The Healthy Living Blog has been silent for many months now. That’s because MultiCare has built a new blog on our website, multicare.org, called Vitals. Vitals brings you local stories, health care news and commentary, and is also the new home to Healthy Living blog content.

Visit multicare.org/vitals to check it out!

Stop by Sunday, Oct. 2, and see what’s new at your local community hospital. Take advantage of free flu shots and free screenings, including bone density, blood pressure, cholesterol, glucose and PSA testing. And chat with leading experts in a wide range of specialties, from diabetes to physical therapy and robotics. We look forward to seeing you.

To learn more, read the Allenmore Open House flyer, call 800.342.9919 or visit multicare.org.

If your child is constipated, chances are it’s frustrating for both of you. Constipation—difficulty passing stool or a longer-than-normal time between bowel movements—is common in children and can sometimes be a cause for concern.

What is normal?
The frequency and consistency of bowel movements in infants and children depend upon age and diet, and an individual child’s patterns can vary widely. “Normal” for an infant could mean a bowel movement every time they eat or only once a week. An older child may go three times a day or once every three days.

When is it constipation?
Your child may be constipated if he or she has had less frequent bowel movements—or difficulty passing stool—for more than two weeks. It’s important to note that even children who go with normal frequency can still have symptoms of constipation. Small, hard or rocklike stools passed daily or very large, firm stools that clog the toilet once a week can both be signs of constipation.

Stool withholding—trying to keep from having a bowel movement—is also a clear indicator that your child is constipated. Infants may arch their back, tighten their buttocks and cry. Toddlers may rock back and forth while stiffening their buttocks and legs, arch their back and wriggle or fidget, squat, or get into other unusual positions. They may also hide in a corner or a special place.

Children withhold because they are afraid passing stool will hurt, and it can be a difficult habit to break. Unfortunately, repeated withholding can make the problem worse.

Young infants may appear constipated or in pain because they strain and get red-faced when they go. This is usually because the muscles used for defecating are still uncoordinated in infants less than 6 months old. A baby is unlikely to be constipated if he or she passes soft stools within a few minutes of straining.

How do I make it better?
Diet changes, illness, stress, toilet training, lack of exercise or unwillingness to stop playing for a bathroom break can all lead to constipation.

The good news is most children with constipation do not have an underlying medical problem. Treatments may include stool softening medications (oral or rectal) to make it easier for the child to go to the bathroom, dietary changes and behavior modification.

Parents should put any toilet training activities on hold until after their child’s constipation has been resolved.

In some cases, constipation can be a symptom of a more serious problem, such as hypothyroidism, Hirschsprung’s disease, celiac disease, spinal cord dysfunction or an adverse effect of some medications. So it’s a good idea to check with your pediatrician before starting any treatment.

Help for a going problem
The MultiCare Mary Bridge Pediatric Gastroenterology and Nutrition Clinic has outpatient clinic locations in Tacoma, Gig Harbor, Covington, Olympia, Puyallup and Silverdale, offering close-to-home services.

Our team provides consultation to referring physicians and comprehensive care for children with a broad range of gastrointestinal, liver and nutritional problems, including:

• Abdominal pain
• Constipation
• Failure to thrive
• Inflammatory bowel disease
• Acute and chronic liver disease

Visit the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition website at www.naspghan.org for more information on gastrointestinal disorders.

People with celiac disease have an immune reaction to gluten, a protein found in cake, bread, pasta, cookies and many other foods containing wheat, barley or rye. This reaction can cause some pretty unpleasant symptoms in both adults and children, like abdominal bloating and pain, chronic diarrhea or constipation, and excess gas.

More seriously, celiac disease damages the small intestine so it can no longer absorb certain nutrients. This can lead to vitamin deficiencies that eventually cause other illnesses, as well as stunted growth in children.

Shifting to Gluten-Free

While there is no cure for celiac disease, it can be managed well through diet changes. So your child’s diagnosis of celiac disease means making some permanent changes in the foods your child—and perhaps your whole family—eats.

“One of the biggest challenges parents have once their child’s been diagnosed with celiac disease is making the decision whether the whole family should go gluten-free at home,” says Judy Tuider, a clinical dietitian with the MultiCare Mary Bridge Gastroenterology and Nutrition Clinic.

Tuider advises families to use mostly naturally gluten-free foods, such as meat, cheese, most yogurts, eggs, peanut butter, milk, rice, potatoes, corn tortillas and corn chips. This helps avoid depending too much on gluten-free products, which can be pricey.

Recipes for Great Birthdays

The good news, though, is that when you do need a gluten-free product—like a birthday cake mix—it’s easier than ever to find one. Betty Crocker, for example, now offers a line of gluten-free baking mixes that are available at many major grocery stores (www.bettycrocker.com/products/gluten-free-baking-mixes). For do-it-from-scratch types, a search on “gluten-free” at recipe websites, such as www.allrecipes.com, yields a long list of recipe choices.

When it comes to a special occasion such as a child’s birthday, it’s nice to know that a gluten-free lifestyle is no barrier to making your child’s memories happy ones.

Kids with Celiac Disease?

You’re not alone. Reaching out to others can be one of the best ways to get support and learn how to manage your child’s celiac disease. Connect with the MultiCare Pediatric Celiac Disease Support Group on Facebook at www.facebook.com/#!/SouthSoundCeliac.

Parents of every baby born at MultiCare Tacoma General Hospital are shown a 10-minute DVD, presented by the National Center on Shaken Baby Syndrome, called The Period of PURPLE Crying (see the key below). The program by the same name teaches parents about the dangers of shaking a baby and offers them coping strategies for when they’re frustrated.

The goal of early parent education is to prevent occurrences of abuse. The push for a proactive educational campaign began after six children died as a result of abuse in Pierce County in 2008.

The video features segments such as “Why shaking a baby is dangerous” and “Consequences of shaking a baby.” It also shares stories from parents whose children died as a result of being shaken.

Additionally, volunteers are donating handmade purple hats to send home with babies born at Tacoma General to help remind parents to keep their baby safe.

The information in the video is based on more than 25 years of research on infant crying and normal infant development conducted by Ronald G. Barr, MDCM, and other scientists. The Period of Purple Crying concept was developed by Dr. Barr, professor of pediatrics at the University of British Columbia in Vancouver, B.C.

To learn more about the Period of Purple Crying program, go to www.purplecrying.org.

Period of PURPLE Crying Key

Peak of crying: Your baby may cry more each week— the most at 2 months, then less at 3 to 5 months.

Unexpected: Crying can come and go, and you don’t know why.

Resists soothing: Your baby may continue to cry no matter what you try.

Pain-like face: Crying babies may look like they are in pain even when they are not.

Long-lasting: Crying can last as much as five hours a day or more.

Evening: Your baby may cry more in the late afternoon and evening.

You may have heard that type 2 diabetes is increasingly being diagnosed in young people in America. But is your child at risk for diabetes?

Take the time to ask some difficult questions about your child’s health habits: Does your child eat a healthy diet? Is he or she active enough? Is he or she overweight?

“Parents need to pay attention to the habits their children are learning and make sure they are healthy habits,” says Barbara Marshall, MD, pediatric endocrinologist at the MultiCare Mary Bridge Pediatric Endocrine and Diabetes Clinic.

Healthy habits matter. Being overweight and inactive are risk factors for developing type 2 diabetes. family history and ethnicity also play a role for some children. If you do see risk factors, take heart.

“The positive thing we are learning about type 2 diabetes in young people is that lifestyle changes can make a difference,” Dr. Marshall says.

Healthy eating habits
“All children need to eat a healthier diet,” Dr. Marshall says. “The first thing I recommend is cutting out soda and juice because kids are drinking far too many calories a day.”

She also advises parents to:

• Serve fruits and vegetables.
• Watch portion sizes.
• Set regular eating times.
• Avoid skipping meals.
• Have meals sitting down at a table.

Exercise
Kids should get at least 60 minutes of activity a day, Dr. Marshall says. “It does not need to be formal exercise,” she says. “Playing on the playground counts.”

You can help boost activity levels by reducing TV and computer time. When kids spend more than an hour a day in front of the screen, their risk for diabetes increases.

To help keep kids active, you can:

• Assign active chores.
• Have kids walk or ride their bikes to school.
• Find a physical activity the whole family enjoys.

Working together
Healthy habits can also help keep weight at a healthy level, which is crucial for diabetes prevention.

“Weight loss decreases your risk of diabetes, but studies have shown that for young people who are heavy, even weight maintenance reduces risk,” Dr. Marshall says.

Families have an important role to play. “Lifestyle changes have to be family changes,” Dr. Marshall says. “Success comes when the family works together to have a positive impact on their health.”

Diabetes Care at Mary Bridge
Type 2 diabetes is increasingly being diagnosed in young people, but type 1 diabetes still accounts for many cases of diabetes among children.

The good news is that management strategies can help children with type 1 diabetes live healthy lives. The care team at the Mary Bridge Pediatric Endocrine and Diabetes Clinic are specially trained to provide the education and support you need to manage the disease.

The Clinic offers individual education with a nurse-certified diabetes educator and a support group in a child- and family-friendly environment. For more information, visit our Mary Bridge Diabetes Education Program online or call 253.792.6630.

But some anxiety about menopause may come from the many myths and misconceptions about this time of life. The antidote? Information. So we asked two MultiCare experts—Laura Sporl, MD, and Moritz Bartels, MD—to share some of the menopause misconceptions they hear from women. 

Myth: Menopause means a woman is old.
“The average age of menopause is 51,” says Dr. Bartels, an obstetrician/gynecologist at the Women’s Health and Wellness Center at MultiCare Gig Harbor Medical Park. “Given the current life expectancy—it’s around 80 years—women still live a large portion of their lives after menopause.”

 Myth: Libido changes at menopause.
At midlife, women may be stressed from jobs, raising teenagers and helping elderly relatives. It’s the demands of everyday life that are often at the root of sexual problems, says Dr. Sporl, an obstetrician/gynecologist at the MultiCare Women’s Center, Northshore Clinic.

But hormonal changes at menopause can cause physical changes that can affect your sex life. A good, honest, open discussion with your doctor can reveal some solutions, such as using lubricants for vaginal dryness or hormones to help with night sweats, according to Dr. Sporl.

Myth: Since menopause is natural and normal, no extra precautions are needed.
“Menopause is a normal occurrence and should be considered as such,” Dr. Bartels says. “However, osteoporosis and other conditions are more likely to happen during or after menopause.” 

 Although these health concerns exist, talking to their health care providers can help women protect themselves during these years.

Myth: Hormone therapy (HT) is bad.
“Yes and no,” Dr. Bartels says. “HT is associated with a minimally increased risk of stroke and breast cancer; however, the study that describes this has some fl aws. Generally HT is still suggested for hot flashes, night sweats, vaginal dryness and prevention of osteoporosis—as long as women use the lowest dose for the shortest period of time.”

Myth: Menopause causes weight gain.
Wrong, says Dr. Bartels. “Diet and lack of exercise are the main reasons for weight gain and obesity.” 

Menopause is a good time to recalibrate your diet, Dr. Sporl says. Metabolism starts to slow as we age. “We just can’t continue to eat like we’re 20-year-olds,” she says. Also, some nutritional needs change. For example, women need 1,000 milligrams of calcium a day before menopause and 1,500 milligrams a day after menopause, according to the National Women’s Health Information Center.

Take the menopause pause
In fact, because menopause is a time of change, it’s also a good time to re-evaluate many things in life, Dr. Sporl says. “Start an exercise program. Work on stress. Get enough sleep. Work on relationships,” she advises. “Examine your life, adjust what you need to and embrace what’s ahead.”

Learn how to manage your hot flashes by visiting multicare.org/hotflash.

“They each want to know how this diagnosis will change their life,” says Ronald J. Graf, MD, FAACE, an endocrinologist with MultiCare Endocrinology Specialists – Tacoma. That leads to questions—about diet, medications, the risk for complications and more. 

These questions are often most fully addressed in diabetes education classes. But a few frequently asked questions are briefly answered here. 

Will I have to give up sweets?
A healthful diet is crucial. It’s low in saturated fats and trans fats. And it contains balanced portions of proteins and carbohydrates, including sugars. 

“It’s the carbohydrates that have the major effect on one’s blood sugar level, but even simple sugars and sweets are allowed in limited amounts,” Dr. Graf says.

Why is exercise important?
Exercise can lower blood sugar levels and help with insulin resistance, which occurs with type 2 diabetes—the type often related to obesity. Insulin resistance means the body has a hard time using the insulin it makes. 

“Exercise can overcome much of that insulin resistance, as well as burn some of the calories we consume in our diet and store in our fat,” Dr. Graf says. That can lead to weight loss, which in turn may lead to less insulin resistance. It may also improve high blood pressure and abnormal cholesterol levels, which often occur in people with diabetes.

 Will I need to take medication?
People with type 1 diabetes must take insulin. People with type 2 diabetes often can control their disease with proper diet and exercise. With time, though, they may need one or more medications.

“Frequently, even those with type 2 diabetes will eventually require insulin treatment to help control elevated blood glucose levels,” Dr. Graf says.

 Will I be able to avoid diabetes complications?
Most people who follow their health care team’s advice can have relatively healthy lives. Says Dr. Graf: “Living with diabetes usually means making some lifestyle changes and some sacrifices. But these changes are usually for the better and can lead to a healthier and longer life.”

MultiCare offers support to people with diabetes
MultiCare’s Chronic Disease Management Program is currently focused on working with patients who are managing diabetes. We offer a number of support services as part of their ongoing care, including:

• Phone calls to patients to schedule follow-up appointments
• Completing lab work and other tests before appointments so patients get results sooner
• Group visits that offer patients the chance to interact with others managing diabetes
• Free “Living Well With Chronic Conditions” workshops

For more information about MultiCare’s Chronic Disease Management Program, call 253.792.6710. For more information about diabetes care services at MultiCare, visit multicare.org/diabetes-care.