Family Expert

Submitted By: Dr. Chuck Weber

I’m in Florida for a few weeks successfully rehabilitating my plantar fasciitis, trying to be careful that Vickie, Jim, and Kathleen don’t walk me into the ground! 

Jim said he and several of the family have a big skin reaction to bug bites. I can tell you how I learned to prevent them from my Army medical training. The Special Forces guys were expected to crawl around through Panama jungles training and would get all bit up, as you can expect. What was found to be most effective at preventing bites was a combination of DEET and permethrin. DEET for the skin and permethrin for clothing. You know DEET(diethyltoluamide) as “Off” or “Cutters” bug spray. It comes in a regular strength of 10-15%, or Deep Woods Off at 25-30%. These are considered safe for use in children (American Academy of Pediatrics). I wouldn’t use it daily, but in the evening when the mosquitoes and biting insects are most active and you expect to be outside at risk for bites. DEET also comes in high-strength containers of up to 100% as Ben’s DEET or Repel branded DEET. This is only appropriate for adult jungle use or hacking through the woods thick with mosquitoes. JP and I used it when camping with Boy Scouts in the Florida Keys. I saw another adult who had every square inch of his clothing and skin covered with mosquitoes; for Dan and I it was like we had a force field surrounding us. We could hear them buzzing, but they didn’t land or bite. It also works for ticks, gnats, biting flies, chiggers and fleas. Some of the diseases one can get are malaria, Lyme Disease, Rocky Mountain spotted fever, and more exotic ones like dengue, Zika, Yellow fever, chikungunya, tularemia, and others (I took the Infectious Disease course at Walter Reed).

Permethrin is a spray or liquid that is sprayed on or soaked in clothing that lasts for a long time, like 6 weeks, and through several washings. It is an insect repellant that works on mosquitoes, spiders, ticks, chiggers and more. It is safe on clothing, hats, and shoes, but is not applied to skin. I get it on Amazon but have seen it at Dicks or Cabella’s. It comes in 0.5% and can be applied to mosquito netting, tents, sleeping bags, etc.

This is the longest-used combination with the best track record of effectiveness and safety. There have been reports of side effects in about 1 in a million people, usually from overuse or taking internally, and include insomnia, seizures, and confusion. Alternatives are not studied as extensively but include Picaridin or more natural ones like oil of eucalyptus, citronella, thyme, catnip, and geranium oil.

If you are allergic or have a big reaction to bites with an intensely itchy welt, it works well to apply ice to numb the spot so you don’t scratch to make it worse, and then a strong cortisone or steroid creme (for instance, prescription clobetasol or fluocinonide) under a band-aid overnight. Generally, the reaction is gone in the morning.

Good luck! If you have questions, I’m always happy to talk about it with family.

Submitted By: Dr. Chuck Weber

Hello, family. I practiced Dermatology for over 40 years, and my own boys have suffered from acne “blemishes” kept in good control by what you can get at the drug store without a prescription. I thought I would share the program with you. 

This works for mild to moderate acne and is a good first step. If it doesn’t control the condition, then go to a Dermatologist for oral antibiotics and topical antibiotics, and if severe and persistent enough, isotretinoin.

1.) Use a 5-10% benzoyl peroxide soap in the shower once or twice daily or at the sink bare-chested or with a white T-shirt on, as if you splash it on clothing or towels, it can bleach out the color. Common names are Oxy-10, Clearasil, and Proactive (more expensive to pay for advertising). If you use a washcloth, use a white one and dry with a white towel so your mother doesn’t complain about bleaching the good-colored ones. Some people, about 1%, get allergic to this, so if it causes itching and redness, you may have to discontinue it. This could also be an irritant reaction, so stop using for a while and let the reaction subside. If on repeated use redness and itching come right back, you have to stop it and use salicylic acid wash as a substitute.

2.) Use Differin or adaptalene gel (generic name) at bedtime. It can be irritating, so apply sparingly: one pea-sized glob for the whole face. Squeeze out the pea on your fingertip and tap it, leaving a small amount on multiple affected areas. Then, moisten fingers with water and use that as a solvent to spread the touches of medicine into a thin coat over the whole face or all of the affected areas.

Costs: The Benzoyl peroxide should be around $10 a bottle. The Differin was a $200 a tube prescription medicine a few years ago, and the company decided to make it over the counter. Expect it to be about $20 a tube. Each should last several months. For less than the copay on most of the prescription products, most people will get excellent results.

What Do You Do?

There are many fulfilling careers that  may not be self-evident to young people trying to find their direction in life. This section is meant to shed light on interesting career paths chosen by members of our family.

How would you describe what you do to earn a living?

Research scientist - biologist. I perform experiments to test hypotheses about why certain biological phenomena occur and to determine how we can leverage that biology to treat disease.

Are you self-employed or do you work for a company?

Company

What are some things you might do on a typical day?

Perform experiments with mouse and human samples (working with my hands is most of the day), write about my experiments and results, analyze and compile data using imaging and calculating software (Adobe and Excel), read scientific literature, attend lectures and meetings to discuss research in other fields of biology, teach undergraduate interns how to perform experiments.

What do you find most rewarding?
Research is a really intellectually stimulating environment. Taking a research project from beginning to end is like solving a giant puzzle, and the intrigue and satisfaction you feel completing a sudoku or assembling a 1000 piece jigsaw is exactly the same. It also is just a SUPER cool job if you think about it: I am paid to discover knowledge that is new to humanity. Other perks: I have a LOT of autonomy in what I do each day and how long I spend in the lab, and I spend most of my time working alone on my own research. No one cares how you dress (sweatpants are pretty popular in labs) or look (tattoos and dyed hair are fine). I am rarely doing one specific task for more than 3 hours in one stint.

What are your biggest challenges?

1) Expectations for productivity are VERY high in research science, and there is often pressure to work long hours / on weekends to produce data very quickly, compromise to attend meetings or answer emails while on vacation, and be responsive to your boss and co-workers pretty much from dawn to dusk.

2) We must juggle multiple very different roles simultaneously. Experiments, writing, and mentorship roles must all receive your full attention and 100% effort all at the same time!

3) Sometimes our hypothesis is just plain wrong. Sometimes an experiment won't work no matter what you try and we never figure out why. There is a lot of research that is out of our control, but it's still your fault and your problem if your work doesn't go right.

What type of background (education or experience) does one need to be qualified to do this type of work?

At minimum, a bachelor's degree and laboratory research experience during or after undergraduate education. Career advancement requires completion of a Ph.D. degree.

What suggestions might you have for someone who may be interested in this field?

Get lab experience during college! And don't be intimidated by scientists in general--- we are no smarter than average, we are just educated and trained a specific way.

How would you describe what you do to earn a living?

I am an “opportunistic entrepreneur.” We focus on business opportunities that arise. We own a “deconstruction” business (commercial and residential), a laundromat, a dumpster company, and various real estate projects. We are always open to new opportunities where we can add value.

Are you self-employed or do you work for a company?

I am most definitely self-employed.

What are some things you might do on a typical day?

Every day is different. I do lots of employee relations; hiring, training, managing employees. I talk to our customers regularly. I work in the field when needed whether to fix machinery/tools, or step in and replace labor when necessary. I’m always looking for new opportunities.

What do you find most rewarding?

* Working closely with my wife in the management and strategy of the business

* Collaborating with team members

* Encouraging employees to accept responsibility to continually learn and grow, then witness the self-satisfaction that comes with their success.

What are your biggest challenges?

Being able to focus on a single issue/problem. I always feel I am spread too thin.

What suggestions might you have for someone who may be interested in this field?

* If your spouse is in business with you, be sure you are compatible and patient with each other

* Have a burning desire to succeed

* Be willing to fail frequently

* Have thick skin

How would you describe what you do to earn a living?

I am a Program Manager for the United States Corps of Engineers in Omaha, Nebraska. We conduct inspections, repairs and construction on military fueling systems (jet fuel, regular gasoline, diesel) throughout the world.

Are you self-employed or do you work for a company?

I am one of about twelve hundred employees in the Omaha District office.

What are some things you might do on a typical day?

1. Develop new business from four branches of the military (Army, Air Force, Navy, Marine Corps). 

2. Facilitate discussions with engineers, construction, contracting military bases, and the Defense Logistics Agency on the exact scope of work to be done within agreed upon timeframes.

3. Oversee the implementation of the contracts to make certain the work is done in a satisfactory manner, on a timely basis and within budget.

What do you find most rewarding?

I enjoy mentoring younger project managers and helping them grow in their careers. It is also rewarding to know that we are doing important work whether it be to provide fuel for aircraft, ground vehicles or ships. 

What are the biggest challenges?

Dealing with different, difficult personalities within the Government keeps life interesting. Trying to effectuate change in a large national organization with political implications can be challenging.

What type of background (education or experience) does one need to be qualified to do this type of work?

To be hired out of college one probably needs a degree in engineering, architecture, project management, or the physical sciences (chemistry, geology, physics, etc.) Alternatively, you could come from the private sector or active-duty military if you have experience in fuels, construction, engineering, or project or program management. 

What suggestions might you have for someone who may be interested in this field?

The U.S.A.C.E. is a good place to work. We do important work in the defense of our country. There is job security, good benefits, a chance to travel the world, and a transparent career path. 

Submitted by: Megan Kluesner

Vascular disease is a leading cause of mortality worldwide. Approximately 795,000 people in the United States have a stroke each year, 87% of which are ischemic.  Stroke is the fifth leading cause of death in the United States and second leading cause of death across the globe.

The purpose of this newsletter article is not to scare or intimidate, but instead to discuss the modifiable risk factors of stroke and importance of risk factor management. Some modifiable risk factors include hypertension, hyperlipidemia, diabetes mellitus and tobacco use. A substantial portion of strokes can be prevented using the approach reviewed in this article. 

Hypertension, also known as high blood pressure, is highly prevalent and significantly increases risk of stroke. Now defined as a blood pressure greater than 130/80 mmHg, management of hypertension has been found to significantly reduce risk of both hemorrhagic and ischemic stroke. Patients with hypertension should be treated with lifestyle modifications and medical therapy to achieve blood pressure less than 130/80 mmHg. Patients are encouraged to increase physical activity by exercising 30 minutes per day, 3 to 4 times per week. Dietary modifications that have suggested benefit in cardiovascular health include low sodium or a Mediterranean based diet. Additionally, DASH is a dietary guideline specifically directed at blood pressure management. DASH (Dietary approaches to Stop Hypertension) encourages high fruit and vegetable, low fat dairy products, low animal protein and high plan protein. In addition to lifestyle modifications and nonpharmacologic approaches, education regarding antihypertensive medications, doses, risks, side effects and importance of adherence is paramount in the management of blood pressure control.

Disorders of glucose metabolism, including type 1 and type 2 diabetes and prediabetes, are major risk factors for stroke. A greater risk for stroke is present in women and patients younger than 65 years of age. A glycated hemoglobin goal (HgbA1c), which measures average blood glucose levels over a three month span, of less than 7% has been recommended to prevent microvascular complications of type II diabetes. Treatment of diabetes mellitus involves participation in self-management support and education as well as lifestyle modifications. The initial pharmacologic intervention is a medication called metformin. 

Dyslipidemia, also known as an imbalance of lipids, has an association with stroke risk. Treatment, typically involving statin therapy, is a critical part of stroke management. Approximately 1/4 of adults in the United States have an elevation in cholesterol levels. The target of treatment with a use of statins is a focus on lowering cholesterol by 50% or more using high potency statins or by 30 – 50% using moderate-potency statins. In addition to statin therapy, it is recommended to encourage a heart healthy diet to lower cholesterol levels as previously discussed in this article. 

Smoking tobacco is a well-established risk factor for stroke and has a high association with atherothrombotic stroke. Smoking cessation significantly reduces risk of stroke. After 5 years of smoking cessation, stroke risk returns to nonsmoker levels. Secondhand smoke, especially when exposed at high levels, also has been found to increase stroke risk. For this reason, avoiding environmental smoke and smoking cessation are recommended. Interventions that have been found advantageous in smoking cessation include physician counseling as well as group counseling, or pharmacologic therapy including nicotine replacement, like patches or gum, or other medications such as bupropion and varenicline. 

There are additional risk factors for stroke that have been identified in recent years, although their role in contributing to stroke is not as well defined. One of these risk factors is sleep apnea. Addressing sleep apnea may further reduce stroke risk, but additional research is needed to fully understand treatment and management in stroke patients. 

Sleep apnea is a condition measured by the apnea-hypopnea index, which calculates the number of respiratory events per hour while sleeping, including cessations in breathing and reductions in airflow. The rate of sleep apnea after stroke is high, although it is unclear is this disordered breathing precedes stroke or develops poststroke. Obstructive sleep apnea has been associated with increased poststroke mortality and poor functional outcome. Given the prevalence of obstructive sleep apnea and potential for a role in secondary stroke prevention and improved outcomes, it is recommended to screen using polysomnography in patients with stroke and sleep apnea symptoms.

Most risk factors for stroke are modifiable. Studies suggest that 90% of strokes can be explained by modifiable risk factors as discussed. Stroke prevention strategies should include treatment of these risk factors using medication and lifestyle modifications. A healthy lifestyle, including dietary modifications, physical activity, smoking cessation and medications adherence, could have significant effect on the incidence of stroke globally. 

References 

Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Cerebrovascular Diseases 2017; 23 (1). Doi: 10.1212/CON.0000000000000416

Submitted by: Cathy Weber

Ever think of volunteering to work with children and their families to make a difference in a child's life? Check out CASA (Court appointed child advocate), some states may refer to it as GAL (Guardian ad Leitem). I believe every state has a program. 

The CASA serves as the “eyes and ears” of the judge for children in foster care. Volunteers spend time with the child or children. They conduct thorough research on the background of the case, review documents, interview everyone involved, including the child & monitor needed services. They make reports to the court, recommending what they believe is best for the child & provide the judges with information that will help them make an informed decision. 

I completed the 5-week training last summer and am currently working my first case. You're a bit of a social worker, detective, and above all an advocate for the child. In my area, you usually only have one case at a time. The DHS workers and attorneys have multiple cases and usually aren't able to focus enough attention on each individual case. That's where the CASA can make a difference. 

The time requirement is up to you, but they do require you meet at least once a month face - face with the child. Personally, I don't know how you can make recommendations with only one visit a month, but that is a case-by-case decision I am told. Again, I'm only on my first case, but I think it's going to be very rewarding and at times, a difficult experience. For more information I highly recommend you check out the book "Three Little Words" by Jenny Holiday. It sheds some light on what benefit a CASA can be.

Submitted by: Jennifer Naslund

Who stole the cookie from the cookie tin?  I am sure this is the question grandma asked herself every time a grandchild visited her kitchen on Fremont Avenue.  I am not sure how she managed to keep her cookie tin full of cookies every time a visiter stopped by, but it was always stashed with the best cookies.  Below is one of my favorite Grandma Cookie recipes that has become a staple in our house every Christmas.

DESCRIPTION

These Chewy Ginger Molasses Cookies are easy to make, super-soft and chewy, and irresistibly delicious.

INGREDIENTS

• 3/4 cups Shortening/Butter
• 1 cup Sugar
• 1 Egg
• 1/4 cup brer rabbit molasses
• 2 cups Flour
• 2 teaspoons baking soda
• 1 teaspoon Cinnamon
• 1/2 teaspoon cloves
• 1/2 teaspoon Ginger
• 1/2 teaspoon Salt

INSTRUCTIONS

1. Cream Shortening/Butter, Sugar, Egg, and Molasses. Add remaining ingredients and chill for several hours.
2. Roll into 1 inch balls and roll in granulated sugar.
3. Place cookie dough balls on an un-greased cookie sheet and bake at 375 degrees Fahrenheit for 8-10 minutes or until the bottom is lightly brown. Best if baked until chewy, not crunchy. DON'T OVERCOOK.

Printable Recipe Link

Article By: ALYSHA KLEIN

Keeping up with our health is very important, that’s why we do yearly check-ups. But have you ever thought about a financial check-up? Financial check-ups are a great way to be sure that you and your family are on the right financial track. Here are 13 steps to help get you started.

1. Track spending to know where your money goes. Identify expenses that can be reduced or eliminated - and take immediate action.
2. Expect and prepare for emergencies. Aim for six months’ worth of expenses set aside in a liquid account.
3. If housing costs are too high, consider downsizing, renting.
4. Communicate about family finances regularly with your spouse or partner, and any of your children you feel are old enough to be involved.
5. Do not try to "keep up with the Joneses."
6. Explore nanny share care, babysitting co-ops, and subsidized daycare. Childcare is the single largest expense for most working parents, so investigate all reasonable options.
7. Explore whether you would be financially better off if one parent were to be a "stay at home" or a "work from home" parent.
8. Unless you have endless funds, accept that you can't buy everything you want for your child. This is often harder than it sounds.
9. Remember that you are the single greatest role model in your child's financial education. He or she will remember everything, from arguments about money to how you deal with debt. Teach good habits now.
10. Pay for unreimbursed medical expenses and dependent care with pretax dollars using a flexible savings account. Check with your employer for availability.
11. Commit yourself to spending within your means. A line of credit should never be confused with an emergency fund or extra income.
12. Remember - you are not being "cheap" for the sake of saving a few dollars. You are doing it for the well-being of your family over the long term, and will come out ahead by doing so.
13. Get professional assistance and support. Contact Tropical Financial for a free financial health check up to help you prioritize your expenses and understand debt repayment options.

Just as we practice good health tips, it’s also important to be sure we are practicing good financial health too. Think about these 13 tips and how you can apply them to your life and your current financial situation now.

Check out the article here.