Alaska Apostille

Retail sales dip in April. General Motors declares bankruptcy. Unemployment rates are rising at unprecedented rates. Familiar headlines, all of them. To help you through these tough times, I'm giving you a fitness stimulus plan full of cheap, easy options to keep your fitness going when money is tight.

In these stressful times, it's more important than ever to maintain your fitness routine. Why? Because the workout you do today will do more to save you money in the long run than you can imagine.

Exercise decreases stress, increases your sense of well-being (think happiness-inducing endorphins), keeps blood pressure under control, regulates blood sugar levels and helps you to sleep better. Having said all that, what's one of the first items on your budgetary chopping block? Probably your gym membership.

The good news is that while you're watching your pennies, you can still get a great workout and continue to enjoy all of the benefits that exercise has to offer. I'll start with my top 5 favorite exercises you can do anytime, anywhere …in the gym, in your living room or in your backyard. Stimulate your fitness routine by adding these to your day.

1. Walking lunges with an overhead press. Balance your body with this work-it-all-at-the-same-time exercise. For extra resistance, pick up a rock if you're outside or a book if you're inside. Begin with feet together, hands at your sides. Step your right foot out about 3 feet and complete a lunge. At the same time, move your hands out to your sides until they're parallel to the floor. Elbows then bend to a 90-degree angle. As you bend your knee into the lunge, press your arms up and hands toward each other. As you come up from the lunge, your hands return down to your sides. Complete 8-10 on each leg.

VIDEO – walking lunges

2. Push-ups with a side plank. One of my all-time favorite exercises for core stability and upper-body strength. As you complete your push-up, you will raise one arm as you rotate your body into a side plank…see photos.

VIDEO – push-ups with a side plank

3. Ice-skaters: This will get in some cardio conditioning while working on your glutes and abductors. I'm talking about speed skating, not figure skating. Stand with your feet apart, bent forward at the hip and a slight bend in your knees. Shift your weight from one foot to the other, creating a wider space between your feet. Arms move forward and back to help with balance. Repeat for 1 minute

VIDEO – Ice-skaters

4. Triceps push-up: For core and upper body with a focus on triceps strength. Get into your push-up position, either on knees on toes. Bring your wrists in-line with your shoulders. Bend your elbows while keeping your elbows pressed tightly against your rib cage. Your goal is to bend the elbow until it's at a right angle. Then push back up keeping your core tight (think planks).

VIDEO – triceps push-up

5. Wood chops: Begin from a squat position with your hands hanging down in front. As you rise up from your squat, rotate your upper body to the right as you raise your hands over your head. Return to starting position and then repeat motion to the left. If you're outside, pick up a rock to add some resistance. If you're at home or the gym, use a medicine ball.

VIDEO – wood chops exercise

Other ways to save money and maintain your fitness program:

Try a no-frills gym…lower membership costs, same equipmentFind a Boot Camp in your area. Boot Camp is the fastest growing group fitness trend in the country. Why? Because you get a great workout for a fraction of the cost. You get to share your triumphs/struggles with people just like you. And did I mention it's inexpensive? Take advantage of the great weather and move your workout outside. Dust off the hiking boots, grease the gears on the bike and hit a local trail.Create your own workout group. Replace your mornings at the coffee shop with friends with fitness walking with friends. You'll all look better, feel better and save $5.00 a day on your latte.Check out MeetUp.com to find other fitness folk in your area.

Whatever you do, keep moving. Create your own fitness stimulus plan or use any of these suggestions. It will save you hundreds, possibly thousands of dollars in medical bills in the future. We all want to age gracefully. The more you do now, the more you'll be able to do as you age. Remember, it's not just about getting into shape; it's about getting into life!

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Ginny Grupp holds a Master of Science in exercise science and health promotion. She is an ACE-certified personal trainer and NASM Performance Enhancement Specialist. She promotes healthy lifestyles through her personal training and fitness education company www.AlaskaFit.com.

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A gathering of special women was held at the Egan Convention Center on Thursday October 23rd. Most were Alaska Native Women. They had come from as far as Dillingham, St. Paul, Sitka, Bethel, Kodiak, Mekoryuk and Kotzebue. They came because they shared one thing . . . they had all been diagnosed with breast cancer and had mastectomies as part of their cancer treatment.

Mastectomies are different from most other surgeries. Unlike having an appendix or gall bladder removed, a woman sees the absence of a breast every morning, every time she bathes, every time she changes clothes or goes swimming. The image of her sexuality is challenged and the memory or anticipation of breast-feeding a child saddens her. Sometimes she wants to hide the loss, other times she wants to show it as a medal, proof that she has survived cancer and a message to other women that they can too. I know because I am a breast cancer survivor who had a mastectomy. I was glad I could coordinate this lunch with the help of my colleagues in the Alaska Native Tribal Health Consortium's cancer program. I felt we could help provide some answers to woman who may not have had access to the resources I did.

Cancer is the leading cause of death for Alaska Natives Women. Breast cancer accounts for 29% of all cancers diagnosed. More than 50% of Alaska Native Women diagnosed with breast cancer undergo mastectomies by choice or as the treatment recommended by the type and stage of their cancer. Only 30-40% of US White women receive mastectomies. The rate in the Alaska Native population is similar to woman across the U.S. who lives in rural communities. When given a choice they may choose mastectomy instead of lumpectomy and radiation since the time they must remain in Anchorage and away from their home is substantially less.

The luncheon was organized by the Alaska Native Tribal Health Consortium Cancer Program and was held to honor Alaska Native breast cancer survivors with mastectomies. The women came to sit and talk with other women who made similar choices and felt similar feelings. They came to learn more about their disease and care options available to them.

Rita Stevens from Kodiak welcomed the women and told her story of cancer. Martha Foster opened the luncheon with a prayer. Berit Madsen, MD spoke on survivorship, the need for eating well, exercising, having regular follow-up exams, and encouraging sisters and daughters to be screened for breast cancer. Jana Cole, a plastic and reconstructive surgeon, addressed options for breast reconstruction. Kristy DeYong, a physical therapist at the Alaska Native Medical Center (ANMC), talked about physical activity, range of motion, and managing lymphadema, a frequent side effect of breast surgery. Mel Hersman and Millie Hennings, oncology nurses at ANMC, ventured into the area of intimate partners and sexuality and suggested ways to enhance physical relationships during and after treatment. Laura Revels, a two time breast cancer survivor told her story using digital storytelling and spoke on the importance of joining or starting support groups in the women's communities. The American Cancer Society, Nordstrom, the National Cancer Institute on the assistance and services they provide to women after surgery. Women were invited to participate in a statewide survey of the needs of cancer survivors in Alaska.

Treatment options for women with breast cancer continue to improve and today women have options for treatment that do not require they stay in Anchorage for extended periods of time. Over time the numbers of Alaska Native Women who opt for mastectomies may decrease.

The State of Alaska Comprehensive Cancer Control Program also attended inviting women representing other minority communities to decide whether a similar event would benefit them. The luncheon was sponsored by the Alaska Run for Women and the Alaska Commercial Company.

The luncheon was a success. My worries that women might not come or might not enjoy themselves were unfounded. There was an instant kinship among the women as soon as they came in the door. They were among friends and didn't have to explain anything. I am pleased that I could use my experience to help other women who are breast cancer survivors.

Pictures:

Luncheon welcome provided by breast cancer survivor Rita Stevens, Kodiak

(Chair of ANTHC Cancer Plan Steering Committee)

“Fruit and Vegetable” dance led by ANTHC Nutrition Research Specialist Diana Redwood

“Fruit and Vegetable” dance

At the end of luncheon, attendee receiving fresh fruit donated by Alaska Commercial

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Cancer Plan Coordinator Judith Muller works for the Office of Alaska Native Health Research at the Alaska Native Tribal Health Consortium.

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Conquering Down syndrome

My name is Bobby Hill and I will be 29 years old May 10th 2008. Being born with Down syndrome has been quite challenging and also rewarding for me. Having Down syndrome has limited me in several areas like being able to drive a car and things like that, but it has not slowed me down to be able to participate in sports and working out and eating right. This is a very important part of my life. I learned at an early age through the help of my parents that exercise and eating right are very important. My family started me early to be involved in healthy eating. My mother, who was born in Korea, said she always watched what I ate and almost always made sure rice was at the table along with fresh vegetables. My dad always makes sure that I go to the gym and gives me a banana smoothie almost every night.

My journey towards fitness started at an early age in the Philippines (My father was in the Air Force) watching my sister workout in the swimming pool. She had to get up very early (5 a.m.) and her practices would last more than two hours. She always seemed to be happy and she ate really well too.

Her working out showed me that if you worked out hard, good things could happen. This is where I became involved with Special Olympics and participated in such events as running, bowling and bocce ball. I really enjoyed the friendship that was established and it helped me as I moved to the United States.

In the United States, I have been involved with Special Olympics for over 20 years and it has really helped me adapt to just about anything that happens to me. My time with Special Olympics and the friends I have met have just been fantastic and one thing I'm very proud of was being selected to represent the United States in 2003 and 2007 at the International Special Olympics games in Dublin, Ireland and Shanghi, China respectively. I won two gold medals in my weight class and finished third overall in Ireland and received four silver medals in China. This is by far my greatest accomplishment and has helped me gain much confidence.

Currently, I train in power lifting: four hours weekly year round, bowling: two hours every Saturday (August – March), floor hockey: two days a week (December – March), bocce: two hours a week (July-September), golf: one round a week (July-September).

When I'm not in training I attend boy scouts every week and attend a two-week camp in the summer. I'm very proud to say that in 2004 I made Eagle Scout.

For the last 10 years starting late July, I have been the Bartlett High School football manager. We won the Alaskan state championship in 2001. I really enjoy being around the guys.

My hopes for the future would be making sure that I always enjoy life and workout at the gym at least once or twice a week.

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Bobby Hill was a member of Team USA for the Special Olympics in Dublin, Ireland (2003) and Shanghai, China (2007). He was selected during the last Alaskan Hall of Fame 2007as a Healthy Hero.

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2nd Opinion – Long-term care 101

As an AARP employee for the past seven years, my eyes have been opened to the incredible number of issues facing today's senior population. From the origins of Social Security and Medicare, we are in a world of change as the Baby Boomers age. The impact of the aging of the Baby Boomers will have an affect on the entire world.

As the United States ushered in the 20th century, only four percent of the population or approximately 3.1 million people were 65 or older. By 1950, 8.1 percent of the population or approximately 12.3 million were 65 or older. By the year 2000, the percentage of individuals age 65 or older in the United State had risen to 12.4 percent of the population or some 35 million people. Due to the aging of the baby boomer generation, by the year 2030, 70 million Americans or one out of every five Americans will be age 65 or older. The baby boomer generation is the cohort of individuals born between 1946 and 1964.

The dramatic demographic profile of the baby boomers as they age will have a tremendous impact on the U.S. health care system. It is not simply the shear number of baby boomers who are aging, but the life expectancy profiles of today's elderly is not the same as an elderly person who helped usher in the 20th century. People are living longer. Almost 80 percent of women who reach the age of 65 will live another 19 years; for the 80 percent of men who reach 65, they can expect to live an additional 15 years. The older a person gets, the more likely they will require extensive health care services.

In the United States, long-term care is assumed to be care received in a nursing home. But long-term care actually involves a variety of services for people of all ages and for a wide variety of health conditions.

Long-term care should be renamed “temporary care,” based on usage. Someone aged 65 in 2007 will need some long-term care for an average of three years. Women need an average of 3.7 years while men need on average 2.2 years. It's important to note that while one-third of all Americans age 65 and older will never need long-term care while 19 percent will need it for a period of more than five years.

Projecting the long-term care needs for people turning 65 requires an understanding that not 100% of the population will require any long-term care. The key is understanding the phrase for those who live to the age of 65. Socioeconomics, lifestyle choices, and genetics will all play a role in whether a person lives to the age of 65.

The majority of Americans attribute long-term care with nursing home care, but that isn't the case. Long-term care is provided by a number of providers, the majority of whom are not paid. Services of long-term care also come in a variety of forms, from homes, home-like settings, and actual institutions. Nursing homes and home care agencies are the traditional paid providers of long-term care and still provide the majority of services, but other types of providers are increasing in use.

In the broadest terms, long-term care includes a variety of services, including (1) supportive services; (2) medical and rehabilitative services; and (3) palliative care services. Supportive services constitute the core of long-term care, including assistance with activities of daily living (ADLs), such as eating, bathing, walking, or simply getting to the toilet. Supportive services also include assistance with instrumental activities of daily living (IADLs), such as paying bills, managing money, household chores, cooking, and shopping. A second category of long-term care is medical and rehabilitative services, in which people with a chronic disabling condition need continual monitoring and/or intervention. Because of an injury or accident, individuals of any age may need rehabilitative services in their recovery process. The third category of long-term care is palliative care, which is usually provided when a person is close to death. The goal of palliative care is making the patient as comfortable as possible while addressing any spiritual, social, physical, and existential needs that may exist.

A mixture of supportive services, medical and rehabilitative services, and palliative care services may be present in the various types of long-term care in America, although palliative care is more likely to take place in a nursing home.

In the U.S., approximately 60 percent of the 9.5 million Americans who sought long-term care were aged 65 or older. The older the person, the more likely he or she may need long-term care. But the percentage of long-term care usage also drives the point home that this service is not exclusively for the elderly.

The majority of individuals who need long-term care are older adults, although individuals recovering from a serious medical injury may also require some period of long-term care. Long-term care providers must deal with a variety of chronic conditions, including Alzheimer's disease, arthritis, diabetes, cancer, as well as physical impairments including hearing loss, blindness, and loss of mobility from either injury or a stroke.

What are the costs?

2008 COSTS

National Average

Alaska

Annual costs – Alaska

FACILITY

Nursing Home

Private Room 1

$ 209 per day

$ 515 per day

$ 187,902

Nursing Home

Semi-Private Room 2

$ 187 per day

$ 514 per day

$ 187,813

Assisted Living (Private one-bedroom) 3

$ 3,008 per month

$ 4,567 per month

$ 54,809

COMMUNITY

Adult Day Care 4

$ 59 per day

$ 70 per day

$ 25,675 8

HOME

Home Health Aide Services (Medicare certified) 5

$38 per hour 10

$ 81 per hour 10

$ 168,282 9

Home Health Aide Services (non-Medicare certified) 6

$19 per hour 10

$ 27 per hour 10

$ 55,438 9

Homemaker Services 7

$18 per hour 10

$ 24 per hour 10

$ 54,866 9

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1 – Provides skilled nursing home care 24 hours a day.

2 – Provides skilled nursing home care 24 hours a day.

3 – Provides “hands on” personal care as well as medical care for those who are not able to live by themselves, but do not require constant care.

4 – Provides social and other related support services in a community-based, protective setting during any part of a day, but less than 24-hour care.

5 – Provides “hands on” personal care and sometimes skilled care associated with a nurse visit in the home. Assist with activities such as bathing, dressing and transfers. This is the rate charged by a Medicare-certified agency.

6 – Provides “hands on” personal care but not medical care in the home with activities such as bathing, dressing and transfers. This is the rate charged by a non-Medicare-certified licensed agency.

7 – Provides “hands on” care such as helping with cooking and running errands. Often referred to as “Personal Care Assistants” or “Companions.” The rate provided is one charged by a non-Medicare certified, licensed agency.

8 – Based on eight hours per day, five days a week of care.

9 – Based on 44 hours per week of care.

10 – Hourly rate for participating agency or organization, not for the individual worker, who would be an employee of the agency/organization.

Source: Genworth Financial 2008 Cost of Care Survey

Who pays?

Ask five people who pays for long-term care and I'll bet you get five different answers, including “I don't know.” The cost of long-term care is a mixture of private and public funds, with the majority of financing bore by individual Americans. People incorrectly assume Medicare will pay for long-term care services. Medicare does not. Medicare pays, on average, about 11% of any long-term care expenses, but with limitations. To be eligible for Medicare coverage in a long-term care or nursing home situation, the individual must be under the care of a physician for a specific condition, require skilled nursing services on an intermittent basis, or who need speech or physical therapy for a specified time.

People sometimes confuse Medicare and Medicaid. Medicare is health insurance for people 65 and older, for those under age 65 with particular disabilities, and for those of any age with End-Stage Renal Disease. Medicaid, on the other hand, is a program to provide health coverage for low-income Americans. Guidelines vary from state to state, but are generally gauged against federal poverty guidelines.

Based on the funding sources for both nursing home and home care, it is not uncommon for individuals to “spend down” in order to qualify to Medicaid. This might be difficult for many Americans to accept. The concept of spending down after a lifetime of working, paying taxes, and saving for retirement is contradicted by the requirement to have no assets in order to qualify for welfare. It doesn't make sense for individuals who have followed the rules to have to give up what they have long worked for in order to pay for end of life care.

Who Pays for Nursing Home Care

Private Long-term Care Insurance

5%

Medicare

8%

Medicaid

41%

Out of Pocket

46%

Who Pays for Home Care

Private Long-term Care Insurance

5%

Medicare

15%

Medicaid

17%

Out of Pocket

63%

(Cost of Care Survey, Genworth Financial, 2008)

Now, because I work for AARP, people assume I know all about products and services available through AARP. In fact, I work for the non-profit side of AARP. Here in the AARP Alaska State Office, our small staff works on legislative and community activities on behalf of Alaska's 95,000 members. All the insurance products and discount programs are managed by the for-profit side of AARP and we actually have a legal responsibility to maintain an arms-length relationship. While I cannot provide information on any insurance products, I can provide a toll free number where people can call about products and services: 1-888-OUR-AARP (1-888-687-2277).

For more information on the issue of long-term care, feel free to contact me in Anchorage at 762-3302, toll free at 866-227-7447 or via email at asecrest@aarp.org

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Ann Secrest is with Alaska AARP.

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Benefits of revised Uniform Anatomical Gift Act of 2006

Editor's note: On June 17, Governor Sarah Palin signed into law a new bill that makes it easier for organ donors and their families to fulfill the donation process. House Bill 196 is based on the 2006 revisions to the Uniform Anatomical Gift Act (UAGA).CEO Bruce Zalneraitis of Life Alaska Donor Services explains the revisions.

There are close to 100,000 people waiting for an organ transplant in the U.S. and around 180 waiting in Alaska. Eighteen people in the U.S. die each day while waiting for a transplant so it is important to simplify and clarify the process of becoming an organ and tissue donor so that more people who want to be donors can do so with fewer obstacles.

Before describing the 2006 version of the Uniform Anatomical Gift Act (UAGA) it may be helpful to offer some background on Uniform State Acts. The National Conference of Commissioners of Uniform State Laws (NCCUSL) meets periodically to make proposed laws to be adopted by each state. The commissioners are appointed by state governors and have expertise in the law as it pertains to state statutes. NCCUSL also invites advisors who have expertise in the area covered by the Uniform Act being drafted, in this case medicine, ethics, and existing federal regulations. An objective of NCCUSL is to see that Uniform Acts are adopted by all states to ensure that uniformity with respect to certain practices will take place across state borders. Because each state has existing statutes that may differ from other states proposed Uniform Acts may be customized to avoid statutory conflicts. The UAGA is an example of one of these Acts.

The first version of the UAGA was drafted in 1968 and was adopted by all states. It recognized the process of granting consent for organ and tissue donation for transplantation and research and described who could grant permission. In 1987 a revision of the UAGA was drafted and adopted by approximately half of the states including Alaska. The 1987 Act introduced first-person consent. In practice however, donation programs still relied on the consent from next-of-kin before proceeding with organ and tissue donation.

Since 1987 a number of developments have taken place within the donation and transplantation field requiring another revision. NCCUSL completed the draft in late

2006 and about 25 states have adopted the revision into law and many additional states are hearing the Act in their respective legislatures.

Among the important additions to the 2006 version is the recognition of donor registries and in particular, first-person consent donor registries and that these donor registries allow for electronic signatures. A donor registry is a searchable database that allows authorized personnel to determine if a potential organ and tissue donor is on the registry and therefore has granted first-person consent for donation. Alaska actually passed into law its statewide donor registry in 2004 that created the Alaska Donor Registry in partnership with the state Division of Motor Vehicles (DMV) and Life Alaska Donor

Services. Presently there are 342,500 citizens on the Alaska Donor Registry (ADR) representing 51 percent of the state population and 70 percent of licensed drivers. Citizens with the new driver's license who are on the registry will have a “red heart” on their license. What has been learned about first-person consent and donor registries is that when asked, most people want to donate organs and tissues for transplant but don't complete donor cards or join a registry unless the process can be coupled with a required step such as license issuance / renewal or obtaining a vehicle registration. Greater than 97 percent of citizens who join the ADR have done so during a visit to a state DMV.

The 2006 revision strengthens language that prevents surviving relatives from refusing donation when first-person consent has been granted by the donor by making the decision irrevocable after the donor's death. For cases where a potential donor is not on a registry and has not made a decision to be a donor the 2006 revision clarifies who may grant consent for donation and expands the list of those who may make an anatomical gift. The revision also prioritizes transplantation over research when no decision has been made regarding research.

The 2006 UAGA also further improves the relationship between the donation organizations in Alaska and the State medical examiner's office. The medical examiner plays a key role in the donation process as most organ and tissue donations involve sudden, unexpected deaths, which by law, fall under the jurisdiction of the medical examiner. The 2006 UAGA also recognizes Advance (medical) Directives made by individuals regarding end of life decisions and allows for consideration of organ and tissue donation while honoring the Advance Directives of the individual.

Finally, but no less important, the 2006 revision recognizes donor registries of other states and honors those registries if a person becomes a potential donor in another state.

For more information visit http://www.lifealaska.org or http://www.alaskadonorregistry.org.

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Bruce Zalneraitis is CEO of Life Alaska Donor Services.

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Alaska Department of Health and Social Services 2009 Priorities

Although I was recently appointed July 24, 2008, by Gov. Sarah Palin, as Commissioner of the Alaska Department of Health and Social Services, I feel my previous five-plus years experience in the department as Acting Commissioner, Deputy Commissioner of Family, Community and Integrated Services and Director of Behavioral Health have prepared me well for my new job.

The department's mission – “to promote and protect the health and well-being of Alaskans” – has not changed. However, the overriding theme for the department's future direction is “helping individuals and families create safe and healthy communities.” Solutions to the health and social service problems we experience in Alaska don't necessarily come from state government – real solutions come from communities. We can provide leadership, direction, guidance and resources but ultimately it's the individuals and families in our smallest villages to our largest cities who will truly make a difference.

I have focused our priorities on five all-important areas of concern: preventing and treating substance abuse; promoting health and wellness; continuing with health-care reform; developing a plan for caring for seniors in Alaska and meeting the needs of vulnerable Alaskans and their families.

Substance abuse

Substance abuse, whether it is alcohol, prescription drugs, illegal drugs or inhalants, affects every family and community in Alaska. It is a contributing factor in crime, suicides, unemployment, domestic violence, child abuse, school dropouts, juvenile delinquency, and any number of other social and health problems. The cost to our society in dollars is significant. The emotional cost unfortunately is difficult to measure. Few families are untouched by substance abuse. The department's major strategies to battle substance abuse include prevention, early intervention, treatment and recovery support.

Health and Wellness

Many Alaskans lead less satisfying and less productive lives, and many die prematurely each year because of disability and death caused by tobacco, substance abuse, injuries, obesity, diabetes, cancer, heart disease and sexually transmitted diseases. Most of this is attributable to personal choice involving diet, lack of physical activity and tobacco use. The economic impact of chronic disease alone in Alaska is staggering: an estimated $600 million is spent annually on direct medical services and $1.9 billion estimated in lost productivity. Most of this is preventable, and we can do a better job of screening, diagnosing and treating these conditions. Our major strategies for promoting health and wellness include prevention efforts through education; expanding the health-care workforce; developing a statewide trauma system; working with communities on emergency response planning and preparedness; and assessing and mitigating environmental impacts on health in Alaska.

Health-care reform

Alaska's health-care system continues to be fragmented and uncoordinated and doesn't produce the kinds of outcomes we should expect. By strategically focusing on care management, reforming Medicaid, creating a Health Care Commission and growing the health-care workforce, we can transform our health-care system. The state's major strategies to reform health care include care management; Medicaid reform; establishing a health-care commission to build public awareness; and partnering with the federal government and other states to increase the health-care workforce.

Long-term Care

Seniors are the fastest growing population in Alaska, and it is our responsibility to determine what kinds of services we want for our aging parents and grandparents in order to keep them at home in their own communities. The department's major strategies for caring for increasing numbers of seniors in Alaska include developing a long-term care plan, which includes support for family caregivers, improved services, and developing a workforce. Other strategies include working with the Alaska Native Tribal Health Consortium, submitting a Medicaid waiver for Alzheimer's disease and related disorders; and promoting expansion of aging and disability resource centers.

Vulnerable Alaskans

We need to ensure that both kids and communities are safe, that developmentally disabled children and adults have access to quality services and supports, and that individuals and their families get the kind of financial and vocational assistance they need. Our major strategies to meet the needs of vulnerable Alaskans and their families include expanding family-centered services centers, which helps families leave public assistance and gain employment; closely monitoring grantees for high performance, implementing licensing and certification standards; and finally recruiting and retaining a qualified social services workforce.

To read more about these priorities, visit www.hss.state.ak.us/commissioner/PDF/2008_priorities.pdf. You can also hear me discuss these priorities at www.hss.state.ak.us/ commissioner/default.htm

For more information on the department's many programs and projects, visit our home page at www.hss.state.ak.us.

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Bill Hogan is the commissionerof the Alaska Department of Health and Social Services.

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2nd Opinion – UAA breaks ground on new Health Sciences Building

The State of Alaska is in great need of well-prepared graduates in the health care workforce. As one of the largest and fastest growing sectors of Alaska's economy, the health care industry makes up more than one in every 12 jobs in Alaska.

As a result of the great demand for health care professionals in Alaska, the University of Alaska Anchorage (UAA) has seen incredible growth in its Allied Health, Nursing and WWAMI (Alaska's Medical School) programs. Last year the Alaska State Legislature provided the University with $46M to begin construction on a much-needed Health Sciences Building on its Anchorage campus.

In late October, UAA held a groundbreaking ceremony for the 62,500 square-foot building. The new facility, designed to deliver state-of-the-art training, will feature distance-education classrooms to connect students from rural communities, interactive simulation labs, clinical and instructional labs and classrooms and instructional spaces designed for interactive learning and collaborative hands-on experiences.

“The Health Sciences Building will offer future nursing students the unique opportunity to collaborate with fellow aspiring health care professionals,” said Megan Kemp, UAA Nursing student. “This will prepare us to enter the workforce where the best patient care is provided when all health care providers work together as a team.”

The building will be located off of Piper Road, just west of Providence Hospital and south of Providence Drive in the heart of the U-MED District.

“The University will work hand-in-hand with industry, government and community entities, and collaborate closely with public and private sector partners, to maintain and develop our programs supporting workforce development and high-demand careers,” said Jan Harris, Vice Provost of Health Programs at UAA.

The University is also committed to providing increased access to more students across Alaska. The University of Alaska's health programs are available via distance delivery to many Alaska communities, allowing more students access to the education they need to enter into or advance their health careers.

The new Health Sciences Building is scheduled to open in fall 2011.

University officials break ground on the new Health Sciences Building.

UAA Chancellor Fran Ulmer and UA President Mark Hamilton break ground on the new Health Sciences Building.

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Turn up the heat!

Secrets to decreasing time in the gym and increasing calorie burn during the holidays.

You've made it through Halloween and are now fully engulfed in the “feastive” holiday season. Americans typically gain 5-15 pounds over the course of the next 8 weeks. Why? A diabolical duo is at work: overeating / under-moving.

It starts with finding yourself short on time because of increased social commitments and shopping / preparing for the holidays. So, what's the first activity to get the boot? Going to the gym. You just can't squeeze one more hour into our day, so just for now, you'll ditch the gym.

The holidays are chock full of social engagements where we allow ourselves to overindulge repeatedly. Before you know it, the blitz is over and you're suffering from the holiday hangover: 10-15 extra pounds hanging over your belt, out of your sleeves and making you feel awful.

Sound familiar? It doesn't have to be that way.

If you're caught up in the “If I don't have at least an hour to work out, it's not worth going to the gym at all” mentality, you're not alone. Change that up this year. It's not how much time you spend on the activity that is important when you're crunched for time. It's the consistency and the intensity of your efforts that counts. Use these secrets to increase calorie burn and intensity of your workout and accomplish everything you need to in 20-30 minutes. Make it intense enough and you'll be able to workout, shower, shop and get back to the office all on your lunch hour. Here are a few secrets from “Beating the Holiday Hangover,” a report available at www.AlaskaFit.com for getting maximum results in minimal time.

1. Do an active warm-up. Don't jump on a piece of cardio equipment for your warm-up and feel as if you're wasting a precious 5-10 minutes. Do light exercises to warm up your muscles and lubricate your joints. Walking lunges (not using any weights), or static lunges repeating 10 times on each leg, then switching, works great! Repeat this for 2-3 sets and your legs will be ready for action. For upper body, do some easy push-ups, either on your knees or against a wall. You don't want to strain to complete these, just get your muscles and joints moving.

2. Add compound exercises. These are total-body exercises. For the holiday season, forget about working just your arms, biceps and triceps today and something else tomorrow. Instead, opt for lunges with dumbbell biceps curls. You'll get legs (lunges with weights), core / balance (walking with the weights) and arms (biceps curls) all at the same time. In addition, with all of this activity, your heart rate will pick up and stay up, so you'll get a cardio interval hit, too. Use your imagination to combine your “regular” sets into total body exercises.

3. Use Active Recovery. If you don't feel coordinated enough to pull off something like a squat with an overhead press or a walking lunge with biceps curls, there are alternatives. Go ahead and complete a set of upper body exercises. Rather than waiting for a minute or so to pass so you can do your next set, do a lower body exercise. Then switch back to upper body. This will make much better use of your time.

4. Integrate cardio intervals into your weight routine. Between your lifts, do a set of jumping jacks for a minute, jump rope, or hop back on a treadmill for one minute. Do something aerobic to increase your heart rate.

Make this the year that you don't have the holiday hangover. Schedule small amounts of time, burn as many calories as you can squeeze out of your body, and you'll be off to an even better start for 2009. Can you think of a better gift this holiday season?

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Ginny Grupp holds a Master of Sciencein exercise science and health promotion. She is an ACE-certified personal trainer and NASM Performance Enhancement Specialist. She promotes healthy lifestyles through her personal training and fitness education company www.AlaskaFit.com.

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My Challenges Living With PTSD Due to MST

This is one of the toughest subjects and one so misunderstood and even stigmatized.

It took many years, before I ever received the proper diagnosis of PTSD due to MST (Military Sexual Trauma)

My MST occurred, when I was stationed at Ft. Greely Alaska as a Heavy Vehicle Operator at the Transportation Motor Pool, 1981 to 1983. I was the only female Driver there, and experienced constant sexual advances, jokes, taunting, and rape by a Temporary Duty Soldier. I did report this to my immediate supervisor, who rejected this, because it was my word against the other. Despite of this, I received an Army Commendation Medal.

By the way, it is still up to the victim has to prove, when filing claim with the VA, and many Veterans, including myself, blocked out many details from the attacks and such. Again, it is the victim who is being victimized again.

My PTSD symptoms did not show it self until 1991, and I had received many diagnoses, such as Borderline Personality Disorder, Depression and even Bi-Polar. I went to College from 91-94, where I received a degree in Nursing. In the mean time, I got sicker. The biggest break downs occurred from 1997 to 2001. It took many years to have a Counselor, who was trained in PTSD and that when I had the received correct diagnosis.

My symptoms are major avoidance of any relationships, hyper vigilance, not sleeping well and such. Any stress made the symptoms worth. 1997 I am receiving Social Security Disability.

Also, in 1997, I applied for disability compensation for the PTSD due to MST, and the claim was denied, cited that I did not serve in combat.

Please note, since the Murder of Lcpl Maria Lauterbach, who was raped and then later murder by her assailant, caused major trigger in many women Veterans, who have experienced MST 20+ years ago and now finding themselves with major PTSD. This is called DEALYED ONSET PTSD.

Little about Military Sexual Trauma, Law defines sexual trauma as: Sexual harassment, Sexual Assault, Rape and other acts of violence. It further defines sexual harassment asrepeated unsolicited,verbal or physical contact of a sexual nature, which isthreateningin nature.

Many veterans have never discussed the incident or their medical or psychological condition with anyone. Yet, these women and men know that they have “not felt the same” since the trauma occurred.Unfortunately, this is a common reaction to an incident of sexual trauma.

Only 16% of rapes that occur in this country are ever officially reported. Many of the victims base their reactions on social misconceptions about those who have experienced sexual trauma. Nearly one-third of all trauma victims develop Post Traumatic Stress Disorder (PTSD) during their lifetime. Physical problems and ageneral feeling of “not feeling well” often accompany PTSD symptoms.

Many veterans who experience anincident of sexual trauma have had no professional counseling and may have misgivings about the need or purpose for talking about theincident so long after it occurred.

The Aftereffects of Sexual Trauma

Theaftereffects of a sexual trauma can include:avoidance of places or objects which recall memories of the traumatic incident feelings that something is missing or not right depression, alcohol and./or substance abuse suicidal thoughts recurring and intrusive thoughts and dreams about the trauma incident non-specific health problems relationship problems

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Cornelia Huebscher served in the U.S. Army and is a MST survivor. She lives in Sitka, Alaska.

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2nd Opinion – A response to the Alaska eHealth Initiative

My name is Mark Moronell. I am a cardiologist here in Anchorage and also the CEO of a small start-up company, GLIA. This is in response to the Alaska eHealth Initiative 2nd Opinion article.

Part of my clinical duties as a cardiologist is to process a great deal of information regarding my patients and insure that their information not only gets filed correctly in my office, but disseminated properly to other caregivers that may be active on their case. If you have ever been a patient then you know the amount of information that can be generated and the long list of people that may need to see it. One of the biggest frustrations that I find in my practice is that the information is not always where it is supposed to be. This includes clinic notes, study results, laboratory tests, etc.

Imagine the difficulty in seeing a patient in the emergency department in the middle of the night who is critically ill, unable to speak and has no one around to present a medical history. This happens to me all the time. Imagine also the aggravation of going from your primary doctor to a specialist and not having your medical information available because someone in one of those offices has not got around to faxing the material at the proper time. Patients complain about this daily.

This frustration is pervasive throughout medicine (not only here in Alaska) and the delays in getting patient information from place to place in a timely and accurate manner not only increases the costs of care but negatively impacts outcomes. It is also a source of tremendous frustration. I started my small business as a means to tackle this problem, improve patient care and perhaps make a reasonable profit.

The issue of using electronic medical records is by no means a new issue. The topic has been discussed for years now and even made it to the presidential debates and the problems associated with medical information transfer has been mentioned already by President Obama as something he is looking to address. The idea of establishing a network to readily share such information is also not new. It is not new here in Alaska either. What makes Alaska unique however is that we are such a large state with many diverse patient types. That we have so many different types of patients here is also an opportunity.

Within the medical community there are many key groups that would benefit substantially from the development of a linked medical record repository: hospital systems, individual hospitals, large, medium and small physician practices and individual patients and families. As a physician I have access to many of these groups. I have spoken personally to hospital CEOs, associated physicians and business leaders around town. Also as a partner in a large practice currently using an electronic medical record system I have seen firsthand the technical difficulties associated with its use and the cost.

I am certain that the development of a statewide electronic medical record repository has not materialized thus far is due to the following:

1. Individual hospitals are hesitant to invest money to make it easier for patients normally seen at their facility to be seen somewhere else.

2. Physicians are leery of investing in current technologies due to a lack of familiarity and fears of increased costs and decreased productivity.

3. Multiple different hospital systems, insurance companies, government organizations and physician groups, all with differing goals and objectives, complicate the process of communication, planning and dissemination.

4. No one has thus far has developed an integrated solution that addresses the problem from an individual, tactical and strategic standpoint that incorporates all the necessary variables.

5. Thus far this effort has only been addressed aggressively by nonprofit entities. It is only through speculation and the prospect of large financial returns that someone will be willing to assume the risk and be able to tackle this project completely. I also feel that the individual spearheading that effort needs to be willing and able to work with all related groups.

6. Adequate marketing has not been done to educate the public on the merits of the effort.

7. There will never be enough money generated through grants and efforts to completely cover the cost of system design, implementation, management and support for the indefinite future.

I have also been following the progress of the Alaska eHealth Initiative but with respect to their efforts it is my belief that a system can be developed in Alaska to solve this problem right now and without further study and analysis. I feel that with a $10M grant there would already be a system in place if my ideas were implemented.

I also feel that the company successful in making this happen will greatly impact the quality of care for everyone here, improve the efficiency of care delivered, save money for the medical system and make a significant profit themselves.

As a small business owner I am limited in what I can accomplish. I have an understanding of the issues and for the past three years I have been developing products to address the problem. And I believe that the only way to tackle this problem is through the introduction of selected niche products to the Alaska market and I have the products designed to do just that.

You see, it is my contention that only by pushing the idea upward from patient to physician to hospital to hospital system, can this problem be solved. Trying to push the idea down from competing hospitals to providers and patients has not shown to be a viable option nor has it been implemented, at least not thus far. My approach therefore and the approach of the Alaska eHealth Initiative are similar. I am just looking at the problem upside down and believe that my path to the solution is the more efficient.

I would welcome the opportunity to discuss these issues at any time.

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Mark W. Moronell, MD FACC is CEO of GLIA, llc. He can be reached at mwm@glialink.com

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