Mammographer Kim Fielder performs a mammogram on a patient at Cherokee Nation W.W. Hastings Hospital in Tahlequah, Oklahoma. Clinical trials and studies show that screening mammograms help reduce breast cancer deaths among women ages 40 to 74, especially for those over 50. ARCHIVE
Mammography exams aid in early detection of breast diseases
TAHLEQUAH – A mammogram aids in the detection and diagnosis of breast diseases in women. A specialized imaging, it uses a low-dose X-ray system to see inside breasts. The X-rays make it possible to detect tumors that cannot be felt.
Screening mammograms can find micro-calcifications (calcium deposits) that can indicate breast cancer. Mammograms can also check for breast cancer after a lump or other sign is found. This mammogram is called a diagnostic mammogram.
Besides a lump, cancer signs can include breast pain, thickening of the breast’s skin, nipple discharge or change in breast size or shape. However, these signs may also be benign conditions.
A diagnostic mammogram can also be used to evaluate changes found in a screening mammogram or to view tissue when it is difficult to obtain a screening mammogram because of special circumstances such as the presence of breast implants.
Retired nurse practitioner Vickie Love said women’s health was “a priority” when she worked at the Wilma P. Mankiller Health Center in Stilwell.
“At the Mankiller clinic there where many people and departments committed to women’s health. The nurses, case managers and providers all reviewed charts to identify and remind patients if they where due for mammograms. The Cherokee Nation incorporated a system into our electronic health record that would flag a patient when they where due for cervical and breast exams,” Love, who retired in 2015 after 21 years, said.
She said a frequent concern about mammograms is pain. During a mammography, a radiologic technologist positions the woman’s breast in the mammography unit. The breast is placed on a special platform and compressed with a clear plastic paddle, and the technologist gradually compresses the breast.
“I was honest to tell them there was pressure involved that could be uncomfortable for just a few seconds and then released. Our mammogram technicians would ask if the women were OK or if they could withstand more compression. If not, the technician would not force more compression,” she said. “I did advise the more they could withstand for those few seconds would provide a better test for the radiologist to review.”
Another frequent concern, she said, is the fear of finding cancer.
“I advised the women that early detection was the key and treatment options where less radical if caught in the earlier stages. I discussed how important it was to have an initial mammogram and how the radiologist could compare future mammograms to this one and determine if there where new findings or if changes where being seen.”
Early cancer detection with screening mammography means treatment can be started earlier, possibly before it spreads. Clinical trials and studies show that screening mammograms help reduce breast cancer deaths among women ages 40 to 74, especially for those over 50. However, studies haven’t shown a benefit from regular screening mammography in women under 40.
To illustrate the importance of getting regular mammograms for women over 40, Love said she asked patients if they had a family member or friend who had breast cancer.
“Often this was affirmed, and I would listen to their recount. I would inquire how the cancer affected the person and/or the family. I would talk about how the family members could be at a higher risk for breast cancer, how each woman needed to follow up and encourage their mothers, grandmothers, daughters and sisters to be vigilant about breast exams and mammograms,” she said. “As women we couldn’t be complacent about our health because future generations depended on us. I also reminded them I had their address in their chart, and I would come looking for them. Caring about each of them and humor were always my allies.”
Love said she believes she was “successful” in getting women patients in for mammograms, but there was still a high overall “no-show rate.”
“I think dispelling rumors and fears are important, but it takes time and effort to find what these are. I believe being a Native provider has also helped me establish rapport and trust with my patients. And I always tell stories about my own experience that coincides with what is being asked of them. Just being real helps,” she said.
TAHLEQUAH – At the Jan. 17 Rules Committee meeting, Deputy Attorney General Chrissi Nimmo reported that the tribe was to receive settlement funds from the federal government. The settlement between the Cherokee Nation and Indian Health Service recoups contract support cost totaling more than $8.2 million.
The money was for unpaid support costs for 1998 in correlation to underpayments of more than $31 million, including interest and underpayments, between 2005 and 2013 and as a result of the Supreme Court case Cherokee Nation, et al v. Leavitt.
According to the 2004 Supreme Court opinion, the “Indian Self-Determination and Education Assistance Act authorizes the Government and Indian tribes to enter into contracts in which tribes promise to supply federally funded services that a Government agency normally would provide.”
It also states the act “requires the government to pay…a tribe’s ‘contract support costs’ which are ‘reasonable costs’ that a federal agency would not have incurred, but which the tribe would incur in managing the program…”
However, in that timeframe the opinion states the reasoning the government did not pay the contract support costs as promised is because Congress had not appropriated enough funds.
“In the first case, the Tribes submitted administrative payment claims under the Contract Disputes Act of 1978, which the Department of the Interior (the appropriations manager) denied. They then brought a breach-of-contract action,” the opinion states. “The District Court found against them, and the Tenth Circuit affirmed. In the second case, the Cherokee Nation submitted claims to the Department of the Interior, which the Board of Contract Appeals ordered paid. The Federal Circuit affirmed.”
Nimmo said the tribe had to cover the IHS contract costs that were denied by using CN General Fund dollars.
“There were questions about whether or not half of it will go to the newly created Sovereign Wealth Fund because that law says that half of all settlements will go there,” Nimmo said. “This money…the reason it all goes to the General Fund is because it was improperly expended. And I say improperly not in the sense that we did anything wrong, but we should have, in 1998, we should have gotten this money from the federal government to support IHS contracts. Because we didn’t, we had to spend general tribal dollars to support those IHS contracts. So this money goes into basically replenish tribal dollars that were spent to support federal contracts.”
Nimmo added that the Tribal Council is able to appropriate the recouped funds however it deems necessary.
“The $8.2 million settlement will go into the tribe’s General Fund, where it will help provide the expanded and improved health care services our citizens deserve.” Nimmo said. “Going forward, we expect contract support costs to be funded in full as designated by treaty and federal trust responsibility.”
TAHLEQUAH – Making meal alterations such as using less salt or taking it out completely can lead to a healthier life for most people. Even making simple changes to old favorites such as mashed potatoes can lead people down a healthier path.
Mark Keeley, a clinical dietitian and 34-year Cherokee Nation employee, said while working with Native Americans he’s stressed that salt doesn’t need to be added to food and could adversely affect a person’s health.
“Salt will retain fluid on your body…that fluid is going to take up lung space. So now you’re trying to breathe around lungs that are trying to fill up,” he said. “If your heart’s not able to pump as well as it used to then the slower your blood stream moves the more some of that salty water will leak off into your ankles and legs, and so now you’re carrying weight around and it kind of waterlogs your system.”
Keeley said he’s had people tell him that they salt their food even before tasting it.
“People have told me, ‘Here’s what I used to do. I use to salt food before I even tasted it and salt it heavy and then taste it.’ Then they say, ‘I don’t do salt anymore.’ I come across a lot more people that tell me that. Those folks are becoming more common, but there’s room for work,” he said.
For people who monitor their blood sugar levels, Keeley said he recommends mashed cauliflower potatoes.
“As a dietitian that’s been working around diabetes for a long time, people want food to taste good, but they don’t want it to blow their blood sugar out of the water, so the cauliflower is basically a…non-starchy, low-carbohydrate vegetable,” he said.
By combining the cauliflower and potatoes, Keeley said a healthier version of mashed potatoes is created. “It actually has…a slightly different flavor. So cooking them up together and mashing them together, a little butter in there for seasoning and…it’s still satisfying, still has potatoes in it, but it doesn’t have the effect after the meal that you don’t like seeing.”
Keeley said the dish typically takes 30 minutes to make, which includes preparation and cook time, and consists of a head of cauliflower, two potatoes and a small portion of salted butter. The butter acts as the dish’s only form of salt.
“It’s not a high time investment meal,” he said. “You do need enough water to pretty near cover the vegetables. It’ll get them soft quicker, ready for the mashing. You could drain it completely or just leave a small amount of water in the bottom. The butter was salted butter. It was the salt (for the recipe) in this case. There was no other salt in it.”
When changing a recipe such as adding cauliflower and removing a bulk of the potatoes, Keeley said the first step is to “decide” if this is something that people want to pursue for a healthier lifestyle.
“The tricks of the trade is one thing, but the first step is to decide. To make the decision, ‘I’m going to do what it takes to get better and stay better,’” he said. “Once people are determined they’ll figure it out. They’ll come up with their own ways to do it.”
Keeley suggests another way to get on a healthier eating track is portion control. “One thing we can always do is we can down portion anything. So if something is pretty stout, pretty sweet, pretty salty, you can eat less of it.”
For more information on meal alterations, visit <a href="http://cherokeepublichealth.org/about-cherokee-nation-public-health/" target="_blank">http://cherokeepublichealth.org/about-cherokee-nation-public-health/</a>
<strong>Recipe for turkey stew or minestrone soup</strong>
2 pounds of ground dark turkey meat
3 cloves of crushed and minced garlic
2 tablespoons of Italian seasoning
3 carrots, thinly sliced
1 large chopped onion
1 small head of chopped cabbage
2 14-ounce cans dies tomatoes
1 14-ounce can of kidney beans
1 14-ounce can of great northern beans
1 32-35 ounce container of chicken broth
1. Brown meat in a heavy pot on high heat, stirring constantly
2. Add garlic, Italian seasoning, carrots and onions. Stir until vegetables start to soften
3. Add tomatoes, beans and broth
4. Bring to a boil, lower heat and let simmer for 10-15 minutes
Cherokee Nation clinical dietitian Mark Keeley suggests when adding the canned products it’s best to drain them to reduce the amount of salt in the meal.
TAHLEQAH – Exercise is important, but for senior citizens physical activity is crucial in living healthier and longer lives.
Dr. Jana Jordan, of Cherokee Nation W.W. Hastings Hospital, said exercising is the “most important thing for seniors to do to stay young.”
With frequent exercise, seniors can delay, improve and even prevent diseases and conditions that come with age such as diabetes, stroke, heart and kidney disease, high blood pressure, osteoporosis and cancers.
“Exercising improves cardiovascular health, so that lowers cholesterol. So in turn that prevents heart attack and stroke. It makes the heart stronger, so that goes along with helping high blood pressure. Almost any condition they may have like heart disease, kidney disease and diabetes is going to be improved by exercising,” Jordan said.
Muscle mass also plays a part in senior health. It declines with age, resulting in loss of balance and bone strength, which can lead to injury. According to the National Council on Aging, falls are the leading cause of death and injury among seniors.
Jordan said exercising is essential to building muscle mass, which can allow seniors mobility and independence. “When those muscles start to decline you can’t get out like you use to. And the less you do means the less you’re able to do. So the people that are staying active can keep going and that keeps them healthy.”
In addition to the physical benefits, seniors can improve their mental health with exercise.
“I have patients that retire and they sit at home and don’t get out. Then their health starts to go bad, and they start to get depressed. So besides all the cardiovascular benefits and helping of the lungs and kidneys, it really helps their mental health. Exercise increases endorphins in the brain that makes them feel better, and when they feel good they become motivated to do more,” Jordan said.
She added that the exercise she recommends to seniors is walking. “You don’t have to go to the gym. You don’t have to go running, and you don’t have to go kayaking to be active, just walk. Anything weight baring is going to be the best exercise for seniors. Walking is weight bearing and doing some kind of strength training is all weight bearing, so it improves bone density and also conditions like osteoporosis.”
However, for handicap seniors or those with limited walking ability, Jordan recommends arm exercises or leg exercises. “If they can lift their legs up and down you can put a sack with some cans in it and move your legs up and down if they can’t walk. If they do that and it helps them improves their muscular strength there’s a possibility they may be able to get up and walk at some point in time.”
For seniors who enjoy attending a gym or fitness classes, the CN Male Seminary Recreational Center in Tahlequah provides a senior stretch and exercise class. It focuses on balance, stability, range of motion and functional movements tailored to acts of daily life.
Heather Dobbins, a MSRC physical activity specialist who teaches the class, said she’s seen how exercise positively impacts seniors and their physical abilities. “I have seen a major improvement in chair squats, which is being able to get up and down from the chair without having to use their lap or the chair to get up and use just the strength in their legs. So everyone started out having to use their lap to get up and now they are able to do chair squats without their hands. That’s what my goal is for them to remain or be independent without needing assistance from a walker, for instance, and I am seeing that progress being made.”
The National Health Service recommends 30 minutes of exercise a day, five days a week. However, Jordan recommends doing what is bearable, especially if beginning.
“Everybody’s health is different, and they’re all at a different place. So start small and add in increments of how long you are doing that so each time they go out and exercise they are improving their ability to exercise. They’re improving their heart and lung function. They’re improving their muscular function so they can do a little bit more each time,” she said.
Although exercise is beneficial, Jordan said it’s best to consult a physician, especially if experiencing chest pains and shortness of breath. However, Jordan said some exercise is better than none.
“Staying active is really, really important, and even if they’re not exercising they need to be getting out and socializing. Maybe they’re getting out and going to church. Maybe they’re going down to the senior citizens (center)…They’re getting some exercise, and they’re getting some socialization,” she said.
TAHLEQUAH – Stress can come in different forms and be caused by various events such as childhood trauma or everyday troubles.
Chris Wofford, Cherokee Nation Behavioral Health Services clinical supervisor, said in some cases stress from “past trauma” in young adults can present “similarly” to Attention Deficit Hyperactivity Disorder or similar “disorders of attention.”
“So they might have difficulty focusing, difficulty staying on task once they start things, difficulty feeling calm or rested. Usually impacts sleep and certainly impact their ability to feel comfortable in groups or around other people. So sometimes that leads to some isolation and stuff like that,” he said.
For day-to-day stress, Wofford said it’s “a little more” identifiable.
“Just regular stress you know day-to-day, ‘I’ve got this homework assignment or I’ve got this task for work that I have to complete.’ Kind of similar, but usually it’s a little more identifiable,” he said.
Wofford said not treating stress could have negative effects on the body.
“There is a lot of research that says your psychological stress is going to manifest physically so ulcers or hypertension or you know a lot of times stress can lead to smoking or using some substance to cope and then that leads to addiction issues. Poor work performance or poor school performance certainly is correlated with having a lot of stress or anxiety as well,” he said.
Wofford said one of the “biggest” things is to “own” a feeling and not to shut them out.
“If you have a feeling about something instead of trying to shut it away or pretend it’s not there to just acknowledge that you have that feeling,” he said. “Then if you’re having trouble dealing with that feeling that’s when you would talk to either natural supports like family or where you might seek out the help of a professional.”
Regardless of where a young adult’s stress stems from, Wofford said it’s important to find “relaxation” activities.
“One of the basic things we teach to pretty much all age ranges that get services here is breathing. Nice deep, relaxing controlled breathing is a way for the body to communicate to the mind to slow down,” he said. “So for kind of everyday stress…just having some time where you’re doing things that you enjoy. It’s really easy to get caught up in the day-to-day routine and quickly it can be overwhelming.”
Wofford said both mental and physical health should be treated the same.
“If you would go to the doctor for a broken leg it’s OK to go to the doctor for a broken thought,” he said. “Just get some help in repairing that thought or that thinking process and getting back on track and feeling like you normally do or like yourself again.”
One important message Wofford wants to get across is that when it comes to experiencing stress-related issues people are “not alone.”
“Many people have found a way through this and you will be able to as well. You’re not broken, you’re not crazy, you’re not anything except a person who’s experiencing life and has hit a bump,” he said. “We all have them, and we all deal with them in different ways, but it is absolutely OK to ask for help.”
For more information, call The HERO Project at 918-772-4004 or the CN Behavioral Health Adult Clinic at 918-207-4977.
TAHLEQUAH – With misinformation about sex so accessible, talking openly with teens about sex can help prevent unintended pregnancies and decrease risks of sexually transmitted diseases.
Barbara Williams, a Cherokee Nation certified prevention specialist, has taught pregnancy prevention for more than 20 years through programs such as “Date but Wait” and “Straight Talk.” Her mission is to help parents and children talk openly about sex to avoid misinformation, a sharp contrast to how she was raised.
“My mother never talked to me about how to prevent pregnancy or anything like that, and I asked her why. She said, ‘Oh, I don’t know. I figured you would learn it from somewhere,’” Williams said.
In 2015, Oklahoma’s teen pregnancy rate was 34.8 per 1,000 females, compared to the national average of 22.3, according to the State Department of Health. Within the CN, Adair County ranks significantly higher with an average between 55.2 and 67.4 pregnancies per 1,000.
“I know there’s a problem with teen pregnancy, and I know it goes back to parents not talking to their kids about it, especially in our Indian families,” Williams said. “There are no (Cherokee) words for anything that has to do with sex. We need to make the tribe know there’s a problem, especially in our rural communities.”
Oklahoma was second in the United States for teen births in 2014, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. The campaign also found that almost 50 percent of Oklahoma teen mothers live in poverty, while only 38 percent who have children before age 18 receive high school diplomas.
For teens who aren’t comfortable talking to their parents about sex, Williams recommends they visit a county health department, which provides family planning information and birth control options including free condoms, pregnancy testing and emergency contraception.
In addition to preventing teen pregnancy, Williams educates teens about sexually transmitted diseases or STDs.
The Centers for Disease Control reports that annually 20 million new STD cases are reported in the United States, with half of them in individuals between 15 and 24 years old. While some STDs have symptoms such as itching or burning, several – including chlamydia and gonorrhea – often do not.
Williams also cautions teens that some STDs do not have a cure and those that are treatable are becoming more dangerous.
“There is now a drug-resistant gonorrhea, which we’ve always had a treatment for gonorrhea, and now it’s a superbug and there’s no guarantee,” she said. “We don’t know how long the medicine we have now is going to quell it. (Teens) need to know that you can’t tell by looking at someone if they have an STD. The best thing to do if you have sex is to wear a condom so you don’t have to worry.”
To request a presentation from Williams, call 918-207-4977, ext. 7186. For more information about teen reproductive health and pregnancy, visit <a href="http://www.cdc.gov/teenpregnancy" target="_blank">www.cdc.gov/teenpregnancy</a>. For confidential and free STD testing, visit <a href="https://gettested.cdc.gov" target="_blank">https://gettested.cdc.gov</a>.