by Janel Arbon, RDN

March is National Nutrition month! The Academy of Nutrition and Dietetics invites everyone to learn about making informed food choices and developing healthy eating and physical activity habits. 

How should you build a healthy meal and fuel your body? We read a million things online about what is healthy and what is not, and all the information seems contradictory. However, building a healthy meal really is simple! The following are some easy steps from Janel Arbon, a Registered Dietitian Nutritionist at Moab Regional Hospital, to start eating healthy.

First off is portion control. Controlling your portions and the amount of food you eat is essential to developing healthy eating habits. Start with a nine or 10-inch plate to help you watch your serving sizes. By managing your calorie intake, you can prevent over-eating and gaining weight.

The second is vegetables! Fill half your plate with non-starchy vegetables; these could be raw or cooked! You might try steamed broccoli and carrots or a spinach salad with bell peppers, cucumbers, and tomatoes. Instead of using heavy store-bought salad dressings, add a squeeze of lemon or lime or add vinegar and olive oil to your salads. Non-starchy vegetables are high in vitamins and minerals, low in calories (to help you maintain weight), and high in fiber, so they are filling and helpful to your digestive system!  

Third, find a healthy protein to make up ¼ of the plate. Choose a lean source of protein, which can be plant-based (tofu) or animal based. Lean animal proteins include skinless chicken or turkey (breast or white meat preferred), fish, pork loin, 90% lean beef, or eggs. The way you prepare your protein makes a difference. Baking or grilling are preferred cooking methods over deep frying or frying. Proteins are made of building blocks called amino acids; these amino acids help build and repair muscles and bones and help produce hormones and enzymes, all while providing energy for you!

Fourth, add a carbohydrate or starchy food for the other ¼ part of your plate. When choosing carbohydrates, it is best to choose a whole grain. 

Examples are brown rice, whole grain pasta, whole wheat roll, sweet potato, etc. Whole grains provide more essential nutrients that your body needs. Carbohydrates also provide the body with glucose, which converts to energy to help support your physical activity. Carbohydrates are typically your primary energy source.

Fifth, add some dairy. Low-fat dairy sources include an eight-ounce glass of skim or 1% milk, soy milk, and fat-free or low-fat yogurt. These choices provide you with calcium, which promotes healthy bones and teeth! Calcium also plays a role in blood clotting, muscle contractions, heart rhythms, and nerve functions.  

Sixth, add some fresh fruit for dessert. Fruit provides essential vitamins to your diet and is full of water which helps you stay hydrated. Fruit also has antioxidants, which help slow the aging process and reduce your risk for cancer. Fruit is also high in fiber, preventing constipation and lowering your risk for heart disease.  

Compliment your meal with a beverage by choosing water or a non-caloric drink. Choosing something non-caloric will keep you from getting unnecessary empty calories.  

Lastly, avoid extra fat. Monounsaturated fats (like olive oil, avocados, and nuts) are healthier fat choices. They should be used over other high-fat foods. High-fat foods increase cholesterol levels and increase your risk for heart-related illnesses. Don’t use heavy gravies or sauces that add to your calorie and fat intake. Eating steamed broccoli is great, but topping it with a lot of cheese sauce makes it much less healthy. Instead, try sprinkling the broccoli with a bit of parmesan cheese. It is still delicious but doesn’t have excessive calories.

These steps will aid in creating a healthy eating routine. Moab Regional Hospital’s Registered Dietitian Nutritionist, Janel Arbon, can help you develop healthy habits that are sustainable and unique to your health needs. To make an appointment with Janel, ask your primary care provider for a referral.

Written by Antje Rath, CMHC

Why is this time of year so difficult for me?

Grief is a difficult thing to experience at any time of year. The holidays, however, can compound that grief in profound ways. While there is no cure for grief, there are some things that can be done to help ease your pain, perhaps helping to make this holiday season just a little bit brighter.

During the holidays we are inundated with messages that this time of year is supposed to be filled with joy, spent with friends and family, free of conflict, and filled with laughter. Those expectations are hard to fulfill, even under the best circumstances, harder still, when we are struggling with grief. We just might not look forward to the season, to family gatherings, to office parties, and to everything else that comes with it.  Grief can keep us from joy.

For those who have lost a loved one, the holidays, with its focus on togetherness and joy, can cause us to miss our loved one even more than usual. Traditions from past years can suddenly feel meaningless or bring up painful memories and sadness. We don’t want to feel like a burden or spoil the season for others, so we might tend to keep our feelings inside. However, if we try to pretend or go through the motions for the sake of others, we often feel worse.

What are some ways we can take care of ourselves and find some peace in this difficult time?

Particularly when we are feeling down and vulnerable, it is important to “cover the basics.” Drinking enough water, eating a balanced diet, exercising, sleeping enough, and avoiding overindulging in alcohol or drugs are a necessary foundation for well-being. Reaching out for support is difficult for many people yet so valuable. People generally want to be helpful but they don’t always know how. Friends and family members might appreciate it if we reach out to them, asking for company while trimming the tree, suggesting to share cooking duties, or just requesting a hug or a listening ear.

If we don’t feel like socializing at all, it is okay to spend some time by ourselves, maybe watching a movie, taking a bubble bath, or meditating. If we find comfort in rituals and traditions, there is nothing wrong with keeping them. However, if they are more painful than helpful, it is absolutely okay to change them. The most important part is to listen to ourselves and to communicate with others around us about wishes, emotions, and expectations. Alone or in company, we can find ways to honor our feelings and the memory of our loved one, for example by lighting a candle at the dinner table, sharing memories, creating new traditions, or donating to a non-profit in our loved one’s name.

Social media can be helpful as well as hurtful during this time. Sharing, receiving support, and being validated can be immensely comforting. And it might be a lot easier to reach out on Facebook or Instagram than in person. However, being confronted with other people’s happy online “reality” or receiving negative responses can be quite distressing. Practicing good self-care and boundaries is as important in this context as everywhere else.

Another way to find some joy in the holidays, although maybe not at first, is to reach out to others in need. After experiencing grief ourselves, it is often easier to comfort someone in a similar situation. We can be the compassionate listener for them just as somebody else was for us at first. We can validate their feelings because we have felt them – or are still feeling them – as well. In addition to reaching out to individuals, we might also consider donating our time to churches or non-profits to connect with our community during the holidays. While COVID has made that a little more challenging, there are still many opportunities to contribute in rewarding ways.

For many people, the holiday season is about spoiling their loved ones in the best sense of the word. And of course, that is much easier to do if you feel good yourself. In order to feel good, you need to take care of your health, both physically and emotionally, so you can extend love to others. Being kind to yourself, making yourself a priority, is not selfish. It is necessary to be able to continue taking care of others and finding comfort during this difficult time. Please don’t hesitate to reach out if you need support, either to friends and family, or to a professional, like a pastor, a therapist, or anybody else you trust.

Wishing you peaceful holidays. 

Antje Rath is a Clinical Mental Health Counselor at Moab Regional Hospital. She leads a Grief Support Group on the first and third Wednesday of each month. To register, call 435-719-5563 or antjer@mrhmoab.org.

By Tami Edwards

In my pre-cancerous life, I was a very healthy and active individual. I had done everything right, according to everything I read after my first diagnosis. Yet, cancer still found me. In 2007, at 33, I found a small bump in my left breast, in the upper, inner quadrant. At first, I thought it was just a pimple and I would pick at it. It would bleed, then grow a little more. I was in a very bad marriage at the time and couldn’t really focus on my own health. I ignored it until it started to hurt. I finally showed it to a coworker who scheduled my appointment with my OBGYN that day. When he saw me, he thought it may be a cyst but referred me to a general surgeon, whom I saw 2 days later. When that doctor tried to aspirate the “cyst”, and couldn’t pull fluid out, he looked at me and said, “I believe this is cancer.” Something in me already knew that.

A mammogram revealed a very strange-looking mass. A biopsy a week later brought the official diagnosis of breast cancer and I was scheduled for surgery. On March 28, 2008, I didn’t know going into the surgery if I’d have a lumpectomy or a mastectomy; it would depend on my lymph nodes. Fortunately, those were clear and I only lost a golf ball sized chunk from my body. My oncologist planned my chemo treatments, 1 round every 3 weeks for 6 cycles, to be followed with 33 rounds of radiation. Then he told me I should do genetic testing because of my Ashkenazi Jewish heritage (all Eastern European). Five weeks later I found out that I am BRCA1, which carries with it a long list of other potential cancers and problems. At this time, I was the only one in my family who had ever been diagnosed with breast cancer. Most of my family had been killed in the Holocaust and so our history was limited. I was told to have a double mastectomy and total hysterectomy but I was only 33. I wanted more kids. So I opted to keep my own parts. And life went on.

Fast forward a little bit. I never did have any more kids. I was rendered essentially infertile from the chemo treatments and left that bad marriage in 2009. I had developed a drinking problem at the end and finally got sober in 2011, meeting my current husband in the rooms of AA. We married in 2014. I had both knees replaced in 2016 due to osteoarthritis brought on by the chemo. It had definitely aged my insides even if I still looked my stated age. In 2016 I was 41. In 2017, we relocated from California to Texas and I gained a lot of weight from the depression that set in. I had already started perimenopause and I was unhappy with my weight and my life.

In July of 2019, I had a cycle that started and then didn’t finish. At first I assumed it was due to the “change”. But then the bleeding got heavier and I was getting weaker and I finally called my doctor (my new GYN in Texas) and he put me on hormones to stop the bleeding and then we did a uterine biopsy. I was now 45 and figured it was time to let go of the idea of being a mom again. I was accepting that it was time to remove the plumbing, because there was no way I could continue with cycles like that for long. We decided on February the following year but 2 days later my biopsy results came back positive for uterine cancer. There was a question as to whether or not it was related to the gene but nothing would be known until my total hysterectomy on October 9, 2019. When I saw the surgeon two weeks later, he confirmed that it had also been found in my right ovary (I knew deep down it would be), a separate primary cancer, and we knew that the gene was responsible.

I went through chemo again, same schedule, different drugs. Fortunately I did not have to have radiation (radiation in my hoo haw??? Who wants that?). I gained more weight from the steroids and now that I’m officially in menopause, it’s stuck to me. And we moved to Utah in June, 2021.

I lost my mom to stage 4 breast cancer on 1/22/14. She had been too ill to meet Robert. She hadn’t wanted to get checked when I had the gene and when she was diagnosed, 3 years after me, it had already spread like wildfire throughout her body. I lost one of my best friends to lung cancer 12/23/20. She had always been too busy to see a doctor and when she was diagnosed, it was also too late. She only lived 9 months. I have lost many other friends to the awful disease of cancer, and some were seemingly preventable.

After my breast cancer, I took ownership of my life. If something doesn’t feel right, doesn’t look right, I go to a doctor. I’d rather it be nothing than find out later it’s too late and I should have done something sooner. Had I waited just two more weeks, the cancer would have invaded my chest wall and I likely wouldn’t be here. My daughter was 13 at that time. I would have missed out on so much. And that gene is still active in this body, waiting to attack something else. I have to stay vigilant.

I’m a big advocate for cancer research, of all types. I used to do charity walks (until the knees) to raise money for the American Cancer Society. I’d like to try that again. And I share my story with anyone who will listen. One in eight women will be diagnosed with breast cancer at some point in their lifetime. But the odds vary among races. One in 40 Ashkenazi Jewish women will face the diagnosis compared to 1 in 500 Asian women. No one wants to be the “lucky” one. So get checked. Do your annual exams and your mammograms. Feel your boobies! But also keep in mind that uterine cancer is one of the most prevalent female cancers. And we are so dismissive! We shouldn’t be. Your odds of survival are so much higher when things are caught early, and the treatments are easier, too. If something doesn’t feel right, get it checked out.

By Dr. Lauren Prest

It’s Alcohol Awareness Month and in Moab, alcohol is abundant. It is a big part of our tourism industry, in particular, which is a positive source of income for many. Alcohol is often seen as helping life feel more fun, relaxing, or pleasurable. On the other hand, alcohol use presents challenges when visitors and locals alike over-imbibe and can result in injury, interpersonal disputes, legal repercussions, and sometimes death.

Certainly in this day in age, the “opioid-emic” is getting far more press. But high-risk alcohol use is more prevalent than opioid and other drug use, and also more socially acceptable. People drink in happy times and sad times. They drink to numb their emotional and physical pain. They drink more or less depending on their stage of life, life stressors, family traditions, friendships, and physical tolerance. The COVID pandemic has changed how many people drink: recent studies indicate alcohol use may have increased by 21% over the last couple of years. Genetics and family dynamics have a role in how people perceive and use alcohol.

Some 14.8 million people in the United States over the age of 12 meet the criteria for Alcohol Use Disorder or alcohol addiction. As we examine our own alcohol use during Alcohol Awareness Month, it may help to understand what amount of drinking is considered excessive from a health standard.

Drinking any amount of alcohol is known to increase harm, but the CDC guidance recommends 2 or fewer drinks for men and just 1 drink or less for women on any given drinking day. It goes without saying that pregnant women, youth, those with significant medical problems, and those with addiction histories should not drink at all.

The most significant short-term consequences of alcohol use, including accidents, injury, and violence, are associated with binge-style drinking. Binge drinking is defined as consuming 5 or more drinks in one sitting for men and 4 or more drinks for women. The long-term health risks of alcohol use include high blood pressure, heart disease, liver disease, gastrointestinal problems, malnourishment, brain damage, and a long list of cancers.

With all these negative health outcomes associated with alcohol use, not to mention the alcohol abuse’s impact on social function and family systems, it can be easy to carry a lot of stigma and shame about drinking and to avoid thinking about how significant the impacts may be on yourself and those who love you. But it’s also important to know how to get help and support if you are struggling to cut back your alcohol use on your own.

Moab Regional Hospital is opening a new recovery center in June 2022 to provide counselors, medical support, and even detox services for our community. It can be life-threatening to suddenly stop regular and heavy alcohol use, so reaching out for medical care is vital. Please have a safe start to the season and come find us at our new Recovery Center if we can support you or your loved ones!

Dr. Lauren Prest is a fellowship-trained addiction psychiatrist who worked at Moab Regional Hospital 2019 – 2022.

By Dr. Lauren Prest, Director of Mental Health and Recovery Services at Moab Regional Hospital

Harm reduction has entered the Zeitgeist! Even though this term has been around since the 1980s, it is finally becoming a concept more and more people are familiar with. Those involved in caring for and treating people who engage in habitual, high-risk behaviors of substance use and addiction, know there’s no amount of negotiating, begging, pleading, or threatening that will change a person’s end action. From this basic truth, harm reduction was born.

Harm reduction means meeting someone where they are and helping negotiate the inevitable outcomes of their decisions. It means increased acceptance toward risky behaviors and finding strategic ways to reduce the associated damages through the core principles of realism, flexibility, pragmatism, and social justice.

Classically, harm reduction interventions have focused on substance using populations due the inherent harms involved. IV drug use, for example, is associated with many infectious diseases because needles may be shared or re-used. Safe needle exchanges, a type of harm reduction program, were created to give individuals who use IV drugs access to sterile needles. These programs also reduce the risk that needles will be shared, reused, or left in unsafe places. As a result, morbidity and death associated with infectious diseases like Hepatitis C and HIV and the cost of treating them have dropped significantly for health systems and communities using needle exchange programs.

Harm reduction philosophy can be applied to non-substance using people as well. We all engage in activities that have the potential for some threat. As an example, many of us wear seatbelts when driving. Wearing a seatbelt doesn’t stop us from getting into accidents, but it does reduce the threat of physical injury.

Of course, some activities go against social norms and as a result, carry more stigma. With this in mind, harm reduction has been growing as a mainstay of addiction care because it also helps fight stigma by allowing people to make their own decisions without judgement. It provides an access point for care and an intervention point for healthcare providers to introduce treatment. Harm reduction keeps people who might avoid treatment engaged in care by allowing them to participate more openly and find aspects of care that work for them.

Allowing those struggling with ambivalence about their behaviors to make their own decisions and empowering them to do so more safely can provide essential and lifesaving time for them. Addiction is not a moral failing – it is a biological and behavioral disease that responds to treatment just like diabetes and high blood pressure. Moreover, hope exists for healing as long as a person can be kept alive.

Nevertheless, because of social stigma, many people may misunderstand what harm reduction is intended to do. It should be understood that harm reduction does not advocate for drug use. In fact, in communities using harm reduction methods, drug use and crime rates both decline. The economic and legal benefits for communities that embrace harm reduction are well established and easily evidenced. And, programs that enhance education and emphasize social interaction are more effective.

As our new Recovery Center opens in June 2022, Moab Regional Hospital will engage in general harm reductionist philosophy to ensure an unbiased access point for care. The new Recovery Center will have strong, evidenced based standards, which include harm reduction as both a clinic culture and a form of treatment.

If you or your loved ones need support, education, or resources for substance use and addiction, please contact us at 435-719-3970. The Recovery Center will have Narcan and harm reduction kits available for anyone who asks.

One of the most serious dangers brought on by advancing years is the risk of slipping and falling. Falls can result in broken bones and other severe injuries. Besides being painful, difficult trials on their own, these injuries can easily precipitate a rapid physical decline. Luckily, seniors do not have to passively accept worsening balance and loss of bodily stability and coordination. Here are five essential exercises older folks can practice to improve their ability to balance.

1. Calf stretches. This simple exercise strengthens the legs. Seniors should perform calf raises by standing and then raising themselves up on their toes as high as possible, before gradually returning to the starting position. Calf stretches can be performed 25 or more times at once.

2. Single leg balance. This exercise is performed standing behind a chair, holding on to the top of the chair. Seniors should lift up one leg and hold it in place for as long as possible. The goal is to be able to hold the pose for a full minute. With time, as strength is regained, seniors can progress to balancing without the aid of a chair.

3. Lunges. Lunges are a lower body exercise that helps seniors regain their balance following a misstep. Lunges are performed from a standing position. Seniors should step one foot forward, bending at the knee until the thigh is straight up and down. This pose should be held for up to 30 seconds. At least ten lunges per leg should be performed.

4. Standing march. This simple exercise is exactly what it sounds like. Seniors march in place for 30 seconds or more, continually raising and lowering their knees throughout. The standing march should be performed as rapidly as is comfortable.

5. Walking a line. This exercise is completed using a line of tape on the floor or any other straight line. Seniors should slowly walk heel to toe for 25 or more steps, being sure to carefully follow the line. Extending the hands out to the side will help improve balance further.

It is true that the process of aging cannot be stopped. However, age-related declines in physical ability are not nearly as inevitable as is commonly assumed. With a proactive, dedicated approach to staying active and relatively fit, it is quite possible to minimize injury risk and to retain a high quality of life deep into old age.

Colorectal cancer is the second leading cause of cancer deaths in the United States, with almost 52,000 deaths in 2019.  In general, however, it is a slow growing cancer that is treatable if caught early enough, and in fact it can actually be prevented. That’s where screening comes in. In the past, screening was advised starting at age 50, but prompted by an alarming increase in colorectal cancers in younger patients, an independent expert panel has recommended that individuals at average risk for the disease start the screening process at age 45. This change in guidelines advocated by the U.S. Preventative Services Task Force (USPSTF) now aligns with that of the American Cancer Society, which made the recommendation for a lower screening age of 45 in 2018. The task force recommendation means that insurers will be required to cover preventative procedures such as stool tests and colonoscopies that can detect colorectal cancer at an early stage. 

In 2020 11% of colon cancers and 15% of rectal cancers occurred in patients younger than 50 years, compared to 5% and 9%, respectively, in 2010. Colorectal cancer is even being seen in increased frequency in patients in their 20s and 30s and by 2030 is expected to be the leading cause of death from malignancy for people in their twenties through forties. 

The reasons for this increase are unclear though there are several known risks factors:  environmental toxins, poor diet, sedentary lifestyles, and obesity.  

In addition, another major study has found that continuing colorectal cancer screening past the age of 75 is felt to be beneficial for some people, whereas previously it was generally advised to stop screening in these patients. 

Colonoscopy is considered to be the “Gold Standard” of colorectal cancer screening. This is because the test physically looks at the lining of the intestine, and also because pre-cancerous polyps can be removed before they ever get the chance to turn into malignant growths. There aren’t many cancers where we can intervene in such a way. Another benefit is that with a normal exam, the next one will not be necessary for ten years, depending on one’s personal and family history. 

Are you afraid to get a colonoscopy?  If so, you are not alone.  Many people think the exam will be painful or embarrassing. In fact, in spite of the preventative benefits of colorectal cancer screening, only around 70% of eligible individuals in the United States undergo screening. But colonoscopy is not something to be feared.  It is quick and painless, you will be covered up during the procedure, and you can be back to normal life the following day. 

In addition, there are other methods of screening available, including stool tests which need to be done every one to three years.  These are all effective screening methods and some are quite inexpensive. If you are unsure which test is best for you, discuss it with your healthcare provider. 

Our current guidelines for screening are:

Average risk, start at age 45

People in good health with a life expectancy more than 10 years should continue regular screening through the age of 75

For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, overall life expectancy, overall health, and prior screening history. 

People at higher risk may need earlier and more frequent screening. This includes people with a personal or a strong family history of colorectal cancer or certain kinds of polyps; a history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease); hereditary colorectal cancer syndromes; or a history of radiation to the abdomen or pelvis. 

With all of the alternatives available, there is no reason not to get screened for colorectal cancer.  No test is perfect, but there is a test that is right for you. So whatever one you choose, just get screened. It is one of the best decisions you can make for your future health. 

As you get older, it is important that you talk to your loved ones about healthcare planning and end-of-life wishes. Though you may want to just enjoy any time that you get to spend together, the truth is that you need to discuss certain things that may be uncomfortable to talk about. You don’t want to wait until it is too late to talk about these things.

So, what are they? Here are some important conversations that you need to have (and soon).

Your healthcare and end-of-life wishes 

It is very important that you take the time to talk to your loved ones about your healthcare and end-of-life wishes. If you are having any health concerns, bring them up with your loved ones. Let them know what medications you are taking for these conditions and what else you need to do about it.

This is also the time to talk about your end-of-life wishes if you become really ill. Do you want the hospital staff to do everything that they can to keep you alive? Do you want to be put on a respirator? Do you want them to do emergency surgery, even if it looks like the outcome isn’t good? Let them know what you want to be done and what you want to avoid.

At this point, you may also want to fill out an Advance Directive that will appoint a healthcare advocate for you, in case you become no longer able to advocate for yourself.

Your lifestyle 

If you are struggling at home and need some more help, they need to know. Otherwise, they won’t be able to help you. You may avoid talking about this because you don’t want them to feel like they have to pitch in more. However, if you are struggling to live at home, you may be able to get help. You can talk to a caregiver agency to figure out how they can make your life a little easier. You may even decide that you would rather move into an assisted living facility to get the care that you need.

Finances

Though it can be hard to talk about finances, it is important to bring it up. Talk to them about how much you have saved for retirement. You may want to let them know how you expect to pay for your medical expenses if they grow. Also, if you end up in an assisted living facility, they need to know how to pay for it.

Estate planning 

Most adults have a will and some sort of plan in place for when they are gone. It is important that you show your loved ones where your important paperwork is and where they can find your will. Let them know what you want done with your body when you are gone. Do you already have a burial plot, or are you going to be cremated? Do you have an idea of any services that you may like to have? The more information that you can give your loved ones, the less they will have to worry about when you are gone.

Though it can be hard to talk to your loved ones, you need to do it before it is too late. Keep them informed of any health concerns that you may have. Let them know what you want to be done medically if you find yourself unable to speak up. Talk to them about needing some extra help or if you want to move into an assisted living facility. Also, talk to them about your finances and how you are prepared to deal with whatever the future throws your way.

Moab Regional Hospital will host an informative presentation on the importance of healthcare planning and how to begin important conversations about healthcare planning and end-of-life wishes with loved ones. Please join Dr. Kathy Williams, Family Medicine physician at Moab Regional Hospital, Christina Sloan, founding member of the Sloan Law Firm, and Kristine Curtis, Registered Nurse with Grand County Hospice, on Tuesday, July 13^th at 6 pm via Facebook Live. On Thursday, July 15^th at 6 pm, Moab Regional Hospital will host an in-person workshop to answer questions about the Utah Advance Directive form that can be found at www.ucoa.utah.edu/directives. Questions? Please call 435-719-3683 or go to www.mrhmoab.org/events.