bmagazine Winter 2015

john ford coley before and after england dan ››

HOLIDAY PLANNING for caregivers

SPECIAL FEATURE: Orthopedics & Pain

Reaching baby boomers 1946 – 1964

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DEDUCTIBLE MET?

Schedule your colonoscopy before the year ends.

P resident and P ublisher Donna K. Anderson

Colon cancer is the third leading cancer killer in the United States, yet preventable and treatable with early detection.

Contact your primary care physician or call RGAL at 717-544-3400 to discuss a screening colonoscopy.

Four Convenient Locations

• Lancaster Health Campus • Oregon Pike-Brownstown • Women’s Digestive Health Center • Elizabethtown www.RGAL.com • 717.544.3400

E ditorial

Vice President and Managing Editor Christianne Rupp Editor Megan Joyce

C ontributing Writers

jason alderman william j. beutler, m.d. barbara trainin blank michael l. fernandez. m.d. sandra gordon rebecca hanlon brett a. himmelwright, d.o. stephen kopfinger lori m. myers william m. parrish, m.d. lisa m. petsche linda rhodes, ed.d. rochelle a. shenk maria v. snyder pete wisniewski

A rt D epartment

Remind your loved ones: Screening Saves Lives!

Production Coordinator Janys ruth Production Artists Renee mcwilliams LAUREN MCNALLEN

P rint/O nline S ales

Account Executives angie jacoby amy kieffer Amy McLane RANEE SHAUB miller Account Representatives Brantley Lefever Jennifer Schmalhofer

A dministration

Business Manager Elizabeth Duvall Events Manager kimberly shaffer Project Coordinator Loren Gochnauer Sales & Event Coordinator eileen culp Marketing Coordinator mariah hammacher Copyright © 2015 On-Line Publishers, Inc. All rights reserved. b magazine is published quarterly. Single copy price $2.95. Four-issue subscriptions are $6.00. Reproduction or use without permission of editorial or graphic content in any manner is strictly prohibited. Views expressed in opinion stories, contributions, articles and letters are not necessarily the views of the Publisher. The appearance of advertisements for products or services does not constitute an endorsement of the particular product or service. The Publisher will not be responsible for mistakes in advertisements unless notified within five days of publication. On-Line Publishers, Inc. reserves the right to revise or reject any and all advertising.

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from the editor ...

I have often been amazed at how quickly time seems to fly! I’m sure you’ve felt the same sensation. It really hit home recently when my husband and I celebrated our 40th wedding anniversary. It just doesn’t seem possible; I don’t feel old enough to be married that long.

My husband, Randy, and I realized that now that our kids are grown and on their own some rooms were just sitting there holding happy memories but no longer being used.

Randy came up with a radical idea and, though it took me a while to get on board, the changeover has been wonderful.

Find out what we did and how it has become the foundation for making new special moments.

Randy is still very active. He loves to golf and does so quite often, and he is on a summer and fall softball team with one of our sons. (And yes, he is very good at both.) Since he is the pitcher he does have sore shins from time to time when the hitter uses him for target practice, but all in all he’s never really had any injuries. He has been lucky.

But whether it’s wear and tear from today’s active lifestyle, from days gone by, or simply heredity, many baby boomers, though, are feeling a few aches and pains. We have

some fabulous specialists in this region who have offered information about conditions and treatments in the special Orthopedics and Pain feature in this issue of b magazine.

We’ve all heard or read about the “negotiations” currently taking place between the U.S. and Iran. Ironically, it is the 35th anniversary of the well-known Iran Hostage Crisis. We look back and remember. Different circumstances, but we’re still at odds with Iran.

There is a lot more in this issue like making it through the holidays when you’re a caregiver of a loved one, sensitive teeth, a veteran’s story, downsizing, and protecting your pension. Grab a drink and enjoy.

Happy holidays,

Vice president and managing editor

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www.bmagazinepa.com Winter 2015 volume 8 issue 4

features 48

HOME REMODELS MAKE ROOM FOR NEW MEMORIES You’ve lived in your home for many years. It’s filled with comfortable memories of special times with now-grown children, family, and friends. But some of the rooms aren’t used any more.

Find out how converting a living room into a game room has presented an opportunity for a whole new collection of memories.

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GRANDPARENTS FACE NEW DILEMMA Prescription drug abuse among teens is startling. Prescription medicines are now the most commonly abused drugs among 12- to 13-year-olds. Be aware of this problem and learn what you can do if you think your grandchild is taking drugs—as well as how to approach them about it so you continue to have the special bond you’ve developed.

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SPECIAL FEATURE 21 ORTHOPEDICS AND PAIN Boomers are living energetic lives, working and participating in sports and other activities later in life. But certain conditions become more prevalent due to age alone or in combination with that lifestyle. Learn about some common boomer conditions and what you can do about them.

anniversary 69

THE IRAN HOSTAGE CRISIS Thirty-five years later.

caregiving

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HOLIDAY PLANNING FOR CAREGIVERS How to keep stress manageable.

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DEMENTIA Types and treatments vary by diagnosis.

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JOHN FORD COLEY

John Ford Coley has had a long life in music beginning in his high school days when he and England Dan formed the group Playboys Five. Coley and Dan later became the successful duo England Dan and John Ford Coley and stayed together until 1980. They opened for Led Zeppelin and Three Dog Night when they were just high school kids. Coley is still performing and singing your favorite songs.

general 72

GOOD VIBRATIONS Meet a fellow boomer.

health 18

THE INCONVENIENCE OF INCONTINENCE It can be alleviated.

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PINNACLEHEALTH SPINE CARE CENTER Meeting the need for back and neck pain care.

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THE ACHES AND PAINS OF THE AGING SPINE Finding new approaches to managing back pain.

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FEELING BETTER WITH FIBROMYALGIA The process can take time.

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DIAGNOSIS AND MANAGEMENT OF KNEE ARTHRITIS Proper attention to details can provide effective treatment.

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HEY, MY SHOULDER HURTS! Common causes for shoulder pain.

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SENSITIVE AND DISCOLORED TEETH Finding your best solution.

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financial 16

PROTECTING YOUR PENSION Planning for your retirement.

home 45

FIREPLACES Add warmth, beauty, and ambiance to your home.

housing 63

DOWNSIZING CAN BE DAUNTING A little TLC from professionals makes it doable.

lifestyle 10

KEEPING IT FRESH Revitalizing the dinner theater experience.

54

MEMORY LOSS It’s only partially likely with aging.

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people 14

LOCAL CHEF SERVED THREE PRESIDENTS Now he’s finding success in his own backyard.

travel 38

SWITZERLAND A small country with amazing scenery.

veteran 66

LOCAL VETERAN TELLS HIS STORY Learning life lessons.

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cover story Left to right: Lane Hoppen, keyboard for Orleans; John Ford Coley; Larry Hoppen, lead singer and guitarist for Orleans; promoter representative; Dave Jenkins, Pablo Cruise; Charley Morgan, drums with Orleans, formerly with Elton John; David Pack, Ambrosia; Jerry Riggs, lead guitar of Orleans; and Barry Dunaway, bass player for Orleans and 38 Special.

finding out that laughter and love are the answers Written by LORI M. MYERS

I’m sure that John Ford Coley had a mischievous twinkle in his eye as he emailed me to set up our phone talk.

His dry sense of humor abounded in his requests for me to send him questions in “Hebrew or French,” or hoping that one of my questions to him might be how he’s “managed to stay so brutally handsome and humble. Don’t forget humble.” Then he always signed off those emails with “Of course, you know I’m joking.”

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So when I phoned on our agreed morning and his first words were that he’d woken up with his dry sense of humor intact, I wasn’t surprised. Thus began an almost two-hour conversation with this award-winning rocker, pianist, guitarist, actor, and now author.

He was one half of the Grammynominated England Dan (Seals) and

John Ford Coley, who popularized such ’70’s hits as “Love Is the Answer,” “I’d Really Love to See You Tonight,” “Nights are Forever Without You,” and others.

In all, the duo released 11 albums and nine singles. Between 1976 and 1979, they had six Top 40 singles.

A single went gold, as did two of

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Jimi Jamison, Coley, and Peter Rivera.

Coley at the Country Music Hall of Fame, January 2009.

Coley with a Martin guitar.

their albums, plus two albums went multiplatinum.

And just a bit of trivia: The song “I’d Really Love To See You Tonight” was a victim of misunderstood (but fun) lyrics, and many radio stations had contests to see if anyone could guess what the real lyrics were.

For example, the correct lyric “I’m not talking ’bout moving in/And I don’t want to change your life ...” was misheard as “I’m not talkin’ ’bout the linen/And I don’t want to change your life ...”

Those pinnacle years for Seals and Coley were a time when the country needed tunes and lyrics to make us forget, even for a few minutes, the tumultuousness of the prior decade, the reality of the world around us, and a war many didn’t want. Those songs of England Dan and John Ford Coley—on which Seals sang lead and Coley harmonized and played keyboard and guitar—were simple and simply about love and relationships.

“

Those pinnacle years for Seals and Coley were a time when the country needed tunes and lyrics to make us forget, even for a few minutes, the reality of the world around us.

”

You’d think that Coley (Seals died in 2009) would favor one of those songs that gained them international acclaim, but he didn’t hesitate to tell me that the song “Soldier in the Rain” is No. 1 on his personal list.

“Most people associate us with our singles,” Coley says. “But ‘Solder in the Rain’ is about soldiers coming home and how you don’t quite fit in.

The song, though, is a bear to play. It’s more classical and has a horrific middle section.”

Coley not only loved the song’s composition, but also that it revealed another side of himself and of his own family history—a history that dates back to his English ancestors in Jamestown in 1611 and his Dutch family in New York in 1662.

“My family were soldiers,” he adds.

“I’ve got blood in the ground.”

Coley is quite proud of that fact and knows specific details of his family’s background, including names, dates, and incidences. He admits he’s an “info

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cover story

Dinner with Imelda Marcos before a show in Manila.

Coley at a tea garden that was restored by the Communists on Gulangyu Island, China.

Cover of Backstage Pass, a book written by Coley.

junkie” and spends a lot of time on the Internet and on social media and reads three to five newspapers a day—both print and online.

“I like to look at historical places,” he says. “I like to see what happened there. It’s exciting to know that someone in your family survived this. It’s thrilling to know what happened.”

Coley was born John Edward Colley in Dallas, Texas, whose family goes back six generations in the state. Growing up, he listened to a variety of musical genres—Bach and Beethoven, church music, show tunes, opera, and some country. He watched a lot of cowboy shows and was influenced by the heroes he saw on the small screen.

Today, when he sits down to write his own music, he never knows what style will come out. It’s one reason music has

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continued to fascinate him.

Coley and Seals met in high school, and Coley admits that the two didn’t like each other at first, but soon they formed a musical bond as well as a brotherly love. Coley played piano and sang harmony and Seals sang lead, and they noticed that their voices attained a natural blend.

They were signed by A&M Records in 1971, and the two moved to Los Angeles and opened for numerous bands. The song “Simone,” recorded in 1972, was their breakthrough, at least in the Japan and France markets.

Two years later, after being let go by A&M, they signed with Atlantic Records and released “I’d Really Love to See You Tonight.” That was the beginning of their hit streak until the two friends disbanded in 1980.

“I loved Dan,” Coley recalls. “He was one of the funniest people I ever met. We were together for 15 years and got to travel the world together. At the end, people got between us and caused a schism. Girlfriends and wives and boyfriends and husbands wreck more bands.”

Like many musicians who made a name for themselves in earlier decades, Coley doesn’t have a lot of respect for today’s music industry and calls today’s music a “cheap imitation.”

“Back then, the industry had people who knew music,” he explains. “You don’t have that now. The music from the 1960s was so fresh and so melodic.

It was music that said something. Now they just want to sell something. The music now is dumbing people down. A lot of these artists are not writers.”

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Susan Blakely and Coley on the set of Dream a Little Dream.

Softrock Cafe with Coley, James Griffin, and Terry Sylvester in 2000.

England Dan (Seals) and Coley, 1971.

Elton John, Coley, and Dee Murray, England, 1971.

Coley continues to perform on stage and loves entertaining crowds with those familiar songs of love, along with those that are more thought-provoking.

“As I’ve gotten older, the subject matter of my music has changed,” he says. “It’s a lot deeper.”

But despite all that seriousness (“I’m an intense person,” he says), Coley is a lover of laughter, and his book Backstage Pass relates the funny situations that happened when he was on the road performing.

No, it’s not about drugs and rock ’n’ roll, and most of the nasty stories were taken out prior to publication, Coley tells me.

They are stories that will bring a smile to readers’ faces.

“It’s all based on fact,” he says. “It made me laugh all over again.” )))

Southwest FOB, 1967, the band Coley started in Dallas, Texas.

Back row, left to right: Doc Woolbright, bass; Ovid Stevens, guitar (Stevens went on to play with Seals and Crofts, Randy Meisner, Belinda Carlisle of the Go-Go’s and England Dan and John Ford Coley); and Coley, keyboards and vocals.

Front row, Dan Seals, saxophone and vocals; Randy Bates, trumpet; Buddy Lay, drums.

A young Coley at the keyboard.

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lifestyle

Dutch Apple Dinner Theatre, prior to major renovations coming in January 2016, but already reflecting the new linens and more spacious seating.

keeping it fresh for theater goers Written by REBECCA HANLON

David DiSavino and his wife, Cindy, still remember when weekend shows at Rainbow Comedy Playhouse in Paradise, Lancaster County, would sell out as crowds piled off of tour buses.

When the couple opened the theater 30 years ago, they catered to people who fit their parents’ demographic.

Their guests came to watch entertaining shows, ready to fill their bellies at the buffet-style dinner.

But fast-forward to present day, and things are looking different, David DiSavino said. Baby boomers aren’t necessarily interested in hopping on buses to travel for a show, he said. Nor do most of them want to stuff themselves for as little money as possible.

So, when the DiSavinos noticed the audience changing about three or four

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years ago, they decided it was time to make some changes.

“We’re not selling our product to our parents anymore,” David DiSavino said.

“We’re selling to our generation.”

While the timeless tradition of dinner and a show still brings a crowd, he said, the details are different. Instead of the quantity of food determining the value, David DiSavino said, people are more concerned with the quality—and they’re often willing to pay a little more for a finer dining experience.

“People like the idea of food made from pan to plate,” Cindy DiSavino said.

“They want a customized dining that gives them a little privacy because going out with the family or other couples is now part of the main event.”

Visitors can still experience Rainbow Comedy Playhouse in its more traditional form—seeing a show and enjoying an unlimited buffet. But this is now only offered during matinees and on Sundays.

People also have the option of ordering from an express menu where, for a lower price, visitors receive admission to the show and can order from a lighter soup, salad, or sandwich

lifestyle ))) dinner theaters

Allenberry Resort Inn and Playhouse actors are part of the Actors’ Equity Association.

menu. A similar deal is offered on Thursday nights where the price includes admission and couples can order from a pub-style dinner menu.

But the flagship is what Rainbow Comedy Playhouse has offered on Fridays and Saturdays since January, David DiSavino said. On these evenings, guests are presented an a la carte menu with a beef, chicken, fish, or pasta dish.

Meals are cooked to order and served fine-dining style directly to the tables.

“When we changed this, we knew it was a good thing, a fresher thing,” Cindy DiSavino said. “It was a better way to go out in the evening. It wasn’t your grandmother’s way of spending a night out.”

Dutch Apple Dinner Theatre in Lancaster also has heard similar

demands from its clientele. Two years ago, the theater’s sister location in Florida was serving a la carte meals but struggled with the transition from feeding hundreds at a buffet to individually preparing each meal, said Denise Trupe, national marketing director with the theater.

“We decided to wait until they got the process underway and worked out all the bugs before we’d transition,” Trupe said.

After the 2015 New Year’s Eve Show, Dutch Apple Dinner Theatre will close for two weeks to go through a transformation. Walls will be painted and redecorated. New lighting will be installed. Some of the seating will be removed to allow for more intimate tables, taking the capacity down from

about 450 to 340.

The new look will allow customers to visit just as a couple or on a double date, two options that have grown in popularity over the years, Trupe said.

Because people aren’t coming in on big buses or group tours like they used to, they’re looking for more of a date-night atmosphere, and the theater is ready to offer it.

By the time the theater opens for the new season—with all of its changes in order—a new menu will be unveiled.

For customers who love the classic American buffet, that option will still be offered Sunday through Wednesday evenings. An a la carte menu will be served out of Smokey Joey’s Café, where diners can choose from prime rib, chicken, fish, pork, and pasta dishes.

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lifestyle

Above: Rainbow Comedy Playhouse touts a new dining experience for theatre goers.

Above right: Their “beer bucket special” of specialty brews.

Fresh foods brought straight to the table will help people experience all that Dutch Apple Dinner Theatre is doing to embrace the future, as well as the changing demands of appetites, Trupe said.

Performances also are moving away from classical musicals to more interactive shows, such as Clue. This type of performance puts more actors in the audience, broadens the environment off the stage, and engages viewers in a different way. The new show styles also help keep audiences interested in coming back to see new shows throughout the season, she said.

“The changes will give people the feeling that they are escaping,” Trupe said. “Life is tough, and what we offer them is a place to come relax, to escape from realities for a couple of hours.”

A similar vision has spurred Allenberry Resort Inn and Playhouse to continue to capture audiences.

The theater in South Middleton Township, Cumberland County, has taken a three-step approach to keeping things fresh for visitors, said Ryan Gibbs, artistic director.

The first change was to shift programming so that “everything old

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is new again,” he said. That means getting back to the classics, such as old-fashioned or classic music that people 10 years ago weren’t interested in watching. In the past couple of years, Gibbs said, their audiences have been gravitating to the classic theater offerings.

The second approach to keeping things new is to get back in a working relationship with a professional union called the Actors’ Equity Association, which caters to actors and stage management.

Allenberry Playhouse worked with the union in the first 55 years of its operation but got away from it about 10 years ago, Gibbs said. The benefit to working with the union is that the playhouse can cast a wider net for talent, often bringing in actors who have a Broadway show or two on their resume.

“It heightens the experience that much more for our audience when we can offer that kind of experience,” Gibbs said.

The third change people might notice is Allenberry Playhouse’s use of social media. While baby boomers use Facebook to keep in touch with

family and friends, the theater uses it to showcase its special programming and offer unique deals only seen on social media accounts.

But there also have been other changes to keep up with the demands of the audience, Gibbs said. For years, Allenberry Playhouse offered a mystery show in the fall, but it got away from the tradition. This year, a two-person who-done-it program will bring back that tradition.

The food options here have also been diverse for several years. While people can choose to just see the show, there also is a dinner-and-a-show package, which includes a buffet. Visitors also have the option to visit the Breeches Bar and Grille for a regular sit-down dinner before the show.

An array of lighter or finer dining options, paired with a rotating craft beer, bourbon, and gin lists, keep the meals interesting, he said.

“Theaters aren’t just a one-stop-shop anymore,” Gibbs said. “Different people are looking for different things, and it’s nice to see that people can go see an entertaining show, have a good meal, and leave feeling like it was a unique experience.” )))

DINNER THEATRE

with

COMING IN 2016 TO DUTCH APPLE DINNER THEATRE MORE DINING OPTIONS | MORE SPACE THAN EVER BEFORE | NEW DÉCOR Dutch Apple is giving you a new Dutch Apple in 2016! New decor will greet you from the lobby to the dining room, seats are being removed to give you more room at your tables and on Thursday-Saturday nights there are more enhanced dining options, fresh white linens, high quality wines and craft beers. Of course, we know some of you love the current experience and that is still available for matinees and Sunday-Wednesday nights!

OPTION 1

THE BUFFET YOU LOVE IS STILL AVAILABLE! Enjoy the dinner theatre experience that you know and love with our great buffet Tuesday and Wednesday evenings, Sunday twilights and all matinees.

OPTION 2

ALL NEW A LA CARTE THURSDAY EVENING! Let us serve you with full service, plated dinners right at your table. Includes a served soup, salad, upscale entrées ?aJ ? JLooLnq o?`k^Ln a?^L¥

OPTION 3

FRIDAY AND SATURDAY ENHANCED BUFFET! This includes the prime rib buffet and other enhanced entrees for those that enjoy our complete salad bar, the buffet choices experience and lots of desserts!

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people

former white house chef finds new success back home

Written by MEGAN JOYCE

“You’re pinching yourself right up to the end. It never wore off— that you’re up here working in this great institution with the most powerful people in the world.”

Former White House chef and Lancaster native John Moeller insists that even when preparing food for his third U.S. president, he still found himself regularly marveling at the fact that his workplace was the White House.

Moeller began his tenure at the White House in 1992 as a sous chef in the kitchens of George H.W. Bush. He would continue there until 2005, having served two more presidents—Bill Clinton and George W. Bush—their first ladies, and their families.

“To be on the outside looking up at Pennsylvania Avenue, and all of a sudden you’re catapulted to the second floor of the White House, interacting with the Secret Service—it’s extraordinary,” Moeller said. “I kept saying, ‘How did I get up here?’”

Moeller’s path to “up there” began as a local student at James Buchanan Elementary School and then Wheatland Middle School before graduating from Lancaster Catholic High School and Willow Street Vo-Tech’s culinary program in 1979.

In 1981, Moeller earned his degree in culinary arts from Johnson & Wales

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Former White House chef and Lancaster native John Moeller. His book Dining at the White House is pictured below.

University in Rhode Island. He worked in New England until 1984, when he joined a friend in Dijon, France, to spend two years studying French cuisine at the University of Dijon. After two more years working in French bistros, restaurants, and hotels, Moeller returned to the States in late 1986.

It was his connection to a group of DC-area chefs that eventually landed him at 1600 Pennsylvania Ave. in 1992. A year and a half after a group member found employment in the White House, Moeller received a phone call from him, asking Moeller if he was interested in coming aboard as his sous chef.

For the next 13 years, Moeller and the rest of the White House kitchen staff prepared all the meals consumed by the sitting president, first lady, and their family, as well as their guests. They planned, cooked, and oversaw the meals presented to visiting dignitaries at official functions and banquets.

“Between all three, all the presidents themselves had a good palate for food.

When they were home they liked comfort food; they were very happy with that.

If they were eating by themselves vs.

when the first ladies were there, we’d cook a little bit differently there,” Moeller said.

“One thing was for sure, though: They were all pretty health conscious. They were exposed to a lot of heavy foods on the road, and even eating at the White House there are a lot of high-caloric foods they were exposed to, so we tried to back off that a bit and give them a healthier alternative.”

Everyone has their favorite and least favorite foods, and the commander in chief is no different. There was indeed a

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White House chefs and kitchen staff with Julia Child.

White House chefs with four presidents.

“dos and don’ts” list for each president, and yes, broccoli was on the “don’ts” list for George H.W. Bush.

But despite Bush’s distaste for that particular vegetable, Moeller said this first of his three presidents offered the most opportunity for variety.

“His palate was the most expansive,” Moeller said. “He had a very good palate; he liked a lot of different foods.

“

He was the most challenging to cook for; he was well traveled and liked a lot of different kinds of cuisines.”

After leaving the White House, Moeller ran his own catering business in Washington, DC, until the economy crashed in 2008, taking Moeller’s enterprise down with it. In 2010, Moeller returned to Lancaster to teach cooking classes; here, he eventually launched his

new catering company, State of Affairs Catering, based in downtown Lancaster.

In 2013, Moeller’s book, Dining at the White House: From the President’s Table to Yours, was published by LifeReloaded Specialty Publishing. It contains more than 100 recipes and insider perspective on what goes into feeding three first families. He also travels nationwide as a guest speaker. )))

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financial

protecting your Written by JASON ALDERMAN

If your employer provides a traditional pension plan, you are part of a vanishing breed. According to the Department of Labor, only about 20 percent of private-sector workers are covered by pensions today, about half the level of 30 years ago.

Many companies seeking to trim expenses—not to mention those undergoing bankruptcy—have frozen pension benefits or terminated their plans outright. Although many such companies end up enriching their 401(k) plans, if employees choose not to participate, they’ll lose out on matching contributions.

Fortunately, the 2006 Pension Protection Act encourages companies to automatically enroll eligible employees in 401(k) plans, likely boosting participation rates.

Younger workers probably still have time to amend their retirementsaving strategies, but people closer to retirement may feel the pinch if pension

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benefits they’ve counted on come up short. Either scenario highlights the importance of closely managing your own retirement savings and not depending on others to do so.

Consider these pension-related issues when planning for your retirement income: Understand the government’s involvement.

The vast majority of pension plans are insured by the government-created Pension Benefit Guaranty Corporation (PBGC), which guarantees payment of vested benefits in participating plans, up to legal limits set annually by Congress.

A few PBGC facts:

• Participating companies fund PBGC through yearly premiums.

• Absorbing several huge, failed plans in recent years has saddled PBGC with a multi-billion-dollar deficit.

• The maximum annual benefit paid

by PBGC to participants retiring at age 65 from underfunded plans terminating in 2009 is $54,000 (it’s higher for those retiring after age 65; lower for those retiring earlier). This likely means all but the most highly paid employees covered by failed plans should receive their full benefit amount.

Track down old pensions.

Many people have had numerous

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employers. If you worked several years for a company that provided a pension at that time, you may be eligible for a pension benefit. But if you’ve moved since then or your former employer merged or went of business, the plan (or the PBGC, if it’s now the plan’s custodian) could have a hard time locating you.

To track down previous employers or successor companies, try checking with: a reference librarian to search corporate name changes; former coworkers; unions you belonged to; or a library, historical society, or chamber of commerce where the company operated.

Other helpful organizations include PBGC itself (www.pbgc. gov), PensionHelp America (www. pensionhelp.org), and the Department of Labor’s Employee Benefits Security

Administration (www.dol.gov/ebsa).

Know your plan.

Your pension plan administrator should provide a summary plan description that explains key information like vesting requirements, pension calculation formulas, and payment options. You should also receive an annual statement with updated benefit estimates.

Carefully review these documents for accuracy, especially the income level used to calculate your benefit. If you don’t understand something, ask. If you haven’t received these documents, contact your current or former employer’s benefits department.

save as much as you can on your own, whether through a 401(k) plan or an IRA or personal savings. Good information sources on pensions and retirement planning include Practical Money Skills for Life, a free personal financial-management site sponsored by Visa Inc. ))) ___________________________ Jason Alderman directs Visa’s financial education programs. Sign up for his free monthly e-newsletters at

www.practicalmoneyskills.com/newsletter.

Boost your own retirement savings.

Rather than relying on Social Security and pension benefits alone,

“

Rather than relying on Social Security and pension benefits alone, save as much as you can on your own.

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health

the inconvenience of incontinence can be alleviated

Written by BARBARA TRAININ BLANK

What women often deny can make their lives uncomfortable.

That something is urinary incontinence, the involuntary leakage of urine.

“Urinary incontinence is very common, increasing with age,” said Dr. Maryanne McLaughlin, an obstetrician/ gynecologist with the Women’s Health Center of Lebanon, Ltd., at WellSpan Good Samaritan Hospital. “But women often don’t reveal it even to doctors, unless you ask them directly. They’re embarrassed.”

The exact prevalence of urinary incontinence is difficult to estimate Dr. Maryanne McLaughlin, an obstetrician/gynecologist with the Women’s Health Center of Lebanon, Ltd.

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for other reasons as well, said Dr. Dominique El-Khawand, director, urogynecology and pelvic reconstructive surgery and chief, division of Female Pelvic Medicine and Reconstructive Surgery at WellSpan Health.

“Many women think it is a normal result of aging; they use coping mechanisms, or they don’t know there are treatments available,” he said.

Because of anatomical differences, urinary incontinence is also a condition affecting mostly women; men rarely experience it.

“Women are more likely to have poor bladder habits,” added McLaughlin, partly because they put off going to the bathroom when necessary.

In spite of all the denial, we do know that in 2010, it was estimated that urinary incontinence impacted more than 18 million women in the United States and is projected to impact 28 million in 2050.

“If we define urinary incontinence as any leakage in the past year, it affects 21 to 51 percent of the population,” El-Khawand noted. “Incontinence is responsible for 6 to 10 percent of U.S. nursing-home admissions.”

Urinary incontinence increases (both in prevalence and severity) by age groups: it affects 7 percent of women aged 20 to 39; 17 percent between the

ages of 40 to 59; 23 percent from 60 to 79; and 32 percent in women 80 and above, he added.

Incontinence actually comes in at least three different types.

Stress urinary incontinence, the involuntary loss of urine on effort of physical exertion, such as coughing, sneezing, jumping, exercising, and laughing, is the most common.

A second type, urgency urinary incontinence, is the involuntary loss of urine associated with urgency—a sudden, compelling desire to pass urine that is difficult to defer.

Then there is mixed urinary incontinence, which is a combination of the two.

A fourth, rare type is overflow incontinence, found in people with neurological disorders, such as diabetic neuropathy and multiple sclerosis.

“They don’t have the neural feedback letting them know they have the urge,” explained McLaughlin.

Other than age, obesity is the strongest risk factor, representing a three-fold increase. Another risk factor is multiparity—the delivery of two or more offspring at birth. Vaginal delivery carries a higher risk than C-section, but having a C-section does not protect women from developing incontinence.

“Stressful, difficult work, such as

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physical labor and being on one’s feet a lot, are other risk factors,” McLaughlin said.

Family history and genetics also play a part, with a possibly higher prevalence found among white, non-Hispanic women.

“But there’s not one gene you can pin down,” El-Khawand noted.

Still other risk factors are caffeine intake, radiation therapy to the pelvis, impaired functional status (in the case of urgency incontinence), and high-impact activities (for stress incontinence). There are also women who inherently have a weaker pelvic floor.

“Smokers, especially those with chronic bronchitis, are also at higher risk,” said McLaughlin. “So are individuals with asthma or emphysema, which put stress on the bladder.”

Nowadays, as is the case with other previously “taboo” subjects, women are more likely to be willing to speak about incontinence. This is partly due to greater awareness about treatment options and medicine’s focus on educating patients and having them participate in the decision-making process.

The spread of information in the media and social media is also a factor, making more women feel empowered to seek knowledge about this condition, decide for themselves if they want treatment, and find the qualified medical professional who can answer their questions and help them manage the condition.

If there’s a down side to the openness, it’s that it may bring with it negative associations the public has with mesh products.

“Some surgery to help incontinent patients involves using a little piece of mesh in a bladder sling, and some women are really scared because of the side effects of other surgeries, like for prolapse,” McLaughlin pointed out.

Prolapse occurs when the bladder, because of age and significant bodily stresses such as childbirth, deteriorates to the point that it is no longer supported and descends into the vagina.

“It’s not the same kind of mesh, but because of press attention, this gets extrapolated,” McLaughlin continued.

“The vaginal mesh is less likely to erode than the mesh used for pelvic floor-support problems.”

Three common sling procedures are TOT (transobturator tape), TVT (transvaginal tape), and the mini arc.

Since urinary incontinence is a qualityof-life issue and not a lifethreatening condition or a disease, the decision about treatment is in the hands of the patient, suggested ElKhawand.

Doing nothing but “crossing your legs” and living with the incontinence is an option for many women who do not wish to have any interventions.

However, there are many available treatment options that can help women regain their lives and improve their quality of life, he added.

Options differ depending on the type of incontinence: For stress incontinence, these include lifestyle and behavioral modifications, pelvic-floor exercise at home or with a physical therapist, a pessary (a device that is place in the vagina nonsurgically), and surgery.

The most common surgery performed is called midurethral sling, a minimally invasive, outpatient, 30-minute procedure with a small incision in the vagina. It has a quick recovery, low risk of complications, and a high success rate of about 80 percent.

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Dr. Dominique El-Khawand, director, urogynecology and pelvic reconstructive surgery and chief, division of Female Pelvic Medicine and Reconstructive Surgery at WellSpan Health.

“Of all the options, surgery is the most successful one,” said El-Khawand.

In cases of urgency incontinence, options include lifestyle and behavioral modifications— avoiding bladder irritants such as caffeine, artificial sweeteners, and

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citrus juices; limiting daily fluid intake to 64 ounces and voiding on a schedule; physical therapy; and medications. The latter come in pills, gel, or patch.

Other options include a bladder “pacemaker” or injections of botulinum (Botox) in the bladder.

“Dietary modifications, especially avoiding bladder irritants, are most successful in treating urgency incontinence,” said El-Khawand.

The options for mixed incontinence are the same as above, but doctors usually start by treating the most dominant component—whether the stress-incontinence or the urgencyincontinence component is bothering the patient more.

Although urinary incontinence is one of the most prevalent pelvicfloor disorders, others include: pelvic organ prolapse, which is feeling or seeing a bulge protruding from the vaginal opening, and anal incontinence (involuntary leakage of fecal material or inability to hold gas back).

Any involuntary leakage of urine is considered incontinence. But women perceive the severity and effect on their quality of life differently. Some leak a few drops and view it “like the end of the world,” while others leak a larger amount and cope with it, noted ElKhawand.

Deciding whether to treat or not to treat (and how to treat) depends on how much the incontinence is bothering the patient and affecting her quality of life.

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pinnaclehealth spine care center meets the growing need for back and neck pain care Written by WILLIAM J. BEUTLER, M.D., and MICHAEL L. FERNANDEZ, M.D.

Studies show that back pain is a common complaint, affecting eight out of 10 people at some point in their life, sometimes making everyday activities such as walking, shopping, or working difficult or unbearable.

In many cases, there may be a physical cause, but most people do not realize that environment or activity can also contribute to neck and back pain.

While many people associate back pain with jobs involving physical labor or accidents, our sedentary lives can be just as bad for our spines. And many people

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are surprised that neck and back pain are increasing in young people due to carrying heavy backpacks and hunching over cell phones.

“People are surprised that poor posture can be a problem, and if prolonged, can lead to long-term issues,” says Michael L. Fernandez,

M.D., assistant medical director of the PinnacleHealth Spine Institute.

“Your head weighs between 10 and 12 pounds, but gravitational pull brings the pressure to higher levels depending on the angle of your neck. For instance, you put 60 pounds of pressure on your neck when you bend down to look at a

phone. There’s even a term for it—it’s called text neck.”

People who sit at computers most of the day often complain of upper back pain, and in many instances it occurs along with neck and shoulder pain. Poor posture at the desk, like pushing one’s head toward the screen, can also cause higher levels of pressure on your neck and can cause muscle strain, pinched nerves, herniated disks, and, over time, changes in the curve of the neck.

“Awareness is a big part of the battle,” says Fernandez. “Don’t adopt bad postures. Make sure your workspace and computer area are ergonomic. If you do check your mobile device frequently, hold your phone directly in front of your face rather than angling your neck to look at the screen.”

Daily flexibility and stretching exercises can expand or preserve range

“

People are surprised that poor posture can be a problem, and if prolonged, can lead to long-term issues.

”

of motion and relieve the stiffness that leads to upper back and neck pain.

And neck strengthening helps maintain improved posture, which in turn will lessen or eliminate recurrent flare-ups of pain.

Pain can also impact the mid- and low back, and the causes are numerous.

Sports injuries, compression fractures, osteoporosis, and overuse injuries are just a few. Determining the source of back pain is an important first step to effectively treating the condition.

The PinnacleHealth Spine Care Center offers a toll-free spine line to help patients get started with determining the cause of pain and then developing treatment options.

“From the moment a patient calls the Spine Care Center, we set our team in motion on a personalized treatment path using the extensive resources of

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Michael L. Fernandez, M.D., assistant medical director of the PinnacleHealth Spine Institute.

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William Beutler, M.D., FA.C.S., board-certified neurosurgeon with the Pennsylvania Spine Institute.

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PinnacleHealth,” says William Beutler, M.D., FA.C.S., medical director of the PinnacleHealth Spine Institute.

“The team combines the expertise of neurosurgeons, orthopedic surgeons, physiatrists, neurologists, painmanagement specialists, nurses, imaging services, and rehabilitation services to create a unique treatment plan and provide optimal care.”

When a patient calls, an intake specialist collects a detailed medical history. Based on your individual problem, we will offer you an appointment with one of our spine specialists.

“Our unique triage process allows us to identify acute situations immediately and schedule that patient quickly,” says Fernandez. “We know right away if an urgent appointment is needed, and the patient isn’t kept waiting for an appointment.”

Spine nurse navigators will help coordinate your treatment plan and provide ongoing education and support.

“Most people who have back pain think they’ll eventually need surgery,”

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says Beutler. “The truth is that about 80 percent of my patients can feel better without surgery—either through physical therapy or other treatments we have available.”

When patients do need surgery, PinnacleHealth works closely with them to make sure they’re prepared for the experience, starting with a pre-surgery class taught by nurse care coordinators at the Spine Institute.

“If self-care isn’t working, pain is constant, things are getting worse, or you have unusual symptoms accompanying your pain like night sweats, you should talk with a healthcare provider,” says Fernandez. “The first step toward relief is getting an accurate diagnosis so that you can move on to an effective treatment plan.”

PinnacleHealth Spine Care Center is offering comprehensive spine and neck care at two new locations: the PinnacleHealth West Shore Campus (2005 Technology Parkway, Mechanicsburg) and the PinnacleHealth Community Campus (4310 Londonderry Road, Harrisburg). For more

information about the Spine Care Center, call 877.499.SPINE or visit www.pinnaclehealth.org/spine. ))) ___________________________ Dr. William J. Beutler is a board-certified neurosurgeon with the Pennsylvania Spine Institute specializing in the treatment of spinal disorders. He completed an orthopedic fellowship in spinal surgery at the Upstate Medical University at State University of New York and neurosurgery residency at Georgetown University Hospital. Beutler offers a unique combination of neurological practice, advanced spine training, and commitment to state-of-the-art treatments.

Dr. Michael L. Fernandez with the Orthopedic Institute of Pennsylvania (OIP) is board certified in orthopedic surgery and focuses on traditional and minimally invasive techniques.

He earned his medical degree at Penn State College of Medicine. Fernandez completed his orthopedic residency at Penn State Milton S. Hershey Medical Center and participated in the Orthopedic and Neurosurgery Spine Fellowship at The University of Utah.

PinnacleHealth Spine Care Center

Is PAIN holding you back?

Get relief from back or neck pain.

Are everyday activities such as walking, shopping or work becoming difficult or unbearable?

Our experts at the PinnacleHealth Spine Care Center can assist you. We will evaluate your back or neck pain, diagnose the cause and, if you have a spine problem, provide treatment with skill, care and a sense of urgency. Our team will support you every step of the way.

To start your road to recovery, call our Spine Care Center at (877) 499-SPINE (7746).

Now open on the east and west shores.

Community Campus Bloom Outpatient Center 4310 Londonderry Road, Suite 1B Harrisburg, PA 17109 West Shore Campus Fredricksen Outpatient Center 2005 Technology Parkway Medical Office Building 2, Suite 100 Mechanicsburg, PA 17050

Know us before you need us.

pinnaclehealth.org/spine

the aches and pains of the aging spine:

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finding new approaches to managing back pain

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If you spent the weekend doing household chores or chasing grandkids around the yard, you might be feeling the tension in your back. A younger version of you might have bounced back pretty quickly, but the aging spine is not as forgiving as it was 40, 30, or even 20 years ago.

For the baby boomer, back pain comes in many forms. It can pop up in acute cases, where a healthy back suddenly struggles to support daily activities, or it can bring chronic pain, where longterm treatments are the only options for managing it.

Drs. Madhavi Reddy and Malissa Barbosa of Lancaster General Health have been treating patients with acute and chronic back pain by using traditional methods, as well as introducing new lifestyle changes that can greatly impact the way a patient feels and functions.

While many things can lead to back pain, some of the simplest causes are

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found in someone’s lifestyle, said Reddy, director of pain specialists at Lancaster General Health. Poor posture and a sedentary lifestyle are common causes of pain from underlying degenerative spinal conditions, she said.

Weight is also a contributing factor, especially for someone with belly weight, she said. Poor abdominal strength puts more pressure on the spine and makes the back have to work harder to support that added weight.

Barbosa, who specializes in family medicine and medical pain management, also has seen menopause and osteoporosis as major causes of back pain in the aging female, she said. The

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increased risk for fracture leaves many women in the baby boomer generation vulnerable to another source of back pain, she added.

“People are sometimes afraid to get moving when they’re experiencing pain, but as long as you’ve talked to your family physician and you’re cleared for activity, you need to get moving,” Reddy said.

Managing pain can be different depending on a patient’s needs. While patients with back pain used to go through a range of tests, including X-rays and MRIs, that isn’t always the case anymore.

Lancaster General Health, with the Acute Low Back Pain Project, has been rolling out proven pathways for backpain management through its satellite family practices the past several months in hopes of finding new ways to help

patients through faster, more effective recovery.

Those without a history of spinal injury or chronic back pain who find themselves at their family doctor with an acute case can jump through hurdles much faster than before, Reddy said.

“It’s about rethinking pain,” Reddy said. “Not all pain must be treated the same way.”

Instead of going through unnecessary and expensive tests and procedures, patients meet with a physical therapist to determine what is causing their pain and how it can be managed. Working with the primary-care physician, the physical therapist is able to answer questions the doctor will ask about that patient’s level of functionality and provide suggestions for how to get him or her back to normal activities as soon as possible.

“We’re looking at the physical

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Dr. Madhavi Reddy of Lancaster General Health.

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Dr. Malissa Barbosa of Lancaster General Health.

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therapist not just as a specialist anymore but as a member of the primary-care team,” Barbosa said.

Patients with acute pain who are seen within 24 to 48 hours often go through four physical-therapy sessions, depending on their needs, and see at least a 50 percent improvement in their functionality, Barbosa said.

Patients with acute back pain also are instructed on proper body mechanics and given steps on how to use non-medication painrelieving methods and exercise routines to try at home.

For patients with chronic back pain, the preliminary steps might be the same, but the treatments can vary.

Reddy performs procedures called radiofrequency ablation that can put certain nerves that carry pain signals to sleep for six months to two years.

Epidural steroid injections can also be used to treat spinal nerves that cause pain into the legs.

“Sometimes people feel better and don’t think they have to do anything else,” Reddy said. “But they aren’t cured.

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While many things can lead to back pain, some of the simplest causes are found in someone’s lifestyle.

”

The pain source isn’t actually gone—you just don’t feel it as much. That’s the time you need to start exercising and taking care of yourself to make sure you’re in a better place for recovery.”

Barbosa also has seen how oral pain medications can help patients aim for 50 percent of what his or her pain level once was before treatment. That type of treatment is often paired with exercises found to help with back pain, such as yoga, tai chi, aqua therapy, and walking.

For a lot of people, Barbosa said, pain management isn’t about getting them back to the quarterback they were in high school but helping them reach the goals they have for today. Sometimes that’s being able to travel, to participate in hobbies, or to walk to the mailbox.

“People with back pain can progress from merely existing to leading active lives with their family, friends, and community,” Barbosa said. “We are finding new ways to help people discover their independence, their new normal, through innovative pain-management strategies.” )))

Improve your quality of life by relieving back pain.

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feeling better with fibromyalgia

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Written by SANDRA GORDON

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The Inside Story Fibromyalgia is a disease of central nervous system processing. Your brain has a network of neuropathways governed by chemicals, such as serotonin, dopamine, norepinephrine, and GABA. “When the flow of these chemicals gets disrupted for whatever reason, you can experience bizarre symptoms,” says Nathan Wei, M.D, F.A.C.P., F.A.C.R., director of the Arthritis Treatment Center in Frederick, Md. Symptoms of fibromyalgia are subtle and cumulative.

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Fibromyalgia is a chronic pain disorder that affects 1 to 4 percent of the population. Although anyone can get it, 80 to 90 percent of fibromyalgia sufferers are midlife women. Read on to learn more about this mysterious condition.

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“Fibromyalgia is like an accident that happens in very slow motion,” says fibromyalgia specialist Seth Lederman, M.D. and CEO of Tonix Pharmaceuticals, which is developing a drug for the condition.

Symptoms include chronic, widespread pain; low energy; and sleep problems, such that you wake up feeling as tired as when you went to bed. You might also experience headaches, migraines, and bladder issues.

Fibromyalgia can occur by itself.

But people with rheumatoid or other

types of arthritis or lupus are more likely to have it.

There’s no known cause, cure, or test to detect fibromyalgia. Diagnosing fibromyalgia is a matter of ruling out other medical issues, such as thyroid disease, rheumatoid arthritis, or lupus, which can occur by themselves and mimic fibromyalgia symptoms.

The good news?

“Most fibromyalgia patients do get better,” Wei says.

If you think you may have fibromyalgia, here’s what you can do to aid in your own recovery.

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It’s a complicated disease, but don’t give up. Keep working at it and you’ll gradually get back on track.

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Treatment Starts with You See the right doctor. Fibromyalgia was once something that was “all in your head.” Fortunately, that mindset is changing.

Still, for the best treatment, “find a doctor who specializes in the condition, preferably someone who has graduated from medical school in the last 15 years,” Lederman says. That doctor could be your primary-care physician, a rheumatologist, or even your gynecologist.

A sign you’re at the right place: Your doctor asks you to complete the

fibromyalgia impact questionnaire, a 21-question survey that’s designed to measure fibromyalgia’s symptoms and functional limitations. Medically managing fibromyalgia takes longer than a typical 15-minute appointment.

“The key thing is to have a good relationship with a doctor who really understands fibromyalgia and is interested in treating it,” Lederman says.

Treatment may include medications, such as gabapentin (Neurontin), pregabalin (Lyrica), or duloxetine (Cymbalta). These prescription drugs can

help provide temporary relief by limiting the brain’s and spinal cord’s releases of chemicals that communicate pain.

To assess if treatment is working, you may be asked to complete a patient global impression of change (PGIC), a seven-question survey that will ask you to gauge whether you’re feeling better or worse.

“The PGIC is the gold standard,” Lederman says.

Take Back the Night It can be hard to get a good night’s sleep with fibromyalgia.

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“Most fibromyalgia patients say they wake up feeling like they haven’t had the benefit of a good night’s sleep, even though they typically fall and stay asleep normally and don’t wake up too early,” Lederman says.

That’s because fibromyalgia can activate your brain throughout the night to nudge you out of a deep sleep.

A quality-sleep deficit can make fibromyalgia pain worse.

“One feeds on the other and leads to a downward spiral,” Lederman says.

To improve the quality of your shuteye, practice good sleep hygiene: Get up at the same time every day and go to bed at a regular time too. Avoid caffeine, starting in the afternoon. Wind down before bed by listening to relaxing music and making your bedroom as quiet and dark as possible.

Prescription sleep aids, such as zolpidem (Ambien), aren’t recommended to treat fibromyalgia because they can be addictive if used long term.

But a promising, new non-addictive sleep medication, Tonmya, is on the horizon that’s designed to specifically help fibromyalgia patients get more restorative sleep. Developed by Lederman and his team, Tonmya isn’t on the market yet. But if you’re interested in participating in the clinical trial for this medication, visit www.affirmstudy.com.

Make Yourself Move When your fibromyalgia flares up, you may be in too much pain or too tired to do

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much. But don’t take it too easy. Research shows that regular exercise, such as swimming, cycling on a stationary bike, or using an elliptical trainer, can reduce pain, help you feel more energetic, and improve your overall quality of life.

Still, a little goes a long way.

“Start slowly,” Wei says, even on days when you feel good.

“Exercise for a minute a day. After a week or two, do two minutes per day, and gradually work up to 30 minutes,” he says. If you push yourself and do too much too soon, you can feel worse.

Try the MELT Method With fibromyalgia, your body’s connective tissue (fascia) becomes stiff and dehydrated, which can, in turn, increase your perception of pain. But MELT, a new self-treatment program, is designed to help.

With MELT, you’ll gently roll soft balls and rollers over your bo.dy for about 10 minutes each day to gently self-massage your body’s connective tissue.

“MELT helps reprogram your nervous system through your fascia,” says Sue Hitzmann, author of The MELT Method and corresponding website. “It’s a way to boost your body’s natural ability to repair itself.”

Hitzmann, a craniosacral and neuromuscular therapist, developed the self-healing technique in 1998.

Today, there are 2,000 MELT instructors worldwide, many of whom are physical therapists. To find a MELT instructor who can help get you started

with the home-based program, just search online for “physical therapist,” “MELT,” and your location.

See a Therapist Fibromyalgia can be stressful. If you feel overwhelmed by the illness, see a therapist who practices cognitive behavioral therapy (CBT). This form of psychotherapy focuses on helping you think positively and redefine your beliefs about the illness, to help you feel more hopeful.

“Under the CBT umbrella are guided imagery, self-hypnosis, and practical strategies, such as using a planner because many patients with fibromyalgia have trouble remembering things,” Wei says.

Stop Smoking People with fibromyalgia who smoke feel the pain of the condition more intensely, according to a study in Mediators of Inflammation. Better fibromyalgia control is yet another reason to quit smoking.

For help with kicking the habit, call 800.QUIT.NOW. The national quitline is staffed by trained tobacco-cessation specialists.

Overall, the process of getting better with fibromyalgia can take time, so be patient.

“It’s a complicated disease,” Wei says. “But don’t give up. Keep working at it and you’ll gradually get back on track.” )))

diagnosis and management of knee arthritis Written by WILLIAM M. PARRISH, M.D.

The history is the most important part of this approach because even though a patient may have radiographic evidence of osteoarthritis, their symptoms may be coming from a different source, such as spinal stenosis or hip arthritis with pain being referred to the knee. Failure to identify these sources of pain will lead to a failure in treatment.

The knee has three distinct compartments: medial, lateral, and patella-femoral. Arthritis may affect each of these compartments individually, or multiple compartments may be affected.

The articular surfaces of the femur, tibia, and patella are covered with cartilage. The cartilage is relatively soft and provides a smooth, low-friction surface for joint motion.

There are four major ligaments in the knee joint. The medial and lateral collateral ligaments provide side-to-side support and the anterior and posterior cruciate ligaments provide front-to-back stability.

The medial and lateral menisci are C-shaped structures that sit between the tibia and femur in the medial and lateral compartments. These help with tracking of the knee joint and are also commonly injured by athletes or with loaded twisting injuries.

It is important to point out the synovial lining of the joint. The synovium

produces fluid that lubricates the joint and provides some nutrition to the articular cartilage.

The synovium may become inflamed with arthritis, especially inflammatory types such as rheumatoid, lupus, etc. When inflamed, the synovium overproduces fluid, resulting in a joint effusion.

Patients with knee osteoarthritis will often complain of pain with activity but little pain at rest. As the disease progresses, pain at rest and at night may become more prevalent.

History of injury both remote and acute is helpful. It is not uncommon to encounter the patient who has had an ACL/medial meniscus injury many years prior to presentation. An unrepaired ACL with chronic instability will increase a patient’s risk for developing OA. Likewise, previous trauma, such as fractures resulting in injury to the articular surface or chronic mechanical mal-alignment causing unequal loading of the joint, will result in arthritis.

The medical history should also include questions to exclude hip disease or spinal stenosis as the primary cause of pain.

Patients with spinal stenosis often complain of leg pain and leg fatigue with activity that goes away with rest.

The classic history is characterized by a reduction in symptoms when using a grocery cart at the store. The forward flexion when bending over the grocery cart opens the nerve canals and takes pressure off of the nerve roots.

If this type of discomfort is occurring, an investigation into the possibility that stenosis is a significant component of the pain is warranted.

Hip disease also commonly refers pain to the knee. Classic hip arthritis results in groin pain that often radiates along the medial thigh to the knee and can be confused with medial compartment knee arthritis.

Treatment options for osteoarthritis include patient education, lifestyle changes, physical therapy, antiinflammatory medications, injection, orthotics, and lastly, surgery.

Conservative measures should be employed before considering surgical intervention. Treatments for osteoarthritis may include:

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Management of patients with knee pain and arthritis should begin with a thorough history, physical examination, imaging, and education of the patient.

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Lifestyle Changes By switching to less stressful activities such as biking, walking, swimming, etc., patients may be able to function day to day more comfortably.

Anti-inflammatory Medications These have the ability to provide pain relief as well as decrease joint inflammation.

Acetaminophen may be an effective alternative, especially for those patients who cannot tolerate NSAIDs, though it does not have any anti-inflammatory effect so you are only treating the pain.

William Parrish, M.D., with Orthopaedic Specialists of Central Pennsylvania.

Mechanical Considerations Mechanical considerations include orthotics, unloading braces, or surgical intervention.

Physical Therapy This treatment may help maximize your range of motion and strengthen the muscles around the knee joint.

Surgical Intervention This should be considered after conservative measures have been exhausted and the patient is no longer able to stay comfortably active. Surgical intervention for osteoarthritis may include arthroscopy, partial knee replacement, or total knee replacement.

Treatment of knee arthritis/pain should be patient specific and begin with the most conservative and economical treatments.

Education of the patient and spending time to do a proper interview and physical exam to identify the etiology of symptoms will result in more successful patient management.

Surgical intervention should be reserved for patients who have failed conservative measures. Care of patients with knee pain/arthritis can be very rewarding. Proper attention to details, beginning with a conservative approach and proper patient selection, can provide effective management of the arthritic knee joint. ))) ___________________________ William Parrish, M.D., is a boardcertified orthopaedic surgeon specializing in musculoskeletal oncology, total joint arthroplasty, and the diagnosis of bone and joint

Lancaster Arthritis & Rheumatology Care

disease. Parrish established the first Orthopaedic Limb Salvage Service in Central Pennsylvania and practices with Orthopaedic Specialists of Central Pennsylvania. He is a member of the medical staff at Lancaster Regional and Heart of Lancaster Regional Medical Centers. To learn more, visit

www.oscpdocs.com.

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Written by BRETT A. HIMMELWRIGHT, D.O.

Shoulder pain and problems are some of the most common orthopedic complaints. Of course, the first thing that everyone thinks is wrong is a rotator cuff tear. Thankfully, although that is one of the reasons for shoulder pain, there are several other good alternatives.

Impingement By far the most common shoulder problem is rotator cuff impingement with subsequent tendinitis. This occurs with repetitive shoulder-level or overhead activities. The rotator cuff and the bursa that lies over it get pinched or impinged between the top of the humerus and the acromion, which is a small bone that overhangs the humerus.

On occasion, the acromion has a prominent hook at the front on its underside. Folks with this hook formation are predisposed to impingement. This impingement results in inflammation or tendinitis of the rotator cuff, which can be quite painful.

Oftentimes, it is most bothersome at night when trying to sleep.

Treatments for this problem include anti-inflammatory medications, physical therapy, and steroid injections.

Occasionally, a small surgical procedure may be necessary to smooth the undersurface of the acromion, which creates more space for the rotator cuff and decreases impingement.

AC Joint Arthritis There is a small joint at the end of the collarbone or clavicle where it meets the acromion. Like any other joint in the body, it can become arthritic. This can be a painful and bothersome condition.

It is fairly easily recognized by a large bump on the top of your shoulder just next to where shoulder straps would lie. It also causes pain with certain shoulder activities, especially cross-body motions.

Treatments include anti-inflammatory medications, steroid injections, and a small surgical procedure to remove a sliver of the end of the collarbone so that the two bones no longer rub.

Shoulder Arthritis Although much less common than hip or knee arthritis, the shoulder joint can become arthritic as well. This can be related to a previous trauma, overuse, or a longstanding rotator cuff tear.

Early in the course of shoulder arthritis, folks generally do well with range-of-motion exercises, medications,

or injections.

If the arthritis is too severe, a shoulder replacement may be necessary.

Different types of shoulder-replacement implants are available depending on the nature and source of the arthritis.

Labral Tears Inside the shoulder, there is a small ring of cartilage along the rim of the cup of the shoulder joint called the labrum.

It is similar in structure to a meniscus in the knee.

Like a meniscus, the labrum can become torn. The tear can be from a traumatic event, such as a fall or even a shoulder dislocation, or it can be sports related. These tears are often painful with reaching and throwing activities, and it often feels as though the pain is deep within the joint.

Some people experience a popping or clicking with shoulder motion when they have a labral tear. Depending on the extent and nature of the tear, it can be surgically repaired or debrided (“cleaned up�).

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hey! my shoulder hurts!

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Dr. Himmelwright, orthopedic surgeon at the Orthopedic Institute of Pennsylvania.

Rotator Cuff Tear Here it is! The granddaddy of all shoulder problems: the rotator cuff tear.

Rotator cuff tears are actually fairly uncommon in younger folks unless there is a specific injury or traumatic event.

However, as we age, the incidence of rotator cuff tear increases. A recent

Balint Balog, M.D. Richard J. Boal, M.D. Adam M. Buerk, D.O. Raymond E. Dahl, D.O. Robert R. Dahmus, M.D. Stephen W. Dailey, M.D. Steven M. DeLuca, D.O. William W. DeMuth, M.D. Michael L. Fernandez, M.D. David P. Frank, M.D. John R. Frankeny, M.D. Curtis A. Goltz, D.O. Richard H. Hallock, M.D. Gregory A. Hanks, M.D. Daniel P. Hely, M.D. Brett A. Himmelwright, D.O. Michael A. Jones, D.O. Matthew J. Kelly, M.D. Ronald W. Lippe, M.D. James A. Oliverio, M.D.

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study suggests that above age 70, the incidence of rotator cuff tear roughly equals our age. That is, a 90-year-old has a 90 percent chance of having a rotator cuff tear.

Tears can range from small, with not much more than a slight achiness, to massive, with significant loss of motion

Michael J. Oplinger, M.D. William J. Polacheck, M.D. William A. Rollé, Jr., M.D. Ernest R. Rubbo, M.D. Thomas M. Skeehan, M.D. Michael R. Werner, M.D. Steven B. Wolf, M.D. Heather M. Bowman, PA-C Amy B. Christine, PA-C Cori M. Davis, PA-C Jesse A. Hallam, PA-C David L. Hallock, PA-C Jeffrey D. Horgan, PA-C Nicki Miller-Griffie, PA-C Kathryn G. Mueller, PA-C Jeffrey W. Peary, PA-C Natalie R. Ryan, PA-C Duane A. Stroup, PA-C Kenneth W. Tomalavage, PA-C Jacob A. Walters, PA-C

and function of the shoulder.

Not all rotator cuff tears need to be fixed. Small tears can be managed for years with exercise, meditation, and/or injections. Larger and more painful tears may need to be repaired surgically.

If the tear is too large or too old and there is significant arthritis, a special type of shoulder replacement can be performed. This implant is designed to use other muscles around the shoulder to substitute for the use of a non-functional rotator cuff.

Summary So there it is. A guided tour of shoulder problems. This is not a comprehensive list but does include the most common issues.

As you can see, there are a lot of good reasons your shoulder can hurt, and thankfully, only a few of them require any type of surgery. Most can be improved with a bit of time, effort, and guidance from your orthopedic surgeon. ))) ___________________________ Dr. Himmelwright is an orthopedic surgeon at the Orthopedic Institute of Pennsylvania.

He has been in private practice for 15 years and sees patients with a variety of orthopedic problems. www.oip.com

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switzerland –

on the rooftop of europe Written by MARIA V. SNYDER

Lake Zurich.

If I were to say Switzerland aloud, what would be the first word that pops into your mind? Cheese? Chocolate? Watches? Swiss bank accounts?

For me, I equate the small, landlocked country in Europe with the Alps. The first time I spotted those majestic mountains was on a bus trip from Germany to Venice, Italy. We drove through Switzerland. Literally. The bus spent more time inside underground tunnels than in the open air. But I never forgot those brief snatches of gorgeous scenery.

The Swiss Alps encompass close to 100 peaks that rise above 12,000 feet and 1,800 glaciers.

The highest point of Switzerland is Monte Rosa’s main summit, named Dufourspitze in honor of the surveyor Guillaume-Henri Dufour.

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It reaches to 15,203 feet and is higher than Swiss’s more well-known Matterhorn, which peaks at 14,692 feet.

The lowest point of Switzerland is Lake Maggiore and is located about 35 miles east of Dufourspitze.

Most people visit Switzerland for the superb scenery, mammoth glaciers, and outdoor activities. For skiers, the Alps are the ultimate destination, and there is a variety of terrain styles, difficulty levels, and accommodations to choose from.

However, there are also hundreds of hiking and biking trails, lakes for boating, and river cruises.

Switzerland has four national

languages— French, Italian, German, and Romansh—although most Swiss speak English as well.

The terrain of Switzerland was shaped by its glaciers, and there are three main regions: the alpine range, the Swiss plateau, and the Jura. The Jura is a limestone range that is noted for the dinosaur tracks and fossils that have been found in this region. The word Jurassic comes from this area.

The main cities of Switzerland are located on the Swiss plateau, and most of the Swiss live in this zone that includes Geneva, Lausanne, Basel, Bern (the capital), and Zurich. The plateau is the center of agricultural production,

travel ))) switzerland

and three major rivers cross it—the Rhône, Rhine, and Aare.

The Swiss landscape is split into 10 areas (or cantons), and during my second visit I spent my limited time in northeastern Switzerland, which includes Zurich. Even though Zurich is the largest city in Switzerland, it didn’t have that “big city” feel. Located on the northern tip of Lake Zurich, it has pure air and is one of the most scenic cities in the world.

While in Zurich, I completed a walking tour of the Alstadt (old town) district, where the two most historic churches, Fraumünster and Grossmünster, reside. Located along the Limmat River, the Fraumünster’s beautiful stained-glass windows were designed by Marc Chagall.

I followed the river to the lakeside promenade. Beyond the bobbing sailboats and swans, the majestic Alps loomed.

I was reminded that the Swiss’s 400year-old watch industry is the largest in the world when I spotted a clock made of

shrubs and flowers near the lake. Known as the center of the industry, Swissmade brands, such as Rolex, Omega, Breitling, Tissot, and Cartier, are known worldwide.

At the end of my walk, I reached Bahnhofstrasse Street. The rows of 19th-century department stores sold enough luxury goods to rival Rodeo Drive in Beverly Hills, Calif. Here you can buy Swiss watches, Tiffany diamonds, Confiserie Sprüngli’s chocolate truffles, Louis Vuitton bags, and designer clothing.

However, if you’re looking for handmade crafts and artwork, you can follow the Limmat River to Schipfe.

A stop at the Landesmuseum (the Swiss National Museum) is a great place to learn about the culture and history of the Swiss people from prehistory all the way to modern times. You’ll also find an eclectic collection of Swiss armor and weapons, folkloric wardrobes, and Swiss clocks.

If you have the time, a visit to the Museum Rietberg is worth the price of

admission. The museum is devoted to non-European cultures and displays art from Asia, Africa, ancient America, and Oceania. Along with a collection of Mexican art is an Aztec sculpture of a rattlesnake. A striking, new glass addition to the museum has been constructed next to the historic building, doubling the exhibition space.

As a counterpoint to Zurich, I visited Appenzell—an authentic Swiss village that has retained the country’s historic folklore. The main square and streets are lined with painted houses, and the shops advertise their wares with intricate signs, letting a shopper know exactly what goods are for sale inside.

Appenzell is known for its status as the yodeling capital of Switzerland and has a reputation for excellent baked goods, embroidery, and chocolate.

Although Swiss brands such as Lindt and Cailler are available worldwide, one of Switzerland’s most iconic brands is Toblerone. The legend is that the triangular-shaped chocolates had been inspired by the Matterhorn;

Appenzell, an authentic Swiss village that has retained the country’s historic folklore.

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however, according to the website, the characteristic shape was inspired by a line of dancers at the Folies Bergère in Paris, who had formed a pyramid at the end of a show.

Near Appenzell is Mount Säntis, the highest peak in the Alpstein massif of northeastern Switzerland. At 8,209 feet, the peak is a visible landmark that can be seen as far away as the Black Forest in Germany. Visitors can easily reach the summit in eight minutes via the aerial tramway Luftseilbahn SchwägalpSäntis, located in Schwägalp.

Dress warmly as the temperatures at the top are much colder and, when I was there in October, snow coated the walkways and stairs of the observation deck. The view was absolutely spectacular.

From the top, you can see six countries if the weather is clear: Switzerland, Germany, Italy, France, Liechtenstein, and Austria.

There is also a restaurant at the top of Mount Säntis with hot food, drink, and an outdoor eating area, which was crowded despite the freezing temperature and ceaseless winds. Birds searching for crumbs hovered in mid-air, Grossmunster Church, Zurich.

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floating on the wind streaming up the side of the mountain.

Visiting the top of Mount Säntis was the highlight of my trip.

For those who have more time to explore Switzerland, there is plenty to see and do. The capital, Bern, is a UNESCO World Heritage Site due to its medieval architecture. You can also join the 20,000 revelers at Fasnacht in Basel. It’s a carnival that dates back to the Middle Ages and begins the Monday after Ash Wednesday.

Another recommended activity is to take a train ride through the Alps.

There are a variety of routes and lengths of time, but all guarantee spectacular scenery. For example, the Glacier Express is the slowest express train in the world since it takes more than seven hours to reach its destination in St. Moritz from Zermatt. However, it crosses almost 300 bridges and traverses 91 tunnels on a track that is a feat of engineering.

Another feat of engineering is about to put Switzerland in the record books for the world’s longest tunnel. The Gotthard tunnel is currently being built deep beneath the Alps. Due to open in Shrub clock, Zurich.

2017, the 35.4-mile tunnel will allow trains to travel from Milan, Italy, to Zurich in less than three hours at speeds close to 155 miles per hour.

Switzerland may be one of the smallest countries in Europe, but it’s a giant when it comes to spectacular scenery, historic cities, quaint villages, and outdoor activities.

Helpful Websites General information: www.myswitzerland.com/en-us/home.html Frommers: www.frommers.com/destinations/switzerland Landesmuseum (Swiss National Museum): www.nationalmuseum.ch/e/zuerich/ Museum Rietberg: www.rietberg.ch/en-gb/home.aspx Appenzell: www.appenzell.info/en/service-navi/home.html Mount Säntis information: www.saentisbahn.ch/en.html The Glacier Express: www.glacierexpress.ch/en/Pages/default.aspx A video of the hovering birds at Mount Säntis: http://officialmariavsnyder.blogspot.com/2010/ 11/back-in-action.html Mount Santis tram.

health how to deal with sensitive and discolored teeth Written by PETE WISNIEWSKI

Have you ever taken a sip of your morning coffee or bitten into a spoonful of ice cream, seeking refreshment, only to be greeted with a sharp pain instead? If so, then you may be one of the many people who suffer from tooth sensitivity.

There are many reasons people may experience tooth sensitivity—grinding of the teeth, tooth decay, damaged or broken teeth, and eating copious amounts of acidic foods are just a few.

One of the most common reasons baby boomers claim to have difficulty with sensitive teeth is simply because gums recede as the body ages.

According to Dr. Daniel Runkle with American Dental Solutions, “One of

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the main causes [of sensitive teeth] is periodontal disease, which causes bone loss and subsequent recession of gums.

Once the gums have begun to recede, it leaves the roots’ surfaces exposed, which then have no enamel to protect them from thermal sensitivity.

“Another common reason people can experience sensitive teeth,” Runkle continued, “is from brushing too hard and causing excessive wear of the

enamel at the gum level. This causes a cervical ledge and exposed dentin under the enamel, which is very sensitive to a thermal stimulus.”

Using a hard toothbrush and causing damage to the enamel and gums is a problem that can be avoided easily by using a softer bristled brush or a power toothbrush that can alert the user if they are brushing too hard.

Runkle explains that tooth enamel

health ))) sensitive teeth

Dr. Melissa Crognale of Crognale & Collins Family Dentistry.

“can be repaired, but it depends on the extent of the damage. Some areas can be repaired by a simple filling, while others could need a crown to fully cover the damaged area and visible root surface.”

He went on to explain that if extreme sensitivity is present, the individual could even possibly need root canal treatment to get rid of the sensitivity before a restoration is placed. A comprehensive evaluation by a dentist will provide the individual the recommended treatment options.

Another issue that can be a cause for sensitive teeth in older adults is the taking of medications. Medications can cause dry mouth, also known as xerostomia. A dry mouth is the result of decreased saliva flow, and it hinders an individual’s ability to fight off various types of bacteria. Increased amounts of bacteria result in periodontal issues, bad breath, and eventually decay and tooth loss if not addressed.

Runkle suggests combating tooth sensitivity by having “regular cleanings/ periodontal evaluations and using desensitizing agents such as Sensodyne toothpaste, ACT mouth rinse, Floridex products, etc.”

He noted that there are also varnishes and other coatings that dentists/ hygienists can place on the teeth to help with sensitive areas.

As teeth age, it is not uncommon for them to develop a yellowish or grayish tint. Teeth whitening has become a popular practice among those who are unsatisfied with the color their oncepearly whites have come to display.

There are a few different options individuals have when considering whitening their teeth and several things to keep in mind.

“There are three main procedures people can use to whiten their teeth,” says Dr. Melissa Crognale of Crognale & Collins Family Dentistry. “In-office

treatments, which consist of a high dose of a hydrogen peroxide solution with a light or laser (this requires few treatments); at-home treatments, which consist of a carbamide peroxide gel put in clear trays (this requires more frequent treatments); or over-thecounter products, but some of those only remove the surface of stains and can contain low levels of hydrogen peroxide.”

“Over-the-counter toothpastes, mouthwashes, and stain removers will not do as thorough of a job as getting prescription treatments from a dentist because the doctor is able to use a higher percentage of peroxide,” says Crognale.

“However, treatments that involve a bleaching process will get teeth whiter, but there is also more of a chance that the patient’s [teeth] will become more sensitive, and [they] could develop the possibility of gum-tissue irritation.”

The causes for tooth sensitivity after

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A comprehensive evaluation by a dentist will provide the individual the recommended treatment options.

whitening are typically one of three issues: frequency, intensity, or duration.

The frequency problem can be solved by not using at-home bleach trays every day, but rather whitening every other day for the recommended course of treatment.

Switching to a lower level of carbamide peroxide gels will reduce the intensity or strength of the application.

The higher strength may be too strong

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for the patient.

And be sure not to leave the trays in for too long a period of time.

Crognale warns against professional whitening if a person already suffers from sensitive teeth.

“It can make your teeth extremely sensitive, even at the lowest percentage of bleach,” Crognale warns.

If a person chooses to get a bleaching procedure at a dentist’s office, they

should expect to do a touch-up once a year and to stay away from dark liquids, coffee, tea, red wine, etc., to ensure the quality lasts as long as possible.

Crognale also recommends using Colgate PreviDent 5000 Sensitive while bleaching to help with any unwanted sensitivity issues.

Of course, any issue of sensitive teeth, or whitening, should be discussed with your dentist before making a decision. )))

home a fireplace adds warmth, beauty, and ambiance to your home SimpliFire built-in electric fireplace.

Written by ROCHELLE A. SHENK

Fireplaces not only add architectural interest, but they also add a cozy and romantic feel to a room.

Rick Soccio of AES Hearth and Patio, Camp Hill, says that homeowners install a fireplace of some type to beautify the home, and some may do so to save on the heating bill. Those seeking the latter may want to consider a high-efficiency insert for a wood or gas fireplace or perhaps a pellet or coal stove.

If there’s an existing fireplace, he says there are ways to give it a fresh look. One of those ways is installing a

new insert. Installing custom fireplace doors is another option.

“Some people may prefer the traditional look of polished brass doors, but there are a host of more modern looks—some have polished brass trim with black frame; others may be black or antique brass or nickel with geometric shapes. New doors can be a relatively inexpensive way to get a new look,” he explains.

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Heat & Glo Northstar wood fireplace.

Yet another option is to reframe the fireplace using granite, marble, tile, or architectural stone. Soccio says that typically when choosing this option, homeowners also install a new wood, gas, or pellet insert. Both of these do change the entire look of the fireplace.

One of the hottest trends in fireplace design is the linear fireplace. It’s often a sleek, rectangular fireplace with a contemporary look in which the flame comes up through glass beads. Glass beads are available in a variety of colors.

Driftwood or river rocks can be used in place of the glass beads for a different effect.

“You see a lot of the linear fireplaces in commercial applications, such as restaurants—both for inside and outdoor dining—or hotels. It’s slowly being adopted for residential use, but we haven’t seen a lot in our area yet,” he observes.

Fireplaces are also no longer confined to the living room or family room. Soccio says that today they’re used almost everywhere, including the dining room, kitchen, bedroom, and in the master bath. Arch-style fireplaces that also contain a warming drawer have been

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Heat & Glo Crescent II direct-vent gas fireplace.

used in kitchens. Fireplaces in the master bedroom can run the gamut from a traditional hearth-and-mantle fireplace to a see-through fireplace that can be viewed in both the master bedroom and the bathroom.

“A fireplace by a garden tub sets a cozy, relaxed tone,” he says.

Fireplaces are also heading to the outdoors and can be seen in outdoor living areas as firepits, grills, or more traditional fireplaces. For those who want the look of a fireplace but don’t want to deal with stoking it with wood, coal, or pellets and who don’t have access to natural gas, an electric fireplace is an option.

“We’re seeing electric fireplaces in a lower-level family room or entertaining area; they’re most often installed on a wall above a bar. It creates a different look,” Soccio explains.

He adds that a lot of the units are designed to slide in and out so they can be plugged into an outlet behind the unit.

That way the electric cord is hidden from view. In case you’re wondering, electric fireplaces do throw off some heat, but it’s minimal.

And unlike a gas, wood-burning, pellet, or coal fireplace, they don’t work when the electricity goes out. Soccio points out that gas fireplaces often have a battery backup or remote wireless system to light the pilot for the flame.

Once you’ve made the decision about the type of fireplace and how it will be fueled, you may want to consider maintenance. Brian Cline, owner of Smokestack Masonry, Willow Street, says that a yearly inspection is a “must” for anything with a chimney, including fireplaces; wood, coal, or pellet stoves; and oil and gas heating units.

It’s especially critical for oil-fired systems, since oil soot—unburned carbon and sulphur—can accumulate on the chimney walls. Sulphur, when mixed with rainwater (from a missing chimney cap) or moisture from the flue gases themselves, is absorbed into the flue tile and starts a deteriorating process called flaking or spalling.

When selecting a company to perform the inspection, he advises homeowners to look for chimney sweep certified by the CSIA (Chimney Safety Institute of America). A listing of

home ))) fireplaces

Heat & Glo Solaris direct-vent gas fireplace.

certified chimney sweeps as well as consumer information can be found on the CSIA website (www.csia.org).

“There are a lot of scam artists in this industry. When you choose a CSIA-certified chimney sweep, you can be assured they’re well trained and knowledgeable,” Cline says.

During the annual inspection, professionals look for cracks, leaks, and soot buildup inside the chimney and check the exterior masonry. The top of the chimney, or crown, is examined closely, since Cline says that often is the part of the chimney that deteriorates first and is where all the leaks begin. Mortar joints are also examined.

“As we do our inspection and cleaning, we take a ‘before’ and ‘after’ video to show the homeowner, so they understand what we did. If any repairs are needed, if you do an annual inspection, you can catch them early,” Cline says.

A common misconception is that the annual inspection should be done in the fall as the temps cool and homeowners are tempted to turn on the heat or light a fire in the fireplace. That’s not the case, says Cline; he advises homeowners to schedule chimney inspections in the spring or summer to allow time for any needed repairs to be completed.

He also has some tips to prolong the life of a chimney and/or its masonry.

It’s a good idea to have a chimney

Heat & Glo SimpliFire wall-mount electric fireplace with color-changing backlight.

cap installed on the chimney. It not only helps keep water out of the chimney, but it also keeps out animals such as squirrels, birds, and bats.

Don’t use a brick/stone-and-mortar chimney as a trellis for plants. It deteriorates brick and mortar, as plants such as ivy seek footholds in the hard surface.

All chimneys should have some type of interior liner.

Older chimneys may have terracotta flue tile. If it is cracked or deteriorated, it should be replaced with stainless steel.

With all this in mind, it’s time to enjoy the cooler fall temps with a cozy fireplace. )))

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feature home remodels make room for new memories Written by MEGAN JOYCE

It’s sometimes hard to consider saying goodbye to outdated furniture and décor in our homes, especially for baby boomers who, by now, have owned their homes and possessions long enough for them to have become imbued with memories.

A wall in the living room was the backdrop for family photos; the cushions of the well-worn sofa served as architecture for many a pillow fort when the children were younger and a comfortable spot for them to complete homework assignments as they grew older. And in one corner of the living room the carpet had been scratched up to make a bed and hideout for a hamster escapee.

Such was the dilemma for Christianne Rupp, editor of b magazine,

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and her husband, Randy, who first presented his idea of converting their living room into a game room about a year ago.

“I didn’t really go for the idea at first,” Chris Rupp said. “I liked the furniture, draperies, and accessories in that room, and it held a lot of memories.”

Over the next few months, however, she realized the idea had its merits.

Their living room had served as an important family gathering spot for

Christmas tree in living room before the renovations.

feature ))) home remodel

^ ^ After Before >>

of interior styles, furniture, and design elements.

Plus, “there are steps going to the second floor, so whatever flooring was selected for the dining room and future game room, it had to ‘flow’ up the

steps,” Chris said.

Fortunately, the Rupps’ son, Colin, is a graduate architect.

“I used our renovations as a means of cohesion,” Colin explained. “In order to create a clear design language, we went

<< Before After ^ ^

decades; by transforming it into a game room, it could continue to be a place for her four grown sons and their families to come together, laugh, and enjoy each other’s company.

Even though the living room never got much use beyond holidays and special occasions, its lingering Christmas memories were particularly compelling—it was the yearly site for the fresh-cut Christmas tree, which, for some reason, always ended up being much taller inside than it appeared out in the field.

“We’d open presents in the living room, each person having their own ‘spot.’ Sooner or later, the boys would end up shooting balled-up wrapping paper at each other,” Chris said. “I will miss all of that … but we are adjusting to transitions in life.”

And the transition from homey living room to cozy game room, fully equipped with pool table, wasn’t a simple one: It also required updating the adjacent rooms, a formal dining room and existing kitchen, which had a mix

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))) home remodel

feature

^ ^ After

Christianne Rupp, editor of b magazine, and her grandsons play pool.

<< Before

through an exercise of finding what had to be removed and what could stay.”

After speaking with his parents—or, his clients—about what they had in mind and taking measurements, Colin came back with three detailed proposals for their consideration.

Each proposal was based on some key elements that were going to stay: a Mediterranean-style wood hutch and table, a porcelain-and-brass chandelier, the stairs’ trim and balusters, and the paint color that ran from the living room to the upstairs hallway.

The first proposal was for a complete refinishing package, Colin said, with allnew floor finishes (porcelain tile, carpet, and solid-wood flooring), new base and door trim, fresh paint, new closet doors,

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and a 15-foot custom wood transition strip.

Option No. 2 replaced the porcelain tile with additional carpet and the solid-wood flooring with laminate wood product—both as a means of reducing the project’s overall expense.

The third proposal was the least invasive and least expensive: all-new carpeting (no tile or wood flooring), new base trim in one room, and new paint.

The Rupps went with the first proposal.

“We spent a little more than we had anticipated, but we wanted to do it right and have it look awesome,” Chris said.

“Plus, as baby boomers, resale value is always in the back of our minds.”

“Once we started to put physical,

material samples and paint swatches in front of [them], they really began to see how it would all work together,” Colin said. “That, coupled with the excitement of the furniture they were going to buy, allowed me to create the space they imagined.”

Although still formal, the oncecarpeted dining room now has porcelain tile resembling real slate, with tones of gray, tan, and rust. The new tile transitions nicely to the existing maple floors in the kitchen and complements the hutch and dining-room table, Colin said.

“We removed the wallpaper and repainted the room in nude and terracotta colors and added new door trim and baseboards, which were painted

white to accent and make the tile ‘pop,’” Chris said.

As for the game room itself, Colin chose a hewn, solid-wood board flooring—which has the advantage of longevity over laminate—in a deep, chestnut-brown color.

“The game room is better than awesome,” Chris said. “The floor is real wood, and we repainted the walls in there to complement the dining room.

The baseboards [in the dining room] flow into this room, and the contrast emphasizes the hardwood flooring, bringing out its beauty.”

Since game rooms tend to be rowdy

places of intense familial competition, the stairs to the second floor received new carpet to muffle the noise for the upstairs bedrooms.

To furnish the new game room, the Rupps chose a bar with comfortable chairs, a bistro table, and, of course, a pool table.

Colin encourages homeowners who plan to sell in the future to take steps to keep their home modern. Even small improvements—like new sinks, door hardware, and carpet—add up to make a home more desirable to buyers.

“As a homeowner, it’s important to keep your house ‘current’ if you plan to

resell it at some point,” he said. “Why wait to make these changes until you’re selling the home? Why not make them while you can still benefit from them and enjoy the ambiance?”

Chris has already found that new memories with a new generation of children are forming in the renovated family space.

“Now, when our kids and their families come to visit, the pool table gets a lot of use,” she said. “Even my grandson Caleb, who is 7, and I play pool. We have found an easier way, though. It’s cue-less. We don’t use the cue sticks … and he wins.” )))

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51

feature

grandparents face new dilemma

Written by DR. LINDA RHODES

The Partnership at DrugFree.org recently released a startling report on prescription drug abuse among teens, and the findings are compelling. Each week, more than 17,000 teens take their first run at drugs using prescription and over-the-counter medications for a mind-altering adventure.

Prescription medicines are now the most commonly abused drugs among 12to 13-year-olds and exceed the abuse of ecstasy, crack, cocaine, heroin, and meth combined among 12- to 17-year-olds.

One out of four teens report having abused a prescription drug in their lifetime, and three out of four will tell you they got those drugs from home and friends.

Grandparents, an age group known to take multiple prescriptions and overthe-counter drugs, can become an easy, unsuspecting supply source, especially

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if the medicine cabinet is stocked with pain pills like Vicodin and OxyContin, anti-anxiety drugs like Xanax, sleeping pills like Ambien, diuretics like Lasix (teens will use them to lose weight), and over-the-counter drugs that contain pseudoephedrine like Sudafed and common cold medicines.

Taking any of these drugs too frequently or too much and combining them with alcohol at parties can spell disaster. Three thousand young adults died from prescription drug overdose in 2010, a stunning 250 percent increase

from 1999; that’s eight people per day.

The spike in teen prescription drug abuse, a 33 percent increase over the past five years, can be attributed to a range of factors: kids seeing commercials on the benefits of medications; the belief among teens that if a doctor prescribes a drug and Grandma can handle it, then it must be safe; the lack of vigilance and warnings among parents over prescription drugs as opposed to street drugs; and the easy accessibility of the family medicine cabinet.

Teens are also drawn to the drugs

feature

“

lecture, you may Given that one in learn the underlying circumstances and four teens report abusing reasons she’s turning prescription and over-theto prescription drugs. counter drugs, experts Dr. Susan Bartell, are warning parents and a psychologist on parenting who grandparents to prevent also advises the the opportunity in the Partnership, would first place. further counsel you to tell your granddaughter that her parents need to know.

“Offer to talk to her parents with her, and role play how you’ll tell them.

Attention Deficit Hyperactivity Disorder Explain to your grandchild that ‘I love (ADHD). Kids rarely find them in their you and I want you to be safe, and that’s most important.’ If I don’t tell your mom grandparents’ medicine cabinets but they sure do among their friends who’ve or dad, there’s a chance you could get been prescribed the medication and are in trouble or get hurt or die, and I’d be willing to share, swap, or sell. Teens responsible for that.” report taking it so they can concentrate Given that one in four teens report abusing prescription and over-the-counter for major tests, study all night, get high, and/or lose weight. drugs, experts are warning parents and Be sure to reach out to your local grandparents to prevent the opportunity pharmacist to identify pills you may in the first place. Store your drugs in have found and suspect your grandchild drawers that aren’t accessible to others is taking. Ask them about any drug or in a locked cabinet, get rid of all “take back” programs they may offer to expired drugs, keep an inventory of your dispose of expired drugs. ))) prescriptions by counting the pills and

))) grandparents dilemma

because they’re “free,” and they don’t have to worry about getting caught by police with legal consequences like they do with marijuana or cocaine.

Combine all of this with a typical teen’s curiosity, growing pains, and risktaking behaviors, and we, as a nation, have a new drug crisis on our hands.

But right now, let’s talk about what’s in your hands if you suspect a grandchild of taking drugs from your medicine cabinet.

Most grandparents and grandchildren enjoy a special bond that allows them more give and take than with Mom and Dad. An older generation that’s seen it all can lend advice to kids who want to see it all. If you share this type of bond, let’s say, with your granddaughter, you don’t want to lose her trust or channels of communication by outright confronting or accusing her.

Instead, take an inventory of your pills before and after she visits (or anyone for that matter) to see if pills are turning up missing. If they are, then you have no choice but to approach your granddaughter.

In this instance, be honest as to how you’ve been worried about her. If you’ve seen changes in her behavior, such as acting withdrawn or hyper, declining grades or performance in sports, drowsiness, or angry outbursts, then share your observations with her as evidence sparking your concern.

Dr. Jane Greer, a family therapist who advises the Partnership at Drugfree.org, urges grandparents not to be judgmental or critical in their approach but rather give teens the space to explain themselves. If you listen rather than

”

monitor usage, and have conversations with your teens warning them of the dangers of taking prescription drugs, as well as street drugs.

And when you’re having “that talk,” be aware that two other drugs teens are reaching for are the stimulants Adderall and Ritalin, both prescribed for

___________________________ Dr. Linda Rhodes, a former secretary of aging for the state of Pennsylvania, is a gerontologist, chief caregiving officer for Care Angel, and author of The Essential Guide on

Caring for Aging Parents (Penguin Group 2012). Go to www.lindarhodescaregiving.com

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lifestyle

memory loss only partially likely with aging

Written by BARBARA TRAININ BLANK

As people age, we Truth or myth?

have trouble

“It is true it takes a little longer to retrieve specific names and other memories as we get older,” noted Paul J. Eslinger, Ph.D., clinical neuropsychologist and professor of Neural and Behavioral Sciences at Penn State Milton S. Hershey Medical Center.

“The research is consistent that the speed of retrieval is slower and more variable relative to our youth, and we all have to muddle through.”

Just as our physical stature undergoes alterations, so our nervous system is affected by some of the same biological changes.

“If you accept the premise that the mind stems from neurobiology, why should it be different than muscle biology?” Eslinger asked.

It is easier than in the past to determine what constitutes the “normal”

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remembering things.

changes of aging. Hershey Medical Center provides neuropsychological testing in any condition causing the brain to malfunction, like stroke or suspected early Alzheimer’s disease (for which there is no diagnostic test yet).

Alzheimer’s is the most common form of dementia, which has more than 50 causes—including hydrocephalus in the brain and vitamin B-12 deficiency.

Neuropsychologists use cognitive assessment to examine the health of different networks/regions of the brain.

Exams begin with listening to the kinds of difficulties patients and family member(s) report, then evaluating physical and neurologic health, including blood tests and usually a brain MRI scan to see if there are shrinkage and spaceoccupying lesions in the brain.

Neurocognitive testing compares

cognition of a patient with that of other individuals his or age in such areas as learning and short-term memory, discrimination of objects and faces, word retrieval, and the ability to solve certain problems, e.g., reading the patient a paragraph and asking what it’s about.

Testers compare immediate recall with delayed recall, e.g., 20 to 30 minutes later.

“Often, a person with early Alzheimer’s has a fair amount of recall right away, but after 30 minutes, the recall slips away,” said Eslinger. “This is equivalent to short-term memory loss.”

A very exciting innovation in neurocognitive testing is the functional MRI. In these studies, neuropsychologists administer cognitive tests while the patient is having his or her brain scanned.

That way, neuropsychologists can not

lifestyle

The stacks of information are specifically linked by people’s associative learning and experiences. Once we remember the name of a person, we also can access the last time we encountered that person and how we feel about him or her, for example. These bits of associated memory may come from many different parts of the cortex.

“We don’t have a good understanding

yet about how this ‘binding’ together and coding of different information and experiences occurs,” Eslinger said. “It is quite a marvel of nature.”

The brain’s storage areas tend to be generally stable throughout healthy aging, while the coding or retrieval areas do seem very susceptible to aging.

“That’s why we may need cues and time to think [as we get older]; we’re

))) memory loss

only assess the patient’s behavioral performance, but also examine online activity in the brain to determine if there are abnormalities.

“These are still mainly research techniques but they are starting to be used for clinical assessment as well,” said Eslinger.

Since there are many variations of Alzheimer’s, and different areas of the brain can be affected in different individuals, you need to assess all of them.

Learning and memory abilities are divided roughly into three stages.

“First, we ‘encode’ new information and experience when we … process it,” said Eslinger. “This is the registration stage …

“Second, that new information and experience becomes physiologically ‘consolidated.’ In this stage, memory becomes more stable physiologically and anatomically, providing the basis for long-term storage.”

Third is pulling out the information so it’s available—the retrieval process, which is what takes more time as we get older.

“Large areas of the brain’s cortex are like stacks of books and journals, with information and experience written on them,” explained Eslinger. “This is the physical basis of our long-term memory and knowledge (e.g., words, faces, objects, actions, personal experiences, etc.).”

The retrieval areas are a kind of physiologic card catalog or search engine that tells the brain where to find information among the hundreds of millions of neurons.

Paul J. Eslinger, Ph.D., clinical neuropsychologist and professor of Neural and Behavioral Sciences at Penn State Milton S. Hershey Medical Center.

“

Alzheimer’s is the most common form of dementia, which has more than 50 causes.

”

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not as quick,” Eslinger added. “But is it aging, or that we have stored a lot more information over time? We don’t know that yet.”

What can be done to delay memory impairment? Exercise has a consistent and powerful effect.

“I approach this as a whole-body process, by [encouraging patients’] improving cardiac health and brain health and meeting metabolic parameters (e.g., blood pressure, glucose, cholesterol) in midlife,” he said.

“The brain takes up 20 percent of the blood flow, so you need to focus on cardiovascular health. Exercising, even a few times a week for 20 to 30 minutes,

increases blood flow and oxygen to the brain.”

There’s also a “curious link” between sleep and memory functions. Research about the onset of Alzheimer’s and Parkinson’s seem to indicate that changes that occur with sleep and circadian rhythms predate some dementias. Sleep apnea and insomnia could certainly be connected as well, so work with your primary-care physician to improve sleep hygiene.

There’s also some evidence that a MIND-style diet (Mediterranean Intervention for Neurodegenerative Delay) is associated with a lowered incidence of dementia.

“This is a better approach than commercial supplements,” said Eslinger.

“These have been advertised, and sound mighty attractive, but it doesn’t seem there’s evidence they’re effective.”

There are trials going on about coconut oil for mild cognitive impairment, but the research “hasn’t yielded benefits for those with stronger symptoms,” he added.

Cognitive stimulation, such as attention training, can have lasting benefits in task completion. Low-cost cognitive exercises offered online make people respond quickly and track their progress over time. Like a cognitive gym, the stimulation puts you under pressure

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to make decisions but can cause a bit of stress.

Maintaining social and recreational activities can also protect against memory loss.

There are many new drug trials going on to delay memory loss, such as brain immuneboosting drugs, amyloid-clearing drugs, and intranasal insulin.

An interesting concept being studied at Alzheimer’s research centers since the 1980s is known as “cognitive reserve.” These studies follow large samples of people for many years to try to unravel early symptoms and types of symptoms.

“It seems if people are physically healthy and active, have higher levels of education, and are metabolically healthier (e.g., not diabetic), they have a much later onset and fewer symptoms of memory loss and dementia,” Eslinger explained. “They may build up reserve capacity by increasing the synapses in and volume of the brain.

“Cognitive reserve can have a genetic or biological component but also environmental ones,” Eslinger said.

Researchers also have learned that fluid IQ (such as flexible problem-solving ability rather than memorized answers) keeps going up in successive generations. This intelligence is also correlated with the degree of education people have and with innovations in that education.

For example, kids today learn math concepts, rather than memorize tables. Fluid reasoning may cause the brain to be nimble and compensate more readily for cognitive aging.

But even brilliance is protective only to a degree, not preventative. Though we know a lot more than we used to, “there’s a lot of ambiguity around memory loss and dementia,” Eslinger added.

Still, it’s “exciting,” he said, that neuropsychology neuroscience is telling us that brain health can be a lifelong process. )))

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                         

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caregiving holiday planning for caregivers how to keep stress manageable during a busy time

Written by LISA M. PETSCHE

The holiday season is a hectic time for many of us. It’s even more challenging when you’re caring for a relative with chronic health problems, a demanding role at even the best of times.

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To keep stress manageable and make your holidays more meaningful, try following these suggestions.

necessary preparations well in advance.

Make lists to stay organized, and keep them handy.

Set realistic expectations, and be prepared to alter traditions. Keep it simple, and let relatives and friends know your needs and limitations. Decide what is really important to you; focus on that and forget the rest.

Include your relative in preparations.

When they can contribute in even small ways, such as deciding what decorations to put where or helping to select gifts from a catalog, they will feel valued and it will create a sense of partnership.

Set a budget for holiday-related expenses and stick to it. If finances allow, consider arranging for a housecleaning or a catered meal, or both, to save precious time and energy.

Reminisce to help you both get into the spirit of the season. Share special memories, bring out photo albums or home movies, and listen to favorite carols.

Whatever tasks you decide to take on, ask for help and delegate responsibilities. Make plans and start

If you accept an invitation, do so on the condition that you may back out at the last minute if you or your relative

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doesn’t feel up to the occasion. Take things one day and one event at a time.

Give yourself permission to attend an event without your relative. If it’s not feasible to take your relative with you but you’d really like to go and can arrange respite care, go.

Space out activities as much as possible by scheduling quiet days between busy ones.

Look after your health: get adequate rest, eat nutritious foods, and try to fit in some exercise. A stationary bike or a treadmill is a good choice year-round since it may be hard to get out for a walk, let alone to a fitness center.

caregiving

Take responsibility for your wellbeing by doing something nice for yourself. Some caregivers treat themselves to a special gift at this time of the year.

Look for moments of joy in which to delight. If you slow your pace and keep your priorities in check, you’ll be sure to find them.

place. Keep gatherings small to minimize noise and confusion for your relative. Otherwise, situate them in another room, and have guests visit one or two at a time. If you’re planning to go out visiting, ensure there’s a quiet spot your relative can retreat to if they can’t handle the stimulation. > Whether you’re at home or out somewhere, be prepared for escalation of challenging behaviors and have a plan in place. If your relative is at risk for wandering or likes to rummage, enlist the help of a family member or friend

to ensure they’re occupied in a harmless manner while you’re mingling or engaged in hosting duties.

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Find something relaxing you can do to give yourself a break, whether it’s quietly enjoying a cup of tea, reading something uplifting, writing in a journal, calling a friend, or listening to some favorite music. Make it a priority to continue this daily time for you in the new year.

> Don’t pressure your relative to take part. Previously enjoyed events may now cause distress if they don’t understand what’s going on or no longer recognize family members and friends. ))) ___________________________ Lisa M. Petsche is a social worker and a freelance writer specializing in boomer and senior health matters. She has personal and professional experience with elder care.

Alzheimer’s Care Here are some extra tips for those caring for relatives with Alzheimer’s disease. > Keep decorations minimal and out of reach as much as possible if your relative is prone to rummaging or hiding things. Don’t put out anything that’s valuable, breakable, or that could be dangerous if ingested. > Avoid lights that flash or play music, as well as sound- or motion-activated items that can startle. > Schedule activities during your relative’s calmest time of day.

Generally, the earlier in the day the better, since behavior tends to worsen as fatigue sets in. > Stick to routines as much as possible to avoid anxiety and confusion. > Entertain at home rather than take your relative out to an unfamiliar

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caregiving

dementia: by any other name...

Written by LORI M. MYERS

You walk into a room and forget why you went there, or you can’t remember someone’s name or phone number. If you’re beyond the age of 50 or 60, you can’t help but fear that you might have the beginnings of Alzheimer’s disease.

After all, it’s the most common type of dementia, gets a lot of media coverage and, according to the Alzheimer’s Association, accounts for an estimated 60 to 80 percent of dementia cases.

But dementia is a general term for loss of memory. There are other mental/physical maladies that fall under the dementia umbrella besides Alzheimer’s—other maladies that your doctor will and should be checking you for to make a proper diagnosis. All have similarities but also some very distinguishable differences.

Among those are vascular dementia, Lewy body dementia, Parkinson’s dementia, and normal pressure hydrocephalus. All are major sub-types of non-Alzheimer’s dementias.

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Vascular Dementia “Vascular dementia is typically best thought of as a dementia secondary to impaired cerebral blood flow resulting in either small strokes or scarring in the brain tissue,” says Jarod B. John, M.D., a neurologist at Brain Orthopedic Spine Specialists in Lancaster. “Therefore, this dementia is often thought of when the patient has risk factors which can lead to impaired blood flow and strokes.”

Those factors include hypertension, diabetes, high cholesterol, heart disease, smoking, and a diet that includes highfat foods. According to John, imaging studies of the brain will show evidence for stroke or scarring in the brain, which helps with the diagnosis of vascular dementia.

While vascular dementia has the typical clinical features of other dementias, including impaired memory, patients with this disease typically do better on memory testing than Alzheimer’s patients, which is the reason vascular dementia is sometimes referred to as “vascular cognitive impairment” rather than true dementia.

“However, vascular cognitive impairment and Alzheimer’s dementia can coexist, and they are typically found together,” John says.

Another way of recognizing vascular dementia is that patients typically have neurological findings other than just memory impairment, such as issues with their gait, weakness, numbness, history of stroke, and history of cardiac issues.

caregiving ))) dementia

Jarod B. John, M.D., a neurologist at Brain Orthopedic Spine Specialists.

As far as treatment, vascular dementia is best treated by preventative measures: controlling high blood pressure, diabetes, and cholesterol; avoiding smoking; and eating a healthy and balanced diet, preferably the Mediterranean diet.

Lewy Body Dementia Lewy body dementia is associated with psychiatric symptoms and autonomic dysfunction, with one characteristic feature being that patients have fluctuating levels of alertness and lucidness. They can be alert and normal and at other times appear very confused or very fatigued and sleepy.

Another common characteristic feature of Lewy body dementia is early onset of psychiatric symptoms, such as hallucinations, delusions, or depression, says John. They also typically have impaired coordination rigidity, poor posture, and a shuffling gait, features typically in those with Parkinson’s disease.

Parkinson’s Dementia Dementia in Parkinson’s patients shares very similar clinical characteristics to Lewy body dementia,

such as psychiatric symptoms, autonomic dysfunction, parkinsonian features, and cognitive dysfunction, according to John.

“One clear distinguishing factor is the fact that the patient who is diagnosed with Parkinson’s dementia must have Parkinson’s,” he says. “In Lewy body dementia, the patient does not have to have any parkinsonian features at onset but does typically develop these features later on in the disease.”

The most characteristic clinical finding in Parkinson’s dementia patients is loss of executive function, which helps people manage time, pay attention, multitask, plan and organize, remember details, and make correct decisions.

Parkinson’s dementia also has a slower rate of progression than either Lewy body dementia or Alzheimer’s dementia.

John says it is difficult to find any preventative measures of Lewy body dementia or Parkinson’s dementia because these two types are associated with changes in the brain that are not yet fully understood.

“Treatments for dementia include medications as well as lifestyle modifications,” he says. “I commonly

recommend that my patients get at least 30 minutes of exercise three times a week, which includes a brisk walk and some mild weight training.

“I also recommend that my patients stay active cognitively on a daily basis, and some common cognitive exercises I recommend are reading, writing, crossword puzzles, number puzzles, and games that involve verbal fluency, such as Scrabble, or card games that require memory and math skills, such as bridge.

“Playing games not only helps people stay sharp cognitively, it also helps people interact socially with others, which can also help keep your brain healthy.”

Normal Pressure Hydrocephalus Normal pressure hydrocephalus (NPH) results from excessive accumulation of fluid in the brain and may play a role in 5 to 10 percent of patients with dementia.

The fluid is called cerebrospinal fluid (CSF) and is produced within the brain’s cavities.

CSF acts to cushion and protect the brain from injuries and maintains the proper balance of nutrients within the central nervous system. When there’s an imbalance, CSF builds up in the brain,

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Thomas Psarros, MD, Chief, Section of Neurologic Surgery at Reading Hospital.

resulting in hydrocephalus.

“NPH is one type of hydrocephalus where this excess fluid accumulates in the fluid-filled chambers or ventricles of the brain,” says Thomas Psarros, M.D., chief, Section of Neurologic Surgery at Reading Hospital. “This results in the stretching of normal parts of the brain next to these fluid-filled areas and the symptoms of NPH.” Those symptoms include difficulty walking, decline in cognitive and thinking skills, and loss of bladder control— symptoms that gradually worsen over a long period of time.

“The earliest feature is most often gait dysfunction,” Psarros says. “Patients often walk with their body bent forward,

LET’S

legs held wide apart, and feet ‘glued’ to the ground. Thinking skills can also become affected, resulting in poor planning and decision-making, reduced concentration, memory loss, and changes in personality. Loss of bladder control generally appears in the later stages of the disease.”

According to Psarros, making a diagnosis of NPH can be challenging, as it tends to mimic other neurological diseases like Alzheimer’s and Parkinson’s disease. Various tests, such as CT and MRI scans of the brain, can determine if excess fluid is present and can help in diagnosing NPH. If these imaging studies suspect NPH, then CSF can be removed using

either high-volume lumbar puncture or external lumbar drainage to determine if there is any improvement in the patient’s condition. If there is, then they are candidates for surgical insertion of a CSF shunt, a long, thin tube that drains excess CSF from the brain to the abdomen.

“There are different types of shunts that can be used for this procedure, but programmable shunts have been used most often because the amount of fluid that is drained can be personalized for each patient,” Psarros says. “Shunting does not help everyone with NPH, and there is still uncertainty about how best to identify those most likely to benefit.

Like many other diseases, early diagnosis and treatment is the key to success.” )))

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housing

a little TLC makes downsizing doable Written by MEGAN JOYCE

Whether you’ve lived in your home for five years or 50, the prospect of moving is a daunting one. And by the time most baby boomers are ready to relocate or downsize their homes, they have acquired several decades’ worth of “stuff”—all of which now needs to be moved, stored, or gotten rid of.

From furniture to clothing to window treatments to your spouse’s thousandcount vinyl LP collection … it all has to relocate along with you. Fortunately, there are realtors and transition experts available whose specialty is exactly that: confronting the intimidating downsizing process.

With compassion, patience, and tact, these professionals can help you prepare your current home for sale; provide options for getting rid of unwanted items; and envision how your “stuff” will fit into your new house, transforming it into a new home.

“We create a plan specific to a client’s needs and help them through each step,” said Rocky Welkowitz, founder of Lancaster-based Transition Solutions for Seniors, LLC, and a certified Senior Real Estate Specialist (SRES®). “We provide as much or as little help as needed to bring the process to a successful conclusion.”

Oftentimes, boomers and seniors make the decision to downsize out of necessity. Because of this, many homeowners are already beginning the downsizing process from a place of stress.

“Often, people become unable—or unwilling—to continue with the upkeep required on a home, inside and out,” Welkowitz said. “Taxes are too high for a retirement income, stairs have become a problem, loss of a spouse, health issues—or friends have already downsized to more carefree situations and are loving every minute of their new lifestyle.”

Of course, a move can’t begin until the current home is put on the market and sold. Twila Glenn, SRES with the Twila C. Glenn Group at Realty RE/MAX Realty Professionals in Harrisburg,

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Twila Glenn shows potential buyers the benefits of downsizing, including walk-in showers.

partners with area independent living and assisted living communities to host educational workshops on downsizing and preparing a home to sell.

“I educate on the ‘HGTV Syndrome,’ as I call it—buyers wanting the end result of the homes like you see on the HGTV makeover shows but not having the cash to do those upgrades,” Glenn said. “So when a home that is updated and tastefully staged comes on the

market, buyers hop on it, as they would rather roll those upgrades into their mortgage than pay for them out of pocket.

“However, taking the family home that might not have any cosmetic updates in the last 20 years and turning it into one of these homes often takes time,” Glenn added.

With her background in banking and investments, Glenn can help sellers

Twila C. Glenn REALTOR® SRES® 717-350-0672 • Cell | 717-652-4700 • Office | 717-364-3343 • Fax 1250 N. Mountain Road • Harrisburg, PA 17112 www.glenngrouprealty.com • tglenn@glenngrouprealty.com Each office is independently owned and operated.

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evaluate the long-term cost benefit of making those upgrades and selling the home more quickly and at a higher price versus selling the home as-is at a reduced price.

“I like to provide statistics to back up these recommendations, such as the average return for de-cluttering, painting, replacing carpet, etc., as well as provide visuals as to what staged homes look like and what is selling quickly versus what is sitting on the market,” Glenn said.

A realtor obtains the SRES certification by completing a two-day course and achieving at least an 80 percent on its exam. They must also maintain active membership in the SRES Council, Glenn said. SRESdesignated realtors are qualified to address the needs of homebuyers and sellers over age 50 and to guide them through the relocating, financing, and selling process.

“Moving from the family home can often be an emotionally charged topic for seniors and their adult children, so SRES designees are trained on asking the right questions, being tactful and diplomatic in their approach, and showing empathy throughout the transaction,” Glenn said.

“Realtors with this designation ultimately enjoy working and interacting with seniors, understand that this can be a hard time for the family, and try to make it as stressfree as possible and are a resource to seniors and their adult children in all aspects of the sale.”

A prominent source of stress is determining which belongings, especially pieces of furniture, will be retained and brought to the new home—not to mention figuring out how those pieces can fit and be arranged in the new living space.

“Make a floor plan and measure, measure, measure!” Welkowitz advised. “We offer this service to

our clients, if needed, and it makes everything so much easier.”

As for the “stuff” that won’t be making the move, Welkowitz uses a variety of outlets for disposing of the items, apart from giving them to family or friends. Auctions, consignment shops, and donating belongings to charity are all options, as is employing an estate liquidator, a solution Welkowitz said “works beautifully for our clients.”

Both Glenn and Welkowitz agree that finding downsizing assistance focused on consideration and education—rather than selling—will make all the difference when it comes time to face the overwhelming moving process head-on.

“My experienced helpers are so very warm, kind, patient, caring, compassionate, and efficient,” Welkowitz said. “They know this can be a difficult, stressful time for many people and are naturally skilled in helping to lighten that burden in any way necessary.” )))

Moving Yourself or Moving Mom & Dad ... You Can Count on Rocky!

Licensed Realtor® With:

Dedicated to Making Older Adult Transitions Easier, More Economical, and Lower in Stress Please Call for a FREE Information Packet

Rochelle “Rocky” Welkowitz Founder

(717) 295-HOME

Direct Line: (717) 615-6507

Serving Lancaster County for over 30 Years!

Cost of living: • Medium family income $6,000 per year • Minimum hourly wage $1.25 • New house $15,000 • Gallon of gas 25¢ • New car $2,500 • Federal/State/Local taxes 20% • Fast food hamburger 20¢ • 1st class postage stamp 4¢ • Color TV set $400 • Refrigerator $500 • Tennis shoes $5 • Movie ticket 50¢ • Popcorn at the movie 20¢ • 45 rpm record $1 • Record album $3

Noteable Events of ’62: 02/14 - First Lady Jacqueline Kennedy gives “A Tour of the White House” via TV. Mare than 46 million people tune in.

03/01 - The first K-Mart and Walmart opens.

03/02 - Philadelphia 76er’s Wilt (the Stilt) Chamberlain scores a record 100 points in a game against the New York Knicks.

03/02 - JFK announces U.S. will resume above-ground nuclear testing.

05/25 - Isley Brothers release “Twist & Shout.”

06/25 - By a vote of 6 to 1, the Supreme Court bans prayer in public schools.

08/11 - Beach boys “Surfin’ Surfari” reached No. 14 and the flip side “409” charted at No. 76.

08/18 - Peter, Paul & Mary release their first hit, “If I Had a Hammer.”

12/08 - 1 14-day newspaper strike begins in NYC.

© 2014 BHH Affiliates, LLC. An independently owned and operated franchisee of BHH Affiliates, LLC. Berkshire Hathaway HomeServices and the Berkshire Hathaway HomeServices symbol are registered service marks of HomeServices of America, Inc.® Equal Housing Opportunity.

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veteran

some of the best life lessons didn’t come on the battlefield

Written by STEPHEN KOPFINGER

Warren Hengst at home with his wife, Maggie.

They happened later, when Warren Hengst, now 68, met a South Korean Marine in a hospital who inspired Hengst by his toughness. Hengst learned something else when he returned to United States shores in 1967 only to meet with antiwar resentment so intense he could not leave his own ship.

Somewhere in between, Hengst, a York County native who served with the 3rd Battalion 4th Marines, endured Parris Island, a drill instructor with a mean streak, a troopship crossing, having his parents told he had been killed, and, incidentally, having a helicopter pretty much fall on him.

And all of this came about and Hengst didn’t even set out to join the Marines.

“I was drafted into the Army,” Hengst remembers getting his marching orders in 1966. He remembers a group of seven comrades, fellow draftees.

“We were offered two years in the Marine Corps. I didn’t want that. I thought the Army was bad enough! But I didn’t want to be the odd man out.”

Still, Hengst admits, if he wanted any

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part of serving, “I was really more of an Air Force guy!”

But it was the Marines where Hengst did his part. He remembers Parris Island, the South Carolina Marine training facility noted for its ability to foster endurance.

“Parris Island! It’s nasty!” Hengst remembers. He also recalls training at Camp Geiger, an offshoot of Camp Lejeune in North Carolina.

There was a drill instructor Hengst never forgot.

“I was picked out as his ‘favorite.’ You take [punishment] for everybody else. I was his ‘favorite!’” Hengst emphasizes.

In many ways, Vietnam was a different kind of conflict than previous wars. It took a while for Americans

to learn about what was going on in a country people here didn’t think about much.

“I knew of one or two [from York County] who got killed,” recalls Hengst of his pre-military experience. “I just didn’t know much about [Vietnam].”

When Hengst was training, he admits being “in the mindset of World War II,” where, on many fields of battle, there was something of an established front.

But for Hengst, whatever his thoughts were had to wait. His timeline was frenetic, to say the least.

“My active duty started in January 1966,” Hengst says. Later, he crossed the Pacific Ocean on the General William Weigel, a transport ship left over from the 1940s. The ship was so big, the men

veteran ))) warren hengst

Above, from left: Celebrating a birthday, November 1967; Hengst, stationed in Quantico as an M.P., with his father in 1967; Hengst (with American flag), with Marine Guard Color Guard, of which he has consistently been a member since the ’70s.

had to be ferried ashore “right outside of Da Nang,” Hengst said. (Da Nang, ironically, is now a large tourist destination.) By the end of June that year, Hengst caught his first taste of war.

“A group of us were picked to do a beach landing in Da Nang. I was scared.”

Hengst did some nighttime patrols in Vietnam. He got firsthand knowledge of the country’s rainy season and learned how to smoke a cigarette in an environment that was both wet and hostile.

“You smoked it under your poncho,” he says.

Humid weather was also a threat to food.

But that was nothing compared to July 1966, when a helicopter came down the wrong way and gave Hengst a ticket to an American hospital in Guam, where he was laid up with a busted leg.

Hengst doesn’t take pity on himself. He remembers being transported in a military ambulance that was “full of other people. One guy had a broken back. He was in terrific pain.

I had no idea how it all happened.”

The ’copter that came down ended up flying again, but Hengst was out of commission. At one point, gangrene proved a threat to his fractured right limb.

“But they saved my leg,” Hengst says.

He did find inspiration in an unlikely source.

When Hengst was rehabilitating, he met a fellow

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Don’t get down.

Expect the worst, face it, and get tough.

”

Hengst with his grandchildren, Shaun and Kaylie, early 1990s.

York County Veteran Treatment court. Hengst is a mentor for veterans dealing with issues.

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When did elegant become so safe?

Our project designers are Aging-in-Place Specialists and also Certified Environmental Accessibility Consultants: trained to look for the areas in the home where better access may be needed or where potential hazards are located.

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York County

April 6, 2016 York Expo Center

Capital Area

August 25, 2016 Radisson Hotel Hbg.

Lancaster County Fall 2016

These events are FREE to attend.

Veterans (of all ages) and the military community and their families are invited to join us!

At the Expo

• Veterans Benefits & Services • Community Services • Products and Services Available • Support/Assistance Programs • Education/Training Services

At the Job Fair

• Employers • Job Counseling • Workshops/Seminars • Resume Writing Assistance

Hosted by:

Sponsor & Exhibitor Opportunities Available

www.VeteransExpo.com (717) 285-1350 www.olpevents.com

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patient who was a South Korean Marine.

Most Americans don’t know that South Korea had a presence in Vietnam, a country that was divided by civil conflict much as Korea was. “[He said] ‘we want to get on this [spread of communism] and stop this.’ They were tough, those South Koreans,” says Hengst.

The worst part of Hengst’s Vietnam experience was when his parents were told that he was “KIA – Killed in Action. They had already notified my parents,” Hengst remembers.

“When I got home, I saw how they had aged.”

The other distressing incident occurred when Hengst was shipped home. The vessel was actually delayed in the harbor at San Diego because of the hostile antiwar protestors who were there.

“Our ship landed probably before daybreak at San Diego,” Hengst remembers of that summer 1967 docking. “We could not even get off the ship until afternoon.

There were protestors with signs that said, ‘We don’t want you.’ It was strange, because California was a big [military] service area.”

Hengst did get home, and, among his career accomplishments, took up a job at the big Allis Chalmers Corporation. He operated machinery and married.

But after all of these years, Hengst has a connection with those who serve overseas today. Vietnam, he says, “was the previous longest war.” Today, conflicts in Iraq and Afghanistan have passed the 10-year mark, marked by military, political, and religious extremism.

“This is a whole society,” Hengst says of those who threaten our fighting forces.

Still, he says, “Don’t get down. Expect the worst, face it, and get tough.” )))

Written by PETE WISNIEWSKI

anniversary

remembering the iran hostage crisis 35 years later

Families wait for the former hostages to disembark the plane. It was the first time the former hostages were on U.S. soil since their release from Iran. Location: Stewart Field, N.Y.

It was a traumatic moment in our nationâ&#x20AC;&#x2122;s history, when every citizenâ&#x20AC;&#x2122;s breath seemed to be held in eager anticipation of what was to come.

Jan. 20, 2016, will mark the 35th anniversary of the American hostages being released from Iran after 444 days in captivity. It was a day of celebration and national pride as the 52 prisoners were set free, and hearts were put at ease knowing their fellow Americans were now safe.

It began on Nov. 4, 1979, as a group of disgruntled Iranian students stormed the gates of the American embassy in Tehran, Iran, and took 66 hostages. Over the course of the coming months, 14 captives were set free, but 52 remained for the duration of the crisis, while their nation waited, hoped, and prayed for

their safe return.

The outcome of the hostage crisis would ultimately change the course of a presidency and become an important emotional staple in American history.

More than 3,000 militant Iranian student protesters climbed the United Sates Embassy gate, fighting through

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))) iran hostage crisis

anniversary

From top: A group photograph of former hostages in the hospital. The 52 hostages spent a few days in the hospital after their release from Iran prior to their departure for the United States. The 52 former hostages board the VC-137B Freedom One aircraft for their departure to the United States after their release from Iran. Vice President George Bush and other VIPs wait to welcome the former hostages to Iran home.

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tear gas, to converge on the embassy on that morning. They then forced their way into the building and began rounding up personnel that included military officials, Marine guards, and embassy workers, who were then blindfolded and had their hands bound.

Workers inside the American embassy who were aware of the intruders began burning and shredding every classified document that they did not want seen by the Iranian people.

Meanwhile, stateside, President Jimmy Carter took action by freezing billions of dollars in Iranian assets anywhere he could and instilled an embargo on Iranian oil. Still, the Iranians refused to release the hostages and were demanding the shahâ&#x20AC;&#x2122;s extradition to Iran, who months earlier had been accepted to the United States for medical treatment.

The television station ABC started a program called Taken Hostage, which gave a nightly update of the hostage crisis and commented on live coverage in Tehran. The show was a way for Americans to stay tuned into what was happening and provide a feeling of connectedness to those who were captured.

Yellow ribbons were also tied around tree trunks throughout the country in support of the hostages, another way the citizens proved the solidarity of the country.

With not much progress being made diplomatically, a covert rescue mission was planned and it was launched on April 24, 1980, in an attempt to liberate the captives and bring them back home. A combination of unfortunate mechanical

anniversary

in the past few years, mostly due to the 2012 movie Argo, which chronicled the endeavor.

In the fall of 1980, the exiled shah died of cancer. In September, Iran agreed to begin negotiations for the hostages’ release. In exchange, the United States turned over $8 billion of Iran’s frozen assets and agreed to abstain from interfering in Iran’s internal affairs in any capacity.

The United States and Iran came to an agreement on Jan. 19, 1981, but the hostages were not released until Jan. 20, the day President Ronald Reagan was

sworn into office.

Soon after Reagan was inaugurated, a plane carrying the 52 remaining hostages left Tehran for a U.S. Army base in Germany. The now former president, Jimmy Carter, had announced the captives were “alive, and well, and free.”

For 444 days, 52 brave and resilient Americans underwent the traumatic experience of being in fear for their lives, enduring sleep deprivation, mock executions, and other horrible acts. Their safe return marked a day of celebration for Americans, and the country was able to breathe a sigh of relief. )))

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errors and sheer bad luck would cause the mission to go horribly wrong. A helicopter and a plane collided in a sandstorm, resulting in eight soldiers losing their lives.

The CIA launched another extremely covert but successful rescue operation during the crisis. The mission was dubbed the Canadian Caper: to sneak out of Iran six American embassy workers who had made their way to the Canadian embassy.

The operation involved disguising them as members of a Canadian film crew on a scouting location for a movie.

The mission has gained great popularity

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Jeff Davis ))) Age: 59 ))) Location: Paxtonia, Harrisburg ))) Born: Furth, Germany, August 1956 Adopted in September 1957

What is the best memory you have from your childhood?

Growing up as an Army brat was a thrill. I was able to live in and visit areas all around the U.S. I met many wonderful people and experienced different lifestyles: from rural Pennsylvania; to the plains in Kansas; to Indian territory in Oklahoma; to Southern living in Alabama; to Glendale, Calif. city life; and the political world and craziness around the Washington, D.C., beltway.

My favorite time had to be in Fort Sill, Okla., [at] the U.S. Army Artillery training center. My dad would occasionally take me with him when the training battalion he commanded would go out for night training. The canon fire in the darkness of the Oklahoma plains was far more exciting than any fireworks display. On top of that [were] the Indian graveyards and the jail where the U.S. Army kept Geronimo imprisoned.

What was your favorite outdoor childhood game?

My summers, wherever I lived, were kept busy playing baseball. I learned to play every position and was named

) ))

Jeff at 4 years old.

an All-Star as both a second baseman and shortstop. This is where the challenges of being an Army brat came into play. I was never able to play with the All-Star teams because we would have to move. But, it was one of those things you learned to accept.

Where are you in life now?

With all the experiences of growing up, the travel and the people, the best part of my life is now. I have a wonderful wife, Pam, of over 33 years. And there’s our son, Louis, and his wife, Beth, and of course the grandchildren, Charlie and Bea. They are all my life and love.

Finally, as time winds down toward retirement, Pam and I are looking and preparing for our future enjoyment.

Our beach house in Lewes, Del., is our getaway as often as possible. And now, to make it even more exciting, we have replaced the old Harley-Davidson Sportster with a new Tri Glide. No more holding up a two-wheel bike. The “trike” is the way to go. We take it everywhere we can. We are planning some day trips on it now. Yes, the best days are ahead of us.

Jeff in the fifth grade.

Right: High school graduation in 1974.

Below: Jeff and his wife, Pam, on their HarleyDavidon Tri Glide.

Read more of Jeff Davis’ story online at www.bmagazinepa.com/goodvibrations.

What memories would you share? To be considered for a future good vibrations column, please visit www.bmagazinepa.com

Please, Join Us! E March 12, 2016 9 a.m. – 2 p.m.

Hershey Lodge

325 University Drive Hershey

Shoppin g fun for w & ome of all age n s!

Demonstrations • Exhibitors Health & Wellness • Beauty • Door Prizes and more!

For guest registration,or for more information, go to:

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FREE advance guest registration online! ($5 at the door)