Wellness from Avera
Select columns and area clinic information from Avera Healthlines and other sources.
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Adult Day Services
By Chris Pellet, RN
Avera Sacred Heart Adult Day Services Clinical Director

There is a service available for those needing a little assistance during the day, but who are not in need of full-time nursing care just yet. It’s called Adult Day Services (ADS). Surprisingly, not many people have heard of services such as ADS and that’s unfortunate because it provides a wonderful experience for those needing care and companionship while providing a respite for their caregivers. Adult Day Services provide numerous activities for a wide range of participants. The program at Avera Sacred Heart is designed for persons who:
  • Do not require 24-hour nursing care
  • Are experiencing isolation or loneliness
  • Are experiencing some confusion and/or suffering occasional memory loss
  • Need assistance with personal care (bath, nail care, etc.)
  • Need their health and medications monitored
  • Need assistance coping due to the aging process
  • Have a need for supervision
  • Need assistance with activities of daily living
  • Have a desire to continue to grow mentally, socially and spiritually
  • Have other special needs

    Participants find a wealth of activities, special events and good, nutritious meals. Many special projects and activities are conducted on a daily basis. It’s important to realize that our goal is to allow each participant to remain in his or her own home, as long as possible. We assist in achieving that goal by fostering spiritual, mental, social and emotional growth while encouraging physical stimulation and restoration. It becomes like a big family where everyone has a part in the decision-making process and continues to grow as a person.

    I can’t stress enough the importance self worth plays in a service such as ours. Every person, regardless of age or needs, has to feel a degree of dignity and value as a human being. By helping participants restore and maintain their maximum level of functioning and participate in the wealth of activities provided, we help to invigorate the spirit and nourish their dignity.

    The respite provided to the caregiver at home can’t be overstated either. It can be difficult at times being a caregiver for a parent or relative. That stress can be overwhelming if the caregiver is trying to juggle his or her caregiving responsibilities, a job and other family obligations. Adult Day Services can help alleviate that load – sometimes on a daily basis or even for just a day at times. It’s not uncommon for us to have someone utilize our services just for a day and then start coming on a daily basis. The participant enjoys the camaraderie and the caregiver enjoys the break so much that they become regular clients.

    The fees for the program are very affordable and financial assistance may be available on a case-by-case basis. No one gets turned away. I would encourage anyone who may benefit from this service to give me call at 668-8625 for more information or stop by for a tour. We’re located in apartment 216 at Avera Sacred Heart Majestic Bluffs Senior Apartments. The hours are 8:30 a.m. to 3:30 p.m. Mondays through Fridays.

    Healthy Eating for Kids
    Doralynne Jarvis, RD, LN
    Assistant Director of Nutrition Services
    Avera Sacred Heart Hospital

    It’s back to school time, which also means packing brown-bag lunches occasionally for some of you. For many kids, eating well is almost equivalent to doing homework. Luckily, children’s eating habits are much easier to change than those of adults. Kid-friendly doesn’t have to mean a peanut butter and jelly sandwich. Kids tend to be curious by nature and sometimes are not given enough credit for their willingness to try new foods. With a little creativity you, and your kids can pack a healthy lunch that is fun at the same time.

    New Flavors
    For example, try to expose your kids to a new flavor each week to enhance good dietary habits and involve them in the selection process. Adding new flavors can be as simple as packing a new fruit such as mango slices or dried banana chips. Your kids may also want to make their sandwich into a wrap using a whole-wheat tortilla for extra fiber and nutrients. Vegetables can add color to their lunch and are easy to eat when cut into bite-size pieces.

    Don’t Give Up
    Remember, it may take several tastes over a period of time before kids may realize that they like the new food item. Don’t give up if your child turns their nose up at the first bite. Continue to “re-offer” that food item in a few weeks, and keep trying. Sometimes it takes kids 15-20 times before they will eat new items.

    Ready-to-Assemble Ingredients
    Another fun approach, which fortunately makes it easier for parents, is to pack ingredients for kids to assemble themselves. Kids love dipping, rolling and stacking their foods into fun eats. You can pack lean deli meats, fresh shredded carrots, cucumber slices, etc to build a sandwich either on a whole-grain roll, bread or tortilla.

    Kids love color, so make sure that their lunch has a variety of colors and shapes. Color is sometimes the key when it comes to nutrition as well. The more color a fruit or vegetable has, usually tells us that there are more nutrients in that item. For example, when selecting lettuce, choose dark leafy greens like baby spinach or Romaine lettuce instead of iceberg. Berries are also a great source of nutrients with their bright, vibrant colors.

    Fun Shapes
    Fruits and vegetables can also be made more exciting by cutting them into fun shape such as triangles or circles or simply using one of their favorite cookie cutters. You can also use this technique when it comes to sandwiches to help spice them up and lessen their lunch boredom.

    Hopefully this will help solve some brown-bag lunch dilemmas, as well as give you ideas on how to pack a healthy lunch.

    By Curt Arens

    Send your questions or comments to bowview@gpcom.net

    GLENVIL, Neb. – Sometimes bad news changes your life for the better. That was the case for Richard Franssen. The good news was that the answer to his health problems could be found in food raised on small family farms.

    This anesthesiologist from Glenvil, NE was away from home, visiting relatives with his wife, when he had an extreme episode of shortness of breath. As a physician, he knew something was terribly wrong.

    After an emergency room visit and a hospital stay, doctors told him that things had to change in his life or he was headed for a major heart attack or stroke.

    After surgery and lots of medication, he found himself alive – but his quality of life was gone, because he couldn’t sleep and he felt terrible most of the time. Many of the pills he was taking to control his health problems were interacting with unforeseen, often unbearable side effects.

    Franssen decided it was time to explore alternative avenues to get his life back. "We need to think about prevention," Franssen said. "Whole, natural food is what makes the difference."

    Franssen now practices general medicine part-time as an employee of the local hospital at a rural clinic in Blue Hill, Nebraska.

    While searching for the right diet combination to improve his heart health, Franssen sought out milk from grassfed dairy animals, because of research showing grass-based milk to be high in heart healthy Omega-3 fatty acids.

    "My great grandfather had a ratio (Omega 3 to Omega 6) of 1 to 2 or 3," he said. "Today, we have ratios of 1 to 20 or 50." Overweight with high cholesterol, high blood sugar and high blood pressure, Franssen started looking at food to help balance Omega 3 and Omega 6 in his diet. He researched everything – Atkins, South Beach, low carbohydrate and other diets.

    He turned to pasture-based, whole foods as the centerpiece of his new, specialized diet. "I took the food approach to help," he said. The three benchmarks of his plan include exercise, stress reduction and eating properly.

    With no grass dairies around Glenvil, he purchased two Jersey cows from Bruns dairy to produce his own milk at home.

    "That’s the thing about northeast Nebraska," he said. "You are much more progressive. There are people living on the land trying to survive economically."

    Franssen said small family dairies, community supported agriculture gardens and the availability of grass-finished meat and other locally raised produce are real assets to the region. "We need to support these small farms," he said.

    He didn’t switch his diet overnight. He talked with clinicians and farmers. His wife is head cook, so she had to buy into their new diet as well.

    With a doctor’s guidance and his food approach, he slowly went off a myriad of medication he’d been taking. And his vital cholesterol, blood pressure and blood sugar numbers responded miraculously.

    "I got a second chance," said Franssen. "That’s why I’m so serious about this. I don’t want my children to go through what I did."

    So the Franssens are trying to pass on their knowledge to their own family members and others who are looking for answers. "Know your farmer. That’s the answer," he said.

    Richard Franssen’s diet relies heavily on whole, unprocessed foods.

    For protein, he eats grassfed red meat like beef, lamb, goat and buffalo, pastured poultry and eggs, fish and milk and dairy products from his own cow, including a cultured milk drink called Kefir.

    The fats in his diet come from cooking with olive oil, butter from grass milk, cottage cheese and hard cheese and some nuts in moderation.

    For carbohydrates, he eats plenty of green asparagus, broccoli, cabbage, cauliflower, celery, cucumbers, kale, leaf lettuce, mushrooms, onions, peppers, radishes, spinach, swiss chard, tomatoes and yellow squash. In moderation, he eats beets, carrots, parsnips and turnips and limits corn, peas and potatoes.

    He also likes fermented vegetables like sauerkraut, carrots and daikon radish. Fresh and frozen apples, blueberries, grapefruit, oranges, raspberries and strawberries are included, with limited bananas and dried fruit. He eats grains like steel cut oats, wheat and hull-less barley, processed at home and soaked over night before cooking.

    Back to top

    By Curt Arens

    Send your comments or questions to bowview@gpcom.net

    BLOOMFIELD, Neb. - L.T. Brahmdat knows his food. As a cardio-pulmonary practitioner, he has seen his share of health problems in his patients. But Brahmdat doesn't go to the pharmacy to prevent "disease and dysfunction" when it comes to health. He just goes to his garden.

    Brahmdat and his wife and children also operate a community supported agriculture (CSA) garden at their home near Des Moines, IA.

    Brahmdat told the group that locally grown, vine ripened fruits and vegetables and free-range, grass fed meat, dairy and egg products are one of the oldest traditional foods known to man.

    Jo Robinson, best-selling author and researcher on grass finished meat wrote, "Although grass-fed meat is low in bad fat (including saturated fat), it gives you from two to six times more of a type of good fat called omega-3 fatty acids. Of all the fats, they are the most heart friendly."

    Another good fat, conjugated linoleic acid or CLA, may be one of the most potent defenses against cancer. They richest known source of CLA's is from meat and milk of grass-fed ruminants like cattle.

    In a classic example of the old adage, "you are what you eat", animals raised on grass eat more omega-3's because it is readily available in green-leafed plants. That's also why these same plants raised locally are nature's best human health food, according to Bhramdat.

    He said that it is convenient to have all kinds of exotic fruits and vegetables shipped from all over the world and available for consumption, but more essential vitamins are often found growing in local gardens or on trees in local orchards.

    Terry Gompert, Extension Agriculture Educator from Knox County said that area farmers are working hard to produce grass-fed meat, dairy and poultry products for consumers, but consumers just don't know where to find them. He said that a connection needs to be made so consumers can find this "health food" more easily.

    One recent connection, the new St. James Marketplace, offers lots of locally grown meat, fruits and vegetables. Local farmers markets and several individual farmers and groups of farmers like Main Bow Meats also offer their products to consumers from the region.

    In addition to operating a CSA garden, the Bhramdats also graze chickens, ducks, goats and a Jersey cow. They provide their 200 customers with cooking demonstrations too. Bhramdat said people have forgotten how to cook their food and by helping them find their cooking skills, he helps them appreciate fresh garden produce more.

    Bhramdats are opening a new on-farm health food store and restaurant to further assist customers and to help more people enjoy their produce and food items.

    Their garden is entirely organic, said Bhramdat. Most of the vegetables are grown from seed under black plastic with irrigation soaker hoses for water. They utilize weeds as a catch crop for insects to prevent bugs from devastating their garden crops.

  • Hospice Care
    By Mary Pistulka, RN
    Avera Sacred Heart Hospice Program

    This past November, we celebrated National Home Care and Hospice Month, a time to recognize hospice care providers as well as an opportunity to once again shed some light on hospice services. While I find that most people have heard of hospice care and have some idea of what hospice care is all about, not many people realize the broad scope of services that hospice entails.

    Modern hospice originated in England in the late 1960s. St. Christopher’s Hospice was founded by Dame Cicely Saunders. Her goal was “to give terminally-ill patients and their families dignity in their last weeks of life, free of pain and knowing that they are among the people and things they love.” In Saunders words, “You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die.” Considered to be the model for quality, compassionate care at the end-of-life, hospice care involves a team-oriented approach to expert medical care, pain management and emotional and spiritual support expressly tailored to the patient’s needs and wishes. The focus is on caring, not curing and, in most cases, care is provided in the patient’s home, or a home-like setting.

    When a patient is referred to hospice, someone from the hospice team will contact the patient/family and care will begin within a day or two. During this initial visit the patient and family’s needs are determined and a plan of care is developed. The hospice team consists of a highly-trained group of nurses, home health aides, social workers, pharmacists, the patient’s personal physician, clergy or other counselors, specially trained volunteers and speech, physical and occupational therapists, if needed. Most importantly, however, the team consists of the patient and the family/caregiver.

    The individualized plan of care outlines the medical and support services required such as nursing, personal care (bathing, dressing, etc.), social services, physician visits, counseling and homemaker services. It will also outline the medical equipment, tests, procedures, medication and treatments necessary to provide high-quality comfort care.

    Some people find hospice care a difficult subject to discuss, because it involves people who are terminally ill. It’s not uncommon for those people to view hospice care as a sign of giving up the fight or that death is imminent. While the emphasis is on caring and not curing, it is important to know that Hospice is about living! The main goals of hospice care are for the patient to feel comfortable, be able to be around family and friends, experience the minimum amount of pain and to put the patient, not the disease, in control.

    A frequently asked question is whether or not the patient can return to typical medical treatment if signs of recovery occur. The answer is yes. Statistics show that in some circumstance patients live longer with hospice care in place. It is often difficult for physicians to determine a patient’s prognosis. At times, following an episode of acute illness, a patient may appear to be very near death, but given comprehensive supportive care, may improve to the point where hospice is no longer the most appropriate care. In such circumstances patients are dismissed from hospice care. Since there is no lifetime limit to the number of days one can receive hospice care, this same patient could be re-admitted to hospice at a later date. The important thing to remember is that it is generally much better to have the support hospice can provide sooner rather than later.

    So when is it time to consider hospice? A good rule of thumb is “when you think you may not be here next year at this time and you have chosen to focus on comfort and quality of life as opposed to seeking further curative or life prolonging treatment.”

    Although the majority of patients using hospice care are the elderly, hospice is available to terminally-ill patients of any age. Hospice care is as critical to the family of the patient as it is to the patient, providing support and counseling. In recent years, the Avera Sacred Heart Hospice Program has served 85 to 95 patients a year in southeast South Dakota and northeast Nebraska.

    Another commonly-asked question is about the cost of hospice care. Hospice care is usually covered under most insurance policies and is also covered by Medicare. The Avera Sacred Heart Hospice Program is Medicare certified and Joint Commission accredited. It is the policy of Avera Sacred Heart to provide care for terminally ill individuals and their families regardless of whether or not they have insurance or Medicare eligibility, however. For this reason hospice accepts Memorial donations to ensure that we will continue to be able to provide services whenever needed.

    For more information on hospice care or the program at Avera Sacred Heart, contact Mary Pistulka, RN, at 605-668-8309.

    On the Net:

    By Curt Arens

    Send your comments or questions to bowview@gpcom.net

    CROFTON, Neb. - Happy animals are what Crofton area farmer Mark Keck wants in his operation. And Keck said that his cattle are happier on pasture than in a muddy feedlot in the spring of the year.

    So Keck and other family-sized farming operations in northeast Nebraska choose to care for their animals using a grass-only diet and marketing their products as health food.

    There are certain challenges in raising milk cows, beef cattle and chickens on grass alone. But one of the biggest hurdles in direct marketing grass finished meat is in consumer perception. Yet health benefits are undeniable.

    Knox County Extension Educator, Terry Gompert said that conjugated linoleic acids (CLA) and Omega-3 fatty acids are good substances to have in a human diet because of the health benefits of both. Ruminants like deer, elk, buffalo, goats, beef and sheep produce high amounts of CLA's in their meat if raised on grass. Once grain is introduced to their diets, the amount of Omega-3's and CLA's goes down considerably, Gompert explained (See related sidebar below).

    Cooking Slow and Low "There is a perception that the meat is tougher," said Gompert. However, proper food preparation is important and easily counters that myth.

    The Keck family likes to prepare some of their grass finished meat in a crock-pot, for slower cooking. "When we started raising it, we had to try it," Keck said. "It wasn't tough and it has more marbling than we thought."

    He said, "Slow and low is how you should prepare it" heating slowly on low heat. "If prepared right, it's very good and tasty."

    Junita Kube, Crofton, raises grass finished beef with her husband Kevin. They like to grill their meat and she said because it takes a little longer to cook grass fed meat, she likes to thaw it out before grilling.

    Gompert said his family seers the outside of steaks and other cuts first, sealing in all the natural juices of the meat, and then cooks on low heat.

    Grass fed meat and other products demand a premium price because of the effort that goes into raising animals on grass.

    Smaller framed animals like Scotch Highland cattle on Pat and Julie Steffen's farm near Fordyce fit the bill because they finish at a lower weight. They grow slower, so the return is also delayed, but Steffen likes the Highland cattle because of their mothering ability and longevity.

    Steffen's family began management intensive grazing fourteen years ago and has been finishing cattle on grass for twelve years.

    Marvin DeBlauw, Hartington, has been raising grass-finished beef for three years. He finishes his steers to 950 lbs. and heifers to 900 lbs. "It's so much easier and more enjoyable," he said about feeding cattle on grass.

    DeBlauw, who used to operate a conventional dairy, said, "I got tired of hauling feed in and manure out."

    "Some people think you can't fatten cattle on grass, but you can get Choice quality grade cattle on grass if you know what you're doing," he said. Feeding calves a salad bar of high quality grass and legumes puts on quick gains and quality meat.

    After eating grass fed beef for the past three years, DeBlauw said he now prefers it. "The health industry tells us how bad meat is," he explained, but the truth is that grass fed meat is actually healthier than a number of "healthy" foods promoted by health care professionals.

    "It's not an easy sell," said DeBlauw. "You have to get people to try it."

    Milk from grass fed Jersey cows is the ultimate health food, said Gompert. Kelly Bruns of Bloomfield once had one of the top producing Jersey cow herds in Nebraska, but he and his wife decided to go to seasonal milking on a grass-only diet.

    Production has declined, but Bruns' New Zealand-style milking parlor, located in his pasture, cost considerably less than conventional milking systems and he and his wife get the winter off from milking.

    They have developed a network of customers who purchase over 60 gallons of whole milk from their farm every week. His customers, who come from a radius of over 60 miles away, can legally purchase whole milk if they pick it up in bulk off the farm, Bruns said.

    Milk inspectors who have visited the farm often told Bruns that his is one of the cleanest operations around. Because they don't feed their cows any grain, manure quantities are much less and the fly problems witnessed by many farmers are almost non-existent. Their open-air style milking parlor allows for better surroundings for the cows and those milking them, he said.

    Inman farmer, Richard Sobotka and his family sell grass-finished meat too, but they've made a name for themselves selling eggs from pastured hens. They also market home-raised beef, pork, lamb, chickens and turkeys and have a community supported agriculture (CSA) garden.

    "When I got married, my wife was more interested in nutrition than I was," he said. Now the Sobotkas and their eight children are all interested in nutrition as well as farm enterprises that become health-products.

    Sobotka is the expert at direct marketing and he gets his entire family involved in various aspects. They market much of their produce at local farmers' markets, but have found their CSA garden to be extremely popular.

    "People like to know the person they're buying from," he said.

    Local Study on Grassfed Food

    Knox County Extension Educator, Terry Gompert said a study conducted by the human nutrition department at the University of Nebraska researched the amount of Omega-3 fats, conjugated linoleic acids (CLA) and crude fat content in meat from animals that were fed grain and those that were finished on grass. The meat studied was processed at the USDA inspected locker at Wausa, NE.

    In the study, grass fed meat compared with grain fed meat had

    • lower crude fat content, 13.1% compared to 16.7%
    • higher amounts of Omega-3's, in fact twelve times higher
    • much more CLA's, 7.4 mg/g fat compared to non detectable amounts in grain-fed meat
    Omega-3 and CLA's have been identified in recent studies to reduce cancer and heart disease. At one time, humans consumed a balanced ratio of Omega-3 fats compared to the less desirable Omega-6 fats that are linked to health problems. However, modern Americans consume much larger quantities of Omega-6's, said Gompert.

    Learn to Recognize the Warning Signs of Heart Disease
    By Will Hurley, MD
    Yankton Medical Clinic, P.C.

    When someone goes into cardiac arrest, it’s a race against the clock to save his or her life. Each day about 700 Americans die before they reach the hospital. During American Heart Month in February, it’s important to learn to recognize the warning signs of heart disease.

    Why are warning signs of heart disease important?
    Heart disease is the leading cause of death in the United States. Coronary artery disease becomes increasingly common in men over age 40 and in women after menopause. Ignoring warning signs of heart disease can be fatal.

    Heart attacks can occur without warning, but often there are symptoms of heart disease years before the attack. Some common warning signs are chest pain with exertion or activity, shortness of breath, swelling in the legs and feet, leg pain with walking, high blood pressure and high blood cholesterol. If you have any of these symptoms, speak with your health care provider about them. If you follow your provider's advice, you may be able to prevent a major heart attack.

    Chest pain (angina)
    Angina is a temporary pain, tightness, or pressure in your chest that occurs if your heart muscles are not getting enough oxygen. The pain may travel to your throat or jaw, around your back, or to your left shoulder or arm. It is possible to have a heart attack with no warning, but many people have angina for some time first.

    Angina that occurs when you exercise and disappears with rest is called stable angina. Angina that is new or comes on unexpectedly or when you are resting is called unstable angina. Unstable angina is much more serious than stable angina and may mean that without immediate medical attention a heart attack will soon occur.

    Shortness of breath
    Shortness of breath is the most common warning sign of heart failure. Heart failure doesn't usually mean your heart has stopped. Generally it means that your heart is having trouble pumping enough blood around your body. This causes fluid to build up in and around your lungs. The fluid makes breathing difficult.

    Heart failure can usually be treated. If it is not treated, it will get steadily worse. If you begin to get breathless going upstairs or after less and less exercise, or if you need more pillows to breathe comfortably in bed, you need to see your health care provider as soon as possible.

    Swelling (edema) in the legs and feet
    Millions of Americans have leg swelling from causes other than heart disease. However, the collection of fluid in your legs can be a warning sign of heart problems. This is especially true if you have other symptoms, such as shortness of breath. You may have swelling in your abdomen, too. Tell your health care provider if you notice fluid collecting in your legs, ankles, or feet.

    Pain in the legs with walking (claudication)
    Pain that occurs in the calf muscles when you walk can be a sign of heart and blood vessel disease. This type of pain happens only with activity and stops a minute or two after you stop the activity. It occurs when your muscles are not getting enough oxygen because of blocked arteries. Blockages in the leg arteries may mean there are blockages in the heart (coronary) arteries as well.

    High blood pressure and high blood cholesterol
    High blood pressure and high blood cholesterol are both warning signs of possible heart problems in the future. You usually can't tell if you have either high blood pressure or high blood cholesterol without measuring your blood pressure or testing your blood. Both measurements may be done routinely at health check-ups. A blood pressure machine may be available in your local pharmacy. Both blood pressure and cholesterol screening may be offered in your community from time to time. High blood pressure and high blood cholesterol can be treated by your health care provider.

    Risk factors
    It’s also important to know your risk factors. These include items such as high cholesterol, high blood pressure, obesity, smoking, diabetes and family history. Your health care provider can help you sort out your risk factors and find ways to live a healthier lifestyle.

    If you have any of these warning symptoms, you should see your health care provider, so he or she can help you determine if you have heart disease.

    By Carla Scott Schmidt
    Avera Sacred Heart Hospital

    Christmas is fast approaching and our holiday eating mode kicked in about three weeks ago with Thanksgiving. Our appetites, for some mysterious reason, always seem to grow during this time of the year. The reason is not that difficult to understand – we are surrounded by so many people and so much good food during this time of year as opposed to most any other time of year.

    The fudge, cookies and peanut brittle are in no short supply. Extravagant meals, often preceded by rich and tasty hors d’oeuvres, are planned for get-togethers. It’s no wonder most of us put on at least a couple of pounds over this time of year.

    I’m not going to preach to you about how you shouldn’t eat these foods or indulge yourself once in a while, but I would like to speak about moderation a bit. If, after dinner, you wind up on the couch, having to unbutton your jeans to feel comfortable, chances are you may have overdone it a bit. At most holiday gatherings, there are snacks available throughout the day. It’s a good idea to snack occasionally – not only from the fudge or cookie tray, but from a veggie tray as well. Also, try not to save all your room for the big dinner. Eating more often, in smaller quantities gives your body a better chance at digesting the food and processing the nutrients for where they belong.

    For all of you hosts and hostesses out there, try to put out veggie trays along with your rich treats and try to serve at least two vegetable choices to compliment, the turkey, stuffing, mashed potatoes and gravy, ham and whatever else you may be serving to your lucky guests. I’m certainly not trying to discourage anyone from enjoying these holiday goodies, but instead encouraging moderation. As with just about anything in life, moderation is the key.

    Here are a few hints to help you enjoy the holidays without overdoing yourself at the snack bar or dinner table:
    ~ Don’t go to a party hungry – we often eat too fast and too much when we are really hungry. Try to eat a good breakfast and lunch on the day of the party to avoid overdoing it at the party.
    ~ Don’t go crazy on portion sizes – have a nice dessert, chocolate or any kind of sweets, but keep an eye on how much you are eating. Go for small portions. Think of it this way – now you can sample all the foods.
    ~ Understand what items are high in fat – try to limit high fat foods to very small portions. These items would include fried foods, creamy soups, cheesy items, pie, processed meats (salami, sausages, etc.) and some pastries and baked goods.
    ~ Drink plenty of water – this does two things for you. First, water will keep you hydrated and is very healthy. Secondly, water will help fill you up as well and keep you from trying that fourth piece of fudge.

    As you can see, I certainly don’t want to be a Scrooge about holiday treats and parties – it is a time for celebration, so celebrate. I’m just encouraging you to celebrate wisely and in moderation. Once those pounds come on, they can be quite difficult to remove. Enjoy yourselves and have a safe and Merry Christmas and Happy Holidays.

    Carla Scott Schmidt, a registered dietitian, is the director of the Avera Sacred Heart Hospital Nutrition Services Department.

    By Terence Pedersen, DPM
    Yankton Foot and Ankle Center/Avera

    Summer is here! If you are determined to start an exercise program, train for that marathon you have always said you would do, or just want to take up walking (let’s not forget Riverboat Days this weekend), then it is time to get started.

    What do all of the above mentioned activities have in common? Shoes!

    Shoes can make or break your favorite physical activity and exercise program. They can be the difference between a successful marathon, and a miserable and painful summer of walking. With all of the different brands, styles and choices of shoes, it can be very confusing to decide which shoe is right for you.

    Walking shoes are designed for low impact. They have a lower heel than running shoes. Running shoes, on the other hand, are built to accommodate high impact. These shoes usually have slight heel elevation, which will reduce stress on the Achilles tendon, but slightly reduce the lateral stability of the ankle. Running shoes also have a larger toe box, more shock absorption, and better pronation control than walking shoes.

    Running shoes are fine for walking exercise, but it is recommended not to use a walking shoe for running. Probably a more important consideration is the condition of the shoe. Do not wear any shoes beyond their useful life.

    Running and walking shoes have a usual life span of 300-600 miles. The soles will begin to wear out and “bevel.” The Beveling will cause strain in the foot and leg leading to injuries. Also, the glue in the shoe will harden over time, and cause loss of shock absorption. So even if you do not walk or run 300 miles in a year, it may be best to change your shoes according to time, rather than mileage. Change our shoes regularly, and use them only for your workouts.

    So now you have some insights on what shoes are right for your specific activity. But what do you do if your shoes do not accommodate the arches of your feet comfortably? Perhaps you have a high arch foot, or your feet have no arches at all. Maybe you have some arthritis in your feet, making running or even walking painful. Many people benefit from the addition of an extra insole, or arch support, in their shoes. These “inserts” can purchased over the counter, or even custom made. Not all inserts are alike, and need to be “custom fit” to your specific needs, just like your shoes.

    Shoes should be purchased at the end of the day. This is when your feet may be just a little bit larger from swelling during the day. Always have your feet measured by a professional shoe salesman every time you buy shoes. Match the shoes to your activity. Shoes should be “sport specific.” Inserts or arch supports should be just that: supportive. Firm arch supports will keep your foot stable. Soft insoles are not supportive, and can make a painful foot and ankle worse. Saving money on cheap or inappropriate shoes will cost you more in the long run through injuries. Get top quality shoes, and change them on a regular basis. Match your shoes to your activity for a healthy and safe summer!

    So get out here this summer and stay active. Feet that are fit are feet that will keep you fit. Pay special attention to your footwear for an injury free summer. If you are having foot pain, and shoes and inserts are not helping resolve that pain, see your Podiatrist right away. We can help identify and treat your foot pain and get you back to your game.

    Dr. Terence Pedersen is a board certified Podiatric foot surgeon with the American Board of Podiatric Surgery (ABPS) and is a Fellow of The American College of Foot and Ankle Surgeons (FACFAS). He currently resides and practices in Yankton, S.D.

    By Doralynne Jarvis, RD
    Avera Sacred Heart Nutrition Services

    In a constantly moving society, it sometimes seems as though there isn’t time to even eat. As we all know, this isn’t a good thing. Fortunately, there are many nutritious ways to get a bite to eat without sacrificing a lot of time. (Of course, it’s still better for a number of other reasons to gather around the table for a good meal with the family.)

    When we’re on the go, however, it’s quick food that we need and we shouldn’t sacrifice nutrition to get it. I’m not saying you should ban fast food restaurants altogether, in fact, many of them are starting to offer healthier alternatives, but nothing is healthier than fresh, whole foods prepared in your own kitchen.

      Here are some quick ideas you can try:
    • String cheese
    • Yogurt
    • Cheese & whole grain crackers (try Ak-Mak crackers)
    • Granola bars (look for at least 3-4 grams fiber per bar and no high fructose corn syrup)
    • Apple wedges and peanut butter
    • Celery sticks with peanut butter
    • Fresh veggies, cut and bagged
    • Water or other non-caffeinated beverage
    • Fresh fruit
    • 100% fruit, canned fruit cups or applesauce
    • Deli-meat roll-ups (Turkey breast with thin cheese slice and baby spinach) roll-up and put toothpick thru to hold together

    Be creative, there are tons of quick healthy snacks out there. My personal favorite is an oatmeal-peanut butter energy bar. I can make a batch of two dozen and use them for breakfast if I’m running late, or simply as a “pick-me-up” during the day. It only takes about 20 minutes to make a batch and they’ll keep for quite a while.

      Oatmeal-Peanut Butter Energy Bars
      Makes 24 servings Ingredients:
    • ½ c. whole wheat pastry flour
    • 1/3 c. ground flaxseed
    • ½ to 1 teaspoon cinnamon
    • ½ teaspoon baking soda
    • 1/8 teaspoon salt
    • ¾ cup natural peanut butter
    • ½ cup brown sugar, packed
    • 1/3 cup honey
    • 1 large omega egg
    • 2 egg whites
    • 2 tablespoons canola oil
    • 2 teaspoons vanilla extract
    • 2 cups old-fashioned rolled oats
    • ½ cup dried cherries
    • ½ cup dried cranberries
    • ½ cup coarsely chopped walnuts or almonds
    • ½ cup dark chocolate or semisweet chocolate chips

    Pre-heat oven to 350°F. Spray a 9 x 13 inch baking pan with nonstick spray.
    In medium bowl, add flour, flaxseed, cinnamon, baking soda and salt. Mix together with a whisk.
    Beat the peanut butter, sugar, and honey in a large mixing bowl with an electric mixer until blended.
    Blend egg and egg whites in small bowl with whisk or fork until well blended.
    Add eggs, oil and vanilla to the peanut butter mixture. Beat until smooth.
    Add reserved flour mixture and mix with rubber spatula.
    Mix in oats, dried fruit, nuts and chocolate.
    Scrape batter into prepared baking pan. Use a piece of wax paper or parchment paper to spread batter into an even layer.
    Bake the bars until light, golden brown and firm to touch, 20-25 minutes. Let cool completely before cutting.
    Nutrition Facts per serving: 213 kcal, 10g fat, 2g sat fat, 9mg cholesterol, 84mg sodium, 27gm carbohydrate, 3g fiber, 14g sugar, 6g protein.

    Doralynne Jarvis, RD, is the assistant director of Nutrition Services at Avera Sacred Heart Hospital.

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