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2 Gazette Health | Spring 2014


A publication of The Gazette and Gazette-Star | Spring 2014 Editor

Anna Joyce


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Spring 2014 | Gazette Health 3

By 2030, those 65 or older are expected to account for 20 percent of the U.S. population. -NIH

Use Laxatives with Caution


he U.S. Food and Drug Administration (FDA) is warning consumers not to order medicines from websites that claim to be Canadian pharmacies, saying most are not legitimate, and the drugs they supply are illegal and potentially dangerous. Claiming to be a Canadian pharmacy is one of the hallmarks of sites that sell illegal prescription drugs which, in many cases, are not made in Canada at all, but in a number of other countries. Even if an online Canadian pharmacy is legitimate, U.S. citizens may not want to order from it because it is generally not legal for individuals to import prescription drugs from other countries, according to the FDA. Medicines offered by these sites are often stolen or counterfeit, said Special Agent Daniel Burke of the FDA’s Cybercrimes Investigations Unit. Unsuspecting consumers may be buying a medicine that does not have the active ingredient that will make it effective, or it may have undisclosed ingredients that could endanger their health or even be life-threatening.

4 Gazette Health | Spring 2014

In June, the FDA, working with other law enforcement agencies, seized and shut down 1,677 illegal pharmacy websites. Many of those appeared to be operated by a criminal network that represented itself as various Canadian pharmacies. The medicines sold on these sites were described as “brand name” or “FDA-approved” when they were neither, the FDA reported. Products purchased by federal agents bypassed safety controls required by FDA, including that they be used with a valid prescription and under the supervision of a licensed health care provider. Some of the illegal sites used the names of well-known U.S. retailers to trick consumers into believing that there was an affiliation with those stores. Examples include and The banner of FDA’s Cybercrimes Investigation Unit is now displayed on the seized sites to identify them as illegal.

For more information, visit


More Reasons to Get Moving Older women who spent the most time being sedentary—defined as sitting or resting, but not sleeping—were at risk of dying sooner than those who were most active, according to a study by Cornell University. In the study of more than 93,000 women, those who were sedentary 11 hours a day were 12 percent more likely to die prematurely from any cause than those who spent only four hourss or fewer sitting around. The he most sedentary group oup also increased its risk sk of premature death ath from cancer by 21 percent.


Beware of illegal online pharmacies

Those over 55 and others with certain health conditions should ask a health care professional before using sodium phosphate laxatives to relieve constipation, as those who take them may be at increased risk for harmful side effects, according to the U.S. Food and Drug Administration (FDA). At particular risk are those who are taking certain drugs that affect how the kidneys work, such as diuretics or fluid medicines; certain medi inhibitors used to in lower blood preslo sure; su angiotensin II receptor recep blockers to treat high blood pressure, heart nonsteroidal antior kidney failure; and n inflammatory drugs (NSAIDs), such as ibuprofen. Those with inflammation of the colon are also at higher risk of complications, which include dehydration and kidney injury, according to the FDA. The most serious harm in recent reports occurred after consumers took higher than recommended doses of these laxatives. “The bottom line is that these products are safe for otherwise healthy adults ... as long as they follow these dosing instructions,” the FDA’s Mona Khurana, M.D., said.

In a recent 10-year span, the percentage of older people who received hospice care in the last 30 days of life increased from 19 percent to 43 percent -NIH


Brain training slows decline


raining to improve cognitive abilities— specifically thinking and learning—in older people lasted to some degree 10 years after the training program was completed, according to a study by the National Institutes of Health. The training, however, showed no effect on memory after 10 years. “Previous data from this clinical trial demonstrated that the effects of the training lasted for five years,” said National Institute on Aging Director Richard J. Hodes, M.D. “Now, these longer term results indicate that particular types of cognitive training can provide a lasting benefit a decade later. They suggest that we should continue to pursue cognitive training as an intervention that might help maintain the mental abilities of older people so that they may remain independent and in the community.”

In the study, volunteers were divided into three memtraining groups—memory, reasoning and g— speed-of-processing— up. plus a control group. At the end of the pants trial, the participants ng in who had training eed of reasoning and speed d less processing showed decline than those in the ol groups. memory and control nitive tests after Results of the cognitive th nearly rl three th quarters 10 years showed that of reasoning-trained participants were still performing those tasks above their pretrial baseline level, compared with about 62 percent of control participants.

This same pattern was seen spe training: About 71 in speed perc percent of speed-trained part participants were performing at or above their baseline level compared with abou 49 percent of those about in the control group. There was no difference in memoper ry performance between the memory group and the control af 10 years. group after Participan in all training Participants th had less difficulty groups said they rf mi the he everyday tasks compared performing with those in the control group. However, standard tests of function conducted by the researchers showed no difference in functional abilities among the groups.



Spring 2014 | Gazette Health 5


GazetteHealth Health| |Spring Spring2014 2014 66 Gazette



Gout most commonly affects middle-aged men and postmenopausal women.



wo years ago, former New York Times food critic Frank Bruni was told by his doctor to cut back on red meat, alcohol and shellfish—all of which figured heavily into Bruni’s job duties—after diagnosing him with gout. The disease unleashed an inflammation in his foot so painful that even putting a sock on felt excruciating, he wrote in a blog. Gout was known historically as “the disease of kings” because of its connection to rich foods and alcohol consumption. In reality, anyone is susceptible to gout as it depends on the ability to excrete uric acid, a waste product created as the body breaks down purines. Naturally found in tissue, purines are also found in many foods, but at higher levels in certain types of meat—like organ and game meats—and shellfish—like scallops and mussels. Alcohol, particularly beer, as well as sugary drinks and packaged foods with high-fructose corn syrup, can also elevate uric acid levels. The disease most commonly strikes middle-aged men and postmenopausal women, according to Rukmini Konatalapalli, M.D., a rheumatologist with Arthritis and Pain Associates, which has offices in Clinton and Greenbelt. Estrogen offers protection from excessive uric acid levels in women before menopause. Of the roughly 3 million Americans suffering from gout, some may be over-producers or underexcretors of uric acid, leading to a condition called hyperuricemia, said Kundan Karkhanis, M.D., a rheumatologist with Shah Associates, a medical practice with offices in Fort Washington and throughout Southern Maryland. But having hyperuricemia doesn’t automatically lead to gout if uric acid levels can be controlled through diet and medication. What leads to a gout flare-up, manifested as painful swelling and redness in the big toe, ankles and other joints, is when uric acid levels in the blood exceed a threshold of 6 milligrams per deciliter, forming needle-like crystals in the joint fluid, Karkhanis said. The body’s immune system goes into overdrive in response to the buildup of uric acid. “Crystals are the triggering factor for the inflammation attack,” he said. These attacks, which Karkhanis said his patients describe as the “most painful experience they’ve had” can last for a few days or up to two weeks, depending on their history—longtime gout patients tend to suffer longer episodes. If gout is left untreated, these crystals can form tophi, chalky deposits that are visible under the skin. Gout is diagnosed by testing fluid from the joints for uric acid, and can sometimes be mistaken for

To Ease or Prevent Gout Attacks:

One doctor said his patients describe gout as the “most painful experience they’ve had.” another form of arthritis called pseudogout, where calcium phosphate, not uric acid, causes pain and swelling, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Patients with gout often present with a laundry list of comorbidities: obesity, hypertension, diabetes and kidney disease, said Konatalapalli. “Diet modification is the major thing,” she said. “The other factor is weight loss.” Hyperuricemia has a strong association with metabolic syndrome, a cluster of conditions like high blood pressure and high sugar and cholesterol levels, as well as excess abdominal fat, according to the Mayo Clinic. In treating gout, “we’re trying to take care of many things at once,” Konatalapalli said. When Karkhanis presents his gout patients with a list of purine-rich foods to limit, their first reaction is, “‘Are you joking? Everything I love is on here,’” he said. Yet even diet recommendations have to be qualified by the fact that certain foods that are good for you—spinach, mushrooms, and legumes—are high in purines. “You don’t want to cut them,” Karkhanis said. “One of the things to know about diet with gout is that it’s not something that’s going to dramatically reduce uric acid levels, but it will reduce the potential for triggers,” he added. continued on 18 GAZETTE.NET


Eat a heart-healthy diet. Avoid foods that are high in purines, such as liver, dried beans, peas, gravy and anchovies.


Avoid high-fructose corn syrup-sweetened beverages and foods.


Drink plenty of water, and limit alcohol intake.


Exercise regularly and maintain a healthy weight.


If you’re overweight, ask your doctor how to lose weight safely. Fast or extreme weight loss can raise uric acid levels.


Tell your health care provider about all the medicines and vitamins you take.


Take prescribed medicines as directed. –NIH NEWS IN HEALTH

Spring 2014 | Gazette Health 7

8 Gazette Health | Spring 2014 8 Gazette Health | Spring 2014





Sun: Main cause of early aging


your body’s largest organ, your skin is both a reflection of the aging process and a mirror of your health. While you cannot completely erase the dermatological sins of your youth, it is possible to slow the more visible signs of aging and improve the vitality of your skin. Time takes its toll on skin. Fine lines and wrinkles appear and the skin becomes more translucent and dry. Intrinsic aging, natural changes in the skin, generally begins in your mid-20s, though there are variations in the timeline “based on race and ethnicity,” said Valerie D. Callender, M.D., a dermatologist with Callender Dermatology and Cosmetic Center in Glenn Dale. “Intrinsic aging is beyond your control. There’s nothing you can do about your heredity and genetic makeup.” “As we get older, collagen production slows down and the skin gets thinner in people of all skin types and nationalities,” said Angela Lotsikas, M.D., a dermatologist with Dermatology and Cosmetic Surgery Associates in Greenbelt. Combine that with elastin fibers that begin to lose their spring and the result is skin that is less able to maintain a smooth, firm appearance and is more susceptible to damage. “Extrinsic aging is something we can have an effect upon,” said Callender, and includes factors “such as smoking, nutrition, and exposure to ultraviolet light.” By making changes, even in our senior years, “we can slow things down somewhat because, with the skin, things are cumulative.” The top cause of premature aging is sunlight, agree the dermatologists. Photoaging stems from repeated exposure to the sun’s ultraviolet rays over a protracted period of time, according to the American Academy of Dermatology (AAD). It accelerates the natural aging process, breaking down existing and impairing the synthesis of new collagen, a protein that gives skin strength and flexibility. It also attacks another protein, elastin. Deep wrinkles and liver spots, as well as leathery or sagging skin, are associated with photoaging. “Excessive sun exposure in childhood and young adulthood sets you up for skin cancer later in life,” said Lotsikas. And skin cancer is not isolated to “those with lighter skin, eyes and hair,” though that is a contributing factor. “Everyone is at risk.” Subtle changes in the skin, which are easy to overlook, “can be potentially dangerous,” said Lotsikas, who recommends an annual full-body skin check by a dermatologist. “From scalp to feet, the skin is checked for anything precancerous. If we catch it early, it can be lifesaving.”

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cumulative. Toxins in cigarettes accelerate the aging of skin, according to the AAD. Smoking causes wrinkles and a dull, sallow complexion. In fact, the repeated puckering required to inhale can cause deep lines around the lips. Even among nonsmokers, repetitive facial movements can lead to fine lines and wrinkles. “Each time we use a facial muscle, a groove forms beneath the surface of the skin, which is why we see lines form...,” according to the AAD website. Frowning, squinting and smiling leave their marks on the forehead, cheeks and chin, and around the mouth and continued on 17

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Spring 2014 | Gazette Health 9


About 18 million Americans suffer from sleep apnea, which makes it as common as Type 2 diabetes. Being ove

Rest for the Weary

How fixing a sleeping problem restored one senior’s energy



he snoring may have been bothersome but the breathing stoppages were downright downrig scary. “My wife would nudge me and I’d start breathing again,” agai said Robert Taylor. Sleep was anything but restful for Taylor and his wife. The lack of sound sleep slee began to take its toll. “I had no energy during the day,” said the 72-year-old Hyattsville resident. “I was tired all the time. It got to the point where just jus getting off the chair to go to the bathroom was exhausting.” Attributing the fatigue to his heart condition, Taylor suffered for nearly two years before mentioning his sleep issues to his physician in 2006. 20 “He sent me to a cardiologist, who ordered a stress test, t which actually turned out fine, from Doctors Community Comm Hospital.” It was there that Taylor met Riad Dakheel, M.D., a board-certified sleep specialist. After listening to Ta Taylor’s symptoms—primarily loud, incessant snoring, acute lethargy, and headaches—and taking his medical history—which included atrial fibrillation and diabetes—Dakheel recommended a polysomnogram or sleep study. Taylor, it appeared, fit the profile of a sleep apnea sufferer. “Apnea,” a word with Latin

“Nothing in medicine is treated as simply and effectively as sleep apnea.”

10 Gazette Health | Spring 2014


Robert Taylor’s CPAP machine, which he’s shown wearing here, solved his sleep apnea problem. He’s regained the energy to travel, and the machine goes along with him.

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Before he got treatment, Robert Taylor would stop breathing while asleep and his wife Marie, right, would have to nudge him until he’d start again.


the Sleep Center at Doctors Community Hospital in Lanham performs more than 2,000 sleep studies and provides sleep apnea treatment to some 600 patients each year. The center conducted two tests on Taylor during his overnight stay. During the first part of the evening, from 9 p.m. to 1 a.m., brain and muscle activity were recorded by electrodes attached to Taylor’s head and face and his heart rate and breathing were monitored. “The test

showed that I stopped breathing 100 times an hour,� Taylor said. With obstructive sleep apnea, “the throat relaxes more than usual and, at a critical point, closes and the person begins to suffocate. That lowers oxygen levels in the body and increases the heart rate. The brain is forced to respond. It arouses the person, though not to the point of consciousness, to get the throat open so that breathing resumes,� said Dakheel. “Unfortunately, as soon as the patient begins to relax, the cycle starts again.� During the second part of the polysomnogram, Taylor wore a mask attached to a CPAP machine. Short for continuous positive airway pressure, CPAP is a therapy that increases air pressure in the throat and keeps the airway open. “Nothing in medicine is treated as simply and effectively as sleep apnea,� said Dakheel. The CPAP machine worked wonders. “I started to get my energy back within a week or two because I continued on 18


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Spring 2014 | Gazette Health 11

seniors’ WELLNESS

Animal products and produce are at the most risk of being contaminated.

what you need to know about

Food Safety F

ritood safety is especially critical as we age. Seniorss often have a weakened immune system due to natural aging, medical conditions and medications, which increases their susceptibility to foodborne illness, generally known as food poisoning. Other challenges may be impaired vision, which makes it hard to read labels, or an impaired sense of taste and smell, making it difficult to tell if food has spoiled. These are reasons that dietitians and physicians advise seniors and their caregiverss om to learn proper food handling—from shopping to storing to cooking. Which foods are most likely to be contaminated or spoil? How do you minimize this risk? mal products The most high-risk foods are animal and fresh produce, according to the United States Department of Agriculture (USDA). “Lettuce, carrots, melons and potatoes carry a higher risk for a bacteria called E. coli. To prevent food poisoning, wash produce thoroughly and sanitize hands and utensils with soapy water,” said Jennifer Westcott, a registered dietitian at MedStar Southern Maryland Hospital Center in Clinton. She advised taking precautions even with lettuce and salads bought in a bag. “With anything you buy with a stalk or stump, pull it apart to remove dirt,” she said. Take precautions with dairy products as well. “Make sure eggs are thoroughly cooked. The whites should not be runny to avoid salmonella,” said Karen Vartan, a registered dietitian and

12 Gazette Health | Spring 2014

nutritionist who consults in Prince George’s County and elsewhere throughout Maryland. Chicken and meats can also be sources of foodborne illness. Meats that are most intact are generally the safest. For instance, ground beef is more susceptible to contamination through the grinding process than a steak, according to Sonja Cooke, a registered dietitian and assistant director of Food Services at Doctors Community Hospital in Lanham. “And a whole chicken breast is safer than chicken that has been cut and added to pasta or salad,” she said. “Ideally, eat well-cooked meats. I would recommend cooking beef until it is medium well to well done, meaning at the most it is a little pink


Storing foods Good food storage practices begin with checking labels, said Mary Bilodeau, a registered dietitian and clinical nutrition manager of Food & Nutrition Services at Dimensions Healthcare System in Che Cheverly and Laurel. And be aware that the label gives more information than a food’s expiration date. “The ‘sell by’ date tells the store the last day they should sell that package. The ‘best if used by’ is the recommended date for best flavor or quality. The ‘use by’ date is the last recommended day for use,” said Bilodeau. “Rotate foods in cupboards and eat those with the quickest approaching expiration dates before you eat newer foods. Also, follow storage instructions, such as refrigerating what needs to be kept cool,” said Westcott. Even some foods that people might not consider perishable must be kept cool. For instance, ketchup and other condiments can be unsafe if not refrigerated once they are opened, said Westcott. Do not buy or keep dented cans. “They can contain a deadly organism called botulism. Especially avoid cans dented at the seal, which


mid in the middle,” said Cooke. With chicken, when its juices run clear, it is likely thorough cooked, she said. oughly Be careful with drinks, as well. Contaminated water or unpasteurized milk can cause foodborne illnesses, warned Dana Magee, a registered dietitian with Rebecca Bitzer MS, RD & Associates in Greenbelt. She advised to not only to be sure milk is pasteurized, but that juices are pasteurized, too.


Ketchup and other condiments can be unsafe if not refrigerated after they are opened.


Even if the food has not expired, if it does not look orr smell mell, if right, pass it up. While it’s best to test by sight or smell, you can’t tell this way, take a very small taste.”

would be the lid or the bottom of the can,” she said, as properly sealed cans prevent dangerous bacteria from seeping in. “Freeze individual portions. You can use containers and heavy-duty bags that keep small portions of food at a high quality in the freezer for a long time,” said Vartan. Leftovers should be cooled and frozen immediately after they are prepared.

How to tell if food is spoiled “Even if the food has not expired, if it does not look or smell right, pass it up,” said Westcott. “While it’s best to test by sight or smell, if you can’t tell this way, take a very small taste.” For leftovers, she advised following the “fourhour rule.” “You do not want to leave food at room temperature for more than four hours, and this includes preparation time,” she said. She recommended erring on the side of caution if you are not sure how long a food has been unrefrigerated, especially when it comes to dishes with several perishable ingredients, such as lasagna, soups or tuna with mayonnaise. Shopping “Seniors should shop weekly and only purchase for the week at hand. Otherwise, they should have a grocery delivery service deliver weekly or bimonthly,” said Magee. And be sure all packaging is intact before placing an item in the grocery cart. Buy frozen foods because they are less likely to be wasted and spoiled. “With fresh foods, like meats, as soon as you get home from the store, put them in one- and two-portion packages and freeze them,” she said. Eating out Restaurants must follow strict food-handling guidelines, mandated by state health departments, so unless your immune system is severely compromised, eating out is generally safe, according to Westcott. “But use your judgment. If the salad bar does not look well maintained or [its] food does not feel cold when you take a bite, choose not to eat it.”

SYMPTOMS OF FOOD POISONING Among the most common symptoms of food poisoning are: n n n

n vomiting n diarrhea nausea bloating n abdominal pain A more serious symptom is fever.

These symptoms may appear anywhere from a couple of hours to 24 hours after food ingestion. The USDA advises contacting a physician immediately diately if you suspect you’ve contracted a foodborne illness. ness. For more information, call the FDA Food Information ation Line at 1-888-SAFE-FOOD (1-888-723-3366) or visit nts.

Bilodeau also cautioned vigilance at self-serve buffets. “Know that everyone is touching the same serving utensil; it’s a good practice to wash your hands when handling these utensils. Never use a serving utensil that is resting on the top of, or inside of, a food dish. “Fresh plates should be used with each revisit to the buffet. And avoid foods that are under- or uncooked, such as sushi, soft-boiled/over-easy eggs, raw sprouts, and unpasteurized fruit and vegetable juices,” she said.

Cooking and food temperatures Eggs and fish should be cooked to a minimum of 145 degrees Fahrenheit. Poultry should be cooked to 165 degrees Fahrenheit. Beef, pork, veal and lamb should be cooked to 145 degrees Fahrenheit, according to Cooke. She suggested buying a cooking thermometer, which can be found at grocery stores, department stores or kitchen utensil stores. Besides washing utensils with soap and water, using separate utensils and separate cutting boards for raw meats, cooked meats and raw fruits and vegetables can help prevent contamination, said Magee. She suggested using differentcolor cutting boards to differentiate.

“And always wash hands for 60 seconds after using the bathroom and when preparing or eating food after touching skin, face, mouth, pets or hair,” she cautioned.

Advice for caregivers Vartan suggested that caregivers or family who visit seniors check for spoiled foods. “If caregivers bring food over, they should date the containers in large print. And they could purchase a bottle of sanitizer to put on the sink so [their loved ones] remember to wash their hands,” she said. “They might also encourage their loved one to have meals with neighbors. This will not only help them stay nourished, but leftovers will be put to use and seniors will be more conscious of what they are buying and of keeping it fresh,” said Vartan. Help to make meals easier If cooking and grocery shopping prove to be too difficult, there are services that prepare meals. Magee suggested seniors or their loved ones look into Meals on Wheels or Mom’s Meals, which provide home deliveries nationwide. GAZETTE.NET

Spring 2014 | Gazette Health 13

seniors’ WELLNESS

More than a quarter of people older than 75 have no natural teeth.

When do you need them and what are the options?



solution of last resort, dentures are worn by millions of Americans, many of them older adults who no longer have any teeth. Nearly nine million adults 65 or older are completely edentulous, according to the Centers for Disease Control and Prevention (CDC). That means 17.5 percent of those ages 65 through 74 and 25.8 percent of those over 75 have no natural teeth. Some of the first dentures, removable devices designed to replace missing teeth, were crafted around 700 B.C. in northern Italy by Etruscans,

14 Gazette Health | Spring 2014

who made them out of human or animal teeth. Over time, the material used to construct dentures evolved. George Washington, who had just one tooth in his mouth when he was inaugurated as the nation’s first president in 1789, wore what was considered a technologically advanced set of dentures. Carved out of hippopotamus ivory and employing gold-wire springs, the dentures used brass screws to hold human teeth in place, according to the website for Mount Vernon Ladies’ Association, which maintains Washington’s Mt. Vernon home. The dentist even left a hole in the dentures to accommodate Washington’s single tooth, as he report-


edly believed a tooth should never be extracted if it could be saved. Unlike Washington’s false teeth, today’s dentures are generally made of acrylic. Aesthetically, they are a close match for missing teeth. Many people see an improvement in their smile. Not only can you pick the size and shape of your replacement teeth, but “you have the ability to select the shade of your teeth,” said Christopher J. Doerrer, D.D.S., a prosthodontist in Mitchellville. “If you want pearly white, you can get pearly white. If you want something natural, we’ll give you natural.” “Some people say that dentures are easier to clean [than natural teeth] and they don’t have



Six percent of U.S. adults, or about 18.5 million people, wear partial dentures.

to worry about cavities,” said Ron Moser, D.D.S., a prosthodontist in Bowie. “But you lose a lot of basic things that affect both function and enjoyment.” Food might taste bland. “You don’t just have taste buds on your tongue,” said Moser. “The floor of the mouth, the roof of the mouth and the gums, areas covered by the denture, also add to your sense of taste.” With gums and palate somewhat encased, a loss of temperature sensation may occur. “I tell patients to use their tongue,” Moser said. “Otherwise they might put it in their mouth and burn their throat.” Chewing consistency is different. “There’s not the same firmness,” he said. “You don’t have the same ability to tear into a sandwich.” Speech can be impaired, at least temporarily. It’s not unusual for new denture wearers to have to practice speaking and eating, according to the American Dental Association (ADA). That said, dentures are a lifesaver for individuals who have lost teeth. A complete denture replaces all teeth on the upper or lower jaw. A partial denture fills in the spaces created by missing teeth, preventing surrounding teeth from shifting position. SOME 18.5 MILLION PEOPLE, OR ABOUT 6 PERCENT

of the adult population, wear partial dentures, according to a 2013 survey by GlaxoSmithKline Consumer Healthcare. Partials generally are preferable to complete dentures. “The idea is to retain as many natural teeth as possible,” said Doerrer. Their presence helps prevent the erosion of bone in the jaw. Partial dentures usually consist of replacement teeth attached to a pink, gum-colored plastic base. “Partials also can be made of metal with clasps that attach to [adjacent] teeth,” said Moser. “The advantage to metal is that it is stronger and can be thinner.” However, in cases where the lifespan of surrounding teeth is short, “we use plastic. You can add onto plastic but not metal.” When partial dentures are fixed in the mouth, they are referred to as bridges. Bridges, which look and feel more like natural teeth, are more expensive than a removable partial denture, according to the Aetna Inc. website Simple Steps to Better Dental Health. Partial and complete dentures are custommade and require several office visits for an impression to be taken; to determine the size, shape and shade of the teeth; and to “try in”

a model of the denture to verify bite, according to the prosthodontists. Then the denture is fabricated. “Dentures are now being digitally made,” said Doerrer, “which makes them more accurate.” THOSE REQUIRING A COMPLETE DENTURE MAY

need to visit an oral surgeon to have teeth removed. In such instances, the first denture crafted is known as an “immediate,” or temporary, denture and will be used for most of the first year. While swelling from the tooth extraction will begin to subside within 72 hours, it takes about four weeks for the gum and up to 10 months for the bone in the jaw to heal, according to Moser. As the gum and bone shrink during the healing process, the immediate denture will need to be relined—which

HOW TO CARE FOR R DENTURES ES Dentures may not get cavities, but they do require cleaning. Proper cleaning helps keep the mouth and gums healthy and prolong dentures’ life span. n



Not only can you pick the size and shape of your replacement


teeth, but “you have the ability to select the shade of your teeth.” involves putting a new surface on the part of the denture that fits against the gum—to ensure a proper fit. Pressure or slippage due to ill-fitting dentures can cause sore spots. “I have an unlimited open-door policy when it comes to adjustments,” said Moser. Because there is no way to predict how much shrinkage will ultimately occur, a new or “complete” denture will eventually need to be made. There is generally an additional charge for a complete denture. Moser puts the cost of complete dentures in Prince George’s County at $1,200-$1,500 per upper or lower arch and up to $3,000 for a full set. WHILE THE NORMAL LIFE SPAN FOR DENTURES

is five to 10 years, according to the ADA, replacement timetables vary widely. Over time, dentures may need to be relined, a procedure that adds new material to the area touching the gums, or rebased, a procedure continued on 18



Handle dentures carefully. Avoid bending or damaging the plastic or the metal clasps when cleaning. To prevent breakage should your dentures drop, stand over a clean, folded towel or a sink full of water. Remove and rinse dentures with water after eating to get rid of food particles. Clean any natural teeth, once dentures have been removed, with a soft-bristled toothbrush. Use gauze or a soft toothbrush to clean the tongue and palate and to massage and clean the gums. Scrub dentures at least once a day with a denture cleaner, mild soap or dishwashing liquid. Use a denture brush or soft toothbrush to remove food and tartar and reduce stains. Avoid harsh or abrasive cleansers or stiff-bristled brushes, which can scratch or damage the dentures. Remove dentures each night and allow the gums to rest. “Just like you don’t wear cowboy boots to bed—you give your feet a break—you don’t wear dentures to bed,” said Ron Moser, D.D.S., a prosthodontist in Bowie. “All that weight on the gums takes a toll on tissue and crimps circulation. Nighttime is when the gums recover.” Soak dentures overnight; do not let them sit out. When dentures dry out, they can lose their shape, crack or break. Use a mild denture solution or, according to Moser, a half-and-half solution of water and mouthwash “so the dentures feel fresh in the morning.” Denture soaks containing chlorine, while effective in eliminating stains, should not be used every night. Avoid chlorinated soaking solutions if dentures have metal attachments, as the metal may tarnish. Rinse dentures in the morning, before placing in your mouth, to remove chemical residue. - KAREN FINUCAN CLARKSON



Spring 2014 | Gazette Health 15

seniors’ WELLNESS

When you sit up straight, you’re more likely to think positively and recall positive memories.

Sit Up Straight Good posture can improve confidence, mood, overall health BY SHARON NAYLOR


16 Gazette Health | Spring 2014



re you a slumper? Check your posture right now to see if your shoulders are rounded forward and your back curled. Chances are you’ve eased into your natural posture: slouched down, head in alignment with your spine, shoulders back, back not straight. And your brain may be paying the price. Researchers at several top academic institutions, including Harvard and Columbia universities, have been studying the link between bad posture and the brain for decades, and their recent findings show that improving posture can improve the brain’s function, and thus your mood and memory levels. Researchers, for instance, found that when you assume what they call “power poses” of confident stance and tall, uplifted posture, your decision-making is subconsciously affected. When you stand or sit up taller, and pull your shoulders back and outward, your brain gets a signal that it’s the confident, powerful you in charge of your thinking, and, in turn, you might make more confident choices. A 2003 Ohio State University study found that when you shake your head “no,” or nod your head “yes” while observing a scenario or listening to information, you may form positive or negative opinions about your observations depending on the motion of your head and its positive or negative message to the brain. And when you sit up straight, you’re more likely to think positively and recall more positive memories. Slumping and slouching can generate negative memories, thoughts and perceptions, which

Taking yoga classes is likely to improve your posture.

create stress hormones in the brain, as opposed to happier hormones that can trickle down into your daily choices and create a more energetic, happier you that feels like working out. Dana Carney, a social psychologist at the University of California, Berkeley, conducted a 2010 survey that was among the first to reveal that power poses demonstrating confidence (regardless of whether or not a person actually feels confident) increase levels of testosterone and lower levels of cortisol—the stress hormone—in the brain. Because testosterone is associated with self-confidence, having good posture can create hormones in the brain that make you feel more self-assured. Carney said the power pose sends a signal to the brain, and what begins as a neural impulse turns into an actual, physiological response that boosts brainpower. Good posture also pertains to walking. If you walk slumped down and in a shuffle, you look bedraggled and burdened, which can make you actually feel bedraggled and burdened. When you walk uplifted and with confidence, your brain registers “uplifted and with confidence,” and pumps out hormones that match that message. Physical pain from bad posture can affect your brain, too. When you slouch often, you may

experience back, neck, shoulder and even wrist pain, which can send signals to the brain that you’re suffering. The brain then needs to create pain-reducing hormones rather than happy ones. It’s quite hard to feel happy when you’re achy, sore or in such pain that you have to take medication for relief. Pain can cause depression when the brain gets sapped of positive hormones. There are several ways to improve your posture, including taking yoga classes. Since yoga elongates the body and retrains your frame to be more upright with your shoulders, back and spine aligned, the position will soon feel more natural to you. Exercise on the whole also helps to improve posture. You might also ask a relative or friend to help you become more mindful of your posture with a gentle touch on your shoulder if you’re slouched down at your desk or kitchen counter. When you feel the touch, you’ll straighten up and send a positive message to your brain. And even if you get a hundred touches in a day, you’ll eventually retrain your frame to hold power poses, and your helper won’t have to signal you to straighten up as often.

SKIN, from 9

can be extended,” said Lotsikas. “A cut or bump on the leg will take even longer to heal than one on the forehead. The reason has to do with slowed circulation and the distance of the wound from the heart.”

eyes. “I’ve read that of all the lines on the face, it is crow’s feet—lines you see when you smile—that seem to cause the most distress in women,” said Callender. In addition to wrinkles and lines, aging skin is subject to bruising. Because thinning skin offers “less of a buffer zone to blood vessels that become more fragile with age,” the vessels rupture more easily, said Lotsikas. Blood thinners exacerbate the condition, known as senile purpura. “It doesn’t have to be Coumadin. Even low-dose, 81-milligram aspirin or fish oil can thin the blood enough to cause easy bruising.” Some medications can cause “excessively dry skin,” said Lotsikas, noting that the normal aging process alone can lower the skin’s moisture level. The loss of sweat and oil glands, common with aging, and ailments such as diabetes and kidney disease can contribute to rough, scaly skin. Aging affects the skin’s ability to repair itself, so wounds are slower to heal. “Depending on the wound’s location on the body, the healing


on the skin, there are ways for older adults to slow the outward effects and maintain the organ’s health. “The number-one anti-aging formula is sunscreen,” said Callender. Older adults “can prevent further cell destruction by using it daily.” Callender recommends a broad-spectrum sunscreen with a SPF of 30 or higher. “Women, and men too for that matter, should use a facial moisturizer with sunscreen each morning. Apply it to the face, neck, chest, and back of the hands all year round.” Sunscreen should be applied to all exposed parts of the body and reapplied every two hours when outdoors. “Use a hydrating cleanser and moisturizer,” said Lotsikas. Apply a moisturizing emollient or cream immediately after showering.

“Lotions have more alcohol and can be drying. And avoid oils, as we don’t want anyone to slip.” An inexpensive option that works well is Vaseline. Maintain a healthy lifestyle, the dermatologists said. Avoid tobacco products, as smoking deprives the skin of oxygen and nutrients. Eating a healthy diet and staying hydrated also benefit the skin. For those who wish to rejuvenate skin and remove some of the visible signs of aging, such as wrinkles, there are numerous products available from and procedures performed by dermatologists. Topical treatments that contain vitamin C or Retin-A can help smooth skin. “Most patients with photo-damage will respond to these cosmeceuticals,” said Callender. Other options, she said, include chemical peels, photodynamic therapy, lasers, Botox and dermal fillers. “We have some wonderful, nonsurgical procedures to fight the aging process,” said the dermatologist. “Some say we should accept it, but I say ‘No,’ fight it every step of the way.” GAZETTE.NET

Spring 2014 | Gazette Health 17

HIS STORY, from 11 GOUT, from 7 When diet alone can’t control gout flare-ups, medications need to be part of the treatment plan. Colcrys is often prescribed within 24 hours of an attack to disrupt the immune response to uric acid crystals, said Konatalapalli, although diarrhea is a common side effect. Non-steroidal antiinflammatory drugs, like aspirin and ibuprofen, are often prescribed for pain or inflammation, as are steroids like prednisone, said Karkhanis. But to get at the heart of the problem—hyperuricemia—doctors may prescribe medicines like allopurinol or febuxostat to block uric acid production, according to the American College of Rheumatology (ACR). Probenecid helps the kidneys excrete uric acid, while pegloticase (Krystexxa) is often prescribed for patients who cannot tolerate other treatments, or when other treatments have failed, according to the ACR. A complicating factor with these drugs is that patients may experience a gout attack when they start taking them, Karkhanis and Konatalapalli both said. While it’s not entirely clear why this happens, uric acid-lowering medications may activate immune response, leading to painful swelling and inflammation. That’s why Colcrys is usually prescribed in tandem with the uric-acid lower drugs: “They need to be on both of these medications,” said Konatalapalli.

18 Gazette Health | Spring 2014

was sleeping longer. Within six weeks, I was able to do things I hadn’t done in years, like cut the grass. And, my headaches quit over time,” Taylor said. Still, it took him a while to adjust to the machine. “I started with a mask, but every time I would turn one way or another, I’d knock the mask and it would leak,” he said. Switching to a nasal CPAP, prongs that fit into the nose, improved Taylor’s comfort and enhanced the machine’s effectiveness.

WHAT CAN YOU DO ON YOUR OWN TO RELIEVE SLEEP APNEA? You can first try to relieve symptoms by making changes in your lifestyle. Unfortunately, there is not much research on whether these types of changes in behavior can help if you have obstructive sleep apnea. However, there are different ways to improve general sleep habits even if they will not automatically reduce breathing pauses: n

Try to avoid stimulants like coffee and tea, as well as large evening meals, 4 to 6 hours before bedtime.


Evening use of alcohol or nicotine can also result in a poor night’s sleep.


A quiet, dark, and, most importantly, comfortable place to sleep that is kept at a pleasant temperature could also help you get restful sleep. - PubMed Health


eliminated Taylor’s snoring, the machine itself was noisy. “You could hear it every time I took a breath,” he said. In mid-February, following a second polysomnogram, Taylor received a new machine. The difference is “night and day. You don’t hear it revving up when I breathe, the tubing is more flexible and the flow of air is much better.” The new machine also allows Dakheel to better monitor Taylor’s usage and adjust the therapy. A

DENTURES, from 15 that preserves the artificial teeth and places them on a new base. Sometimes replacement dentures are required. Beyond the typical wear and tear, a change in body weight can affect the denture’s fit. “A gain or loss of as little as 5 pounds can make a difference,” said Moser. For that reason, Moser recommends annual dental checks. “We’ll check the fit and for signs of oral cancer,” said the prosthodontist. “A loose denture can cause the wearing of cells. When you slough off cells, they rebuild. That rebuilding increases the chance of immature cells, which are cancer cells, developing.” Individuals who are missing teeth and want to avoid dentures have A GAZETTE AND GAZETTE-STAR PUBLICATION

computer chip records information such as hours used per night, air pressure and leakage, and breathing stoppages. Medicare foots the bill for Taylor’s machine, which Dakheel said is common. “Medicare covers the CPAP and sleep study. Most insurances do, though some managed-care groups are pushing for in-home studies,” said the sleep physician. “The studies we do in the lab are much more comprehen-

sive. Studies done in the home can miss a lot of issues.” Not a day goes by when Taylor doesn’t use his CPAP machine. “I put it on when I start to feel sleepy, even if I’m in a chair watching TV and feeling like I might nap,” he said. The machine’s portability allows him to take it out of the house. “The last three years it’s gone with me on vacation in North Carolina. It’s my companion.”

“If you have the finances, you can have anywhere from eight to 14 implants in the upper or lower jaw.”

port full or partial dentures. Because bottom dentures sometimes have trouble adhering to the lower jaw, bars or balls can be implanted and the denture designed to snap onto the metal attachments, Moser said. Look for dentures to continue to improve, said Doerrer, who anticipates advancements in materials. “We will eventually find a better adhesive material than acrylic….and we’ll see more flexible dentures that are lighter in weight and not as heavy on the gums. There are already some out there. The biggest change though is in prevention. We’re seeing fewer people losing teeth at an early age. Generations ago, people got dentures in their 20s. We’ve pushed that back and will keep doing so.”

an alternative—dental implants. “Outside of your natural teeth and putting in crowns, implants are the closest thing to giving people back the teeth that they were born with,” said Moser. “If you have the finances, you can have anywhere from eight to 14 implants in the upper or lower jaw.” Implants also are used to sup-

From the Experts

A rare, inherited form of Alzheimer’s disease can also occur in people in their 30s, 40s or 50s.

Dealing with Dementia


ementia is a brain disorder that most often affects the elderly. It’s caused by the failure or death of nerve cells in the brain. By some estimates, up to half of people 85 and older may have Alzheimer’s disease, the most common cause of dementia. Although age is the greatest risk factor for dementia, it isn’t a normal part of aging. Some people live into their 90s and beyond with no signs of it at all. “Dementia really isn’t a disease itself. Instead, dementia is a group of symptoms that can be caused by many different diseases,” said Dr. Sanjay Asthana, who heads an NIH-supported Alzheimer’s disease center at the University of Wisconsin. “Symptoms of dementia can include problems with memory, thinking, and language, along with impairments to social skills and some behavioral symptoms.”


for developing dementia. These include aging, smoking, uncontrolled diabetes, high blood pressure and drinking too much alcohol. The risk also increases if family members have had dementia. Dementia can be reversed when it’s caused by dehydration or other treatable conditions, but most forms of it worsen gradually over time and can’t be corrected. Scientists are searching for ways to slow down this process or prevent it from starting in the first place. The two most common causes of dementia in older people are Alzheimer’s disease and vascular dementia, a condition that involves changes to the brain’s blood supply. Vascular dementia often arises from stroke or arteriosclerosis (hardening of the arteries) in the brain. Other causes of dementia include Parkinson’s disease, HIV infection, head injury, and Lewy body disease. Lewy bodies are abnormal protein clumps in brain cells. Dementia in people under age 60 is often caused by a group of brain diseases called frontotemporal disorders. These conditions begin in the front or sides of the brain and gradually spread. A rare, inherited form of Alzheimer’s disease can also occur in people in their 30s, 40s and 50s.



regions are damaged. “In general, the left side of the brain is involved in language, and the right side is very involved in social behavior,” said Dr. Bruce L. Miller, who directs an NIH-funded dementia center at the University of California, San Francisco. In the case of a frontotemporal disorder, “if it begins in the left side of the brain, you tend to have worsening language problems; if it starts on the right, it affects behavior and might be mistaken for a psychiatric condition,” Miller said. Damage to particular left brain regions can

cause people to become apathetic, lose their inhibitions, or show no consideration for the feelings of others. With Alzheimer’s disease, memory-related areas in the lower and back parts of the brain tend to be affected first. Other types of dementia can affect regions that control movement. “The treatment for all of these disorders is slightly different,” Miller said. That’s why it’s important to get an accurate diagnosis. Because different types of dementia can have overlapping symptoms, and some people have more than one underlying condition, it’s best to see a clinician who has expertise in diagnosing dementia. To find NIH centers that specialize in this, visit To make a diagnosis, physicians usually ask about a person’s medical history and do a physical exam that includes blood tests. They also check for mental abilities and sometimes perform brain scans. These tests can determine if the symptoms are related to a treatable condition, such as depression, an infection, medication side effects or vitamin B12 deficiency. WITH SOME TYPES OF DEMENTIA, A CLEAR

diagnosis can’t be made until the brain is examined after death. “There’s no single blood test or brain scan that can diagnose Alzheimer’s disease or some other types of dementia with certainty,” Asthana said. “In these cases, a definite diagnosis can be made only at autopsy.” Many researchers are working to change that. More than a decade ago, NIH-supported scientists found a way to detect signs of Alzheimer’s disease in the brains of living people. Their sophisticated brain scans can spot abnormal protein clumps known as amyloid plaques. All people with Alzheimer’s disease have amyloid plaques. But extensive plaque buildup can also be found in some people who have no signs of dementia. Because of this uncertainty, amyloid imaging isn’t considered a definitive tool for diagnosing Alzheimer’s disease. But it is being widely used in clinical research studies. “So far, no studies have shown that clearing the brain of amyloid protein can actually translate into improved symptoms,” Asthana said. Different drugs are being used to treat Alzheimer’s disease, Parkinson’s dementia, and certain other forms of dementia. These may improve symptoms, but none can halt or reverse progressive damage to the brain. “In contrast, if the dementia is due to vascular disease, there are many things we can do to prevent it from progressing. It’s the same things we do to prevent cardiovascular disease,” said Dr. Helena Chui, director of an NIH-funded Alzheimer’s center at the University of Southern California. -NIH News in Health GAZETTE.NET

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