Creating a Circle of Support for Moms-to-Be

By Jorge Gomez

IACH Public Affairs Office

This story is the first in a series that chronicles the experience of an IACH patient as she prepares for delivery.

Amanda Shumaker is 700 miles away from the nearest family member. Yet the mom-to-be said, “I still don’t feel like I’m doing this alone.”

As part of Group Prenatal Care at Irwin Army Community Hospital, Shumaker meets monthly with other women who are at the same stage of pregnancy. Instead of an individual prenatal appointment, she sits in a circle with others who share the same mix of happiness and worry.

At the start of the two-hour meeting moms-to-be take turns going behind a curtain for “tummy time.” After bellies get measured and fetal heart rates checked a discussion begins.

It’s not a class. It’s a group of pregnant women together on a journey with providers investing in their well-being and the health of their babies.

“The concept of Group Prenatal Care is to provide education primarily to first time parents,” said Mandy DeDonder, an IACH registered nurse and Group facilitator. “Group allows them the opportunity to meet other couples who will be delivering during the same timeframe.”

Shumaker said she likes the freedom of asking anything no matter how weird it might sound.

“Your body just goes through weird stuff and you get to talk about it with others. Someone always says, ‘I’ve had that happen,’” said Shumaker.

They learn from the questions others ask such as whether it’s safe to travel, go swimming or see a chiropractor. The women spend so much time hearing each other they build enough trust to tackle subjects providers can’t easily address in an office visit, said DeDonder.

Nor can they abbreviate an interactive education of 1,440 Group minutes into 200 minutes of individual appointments. The cumulative time spent in Group towers over individual appointments.

“Regardless of the format all patients have their questions answered, but Group has the advantage of learning things you wouldn’t think to ask,” said DeDonder. “They form friendships, a meaningful circle of support, and many times these relationships carry on beyond Group.”

Shumaker said moving around in the Army has taken her far from home but in Group she has met many in the same situation.

“I love the camaraderie, it’s a really neat community and being with people who know your story makes you feel at home,” Shumaker said.

During February’s meeting, the Group learned exercises to strengthen their core muscles as alternatives to sit-ups.

“I just have to lift my knee and hold it for 10 seconds a few times. It’s so easy that you can do it anywhere like when you’re watching TV,” said Shumaker.

Unlike an exam room, Group uses a large space where facilitators and patients can perform stretches and exercises. Even a physical therapist is invited to thoroughly engage them on topics specific to pregnant women.

Group Prenatal Care is encouraged for all first time moms but it may not work for everyone. Some women prefer privacy or just can’t carve out two hours for an office visit. For those open to the format, Group offers an intimate and in-depth education, said DeDonder.

That education is having positive results. DeDonder tracks outcomes with all patients who go through Group.

“The statistics show less preterm labor, less inductions and higher rates of successful breastfeeding,” said DeDonder.

For Shumaker making a home away from home also counts as Group success.

Outstepping Your Colleagues

Liz Harrell is determined to outstep her rival who bears the same first name Lizzie Gutierrez. Since Irwin Army Community Hospital launched an internal Performance Triad challenge in October that happened only once.

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Staff from the OB/GYN clinic at Irwin Army Community Hospital can sometimes be seen taking walks around the hospital during lunch. As part of the Performance Triad challenge, they each strive to reach 10,000 steps per day.

“I ran three miles in the morning and walked up a hill during lunch. It felt good to beat Lizzie,” Harrell said. “And that’s probably the only way I can outstep her.”

Both Harrell and Gutierrez are staff nurses in the OB/GYN Clinic at Irwin Army Community Hospital. Their friendly competition grew into a movement within the clinic’s staff who wanted in on the excitement. By November the count had grown to 13 participants.

Although it was occasioned by an inner hospital program, what made the rivalry possible was the distribution of a wearable activity tracker. The device tracks the wearer’s activity, exercise, nutrition (when the wearer manually inputs the data) and sleep. Users can sync or upload their stats to an online site to let friends see how well they are doing at a given time.

“Our goal throughout this challenge has been to encourage our hospital staff to learn more about the Performance Triad and experience the positive effects from it,” said Lt. Col. Amanda Forristal, Deputy Commander for Surgical Services. “As medical personnel we often advise patients to be active, eat healthy and get more sleep. What better way is there to educate patients than by exemplifying?”

The Performance Triad is an Army Medicine campaign designed to improve readiness and resilience among Soldiers. But program has spread to civilian staff and families who value health and optimal performance. It focuses on three core principles: sleep, activity and nutrition. A hospital committee designated the months of October, November and December respectively for each core event. Depending on the month, classes were provided to educate staff on the intricacies of sleep, activity or nutrition.

Anecdotal evidence suggests that the program had a slow start in gaining traction among staff but became more popular by mid November, said Forristal.

“More people started asking questions about the events we had listed. They asked if we would offer makeup classes on sleep or if more wearable activity trackers would be available,” she said.

Based on the popularity of the program the committee launched a second edition starting in February. New events for each month have been such as drinking the right amount of water for seven days, eating a meal that one would typically skip, or maintaining consistent sleep and wake times.

This second edition will give clinicians like Harrell and Gutierrez another opportunity to compete for the greatest number of steps.

Harrell was already active before the hospital launched the Performance Triad initiative.

But using a wearable device helped quantify her activity throughout the day. Syncing her steps online gave it a social component. An app allows Harrell and others to view each other steps, feeding a healthy competitiveness among staff with similar responsibilities in the same work environment.

It takes about 10,000 steps for the average person to log about five miles. At that point the device tingles to congratulate the wearer.

“It sounds like a lot but you can cover that distance in the course of an average day without even trying, especially if you have stairs like here in the hospital,” Gutierrez said. “Or a long hallway to walk up and down. Every little bit helps.”

Sometimes Gutierrez and Harrell corral the clinic staff during lunch to walk with them around the hospital building. It has the effect of getting those extra steps needed to reach one’s daily goal.

But in Gutierrez and Harrell’s world, getting from point A to point B has turned into a competition for who can lengthen the distance.

Harrell said it isn’t easy keeping up with Gutierrez who tends to achieve 7k steps before 9 a.m. But that’s a good thing.

“She keeps me on my toes,” Harrell said.

January is Cervical Cancer Awareness Month

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Kaya Sparks receives her first dose of the human papillomavirus vaccine. Young adults and children 9-26 years old can protect themselves from HPV related cancers with the HPV vaccine.

No woman should die of cervical cancer according to the Centers for Disease Control and Prevention. Cervical cancer, which is caused by the human papillomavirus or HPV, remains the most preventable cancer in women who have regular screening tests to include yearly well woman exams and Pap tests, said Ramona Derousseau, IACH Well Woman Clinic nurse practitioner.

The Pap test looks for precancers, which are cell changes on the cervix that might become cancerous if not treated. Women should get Pap tests regularly starting at age 21. Routine screening is recommended every three years for women 21-65 years who have a normal Pap test with a negative HPV test according to the CDC. Women who are 30 years and older with an unclear Pap test are also tested for HPV.

Women of all ages should also have yearly well woman exams for their reproductive health care needs, Derousseau said.

“I recommend all women have yearly well woman exams because a Pap test doesn’t tell us if the ovaries are normal size or if there are any changes to the uterus,” she said.

The well woman exam includes a breast and pelvic examination, a Pap test if needed, a review of labs and medications, a review of family history and testing for sexually transmitted diseases.

If a Pap test comes back abnormal or if a woman is diagnosed positive for HPV, it does not mean cervical cancer is present, according to the CDC. HPV can cause normal cells on the cervix to turn abnormal. Over many years, abnormal cells can turn into cancer if they are not found or treated.

“I tell women it only takes one encounter to get HPV and once you are exposed it stays in your body. Your body takes up to two years or more to suppress the virus. We monitor it to make sure it stays suppressed,” Derousseau said.

Young adults and youth may also protect themselves from HPV related cancers with the HPV vaccine.

The CDC recommends youth begin all three doses of the HPV vaccine at age 11 or 12, the vaccine is most effective when all does are received before a person has their first sexual encounter.

Youth and young adults up to age 26 are encouraged to get vaccinated.

TRICARE coverage of the HPV vaccine starts at age 9 through 26. For more information on the HPV vaccine, contact your medical team through Secure Messaging Services at https://app.relayhealth.com/.

To schedule a well woman exam or Pap test, visit http://www.tricareonline.com, or call the appointment line at 785-239-DOCS (3627).

 

Hooking Youth on Cotton Candy Nicotine

Pvt. Hunter Chubb had already quit smoking. Basic Combat Training left him no choice.

The marketings efforts of the electronic cigarette industry are catching the attention of a new generation of consumers: youth. Pvt. Hunter Chubb, a former vaper, believes that’s on purpose.
The marketing efforts of the electronic cigarette industry are catching the attention of a new generation of consumers: youth. Pvt. Hunter Chubb, a former vaper, believes that’s on purpose.

“That was a good thing,” said the preventive medicine specialist with the Fort Riley Public Health Department. “I came to appreciate my new found freedom.”

Weeks after completing boot camp his freedom was cut short. A friend introduced him to the electronic cigarette. It wasn’t the first time he’d seen the device. But there was something different.

“It looked really cool,” said Chubb, “similar to owning a flip phone and seeing a smartphone for the first time. You just really want it.”

An array of juices, or flavored nicotine, also made vaping an appealing recreation.

“’Vaping’ and ‘juices’ are terms the industry uses to distinguish the activity from smoking or tobacco consumption,” said Wayne Darsow, Fort Riley Public Health Nurse Practitioner.

Chubb said his initial interest in the electronic device was more about the technology and social lures.

“I didn’t have a desire for nicotine so I started with the lightest level available,” he said.

He began vaping at 6 mg/mL of chocolate flavored nicotine, which is considered entry-level strength. A week later he increased it to 12. A month later to 18.

“I wanted to keep feeling the effect from when I first started,” Chubb said.

Darsow said Chubb’s description is typical of a smoker who gradually develops a nicotine tolerance. To maintain the euphoric effect, smokers increase the number of cigarettes they smoke to intensify the levels of nicotine. With electronic devices, vapers increase the nicotine strength level in the juice.

“After a while I started smoking cigarettes because vaping wasn’t enough,” Chubb said.

He was back to where he was before he joined the Army.

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Electronic nicotine devices, or e-cigarettes, are marketed as healthy alternatives to smoking, Darsow said.

Advertisements for e-cigarettes report they are free from chemicals that cause cancer and other respiratory diseases.

“E-cigarette ads are also attracting a younger population,” Darsow said. “YouTube commercials for e-cigarettes show attractive people promoting the latest features. Their message is that vaping is glamorous, independent, and high tech. And this appeals to youth.”

Darsow said he doubts that vape juice flavors like cotton candy and chocolate are targeted to adults.

“It’s no accident that e-cigarette use among youth is increasing,” Darsow said. “It’s very easy for students to vape in schools without teachers suspecting a thing. Vaping leaves no smell behind.”

Data from the Center for Disease Control indicates that e-cigarette use among middle and high school students tripled from 2013 to 2014.

The upward trend among youth usage is a serious public health problem, Darsow said.

“We don’t want our kids experimenting with vaping. Nicotine exposure at an early age permanently alters neuro-receptors in the brain that then manifest into an addiction,” said Darsow.

Currently e-cigarettes are not officially deemed tobacco products by the federal government. That means there is little regulation on the marketing of e-cigarettes, Darsow said.

In November, the Kansas City metro area adopted ordinances raising the legal age to purchase cigarettes, e-cigarettes, and related products to 21. But in spite of these local and regional movements to curb sales among youth, e-cigarettes are not subject to the same marketing restrictions as traditional cigarettes.

“E-cigarettes are the perfect machine luring a new generation of young people to lifelong nicotine dependence. We as a community must be vigiliant to protect our youth through education while policies and regulations catch up,” Darsow said.

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“I wholeheartedly believe that vaping is more addictive than cigarettes,” Chubb said.

In October 2015, Chubb learned about the Fort Riley Tobacco Cessation Support Program and enrolled. The news of becoming a father gave him the motivation to quit – again.

“This time I’m quitting for good,” he said. “But if I relapse it won’t be because of the latest features on an electronic device. I know better now. ”

Operating Room Soldier Shoots for Holistic Future

SPC Samantha Smith-Slofer spends up to 10 minutes scrubbing before a surgical case at Irwin Army Community Hospital. She uses povidone-iodine to reduce bacterial count and to push microbes away from the tips of her fingers above her elbows. IAC_7391 copy

As an operating room specialist, Smith-Slofer assists physicians during surgical procedures. She is responsible for preparing and maintaining sterile medical supplies and specialized equipment. Depending on the complexity of the case, this Soldier will be charged with the sterility of more than 40 instruments at a time.

“Army Medicine has given me the opportunity to learn skills I would never have gained. I have more experience now than I would have in the civilian healthcare community at this point in my career,” said Smith-Slofer.

Her goals in the Army are further advancement, to expand her medical knowledge and to perfect both her medical and military skills. She plans to complete a college degree during her Army career in either exercise science or holistic medicine.

Smith-Slofer has served the Fort Riley community for 12 months. The Pittsburg, Pa., native was promoted to the rank of specialist in September of 2015.