HealthWatch Spring 2015 by Tahlequah Daily Press

Table of Contents 4

‘Fat tax’ facts

It’s been a source of speculation, but experts doubts its viability.

Safe sex

I’s still all about preventing STDs.

The nose knows

It’s allergy season again, and that means tissues and medications that spell relief.

Eating for the cure

Research suggests what you eat can determine whether you get cancer.

Who we are

The faces of cancer

Landmark Cancer Centers use state-ofthe-art medicine to ensure the best survival rates.

Counting sheep

How to make sure you always get the right amount of sleep – which varies from person to person.

A shot in the arm

Here’s a list of recommended vaccinations for people over 50 to keep them healthy into the golden years.

On the cover Joshua Garren, M.D., chief radiation oncologist at Landmark, meets with patient Jackie Moore and Ravikumar Vasireddy, M.D, chief medical oncologist at Landmark Cancer Center in Muskogee.

Publisher: Keith Hansen Advertising: Bronwyn Duncan, Denise Butler, Jacki Christie

Editor and Page Design: Kim Poindexter Cover and Logo Design: Josh Newton

Contributing writers: Dana Eversole and Renee Fite HealthWatch is a quarterly publication of the Tahlequah Daily Press. For advertising opportunities, call a member of the advertising team at (918) 456-8833. For suggested story topics, email kpoindexter@cnhi.com

Renita Dick, left, and Renda Reese Davis, of 2 Sisters Financial, discuss whether a “fat tax” would be conceivable. Photo by Renee Fite

By RENEE FITE TDP HealthWatch Writer

iven the stereotypical tendencies of the government to tell people what’s good for them, and the escalating rates of obesity in the U.S., it might not surprise many Americans if the government or insurance companies tried to penalize them based on their body mass index or body weight.

Johnathan Gruber, a professor of economics at MIT, helped cobble together a health reform law in Massachusetts under then–Gov. Mitt Romney and was paid $400,000 as a consultant for the federal health care law known as “Obamacare.” In 2010, Gruber wrote a paper that speculated in the future, insurance companies might charge policy holders according to their body mass index – a situation some in the media are calling a “fat tax” – in the same way cigarettes are taxed. In the April 2010 paper, Gruber wrote, “While it is hard to conceive of this approach being a common public policy tool in the near term, such taxation may be happening indirectly through health insurance surcharges. Currently, employers may charge up to

20 percent higher health insurance premiums for employees who fail to meet certain health-related standards, such as attaining a healthy BMI. The new health reform legislation increases this differential to 30 percent, with the possibility of rising to 50 percent. Results of programs that use differential premiums

to impose direct financial penalties for obesity will bear watching in the future.” The cost of the health insurance premiums are established by the “Marketplace,” established as part of health care reform, said Renita Dick, of 2 Sisters Financial. An agent cannot adjust

someone’s premium up or down due to their build. “The people who don’t qualify for a subsidy on the Marketplace are paying for the people who get a ‘tax credit’ or the ability to pay a lower premium than others,” said Dick. She does agrees people should exer-

cise to be fit and healthy, which reduces the risk of seeking medical care. “It would be nice to get some credits for this [maintaining health], but people should do this for themselves. If everyone would do this, then the overall cost would go down,” she said. “People in China walk or ride a bike everywhere. They are not overweight at all for this reason.” The need for health insurance is very important to everyone, Dick said, because those who don’t have health insurance run the risk of getting sued by the health insurance provider. “For example, if you are selfemployed, and you don’t have insurance, the doctor office, and/or hospital can start to go after your assets to pay for the care you received,” she said. “Plus, you run the risk of not getting all the tests or care you could have gotten, had you had insurance. They don’t want to run a bunch of tests, if you don’t have the ability to pay for them.” The Affordable Care Act contains essential health benefits, and since preexisting conditions are grandfathered in, health questions aren’t asked, Dick said. “The only questions asked are: name, address, zip code, tobacco user or not, and gender. Health questions are a thing of the past,” said Dick. Anyone who has an individual policy written or changed after March 23, 2010, has to change his or her plan to the Obamacare policies, she said. “There were open enrollment periods to purchase health insurance and that was between Nov. 15 to Feb. 15,”

she said. “You can only purchase an individual policy now until December 2015 if you have a qualifying event – change of jobs where you lost coverage – not that you chose to drop it – or marriage, birth of a child, etc.” A poll on the Tahlequah Daily Press website asked readers whether they believed they should have to pay (in the form of higher taxes or insurance premiums) according to body weight. More than half, 52.6 percent, strongly disagreed, while about a fourth, 23.7 percent, agreed somewhat. Only 15.8 percent strongly agreed, and about 8 percent were undecided. Comments from area citizens on a Feb. 7-8 Saturday Forum on the Daily Press Facebook page also ranged from a solid “no” to suggestions to cope with weight loss. Shannon Grimes, a local chiropractor who recently chaired the Cherokee County Republican Party, said companies can choose to charge however they want. “Insurance companies already consider risk factors when determining their prices,” said Grimes. “Well, they try to, but government is restricting their ability to calculate costs.” Like many people, Carlos Charlie Rodriguez wonders who are the “fat people”? “Not Hollywood A-listers and for, the most part not ‘1 percent’ or most middle class,” said Rodriguez. “Is it the bottom 50 percent who have to get food stamps and other welfare and don’t pay taxes. So does that mean we are going to subsidies their fat tax?”

It’s still about preventing the spread of STDs. By DANA EVERSOLE TDP HealthWatch Writer

ccording to the Oklahoma State Department of Health, almost half of the new sexually transmitted disease infections that occur in Oklahoma each year are among young people 15 to 24 years of age.

“Oklahoma joins the nation in raising awareness about the ongoing STD epidemic during April, which is National STD Awareness Month,” said Lindsey Sarver, health educator for the Cherokee County Health Department. Statistics from the Centers for Disease Control and Prevention indicate about 20 million new sexually transmitted infections occur every year, which costs the U.S. health care system $16 billion annually, not including the cost to individuals in terms of

Libby Rogers, director of Health Services on the Northeastern State University campus, replenishes the free condoms available at the Photo by Cassie Freise Student Health Center.

acute and long-term care consequences. Those areas of concern include the following: • Both rates and consequences of chlamydia and gonorrhea are far more severe among women than men. Undetected and untreated chlamydia and gonorrhea can result in pelvic inflammatory disease in women, a condition that can cause infertility. In 2012, females in Oklahoma made up about 74 percent of reported chlamydia and 59 percent of gonorrhea cases. • In Oklahoma, males accounted for 92.8 percent of the total reported syphilis cases. • In 2012, gonorrhea, chlamydia and syphilis rates were highest among African-Americans, which was also true in Oklahoma, according to www.health.ok.gov. “The best way to prevent the spread of HIV/STDs would be to practice abstinence. If choosing to participate in sexual activity, it is always recommended to use a condom for protection from these diseases,” she said. “We provide

free condoms to the community at the Cherokee County Health Department.” Libby Rogers, director of Health Services at Northeastern State University, said the Student Health Clinic also provides free condoms. “We have plenty of students wanting to know if they may have an STD, but we do not have a lot of those who test positive,” she said. Rogers said she encourages students to use condoms and to talk to their partners before having sex for the first time. “Ask your partner when was the last time he was tested. I tell the students to get tested every year ,whether or not they may have symptoms,” said Rogers. Sarver said that in Oklahoma, county health departments have STD clinics that test for gonorrhea, chlamydia, and syphilis. “They also offer HIV testing, since infection with other STDs increases the risk for acquiring HIV,” she said. Services are offered between the hours of 8 a.m.- 5 p.m., Monday–Friday.

Inside the nose is some pretty amazing anatomy that provides impressive defense, especially with respect to allergic rhinitis where there is inflammation of the nose due to allergies, said Dr. Tracey Childers. Photo by Renee Fite

By RENEE FITE TDP HealthWatch Writer

It’s allergy season, and that means tissues and medication that spells relief.

pring showers and warmer temperatures will bring blooming trees and flowers, and for some, that means the misery of allergies and asthma.

Symptoms such as watery eyes, congestion, frequent sneezing, runny nose, and coughing – all due to seasonal allergens – make soft tissues a must for coping with the non-stop mucus drip. People who have allergies can live healthy and active lives, according to the Asthma and Allergy Foundation of America, a not-for-profit organization founded in 1953. The leading patient

organization for people with asthma and allergies, AAFA is also the oldest asthma and allergy patient group in the world. Its website, www.aafa.org, states it has the mission of educating and raising awareness of treating symptoms that affect more than 45 million Americans who live with seasonal allergic rhinitis. Asthma is a chronic disease of the lungs in which the airways become blocked or narrowed causing breathing difficulty. It affects 20 million Americans with allergic (extrinsic) asthma and non-allergic (intrinsic) asthma. Allergies are diseases of the immune system, which cause an overreaction to substances called “allergens.” These triggers vary by time of year or where symptoms appear on the body. Indoor and outdoor allergies are called “hay

fever,” “seasonal,” “perennial” or “nasal” allergies, which cause eye, skin, insect, latex and food allergies. Experts say 35 million Americans suffer from allergies from airborne pollen, tiny particles released from trees, weeds and grasses. With allergy season near, people will soon have to decide how to deal with those pesky symptoms” “grin and bear it”; try over-the-counter options; or seek the help of a professional, said Tracey W. Childers, DO, FAOCO, FAAOA. Childers is board-certified in otolaryngology and facial plastic surgery, and fellowship-trained in otolaryngic allergy. Childers has been practicing in Tahlequah for more than 15 years. “There is some pretty amazing anatomy inside the nose that provides impressive defense, especially with

respect to allergic rhinitis, where there is inflammation of the nose due to allergies,” Childers said. “Inside the nose, the septum separates the right and left halves, turbinates act as filters and are located on the side walls of the nose. This is where pollen, fumes, bacteria and viruses will collect and start their inflammatory process, and where our immune systems can become overwhelmed. Common defenses, such as congestion, sneezing and excessive nasal mucous, are efforts by our immune system to protect us.” If a person can identify triggering agents, the easiest recommendation is avoidance. However, that is not always possible, with the tree pollen in the spring and winds are strong as they are in Northeast Oklahoma, Childers said.

Saline nasal spray is probably the most natural, reasonable and least expensive effort available to fight allergies. “I recommend saline be used at least twice a day to flush pollen and other debris from the nasal membranes,” said Childers. “By spraying this toward the outside wall of the nose, you can cleanse your nose and flush the offending pollen away, giving your immune system an opportunity to recover and focus on other needs your body has.” Three treatment strategies for allergens are avoidance of allergens, medication and/or immunotherapy (allergy shots), said Childers, since painful complications such as sinus or ear infections can result from untreated allergies. Antihistamines and decongestants are the most common medicines used for treating allergies, said Childers. Antihistamines help relieve rashes, hives, sneezing, itching and runny nose. Decongestant sreduce stuffiness by shrinking swollen membranes in the nose and come as pills, sprays, and nose drops. “When medications alone do not solve the problem, immunotherapy can prevent allergy symptoms, by giving a person higher doses of their allergen over time,” Childers said. “For those with hereditary predisposition, multiple exposures over the years can trigger a cascade of symptoms and lead to other complications, such as sinus infections, headaches, eye infections, extreme fatigue, lost productivity at work, etc.” Many of the over-the-counter medications have been around for years, and are very reliable, said Childers. “Diphenhydramine, also known as Benadryl, is the main ingredient in many OTC sleeping pills and may not

be the best choice if you need to drive or be responsible. Also, take note of the duration of action of whatever medication you are considering. Some have strong sedating side effects,” she said. Several newer non-sedating antihistamines areavailable over the counter. Although these may seem expensive, when considering the benefits (one dose lasts up to 24 hours) and absence of sedative effects, these medications are worth it, Childers says. Examples of non-sedating antihistamines include loratadine, cetrizine, and fexofenadine. Nasal sprays are not “addictive” and are very safe, compared to the steroids prescribed in past years, Childers said. “Allergy testing and desensitization are effective and are the only way to overcome the symptoms of allergy. By carefully identifying offending triggers, avoidance is easier, and your immune system can be incrementally strengthened to minimize and hopefully eliminate allergy symptoms, reducing the need for allergy medications,” she said. Prevention, the AAFA website said, includes dusting, vacuuming, and washing. Dusting surfaces and washing bedding often can control dust mites in a home. Vacuuming once or twice a week will reduce surface dust mites. Wearing a mask when doing housework will help avoid allergens. Use a vacuum with an air filter to capture dust. Avoid pet dander, pets with feathers or fur-like birds; dogs and cats leave saliva and dead skin, or pet dander, which can cause reactions. Avoid mold spores by reducing moisture in the bathroom and kitchen. Dehumidifiers will help reduce mold, along with fixing leaks and cleaning up moldy areas.

Good nutrition is more important than ever, with evidence now suggesting what you eat may affect whether you get cancer.

ancer remains the second-leading cause of death in the United States, according to the Center for Disease Control, and April is National Cancer Month.

cer,” said Wedding. She said this can be difficult for the typical American, whose main diet is heavily based on meat, starchy foods and vegetables that consist of potatoes, green beans, green peas and corn, while the main fruits consumed are bananas, oranges, apples, and grapes. “The best fruits and vegetables for cancer prevention are “While it is impossible to completely eliminate the risk of cancer, we deep orange, deep green, purcan take action to reduce our chances ple, and red. The phytochemicals in these fruits and vegetaof developing this disease. Not smokbles have been shown to have ing, eating a healthy diet rich in fruit amazing cancer-fighting propand vegetables, getting regular exererties,” said Wedding. cise, and limiting alcohol consumpWedding said people should really tion and sun exposure can decrease research or talk to a the risk of cernutritionist before By DANA EVERSOLE tain cancers buying a lot of usewhile also keepTDP HealthWatch Writer less items. ing us healthy “There are lots of day-to-day,” said diets and diet supplements out there President Barack Obama in his declathat say they have the ability to put ration of National Cancer Awareness cancer into remission, but they are not Month last year. based on good scientific research,” Pamella Wedding, RDN, Cherokee she said. Nation WIC Nutrition Program nutriShe said the best tips for cancer tion education coordinator, said nutriprevention in individuals of all ages is tion plays a major role in fighting canto make sure half your plate consists cer. of fruits and vegetables, with small “The Mediterranean diet promotes portions of lean meat, fish, poultry (2 eating lots of fruits and vegetables, to 3 ounces), and a serving of a whole fish, olive oil and very little amounts grains such as brown rice, 100 perof meat and poultry. There is lots of science that backs the inclusion of lots cent whole wheat or whole grain bread or tortillas, or quinoa and lowof fruits and vegetables in a rainbow fat or nonfat milk. of colors in the diet to prevent can-

Traci Huggins, director of Operations for Sodexo, checks the number of fruits and vegetables on the salad bar in the Café. Healthy foods are good for fighting cancer. Photo by Cassie Freise

“Limit red meat consumption to two to three servings per week. Add fish such as tuna and salmon or other fish that are high in Omega 3 fatty acids at least twice a week. Use olive or canola oil for cooking instead of shortening and butter,” said Wedding. Dr. Ravikumar Vasireddy, hermatology and oncology with the Landmark Cancer Center in Muskogee, said too much of anything is proba-

bly not good. “I am not an expert in nutrition, but it is important for people to have a balanced diet and avoid taking too many vitamins,” said Vasireddy. He said this applies to all individuals with all types of cancer. The best advice for parents and grandparents is to be good role models for the children in their lives, Wedding said. “Children whose parents and grandparents eat a variety of foods are more likely to eat a variety of foods. Also, children need at least 60 minutes of daily physical activity – activity that increases their heart rates such as running, jumping rope, playing soccer, basketball, etc. Adults need at least 30 minutes of physical activity daily,” said Wedding.

Joshua Garren, MD., chief radiation oncologist at Landmark, chats with patient Wren Stratton, a former Muskogee mayor and co-founder of a group that supports breast cancer patients Photos by Keith Hansen and pays for mammograms.

SURVIVORS:

hen Brian McMurray was looking for the best oncology doctors for the Landmark Cancer Center in Rogers, Ark., he landed in Muskogee.

McMurray, regional director of Landmark, met with, Dr. Ravikumar Vasireddy, M.D., and asked him to join the staff in Rogers. Vasireddy told him Muskogee was his home and he wanted to stay. McMurray was so intent on bringing Vasireddy to Landmark that he brought Landmark to Vasireddy. Landmark has the opened its newest state-of-the-art cancer treatment facility. Located right off U.S. Highway 69 in Muskogee, Okla., it is convenient for all surrounding area residents, said McMurray. The Center is under the direction Vasireddy and Joshua Garren, M.D. “Dr. Vasireddy has served the Tulsa and Muskogee communities with distinction for over 16 years,” said McMurray. “Dr. Garren, who received his education from Harvard and Brown Universities, was named to the first US News and World Report list of top doctors in the United States.” Bonnie Wilson, Muskogee resident, visits Landmark with her daughter, Susan, who is battling her second bout

of cervical cancer. “People comment that Dr. Vasireddy is as good as the doctors at M.D. Anderson, and he is right here in Muskogee,” said Wilson. “My daughter has had excellent experience at Landmark.” McMurray said Landmark watches the research closely in cancer treatment and also keeps up with the latest technology. “We are adding a 3D Tomo mammography system for advanced breast screening,” said McMurray. “This will allow doctors to see a 3D image of the breast.” The research on this new technology indicates a 41 percent increase in detecting invasion breast cancer and a significant reduction in false positive detections. “Landmark is the first in the area, including Tulsa, to acquire this equipment,” said McMurray. “We are bringing this to the community and area this spring.” Cassandra Gaines, Muskogee resident, was first diagnosed with breast cancer 15 years ago. She is in remission, but still sees Vasireddy several times a year. “He stays on top of health,” said Gaines. “He thoroughly checks my blood work, and if I cough wrong, I am back in his office.” Gaines said Vasireddy listens to the patient, but he also wants the patient to listen to him. “You need to listen to him and do

what he says,” said Gaines. “He takes lots of time with you and he gets to know you. He develops a relationship with you, step by step. He cares.” Vasireddy said he spends anywhere from 45 minutes to an hour with his patients, going over the diagnoses and the treatment plan. Patient progress is monitored closely through the treatment. “You need to stay on top of cancer,”

Brian McMurray is Landmark Cancer Center’s regional director.

By DANA EVERSOLE TDP HealthWatch Writer he said. Jackie Moore, Muskogee resident, was diagnosed with Non-Hodgkins Lymphoma in 2007. “I had two tumors in my stomach the size of oranges,” said Moore. “I was having stomach pain, migraine headaches and my blood pressure was high.” Moore said his wife knew of Vasireddy’s reputation because she had worked in the local medical community for 14 years. “She would not let me go to anyone else,” said Moore. “He is an exceptional man and he tells you the truth.” Vasireddy put him on treatments with chemotherapy and radiation. “I treat the cancer,” said Vasireddy. “Care plans are tailored to each individual’s health risk factors and personal needs.” Garren came to Landmark because he wanted to work with Vasireddy. He treats all types of cancer. “He is one of the smartest people I have met,” said Garren. “I wanted to partner with him and bring quality care to people in this area. This is win-win.” He said he treats about 50 tumors a month, and the advancement of radiation treatment is more careful to kill the cancer with the least amount of damage done to healthy tissue. There is

Duo takes up arms for breast cancer battle

hen Wren Stratton received a call from an upset friend, she immediately went to her house. Her friend told her she had breast cancer.

“I said to her, ‘I hate it happened to you, girlfriend, but we now have a voice in the community,’” Stratton recalled. “‘Dry those tears now and quit feeling sorry for yourself.’” Fifteen years ago, Women Who Care was created under the leadership of Stratton and her friend, Cassandra Gaines. Since that time, more than 1,000 women have had mammograms paid for by the organization. “We pay for mammograms, hold fundraisers and conduct educational seminars,” said Stratton, former Muskogee mayor, R.N. and educator. Stratton said different organizations or groups hold fundraisers for Women Who Care throughout the year, and the Cherokee Nation has helped. Stratton, a breast cancer survivor of 21 years, was diagnosed after having her first mammogram at the age of 40. “That mammogram saved my life,” she said. Statistics show that one in 10 women will develop breast cancer. “Breast cancer touches a lot of us, and the money given to Women Who Care stays right here,” said Stratton. The organization has a 501(c)3 non-

humanity and compassion for each individual patient. He said doctors today are able to find more cancers at a curable stage. Garren said that in the old days, doctors would take a image of the

profit status with a six-member board. There is no overhead, and all the money goes to pay for breast exams and mammograms. Gaines, the director of the Muskogee Civic Center and the Roxy Theatre, said she had just finished an event, and a voice inside her head told her to go get a mammogram. She was 48 and had never had one. “The doctor did a self-exam, then a mammogram, and the radiologist came and told me it was Stage 2 breast cancer,” said Gaines. “I had a bunch of

Landmark Cancer Center radiation technicians Jeremy Scott and Tiffany Slape capture images during radiation treatment.

Patients of Dr. Ravikumar Vasireddy – Wren Stratton, left, and her coleader in Women Who Care, Cassandra Gaines – battled cancer and set out to assist others with the dreaded diseaxe. Stratton is a former mayor of Muskogee.

travel miles that I was going to use. This put everything on hold.” After a year and a half of treatment, Gaines boarded a plane. “I was on my way to Philly, and all of a sudden, here comes all of this turbulence and I thought, ‘Wow, what I have been through to now go down with a plane,’” she said. Stratton teaches classes to help women learn self-examination, and she talks to many civic organizations about Women Who Care. “We usually give out a voucher a week for mammograms, but the end of September and all of October, we give a lot out,” she said. The organization hopes to make the process a one-stop shop where each woman can get a self-exam and mammogram. To find out more information about Women Who Care, call Stratton at 918-869-8453. To donate to the organization, mail it to Women Who Care, 324 N. Camden Place, Muskogee, OK, 74403.

tumor and circle the image. “Today, we are able to use a floating 3D model of the patient,” said Garren. Landmark Cancer Center is equipped with advanced radiation technology from Varian, which is used

mark Cancer Center, they can do so with the confidence and knowledge they will receive outstanding care from one of the finest cancer treatment centers in all of America. Landmark Cancer delivers advanced care close to home,”

by most of the top cancer centers in the U.S. Patients are assisted with practical issues, such as transportation, health care coverage, financial concerns and family needs that may arise. “When individuals choose Land-

SHEEP

COUNTING

This is one of the results of a new study published in “Sleep Health: The Official Journal of the National Sleep Foundation.” Findings are age–based sleep recommendations that adjust durations for infants, and introduce new specifications for adults in their early 20s and those over 65. The panel emphasized some individuals might sleep longer or

Good news for teens: Doctors have determined the norm is eight to 10 hours a night. The new sleep range adds a half hour to previous findings.

shorter than the recommended times with no adverse effects. However, individuals with sleep durations far outside the normal range may be engaging in sleep restriction or have serious health problems. An individual who intentionally restricts sleep over a prolonged period may be compromising his or her health and well-being, the study indicates. “Good sleep hygiene will lead to a good night’s sleep,” said Dr. Richard Bregman, sleep clinic medical director for the Sleep Disorder Center at St. Francis Hospital in Tulsa, which also operates a clinic in Tahlequah. “Sleep is an integral part of everyone’s life. It is taken for granted until a person encounters difficulty sleeping or misses a night’s sleep,” said Bregman.

How to get the right amount of sleep.

By RENEE FITE TDP HealthWatch Writer

leep often escapes people. Either they can’t get to sleep and stay asleep, or like teens, they sleep as long as they want with parental blessing.

“Then it becomes more important than ever before.” Among adults in the U.S., 95 percent experience difficulty sleeping at some time in their lives, he said. “You can’t catch up on lost sleep,” said Bregman. “Get as much as you need to feel refreshed and healthy, but not more. Don’t go to bed out of boredom or to escape an unpleasant situation.” Naps, hunger, caffeine, tobacco, alcohol and other stimulants should be avoided, because they can disturb sleep, he said. That can decrease concentration, decrease memory and cause high blood pressure and even car accidents. A good routine and stable bedtime schedule – going to bed and getting up at the same time – will help with sleep, and a few weeks of having a schedule will result in regular sleep habits, said Bregman. For good sleep hygiene, Bregman said, regular exercise – three to four times a week – tends to enhance sleep by releasing energy and mental tensions. Exercise should be done in the morning, with strenuous exercise avoided three hours before bedtime. Some people find it helpful to set aside 30 minutes to write down tasks or consider solutions to situations of concern. Other tips offered for good sleep hygiene include: • Take time to unwind as bedtime approaches, and make the bedroom setting comfortable. • Avoid lights after going to bed. There’s some indication the brain is very sensitive to light, which tells the brain it’s time to wake up. Bright lights and sunshine during the day can help orient the brain to the light/dark cycle. • Take slow, deep breaths, in sets of three, exhaling fully after each; this can bring on drowsiness. Sleep disorders should be reported to a physician who can consider treatments as basic as mouth guards or serious as surgery. “Sleep apnea, which affects 15 percent of men and women as pauses in breathing and snoring, leads to heart attach, stroke, car accidents, depression, diabetes, irritability, decreased

concentration and decreased memory,” he said. Seventy percent of the people with sleep apnea are overwe-iht, Bregman said. Two of the most common symptoms are daytime sleepiness and snoring. “Collar size for men of 17 inches or greater, and in women of 16 inches or greater, is another indicator,” he said. Treatment can include use a positive pressure machine CPAP, which forces air in airways; weight loss; or dental appliances. Consider the following guide of the new recommendations of normal sleep, by a panel of sleep experts. • Newborns (birth–3 months): Sleep range narrowed to 14–17 hours each day (previously 12–18). • Infants (4–11 months): Sleep range widened two hours to 12–15 hours (previously 14–15). • Toddlers (1–2 years): Sleep range widened by one hour to 11–14 hours (previously 12–14). • Preschoolers (3–5): Sleep range widened by one hour to 10–13 hours

(previously 11–13). • School-age children (6–13): Sleep range widened by one hour to 9–11 hours (previously 10–11) • Teenagers (14–17): Sleep range widened by one hour to 8–10 hours (previously 8.5–9.5). • Younger adults (18–25): Sleep range is 7–9 hours (new age category). • Adults (26–64): Sleep range did not change and remains 7–9 hours. • Older adults (65-plus): Sleep range is 7–8 hours (new age category). Time in bed and actual sleep time are not well distinguished in the study, and actual sleep time is typically less than time in bed, which biases data toward higher sleep duration estimates. Restorative properties of sleep depend on sleep quality, sleep architecture, and the timing of sleep within the day, the study indicators. More research is needed to evaluate sleep dimensions and measures. The study concluded that sufficient sleep duration requirements vary across lifespans and from person to person.

Recommended immunizations for those over 50

outine immunizations can keep people safe and healthy. Certain vaccinations can prevent diseases from producing symptoms, while others can lessen the duration of an illness or make conditions less severe. Vaccination schedules become a way of life for parents to young children. But vaccinations aren’t just for kids, and adults should keep tabs on their immunization histories to ensure they’re up-to-date with vaccinations for their particular age group and lifestyle. The Centers for Disease Control and Prevention warns that the elderly are more likely to die of a vaccine-preventable disease than other age groups. The immune system begins to decline as we age, so the body can benefit from the disease-fighting boost provided by vaccinations. Individuals at any age should discuss immunizations with their doctors, but it’s a particularly important conversation for those age 50 and older. Vaccine schedules and recommendations may vary depending on where a person lives, but the following immunization recommendations are offered

courtesy of the CDC. • Influenza. An annual flu shot can help prevent the nearly 36,000 deaths that occur due to flu each year in the United States. The flu vaccine is designed to combat the current strain of flu, so it is recommended anytime between September to March, which is the prime flu season. People age 50 and older should opt for the injection rather than the nasal form of the vaccine. • Tdap. This vaccine protects against tetanus, diph-

theria and pertussis and is especially necessary for people who have close contact with young infants. Pertussis, or whooping cough, can be passed on to youngsters and make them very ill. If you’ve never received a Tdap vaccine, the CDC suggests getting it at least once. Individual tetanus boosters should be received every 10 years. • Pneumococcal. Pneumococcal disease is an infection caused by the pneumococcus bacteria. It can cause pneumonia, blood infection, ear infections, and even bacterial meningitis. This vaccine is given to adults age 65 and older or to younger adults at their physicians’ discretion. • Hepatitis A. Individuals with medical, occupational or lifestyle conditions, such as healthcare workers or people with chronic liver disease, may need a two-dose series of the hepatitis A vaccine. • Adults who are avid travelers to various parts of the world that may bring them in contact with animals or people who do not receive the same course of immunizations may need additional vaccines. Speak with a doctor about which immunizations are recommended before travel.

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