Dr. Jeffrey Gastorf
CN doctor earns A.T. Still Award of Excellence
TAHLEQUAH, Okla. – The Oklahoma Osteopathic Association recently awarded Cherokee Nation Dr. Jeffrey Gastorf the 2017 A.T. Still Award of Excellence.
It is given to one osteopathic physician statewide in honor of A.T. Still, who was the founder of osteopathy and osteopathic medicine that focuses on total body health and the ability for the body to heal itself.
Gastorf, 41, is a general physician at the Vinita Health Center.
“Dr. Gastorf embodies the teachings of Dr. A.T. Still and seeks out opportunities to share his knowledge with residents and students. His patient-centered approach is the foundation of osteopathic medicine and benefits the lives of his patients,” Kenneth E. Calabrese, president of the Oklahoma Osteopathic Association, said.
Gastorf completed his medical school training at Oklahoma State University and his residency training at Durant Family Medicine Residency.
He is the former director of the Durant Family Medicine Residency Program, where he served for eight years before joining the tribe’s Vinita Health Center in January.
“I wanted to focus more on patient care, and I appreciate that Cherokee Nation is truly concerned about providing care and having resources to help patients,” Gastorf said. “The most rewarding thing is when patients are appreciative of the care they receive and thank you for your help.”
Gastorf also serves on the Graduate Medical Education committee for the Oklahoma Osteopathic Association and previously served as president of the Oklahoma chapter of the American College of Osteopathic Family Physicians.
CN Health Services operates the largest tribally run health system in the country, with more than a million patient visits per year. It consists of eight health centers and W.W. Hastings Hospital in Tahlequah.
TAHLEQUAH, Okla. — Thousands of Cherokee Nation citizens across the tribe’s 14-county jurisdiction are changing their lives through a dietary program.
Offered at all CN health centers and W.W. Hastings Hospital, the program helped 6,482 citizens with weight management, high cholesterol, pre-diabetes and gestational diabetes in fiscal year 2016.
CN citizen Kevin Hannah is a participant and has lost 100 pounds during his time in the program.
“When I came for the first appointment, I was just fulfilling doctor’s orders and I couldn’t care less about any of it. Meeting with clinical dietitian Jennifer Newton at Three Rivers Health Center in Muskogee changed my perception, and it changed my life,” Hannah said.
After one year of working with Newton through the dietary program, Hannah, a pre-diabetic patient, has decreased his weight, cholesterol and blood sugar levels and describes his experience as life-changing.
“I want everyone to know that they can change their lives. I’ve been there. It’s depressing, and talking to someone who cared about me and about my success gave me the motivation to get up and try,” Hannah said. “Desire and information are the keys to success.”
Newton’s focus for her patients is setting small goals and sustainable changes.
“We always start by walking through what they’re already doing and encourage small, gradual changes that they can sustain long term,” Newton said.
Lisa Burton, a dietary patient from the Cooweescoowee Health Center in Ochelata, is experiencing similar success in the program.
“I started back in July and have noticed a big difference in my energy level already,” Burton said. “I have lost 70 pounds, and I plan to keep it up. Having the support and someone to watch over me and make sure I am doing what I am supposed to is making all the difference.”
Patients who seek dietary help complete a screening process and are matched with a dietitian to work one-on-one through their eating and exercise needs.
Dietitian adviser Denise Goss oversees the program through CN health centers. She said CN dietitians can teach tribal citizens to make healthy lifestyle choices to enhance their quality of life.
“We provide valuable support by offering frequent follow-up visits and the encouragement and tools needed to reach their goals,” Goss said.
To find a health center near you with the dietary program, visit <a href="http://www.cherokee.org/Services/Health/Health-Centers-Hospitals" target="_blank">http://www.cherokee.org/Services/Health/Health-Centers-Hospitals</a>.
ANCHORAGE, Alaska – Cherokee Nation Health Services recently received the Public Health Innovation Award from the National Indian Health Board at a national conference in June.
The Public Health Innovation Award is given annually to the tribal government, individual, organization or program that best exemplifies the advancement of public health for Native Americans and Alaskan Natives.
The tribe was recognized for its efforts at the eighth annual National Tribal Public Health Summit in Anchorage.
“Cherokee Nation Health Services strives to be a leader in health care throughout Indian Country,” Connie Davis, CNHS executive director, said. “On behalf of our Cherokee Nation Health Services employees, I thank the National Indian Health Board for this honor. It’s truly humbling for our team to receive this recognition, and I commend each and every one of our employees who make Cherokee Nation Health Services a first-class department.”
The tribe’s Public Health department educates citizens on healthy eating and exercise habits, and also addresses common challenges such as alcohol and tobacco use awareness within the tribe.
Senior Director of Public Health Lisa Pivec accepted the award and spoke about building public health infrastructure.
“The most rewarding aspect of the recognition is knowing we are honoring those who have gone before us to ensure we have this great Cherokee Nation to protect and preserve,” Pivec said. “I believe that any successes are the result of the work of so many citizens over the years, people devoted to paving the way for our next generations.”
In 2016, Pivec was also recognized by the NIHB with its area impact award. The award highlighted her impact on the tribe’s growing public health program since 1994, when Pivec helped start the tribe’s Healthy Nation program.
“Lisa led the development of public health at Cherokee Nation from its infancy, and the tribal nation is now the first Public Health Accreditation Board-accredited tribal public health system,” the NIHB said in a statement about the nomination. “Now, Cherokee citizens consider the vast number of prevention programs she developed as a part of their daily activities. Along with her staff, Lisa has created great changes in health among the Cherokee people she serves.”
In addition to presenting awards for public health innovation and area impact, the NIHB works with tribes on advocacy, training and legislation to better Native health care.
“Public health is about addressing the social determinants of health and strengthening the environments where we live, work, play, learn and worship,” Pivec said. “I have been blessed to have had the opportunity to serve and do work that doesn’t feel like a job but more like a life purpose.”
TULSA, Okla. – It’s been more than a year since 10-year-old Cherokee Nation citizen Josiah Wright was diagnosed with Type 1 diabetes, but that didn’t stop him from recently walking a 5K and raising $875 for the American Diabetes Association.
“It’s important to find a cure for diabetes,” said Wright, who indicated that was the driving factor for walking in the ADA’s “Tour de Cure 5k Walk” on June 3.
Normally a bicycle event, this year it was expanded to include the walk.
It was Wright’s mother, Lila Bark, who came up with the idea to participate after contacting the ADA for more ways to get involved.
“Josiah has been diagnosed for over a year, and his first year was quite a learning experience and still is,” Bark said. “I wanted us to get involved to show Josiah there are people who want to find a cure and support the cause.”
The family put together Team Josiah consisting of 18 individuals, 11 of them being under the age of 15.
“I felt honored and appreciated all the people that came to walk with me,” Wright said.
The family also found other ways to raise money, including selling candy bars, #TeamJosiah T-shirts and hosting a yard sale.
Wright learned he was a Type 1 diabetic in January 2016 after bladder issues led him to the CN’s A-Mo Health Center in Salina, where doctors discovered his blood glucose level was 324.
A normal blood glucose range is around 100 or less, according to the ADA.
Wright was immediately referred to Laura Chalmers of the Harold Hamm Oklahoma Diabetes Center, who gave the diagnosis to the family.
“I was heartbroken,” Bark said. “Still now as I talk about it with people I get teary eyed and emotional, but I am better than I was on that day. It was hard to take in, that your child will have to live with this disease for the rest of his life or until a cure is found.”
Since the diagnosis, the family has altered its lifestyle drastically by monitoring food intake and making exercise a priority.
“I now have to watch what I eat, especially the carbs,” Wright, who is on a special carbohydrate diet, said. “I have to remember to check my sugar and take my insulin before I eat. I eat more vegetables, less pasta and less junk food. I try to put in an hour of physical activity daily.”
Mother and son are also reaching out to groups through Facebook for support and advice, though Bark admits it is difficult finding children who are Type 1.
According to the ADA, only 5 percent of all diabetics are Type 1. For those with the condition, the body does not produce insulin naturally. Insulin is a hormone required to move glucose, a source of energy, from the bloodstream into cells.
“I met another parent through a friend from work whose son is T1, so gradually I am slowly meeting people, but the community around us is very small,” she said. “I would love to start a support group locally or even get involved with the support groups in Tulsa eventually.”
Until then, the family plans to keep participating in 5Ks to raise awareness.
“It was a fun experience and will be a yearly event we participate in,” Bark said. “We hope our fundraising and group get larger every year.”
For more information on diabetes, its symptoms and how to manage it, visit <a href="http://www.diabetes.org" target="_blank">www.diabetes.org</a>.
OKLAHOMA CITY (AP) — Health officials say mosquitoes found in Oklahoma County have tested positive for the potentially fatal West Nile Virus.
The Oklahoma City-County Health Department reports that experts confirmed mosquitoes have tested positive for the virus, however there are no reported human cases of the virus.
Agency Public Health Protection Director Phil Maytubby says recent rain and warm weather created an environment favorable for virus-carrying mosquitoes.
Oklahoma State Department of Health records show no deaths in the state due to the virus last year, but 10 deaths were recorded in 2015 and a record 15 deaths occurred in 2012.
The virus is spread primarily through the bite of the Culex mosquito and symptoms include fever, headache and body aches.
TAHLEQUAH, Okla. – As spring turns to summer, more people will venture outdoors for activities, which means increased exposure to mosquitos and possibly the West Nile Virus some mosquitos carry.
Experts at the Centers for Disease Control believe WNV is established as a seasonal epidemic in North America that flares up in the summer and continues into the fall.
According to the CDC, the virus can be a life-altering and sometimes fatal disease. In 2012, the CDC reported 5,674 confirmed human cases of WNV with 286 of them resulting in death. The CDC states that every state in the U.S., except Hawaii and Alaska, reported WNV cases in 2012. In Oklahoma, 178 humans were diagnosed with WNV with 15 deaths in 2012, according to the Oklahoma State Department of Health.
The CDC states that about one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.
Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks. Approximately 80 percent of people who are infected with WNV will not show any symptoms at all, according to the CDC.
The CDC has predicted it could be a bad year because of weather conditions that promoted breeding of the mosquitoes that spread the virus to people.
In Oklahoma, the WNV season runs from May to November. People are at greatest risk of exposure to infected mosquitoes from July through October in the state. People of any age can become ill after being bitten by an infected mosquito, but those over the age of 50 are at greater risk of developing serious illness involving the nervous system.
The OSDH advises use of insect repellents – particularly those containing DEET, picaridin, oil of lemon eucalyptus (PMD), or IR 3535 – when outdoors. The types of mosquitoes that transmit WNV are most active during early morning and evening hours, so take mosquito bite precautions during those times. It is also recommended to drain or treat standing water around your home with a mosquito larvacide to reduce mosquito-breeding sites.
<strong>How does WNV spread? </strong>
Most often, WNV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals.
In a small number of cases, WNV also has been spread through blood transfusions, organ transplants, breastfeeding and even during pregnancy from mother to baby.
<strong>How soon do infected people get sick? </strong>
People typically develop symptoms between three and 14 days after they are bitten by an infected mosquito.
<strong>How is WNV infection treated? </strong>
There is no specific treatment for WNV infection. In cases with milder symptoms, people experience symptoms such as fever and aches that pass on their own, although even healthy people have become sick for several weeks. In more severe cases, people usually need to go to the hospital where they can receive supportive treatment, including intravenous fluids, help with breathing and nursing care.
<strong>What should I do if I think I have WNV? </strong>
Milder WNV illness improves on its own and people do not necessarily need to seek medical attention for this infection though they may choose to do so. If you develop symptoms of severe WNV illness such as unusually severe headaches or confusion, seek medical attention immediately. Severe WNV illness usually requires hospitalization. Pregnant women and nursing mothers are encouraged to talk to their doctor if they develop symptoms that could be WNV.
<strong>What is the risk of getting sick from WNV? </strong>
People over 50 at higher risk to get severe illness. People over the age of 50 are more likely to develop serious symptoms of WNV if they do get sick and should take special care to avoid mosquito bites.
<strong>Is there a vaccine against West Nile encephalitis? </strong>
No, but some groups are working towards developing a vaccine.
<strong>What can be done to prevent outbreaks of WNV?</strong>
Prevention and control of WNV and other arboviral diseases is most effectively accomplished through integrated vector management programs. These programs should include surveillance for WNV activity in mosquito vectors, birds, horses, other animals and humans and implementation of appropriate mosquito control measures to reduce mosquito populations when necessary. Additionally, when virus activity is detected in an area, residents should be alerted and advised to increase measures to reduce contact with mosquitoes.
<strong>How often should repellent be reapplied?</strong>
In general you should re-apply repellent if you are being bitten by mosquitoes. Always follow the directions on the product you are using. Sweating, perspiration or getting wet may mean that you need to re-apply repellent more frequently. Repellents containing a higher concentration (higher percentage) of active ingredient typically provide longer-lasting protection.
<strong>Which mosquito repellents work best?</strong>
CDC recommends using products that have been shown to work in scientific trials and that contain active ingredients that have been registered with the Environmental Protection Agency for use as insect repellents on skin or clothing. When EPA registers a repellent, they evaluate the product for efficacy and potential effects on human beings and the environment. EPA registration means that EPA does not expect a product, when used according to the instructions on the label, to cause unreasonable adverse effects to human health or the environment.
Of the active ingredients registered with the EPA, CDC believes that two have demonstrated a higher degree of efficacy in the peer-reviewed, scientific literature. Products containing these active ingredients typically provide longer-lasting protection than others:
Oil of lemon eucalyptus, a plant-based repellent, is also registered with EPA. In two recent scientific publications, when oil of lemon eucalyptus was tested against mosquitoes found in the U.S. it provided protection similar to repellents with low concentrations of DEET.
<strong>Can insect repellents be used on children?</strong>
Repellent products must state any age restriction. If there is none, EPA has not required a restriction on the use of the product.
According to the label, oil of lemon eucalyptus products should NOT be used on children under 3 years. In addition to EPA’s decisions about use of products on children, look to the opinion of the American Academy of Pediatrics. The AAP does have an opinion on the use of DEET in children. AAP has not issued recommendations or opinions on the use of picaridin or oil of lemon eucalyptus for children.
What guidelines are available for using a repellent on children?
• When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children’s eyes and mouth and use it sparingly around their ears.
• Do not apply repellent to children’s hands.
• Do not allow young children to apply insect repellent to themselves; have an adult do it for them.
• Keep repellents out of reach of children.
• Do not apply repellent under clothing. If repellent is applied to clothing, wash treated clothing before wearing again.
<strong>How else can I protect children from mosquito bites?</strong>
Using repellents on the skin is not the only way to avoid mosquito bites. Children (and adults) can wear clothing with long pants and long sleeves while outdoors. DEET or other repellents such as permethrin can also be applied to clothing, as mosquitoes may bite through thin fabric. Also, mosquito netting can be used over infant carriers.
<strong>Be aware of peak mosquito hours</strong>
The hours from dusk to dawn are peak biting times for many species of mosquitoes. Take extra care to use repellent and protective clothing during evening and early morning or consider avoiding outdoor activities during these times.
<strong>Install or repair screens</strong>
Some mosquitoes like to come indoors. Keep them outside by having well-fitting screens on both windows and doors. Offer to help neighbors whose screens might be in bad shape.
<strong>Dispose of breeding grounds</strong>
Also, it may be possible to reduce the number of mosquitoes in the area by getting rid of containers with standing water that provide breeding places for mosquitoes.
Help reduce the number of mosquitoes in areas outdoors where you work or play, by draining sources of standing water. In this way, you reduce the number of places mosquitoes can lay their eggs and breed.
At least once or twice a week, empty water from flowerpots, pet food and water dishes, birdbaths, swimming pool covers, buckets, barrels, and cans.
Check for clogged rain gutters and clean them out.
Remove discarded tires, and other items that could collect water.
Be sure to check for containers or trash in places that may be hard to see, such as under bushes or under your home.
TAHLEQUAH, Okla. – People tend to spend more time participating in outdoor activities in warmer weather. But it’s important to remember that warmer weather brings ticks and the illnesses they can carry.
Oklahoma ranks among the states with the highest rates of ehrlichiosis, Rocky Mountain spotted fever and tularemia, and May through August are the months when ticks are most active.
Human ehrlichiosis is caused by Ehrlichia chaffeensis, Ehrlichia ewingii and a third Ehrlichia species provisionally called Ehrlichia muris-like.
Ehrlichiae are transmitted to humans by the bite of an infected tick. The lone star tick is the primary vector of both Ehrlichia chaffeensis and Ehrlichia ewingii in the United States. Typical symptoms include fever, headache, fatigue, chills, nausea, vomiting, diarrhea, confusion, rash and muscle aches. Usually, these symptoms occur within one to two weeks following a tick bite.
Ehrlichiosis is an illness that can be fatal if not treated correctly. The estimated fatality rate is 1.8 percent. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care.
The severity may depend on the patient’s immune status. People with compromised immunity caused by immunosuppressive therapies, HIV infection or splenectomy appear to develop a more severe disease and may also have higher fatality rates.
Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever ehrlichiosis is suspected.
Use of antibiotics other than doxycycline and other tetracyclines is associated with a higher risk of fatal outcome for some rickettsial infections. Doxycycline is most effective at preventing severe complications from developing if it is started early in the course of disease. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return.
<strong>Rocky Mountain spotted fever</strong>
RMSF is caused by the bacterium Rickettsia rickettsia and is transmitted to humans by the bite of infected ticks. In the United States, these include the American dog tick, Rocky Mountain wood tick and brown dog tick.
Typical symptoms include fever, headache, abdominal pain, vomiting and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops. RMSF can be severe or even fatal if not treated in the first few days of symptoms. Doxycycline is the first line treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms.
The first symptoms of RMSF typically begin two to 14 days after the bite. The disease frequently begins as a sudden onset of fever and headache and most people visit a health care provider during the first few days of symptoms. Because early symptoms may be non-specific, several visits may occur before the diagnosis is made and correct treatment begins. It is a serious illness that can be fatal in the first eight days of symptoms if not treated correctly.
A classic case involves a rash that first appears two to five days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to include the trunk and sometimes the palms and soles. Often the rash varies from this description, and people who fail to develop a rash, or develop an atypical rash, are at increased risk of being misdiagnosed.
The red to purple, spotted (petechial) rash is usually not seen until the sixth day or later after onset of symptoms and occurs in 35 percent to 60 percent of patients with the infection. This is a sign of progression to severe disease, and every attempt should be made to begin treatment before petechiae develop.
Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever RMSF is suspected.
The bacterium that causes tularemia is highly infectious and can enter the human body through the skin, eyes, mouth or lungs. In the United States, ticks that transmit tularemia to humans include the dog tick, the wood tick and the lone star tick. Deer flies have been shown to transmit tularemia in the western United States.
The signs and symptoms of tularemia vary depending on how the bacteria enter the body. Illness ranges from mild to life-threatening. All forms are accompanied by fever, which can be as high as 104 degrees Fahrenheit. Main forms of this disease are:
• Ulceroglandular. This is the most common form of tularemia and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the bacteria entered. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
• Glandular. Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals.
• Oculoglandular. This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of the eye and swelling of lymph glands in front of the ear.
• Oropharyngeal. This form results from eating or drinking contaminated food or water. Patients with oropharyngeal tularemia may have sore throat, mouth ulcers, tonsillitis and swelling of lymph glands in the neck.
• Pneumonic. This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.
• Typhoidal. This form is characterized by any combination of the general symptoms (without the localizing symptoms of other syndromes).
Tularemia is a rare disease, and the symptoms can be mistaken for other, more common, illnesses. It is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals.
Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for weeks, most patients completely recover.
While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months when ticks are most active.
• Avoid wooded and brushy areas with high grass and leaf litter.
• Walk in the center of trails.
• Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.
• Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5 percent permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.
• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats and day packs.
• Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.
• If the clothes are damp, additional time may be needed.
• If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.