Osteoporosis affects up to half of all women and a quarter of all men over the age of 50. Yet, many people don't realize osteoporosis is not an inevitable part of growing older. 

"People assume you just get shorter and develop a hunched back in old age, but this is a treatable disease," says Robert Goiney, MD, a radiologist with the Northwest Osteoporosis Center at Northwest Hospital. 

Bones constantly remodel, with a cycle of old bone removal and replacement taking approximately 90 days. Bone mass generally peaks by age 30, then begins to slowly decrease. Osteoporosis occurs when bone is lost faster than it can be replaced. 

Women face a greater risk of osteoporosis because they lose bone mass rapidly when their estrogen levels decrease during menopause. For men, the hormone decrease is more gradual. By age 65, both sexes tend to lose bone tissue at the same rate. (See Risk Factors for Osteoporosis, page 2.) 

Because the disease is painless, the first symptom of osteoporosis may be a non-traumatic fracture. Experts say something as simple as lifting a bag of groceries can create enough pressure to compress the vertebra, causing a compression fracture. 

Physicians at Northwest Hospital have developed a multidisciplinary approach to prevent and treat osteoporosis before that occurs. Exercise, a healthy diet with adequate calcium and Vitamin D--not to mention new medications--can prevent or halt bone loss, but the key is detecting the problem early. 

Right now, the best tool for early detection is the bone mineral density test, says Dr. Goiney. Northwest Hospital uses the Dual Energy X-ray Absorptiometry (DEXA), considered the gold standard for its accuracy. The test, which takes about five minutes, is simple and painless. The patient doesn't even have to change clothes. He or she just lies on the table while the movable arm of the x-ray machine passes over the test area." 

The physicians of the Northwest Osteoporosis Center have developed a detailed risk assessment questionnaire along with a "get-up-and-go" test for assessing a patient's balance and risk of falls. Dr. Goiney says about seven percent of 3,000 people tested each year cannot perform part of the test--to rise from a chair without using their arms. 

Northwest Hospital's comprehensive screening process means treatment can be tailored to a patient's special needs. Those options could include nutritional counseling or referral to SAGE--the Safety and Gait Enhancement program--an award-winning physical therapy program designed to improve balance and mobility in seniors. 

"Inherently, it makes a lot more sense to prevent a hip fracture than to treat a hip fracture," says Jeffrey Carlin, MD, rheumatologist, at the Northwest Outpatient Medical Center. 

About half the people who suffer hip fractures never fully recover. Dr. Carlin believes every woman should go through bone density screening when she goes through menopause. "Bone density awareness is where cholesterol awareness was ten years ago," he says. "Now everyone knows their cholesterol level, but few people know their bone density." 

Doctors today have several medications available to prevent and treat osteoporosis. Estrogen remains the most commonly prescribed drug for women, but in the last four years, a number of new medications have come on the market and more are expected next year, Dr. Carlin says.Still the best tool for fostering strong bones and preventing osteoporosis is getting the word out to young women to watch their calcium intake, exercise, and quit smoking. 

"You can increase the strength of the remaining bone," says Dr. Carlin. "But, you can't replace what is gone." 

Senior Health Fair
10:00 am - 3:00 pm
Health care professionals provide education and free information on a variety of topics including heart disease, stroke, diabetes, cancer, nutrition and medications, injury prevention, and incontinence. Blood sugar and blood pressure checks, as well as massages will be offered on site.

Presentations by health care professionals:
Anxiety and Stress 10 am - 11 am
Osteoporosis 11 am - 12 pm 1 pm - 2 pm
Walking and Balance 2 pm - 3 pm

Osteoporosis Screening
8:30 am - 4:30 pm
Pre-registration is required for screening. Please see Community Health Events on page 4 for details.

Quivering Heart Increases Risk of Stroke

Most of us take our hearts for granted. That is, until a flutter or palpitation makes us aware of a change in its rhythm. It is estimated that 2.3 million Americans suffer from atrial fibrillation (AF), a disorder in which the two small upper chambers of the heart quiver instead of beating effectively.Atrial fibrillation requires treatment to lower the risk of both short- and long-term complications. Complications include an increased risk of stroke, heart damage, and even death. The main reason to treat AF is because if it is untreated there is an increased risk of stroke.

AF is responsible for 15 percent of all cases of stroke. The Framingham Heart Study found that for those with rheumatic heart disease and AF, the risk of stroke increased 17 fold. Others with AF faced an increased risk of stroke five times that of persons without the heart irregularity.

"Most people with AF come in because they feel that something's just not right in the chest. They may feel their heart racing, or going in and out of rhythm," says Julie Heyn, MD, cardiologist at Summit Cardiology at Northwest Hospital.

An occasional skipped heartbeat is of little concern, Dr. Heyn says. "A skipped heartbeat does not mean you have atrial fibrillation. Most skipped heartbeats are usually benign," she says. "It's when an irregular rhythm is frequent or sustained and causes dizziness, lightheadedness, breathlessness, or a feeling of faintness that the symptoms should be evaluated by your physician."

"Your heart is governed by its own electrical system," Dr. Heyn explains. "Each normal heartbeat begins with an electrical signal, located in the upper right chamber of the heart. In atrial fibrillation, the top chamber beats faster than the bottom chamber."

When atrial fibrillation occurs, multiple electrical signals fire in the upper chambers causing them to beat so fast that they begin to quiver and fibrillate rather than contracting as a unit. Hundreds of random electrical signals are sent to the atrioventrical (AV) node that is working overtime to protect the ventricles from the random impulses and maintain an orderly flow. When the AV node becomes unable to prevent the disorganized signals from reaching the ventricles, they begin to contract rapidly and pulse and heart rate rise. The pulse can jump from a normal 60 to 100 beats per minute to 200 or more.

"People don't like their hearts racing at 150 beats per minute at rest. It weakens the heart muscles and doesn't feel good," Dr. Heyn says, noting that when the heartbeat is irregular, the amount of blood pumped varies and can cause lightheadedness and weakness.

The likelihood of developing AF rises sharply with age. "As people age, the atria become more stiff. Changes in the heart caused by hypertension, hyperthyroidism, or heart failure can cause atrial fibrillation," Dr. Heyn says. "AF is more common in those 65 and older. But we do see it occasionally in people in their 30s and 40s."

Common Causes
The most common causes of AF are:

• Heart surgery complications account for 30 percent of cases.
• Overactive thyroid (hyperthyroidism). Between 10 and 20 percent of those diagnosed with overactive thyroid develop AF. Those newly diagnosed with AF should be tested for hyperthyroidism.
• Chronic high blood pressure (hypertension).
• Coronary artery disease.
• Rheumatic heart disease.

Treatment Options
Atrial fibrillation can be either acute or chronic. Acute AF is generally defined as symptoms that began in the previous 48 hours. The first line of treatment for patients who seek medical care for acute AF is to try to get the heart to resume its normal rhythm. Many patients will relapse within a year without further treatment.

If the heart does not return to its normal rhythm on its own, physicians can try to convert it with anti-arrhythmic medications.

If drugs fail to do the job, another option is electrical cardioversion, a procedure that involves placing paddles on the patient's chest and delivering an electrical current that resets the heart's electrical activity, which frequently returns to normal. Electrical cardioversion is performed with the patient anesthetized.

Occasionally, a combination of medications and electrical therapy are required. For some patients, a return to normal rhythm means their heart is working efficiently, and they don't require drugs. Others, however, may need to take anti-arrhythmic medications to maintain a normal rhythm.

Julie Heyn, MD, new to Summit Cardiology, specializes in echo cardiography and heart failure. She is American Board Certified in Internal Medicine and Cardiology. Her office is located in the Medical Office Building, 1560 115th St., Suite 206. Her phone number is (206) 363-1004.

Brain Attack Is A Life-Threatening Emergency!

Doctors want people to think of a stroke as a brain attack and to treat it as a medical emergency, just as they would a heart attack.

A stroke is the blockage of an artery, causing a lack of blood flow and oxygen to a particular part of the brain and ultimately causing damage or death of brain tissue.

"Because it's usually not painful, many people do not go to the Emergency Room when they have symptoms. They tend to think they can go to bed and sleep it off. That's a big mistake," says Victor Erlich, MD, neurologist.

"I urge people to come in promptly for an evaluation. A lot can be done to treat a patient if they come in within three hours of the onset of symptoms," Dr. Erlich says.

Patients who seek treatment within three hours of a beginning of stroke symptoms may be candidates for treatment with recombinant tissue-type plasminogen activator (r-tPA), a Food and Drug Administration approved drug that helps restore blood flow to the brain. But, it is only used if a patient is treated within three hours of the onset of symptoms.

Most patients come to the hospital after more than three hoursÑsome because they aren't sure what their symptoms mean, others because the stroke occurred while they were sleeping.

Recognize the Warning Signs
The difficulty of reversing a stroke and the long rehabilitation period patients typically undergo underline the benefits of both early detection and prevention. One or more of the following signs may mean you are experiencing a stroke or that one may be imminent. In either case, seek medical help immediately.

• A sudden feeling of weakness or numbness of an arm, leg, or of the face, especially if it is confined to one side
• Slurred speech or trouble understanding speech
• Loss of vision or blurred or double vision, especially in one eye
• A sudden, severe headache that occurs for no known reason and seems different from others you have experienced
• Unexplained dizziness, loss of coordination, or a sudden fall with no apparent cause
• Difficulty swallowing

Stroke is a leading cause of death and disability in the United States. There are at least 700,000 new cases of stroke each year, the majority affecting senior citizens.

Dr. Erlich estimates that Northwest Hospital treats about 250 patients a year for stroke, making it one of the top three hospitals for treating strokes in the Seattle area.

Risk Factors
Stroke is a highly preventable condition. The Advisory Board of the National Stroke Association (NSA) has identified the major risk factors for a first stroke as well as lifestyle measures that can lower stroke risk. High blood pressure is the most common and the most preventable risk factor. Treating high blood pressure significantly reduces the risk of stroke. High cholesterol levels also increase the risk of stroke. The NSA recommends that all persons with elevated cholesterol take steps to lower it.Diabetes increases stroke risk. Maintaining blood sugars within recommended ranges can help lower the risk of both heart disease and stroke.Lifestyle measures that decrease stroke risk include not smoking, getting regular exercise and eating a diet rich in fruits and vegetables.Dr. Erlich encourage all patients to become informed about strokes and heart attacks.

"Patients should talk to their doctors about stroke and heart attack prevention; they should know their risks for both; and they should know the warning signs of both and get emergency medical care if they have symptoms."

Heart Attack Warning!

A blood clot or a plaque deposit that prevents the flow of blood to the heart causes a heart attack, also known as a myocardial infarction. Without blood and oxygen, the heart muscle becomes damaged.In some cases, the heart also goes into an abnormal rhythm, such as a very slow heart rate (heart block) or a chaotic rhythm (ventricular fibrillation) that makes it difficult for the heart to pump blood efficiently to other parts of the body, including the brain.According to the American Heart Association, warning signs of a heart attack include:

• Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest lasting more than a few minute
• Pain spreading to the shoulders, neck, or arm
• Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath

• Atypical chest pain, stomach, or abdominal pain
• Nausea or dizziness
• Shortness of breath and difficulty breathing
• Unexplained anxiety, weakness, or fatigue
• Palpitations, cold sweat, or paleness
• Jaw pain or pain between the shoulder blades

Free Prostate Screening

As part of a research study on a new form of prostate specific antigen (PSA), the Northwest Prostate Institute is conducting free prostate screening for men age 50 and older who have had no previous diagnosis of prostate cancer. This investigational PSA appears to be more accurate for the detection of cancer. The Institute is one of only a few places in the U. S. that is testing this particular PSA. The screening includes a prostate exam and a small blood sample for PSA testing. Each participant in the screening will be notified of his results. Call (800) 633-4636 for an appointment.

Northwest Hospital Childbirth Center Welcomes T. Berry Brazelton, MD

Join internationally renowned pediatrician, child psychiatrist, and author for a lecture about infant and child development for today's families!

June 15, 2000
7:00 - 8:30 PM
Fifth Avenue Theater
Seattle, WA

On June 16, Dr. Brazelton will offer a full-day seminar for professionals in medicine, child development, education, and childcare!

Watch for details in coming months in this newsletter or on our website at www.nwhospital.org.

Community Health Events

Unless otherwise noted, all classes are held in the Lindsay Gould Auditorium at Northwest Hospital. Please use the registration on this page to sign up for classes or visit our website at www.nwhospital.org.

Osteoporosis Screening for women over 65: Must have at least one of the following risk factors: no hormone replacement therapy, have suffered a non-trauma induced broken bone after age 50, thin or small build, and/or who have lost height due to compression fractures to spine. Outpatient Medical Center, 10330 Meridian Ave., N. March 4, 8:30 am-4:30 pm. Space is limited. Pre-registration required. For appointment, call (206) 633-4636, between 8am and 4 pm, M-F.

Senior Health Fair: Displays of health information specifically targeted to senior citizens and presentations on osteoporosis, anxiety and stress, and walking and balance. (See page 1). Outpatient Medical Center, 10330 Meridian Ave., N., Second Floor. March 4, 10 am-3 pm.

Advance Directives: Who would make health care decisions for you if you were not able? Why should you consider planning in advance for your health care decisions? What is the difference between a "Living Will" and a "Power of Attorney for Health Care"? Come get some great information that will help you to make decisions that are best for you. Speakers: James Gordon, MD, FRCPC and Katharine Witter Brindley, RN, JD. March 7, 12 pm-1:30pm OR March 30, 5:30-7 pm.

Breast Reconstruction: Wandra Miles, MD, a Northwest Hospital plastic surgeon, presents different reconstruction options available following mastectomy for breast cancer and addresses most commonly asked questions and concerns of patients. March 15, 6-8 pm.

Living Well With Diabetes: Gain information and skills to manage your diabetes in this six-session series offered several times a year. Physician referral is required for class registration. If interested, contact your physician.

Childbirth and Parenting Classes

No instruction manual can tell you absolutely everything to expect from pregnancy, childbirth, and parenthood. But, there are ways to learn what you need to know. You'll learn by attending classes and support groups offered right here at Northwest Hospital. The Childbirth Center Prenatal Education Program is a resource you won't want to do without!

Prepared Childbirth Series: This comprehensive program will help you through your pregnancy, labor, delivery, and early parenting. Call (206) 368-1784 for a brochure with more details and schedule of classes. Cost $93 per couple.

Boot Camp for New Dads: This absolutely men-only workshop is fun, frank, and a real eye-opener. Babies and veteran dads coach dads-to-be through hands-on infant care. Dads engage in straight talk about fatherhood and changing family relationships. March 11, April 8, May 13, 9:30 am-12:30 pm. Cost: $15.

Listening Mothersª: During baby's first year, new mothers get together for small group sessions that are offered on an ongoing basis. Listening Mothersª support groups, led by health care professionals with special training in infant emotional development, meet once a week for six weeks. Sponsored by Family Services. Call (206) 521-8093 or (425) 450-0332 for more information and to register. Cost: $50 for six sessions. Scholarships are available.

Infant CPR and Safety (0-12 months old): This information-packed class provides valuable information on product safety, how to protect infants from injury, and skills for handling emergency situations. For parents, grandparents, and others. Feb 23, March 29, April 11, May 23, 7-10 pm. Cost: $20 per person; $35 per couple.

Grandparents: If this is your first time as a grandparent, this class is made for you. Participants learn about various grandparent roles within the family, modern maternity care, and current recommendations for baby care. A Childbirth Center nurse who is also an experienced grandmother teaches this class. March 6, 7-9 pm. Cost: $20 per household.

Refresher: Each labor is different and childbirth procedures change on a continual basis. Join our refresher course for updates and refreshers about labor and delivery. Discussed are previous labor and coping methods, birth options, and pain control methods. Preparations for sibling adjustment and changes in family structure are also covered. March 10 and May 19, 6:30-9:30 pm; April 8, 9:30 am-12:30 pm; Cost: $40 per person; $35 per couple.

Siblings: Help your children be part of this big event. Children ages three to seven get a tour of the Childbirth Center and join in a discussion tailored to their ages. Topics are approached in a manner that helps diffuse animosity and jealousy regarding the initial attention newborns receive. The class also helps develop children's self-esteem and pride in their roles as older sibling. March 21, 6-7:30 pm or May 20, 2:30-4 pm. Cost: $12 for the first child; $3 for each additional child.

The Terrific Two's: How to Understand and Cope with the Challenging Behavior of Your Toddler: Class one of this two-part program focuses on understanding the changes that transform your baby into a preschooler, and how it all impacts your child and results in challenging behaviors. Class two focuses on how best to respond to these behaviors and provides you with ideas that you can take home and begin using that night! March 16 & 23, 7-9pm or May 18 & 25, 7-9 pm. Cost: $45 per couple.

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Northwest Hospital Participates in SeniorsFirst Medicare Plan

Northwest Hospital and its affiliated physicians are proud to be part of a Medicare Plan called SeniorsFirst.SeniorsFirst, developed by local doctors and hospitals, like Northwest Hospital, gives you and your doctor greater control over your care. Besides the standard services of most Medicare Plans, SeniorsFirst pays for deductibles and co-insurance so you may not need Medigap or other supplemental insurance; preventive and wellness care, including routine eye and hearing exams; hospital outpatient coverage (you pay nothing for day surgery); skilled nursing facility coverage; lab services, home health care, outpatient hospital services, blood, and mammograms; worldwide emergency care; and travel coverage up to $2000 in a calendar year for non-urgent care within the United States.

SeniorsFirst also offers you access to local hospitals, physicians, and other health professionals, including those at Northwest Hospital; minimal paperwork when using plan providers; and nominal co-payments.To find out more about this plan, call SeniorsFirst at (800) 864-1190.

SeniorsFirst is a Medicare + Choice plan available to all Medicare beneficiaries. Anyone with Medicare Part A and Part B may apply. All members must continue to pay Medicare Part B premiums and use plan contracting providers. Coverage is underwritten and administered by First Choice Health.

If you have questions about other Medicare supplement plans that include Northwest Hospital, call Norm Brown, insurance representative, at (206) 368-6070.

Northwest Hospital Continues
Focus on Community Outreach

As you can see by the articles in this issue of MED-INFO, Northwest Hospital continues its emphasis on improving the health of our community by promoting prevention and early detection of disease through screenings, research, education, and information.

Our success in improving the quality of health in our community--one person at a time--depends on the generous financial support of people like you. For example, your gift of $120, just $10 a month, to Northwest Hospital Foundation's Peer Program helps to cover the cost of early detection screening for one person.

Thanks for your continuing support of Northwest Hospital and your friends and neighbors throughout this new year!

Risk Factors for Osteoporosis

The National Osteoporosis Foundation recommends bone density testing for all women age 65 and older, but younger women with one or more risk factors should talk to their doctors about the benefits of testing. Risk factors include:

• Caucasian or Asian descent
• Small build
• Previous fracture
• Family history of osteoporosis
• Menopause before age 45
• Smoking
• Alcohol abuse
• Inactive lifestyle
• Low calcium in diet
• Medications such as steroids and thyroid hormones

Northwest Hospital Participates in SeniorsFirst Medicare Plan

Northwest Hospital and its affiliated physicians are proud to be part of a Medicare Plan called SeniorsFirst.SeniorsFirst, developed by local doctors and hospitals, like Northwest Hospital, gives you and your doctor greater control over your care. Besides the standard services of most Medicare Plans, SeniorsFirst pays for deductibles and co-insurance so you may not need Medigap or other supplemental insurance; preventive and wellness care, including routine eye and hearing exams; hospital outpatient coverage (you pay nothing for day surgery); skilled nursing facility coverage; lab services, home health care, outpatient hospital services, blood, and mammograms; worldwide emergency care; and travel coverage up to $2000 in a calendar year for non-urgent care within the United States.

SeniorsFirst also offers you access to local hospitals, physicians, and other health professionals, including those at Northwest Hospital; minimal paperwork when using plan providers; and nominal co-payments.

To find out more about this plan, call SeniorsFirst at (800) 864-1190.SeniorsFirst is a Medicare + Choice plan available to all Medicare beneficiaries. Anyone with Medicare Part A and Part B may apply. All members must continue to pay Medicare Part B premiums and use plan contracting providers. Coverage is underwritten and administered by First Choice Health.

If you have questions about other Medicare supplement plans that include Northwest Hospital, call Norm Brown, insurance representative, at (206) 368-6070.

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