Kettering Health | Strive | Spring 2023

FOR YOUR BEST HEALTH SPRING 2023 Our mission in action Kettering College welcomes Ukrainian students SEIZE THE DAY With a positive start FACT OR FICTION Is sitting the new smoking?

Spring 2023 STRIVE is published three times a year by Kettering Health, 3535 Southern Blvd., Kettering, OH 45429, to improve the health literacy of the community and connect readers to health information and services. Interim CEO Michael Mewhirter Vice President of Marketing and Communications Jimmy Phillips Executive Editor Catherine Morris Managing Editor Carrie Bebris Art Direction Kelly Long Photography AGI Studios, John Rossi, Lee Ann Yahle, and Kettering Health staff Writing Carrie Bebris, Addison Griffin, Erin Laviola, Katlyn Stechschulte, and Kettering Health staff /KetteringHealth @KetteringHealth /KetteringHealth Connect with us Information in STRIVE comes from a wide range of medical experts. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that might affect your health, please contact your healthcare provider. 2023 © Kettering Health and Coffey Communications, Inc. All rights reserved. 9 6 10 HEALTHY LIVING Visit or scan the QR code to explore fun, informative fitness and health classes and more. 4 Fact or Fiction: Is prolonged sitting as harmful as smoking? 5 Embarrassed to Ask: Help for heavy periods 6 K ettering College offers refuge to 50 students displaced by the war in Ukraine 9 Swap Out: Craving comfort foods? Consider these healthier options 10 Uncovering a “silent killer”: Hypertension explained 12 Maintain your balance as you age 14 Get to the bottom of sleepless nights with a sleep study 15 At Our Best for the community 2

Beginning your day on a positive note involves more than waking up on the right side of the bed. “How you start your morning can set the tone for your entire day,” says Julie Manuel. Even if your schedule feels crammed, these five strategies are simple to practice and can significantly improve your attitude for the entire day. 1 Set one alarm. “Setting multiple alarms sets a precedent of pushing things off,” says Julie. “When you hit snooze, not only do you start the day feeling rushed, but you begin it with a pattern of delaying tasks.” 2 Skip the scroll. When you use your phone as your alarm, it’s easy to start checking texts, emails, and social media notifications before getting out of bed. Set the tone for a better day WE’RE HERE FOR YOU If you feel like your daily life is becoming unmanageable due to stress, anxiety, or depression, help is available. Call 1-855-807-5590 or visit to learn more about our behavioral and mental health services. Julie Manuel is a licensed professional clinical counselor and clinical program manager at Kettering Health Behavioral Medical Center FASTFIVE “I recommend removing all apps from your home screen,” says Julie. “Just seeing notification flags on app icons can trigger stress.” Save checking texts, emails, and other notifications until you are ready for the day. 3 Stretch. The health benefits of exercise are undeniable, but you may not always have time for a morning workout. One thing you can do while still lying in bed? Stretch. “When you stretch appropriately and do a deep stretch, it releases dopamine,” says Julie. “Starting your day with stretching or exercise will help you feel centered and give you the added perk of a mood boost.” 4 Show gratitude. Many people might journal or pray in the evenings, but starting your morning by showing gratitude can offer perspective that lasts all day by bringing your awareness to all the good in your life. 5 Say, “Good morning.” “Humans are wired for connection,” says Julie. “Taking a few moments to connect with your family, friends, or neighbors—whether it’s a short conversation in person or a brief phone call on your commute— primes your brain to know you don’t have to go through your day alone.” 3

Is sitting for extended periods of time really as harmful to your health as smoking? Rukan Ahmed, DO, explains. Q: How does sitting affect our health? A: American adults spend roughly half of their day—or more—sitting. Similar to smoking, uninterrupted periods of sitting are associated with the development or worsening of heart disease, diabetes, and a serious type of blood clot known as deep vein thrombosis (DVT). Part of the basic philosophy of osteopathic medicine is that the human body has an inherent capacity to recover and heal itself; however, smoking and sitting both undermine the body’s natural ability to recover. Q: Are the health risks of sitting and smoking similar? A: While it is certainly important to identify how multiple aspects of a person’s lifestyle can contribute to worsening health, it is equally important to be wary of drawing parallels between two otherwise unrelated lifestyle habits. Is sitting the new smoking? FACT OR FICTION Rukan Ahmed, DO, is a family medicine physician with Kettering Health There is a notable overlap of the risks associated with both smoking and sitting—but the risk of sitting is far less. Even smoking fewer than five cigarettes per day is associated with a greater risk of all-cause mortality than prolonged sitting. Q: What’s your advice for people who tend to sit all day? A: If you sit at a desk for most of the day, consider taking semi-frequent breaks to stretch your legs, use the restroom, finish a chore, or engage in watercooler conversation. There are also multiple options to stay a bit more active while working, such as using an underthe-desk bike or standing desk. Taking a walk during the lunch hour also does wonders! Outside of work hours, try to engage in hobbies that encourage you to be more active, such as cooking, building something, taking pets for a walk, playing with your children, or just cleaning the house. Like any lifestyle changes, modifying our habits is a gradual process. Positive changes are easier when you have a particular goal in mind, and collaborating with your primary care provider on those goals can help. Try to bring about meaningful changes even just by sitting less. I think our health is something for which we can all stand! 4 TAKE A STEP Visit or call 1-888-796-9704 to find a primary care provider who will work with you on your goals.

EMBARRASSED TO ASK? Approximately 20% of women in the U.S. deal with heavy periods. Your physician can help, explains Kristen Caldwell, DO. What’s considered heavy? What defines a “heavy” period varies from patient to patient. Volume is one consideration. Heavy bleeding can mean changing a pad or tampon every 30 minutes or every few hours. Frequency is also a key factor, even if the bleeding doesn’t feel heavy. Getting a period every 14 days, for example, is abnormal. Postmenopausal women should seek medical evaluation if they experience any bleeding. Causes Heavy periods may be caused by structural issues within the uterus, such as polyps or fibroids. Precancerous or cancerous cells can also cause heavy bleeding. Nonstructural issues such as bleeding disorders or a hormone imbalance can also trigger heavy bleeding. Polycystic ovary syndrome (PCOS) can cause irregular menstrual cycles and is common during reproductive years. Heavy bleeding could also be a side effect from medications such as blood thinners. At the doctor’s office Your evaluation will include a thorough medical and family history. “I ask patients about previous pregnancies and surgeries,” Dr. Caldwell says. Help for heavy periods Kristen Caldwell, DO, is an obstetrician and gynecologist at Kettering Health FEEL BETTER You can find a Kettering Health gynecologist by visiting Your visit will also include a pelvic exam, which enables your doctor to pinpoint structural issues and rule out other sources like rectal or bladder bleeding. In addition, your doctor might order laboratory testing and/or imaging procedures such as an ultrasound or a CT scan. Treatment options Medication—a pill, IV therapy, or hormone therapy—is typically the preferred initial treatment. Nonhormonal medications are also used to help prevent blood clots in the uterus. If you need a procedure, some can be performed at your doctor’s office, such as endometrial ablation to destroy the lining of the uterus. In an emergency, a hysterectomy may be necessary. It’s also an option for patients who don’t respond to medical therapy. Speak up Many women think heavy periods are something they just have to deal with, but that’s not the case. You shouldn’t be bleeding through your clothes or changing your plans to accommodate your cycle. If your period is disrupting your daily life, talk to your doctor. 5

They reached Volyn and faced more heart-wrenching goodbyes. In Ukraine, men 18 to 60 years old are not allowed to leave the country unless they’re studying at a foreign university. Otherwise, their duty is to defend Ukraine. “I will never forget that feeling of sadness when you understand that you may have hugged your brother and grandfather for the last time,” Svitlana says. The women continued their journey. For months, they lived in the Czech Republic with extended family, applying for travel visas. They hoped to reach Toronto, where Svitlana’s sister lives. When they couldn’t obtain the documents from the Canadian Embassy in Prague, they went to the Canadian Embassy in Poland. “It was a difficult path—long lines and sleepless nights,” Svitlana says. Meanwhile, they worried about her father. “My father risked his life to get people out of the most hostile and dangerous cities,” she says. “He was surrounded, and we lost contact with him for several days.” Svitlana says that when he could communicate again, “the first word he sent me was a message about Kettering College.” He had learned about the opportunity, remembering her dream to be a doctor. “It was like a ray of hope,” she says. Vladyslav Vladyslav (“Vlad”) Malishevskyi’s family lives in central Ukraine. “We did not experience the loss of our home or the loss of relatives,” he says. “But the whole family suffered a lot of stress due to not knowing what would happen next—especially because I was 17 at the time, and my family was worried that I would soon be 18 and have to be a soldier.” Vlad, whose mother is a doctor, was studying agronomy at a local university. He heard his pastor’s announcement in church about the opportunity to come to Kettering College, but, Vlad says, “I could not believe that I could be so lucky.” He and his parents struggled with a difficult decision. “They really did not want to let me go, but they were very worried about me and did not see a future [for me in Ukraine].” When Vlad was accepted into the program, his 18th birthday loomed near. He needed to leave Ukraine, but he hadn’t obtained all the necessary documents for a visa. So he went to Poland, where he lived in a church for over a month while working with the U.S. Embassy to get his visa. When he finally obtained it, “The trip itself was quite difficult because it was my first experience with airports,” Vlad says. “I flew from Warsaw to Paris—and from there to Cincinnati, where I was met by the college staff.” —Continued on page 8 RAYS OF HOPE To support Ukrainian students at Kettering College, visit giving/UkraineStudentFund or scan the QR code with your cellphone. Vladyslav 7

Kettering College He arrived at Kettering College after the fall semester had begun. But he was here at last. Daniela When Daniela Korchuk, now 18, was a young teenager, her father told her: “No matter which occupation you choose, the only thing that matters is to serve people. It’s all about God.” As a college student at the Ukrainian Institute of Arts and Sciences in Bucha, she chose to study economics but never actually saw herself in that profession. “I didn’t know how I would be able to serve people,” she says. When the invasion halted her studies, friends fleeing to western Ukraine invited Daniela and her mother to join them. At their destination, crowded into a small house with 15 people, they decided to continue west. By the time Daniela arrived at Kettering College with all the documents required to study here, her journey had taken her to Slovakia, the Czech Republic, the United States, Norway, and back to the U.S. Meanwhile, loss of electricity and other war-related circumstances have caused her family to leave their home more than once. On one occasion, her father returned to find one side of the house full of holes—shrapnel scars left from a rocket striking their neighbor’s house—and his office ransacked by the Russians who had occupied another nearby home. Life at Kettering College The students keep in touch with their families through phone calls, texts, and video calls. Although communication gets disrupted by power outages in Ukraine, most days the students receive messages saying their families are OK. All three students have settled into their new community and are adjusting to cultural differences. “Everything is different here,” says Vlad. “Roads, houses, food, public transport, cars.” As they adjust, they all believe God’s plan led them here—to safety and the opportunity to train for a career in medicine. Svitlana, especially, has no doubt. The hand of God Five years ago, long before the invasion, Svitlana was ill and asked God to show her his plan for her. That night, she dreamed about a room with a high bed. “I sat down on this high bed and read huge books in a not-native language for me,” Svitlana says, adding that she saw details “so vividly that I was able to draw them.” The dream left Svitlana with more confusion than clarity—until she arrived at Kettering College and a staff member opened the door to her dorm room. “I couldn’t breathe,” she says. From the high bed and white furniture to the mirror, wall colors, and wooden floor, “I [saw] the same room from my dream.” “As the war in Ukraine continues, we still worry about our parents,” Daniela says, “but God cares about them, and everything will be good with our families.” Svitlana adds, “I like that God can turn evil—as in war— into something good, like the opportunity for us to be here and study.” “And then,” Daniela says, “God can use us to help other people.” —Continued from page 7 Daniela MORE TO THE STORY Read about how Kettering College’s administration and staff made this happen: 8

SWAP OUT “We seek out comfort foods for different reasons, including stress, illness, hormonal fluctuations, and even nostalgia,” says Alicia Buterbaugh. Because some comfort foods are high in sugar and fat, using them to routinely deal with emotions can affect your health. “If you are regularly using comfort foods to cope with stress, anxiety, or sadness, you are increasing your risk of weight gain and developing chronic diseases—and you are avoiding dealing with the emotions you’re experiencing,” says Alicia. “Before reaching for those chips or cookies, try addressing your feelings by talking to a friend, going for a walk, or journaling.” Holiday seasons or celebrations can also make us seek comfort foods because we have memories attached to certain foods. “If you are seeking comfort food because of a holiday or celebration, you can choose healthier versions of the foods you crave, or eat smaller portions of the items you know may be less nutritious,” Alicia says. Are you craving comfort foods? Alicia Buterbaugh is a registered dietitian and diabetes educator with Kettering Health Instead of cream-based soups, consider brothbased soups containing whole grains, vegetables, and lean meats. Buy small ice cream cups or order a single scoop in a cup to mindfully manage portion size. Low-fat frozen yogurt or fruit-based frozen treats are other options when craving something cold and sweet. Consider thin crust over thick, and include plenty of vegetables as toppings. If you are used to having meat on your pizza, try thin crust with veggies and chicken. Soup Ice cream Pizza CRAVING THAT? CONSIDER THIS EAT SMART Get healthy and tasty recipe ideas at recipes Reinvent your favorites: Healthier options to consider Listening to your body and eating in response to hunger cues instead of emotions can lead to overall improved health. “As a dietitian, I don’t promote thinking of foods as good or bad,” says Alicia. “Some you eat in smaller amounts or less often, but they are not bad. Awareness of what you are eating, why you are eating, and moderating portions is important. All foods, including comfort foods, can fit!” 9

UNCOVERING A SILENT 10 Mohamed Abdelrahman, MD, is a cardiologist at Kettering Health Hypertension explained Chronic elevated blood pressure, known as hypertension, is one of the most common medical conditions affecting Americans. Nearly half of U.S. adults have it, according to the Centers for Disease Control and Prevention. Of those adults, only about 24% successfully control it. A blood pressure reading is given as two numbers: a systolic (upper) and a diastolic (lower) number. Normal blood pressure is less than 120 and less than 80 mmHg. Hypertension refers to blood pressure that consistently measures at or above 130 systolic over 80 diastolic. It strains the blood vessels and puts patients at increased risk for heart disease, kidney damage, and stroke. How is hypertension diagnosed? Anxiety and adrenaline can temporarily speed up your heart rate, but briefly feeling your heart racing does not mean you have hypertension. Unfortunately, the condition operates more covertly. The U.S. Food and Drug Administration (FDA) calls hypertension the “silent killer.” Most people are unaware of their chronically high blood pressure because it is asymptomatic. The only way to detect hypertension is with blood pressure readings. “We need at least two separate readings taken during separate visits,” says Mohamed Abdelrahman, MD. “If both readings are above 130 over 80 mmHg, then we can diagnose hypertension.” Since it’s common for patients to have anxiety at the doctor’s office, Dr. Abdelrahman says he often advises patients to conduct their own readings once a week with an at-home blood pressure cuff. “It’s a good way to keep an eye on their blood pressure, identify hypertension as early as possible, and guide future therapy,” he says. To get an accurate blood pressure reading on a home monitor, Dr. Abdelrahman advises sitting for five minutes before taking the reading. Make sure to support the arm and use the correct cuff size. What causes hypertension? Primary hypertension accounts for about 90% of cases. “In most cases of primary hypertension, the exact cause of elevated blood pressure is unknown,” says Dr. Abdelrahman. “However, multiple studies have demonstrated the significant role of genetic predisposition and environmental risk factors.” Common risk factors for high blood pressure include • Smoking • Obesity or being overweight • Excessive alcohol consumption KILLER Heart health ARE YOU AT RISK FOR HYPERTENSION? Go to to take Kettering Health’s heart quiz.

• Lack of physical activity • Poor diet, especially one that’s high in sodium Family history also plays a role. “I see patients in their 30s with high blood pressure,” says Dr. Abdelrahman. “A genetic predisposition, combined with unhealthy choices, can cause hypertension even at younger ages.” Secondary hypertension, on the other hand, refers to cases with a known cause. Conditions impacting the kidneys, adrenal system, and thyroid all can cause chronic high blood pressure. Sleep apnea and medications like antidepressants, decongestants, and birth control can also trigger high blood pressure in some patients. How is hypertension treated? The degree of blood pressure elevation usually determines whether medications are necessary. Dr. Abdelrahman says providers consider how high the blood pressure reading is and what other diseases or medical conditions the patient has. “But treatment options always start with lifestyle modifications,” Dr. Abdelrahman says. “A lot of patients underestimate how their daily habits can have an impact in reducing blood pressure. Even for patients who are on multiple medications, lifestyle adjustments can help them get off some of the medications.” He advises patients to quit smoking and to walk for 30 minutes at least five times per week. He also recommends maintaining a diet that includes plenty of vegetables, fruits, whole grains, and lean meats, as well as limiting foods that are high in saturated fat, sugar, and sodium. Care you can count on Kettering Health is a nationally recognized leader in helping patients control blood pressure rates. The American Heart Association and American Medical Association recently honored Kettering Health Medical Group as part of its Target: BP initiative. The program focuses on helping healthcare systems prioritize hypertension control to reduce heart attacks and strokes. 11

The Centers for Disease Control and Prevention (CDC)1 estimates that each year, more than 1 in 4 American adults older than 65 fall. Less than half of those who fall tell their doctor, while many become fearful and less active. Megan Skidmore and Jessica Hunt are physical therapists at Kettering Health Building better Aging well 12

Balance 101 Want to learn more specifics about building better balance? Kettering Health offers a lecturestyle class called Balance 101, where a physical therapist provides comprehensive education about • All the components of the balance system • Exercises for increasing strength and balance • Home safety and fall prevention • Risk factors for falls Class participants also receive a quick balance screening called the “sit-to-stand test.” Starting in a sitting position with your arms folded across your chest, you should be able to stand and sit five times in a row within 12 seconds. The group facilitator demonstrates other self-screenings that can help you evaluate whether to ask your provider for a physical therapy referral. 1 2 STEADY AS YOU GO Visit to learn more about upcoming Balance 101 classes. Unfortunately, when you move less, you lose strength and balance, increasing your fall risk even more. Avoiding falls is important as you age— 1 in 5 falls causes a serious injury, and falling is the leading cause of injury-related death in older adults.2 “Falls aren’t a normal part of aging,” says Megan Skidmore. If you have fallen or feel unsteady on your feet, tell your healthcare provider. You can take multiple steps to increase your strength and lower your fall risk. What causes falls? The main cause of falling often comes down to problems with your balance system. “There are lots of pieces to the puzzle of balance,” explains Jessica Hunt. Your vision, sensory systems, inner-ear function, strength, and joint health all contribute to your balance system’s function. “By age 65, most people have lost at least 25% of their muscle mass, which can take a big toll on their balance system,” says Jessica. It’s important to rule out underlying medical causes of balance problems, such as medication side effects, neuropathy, or cardiovascular conditions. Always see your healthcare provider if you experience dizziness, unsteadiness, or have fallen. Balance-boosting exercises The good news? Exercise can help you retain muscle mass as you age and lower your risk of falls. “Walking is the single best exercise for almost everything,” Megan says. It increases your muscle strength, bone health, heart health, endurance, and your balance system. Low-impact strength training can also increase your balance. You may practice specific balancebuilding exercises, but be sure to stand in a corner or near a wall in case you lose your balance. You can try • Standing with your eyes closed • Closing your eyes and moving your head up and down or side to side • Standing with your feet closer together than usual How physical therapy can help Because balance is so multifaceted, many people benefit from working with a physical therapist. If you’ve already fallen, Jessica advises asking your primary care provider about a referral to a physical therapist. “We can help figure out where the challenges lie and what we can do about it,” she says. “A lot of people tend to sit back and let aging happen,” says Megan. “But falls aren’t just part of aging. You may have to work a bit harder than you did at 20, but you can keep your strength and balance as you get older.” 13

Sleep medicine Adults need seven to nine hours of sleep per night, but more than one-third of Americans report sleeping less than the recommended amount. And the problems that can follow from lack of sleep are more than just feeling groggy in the morning. “Sleep plays a key part in maintaining your immune system, hormones, emotional and psychiatric health, memory, and more,” says Sarah Hussain, MD. “When you lose sleep, your health can suffer long-term consequences.” If you have trouble falling asleep, staying asleep, or achieving restful sleep, you might have a sleep disorder. A sleep study can help determine if you have one. What is a sleep study? “A sleep study is a diagnostic test to check for sleep disorders, including obstructive sleep apnea, central sleep apnea, periodic limb movement disorder, and rapid eye movement (REM) behavior disorder, among others,” says Dr. Hussain. How is a sleep study performed? Sleep studies can be done in a sleep lab or at your home. An at-home sleep apnea test is performed by your wearing a portable breathing monitor overnight while sleeping in your bed. The device records results that your doctor reads. Sarah Hussain, MD, is the medical director of Kettering Health Miamisburg’s Sleep Center Get to the bottom of sleepless nights A polysomnogram is an in-lab test, with sensors attached to your body to monitor you while you sleep overnight in a sleep lab. “A polysomnogram is more detailed, accurate, and can diagnose not just sleep-related breathing disorders like sleep apnea, but also can detect other sleep disorders like periodic limb movements of sleep, REM behavior disorder, and narcolepsy,” says Dr. Hussain. “It may even detect cardiac arrhythmias and seizure activity.” A sleep specialist can perform a detailed history and a physical to order the appropriate sleep study for you. Treating sleep disorders “Treatment for sleep disorders is individualized, based on each patient’s sleep study results and diagnosis,” says Dr. Hussain. “Treatment options are available that can improve quality of sleep and quality of life.” Do I need a sleep study? If you are experiencing the following symptoms, you might benefit from a sleep study: • Excessive daytime sleepiness • Fatigue, tiredness, or lack of motivation • Feeling foggy or having concentration or memory issues • Loud snoring noted by others • Non-restorative sleep A sleep study can offer answers and relief REST EASY. To schedule an appointment, call 1-855-816-3545 or talk to your primary care provider. 14

Kettering Health is committed to providing the best care to our community. AT OUR BEST Kettering College creates community health worker program The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services recently awarded Kettering College a grant to create and implement a community health-worker training program. Community health workers (CHWs) are grassroots health workers who live in the communities they serve, partnering with friends, families, and neighbors to bring reliable health information and services to underresourced communities. The college will develop the first apprenticeship program for CHWs in the Dayton region and implement a continuing education program for current CHWs. These efforts focus on increasing the presence of CHWs in Dayton and Trotwood, where many under-resourced people of color live. We’re proud to be part of this initiative to help support our communities in getting and staying healthy. Kettering Health Hamilton verified as a Level III Trauma Center Kettering Health Hamilton has been verified as a Level III Trauma Center by the Verification Review Committee of the American College of Surgeons. This achievement recognizes our dedication to providing prompt, expert emergency care. Level III trauma centers have • 24-hour coverage with emergency medicine physicians and prompt availability of general surgeons and anesthesiologists • Comprehensive quality assessment programs • Continued education for nursing and allied health professionals • Transfer agreements for patients who need more comprehensive care Centerville Health Center now open Kettering Health continues to expand access to care in the Centerville community with a new health center. The Centerville Health Center provides a spectrum of services, including primary care and specialty care: • Cardiology • OB-GYN services, staffed by certified nurse-midwives • Lab and imaging (with a referral from a Kettering Health Medical Group provider) 15

Kettering Health 3535 Southern Blvd. Kettering, OH 45429 Update or remove address by emailing Nonprofit Org. U.S. Postage PAID Walla Walla, WA Permit No. 44 At Kettering Health, we strive to provide you with the exceptional care you deserve—from fighting cancer with advanced technology to outstanding doctors who care about you not only as a patient, but also as a person. We give everything it takes to empower the best in you. Find care to reach your best health at Every day, we renew our commitment to your good health. WE GIVE OUR BEST TO HELP YOU FIND YOURS Official Healthcare Provider of the Cincinnati Bengals