Eating for 2

The scale can be a daunting instrument. Sometimes, it tells you what you like to hear. Other times, it doesn’t. For expectant mothers, it gets even more complicated.

Weight gain during pregnancy is good, but too much can be unhealthy. The recommended amount of weight gain during pregnancy is 25 to 35 pounds, says David Amsbury, DO, an obstetrician/gynecologist with Trinity Health.

However, birth data from the 2015 National Vital Statistics System says that 48 percent of women are above the recommended levels of gestational weight gain. (Additionally, 21 percent were below the recommended levels.)

“Obesity and pregnancy don’t mesh very well,” Amsbury says. But while it doesn’t go together, it is very common.

In fact, a recent[JCF1]  study in the British Medical Journal states that a child’s risk of major congenital malformations during the first year of life increases with a mother’s weight, from 5 percent higher in women who are overweight to 37 percent in women with the most severe obesity.

Body Mass Index, a formula calculating the amount of body fat a person has based on their height and weight, defines someone with a BMI of 25 to 30 as being overweight; 30 or higher is obese.

Obesity during pregnancy is associated with an increased risk of issues such as:

  • GESTATIONAL DIABETES: Diabetes that develops during pregnancy, which can affect your health or cause complications such as early birth or excessive birth weight.
  • PREECLAMPSIA: Characterized by high blood pressure and signs of damage to another organ system, often the kidneys and liver; potentially life-threatening.
  • INCREASED RISK OF INFECTIONS in the urinary tract and postpartum
  • OVERDUE PREGNANCY: Pregnancy beyond the expected due date.
  • LABOR PROBLEMS
  • C-SECTIONS: Increased change of cesarean sections as well as C-section complications, such as wound infections.
  • PREGNANCY LOSS: increased risk of miscarriage during the first term of pregnancy.

An infant born to an obese mother can also be affected. According to Amsbury, the child can suffer neural tube defects, including spina bifida, when the spine doesn’t form properly around the spinal cord, and anencephaly, when the baby is born without parts of the brain or skull.

Amsbury discourages dieting or vigorously watching your weight if you are pregnant. Portion control is not a good idea, he says, because an increase in calories is needed for the baby. While it is important to monitor weight during pregnancy, baing militant about diet is not a good thing.

“You shouldn’t eat less when you’re pregnant,”. Amsbury advises. “If you are hungry, you need to eat.”

 “There is the cliché: ‘You are what you eat,’”Amsbury says. “What you eat is what you are feeding the child.” This is especially true during the first 13 weeks of pregnancy, when the diet contributes to the development of the fetus. Development can be disrupted if there is a deficiency in the diet.

Another recommendation for a healthy weight is exercise. If you exercised before becoming pregnant, good – keep it up, Amsbury says. If you didn’t exercise before, pregnancy is not the time to start a rigorous program (like CrossFit), he says. It is best to try exercise, but nothing that is high intensity. Think walks and prenatal yoga.

Not yet pregnant, but thinking about it? If you’re overweight, it’s a good idea to drop a few pounds before you get pregnant, and work some exercise into your routine, Amsbury says. You want to be in the best shape possible once you conceive.

Trinity Health’s team of obstetricians/gynecologists is on hand to help care for women and their children during pregnancy, and during and after childbirth. David Amsbury, DO, Heather Bedell MD, Tim Bedell, MD, and Jennifer Johnson, MD, have offices at Health Center-Medical Arts and can be reached at 857-7397. David Billings, MD, Jessie Fauntleroy, MD, Margaret Nordell, MD, and Carol Schaffner, MD, have offices at Health Center-Town & Country and can be reached at 857-7394.


Say Goodbye to Floaters

About seven years ago, Jane Urbatsch of Williston first noticed something in her line of vision.  It would float to the top of her line of vision, and then to the bottom; eventually, it stopped floating back and forth and remained right in the middle of her vision. “It was a big worm,” she said, noting that it was opaque, dense, and you couldn’t see through it.

What Urbatsch saw is more commonly known as a “floater,” a deposit of vitreous humour – the clear gel that fills the space between the lens and the retina – that floats (hence its name) in a person’s field of vision.

While it didn’t cause Urbatsch any pain, it was certainly a serious inconvenience. Urbatsch loves to read (period westerns are her favorite), so when the floater remained centrally static, it prevented her from reading, or pretty much doing anything. “It was blinding me,” she said.

The floater was only in her right eye, so to do things (like reading), she would close her right eye and focus with her left. However, coupled with glaucoma and astigmatism, focusing with just her left eye began to put a strain on her “poor left eye.”

Floaters are “consolidations of the vitreous that occur with age,” explained Mark Raymond, MD, an ophthalmologist with Trinity Regional Eyecare – Western Dakota. As a person ages, he said, the vitreous separates from the retina and forms into clumps, which are perceived in the vision as a floater.

Having floaters is a part of the natural aging process, Raymond said. “We all go through it sooner or later.” The National Eye Institute stated on its website that floaters “are more common in people who are very nearsighted, have diabetes, or who have had a cataract operation.” However, trauma, inflammation, or bleeding of the eye can cause premature floaters, Raymond added.

The solution for floaters, which is now available at Trinity Regional Eyecare –Western Dakota, is YAG laser vitreolysis, which breaks up the floaters in a ten-minute, in-office procedure. Recently, TRE – Western Dakota upgraded its technology to include YAG laser vitreolysis.

The procedure is similar to a standard eye exam: a patient would sit in the chair while the doctor looks in the eye with a slit lamp, a biomicroscope. Prominent floaters are identified and obliterated with the laser.

“You feel nothing,” Urbatsch said, of the surgery. “It was amazing.”

As Dr. Raymond noted, the surgery is not painful and requires no significant aftercare. The evening after her surgery, “it was just totally awesome” that she was able to have her vision restored in her right eye. She didn’t waste any time enjoying her new sight: she went online and ordered more books to read.

“I would recommend the surgery,” Urbatsch said. “I tell everybody about it.”

Trinity Regional Eyecare – Western Dakota acquired the technology in September and since then, Raymond has performed the procedure on three patients.

“I love it,” Dr. Raymond said. “You can’t have happier patients than Jane.”

Over the next month, Urbatsch had additional surgeries – also performed by Dr. Raymond – for her cataracts. “I can see again. It was so nice,” she said. “Why live with this if you don’t have to?”

A doctor’s referral is not needed for the procedure. To schedule an appointment, call Dr. Raymond’s office at (800) 735-4926 or 572-7641. Trinity Regional Eyecare –Western Dakota is located at Trinity Community Clinic –Western Dakota, 1321 West Dakota Parkway, Williston.

Cervical Cancer can be Prevented

Cervical cancer concept

Cancer of the cervix, the lower part of the uterus (womb), is the second-most common cause of female-specific cancer – breast cancer is the most common – and it can be detected through recommended screenings.

The American Cancer Society estimates that in 2017, about 12,820 new cases of invasive cervical cancer would be diagnosed and about 4,210 women would die from it.

Cervical cancer is also preventable. Like mammograms and self-breast exams with breast cancer, David Amsbury, DO, an OB/GYN with Trinity Health, said that staying up to date with Pap smears and following recommended guidelines is integral to prevent cervical cancer.

“Cervical cancer is something that no woman should have to die from,” Dr. Amsbury said.

Early vaccination, along with regular Pap smears and HPV testing when recommended, is now the best way to prevent cervical cancer, the Foundation for Women’s Cancer said.

The Papanicolaou test, known more commonly as a Pap smear, is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix. The Foundation for Women’s Cancer states that since its inception in the 1940s, the Pap smear has reduced deaths from cervical cancer by more than 70 percent. “It is hoped with wide-spread vaccination and improved screening strategies, fewer and fewer women will be affected by cervical cancer and pre-cancers in the future,” the organization stated on its website.” It added that cervical cancer was once one of the most common causes of cancer death for American women.

Since 2012, the American Cancer Society recommends that cervical cancer screenings, such as Pap smears, should first be performed at the age of 21. The previous guideline was 18 years of age, but, as Margaret Nordell, MD, an OB/GYN with Trinity Health, stated, young women who were still going through the maturation process would be tested and given false positives, leading to unnecessary surgeries.

After the first Pap smear, women are encouraged to get one every three years between the ages of 21 to 29, unless recommended otherwise. From the ages of 30 to 65, the testing would be done every three years or every five years if combined with HPV testing. From the age of 65, recommendations suggest against screening for those women who are not at a high risk for cervical cancer.

“High risk, in general, refers to people who have had a history of abnormal Pap smears or multiple sex partners, as that is how you get exposed to HPV. Those are your two high risk groups,” Dr, Amsbury said.

“If you get the HPV vaccine at a younger age, theoretically, you are protecting yourself from cervical cancer later in life,” Dr. Amsbury said. “You are now vaccinated against those high risk strains of HPV.”

The vaccine is called Gardasil, a routine HPV vaccination for all 11-12-year old girls. Gardisil is recommended by the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices, and the North Dakota Department of Health.

Catch-up vaccination is also recommended for females ages 13 to 18, and for adults 19 to  26 who were not previously vaccinated. Amsbury recommends that, if you are a younger person, the Gardasil vaccine should be discussed with a physician.

According to the CDC, risk factors for cervical cancer include smoking, having HIV or another condition that makes it hard for your body to fight off health problems, using birth control pills for a long time (five or more years), having given birth to three or more children, or having several sexual partners.

“HPV virus causes the most of these cervical problems,” said Dr. Nordell. It wasn’t until the 1980s that HPV was identified in cervical cancer tissue, implicating it in virtually all cervical cancers. “We don’t know how the HPV virus is out there, but the way to take care of cervical cancer is to get a Pap smear and treat it accordingly.”

As cervical cancer progresses, symptoms can include vaginal bleeding after intercourse, between periods, or after menopause; watery, bloody vaginal discharge; and pelvic pain or painful intercourse.

Depending on its stage, treatment for cervical cancer can vary.

Trinity Health’s obstetrics and gynecological providers deal with the surgical care of women and their children during pregnancy, childbirth, and the postnatal period. For more information, visit: http://trinityhealth.org/gynecology.

Trinity Health’s staff of OB/GYNs are available to help with all of your gynecological needs.

David Amsbury, DO, is based at Health Center – Medical Arts, and can be reached at 857-7385.

Heather Bedell, MD, Tim Bedell, MD, and Jennifer Johnson, MD, are based at Health Center – Medical Arts, and can be reached at 857-7397.

Lori Dockter, PA-C, is based at Health Center – Medical Arts, and can be reached at 857-5050.

David Billings, MD, is based at Health Center – Town & Country, and can be reached at 857-7394.

Jessie Fauntleroy, MD, Margaret Nordell, MD, and Carol Schaffner, MD, are based at Health Center – Town & Country, Suite 102, and can be reached at 857-5703.

Increased Flu Activity Underscores Need to Get Vaccinated

What’s been described as an “active flu season” now appears to be hitting home for residents of Minot and Ward County.  The North Dakota Health Department has been reporting higher than normal influenza activity this season, primarily in the southern part of the state.   But recent days are seeing a higher number of flu cases in Ward County.

Casmiar Nwaigwe, MD, Infectious Disease specialist with Trinity Health, says there’s been an uptick in the number of people hospitalized with the flu.  He says the rise in activity highlights the need to get a flu shot and to use common sense precautions, such as handwashing. 

“The thing to keep in mind is that we’re not that far into the 2017-2018 flu season,” Dr. Nwaigwe noted.  “In most years the peak doesn’t come until February or even March, so there’s ample reason to get a flu shot to protect yourself and the people around you.”

Dr. Nwaigwe says news reports claiming this season’s flu vaccine is only 10 percent effective are misleading.  He says the Centers for Disease Control and Prevention studies the ongoing effectiveness of the vaccine, and at this point in the season the vaccine’s effectiveness appears to be in the mid-30s, which isn’t much lower than the overall effectiveness last season.

“Even if it’s lower than that, it’s still worth it,” Dr. Nwaigwe said.  “If you end up getting the flu you’ll do better if you’ve had a flu shot.  Vaccinated people tend to be less sick, and are less likely to have severe outcomes because of their illness.”

State health officials report that influenza activity is now widespread throughout North Dakota.  Case counts increased again this past week, and other influenza indicators are above their seasonal baselines, according to the department’s most recent surveillance report.  “We do not know how long it will take to reach our seasonal peak, but cases will most likely continue to increase for several weeks at least,” the report states.

The North Dakota State Health Department and the CDC recommend that everyone six months and older should receive a flu shot regardless of age or health status.

Trinity Health Bond Offering a Success

Trinity Health officials say a recent pricing and bond sale of more than $350 million tax-exempt revenue bonds (2017C Bonds) has ended with unqualified success.  The bonds were fully subscribed within one hour of being made available to retail and institutional investors. 

At the conclusion of the order period there was significant oversubscription well in excess of the amount offered and indicative of investor sentiment towards the creditworthiness of Trinity Health.  As a result of the significant investor demand for the bonds, Trinity Health was able to secure long-term all-in true interest cost (TIC) of 4.446 percent. 

The proceeds of the 2017C Bonds are being utilized to fulfill multiple Trinity Health objectives, including funding capital investments into signature projects such as a new healthcare campus and medical district in southwest Minot. 

“Achieving an appropriate level of permanence to the capital structure of Trinity Health is vital to its financial stability and ability to fulfill its mission,” stated Trinity’s Chairman of the Board, Patrick Holien. “The overwhelming interest the market has shown in this offering is a recognition of the strength of Trinity Health, the critical role it plays in our community, and the level of confidence the market has in our management team and board.”

According to John M. Kutch, Trinity Health’s President and Chief Executive Officer, this development points to a positive prognosis for the future of Trinity Health.  “The bond sale is a significant milestone in our turnaround and transformation,” Kutch noted, adding, “This excellent pricing and sale result is the culmination of several months of careful planning and strategic decision making and is another step in ensuring the financial stability of Trinity Health for the foreseeable future.” 

Slated to begin in 2018, the new hospital campus and medical district will be built in southwest Minot and will include a state-of-the-art digital, patient-centered hospital and outpatient center that provides easy access to a wide variety of comprehensive services.  According to Mr. Kutch, this investment will transform healthcare delivery in the region. “This initiative is not only about improving the future of healthcare in our region,” Kutch emphasized, “it is about investing in the future of the northwest region of North Dakota.”

Personal Training for the New Year

It’s that time of year again. With the beginning of the upcoming new year come the resolutions: a new year and a new you.

That is usually accompanied by promises of changing your habits for the better. It could be eating right, doing less of something you enjoy (that you know isn’t exactly good for you), or maybe taking more exercise into your life.

For the latter, why not make good on those promises and work on improving your fitness?

This can be easier said than done for many people. Exercise can be intimidating to a novice, leading some people to second guessing: What do I do? How should I do it? Am I doing it right? Many may think there are a thousand pairs of judgmental eyes watching them at the gym, waiting for the slightest slip-up. While that isn’t usually the case, there may be some impediments to reaching this healthy step.

Trinity Health’s Exercise Physiology Department, based at the Minot Family YMCA, can help. (Personal training services at the Y are available to members and non-members for an extra fee; it is not included with a Y membership.) With a staff of seven, including three whose primary focus is personal training, there is sure to be someone in Exercise Physiology that can help with your fitness goals.

Personal training is the opportunity to help those get the start they need, explained Nicole Myers, BS, ISSA-FT, CF-L1, a personal trainer with the department. “A lot of times, people aren’t really sure where to start, what to do, or if they are exercising right,” Myers said, adding that personal training is a great way for people to get started and feel comfortable with what they are doing, with the one-on-one attention they need.

The process begins once an individual visits with a personal trainer for a free initial consultation, where the client describes what they want to achieve.

Are all personal training sessions the same? Absolutely not, Myers said. Following the consultation, a personal trainer creates an individualized plan tailored to the client’s goals; those goals can vary, depending on the individual client. “I have clients coming to me wanting something different than their regular routine,” she said. “They want something new; they want something different.”

While not all sessions are the same, personal training tends to lead to the same goal: losing weight. “They want to get toned, they want to feel better,” Myers said. For about 95 percent of them, “they want to lose weight but don’t know where to start.”

With light, steady breaths, Karen Walz lifts 45 pounds on the bench press before moving on to kettlebell exercises. “Keep the abs nice and solid,” advised Tanya Gillen, CPT, a personal trainer with Trinity Health’s Exercise Physiology, as Walz lifted 15-pound kettlebells. Walz almost loses her balance, but Tanya steadies her. “Two more.”

As Walz exercises, Gillen nods with silent approval. Walz began personal training with Gillen in January 2017, hoping to get back some strength.

“I was out of shape,” said Walz, of Minot, adding that she wanted to get back to working out with weights. And with health issues — lumbar fusion surgery, Type 2 diabetes, and an aneurysm — she wanted to make sure she didn’t do anything to exacerbate those problems. She said she wanted to work with a professional “to make sure she didn’t do the wrong things.”

After retiring three years ago, Walz would go to the Minot Family YMCA to work out often — about three to five times a week — and had lost 30 pounds and maintained her A1C below 6.0. But in 2016, when new health problems surfaced, her workout routine waned. “When I found out about the aneurysm, I kind of babied myself,” she said. The pounds came back and her A1C went up.

Now, she wants to get back to a regular training routine. “I know the stronger I get, the fewer issues I will have with my back,” Walz said. “And regular exercise will help me control my blood sugar levels.”

Personal trainers are willing to help with anything, Myers said, noting that they all possess different scopes of practice and knowledge — something that personal training clients should take advantage of.

Since Walz began personal training with Gillen, she has indeed gained the strength she hoped to recoup. In fact, Gillen noted that Walz is her fastest progressing client, even though she sees her once a week.

“I try to get here between sessions,” Walz said. She admitted that she needs to be more responsible when it comes to exercising. Having Gillen as a personal trainer helps keep her accountable, Walz said. “It’s harder to procrastinate when you have someone to answer to.”

The length and frequency of personal training sessions also varies: some participate for a half hour, others for 45 minutes. Some come for two days a week and others for three. “I fit it into their schedule because they have other things going on,” Myers said, noting that a lot of her clients are high school students involved in school sports. “I balance their training at school with my training.”

Myers noted that some clients see her for a total of 12 weeks — long enough for them to get started and more comfortable. “A lot of times, I think it turns into a routine, and once they start, they see us for something new and something different, to keep it interesting.”

As for Walz, who has been seeing Gillen for a year, she said she doesn’t “see an end in sight” to personal training. “There’s always more that I can learn with Tanya,” she added.

Personal training is offered through the Trinity Health Exercise Physiology Department at the Minot Family YMCA. To set up an appointment for a free consultation, please call 857-2950.

Tanya Gillen, CPT, a personal trainer with Trinity Health’s exercise physiology department, assists Karen Walz, left, during a workout.

 Tanya Gillen, CPT, a personal trainer with Trinity Health’s exercise physiology department, assists Karen Walz, left, during a workout.

 

Snow Blower Safety

Snowblower on Driveway Winter Snow Horizontal

As winter approaches, serious snowfall can’t be too far away. That means an increase in emergency rooms visits for snow-blower-related injuries. According to the American Society for Surgery of the Hand, the most common of these injuries is amputation of the tips of the fingers. The best outcome is to avoid the injury all together.

Snow-blowing injuries are more likely to occur when snow is heavy, wet, or has accumulated several inches. The snow clogs the exit chute or blades and the person using the machine tries to clear the clog using her/his hand. The following safety tips are designed to keep you safe and intact throughout the upcoming winter months.

How to keep your snow blower from clogging:

• Work at a brisk pace. The faster the blades and the pace, the less likely snow will stick.

• If heavy, wet snow is anticipated, consider snow blowing several times during the snowfall.

• A spray-on lubricant – cooking spray or oil – applied to the blades may prevent clogs.

If your snow blower clogs:

• Turn it off!

• Disengage the clutch

• Wait 10 seconds after shutting the machine off to allow the impeller blades to stop rotating.

• ALWAYS use the provided tool or a stick to clear impacted snow.

• NEVER put your hand down the chute or around the blades.

• Keep all shields in place. DO NOT REMOVE the safety devices on the machine.

• Keep your hands and feet away from all moving parts.

Remember:

• Stay focused while blowing snow.

• Wear boots with traction to avoid slipping.

• Do not drink alcohol or use narcotics before using your snow blower.

Accutane Can Help You Say Goodbye to Acne

Ryan Siewert, MD

Ryan Siewert, MD

 

Globally, acne affects 650 million people, or about 9.4 percent of the global population.

Now, those who suffer from acne now have an easier way to be treated, without stepping foot in a dermatologist’s office. Ryan Siewert, MD, a family medicine physician at Trinity Community Clinic-Western Dakota, can prescribe Isotretinoin, also known as Accutane, to help with acne.

Accutane is a daily pill which is normally taken for four to six months.

“When you’re done with the treatment course, your acne improves to the point where you don’t need to be on anything any longer,” he says, noting that by the course’s end, your “acne will ideally be where you want it to be.”

Acne vulgaris, or more commonly known (and feared by teenagers everywhere) as acne, is caused when hair follicles are clogged with dead skin cells and oil from the skin. Genes, hormones, infections, diet, smoking, and stress have all been said to be contributing factors for acne.

Siewert says that through this prescription, patients would not need to travel far to see a dermatologist, thus allowing patients with acne issues to be treated sooner.

“Accutane is one of the most effective, if not the most effective, for acne treatment,” Siewert adds.

To make an appointment with Dr. Siewert, please call the Trinity Community Clinic – Western Dakota, at (701) 572-7711. Trinity Community Clinic – Western Dakota is located at 1321 West Dakota Parkway, in Williston.

Trinity Health Launches Fixed Wing Service in Williston

An extension of the Minot-based NorthStar Criticair helicopter and airplane service has launched in Williston. The NorthStar Criticair Fixed Wing Williston will join the NorthStar Criticair airplane service, pictured here.

An extension of the Minot-based NorthStar Criticair helicopter and airplane service has launched in Williston. The NorthStar Criticair Fixed Wing Williston will join the NorthStar Criticair airplane service, pictured here.

A new air ambulance gets off the ground today in Williston.  Trinity Health has launched a regional fixed wing emergency transport service out of Williston that will be an extension of its Minot-based NorthStar Criticair helicopter and airplane services.  The Williston service is up and running as of today, December 13.    

Lorrie Antos, Director of Critical Care Services, says the new transport is called NorthStar Criticair Fixed Wing Williston and is available 24-hours-a-day, seven-days-a-week, to provide medical transport for patients from Williston and surrounding communities. 

“We’re excited to provide this extension of our NorthStar Criticair service,” she said.  “There’s been a need for reliable air transport out of Williston.  We feel very fortunate and privileged to be part of Williston’s medical community, and we’re committed to doing all we can to give the very best care to patients.”   

Each NorthStar Fixed Wing Williston mission will be staffed by a dedicated flight crew consisting of a pilot, paramedic and critical care nurse, who will be on call 24/7.  “We’ll fly to any receiving facility,” said Antos, “typically it would be a specialized facility outside of the region.”

The aircraft is equipped to fly pediatric and adult missions, including high-risk labor/delivery patients.  “Our critical care helicopter out of Minot will continue to provide transport for neonatal missions,” Antos added, “and the helicopter will serve the region as it has since 1992 with critical care transport and rescue.”

As is the case with its Minot-based rotor and fixed wing services, Trinity Health is collaborating with Executive Air Taxi Corp. to provide aircraft, pilots, and maintenance expertise.  The aircraft, a King Air 90, is equipped with state-of-the-art instrumentation to ensure that clinical teams can provide exceptional care for patients.  In addition, the cabin is large enough to accommodate a patient’s family member, if appropriate for the situation.

The Williston service is the first geographic expansion of NorthStar Criticair, which was established by Trinity Health in 1992 as a critical care helicopter and was expanded in 2015 to include fixed wing capability.   Mark Chilson, NorthStar’s lead paramedic, will oversee the Williston service, which will be dispatched by Trinity’s Direct and Dispatch communication center in Minot.

Winter Safety to Remember

It’s December. If winter weather isn’t already here, it will be soon.

With the cheerful holiday atmosphere and placidity of freshly fallen snow, this time of year can also bring accidents and other incidents that could be harmful to a person’s health.

Walking

Taking that first step outdoors can be a hazard if the weather conditions are slippery.

During the winter months, one of the most common causes of injury is related to falling after slipping on ice or snow, explained Laurie Ramsey, RN, BSN, lead trauma registrar and injury prevention coordinator with Trinity Health.

“Some injuries may be minimal and only result in a simple bump or bruise, but very serious injuries do occur,” Ramsey said, noting that from January to March 2017, over 80 percent of patients with snow- or ice-related falls seen at Trinity Health’s emergency department resulted in a broken bone or fracture.

As odd as it sounds, it helps to walk like a duck:

• Keep your feet flat and slightly spread apart.

• Point your toes slightly outward.

• Take slow, short steps. Keep your center of balance under you.

• Make wide turns at corners.

• Keep your arms at your sides. This gives additional balance and keeps your arms available for support if you fall.

It also helps to wear proper footwear in ice and snow conditions.

Driving

In snowy or icy conditions, more “fender bender” types of collisions occur, simply from the inability to stop in time.

Although the injuries from fender benders tend to be less severe in nature, many do require medical attention, Ramsey said. Additionally, if you experience car trouble during travel, having a winter kit accessible could reduce the severity of weather-related injuries, like hypothermia and frostbite.

Here are some tips to help drivers in the snow:

• Check the weather before you go. If there is a storm approaching, try to wait to travel.

• If you do travel and become stranded, DO NOT leave your car. Light flares outside your car and ensure the exhaust pipe is not blocked by snow to prevent carbon monoxide poisoning.

• Prepare your car for winter by checking your tires, brakes, battery, antifreeze levels, fuel, and all wires and hoses, to be sure everything is in proper working order.

• DO NOT use cruise control in wintery conditions.

• Accelerate and decelerate slowly.

• Keep your gas tank at least half full.

• Increase following distance as it may take longer to stop.

• Know if you have anti-lock brakes as that system will “pump” the brakes for you.

• Keep a winter kit in your vehicle at all times. This should include items like a shovel, jumper cables, tow strap, bag of salt or kitty litter (non-clumping style), flashlight and batteries, matches, ice scraper, and first aid kit; nonperishable, high-energy foods such as unsalted canned nuts, dried fruits, and hard candy; and blankets, mittens and socks.

Carbon Monoxide

Carbon monoxide (CO) is a colorless, odorless gas that interferes with the delivery of oxygen in the blood to the rest of the body. It is produced by the incomplete combustion of fuels, which can be emitted by heaters, furnaces, wood stoves, gas stoves, or auto exhaust.

Problems occur when those things are not installed properly or there is inadequate ventilation. Health effects include fatigue, headache, weakness, dizziness, confusion, and even death. To prevent carbon monoxide poisoning, chimneys, fireplaces and other areas should be cleaned and inspected by a certified technician. Do not use ovens or gas ranges to heat your home. Do not leave your car running in an enclosed space, such as a garage. Have a carbon monoxide alarm in your house, and if it alarms, check for poisoning symptoms and clear out immediately if someone is experiencing symptoms. If not, thoroughly ventilate your home. If you or someone is experiencing symptoms, get to fresh air immediately. Open doors and windows, turn off combustion appliances, and leave the house. Go to an emergency room and be sure to tell them you suspect carbon monoxide poisoning.

Snow

The thought of moving hundreds of pounds of snow is not only emotionally straining, but it can put a big strain on your heart and body. The cold is also a factor, as it can increase your heart rate and blood pressure. The cold can also make blood clot more easily and constrict arteries, which can decrease blood supply. Pushing heavy snow or a snow blower can also cause strain to the back and other areas of the body. Here are some safety tips that can help to ease that strain:

• Do not shovel after eating or while smoking.

• Take it slow and stretch out before you begin.

• Shovel only the fresh powdery snow, as it is lighter.

• Push snow rather than lifting it.

• If you do have to lift it, use a small shovel and only partially fill the shovel to prevent injury.

• Lift with your legs, not your back.

• Do not work to the point of exhaustion.

• If you have heart disease, make sure to talk to your doctor about shoveling.

• Stop shoveling immediately if you have chest tightness, dizziness, or chest pain.

If you are using a snow blower, please remember to follow these guidelines for safety:

• If the blower jams, turn it off prior to trying to reach in and unjam it.

• Keep hands away from all moving parts.

• Refuel the snow blower only when it is off.

• Do not drink alcohol and use the snow blower.

• Be aware of the carbon monoxide risk of running a snow blower in an enclosed space.

Frostbite

When you are enjoying the winter weather, it is easy to forget about frostbite.

The wind chill – or the “real feel” temperature – plays a large role, Ramsey said. “The colder the ‘real feel’ temperature, the faster frostbite can occur. When temperatures drop below 0 degrees Fahrenheit, it is possible for frostbite to occur within five minutes to exposed skin. It is best to be prepared. Cover exposed skin with winter gear, even when you’re not expecting to be outside long, such as when walking to the mailbox or across a parking lot. A fall on the ice could prevent your ability to get back indoors quickly.”

Remember that even covered skin can get frostbite. It is the most common injury resulting from exposure to severe cold and usually occurs in fingers, toes, nose, ears, cheeks and chin. If caught early, it is possible to prevent damage, but if not, frostbite can lead to amputation.

Superficial frostbite affects the skin surface, while the underlying tissue remains soft. The skin will appear white, waxy or grayish-yellow and is cold and numb. As it progresses to the underlying tissue, the skin may become completely numb, and blisters may form. Eventually, the skin tissue will die and turn black.

If you suspect frostbite, you should move indoors immediately. Remove constrictive clothing and jewelry that could impair circulation. You should also seek medical attention immediately.