More mothers are choosing to breastfeed: Breastfeeding Awareness Month a platform for education, experts say

by Alyssa Harvey, The Daily News, originally published on 8/6/2010

Amanda Hughes remembers how difficult it was to breastfeed her son, Josiah, when he was born four weeks ago.

“I worried that I wouldn’t have enough milk because I had a breast reduction four years ago,” the Bowling Green woman said. “I did a lot of research about how to increase my milk supply and why (breastfeeding) is better. It was kind of difficult at first because my husband couldn’t feed him, but it’s easier now. Once we get into more of a routine, it’ll get better. I’m really enjoying it.”

As World Breastfeeding Week draws to a close Saturday and Breastfeeding Awareness Month continues in Kentucky through August, advocates promote ways to successfully nurse. This year’s theme is “The 10 Steps,” which refers to steps identified by UNICEF and the World Health Organization as crucial to providing optimal breastfeeding care for new mothers and babies in maternity care settings and are standard requirements for recognition as a Baby-Friendly hospital or birthing facility. The steps are listed at UNICEF’s website at www.unicef.org.

To celebrate the month, the Barren River District Health Department has displays and giveaways and mailed letters to breastfeeding mothers, said Susan Brown, a board certified lactation consultant at the health department.

“Statistics show moms want to breastfeed,” she said. “Once they do it, they need support to carry through, and that takes a whole community.”

Marilyn Thomas, a board certified lactation consultant at The Medical Center, agreed. More mothers giving birth there want to breastfeed, she said.

“In the past six months, an average of 72 percent of moms came in requesting to breastfeed,” she said.

Breastfeeding is recommended by various health organizations. The district health department and the American Academy of Pediatrics support breastfeeding as the ideal and the only nutrition a baby needs during the first six months of life. The academy also encourages breastfeeding with complementary food for at least the first year and beyond if both mother and the baby desire. The World Health Organization and UNICEF recommend breastfeeding continue with appropriate complementary foods through the child’s second year and beyond.

“Breastfeeding is healthier for society and better for the economy. More and more of the studies say that this is true,” Brown said. “There is nothing to throw away. The milk is ever changing. It’s not the same from breast to breast and feeding to feeding.”

Some benefits include enhanced brain development, higher IQ scores, better speech development, straighter teeth, stronger and more developed facial muscles, optimum mother-infant bonding and a reduced risk of ear infections, asthma, allergies, childhood leukemia, diabetes, hereditary high cholesterol, sudden infant death syndrome and obesity.

“Breastfeeding improves temperature with skin-to-skin contact,” Brown said.

The health department, The Medical Center and various other organizations work together to ensure that mothers have the support they need to breastfeed successfully. For example, when patients participating in Women, Infants and Children – a national supplemental food program administered by the U.S. Department of Agriculture – are in the hospital, they are referred to Brown, who can call the mothers before they are released from the hospital. Breastfeeding peer counselors are available through the health department. Mothers can also receive help after they are discharged from lactation consultants at the hospital for a fee.

“We see outpatients as needed,” Thomas said. “Some doctors send patients for a consult visit.”

One aspect of breastfeeding that Thomas and Brown agreed needs improvement is support from businesses once breastfeeding mothers return to work. For example, The Medical Center has a place where lactating mothers can pump their milk, Thomas said.

“Many moms go back to work and don’t have an office where they can pump,” Brown said.

WIC clients returning to work qualify for an electric breast pump, Brown said. Even for those who don’t pump, though, breastfeeding doesn’t have to be an all-or-nothing way of life.

“It can work if you only breastfeed at home,” she said.

Hughes said that at first she only planned to nurse Josiah for six weeks. Now her goal is to breastfeed him for six months to a year. She also plans to pump once she returns to work. She urges mothers who are having a difficult time breastfeeding to stick with it if possible.

“It’s definitely going to be frustrating in the beginning. Once you and your baby get used to it in the beginning, it will be worth it,” she said. “When you get frustrated, remember why you did it in the first place – for your child. It’s definitely healthier for them.”

Free breastfeeding classes are available from 1 p.m. to 3 p.m. the second Tuesday of odd-numbered months. For more information, call 781-8039.

The Medical Center also offers free breastfeeding classes monthly. For more information, visit www.mcbg.org.

Copyright 2010 News Publishing LLC (Bowling Green, KY)

Healthy habits: 'My Pyramid Workshop' teaches children proper nutrition

by Alyssa Harvey, The Daily News, originally published on 7/30/2010

In the past, 10-year-old Avery Peerce didn’t eat many vegetables in her school lunches.

The Rich Pond Elementary School fifth-grader plans to turn over a new leaf when school starts next week.

“The cafeteria didn’t have as many fruit and vegetable choices as I wanted, but I’m going to start trying more fruits and vegetables that they have,” she said. “I’m going to try to eat more from the (U.S. Department of Agriculture) Food Pyramid.”

To prepare for healthier eating at school, Avery took a three-class series for children, “My Pyramid Workshop,” at The Medical Center’s Health and Wellness Center at Greenwood Mall. In the program, community wellness manager Jenny Golden discussed the USDA’s Food Pyramid, reading food labels and healthy meal planning.

“I took it so that I can be healthy with my choices in food,” Avery said.

At a recent class, Golden told students how their plates should look when planning a healthy meal.

“The best way to get fiber is from fruits and vegetables,” she said. “One-half (of the plate) should be a nonstarchy vegetable. One-fourth should be a meat, fish, eggs, beans or some other type of protein. One-fourth should be breads, grains or starches.”

Various everyday items can be used to figure out one serving size, Golden said. For example, 1 ounce of cheese is equal to the size of four stacked dice. One cup of broccoli is equal to the size of a fist. One-half cup of ice cream is the size of a tennis ball.

“One ounce of nuts or small candies is equal to the palm of your hand, not your whole hand,” she said.

Golden encouraged kids to drink more water, eat more whole foods and less processed foods and eat breakfast because it is the most important meal of the day. She also talked about “Go, Slow and Whoa” foods. “Go” foods are healthy and can be eaten almost anytime, such as fruits and vegetables. “Slow” foods, such as waffles, can be eaten in moderation, maybe two to four times a week. People should not eat “Whoa” foods, such as candy, very often.

“We need to eat healthy food to stay as healthy as we can,” she said.

Whether children eat in school cafeterias or pack lunches from home, eating healthy is important, said Andrea Norris, registered dietitian at The Medical Center. Some healthy choices children may see in school include 2 percent or 1 percent milk, fresh vegetables and 100 percent juice.

“More schools are trying to offer fresh fruit,” she said.

Packing lunch from home can be easy, Norris said. Those who choose this option can pack foods such as individual serving sizes of vegetables or fruits, cheese sticks and sandwiches on whole wheat, pita bread or tortillas.

“If you’re going to use lunch meat, use a lean one like turkey or ham, and try to stay away from bologna and salami,” she said. “Deli meat has less sodium than packaged meat.”

For a sweet treat, angel food cake, trail mix and fruit are good choices, Norris said.

“Don’t do too much dried fruit because of the sugar content,” she said.

When children are armed with knowledge, they can make good food choices, Norris said.

“It starts with education at home when it comes to picking healthy foods at school,” she said. “Encourage them to try that.”

Copyright 2010 News Publishing LLC (Bowling Green, KY)

Hedges named specialty hospital’s Nurse of the Year

by Alyssa Harvey, The Daily News, originally published on 7/30/2010

Tiffany Hedges wasn’t planning to become a nurse.

Instead, she had her sights on a career that would have her working with money instead of medicine.

“I went my first year (of college) to be an accountant,” she said.

It wasn’t long before she realized accounting was not for her.

“I didn’t want a 9-to-5 job where I didn’t feel like I was helping anybody,” Hedges said.

Now a registered nurse at Commonwealth Regional Specialty Hospital, a long-term acute care hospital within The Medical Center, Hedges was recently recognized for helping patients by being named the specialty hospital’s Nurse of the Year. She has worked there for three years.

“I was completely surprised,” she said.

Hedges’ job includes various aspects of taking care of patients, including getting their medication, doing assessments and getting them ready for procedures.

“I enjoy the critical aspect of it. Anything critical care I enjoy,” she said. “We have patients here for a long time, and we really get to know them. I like to see patients come back after they recover.”

The Louisville native moved to Bowling Green when she was in middle school. She said she was inspired by her grandfather to go into a profession that would help others.

“I got the idea from my grandfather, who was an (emergency medical technician), policeman and fireman. He was an athletic trainer for (St. Xavier High School) in Louisville,” she said. “He was really sympathetic to people. I liked seeing how much joy he brought to other people’s lives.”

Hedges earned an associate’s degree in nursing from Western Kentucky University. While she spent the first part of nursing school working as a manager at McDonald’s, she decided to devote the second part of it concentrating solely on school.

“I got through nursing school with a lot of support from my family,” she said.

Nursing has enough variety to keep her busy.

“I always have something different every day,” she said. “It keeps you on your toes.”

Copyright 2010 News Publishing LLC (Bowling Green, KY)

Group predicts major hospital revenue losses after reform

by Robyn Minor, The Daily News, originally published on 7/25/2010

While Warren County hospitals individually are still trying to figure out how they will be affected by health care reforms, the Kentucky Hospital Association is predicting that the state’s hospitals stand to lose $1.2 billion in revenue over the next 10 years.

Lower revenues will mean less money for wages and salaries of employees, less direct and indirect spending in each facility’s community, and delayed facility improvements.

That prediction is based on the economic impact that hospitals have now. The most recent report available showed that the state’s hospitals treated nearly 10 million people in all facets of their operations during 2008. Those hospitals employed 80,000 people with annual wages and salaries of $3.52 billion.

Some hospitals, because of current economic conditions, have already laid off employees. Jewish Hospital and St. Mary’s HealthCare in the Louisville area cut 500 positions this year. The provider and its parent company have been in talks recently about a merger with another health care provider to help with a failing bottom line.

“We are not there and we are hoping that we don’t have to do something like that (layoff),” Greenview Regional Hospital CEO Mark Marsh said.

Marsh said the hospital already is cutting costs where it can and deferring nonemergency spending on projects.

“But those can only go so far,” he said.

Marsh said the hospital hasn’t quantified exactly how health care reforms that are set to phase in through 2014 and beyond will affect the hospital.

“But we know that the Medicaid rolls are going to increase,” Marsh said.

The Medical Center also is beginning to weigh what the possible impact.

“The Medical Center is closely monitoring developments in government sponsored healthcare reimbursement programs, specifically Medicare and Medicaid, following the passage of recent health reform legislation,” Commonwealth Health Corp. Executive Vice President Ron Sowell said in an e-mail to the Daily News. “While it is too early in the development of expected regulations to fully model the financial impact of the legislation, it is apparent that Medicare reimbursements to hospitals across our country will be reduced over the next 10 years if the legislation is not amended by Congress.

“The Medicaid program is also expected to add a significant number of newly covered individuals under plans contained in the reform legislation,” Sowell said. “Neither Medicare nor Medicaid currently covers the full cost of hospital care provided to individuals in those programs.”

Changes in reimbursement come at a time when people who have health insurance are seeing their premiums and co-payments rise or COBRA insurance for the unemployed is running out or is too costly, all increasing the likelihood that hospitals will see more bad debt and charity cases, Marsh said.

In 2008, the cost for indigent care to Kentucky hospitals was $370.6 million, according to the Kentucky Hospital Association.

Greenview, a for-profit hospital, estimated in 2008 that it spent nearly $1 million to care for those patients who were uninsured or fell below the federal poverty line and consequently weren’t billed.

The Medical Center, a nonprofit hospital, estimated that $7.3 million was spent treating patients whose income was below the federal poverty level.

Neither hospital’s indigent care figure includes charity care to other uninsured people, or the full costs for Medicare and Medicaid services.

While local hospitals, in providing this report to the KHA, didn’t take into account health care reform legislation that was not yet passed, the reports did consider what a 10 percent reduction in collected revenues would mean.

Greenview, which says that 72 percent of its patients are covered by either Medicaid or Medicare, said the loss would reduce hospital wages and salaries annually by $1.8 million, reduce state and local tax revenue by $430,000 and have a ripple effect of a $9.4 million loss in regional sales.

The Medical Center’s report, which estimates that 66 percent of its patients are covered by government programs, would see a reduction in hospital wages and salaries annually of $7.7 million, $1.8 million less in state and local tax revenues and a $36.1 million loss in regional sales.

Marsh said some hospitals already are seeing a reduction in what they spend on purchases for equipment.

“Some are losing basic patient care when equipment breaks that they can’t replace,” he said.

Marsh said the future of hospital care still has many unknowns.

“We are trying to be as prudent with our resources as we can be,” he said.

Sowell said The Medical Center will continue to try to improve care while cutting costs.

“Our success in these two areas will allow The Medical Center to adapt to the changes in reimbursements created under the reform legislation while at the same time providing us the financial means to continue our investments in the latest technology, facilities, and a highly trained workforce.”

— For information about health care reforms and the dates they are set to be phased in, go to www.healthcare.gov

Copyright 2010 News Publishing LLC (Bowling Green, KY)

Registered nurse didn’t take direct route to her profession

by Alyssa Harvey, The Daily News, originally published on 7/17/2010

Jackie Wofford’s motto is a quote attributed to late author Erma Bombeck: “Seize the moment. Just remember all those women on the Titanic who waved off the dessert cart.”

When a bout with breast cancer forced her to choose between teaching and nursing, two professions she loved, she went with the one that was more of a calling.

“This fulfilled me. I always liked working with patients,” she said of her career as a nurse. “I felt like that was what God was saying. I feel like I make a difference.”

Wofford has been a registered nurse in The Medical Center at Scottsville’s emergency room for a little more than two years. She does triage, meaning that she sorts patients based on medical need and treats them.

“In a small ER like this, you see everything. Not everything is an emergency, but it’s important to the people who come here,” she said. “Allen County has a lot of heart attacks. We also see pain, car wrecks and trauma.”

Although she had always wanted to be a nurse, Wofford said she didn’t take a direct route there. When she was 22, she became an emergency medical technician and then a paramedic. She was one of the first female paramedics in the region. She later earned a bachelor’s degree in nursing from McKendree University and a master’s degree from Spalding University, both in Louisville. As a student, she also worked and raised a family.

“I worked in Louisville for several years,” she said. “I worked in long-term care mostly. I also worked for a psychiatrist.”

For more than a year, she taught in the associate’s degree nursing program at Western Kentucky University’s South and Glasgow campuses and worked at The Medical Center at Scottsville at the same time. She had worked at the hospital years ago when it was called the Allen County War Memorial Hospital.

“We did everything there,” she said of the old hospital. “Everyone wore a cap. We did labor and delivery. We mixed medicine.”

Doctors and nurses seemed to be on different levels then, but now things seem different, Wofford said.

“It’s much more of a team concept,” she said. “We’re more partners in care. It’s a really good trend.”

Her battle with breast cancer last year made her realize she couldn’t keep up the pace of nursing and teaching. Wofford received radiation for six weeks while working both jobs.

“I never missed work. I never dread coming to work,” she said. “That’s a real blessing. I really love it here.”

Some of her favorite things about being a nurse are making people feel better, working with families and problem-solving when outcomes are going in a different direction than the wishes of the medical staff. She said she believes Commonwealth Health Corp., the parent company of The Medical Center at Scottsville, and the hospital itself are patient-oriented.

“They want good patient care, good outcomes and want to help you get there,” she said.

Copyright 2010 News Publishing LLC (Bowling Green, KY)

Kentuckians’ obesity rate still high; local agencies try to help: Recent study shows state seventh most obese

by Liz Switzer, The Daily News, originally published on 7/2/2010

A new study shows that obesity rates for Kentuckians remain among the highest in the nation – particularly among school age children.

While adult obesity rates have increased in 28 states, with marked disparities along racial and ethnic lines, four states last year had obesity rates above 30 percent. This year, Kentucky adults join that group, ranking as the seventh most obese state, while Kentucky children ranked third behind only Mississippi and Georgia.

As the country’s obesity epidemic worsens, obesity rates for adults now exceed 25 percent in more than two-thirds of the states, with the highest rates among Latinos and blacks, according to the report F as in Fat 2010: How the Obesity Crisis Threatens America’s Future, authored by the Trust for America’s Health and the Robert Wood Johnson Foundation.

Eight states now have rates above 30 percent – Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia. Nine of the 10 states with the highest rates of obese children are in the South.

Obesity rates for children ages 10–17, defined as body mass index greater than the 95th percentile for the age group, ranged from a low of 9.6 percent in Oregon to a high of 21.9 percent in Mississippi.

While the news was bad, researchers also suggested ways to ensure that obesity prevention measures are implemented most strategically to help address the problem including the expansion of community-based prevention programs and investments in research and evaluation.

The Barren River Regional Health Department, The Medical Center’s Health and Wellness Center and Bowling Green pediatrician Dr. Debra Sowell are pursuing community-based initiatives, including a walking program for kids that also includes nutrition counseling. There is no fee to join, but participants are asked to complete a registration form and log the miles he or she walks.

The program was launched about two weeks ago and the response so far has been lukewarm, Sowell said, despite stepped-up nutritional and physical activity efforts of area local schools.

“Kentucky has a big problem,” she said, responding to results of the obesity report. “A lot has been done but you would be surprised at the numbers of kindergarten and sixth-grade kids I’m still seeing.”

The school programs in Warren County and Bowling Green are still fairly new so the new research may not truly reflect the whole situation here, according to Barren River Regional Health Department dietitian, Teresia Huddleston.

The health department has also begun collecting data from schools in the region on body mass index to help with grants directed at exercise and nutritional programs, While Bowling Green and Warren County schools have implemented nutritional program aimed at reducing obesity, many rural schools in the region are not doing as much, Huddleston said.

The 2010 Nutrition and Physical Activity Report Cards for Warren County and Bowling Green Independent schools show that new health initiatives – zero trans fats, low-fat milk, steamed and baked entrees – are meeting goals designed to improve the health of students. The schools are meeting those goals while holding the line on costs as well.

More than 1.8 million lunches will be served in Warren County schools this year, and those meals are healthier and provide more nutritious choices for students, while the cost has not increased since the 2003-04 school year, according to Gina Howard, director of food service and nutrition for the district.

Schools are close to meeting goals for reduced calories and high nutritional value with a target of 664 calories in a meal. The 2010 analysis showed that the actual calorie count is 700, along with increases in iron, calcium, vitamin A, vitamin C and protein. The district also exceeded its goal in total fat intake, aiming for 30 percent of total calories when the actual was lower at 25 percent. Students are also consuming less saturated fat with 6.93 percent of calories coming from that source.

For $1.75 – or 40 cents reduced – Warren County’s 21 schools have begun offering whole grains, fresh fruits, vegetables and low-fat milk daily in addition to using zero trans fat oils and improved cooking equipment that allows vegetables, pizza and french fries to be steamed.

The cost factor is particularly important too as the national report also shows that obesity rates appear to have some relationship with poverty rates in many states, including Kentucky, Mississippi, Washington, D.C., Louisiana, New Mexico, Texas, Arkansas, Arizona and West Virginia.

The number of Warren County students eating breakfast is also growing with an average of 646,289 participants now over last year’s 614,498.

The Bowling Green Independent Schools district is also making strides to meet its nutrition goals. The district is currently meeting its target of 645 calories while the local analysis showed the district was over its targets for iron, calcium, vitamin A, vitamin C and protein. In fat intake, aiming for 30 percent of total calories, the district is consuming 2.8 percent more than its goal.

The number of lunches and breakfasts served increased over the previous year. According the school system’s nutrition and physical activity report card, 550,993 lunches were served, with an average daily participation of more than 3,000 students. The report card noted that 1,824 students eat free, 211 eat at the reduced price of 40 cents and 1,704 eat at the regular lunch price of $2.

— For more information on the walking program, call The Medical Center Community Wellness Department at 745-1010 or 1-800-624-2318. For more on the report, go to Trust for America’s Health: http://healthyamericans.org/reports/obesity2010.

Copyright 2010 News Publishing LLC (Bowling Green, KY)

Commonwealth Regional Specialty Hospital’s Kariman honored

by Alyssa Harvey, The Daily News, originally published on 6/26/2010

Mahsa Kariman has wanted to make sure her patients get the best care ever since she became a certified nursing assistant.

“I take care of my patients the best way I can,” she said. “I love caring for my patients.”

Still, she was surprised when she was recently named the Clinical Support Employee of the Year at Commonwealth Regional Specialty Hospital.

“I was very surprised,” she said. “I thank my co-workers. It meant a lot to me that they thought I could make a difference in someone’s life.”

Kariman has been a CNA at the specialty hospital, a long-term acute care hospital within The Medical Center, for a little more than five years. She helps the nurses take care of patients by doing a variety of tasks, including checking vital signs, helping with baths or getting them to the bathroom or helping them eat.

“If someone needs to be fed, I feed them,” she said. “Patients are usually here for 25 days or more. They are very sick when they come up.”

A 2004 graduate of Warren East High School, Kariman first became interested in health care while she was still a student.

“In my senior year I was done with credits for high school. I could either graduate early or go the whole year,” she said. “I decided to do a co-op.”

The co-op class was for students interested in becoming CNAs and was done at Warren Central High School. The first semester was mainly in-class work, but the second semester had students visiting places where CNAs may work, such as nursing homes.

“I started to like it,” she said of the possibility of working in health care. “Before that, hospitals always scared me.”

At first, Kariman thought she might want to be a nurse. She became a student at Western Kentucky University and began working at the specialty hospital. She still enjoyed taking care of patients, but the possibility of any of them dying began taking its toll on her.

“I’ve seen a lot of deaths,” she said. “I get attached too fast to people. I told my mom this will be stressful for me.”

Kariman changed her major to public health in her sophomore year at Western. She recently received her bachelor’s degree and plans to continue her education by pursuing a master’s degree in the fall of 2011.

“I want to take a year to research and find out exactly what I’m interested in,” she said. “I hate to leave hospital work because I love caring for people.”

Kariman said she loves it when her patients get well.

“They come in very sick and end up walking out of here,” she said. “There’s something very joyful about that.”

Copyright 2010 News Publishing LLC (Bowling Green, KY)