphangitis: A bacterial infection ofthe lymphatic system often recognizedby faint or distinct red lines.Cellulitis: An acute infection of the skinor subcutaneous fatty tissue that tendsto reoccur.LANA: Lymphology Association ofNorth AmericaAxilla: The region under your armScapular Region: Shoulder bladeFascia: Connective tissue that extendsfrom head to toe. It is responsible formaintaining structural integrity.TreatmentStretching exercises are a major factorin overcoming Axillary Web Syndrome.Soft tissue mobilization (STM) and myofacialrelease (MFR), a touch therapy techniqueto eliminate pain and restore motion,will be performed. You can expect treatmentto begin at the distal (lowest) end ofthe axillary web (AW) cord of the affectedarm and move toward the axilla (underarm)as the cord releases. AW cordingcan also be visible in the chest wall andin the trunk region. However, it is muchmore difficult to locate in this area ofthe body, so communication to yourCertified Lymphatic Therapist (CLT) aboutsymptoms you may be feeling is veryimportant.The treatment for Tissue Fibrosis isalso MFR, although in this case, treatmentwill be administered to the chestwall or breast. Fascia (connective tissue)is one structure that exists from head tofoot without interruption. Fascia alsoplays an important role in the supportof our bodies since it surrounds andattaches to all structures. When weexperience physical trauma or scarringfrom surgery or radiation, the fasciabecomes tight and restricted. MyofacialRelease releases the fascia.24 l Valley Health Magazine

Treatment for lymphedema is “ComplexDecongestive Therapy” (CDT). Thistherapy usually includes:Education- Gaining an understandingof the anatomy and physiology of thelymphatic system and precautions forlymphedema.Instruction in self-massage techniques-Developing a home exercise programto move lymph fluids from the congestedarea.Manual lymphatic drainage (MLD)- Thisis a skin technique, not to be confusedwith massage, which is the manipulationof the soft tissue. With MLD, the pressureis very light, (about the weight of aquarter) allowing careful stretching andtwisting hand movements to move fluidcollected under the skin and to stimulatethe pumping action of the lymph vessels.Compression Bandaging- Compressionbandages apply external pressure to aswollen arm or leg. When swelling ispresent, as with lymphedema, the tissueloses some of its elasticity and doesnot return to its original position andshape even when the fluid decreases.The bandages support the skin and itsunderlying vessels.Some symptoms your bodymay be giving you if you areexperiencing lymphedema are:Thickness or heavy feeling in the upperarm of your affected side.A dull ache in the back of your shoulder.A feeling of fullness or pressure in youraffected arm.The sensation of swelling, which canoften be present even before swellingcan be seen.Any increase in size of your affectedarm or hand.Pitting: if you press the skin and hold it,the skin does not bounce back, formingan indentation.Long term accumulation of lymph fluid(lymphedema) eventually results in thickand hardened tissue (fibrosis), whichcreates further resistance when drainingthe fluid, from the limb (arm or leg).Getting ReliefSo, you are probably asking yourselfwhere you can go to get all these postbreast cancer complications treated soyou can have a better quality of life?Glad you asked! You go to a CertifiedLymphatic Therapist (CLT). The key wordis “certified.” These therapists are completelydifferent from physical therapistsor massage therapists in a spa setting.Massage therapists that offer manuallymphatic drainage may have taken onlya weekend course, and been given acertificate of completion, allowing themto perform manual lymphatic drainageon customers who request it. Physicaltherapists are provided little knowledgeof the lymphatic system in school andmaybe some instruction in manual lymphaticdrainage. In no uncertain circumstancesshould these therapists be treatinga patient for lymphedema or any ofthe complications mentioned above.A CLT has been through a 135 to 160hour intense course covering the anatomyand physiology of the lymphatic system,manual lymphatic drainage, bandagingtechniques, and precautions and contraindicationsto receive this certification.We are very fortunate in Fresno to havesix Certified Lymphatic Therapists. Fiveof the six have achieved the LANA certification.This is a national certificationexam exclusively for lymphatic therapiststo test the knowledge considered fundamentalin the treatment of lymphedema.There are only seventy-four LANA certifiedtherapists in the state of Californiaand we have five of them right herein Fresno. LANA Certified LymphaticTherapists are required to be re-certifiedevery six years. Your CLT will adapt treatmentaccording to your symptoms andgoals in order to restore your function tothe maximum level.Oh, and one more bit of news: Insurancewill pay for your treatment as longas you have a written referral from yourdoctor. So, what are you waiting for?Call the office of your Surgeon orOncologist for a referral to a CertifiedLymphatic Therapist and get back toliving life again.ComplementaryBren’sSTORYMy husband of eleven years,Ron, and our children Milan (8) andCameron (4) had just returned from ourfirst trip to Disneyland. The followingday, I was enjoying a long shower, minusMickey Mouse and all the chaos travelingwith children can be. It was the 24th ofApril 2007 and Stefani Booroojian of KSEE24 had reminded me that it was “BuddyCheck Day” just before I slipped into theshower. Soon after I started my self-exam, Ifound a lump in my right breast. I don’treally remember what I felt at that moment,but I do remember thinking that I alreadyknew what it was.I called my doctor and made an appointmentfor the following Monday. She didher exam and referred me to an imagingfacility for a more thorough review. Threeweeks later, I had a mammogram andan ultrasound. During the procedures Inoticed that the technician went fromfriendly and conversational to reluctant tomeet my gaze. They asked me to returnthe following day for a biopsy. Beforethe doctor began the biopsy, I asked ifhe thought I had cancer and he repliedsimply, “yes”. But again, I already knew.Valley Health Magazine l 25

ComplementaryFollowing the biopsy, my husband droveme home but I remember nothing of thedrive. I called my sister, Lisa, and gave herthe news through tears. She asked whatshe could do and I gave her the mostunimaginable task: tell our parents thattheir youngest child has breast cancer. Iremember that my husband and I lay downon the bed and watched a movie. I justwanted to forget, for at least a couple ofhours, that I had cancer. After the movieended, I fell asleep. I later learned that mydear, sweet husband sat on our porch whileI slept, and he cried.After the biopsy was completed, thepathology report confirmed I had stage IIIbreast cancer with a 2.5 centimeter tumor.Not good news…really not good news if youdid any research on the Internet like I did.During this time, while all the tests wereperformed, we started to share the news ofmy diagnosis with family, friends, co-workersand eventually, our children. How doyou tell your children that there is somethingin your body making you sick? Andthat the “owie” they can’t see is about tochange their lives? Finally we did tell themand they were amazing. Our daughter toldme she would help take care of her brotherand me. My little boy—well, he just wantedto be sure that his little world was going tostay the same.My oncologist explained that I hadstage III breast cancer and a whole host ofother details. However, the most importantthing he said that day was that I was notgoing to die of breast cancer. And I knewthat he was telling me the truth.On June 20th 2007, I had a full mastectomy.Two weeks later, I began chemotherapy.The office staff walked me though theentire process. Following the infusion, I washanded a bag of drugs and my husbandand I were told what each and every oneof them was and how important it was totake them on a strict schedule. For the nextseveral months, driving to appointments,sitting in waiting rooms, and looking afterme would be my mother’s new full time job.And so began sixteen weeks of chemotherapy.One week on, one week off. Asexpected, my hair began to fall out. So oneevening I sat in a chair at my home andasked my husband and daughter to shavemy head. Tears came to my eyes watchingmy hair fall to the ground but I tried to hidethem. It was an opportunity to teach mydaughter to handle adversity with strengthand I was determined not to let thatopportunity pass.In November, I began radiation. I mistakenlybelieved that chemotherapy wasthe hard part and that radiation was goingto be a breeze. My skin burned, my ribsached, and I felt nauseous all the time.Radiation was the real test of my strengthand commitment to getting rid of thisdisease. I knew I could do it.Throughout the process I also madeuse of a Certified Lymphatic Therapist. Itamazed me that the treatments thatwould save my life were also accompaniedby debilitating pain that kept mefrom working, sleeping and moving theway I used to on a daily basis. My CLTworked with me after each surgery toregain range of motion and ease thepain. She understood the unique issuesthat breast cancer patients face. Andalthough the treatments were difficult attimes, I always knew she was the personwho was going to help me get back todoing all the activities I love.In early March of 2008, I returned towork part-time at KVPT. It was a difficulttransition from treatment to work. Lots ofthings had changed, but I knew that thebiggest change was in me.In June I began the reconstructionprocess. And although reconstruction comeswith its own risks and more pain, I wantedto do it. It marks the end of the treatmentphase and gets me on the road to gettingback to Bren.Some describe me as a “Cancer Survivor”,and while that it is true, I don’t like thetitle. It gives cancer too much power. I didnot just survive cancer….cancer did notsurvive Bren. But if you know me, youalways knew that.26 l Valley Health Magazine

PROSTATE CANCERScreening, Testing & TreatmentBy Jedidiah Monson, M.D.Board Certified Radiation OncologistCancer Care AssociatesMEN ARE DOERS, NOT TALKERS. WE DON’T EXPLORE OUR FEELINGS,WE BUILD THINGS. WE DON’T PROCESS PROBLEMS, WE TAKE ACTION.In the early 1970’s a book about women’s health called Our Bodies, Ourselves becamea huge bestseller. This book came to symbolize the women’s movement ofexploring and processing health-related questions. There will probably never be a man’sversion of Our Bodies, Ourselves. If there is, it won’t make the best seller list. But menhave many undisclosed health risks, and the simple fact is that every year in the UnitedStates over 200,000 men will be diagnosed with prostate cancer. Prostate cancer is themost common cancer in men (excluding skin cancers) and slightly more common than thecombined totals of lung cancer (the second most common cancer in men) or colon cancer(the third most common cancer in men). Prostate cancer will also ultimately claim the livesof 1 out of every 8 men who are diagnosed with it. So even though most men might nottypically be talkers, this is one conversation that no man should try and live without.Valley Health Magazine l 27

MenThe Prostate GlandThe prostate gland is a smooth organabout the size of a golf-ball or a largewalnut. It is located deep in the pelvisdirectly behind the bladder and in front ofthe rectum. The urethra travels through theprostate gland as it carries urine from thebladder to the penis.The main function of the prostate glandis to produce and secrete about 30% of theseminal fluid. The rest of the seminal fluidis produced by the seminal vesicles, 2smaller organs attached to the top of theprostate. Together with spermatozoa, theseminal fluid constitutes semen. In additionto glandular tissue, the prostate alsocontains a significant amount of musclethat is responsible for intense contractionsof the prostate during ejaculation.Benign Prostatic HyperplasiaAs men grow older, our prostate glandsoften enlarge, a condition known asbenign prostatic hyperplasia or BPH. InBPH, the enlarging prostate compressesthe urethra making urination progressivelymore difficult. As a result, men with BPHare only able to void small amounts ofurine at a time requiring frequent trips torestroom throughout the day and night.The International Prostate SymptomScore (or IPSS) is a widely used questionnaireto screen and diagnose BPH. TheIPSS was designed for men to answer ontheir own based on their assessment ofany symptoms they be experiencing. TheIPSS test is very straightforward and easyto answer. Men are asked to assign anumerical value to symptoms they maybe experiencing from 0 (no symptoms) to 5(almost always). Based on a man’s totalscore he can then assess whether he ismildly symptomatic, moderately symptomaticor severely symptomatic for BPH. TheIPSS consists of only 8 simple questionsand can be completed in a matter ofminutes.BPH does not appear to be directlyrelated to prostate cancer and the overwhelmingmajority of men with BPHneither have prostate cancer nor will theyever get prostate cancer. However, BPHcan occur in conjunction with prostatecancer and more importantly, prostateThe good news about prostatecancer is that there areoutstanding ways for mento find out if they have prostatecancer. And as with anycancer, the earlier you findit, the greater the chanceyou have of being cured.cancer can present itself with many of thesame symptoms as BPH. If you are havingBPH symptoms, you should inform yourdoctor. There are a lot of life-improvingtreatment options available ranging fromdietary modification and medications tosurgery.Clinical Risk for Prostate Cancer & RiskGroupsWe have all heard about how smokingcauses lung cancer and that the HPV virusis related to cervical cancer. Unfortunately,the question, “What causes prostatecancer?” is largely unanswered. Althoughtobacco and alcohol use cause otherhealth problems, they do not appear to bedirectly related to prostate cancer. The roleof diet and exercise in prostate cancer isalso controversial. There are, however,some important associations. Age is themost important risk factor for prostatecancer. Prostate cancer rarely occursbefore a man turns 40. Once a man turns50, however, his likelihood for developingprostate cancer begins to accelerate,reaching a peak in his early 70s. Race isalso an important risk factor. African Americanmen, worldwide, are more likely todevelop prostate cancer than others. Theyare also more likely to develop prostatecancer at a younger age and to have moreserious and aggressive forms of prostatecancer. Family history has also been identifiedas a strong risk factor. A man whosebrother or father developed prostatecancer (especially if in his 50s) is at amuch higher risk for developing prostatecancer himself.ScreeningThe good news about prostate canceris that there are outstanding ways for mento find out if they have prostate cancer.And as with any cancer, the earlier youfind it, the greater the chance you have ofbeing cured.Prostate Specific AntigenProstate Specific Antigen or PSA is one ofthe greatest discoveries in cancer medicine.As the name implies, PSA is a naturallyoccurprotein produced by a man’s prostategland. Your PSA level is checked with asimple blood test and should be ordered byyour doctor at least once a year beginning28 l Valley Health Magazine

Menat age 50 (age 40 for men with a familyhistory of prostate cancer).Unfortunately, the PSA blood testis not 100% foolproof. Some men withnormal PSA levels (even as low as

Menoffered prostate cancer treatment guidelinesbased on a man’s risk group status.Expectant Management: This refers to astrategy of following a man with prostatecancer with regular PSA checks every 3months and DRE every 6 months. Noimmediate medical, surgical or radiationtherapy is administered. If a man iselderly or in poor health, with an overalllife expectancy of less than 5 years and ifhis prostate cancer is low risk, then acourse of expectant management maybe reasonable.The logic for expectant managementis that a man with a short-term life expectancyand with low risk cancer has a minimallikelihood of his prostate cancer killinghim in the next 5 years. However, if duringhis follow-up exams, the patient’s PSArises or his DRE becomes markedly abnormal,treatment may then be necessary.Radiation Therapy: Radiation therapy isthe medicine of using ionizing radiationtreatments to kill cancer cells. There are2 different kinds of radiation therapy:External-Beam Radiation Therapy (EBRT)and Brachytherapy (BT). Depending onthe clinical situation, a patient may berecommended for treatment with EBRT,BT or a combination of EBRT + BT.EBRT utilizes high-energy radiationwaves produced in a linear accelerator.The patient would be placed on a treatmenttable and the radiation beam directedto his prostate gland. The treatments aretypically given 5 days/week for about 7-8weeks. Although the beam is directed primarilyto the prostate, the area treatedcan, if appropriate, be enlarged to alsotreat the seminal vesicles, or cancer cellsjust outside of the prostate gland andsometimes even to the lymph nodes in thepelvis. The majority of men who are treatedwith radiation therapy for prostate cancerare treated with EBRT.BT involves the permanent placementof radioactive seeds or pellets into theprostate gland. Typically, BT is directedexclusively to the prostate gland only,without coverage of either the seminalvesicles or the pelvic lymph nodes. BTcan sometimes be performed as the onlytreatment necessary, sometimes a smallerdose of BT is recommended to complementa course of EBRT.Surgery: The surgery for prostate cancer iscalled a radical prostatectomy. During thisprocedure the prostate gland is removedtogether with the seminal vesicles. Theurethra is cut (remember the urethratravels from the bladder, through theprostate gland and then into the penis)and then reconnected directly to thebladder. The nerves responsible for a man’serections lie very close to the prostategland. If a man desires maintaining erectilefunction, he may be eligible for anerve-sparing prostatectomy. In additionto removing the prostate and seminalIf you are over 50 (40 ifAfrican American or have adad/brother with prostatecancer), you need a PSAand DRE once a year. Ifyou have symptoms of BPHcall your doctor and reportthese symptoms.vesicles, the surgeon will also removeseveral of the lymph nodes in the pelvis. Ifcancer is found to have spread into thelymph nodes, the likelihood of the cancercoming back increases significantly.There have been tremendous advancesin prostate surgical technique.Laparoscopic Prostatectomies (LP) are nowcommon. In an LP, several very smallincisions are made and surgical instrumentsare then inserted into the body. Thesurgery is performed with the help of apencil sized video camera, also insertedinto one of the small incisions. Robotic-Assisted Laparoscopic Prostatectomies(RALP) represent an even further surgicaladvance. In RALP the surgeon is furtherassisted with a 3-D computer visionsystem that operates several roboticarms. Both LP and RALP are recognized asmajor advances in prostate surgery withsignificantly decreased complications andblood loss.Hormone Therapy: Prostate cancer isstimulated by androgens (the male sexhormone). Blocking or eliminating androgenscan therefore be an important tool inprostate cancer therapy. Medications thateither block the production of androgens(Lupron injections), or medications thatcounter the effects of androgens (Casodexpills), can be prescribed.All too often, a man is diagnosed withprostate cancer when it is too late for eithertreatment with radiation therapy or withsurgery. If a man’s prostate cancer is foundto have spread to his lung, bones, or evento his lymph nodes in the pelvis, a cureis highly unlikely. In these cases, antiandrogentherapy could be used to “slowthe cancer down.” The hormones won’tcure the cancer but they may significantlyslow the process for months or even years.Even when the cancer has not spreadoutside the prostate, hormones might bebeneficial. Hormones can sometimes beused in conjunction with either radiationtherapy or surgery to both shrink the sizeof the prostate as well as to potentiallyintensify the overall effectiveness of theradiation treatments. In these situations,hormones are typically only prescribed fora short period of time (i.e., 3-6 months).In the words of…Former football great Dan Marino hasrecently been on television as a spokesmanfor a weight loss program. The hallof-famerrecently dropped 20 pounds ofexcess weight and is now promoting theprogram that made it happen. His tagline at the end of the commercial, “Git-R-Done”, is a simple challenge popularizedby his co-spokesman, Larry the CableGuy. I’d like to borrow this pithy phrasefor the men reading this article. If youare over 50 (40 if African American orhave a dad/brother with prostate cancer),you need a PSA and DRE once a year.If you have symptoms of BPH, call yourdoctor and report these symptoms. Ifthey do a biopsy and find cancer, picka treatment plan and take care of business.Or, in the words of Dan and Larry,“Git-R-Done.”30 l Valley Health Magazine

Calming theCHAOSThe Challenge of Balancing HormonesBy Diana Morton, Pharm.D.Jenny Williams has always beensuccessful. She works hard at everythingshe does. As a high producing realtorriding the swell of the real estate boom,she has always found a way to wedgein regular strenuous workouts at thegym or go for a run. On weekends, shesnow skis or rides bicycles with her husbandor friends. Her social life is veryrobust, as she enjoys entertaining atdinners and fundraisers. Jenny and herhusband enjoyed this busy, intense lifestylefor many years. But it all changedwhen she turned 45.

WomenTired of not sleeping well, not enjoyingor wanting sex, feeling depressedand fatigued, gaining weight while stilleating well, and having pain in her jointsand back, Jenny decided it was time tosee her doctor.Jenny’s initial experience with herdoctor was eye opening. Diagnosis wasthat she was peri-, or pre-menopausaland needed hormones, anti-depressants,an anti-inflammatory for pain, sleepingpills at night, and stimulants for theday. She was stunned. Was she goingto have to take all these pills for therest of her life? What would be the sideeffects of this regimen, and would itmake her healthy again or just treatthe symptoms? She had worked so hardfor years to be healthy and stay in shapejust so she would not end up in this verysituation in her mid-forties. Jenny toldher doctor that there must be a bettertreatment. Her doctor recommendedshe try a less conventional method usinga clinical pharmacist and an integrativeapproach.Jenny’s first course of action, in partnershipwith her doctor and a clinical pharmacist,was to have saliva and blood-spottests done. The results would be reviewedJenny’s initial response tothis program was that shewas sleeping much better,waking in the morningrefreshed and her achesand pains were minimized.Improvements in her mood,sex drive and memory soonfollowed.by the pharmacist and recommendationsmade to the doctor, who would thendetermine a more subtle approach forJenny. Based on her test results, a specifichormone regimen of low dose Testosteroneand Bio-Identical Estrogens taken duringthe day and topical Progesterone appliedat night were prescribed. In addition, thepharmacist recommended various highgrade supplements including minerals,Essential Fatty Acids, and Amino Acidsto help with her aches and pains and brainfunction, as well as improve her sleep.Dietary recommendations were also givenconsisting of lean ‘clean’ protein (hormonefree),high fiber, and low glycemic foodsthat were the final key to feeling better.Ultimately it took 30 to 45 days with someminor dosing adjustments before Jennyachieved a successful recovery.Jenny’s initial response to this programwas that she was sleeping muchbetter, waking in the morning refreshedand her aches and pains were minimized.Improvements in her mood, sex drive andmemory soon followed. Today, she andher husband have never been happier.Jenny’s energy and vitality are back andshe says she feels ten years younger.32 l Valley Health Magazine

Common Symptoms of Hormonal Imbalance in WomenWomenCATEGORY 1:BASIC HORMONAL IMBALANCECATEGORY 2:ADRENAL HORMONE IMBALANCECATEGORY 3:THYROID HORMONE IMBALANCEHot FlashesMood Swings(PMS)Urinary IncontinenceNight SweatsHeart PalpitationsCystic OvariesVaginal DrynessAcneHeavy MensesFoggy ThinkingWeight GainDepressionFibrocystic BreastsFacial HairIrritabilityHeadachesThinning SkinUterine FibroidsBone LossAches and PainsElevated TriglyceridesMorning FatigueBone LossSleep DisturbancesBlood Sugar ImbalancesDepressionAnxietyInfertilityNervousnessAllergic ConditionsAutoimmune IllnessChronic IllnessEvening FatigueSusceptibility to InfectionsDry SkinAnxietyBrittle NailsDepressionFatigueFoggy ThinkingCold Hands and FeetHeadachesConstipationThinning HairWeight GainIrregular MensesInfertilityLow LibidoAre you at risk?The health problems Jenny experiencedare far from uncommon. Men andwomen of all ages experience similar symptoms.Risk factors for hormonal imbalancesare the basic elements of all our lives. Hecticschedules, poor nutrition, lack of consistentexercise, no relaxation, toxic overload(from caffeine, nicotine, or alcohol), and justplain getting older are the usual suspects.Once the Endocrine system (the hormoneproducers) gets out of balance, the bodysystems attempt to adjust but eventuallybecome misaligned, creating chaos within.Hormones do not go out of balance individually.When one goes up, one goesdown. Thorough testing is required to findthe multiple sub-systems that are out ofbalance. Testing may include blood, salivaand/or urine analysis.An Alternative ChoiceThe challenge of balancing hormonesrequires a multi-faceted approach. Itall starts with nutrition and regularexercise. We all need to make betterchoices on what we put inside of ourbodies. When symptoms persist, a visitto the doctor is the next step. Thoroughtesting is essential in determining whichbody systems are out of balance. Thisis sometimes difficult to see in bloodtesting. Conventional medicine relieson the blood to tell the story, but oftenthe imbalance lies within the cells andglands themselves, which are the endpoints of hormones and neurotransmitters.Many patients are told they arefine and that their test resultsdid not show any problems, butsymptoms persist.Conventional current treatmentsfor hormonal imbalancesinclude synthetic estrogens andtestosterone, progestins, birthcontrol, porcine thyroid medications,injectable growthhormone, various insulins, and antidepressants.Often times these types ofpotent, synthetic medications suppressnatural function of the endocrine glandsand accumulate within the body due topoor metabolism. These courses of treatmentcan significantly reducea person’s symptomsbut they won’taddresso rValley Health Magazine l 33

Womenrestore the body to its optimal function.Today, men and women have additionalchoices when trying to manage their hormonesand reduce symptoms by usingBio-Identical hormones.The concept of Bio-Identical Hormonesis not new. Estradiol has been used fordecades to help women minimize thesymptoms of declining estrogen. NaturalProgesterone is available as well via prescriptionand in many over-the-countercreams. Unfortunately, there are not manyoptions for Testosterone for women.There are products in the pipelineawaiting approval by the FDA, but theirrelease has been slowed due to a lackof safety data. The main idea behindBio-Identical Hormone replacement is toaugment the body’s function and reducesymptoms by using hormones that areidentical in structure to those made bythe human body in doses that do notexceed physiologic levels. There isno one size fits all. No magic pill. Itis a customized approach to balancinghormones based on thorough testing,lifestyle management, high-grade supplementsand gentle hormone supplementation.It can take time for symptoms tominimize and for patients to feel better,but improvements are long lasting. Bio-Identical Hormones can be compoundedin many different forms. Topical creamsand ointments, suppositories, capsules,sublingual troches (treatments that dissolveunder the tongue), and oils are all availablewith your physician’s prescription.Topical creams and ointments,suppositories, capsules,sublingual troches(treatments that dissolveunder the tongue), and oilsare all available with yourphysician’s prescription.Our baby boomer population is veryeducated and unwilling to accept thestatus quo of treatment for hormonalimbalances. In the past, many havetraveled outside of the community toseek symptom relief. As we emerge intothe 21st century, we are lucky to havemany doctors and health care practitionersin our great San Joaquin Valleythat are open to new types of treatmentsfor old common problems. If you feel youare experiencing hormonal imbalances,start by listening to your body. Yourbody wants to be well and gives youmany signs of what it needs. Assessyour symptoms. Make adjustmentsto your lifestyle with proper diet andregular exercise. Take a high grademulti-vitamin with minerals, antioxidantsand essential fatty acids. If symptomspersist, see your physician, get the appropriatetesting, consider your recommendedtreatment options carefully andconsider a customized, compoundedBio-Identical Hormone regimen that hasbeen specifically designed for you.34 l Valley Health Magazine

BeautyVAGINALCosmetic SurgeriesBy Wade Dickinson, M.D.Many women who experience multiple natural births canhonestly say their genital area is not the same as prior topregnancy and childbirth. Often after childbirth, a woman’s bodymay not return to its pre-pregnancy condition. One reason thesesymptoms might occur is the stretching of the vaginal opening thatoccurs after a natural childbirth. Simple aging, inherited weakness ofsupporting tissues, obesity, unusual strain in supporting tissue causedby a chronic cough or unusual increase in abdominal pressure can beother reasons for vaginal relaxation. Obstetricians often instruct awoman to practice Kegel exercises, a conscious tightening and relaxingof the vaginal muscles to help aid in childbirth and recovery. AlthoughKegel exercises may help strengthen muscles, in some cases they are ineffective.Multiple births may so stretch the vaginal muscles that sex is nolonger pleasurable. Although ‘loose’ vaginal muscles do not prohibit afulfilling sexual life, a woman may experience diminished quality in herintimate relationship as a result of feeling insecure about the changes inher body.Relatively new terms, Vaginal Rejuvenation Surgery (VRS) orLaser Vaginal Rejuvenation Surgery (LVR), was coined by Dr. David Matlock,Valley Health Magazine l 35

BeautyVaginoplasty is a part of alarger surgical procedurethat has commonly helpedwomen who experience cystocele(prolapsed bladder),rectocele (rectum wall bulgesinto the uterus), prolapse(the weakening of the vaginalwalls) or incontinence due tomultiple natural births.M.D., M.B.A., F.A.C.O.G., and founder ofthe Laser Vaginal Rejuvenation Center ofLos Angeles California. Dr. Matlock pioneeredthe use of vaginoplasty and labiaplastyover 10 years ago as a new meansfor women to choose to cosmetically altertheir own bodies. VRS refers to the reconstructionof the vaginal opening and/orlabia minora areas of a woman’s body. Themost current statistics from the AmericanSociety of Plastic Surgeons show that in2005, there were 793 vaginal rejuvenationsurgeries and 1,030 in 2006. Although nota mainstream cosmetic procedure, statisticsshow an increase of 30% in one year.VAGINOPLASTYVaginoplasty is a part of a largersurgical procedure that has commonlyhelped women who experience cystocele(prolapsed bladder), rectocele (rectumwall bulges into the uterus), prolapse (theweakening of the vaginal walls) or inconti-nence due to multiple natural births. Avaginoplasty will also narrow the entranceto the vagina. Due to the repair of an episiotomy,an incision made during childbirthinto the perineum (area of skin between thevagina and anus) to enlarge the vaginalopening, many women have alreadyexperienced a modified vaginoplasty whentheir obstetrician repaired minor damageinflicted during natural childbirth. During avaginoplasty surgery, the stretched muscleat the opening of the vagina is joinedtogether and narrowed with dissolvablestitches. The excess tissue at the entranceis removed. By reducing the excess tissue,the vaginal muscles and the surroundingsoft tissues are tightened. The result is animmediate decrease in the diameter of thevaginal opening and an increase in thetightness of vaginal muscles that mayhave ‘relaxed’ during the strain of childbirthor from other strain that has stretchedthe muscles.LABIAPLASTYThroughout the scope of practice inGynecology, physicians find women whoselabia minora (the small lips on the outsideof the vagina) have excess tissue that maybe asymmetrical or protrudes. While thismay seem a minor problem, women wholive with this condition may they feel selfconsciousof their appearance and sexmay be uncomfortable. Other difficultiesof enlarged or protruding labia may bepain and embarrassment while trying to doevery day activities such as bike riding, orwearing fitted clothing like jeans, a swimsuit,or exercise clothing. Labiaplasty, theVAGINAL REJUVENATION:could this be the procedure for you?Vaginal rejuvenation candidatesmay include women with:Loss of sexual pleasure or pain withsexual intercourse.A feeling of looseness at the vaginalopening.Lack of sensation at the vaginalopening due to loss of muscle tone.

surgical trimming of excessive labial skin, isnot a new procedure. What began as anamputation of the excessive labia tissue,with all the inherited problems ofscar contracture, pigmentationissues, and irregularities, hasevolved into a cosmetic procedurethat has the potential to relieve awomen of her insecurities andgive her the freedom toenjoy normal activities.As women learn thatthey can use cosmetic surgeryto change even the most private area oftheir bodies, more women are requestingthis surgery. There is no alternative otherthan labiaplasty when it comes to reducingthe size of large labia minora, althoughthere are different methods, all of whichcan achieve a similar cosmetic result. Asimple trimming of the excess tissue to anattractive, symmetrical length can be performedeasily in the office as an outpatient.For patients who are more interested inappearance than functionality, a wedgeshapedincision can be made followed byreapproximation of the upper portion ofthe labia. Either one of these proceduresmay be performed in the office.HYMEN REPAIRThe hymen is a thin, delicate membraneconsisting of elastic and fibrous tissue. Itpartially covers the opening of the vaginain most girls. Repairing or restoring thehymen is called hymenoplasty and is donefor various ethnic, cultural and religiousreasons. Since bleeding occurs when thehymen tears, which is typically the result ofa woman’s first experience with intercourse,the torn tissue is pulled back together andstitched into place, physically restoring awoman to a ‘virgin-like’ status.As with all surgeries, patients choosingcosmetic vaginal procedures shoulddiscuss all risks associated with electivesurgery. For many years, plastic surgeonshave done labiaplasty surgeries on theirfemale patients, but when a cosmetic surgeryis warranted for the uterus and vaginalareas of a woman’s body, many plasticsurgeons have recommended that aboard certified obstetrician/gynecologistbe consulted. Most OB-GYN physiciansalso performgynecologicalsurgeries andare experts in thefemale genitalia andfemale anatomy. Performing correctiveanterior and posterior repair on the vaginalwalls has made the gynecologist-surgeonthe professional of choice in vaginoplastyand vaginal cosmetic surgery.Physicians performing these cosmeticsurgeries maintain that it is a woman’schoice to change or alter her appearanceas she wants. As with any cosmetic surgery,issues of self-esteem and perceived bodyappearance should be a part of the consultationprocess with the physician. When awoman is emotionally and physicallyunhappy with her body, her physicianshould be able to offer some crediblesuggestions to help her.For the most part, vaginal rejuvenation isconsidered a cosmetic procedure that is notcovered by insurance. Expenses involvedcan include the scope of surgical services,surgical procedure room, and outpatientcoverage. A look at some of the websites ofphysicians offering these procedures in largecities across the United States show costscan run from $1,500.00 for a single surgeryto more than $10,000.00 for multiple surgeriesperformed at the same time, dependingon location and cosmetic surgery desired. Inthe last couple of years, physicians in theCentral Valley have been performing theseprocedures, saving in time, travel, and coststo their patients. Procedures done locallycan cost significantly less and have theadded advantage of being able to recoverin your own home.Vaginal Cosmetic Surgeriesis an umbrella term that includes differentcosmetic surgery procedures.VaginoplastyThe specialized surgical tightening ofthe vaginal opening.LabiaplastyThe trimming of excessive labia tissuethat is asymmetrical or protruding.Hymen RepairRestoring the hymen tissue to conformto cultural or ethnic values.As with all surgeries, there is risk. Risksof any surgery include: bleeding, infection,damage to other organs, the need forfurther surgery, and adverse reactions toanesthesia. In particular, vaginal cosmeticsurgery risks also include: scarring, painfulintercourse, and the inability to meetpatient expectations. Enhanced sexualexperience can never be guaranteed, asthere are many factors that affect sexualityand intimacy. Cosmetic surgeries shouldonly be performed by the appropriatesurgeon, trained and certified in his/herfield of specialty.A consultation with a physician who canperform vaginal rejuvenation surgeries willdetermine if a woman is a candidate for anycosmetic procedure. Your physician willdetermine if the vaginoplasty, labiaplasty,or both, can be performed in office, or ifthe surgery necessitates using a surgicalroom and outpatient status. Healing time isgenerally six weeks with an almost immediateability to return to normal activities.Post-operative follow up appointments arealso required.Valley Health Magazine l 37

Airway Developmentin Children & AdultsBy Donna J. Blair, D.D.SAs the old saying goes, “ten fingersand ten toes” are two of the mostobvious trademarks of a normal,developing child. Add pink cheeks, shiningeyes and a little nose, and you’ve got justabout every parent’s dream baby. Yet, theremay be less visible physical developmentalproblems that even the most observantparents can overlook. Airway developmentin children is one critical example, and ithas been well documented that the lackof airway development can have serious,life-long ramifications and prevent yourchild from living to their fullest potential.Because your child will most likely findsome way to adapt, many children are notseen by the appropriate care provider untilthey are adolescents, which makes treatingthis condition challenging.BREATHING & AIRWAY DEVELOPMENTDevelopmentally, the largest increase inCranio-Facial development occurs in thefirst 4 years of life and is 90 % completed byage 12. One thing you can do to help yourchild’s airway develop properly is to breastfeed.There is ample evidence that sucklingcreates the most ideal mouth architecturefor the child. The muscles of the mouthdevelop differently while breastfeeding dueto the shape of the mother’s nipple, versusthat of a non-anatomic bottle nipple. Thechild has to work harder with the mother’sbreast and the tongue is held by the infantin the correct position on the palate toallow for the proper, wide mouth arch andairway development. When a child is fedwith a conventional bottle that has a largerhole than a nipple, the milk flows tooreadily and does not encourage muscledevelopment, and more importantly, thetongue is held forward with bottle-feeding,which leads to a narrowing of the upperjaw. With this type of development, a narrowingof the upper and lower jaws createscrowding and cross bites, where the teethdo not match up properly. Every time thatchild swallows, their tongue thrusts forwardinstead of up to the roof of the mouth whereit belongs. This can lead to tongue scallopingseen in adult patients when their tonguedoesn’t have enough room in the narrowedValley Health Magazine l 39

DentalFIGURE 1:FIGURE 3:provided by Dr. John MewFIGURE 4:ABClass II Bite showing deep overbite and crowdingTongue scalloping indicating anarrow archFIGURE 2:Enlarged TonsilsDid YOU KNOW?A NECK SIZE GREATER THAN 17INCHES IS VERY TELLING as towhether or not a person may be asleep apnea sufferer. A study of 302professional football players in the“Super Bowl Study,” was published inthe New England Journal of Medicinea few days prior to Super Bowl XXX-VII. The prevalence of ObstrctiveSleep Apnea (OSA) in the footballplayers was nearly 5 times higherthan noted in previous studies ofsimilar-aged adults. The prevalenceamong the heavier players, theOffensive and Defensive linemen,was an astonishing 34%. The resultsof this study has implications for anyman of similar size and age, and itdoesn’t matter whether that 17 inchneck size is made up muscle, fator both!***Some children may be underweightbecause of the difficulties inattempting to eat and breathe at thesame time—it’s too much work forthem!A. Normal facial development, age 10B. Deficient chin profile by age 15arches of the mouth. The scallops areindentations of the teeth on the sides ofthe tongue (see figure 1). Breastfeeding isnot just crucial for the immune system, italso encourages the optimal physiologicaldevelopment of a child as well. In fact,most area hospitals are encouragingbreast feeding by no longer supplyingfree formula for newborns.If a child cannot breathe properly, theywill develop habitual positions, which allowthem to get adequate air. Usually, thesehabitual positions involve swallowing withthe tongue moving forward instead of upto the roof of the mouth, an open mouthwhile at rest, and tilting of the head slightlybackward to open up the airway.A child’s airway can be small orobstructed simply due the size of thetonsils (see figure 2). In most cases,removal of the Tonsil and Adenoid tissuecan greatly increase the size of the airwayto allow proper breathing. Often, when thetonsils or adenoids are removed a child willexperience a growth spurt due to the abilityto breathe while eating at the same timeand assist in getting the sleep they need.Another important issue in facialdevelopment and an open airway isdetermining whether or not a child hasallergies. Food allergies, particularly todairy products (not Raw Dairy), and petallergies contribute the enlargement of thetonsils and adenoids, which can obstructthe airway regardless of normal development.Dr. John Mew, of the United Kingdom,has published many scientific articlesabout changes in facial development withregards to compromised airways. Figure3 shows the same child from age 10 toage 15 after a pet gerbil arrived at hishome, which created allergy issues.LONG TERM EFFECTS & ASSOCIATEDPROBLEMSBone StructureThe most obvious effect of airwayissues is one of appearance. When a childhas a tongue forward swallowing patternand open lip posture while at rest, thechild’s cheek muscles do not develop properlyand contribute to the narrowing of theroof of the mouth and a lengthening of theface. This in turn may result in what is calleda Class II Bite, which is marked by a profilestructure with a small or receding chin, andupper teeth that nearly cover the lowerteeth when in a bite position (see figure 4).The earlier a child is evaluated, the betterthe opportunity for correcting issues thathave developed in the airway and minimizingfuture impact upon facial structure. nObstructive Sleep ApneaOf much more importance than appearancechanges, is the effect that airwayissues will continue to have on the childwell into adulthood. Obstructive SleepApnea (OSA) can be a killer. When a patientsuffers from an airway obstruction, it causesbreathing to pause during sleep, disturbingthe quality of sleep continuously and withpossible dangerous consequences. Onecondition, known as Metabolic Syndrome Xis associated with a cluster of inter-relatedrisk factors for cardio-vascular disease thatincludes:• Systemic Hypertension (HighBlood Pressure)• Insulin Resistance (Diabetes)• Dyslipidaemia (High Triglyceridesand Reduced HDL Cholesterol)• Central Obesity (Abdominal Fat)OSA signs and symptoms include:• Heart attacks or irregular heartbeat• Impotence• High Blood Pressure40 l Valley Health Magazine

DentalFIGURE 5:A CASE STUDY• Stroke• Heartburn or GERD• Morning Headaches• Dry Mouth• Impaired Concentration• Depression• Irritability• Chronic Sleepiness• BruxismOSA is often present in people withMetabolic Syndrome X and physicians arenow regarding this condition as MetabolicSyndrome Z.Acid RefluxThe link between airway obstructionsand acid reflux (GERD) is well proven. Manypatients who have their airway issuesresolved will also be relieved of their GERDcondition, too. Malignant changes in thelower esophagus from the constant irritationfrom acid, called Barrett’s Esophagus,can be deadly. Often patients can haveerosion of the esophagus but experienceno noticeable symptoms. Many timesGERD patients are unaware of their conditionuntil acid erosion on their teeth isdetected by a dentist. At that time, thedentist may refer the patient to a Gastroenterologistfor possible treatment of GERD.Figure 5 shows a patient who wasasymptomatic but had evidence of severeacid erosion on his teeth. Note the redulcerations on his lower esophagus fromrepeated acid exposure. Just because youare not experiencing painful symptomsdoesn’t mean that there is not damageoccurring.GETTING HELP: TREATMENTOrthodontics & TonsillectomyA recent study completed on 32children with Obstructive Sleep Apneacompared removing the tonsils to enlargingthe roof of the mouth through orthodontics.Of those in the study, 14 out of 16Esophageal erosionhad expansion first and still requiredtonsillectomy to resolve the OSA issues. Ofthe other 16 children, all of them hadtonsillectomy first and still needed expansion.Basically, there was no resolution ofsymptoms with either approach alone,hence, the best treatment should beintegrative.Many adult patients who had orthodonticsin the past have experienced relapsedue to the swallowing or breathing patternsthat were established in early childhood.Additionally, orthodontic treatments maybe paired with tonsillectomy to clear airwayobstruction and to remove impeding excesstissue that is compounding the problem ofa narrow archway.IT’S NOT JUST ABOUT THE TEETHOften, the questions patients haveabout dentistry revolve around their teethand the attractiveness of their smile. Manyare pretty surprised when the answers havemuch larger, whole body implications fortheir health.Whether you are concerned about thehealth your child or if you are an adult whohas any of the cardiovascular risk factorsassociated with Metabolic Syndrome X,you need to seek treatment immediately.It’s very sobering to think that a child’s swallowinghabits or a simple allergy to a familypet can have life shortening consequencesfor them as an adult. Likewise, consistenttrouble sleeping as an adult may be asymptom of airway obstruction and seekingtreatment could significantly loweryour risk for cardiovascular disease and ashortened lifespan.The example below shows ayoung man who actually had hisorthodontic treatment completedat age 13 and at that time it wasrecommended to get his tonsilsremoved. Unfortunately that wasnot done and the atypical swallowingpattern that he had developedwith his tongue thrusting forwardcontinued and contributed to thechange in his facial profile as ayoung adult.Eventually he did get his tonsilsand adenoids removed but at ahigh cost. He can now breathebut the deformation of his lowerjaw cannot be reversed withoutmajor intervention, and even then,correcting his tongue thrustinghabit will be very difficult, if notimpossible, at this late date. It maybe statistically true that 70% oftonsils shrink with age, but thedamage caused by their enlargementcan be a life long sentence.Photos provided by Dr. Prabu RamanABA. Patient with normal profile, at 13B. Abnormal profile, at 22Same patient displaying forwardtongue thrust at age 22.Valley Health Magazine l 41

T. Gary Forester, DDSDavid P. Forester, DDSVisit us in our beautiful NEW LOCATIONIn our new, state of the art facility, our experienced team looksforward to carrying out our vision for dental care utilizingthe following services:• CEREC one-visit porcelain crowns using CAD/CAM technology• Digital X-rays with reduced exposure• Digital intraoral photography• Laser detection of early cavities• Invisalign invisible orthodontics• Laser periodontal/gum surgery• Conservative porcelain veneers• Sports mouthguards• Appliances for sleep apnea and grinding teeth• Custom tooth whitening• Sedation dentistrye value the relationships we have had with our patients over the pastthirty years and are excited about the opportunities for excellent,comprehensive dentistry in the future. We always welcome new patientsand families to our practice.At Forester Dental, we are committed to providingcomprehensive oral health care that is:• Conservative • Preventative • Educational• Aesthetic • Proactive rather than reactive• Evidence-based and technologically current7525 N. Cedar, #117(at Alluvial)Fresno, CA 93720foresterdental.cominfo@foresterdental.com559.432.1300

l Special Advertising Section lDental ProfilesPeople of the Valley have many choices when it comes to quality dental care and finding the right dentist,orthodontist, periodontist, or oral surgeon can seem overwhelming at times. Rest assured, these medicalprofessionals are at the top of their game and offer the best care available for your family.Table of ContentsRobert L. Garabedian, D.D.S. - 44Donna Blair, D.D.S. - 45Valley Health Magazine l 43

l Special Advertising Section lRemoval of Mercury FillingsA Patient Speaks Outbody. He removed 8 amalgam fillings and replaced7 of them with fillings and 1 with a crown. Heand his staff went to great lengths to protect me(and themselves) from more intoxication duringthese procedures. They administered charcoaltablets and a special form of vitamin C followingeach procedure to assist my body in detoxificationfrom the mercury we were disturbing. The results:Wow! My mercury level dropped more than 24.3ug/g. Although I still have significant levels of leadin my system I am much improved. Symptomsthat are significantly improved: insomnia (nonexistent),menstrual cycle (normal), that foggyfeeling is much improved, headaches are rare, andconstipation improved. I do not yet feel “normal”,but I feel so much better. I did not make any othersignificant changes in my life during this time,only the removal of my amalgam fillings. I wouldencourage anyone suffering from mercury poisoningand experiencing symptoms (however vague)to consider the removal of their amalgams. I feelblessed to have found Dr. and Mrs. Garabedianand Judy Koehn and would highly recommendthis team. Thank you! — Patty WeberIam a 42 year-old woman. Over the last severalyears, my health has declined. My symptomsare numerous but I will list them as best Ican: extreme fatigue, severe headaches, insomnia,digestive problems, constipation, frequent andheavy menstrual periods, memory loss, chronicpain in neck and back, and decreased cognitivefunctioning. By far the most debilitating symptom:I literally felt I was loosing my mind. Ihad a great deal of mental confusion, difficultymaking decisions, and generally “foggy.” WhileI am no genius, I am a well-educated personhaving earned advanced degrees and experiencein academia as an instructor in mathematics atthe junior college level. My physician diagnosedme with metal poisoning. The levels of lead andmercury in my system were dangerously high. ItPatty Weber and Robert L. Garabedian, D.D.S.MY PHYSICIAN RECOMMENDEDDR. GARABEDIAN. AS SOON AS ICONSULTED WITH HIM, I KNEWHIS TEAM WAS THE ONE TOFIGHT THIS BATTLE WITH ME.was no surprise to find such high mercury levelshigh since my mouth was full of amalgam fillings–allreceived in my middle school years. Myphysician recommended Dr. Garabedian. As soonas I consulted with him, I knew his team was theone to fight this battle with me. He was straightforwardand very clear in the initial consultation.He outlined the procedures and required a specialblood test to determine what new material wouldreplace the amalgam and be appropriate for myDr. Garabedian is trained by Dr. HalHuggins, and certified as 1 of only 56Alliance members in the U.S. for the saferemoval of mercury fillings. Dr. Hugginsprotocol is strictly followed including specialair filtration systems in the room utilizedfor removing mercury fillings. Over the last20 years, Dr. Garabedian has emphasizedtreating people with autoimmune diseasesand continues to be mercury free. Dr.Garabedian and staff are wonderfulwith the whole family.Robert L. Garabedian, D.D.S.1616 W. Shaw Ave., Suite C-2Fresno, CA 93711(559) 229-6553www.rlgarabediandds.com44 l Valley Health Magazine

l Special Advertising Section lDonna J. Blair, D.D.S.Now Offering Pure Power MouthguardsProvider of:Donna J. Blair, D.D.S.Donna J Blair DDS is a graduateof the University of the PacificArthur Dugoni School of Dentistryand completed an additional year of hospitalbased training in a General Practice Residencyat University Medical Center (then ValleyMedical Center in Fresno).One thing that you can always count onis that Dr. Blair is an enthusiastic perpetualstudent of the Art and Science of Dentistry.Since advances in Dentistry arrive at an everincreasing pace, she prides herself on stayingPure Power MouthguardTHE PURE POWER MOUTH-GUARD (PPM) IS A PATENTEDDEVICE THAT IS FITTED FORANY SPORT, CONTACT OR NOT.IT IS A USEFUL TOOL FOR ANY-ONE WHO WOULD LIKE TOHAVE AN EDGE IN BOTH THEIRTRAINING AND GAME DAYPERFORMANCE.abreast of new developments through extensiveannual continuing education, well above theminimum requirements of the State of Californialicensing board. She is proud of herassociation with the Las Vegas Institute ofAdvanced Dental Studies (LVI) which hasprovided her with advanced training in NeuromuscularOcclusion, Cosmetics, Airway Issues,Orthodontics, and TMJ treatment.She has been mercury free for over 22 yearsand is pleased to be able to offer long lastingalternatives for patients that are both estheticand durable. Cosmetics is one of her favoriteaspects of dentistry from both the estheticstandpoint and the emotional standpoint aswell. A beautiful smile can do wonders for aperson’s self esteem. Dr. Blair’s entire officerelishes the opportunity to accompany a patienton that emotionally satisfying journey.Neuromuscular Dentistry has become ahuge portion of her practice due to thedemands of chronic pain and TMJ patientsseeking a solution that has not previously beenavailable to them.A great side benefit of NeuromuscularDentistry has been the opportunity tobecome a certified PPM provider. The PPM(Pure Power Mouthguard) is a patented devicethat is fitted for any sport, contact or not. It is auseful tool for anyone who would like to havean edge in both their training and game dayperformance. Being the sports enthusiast thatshe is, this most recent addition to her servicesis exciting to say the least!What is the PPM difference? The optimalposition of the jaw is determined with precisemeasurements instead of “guesstimates”. Thisallows for increased flexibility, balance, airexchange, and power. The fact that the PPMenhances the range of motion for a golfer’s backswing or allows a lineman to have more power,makes it unique. There is no mistaking theresults! The increase in the flexibility occursimmediately when the appliance is placed inthe mouth!Dr. Blair offers a complimentary consultationto assess your dental needs or to see ifyou are a candidate for the PPM. Give Dr.Blair’s office a call today! (559) 431-4488.Donna J. Blair, D.D.S.5777 N. Fresno St., #108Fresno, CA 93710(559) 431-4488www.SmilesForFresno.comValley Health Magazine l 45

l Special Advertising Section lHealth ProfilesPeople of the Valley have many choices when it comes to quality healthcare and finding the right doctor canseem overwhelming at times. Rest assured, these medical professionals are at the top of their game andoffer the best care available for your family.Table of ContentsD. Kevin Lester, M.D. - 48-49Christopher Perkins, M.D. - 50Children’s Hospital Central California - 51Natural Path Health Center - 51Valley Health Magazine l 47

l Special Advertising Section lD. Kevin Lester, M.D.Exclusively offering Mini Incision Knee Replacement with ON-Q C-BLOC“IT’S ONLY BEEN A MONTH. IFEEL PRETTY GOOD THAT I’VECOME THIS FAR. I WALKED WITHA CANE RIGHT AFTER SUR-GERY…AND NOW I’M DONEWITH IT. BEFORE SURGERY, IPROBABLY COULD HAVE USEDA WALKER.”- Frank ChaconeFrank Chacone walking Gracie 1 month after Partial Knee ReplacementFrank Chacone, 58, had been suffering from minimal, Dr. Lester explained. Frank was skepticalthe early symptoms of arthritis for years. Minor (and afraid of the pain) but he agreed to attend aaches and pains in his knees eventually led to sleeplessnights, swollen legs at the end of the work day, where new patients can talk to other patients whomonthly educational social given by Dr. Lesterand the inability to spend time doing the things he have undergone the same procedure. “I got to talkloves—like yard work and taking Gracie for her to people who did the same thing and they said itwalks at Woodward Park. When things got to the was great. They made it clear exactly what it wouldpoint that climbing stairs and kneeling, daily activitiesrequired by his job at the Fresno Waste, Water partial knee replacement is finished, he couldn’t bebe like,” says Frank. And now that Frank’sTreatment Plant became difficult, he knew somethinghad to be done. A friend referred him to Dr. there are surprised at how well I’m doing. I’m heal-happier. “I’m still in physical therapy, but the peopleKevin Lester of the Center for Excellence, who recommendedthat Frank have a partial knee replace-they told me it might be three months before Iing much faster compared to other patients. At firstment. This would be done with the help of ON-Q could back to work. Three months without a paycheck—that’stough. Now it will be sooner.” In fact,C-BLOC, a catheter attached to a small, discreetpouch that dispenses local anesthetic directly to the Frank is so pleased and surprised at how easy thesurgical site. ON-Q would make the whole procedurevirtually painless, the recovery process faster, next one: “I’m going to have my other knee done,procedure was he’s actually looking forward to theand the need for other post-op pain medications too!”Dr. Kevin Lester developed the Mini-Incision (MIS) technique in 1986. Hisgoal was to offer patients a less invasivejoint replacement procedure with the benefitsof less pain and faster healing. In his quest tocontinually improve patient recovery, Dr. Lesterintroduces yet another exciting advancement to theCentral Valley: ON-Q C-BLOC. ON-Q C-BLOCis a small pump attached to a catheter placedduring surgery that provides a slow, steady doseof non-narcotic pain relief directly to the nervessurrounding the joint replacement site. Traditionallyafter surgery, pain equals medications,which leaves patients groggy and unable to startmoving for days. Immobility further weakensthe supporting tissues and nerves affected bysurgery, creating a discouraging cycle of pain anddiminished sense of wellbeing. ON-Q allowspatients to wake from surgery pain-free and beginimmediate rehabilitation goals within hours, notdays. Without the unwanted side affects ofprescription medications, Dr. Lester and ON-Qhave broken the circle of fear, pain, and prolongedleaves of absences from work commonly associatedwith surgical procedures. Why wait? As Dr.Lester tells his patients, “Get Your Life Back Now!”JOIN US!Attend a FREE Monthly Seminarto learn more about jointreplacement, non-surgicalsolutions, and to hear patienttestimonies. Seminar held once amonth. Call to make a reservation:559.285.833348 l Valley Health Magazine

l Special Advertising Section lMORE BENEFITS OFCHOOSING ON-Q C-BLOC• Recover and rehabilitate quicker becauseof Dr. Lesters Minimally InvasiveSurgical Techniques and ON-Q paincontrol.• Eliminate side effects of traditionalnarcotics that may cause nausea, constipation,grogginess, difficulty breathing,and may become habit-forming.• Dr. Lester has a hand picked team ofprofessionals trained in the safe andeffective use of ON-Q C-BLOC.• ON-Q C-BLOC provides continuousrelief that lasts up to ten times longerthan a single injection.A Closer Look“Partial or total knee surgery is not foreveryone,” says Dr.Lester, “I also offer patientsnon surgical solutions that can help reduce painand regain mobility before the need for surgery.”KNEE REPLACEMENT SURGERIESHAVE TRIPLED AMONG ADULTS45-65 IN THE LAST TEN YEARS,ACCORDING TO A RECENTSTUDY BY THE DEPARTMENT OFHEALTH & HUMAN SERVICES.Once the non surgical options have been tried,you may be facing surgery. It’s likely you havetalked with friends or family and are probablyconcerned about pain afterwards. In fact manypeople postpone having an elective operationbecause they are worried about a long uncomfortablerecovery. As part of the team thatworks with Dr.Lester, Gloria Lovering, N.P.,monitors the progress of each patient to helpprovide a rapid recovery with virtually nopain at all during their stay on the orthopedicunit at Community Regional Medical Center.“Simply stated, the benefits observed are; thepatients ambulate sooner, experience verylittle or no pain at the surgical site and havedecreased post-opertive nausea and vomiting.”Gloria says.Knee replacement surgeries have tripledamong adults 45-65 in the last ten years, accordingto a recent study by the Department of Health& Human Services. This is due to the increasedpopulation of baby boomers coinciding withtechnical advancements. These technical advancementsin joint replacement include MinimallyInvasive Surgery, Partial Knee Replacements,and now ON-Q C-BLOC. Although Dr. Lestermaintains that joint replacement surgery is notalways necessary, patients who need surgerywill experience minimal pain and maximumrecovery.D. Kevin Lester, M.D.6085 N. First St., #101Fresno, CA 93710(559) 431-2332www.mini-incision.comValley Health Magazine l 49

l Special Advertising Section lChristopher Perkins, M.D.California Oncology of the Central ValleyThe Art of Life 2008 ExhibitionWednesday, October 29th6:00 – 9:00 pmAt California Oncology – 6121 N. Thesta,Fresno (North of Bullard & East of Hwy 41)What do you get when you combine 20 localartists with 65 women cancer survivors toco-create 20 works of art during NationalBreast Cancer Awareness Month? Astunning, joyful exhibit about LIFE!Please join us for the unveiling of “The Artof Life” on canvas—open to the public, free ofcharge. You will also enjoy refreshments,a silent auction, commemorative artcards and more.Christopher Perkins, M.D. is the MedicalDirector and founder of CaliforniaOncology, a beautiful cancer treatmentfacility in Fresno, California. He has been in practicefor nearly 20 years and is a Board CertifiedMedical Oncologist specializing in comprehensivetreatment of breast and gynecological cancer.Believing strongly in listening to how patientswant to be treated, Dr. Perkins focuses his practiceon wholeness and individualized attention torestore the body, mind and spirit of his patients.He has committed his practice to evidence-basedmedicine, applied research, and hospitalityinspiredservice. Patients have responded withletters and comments like, “The time Dr. Perkinstakes with me makes me feel well pamperedand cared for both physically and emotionally.”Another said, “I wouldn’t put my life in anyoneelse’s hands except Dr. Perkins.”Christopher Perkins, M.D.Dr. Perkins received medical training at LaSalle University School of Medicine in MexicoCity, where he became fluent in Spanish. Hecompleted his internship and residency throughUMC (formerly known as Valley Medical Center)and then completed his fellowship at theUniversity of Davis.Since limiting his practice to patients withbreast and gynecological cancer, Dr. Perkins hasfound sub-specializing to be personally andprofessionally rewarding. He has become anexpert in the field of breast and gynecologicalcancer with a commitment to patients above andbeyond the call of duty. Those who know himdescribe him as compassionate. He is a man whogives one hundred percent of himself to peopleand to his practice.His dedication to making a difference in thelives of those around him goes beyond the walls ofhis practice into the community. For many yearsDr. Perkins has supported a variety of organizationslike Susan G. Komen Foundation, BigBrothers Big Sisters, the American Cancer Society,and the Leukemia & Lymphoma Society.He also worked with the Economic OpportunityCommission Sanctuary Program to develop anon-welfare program called Step-Up. This community-basedprogram assists carefully selectedfamilies with housing, healthcare, life skills,employment, education and more. Through thisprogram the staff at California Oncology investstheir time, their talents and their dollars to help aStep Up family, reflecting Dr. Perkins’ and hisstaff ’s commitment to supporting the greaterFresno community.Christopher Perkins, M.D.6121 N. Thesta Ave. #204Fresno, CA 93710(559) 438-7390www.california-oncology.com50 l Valley Health Magazine

l Special Advertising Section lChildren’s Hospital Central CaliforniaPhysician FocusPeter Witt, MD - Medical Director of Plastic SurgeryDr. Peter Witt, an expert in cleft palatetreatment and other plastic surgerytechniques, joined the Children’sHospital Central California medical staffin 2002. A board-certified plastic surgeon,Dr. Witt has had an unarguable impact onCentral California’s pediatric population aspart of a team that performs more than 500procedures a year. Dr. Witt publishes regularlyin journals including the Journal of Plastic &Reconstructive Surgery and The Annals ofPlastic Surgery.Dr. Witt’s expertise is in cleft-lip andpalate repair and he takes a personal interestNatural Path Health CenterWeight Loss Resistance ProgramDid you know that our bodiesare designed to burn fat?If this is true, why are somany people fat storing instead offat burning? It could be due to anunderlying physiological problem thatcauses a resistance to weight loss. Youmay have a great diet, and exercise likecrazy, but still keep packing on thepounds. It doesn’t seem fair! Insteadof a diet program that is short livedand unsuccessful, try a healthy lifestyle program that fixes the rootproblem! Food should not be your enemy. And changing how yourbody processes it could turn your body into a fat burning machine!Michael Allshouse, DO – Medical Director of PediatricSurgery and Pediatric Traumain the subsequent speech issues. His practiceoperates a Craniofacial Clinic that has 1,600visits a year and uses a team-based approachin accordance with the American Cleft PalateAssociation (ACPA) standards. The PlasticSurgery Division also specializes in handsurgery and many other procedures.Dr. Witt places high value in faith andfamily and spends free time with his wife Aliceand their five children.Dr. Michael Allshouse returned toChildren’s Hospital Central California asthe Medical Director of Pediatric Surgeryand Pediatric Trauma in September 2007.He is a board certified surgeon with specialqualifications in pediatric surgery and surgicalcritical care and is renowned for his workwith children with biliary tract disorders andcongenital anorectal malformations.He is a national expert in the care ofchildren with Down syndrome, serving asthe only pediatric surgical member of theDown Syndrome Medical Interest Group.Dr. Allshouse has expertise in many aspectsof pediatric and neonatal surgery, includingtraditional and minimally invasive surgicaloptions for newborns, children, teens andyoung adults.Dr. Allshouse’s free time is occupied byhis wife Denise and their five children - allof whom have received world-class care atChildren’s.9300 Valley Children’s PlaceMadera, California 93636(559) 353-3000www.childrenscentralcal.orgThe Weight Loss Resistance program is designed to pinpoint all of thereasons your body may be fat storing, and not fat burning. This programhelps to permanently fix the problems so weight becomes a non-issuefor you! If you are serious about changing your life, sign up for a 6 week“jumpstart” weight loss program.Call the office for more details orinformation on upcoming classes.The longer you wait the fatteryou may get!Dr. Mikell Suzanne Parsons6103 N. First St #104Fresno, CA 93710(559) 447-1404Valley Health Magazine l 51

Welcome Home toOakdale HeightsR Nurses on-site7 days a weekR Support groupsR Comfortable apartmentswith kitchenetteR Social and wellnessprogramsR 24 hour staffingIt’s all about the People ...theWonderfulpeople!7442 N. Millbrook Ave.Fresno, CA 93720Lic.# 107201526 & 107201502(559) 446-1266www.oakdaleheights.com

By Dr. Soe NaingAlzheimer’s Is BeatableBy David Margolin, M.D., Ph.D.

SeniorShortly after the ending of the 2008Olympic games, I heard on the radiothat in acknowledgment of MichaelPhelps’ 8-gold-medal performance, thereshould be a new adjective in the Englishlanguage to refer to such astoundingachievement—Phelpsian. By definition,few of us will ever achieve at the Phelpsianlevel, but life does afford us opportunitiesto contribute to society in importantways, such as caring for an ailing familymember. Even though I treat Alzheimer’spatients on a daily basis, I am frequentlystruck by the dedication and responsibilitythat family members show when caringfor Alzheimer’s patients. As this devastating,relentless disease progressively robspatients of their ability to care for andprotect themselves, the caregivers graduallyprovide more and more supervisionand help. It is not always easy, but somethingsees these heroic caregivers throughthe process.With an estimated over 5 million individualswith Alzheimer’s disease in theUnited States, and 22 million worldwide,few families are unscathed by this disease.For reasons not yet known, this diseasecauses a progressive loss of brain cells,a process known as neurodegeneration.Gradually, the loss of brain cells leads tomemory loss and particularly affects theability of the patient to learn new things.Symptoms include forgetting recent eventsand conversations, difficulty keeping trackof appointments, trouble recalling names,and increased misplacing of belongings.Eventually other types of thinking; includingjudgment, problem solving, speech,organization and planning are impaired.If you have a friend or family memberwith these symptoms, arrange for themto be seen by a physician knowledgeablein Alzheimer’s disease. The best chancefor a correct diagnosis is to have an evaluationby a neurologist subspecializingin Alzheimer’s disease and other types ofdementia. Dementia is a more generalterm than Alzheimer’s disease. Dementiameans that the problems in memory andthinking are abnormal and are interferingwith the person’s ability to function in atleast some of his or her usual activities. Ifthe diagnosis is dementia, the next step is54 l Valley Health Magazine

to determine the cause of the dementia.In most, but not all patients with dementia,the cause is Alzheimer’s disease.There is no shortcut, such as a bloodtest or brain scan, to making a diagnosisof Alzheimer’s disease. The diagnosis ismade through a process that includesinterviewing the patient and family memberor other historian, testing the patient’smemory and other intellectual abilities,and a neurological examination. There areblood tests and a brain scan performed,but they are a minor part of the evaluation.After this information is collected,the neurologist should be able to determineif the patient has dementia or not,and whether the dementia is due toAlzheimer’s disease or some other cause.Patients and families should beinformed of the diagnosis and given informationabout available communityresources and educational materials. Inmy practice, which is subspecialized inAlzheimer’s and Parkinson’s diseases,the family is advised to provide as muchsupervision as needed in order to keepthe patient safe. Since this is a progressiveillness, the appropriate level of supervisionis a moving target. There is, however,one simple rule: if a patient’s memory lossis severe enough to diagnose Alzheimer’sdisease, even if the degree of dementia isIf a patient’s memory loss issevere enough to diagnoseAlzheimer’s disease, evenif the degree of dementiais very mild, a caregivershould be in strict charge ofstoring and dispensing thepatient’s medication.very mild, a caregiver should be in strictcharge of storing and dispensing thepatient’s medication. Careful observationof the patient’s symptoms will alert thecaregiver that other restrictions are warranted.Eventually, it may be unsafe for thepatient to drive or to spend time alone.It is easy to see that this process cantake its toll on the caregiver. Fortunatelythere are excellent resources in the Fresnoarea to assist caregivers, including theAlzheimer’s Foundation of Central Californiaand the Valley Caregiver ResourceCenter. Families and patients may benefitfrom taking advantage of adult day careprograms and eventually residential facilitiesor board-and-care homes experiencedin the care of dementia patients.SeniorThe good news is that we are makingprogress in treating this disease. There arecurrently four prescription medicationsthat may slow down the rate of cognitivedecline. In addition, there are many medicationscurrently being tested throughresearch protocols (clinical trials or drugstudies). Some of these investigationalmedications may block the developmentof abnormal proteins in the brain that arethought to harm brain cells. Several suchstudies are currently underway in Fresno.In addition to patients volunteering toparticipate in these clinical trials, the caregiverparticipates as well, making sure thatthe research medication is taken properlyand providing information to the researcherabout the patient’s ability to function andgeneral health condition. Caregivers thusserve a vital role in the research process.In research, one never knows if a particularresearch treatment will be beneficial.But, it is clear that this research is the onlypath that will eventually lead to improvedtreatments and ultimately a cure: a trulyPhelpsian accomplishment. It will not,however, be through the effort of a singlesuper performer. It will be through thecombined effort of patient volunteers, theirfamilies, research physicians, and pharmaceuticalcompanies.Valley Health Magazine l 55

Imagine. A life free of foot problems,foot pain and discomfort.PODIATRIC SERVICES• Ankle Pain• Arthritis of the Foot• Bunions• Childrens Foot Care• Diabetic Foot Care• Foot Injuries• Foot Warts• Hammer Toes• Heel Spurs• Ingrown Toenails• Nail Fungus Infections• Sports Medicine• Skin Conditions(Dermatitis, Athletes Foot)Dr. Scortt and Dr. Mukker have active privileges atSaint Agnes Medical Center & Community RegionalMedical Center (Most insurances accepted)JOIN DR. SCORTT for a live interview everyFriday at 3pm on Voiceamerica.comLARRY D. SCORTT, DPMwww.thepodiatrist.comJAY MUKKER, DPMwww.drmukker.comCall todayfor a complimentary foot exam and consultation(559) 224-51014005 North Fresno Street, Suite 106 • Fresno, California 9372656 l Valley Health Magazine

THINKBefore YouDRINKBy Deborah Newlin, R.D.

Diet & NutritionBeverage selection has become anincreasingly complicated issue.Probably ever since coffee beanswere first discovered, people have beenrealizing that drinks have just as muchpotential to fuel the body as food. Fastforward to modern day. Currently on themarket, consumers can choose from awide selection of drinks ranging fromthose meant to be food substitutes toenergy drinks and even enhanced orfortified water. But unlike food, most ofus forget to consider the nutrient value,sugar load, or calories associated withwhat we’re sipping on. Sport and energydrinks rank at the top of the list of thegrowing beverage market and have evenmade it to surprising outlets such asschool campuses and bars where theyare used as cocktail mixers. The popularityof such drinks raises a few importantquestions. What should you drink? Aresport drinks really healthy? What ingredientsare in these beverages? Is there adifference between drinking calories andeating them?How to HydrateThe average adult, depending on howmuscular you are, is comprised of 55-70%water. When you sweat, you lose waterthat must be replaced to continue toperform at your best. It is recommendedthat you hydrate yourself by drinking fluidsbefore, during, and after all workouts orphysical activities. The amount of fluid thatneeds to be replaced will depend uponhow much was lost during the workout oractivity. A simple guideline for hydrationis to drink 15-20 fluid ounces 2-3 hoursbefore you exercise, then 10-15 minutesbefore the event, drink another 8-10 fluidounces. Every 15 minutes throughout theworkout or event drink 8-10 fluid ounces.Finally, upon finishing the workout, drinkanother 20-24 fluid ounces of water within30 minutes to rehydrate your body. Thiswill minimize or replace fluids that are lostduring exercise and help your body cooldown. There is a 45-minute period afterIn 2006, sport drinks hit $7.5billion in sales according tothe trade journal BeverageDigest. It is the third fastestgrowing beverage categoryafter energy drinks and bottledwater.drinking any fluid that your body will use toclear excess fluids. Outside temperaturemay cause your hydration needs to increase.Water has typically been the hydrationfluid choice, but many sport drinks claimthat they are better in providing additionalelectrolytes that are needed after exercise.Sport Drink Benefits?Sport drinks have become a popularfluid replacement for many, regardless ofage and whether you are exercising ornot. These sport drinks are helpful ifyou are participating in a high intensitycardiovascular exercise like playing tennis,soccer, basketball or running for 90 ormore minutes. Sport drinks can supply60-100 calories or 15-18 grams of carbohydratein every 8 fluid ounces to yourbody. These additional calories will helpsupport the continued activity. Sport drinkshigher than 18 grams of carbohydrate in 8fluid ounces will only delay water absorption.The carbohydrate in this type ofbeverage will slow the transit time of freewater in your body until it is finally reabsorbedin the large intestines. Some sportdrinks in this range have the potential tocause dehydration, cramps, nausea, ordiarrhea. Contrary to most sport drinksmarketing campaigns, it is not necessaryto replace losses of sodium, potassium,and other electrolytes during most exercise.You have not likely depleted yourbody’s stores of these minerals during anynormal training event or physical activity.However, marathons, Ironman events, orultra-marathons are examples of extremephysical conditions lasting 3-5 hours, whichmake electrolyte replacement a necessity.58 l Valley Health Magazine

Beverage Boom ConfusionIn 2006, sport drinks hit $7.5 billion insales according to the trade journal BeverageDigest. It is the third fastest growingbeverage category after energy drinks andbottled water. The ingredients of energydrinks are similar to sport drinks with theaddition of high quantities of caffeine.One known energy drink, like RedBull,has 80 mg of caffeine —the same as a 6fluid ounce cup of coffee. Some studiessuggest the moderate quantity of caffeinearound 300 mg daily is safe for mostadults. A child’s recommended intake isconsiderably less. Since caffeine is knownto be a diuretic, energy drinks will onlydehydrate the body further. Normally,sport drinks do not contain caffeine, butread the label to ensure that some energybooster (caffeine) has not been added.Energy drinks stimulate the body but donot have the hydrating benefits of anormal sport drink that may be needed forexercise. The marketing of these energyand sport drinks has made this an increasinglyconfusing topic.Big business has spent an enormoussum of money marketing the idea thatsport drinks like Propel or Gatorade arehealthy. A portion of this advertising isgeared toward children and adolescents.A report from the University of CaliforniaBerkley warns that a student who drinksone 20-ounce sport drink every day for ayear may gain about 13 pounds. Thisweight gain was attributed to the additionalcarbohydrates these beveragescontain. This may be one componentleading to the rise in childhood and adolescentobesity. It may also be easy for achild who thinks these drinks are healthyto unwittingly substitute them for thewater they should be drinking.Ingredient ImpactThe main ingredients for many of thesebeverages are water, high fructose cornsyrup and salt. High fructose corn syrup(HFCS) provides the highest single sourceof calories from any single item consumedin the United States. This simple sugarmay make your insulin work overtime andaccount for one quarter of your averagedaily caloric intake. HFCS, along withother simple sugars, has been linked tothe rise in obesity and other metabolicsyndromes, which are in turn linked to theincreasing prevalence of cancer, diabetes,heart disease, arthritis, and osteoporosis.There is new evidence that HFCS in liquidform may even cause a negative metaboliceffect to be magnified. In his book,Influence of Dietary Sucrose on BiologicalAging, Roger B. McDonald found there issignificant evidence that high fructosediets may alter intracellular metabolism,which in turn, facilitates accelerated agingthrough oxidative damage. Scientists foundthat the rats given fructose had moreundesirable cross-linking changes in thecollagen of their skin than in the othergroups. These changes are also thoughtto be markers for aging and lack of collagenand elastin growth. Many scientistssay it is the fructose molecule in the sucrose(not the glucose) that plays the part. Perhaps,HFCS is not a healthy option.New studies are being done to test thehormone named ghreline which seems tosignal the body when it is time to eat.DRINKING IN THE FACTSIf you’re an average adult, every day youlose more than 10 cups of water simplyby sweating, breathing and eliminatingwaste. When you eliminate more waterand salts than you replace, dehydrationresults — your system literally driesout.Mild to moderate dehydrationis likely to cause:Dry, sticky mouthSleepiness or tiredness.ThirstDecreased urine output — fewerthan 6 wet diapers a day for infantsand 8+ hours without urination forolder children and teensFew or no tears when cryingMuscle weaknessHeadacheDizziness or lightheadednessSevere dehydration is a medicalemergency and can cause:Extreme thirstExtreme fussiness or sleepiness ininfants and childrenIrritability and confusion in adultsVery dry mouth, skin and mucousmembranesLack of sweatingLittle or no urination — any urineproduced will be dark or amberSunken eyesShriveled and dry skin that lackselasticity and doesn’t “bounce back”when pinched into a foldIn infants, sunken fontanels (thesoft spots on top of a baby’s head)Low blood pressureRapid heartbeatFeverDiet & NutritionIn the most serious cases, deliriumor unconsciousnessSource: MayoClinic.comValley Health Magazine l 59

Diet & NutritionSimple sugar beverages likesport or energy drinks had anegative impact on childrenand adolescent total dietcalcium intake.When you drink a simple sugar beverage,the amount of this particular hormonedoes not change and the body may notrealize that calories have been consumed.Despite utilizing some of these calorieswhen exercising, typically a larger amountis taken in than expended. Your hungerwill not decrease as much when you consumea beverage as when you consumefood. Sport drinks don’t trigger ghreline,so people don’t realize they’re consumingcalories in drink. Sport drinks will not giveyou that feeling of fullness which triggers aperson to stop eating. In the meantime,many calories have been ingested.The Journal of Adolescent Healthreported that children and adolescentswho consumed a non-sugar-sweetenedbeverage had an average calcium intakethat met the adequate intakes (AI) becausethey were more likely to eat and drinkfoods and beverages that contained calcium.On the other hand, simple sugar beverageslike sport or energy drinks had a negativeimpact on children and adolescent totaldiet calcium intake. The increase of beverageslike sport drinks was directly reflectedin a lower dietary intake of vital nutrients.Children and adolescents filled up on thesebeverages instead of having foods andbeverages of a higher nutritional value.Back to BasicsH 2 0 is the the original form of liquidhydration. Besides drinking plain water,there are several options to flavor up thisold standby. Flavoring from a fruit juice(lemon, lime, orange, grapefruit, or cranberry)or extracts (peppermint, ginger,lemon, lime, spearmint) will allow you theoption to get the taste you precisely want.The trick is to remember to write downyour desired flavoring so that it can berepeated quickly when you want anotherbottle or glass. Next time you are in themood for something different, try creatingyour own recipe.Sample Recipe:• 1 quart (32 oz) or 1 liter water• 1/3 cup fruit juice (orange, lemon,grapefruit, lime, cranberry, etc.• 1/4 teaspoon table salt• Extract flavoring to taste peppermint,spearmint, lemon, lime, ginger, etc.• Keep refrigerated• Other flavoring optionsunsweeteneddrink mix (Kool-Aid,Wyler’s, etc.) 1/3 of a packetThink about your beverage choicebefore you are thirsty. If you wait, you willgrab anything to quench that thirst. It issimilar to the philosophy of never going tothe grocery store when you are hungry.You will tend to impulse purchase food,or with drinks, pre-made sport drinks orenergy drinks so they can be consumedon the way home from the store.You may be utilizing a “healthy” hydrationbeverage. To find out, first read thelabel of what you drink. This will enlightenyou as to what is in your beverage. Youmay be surprised at the many differenttypes of simple sugars and dyes that havebeen added to your beverage, or theamount of carbohydrates they contain. Tryto avoid as many additives as possible.The effects of many of these additives areunknown and still being studied.Water continues to be the best optionfor both hydration and to eliminate unwantedingredients. Proper liquid hydrationis essential to life. Without it, your bodycannot function or lacks the ability to functionto it’s potential. Make sure you knowwhat you are really getting and remember:Think Before you Drink!60 l Valley Health Magazine

Valley Health Magazine l 61

Healthy DiningSpecial Order:Dining Out On A Healthy DietA restaurant review of healthy choices by Mikell Suzanne Parsons, D.C., C.C.N.When it comes to leading a healthy life, it’s not just what we do with our bodies thatmatters. It’s also about what we put into them. Proper nutrition is one component offeeling great and living a long healthy life. In this area, most of us could use a lot ofimprovement. Here, I will show you how to enjoy dining out while still maintaining ahealthy diet. You don’t have to forego your favorite hangout, or dinner with friends andfamily to enjoy a balanced, satisfying meal.Restaurant:Bistro Rustico5789 N. Palm Ave.Fresno, CA 93704(559) 440-9603Here’s how to do it:What causes me to return to a restaurant?Healthy, well-balanced meals, a wait staff thatis happy to see me, and good-tasting, highquality food that doesn’t break my bankaccount. You will get all of these at BistroRustico located on the southwest corner ofBullard and Palm! What makes this restaurantunique and special is Chef and owner VaroujKachichian. Anyone who attends culinaryschool in Italy at the age of 14 has got tobe passionate about their profession! BistroRustico features all natural beef, pork, lamband chicken.You will find Chef Varouj at theFarmers Market two times per week shoppingfor the best seasonal organic fruit and vegetables.Because of Chef Varouj’s high standardsand uncompromising quality you can beassured of having a delicious meal every time.Picky eaters and those of us with allergy issuesare welcome here. This is my kind of place!Another passion of his is making his ownbreads and pastries and he will be opening abakery in the near future.Over the past several months I have takenmany people to Bistro Rustico, including mywhole office staff. I have discovered my alltime favorite salad (yes, a salad), is the organicbaby spinach with strawberries, glazed walnutsand Gorgonzola cheese tossed with basil-balsamic vinaigrette. I also add grilled chickenbreast for my lean protein but you can chooseshrimp or salmon if you prefer. Because Iam allergic to lettuce, I substitute the mixedgreens and have the spinach instead—soundsstrange but yes, you can be allergic to anything!This salad has just the right amount ofprotein (chicken), non-starchy carbohydrate(spinach) and healthy fats (sprinkle of cheeseand the oil in the salad dressing). It comes in asmall or large size. I find the small to be justright. However, if I feel I am not going to getenough non-starchy veggies in for the day,then I will get the large size. For a wellbalancedday of food you need at least 7 cupsof raw veggies or 3 1/2 cups cooked nonstarchyfoods. The dressing is not full ofsugar so I don’t feel the need to get it on theside. Many dressings are what I call “dressingcandy”. If it tastes sugary sweet, it probablyis and needs to be used with caution andordered on the side.Another dish that is out of this world, andfantastic from a nutritional standpoint, is thegrilled marinated chicken breast with grilledseasonal vegetables topped with shavedParmigiano and basil, served with Romescosauce (a pepper based sauce) and grilledfocaccia bread. Wow, everything had suchamazing flavor! I am not sure what his grillingsecret on veggies is but I am going to try tofind out. My veggies never taste like that athome.For someone who is on the quest for optimalhealth, I have to be aware of foods thatturn me into a gluttonous pig. These arethings that taste so amazing, I lose all selfcontrol and overeat to the point of misery. Ifound such a dish at Bistro Rustico. Picturethis: braised boneless beef short ribs withcelery root puree and seasonal vegetables.When you read “celery root puree,” it soundsto me as something on the weird, scary side,but I am likewise on a mission to broaden mytaste buds, so I tried it. Thank goodness Icould not sneak back into the kitchen to getmore! This dish is one of the most amazing,flavorful things I have ever tasted. My friendwanted to taste it and I actually thought aboutstabbing her hand with my fork. I had such ahard time sharing! (Beware my friend: nexttime you’ll need to get your own!) Nutritionally,the mashed potatoes (starchy vegetable)that the boneless beef short ribs came on didnot support my weight loss goals and thebraised beef doesn’t meet my “lean protein”requirements. If (or when) I order this dishagain, I will order an additional side of grilledveggies for a better-balanced meal.When you are looking for a change fromyour home cooking, or would like to trysomething new, I strongly encourage you totry Bistro Rustico. Look for me there—I will bethe one with a smile on her face enjoying awonderful meal!As a result of several amazing experiencesat Bistro Rustico, Dr. MikellSuzanne Parsons has teamed up withChef Varouj to create a gluten-free menufor those allergic to wheat products.Stop by the restaurant to learn moreabout these exciting new dishes!62 l Valley Health Magazine