Most people get lab tests after a doctor recommends them during a visit. Now, a small but growing number of consumers are skipping the time and expense of seeing a physician and are ordering up their own tests, with heart-related assays among the most popular. For some, it’s a way to keep track of measures that they want to regularly monitor, such as cholesterol levels or the blood-sugar indicator known as hemoglobin A1C, which is important to people with diabetes. For others, a broad-based panel of tests may provide a quick snapshot of overall health.

The lagging economy, which has left some people without insurance coverage, has also helped fuel the direct-to-consumer testing market.  Even many people with coverage are facing bigger deductibles and other out-of-pocket expenses

Consumers should make sure their testing is being performed by a CLIA-certified laboratory or the federal Clinical Laboratory Improvement Amendments, and accredited by an established entity such as the College of American Pathologists. The college maintains a list of the labs it checks at www.cap.org.  Riverview Hospital Laboratory is accredited by CAP and CLIA.

Laboratory test results cannot substitute for medical advice, diagnosis or treatment. Diagnosis and treatment of human illness should be based on your medical history, including your family’s medical history and a physical examination along with your doctor’s professional judgment and review of test results.  It is therefore important for you to discuss your test results with your personal physician.  Physician judgment must remain central to the selection of diagnostic tests and therapy options of a specific patient’s medical condition.  Always seek the advice of your doctor if you have any questions and before you stop, start or change any treatment plan, including use of medication.  If any of your results are abnormal, or if you are continuing to have symptoms that prompted you to request these tests, it is recommended that you see a physician.  In the context of a physical exam and medical history, your physician my determine it necessary to repeat this test.

Learn more about the menu of services available though Direct Access laboratory testing at Riverview Hospital here.

Linda Vyain
Directory of Laboratory Services at Riverview Hospital

William Fecht, MD

March is Colorectal Cancer Awareness Month. In recognition, we offer some useful information regarding the importance of prevention.

Colonoscopy is one of the least common screening exams sought by patients. The reasons range from the physician not mentioning it to fear of pain and discomfort both during the procedure and in the preparation for the procedure.

William Fecht, MD, a board certified gastroenterologist on staff at Riverview Hospital, says that the benefits of colonoscopy far outweigh any fears about pain or discomfort.  “A colonoscopy allows me to diagnose and sometimes immediately remove polyps or lesions during the same exam,” said Fecht.  “There really is no other screening tool that offers such a wide range of diagnostic and treatment options.”

Among the issues identified and sometimes treated during a colonoscopy are:

• Polyps
• Colon cancer
• Diverticulitis
• Hemorrhoids
• Irritable bowel syndrome
• Bleeding and abdominal pain

“The preparation for a colonoscopy is often what frightens patients the most,” he said.  The bowel must be cleared before the procedure requiring patients to take laxatives to stimulate diarrhea for several hours the day before the exam. However, Dr. Fecht will recommend laxatives such as Miralax that greatly reduce cramping and discomfort during this cleanse.

The procedure itself is nearly painless.  Patients are given a light anesthetic and are kept in a drowsy, but comfortable state.  The medications typically ensure that the patient has no memory of the procedure at all.

Most men and women should have their first colonoscopy around the age of 50.  Then, barring any findings or family history, once a decade is sufficient.

William Fecht, Jr., MD is a Gastroenterologist at Riverview Hospital. He is Board Certified in internal medicine, gastroenterology and hepatology. To make an appointment with Dr. Fecht or to speak to a member of his staff, call (317) 872-1611 or visit www.indianagastro.com.

Riverview Hospital Registered Dietitian, Laura Kenny, RD and Riverview Rehab & Fitness Exercise Specialist, Ryan Lawson, offer helpful information on making fitness resolutions last all year…

The start of a brand new year is a time for new beginnings. Resolutions to eat better and increasing your physical activity are a great place to start. To promote success, a proper action plan that has clear, measurable objectives, tracks your progress and emulates healthy habits will cultivate positive returns. Develop and follow your plan and results are sure to follow!

Goal Setting

There are two types of goals – long and short term. Long-term goals focus on the “big picture” and should take six months to a year to complete. Losing 35 pounds or being able to run a 5K race fit this category. The second type, short-term goals, are stepping stones towards long term goal(s). Lifestyle modifications such as exercising 3 times a week for 30 minutes or drinking 2 fewer carbonated beverages per week are examples. All goals need to be realistic, measurable and have a completion date.

Keep it simple! All goals should adhere to the SMART principle:

S   =  Specific

M  =  Measurable

A   =  Achievable

R   =  Realistic

T   =  Time-Orientated

Importance of Journaling

While commonly referred to as painful and inconvenient, journaling truly can be the key to successful long-term weight loss and improved fitness. Just like monitoring a financial budget, a “calorie budget” is something most Americans could benefit from keeping. If you want to lose weight or maintain your weight loss, a journal may be the key you need…yet are avoiding! Most of us do not have unlimited funds for our finances; this holds true for calories too. By not enforcing limits, we suffer negative repercussions.

An effective journal details when, why and how you eat, promotes accountability for choices and identifies trouble areas which should be turned into target areas for improvement. An exercise log allows you to monitor minutes and exercise intensity to maximize your time while avoiding the affects of over-training. Logging what foods you eat will make you aware of what you are eating along with pinpointing where you may not be getting enough of certain nutrients such as fiber or vitamin C.

Since it can be difficult to recall what you ate throughout the day, it is best to record your intake immediately. If you do not have access to your food journal at that moment, you could always jot your food or beverage down on a napkin, send yourself a text or take a photo of the meal with your phone and then transfer into your journal later.

Healthy Habits = Healthy Lifestyle

Since its inception, the National Weight Control Registry has surveyed more than 10,000 adults that have lost a minimum of 30 pounds and kept it off for at least 1 year. Examination reveals similar characteristics to their success:

98% – Food intake modification

94% – Increase physical activity

90% – Average 1 hour of physical activity throughout the day

78% – Eat breakfast daily

75% – Weigh in 1 time a week

Combine education and proper planning with motivation and your possibilities are endless! Stick with it, hold yourself accountable and before you know it, those resolutions will become daily, healthy habits.

“Even though current guidelines recommend calling 9-1-1 to activate emergency medical services (EMS) for the expedited triage of patients experiencing cardiac chest pain, EMS has been, and is still underutilized by patients experiencing these symptoms,” explains Kenny Williams, Noblesville EMS Chief.  “For the best chances of recovery, patients should receive heart attack treatments within an hour of experiencing symptoms.”

The fact that these heart attacks don’t cause chest pain doesn’t mean they are less serious. Mark Rieger, MD, a board certified emergency physician at Riverview Hospital says that just the opposite is true. “Often, heart attacks without chest pain can be the most deadly,” he said. People who have this type of heart attack are twice as likely to die within a month—and nearly three times as likely to die within a year—as those who have an attack signaled by chest pain. Scientists are trying to unravel why this is the case.

The bottom line is this: Call for an ambulance within five minutes of having symptoms, even if you aren’t sure you’re having a heart attack. The longer you wait, the more you put your health at risk.

Would you know if you or a loved one was having a heart attack?

The symptoms of a heart attack can vary. If you think you or someone else is having a heart attack, don’t wait. Call 911, every second counts!

Some of the most common symptoms involve:

• Discomfort in the center of the chest, such as uncomfortable pressure, squeezing or pain in the chest, it may go away and return.
• Discomfort in other areas of the upper body, pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest pain.
• Breaking out in a cold sweat, nausea or light-headedness.

If these signs are present, call 9-1-1. Your life or the life of someone you love may depend on it.

We are so proud of our outstanding nursing staff that provides world-class care to our patients. This quarter, we recognize a stellar nurse from our Maternity Center, Dede Flaherty. Dede works tirelessly to ensure our patients receive the best care possible and she is a deserving recipient of the Daisy Award!

The Daisy Award was established by the family of J. Patrick Barnes as a way to honor nurses who go above and beyond the call of duty. The Daisy award is given at Riverview – and hundreds of other hospitals across the country – on a quarterly basis. Patients, family members, visitors, staff members, and volunteers can nominate a nurse for a Daisy Award.

Dede has been instrumental in developing the Maternity Center’s Halos of Hope program which provides support to those who have lost an infant through miscarriage, ectopic pregnancy, still birth, or neonatal loss. Dede took the initiative to put the program together and to organize a support group. Suffering a loss can be devastating, but connecting with individuals who have experienced a similar event can be helpful in the healing process. Thanks to Dede’s leadership and dedication, Riverview now offers this structured program.

We commend Dede on her continual efforts and we are grateful to have her on our nursing staff. Congrats to another “Daisy” and to all of the nominees who display excellent clinical skills and compassionate care!

Interested in nominating a nurse for a Daisy Award? You can do so here.

Ryan Lawson, Exercise Specialist

It is that time of year again; the cooling temperature compounded by extra commitments of the holiday season leads to more stress and less physical activity. With proper planning and a positive approach, you will discover that even a little bit of exercise throughout the day can diffuse stress and lead to a saner, more energetic you!

In response to stress, the body goes into what is called “fight or flight” mode. More common this time of year, this reaction leads to a release of adrenaline, increased heart rate and a shunting of blood flow that results in a surge of energy and strength. Unfortunately, this reaction often occurs in situations, such as waiting in line or during a stressful day of work, where an appropriate outlet is not possible.

A perfectly acceptable response and an integral facet of a stress management program, exercise provides the perfect outlet to your “fight or flight” reaction. Exercise also provides a distraction, improves overall efficiency and makes you feel better! Focus on quality over quantity; penciling in even 20 minutes of your day for exercise can pay major dividends.

There is no reason you cannot stay lean and enjoy your holidays. As with anything, a realistic approach and plan is crucial.

Here are some tips to make this a reality:

• Plan ahead – make an exercise calendar, targeting the best days to commit.
• Complete a tough workout before the party – be proactive and burn calories before hand so you can cheat a bit on your diet without the guilt.
• Don’t succumb to excuses – if you find yourself making excuses, write them down to analyze and evaluate. If you have to miss a day, don’t dwell on it, forget about it and get back on track!
• Do what you enjoy – by doing exercise you like, you will look forward to it instead of treating it like a chore.
• Mix it up – changing up your routine can inject benefits as well as avoiding boredom. Need ideas; see an exercise specialist.
• Partner Up – knowing someone else is going to be there promotes accountability. Plus, it makes the time go by faster.
• Set goals – looking for a guilt-free reason to reward yourself; set a fitness goal, and once you accomplish it, reward yourself!

Ryan Lawson is an Exercise Specialist with Riverview Rehab & Fitness.

As they try to navigate through the maze called “health care,” bouncing from one appointment to the next, drinking all sorts of ill-tasting contrast solutions, getting poked in every which way, hearing terms they cannot grasp, they feel completely overwhelmed. They need an Oncology Nurse! It is our responsibility to help patients through this difficult road. To give them chemo is but a small part of what we do.

As we look at the patients and their families, we can see fear in their eyes and hear uncertainty in their voices. So we help them to make some sense of all the information, instructions, precautions, medications, side effects…the list goes on and on. We become their point of reference and we find the trust in their eyes and hope in their voices. That is a privilege.

If my patients believe that I really care, when they understand that I am willing to walk the extra mile so they don’t have to, then I know that I am keeping the commitment. I am their advocate, because they have become part of my family and they have welcomed me into theirs. We cry together to the sound of bad news, but we laugh at the sight of our own silliness. We take just one day at a time, and we thank God for every victory, big or small.

The best part, though, is when my patients give me a hug, say they love me, and smile as they express their genuine appreciation for what we nurses do. That makes it all worth it!

Maria Cline, RN, OCN

Maria Cline has worked at Riverview since June 2000 and has worked in the Short Stay Unit at Riverview for the past nine years.

Samuel Heiser, MD

Is there anything more frightening than performing your monthly self-breast exam and discovering a lump in your breast? Fortunately, the vast majority of breast lumps, particularly those that develop before menopause, are not cancerous. All, however, need to be taken seriously.

One in nine women will experience breast cancer, but most can be cured. Early detection is the key. Research has shown that mammograms are the best tools for detecting breast cancer at an early stage, but you should be familiar with how your breasts feel. Even with mammograms, it is not unusual for a woman to discover a new breast cancer herself.

The best time for a premenopausal woman to examine her breasts is approximately one week after her period ends. Normal breast changes that occur during menstrual cycles can often create a lumpy feeling in the breasts. Following menopause, women should pick a predetermined day each month.

A woman’s breasts are more likely to feel lumpy during her 30s and 40s. Lumpiness is a non-cancerous condition and is different than a breast lump. Approximately 60% of women under the age of 50 have lumpy breasts. This results from the constant hormonal ebb and flow experienced by women. Breast lumpiness often occurs in both breasts. While not considered a serious problem, it can cause discomfort and pain. Avoiding caffeine, taking over the counter pain relievers, or using a heating pad may all help relieve this discomfort.

Cancerous lumps tend to be difficult to move when you push them with your fingertips. They are often described by women as “rock hard”, but any change is noteworthy. Several non-cancerous conditions can also cause breast lumps. Among the most common are cysts, which are fluid filled sacs that typically feel smooth and firm and are easy to move. These are most common in women between the ages of 35 and 50. Another common lump is a fibroadenoma, a solid, somewhat rubbery lump that can usually be moved around. These often occur in young women.

The best protection against breast cancer is a three step program.

• Monthly breast self-exams. Many women who perform self exams discover breast cancer at an early stage.
• Breast exams annually by your physician.
• Mammograms annually after age 40, or as your primary physician recommends.

Never hesitate to call your physician about any changes your find in your breast.

Samuel Heiser, MD is  a board certified surgeon on staff at Riverview Hospital and is a member of Riverview’s Breast Care Team, a multi-disciplinary team of radiologists, breast surgeons, oncologists and other clinicians whose knowledge and expertise is combined to offer unmatched care for women undergoing breast cancer treatment. Contact our Women’s Center by calling (317) 776-7133.

Learn more about Riverview’s Breast Care Team.

Mammograms Save Lives!

According to the American Cancer Society, one out of nine women in the U.S. will develop breast cancer. Mammography is especially valuable as an early detection tool because it can identify breast cancer at an early stage, usually before physical symptoms develop. Please refer to the recommendations below as your breast health guide.

American Cancer Society Recommendations:

• Yearly mammograms starting at age 40, and continuing for as long as a woman is in good health.
• Clinical breast exams by a health care provider should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over (close to and preferably before the scheduled mammogram).
• Women should report any breast change promptly to their health care providers.
• Women at an increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting screening mammography earlier, having additional tests (e.g. breast ultrasound or MRI) or having more frequent exams.

Learn more about the Riverview Women’s Center for Breast Care.

It is possible to prevent 35% of cancers by:

• Following a healthy diet
• Maintaining a healthy weight
• Performing regular exercise

The Anti-Cancer Diet (printable)

It is possible to prevent 30% of cancers by:

• Not using tobacco

Guidelines for cancer prevention:

• Choose a diet rich in a variety of plant-based foods.
• Eat plenty of fruits and vegetables.
• Maintain an healthy weight and be physically active.
• Drink alcohol only in moderation, if at all.
• Select foods low in fat and salt.
• Prepare and store food safely.

Obesity is a risk factor for the following types of cancers, primarily:

• Breast
• Colon
• Endometrial
• Esophogeal
• Gall bladder
• Pancreas
• Kidney
• Reccuring cancer

Color Your Plate with Salad (printable)

Obesity acts as a tumor promoter and may increase the risk of cancer by 150-450%. Obesity is a risk factor for the following types of cancers:

• Breast
• Colon
• Endometrial
• Esophageal
• Gall Bladder
• Pancreatic
• Kidney
• Recurring cancer

Dietary fat:

• High fat diets are associated with obesity.
• High intakes of total and saturated fat increases the risk of breast, colon, lung and prostate cancers.
• Animal fat increases the risk of breast cancer.
• Higher Omega-3 versus Omega-6 may reduce the risk of breast cancer.

Protein:

• Low protein diets reduce the risk of cancer.
• Increased red meat intake is associated with an increased risk of colon and advanced prostate cancer.
• The recommended daily amount of protein is approximately 50-60 grams.
• 1 ounce of meat = 7 grams of protein.
• Limit your consumption of red meat.
• Choose fish, poultry or beans and an alternative to beef, pork, and lamb.
• When you eat meat, select lean cuts and smaller portions.
• Prepare meat by baking, broiling or poaching rather than by frying or charbroiling.

Fiber:

• Fiber-rich diets protect against colon cancer.
• Higher intakes of vegetables decrease colon cancer risk.
• High fiber diets tend to be meat, fat, and refined carbohydrates.
• A daily fiber goal should be 20-35 grams.

Fruits and Vegetables:

• Increased consumption lowers the risk of most cancers.
• Flavenoids and lingans are associated with a lower risk of most sex hormone-related cancers.
• Great sources of antioxidants, Vitamins C, E and Selenium as well as phytochemicals.
• Eat 5+ servings of fruits and vegetables daily.
• Include vegetables and fruits and every meal and for snacks.
• Eat a variety of vegetables and fruits.
• Limit French fries, potato chips and other fried vegetable products.
• Choose 100% juice.

Food Safety:

• Choose in-season, locally-grown produce.
• Rinse fruits and vegetables and remove outer leaves.
• Use proper food storage to prevent growth of fungal carcinogens.
• Marinate protein foods to decrease cooking time.
• Use cooking methods to avoid contact of foods and food drippings with flames.
• Use lower cooking temperatures with protein foods.

Grains:

• Choose whole grains instead of processed (refined) grains and sugars.
• Choose whole grain rice, bread, pasta and cereals.
• Limit the consumption of refined carbohydrates, including pastries, sweetened cereals, soft drinks and sugars.