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Start now, and you’ll have all the time you need to plan your "teen sport days" for the fall of next year, says Diane Holmay, RN, MS, director of the Center for Women’s Health at Franciscan Health Care in LaCrosse, WI. Your center can provide the physical exams that young girls will be required to have when they go back to school and want to participate in organized sports.
Holmay chooses three days two full days and one evening in July and August to offer the comprehensive exams for girls between the ages of 12 and 17. During those days, her women’s center closes its normal business and caters only to the girls and their mothers. One large room of the center is divided into the following stations:
• Check-in. Nurses take the girls’ blood pressure, check their weight, and make sure they’re current on immunizations.
• Muscle testing. Four physical therapists check for muscle flexibility and provide tips on preventing injury during exercise.
• Gynecology. Nurses discuss birth control if the girls are sexually active and encourage them to come back for a Pap smear and a pelvic exam.
• Nutrition. Dietitians are available to discuss the proper diet.
• Physical. After visiting the other stations, the girls end with a 15-minute assessment by a physician who listens to their heart and lungs and answers any questions they may have.
After four years of providing this service, Holmay tells what she learned from her mistakes:
• Be organized. Plan ahead how the "traffic pattern" will flow through your center, Holmay advises. Can the girls go to the stations in any order they want, or should they go to each one in a linear fashion?
• Keep the girls entertained. Offer snacks in a center meeting area, and play health-related videos in the hallways. Holmay first tried offering the videos in a conference room but found the girls didn’t want their peers to know they were interested in the information. When the tapes are playing in the hallway, "they can pretend they aren’t watching them," Holmay explains.
• Coordinate workers. Don’t duplicate the efforts of clinicians at the different stations.
• Be consistent with prices. Print a flier that clearly defines what the exam entails and what will cost extra. Holmay charges according to standard preventive codes that increase fees with age, $45 for 12- to 13-year-olds; $67 for 14- to 15-year-olds; and $75 for 16- to 17-year-olds.
• Incorporate new ideas. Get staff feedback and act on their good ideas.
• Market in the right places. Holmay sends letters to area schools at the end of the school year. She also targets child care centers and fitness centers, and fliers about the sport days always are posted at the center. Her best marketing, however, is in newspaper ads and word of mouth from teens and their moms.
The teen market is important at Holmay’s center because the needs of students are not well met in her community, she says. Teen sport days help build relationships not only with the young people, but also with their mothers. "Teens don’t enter into the health care system very easily," she says. "We wanted them and their moms to feel comfortable coming to our women’s center."
Many communities already have teen health programs. You can strengthen your own project by cooperating with and building on those programs. That’s how Penny Koger, MSN, vice president of patient services at Henry County Memorial Hospital in New Castle, IN, filled a service need when she created a teen prenatal education program. Here’s how she avoided turf battles and forged solid community cooperation:
• Contact your local health department to determine the needs in your area and see if there already are programs under way with which you can get involved.
• Partner with the health department and other community groups for insights on cultural aspects of the population you’re trying to reach.
• Expect a small reaction at first. "There’s so much stuff going on with AIDS and gang violence and brutality, and when you are trying to live day-to-day, it’s hard to look at preventive medicine and take care of yourself," Koger explains. "But I think when you try to instill in these kids at a young age that yes, they can affect what happens to them, and they can help their parents, it makes a difference."
Where can I go for free or low-cost patient education material?
Submitted by Alice Beers, BBN, OCN, Clinical Nurse Oncologist in Gynecological Oncology, Columbia Hospital, Washington, DC
Free patient education materials in bulk quantities are nearly extinct. However, you and your patients still can obtain single copies of brochures on many women’s health concerns. The Internet is a growing source of cost-effective patient information. Many agencies post educational material you can print for nothing if you have Internet access. Look for the World Wide Web addresses below with their respective host agencies.
Here are patient information resources on a dozen women’s health concerns:
• American Cancer Society.
Free single copies of pamphlets and detailed database printouts tailored to individual patient questions. Answers to specific cancer questions such as locations of breast cancer support groups. Pamphlets on prevention, treatment, rehabilitation, and living with all forms of cancer. State chapters price bulk orders according to their budgets. Contact: American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329. Telephone: (800) 227-2345, staffed by oncology nurses; (404) 329-5739. Fax: (404) 329-5787. World Wide Web: http://www.cancer.org.
• National Cancer Institute.
Free single copies and bulk quantities of can- cer information. English and Spanish versions. Contact: National Cancer Institute, Cancer Information Service, 31 Center Drive, MSC 2580, Building 31, Room 10A16, Bethesda, MD 20892-2580. Telephone: (800) 422-6237. Fax: (301) 330-7968. National Cancer Institute’s CancerFax line offers extensive fax printouts on patient concerns involving prevention, treatment, and clinical trials. On a fax machine phone, pick up the receiver, dial, and follow the voice prompts: (301) 402-5874.
• Y-ME National Breast Cancer Organization.
Free single copies of breast cancer materials, including locations of nearby breast cancer support groups. Packets tailored to callers’ questions. Contact: Y-ME National Breast Cancer Organization, 212 W. Van Buren St., 4th Floor, Chicago, IL 60607-3908. National hotline: (800) 221-2141. Spanish hotline: (800) 986-9505. Fax: (312) 986-0020. World Wide Web: http://www. y-me.org.
• Planned Parenthood Federation of America.
Free single copies for individual patient requests and for inspection; bulk orders vary by title (typical price $38 per 100). Contact: Planned Parenthood Federation of America, 810 Seventh Ave., New York, NY 10019. Order line: (800) 669-0156 (9 a.m to 5 p.m. EST). Fax: (212) 245-1845. World Wide Web: htttp://www.ppfa.org/ppfa.
• National Headache Foundation.
Single copies of the booklet, Headaches: An Overview, are available. Send a self-addressed envelope with three first-class stamps. Packets tailored to individual’s questions, $1. Contact: National Headache Foundation, 428 W. St. James Place, Second Floor, Chicago, IL 60614. Telephone: (800) 843-2256. Fax: (312) 515-7357. World Wide Web: http://www. headaches.org.
• American Heart Association.
Single copies free. Bulk prices set by state chapters. Subjects include risk factors for women, weight management, and healthful eating. Contact: American Heart Association, 7272 Greenville Ave., Dallas, TX 75231. Telephone: (800) 242-8721 routes calls to state chapters. World Wide Web: http://www.amhrt.org.
• National Kidney and Urologic Diseases Information Clearinghouse.
Up to 25 health facility kits free, containing 24-page provider’s guide, Let’s talk about bladder control for women, plus patient brochures. Single free copies of consumer kits on prevention, treatment, and control of incontinence; additional booklets 50 cents each. Contact: National Kidney and Urologic Diseases Information Clearinghouse, Attention: BCW, 3 Information Way, Bethesda, MD 20892-3580. Telephone: (800) 891-5388; (301) 654-4415. Fax: (301) 977-8906. E-mail: firstname.lastname@example.org.
• Lupus Foundation of America.
Typical pamphlet cost is 25 cents plus $5 shipping on orders up to $25. Topics include diagnosing lupus, lupus management, and pregnancy and lupus. English and Spanish versions. Contact: Lupus Foundation of America, 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. Telephone: (800) 558-0121; (301) 670-9292. Fax: (301) 670-9486.
• American Menopause Foundation.
Free single patient education packets tailored to individual questions. Free bulk quantities of pamphlets for women’s education events. Topics include diet, hormone replacement therapy, and exercise. Contact: American Menopause Foundation, The Empire State Building, 350 Fifth Ave., Suite 2822, New York, NY 10118. Telephone: (212) 714-2398.
• North American Menopause Society.
Orders of 25 pamphlets, $18.75 plus $5 shipping. Samples of 10 titles, $10 plus shipping. Titles include Menopause Basics, Abnormal Bleeding, and Mental Health. Contact: North American Menopause Society, P.O. Box 94527, Cleveland, OH 44101-4527. Telephone: (216) 844-8748. Fax: (216) 844-8708. E-mail: nams@ apk.net. World Wide Web: http://www. menopause.org.
• National Osteoporosis Foundation.
Free single copies. Typical bulk quantity prices are 40 cents each up to 499 and 35 cents for 500 or more. Shipping costs vary by order size. Topics include bone density testing, menopause, and osteoporosis. Contact: National Osteoporosis Foundation, 1150 17th St. NW, Suite 500, Washington, DC 20036-4603. Telephone: (202) 223-2226. Fax: (202) 223-2237.
• American Chronic Pain Association.
Free single copies of patient information packets, including referrals to local support groups. Bulk quantities of pain management pamphlets are 5 cents each. Contact: American Chronic Pain Association, P.O. Box 850, Rocklin, CA 95677-0850. Telephone: (916) 632-0922. Fax: (916) 632-3208.
• Worldwide Congress on Pain.
Electronic library on pain. Patient education pages available to print. Accessible only through World Wide Web: http://www. pain.com.
• March of Dimes.
Resource Center offers free single copies of information, as well as answers to patient questions on pregnancy and related subjects. Staffed by resource specialists, 9 a.m. to 6 p.m. EST. Contact: March of Dimes, 1275 Mamaroneck Ave., White Plains, New York 10605. Telephone: toll-free (888) 663-4637; (914) 428- 7100; TTY for hearing impaired (914) 997-4764. Fax: (914) 997-4450. E-mail: email@example.com. For bulk quantities, typical prices are $8 to $12 for 50 copies; shipping costs $4.50 to $30, plus 15% of order. Contact: March of Dimes Fulfillment Center, P.O. Box 1657, Wilkes-Barre, PA 18703-1657. Telephone: (800) 367-6630. Fax: (717) 825-1987. World Wide Web: http://www. modimes. org.
• National Maternal and Child Health Clearinghouse.
Free single copies of maternal and child health patient education bibliography compiled from diverse sources. Contact: National Maternal and Child Health Clearinghouse, 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182-2536. Telephone: (703) 356-1964. Fax: (703) 821-2098. E-mail: firstname.lastname@example.org.
• American Academy of Head, Neck and Facial Pain.
Single copies of educational pamphlet and, if requested, list of local temporomandibular joint disorder (TMJ) specialists for self-addressed stamped business-size envelope. Contact: American Academy of Head, Neck, and Facial Pain, 520 West Pipeline Road, Hurst, TX 76053. Telephone: (800) 322-8651 or (817) 282-1501. Fax: (817) 282-8012.
• National Vaginitis Association.
Up to 50 copies free, additional quantities for $7.50 per 50, includes shipping. One title only, Women’s Guide to Vaginal Infections. Contact: National Vaginitis Association, 117 S. Cook St., Suite 315, Barrington, IL 60010. Telephone and fax numbers withheld at agency’s request.
[Editor’s note: For more information on teaching techniques and materials for cancer patients, contact Alice Beers, Clinical Nurse Oncologist in Gynecological Oncology, Columbia Hospital, 2425 L St. NW, Washington, DC 20037. Telephone: (202) 293-5217. Fax: (202) 293-6784.
Reader Question is a new feature in which we’ll address your questions with the most current information. Send your questions to Editor, Women’s Health Center Management, American Health Consultants, P.O. Box 740056, Atlanta, GA 30374. Let us hear from you!]
• The May issue of Working Mother brings good news to your patients who suffer from urinary-tract infections. The U.S. Food and Drug Administration recently approved a one-dose treatment. The new drug, called Monurol, has longer staying power than other antibiotics typically prescribed for such infections. An alternative to the new antibiotic is a stronger dose of commonly-used drugs like amoxicillin, says Nicolette Horbach, MD, urogynecologist and associate clinical professor at George Washington University in Washington, DC. Horbach tells readers it’s safe to use as a one-dose therapy; just confer with your physician first.
The issue also features massage, which has the solid therapeutic benefits of improving muscle flexibility and engaging little-used muscle groups. The technique is helpful for active and sedentary women. Massage techniques include: Chi, in which the massage therapist stretches the arms and legs; reflexology, therapeutic foot rub; seated, in which the client sits in a chair instead of lying on a table; shiatsu, different degrees of finger pressure to relieve tension; sports, intense pressure to relieve muscle tension after vigorous fitness workouts or sports; Swedish, long strokes and kneading to work out kinks and improve circulation. If you don’t have an on-site massage therapist, call the American Massage Therapy Association at (847) 864-0123 for a list of area therapists.
• May’s McCall’s warns women of their heart attack risks. The report highlights the dangers of high cholesterol readings. One study shows that women as young as 25 to 34 often have evidence of plaque in their coronary arteries. Even women who are capable of running a marathon can have incipient signs of narrowing arteries.
So what’s a woman to do? The report cites good news about reversing early problems or existent heart disease. It stems from the research of Dean Ornish, MD, president and director of the Preventive Medicine Research Institute in Sausalito, CA. Ornish’s findings affirm healthy lifestyle principles such as quitting smoking and starting an exercise program. Doing the two in combination, Ornish says, can prevent the weight gain that often sets in with nicotine withdrawal.
Women are urged to build a diet around vegetables, beans, whole grains, fruit, and fat-free dairy products. They also are advised to do one-half to one hour of brisk exercise five times a week and lift weights for 20 to 30 minutes three times a week. Ornish recommends daily intake of antioxidents, preferably from foods instead of vitamin supplements. Reducing stress is a must.
He cites the special payoff women derive from the lifestyle: "While we don’t know why, evidence increasingly indicates that females who eat a low-fat diet, exercise, and practice stress management can improve their heart health more easily than men who adhere to this program."
• Two of the many stress-related disorders, irritable bowel syndrome and inflammatory bowel disease, are the subjects of a May health report in Good Housekeeping. Up to 15% to 20% of adults in the United States cope with irritable bowel flare ups. It’s the second leading cause of absenteeism from work; colds are the first.
The symptoms include diarrhea, constipation, bloating, stomach spasms, and gas. In fact, sometimes the pain is so incapacitating that women undergo tests for ovarian cysts and stomach ulcers, only to learn that their problem is really the elusive irritable bowel syndrome. The condition is hard to diagnose because the bowel looks normal. It’s just super-sensitive to normal stimuli, including stress. Inflammatory bowel disease causes inflammation of the intestinal tract and sometimes involves the mouth and esophagus.
Experts say irritable bowel syndrome is equally common among men and women, although women seek help for it more often than men. Some sufferers find relief in over-the-counter antidiarrheals or laxatives. Others turn to prescription antispasmodics. For irritable bowel disease, prescription anti-inflammatory drugs sometimes help. Other remedies include three to four vigorous exercise sessions every week; exercise releases endorphins, which relax the digestive tract. Avoiding cauliflower, cabbage, and sorbitol-sweetened and fatty foods reduces gas. Muscle relaxation, deep breathing, and meditation also reduce stress and mitigate bowel disorders.
• In May’s Mademoiselle, readers find a discussion of a condition most wish they had a stick figure. This isn’t anorexia; it’s the virtually curve-free, slender figure that few women come by naturally. But it’s not as rare as some would think, says Connie Diekman, RD, a St. Louis, MO-based nutritionist. Diekman says one in 20 women who visit her office want to gain weight. Suggestions include eating small portions often. Keeping a detailed eating diary and totaling calories gives a true picture of actual calorie intake. To gain a pound a week, readers are advised to take in an extra 500 calories a day. Don’t turn to junk foods and desserts for the extra calories. Instead, eat regular yogurt or granola. Add a couple of tablespoons of peanut butter to a bagel.
A word to the wise: All that eating without exercise will let your body send the extra pounds to its designated storage center the belly. Lift weights to route the bulk to the muscle groups you’d like to fill out. Be patient, the article says in closing. Everyone’s metabolism slows down in their 30s. So when those wiry-figured women reach their 40s, they might find the curves they always wished for.
How to know whether thinness is abnormal? Here are the signs of problems: Menstruation stops, hair loses its luster, skin and nails crack from dryness, and weight drops suddenly for no apparent reason.