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Minimally Invasive Spine Surgery

Dr. Paraiso’s No. 1 priority is patient care and he treats his patients with compassion, empathy and knowledge. He takes pride in seeing his patients live active and enjoyable lives. Specializing in Minimally Invasive Spine Surgery for • Spinal Stenosis • Failed Laser Spine Surgery • Herniated Discs • Back & Leg Pain Clinical Assistant Professor University of Florida Department of Orthopedics – Spine Surgery Published Author and Minimally Invasive Spine Surgery Instructor Board Certified & Fellowship Trained Health Grades® Five-Star Recipient

Dr. Paraiso received his Bachelor of Science Degree from the University of Florida in Gainesville in 1995. He then obtained his medical degree from Kirksville College of Osteopathic Medicine in 1999. In 2004, Dr. Paraiso completed his internship and orthopaedic surgery residency at Michigan State University/Genesys Regional Medical Center in Grand Blanc, Michigan. He received further advanced spinal surgery training during a 12 month spine fellowship at the Florida Orthopaedic Institute’s Center for Spinal Disorders in Tampa, Florida. Dr. Paraiso was specialty trained in and practices minimally invasive spine surgery using tried and proven methods.


BENEFICIAL HEARING DID YOU KNOW THAT IT’S NATIONAL BETTER HEARING AND SPEECH MONTH? THIS MAY, BENEFICIAL HEARING AID CENTER IS FOCUSING THEIR EFFORTS ON ENCOURAGING PEOPLE TO GET THEIR HEARING CHECKED EARLY SO THEY CAN BETTER MANAGE THE QUALITY OF LIFE ISSUES THAT OFTEN RESULT FROM UNADDRESSED HEARING LOSS.

three people with hearing loss are below retirement age.

WHAT HABITS DO YOU ENCOURAGE FOR PROPER HEARING HEALTH?

Too many people cling to the old, stubborn belief that wearing a hearing aid won’t help fix their hearing problem. The good news is that hearing loss can be easily diagnosed, and for most people, there are solutions in the form of digitally programmable hearing instruments, many of which are so small and discreet they are invisible. I hope people understand that hearing instruments work better than ever due to continuing advancements in technology and can dramatically improve the quality of their lives.

It is important to practice good hearing hygiene and use proper hearing protection when exposed to loud levels. Skip the cotton swabs because they may end up pushing wax deeper into the canal, which leads to a wax impaction causing hearing loss, tinnitus and/or pain. Instead, have a properly trained certified audiologist provide safe, sterilized wax removal to keep your ear canals clear and healthy. You should have an initial comprehensive diagnostic audiological evaluation by a certified audiologist and annual screenings to ensure that you are always hearing your best!

WHO IS AT RISK FOR HEARING LOSS? Many people associate hearing

loss with advanced age but it is also associated with ear infections, childhood diseases, genetics, exposure to loud noise, accidents, head trauma, stroke, even medications to name a few. Two out of

WHAT ARE THE SIGNS OF HEARING LOSS?

The symptoms of hearing loss include you hear but don’t always understand, people seem to mumble, you frequently ask your spouse or friends to repeat and you have difficulty hearing in a crowd or restaurant. If you see yourself in these statements, you should have a hearing test by a certified audiologist.

WHAT CAN YOU SAY TO ENCOURAGE OTHERS TO SEEK TREATMENT?

HOW IS BENEFICIAL HEARING AID CENTER PARTICIPATING IN NATIONAL BETTER HEARING AND SPEECH MONTH?

We are offering a free hearing screening, consultation and demonstration during the month of May. We welcome the opportunity to show you the “beneficial difference” through better hearing.

LEIGH ANN WATTS / DOCTOR OF AUDIOLOGY

352.629.4418 / 1847 SW 1ST AVE., OCALA / BENEFICIALHEARING.COM


may 2 0 1 3

| vol. 1 no. 2

features bone basics p24

ON THE COVER

The gray-haired woman with the stooped, rounded shoulders is the quintessential representation of the “little old lady.” And while this stirs up images of grandmas everywhere, those stooped shoulders are nothing to laugh at.

birthing without boundaries p42

Joanne Jansen’s mother Ruth had lived in the same home for 45 years. Ruth had been living alone for 12 years since her husband passed away, and despite Joanne’s efforts, she could tell her mom wasn’t eating well and was becoming more confused.

BY CYNTHIA MCFARLAND

If the word “midwife” brings to mind a self-taught woman in a broomstick skirt delivering babies BY BONNIE KRETCHIK at home with no pain medication, when it’s time to parent a parent p30 think again.

BY DEBBIE INGRAM

living with allergies p36

A couple months ago, I’d have told you I was pretty much allergy free. Apparently, I was wrong. Face down on a papercovered doctor’s exam table, I’m undergoing an allergy skin test, and judging by the reaction I’m having at the moment, it’s obvious I have allergies.

PHOTO BY JOHN JERNIGAN

BY CYNTHIA MCFARLAND

COVER PHOTO BY JOHN JERNIGAN COVER MODELS: LEIGH BAKER, CNM, DNP, WITH MATTHEW (LEFT) AND MORGAN

hot on the trail p47 digital foodies: who’s who among An historical debacle made ocala’s food way for one of Marion bloggers p63 County’s best-kept secrets— the Santos Trail.

BY CYNTHIA MCFARLAND

a green approach to growing p52

In recent years, there has been an increasing emphasis on the American diet. The overall declining health of our population has begun inspiring people to return to a cleaner, more natural way of eating.

After combing the Internet for Ocala food bloggers, I finally got to know some of our small town’s foodies and discover where they’ve been hiding out. It figures they were here all along.

BY AMANDA FURRER

BY BONNIE KRETCHIK

the mysterious case of lupus p58

It’s an incurable disease that affects 1.5 million Americans. Yet it remains one of the most persistent medical mysteries, both before and after diagnosis.

BY KRISTINA KOLESA

MAY 2013

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departments

9

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beat

TRENDS | NEWS | PEOPLE

BY MACKENSIE GIBSON & BONNIE KRETCHIK

p12

p9

p10 Outdoor bonding begins here.

p16

p11 Mind your manners. p12 Saving some moolah. p13 A triathlon triumph. p14 Catching up with Mother Nature.

15

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dose

INSIGHT | ADVICE | SOLUTIONS

BY MACKENSIE GIBSON & BONNIE KRETCHIK

p16 Pinning down PCOS. p18 The online pharmacist.

p15

p13

p20 Connecting with KidCare. p22 Getting a good night’s sleep.

67

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body

p20

NUTRITION | FITNESS | BEAUT Y

BY MACKENSIE GIBSON, MARIE GLASS HARRINGTON & BONNIE KRETCHIK

p68 Reforming school lunches. p70 Introducing The Chef’s Kitchen. p72 Improving your balance.

p79

p74 An Rx for better hair.

75

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balance

p70

MIND | SPIRIT | FINANCE

B Y K A R I N F A B R Y - C U S H E N B E R Y, M A C K E N S I E G I B S O N , B O N N I E K R E T C H I K & T H O M A S S A N TA N G E L O

p68

p76 Baby necessities. p77 Home hazards. p78 Helping your home value. p79 Feng shui finesse. p80 Taming the green-eyed monster. p76

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marionhealthyliving.com | MAY 2013


We make dealing with gynecological issues

a walk in the park.

Have you been treated for uterine fibroids, urinary incontinence or other women’s issues without success? Then you may be facing surgery. But you don’t have to put your life on hold to have the procedure you need. With robotic surgery, you can get back to your active life sooner. Because the surgery requires smaller incisions, there’s less pain, less blood loss and a faster recovery. And our expertly trained surgeons perform procedures with a high degree of precision using the state-of-the-art da Vinci Surgical System. Don’t suffer needlessly. Robotic surgery can eliminate your pain and make recovery easier than you imagined. Call 1-800-530 -1188 for a physician referral. Ocala Regional Medical Center | 1-800-530-1188

ocalahealthsystem.com


ADJUSTABLE BEDS PROMOTE HEALTHY LIVING

Do you suffer from lower back pain? Do you have acid reflux or poor circulation? The mattress you’re sleeping on now may not be helping. Upgrading your mattress to an adjustable bed might be just what you need. Adjustable beds offer numerous medical and lifestyle benefits, relieving the lower back pain that millions of people suffer from every day. By simply raising your head while you sleep, you can reduce snoring and acid reflux. With the many styles and features available, adjustable beds are no longer just for hospital patients.

We have the area's largest mattress selection, including some of the highest quality innerspring, memory foam and latex mattresses. We also have a large selection of futons, daybeds, headboards, sheets, pillows and more. So come on by and take a nap.

Scan here with your smartphone using Microsoft Tag app. Also visit us on Facebook.

3055 SW College Rd Ocala, FL 34474

11250 SW 93rd Ct Rd Ocala, FL 34481

2255-A Parr Dr The Villages, FL 32162

(across from mall, next to AAA travel)

(SR200 & 484, next to Chili’s)

(466, near Bob Evans by Walgreens)

352.690.2339

352.732.3100

352.753.0672

Adjustable beds allow you to raise the head and foot of the mattress, which puts your spine in the fetus position, takes pressure off your lower spine and positions your body in at zero gravity, giving you better circulation throughout the night. Do you snore? Snoring happens when your windpipe closes due to the weight of your neck. With your head raised, you change the direction of gravity, reducing snoring. Sleeping on an adjustable bed can also reduce pain from arthritis, ease swollen legs and feet, and help in the treatment of heart problems. Beyond the medical benefits, there are lifestyle advantages as well. Adjustable beds are perfect for anyone who reads or watches TV in bed. With a simple push of a button, you can raise your upper body to a comfortable position. With the head of the mattress elevated, you won’t need multiple pillows to support your head. Most adjustable beds come with a massage feature. If you muscles are sore from a long day at work, you can relax in bed and massage your aches away. The stereotype for adjustable beds is that they are for the elderly or sick. That is simply no longer the case. They are great for everyone, regardless of age or lifestyle. If you suffer from any of these conditions, you owe it to yourself to see whether an adjustable bed is right for you. This is a helpful tip from your Mattress Experts.

Adjustable Beds starting at

899!

$


MARION

marionhealthyliving.com / 352.732.0073

publisher

KATHY JOHNSON

kathy@marionhealthyliving.com

office/production manager

CYNTHIA BROWN

cynthia@marionhealthyliving.com

EDITORIAL

Ocala Health Welcomes

Eric Keyser, MD, FACC with Cardiac Surgical Associates

editorial@marionhealthyliving.com

executive editor

KARIN FABRY-CUSHENBERY managing editor

MELISSA PETERSON health editor

BONNIE KRETCHIK contributing writers

MARY ANN DESANTIS AMANDA FURRER MACKENSIE GIBSON JOANN GUIDRY MARIE GLASS HARRINGTON DEBBIE INGRAM KRISTINA KOLESA CYNTHIA MCFARLAND

Eric Keyser, MD, FACC, Medical Director Cardiovascular Surgery, Ocala Health

ART

art@marionhealthyliving.com

creative director

JASON FUGATE

graphic designers

CASEY ALLEN KRISTEN NETHEN photographer

JOHN JERNIGAN SALES director of sales

DEAN JOHNSON

deanjohnson@marionhealthyliving.com

account executives

PEGGY SUE MUNDAY

peggysue@marionhealthyliving.com

SHARON MORGAN LORI TANI MITZI WELCH accounting

LISA CONNOLLY

billing@marionhealthyliving.com

collections

LYNSEY JOHNSON distribution

DAVE ADAMS

Marion Healthy Living, May 2013. Published monthly by Ocala Publications Inc., 1007 E. Fort King Street, Ocala, FL 34471. (352) 732-0073. All contents copyright 2013 by Ocala Publications Inc. All rights reserved. Nothing may be reprinted in whole or in part without written permission from the publisher. For back issues or advertising information, call (352) 732-0073. Return postage must accompany all unsolicited manuscripts and artwork if they are to be returned. Manuscripts are welcomed, but no responsibility can be assumed for unsolicited materials. “Promotional” and “Promotional Feature” denote a paid advertising feature. Publisher is not responsible for claims and content of advertisements.

Ocala Health has a 25-year history of providing innovative cardiovascular care to the community and, in that tradition, welcomes Dr. Eric Keyser to lead its highly sophisticated heart surgery program. Dr. Keyser joins an integrated team of patient-centered specialists who have been recognized for their clinical advancements and quality outcomes. He specializes in the latest minimally invasive cardiovascular surgical techniques that offer patients faster recovery and fewer complications.

Cardiovascular Surgery

Thoracic Surgery

• Beating Heart • Bypass • Reoperative • Valve replacement • Complex Mitral Valve Repair • Great Vessel, Aorta • Cardiac Tumor • Carotid Artery • Thoracic Aortic

• Minimally-invasive • Bronchoscopy • Mediastinoscopy • Lung Tumor Removal • Chest Tumor Removal • Lung Biopsy

To learn more about Ocala Health cardiovascular surgical services, call 1-800-533-1188 or visit us at ocalahealthsystem.com. OHS-4507 Cardiac Physician Welcome Ad 5.25x9.875.indd 1

MAY 2013

3/15/13 11:40 AM

| marionhealthyliving.com

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of IMNE TDEI RC NI NA EL

Shouldn’t financial guidance be about

trust, not sales?

I can give you trusted, understandable – and FREE* financial guidance to help you achieve your financial goals. Let’s talk – I can help you plan for life. Modern Woodmen of America

Dr. Jayanti Panchal has been keeping Ocala residents healthy for the past 18 years. With close to 30 years of experience in diabetes, internal medicine and cardiology, he offers patients top-notch care combined with convenient services and a comfortable atmosphere in his Ocala office. Dr. Panchal’s patients do not make extra trips. Procedures such as varicose vein closure, echo-cardiogram and EKG, carotid artery and abdominal aortic aneurysm ultrasound, nerve conduction study, pulmonary function test, as well as complete laboratory testing can all be performed in the comfort and familiarity of Dr. Panchal’s office. One of Dr. Panchal’s newest ventures, Success By Design weight loss program, is a supervised program that has been seen to render impressive results with participating patients for more than 3 years. His weight loss clinic has helped his patients with diabetes and heart failure. With his wealth of experience and knowledge combined with a strong emphasis on patient comfort and convenience, Dr. Panchal continues to keep the people of Ocala living long, healthy lives.

Randy Alvord, FIC Managing Partner 1811 E. Fort King St. Ocala, FL 34471 352-274-8333 Randall.E.Alvord@mwarep.org

* There is no obligation to buy.

ATTORNEYS AT LAW

Serving Central Florida with Integrity and Commitment SERIOUS PERSONAL INJURY SOCIAL SECURITY DISABILITY

Janet L. Fuller, Esq. & John B. Fuller, Esq.

1396 NE 20th Ave, Suite 500, Ocala

352.547.4292 855.534.2565 Toll Free

www.ocala-lawyer.com

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beat TRENDS | NEWS | PEOPLE

splish splash The summer sun is shining, and it’s time to take a dip. The city pools will be opening up later this month and will remain open through early September. Swim lessons, movie nights and lifeguard training sessions will all take place over the coming months. For a complete list of aquatic activities, along with pool locations and hours of operation, visit ocalafl.org or call (352) 401-3918.

MAY 2013

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beat the lineup

let the games begin O ne of the best ways to bond with family members and friends is through a little friendly competition. Games that get everyone laughing and active are the perfect addition to any outdoor gathering. Here are some great games to bring along to the next barbeque, picnic or beach trip.

BeginAgain Kickin’ Putt

This active game of toss and kick includes two rubber kickin’ golf balls and one flying scoring disc. Simply toss the disc to set the ‘hole,’ and try kicking the rubber ball so that it will land in the disc. Variations of the game can be made with pars, bases and more. This is the perfect game for kids who love soccer, golf or kickball, and it’s great for letting players use their imaginations. Combining several sets can make for a tournament style game in the backyard. The disc is made in the USA from wheat plastic, and the balls are made from natural rubber. beginagaintoys.com

ROLLORS ROLLORS is a game of chance and skill as players take turns rolling round discs, marked with numbers on each side, like a bowling ball. The discs must hit the ground before they have traveled 4 feet, and once they stop rolling, they are worth a certain amount of points depending on the landing position. For example, discs that land touching the goal post are worth the number showing multiplied by two. The team that gets 21 points and is at least two points ahead of the opponent wins. This versatile, easily transported game can be set up on any flat surface, and it’s great for people of all ages and skill levels. rollors.net

Triumph Sports LED Ladder Toss This spin on the classic ladder toss game is great for families who want to keep the fun going even after the sun goes down. The green, blue and red rungs of the ladder glow in the dark with the help of AAA batteries, allowing players to toss the six blue and red bolas into the night. The included carrying bag and easy assembly make it a great addition to any outdoor gathering.

sportinggoodscentral.com

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marionhealthyliving.com | MAY 2013


Source: etiquettescholar.com

WOMAN © PHB.CZ (RICHARD SEMIK) / SHUTTERSTOCK.COM

HE ALT H Y

beat manners

Terms to know:

managing manners E ver ponder the “proper” way to do things? To save yourself the embarrassment of a social blunder, we offer tips and tricks of proper etiquette to keep you minding your manners.

ordering wine—the proper way THREE STEPS BEFORE YOU IMBIBE

1. SELECT YOUR PRICE POINT. To estimate how many bottles you will need to order that night, a good rule of thumb is one half bottle per person. To discreetly show the sommelier how much you’d like to spend, ask him or her their advice about a specific bottle and point to the price not the name of the wine. This indicates the price point you’d like to work with.

2. SELECT THE WINE. If you’re not familiar with the flavors of each region, ordering a “safe wine” that pairs well with most foods and comes in a variety of price ranges is the way to go. For a red, opt for Pinot Noir; if you’re looking for a white, a dry Riesling is quite versatile. If you’d like to explore more exotic flavors, ask the sommelier for his or her advice on what will pair well with your meal.

SOMMELIER:

A TRAINED WINE SPECIALIST; HE OR SHE CREATES THE RESTAURANT’S WINE LIST AND HAS INTIMATE KNOWLEDGE OF THE WINES ON IT.

brought to the table. Next, the cork will be removed and placed on the table. Pick it up and feel for crumbliness or complete soakage, this indicates that air has made it into the bottle and spoiled the wine. If all is well, a small amount will be poured into your glass. Swirl it around, and smell it. Take a sip and roll it around your mouth. If the wine is “off” or tastes of vinegar, you can simply say, “I’m afraid this is a bad bottle. I’d like to send it back.” Even if you are the only one who feels this is true, the server should replace the bottle for free. If everything seems fine, indicate that the wine is good and enjoy.

3. INSPECT AND TASTE. When the wine finally arrives it will be offered for your inspection. First, read the label to be sure the proper wine was

MAY 2013

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beat the challenge

the cash challenge Each month we create a new challenge for our readers to try to improve their health and wellness. Last month the challenge was to walk 10,000 steps a day, and now that you’re taking care of your bodies, we challenge you to take care of your bank account.

MONEY © ULTRASHOCK / SHUTTERSTOCK.COM

HE ALT H Y

THE CHALLENGE: save $100 this month Here are some painless ways to have an extra $100 in H your pocket come May 31.

coffee By now, you have probably noticed the huge markup price on designer lattes, but we don’t expect you to quit cold turkey and suffer through the caffeine headache. Instead, brew your coffee at home twice a week. The average medium-sized latte costs $3.53, so bringing your own java twice a week saves you $7.06 each week or $28.24 for the month.

commute

Lunchtime can be an important time for networking and making new connections at work, but eating at a restaurant every day adds up quickly. If you bring a packed lunch to work once a week, you will save approximately $8 each week or $32 for the month.

If your vehicle gets 20 miles to the gallon and your workplace is 10 miles from home, cost of transportation averages to about $18 per week. If you take public transportation or ride a bike to work once a week, you will save about $3.60 per week or $14.40 per month.

pay yourself

loose change

Set up a high yield savings account and contribute $10 from each paycheck. If you get paid biweekly, you’ll save $20 for the month. If the money goes straight from the check to the savings account, you won’t miss it, and a high yield savings account will accrue interest with time.

Search your car, house and piggy bank for loose change to cash in at the bank. If you can find 20 quarters, that’s an extra $5 in your pocket. You can even take your change to a CoinStar machine where it does the work for you for a small service charge. If you can conjure up $5.36 in change this month, you’re up to $100 for the month.

BY MAKING THESE LIT TLE CHANGES THIS MONTH, YOU’VE MANAGED TO SAVE AN EXTRA $100. THAT’S AN EXTRA $1,200 AT THE END OF THE YEAR THAT YOU NEVER EVEN KNEW YOU MISSED.

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Sources: duke.edu, humuch.com

bagged lunch


beat people © BB ACTION PHOTO

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she’ll ‘tri’ anything INTERVIEW BY BONNIE KRETCHIK

F

or most people, taking on a new sport at age 45 is a rarity. But that’s not true for Nancy Fitzpatrick, who has never been afraid to tackle something new.

A competitive swimmer in high school and an avid cyclist, Nancy turned to triathlons at age 45 after being introduced to the sport by a fellow cyclist. “I didn’t realize there were distances other than the Ironman,” she says. She signed up for her fist sprint triathlon in 2001 and, after taking home the first-place award, knew she was hooked. Today, Nancy has competed in nearly 90 races in her career, and this past season alone, she ranked 12th in Florida in the 55-59 age group. Plus, she won a podium finish at each event. “There’s something about being on the podium; it inspires you to train harder,” she says, admitting that she’s naturally a competitive person. Competing in new sports is nothing new to Nancy. Prior to moving to Florida from Vermont in 2000, she took up the equine sport of eventing after watching her daughter ride. “I’d go take pictures, and she just looked like she was having way too much fun,” she says. She proceeded to buy a mount and take up the reins herself. After competing for a few years in Vermont, she moved to Florida and began fox hunting before making the switch to triathlons.

“It’s hard having to count on a partner. In triathlons, it’s just me,” she says. Though it isn’t “just her” any more. In 2009, she met her husband, Rod, via the popular online dating site Match.com. In typical Nancy style, she and her husband decided to get married in 2011 on a six-day bicycling trip through Tuscany where their fellow cyclists served as guests and witnesses. “For active people like us, it was just phenomenal,” she says. Today, Nancy and Rod compete in triathlons together. And if they’re not swimming, cycling or running, you’ll find them on the golf course with no plans to slow down any time soon. “I love to compete, and I like to eat, and you can’t do one without the other,” laughs Nancy. She admits that she has to take care of her body more now than when she was younger, but take one look at her and you know this 57 year old must be doing something right.

MAY 2013

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beat pursuits

summer W excursions

ith the summer months approaching and the weather heating up, it’s time to spend some quality time outside. There are tons of local activities and events coming up to help you get reacquainted with Mother Nature.

MAY

5

eco tram tours CARNEY ISLAND

Explore nature trails from the comfort of a tram, and see local wildlife, such as deer, turkeys, great horned owls and redshouldered hawks. These tours JUN

1

BRICK CITY ADVENTURE PARK

AUG

AUG

fish camp

6 3

5-9

8

JUL

13

WANT MORE INFO? To register for these activities and many others, visit marioncountyfl.org or call (352) 671-8560.

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marionhealthyliving.com | MAY 2013

AUG

10

will be crawling and climbing on rocky surfaces in tight quarters, so don’t forget long pants, gloves and sturdy shoes. The

escapades start at 9am and cost $35 per person.

BRICK CITY ADVENTURE PARK

This summer camp is great for children who love being around water. Children ages 8-15 will be provided with a rod and reel, tackle box and fishing gear while they spend the week learning how to fish from a bank and boat, boating safety, JUN

at 9am and cost $8 per person.

basic wild caving experience This adventure takes explorers into the heart of unimproved wild caves in the quarry at Brick City Adventure Park. This beginner program is suitable for children and adults starting at age 8. Participants

JUL

are perfect for people of all ages and abilities, as there are accommodations for those with special needs. Tours start

casting tips, tying knots, types of tackle, fish identification, how to clean and prepare fish, etiquette and more. Camp lasts

from 8am-5pm each day and the enrollment fee is $130 per person. Register early; enrollment is limited.

kayak 101 CARNEY ISLAND

This beginner kayak program is for everyone ages 10 and up and includes instruction on the basics of kayaking, including getting in and out of a kayak,

safety tips and paddling techniques. The

program starts at 9:30am and costs $13 per person plus park entry fee.

JUN

paddleboard outings

JUL

Find out what stand-up paddling is all participants to the tubers’ exit. This about with this fun excursion down the adventure costs $18 per person plus Rainbow River for everyone ages 10 and park entry fee. up. The tour starts at KP Hole and takes

23

28 AUG

16

RAINBOW RIVER

POLE © CIVDIS / SHUTTERSTOCK.COM

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dose INSIGHT | ADVICE | SOLUTIONS

the wonderful walnut Try Them!

• SPRINKLE ON SALADS, CEREAL, YOGURT OR OATMEAL. • SWAP WALNUT BUTTER FOR PEANUT. • EAT THEM RIGHT OUT OF THEIR SHELL AS A SNACK.

Source: jn.nutrition.org

WALNUT © BIORAVEN // SHUTTERSTOCK.COM

A recent study concludes that eating walnuts may cut the risk of developing type II diabetes in women. Beginning in 1999, the diets of 138,000 women were tracked. Those who consumed eight ounces (seven walnuts make up one ounce) of walnuts per month cut their risk by 24 percent. Walnuts’ high omega-3 and -6 content may contribute to their diabetes-busting affect.

MAY 2013

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dose

what is that? P erhaps you’ve heard of a condition before but don’t know anything about the symptoms or side effects. Each month we’ll answer some common questions about some uncommon conditions that make you ask, what is that?

THIS MONTH’S CONDITION:

Polycystic Ovarian Syndrome (PCOS) PCOS is an endocrine condition that affects approximately one in 15 women. PCOS sufferers experience an imbalance of hormones. Although doctors are still not sure what initially triggers the hormonal system, excessive insulin, heredity and low-grade inflammation are thought to play a role. Symptoms can start as young as 8 years old or as late as post-menopause. When hormones are out of balance, multiple body systems are disrupted, leading to numerous side effects. Women with PCOS experience a rise in male hormone (androgen) production, which can result in: • ACNE • EXCESS FACIAL OR BODY HAIR • OVULATION AND MENSTRUATION IRREGULARITIES • TROUBLE LOSING WEIGHT • CYSTS ON THE OVARIES • FERTILITY PROBLEMS • DEPRESSION

TESTING FOR PCOS • DOCTORS MAY PERFORM THE FOLLOWING TESTS TO CHECK FOR PCOS, AS THERE ISN’T CURRENTLY A DEFINITIVE PCOS TEST. • PHYSICAL EXAM CHECKING FOR FACIAL OR BODY HAIR • BLOOD PRESSURE CHECK • BMI TEST • LAB TESTS TO CHECK BLOOD SUGAR, INSULIN AND HORMONE LEVELS • PELVIC ULTRASOUND TO CHECK FOR OVARIAN CYSTS

Weight management is key for women dealing with PCOS. In 60 percent of cases, women experience weightmanagement issues, which can lead to other chronic diseases.

MANAGING PCOS • EAT A HEALTHY DIET AND GET REGULAR EXERCISE; EVEN LOSING A FEW POUNDS CAN AFFECT HORMONE BALANCE AND CUT THE RISK FOR HEART DISEASE, HIGH BLOOD PRESSURE AND DIABETES. • QUIT SMOKING; SMOKERS TEND TO HAVE HIGHER ANDROGEN LEVELS THAN NON-SMOKERS. • DOCTORS MAY PRESCRIBE MEDICATIONS TO HELP BALANCE HORMONES. • WOMEN WITH CERTAIN SIDE EFFECTS MAY WANT TO TRY HAIR REMOVAL AND ACNE TREATMENTS.

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marionhealthyliving.com | MAY 2013

GIRL ON BACKGROUND© JOCHEN SCHOENFELD / SHUTTERSTOCK.COM

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Serving the Ocala Area for 30 Years in the Same Location

Express Care of Ocala is an urgent care center that began in 1990. Express Care of Ocala provides a variety of services, including urgent care for all but the most serious medical emergencies for adults as well as pediatric urgent care. This includes acute medical conditions as well as minimal and serious injuries for adults and children.

FRANK F. REISNER M.D.

AMBER STARLING, ARNP

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WALK-INS WELCOME

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DEALING WITH HIGH POTASSIUM? If you are at least 18 years old, you may qualify to participate in a clinical research study testing an investigational medication for mild to moderate Hyperkalemia (high potassium). Qualified individuals may be reimbursed for study related time and travel. To learn more call Lakeview Medical Research at

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or visit lowermylevel.com MAY 2013

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dose

the pharmacist will (not) see you now W R E PHA ONLIN

MACIE

S

THE CONSEQUENCES OF THE ONLINE RX • YOU COULD BE PAYING FOR COUNTERFEITS, CONTAMINATED AND EXPIRED MEDICATIONS. • MEDICATIONS FROM OTHER COUNTRIES CAN HAVE DIFFERENT INGREDIENTS OR

VARIATIONS, CAUSING FATAL SIDE EFFECTS OR INTERACTIONS. • YOUR PERSONAL INFORMATION COULD BE COMPROMISED ON NON-SECURE SITES.

e can pretty much do anything we’d like over the Internet these days. Talk with friends, rent a movie, order dinner and even buy groceries. So it only seems natural that we can now fill our prescriptions with the click of a button. However, before you pop those pills, you may want to do a little research of your own. Last year, the U.S. Food and Drug Administration (FDA) shut down more than 18,000 online pharmacies for illegally selling medications. The shutdown resulted in more than $10.5 million in pharmaceuticals worldwide being confiscated. Although it may seem like a simple time-saving solution, filling prescriptions online can turn out to be a recipe for disaster, as more and more counterfeit pharmacies pop up around the world. And maybe sub-par rash ointment or watered-down acne cleanser won’t kill you, but those relying on medications for serious medical conditions can suffer the consequences of these bogus pills and patches with their lives.

IS IT THE REAL DEAL? • NO LEGITIMATE PHARMACY WILL SELL MEDICATION WITHOUT A DOCTOR’S PRESCRIPTION. • IF THE DEALS SEEM TOO GOOD TO BE TRUE, THEY PROBABLY ARE. • IF THERE’S NO PHYSICAL ADDRESS INSIDE THE

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UNITED STATES, STEER CLEAR. • LEGITIMATE ONLINE PHARMACIES HAVE A PHARMACIST ON HAND TO TALK TO. • IF THE ONLINE PHARMACY ISN’T LICENSED WITHIN THE UNITED STATES, FIND A DIFFERENT OPTION.

ARE YOU BEING SCAMMED? The best option is to just make the trek to your neighborhood pharmacy. But if online prescription filling is your only option, visit the FDA’s website and check your online pharmacy’s license through the state board license database. Visit fda.gov.

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HE ALT H Y


RADIOLOGY ASSOCIATES OF OCALA

For everyone counting on you, count on RAO When choosing an imaging center, you want the assurance that you’ll receive fast, accurate detection, the most advanced technology, and experts trained to catch the finest details. From MRI, high-resolution PET/CT, digital mammography and stereotactic breast biopsy to pain injections, stents and treatments for leg veins and back pain, RAO imaging centers are devoted to you and your loved ones every step of the way. Our experience and dedication have made RAO’s board-certified doctors the area’s only radiologists with hospital privileges at Munroe Regional Medical Center, Ocala Regional Medical Center, and West Marion Community Hospital, so whether you need in- or outpatient care, you’re always in the thoughtful hands of leading local experts.

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HE ALT H Y

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or parents, keeping their children healthy is at the top of the priority list, but sometimes, the “what if” or “just in case” precautions seem unattainable. Florida KidCare, however, makes it that much easier and more affordable to make sure your children have proper health insurance.

This program, specific to Sunshine State residents, provides insurance to children from birth to age 18 and has different plans specific to you and your family’s needs. Plans provide preventive care, such as doctor visits, check-ups and vaccinations as well as hospital, prescription medications, vision and hearing, dental and mental health coverage. After applying for Florida KidCare, children will be categorized according to the age of the child and family income. There are four partner agencies of the program: Medikids, Healthy Kids, Children’s Medical Services Network and Medicaid.

KIDS©ANATOLIYSAMARA / SHUTTERSTOCK.COM

keeping kids healthy F MEDIKIDS ADMINISTERED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION, MEDIKIDS PROVIDES FOR CHILDREN AGES 1 THROUGH 4 AND IS SIMILAR TO MEDICAID, AS CHILDREN RECEIVE THE SAME SERVICES AND BENEFITS AS INDIVIDUALS WITH MEDICAID. THIS PROGRAM COSTS BETWEEN $15-$20 EACH MONTH, DEPENDING ON THE APPLICANT’S INCOME, WITH NO DEDUCTIBLES OR CO-PAYMENTS. IF YOUR INCOME IS TOO HIGH FOR THE CUTOFF, THERE IS ALSO A FULL-PAY OPTION THAT COSTS $196 EACH MONTH. fdhc.state.f l.us/Medicaid/MediKids/

FLORIDA HEALTHY KIDS THIS GOVERNMENT-FUNDED PROGRAM IS AVAILABLE TO ALL FLORIDA CHILDREN AGES 5 THROUGH 18 AND CAN COST AS LITTLE AS $15-$20 PER MONTH WITH A FULLPAY OPTION FOR HIGHER INCOME FAMILIES. healthykids.org

MEDICAID THE DEPARTMENT OF CHILDREN AND FAMILIES DETERMINES THE ELIGIBILITY OF FAMILIES FOR MEDICAID, WHICH PROVIDES THOSE WHO QUALIFY WITH CHILDREN’S HEALTH CARE FROM BIRTH THROUGH AGE 18 WITH LITTLE TO NO COST. MYFLFAMILIES.COM ENROLLMENT IS OPEN YEAR-ROUND, AND YOU CAN APPLY ONLINE AT FLORIDAKIDCARE.ORG OR BY PHONE BY CALLING (888) 540-5437.

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CHILDREN’S MEDICAL SERVICES NETWORK Children’s Medical Services Network is a group of programs for children with special needs from birth through age 18. Eligibility is determined by clinical screenings and the family’s most current year income level, but there is not a full-pay option for this program. cms-kids.com


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more than just a snore BY BONNIE KRETCHIK

A

pproximately half of all adults snore. Snoring occurs when your breathing is partially obstructed while you sleep. It can be as minor as a faint whisper or so noisy it keeps the rest of the family up at night. And while it may seem harmless, snoring can be a sign of a much more serious health problem: sleep apnea. APNEA

What’s The Difference? When you snore, your airways are partially obstructed. In most cases, this occurs when the tissues in your throat are relaxed and the air that passes through causes respiratory structures to vibrate. With sleep apnea, your breathing actually stops for periods of time, and you wake (or not) with a choke or gasp for oxygen. The non-breathing gaps may last as little as a few seconds to as long as a few minutes and may occur up to 30 times in an hour. As a snorer, you will more than likely sleep through the night undisturbed (unless an irritated spouse gives you a shove or shake). However, if you have sleep apnea, you are facing more serious consequences. “Sleep apnea can be related to other serious health conditions,” says Dr. Jose Delgado-Elvir of Florida Sleep Solutions in Ocala. He explains that heart-related problems, high blood pressure, stroke and diabetes can all be associated with sleep apnea. Furthermore, and just as important, disrupted sleep is also a major side effect, Dr. Delgado-Elvir explains. When your body has to choke or gasp for air, even if you don’t wake up, you now have shifted from deep to light sleep. And disrupted sleep patterns influence everything from your mood, concentration, productivity and lifestyle choices during the daytime hours.

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Sources: nhbli.nih.gov, sleepapnea.org, mayoclinic.com

SLEEP

SLEEP ILLUSTRATION © MARAGA.CPAP MAN © HOWARD SANDLLER / SHUTTERSTOCK.COM

HE ALT H Y


Weighing The Risks “Over the years, the disease has become much more prevalent, especially due to the rising obesity levels,” says Dr. Delgado-Elvir. In addition to obesity, there are several other risk factors to consider when analyzing your risk for developing sleep apnea: Sorry guys, but men are more likely to develop sleep apnea than women. Although it can occur at any age, the likelihood of developing sleep apnea increases as you age. Factors beyond your control, like the size of your nose and throat airways or the size of your mouth, also play a role. Smaller passageways equal a better chance for obstruction. People currently suffering from heart disease or who have had a stroke are more likely to develop sleep apnea. Like most conditions, if your parents or grandparents have it, there’s a risk you may, too. In terms of testing, it’s not as simple as a blood test. Often, it’s your spouse that recognizes the symptoms before you realize there is a problem. “Many cases go undiagnosed because people don’t even realize what’s going on at night,” says Dr. Delgado-Elvir. Doctors will take a family history and may perform a physical exam looking for larger than normal tissues in the throat or nasal passageways. There are also sleep studies that record brain activity, eye movements, heart rate and blood pressure as well as chest movements to determine if you are struggling to breathe. These may be performed in a sleep lab or at home via the use of an at-home monitor.

How To Treat For a Good Night’s Sleep How your doctor decides to treat sleep apnea depends on the severity of your condition and your history. There are several lifestyle changes that can be adopted to help symptoms, such as avoiding alcohol before bedtime. In cases where the patient is overweight or obese, weight loss can have a profound effect. For some, sleeping on their side can help improve airflow. For those who need more help, Dr. Delgado-Elvir recommends the use of a special breathing mask known as a continuous positive airway pressure (CPAP) treatment. The

mask gently blows air into your throat to keep the airways open while you sleep. “The CPAP is the most effective treatment, but there are other options as well,” says Dr. Delgado-Elvir. He recommends patients visit a dental sleep medicine specialist to be fitted for night guards, which can also be effective and less cumbersome. Regardless of the treatment you choose, it’s important to remember that sleep apnea can be a side effect of other serious health conditions and seeking the help of a medical professional to determine any underlying conditions can be the best route to a healthy (and rested) you.

MAY 2013

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basics The gray-haired woman with the stooped, rounded shoulders,

or more commonly referred to as “hunched back,” is the quintessential representation of the “little old lady.” And while this perhaps stirs up images of grandmas everywhere, those stooped shoulders are nothing to laugh at. Osteoporosis is a disease of the bones that affects millions of Americans each year. While the most obvious victims are the little old ladies of the world, what women—and yes, men too—do as young as 18 can keep that bent back from sneaking up on them decades later. WRITTEN BY

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BONNIE KRETCHIK


ou focus on your skin, your hair, your weight, your muscle tone and any little ache or pain you may experience in the course of a day. And your bones? Well, those aren’t like organs or muscles. They’re hard and sturdy, and you don’t need to worry about them, right? The answer is a resounding “wrong!” Bones, like other parts of your body, are living tissue. Fifty percent of bone mass is comprised of solid matter. The other 50 percent is water, meaning your bones aren’t as solid as you would like to think. Collagen is the protein that provides a soft framework for the bone, and the mineral calcium phosphate strengthens and hardens that framework. In fact, if you were to look at your bones under a microscope, you would notice that they are actually porous, resembling a spongy, rather honeycomb-like structure.

Special cells called osteoclasts break down and remove old bone tissue on a regular basis. A number of hormones, including both estrogen and testosterone, help to regulate new bone formation. For the first 18 years of our lives, new bone is created and laid down faster than the old bone is removed, which is how bones grow bigger and stronger. By our mid-20s, we’ve reached our peak bone mass, meaning the whole process begins to slow down and the “build-up” phase begins to meet the speed of the “breakdown” phase. In other words, we stop growing.

S O, W HE N DOE S THE HU M P F OR M ? Osteoporosis occurs when the bone breakdown process is faster than the bone build-up process, resulting in a more porous structure. “It’s a silent disease. You can’t feel your bones getting weaker,” says Melissa Lozano,

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ARNP, of Family Care Specialists in Ocala. Melissa has seen many patients coping with several stages of osteoporosis, the first stage being osteopenia. Many have never heard of the disease let alone know they are suffering from it. She explains that the most obvious symptom is the rounded shoulders or “hump” that older women tend to experience, but that doesn’t generally occur until the disease is further advanced. “Bone fractures are the earliest signs of weak bones,” says Melissa. She —MELISSA LOZANO points out that osteoporosisrelated fractures are more prevalent than cases of heart attack, stroke and breast cancer combined.

“Bone fractures are the earliest signs of weak bones.”

FA L L S , F R AC TU R E S A N D S HR I N KI N G S P I N E S

One of the first signs that osteoporosis is sneaking up on you are bone fractures from minor bumps and falls. Perhaps it’s something as simple as stubbing your toe against a chair

WHEN THE MEDS THAT HELP ACTUALLY

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The natural aging process isn’t the only way bone mass is lost. Prolonged steroid or medication use can also speed up the process. Denise Roesler always had strong bones and faithfully went for DEXA scans. At age 64, she was diagnosed with breast cancer and began taking Arimidex, a medication used as treatment. Unknowingly,

the medication was weakening her bones. She began to notice there was a problem when she couldn’t recover from a partial hip replacement and experienced multiple fractures in her leg. “I’ve had so many nuts and bolts put into my leg to hold it together, but nothing would hold. The bones were


or table that results in a broken toe. Or maybe just stepping out of your car or off of a ladder leads to a fracture in your foot. You may think it’s just bad timing, when, in fact, your bones now lack the strength to handle the stresses they once used to. Minor fractures are one thing, but major breaks are another entirely. According to the National Osteoporosis Foundation, 20 percent of seniors who break a hip die within one year from complications relating to the break and the surgery to repair it. “A broken hip or leg is not only extremely painful but really takes away from your quality of life,” says Melissa. “You can’t get out and do the things you used to, and if you have advanced osteoporosis, your bones aren’t going to heal nearly as quickly as they should,” she says. Advanced osteoporosis patients can even fracture a bone doing something as simple as sneezing. There is a psychological component to osteoporosis as well. Patients who have fractured or broken bones often develop a fear of falling or fracturing something again. “The dread of getting hurt again can really affect a person psychologically. They don’t

just too porous,” she says. After a final surgery that included more “nuts and bolts,” a bone stimulator and a bone graft, Denise, who used to be quite active, is finally starting to get around more with the use of a walker and wheel chair. “I was shocked when they told me my bones were so weak,” she says. “I

want to go places or do things they used to enjoy,” says Melissa, adding that this lifestyle change often leads to irritability or depression.

W HE R E ’ S THE C OL OR F OR B ON E HE A LTH?

If osteoporosis-related fractures are more common than instances of heart attack, stroke and breast cancer combined, then why aren’t people more aware of this all-toocommon bone disease? This question is first and foremost on Melissa’s mind. She takes time to host talks about the disease and inform as many people as she can about what they can do now to prevent problems later. “Breast cancer has its own month; heart disease has its own month; people wear red; and we even have NFL players wearing pink! When are we going to get a color or a month for bone health?” asks Melissa. She points out that osteoporosis testing has really only become available over the past 10 years and the more we test, the more we learn about bone density issues and who they affect and why. “Our main goal is to prevent fractures,” she says. There are a number of lifestyle changes

always went for bone tests, but when I was diagnosed with cancer, my priorities changed and I took my bones for granted.” Today, Denise is on a bone-building medication as well as calcium, magnesium and vitamin D supplements. She and her husband check the labels of any medication they are prescribed and talk

to their doctor about any possible side effects. Denise emphasizes to others the importance of getting regular bone density tests and talking to their doctor about how medications and supplements affect bone health—a lesson she had to learn the hard way.

A WOMAN’S THINK AGAIN! •

UP TO ONE IN FOUR MEN OVER 50 WILL BREAK A BONE DUE TO OSTEOPOROSIS. •

MEN OVER 50 ARE MORE LIKELY TO SUFFER AN OSTEOPOROSIS-RELATED FRACTURE THAN TO DEVELOP PROSTATE CANCER. •

EACH YEAR, 80,000 MEN BREAK A HIP. •

MEN ARE MORE LIKELY TO DIE WITHIN ONE YEAR OF BREAKING A HIP THAN WOMEN. •

RISK FACTORS FOR MEN INCLUDE LACK OF EXERCISE, SMOKING, ALCOHOL CONSUMPTION, MEDICATION AND STEROID USE, AND LOW TESTOSTERONE LEVELS.

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CALCIUM IS AN ESSENTIAL MINERAL NEEDED FOR EVERYDAY BODILY FUNCTIONS LIKE MUSCLE CONTRACTIONS AND NERVE HEALTH AS WELL AS THE ALLIMPORTANT BONE BUILDING. UNFORTUNATELY, WE CANNOT MAKE CALCIUM IN OUR BODIES AND INSTEAD HAVE TO RELY ON FOODS OR SUPPLEMENTS. THE RECOMMENDED DAILY DOSE FOR BOTH MEN AND WOMEN IS 1,000MG. HOWEVER, HOW YOU GET YOUR CALCIUM AND WITH WHAT IS IMPORTANT. HERE ARE SOME FACTS TO FOLLOW WHEN ADDING UP YOUR DOSES. •

28

BEST ABSORBED WHEN TAKEN IN 500-600MG DOSES OR LESS. •

FOUND IN LEAFY GREEN VEGGIES, LOW-FAT DAIRY, FORTIFIED CEREALS, JUICES AND NON-DAIRY MILKS. •

SUPPLEMENTS ARE BEST ABSORBED WHEN TAKEN WITH FOOD. •

NEEDS VITAMIN D TO HELP ABSORB INTO THE BODY.

marionhealthyliving.com | MAY 2013

as well as medications that people can take to build bone mass and prevent higher rates of loss. However, if people aren’t aware of their current bone density, chances are they aren’t actively doing anything to preserve it.

MILK, MARCHING AND TEST-TAKING

So where do you begin? Melissa suggests that all post-menopausal women over age 50 get their bone density tested with a DEXA scan every two years. “It’s a completely painless procedure that most insurance plans will cover,” says Melissa. She points out that women with a family history of the disease should get tested earlier and more frequently. Next, take a look at your risk factors. “Smoking, alcohol, family history and age are all risk factors that pre-dispose you as well as being very thin and being Caucasian or Asian,” explains Melissa. Diet and exercise are also important factors that influence bone density. The recommended calcium intake for people ages 18 to 70 is greater than 1,200mg per day. Calcium-rich foods include low-fat dairy products, dark leafy green vegetables, salmon and almonds. Calcium supplements, if recommended by a physician, are available at any pharmacy.

BA B Y THOS E B ON E S

Osteoporosis is responsible for millions of dollars in health care costs each year, and though the disease is not talked about as often as others, it carries an equally heavy toll. “I worked in an ER for seven years, and so many people came through those doors with broken bones from falls and wound up never going home,” says Melissa. “Whether we get a week or a month or a color to support bone health or not, it’s time we spread the word,” she says.

FOR MORE INFORMATION ABOUT OSTEOPOROSIS VISIT THESE SITES: •

NATIONAL OSTEOPOROSIS FOUNDATION, NOF.ORG •

THE CENTERS FOR DISEASE CONTROL AND PREVENTION, CDC.ORG •

THE NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASE, NIAMS.NIH.GOV •

AMERICAN BONE HEALTH, AMERICANBONEHEALTH.ORG

Sources: National Osteoporosis Foundation at nof.org, cdc.org, niams.nih.gov, americanbonehealth.org

THE CALCIUM

Weight-bearing exercise is also a contributing factor for healthy bones. Melissa explains that smaller people are at a greater risk for weak bones because it doesn’t take as much stress on the bones to carry a body of little mass, so weigh-bearing exercises, like weightlifting, walking and running, help to place the right stresses on the bones to promote growth. “Simply carrying a 2-pound weight can significantly help,” says Melissa, who recommends talking to a doctor before implementing any dietary changes or exercise plans. “You may drink more calcium-fortified orange juice thinking it will help, but if you’ve got a condition like diabetes, the extra sugar can be dangerous,” she warns.


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When It’s Time to

Parent a BY DEBBIE INGRAM

J

oanne Jansen’s mother Ruth* had lived in the same home for 45 years. Ruth raised three children there, nursed her husband there until his death and kept a box of toys in the hall closet for when the great-grandchildren visited. Ruth had been living alone for 12 years since her husband passed away, and despite Joanne’s efforts, she could tell her mom wasn’t eating well and was becoming more confused. Some days, Ruth forgot to eat, or she didn’t feel like going through the trouble of fixing a meal for herself. As she lost weight and became increasingly frail, she began sleeping more throughout the day, causing her to wake up disoriented and not know when it was time to take her medications.

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“I got into a routine where I’d get off work, run by the store and pick up a few things, and go by Mom’s,” Joanne says. “I’d make sure she had taken her medicine and that she’d eaten something, and I’d try to snoop around a little and check her mail or the laundry.” Gradually, the daily visits became longer. “Little by little, I’d see more and more that needed to be done,” she says. “She’d forget to pay a bill or finish a load of laundry, and then it would have to be washed again. Or she’d leave food in the fridge too long; I was afraid she’d get sick from eating something bad.” As Ruth gradually required more and more attention, Joanne realized it was affecting her own health. She was feeling overwhelmed, resentful and depressed. Joanne’s husband, Tom, noticed when things were getting out of hand. “She’d get home from her mom’s house at 8:00 or 9:00 at night and still have her own affairs to tend to,” says Tom. “Our kids and I tried to pitch in and do what we could to help ease the load, but it’s not as easy as you’d think. There are the things she


Parent

“Her existence had been reduced to a series of tasks that she could never catch up with.” ~TOM JANSEN

enjoys doing for us or for herself, and she just didn’t have time to do it all. Her existence had been reduced to a series of tasks that she could never catch up with. I was afraid she’d have a stroke. Something had to change.” But change was just what Joanne feared Ruth would not handle well. She liked her home, her neighborhood and her routines. “Mom had to give up driving a couple of years earlier, but we had a routine that seemed to work. I’d leave work to run her to doctor’s appointments, and I’d take her to the hairdresser and grocery store on Saturdays.” Ruth’s neighbor took her to church on Sunday, and Joanne says her mother was satisfied with that arrangement. “She didn’t want to lose what independence she still had, she didn’t want to be a burden on anyone and she sure didn’t want to leave her home.” Eventually, Joanne knew it was time to talk to Ruth about moving out of her home and what her options would be. With Joanne and Tom working full time and no other family nearby,

they felt that moving her in with them wouldn’t solve all their problems. “It’s not that I wouldn’t have taken her in to live with us,” she explains, “but we didn’t feel like we would be solving anything with my husband and I both gone 10 hours a day.” It was evident to Joanne that, in order to give her mother quality care for her remaining lifetime, they would need to look into an arrangement that met her needs, while freeing Joanne from the role of sole caregiver. Finding the right time to bring up the subject proved difficult. “I wanted to wait until my brother, Mark, could come down from Virginia so we could present a united front,” Joanne remembers. “We finally made plans for Mark and his family to visit over the Fourth of July, which was about a month away.” * Names have been changed to protect resident’s privacy

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And then, in late June, Joanne got the call she’d been dreading. Ruth’s neighbor had come by to get her for church one Sunday, and Ruth did not answer the door. The neighbor used the key Joanne had given her for just such an emergency and found Ruth on her kitchen floor, where she had fallen hours before. “Thankfully, she wasn’t hurt, except for her pride, but she had nothing to grasp onto to try and pull herself up,” Joanne explains, “So she had laid there for hours. She had wet herself. She was exhausted and embarrassed.” It was not the scenario Joanne wanted to open a dialogue with, but she was able to get her mother to see that this arrangement was a burden for the whole family and that they needed the peace of mind that a facility could provide. After speaking with Ruth’s doctor, Joanne determined that Ruth was the perfect candidate for an assisted living facility, or ALF. She didn’t need constant supervision or skilled nursing care, and she could do most things for herself, but she required assistance with some activities of daily living, such as meal preparation, laundry and medication reminders. Today, Ruth has her own apartment in an assisted living facility just a couple of miles from Joanne’s home. She has a housekeeper and laundry service, assistance with grooming and medications, and the security of knowing help is available around the clock. When her great-grandchildren come to visit, she still has the box of toys from home she can pull out to entertain them or they go outside to feed the ducks that frequent the pond out back. She takes the facility’s bus to the grocery store and the

pharmacy, and her former neighbor still comes by to pick her up for church on Sundays so they can catch up. She participates in the book club, bingo and goes to movie nights. The best part? Her daughter has gone back to being a daughter, wife and mother, instead of caregiver. This is the ultimate goal of assisted living: returning adult children to their familial roles while providing quality care to family members. “The best thing we can do is let sons and daughters become sons and daughters again. They can go to work or go on vacation without worrying,” says Geoff Oetjen, director of sales and marketing at Chambrel Pinecastle, an Ocala assisted living facility. One of his favorite success stories involves a 92-year-old man who was moved into Chambrel by his son. The son called a few days after his dad moved in and asked Geoff what he’d done to his father. “Dad’s talking more; he’s more animated,” Geoff recalls him saying. Geoff had the pleasure of calling the son later to let him know his father was attending the facility’s happy hour and dancing! He told Geoff, “You just don’t know how much you’ve made my day.” Another success story occurred when a mom told her son he shouldn’t visit that day because she didn’t want to miss bingo! Geoff and his associate, Mary Peters, stress that it’s all about giving people choices so that they maintain an active lifestyle and the independence to choose their activities while providing assistance where needed. “We get feedback all the time from families saying their loved ones are happier because they are with people their own age with similar interests,” Mary says. “They are eating better, taking their medications more regularly, and they don’t have the stress of taking care of a house.” While many people wait until an event like Ruth’s fall before investigating their options, more and more are becoming proactive. The Internet is a great tool for research with many support organizations for caregivers. Investigate your options, and have a plan in place that you can discuss with your parents so they are invested in the “The best thing we can do is let sons and daughters process.

become sons and daughters again.” ~GEOFF OETJEN

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“We get feedback all the time from families saying their loved ones are happier because they are with people their own age with similar interests.” ~MARY PETERS

Investigate The Options A NEARBY APARTMENT OR RETIREMENT COMMUNITY. Your first step may be to move mom or dad closer to you, especially if you are not in the same city or state to begin with. An apartment complex with an active, caring management staff or a retirement community where the other residents are seniors who take an interest in looking out for each other can provide some security while still affording your parents complete independence. YOUR HOME. Moving a parent in with you does have its advantages, which is why 70 percent of caregivers are caring for a loved one in their own home. You cut out time spent traveling back and forth to check on a parent, you can monitor his or her activities and health care and you can enjoy family activities together daily. The No. 1 reason many people choose this option, of course, is to save money that would be spent on another residence. ASSISTED LIVING FACILITY. ALFs are ideal for people who are independent but require assistance with activities of daily living, such as meals, housekeeping, grooming, bathing, medications, using the bathroom or transportation. Skilled nursing care is not provided. The monthly cost of ALFs depends upon the level of assistance needed and living quarters. ALFs can exist in a residential home setting or apartment-style living. INTERMEDIATE CARE FACILITY. These facilities provide all the assistance of an ALF for people who cannot live on their own,

but they also provide some nursing care, though not 24 hours a day. Often, an ALF will have an intermediate care wing where a resident may transfer as he or she requires more care. SKILLED NURSING FACILITY. Nursing homes provide continuous skilled nursing care to residents who cannot live on their own. Monitoring blood pressure or ventilators, administering injections or intravenous feedings are examples of skilled nursing care. Nursing homes are not just for the elderly. Adults of any age may go to a nursing facility temporarily to recover from a stroke, fall or surgery if they require round-the-clock skilled nursing care. Others may live out the remainder of their lives in a nursing facility. Nursing homes offer a variety of activities to residents of all ability levels.

Take A Tour “Tour, tour, tour,” says Trey Adams, admissions director of Ocala Health and Rehabilitation, a skilled nursing facility in Ocala. Adams says when looking for a nursing facility for your loved one, visit the facilities you are considering more than once, and use your senses! “Watch the residents and staff: Do they interact with each other and know each other’s names? Do they look happy? Talk to the residents, and listen to what they have to say about their home. Smell the rooms: Is there an odor, or are they clean?” Adams recommends having a meal at the facility. “Taste the food. Would you serve it to your mother?”

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Using your own senses will help you get a real feel for the home. Additionally, ask great questions. Adams suggests the following questions when looking for a skilled nursing facility: What is the average length of employment of staff? A facility with a high turnover rate is a warning sign, particularly nursing staff. You want to know the staff is happy working there and that there is continuity of care. Residents with Alzheimer’s or dementia do better when the staff is not constantly changing. How many doctors serve the facility? One doctor means long wait times for answers or visits, while 100 doctors means you never know who will be taking care of your parent. Ideally, somewhere between four and 20 doctors serving the facility will ensure you have accessibility and familiarity. What are the visiting hours? Look for a facility with no restrictions on visitors. Some facilities up staff during the day and down staff at night. If your parent’s nursing home makes you leave at 8pm, you don’t want to wonder what happens after you leave. If you work nights or odd hours, you want to know you can come visit whenever it fits your schedule.

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Financial and Legal Considerations One of the first conversations you should have when considering a parent’s living arrangement is with your siblings. It may be necessary to have one sibling handle finances, and this is an area that can cause tension or resentment in the family. Deciding who is the best choice to manage financial affairs should be based on who can most effectively communicate their needs with your parents, their financial institution and their caregivers. Whoever is given this responsibility needs to know where Mom or Dad keep their financial and legal documents and whether retirement accounts, insurance policies and wills have been kept up to date. If your loved one is forgetting to pay bills but does not want to give up control of his or her finances, you may begin by establishing a joint bank account so you or a sibling can check monthly statements and make sure bills are being paid. You may also utilize online banking, setting up automatic payments for regular monthly bills. A sibling with access to the login information can check and make sure payments are being made. One of the most important things you can do right away is to make sure your parents have a durable power of attorney. This legal document gives someone the right to make financial and legal decisions for your parent if he or she becomes incapacitated. You do not want to wait until an event occurs, as then you will have to go to court and seek guardianship, a complicated process anytime but especially in a time of crises.


Paying for Care Medicare covers short-term care in a skilled nursing facility after a hospital stay of at least three days. If a person needs to go into a nursing home to recover from a stroke or surgery, Medicare will pay all costs for 20 days and partial costs for an additional 80 days. Medicare will pay for home health care for a maximum of 35 hours per week and Hospice care for the terminally ill. Medicare does not cover assisted living or adult day care. Medicaid covers skilled nursing care while allowing a person to retain their personal savings for additional expenses such as telephone and TV service, dentures, hearing aids, beauty shop appointments and personal belongings. Medicaid is a viable option for those whose household income is not sufficient to cover care privately. The application process can take several weeks and is complicated, so it may help to enlist the aid of an eldercare representative. Long-term care insurance policies usually cover skilled nursing care in a licensed nursing home or home health care facility. Some policies also cover physical therapy, housekeeping, assisted living facilities, adult day care and respite care for caregivers. Many people are turned down for coverage due to preexisting conditions, alcohol or drug abuse and some mental disorders. Long-term care policies usually have a maximum daily benefit and maximum number of days covered. For example, a policy may pay $100 a day for up to five years and is renewable as long as premiums are paid. Premiums are higher as people age, so more and more people are purchasing policies 20 to 30 years before care is needed. The high premiums of long-term care policies often scare people from purchasing one, but the cost of care without benefits is even higher. Some offer a death benefit, which returns some benefits after death, so it’s important to shop around. Check with your parent’s insurance provider to see whether long-term care can be added to an existing policy. Reverse mortgages allow homeowners to receive cash payments against the equity they have built up in their home. No repayments are required until the home is sold. To qualify, homeowners must be at least 62 years of age and have paid off all or most of their mortgage. The reverse mortgage will pay off any remaining amount on the original mortgage before you receive any money, so if you have a large unpaid amount on your mortgage, a reverse mortgage won’t work for you. Veterans’ pensions are available to those who served during any U.S. conflict through Desert Storm. Additionally, benefits are available to cover medical costs and housing renovations necessary to cope with disabilities resulting from service, even if the disability did not appear until later in life. Check with your local VA office.

ONLINE RESOURCES FOR CAREGIVERS Family Caregiver Alliance, caregiver.org National Alliance for Caregiving, caregiving.org strengthforcaring.com caremanager.org aoa.gov caring.com myseniorcareguide.com eldercare.gov va.gov

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Living with allergies

By Cynthia McFarland

It’sthestrangest

sensation.

One minute I’m lying here feeling completely normal. Less than two minutes later, it feels like someone scattered itching powder across my back—extra strength and lots of it. A couple months ago, I’d have told you I was pretty much allergy free. Apparently, I was wrong. Face down on a paper-covered doctor’s exam table, I’m undergoing an allergy skin test, and judging by the reaction I’m having at the moment, it’s obvious I have allergies… and to more than just one. Back in January, I started noticing I felt a bit breathless when I hopped on my bike for a short ride. I chalked it up to a lack of serious exercise recently, but when I started feeling winded during my daily walks, a red flag popped up. What if something really was wrong?

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A doctor’s work-up assured me that my heart was just fine, so what was this breathless feeling? For an active person, it was both frustrating and frightening. This first surfaced during our freak early spring when the azaleas and red bud trees started budding a month early. Pollen from the pine trees around my home was so heavy I could literally see it shifting through the air, blanketing everything with a coating of yellow-green powder. A light went on in my brain. Maybe I had allergies after all. After searching my symptoms on webmd.com late one night, an even more disturbing possibility loomed. Could I have developed asthma? The website noted that 8 percent of Americans have asthma; in fact, 3,447 people died from the


U.S. POPULATION

condition in 2007. Hmmm, that wasn’t exactly a comforting discovery. Concerned and in search of answers, I made an appointment at Allergy & Asthma Care of Florida, Inc. (aacfinc.com). During my appointment with Thomas L. Johnson II, MD, he told me that allergies can definitely surface in adulthood. Thus, my current state on the exam table and my body’s response to allergy testing. At least I only have to lie there for 15 minutes before the medical assistant returns and confirms what I already realized: “Yes, you are allergic and to multiple things.” Fortunately, she counteracts the itching, tingling discomfort with a steroid cream that immediately cools and soothes the skin. Before the skin testing, Dr. Johnson had me take two different pulmonary function tests that proved—thankfully—I was not presently experiencing any asthmatic symptoms. That was good to know, but now the medical assistant returns to do intradermal skin testing for selected allergens that were negative on my back. She injects a tiny drop of two different allergens just under the skin of my left forearm, then leaves me to sit and read a magazine for another 15 minutes. Even before she returns, I can tell that whatever those allergens were, I must be sensitive to them, as well. When Dr. Johnson returns to the room to go over the test results with me, I have to admit I’m stunned. I tested positive to a variety of grasses, weeds, dust mites, cats and dogs. Uh-oh… I live on a farm; I have animals, I feed and handle hay, I spend hours on the tractor mowing the very grass I’ve just reacted to in testing. He might as well have said I tested positive to my life. When it comes to allergies suddenly cropping up in mid-life, turns out I’m not alone. Dr. Johnson explains that someone can cruise along for years without any symptoms and then develop them. Just because you didn’t have allergies as a child (I didn’t), doesn’t mean you won’t develop them as an adult. Genetics also seem to play a role.

“If two parents have allergies or asthma, their children could have those issues at a higher rate than normal,” says Johnson. Statistics show that a child with one allergic parent has a 33 percent chance of developing allergies, while those odds jump to 70 percent if both parents are allergic. Even when a person has a genetic predisposition to allergies or asthma, it may take years of exposure before their body responds in a negative way. Before my own experience, I had no idea how prevalent allergies are in this country. Allergists note that roughly 36 million Americans suffer from hay fever (allergic rhinitis), 10 million are allergic to cat and dog dander and 2 million are allergic to insect stings. Studies show that 55 percent of the U.S. population tests positive to one or more allergen and that a startling one in five people in the United States have either allergy or asthma symptoms. Even more shocking is the financial impact of allergies. One estimate puts the annual cost of allergies to the health care system and U.S. businesses at a staggering $7.9 billion. This is understandable when you learn that people suffering from hay fever alone miss an average of 4 million workdays each year. “Allergies may not always be the most serious medical condition a patient has, but those who suffer from allergies can have frequent annoying symptoms,” says Dr. Johnson. “Fortunately, with the right care, patients can find relief.”

HAY FEVER

36

MILLION

DOG & CAT DANDER

10

MILLION

INSECT STINGS

2

MILLION


SIGNS of

allergies Sure, a runny nose may be a classic allergy symptom, but that’s hardly the only sign. Others may include:

Itchy, watery eyes

Nasal/sinus congestion

Frequent sneezing

Scratchy throat

Fatigue

Mental “fogginess”

Feeling “lightheaded” or slightly dizzy Disturbed sleep

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Food Allergies

A

lthough my allergies were “environmental,” food allergies are a whole other “can of worms,” so to speak. In the United States, food allergies result in about 30,000 emergency room visits every year. Anyone who’s seen the comedy movie Hitch no doubt laughed at Will Smith’s hilarious scene when his character had an allergic reaction to shellfish. In real life, however, such moments are far from amusing. In

about 3 to 4 percent of those people actually have a food allergy. “I have seen a lot of patients who feel better when they are off wheat, but that doesn’t necessarily mean they have a wheat allergy,” observes Johnson. Food intolerances and sensitivities may not have a life-or-death reaction such as anaphylaxis, but they can, nonetheless, seriously impact quality of life. Those food “issues” don’t always exhibit in predictable ways, and it can take months—sometimes years—to find answers. My friend Kate, for example, was convinced she had a brain tumor. “In addition to complete lethargy and exhaustion, I felt as though my brain was stuffed with cotton. Clear

“It was outside the scope of my knowledge that reactions to food could make such a difference in my mental, physical and emotional life.” -Kate Riordan

some instances, they can even be life threatening. Someone who is actually allergic to a food—whether it be shellfish, peanuts, gluten or any number of things—can suffer anaphylaxis, which quickly results in swollen airways, making it difficult to breathe. Dizziness and a sudden drop in blood pressure may follow. Such reactions require immediate emergency medical attention and an injection of epinephrine. Other treatment, such as intravenous fluids and drug therapy, may also be necessary. Dr. Johnson explains that while one person may have actual food allergies, another may have sensitivities and intolerances. Although as many as 15 percent of Americans believe they have a food allergy, statistics show that only

thinking was not only diminished, but I would transpose numbers and sometimes could not think of the proper word during conversations,” says Kate Riordan, who owns a marketing and public relations business in Georgetown, California. She also had a constant ringing in the ears, joint pain and stiffness, unsteadiness, coughing after eating (sometimes to the point of vomiting), a persistent ache in the gut and consistently low body temperature, sometimes as low as 95.1 for days at a time. Add depression to the list, and it’s easy to see why this normally cheerful and sharp-as-a-tack woman was certain something was seriously wrong with her brain and was affecting her body.


Blood tests all came back within normal parameters, and two visits to an ear/nose/throat doctor yielded no definitive diagnosis. Frustrated and at her wit’s end, Kate demanded he prescribe a brain MRI. She was desperate to come up with a reason for her array of debilitating symptoms but terrified to learn the results. The results of the MRI showed no tumor or anything wrong with her brain.

Although grateful for those negative results, she still had no answers for the downward spiral her body was taking. After much online research about her confusing symptoms, Kate decided to make an appointment with a naturopath. That visit literally changed her life. At the end of that first 90-minute appointment, the doctor told Kate to eliminate all wheat and dairy products from her diet for two weeks. A thorough

examination and bloodwork results led the doctor to believe Kate’s body was experiencing toxic responses to certain foods, in this case, dairy and gluten. “I adhered to the strict no gluten, no dairy routine,” recalls Kate. “On the third day, I found my energy level soaring to the point where I was cleaning out kitchen cupboards and the junk drawer. Mind you, three days before, I could barely get off the couch.


TREATMENT

of allergies Depending on the specifIc allergy, there are a number of treatment options, including:

» »

»

»

» »

Avoidance of allergens & irritants Over-the-counter (OTC) antihistamines and nasal spray decongestants Prescription antihistamines and nasal spray decongestants Combination antihistamines/ decongestants Nasal steroids Allergy injections (“allergy shots”)

(Keep in mind that some OTC medications are not recommended for persons with high blood pressure or other health conditions, so get a doctor’s advice.)

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“By the end of the first week, literally all my symptoms had disappeared,” she adds. “My brain was functioning at capacity, my body temperature returned to 98.6, my joints no longer ached, my depression flew out the window, and I was, at long last, me again. It was outside the scope of my knowledge that reactions to food could make such a difference in my mental, physical and emotional life.”

Relief for Allergies

A

s challenging as allergies can be, there are a variety of treatment options, depending on each specific scenario. In addition to “elimination tests,” (taking specific foods out of the diet and gauging the patient’s response), skin and blood tests can also be used

to determine food allergies. As Kate discovered, eliminating the offending food item(s) is the simplest method of treating food allergies, sensitivities and intolerances. People with severe allergic reactions to specific foods will generally carry an epinephrine self-injection pen (such as the EpiPen), which can buy precious minutes when it comes to slowing or preventing anaphylactic shock. (Doctors say you should always call 911, even if you’ve used an EpiPen.) Fortunately, there are now a number of medications that relieve allergy symptoms and are safe, effective, require less-frequent dosing and don’t make you feel like you’re walking around in a daze. Many patients with serious symptoms opt for allergy shots. Doctors find that such a regimen, combined with medication, can actually cure some patients. For others, they may not be “cured” but will experience significantly reduced or controlled symptoms. The


According to the American Academy of Allergy, Asthma and Immunology:

standard protocol is one or two shots a week for four to six months, dropping to once or twice a month for anywhere from three to five years. There may actually be a vaccine for ragweed within the next five years, good news for the millions of Americans allergic to this common weed. In my case, Dr. Johnson recommended a multi-pronged approach. “Avoidance is the first recommendation for environmental allergies like yours,” he notes. While I’m not about to relinquish my beloved feline friends, he suggests keeping them out of the bedroom, using allergy filters in the AC/heat ducts, vacuuming frequently with a HEPA vacuum and using free-standing HEPA air cleaners in the rooms where I spend the most time. (Anyone who has cats will understand, however, why I burst out laughing at the recommendation to wash my cats twice weekly. Somehow, I don’t see that happening…) He advises encasing my mattress and pillows in impermeable covers, washing bedding in hot water and replacing carpet with hard surface flooring, where possible. He also prescribes a daily dose of Zyrtec and, if I feel it’s necessary, a bronchodilator to use before exercise. I was grateful to have Dr. Johnson’s input and expertise while going through this unexpected experience. While I never thought I’d find myself in an allergist’s office, I’ve realized they play an important role in helping reduce the symptoms from allergies and/or asthma while working with a primary care provider and other medical specialists.

Allergies By The Numbers

7.8

percent of people 18 and over in the United States have hay fever.

10

percent of white children were more likely to have hay fever as opposed to 7 percent of black children in 2010.

10

to 30 percent of the population is affected by allergic rhinitis.

10

percent of the world’s population will experience adverse drug affects. 20 percent of hospitalized patients are affected.

20 8 38.7

50

percent of fatalities due to anaphylaxis may be related to drugs. percent of 38,480 children (infant to 18) from 2009-2010 have a food allergy. percent of food allergic children have a history of severe reactions. percent of individuals with no past documented systemic reaction have fatal insect allergic reactions.

13

percent of people 18 and over in the united states have sinusitis.

13

percent of United States children aged 17 years and under suffered from skin allergies in 2010 in 12 months.

17

percent of black children in the United States were more likely to have bad skin allergies than white (12 percent) or asian (10 percent) children.

Source: aaaai.org MAY 2013

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BACK LEFT: Leigh Baker, CNM, DNP BACK RIGHT: Alice Carlisle, CNM, Ph.D. FRONT: Amy Reynolds, LM, CPM


I A closer look at why more women are choosing midwives for childbirth and routine care BY CYNTHIA MCFARLAND PHOTOS BY JOHN JERNIGAN

f the word “midwife” brings to mind a self-taught woman in a broomstick skirt delivering babies at home with no pain medication, think again. Modern midwives defy these old stereotypes. Many not only have nursing degrees but also master’s and doctorate education on top of that. Although some deliver in home settings, many frequently deliver in a hospital where mothers using midwives have all of the same painrelief options as an obstetrician-attended birth. A midwife is defined as “a person who assists women in childbirth,” and although that description certainly fits anyone who assists with birth, it doesn’t address the differences that exist between midwives and their levels of education. Not all states are “midwife friendly,” but Florida has a long tradition of midwifery. A mother-to-be in Ocala has the choice of a Florida Licensed Midwife (LM) or a Certified Nurse Midwife (CNM). Midwives often have more than one certification. For example, at Midwives of Ocala, the area’s oldest midwifery practice, each of the midwives is also registered in the state of Florida as an Advanced

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systems. A doula stays at the mother’s side throughout labor and delivery, while the midwife may only be there for the delivery process.

COMFORT & FAMILIARITY

Registered Nurse Practitioner (ARNP). In Florida, an ARNP must have a master’s degree. The American College of Nurse-Midwives (ACNM) was founded in 1955 and is the professional association that represents certified nurse midwives and certified midwives. Programs accredited by the ACNM require students to have a bachelor’s degree; many programs also require the student be a registered nurse. Programs, such as the Florida School of Traditional Midwifery, Inc. in Gainesville, don’t require a college degree for entry but do require several years of study in order to become licensed. Another category of birth assistants known as “doulas” aren’t trained for actual medical care and delivery but function as coaches and support

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So, why are an increasing number of women opting for midwifery? Most midwives are women, and many mothers just appreciate the fact that their health care professional understands what it’s like to be female. “It’s all about what women want and supporting their decisions,” says Alice Carlisle, CNM, Ph.D., who works out of Dr. Seaborn Hunt’s office and also with Midwives of Ocala. “If a woman wants to walk around while in labor, not have intravenous fluids or not have an episiotomy, that’s easy to do. If a woman wants no medication or epidural, I support that, but I also educate her as to the risks and benefits of those choices.” Another advantage to using a midwife is how they get to know their patients. “I have more time to spend with the patient, so I try to use every visit to teach about what to expect or what’s going on with their pregnancy,” adds Carlisle. “I listen and try to give them what they want for their choices.” “With a midwife you don’t feel like you’re just a number. I definitely felt like every time the visit was personal and comfortable. I could talk about anything and didn’t feel rushed. The comfort level is high, and you never feel silly asking any question,” says Tonya Holland, 39, an Ocala resident whose two sons, Alexander and Miles, were both delivered by midwives, the youngest by Carlisle. “Dr. Hunt’s been around forever and even delivered my husband,” adds Holland. “I saw Dr. Hunt once (while pregnant) and then Alice the rest of the time. I felt very confident that if there were any problems, he’d be there, but I felt very safe with Alice and that she would guide us in the right way.” Holland, in fact, did have a problem. With Miles, she went into early pre-term labor at 34 weeks, was sent to Shands for three days and then came home to total bed rest. Carlisle delivered Miles at 38 weeks and all was fine. With this history, Holland was glad to be giving birth in a hospital and more than happy to have an epidural with both babies. “Home delivery is fine for some people and a beautiful thing, but it’s not for me,” she says. “I just feel safer being at the hospital in case something goes wrong.”


WORKING WITH PHYSICIANS

“With a midwife, it’s more one on one,” says Reed. “The appointments are lengthier but in a good way. They walk you through what’s happening in your pregnancy.”

A survey conducted by the ACNM in 2007 showed that hospitals and medical centers are the largest employers of midwives (32.7 percent), followed by physician practices at 30.5 percent. That rings true in Marion County. For midwives such as Alice Carlisle, CNM, Ph.D., Midwives of Ocala and others, it’s standard “Midwives like to look at the whole woman. In procedure to work hand in hand with an our practice, we offer family planning and routine obstetrician and deliver babies in a hospital. well-woman gynecological care,” notes Baker. “In Ocala, we’ve very lucky in that almost “Dr. Raymond Marquette is the doctor we work every physician in town is very pro-midwife. Many with in consultation or if a woman is high risk.” midwives work for a physician and are paid a Baker brings up a good point, one many salary by that doctor’s office,” explains Carlisle. people wouldn’t know. “All my patients see the doctor at least once during A woman doesn’t have to be pregnant to take their pregnancy. If for some reason I am out of advantage of the services offered by midwives town, the doctor will deliver the baby. If for any because they provide more than just prenatal reason there’s an emergency and he has to perform visits and actual delivery. Midwives also serve a Caesarian or other procedure, the patient already as primary health care providers, offering routine knows him. I have found that a mother wants one well-woman gynecological care, lab testing, thing above all others and that is a healthy baby. If contraception and other related medications. In I feel there are any problems or I have any addition, they may provide health education and concerns, it’s a very smooth transition counseling to their patients. to bring in the doctor. Midwife services do tend to cost “Birth is a very natural somewhat less than a regular OB/ process that women are GYN practice charges, if you designed to do, but I’ve also are responsible for all costs, seen how easily things but Baker points out that can go wrong, so I like the great majority of to make it as natural patients in Marion as possible, while County either have having the hospital insurance or are equipment and on Medicaid. technology available Baker if needed,” she adds. gravitated to “From the patient’s midwifery while —LEIGH BAKER point of view, the primary working as a nurse in difference between using a midwife and labor and delivery. In fact, she an obstetrician is that midwives tend to have recommends working in that field first to anyone the luxury of spending more time with patients who thinks they might want to be a midwife. and getting to know them a little better,” says “I just fell in love with birth, but at one Leigh Baker, CNM, DNP, a certified nurse midwife hospital where I worked, I saw a very high and director of Midwives of Ocala, which is owned C-section rate. I was drawn to birth but in a more by Munroe Regional Medical Center. natural way, with less intervention.” “For me, the most satisfying thing is getting to know the patients,” says Baker. “I’ve been here since 1991; I’m now seeing some of the babies I delivered come back as adult patients.” Some mothers in the Ocala area prefer to have Traci Reed, 23, of Ocala, saw an obstetrician their babies at home. In that case, they may be for her first pregnancy and delivery but is now a calling Amy Reynolds, LM, CPM, a midwife who patient at Midwives of Ocala; her second child specializes in out-of-hospital births. is due May 12. She likes the “safety factor” of Since becoming a midwife in 2010 after delivering in a hospital but loves the personalized three intense years of study at the Florida School attention to detail of a midwife. of Traditional Midwifery, Inc., Reynolds has

NOT JUST FOR PREGNANCY

“The primary difference between using a midwife and an obstetrician is that midwives tend to have the luxury of spending more time with patients and getting to know them a little better.”

HOME BIRTHS

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delivered more than 100 babies. A trained lactation consultant since 1996, Reynolds also helps new mothers with breastfeeding. She’s the first to admit she absolutely loves babies. “Since I was a very young girl, I’ve felt it was my calling to be a mother and then a midwife. When everyone else’s Barbies were dating, mine were having babies,” smiles Reynolds, who’s had six children, the last two born at home with a midwife. “I feel women are much more open to midwifery now,” says Reynolds. “There was a movement in the 1970s that kind of fizzled out, but now there’s a huge movement toward midwives that started about five years ago.” For women who don’t wish to give birth in a hospital but aren’t totally comfortable with doing so at home, another option is the Ocala Birth Center, which Reynolds opened last June. It became a Florida licensed birth center in March 2013. With a home birth, Reynolds brings all of her equipment to the mother’s residence, while the birth center offers a home-like setting with all the necessary equipment in place. Reynolds maintains a relationship with a local physician for consultation, but she’s found it’s not usually necessary to transfer a mother to the hospital. In the case of a true emergency—or if the mother simply chooses—she can quickly be taken to Munroe Regional Medical Center, which is mere minutes from the Ocala Birth Center. “Childbirth is a natural biological function, not an illness or disease,” Reynolds observes. “I’m glad for the training I have, and I’m all for

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interventions when necessary for safety, but birth can be very natural and safe.” Roughly 25 percent of Reynolds’ mothers opt for a “water birth,” in which the latter stages of labor—and even the birth, if desired—take place in a shallow pool of warm water between 95 to 100 degrees Fahrenheit. “Many women use it for pain relief,” notes Reynolds. “We refer to it as an ‘aquadural’ instead of an epidural because the pool helps them get through labor with less pain. If they stay in the pool and deliver there, it’s a smooth transition for the baby, who has been living in a fluid environment for nine months.” In a water birth, the midwife typically lifts the baby out of the water within 10 seconds or less of delivery and places the newborn on his/her mother’s chest with the umbilical cord still attached.

NOT FOR EVERYONE

Not every mother-to-be fits seamlessly into the midwifery model. If a first-time mother in her early 40s approached a midwife practice, she’d probably be referred to an OB/GYN physician, simply because having a first child at that age raises the chance of complications. Using a midwife is best for healthy mothers who have low risk pregnancies. “The state of Florida requires each woman go through a screening process to make sure she’s in a low-risk category before using a midwife,” explains Reynolds. “My husband, James, and I watched the documentary The Business of Being Born, and that really opened our eyes to the thought that home birth was possible,” says Melissa Auten, whose first child, Miles, was delivered at home on March 8 by Reynolds. “I didn’t want to go to the hospital; I just wanted a more natural experience without all the medications and to have more control over our labor and birth,” she adds. “It was wonderful; we couldn’t have asked for a better midwife or experience. I would do home birth with another baby. If a woman is healthy and low risk, home birth is an option.”

MUNROEREGIONAL.COM/OUR-SERVICES/MIDWIVES-OF-OCALA OCALABIRTHCENTER.COM APEACEFULBEGINNING.COM


An historical debacle made way for one of Marion County’s bestkept secrets—the Santos Trail. Today, it’s a natural destination for bikers, hikers and riders alike. Have you been out to Santos yet? By Cynthia McFarland

H

idden treasure. As youngsters, we’d spend hours, even days searching for that “great discovery” that would make us rich, maybe even famous. Growing up in Tucson, Arizona, exploring the desert trails and foothills on my horse, I was sure that one day I’d find something extraordinary. As an adult though, I’ve realized that if you know where to look, treasures aren’t necessarily hidden. Sometimes, they’re just around the corner. Literally. The Santos Trail in south Marion County is one of those remarkable finds. What’s amazing is that many locals don’t even know it’s there. Come onboard, fellow explorers, and prepare to make a grand discovery. Dozens of miles

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Photo by John Moran

of mountain bike trails, hiking paths and horseback riding trails are waiting. Ironically, the Santos Trail, which is part of the Marjorie Harris Carr Cross Florida Greenway, came into being as a result of what many consider one of the biggest blunders in Florida history, the Cross Florida Barge Canal Project. Hard as it is to believe today, government officials once thought it would be a completely sane idea to dig a canal right across the middle of the Sunshine State. Instead of having to take the long sea route all the way around the peninsula, ships could save time and money by using the canal. Multiple surveys for a proposed canal across Florida took place over the span of a century, beginning in the early 1800s. Federal surveyors sent to the area realized the impracticality of the concept, but canal supporters refused to relinquish the idea, leading to the establishment of the Florida State Canal Commission in 1931. The Ocala Star-Banner itself published an abundance of “pro-canal” stories and editorials. The Great Depression gave President Franklin Roosevelt an excellent excuse to revive the project under the auspices of job creation. Over 6,000 workers tackled the enormous task, clearing some 4,000 acres and making 30 cents per hour, a good wage at the time. Many of those workers spent their hard-earned dollars in Ocala, resulting in a substantial business and entertainment boom for the town known as “The Brick City.” Federal funding for the canal dried up in 1936, even though only about one-third of the land was cleared. The project idled for nearly three decades until President John F. Kennedy resurrected it again in the early 1960s. President Lyndon Johnson continued to support the project after Kennedy’s assassination.

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Marjorie Harris Carr, a native of Boston who moved to Florida in the late 1920s, was stirred to action after realizing the environmental threat the canal posed to the area, particularly the Ocklawaha River. She and other activists formed the Florida Defenders of the Environment and worked tirelessly to halt the project. Their efforts finally resulted in a federal court injunction, and President Richard Nixon pulled the plug on canal construction in 1971. By that point, some $74 million had been poured into the project. Supporters spent nearly another decade arguing for the canal’s completion, but in January 1991, the federal government officially “deauthorized” the Cross Florida Barge Canal Project. The “blunder” then became a blessing in 1998 when the state of Florida turned the former canal route into a 110-mile-long

Left: More than 70 miles of biking trails, ranging from easy to extreme, are available at the Santos Trail. Opposite: Hills, turns and uneven footing make portions of the Santos Trail challenging for even the most dedicated hiker.

“Santos Trail is one of the top three trails to ride in the state, if not the whole Southeast. It’s a diamondin-therough that attracts thousands a year.” —CHRIS FERNANDEZ, SANTOS BIKE SHOP


Photo by John Moran

corridor aptly named the Marjorie Harris Carr Cross Florida Greenway, which runs from the Gulf of Mexico to the St. Johns River. Here in Marion County, the Santos Trail is just part of that vast greenway where visitors can experience Florida’s great outdoors much as it was a century ago. The trailhead takes its name from the former town of Santos, a predominately African-American community of approximately 300 that was destroyed in the 1930s to accomodate canal construction. At one time, Santos was an important rail stop for the Florida Transit and Peninsular Railway. Today, it’s the ideal spot for adventure seekers eager to take advantage of the area’s abundant outdoor activities. “The Santos Trail is one of the top three trails to ride in the whole state of Florida, if not the whole Southeast. We meet new

people from all over the state, even all over the country. We even have people from out of the country,” says Chris Fernandez, an avid cyclist and owner of the Santos Bike Shop, which sells bikes, clothing and accessories and also offers bike rentals and service. “It’s a secret in Ocala, a diamond-in-therough, if you will, that attracts thousands of people a year,” Chris continues. “People who live here really have a great resource to take advantage of, but I think there are more people from out of the county who know this place. We have tons of people from Orlando come here all the time to ride, almost on a weekly basis. It’s unfortunate that not a lot of people who live here know about this trail.” But some Ocalans are catching on to the rich opportunity in their own backyard. Residents

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Melissa and Ed English head to Santos Trail about twice a month during cooler weather. “It’s so convenient. The trails are well maintained, and there are bike shops close by,” says Ed, noting that they ride between 10 to 23 miles at a time, typically on the intermediate (blue) trails. “The trails are gorgeous,” adds Melissa. “It feels like you’re getting away from everything.” “There’s something for everyone, including the BMX riders at the Vortex,” says Ed. “There are some real diehard riders there doing tricks, and some have cameras on their helmets.” (Check out their amazing videos on youtube.com, keyword “Santos Trail.”) Dano Kinnee, who owns Greenway Bicycles with his wife, Jessica, says the best thing about the Santos Trail is that it’s easy enough for beginners and technical enough for the most experienced riders. Their popular shop offers bike rentals, retail sales, bike repair and a convenience store where riders can purchase snacks and drinks. “People have a passion for riding bikes,” adds Dano, a certified United States Cycling Federation (USCF) bicycle mechanic. “If you were to poll the people out in the parking lot, probably only one-fourth of them are from Ocala. It’s amazing. People from all over come here.” Although the Santos Trail is primarily designated as a mountain biking trailhead, you don’t need wheels to tackle the trails. Equestrians appreciate the fact that the “staging area” is fenced, and there’s even a small corral on-site, although this trailhead is smaller than some of the other Greenway trailheads that cater mostly to horseback riders. “I ride there all the time and have ridden those trails for years,” says Iris Diaz,

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president of the local Sun Country Trail Blazers riding club. Diaz says she regularly heads to the Santos Trail, whether for an organized club ride or with a group of riding buddies. “This is the most flat of all the greenway trails, and the footing is great,” she notes. “It’s good in the summer because there’s a lot of shade. You can ride straight out on a loop ride for a couple hours at a slow pace. You can also cross the street and enter the 110th Street trailhead.” Bathrooms are an added benefit, and picnic tables make it easy to relax and have a snack before or after your ride. In addition to the restrooms, which have potable water, there are 80 paved parking spots and three picnic pavilions. “We always bring lunch and rest the horses while we eat,” says Iris. “It’s nice that there’s water and you can hose the horses off.” Hikers often venture out on the trails, many bringing their dogs on a leash. Trails are clearly marked, and for safety reasons, there are separate trails for mountain bikers, equestrians and hikers, so you don’t have to worry about sharing the path. There are places where some of the trails cross each other, but those who use the trails regularly say it’s never a problem because the trails quickly veer off in different directions. On the Cross Florida Greenway as a whole, there are approximately 40 miles of equestrian trails, 40 miles of hiking trails and 70 miles of mountain biking trails. The more than 30 miles of mountain biking trails at Santos are broken down into three levels of difficulty: Yellow is easiest, blue is labeled intermediate and red is for experts. Trails are color-coded, which makes them easy to follow. Anytime you see “TH” with an arrow on a trail sign, this will lead you back to the trailhead. On the day I hit the trails, I saw everyone from families with young children on the yellow trails to BMX riders pulling off some hair-raising stunts on the red trails. Personally, I decided the blue trails were more my style. The majority of all trails are shaded, but the number of roots, rocks, ups


and downs, and twists and turns will vary greatly depending on the level of trail you opt to ride. The Ocala Mountain Bike Association (OMBA) does a masterful job of maintaining the trails as well as cutting new ones. “The amount of hours our volunteers [donate] in one year is the equivalent of the state spending about $80,000,” says OMBA President Tim Mulhall. “The first Saturday of every month, anywhere from 15 to 20 members show up to maintain existing trails and build new ones.” As I learned from firsthand experience, it’s possible to take a tumble on the blue trails if you don’t negotiate the rocky areas successfully. But for the most part, I found the blue trails to be a blast. They were challenging enough but not too intimidating. Wear a helmet, bring along extra water and ride safely. The Santos trails are yours to enjoy, so make the most of them!

Want To Learn More? Marjorie Harris Carr Cross Florida Greenway Headquarters floridagreenwaysandtrails.org / (352) 236-7143 Greenway Bike Shop (Offers bike rentals) greenwaybikeshop.com / (352) 351-3475 Santos Bike Shop (Offers bike rentals) santosbikeshop.com (352) 307-BIKE (2453) Ocala Mountain Bike Association omba.org

Santos & Vortex Area Trailheads

Scan here to load this map on your smartphone before you hit the trails!

This map was produced and intended as a general reference guide only. Steep Trail

N

OMBA Park Bench OGT Info Kiosk

Water

Parking

Camping

Picnic Area

Greenway Donations

Restrooms

OMBA Yellow (Easiest) OMBA Blue (More Difficult) OMBA Red (Most Difficult) Horses Hiking

Cut A Path To The Trail! From I-75: Go south from Ocala and take exit 341 (Don Garlits Museum exit). Go east on 484 and take 475 north. Turn east onto 80th. The Santos trailhead is on the right just before you get to US 441. From US 441: Go south on 441 until you come to 80th. The Marion County Sheriff Substation is located at this intersection. Turn right on 80th and the Santos trailhead parking lot is just ahead on the left.

A helmet is required. Eye protection is recommended. Ride with your head—not over it. A “qualifier” controls access to the freeride area. If you can ride over the obstacle, you can most likely handle the rest of the trail. Read, understand and obey all posted signs.

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a

gReEn

ApPrOach To

GrowIng WritTen By

I

BonNiE Kretchik

/ photOs bY

john JErNigan

n recent years, there has been an increasing emphasis on the American diet. The

obesity epidemic, a rise in chronic diseases, documentaries and investigations into our food supply—who can forget the “pink slime” reports—and the overall declining health of our population has begun inspiring people to return to a cleaner, more natural way of eating. In theory, it would be easy: We would simply go to the grocery store, select our meats, fish, fruits and veggies and prepare them ourselves versus the alternative of a microwavable, highly processed and, let’s face it, tasteless meal, void of much nutrition yet with an ingredient list 10 lines long. However, the theory that selecting fresh produce from a store means that it’s healthy isn’t always 100 percent correct. According to the Environmental Working Group, tests conducted by the Food and Drug Administration (FDA) and the United States Department of Agriculture (USDA) have found that a striking amount of produce tests positive

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composting and growing could revolutionize for pesticides. Domestic blueberries alone the farming and equine industries, ultimately tested positive for 42 different chemicals leading to a cleaner, more environmentally used to keep insects away, and grapes can carry over 64 different chemicals at any time. friendly state. The farm on Anthony Road is like Brian’s Are these chemicals dangerous? Will science lab. Here, he utilizes his methods of they harm our children? Do they have longgreen and sustainable farming, constantly term effects? The answers to these questions tweaking and experimenting with the ultimate are often debated, with no clear answer. goal of empowering everyone—from largeAnd what about current farming methods? scale farmers to the backyard grower. Are they wasteful? Are we taking up too “This is my research facility,” he says much land and producing food that lacks the excitedly. He’s quick to demonstrate his nutrition it did 50 years ago? Why are there “waste to taste” platform to anyone interested fewer farmers than ever before, and can in sustainable farming. they afford to make a living? These are all questions we should ask ourselves today, yet many of us simply do not. Brian Donnolley has seen enough. He’s seen enough waste, chemical use, destruction Brian’s motto is one that many might shy of land and poor farming practices to inspire away from upon first hearing it. But Sun State him to do something about it. Organics has developed multiple solutions to Sun State Organics, based right here in the “waste” problem. Ocala, was founded by Brian. He’s traveled “It’s no secret. Animals poop, and farmers all over the world, need to call in a literally, helping company to have that foreign nations poop removed, where and organizations it then goes to sit in a develop sustainable landfill. It’s expensive farming and waste and doesn’t make any management methods. sense,” he says. “I’ve been all over One component the world on garbage,” of Sun State Organics says Brain laughing. answers the question Brian’s Rotary Composter He recalls his work in of what to do with that Sri Lanka involving waste. The answer? the establishment of their first recycling Zero-emissions composting. committee, his work with the city of London Brian’s rotary composters can compost and Terre Verde Global working to turn the any organic matter in a matter of days. He city’s waste into sustainable energy sources explains that they come in different sizes, and countless other projects he’s been involved so anyone from the private stable with a few in over the years. horses to a larger professional operation can “I’ve literally been all over the place, and easily compost the farm’s waste, cutting out it’s a circle of death out there, not a circle of the cost of removal. life,” he says, referring to the amount of human “We’ve made them easy to use, and waste and pollution he’s encountered across the rate of return is huge,” he says, always the globe. And unfortunately, it’s the quality of happy to demonstrate with one of the our food supply that is taking the hardest hit. composters on the farm. “I want to enable farmers to succeed. They can’t succeed if they have to spend their profits on things like manure removal,” he says, noting that the Brian came to Ocala three years ago knowing equine industry especially can benefit from composting, thus helping to restore it to its that the equine industry was a major part of the county’s economy and that his methods of glory days of years ago.

Waste To Taste

What Is Sun State Organics?


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A Word on Worms

Composting via Brian’s methods is one method he is eager to share. But it doesn’t end there. If you think the easy-to-operate composters are impressive, his bed of worms—yes worms—is even more so. Vermiculture is the use of earthworms to decompose waste. It essentially involves adding earthworms to organic matter to be composted. The worms break down the matter, and their byproduct is a nutrientrich fertilizer. And since earthworms are hermaphroditic, meaning they are both male and female and can each lay and fertilize eggs, there isn’t a need to add more worms after the initial batch. Under perfect conditions, a mature worm will lay an egg capable of producing over a dozen hatchlings every seven to 10 days. Once hatched, the new worms reach maturity in four to six weeks. So, essentially the population has the potential to double monthly. “They’ve been doing this in other countries for years. It’s time we started looking at these other techniques instead of shipping everything off to landfills,” he says, noting that vermiculture is another means of enabling farmers to be self-sustaining. “I want people to farm. I want farmers to make money. These are the techniques that will allow them to do it while preserving the environment at the same time,” he says enthusiastically.

Growing Up

“They say that we need a landmass the size of Brazil in order to have enough land to feed the current population of the world. The last time I checked, there weren’t any Brazils just laying around, so we’ve got to come up with an alternative,” says Brian, moving on to yet another aspect of Sun State Organic’s sustainable farming methods. “If you can’t grow out, you’ve got to grow up,” explains Brian. His vertical growing systems enable anyone to double or triple their yield without acquiring more land.

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“These systems allow the farmers to grow more. It allows someone who cares about where their food came from to grow their own plants organically, and best of all, it’s incredibly easy,” says Brian. He jokes that the system had to be “Brian-proof,” as he himself is not only not a farmer but has no background in farming. And with an increased emphasis on locally grown, organic produce, people are becoming more intrigued by the idea of growing their own food but either don’t have the time or the training to tend a garden. “With these systems there’s no bending, no bugs, no weeding, no watering. It’s Brianproof,” he says. The systems come in multiple pole heights with multiple pole-system options. For example, a family may purchase a fourpole system that is capable of hosting 80 8-inch pots, while an individual may only want to purchase a single pole. A large-scale operation may choose to purchase even larger systems. The irrigation systems waste far less water than traditional systems. Each pot is fed via an individual tube that can be regulated so as not to over or under water a particular plant. And if a pot is vacant, the tube can be switched off. As for lighting, the use of natural sunlight will of course work if the system is kept outdoors, but for those living in an apartment or condo, a light source is built into the pole to assure easy growing indoors. “You can essentially grow food anywhere with this system, and best yet, you know where it came from and you know what’s on it,” says Brian, who believes that vertical systems are the wave of the future when it comes to growing food. “We’re running out of land. Our population is growing, and with our current farming practices, we’re not going to be able

Want To Learn More?

to feed all the people on the planet by the year 2050. We’ve got to do something, and we’ve accepted that challenge,” he says.

Putting It All Together

Theoretically, if you were to purchase the composter, the vermiculture beds and the vertical growing system, you could essentially run a farm that puts energy back into the grid. But you don’t have to go that far in order to make a difference. “There are so many ways to use this system,” says Brian. He says that utilizing one aspect of the system can still have a major impact on the environment. A clean compost spread will lead to healthier fields for animals to graze on or plants to grow in, thus creating a healthier product. Vertical growing systems can help the famer produce more yield on less land with less waste. And those wanting to do their part and grow their own organic fruits, veggies, herbs or other plants can do so in their own backyard or even garage. “We’ve gotten so off track,” says Brian, a self-admitted former fast-food junkie. “There is nothing more important than what we eat, and right now, we are eating a lot of bad things,” he says. “We need to start making changes in the way we farm and the way we eat in this country,” he says. Sun State Organic’s systems have already been implemented in other nations around the world with much acclaim, and locally, the company has partnered with Feed The Need Garden in an effort to help fund the non-profit organization dedicated to sustainable agriculture practices. “We want to see more farming, more gardening and better practices. It’s time to just say no to bad food,” says Brian, hoping that more people begin to see the need for change before it’s too late.

A Winning Combination Sun State Organics has partnered with Feed The Need Garden, a non-profit organization that promotes sustainable agricultural practices and teaches gardening techniques to those in need. Purchasing a vertical growing system through Feed The Need results in a 30 percent tax deduction for the buyer and helps fund the organization. To learn more, visit feedtheneedgarden.com.

Sun State Organics is located at 8903 West Anthony Road in Ocala. They offer consultations to farmers, commercial industries and individuals looking to implement one of their systems. To learn more, visit sunstateorganics.com or call (352) 620-8444.

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of

THE MYSTERIOUS CASE

It’s an incurable disease that affects 1.5 million Americans. Yet it remains one of the most persistent medical mysteries, both before and after diagnosis. In honor of Lupus Awareness Month, Marion Healthy Living examines this mystifying disease. BY KRISTINA KOLESA

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F

RIBBON © MIHAI MAXIM / SHUTTERSTOCK.COM

or nine long months after her diagnosis, Linda Ruescher couldn’t bring herself even to read about her disease. She had lived with the unknown affliction for nearly 40 years, and at last, she had a name for it. It wasn’t the flu. It wasn’t exhaustion. Linda Ruescher had lupus.

“Finally, I figured if I was living with it, I might as well know what it was and what it does,” Ruescher says. “I bought a 1,500-page rheumatology textbook and began studying lupus.” Today, Ruescher, 61, is a veritable expert on the disease. She can speak at length about mitochondrial dysfunction, monoclonal antibodies and the long-term effects of hydroxychloroquine. She regularly counsels fellow sufferers, helping them adjust to life with lupus and directing them to important resources as the program director of the Lupus Foundation of Florida, based in St. Petersburg. Ruescher’s own diagnosis was decades in the making. It was only after an emergency hospitalization at age 51 that she received a definitive verdict about her affliction. “I was losing weight. I had chest pain and shortness of breath. My ankles had started swelling,” she recalls. “Then, I got up one morning, managed to take a shower and that’s the last strength I had.” Ruescher called a friend, who in turn called 911. She would remain in the hospital for the next 14 days. Doctors diagnosed her with congestive heart failure, kidney failure, bone marrow failure and inflammation of the brain. Most importantly, they put a name to the disease that Ruescher first recalls experiencing at age 13. Ruescher is one of the 1.5 million Americans living with lupus, a prototypical autoimmune disease and one of some 80 autoimmune diseases classified by the National Institutes of Health. It is a chronic, incurable disease. As with all autoimmune diseases, lupus causes the body’s immune system to attack the body, leading to inflammation and tissue damage. Unlike other autoimmune diseases, however, lupus can affect any part of the body: joints, heart, kidneys, brain, lungs. Scientists do not know precisely what causes lupus,

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may be prescribed if other treatments are ineffective or if a patient is unable to endure prolonged steroid treatments. However, the side effects of continued use of any of these drugs can lead to additional health problems. Weakening of the bones and a diminished blood supply to the joints are, for example, just some of the effects of long-term steroid use. “The majority of people with lupus who have good care can live a relatively normal lifespan,” Ruescher says. “But we do have an increased risk of a cardiovascular event because of long-term inflammation, and we are at a higher risk of infection because we take drugs to weaken our immune systems. Kidney failure is also a high risk for us.” Throughout their lives, sufferers vacillate between periods of well-being (remission) and bouts of severe illness. The latter, called “flares,” can occur at anytime and can also be brought on by a number of external stressors. This is why Ruescher says she works so hard to maintain a balanced, positive lifestyle. “I get in about 120 minutes of cardio a week and practice long periods of meditation,” she explains. “I don’t allow anything into my life that’s stressful, and I work really hard on the avenue of mental health, on having a positive attitude, being very mindful and as much in the present moment as I possibly can.” For a disease that has so many unanswered questions, research is critical to advancements in lupus treatment. In 2011, the Food and Drug Administration approved the first new lupus drug in 50 years, Benlysta. The medication

BUTTERFLY © SKY DESIGNS; LETTERS © YIENKEAT / SHUTTERSTOCK.COM

however genetics, hormones and environment are known to be major contributors. The disease inordinately affects females—nine out of 10 sufferers are women—and is more prevalent among African-Americans, Latinos, Asians and Native Americans. The symptoms of lupus can be as puzzling as the disease itself: fever, joint swelling and pain, rashes, extreme fatigue, sensitivity to light. Taken separately or even together, these relatively ambiguous manifestations of lupus often go undiagnosed or are misdiagnosed altogether. The “butterfly” facial rash, for example, which so much of the public associates with lupus, does not manifest in every lupus patient. According to Ruescher, the average wait time between the first flare up and a lupus diagnosis is three to five years. “People who have lupus will doubt themselves,” Ruescher explains. “Oftentimes, once we get to the doctor’s, the symptoms are gone. So we begin to doubt ourselves. It’s very common.” There is no single test for lupus. Rather, a multitude of tests, coupled with medical history and an examination of symptoms, is employed to reach a diagnosis. Lupus patients will often see a variety of doctors over the course of their lives, however most often, their primary physician is a rheumatologist. The medications used to treat lupus include anti-inflammatories (aspirin, for example), steroids such as prednisone and antimalarials, which work to reduce the body’s creation of autoantibodies. Immunosuppressive medications


Sources: Mayo Clinic, National Institute of Health, Alliance for Lupus Research, Lupus Foundation of America, Food and Drug Administration, Centers for Disease Control and Prevention

specifically targets a group of immune cells, called B cells, which overproduce antibodies in lupus patients. It was hailed as a breakthrough with the disease. The U.S. government’s recent sequestration measures, however, have had a substantial impact on medical research funding across the board, particularly at the National Institutes of Health. In late March with the passage of “The Consolidated and Further Continuing Appropriations Act” (H.R. 933), the lupus community did receive moderately good news that some lupus-related initiatives would be preserved despite the federal budget cuts. Lupus research, like so much medical research, relies on robust and readily available NIH funds. “Without sufficient funding for the NIH and other federal agencies, research studies to find the causes of lupus and discover new, more tolerable and effective treatments for lupus will be delayed, and the search for cures will be seriously impaired,” Sandra C. Raymond, president and CEO of the Lupus Foundation of America, cautioned in a public statement after the passage of H.R. 933. “Lupus research remains underfunded relative to the disease’s scope and devastation.” Meanwhile, organizations like the Lupus Foundation of Florida, which was founded in 1979, continue to advocate for research at the local and national levels and provide support groups throughout the state with trained volunteers and educational material. Striving to maintain a sense of normalcy in one’s life is a common trait among lupus sufferers. Ruescher, who was a single mother at the time of her diagnosis, recalls her own pre-diagnosis cycle: pushing herself to her physical limits at work and at home, finally succumbing to a severe bout of exhaustion and sickness, then rallying long enough before her next collapse. Today, Ruescher has more than achieved that sense of normalcy, enjoying a lifestyle that would put most perfectly healthy people to shame. She is a classically trained organist and choral conductor and teaches performing arts at a private, all-girls high school. She also works at her local church and is a master trainer for Stanford University’s Chronic Disease and Diabetes Self-Management programs. She is writing a book and, together with her outreach work with the Lupus Foundation of Florida, works virtually seven days a week. She finds her counseling work to be particularly rewarding and anything but exhausting or draining. “It’s given me a new direction in life, helping other people navigate the adjustment process,” she says. “People call me about new clinical trials. They call about their depression. There’s a process you have to go through to really be at peace with lupus so that you’re then able to work on getting as healthy as you possibly can be.”

FAST FACTS ABOUT LUPUS • LUPUS IS A CHRONIC, INCURABLE AUTOIMMUNE DISEASE.

ON THE FACE; CHEST PAIN; EXHAUSTION; HAIR LOSS AND SENSITIVITY TO SUNLIGHT.

• LUPUS TESTING CAN INCLUDE • IN ADDITION TO THE A PHYSICAL EXAM, BLOOD MOST COMMON FORM TESTS, SKIN BIOPSY, KIDNEY OF LUPUS, SYSTEMIC BIOPSY AND MEDICAL LUPUS ERYTHEMATOSUS, HISTORY. THERE IS ALSO DISCOID LUPUS ERYTHEMATOSUS • DURING THE COURSE (PERSISTENT SKIN RASH), SUBACUTE CUTANEOUS LUPUS OF HIS OR HER LIFE, A ERYTHEMATOSUS (SORES ON LUPUS PATIENT MAY SEE A RHEUMATOLOGIST, AREAS OF SKIN EXPOSED TO IMMUNOLOGIST, THE SUN), DRUG-INDUCED LUPUS AND NEONATAL LUPUS ENDOCRINOLOGIST, NEPHROLOGIST, (NEWBORNS). CARDIOLOGIST, HEMATOLOGIST AND • LUPUS IS MUCH MORE DERMATOLOGIST, COMMON IN WOMEN, AMONG OTHERS. PARTICULARLY AFRICANAMERICAN, HISPANIC, • MOST PREGNANT WOMEN ASIAN AND NATIVE WITH LUPUS ARE ABLE AMERICAN WOMEN. TO ENJOY A NORMAL PREGNANCY IF THEY • THE PRECISE CAUSE OF CONSULT REGULARLY WITH LUPUS IS UNKNOWN. THEIR DOCTORS. • SYMPTOMS INCLUDE PAIN/ SWELLING OF THE JOINTS; Source: National Institute of Arthritis and Musculoskeletal and UNEXPLAINED FEVER; Skin Diseases RASHES, PARTICULARLY

Want More Information?

Learn more about the Lupus Foundation of Florida at lupusflorida.org or (727) 447-7075.

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MOVING OUR COMMUNITY FORWARD At the Y, we invest in our future leaders by developing our youth and teaching them the core values and life skills they need to be successful. We invest in families by providing activities and programs that allow parents and kids to spend time growing stronger together. We invest in adults and seniors by creating a sense of belonging and allowing them to thrive through volunteerism and giving back to others. Day in and day out, the Y makes our community stronger by investing in every individual who walks through our doors. And now, Frank DeLuca is investing in the Y. The community leader and philanthropist announced his $1 million gift, which will be applied to the YMCA’s $4.5 million capital campaign to renovate the existing building. “Giving back feels good and it’s the right thing to do,” explains Frank. “I am honored and extremely proud to be blessed to be in a position to support the Y and our great community in this way. I cannot think of a more worthy organization than the YMCA to support at this level.” At the Y, we are committed to nurturing the potential of kids, promoting healthy living and fostering a sense of social responsibility. The Marion County Y, now the Frank DeLuca Y, currently reaches 20,000 people in Marion County and serves 8,000 kids. Central Florida Y CEO Jim Ferber is encouraged by Frank’s investment in the Y’s mission. “Frank’s leadership is inspiring. It will hopefully encourage others to understand the Y’s role as a nonprofit organization committed to helping move people and communities forward." And with the help of Frank DeLuca and other community partners, the Frank DeLuca YMCA’s vision for the future is brighter than ever. With the capital improvements over the next three years, we are on track to serve more than 35,000 adults and children, allowing us to share the Y with everyone in Marion County. “The Marion County YMCA is not just a ‘gym,’” Frank says. “The Y builds character in our children and families and remains focused on addressing the changing needs of Marion County’s families and improving the overall wellness of our community.”

FRANK DELUCA YMCA 3200 SE 17th Street Ocala, FL 34471 352.368.9622 Facebook.com/MarionCountyYMCA Ymcacentralflorida.com/y-locations/Marion


WHO’S WHO AMONG OCALA’S FOOD BLOGGERS By Amanda Furrer

N

ot so long ago, blogging appeared on the World Wide Web and food enthusiasts soon took note. But while food bloggers are taking over the world one computer login at a time, just where are Ocala’s food bloggers? Why haven’t many Ocalans created their own Web space chronicling their food expeditions in our little city? After combing the Internet for Ocala food bloggers, I finally got to know some of our small town’s foodies and discover where they’ve been hiding out. It figures they were here all along. You just need to know where to look…

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http://colormepink.com

THE PINK LADY

Christine’s Blogger Profile

Christine Leiser Schroeder

colormepink.com HOME

C FAVORITE OCALA RESTAURANT:

Stella’s Food Pantry; “They’re always doing something innovative and delicious, and they’re so friendly that it’s like having dinner with old friends.”

ON HER FOOD BUCKET LIST:

Scallops, sushi, clams on the half shell

KITCHEN ESSENTIALS: Flavored vinegars

DESCRIBE YOUR BLOG IN THREE WORDS: Delicious, doable dinners

CHRISTINE’S PICK Steelhead Trout with Lemon Butter Sauce with Capers and Garlic

SERVES 4

hristine Leiser Schroeder over at ColorMePink! may seem like a girly-girl at first click. But upon closer inspection, you’ll catch clues that this mother’s a techie at heart. With a tab that reads “Geek Girl and Gadgetry” and “We are the Little House on the Matrix” on her site’s banner, Christine has more layers than a lemon cake. In just one week, she posted about iPad apps, Fiore’s Café and a homemade Sunday dinner. Originally from Long Island, New York, Christine has called Ocala her home since 1998. A Web developer and social media consultant, she started blogging in 2002 but didn’t start blogging about food until a couple years later. Now, Christine devotes a portion of her blog to mealtime tips and recipes. “I’m really committed to making everything as fresh, healthy, local and chemical free as possible, so we make everything from scratch,” Christine says. “It really makes a tremendous difference in the flavor, and it’s not as hard as you might think.”

ABOUT

CONTACT CONTAC

But cooking wasn’t always Christine’s forte. The blogger admits she could barely boil pasta 20 years ago. Through self-education—cooking shows and scores of cookbooks borrowed from the library—Christine became an expert in her kitchen. And her husband, Jim, son, Travis, and daughter, Haley, are willing participants, whether it’s eating Christine’s food or helping her make meals. “Everyone helps, and everyone has their own specialties. Jim loves to grill and makes a great steak! Travis likes to experiment with different noodle dishes, and Haley is the salad whisperer,” Christine says. For Christine, planning ahead is the best advice she can give to mothers when it comes to cooking healthy meals. “With a little planning, moving your family to a healthier way of life is not as daunting as you might think. With a couple of tricks and the willingness to experiment, you can totally do this.”

W H AT W O U L D Y O U B E I F Y O U W E R E A . . . VEGETABLE:

FRUIT:

COOKIE:

SANDWICH:

A tomato. I'm adaptable and useful in different situations.

Apple. I love technology.

A fortune cookie. I always have something to say.

Pulled pork with coleslaw, just because it's my favorite.

Like mother like daughter, Christine’s daughter, Haley, loves seafood. This dish is one of Haley’s favorites. 1 large fillet of trout (over 1 1/2 pounds)

4 cloves garlic, chopped

2 tablespoons butter

1/2 jar of balsamic or regular capers

1 tablespoon olive oil Preheat oven to 400°F. Heat pan on medium-high heat. Add olive oil; when it simmers, add butter. When butter is melted, add garlic and sauté for 2-3 minutes. Add capers, toss and remove from heat; set aside. Put fish on cutting board, and portion into four pieces. Cut four pieces of aluminum foil, big enough to put each portion onto, with room to seal top. Lay portion of fish onto piece of foil, and brush with butter mixture; spoon some garlic and capers on top. Pull up sides of packet and roll top and sides to seal it so fish will steam and sauce doesn’t leak. Place on sheet pan, and repeat for remaining portions; cook for 20 minutes or until fish is flaky. Carefully remove fish from packets. Pour remaining sauce over fish. Serve with tossed salad dressed with balsamic vinaigrette.


http://theworldofdeej.com

THE HUNGRY TRAVELER

F

irst and foremost, Daniel Jones is a travel blogger with an adventurous appetite. Daniel, or DJ as everyone else calls him, started his blog, The World of Deej, on a pure whim. “One random night about two and a half years ago, I decided to start a blog rather than watch yet another rerun of The Office. I could never have known when I hit ‘publish’ for the first time that I was basically dropping a pebble from the top of a snow-covered mountain.” DJ moved to Ocala when he was only a few months old. A “certifiable hotel junkie,” DJ and his wife, Megan (MJ, as she’s known on the blog), try to

get away for a weekend once a month to a destination nearby. “[My wife and I] happen to be Disney geeks, which makes living in Ocala particularly convenient.” A section of The World of Deej is dedicated to all things Mickey, including visits to the West Coast’s park. The “scallop steak” pictured here is a dish from Disneyland’s Napa

Rose, located in Disney’s Grand Californian Hotel. “You wouldn’t be blamed for not equating Disneyland with outstanding food,” comments DJ, “but it’s hard to argue otherwise when they put out plates this beautiful.” DJ tries to squeeze in two “big” trips a year and fit in several long weekends around the country when he can. If a map of the United States hung on DJ’s wall, there’d be 15 thumbtacks for the places he’s been to outside Florida. The Pacific Northwest and Chicago are two “glaring blank places” known for local cuisines he someday hopes to explore. In a word, DJ describes Ocala’s cuisine as “evolving.” “A decade ago, there were no independent, high-end restaurants in Ocala; now we have several,” says DJ. Of the hidden treasures in our city he’s willing to share, DJ has one. “The fudge brownies from Betty Cakes will change your life. That’s your only clue, although I fear I’ve said too much…”

DEEJISMS

EAT FIRST, ASK QUESTIONS LATER: The blogger admits, “I’m passionate about food, but I’m still a little picky.” Because he doesn’t want to miss out on anything, DJ keeps mum when food is served. “Some of the best surprises have come when I just ate what the chef presented and then asked what was in it.”

HOME

ABOUT

CONTACT

THE WORLD OF DEEJ TRAVEL GUIDE: As reputable as trusty Fyodor and reliable as Lonely Planet, DJ gives you traveler’s tips so you can add a stamp to your passport to foodie greatness. For the Ocalan looking to broaden his or her taste buds’ horizons, DJ recommends starting with nearby Atlanta, Georgia, and Ashville, North Carolina, two places he says are often overlooked for their food.

A GAME OF

‘I Say, CHINESE:

MEXICAN: ITALIAN:

He Says’ ...The crispy skin of Peking duck ...El Toreo. My wife's guilty pleasure ...Cheesecake counts, right? ...A noisy tapas

MEDITERRANEAN: bar in Barcelona AMERICAN SOUTH:

...Shrimp and grits

DJ’s Blogger Profile: The World of Deej,

theworldofdeej.com

FAVORITE OCALA RESTAURANT: Latinos Y Mas; “Their palomilla is some of the best outside Miami and should be enjoyed with a pitcher of red sangria.”

RESTAURANTS YET TO BE VISITED:

Le Bernardin in New York, Noma in Copenhagen, St. John in London.

ON HIS TRAVEL BUCKET LIST:

Singapore. DJ is fascinated by the city’s hawker centres; “Imagine giant food courts, but replace Sbarro and Subway with stall after stall of delicious Asian street food.”

Yountville, California: “A city that makes Ocala look like a Austin, Texas: “Austin has an metropolis. Yountville lays claim awesome food truck culture. to more Michelin stars per capita Find one called Gourdough’s, than any other city in the world a truck whose Flying Pig and is home to The French Laundonut will make you weak in dry, regarded as one of the greatthe knees.” est restaurants on the planet.”

TWO OTHER DJ HOTSPOTS:

SURVEY THE SURROUNDINGS BEFORE CHOOSING WHERE TO EAT:

“Let’s say you should find yourself at San Francisco’s Fisherman’s Wharf, and there are four vendors selling steamed crab.” One vendor has a line of 10 people while the other three are begging for tourists to stop. DJ advises the long line is worth the wait. “Don’t bother with the other three.”

HAVE A TRAVEL BUDDY:

“I would never dream of taking adventures without my wife, Megan. She is chief navigator and photographer and helps me find the quirky, off-the-path sites I would otherwise overlook in my search for the nearest Starbucks.”

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http://pbfingers.com

the fit foodie HOME

ABOUT

SOMETIMES IT’S ALL ABOUT THE SIMPLE PLEASURES IN LIFE. LIKE A KID WITH HIS HAND IN THE COOKIE JAR, JULIE FAGAN LOVES HER PEANUT BUTTER.

R

yan (her husband) was actually the one who came up with the name of my blog,” Julie writes in a 2010 entry. “He was always catching me in the kitchen with my finger in the peanut butter jar and said I was the queen of peanut butter fingers. When he suggested ‘Peanut Butter Fingers’ as the name of my blog, I was instantly smitten.” Begun in 2009, Peanut Butter Fingers soon attracted readers with a shared interest in food and fitness. A Palatine, Illinois, native, Julie and her husband moved to Ocala in July 2011. At the time, Julie worked as a content team manager, writing about pharmaceuticals and medication side effects. “My blog became an outlet for me to write about things I wanted to write about,” she says. Now, Julie blogs and works as a freelance writer full time. At Peanut Butter Fingers’ center are in-depth workouts and healthy recipes. A half-marathon runner, Julie’s favorite post-workout food is her banana bread protein pancakes. As for her version of a perfect meal, Julie adores seafood. “Give me a pot of crab legs, mussels, clams and oysters and I’m a happy camper,” Julie says. “

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“A dessert that incorporates ice cream is a must!” Her blog also gives advice to readers hoping to start a blog of their own. For Ocala’s future food bloggers, Julie offers the following advice. “Stay true to yourself!” she says. “When I first started blogging, I felt like I had to write a certain way and eventually realized that I was removing my personality from my blog posts just so I could sound like other bloggers because that’s the way I thought I was supposed to blog.” “There are millions of blogs out there that are so similar, but people love reading blogs that have a personality! Be genuine. Be yourself.”

CONTACT

Julie’s Blogger Profile Peanut Butter Fingers, pbfingers.com

ocala foodie-must:

’S FAVORITE GAME TAILORED IN HONOR OF JULIE’S FAVORITE SNACK

The Taste of Ocala; “As someone who is new to Ocala, it was such a wonderful event to attend because I was able to sample food from some amazing restaurants in the area.”

kitchen essential: A quality blender

yet to make:

Ice cream; “I haven’t tried making my own ice cream yet and would love to give that a go in the future. I fear I may unleash a monster once I start!”

describe your blog in three words: Lighthearted. Fun. Happy.

Peanut Butter: I haven’t met a jar of peanut butter that I didn’t like.

PB+celery:

“ ” “ ” “ ” The celery is just a vehicle for the peanut butter.

PB+J:

One of life’s simple pleasures.

PB+aPPles:

The perfect combination of salty and sweet.

Julie’s Pick:

Julie may be nutty about peanut butter, but almond butter comes in as a close second. “One of my favorite go-to snacks is my almond butter granola. It’s so easy to make, and it is a great on-the-go snack.” 4 tablespoons almond butter

1/2 teaspoon vanilla extract

4 tablespoons honey

2 tablespoons chia seeds

1/2 teaspoon cinnamon

2 cups oats

Preheat oven to 325°F, and spray cookie sheet with cooking spray. Combine almond butter and honey in a bowl and microwave until almond butter is slightly melted (about 30 seconds). Stir almond butter and honey together. Add cinnamon and vanilla to almond butter mixture. Stir oats and chia seeds into almond butter mixture, completely coating oats in mixture. Spread oats onto cookie sheet, and bake for 8 minutes before tossing oats and baking for another 4 minutes until granola is slightly brown. Let cool until granola is crunchy.

almond butter granola serVes 8 (1/4 cuP Per serVing)


MILK © TARASYUK IGOR; DISGUISE © MELKERW / SHUTTERSTOCK.COM

HE ALT H Y

body NUTRITION | FITNESS | BEAUT Y

Source: doctoroz.com/videos/artificial-sweeteners-milk

sip safely Thought you could avoid artificial sweeteners by checking the label? Think again. The International Dairy Foods Association and the National Milk Producers Federation are petitioning the FDA to be allowed to add artificial sweeteners (including the controversial aspartame) to dairy products without having to list it on the label. The FDA is seeking public opinion on this matter through May 21. For more information and to voice your opinion, visit regulations.gov or call the FDA at (240) 402-2371.

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body TRAYS © ROBERT GUBBINS ; GIRL © JILL CHEN / SHUTTERSTOCK.COM

HE ALT H Y

new meals, healthier kids M WRITTEN BY MACKENSIE GIBSON

arion County is on a quest to raise healthy, strong and foodsmart children in accordance with the Healthy HungerFree Kids Act of 2010. The New Meal Pattern is an innovative effort to set nutrition standards for school breakfasts and lunches based on new research findings, requirements of the USDA and realistic circumstances in American schools.

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The new standards will require schools to increase the number of fruits, vegetables, whole grains and fat-free and low-fat milk and decrease sodium, saturated and trans-fat levels in the meals available to children. These changes to school menus, recommended by the Institute of Medicine of the National Academies, are aimed at improving the nutrition of children while helping combat the childhood obesity epidemic. “We come up with the menu as a collaborative effort. It’s one thing to menu something, but it’s another to try to find a kid-friendly menu,” says Susan Johnson, supervisor of Marion County Public School’s Food Services. The previous system of menus included only two menus for all age groups. The newand-improved process includes three menus, one for elementary, middle and high schoolaged children. Marion County public school kitchens will follow the recipes put together by the district officials as determined by the Marion County Grocery List, which will include plenty of in-season produce. “This is our first change in school lunches in 15 years, and I think it’s a change for the better,” says Susan. About 26 menus are compiled all together, which are changed every three months or so throughout the school year to provide variety and introduce new dishes. In addition, a “Meatless Monday” will be implemented. Students purchasing a school lunch must choose three items as they go through the lunch line, and one of the items must be a fruit or vegetable. Gluten and dairy-free options are available to students as

well: When a code is entered, the student’s tray is flagged and the tray will be checked for offending substances. Marion County officials are trying to switch to fresh, local fruits and vegetables as opposed to frozen and canned varieties in addition to meeting the requirement of no more than 30 percent overall fat, no more than 10 percent trans fat and half of all grains served have to be whole grain rich. There are even requirements within the vegetables, assuring that students are offererd the proper amount of dark greens, red/orange, legumes and starchy vegetables. So far broccoli and romaine lettuce have been successful in supplying students with their vegetable servings, whereas sweet potato fries were unpopular among students. Sweet potato casserole, on the other hand, was popular. Some entrées even have “hidden” health benefits, such as vegetables in Alfredo sauce. It’s all about finding a healthy balance when dealing with potentially picky eaters. “There are a lot of changes,” Susan explains. “Childhood obesity is an issue. Some is hereditary, some is lack of exercise and some is learning how to eat right.”


breakfast basics

lunch specifics

5 CUPS OF

7-10 OZ. OF

5 CUPS OF

per week

per week

per week

FRUIT

GRAINS

430

350-500

MILLIGRAMS OR LESS OF SODIUM AND ALL LABELS MUST INDICATE THAT THERE ARE ZERO GRAMS OF TRANS FAT PER SERVING

CALORIES, LESS THAN 10 PERCENT OF TOTAL CALORIES FROM SATURATED FAT

5

8-10 OZ. OF

per week

per week

GRAINS

470

9-10 OZ. OF

per week

per week

500 per meal

GRAINS

per week

CUPS OF FRUIT per week

MEAT ALTERNATIVE per week

640

CALORIES, LESS THAN 10 PERCENT OF TOTAL CALORIES FROM SATURATED FAT per meal

OZ. OF GRAINS

per week

5

per week

9-10 OZ. OF MEAT OR

MEAT ALTERNATIVE

710

CALORIES, LESS THAN 10 PERCENT OF TOTAL CALORIES FROM SATURATED FAT per meal

450-600

CALORIES, LESS THAN 10 PERCENT OF TOTAL CALORIES FROM SATURATED FAT

10-12

OZ. OF GRAINS

per week

740

5

&

&

5

per week

600-700

MILLIGRAMS OR LESS OF SODIUM AND ALL LABELS MUST INDICATE THAT THERE ARE ZERO GRAMS OF TRANS FAT PER SERVING

CUPS OF FRUIT

CUPS OF MILK

per week

5 CUPS OF FRUIT HIGH SCHOOL STUDENTS, NINTH THROUGH 12TH GRADE

5

&

&

CUPS OF FRUIT

per week

8-10

MIDDLE SCHOOL STUDENTS, SIXTH THROUGH EIGHTH GRADE

CUPS OF MILK

550-650

MILLIGRAMS OR LESS OF SODIUM AND ALL LABELS MUST INDICATE THAT THERE ARE ZERO GRAMS OF TRANS FAT PER SERVING

per meal

CUPS OF MILK

per meal

8-10 OZ. OF MEAT OR

CUPS OF FRUIT

per meal

5

MILLIGRAMS OR LESS OF SODIUM AND ALL LABELS MUST INDICATE THAT THERE ARE ZERO GRAMS OF TRANS FAT PER SERVING

5

CUPS OF MILK

10 PERCENT OF TOTAL CALORIES FROM SATURATED FAT

per meal

CUPS OF FRUIT

ELEMENTARY SCHOOL STUDENTS, KINDERGARTEN THROUGH FIFTH GRADE

5

&

per meal

400-550 CALORIES, LESS THAN

MILLIGRAMS OR LESS OF SODIUM AND ALL LABELS MUST INDICATE THAT THERE ARE ZERO GRAMS OF TRANS FAT PER SERVING

OZ. OF GRAINS

&

per meal

per meal

CUPS OF FRUIT

MILK

8-9

CUPS OF FRUIT

10-12 OZ. OF MEAT OR

MEAT ALTERNATIVE

MILLIGRAMS OR LESS OF SODIUM AND ALL LABELS MUST INDICATE THAT THERE ARE ZERO GRAMS OF TRANS FAT PER SERVING

CUPS OF MILK

per week

per week

750-850

CALORIES, LESS THAN 10 PERCENT OF TOTAL CALORIES FROM SATURATED FAT per meal

per meal

WANT MORE INFORMATION? To find out more about the Healthy Hunger-Free Kids Act of 2010 and its implementation, visit schoolnutrition.org and www.fns.usda.gov/slp. To view monthly menus, log onto Marion County Public School’s website and view the Parent Portal.

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HE ALT H Y

body

the chef’s kitchen Each month, local chef and culinary expert Marie Glass Harrington cooks up something to tempt your taste buds.

mom’s mini chocolate cakes with strawberries & honey yogurt

My mom loved chocolate! As a tribute to my mom, Nancy Koppenhaver Glass, I have created a healthy variation of her favorite black chocolate birthday cake recipe with these mini fat-free chocolate cakes. I’ve taken out the oil, added bananas and layered it with sliced strawberries and yogurt. The strawberries are a great source of fiber and vitamin C. Bananas are considered by many as a “super food.” The yogurt helps with your daily calcium allowance. My reasoning for serving the cake as individual mini cakes is simple: A big piece of cake would overwhelm my mom. For me, cutting the cake into mini cakes is great for portion control. I used a 2-inch round cookie cutter for the base cake and a 1-inch cutter for the top cake. Sometimes, you can find honey-flavored yogurt at the store, so there is no need to stir together your own mixture. Now health-conscious eaters can have their chocolate cake and eat it, too! YIELDS ONE 13X9X2-INCH CAKE (ABOUT 15 SERVINGS) 2

cups sugar

1

teaspoon baking powder

2

cups unbleached all-purpose flour

¼ teaspoon salt

¾ cup unsweetened cocoa

2

eggs

teaspoons baking soda

2

teaspoons vanilla

1

cup skim milk

2

1

cup black coffee

1

cup very ripe bananas, mashed well (about 2½ bananas)

Preheat oven to 350°F. Spray a 13x9x2-inch baking pan with baking spray. Set aside. In a medium bowl, sift or whisk together sugar, flour, cocoa, baking soda, baking powder and salt. Set aside. In a large bowl, mix together eggs, vanilla, milk, coffee and bananas. Add flour mixture to the egg mixture. Mix well, about 2 minutes. Pour batter into prepared pan. Bake at 350°F for about 40 minutes or until tests done with a toothpick or skewer. Cool before cutting. Cut cake into desired shapes. STRAWBERRY INGREDIENTS: 8

cups sliced strawberries

1

tablespoon honey

In a medium bowl, mix together gently. Cover and set aside in refrigerator until plating. YOGURT INGREDIENTS: 1

cup nonfat Greek yogurt

1

tablespoon honey

In a small bowl, stir together gently. Cover and set aside in refrigerator until plating. ASSEMBLY: Slice a 2-inch round cake in half horizontally. Place half on serving plate. Top with a heaping teaspoon of honey yogurt. Top with other half of the cake round. Repeat with yogurt and strawberry layers. Center a 1-inch cake round on top. Add 1/2 cup strawberries to the side of the mini cake. Garnish with a tablespoon of the honey yogurt mixture. Serve immediately.

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body

staying centered According to the Centers For Disease Control and Prevention, falls are the leading cause of injury deaths and disabilities among older adults, with hip fractures being the most serious fall-related injury. In fact, a whopping 95 percent of all hip fractures are the result of a fall. One out of every three adults over the age of 65 falls each year, with 30 percent of those slips leading to moderate or serious injuries that limit activity and reduce quality of life. And while there’s no guarantee that you won’t take a tumble now and again, there are a few exercises you can do right at home to improve your balance so you’re better able to handle those bobbles.

weight shifts

bicep curls for balance

Begin with your feet shoulderwidth apart. Shift your weight to your right side, and slowly lift your left foot off the ground. Maintain balance for up to 30 seconds, and repeat on the other side.

Begin with your legs hip-width apart with your weight equally distributed on each foot. Hold a dumbbell in your left hand with the palm facing upward. Lift your right leg upward, and bend your knee backward. Hold the position for up to 30 seconds, and repeat on the opposite side.

single-leg balance

shoulder press for balance

Begin with your legs hip-width apart with your weight equally distributed on each foot. Place your hands on your hips, and lift one leg with your knee bent. Hold the position for up to 30 seconds, and repeat on the opposite leg.

Begin with your legs hip-width apart with your weight equally distributed on each foot. Hold a dumbbell in your left hand, and press upward so that your forearm is perpendicular to the floor. Lift your right leg upward, and bend your knee backward. Hold the position for up to 30 seconds, and repeat on the opposite side.

ILLUSTRATIONS BY CASEY ALLEN. GLASSES © SASHA CHEBOTAREV / SHUTTERSTOCK.COM

HE ALT H Y

OTHER STEPS TO TAKE TO PREVENT A FALL

Get your vision checked regularly. Keep clutter away from walkways and stairways. Have a pharmacist check your medications to be sure none cause drowsiness or dizziness. Use non-slip mats in showers and bathrooms. Don’t wear slippers or shoes inside your home without a rubber sole.

It is important to get a doctor’s permission before beginning an exercise routine.

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Sources: cdc.com, mayoclinic.com

Note: All of these exercises can be made more difficult by standing on an unstable surface like a pillow or Bosu balance trainer.


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body

lather, rinse, deplete L

ather, rinse, repeat” has appeared on the directions of shampoo bottles everywhere for years. Although lathering cleanser into hair has become the standard, the chemicals that make your hair products foam up are actually the same ones that dry out and damage your hair.

Sulfate, also known as sodium lauryl sulfate or SLS, is a chemical found in most hair cleansing products currently on the market, and it’s the same chemical used in kitchen cleaning products as a grease cutter and drying agent. Even though most don’t think of Dawn dish detergent as a good shampoo substitute, these chemicals remain in the majority of our shampoo products because they are a surfactant, meaning they allow the mixing of oil and water to create that lather sensation we all associate with cleanliness. The problem is if these sulfates can cut the grease in the kitchen, you can only imagine how they react to the natural oils found in hair. Depriving your hair of these natural oils not only dries out hair, leading to frizz and breakage, but it also causes the body to create excess oil. This can lead to acne on the skin it comes in contact with, over-washing and damaged hair, which can also cause dandruff. Sulfates have also been known to impair hair growth, cause eye damage in young children and irritate skin in large quantities.

WOMAN © VALUA VITALY; BAKING SODA © PHLOEN ; VINEGAR © DANNY SMYTHE / SHUTTERSTOCK.COM

HE ALT H Y

Here are a few sulfate-free products available today:

SALON GRAFIX: At only $7.99 a bottle, this is a shampoo and conditioner that doesn’t strip hair of natural oils, creating shiny hair that’s not weighed down. Salon Grafix uses soy and wheat proteins to moisturize strands.

HAIR ONE: This cleansing conditioner uses argan oil, keratin, fatty acids, proteins and other nutrients to improve hair health, and a 12-ounce bottle can be found online for $11.99.

d.i.y. hair care

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FOR THOSE ON A BUDGET HOPING TO CUT SULFATES OUT OF THEIR HAIR REGIMEN, HERE IS AN EASY HOMEMADE SOLUTION. Combine 1 tablespoon of baking soda and 1 cup of warm or hot water until baking soda is dissolved, and use immediately. For conditioner, simply use apple cider vinegar. It can be left in or rinsed out after.

Sources: healthyhairplus.com, livestrong.com

WEN: This shampoo and conditioner combination uses glycerin, chamomile extract, wild cherry bark, rosemary extract and panthenol to strengthen, smooth and moisturize hair. A 30-day kit can be purchased for $29.95.


HE ALT H Y

balance MIND | SPIRIT | FINANCE

ROAD © IAKOV KALININ / SHUTTERSTOCK.COM

on the road again Road trips are one of the best ways to unwind with friends or get in a little quality time with your family. This summer, grabs some gasstation goodies and plug in your iPod, because it’s one of the best times of the year to plan a getaway! Not sure where to go? Here’s a list of some of the top road tripplanning sites to help you map your route. PLAN-YOUR-TRIP.COM ROADTRIPUSA.COM ONTHEWAY.COM

MAY 2013

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balance

must-haves for mom (and dad) T here’s nothing more chaotic than being a mom these days. Busy schedules, little sleep, sticky fingers, germs galore. Being a mom (and yes, dad) is hard. We’ve compiled a list of a few products that just might make your life a bit easier and hopefully help you (and your little ones) get a bit of shuteye as well!

be gone, germs! When you take your toddler out in public, a trip to the potty seems inevitable. And if you’re a bit of a germaphobe, the thought of your little prince or princess placing their hands on a public toilet is enough to make you cringe. And don’t even think about the germs they’ll pick up if they get their hands to their face before you have a chance to wash them. With Summer’s Keep Me Clean Disposable Potty Protectors, it’s a non-issue! These Earth-friendly, biodegradable protectors are large enough to provide a germ barrier for both their bottoms and their hands. Problem solved! The Keep Me Clean Color Me Placements are perfect for restaurant visits! Not only do they provide protection from lingering table germs, they provide your little one with a creative outlet as well. summerbaby.com.

safety first If you’re one that wakes up to ensure baby is safely slumbering multiple times a night, an Angelcare baby monitor can help you get a good night’s rest once again. These under-the-mattress movement sensors are so sensitive, that even the littlest breath will trigger the system to show mom and dad a reassuring heartbeat blip. Should baby stop breathing for a few seconds, an alarm will sound, alerting you to check the baby. Some models even feature a video camera and a temperature display and control, ensuring baby’s room is never too cold or too hot. angelcarebaby.com.

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sleep solutions If every little noise your baby makes in his sleep has you instantly shushing or fumbling for the activate button on the sound machine, this product is for you. Cloud b’s Sleep Sheep Smart Sensor gently relaxes your little one to sleep with one of four relaxing sounds. The best part? If baby wakes and begins to make noise, this cuddly unit automatically turns back on, lulling them back to sleep before you know it. Is getting your child to sleep on his or her own the problem? Then try Cloud b’s Dreamy Stars line. Disney Baby Dreamy Stars transform any room into a starry night sky with a colorful, soothing projection of stars. Your little one’s attention will be captured and relaxation is sure to follow. Dreamy Stars comes in Winnie The Pooh, Minnie Mouse, Dumbo and Lion King characters. cloudb.com.


HE ALT H Y

balance

home hazards S BY THOMAS SANTANGELO

ince time immemorial, home has conjured up images of happiness, tranquility and togetherness. Surprisingly, though, your home may contain hazards that could quickly transform it from a peaceful abode to a house of horrors. Many mishaps in the home can be avoided by taking a few simple steps to make it a safer haven for you and your family.

slippery slope Falls in the home keep orthopedists busy throughout the year. To reduce the possibility of a fall, place a non-slip doormat near entrances to absorb moisture that may be tracked into the house and install handrails and non-slip bath mats in and around tubs and showers, particularly those used by seniors and people with disabilities. Keep stairways free of clutter, and if you have to get up during the night, turn a light on first.

med mishaps Medications, household cleaning agents, pesticides and other toxic substances can go from helpful to harmful when placed in the wrong hands. Keep these substances out of the reach of children, those with impaired mental functioning and pets. Inspect your kitchen and bathroom cabinets, laundry area and garage to make sure hazardous substances are out of reach. Even certain household plants can pose a serious threat if the leaves are ingested.

hot, hot, hot Countless burns, some serious, occur in homes each day. Use potholders or other protection when removing hot items from the oven, stove or microwave. Turn pot handles in to prevent toddlers from reaching for them and make sure only microwave-safe plates and containers are placed in the microwave. Take particular care when burning candles and make sure they are extinguished before leaving the house. Check smoke detectors regularly, making sure they are operational with fresh batteries.

free fall To small children, heavy objects around the house could transform from decorative to detrimental in the blink of an eye. Large screen TVs, entertainment centers, large bookshelves and other large pieces of furniture are just a few of the culprits. Be sure TVs are securely mounted or are stable in their stands. Furniture can also be mounted to walls for extra security. Finally, keep childrenâ&#x20AC;&#x2122;s cribs, beds and play areas away from window coverings with cords, objects on the wall and anything that could present a choking or smothering hazard.

MAY 2013

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balance HOUSE © ARTAZUM / SHUTTERSTOCK.COM

HE ALT H Y

helping your home value 1 S PAINT: A fresh layer of paint can work wonders for a home that needs sprucing up, and at about $25 per gallon, there should be plenty of funds left over for rollers, drop sheets and other paint supplies to protect the house from splashes. Be sure to choose neutral colors, as they appeal most to potential buyers.

2 GOING GREEN:

5 BATHROOM:

3

6 ROOMY ROOMS:

A great selling point for environmentally conscience buyers is energy efficiency. Consider installing a solar water heater, energy-efficient light fixtures, bamboo wood flooring or even a whole house fan to conserve energy and money.

CURB APPEAL: It might

seem obvious, but the first impression people get from your home is the view from the front. A beautiful lawn, shady trees and a grand entrance make a good first impression. Even small improvements like planting droughtresistant shrubs, replacing an unimpressive doorknob or planting sod in patches in your lawn can make a big difference.

4 KITCHEN:

Many Realtors agree that if there’s only one room you can afford to improve on,

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your kitchen is the No. 1 place to add value to your home. As a central gathering point for many, the kitchen should be open, attractive and party friendly. Investing in new, matching appliances is a great way to improve aesthetics, but a smaller investment could be replacing old-fashioned wallpaper, adding granite countertops or staining cabinet faces. The second most important room in the house to improve upon is the bathroom. Replacing cracked or grungy tiles, grout and faucets can go a long way.

It’s important to maximize the space in each room of your house, making them look bigger and brighter. Do this by adding plenty of lighting options, replacing heavy draperies with vertical blinds and decorating with a large mirror.

7 STORAGE SPACE:

A huge selling point for potential buyers is storage space. Make a good impression by keeping closets clean and organized for showing, or even have a closet installed in a den area so it can be considered an extra bedroom.

Source: hgtv.com, bankrate.com

elling a house in this economy is no easy task, but there are some simple things you can do to add value to your property now and reap the benefits if you ever decide to sell down the road. Here are seven fairly inexpensive improvements you can make to increase your home value today.


living in the flow of things F eng shui. No, it’s not the latest Asian-fusion restaurant. Feng shui is an ancient Chinese system of laws thought to govern the arrangement of space that allow a clear flow of energy (qi) in both interior and exterior design. There are five elements to consider when designing with feng shui, each representing a different mood or atmosphere. Not loving your space? Try tinkering with these elements to create a customized room perfect for you.

keep the qi aflowing... When designing with feng shui, it’s important that each room represents the emotions you wish to express. But before you begin purchasing new odds and ends, follow these tips to get the most out of your qi.

REMOVE CLUTTER. Energy

DEFINE THE BAGUA. The begua

cannot flow freely through a stack of magazines or knickknacks.

ALLOW GOOD QUALIT Y AIR AND LIGHT.

INTERIOR © ZING / SHUTTERSTOCK.COM

balance

is the feng shui map of your home. Which rooms do you want fire present; which metal? Think carefully before choosing a color scheme.

Open windows, and allow natural light to channel energy throughout the house.

REMOVE ELECTRONICS.

Turn off electronics at night. Electronic energy disrupts the flow of natural qi.

USE SOOTHING COLORS IN PLACES OF REST.

You may like animal prints and bright red, but keep it to a minimum in places you intend to rest.

ELEMENT

COLORS/MATERIALS

REPRESENTS

TOO MUCH

TOO LITTLE

WOOD

Blues and greens; plants, natural materials

Creativity and expansion

Rigidity and stubbornness

Ambivalence and stagnancy

FIRE

Reds, pinks and purples; candles, animal prints and light.

Enthusiasm and leadership

Anger and aggression

Low self-esteem and emotional coldness

EARTH

Earth tones; square, rectangular shapes

Physical strength, balance and stability

Heaviness, boredness and sluggishness

Disorganization and chaos

METAL

Gray, white, light pastels

Clarity and logic

Overly critical

Quietness, lack of focus

WATER

Black, deep and dark tones; reflective surfaces and water

Spirituality and emotions

Overwhelmed and overly social

Loneliness and isolation

MAY 2013

Sources: hgtv.com, distinctivefabricsandfurniture.com

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the

greeneyed monster

W

e wouldn’t be human if we didn’t admit that every now and then the green-eyed monster doesn’t whisper in our ear. Jealousy and envy are feelings we all experience. They can be completely harmless and perhaps even beneficial if guided in the right direction. For example, seeing a teammate or co-worker succeed may encourage you to practice a little harder or work a little longer. But when these emotions get out of control, the physical and psychological effects can take its toll.

WOMAN © JOHAN LARSON / SHUTTERSTOCK.COM

HE ALT H Y

jealousy vs. envy It’s important to differentiate between the two emotions. Jealousy is the threat to one’s own success due to a competitor. Envy is a response to another person’s success, qualities or traits. People are more likely to be envious or jealous of those who are similar to them or whose traits they admire. For example, a 30-something-year-old mother is more likely to be jealous or envious of another 30-something-year-old mother whom she perceives to have better parenting skills.

a health hindrance

The same neural nodes of the brain associated with fear, anger and disgust are triggered • during bouts of jealousy, releasing a rush of emotion. The fight-or-flight response releases a surge of adrenaline, causing a loss of appetite and

an inability to concentrate on other tasks. The sympathetic nervous system goes into overdrive. Heart rate quickens, blood pressure spikes and, on an extreme level, heart attack-like symptoms can occur.

the technology tie-in Research shows that 11⁄₃ of Facebook users polled felt feelings of “frustration” after a session of scrolling through status updates. Reading of others’ successes, vacations, gym routines, etc. often leaves users feeling less satisfied with their own situation and encourages profile embellishments that only fuel the fire for other jealous users.

master the monster Relax, you’re normal. These emotions affect us all. Take a moment to analyze the route of your jealousy, and find steps to combat it. Look at your own situation. What are you thankful for? What positive qualities do you possess? Chances are, you are also a source of someone else’s envy.

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Sources: sciencedaily.com, everydayhealth.com, thealternativedaily.com


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