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;;;+HDOWK :HOOQHVV3DJH &RORU . W3ULQWHG G 2E Kingsport Times-News / Wednesday, June 27, 2012

Contributors A. Stephen May A mild winter and early spring means ticks have arrived in full force much sooner than in previous years. Already, cases of Rocky Mountain Spotted Fever have occurred in the state. Now is the time to take preventative measures to ensure that you are not bitten by a tick during the high-risk summer months. Page 4.

Andy & the Beats Andy Rogers has battled type 1 diabetes since he was 15. Now, he has combined his dual interests in biochemistry and performing arts to create a musical dramedy that shows how a young boy learns to deal with the challenges of the life-altering disease. Page 6.

Wendy Vogel Clinical trials help researchers develop drugs to fight cancer. However, there is a lot of misunderstanding about what clinical trials do and who can participate. Learn what’s myth and what’s truth about participating in a clinical trial while you’re a cancer patient. Page 5.

Tara Lange A common form of thumb tendinitis, called de Quervain’s, is caused by pinching and gripping in combination with wrist sideway motion, which aggravate the tendons at the base of the thumb, around the back of the wrist. Physical therapy can help relieve the pain. Page 7

Tim Martin Excessive daytime sleepiness, which may result from a wide range of medical disorders and medications, can put us at significant risk for accidents and have a major impact on our health and sense of well-being. Page 10.

Misdiagnosis

Danielle Combs

When an older adult begins to experience confusion, forgetfulness and other signs of dementia, many, including doctors, are quick to jump to the diagnosis of Alzheimer’s disease. Recent research shows they may be wrong one-third of the time. Page 16.

When deciding to purchase a hearing aid, there are a number of factors to take into consideration, such as what you do and where you go, how minimal or severe your hearing loss is, and what your expectations are. Page 13.

Marie Browning

Protein power The popularity of protein has now surpassed the popularity of high fiber and low fat. However, the consumption of high protein supplements may not do anymore for a person’s diet than just eating a healthy balance of foods. Page 14.

An apple cider vinegar tonic has been used for thousands of years. It can regulate blood glucose in diabetics, heal a sunburn, treat swimmer’s ear infections and ease acid reflux. And this is only the beginning. Page 15.

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;;;+HDOWK :HOOQHVV3DJH &RORU . W3ULQWHG G 4E Kingsport Times-News / Wednesday, June 27, 2012

Rocky Mountain Spotted Fever on rise this year With the light winter and advent of early spring, ticks have come out early and with them an increase in the reported cases of Rocky Mountain Spotted Fever (RMSF). RMSF is a disease that is reportable to the Tennessee Department of Health (TDH) and the Centers for Disease Control and Prevention (CDC). According to TDH statistics, there were 255 cases in the state last year. Currently, there are 229 cases reported in Tennessee with two of those cases from Sullivan County and the summer/peak season is still ahead of us. Although RMSF cases have been reported throughout most of the contiguous United States, five states (North Carolina, Oklahoma, Arkansas, Tennessee and Missouri) account for more than 60 percent of RMSF cases. The primary tick that transmits R. rickettsii in these states is the American dog tick (Dermacentor variabilis Dermacentor andersoni). Although cases of RMSF can occur during any month of the year, the majority of cases reported to the CDC have an illness onset during the summer months with a peak in cases typically occurring in June and July. This seasonality varies somewhat for different regions of the country due to the climate and the tick vectors involved. The frequency of reported cases of RMSF is highest among men, American Indians and people aged 50 to 69. Individuals with frequent exposure to dogs and who reside near wooded areas or areas with high grass may be at increased risk of infection. Children from birth through age 9 and American Indians have an increased risk of fatal outcome from RMSF.

A. Stephen MAY The first symptoms of RMSF typically begin two to 14 days after the bite of an infected tick. A tick bite is usually painless, and about half of the people who develop RMSF do not remember being bitten. The disease frequently begins as a sudden onset of fever and headache, and most people visit a healthcare provider during the first few days of symptoms. Because early symptoms may be non-specific, several visits may occur before the diagnosis of RMSF is made, and correct treatment begins. The following is a list of symptoms commonly seen with this disease. However, it is important to note that few people with the disease will develop all symptoms, and the number and combination of symptoms varies greatly from person to person. Symptoms are fever, rash (occurs two to five days after fever, may be absent in some cases; see below), headache, nausea, vomiting, abdominal pain (may mimic appendicitis or other causes of acute abdominal pain), muscle pain, lack of appetite and conjunctival injection (red eyes). RMSF is a serious illness that

can be fatal in the first eight days of symptoms if not treated correctly, even in previously healthy people. The progression of the disease varies greatly. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care. While most people with RMSF (90 percent) have some type of rash during the course of illness, some people do not develop the rash until late in the disease process, after treatment should have already begun. Approximately 10 percent of RMSF patients never develop a rash. It is important for physicians to consider RMSF if other signs and symptoms support a diagnosis, even if a rash is not present. Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever RMSF is suspected. Antibiotic treatment following a tick bite is not recommended as a means to prevent RMSF. There is no evidence this practice is effective and may simply delay onset of disease. Instead, persons who experience a tick bite should be alert for symptoms suggestive of tick-borne illness and consult a physician if fever, rash or other symptoms of concern develop. The clinical presentation for RMSF can also resemble other tick-borne diseases, such as ehrlichiosis and anaplasmosis. Similar to RMSF, these infections respond well to treatment with doxycycline. For more information, visit www.cdc.gov or www.sullivanhealth.org.

Preventing tick bites While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active. Avoid direct contact with ticks, avoid wooded and bushy areas with high grass and leaf litter, and walk in the center of trails.

Repel ticks with DEET or permethrin Use repellents that contain 20 percent or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes and mouth. Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings. Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and remove ticks from your body Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you. Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-in-

fested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist and especially in their hair. Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

Tick removal

If you find a tick attached to your skin, there’s no need to panic. There are several tick removal devices on the market, but a plain set of fine-tipped tweezers will remove a tick quite effectively. 1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. 2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal. 3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water. 4. If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick. Andrew Stephen May, M.D., FAAFP, is medical director for the Sullivan County Regional Health Department.

Good health key to keeping wealth in retirement years By Donna Gehrke-White Ruth H. Clark of Pompano Beach, Fla., is a 95-year-old aerobic wonder, working out seven days a week. But Clark is not just flexing her muscles, she’s protecting her retirement nest egg by staying healthy. Economists say health care will become more crucial in retirement planning as medical expenses climb for the elderly. People on Medicare already spend three times more as a percent of income out-of-pocket for health care compared to non-Medicare households — 14.7 percent vs. 4.9 percent, according to the National Council on Aging.

“The financial burden is highest for beneficiaries who are older, in relatively poor health, and have low or modest incomes,” said council spokesman Ken Schwartz. Medicare recipients 85 and older spend an average of 30 percent of their income for out-of-pocket medical expenses, or $4,615 a year, according to an analysis on the website NewRetirement.com. Many seniors who have higher retirement savings and income pay even more: Older clients of Boca Raton financial planner Mari Adam spend about $10,000 to $20,000 per year for medical expenses, she estimated. “High dental bills are not uncommon,”

Adam said. The nonprofit Employee Benefit Research Institute estimates a 65-year-old couple will need $271,000 to give themselves a 90 percent chance of having enough savings to cover their out-of-pocket medical expenses during retirement. Clark said she has managed to stay out of the hospital since the mid-1970s, except for a nasty bout with a nose bleed a few years ago. She has saved tens of thousands of dollars in medical costs, from hospital bills to paying for home healthcare nurses. Clark, for example, “treats” arthritis by bending, stretching and moving about during her daily 30-minute workouts in her apartment at the John Knox Village. She

adds two-pound weights to her regimen every other day. “Every single joint gets moved,” Clark said. To keep her good health, Clark stopped bad habits early. She quit smoking in 1960, four years before the U.S. Surgeon General issued a warning about the dangers of cigarettes. The former Connecticut state senator also sticks to mostly fruits and vegetables. She has avoided diabetes, heart problems and other chronic ailments, partly thanks to such a healthy diet. Indeed, Clark thinks her parents’ meat-and-potatoes diet may have contributed to their relatively early deaths.


;;;+HDOWK :HOOQHVV3DJH &RORU . W3ULQWHG G Wednesday, June 27, 2012 / Kingsport Times-News 5E

Learning myths and truth about cancer clinical trials Have you ever wondered what a clinical trial is? Perhaps you have been asked to participate in a clinical trial and were not quite sure if it was safe? Patients with cancer may be asked if they are interested in participating in a clinical trial. Some patients will seek out a clinical trial in order to receive a new drug that might not be available yet on the market. Unfortunately there are several myths about clinical trials that make people hesitate to be a part of this process. These myths slow down needed cancer research. Learning the truth about clinical trials will increase participation and further the fight against cancer. Just what are clinical trials? Clinical trials are how we get new treatment advances on the market to better fight cancer or other diseases. All our current treatments have been through this rigorous and time-consuming study process. The FDA (Food and Drug Administration) carefully examines the data obtained from clinical trials and determines if the study drug is effective and if it is safe to put on the market. Clinical trials have different “phases” of testing. The drug is first tested in the lab — called “pre-clinical” testing before it is tried in a human being. The FDA examines the pre-clinical data and decides if the drug can move into human testing. Once this permission has been granted, the drug moves into a phase I trial. In a phase I trial, the safety of the study drug in human beings is examined. Data is collected from the phase I trial and again closely studied by the FDA. If deemed safe, the drug then moves into Phase II and then into Phase III studies, then possibly Phase IV studies. Phase II studies determine if the drug is effective. Phase III studies compares the new drug to current treatments. Phase IV studies may examine long-term effects and uses in other diseases. So what do people believe about clinical trials, and what is really true? Here are some common misconceptions about clinical trials and the actual facts! MYTH: I’d just be a guinea pig or a lab rat if I am part of a clinical trial. TRUTH: People who are en-

Wendy VOGEL rolled in a clinical trial are monitored very closely by both physicians and nursing staff. Detailed information (such as physical exam findings, lab studies and more) is required on every patient on a clinical trial. Any side effects of the study drug are carefully managed by the healthcare team. Patients are educated thoroughly about how the treatment works; any needed procedures; risk and benefits; and any possible side effects during the “informed consent” process prior to clinical trial enrollment. The risks of participation are explained in detail. If the clinical trial team thinks that the treatment is harming you, they will stop the study treatment. If you decide to stop the treatment, you may do so at any time. Participation is always voluntary. MYTH: My insurance won’t cover clinical trials. TRUTH: Most insurances cover the normal costs of treatments in cancer clinical trials. There are some states that require insurances to cover the costs. Medicare provides coverage for participation in clinical trials. Some clinical trials will provide the study drug for free and may pay for tests not covered by insurance. Your clinical trial coordinator will explain this to you in the “informed consent” process prior to beginning a clinical trial. MYTH: I could get a “placebo” or sugar pill if I participate in a clinical trial. TRUTH: Most cancer clinical trials do not use placebos. Patients will either receive the best and most current standard treatment or the study drug. MYTH: I am too old to partici-

pate in a clinical trial. TRUTH: People older than age 65 are often underrepresented in clinical trials. Only about 25 percent of clinical trial participants are older than 65. However, to learn about how new drugs work in various ages, it is necessary to have an adequate number of people in that age category. Most researchers are seeking participants in all age groups. However, many people do not even know that a clinical trial might be an option — so ask about this — regardless of your age. MYTH: I cannot participate in a clinical trial unless I go to a big cancer center or university. TRUTH: You can participate in many clinical trials with your current oncology professionals. Many clinical trials are offered through “cooperative groups” that work with community clinical oncology practices. Ask your oncologist if they offer clinical trials. There are many different clinical trials offered here in the East Tennessee and Southwest Virginia region. MYTH: Clinical trials are a “last resort.” TRUTH: There are many different types of clinical trials and different reasons for being part of a clinical trial. Some people may participate in a clinical trial because there are no other treatment options. Some people may choose to participate in order to receive a promising new drug. Others may participate in a clinical trial to prevent a cancer. Some clinical trials are “observational” meaning that researchers merely observe the treatment and effectiveness of a drug already on the market and collecting data about this. So how do you learn more about clinical trials or what might be available for a certain cancer? You can go to one of the Internet sites or call the toll-free number listed below. U.S. National Institute of Health: http://clinicaltrials.gov/ TrialCheck: http://www.cancertrialshelp.org/ (or call 1-877-227-8451) And if you have more questions …. ask your nurse practitioner! Wendy H. Vogel, M.S.N., F.N.P., AOCNP, is an oncology nurse practitioner with Kingsport Hematology/Oncology Associates in Kingsport.

New therapy may lower risk of diabetes-related amputation By Julie Deardorff Jim Keenan wasn’t particularly alarmed by a small blister that developed on his heel. Five days later, the 62-year-old’s foot was so seriously infected doctors feared they might need to amputate his lower leg. Keenan, who also has type 2 diabetes, instead tried the emerging treatment called hyperbaric oxygen therapy. Best known as an antidote for underwater diving disorders, HBOT involves inhaling pure oxygen while reclining in a pressurized chamber. The intense flood of oxygen to the blood can stimulate cell growth, promote the formation of new blood vessels and fight certain infections, said Dr. Alan Davis, who directs the Center for Wound Care and HBOT at Northwest Hospital outside Baltimore. Swedish researchers have shown HBOT can help foot ulcers heal in certain patients with diabetes, according to a 2010 study published in the journal Diabetes Care. A review of other trials also found that HBOT seemed to reduce the number of amputations in people with diabetes who have chronic foot ulcers, according to a Cochrane Review of the literature. But while the data on chronic wound healing are promising, research is also sparse and many physicians are still skeptical. The Swedish study appeared to be “well done,” but “it still doesn’t tell us which patients will benefit from this very expensive treatment,” said Dr. Tony Berendt, an infectious disease physician at Oxford and co-author of several clinical guidelines on diabetic foot infection.

Diabetes develops when a person’s body can’t make a normal amount of insulin, or uses it incorrectly. “Insulin controls blood sugar; if the levels are too high, blood vessel and/or nerves can be harmed,” said Davis. Damage to the blood vessels or nerves can result in a loss of circulation or reduced sensation to the feet. This can make it difficult to detect a sore or injury. “Those with diabetes lose the gift of pain,” said David Armstrong, director of the Southern Arizona Limb Salvage Alliance at the University of Arizona department of surgery. Armstrong’s research has shown that up to 25 percent of those with diabetes will develop a foot ulcer. More than half of foot ulcers become infected; one in five infections require amputation. HBOT may improve the oxygen concentration in the peripheral tissues, and that increased oxygen concentration may improve healing, Armstrong said. But, he said, if blood isn’t able to flow, due to peripheral vascular disease, the super oxygenated blood won’t be able to get to the extremities and HBOT will be nearly useless. Keenan, who lives in Bettendorf, Iowa, was diagnosed with diabetes at 58. At the Genesis Wound and Hyperbaric Institute in Davenport, he underwent 40 two-hour treatments in the pressurized hyperbaric chamber, five days a week, to improve oxygen flow to his foot. At the same time, he was treated with a series of dressings, grafts and vascular surgeries to improve blood flow to his foot. The treatment lasted nearly two years.

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;;;+HDOWK :HOOQHVV3DJH &RORU &0<. W3ULQWHG G 6E Kingsport Times-News / Wednesday, June 27, 2012

Andy & The Beats

Musical dramedy reveals challenges of living with type 1 diabetes By Leigh Ann Laube When Andy Rogers was diagnosed with type 1 diabetes at age 15, it really wasn’t that big a deal. His older sister had been diagnosed seven years earlier, and when Andy began having some of the same symptoms, he knew. “I was OK. I thought, ‘This makes sense. Game on. Let’s go.’” he said. “I looked up to my sister a lot. I really admire and look up to both my brother and my sister. I'm the youngest in the family. I was like, ‘She has it. She can do it. I can be a support for her, and she can support me.’” Andy is 23 now and a December graduate of the University of Tennessee’s College of Arts and Sciences. The son of a doctor, he was torn during his years at UT — should he choose the arts or the sciences? “I fell in love with theater and fell in love with the arts,” he said. “I found out I had a talent for it, and you can’t pursue both of those at the same time. I tried.” But diabetes is always on his mind, even when he was preparing for his senior thesis. “I started thinking about things I would be interested in — diabetes and health. I'm passionate about it and interested in learning more. I was taking a run one day and thought it would be funny to write a musical about it,” he said. “It was more of a joke at first. If diabetes were a musical, what would a song be? Then a story started to develop. I could be in this show, so I could showcase and grow as an artistic, an actor, a singer and dancer. I could study something that’s important to me and showcase the biochemistry. ... There are more effective ways of teaching than putting something up on a screen and having me write it down. “I put together a proposal and e-mailed my adviser. I said, ‘Listen, this is going to sound very crazy, but this is some thing I really want to do.’ I said I would write a research paper to back everything up, so it’s not just my word. So, I wrote a musical that is backed by a 52-page biochemistry research paper that acts as a guide to the musical — why certain characters are in there, why the pancreas would sing a certain song, etc. — and as a hitchhiker’s guide to being a dia-

Contributed photo

Andy Rogers was diagnosed with type 1 diabetes when he was 15. Drawn to the performing arts, Rogers decided to create a musical dramedy, “Andy & The Beats,” about the challenges of living with the disease. The dramedy premiered in 2011 and was performed this week in Knoxville. betic from the perspective of a diabetic. That musical, “Andy & The Beats,” was first presented in 2011 at the Clarence Brown Theater on the UT campus. Four days ago, the diabetic musical dramedy was performed at the Bijou Theatre in downtown Knoxville.

•••

Andy moved to Kingsport with his parents, Tom and Jenny Rogers, and older siblings, Ben and Kelli, when he was in the eighth grade. Kelli had been diagnosed with type 1 diabetes — a lifelong disease in which there are high levels of glucose in the blood — when she was 9. “We have no family history

that we know of,” Andy said. “It’s just the two of us. Usually the trend is it skips a generation, but we don’t have any family history.” Although both were initially diagnosed by their dad, Kelli and Andy got the official word from doctors at East Tennessee Children’s Hospital in Knoxville. “My symptoms were really obvious. I knew something was wrong,” Andy said. “Being around the disease so much and having it be a pretty prevalent part of my life, it’s kind of when a family member gets diagnosed, the whole family gets diagnosed. You understand what it means to be diabetic.” Andy quickly learned to man-

age his diabetes, and he’s managed it well, though its not without thought. “It’s not a disease you can put on the back burner of your mind,” he said. “You have make sure you have enough insulin when you’re traveling. How do I adjust my insulin pump when I have the flu because it’s making my blood sugars go out of whack? Or, there’s a kink in my pump and I have leave work. What am I going to eat for lunch? How many carbs are in my lunch? It gets cumbersome, but it never ends, so it’s not like I can do this for three months, get my treatment and I don’t have it any more. It’s like a constant math problem that you can never get right but you have to try.” After graduation from Dobyns-Bennett High School in 2007, Andy was set to start UT that fall. Before school started, he used some of his graduation money to fly to New York and see some professional theater. He decided to minor in theater at UT, but halfway through his sophomore year, he dropped out. “I was only really thinking about theater and not organic chemistry, and I was very confused about whether to go arts or sciences,” he said. He took a year off, but wasn’t planning on ever going back to Knoxville. ”I thought I didn’t need a college education. I needed experience. I did Up With People for six months and loved it,” he said. When his stint with Up With People was over, he came back to Kingsport to work. But he seized another opportunity to go to New York. “I had an awful experience with auditioning and working. I had a wake-up call and realized I'm not ready to be a professional actor at age 19,” he said. “I went back to UT to study biochemistry and theater. I felt like I needed to finish something that I started.”

•••

It took him about eight months to get his senior project to the stage. “Andy & the Beats” is story of a healthy 12-year-old boy named Andy who wakes up one morning to find that his immune system has been attacked by a virus, which causes him to develop type 1 diabetes.

From the outside, Andy’s future looks manageable, but on the inside it’s not. Trapped by fear and confusion, he meets up with a trio of fantasy friends called “the Beats,” who educate and encourage him in his efforts to understand what, why, how and when is the cure. “I want people to learn something. I want them to learn about type 1 diabetes,” Andy said. “If you didn’t know one thing going into the show, I want you to know one thing coming out of it. The main point is to get people to care about the disease. This disease gets put on the back burner a lot. This disease causes so many other complications — heart disease, blindness, amputation. I want to get rid of the stereotypes.” The cast includes a children’s ensemble, children who actually have type 1 diabetes. Although tickets to the performance at Clarence Brown were free, donations were encouraged for Juvenile Diabetes Research Foundation. That performance raised $1,800 for the non-profit. The show at the Bijou was also a fund-raiser for the JDRF. Reaction to the initial performance was better than Andy expected, he said. “I was anticipating people to like it, to enjoy it, but more people were moved by it than I expected,” he said. “It was a wonderful and terrible experience at the same time. I felt very vulnerable, but I knew a lot of people were moved by the show. I felt like I had a lot riding on it. I had this baby and I was nurturing this baby and I worked so hard and I wanted it to reflect who I was.” Andy is working to have the show fully licensed and copyrighted so other theaters can produce it and raise money for JDRF in their community. Since graduation, Andy had been working for the Knoxville JDRF in its school program. That job recently ended but he has other plans. “I want to perform. I thought I didn’t want to be a full-time performer, but I'm going to go back out on the audition route,” he said. “I want to pursue acting full time.” For more information, visit “Andy & the Beats” on Faceboook.


;;;+HDOWK :HOOQHVV3DJH &RORU . W3ULQWHG G Wednesday, June 27, 2012 / Kingsport Times-News 7E

Hand therapy may relieve common thumb tendinitis If you use your hands for a lot of pinching and gripping and are having pain you may be experiencing a type of thumb tendinitis. Often pinching and gripping in combination with wrist sideway motion can aggravate the tendons at the base of the thumb, around the back of your wrist. This tendinitis is called de Quervain’s, named after a Swiss surgeon who described this condition in 1895. It is a fairly common condition. Two of the main tendons of the thumb, the abductor pollicis longus and the extensor pollicis brevis, pass through a tunnel or sheath on the thumb side of the wrist. If there is swelling of the tendons or thickening of the sheaths, it makes it difficult for the tendons to move easily. This condition may occur gradually or suddenly. It may be caused by overuse, can be associated with pregnancy, rheumatoid disease, or can be from an acute injury. The specific cause of de Quervain’s is not known. It remains idiopathic. Overuse, forceful gripping and activities requiring sustained or repetitive grasp/pinch with wrist motion can lead to symptoms associated with de Quervain’s. Activities such as opening jars, using scissors, wringing things out and repetitive grasping/pinching are a few examples of activities that may aggravate the condition. Acute injuries such as a direct blow to the thumb, sudden wrenching of the wrist and thumb while trying to restrain an object or person, or a fall on an outstretched hand can be associated with de Quervain’s. This type of occurrence is less common. Often, there may be no known cause, and your tendons/sheaths may just not have enough space to function properly. Women are more often affected than men. Symptoms of de Quervain’s include pain along the back of the thumb. This pain may radiate along the thumb or forearm and may be increased with certain thumb motions and/or wrist motions. Some people may have localized swelling and some may have tenderness to direct pressure of the involved area. Sometimes a “catching” sensation is felt with thumb movement. Occasionally numbness may be experienced if a nerve around the tendon sheath is irritated. If you feel you are experienc-

Tara LANGE ing this type of problem with your thumb, a visit to your physician may be beneficial for diagnosis and treatment. Diagnosis may be made by physical examination as well as testing to rule out any other possible sources of thumb side wrist pain. Treatment of de Quervain’s usually includes wearing a thumb/wrist splint or orthosis for four to six weeks to immobilize the involved area and prevent use of the thumb/hand in activities which may be aggravating the condition. Often ice and anti-inflammatory medications may be recommended. Sometimes a steroid injection may be beneficial to decrease pain and swelling. In some people where the condition has developed gradually, de Quervain’s can be more resistant to treatment. Surgical release of the covering of the tendons may be recommended if conservative medical treatment is not effective. The goal of surgery is to open the compartment to allow more room for the tendons. Surgery is usually an outpatient procedure, and hand therapy may be recommended after surgery. Hand therapy may be beneficial both in conservative treatment as well as post-operatively. In conservative treatment, therapy would address splinting by fitting or fabricating a splint, managing symptoms with use of thermal modalities, instructing in pain-free motion of the wrist and thumb, advising on modification of activities to allow healing and reduction of symptoms, and progression to strengthening and restoring functional use of the thumb/hand. If symptoms persist and surgery is recommended, therapy

Often pinching and gripping in combination with wrist sideway motion can aggravate the tendons at the base of the thumb, around the back of your wrist. This tendinitis is called de Quervain’s, named after a Swiss surgeon who described this condition in 1895. It is a fairly common condition.

may follow surgery to get you using your hand normally again. Often, just a few sessions may be needed to get instruction in a home program. Sources: www.orthoinfo.aaos.org, www.webMD.com, www.Wikipedia.org, Rehabilitation of the Hand and Upper Extremity, 6th edition, Hand and Upper Extremity Rehabilitation A Practical Guide, 3rd Edition. Tara Lange, OTR/L, CHT, is a physical therpaist with Wellmont Health System.

Music training improves the aging process By Harry Jackson Jr. Music training has a lifelong good impact on the aging process, says a new study out of Northwestern University. Researchers in the Auditory Neuroscience Laboratory at Northwestern measured the automatic brain responses of younger and older musicians and non-musicians to speech sounds. Researchers discovered that older musicians had a distinct neural timing advantage. Researchers concluded that age-related delays in neural timing are not inevitable and can be avoided or offset with musical training. ”The older musicians not only outperformed their older non-musician counterparts, they encoded the sound stimuli as quickly and accurately as the younger non-musicians,” said neuroscientist Nina Kraus. “This reinforces the idea that how we actively experience sound over the course of our lives has a profound effect on how our nervous system functions,” she said. Kraus, professor of communication sciences in the School of Communication and profes-

sor of neurobiology and physiology in the Weinberg College of Arts and Sciences, is co-author of “Musical experience offsets age-related delays in neural timing.” The data, with recent animal data from other research centers suggest that intensive training even late in life could improve speech processing in older adults and improve their ability to communicate in complex, noisy acoustic environments, said Don Caspary, a researcher on age-related hearing loss at Southern Illinois University School of Medicine. “They support the idea that the brain can be trained to overcome, in part, some age-related hearing loss,”Caspary added. Previous studies from Kraus’ Auditory Neuroscience Laboratory suggest that musical training also offset losses in memory and difficulties hearing speech in noise — two common complaints of older adults. The lab has been extensively studying the effects of musical experience on brain plasticity across the life span in normal and clinical populations, and in educational settings.

What Will Hearing Aids Do for Me? Perhaps the single most important goal when considering the use of a hearing aid is to improve personal communication and yet maintain independence and freedom to make choices in a world of fast-paced communication. For people with hearing loss, a hearing aid frequently helps achieve this goal. There are three important things to understand about hearing aids: 1. Hearing aids do not restore normal hearing. The most common reason hearing aids are fitted is to help people hear speech in order to effectively communicate. The hearing loss is generally sensorineural (permanent), and the hearing aid is adjusted mechanically and electronically to help compensate for parts of the ear and central nervous system that are damaged. 2. A hearing aid is a guest in the ear. Hearing aids work well when they are custom made to fit a person’s

ear. Patients that are first fitted with a hearing aid generally experience some level of tenderness in the ear. The level of tenderness may be as simple as adjusting to a new pair of shoes or it may be an irritation that requires an audiologist to make adjustments for the hearing aid to feel as natural as possible. 3. Hearing aids require guided practice, patience and persistence. They work best in quiet listening conditions. Adjusting to everyday sounds is challenging and takes practice (e.g. birds, dishes, paper sounds and the sound of one’s own voice). Patience and realistic expectations are the key ingredients to being a successful hearing aid user. Once you understand this, you are more likely to be successful and satisfied with your hearing aid. Call us at 423-246-8155 to schedule an appointment with one of our certified audiologists and learn how a hearing aid might benefit you.

Meadowview Ear, Nose and Throat Specialists Carl Slocum, M.D. • W. Jeffrey Wallace, D.O. • David Osterhus, M.D. • Jennifer Greiner, D.O. Audiologists - Toby Johnson, M.A., CCC-A • Jolene Hoffman, M.A., CCC-A • Pam Babb, M.A., CCC-A

Locations in Kingsport, Bristol, Elizabethton and Big Stone Gap 423-246-8155 Comprehensive Ear, Nose and Throat Care, Including Hearing Aids


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Daytime sleepiness accident waiting to happen Do you suffer from excessive daytime sleepiness? How do we know when we are too sleepy, for instance, to safely drive an automobile? Did you know that 20 percent of automobile accidents are related to being sleepy? Sleepiness is a common symptom noted by as many as one out of five adults and adolescents. Most of us can relate some instances of falling asleep when we intended to be awake. Sleepiness is a normal feeling as we approach a typical sleep period or after prolonged wakefulness. However, excessive sleepiness occurs when we enter sleep at an inappropriate setting or have episodes of unintentional sleep. The sleep may be irresistible and may intrude on such activities as driving, having a conversation or eating meals. This degree of sleepiness may place us at significant risk for accidents and have a major impact on our health and sense of well-being. We may not recognize our sleepiness, describing the situation as only a lapse of attention, such as missing an exit on the highway. Those who are chronically sleep-deprived become accustomed to their impairment and are

Tim MARTIN less likely to recognize their degree of sleepiness. Excessive sleepiness may result from a wide range of medical disorders and medications. Patients with heart, kidney or liver failure, and rheumatologic or endocrinologic disorders such as hypothyroidism and diabetes may note sleepiness and fatigue. Neurologic disorders, such as strokes, tumors, demyelinating diseases and head trauma, can evoke excessive daytime sleepiness. Sleepiness is also frequently the cardinal symptom of many

sleep disorders. Patients with sleep apnea and narcolepsy, restless legs syndrome and periodic limb movements during sleep may note excessive daytime sleepiness as their main complaint. Physical findings can seem minor to us, such as frequent pauses, slowed responses, drooping eyelids, repetitive yawning or dark circles under the eyes. The Epworth Sleepiness Scale is used by sleep specialists to evaluate a person’s daytime sleepiness. Take just a minute to answer the questions on this short test and see if you are unusually sleepy during the day.

The Epworth Sleepiness Scale How likely are you to doze off or fall asleep in the following situations? Use the following scale to choose the most appropriate number for each situation. 0 — would never doze 1 — slight chance of dozing 2 — moderate chance of dozing 3 — high chance of dozing Situation Chance of dozing

Sitting and reading Watching TV Sitting, inactive in a public place (movie or meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon Sitting and talking to someone Sitting quietly after a lunch without alcohol In a car, while stopped for a few minutes in traffic Total Score Add up your score. If your score is higher than 9, you have excessive daytime sleepiness. You may want to consider calling for an appointment with your physician or sleep specialist before you become one of those 20 percent of automobile accidents caused by falling asleep at the wheel. Your family will appreciate it, especial-

Health, fitness magazines differ in approaches By Julie Deardorff I’m one of those women who likes reading men’s health and fitness magazines. Though they all promise bodies and sex lives that most of us will never have, I’m drawn to the funny, self-deprecating tone, the functional workout tips and the emphasis on sweat, competition and strength training. Yes, women’s magazines have these elements but on a vastly diminished scale. They’re fluffier, in part because beauty products and clothes are considered health-related, but also because women are still plagued by the irrational fear of “bulking up.” We won’t get huge without added testosterone, but some magazines still perpetuate the notion that men should build insanely huge muscles and women need to lose fat. A recent Muscle & Fitness magazine cover, for example, promised “75 of the Best Muscle Building Exercises.” By contrast, Muscle & Fitness Hers, the female counterpart to the bodybuilder mag, featured thinspiration, including “The Skinny on Fat Loss” and “The Best Natural Appetite Suppressants.” The majority of advertisements touted fat-burning supplements, stimulants and weight-loss products. Men’s Health and Women’s Health magazines have plenty of overlapping content. Both recognize that both genders compete in marathons and triathlons, want great abs in 15 minutes and need nutritional guidance. But the editors use considerably different voices

to reach their male and female readers. “For Women’s Health, it’s a confiding, challenging, sisterly thing — equal parts encouragement, sympathy and advice. It comes from a place of ‘just us girls,’” said David Zinczenko, editor-in-chief of Men’s Health and editorial director of Women’s Health. “Guys tend to be a bit more bracing with their counsel, with a healthy dose of humor — plus self-denigration — thrown into the mix,” Zinczenko added. “First we laugh at ourselves, then we laugh at you, then we deliver the goods straight up, with an expert chaser.” The direct “male” approach is what I find appealing. Men’s workouts are usually cast as a way to build a stronger body. Women’s exercises are given cute, superficial names, such as “The Wedding Dress Workout” or “The Bikini Body Booty routine.” Rather than sending the message that exercise builds muscle, confidence and improves mental health, the emphasis is on looking good. If your workout goal is to fit into a swimsuit, you’re using an unsustainable approach to fitness. But if your goal is to get healthy — which means incorporating it as a lifestyle — you’ll have a body that you want to show off.

Taking cues from the opposite sex What women can learn from reading men’s magazines: 1. Worry more about building muscle than burning fat. Women “focus on working out with low weights and high repetitions, using

weights that are significantly lighter than objects they lift all day long, such as children,” fitness trainer Tom Holland wrote in his book “Beat the Gym.” This increases the muscles’ endurance without making any meaningful changes. “It’s a waste of time,” he said. 2. Play games. Men often think of themselves as athletes; they play pickup basketball, hit the driving range or join a soccer game to keep workouts fresh and fun. Chose an activity over the elliptical machine or treadmill. 3. Learn from real athletes. Women’s magazines often feature workouts from actresses who have to look good for the camera. Men’s magazines are full of training secrets from athletes who have to perform. What men can learn from women’s fitness magazines: 1. Join a class. Men were the ones who invented Zumba and Pilates; yoga and barre can also strengthen muscles men didn’t know they had, increase flexibility, help prevent injury and shift the focus from boring gym routines. 2. Lighten up. While women could use heavier weights, men can benefit from lighter ones or even body weight exercises. “With men, the major problem is ego; they want to impress the other guys in the gym,” said Holland. “It leads to bad form, decreased results and inevitable injury.” 3. Balance: Men typically train their mirror muscles — the chest and biceps. Incorporating a workout from a woman’s magazine could help target other muscle groups and result in a more balanced physique.

ly if they are passengers in the car while you are driving. Source. Principles and Practice of Sleep Medicine by Meir Kryger, et al. 2011 edition Dr. Tim Martin practices dentistry in Kingsport with his son, Dr. Kevin Martin at Martin Dentistry and The Center for Dental Sleep Medicine.

Dr. Michael Kauzlarich Cholesterol and Heart Disease Cholesterol helps your body build new cells, insulate nerves, and produce hormones. Normally the liver makes all the cholesterol the body needs but cholesterol also enters your body from food, such as animal-based foods like milk, eggs, and meat. Too much cholesterol in your body is a major risk factor for heart disease. When there is too much cholesterol in your blood, it builds up in the walls of your arteries causing a process called atherosclerosis, a form of heart disease. The arteries become narrowed and blood flow to the heart muscle is slowed down or blocked. Blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack. There are two forms of cholesterol that most Americans are familiar with: Low-density lipoprotein (LDL or “bad” cholesterol) and high-density lipoprotein (HDL or “good” cholesterol.) These are the forms in which cholesterol travels in the blood. LDL is the main source of artery-clogging plaque. HDL actually works to clear cholesterol from the arteries and transports it back to the liver to be eliminated in the stool. Triglycerides are another fat in our bloodstream. Though research is now showing that high levels of triglycerides may also be linked to heart disease, the connection is still controversial. High cholesterol itself does not cause any symptoms so many people are unaware that their cholesterol levels are too high. Talk to your doctor and find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it. Mountain Region Family Medicine, P.C. 444 Clinchfield Street, Suite 201 Kingsport, TN 37660 423-230-2700


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Implantable pain disk gives relief to cancer patients By Meredith Cohn An estimated 3.5 million cancer patients around the globe are in severe pain from their disease, but many get no relief. In poor countries the cost is considered too high for drugs like morphine when such opioids are often stolen, abused or not taken according to instruction. But some Johns Hopkins University scientists have been working on a solution for those patients, as well as some in the United States, that uses a flexible button-sized disk implanted under the skin that releases consistent doses of painkiller over a month. No pills, no measuring, no trips to the clinic. If an upcoming clinical trial for safety goes well, the device could be available next year, doctors say. It also could be retooled to treat other diseases and injury, and maybe even some opioid addicts. “With all the problems, the health officials [in developing countries] would prefer to spend money on antibiotics that cure diseases, vaccines that prevent diseases or children with a long life ahead of them rather than those with terminal cancer,” said Dr. Stuart A. Grossman, a Johns Hopkins professor of oncology, medicine and neurosurgery and a pain management expert in Hopkins’ Sidney Kimmel Comprehensive Cancer Center. Grossman grew up overseas but when he returned to India and other poor countries as an oncologist and worked in cancer centers he saw how hard it was for patients with cancer to get opioid pain medications. He and others began working on a solution about 15 years ago. They came up with something that works a little like Norplant, the rods inserted under the skin that release contraceptives over weeks. Only this round, plastic disk just over a centimeter wide delivers hydromorphone, a more potent form of morphine, through a channel in its center. The rest of the device is sealed to prevent an initial burst of the drug that could kill a patient. The disk could be made wider to deliver drugs longer, or thicker to deliver higher doses. It eventually could deliver a different drug or be used by veterinarians on animals. But for now, the scientists are focusing on one device for cancer patients that would cost about $50 a month, or about the same as the bill for relatively

There are people out there who would benefit from having something in their body releasing drugs at all times that doesn’t involve the patient and can’t be changed by them. These are people who you fear might overdose if you give them pills, or there is an abuser in the household.

— Dr. Stuart A. Grossman

Photo by Algerina Perna

Dr. Suzanne A. Nesbit and Dr. Stuart A. Grossman of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, are working on a polymer disk, which Grossman is holding, that’s inserted under the skin and releases pain medication. The disk would be especially useful in developing countries were opiods are much harder to get. cheap morphine pills. With Hopkins’ blessing, Grossman patented the device and formed a company called Axxia. Dr. Suzanne A. Nesbit, a clinical pharmacy specialist in pain management and a research associate in the Hopkins oncology department, will run the clinical trial, which was delayed a bit when the maker of the plastic they preferred decided to stick to producing the soles of shoes. They’re working with a new plastic that already is approved for medical implants by the U.S. Food and Drug Administration but requires some fine tuning. The clinical trial for the disk will be conducted in the Philippines, Singapore and East Baltimore, where Hopkins has a presence. Grossman said a U.S. manufacturer would make the drug device and Axxia will rely on pharmaceutical companies around the world to distribute it and train doctors unaccustomed to assessing pain, dosing and monitoring patients. Some of those who treat pain and addiction believe the disk

would serve some populations well and look forward to having another tool for tricky patients, though they also see some challenges. There are an estimated 5 million Americans on opioid therapy for pain, or 2.5 percent of the population, though most take a short-acting, low-dose Vicodin or similar pill and not every day, said Dr. Nathaniel Katz, the director of the nonprofit Program on Opioid Risk Management at the Tufts Health Care Institute. Opioids don’t work well managing everyone’s pain, and about 5 percent of people who take them become addicted to the medications. Others don’t stick to their regimen, said Katz, who is also the CEO of a pain-drug development company called Analgesic Solutions. There may be a role for Grossman’s pain disk in addicts and those who don’t follow their prescriptions, he said. “There are people out there who would benefit from having something in their body releasing drugs at all times that doesn’t involve the patient and can’t be

changed by them,” he said. “These are people who you fear might overdose if you give them pills, or there is an abuser in the household, or the person has mental illness like PTSD, or Parkinson’s disease.” Many don’t have consistent pain, and it would be better if they could change their dosage as needed, Katz said. But when that’s not possible, some relief is better than none, Katz added. The disk, he said, may not solve all illicit use of the drug. Even though they are meant to be implanted by a doctor, addicts are crafty and will find ways to acquire them, melt them down and ingest them, said Katz, adding many such recipes end up on Internet. Some addicts have been known to eat pain patches even though that can be fatal, Katz said. The disks could only be used to treat addiction if they delivered a different drug than hydromorphone because that drug is not approved by the FDA for treating addiction, only for pain, he said. Only methadone and buprenorphine currently have that stamp from the FDA. There is a growing need for new treatments for addiction to prescription drugs such as oxycodone and morphine, said Dr. Michael Fingerhood, an associate professor of medicine at the Johns Hopkins University. The number of admissions to Maryland Alcohol and Drug Abuse Administration-funded treatment programs for prescription drug addiction doubled to 7,000 between 2007 and 2010, according to the state Department of Health and Mental Hygiene. Others, especially teens, find unused opioids in their parents’ medicine cabinets. About 2,500 American teens use prescription drugs every day to get high for the first time, according to the Partnership for a Drug Free America.

Maryland joined dozens of other states this year in creating a database to track filled prescriptions so doctors know when someone may be shopping for extra drugs, but the system is not yet up and running. The trend is likely to continue until doctors stop prescribing so many addictive drugs, said Fingerhood, who treats addicts. He said addicts still often have pain, but the pain becomes difficult to treat because they can’t be handed more pills. This is where Dr. Grossman’s disk may come in. Not for treating the addiction — there already is a similar rod implant developed by Titan Pharmaceuticals Inc. awaiting FDA approval that contains buprenorphine for that purpose. But to treat the pain, said Fingerhood, who also is the director of the division of chemical dependence at Hopkins Bayview Medical Center. “It’s a great option for pain,” he said. “It’s treated poorly now in this population because they can’t take traditional pills. ... And I think implants are going to be the wave of the future with other medications as well.” EXCLUSIVELY AT CUSTOM COMPOUNDING CENTERS OF AMERICA!

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Aging

Ageless Grace Series, 10:30 a.m., Mondays and Wednesdays, July 9-25, IPMC Health Resource Center, Kingsport Town Center. Focusing on different anti-aging techniques, joint mobility, spinal flexibility, right/left brain coordination, cognitive function, systemic stimulation, balance, confidence and playfulness. $5 per session. To register, call 1-800-888-5551.

Alternative medicine

Tai chi, 3 p.m., Tuesdays, July 3-31, IPMC Health Resource Center, Kingsport Town Center. $40 for month. To register, call 1-800-888-5551.

Cancer

IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Breastfeeding Basics, 6:30-9:30 p.m., July 26, Holston Valley Medical Center, Allandale Room. To register, call 877-230-NURSE.

CPR/first aid

Adult first aid/CPR/AED, 9 a.m. to 4 p.m., July 9, American Red Cross, 501 S. Wilcox Drive, Kingsport. To register, call 1-800-REDCROSS or visit redcross.org/takeaclass.

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First aid, 5:30-8:30 p.m., July 10, American Red Cross, 501 S. Wilcox Drive, Kingsport. To register, call 1-800-REDCROSS or visit redcross.org/takeaclass.

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Alternative Treatments for the Side Effects of Cancer-Related Disease, noon, July 19, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

Adult CPR/AED, 5:30-8:30 p.m., July 12, American Red Cross, 501 S. Wilcox Drive, Kingsport. To register, call 1-800-REDCROSS or visit redcross.org/takeaclass.

Survive & Thrive, 6:30 p.m, Tuesdays, oncology library, third floor, Wilcox Hall, Holston Valley Medical Center. Call 224-5592.

Adult first aid/CPR/AED, 9 a.m. to 4 p.m., July 18, American Red Cross, 501 S. Wilcox Drive, Kingsport. To register, call 1-800-REDCROSS or visit redcross.org/takeaclass.

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Sisters, for women who have been touched by breast cancer, 6:30 p.m., first Thursday, oncology library, third floor of Wilcox Hall, Holston Valley Medical Center. Call 224-5592.

Children/parenting

Immunizations, Your Child’s Best Shot, 4 p.m., July 10, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Mommy’s Milk Club, 4 p.m., July 12 and 26, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Marathon Childbirth Class, 9 a.m. to 4 p.m., July 14, IPMC Health Resource Center, Kingsport Town Center. $20. To register, call 1-800-888-5551.

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Childbirth, 10 a.m. to 5:30 p.m., July 14, Holston Valley Medical Center, Heritage Room. To register, call 877-230-NURSE.

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Sibling Class, noon, July 21, Holston Valley Medical Center, Birthplace Conference Room. To register, call 877-230-NURSE.

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Prevention of Sports Injury, 3 p.m., July 23, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Carseat/Booster Safety Class and Carseat Check, 3 p.m., July 24,

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First aid, 5:30-8:30 p.m., July 24, American Red Cross, 501 S. Wilcox Drive, Kingsport. To register, call 1-800-REDCROSS or visit redcross.org/takeaclass.

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Adult CPR/AED, 5:30-8:30 p.m., July 31, American Red Cross, 501 S. Wilcox Drive, Kingsport. To register, call 1-800-REDCROSS or visit redcross.org/takeaclass.

Diabetes

Diabetes self-management, 9 a.m. to 4 p.m., July 2, Lee Regional Medical Center, Pennington Gap, Va. Physician referral required. To register, call 224-3575 or 844-2950.

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Know Your Nutrition, 5 p.m., July 10, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Advanced nutrition, 9-11 a.m., July 11, Diabetes Treatment Center, Kingsport. Physician referral required. To register, call 224-3575 or 844-2950.

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Diabetes self-management, 1-4:30 p.m., July 11-12; 9 a.m. to 5 p.m., July 18, Diabetes Treatment Center, Kingsport. Physician referral required. To register, call 224-3575 or 844-2950.

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Better Blood Sugar in 30 Days, 4 p.m., July 16, IPMC Health Resource Center, Kingsport Town Center. To register, call

1-800-888-5551.

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Know Your Numbers, 5 p.m., July 17, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Diabetes self-management, 8 a.m. to noon, July 19; 8-10:30 a.m., July 20, Hawkins County Memorial Hospital. Physician referral required. To register, call 224-3575 or 844-2950.

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Know Your Healthy Steps, 5 p.m., July 24, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Diabetes Self-Management, 8:30 a.m. to 4 p.m., July 26, IPMC Health Resource Center, Kingsport Town Center. $40. To register, call 1-800-888-5551.

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Got #’s? noon, July 30, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Kingsport Diabetes Association, 7 p.m., second Tuesday, Indian Path Hospital Building 2002, Room 203, Kingsport. Helping diabetics and their families better deal with the serious disease of diabetes. Call 534-2646.

Emotional health

Parent support group for parents and caregivers of children with autism or Asperger Syndrome, 6 p.m., first Tuesday, Mountain Region Speech and Hearing Center. Call Melissa Keeler at 863-6473 or Liz Dotson at 246-4600 or e-mail mkeeler1@gmail.com or lizdotson@mrshc.org.

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Depression and/or anxiety disorders support group, 7 p.m., Thursdays, at 645 E. Main St., downtown Kingsport.

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Stress, noon, July 26, IPMC Health Resource Center, Kingsport Town Center. to register, call 1-800-888-5551.

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Compassionate Friends of TennVa, 2 p.m., second Sunday, Bristol Public Library, corner of Piedmont Avenue and Good Street, Bristol, Va. Assisting families toward a positive personal acceptance of grief following the death of a child of any age and to provide information to help others be supportive.

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Alzheimer’s Support Group Meeting for Caregivers, 10 a.m., first Tuesday, Preston Place II, 2303 N. John B. Dennis Hwy., Kingsport. RSVP by calling 378-HOPE.

Fibromyalgia

Fibromyalgia Support Group, 2 p.m., July 9, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

Heart health

Coronary Risk Panel, 7 a.m. to 9 a.m. July 10, IPMC Health Resource Center, Kingsport Town Center. $15. To register, call 1-800-888-5551.

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Congestive Heart Failure, noon, July 31, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

HIV/AIDS

POZ Support Group, for all those affected by HIV, 6:30 p.m., first and third Thursdays, Hillrise Hall conference room. Call 439-6006 and 439-6019.

Laryngectomy

Parkinson’s support group, 7 p.m., fourth Tuesday, Asbury Baysmont, 100 Netherland Lane, Kingsport. Call 245-0360.

Respiratory health

Hereditary Emphysema: Could Your Genes Be Responsible? 1 p.m., July 11, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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The Young and the Breathless, a support group for pulmonary patients and their families, 5 p.m., fourth Thursday, Heritage Room, D Building, Wellmont Holston Valley Medical Center. Call 224-5800.

Skin care

Sun Exposure: How Much Are You at Risk? noon, July 18, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Don’t Get Bugged This Summer, noon, July 25, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

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Skin Care for Teens, 2 p.m., July 28, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

Visual health

Kingsport Association for the Visually Impaired, a support group for visually impaired persons, 7 p.m., first Tuesday, Bethel Presbyterian Church, 1593 Warpath Drive, Kingsport.

Mental health

Weight loss

Johnson City National Alliance for the Mentally Ill, (NAMI), 7 p.m., second Thursday, Harrison Christian Church, off Browns Mill Road, Johnson City. Call 538-4216 or 239-6492.

•••

Tri-Cities Survivors of Suicide Support Group, 6-8 p.m., fourth Monday, Boones Creek Christian Church, Entrance K, Room 403. SOS is for those who have lost someone by suicide, are interested in suicide prevention or might have helpful information for those who do. Call Linda Phipps Harold at 361-2087. Survivors of suicide support group, 6 p.m., fourth Thursday, Lee Behavioral Health, Jonesville, Va. Call (276) 346-3590 or (276) 346-1641.

•••

•••

Parkinson’s

Nu-Voice Club, support group for laryngectomy patients, 6 p.m., fourth Tuesday of each month, Bristol Regional Medical Center Conference Center Elm Room.

Kingsport National Alliance on Mental Illness (NAMI), 7 p.m. first Thursday, First Baptist Church, Church Circle, Kingsport. Call 234-2516 or 866-337-3291.

•••

ly 30, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

Nutritional health

Berry Beneficial, noon, July 6, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551. Cooking for 1 or 2, noon, July 12, IPMC Health Resource Center, Kingsport Town Center. To register, call 1-800-888-5551.

•••

Vegetarian Cooking, 4 p.m., Ju-

Exploring the Weight Loss Surgery, 6 p.m., July 5 and 16, Madison House, Kingsport. To register, call 877-230-NURSE.

•••

Lose it 4Good, 6 p.m., third Tuesday, HMG Medical Plaza, 2nd Floor Conference Room, 105 W. Stone Drive. Free and open to the public. Call 857-2790.

•••

T.O.P.S. (Take Off Pounds Sensibly) Chapter 58 Thursdays, Concordia Lutheran Church, 725 Truxton Drive, Kingsport. Weigh-in, 10 a.m.; meeting, 10:30 a.m. Call (423) 254-0708.

•••

TOPS Tennessee Support Group Chapter 520, 6 p.m., Mondays, Bethel Presbyterian Church, Kingsport. TOPS (Take Off Pounds Sensibly) is an international non-profit weight loss support group. Call 245-6496.


;;;+HDOWK :HOOQHVV3DJH &RORU . W3ULQWHG G Wednesday, June 27, 2012 / Kingsport Times-News 13E

A guide to assist you in buying hearing aids

Danielle COMBS have a medical condition involving your ear or a history of surgery on your ear, then a physician will need to determine if you are able to wear a hearing aid. Another point to consider is having the hearing aid features fit your lifestyle needs. What features do you really need on a hearing aid? Will the

benefit of additional features outweigh the additional cost? If you have a quiet lifestyle you may not need a hearing aid that is as advanced as someone who is actively involved in work, meetings, social events and other highly varied listening environments. If the size of the hearing aid is not the main concern to you, then you will have the benefit of better listening options and longer battery life of a slightly larger hearing aid. Other particulars regarding hearing aids, like service, may also need to be considered. Most hearing aids come with a warranty, but you will need to know if the warranty covers loss and damage or just repairs, and the length of the warranty period for each service. Also, determine if the warranty can be extended and the amount of time it can be extended. In most states, a law requires

Landlines still life lines for many By Kim Ode Dust always needs a place to land. Take the record turntable, rarely used, but there when you want to listen to some classic vinyl. Or the transistor radio. The sound quality is awful, but it’ll come in handy if a storm knocks out the power. The telephone? Well, every once in a while, it does ring. Sometimes you might even see it sporting a blinking light — if you ever looked. “We got rid of our land line a couple of years ago because no one would listen to the messages,” said Deb Balzer, a publicist in Minneapolis. “We actually would have disagreements or discord because no one would listen to the messages, let alone pick up the phone. All of our friends have our cell, so we’d assume if someone was calling the house, it was a solicitor or worse.” Pity the telephone. More than eight in 10 U.S. adults own a cellphone. That proportion likely increased while you read that sentence. That makes the cellphone the most popular electronic gadget owned by adults in the United States, according to the Pew Research Center’s Internet and American Life Project. No wonder that by December 2010, three of every 10 U.S. homes had only wireless telephones — an increase of more than 3 percent in that year alone, as reported by the National Center for Health Statistics. Also: Even in homes that still have a traditional phone, one in six of them received all or almost all of their calls on wireless phones. But there are reasons people keep a land line (which is a classic retronym, or term for something devised after a similar, but newer, thing has come into use). Jan Russell of St. Louis Park, Minn., said her household keeps its land line because they have two young boys “and we wanted to make sure that they could call 911 if something were to happen to us or their 78-year-old grandpa who lives with us.”

Russell raised a common concern: whether in emergencies, a cellphone could provide a location, especially if the caller can’t do so, or if the cellphone has a different area code than where it’s being used. The good news is that most cell- and smartphones now have GPS, or global tracking features. You can be tracked whether you like this “feature” or not. Still, when time is of the essence, people worry that a cellphone might not be charged, the call might get dropped or that they might not even be able to find it. As with TV remotes, a cellphone never seems to be in the same place twice. It may be in the bottom of a cavernous purse, forgotten in the car (not that anyone used it there), or simply away with its owner, leaving a household incommunicado. In this new world, “household” becomes an operative term. Back in the day, a phone number connected you to everyone who lived under one roof. Now, callers to homes without a land line need to decide whose cellphone is the best way to contact a family. In some households, land lines may follow the arrival of children, especially when parents don’t want every homework question or “come out and play” call coming in through their cellphones. When Amanda Lancette and her husband set up housekeeping, each used their own cellphones. “People could contact us directly, and we didn’t miss having a land line at all,” she said. When they bought a desktop computer in 2000, however, they needed a land line for dial-up Internet. With a baby in 2005, it made even more sense to keep the phone for her mother-in-law, who cared for the baby. “If we did get rid of our land line again, our [cell] phones would certainly become community property,” said Lancette, of Eagan, Minn. “We already have the issue of missed texts and things because the boys are playing apps on our phones.” Still, once the boys are old enough to have cellphones, she said they’ll likely drop the land line.

that hearing aids come with a trial period. You will need to know the length of the trial period, and whether or not the trial period can be extended if the hearing aid has to be remade or repaired. Learn about any up front fees you pay with the trial period, and what fees are refundable if the hearing aid is returned. Also, what adjustments and services can be performed in the office? How long are these services provided, and do you need an appointment for these services? It may be beneficial to have a friend or family member come with you to the appointments for

Providing you with the quality care we expect for our own family.

Before buying a hearing aid, there are several aspects that you need to consider. These can include your medical history, the results of your hearing evaluation, the listening needs for your lifestyle, as well as hearing aid features and services. One main objective to consider is whether or not you even need a hearing aid or if you are even a candidate for wearing a hearing aid. If you have a mild loss you may or may not need a hearing aid. Each individual is different. Some people with mild hearing loss struggle with communication while others with the same degree of loss may only have difficulty hearing, if they are sitting farther away from the source of the sound. If you have a very severe hearing loss, then you may not be a candidate for a traditional hearing aid or a hearing aid may be of limited benefit. If you

your hearing evaluation, hearing aid assessment and hearing aid fitting. Having someone with you can help ease anxiety. This person can also serve as a second opinion regarding hearing aid options, or help you remember useful information later on. Purchasing hearing aids can seem like a daunting process if you do not know what to expect. But if you do your research, ask the right questions and provide honest information, you can soon have better hearing with ease. Danielle Combs is a clinical audiologist who staffs The Hearing Center at Holston Valley Medical Center. E-mail her at danielle.combs@wellmont.org

Peace.

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;;;+HDOWK :HOOQHVV3DJH &RORU &0<. W3ULQWHG G 14E Kingsport Times-News / Wednesday, June 27, 2012

Beyond meat: Americans preoccupied with protein By Michael Hill Carbs? Calories? Fat? They are so very last decade. Dieters and would-be healthy eaters know the nutrient of the moment being tallied, sought and bought is protein. Spurred by trainers, diet gurus and weight-loss plans, Americans are seeking more— and more unique — sources of protein, from almonds ground into milk and soy reshaped as pasta, to peas and whey turned into powders and shakes. And food producers are happy to oblige. Powders and energy bars packed with 20, 30 or even more grams of protein per serving are selling briskly. Supermarket shelves once crowded with foods boasting of being high in fiber or low in fat now are jammed with claims of protein content. Yet this is happening even as Americans eat less meat, the go-to source of protein for generations. “People are getting smarter about foods in general,” said Phil Lempert, a food marketing expert known as The Supermarket Guru. He sees higher meat prices driving people to other sources of protein, a movement that has becoming more pronounced this year. “Longer term, I think you’re going to see people starting to look at more vegetables and different combinations to create proteins like rice and beans.” Amanda Perry — an on-the-go mom with two jobs and a 1-year-old — is a good example. She counts on lots of protein to keep her feeling full and full of energy. But she needs it to be portable, so she often mixes protein powder with almond milk, maybe a banana and some peanut butter. “It’s easily portable, which I think is awesome for busy people because you’re on the run,” said Perry, a 31-year-old personal trainer who owns a gym in Chelmsford, Mass., with her husband. “You can’t really take a chicken breast or a piece of steak with you if you’re going to be out for several hours.” Red meat, a rich source of protein, is going through an especially bumpy run. Prices are up, and so are health concerns about beef and its saturated fat content. Americans are expected to consume about 15 percent less beef on a per capita basis this year compared to 2007, according to Steiner & Company, an economic consultant to the food

Photo by Charles Krupa

Amanda Perry, a wife and mom who works two jobs, gets her protein from a shake in which she blends a vegan protein powder with almond milk, natural peanut butter, ice and a banana. industry. Per capita consumption of all red meat and poultry is expected to be down by 10 percent over the same period. But if forces are pushing people away from meat, health conscious Americans are simultaneously being lured to other sources of protein, such as nuts, beans, soy and seafood. Protein has had popularity peaks before — think of the Atkins diet craze not so many years ago — though this time there are a chorus of voices touting the benefits of protein-heavy regimens like the Paleo Diet, which stresses the lean meats and wild plants eaten by our ancestors. And it’s being helped along by accumulating evidence that plant-based protein can lower cholesterol levels and have other beneficial effects. A trip down the grocery aisle shows food makers are tuned in to this trend and happy to engage shoppers about it, from Yoplait Greek yogurts (“2X protein”) to Boca meatless lasagna (“21 g protein”) to Perdue chicken breast tenders (“excellent source of protein”). Like your protein concentrated? Analysts say sales are up for high-protein bars. “As Americans are becoming more health conscious and busier, protein bar sales are increasing because they are a convenient way to gain protein on the go,” said IBISWorld analyst Mary Nanfelt, adding that many protein bars are eaten after a workout to help the stressed-out muscles.

Also popular are the protein-rich powders, often made with whey, once associated mostly with weightlifters looking to bulk up. Perry said her protein powders — which are vegan because they sit in her stomach better — make her feel more energetic. “I used to be afraid of it. And I have friends and clients who are sort of afraid of it. They think, ‘Oh, I’m going to gain too much weight, it’s too many calories.’ But what they don’t know — and this is common for a lot of women — is that they’re not getting enough calories, and they’re not getting enough protein.” Actually, most Americans eat plenty of protein. The latest available federal survey of what Americans eat, which covers 2007-2008, shows both men and women commonly consuming more protein than needed, sometimes by a third or more. Of course, the amount of protein needed varies by age, weight and activity level, though federal recommendations suggest 56 grams daily for a 154 pound man and 46 grams for a 126 pound woman. Those levels are not difficult to achieve if, say, you scramble eggs for breakfast, grab a couple of slices of pepperoni pizza for lunch and eat chicken and broccoli for dinner. “There’s this whole idea that I think a lot of people are plagued by that you have to get so much protein. And the truth is most of us do get enough protein and you don’t have to have as much as you think,” said Marisa

Moore, an Atlanta-based dietitian and spokeswoman for the Academy of Nutrition and Dietetics. People worried about protein might do better focusing on a healthy, diverse diet rather than counting grams. Margaret McDowell, a nutritionist with the National Institutes of Health’s Division of Nutrition Research Coordination, notes that lean meats and poultry, seafood and fat-free dairy products are all good ways to get protein. “If you can consume your foods from a normal diet, that would be preferable because foods give a lot of other things beside protein and it’s probably more tasty and enjoyable to eat a lean piece of grilled chicken,” McDowell said. “I only eat protein bars if I’m desperate, if I’m running for a long time or need a quick snack.”

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;;;+HDOWK :HOOQHVV3DJH &RORU . W3ULQWHG G Wednesday, June 27, 2012 / Kingsport Times-News 15E

Apple cider vinegar tonic may cure what ails you Summer is a great time for becoming healthier, and there are many reported health benefits of using apple cider vinegar (ACV). Some have clinical support, but the science behind its efficacy is lacking or poorly understood most of the time. So far, researchers can only agree there is something about ACV that works for a wide variety of ailments. It is important to me that a natural remedy be, first and foremost, harmless to the average person. Certainly any product, natural or synthetic, can cause a problem for someone. However, ACV has at least a 3,000 year track record of safety and efficacy. What modern medicine can make the same claim? The basic ACV “tonic” consists of two or three teaspoons of ACV per cup of water. For optimal results, please use a quality raw ACV such as Bragg’s, Spectrum or Earth Fare. Adding a spoonful of natural raw honey creates a more palatable drink and adds its own health benefits. Cautions: Always rinse your mouth with water after consuming vinegar to avoid damage to tooth enamel, and check with a healthcare professional before using ACV therapeutically if you take any medications, as some have the potential to interact with vinegar. Here are a few common conditions that apple cider vinegar can help resolve: • Diabetes: Several studies, including the one below, have confirmed that ACV helps regulate blood glucose. Most studies have subjects drink ACV in water just before or during one or two meals per day. ACV appears to interfere with the absorption of carbohydrates and slows the rise of blood sugar. (Johnston C, Kim C, Buller A: Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or diabetes. Diabetes Care 27:281-282, 2004) • Sunburn: ACV can speed healing of sunburned skin, reducing pain, redness and peeling. It can be sprayed or dabbed on full strength, or diluted with a little water. Several cups can be added to a tubful of warm water for full body relief as well. Iced ACV for soaking burned feet is nearly miraculous. I rec-

How to cut back on high-calorie juice By Monica Eng

Marie BROWNING ommend following the ACV with application of pure, raw coconut oil to further skin healing. • Swimmer’s ear infections: Infections like swimmer’s ear can be prevented or managed by irrigating the ear with a 50/50 solution of ACV and water. This was first recommended to me by a local physician, and its regular use put an end to my kids’ problems during swim team and lake living years. Since ACV is a natural anti-fungal agent, it has numerous related applications. • Acid reflux: ACV tonic helps regulate acidity and stop painful reflux for many people. It may sound strange, but you would be amazed at how well this works. • Sinusitis: The ACV tonic is a natural expectorant and appears helpful in reducing the pain and inflammation associated with sinusitis. Sniffing a 50/50 percent mixture of ACV and water can also help clear out infections. One easy way to do this is by using a clean nasal spray bottle to spray into the nose, letting it run down behind the nasal passages and down the back of the throat. • Hypertension: Preliminary studies show ACV to be effective at reducing high blood pressure. This does not mean medications can be immediately discontinued! ACV is merely one of several healthy lifestyle habits that result in normal BP. • Arthritis: Virtually everyone who tries the ACV tonic reports significant decrease in arthritis type pain. The usual dosage for this application is two to three times per day. • Sleep quality: Drinking a small glass of the ACV “tonic” helps many people sleep more soundly with fewer nighttime

So far, researchers can only agree there is something about ACV that works for a wide variety of ailments. It is important to me that a natural remedy be, first and foremost, harmless to the average person. Certainly any product, natural or synthetic, can cause a problem for someone. However, ACV has at least a 3,000 year track record of safety and efficacy. What modern medicine can make the same claim? The basic ACV “tonic” consists of two or three teaspoons of ACV per cup of water. For optimal results, please use a quality raw ACV such as Bragg’s, Spectrum or Earth Fare. Adding a spoonful of natural raw honey creates a more palatable drink and adds its own health benefits. Cautions: Always rinse your mouth with water after consuming vinegar to avoid damage to tooth enamel, and check with a healthcare professional before using ACV therapeutically. bathroom visits. This age-old remedy has been touted as a cure-all for hundreds of years. It may not cure everything, but it sure comes close! I’ve only touched on a handful of applications. I’d love to hear how ACV has helped you. Have a safe Independence Day, everyone! Marie Browning holds a master’s degree in holistic nutrition and is certified in nutritional wellness. She offers seminars and private consultation in the Tri-Cities area. Her website is www.healthiersolutionsbymarie.com or call her at 367-1396.

Many public health officials are now warning patients that fruit juice poses many of the same health risks as soda when it comes to obesity and diabetes. What concrete actions can consumers take? Global nutrition professor Barry Popkin and others advise eating whole fruits (which contain fiber) instead of drinking fruit juices, so that a feeling of fullness is delivered with the sugars and calories. Some new, less sugary juice products are on the market, he said, but parents also can simply water down juice at home. Although liquids won’t quell hunger as well as solid foods, Popkin said a smoothie made, for example, with bananas, blueberries, ice and no sugar would be “a hell of a lot

better than just blueberry juice” because the smoothie would still contain the fruits’ fiber. Health advocates also note that even if a product is labeled as 100 percent juice with no added sugar, it can contain high levels of “natural” sugar. Fruit juice concentrates also can make a product much sweeter than juice obtained simply from squeezing fruit. New York University nutrition professor Marion Nestle acknowledges that cutting juice out entirely may not be realistic for everyone. “In theory, it’s absolutely true,” Nestle said of the need to avoid juice. “In practice, it’s best to restrict to 6 or 8 ounces a day, max. The best advice? Don’t drink your calories!”

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;;;+HDOWK :HOOQHVV3DJH &RORU &0<. W3ULQWHG G 16E Kingsport Times-News / Wednesday, June 27, 2012

When Alzheimer’s not the real problem

By Robin Erb His loved ones dreaded what might be next: a diagnosis of Alzheimer’s. Martin Rosenfeld had called too many times — confused and frustrated — from a parking lot outside his synagogue, after driving there in the middle of the night for services that wouldn’t begin for hours. Once a meticulous pattern-maker in the clothing industry, he now nodded off mid-conversation. Spilled things. Mumbled. “We’d be getting calls all night long. He’d say, ‘What time is it? Can I get up now?’” said his daughter, Shelley Rosenberg, whose husband, Don Rosenberg, chairs the Alzheimer’s Association’s Greater Michigan Chapter. Rosenfeld’s confusion, which turned out to be caused partly by sleep apnea, reflects what the head of Wayne State University’s Institute of Gerontology worries is a growing trend in the number of Americans being wrongfully assumed — even medically misdiagnosed — with Alzheimer’s, the most common form of dementia and perhaps the most feared disease of old age. “It’s a real problem. If you’re older, and you get a label of Alzheimer’s — even a hint that you have Alzheimer’s — there’s no more critical thinking about it. You’re written off by a lot of people,” said Peter Lichtenberg, head of the institute and a clinical psychologist who has testified in several probate cases in which a person’s mental capacity was at issue. Lichtenberg, in a December paper for the journal Clinical Gerontology, highlighted two case studies: in one, a man’s bouts of confusion and agitation in his late 70s were caused by illness and painful cellulitis, not Alzheimer’s; in the other, an 87-year-old woman, who seemed suddenly confused, was suffering from depression. Lichtenberg’s paper builds on research elsewhere that suggests that the difficulty in pinning down Alzheimer’s makes misdiagnosis too easy. The research is based mostly on small studies but also on an ongoing, long-term study supported by the National Institute on Aging, which is part of the National Institutes of Health. In cases reviewed so far, about one-third of Alzheimer’s diagnoses were incorrect, said lead researcher, Lon White.

The diagnosis was dead wrong one-third of the time, and it was partially wrong a third of the time, and it was right one-third of the time.

— Lon White lead researcher National Institute of Aging study

Photo by Susan Tusa

Martin Rosenfeld, 90, was originally diagnosed with Alzheimer’s disease when he became confushed and disorganized in his thinking. But further tests showed it was sleep apnea causing symptoms similar to Alzheimer’s. A breathing machine has made a huge difference, returning him to his former self. “The diagnosis was dead wrong one-third of the time, and it was partially wrong a third of the time, and it was right one-third of the time,” White said. The project, called the Honolulu-Asia Aging Study, has been under way since 1991 and focused on the precise brain changes linked to Alzheimer’s disease and other types of dementia. Pathologists examined the brains of 852 men born between 1900 and 1919, about 20 percent of whom were diagnosed with Alzheimer’s. In the cases carrying an Alzheimer’s diagnosis, two-thirds of the brains exhibited the types of lesions closely linked to Alzheimer’s. Half of those featured other problems, as well, such as scarring on the hippocampus, the part of the brain responsible for memory, White said. That didn’t mean that those without the Alzheimer’s lesions were otherwise healthy, “but what we’re calling Alzheimer’s is very often a mixture of different disease processes,” White said. Lichtenberg said his concerns about misdiagnosis in no way lessen the enormity of Alzheimer’s impact. “I don’t know how vast a prob-

lem it is, but I see it too often,” Lichtenberg said. The Alzheimer’s Association estimates that 5.4 million Americans are living with Alzheimer’s. Lichtenberg’s grandmother had the disease. A picture of her, dancing, sits in his office at Wayne State. But understanding how often Alzheimer’s and other dementia are misdiagnosed is hard to quantify. Sometimes, that’s because loved ones have not yet noticed a decline; sometimes, they don’t want to face the possibility, Lichtenberg said. Rosenfeld’s most pressing problem was severe sleep apnea that had aggravated the more manageable symptoms of undiagnosed Lewy-body dementia. Lewy-body dementia causes a visual processing disorder, disrupts the ability to organize, plan and focus and can causes sleep problems and hallucinations. A breathing machine at night made a dramatic difference, said Shelley Rosenberg: “I’m thrilled. He is what he used to be. I have my father back.” It’s a difficult balance for the Alzheimer’s Association: trying to raise awareness and boost early intervention efforts for Alzheimer’s and other dementias, while also cautioning fami-

lies and clinicians not to jump to conclusions. Diagnosing Alzheimer’s is tricky and is done, in part, by ruling out other health problems, such as an undetected stroke or brain tumor. Even well-meaning doctors can be too quick to judge, especially when confronted by worried loved ones listing Mom’s memory lapses, said Jennifer Howard, executive director of the Alzheimer’s Association — Michigan Great Lakes Chapter. An expert evaluation by an interdisciplinary team that includes a geriatrician and neurologist is crucial, she said. “The brain is not just a physical structure. It’s this incredible computer. It’s constantly computing where resources are needed and redirecting, depending on energy is coming from and what task you need to do,” said Rhonna Shatz, director of Behavioral Neurology at Henry Ford Hospital in Detroit. For that reason, a common urinary tract infection, a sudden change in blood pressure or depression are all stresses on an older brain that, combined with other problems, can quickly short-circuit it, Shatz said. The result is acute confusion or delirium that, to an untrained

eye, may look like Alzheimer’s disease. “Pulling these things apart and the need for a real diagnosis — that’s important so people can live the best quality of life as possible for as long as possible,” said Howard at the Alzheimer’s Association. In the case of Al Edelson, a former Wayne State professor and cancer survivor, the confusion was really the result of a regular cocktail of 18 medications prescribed for a variety of health issues. In his mid-’70s, the once sharp-witted, effervescent professor of instructional technology began to withdraw, family members said. For years, he and his wife traveled frequently, but he began to be more comfortable remaining near his family’s Huntington Woods, Mich., home. In the hours before their 5 a.m. departure for a trip to Britain aboard the Queen Mary 2 several years ago, Edelson was wide awake, anxious. “He said, ‘I think I need to cancel this.’ It was 2 a.m. I said, ‘I will never forgive you,’” his wife, Joanna Edelson, recalled, chuckling. But the change had become undeniable: Usually at ease dancing with his wife or leading group conversations, the now-retired professor was awkward and withdrawn on the ship, Edelson said. Eventually, a doctor gave the diagnosis of Alzheimer’s. “The problem is that when you’re older and you have a lot of medical conditions, no doctor speaks to the other doctor, and that’s basically what happened,” said Edelson, a retired teacher. After consulting with other doctors, family members scaled back Al Edelson’s drugs. They were amazed. “It was like he came out of a coma,” his wife said. When he died in December, having just turned 80, the cause was pneumonia, Joanna Edelson said: “Dementia did not kill my husband.”


July 2012 Health and Wellness