Being Well, Winter 2021-2022

Brown & Toland Physicians P.0. Box 72710 Oakland, CA 94612

PERSPECTIVES ON GOOD HEALTH

WINTER 2021/2022

Being Well

Here are a few key pain management tips: It hurts. All the time.

Chronic pain can arise for a wide variety of reasons, ranging from conditions such as arthritis and fibromyalgia to simply exhibiting poor posture over a long period of time. Nonetheless, chronic pain can pose a great burden for people who must fight through it in their day-to-day life.

The good news?

Chronic pain can be managed.

Comfortable amounts of exercise One effective way to fight back against chronic pain is to find some new, comfortable ways to exercise. You don’t want this new physical activity to be too strenuous but try and find a particular activity you enjoy.

A healthier diet If you eat healthier, you will eventually find that your body responds by giving you more vitality. Obesity or a poor diet can add strain to your joints and muscles, sometimes aggravating conditions of chronic pain that you may already have. Try substituting your usual go-to foods that might be high in fat content with fruits, nuts or whole grains.

When talking with your doctor, strive for five.

Whether it’s chronic pain or other symptoms you’re experiencing, your ability to describe health problems — and help your doctor understand them — is critical.

Breathing techniques

1. Ask questions.

Ask as many as you need to understand your doctor’s advice.

Deep breathing and other forms of meditation exist for the purpose of helping your body relax. As you breathe deeply, you can eventually loosen the muscles in your body, releasing tension and granting pain relief.

Practice healthier sleep habits Sleep is important for managing chronic pain and inflammation. This can be achieved by creating a routine and sticking to healthy habits before bed.

2. Make a list.

Track symptoms or other concerns.

The details are important.

Minimize stressful activities

Haven’t Got Time for the Pain?

Here’s a startling statistic: Approximately 50 million Americans suffer from chronic pain.

3. Listen.

Sometimes it feels like the appointment is over before you even got started. Consider taking notes.

In most cases, situations that cause mental or emotional stress tend to exacerbate conditions of chronic pain. If you find that particular settings or interactions in your daily life cause you anxiety or frustration, try as best you can to avoid them or practice relaxation techniques to navigate them more easily.

Maintain good posture Our posture can easily become something we forget about unless we pay close attention. When we’re distracted by phones in our hands or TVs while on the couch, we may slouch or bend our spines in ways that are unhealthy in the long term, leading to more pain.

Chronic pain support groups Support groups can introduce you to many others suffering from similar conditions, giving you the chance to experience some new advice and insights.

For more tips on managing chronic pain, visit brownandtoland.com/pain.

4. Be honest.

If you’re uncomfortable talking, remember: Your doctor can’t share information about you without your written permission.

5. Work together.

If your doctor recommends a treatment, ask about possible side-effects or other options.

We sat down with Brown & Toland gastroenterologist Satya B. Allaparthi, MD, to discuss colorectal cancer risk and the most effective tool for its prevention and treatment – the colonoscopy.

B&T: What is a colonoscopy and why are

B&T: Many patients who know they should get a

they important?

colonoscopy don’t, primarily due to fears about the procedure. What are patients typically afraid of, and what do you tell them to allay those fears?

Dr. Allaparthi: A colonoscopy involves looking at the colon from inside the body using a long, thin (about the width of your little finger), flexible tube called an endoscope. There is a tiny camera on the end of the tube through which the doctor can examine your entire colon and rectum for polyps or cancer.

Entering the Twilight Zone Getting comfortable with colorectal cancer screenings.

Men and women should begin screening earlier if they have any of the following risk factors:

COLORECTAL CANCER (CRC) IS ONE OF THE MOST COMMONLY

•A family history of CRC or polyps

DIAGNOSED EACH YEAR.

• A known family history of inherited CRC syndromes • A personal history of CRC or a personal history of chronic inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

DIAGNOSED CANCERS IN THE UNITED STATES — AND THE THIRD MOST COMMON CAUSE OF CANCER DEATHS AMONG MEN AND

If the doctor detects any polyps during a colonoscopy, he or she will remove them during the procedure. You do not feel when a polyp is removed and removing them does not affect recovery time. Removing polyps during a colonoscopy could stop colon cancer from growing or even cure it.

B&T: Who should be screened?

Dr. Allaparthi: Patients delay colonoscopy because it is invasive with concern for the safety of the procedure and intolerance of preparing for the procedure. Some patients also worry about high deductibles/copays and logistics (taking time off from work, arranging transportation).

Again, I recommend colonoscopy as, by far, the most sensitive test and the only test that prevents colon cancer. It’s a safe and well-tolerated procedure when done in expert hands.

B&T: In addition to colonoscopy, is there anything

Dr. Allaparthi: The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screening starting at age 50 and earlier for African Americans (age 45). In fact, the American Cancer Society recommends screening for everyone beginning at age 45.

The risk of developing colorectal cancer increases with age, with more than 90 percent of cases occurring in those age 50 or older. All men and women at average risk for developing CRC should have a colonoscopy every 10 years.

I can do to reduce my risk of colorectal cancer?

Dr. Allaparthi: Yes, increase your daily intake of fruit and vegetables and limit or avoid red meat and processed meat. Quit smoking and limit alcohol use. Lose weight and control type 2 diabetes through exercise and a balanced, healthy diet.

Is a virtual colonoscopy or fecal test right for you? Looking for some useful tips on how to best prepare for your screening? Read the full interview with Dr. Allaparthi at:

brownandtoland.com/coloncancer.

WOMEN COMBINED. ABOUT 100,000 CASES OF COLON CANCER, AND JUST UNDER 45,000 CASES OF RECTAL CANCER, ARE

These cancers develop in the large intestine (colon and rectum), often from growths called polyps. Polyps are found in a third of all people.

Initially benign, these growths may transform into cancer. In some cases, these cancers can become advanced or metastatic, breaking away from the large intestine to form new tumors elsewhere in the body. Although it is a very serious disease, colorectal cancer is preventable and can be successfully treated if detected early.

“ Colonoscopy remains the only test that prevents cancer of the entire colon by 60-90 percent — that’s preventing it, not detecting early.”

About Dr. Allaparthi Satya B. Allaparthi, MD, practices at Gastroenterology Specialists Medical Group Inc. in Castro Valley which has been providing professional services in gastroenterology and liver diseases in the East Bay for more than 30 years. Dr. Allaparthi specializes in the diagnosis and treatment of both acute and chronic conditions of the digestive system.

Call for an appointment at 510-537-4415. Depending on your plan, a referral from your primary care physician may be required.

Why you should be concerned Being overweight or obese places a child at risk for many health problems.

An obese child is more likely to develop type 2 diabetes, a condition that used to occur only in adults.

Healthy Habits: Not Just for Kids

Obese children often have high cholesterol and high blood pressure, increasing their risk for heart disease. Children who are obese are more likely to have asthma and sleep apnea, a breathing problem that interrupts sleep, as well as bone and joint disorders. And overweight children are more likely to become overweight adults.

Is Your Child Overweight?

The psychological stress that overweight children experience can be as devastating as the medical problems. They are often teased by other children and as a result suffer poor self-image, low selfesteem and depression.

Here’s what you can do.

Obesity is a critical and growing health problem in the U.S., and it starts at a young age. One in every six children and teenagers is obese (18.5 percent).

Extra pounds have serious consequences for children, including low self-esteem, social problems and increased risk for chronic diseases. Why are so many children too heavy? Genetics plays a role, but too little physical activity and poor food choices are more often the culprits.

Too little activity Childhood should be filled with hours of energetic play, but children today are less active than past generations.

With more families living in cities, fewer children walk to school, and parents may keep children indoors more often out of concern for their safety. A national survey found that 20 percent of children ages 8 to 16 in the United States are vigorously active only twice a week or less.

Keeping an eye on screen time Research has shown a relationship between the use of video games, computers and phones and obesity in children and adolescents. In fact, Obesity is a proven outcome of screen media exposure.

Food woes High-calorie foods are everywhere a child turns: in school vending machines, at fast-food restaurants, at corner convenience stores and even in kitchen cupboards at home. Hectic schedules mean home-cooked family meals are often skipped and replaced with grab-and-go foods where potion sizes are too big with too many calories and too much fat.

Your pediatrician can help If you’re concerned about your child’s weight, first talk to your pediatrician or family doctor. The doctor can determine whether your child is at a healthy weight by calculating body mass index (known as BMI). BMI is the ratio of weight to height and is considered the best method for evaluating weight in children.

Your pediatrician can help you identify appropriate weight management goals for your child. Restrictive diets are not recommended for overweight children.

Rather, the goal is to help them maintain their weight as they grow taller.

Most important, let your children know that you love them, regardless of their weight. Give your children plenty of support and approval. Helping to build your children’s self-esteem is a great way to help them develop healthy new habits.

Feel like you don’t know where to start when it comes to setting and achieving your wellness goals? As a Brown & Toland member, you have access to a growing series of virtual workshops to get you started. From assistance managing a chronic illness to simply maintaining good health, our webinars support your wellness goals with the tools and expertise to help you achieve them.

To learn more — and to view past workshops — go to brownandtoland.com/wellness.

The New Normal Your body after menopause.

Although irregular periods, heavy bleeding or bleeding longer than normal often is a normal part of the years leading up to menopause, any of these also can be a warning sign of cancer. If your periods become irregular, heavier or longer than usual, or if you have bleeding between periods, keep a menstrual diary and discuss it with your health care provider, who may decide to check for uterine cancer.

Navigating the Change What you need to know about menopause.

Self-care tips for menopause

The risk of cardiovascular disease rises with menopause A woman’s risk for heart disease and stroke increases after menopause.

Natural estrogen may help to protect the heart and blood vessels by decreasing the LDL (“bad”) cholesterol and increasing the HDL (“good”) cholesterol in the blood and by having positive effects on blood vessels.

Although hormonal therapy (HT) may help relieve menopausal symptoms, it does not appear to prevent heart disease and increases the risk for breast cancer. You can take other steps to reduce your risk for heart disease after menopause by eating a healthy diet, exercising regularly, maintaining a healthy weight, avoiding smoking and, if you have diabetes or high blood pressure, following your treatment plan.

Bone loss increases with menopause 10 signs you’re going through perimenopause:

MENOPAUSE — WHEN A WOMAN’S BODY STOPS MENSTRUATING, OVULATING AND PRODUCING ESTROGEN AND PROGESTERONE — IS A NATURAL PART OF A WOMAN’S LIFE. THE AVERAGE AGE THAT WOMEN REACH MENOPAUSE IS 51.

Irregular periods Vaginal dryness Hot flashes Chills Night sweats Sleep problems Mood changes Weight gain and slowed metabolism Thinning hair and dry skin Loss of breast fullness

And you don’t actually go through menopause. Technically, you go through perimenopause, the transitional period of time before you hit menopause which is the specific marker that signifies you haven’t had a menstrual cycle in a year.

The years leading up to perimenopause usually occur between ages 45 and 55. During this time, estrogen production declines.

Perimenopause differs from woman to woman. Some women menstruate regularly until their periods suddenly stop. Others may see changes in the amount of menstrual flow or the length of time between periods. Still others have missed periods or bleeding between periods.

Until a woman turns 30, her body builds bone; after age 30, bone is broken down faster than it is replaced. Mild bone loss will not cause problems, but when the loss becomes excessive, bones weaken and fractures occur. Eating a diet that provides 1,200 to 1,500 mg of calcium a day and 400 to 800 IU of vitamin D (or taking equivalent amounts in supplements), doing weight-bearing exercises and taking medications that help build bone can help prevent excessive bone loss and fractures.

Finding relief Oral hormone therapy (HT) can relieve vaginal dryness, reduce or end hot flashes and help bladder symptoms. HT, however, increases other health risks. For vaginal dryness and urinary incontinence, a prescribed vaginal cream containing estrogen may be helpful. Water-based lubricants can make sexual intercourse less painful.

Nonhormonal measures also are available to help relieve menopausal symptoms. Herbal products containing estrogen-like substances are not recommended for control of symptoms because their quality cannot be assured and many of their effects have not been studied.

• Dress in layers and wear loose clothing • Drink plenty of water • Do weight-bearing exercise for 30 to 60 minutes a day most days of the week • Avoid caffeine and alcohol, which can intensify hot flashes and cause insomnia • Eat a balanced diet including fruits and vegetables and 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin D a day • Achieve and maintain a healthy weight

What can you do to feel better?

What is depression?

Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help.

Get moving.

When you’re depressed, just getting out of bed can seem daunting, let alone exercising. But regular exercise can be as effective as antidepressant medication in countering the symptoms of depression.

Beyond Blue Coping with depression in uncertain times.

There’s never been a better time to learn what you need to know about this disease, both in others and in yourself.

A lot of people haven’t been feeling like themselves lately.

They are exhausted but can’t sleep; their heart is racing, their muscles ache and they have trouble concentrating.

There’s a baseline of worry that won’t go away, even among people who typically roll with stress. Welcome to what the news is reporting as “pandemic induced anxiety.”

These feelings are borne out by the numbers: According to the Centers for Disease Control, adults in the United States reported that their mental health has been negatively affected due to worry and stress over the coronavirus. U.S. Census Bureau data shows the jump in people reporting symptoms of anxiety and depression happening as COVID-19 became a part of our lives, going from 11 percent of adults from January-June of 2020 to 42 percent by

December. As the pandemic recedes, these feelings may not necessarily improve on their own.

The divisive state of U.S. politics is also taking a toll. A recent study by the American Psychological Association revealed 62 percent of Americans say they are stressed by the current political climate.

Feelings of sadness and worry are normal responses to all this uncertainty and loss. But at what point do these feelings indicate something more serious? According to the CDC’s National Center for Health Statistics, nearly a third of Americans are now showing signs of clinical levels of depression or anxiety, meaning more than just normal sadness or stress.

Can I pay for mental health care using my FSA or HSA? Perhaps now more than ever, it’s important to remember that your emotional and mental health are just as important as your physical health. The good news is that you can pay for many mental health treatments and services (including some forms of online therapy) with your flexible spending account (FSA) or your health savings account (HSA), to offset out-ofpocket expenses. Check with your health plan for details.

Eat a mood-boosting healthy diet.

Reduce your intake of foods that can adversely affect your mood, such as caffeine, alcohol, trans fats, sugar and refined carbs. And increase moodenhancing nutrients such as Omega-3 fatty acids.

Find ways to engage again with the world.

Spend some time in nature, care for a pet, volunteer, pick up a hobby you used to enjoy (or take up a new one).

Depression symptoms can vary from mild to severe and can include: • Feeling sad or having a depressed mood • Loss of interest or pleasure in activities once enjoyed •C hanges in appetite — weight loss or gain unrelated to dieting • Trouble sleeping or sleeping too much • Loss of energy or increased fatigue

When should you seek help?

• I ncrease in purposeless physical activity (e.g., handwringing or pacing) or slowed movements and speech (actions observable by others)

You don’t have to wait until things are terrible. Talk to your friends and family, and don’t forget that your primary care provider will be always willing to help and prevent things from getting worse.

Your primary care provider can help determine whether you are depressed and rule out other medical conditions that may cause similar symptoms, as well as help develop a personalized care plan.

• Feeling worthless or guilty • Difficulty thinking, concentrating or making decisions • Thoughts of death or suicide

If you have thoughts of harming yourself, or need to speak with someone immediately about yourself or someone you are worried about, please contact the national suicide prevention line, 800-273-8255, or the national crisis text line (text 741-741) which provides anonymous and confidential crisis counseling via text messages.

Member Resources Exceptional care isn’t just for when you’re sick – we’re also here to help you prevent illness and maintain your best health. Here are just a few things we offer:

Health and wellness programs From assistance managing a chronic illness to simply maintaining good health, we support your wellness goals with the tools and expertise to help you achieve them. Browse our upcoming and on-demand virtual wellness workshops. brownandtoland.com/wellness

Your health blog Our health and wellness blog provides information designed to inspire you to be well and empower you with information that helps you achieve your health goals. brownandtoland.com/blog

MyChart Access important health information – including your medical history, test results, upcoming appointments and billing information – easily with MyChart.

If your physician has begun using MyChart, sign in or sign up at the link below. mychart.brownandtoland.com

Patient experience surveys Throughout the year, you may be asked to share your feedback through mail surveys with NRC Health and others. The information you share remains private and will be combined with other patients’ comments to help your doctor put together a plan to meet their ultimate goal: to provide you with excellent care.

Follow us on social media: This magazine is published by Brown & Toland Physicians as a community service and is not intended for the purpose of diagnosing or prescribing.

ABOUT BROWN & TOLAND PHYSICIANS Brown & Toland is a network of more than 2,700 Bay Area physicians who care for more than 355,000 patients throughout the region. We are also the care coordinators and health care professionals behind the scenes who ensure your doctors have the time and support to do what they do best — care for you. Together, we partner with you on every step of your health journey to help you reach and maintain your optimal health.

Being Well is published throughout the year. If you no longer wish to receive Being Well, please email your full name and address to customerservice@btmg.com.