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Real People. Real Life.

HEALTHY Fall Issue

Get the Facts on Measles to Remain Protected Simple Ways to Incorporate More Fruits and Vegetables into Your Diet How much exercise does someone need?

Marysville • Arlington • Smokey Point • Quil Ceda Village • Tulalip A Special Supplement to the North County Outlook, September 2019

North County Outlook • September 25, 2019 HEALTHY


Get the facts on measles to remain protected

ways 8 Simple to incorporate

more fruits and vegetables into your diet


How much exercise does someone need?


Learn to make mammograms more comfortable


Signs that you might be overtraining


Help kids feel comfortable at the dentist


Understanding and living with sciatica


5 tips when reading nutrition facts labels


Learn how to sleep like a child again

Publisher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sue Stevenson Editor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scott Frank Staff Writers. . . . . . . . . . . . . . . . . . . . . . . . . . . Christopher Andersson, Andrew Hines Display Ad Sales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Terrie McClay, Carole Estenson Directory Ad Sales �������������������������������������������������������������������������������������Leslie Buell Graphic Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Christina Poisal, Nathan Whalen Office Manager. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Leah Hughes-Anderson


Real People. Real Life.

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September 25, 2019 • North County Outlook

Learn to make mammograms more comfortable


ammograms remain one of the best methods to detecting breast cancers, giving women the opportunity to start treatment early if cancer is detected. “It is really important to get mammograms as that is the most common way we find breast cancer,” said Jennifer Barber, family medicine physician at the Kaiser-Permanente Everett Medical Center. Barber said that one in eight women will eventually get breast cancer. “Behind skin cancer it is the most frequent type of cancer,” she said. In countries with early access to quality screening and treatment, breast cancer survival rates are now greater than 80 percent. The organization Mammography Saves Lives says that, since 1990, mammography has helped reduce breast cancer mortality in the United States by 40 percent. Mammograms usually take around 20 minutes. “We’ve come a long way with not only our ability to screen for breast cancer but also in how we treat it,” said Barber. “The earlier we can catch it, the more we can do to help,” she said. There has been a lot of media about when the optimal time to begin screenings is, she said, because of the different guidelines from different organizations. The American College of Obstetricians and Gynecologists recommends screenings begin at 40 years old while the American Cancer Association recommends 45 years old and the United States Preventive Services Task Force recommends 50 years old.

Barber suggests you start discussing with your doctor when you are in your 30s about when the right time is for you. “If you have a history of breast cancer in your immediate relatives,” you may want to start earlier, said Barber. In Everett those with breast implants often assume they can’t get tested, but Barber said that is not true. “They often assume we can’t test if they have breast implants, but we have tools for that,” she said. During a traditional mammogram, a woman’s breast is placed between two plates. One plate holds the breast in place, while the other takes images, and the breasts must be compressed to get clear pictures of breast tissue. Some women find the process to be uncomfortable. Even though mammograms can be essential parts of preventive healthcare, many women avoid them because of pain and other discomfort. “One of the biggest things is that you should know why you’re doing it,” said Barber. “In our general opinion it is better to be proactive than to be reactive.” She said that it can be “an uncomfortable test” that is both emotionally and physically taxing. “If you are able to share with your doctor when you are uncomfortable, we are better able to support you,” said Barber. “Be honest and have a conversation because that lets us better know what you need,” she said. There are many ways to avoid pain during mammograms that can make the entire experience more comfortable. n Schedule the mammogram for a

Mammograms are one of the best ways to detect breast cancer.

week after a menstrual period when hormonal swings are less likely to increase breast sensitivity. n Caffeine can make the breasts more tender. Reducing caffeine consumption for two weeks before the mammogram can help. n Keep your feet and trunk facing forward and simply turn your head at the mammogram machine. n Reduce tension by breathing deeply a few times before the procedure. n Try a pain reliever before the mammogram. n Ask the mammography center if it has padding, as cushioning between the breasts and the plates of the mammogram machine can reduce pain. By taking these steps, women may be more comfortable during mammograms, which can play a vital role in the detection and ultimate treatment of breast cancer. “October is Breast Cancer Awareness month so we should be talking about it, both then and year round,” said Barber.

North County Outlook • September 25, 2019 HEALTHY




September 25, 2019 • North County Outlook

Signs that you might be overtraining


xercise is a vital component of a healthy lifestyle. Many people find that pairing a nutritious, well-balanced diet with routine exercise is a successful formula for a long and healthy life. People typically know when to stop eating. In fact, the brain signals when the stomach is full to prevent the body from eating too much. Exercise can be a little trickier, as men and women may be inclined to ignore certain warning signs of overexertion during a workout. The well-known workout motto “no pain, no

gain” implies that rewards await those who push through their pain during a workout. However, ignoring signals that the body is being overtrained can have a detrimental effect on both short- and long-term health. Sometimes signs of overtraining can indicate problems elsewhere. “You need to consider your entire lifestyle,” said Ryan Swobody, owner of Remedy Fitness, a CrossFit gym located in downtown Marysville. Those problems include

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There are a number of signs that can indicate that you may be overtraining.


North County Outlook • September 25, 2019 HEALTHY

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Washington is one of the more than 20 states in which measles have recently been reported.

Get the facts on measles to remain protected


disease once thought to have been eradicated in developed countries has become a newsmaker once again, with reported cases affecting various areas of North America. The American Red Cross says the United States is presently experiencing the highest number of measles cases since the disease was considered eliminated in the country back in 2000. Seventy-five new cases were reported in one week in May 2019, bringing the total confirmed cases to 839 across 23 states at

that point. Canada reported six confirmed cases at the same time. In recent months, measles has been reported in Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Tennessee, Texas, and Washington. Even though all 50 states require measles vaccinations See MEASLES on page 16

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September 25, 2019 • North County Outlook

Simple ways to incorporate more fruits and veggies into your diet


arents imploring their children to eat their fruits and vegetables is a nightly occurrence at many dinner tables. Reluctant youngsters may have a seemingly innate resistance to vegetables, but parents should stay the course, as the importance of making fruits and vegetables a routine part of one’s daily diet is hard to overstate. Children might be seen as the most resistant to fruits and vegetables, but reports indicate they’re not alone. A 2017 report from the Centers for Disease Control and Prevention found that just 12 percent of adults in the United States are meeting the standards for fruit consumption as established by the Dietary Guidelines for Americans, which are determined by the Office

of Disease Prevention and Health Promotion. Even fewer people (9 percent) are meeting the standard for vegetables. The picture is somewhat better in Canada, where the Canadian Community Health Survey, 2017, found that 28.6 percent of Canadians ages 12 and older report consuming fruits and vegetables more than five times per day. However, that figure has steadily declined since 2015. That’s unfortunate, as fruits and vegetables have been linked to a host of health benefits. Jessica Johnston, owner of Arlington’s Rain City Fitness, said she approaches nutrition from a lifestyle standpoint. Rain City Fitness offers nutritional coaching in addition to private fitness classes and personal

The importance of making fruits and vegetables a routine part of your diet is hard to overstate.

training sessions. “Vegetables are a good source of carbohydrates, which is energy,” Johnston said of vegetables, in addition to containing a ton of nutrients. She highlighted ways people can add more

vegetables into meals throughout the day. Smoothies are great and “fruits and vegetables are great ingredients in every smoothie.” Such ingredients as See DIET on page 17

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North County Outlook • September 25, 2019 HEALTHY


Help kids feel comfortable at the dentist


outine dental examinations and cleanings are an important component of oral healthcare for both children and adults. However, many children do not visit the dentist until well after the time recommended by medical and dental professionals. Parents may be unaware of the dental health timeline, or they could be reluctant to bring their children for fear of how their kids will behave, especially if parents are harboring their own apprehensions about the dentist.

“People tend to let their own anxiety reflect on their kids,� said Dr. Chad Slaven, a dentist with Puget Sound Pediatric Dentistry that has offices in Marysville, Lake Stevens, Monroe and Stanwood. He encourages parents to make their children’s first visit to the dentist as fun as possible. The American Academy of Pediatric Dentistry recommends that a child go to the dentist by age 1, or within six months of the eruption of his or her first tooth. Yet, according to a See DENTIST on page 18

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The pain from suffering from sciatica can have an adverse affect on everyday life.

Understanding and living with sciatica


he largest nerve in the human body is the sciatic nerve, which originates in the lower back and travels through the back of each leg. Injury or pressure on this nerve can lead to a type of pain known as sciatica. Sciatica can have an adverse effect on everyday life, causing pain that can radiate from the lower back through the hips and buttocks and down the legs. People experiencing pain in these areas should consult a physician immediately,

as the American Academy of Orthopaedic Surgeons notes that between 80 and 90 percent of people diagnosed with sciatica get better over time without surgery. Many typically feel better within several weeks of beginning treatment. For Dr. Yuri Tsirulnikov, a pain intervention specialist at Skagit Valley Regional Hospital that operates Cascade Valley Hospital, sciatica can be a confusing term because it means leg pain. “I never use the term.” He recommends See SCIATICA on page 19

North County Outlook • September 25, 2019 HEALTHY


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Exercise is an important part of a healthy lifestyle and people should understand how much exercise they need.

How much exercise does someone need


xercise is an essential component of a healthy lifestyle. Exercise helps people maintain healthy weights, improves mood, reduces the risk for various health ailments, and much more. But how much exercise is necessary for optimal health? Research indicates that the answer to that question depends on the person and his or her individual health goals. “It doesn’t really matter what your physical state is, movement and exercise is always good for the

body,” said Suzanne Barrett, healthy living program coordinator at the Marysville YMCA. It’s an individual journey. People should always evaluate their fitness on a personal level. According to David Bassett, Jr., PhD, a professor of exercise physiology at the University of Tennessee in Knoxville, having a clear set of exercise goals can help a person determine just how much exercise he or she needs, particularly if a

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September 25, 2019 • North County Outlook

5 tips when reading nutrition facts labels


uch about trips to the grocery store has changed since many adults were children. Many grocery stores are considerably larger than they were as recently as 20 years ago and now sell everything from traditional grocery store fare to clothing to items one might expect to find in a hardware store. Another aspect of grocery shopping that has changed over the years is the groceries themselves. Nutrition labels have been around for decades,

though today’s labels contain considerably more information than they did in years past. As a result, many shoppers, even those who make sure to read product labels before placing items in their shopping carts, may not know exactly what they’re buying. Nutrition labels can be complicated, and ingredients that are beneficial for some consumers may be harmful to others. Seniors

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North County Outlook • September 25, 2019 HEALTHY


Learn how to sleep like a child again


any adults lament that even if they were solid sleepers in their younger years, by the age of 50 their quality of sleep has unraveled. Some cling to the wisdom that people simply do not need as much sleep as they get older. Even though that is partly true, sufficient sleep is still a vital component of a healthy life. “We think sleep goes with other facets of health,” said Anjuli Brighton, a doctor in pulmonary and sleep medicine at The Everett Clinic. “We have shown that it impacts performance drive.” Sleep impacts mood and emotional health and the body’s maintenance as well as immune function, Brighton said. The National Sleep Foundation recently updated its sleep recommendations per age group to include categories “may be appropriate” and “not recommended.” This includes a range of hours that may be adequate for certain adults. Adults between the ages of 26 and 65 are advised to get seven to nine hours of sleep per evening. However, six hours or 10 hours also may be acceptable. People over the age of

Many people have difficulty getting the proper amount of sleep each night which can impact their mood and emotional health.

65 need roughly seven to eight hours of sleep each night, though between five and six hours also may be fine. Generally speaking, anything under five hours is not recommended based on data reviewed by sleep experts. Many older adults do not get enough sleep due to insomnia, states Jack Gardner, MD, a neurologist certified in sleep medicine. They’re concerned about health issues, may have sleep apnea, can experience

pain or frequent urination, or may be taking medication that impedes sleep. Dr. Leila Kheirandish-Gozal, director of clinical sleep research at the University of Chicago, says that, over time, insufficient sleep can impact metabolism, mood, memory, and heart function. In cases of sleep apnea in older people, Brighton said muscles change See SLEEP on page 22

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September 25, 2019 • North County Outlook

OVERTRAINING Continued from page 6

sleep habits, nutrition, the amount of exercise or stress levels, Swobody said. He said a good night sleep helps restore the body’s functions and getting quality sleep is difficult in a society where an indicator of success is how hard people work. “The switch is always on.” People should develop good sleeping habits that includes no caffeine before bedtime, avoid screen time at least an hour before bedtime and sleep in a dark, cool, decluttered

room, Swobody said. “People are chronically stressed,” Swobody said. Exercise is a way to put aside stressors in their lives because it’s something people do for themselves, which will help decrease the stress load. Swobody started Remedy Fitness in 2010 and offers personal training and group fitness classes. “The goal is to bring a higher level of training and coaching at an affordable price.” According to the American Council on Exercise®, there is a tipping point in regard to how much exercise the body can take. ACE notes

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eople looking for a good cardiovascular or aerobic exercise may not need to invest in a gym membership or treadmill. According to Rally Health®, a digital health experience that helps you make simple changes in your daily routine, walking can be an effective cardio exercise if one goes at a brisk pace of at least three miles per hour. Walking at this pace can effectively push the heart and lungs to work hard without adversely affecting the joints in the way that other aerobic exercises might. Harvard Health says that walking of any kind can help people maintain healthy weights, lower their risk for various diseases, keep blood pressure in check, lift mood, and strengthen bones. A number of studies also show that walking can help people improve memory and avoid age-related memory loss.

that, when people pass that point, the exercise they engage in can actually do more harm than good. ACE refers to the tipping point as overtraining syndrome, or OTS, which can actually contribute to a reduction in overall fitness and increase a person’s risk for injury. People dealing with OTS may not recognize its symptoms as readily as they would a full stomach. As a result, it can be easier to overtrain than overeat. For instance, people focused on living healthy often know when to call it quits at the dinner table, but might not know when to end a workout. Overtraining can be just as harmful as overeating, and athletes can help themselves by learning to recognize various signs of overtraining. Decreased performance: ACE notes that a lack of improved performance, despite an increase in training intensity or volume, is a telltale sign of OTS. Athletes who recognize a decrease in their agility, strength and endurance might be dealing with OTS. Increased perceive effort during workouts: OTS can make seemingly effortless workouts seem difficult. An abnormally elevated heart rate during exercise or even throughout the day may indicate OTS. Excessive fatigue: Too much training can

contribute to fatigue because the body is not being given ample time to recover between workouts. Agitation and moodiness: Overtraining can contribute to a hormonal imbalance that affects stress levels, potentially making people more irritable and contributing to moodiness. Insomnia or restless sleep: The overproduction of stress hormones that can occur when overtraining can adversely affect a person’s ability to get adequate sleep. When Swobody encounters someone who is suffering overtraining, he often tries to get them back in touch with their goals. “People are finding they are doing too much,” Swobody said. He said when people constantly revisit their goals, they realize their goals could be accomplished with minimal amount of exercise, between 45 and 60 minutes a day. “We want to show it’s not as hard as they think. All it takes is a little commitment,”Swobody said. Additional signs of overtraining include loss of appetite, chronic or nagging injuries, metabolic imbalances, and stress and/or depression. More information about OTS and how to avoid it is available at www.acefitness.org.

North County Outlook • September 25, 2019 HEALTHY




September 25, 2019 • North County Outlook

MEASLES Continued from page 7

prior to children entering school, there are some medical exemptions, and exemptions for religious and philosophical reasons, according to the Red Cross. “Around the world in 2015 more than 100,000 people died from measles, and most of those were children,” said Hervey Froehlich, a doctor at the Kaiser Permanente Everett Medical Center. “2016 was the first year ever that fewer than 100,000 people died,” and that was largely the result of worldwide vaccination efforts that have provided vaccines to about 85 percent of people said Froehlich. Those efforts have almost eradicated the disease, which was once more a part of everyday life. “Measles went from a common, everyone-gets-it infection to a rare illness,” said Froehlich. In the U.S. the incidence of measles decreased until it hit a low point in the ‘90s, he said. The Centers for Disease Control and Prevention says that measles outbreaks are linked to travelers who bring measles back from other countries. Measles outbreaks have been documented in Israel, Ukraine and the Philippines.

In New York, state senators and other politicians have pushed to end non-medical exemptions, including religious waivers from vaccinations. Roughly 530 cases of measles were confirmed in an area of Brooklyn, New York, between October 2018 and May 2019, leading Mayor Bill de Blasio to declare a public health emergency and ordering mandatory vaccinations under the threat of $1,000 fines. Schools in Lakewood, New Jersey, were shuttered for many days due to measles cases. Some schools sent the message that children will not be able to attend without proof of vaccination. Measles is a highly contagious virus that lives in the mucus of infected people. It is spread through coughing and sneezing. Measles is so contagious that if one person has it, 90 percent of those close to that individual who are not immune will be infected, says the CDC. Early symptoms include a high fever, cough, runny nose, and red, watery eyes. Within two or three days of such symptoms surfacing, small white spots may appear in the mouth before a red measles rash on the face and body develops. “The best way to stay protected is to make sure everyone has been immunized from measles,” said Froehlich.

Measles is a highly contagious virus so it is important that people be vaccinated.

Children typically receive two doses of MMR - one as an infant and one between the ages of four and six. “Any adult born after 1957 needs to have at least one recent measles vaccine,” said Froehlich. Adults can check their healthcare records to see if they need one. “At Kaiser-Permanente all our records are electronic so it is very easy to check,” he said. Those concerned about measles can speak with their doctors about a measles booster and the various risk factors for the virus. Although one study showed a link between the measles vaccine and autism, that study was from “an English doctor who first had his article revoked and then his medical license revoked,” said Froehlich.

Future studies that looked into the issue with a bigger sample size, for example one that looked at 20,000 children, show that the rate of autism was not any lower for those that didn’t vaccinate, said Froehlich. “The few side effects have been studied for more than 40 years. In very, very rare cases there are allergic reactions,” he said. Sometimes there is a minor fever or a slight rash. “When people are concerned, they should be directed to reliable health sources,” he said. “There are a lot of blogs and websites that give people misinformation,” he said. He suggests sources like the Snohomish Health District or the American Academy of Pediatrics.

North County Outlook • September 25, 2019 HEALTHY

DIET Continued from page 8

carrots and zucchini can be shaved and added to pastas. Sweet potatoes are a low-glycemic food and won’t spike or reduce blood sugar levels, and vegetables like carrots are a great snack when dipped in hummus. Why eat fruit and vegetables? The U.S. Department of Agriculture notes that fruits do not contain cholesterol and are naturally low in fat, sodium and calories. In addition, fruits contain a host of essential nutrients, including potassium, dietary fiber, vitamin C, and folate, that are historically underconsumed. Similarly, studies have shown that vegetables, which also are great sources of vitamins and minerals, can help people reduce their risk for a variety of conditions, including heart disease, stroke and certain types of cancer.

How can I include more fruits and vegetables in my diet? Routine is a big part of many people’s lives, and some may find it hard to change their dietary routines. But people who aren’t eating enough fruits and vegetables likely don’t need to completely overhaul their diets in order to include more fruits and vegetables. In fact, the American Heart Association notes that the following are some easy ways for people to sneak more fruits and vegetables into their diets. Johnston said people can make breakfast muffins. Similar to an egg bite, people can add omelet ingredients or sweet potatoes and make a breakfast cupcake. She added a potato puree is a great component. Banana pancakes are great too, where bananas are mashed together with eggs and other ingredients. She noted the public wants to see more healthy substitutions available. She noted that MOD Pizza

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and don’t forget to include steamed vegetables, even frozen ones, on your dinner plate every night. Add chopped vegetables, such as onions, garlic and celery, when making soups or stews. A few simple strategies can help people eat more fruits and vegetables and reap the many rewards that such foods provide. When people seek help with their diet, she helps them look at their relationships with food and why they aren’t eating well. “When you’re trying everything and it’s not working, then it’s time to meet with a nutrition professional,” Johnston said.

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September 25, 2019 • North County Outlook

DENTIST Continued from page 9

survey commissioned by Delta Dental Plans, the average age of a child’s first dental visit is 2.6 years. “It becomes instilled in them and they think it’s part of their normal life,” Slaven said of starting regular dental visits at an early age. He has examined children as young as seven months. Parents worried about how their kids will respond to the dentist can take the following steps to acclimate kids to dental visits to make them more comfortable during their appointments now and down the road. n Be a positive role model. Children frequently learn by example. If they see their parents being diligent about dental care, they’re more likely to embrace proper oral hygiene. Bring children to your own dental appointments so they understand the process and become familiar with the type of equipment used. n Stick to the first-tooth milestone. Take your child to the dentist on or about when his or her first tooth erupts. Early dental visits will get kids used to going to the dentist and prevent minor problems that may lead to more complex dental issues. n Read books about the dentist

and role play. Information can allay kids’ fears about the dentist. Read books together about dental visits and act out possible scenarios with your kids. Give kids toy dental health tools and have them practice exams on you and vice-versa. Slaven encourages families to view videos online of children visiting a dentist. He added children are comforted when they see other children do well when they see the dentist. He also encouraged parents and children to check out the dentist office websites to learn about dentists and their offices. n Be supportive and instill trust. Avoid telling your child that everything will be okay. If a procedure is needed, this could affect his or her trust in you and make the dental office an even greater source of anxiety. Simply be supportive and offer a hand to squeeze or a hug if your child needs you. “Make their first visit as fun as they can,” Slaven said. “Try to make it a positive experience.” n Consider using your dentist. Some parents like to take their children to a pediatric dentist, but it may not always be necessary. Many family practices cater to patients of all ages, and the familiarity of the office may help make children feel more comfortable. Speak with your dentist

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about the ages they see. n Steer clear of negative words. Michael J. Hanna, DMD, a national spokesperson for the AAPD, suggests using positive phrases like “clean, strong, healthy teeth” to make the visit seem fun and positive rather than scary and alarming. Let the office staff come up with their own words to describe processes that won’t seem too frightening. Parents should avoid scary words like “shot and drill.” Slaven said he uses kid-friendly terms to help describe procedures to a patient - a shot is sleepy juice that helps a tooth snore and a drill is a squirt gun. By employing these techniques, kids’ dental visits can be more pleasant for all involved, paving the way for a lifetime of healthy teeth. “We want to be the home that you can come to for anything,” Slaven said of meeting his patients’ dental needs.

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North County Outlook • September 25, 2019 HEALTHY

SCIATICA Continued from page 10

people should see a doctor to help establish a proper diagnosis. By meeting with a doctor they can discuss symptoms and patient history. A doctor should conduct a physical examination and start finding answers to questions. Are there any motor or sensory deficiencies? Is there any weakness in the legs? How do the muscles look? Are there any range-of-motion issues? Any spinal issues? Finally lab or imaging procedures should take place to help a doctor confirm a diagnosis. What are the symptoms of sciatica? The AAOS notes that sciatica may feel like a bad leg cramp that lasts for weeks before it goes away. According to Spinehealth.com, a property of the health publisher Veritas Health, sciatica pain is often described as burning, tingling or searing as opposed to a dull ache. In addition, pain resulting from sciatica may be worse when sitting, even though sharp pain associated with sciatica can make it difficult to stand up or walk. Numbness characterized by a “pins and needles” feeling, weakness or a burning or tingling sensation down the leg are some additional symptoms of sciatica.

Does sciatica affect both legs? WebMD notes sciatica usually affects only one leg, though the buttock or leg on the affected side may feel like it is in constant pain. What causes sciatica? Spine-health.com notes that the following five lower back problems are among the most common causes of sciatica: n Lumber herniated disc: This occurs when the soft inner material of the disc herniates, or leaks out, through the fibrous outer core, irritating or pinching the nerve root. n Degenerative disc disease: Discs in the back can degenerate with age and never contribute to a problem like sciatica. However, degeneration in one or more discs in the lower back can sometimes irritate a nerve root and lead to sciatica. n Isthmic spondylolisthesis: This occurs when a small stress fracture allows one vertebral body to slip forward on another. The combination of collapsing disc space, a fracture and the slipping forward of the vertebral body can pinch the nerve and cause sciatica. nLumbar spinal stenosis: In this condition, which is common among people older than 60, a narrowing of the spinal canal can contribute to sciatica.

n Piriformis syndrome: A muscle found deep within the buttocks, the piriformis connects the lower spine to the upper thighbone, running directly over the sciatic nerve. Spasms in the piriformis can put pressure on the sciatic nerve, triggering sciatica. Treating sciatica “We always try to treat it conservatively,” he said, adding anti-inflammatories and physical therapy helps. “Most of the time, it will get better on its own.” Sciatica often can be treated successfully without surgery. Doctors may recommend applying heat and/or ice packs


for acute sciatic pain. In addition, over-the-counter and prescription pain medications can effectively reduce or relieve sciatic pain. Doctors also may explore other treatments, including chiropractic manipulation, acupuncture, massage therapy, or surgery. He added if someone is experiencing something acute such as motor deficits, weakness, numbness, or bowel or bladder changes, they should see someone right away. “It’s always good to utilize a primary care physician,” Tsirulnikov said. More information is at www.orthoinfo.aaos.org.

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September 25, 2019 • North County Outlook

EXERCISE Continued from page 11

person is exercising to control his or her weight or reduce his or her stress. The U.S. Department of Health and Human Services recommends that most healthy adults get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or a combination thereof, every week. Try to engage in strength training for all major muscle groups at least two times per week. The Mayo Clinic says a general goal for most people is to aim for at least 30 minutes of moderate physical activity every day. Barrett said people should use the “talk test.” If someone is working out and able to carry a conversation, then they may want to increase

intensity. Likewise, people should feel warm and energized after a workout and feel encouraged to come back another day. “It’s always about paying attention to you and how you feel,” Barrett said. On a scale of one-to-ten with 10 being out-of-breath, dizzy and feeling close to passing out, people should be breathing in a range of four to seven. “With any kind of exercise, it’s very much a person-to-person experience,” Barrett said. People can break up the amount of vigorous activity — walk for 15 minutes, complete 5 minutes of vigorous work and then walk again. This is similar to High Intensity Interval Training and is a great way to build intensity in a workout. She added people have to respect their strengths and to work with the body they have.

Low-impact cardiovascular exercise mixed with intervals of strength training can be the right formula for losing weight with a sluggish metabolism.

Health experts say that this exercise needn’t all occur at once, either. If a 30-minute walk is not possible, split that up into a few 10-minute walks throughout the day. Any activity is better than doing nothing at all. For those with specific fitness goals, it could be wise to speak with a trainer or a doctor about which types of exercises (and durations) are effective. Physicians may be able to map out a fitness plan that works. For more information about the YMCA, go to www.ymca-snoco.org.

Did you know?

The American Academy of Family Physicians notes that children should get at least one hour of physical activity per day. The AAFP notes that many kids easily achieve that marker simply by being children and engaging in the activities kids are drawn to each day, such as running, climbing and playing games like tag with other youngsters. The Canadian Paediatric Society notes that exercise needs change as children advance through various stages in life, and that means activities should change along with them. For example, the CPS recommends that physical activities for toddlers should be fun and encourage children to explore and try new things. Unstructured physical activity or free play can benefit toddlers. As toddlers become preschoolers, physical activities can become more structured, though the CPS notes that children this age may not understand the rules of organized sports nor are they necessarily coordinated enough to participate in them. However, structured activities like games of tag and throwing and catching may be appropriate for some preschoolers. As children enter kindergarten and advance through elementary school, physical activities can be moderate to vigorous in intensity. Organized sports can become part of the fitness regimen at this time, though the CPS recommends short instruction times, flexible rules, free time in practices, and a focus on fun rather than competition. Parents who want to learn about age-appropriate physical activities can encourage their children to embrace fitness and are urged to speak with their children’s physicians.

North County Outlook • September 25, 2019 HEALTHY

LABELS Continued from page 12

and people with existing medical conditions should always discuss their diets with their physicians, asking if there are specific foods they should avoid or seek out. In addition, the following three tips, courtesy of the Academy of Nutrition and Dietetics, can help consumers understand nutrition labels and make sound choices. 1. Read the serving size information Serving size information on nutrition labels indicates both the recommended serving size and the number of servings contained in the package. The AND recommends that consumers compare the portion size they actually eat to the serving size listed on the label. Some people may consume more than one serving size per meal, and that can affect just how much of each ingredient, including ingredients like sodium that can be harmful if consumed in excess, a person is eating. “A lot of products will try and trick people,” said Emily Countryman, health coach and owner of Smokey Point’s Ideal Wellness. “They’ll look at the nutritional panel and then drink an entire bottle without realizing they’re drinking two or more servings.”

2. Pay attention to calorie count Nutrition labels contain calorie counts, which can help people maintain healthy weights. Being at a healthy weight has been linked to a reduced risk for various conditions, including type 2 diabetes and cardiovascular disease. Nutrition labels list calories per serving, so people trying limit their calorie intake to lose weight or maintain a healthy weight should pay particular attention to this information. 3. Avoid added sugars Not all sugar is created equal and some forms are worse than others. “When you’re looking at the amount of sugar, see if it’s coming from added sugar or natural sugar,” said Countryman. She said that salsa, for example, has sugar from the tomatoes that are part of it, but that kind of natural sugar is not as bad for you. “If it’s added sugar, that’s really when you want to avoid it,” she said. “Avoid anything ending with -ose,” said Countryman. “Those are usually the fake sugars or sugar alternatives.” 4. Let percent daily values guide you The AND notes that percent daily values, which are listed as “DV” on food labels, help consumers determine how particular foods fit into their daily meal plans. These values are

based on a 2,000 calorie per day diet, though some people may need more or fewer calories than that. In addition, some people may need more than the 100 percent recommended daily value of a given nutrient. Consumers should discuss their specific needs regarding calorie and nutrient intake with their physicians. For those advised to heed the daily values recommendations, ingredients that are listed at 5 percent DV or less are considered low, while those that are 20 percent DV or higher are considered high. The AND recommends aiming low for ingredients like sodium, saturated fat


and cholesterol, while foods high in vitamins, minerals and fiber can be beneficial. 5. Net carbohydrates matter more than total carbohydrates If you’re avoiding eating carbohydrates you should be looking at the net amount of carbohydrates, said Countryman. “If you look just below the carbs listing you will see the amount of fiber, which you should subtract from the carbs,” she said. Those avoiding carbohydrates should be getting their carbohydrates from high fiber foods, she said. More information about nutrition labels is at www. eatingright.org.



September 25, 2019 • North County Outlook

SLEEP Continued from page 13

and the airway narrows as people age. “The key is being alert to recognize symptoms,” she said. Those symptoms include snoring, pauses in breathing, snorting or gasping for air. Various strategies can help people get more sleep and enjoy better sleep quality. “Be mindful of creating good conditions for sleep,” Brighton said. People ages 18 and older should set a schedule for seven hours of sleep. They should also maintain an environment

conducive for sleep that includes dark, cool conditions free of noise. Other strategies include:  n Create a luxury bed environment. Splurge on the largest mattress you can afford and one that is comfortable for both parties (if married/coupled). A roomy bed routinely invites sleep. If you have a restless partner, try two separate beds pushed against each other. n Consider white noise. The sounds of the house or outdoors may be keeping you up. Many people find that the gentle hum of a fan or a white-noise machine with a calming sound effect makes it easier for them

to doze off than complete quiet. It can also block out extraneous noises. n Keep electronics out of the bedroom. It can be challenging to disconnect from electronics, but it is essential to falling asleep. Even a back-lit text coming through in the wee hours can be enough illumination to disrupt sleep. n See your doctor. If medications or illnesses are keeping you up, a change in regimen may provide the relief you need. Older adults can learn the steps to sleeping more soundly and easily. Brighton said people

should know signs that indicate they should seek medical help – sleep problems during the daytime, experiencing excessive sleepiness while driving, seeing that sleep isn’t refreshing and waking up exhausted and tired, or waking in the morning with headaches. People should also consult with their primary care doctor who will evaluate whether to bring in a sleep specialist. She added that a good resource people should use is the American Academy of Sleep Medicine at www. sleepeducation.org.

Getting the proper amount of quality sleep each night is very important to your overall health.

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Aaron Brinklow, DO

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2019 Fall Healthy Living  

2019 Fall Healthy Living