HEALTH&CARE Journal Fall/Winter 2022-23

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e F E S e Su or W ! e bs a pa c r g ip e ti 4 on

Fr e

FALL / WINTER 2022-23 | ST. LOUIS METRO

Jane Tucker: A Remarkable 22 Year Journey with Cancer America Is Losing the War Against Diabetes High Blood Pressure (Hypertension) Explained Caregiving After a Stroke Americans Plagued

by Back Pain

Foods That Cut Your Odds for Colon Cancer More Than a Snore?

Recognize the Signs of Sleep Apnea Preventing Alzheimer’s New Maladies that can Follow COVID Controlling Back Pain A Life Saving Transplant Loneliness Can Be a Real Heartbreaker

Say Hello to New Friends!

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Welcome to the Premier Issue of HEALTH&CARE Journal.

Publisher Editor Todd Abrams Design Art Direction Production Michael Kilfoy Studio X Account Executive Carol Kindinger Printing Walsworth Fenton Advisory Board Dr. Donald Bassman Dr. Joshua Cohen Dr. Shaun Donegan Katy Dowd

Our mission is to provide readers with understanding about leading chronic health conditions that can help them prevent or seek appropriate treatment and care if they or their family face those conditions.

Each issue will feature informative articles about developments in research, diagnosing, treating and caregiving for chronic health conditions, from national and St. Louis area institutions and experts. Other articles will cover elderly and special needs caregiving, general health issues such as pain management, weight control, orthopedics, women's health and mental health. Each issue will also have Health Briefs, Healthy Humor and Featured Practice profiles.

Dr. James Jenkins Dr. Steve Lauter

Todd Abrams

Joel Iskiwitch

Humor Credits: Robert Mankoff

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Healthcare is the largest industry in the St. Louis Metro area, as it is in just about every major market, and for most adults, their health and the health of their loved ones are at the very top of their concerns. But until now there has been no consumer publication in the St. Louis Metro area focused specifically on providing useful information about serious health and care topics.

We are very interested in hearing from readers about HEALTH&CARE Journal– about what you read in the magazine, topics you would like to see covered and other information that would be helpful to you for maintaining your health and the health of your family. You can write to me at the email address below.

Robert Fruend

4

The whole world has been consumed for the past two years with the COVID-19 pandemic. At the same time, a second health crisis has developed, as many people who have ongoing health needs have either been reluctant to seek care or have been unable to access care because first, hospitals and specialists were consumed with treating COVID patients, and now they are very busy with those who waited to get treatment for their ongoing conditions.

toddabrams1@gmail.com

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J O U R N A L

Fall/Winter 2022-23 A R T I C L E S

I N

T H I S

Heart & Vascular Health

14 More Young Americans Have Predictors of Heart Disease

I S S U E

39 Study Supports Colonoscopies for Women Under 50 40 Adding MRI to Screening Can Cut

16 Plant-Based or Low-Fat Diet: Which Prostate Cancer Overdiagnosis Is Better for Your Heart?

Diabetes Care & Prevention

17 Quiz on Healthier Heart Diet

41 America Is Losing the War Against

20 Daily Coffee Tied to Longer,

Healthier Life

Screening Age for Diabetes to 35

Heart?

43 Diabetes: The Exercise Prescription

24 Loneliness Can Be a Real Heartbreaker

44 Not Just Obesity: Fat Threshold for Type 2 Diabetes

26 High Blood Pressure

45 Have Diabetes? Here’s How to Save

(Hypertension) Explained

Your Sight

Neurology & Stroke

Kidney Disease

28 Caregiving After a Stroke

46 Kidney Damage Can Be Another Consequence of Long COVID

Within 1 Hour of Good Stroke Care

31 Flu Shot Lowers Risk for Stroke 32 Former College Football Players

47 New Way to Blast Kidney Stones

Can Be Done in Doctor’s Office

48 Innovative Kidney Donor ‘Voucher’ System Is Saving Lives

Suffer More Brain Damage as They Age

Aches & Pains

Cancer Prevention & Treatment

50 More than Half of Americans

33 Pandemic Delays in Screening

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42 Expert Panel Lowers Routine

22 How Important is Exercise for My

30 Almost All Americans Are Now

6

Diabetes

Mean More Breast Cancer Deaths Ahead

34 The Five Foods that Cut Your Odds for Colon Cancer

36 Cover Story: A Remarkable 22-year Journey with Cancer

Plagued by Back and Leg Pain

51 Many Seniors Love Pickleball, But Injuries Can Happen 52 One Young Mom’s Journey with

Rheumatoid Arthritis

54 What’s the Difference Between a Strain and a Sprain?

Better Breathing

56 More Than a Snore? Recognize the

Signs of Sleep Apnea

57 Sleep Apnea Doubles Odds for Sudden Death 58 After COVID, Many Americans Are Struck by New Maladies

60 More Than Half of People with

Asthma Aren’t Seeing a Specialist

Women’s Health

62 Mammograms Can Also Highlight Heart Risks

63 Excessive Sugary Drinks Double Risk of Colon Cancer in Younger Women 64 Early Menopause May Raise a Woman’s Odds for Dementia

65 Women More Susceptible Than Men to Long COVID Aging & Caregiving

66 Caregiving: Reaching Out for Help

HEALTH&CARE JOURNAL is published twice

a year by HealthCom Network LLC and distributed to Missouri and Illinois homes in the St. Louis Metro area.

Article topics are chosen to provide helpful information about health and care topics of interest.

Opinions expressed in articles and editorials are those of the authors, and do not necessarily reflect the views of HealthCom Network. While every effort is made to assure accuracy, we are not responsible for how information found in HEALTH&CARE Journal is used. Readers are encouraged to consult with their healthcare providers for advice about their own care.

We are very interested in hearing from readers about content in this magazine, and about topics they would like covered. Correspondence should be sent to the address below or to toddabrams1@gmail.com Reproduction of content of this magazine without permission is prohibited. All submitted materials, including images, logos and text for advertising, articles and editorials are assumed to be the property of the contributor, and HealthCom Network does not take responsibility for unintentional copyright infringement. HealthCom Network has the right to refuse advertising and content not deemed appropriate for this publication.

For information regarding advertising, call, write or email: HealthCom Network

P.O. Box 411036 St. Louis, MO 63141

72 Almost 1 in 3 U.S. Seniors Now Sees

Todd Abrams, Publisher toddabrams1@gmail.com 314-443-3024

74 An Hour of Weight Training Per

Carol Kindinger, Account Executive carolkindinger@gmail.com 314-452-3576

70 Preventing Alzheimer’s Disease at Least Five Doctors Per Year

Week Can Extend Your Life

76 Sex in the Senior Years: Why It’s Key to Overall Health

77 Multivitamins Linked to Healthier Brains in Old Age

78 High-Tech Socks Could Prevent Falls in At-Risk Patients

80 For Families Dealing with Alzheimer’s Disease 82 Book Review & Healthy Humor

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Features in this Issue 12 A Life-Saving Transplant 36 Cover Story: A Remarkable 22Year Journey with Cancer 58 Covid Long Haulers with New Maladies 70 Preventing Alzheimer’s Disease 72 U.S. Seniors Are Seeing More Specialists 8 H&C

Primary Care Anywhere BJC PROVIDERS ARE ACCEPTING NEW PATIENTS We get it, life’s busy and you’ve got a lot on your plate. But, what if health care didn’t have to run a close second to everything else?

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Health Briefs Sleep, exercise & your odds of a long life.

Life expectancy of Americans living with HIV is near normal.

Far from being the death sentence it once was, HIV infection can now be managed with powerful drugs: A new study finds that people living with the virus have life spans approaching those of the general population.

New research shows that a history of poor sleep could shave life expectancy. But there was good news, too: regular exercise can counter the effect.

British Journal of Sports Medicine

Annals of Internal Medicine

Can you eat your way to fewer migraines?

People with migraines who consumed a lot of the omega-3 fatty acids found in oily fish such as salmon or mackerel appear to reduce their headaches by up to 40%.

British Medical Journal

The best blood sugar meds for people with diabetes.

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People with type 2 diabetes face an array of drugs to help control blood sugar levels. A new NIH-funded study looks at which work best when taken with metformin.

American Diabetes Association meeting

A new treatment for celiac disease?

Sticking to a strict, gluten-free diet is the only way people with celiac disease can curb the illness. But an experimental drug, dubbed ZED1227, appears to inhibit an enzyme that helps drive the condition.

New England Journal of Medicine

Healthy diets can thwart cancer, but most don’t follow one.

A new study of 31,000 Americans finds the vast majority aren’t eating in a way that could lower their odds for a variety of tumors.

Journal of Nutrition

When getting hitched isn’t healthy.

Once-a-week drug boosts diabetes outcomes.

A new study finds that men stuck in unhappy marriages tend to die earlier – the effect on health equal to that of smoking or being a ‘couch potato.’

A new drug called efpeglenatide, given once a week via injection, appears to curb the odds for heart trouble and kidney disease in people with diabetes.

Journal of Clinical Medicine

Healthy living helps the brain.

There’s no cure or good treatment for Alzheimer’s disease. But eating right, exercising and other healthy habits can cut your odds for developing the illness.

Penn State Health

American Diabetes Association

A DNA-based blood test spots hidden cancers.

Researchers say telltale genes reveal late-stage hidden cancers with great accuracy. But is that enough to help patients?

Annals of Oncology

Breathe in, breathe out for better blood pressure.

A daily 5-minute breathing exercise that gives the diaphragm a workout may be equal to medication in helping to lower high blood pressure.

Journal of the American Heart Association

Worry over milestones.

Delicious but deadly.

A new poll finds that a quarter of parents are concerned their child isn’t reaching key developmental milestones. But of these, over 80% asked for advice from healthcare providers or childcare providers; over 60% sought information online.

Fried chicken, pork rinds, red velvet cake: Southern foods are tempting, but new research suggests a steady diet of such fare can raise your odds for sudden cardiac death.

C.S. Mott Children’s Hospital National Poll

Journal of the American Heart Association

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P E R S O N A L

J O U R N E Y S University and Barnes-Jewish Transplant Center from his daughter, who lives in St. Louis with her husband and two children.

Duncan was impressed by the hospital’s reputation, and in June 2012, he and his wife, Joyce, made the move.

When Liver Disease Affected the Mind and Body, a Transplant Was the Answer Checking in on Jay Duncan, still going strong nine years later.

D

uncan says, “My job requires me to use my brain very actively. But when I was sick, I couldn’t keep a thought. I couldn’t stay on one subject. I slurred my words. People couldn’t understand me.”

Primary Bilary Cirrhosis

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His symptoms came on gradually after he was diagnosed in 2010 with primary biliary cirrhosis (PBC), a chronic disease that slowly destroys bile ducts in the liver.

Unlike the more common types of cirrhosis, often caused by hepatitis C or heavy alcohol consumption, PBC is thought to be an autoimmune disease—a disorder in which the body attacks its own cells.

Duncan’s cognitive problems were related to the fact that his diseased liver couldn’t

efficiently filter blood. When this happens, toxins build up in the bloodstream.

One of these toxins, ammonia, affects nerve transmission and disrupts thought processes.

The Move to St. Louis In addition to PBC, Duncan was diagnosed with liver cancer and needed a liver transplant. After waiting on a transplant wait list in Chicago for over a year, he decided to move to St. Louis to seek treatment at Barnes-Jewish Hospital instead.

He had learned about the liver transplant program at the Washington

Duncan also has coronary artery disease, so before he could be placed on a new wait list, he was evaluated by a Washington University cardiologist at Barnes-Jewish Hospital. His coronary disease, which wasn’t causing any symptoms, was found not to be a barrier to transplantation.

“Twenty years ago, most centers would have said Mr. Duncan—in his late 60s, with a heart condition— was clearly not a transplant candidate,” says Jeffrey Crippin, MD, medical director of the Washington University and Barnes-Jewish Transplant Center. “But we have learned that with appropriate follow-up and appropriate intervention, many patients like Mr. Duncan do incredibly well after a transplant.”

In November 2012, just five months after moving to St. Louis, Duncan got the call: There was a liver available. He canceled his plans for the day and headed to the hospital, where he was third in line for a donor liver. The first two on the list didn’t qualify, so Jay was able to receive it.

Before he went into the operating room, he spoke to his wife, daughter and son, who were all there with him. Shortly thereafter, he was wheeled away and given general anesthesia. The next thing he remembers is waking up. His operation, performed by Maria Doyle, MD, a Washington University transplant surgeon at Barnes-Jewish Hospital, had been a success.

“I felt quite confident having Dr. Doyle as my surgeon,” Duncan says. “It’s amazing

to think that she and her team put a liver from someone else’s body into my body and made it function.”

“Ruth is the best,” Duncan says.

“She made everything happen right and happen on time. She is an amazing, amazing lady.”

Doyle describes organ donors and their families as heroes. “The families are the ones going through the trauma of losing a loved one,” she says. “Their ability to allow their loved ones’ organs to be transplanted is so important. Without these families, there would be very little organ donation.”

William Chapman, MD, surgical director of the Transplant Center, says Duncan’s story is an example of the outstanding outcomes experienced by the hospital’s liver transplant patients. “He has had an excellent result. When we combine upfront treatment of a tumor with a liver transplant, which is what we did with Mr. Duncan, we are more than 90 percent likely to see a long-term cure. That’s what we’re expecting for Mr. Duncan.”

Great Care and Results Duncan has kind words for everyone who helped care for him during his post-transplant hospital stay.

“I have never had better care in my life anywhere,” he says. “The physicians and staff were hands-on, caring and highly talented. It was just incredible.”

He is especially thankful for Ruth Bander,

F E A T U R E D

his transplant coordinator. Barnes-Jewish Hospital’s transplant nurse coordinators are responsible for coordinating all aspects of patients’ care both before and after transplantation. They provide patient education, schedule diagnostic testing and follow-up care, answer patients’ questions, and handle any problems that arise.

Now, almost nine years after his transplant, Duncan, at age 77, feels better than ever. He exercises daily, runs his marketing communications business from his home and sees his grandchildren regularly.

–Barnes-Jewish Hospital

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H E A R T

&

V A S C U L A R

H E A L T H

More Young Americans Have Predictors of Heart Disease

A

new study finds that one in five people under age 40 now have metabolic syndrome, a group of risk factors that together increase the odds for many serious conditions, including diabetes, heart disease and stroke.

The rate of metabolic syndrome is rising in all age groups – as many as half of adults over 60 have it. But among 20- to 39-year-olds, the rate rose 5 percentage points over five years, the study reported.

immediate concern is COVID-19. People with metabolic syndrome, including younger people, have greater odds for developing severe complications if infected with the new coronavirus, according to Wong.

The study included data from a nationally representative group of more than 17,000 volunteers. More than 1 in 3 (35%) had metabolic syndrome. Rates were similar in both men and women.

Metabolic syndrome is a group of heart disease risk factors that occur together.

They include: ■ A large waistline ■ Higher-than-normal blood sugar levels ■ High triglyceride levels (triglycerides are a type of blood fat) “The trends for metabolic syndrome are very alarming. A huge proportion of the adult population is affected – overall, 37% of adults in the United States. In young adults, the prevalence was remarkably higher than in our previous study through 2012,” said study co-author Dr. Robert Wong, from the Veterans Affairs Palo Alto Health Care System in California.

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Wong said the specific effects of metabolic syndrome in younger people haven’t been well studied yet, but it’s concerning to see because the impact is cumulative. “Young adults have so many years for damage and impact from metabolic syndrome,” he said.

Metabolic Syndrome and COVID-19 While many effects of metabolic syndrome take years to develop, a more

While genetics may play a role, Wong said lifestyle appears to be the biggest contributor to the rise. He said targeted interventions to help people eat healthier and get more activity are needed.

“The challenge with metabolic syndrome is that for the most part, it has no symptoms. You may feel fine now, but these risk factors can culminate into serious outcomes like heart attack, stroke and cancers,” Wong said.

Dr. John Osborne, director of cardiology at State of the Heart Cardiology in Southlake, Texas, reviewed the findings and said the rising rates in younger people were concerning.

“It’s not just having a condition, it’s the duration,” he said.

“The longer you have metabolic syndrome, the more likely it is that it will ultimately turn into diabetes, heart disease, stroke, acid reflux, sleep apnea and other problems.”

Osborne said the biggest trends in the rise boil down to two big factors: “As a population, we’re getting grayer [older] and we’re getting fluffier [more overweight].”

■ High blood pressure

■ Low levels of good (HDL) cholesterol

64%. In Hispanics 60 and older, it was 57%.

The researchers compared data on cases in 2011-2012 to levels in 2015-2016.

Demographics and Lifestyle Among 20- to 39-year-olds, metabolic syndrome rose from 16% to 21%. For 40- to 59-year-olds, the rate went from 38% to 42%, and in those over 60, it rose from 47% to 50%. Only the change in the youngest group was considered statistically significant, Wong said.

Researchers also examined rates by race and ethnic group. They noticed that levels stayed roughly the same over the period among Blacks, but rose about five percentage points for whites. The biggest increases were seen in Asians, Hispanics and people who identified with other groups, according to Wong.

Among people 60 and older who did not identify as Hispanic, White, Black or Asian, the rate of metabolic syndrome was

While acknowledging that it can be hard, he said it’s crucial for your health to try to eat better and move more. Osborne recommended a more Mediterranean diet – lots of plant-based foods and less processed foods.

“Try to eat real food and avoid simple sugars,” he advised.

The findings were published in June of 2021 as a letter in Journal of the American Medical Association.

More information Learn more about metabolic syndrome from the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Robert Wong, M.D., staff physician, Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.; John Osborne, M.D., director, cardiology, State of the Heart Cardiology, Southlake, Texas; Journal of the American Medical Association, June 2021

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• Family history • High blood pressure & cholesterol • Smoking • Unhealthy weight • Diabetes • Diet high in fat and salt • Lack of physical activity • Excessive alcohol consumption

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CS_914803_4.22

Plant-Based or LowFat Diet: Which Is Better for Your Heart?

H

oping to eat your way to a healthier heart? Diets rich in plant foods may beat low-fat eating regimens for cutting the risk of heart disease and stroke, a new study finds.

Saturated fat, the kind largely found in animal products, has long been viewed as the enemy of the heart, since it can raise “bad” LDL cholesterol.

In the new study, which tracked more than 5,100 Americans, researchers found that people with diets low in saturated fat did indeed have better LDL levels. But that did not translate into a lower risk of heart disease or stroke, the study found.

On the other hand, people who consumed plenty of plant foods – vegetables, fruits, whole grains, beans and nuts – did have lower risks of cardiovascular trouble. Experts said the findings do not mean that LDL cholesterol, or saturated fat, are unimportant. People who eat a lot of plant foods also tend to have low LDL, and their diets are often fairly low in saturated fat by virtue of limiting meat and dairy.

Holistic Approach to Eating

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But focusing on saturated fat can “miss many aspects of diet quality,” said study author Yuni Choi, a postdoctoral fellow at the University of Minnesota. Instead, she said, a more “holistic” approach to eating is likely better for heart health. Choi presented the findings at the American Society for Nutrition’s annual meeting held online in June of last year. Studies released at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

The results come from a long-running study of heart health that began recruiting young U.S. adults in the 1980s. Over 32

years, 135 participants developed coronary heart disease, where “plaques” build up in the arteries and slow blood flow to the heart. Another 92 suffered a stroke.

Choi and her colleagues assessed all study participants’ diet histories, assigning them “scores” based on how many plant foods and how much saturated fat they typically ate.

Overall, both vegetable fans and those who shunned saturated fat had lower LDL cholesterol. But only plant-rich diets were linked to lower risks of heart disease and stroke. For every incremental increase in those scores, the risk of heart disease declined by 19%, on average. The risk of stroke, meanwhile, dropped by 29%.

That was with factors like smoking, body weight, and income and education levels taken into account.

In what may be good news to burger lovers, “plant-based” does not have to mean becoming vegetarian or vegan. Try filling 70% to 80% of your plate with vegetables, beans, whole grains and the like, said senior researcher David Jacobs, a professor of public health at the University of Minnesota.

Jeremy Leidenfrost, MD, Chief of Cardiothoracic Surgery at St. Luke’s Heart and Vascular Institute in Chesterfield, was not involved in the study, but adds, “Plant based diets have been proven beneficial

in many different ways. There are many things you can do to change your diet to include more plant-based foods. Even when becoming a vegetarian is not an option choosing to participate in this lifestyle change even part time can have significant health benefits.”

It’s important to eat those foods “close to the way they’re grown,” Jacobs said – rather than buying heavily processed versions.

Variety is also key. “You want to have a colorful, beautiful plate,” Jacobs said.

Plant Foods in Their Natural Form Dr. Andrew Freeman, a cardiologist not involved in the study, agreed that a “predominantly plant-based” diet is the way to go for heart health. “Animal products are not meant to be part of every meal,” said Freeman, who directs cardiovascular prevention and wellness at National Jewish Health in Denver. Instead, he encourages patients to consume a wide range of plant foods, in their “natural form.” “Eat the avocado rather than avocado oil,” Freeman said.

He cautioned that the new study does not mean saturated fat is meaningless. And if people focus on building a plant-centric diet, Freeman said, they will likely consume fairly low amounts of the fat.

Why are plant-rich diets so heart-friendly? It’s not any single magic ingredient, the researchers said. Such diets are typically high in fiber, unsaturated fat, and a slew of vitamins and minerals – but the explanation may go beyond those nutrients, according to Jacobs. Unlike animals, he pointed out, plants boast an array of self-generated chemicals that protect them from the environment. And those so-called bioactive compounds may benefit the humans who eat them.

Choi said the researchers also want to study the ways in which different diets affect the gut microbiome – the vast collection of bacteria and other microbes that dwell in the gut and perform numerous vital functions. It’s possible, she said, that plant-based diets partly benefit the heart via effects on the gut microbiome.

Quiz: Do You Know How to Eat Your Way to a Healthier Heart?

Whether you’re ordering at a restaurant or combing through the fridge, your choices could be putting your heart at risk.

But food isn’t the enemy. In fact, a healthy diet can be one of the most effective weapons against heart disease. Take this

short quiz to see how much you know about a heart-healthy diet.

1. Which of these foods can help lower your risk of heart attack?

4. Scanning the list of ingredients on a box of low-fat cookies, you see “partially hydrogenated vegetable oil” near the top.

What should you do? a. Buy them – they’re healthier than most snacks

a. Nuts b. Fish

b. Put them back – they could be bad for your heart

c. Soybeans d. All of the above

2. Which of these steps is MOST likely to lower your cholesterol levels? a. Choosing foods low in cholesterol b. Choosing foods low in saturated fat

c. Keep reading – other ingredients are much more important

5. How do fruits and vegetables help prevent heart disease? a. By protecting arteries from injury b. By lowering cholesterol levels

c. Choosing foods high in fiber

c. By lowering blood pressure

d. Choosing foods low in polyunsaturated fat

d. All of the above

3. Monounsaturated fats, such as olive oil, can actually be good for your heart. True or false?

Answers on the next page

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Diet and Heart Disease Answers to the Quiz 1. Which of these foods can help lower your risk of heart attack?

The correct answer is: d. All of the above All of these foods seem tailormade to help the heart. Like other types of beans, soybeans will both lower your LDL “bad” cholesterol and increase your HDL “good” cholesterol. Nuts are packed with monounsaturated fats that help keep cholesterol from sticking to your arteries (just limit them to a handful a day, and cut back on other calories if necessary). Fish – especially fatty fish such as salmon – contain omega-3 fatty acids that can help your heart stay in rhythm. The oil in fish also thins the blood, lowering the risk of dangerous blood clots. (Some fish, including swordfish, have unusually high mercury counts; check with your doctor if you have questions.)

2. Which of these steps is MOST likely to lower your cholesterol levels?

The correct answer is: b.

Choosing foods low in saturated fat

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Nothing in your diet will boost your cholesterol levels faster than saturated fats. (Saturated fats are most often found in milk, meat, cheese and butter, and baked goods.) The American Heart Association recommends getting less than 7 percent of your calories from saturated fats. For someone eating an average of 2,000 calories a day, this adds up to no more than 16 grams of sat fat (checking food labels will help).

To reach this goal, you should also go easy on fried foods, fatty meats, and dairy products made from whole or 2 percent milk (i.e., drink skim or 1 percent milk.) Besides cutting down on saturated fats, exercise and a diet very high in fiber (including fruits, vegetables, and nuts) may also dramatically help lower your cholesterol.

3. Monounsaturated fats, such as olive oil, can actually be good for your heart. True or false?

The correct answer is: True These fats help keep cholesterol from clogging your arteries. One study of heart patients found that a so-called Mediterranean diet rich in monounsaturated fats cut the risk of a heart attack by 80 percent. Just remember, even healthy oils have a lot of calories, so don’t drown your salad in them – the key is always moderation.

4. Scanning the list of ingredients on a box of lowfat cookies, you see “partially hydrogenated vegetable oil” near the top. What should you do?

The correct answer is: b. Put them back – they could be bad for your heart.

Anything made with partially hydrogenated vegetable oil contains a dietary villain known as trans fat. This type of fat, which lurks in stick margarine, fried foods, and many snack foods, threatens the heart in two ways. Not only does it increase your artery-clogging LDL cholesterol, it also lowers your HDL (“good”) cholesterol.

A recent Harvard study of more than 80,000 women suggested that replacing just 2 percent of trans fat calories with calories from healthier fats reduced the risk of heart disease by more than 50 percent. You can help lower your trans fat intake by avoiding potato chips and other foods that crinkle, getting margarine in a tub rather than a stick, and buying crackers made with olive oil. One exception is peanut butter. Although “partially hydrogenated vegetable oil” is usually on the label, it’s still considered good for you.

5. How do fruits and vegetables help prevent heart disease?

The correct answer is: d. All of the above For all of these reasons, the American Heart Association recommends eating four to five servings each of fruits and vegetables every day if you’re eating 2,000 calories a day. Just remember that some fruits and fruit juices are high in sugar and calories, and should be avoided in large quantities (if you’re diabetic or have questions about this, check with your doctor).

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Drink Up!

Daily Coffee Tied to Longer, Healthier Life

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In yet another finding that highlights the health perks coffee can brew, new studies show that having two to three cups a day not only wakes you up, it’s also good for your heart and may help you live longer.

In this largest ever analysis of nearly 383,000 men and women who were part of the UK Biobank, researchers discovered that, over 10 years, drinking two to three cups of coffee a day lowered the risk for heart disease, stroke, dangerous heart arrhythmias, dying from heart disease and dying from any cause by 10% to 15%.

“Observational analyses have shown that coffee drinking is associated with lower rates of cardiovascular events and lower all-cause mortality compared to individuals not drinking coffee,” said Dr. Gregg Fonarow, director of the Ahmanson-University of California, Los Angeles, Cardiomyopathy Center.

compounds, Kistler noted. These chemicals can help reduce oxidative stress and inflammation, improve insulin sensitivity, boost metabolism, inhibit the gut’s absorption of fat and block receptors known to be involved with abnormal heart rhythms, he explained.

how much coffee they drank from memory, which could be mistaken, he noted.

“Coffee drinkers should feel reassured that they can continue to enjoy coffee even if they have heart disease. Coffee is the most common cognitive enhancer — it wakes you up, makes you mentally sharper and it’s a very important component of many people’s daily lives.”

“If you are somebody who drinks two to three cups of coffee a day and hasn’t had any issues with, let’s say, atrial fibrillation being triggered by your coffee drinking, then maybe it would make you feel a little more comfortable with not feeling like you’re doing something bad for your health and that you need to stop,” he added.

Dr. Laurence Epstein, system director of electrophysiology at Northwell Health in Manhasset, N.Y., said that while these findings show coffee may be beneficial, it may not help everyone. “Every person is an individual,” he said. “So despite the research, you always have to assess things on an individual basis.”

“I wouldn’t say, based on this, if you’re not a coffee drinker that you should run out and start drinking coffee to protect your heart. I don’t think these data support that,” Epstein said.

But too much coffee isn’t good, Epstein said. “Caffeine is a stimulant, and so too much isn’t healthy. Caffeine is also a diuretic, so people can get dehydrated and that can have a negative impact as well.

An earlier analysis of the UK Biobank found that coffee drinking was associated with lower mortality, even among those drinking up to eight cups per day. This finding was seen in people who were fast and slow metabolizers of caffeine.

“This new study reinforces these findings associated with two to three cups per day in terms of arrhythmias, cardiovascular disease mortality and all-cause mortality,” he said.

Still, Fonarow said that because this is an observational study, it can’t prove that coffee was responsible for these protective effects, only that there appears to be a connection.

“Overall, however, these results provide further evidence that coffee drinking appears safe and may be part of a healthy nutritional approach,” Fonarow added.

Lead researcher Dr. Peter Kistler added in a news release from the American College of Cardiology that the new data suggests “daily coffee intake shouldn’t be discouraged, but rather included as a part of a healthy diet for people with and without heart disease. We found coffee drinking had either a neutral effect — meaning that it did no harm — or was associated with benefits to heart health.”

Coffee has over 100 biologically active

For example, atrial fibrillation, which is the most common arrhythmia, can be triggered by coffee. “Each individual needs to understand what their triggers are. Even though the study might say coffee is safe, if you’re a person where coffee triggers a-fib, then the study really doesn’t matter,” he said. Epstein added that it is unclear which component of coffee may be protective, and drinking coffee might be a marker of other behaviors that could reduce the risk of heart disease, stroke and death. Also, people in the study reported

My takeaway from this is what I tell all my patients all the time, the key is moderation — living healthily in moderation,” he advised.

The studies were presented this year at the annual meeting of the American College of Cardiology in Washington, D.C. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

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feeding the heart become clogged – a condition called coronary heart disease – a heart attack may be just around the corner.

The protection doesn’t stop there.

Exercise also increases your level of HDL (“good”) cholesterol, a substance that helps keep your arteries clear.

How Important is Exercise for My Heart?

Y

ou may not care about increasing your strength.

“Firm, sexy abs” may be the last thing on your mind.

Fine. But even if you don’t know your biceps from your bicuspids, there’s one muscle you should never ignore: your heart.

Other muscles just get small and flabby when they aren’t used. Your heart, on the other hand, might stop working. According to the American Heart Association, physical inactivity is a major risk factor for developing heart disease. The good news is that even moderate exercise, such as brisk walking, can make a big difference if done regularly. One study of healthy people over age 65 showed that those who exercised four to five times a week during their lifetimes had about 54 percent of the heart benefits seen in “master” athletes.

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Exercise is also important if you have a chronic illness, such as diabetes, that’s often accompanied by heart trouble. People with diabetes are two to four times more likely to develop cardiovascular disease, according to the American Heart Association. If you want to avoid heart disease – or you’re recovering from heart trouble – a little sweat can work wonders.

I’ve been a couch potato all my life – isn’t it too late to start exercising?

No, that’s just one more reason to get moving. Even if you’ve already had a heart attack, a little exercise could save your life.

A study published in the medical journal Circulation found that heart attack survivors who increased their activity levels were 90 percent more likely than inactive patients to be alive seven years after the attack!

How does exercise protect the heart?

Like any other muscle, the heart gets stronger with exercise. If you work out regularly, your heart muscle will grow a little larger and stronger, allowing it to move more blood with each beat. As a result, it takes fewer beats to get you through the day. Your heart rate drops, and your heart will enjoy a well-deserved rest.

Even more important, exercise helps protect your arteries – where heart attacks get their start. Regular exercise removes LDL (“bad”) cholesterol from your blood. If you have too much of this fatty substance, it starts sticking to the walls of your arteries, causing arteriosclerosis, or hardening of the arteries. If the arteries

In fact, your goal should be to make regular exercise a permanent part of your life. Besides being good for your heart, exercise has numerous other benefits, such as reducing stress, building strength and endurance, and helping prevent osteoporosis, or bone thinning. Regular workouts can also lower high blood pressure and prevent Type 2 diabetes, a condition that greatly raises the risk of heart trouble.

What kind of exercise is best?

You don’t have to live at the gym to protect your heart. The American Heart Association (AHA) recommends at 30 minutes of moderate exercise (like brisk walking) five days a week, or 25 minutes of vigorous exercise on at least three days a week. In addition, the AHA recommends that adults lift weights or doing other muscular strength and endurance exercises at least twice a week. (If you need to lower your blood pressure or cholesterol, up that work out to 40 minutes at least 3 or 4 times a week.)

After getting the go-ahead from your doctor, exercise to the point that you break a sweat or feel yourself short of breath.

Start with as little as 5 minutes of exercise, which just about anyone can do, and build it into your daily routine. For example, you might start by taking a 5-minute daily walk at lunchtime, or walking up and down a staircase for 5 minutes at a time. Try increasing the amount you exercise by a few minutes each week until you reach your target; realistic goals make it easier to succeed. The reward: Unlike the stock market, exercise will give back everything you invest in it, with some benefits that are almost immediate.

Vigorous exercise – aerobic dancing, cycling, uphill hiking, swimming, and

jumping rope – will definitely condition the heart and lungs; stop-and-go activities like basketball, tennis, and soccer can help condition them as well. Interestingly, aerobic activities that involve the upper arms seem to offer more protection than other types. If you don’t like rowing, swimming, or team sports, your best bet for heart protection is probably brisk walking.

You can start anytime, and best of all, it’s completely free.

Mark Gdowski, MD, cardiologist at St. Luke’s Hospital in Chesterfield, underscores the benefits of exercise for your heart. "Exercise is one of the most important things you can do for your heart health. By performing something as simple as exercise on a routine basis, you can greatly reduce the risk of developing cardiovascular disease. It is something you can control and take into your own hands in order to be successful."

If I’m a construction worker, do I still need to exercise?

Yes. It’s a common myth that people who have non-sedentary jobs get enough exercise. They may do a lot of walking around, but it is usually not sustained. You need

F E A T U R E D

at least 15 to 20 minutes of uninterrupted exercise to get the metabolic benefits.

Is it safe for me to exercise?

If you’re overweight or have been sedentary for a while, you’ll want to get back into exercising gradually. In addition, you should have a thorough checkup before starting an exercise program.

Ask your doctor what heart rates you should target while exercising, especially if you’re over 50, are pregnant, or have a condition that might make it difficult for you to exercise. Once you get the go-ahead, start slowly. Drink lots of water, including a glass before and after exercising, and keep a water bottle with you at all times; keeping the body supplied with plenty of water helps prevent heat exhaustion and dehydration. See a doctor immediately if you feel light-headed, disoriented, faint, or experience chest pain, dizziness, and nausea.

Also, avoid being a “weekend warrior.” If you’re sedentary all week – that is, staring at a monitor or being a couch potato – don’t go full blast on the weekends to make up. Not only is it a good way to get injured, but older, infrequent exercisers

who work out too vigorously may even risk a heart attack, according to a 2007 report in the journal Circulation. Any exercise is better than none, but sedentary types should exercise moderately and check with their doctor before starting a workout regime.

Not every heart, in fact, can handle all the rigors of exercise. If you have heart disease, you should have a thorough checkup before starting an exercise program, even if you just want to walk around the block.

If you have heart pains or experience shortness of breath after a walk up the stairs, your doctor may want to give you a stress test, an exam that monitors your heart while you walk on a treadmill or ride a stationary bicycle.

The good news is that most people with heart disease can continue to lead an active life. As soon as you get your doctor’s okay, you can start reaping the benefits of exercise. You’ll feel stronger, more energetic, and less stressed. And one muscle will be especially grateful.

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Health. "Individuals can lead a relatively isolated life and not feel lonely, and conversely, people with many social contacts may still experience loneliness."

Social isolation is having infrequent in-person contact with people for social relationships, such as family, friends, or members of the same community or religious group. Loneliness is when you feel like you are alone or have less connection with others than you desire.

Loneliness Can Be a Real Heartbreaker

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ocial isolation and loneliness put people at a 30% higher risk of heart attack, stroke or death from either, a new scientific statement from the American Heart Association (AHA) warns.

the loneliest generation is Gen Z — 18to 22-year-olds — which also may be the most isolated. A possible reason: They spend more time on social media and less time engaging in meaningful in-person activities.

The statement also highlights the lack of data on interventions that could improve heart health in isolated or lonely people. It was published Aug. 4 in the Journal of the American Heart Association.

And the pandemic appears to have made matters worse among younger and older adults, as well as women and the poor.

"Over four decades of research has clearly demonstrated that social isolation and loneliness are both associated with adverse health outcomes," said Dr. Crystal Wiley Cené, who headed the team that wrote the statement. "Given the prevalence of social disconnectedness across the U.S., the public health impact is quite significant."

Nearly a quarter of U.S. adults aged 65 and older are socially isolated, and as many as 47% may be lonely, according to AHA. The risk rises with age due to such factors as retirement and widowhood.

But a Harvard University survey suggests

To investigate the relationship between social isolation and heart, blood vessel and brain health, the writing group reviewed research on social isolation published through July 2021. The review found: ■ Social isolation and loneliness are frequent but under-appreciated factors that affect the heart, blood vessels and brain.

■ Lack of social connections is associated with a higher risk of premature death from any cause, particularly in men.

■ Folks who were less socially connected were more likely to exhibit physical symptoms of chronic stress. Isolation and loneliness are linked to increased inflammation.

■ When evaluating risk factors for social isolation, it is important to remember that depression may cause isolation, "Over four decades of research and isolation may make has clearly demonstrated that depression more likely.

social isolation and loneliness are both associated with adverse health outcomes," – DR. CRYSTAL WILEY CENÉ

"Although social isolation and feeling lonely are related, they are not the same thing," said Cené, chief administrator for health equity, diversity and inclusion at the University of California San Diego

■ Social isolation in childhood is linked to increased heart health risk factors, including obesity, high blood pressure and elevated blood sugar levels.

■ Transportation, housing, family discontent, the pandemic and natural disasters are a few social and environmental factors that have affect social interactions.

"There is strong evidence linking social isolation and loneliness with increased

risk of worse heart and brain health in general; however, the data on the association with certain outcomes, such as heart failure, dementia and cognitive impairment is sparse," Cené said.

The strongest evidence points to a connection between social isolation, loneliness, and death from heart disease and stroke, with a 32% higher risk of stroke and death from stroke and a 29% higher heart attack risk.

"Social isolation and loneliness are also associated with worse prognosis in individuals who already have coronary heart disease or stroke," Cené said.

Along with behaviors that have a detrimental effect on heart and brain health, isolation and loneliness are linked to lower levels of self-reported physical activity and a lower intake of fruits and vegetables.

Additionally, numerous large studies have

F E A T U R E D

found significant links between loneliness and a higher likelihood of smoking.

"There is an urgent need to develop, implement and evaluate programs and strategies to reduce the negative effects of social isolation and loneliness on cardiovascular and brain health, particularly for at-risk populations," Cené said in an AHA news release.

She said clinicians should ask patients about their social activity and whether they are satisfied with their level of interaction with friends and family.

"They should then be prepared to refer people who are socially isolated or lonely — especially those with a history of heart disease or stroke — to community resources to help them connect with others," she added.

The authors said more research is required to understand how isolation affects heart

and brain health in children and young adults; people from under-represented racial and ethnic groups; LGBTQ people; people with physical or hearing disabilities; those in rural areas; and people with limited resources.

The statement noted that studies in senior citizens have found that interventions addressing negative thoughts and low self-worth, as well as fitness programs and recreational activities at senior centers, have shown promise in reducing isolation and loneliness.

"It is unclear whether actually being isolated [social isolation] or feeling isolated [loneliness] matters most for cardiovascular and brain health because only a few studies have examined both in the same sample," Cené said, adding that more research is needed.

SOURCE: American Heart Association, news release, Aug. 3, 2022

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a magnetic field that stimulates specific regions of the brain to increase neuronal activity that can alleviate depression. Leading neurology and psychiatric hospitals in the US, including the Mayo Clinic, Massachusetts General Hospital, Stanford, and Johns Hopkins incorporate TMS in their treatment of depression.

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weight, drinks too much alcohol, or, in some cases, eats too much salt is at the risk of developing hypertension.

Contrary to popular belief, coffee does not appear to contribute to hypertension, at least not in women. A 12-year study of more than 150,000 women published in the Journal of the American Medical Association (JAMA) found neither caffeinated nor decaf coffee contributed to long-term hypertension and, ironically, that drinking coffee might actually decrease the risk of hypertension.

High Blood Pressure (Hypertension) Explained

E

What is hypertension? very time you get your blood pressure checked, you get two numbers, perhaps something like 130/85. These numbers tell you how hard your blood pushes against the walls of your arteries as it flows through your body. The higher figure, called systolic pressure, indicates the force pushing on blood vessels as the heart contracts. The lower figure, called diastolic pressure, shows the force when the heart relaxes.

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Whether you're a card player or tennis player, a healthy blood pressure reading is below 120/80. There's no single cutoff between healthy and unhealthy numbers, but high blood pressure is now defined as 130-139 over 80-89. In these ranges, both the heart and arteries are straining too hard to move blood. This condition is called hypertension or high blood pressure, and it affects about one in three U.S. adults.

Even if your blood pressure is 120/80, you should still keep an eye on it. This category is considered prehypertension,

and according to the NHLBI, you should be sure to exercise regularly, eat plenty of fruits and vegetables, and live a hearthealthy lifestyle to prevent your blood pressure from going any higher.

Is hypertension dangerous?

Hypertension is a major contributor to some of the most dangerous diseases in our country. Compared to a person with normal blood pressure, someone with hypertension is more than twice as likely to develop heart disease and six times more likely to have a stroke. High blood pressure can cause blindness and also severely damage your kidneys.

What causes hypertension?

Some people develop high blood pressure during pregnancy or because of hormone imbalances or an illness such as kidney disease. But for most people, hypertension can't be traced to a single cause. Doctors do know, however, that some things make the condition much more likely. A family history of hypertension doubles your chances of having it. High blood pressure is also more common in older people.

Anyone who doesn't exercise, is over-

The study cautioned, however, that other caffeinated beverages, such as soft drinks and tea, do appear to increase the risk of hypertension. Women who drank more than three cans of cola per day, for instance, were up to 44 percent more likely to be diagnosed with hypertension than those who drank only one.

Stress can temporarily boost high blood pressure. For instance, some people have short-term hikes in pressure whenever they visit a doctor's office. When it comes to controlling blood pressure, stress is a much less important factor than diet or exercise. If you continually feel a lot of stress, however, it's useful to explore such stress-reduction measures as yoga, progressive relaxation, and meditation.

Can children have hypertension?

Yes. In recent years, a younger generation of Americans, including children in their teenage years, has seen its blood pressure rise as a growing number of them become overweight. Researchers blame the higher blood pressure readings on lack of exercise, poor eating habits, and excess weight.

In response to the problem, the government released federal guidelines recommending blood pressure checks for children over the age of 3 during routine office visits. A reading over the 95th percentile for the child's size and age would be considered to be hypertension, and a reading between the 90th and 95th percentile would be considered prehypertension.

Doctors say that children may be able to avoid both labels entirely by pursuing healthy lifestyles with regular exercise and

a low-fat diet rich in fruits and vegetables.

How can I tell if I have hypertension?

Many people with hypertension don't even know they have it. Blood pressure usually rises gradually, and you're not likely to notice any symptoms even as your pressure climbs to dangerous levels.

That's why it's important to get your pressure checked regularly even if you feel fine. If you've always had normal blood pressure, you should get checked every two years. If your last reading was borderline high or if your age, lifestyle or family history puts you at risk for the condition, have your pressure checked at least once a year.

How can I keep my blood pressure low?

Whether you already have hypertension or simply want to keep your pressure down, a few healthy lifestyle changes can make a big difference: Stay active. Any regular exercise that gets the heart pumping faster, such as brisk walking, can take points off your blood pressure and strengthen your heart. Blood pressure actually rises slightly during a workout, but it eventually finds a lower resting place. However, high-resistance exercises such as lifting heavy weights can lead to long-term increases in blood pressure. If you want to build strength, use moderate weights. (If you haven't exercised in a while, check with your doctor.)

Eat less saturated fat. If you like hamburgers, cheese, and whole-fat milk, adopting a low-fat, low-cholesterol diet will probably

reduce your blood pressure at least slightly. More important, switching to a leaner diet will definitely help prevent clogged arteries and heart attacks. "Good" fats like olive oil omega-3 fatty acids found in fish are good for your heart, too.

If you smoke, stop. Cigarettes can damage the heart and arteries and greatly increase the risk of heart attack and stroke. A person who manages to lower his blood pressure but still smokes has won only half of the battle.

Stay trim. Blood pressure tends to rise with extra weight. Heavy people with hypertension can drop almost one point from their pressure for every two pounds lost.

Track your pressure. People with hypertension should keep tabs on their condition. If you have severe hypertension, you may want to get a blood pressure monitor to use at home periodically.

With repeated measurements in a relaxed setting, you'll learn your average pressure and be able to tell if your lifestyle changes are working.

Eat more produce. Most fruits and vegetables contain potassium, a mineral that seems to lower blood pressure. Orange juice, tomato juice, bananas, and potatoes are all high in potassium; some studies have shown, in fact, that eating two bananas a day may lower blood pressure significantly. Try to eat the recommended daily allowance of eight to 11 servings of fruit and vegetables.

Cut back on salt. This advice isn't for everyone. About 58 percent of the people with high blood pressure are salt sensitive. The rest will hardly nudge their pressure by eating less salt. The best way to find out if you're salt sensitive is to talk to your doctor about trying a low-salt diet for two weeks to see if your pressure drops. Remember that packaged meals, canned foods and fast food can be much bigger sources of salt in your diet than the shaker.

Seek treatment for depression or chronic anxiety. Researchers at the Centers for Disease Control and Prevention completed a study that indicates depression and anxiety can more than double a person's risk of developing high blood pressure.

Consult your physician for advice.

How is high blood pressure treated?

Before filling out a prescription for medication, your doctor will probably want you to first tackle the problem by exercising regularly, trying to lose excess weight, and cutting back on saturated fats, alcohol, and possibly salt. If your blood pressure remains high, it may be time to consider medication. Be sure to talk with your doctor about possible side DIASTOLIC mm Hg effects and drug interac(lower number) tions.

Blood Pressure Categories BLOOD PRESSURE CATEGORY

Drink sensibly. One alcoholic drink a day or less may lower your blood pressure and protect your heart, but drinking much more will raise your blood pressure.

Federal health agencies say that a sensible limit is two drinks a day or less for men and one drink a day or less for women; however, even this low level of drinking may increase the risk of various illnesses, including some cancers, according to the CDC. (A drink is defined as the amount of alcohol in 12 ounces of regular or light beer, 5 ounces of wine, and 1.5 ounces of distilled spirits, or hard liquor.)

Alcoholism in itself can also be a cause of hypertension.

SYSTOLIC mm Hg (upper number)

NORMAL

LESS THAN 120

and

LESS THAN 80

ELEVATED

120-129

and

LESS THAN 80

HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1

130-139

or

80-89

HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2

140 OR HIGHER

or

90 OR HIGHER

HYPERTENSIVE CRISIS (consult your doctor immediately)

HIGHER THAN 180

and/or

HIGHER THAN 120

©American Heart Association. DS-16580 8/20

heart.org/bplevels

Remember, however, that hypertension drugs should always be accompanied by a healthy lifestyle. By exercising and eating right, you may someday be able to control your blood pressure without taking medication.

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N E U R O L O G Y

&

S T R O K E The left-brain stroke Injuries to the left side of the brain – the side that controls language – can be extremely distressing for the survivor and her family. She may have trouble reading, writing, speaking, or understanding the words of others. Some survivors can't speak at all, some can manage only one- or two-word sentences, and some sprinkle their conversations with odd word choices or bits of gibberish. This constellation of speaking and comprehension disorders is called aphasia.

Caregiving After a Stroke

S

troke survivors often feel as though they're lost in an alien landscape. Words can lose their meaning, familiar places and objects can become bewildering, and even the simplest tasks can seem overwhelming. Sufferers may someday return to their old world, but they can't make the trip on their own.

For these reasons, stroke survivors need a concerned caregiver who can help ease the way to recovery.

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If you're caring for a stroke survivor, you should learn everything you can about the challenges ahead. If your loved one has been seen only by his or her primary care physician, you may want to ask about an appointment with a specialist (such as a neurologist) who can assess the brain damage and tell you what to expect. Even if complete recovery isn't possible, you can take steps to make the survivor's life as pleasant and productive as it can be.

The right-brain stroke Strokes in the right side of the brain – the half that governs emotions, spatial perceptions, judgment, concentration,

and nonverbal communication – may cause bewildering changes in behavior and perception.

For example, a stroke survivor may laugh uproariously or burst into a fit of sobbing for no apparent reason. He may not have the attention span to complete simple tasks. Because right-brain damage also clouds judgment, he may push himself too hard or take unnecessary risks. For instance, he may try climbing the stairs when he can barely walk. If he's confused or if his memory is failing, he may wander away.

Survivors with right-brain damage often struggle with perception. The person you're caring for may drop a plate on the floor because he missed the edge of a table.

He may even mistake one object for another. "My brother tried to brush his teeth with a pencil," says a caregiver in Marilynn Larkin's book When Someone You Love Has a Stroke. "We had to take all the medicines and cleaning supplies out of the cabinets when he tried to drink the detergent, thinking it was a bottle of soda."

Writing to an Internet forum on aphasia, one woman affected by the disorder describes the dissonance between her thoughts and her words. "I often cannot express the word for an object but can picture it in my mind. For example, 'Put the roast in the square hot box' means 'Put the roast in the oven.'"

Not surprisingly, such problems with basic communication can shake a person's confidence and radically change her personality. "Survivors with left brain damage tend to behave in a cautious, compulsive, or disorganized way and are easily frustrated," writes Larkin.

Fortunately, aphasia is often temporary, especially when a patient receives aggressive speech therapy soon after the stroke.

According to a report in the Journal of Internal Medicine, "even patients with severe speech impairment have a considerable potential for recovery, particularly in the first three months after stroke."

The long road back: Tips for caregivers For any caregiver, safety is always the top priority. It can also be the biggest challenge, especially if your loved one has an injury to the right side of his brain. If his judgment or perception are severely clouded, he shouldn't be left alone. All poisonous substances or dangerous objects will have to be hidden away or put out of reach. And if he's at all inclined to wander, make sure he has an ID bracelet with his name, address, and phone number.

After ensuring his safety, you can take

steps to improve his quality of life – as well as your own. If he starts laughing or sobbing in the middle of a conversation, try to distract him by calling his name or changing the subject. As soon as he stops, continue the conversation as if nothing has happened. If he apologizes, remind him that the fault lies with the brain injury, not with him.

If he has trouble completing a task, try breaking it down into small segments.

You can make it easier to stick to the task by turning off the television or eliminating any other distractions. Not only will you cut down on frustration, you'll give him a valuable sense of accomplishment that comes with successfully performing the task.

It takes patience and perseverance to cope with aphasia. Talk to your loved one's speech therapist for advice. Here are some of the tips Larkin offers: If the stroke survivor cannot comprehend what you're saying, use gestures and facial expressions to communicate as much as possible.

Speak in simple sentences that express one idea, such as "Let's go outside," then

"Let's go for a walk," instead of saying, "Let's go outside for a walk."

If the stroke survivor can speak but is impaired, ask questions that take a yes or no response. "My parents took care of my grandfather, who had such a severe stroke that he couldn't walk and could only say 'yes' and 'no,'" says Diana Hembree from Atlanta, Georgia. "But he could put a world of feeling – from sly humor to exasperation – into each 'yes' and 'no.' So we would have great conversations playing 20 Questions. He could still smile and frown, too. And sometimes he would cry with frustration, and I'd pat his hand and say, 'It's all right, Granddaddy – we're here for you. We love you.'"

Find creative ways to help the patient communicate. One caregiver used pictures and labels to help his wife make her choice for dinner.

Talk with your doctor about new technology to help stroke victims. New technologies are being developed that will give stroke victims feedback on which muscles they need to use to, say, pick up a cup or move their hand. Some of the machines can actually recognize and signal someone's "intent" to move a particular muscle.

Researchers feel these technologies may one day be able to free many stroke and accident victims from paralysis.

Finally, don't hesitate to ask for help. No matter what the impairment you are facing, some caregiver or stroke survivor has already found a way to cope. Join a stroke support group, and ask your loved one's therapists and doctors plenty of questions. It takes compassion and knowledge to help someone overcome a stroke. The first just comes naturally; the second takes work.

But as you see your loved one making strides toward recovery, you'll know it was all worth it.

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emergency departments are included.

The findings were presented at a conference of the American Stroke Association, held in New Orleans and virtually, Feb. 8-11.

“There is a narrow window of time for delivering disability-reducing stroke treatments,” Zachrison said in a meeting news release.

Almost All Americans Are Now Within 1 Hour of Good Stroke Care

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ine in 10 Americans – 91% – live within an hour of lifesaving stroke care, researchers say.

That’s up from about 80% a decade ago, due to an increase in hospitals with specialized staff, tools and resources, as well as expanded use of telestroke services that use the internet to link small and rural hospitals with stroke specialists in large facilities.

Stroke definition and prognosis A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain.

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The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause.

There are two forms of stroke: ischemic - blockage of a blood vessel supplying the brain, and hemorrhagic - bleeding into or

around the brain.

Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis.

Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression.

“Investments in improving stroke systems of care have been successful, and we are seeing improved access to stroke expertise and improved health care for patients who are remote from centers of expertise, so it’s a message of hope,” said study lead author Dr. Kori Zachrison, an associate professor of emergency medicine at Massachusetts General Hospital and Harvard Medical School in Boston.

The analysis of 2019 and 2020 national data showed that 91% of the U.S. population can reach an acute stroke ready hospital or center within an hour by ambulance.

That rises to 96% if telestroke-capable

“Improving post-stroke outcomes for patients depends on a patient’s ability to access that care,” she said. “With increased implementation of telestroke, optimal stroke care has been made possible for an estimated 96% of the U.S. population, which is remarkable, considering the geographic span of our country.”

Still, the percentage of the population without access to either an acute care hospital or telestroke care varied widely by region – from 1% in the Middle Atlantic states to 9% in the Mountain West, a region that includes Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada and Wyoming.

“Unfortunately, geography plays a role in access to health care – if you live in rural areas your access to advance stroke care is not as available as if you live in the middle of Boston or New York City, for example,” Zachrison said. “Through telestroke, we have been able to begin to close geographic disparities and improve access to optimal care by bringing stroke expertise to patients where they are – this is profound.”

Of 5,587 emergency departments nationwide, 46% are in an acute stroke ready hospital or stroke center, the study found. Of these, 55% also have telestroke services.

Of the emergency departments that are not in an acute stroke-ready hospital or stroke center, 36% have telestroke services, according to the findings.

Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

In May 2020, the American Heart Association’s Stroke Council issued new guidance on how to handle suspected stroke cases before they arrive at a hospital during the COVID-19 crisis and future pandemics.

More information There’s more about stroke symptoms and treatment at the U.S. National Institute of Neurological Disorders and Stroke.

It's known, de Abajo said, that flu infection can temporarily raise the risk of stroke in vulnerable people. So, in theory, a vaccine that helps prevent the flu would, in turn, prevent some strokes.

But there may be more going on, as well, the experts said.

Another Reason to Get the Flu Shot: Lowered Risk for Stroke

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s flu season approaches, a new study is pointing to a possible bonus from vaccination: a lower risk of stroke.

Researchers in Spain found that among nearly 86,000 middle-aged and older adults, those who got their annual flu shot were less likely to suffer an ischemic stroke over the next year. Ischemic strokes, which account for most strokes, are caused by a blood clot that diminishes blood flow to the brain.

The risk reduction linked to the flu shot was not huge: On average, vaccinated people were 12% less likely to suffer a stroke compared to their unvaccinated counterparts.

But senior researcher Dr. Francisco Jose de Abajo pointed to the bigger context: A huge number of people worldwide suffer a stroke each year, and a huge number get – or could get – a flu shot.

So even a modest protective effect from vaccination could translate into a substantial number of strokes averted, said de Abajo, a professor at the University of Alcalá in Madrid.

That assumes, however, that the flu shot does directly lower stroke risk.

The new findings, published Sept. 7 in the journal Neurology, do not prove that.

They show only an association between flu

vaccination and lower stroke risk.

It's difficult, de Abajo said, to account for all the differences between people who get a yearly flu shot and those who do not. People who get the recommended vaccinations are likely, for example, to be health-conscious in many ways – eating healthier, exercising or taking medications to get conditions like high blood pressure or high cholesterol under control.

But researchers accounted for the differences they could, including body weight, smoking and chronic health conditions.

And the link between flu vaccination and lower stroke risk held up.

They also looked at whether people who received another recommended vaccination – the pneumococcal vaccine against pneumonia – had a lower stroke risk. It turned out they did not.

That's one of the strengths of the study, said Dr. Mitchell Elkind, a professor of neurology at Columbia University in New York City. He co-authored an editorial published with the study.

If getting vaccinated against the flu is simply a marker of better health or greater health consciousness, Elkind said, then you'd expect other vaccinations to be tied to a lower stroke risk, too.

Why would a flu shot help ward off a stroke?

The study found that stroke risk went down quickly after people were vaccinated – within two weeks to a month. And the benefit emerged during the "pre-epidemic" period, between September and the annual flu surge. That's a time when people would be getting their flu shots, but the virus would not yet be widely circulating.

It's possible, Elkind said, that the vaccine reduces inflammation or has other beneficial effects on the blood vessels. But more research is needed to answer those questions, he said.

The findings are based on adults ages 40 to 99 whose medical records were part of a Spanish primary care database. Over 14 years, 14,322 of them suffered a first-time ischemic stroke. The researchers compared each of them with five stroke-free patients of the same age and sex.

In both patient groups, about 40% received a flu shot – which Elkind said shows a lot of room for improvement.

"The flu shot is not 100% effective," he said, "but it's pretty darn good."

And even if vaccination does not prevent infection entirely, Elkind noted, it can reduce the severity of the flu. People with a history of stroke, or risk factors for it, are among those at increased risk of severe flu complications.

The new findings, Elkind said, offer even more incentive to get the flu shot.

De Abajo agreed.

"We hope that studies such as ours will help to enhance public awareness of the benefits of being vaccinated," he said.

As for COVID vaccination, it's unclear whether it might help ward off strokes.

But it's known, Elkind said, that COVID can promote blood clotting and increase the risk of stroke. Studies show that of people hospitalized with the infection, roughly 1% to 2% suffer a stroke.

One recent study from Korea did find that fully vaccinated people were less likely to suffer a stroke or heart attack if they contracted COVID-19, versus unvaccinated people.

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between 1964 and 1980. In all, the researchers had data from 447 players on those rosters.

The researchers noted that 15% of the living Notre Dame survey respondents also played pro football. They found no significant differences in health outcomes between them and men who did not play professionally.

Dr. Daniel Sciubba, senior vice president for neurosurgery at Northwell Health in Great Neck, N.Y., said this study suggests that mental impairment in older football players has already started in college.

Former College Football Players Suffer More Brain Disorders as They Age

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ollege football players live longer than those who didn't play, but they suffer more brain-related issues as they age, a new study finds.

Among former Notre Dame football players, being physically fit was tied to lower deaths from heart disease and diabetes.

But the former players were five times more likely to have impaired thinking and memory ("cognition") and 2.5 times more likely to suffer recurrent headaches, the researchers found.

"We found that the overall [death rate] among the former college football players was significantly lower than the general U.S. population of same-age men," said lead researcher Robert Stern. He is director of clinical research at Boston University's CTE Center. (CTE, or chronic traumatic encephalopathy, is brain degeneration caused by repeated head injuries.)

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Consistent with reports of former National Football League (NFL) players, death rates due to degenerative brain disease — specifically Parkinson's disease and ALS (amyotrophic lateral sclerosis) — were higher in the former college players than in the general population, the study showed. But, Stern noted, the difference was not statistically significant.

Unexpectedly, the researchers found that death rates from brain and other nervous

system cancers were almost four times higher in the former college players than in the general population. "This was statistically significant," Stern said.

This study doesn't prove that football injuries caused cognitive skills to decline, only that there appears to be an association. These findings, however, are similar to what's seen among former NFL players, Stern noted. Other research has found that college players underestimate their health risks.

The long-term neurological consequences of repeated blows to the head are seen in former players at both levels, he said.

"By the time you're done with college, there's an association that you will have worse cognition than a dude who's your age, who never played college football," Sciubba said.

As college football players have gotten bigger and faster, Sciubba suspects improved helmets have made little difference.

"You're now getting guys who run 30 miles an hour, where in the 1950s, they ran 15 miles an hour, so it's probably a wash, because now guys are harder, stronger and bigger," he said.

Sciubba said that young athletes need to think about the long-term consequences of contact sports like football when choosing what to play.

"We need to think about the number of repetitive head injuries in collision sports in young athletes, because they may see cognitive decline 20 to 30 years later," he said.

"I would think that an important way to reduce risk for later-life brain disorders associated with American football is to reduce the overall exposure to repetitive head impacts, including those impacts resulting in symptomatic concussions, as well as the much, much more common subconcussive trauma, the injuries to the brain that do not immediately result in the symptoms of concussion," Stern said.

The NFL constantly says it is changing the rules, Sciubba noted. "But they still want to put people in the stands of a collision sport — a Gladiator sport," he said. "One has to think about enrolling in sports like football or hockey or hope that the leaders of these sports change the rules to limit repetitive head injuries in the future."

This doesn't mean just designing a bigger helmet, he added. "It means removing the head from the game and from practice as much as possible," he said.

More information

For the study, Stern and his colleagues surveyed 216 men who were seniors on Notre Dame Fighting Irish football teams

The research was published online April 20 in JAMA Network Open.

For more on sports and head injuries, visit the American Association of Neurological Surgeons.

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P R E V E N T I O N

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T R E A T M E N T appointments. In addition, 25% of women delayed evaluations for their breast cancer symptoms, resulting in delayed diagnosis and treatment.

The models suggest that the number of excess breast cancer deaths due to the COVID-19 pandemic’s impact on screening, diagnosis and chemotherapy treatment could reach 2,487 over the next decade.

That number includes 950 additional breast cancer deaths related to reduced screening, 1,314 associated with delayed diagnosis of symptomatic cases, and 151 due to reduced chemotherapy use in women with early-stage breast cancer, Alagoz and colleagues reported.

Pandemic Delays in Screening Mean More Breast Cancer Deaths Ahead

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he COVID-19 pandemic could leave a grim legacy for women’s health.

New research suggests that disruptions in breast cancer screening and treatment in the United States during the COVID-19 pandemic could lead to an increase in deaths from the disease.

While mammography rates have accelerated in 2021, “facilities should prioritize screening women who missed their routine mammography exam during the pandemic” to help save lives, said study lead author Oguzhan Alagoz. He’s professor in the department of population health sciences at the University of Wisconsin, Madison.

As part of pandemic-related public health measures introduced in March 2020, mammography was among the many elective procedures Americans put on hold.

As a result, mammograms fell by as much as 80%, the study noted.

“Hospitals and outpatient centers were unavailable due to limited personal protective equipment, and the need for social distancing among health care personnel and patients,” said Baron, who wasn’t involved in the new study.

“The result was a significant drop in numbers of women undergoing screening mammography, delays in diagnosis due to patients not seeking out their health care providers with new breast masses, and reduced use of chemotherapy for women with early-stage disease,” Baron said.

To predict how these disruptions in the first six months of the pandemic will affect future breast cancer death numbers, the Wisconsin researchers turned to three independently developed breast cancer simulation models developed by the U.S. National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network.

Also, many patients already battling breast cancer saw their treatments delayed or faced reductions in planned or expected chemotherapy treatments.

Data used in the models came from the Epic Health Research Network, which collected numbers from 60 health care organizations representing 10 million women from 306 hospitals across 28 states.

Dr. Paul Baron, director of the breast cancer program at Lenox Hill Hospital in New York City, saw all this firsthand.

The Epic data showed that about 50% of women who were scheduled to undergo screening mammograms missed their

The predicted overall number of excess deaths would mean a 0.52% increase in breast cancer deaths between 2020 and 2030, according to the study published in July of 2021 in the Journal of the National Cancer Institute.

Speaking in a journal news release, Alagoz said that many health centers have launched rapid “strategies to resume breast cancer screening, diagnosis, and treatment services” over the past six months, and that could potentially reduce the overall impact on future breast cancer deaths.

For his part, Baron agreed that “the U.S. health care system’s efforts to resume normal operations likely saved lives.”

Nevertheless, he added, “the impact of COVID-19 will be felt for many years to come.”

Dr. Nina Vincoff is chief of breast imaging at Northwell Health in Lake Success, N.Y. Reading over the new study, she said it “demonstrates that even a short delay in screening mammography can cause an increase in breast cancer deaths.”

Vincoff believes that, “in the future, when pandemics or other emergencies arise, health care facilities should aim to maintain access to preventative health visits. If routine screening must be delayed during emergency situations, patients should be encouraged to return to care as soon as possible.”

More information

The American Cancer Society has more on breast cancer.

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You are cordially invited to the

2022 Annual Men’s Dinner Thursday, November 10 5:45PM The Ritz-Carlton St. Louis

The Five Foods That Cut Your Odds for Colon Cancer When it comes to guarding against colon cancer, what you eat is everything. You can reduce your risk of colon cancer by eating five food types: “Vegetables contain cancer-preventing nutrients called

carotenoids and flavonoids,” said Amy Rosenfeld, program coordinator of community health, education and outreach and a registered dietitian at the Center for Healthy Living at Northern Westchester Hospital, in Mount Kisco, N.Y. “Vegetables are high in fiber, bulking your stool and limiting the amount of time waste spends in your colon, reducing your risk for colorectal cancers,” she added.

Featured Speaker: Kelly Chase MC: Martin Kilcoyne

The Annual Men’s Dinner raises funds for cancer research, care and prevention for men, women, pediatric through geriatric.

Cost: $395 per person Every man who attends will enjoy a dinner valued at $145 and receive a $150 gift certificate that can be used at one of 7 different stores.

Dress Code: jacket and tie For more information about the St. Louis Men’s Group Against Cancer, visit

www.mensgroupagainstcancer.org

314-786-5950 Invitations will be mailed the first week in October and are available online.

Whole grain foods have high levels of fiber. Select bread and cereal products that list whole grain ingredients first. “Try replacing white grains -- like white rice -- with whole grains or mixing the two together. Eating three servings, or about three ounces of whole grains a day, will not only increase fiber, but also B vitamins and important minerals, such as iron, zinc, copper and magnesium,” Rosenfeld said. Whole grain products include whole wheat bread, barley, oats, quinoa, buckwheat, corn, brown rice and wild rice.

Legumes have lots of fiber and help keep your digestive tract healthy. “By regularly eating beans and lentils, you lower your risk for cancerous colon polyps (small growths),” Rosenfeld said.

"Try substituting beans or lentils for meat twice a week or reducing meat in your recipes and add in legumes." These include navy beans, chickpeas, fava beans, kidney beans, lentils, lima beans, black beans and cannellini beans.

Nuts and seeds “are the perfect foods," according to Rosenfeld. "Their fiber, healthy fat, phytochemicals, and antioxidants all have cancer-fighting properties. Try snacking on nuts or seeds instead of chips or pretzels. Natural nut and seed butters make a great dip for your favorite fruit. Mix in ground flax seeds or chia seeds into oatmeal.”

“Eat the rainbow when it comes to fruits,” Rosenfeld recommended. “Try to eat one to two cups of fruit each day and mix up the colors. Each color fruit has a unique combination of nutrients with cancer-fighting properties. Fruit also has fiber, vitamins and minerals, and its natural sweetness helps you resist refined sugary treats without nutritional benefits.”

ONE CATCH Can Make All the Difference

Schedule Your Cancer Screening Today Yadier Molina makes great catches every day and so can you by getting screened for cancer, because one catch can make all the difference.

Four out of 10 adults will develop cancer in their lifetime, but screening tests can catch cancer early and help save lives. Give yourself and those who love you peace of mind, schedule a routine cancer screening and take control of your health today.

To learn more about available cancer screenings and locations in your area, visit getscreenednow.com or call 314-866-9311.

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#10 in the country. #1 in Missouri.

been diagnosed with lymphoma four years before, he decided to biopsy it. Jane had been told that her sister’s condition is not genetic and doesn’t run in families.

The Diagnosis Jane was a volunteer at Central Institute for the Deaf, where her son had been a student.

She never had any symptoms of cancer like weight loss or fatigue, and there was no sign of it in her blood tests. After nervously waiting for two weeks for the pathology results, at the end of May, Dr. Buettner called her at CID and told her the news. It was follicular non-Hodgkin’s lymphoma, the same cancer her sister had. Jane was stunned and called her husband Mark, who came right away to pick her up. They arranged a CT scan and bone marrow biopsy at St. Luke’s Hospital to complete the staging and found her lymphoma was Stage I and limited to lymph nodes in the neck.

C O V E R

S T O R Y

A Remarkable 22 Year Journey with Cancer Jane’s story tells the great progress made in treatment of lymphoma

W Todd Abrams

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hat started with the detection of a small lump on the back of her neck in 1999 has progressed to a 22-year journey for Jane Tucker through the trials of cancer, and a frontrow seat in the advancements in cancer treatments.

When Jane felt a tiny lump under the skin on the back of her neck, it didn’t seem like

anything serious. She didn’t think much about it, and a few months later in a routine breast examination with Dr. John Buettner, she forgot to mention it to him. When she got home, she called, told him about it and went back to see him.

He thought it was nothing but because her sister, who was twelve years older, had

Jane knew of the reputation of Dr. Nancy Bartlett at Washington University, who she had met when her sister was first treated there. Dr. Bartlett confirmed the diagnosis, and Jane and Mark decided to get a couple of additional opinions. Jane called the Stanford University Cancer Center and was told they knew Dr. Bartlett well and couldn’t do better than her. Then they travelled to Harvard University, where they met with a cancer expert who reviewed her scans and biopsies and said Dr. Bartlett was the best and they should go home and be treated by her.

Non-Hodgkin’s lymphoma is a cancer of the lymphatic system. There are many varieties.

Some are curable, some are not. Jane’s is not curable, but it is treatable. And, as Jane’s story shows, there have been remarkable advances over her 22 years.

Early Treatment In early June 1999, Jane started at Washington University with a treatment called CHOP, a chemotherapy combination of drugs administered intravenously every 3 weeks for three to six months depending on the stage. Chemotherapy compromises the immune system, and Jane felt very sick with nausea and fatigue, spending much of that time in bed. She said that even water tasted bad. This was followed by radiation every day for four weeks.

She lost her hair, gained weight, and with her son going off to college Dr. Nancy Bartlett

protested the decision, and not only got the process covered for Jane, but the insurance provider changed its policy so that other patients would also benefit from harvesting and storing stem cells for future use.

Symptoms Return, and New Treatments are Available Jane’s first remission lasted three years. By the time her symptoms returned, there was a new treatment available, Rituxan®, a monoclonal antibody therapy that targets and attaches to a protein found on the surface of lymphoma cells. It works by helping the immune system destroy the cancer cells and by destroying the cancer cells on its own.

Once again, her remission lasted three years, and when symptoms came back, there was again the opportunity to try a promising new therapy. This time it was Bexxar®, an intravenous radioactive medication that contains monoclonal antibodies and an isotope that targets and delivers radiation to B-cells, the cells that grow out of control in this type of cancer.

for the first time and her daughter going back to college, and having to cancel trips they had planned, it was a difficult time.

Meanwhile, Jane’s sister had died after several years of treatment. Since she had the same diagnosis, Jane, who was 47 at the time, feared the same outcome for herself.

Mark was a big assist to Jane. He was with her at every appointment and asked a lot of questions. After disappointing results, he kept her steady, and after a good appointment they talked about where they wanted to travel next. And there was some fun involved. When Jane lost her hair from the radiation treatment, Mark and the kids all wore bald wigs for her.

First remission and “Rainy Day Protection” In late 1999 Jane went into remission, which in the case of non-Hodgkin’s lymphoma means that the clinical signs and symptoms of cancer are reduced. Dr. Bartlett suggested they harvest Jane’s stem cells and freeze them for a possible stem cell transplant in the future.

Doses of chemotherapy drugs are normally limited because even if higher doses

might kill more cancer cells, they would severely damage the bone marrow, where new blood cells are made. But with a stem cell transplant, higher doses of chemo can be used because the transplant afterwards of blood-forming stem cells restores bone marrow.

This is where they ran into resistance from their health insurance provider. They said that because the stem cells would not be used right away, the insurance company considered the procedure “rainy day protection”, and the cost of harvesting and storing them would not be covered. Jane and Mark

When she went in for this treatment, Jane was shocked to see all the doctors in what looked like space suits to protect them from the radiation. Through real-time imaging on a monitor, Mark was able to see the tumors in her lymph system lighting up as the radioactive infusion attached to them. Even after she left the hospital, she was advised not to get too close to other people for a while, since she was still radioactive.

In 2010, Jane’s spleen was enlarged, which could be a sign that the cancer was more aggressive. She had her spleen removed, and the biopsy showed that the cancer had not become more aggressive. But without her spleen, she is now more prone to infections and takes extra precautions. At this time, Jane’s lymphoma was successfully treated with Rituxan and bendamustine, a drug first developed in East Germany and not available in the US until after the fall of the Berlin Wall. Every six months she would get CT scans to see if there was increased activity in her lymph nodes.

Jane was in remission until 2017, when she was treated on a clinical trial with an immune therapy called ALT-803, which had shown great promise in combination with Rituxan in reducing tumors. She stayed in remission for another four years until 2021, when a CAT scan revealed new activity.

At that time, she was able to get a slot in a late-stage trial for a new immunotherapy drug called mosunetuzumab that has been showing great promise in the treatment of follicular non-Hodgkin lymphoma and Jane is again in complete remission. So, during Jane’s 22 years with cancer, her treatment

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has evolved from the very harsh chemotherapy to a variety of new targeted treatments that are much easier to tolerate. Her current treatment at Siteman Cancer Center consists of an injection every three weeks with very few side effects.

Dr. Bartlett ads, “I would like to reiterate the tremendous progress we have made in treating many cancers including follicular lymphoma over the last 20 years. Finding ways to harness a patient’s own immune system has been a game-changer in the treatment of lymphoma. Treatments like bispecific antibodies (Jane’s current treatment) and CAR-T cell therapy are providing very durable remissions and hopefully cures for many patients with lymphoma. As researchers and clinicians, we are extremely appreciative of our patients’ willingness to participate in clinical trials of new therapies.

Without this commitment by patients, there would be no progress.”

How Cancer and Treatments have Affected Her

many stories, and felt humbled. She no longer feels sorry for herself.

Despite all she has been through, Jane is still the same vibrant, upbeat person she has always been. She says she tries to eat healthy and exercises every day but doesn’t “go overboard.” Even though she had some bad times, she believes in the advice from a Charlie Chaplin song, “Smile, though your heart is aching, smile” and it does help.

There were many things she wanted to do and had to put off, but cancer has given her a new appreciation for life.

One patient who Jane especially remembers was a farmer who had been recently diagnosed with lymphoma and was in bad shape. He had to get up at 3 in the morning to get to his 6 am appointment in time. In May, which was planting time, he was in too much pain to work his 700 acres. After a treatment, when he got back to the farm in the evening he saw 15 tractors on his property – his farm neighbors all got together to do his planting for him.

Jane has been greatly impressed by Dr. Bartlett and the whole hospital staff, and said she has full confidence in them, never had to second guess what they recommended. She appreciates how hard they work and how caring they are. She was also greatly affected by patients she met at her appointments. At first, she would walk into a treatment area and was in disbelief that she was there. Over the years she has met many patients, heard

The most important advice Jane would like to share with you: 1. Be aware of changes in your own body; nobody knows it like you do.

2. Find the best health care providers available and ask about their experience with new treatments. Over time, treatments can progress to reflect new learning.

3. Don’t be afraid to get second opinions.

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4. Sometimes friends or family tell you things that are scary or too much information. It’s OK to just say you can’t handle hearing it.

5. Have a partner, friend or relative who can be an advocate for you through diagnosis and treatment.

6. Sometimes it is normal that you feel the effects of the treatments more than the disease.

7. Don’t be hard on yourself.

Remember, it’s biology. You didn’t do anything wrong. It’s OK to sometimes have a bad attitude. You probably didn’t always have a good attitude when you didn’t have cancer.

However bad you feel, there is someone whose case is worse than yours.

It takes a team of experts to fight a complex disease like cancer.

St. Luke’s Center for Cancer Care is a remarkable place where physicians and other health care providers work daily, armed with expertise and compassion, to provide patients with strength for today and hope for tomorrow.

As an accredited Commission on Cancer (CoC) program, St. Luke’s Center for Cancer Care offers comprehensive inpatient and outpatient services. The center is designed with the patient experience in mind, providing services in one convenient location.

St. Luke’s Center for Cancer Care 232 South Woods Mill Road Suite 330 East Chesterfield, MO 63017 314-205-6737 | stlukes-stl.com

The Center for Cancer Care is committed to providing convenient and accelerated access to care, offering new patients appointments within 48 hours.

Study Supports Colonoscopies for Women Under 50

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olonoscopies in younger women can significantly cut their risk of colon cancer, a new study claims.

"While there's been an alarming increase in the incidence of colorectal cancer in recent decades in younger individuals, screening has largely been focused on people over 50," noted senior study author Dr. Andrew Chan, a gastroenterologist and epidemiologist at Massachusetts General Hospital.

Colon cancer is the third leading cause of cancer death in both men and women in the United States. While the overall number of colon cancer cases has declined, the rate among people younger than 50 rose by 51% between 1974 and 2013.

In recent years, the American Cancer Society and the U.S. Preventive Services Task Force have recommended colon cancer screening begin at age 45.

Chan and his colleagues analyzed data from nearly 112,000 U.S. women in the Nurses' Health Study II. They found that women who started screening at age 45 had a 50% to 60% lower risk of developing colon cancer than those who had no screening.

Also, those who started screening at ages 45 to 49 had much lower rates of colon cancer through age 60 than those who began screening at ages 50 to 54, according to the study. While the findings are from women, the same benefits likely apply to

men, according to Chan.

"Our work provides first-of-its-kind data to show that initiating screening at a younger age can reduce an individual's risk of colorectal cancer and the population's overall incidence of cancer, thus demonstrating the substantial impact of earlier screening on both individual and population-wide scales," Chan said in a hospital news release.

The findings were published May 5 in the journal JAMA Oncology.

Colonoscopy is an invasive procedure, but noninvasive stool-based screening tests are also available.

"Our data show that we have an effective tool to address the epidemic of colorectal cancer among younger adults, and hopefully this will encourage physicians to have a conversation about screening with their younger patients which, in turn, will motivate them to follow through and get screened," Chan said.

More information

There's more about colon cancer screening at the U.S. National Cancer Institute.

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Adding MRI to Screening Reduces Prostate Cancer Overdiagnosis

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ne of the big issues in prostate cancer care is overdiagnosis — men who are treated for low-risk, slow-growing tumors that might be better left monitored and untreated.

Now, research out of Sweden suggests that having patients undergo MRI screening, along with targeted biopsies, could reduce the number of prostate cancer overdiagnoses by half.

introduction of nationwide screening,” Nordström explained in an institute news release. One expert in the United States said the research holds real promise. “For the past 20 years, urologists and researchers have been striving to improve prostate cancer screening to target men with clinically significant prostate cancer and avoid overdiagnosis in men with low-risk prostate cancer,” said Dr. Manish Vira, system chief of urology at Northwell Health Cancer Institute in New Hyde Park, N.Y.

the tumor to the patient’s health.

But is there a better way to spot those higher-risk tumors that do need treatment?

In the new study, the Karolinska team tracked outcomes for 12,750 Swedish men between 2018 and 2021. Blood samples were collected from the men for PSA analysis, as well as analysis by the new Stockholm3 test, developed by institute researchers.

Men whose tests revealed elevated PSA levels were then randomly selected to undergo either traditional biopsies or they underwent MRI. In the MRI group, biopsies were conducted only on suspected tumors identified by MRI. The new approach can detect just as many clinically significant tumors as current methods, the researchers said, but it reduces unnecessary biopsies and the identification of minor low-risk tumors.

Vira explained that “by incorporating MRI into the prostate cancer screening process, we can better recommend biopsy in those men who are at high risk, and perhaps just as importantly, avoid unnecessary biopsies in men who don’t have prostate cancer or have indolent/insignificant disease.”

The new approach can detect just as many clinically significant tumors as current methods, but reduces unnecessary biopsies and the identification of minor low-risk tumors, according to the study presented last year at the European Association of Urology Congress. The findings were published simultaneously in the New England Journal of Medicine.

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The findings show that “modern methods for prostate cancer screening maintain the benefits of screening, while decreasing the harms substantially,” said study co-leader Tobias Nordström. He is associate professor of urology at Danderyd Hospital at the Karolinska Institute.

“This addresses the greatest barrier to the

The Swedish findings show how the use of highly targeted MRI “has moved our field closer to the goal,” said Vira, who wasn’t involved in the new study.

As the Stockholm team explained, most countries no longer have nationwide prostate-cancer screening programs in place because current methods — PSA (prostate-specific antigen) blood testing plus traditional biopsies — often result in overdiagnosis and unnecessary biopsies, meaning the risks of screening can outweigh the benefits. In too many cases, so-called “indolent” prostate tumors grow at such a slow pace that treating them brings harms (such as urinary issues and impotence) that exceed any real risk from

Dr. Art R. Rastinehad is associate professor of urology and radiology and vice chair of urology at Lenox Hill Hospital in New York City. He wasn’t involved in the Swedish research, but called it “another great study supporting the use of MRI before a prostate biopsy in men at risk of prostate cancer.” He pointed out that “prostate cancer was the last solid organ malignancy that was diagnosed without imaging, so we are very excited to continue to use advanced imaging technologies to help our patients.”

The potential benefits to patients are clear, he added. “It is estimated that up to 51% of patients having their prostate removed may be candidates for a less invasive, outpatient treatment that helps them get back to their normal lives with a lower risk of urinary incontinence and/or erectile dysfunction,” Rastinehad said.

More information

The U.S. National Cancer Institute has more on prostate cancer screening.

SOURCES: Art R. Rastinehad, DO, associate professor of urology and radiology, vice chair of urology, Lenox Hill Hospital, New York City; Manish A. Vira, MD, system chief of urology, Northwell Health Cancer Institute, New Hyde Park, N.Y.; Karolinska Institute, news release, July 9, 2021

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America Is Losing the War Against Diabetes

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fter years of improvement, Americans with diabetes may be losing some ground in controlling the condition, a government-funded study showed. Researchers found that between 1999 and the early 2010s, U.S. adults with diabetes made substantial gains: A growing percentage had their blood sugar, blood pressure and cholesterol down to recommended levels.

So, why would control of those conditions be worsening? It's not clear from the study, but Selvin pointed to some possibilities.

In 2008 and 2009, three clinical trials were published that questioned the value of "intensive" blood sugar control: Diabetes patients assigned to that regimen showed no further reduction in their risk

Since then, the picture has changed: Progress on cholesterol has stalled, and fewer patients have their blood sugar and blood pressure under control than a decade ago. The findings are concerning, the researchers said, since the trends could put more Americans at risk of heart disease, stroke and other diabetes complications.

"This is very sobering," said senior researcher Elizabeth Selvin, a professor at Johns Hopkins Bloomberg School of Public Health in Baltimore.

"It's not just that rates [of control] are plateauing, they're worsening." Selvin and her colleagues published the findings in the New England Journal of Medicine.

As of 2018, over 34 million Americans had diabetes, according to American Diabetes Association. The vast majority had type 2 diabetes, where the body can no longer properly use insulin, a hormone that regulates blood sugar.

As a result, blood sugar levels soar. Over time, uncontrolled blood sugar can damage the blood vessels and nerves, contributing to complications such as heart disease, stroke, kidney failure and eye disease. On top of that, people with diabetes often have other chronic conditions, like high blood pressure and elevated cholesterol, which can also feed those complications.

similar. Over the earlier time period, the percentage of diabetes patients meeting blood pressure goals improved from 64% to 74%. That figure dipped thereafter, to 70%. (Control was defined as below 140/90 mm Hg.) The reasons are not clear, but Selvin noted the pattern matches that of the U.S. population as a whole.

Dr. Joanna Mitri is an endocrinologist and research associate at Joslin Diabetes Center in Boston. She had no role in the study.

Mitri said that after the trials of intensive glucose (blood sugar) lowering came out, treatment guidelines shifted away from being "glucose-centric" toward a broader focus on controlling other cardiovascular risk factors as well.

For some patients, she said, a relatively higher A1C may be appropriate -for example, an older adult at risk of low blood sugar episodes. For other patients, keeping A1C below 7% may be the right goal.

The point is, the treatment plan should be individualized, Mitri said. She encouraged diabetes patients to ask their doctor what their A1C goal is, why that's the target, and how best to achieve it.

of heart trouble or stroke -- but they did have a greater risk of potentially dangerous drops in blood sugar.

Those trials tested the effects of especially tight control of patients' A1C levels. That's a measure of a person's average blood sugar levels over the past three months. The trials aimed to get patients' A1C to below 6.5% or 6% -- versus the standard 7%.

After the results were published, some doctors began backing off from tight blood sugar control. "I think what we're seeing now is something of an overcorrection," Selvin said. That's because fewer Americans are now achieving even the standard A1C goal of below 7%.

Selvin's team found that between 1999 and the early 2010s, the proportion of diabetes patients meeting that target rose from 44% to 57%. By 2018, that had declined to 50%.

The trends for blood pressure control were

But don't forget the bigger picture.

"We need to improve all three things -- blood glucose, blood pressure and cholesterol -- in addition to weight management, diet and exercise," Mitri said.

According to Selvin, it's possible that lifestyle-related factors, including trends in obesity, contributed to declines in blood sugar and blood pressure control in recent years. "Complementing medication with lifestyle changes is very important," she said. "Preventing further weight gain is very important."

Selvin also noted that since the 2008/2009 trials, new diabetes medications have become available that can lower blood sugar with less risk of dangerous lows. Like Mitri, she suggested patients talk to their doctors about their treatment goals and ask whether they are on "optimal" management.

The study was funded by the U.S. National Heart, Lung, and Blood Institute.

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Expert Panel Lowers Routine Screening Age for Diabetes to 35

T

he recommended age to start screening overweight and obese people for diabetes has been lowered by five years from 40 to 35, the nation’s leading panel of preventive health experts has announced.

The U.S. Preventive Services Task Force (USPSTF) has decided an earlier five years of testing could help detect more people who have prediabetes, said Dr. Michael Barry, vice chair of the USPSTF.

with diabetes, 21.4% were not aware of or did not report having diabetes, and only 15.3% of persons with prediabetes reported being told by a health professional that they had this condition.

“We know that epidemiologically we see a spike in the prevalence of both diabetes and prediabetes around age 35,” Barry said.

The new recommendation and the science behind it were published last year in the

That would give those folks a chance to avoid full-blown diabetes by adopting a healthier diet, exercising more often and losing weight, said Barry, director of the Informed Medical Decisions Program at Massachusetts General Hospital in Boston.

Diabetes is “a major risk factor for heart attacks and strokes, but also the leading cause of blindness and kidney failure in the United States, and a major reason behind limb amputations,” he said. “No one would say this isn’t important.”

It is also associated with increased risks of non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis, and was estimated to be the seventh leading cause of death in the US in 2017. Screening asymptomatic adults for prediabetes and type 2 diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes.

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About 13% of American adults — 34 million people — have diabetes, according to the U.S. Centers for Disease Control and Prevention.

But more than one in three (35%) have prediabetes, a condition in which blood sugar levels are higher than normal but haven’t yet irreversibly harmed the body’s ability to respond to insulin. Of persons

cal officer. “Lowering the age requirement down to 35 for those that are overweight or obese is a step in the right direction.”

Endocrinologist Dr. Emily Gallagher noted that the guidelines also say doctors should consider diabetes screening for people in higher-risk groups at an even earlier age. Those include folks who: ■ Belong to certain ethnic groups harder hit by diabetes, including American Indian/Alaska Natives, Asians, Blacks, Hispanics and Pacific Islanders.

■ Have a family history of diabetes.

■ Had gestational diabetes during pregnancy.

■ Have a history of ovarian cysts.

“It is critical to note these caveats to the recommendations, particularly when treating diverse populations where there are higher risks of diabetes in normal weight individuals,” said Gallagher, of Mount Sinai Hospital in New York City.

Some doctors feel the screening age could be even lower, given America’s ongoing obesity crisis.

Journal of the American Medical Association.

The USPSTF’s recommendation is important because under the Affordable Care Act (“Obamacare”), insurers are required to fully cover any screening the task force endorses, with no out-of-pocket cost to patients.

In the case of diabetes, screening entails a safe and simple blood test to check for levels of either fasting blood sugar or hemoglobin A1C, Barry said.

The American Diabetes Association hailed the updated screening recommendations. “New cases of diabetes continue to rise, and we know that approximately one-fourth of those with diabetes remain undiagnosed,” said Dr. Robert Gabbay, the association’s chief scientific and medi-

“I personally think it probably would have been more beneficial to bring it further down, especially since the rate of obesity and incidence of type 2 diabetes in the younger population has also skyrocketed,” said Cleveland Clinic endocrinologist Dr. Mary Vouyiouklis Kellis.

Kellis pointed to another study published last August in Journal of the American Medical Association that found the rate of type 2 diabetes in youths 19 and younger nearly doubled between 2001 and 2017.

The greatest increases occurred among Black youths and Hispanic youths.

But while the number of young people with diabetes is increasing, it remains relatively low. Fewer than one of every 1,000 American children had type 2 diabetes in 2017, study results indicate.

Barry said, “Even though there is certainly growing obesity in younger people, the increase in prediabetes and diabetes really starts at age 35. We could not find the evidence that would allow us to further lower the screening age.”

crash unexpectedly, briefly putting them back on the sidelines. " If you're having trouble controlling your blood sugar during exercise, your doctor may refer you to an exercise physiologist who is specially trained to treat diabetics.

What other precautions should I take?

Your doctor or exercise physiologist can give you safety tips for your particular workouts. Here are a few general guidelines: Warm up with five to 10 minutes of gentle stretching and five to 10 minutes of light aerobic activity (such as walking or jogging in place).

Diabetes: The Exercise Prescription

E

xercising can improve anyone's health, but it's especially valuable for people with diabetes.

Every time Natalie Wayne climbs a mountain or goes speed skating, sugar pills are part of her equipment. Wright, who lives in Wakefield, Rhode Island, is a certified diabetes educator, an exercise physiologist, and a self-proclaimed "exercise nut" who happens to have type 1 diabetes. Wayne has to take steps to keep her blood sugar from crashing while she exercises, but diabetes has never slowed her down. She knows that a good workout boosts both her body and her mind.

(under the supervision of their physician).

What type of exercise is best?

The American Diabetes Association recommends at least 150 minutes a week of moderate exercise -- that's just a little more than 20 minutes a day -- and two sessions of resistance exercises a week unless your doctor recommends against it.

Should I see my doctor before I start exercising?

Exercise can be crucial for people with diabetes if they are also overweight, especially those with type 2 diabetes, whose weight is a likely contributor to their disease.

Your doctor can help you choose the exercises that best fit your abilities and needs.

In some cases, physicians will recommend testing the health of a patient's heart before allowing him or her to participate in a strenuous exercise program. If you have numbness in your feet, for example, jogging could cause sores or even fractures; your physician may recommend that you switch to swimming or cycling.

For many patients with type 2 diabetes, physical exertion can often rein in high blood sugar as effectively as a medication.

Not only does exercise burn extra sugar in the blood, it also helps make the body more sensitive to insulin. While patients who have diabetes will still require medication, some people with type 2 diabetes who embrace exercise and a healthy diet may be able to reduce their medications

Your doctor can help you fit exercise into your overall health plan. You may need to adjust your medications, carry snacks or drinks, or tweak your diet to help prevent hypoglycemia (low blood sugar). This can happen to people with type 2 diabetes, but it's much more common for people with type 1. No matter how careful they are, people with type 1 diabetes should expect a few setbacks. Their sugar levels might

Proper footwear is essential, especially if you have poor circulation or numbness in your feet. A gel insert and polyester or poly-blend socks will help keep your feet comfortable, dry, and blister-free.

Check your feet carefully for blisters and other sores before and after exercise.

Dehydration can affect your sugar levels, so be sure to get plenty of fluids before, during, and after exercise. Water is often an excellent choice. Your doctor may suggest taking along some fruit juice or sugary sports drink if you're at risk for low blood sugar.

Wear a diabetes identification bracelet or tag. This precaution is especially important if there's a chance you could lose consciousness from hypoglycemia.

Getting started People with diabetes are just like everyone else -- if they're not used to breaking a sweat, it can be very hard to get started.

Wayne motivates her clients by having them check their blood sugar before and after a walk. "When they see the numbers drop, it really clicks," she says. If they're still having trouble taking that first step, she encourages them to find a friend or family member who'll walk or jog or ride bikes with them. It's much easier to stick to an exercise routine if you don't have to do it alone.

Exercise isn't a miracle cure, but it's still one of the best things you can do for your body. So talk to your doctor, get moving, and have fun.

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Not Just Obesity: Everyone May Have a Fat Threshold for Type 2 Diabetes

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f you are one of the millions of people with type 2 diabetes, losing weight can help reverse the blood sugar disease even if you aren't overweight or obese, new research reveals.

Here's the proof: 70% of people with type 2 diabetes who were a normal weight during the study went into remission after they lost roughly 10% of their body weight.

threshold, he added.

For the study, 20 people with diabetes who weren't overweight or obese ate 800 calories a day (from low-calorie soups and shakes and non-starchy vegetables) for two to four weeks. They did these three times,

the insulin-producing cells returned to normal.

It doesn't take much extra fat to thwart the activity of insulin-producing cells in the pancreas. "You only need an extra half gram of fat in the pancreas to prevent normal insulin production," Taylor said.

"Regardless of body mass index (BMI), people diagnosed with type 2 diabetes have more fat inside the body than they can cope with," he said. "There is a good chance of remission if they can lose around 10% of their starting weight."

The study was presented in May 2022 at the European Association for the Study of Diabetes meeting in Stockholm. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

The relationship between obesity and diabetes is consistent and strong, said Dr. Scott Kahan, director of the National Center for Weight and Wellness, in Washington, D.C. "Even exceedingly small amounts of weight gain or excess weight can increase the risk for type 2 diabetes significantly — even in people who are relatively thin,"

Type 2 diabetes is the form of the disease most closely tied to obesity, yet around 15% of patients aren't overweight or obese.

They may, however, be pushing their personal "fat threshold."

"Everyone has a level at which they can no longer store fat safely inside the body — that is determined by genes," said study author Dr. Roy Taylor, a professor of medicine and metabolism at Newcastle University in the United Kingdom.

"If you can't store more fat under your skin, the fat spills over and starts building up inside the liver," he explained. When this happens, too much fat goes to the rest of the body, including the pancreas.

Insulin-producing cells in the pancreas then stop working correctly, triggering diabetes.

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"Type 2 diabetes happens to those who are susceptible, but only when they have become too heavy for their own body," Taylor noted.

No test can say "you have exceeded your personal fat threshold" yet, but some blood markers of stress in fat may one day prove to be a reliable way to measure that

with each cycle followed by four to six weeks of weight maintenance.

They lost about 10.7% of their weight overall, and kept it off for six months to a year.

Fourteen people achieved diabetes remission, based on their HbA1c levels.

This provides a snapshot of average blood glucose levels over several weeks. Folks in remission no longer needed to take diabetes medication. This mirrors what is seen among people with type 2 diabetes who are overweight or obese and lose weight, Taylor said.

MRI scans showed declines of fat inside the liver and pancreas that were in line with what is seen in people without diabetes. Specifically, fat in the pancreas fell from an average of 5.8% to 4.3% among people with diabetes, and the activity of

Kahan noted.

The good news is that small weight losses, often on the order of just a few pounds, can improve blood sugar control and diabetes risk.

"This study further supports the importance of weight management for the prevention and treatment of type 2 diabetes, and strongly suggests that weight management guidance, support and intervention will likely be valuable even in persons with only small amounts of excess weight," Kahan said.

More information The American Diabetes Association provides tips on how to lose weight if you have diabetes.

F E A T U R E D

P R A C T I C E

Nancy M. Buchser, M.D.,

Vision Is Our Most Important Sense – Are You Really Protecting Yours?

Think about how much you depend on your eyesight – all day, every day. But are you doing what is needed to keep your eyes healthy? Most adults periodically have their vision tested, but only about half get comprehensive eye exams. This includes a thorough examination of the eye, which is critically important for discovering conditions like retinal tears, glaucoma and macular degeneration early in their course. When indicated,

we perform detailed scans of the retina and optic nerve to further evaluate the visual system.

At Cohen Eye Associates, Limited, we have been known for 35 years for our very thorough eye examinations, spending needed time with patients and monitoring conditions over time. We also offer advanced surgery for cataracts, with options for implanting multifocal lenses for distant and closer vision, as

Bruce H. Cohen, M.D., Kathryn L. Noonan, O.D.

well as laser surgeries where appropriate to correct vision.

We work with our patients to identify the option that best addresses their specific needs and desires, and with their health insurance to cover as much as possible.

Our office is in the Center for Advanced Medicine at Barnes Jewish Hospital, with parking in the Euclid Garage. We also perform surgeries at the St. Louis Eye Surgery and Laser Center on Manchester Road

To schedule an appointment, contact us by phone or fill out the form on our website.

Have Diabetes?

Here’s How to Save Your Sight Managing your diabetes can be tough, but your eyes might thank you for it.

D

iabetic retinopathy is a diabetes complication that damages the retina's blood vessels, often resulting in vision loss and blindness.

The condition occurs in more than half of people with diabetes. It affects nearly 8 million Americans, and that number is expected to double by 2050, according to an American Society of Retina Specialists (ASRS).

"With new technologies that aid in early diagnosis and breakthroughs in treatment, we've entered a new era in which no one with diabetes need suffer the devastating effects of diabetic retinopathy," ASRS president Dr. Philip Ferrone said in a society news release.

"With more awareness about the condition, including the common risk factors and symptoms to watch for, everyone with diabetes can be armed with the information they need to preserve their sight," Ferrone added.

Anyone with diabetes — including type 1, type 2 and gestational diabetes — is at risk of developing diabetic retinopathy. The longer a person has diabetes, the greater their risk. Other factors that increase the risk include poor control of blood sugar levels over time; high blood pressure; kidney disease; high cholesterol levels; and pregnancy.

Many people have diabetic retinopathy for a long time without symptoms. By

in Des Peres. Our Optical Center offers a full range of frame and lens options, as well as contact lenses.

For our patients who have chronic health conditions such as diabetes, we become familiar with their medical histories and watch for symptoms that can threaten their eye health, and medications that can cause eye problems ranging from dry eye to vision loss.

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the time symptoms appear, there may be significant damage.

Symptoms may include blurred or distorted vision; difficulty reading; spots or "floaters" in your vision; a shadow across the field of vision; eye pressure; difficulty with color perception. People with any of these symptoms should be checked as soon as possible. Treatments for diabetic retinopathy include intravitreal (inside the eye) injections, laser treatments and surgery.

People at risk for diabetic retinopathy can protect their vision by controlling blood sugar, blood pressure and cholesterol; maintaining a healthy weight; taking all prescribed diabetes medications; having regular dilated retina exams; quitting smoking; and staying active.

"From focusing on healthy lifestyle habits to making regular dilated retina exams a priority, there are many ways people with diabetes can maintain excellent vision for life," Ferrone said.

More information The U.S. National Eye Institute has more on diabetic retinopathy.

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K I D N E Y

D I S E A S E

Kidney Damage Can Be Another Consequence of Long COVID

P

eople hospitalized for COVID-19, and even some with milder cases, may suffer lasting damage to their kidneys, new research finds.

The study of more than 1.7 million patients in the U.S. Veterans Affairs system adds to concerns about the lingering effects of COVID – particularly among people sick enough to need hospitalization.

tant professor at Washington University School of Medicine in St. Louis.

Inflammation to blame?

Wilson said the "big question" is why?

"Is this reflecting some ongoing immune system stimulation and inflammation?" he asked. "It will take more research to figure that out."

Researchers found that months after their initial infection, COVID survivors were at increased risk of various types of kidney damage – from reduced kidney function to advanced kidney failure. People who'd been most severely ill – requiring ICU care – had the highest risk of long-term kidney damage.

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Similarly, patients who'd developed acute kidney injury during their COVID hospitalization had higher risks than COVID patients with no apparent kidney problems during their hospital stay. But what's striking is that those latter patients were not out of the woods, said Dr. F. Perry Wilson, a kidney specialist who was not involved in the study. They were still about two to five times more likely to develop some degree of kidney dysfunction or disease than VA patients who were not diagnosed with COVID. The study found that even VA patients who were sick at home with COVID were at increased risk of kidney problems.

"There were risks, albeit smaller, among these patients who never had major problems when they were sick," said senior researcher Dr. Ziyad Al-Aly, an assis-

Overall, COVID patients were more likely to show a substantial drop in the kidneys' glomerular filtration rate (GFR), a measure of how well the organs are filtering waste from the blood. Just over 5% of COVID patients had a GFR decline of 30% or more, the study found. And compared with the general VA patient population, their risk was 25% higher.

Since adults naturally lose about 1% of their kidney function per year, a 30% decline in GFR is akin to losing 30 years of kidney function, according to Wilson.

The study also examined the risk of acute kidney injury, where the organs suddenly lose function. It can cause symptoms such as swelling in the legs, fatigue and breathing difficulty, but sometimes causes no overt problems.

COVID patients were nearly twice as likely to develop acute kidney injury, though it varied according to initial COVID severity.

Will the damage last?

Those who'd been hospitalized were five to eight times more likely than non-COVID patients to develop acute kidney injury; people who'd been sick at home with COVID had a 30% higher risk, versus the non-COVID group.

It's not yet known what it all means for COVID patients' long-term kidney health, Al-Aly said. One question now, he noted, is whether the GFR declines in some patients will level off.

As for acute kidney injury, people can recover from it with no lasting harm, Wilson said. And if a drop in GFR is related to acute kidney injury, he noted, it may well rebound.

Some patients in the study did develop end-stage kidney failure.

Those odds were greatest among COVID patients who'd been in the ICU: They developed the disease at a rate of about 21 cases per 1,000 patients per year – making their risk 13 times higher than other VA patients'. Smaller risks were also seen among other COVID patients, hospitalized or not.

A limitation of the study is that the VA patients were mostly older men.

It's unclear how the results apply more broadly, according to Al-Aly. The risks presented to non-hospitalized patients are also somewhat murky. They are far from a uniform group, both doctors said.

Wilson suspects that people only mildly affected by COVID would be unlikely to develop kidney problems, whereas those who are "really knocked out for weeks" might have a relatively greater risk.

The good news, Al-Aly said, is that kidney dysfunction is readily detectable through basic blood work done at primary care visits.

Wilson said that kind of check-up might be worthwhile for people who were more severely ill with COVID.

New Way to Blast Kidney Stones Can Be Done in Doctor’s Office

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noninvasive ultrasound technique is capable of quickly pulverizing kidney stones, an early study shows — in what researchers call a first step toward a simpler, anesthesia-free treatment for the painful problem.

The study reports on the first 19 patients who’ve had kidney stones treated with the ultrasound “bursts.” So far, it’s been able to completely, or nearly completely, break up stones within 10 minutes.

Much more research lies ahead, but experts not involved in the study called the early results “exciting.” If it pans out, they said, the ultrasound technique could make noninvasive treatment for kidney stones more readily available to patients.

Kidney stones are common, affecting about 10% of people at some point, according to the National Kidney Foundation. Often, a stone can be passed in the urine without too much agony. In other cases — such as when a larger stone is causing a blockage or unbearable pain — treatment is necessary.

Right now, many kidney stones can be treated with a procedure called shock wave lithotripsy.

It delivers high-energy sound waves through the skin to break the stone into tiny fragments that can then be passed.

But there are downsides, said Dr. Mathew Sorenson, of the University

of Washington School of Medicine in Seattle, one of the researchers on the new work. Shock wave therapy can be painful, so it’s typically done in the operating room, with patients under anesthesia, in the United States.

Sorenson and his colleagues have been developing an alternative approach called burst wave lithotripsy. They say it has the potential to blast kidney stones in a shorter amount of time, and possibly without anesthesia.

The ultimate goal, the researchers said, is to perform the procedure on fully awake patients, during an office visit with a urologist — or even in the emergency room when patients arrive in severe pain.

Unlike shock wave therapy, the burst wave approach uses “short harmonic bursts” of ultrasound energy, according to the research team. Previous research has suggested it can break up stones more quickly, and with less pain, than shock waves.

Because ureteroscopy requires anesthesia, the study patients were under when the ultrasound bursts were applied, for up

to 10 minutes. Overall, the researchers found, that was enough to fragment 21 of 23 stones. Half of the stones had at least 90% of their volume pulverized to pieces of no more than 2 millimeters (mm). And nine stones (39%) were completely broken down to that degree.

Kidney stones broken down to 2 mm or less should be relatively easy to pass, said Dr. Mantu Gupta, director of the Kidney Stone Center at Mount Sinai, in New York City. Gupta noted that the study did not actually test the hoped-for, real-world scenario: Using the technique without anesthesia. But previous work by the team has indicated patients can tolerate it.

Some patients showed mild bleeding, with small amounts of blood in the urine.

Whether burst waves could be more effective is unclear, but Roberts said that if the procedure can, in fact, be done in the urologist’s office, that would be a big advantage.

None of that means the technology would help everyone with kidney stones. Roberts noted that while 19 patients were treated, a similar number entered the study but could not receive the ultrasound treatment: Some had stones that were too deep, for instance, or were obstructed by a rib or the bowel. Still, Roberts said, even if only certain patients could have the procedure, its potential to be “more accessible” would be a boon.

But Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation, said that while the procedure is “promising,” most of the study patients were of normal body mass index (BMI), which makes breaking up stones with shock wave therapy easier.

Since earlier work suggests the burst wave approach is tolerable, patients might not need pain medication afterward to deal with the procedure itself, Roberts said — though they might need a pain reliever like acetaminophen (Tylenol) if passing the fragments proves uncomfortable.

The findings were published recently in The Journal of Urology.

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Innovative Kidney Donor ‘Voucher’ System Is Saving Lives

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n the world of chronic kidney disease, the dilemma is not uncommon: A relatively young patient with kidney trouble may need a transplant down the road, and an older family member is more than ready to step up. But the need for a kidney transplant, while predictable, is not immediate.

(UCLA) David Geffen School of Medicine. “And it makes a lot of sense. Particularly for people of advanced age who want to be living donors — grandparents, for example — but who would need to donate right now, even if the family member for whom their kidney is intended doesn’t need it right now.”

the idea seven years back. Under Veale’s care at the time, Broadman had decided to donate one of his kidneys to a stranger, with the understanding that in so doing he could then “bank” a kidney for his grandson, should the need arise.

So the older donor doesn’t act. Given that donor supply has never met demand, the loss of a golden opportunity — due to age or circumstance — has long frustrated those in the kidney transplant community.

Veale explained that when donors sign up for the voucher program, what they’re in effect doing is giving their kidney to a stranger with an immediate need. But in so doing they are then given a voucher, which they can then assign to the person or persons they truly want to help.

Since then, the voucher program has expanded to 79 facilities across the United States, where the process is highly regulated and controlled.

But a new study reports on what appears to be a possible solution to the problem: kidney vouchers.

“It’s like a coupon to use in the future,” said study author Dr. Jeffrey Veale. He is a renal transplantation specialist with the Kidney Transplant Exchange Program at the University of California, Los Angeles

In turn, that patient can then “cash out” their voucher at any time in the future, gaining immediate “priority status” on the donor waiting list for another living donor whenever their need becomes immediate.

Veale said it was a UCLA patient, Judge Howard Broadman, who first proposed

Kidney vouchers have encouraged ‘living donations’

Kidney vouchers are assigned at the time a donation is made and are non-transferable. Each donor can assign a voucher to up to five different potential recipients, even including those without kidney disease. But in the end, only one of them — the first in need — will be able to use it.

The vouchers also offer no guarantee that a kidney will actually be available right away. Nor do they move the holder ahead

otherwise wouldn’t donate.”

Given that “the need for lifesaving [living] kidney transplants significantly outweighs the supply,” that’s a good thing, said Dianne LaPointe Rudow. She’s director of the living donor program with the department of population health science and policy at Mount Sinai Hospital’s Recanati Miller Transplantation Institute, in New York City.

Rudow noted that while roughly 98,000 patients are on the kidney transplant waiting list, only about 39,000 transplants are performed each year. Of those, just 5,000 to 6,000 are from living donors. on the queue for a kidney acquired from someone who dies; priority is assigned only for kidneys offered by other living donors. And if the holder dies or becomes, for whatever reason, ineligible for a transplant the voucher becomes null and void.

So, have kidney vouchers triggered an uptick in living kidney donations?

After reviewing data compiled by the National Kidney Registry, Veale said the answer is yes.

Registry figures reveal that between 2014 and 2021, there were a total of 250 donations made under the voucher program at the 79 transplant centers.

Donors ranged in age from 19 to 78. Of those, nearly 8% were over 65 years of age.

Nearly two-thirds were women, and nearly all (96%) were white, the findings

showed.

Better outcomes when kidney comes from living donor During the study period, six recipients redeemed the voucher. Meanwhile, the transplant waiting period for those enrolled with the registry dropped by three months, according to the report published online June 23, 2021 in JAMA Surgery.

Veale’s team concluded that the voucher program does what it’s designed to do: convince hesitant donors to move ahead, knowing their loved ones are covered.

“The idea was initially resisted in the transplant community, because it was really outside the box,” Veale said. “But it’s growing huge. Hundreds of vouchers have been completed. And it definitely makes a difference. There is no question that the program is able to get donors who

“Living donor kidneys typically have superior outcomes and last longer,” she said.

“Plus you can time the transplant before a patient spends years on dialysis.”

But while “cautiously optimistic” about the voucher program’s ability to improve the numbers, Rudow said it’s important that potential donors know the details.

For example, she pointed out that as a private nonprofit, the kidney registry “has no federal oversight, and there is no guarantee they will be in existence when the person is ready for a kidney.”

Still, “the voucher concept may help people feel comfortable with being a living donor to a stranger, especially if they know there is a protection for their family,” Rudow added.

More information There’s more on living kidney donations at the National Kidney Foundation.

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pain were those aged 18 to 29, men, Asian adults and those with an income 200% of the federal poverty level or above.

Huang said chronic pain is often musculoskeletal and associated with degenerative wear-and-tear, often due to a physically demanding job or aging.

“Women, especially those who are postmenopausal, have a higher incidence of musculoskeletal pain, possibly because of hormonal differences, although the association between hormones and lower back pain is not well understood,” Huang said.

Socioeconomic factors and health are inherently linked, he added.

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&

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More Than Half of Americans Plagued

by Back and Leg Pain

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here’s much Americans may disagree on, but many share one thing in common: chronic pain.

More than half of U.S. adults suffer from pain, with backs and legs the most common sources, according to researchers from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

Overall, the investigators found that nearly 59% of American men and women were saddled with pain.

“Pain is one of the most common presenting complaints to a doctor’s office,” said Dr. Yili Huang, director of the Pain Management Center at Northwell Health’s Phelps Hospital, in Sleepy Hollow, N.Y.

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“It is often the body’s warning sign that something may be wrong. Pain is a symptom and not a disease, so when experiencing new pain, it is important to seek medical advice to help diagnose the cause and to ensure that it is not an emergent or urgent medical condition,” said Huang, who was not involved in the research.

Using 2019 data from the National Health Interview Survey, the NCHS researchers found that 39% of adults had

back pain, 37% had hip, knee or foot pain, and nearly one-third had hand, arm or shoulder pain in the past three months.

About one in 10 suffered from toothaches.

The goal of the survey was not to draw conclusions from the data, but to provide the groundwork for further analyses, the researchers said.

“Given what we know about the short- and long-term effects of pain, timely, up-todate national estimates of location-specific pain are an important step in understanding the burden of pain on U.S. adults,” said lead author Jacqueline Lucas, a health statistician/epidemiologist at the NCHS in Hyattsville, Md. Demographics of Pain The odds of experiencing pain were related to economics and age, according to the report published July 29 in an NCHS Data Brief.

Those 65 and older, women, white adults and those with incomes below the federal poverty level ($25,750 for family of four in 2019) were most likely to have back pain and lower limb pain, as well as hand, arm or shoulder pain, the report noted.

Among those least likely to experience

“It is well-established that pain is associated with social-economic status. Part of that is likely because those who have chronic lower back pain often have physically demanding work. Also, studies have shown a strong association with chronic back, leg and arm pain, and patients with the lowest educational levels and blue-collar workers, likely because of the nature of the work,” Huang said.

Degeneration, Age and Weight Most chronic musculoskeletal pain is probably caused by degeneration and age.

Also, “being overweight can lead to added stress to joints of the back and extremities as well, which can lead to increased degeneration,” he noted.

Most people will develop chronic degenerative pain sometime in their lives. “The key to treatment is to focus on quality of life and function, not just the pain,” Huang said.

That doesn’t mean just living with it, however.“Activities that help us adapt to whatever is causing the pain can be helpful. That can be physical therapy, like exercises, or psychological therapy, like biofeedback or meditation, or medications,” Huang said. “It often makes sense to find a medical professional that is able to help diagnose the source of pain and work with you to find safe options to treat it.”

More information For more on pain, head to the U.S. National Library of Medicine.

SOURCES: Jacqueline Lucas, MPH, health statistician/epidemiologist, U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md.; Yili Huang, DO, director, Pain Management Center, Northwell Health’s Phelps Hospital, Sleepy Hollow, N.Y.; NCHS Data Brief, July 29, 2021

Many Seniors Love Pickleball, But Injuries Can Happen

P

ickleball has become a wildly popular sport for older Americans, but seniors who enjoy playing it should know about potential injuries and how to

avoid them.

For a lot of people, it's not an accident or injury that causes rotator cuff damage, but use over time. Pickleball requires people to reach overhead while using a lot of force, which can risk damaging or tearing the rotator cuff.

The most common problem is with the rotator cuff tendon in the shoulder, which can cause pain. Issues can include tendonitis, bursitis and even a tear in the tendon. Bigger tears are harder to fix and can make your arm weak.

"The unfortunate reality of the rotator cuff is that everyday use can cause tearing and damage," said Dr. Bruce Moseley, a surgeon in the Joseph Barnhart Department of Orthopedic Surgery at Baylor College of Medicine in Houston.

F E A T U R E D

fore your activity and ice down afterwards, your shoulder will be better prepared for the activity and will recover quicker," Moseley said.

If you are experiencing shoulder pain, don't wait to see a doctor. "The success rate of surgery to permanently fix the problem goes down as the size of the tear goes up, so if you're having lingering shoulder pain that isn't getting better over time and the pain is getting worse as the activity continues, I recommended seeing a specialist," Moseley said. "If we can get to the tear and fix it while it is small, the success rate is much higher."

The only way to repair a torn rotator cuff is through surgery.

Living with it can be painful and limit movement, and it would be difficult to remain active.

Tears aren't always preventable, but stretching and light or moderate strength training may keep it healthier and more flexible. "If you warm up and stretch be-

Other potential racquet sports injuries are meniscus tears, tendon ruptures and aggravation of arthritic knees.

More information medlineplus.gov/rotatorcuffinjuries.html

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Our practice includes total knee and hip replace-

ments, sports medicine, and arthroscopy of shoulders and knees for patients from school age to seniors.

We have followed the care of patients into their elder years, their kids and then their kids’ kids, all with the goal of making them pain free. I also take care of several high school sports teams, including John Burroughs, Villa Duchesne, and Chaminade.

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One Young Mom’s Journey with Rheumatoid Arthritis

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early 10 years ago, Tania Morales was a busy working mom when she was suddenly struck by pain, joint stiffness and exhaustion.

up, because RA is something that crept up in my life," said Morales, who has been married to her husband, Eddie, for 33 years. They have three grown sons and live in northeastern New Jersey.

"I felt alarmed, where it got to a point where I was telling my husband, 'Something's not right with my body and we need to check this out,'" said Morales, who is now 53. "I was literally in so much pain that I was scared. I'm a first-grade teacher.

I had to go about my life."

Morales' experience with RA began when she was in her early 40s. No one in her family had ever been diagnosed with the disease. People think of RA as a painful joint condition, but it's really a disease where the immune system malfunctions and attacks the body. In Morales' case, it came on suddenly.

Morales was diagnosed with rheumatoid arthritis (RA) and fibromyalgia. She spent several years trying to find the right mix of lifestyle changes and medication, collaborating with her doctor on a plan that helps her make the most of living with a chronic illness.

Now, she feels great.

"All I can say is never give up. Never feel like you're defeated with any illness. I mean, it could be cancer, it could be RA, it could be anything that really shakes you

RA affects women three times more than men, and onset typically starts in the third to fifth decades of life, said Dr. Yousaf Ali, chief of Mount Sinai's division of rheumatology and Morales' doctor.

Morales had pain in her fingers and ankles. It was hard to get out of bed or to sit up. After confirming RA through blood tests, her primary care doctor referred her to a rheumatologist. On the advice of a friend, she later switched to Ali of Mount Sinai, in New York City.

Finding the right meds Morales initially resisted taking medication, first the steroid prednisone and methotrexate pills, then the injectable biologic Enbrel and the oral biologic Xeljanz that eventually put her in remission. But she decided to take her doctor's advice to get her condition under control.

"He said, 'This is what we have to do to get you mobile, to get you better.' So, I understood, I jumped on the bandwagon," Morales said. In almost everyone, if you do nothing the disease will progress, Ali said. Once damage happens, it's irreversible.

Morales' medication hesitation meant she never fully felt comfortable with certain treatments. She was able to work with Ali on eventually eliminating the prednisone and methotrexate. Now, she just takes a single biologic drug every day. She has been in remission for a few years now, with very few flareups and minimal morning stiffness.

Morales also worked on lifestyle changes, including eating a healthier diet, walking daily, going to the gym and adding in yoga and stretching. Morales credits Ali with being a good listener and working with her to limit medications where possible.

"I feel wonderful," Morales said. "I get up and go. I don't need to nap during the day.

I feel energetic. I'm happy."

Lifestyle changes also matter Dr. Brett Smith, a rheumatologist from Knoxville, Tenn., who was not involved in Morales' case, said it can be hard to understand why some people develop RA. Risk factors can include genetic predisposition, smoking, obesity, and even traumatic injuries that trigger inflammatory arthritis.

How a person's body reacts to the disease can also vary. "Some people, honestly, have very easy-to-control rheumatoid [arthritis]," Smith said. "It takes one medicine, sometimes two at the most. And then other people, it's not that common, but sometimes you might try 10 different medicines and just never gain control for some reason. And there are people that have a variety of side effects to the medication," which makes it more complicated, he noted.

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"I think, unfortunately, it's a challenging disease, even though it probably is the best studied inflammatory arthritis on the planet. Anything that we do has risk to it and anything that we don't do potentially has risk by not being aggressive enough," Smith said.

"People envision rheumatoid [arthritis] as kind of the crippling arthritis or people in wheelchairs. With the advent of biologics, just over 20 years ago, we really don't see that nearly as much anymore. And people have pretty normal lifestyles now for the most part. So, it's been a dramatic change for the patient," Smith added.

Ali stressed that some lifestyle factors can also help keep symptoms under control.

Patients in toxic work environments should try to find a new job. Meditation can be helpful. Exercise daily if the joints allow it, possibly with non-weight

bearing exercise like an elliptical machine, biking or swimming, Ali suggested. It's possible that stress is a trigger because it may amplify pain signals to the brain, he added. The goal is to return the patient to a normal life.

Morales appreciates the collaboration with her doctor. "I was a stickler with Dr. Ali, but I admire him for being my friend, but also being my doctor, a good listener, never treating me like he was the only one that had the authority over my health condition," Morales said. "We worked as a team and I think that's important, too.

Anybody who struggles with any illness, could be RA, anything, you have to feel comfortable, not only within yourself, but also with your doctor. Is the doctor working with you? Is the doctor listening to you? Is the doctor trying to help you get better?"

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Holistic Medicine. She is at the forefront of Healthy Aging, Longevity & Regenerative Medicine.

One important way we differ from other primary care and concierge practices is our holistic understanding of health and healing. We operate under the understanding that our bodies have the remarkable ability to heal themselves, if given the right conditions.

This allows our practice to offer an Integrative, Functional Medicine model to address illness that includes alternative non-pharmaceutical treatments documented in leading medical journals.

We do not seek to "manage" chronic disease; instead,

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Partners. We take the time to work with them collaboratively to help them create, regain, and maintain vibrant health.

Practice Partners also enjoy direct communication with Dr. Salter as part of their therapeutic journey. Dr. Salter and her amazing team invite you to become a Practice Partner to experience Vibrant Health & Wellness through our personalized, advanced, integrative concierge approach.

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Strains and Sprains

B

What’s the difference between a strain and a sprain? oth strains and sprains are injuries caused by over-stretching. The muscles, tendons, and ligaments in your body are all elastic tissues, made for stretching to a point. Past that point, the tissue breaks. Both types of injuries can cause sharp and immediate pain.

A strain is damage to a muscle or the tendon that links muscle to bone. The most common places for this sort of injury to happen is in the neck, back, thigh, or calf. A strain hurts, and you may see a bruise or experience tenderness deep in the muscle.

A sprain is an injury to a ligament, the elastic tissue in your joints like the ankle, knee, wrist, or elbow. You may actually hear a snap or pop when a sprain happens.

The joint will swell or bruise. Very rapid swelling can be one sign that the injury is severe. If that happens or if you are unable to put any weight on the joint without intense pain, you should see a doctor.

How do these injuries occur?

Strains occur most frequently when a muscle gets stretched in an awkward or unexpected way. Bending at the waist to lift a heavy object is a prime cause of back strain. Another cause of strain is sudden effort, like breaking into a sprint or jumping right into a weight-lifting exercise without warming up first.

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Sprains are more likely to happen when you stumble or fall. When your foot rolls sideways on a rocky trail or the edge of a curb, you can sprain your ankle. Similar pressures can happen while you move and brake quickly while playing sports like basketball or tennis. Another cause of sprains is a bad landing after a jump. You might stretch or tear ligaments in your wrist or elbow if you try to break a fall with an outstretched arm, forcing those joints to absorb your full weight.

How can I avoid strains and sprains?

To avoid strains, take the time to learn how to lift properly, using your leg muscles instead of your back. If you exercise

more regularly, you may be able to prevent some strains simply because the muscles will be both stronger and more flexible.

You can lower your risk of sprains by choosing the right shoes and protective sports gear. Running shoes are designed to cushion and absorb the shocks that happen during long, regular strides. That cushioning can actually cause problems if you use those shoes for tennis or a back-country hike, because those activities require more ankle support. You can't be prepared for accidental falls, but tumbles are bound to happen while you learn a new sport like in-line skating or snowboarding, so plan accordingly. Wear protective wrist, elbow, and knee pads to keep those joints in working order.

And warming up before exercise really is worth it. A few minutes of light aerobic activity heats up your muscles and ligaments, making them more pliable and less prone to tearing. Stretching is also a good idea, especially if you make it a regular practice, since it can increase flexibility.

It's worth repeating that exercise is your first defense. The payoff is stronger muscles that are less likely to strain.

And exercise improves your balance and coordination, reducing the chance you will experience an accidental fall. Just make sure you respect your body and ease into any new stretches or activities.

flammation. If you don't have an ice pack, grab a bag of frozen peas. Protect your skin with a layer of damp towel, though, and don't leave the pack on for more than 20 minutes at a time. Apply the ice pack at least three times a day for the first couple of days.

Compression: Fluid can accumulate in the damaged tissue. An elastic bandage can provide the compression you need, but be careful not to wrap it too tightly since that can restrict blood flow. Tingling, cold, or a bluish tint are all signs that the bandage is too tight.

Elevation: Position the injured area so it is higher than your heart. This means sitting or stretching out with a pillow under your leg or arm. This will help reduce swelling.

In addition to the RICE remedy, you should take an anti-inflammatory pain reliever such as aspirin or ibuprofen.

You'll hurt less, and the swelling should go down.

It may take a week or more for the healing to take place. Take it easy when you resume normal activity. If it hurts to move the joint, don't push it. Once you can move it without pain, start strengthening the muscles around it. A physical therapist can give you advice about exercises.

When should I see a doctor?

How should I treat a strain or sprain?

Moderate and severe sprains and strains will benefit from prompt treatment. Don't ignore these symptoms:

Both a strain and a minor sprain can benefit from the RICE treatment:

■ Severe pain or extreme sensitivity to touch.

Rest: Give the injury 24 to 48 hours of quiet to heal. Use crutches or a sling to take the pressure off damaged joints.

■ Inability to bear weight.

Ice: Get ice on the injury as soon as you can. Cold can ease pain and reduce in-

■ Swelling is normal, but lumps or crookedness along the injured joint or muscle are not.

■ Numbness in the injured area.

■ Redness or red streaks spreading out from the injury.

References American Academy of Orthopaedic Surgeons.

Sprains and strains: Whats the difference?

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Sprains and strains.

Mayo Clinic. Sprains and strains.

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More Than a Snore?

Recognize the Signs of Sleep Apnea Does your bed partner claim that you snore?

I

f so, don’t just tune him or her out. It may mean you have obstructive sleep apnea (OSA).

Untreated sleep apnea – which causes repeated breathing interruptions during sleep – can lead to serious health problems, so the American Academy of Sleep Medicine (AASM) wants you to consider: Is it more than a snore?

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“While not everyone who snores has sleep apnea, snoring is a warning sign that should be taken seriously,” said AASM President Dr. Kannan Ramar.

“If your bed partner snores, or if you’ve been told that you snore, then it is important to talk to a medical provider about screening or testing for sleep apnea.”

Treating obstructive sleep apnea can improve overall health and quality of life, he added.

Nearly 70% of Americans who sleep with a partner say their bed mate snores, according to a 2021 AASM survey. The same survey found that 26% of Americans are unfamiliar with OSA, and 48% don’t know its symptoms.

Nearly 30 million U.S. adults have OSA, but AASM estimates that 23.5 million of those cases are undiagnosed.

These are the five warning signs to be aware of: snoring, choking or gasping during sleep; fatigue or daytime sleepiness; obesity; and high blood pressure.

Other indications of apnea include: unrefreshing sleep, insomnia, morning headaches, waking during the night to go to the bathroom, difficulty concentrating, memory loss, decreased sexual desire, irritability, or difficulty staying awake while watching TV or driving.

“Delaying treatment for sleep apnea can lead to more serious health problems,” Ramar said. “Fortunately, many of the damaging effects of sleep apnea can be stopped, and even reversed, through diagnosis and treatment by the sleep team at an accredited sleep center, where patients receive care in safe and comfortable accommodations.”

The typical treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy. CPAP keeps the airway open by providing a steady stream of air through a mask that’s worn while sleeping.

Using CPAP can improve quality of sleep, boost daytime alertness, concentration and mood and even improve brain and heart health, according to AASM. Other treatments include positional therapy, oral appliance therapy and surgery.

Sleep Apnea Doubles Odds for Sudden Death

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ith apologies to William Shakespeare, this is the stuff bad dreams are made of: Sleep apnea may double your risk for sudden death.

For the study, a team at Penn State University reviewed 22 studies that included more than 42,000 patients worldwide.

Their review revealed that people with obstructive sleep apnea had a greater risk of dying suddenly and the risk rose as patients aged.

The condition — in which a person’s airway is repeatedly blocked during sleep, causing pauses in breathing — may also

“Our research shows this condition can be life-threatening,” principal investigator Anna Ssentongo said in a university news

moderate to severe apnea, according to the AASM. CPAP provides a steady stream of pressurized air through a mask worn during sleep. The airflow keeps the airway open, preventing pauses in breathing while restoring normal oxygen levels.

Other options include oral appliances designed to keep the airway open and, in some cases, surgery to remove tissue from the soft palate, uvula, tonsils, adenoids or tongue.

Losing weight also benefits many people with sleep apnea, as does sleeping on one’s side. Generally, over-the-counter nasal strips, internal nasal dilators, and lubricant sprays reduce snoring, but AASM says there is no evidence that they help treat sleep apnea.

Dr. Tetyana Kendzerska, an assistant professor of medicine in the division of respirology at the University of Ottawa in Canada, noted that this is not the first study to find a link between sleep apnea and early death.

She noted that apnea can increase the risk of sudden death in several ways, including off-and-on deficiency in supply of oxygen to tissues; sleep fragmentation; inflammation; and chronic activation of the nervous system.

Kendzerska, who was not involved in the study, said it might be assumed that treating apnea would reduce the risk of sudden death, but that may not be the case.

increase the risk for high blood pressure, coronary artery disease and congestive heart failure, new research shows.

“This [study] adds to the growing body of evidence that highlights the importance of screening, diagnosis and treatment of sleep apnea,” said Dr. Kannan Ramar, immediate past president of the American Academy of Sleep Medicine (AASM).

Ramar, who reviewed the findings, said they underscore the importance of recognizing a widespread and often underdiagnosed condition that has become a growing public health concern.

release. She’s an assistant professor and epidemiologist at Penn State.

The repeated lapses in breathing in sleep apnea cut off oxygen supply to cells, which can result in an imbalance of antioxidants in the body. This imbalance harms cells and may speed up the aging process, leading to many health problems, the researchers said.

The study authors said the findings underscore the urgency of treating sleep apnea.

Treatment Options Continuous positive airway pressure (CPAP) is the standard treatment for

She noted that a preliminary report from the U.S. Agency for Healthcare Research and Quality suggested there is scant evidence that CPAP lowers the risk of all-cause death, stroke, heart attack or other heart problems.

“It means that we need more and better quality studies to show the effect of CPAP on all-cause mortality and cardiovascular outcomes,” she said.

The findings were recently published online in the journal BMJ Open Respiratory Research.

More information To learn more about sleep apnea, visit the American Academy of Sleep Medicine.

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Gelburd said that since asymptomatic people can have post-COVID symptoms, patients and doctors alike should consider the possibility that some health issues may actually be aftereffects of coronavirus infection.

After COVID, Many Americans Are Struck

by New Maladies

S

uffering through a case of COVID-19 unleashed a host of other health problems in hundreds of thousands of Americans participating in the largest study yet of the long-term effects of coronavirus infection.

Tracking the health insurance records of nearly 2 million people who caught the coronavirus in 2020, researchers found that one month or more after their infection, almost one-quarter of them sought medical treatment for new conditions, The New York Times reported.

Wide Range of Effects

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The range of both those affected and the symptoms that struck them was wide.

The health issues affected all ages, including children.

The most common new health problems were pain; breathing difficulties; high cholesterol; malaise and fatigue; and high blood pressure. But symptoms did not stop there: Some suffered intestinal symptoms; migraines; skin problems; heart abnormal-

ities; sleep disorders; and mental health conditions like anxiety and depression.

Post-COVID health problems did not spare those who had not been seriously ill: While nearly half of patients who were hospitalized for COVID-19 experienced subsequent medical issues, so did 27 percent of people who had mild or moderate symptoms and 19 percent of people who said they were asymptomatic.

“One thing that was surprising to us was the large percentage of asymptomatic patients that are in that category of long COVID,” Robin Gelburd, president of the nonprofit FAIR Health, told the Times.

In total, the report found that more than 454,000 people consulted health providers for symptoms 30 days or more after their infection. The analysis was evaluated by an independent academic reviewer but was not formally peer-reviewed, according to FAIR Health.

“The strength of this study is really its size and its ability to look across the range of disease severity in a diversity of age groups,” Dr. Helen Chu, an associate professor of medicine and infectious diseases at the University of Washington’s School of Medicine, told the Times.

The report “drives home the point that long COVID can affect nearly every organ system,” Dr. Ziyad Al-Aly, chief of the research and development service at the VA St. Louis Health Care System, told the Times.

“Some of these manifestations are chronic conditions that will last a lifetime and will forever scar some individuals and families,” added Al-Aly, who authored a large study published in April on lingering symptoms in COVID-19 patients in the Department of Veterans Affairs health system.

Pain, Malaise and Fatigue In the latest report, the most common issue for which patients sought medical care was pain — including nerve inflammation and aches and pains associated with nerves and muscles. It was reported by more than a fifth of those who reported post-COVID problems. Breathing difficulties, including shortness of breath, were experienced by 3.5 percent of post-COVID patients.

Nearly 3 percent of patients sought treatment for symptoms that were labeled with diagnostic codes for malaise and fatigue, a far-reaching category that could include issues like brain fog and exhaustion that worsens after physical or mental activity, the Times reported.

COVID-19 vaccines,” Novavax president and CEO Stanley Erck said in a statement. “These clinical results reinforce that [the vaccine] is extremely effective and offers complete protection against both moderate and severe COVID-19 infection.”

The database included only people with private health insurance or Medicare Advantage, not those uninsured or covered

by Medicare Parts A, B and D, Medicaid or other government health programs.

Chu told the Times that people without insurance or with incomes low enough to qualify for Medicaid are often “more likely to have worse outcomes.”

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said, “It’s really very impressive,” noting that the vaccine was as good as the most effective shots developed so far during the pandemic. “It’s very important for the world’s population to have, yet again, another highly efficacious vaccine that looks in its trial to have a

Also, the study did not compare people who had COVID-19 with those who did not, to see if such symptoms were higher than in the general population. The report did exclude patients with certain serious or chronic preexisting conditions like cancer, kidney disease, HIV, liver disease and stroke, to separate their previous health status from postCOVID symptoms.

Novavax COVID Vaccine Shines in Trial Novavax, a Maryland biotechnology company that has struggled mightily with delays in developing its coronavirus vaccine, announced in late 2021 that its two-shot regimen was over 90% effective overall in a trial that unfolded even as more contagious variants emerged.

Among 30,000 volunteers — all of them from either the United States or Mexico — vaccinated people were completely protected against severe and even moderate cases of illness. There were no cases of hospitalization or death among people who received the vaccine, the company reported. Side effects were mild — fatigue, headaches and muscle pain — and reactions tended to be less frequent than those triggered by some already authorized vaccines, the company said.

“Today, Novavax is one step closer to addressing the critical and persistent global public health need for additional

past manufacturing issues that slowed its bid for regulatory approval. Erck had expected the vaccine to be approved by May of 2021, but problems in some of Novavax’s factories reportedly delayed the company’s application for FDA approval, prolonging the process of bringing the vaccine to market.

Erck said the vaccine will likely have its biggest initial impact globally, through the World Health Organization’s COVAX initiative. “A lot of our vaccine is going to be targeted in the early stages for COVAX … and so a lot of those doses are going to get into the low- and middle-income countries first, which is a good thing,” Erck said. Novavax has pledged 1.1 billion doses to COVAX. The Novavax vaccine was one of six candidates the U.S. government made a huge bet on, investing $1.6 billion to pay for research and development and preordering 110 million doses, the Post reported.

good safety profile,” Fauci told the Washington Post.

As heartening as the results were, the vaccine may not become a key player in the pandemic until later this year.

Erck says that Novavax is ready to fill the “pent up demand” for its COVID-19 vaccine. He expects 10 regulatory agencies, including in the US, to approve Novavax’s COVID-19 vaccine in the coming months. On its website, Novavax says it has pending applications in countries that include the U.S. Japan, Singapore, New Zealand, Canada, Australia, the U.K., South Korea and the United Arab Emirates.

At the end 0f 2021, Novavax announced that it submitted its final data package to the U.S. Food and Drug Administration and filed its application for emergency use approval at the end of January.

Novavax is hoping that it has overcome

In early 2021, a large U.K. trial showed it was nearly 90% effective, even once a more transmissible variant had taken hold. Since then, health officials and scientists have waited anxiously for confirming evidence from the U.S. trial. But that second study did not start until the end of December, due in part to manufacturing delays.

Plenty of Vaccine Available Meanwhile, the United States had secured more than enough shots from the three companies with authorized vaccines — Pfizer, Moderna and Johnson & Johnson — to satisfy demand. A fourth, from AstraZeneca, reported results in March.

Recombinant protein vaccines such as Novavax’s — the hepatitis B vaccine is another example — teach the immune system to recognize a virus by introducing a lab-made version of a viral protein.

Once the production process is in place, the vaccine offers potential advantages.

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More Than Half of People With Asthma Aren’t Seeing a Specialist

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mong Americans with severe asthma, less than half see a specialist to manage their condition, new research shows.

The U.S. National Heart, Lung, and Blood Institute recommends patients with severe asthma be referred to a specialist for evaluation and care.

To find out how many people with se-

After a specialist visit, asthma attacks were much lower (about 38% versus 49%). Hospitalizations, emergency department visits and use of rescue inhalers also were lower for patients during the 12 months after their first visit to a specialist, the study found.

The greatest predictors for a specialist visit were higher numbers of asthma attacks, younger age, and having severe asthma identified in a recent year.

Patients with other non-respiratory health conditions, those 65 and older, and males were less likely to seek specialist care, according to the report published online June 17, 2021 in The Journal of Allergy and Clinical Immunology: In Practice.

vere asthma see a specialist, researchers examined insurance data from more than 54,000 patients who were 6 years of age and older.

Only 38% saw an allergist/immunologist or a pulmonologist at least once in the year before or after the first observation of severe asthma, the investigators found.

“Specialist care is important for managing any condition, especially a chronic one such as severe asthma,” said lead author Dr. Jessica Most, a pulmonologist at Jefferson Health/ National Jewish Health, in Philadelphia.

An analysis of a smaller group of nearly 6,000 patients showed that controller medication fills and prescriptions for biologic medications were higher for those seeing a specialist.

“Our findings suggest that specialist visits for severe asthma are very underutilized, with only four in 10 patients seeking care over a 2-year period,” Most said in a journal news release.

She added that efforts should be made to increase specialist referrals, especially for patients who are less likely to seek out care from an allergist/immunologist or pulmonologist.

More information The American Lung Association has more on asthma.

SOURCE: The Journal of Allergy and Clinical Immunology: In Practice, news release, June 17, 2021

F E A T U R E D

P R A C T I C E

A Painless, Lasting Treatment for Hemorrhoids: Infrared Coagulation Almost everyone suffers from hemorrhoids at some time in their lives. Hemorrhoids are normal “cushions” of tissue filled with blood vessels at the end of the rectum. If enlarged, they can cause unpleasant symptoms. If left untreated, surgery may be required, which can be painful and require days to weeks of recovery.

Topical medications can relieve itching and shrink mild hemorrhoids. But for enlarged or bleeding hemorrhoids, options for longer-term relief have been limited to sclerotherapy, involving injections

similar to those for varicose veins, rubber band ligation, stapling and surgery. Each can have varying results, days of discomfort and possibly complications, some of which are severe.

Our practice, Midwest Hemorrhoid Treatment Center, offers another option, an outpatient procedure called infrared coagulation (IRC). It is a minimally invasive, non-surgical procedure that many studies have shown to be the optimal non-operative treatment of choice.

It is fast, effective, well tolerated and has fewer complications than other

options. Dr. Betsy Clemens, MD has performed almost 30,000 IRC procedures with very high levels of patient satisfaction.

The IRC treatment focuses infrared light on hemorrhoidal tissues. This coagulates blood vessels, causing the hemorrhoid to shrink and retract. The IRC procedure does not require anesthesia or special preparation. Patients may feel a slight warm sensation, but it usually is painless, and most patients return to work the same day. IRC received FDA clearance in 1984 and is covered by most insurance plans.

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said. “A relatively small proportion already do, but more importantly, there is research showing that women overwhelmingly want this information provided to them and their primary care doctors,” he said.

Because this information can be obtained during a routine screening mammogram, there would be no extra cost or radiation exposure.

The findings were published in the journal Circulation: Cardiovascular Imaging.

W O M E N ’ S

H E A L T H

Mammograms Can Also Highlight Heart Risks

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our annual screening mammogram may do more than spot breast cancer early — it may give you a heads up on your heart disease risk, too.

Digital breast X-rays can also detect a build-up of calcium in the arteries of your breasts, an early sign of heart disease.

These white areas — known as breast arterial calcification, or BAC — are markers of hardening in the arteries and tend to go along with advancing age, type 2 diabetes, high blood pressure and inflammation. (It is not the same as calcification of the inner layer of the arteries that is often found in smokers or people with high cholesterol.)

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“A single test that is universally accepted can address the two leading causes of death in women,” said study author Dr. Carlos Iribarren. He is a research scientist at the Kaiser Permanente Northern California Division of Research, in Oakland.

For the study, his team reviewed health records of more than 5,000 women, aged 60 to 79, who underwent one or more screening mammograms. None of these women had a history of heart disease or breast cancer when the study began. They were followed for about 6.5 years.

Dr. Natalie Avella Cameron, an instructor at Northwestern University’s Feinberg School of Medicine in Chicago, co-wrote an editorial that accompanied the findings.

“If future research shows that BAC improves heart disease risk prediction among women not yet on cholesterol-lowering medications, BAC could serve as a powerful tool to help guide heart disease prevention for the millions of women who undergo routine mammography each year,” she said.

Those whose mammogram showed breast arterial calcifications were 51% more likely to develop heart disease or have a stroke compared with women without calcium build-up in their arteries, the study found.

In addition, women with calcium build-up were 23% more likely to develop any type of heart or vascular disorder, including heart disease, stroke, heart failure and related diseases, the study showed.

But, Cameron noted, women without calcium build-up on their breast arteries can still develop heart disease. “We should be assessing heart disease risk factors such as obesity, high blood pressure, high cholesterol and diabetes, and discussing how to optimize heart health through lifestyle changes such as eating a plant-based diet and staying active, regardless of BAC status,” she said.

“BAC provides additional information and is not intended to replace any current risk factors for heart disease,” Iribarren said. Counseling should be done in the context of a woman’s overall heart disease risk, he said.

Knowledge of BAC status could be powerful and potentially life-saving information, said cardiologist Dr. Nieca Goldberg, who reviewed the findings. She’s medical director at Atria New York City and a clinical associate professor of medicine at New York University. “Heart disease is the No. 1 killer of women, yet many women are more worried about breast cancer,” Goldberg said. “Women’s health issues are not siloed. A test for breast cancer can give us clues to heart disease risk, too.”

“For women with low risk, BAC presence should be a trigger of adhering to healthy lifestyles including a heart-healthy diet, avoiding smoking and exercising regularly,” he advised. “For women with intermediate-risk, BAC should also prompt a discussion with the doctor about initiating treatment for risk factors such as cholesterol, blood pressure and diabetes that are not well controlled by lifestyle alone.”

Although reporting of BAC levels is not mandatory, radiologists should include this information in their report, Iribarren

Calcium build-up in arteries is an early sign of heart disease risk. “We don’t know how any intervention would change calcifications, but exercising, quitting smoking, getting diabetes under control, eating a healthier diet, and managing cholesterol and blood pressure can help lower risk for heart attack,” Goldberg said.

Excessive Sugary Drinks Double the Risk of Colon Cancer in Younger Women

Know your breast cancer risk.

Create a plan.

R

ates of colon cancer among young Americans are on the rise, and a new study suggests that drinking too many sugary beverages may be to blame -- at least for women.

Women who drank two or more sugar-sweetened beverages such as soda, fruity drinks or sports and energy drinks per day had double the risk of developing colon cancer before the age of 50, compared to women who consumed one or fewer sugary drinks per week.

"On top of the well-known adverse metabolic and health consequences of sugar-sweetened beverages, our findings have added another reason to avoid sugar-sweetened beverages," said study author Yin Cao, an associate professor of surgery at the Washington University School of Medicine in St. Louis.

The study included more than 95,000 women from the ongoing Nurses' Health Study II. The nurses were aged 25 through 42 when the study began in 1989 and provided information on their diet every four years for nearly 25 years.

Of these, 41,272 reported on what, and how much, they drank in their teen years. During 24 years of follow-up, 109 women developed colon cancer before turning 50.

Having a higher intake of sugar-sweetened drinks in adulthood was associated with a higher risk of the disease, even controlling for other factors such as family history. This risk was even greater when women consumed sodas and other sugary drinks during their teen years.

Substituting sugar-sweetened drinks with artificially sweetened beverages, coffee or milk was associated with a 17% to 36% lower risk of developing colon cancer before age of 50, the study found.

The new study was not designed to say how, or even if, drinking sugary beverages causes colon cancer risk to rise. But people who consume sugary beverages are more likely to be overweight or obese and have type 2 diabetes, all of which can up risk for early-onset colon cancer. The high-fructose corn syrup in these drinks may also promote the development of colon cancer in its own right, Cao said.

St. Luke’s High-Risk Breast Services Knowing your personal breast cancer risk can help you take steps to reduce your chances of developing it or catch it early, when it is most treatable.

St. Luke’s Women’s Center offers a comprehensive high-risk program to help you learn your risk and work with our specialists to develop a personalized plan and seamlessly coordinate your care. It begins with a breast risk assessment at your annual mammogram.

Learn more about St. Luke’s High-Risk Breast Services at stlukes-stl.com/BreastHealth, or call 636-530-5512.

The study was published online May 6 in the journal Gut.

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dementia risk, including age at last exam, race, education, cigarette and alcohol use, body fat, heart disease, diabetes, income and leisure and physical activities. The study did not include information on whether women had a family history of dementia or if women entered menopause early for natural or medical reasons, which could affect the findings.

The findings were presented earlier this year at a meeting of the American Heart Association held in Chicago and online.

Research presented at medical meetings is typically considered preliminary until published in a peer-reviewed journal.

Early Menopause May Raise a Woman’s Odds for Dementia

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omen who enter menopause early may be more likely to develop dementia later in life, new

research indicates.

During menopause, production of the female sex hormone estrogen drops dramatically, and a woman's periods come to an end. While women typically enter menopause in their early 50s, many do so earlier — either naturally or due to a medical condition or treatment such as a hysterectomy (removal of the uterus).

This large study found that women in the U.K. who entered menopause before age 40 were 35% more likely to develop dementia later in life than women who started menopause around age 50.

What's more, women who entered menopause before age 45 were 1.3 times more likely to develop dementia before their 65th birthday, the new study showed.

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"Women with early menopause may need a close monitoring of their cognitive decline in clinical practice," said study author Dr. Wenting Hao, a Ph.D. candidate at Shandong University in Jinan, China.

The higher risk for dementia may be due to the sharp estrogen drop that takes place during menopause, Hao said. "Estrogen can activate cellular antioxidants such as glutathione, reduce ApoE4, the most common genetic risk factor in the

pathogenesis of dementia, and reduce amyloid plaque deposition in the brain," she explained.

The build-up of amyloid plaques in the brain is one of the hallmarks of Alzheimer's disease, the most common type of dementia.

This doesn't mean that women who start menopause early are powerless against dementia, Hao said. "Dementia can be prevented, and there are a number of ways women who experience early menopause may be able to reduce their risk of dementia," he said. This includes getting regular exercise, participating in leisure and educational activities, not smoking or using alcohol, and maintaining a healthy weight, she said.

For the study, researchers compared age at menopause and dementia diagnosis among 153,291 women (average age: 60) who were part of the UK Biobank, a large database of genetic and health information on people living in the United Kingdom. They looked for all types of dementia, including Alzheimer's.

Postmenopausal women are at greater risk of stroke than pre-menopausal women, and stroke may cause vascular dementia, but the study found no link between age at menopause and the risk of this type of dementia.

The new findings held after researchers accounted for other factors that may boost

These findings are consistent with other studies showing a greater risk of dementia among women with premature or early menopause, said Dr. Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic Center for Women's Health.

"The early loss of estrogen is linked with an increased risk of multiple adverse long-term health outcomes, and dementia is just one of them," said Faubion. Others include heart disease, brittle bone disease, osteoporosis, mood disorders, sexual dysfunction and early death.

There may be a role for hormone replacement therapy, she said. "In addition to suggesting monitoring of these women, replacing estrogen is a key strategy and has been shown to mitigate dementia risk (and other risks) in women with premature or early menopause," Faubion said.

For years, hormone replacement therapy was widely prescribed to treat symptoms of menopause and lower risk for heart disease, osteoporosis and dementia.

This all changed when the landmark Women's Health Initiative study showed that taking estrogen and progestin after menopause may increase women's risk for stroke, heart disease, blood clots and breast cancer. (Estrogen helps with menopause symptoms like hot flashes and vaginal dryness, and progestin is added to protect against uterine cancer in women who still have a uterus.)

Today, hormone replacement therapy may be prescribed in the lowest dose for the shortest amount of time to maximize benefits and minimize potential risks.

More information The Alzheimer's Association offers tips on preventing dementia.

Women More Susceptible Than Men to Long COVID

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omen are far more likely than men to suffer from long COVID, according to a broad new research review. The review, published June 21 in the journal Current Medical Research and Opinion, included 1.3 million patients, and revealed women were 22% more likely to develop persistent symptoms after a COVID infection.

For women, lingering symptoms after a COVID infection included fatigue; ear, nose and throat issues; as well as mood disorders like depression. They also had respiratory symptoms, and neurological, skin, gastrointestinal and rheumatic disorders.

In contrast, men with long COVID were more likely to have endocrine disorders, including diabetes and kidney issues.

"Knowledge about fundamental sex differences underpinning the clinical manifestations, disease progression, and health outcomes of COVID-19 is crucial for the identification and rational design of effective therapies and public health interventions that are inclusive of and sensitive to the potential differential treatment needs of both sexes," the authors said in a journal news release.

Led by Shirley Sylvester, senior medical director for women's health at Johnson & Johnson in New Brunswick, N.J., the researchers noted that differences in how men's and women's immune systems function could be an important factor.

"Females mount more rapid and robust innate and adaptive immune responses, which can protect them from initial infection and severity," Sylvester and colleagues wrote. "However, this same difference can render females more vulnerable to prolonged autoimmune-related diseases."

The review included data from papers published between December 2019 and June 2021. In all, just 35 of the more than 640,600 papers broke down data by gender with enough detail about symptoms to effectively compare differences in the way men and women respond to the disease. Other, more recent studies have examined the issue.

More studies have examined sex differences in hospitalization, ICU admission, ventilation support and death rates. But researchers said symptoms and long-term damage to the body have not been studied enough by sex.

"Sex differences in outcomes have been reported during previous coronavirus outbreaks," the researchers said. "Therefore, differences in outcomes between females and males infected with SARS-CoV-2 could have been anticipated. Unfortunately, most studies did not evaluate or report granular data by sex, which limited sex-specific clinical insights that may be impacting treatment."

The authors said data broken down by sex should be made available even if that was not a study's primary objective because the information could be of value to others. Analyzing that information is a key to addressing disparate disease outcomes, they said.

Researchers noted that women in professions such as nursing and education may be at higher risk of exposure to SARSCoV-2. There may also be gender-based differences in access to care that could affect treatment and lead to more complications.

More information The U.S. Centers for Disease Control and Prevention has more on COVID-19.

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A G I N G

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C A R E G I V I N G manager and former program director of the Family Caregiver Alliance, an organization based in San Francisco. "They don't look for help until they're desperate," she says.

Over the years, Schempp has worked with many caregivers who have pushed themselves to the edge of desperation and beyond. Even as their own physical and mental health started to erode, they wouldn't ask for or accept assistance.

Caregiving: Reaching Out for Help

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ichelle Booth of Foster City, California, remembers that when she first moved in with her parents, her three-yearold daughter was in tow. Her parents were then both in their late 70s, but they had the strength and the good health to be helpful, doting grandparents. That was years before her father suffered several strokes and before her mother developed Alzheimer's disease.

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Booth still lived with her parents, but she became the one providing all the support.

"They were a great source of help to me," she says. "Now the roles are reversed."

Her father moved at a "turtle's pace" even with his walker. And her mother couldn't always remember her daughter's first name. With their deteriorating health, caring for them became a 24-hour,

one-woman job. Booth's four siblings were scattered from Israel to Honolulu, and none of them were able to offer much help.

And even as Booth became overwhelmed and exhausted, she was reluctant to ask anyone else to lend a hand. "I took this on voluntarily," she says. "I wasn't ready to say that I couldn't handle it."

When being a hero works against you Millions of Americans have taken on the immense responsibility of caring for an aging parent or a spouse. Caregivers have many options for help – including adult day care programs or home health workers – but far too many try to tackle the job alone, says Donna Schempp, LCSW, a geriatric care

Such dedication is heroic, but it's also counterproductive, Schempp says.

Caregivers who do everything themselves end up shortchanging their loved ones as well as themselves, she says. "Caregivers who don't get enough help tend to lose their patience and their understanding," she says.

As the job gets more and more demanding, a sense of loyalty and duty can keep a person from asking for help, Schempp says. For both spouses and children, the reluctance to seek help often boils down to one key concern, she says. "People always say 'nobody can care for this person the way I can,'" she says. "And that's probably true. But different isn't necessarily bad."

Money is also an issue. Caregivers may assume that they could never afford outside help, even though there may be low-cost options available, such as adult day care.

In most cases, however, caregivers who try to do everything themselves aren't trying to save money, Schempp says. They're simply trying to do everything they can, even if it's too much.

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Reducing sibling stress Many caregivers are lucky enough to have siblings or children who can share much of the load. Even in the best-case scenarios, though, it usually takes a little nudging to encourage a relative to help, Schempp says. In too many cases, one family member seems to end up doing all (or nearly all) of the work.

usual day.' Describe your day and what you have to confront. Then lay out an agenda: 'Here's what I would like us to talk about.'"

The actual call, Butler says, may involve legal, financial, and personal issues. If you've had to miss a lot of work and pay

Siblings and other relatives can often be surprisingly helpful if a caregiver finds the right way to ask. The Family Caregivers Alliance recommends staying assertive without being hostile or accusing. And if a relative declines an offer to help, don't be afraid to ask again. If siblings are unable to help with caregiving because they live far away or have other obligations, you could still ask them for help with such things as finances and legal issues.

In Caring for Yourself While Caring for Your Aging Parents, author Claire Berman writes that communication is the key to shared caregiving. After spending many years caring for a widowed mom with Alzheimer's, and a sick, frail mother-in-law, she has developed some rules for reducing the stress between caregivers and siblings.

Don't necessarily expect anything, she advises; that way you won't be crushed if it doesn't happen. She also advises caregivers to be responsible, very clear about their abilities, and open, honest, and forgiving.

In addition, she says, make sure you appreciate the good things your siblings do. ("Thanks for visiting Mom," she suggests, rather than "So you finally visited Mom – it's about time.") She advises primary caregivers to always keep their siblings informed about what's going on, so they won't develop their own resentments.

Also, let them have their say, and accept that you may respectfully disagree over the best way to care for your parents.

Getting the help you need

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It's especially important not to let resentments fester. If conflict is building up, Berman says, a family conference can make a big difference. Her book quotes the respected geriatrician Robert Butler, who says caregivers might want to "send a thoughtful letter, laying out the circumstances: 'When you guys call, frequently Mom sounds pretty good. But here's the

for your parent's medications, food, and other expenses, he advises telling your siblings: "I'd appreciate it if you'd consider sharing this financial burden with me."

You could volunteer to send bills for a given month, or estimate the cost of your lost productivity, or ask about sharing the cost for an in-home health aide. He suggests saying something like: "When can you make visits or have Mother visit you? Let's make a schedule, because time [for visiting] is short."

If relatives live nearby and drop in sporadically, consider asking whether they can commit to a certain schedule, while being free to visit anytime. If they're uncertain about what to do, you might want to make a specific list of the chores or errands they could help with. These might include grocery shopping, picking up medications, doing the laundry, or simply volunteering to stay at the house while the caregiver gets out for a couple of hours. Be as specific as possible: "Could you drive dad to his weekly doctors’ appointments?" is more likely to get a positive response than "It would be great if you could pitch in once in a while." Potential helpers can look over the to-do list and pick something that works for them.

Looking beyond the family Caregivers may need to look beyond their immediate family to find willing helpers, Schempp says. Neighbors, other relatives,

and friends – particularly those who have served as caregivers – may be more than willing to pitch in. But when caregivers need more help every day, they may have to start looking into more formal, professional options.

But first, caregivers need to take a thorough inventory of their needs once again. If they simply need someone to pitch in with the laundry and meals while providing a little companionship, they don't necessarily need to find someone with extensive training. (A kind heart is still mandatory.) Some caregivers in this situation find excellent in-home help through churches or senior centers.

The other approach is to contact a home-care agency. A reputable agency will perform thorough background checks on all of its employees. Some doctors may also be able to refer you to social workers who can help.

Finding the right services or combination of services can be a challenge. Fortunately, there are people who can help caregivers make the tough choices. They're called "professional care managers," and they work with families, physicians, and local agencies to find the best care options. In many cases, the cost of hiring a manager may be covered by Medicaid or Medicare.

Caregivers can find care managers and learn more about care options by contacting the local Area Agency on Aging. (https://eldercare.acl.gov) When Booth finally realized that she couldn't do everything on her own, she turned to a local adult day care program, another valuable resource for caregivers.

This particular program was recommended by hospital staff after her dad had one of his strokes. She dropped off her mother and father in the morning and picked them up in the afternoon. Not only did her parents receive quality care and close supervision during the day, they also enjoyed the chance to get out of the house and socialize with other people their age.

As her parents' health declined, they eventually needed nearly constant medical care. But she was grateful for every day they were around – even if she did need a little extra help.

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Extended Care

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is to convince everyone willing to listen that you've got to do everything possible to reduce inflammation," including eating healthful fats like omega-3 fatty acids.

Warding off Alzheimer's with exercise

Preventing Alzheimer’s

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here's still no cure for Alzheimer's or known way to prevent it. But if you're worried about developing the disease, your doctor just might give you an unexpected prescription. She might urge you to exercise daily, eat a diet rich in whole foods, and watch your weight. She might even recommend taking a language class or some dance lessons. Or having a fish dinner twice a week. Or adding curry dishes to your menu.

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Many recent studies have pointed to several promising theories on helping prevent Alzheimer's. A report in the Annual Review of Public Health stressed that researchers are increasingly looking at Alzheimer's the way they do other chronic conditions in which lifestyle plays a role.

Many feel that it's not too soon to take action – especially if you have a family history that puts you at risk.

Protect the heart, protect the brain Obesity, high cholesterol, and high blood pressure all significantly raise the risk of Alzheimer's, researchers report. Swedish and Finnish researchers followed a group

of 1,500 older subjects for an average of 21 years. A combination of all three factors increased the risk by six-fold.

These same risk factors also contribute to heart disease, the number-one killer in this country. Doctors have long encouraged patients to protect themselves from heart disease with regular exercise and a healthy diet. Now there's growing evidence that a heart-healthy lifestyle may also be good for the brain.

Having excess belly fat may increase your risk of Alzheimer's disease. A long-term study of more than 6,500 people published in Neurology found that those who had the most abdominal fat between the ages of 40 and 45 were about three times more likely to develop dementia in later life than those with the least.

Excess fat is also thought to contribute to inflammation in the body, which is linked to heart disease and, increasingly, with dementia. "Inflammation is actually a pivotal player in such diverse brain conditions as Alzheimer's disease, multiple sclerosis, Parkinson's disease and even autism," says neurologist David Perlmutter, MD. "My most fundamental take home message ...

More and more evidence suggests that people who exercise regularly into their later years are less likely to develop Alzheimer's: In a recent study, older women who were physically active during the six to eight years of follow-up were less likely to suffer from impaired memory and reasoning. In addition, several case-control studies suggest that a sedentary lifestyle is a risk factor for the disease.

One study released suggested that walking at least 6 miles a week – the equivalent of 72 city blocks – will help prevent the onset of Alzheimer's. In the first decade of a 20-year study of 426 older adults, the researchers also found that adults who already had Alzheimer's or mild cognitive impairment were able to preserve the brain's key memory and learning centers over at least a 10-year period by walking 5 miles a week.

And it's never too late to get started – exercising in midlife can significantly reduce your risk of Alzheimer's, especially if you're at genetic risk for the disease.

In a study published in Lancet Neurology, Swedish researchers reported that older people who exercised at least twice a week had approximately a 60 percent lower risk of suffering from Alzheimer's and dementia than their less active peers. Carriers of the Apo-E gene, which puts people at high risk of developing Alzheimer's, reaped the largest benefits. Exercise may ward off Alzheimer's by boosting blood flow to the brain and helping protect blood vessels there, researchers speculated.

And even a little exercise may yield tremendous gains. In a recent U.S. study involving more than 1,700 adults followed over a six-year period, adults over 65 who exercised for 15 minutes three times a week reduced their risk for dementia by one-third.

Alzheimer's is blood cholesterol levels.

Among other things, it says, scientists have found that high blood cholesterol levels may increase the rate of plaque deposition in laboratory mice.

Finally, exercise helps protect against insulin resistance and diabetes, which are both considered risk factors for Alzheimer's disease. If you don't enjoy the thought of working out, consider this: A recent study found that a certain physical activity – dancing – was especially valuable for preventing Alzheimer's. Whether it's salsa, rock and roll, hip-hop, folk or line dancing, or a waltz, dancing seems to be good medicine.

A heart-healthy diet may protect the brain As reported in the newspaper of the American Medical Association, a healthy diet may turn out to be a strong defense against Alzheimer's. A four-year study of 815 Chicago seniors published in the Archives of Neurology found that a diet high in artery-clogging saturated fat doubled the risk of the disease. (A diet high in trans fats was also linked to a strong increased risk.) At the same time, a diet high in unsaturated vegetable fats – such as those found in vegetable oils – lowered the risk.

In fact, the eating pattern known as the Mediterranean diet – which is rich in fish, fruits, vegetables, nuts, whole grains and healthy fats such as olive oil – has been found to reduce Alzheimer's risk by 40 to 60 percent, according to a recent Johns Hopkins report.

Fish, a rich source of healthy omega-3 fatty acids, may turn out to be particularly effective for lowering the risk of developing Alzheimer's. Researchers found that those who ate one serving or more of fish each week had a 60 percent lower risk of developing Alzheimer's than those who seldom or never ate fish. Fried fish, however, doesn't seem to confer the same benefits.

Your own kitchen may supply other sources of food Rx. Some studies suggest that plant chemicals, such as quercetin in apples (mostly the peels), red onions, beta-carotene (found in carrots, sweet potatoes, and many other vegetables), and polyphenols (found in red wine), may protect against dementia.

Curcumin – the plant from which turmeric is made – has strong antioxidant and anti-inflammatory properties, and it has been found in mouse studies to reduce the accumulation in the brain of the protein beta amyloid plaques, a hallmark of Alzheimer's. Research involving curcumin and Alzheimer's patients is ongoing.

The high blood pressure connection In some people, having high blood pressure may also set the stage for memory loss. According to a study from the National Institute on Aging, people in their mid-50s and older with high blood pressure scored lower on memory tests than people with normal pressure. Other studies, however, have found no association between high blood pressure and cognitive decline.

The possible connection between Alzheimer's and vascular disease, however, intrigues researchers. According to the Progress Report on Alzheimer's Disease, issued by the Alzheimer's Disease Education and Referral Center, "Cerebrovascular disease is the second most common cause of dementia and there is some evidence that brain infarctions (strokes) and AD may possibly be linked. Although major strokes have obvious consequences, small ones may go undetected clinically."

According to the report, another lifestyle factor that may turn out to influence

"It's definitely a good idea to keep blood pressure under control if you already have memory problems, because poorly controlled hypertension can lead to multi-infarct dementia and therefore worsening memory," says Dr. Michael Potter, an associate professor and attending physician at the University of California at San Francisco Medical Center. "This may be especially important in people who already have poor memory due to Alzheimer's."

Mental activity thought protective According to some researchers, activities that stimulate the mind just might help ward off dementia. In a five-year study of 469 seniors published in the New England Journal of Medicine, researchers found that playing board games, reading, and playing a musical instrument were all linked to a lower risk of dementia.

French researchers have found that knitting, gardening, doing odd jobs, and traveling all help keep the mind sharp and reduce the chances of all types of dementia. Other studies suggest that higher education and a mentally challenging job may also protect against the disease.

Researchers believe that mind-stimulating activities help to create a rich network of connections between brain cells. If some of these connections break down, the theory goes, others will take over.

Of course, the research on mental activity and Alzheimer's prevention is not conclusive. The association may simply boil down to this: Older people may be more likely to play chess or engage in mentally challenging jobs because they don't have Alzheimer's, whereas those who've unknowingly experienced early, insidious changes in the brain caused by Alzheimer's may withdraw from those activities at an earlier age.

But whether or not these lifestyle changes prevent dementia, they'll help keep you healthy in other ways. So eat well, stay active, and keep your mind busy. It's more than just a promising way to avoid Alzheimer's. It's a good way to live.

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So the broader question of how all this specialist care is affecting older Americans’ quality of life is a complicated one, according to Barnett.

Primary vs. Specialist Care What is clear, he said, is that the American health care system is “very specialist-oriented.”

Back in 1980, Americans aged 65 and older mostly saw primary care providers.

About 62% of their medical appointments were with a primary care doctor, while 38% were with specialists, according to Barnett’s team.

But by 2013, those figures had flipped.

That makes the United States different from many other developed health systems in the world, which put more emphasis on primary care. And, the Harvard researchers said, studies suggest those systems provide better care at lower costs.

Almost 1 in 3 U.S. Seniors Now Sees at Least Five Doctors Per Year

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early one-third of older U.S. adults visit at least five different doctors each year — reflecting the growing role of specialists in Americans’ health care, a new study finds.

Over the past 20 years, Americans on Medicare have been increasingly seeing specialists, researchers found, with almost no change in visits with their primary care doctor.

On average, beneficiaries saw a 34% increase in the number of specialists they visited each year. And the proportion of patients seeing five or more doctors rose from about 18% in 2000, to 30% in 2019.

Is the Trend Good or Bad?

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Is the trend good or bad? “It’s probably both,” said Dr. Michael Barnett, the lead researcher.

On one hand, he noted, medicine has grown by leaps and bounds in recent decades — yielding a deeper knowledge of various health conditions and more options for diagnosing and treating them.

“There are a lot more things that a specialist can do now, and that’s good,” said Barnett, a primary care doctor and an assistant professor at the Harvard T.H. Chan School of Public Health in Boston.

However, managing all of those medical appointments, various prescriptions and information from different providers can be “maddening,” Barnett pointed out.

“If nothing else,” he said, “transportation to those appointments is a big issue for older adults.”

The new findings — published Nov. 1, 2021 in the Annals of Internal Medicine — are based on claims data from Americans on Medicare between 2000 and 2019.

Over time, the average beneficiary saw more specialists and had more visits to specialists, the investigators found. But there was no real change in their number of annual visits to primary care providers.

By 2019, Medicare recipients saw two specialists, on average. But many saw more: That included the 30% of beneficiaries who saw five or more doctors.

Alice Bonner is a geriatric nurse practitioner and senior advisor to the nonprofit Institute for Healthcare Improvement.

She agreed that the trend toward more — and pricier — specialist care is neither good nor bad, but more complex than that.

Specialist care also adds complexity to the job of primary care providers, who are supposed to be coordinating it all, Barnett pointed out. In the current system, that may or may not be happening smoothly.

“It could be that it’s helping people, or it could be that it’s wasteful,” Bonner said. “It’s so dependent on the individual situation.”

One question, she noted, is whether older adults are becoming “more assertive” in asking to see specialists.

Visits to a busy primary care provider can be brief, Bonner pointed out.

“If people are not having their concerns addressed,” she said, “they may seek care elsewhere.”

Like Barnett, she said that seeing multiple doctors can add a layer of complexity that burdens older adults — from transportation to managing medications.

“It’s not uncommon for patients to be on nine or more medications,” Bonner noted.

Living Better, Not Just Longer Ideally, health care should be helping older adults live not only longer but better, and understanding “what matters” to any one patient is key, according to Bonner.

“Most older people tell us they don’t want their lives overmedicalized,” she said.

“If they’re busy traveling from doctor to

Since doctors are mainly paid per service they provide during an office visit, any time spent coordinating patients’ care is uncompensated.

That system, the researchers said, is a “disincentive.” doctor, they may have less time for doing what matters to them.”

Barnett made a similar point, saying primary care doctors should “help patients do what matters most to them.”

In some cases, Barnett said, that might mean “pulling back” on some specialist care — though, he noted, the general culture of the health care system is to add care rather than take away. So patients may need to ask.

More information The U.S. Department of Health and Human Services has advice on choosing health care providers.

SOURCES: Michael Barnett, MD, assistant professor, health policy and management, Harvard T.H. Chan School of Public Health, Boston; Alice Bonner, PhD, RN, senior advisor, Institute for Healthcare Improvement, Boston, and adjunct faculty, Johns Hopkins School of Nursing, Baltimore; Annals of Internal Medicine, Nov. 1, 2021, online

“It’s always reasonable for patients to ask their primary care doctor whether any care they’re receiving is still necessary and needs to continue,” Barnett said.

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vessel disease by 46%, and cancer by 28%, the researchers found.

The findings were published online Feb. 28 in the British Journal of Sports Medicine.

An Hour of Weight Training Per Week Can Extend Your Life

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dding regular strength training to your exercise routine may not only make you stronger, but let you live longer, too, researchers in Japan report.

Their new study says 30 to 60 minutes a week of muscle strengthening may reduce your risk of dying early from any cause, and from heart and blood vessel disease, diabetes or cancer by up to 20%.

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“Doing muscle-strengthening activities has a health benefit independent of aerobic activities,” said lead researcher Haruki Momma, a lecturer in medicine and science in sports and exercise at Tohoku University Graduate School of Medicine in Sendai. Strengthening exercises include lifting weights, using resistance bands and doing pushups, sit-ups and squats. It can also include heavy gardening, such as digging and shoveling, researchers said.

“Although several physical activity guidelines recommend that adults perform muscle-strengthening activities based on musculoskeletal health benefits, our findings support this recommendation in terms of preventing premature death and major chronic diseases,” Momma said.

“Also, our findings suggest that optimal doses of muscle-strengthening activities for the prevention of all-cause death, cardiovascular and cancer may exist.”

For the study, Momma and his colleagues pooled data from 16 published studies.

The studies, which included both men and women, ranged in size from nearly 4,000 participants to almost 480,000. The analysis found that muscle strengthening was linked with a 10% to 17% lower risk of premature death from any cause, as well as from heart and blood vessel disease, stroke, diabetes, lung cancer and cancer as a whole. They found no link between muscle strengthening and any reduced risk of colon, kidney, bladder or pancreatic cancer.

The greatest benefit was seen when strength training was done up to an hour a week. But more wasn’t necessarily better. After 60 minutes of strengthening exercise in a week, no further benefit in preventing premature death was seen.

Even better than strength training alone was combining it with aerobic exercise.

(Aerobic exercises include swimming, cycling, walking and rowing.) The combination reduced the risk of dying prematurely from any cause by 40%; heart and blood

Dr. Russell Camhi, a sports medicine specialist at Northwell Health in Great Neck, N.Y., reviewed the new study.

“There’s good evidence that people should be incorporating strength training as part of their workout regimen,” Camhi said. For men, strength training increases testosterone. For both men and women, it helps keep bone density up and decreases the risk of falls and fractures, he said.

“Strength training has also been shown to help with mental health and mood,” Camhi said. “There’s a lot of benefit that comes from the muscular system being activated.”

Camhi recommends starting with weight-bearing exercise and gradually working up to using weights or other equipment. Weight-bearing exercises include walking, dancing and stair-climbing. “Start with simple weight-bearing exercise, and then start adding in small weights as tolerated,” Camhi advised.

“You don’t want to go into strength training too quickly, because that can lead to some overuse and sometimes injury if not done correctly,” he added.

Camhi noted that videos and other instructional materials are easy to find online, and classes and personal trainers can also get you going. It’s never too late to start a strength-training regimen, he said. “There’s always benefits that can be gained. We cannot always undo all the loss from chronic disease, but there’s always benefit that can be gained from exercise,” Camhi said.

More information For more on the benefits of exercise, see the U.S. Centers for Disease Control and Prevention.

SOURCES: Haruki Momma, PhD, lecturer, Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan; Russell Camhi, DO, sports medicine specialist, Northwell Health, Great Neck, N.Y.; British Journal of Sports Medicine, Feb. 28, 2022, online

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Making a Home for Memory Support Residents

By Jean Albaugh, RN Director of Nursing Bethesda Meadow At Bethesda, our primary goal is for our residents to feel comfortable living in their home with us, and that’s especially true for our Memory Support residents. We encourage them to be active and do things they like.

There are participatory cooking demonstrations, daily group music therapy, and exercise and painting classes. Each family completes a “My Life Story,” which gives the staff insights about the resident for enjoyable conversations.

In addition, families and others bring dogs for pet therapy. We have Holiday parties where family members are invited to join in, held on covered outdoor patios when weather permits. And although

most Covid restrictions have been lifted and activities are getting back to normal, safety and comfort remain our top concerns, and as medical providers, we follow very specific guidelines.

We get to know our Memory Support residents very well, and when we notice any changes, we perform assessments and revise their care plans as needed. Routine is important, and the same staff are assigned to care for a resident whenever possible. If there is someone you know who may need Memory Support, we would love to help. Please call for more information.

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affect the sex lives of older men and women, Miller said.

“For women, vaginal dryness is a big issue.

With men, it’s erectile dysfunction,” Miller said.

Sex in the Senior Years: Why It’s Key to Overall Health

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ovemaking isn’t just for the young — older people gain a lot of satisfaction from amorous relations as well.

But things get complicated as people age, and many folks let this important part of life drift away rather than talk about sexual problems with either their partner or their doctor.

“Not many people talk about sex with their doctors, especially as we age,” said Alexis Bender, an assistant professor of geriatrics with the Emory University School of Medicine, in Atlanta. “So many people do report sexual dysfunction on surveys, but they don’t when they’re talking to their doctors. And so it’s important to have those conversations with primary care physicians.”

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It’s worth discussing. A healthy sex life brings many benefits to seniors, experts say.

Sex has been linked to heart health, as well as overall mental and physical health.

“It’s definitely an association, and it’s positive,” Bender said.

For example, lots of beneficial biochemicals are released by the body during sex,

said medical correspondent Dr. Robin Miller. These include DHEA, a hormone that helps with cognitive function, and oxytocin, another hormone that plays a role in social bonding, affection and intimacy.

“Having sex is a really important part of overall health and happiness, and people that have it, they live longer,” said Miller, a practicing physician with Triune Integrative Medicine in Medford, Ore. Sex can actually get better as you get older, Miller added. “For instance, for men, they can control their ejaculation better as they get older,” Miller said. “Women aren’t worried about pregnancy once they go through menopause, so they’re freer.”

Unfortunately, aging does complicate matters a bit when it comes to sex, Bender noted. “For both men and women, we see changes in physical health such as diabetes or cardiac conditions that might limit desire or ability to have sex,” Bender said. “Activity decreases with age, but interest and desire does not, for both men and women.” The changes wrought by menopause and andropause (Aging-related hormone changes in men) also can

Luckily, modern medicine has made advances that can help with these problems.

Hormone replacement therapy can help women with the physical symptoms of menopause that interfere with sex, Miller said, and men have Viagra and other erectile dysfunction drugs. Women can take Viagra as well, “but women don’t like the side effects. Men don’t really like them, either, but they’re willing to put up with them,” Miller said.

So help is out there, but seniors will have to get over their hang-ups and talk to their doctor to take advantage of these options, the experts said. “Sex and sexuality are taboo in our society,” Bender said. Miller said, “I think it’s generational. Some Baby Boomers have a hard time talking about sex. My kids don’t have any trouble talking about it. I bet yours don’t either.”

Women also face practical problems when it comes to finding a sex partner, particularly if they’re looking for a man, Bender said. Women outlive men, so the dating pool shrinks as time goes on, and men tend to choose younger partners.

Through her research, Miller was surprised to learn that many women just give up on the search. “Even though I think it’s important to have a healthy sex life and healthy partnership, a lot of women don’t want to reengage in partnership as they get older,” Miller said. “They’ve been married. They’ve taken care of people for a very long time. They’ve taken care of their husbands and their children. And they just say, I don’t want that anymore. I’m happy to sit and hold hands with someone, but I don’t want to get into a relationship again. And so that kind of challenged some of my generational thinking about what relationships mean over time.”

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In a trial of more than 21,000 men and women, the study authors reported that cocoa had no benefit on thinking skills but taking a multivitamin every day did improve cognition among the 2,000 participants. All were aged 65 and older.

"Our results are promising as they point to a potentially highly accessible, safe and inexpensive intervention that may provide a layer of protection against thinking declines in older adults. But more work is needed before widespread recommendations about regular use can be made," said lead researcher Laura

For a confidential, no obligation discussion about needs for you or a loved one, call or email today.

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Multivitamins Linked to Healthier Brains in Old Age daily multivitamin might help keep your brain free from any decline in thinking skills, a new study suggests.

Maria Miskovic MSW, LCSW, C-ASWCM

Baker. She is a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, N.C. Baker's team found that taking a multivitamin over the course of three years reduced thinking declines by about 60%.

The benefits were greater among people with heart disease, which is important because they are already at risk for thinking declines, the researchers noted.

Cocoa's effect on brain power was a main focus of the study, but it flopped. On the other hand, the multivitamin was associated with better cognition. It's not clear why a multivitamin might have this effect, Baker said.

Other studies assessing the value of taking a multivitamin have

found no benefit. But Baker added that most of these studies were done among men and women who are professionals and more likely to have healthy diets.

Maria Carrillo, chief science officer for the Alzheimer's Association, said that although the results are encouraging, the association is not recommending the use of a multivitamin to reduce the risk of thinking declines in older adults.

"Before any recommendation, independent confirmatory studies are needed in larger, more diverse study populations. It is critical that future treatments and preventions are effective in all populations," Carrillo said.

If these findings can be confirmed, Carrillo said, it has the potential to "significantly impact public health — improving brain health, lowering health care costs and reducing caregiver burden — especially among older adults. People should talk with their health care provider about the benefits and risks of ... multivitamins."

The report was published online Sept. 14 in the journal Alzheimer's & Dementia.

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High-Tech Socks Could Prevent Falls in At-Risk Patients

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very year, anywhere from 700,000 to 1 million people fall while in U.S. hospitals, and this often triggers a downward health spiral.

Little has been shown to make a dent in those numbers. Until now.

Enter Smart Socks, which are wired with sensors that send an alert when a patient tries to get up from a hospital bed and puts pressure on the socks.

In a 13-month study, nobody who wore the socks fell, which equaled a rate of 0 falls per 1,000 patient-days. Patient-days refers to the number of falls and the number of occupied bed days on a hospital unit over a study period. Historically, this rate is 4 falls per 1,000 patient-days.

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"While further study is needed, I do believe there is an opportunity for these socks to be used in inpatient hospital settings, nursing homes and rehab facilities," said study author Tammy Moore. She's the associate chief nurse at Ohio State's Neurological Institute and Medical Surgical in Columbus.

The study was funded by Palarum's PUP (Patient is Up) Smart Socks, but Moore and colleagues have no financial ties to the company.

For the study, 569 people who were at high risk for falling in the hospital wore the socks. No other fall prevention systems, such as chair or bed alarms, were used. There were 5,010 alarms sounded by the socks during the study period, and 11 of these were considered false alarms,

indicating that 99.8% of the alarms correctly alerted nurses when a person attempted to stand.

When the socks detect an attempt to stand up, the system alerts the three nurses closest to the alarm via wearable smart badges. If no one responds within one minute, the call goes out to the next three closest nurses. If no one responds within 90 seconds, the system alerts everyone with a smart badge.

Nurse response times ranged from one second to nearly 10 minutes, with an average of 24 seconds, the study showed.

There wasn't any information on nurse response times for bed and chair pressure sensors available for comparison.

Now, researchers plan to test the sock system in a variety of units at the hospital, Moore said. "We believe that there is efficacy of the product, but it needs to be tested in a variety of settings and [on] more patients," she explained.

The study was published online recently in the Journal of Nursing Care Quality.

As the co-chair of the Falls Oversight Committee at Rush University Medical

frailty, so that when patients go home they are weaker and more likely to fall at home."

Center in Chicago, Megan Dunning is always looking for innovative ways to prevent her patients from falling.

"I think there is a role for the socks in fall prevention in an inpatient setting," said Dunning, who reviewed the new study. "The evidence in the article makes a pretty big statement, since the unit had 0 falls during the pilot period, [and it] also seems promising that the nurse response times were quick, as nurses knew that the chance this was a false positive was low," Dunning said.

Cost may be a factor for hospitals who are considering implementing this type of system, she noted.

One of the only things that has been found to decrease falls is walking around, she added. "Mobilizing patients while they are in the hospital, to prevent deconditioning and complications, can be very

Still, the research "addresses a huge problem since injurious falls in the hospital are very common and not only hurt, but literally kill, patients every year," said Sarkisian.

It's too early to draw any conclusions about what role these socks may play in preventing falls in the hospital, said Sarkisian. effective in reducing falls," Dunning said.

Dr. Catherine Sarkisian, a geriatrician and professor at the University of California, Los Angeles, agreed that getting people up and walking is really important.

Unfortunately, these socks would force people to stay in bed.

"Staying in bed is a very strong driver of new disability for older adults who are hospitalized," she said. "Even if the Smart Socks actually prevented falls in the hospital, it might cause more disability and

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"The one intervention that has been shown to work is for patients with known low vitamin D levels: that is to replete the vitamin D in those patients and that does decrease falls," Sarkisian said.

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For Families Dealing with Alzheimer’s Disease Drug therapy or social therapy for disturbing behaviors?

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he slow mental decline wrought

by Alzheimer's may be hard to witness, but it's the disturbing behaviors -wandering, paranoia, violent outbursts, and so on -- that often put family members over the edge. Anything that will control these behaviors can go a long way toward helping a patient stay at home for as long as possible. For this reason, more doctors are looking beyond Alzheimer's medications for treatment options.

Drug therapy In cases of persistent and highly disturbing behaviors, doctors sometimes prescribe sleeping pills, antianxiety medication, and even antipsychotic drugs such as Zyprexa (olanzapine) and Risperdal (risperidone). Although the last two drugs have FDA approval only for schizophrenia and other psychiatric disorders, there is some evidence that they may reduce aggression in people with Alzheimer's.

However, these drugs should not be prescribed lightly. Doctors should only consider prescribing the drugs when a person's behaviors are causing serious distress, other approaches have been tried, and no underlying medical or environment cause can be found, according to a Johns Hopkins White Paper.

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Even as a last resort, any patients taking the drugs still need to be closely monitored by doctors and family members alike. Studies have long shown that the negative side effects of antipsychotic drugs for Alzheimer's patients -- like sedation, confusion, weight gain, mini-strokes, and sudden death -- may outweigh the benefits. And now data also show that Alzheimer's patients prescribed antipsy-

"Taken together, these studies introduce the exciting notion that older people in the early stages of Alzheimer's can be taught techniques that help them stay engaged in everyday life," said Neil Buckholtz, PhD, then head of the Dementia's of Aging Branch of the NIA, at the time.

These findings suggest it's possible to pinpoint the memory capabilities that are preserved in early Alzheimer's, "and make the most of them," said Buckholtz, who now works at the Global Alzheimer's Platform Foundation.

Reality Orientation and Patients’ Environment

chotic drugs do not live as long as those who do not take these medications.

Early-stage Alzheimer's Patients Are Capable of Learning According to two recent studies supported by the National Institute on Aging, people who have early-stage Alzheimer's disease have far more capacity to learn new things than previously thought.

Researchers in Miami, Florida found that mildly impaired Alzheimer's patients who took three to four months of "cognitive rehabilitation" classes had a 170 percent improvement in their ability to recall faces and names, along with a 71 percent improvement in their skill at giving the proper change for a purchase. The findings were published in the American Journal of Geriatric Psychiatry.

This report followed on the heels of an earlier study from Washington University in St. Louis, which found that older people in the early stages of Alzheimer's retained working levels of "implicit memory" similar to those in young and older adults who were free of Alzheimer's.

Implicit memory, researchers noted, is largely automatic and unconscious, surfacing in skills such as speaking a language and riding a bicycle.

One way to make the most of these capabilities may be reality orientation therapy, which focuses on helping patients relearn new information such as dates, times of day, and location. One meta-analysis of six controlled trials found that classroom reality orientation produced modest cognitive gains in 125 Alzheimer's patients, and improved behavior in 48 -- benefits that in one study persisted a month after participants stopped attending the sessions.

Many Alzheimer's behaviors can be controlled by keeping patients' environment as calm, nonthreatening, and familiar as possible. Many families and caregivers can adapt the techniques used by researchers by hanging a blackboard or bulletin board where the patient can read it, and posting the day of the week, date, weather, season, and name and time of the person's next meal. (Books on caregiving show that, in fact, some families have long used similar techniques to help their loved ones.) Keeping a large clock, calendar, and schedule can also help people with Alzheimer's keep current; some may even review the calendar daily to remind themselves what happened the day or week before.

These techniques should be adapted to the individual, however, and in no cases should someone be "forced" into the present if he or she becomes disturbed or agitated. In addition, if the patient regularly mentions recent visits by a sister that died years ago, the latest thinking is that caregivers should simply acknowledge how much she loves her sister. Reality orientation is only valuable when it benefits the patient: Forcing someone to continually relive a painful loss would be cruel rather than helpful.

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B O O K

R E V I E W

Aging and Health for the US Elderly: A Health Primer for Ages 60 to 90

S

by Dr. Harold Kennedy

eniors today find themselves living in a time when rapid changes in health care delivery have made vital decisions about when and how best to obtain medical treatment difficult and confusing to navigate. At the same time, seniors proportionately need more health care services, have a higher incidence of chronic disease, and take more medications than any other demographic—and yet have the lowest rate of health literacy.

In this short, easy-toread book designed as a concise but effective healthcare guide, Dr. Harold Kennedy, with more than 60 years of experience practicing medicine, guides readers through the healthcare maze faced by many seniors. While the information in this book is not intended to diagnose or treat ailments, it will give readers a valuable foundation of health literacy, crucial in making good decisions regarding their

Healthy Humor

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health and medical care services, and that of their loved ones.

Written expressly to help persons aged 60 years and older, Aging and Health for the US Elderly: A Health Primer for Ages 60 to 90 is essential reading for all older Americans. Chapter topics include health risk factors; social determinants of disease; best practices; and up-to-date prevention, surveillance, and wellness, with special chapters tailored specifically for women and for men. Coverage also includes an overview of the U.S. health care system, both its history and the current state of affairs. Scientific validity of the evidence is provided by more than 180 references.

Harold L. Kennedy MD MPH FACC FESC is a cardiologist in Clayton, Missouri. He is Director at The Cardiovascular Research Foundation. Dr. Kennedy received his medical degree from University of Missouri-Columbia School of Medicine and master’s in public health in Epidemiology from Johns Hopkins University.

The book is available at www.amazon.com and www.barnesandnoble.com.

F E A T U R E D

P R A C T I C E

Your Oral Health Affects Your Overall Health (and vice-versa) You may be surprised to learn how closely good oral health is tied to maintaining whole-person health – especially for people with certain chronic medical conditions. Here are some examples:

severe gum disease. Blood thinners and aspirin can affect clotting times and cause complications from dental surgery.

And it works the other way: The bacteria that cause periodontitis and gingivitis can travel through the bloodstream, causing inflammation and damage to blood vessels in the heart and brain, potentially contributing to heart attack or stroke, and also rheumatoid arthritis.

Regular preventive dental care can help mitigate the oral side effects of medical conditions, so it’s important for patients to brush and floss daily, keep their dentists informed of their health status, and schedule regular checkups.

Diabetes that is not well-controlled can lead to periodontal disease – an infection of the gum and bone that hold the teeth in place, which can cause pain, bad breath, and tooth loss. Diabetes also increases the level of sugar in saliva, which can lead to thrush – a fungal infection that causes painful white patches in the mouth.

Many cancers and their treatments weaken the body’s immune system, leading to oral infections, especially with unhealthy gums. Radiation therapy for cancer can cause reduced saliva flow, which in turn can cause rampant decay.

Kidney disease that weakens the immune system can make patients more susceptible to infections caused by

Improving oral health, including routine preventive dental care, can also reduce overall health care costs. A recent study

by Cigna Health found that those who receive consistent preventive dental care reduce their total medical costs by 4.4% per year on average. For those with diabetes, savings was even higher – an average of 12.25% per year.

A Knowledgeable and Attentive Dentist is Important This is why it is important for our office to have a medical history for each patient, as well as knowing what prescriptions patients are taking, because there are also many interactions of drugs that can affect dental care.

If you have dental problems, it may be worthwhile to re-explore your dental treatment or management options.

At Westport Dental we take pride in understanding each patient’s relevant health status and current treatments and medications, to optimize their oral health and make sure that our care contributes positively to their overall health.

Call to schedule an appointment with Dr. Birk

(314) 434-7300

77 Westport Plaza Dr. #251 Maryland Heights, MO 63146

Dr. Adam Birk is owner of Westport Dental. Dr. Birk employs many advanced technologies to enable more accurate, safe, longlasting, and aesthetically pleasing dental solutions, while assuring patient comfort. He is a graduate of Southern Illinois University Edwardsville and Southern Illinois University School of Dental Medicine.

Dr. Birk is a current member of the Academy of General Dentistry, American Academy of Implant Dentistry, Greater St. Louis Dental Society, Missouri Dental Association and American Dental Association.

He has attended multiple continuing education courses including the yearlong AAID Las Vegas Maxicourse that focused on implant placement and restoration.

To schedule an appointment with Dr. Birk, you can call our office, scan the QR code below or visit our website www.westportdentalstl.com All County Health guidelines are observed to protect patients and staff.