Battle plan

Fighting our Top 10 causes of death

Christopher Blake, of Operation Fight for a Fitter Fort, photography by Neal Bruns
Marsha Haffner, MA, Director of Clinical Services for Cancer Services of Northeast Indiana, photography by Neal Bruns
Amy Wills, RN, BSN, Stroke Program Coordinator for Lutheran Hospital, photography by Neal Bruns
Britney Schwartz, RN, BSN, Trauma Prevention Specialist, is in charge of Parkview's Safety Store and prevention campaigns, photography by Neal Bruns
Wendy Spitznagel, director of Health Initiatives for YMCA of Greater Fort Wayne, photography by Neal Bruns

When it comes to the top 10 causes of death in Indiana, we Hoosiers aren’t much different from the rest of the nation. And like many other areas, it turns out there are plenty of people in Northeast Indiana working to help people who’ve been diagnosed with these causes of death. Fighting premature deaths and easing the suffering of those with terminal illnesses is the guiding force for these groups, and the region is lucky to have such dedicated people.

One factor links many of the top 10 causes of death: obesity. It contributes to heart disease, cancer, Alzheimer’s disease, diabetes and kidney disease. Efforts to help Northeast Indiana residents drop pounds – and potentially lengthen their lives – are ongoing, but as obesity continues to rise, it sometimes feels like a losing (not literally) battle. Fortunately, we have groups like Operation Fight for a Fitter Fort, run by Christopher Blake and Ted Sobol and endorsed by the City of Fort Wayne. The group wants city residents to lose a total of a half-million pounds by the end of 2016.

“We have to change the path,” Blake said. “This is a war.”

Far more needs to be done.

No. 1 Heart Disease

More Hoosiers die of heart-related problems than any other cause, and for Fort Wayne residents Allison Bluth, Denise Beights and Marsha Wulpi, the diagnosis of heart disease came as a shock. Bluth was just six weeks into her new married life last summer when she began having trouble breathing. Thinking it was just a case of bronchitis, she went to a walk-in clinic to be examined. A chest X-ray showed that her heart was enlarged, and she was sent to the emergency room. One MRI later, she was admitted and spent a week in the hospital being treated for myocarditis and cardiomyopathy. She was just 26 years old.

“It makes you more aware of things happening,” she said. “I see life through a different lens.”

Wulpi described herself as sedentary, overweight and post-menopausal when she suffered a heart attack on Nov. 18, 2014. She was in “disbelief,” she said, thinking a heart attack wouldn’t happen to her. Her symptoms included her arm feeling like she’d slept on it wrong and she also had shortness of breath.

“It never occurred to me I was having a heart attack,” she said. “It doesn’t happen like in the movies.”

For Beights, concern over her mother’s sudden death of a heart attack at 49 led her to consult a cardiologist, but she was 43 when she had a heart attack on April 13, 2014. Even knowing that heart disease ran in her family, Beights still didn’t recognize the symptoms of a heart attack. She felt tired and sweaty after a workout, which isn’t unusual, but she felt bad enough to text her husband. She ended up staying five days in intensive care after three blockages were found in her heart.

“What we see in our head is a 68-year-old man clutching his chest,” Beights said. “I feel my mortality now. I just want to make every day count.”

The three women now work to educate other women about the varying symptoms of a heart attack, and they participate in heart support groups sponsored by the American Heart Association and local hospitals. They said women especially should be aware of heart disease, noting that while most women are aware of breast cancer signs, they may not realize they are far more likely to die of heart disease than breast cancer. The Northeast Indiana Heart Walk is Sept. 12 at Ivy Tech’s North Campus.

No. 2 Cancer

Cancer is the second-leading cause of death in Indiana, coming in just behind heart disease, with a total of 154,990 cases diagnosed across the state in 2012, the last year for which statistics are available, according to the Indiana Cancer Consortium. Some 63,731 people died from cancer that year, according to the Indiana State Cancer Registry. (Allen County had 8,050 diagnosed cases of cancer in 2012, with 3,121 deaths from the disease.) Lung cancer claims more Hoosiers than other types of cancer, with nearly 26,000 cases diagnosed in 2012. Breast cancer was diagnosed in 20,511 women, while prostate cancer was diagnosed in 19,770 men that year. Cancers of the colon and rectum were diagnosed in 16,739 people.

Cancer Services of Northeast Indiana aims to reduce the suffering and ease treatments for people with cancer and their caregivers. Marsha Haffner, MA, is director of clinical services for the agency, which began its work in 1944. Cancer Services helps more than 3,000 people each year, with about a third being newly diagnosed.

“We are looking to enhance quality of life by helping with practical needs,” Haffner said. The agency focuses on a “psycho-social approach of relieving people’s burdens.”

To that end, Cancer Services provides everything from wigs for chemotherapy patients to support groups for caregivers and patients and even loans out medical supplies like bed pads and walkers. Massage, meditation and transportation are also available, and nearly every service is free. The nonprofit group is supported solely by donations.

“We’re in this together here,” Haffner said. “There’s a hopefulness that life is still valid. We are empowering people to do what they still can. There really are people who are out there in your corner.”

No. 3 COPD/Chronic Lower Respiratory Disease

Chronic Obstructive Pulmonary Disease, COPD, is the most deadly of the chronic lower respiratory diseases, and is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma and some forms of bronchiectasis. If you have emphysema, some of the air sacs in your lungs are damaged, making it hard for your body to get the oxygen it needs. If you have chronic bronchitis, the lining of the lungs’ airways are red and swollen. Over time, the airways become narrow and partly clogged with mucus that cannot be cleared, according to the U.S. Department of Health and Human Services. The majority of patients with COPD got the illnesses from smoking cigarettes, according to Dr. Harish Ardeshna, chief of the medical staff of Lutheran Health Network’s Bluffton Regional Medical Center and a board-certified pulmonologist.

“A person dies every four minutes” from COPD, Ardeshna said, “and 90 percent (of cases) are caused by smoking.”

According to the Mayo Clinic, “symptoms of COPD often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and sputum production at least three months a year for two consecutive years.”

Other signs and symptoms of COPD include:
• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• Having to clear your throat first thing in the morning, due to excess mucus in your lungs
• A chronic cough that produces sputum that may be clear, white, yellow or greenish
• Blueness of the lips or fingernail beds (cyanosis)

While there is no cure for COPD, there are improved treatments that are helping people live longer, Ardeshna said. Medicare pays for outpatient pulmonary rehabilitation, which helps improve endurance so that patients can do more. Ardeshna said lifestyle changes, including stopping smoking and getting exercise, help reduce symptoms, too. He urged anyone with COPD or other lung ailments to be sure to get their flu shots every year, as influenza can be fatal for a COPD patient.

No. 4 Stroke

Strokes happen when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die, according to the Mayo Clinic. Nearly 3,000 Hoosiers died from stroke in 2013, according to the Indiana State Department of Health. In Fort Wayne, Amy Wills, RN, BSN, is the stroke program coordinator for Lutheran Hospital. She said obesity is a controllable risk factor for stroke, noting that being overweight can raise blood pressure to unhealthy levels, putting stress on blood vessels in the brain.

“Stroke is the No. 1 cause of disability in the nation and in Indiana,” she said. “Those brain cells don’t regenerate the way we’d like.”

Knowing the symptoms of a stroke is vital, because time is of the essence in treating stroke. Wills said to remember “FAST” – is the Face drooping, are their Arms numb or weak, can they Speak properly and if those factors are present, it’s Time to call 911.

There have been some advancements in treating strokes, including clot-busting drugs and new catheterization procedures, but “it’s a brain attack like a heart attack,” Wills said. Most of Indiana’s hospitals, including the hospitals owned by Parkview and Lutheran Health Network, are members of the Stroke Care Now Network, which uses telemedicine (transmitting brain images to doctors at other facilities for consultation) and other services to improve treatment.

No. 5 Accidents and Unintentional Injuries

Car crashes, falls and other unintentional incidents that injure people are the fifth-leading cause of death in Indiana, with 2,854 deaths in 2013 statewide. Lisa Hollister, RN, BSN, is the director of trauma and acute care surgery for Parkview Regional Medical Center. She oversees many of the hospital system’s prevention programs, including the ubiquitous “Don’t Text and Drive” and “Share the Road” campaigns and a fall prevention program for the region’s elderly population.

“There’s a lot of reasons people can fall,” she noted. There’s a fall risk assessment that can be done of an elderly person’s home, she said, and exercise that improves a person’s balance can also reduce the fall risk. The “fall clinic” at Parkview’s Randallia campus can help prevent future falls, with an eye to reducing hip fractures, which can be deadly.

“Preventing falls, preventing fractures – it’s complicated,” Hollister said.

Not quite so complicated, but just as important and preventable, are car crashes. “We don’t call anything an ‘accident’ anymore,” Hollister said. “It’s all 100 percent preventable. Every injury is preventable. There’s always something you could have done to prevent it.”

Thus, the Don’t Text and Drive and Share the Road campaigns. Eleven teens die every day across the nation because of distracted driving, particularly texting while driving. Drivers are 23 times more likely to have a crash if they are texting while driving, according to Parkview. The Share the Road campaigns encourage drivers to remember to make room for other types of vehicles, including bicycles and Amish buggies.

Parkview’s Randallia campus recently reopened its Safety Store, where people can purchase – at cost – bike helmets and other safety gear for bicyclists. It’s open on Tuesdays 10 a.m.-1 p.m. and 4-7 p.m.

No. 6 Alzheimer’s Disease

growing threat, Alzheimer’s disease claimed nearly 2,100 Hoosiers in 2013, according to the state health department. Alzheimer’s is a disease of the brain that causes problems with memory, thinking and behavior. There is no cure, but there are treatments that can delay its progression. Lori Stock, MSW, is a care consultant with the Greater Indiana Chapter of the Alzheimer’s Association. The Fort Wayne-based group offers disease education and support for caregivers and patients.

“We have trained support group facilitators,” Stock said. “The caregivers support each other by (sharing) strategies that have worked for them.”

Alzheimer’s disease can cause people to lose their memories and personality, and caregivers are often at a loss to know how to cope with their loved one’s changed behavior. That’s where the Alzheimer’s Association can help. By sharing stories and techniques, families bolster each other. Stock described caregivers as “heroic underdogs.” The Alzheimer’s Association fundraising and awareness walk is Oct. 3 at Parkview Field. Support groups meet monthly across the city, and the association is available for both people who are newly diagnosed and those who’ve lived with the brain-robbing disease for years. Alzheimer’s eventually kills by shutting down the brain’s ability to regulate heartbeat and breathing.

“The biggest message is don’t ignore” memory loss, which is often the first noticeable symptom, Stock said. “Go see a neurologist, and get some cognitive testing done. They’ll do a full diagnostic workup, and they’ll rule out everything else. It’s really important to never ignore those symptoms.”

No. 7 Diabetes

Diabetes is a group of diseases resulting in high levels of blood glucose (a form of sugar) due to defects in insulin production, action or both. Diabetes can lead to serious complications and is the seventh-leading cause of death in Indiana. There are two major types of diabetes. Type 1 diabetes, also known as juvenile diabetes, is surpassed by Type 2, also known as adult-onset diabetes. Type 2 mainly affects people who are overweight or obese, though slim people can also develop the disease.

A bright piece of news, however, is that the mortality rate from diabetes in Indiana is falling, thanks in part to programs like the Greater Fort Wayne YMCA’s diabetes education program and programs sponsored by both Fort Wayne-area hospital systems.

Julea Diffenderfer, RD, CDE, is the diabetes education program coordinator for Lutheran Health Network.

“We’re doing better,” Diffenderfer said. “Unfortunately we still see people with no insurance or underinsured, and that is a challenge. That’s still a major problem.”

Having no health insurance or being underinsured means that people often can’t visit a primary care physician regularly and thus aren’t screened for diseases including diabetes. Caught early, diabetes can be controlled or even eliminated through medication, diet and exercise and other lifestyle changes.

“Diabetes is every day,” she said. “All the lifestyle changes, eating healthier, being active, it’s definitely every day, all day.”

Americans’ ever-increasing waistlines and high-sugar, high-fat diets are contributing to a surge in diabetes, but proper controls have lowered the death rates, which is good, says Wendy Spitznagel, director of health initiatives for the YMCA of Greater Fort Wayne. Across the country, YMCAs have adopted guidelines from the Centers for Disease Control and Prevention into a Diabetes Prevention Program. The yearlong, group-based program consists of 16 one-hour weekly sessions, followed by monthly sessions led by a trained coach who will introduce topics in a supportive, small group environment and encourage participants as they explore how healthy eating, physical activity and behavior changes can benefit their health, according to the YMCA.

“Fort Wayne was one of 10 Y’s in 2010” to pioneer the program, Spitznagel said. “We’ve spread to over 400 (additional) Y’s.”

Diabetes kills because the buildup of blood glucose can shut down circulation, causing blindness, strokes and heart disease. Most people with diabetes also have other medical problems like heart disease and high blood pressure, and the combination is deadly.

No. 8 Kidney Disease

Kidney failure killed 1,346 Hoosiers in 2013, and – like diabetes – kidney disease often progresses silently. One in three American adults is at risk for developing kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, a family history of kidney failure, smoking, obesity and cardiovascular disease, according to the National Kidney Foundation. Kidneys filter all the blood in the body every 30 minutes, removing waste and excess fluids.

In Fort Wayne, the National Kidney Foundation’s annual Kidney Walk is held annually in June and raises funds to support research, education and lifesaving programs for people with kidney disease and to raise awareness for those who may be at risk.

No. 9 & 10 Influenza/Pneumonia and Septicemia

We’ve combined these last two causes of death because they are so interlinked: they are both caused by infections of bacteria or viruses. Influenza/pneumonia killed 1,126 Hoosiers in 2013, while septicemia (blood infections) claimed another 1,023. More than 2 million Americans are sickened by antibiotic-resistant infections each year, with 23,000 dying as a result, according to the Infectious Disease Society of America.

There’s a reason flu shots are urged so strongly each fall: Untreated influenza can quickly kill you. Most people who get the flu will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks. Some people, however, are more likely to get flu complications that result in being hospitalized and occasionally result in death. Dr. R. Scott Stienecker is medical director of epidemiology and infection prevention for Parkview Health and is a nationally recognized physician in the field.

Bacteria are not, in and of themselves, bad or good, he noted. “We are dependent on bacteria,” Stienecker said. “Without them we’d be shorter, smaller and more sickly.”

That said, when bacteria or viruses proliferate out of control, they can make people very, very sick. And growing antibiotic resistance means many of the drugs we have don’t work as well any longer. Stienecker said he’s “a little more optimistic” that new developments in the ways we treat bacterial infections will counter that growing resistance. He said the federal STAAR (Strategies to Address Antimicrobial Resistance) Act will bring more funding into the drug development system to jump-start efforts to fight the microbes that sicken so many Americans.

And new diagnostic tests can rapidly figure out whether the “bug” that’s making a person sick is a bacteria or a virus. Antibiotics don’t kill viruses, and the overuse of antibiotics has led to those very antibiotics not working effectively any longer. In prior years, blood tests could take two days to identify the type of bacteria or virus causing illness and indicate what medication could treat it. But doctors would prescribe antibiotics without knowing precisely which medication – if any – should be prescribed. Newer tests can give results within six hours and are far more precise, Stienecker said.

“We have seen significant improvement in the antibiotic (development) pipeline,” he said. “We’re identifying best practices … and we have a much better focus that’s driving mortality down.”

First appeared in the 2015 issue of Fort Wayne Magazine’s Health.

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