H ealtHful H abits RN&R’s 2013 HE ALTH GUIDE
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H ealtHful Habits RepRoductive he alth affects the whole body and information about services and programs offered there. We also have Caitlin Thomas’ story exploring some of the services provided for students at University of Nevada, Reno’s Student Health Center. And Derek Armstrong talks about sexual education in the state of Nevada. This guide has more than just stories about the nether regions, though. Turn to Cambria Roth’s story about breast cancer to hear from a breast cancer survivor and from a breast surgeon about how to diagnose this disease earlier rather than later. Your reproductive health is largely in your own hands. Hopefully, this guide will give you information to begin taking control.
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oncern about health is unavoidable. It’s too important in each of our lives to ignore it, even if we often choose to push it to the back of our minds. And human beings are made to reproduce, so keeping ourselves healthy in that department is especially important. Reproductive health and the issues that come with it have and will probably always be hot topics, and that’s why this year’s health guide revolves around keeping our reproductive systems in tip top shape. If you turn to page 6, you’ll find a question and answer piece with Jill Anderson from Planned Parenthood with some health tips
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ka ren ba r to n sh ows h e r “past, p r e sent, fu tur e” rin g h e r h u sba n d bo u g h t h e r af te r los ing h e r h a ir a n d b e atin g br e as t c anc e r. p H o t o /C a m B r i a r o t H
F amily matters Tre aTmenT is imporTanT, buT caring family members can make all The difference when The diagnosis is bre asT cancer by Cambria roth
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then Karen Barton first received that call on a Friday afternoon, she was scared. On the other end of the line the doctor said, “You have breast cancer …” He went into treatment options, but after that, all she heard was “blah, blah, blah.” Barton was an average, active mom. At 38 years old, she would get her son ready for school, go to work, come home, cook dinner, and maybe go to a baseball game or wrestling match. “I had never even had a breast exam, and for some reason one day I decided to, and I found a lump,” Barton said. “It was right after my father passed away, and I swear he had a part in everything.” It was important to her not to lose her hair, and she was grateful that she was able
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to have radiation that avoided that. She continued to work and live her daily life, but she did have a partial mastectomy. Eight years later, she was scheduled for a bone marrow biopsy for lymphoma, and she told her doctor that she had felt another breast lump. “He removed the tumor and told me he had good news and bad news,” Barton said. “The good news was that my bone marrow was fine, but I had breast cancer again.” This time she had to have chemotherapy, and one of her worst fears came true—she lost her hair. “It is bad enough to lose your breasts, but to lose your hair on top of it makes it all real,” she said. “I was sitting at my desk, and a handful of hair would just fall out into my hands.”
Her positive attitude, close friends and loving husband helped her through everything she would overcome after the reoccurrence. Her husband went to every treatment, every reconstruction, and was her rock. After hearing the news about her hair, he drove her to the mall, took her to a jewelry store and bought her a past, present, future diamond ring. “It is really hard on the person who has cancer, but it is even harder on the family because there isn’t really a lot they can do for you,” Barton said. Her friend Dana was holding her hand when she woke up from a total mastectomy, and helped soothe her with the words, “Everything is temporary, and it gets better.” Dr. Brian Juell’s, M.D., F.A.C.S., main focus is just that—it gets better. Juell is a general surgeon who is well regarded for his work with conditions of the breast. He is the current director for Renown’s Breast Cancer Center and a member of the American Society of Breast Surgeons. “We are very successful in treating patients with breast cancer,” Juell said. “There are about 400,000 women that develop breast cancer each year as a new diagnosis, and we successfully treat at least 70 percent of those patients.” Breast cancer is a malignancy that starts in the breast and can spread depending on its stage. Juell said that 1 in 8 women develop breast cancer in their life, and it is more common in 50 to 70 year old women. Breast cancer develops differently than other cancers because it can grow to a fairly large size before obtaining the ability to spread. This makes awareness essential to catching the cancer in the early stages so it’s curable. Women should look for any unusual mass on the breast, redness and unusual drainage from the nipple, or deformity on the skin. However, it isn’t always this easy. “We try to encourage women who are in vulnerable age groups to have screening tests by either a physician or a mammogram,” Juell said. “On a mammogram, we can find a tumor as small as a few millimeters in diameter whereas you cannot possibly feel that.”
Most cancers Juell discovers through screening are early stage cancers where treatment is primarily surgical. Other treatments include chemotherapy, hormonal manipulation and radiation. One treatment that Juell is looking to bring to Reno is Radio Frequency Inflation. This is a way of using high frequency sound waves or radio waves to heat the tissue and kill it with a “microwave treatment.” Genetics do play a significant role in the susceptibility of breast cancer for certain individuals who have a family history of cancer. For example, Angelina Jolie made headlines when she made the decision to have both breasts removed because her mother died from breast cancer at a young age. “BRCA1 and BRCA2 genes and other genetic defects can be identified through genetic testing,” Juell said. “We like to test patients and look at their history to give them the opportunity to subject to periodical screening, or in some cases like Jolie’s, have a double mastectomy to reduce the risk.” For Juell, it is all about talking with patients. He was drawn to this aspect of general surgery because he wanted to be the kind of doctor that spent time with patients and supported them. At Renown, there are programs for patients that focus on survivorship. “The fact that there are so many women who beat this type of cancer is critical to helping patients go back to enjoying their life without that constant fear of reoccurrence,” Jeull said. “It gives patients hope, and in a bleak period in their lives it is important for them to be optimistic.” For Barton, her experience helped her to live every day to its fullest and to not take things for granted. When her husband retires in February, they will hike, golf and fish in Hawaii, or if they don’t feel like doing anything, they won’t. “When patients see you doing well it really does give them hope,” Barton said. For more inF ormation on B rian Juell, m . D. , F. a.C. S. , v iSit w w w. premiereSurgiCal. net.
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Jill a n d e r so n wo rks at planne d par enth o o d ’s fi f th st re e t he a l th c en te r as a c o m m uni t y h e al th e d u cato r a n d th e le ad te en s uc c e ss fac ili tato r. PHOTO/SAGE LEEHE Y
H ealtHy Hints
by Sage Leehey
RepRoductive he alth infoRmation and seRvices Jill Anderson works on various projects and programs in the Reno area to educate people about reproductive health topics as an employee of Planned Parenthood.
What do you do here? I’m a community health educator and the lead Teen Success facilitator.
What does that entail? The community health education part means that I provide community health education, usually sexual health education. As part of that, we have a weekly program where we go up to Job Corps and provide their students with general sexual health education—healthy relationships, anatomy, kind of like the basics. I’ve also been involved in several other community health programs throughout the four years that I worked here, including Street Smart programs, and most of these programs are aimed at youth. We also have a program called Someone Else’s Shoes that I do,
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which is a program to help provide— basically, the focus of that program is on teen pregnancy prevention. And so it’s a program that we provide to different venues. We’ve done it for high schools, middle schools, college-age level, and it talks about teen pregnancy and its impact on the community and what we can do to best support teen moms to be successful, and also what we can do to help prevent unwanted and unplanned teen pregnancy. And then on the Teen Success facilitation side of it, the Teen Success group is a support group for pregnant and parenting teen moms, and the two main goals of that group are to help teen moms maintain their family size until after they graduate high school and also complete their high school education. That’s a really successful program. We’re really proud of that. In the general population, teen moms have a repeat pregnancy 20 percent of the time in Nevada, and girls who are members of Teen Success, only 1 to 2 percent have a repeat pregnancy. So that’s really successful. And as far as high school graduation rate, the high
school graduation rate for teen moms in the general population is 50 percent and of girls who are involved in the Teen Success program, there’s a 98 percent graduation rate from high school or getting their GED. … We do sometimes offer one-onone kind of like mini lessons ... for people who are interested in that—it’s usually for youth or children—but primarily, we do kind of like group programs. ... They kind of vary a little bit. Some are like ongoing multisession groups with an education focus. Some of the programs that we do, like my colleague does a lot of programming with UNR and TMCC, so he’ll go in and he’ll do one-off kind of sessions of general sexual education, topics around sexuality, how to talk to your kids about sex, that kind of a thing. That’s also what Someone Else’s Shoes program is, it’s a one-off program. And then the Teen Success program is an ongoing support group, so members come weekly to that group. Those are kind of the basics. Sometimes we also do other one-off sessions because community agencies will contact us and say, “Hey, we want someone to come and talk to social workers and psychologists and mental health professionals about how a person’s sexuality and sexual health can affect their mental health.” That’s a program that we’re putting together for NNAMHS (Northern Nevada Adult Mental Health Services) over on Galletti.
What are some of the things you talk about in a typical education program or session? It kind of varies depending on the program. For the Teen Success program we focus on goal setting, parenting skills and child development, healthy relationships, decision-making, sexual health and that kind of thing. And then the ¡Cuidate! program is aimed at a younger crowd and talks a lot about anatomy, puberty, birth control, including abstinence and STIs. Those are usually the main focus of our education programs— anatomy and sexual health, birth control, including abstinence and STIs. We also have a parents talk program where we talk to parents about how to talk to their kids about sex and sexual health at different ages. We totally have a wide range of topics. Sometimes we do a condom demonstration and condom negotiation—
when to talk about condoms, how to bring it up, reasons to use condoms, why it’s important, that kind of thing. At the Teen Success group, we also do a cooking class so we talk about nutrition and general health, too.
What’s your favorite part of your job here? Oh gosh. That’s a pretty tough question. I really like a lot of the programs that we do here. I think probably my favorite part is the Teen Success program. It’s one that I’ve been involved in pretty intimately and like heavily since I started working here. I just really enjoy the opportunity to get to work with young moms. It’s very motivating. It’s really inspiring just to be able to give them a safe space to come and have a nonjudgmental experience and being with other teen moms and getting to work with adult mentors, it’s pretty amazing. We do like a cooking class once a quarter, and we also have a scholarship opportunity for girls in that program. So we have a scholarship luncheon once a year, and that’s also like a really amazing opportunity for them. This year the girls did an amazing job. We had seven recipients of the scholarship and so that was a great time just at that luncheon.
What would be some of your advice for the general population about reproductive health? October is “Let’s Talk” month, so like talking to your kids about sexual health and kind of being able to start doing that. Studies have found that parents have a really big influence on how kids relate to sex and sexuality and their own experience with it. And so kids who have parents who are able and willing to talk to them and give them medically accurate information that’s age appropriate in kind of an environment that’s open and nonjudgmental, so that kids get to kind of generally get to explore, “Hey, this is what I’m hearing on the playground. Is that true?” I think that that’s some excellent advice that it’s especially important for parents to talk to their kids. One thing that I’ve found in doing sexual health education is that kids really are curious about sex and sexuality and sexual
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For those parts of reproductive health, what would be some of your advice?
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Like other kinds of preventative health care? Yes. Planned Parenthood does offer that. Not mammograms, but breast exams. Also cervical cancer screening, annual well woman exams, so like pelvic exams. We do the HPV vaccine, which is a big thing, the Human Papilloma Virus. We offer that vaccine, which is a huge benefit to young people. It’s available to men and girls aged 11 to 26. It’s a series of three shots, and when all three shots are administered it’s a really great protective factor for those people because HPV is pretty prolific. And if people are sexually active, it’s a really great protective measure. It’s not 100 percent to protect against HPV, but it’s a really good thing that people can do to help protect themselves. And, obviously, Planned Parenthood offers like birth control and also STI, sexually transmitted infection, testing and treatment.
I think just like knowing that the services are available is really an important part of keeping the community as a whole healthier and safer and also knowing that it’s available in a judgment-free environment. So if someone were to come in and say they haven’t had a pap smear in five years or something, I think there can sometimes be some shame associated with that or like, “Oh no, I haven’t done this.” So Planned Parenthood is a good place to come to where you’re not going to get that kind of reaction. We just want you to come in and be healthy. We want the services to be as affordable as possible and available to anybody who wants them.
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health. They have a lot of questions when given the opportunity, and it’s stuff that they really do want to know and are interested in. So being able to provide them with medically accurate information is so important because they can go out and make informed choices.
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Ch r is to p h e r Danie ls is a c o m m uni t y h e al th e duc ato r and o u t r e ac h s pe c ialis t fo r P lanne d Par enth o o d. PHOTO/DEREK ARMSTRONG
L et ’ s taLk about sex Why are PeoPle so afraiD of aCCurate information about What PeoPle Do When they’re nakeD?
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round the country, adolescents are growing up in a whirlwind of vigorous change. This is both a blessing and a curse in modern society; allowing for some individuals the opportunity of choice, and for others, a padlock of unrelenting judgment. This can most evidently be seen in the rise, fall, rise again, fall again of sexual knowledge and acceptance. Two questions have been asked throughout modern history: Should Americans have access to information about sex and sexual health? How much information should they have? Christopher Daniels, a community health educator and outreach specialist for Planned Parenthood, questions the existence of a limit on the amount of information people should have. “Talking and asking questions about our sexual health can be awkward,” Daniels said. “And with rampant misinformation trolling the internet, it is crucial to have a space where anyone—men, women, teens, gay, straight, bisexual and transgender individuals—can get the answers they need.” “Sexual health and responsibility are the basis for intimate relationships, happy families and having healthy children. Proper sex education allows people to make informed decisions and choices about their sexual and reproductive health.”
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by Derek Armstrong
In a state with the fourth highest pregnancy rate in America, it’s important to have a sanctuary where people from all walks of life can go for information and support. “The goal of Planned Parenthood is to provide a safe space where people can receive medically accurate and age appropriate information,” he explained. “Free of judgment or stigma.” The opposition to this view, however, is that by educating young adults in sexual responsibility we are mass-producing an intimately indiscriminate and downright promiscuous youth. Since the dawn of the Common Era, there has been a desire to hide human sexuality. Planned Parenthood’s methods and morals have been under scrutiny for just as long as the organization has existed. To these questions, Daniels says accuracy is key: “Misinformation and lies breed paranoia. People are afraid that a proper sex education bill will promote sex among youth, normalize members of the LGBT community and throw abstinence to the wind.” A sex education bill passed on a 26-15 party line vote in the Nevada Assembly, but later failed in the Senate. The bill would have replaced a 30-year-old sex education program implemented in schools grade eight and above, but would also have enacted unrelated fields of study.
“This bill would have updated and standardized the sex education system across the state,” Daniels said. Currently in the United States, only 22 states and the District of Columbia require schools to include sexual education in their curriculum. Of these, only 19 mandate that all information must be medically, factually and technically accurate. The most recent Centers for Disease Control and Prevention (CDC) survey indicated that more than 47 percent of all high school students say they have had sex and 15 percent said they have had sex with four or more partners during their lifetime. Among students who had sex in the three months prior to the survey, 60 percent reported condom use and 23 percent reported birth control pill use during their last sexual encounter. “There is a battle that exists between parents and schools over who is responsible for educating our youth about sex,” he said. “This battle halts progress.” Sexual and reproductive health standards are always changing, but sex education has not. Recently, Nevada became the 16th highest for STD’s based on countrywide surveys. Still, though, many schools are teaching abstinence as the only option. “Programs need to be culturally appropriate,” Daniels said. “Sensitive to gender, sexual orientation, social class, etc. They cannot be one size fits all.” Planned Parenthood is doing everything in its ability to stay on the cutting edge of information, according to Daniels, including special workshops and classes designed to help different demographics. “¡Cuidate!” is one of these programs, which is customized for Latina women ages 1317 with an emphasis on pregnancy prevention. They also have programs focusing on helping teen parents complete high school and maintain their family size and educating parents on how to discuss sex and reproductive health with their children. “What could be more important than educating our youth about the consequences—both good and bad—of sex and equip our populace with the tools necessary to make responsible sexual decisions?” he said. Daniels believes the importance of reproductive health and sexual awareness goes far beyond just educating high school students on STDs and unplanned pregnancy, however. “Honesty is critical and essential in sexual health. Honestly communicating one’s wants and needs in a relationship results in a healthier, more equitable partnership. Much of the stigma surrounding sexually transmitted diseases and unplanned pregnancy would be eliminated if we were honest with our doctors, with our partners, and with ourselves. If we honestly admitted and openly faced the problems facing our country, our community, whether it’s teen pregnancy, health care, or STD prevalence, we can begin to properly address and solve these issues.”
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xperimentation could be the most popular college subject. Being on the cusp of an emerging adulthood manipulates one’s behavior in surprising ways. Maybe it was the cheap beer in the signature red party cup. Maybe he was carrying your books to class. It could have been the scent of the girl who sits in front of you in sociology. The forces of nature tend to take control in the college years. Fortunately, students have a home for the growing pains. No parental consent necessary. The Student Health Center is on the University of Nevada, Reno’s north campus area in the Redfield building on the medical school campus. They provide care for students that varies from immunizations to radiology. Enid Jennings, a health educator for the University of Nevada, Reno, decided there weren’t enough opportunities for check-ups in the down-there zone. It seemed like an excellent time to increase free testing periods. “We used to do free STD testing once a semester,” Jennings says. “But we piloted once a week testing last semester which was fairly successful, so now it’s once a week, always tailoring to students, always free on some level.” Jennings proved there was a real need for an increase of STD awareness. A consistent number of students showed once a week (ranging from
18 to 20 students) in the two-hour time period in which free testing was offered. However, there remains a number of students hesitant to take that step, so the health center encourages awareness starting from the very beginning of the college cycle. “We present on the importance of sexual health during orientation,” she said. “It’s really important that students understand that most STDs go untreated and there are serious consequences to this.” A wide array of STDs are spread on campus. The most common is HPV, human papillomavirus, which has been proven the major cause of cervical cancer. HIV, human immunodeficiency virus, is rarely diagnosed. Students are usually fairly intimidated when confronted with questions on sexual history, however there is no shame in blushing. “My advice would be not to be nervous,” Jennings says. “There are no stigmas here, it’s just another piece of health.” Soon the cause will come full circle. Next semester, students will run the program, answering questions for their fellow students undergoing the tests. Training is happening now with big hopes for the future. “We are adding a peer education to the program,” Jenning exerts. “It will literally be student to student.” F o r mo r e i n For mati on on the Stu den t h e a lt h C e n ter , vi S i t w w w.u n r .edu/ShC .
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