Health Matters East County August 2021 by The Observer Group Inc.

EAST COUNTY

Health Matters Observer

AUGUST 2021

GREEN YOUR THUMB Gardening has blossomed during the pandemic, helping mind and body health. PAGE 2

DIGITAL WELLNESS

STRIKE A BALANCE

PHYSICIAN SPOTLIGHT

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Health apps are increasingly popular — but can be pricey.

Doctors explain how balance impacts your overall health.

SMH spinal surgeon talks technological advancements.

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AUGUST 2021

GROW YOUR OWN MEAL Growing your own food can satisfy more than your stomach. It can also improve your mood. NAT KAEMMERER STAFF WRITER

Nat Kaemmerer

Heather Rippy is a lifelong gardener and founded gardening nonprofit Global Gardens in Tulsa, Oklahoma, in 2001.

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Some herbs, such as mint, basically grow themselves. If you buy a young mint plant, keep its soil damp and give it some sun, it will grow like crazy. Herbs do very well in pots about 6 inches wide and can grow all year round. Another easy grower is rosemary, and Rippy said that it actually does plenty

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uring a year when everyone was supposed to be inside as much as possible, some brought nature to their own backyards or apartments. Not unlike the victory gardens of World War II, pandemic gardens sprouted up everywhere. A survey from Axiom Marketing found that half who did it picked up the healthy hobby to relieve stress and get some fresh air, and it’s becoming more well known that spending time in a green space relieves tension and symptoms of depression. “I think we’re always going to feel better when we’re more connected to nature,” lifelong gardener and Driftwood Beach Home and Garden owner Heather Rippy said. “I have always gardened. … I think it used to be the thing that everybody did, and I just think it’s a really healthy thing to do.” Rippy has grown most of the produce section in the past, from strawberries, watermelons and pumpkins to herbs and greens. This year she focused on her tomatoes, but her two daughters love when the family grows green beans.

“I love that you’ll never know everything, and there’s always something to learn,” Rippy said. “I think it’s an incredible experience watching things grow and caring for things and to just be able to start with a tiny seed and make it into something that feeds your family.” There are a few rules of thumb that apply to most plants in Florida, Rippy said. For the most part, it’s best to plant in planters or pots because the sandy soil can make it tricky for edibles to thrive. Nematodes, or eelworms, are another Floridian problem. They’re parasitic and chomp through the root and stem of plants, so keep your plant babies out of the ground. Any pot you put a plant in will need drainage so the roots don’t rot, too. “No gardener knows everything,” Rippy said. “You’re always learning.”

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HOW FAR YOUR FOOD TRAVELS

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Rippy also advocates for gardening for the control it gives you over what you eat. You can grow whatever varieties you want, and the environmental impact is significant. Food grown at home has fewer pesticides and fertilizers, and it doesn’t have to travel to get to your plate. “The food that you grow really does taste so much better,” Rippy said. “Everything we buy at the grocery store, we don’t know kind of what it’s been through. If you’re not going to garden yourself, at least buy at the farmer’s market. … We really don’t need to be importing stuff.” Here’s how far it takes produce grown by brands found in Publix to get to shelves. For this, we’re heading to the Publix at 2031 Bay St. n A peach grown by Brandt Farms travels about 2,703 miles from Reedley, California. n A Sunset Grown tomato is grown in Ontario and travels about 1,257 miles. n Romaine lettuce grown by Pacific International Marketing is grown in three places. It takes 2,813 miles from Salinas, California; 2,379 from Santa Maria, California; and 2,333 from Yuma, Arizona.

well in the sandy Floridian soil. Take care not to overwater this, though — keep it to once a week at most. RADISHES

Radishes are the perfect plant for the impatient grower, Rippy said. When you plant a radish seed, you’ll have a radish in about a month. Rippy said you should grow all root vegetables, such as carrots, from seeds. Because you’ll be eating the root, if you move an already growing plant, it will disturb the growing process. Get these growing in a planter with plenty of drainage, and keep the soil evenly moist but not too wet. Don’t water it daily. GREENS

Greens, such as arugula and Swiss chard, are good to plant from seeds in September, Rippy said. They don’t like heat once their leaves are growing, but they need heat to sprout. Arugula is easy and sprouts quickly. Plant about 10 seeds in a raised bed with a mix of soil and compost, and water frequently. Once the top inch of soil feels dry, give it a hefty pour. Leafy greens (as opposed to head lettuce) are great because they’re “cut and come again” plants, meaning you can snip leaves from a couple plants and leave some for your next salad.

CUCUMBERS

This vine can be tough to get started and fruited, but it’s well worth it, Rippy said. Cucumbers love water and need a pot about a foot deep. Put in some sticks to act as a trellis, and gently tie the plants to them as they grow. TOMATOES

They can be tricky, but Rippy said nothing tastes better than a homegrown tomato. She does hers every year, started from seeds. Plant the seeds in a pot, and give them about six hours of full sun a day. They need about 1-2 inches of water per week; just check if the soil is dry about an inch deep, and give them a drink if it is.

FOR THE DETERMINED GROWER CAULIFLOWER

Cauliflower can be frustrating, so arm yourse lf w i t h patience and the knowledge that it’s OK to fail in the garden. Start from seeds as soon as possible because they need heat to sprout. Space your seeds about a foot to 18 inches apart in moist soil. Once they’ve sprouted, give them a good soak once a week.

AUGUST 2021

COMPOST One way to get your home garden producing is to add a little compost. No matter the space, you can compost at home — with a little know-how. Tracie Troxler from Sunshine Community Compost suggests that newbies get a small, premade bin. It’s difficult for scavengers (such as bugs if it’s indoors or animals if it’s outdoors) to get into and for smells to get out of. Sunshine Community Compost also offers kitchen scrap containers where people can store kitchen scraps and bring them in every week to add to the organization’s compost pile. “Let’s say the average (home bin) is a gallon and a half to two gallons,” Troxler said. “You must have a lid to keep fruit flies out of your house. People tend to put their little kitchen scraps under their sink, in their fridge, on their back patio or in a pantry, depending on what your space size is. … There shouldn’t be a smell if you go to your compost bin at least weekly. “We just try to keep coming up with little tweaks that make it easy and user-friendly.” To put it simply, most things that were once alive can be composted, including fruit and veggie scraps, grain-based foods, coffee grinds and eggshells. Troxler said eggshells are the only animal product they’ll accept because flesh, bones and lard will smother the microbes that create compost. It’s important to start with some carbon, such as paper or cardboard, to kick-start the decomposition. Once you can no longer recognize the original materials, the compost is ready to go, Troxler said. Sunshine Community Compost sifts out the pieces that haven’t broken down already and mixes the compost in with the soil. For new planting, try a 1-to-1 soil-to-compost ratio. If you’ve already planted, you can still massage it into the topsoil around plants. It’s also great for feeding fruit trees.

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AUGUST 2021

The cost of digital health Are subscription weight-loss and wellness applications worth the sometimes-hefty cost? RYAN KOHN STAFF WRITER

The health services world becomes more digital each year — but are any of the most popular services actually worth the cost? There are loads of options, including Noom and WW, formerly known as Weight Watchers. Noom is about “tricking” your body into better habits while WW focuses on the company’s SmartPoints system of determining healthy foods to eat. Every service offers something unique, and some of them can work — but they can also be expensive. Noom can run users up to $60 per month. For people with less disposable income, that can be a tall barrier. According to Bonni London, a Sarasota-based dietitian and wellness expert, there is no general answer to whether a service is worth the money. It all depends on what a user is looking for. London said she sees many clients who try such apps as WW, lose a lot of weight initially and then gain it all back. She said it is difficult to keep up strict programs like that for the long term. Apps also tend to be less personalized. In an age where people’s diets should be more personal than ever, with knowledge about gluten and dairy sensitivity, etc., that’s a disadvantage. Even an app like Noom, which

Noom: A subscription service that asks users to make behavioral changes in order to live healthier. “Once you determine the things you’re ready to work on, your mindset will help you form new neural connections over time to change your habits,” Noom tells users. This approach involves lots of psychological quizzes, calorie budgeting and personal responsibility to follow through on its teachings. The app can cost up to $60 a month after a oneweek free trial, but because pricing takes into account a person’s weight-loss goals and the time it will take to achieve them, personalized plans might be discounted. MyFitnessPal: A less comprehensive app than Noom, MyFitnessPal helps users count calories and nutrients from all the foods they ingest during a given day, providing a breakdown of fat, carbohydrate and protein consumption. A barcode scanner in the app makes keeping track of foods simple. There is also a message board where users can trade helpful tips. The app has a free version; the premium version costs $10 a month or $50 for a year.

offers daily messages from one of the company’s behavior-change specialists, is not as personalized as talking to an expert in person. That doesn’t necessarily mean the apps are ineffective. According to a report from WebMD, 78% of Noom users lost weight using the app, and 23% lost more than 10% of their body fat. But, as London said, the challenge also about keeping the weight off. There is a lot of work that goes into that. Noom users get food guides advising them what to eat but still have to do the shopping and cooking for themselves. They are also advised to exercise and log their routines in the app to track their progress. It’s easier to lie about behavioral changes to a digital screen than it is to an in-person professional, meaning

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there is less accountability. Some users’ gripes have nothing to do with the content and everything to do with its delivery system. For example, Noom sends users work to do every day, either of tips to memorize or quizzes to reinforce those tips. If that sounds like an annoyance, the app might not be for you. “The No. 1 recommendation I make to everyone is setting their environment up for success,” London said. “That could be the people around them that influence them. It could be the stuff in their cabinets. You basically want to take the brains out of this stuff as much as possible. … Whatever it is for you, the less you have to think about it, the more likely you are to sustain the changes into the future.”

WW: Formerly known as Weight Watchers, this app uses a SmartPoints system to assign values to different foods to promote fat loss. Like MyFitnessPal, WW includes a barcode scanner to easily track the foods you eat. The app also includes more than 8,000 healthy recipes for users to try, and a deluxe version of the app includes digital coaching from someone on the WW team. WW’s basic version costs $3.38 per week while the premium version with coaching costs $4.61 per week. Headspace: Although not directly focusing on weight loss, mental health app Headspace does help regulate users’ sleep habits, stop cravings and promote healthy behaviors, which can have a secondary effect of helping people in their weight-loss journey. The premium version, Headspace Plus, also includes access to mindfulness workouts and meditations designed to help users get through intense experiences. A Headspace Plus subscription costs $13 per month or $70 for one year.

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BALANCING ACT People’s balance often begins to decline as people age.

MARK BERGIN STAFF WRITER

Physical therapist Dr. Danielle Frain considers herself a detective when patients tell her about losing balance or that they’ve fallen. “I want to see why. What’s the underlying cause?” she said. “I do a detailed assessment of really their entire body, but especially I’m looking for those balance systems.” Balance is the ability to maintain an upright posture, which is especially important as you age. “There’s a possibility for there to be natural changes or decline in balance because every system declines as we age,” Frain said. Three systems contribute to balance: n Vision: The ability to see to help the brain coordinate movements. n Vestibular system: Parts of the inner ear and brain that help control balance and eye movements. n Sensory system: Receptors on the bottom of feet and receptors in joints. Dr. Steven Papuchis, a specialist in physical medicine and rehabilitation, said the minimum for “decent balance” is to have two of three systems functioning. “If your balance is off, then you can’t walk,” he said. “Sometimes you can’t sit, and it makes it very, very difficult to complete even basic tasks. On top of that, it can dramatically impact your overall

COMMON CAUSES OF IMBALANCE Neuropathies: Nerves in your feet and bodiy start to not function as well as they should. It can cause you not to feel where you are. Vertigo: The vestibular system is dysfunctional, which can cause wrong inputs into your brain and make you feel dizzy. Poor vision or blindness: You struggle to figure out the horizon or judge inclines. Photo courtesy of Sarasota Memorial Hospital

health because … you’re not going to be able to exercise as well or as often as you should.” More than one in four older adults fall each year, according to the Centers for Disease Control and Prevention. “There’s a lot of data to suggest that people above the age of 65 who fall have a significantly increased level of morbidity and mortality that you worry about, especially the first year after a fall,” Papuchis said. “One of the most common things that can happen after a fall is a hip fracture.” Women tend to fracture more than men because they have an increased risk of osteoporosis after menopause, Papuchis said. There is also an increased risk of diabetes,

only OPHTHALMOLOGY

Physical therapist Rebecca Paquette (right) helped a patient use an assistive device. Therapists might recommend assistive devices for helping people return to the activities they enjoy.

Physical therapist Dr. Danielle Frain stresses the importance of reducing fall risk because of the morbidity and mortality associated with falls.

Dr. Steven Papuchis is a specialist in physical medicine and rehabilitation.

AUGUST 2021

obesity, heart disease and chronic obstructive pulmonary disease in the year after a hip fracture. To prevent falls from happening, both Papuchis and Frain recommend regular exercises that require balance and coordination, such as standing on one leg or walking on different surfaces, like the beach instead of concrete. “If people are not consistently working on their strengths, working on their balance, then their condition has the potential to worsen over time, which leads to more risk of falls,” Frain said. Papuchis said his practice uses the Romberg test to evaluate someone’s balance. “You put your feet close together, you stick your hands out in front of you, and then you close your eyes,” Papuchis said. “That really challenges that vestibular system as well as the sensation in your feet.” The Mayo Clinic recommends changing the base of support, safely trying to balance with your eyes closed, turning your head or adding movement elsewhere. “If you’re doing a normal movement that historically you had no problem with, and then now you have that fear, or you have a misstep or an unsure step, then that to me says: ‘This is not as good as it used to be. I probably should go and see if I need a balanced assessment or a tuneup with their exercise program,’” Frain said. Papuchis said anyone feeling really unsteady should seek help. “Getting someone who thinks they have impaired balance into a doctor’s office — so we can evaluate them and get on a treatment plan to help them improve their balance to prevent all the complications — is really, really important,” Papuchis said.

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ave you ever felt like you’ve been swallowed by a beluga whale and are just floating around in a dark abyss? No? I’d like to say “me too,” but then I’d be a liar. I wasn’t actually swallowed by a whale. I simply stripped to the buff, put in earplugs and stepped into a pitch-black, fully enclosed tank of saltwater. I know, this sounds like the beginning of a horror movie, but the experience is actually part of a spa treatment designed to help people relax. MindSpa Integrative Wellness Center, at 5632 Bee Ridge Road, offers sensory deprivation flotation tanks where clients float in individual pods filled with 10 inches of water and 850 pounds of dissolved magnesium-enriched Epsom salt. The service costs $60 for an hour in the tank. After a person enters the tank, the lid is closed to create total darkness. The idea is to reduce stimuli and create a relaxing atmosphere through water that rests at about 95 degrees, a completely quiet setting (hello, earplugs), total darkness and a zerogravity environment. The treatment, which has been around commercially since 1972, is said to reduce symptoms of stress, anxiety, depression, chronic fatigue, fibromyalgia, arthritis, insomnia, sports injuries and PTSD. It can help with high blood pressure, migraines and premenstrual tension. And because the salt contains an abundance of magnesium, other benefits include detoxification of the body, strengthening of the immune system and heightened endorphins release. However, MindSpa Manager Angela Chittum said the best benefits are those in the brain. According to several studies, chronic stress can impact the brain’s function by killing brain cells, disrupting synapse regulation and reducing the size of the brain. It also can reduce the prefrontal cortex, which is responsible for memory and learning.

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After ensuring I didn’t have disqualifying circumstances — such as epilepsy, being under the influence of alcohol or drugs, or having open skin wounds — I was asked to take a quick shower before getting into the pod. As someone who usually floats like a boat, it was not difficult to get comfortable. For those who are, shall we say, not so buoyant, no need to worry. The large salt quantity means it’s as easy to float as if you were in the Dead Sea. But after flipping off the lights, it took me awhile to relax. As someone with anxiety, I couldn’t stop my mind from wandering. Did I ever call that source back? How am I going to have time to make dinner before a school board meeting? Are those the lyrics to “Sleigh Ride”? Am I doing this wrong? How much time is left? God, why did I open my eyes?! Chittum said first-time floaters often have the same experience I did, so I decided to give a second float a try, and I’m glad I did. It was euphoria. I have tried many activities to relax — meditation, massages and even an infrared sauna — but nothing worked as well as the floatation tank. And I’m not alone. Jessica Childs, a licensed massage therapist at MindSpa, also uses the flotation tanks, often pairing them with a massage. “It’s amazing. You just hit a new level of relaxation,” Childs said. “You relax your muscles and then move all the toxins out of your body with the Epsom salt. It’s like a total body relaxer.” Aside from the immediate relaxation, I felt fewer aches and pains in my body, I focused more on work, and I slept well the week following. Although this therapy might not be for everyone, I would recommend giving it a try. Just remember one thing: Always keep your eyes closed.

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Photo courtesy of Sarasota Memorial Hospital

Dr. Ashvin Patel is studying the use of a two-level disk replacement through a disk implant that could be done instead of spinal fusion.

Dr. Ashvin Patel BRENDAN LAVELL STAFF WRITER

arasota resident Dr. Ashvin Patel is a spine surgeon at Sarasota Memorial Hospital. He is leading studies at the hospital that aim to create

new and improved techniques for spinal surgery to reduce pain.

How did you decide that you wanted to become a surgeon? I like that you can have immediate results. In a surgical field, you have a problem, and when you address it, usually the result is fairly evident. I like the cerebral part of figuring things out but also the mechanical part of the job. It gives you a chance to use your brains as well as your hands and your skills. You can’t be a good surgeon if you’re not a good clinician or diagnostician. I wanted to do spine surgery, specifically, because it’s more pensive. It’s more analytical. You have to figure out which nerve is causing the patient’s symptoms. You have to know a lot of different disciplines. Also, I think I chose spine surgery above all the other subspecialties in orthopedics because when I was in my training, they did not have their revolution of new, successful operations. They were just starting to scratch the surface. I figured that during my lifetime, I would see tremendous changes in the field, and I would be able to stay interested in the field because there are so many changes coming. I would be able to offer better treatments than my mentors or predecessors had. Did you have a role model or someone who influenced you to become a surgeon? I have a lot of doctors in my family. My father is a physician, and he certainly had an impact on my choice. The orthopedic surgeons I worked with were generally happy in their field. A lot of surgeons

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you meet are so stressed. When I did my fellowship, there were a couple of surgeons that inspired me to pursue newer technology and disc replacements, for example. What should people know about your research in nonfusion technologies? The benefits of fusion are obvious. You have an unstable spine, and you stabilize it, and the person’s pain relief is generally predictable. The problem with fusion is it affects the level above and below where you perform the fusion. If you fuse one vertebrae at one level in the lumbar spine, the level above and below now have to compensate by doing more work. That puts them at higher risk for getting adjacent segment disease or early arthritis. The two studies I’m doing, one is for the cervical spine, which is a two-level disk replacement study where instead of fusing the two levels, we replace them with a disk. The second study is where we replace the facet with an implant that allows motion. A facet is a joint in the back of your spinal column. Are there any other advancements in your field that you’re looking forward to or hoping might come soon? We’re starting to use robotics for placement of implants and screws. We’re also getting better at biologics. When we try to fuse somebody, instead of harvesting bone from their pelvis, we are using biologic materials that are made in the laboratory to try to get bones to fuse.

AUGUST 2021

What is the most rewarding part of your job? When the patient comes back and tells you their arm or leg or back or neck pain is gone. The most rewarding part is seeing the patient walk again and do their activities of daily living and be more active, which in itself is a requirement if you’re going to live the long life that most of us are now going to live because of improvements in our diet and health care. When someone is able to remain active, they don’t get as many chronic diseases. When you’re not working, what do you enjoy doing? I like hiking, biking, skiing. I try to play tennis twice a week. I try to swim about four times a week. I like traveling. I’m a product of an immigrant family, so I’ve come from another part of the world. My family traveled a lot when I was younger. I like seeing different parts of the world and meeting different kinds of people, trying out different food, learning about cultural differences and so on. Where is your favorite place that you’ve traveled to? In the U.S., I travel to Colorado because I like the recreational activities that you can do there: skiing, hiking, biking. Overseas, I like traveling to Africa because it’s so different from the rest of the world. The geography, the wildlife, the people, and there’s a lot of diversity. I like traveling to my homeland, India, to see my relatives. It’s really special for me to talk to a street vendor or go to a restaurant and be able to speak the language.

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