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Show TTT Messenger-Enterpris- Pastoral Counseling Seen As Important James W, Hanson, M.D. and Elizabeth J. Thomson, R.N..B.S.N. Division of Medical Genetics Department of Pediatrics University of Iowa Iowa City, Iowa By In the five years since the Iowa Legislature appropriated funds for support of a Regional Genetic Con-sultati- Service, we have developed a network of 15 clinic sites throughout the state. The impact of this program can be seen in the increased number of families served since 1976. Before we had these regional clinics, there were about 300 patient visits here at Iowa City where the program is based. By 1980, these visits had increased to 1700 throughout the state. We serve families with a wide variety of birth defects. To help them fully, the RGCS provides diagnostic services and intensive counseling about the genetics of the disorder, medical management of the condition, reproductive alternatives, available support services, and plans for further follow-uIn addition to providing medical information, we are deeply aware of the human concerns raised when birth defects occur in a family. Our staff encourages pastoral counseling e for families facing such social and physical, emotional, financial problems. The risk of recurrence is a primary question. Our counseling is We do not tell people what to do. Instead we try to give them all the information available so they can arrive at their own decision. It is important that they choose the course of action which seems best for them in view of their family gqals and their ethical and Another significant problem families encounter is dealing with the grief process. Grief (denial, anger, guilt, depression) is a natural reaction to having a child with a birth defect. Families require a great deal of support in order to begin to cope with many of these feelings. Pastoral counseling provides one alternative in the process of dealing with this type of grief. When families visit our program here at the University, or at regional clinics, we encourage them to bring along support persons. This means that they can or will have an informed resource person who can discuss their problems with them p. long-rang- e. once they have left the clinic setting. Since so many people seek pastoral guidance in times of crisis, we are delighted when families bring with them someone in whom they have such confidence. During our genetic counseling sessions, we are able to share the prognosis with their religious advisors who can then combine a grasp of the medical problem and the spiritual values of the family. The religious leaders in Iowa have expressed strong interest in working with us. We are planning a followup seminar to a Pastoral Concerns Day on Genetics, Society, and Medicine, that we assisted in providing at Mercy Hospital Medical Center in Des Moines. The program was offered to clergy, physicians, registered nurses and other health care professionals. Much of our own awareness about the value of pastoral care in genetic counseling came from Dr. Wayne Clark, a United Methodist minister. He came to us for genetic counseling because he had children with birth defects. Dr. Clark instantly recognized that he, as a by Dale O. Nelson, Professor Health, Physical Education ' and Recreation Utah State University The March 31 deadline for removal of studded snow tires from vehicles in Utah has been permanently extended to April 15 by the Utah Transportation Commission. Until now, tires with tungsten carbide studs have been allowed on Utah roads between October 15 and March 31. The Transportation Commission has occasionally extended the deadline to April 15 in years when Utah has received above average snowfall or late winter storms. Studies show that studded snow tires wear down roads more quickly than conventional tires so time limits were placed upon their use. However, tax revenues generated by the sale of studded snow tires in Utah fell in recent years indicating that the number of studded tires being sold had dwindled. The tax was subsequently abandoned State by the Utah Legislature in 1981. The popularity of tires lessened the Commissions concern about wear and tear to Utah roads due to studded tires. The Commission will recommend that the Utah State Legislature consider lifting the ban on studded snow tires altogether. er Shop afl Homo! or one glass of wine). Dr. Beilin measured a one point rise in blood pressure. He found that people who drank even minimal quantities of alcohol had higher blood pressures than teetotalers, and hypertension (defined as blood pressure over 14090 was four times greater in heavier drinkers than among More specifics Of 260 men in the study who consumed more than three glasses of beer a day, 10.4 percent had systolic blood pressures (upper number of blood pressure reading) over 140, compared to 2.6percentof 117 nondrinkers. Diastolic pressures over 90 (the lower number) were found in 10 percent of the high alcohol population and only 3.4 percent in the nondrinking group. Additional hypertension correlates Since we have highlighted high blood pressure, a glaring heart disease risk factor, lets not lose sight of the American salt problem. In the U.S. today, the average adult consumes two to two and a half teaspoons of salt a day, more than 20 times what your body ' needs. , Dr. Lot Page, Chief of Medicine at the Newton-Wellesle- y Hospital, says. The link between salt and hypertension is as firm as the link between high cholesterol and heart disease." A final reminder, too, smoking and obesity also contributed to high blood pressure. The bottom line in the research literature today is that you should adjust your life style toward being a thin, The American Heart Association reports that more than 40 million Americans have some form of heart disease requiring treatment. Also, the report estimates 35 million people have high blood pressure, a major risk factor in the development of heart disease, our No. 1 killer. With this information plugged into your computer, you may recall the media has consistently made a big deal of the beneficial effects of drinking alcohol (in moderation) for the prevention of heart disease. Yes, it does raise the high which density lipoproteins-cholestro- l, seem to play a favorable role in helping our bodies process the abnormally large amount of undesirable low density lipoproteins-cholestrol. But this makes alcohol appear to be a long lost friend rather than what it really is. The dark side of the coin S By Dr. Henry L. Nudler Dean and professor of Pediatrics Wayne Stale University Medical School Detroit, Michigan Genetics. A word that people often hear now, and one that is sometimes confusing and misunderstood. For Ruth and Dennis Nasiopulos, genetic counseling enabled them to understand why past pregnancies had ended in miscarriage. This had been a bitter to them because disappointment they were eager to become parents. In time they did, and they are now parents of a lovely daughter, Hara Niki. Her birth followed our diagnosis that Mrs. Nasiopulos was not a woman with an unexplainable history of miscarriages, but a woman with a rare genetic history. Mrs. Nasiopulos was referred to Childrens Memorial Hospital in Chicago by a physician who treated her after her last miscarriage. At the time, I was head of the Genetics Division there. Over a nine-yea- r period, Mrs. Nasiopulos had had Each one ocfive miscarriages. curred during the first trimester. Because of the sadness that accompanied each miscarriage, one doctor advised them to adopt a child rather than risk the pain of repeated disappointment. But her last doctor correctly believed that her inability to carry a pregnancy to term required more careful study. Today, genetic services offer a wide range of specialized diagnostic procedures. This growth in services has happened since 1970, when there were fewer than 10 centers in the country. The March of Dimes Birth Defects Foundation, through public contributions, has provided grants to medical centers around the country that helped set up more than 100 such programs. Their availability has made it possible to assist couples such as Ruth and Dennis Nasiopulos. When I saw Mrs. Nasiopulos for DR. HENRY L. NADLER, chairman of the Genetics Division at Northwestern University, greets Hara Niki, and her mother, Ruth Nasiopulos. Genetic counseling enabled the Nasiopulos to have their long-desire- baby. the first time, I noticed that she had some minor facial, dental and hand abnormalities. They were not particularly obvious; an untrained observer would not find anything unusual about her appearance. For a geneticist, though, it was something to consider. Genetic counseling for the couple began with a family health history of both Mr. and Mrs. Nasiopulos and chromosome analysis for each. We learned that the husband had no but that unusual characteristics Mrs. Nasiopulos had a rare genetic makeup. The mild, barely discern-abl- e small features that I had noticed at our first meeting, and which did not affect her, were diagnosed as syndrome Type 1 (OFD-1- ). Her chromosome analysis, taken from blood samples, showed that she also had a 47, triple X karyotype. This extra X chromosome could cause mental retardation in any child she might have. In discussing this information, we told the couple that OFD-- 1 is indominant herited as a trait which is fatal in males. It was highly likely that some if not all her previous pregnancies had been sons. If Mrs. Nasiopulos became pregnant and carried beyond the first trimester, she would probably be sex-link- carrying a girl. As unusual as her genetic history was, it still did not rule out the possiblity of her having a son without any trace of OFD-1- . However, there was still a high risk of either a son or daughter inheriting one or both of the genetic traits she carried. Mrs. Nasiopulos became pregnant in November 1979, almost a year after she and her husband first came to see us. Her pregnancy went beyond the first trimester and amniocentesis showed that she was carrying a daughter who was perfectly normal. Since Hara Nikis birth, Mrs. Nasiopulos tells me that the babys grandparents never tire of photographing her. Her parents find the her genetic history surrounding birth often is a complicated one to explain to friends, but they are happy to try if it will help other couples. Genetic counseling cleared up years of repeated disappointments and lack of information about why they could not have a baby. As we continue to learn more about the science of genetics, all of us in this field look forward to being able to help other couples like Ruth and Dennis Nasiopulos. Did you find that s. addition to all of the well known detrimental effects of alcohol on man and society, it also plays a significant role in the onset of high blood pressure. According to Dr. Lawrence J. Beilin of Australia, alcohol consumption ranks close to obesity as a preventable cause of hypertension. He and his associates found a direct relationship between alcohol consumption and high blood pressure rise. In active, ofbeer consumed a day nonsmoking, nondrinking vegetarian. Is there any better time to get started than now? (equivalent to one ounce of hard alcohol Ths t is only ens way. to was getting ready since but youre from close, on in, come out of town, Well, extended m Fitness Update For each glass deadline pastoral counselor, could have a role in caring for the emotional needs of families with birth defects. In fact, he designed his own to learn more about clinical genetics, genetic counseling, and the contributions a minister might make. Sister Margaret Ann McManus, Ph.D., genetic counselor at Mercy Hospital in Cedar Rapids, and the Reverend John Boyle, Ph.D., director and associate professor of the School of Religion here at the University, also believe those who provide pastoral care can have a role in providing this important supportive care. We also work with the Reverend Dr. Russell C. Stiffier, director of chaplaincy at Saint Lukes Methodist Hospital in Cedar Rapids. This spirit of cooperation with the pastoral community in Iowa has been important to all of us. Recently, the March of Dimes Birth Defects Foundation sponsored a seminar at Georgetown University in Washington, D.C., on Genetic Decision Making and Pastoral Care for interdenominational clergy frtm around the country. The March of Dimes has funded genetic service programs nationwide, including the University of Iowa, over the past 12 years. The religious leaders with whom we have been dealing either have had personal experience of birth defects in their own family or have worked with families who have had affected members. We believe they have a clear idea of what these families encounter in their communities and how pastoral counseling can help them. By identifying these concerns, we can begin to ease apprehensions and fulfill some of their needs. religious standards. 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