Graceful Health

The following articles were originally published in the Brattleboro Reformer on the dates indicated.

Advance Care Planning: Why it’s Good to be Prepared

By Dr. Anne Brewer, Grace Cottage Hospital

I was a Girl Scout when I was young, and well I remember the Scout motto: Be Prepared. It’s applicable to many areas in life, including medicine.

One of the most important ways that a patient can be prepared is by completing an Advance Care Planning document.   

Advance Care Planning, also known as advance directives, offers all adults the opportunity to be prepared for a time when they cannot express their wishes about what type of care they want to receive. It allows them to give guidance to their family and medical care team in the event that they cannot speak directly for themselves because of terminal illness, serious injury, coma, dementia, or another situation.

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What Do You Know About E-Cigarettes?

By Dr. Elizabeth Linder, Grace Cottage Family Health Pediatrician

The use of e-cigarettes is a rising trend these days, for adults, but also particularly for teens. In just over a decade, this fad has grown into huge industry, with hundreds of thousands of users.

Use among teens has seen the fastest growth. The National Youth Tobacco Survey for 2011-15 shows that the rate among teens was 2% in 2011 and had risen to 16% just four years later. In 2015, more teens reported use of e-cigarettes than conventional cigarettes (15% vs. 11%). Nearly one in four Vermont middle- and high-school students have tried an e-cigarette.

If you are a parent, or any adult who takes care of, and cares for children, what do you need to know about e-cigarettes? Are they really a safe alternative to regular cigarettes? How do you talk to your kids about e-cigarettes?

First, you have to know the vocabulary.

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Another Tick-Borne Disease

By David McCormack, Grace Cottage Family Health FNP

Lyme disease is often in the news these days, so by now, most people know at least the basics about how it is contracted, what to do if you get a tick bite, and how to avoid it.

What about the other common tick-borne disease—anaplasmosis?

The Vermont Department of Health says that anaplasmosis is the second most commonly reported tick-borne disease in Vermont, and it’s on the rise. In 2011, there were only 10 cases of suspected or confirmed anaplasmosis. In 2016, there were 201.

When not diagnosed and treated properly, over one-third of those with the disease end up hospitalized, and anaplasmosis can in rare cases be fatal, especially for those with compromised immune systems. While less than 1% of people infected die as a result, this is a disease to take seriously.

One of the hardest things about diagnosing this disease is that, unlike Lyme disease, there is no telltale rash, and the symptoms are fairly common: aches and pains, headaches, chills, fever, fatigue. So how do you know if it’s anaplasmosis?

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Hypertension: What It Is, How to Manage It

Dr. Moss Linder

By Dr. Moss Linder, Grace Cottage Family Health

In the doctor’s office, emergency room and hospital, we are always on the lookout for high blood pressure, also known as hypertension. Unfortunately, in the United States, hypertension is a common condition and is prevalent in about 32% of adults 18 years or older. The prevalence is higher in people over age 60 compared to younger adults and is higher in African-Americans than white or Hispanic Americans.

Hypertension is generally referred to as a “silent illness.” That is, most people who have elevated blood pressure do not have any symptoms associated with it. Sometimes someone with hypertension may have a headache, but this is more likely an exception, rather than the rule. Therefore, it is very important to have regular blood pressure checks.

Because hypertension is usually an asymptomatic illness, it would be recommended that people check their blood pressure once a year just to make sure that it is normal. This is probably best done as part of an annual wellness examination. The frequency of checking blood pressures in a person with hypertension would be at the recommendation of their clinician.

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Having Happy Feet

By Margaret van den Bergh, Grace Cottage Physical Therapist 

Are your feet happy?

Our feet hit the ground first every morning. They are so important to everything we do, but it is easy to ignore them. Many times we cram them into shoes that don’t even resemble the shape of a foot, or walk in heels that change everything about our gait. We stand on them all day long, and we carry heavy loads that add to the body weight our feet are already carrying.

The amount of force every time your heel strikes the ground can be 2.5 times your body weight and 3.5 times when running. Multiply all that force with the amount of steps that you take in a typical day, and you can begin to imagine how tough our little feet need to be to handle all that abuse. Our feet were initially designed to be barefoot and to be on softer surfaces than what modern life throws at us. 

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Doc, Should I Go to the ER?

By Dr. Kenneth Rudd, MD, MPH, MHCDS from Grace Cottage Family Health & Hospital

How do you know when it’s time to go to the hospital Emergency Room versus seeking care elsewhere?

Because I work as both an Emergency Room doctor for Grace Cottage Family Health & Hospital in Townshend, VT, and as a primary care doctor for Dartmouth-Hitchcock in Lebanon, NH, and have also worked for an Urgent Care Center, I enjoy helping patients navigate the best place to go for healthcare.

The Primary Care Advantage:

My main advice, which I have seen hold true all over the world, from living in China for seven years, to studying Public Health, to working at Dartmouth College and the World Health Organization on international healthcare collaborations, to global primary care research on shared decision making, is, whenever possible, see your primary care provider (PCP).  

What doctor knows you best?  Where do you have relationship and trust? If it isn’t with your PCP, then find a provider that is a good fit for you and build this. 

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Lymphedema Therapy: Not Just for Breast Cancer Survivors

Lymphedema Therapy

Abigail Abbott and Cindy Kenyon, Grace Cottage Physical Therapists

If you have had breast cancer, it’s quite likely that you’ve heard of Lymphedema. As many as 50% of breast cancer survivors must deal with this condition.

But breast cancer isn’t the only cause of Lymphedema. It can be congenital, meaning you can be born with the tendency. Or it can be caused by dysfunction of valves in the vein of an arm or leg (in medical terms, this is called chronic venous insufficiency). If you have unexplained swelling in an arm or leg, it could be due to Lymphedema.

The good news is that help is available to relieve this swelling. Specially trained therapists can offer treatment to start you in the right direction, and they can teach you to carry on with this treatment for yourself.

Further good news: Lymphedema therapists are few and far between, but Grace Cottage now has two physical therapists certified to provide this therapy, Cindy Kenyon and Abby Abbott.

In order for us to explain what is involved with Lymphedema therapy, we first need to explain what causes Lymphedema.

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Graston Technique Promotes Faster Soft Tissue Healing

By Margaret van den Bergh, PT

Graston Technique. It’s a strange-sounding name for a new physical therapy method that can help patients heal faster from soft tissue injuries like sprains, fibromyalgia, tennis elbow, golfer’s elbow, back pain, carpal tunnel syndrome, tendonitis, shin splints, trigger finger, and plantar fasciitis, to name a few.

Backed by over 20 years of research, clinical studies, and successful clinical application. GT therapy is part of the curriculum for 43 advanced degree programs in physical therapy, chiropractics, and athletic training. It is used regularly by over 250 professional and amateur sports teams and by U.S. Olympic training centers. There are over 16,000 certified physical therapists, chiropractors, and athlete trainers worldwide.

Now three Grace Cottage Family Health & Hospital’s physical therapy staff members are also certified to offer this treatment: Rebecca Griswold, PTA; Melissa Walker, DPT; and me.

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Be a Life Saver!

By Dr. Timothy Shafer, Grace Cottage Family Health

Did you know that you have the potential to save eight lives, by donating your organs after you die? All across the nation, thousands of people are waiting for a heart, lung, liver, pancreas, kidney, or intestines. Others could benefit from a tissue donation. You could make the difference.

It’s understandable that talking about organ donation is difficult. Until the issue touches you directly, affecting you or someone you know, it’s easier to avoid the topic.

Consider, though, that this is one way you can save someone’s life without risk to your own.

Consider also the following illustrative story: A baby boy was born a few years ago. It should have been a happy occasion, but instead, there was much anxiety because the baby had two malfunctioning kidneys. If only one kidney was faulty, he could have survived that way.

It is actually fairly common to live with one kidney. Some people are born this way. Amazingly, others give away one of their kidneys to help someone who needs it. As long as they protect the remaining kidney, they can live normal lives.

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Time for a Colon Cancer Screening Test? You Have Options

By Dr. Ewa Arnold, Grace Cottage Family Health

Is it time for your colonoscopy? I bet you’re not looking forward to that! Colon cancer screening tests are highly unpopular, but they are certainly worth the discomfort.

Did you know that colon cancer is the second leading cause of cancer deaths in the U.S.? The disease affects both men and women, mainly but not exclusively those over age 50. Despite this dire morbidity statistic, it’s important to remember that colon cancer is highly treatable—if discovered early. That’s why it’s so important to have your colon screening tests on schedule.

March is National Colorectal Cancer Awareness Month, so this is a good time to revisit the topic.

The Centers for Disease Control (CDC) recommends that, beginning at age 50, adults have regular screenings until at least age 75. Colon cancers generally develop slowly. After age 75, you should discuss the alternatives with your provider.

Despite the notoriously uncomfortable preparation required,

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