Sudden Infant Death Syndrome remains a mystery
TAHLEQUAH, Okla. – Cherokee Nation citizen Angela Garrett remembers the cold day in January 1993 as one that began like a normal day.
She had just per her 2-month-old son, Blaine, down for a nap in his crib. She checked on him frequently, but despite that, one hour later Blaine died in his sleep. The cause was Sudden Infant Death Syndrome.
October is Sudden Infant Death Syndrome, or SIDS, Awareness Month. SIDS occurs at a rate of about 0.5 per 1,000 births. However, in American Indian and African American populations, the rate is around one per 1,000 births.
SIDS is considered the death of a child less than 1 year old that remains “unexplained” after a thorough investigation including an autopsy, review of clinical history and investigation of the scene of death, said Dr. Tom Kincade, chief of Pediatrics at the Cherokee Nation Three Rivers Health Center in Muskogee.
“I think it is important for our communities to know abut SIDS due to the increased rates in Native Americans and also to be aware of the factors that can help prevent SIDS,” Kincade said.
SIDS remains a leading cause of death in healthy infants less than 1 year old, and approximately 2,100 infants in the United States die of SIDS per year, he said.
Parents can reduce the risk of SIDS by placing babies on their backs to sleep.
“Studies show that over 90 percent of infants that died from SIDS were not sleeping on their backs,” he said. “Most were sleeping on their stomachs.”
Garrett said she put Blaine on his back for his nap, but when she found him, he was on his stomach and his face was in the crib mattress.
“Somehow, at 2 months old he rolled over,” she said. “He was already gone when I found him. I didn’t even call 911(immediately.) I called my mom because he was already gone.”
She said afterward she was in a state of shock, and since then she’s blocked out most of the memory of losing Blaine to SIDS.
“I don’t even remember them taking him out,” she said. “I thought he was still in the room after the ambulance got there and everything. It was a couple of hours later and I thought he was still there.”
Even now, 14 years later, Garrett said she’s stilly trying to understand SIDS.
“From the moment I found him, I don’t remember too much of anything else,” she said. “He wasn’t sick. He didn’t have a cold. There wasn’t anything wrong with him.”
Studies have also shown that letting babies use pacifiers while sleeping can reduce the SIDS risk, Kincade said. He added that infants should sleep on a firm sleeping surface, should not be overdressed while they sleep and stuffed animals, excess bedding and blankets should be avoided.
“When babies leave the hospital nursery they should be able to maintain a normal body temperature which means if parents feel comfortable in shorts and a tee shirt, their babies will too,” he said.
Educational materials about SIDS have been placed in the clinic and exam rooms at the Three Rivers Health Center, and other tribal clinics have been encouraged to do the same, Kincade said.
WASHINGTON – The Indian Health Service on Jan. 9 published a report outlining a policy and implementation plan to expand the use of community health aides in American Indian and Alaska Native health programs across the country.
Community health aides are paraprofessional health care workers who can perform a range of duties in health programs to improve access to quality care for American Indians and Alaska Natives.
Under the new policy, facilities operated by the federal government and tribally operated facilities could see expanded opportunities for using these aides, a group that could include dental health aide therapists and workers in substance use and suicide prevention, health education, communicable disease control, maternal and child health, environmental health and other fields.
“Increased access to health care is a top priority for IHS, and community health aides expand much-needed health services for American Indian and Alaska Native communities,” said Mary L. Smith, IHS principal deputy director. “I thank all of our tribal partners for sharing their feedback, and I look forward to their continued participation and partnership as we work together to develop a robust implementation plan. Community health aides are already providing quality health care in some parts of Indian Country, and with the expansion of this program, Native American communities across the nation will have access to these valuable health workers.”
In June, IHS invited comments from tribal leaders on a draft policy statement to begin a process of expanding the use of community health aides at IHS facilities across the country. January’s announcement includes a report summarizing the comments received during consultation meetings and other comments sent to the IHS.
As described in the report, IHS will establish a national workgroup that includes tribal leaders and outside experts to advise IHS on the development of a policy and implementation plan for the Community Health Aide Program. IHS will then seek input through the formal tribal consultation process, and finalize the policy. IHS already runs an evaluation system mandated by statute to monitor current IHS community health aides to assure that quality health care is being provided to patients.
The Report on the Tribal Consultation for the IHS Policy Statement on Creating a National IHS Community Health Aide Program and Dear Tribal Leader Letter announcing the report are available at <a href="http://www.ihs.gov" target="_blank">www.ihs.gov</a>.
In August, through the Community Health Aide Program Certification Board it manages, IHS certified the latest group of community health aides in Alaska, totaling 171 behavioral health, dental health and other aides and practitioners.
Many community health aides come from the local communities and immediate surrounding areas.
OKLAHOMA CITY (AP) — The agency that oversees Medicaid in Oklahoma is requesting an additional $200 million, mostly to maintain its current level of health care services for low-income residents, the agency's new leader told state lawmakers on Tuesday.
Becky Pasternik-Ikard, the new chief executive officer of the Oklahoma Health Care Authority, outlined her agency's budget during a hearing on Tuesday before the House Appropriations and Budget Committee.
Pasternik-Ikard said about $120 million of the agency's requested budget increase for the fiscal year that begins July 1 is to maintain its current level of programs. An additional $24 million would be required to restore a 3 percent rate cut to Medicaid providers in the state that was implemented last year.
The Health Care Authority received nearly $1 billion in state appropriations last year and was one of the few agencies to receive a funding increase amid a $1.3 billion shortfall.
"Last session was not easy. And we fared very well in that appropriations process," Pasternik-Ikard told lawmakers. "We're very grateful."
Lawmakers this year are facing another shortfall of about $870 million. Without additional funding, Pasternik-Ikard said one of the few options the agency has to save money is reducing the amount it pays to health care providers for services to Medicaid recipients. But as reimbursement rates shrink, many providers stop providing care to Medicaid patients.
There are currently about 816,000 state residents, more than 20 percent of the state's population and mostly children, enrolled in Medicaid, called Soonercare in Oklahoma. About 57 percent of all births in Oklahoma are covered by Medicaid.
Every 1 percent cut to provider reimbursement rate equates to a savings of about $8.6 million in state appropriations, Pasternik-Ikard said.
"The Health Care Authority has a tremendous challenge in front of them," said Rep. Chad Caldwell, R-Enid. "I think we're in a similar place to where we were last year, where just to maintain where we are now they're going to need an increase in their budget."
The Health Care Authority is one of the five in Oklahoma that receive nearly 80 percent of all state-appropriated funding. The others are the departments of education, transportation, higher education and human services. Officials with each of those five agencies presented budget information over the last several days to legislators ahead of the session that begins Feb. 6.
TAHLEQUAH, Okla. – The Cherokee Nation’s Food Distribution Program on Jan. 11 received a $20,000 grant from the First Nations Development Institute to start a “Smoothie Demonstration Project” with hopes of getting clients to add more fruits and vegetables into their diets.
According to a First Nations release, the CN was one of 21 tribes and Native American organizations to receive grants to start or expand nutrition education programming in their communities.
According to a CN release, the tribe’s Human Services, under which the Food Distribution Program falls, will use the grant to give 150 participants free blenders in exchange for meeting monthly to get smoothie recipes and track activity and nutrition.
“Eating healthy, staying active and being physically fit should not be a burden,” Leah Duncan, Food Distribution manager, said. “The ‘Smoothie Demonstration Project’ is a tasty, healthy, inexpensive gateway into a better life for tribal citizens willing to participate, especially since many of our participants are elders or families with young children and may want a faster, easier way to get in all their food groups on the go.”
According to the CN release, Food Distribution operates six self-serve food stores to ensure that citizens of federally recognized tribes who are income-eligible and live within the tribe’s 14-county jurisdiction have access to healthy foods. More than 11,000 participants use the program monthly.
“We want to thank the First Nations Development Institute for this grant to better serve our people and encourage healthy living styles,” Human Services Executive Director Marsha Lamb said.
To participate in the “Smoothie Demonstration Project,” participants must already be Food Distribution clients and use the Tahlequah, Stilwell or Sallisaw stores. Participants must also agree to attend monthly meetings.
For more information, call Ella Sands at 918-207-3911 or Glenda Downing and Doreen Williamson at 918-207-3920.
According to the Longmont, Colorado-based First Nations, with the support of the Walmart Foundation it awarded $310,000 to 21 grantees across 12 states on Jan. 11. The grants should allow tribes to design or expand culturally and community based nutrition education projects that encourage individuals and families to improve their nutrition, healthy habits, plus broaden access to nutrition education programs, the First Nations release states.
CLAREMORE, Okla. – The Claremore Indian Hospital was one of 27 Indian Health Service and tribal hospitals recently designated as eligible for selection by health care providers in their outpatient and inpatient settings under the National Health Service Corps program.
This means recruitment opportunities at NHSC-approved outpatient care sites, including health care facilities that provide ambulatory and primary health services in urban and rural communities with limited access to health care.
“This announcement puts IHS on par with critical access hospitals for the first time and expands the resources of the NHSC to tribally-operated hospitals,” said IHS Principal Deputy Director Mary L. Smith. “Recruiting and retaining qualified health care providers at rural hospitals, including IHS facilities, is a major challenge. Programs such as the National Health Service Corps help us attract talented doctors, dentists, behavioral health providers, nurse practitioners and other health professionals to serve our patients.”
This expands the current list of 12 IHS and tribal hospitals that participate as eligible inpatient and outpatient sites for NHSC member clinicians through the Critical Access Hospital designation. The participating hospitals can utilize this expansion to provide enhanced staffing throughout their hospital service delivery system. This expansion will allow qualified health care providers to serve at additional hospitals and assist in recruiting and retaining these providers beyond their two-year commitment.
The NHSC helps bring health care to those who need it most by awarding scholarships and loan repayment to primary care clinicians who commit to serving for at least two years at an approved site located in a Health Professional Shortage Area. Health Professional Shortage Areas are designated by HRSA as having shortages of primary care, dental care or mental health providers and may be geographic (a county or service area), population (e.g., low income or Medicaid eligible) or facilities (e.g., federally qualified health centers, or state or federal prisons).
BOATMAN, Okla. – After multiple tests and hospital visits, Cherokee Nation citizen Robert Jackson could receive a call anytime from the Cleveland Clinic notifying him that organs are available for his heart and double-lung transplants.
Dot, Robert’s wife, said when notified a jet would pick them up at the Claremore Regional Airport.
“Average wait once you get to this point continues to be about six months on heart-lung. So it could be the next day until we get to that point or we could be sitting here next fall,” she said. “You don’t know because there’s a lot to the match. It’s not a simple process at all. Cleveland (Clinic official) feels that Robert’s just a very good candidate because his kidneys are good, his liver’s good.”
The reason for the transplants, Robert said, is because he was born with a congenital heart defect that eventually caused him to not only need a new heart but also new lungs.
He said doctors told his parents he wouldn’t live to be 6 years old, but at 42 he’s beaten the odds.
“They told me I wouldn’t live until I was 6 years old, told my mom and dad that. Then it was 12, then 18. Said that I’d never graduate. Well, I’m sitting here right now 42 years old, and I have graduated,” he said.
Dot said the transplant is a “drastic, high-risk” surgery, but if something isn’t done the outlook for the next year “isn’t good.”
“If they can’t find a match soon enough, they said if he ended up in the hospital, they’d medical transport him up there and they have the machines called ECMO’s (extracorporeal membrane oxygenation) that basically can breathe and help his heart pump until they can find a match,” she said.
Now, Robert said, they’re waiting for the call and trying to prepare for recovery after the surgery.
“You’ll be in the hospital for at least two months after the surgery then back and forth,” he said.
Dot said the hospital has advised them to save $20,000, which includes the jet price, boarding and any other things they may need while in Cleveland.
“Our insurance will cover up to $10,000 so that means we’ve got 10 more to get. We’ll do whatever we have to do,” she said. “If it gets to the point where we have to start selling the house, the cars and everything else to keep him alive that’s what we do. Then you don’t have anything to come back to so that’s kind of hard, too.”
She said after the surgery Robert would be on medications before being weaned off some of them.
“We’re going to have a medication expense between $350 and $400 a month. He’ll gradually get off some of them, but it’s not like we don’t have a pretty big hurdle in front of us, but you have to take the hurdle,” she said.
Robert said he’s been on the transplant list since 2006 but because his health has been better than others he hasn’t had to be moved up until recently.
“I had a heart attack in 2005, and that day I forced myself to work. I thought I had a sinus infection. Well, kept getting worse and I was going to the bathroom and I couldn’t walk down the hallway. So we went to Claremore Indian Hospital and they sent me to Hillcrest (Medical Center), and Hillcrest is the one that told me in 2005 I had a heart attack,” he said. “In 2006 I was on the list. This is how long I’ve been waiting. They ain’t going to give you organs if you’re doing as good as...me. I can still walk a little ways. Take my own shower. You’re not going to do the surgery unless something absolutely major happens.”
Jackson said later when he visited Barnes-Jewish Hospital in St. Louis he was informed that he would also need a double-lung transplant.
“It seems like every year I go down and down further and further. I came in the house the other night and I couldn’t hardly walk,” he said. “People don’t understand when you can’t breathe how much your body hurts.”
Robert said he tries not to dwell on his conditions but live life the “best” he can.
“If I want to go to Pryor and get an ice cream cone I will,” he said. “I don’t say that I don’t think about it, I do, but I don’t do it all the time. I don’t let it ruin my life because if you did that you’re going to live in misery.”
TAHLEQUAH, Okla. – Larissa Hancock, a registered dietician at W.W. Hastings Hospital, said when snacking, portion sizes and reading nutrition labels are key to staying healthy.
She said not being mindful of portions with snacks such as potato chips is potentially harmful.
“When you grab a bag of Doritos off the shelf right there by the checkout stand you may not realize that it’s 2 or 3 and a half servings depending on how big the bag is. A 1-ounce serving of chips is, they vary a little a bit, 150 calories, 140 calories. Or we get the Big Grab, which is about 3-1/2 servings. So you multiple that by three and people eat the whole thing, so we end up taking in 500 or 600 calories from a bag of chips. It adds up very quickly.”
She said a good alternative to potato chips is nuts, but portions still need to be watched.
“Nuts are a good alternative, but you do have to watch those portion sizes on nuts because they are high-calorie,” she said. “They do come from healthy unsaturated fats, but they also add up very quickly. So we’re talking a handful, but you have labels for those.”
She said other healthier alternatives could be anything from egg whites to tuna and crackers.
“If you take a boiled egg, that egg white is where that protein is and it turns it into a pretty lean protein,” Hancock said. “Some other good proteins, what about a packet of tuna and some crackers or something where you’re getting 80 to 90 calories but you’re getting 12 or 13 grams of protein? Then you have a few whole-wheat crackers and you get some carbohydrates there with some good fiber. It kind of just rounds it out, and that protein is what’s really going to help us feel full and satisfied.”
She said for a sweet snack, appropriately portioned fruits and peanut butter are healthy options.
“Fruit is a very good option and always trying to combine a carbohydrate with a protein and maybe a little bit of healthy fats is a good idea because it helps to carry out that snack and make it last a little bit longer,” she said.
Hancock said by reading the Nutrition Facts label the consumer will know the product’s serving size as well as its other facts.
“So if it’s 12 crackers, count out 12 little snack crackers,” she said. “Even if you want a cookie, the cookie is about 2-1/2 inch diameter, not 5 inches like the Grandma’s Cookies or whatever we get in the package, and normally there’s two so things are kind of set up to make it hard for us. So that’s why…reading labels is very important because you’re really the only person looking out for yourself.”
Hancock said a good way to track nutrition facts is to use apps or websites with trackers.
“I think that’s (My Fitness Pal) probably the most popular. There are some different ones like the Fit Bit app. If people use their Fit Bit they can track their food in there. There is a SuperTracker on the USDA (U.S. Department of Agriculture) website that is a really good one,” she said. “I think putting that food in before you eat it helps you make better decisions because it kind of makes you aware before the fact instead of after because if you’re shocked that a fast food meal has 1,600 calories in it…when most people need 1,600 calories in an entire day…then it’s best to kind of keep an eye on those before you get started.”
Hancock said when snacking or eating a meal it’s important to understand from where the calories are coming.
“That’s one thing I don’t think people think about very often is where those calories are coming from nutritionally because it does make a difference,” she said. “If it’s from the protein or from the sugar or whatever else at least that protein and even those healthy fats are giving your body something it needs whereas carbohydrates and sugar aren’t doing anything except increasing our blood sugar and our weight most of the time.”
She said a good thing about healthy snacking is it can help control portions during meals.
“If we’ve waited several hours between lunch and dinner we are more likely to overeat,” she said. “If we have a snack that is a good choice, a sound amount of protein and carbohydrates and maybe a little healthy fat then we tend to not be as hungry at the next meal.”
She said meal planning is a “good percentage” of healthy eating and could help people stay away from those quick-grab snacks and meals.
“It doesn’t have to be anything set in stone, but if you would take a few minutes and write down, ‘this is what we’re going to have Monday evening, Tuesday evening.’ It just takes a little bit of effort to do that. Once it becomes a habit it’s easier just like anything else,” she said.
Hancock said healthy eating habits should start at a young age and that once people start to alter their snacks and meals, the choice of healthy food would be easier.
“I think it’s a good thing to kind of teach people healthy eating habits from the get-go, and with snacking, as long as we’re giving them healthy options it helps them mold into making healthy decisions as adults,” she said. “It seems when you start making good decisions they’re easier to stick with.”
According to health.gov these are the average calories a day for specific types of people by age, sex and physical activity level. For a complete list, visit <a href=" http://bit.ly/2guWn57" target="_blank">http://bit.ly/2guWn57</a>.
Age Sedentary Moderately active Active
10 1,600 1,800 2,200
26-30 2,400 2,600 3,000
Age Sedentary Moderately active Active
10 1,400 1,800 2,000
26-30 1,800 2,000 2,400
A sedentary lifestyle includes the physical activity of independent living. A moderately active lifestyle includes the physical activity of independent living and physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour An active lifestyle includes the physical activity of independent living and physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour.
Serving size (1 oz.) Overall amount
Doritos Nacho Cheese 140 calories (11 chips) 420 calories (approximate) (3 1/8 oz.)
Cheetos Crunchy 150 calories (21 chips) 525 calories (approximate) (3 ½ oz.)
Ruffles Cheddar 160 calories (11 chips) 410 calories (2 5/8 oz.)
& Sour Cream
Serving size (package)
Snickers 250 calories (1 bar)
Reese’s 220 calories (2 cups)
Hershey’s 220 calories (1 bar)
<strong>Reading a Nutrition Label</strong>
“Starting at the top where it talks about the serving sizes is really important because the rest of the numbers on that label are only correct if we eat that amount of food. If we double that portion size then we need to double everything else on the label,” registered dietitian Larissa Hancock said.