Health Watch - 2018 Edition

lifestyle, fitness & nutrition

FALL 2018

CHOOSE HEALTH!

LIFESTYLE CHANGES CAN BOOST LONGEVITY

TAKE A WALK THERE ARE MORE BENEFITS THAN YOU THINK

UNDERSTANDING INFLAMMATION

LOVING LIFE AT 65+

6 AMAZING PEOPLE SHARE THEIR INSIGHTS 1 i m a g e t re n d wa t c h • 2013

$4.95

FALL 2018

image/health watch

healthwatch IMAGE MAGAZINE’S

CONTENTS FEATURES

DEPARTMENTS

16 AROMATHERAPY

8 Editor’s Note

47 Healthy Solutions

10 Word on Health

Sleep disordered breathing.

by Donald J. Neely, DMD, MSD

From mysticism and magic to moods and medicine.

By E. Senteio

24 TYPE 2 DIABETES A staggering burden.

by Elaine Ambrose

36 WHAT IS CHRONIC

INFLAMMATION?

Tackling a modern health problem.

by Nancy Fontaine

52 READY. SET. GO MEATLESS Becoming a vegetarian.

by E. Senteio

65 LIVING THE GOOD LIFE With age comes insight.

by Sara Tucker

76 THE BENEFITS OF WALKING OVER 50

It’s never too late to start.

by Anne Richter Arnold

86 SUSPECT IT’S LYME DISEASE? Persistence is key.

by Katherine P. Cox

It is health that is real wealth and not pieces of gold and silver.

—Mahatma Gandhi

6 i m a g e h e a l t h wa t c h • 2018

News, tips, and information for your well-being.

22 Living Well Powerhouse Hearing Center.

by Mike Morin

32 Innovations A courageous advocate for simplifying health care.

by Mark Aiken

43 Tech Smart

50 Financial Well-Being Too busy building wealth to manage it?

by Mike Morin

59 To Your Health Mix up a healthy lifestyle.

60 Achieving Balance Open Door Integrative Wellness.

by Susan Nye

What do solutions for hearing loss sound like?

by Mike Morin

63 Healthy Habits

45 Everyday Health

8 reasons to meditate.

by E. Senteio

5 stellar superfoods.

Benefits of yoga.

83 Body & Mind

94 Financial Health Be prepared for the future.

by Mike Morin

e d ito r ’s note | BY DEBORAH THOMPSON

health watch IMAGE MAGAZINE’S

FALL 2018

lifestyle, fitness & nutrition

Be Your Best

Mountain View Publishing, LLC

he staff and I are delighted to present our

135 Lyme Road Hanover, NH 03755 (603) 643-1830

second annual issue of Health Watch, a

www.uppervalleyimage.com

T

magazine designed to bring you the latest infor-

P HOTO BY I A N R AYM O N D

mation for living a healthy lifestyle. Health care professionals from all over the Upper Valley are sharing their years of experience, knowledge, and expertise with us in our quest to be our best on the way to living long, healthy lives.

We’re especially happy to bring you an engaging feature spotlighting six remarkable seniors who live locally (page 65). When you read their comments, you’ll detect a theme: All of them are resilient, they have positive attitudes, they’ve overcome obstacles, they have many interests and are lifelong learners, and they exercise regularly and remain active. We’ve been inspired by them, and we think you will be too.

In other articles, we’re exploring type 2 diabetes (page 24), inflammation (page 36), and Lyme disease (86). We’re grateful to Kristiana Ploss of Woodstock for sharing with us the story of her long, harrowing ordeal with Lyme disease.

Publishers

Bob Frisch Cheryl Frisch Executive Editor

Deborah Thompson Associate Editor

Kristy Erickson Copy Editor

Elaine Ambrose Creative Director/Design

Ellen Klempner-Béguin Advertising Design

Hutchens Media, LLC Web Design

Locable

Inbound Marketing Manager

Erin Frisch

Advertising

Bob Frisch

Tiny ticks can cause serious illnesses, so you’ll want to follow the precautions outlined to protect yourself and your family. We’re also examining the many benefits of walking (page 76), aromatherapy (page 16), yoga (page 63), meditation (page 83), going vegetarian (page 52), and more.

We hope you’ll put all the information that’s jam-packed into this issue to work in your life as you strive to be healthier and feel better. Here’s to your health! Enjoy! 

Deborah Thompson Executive Editor dthompson@mountainviewpublishing.com

LIKE US www.mountainviewpublishing.com/facebook

8 i m a g e h e a l t h wa t c h • 2018

KEEP US POSTED: Health Watch magazine wants to hear from readers. Correspondence may be addressed to: Letters to the Editor, Health Watch 135 Lyme Road, Hanover, NH 03755. Or email us at: dthompson@mount ainviewpublishing.com. Advertising inquiries may be made by email to rcfrisch1@comcast. net. Health Watch is published annually by Mountain View Publishing, LLC© 2018. All rights reserved. Reproduction in whole or part is strictly prohibited. Health Watch magazine accepts no responsibility for unsolicited manuscripts, artwork, or photographs.

word on health NEWS, TIPS, AND INFORMATION FOR YOUR WELL-BEING

BUNDLE UP OR YOU’LL CATCH A COLD! Turns out Mom was right: Your odds of catching a cold are lower if you stay warm. Warmer body temperatures appear to help prevent the cold virus from spreading. In one study, when infected cells were exposed to healthy core body temperatures, the virus died off more quickly and wasn’t able to replicate as well. Warmer body temps also enhanced the activity of an enzyme that attacks and destroys viruses. Previous research shows that at several degrees below core body temperature, virus-fighting interferons are less able to do their job.

NO MORE YO-YO DIETING Anyone who has tried to lose weight knows it isn’t easy—and that it’s all too common to regain at least some of the weight you’ve lost.

According to a study from Stanford University, learning “forever skills” before starting a new diet can lead to greater long-term success. These include learning how to be more active and eat healthy with correct portion sizes. Study authors also recommend approaching dieting with a more relaxed attitude.

Once these skills are in place, practice mindful eating, eat in moderation, make small changes over time, and reward yourself with nonfood reinforcement. Another key to long-term success?

Eat breakfast. Research shows that 78 percent of people who have lost weight and kept it off for more than a year eat breakfast every day. Skipping the morning meal causes late-day hunger, bingeing, and an increased insulin response, which leads to weight gain.

“Exercise can help with weight loss as well as overall muscle and bone strength. Exercise is also key to cardiovascular health and helps control blood pressure and blood sugar levels.”

—Barbara Quealy, RN, Senior Director, Home Health Services, Visiting Nurse and Hospice for Vermont and New Hampshire

78%

OF PEOPLE WHO HAVE LOST WEIGHT AND KEPT IT OFF FOR MORE THAN A YEAR EAT EAT BREAKFAST BREAKFAST EVERY DAY. DAY.

10 i m a g e h e a l t h w a t c h • 2 0 1 8

BRUSHIN’ AND BALANCIN’

word on health

You’re already a proficient multitasker.

Take your skills to new heights! It’s wellknown that falls are hazardous as we age, and poor balance is a common risk factor for falling. If your balance could use a “brush up,” try standing on one foot while you brush your teeth. The trick is to focus on something on the horizon before you lift one leg. Then, as you brush, stand on one leg for a count of 8 or 10. Be near a counter or other surface to lean on if you need to. Then shake out the leg you stood on and switch legs.

When you get better at balancing, try doing 8 forward kicks with each lifted leg, then 8 backward kicks. Remember to keep your focus on the horizon.

An added bonus?

You’re likely to brush longer.

Green Veggies Every Day May Keep Dementia Away A serving of green veggies like spin-

“We know generally that what you

ach, kale, and mustard greens may

eat, or don’t eat, can affect your risk for

slow mental decline. The brain benefi ts

high blood pressure and vascular dis-

of leafy greens stem from several key

ease, which can both worsen the course

nutrients, especially vitamin K. “It makes

of dementia,” she says. Researchers are

sense that leafy green vegetables would

still examining exactly how leafy greens

have an effect on mental health,” says

alter dementia risk. “But while it’s still

Dr. Yvette Sheline, professor of psy-

being worked out, I’d say go to your

chiatry and neurology at the University

local grocery store and pick up some

of Pennsylvania Perelman School of

kale,” says Dr. Sheline. “There’s certainly

Medicine.

no harm done.”

FEELING DIZZY? WHEN TO SEE YOUR DOCTOR Occasional dizziness isn’t a major concern, but if you’re dizzy often or it’s interfering with your daily life, it’s time to see your doctor.

Ear infections, head injuries, certain medications, and low blood pressure are common causes of dizziness. The National Institutes of Health suggests visiting your doctor if: •You often feel dizzy or unsteady.

•You feel like you’re moving when you’re sitting or standing still.

•You feel as if you’re falling, or you lose your balance and fall.

•You feel lightheaded or as if you will faint.

•Your vision becomes blurred.

•You feel disoriented, losing your sense of time, place, or identity.

Vertigo, a more serious condition, makes you feel like the room is spinning as you stand still. It affects nearly 40 percent of people over age 40 at some point in their life. Unlike a brief dizzy spell that makes you feel momentarily unbalanced, vertigo is often prolonged and causes nausea and vomiting. It can be totally debilitating.

If you’re concerned about dizziness or suspect you have vertigo, make an appointment with your doctor.

12 i m a g e h e a l t h w a t c h • 2 0 1 8

“When we move our bodies, we are stimulating receptors in the joints, muscles, and tendons that send signals back to our brains. This bombardment of input lights up neural activity and stimulates our brains. Of course, exercising to keep strength and flexibility is important too.”

—Dr. Randy Schaetzke, DC, DIBAK

word on health How Much Protein Do You Need?

Adult women need about

46 a day

grams

Adult men need about

56 a day

grams

“WHEY” TO GO Older people might consider taking a tip from bodybuilders and incorporating whey protein into their diets. Sarcopenia, like osteoporosis, is an age-related decline, only instead of bone mass, it’s muscle mass that we lose as we age, and that can lead to physical disability and other health problems. By the time a person reaches 80, her muscle mass is a little more than half what it was in her twenties.

Researchers at McMaster University found that drinking a whey-based shake could increase strength in a group of men over 70. Resistance exercise training combined with nutritional supplements such as whey protein were shown to counter loss of muscle mass and increase strength. The recommended dietary allowance (RDA) for adults for protein is 0.8 grams of protein per kilogram of body weight (see chart), but adequate intake can be diffi cult for older adults to achieve.

A typical whey protein shake contains between 12 and 17 grams of protein. Taking whey protein and doing weight-bearing exercises can help preserve muscle mass and even help rebuild muscle.

Don’t use whey protein if you have a dairy allergy. Typically sold in powdered form, whey protein can be added to liquids or soft foods such as applesauce or blended with ice and fresh fruit to make a smoothie.

14 i m a g e h e a l t h w a t c h • 2 0 1 8

For a more specific calculation, weigh yourself at the beginning of the day, and average your numbers over a few days. Convert the weight from pounds to kilograms. There are 2.2 pounds per 1 kg, so if you weigh 150, divide 150 by 2.2 to get 68 kg. Then multiply 68 by 0.8 (number of grams of pro-

Benefits of Aromatherapy “Aromatherapy and the use of essential oils have many psychological and physiological benefits including stress relief, increased energy, pain relief, improved mood, better sleep, and increased immune function.”

—Becca Gosselin, Activity Therapy Module Educator, Mountain Valley Treatment Center

tein needed per kg) to arrive at 54.

COURTING RESILIENCE We’ve all heard the old saw “aging is not for sissies,” and a generation of baby boomers is becoming all too familiar with its validity. Resilience is being able to “bounce back” from life’s inevitable misfortunes, illnesses, and other adversities. It’s that quality that allows some people knocked down by life’s misfortunes to come back stronger. Adapting to adversity, whether in our health, our relationships, in the workplace, or fi nancially, is a critical quality for well-being. So, how can we become more resilient?

Dr. Carol Hoare, in her article “Resilience in the Elderly,” published in the fall 2015 issue of the Journal of Aging Life Care, discusses interventions that may help us develop resiliency, including mindfulness meditation. Mindfulness meditation has been shown to improve the ability to cope. It involves practicing skills that help us focus on the moment and may contribute to building tolerance and regulating emotions. Other techniques involve developing coping skills and effective responses to life’s challenges.

According to the Mayo Clinic, resilience training includes emotional, cognitive and mental, physical, and spiritual resilience. Learning to be more resilient can decrease stress and anxiety, and teach us to consider challenges as opportunities. One place to start is The Resilience Workbook: Essential Skills to Recover from Stress, Trauma, and Adversity by Glenn Schiraldi.

AROMATHER A 16 i m a g e h e a l t h w a t c h • 2 0 1 8

BY E. SENTEIO

FROM MYSTICISM AND MAGIC TO MOODS AND MEDICINE

R APY

T

he next time you pass a fragrant bush of honeysuckle or blooming rugosa rose, stop for a minute. What do you feel? What emotion was triggered? Did your heart rate increase or decrease? You can’t turn over a rock these days without seeing the word aromatherapy. From candles and pillow sprays, massages and steam showers to certified holistic practitioners, maybe it’s time to make “scents” of all the hype.

What Is Aromatherapy?

Aromatherapy is the practice of breathing or applying essential oils for therapeutic or beneficial effects on the body or mind, sometimes both. Essential oils come from the distillation of plants (or other substances, such as coffee beans) to capture their aromatic “essence.” Because of their high potency, they must be paired with a carrier oil, like jojoba or almond oil, for topical application.

The origin of essential oil use is as murky as smoke from an incense cone. Plant extracts were used in rituals and as perfumes by ancient Egyptians and Greeks. The Chinese used them for their mood-altering properties, and Hippocrates used them for healing, as did medics treating burns during World War II. Researchers surmise that plant extracts have been in use for at least 6,000 years; however, the term aromatherapy wasn’t coined until 1937

by French chemist René-Maurice Gattefossé.

“Smell is a potent wizard that transports us across thousands of miles and all the years that we have lived.” —Helen Keller www.uppervalleyimage.com •

17

A SAMPLING OF BENEFICIAL ESSENTIAL OILS A full list of essential oils and their potential benefits would be extensive.

Here are several of the most popular oils, each with one of its most common uses. To delve into essential oils and their many uses, consult The Complete Book of Essential Oils & Aromatherapy by Valerie Ann Worwood or check the National Institutes of Health (NIH) website at www.nih.gov.

Bergamot relieves depression Cedarwood reduces stress Chamomile calming Eucalyptus concentration Frankincense helps insomnia

Jasmine eases respiratory discomfort Lavender relaxation Lemon boosts immunity

Peppermint energy-boosting

Sandalwood mental clarity Tea Tree healing Ylang-Ylang may reduce high blood pressure Rosemary mental alertness

Marjoram calms hyperactivity Patchouli relieves fatigue

Rose heart health

To help induce sleep, put 3 or 4 drops of lavender oil on your pillow.

For babies, add 1 drop each of lavender and geranium oil to a carrier oil. Massage gently onto baby’s back or add a few drops to the bedtime bath.

18 i m a g e h e a l t h w a t c h • 2 0 1 8

“The sense of smell has a more intimate link to memories and feelings than any other sense; this may be related to why aromatherapy has the power it does, to help alleviate insomnia and anxiety, reduce pain, and generally improve life for those dealing with chronic health issues.”

HOSPITALS WHAT IS A DIFFUSER? Diffusers are devices that disperse essential oils into the air through a variety of methods.

—Gretchen Stokes, RN, Good Neighbor Health Clinic volunteer

According to the National Cancer Institute, studies suggest that aromatherapy may help improve mood, sleep, nausea, anxiety, and pain in people with cancer.

A LOT = A LITTLE What Does the Science Say? When hair-like cilia in nasal passages are stimulated by scent, they activate receptors that send a signal to the brain. These signals not only head to the olfactory bulb—the area of the brain that processes smells—but also to the limbic system, specifically to the amygdala, responsible in part for emotion and memory, and to the hypothalamus, which regulates blood pressure and heart rate. But it’s not only the nose that knows. Recent studies have found that the body—inside and out, including the skin—has olfactory receptors. Essential oils stimulate both body and mind.

or inhalation have had mixed results.

Some reports showed improvements in mood, anxiety, sleep, nausea, and pain, while others showed no change. In a trial of 103 cancer patients, the group that was massaged with essential oil showed a decrease in anxiety and an improvement in symptoms; the group that received massage only did not.

Tea tree essential oil used as a topical treatment to clear antibiotic-resistant MRSA (bacteria from the skin of hospital patients) was found to be as effective as the standard ointment. However, aromatherapy is still an unregulated and unlicensed field.

Does Aromatherapy Work?

According to the National Center for Biotechnology Information, recent clinical studies of aromatherapy massage

Is Aromatherapy Right for You? You don’t need researchers to tell you that a smell can trigger memories and feelings, good or bad. But can it also

To distill

ONE pound

of rose, lavender, or lemon

essential oil it takes: 10,000 pounds of rose petals

250 pounds of lavender 1,500 lemons

Source: EcoWatch.com

www.uppervalleyimage.com •

19

motivate you, calm you, uplift you, heal you? Sit back, relax, and breathe. Start small. Try an aromatherapy diffuser, or a pure beeswax candle (breathing in paraffin toxins defeats the purpose).

Because of their high concentration, essential oils can be found in bottles as small as one milliliter, and some can be quite expensive. Sample a few scents that appeal to you and that support your well-being goals. Anxious about a speaking engagement? Lemongrass neutralizes anxiety. Trying to drop belly fat? Lavender targets cortisol. Not enough time at home? Try a car-vent clip diffuser with a drop or two of rosewood oil to keep calm and drive on. What you’ll want is quality 100 percent pure essential oil, so research brands before you buy. 

Try a car-vent clip diffuser with a drop or two of rosewood oil to keep calm and drive on.

Usually you need to add only 2 or 3 drops of your favorite essential oil to the pad. You can add more essential oil to the pads if you prefer a stronger scent.

Car Vent Diffuser Clip by FIKA

20 i m a g e h e a l t h w a t c h • 2 0 1 8

USE WITH CARE Never ingest essential oils directly.

Undiluted essential oils can cause a mild to severe rash or worse if applied to the skin. Some oils should not be used prior to sun exposure.

Talk with your doctor or a reputable aromatherapist if you’re interested in topical applications or if you are pregnant. Essential oils may have been around for thousands of years, but if they’re new to you, do your research. With that caveat, when used appropriately, aromatherapy has been found to have little to no negative side effects, and for many people, it enhances a sense of wellbeing.

NOTE: Essential oils should never be ingested by or applied directly to pets!

To prevent respiratory issues, consider your pet’s size when dispensing drops into a diffuser; cats are particularly sensitive.

liv in g we ll | BY MIKE MORIN

Powerhouse Hearing Center HEAR THE DIFFERENCE

“The sooner you take action to contact a hearing specialist, the sooner you put a stop to the many negative effects of hearing loss.”

“I wish I had done this sooner. I couldn’t live without these now!”

Cindy Edmondson hears that frequently from patients. It never gets old. Powerhouse Hearing Center’s expertise in hearing instruments brings relief and joy to new users that Cindy says family and friends notice immediately.

“The clarity, brightness, and depth of sound is great, and I can keep up with conversations. I don’t feel left out anymore,” is another comment Cindy hears often. After a short time, clients forget they’re wearing hearing aids, and many other people aren’t even aware of the devices.

Cindy explains that today’s hearing aids are mini computers programmed to recognize speech versus noise. They work with our brain to train it to process sound and recognize speech using smart technology, and today’s discreet designs are smaller and—in some cases—invisible.

“Depending upon the degree and severity of the loss, most people have some idea as to what they do and do not want when it comes to the look, style, and comfort of a hearing

22 i m a g e h e a l t h w a t c h • 2 0 1 8

instrument,” Cindy says. “As professionals, it is our responsibility to recommend what instrument will give the best speech discrimination and noise control while providing a comfortable, stable fit for the size and shape of each ear canal.” She continues, “It is our job to point out the benefits as well as the limitations or reasons why a certain style might be inappropriate for an individual’s hearing loss and/or lifestyle. Fortunately, today’s hearing instruments are smaller, more comfortable, faster, and more powerful than ever before!”

Her best advice is, “The sooner you take action to contact a hearing specialist, the sooner you put a stop to the many negative effects of hearing loss. When you hear the sounds of life, you experience a fuller and richer quality of life, and that is so much better for you and those around you!” 

Powerhouse Hearing Center 23 PowerHouse Mall 8 Glen Road West Lebanon, NH (603) 298-9775 www.powerhousehearingcenter.com

24 i m a g e h e a l t h w a t c h • 2 0 1 8

BY ELAINE AMBROSE

TYPE 2 DIABETES A STAGGERING BURDEN

DIABETES IS AN EPIDEMIC THAT AFFECTS 30 MILLION AMERICAN CHILDREN AND ADULTS, ACCORDING TO THE AMERICAN DIABETES ASSOCIATION (ADA). AN ADDITIONAL 84 MILLION ARE PREDIABETIC AND AT RISK FOR TYPE 2 DIABETES, WHICH CAN LEAD TO SIGNIFICANT HEALTH PROBLEMS INCLUDING STROKE, BLINDNESS, KIDNEY DISEASE, AND LOSS OF TOES, FEET, OR LEGS. JUST AS STAGGERING ARE ITS ECONOMIC COSTS—$327 BILLION A YEAR AND RISING.

www.uppervalleyimage.com •

25

TIPS FOR MANAGING DIABETES • Diet is key.

• Eat whole grains; they are more filling and beneficial to your overall health.

• When choosing carbohydrates, think good fats—avocado, nuts, olive oil.

• There is a lower chance of a spike in blood sugars if you eat lean meats, chicken or fish, vegetables, eggs, and cheese.

• Invest in a lean or light cooking cookbook or search for these types of recipes on the Internet. Managing your diet is easier when you eat at home.

• Read food ingredients lists on labels. Prepared food often contains added fillers that are high in fat or carbs that can lead to spikes in blood sugar.

—Catherine Cullen, PT, Chief Clinical Officer, Visiting Nurse and Hospice for Vermont and New Hampshire

The Crux of the Problem In type 2 diabetes, as in other types of diabetes mellitus, the body doesn’t make enough insulin, a hormone, or can’t use what it produces effectively, or a combination of these. Normally, the body breaks down sugars and carbohydrates from foods into glucose, the primary source of fuel for our cells, and we need insulin to take in glucose and use it for energy.

Initially, the pancreas produces extra insulin to cover the deficit, but over time, it can’t keep up. Too much glucose stays in the blood, not enough reaches the cells, and the resulting high blood-glucose level can damage tiny blood vessels in the kidneys, eyes, nervous system, or heart, resulting in stroke, cardiovascular disease, kidney disease, vision loss, and nerve damage.

Who’s at Risk?

According to the Centers for Disease Control and Prevention, risks for developing type 2 diabetes include overweight, being 45 years old or older, having a parent or sibling with it, and being physically active fewer than three times a week. Other groups at risk are African Americans, Hispanic Americans, American Indians, and women who’ve had diabetes during pregnancy (gestational diabetes).

Metabolic Syndrome Dr. Richard Comi, diabetologist and endocrinologist affiliated with Dartmouth–Hitchcock Medical Center in Lebanon, New Hampshire, says that type 2 diabetes “appears to be a genetic disorder, but not the classic genetic order we think of as being related to a defective gene.” He describes it as a group of genetic tendencies that lead to weight gain, adding that a large proportion of the population appears to have these tendencies.

“Diets high in saturated fats and sedentary lifestyles result in many people gaining weight in their 30s and 40s,” Dr. Comi says, and the subsequent development of type 2 diabetes in many of them. “Among those with normal weight,” he notes, “only about 20 percent develop type 2 diabetes.”

Metabolic syndrome, a cluster of conditions that often occur together, is another risk factor. Rather than a disease, it’s a constellation of factors that can include hypertension, hyperglycemia, excess fat around the waist, and abnormal cholesterol and triglyceride levels. Having more than one of these increases the risk for type 2 diabetes; having three often leads to a diagnosis. And while very high blood sugar might cause increased thirst and urination, blurred vision, and fatigue, disorders linked to metabolic syndrome can be symptomless.

Prediabetes “Prediabetes is not a disease,” explains Dr. Comi, “but it puts you at high risk for becoming diabetic.” He adds that if you have prediabetes, you might notice “burning or tingling in your feet,” but

26 i m a g e h e a l t h w a t c h • 2 0 1 8

mood

KNOW YOUR BODY MASS INDEX Body mass index (BMI) is a measure-

fat changes with age and differs for

ment of body fat based on height

girls and boys.

and weight. It’s an easy method of

Although BMI appears to be cor-

screening for overweight and obe-

related with a number of metabolic

sity that’s calculated using weight

and disease outcomes, it doesn’t

in pounds or kilograms divided by

predict your health. A quick way

height in inches or meters. BMI is in-

to find your BMI is to use an online

terpreted differently for children and

calculator like the one at the National

teens, taking into account age and

Heart, Lung, and Blood Institute

gender since their amount of body

website at www.nhlbi.nih.gov.

BMI CATEGORIES Underweight = BMI less than 18.5 Normal weight = BMI 18.5–24.9 Overweight = BMI 25–29.9 Obese = BMI 30 or higher

IF YOUR SCORE IS 3 TO 8 POINTS This means your risk is probably low for having prediabetes now. Keep your risk low. If you’re overweight, lose weight.

Be active most days, and don’t use tobacco. Eat low-fat meals with fruits, vegetables, and whole-grain foods. If you have high cholesterol or high blood pressure, talk to your health care provider about your risk for type 2 diabetes.

IF YOUR SCORE IS 9 OR MORE POINTS This means your risk is high for having prediabetes now.

Please make an appoint-ment with your health care provider soon.

National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation

www.uppervalleyimage.com •

27

DIABETIC RETINOPATHY TINY BLOOD VESSELS LEAK FLUID INTO THE RETINA PUPIL

NORMAL EYE

EYE WITH RETINOPATHY

EYE HEALTH “Complications of diabetes are the leading cause of blindness in adults in this country,” says Dr. Eugene Bernal of White River Family Eyecare and Hanover Eyecare. “The most common complication, known as diabetic retinopathy, occurs when the tiny blood vessels in the back of the eye, the retina, are damaged,” he explains, adding that about 40 percent of those with diabetes have some stage of diabetic retinopathy, but only half are aware of it.

For this reason, “all diabetic and prediabetic

not vision problems and other related issues you’re at risk for with type 2 diabetes. A fasting blood-sugar level less than 100 mg/dL is normal; from 100 to 125 mg/dL is considered prediabetes, and if it’s 126 mg/dL or higher on two separate tests, diabetes is indicated.

Also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), prediabetes also increases your risk for cardiovascular disease, and without obvious symptoms, it’s possible to have it without knowing it.

According to the ADA, that’s the case for 1 in 10 Americans.

level below 7 percent; ask your doctor what your A1C target is.

When it comes to diet, “Carbs and calories count,” says Dr. Comi. “In America, we eat a lot of carbs,” he adds, “so restricting calories usually means cutting carbs.” If you receive a prediabetes diagnosis, “losing weight cuts your risk for developing type 2 diabetes in half over 10 years. Prediabetes serves as a warning; you want to delay a diabetes diagnosis for your lifespan or for as many years as possible,” he explains.

Whether you choose to follow a Mediterranean-style diet, a

If you receive a prediabetes diagnosis, “losing weight cuts your risk for developing type 2 diabetes in half over 10 years.”

—Dr. Richard Comi

people need a thorough eye examination at least annually, even if they have not noticed any visual problems,” Dr. Bernal stresses. Other complications of diabetes include dry eyes, frequent prescription changes, cataracts, and an increased risk of glaucoma.

“The good news,” he adds, “is that new and appropriate medical and surgical interventions can be initiated before irreversible damage occurs to the eyes. A dilated retinal exam, often combined with our latest imaging technology, can detect subtle changes to the structures of the eye long before visual symptoms occur. The eye exam is, therefore, the most important thing that all diabetic and prediabetic people can do to reduce the likelihood of vision loss.”

Dr. Bernal says, “The ultimate goal of maintaining a lifetime of good vision is dependent on consistent management of diabetes. Taking care of your eyes means taking care of your diabetes.

Working with your health care team to guide you in nutrition, exercise, lifestyle, and accurate monitoring are all essential components of living well and seeing well with this disease.”

28 i m a g e h e a l t h w a t c h • 2 0 1 8

Managing Type 2 Diabetes There’s no cure for diabetes, which tends to progress and may require medication at some point, but type 2 can often be controlled by lifestyle changes including weight loss if you’re overweight, improved nutrition, and regular exercise. These changes also address prediabetes, metabolic syndrome, and other risk factors, so they can kick-start a healthier lifestyle.

A1C, a blood test typically administered a few times a year, estimates average blood-glucose levels over the previous three months. Periodic A1C testing can determine how well diet, exercise, and medications, such as metformin, are working to control blood sugar and prevent organ damage. For most people, the ADA recommends an A1C

Paleo diet, or another one, the important factor to remember, Dr. Comi adds, is that “nobody eats a diet they don’t like.”

What to Eat? Amy Tuller, a registered dietitian and certified diabetes educator in New Hampshire and Vermont, has been practicing in the field of nutrition for more than two decades. She says to lower your risk of type 2 diabetes, losing even 5 to 10 percent of your body weight can make a big difference if you’re overweight. “Be physically active every day; walking, swimming, and dancing are good examples,” she adds.

When it comes to diet, says Amy, “Healthy choices include whole foods such as lean proteins, whole grains, fresh fruits

Foods to limit include deepfried foods and those made with refined white flours, added sugars, and hydrogenated oils. and vegetables, and healthy fats rather than processed foods. To lose weight, pay attention to portion control. Your body may not need as much energy as it did when you were younger.”

Amy explains, “The best diet for managing diabetes is an individualized approach.

Different people need different amounts of energy (calories) and macronutrients (carbohydrate, protein, and fat) based on their body and lifestyle. In the 1980s and ’90s, fat seemed to be the evil macronutrient.

Over the past several years, carbohydrates have taken center stage as the nutrient to avoid. Many people believe that if you have diabetes or are trying to prevent it, you should go low carb or no carb.

“Because carbohydrates break down to glucose when digested, it makes sense to pay attention to not only how much but also what type of carbohydrates we eat,” Amy explains. “Glucose is used as fuel for the brain, so some carbs are very useful. Try to get them from whole foods rather than ‘refined’ carbohydrates such as white flours and sugars. Carbs from vegetables, fruits, beans/lentils, and whole grains come with valuable nutrients such as fiber, vitamins, minerals, and antioxidants, which provide health benefits and tend to break down more slowly than refined carbs. Dairy also provides many vitamins, minerals, and protein along with its carbohydrates.”

Amy recommends that foods to limit include deep-fried foods and those made with refined white flours, added sugars, and hydrogenated oils. Focus on what to add to your diet to stay healthy, and be sure to include: •Beans, which are packed with fiber and vitamins and minerals including potassium and magnesium for blood pressure control; a half-cup has as much protein as an ounce of meat. www.uppervalleyimage.com •

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Although diabetes symptoms can be so mild that they go unnoticed, they can include: Frequent urination Frequent thirst Hunger, even though you’ve eaten Extreme fatigue Blurred vision Cuts/bruises that are slow to heal Weight loss without dieting (type 1) Tingling, pain, or numbness in hands, legs, feet (type 2)

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•Whole grains, a great source of fiber for heart health plus vitamins and minerals, including B vitamins, iron, and zinc.

•Fish, an excellent source of protein and omega 3 fatty acids, shown to reduce inflammation and heart disease risk, especially fatty fish (salmon, herring, sardines, mackerel, and tuna).

•Nuts, which provide protein and healthy monounsaturated fat and omega 3 fatty acids. High in calories, portion control is important; aim for a handful a day. Adding protein to a snack can slow the absorption of carbs and help stabilize blood sugar.

•Healthy fats, like avocado, olive oil, and nuts are tasty, filling, and offer heart-healthy unsaturated fats and antioxidants.

•Non-starchy vegetables, such as dark greens, carrots, squash, and beets are low in calories and carbohydrates compared to their high vitamin, mineral, antioxidant, and fiber content. Aim for at least 5 halfcup servings daily.

•Fruit, especially berries and seasonal fresh fruits. These have high levels of antioxidants, vitamins, and fiber. Try grilling or roasting to bring out their sweetness and eat them instead of sugary desserts.

•Dairy, a great source of carbohydrate, protein, vitamins, and minerals. Fruited Greek yogurt tends to have less added sugar than traditional fruited yogurts and contains about twice as much protein as well as probiotics for a healthy addition to your diet.

If you’re ready to improve your diet and lifestyle and want a personal plan for healthier eating, visit a diabetes educator or registered dietitian nutritionist, who will help you sort out what foods to eat and how much to build into your diet for lifelong health. 

DIABETIC SUPPORT GROUP Lake Sunapee Region VNA & Hospice provides a free Diabetic Support Group on the first Tuesday of every month at Valley Regional Hospital’s Library Conference Room from 10 to 11am and at Newport Health Center’s Community Room from 12 to 1pm. Facilitator Lauri Smerald, RN, Certified Diabetic Educator, explains, “I am there to address questions about things like diet, medications, and foot care, but I hope participants learn from each other’s experiences as well.”

For more information, call (603) 526-4077.

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“We’re trying to make health care costs predictable,” Dr. Alvord says. “There is no disincentive to call or come in.”

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HOSPITALS

innovations | BY MARK AIKEN  PHOTOS BY SOPHIE CAULFIELD

A Courageous Advocate

for Simplifying Health Care

THAT’S GINNY ALVORD, MD, AT MONARCH FAMILY MEDICINE

Have you ever wondered whether you should call your doctor? For example, you have a bad cough. Is it worth paying for an office visit, knowing your primary care provider will probably order a chest X-ray (which also costs money) that will, likely as not, come back inconclusive? On the other hand, if you suffer through another week of hacking and coughing, maybe it will just go away.

This cost-versus-health analysis is a symptom of a flawed health care system. And when it comes to affordable health care and a system that actually works, it sometimes seems like everyone is all talk. Well, Dr. Ginny Alvord, a family physician in West Lebanon, has taken action. Her practice, Monarch Family Medicine, does not deal with insurance companies (except Medicare).

Rather, Monarch uses a system called Direct Primary Care (DPC) through which patients pay a simple, flat, monthly fee that covers all primary care services.

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in n ovat ions

A small staff and low overhead keep DPC costs down.

“I do what lab work I can in my office,” says Dr. Alvord. “Patients are often surprised at the price I can offer for lab work.”

MONARCH USES A SYSTEM CALLED DIRECT PRIMARY CARE (DPC) THROUGH WHICH PATIENTS PAY A SIMPLE, FLAT, MONTHLY FEE THAT COVERS ALL PRIMARY CARE SERVICES.

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Making Health Care Costs Predictable This approach challenges the traditional fee-forservices model of health care delivery—a model where health care costs can escalate and cause patients to weigh the potential benefits versus costs of seeing a doctor. With Monarch’s model, patients could come to Dr. Alvord 20 times in a month or not even once, and the cost would be equal. “We’re trying to make health care costs predictable,” she says. “There is no disincentive to call or come in.”

A doctor who doesn’t take my insurance, you say? No way! Before passing judgment, consider your insurance policy. It most likely has a deductible—and, just as likely, it’s a big deductible.

Primary visit costs are almost certainly below the amount of your deductible, so unless you or your partner had a major surgery or other medical situation earlier this year, you are probably paying for primary visits anyway.

Meanwhile, primary visits often turn into referrals to specialists. Dr. Alvord points to statistics that show decreased specialist visits for patients using DPC models. “Familiarity with patients may give a doctor a chance to treat before referring to a specialist,” Dr. Alvord says.

Even if a specialist isn’t involved, primary care

providers often send lab work to a third-party lab. “I do what lab work I can in my office,” says Dr. Alvord. “Patients are often surprised at the price I can offer for lab work.”

A Simpler Way After graduating from medical school at the University of Connecticut, Dr. Alvord did her residency training at a University of Washington program specializing in rural medicine. After 12 years in private practice, she has spent the past decade working for Littleton Regional Hospital and then Dartmouth-Hitchcock Medical Center. In large organizations, it becomes necessary to focus on team approaches to care. Larger patient numbers and insurance-related paperwork make it impossible for a provider to do everything himself or herself. “Teams can become complicated,” Dr. Alvord says. At many turns, she says, she would encounter barriers to providing care. And she yearned for a system that made delivering care simpler.

In December 2017, she opened Monarch Family Medicine. It is simpler, to be sure: it’s just her. She answers the phone, greets patients, treats patients, and writes referrals. “I have lived in the other system, and I understand the reasons for it,” Dr. Alvord says. “I don’t disparage anyone.”

While there are other examples of physicians using a DPC model in the United States (for example, the state of New Jersey offers a DPC benefit to state employees), they are far from mainstream. To go from an established hospital like Dartmouth (where Dr. Alvord still does per diem work) to a tiny, one-person “micro-practice” using an out-of-the-box approach takes courage.

For Dr. Alvord, it comes down to her ability to provide care for her patients: “What if there was a provider and a patient, and you took the rest of it away as much as you can?” she asks.

At Monarch Family Medicine, Dr. Ginny Alvord is doing just that.  Monarch Family Medicine 1 Oak Ridge Road, Suite 10B West Lebanon, NH (603) 277-9162 www.monarchfamilymedicine.com www.uppervalleyimage.com •

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BRAIN

JOINTS

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KIDNEYS

HEART

BY NANCY FONTAINE

WHAT IS CHRONIC

INFLAMMATION? TACKLING A MODERN HEALTH PROBLEM

K

nown in the medical field as the inflammatory response, inflammation is a series of bodily reactions to injury or infection. According to the Harvard Medical School guide Understanding Inflammation, it “represents an essential survival mechanism that helps the body fight off

hostile microbes and repair damaged tissue.”

If you’ve ever cut your finger or been stung by a bee, you’re familiar with inflammation as the pain, warmth, redness, and swelling that can occur at the site of the injury. When the body is hurt, tiny blood vessels expand and become more porous to bring blood, fluids, proteins, and white blood cells to the threatened area. Once the threat has been managed, cell regeneration and repair begin.

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CONSIDER THE SOURCE If you’re like most people, you head to the Internet to ask Dr. Google when you have questions about health. You need to be careful here.

The aim of many people and sites on the web is to sell you something. If you want to avoid snake oil, you have to consider the source.

Good sources of information rely on scientific evidence. (If you

“We’ve all heard that not getting enough omega 3s is problematic, and that is true.

Now there are tests to find out your omega 3 to 6 ratios. Measuring inflammation in your body will help you know what you have to do to prevent excessive oxidation (think rusting) and inflammation.”

—Dr. Randy Schaetzke, DC, DIBAK

don’t trust scientific evidence, fair enough, but then you’re on your own.) In general, sites that end in .gov, .edu, or .org, which means they are produced by the government, an educational institution, or a nonprofit organization, are more likely to be reliable and less profit-driven.

The US government provides the premier database of scientific medical literature called Medline. It is freely available to the public via the PubMed search engine (www.ncbi .nlm.nih.gov/pubmed), but it is geared toward doctors and researchers; understanding its contents requires professional training or guidance from a professional.

Happily, the managers of Medline understand this and have created a gateway for patients called Medline Plus (medlineplus.gov).

Another doctor-curated, trustworthy source is called MedicineNet (www.medicinenet.com).

The immune system doesn’t always confine its actions to external threats. “When the normally protective immune response goes awry, it may be because of a reaction to an otherwise harmless environmental substance, which is what takes place during an allergic reaction,” says the Harvard guide. “In autoimmune conditions, the body’s defense system mistakenly wages war on an individual’s own tissues, leading to inflammation.”

Acute versus Chronic Inflammation Inflammation can be acute or chronic. Acute inflammation comes on quickly and is short-lived, typically lasting only a few days. If the inflammatory response is longer lasting, it’s referred to as chronic inflammation, and it may last weeks, months, or longer.

How does chronic inflammation happen? In some cases, the issue isn’t resolved initially, and the inflammation remains active. But sometimes low-level inflammation occurs without an apparent cause. Unfortunately, lingering and unprovoked responses can cause damage to the body. In the last 20 to 30 years, scientific research has shown that many illnesses, including heart disease and diabetes, have chronic inflammation in common. It also appears to play a part in cancer, Alzheimer’s disease, rheumatoid arthritis, and cirrhosis of the liver.

In addition, metabolic syndrome is linked to chronic inflammation.

Its cluster of symptoms—high blood pressure and cholesterol levels, abdominal fat, and insulin resistance—is a risk factor for heart disease, diabetes, stroke, and cancer. Although much remains unknown about the syndrome, chronic low-grade inflammation appears to be both a consequence and a cause.

Determine Your Level CRP, or C-reactive protein, is produced by the liver and increases in response to inflammation anywhere in the body. A CRP blood test measures CRP levels. It is often used to check for flare-ups of diseases such as rheumatoid arthritis, vasculitis, or lupus. Elevated CRP levels have also been recognized as an indicator of heart disease.

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mood

Olive oil

Nuts

Berries

Pineapple Onions & Garlic

Spinach

Turmeric

Green tea

Cherries

Salmon

AN ANTI-INFLAMMATORY DIET Foods and drinks that have

Eating seeds and nuts,

brightly colored fruits and

with anti-inflammatory effects.

been linked to reductions

studies have found, is

vegetables their vibrant

in inflammation and chronic

associated not only with

hues, may help lower CRP

disease include fruits and

reduced indications of

levels.

vegetables; nuts and seeds;

inflammation but also with

Fruits, nuts, berries,

and coffee, cocoa, and

lower risk of diabetes and

seeds, beans, and greens

flaxseed oil, and fatty fish

green tea.

heart disease. A handful

add more fiber to a diet as

(like salmon, sardines, and

Most brightly colored

There is evidence that foods rich in omega 3 fatty acids, such as olive oil,

(1.5 ounces) a day of

well, which research has

mackerel), are helpful in

vegetables and fruits

almonds, pine nuts, pista-

shown helps control blood

reducing inflammation, but

contain high levels of poly-

chios, or walnuts is about

sugar levels, lower choles-

consult your doctor before

phenols (protective com-

right.

terol, and promote good

you jump into taking fish

bacteria in the gut.

oil supplements or eating

pounds found in plants)

Other good inflamma-

and antioxidants. Good

tion-fighting foods include

It’s good to cut down

fish more than a couple of

examples of these foods

beans (like kidney, black,

on salt, but don’t skimp on

times a week. More is not

are blueberries, blackber-

pinto, or garbanzo beans)

the spices: garlic, turmeric,

always better, depend-

ries, strawberries, cherries,

and onions. Carotenoids,

ginger, cinnamon, and cay-

ing on what other health

broccoli, kale, and spinach.

the antioxidants that give

enne all have chemicals

conditions you have. www.uppervalleyimage.com •

39

“New studies indicate that it is INFLAMMATION that CAUSES certain HEART DISEASE as well as ALZHEIMER’S disease and other DEMENTIA-RELATED DISORDERS. Chronic inflammation can put the body into overdrive, causing irreparable harm to vital organs.”

—Mohamed Basha, RN, CEO, TLC HomeCare Services, Inc.

The CRP test isn’t specific, however; it can’t tell where the inflammation is in the body. It isn’t always able to tell when there is inflammation either. Moreover, positive CRP test results are seen during the last half of pregnancy and with the use of birth control pills.

What’s a body to do? Is there any way to treat or influence a chronic inflammatory response? Modern medicine doesn’t have any easy answers for treating chronic inflammation.

The effects can vary too much, depending on what part of the body it affects. Currently, there is no single medication or treatment that can address all these complexities.

That’s not to say nothing can be done. In fact, there is a class of medicines that is well-known and sometimes helps: the nonsteroidal anti-inflammatory drugs or NSAIDs. Everyone has heard of them because aspirin is one. Advil, Motrin, Aleve (all over-the-counter drugs), and Celebrex (a prescription drug) are other commonly known products. They have side effects with long-term use, however, including stomach

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problems. There are other, more potent medications to address chronic inflammation, including corticosteroids, that a doctor may prescribe, but these are used with greater caution due to their potential side effects.

A Natural Approach Medication need not be the only response to chronic inflammation; physical therapy is another approach. Josh Roylance of Upper Valley Rehab in Woodstock combines osteopathic manipulative treatment (OMT) with traditional physical therapy. He says, “For the chronic inflammation patient, such as someone with rheumatoid arthritis, OMT helps improve the functionality of joint and muscle imbalances, reduces adverse effects of inflammatory processes, and improves the internal balance, or homeostasis, of the body.”

Diet, lifestyle, and family history play a role in the conditions that result from chronic inflammation. You can’t change your family history, but you can change your habits.

“There is not a part of your mind, body, and spirit that doesn’t benefit from exercise, so get started!”

—David Edson, PT, Rehab Manager, Visiting Nurse and Hospice for Vermont and New Hampshire First, quit smoking. Aside from other well-known issues and diseases associated with smoking, like lung cancer, it raises levels of inflammation. Dr. Mark Creager, director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center, recommends, “Don’t smoke, and if you do, try to stop on your own or seek professional help.”

Next, get moving. Moderate exercise has all kinds of health benefits, such as better sleep (poor sleep is also linked to inflammation), decreased levels of depression, and better cognitive function. It also appears to help reduce inflammation and can assist with weight loss, which is important. “Just 30 minutes a day of moderate exercise, such as walking briskly, five times a week has benefits,” says Dr. Creager.

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“Chronic inflammation is a constant state of high alert for the body. It’s like an inflamed cut, except the whole body is reacting. It overburdens all the systems, particularly the immune system. With the body spending so many resources just dealing with the ‘high alert’ state, there are few resources to devote to dealing with the normal internal and external stressors. Thus, chronic inflammation sets the stage to turn another small event into the ‘straw that breaks the camel’s back.’”

—Gretchen Stokes, RN, Good Neighbor Health Clinic volunteer

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Eat a healthy diet. Eating for good health includes staying away from refined carbohydrates (like white bread and pasta), saturated fats, processed foods, and too much red meat. Instead, eat more leafy greens and choose whole grains and lean meats and fish.

Dr. Creager advises, “Read food labels, watch your calories, and lower your intake of sugar. . . . Be careful about fatty foods, as these increase blood cholesterol levels and can lead to blockages in your heart’s arteries.” He adds, “If you have high blood pressure, avoid the salt shaker, and limit foods enriched with sodium such as processed foods, canned soups, and even bread.”

If you are health conscious, you may well be following these practices already. Good for you; until science advances, the best we can do is work to be healthy and keep inflammation at bay. 

tec h s ma rt | BY MIKE MORIN

FIND OUT AT JOHNSON AUDIOLOGY

What Do Solutions for Hearing Loss Sound Like?

For many people, it starts with straining to hear a conversation in a restaurant buzzing with the din of voices and dishware. For others, it might be constantly asking, “What did you say?” And for many more, it may be turning up the television volume to 64 when 25 was once good enough. For a growing number of people experiencing hearing loss, these signs of frustration are common.

If you can identify with any of the scenarios above, you’re not alone. By the time you reach your 60s, there is a one-in-four chance you will experience age-related hearing loss, according to recent studies by both the National Academy of Sciences and the President’s Council of Advisors on Science and Technology. These also confirm that hearing declines in one’s 70s, with over half of us experiencing hearing loss.

New Options for Better Hearing Advances in science and technology have created exciting new options to help us hear better. The challenge is finding the best solution for your situation. It can be difficult to navigate through the flood of advertisements,

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43

te ch s m art

You don’t have to look far to find patients whose lives have improved after working with Drs. Johnson and Rieke.

“Working in retail presents a specific set of challenges: noisy crowds at times, children’s soft voices at others. [Johnson Audiology] is sensitive to the expense side of hearing devices, helping me choose the appropriate devices for my budget.” —Liza Bernard “Practicing in the Upper Valley for 20 years, I’ve heard a lot of critiques of where people get great care. Julie Johnson’s work has been noteworthy as a problem solver for people frustrated with their hearing.” —Adam Schwarz, MD “I cannot give enough praise to Johnson Audiology for getting me set up with my hearing aids.

The only drawback is I now have less reason for selective hearing!”

—Dan Bartlett

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from mail-order offers to newspaper or online ads. The first step is to find a reputable hearing health care provider who can administer a comprehensive hearing evaluation.

Johnson Audiology in downtown Hanover offers a refreshing perspective: consulting services for hearing loss. Julie Johnson and Catherine Rieke, doctors of audiology, work with each patient to help solve the everyday challenges of living with hearing loss.

Dr. Johnson says, “Our mission is to help patients navigate the process and ultimately help people hear better using evidence-based methods.”

If hearing aids are recommended, Drs. Johnson and Rieke follow best practice to ensure each patient has appropriate amplification. “The most important test we do during a hearingaid fitting is called real-ear measures,” Dr. Johnson adds. “It is our way to be certain hearing aids are improving a patient’s ability to hear well at each pitch based on the individual’s hearing test, unique ear size, and ear shape.”

There are also other examination protocols that help Drs. Johnson and Rieke evaluate the best hearing solutions for each patient’s specific needs.

The diagnostic evaluation will include: • A discussion of ear health, medical history, hearing history, and current lifestyle • A physical examination of the ear via otoscopy and wax removal when needed • Pure-tone audiometry and speechrecognition testing in a soundtreated booth. Speech testing is performed in a quiet environment as well as with varying levels of background noise, with and without hearing aids.

Following the evaluation, the audiologist will explain the results and make recommendations. These may include a referral to an ear, nose, and throat

specialist; adjustment of one’s current hearing aids; new amplification options; hearing protection; and/or suggestions for school or workplace accommodations. In some cases, devices such as amplified or captioned phones, TV amplifiers, or over-the-counter hearing products are recommended instead of, or in addition to, hearing aids.

“We want patients to feel they’re receiving information and guidance about their hearing care options, without feeling pressure to purchase hearing aids,” Dr. Rieke says. “The focus is not on a product but rather on an individualized solution to help someone hear better.”

Because solving hearing loss is not a one-size-fits-all proposition and because consumers are bombarded with so much conflicting and confusing information about hearing aids, Johnson Audiology offers personal, one-on-one information that takes the mystery out of finding the right solution for your specific hearing loss circumstances.

What to Expect With over 15 years of combined professional experience and strong educational backgrounds, Drs. Johnson and Rieke offer evidence-based practice in audiology. Both enjoy excellent reputations for working with patients to identify their best solutions. Johnson Audiology offers online self-scheduling at two convenient locations—one in downtown Hanover and one at Kendal of Hanover (for Kendal residents).

Patients are typically scheduled within two weeks. Visit johnsonaudiology.org or call (603) 643-HEAR to schedule an appointment today. 

Johnson Audiology 2 Dorrance Place (inside Doctor Sam’s Eyecare) Hanover, NH (603) 643-HEAR (4327) care@johnsonaudiology.org JohnsonAudiology.org

everyd ay hea l t h

5 STELLAR SUPERFOODS BOOST YOUR DIET WITH THESE NUTRITIONAL POWERHOUSES

BERRIES Raspberries, strawberries, blueberries, and others are packed with vitamins, minerals, and fiber.

KEY BENEFITS: Berries’ antioxidant activity is associated with a decreased risk of cardiovascular disease, cancer, and other inflammatory conditions.

NUTS & SEEDS

LEAFY GREENS

Rich in fiber and healthy fats, make almonds, walnuts, pecans, peanuts, and sunflower and pumpkin seeds part of your healthy diet.

Dark green leafy vegetables (DGLVs) such as kale, spinach, Swiss chard, and collard and turnip greens provide folate, zinc, calcium, iron, magnesium, vitamin C, and fiber.

KEY BENEFITS: Nuts and seeds may reduce the risk of heart disease while promoting healthy weight loss.

KEY BENEFITS: DGLVs have been shown to potentially reduce the risk of heart disease and type 2 diabetes.

Their anti-inflammatory carotenoids may protect against certain cancers.

OLIVE OIL

GARLIC

Health benefits of olive oil come from its monounsaturated fatty acids.

Used for centuries for its medicinal benefits, garlic is a good source of manganese, vitamin C, vitamin B6, selenium, and fiber.

KEY BENEFITS: Olive oil is packed with antioxidants that protect cells from oxidative damage, and it is believed to be beneficial in reducing heart disease, diabetes, and other inflammatory conditions.

KEY BENEFITS: Studies show that garlic may help reduce cholesterol and blood pressure while supporting healthy immune function. Its sulfur-containing compounds may help prevent certain types of cancer.  www.uppervalleyimage.com •

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hea l t hy s o l ut i o ns

BY DONALD J. NEELY, DMD, MSD (ORTHODONTICS)

Sleep Disordered Breathing TREAT CONDITIONS EARLY FOR GOOD OUTCOMES Being able to get a good night’s sleep and awake rested and refreshed improves your health and quality of life. Having your child realize his or her full potential health and appearance through optimum growth and health is enormously satisfying. Your best gifts are a great smile and self-confidence.

Sleep Disordered Breathing (SDB) is a new term that includes open-mouth breathing and sleep apnea.

Both conditions affect the growth and proportions of your child’s face and general health. As an orthodontist, I am concerned because I treat the consequences of these problems. You need to learn to recognize them and have them diagnosed by a specialist, such as an orthodontist, otolaryngologist (an ear, nose, and

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h e a lt hy solutions

SIGNS AND SYMPTOMS IN CHILDREN • Open-mouth breathing when asleep and during the day • Loud snoring, noisy breathing, gasping and snorting sounds, restless sleep, nightmares • Apnea episodes: breathing stops for 10 or more seconds, more than 5 times an hour • Underdeveloped jaws: high arched palate, crowding, crossbites, open bites, tongue thrust • Bed wetting • Difficulty waking up, dry mouth, morning headache • Chronic allergies, frequent tonsillitis, sore throats, upper respiratory and ear infections • Abnormally slow growth • Daytime sleepiness and irritability, difficulty paying attention while awake • Behavioral changes and difficulty at school: moody, disruptive, symptoms of attention deficit disorder

Being able to get a good night’s sleep and awake rested and refreshed improves your health and quality of life. throat specialist), or a sleep physician. The best outcomes depend on early screening at age three, diagnosis, prevention, and treatment. It is important that all children be able to breathe easily and comfortably through their noses day and night in all seasons.

Consequences In a child, open-mouth breathing interferes with normal facial growth and development. How a child breathes changes the way the facial muscles and nerves function and grow and even changes the shape of the

Studies have shown that as many as 25% of children diagnosed with attention-deficit hyperactivity disorder may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep.

For more, go to: medlineplus.gov/sleepapnea.

face, both the underlying skeleton and the soft tissues. In obstructive sleep apnea (OSA), repeated episodes of partial and complete blockage of the airway during sleep are associated with low blood oxygen and increased blood pressure. The brain is aroused, and sleep is disturbed.

In Nature, Form Follows Function When the total airway resistance becomes greater than 4.5 centimeters of water/liter/second (as measured by a device called a pneumotachograph), the jaw and tongue drop and move

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forward, and breathing through the mouth takes over. Anatomical changes follow. The distance from the nose to the chin gets longer, the lower jaw recedes, the nostrils become smaller, the upper teeth and gums protrude, the jaws narrow, and the teeth are crowded. Untreated, the result is long face syndrome or adenoidal facies, the medical term that describes a long, open-mouthed, slack-jawed face with droopy eyelids and prominent upper teeth and gums. This facial appearance may disrupt a person’s social development and erode his or her self-confidence.

Diagnosis and Treatment Begin by having your child undergo an early screening examination.

Orthodontists are dental specialists with years of extra training in the recognition and treatment of problems related to the growth and development of the face and irregularities of the teeth. They have the knowledge and experience to diagnose the problem and can steer you to the right specialists to help treat the problem.

Most orthodontists provide a free examination as a courtesy.

Recognition and treatment should begin early. From medical school,

HOSPITALS

physicians remember that the tonsils and adenoids shrink by late adolescence, but by then, it is too late because the face is almost completely grown. The first principle is to remove obstructions in the airway. Physics tells us that if you double the radius of the airway, the airflow through it increases by a factor of 16!

Professionals trained in the diagnosis and treatment of these disorders can help: An otolaryngologist (ENT) can diagnose nasopharyngeal obstructions; reshape hard tissues such as the turbinates, nasal septum, and bone spurs; remove obstructive soft tissues such as tonsils, adenoids, and polyps; reposition flabby soft tissues with a pharyngeal lift procedure; open collapsed nostrils with an alar batten graft; and shrink swollen nasal linings by prescribing steroid nasal sprays, nasal lavage, and medications.

A sleep physician performs a sleep study to definitively diagnose sleep apnea, document the severity, and prescribe a CPAP machine and mask.

These are effective, but a large percentage of patients do not tolerate them.

An orthodontist can perform rapid maxillary expansion (RME). This is an orthopedic procedure to stretch the mid-palatal suture and widen the palate.

The nasal airway is on the opposite side of the same structures, so it is enlarged at the same time a crossbite is corrected.

Conventional orthodontics with Invisalign or braces can reposition the jaw and improve the airway. Removable oral appliances for the treatment of dentofacial development issues and mouth breathing can be worn at night, after obstructions have been cleared. A removable appliance, such as the sleep apnea Herbst, can be used to open the airway by repositioning the lower jaw at night. There are a variety of appliances that are well tolerated.

An oral surgeon can perform maxillomandibular advancement surgery (MMA) to increase the pharyngeal space and airway by moving the jaws forward using the same principle as the CPR maneuver of pulling the lower jaw down and forward to open the airway.

Surgically assisted rapid maxillary expansion (SARME) can reopen the sutures and allow the orthodontist to widen the upper jaw with the same appliance used for children.

Infants and young children with obstructive sleep apnea don’t always snore. They might just have disturbed sleep. www.mayoclinic.org

An allergist can identify irritants and help remove them from the child’s environment and diet and can prescribe medications, nasal sprays, and lavage to shrink hypertrophied soft tissues.

For more information on adult sleep apnea and the medical problems associated with it, go to www.mayoclinic.org or www.drneely.com.  Dr. Donald Neely has maintained a private practice in the Upper Valley for many decades and is a member of the Craniofacial Clinic team at the Children’s Hospital at Dartmouth-Hitchcock (CHaD).

The opinions expressed in this article are his own.

Donald Neely, DMD, MSD Hanover Orthodontics 7 Allen Street, #300 Hanover, NH (603) 643-1200 www.drneely.com

A good night’s sleep makes for happy, healthy kids.

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f in a n c ia l we ll- b e ing | BY MIKE MORIN

Too Busy Building Wealth to Manage It? PRIVATE BANKING AT LEDYARD HAS YOU COVERED

William Logan Senior Vice President Private Banking Manager

LEDYARD NATIONAL BANK 38 Main Street, PO Box 799 Hanover, NH (603) 640-2743 www.ledyardbank.com Other locations in Concord Hanover Lyme New London Norwich, VT West Lebanon

William Logan joined Ledyard National Bank’s Private Banking division in 2018 and has more than 25 years of wealth management and banking experience. His expertise centers on managing complex lending, banking, trust, and investment relationships by providing customized strategies for individuals, families, and institutions.

Successful professionals are often too busy building wealth to effectively manage it themselves. While they may be experts in their chosen fields, many do not have the training or experience to safely manage their assets. Ledyard National Bank’s Private Banking offers tailored banking and financial solutions to not only manage the business needs of a professional practice but also provide the guidance and professional tools to assure stability and asset growth. Bill Logan, Senior Vice President and Private Banking Manager at Ledyard National Bank, answers our questions.

What is Private Banking at Ledyard?

We are a division of the bank that provides customized banking, lending, and financial solutions for our affluent client base. The Private Banking Team, which was formed in 2014, works with individuals and families to design strategies and tailored solutions while providing priority service for each client.

Who are the typical clients of Private Banking?

Professionals in the medical, dental, educational, engineering, legal, and real estate fields; entrepreneurs; and business executives make up the majority of our clientele.

It’s a great mix of folks with varied backgrounds and experiences but with a common trait—our clients have the need for a convenient, simple, and cost-effective financial relationship.

Give a specific example of the services and products you provide to affluent individuals and families.

Our clients have customized mortgages, secured lines of credit, sometimes a commercial loan for their practice or business, high-balance checking/savings accounts, money market accounts, often an investment relationship with Ledyard Financial Advisors, and typically a net worth in excess of $500K. What is the cost to be a Private Banking client at Ledyard?

We provide these services at no additional cost to our clients. In fact, as a Private Banking client, fees on checking and savings accounts are waived and card limits are increased on debit and cash transactions.

How many clients are part of Private Banking at Ledyard?

We have more than 250 individuals and families who are part of the Private Banking Group, and we’re expanding our team to work with more clients who would benefit from the high-touch service we provide. We want to help people Plan Well and Live Well. 

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“This is all about making it easier for patients to coordinate their care.”

BY E. SENTEIO

Ready. Set.

GO MEATLESS B ECO M IN G A VE GE TA R I A N VEGETARIAN. Maybe the word makes

you curious. Maybe it makes you scoff. Or maybe . . . it makes you feel empowered and hopeful. Becoming a vegetarian means making a conscious decision about what you are putting in your body and your impact on the planet. In the United States, only 3.2 percent of us are vegetarians. This small percentage eats no animal flesh, minimizes its impact on the environment, and is likely to live longer, healthier lives.

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Eat to Live Numerous studies have shown that individuals who eat a plant-based diet are healthier than their meat-eating brethren. Vegetarianism can help to prevent heart disease and lower blood pressure, which is no surprise considering that artery-hardening cholesterol is found only in animal products. Eating a vegetarian diet can help control blood sugar, and some claim it can even reverse diabetes. Vegetarians are also about 40 percent less likely to develop cancer.

Individuals choose a plant-based diet for two primary reasons: health benefits and to reduce the suffering of animals. The ASPCA reports that most

meats come “from industrial farms where efficiency trumps welfare—and animals are paying the price.”

Have a Reason In the US, vegetarianism is a choice— and a commitment. What begins in your head, your body follows. It doesn’t matter what your reason is for wanting to be a vegetarian—health, animals, environment, self-discipline—just make sure you have one. Decide what you’re committed to. That is what you will hold onto in your early days of transitioning to a meat-free life.

Oh, just the thought (meat-free life!) makes you doubt whether you can do it?

You may surprise yourself. Don’t think of it as meatless, but as a plant-abundant life. As you adjust your thinking and eating habits, your taste buds are also adjusting. It may be hard to imagine now, but if you stick with it, one day meat will be a distant regret, and you’ll wake up a vegetarian.

Where to Start There is no one correct way to become a vegetarian. Figure out what works for you. Some people go cold turkey, forgive the pun: From this day forth, I will never eat meat again. This works for some and avoids the slippery slope of “just one bite” to a belly full of brisket. Others

TYPES OF VEGETARIANS There are many types of vegetarians. Some eat dairy foods, such as cheese and yogurt; others eat eggs, while others abstain entirely from any product that comes from an animal.

A lacto-vegetarian diet (sometimes referred to as a lactarian; from the Latin root lact-, meaning milk) is one that includes vegetables as well as dairy products such as milk, cheese, yogurt, butter, ghee, cream, and kefir, but excludes eggs.

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A lacto-ovo vegetarian consumes milk and dairy foods, eggs, grains, fruits, vegetables, beans, nuts, and seeds, but abstains from meat, fish, and poultry.

A pescatarian is a vegetarian who eats fish. The term first originated in 1993 and is a blend of the Italian word for fish, pesce, and the word vegetarian.

A vegan is a strict vegetarian who consumes no food (such as meat, eggs, or dairy products) that comes from animals; vegans also abstain from using other animal products (such as leather).

choose a less definitive path: From this day forth, I will eat less meat. Admirable, yes, but meatless Mondays won’t even scratch the surface of potential benefits. Another variant: From this day forth, I will eat more vegetables and fruits. Good for you. Your body will thank you for the influx of nutrients and fiber. One danger here is unconsciously matching your meat serving to your vegetable serving, thereby increasing your meat intake.

Each of these options is fine—as a starting point. Often, people will claim they are vegetarian when practicing one of the latter two options. Fact: If you eat any animal flesh at all, you are not a vegetarian.

Being a vegetarian is easy. Yes, easy. Becoming a vegetarian takes effort and consistency, like any change of habit or lifestyle. Approximately 8 million individuals in the US have embraced vegetarianism. The number continues to grow.

Welcome to the ranks. The few. The proud. The meatless.

Make a plan. Becoming a vegetarian rarely just happens.

Planning will increase your chances of sticking with it.

Do your research. Read. Listen. Ask questions. Information is abundant—good and bad. Be selective and look for reliable sources. Vegetarian Times has been around for more than 40 years. Try the online version for tons of information and free, nicely organized recipes. Don’t forget blogs.

There are newbies just like you as well as veterans who are happy to share their experiences. Everyone has an opinion.

Figure out what works for you.

TIP Don’t get overwhelmed. This is a personal journey, so consider what works for you.

Whatever will you eat? Vegetarians—while abstaining from animal flesh—generally consume dairy products,

TAKE A CLASS! “Vegetarian dishes seem to take a bit more time to prepare than many meat dishes at first, but there are several ways to make cooking more efficient and pleasurable,” says Lindsay Smith, Food Education Specialist at the Co-op Food Stores. “One of the best ways to develop new skills and explore new flavors is to take a class.”

Here are a few to consider:

KNIFE SKILLS 101 November 4, 11:30am to 2pm (offered monthly)

Vegetarians spend more time chopping and prepping vegetables, so learning the right techniques (and using the correct knife) is an invaluable way to decrease prep time and make cooking more enjoyable.

SIMPLY IN SEASON: PUMPKINS AND SQUASH November 12, 5:30 to 7:30pm

Learn to cook from ingredients, not recipes.

By starting with what you have and what is available locally and seasonally, and then finding a recipe, it’s easier to start thinking like a vegetarian.

COOKING ESSENTIALS: THE SPICE-DRAWER CLASS November 13, 5:30 to 7:30pm

Spices and herbs are a way to take the same dish and transport it all over the world.

Playing with new taste combinations leads to more creative, exciting dishes.

All classes are held at the Culinary Learning Center located at the Lebanon Co-op, 12 Centerra Parkway, Lebanon, New Hampshire. For more information, go to coopfoodstore.coop. www.uppervalleyimage.com •

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such as milk, cheese, or eggs. You’ll likely eat what you ate before, minus the meat. However, vegetables, fruits, whole grains, legumes, and nuts are the foundation of a healthy vegetarian diet.

TIP Reap the benefits and be careful not to turn to carbohydrates and starches as go-to foods. Bread, cheese, and pasta can derail your goals.

Recipes help keep you focused. Contrary to what some believe, vegetarians never lack options. Type “vegetarian recipes” into a browser, and there are literally over a billion hits. As you start

out, keep it simple. Try easy recipes with few ingredients. Choose a few standbys you can throw together quickly after a long day at work. If you make meal prep too cumbersome and complicated, your commitment will crumble.

TIP By all means explore, but before cravings hit, be specific and narrow your search. Type in “vegetarian comfort food” or “quick vegetarian snacks.”

Rethink your grocery list. Be prepared to change your eating and shopping habits. How you eat is a habit. Don’t think meat/starch/vegetable/dessert.

Think vegetable/legumes/grains/fruit.

Keep those main staples on hand. And remember your recipes! To get started, grab ingredients for quick meals and one or two more elaborate weekend feasts.

TIP Veggie burgers, hot dogs, and other meat substitutes should only supplement your diet, not be a main staple.

Leave the cow alone. Yes, in your nascent days a sizzling steak commercial might make you blink. In time, meaty temptations pass. Really, they do. Your heart will strengthen along with your resolve.

 At least once a month, reward your commitment by dining out at a highly rated vegetarian restaurant. This is also an effective tactic if commitment starts to waiver. A good meal can teach you so much about possibilities.  This is a new way of eating and thinking. You are bound to have some weak spots. Patch them over with hummus and veggie sticks and don’t give in.  Don’t make the mistake of thinking of meat substitutes as the real thing. Approach them as something new, and you’re more likely to be pleasantly surprised. Consider healthy mushrooms, beans, or tofu for that “meaty” texture.  Be a generous guest and bring a vegetable casserole to a picnic or veggie dogs and bean burgers to cookouts. That way you’ll have something hot from the grill.

HELPFUL HINTS  Shop and learn at the local farmers’ market. Try at least one new fruit or vegetable each visit.  When you feel lost, take a vegetarian cooking class. Learn from the experts.  Know your numbers. Visit your doctor for a blood panel (cholesterol, blood pressure, iron levels, etc.) before you start. Watch the impact your new lifestyle has on your health.

Celebrate.

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 Being a vegetarian won’t make you stand out unless you want to.

Family and close friends may know, but coworkers and acquaintances are unlikely to notice unless you draw attention to it. If you want, share your spiel. Once. Preachy, pushy vegetarians get a bad rap for acting superior.

Some deservedly so. If asked, share your experience and move on—or start a blog. Vegetarianism is an individual choice.  Your body needs protein and iron; it does not need meat. Beans and tofu are great choices. One cup of red kidney beans has 15 grams of protein.

The RDA is 0.8 grams per kilogram of body weight. Get your B12 from dairy or supplements.  Not all vegetarians eat healthily. Not all vegetarians are thin. Not all vegetarians are hippies or preppies. Although the populations are vastly different, there is as much diversity among vegetarians as among meat-eaters.  Try new dishes and give yourself permission to mess them up. Adjust ingredients, seasonings, or cooking time, and try again until you get it right.

“Cultural changes mean that restaurants of all types have plentiful vegetarian options, and cooking at home is easier with tons of choices in the markets as well.”

—Gretchen Stokes, RN, Good Neighbor Health Clinic volunteer

Vegetarianism is an adventure.

Experiment. Enjoy new tastes, be creative, explore. Try endless variations of chilis and soups. Discover your favorites.

Get to know spices! Embrace roasted seasoned vegetables, give peas a chance, curl up with vegetarian shepherd’s pie.

Learn to love the variety and versatility of beans.

Remember your reasons. Keep your commitment. Reap the benefits. Vegetarian. Maybe the word makes you feel empowered and hopeful. Ready.

Set. Go meatless. 

CHILI IS MY FRIEND 1 cup chopped onions 3 cloves garlic, chopped 2 Tbsp chili powder, or to taste 1 tsp cumin, or to taste 3½ cups diced tomatoes 3 cups of your favorite beans, cooked/canned Texture options 1 lb firm tofu, frozen, then thawed and crumbled 2 cups diced mushrooms www.uppervalleyimage.com •

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Add-in options 1½ cups fresh or frozen corn kernels ½ cup chopped mild or hot green chilies, drained 3 cups frozen cauliflower, thawed and finely chopped 2 large zucchinis, finely chopped 1½ cups chopped butternut squash 1 bunch Swiss chard, tough stems removed, chopped 1 cup salsa (for a mild to spicy kick) If it’s too thick, add either carrot juice (adds a nice sweetness!), vegetable broth, or water.

1. Heat a small amount of water in a large pot over medium-high heat. Add onion and sauté for about 3 minutes.

Add garlic and sauté 1 minute more.

Add spices. Cook, stirring for about 30 seconds.

2. Add your choice of vegetables (except leafy greens) and cook until they just start to soften. Add tomatoes and their juice. Bring to a simmer.

Reduce heat to medium-low, stirring occasionally, about 20 minutes. Add beans, return to a simmer, and cook until just before it’s reached your desired tenderness. Add any leafy greens. Cook for 5 minutes. Enjoy!

Don’t be so rigid! Measurements are suggestions. Kick up the spices, chunk up the vegetables, use three types of beans. Less onion, more garlic, spicy salsa. Wing it.

cado. ooms, tomatoes, and avo Chickpea Chili with mushr 58 i m a g e h e a l t h w a t c h • 2 0 1 8

to yo ur hea l t h

IT’S EASY WITH APPLIANCES FROM MAIN STREET KITCHENS

Mix Up a Healthy Lifestyle “At Main Street Kitchens in Hanover, we strive to provide you with the

THE BREVILLE BOSS TO GO SPORT

CUISINART 5-TRAY DEHYDRATOR

tools and equipment necessary for your healthy lifestyle and kitchen needs,” says David Barrette, who with his wife Kaitlyn acquired the downtown store in June.

One of the newer products in the store is the Breville Boss to Go Sport, a compact and convenient blender for people on the go. “This appliance makes it simple to make a nutritious shake or smoothie quickly and then bring that same vessel you blended it in to work or school,” Michael explains. “You can blend whole fruits and vegetables, fiber-filled nuts, and leafy greens into a removable cup that you can simply grab and go.” The Breville Boss to Go Sport also features Bluetooth technology, which enables you to keep track of the nutritional value of your smoothies, and the blender’s app can assist you with shopping lists and selecting from hundreds of recipes.

Another new item in the store is the Cuisinart 5-Tray Dehydrator, which is indispensable for preparing “raw” cuisine. Raw food has not been refined, canned, or chemically processed and has not been heated above 118 degrees F. Raw cuisine has grown in popularity for its health benefits; enzymes and vitamins in fruits and vegetables aren’t denatured or destroyed by heat.

“My favorite item to make with the dehydrator is beet chips,” says Michael. “It’s a perfect way to make a healthy snack that feels like it should be a cheat, and the dehydrator’s five trays allow you to prep in bulk for the week.”

Michael and Kaitlyn are stocking many other healthy lifestyle options in the store, so stop in to see them soon.  Main Street Kitchens 24 South Main Street Hanover, NH (603) 643-9100 main-street-kitchens.com www.uppervalleyimage.com •

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a ch iev in g b alan ce | STORY BY SUSAN NYE  PHOTOS BY MIRIAH WALL

OPEN DOOR INTEGRATIVE WELLNESS

Helping You Live Your Best Life When it comes to health, Kate Gamble, founding partner of Open Door Integrative Wellness, likes to think outside the box. “Health care isn’t linear,” she says. “You need to look at health and well-being from multiple angles.” When Kate and her team begin work with a new client at Open Door, they want to understand what quality of life means for that individual. “It’s important to understand their values, choices, and limitations.

At Open Door, we look at all aspects of a person—mind, body, and spirit,” says Kate.

Founded in 2014, Open Door has grown steadily. From worldclass athletes to people challenged by the basics of daily life, the goal is to meet people where they are. Perhaps you want to carve a minute off your 10k time or enter a triathlon. Maybe you’re having trouble sleeping or suffering from stress and anxiety. Or your issues might include balance, strength, and flexibility. The Open Door team can provide options and tools to help you achieve your most successful life.

A Unique and Integrated Approach Trained as a dancer, Kate added a master’s degree in physical therapy from the Mayo Clinic to her tool kit. Specializing in neurological problems, she has 30 years of experience. This combination of dance and focus on neurological issues produces a unique approach to problem solving.

“With neurological problems, there is always a team of practitioners,” says Kate. “We see the patient and the problem from a variety of viewpoints and interdependencies.” As for dance, it not only helps many of her clients with movement concerns but also sharpens her own creative thought processes.

A diversity of personnel and a wide range of services, classes, and workshops are Open Door’s key strengths. Dedicated physical therapists, massage therapists, acupuncturists, personal trainers, mental health counselors, as well as fitness, martial arts, and dance instructors make up the team. Working together, they gain an understanding of the many facets of your health goals or challenges to help you achieve the best results.

Mark Laser, a lecturer at Dartmouth’s Thayer School of Engineering, was diagnosed with multiple sclerosis more than 20 years ago. He has been wheelchair-bound since 2009. Mark began working with Kate soon after she opened. “My ultimate 60 i m a g e h e a l t h w a t c h • 2 0 1 8

Left: Kate Gamble, BFA, MSPT, founder.

Below, from left: Massage therapist Julie Clemons and her daughter Walker.

Aerial yoga.

“AT OPEN DOOR, WE LOOK AT ALL ASPECTS OF A PERSON— MIND, BODY, AND SPIRIT,” SAYS KATE.

DANCING FOR PARKINSON’S It started as an experiment in Brooklyn. Could a creative dance class improve the lives of people with Parkinson’s disease and other neuromotor conditions?

The Brooklyn Parkinson Group approached the Mark Morris Dance Group for help. The experiment became an ongoing program in Brooklyn. Outreach and training to dance instructors throughout the world has continued to grow and spread the program.

The classes are built on the fundamental premise that professionally trained dancers are movement experts, and their knowledge is useful to people with neuromotor

challenges. Stretching and strengthening muscles, balance, and rhythm as well as concentration are fundamentals of dance.

Movement and choreography from modern dance and ballet as well as improvisation engage the participants’ minds and bodies.

The students as well as their families and caregivers come together for an engaging social hour and the joy of dance for dance’s sake.

Kate Gamble trained with David Leventhal from the Mark Morris Dance Company and leads the class at Open Door Integrative Wellness. www.uppervalleyimage.com •

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a c h iev in g b alan ce

Britton Mann, partner and Doctor of Acupuncture and Oriental Medicine.

“Our goal at Open Door is to meet you where you are and help you achieve better balance,” says Britton. goal is to walk again,” he says.

While he has made significant progress, the path has not always been straight or smooth.

He says, “I know I need to strike a balance. I don’t want to be obsessively driven and end up feeling awful if I miss a milestone.”

Mark finds Open Door’s integrated approach very beneficial.

In addition to working with Kate, his treatments include massage therapy, Shamanic energy sessions, and acupuncture.

“Not only does the team work together for me—I am part of the team. It is a symbiotic relationship,” says Mark. “When I’m at Open Door, I don’t feel like a patient. I feel like a whole person.”

Susan Gillotti met Kate when her husband Al was having balance problems after brain surgery. “Kate was amazing,” says Susan. “She got Al up and walking. She was able to get him to do things I never could. There were huge improvements—and she made him laugh too.”

Open Door is now working with Susan on her health goals.

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A registered nurse with a master’s degree in nutrition, Holly Westling has helped Susan change her diet without feeling deprived. “Holly has given me a new perspective on food.

Food is exciting again but in a new, healthy way,” says Susan.

Although she doesn’t feel the loss, she has given up sugar and refined carbohydrates and dropped 15 pounds. A writer, Susan says, “I have more energy and I’m feeling more creative.

I have a wonderful new life.”

Achieve Better Balance Britton Mann, Doctor of Acupuncture and Oriental Medicine, became a partner at Open Door about a year and a half ago. In addition to sharing Kate’s holistic approach to wellness, he has a lifelong interest in traditional Asian healing and martial arts. “The stresses and trials of life can take you out of balance. Our goal at Open Door is to meet you where you are and help you achieve better balance,” says Britton.

While Britton takes an Eastern approach to healing, he sees many of the same problems Western doctors do. “People come to me with headaches, autoimmune issues, gastrointestinal problems, fibromyalgia, aching joints, and insomnia,” says Britton.

Instead of writing a prescription, he looks at the entire ecosystem—a person’s lifestyle, relationships, communities, nutrition, and physical and emotional health.

Hailey Swett, a senior at Sharon Academy, began seeing Britton more than a year ago when a bad case of Lyme disease triggered an autoimmune disorder.

Already a dance student at Open Door, it was important for her to keep moving and regain her strength.

“Dance is good for me in so many ways,” says Hailey.

“It helps me express myself and feel good about myself. After a day at school, it calms me down, destresses, and centers me. I’m re-energized after dance class.” After her Lyme disease diagnosis, she began acupuncture and herbal remedies to ease pain and inflammation. She also worked one-on-one with Kate to ease back into her dance classes.

Peter Graves of ski announcing and commentary fame spends about 100 days a year on the road. “I sit a lot. I sit in airplanes. I sit when I work,” Peter says.

A cross-country ski racer in college, he admits, “My fitness level has all but disappeared.” Things got worse when he pulled his back out at the Olympic games in South Korea. He was in agony by the time he got home to the Upper Valley.

Peter started to work with Kate on stretching and flexibility. Finding success, he added massage, acupuncture, and mindfulness to his treatment. “Open Door has been a godsend. I’ve made good progress.

I feel better, have dropped some weight, and sleep better,” says Peter.

“As soon as I walk through the door, I relax. From the calming colors to the smiles all around, I feel welcome,” says Susan Gillotti. Kate, Britton, and the entire team look forward to welcoming you at Open Door soon. 

Open Door Integrative Wellness 18 North Main Street White River Junction, VT (904) 626-5284 www.opendoorwork shop.com

hea l t hy ha b i t s

Benefits of Yoga IMPROVE PHYSICAL AND MENTAL WELL-BEING

The health benefits of practicing yoga are many—both physical and mental. Besides improving flexibility, strength, and balance, the meditating and breathing aspects of yoga can increase calmness and reduce stress, improving mental well-being as well. In addition, yoga’s relaxation techniques can help relieve the chronic pain of arthritis, headaches, and lower back pain.

If you’re a beginner, don’t worry. Because there are hundreds of styles of yoga and modifications for every pose, your fitness level does not matter.

PHYSICAL BENEFITS OF YOGA INCLUDE: Increased flexibility Increased muscle strength and tone Improved respiration, energy, and vitality Cardio and circulatory health Protection from injury COGNITIVE BENEFITS INCLUDE: Increased mental clarity and calmness Increased body awareness Relieves chronic stress patterns Relaxes the mind Centers attention and sharpens concentration  Source: American Osteopathic Association, osteopathic.org

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BY SARA TUCKER PHOTOS BY LYNN BOHANNON

Living the Good Life With Age Comes Insight HOW TO STAY HEALTHY AND ENJOY LIFE AS WE AGE: THAT IS THE BURNING QUESTION FOR AMERICAN BABY BOOMERS WHO ARE NOW TURNING 65 AT THE RATE OF 10,000 EACH DAY. When Health Watch asked six very active Upper Valley residents between the ages of 67 and 88 how they make the most of this phase of their lives, several themes emerged. Among them are community involvement, intellectual pursuits, and fitness activities that they enjoy.

Most preferred exercising in a group, finding the social aspect motivating. One 87-year-old plays tournament tennis; another likes to kayak on the Connecticut River. A 72-year-old skis at Okemo 20 times a year on average, clocking himself at speeds up to 35 miles an hour. A 67-year-old takes a modern dance class; a 68-year-old hikes with a group of friends. Another theme is the pleasures of teaching and learning. All six men and women, along with their spouses, like to travel and find it stimulating. Several spoke about resilience and the need to rebound from life’s setbacks. Finally, all, without exception, spoke about the importance of optimism and looking on the bright side.

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66 i m a g e h e a l t h w a t c h • 2 0 1 8

JEAN BROWN, 67

singer, dancer, organizer A former actress, public relations director, and congressional candidate, Jean now heads the Friends of Norris Cotton Cancer Center. At 67, she has no immediate plans to retire.

KNOWING WHEN TO MAKE AN EXIT

I was an actress for 12 years, and my career was rolling so fast I could barely hold onto it. Then it plateaued, but I had achieved what I wanted, so it was okay. I wanted to stop working nights and weekends when everybody else was playing.

MAKING ROOM FOR THE NEXT GENERATION

I have staff, and they need to shine, which means I have to train and groom and not always be center stage. It’s about sharing. You have to ask yourself, “How is this going to continue without me?”

ON HAVING KNEE SURGERY

Some people would be happy just to be without pain, but I wanted more.

I wanted my leg back. It took a long time and lots of physical therapy and lots of working out, but now I’m able to play tennis for the first time in 30 years.

ON FLEXIBILITY I believe that flexibility and stretching are key as you get older. I take a Martha Graham dance class at Dartmouth— the woman teaching it is four years older than I am.

ON RETIREMENT I can’t say that I know the shape of it yet.

It’s like going to college when you don’t know what your major is. You say, hmm, I could do this, or I could do that. Maybe I’ll go back to the theater. Who knows?

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DONNA PALATUCCI, 68 teacher, learner, fighter for social justice A specialist in early childhood education, a church deacon, a cancer survivor, and the mother of two, Donna retired at age 62 so she could spend more time traveling with her husband. At 68, she is cancer free and enjoying life to the fullest.

ON BEING DIAGNOSED WITH CANCER

ON FRIENDSHIP

All I could think of was, I have to see my children graduate. My son was in his third year of high school and my daughter was in her second year of college. So that’s what I hung onto—and also that I wasn’t ready yet. I thought, whoa, wait a minute, there’s tons to do yet.

I just came back from my 50th high school reunion, and I can’t believe how much fun I had. My cheeks hurt from laughing, and my legs hurt from dancing so much. Some of these people I went to kindergarten with; we danced together at pajama parties when we were 13. They’re threads in the quilt of my life.

ON FEAR

I had lost both my parents early to cancer, my mother at 62 and my dad at 48, so when I heard those words, “You have breast cancer,” I thought, wait, I thought I had done my time with cancer. How can this be? I’m very much an optimist, and I had never been so scared.

ON ASKING FOR HELP

I knew I could lean on my friends because they could lean on me. That was never a question—but the asking part? It’s hard learning to say, “You want to come and make dinner for my family? Thank you. I would appreciate that.”

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ON SPEAKING UP

I was a protestor in college. There’s always been that part of me that has to fight for the underdog. I hope I never lose that passion for justice.

ON GOALS

I’m building memories for my children because I would have liked that with my own parents.

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DAVID HENDERSON, 72 scientist, skier, musician David, 72, and his wife are among the younger residents of Kendal, a retirement community in Hanover. Among his passions are skiing, music, and his two grandchildren, who were born a few months apart this year.

LIVING IN A RETIREMENT COMMUNITY

One of the best things about living at Kendal is the constant social connection.

I went down to get the paper today, and it took me 45 minutes because I kept stopping to chat with people.

LIVING WITH A BACK INJURY

I’ve had ongoing back problems, so I have a physical therapy routine that takes about 15 minutes. It’s classic crunches and leg lifts and bridges and pushups, and I do that basically every day. I also do a circuit class that pretty much does weight training for every muscle group, and my wife teaches spinning, so I take her class when I can’t bike outside. I have to keep myself in good shape all summer so I’m ready for ski season.

EXERCISING THE BRAIN

After a couple years of retirement, I started teaching chemistry again online.

It keeps the science part of my brain active.

I also get a lot of intellectual stimulation through music. This fall, I’ll be in four singing groups, and one of them is very challenging. We’ve sung in Armenian and Ukrainian, as well as French, German, Spanish, English, and Latin, and the music is hard. It’s also a really fun group.

ON BABYSITTING FOR A NEW GRANDCHILD

It’s a wonderful challenge, and we love that we can help out, but after three days of taking care of little Maddie, it took about four or five days to recover!

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RAYMOND MALLEY, 87 teacher, writer, tennis athlete A former US diplomat, Ray, 87, teaches courses in international relations at the Osher Lifelong Learning Institute at Dartmouth, plays tournament tennis, and has just published his third book, Cold Waters, an account of his travels in polar regions.

ON LIFELONG LEARNING

I’m a massive believer in education. The more education the better, formal and informal, at every age. I’m constantly working on my course on US diplomacy for Dartmouth’s extended learning program. I know the topic well, but there are always gaps to research. I also dabble in oil painting, and I want to get better.

And I have notes for three more books.

One is tentatively titled Thoughts at 85, but I haven’t gotten very far. Maybe I should drop it and start Thoughts at 90.

ON PURSUING A HOBBY

It’s important to have something that you pursue seriously outside of your main act. You might call it a hobby. My main acts have been diplomacy and business, but I have also pursued tennis and the history of vaudeville. You might study chess seriously or be a devotee of Shakespeare’s tragedies, or better yet, his comedies.

ON SETTING GOALS

I like to have some kind of workout every day. I work out on the treadmill.

I take long walks, and occasionally I play golf. I want to improve my tennis standings, which are now number 14 in my age group in the US and have declined in France.

ON OPTIMISM

I always think that the next year is going to be the best.

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TOM WILSON, 88 swimmer, kayaker, mentor Tom was a pediatrician in Princeton, New Jersey, before his retirement. A great-grandfather, he keeps in touch with younger family members through email and frequent visits. At 88, he enjoys masters swimming, cruising European rivers, and kayaking.

ON CHOOSING A RETIREMENT HOME

Both Joan’s and my parents had been in continuing-care retirement communities, and we felt that was worthwhile rather than staying in a big old empty house. We knew we wanted to travel, to be in an academic community, and a community where we were involved. We moved to Kendal in 2001; it’s the second-longest home we’ve ever had.

CONNECTING WITH YOUNG PEOPLE

We make a big effort to do things outside of Kendal. I swim on a masters swim team, and there are all age groups in that. We like the cultural things that Dartmouth offers, and I’m a big sports fan, so I go to quite a few Dartmouth sporting events. As a retired physician, I’m involved with the first-year medical students, and a group of us who are old folks meet with the fourth-year medical students for lunch and a two-hour discussion of what life is like for our age group and where we interact with medicine.

JOAN WILSON, 87

homemaker, music maker, community volunteer

Joan, a lifelong musician, sold her viola da gamba when she moved to Hanover because she couldn’t find other players, but music remains an important part of her life. She also enjoys her family, reading mysteries and biographies, travel, and community service.

ON THE GIFT OF MUSIC

I majored in music at Brown University and spent most of my life in Princeton teaching the recorder. I’m still playing it now. A group of us play four-person, eight-hand piano, and I also play with a gentleman who has some dementia but loves to play his cello.

ON DISCIPLINE

I had a bout of sciatica, and when it started coming back, my physical therapist said, “Well, are you doing your exercises?”

And I said no. And she said, “Do your exercises!” So I’ve been doing them every day—but never on Sunday.

ON GIVING ADVICE

I cannot give young people suggestions about what to do because what’s going on in the world today is so different from what my world was. My ambition was to finish college, get married, and have kids, but it’s not like that anymore. People say don’t do this, don’t do that, but that’s not right. Without change, we’d be stagnant, and we’d be in trouble.

ON BEING AN EARLY RISER

ON TEAMWORK

When we were scuba divers, swimming was a way of keeping fit, and we’ve kept that up since. The alarm goes off at 5:30, and within 10 or 15 minutes we’re in the pool. Then Joan walks and I jog a couple of miles, so we have most of our exercise done before breakfast.

I do the Prouty each year; it’s a fundraiser for cancer research. There’s an amazing camaraderie. We thrive on the idea that if you do things together for a positive purpose, that makes life after 65 pretty good. 

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BY ANNE RICHTER ARNOLD

IT ’ S NEVER TOO LATE TO START

THE BENEFITS OF

WALKING

OVER 50 You might say there’s no better exercise than walking, especially as we get older. The human body is perfectly suited for it; walking requires no special movements, and you can do it easily without any instructions or special equipment. It provides cardiovascular benefits and is also a weight-bearing exercise that strengthens muscles and bones. And you can do it for free, just about anywhere, at almost any time.

Researchers say walking reduces the risk of

31% and the risk of dying from a heart-related event by 32%. cardiovascular events by

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Taking regular walks for exercise reduced the risk of developing a physical disability by 41%.

“Adequate exercise not only helps to reduce stress and lower blood pressure, it has an equal benefit to using or adding a medication for depression or anxiety.”

—Dr. Erin McNeely, Internal Medicine, Primary Care at Alice Peck Day Memorial Hospital

Multiple Benefits One benefit to walking, as with any regular exercise, is weight control. Burning more calories and building muscle helps speed up your metabolism, and weight loss can be a large factor in preventing cardiovascular disease and diabetes. But longevity is an added bonus, whatever your age. In a 2015 study at St. George’s University Hospitals NHS Foundation Trust in London, researchers found that walking 25 minutes a day added up to seven years to participants’ life spans.

Another benefit is the improvement to your quality of life as you age.

Making walking part of your daily routine helps stave off disability as you age, allowing you to maintain your independence and be more likely to continue to live at home. Of all “activities of daily living” (ADLs), walking without assistance is the one that most accurately determines whether a person can continue to live independently.

In 2008, a study of elderly adults by the University of Georgia found that taking regular walks for exercise reduced the risk of developing a physical disability by 41 percent; this also contributes to the quality of life as we age.

FIND A WALKING TRAIL NEAR YOU

Balch Hill, Hanover, New Hampshire.

Photo courtesy of Hanover Conservancy

Our area is filled with walking trails,

walking trails to keep things fresh and

so if you decide to venture out from

interesting. Weather not cooperating?

your neighborhood or want to explore

They even have designated routes at

a new location, go to the Upper Valley

DHMC and the PowerHouse Mall on

Trails Alliance website.

their “Indoor Walking” web page!

Russell Hirschler, executive director

Need more choices? The UVTA

of the UV Trails Alliance, says, “At the

offers more resources, says Russell.

Upper Valley Trails Alliance (UVTA),

“Since 1999, UVTA has been working

we know the value of exercise and

to advocate for the maintenance, use,

walking in the outdoors, especially for

and development of trails, and

older adults. Walking outside for just

in 2014 we launched Trail Finder

five minutes a day has been proven to

(www.trailfinder.info), our online trails

improve health, decrease obesity, fight

database. Users can find any kind of

off certain kinds of cancer, and greatly

outdoor recreation they desire that

improve mental health, mood, and

suits their ability. Trail resources can

self-esteem. In the Upper Valley region

be sorted by activity, difficulty, geog-

in particular, trails and access are plen-

raphy, and type of access, and infor-

tiful. Virtually every town has trails and

mation about trail surface, trailhead

open space that they manage, and

directions and access, and permitted

even in-town walking will contribute

use can be found for every trail. With

to better health.”

over 400 trails in Vermont and New

Their Trails Directory by Town

78 i m a g e h e a l t h w a t c h • 2 0 1 8

Hampshire currently featured, Trail

(www.uvtrails.org/trails-by-town) is a

Finder gives you plenty of options to

fantastic resource for finding perfect

get outside and exercise.”

mood

All you need is a good pair of shoes. Those shown here have received top ratings.

Saucony Women’s ProGrid Integrity ST2 Walking Shoe

GET OUT AND TAKE A WALK “Regular exercise helps keep your muscles strong, joints limber, lungs clear, circulation moving, and mind alert. Walking is a wonderful low-stress form of exercise to accomplish this. Make sure you get your doctor’s approval and any specific limitations based on your personal health situation and have good supportive shoes.”

ASICS Men’s GEL-Tech Walker Neo 4 Walking Shoe

—Robin Palermo, Physical Therapist, Lake Sunapee Region VNA & Hospice

Getting Started According to a 2017 article from the American Council on Exercise (ACE), the best way for anyone, especially older adults, to start reaping the health benefits of walking as a form of cardio exercise is to simply walk at their own pace, using duration as a baseline and an indicator of improvement. ACE recommends walking at a moderate pace for as long as you feel comfortable and increasing that as you build strength and endurance.

Any age is a good age to begin a

walking routine. Start with as little as five minutes a day and work up to the minimum 150 minutes a week of moderate-intensity exercise that the CDC recommends for adults. The minutes can be spread throughout the week for whatever time period works best for your schedule.

According to ACE, walking is one of the most underrated forms of cardiovascular training, especially for older adults. Since many seniors have joint or balance issues that can prohibit them from taking part in more

New Balance Men’s M840v2 Running Shoe

Skechers Performance Women’s Go Walk 4 Pursuit Walking Shoe

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“Daily exercise doesn’t have to be formal—it can be informal, like walking, doing housework or errands, and gardening and still benefit the musculoskeletal, circulatory, neurologic, and digestive systems.”

—Gretchen Stokes, RN, Good Neighbor Health Clinic volunteer

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strenuous exercise like running or aerobics classes, walking can be a highly effective way for them to get the aerobic exercise they need to stay healthy.

Older adults have several special considerations regarding walking, especially outside, say ACE experts. They advise seniors to skip their walks during inclement weather, including high heat and humidity as well as very cold or icy conditions. And seniors who use a treadmill should make sure they use proper form, follow all safety rules, and be supervised if necessary.

Lace Up and Go If you assume you’re too old or too out of condition to get any benefit from walking, think again. In a 2014 trial conducted by the Journal of the American Medical Association’s Lifestyle Interventions and Independence for Elders (LIFE) research group, which included

more than 1,600 men and women between the ages of 70 and 89, researchers concluded that walking can be the key to maintaining health and mobility as we age, even if you start late in life.

All the participants were frail and out of condition, and none exercised regularly.

Half took part in an exercise program that included daily walking plus strength and balance exercises, and the other half participated in workshops on healthy aging that included some gentle stretching routines.

After two and a half years, those who exercised were 28 percent less likely to have become disabled (defined in the trial as the inability to walk about 400 yards without help) and 18 percent less likely to have had any episode of physical disability. The LIFE research group demonstrated that starting exercise at any age offers health benefits.

“Studies show a correlation in a decrease in Alzheimer’s disease and other dementiarelated conditions with people who regularly walk for exercise.”

—Mohamed Basha, RN, CEO, TLC HomeCare Services, Inc.

Take It from an Expert Liz Estabrook-Hatfield, an Upper Valley fitness professional, sees the benefits of walking and recommends this mode of exercise, especially to her older clients. “As we grow older, an active lifestyle becomes more important than ever to our health.

Getting moving can help boost our energy, maintain our independence, protect our heart, and manage symptoms of illness or pain as well as our weight,” says Liz. “Walking is a perfect way to either start exercising or use it as a springboard to other physical activities. It requires no special equipment, aside from a pair of comfortable walking shoes, and it can be done anywhere and for varying lengths of time,” she adds. Walking is something we are all familiar with; it can be done alone or with others and has multiple modifications providing progressions (walking, fast walking, stair walking, and hiking). When walking, we can explore different speeds and gaits to help maintain and improve balance and stability. Older adults can obtain significant health benefits with a moderate amount of physical activity, preferably daily. Walk your way to a healthy lifestyle and just keep moving!”

New Trails, New Friends ACE experts suggest that older adults can get more motivation to walk by finding friends or family members to join them daily or weekly. Many towns and cities have walking groups organized by their www.uppervalleyimage.com •

81

recreation centers, or you can start one with like-minded people in your neighborhood or area.

In Hartford, Vermont, the Wednesday Walkers meet at the Hartford Town Hall at 9am and carpool to the trailhead. Walks last about three hours, are free, and anyone is welcome to join. “The Wednesday Walkers program allows you to experience local hiking trails, socialize with new or old friends, and get some exercise as you enjoy some fresh air and take in the beauty of the outdoors,” says Jay McDonough, Program Coordinator at Hartford Parks & Recreation Department. Hikes are easy to moderately difficult and are offered in the fall, winter, and spring.

Upcoming hikes include Mt. Tom in Woodstock, Vermont, on October 17 and Boston Lot Lake in West Lebanon, New Hampshire, on November 7. For more information, contact the Hartford Rec Office at (802) 295-5036 or register online at www.hartfordrec.com.

In New Hampshire, the city of Lebanon’s Recreation and Parks Department has two more Rail Trail Walks scheduled this fall from 10 to 11am on October 19 beginning in Enfield and October 26 beginning in Canaan. Walks are free. Snowshoe walks on the Alice Peck Day Trails are set for February 1, 8, and 15, 2019, from 10am to 12pm.

“Our walkers say that the time spent walking goes faster because they have folks from the community to socialize with,” says Kristine Flythe, Recreation Coordinator at Lebanon Recreation and Parks. “It’s been a lot of fun, and we continue to try new walking programs every season.” For more information, call (603) 448-5121 or check online at lebanonnh. gov/246/Recreation-Parks.

With all the benefits and no barriers to getting started other than lacing up your shoes, there’s no reason not to start walking. And it’s never too late to make it a habit. With all the beautiful scenery and easily accessible walking trails nearby, why not grab a buddy and go for a walk?

The time you put in now to improve your health will make your golden years more independent and enjoyable.  82 i m a g e h e a l t h w a t c h • 2 0 1 8

body & mi nd | BY E. SENTEIO

8 REASONS TO CLEAR YOUR MIND AND FEEL BETTER

MEDITATE

WHY MEDITATE? Meditation calms the nerves, heals the body, and brings balance and peace to your life. Who doesn’t want that? When is the last time you spent time with you? Being quiet and intentional while focusing on your breathing helps to clear away the cobwebs, opening you to a new awareness. It’s likely you’ll recall a few things about yourself that you may have forgotten: You are an individual—not just a parent, a spouse, an employee, or a friend.

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bo d y & m ind TYPES OF MEDITATION Here are a few options to consider.

“Even just a couple minutes of meditation a day can show benefits—reduced heart rate and increased calmness and productivity.”

—David Edson, PT, Rehab Manager, Visiting Nurse and Hospice for Vermont and New Hampshire

Guided meditation is exactly that; a guide softly talks you through a series of visualization and relaxation techniques.

Mantra meditation: You repeat a word or phrase that helps you focus your mind away from distractions.

Mindfulness meditation: Focus on sensations of breathing and notice thoughts, emotions, sounds, and sensations.

Qigong (CHEE-gung) and tai chi (TIE-CHEE): Physical forms of meditation (no athleticism required) that focus on breathing, posture, and balance using slow, graceful movements.

Transcendental meditation, like mantra, aims for inner peace and deeper relaxation.

Yoga also focuses on movement and breathing through a series of poses.

Grant yourself 15 minutes. Get away from it all and get reacquainted with yourself. Don’t you deserve a measly 15 minutes all your own? Maybe as soon as you get up, before the day overtakes you, or at lunchtime, or right before bed. You don’t have to make time, you just have to claim it. Now, let’s be mindful.

HERE ARE EIGHT REASONS TO MAKE MEDITATION A HABIT:

1

It’s judgment free. There is no right or wrong way to meditate. Meditation comes in many forms. Find what works best for you.

2

It doesn’t have to be complicated. People often shy away from meditating, saying it’s too complicated or boring. Learn to love yourself, and you will never find your own company boring. Meditation is what you make it and what you take from it. It’s about changing your relationship with your thoughts and surroundings.

3

It reduces stress. Studies of mindfulness-based stress reduction (MBSR), as well as other forms of meditation, show reductions in depression, anxiety, anger, confusion, stress, high blood pressure, and more.

4

Anyone can do it. Anyone, at any age, can practice meditation. There are no physical, age, or space limitations. All you need is a little time; even as few as five minutes of meditation a day can adjust your mood . . . if you let it.

5

Practicing tai chi is said to calm and focus the mind and improve balance.

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It may help manage pain.

MBSR can be helpful for pain related to injuries and aging, as well as pain linked to conditions such as cancer, asthma, and heart disease, and with sleep problems.

“Anything that shifts your nervous system from chronic ‘flight or fight’ (sympathetic dominance) to ‘rest and digest’ (parasympathetic dominance) is desirable.”

—Dr. Randy Schaetzke, DC, DIBAK

6

No equipment is required.

Sit in a chair, on a rug, towel, pillow, or sand. Walk around the block, through the forest, across the street. Be mindful.

Breathe, let go. Breathe, let go. Repeat.

7

There’s an app for that! Download any of the numerous free meditation apps to get started with a guided meditation. Try a walking meditation app if that is more your speed.

8

You deserve it.

Really. Imagine 15 minutes with absolutely no demands on your time— not even from you. No emails, no phone calls, no meals, music, or television. It is quiet enough that you can hear your breath (or your guided meditation app).

Sit, be, breathe.

Sounds like a waste of time? Experts and practitioners disagree. Meditation is a proven, time-tested practice to improve your health and sense of well-being.

You have nothing to lose if you try it, and so very much to gain. Life happens.

Meditation is the calm in the eye of the storm. Peace is attainable, if you claim time for it.  www.uppervalleyimage.com •

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86 i m a g e h e a l t h w a t c h • 2 0 1 8

BY KATHERINE P. COX PHOTOS BY LYNN BOHANNON

Suspect It’s Lyme Disease?

PERSISTENCE IS KEY Woodstock resident Kristiana Ploss shares her harrowing ordeal

There’s not a person in New England who hasn’t heard of Lyme disease, first detected in 1975 in the southeastern Connecticut town of Lyme.

According to the Centers for Disease Control and Prevention, it’s caused by the bacterium Borrelia burgdorferi and transmitted to humans through the bite of the infected black-legged tick. Antibiotics were starting to be used as a treatment in 1980. Yet to this day, Lyme disease continues to evade a definitive diagnosis and treatment, leaving thousands of victims undiagnosed, misdiagnosed, or ignored—despite the fact that blood tests now exist that can affirm its presence.

Nevertheless, it took almost five years, numerous doctors, various incorrect diagnoses, and five positive blood tests before Kristiana Ploss of Woodstock finally found a doctor who listened to her and took her seriously. She doesn’t remember being bitten by a tick, nor did she have the typical bull’s-eye rash.

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A Life Disrupted A competitive figure skater since the age of 7, Kristiana, now 25, led an active life. She says her whole life centered on figure skating. She skated with the Skating Club at Dartmouth in Hanover, spent summers in Lake Placid, New York, at the Olympic training center, and traveled to rinks around New England competing and testing.

“I was a full-year skater,” she says.

In 2011, Kristiana entered the University of New Hampshire as an art history major. The following year, as a sophomore, she developed severe stomachaches and headaches, gained almost 150 pounds, and experienced crippling anxiety for the first time in her life. She saw the campus doctors, who encouraged her to see her primary care doctors at Dartmouth-Hitchcock Medical Center.

At first, they thought her symptoms might be related to HSP (Henoch-Schonlein purpura), a disorder that causes inflammation and bleeding in the small blood vessels. Kristiana had been diagnosed with it when she was five years old.

“It typically fades away as a child grows, as mine did,” Kristiana says. “There’s no real treatment, and conditions usually improve over time without treatment.”

Her doctors suggested she take more over-the-counter medicines for the headaches and try to figure out which foods might be contributing to her stomachaches. But these strategies didn’t help.

Her health continued to deteriorate during her junior year at UNH. Doctors next looked at her thyroid gland, specifically hypothyroidism, but that proved inconclusive. Things were getting worse, she says, to the point that her symptoms were affecting her quality of life.

“Socially, of course, but especially academically being at college. I’d miss class because I couldn’t get out of bed. I’d go days without wanting to eat,” she explains.

She tried to live a normal life at college, joining Delta Xi Phi Multicultural Sorority and becoming a founding member of the UNH Freestyle Figure-Skating Club, but these activities proved too difficult.

Persisting Despite the Pain In the summer of 2015, Kristiana’s parents said enough is enough. “My mother was concerned for my life. I think she thought if things continued, I’d die at an early age.” She was back at home by the end of the summer, continuing to make the rounds of doctors at Dartmouth-Hitchcock’s Heater Road clinic, “seeing whoever was available on the days I was so sick I had to see someone.” It was the same thing over and over, she says: HSP, thyroid, no answers. They suggested she try a dairy-free diet. That eased some of her stomach problems.

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Kristiana has incorporated yoga, meditation, nutrition, and mindfulness into her life and says these have made a huge impact on her health.

“I had five tests in total for Lyme, and every single one came back positive,” she says. “Every single time, we were told they were false positives.”

In the meantime, she enrolled online at Southern New Hampshire University in the fall of 2015 and earned a bachelor’s degree in graphic design and media studies in May of 2017. “Some days were really bad, and some were just mediocre. I tried to keep chugging along,” she says. Along with keeping up with her studies, she did a summer internship at the AVA Art Gallery and Art Center in Lebanon, started coaching figure skating in Woodstock and Hanover, and became an assistant in the After-School Program at Woodstock Elementary School.

“Every day I would wake up and not know what the day would hold, whether I was going to be sick all day.” She took the job at the elementary school because it required just a few hours in the afternoon; it was doable and all she could handle. From 2015 until 2017, she was still sick. “Nothing was getting better,” she says.

A Turn for the Worse In April 2017, Kristiana began experiencing additional problems. She developed excruciating migraines, and one morning after stepping out of the shower, her right leg gave out from under her and she fell. She thought she might have just slipped, but the same thing happened as she was getting dressed. “I couldn’t even stand up or put any weight on my leg at all,” she explains.

Once again, doctors discounted the cause of her symptoms. They suggested physical therapy for her leg, so she began going to Upper Valley Rehab to regain strength in her knee. In June her health took a turn for the worse. “I wasn’t able to get out of bed. I had no strength; everything was sore and hurt. I had migraines every day, and anything I ate made

Protect Yourself from Ticks About 30,000 cases of Lyme disease are reported to the CDC every year. Knowing how to prevent exposure to ticks will help reduce your chances of getting the disease.

Ticks live in grassy, brushy, or wooded areas, so you can get a tick bite gardening in your yard, hiking on trails, or cutting brush.

The CDC recommends treating your clothing with permethrin before going outside or using an insect repellent containing DEET. When you come back inside, carefully check your clothing and your body for ticks and remove them. Do a full-body check: under the arms, the back of the knees, on the head and hair, around the waist, and between the legs. Shower as soon as possible after being outside. Check your pets as well.

If you find a tick attached to your body, the American Lyme Disease Foundation recommends removing it with tweezers steadily by the head; do not twist it. Then place it in alcohol to kill it. Clean the bite area with a disinfectant and monitor the area for a rash within a few days to a month. Contact a doctor within 36 hours if you have a rash or exhibit other symptoms such as fever or fatigue. www.uppervalleyimage.com •

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me feel nauseated. I constantly felt dizzy, had what felt like a never-ending anxiety attack, and was covered in bruises.”

The doctors treated her for walking pneumonia, strep, and sinus infections. “I was just down and out,” she says. She had several blood tests to try to determine what was going on, and one came back positive for Lyme. The doctors said it was a false positive. More blood tests were done. “I had five tests in total for Lyme, and every single one came back positive,” she says.

“Every single time, we were told they were false positives.”

Finally, Kristiana—sick, angry, and frustrated—and her parents confronted the doctors and asked why they were dismissing the positive tests. “We felt they weren’t paying attention.” Once again, the doctors discounted the test results. “We could not understand why they wouldn’t even have a conversation about Lyme.”

Finding Dr. Segal Kristiana’s family called a close friend who had Lyme disease, and they were advised to find someone who would listen to Kristiana and take her seriously. She made an appointment with Dr. Larissa Segal, who Kristiana knew personally, at the Ottauquechee Health Center run by Mt. Ascutney Hospital.

“I told her everything. I sat with her explaining the whole story,” recalls Kristiana. Dr. Segal ordered another Lyme test. Within days, she put Kristiana on doxycycline twice a day for 21 days. “It’s a harsh medicine. It took a lot out of me,” she says. “But at the same time, I started to feel slightly better. I finally had someone who was listening to me. I felt like there was a light at the end of this long tunnel.”

They discussed magnetic therapy for Lyme disease, which uses magnets placed on various parts of the body to relieve pain, move the disease through the body, and expel it, Kristiana says. She found a practitioner in White River Junction, Jesey Joy, and started to see results almost immediately.

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“She started to turn the story around for me. For the first time in four years, I didn’t have a pounding headache.” She saw Jesey from July until October and also received guidance about foods to avoid, meditation, and yoga movement, pursuing a holistic approach that helped ease many of her Lyme disease symptoms.

However, by October, her progress had stalled.

“Things were better. I was getting through my day, and I wasn’t bedridden. But I still wasn’t back to myself.”

Dr. Segal put her on another round of doxycycline.

But the headaches persisted, so Kristiana underwent a neurological examination at Upper Valley Rehab out of Woodstock and Taftsville, Vermont, and began seeing physical therapist Josh Roylance.

Together they worked to alleviate the stress in her neurological system to help relieve and prevent headaches, starting with visits twice a week, now down to once every few weeks. “Physical therapy has made a huge difference in my headaches and in getting my daily life back, and it’s something I am continuing to help manage the headaches.” She also began a migraine prevention medication. “I started to get relief again,” Kristiana recounts.

Kristiana’s advice for people facing Lyme disease? “Keep pushing to get a doctor who listens to you.

Have a strong support system of people who listen and care about you.”

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Another Path to Wellness “Since November I haven’t had any active Lyme in my body,” she says. Last February, she stumbled on wellness coach Lauren Atwood’s Instagram posting, Blissfully Lively, and decided to contact her. “She changed everything for me.” They focused on movement, nutrition, and mindfulness. “She said I was going to get stronger, healthier, and happier.” Kristiana has incorporated yoga, meditation, nutrition, and mindfulness into her life and says these have made a huge impact on her health.

“Kristiana reached out to me at a point in time when she was feeling a bit lost on her wellness journey and connected with me in hopes that she could learn the tools to become healthier and more energized,” says Lauren. “We worked to root her choices in what would give her the most energy and freedom. Through moving daily, choosing only foods that energized her, and slowing down and being more present, she regained trust within herself, which created a positive domino effect throughout her life.”

Kristiana still has headaches, but “I’m living life now,” she says. “I’m back to coaching figure skating at Union Arena Figure Skating Club and serving on their board of directors.

I’m the director of Woodstock Elementary School’s After-School Program, and I am a freelance graphic designer working for businesses throughout the Upper Valley.”

She tries to live a holistic and healthy lifestyle, incorporating yoga and meditation to help her cope with her health struggles.

“I’m able to hang out with friends. I have a relationship. I’m happy again. I’ve lost the weight I gained and feel healthy,” she says.

“But some nights when I go to bed with a pounding headache, I’m reminded that it’s still there. Things aren’t fully resolved yet.”

Kristiana’s advice for people facing Lyme disease? “Keep pushing to get a doctor who listens to you. Have a strong support system of people who listen and care about you. We don’t realize until we need it how important one’s family and support system really are.”

More than anything, Kristiana says, listen to what your body is telling you, and do what helps you feel happy and healthy.  92 i m a g e h e a l t h w a t c h • 2 0 1 8

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Fall 20 18 no. 3 $4.95

ANOV ER

Share the wonder of our beautiful area and the latest news all year long with a Here in Hanover and image gift subscription. Friends and family who have moved away from the area will be especially appreciative.

Be sure to order a subscription for yourself too!

FALL 2018

arn Explore & nLeover

a with the H

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THE TH OF THE RILL HUNT W ITH

e Inn & The New Lym urant sta Ariana’s Re with CHaD Catching Up

NO RT H

CO UN

TR Y HO

UN DS

Explore the Sout Connechern ticut River Valley Celebra ting 100 New LoYears: ndon Hospita l

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www.mountainviewpublishing.com •

93

f in a n cia l he alth | BY MIKE MORIN

WHERE LONG-TERM CARE HAPPENS

Be Prepared for the Future BEING INFORMED IS KEY

A person at age 65 has a

70% chance

of needing some type of long-term care during retirement. But long term care doesn’t mean a nursing home.

51%

Home health care

31%

Nursing home

18%

Assisted living or adult day care Guaraldi Agency 21 Bank Street Lebanon, NH (603) 448-3250 www.guaraldi.com

94 i m a g e h e a l t h w a t c h • 2 0 1 8

We asked Tim Guaraldi what important points we need to be aware of when it comes to our insurance needs, at any time of life but especially as we age.

What types of financial services do you offer, especially for people looking toward retirement and estate planning?

We can provide LTC (long-term care) planning, retirement planning, and financial planning. We partner with other professionals from the local area or out of the area. Each client is different and may have different wants and needs—and some clients don’t have any idea. A lot of what we do is educate our clients so they can make informed decisions. LTC in particular is an area that is increasingly missed in the retirement planning process. The clients who get it are the ones who have had to take care of an elderly parent or spouse. It is exhausting to the caregivers, many times on top of their existing jobs. We work with clients to help them understand the importance of having a longterm care policy in place to help with the care and expenses that go along with taking care of a senior parent or spouse. LTC can be an important part of a well-planned retirement.

How can families use life insurance as a tool for planning financial security?

Life insurance is an important part of any family’s financial security plan, from paying off the mortgage or other long- or short-term debt, extending living-expense coverage and covering the cost of college, to planning for final expenses (funeral) and creating a trust for special-needs children. All these can be protected by purchasing life insurance. It just takes planning, and that’s the hard part for most families—finding the time to sit down and make a plan.

For those approaching or in the retirement phase of life, explain 401(k) rollovers with an eye toward tax-deferred strategies.

Everyone has a different risk tolerance when it comes to investing, especially when you are going into your retirement years. Did I save enough to last through my retirement? Have I been too conservative with investments? What should I do with my 401k, 403b, simple IRA, Roth IRA, or traditional IRA? My job is to help you work through those fears and ease you into your retirement. It is also to be honest with you and advise you when you may not have enough to retire and may have to continue to work full or part time. What are your plans and do they fit with your financial situation? 

ADVERTISERS INDEX Alice Peck Day Memorial Hospital 58

Johnson Audiology 29

Amy Tuller, Registered Dietitician Nutritionist 35

Lake Sunapee Region VNA & Hospice 3

Annemarie Schmidt European Face & Body Studio Back cover

Lou’s Restaurant 57

Appletree Opticians 85

Ledyard Private Banking 51 Main Street Kitchens 13 Mascoma Dental Associates 58

Baker Orthodontics 7

Mertens House 42

CCBA 92 ClearChoiceMD Urgent Care 15 Co-op Food Stores 64

Monarch Family Medicine 92 Mountain Valley Treatment Center 82

Springfield Medical Centers Inside front cover Springfield Pharmacy 82 Sugar River Kitchens Bath & Flooring 90 Summer Court Dental 11 Summercrest Senior Living 29 The Village at White River Junction 9 Therapy Works 30 TLC HomeCare Services 20 Upper Valley Oral Surgery 2

Dartmouth-Hitchcock Dermatology 81

Mt. Ascutney Hospital and Health Center Inside back cover

Dartmouth-Hitchcock Medical Center 5

Neely Orthodontics 90

Upper Valley Rehab 35

Good Neighbor Health Clinics 31

Open Door Integrated Wellness 81

Valley Regional Healthcare 41

Guaraldi Insurance 95

Powerhouse Hearing Center 46

Hanover Terrace Health & Rehabilitation Center 31

Quail Hollow 85

Visiting Nurse and Hospice for Vermont and New Hampshire 93

Hill Opticians 1

Randy Schaetzke, DC, Wholistic Health Services of Vermont 21

Historic Homes of Runnemede 57

Roger A. Phillips, DMD 23

Upper Valley Pediatric Dentistry 4

White River Family Eyecare 80 Woodcrest Village 91

For more information about print and online advertising opportunities, contact Bob Frisch at (603) 643-1830 or email rcfrisch1@comcast.net.

96 i m a g e h e a l t h w a t c h • 2 0 1 8