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To Your Health! A SPECIAL SECTION OF THE RIVERTOWNS ENTERPRISE

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OCTOBER 6, 2017

Prediabetes now and in your future By LAURIE SULLIVAN

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rediabetes is silent and could be lurking when we least expect it. But the risk factors are clear. Prediabetes, the precursor to Type 2 diabetes, can happen to people with specific risk factors, including being overweight especially with a lot of abdominal fat, and those of us given to inactivity or at least not getting enough exercise. Genetics and family history play a huge role in being predisposed in developing prediabetes, as do certain ethnic groups. According to the Mayo Clinic’s website, people with prediabetes don’t process sugar (glucose) properly anymore. As a result, sugar accumulates in the bloodstream, instead of doing its normal job of fueling the cells that make up muscles and other tissues. According to the site, insulin comes from, the pancreas, a gland located behind the stomach. Your pancreas secretes insulin into your bloodstream when you eat. To cut to the chase, when you have prediabetes the process of processing glucose in the pancreas begins to work improperly. Instead of fueling cells, sugar builds up in your bloodstream and high blood sugar occurs when your pancreas doesn’t make enough insulin or your cells become resistant to the action of insulin or both. This is reason enough to take action if you are at risk, even if you feel fine.

Prevention solutions Dr. Jeffrey Powell is chief of endocrinology at Northern Westchester Hospital and an endocrinologist at CareMount, an outpatient clinic in Mount Kisco. He sees patients with prediabetes and diabetes conditions and those with glandular and other hormonal issues. When treating patients with prediabetes he recommends lifestyle changes to be of the upmost importance. That includes diet management and exercise. There are some medications that could also be prescribed, but Dr. Powell believes patients should try lifestyle changes first. If someone is prediabetic and fails to improve their blood sugars, “We would use some diabetes medicine.”

Internists sometimes refer patients to Powell, but often he sees patients for unrelated issues and it turns up. “If patients have a first-degree relative or many second-degree relatives [with diabetes], you should screen,” he said. Someone who is overweight or had gestational diabetes when they were pregnant should also be tested. Dr. Powell said most people try to modify their diet and exercise. He said because prediabetes has no symptoms it’s hard to get people to change their dietary habits and physical exercise “if they’re not feeling any different.” They may also have high blood pressure as well. “I think if they know someone who has dia-

betes and seen the effects it of it, they are more likely to do something about their own issues,” Dr. Powell said. In addition to family history and genetics, he stressed that those of African American, Latino and Native American descent are more predisposed to getting diabetes. There may be a higher incidence of being overweight. Dr. Powell said there are a couple tests to screen for prediabetes, including a fasting glucose or oral glucose tolerance test and hemoglobin A 1 C, showing the range of normal values, prediabetes values and diabetes values. Continued on page 9A

Happy feet make life much more sweet

INSIDE

By MAJA TARATETA

5A Sleep: How to get what you need..........2A Reducing knee and hip pain without surgery, prescriptions................. 3A Pain, mystery symptoms: autoimmunity is on the rise...................... 4A Good relationships are key to maintaining good health...................... 5A Auditory therapies for brain health.......... 6A Opioid Crisis: Collaboration needed for addiction treatment............... 8A Top 5 Diet Tips...................................... 10A Endpaper: Got a symptom? Don't wait to get help like I did..............12A

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h, my aching dogs!” It’s an expression that signifies that feet are tired, sore or in serious pain. The reasons behind foot ailments are many. Bunions, ingrown toenails, fungus, plantar fasciitis, hammer toes, warts, deformities and sports injuries top the lists of reasons that patients are running — well, limping — to the podiatrist’s office. But many don’t go right away. “People accept their foot pain,” said Dr. Ryan Minara, DPM, a podiatrist at the Center for Pediatric Care & Sports Medicine in Manhattan and White Plains. “They feel foot pain is natural and their feet should hurt. To some extent this is true — feet can often feel tired. But pain is a sign that something is wrong that should be addressed.” Podiatrists are doctors who specialize in

and treat conditions of the foot, ankle and related structures of the leg. They complete four years of medical school training and currently three years of residency. They can be board certified. And they are on the front lines of diagnosing and treating the feet of patients of all ages and with a variety of other medical issues. “Everything begins with the foot you inherit and how it functions after that,” said Dr. Stuart Bernstein, DPM, who has a practice in Manhat-

tan and Hastings-on-Hudson. “You need to look at feet though the lens of foot mechanics, or as I like to call it, the lost art of podiatry.” A self-described conservative, holistic podiatrist, Dr. Bernstein believes that many foot ailments can be traced to the way patients walk and the shoes they wear. “You can get an infection from a bad pedicure or cutting your nail the wrong way,” he said. “But the usual reason that people don’t get better is their way of walking.” Believing that some doctors are overly eager to perform surgeries on patients rather than investigate biomechanics, Bernstein said he has decided to focus his practice on making custom orthotics to help people’s feet function better. Dr. Bernstein prescribes orthotics for many foot concerns, even bunions. “You can put an orthotic in a shoe, walk a different way, and the bunion can feel Continued on page 13A


Page 2A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

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f you’re reading this, there’s a good chance you’re not getting enough sleep. You could probably use a nap — and you’re not alone. Data from the Centers for Disease Control and Prevention (CDC) shows that about 70 million U.S. adults report sleeping six hours or less on average. This is well below the seven or more hours of nightly sleep that the American Academy of Sleep Medicine (AASM) recommends for optimal health. It’s important for you to get the sleep you need. No matter the age, children and adults report improved alertness, energy, mood and wellbeing when enjoying healthy, consistent sleep. However, with different sleep needs for each family member, making sure that everyone gets the sleep they need can be a real challenge. Therefore, families should make it a priority to adopt routines that fit each individual’s unique lifestyle and sleep needs. Whatever your situation, these four tips can help you and your family get on a consistent sleep schedule, sleep better, and in the process, lead healthier lives: 1) Use a bedtime calculator. The National Healthy Sleep Awareness Project has developed a bedtime calculator that can help you generate a customized sleep plan. Simply visit projecthealthysleep.org and enter your age and wake-up time. The calculator will tell you what time you need to go to bed to get an adequate amount of sleep. This personalized calculation can help you and your loved ones keep a schedule that allows everyone to get the sleep they need. The AASM recommends that each age group get the following amount of sleep on a regular basis, including naps for infants through age 5: · Infants 4 to 12 months old: 12 to 16 hours · Children 1 to 2 years old: 11 to 14 hours · Children 3 to 5 years old: 10 to 13 hours · Children 6 to 12 years old: Nine to 12 hours · Teens 13 to 18 years old: Eight to 10 hours · Adults: Seven hours or more. 2) Limit your screen activity. It may be tempting to watch television and scroll through apps until you fall asleep, but this is one of the worst bedtime habits. The blue light emitted from phones, tablets and laptops resets your circadian clock and tricks your brain into thinking it’s time to be awake. Late-night screen time is one of the most common sleep hygiene violations, and a new study links binge-watching in young adults with poorer sleep quality, more fatigue and increased insomnia. To promote responsible screen time, the American Academy of Sleep Medicine recommends setting an episode or time limit each night; using one of the apps for your computer, tablet and smartphone that filters out blue

light; avoiding use of mobile devices while in bed; and turning off all screens at least a half hour before your bedtime. 3) Implement a relaxing routine before bed. Studies have shown that children sleep better when they have a bedtime routine. Parents should develop a consistent, nightly routine that includes relaxing, calming activities, like reading a story before bed. Whatever your age, it’s important to turn off your computer or television at least 30 minutes before going to bed. Prepare to go to sleep by doing something relaxing, whether it’s reading, writing in a journal or taking a warm bath. 4) Add daily exercise to the routine. Many people lead busy lives that are mentally tiring, but consist of little to no physical activity. This can be a recipe for a poor night’s sleep. Contrary to what you may believe, you don’t have to do an exhausting workout to sleep better. Even small amounts of routine physical activity may improve your sleep and overall well-being. Getting enough sleep isn’t just a matter of feeling well rested and alert: it’s a necessary component of good health. Sleeping six hours or less per night increases the risk of a stroke, coronary heart disease, diabetes and obesity. Insufficient sleep is such a widespread problem that the CDC has named insufficient sleep a public health problem. Therefore, it’s important to remember that healthy sleep is not a luxury — it’s a necessity. If you’re having trouble sleeping, help is available at more than 2,500 sleep disorders centers that are accredited by the American Academy of Sleep Medicine. For more information, visit aasmnet.org. — BPT

To Your Health! A special section of

The Rivertowns Enterprise 95 Main Street, Dobbs Ferry, NY 10522 (914) 478-2787

www.rivertownsenterprise.net

PUBLISHER..................................Deborah G. White SECTION EDITOR.....................................Todd Sliss ART DIRECTOR............................. Ann Marie Rezen AD DESIGN.......................................Suzanne Brown AD SALES.......Marilyn Petrosa, Thomas O’Halloran, and Francesca Lynch ©2017 W.H. WHITE PUBLICATIONS, INC. ALL RIGHTS RESERVED. REPRODUCTION IN WHOLE OR IN PART IS FORBIDDEN WITHOUT THE PUBLISHER’S WRITTEN PERMISSION.


Friday, October 6, 2017 | The Rivertowns Enterprise

To Your Health! | Page 3A

Reducing knee and hip pain without surgery, prescriptions

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By MARY LEGRAND

here are many reasons why someone might experience knee and hip pain over the course of his or her lifetime, and, not surprisingly, numerous ways to possibly reduce that pain. On arthritis.org, the website of the Arthritis Foundation, experts advise that those who are in pain may have even more options than they might first realize. Potential non-drug treatments include education and self-management; exercise; weight loss; acupuncture; balneotherapy, or bathing in warm mineral springs; transcutaneous electrical nerve stimulation, or TENS; the use of knee braces, sleeves and other devices; and the use of canes and crutches. In addition to traditional treatment, one option is chiropractic care. Dr. Marc Kaplan, DC, CCSP, with a specialty in sports medicine and rehabilitation, is with Hastings Chiropractic and director of the Center for Balance, Gait and Fall Prevention at Hudson Valley Cerebral Palsy Association in Brewster. “A 2006 CDC survey of adults reported that 30 percent of all adults experienced ‘pain’ of some sort in the past 30 days,” Dr. Kaplan said. “Knee pain accounts for 18 percent, hip pain accounted for seven percent, tied with finger pain. Shoulder pain accounted for nine percent, and the most common pain was that of the lower back [27 percent], followed by neck, and headache [15 percent].” The causes of knee pain are “many and varied,” Dr. Kaplan said, “Primarily due to the fact that the knee joint is fairly unstable, given the kinds of stresses we subject it to. Biomechancally, Continued on page 12A

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Page 4A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

Pain, mystery symptoms: autoimmunity is on the rise By JENNIFER LEAVITT

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ore and more people are heading to doctors with vague complaints of malaise, fatigue and a wide variety of strange and mysterious symptoms. It is no coincidence that this trend comes at a time when autoimmunity is on the rise at an alarming pace. Autoimmune disease occurs when the body mistakenly recognizes some aspect of itself as a foreign invader, and then attacks it. The most common result is inflammation, which can lead to anything from indigestion to difficulty breathing. Autoimmune diseases are often great imitators of other conditions, usually have no concrete diagnostic tools and can be entirely confounding to both patient and physician. They can also wax and wane, flare up and then make a quick exit, usually right about the time a patient steps into a doctor’s office to be examined. One of the additional challenges is that autoimmune diseases are not typically grouped into one category. Instead, each of these 100 or so diseases is handed over to some other specialty, whether it is endocrinology, gastroenterology, rheumatology or something else. Autoimmunity does not have its very own experts. If it did — and these 100 disease were categorized together — autoimmunity would compete with cancer and heart disease for a top spot. It would also command a lot more research and funding. For the time being though, health statistics estimate that it takes an average of four years to correctly diagnose an autoimmune disease. And once diagnosed, successful treatment is not necessarily forthcoming. The stress of feeling ill, but not being able to pinpoint a specific cause or treatment, can be debilitating. These diseases are not rare. According to the U.S. Department of Health and Human Services, 23.5 million Americans have one. And while 80 percent of patients are female, many men also experience autoimmunity. Common symptoms While autoimmunity can manifest in hundreds of ways, there are a handful of symptoms that show up most frequently across the breadth of autoimmune disease. These include: • Joint and muscle pain or weakness • Tremor, shakiness, or rapid heartbeat • Weight loss or weight gain • Insomnia or severe fatigue • Heat or cold intolerance • Recurrent hives, rashes, or sun sensitivity • White patches or skin discoloration • Difficulty concentrating or focusing • Mouth sores or patches • Abdominal pain • Blood or mucus in the stool

• Dry eyes, mouth or skin • Numbness or tingling • Fertility problems, miscarriages or blood clots • Random or shooting pains • Thrush, yeast infections or other frequent infections. Common diseases Those who can actually get a diagnosis relatively quickly are among the lucky. Among the most debilitating and most easily diagnosed are: • Rheumatoid arthritis, in which the the immune system generates antibodies that gather in the joints, causing inflammation and pain. In time, the damage becomes permanent. • In Systemic lupus erythematosus, the antibodies migrate throughout the body, attaching to blood cells, joints, nerves, lungs, kidneys and other areas. • Inflammatory bowel disease attacks the intestinal lining, leading to digestive problems, diarrhea, fever, rectal bleeding and weight loss. Crohn’s disease and ulcerative colitis are the two major forms of IBD. • In vasculitis, the immune system attacks the blood vessels anywhere in the body, and potentially everywhere, causing a wide variety of symptoms in many organs. • Multiple sclerosis involves an autoimmune attack against nerve cells, which manifests in muscle spasms, blindness and poor coordination. • In Guillain-Barre syndrome, nerves are

also the target, but this condition is temporary. It results in weakness and sometimes paralysis. Chronic inflammatory demyelinating polyneuropathy is similar, but can last much longer. Myasthenia gravis attacks nerves as well, causing drooping facial muscles, double vision and unsteady gait. • In psoriasis, the immune system produces T-cells so quickly that they amass on the skin, producing silvery, scaly plaques. • Two different autoimmune diseases can affect the thyroid gland. In Grave’s disease, the antibodies stimulate excess amounts of hormone, creating weight loss, nervousness, irritability and rapid heart rate. In Hashimoto’s thyroiditis, antibodies destroy the thyroid gland until it’s no longer working. Hashimoto’s causes fatigue, weight gain, depression, constipation, dry skin and cold sensitivity. Cracking the case For those with a harder to crack case, there is much detective work needed. Patients with autoimmune disease are often frustrated when physicians seek to treat symptoms without doing more to determine the underlying disease process. It can be a laborious process, but the best way to find most effective treatments is to have a clear understanding of the specific autoimmune pathology. There are a few key strategies and one very important strength: persistence. Providers should order antibody blood tests,

for starters. Although not all autoimmune diseases produce autoantibodies, some do. The antinuclear antibody (ANA) test is most important. A positive result won’t prove disease, but high levels strongly suggest lupus, scleroderma, juvenile arthritis or other conditions. Next up is an organ function tests, to determine whether the kidneys and liver, in particular, are functioning properly. Patients should ask for a comprehensive metabolic panel, complete blood count and urinalysis. It is also important to track symptoms carefully, including details about when they appear, and to review and share family history with physicians. Sometimes something that seems completely irrelevant will tip a clinician off. Autoimmune disease can affect different body parts or systems, even rotating between them from one day to another. Because symptoms can be so non-specific, having to see a number of specialists may be par for the course. Just because they can’t figure it out right away doesn’t mean they never will. There is no specific test for autoimmunity. Lack of diagnosis or misdiagnosis are both common. It is also the case that patients with not-yet-diagnosed autoimmune diseases may be told they are “just” experiencing stress. Patience, too, is a virtue when it comes to diagnosing autoimmune disease, but no one should get too patient, lest they forget to be persistent and insistent.

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Friday, October 6, 2017 | The Rivertowns Enterprise

To Your Health! | Page 5A

Good relationships are key to maintaining good health 
By BRENDA BOATSWAIN

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here has been a lot of press, including the New York Times and Ted Talk, about the Harvard 75-year adult development study that tracked the physical and emotional well-being of two populations: poor men growing up in Boston from 1939 to 2014 and male graduates from Harvard’s classes of 1939-1944. The study found that “good relationships keep us happier and healthier.” In fact, the American Psychological Association in the September 2017 issue of the journal American Psychologist published a special issue entitled “Close Family Relationships and Health” in which the current thinking and research on relationships and health is elucidated. The convergence of relationship science, health psychology and neuroscience research have shown that the presence and quality of close relationships can affect physical and mental health and length of life. Here’s a look at some of the research findings on the possible links between relationships and health across the life span: • Emotionally responsive, warm and nurturing parents promote securely attached infants who become resilient and competent adults. • Close, positive childhood family relationships can serve as a buffer against stress.
 • Higher levels of parental caring in college age adolescents related to lower likelihood of chronic conditions such as cardiovascular disease 35 years later.
 • Chronic negative interactions may promote poor health by disrupting cardiovascular, endocrine and immune functioning.

• Persistent social conflict linked to higher rates of mortality.
 • Throughout adulthood, being socially connected and having access to social support are related to better health. • Aging adults with social ties have reduced risk for cognitive and physical decline and overall mortality. Research and the medical community has given clear guidelines of lifestyle choices that promote good health: eat fruits and vegetables, get adequate sleep, exercise and manage stress. We can now add making connections to this list. Having close ties can now be considered an important health behavior. The next step is to develop and support interventions to improve social relationships. Interventions to improve social relationships can play a vital role in one’s physical and mental health. One such intervention is group work or group therapy. Group therapy is a small group of people working on developing skills to have a healthier relationship with their individual self and others with the help of a trained facilitator in a supportive environment. What social goals do you have to improve the quality of your relationships, life, and health? Maybe you have thought about managing your social anxiety or improving your marital relationship or parenting skills? Well, there’s a group for that. 
Brenda Boatswain, Ph.D., CGP is a local licensed New York psychologist and certified group psychotherapist, educator, author and speaker trained in evidenced-based mind-body-spirit practices with over 20 years of experience as a trusted professional. Learn more at www.godsendpsychologist.com.

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Page 6A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

Auditory therapies for brain health

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By JENNIFER LEAVITT

he research is in: our brains can be manipulated by sound in fascinating ways, aiding in cognition, attention-deficit/ hyperactivity disorder, even Alzheimer’s. At first blush, the ear would seem merely to be a vessel for the everyday sounds that we need to process in order to make it through life: the sound of a friend or colleague talking, the rush of a car coming up the street and the beep of its horn so we can get out of the way. But what happens to the brain when the soundwaves reach it? Scientists have long been exploring this question. What they have learned over the decades confirms what humans have probably known inherently for millenia, that sound has a profound affect on cognition, emotion and even neurological health. Music therapy, sound therapy and brainwave synchronization (“entrainment”) have all been used successfully to improve cognition, depression, anxiety, ADHD, dementia and other conditions. When certain sustained soundwave patterns enter the ear, our brainwaves play follow the leader, mimicking those patterns until soundwave and brainwave patterns appear identical. Because sound can be produced, replicated and manipulated by humans, scientists realized how possible passive observational studies and development of specific therapies really is. There are five major brainwave states that

humans most often manifest: · Delta, which most people produce when sleeping, ranges from 0.2 Hz to 3 Hz. With delta and sub-delta brainwaves, people tend enter an entirely dissociative state. • Theta waves are active during daydreaming, intense creativity, or falling asleep, and are in the 3-8 Hz range. • Alpha waves occur when we are awake but relaxed at 8-12 Hz, also the typical range during meditation. • Beta waves, which are common during wake-

fulness and alertness, have a range of 12-30 Hz. • Energetic, high achievers are frequently in the beta range, a state not nearly as familiar to those with ADHD, autism or other cognitive challenges. These people are instead more likely to be in a gamma wave state, at 30 Hz or higher, where intense cognition an introspection take place. A group of researchers in California theorized that children with ADHD would benefit from brainwave synchronization, also known as entrainment. To decrease theta waves, the children were first entrained to a mu-alpha rhythm (7-9

Hz). Afterwards, the session focused on SMRbeta waves. The subjects exhibited significant improvements in inattentiveness, impulsivity, variability and overall behavior. A right-brain entrainment protocol is being used as an Adderall alternative in children. A series of school-based studies worked with children who have ADHD as well as those without, using entrainment to successfully influence Continued on the next page

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Friday, October 6, 2017 | The Rivertowns Enterprise Continued from the previous page

cognition and improve attention, non-verbal skills, memory, attention and GPA, using alpha and beta stimulation. Yet another trial set out to influence academic skills using entrainment. It started with a frequency of 14 Hz and slowly ramped it up to 40 Hz. Afterwards, the facilitators started at 30 Hz and slowly tapered down to 14 Hz, over a period of six weeks. When the process was complete, the children had a measurable improvement in their arithmetic abilities. Ongoing research has revealed that children with learning disabilities have lower beta waves. Through beta stimulation protocols, however, these children achieved a reduction in their LD symptoms and an increase in GPA. Other scientists have been focused exclusively on Alzheimer’s Disease, in which beta amyloid proteins form plaques in the brain and kill nerve cells with an end result of worsening dementia. Research from Washington University School of Medicine in St. Louis revealed that when a person’s brain is in a delta brainwave state, beta amyloid production ceases and the disease-related toxins are removed. Longer-term studies are ongoing to quantify the benefits of brainwave entrainment in Alzheimer’s Disease. Music therapy has also shown promise in this group. When people with Alzheimer’s Disease listen to music they were once familiar with and sing karaoke songs, neural activities in the right angular gyrus and left lingual gyrus increase considerably. It appears to improve neuroplasticity in the AD brain. There is little double that entrainment actually works. The question is, how are we going to be using it in the future?

To Your Health! | Page 7A

Iyengar Yoga a transformative method Iyengar Yoga is a profound transformative method of learning yoga. Aligning mind, body and breath, Iyengar Yoga quiets the senses, enabling connection to self and transforming life’s journey. Students develop coordination, flexibility, balance, strength and stamina. Using physical alignment as a starting point, Iyengar Yoga encourages the spread of intelligence throughout the body, the growth of self-awareness, and an experience of the asanas as a form of “meditation in action.” In B.K.S. Iyengar’s teachings, the yoga asanas and Pranayama — the control of the breath — create the springboard that allows students to penetrate beyond the outer physical layers and explore spiritual connection. Students in Iyengar Yoga begin with basic standing poses. In time, forward bends, back bends, twists, inversions and restorative poses are taught. As students mature, so does the practice. Teachers may use props such as blankets, blocks, belts and wall ropes to help students benefit from the poses with modifications for individual needs adapted for their physical condition and level of experience. As a certified Iyengar Yoga teacher with over 20 years of experience, Nancy Kardon of Scarsdale knows how to guide students of all ages and abilities. Her ability to clearly demonstrate postures, sharp observation and effective teaching skills help students mature and progress. Visit yogascarsdale.com or contact nkardon@gmail.com or 629-1994.

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Page 8A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

Singh’s yoga journey leads back to U.S.

OPIOID CRISIS

Collaboration needed for addiction treatment By DR. ROSS FISHMAN

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s Innovative Health Systems closes out its 32nd year in October, it is also celebrating six years of being the first clinic in Westchester County to provide medically-assisted (MAT) treatment to opioid dependent patients. As Richard Juman, PsyD, recently pointed out, “The rise of Suboxone and other buprenorphine-based treatments for opioid-use disorders… has created an environment in which thousands of opioid dependent people are now able to receive MAT for their disorder. Dr. Ross Fishman reminds us that we are still in the early stages of MAT, and that there is no consistent formula for either prescribing buprenorphine or weaning people off of it. Additionally, many people receive MAT in private offices with little or no psychosocial treatments for addiction available… [in contrast to] a preferred treatment environment in which prescribers, counselors and therapists are all working together in one integrated model of treatment for opioid use disorder.” It is necessary to acknowledge the growing concern as opioid use and opioid overdosing appear to be spreading across the country, a growing problem of prescription drug misuse, heroin misuse, the overdose deaths attributed to both, the increasing presence of fentanyl in

bags of heroin and the lack of accessibility to treatment. Buprenorphine is a valid, medically proven assisted treatment for heroin addiction and its availability and proper use make for the most effective treatment approach, physiologically and psychologically. Nevertheless, the ongoing misunderstanding of the nature of opioid addiction — its long-term impact on the structure and function of the brain and the psychological impact on the user — continues the groundless argument that these medications are “just substitutes.” It must be emphasized that MAT was never intended to be a stand-alone solution. The federal guidelines that made buprenorphine available — the DATA 2000 legislation — recommend that the physician “should pursue a team approach to the treatment of opioid addiction including referral for counseling and other ancillary services,” and to use toxicology tests to indicate that patients are free of illicit drugs. Unfortunately, physicians are not bound by these guidelines that define complete or best practice. As a result, some patients are receiving a necessary, but not sufficient, component of treatment that can lead to effective recovery. There is a disconnect, therefore, between many prescribing physicians in private practice who do not refer to substance use disorder professionals — psychiatrists, psychologists,

social workers, mental health counselors and addiction counselors — who attend to the psychosocial aspects of people seeking recovery. To repair the disconnect, prescribers and therapists must work collaboratively; they should be in frequent contact so that physiological and psychological progress can proceed concurrently as much as possible. At Innovative Health Systems, our certified medical director and the counseling team confer frequently. Toxicology results are shared, urine specimens are obtained before each medical visit and sometimes more than once a week. Initial prescriptions are limited to once a week for the first 12 weeks, then longer if the patient is showing progress toward treatment plan goals. Treatment outcomes for opioid use disorders can be improved through an approach that comprises the medically-assisted benefits of buprenorphine, ongoing counseling to build relapse prevention strategies and harm reduction psychotherapy that focuses on both the developmental roots of drug-using behavior and the plans that strengthen the patient’s path to recovery. Dr. Ross Fishman, Ph.D. is president of Innovative Health Systems, which has recently relocated to 20 Church St. in White Plains. Visit innovativehealthsystemsinc.com.

As a dedicated yoga teacher for the past six years, Shivani Singh has helped her clients improve their health and reach their goals. Her practice can be described as an eclectic amalgam of her personal experiences which she uses to design programs that fit her client’s needs. Singh’s yoga journey started in 2008 in India to lose weight. In 2012, she moved to Singapore, where she began to practice a host of different styles of yoga. Organically, Singh also began to incorporate kettle bells into her practice, augmenting the core yoga values of focus, balance and breath work. Moving back to New York in 2014 she completed her teacher training with the goal of making yoga safe and accessible for everyone. Singh believes that Yoga is not a randomness of poses and just inhale and exhale — it’s a structured way to fuse the physical movement with various breathing techniques. Yoga helps lower resting heart rate and calms the mind, brings clarity in thoughts, emotions, speech, food and limits consumerism. Over the years she has given workshops, taught at Hunter College to kids with special needs, worked with heart patients, those with chronic back problems, athletes and many more. “I’ve studied yoga on and off for over 15 years and I never found a class that enabled me to progress beyond an upper beginner level until I began practicing with Shivani,” said Judith Hirschman. “Her classes can be challenging, but she makes them accessible for a wide variety of levels. She is clear, compassionate, and highly knowledgeable.” Singh, of Scarsdale, can also be found at Westchester Yoga Arts. Visit shivaniyoga.nyc and ShivaniYoga on Facebook or email shivanichauhan@yahoo.com.

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Friday, October 6, 2017 | The Rivertowns Enterprise

To Your Health! | Page 9A

PREDIABETES Continued from page 1A

Tests should be repeated more than once before categorizing someone as prediabetic, he noted. At annual physical exams, many doctors do tests if they have a patient that has any of these issues. “I think the tests is done quite a bit,” Dr. Powell said. So how likely will someone with prediabetes develop diabetes? Dr. Powell said on average 15 to 30 percent without intervention. Most internists treat patients with diabetes, but if a patient is on many drugs and takes insulin he or she would go to an endocrinologist. Type 1 diabetes, an autoimmune disease, is more likely to occur in children or patients in their 20s. In Type 2 diabetes, your liver is producing too much glucose and/or there is inadequate pancreatic function. Essentially, it’s under functioning. In prediabetes there is the component of the liver making too much glucose and the pancreas not working to full capacity. Weight loss and exercise can increase sensitivity to insulin so that insulin works better to get the glucose out of the blood and into the cells in your body. High glucose levels damage your blood vessels. “That’s why people with diabetes develop eye problems, kidney problems, nerve problems and problems with their circulation,” Dr. Powell said. What can prediabetics do? Dr. Powell stressed how large a role diet plays in preventing diabetes. In studies they’ve compared Mediterranean diets, low carbohydrate diets and a Weight Watchers diet. He said, “Whatever you’re comfortable doing — all are good.” In terms of exercise he recommends 30 minutes of daily activity of moderate intensity: brisk walking, bicycling, using a treadmill. Any exercise that gives you a high-sustained heart rate is optimal for patients.

With diet and exercise you can significantly reduce the risk of developing diabetes. Some studies have shown these interventions to reduce risk by 50 percent. “That’s why it’s so cliché to say diet and exercise, but it really, really does help,” Dr. Powell said. A dietician weighs in Dietician Stephanie Casper at White Plains Physician Associates sees patients mainly at their New Rochelle office and one day a week in their Armonk office. She said prediabetes can be diagnosed in the A 1 C blood test, a blood glucose or blood sugar test that tests levels for the past three months. It is given based on a patient’s risk factor — heredity, being over 50 years old and in certain cultures who are more at risk. Casper described the A 1 C as a simple blood test that can be done as part of an annual physical. “If you are high risk they may start earlier,” she said. Since prediabetes has no symptoms the doctor would typically give the test if you are overweight and lead a sedentary lifestyle. Although this doesn’t cause prediabetes it does increase the risk if you have other risk factors like the genetic

component to developing diabetes. Casper recommends losing just five percent of your body weight and exercising at least 150 minutes each week to help avoid that jump to Type 2 diabetes. She recommended the DASH diet, which is the dietary approach to stop hypertension, the Mediterranean diet and others. “It’s obviously a precursor to diabetes so taking steps to do things to prevent diabetes is very important,” Casper said. “Diabetes can be a serious condition and should be managed by a doctor, a dietician, a complete health care team.” She added, “In general everyone should strive to have a healthy lifestyle, maintain healthy weight.” Early detection Internist Dr. Oxana Popescu in Hastings makes screening part of all her patients’ routine annual exams. She does an A 1 C test, which reflects the average level of a person’s blood glucose over the past three months. Tests are the same for prediabetes and diabetes. Patients in early diabetes can transition to the diabetes group and patients who have diabetes can come off some of their medications with weight loss. “Big weight loss does the trick, especially with

diabetes,” Dr. Popescu said. “There’s no rule of how much weight loss. I see improvement from 20 pounds. When they lose more than 20 pounds they can even come off medications or have them switched.” The doctor noted that patients who have weight loss surgery may even reverse diabetes and hypertension. “Most of the time patients with prediabetes, it’s not automatic that they develop diabetes,” she said. “We recommend having the hemoglobin A 1 C test done often.” If a patient has the gene, there is not much they can do about it, she said, especially if the patient is heavier and doesn’t exercise. That means more medications, which often have side effects. Though all patients are screened annually, for overweight patients Popescu would screen every six months. According to result values, she might have patients do other tests, including a threehour fasting glucose test, which might show if the patient is more prone to diabetes or may have full blown diabetes. “If a patients has a full-blown diabetes, they would urinate more often, crave more sweets, have numbness in legs and hands at night and lightheadedness,” Dr. Popescu said. For exercise, Popescu recommends an hour a day for at least five days a week. Patients should “maintain a healthy BMI [body mass index] that should come close to 25… There’s no study to tell you how much to lose, but just losing weight will help you feel better.” Listen to the doctor Endocrinologist Dr. Marvin M. Lipman of Scarsdale Medical Center and professor emeritus of clinical medicine at New York Medical College in Valhalla said prediabetes is almost always caused by resistance to insulin and seen in patients who have “a large circumference around the belly.” He explained it as metabolic syndrome, which means the risk factors in developContinued on page 11A

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Page 10A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

THE TOP 5

Diet Tips By JENNIFER LEAVITT

T

he dizzying and often contradictory barrage of dietary advice out there is enough to make a person reach for a doughnut. Healthy eating shouldn’t require supermarket scavenger hunts and a nutrition manual, but it can certainly feel that way. One hundred and five books could be written to cover all the perils and benefits of very specific ingredients and foods, but the scientific community has narrowed it down in no uncertain terms. A recent study in the Journal of Clinical Nutrition looked at which foods

and what portions reduced, increased or maintained mortality rates. A recent study published in the Journal of the American Medical Association reported that nearly half of all cardiometabolic deaths in the United States — those from heart disease, stroke or diabetes — “were associated with suboptimal intakes” of healthful foods. So which foods are most important? A rainbow on your plate Instead of obsessing about which green or berry is best, nutritionists make vegetables and fruits the cornerstone of every meal. The AHA recommends that at least half your plate

be filled with fruits and vegetables. The more we eat, the lower the chance of death from any cause — it’s that simple. Vegetables are most protective, but fruits are also enormously beneficial. (Although more research is needed, studies suggest that canned and frozen fruit may not confer the same benefits as fresh). To cover all the carotenoid, flavonoid, antioxidant and other nutritional bases, the best bet is to eat the widest variety of produce, combining as many colors and textures as possible. The chances of remaining healthy rise by 5 percent for each additional serving, up to five servings per day.

Those good fats The same JCN study showed a correlation between longevity and nut consumption. As few as 10 peanuts or tree nuts per day, or even just one or two for brazil and walnuts, can provide major cardiovascular and overall health benefits. The third most prominent dietary factor in the JCN study was fatty fish. Eating at least one serving per week increased wellness and decreased rates of disease. Another peer-reviewed study found that increasing consumption from one to three servings per week also resulted in substantial protection. In contrast, some 7.8 percent of cardiometabolic deaths have been linked to low levels of dietary omega-3. Salmon and sardines are good sources of omega 3. Remember though, that there can always be too much of a good thing. All fish has traces of mercury. Avoid those with the highest levels, such as shark, swordfish, king mackerel and tilefish. Eating up to 12 ounces (340 grams) per week of lower-mercury fish and shellfish, including salmon, shrimp, canned light tuna, catfish and pollock can keep omega 3 levels up to par. Although fish oils, which contain EPA and DHA, offer the most bioavailable source, vegetarians and vegans can choose walnut, canola, avocado, flax and chia seed oils, which contain ALA, a precursor to the omega 3s. Olive oil also contains ALA, as well as anti-inflammatory and immune protective components. A pass on processed “Processed food” has no single definition, but they are ever prevalent in our society. Unfortunately, pre-made or packaged snacks, meals and beverages often include a variety of chemicals to preserve color, flavor, taste, texContinued on the next page

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Friday, October 6, 2017 | The Rivertowns Enterprise

PREDIABETES Continued from page 9A

ing a disease such as diabetes and can also refer to heart attack and stroke. Young women with Polycystic Ovary Syndrome — symptoms include irregular periods and obesity — are also at risk for developing diabetes. PCOS and Type 2 diabetes are both obesity related conditions that share insulin resistance. Prediabetes is, said Dr. Lipman, “largely asymptomatic — it’s usually discovered by accident.” In patients with prediabetes, their fasting blood sugar is anywhere from 101 to 125. For diabetics it’s over 126.

To Your Health! | Page 11A

Dr. Lipman said 70 percent of people with prediabetes will develop diabetes within 10-15 years. He noted there are a few kinds of medications that make insulin work better, Actos and Metformin among them. For prediabetes the question often comes up whether to give medications. “I prefer to try lifestyle changes first for at least six to eight months,” he said. For weight loss Dr. Lipman prefers the Mediterranean diet, eating fish instead of meat, nuts, legumes, olive oil and other oils with relatively low saturated fat — the type of diet that gives rise to low blood sugar levels. “It all depends on how much you eat,” he said. “A calorie is a calorie. Fat makes you insulin resistant. If you do away with fat the less sensitive you are to your own insulin. Exercise helps in

the utilization of glucose and it uses any excess glucose you may have in the blood.” The standard recommendation of the American Heart Association and other medical societies is 30 minutes a day — 150 minutes per week — of moderate exercise like brisk walking or slow jogging. Dr. Lipman recommends for anyone over 55 who has been sedentary to check with their doctor, “Especially if you have high cholesterol or high blood pressure.” A diabetes prevention study done over 15 years and published in the New England Journal of Medicine showed you can reduce the likelihood 27 percent with diet and exercise. The study was done with a control group. With medication, it was 18 percent. “It was a well done study,” Dr. Lipman said. “It’s impressive if patients are compliant in losing weight and exercise.”

Continued from the previous page

ture and shelf life. They are usually high in sugar and salt, which are both threats to longevity when consumed in excess. Processed foods are typically chock full of refined carbohydrates, such as white flour. It’s common knowledge that whole grain is healthier, but many do not realize that white bread acts like sugar in the body. Whole grains were also cited in the JCN study. In addition, a meta analysis of multiple studies, published in the medical journal Circulation, showed that health and longevity increased by almost one percent with each 90g serving of whole grains consumed, up to an ideal intake of 225 grams per day. The take away is that foods should be in their most natural and freshest forms, prepared at home whenever possible. Go easy on the meat One of the most studied and suspect forms of processed foods is meat. Smoked and preserved meats have carcinogenic properties. Research shows that cold cuts, bacon, salami and sausage consumption should be limited to one serving per week. It is not only processed meats that are implicated though. Eating red meat, as it turns out, is also linked to several disease states and should be limited. Studies found that regularly swapping out red meat with poultry, fish, nuts, legumes or low-fat dairy was associated with increased longevity. Smart hydration Once in the body, beverages transport nutrients to every organ, regulate temperature and lubricate joints. Even mild dehydration can sap energy and compromise health. But the type of beverages we choose makes all the difference as well. Water is the best source of hydration, while sodas leach essential minerals from the body. There are some other beneficial choices as well, though. Herbal teas, green tea and even coffee have been the subjects of voluminous research showing their health benefits. It’s not too late Research by the department of nutrition at Harvard University recently found that “even modest improvements in diet quality could meaningfully influence” health and longevity. Adapting a healthier diet now, based on all the recent findings, can still dramatically improve health and add years to your life.

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Page 12A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

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the knee joint is like placing a table, upside down, on top of another table — stable so long as it ‘stays still.’ However, the ligaments, muscles and tendons surrounding it and acting upon it give it the stability needed to be extremely mobile. So injuries to the knee mostly involve overuse, poor postural mechanics and osteoarthritic change, and, rarely, due to rupture of the soft tissues that stabilize the knee, such as meniscus tears or ACL tears, which require non-conservative measures.” Causes of hip pain are less varied, Dr. Kaplan said, since the hip joint, defined as the acetabulafemoral joint, is “extremely stable,” a ball and socket joint that is “beautifully deep and strong, with strong ligaments.” Dr. Kaplan said the location of knee pain is easy for patients to describe: “You can point to the pain, either on the inside of the knee, the outside of the knee, over the kneecap [patella], or in the back of the knee.” Hip pain is more difficult to describe, he said, “because many patients will describe having ‘hip’ pain when, in fact, they really mean pain of their lumbosacral spine [low back and side of their pelvis], their sacro-iliac joint [along the low back, often radiating into the side of their pelvis] or soft tissue pain along the outside of their pelvis/ thigh [often the ilio-tibial band; or the bursa of their trochanter].” “Chiropractic places emphasis on the concept that the body has a way to self-repair, when given the right environment, circumstances and care,” Dr. Kaplan said. “Professionally, we place the emphasis primarily on the biomechanical nature of injury or injuries — in this case the hip and knee — and to its relationship to the rest of the body, especially muscles, nerve and skeletal structure that influence it, including the spine.” Postural mechanics must be considered as well, he continued. How do the structures of your foot relate to the functioning of your knee and that of your hip and low back? The first step is to perform a thorough assessment of the injury, through a complete history, orthopedic, neurological, biomechanical and kinesiological exam. “Our first goal is to determine the underlying cause, and if it is amenable to conservative chiropractic care,” Dr. Kaplan said. “Once determined, we begin a program to reduce the pain or inflammatory reaction. Along with that, we begin a correction/rehabilitative program to return normal mechanics to the structure, by way of mobilization techniques, chiropractic adjustive/manipulative techniques, postural and biomechanical re-education and specific exercises, to stabilize it.” There are some basic lifestyle changes can help reduce hip and knee pain. “We give all our patients guidance in ergonomics and postural/ biomechanical reeducation as an approach to not only correct issues that may have brought about their present knee and/or hip pain, but how to

avoid these same issues in the future,” Kaplan said. “We cannot change our past, but we can change our future. Understanding the stresses of sitting, being a weekend warrior; types of styles of footwear; the types of frequencies of workouts — these all can contribute to biomechanical issues that will cause problems in knee and hip pain/injury.” Weight loss is also an issue and “most patients who come into the office with knee and/or hip issues, as well as low back issues, generally already know about their issues of weight,” Dr. Kaplan said. “They have already been told, lectured, sometimes even harassed about their weight issue, or their ‘couch potato’ issue. My goal is not to beat my patients over the head with the obvious, but to educate them, partner with them in what their ultimate goals are for better health. “The word ‘doctor’ is derived from the Latin docere, ‘to teach.’ My goal in practice for well over 30 years now has always been to give my patients the tools necessary to help themselves remain healthy and pain free, not to be dependent on any caregiver.” Dr. Kaplan said that “as a chiropractor, we have been in the forefront of steering our patients away from the drug dependency that other fields have relied on. Chiropractic is the world’s largest drug-free health profession and we pride ourselves in helping our patients alleviate pain and disability without the use of drugs, opioids included. As a profession, chiropractors do not prescribe, never have. Of course, there is a role for drug intervention, and when pain is not controllable through other means, recommendations are made to consult with an allopathic or osteopathic physician.” In the vast majority of patients Dr. Kaplan has seen in three decades of practice, he said, “Rarely have I had to make these recommendations. I pride myself on working with my medical colleagues when appropriate for the health of my patients, and it is amazing how a chiropractic adjustment can work as a miracle drug. The use of ice packs and heat packs, used appropriately, can also help to manage pain effectively.”

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Friday, October 6, 2017 | The Rivertowns Enterprise

HAPPY FEET Continued from page 1A

better,” he said. “My message would be to look at the mechanics first — the way you walk and how your foot functions is really the root of everything and the basis of foot health.” Dr. Minara specializes mostly in sports medicine and sees a lot of foot and ankle injuries, plantar fasciitis, tendonitis, over-use injuries and ailments caused by traumatic events, including stress fractures and weakening bones. Proper footwear, Dr. Minara said, can be a first line of defense against common foot problems. Flatter, ill-supportive footwear is a no-no, he said, along with walking barefoot. He said he sees a lot of patients in September complaining of heel pain after a season of flip flops and barefoot strolls on the beach. In fact, the first thing Dr. Minara discusses with patients is footwear. “Wear sneakers,” he advised. “Avoid walking barefoot and avoid flat shoes. A small, one and a half inch wedge heel will alleviate symptoms for women who can’t wear sneakers.” After exploring that, Dr. Minara focuses on other pre-surgical treatment options, including oral, topical or injectable medications. “Any good surgeon should save surgery as a last resort,” he said. “Stay conservative first, and start with the basics.” Dr. John O’Hanlon, DPM, is a sole practitioner at Armonk & Somers Podiatry and a member of the staff at Northern Westchester Hospital in Mount Kisco, as well as several assisted living and nursing homes. He runs a “broad and diversified practice” where he sees patients ages five to 95. In children, he sees a lot of ingrown toenails, warts and foot deformities. In teens and young adults, the complaints are mostly hammer toes,

bunions and heel pain. In older patients, he treats many diabetics and in need of both palliative care and education. The most common ailment Dr. O’Hanlon sees involves nail pathology. “Ingrown, fungal, traumatized — this is the bread and butter of podiatry,” he said, involving patients young and old. O’Hanlon can also see very serious medical cases, though. He recently diagnosed basal cell carcinoma in a patient’s foot that had been missed by the patient’s dermatologist. Another patient, a teenager, had been told by a pediatrician that he would outgrow his foot deformity. Instead, his feet were getting worse, leading the young man to have trouble walking and shunning sports to avoid pain. “Had he been seen by a competent podiatrist, sent to the right podiatrist at an early age, the severity could have been prevented by custom orthotics,” Dr. O’Hanlon said. “Now, we have to operate.” His advice to people with sore feet? “Come early,” he said. “Any person who has diabetes should see a podiatrist for an annual screen. Any other person, don’t ignore your feet.” O’Hanlon’s list of dos and don’ts continues: “Dry well between your toes. Tie your shoes. The best pair of sneakers untied is no better than a pair of slippers. Wear laced shoes over loafers. Wear elevated flip-flops over flat flip-flops. And I am opposed to minimalistic sneakers and shoes—they are really dangerous.” He also strongly advises switching up your footwear. “Wear different shoes every day. Rotate your shoes. Fungus develops in dark, moist environments. You should air out your shoes between use for 24 hours.” And as for bare feet? “I’m opposed to bare feet in an urban environment,” Dr. O’Hanlon said. “If you live in the woods, it’s OK.”

To Your Health! | Page 13A

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Certified & & insured insured with with over over 10 10 years years of of international international experience experience Certified


Page 14A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

ENDPAPER:

Got a symptom? Don't wait to get help like I did By TODD SLISS

unteer for started to get a “you’re old and fat” low-key game going Sunday mornings. I think I lasted two weeks. During the second game it hurt every time I ran and put pressure on my left foot. The pain seemed to be coming from my lower back and shooting down. Comparatively it was a dull pain. I stopped playing and pretty much ignored it. It got a little worse over the summer and finally in September I made an appointment. Six-week wait? Annoying, but didn’t seem like the end of the world. I don’t know exactly when during that time the pain started to get bad. But my online searches kept coming back to one thing: sciatica. The description was dead-on — couldn’t be anything else. Well, it was something else. From my first appointment to my X-ray and MRI to my diagnosis it was a couple of weeks. Then it was another month of appointments and tests and sorting things out before my actual surgery. To me, the painkillers weren’t even working. My wife says otherwise. The pain was mostly dulled within a couple of weeks of surgery, but at the same time I could barely walk, first without a cane, then without a walker. I was working into November, but it was getting tougher. Things would get worse as the day wore on. I remember covering the Section 1 Class A field hockey finals up at Brewster. My calendar shows that date as Nov. 1. That’s a full month before my surgery and a couple of weeks after my appointment. It was a night game, so I drove up north, parked my car and walked a decent distance to the field. Once I got there I was propped up against a fence and I couldn’t move. For at least 45 minutes. Eventually I made my way over to some bleachers and sat for a bit. I didn’t know how I would get home that night. Thankfully by the end of the game I was more mobile, but it was a scary event. That was my worst moment workwise, but not long after that I wasn’t leaving the house much on my own, I don’t think. I’ll never forget the surgery was Dec. 5, but I don’t much remember anything about Dec. 5. Went to the hospital early, got prepped, came to around 8 or 9 p.m. and had some dinner. Apparently I wasn’t exactly friendly to the nurse. My wife had taken my glasses and cell phone home with her. I insisted I needed them, so the nurse called my wife, who brought them to me. It was a good thing because I was up all night and needed the entertainment of my phone and the glasses to watch TV. I had to spend two full days

M

y wife should be writing this. She remembers way better than I do. In fact, just the other night, 10 months after my surgery, she told me something I didn’t know. Apparently I could have been paralyzed by the tumor that was wreaking havoc with my lower body because of where it sat on a nerve sac jamming against my spine in the middle of my back. By the time we were receiving a lot of information from my spine specialist and surgeons I was worn down by the pain and the painkillers. Two weeks before my Dec. 5 surgery walking was a major issue for me. I realized this when one afternoon it took me literally minutes to get from my front door to the street to get my kids off the bus. The pain I had been feeling, I don’t really know what to compare it to. The best I can come up with is lightning shooting down my legs, mostly my left leg. No, I’ve never been struck by lightning, but it was a constant stream of pain shooting down from the small of my back. Sometimes it would last for three hours nonstop. At a certain point my wife and kids just learned to ignore me sitting or standing there screaming. Speaking of those painkillers, it took me a few weeks to get them. Nobody wanted to give me anything. I was going into urgent care and the emergency room begging for a remedy, but until I got to see the spine doc — which was a six-week wait — and got the X-ray back, they treated me like an addict who was there for the good stuff. The moment I met with my surgeon to go over the X-ray, which showed a mass on my spine, he couldn’t write me prescriptions fast enough. But let’s back up here. The pain wasn’t always intense. It started with a little pinge in my lower back and stayed that way for months. Then it got bad fast. I can’t say I’ve ever been in great shape in my life, though I did run the first-ever Westchester Half Marathon in 2005. As a sportswriter I had heard marathon runners always say that anyone can complete the 26.2-mile trek with proper training. I decided I could commit to training for and running a half. I started training in June and ran in October of that year. I was still out of shape afterward, but I completed the trek up and down the Bronx River Parkway. Never ran again after that. Hated it. Anyway, in the spring of 2016, some of the guys from the youth soccer organization I vol-

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flat on my back, no pillows. I’m a side sleeper and a tosser and turner, so this was torture. Back to the important stuff, though. The middle of my back hurt like hell from the incision. But the pain was gone — there was nothing shooting down my legs. From what I heard — and based on what I was feeling, or not feeling, I suppose — the surgery was successful. They got everything out without having to scrape out any bone or put in any screws. And, I would later find out after testing, the tumor was benign as my surgeons had initially thought. Of course recovery was the next step. And there was a wee bit of a hiccup yet to come. On the third day, a Wednesday, I was allowed to recline finally and the pain was subsiding from the surgery. The next couple of days I received some physical therapy, which was basically learning to get out of bed and walking, which really meant inching my way down the hallway for what seemed like an eternity to get back to my room. On Friday, when I was discharged they taught me how to maneuver stairs, though I was discouraged from actually doing that for a while. I went home Friday, was home for the weekend and was home Monday. My days consisted of sitting in a chair and then sleeping at night on my back in the guest room on the first floor, though at least I had pillows, so I learned to adapt to that. I wouldn’t be surprised to learn that I was nodding off while sitting in my chair during the day as I am prone to such sort of behavior. Then I’ll never forget the night of Dec. 12. I was feeling particularly drowsy and was considering going to bed around 8 when my wife and older son got home from Cub Scouts. I started having trouble breathing. Within 10 minutes there was pain in my chest. Bad pain. I thought I might be having a heart attack. When I finally told my wife, it was back to the hospital for me. The pain of each breath persisted for 12 hours overnight in the emergency room. Long story short and many tests later — including having to lie still for an MRI for 10 or 15

minutes — it turned out to be blood clots in my chest and left calf. Another week in the hospital, injections to get me ready for a few months of blood thinners and a major setback in my recovery later, I was back home the following Saturday. It’s now mid-December. The 17th to be exact. Now with everything that had gone on my calves and feet had swollen, especially that left side. And that left one hurt. This felt more like knives than lightning. As I think back now, one of the worst parts was feeling helpless. You can’t dress yourself or get up and grab something from the fridge whenever you want. Now this didn’t last very long and I knew I was going to improve, but at the time it was the most depressing thing and you feel like it’s never going to end. It’s not a fun thought when you’re supposed to be enjoying the final year of your 30s. By the last week of December I was noticing I really wasn’t in any pain. I was just slow. So much of the strength from my body had been wiped by the whole ordeal, specifically my legs. They were shot. My surgeon suggested if I felt OK to take one less painkiller and see how long I lasted. If I could go 24 hours, then go 48. Much to my mom’s delight — she was legitimately convinced I was going to get hooked on the painkillers — I was off the pills by the new year. The doctor encouraged me to get up as much as possible and take walks. I didn’t do that much on my own until the second week of January. At one point before the new year I told my wife I need to get out of the house. We packed into the car and went to the Palisades Mall. It was great to be out, but I was about 13 stores behind my wife and kids. Yep, they left me in the dust. Walking got better in January as I cut my time down walking around the block and finally the final week of the month I was cleared to start physical therapy, which interestingly enough focused mostly on my legs and core. After all, I hadn’t been allowed to do anything but walk, Continued on the next page

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Friday, October 6, 2017 | The Rivertowns Enterprise Continued from the previous page

not even bend, for two months. I was doing PT a few times a week while taking blood thinners and gradually getting better. My body became stable again and, though I was still on the slower side, I returned to work in late February for the high school postseason. It was great to be back functioning like a human again. Sitting around and not working sounds great for a couple of weeks, not three months. I was still slow at that point and uncomfortable and easily fatigued, but I was a world away from where I had been. After this whole ordeal I have a new appreciation for two things: pain and needles. Yes, I also better appreciate the health profession and what families go through during times of medical crisis. And I appreciate how much worse this could have been. But pain and needles. I’ve never experienced so much pain or so many needles and I certainly hope to never again. My wife always said I had a low pain threshold. And when I’d get a shot or have blood drawn within a couple of minutes I was a little woozy. Not this time. They were poking me left, right and center for two weeks, multiple times every couple of hours at all hours of the day. As bad as the pain was, the mental aspect was similarly rough. I never really thought anything bad was going to happen, but afterward when you’re cooped up sitting in a chair barely able to walk feeling useless while your loved ones are doing everything for you — my wife’s mom moved in the first week I was in the hospital and my mom was with us the following two weeks until I felt I could be alone with my kids again — it can put you in a bad place. It wasn’t until I could get out and take those walks and drive to a doctor’s appointment or physical therapy that I really felt normal again. Anyone who knows how much time and effort I put into my job, the only one I’ve known since graduating college in 1999, knows how

difficult it was for me to miss an entire sports season. Thankfully I have a publisher who just wanted me healthy and even when I did come back continually asked if I was rushing back. Maybe I was. There were some days I regretted being back to the grind when I got tired or overwhelmed, but being able to do things for work — and most importantly for my family — was way more important to my psyche. In late winter I was helping coach my older son’s basketball team. In the spring I was coaching both my boys in baseball. I continued that in summer and now fall for my older son. I’ve been throwing a lot of batting practice and also getting out there to play tennis with the kids. Just this week I did a few laps around the field with my fall baseball team. Sure, my back is still sore at times. Maybe it’s from overdoing it, not doing enough, there being something missing from my back or scar tissue. The worst of it is my left calf and foot. The skin feels different and is very sensitive. My toes feel like they are constantly asleep. That’s nerve damage for you. I’m thinking I won’t be getting that normal feeling back, but for what that part of my body has been through, it’s something I can live with. At this point it’s a minor annoyance. I often think back on this and all the love and support I got from family and friends. Also how lucky I am this wasn’t much worse. And I think about how I waited months to have my ailment looked into. It reminds me of that famous Woody Woodpecker line: “If Woody had gone right to the police, this never would have happened.” Yes, this still would have happened, but it wouldn’t have been as bad. And as I finish writing this I realize the suffering might not be over just yet. The other day, after thinking we had reached all limits on our medical bills, I got one out of the blue for $12,000 and change. Guess the pain’s not over quite yet.

To Your Health! | Page 15A

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Page 16A | To Your Health!

The Rivertowns Enterprise | Friday, October 6, 2017

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