When Kathy Parker was diagnosed with breast cancer – her second form of cancer in 10 years – she knew she had the strength to pull through.

Thanks to a vigorous exercise program after her prior bout with a rare cancer called vulvar sarcoma, Parker felt more prepared than the average person. She was ready once again to show cancer “who’s boss.”

“I made it my mission to be able to run again, and I had the attitude that I was going to ‘show’ cancer,” said Parker, who lives in Athens. “I wasn’t going to let it beat me.”

That’s part of the reason she decided to join a University of Georgia study about fatigue and pain in post-menopausal women and breast cancer survivors – to help other women do the same.

In August 2012, there were more than 2.9 million breast cancer survivors in the United States. About 12 percent of women will develop invasive breast cancer during their lifetime, according to the American Cancer Society. In 2012, an estimated 8,907 Georgians were diagnosed with the disease.

“I’ve been in a position as a breast cancer survivor to promote participation in clinical trials, because it’s one of the only ways we learn about different medications and protocols,” Parker said. “I felt that it was both interesting and a way that I could make a contribution.”

The Body Composition and Metabolism Lab in UGA’s kinesiology department, which primarily focuses on women’s health, started a new study this spring that will investigate whether breast cancer survivors have a lower tolerance for pain, become tired more easily, and have a smaller range of motion than post-menopausal women who have not had breast cancer. If so, lab members hope to create exercise plans that are tailored to survivors.

“Some women who are survivors may have physical compromise due to muscular damage or removed lymph nodes,” said Christie Ward Ritacco, a doctoral student in kinesiology who is leading the research. “Their mental energy is also impacted, especially when raising a family and at the time of life that’s often the busiest and most important.”

A focus on pain

Ritacco and three other students – Amanda Caravalho Adrian, a doctoral student in kinesiology; Courtney Vickery, a master’s student in nutrition; and Jessica Binkowski, a master’s student in kinesiology – are teaming up on the project. Ritacco fondly calls it her “kitchen sink” dissertation, because it combines previous studies in the UGA lab.

The “novel” piece, Ritacco noted, is testing for pain tolerance in post-menopausal women.

About one-fourth of women who undergo breast cancer surgery have significant, persistent breast pain six months after the procedure, according to a recent study published in the Journal of Pain.

In addition, weight gain and a lack of physical activity after surgery put survivors at risk for long-term pain, according to a study published in December in Breast Cancer Research and Treatment.

Pain is difficult to study because it’s subjective. The researchers will try to standardize pain in this study by using the same temperatures of hot and cold water to measure pain with each participant, Adrian said. “We’re looking for a difference between those who are physically active and not, those with a healthy diet, and those who’ve had breast cancer.”

Ritacco and Binkowski use machines to measure women’s range of motion during exercises that mimic everyday tasks such as closing a car trunk or kicking a ball. After each exercise, the participant measures her feelings of pain and fatigue based on the standardized scale.

Studies like this are important because compared to men, “women have higher rates of obesity, physical disability and are less functionally able,” said Ellen Evans, an associate professor of kinesiology in charge of the research lab. “We outlast men, but we don’t live as well.”

Volunteers being sought

After the cross-sectional study, Ritacco and Evans hope to conduct a longitudinal study, the kind that will follow the breast cancer survivors over an extended period of time. The researchers will use that to create an exercise and nutrition program for the women.

While conducting this year’s pilot study, Ritacco and Evans plan to find 90 survivors between 45 and 65 in the Athens area to test and evaluate their program.

Evans is developing collaborations with Athens Regional Medical Center’s Loran Smith Center for Cancer Support and the University of Alabama at Birmingham Comprehensive Cancer Center to create a breast cancer research focus and multi-center clinical trial.

For Evans and Ritacco, the research combines their professional expertise with a personal passion. Evans has a family history of breast cancer, and Ritacco’s aunt was diagnosed at age 35 and survived for 10 years.

“I like doing research that has an application in the community and puts a smile on someone’s face,” Ritacco said. “When I can tell people, ‘If you try this, you may feel better,’ I feel good as a researcher.”

Ritacco hopes to see initial results this spring so she can begin planning for the next study that follows breast cancer survivors.

The lab is still looking for study participants. If you or someone you know would like to participate, contact the lab through uga.bcml@gmail.com or 706-389-4272.

Carolyn Crist is pursuing her master’s degree in Health and Medical Journalism from the University of Georgia. She graduated from UGA in 2010 with degrees in newspapers and English and worked at The Times in Gainesville  as an education and political reporter.

Carrollton elementary school children enjoy a healthy lunch. Photo by Jodi Murphy

Cole Cook stands out among his peers.

At 17, he’s already 6 feet 6 inches tall and weighs 228 pounds. The high school junior is a tight end on the Carrollton High football team and being aggressively recruited by some of the best college programs in the country.

Not surprisingly, Cook has a healthy appetite. But in this era of “lighter” school meals, does a fast-growing teenager in a calorie-burning sport get enough to eat in the lunchroom? Or does he leave the table still hungry?

Cook says he does just fine.

He praises the program instituted by the Carrollton High nutrition director, registered dietician Linette Dodson, and her staff. He says it meets even his exceptional needs.

“They really give me good protein and nutrients and good carbs, so I can make it through practice and not cramp up or go down because of lack of nutrition,” Cook says. (The program does not have a special meal for athletes, but everyone has the option to purchase extra servings.)

But this school nutrition program has done more than win over a star athlete. It has won national acclaim – for its healthy offerings. Its success is proof that it is possible to maximize nutrition while satisfying student appetites.

A push for higher standards

In 2010, the national Healthy, Hunger-Free Kids Act was implemented, allocating $4.5 billion to help schools meet new nutrition standards. The bill puts strict requirements on the food that can be available to public school students, mandating that it be higher in nutritional value and lower in empty calories.

Although many school systems struggle to meet the requirements of the act, Carrollton City Schools are exceeding expectations. In spring 2012, the USDA recognized Carrollton City Schools for reaching Gold status in the Healthier US Schools Challenge. The requirements for Gold are more rigorous than those of the Healthy, Hunger-Free Kids Act.

Carrollton is the only school system in Georgia to achieve this status. Nationwide, less than 3 percent of schools that took the challenge reached this achievement.

“We went to offering as many whole grain options as we possibly could,” says Dodson. “The regulations say 50 percent, but we’re trying to get to 100 percent, and some of our limitations are just availability of products. So, as those become more available, we’re getting very close to having 100 percent all whole-grain items.”

Grants provide funding for schools to get fresh produce from local farms and gardens. And the federal Hunger-Free law increased the number of children who qualify for free or discounted lunches and reimbursement for after-school meals.

American youngsters are accustomed to diets high in sugar and starch, and complaints about school lunches are as old as public schools themselves. So some pushback against the new standards was probably inevitable. And it has come.

Many students around the country now complain that school lunches are no longer satisfying. A group of high schoolers in Kansas, expressing their displeasure through satire, created a video called “We Are Hungry” – a parody of the song “We Are Young.” It showed them appearing to collapse from hunger because of skimpy school food. The video has been viewed more than a million times on YouTube.

Dodson ensures that the meals in the Carrollton City School System are sufficient that students won’t be left hungry, and that the food exceeds nutritional standards. She admits, however, that student tastes have to be reckoned with. Feeding kids things they’ve never seen before can prove difficult, she says.

“Obviously, if they haven’t been introduced to it at home,” says Dodson, “being introduced to it at school can be a little challenging.”

Dodson insists on providing her students with the very best in nutrition, regardless of initial reactions to some new foods.

“The application process for the Healthier US School Challenge certainly made us re-evaluate menus and make some adjustments by offering very specific vegetable subgroups,” Dodson says.

The “new” foods have won many students over. Although the school lunch purchase rate has remained the same, the number of items picked up in the line, such as fruit and vegetable sides, has increased. The number of students eating breakfast at school has increased as well.

Getting the kids involved

The key to success in the nutritional program lies in empowering the students.

Students are educated on nutrition in science and physical education classes. They are given an increasing number of choices as they progress from one school to the next. Bulletin boards and posters remind students of healthy food choices. Students on each school’s Nutrition Advisory Council are even consulted on new recipes and cooking techniques suggested by local chefs.

“We do a lot of nutrition ed within those groups,” says Dodson, “And then we let those students be ambassadors for our program to the other students.”

Students aren’t the only ones to benefit from the new lunches. Food services employee Keila Carter enjoys seeing elementary school students happily eating carrots and has gained enthusiasm for her own health.

“I find myself eating more fruits and more vegetables,” Carter says. “Instead of taking some chips or some cookies, I find myself eating carrots or celery.”

Buying higher-quality foods is generally more expensive, but some of that cost has been offset by the numerous grants that Dodson has acquired, including a USDA Planning Grant, which will allow her to serve more food purchased directly from local farms.

Dodson has also dealt with the financial loss brought on by eliminating some vending machine items. (Machines no longer offer candy or chips, and the drink machines are limited to water and 100 percent juice.) Money from the sale of stickers, T-shirts and other school spirit items have made up for some of those losses.

As her work gains ground within the schools, Dodson hopes the principles of nutrition will prevail throughout the community. Her next projects will work toward increasing partnerships to build community involvement.

But as always, Dodson’s primary concern is the students.

“I hope that we’re laying a foundation [for] healthy choices that will follow them throughout their life.”

Jodi Murphy is a graduate student at the University of Georgia Grady College of Journalism and Mass Communication, pursuing a concentration in Health and Medical Journalism.  She is particularly interested in environmental and global health, as well as women’s issues.

As a junior in high school, Erica says, “I was the All-American girl.’’ She had solid grades, came from a good family, and played varsity girls’ sports at her Gwinnett County school. That’s when she met the guy. “He was cute. He was really sweet,’’ she says now, 10 years later. “He really wooed me.’’ The two started dating. After a while, her boyfriend started calling her constantly during the day. “If I didn’t answer or have time to talk, he would get really mad at me and call me names,’’ says Erica, now 26. “And he started making me feel bad because I was playing so many sports,’’ she says. He also grew upset about her spending time with friends. After a few months of dating, he began hitting her. Erica’s story demonstrates the abuse that a high number of teenage girls suffer while dating. “Teens think domestic violence happens to adults, not them,’’ says Laura Barton, prevention and outreach director for the Decatur-based Partnership Against Domestic Violence (PAVD). But that’s far from true, particularly in Georgia. The anti-violence group, citing data from the CDC, says Georgia leads the nation in teen dating violence. Dating violence is defined as the use of physical, sexual, emotional or verbal force by one dating partner toward another. It can include threats, constant text messaging or instant messaging, cyber-stalking, insults, isolation from family and friends, sexual abuse, name-calling, emotional abuse and controlling a partner’s behavior and appearance, the PADV says. The organization’s goal is “to try to turn victims into survivors, and help them get control back into their lives,’’ Barton says.

A problem that’s often unrecognized

Trouble within a relationship is not always easy for an outsider to assess. The point at which disagreements turn into verbal or emotional abuse can be hard to define. Sometimes there is mutual abuse, or there are mutual accusations of abuse that are difficult to untangle. But many teenagers who are in toxic relationships know when something is wrong. And statistics prove how serious the consequences are when abuse occurs. One in three Georgia teens is a victim of violence in a dating relationship, Barton says. Teen dating violence is very similar to adult domestic violence, which is experienced by one in four women, Barton says. Georgia ranks 10th in the country for its rate at which men kill women in single-victim homicides – and many are domestic violence murders, according to the Violence Policy Center, a Washington-based non-profit Friends of a possible victim should look for whether their friend is withdrawn, whether she is constantly reporting back to her partner, whether she has unexplained injuries, Barton says. Erica says her boyfriend never hit her in the face – the blows came to her arms, legs, neck. “He made it seem like it was my fault,’’ she says. “I was so in love with him that I believed it wouldn’t happen again.’’ Instead, it happened more frequently. Erica never told her friends or family what was going on, even when her mother questioned the bruises on her legs and arms. “I was embarrassed,’’ she says now. But what was worse than the physical abuse, she says, was the emotional scorn she suffered. “Most of the time, I would rather had him hit me [than say] the words – like, ‘You are worthless.’ ‘You are not as pretty as this person.’ ’’ He also called her “a whore,’’ she recalls. She stayed with him almost a year and a half before she broke up with him. Then Erica started “self-medicating’’ herself with alcohol and prescription pills. “I didn’t feel anything,’’ she says. “I lost who I was.’’ And she went back to him again briefly, for three weeks. “It all went back to how it was,’’ Erica says. It finally ended one night when he attacked her again, she says. She was able to flee his vehicle and told her parents about the abuse. They helped her get into therapy. “I built my self-esteem and self-worth back up,’’ she says. But the recovery was far from swift. She had depression, post-traumatic stress disorder and a substance abuse problem. And she had anger that she had to let go. “Three years afterward, I’d have nightmares.’’ She learned that it wasn’t her fault. “I can’t change what happened in my past,’’ Erica says now. “I can change my future.’’

Part of the solution

Erica is now married to a man who is supportive and caring, and they have children. She still has some residue of anger. Drawing on her own experience as a way to help others, Erica now talks to girls and women who are dating abusive people. “People don’t realize how frequently it happens to people in high school,’’ she says. Barton of PADV says that like Erica, many women go back to their men several times before they leave for good. “Many go back with the hope they can change their partner,’’ Barton says. Teen dating violence doesn’t have to include physical hitting, she adds. “Emotional abuse sticks with them longer.’’ Her organization tries to educate teens about healthy relationships – about boundaries, trust and honesty. PADV offers a 24-hour crisis line for victims and their friends and families. (404-873-1766). The nonprofit can help teenagers and adults get into an emergency shelter, if needed. Support groups are offered, and victims can be connected to counselors. Violence among teens in domestic and dating situations is “one of the greatest public health issues out there,’’ Barton says.

Med students in Athens want to maintain their fitness levels while studying to become doctors

Med student Brian Brewer is working on a body — his own.

He grips the pull-up bar and slowly uses it to raise himself, then goes back down and repeats the procedure. After completing a set of pull-ups, he drops to the floor for pushups. He follows that with core training to work his lower back and abdominals.

Keeping fit has been a lifelong habit for Brewer, a former “walk-on’’ running back on the UGA football team. Now, at age 25, he’s a second-year medical student at the Georgia Health Sciences University-University of Georgia Medical Partnership in Athens. And although his workout routine has evolved since his gridiron days, he still does an hour of exercise five days a week.

“I feel like it’s very important to be almost like a guide to the patient on physical fitness, because it can be used in so much prevention work,” Brewer said.

Once he becomes a practicing physician, he plans to be a fitness role model for his patients.

It’s widely known that physically active people are healthier overall than people who are sedentary. To note a few medical specifics, active people are less likely to gain excess weight, and they have a smaller chance of developing chronic conditions such as high blood pressure, diabetes and heart disease.

But while fitness is important, doctors have not always gotten that message across to patients.

Although U.S. doctors are giving their adult patients more advice on exercise than they used to, only about a third of all doctor-patient encounters in 2010 included such counseling, according to a report published by researchers at the CDC.

“If exercise is a viable option it would be mentioned, or should be mentioned, by a physician,” said microbiologist Brian Higgins, Ph.D., an assistant professor at the Medical Partnership. “There are definitely going to be patients who have to clear a few other physiological hurdles before they approach exercise.”

An embarrassed silence?

Out-of-shape patients are only one part of the equation. Doctors’ own sedentary habits can be an issue.

Physically inactive doctors are more likely to sidestep the subject of exercise than are fit physicians, according to an international study published in the British Journal of Sports Medicine in 2008. The researchers found that physically active doctors were more likely to encourage and motivate patients to do the same.

“I think it’s a lot easier to communicate the importance of it to a patient if you are physically fit,” Brewer said.

In addition to its physical benefits, staying active improves mental health, aids in sleep and can sharpen learning and judgment, according to the CDC.

“Basically, you would expect exercise to enhance cognitive function,” said UGA psychology professor Philip Holmes, who chairs the interdisciplinary neuroscience program at the university and teaches at the medical school.

Holmes, whose research focuses on the effects of exercise on brain function, also believes medical students can benefit from the stress relief that exercise provides.

Exercise enables people to let off mental steam, decreasing their stress and helping protect them against mounting anxiety or depression.

“We’re constantly sitting and studying,” said Brewer. “I think sometimes we just want to get up and move so we can reset.”

Medical school is so time-consuming that students can feel they have time for nothing but classes and studying. Once doctors enter practice, they often cite their busy schedules as an obstacle to keeping fit.

But Brewer is not the only GHSU-UGA med student who makes physical activity part of his daily routine.

When the clock strikes noon on weekdays, some medical students converge on Pound Hall, the cardio and strength training facility on the new Health Sciences Campus.

“Because the students have structured their schedules so well, depending on the time of day it is at Pound Hall, I can tell you which students are going to be in there,” said Higgins.

Some of the students grab basketballs or volleyballs from a bin by the door and head down a ramp into Wheeler Gymnasium, where the sounds of practice and competition soon resonate.

By 1 p.m. the rush is over. The medical students are back at their studies and Pound Hall is quiet again — until the next surge of activity.

Building doctors’ confidence

The Medical Partnership’s student body includes people with all sorts of exercise experience. Some were into running or cycling before they began medical school. Some competed in sports, including football, soccer and rowing.

Most of these people want to maintain their fitness levels while studying to become doctors, Higgins said, but they’ve had to dial back their workouts “because they just don’t have the same kind of time.”

Lack of confidence in their own counseling ability, or recognition that they don’t practice what they preach, can keep doctors from offering exercise advice. To counter this, the American Medical Association offers continuing education activities to medical students and practicing physicians, as well as a “personal health toolkit,’’ a sort of manual for doctors.

This guide, written by physicians and scientists, lays out what it takes to maintain a healthy lifestyle, including the 150 minutes a week of moderate-intensity activity recommended by the CDC.

Although 150 minutes sounds like a lot of time, especially for the busy and the tired, it doesn’t have to be one big block. Instead of a single long session, the activity can be spread out during the week. The CDC says short bursts of moderate or vigorous activity are beneficial if they last at least 10 minutes each.

“I don’t think the exercise has to be really strenuous to be beneficial, so they may not have to exercise to the point of being tired,” said Holmes. “Even if it’s just 20 minutes or a half-hour a day, that may be enough to get the benefits.”

Lacey Avery is an independent journalist and graduate student at the University of Georgia pursuing health and medical journalism. Avery also works with Georgia Sea Grant, a program that promotes research, education and outreach on the Georgia coast; additional work can be found at laceyavery.weebly.com.

Allison Tackett, 27, died of lung cancer recently. Her parents urge people to get their homes tested for radon with a kit such as the one pictured above.

Three years ago, Gail Dobbs had a CT scan done for an abdominal problem. The test showed something unexpected — a small spot on her lung.

It was lung cancer.

Dobbs, who had never smoked, was stunned to have a health problem that people commonly associate with smoking. She had surgery to remove the small growth.

At the urging of her son, she also had her home tested for radon, an odorless, radioactive gas that can cause lung cancer.

The radon readings in their Monroe home registered a high rate — more than 4 picocuries per liter. That led her to believe that radon created her problem.

Radon, a naturally occurring element, is the second-leading cause of lung cancer. (Smoking is first.) In the United States, radon is estimated to cause more than 20,000 lung cancer deaths a year.

The danger begins in the ground. Radon comes from the natural breakdown of uranium in soil, rock and water.

Because radon is a gas, it can seep from the ground and into homes and other buildings. It typically enters through cracks and other holes in the building’s foundation. A building can trap radon inside, causing the gas to build up and be inhaled by the occupants.

Georgia’s estimated radon-linked deaths are higher than those of other Southeastern states, says Becky Chenhall of the University of Georgia Cooperative Extension’s radon education program.

“A lot of people don’t know that radon is deadly,’’ says Chenhall. “It’s a silent killer.’’

Dobbs, 61, says she’s fortunate her cancer was caught in time. “I call it my miracle,’’ she says.

A nationwide menace

For a problem that so often goes unnoticed, radon contamination is common. One in every 15 homes across the U.S. is estimated to have an elevated level of radon, the EPA says. In Georgia, the northern third of the state, which has a great deal of granite, is where most of the high levels of radon are found.

Gov. Nathan Deal recently proclaimed January as Radon Action Month in Georgia, urging everyone to test for radon.

Test kits cost $8 to $10, depending on where you get them.

The average indoor radon level is estimated to be about 1.3 picocuries per liter. The EPA recommends that a home be fixed if its radon level is 4 or more.

Don Linke of Gainesville, a retired airline pilot, felt compelled to test for radon after a neighbor’s home got a high reading. The Linke home registered readings of 7.7 and 8.0 in separate tests. “I thought, I better do something,’’ he says now.

He advises homeowners to educate themselves, get guarantees written into a contract, and monitor the work that is done.

Remediation can cost $2,000 or more. Dobbs paid about $2,000 to fix her property. “It’s well worth the money,’’ she says.

An elusive culprit

Many states require home sellers to disclose whether the property has been tested for radon or has a known radon hazard.

There’s no such regulation in Georgia, says Ginger Bennett, a Hall County-based UGA Cooperative Extension employee. “It’s not regulated in any shape or form,’’ Bennett says.

She also says the link between radon and lung cancer can’t be clearly delineated in individual cases.

“You can’t look at [cancerous] tissue and say, ‘This was caused by radon exposure.’ ’’ Bennett says.

Ann and Randy Tackett recently lost their daughter Allison to lung cancer. She was 27, and did not smoke.

When Allison was diagnosed, her physician recommended that the Tacketts test their Athens home for radon. “We were dumbfounded,’’ Ann Tackett says. “We didn’t even know radon was a problem.’’

The reading was above average, at 3.1.

The Tacketts, though, are also considering the possibility that Allison’s cancer could have been also caused by a genetic mutation.

Neverthless, the Tacketts urge people to be aware of radon’s dangers and get their homes tested.

“Just see if your house has radon,’’ Ann says. “If it does, get it fixed.”