Image Magazine's Health Watch - 2019 Edition

$4.95

FALL 2019

image/health watch

healthwatch IMAGE MAGAZINE’S

lifestyle, fitness & nutrition

ENDING THE STIGMA OF MENTAL ILLNESS FALL 2019

SLOWING DEMENTIA

LIFESTYLE MATTERS

1 i m a g e t re n d wa t c h • 2013

Be HEALTHY at EVERY AGE NUTRITION & FITNESS TIPS

CONTENTS FEATURES

28 MASCOMA COMMUNITY

DEPARTMENTS

76 Living Well

HEALTH CENTER

14 Word on Health

Affordable, effective care at the grassroots level.

by Nancy Fontaine

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

Listen up!

by Pamela Brown

35 BE HEALTHY AT EVERY AGE

Caring for Upper Valley families.

Ensuring an active life for the long run.

by Katherine P. Cox and Amy Tuller, RD, LD, CDE

48 KEEPING AN EYE ON NUTRITION

Protect this vital sense for the long haul.

by Dr. Dorothy L. Hitchmoth

56 CARING FOR WOMEN

22 Community 24 To Your Health 8 tips for clean eating.

by Kristy Erickson

64 Financial Well-Being Comprehensive wealth management.

by John O’Dowd, CTFA, Ledyard Financial Advisors

66 Wellness Quiz

90 Financial Health Caldwell Law can help.

by Renée A. Harvey and Timothy W. Caldwell

99 Healthy Solutions Quality pet food counts.

by Elaine Ambrose

102 Smart Strategies Four ways millennials can start saving for retirement.

by Tina Blythe, Sugar River Bank

104 Advertisers Index

IN CRISIS

WISE and SANE collaborate in survivor-centered care.

by Anne Richter Arnold

68

ENDING THE STIGMA OF MENTAL ILLNESS Upper Valley advocates weigh in.

by Elizabeth Kelsey

78 BE A SAVVIER TRAVELER! 10 tips to avoid getting sick.

by Lisa Ballard

84 COMPLETE CARE: MIND, BODY, SPIRIT

Integrative medicine benefits long-term health and happiness.

by E. Senteio

92

SLOWING THE PROGRESSION OF DEMENTIA A healthy lifestyle and staying engaged can help patients and caregivers alike.

by Susan Nye

46 Healthy Choices A guide to goods and services in the community.

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“Health is a state of complete mental, social, and physical well-being, not merely the absence of disease or infirmity.”

– World Health Organization, 1948

healthwatch IMAGE MAGAZINE’S

FALL 2019

lifestyle, fitness & nutrition

Mountain View Publishing, LLC 135 Lyme Road Hanover, NH 03755 (603) 643-1830

www.uppervalleyimage.com 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

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© 2019. All rights reserved. Reproduction in whole or part is strictly prohibited. Health Watch magazine accepts no responsibility for unsolicited manuscripts, artwork, or photographs.

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e d ito r ’s note | BY DEBORAH THOMPSON

Healthy Choices

W

elcome to the third annual issue of Health Watch. The staff and I have enjoyed putting

it together for you. We’ve reached out to many local P HOTO BY I A N R AYM O N D

health care professionals and included their best advice for living a healthy lifestyle. We think you’ll appreciate what they have to say, and we hope you take it to heart. (Pun intended!)

We’ve noticed a common thread running through several of our articles. It seems no matter what aspect of good health we’re discussing, every part of the human body and all its systems benefit from good nutrition. Dietitian Amy Tuller outlines nutrition guidelines for us at every age, and Dr. Dorothy Hitchmoth reinforces that information with a list of foods that provide essential vitamins, minerals, and other nutrients we need to maintain healthy vision for a lifetime. Besides our eyes, eating well benefits the heart, the digestive system, the mind—the whole body.

A balanced diet including lots of fruits and vegetables, whole grains, and lean protein is the basis for achieving and maintaining maximum health. It sounds so simple, doesn’t it? Yet we struggle to eat better and, for the sake of convenience, often opt for processed foods and even fast foods, which can be packed with harmful preservatives, artery-clogging fat, unhealthy fillers, and way too much salt and sugar. After reading the articles in this issue, make a commitment to give up at least one unhealthy eating habit, or at least cut down on some of the harmful ingredients you may be consuming—often unwittingly. Always read labels!

We’d love to hear from you, so please send your feedback to me at dthompson@ mountainviewpublishing.com. Here’s wishing you well-being and a healthy life!

Deborah Thompson Executive Editor dthompson@mountainviewpublishing.com

LIKE US www.mountainviewpublishing.com/facebook www.uppervalleyimage.com •

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word on health N E W S , T I P S , A N D I N F O R M AT A T II O ON N F FO OR R YO Y OU UR R W WEELLLL--BBEEIIN NG G

THE LATEST ON E-CIGS If you’re the parent of a teenager, chances are e-cigarettes have made it onto your radar. E-cigarettes, which are sometimes called e-cigs or vape pens, are electronic devices that heat a liquid that usually contains nicotine, fl avorings, and other chemicals and produce an aerosol. Some look like cigarettes or pipes, while others look like pens, USB fl ash drives, and other everyday items.

Thanks to e-cigarettes, nicotine use among teens is soaring— and research shows that many teens don’t know they’re vaping nicotine. According to the National Institute on Drug Abuse for Teens, young people who use nicotine are at risk for long-term effects, including learning defi ciencies, a decrease in attention span, mood disorders, decreased impulse control, and increased likelihood of using drugs. What can parents do to prevent their child from using e-cigarettes or help them stop? First, set a good example by being tobacco-free. Talk to your teen about why e-cigs are harmful. For more information, visit e-cigarettes.surgeongeneral.gov.

“I try to reinforce to teens that lungs are designed for one thing and one thing only—breathing air. Anything else you put in them is going to cause inflammation, damage, and health problems.”

—Clare Drebitko, MD, Ottauquechee Health Center

“I am deeply concerned by the rapid

rise of e-cigarette use across all ages.

As we are only now shockingly learning about the lung damage that can result from a single use, we still do not know the long-term effects. Nobody should consider e-cigarettes a safe alternative to smoking.”

—Marcus Hampers, MD, CEO of ClearChoiceMD Urgent Care

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Source: National Institute on Drug Abuse; National Institutes of Health; US Department of Health and Human Services

word on health

“Everything that slows us down and forces patience, everything that sets us back into the slow circles of nature is a help. Gardening is an instrument of grace.” —May Sarton Dial Down the Stress

YOUR PARENTS MAY NEED HELP Sometimes it’s obvious when aging parents need outside help, like when they’re managing an illness or losing mobility. But cognitive issues may not be as easy to spot. Forgetfulness is a normal sign of aging, but it could signal something more serious, such as dementia. Be aware of a few warning signs that require a doctor’s visit: • Foods that are well past their “use by” dates or an empty fridge are signs your parent may not be eating properly.

• Soiled clothing and linens are a sign that they’re neglecting personal

Stress is a part of everyday life, but how you manage it determines how it affects your physical and mental health. First, never underestimate the power of a few deep breaths. Breathing deeply slows your heart rate, lowers blood pressure, and reduces the production of stress hormones like cortisol. If things get stressful in your household, inhale slowly and deeply through your nose. Hold your breath for two to four seconds and empty your lungs by slowly exhaling through your mouth.

Repeat four or fi ve times until you feel the calming effects.

Encourage your spouse and kids to do the same when tensions rise.

hygiene.

• Piles of unopened mail and past-due bills could indicate that they’re not able to manage their finances.

• Difficulties having a conversation, such as repeating the same story or asking the same question, might be signs of memory loss.

Accompany your parent to a doctor’s appointment to bring up these issues.

Additionally, the US National Institute on Aging has several tests that assess impairment. Visit www.nia.nih.gov/ health/assessing-cognitive-impairmentolder-patients for more information.

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DEEP BREATHING is one of the best ways to lower stress in the body.

This is because when you breathe deeply, it sends a message to your brain to calm down and relax.

DEEP BREATHING increases the supply of oxygen to your brain and stimulates the parasympathetic nervous system, which promotes a state of calmness. Breathing techniques help you feel connected to your body and bring your awareness away from the worries in your head and quiet your mind.

word on health

DRINK DAIRY-FREE MILK? YOU MAY NEED EXTRA CALCIUM

Feeling out of sorts?

HEAD FOR THE WOODS! A 2018 article in the journal Environmental Research conducted a systematic review and meta-analysis of the health outcomes of green space exposure. As you might guess, the authors identified significant and far-reaching human health benefits of spending time outside and close to nature, including but not limited to reducing risks for type 2 diabetes, stress, hypertension, cardiovascular disease, and even preterm labor.

The researchers from the University of East Anglia Norwich Medical School gathered evidence from more than 140 studies (almost 300 million people) to determine whether time spent in nature could boost human health.

Samples included populations in the UK, US, France, Germany, Australia, and Japan, where Shinrin yoku (forest bathing) is a common practice.

The team analyzed how the health of people with little access to green spaces compared to that of people with the highest amounts of exposure. Significantly, the researchers found that exposure to green space reduces levels of salivary cortisol, a physiological marker of stress. According to the authors, the mechanism may involve phytoncides, organic compounds with antibacterial properties released by trees. The researchers added that being exposed to a variety of bacteria might benefit the immune system and reduce inflammation.

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Many milk alternatives are available, including those made from soy, rice, almonds, coconut, and oats. But these products may not contain as much calcium and protein as dairy milk. For kids, athletes, and seniors looking to increase their calcium and protein levels, soy ranks highest among alternative milks. A well-balanced diet and a daily multivitamin will provide the calcium needed for healthy growth and bone development.

For adults and seniors, supplements specially formulated for bone health will provide additional support. Talk to your doctor about your calcium levels to be sure you’re getting enough of this critical mineral.

“SLOW DOWN—YOU MOVE TOO FAST” Simon & Garfunkel had that right! Surrounded by technology touted to save us time, we seem to lead increasingly more hectic lives. Multitasking is considered a virtue by many. But in reality, it’s made us less focused, more stressed, and less attentive to those who matter most.

Make an effort to consciously slow yourself down.

Aim to do only one thing at a time.

Disconnect from technology whenever you can.

Remember to breathe.

Eat more slowly; savor flavors, textures, aromas.

Enjoy time with loved ones.

Learn to be present in the moment.

Replace your to-do list with a to-be list (to be still, to be calm, to be quiet).

Listen more than you speak, relax more than you rush.

Live in the moment.

Don’t confuse relaxation with not being productive.

Remember that you are a human being and not a human doing.

“There is more to life than increasing its speed.”

—Mohandas K. Gandhi

word on health Know Your Cardiorespiratory Fitness You may know your blood pressure and cholesterol numbers, but do you know your cardiorespiratory fitness level? According to the American Heart Association, this number may be an even better gauge of heart health. Cardiorespiratory fitness measures how aerobically fit you are and how effectively your circulatory system sends oxygen throughout the body. Poor aerobic fitness is linked to a high risk of heart disease, and it’s as dangerous as chronic illnesses and smoking.

Cardiorespiratory fitness is the one risk factor not routinely checked at doctor’s visits, so you have to request it. Your doctor will measure your maximal oxygen consumption (VO2 max) from readings while you do an aerobic workout. To get a general idea of your cardiorespiratory fitness, visit world fitnesslevel.org and fill out an online questionnaire.

Activities such as running, swimming, and bicycling improve cardiorespiratory endurance.

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co mmu n ity

CARING FOR UPPER VALLEY FAMILIES

LOCAL ORGANIZATIONS OFFER A DAY OF DISCOVERY

Dartmouth-Hitchcock and the Hanover Area Chamber of Commerce are partnering to provide an interactive event, the Upper Valley Health & Wellness Fair, on Saturday, October 12, 2019, from 10am to 2pm at the Hilton Garden Inn, Lebanon, New Hampshire. The event is free and open to the public. Over 30 area organizations will participate with free medical screenings, demonstrations, giveaways, and wellness education. Visit uvhealthfair .org to learn what each organization will be offering.

The Hanover Area Chamber of Commerce is proud to facilitate this community event in partnership with Dartmouth-Hitchcock. “Our organization is comprised of businesses and organizations from all around the Upper Valley. Nearly 20 percent of our membership are nonprofits and approximately 11 percent are health care related,” says Tracy Hutchins, president of the Hanover Area Chamber of Commerce. “We hope this event will reinforce these characteristics of our community and enable the Upper Valley to be an example of how to create a healthy, happy culture.” 

Saturday, October 12, 2019 10am to 2pm Hilton Garden Inn Lebanon, New Hampshire FREE and open to the public Screenings, activities, and demos 22 i m a g e h e a l t h w a t c h • 2 0 1 9

to yo u r he alth | BY KRISTY ERICKSON

8

TIPS FOR

CLEAN

EATING GET BACK TO BASICS TO NOURISH YOUR BODY

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WHAT ARE THE BENEFITS OF EATING HEALTHY? Weight loss Reduced cancer risk Diabetes management Heart health and stroke prevention The health of the next generation Strong bones and teeth Better mood Improved memory www.medicalnewstoday.com

YOU’VE PROBABLY HEARD OF CLEAN EATING, but how exactly would you go about cleaning up your own diet? Some clean-eating plans have a lot of rules; one may recommend detoxing or juicing, while another recommends eliminating entire food groups (like grains or dairy). Overly restrictive diets aren’t realistic or sustainable—and they take away the joy of eating! Clean eating can be simple and nourishing. At its core, it’s a dietary pattern that focuses on fresh, whole foods that are as close to their natural state as possible. Here are some general guidelines that will help you move toward a cleaner diet.

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1. Eat more fruits and vegetables.

Fruits and veggies are loaded with fiber, vitamins, minerals, and other plant compounds that fight inflammation and reduce the risk of many diseases, including heart disease and cancer.

Plant-based foods should form the basis of a clean-eating diet. Incorporate fruits and veggies into every meal and make salads and other dishes as colorful as possible.

2. Choose organic when it’s available, but don’t fear conventional produce.

Organic farming methods use fewer toxic pesticides, which is good for both human and environmental health. Local produce is also a great option, and farmers’ markets offer shoppers opportunities to chat with those who grow the produce about their use of pesticides (they may use nontoxic pestmanagement methods or fewer pesticides than conventional farming but have not taken the steps to become certified organic). At the grocery store, choose organic versions of fruits and veggies that contain the most pesticide residue, including berries, spinach, apples, and grapes. But if your budget doesn’t allow for organic or it’s not available, just focus on eating more produce and washing it thoroughly.

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3. Go for whole grains.

Whole grains contain fiber, B vitamins, and minerals that support good health.

Refined grains like white flour and white rice lose one-half to two-thirds of their nutrients during the refining process. The most minimally processed grains include steel-cut oats, barley, quinoa, and farro. Look for whole-grain versions of pasta and bread.

4. Cut back on sugar.

If you’re trying to eat clean, it’s important to avoid added sugar. Limit sweets like soda and baked goods, and keep an eye out for sugar and high-fructose corn syrup in packaged foods like tomato sauce and cereal.

5. Always read labels.

To eat a cleaner diet, it’s critical to read labels.

Look for foods without sugar as the main ingredient. Cleaner whole-grain packaged foods will list whole grains as the first ingredient. Check labels and avoid foods with unpronounceable ingredients.

6. There’s no need to eliminate all processed foods.

Steer clear of packaged foods containing ingredients that look like a list of chemicals, including overly processed and sugary cereals and snack foods. Yogurt, nuts, canned tomatoes and beans, and frozen fruits and vegetables are also processed, but they’re on the clean end of the spectrum.

RULE TO REMEMBER: The healthiest foods don’t have an ingredients list.

7.

Make water your primary beverage.

Water is the purest and healthiest beverage you can drink. It has no additives, sugars, artificial sweeteners, or other questionable ingredients. Unsweetened coffee and tea (organic if possible) are also good choices.

8. Don’t be overly rigid.

Making a food off-limits or calling it “dirty” is likely to make that food even more tempting. Listen to your body, and if a food doesn’t make you feel good, then don’t eat it. Listen also to your heart—going out for ice cream occasionally with your family offers a different kind of nourishment, and in moderation, it won’t derail your clean-eating lifestyle. Be mindful of what you’re putting in your body, choose minimally processed and real foods in their natural state, and make healthy choices most of the time. You’ll boost your health and start to appreciate food in a new way. 

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“Our aim is to provide high-quality care close to home.”

Lobby and waiting area.

Opposite: Check-in station.

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BY NANCY FONTAINE

PHOTOS BY CPERRY PHOTOGRAPHY

Mascoma Community

HEALTH CENTER

Affordable, effective care at the grassroots level What do you do when your only options for health and dental care are 30 or 40 minutes away by car? For some enterprising people in the Mascoma towns of Canaan, Dorchester, Enfield, Grafton, and Orange, the answer was to open a local, nonprofit, independent clinic.

The Mascoma Community Health Center (MCHC) is a state of the art medical building at the corner of Route 4 and Roberts Road in Canaan. Opened in 2017, the 13,000-square-foot building is suffused with natural light and houses both medical and dental clinics and a lab, plus space for future behavioral health, physical therapy, pharmacy, and radiography services. In addition, the clinic hosts after-hours wellness activities, parenting programs, and an opioid addiction treatment program. www.uppervalleyimage.com •

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“Research has shown that primary health care can be delivered cheaper and more effectively at the community level,” says acting director Scott Berry (another volunteer).

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Clockwise from far left: Scott Berry, acting director. Kimberly Cotto, RN, and Karl Stanford, nurse practitioner, at the provider work station.

Jeanne-Marie Bolduc, dental hygienist. Jean Patten, coordinator for Medicare, Medicaid, and sliding-fee scale enrollment.

High-Quality Care Close to Home The idea for the health center emerged from several health care forums sponsored by the town of Canaan in 2013. Residents of the Mascoma towns were invited to discuss their concerns, needs, and options. Not willing to wait on federal or state governments or the existing health care industry to address their issues, volunteers formed a board, secured a USDA loan to build the clinic, and then raised local funds to supplement operations ($1.56 million to date). The 16-member volunteer board comprises residents of the communities, and most are patients.

Investments in rural health clinics can really pay off. “Research has shown that primary health care can be delivered cheaper and more effectively at the community level,” says acting director Scott Berry (another volunteer). “Our aim is to provide high-quality care close to home.”

“Accessibility is a big issue for our community,” says board member Karen Wolk. “You’ve got to make the long drive, and then there are the psychological barriers of dealing with a large hospital system. It’s a disincentive. With a local clinic, patients get care before problems become critical. I’ve seen patients who had been embarrassed by the state of their teeth go on to get better jobs after being treated by our dental team. It improves their self-esteem as well as their physical health,” she says. www.uppervalleyimage.com •

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“We take care of everyone. Our patients are a mix of those with insurance and those without.

We happily take Medicare and Medicaid patients and are seeing many patients from the wider Upper Valley region.”

Clockwise from above: Children’s corner in the waiting room.

Pediatric exam room.

Laboratory.

“We are looking for philanthropic support from those who value affordable health care for all.”

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A Solid Start and Future Outlook “Our sliding-fee scale for residents in the Mascoma towns makes care affordable.

Hospitals do that too, but it’s complicated and can be intimidating to patients,” says Scott. “And 85 percent of our staff live in these towns. Community providers are approachable,” he adds.

MCHC has been growing steadily, at about 100 new patients a month, and reached 3,000 patients in August 2019.

Scott states, “We take care of everyone.

Our patients are a mix of those with insurance and those without. We happily take Medicare and Medicaid patients and are seeing many patients from the wider Upper Valley region.”

Among MCHC’s major goals are becoming self-sustaining and being designated a Federally Qualified Health Center, which will bring substantial federal financial assistance. “To get there, we need to continue to subsidize our operating budget with donations for the next six to eight months,” says Tim Jennings, chair of the development committee. “We are looking for philanthropic support from those who value affordable health care for all.”

Mascoma Community Health Center has made a solid start. With a little help from the wider Upper Valley community, the health center can continue to deliver extraordinary services for years to come.  Mascoma Community Health Center 18 Roberts Road Canaan, NH (603) 523-4343 mascomacommunityhealthcare.org

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NUTRITION BY AMY TULLER, RD, LD, CDE FITNESS BY KATHERINE P. COX

BE HEALTHY ENSURING AN ACTIVE LIFE FOR THE LONG RUN

at

EVERY AGE

We all know the dos and the don’ts: Do eat healthy foods; don’t smoke. Do exercise regularly; don’t drink alcohol to excess. Do get sufficient sleep; don’t take drugs. But staying healthy through the ages requires more than that. Behaviors in our early years can affect our health later in life. What should we look out for? We asked nutritionists and fitness experts for advice on how to ensure good health for you and your children from the cradle to the golden years.

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AGES 0–12 IMPORTANT NUTRIENTS

NUTRITION

Calcium, vitamin D, vitamin K

Nutritional needs change greatly throughout this time period.

During the first year of life, infants increase their height by 50 percent and triple their weight. Because of this, requirements for macronutrients (carbohydrates, proteins, and fat) and micronutrients (vitamins and minerals) are higher than at any other stage in life, on a per kilogram basis.

For the first six months, breast milk is the best source of food

Macronutrients (carbohydrates, proteins, fats— especially unsaturated and omega-3 fatty acids) Iron

During the

first year of life, infants increase their height by 50 percent and triple their weight.

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to fulfill nutritional requirements for almost all infants, and they may require eight to twelve feedings per day to meet their nutrition and fluid needs. Breast milk also helps boost the baby’s immune system and lower the risk for respiratory diseases, gastrointestinal problems, allergies, and ear infections. All these benefits continue even after the baby is weaned.

Breast milk is low in vitamin K, which

is required for blood clotting, and babies are born with limited vitamin K stores, so initial supplementation may be necessary. Most babies receive a vitamin K injection right after birth.

Breast milk is also low in iron, an important nutrient for blood-cell manufacturing, growth, and intellectual development, but this iron is well absorbed. Breast milk can also be low in vitamin D, so a supplement may be needed.

A high-fat diet is necessary to encourage the development of neural pathways in infants and young children’s brains. Three especially important fatty acids are DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), and ALA (alpha-linolenic acid),

which are found in fish and seafood as well as in nuts and seeds, and DHA is present in breast milk. However, trans fatty acids and high saturated fat intake inhibit this neural growth, so for babies eating solid foods, after the age of six months, parents should focus on unsaturated plant oils.

A healthy diet not only affects growth but also immunity, intellectual capabilities, and emotional wellbeing. Since eating habits develop early in life, one of the most important jobs of parenting is making sure that children receive an adequate amount of needed nutrients to provide a strong foundation for the rest of their lives.

FITNESS Rick Dickson, fitness coordinator at the Carter Community Building Association (CCBA) in Lebanon, says keep activity fun. Find something that will hold young people’s attention.

Maeve Ryan, yoga instructor at Twin Farms, The Woodstock Inn & Resort, and Mighty Yoga, says, “It’s never too early to start yoga.”

She recommends beginning with Mom and Me-type classes. For older kids, “it helps them get into their bodies.” She praises schools that are beginning to incorporate yoga and meditation into their programs. Maeve recommends that children and their parents find an organized yoga class at a school or gym that is geared to their age group. “They need the structure of that,” she says, rather than turning to an app or video.

Get kids involved in classes or programs where the activities are accessible and they have input.

For younger kids, it should be about play, Rick says. For older kids, more structured, gym-type activities are good. Swimming is great for all ages.

Kevin Stanton, a physical therapist at BE Fit Physical Therapy in Hanover and White River Junction, says flexibility and stretching exercises help with “growing pains.”

“It’s never too early to start yoga.”

—Maeve Ryan, yoga instructor at Twin Farms, The Woodstock Inn & Resort, and Mighty Yoga

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AGES 13–18 NUTRITION Puberty and the teen years are also periods of rapid growth. Energy needs vary depending on a child’s size, gender, and level of physical activity. A number of factors can influence children’s eating habits and attitudes toward food, including family environment, societal trends, taste preferences, and messages in the media. Advertisements can entice children to consume sugary products, fatty fast foods, excess calories, refined ingredients, IMPORTANT NUTRIENTS Macronutrients (carbohydrates, proteins, fats—especially unsaturated and omega-3 fatty acids) Calcium, phosphorus, vitamin D, vitamin K for bone building Vitamin A, vitamin B12 Iron (menstruating females have higher needs)

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and sodium. Therefore, it is critical that parents and caregivers direct children toward healthy choices. As teens become more independent in their food choices, they tend to move away from healthier food choices in favor of fast foods or convenience foods.

Continuing to encourage and make available at least five daily servings of fruits and vegetables, as well as other healthy whole food choices, can help teens meet their nutritional needs.

“MOVE MORE, SIT LESS.”

—Kevin Stanton

YOGA Improves Body Image – Teenagers often have a poor body image, and many try to change their appearance to fit in.

Yoga promotes self-awareness and acceptance, which helps teenagers overcome a poor self-image.

Yoga Helps Teens Cope With Anxiety Researchers from Brigham and Women’s Hospital and Harvard Medical School studied 51 high school students who took either a regular PE class or a yoga class involving meditation, relaxation, breathing exercises, and poses. At the beginning of the 10-week study, the students underwent a number of psychological tests. At the end of the study, the students who took yoga scored higher on the same tests versus the students who took PE and actually scored lower.

The study was published in the Journal of Developmental and Behavioral Pediatrics and also showed that the teens who participated in yoga enjoyed the class and experienced more stable emotions throughout. lajollamom.com/reasons-why-tweens-teens-should-do-yoga

“Bodies are growing, and teenagers should get a minimum of one hour of physical activity a day.”

—Jared Walker, owner, head coach, and personal trainer at Amped Fitness in Lebanon

FITNESS Physical activity is very important in this group, says Jared Walker, owner, head coach, and personal trainer at Amped Fitness in Lebanon. “The unfortunate truth is childhood obesity is on the rise. We really need to promote children to be moving!” he says. Kevin Stanton echoes that, saying, “Move more, sit less.”

Bodies are growing, and teenagers should get a minimum of one hour of physical activity a day, Jared advises. “This should be moderate to strong physical activity,” he says. It should include aerobic activity and strength training monitored by a personal trainer, coach, athletic trainer, or a fitness professional.

Kevin suggests teenagers participate in a variety of sports that work different muscles to avoid chronic injuries that can arise when teens specialize in one sport.

This is the most stressful time in a kid’s life, Maeve says, and yoga can help teenagers with stress and help them make better decisions and resist negative peer pressure.

Teenagers should find a practice that interests them and should understand that it will take time to see results.

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AGES 19–35 IMPORTANT NUTRIENTS Magnesium and potassium, iron, vitamin B12, folate, calcium, vitamin D

The American Institute for Cancer Research encourages adults to aim for not more than a 10-pound weight gain once physical maturity is reached.

NUTRITION The Acceptable Macronutrient Distribution Ranges for carbohydrates, protein, fat, fiber, and fluids remain the same from young adulthood into middle age.

Most people become more sedentary during this phase of life, so it is important to avoid putting on excess pounds and to limit intake of saturated fatty acids to help avoid cardiovascular disease, diabetes, and other chronic conditions. The American Institute for Cancer Research encourages adults to aim for not more than a 10-pound weight gain once physical maturity is reached.

There are some differences, however, regarding micronutrients. For men, the recommendation for magnesium increases to 420 milligrams daily, while middle-aged women should increase their intake of magnesium to 320 milligrams per day. Magnesium helps to maintain normal nerve and muscle function, 40 i m a g e h e a l t h w a t c h • 2 0 1 9

supports a healthy immune system, keeps the heartbeat steady, and helps bones remain strong. It also helps adjust blood glucose levels.

Other key vitamins needed during middle age include folate and vitamins B6 and B12 to help prevent elevation of homocysteine, a byproduct of metabolism that can damage arterial walls and lead to atherosclerosis, a cardiovascular condition. Women who may become pregnant are urged to get adequate folic acid (400 micrograms per day) in their diets or supplements to help prevent neural tube defects during the first few weeks of pregnancy.

Keep in mind that the foods you consume in your younger years will influence your health as you age. Eating a whole-food, plant-centered diet, such as the traditional Mediterranean diet or the DASH diet, can help you to easily meet your nutrient needs and promote a lifetime of good health.

Foods you consume in your younger years will influence your health as you age.

A Mediterranean diet may include a Greek salad with baked salmon.

FITNESS “This is the time in our lives where we are typically under a lot of stress.

Finding our way in life after school or college, we are under a lot of pressure to establish ourselves as young adults. Physical activity is a great way to reduce that stress,” Jared says.

High-intensity workouts with a variety of body-weight movements, cardio, and compound strength-training movements for 30 to 50 minutes a day, three to five days a week, is recommended.

Keep physical activity fun! Jared suggests that people join some type of recreational sports group such as a men’s or women’s basketball league, a pick-up soccer or volleyball group, or a men’s or women’s hockey league. “There are lots of options in the Upper Valley for adult sports,” he says.

If you have to sit at your desk all day, Kevin recommends setting a timer, and every 30 to 45 minutes, stand and take a walk around the office or building. It’s important to change posture and give yourself that break from sitting.

A regular yoga practice during these years can help to balance the body’s chemistry and physiology and will benefit the mind, body, and soul.

Aerobic exercise activates your immune system in a good way.

This may leave you less susceptible to minor viral illnesses, such as colds and flu. www.uppervalleyimage.com •

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AGES 36–59 “Eat the rainbow” or include fruits and vegetables of all colors to help you benefit from the many various phytochemicals available.

Phytochemicals are compounds in fruits and vegetables that act as defense systems for plants.

NUTRITION Many people in their late 30s and 40s notice body composition changes due to fat deposits in the trunk. To maintain health and wellness during middle age and beyond, it is important to maintain a healthy weight, consume nutrient-dense foods, drink alcohol moderately or not at all, and engage in moderate physical activity at least 150 minutes per week.

The energy requirements for ages 31 to 50 are 1,800 to 2,200 calories for women and 2,200 to 3,000 calories for men, depending on activIMPORTANT NUTRIENTS Phytochemicals, antioxidants Magnesium, potassium, folate, iron, vitamin B12 Protein Calcium, vitamin D

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ity level. These estimates do not include women who are pregnant or breastfeeding.

During middle age, preventive nutrition can promote wellness and help organ systems to function optimally throughout aging. Preventive nutrition is defined as dietary practices directed toward reducing disease and promoting health and well-being.

Healthy eating in general— such as eating unrefined carbohydrates instead of refined carbohydrates and avoiding trans fats and saturated fats—helps to

promote wellness. However, there are also some things that people can do to target specific concerns. One example is consuming foods high in antioxidants, such as strawberries, blueberries, and other colorful fruits and vegetables, to reduce the risk of cancer and heart disease.

Phytochemicals are compounds in fruits and vegetables that act as defense systems for plants.

Different phytochemicals are beneficial in different ways. For example, carotenoids, which are found in

Berries may improve blood sugar and insulin response when consumed with high-carb foods or included in smoothies.

carrots, cantaloupes, sweet potatoes, and butternut squash, may protect against cardiovascular disease by helping to prevent the oxidation of cholesterol in the arteries, although research is ongoing. A good way to help ensure that you are getting a diet high in phytochemicals is to aim for at least 5 to 10 servings of fruits and vegetables per day and to “eat the rainbow” or include fruits and vegetables of all colors to help you benefit from the many various phytochemicals available.

“Working out in these years will really determine our longevity.”

FITNESS

—Jared Walker, owner, head coach, and personal trainer at Amped Fitness in Lebanon

“After 45, our body automatically starts reducing our muscle mass. I feel this is the most important time for women specifically to strength train,” Jared says.

Strength training increases bone density; 50 minutes to an hour of moderate exercise is recommended.

Strength training should be performed two to three times a week, Jared says. Aim to perform 30-minute cardio intervals two to three times a week as well.

Factor in one to two rest days per week.

The important thing is to keep moving and find activities that you enjoy, Kevin says, and stay with them, adding, “Any physical activity counts.”

“Any physical activity counts.”

A workout buddy helps you stay motivated, promotes healthy competition, and makes your average gym session fun.

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AGES 60+ NUTRITION An adult’s body changes during older age in many ways, including a decline in hormone production, muscle mass, and strength. Also in the later years, the heart has to work harder because each pump might not be as efficient as it used to be. Kidneys may not be as effective in excreting metabolic products such as sodium, acid, and potassium, which can alter water balance and increase the risk for over- or underhydration. In addition, immune function decreases, and there is lower efficiency in the absorption of vitamins and minerals.

Due to reductions in lean body mass and metabolic rate, older adults require less energy than younger adults. The energy requirements for people ages 51 and over are

IMPORTANT NUTRIENTS Calcium Vitamin D Protein B vitamins

1,600 to 2,200 calories for women and 2,000 to 2,800 calories for men, depending on activity level. The decrease in physical activity that is typical of older adults also influences nutritional requirements. In order to help maintain lean muscle mass, this is an important time to stay as physically active as possible, including doing regular strength exercises.

An increase in certain micronutrients can help maintain health during this life stage. The recommendations for calcium increase to 1,200 milligrams per day for both men and women to slow bone loss. Also to help protect bones, vitamin D recommendations increase to 10 to 15 micrograms a day for men and women.

Vitamin B6 recommendations rise to 1.7

milligrams a day for older men and 1.5 milligrams a day for older women to help lower levels of homocysteine and protect against cardiovascular disease. As adults age, the production of stomach acid can decrease and lead to an overgrowth of bacteria in the small intestine. This can affect the absorption of vitamin B12 and cause a deficiency. As a result, older adults need more B12 than younger adults and require an intake of 2.4 micrograms a day, which helps promote healthy brain functioning. For women, higher iron levels are no longer needed post-menopause and recommendations decrease to 8 milligrams per day. People over age 50 should eat foods rich with all of these micronutrients.

Older adults need more B12 than younger adults and require an intake of 2.4 micrograms a day to help promote healthy brain functioning.

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The energy requirements for people ages 51 and over are 1,600 to 2,200 calories for women and 2,000 to 2,800 calories for men, depending on activity level.

FITNESS Stay active. Muscle mass and bone density decline as we age, and balance issues put older adults at greater risk of falling. Staying fit and exercising reduces that risk.

Know your limitations and health risk factors, says Rick, but as long as you are able to do something, do it.

Join a group or a class. Many gyms have classes specifically geared for seniors that accommodate a wide range of abilities.

“Being a part of a community greatly increases the likelihood of staying physically active,” Jared says. Keep walking, jogging, biking, swimming, and playing tennis.

Include activities like yoga and Pilates.

Strength training is best for maintaining muscle mass, Rick says, and balance training should be part of every fitness regimen. Research shows that tai chi benefits balance and stability, Kevin says.

Stretching regularly can improve your body’s range of motion, relieve stress, and make you feel better overall.

Warm raise for e

Gratitude is the best attitude for overall health!

More and more people in their 60s and older are getting joints replaced. After physical therapy, fitness experts help patients recover by continuing efforts to increase range of motion and flexibility, strengthen mechanics, and restore balance, strength, and endurance, says Rick. The pace of recovery varies widely, especially after knee replacement, he adds.

Coaching people safely back to the activities they enjoy is important, Kevin says.

He advises having a game plan with your physical therapist.

Activities that focus on motor skills and mind–body connections, such as boxing and dancing, are beneficial for people with Parkinson’s disease, according to Rick.

And for those who have suffered strokes, cardiovascular and strength-training exercises can be beneficial. 

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Healthy Choices

THROUGHOUT THE UPPER VALLEY

Valley Vision

AboutFace Skin Therapy

Johnson Audiology

Sheila Hastie, O.D. | Andrew Jones, O.D. 165 Mechanic Street Lebanon, NH (603) 678-8185 www.valleyvisioneyes.com

Susan M. Sorensen, LE

2 Dorrance Place Hanover, NH (603) 643-HEAR (4327) www.johnsonaudiology.org

Mon–Fri 8:30am–5:30pm Wed 8:30am–6:30pm

1 School Street Lebanon, NH (603) 448-5800 www.aboutfacesusan.com Tue–Fri 9am–5pm

Amy Tuller

Strong House Spa

Monarch Family Medicine

Registered Dietitian Nutritionist

CBD Products & Services

303 Route 5 South Norwich, VT (802) 649-1444 www.amytuller.com

694 Main Street Quechee, VT (802) 295-1718 www.stronghousespa.com

One Oak Ridge Road Building One, Suite 10-B West Lebanon, NH (603) 277-9162 www.monarchfamilymedicine.com

Open daily 10am–6pm

Mon–Fri 8am–5pm

Raq-on Dance Studio

Presenting Sponsor: Dartmouth-Hitchcock Saturday, October 12 10AM to 2PM

Omer & Bob’s 20 Hanover Street Lebanon, NH (603) 448-3522 www.OmerandBobs.com Mon–Fri 9am–6pm Sat 9am–5pm Sun 11am–4pm (Nov to Feb only) 46 i m a g e h e a l t h w a t c h • 2 0 1 9

Belly Dance and Middle Eastern Dance Classes 58 Bridge Street White River Junction, VT (603) 304-8676 www.Raq-on.net

Hilton Garden Inn, Lebanon Free screenings, activities, and demos for the whole family.

THROUGHOUT THE UPPER VALLEY

Smart Choices

Eyeglass Outlet

Colonial Pharmacy

Historic Homes of Runnemede

24 Hanover Street #3 On the Mall Lebanon, NH (603) 448-0030

82 Newport Road New London, NH (603) 526-2233 www.ColonialPharmacy.com

A Senior Living Community

Mon–Wed & Fri 9am–6pm Thu 9am–7pm

Mon–Fri 8am–8pm Sat 8am–6pm Sun 8am–5pm

The Gilded Edge Frame Shop & Gallery

The Creation Place

Blue Sparrow Kitchen

207 Main Street New London, NH www.thecreationplacenh.com

289 Main Street Norwich, VT (802) 649-7003 www.bluesparrowkitchen.com

69 Hanover Street Lebanon, NH (603) 643-2884 Mon–Sat 10am–6:30pm

Mon 12–6pm, Thu & Fri 12–8pm Sat 12–5pm, Sun 12–4pm

40 Maxwell Perkins Lane Windsor, VT (802) 674-6733 www.HHRliving.org

Mon–Fri 7:30am–4pm Sat 9am–3pm

River Road Veterinary Clinic

Small Animal In-Home Veterinary Care

Local Delivery Available

Large, Small and Exotic Animals

Dr. Abbie Fisher (603) 558-4662 www.NPLHvet.com NPLHvet@gmail.com

277 Newport Road New London, NH (603) 526-2088 www.UnleashedNH.com

445 US Route 5 North Norwich, VT (802) 649-3877 www.riverroadveterinary.com rrvcvt@gmail.com

Unleashed

Mon–Fri 9am–5:30pm Sat 9am–5pm, Sun 10am–2pm

Office hours by appointment www.uppervalleyimage.com •

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Dr. Hitchmoth believes vision loss can be largely prevented, and her philosophy of care starts with the belief that a healthy body lends itself to a lifetime of good vision.

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BY DR. DOROTHY L. HITCHMOTH

KEEPING AN

EYE ON NUTRITION

Protect this vital sense for the long haul Vision is undeniably our most important sense, and the possibility of losing it is terrifying. But the most common forms of vision loss and blindness can be prevented. It’s all about making a commitment to good health—eating nutritious foods, exercising, avoiding smoking, and protecting our eyes. Among adults, vision loss is most often related to diabetic eye disease, macular degeneration, glaucoma, or injury. In children, amblyopia is the most common cause of poor vision.

TIPS TO PRESERVE VISION 1. Get a yearly eye exam. You’ve heard that the eyes are the windows to the soul, but did you know that they also provide information about our general health? An eye exam gives your optometrist or ophthalmologist a glimpse of your total health picture and can help you understand your risks for the most common causes of vision loss. With a thorough exam, the blood vessels

leading from your heart to your brain, as well as the ends of the million fibers running through your brain to your eye and the lenses in your eyes, are visible. These anatomical landmarks reveal much about your current health and future risks for vision-threatening conditions, often before symptoms appear.

2. Wear eye protection whenever you engage in a potentially dangerous job or activity.

Injuries often occur at or around the home, so even if your work might never result in an eye injury, be careful in the yard and house. Eye injury is the number-one cause of vision loss and blindness in people under 30.

3. Wear sunglasses and be cautious about blue light from devices. Scientific evidence has shown that overexposure to sunlight contributes to cataracts, macular degeneration, and damage to the skin around the eyes; it also disrupts

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As many as 11 million people in the United States have some form of age-related macular degeneration.

This number is expected to double to nearly 22 million by 2050.

The number of people living with macular degeneration is expected to reach 196 million worldwide by 2020 and increase to 288 million by 2040.

Age is a prominent risk factor for age-related macular degeneration.

The risk of getting advanced agerelated macular degeneration increases from 2% for those ages 50–59 to nearly 30% for those over the age of 75. www.brightfocus.org

the sleep cycle. Blue light from devices may impact vision as well. The research literature has yet to provide clear evidence about exposure to blue light from computers, LED bulbs, and cell phones, but we’re in the first decades of innovations that have resulted in excessive blue-light exposure. Consider using devices or settings on phones and computers that reduce or eliminate blue light, or choose alternative light sources at home and at work if possible. Consider innovative products; Apple’s Night Shift setting and Smart Lights both eliminate potentially harmful blue-light wavelengths.

4. Don’t smoke. Most people know it’s detrimental to health, yet there is still a lack of common knowledge about smoking and the eyes. Research strongly links smoking to macular degeneration. It’s also implicated in eye conditions such as cataracts, normal-pressure glaucoma, blood-vessel diseases in the eye, dry-eye syndrome, and others. What’s bad for your heart and lungs is also bad for your eyes!

5. “Let food be thy medicine.” This advice from Hippocrates, the father of medicine, holds true for your eyes. Research shows that a wide variety of plant-based nutrients may stave off eye diseases and improve quality of life and longevity. A healthy diet and proper supplement use can reduce your risk for degenerative diseases, including macular degeneration, cataracts, glaucoma, and diabetic retinopathy. The same nutrients that can reduce your risk of vision loss help protect against other degenerative diseases such as Alzheimer’s, cardiovascular disease, certain cancers, and diabetes.

6. Be active. Aim for at least 30 minutes of moderate physical activity daily, advises the Mayo Clinic. Even brief bouts of activity offer benefits, so if you can’t fit a 30-minute walk in during the day, take a few fiveminute walks instead.

DID YOU KNOW? Discussing nutrition with your eye doctor can have far-reaching health benefits. The National Eye Institute has long recognized the importance of a specific group of nutrients for age-related macular degeneration. A two-decade, longitudinal group of studies—the AgeRelated Eye Disease Studies (AREDS)— has resulted in a paradigm shift in how eye doctors treat patients with this condition, often prescribing certain vitamins.

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EAT FOR YOUR EYES Nutrients work best in harmony to perform specific functions in the body, including the eye, so eat a variety of nutrient-dense foods daily. A plant-based diet rich in balanced levels of fatty acids, carotenoids (plant pigments), vitamins, minerals, protein, and other antioxidants is critical for maintaining good vision. If your diet is poor or you have medical conditions or take medications that can rob your body of key nutrients, talk to your doctor about nutritional supplements. Just remember: They’re designed to add to—not replace—nutrients provided by a healthful diet.

Balance is key. Some supplements and foods can interact adversely with certain medications; others can be harmful if ingested in mega doses. Likewise, some supplements contain an imbalance of nutrients that can block the absorption of other important nutrients, and certain medical conditions can be exacerbated by excessive intake or an imbalance of certain nutrients. You are your own best health advocate, but always consult your eye doctor, primary care provider, and a nutrition expert for individualized advice.

Foods, medicines, and other elements either create or protect us from free radicals, which set the stage for disease and premature aging, and the damage can accumulate over the life span.

FREE RADICALS Our bodies and their interactions with foods and the environment are complex, but making wise food and supplement choices boils down to a few simple principles. Foods, medicines, and other elements either create or protect us from free radicals, which set the stage for disease and premature aging, and the damage can accumulate over the life span. Nutrients that create free radicals are called oxidants; those that protect against them are called antioxidants. If you think your diet is antioxidant-deficient, talk to your health provider about how to improve it.

SUPPLEMENTS IMPORTANT FOR EYE HEALTH Vitamins: A, B-complex vitamins (B1, B2, B3, B5, B6, B12, folic acid, choline, and biotin), C, D, and vitamin E in mixed form (tocopherols and trienols).

Each of these vitamin groups offers unique and synergistic benefits. For example, vitamin A may help protect against night blindness and dry eyes, and vitamin C may reduce the risk of cataracts and macular degeneration and help support medical glaucoma treatment. Along with A and C, vitamin E seems to slow the body’s normal oxidation process, helping to prevent or slow the progression of age-related

ASK YOUR EYE CARE PROFESSIONAL Which vitamins and minerals should I be consuming daily? How much of each should I take?

Is it okay to take supplements, or should all my nutrients come from food?

Which vitamins and minerals are right for me?

What else should I know about maintaining my vision and eye health? www.uppervalleyimage.com •

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Nutrients work best in harmony to perform specific functions in the body, including the eye, so eat a variety of nutrient-dense foods daily.

LIFESTYLE CHOICES AND MEDICATIONS MATTER Smoking, excess alcohol, excess meats high in iron, refined grains, sugar, hydrogenated oils, and artificial flavorings and food coloring can deplete your body of nutrients important for optimal health. Avoiding processed foods, smoking, and excess alcohol is an important first step for a healthy body and eyes.

Many over-the-counter and prescription medications can contribute to nutritional deficits, so talk to your doctor or a nutritionist about how to balance medication use with a healthy lifestyle to help prevent vision loss.

macular degeneration. Fruits, vegetables, nuts, seeds, beans, and animal meats are rich in these vitamins.

Vitamin Cofactors and Minerals (enzymatic antioxidants): calcium, magnesium, zinc, copper, manganese (superoxide dismutase), selenium (glutathione), and coenzyme Q10 and iodide.

Minerals and vitamin cofactors can help your body absorb other antioxidants important for eye health. For example, zinc helps the body absorb vitamin A and has been shown to protect against macular degeneration and night blindness. It’s vital to our health, in moderation, but higher doses of zinc have been associated with adverse effects and may even worsen macular degeneration in a minority of patients. Selenium is a mineral that helps your body absorb vitamin E. Look for minerals that are wrapped with amino acids or other appropriate nutrients for optimal absorption. Be sure to consult your doctor before taking any minerals. Nuts, seeds, organ meats, fatty fish, soybeans, broccoli, and cauliflower contain many of the cofactors you need to absorb vitamins.

CAROTENOIDS Carotenoids are molecules that give plants their color. Only two are concentrated or absorbed in the eye and should be consumed daily: lutein and zeaxanthin, plant-based pigments that protect the eye from the harmful rays of the sun. They can also help slow the progression of macular degeneration, especially if taken with certain other antioxidants, minerals, and omega-3 fatty acids.

Lutein and zeaxanthin have also been shown to slow the progression of cataracts and diabetic retinopathy. Brightly colored fruits and vegetables such as sweet bell peppers, blueberries, kale, and spinach are rich in carotenoids.

PLANT-BASED ANTIOXIDANTS Plants contain a wide variety of antioxidant substances that protect the eye. Polyphenols, flavonoids, flavanones, isoflavones, stilbenoids, anthocyanins, phenolic acids, curcumin, flavonolignans, xanthones, eugenol, capsaicin, bilirubin, citric acid, oxalic acid, phytic acid, n-acetylcysteine (glutathione helper), a-lipoic acid, uric acid, and melatonin all play roles in keeping the blood vessels that feed the eye healthy. Red wine, grape juice, grapes, blueberries, garlic, turmeric, and green tea are commonly consumed foods that contain some of these substances.

Dr. Dorothy L. Hitchmoth

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Which foods are most beneficial for healthy eyes? Here’s a list of foods that are good—and bad—for your eyes.

FOODS THAT SUPPORT HEALTHY EYES (antioxidants) Vegetables: carrots, kale, broccoli, spinach, bell peppers (red, orange, yellow, and green), chili peppers, paprika peppers, artichokes, cabbage, asparagus, beetroot, squash, sweet potatoes, Swiss chard, cauliflower, green beans, red and green algae, seaweed, okra, chicory, collards Fruits and berries: cranberries, blueberries, plums, blackberries, raspberries, strawberries, black currants, figs, cherries, grapes, pomegranate, tomatoes, mangoes,

oranges, sea buckthorn berries, wolfberries (goji), cantaloupe, peaches, apricots, bananas, guava, watermelon Proteins: pecans, black walnuts, brazil nuts, hazelnuts, pistachios, almonds, cashews, macadamia nuts, sesame seeds, peanuts, pine nuts, pumpkin seeds, squash seeds, flax seeds, navy beans, chickpeas, chia seeds, soy beans, black eye peas, lima beans, whey protein, eggs, fish, dairy (milk, yogurt, and cheese), chicken, beef, pork, liver

Whole grains: wheat germ, rice bran, oat bran, quinoa, bulgur wheat, buckwheat, whole or steel-cut oats, rye flour Fats: avocado, avocado oil, fish liver oil, olive oil, black currant seed oil, grape seed oil, coconut oil, walnut oil, hemp seed, chia seed, fatty fish (mackerel, herring, sardines, salmon)

tea, water (mineral, tap, or bottled without added components) Spices: clove, cocoa, cinnamon, turmeric, cumin, curry powder, mustard seed, ginger, pepper, chili powder, paprika, coriander, cardamom, iodized salt

Drinks: wine, grape juice, pomegranate juice, coffee, green tea, white tea, herbal

Herbs: cilantro, oregano, parsley, basil, sage, garlic, thyme, marjoram, tarragon, peppermint, savory, rosemary, dill weed, saffron, lemon balm, milk thistle

Processed and nitratepreserved meats such as sausage, bologna, and ham.

Processed (hydrolyzed) fats such as those found in margarine

Processed dairy products with added sugar and/or reduced fat, flavored water and juices with added chemicals and artificial sweeteners or sugar

FOODS TO AVOID (oxidants) Processed fruits and vegetables, nuts and seeds with added sugar and salt

Processed grains with and without added sugar, such as instant oats, most processed cereals and corn, white flour, white rice, and white potato products

For More Information: Ocular Nutrition and Wellness Society: www.repsonsiblefoods.org Institute for Responsible Nutrition: www.ocularnutritionsoci ety.org Physicians Committee for Responsible Medicine: www.pcrm.org Eye Foods: www.eyefoods.com Visionary Kitchen: www.visionarykitchen.com

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What About Sugar and Salt?

A plant-based, whole-foods diet high in antioxidants and fiber will eliminate excess amounts of sugar and salt, often found in prepared foods. Excess sugar can lead to diabetes, a leading cause of blindness, and it’s added to most prepared foods in the US and labeled using more than 50 different names.

PROTEIN-BASED ANTIOXIDANTS Taurine is important for maintaining eye and brain health; it’s an amino acid made from methionine and cysteine in the body. These substances are found in protein-based foods from both vegetarian and nonvegetarian sources. Meat, fish, sea algae, and plants contain the nutrients needed to maintain healthy levels of this substance in the body.

ESSENTIAL FATTY ACIDS Essential fatty acids don’t necessarily have a high antioxidant content, but they’re critical for the absorption and function of other antioxidant nutrients, including lutein and zeaxanthin (carotenoids). The essential fatty acids omega 3 (alpha-linolenic acid) and omega 6 (linoleic acid) must be consumed in a balanced way to avoid inflammation and to keep the blood from getting too “sticky.” Inflammation has been implicated in eye, brain, and cardiovascular disease, and it also increases the body’s need for antioxidants. Omega 3 dampens inflammatory response while omega 6 often promotes it, so your diet should 54 i m a g e h e a l t h w a t c h • 2 0 1 9

Salmon is one of the most nutrientdense foods on the planet.

Omega-3 content: 4,023 mg in half a fillet of cooked Atlantic salmon or 2,260 mg in 3.5 ounces (100 grams)

include a higher proportion of omega 3 and a lower proportion of omega 6.

Eating a plant-based diet high in antioxidants will help balance this ratio. Foods rich in healthy fats include coconut oil, fatty fishes, chia seeds, and hemp seeds.

FIBER A plant-based, whole-foods diet high in antioxidants provides the fiber needed to balance digestion and normalize blood sugar. Whole foods are often low on the “glycemic index” (a measure of how fast and high a specific food elevates your blood sugar levels) and high in fiber.

Prepared foods with added fiber often have reduced whole grain components, which reduce antioxidant levels. 

Dr. Hitchmoth is a nationally recognized award-winning professor, lecturer, and educator. She is currently in private practice and works for Zeiss Meditec AG, Global.

She has been in practice for 23 years and serves on numerous scientific and patient advocacy boards. She is on the executive board for the Ocular Nutrition and Wellness Society and serves as chief editor for various clinical publications focused on nutrition and wellness. She believes vision loss can be largely prevented and her philosophy of care starts with the belief that a healthy body lends itself to a lifetime of good vision. You can learn more about the author at www .drdorothy.org. www.uppervalleyimage.com •

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BY ANNE RICHTER ARNOLD PHOTOS BY CPERRY PHOTOGRAPHY

CARING FOR WOMEN IN CRISIS

WISE AND SANE COLLABORATE IN SURVIVOR - CENTERED CARE

G

etting treatment after a sexual assault or an incident of domestic violence can be one of the most traumatic experiences in a woman’s life. It can also be one of the most crucial moments, when medical

expertise and patient-centered care come together to address the most vulnerable patients’ needs.

In the Upper Valley, at both Dartmouth-Hitchcock Medical Center (DHMC) and Mt. Ascutney Hospital (MAH), two specially trained groups partner to provide help when victims need it most. Sexual Assault Nurse Examiners (SANE), skilled in addressing the medical and psychological needs of victims of gender-based violence, are on hand when a victim comes to either hospital. Advocates from the Women’s Informational Service, Inc. (WISE) are called in to assist in nonmedical ways and to support the victim after discharge. Together, these professionals help victims through the difficult aftermath of assault with compassionate, patient-centered care.

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WHAT IS DOMESTIC VIOLENCE? Domestic violence is a pattern of coercive and manipulative behaviors committed against a current or former intimate partner to gain power and control. Intimate partner violence, relationships violence, and dating violence are all terms used to refer to a relationship that is abusive. Anyone can be a victim or perpetrator; either can come from all demographics.

WHAT IS SEXUAL VIOLENCE? Sexual violence is any unwanted sexual contact or behavior including: sexual harassment, voyeurism, and rape. Only we can decide what happens to our bodies, and it is never our fault when someone chooses to violate that right.

Sexual violence is: Any sexual act with someone who, for any reason, cannot consent or refuse.

Any act of violence where sex is a weapon.

Any form of nonconsensual sexual activity.

PHOTO BY MOTORTION

Any sexual act one is forced to perform.

every hour, every day (866) 348-WISE

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WISE MISSION WISE leads the Upper Valley to end gender-based violence through survivor-centered advocacy, prevention, education, and mobilization for social change.

WISE VISION A world of freedom, justice, equality, and dignity where all thrive.

Sexual assault is one of the most under-reported crimes, with 60% left unreported.

(US Department of Justice, 2008–2012)

Bailey Ray, WISE Advocate (left), and Janet Carroll, RN. Photo courtesy of DHMC.

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Expert Care and Treatment SANE nurses provide specialized care and conduct extensive exams needed for law enforcement should a victim decide to move forward.

The mission of the SANE program is to deliver comprehensive, ethical, culturally sensitive expert medical forensic care and treatment to patients who have experienced violence such as sexual assault, intimate partner violence, and elder/vulnerable adult abuse. SANE also provides specialized care for several other kinds of traumatic violence, such as human trafficking, strangulation, gunshot wounds, or stab wounds.

WISE is an Upper Valley nonprofit that has been committed to supporting survivors of domestic and sexual violence through crisis intervention and support services for 48 years. It serves the 21 communities of the Upper Valley 24 hours a day and seven days a week through its offices and its crisis hotline.

Since 2008, Janet Carroll has served as clinical coordinator for DHMC’s SANE program and codirects New Hampshire’s state SANE program. She understands the importance of SANE nurses for giving victims the one-on-one care they need. “When a physician sees a patient, it can be for as little as 10 to 15 minutes,” says Janet, “whereas when a SANE nurse sees a patient, it is generally three or more hours of one-on-one time.”

Every patient seen is offered a comprehensive medical forensic evaluation that includes a physical assessment with injury documentation, forensic photography, evidence collection, resources, and referrals within DHMC and the community. If appropriate, the patient is also offered prophylaxis and testing for pregnancy, sexually transmitted infections (STIs), HIV, and other immunization needs.

Special People with Special Skills Caring for victims of gender-based violence requires a special set of skills and training based on a patient-centered approach. While most doctors have so much to learn in their medical education that they receive only a few hours of training on the subject, the SANE certification process includes a 64-hour course, hands-on clinical simulations, and an extensive orientation period.

“In addition to expertise in medical forensic evaluations,” says Janet, “we are specially trained as an empathetic resource, giving careful attention to each victim’s assessment and treatment plan and addressing their emotional needs. SANE training uses a patientcentered approach and empowerment so we can provide attentive, compassionate care to a uniquely vulnerable population. We adapt the care specifically to each patient, using a trauma-informed care model taught during our training. SANE continuing education includes four eight-hour days per year, and we meet every other month at DHMC to make sure we are doing everything up to date, using best practices, and continually finding ways to improve.”

mood

Abby Tassel (far left), Senior Program Advisor/Director who leads Supporting Survivors Training at DHMC, and Stacey Glazer (far right), WISE Program Operations Coordinator with WISE volunteers.

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From left: Jillian Murray-Duchesne, RN; Moriah Tidwell, RN; Janet Carroll, RN; Laura Kelliher, RN; Betsy Kohl, WISE Volunteer Advocate; Bailey Ray, WISE Advocate. Photo courtesy of DHMC.

“When a physician sees a patient, it can be for as little as 10 to 15 minutes,” says Janet, “whereas when a SANE nurse sees a patient, it is generally three or more hours of one-on-one time.”

IN THEIR LAST FISCAL YEAR, WISE supported 1,427 people, a 13.3% increase over the prior year.

1,049 people were new to WISE, 73.5% of the total. This is a 23.6% increase over last year.

There were 206 accompaniments to hospitals, a 73.1% increase over last year.

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Advocates Offer Additional Support When someone presents at either hospital, a protocol is in place to contact WISE for in-person advocacy. The patient is asked if she or he would like to meet with an advocate who can provide emotional support and information so that they can make the best decisions for themselves. Should a patient decline, SANE still provides information on how she can utilize WISE services.

For many years, WISE has had a strong collaborative relationship with DHMC and MAH to provide trauma-informed response to survivors of gender-based violence. Advocates work closely with the SANE nurses, doing grand rounds and training, and an advocate is in the room during SANE exams.

“The SANE partnership with advocates is an important part of caring for these vulnerable populations,” says Janet. “While we give medical care, the advocates are there solely for patient support. For SANE, our care stops at the time of discharge, so we rely heavily on WISE for post-discharge patient needs.”

“Our 6 full-time and 21 after-hours advocates are community members who are truly dedicated to giving their time to help and to be there for people in crisis.”

Abby Tassel and WISE volunteers in the Emergency Department at DHMC.

Bailey Ray is a WISE advocate and has worked closely with SANE to help victims. When hospital staff call the WISE 24/7 crisis line, an advocate responds quickly, quietly, and confidentially. “When we introduce ourselves to the victim, we explain that we are a totally confidential service and are there to support them step by step through the SANE exam and going forward,” Bailey says.

“Any act of violence can be frightening and isolating, specifically when there is a sexual assault.

If a victim has come to the ER or a medical office, she is probably overwhelmed and doesn’t know how things will proceed. Even understanding the criminal legal system relating to these incidents can be overwhelming. As advocates, our role is solely to show up and be there for the survivor. We make sure the victim knows she is not alone; we are there to do whatever the survivor needs, which can be anything from just listening, holding a hand, discussing protective orders, or something as simple as finding out if she’s hungry. They are the experts

Domestic violence, sexual violence, and stalking happen everywhere, including the Upper Valley. WISE advocates are here to listen and support you. We know that you can make your own decisions when you have information and support. You are the expert in your life.

Supporting a friend or loved one who is in an abusive relationship can feel frustrating, overwhelming, and scary, but it is very important.

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Volunteer training at the WISE Program Center in Lebanon, New Hampshire.

“The partnership between WISE and the SANE programs is crucial,” explains Bailey. “We have had this relationship with area hospitals for several decades, and it continues to strengthen. Our work together is about supporting our own community as well as the individual survivors.”

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on their lives and experience, and as advocates, our role is to provide information and support so that they can make the right decisions about how to move forward.

“New Hampshire has a requirement of 30 hours of training,” states Bailey, “and all our advocates, many of whom are volunteers, have this training as well as participating in continuing education. Training begins with the understanding of the causes of gender-based violence. Advocates also learn how to support survivors, and they receive training around what happens when police are called, what happens at the hospital, and what the effect of trauma is on the brain. Advocates are trained to handle many situations, including those at medical facilities. For example, SANE exams are very invasive, and it can be a little less difficult with an advocate there.

“WISE has strong relationships with community partners like DHMC and MAH that we have cultivated over time,” continues Bailey, “and they know they can rely on us to have advocates there whenever needed. Our 6 full-time and 21 after-hours advocates are community members who are truly dedicated to giving their time to help and to be there for people in crisis.”

Interacting on a Community Level Jill Lord, director of community health at MAH, was involved in the group that facilitated funding for a WISE satellite office in Windsor. “We regularly call the WISE staff at MAH, and now, having WISE in Windsor has and will continue to strengthen the work we do together, interacting on a community level,” says Jill. “WISE has done an assessment as to the needs in the community MAH serves, and we integrated their ideas into our programs and with our community partners. Having the direct partnership with WISE makes a difference far beyond what we do here at MAH. The satellite office has not only improved access to increase support; the closer relationship has significantly improved awareness and expanded our thinking about domestic violence and sexual assault at a community level.”

“The partnership between WISE and the SANE programs is crucial,” explains Bailey. “We have had this relationship with area hospitals for several decades, and it continues to strengthen. Our work together is about supporting our own community as well as the individual survivors. Together, we are providing the best possible care for survivors and making it just that much easier for someone in crisis.”  WISE 38 Bank Street Lebanon, NH (603) 448-5922 24-hour crisis line: (866) 348-9473 wiseuv.org www.uppervalleyimage.com •

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f in a n c ia l we ll- b e ing | BY JOHN W. O’DOWD, CTFA

Comprehensive Wealth Management A ROAD MAP TO YOUR FINANCIAL FUTURE

John W. O’Dowd, CTFA Senior Vice President, Director of Client Relations at Ledyard Financial Advisors

38 South Main Street Hanover, NH (603) 640-2743 www.ledyardbank.com Other locations in Concord Hanover Lebanon Lyme New London Norwich, VT West Lebanon

Personal and business banking relationships within the retail bank are subject to FDIC insurance coverage limits. Investment, tax, and wealth management services offered by Ledyard Financial Advisors are not insured by the FDIC, are not deposits or other obligations of, or guaranteed by the Bank or any affiliate, and are subject to investment risk including the possible loss of principal amount invested.

A wealth management plan should be the road map to your secure financial future. Too often, people think of their plan only in terms of an investment portfolio, but investments are only one part of the equation. A comprehensive plan is designed to achieve a wide range of specific financial goals and objectives. The process should begin with an extensive fact-finding process that provides an overview of your entire financial situation.

An effective approach will define where you are starting, where you are going, and how you will get there. As you work on the development of your plan, it is important to be realistic.

Assume there will be unexpected life events that may require you to change course. The following areas may be included in the development of a comprehensive wealth management strategy.

1. INVESTMENTS – Create an appropriate investment plan to meet income needs while preserving and building wealth.

2. INSURANCE – Review the adequacy and costs of coverage to ensure that you and your family are properly protected. This step is often referred to as risk management. All types of insurance should be considered, including health, life, home, auto, disability, and liability coverage.

3. RETIREMENT PLANS & IRAs – Focus on election, distribution, and beneficiary decisions to ensure that you maximize your benefits.

4. TAXES – Strategize to minimize tax liabilities and preparation of personal tax returns. Tax management is more than just reporting history on tax returns. Proactive tax management is important.

5. BANKING – Optimize the use of credit and banking resources to simplify cash management, leverage assets, and preserve established wealth.

6. FINANCIAL PLANNING – Determine cash flow and plan for meeting future needs.

7. BUSINESS SUCCESSION – Create the right transition plans for your business.

8. DURABLE POWER OF ATTORNEY – Identify the appropriate designee to make financial and medical decisions on your behalf in the event that you are unable.

9. FAMILY GIVING – Review giving strategies to your children and/or family during your lifetime.

10. CHARITABLE GIFTING – Explore appropriate tax-advantaged charitable gifting strategies.

11. TITLING OF ASSETS – Review to ensure that your assets are titled to reflect your intentions.

12. EXECUTOR/TRUSTEE – Select the most appropriate family and/or corporate representative to carry out your estate plans.

13. DISTRIBUTION OF WEALTH – Strategize to maximize the distribution of wealth at death.

These 13 wealth management issues are only as good as the team helping you navigate them.

Therefore, it is critical to select a financial advisor carefully. Look for an advisor who uses a comprehensive approach. Providing effective communication is one of the most important aspects of being a good financial advisor. At a minimum, he or she should meet with you annually to review your plan.

Have a clear understanding of the fees you are paying. There are two basic methods of paying an advisor: a fee based on a percentage of your portfolio value, often called an “assets under management” fee, and fees and commissions paid on a per-transaction basis.

Financial planning is an ongoing process, not a one-time event. It is prudent and necessary to have periodic reviews of your plan, understanding that changes in goals may require adjustments or amendments to that plan. 

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

Test your knowledge by answering the questions below, then challenge your family and friends to see who gets the most correct answers.

PHYSICAL HEALTH What should you do if you feel pain during exercise?

A. Continue exercising and push through the pain.

B. Modify the exercise—slow down on the treadmill or grab a lighter weight.

C. Switch to a different exercise or call it a day.

Best answer: C. It’s important to challenge yourself, but pain during exercise is a warning that you’re pushing yourself too hard. According to the Cleveland Clinic, you should never ignore pain because it’s a sign that you’re potentially stressing or damaging your joints.

Do you know the most common signs of a heart attack?

A. Chest pain.

B. Chest pain, discomfort in other areas of the upper body, and shortness of breath.

C. Nausea, back pain, and lightheadedness.

Best answer: B. Chest pain, upper body discomfort, and shortness of breath are the most common signs of a heart attack. However, nausea, back pain, and breaking out in a cold sweat are also red flags. Women are more likely than men to experience shortness of breath, nausea/vomiting, and back or jaw pain during a heart attack.

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How often do you wear sunscreen?

A. Every day.

B. Only in the summer when the sun’s rays are strongest.

C. Only to prevent sunburn on days when I plan to be outside all day.

Best answer: A. Although the sun’s rays are stronger during the spring and summer months, they can damage skin and cause skin cancer year-round, according to the American Cancer Society. In the fall and winter, water and snow reflect UV rays, leading to an increase in exposure. We’re even exposed to them on overcast days. Apply sunscreen year-round, and don’t forget your hands.

Do you doze off during the day?

A. Never.

B. Occasionally, but only for 20 to 30 minutes.

C. Yes, I take multiple naps throughout the day.

Best answer: B. According to the National Sleep Foundation, a daily 20- to 30-minute power nap can improve alertness and performance without interfering with nighttime sleep. But research shows that if you doze off multiple times during the day, it may be an early harbinger of Alzheimer’s, since this disease attacks brain regions responsible for daytime wakefulness.

“Life is not measured by the number of breaths we take, but by the moments that take our breath away.” —Maya Angelou

MENTAL/COGNITIVE HEALTH Which of the following may be a sign of a panic attack?

A. The feeling lasts at least 60 minutes.

B. Difficulty swallowing or breathing.

C. A sudden and severe headache.

Best answer: C. The National Institute of Mental Health notes that panic attacks generally persist for about 10 minutes, when they peak, and most end within 20 to 30 minutes, so A is not the answer. One-half to two-thirds of women and 35 to 40 percent of men who have panic disorder suffer from frequent headaches, and they are up to seven times more likely to suffer the most severe of all headaches: a migraine.

Which of the following foods have been shown to calm anxiety?

A. Lean pork B. Coffee C. Yogurt Best answer: C. Along with salmon, dark chocolate, turmeric, chamomile, and green tea, yogurt has been shown to calm anxiety. Healthline notes that, while research on specific foods and anxiety prevention is still sparse, a number of lab studies on animals have found a link between these six foods and reduced anxiety. High-quality human studies are needed, but in the meantime, these six may boost brain health.

SOCIAL/EMOTIONAL HEALTH How many minutes of physical exercise have been proven to reduce anxiety?

A. A minimum of 30 minutes.

B. At least 10 minutes.

C. 60 minutes of exercise can reduce anxiety.

Best answer: B. According to the Anxiety and Depression Association of America, a brisk 10-minute walk can be as helpful as 45 minutes of vigorous exercise to reduce anxiety as well as depression.

Why is it a good idea to spend time with friends?

A. You will enjoy better physical health.

B. You will enjoy better mental health.

C. You may lower your risk of dementia.

Best answer: All of the above. Social engagement boosts your immune system, increases feelings of well-being, and is good for your brain health.

Making social connections may also help you live longer, according to Psychology Today.

What’s the best way to achieve happiness?

A. Earning a college degree.

B. Purchasing the home of your dreams.

C. Being grateful and counting your blessings.

Best answer: C. Besides enjoying relationships with family and friends, performing meaningful work, thinking positively, and giving to others, practicing gratitude is key to living a happy life.

Why is it important to cultivate a spiritual life?

A. To be more well-rounded.

B. To practice yoga and lose weight.

C. To be healthier.

Best answer: C. Studies show that people who attend church or who simply feel that they are spiritual experience less depression and anxiety and tend to have lower blood pressure and fewer strokes. 

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BY ELIZABETH KELSEY

ENDING THE

STIGMA OF

UPPER VALLEY ADVOCATES WEIGH IN

A competent mother, unable to care for her children during an episode of mental illness, struggles to regain custody once she’s in remission and doing well. An individual with mental illness doesn’t want to tell his boss about his illness because he fears he’ll lose his job. Another individual experiences microaggressions regarding her mental health challenges.

Since she became medical director of West Central Behavioral Health in 2007, psychiatrist Diane Roston has witnessed these effects of stigma on people with mental illness. Where does such stigma originate? “When we don’t know the cause or the cure of a condition, we fear it,” says Dr. Roston. “We want to avoid people with these conditions, so we separate them from the rest of us.”

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According to the National Alliance on Mental Illness (NAMI), one in five adults in the United States

experiences mental illness in a given year, and one in five youth ages 13 to 18 will experience a severe mental disorder at some point in his or her life.

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According to the National Alliance on Mental Illness (NAMI), one in five adults in the United States experiences mental illness in a given year, and one in five youth ages 13 to 18 experiences a severe mental disorder at some point in his or her life.

Despite the high prevalence of mental health challenges, stigma persists. On an individual level, Dr. Roston says, “Stigma causes people to feel ashamed and marginalized, and can prevent them from seeking help.” She adds that on a societal level, it results in bias in the workplace, a system that provides inadequate resources, and a lack of parity for mental health treatment and physical health treatment.

Anyone Can Be Affected Mental illness, as well as the stigma and silence that often surround it, affects people from all walks of life. Mountain Valley, a Plainfield, New Hampshire–based residential treatment center for anxiety, OCD, and related disorders, treats adolescent clients from around the world. Clinical director Timothy DiGiacomo, PsyD, says, “Many of our residents come from high-performing schools and families. Even

Adventure programming, challenge courses, and team building can provide opportunities for augmenting treatment modalities for mental health disorders such as anxiety, OCD, and depression. Photo courtesy of Mountain Valley Treatment Center.

“Recovery is Possible”: A Conversation with Angela Montano Angela Montano has borderline personality disorder, post-traumatic stress disorder (PTSD), and generalized anxiety disorder, as well as a substance-use disorder. While she has experienced discrimination from others who haven’t understood her mental health challenges, she says she’s also struggled with selfstigma. “There was a tremendous amount of shame and feeling very different than others,” she says.

“I have actively self-harmed— something that I used as a negative coping skill for many years,” she adds. “I started doing it at a young

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age.” Now 59, Angela says it wasn’t until she was hospitalized in her 40s that she realized other people had similar experiences. “It was then that I felt less isolated.”

Angela has continued to walk the path of recovery. She goes to therapy, attends a support group, and works with her doctor to make sure she’s taking the right combination of medications. “I was not put on the face of this earth to suffer the whole time,” she says. “I often thought that things would never change. It takes a great deal of courage, but people can live very

mood

RESOURCES

“HELP IS POSSIBLE,” SAYS JUSTICE JOHN BRODERICK. “IT’S NOT THAT COMPLEX, BUT IT’S IMPOSSIBLE IF WE KEEP OUR SUFFERING IN THE SHADOWS.”

NATIONAL National Suicide Prevention Lifeline (800) 273-8255 National Alliance on Mental Illness (NAMI) nami.org NAMI New Hampshire naminh.org Change Direction changedirection.org NEW HAMPSHIRE West Central Behavioral Health wcbh.org Emergency Number (800) 564-2578 Mountain Valley Treatment Center mountainvalley treatment.org OTHER NH COMMUNITY HEALTH CENTERS New Hampshire Community Behavioral Health Association nhcbha.org 211 NH 211nh.org

productive lives and represent the good that can come out of an illness.”

Angela is a peer support specialist in West Central Behavioral Health’s Common Ground program, where she and her colleagues help clients realize they’re part of their own treatment. She wants clients to know that recovery is possible.

“It’s important to reach out to support systems, friends, and professionals and to know that life is to be lived.

“People with mental-health challenges are no different than any-

body else on the face of this earth,” Angela says. “We see things a little differently. We may experience things differently—frequently, it’s a result of trauma. We are human beings like the rest of the people on this earth.

“I missed the boat on how to take care of myself,” she adds, “but through many years of therapy and being brutally honest—and a lot of blood, sweat, and tears— I realized there’s a lot of beauty in the world. There’s stigma and negativity, but I feel blessed. I feel like I was given a second chance.”

VERMONT Health Care & Rehabilitation Services (HCRS) hcrs.org Vermont 2-1-1 vermont211.org

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“When open communication about lived experience increases, stigma decreases.

It is particularly influential when influential people, such as leaders, actors, and athletes, speak out.”

—Dr. Diane Roston

when schools and families are not putting so much pressure on them to perform, the residents still feel the need to perform.” He says anxiety and OCD create additional barriers to success, and that it can be difficult for those with the conditions to discuss their experiences, even in supportive environments.

Whitney Hussong, MSW, a social worker employed by Vermont’s Health Care and Rehabilitation Services (HCRS), is embedded full time in the Hartford Police Department, where she witnesses the town’s residents struggle with poverty, housing, transportation, and mental health issues.

“The word I hear most often when describing someone with mental health challenges is that someone is ‘crazy,’” she says. “I find that people tend to use this word without much basis to describe someone who might do or say things that are different from their own perception of the world. There tends to be a lack of acknowledgement that someone who is struggling with a mental health issue did not ask to have these challenges brought upon them and that there is true difficulty in addressing the cause of the issue.”

Change Is Coming, but Slowly According to Dr. Roston, stigma surrounding mental illness is decreasing as science reveals genetic, biological, and 72 i m a g e h e a l t h w a t c h • 2 0 1 9

Dr. Diane Roston

biosocial causes and correlations—and as we see more people living full lives while managing mental health conditions. She says it’s also important when people share their struggles. “When open communication about lived experience increases, stigma decreases. It is particularly influential when influential people, such as leaders, actors, and athletes, speak out.”

Retired New Hampshire Supreme Court Justice John Broderick is one of the prominent individuals who is speaking up. In 2002, Justice Broderick’s older son Christian assaulted him as a result of an undiagnosed mental illness. John ended up in the ICU for several days. Then 30 years old, Christian went to prison for three years, where he received the diagnosis and treatment he needed for the anxiety and depression that had remained hidden since adolescence.

Justice Broderick says that, as difficult as the crisis had been, it put his family on the path to healing; they became aware of Christian’s struggles, and he received help and is now thriving.

“I grew up at a time when no one talked about mental illness,” Justice Broderick says. “I was affected by stigma in the sense that, from an early age, you never talked about it, and because no one talked about it, I knew nothing www.uppervalleyimage.com •

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Justice John Broderick wants the public to question why people with mental illness should be treated any differently from those with breast cancer or broken bones. about it. So when mental health issues started to arise in my own family involving one of my two sons when he was 13, I didn’t see it.”

Justice Broderick’s experiences inspired him to become a mental health advocate. He participates in two campaigns: Change Direction, a collection of concerned citizens unified to transform the culture around mental health, mental illness, and wellness, and REACT, which he manages through his role as Dartmouth-Hitchcock Health’s senior director of external affairs and which complements Change Direction by guiding people about how to respond when they see someone experiencing emotional distress.

As of July 2019, Justice Broderick had spoken 430 times to high school and middle school students, chambers of commerce, civic organizations, nurses’ groups, and at grand rounds at hospitals.

His message has reached approximately 93,000 people. “It doesn’t matter where I go,” he says. “My talk is essentially the same. It’s an awareness talk from someone who wasn’t very aware for most of his life. But I’m aware now.”

Justice Broderick strives to enlighten society about how difficult it is for people with mental health conditions to receive treatment. He wants the public to question why people with mental illness should be treated any differently from those with breast cancer or broken bones.

“Help is possible,” he says. “It’s not that complex, but it’s impossible if we keep our suffering in the shadows.”  74 i m a g e h e a l t h w a t c h • 2 0 1 9

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liv in g we ll | BY PAMELA BROWN

“Hearing loss is the third most common physical condition in older Americans,” says Cindy Edmondson, owner of Powerhouse Hearing Center in Lebanon, New Hampshire.

35 million Americans have difficulty hearing, yet

fewer than 30% use a hearing aid.

Today’s hearing aids are small and nearly invisible (smaller than the earbuds folks wear at the gym).

Cindy Edmondson, owner Powerhouse Hearing Center

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LISTEN UP! LOSS OF HEARING IS A SERIOUS CONDITION There’s nothing more exasperating than struggling to hear someone speak or trying to identify a noise you think you hear. When my mom recently experienced temporary hearing loss due to earwax buildup, she immediately sought help, but during that time she felt frustrated, at a disadvantage, and worried that she would never hear clearly again.

She’s not alone. Hearing loss affects a wide spectrum of people across all age groups.

“Hearing loss is the third most common physical condition in older Americans,” explains Cindy Edmondson, owner of Powerhouse Hearing Center in Lebanon, New Hampshire. Her center helps improve the lives of people with hearing difficulties. According to Cindy, hearing loss affects one in three people over 60, one in six baby boomers, and one in five teenagers.

Two Common Types of Hearing Loss The center’s website reports approximately 35 million Americans experience some degree of hearing loss. Two of the most common types of loss are sensorineural (SNHL) and conductive. Sensorineural, which is very gradual at the onset and can last several years or a lifetime, results from damage to the cochlea or nerves. It can be treated only with hearing instruments.

Conductive hearing loss occurs when sounds are impeded on their way to the inner ear.

Loss can be from arthritis of the bones in the middle ear, middle-ear fluid, acoustic neuroma, cancer, and other conditions. This type of loss is treated only by medicine or surgery.

“Usually a combination of factors causes loss,” says Cindy.

These include, but are not limited to, aging, genetics, noise induced from loud sounds, a loud work environment, and ototoxic medications such as aspirin, quinine, and some antibiotics and anesthetics. Certain people are inclined to experience some type of hearing loss. “In addition to people with hypertension, it’s twice as common in people with diabetes, and smokers have a 70 percent higher risk,” she adds.

The ramifications of hearing loss can be extremely serious.

Even people with mild loss are two times more likely to develop dementia, and those experiencing severe loss are five times more likely, Cindy points out. “They are also less likely to participate in social activities and are more prone to depression and paranoia.”

Amazing New Technology As with any medical issue, the earlier a hearing loss is identified and corrected, the more effective the results will be, and the easier it will be to adjust to the loss. That’s where Powerhouse Hearing Center can help. According to Cindy, approximately 90 to 95 percent of people with hearing loss can benefit by wearing hearing instruments.

The center offers a vast assortment of discreet, comfortable,

custom-made hearing aids to suit every person’s needs and lifestyle, including Livio® AI, the most advanced, cutting-edge technology using artificial intelligence. This modern hearing aid provides better clarity in noisy environments such as restaurants, gatherings, church, and even your car. Cindy describes it as a Fitbit for the ear that tracks fitness and brain activity, sends fall alerts, and translates languages as well as streaming music, books, movies, and phone calls. It even has a GPS and a five-year rechargeable battery.

Don’t let hearing loss keep you from enjoying life to the fullest. If you feel you’re not hearing correctly, don’t hesitate to reach out to a hearing specialist who can provide you with a hearing evaluation and help guide you to the right solution.

“The human touch with personalization, providing comfort, maintenance, and service, is more essential than ever,” stresses Cindy. “Everyone needs that personal relationship with a hearing specialist you trust and who listens to your needs and what you want because to hear better is to live better!”  For more information, visit Powerhouse Hearing Center located at 23 PowerHouse Mall, 8 Glen Road, West Lebanon, NH, call (603) 298-9775, or visit powerhousehearingcenter.com.

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Market tables with fresh fruits and vegetables on a narrow street in Bologna, Italy. ©Danielal | Dreamstime.com

BE A SAVVIER

TRAVELER! 78 i m a g e h e a l t h w a t c h • 2 0 1 9

Below: A roadside restaurant outside of Mexico City serves homemade tortillas with all the fixings.

Bottom: A selection of quick snacks and hot peppers at a Mexican market stand.

reet

rom st f t a e r t n sweet epublic. o m m o c a , R Trdelnik Prague, Czech in vendors

10 TIPS

STORY AND PHOTOS

BY LISA BALLARD

TO AVOID GETTING SICK

I

n 1519, when Spanish conquistador Hernán Cortés came ashore on what’s now the east coast of Mexico, the great Aztec emperor Montezuma II invited him to his palace. Cortés stayed for several months. In one of the greatest mistranslations of humankind, Cortés mistook Montezuma’s polite offer to make himself at home to mean the emperor had gifted his extensive domain to Spain. War broke out, European diseases to which the Aztecs had no immunity spread, and Spain conquered the Aztecs. Though Montezuma died in the melee, he has sought his revenge on travelers to Mexico and many other parts of the world ever since.

“Montezuma’s revenge,” also called traveler’s diarrhea, is a common digestive disorder that afflicts millions of tourists and trekkers after they inadvertently consume contaminated food or drink impure water. It’s one of a number of illnesses that can turn a life-list vacation or important business trip into an agonizing affair. The symptoms are not limited to an acute case of diarrhea. Fever, nausea, bloating, weakness, gas, cramps, and a loss of appetite can also waylay travelers without warning. www.uppervalleyimage.com •

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Locals in foreign lands are used to the various bacteria and parasites in their drinking water, but as a traveler, you need to be savvy about what you eat and how you stay hydrated, especially in less developed parts of the world. E. coli, a type of bacteria, and Giardia lamblia, a parasite, are common causes of digestive-tract illnesses abroad, though they are just two culprits on a long list of nasties that can make you sick.

To avoid spending your trip traipsing between your bed and the bathroom, the best policy is to adhere to the adage for food: If you don’t peel it yourself, or if it’s not cooked, don’t eat it. For beverages, if it’s not from a factory-sealed bottle or boiled, don’t drink it.

Travelers attempting to follow these two rules often feel Montezuma’s wrath because they miss a critical nuance. The classic mistake is rinsing one’s toothbrush in tap water. Other mistakes include ordering a beverage with ice in it or washing your hands with contaminated water and then touching your food. A cook can also transmit a disease to you by touching your food or by washing it in contaminated water—key reasons to stick with cooked foods. You can still contract foodborne illnesses from cooked food, but the risk is much lower.

Sometimes a malady like Montezuma’s revenge is short-lived and curable, but occasionally, it can be life-threatening, depending on what you contract. Besides eating or drinking tainted food or beverages, travelers can fall prey to serious diseases transmitted by insect bites, animal bites, intimate relations, and poor sanitation. Malaria, hepatitis A and B, typhoid fever, cholera, dengue fever, tetanus, and yellow fever are among the major maladies you’re at risk for, depending on where your travels take you.

There can also be a time lag between the trip and the appearance of symptoms. If you suffer from any abnormalities in your health, even a month or two after you’ve returned home, see a doctor immediately, and don’t forget to tell your doctor where you’ve been.

Fortunately, there are vaccines and other preventive measures to help you avoid many of these diseases, as well as ways of traveling more wisely to reduce your risk.

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Children chase bubbles in Old Town Square, a center of tourism in Prague, Czech Republic.

Opposite page: A local restaurant in a small Mexican village.

10 TIPS FOR STAYING HEALTHIER ABROAD

1 DO YOUR RESEARCH. Check with a credible travel clinic, such as the International Travel Clinic at Dartmouth-Hitchcock Medical Center (dartmouthhitchcock.org), to understand the health risks at your destination. The Centers for Disease Control and Prevention (cdc.gov) is the go-to source online for information on most countries around the globe.

2 PLAN AHEAD. Two to three months before your trip, talk to your doctor to schedule the shots you need and the medicine(s) you should take. Some immunizations and preventive prescriptions require a series of shots or doses that start before you depart. Be sure your tetanus shot is up to date too.

3 AVOID MOSQUITOES. If malaria or another mosquito-borne or buginflicted illness is a risk, use repellent, wear protective clothing, and close a bug net around you when you sleep.

Bring a bug net if it’s not provided.

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Woman sellin in Tanzania. g vegetables KEEP THESE RULES IN MIND

How Travel BENEFITS MENTAL HEALTH

IF YOU DON’T PEEL IT YOURSELF, OR IF IT’S NOT COOKED, DON’T EAT IT.

IT’S A REJUVENATOR It helps to relax and recharge us by changing our daily patterns.

FOR BEVERAGES, IF IT’S NOT FROM A FACTORY-SEALED BOTTLE OR BOILED, DON’T DRINK IT.

4 KEEP YOUR

5 BRING HAND

DISTANCE. Know what types of poisonous creatures, such as scorpions, spiders, and snakes, exist where you are going. Learn where they lurk and how to identify them.

SANITIZER AND USE IT FREQUENTLY. Avoid touching your hands to your eyes, nose, and mouth to keep germs away.

7 TAKE CARE OF 6 STAY OUT OF DIRTY WATER. If water quality is a concern or if conditions are unsanitary, use baby wipes to wash your face and body instead of bathing or swimming.

YOURSELF. Keep your immune system charged up by eating healthy food, staying hydrated, and getting enough sleep before you depart and while you’re traveling.

IT CAN BOOST CREATIVITY A change of scenery, sampling new foods, and experiencing a new culture are great ways to see life in a new light.

IT CAN RELIEVE STRESS Traveling helps you reset your outlook because you’ll focus on the present moment.

IT CHANGES YOUR VIEW OF THE WORLD Exposure to different languages and new places, people, and ideas challenges you to broaden your worldview.

IT CAN BUILD CONFIDENCE Having to navigate in a different culture boosts your confidence.

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8 DRINK PURIFIED WATER. Bring Aquamira, iodine tablets, or a SteriPEN if you are not sure you can obtain sealed, pure water or boiled water.

9 BE PREPARED FOR MINOR EMERGENCIES. Carry a small first aid kit with medications to treat diarrhea, constipation, allergies, minor cuts, pain, fever, motion sickness, and other minor ailments.

10 RESPECT ALTITUDE. If you’re 1 planning a trek at high altitudes (above 8,000 feet), even if you are an uber-fit marathoner, you’ll probably experience shortness of breath after only minimal exertion, and you may sleep restlessly until you acclimatize. Go slowly! If you get a headache and/or nausea, go lower—losing elevation is the only way to cure acute mountain sickness. A prescription medication like Diamox can help.

Traveling abroad, learning about other cultures, meeting people with different backgrounds, and having adventures unique to a particular region of the world are among life’s most rewarding experiences. Don’t stay home because you worry about picking up a strange disease. If you’re a savvy traveler who takes reasonable precautions, chances are you’ll have a fulfilling experience and a memorable journey— with no medical issues as souvenirs!  An award-winning writer/photographer, Lisa Ballard has spent a lifetime traveling to remote, exotic places around the world.

To read about her adventures, pick up any issue of image or go to www.LisaBallardOutdoors.com.

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BY E. SENTEIO

COMPLETE CARE:

MIND, BODY, SPIRIT INTEGRATIVE MEDICINE BENEFITS LONG-TERM HEALTH AND HAPPINESS

Janelle enjoys video games, is an avid softball player, eats too much chocolate, recently separated from her partner, makes wall art from found items, and thinks about trying Pilates or getting a dog. She also has an illness.

Each person who stands before a health professional has a more substantial life story than the chapter titled “Disease.” As the understanding of the role the mind–body connection plays in health and healing continues to expand, there is a progression toward the more comprehensive and robust approach of integrative medicine.

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“Like other types of primary care, integrative medicine tends to the whole person— body, mind, and spirit—taking into account all aspects of a patient’s lifestyle,” explains Louis Kazal Jr., MD, family physician at Dartmouth-Hitchcock Medical Center.

A BETTER WAY Integrative medicine brings together the best possible combinations of traditional and alternative therapies for overall health and wellbeing. “Like primary care, integrative medicine tends to the whole person—body, mind, and spirit—taking into account all aspects of a patient’s lifestyle,” explains Louis Kazal Jr., MD, family physician at Dartmouth-Hitchcock Medical Center. It is not unlike holistic medicine in its multipronged approach yet has greater specificity and datadriven amalgamations. Dr. Kazal says, “It’s a judicious combination of complementary therapies, such as chiropractic and acupuncture, with conventional Western therapies.”

The predominant medical model—the way in which medical professionals evaluate, diagnose, and treat patients—has many labels: conventional medicine, Western medicine, traditional medicine. Its primary function is to diagnose the disease and determine how it can be eliminated, impeded, or managed. While it may be effective in its aim, an integrative strategy is more beneficial not only to an individual’s long-term health but also to his or her happiness.

Health, as defined by the World Health Organization, is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” To reach this classification of health requires more than surgical instruments or mending broken bones.

Integrative medicine embraces this broader, all-encompassing view, asking more than “Where does it hurt?” and delving deeper into “Why did this disease or ailment manifest at all in this particular individual?

What is the root cause?”

A BETTER UNDERSTANDING This level of patient care requires practitioners to better understand a patient’s life beyond illness and to become familiar with the individual’s habits, environment, and health goals. Integrating therapies, says Dr. Kazal, puts “an emphasis on the patient–clinician partnership.” Open communication between practitioner and patient is necessary to determine the appropriate and most effective complementary therapies beyond the doctor’s office in relation to a patient’s immediate and continuing well-being.

By design and necessity, the integrative medicine model also fosters coordination and collaboration between providers across disciplines and institutions. An integrative medicine group can comprise any combination of MDs, DOs, licensed acupuncturists, chiropractors, massage therapists, naturopaths, homeopathic doctors, practitioners of Ayurvedic medicine, yoga, and so on.

A BETTER LIFE The concept of integrated health is a boon to patient health from diagnosis to treatment, as well as prevention. A practitioner designs an individualized treatment plan for each patient’s lifestyle and health goals. According to Dr. Kazal, patients who seek integrative medicine are usually very motivated to take a greater role in their own health care. From the emotional, mental, social, and environmental aspects

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mood

Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by “laying on hands” and is based on the idea that an unseen life force energy flows through us and is what causes us to be alive. If our life force energy is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy. www.uppervalleyimage.com •

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MEDITATION

CHIROPRACTIC

ACUPUNCTURE

Someone who practices meditation is less likely to have a heart attack. Qigong improves balance and helps prevent falls.

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QIGONG

to the physical and topical, an integrative medicine practitioner, in partnership with his or her patient, can devise the most advantageous health care plan and holistic network targeting the areas in the individual’s life that would be most beneficial to overall health and wellness.

There is also a strong preventive component. Someone who practices meditation is less likely to have a heart attack. Qigong improves balance and helps prevent falls. These early interventions and others like them not only keep individuals out of the doctor’s office for more serious ailments but also lighten the burden on the health care system in regard to preventable health problems.

Traditionally, the concept of healthy living is measured primarily by diet and exercise. However, advances across disciplines continually show the interconnectedness of mind, body, and spirit. Positive thinking improves health outcomes; the act of praying can relieve stress; exercise strengthens the heart; stretching helps with flexibility. Health and wellness come from a sense of wholeness that is only possible when there is a balance in one’s life between the mind, body, and spirit. Integrative medicine lands on this inclusive intersection.

“It is more important to know what sort of person has a disease than to know what sort of disease a person has.” — Hippocrates (460–377 BC)

A BETTER OUTCOME While physical ailments will still arise and surgeries will be required, the integrative medicine model expands care beyond the operating room into the “living” room, where a patient is an interconnected, multifaceted individual. It’s a lofty aim, this approach to redefining health as more than the physical to consider all aspects of patients’ lives and then partner with them to achieve holistic well-being.

Why rock the boat? Because it is the best practice for the patient and results in better long-term outcomes. “Evidencebased integrative medicine can benefit everyone—people who are healthy and want to stay healthy and patients with chronic conditions,” says Dr. Kazal. And although coverage by health insurance is variable, Dr. Kazal says, “alternative therapies, such as chiropractic, have become more routinely included in health coverage policies.”

The integrative medicine model creates a more dynamic relationship between patient and provider, which serves to balance and elevate quality of life as well as the overall patient experience. In partnership with her provider, Janelle may decide to try a masseuse for her pitching arm before considering surgery, a dietician to help with her chocolate cravings, a counseling session or meditation to move past her relationship, and a dog with floppy ears to make her laugh more often, which decreases stress hormones and releases endorphins that promote an overall sense of well-being.  www.uppervalleyimage.com •

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f in a n c ia l h e alth | BY RENÉE A. HARVEY AND TIMOTHY W. CALDWELL

Making a Plan is Essential CALDWELL LAW CAN HELP

Timothy W. Caldwell, Counselor at Law Renée A. Harvey, Counselor at Law Renée A. Harvey, Counselor at Law, has worked in the New York, Vermont, and New Hampshire legal systems since 1990. She is a graduate of Vermont Law School. Her practice focuses on estate planning, settlement, and assisting clients in making informed decisions. She is a Respecting Choices® Advance Care Planning Certified Facilitator and a certified mediator. Renée also serves on the New Hampshire Bar Association’s Dispute Resolution Committee and the Patient Choices Vermont Advisory Committee.

Timothy W. Caldwell, Counselor at Law, has 28 years of experience in the Upper Valley and since 1997 has concentrated his practice on estate planning and settlement. He graduated cum laude from Dartmouth College and earned his Juris Doctorate from Georgetown University Law Center. He served as chair and member of the Lyme School Board and the Upper Valley Planned Giving Council, and he currently serves on the Upper Valley Regional Advisory Board to the New Hampshire Charitable Foundation. Tim was instrumental in establishing LeaveALegacy®NH/VT.

Estate planning is about coming to terms with the fact that, ultimately, we all lose control—either because of incapacity or death—and then doing something about it. Estate planning is about you and your beneficiaries. Because life changes, it is a process; family, beneficiaries, assets, laws, circumstances, goals, your thinking—all may change. Our goal is to help all our clients answer “yes” to four questions: Do I understand my plan?

When thinking about your planning, it is essential to understand your options in order to prepare for your needs and wants as well as those of your beneficiaries.

An effective plan successfully manages current and future financial and health challenges and meets the needs and wishes you have defined for yourself and your beneficiaries.

Will my plan take care of me and those I love?

Imagine you have dementia: Will you be cared for in the manner you want to be cared for? Will you receive the medical treatment you want and not receive treatment you don’t want? After your death, will the gifts you make to your beneficiaries be beneficial to them, or will they be lost to a divorcing spouse, another creditor, addiction, or the cost of long-term care?

Are my assets titled in a manner that is consistent with my plan?

Title, meaning the way you own your assets, is critical to the success of your plan.

Title controls how your assets are managed during your life and how they will be distributed following your death. Most commonly, if you use a will, your assets will be titled in your name alone. If you use a trust for your planning, you will own your assets as a trustee. Assets controlled by beneficiary designations, such as retirement accounts and life insurance, will name your beneficiaries, either individuals, charities, or trusts. Review your assets individually, asset by asset, and make sure that each is titled in a manner consistent with the terms of your plan. Doing so could avoid heartache, wasted time, and unnecessary expenses.

Do my helpers (fiduciaries) understand their responsibilities?

Agents, executors, trustees—we call them “helpers.” Choosing your helpers is a critical part of estate planning. Once chosen, teaching them what you want them to do for you is essential. Assume nothing. Be clear about your wishes, especially with respect to health care matters. And remember, things change, so keep your helpers up to date! 

367 Route 120, Suite B-6 Lebanon, NH (603) 643-7577 estateandelderlawgroup.com

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

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BY SUSAN NYE

Slowing the Progression OF

DEMENTIA A HEALTHY LIFESTYLE AND STAYING ENGAGED CAN HELP PATIENTS AND CAREGIVERS ALIKE

Learning that you or someone you love has dementia is like a punch in the gut. It takes your breath away and sends you reeling. Dementia is a catchall term for cognitive disorders such as Alzheimer’s disease, and while Alzheimer’s makes up about 70 percent of all dementia cases, the category includes Lewy body dementia, vascular dementia, Huntington’s disease, and more. The terms Alzheimer’s and dementia are often used interchangeably, but they are not the same. It might help to think of it this way: Chicken pox is a childhood disease, but not all childhood diseases are chicken pox.

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Unlike chicken pox, there is no magic pill or vaccine to combat these diseases. The sixth leading cause of death in the United States, Alzheimer’s is unique in that it is the only cause of death ranked in the top 10 that has no cure. However, Director of Dartmouth Centers for Health & Aging and Assistant Professor Ellen Flaherty, PhD, ARNP, says there are ways to slow down this debilitative, degenerative disease and other dementias. She urges patients and potential patients to delay their onset or progression by working on modifiable risk factors.

Practice a Healthy Lifestyle By keeping both your brain and body strong, you may be able to slow the progression of dementia. Many age-related health conditions influence cognitive function. High blood pressure,

diabetes, and high levels of LDL (bad) cholesterol put the brain at risk. Dr. Flaherty says, “Staying fit will not prevent dementia, but it may help slow its progress.”

Tony Venti, executive director at Sunapee Cove Assisted Living in George’s Mills, adds that there is no cure for dementia. “You can only slow it down. Environment and socialization play a role in keeping our residents healthy and engaged longer,” he says.

A healthy lifestyle is also important for caregivers. Caring for a spouse or parent is stressful. As dementia progresses, caregivers face numerous tasks, decisions, and concerns. From showering and hygiene to dressing and eating, dementia patients need help with many—and eventually all—the activities of daily life. In addition, caregivers worry about their loved one’s safety and the high cost of health care.

Slow Alzheimer’s and Improve Quality of Life Dr. Flaherty says there are a number of lifestyle changes people can make both before and after the onset of Alzheimer’s.

These six tips may help slow the disease and improve quality of life as it inevitably progresses.

1. Stay active.

Regular exercise is important for both physical and mental well-being. Don’t force yourself to endure a sport or activity you hate. Instead, find something you love or at least like. As long as you enjoy the activity, you’ll continue it. The staff at Sunapee Cove Assisted Living works diligently to keep residents active and engaged. Activities including chair exercises, games, discussions, and music, including sing-alongs, fill the day. “We also go on walks to the harbor and field trips,” says Tony. “Our goal is to continue to keep people involved and stimulated.”

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GAGED

EN STAY ACTIVE AND

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A LOOK AT THE NUMBERS 5.8 million Americans are living with An estimated

Alzheimer’s disease or another form of dementia. While a small number develop early-onset Alzheimer’s, it is largely

a disease of advancing age.

ET EAT A HEALTHY DI 2. Achieve better health through better nutrition.

The Mediterranean-style diet is not just a trend; it really is good for you. This style of eating emphasizes fruits, vegetables, nuts, whole grains, unsaturated oils such as olive oil, and fish and plant proteins. It will help maintain a strong heart, which in turn helps your brain stay healthy longer.

3. Exercise your brain.

Challenging your mind is a great way to slow cognitive decline.

Dr. Flaherty urges people to use and stimulate their brains by trying and learning new things. If you’re interested in travel and new ideas, study a new language or attend a lecture series. If you love music, take dance lessons or learn to play an instrument. If you’re more of an introvert, read a book or write poetry.

disease strikes one in 10 people age 65 and older, and its The

prevalence increases with age.

The longer you live, the more likely you are to develop Alzheimer’s disease.

The effects of dementia are

Family and close friends are all impacted by the disease.

far reaching.

Not only do grandchildren lose out on the joy of growing up with Nana or Gramps; many

TRY SOMETHING N EW

spouses and adult children take on roles as unpaid caregivers.

More than 16 million Americans provide an estimated

18.5

billion hours of unpaid care to a loved one, with a value of nearly $234 billion.

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SOLUTIONS FOR TODAY AND THE FUTURE Lynne Neuwirt, an occupational therapist with Lake Sunapee VNA and Hospice, supports families and helps individuals understand the issues they face now and in the future. Knowing that most people want to remain at home, the LSVNA helps clients stay safe at home for as long as possible.

Lynne works with clients to help them understand what’s

SPEND TIME WITH

FRIENDS AND FAM

ILY

happening now and what to expect. She tries to uncover what is meaningful for each individual.

“It could be as simple as raking leaves or walking the dog,” she says. Unfortunately, outside activities can be problematic as

4. Maintain a strong social network.

Friends and family can be as therapeutic as many medicines. Spending time with loved ones is a wonderful way to relieve stress and to stay happy and healthy longer. Maintain connections with people of all ages by volunteering, attending local arts and athletic events, and staying active in your church or community activities.

many people with Alzheimer’s wander. Lynne explains, “Together, we look for solutions; we develop a plan to help them safely pursue their favorite activities.”

COMPLETE YOUR ADVANCE DIRECTIVE As dementia advances, patients lose the capacity to make decisions for themselves. However, the Patient Self-Determination Act gives Americans the right to participate in their own health care decisions. It is important for

CALM YOUR MIND

anyone with dementia to create an Advance Directive early. As the disease progresses, people become incapable of asserting their right to make their own decisions.

Completing an Advance Direc-

5. Reduce stress.

No one can avoid stress all the time, but a healthy lifestyle can help combat it. Breathing exercises, yoga, and meditation are good ways to calm the mind. In addition, caregivers should consider talking to a counselor or friend or joining a support group.

tive ensures that your health care wishes are honored.

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6. Get enough sleep.

Adults, regardless of age, need seven to nine hours of sleep a night. A regular bedtime and routine will help improve sleep patterns.

Support for Patients and Caregivers Alzheimer’s disease can be an extremely isolating illness for both patients and caregivers. As the disease progresses, people are not able to participate in activities they once enjoyed. It becomes difficult for them to follow conversations, keep score during a golf game, read a book, complete household chores, or take care of a hundred big and little things.

From memory cafés, exercise classes, and art and music programs to adult day care services and residential assisted living, a variety of possibilities for help and support exist. As dementia develops, it is important to identify and adapt activities to changing skill levels and capabilities. A good match maximizes participation, enhances well-being, and provides a sense of accomplishment.

Caregivers also need support. Caregiving, especially for a loved one, is incredibly demanding. Caregivers need to develop strategies to curb their fatigue and enlist help with many physical tasks. “They need to rethink when to ask and when to tell. Perhaps, most difficult,” says Dr. Flaherty, “is they have to learn to lie.”

Dementia patients can become “stuck” on a difficult question. They will frequently ask about a parent or favorite relative who has long since died. No matter how many times you answer, they circle back and ask again. The truth does nothing but fill them with sadness.

Telling a loved one what might be called “white lies” takes practice—and a lot of support from family and friends.

Caregiver groups, formal and informal, provide critical support. Participants share tips and tricks, like how to get a loved one into the shower. Moreover, they understand that showering is an issue, and they agree that every other day is fine. They’ll reassure you that it’s okay to lie and, most important of all, a support group helps caregivers feel a little less alone. 

CAREGIVERS NEED

SUPPORT

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LOCAL RESOURCES DARTMOUTH-HITCHCOCK AGING RESOURCE CENTER Dartmouth-Hitchcock Aging Resource Center provides older adults, families, and community members with information, education, and support to help them live healthier and more informed lives. The center hosts a monthly memory café and offers caregiver workshops and a biweekly support group.

46 Centerra Parkway Lebanon, NH (603) 653-3460 agingcenter@hitchcock.org www.dartmouth-hitchcock.org/aging_ resource_center

GOOD DAY RESPITE Lake Sunapee VNA and Hospice offers respite care three days a week from 10am to 3pm for people with Alzheimer’s, dementia, and Parkinson’s disease.

LSRVNA staff and volunteers provide interactive and stimulating activities in a safe and supportive environment.

The all-day program includes a nutritious lunch and snacks. As well as helping participants, Good Day Respite gives caregivers much-needed breaks, essential to their health and well-being.

107 Newport Road New London, NH (603) 526-4077 info@lakesunapeevna.org www.lakesunapeevna.org/services/respite

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hea lthy solution s | BY ELAINE AMBROSE

QUALITY COUNTS FEED YOUR BEST FRIEND FOR GOOD HEALTH AND LONGEVITY What we feed our pets affects their general health, weight, and longevity. And veterinarians

When we consider the various stages of growth, from puppyhood to (potentially) reproduction, pregnancy, and nursing, then adult maintenance and aging, and the five basic kinds of dog food—dry or kibble, wet or canned, semi-moist, home-cooked, and raw foods, it’s easy to see how feeding your best friend can become complicated.

say they field more questions about nutrition than almost any other pet-related topic—no wonder, with all the dog foods on the market. What brands are best? Should you go grain free, try raw food, feed table scraps?

A few pointers can clear the fog but “if it ain’t broke, don’t fix it.” If a dog is doing well on its current diet, don’t change it. If you’d like to try a better-quality food, or your aging dog’s diet doesn’t meet his changing nutritional needs, or if allergies develop, then a change might be in order. Food allergies manifest as flatulence, loose stools or diarrhea, rash and skin irritations (sometimes with licking or biting to relieve itch), vomiting, and even ear infections, and certain breeds seem to be prone to them; examples include Retrievers, Boxers, Dachshunds, and Westies.

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h e a lt hy solutions DON’T GIVE YOUR DOG Apple Seeds Avocado Candy Chewing Gum Toothpaste Mouthwash Cat Food Chocolate Coffee Tea Caffeine Cooked Bones

WHAT FRUITS ARE BAD FOR DOGS? Cherries are toxic to both cats and dogs, and grapes and raisins can cause kidney damage.

Citrus including lemons, limes, and grapefruit as well as persimmons cause stomach upset.

CAN DOGS EAT ICE CREAM? Since it’s made with milk, ice cream may cause gas, bloating, constipation, diarrhea, or vomiting.

While it’s not dangerous eaten in small amounts as an occasional treat, dogs that are overweight or have diabetes, allergies, or dairy intolerance should avoid ice cream.

Choose a diet rich in protein. Diets higher in protein and lower in wheat and processed grains (found in most shelf-stable commercial dog foods) offer your dog more energy and fewer GI problems.

Grain Free?

Dog foods marketed as grain free (and, thus, gluten free) contain a high amount of peas, lentils, other legumes, or potatoes in various forms (whole, flour, protein). These will appear among the first 10 ingredients on the label, before vitamins and minerals. Many grain-free foods offer more protein and fewer carbs, so they’re more digestible. Benefits include healthier skin, better breath, and a potential to reduce food allergies.

But a recent review of more than 500 cases of canine dilated cardiomyopathy (DCM) prompted the US Food and Drug Administration to warn of a possible link to certain grain-free foods. Almost all dogs in these cases had eaten mostly grain-free products.

The Canine Journal urges caution regarding grain-free diets until the FDA learns more, but your trusted veterinarian should guide your choices about diet.

Guidelines to Consider First, aim for high-quality dog food, sometimes called “premium.” These generally use better ingredients and fewer chemical preservatives, and they’re formulated to meet or exceed AAFCO (Association of American Feed Control Officials) standards. A nonprofit, the AAFCO sets standards for animal feeds and pet foods in the US. You’ll pay more for highquality foods, but you’ll save time and money on veterinary care related to digestive upsets, skin problems, allergies, and other ills related to an inadequate diet.

Second, keep it simple. The contents list for a quality food should have meat or fish as its first ingredient—not meat byproducts. The fewer ingredients, the easier it is for your vet to determine which one is causing a problem should one arise.

Third, if you change your dog’s diet, do it slowly—over a week or longer—and check

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with your vet for advice. Start by replacing her regular chow with an eighth cup of the new one. For smaller dogs, the amount will be less.

If it’s well tolerated, move up to a fourth cup after a couple of days, then a third cup for two days, and to a half cup by the end of a week or longer. To avoid digestive upsets (vomiting, diarrhea), don’t rush it!

If you’ve adopted a shelter dog, good for you! But keep him on the same food he ate there for a while and make that switch even more slowly—adjusting to a new home and family can cause digestive issues on its own related to anxiety.

Made in the USA? In recent years, dog-food makers have fielded hundreds of consumer complaints about dogs sickened by their foods. Chinese imports were found to be the greatest source of problems, and huge recalls followed. Now, savvy pet guardians look for treats and foods made in the United States.

A problem remains, however. Heating and processing means that important nutrients must be added at the end for dog food to be well-balanced nutritionally. These may be in the form of a blend of 20 or more vitamins, minerals, and maybe other nutrients in what’s called a premix. Unfortunately, these premixes are nearly all made in China or India. And while reputable manufacturers aim to source the safest premixes they can, it’s difficult for them to determine the origin of individual ingredients and whether quality control measures were in place.

Be a Smart Consumer Get to know the Animal Health Foundation, which maintains a list of recalled pet food products at animalhealthfoundation.net. It makes sense to check the wesite occasionally and especially if a problem arises. If you’re confused about all the hype about raw foods

HOSPITALS

PETS AND OUR QUALITY OF LIFE

Sharing your life with a companion animal is one of the most rewarding relationships you’ll ever have. And plenty of sound research shows that human–animal interaction, or HAI, offers emotional, social, physical, and even cognitive benefits to people of all ages.

Pets can calm children, help them release excess energy, provide a sense of security, and teach responsibility.

Research shows that kids raised with a cat or dog are less likely to have asthma. More recently, evidence points to benefits for children with ADD/ADHD and Autism Spectrum Disorder. Dogs even play a role in literacy, visiting local libraries where young readers share stories with them.

At the other end of the lifespan, pets ease loneliness and isolation, reduce stress, and help us stay active and mentally alert. Walking a dog offers opportunities to meet others and stay connected, improving social-emotional well-being as well as general health.

At all ages, living with a pet has been found to reduce blood pressure, improve cholesterol levels, and decrease risks for heart disease. Dogs can even warn owners about seizure activity, hypoglycemia, and other health prob-

lems. And their visits to hospitals and nursing homes indicate that pets not only keep us from getting ill but also speed recovery when we do have an illness or injury.

Those who share their lives with a pet report less anxiety and depression.

Just petting a cat, dog, or rabbit can reduce stress. They even help us practice mindfulness—that quality of being in the present moment and appreciating life.

Need more reasons to help clear your local shelter? “Get Healthy, Get a Dog,” a new Special Health Report from Harvard Medical School and Angell Animal Medical Center, offers exercises to share with your pet, training tips, and ways to benefit from contact with these furry miracle workers when your situation doesn’t allow you to have one. Learn more at www.health .harvard.edu/staying-healthy/gethealthy-get-a-dog.

versus grain free versus traditional dog foods, you’re not alone. And those table scraps? If your dog does well on these, and your vet agrees, go ahead.

Just make sure that they don’t contain ingredients like onions that can sicken dogs. Especially for dogs that have sensitive tummies, staying on a quality food that’s well-balanced to meet life-stage nutritional needs is the best route and one that will keep your best friend well and thriving for the long run. Follow your veterinarian’s advice and ask for food recommendations and, especially, how much to feed your dog to avoid overweight. Always measure!

Finally, always provide your pet with plenty of fresh, clean water and avoid plastic dishware. Preventing health problems is well worth the investment and is less costly than veterinary visits, prescription drugs, and medical care.  www.uppervalleyimage.com •

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s m a r t st rate g ie s | BY TINA BLYTHE, VICE PRESIDENT/RETAIL ADMINISTRATION AT SUGAR RIVER BANK

Four Ways Millennials Can Start Saving for Retirement THERE’S AN APP (OR THREE) FOR THAT!

Tina Blythe, Vice President/Retail Administration

How can I save when I have student debt?

Unquestionably, this is the biggest obstacle millennials have to saving. The interest rate on student loans is a huge factor in deciding how much to save. If your loans have a higher rate than your investments are earning, it may make more sense to accelerate paying them off. You might want to consider consolidating or refinancing student loans at a lower rate, and with the extra money, start a retirement account.

What’s the best way to track my spending and stay on a budget?

Keeping tabs on spending provides a clear understanding of cash flow. There are many financial apps millennials can use to record purchases by linking to checking and credit card accounts. You can see exactly where each dollar is going and determine whether you can cut unnecessary expenses. If the budget is tight, where can you save money? Skip the daily caramel macchiato or dining out frequently. An alternative could be brewing coffee at home or dining in with friends once a week. Finding ways to save doesn’t have to mean giving up fun, but it does mean finding new approaches.

10 North Main Street Newport, NH (603) 863-3000 www.sugarriverbank.com Member FDIC | Equal Housing Lender Other locations in Concord Grantham New London Sunapee Warner

How do I take advantage of my employer’s retirement plan?

If you’re a millennial who’s lucky enough to have the benefit of a retirement fund, generally a 401(k) offered at work, it is in your best interest to start saving as soon as you’re eligible. Educating yourself about how 401(k)s can reduce taxable income and about the significant benefits of employer matching may convince you to take advantage of this savings opportunity. When you don’t chip in to get the employer match, real money is being left on the table. What if there is no 401(k) at work? Opening an Individual Retirement Account (IRA) at your local community bank and making consistent contributions can still offer significant tax advantages and savings.

What if I can save only a small amount?

The good news is that there is no minimum amount to start saving! Even if you have only an extra $25 a month to save and it’s invested consistently throughout the year, that’s a great start. Financial planners also suggest micro savings apps, which allow you to invest spare change and track it from a smartphone.

The amount is not important, but starting early and being consistent are key factors. 

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

ADVERTISERS INDEX Randy Schaetzke Wholistic Health Services of Vermont 17

AboutFace Skin Therapy 46

Hill Opticians 20

Alice Peck Day Memorial Hospital 12

Hillside Village Keene 12

Allen Pools & Spas 72

Historic Homes of Runnemede 47

Amped Fitness 1

James R. Predmore, DDS, AAACD 3

Amy Tuller, Registered Dietitian Nutritionist 46

Johnson Audiology 46

Annemarie Schmidt European Face & Body Studio Back cover

Junction Frame Shop 73 LaValley Building Supply 74

Blue Cross and Blue Shield of Vermont 75

Ledyard Financial Advisors 65

Brown Furniture 9

Mascoma Community Health Center 97

ClearChoiceMD Urgent Care 6

Mascoma Dental Associates 63

Clover Gift Shop 98

Mertens House 75

Colonial Pharmacy 47

Mountain Valley Treatment Center 82

Dartmouth-Hitchcock 8

Sugar River Kitchens, Bath & Flooring 63 Summer Court Dental 15 Sunapee Cove 2 TLC Homecare 53

Monarch Family Medicine 46

Co-op Food Stores 34

Schellnoble 33

Sugar River Bank 103

Love’s Bedding & Furniture 83

Caldwell Law 91

Roger A. Phillips, DMD 19

Strong House Spa 46

Little Istanbul 89

CCBA 74

River Road Veterinary Clinic 47

Springfield Medical Care Centers Inside Front Cover

League of NH Craftsmen 73

Blue Sparrow Kitchen 47

Richard Electric 55 Robert Alvarenga, DMD 82

Lake Sunapee Region VNA & Hospice 72

Baker Orthodontics 11

Raq-On Dance Studio 46

Doctor Sam’s Eyecare 62

Mt. Ascutney Hospital and Health Center Inside Back Cover

Dr. Donna Reed, Optometrist 33

Neal Wallace Dental 54

Dr. Dorothy Hitchmoth 4

Neely Orthodontics 7

Eyeglass Outlet 47

New London Hospital 20

Good Neighbor Health Clinics 55

No Place Like Home Mobile Vet 47

Guaraldi Agency 21

Omer & Bob’s 46

Hanover Eyecare 83

Powerhouse Hearing Center 23

Hanover Terrace Health & Rehabilitation Center 98

Quail Hollow 54

The Creation Place 47 The Gilded Edge Frame Shop & Gallery 47 The Village at White River Junction 5 Unleashed 47 Upper Valley Health & Wellness Fair 46 Valley Vision Family Eyecare 46 Visiting Nurse and Hospice for Vermont and New Hampshire 77 WISE 13 White River Family Eyecare 83

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

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