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Opioid Addiction Recovery LW3 ‘Lifestyle’ Calendar LW4 Get the Skinny: Salads as Entrées LW5

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September 2017

Follow us Livingwell.azcentral.com Check out the latest stories, as well as past articles and trending health-care information that you might have missed from past issues of Livingwell.

Trending now: Healthy news just for you Kids and Teens

Blow out the candles, spread some germs THE MESSAGE: Blowing out candles on birthday cake spreads germs. THE SCOOP: The act increases the number of bacteria on the cake by 1,400 percent. THE BOTTOM LINE: Probably not a big concern unless a person is already ill. Consider getting a small cake just for blowing out the candles. SOURCE: Journal of Food Research, TheAtlantic.com


Binge-watching may harm your health THE MESSAGE: New study published in the Journal of Clinical Sleep Medicine suggests that binge-watching your favorite shows can affect sleep quality. THE SCOOP: The issue is cognitive arousal, meaning too much binge-watching will affect your ability to turn your mind off and get a good night’s sleep. The binge-watchers, mostly college students in the study, reported insomnia, fatigue the next day, and poorer sleep quality. Not surprisingly, the bingers reported they didn’t mean to do it, they just sort of got hooked on a show. THE BOTTOM LINE: Since binge-watching may make it harder to get a good night’s sleep, it might be best to limit it to weekends, but there’s always one more episode!

Putting an

end to pain Conservative and alternative treatments to manage pain Story by Meghann Finn Sepulveda | Photos by Rick D'Elia


illions of Americans suffer from chronic pain, sometimes so debilitating it causes both physical and emotional stress, affecting a person’s overall quality of life. The costs of unrelieved pain can result in longer hospital stays, increased rates of rehospitalization and outpatient visits, and decreased ability to function fully leading to lost income and insurance coverage, according to the American Academy of Pain Medicine. Fortunately, there are effective ways to take control of pain. Diagnosing pain Pain can be felt in muscles, nerves, joints and bones, and is categorized as either acute pain, which typically comes on suddenly and resolves quickly, or chronic pain, which is more persistent and lasts longer. The most common source of pain is low back pain, according to the National Institute of Health Statistics survey, which is also the leading cause of disability in Americans under 45 years old.

SOURCE: Forbes, TeenVogue.com

“Low back pain can occur as part of the normal aging process,” said Cecil Graham, M.D., interventional pain specialist and medical director of Catalyst Pain Solutions. “It can also be due to improper mechanics when bending or lifting in the younger population.” Other common sources of pain include severe headache or migraine pain, neck pain and facial ache or pain, according to the National Institute of Health Statistics survey. “Sometimes patients with chronic headaches are not aware that the pain is coming from the back of the neck,” Graham added. “It’s important to identify the underlying cause of pain to determine the best approach to treatment.”

30 to 40s: „MANAGING PAIN, continued on page 4

Drink and live longer? THE MESSAGE: A new study suggests that drinking alcohol can lengthen your life. THE SCOOP: Light to moderate drinking (three drinks or less/week) was found to reduce the risk of dying from heart disease by 26 percent and overall premature death by 21 percent. THE BOTTOM LINE: The study authors emphasize the results are with light drinking, heavy drinkers up their risk for diseases such as heart disease and cancer. SOURCE: HealthDay News, Today.com

50 PLUS:

Don’t let falls trip you up THE MESSAGE: You may not think that your own feet are the biggest danger in your home, but they are. Falls are one of the main reasons more than 2.8 million seniors end up in the ER. THE SCOOP: Not only can falls be deadly, accounting for some 31,000 deaths each year, but they can also result in debilitating injuries from hip fractures to brain trauma. THE BOTTOM LINE: Practice safety first and make sure your environment doesn’t have fall hazards such as scatter rugs. Install grab bars in the shower. Also, be aware of medication side effects that might make you less steady on your feet.

“I approached pain like most athletes do. I tried chiropractic care and massage therapy, but the pain never improved.” — Dan O’Brien, 1996 Olympic Decathlon Gold Medalist

SOURCE: Next Avenue, CDC

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'Pulling back curtains' New treatment option for benign prostic hyperplasia Joan Westlake rading daily medication or near-certain surgical side effects for a roughly five-minute in-office procedure to treat one of the most common conditions affecting men sounds too good to be true. Thanks to the UroLift® System, however, that’s exactly what men are doing to treat the symptoms of age-related prostate enlargement known as benign prostatic hyperplasia or BPH. Introduced in Australia in 2005 and unveiled in the U.S. in 2013, the UroLift System is a relatively new medical technology being used to treat BPH. The condition is estimated by the Urology Care Foundation to affect half of all men between 51 and 60. Approximately 90 percent of men over age 80 are believed to suffer the symptoms, which generally include increased frequency of urination, weak stream, inability to hold urine, sudden or urgent need to urinate, and the need to urinate several times during the night.



Dr. Jonathan Agins, of Valley Urology Associates, chose Larry White as one of his early candidates for Urolift. He said White exceeded all his expectations saying it was enormously successful.

Finding an alternative “Before UroLift, treatment for BPH included daily medication, which is a temporary fix and only slows the progression of symptoms, or surgery, which has side effects in the vast majority of patients,” explained Jonathan Agins, MD, a urologist at Valley Urologic Associates. The prostate is a gland located between the bladder and penis that surrounds the urethra, the channel through which urine and semen travels. As the prostate gets bigger, the channel gets compressed. The bladder must work harder to push urine through the narrowed urethra. As the urethra is narrowed and the bladder weakens, urinary side effects set in. “It’s a matter of plumbing,” said Dr. Agins. “As the prostate grows and the

September | Vol. 7, No. 9

'Center of Excellence' channel gets squeezed, patients develop many irritative and obstructive symptoms. They have to pee more frequently, and they start getting up several times a night to pee. Getting up once is normal. Getting up more than once is not.” Surgical treatment of BPH is transurethral resection of the prostate, commonly referred to as TURP. While it is effective in relieving symptoms, Dr. Agins says TURP causes damage to the prostate that leads to sexual dysfunction in most patients. More specifically, it prohibits the release of semen during sex, leading to dry orgasm. Today’s patients have a new option – the UroLift System from NeotTract. This minimally invasive procedure uses only

Living Well A-Z usually publishes on the first Wednesday of the month. From A to Z, we tackle a broad range of health issues and offer resources to find more specific information.

a local anesthetic and nets much shorter recovery times (48 hours compared to 2 - 3 months), zero threat of sexual dysfunction, little to no downtime and no need for opioid pain medication. Rather than cut through, heat or remove prostate tissue, the UroLift System uses a microscopic camera inserted through the penis to deliver a stitch that pulls back the enlarged prostate to relieve urethral compression. Dr. Agins likens it to pulling back curtains instead of ripping them down.

Tracking outcomes Dr. Agins, who was among the first urologists in the country to use the UroLift System, has performed the procedure hundreds of times, monitoring patients

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The data Dr. Agins collected over the five years he has been using the UroLift System demonstrate consistency in clinical expertise, a commitment to excellent patient care and a robust track record for successful outcomes. All of this and more earned Valley Urologic Associates, on behalf of Dr. Agins, distinction as a UroLift Center of Excellence. There are only 15 UroLift Centers of Excellence across the country. Dr. Agins is the first in Arizona to achieve the coveted designation. To learn more about the UroLift System or to schedule a consultation, call Valley Urologic Associates, which has four locations across the Valley, at 623-935-5522.

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Shoulder Pain

and tracking outcomes along the way. He continues to be impressed by the lack of pain associated with the treatment. “I have not written a single prescription for pain medication and none of my patients have had any side effects,” Dr. Agins commented. “It [UroLift] has completely changed my practice.” UroLift also changed the life of 70-year-old Larry White. “I began noticing symptoms in my late 50s,” Larry said. “It didn’t affect my [sexual] performance, but it progressively interfered with my ability to urinate normally. Then I started having leakage.” Larry met Dr. Agins when his wife, Shirley, was one of the doctor’s patients. “I liked his frank style and honesty,” Larry recalled. “I had a lot of faith in him after seeing what he did for my wife. I made a comment in passing about my issues and he said he could help me.” In 2014, Dr. Agins used the UroLift System to successfully alleviate Larry’s prostate-related issues. “I saw symptom relief within about 48 hours,” Larry shared. “It was easy.”



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September 2017 | Livingwell | 3


Getting a fighting chance


Innovative approach increases opioid addiction recovery success By Joan Westlake


he statistics are grim. The National Center for Health Statistics indicates that teen overdose deaths soared by 20 percent last year. Opioid-related admissions and deaths in hospital intensive care units spiked nearly 40 percent over the past seven years.

Understanding the challenge To more effectively address the complex nature of opioid abuse, Sieffert joined with fellow Arizona State University MBA colleagues and local professionals to establish Addiction Recovery Centers (ARC). The out-patient facilities offer programs based on Medication-Assisted Treatment (MAT), which uses a combination of a non-addictive drug and individualized counseling. A report by the surgeon general’s office under Vivek Murthy concluded MAT is very effective. “The research clearly demonstrates that MAT leads to better treatment outcomes compared to behavioral treatments alone,” the report said. “Moreover, withholding medications greatly increases the risk of relapse to illicit opioid use and overdose death. Decades of research have shown that the benefits of MAT greatly outweigh the risks associated with diversion.”

Blocking the receptors ARC’s innovative approach to giving patients a fighting chance against opioids is to implant the non-addictive drug Naltrexone. “The implant is two pellets that go under the skin and last roughly six months,”

Dr. Sieffert explained. “Naltrexone, which is Federal Drug Administration approved for opioid and alcohol treatment, blocks the receptors that give patients the euphoric feelings when using the drugs. Although Naltrexone is available in pill form or injection, the implant method has proven more effective because patients don’t need to remember to take that daily pill or set up an appointment for an injection.” Ellen Sohus, LPC, LISAC, a counselor for ARC, cautions that this is not a magic pill but one part of a comprehensive treatment program that includes private sessions with a licensed therapist, who works with each patient’s personal recovery coach and patient advocate as well as clinical and medical staff. GETTY

James Sieffert, DC, MHSM, said that working at the Arizona-based Pain Stop Clinics, he saw the human heartbreak behind some of those statistics— patients struggling to overcome opioid addiction while fighting physical pain.

A burden lifted “I prefer our counseling sessions to be face-to-face,” said Sohus, “but we do offer telemedicine video sessions for those who live in rural areas or have time and travel issues. People don’t realize how vital counseling can be in helping cope with emotions and acquiring sobriety skills and tools. “Clients in the program tell me it feels like a burden has been lifted and they are truly grateful. Now, they are not obsessed with trying to get the opiates or struggling with withdrawal symptoms. They can fully participate in their lives because they’ve been guided on a path to succeed.”

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FUN RUNS/RACES STEPHEN SILLER TUNNEL TO TOWERS 5K Sep. 9, Tempe Town Lake Tunnel2Towers.org TUTU RUN Sep. 9, Kiwanis Park 6111 S. All-America Way, Tempe 4PeaksRacing.com

COMMUNITY HEALTH LECTURE Sep. 19, 6:30–7:30 p.m. Midwestern University Foothills Branch Library 19055 N. 57th Ave., Glendale 623-572-3353 FLU SHOT CLINIC Sep. 25, 10 a.m.–2 p.m. Humana; 480-325-4707 Must show proof of insurance 5943 E. McKellips Rd., Mesa HEART HEALTHY LIVING Sep. 28, 12:15–1:15 p.m. Humana; 480-325-4707 5943 E. McKellips Rd., Mesa


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Pain affects your quality of life „MANAGING PAIN, continued from cover

Years of suffering

Conventional, alternative treatment Treatment often begins with medication and trigger point injections. In 2014, O’Brien went to Catalyst Pain Solutions and began receiving non-steroidal anti-inflammatory injections. “I felt immediate relief,” he said. An athlete and coach, O’Brien continued to run, lift weights and play golf. However, the pain, while much less severe, slowly crept back. Looking for a more aggressive approach to treatment and hoping to avoid surgery,

“I feel so good, better than I ever have, I now have freedom to do the things I enjoy.” — Dan O’Brien, 1996 Olympic Decathlon Gold Medalist .


For years, Dan O’Brien suffered from back pain. The 1996 U.S. Olympic decathlon gold medalist tried conservative treatment methods without medication to manage his pain. “I approached pain like most athletes do,” he said. “I tried chiropractic care and massage therapy, but the pain never improved.” Eventually, O’Brien had an MRI and learned he was suffering from a bulging disc. Bulging discs and other spinal conditions along with fibromyalgia, neuropathy, multiple sclerosis and arthritis are common contributors of pain. Experts say there is also a psychological connection to pain. “People who are overweight and those who suffer from anxiety, depression and mood disorders, often have increased pain,” said Mark Luba, M.D., a primary care physician at Iora Primary Care. When the body is stressed, muscles tense up, which is considered a reflex reaction to stress and the body's way of guarding against injury and pain, according to the American Psychological Association. “These factors can significantly turn up the volume on pain,” Luba added.

O’Brien learned about the regenerative stem cell procedure, an exciting new medical advancement available at Catalyst Pain Solutions, which uses the body’s own stem cells or blood platelets that act as healing factors, to alleviate pain and improve function. “This treatment is simple, safe and fairly quick,” Graham said. During a regenerative stem cell procedure, doctors take blood from a patient and send it to a lab to be processed before re-injecting it into the area of repair using imaging guidance. O’Brien is currently completing his fourth treatment.

“I feel so good, better than I ever have,” he said. “I now have freedom to do the things I enjoy.”

coping skills, increasing confidence and self-efficacy for managing pain, and changing how individuals behave in response to pain, according to the American Chronic Pain Association. Complementary therapies In addition to receiving treatment for Experts say that one of the best, most natural ways to treat pain is through movement. chronic pain, patients at Iora Primary Care, which is designed to specifically “Exercise, meditation and Tai Chi can meet the needs of people age 65 and sometimes work on their own or be comolder, can take advantage of regular bined with other treatment modalities to health, mindfulness and exercise classes. manage pain,” Luba explained. “Even just “Our goal is to educate and empower 10 minutes of low impact exercise a day patients to explore other treatment can make a big difference.” Cognitive-behavioral therapy, which can options to decrease pain, improve funcalso be beneficial in treating pain, includes tion and promote overall wellbeing,” Luba said. a range of strategies aimed at enhancing



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September 2017 | Livingwell | 5



Get the skinny: Eating for Life

Get back to living.

By Debra Gelbart


salad doesn’t have to be limited to a supporting role at dinnertime. Limitless options can make it a delicious main attraction. “A salad can be a wonderful and nutritionally balanced meal,” said Jaclyn Chamberlain, RDN, a registered dietitian nutritionist with Pinnacle Prevention, a Chandlerbased nonprofit that works to improve access to healthy food and to create opportunities for active living. A key difference between salad as a go-with and as an entrée: protein. “Adequate protein in a meal helps provide enough calories and helps you meet your protein needs, but more importantly, it helps add to the satiety and satisfaction of a meal,” Chamberlain said.

Look beyond the deli Added protein in a salad doesn’t have to be restricted to meat or cheese, she pointed out. “Salads that contain beans, nuts, egg or even additions like quinoa can be very satisfying.” By contrast, she said, salads that are primarily iceberg lettuce without a variety of ingredients are likely to be more unsatisfying and less nutritionally diverse. “The more colorful – the better.” Beware of entrée salads at restaurants, Chamberlain cautioned. “Some may have more (calories) than you bargain for.” Here are her suggestions when ordering a salad: • Be mindful when eating fried foods often added to salads, such as fried onions, tortilla strips or fried crispy meats like chicken. These foods add flavor and crunch, but a little goes a long way. If a salad contains multiple fried elements, swap or omit a few and keep your favorite. Ideal swaps can include grilled meats or vegetables like jicama, radish or snow peas. • Develop an eye for portion distortion. Often entrée salads in restaurants are supersized. “Items like cheese,

croutons, rolls, dressing or even too many nuts and seeds can overwhelm the salad.” Ask for items on the side and then add as you please, or ask for half portions. • Avoid the sugar trap. Some naturally sweet foods like fruit are a great way to liven up a salad and boost flavor. Sugar, however, can be lurking in unexpected items, including salad dressing. Some sugary dressings are easy to identify, she said, “but others are harder to spot. Low-fat dressings are especially guilty of adding extra sugar to improve the taste.”

How to build a great entrée salad A good balance of protein foods (meat, cheese, beans, nuts, eggs, seeds), fat (avocado and olive-oil based dressing) and carbohydrates (fruit, whole grains, beans, other legumes and starchy vegetables) will make that entrée salad a meal, Chamberlain said. Tofu, a plant-based protein, can be baked, sautéed, crumbled fresh or even fried. Marinade tofu with salad dressing and bake until crisp, she suggested. “For meat eaters, the sky is the limit. Grilled, roasted, smoked – it all fits into a salad. Seafood is also a great option, as it often provides good hearthealthy fats. Canned salmon (wildcaught) is a nice, inexpensive highprotein addition that also provides heart-healthy fats and mixes well into a salad.”

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310 calories per serving Ingredients: 8 ounces whole wheat fusilli pasta 4 ounces goat cheese, crumb led 2 tablespoons extra virgin oliv e oil 2 tablespoons lemon juice 1/2 teaspoon sea salt 1/2 teaspoon black pepper 1/4 teaspoon red pepper flake s 6 ounces baby arugula 1 pint cherry tomatoes, thin ly sliced 1/2 cup pitted kalamata oliv Recipe es, sliced Directions: 1. Bring a salted pot of water to a boil and cook the pasta until it's al dente, according to the directions. 2. Before draining, reserve about 1 cup of the pasta wa ter. Drain the pasta water and place it in a large serving bow l. 3. Sprinkle the goat cheese over the pasta, then drizzle in the olive oil and lemon juic Sprinkle in the salt, red pepper e. and black pepper over top. Pou r about 1/3 cup of the pasta water over top and tos s until the pasta is super cre amy. 4. Add the arugula, tomatoes and olives and toss to combin e. If the pasta is too dry, drizzle in more of the pasta water and stir. You can also add in more olive oil if desired Taste and season more if nee . ded. Serve immediately. You can store this salad in the fridge for a few days. A quick reheating in the microwave will make the goa t cheese creamy again!

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NSAIDs as a pain relief option Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), like ibuprofen and aspirin, are among the most popular and widely-used pain medications. Below is the history of NSAIDS from Banner CORE Center for Orthopedics



WHY THEY’RE USED, HOW THEY WORK The origins of anti-inflammatory drugs like NSAIDs can be traced back to plant extracts in the 1800s, which were sought to treat fever, pain and inflammatory disorders. As medicine evolved, they became a go-to for conditions like rheumatoid and osteoarthritis.

By the mid-19th century, aspirin was discovered, which is considered the first NSAID. After World War II up until the late 1980s and early 90s, more NSAIDs were produced and name brand ibuprofen products like Motrin and Advil, along with their generic counterparts, came to market. Some other brands seen today include Celebrex, Daypro and Aleve, as well as others. NSAIDs work by blocking the body’s cyclooxygenase (COX) enzymes. These enzymes - there are two, COX-1 and COX-2 - create prostaglandins, which are chemicals produced by our body’s cells that promote inflammation necessary for healing. Unfortunately, this inflammation can also produce pain, which NSAIDs quite effectively eliminate.


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Prostaglandins also protect the stomach and support the body’s production of platelets needed for blood clotting.With NSAIDs, gastrointestinal upset is one of the primary side effects. Some patients may experience bleeding and stomach ulcers.The American Journal of Medicine estimates roughly 100,000 people are hospitalized annually due to NSAID side effects. Not all of them are stomach related. In the 1990s, scientists learned of the second COX enzyme (COX-2) and some research suggested it was the enzyme primarily involved in causing inflammation.The thinking then was that only the second enzyme needed to be targeted, so coxibs (celecoxib and rofecoxib) were created, arriving with the claim of far fewer GI side effects.

In 2004, cardiovascular concerns arose and the drugs were withdrawn.Today, NSAIDs have been associated with heart concerns, stomach pain (even ulcers), rashes, high blood pressure, ringing in the ears, as well as liver and kidney problems.

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