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April 2013 issue TM


care  to

Little Lungs By Malinda Silva, CareATC

Inside this issue This quarter’s topics !

Benefits of Vitamin D!

When I got married, I was blessed with a beautiful, smart, and loving daughter, Kensley, who grew on my heart quickly. There was nothing I wouldn’t do for her. It seemed Kensley was always getting sick, and I felt horrible for her. My husband told me that she had Reactive Airway Disease (RAD) and was diagnosed at 1 year old. To be honest, I had no idea what Reactive Airway Disease was. Of course, my source was Google. Through my research I found out that RAD was similar to asthma in many ways. Kensley had certain triggers such as pollen, weather changes, physical activity, and dust. Every time she experienced one of these triggers, she would have an episode. Kensley’s episodes included a constant dry cough, difficulty breathing, and retracting when she inhaled. Kensley, now 5 years old, had been dealing with this and never knew that it wasn’t normal for kids to constantly have issues with breathing and coughing. In October 2012, I took Kensley to her pediatrician for her 5 year well child check and asked about her RAD. He said the

same thing he always said‌ breathing treatments.


Information adapted from Eating Well regarding adequate vitamin D intake

For days we would give her Albuterol and Pulmicort breathing treatments every four hours. But, after 3 weeks straight of these episodes, I made the decision to get a second opinion on treatment. What we were doing clearly wasn’t working. We found a fantastic pediatrician who said our current treatment plan wasn’t working and we needed to be more aggressive with her treatment.

Recipe Corner!

Kensley immediately began taking Singulair to help with the some of the specific triggers that were causing her episodes. She now also takes a Flovent inhaler 2 times a day. Since we began this treatment plan, Kensley has been able to go about her life as a “normal� child, whereas before, if certain allergens were high, we couldn’t let her go outside because it would trigger an episode.

Food For Thought! & Additional Resources

I hope no child ever has to go through the difficulties Kensley has; however, I know that is wishful thinking. Please be aware of your child’s triggers for episodes and communicate with your physician frequently as treatment plans may need adjusting.


A brief overview of osteoarthritis, asthma, and vitamin D


Check out Malinda’s low-calorie recipe for Ham and swiss rÜsti

Notes for a Healthier You!


A Pep Talk from Coach Moon, the “Wellness Dude�



Learn the eects of osteoarthritis and what you can do to control your symptoms

Check   out    page   4   for    information    on   vitamin   D



April Osteoarthritis

27 million


More than 27 million adults in the United States currently suffer from osteoarthritis.

A 2001 study conducted by Harvard found that wearing high heels can set the stage for osteoarthritis of the knees.

$5.6 billion


Information from osteoarthritis

$13.2 billion $13.2 billion is spent each year on job-related osteoarthritis in the United States.




$5.6 billion is spent each year on asthma in the United States.

The number of people who die each day from asthma.

1 in 12 1 in 12 adults in the United States currently have asthma. 1 in 11 children currently have asthma.

Information from


Vitamin  Â D Information from &

fish  Â oils


23  Â million

Fatty fish (i.e. salmon, tuna, mackerel, etc.) are the best sources of vitamin D in food.

Cloudy weather reduces natural vitamin D exposure by 50%. Shade can reduce exposure by up to 60%.

23 million adults in the United States (8%) are considered vitamin D deficient. This is 10% of all adult females, and 6% of all adult males.



In April, we will focus on osteoarthritis. Osteoarthritis (OA) is a disease characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands and spine. The specific cause of osteoarthritis is unknown, but is believed to be a result of mechanical and molecular events in the affected joint. Disease onset is gradual and usually begins after the age of 40. Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, and use of medications. What can you do to help control your OA? • Be active • Watch your weight • See your doctor • Protect your joints

In May, we will focus on asthma. Asthma is a disease that affects your lungs. It is one of the most common long-term diseases of children, but adults can have asthma, too. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs. In most cases, we don’t know what causes asthma, and we don’t know how to cure it. We know that if someone in your family has asthma you are more likely to have it. You can control your asthma. With your healthcare provider’s help, make your own asthma action plan. Decide who should have a copy of your plan and where he or she should keep it. Take your long-term control medicine even when you don’t have symptoms.

In June, we will focus on vitamin D. Vitamin D is important to the body in many ways. Muscles need it to move, nerves need it to carry messages between the brain and body parts, and the immune system needs vitamin D to fight off invading bacteria and viruses. Together with calcium, vitamin D is also important for good bone health. Vitamin D is found in many dietary sources, such as fish, eggs, fortified milk, and cod liver oil. The sun also contributes significantly to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. The term "vitamin D" refers to several different forms of this vitamin. Two forms are important in humans: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is synthesized by plants. Vitamin D3 is synthesized by humans in the skin when it is exposed to ultraviolet B (UVB) rays from sunlight. Foods may be fortified with vitamin D2 or D3.



How   much    vitamin   D   is    enough?

(adapted from For now, the US recommendations for adequate intake of vitamin D are 200 international units (IU) per day for adults under age 50, 400 IU for adults aged 50 to 70 and 600 IU for adults over 70. “How much you need from your diet is inversely proportional to what you make from the sun,� explains Dr. Edward Giovannucci, professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. Most people need to be more vigilant, unless we take supplements or love drinking milk. Since many Americans have trouble getting the recommended doses, the 2005 Dietary Guidelines for Americans declared that the elderly, people with darker skin and those exposed to insufficient sunlight need 1,000 IU daily—an amount that’s hard to achieve without taking a daily supplement. See below for a list of food sources. Food Source


Salmon, 3.5 oz.


Sardines, 1.75 oz.


Tuna, 3 oz.


Cow’s milk, 8 oz.


Orange juice, 8 oz.


Margarine, 1 tbsp.


Cereals, fortified with 10% DV, 3/4-1 cup


Egg yolk, large


* IU = International Unit

The   Benefits    of   Vitamin   D

By Jenny Avera (adapted from

Vitamin D is so critical to our health that nature designed a fail-safe way to obtain it: from the sun. Throughout history, exposure to the sun gave humans the vital doses needed to build bones, protecting children against the characteristic bowed legs of rickets and adults from osteomalacia, or softening of the bones Certainly, some of our vitamin D is provided by foods—fatty fish and egg yolks, for example. But until 1931, when milk began to be fortified with this fat-soluble vitamin, the sun was our main source, its ultraviolet B rays penetrating the skin’s uppermost layer, causing skin cells to produce a vitamin D precursor. (The precursor, along with vitamin D from food, is processed by the liver and kidneys and converted to D3—the active form of the vitamin.) Now, we spend more time indoors, in cars or behind computers. We drink less milk and when we do go out, slather on sunscreen. It is no coincidence, experts say, that rickets (which had been virtually wiped out until the 1990s) is making a comeback. Scattered cases of rickets in African-American infants and breast-fed babies have been documented as far south as Georgia; just last February, researchers at the University of Pittsburgh found that over 80 percent of pregnant black women and nearly half of pregnant white women (and the babies they later gave birth to) were classified as “insufficient� or “deficient� in vitamin D. Older people in hospitals and nursing homes are especially likely to lack the vitamin; in one study, 57 percent of elderly patients admitted to a Boston hospital were found to be vitamin D-deficient, according to blood samples and diet records. What’s more, dietary surveys suggest that most Americans, young and old, aren’t getting recommended amounts of the vitamin.



Ham And Swiss RÖsti from the kitchen of Malinda Silva, CareATC

Rösti is a traditional Swiss potato pancake typically served as a side dish but we added ham and cheese to transform it into an easy weeknight supper. Enjoy with steamed asparagus and chunky applesauce on the side. INGREDIENTS 1 large egg 1 cup diced ham, (about 5 ounces) 1 cup shredded part-skim Jarlsberg, or Swiss cheese, divided 1 shallot, minced 1 teaspoon chopped fresh rosemary, or 1/4 teaspoon dried 1/2 teaspoon freshly ground pepper 1/4 teaspoon salt 4 cups frozen hash brown potatoes 2 tablespoons extra-virgin olive oil, divided

PREP ARATION 1. Beat egg in a large bowl. Stir in ham, 1/2 cup cheese, shallot, rosemary, pepper and salt. Add frozen potatoes and stir to combine. 2. Heat 1 tablespoon oil in a large nonstick skillet over medium heat. Pat the potato mixture into an even round in the pan. Cover and cook until browned and crispy on the bottom, 4 to 6 minutes. 3. Add tomatoes, broth, wine and orzo (or other tiny pasta); increase heat to high and bring to a boil, stirring occasionally. Reduce heat to a simmer and cook until the pasta is tender, about 8 minutes, or according to package directions. 4. Remove the pan from the heat. Place a rimless baking sheet on top. Wearing oven mitts, grasp the pan and baking sheet together and carefully invert, unmolding the rösti onto the baking sheet. Wipe out any browned bits from the pan. Return it to the heat and add the remaining 1 tablespoon oil. Slide the rösti back into the pan. Top with the remaining 1/2 cup cheese, cover and cook the second side until crispy and browned, 4 to 6 minutes. Slide onto a platter, cut into wedges and serve.

NUTRITION Per serving (makes 4 servings total): 262 calories; 13 g fat ( 3 g sat , 8 g mono ); 94 mg cholesterol;  15 g carbohydrates; 0 g added sugars; 21 g protein; 2 g fiber; 276 mg sodium; 174 mg potassium




Notes for a Healthier You A Pep Talk with Coach Moon, the “Wellness Dude” By Eric Moon, MA, NASM, The Holmes Organisation

This is a list you can put on your refrigerator to remind you of small changes you can make to eat healthier. ✓ Eat 5-6 times a day and decorate your smaller plate! Choose fresh “fridge” food when you can. Bright and deep colors usually mean more vitamins. Flash frozen fruits and veggies are just as good! ✓ The 60-70-80-90% rule. Follow your nutrition plan 90% of the time. If you can’t commit yet, start with 60%, then 70%, etc. until you work your way up to 90%. ✓ Drink more water. It has zero calories and is good for you. Drink when you’re thirsty, and during/after exercise. To calculate the total ounces you should drink, take your body weight, divide it by 2, and then convert it to ounces. ✓ Never skip breakfast. People who eat breakfast have a tendency to be healthier and avoid binge eating, poor food choices, and fast-food. ✓ Use meal replacement products instead of fast-food. Liquid or candy bar style meal replacements are easy solutions when good food is not available. ✓ Learn to read labels. Limit consumption of sugars and processed foods. Avoid, puffed, sugared cereals, processed, or packaged food and all the preservatives that come with it. You are what you eat. Longer ingredient lists are generally bad signs. ✓ Listen to your body. If a meal did not settle well, there is a reason. Study the cause & effect, and make appropriate changes. ✓ Use natural spices in food. Many spicy items have valuable components that aid in body function. ✓ Include cold-water fish like salmon in your diet. Include fish in at least one or two meals each week. It is high in protein, low in fat, and a great source of muchneeded omega-3 fatty acids. ✓ Determine your ideal weight. Base it upon professional scientific and medical advice and what you personally feel good about. Muscle weighs more than fat, so if you’re adding a gym routine, expect your shape to change more than your weight in the beginning.

✓ Eat the calories for the body you want, not the body you have. For example: If you are 200 pounds and you want to lose 20 pounds, start eating like you weigh 180 pounds. ✓ Don’t covet the bad food. A powerful person can say “I can eat that but I choose not to,” rather than “I can’t.” You will feel guilty. Don’t deny yourself some foods that you know are not beneficial, but practice self-control. Let in to some cravings that persist for days. ✓ When determining your diet, include food that you enjoy and is good for you. Know why your food is good for you. Know what foods are poor choices and practice moderation and balance between the two. Don’t try to live on rice cakes and cantaloupe. Make sure you eat recovery foods, especially after exercise. ✓ Avoid “fad diets” and yo-yo weight loss and gain. 1-2 pounds per week is a good rule for weight loss or gain depending on your goal. If you are tracking your weight, use the same time and scale to keep an accurate record. ✓ Stay out of the fridge when stressed! Do not turn to food for comfort, or stress relief. It only temporarily delays the stress, and then may cause it to be magnified depending on the situation. Try exercise instead. Eating a pint of ice cream may temporarily reduce your stress, but can also add pounds of guilt. ✓ Be aware of slow weight gain. 2 pounds a year doesn’t seem like much until it has been 20 years. Body fat is harder to lose than it is to keep off. Learn to exercise, use portion control, and make good choices. ✓ Bounce back from a binge. Letting go once can lead to letting go often or totally. Have your moments but make up for it by using that new found willpower and determination! Are you really going to let a TV commercial derail your health plan? Does the smell of a french fry really have that much power over you? Recognize the relapse and try again having learned from it!



Osteoarthritis (adapted from

Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time. While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips. Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function. Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone. Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include: • Pain. Your joint may hurt during or after movement. • Tenderness. Your joint may feel tender when you apply light pressure. • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity. • Loss of flexibility. You may not be able to move your joint through its full range of motion. • Grating sensation. You may hear or feel a grating sensation when you use the joint. • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor: If you have swelling or stiffness in your joints that lasts for more than a few weeks, make an appointment with your doctor.

Tips to Control Osteoarthritis

Be Active

Research shows physical activity decreases pain, improves function and delays disability. It is recommended that people with arthritis undertake 30 minutes of moderate physical activity at least 5 times a week. Details of appropriate types of physical activity can be found on

Watch Your Weight Research confirms that maintaining a healthy weight can limit disease progression and activity limitation. For every pound lost, there is a 4 pound reduction in the load exerted on the knee. Modest weight loss (5%) can help reduce pain and disability.

See Your Doctor Early diagnosis and professionally guided management is critical to maintaining a good quality of life, particularly for people with inflammatory arthritis.

Protect Your Joints Sports or occupational based injuries to joints can increase the likelihood of developing osteoarthritis. Jobs that have repetitive motions, e.g. repeated knee bending, place individuals at higher risk.



food for thought

Breakfast: Smarter, Slimmer, Sweeter Adapted from

A healthy breakfast will fuel your morning, and can make you smarter, slimmer, and sweeter. Smarter: Research shows that eating breakfast may enhance your memory, improve your cognitive ability, and help increase your attention span, to name a few mind-boggling advantages. Slimmer: Some research suggests that people who skip breakfast have a higher body mass index (BMI), which is a measure of your weight in relationship to your height and a higher tendency of being overweight. Sweeter: Research suggests that eating breakfast, specifically carbohydrate-rich cereals, can improve your mood. Eating in the morning after a night's slumber will provide glucose to your starved brain. Feed yourself in the morning so that you are in a better mood and sweeter to those around you. See below for a recipe for a gluten free and vegan friendly treat packed with fiber and just sweet enough to satisfy a breakfast (or dessert!) craving.

Energy Bites


from the kitchen of Sheree Morgan, CareATC

1. Add all dry ingredients together in a bowl. Then add Agave Nectar and Almond Butter. Mix well.

Ingredients The Arthritis Foundation offers information and tools to help people live a better life with arthritis. The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through Education, Advocacy and Research.

The Vitamin D Revolution: How the Power of This Amazing Vitamin Can Change Your Life by Soram Khalsa, MD

3.5 cups rolled oats 1 cup raw sunflower seeds ½ cup flaxseed 2 tsp cinnamon 2. Refrigerate mixture for approximately 20 1 cup banana chips, crumbled minutes or until firm (this helps when rolling into ball shape) ½ cup dried blueberries 1 cup dark chocolate chips 3. Use a teaspoon to measure, roll into 2 cups almond butter (could also use balls. Store in refrigerator or freezer in peanut butter or sunflower seed butter) an airtight container. ½ cup Agave Nectar

Upcoming Newsletter Topics July



Weight Maintenance

Back Pain


Recent, groundbreaking medical research has made a connection between Vitamin D deficiency and many illnesses, including various cancers, influenza, diabetes, multiple sclerosis, and heart disease. This book sheds new light on the power of this long-forgotten vitamin and how to recognize signs of deficiency, which has reached epidemic proportions in North America, and then shares insights from his own medical practice, where he normalizes patients' Vitamin D levels for their optimal health.



CareATC Newsletter 2013 Issue 2  
CareATC Newsletter 2013 Issue 2  

CareATC wellness newsletter featuring osteoarthritis, asthma, and vitamin D.