To Your Health - Scarsdale Inquirer

To Your Health!

A special section of the scarsdale Inquirer

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October 4, 2013

Balance The key to good health

By JENNIFER EPEL MULLER

H

ow do you know if you’re healthy? With health fads all around us and the cultural message that thinness is everything obscuring our view of health, it’s easy to get confused about what it actually means to get healthy. Should you drink kale juice? Go gluten-free? Eliminate all high fructose corn syrup from your diet? How do you find time to exercise and how do you deal with the stress of finding time to exercise?

Two Westchester nutritionists think of health in terms of how you feel. “There’s a medical way of defining health, which would be having a normal blood pressure, cholesterol, triglycerides, blood sugar,” said Karen Dolins, a White Plains-based nutrition consultant and exercise physiologist. “But there’s also a sense of well-being that goes along with health. People are likely to come to me because they feel fatigued, they don’t feel energetic, they don’t feel the way they want to feel. I think the most common thing I hear from people is that they want to have more energy.”

Balance is the key, said Erica Leon, a registered dietitian and nutritionist who practices in Ardsley and White Plains. “One has to assume responsibility for the quality of one’s life, to shape a healthy lifestyle,” she said. “It’s finding a balance between healthy eating, getting adequate exercise, sleep and managing stress. It’s important to have pleasurable activity and companionship. I work with people whose lives are out of balance in many ways.”

One important way to get more of a healthy balance into your diet is to make sure you’re eating the right amount of food at the right time of day. “Lots of the time, people will eat more energy than their body needs at one time of day, and less at another time of day, and that’ll cause them to gain weight and feel sluggish,” Dolins said. “People think of calories as bad things, but calories can be thought of as how much gas is in your gas tank. Clearly people aren’t going to go around adding up their calories all day long, but if they’re eating most of their calories at the end of the day, they should be aware of it. Roughly, you should be eating similar amounts in the morning, afternoon and evening.

We do best if we have something to eat approximately every three or four hours.”

This kind of balance can help ward off the 4 p.m. slump that many people experience.

Another type of dietary balance is in your effort to make healthier choices, to make sure you aren’t too rigid and leave room for the variety of food situations that life throws at you. Leon said, “There has to be room in people’s diets and lifestyles to enjoy food, because it’s a source of pleasure and family and companionship, and know our body makes mistakes. I tell people to keep a food record — it’s not about judging yourself, it’s about getting information and seeing the type and quantity of food they eat.

You can look and see how many calories you’re supposed to eat, but that can be dangerous. I don’t like people to get obsessed with it.”

On that note, it’s definitely possible to be overweight and healthy, Leon said: “I think it’s very important to respect your body’s genetic makeup. People come in many sizes and shapes. Someone may have a higher BMI [body mass index], but are eating in a way that feels good for them, with lots of fruits, vegetables and whole grains, and are getting plenty of exercise. Some overweight people run marathons. Who’s to say they’re not healthy? Let’s look at other components of your life.”

Eating minimally processed food is an important component of a healthy diet, both nutritionists agree.

How do you know how processed a food is? “The closer a food is to its natural form, the less processed it’s going to be,” Dolins said. “A baked potato is clearly a potato, for example. French fries are less recognizable as a potato. You can also look at how many ingredients have been added to it. If you buy applesauce that has a lot of sugar added to it, it’s more processed.”

But don’t just assume that if it’s “natural,” it’s healthy, Dolins said. “Sugar and salt are natural. It’s not the fact that they’re natural that makes foods healthy. I mean ‘natural’ in terms of less processed.”

But it isn’t as simple as cutting out high fructose corn syrup — or cutting down on sugar. “There’s a lot of debate about the role of high fructose corn syrup,” Dolins said. “I can’t say the science strongly shows it’s responsible for health problems. The problem seems more to be that it’s so cheap to Continued on page 4A

Getting the skinny on

By EVE MARX

F

or many people, the first time they saw an electronic cigarette or “e-cig” was during an episode of “The Real Housewives of Beverly Hills” two seasons ago when psychic to the stars Allison DuBois “fired one up.” The message boards online went viral as people virtually went crazy talking about it. E-cigarette devices were still very new to the market, and watching an attractive woman smoke one was still quite a shock.

Since then, thousands of longtime nicotine users have made the electronic switch — and endorsements are being made by actor Stephen Dorff and actress Jenny McCarthy — even as young people who never smoked before are giving the fashionable no-smoke smokes a test as e-cigarette companies are now marketing their products directly to kids by offering flavors like cherry, strawberry and cookie cream.

So what’s the skinny on e-cigs? Are they a boon to people who wish to quit cigarettes altogether or are they just the newest way to get hooked?

electronic cigarettes in another form.

“The smoke is produced by inhaling vaporized polyethylene glycol or a similar substance, which is similar to antifreeze,” he said. “They were originally conceived to be a tool to help people withdraw from tobacco, but now they’re just another addictive substance.”

A Katonah mother and lifelong smoker who grew up in a state that raises tobacco said she switched from regular cigarettes to e-cigarettes about a year ago. “I thought using them would get me off the real ones,” she said.

She’s been trying, unsuccessfully, to quit for years. “In terms of how they satisfy my craving for nicotine, they are satisfying to smoke, although not in the same way as real ones,” she said.

The good news is that electronic cigarettes have reduced her regular cigarette smoking “at least in half.”

E-cigarettes, she maintained, also have a financial benefit. “They’re definitely cheaper than real cigarettes, especially if you mix your own liquids and use your own equipment, not buying the disposables,” she said. “They are about half the price of real smokes.”

Last week, Thomas Frieden, director of the Centers for Disease Control and Prevention, released a statement to The Washington Post stating: “The increased use of e-cigarettes by teens is deeply troubling. Nicotine is a highly addictive drug.”

It’s been determined that nearly 2 million teens have reported experimenting with the devices (there are numerous brands) which use water vapor to deliver nicotine to the lungs and bloodstream. While makers of the electronic cigarettes contend their products are safer than traditional cigarettes because they don’t burn tobacco and don’t produce tar or carbon monoxide, e-cigarettes still hook users on nicotine and may even encourage them to try traditional cigarettes down the line.

Dr. Ira Sutton of Scarsdale Family Doctors in Scarsdale said that electronic cigarettes are just as addictive as tobacco. “They may be worse,” Dr. Sutton said. “They are totally unregulated by the FDA at this time.”

Sutton said he is under the assumption that the nicotine used in an electronic cigarette comes from the same producers of regular cigarettes, just

Another woman, who is in her 40s and has smoked since she was a teen, said it isn’t as though she hasn’t tried to quit: she’s tried willpower, hypnosis, the patch, even nicotine gum.

“Nicotine gum gave me TMJ,” she said. “Willpower? I have none where cigarettes are concerned. I tried hypnosis, but I can’t be hypnotized.

I tried Chantix, but I have a panic disorder and that drug made it worse. I’m afraid to try the patch for the same reason. Lozenges to stop smoking are disgusting. So I’m trying the e-cigarettes.”

She said she’s been using them now for about eight months: “They’re not a totally satisfactory substitute for real cigarettes, but they’re doing the job of keeping me from really smoking, and I’ll settle for that.”

Yet another person, a 44-year-old man, is a committed e-cigarette smoker who says he likes the device very much.

“It tastes like a cigarette, there is good tobacco flavor and it stops my cravings,” he said.

Does he think electronic cigarettes are safer than regular smokes? “I’m not so sure about that,” Continued on page 4A

Experts Weigh in

The best fitness advice… in 50 words or less Inside Health...

Living in a gluten-free world........... 2A The better to hear you with: Procedures, for adult hearing loss.. 3A Counteracting chronic pain............. 5A Shingles vaccine............................. 6A Partners in Lyme: Other tick-borne diseases pose local threat................7A A daughter’s perspective: Life with advanced breast cancer........... 8A Health notes.............................. 8A-9A

A

s a runner, I discovered that indoor cycling was a great high intensity, low impact cross training option for me.

When your bike is set up specifically for you, using correct form and having the right resistance for sitting, standing, sprinting and jumping collectively will ensure a great, safe workout.

Patricia Straub, Spincredible Indoor Cycling, Ardsley

W

hen it comes to transitioning into a healthy lifestyle we make it more difficult than it should b e. Getting off your couch and in the gym seven days a week and eating only grilled/ boiled/steamed foods may be too extreme too soon. This may prepare you to fail.

Take it slow.

Vito DiMatteo, Will2Lose Weight Loss Fitness Club, Scarsdale

Y

oga addresses your whole self.

Iyengar Yoga becomes meditatio n in action, physical fitness with attention and awareness.

Guided by attention to anatomical alignment, you connect mind to body while practicing postures that cultivate strength, agility and balance.

Practice of conscious breathing re-educates your senses and quiets your nervous system.

Nancy Kardon Iyengar Yoga, Scarsdale/Greenwich Continued on page 20A

T

he best way to stick to your fitness plan is to schedule workouts in advance.

Be specific with goals and how to achieve them.

We build from our habits, so make fitness part of your regular routine. Find a workout you love to do and it’ll never feel like work.

Tanya Becker, Physique 57, S carsdale Continued on page 8A

Page 2A | To Your Health!

ThE scarsdale INquirer | Friday, October 4, 2013

Living in a gluten-free world:

Health Tips

An alternative for people who really need it

By LAURIE SULLIVAN

G

oodbye bread! Pasta! Cookies! Chocolate cake! Pizza!

(Well, all the regular kinds, at least). Of course, this is all the dietary lifeline for this writer. Not to mention beer and other grain alcohols. So why give up some of life’s guilty pleasures most of us have known and loved and have always taken for granted?

All of the above, and many everyday foods we consume, contain gluten and are now off limits to people with celiac disease or who are gluten sensitive.

So what is gluten? It’s a protein that is found in wheat, rye and barley and for those with celiac disease, it can make them very, very sick — with a whole host of physical and emotional side effects.

Gluten-free has very recently become a buzzword that some people translate into a healthier way of eating. But if it’s not a health issue, there’s no advantage to switching to what is a fairly difficult diet to follow.

Ads on TV tout gluten-free products.

Restaurants offer gluten-free menu items.

Both are good news for celiacs.

But why is it only recently that glutenfree foods have gotten our attention?

Well, for one, more people are being diagnosed with celiac and gluten sensitivities. Dr. Jack Rosemarin, a board-certified gastroenterologist with the Digestive Disease & Nutrition Center in White Plains, said those numbers could grow substantially when doctors look beyond their specialties and take a broader view of their patients’ symptoms.

Mixing meds and food can be deadly More than one-third of adults in the U.S. have high cholesterol and high blood pressure. Yet many of those treated for these conditions don’t realize they are putting themselves at risk by not understanding the basics about their medications.

Many commonly prescribed drugs have potentially fatal side-effects when mixed with other medications, over-the-counter drugs, supplements and even foods. This is true for the widely used cholesterol-lowering drugs known as statins, which can be deadly when mixed with grapefruit juice.

These medications include atorvastatin, simvastatin, lovastatin and fluvastatin.

“Most people don’t know that something as common as drinking grapefruit juice when taking statins can increase the risk of muscle pain and have serious adverse side effects that can be life-threatening,” said Ed Dannemiller, specialist pharmacist in the Express Scripts Cardiovascular Therapeutic Resource Center (TRC). “The juice can substantially raise the concentration of statins in the body and make them much more potent.”

As a specialist pharmacist, Dannemiller is one of a team of experts who are specifically trained to help patients with heart disease understand everything they need to know about their medications, including how their diet and other medications they take may affect their health.

They also work closely with physicians to prevent potential problems that medications may pose to their patients.

“Another popular drug, warfarin, which is a blood thinner that helps prevent heart attack and stroke, can react harmfully with a number of commonly used products,” he said. “When warfarin is mixed with antidepressants, alcohol, ibuprofen or aspirin, and even herbal products like gingko biloba or garlic, patients may be at risk of internal bleeding.”

If you are one of the millions of Americans being treated for one of these com-

have this problem [and] are eating glutenfree diets. It has a placebo effect.”

When asked if people with celiac disease need any supplements, Rosemarin said, “No, just diet changes. All they need to do is to avoid food with wheat, rye and barley. Within a couple of weeks of eating gluten-free, celiacs can feel great.

The small intestine lining is completely healed in 3 to 6 months.”

Rosemarin, who has a subspecialty in nutrition and offers a weight loss program for overweight and obese patients, helps his celiac patients transition to a glutenfree diet, along with a registered dietician in his office who is trained in taking care of celiac patients.

“We often see patients who have been diagnosed previously by others, but are not responding to a diet,” Rosemarin said.

“We try to help them, but oftentimes we diagnose concomitant diseases or other problems as cause for their continued symptoms.”

So why the sudden “craze” for eating gluten-free foods? “A small group of people will think they have a gluten problem,” he said. “[There’s] no problem if they eat them. It’s like the new kid on the block disease. People latch onto it when it may not be the problem at all.”

mon conditions, Dannemiller offers these tips to help prevent medication interactions: • Ask before you use: Check with your doctor or pharmacist to find out what foods, medications and supplements should be avoided when taking a medication. Some combinations cause bad reactions by making the drug more potent, while others can make the medication less effective.

• Read the fine print: Always read the caution information provided in the medication package and make sure you understand how and when to take your medications. Instructions such as taking your dose with food or on an empty stomach should not be overlooked. Also, taking too much or too little of a drug can significantly impact how well the drug works.

• Look beyond prescriptions: Make sure your physicians know all the other medications and supplements you’re taking, such as herbal remedies and overthe-counter products, including vitamins since some interactions can cause life threatening side-effects.

• Follow doctor’s orders: Taking your medications as prescribed by your doctor is essential for ensuring that they’ll effectively treat your condition. Don’t ever stop taking your medications or simply use them “when needed” without talking to your physician or specialist pharmacist.

Even if you have no apparent symptoms, you may still be at risk. For example, blood pressure can reach dangerous levels, yet a patient may not be aware of any of the warning signs. Remember, just because you don’t notice any symptoms doesn’t mean that your disease is under control.

For more information and additional ways you can avoid harmful drug interactions, visit Express Scripts’ Healthcare Insights blog at lab.express-scripts.com.

— Brandpoint

The doctor weighs in Dr. Rosemarin explained that “obviously” if someone has celiac disease they react to eating gluten. Intake of gluten causes the creation of autoantibodies.

The body then mounts an attack on those antibodies that flatten the villi that should be standing up and flowing on the lining of the walls of the small intestine, where the body absorbs food. The lack of proper absorption causes deficiencies.

“People are born with celiac disease, but it can manifest itself at any age,” Rosemarin said. “It depends on how much gluten they are taking in. It could

Eating healthy for life

be as a child or later on as an adult.”

Interestingly, the doctor noted that the disease is fairly common: about 1 in 133 people have it — that translates to about 2 million people. The odds increase to 1 in 22 for those genetically disposed to celiac. The numbers vary in other countries.

According to Rosemarin, people can have a genetic predilection to the disease.

“If a first degree relative [mother, father, sister, brother] has a sensitivity to gluten, the rest of the family should be tested,” the G.I. doctor explained. “Doctors may only deal with their specialty and ignore what the real problem is. They don’t look beyond other possibilities.”

There are two basic ways to determine if a patient has celiac disease: either by endoscopy where a biopsy is taken, or more commonly by blood tests. Rosema-

rin tells patients to eat gluten before they are tested, “otherwise it won’t show up.”

There are a whole host of symptoms that celiacs exhibit, including recurring bloating, smelly stools, muscle cramps, seizures, infertility, miscarriages, even depression and behavior changes, delayed growth in children, failure to thrive in kids and more.

“A person may not have any symptoms because they may not be taking in enough wheat to have symptoms,” Rosemarin said. “Others may be gluten sensitive with diarrhea, which causes bloating, gas, but not causing any damage. The cause is an allergic reaction. There’s also a matter of a misdiagnosed disease that is actually celiac, including Crohn’s disease. Everyone who has Epstein Barr or Chronic Fatigue Syndrome think they could have celiac when they really don’t

Registered dietician and nutritionist Linda Arpino, founder of the Life Focus Nutrition Centers, is celebrating 30 years in private practice, with offices in Port Chester and Stamford. When treating celiacs, she prefers that her clients have a doctor’s referral before she works with them to first determine if they actually have celiac.

“There is a lot of trend out there with people who think they have a gluten sensitivity [or celiac disease],” she said.

“They feel better not eating gluten, but they must have a stomach biopsy or blood test.”

Arpino said there has been a much greater rise in the number of people with celiac disease, noting, “In the past, doctors were not always in tune in diagnosing it.”

When Arpino treats celiac clients the first thing she does is a diet inventory. Then she gives them a grocery list Continued on page 9A

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Stop by to meet us and tour our hospital and boarding facilities.

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The better to hear you with Procedures, advancements for adult hearing loss

By JENNIFER LEAVITT

I

t can start with muffled sounds, swishing or buzzing in the ear or, despite adequate sound, not being able to discern the actual words another person is saying. Sometimes the TV volume or phone ringer just needs to be on a tad higher. However it manifests itself, hearing loss can start slowly and inconspicuously, developing into a real hindrance to well-being and daily functioning. Fortunately, there have been a number of advancements in hearing loss treatment in recent years.

Oftentimes, people don’t even realize they have reduced hearing until someone else points it out. The first step is to visit a hearing professional for a diagnostic audiogram. Sensible Hearing Solutions of Harrison and Mohegan Lake states that a full audiometric evaluation should consist of pure tone air and bone conduction testing and speech audiometry. “A speech audiometer is obtained to evaluate the individual’s ability to understand speech at elevated comfortable volume.” Pure tone testing is important to help determine the degree of hearing loss, and to understand “whether the hearing loss is conductive or sensorineural.”

According to Dr. Robert A. Cohen, AuD of Sprain Brook Audiology, the plethora of information and screening technology now available has made early detection easier. The benefits of treatment have also been more significantly proven of late, in particular, improved cognitive and social functioning.

“We’re seeing patients sooner than ever before,” Dr. Cohen said. “Early intervention is key” to successful treatment. It also goes a long way to preventing some of the side effects of hearing loss, such as confusion, poor focus, memory problems, alienation and depression. If these issues already exist, reversal typically begins as soon as treatment does.

Hearing loss can be temporary or permanent. It is important to have it evaluated by a physician who can rule out infections, blockages, aural growths or other factors that may be to blame.

Ten percent of patients might require interventions that are more extreme than a standard hearing aid, such as a cochlear implant, a stapedectomy or stapedotomy, bone-conduction or bone-anchored hearing aids.

A cochlear implant is useful for patients with severe hearing impairment, including those with damaged sensory hair cells. It is a surgically implanted electronic device consisting of a microphone, speech processor, transmitter, receiver, stimulator and electrodes. Unlike a hearing aid, it can bypass damaged areas of the auditory system to directly stimulate the hearing nerve, which allows the patient to hear more loudly and clearly.

Rather than restoring normal hearing, these devices enable patient brains to process sounds.

In other cases, if the stapes footplate of the middle ear is not mobile, as it should be, or if abnormal mineralization of the temporal bone has taken place, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis — a stapedectomy — or, by creating a small hole in the fixed stapes

footplate and inserting a tiny, pistonlike prosthesis — a stapedotomy.

Bone-anchored hearing systems use the body’s natural ability to transfer sound through bone conduction. The processor picks up sounds, converts them into vibrations, then transmits them through the skull bone directly into the inner ear, circumventing any within the ear canal or middle ear. These systems consist of a small titanium implant that sits in the bone behind the ear, a connector and a sound processor.

Ninety percent of patients with permanent hearing loss can experience great improvements with a standard hearing aid (analog, programmable or digital), and there are numerous options to choose from, with technology advancing all the time. Patients can make hearing aid choices based on the extent and nature of hearing loss, as well as issues of comfort, style, expense and situational requirements.

When expense is not an issue, surveys show that patients are more satisfied with programmable technology, which allows the dispenser to adjust the hearing aid with great precision to each patient’s specific hearing loss characteristics. If the product needs tweaking, the hearing professional can handle that, instead of having to send it back to the manufacturer for adjustment.

“There have been many advances in hearing loss treatment in the last few years,” said Dr. Ed Bravo, Au.D, president of Audio Help Hearing Center in Scarsdale. “Most hearing impaired patients have great difficulties hearing in noisy environments. New hearing technology has improved the ability to understand con-

versation even in the presence of background noise. In our practice, patients can actually test drive different hearing aids and hear the difference before selecting the appropriate amplification device.”

People with or without hearing aids may also benefit from assistive listening devices, which capture an audio source and broadcast it wirelessly over an FM, infra red, induction loop or other transmission method. The patient may also use a receiver to tune into the signal and customize volume.

“Digital technology now allows Bluetooth connectivity between hearing devices and cell phones or television, improving speech understanding,” Dr. Bravo said. “We demonstrate this technology in our offices.”

He added, “Auditory rehabilitation is now available for individuals of all ages who have hearing loss. New and modernized techniques include assistance in everyday listening through custom-designed personal hearing aids; help for those with profound deafness,” not only through implants and tactile aids, but also through alerting devices that use vibrations, light or other methods of communication; and, counseling and specially designed maskers for those who suffer from tinnitus [ringing in the ears].”

Many people are resistant to seeking help for hearing loss, but from advanced screening techniques, proven procedures and high-tech devices, to “invisible” hearing aids for the aesthetically self conscious, there has never been a better time to address hearing loss and improve quality of life.

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Page 4A | To Your Health!

ThE scarsdale INquirer | Friday, October 4, 2013

E-cigarettes Continued

Healthy balance Continued

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make that manufacturers are putting more sugar in products when they’re using it.”

Leon said the main problem with both HFCS and other sugars is that they are often added to processed foods. “Dressings, jarred sauces — they have things added to them,” she said. “The sugar is just another form of calories. In general I tell people to cut back on simple sugars, but don’t get too crazy. There’s nothing wrong with using a little bit of sugar. Everything in moderation.”

The current “juicing” trend is another area where people get sidetracked from the goal of just eating more whole foods, and doesn’t necessarily lead to better health. “A whole orange is more satisfying than 4 ounces of orange juice,” Leon said. “The whole concept of juicing is probably not the most effective way to stay healthy. Get nutrients in their most natural form.”

Dolins said, “Some people find it easier to get their fruits and vegetables in one shot, but when you do that, you’re less likely to eat healthily the rest of the day. If you’re having a piece of fruit three times a day, you’re less likely to have chips.”

And if you’re not gluten intolerant, there’s no reason to go gluten-free. “You could be avoiding foods that provide important nutrients for no reason,” Dolins said. “Whole grains are healthful. They’ll give you fiber, energy, vitamins and min-

es... ntacts... ry.

erals. Variety is very important in nutrition. When you go gluten-free, you’re limiting that variety.”

“Gluten-free has become a buzzword,” Leon said. “We are definitely increasing our awareness of people with celiac disease, and they need to be on gluten-free diets for life, but the problem is when a lot of packaged gluten-free foods are higher in fat and calories and lower in fiber. If you’re not gluten intolerant, it’s actually good to have whole wheat bread, with whole wheat as the first ingredient.”

In other words, gluten-free foods that are processed can be just as bad for you as other processed foods.

“Balance” is also the word of the day when it comes to exercise. First, exercise should include both strength training and aerobic activity, Dolins said. If you can do that type of balanced exercise routine an hour a day, she said, “you’ll have more energy, less huffing and puffing and an overall better sense of well-being.”

Leon asks her clients what’s keeping them from exercising, and said that a lack of exercise is often due to something else being out of balance. “Is it because you’re working 80 hours a week? Or are you just too tired? Something is out of balance if you’re not able to get exercise,” she said.

“I say the same thing about sleep. I work with teenagers, and they’re so stressed out.

These superachieving kids are not exercising, they’re snacking more than they need to be and they’re out of balance.”

And if these changes seem too overwhelming? “Start slow,” Leon said. Walking is a good exercise to start with. “You do what you can. It’s not all or nothing.”

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he said. “The new reports are disturbing.

They’re not rated by the FDA and mine are made in China. Lord knows what we are actually smoking.”

His co-worker would like to quit smoking but feels it’s impossible: “Right now I smoke two or three regular cigarettes a day, but I’m always chewing nicotine gum.

I have thought about switching to the ecig because I hate this incessant chewing, which makes me feel like a cow. However, I do like the way the gum wakes me up in the morning. Not sure the e-cig would do the same.”

A man from Westchester reports he’s been using electronic cigarettes since he quit smoking regular cigarettes last January. “I find them more satisfying than nicotine gum or the patch, and very easy and convenient to use,” he said. “Most importantly, I haven’t had a cigarette this entire year and I’m sure I never will again. As time goes on, I find I need the e-cigarette less and less, but I still do use them daily.”

A Pound Ridge man who has been smoking since his college days, about 30 years, said “I’ve been using them [e-cigarettes] for about a year. At first my use was sporadic, but it’s become more regular recently. I really am trying to transition.”

He made the switch primarily for professional reasons: “It’s become such a chore to smoke at the office. They made our work campus tobacco free. For those people who can’t or won’t quit, this has had the perverse effect of increasing smoking. Instead of stepping outside for a quick smoke, now people have to jump in their car and drive to an adjacent mall or shopping area and smoke numerous cigarettes in a row since most of the day is filled with meetings. E-cigarettes help bridge the gap on a busy day and do seem to help in reducing smoking if you are conscientious about alternating or substituting.”

While he still does smoke Merit Ultralights that he alternates with e-cigs, he said, “Less smoking definitely feels better and I do want to cut down. Gradually I seem to be using the e-cigarettes more frequently and don’t miss my regular cigarettes as much.”

The glamour of cigarette smoking may have been tamped down in the past two decades, but it never has gone away, despite the health risks involved. Cable television shows such as AMC’s “Mad Men” make smoking look downright sexy again.

“If you search The New York Times, you will find an article about a popular shop in Paris with over 60 flavors,” Sut-

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“Instead of helping people stop smoking, e-cigarettes have just become another addictive product on the market. The longterm effects of inhaling pure high dose nicotine won’t be known for years, but can’t be good, the same for the artificial smoke.”

Dr. Ira Sutton of Scarsdale Family Doctors

ton said. “Instead of helping people stop smoking, e-cigarettes have just become another addictive product on the market.

The long-term effects of inhaling pure high dose nicotine won’t be known for years, but can’t be good, the same for the artificial smoke.”

Anna Jade Flournoy Latimer is a college freshman who recently switched to ecigs in an effort to quit smoking entirely.

“It’s been a very emotional process for me, since smoking calms my nerves,” she said.

She said she never was a big smoker, “maybe 2-3 cigarettes a day.” Her brand of choice is American Spirit, which are higher in nicotine than other filtered brands. “When you smoke a cigarette with a higher nicotine, you smoke less because the craving for nicotine is more easily satisfied,” Latimer said.

About e-cigarettes, she said she purchased hers at DeCicco’s Supermarket where the choice was between the brands Blu and Logic. “The brands you get at the

gas station, the disposables, are a horrible investment,” Latimer said.

The first e-cig she tried was Logic.

“Within two days I had canker sores and a cough and my chest felt sore,” she said.

“That was creepy, because I never had a smoker’s cough.” She said she checked the list of ingredients and researched propylene glycol: “People keep saying it’s safe, but when I did some research online, I found out that there is a relationship between propylene glycol and antifreeze.

Heating it converts it or something I don’t trust or understand.”

Her second choice was Blu, another disposable, but, she said, “There were no side effects. Also no propylene glycol.” Blu satisfied her craving for nicotine, she said, but the device isn’t built to last.

Latimer said that she reads all the disclaimers on the e-cigarette brands. “They all say something about not being a way to actually quit nicotine addiction, but rather are a healthier alternative to tobacco

smoke, which creates tar,” she said. “My personal opinion is that since I bought a good quality rechargeable e-cig with a wise choice of vapor such as Virgin Vapor, it is helping me quit. I’m at 12 mg right now, and plan to keep buying lower and lower nicotine vapors until I’m at 0 and from there it will only be the mental attachment to master, which is much less tormenting than the chemical addiction.

“There are different nicotine levels to choose. If you’re trying to use e-cigs to wean off of the nicotine addiction, you can buy 36 mg or 0 mg, or anything in between.”

A site she likes is Virgin Vapor at www. virginvapor.com: “They have certified organic flavors in a vegetable glycerin base and water, as opposed to the usual propylene glycol and water base. You can even get flavorings without alcohol. Most flavorings have alcohol, by the way.”

Latimer shared a personal anecdote about cigarettes and their coolness factor.

“I was at a frat party in the city and a girl came up to me and asked if she could try my e-cig,” she said. “I asked her if she was a smoker and she said, ‘No, but I keep seeing these and want to see how they taste.’

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To Your Health! | Page 5A

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By JENNIFER LEAVITT

hey say time heals all wounds, but the 100 million Americans living with chronic pain probably disagree. With so many people suffering, is there any relief in sight?

Over the past decade, researchers have made quite a few discoveries about the origins of pain, and understanding its source may lead to better treatments in the future. But as the American Pain Society reports, funding that could turn these findings into tangible treatment is woefully lacking.

Sufferers and their doctors can, though, use some of this newer knowledge to come up with multifaceted treatment plans. Often, there are also more options for tackling chronic pain than patients are ever made aware of and, however slowly, some new options have emerged as well.

One of those new options is a drug called Lyrica (pregabalin), significant because it targets nerve pain, a type of pain not usually relieved by NSAIDs (nonsteroidal anti-inflammatory drugs) and other common treatments. Lyrica is FDA approved to treat fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain and pain from a shingles attack.

“It controls nerve pain and has a lower side effect profile than previous treatments,” said Dr. Giovanni Angelino, M.D., R.Ph, and pain management specialist at Northern Westchester Hospital. “Fibromyalgia is stubborn, with widespread neuropathic involvement. As doctors for these patients, we were always chasing the area of pain.”

But this drug is working well for fibromyalgia in particular, and for the other conditions as well. Doctors may also prescribe Lyrica off-label for nerve pain of varying origin.

Some newer treatments are aimed at rewiring brain signals, which can disrupt pain stimuli transmitted from the spinal cord to the brain. The spine, of course, is key in many pain treatments.

For failed back syndrome patients “who have gone through one or more surgeries, chiropractic, physical therapy, injections and still failed, a spinal cord stimulator may help,” Dr. Angelino said. These stimulators involve an electrode lead in the epidural canal that basically counters the bad messages with good ones. Before the implant, patients can test out the unit by wearing it externally.

“The computer chips have progressed so that we can now program the stimulators with much more precision,” Angelino said. “And Medtronic recently came up with leads that allow a patient to have an MRI.” (Previous versions contraindicated MRIs. This meant that a patient using a spinal stimulator could only get a CT scan, which is based on radiation.)

For cancer and other acutely ill patients, an intraspinal insert pump can infuse morphine and other narcotics.

“Because the method is so direct, less medication is required, the patient is more lucid, can maintain a better connection with friends and family, and maintain improved quality of life,” Angelino said.

Another treatment for patients with acute illness is the Ganglion block, which uses a powerful agent such as phenol to completely stop nerve transmissions that are causing debilitating pain from deep within the body.

So many of the patients living with chronic pain, though, do not have an acute illness, so their quest is for effective pain management that can be used long term, even indefinitely. Opioids, the most effective and most abused oral medication for treating pain, “are not a long-term solution,” according to Angelino. “They lead to serious addiction and all they do is block the pain, while other drugs actually treat the cause. Muscle relaxants actually relax the muscle, rather than just blocking a feeling of pain.”

Recent clinical research shows that chronic pain has specific neurobiological foundations that differ greatly from acute pain mechanisms. Until recently, all focus was on the nerves on site, in the aching lumbar, jaw or knee. Pain, however, is dependent on perception, which occurs

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solely in the brain. The sensation of pain includes the physical feeling, emotional reaction and intellectual response. Pain can only exist with perception.

Studies have shown that brain stimulators can activate areas of the brain that provide pain relief and suppress stimuli.

Strategies that teach patients control over brain activity, such as meditation and self-hypnosis, are also showing promise. The neurotransmitters epinephrine, norepinephrine and dopamine are being examined for their role as well. For all these and other reasons, cognitivebehavioral therapy and clinical antidepressants are very legitimate treatments for physical pain.

If pain is all-consuming, more drastic methods may be necessary before a patient can even manage to sit still for something like meditation or hypnosis.

One possible solution is radio frequency nerve ablation, in which radio waves heat the myelin sheath around a nerve until it sheds (a few weeks after the procedure), and the nerve is unable to transmit pain signals until the sheath returns, 3-18 months later, at which time the procedure can be performed again.

“The news reports RF nerve ablation as if it’s something new,” Angelino said.

“But it’s not new, it’s just that not all doctors are trained in it. They may just be becoming aware of it.”

Angelino has been using the procedure to treat pain at Northern Westches-

ter Hospital since 1998.

Not everyone needs narcotics or surgery to treat their pain. For some, acupuncture, physical therapy or chiropractic can completely restore quality of life.

A significant correlation between foot problems and back pain has really come to light in recent years, said Dr. David Klein, a chiropractor and kinesiologist in Scarsdale and on Madison Avenue.

Knee and hip pain can also be related to the spine. Dr. Klein uses a small impact tool known as an activator to make most body and spinal corrections. “It is far more gentle and safer than the pushing, pulling and cracking people envision with chiropractic care,” he said.

Another chronic pain that Klein treats is that caused by temporomandibular disorders, such as TMJ, which can cause neuralgia, facial, jaw and neck pain. In mandibular orthopedic repositioning, the chiropractor and dentist work together to correct the problems causing pain. “It’s a great success,” Klein said.

Sometimes, patients need to be their own advocates. An oncologist could be great at curing cancer, and an orthopedic surgeon may do the best knee replacements in town, but they can’t be jacks of all medical trades. Visiting a doctor who specializes in pain management is the key to being treated for pain, and when current research does lead to new and better treatments, they will be the first to know.

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ThE scarsdale INquirer | Friday, October 4, 2013

Shingles vaccine little known, but recommended Question: I heard that you not only treat the area of pain but ALSO the problem that causes the pain.

Answer: Yes, this is true. Too often doctors are only interested in the area of pain. In my practice, I look for the PROBLEM that causes the pain. For instance a chronic lower back or hip pain can be caused by a foot or knee problem. A chronic shoulder or arm pain may be really coming from an undiagnosed neck problem. The patient who has been struggling with an area of pain can be evaluated in my office to determine the root of the PROBLEM that causes their pain.

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635 Madison Avenue New York, N.Y. 10022 212-486-3886

By JOHN ROCHE

D

espite the fact that a vaccine exists for shingles, a surprisingly low rate of Americans get the shot, according to a new study released in September, prompting a call by national medical officials and some local experts to urge older adults to discuss the vaccine with their doctors.

Fewer than 2 of 10 Americans aged 60 and older have been vaccinated, while the rate is less than half that for people in their 50s, according to the study presented this fall at a leading medical conference in Denver. That’s an extremely low rate, given that almost one-third of Americans will get shingles in their lifetime, with about 1 million cases in the U.S. each year, according to the Centers for Disease Control and Prevention (CDC).

The chances of getting shingles substantially increase with age, according to the National Institutes of Health, and by age 80, 50 percent of Americans will contract shingles.

Shingles, or herpes zoster, is caused by the same virus as chickenpox, and can remain in the body after a chickenpox infection and become active again years later.

Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso, according to the Mayo Clinic. It is characterized by a painful rash that generally clears within a month and can be accompanied by fever, stomach ache and chills.

A more problematic lasting side effect is postherpetic neuralgia, a burning nerve pain that can be severe enough to disrupt the daily lives of those suffering from it.

Postherpetic neuralgia (PHN) can last anywhere from 30 days to months or even years after the rash has passed. A major problem is that effective treatments for the pain don’t exist.

The CDC recommends a single dose of the shingles vaccine for all adults over 60, and Dr. Gary Wormser, chief of infectious diseases at Westchester Medical Center, agrees.

“The vaccine is effective, not 100 percent, but much more than not getting it, in preventing shingles and the often extremely painful and long-lasting sequela of postherpetic neuralgia,” said Dr. Wormser, adding his voice to research that suggests the vaccine can not only reduce your risk of contracting shingles by 50-70 percent, but can also lessen your pain, should you still come down with this debilitating disease.

The vaccine, Zostavax, is relatively new.

It was cleared for sale in 2006 for people 60 and older, and for use by those in their 50s in 2011. The Food and Drug Administration lowered the approval age after research showed it helped reduce the risk of shingles by up to 70 percent, compared with those who used a placebo.

While some public health advocates and individuals have pointed to potential side effects and high cost for those who are uninsured as the key reasons for the low rate of vaccination, Wormser and other local experts believe it’s more likely a case that the public — particularly those in the at-risk demographic — are unaware of the preventive measure.

“I don’t think that the vaccine is widely known to the people who might benefit from receiving it,” Wormser said.

Especially in light of the national study that highlighted the low rate of vaccines in older Americans, a growing number of experts are urging that public health efforts should seek to raise awareness for vaccination and that health care professionals should address both shingles and the vaccination with their patients in their 50s or older.

Similar to a flu shot, the shingles vaccine is given in the back of the upper arm.

“Side effects are generally predictable and mild, including pain at site of injection,” Wormser said.

Other possible side effects of the vaccine may include redness, soreness, swelling or itching where the shot was given.

Less common side effects include headache and nausea.

“I got a pretty nasty flulike reaction but having had shingles I’d still rather have two days of feeling like that rather than a month of pain,” said one woman who had the vaccine. “I was told that they had very few reactions, so maybe I was the exception. I don’t know if I got a reaction because I’d already had shingles.”

The vaccine is generally covered by insurers for those aged 60 and older, but for those who are under 60 or whose insurance doesn’t cover it, the vaccine may

cost about $200 out of pocket. The CDC’s website states that all Medicare Part D plans cover the shingles vaccine, but the amount of cost-sharing, or money a patient is responsible for, varies.

Medicare Part B does not cover the shingles vaccine. Medicaid may or may not cover the vaccine; contact your insurer to find out.

Some pharmaceutical companies provide vaccines to eligible adults who cannot afford them, the CDC points out.

Even those who have already had a bout of shingles are encouraged to get the vaccine, according to the CDC. Because shingles can recur, the shingles vaccine may give protection from having shingles again.

“The vaccine is not recommended for persons who are immuno-suppressed,” Wormser cautioned. For example, those with HIV infection or who are receiving cancer treatments that can weaken their immune systems are generally not candidates to receive the vaccine. Also, those who receive organ transplants are vulnerable to shingles because they are given drugs that suppress the immune system, medical experts point out.

A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. A person with chickenpox cannot communicate shingles to someone else. Shingles comes from the virus hiding inside the person’s body, not from an outside source, according to the National Institutes of Health.

The impact of chickenpox, or varicella, has plummeted with the advent of a vaccine that became available in 1995. Before that, about 4 million people nationwide got chickenpox each year, more than 10,000 were hospitalized and as many as 150 died, according to the Centers for Disease Control and Prevention.

From 2000 to 2010, chickenpox incidence dropped 82 percent in the U.S, and the CDC estimates that the vaccine prevents 3.5 million cases of chickenpox and 100 deaths a year linked to the disease.

Health Tips

Dispelling five common myths about depression

T

here are more than 19 million adults in the United States living with depression and many more people could be suffering, but are unaware that what they are feeling is depression, according to the National Institute of Mental Health. This common and treatable illness affects people from all walks of life and can significantly interfere with a person’s behavior, physical health and interaction with others.

The more you know about depression, the more likely you are to be able to help yourself or help others. While great strides have been made in recent years to educate the public about depression and reduce stigma surrounding mental illness, many myths still remain about the condition.

Myth — Depression is a character flaw: Depression is not a personal weakness and it should be viewed as any other medical condition. People who are depressed are often unable to function as they had in the past and struggle to accomplish everyday

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tasks. This is not because they are lazy or being dramatic; it is because depression is a serious health issue that should be recognized and treated as early as possible. Both young people and adults who are depressed need professional treatment.

Myth — Only certain types of people have depression: Depression affects all ages, races and genders. Sometimes people believe that only certain types of people can be depressed. Even people who seem to have everything, including a good job and healthy relationships, can have depression.

While statistics show that some groups, like older adults, are more likely to suffer from depression, anyone can struggle with the illness. It can run in families, but anyone, even those without a family history, can be depressed.

Myth — Depression causes people to be violent: People who are depressed are no more likely to be violent or commit crimes than members of the general population.

Although some people with depression do experience feelings of anger and sometimes

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have outbursts, the vast majority of people who have depression never harm anyone.

Myth — Depression is not a big deal: If left untreated, depression can lead to extreme changes in your mood, thoughts, behaviors and bodily functions, and for some people suicidal thoughts. Almost everyone who dies by suicide has given some clue or warning. Do not ignore suicide threats.

Statements like, “You’ll be sorry when I’m dead,” or “I can’t see any way out” — no matter how casually or jokingly said — may indicate serious suicidal feelings.

Myth — Depression will go away on its own: Positive thinking is not enough to cure depression. Some people who have mild depression can make lifestyle changes which can help alleviate symptoms of depression, but many others need to seek treatment to get better. A mental health professional can help them learn more positive ways to think about themselves, change behaviors, cope with problems or handle relationships.

A clinician can prescribe medications to help relieve the symptoms of depression. For

many people, a combination of psychotherapy and medication is beneficial. Early detection is extremely important because 80 percent of people who receive some form of treatment for depression can learn to manage the condition and live a fulfilling life.

Fact — Help is available: If you think you or someone you know might be struggling with depression, you are encouraged to visit HelpYourselfHelpOthers.org and take an online mental health screening. Online screenings are free, anonymous and available 24/7.

Although the screenings are not diagnostic, they do provide valuable insight helping to identify if you are exhibiting symptoms associated with depression and connecting you with appropriate treatment resources.

NOTE: If you or someone you know is in immediate danger because of thoughts of suicide, call 911 immediately. If there is no immediate danger but rather a need to talk to someone, call the national suicide prevention line at 800-273-TALK (8255).

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To Your Health! | Page 7A

Partners in Lyme: Other tick-borne diseases pose local threat

By JENNIFER LEAVITT

O

ver the past few decades, Lyme disease has gone from a mysterious unnamed illness in rural Connecticut to one that’s on the radar of every doctor, parent, teacher and camp counselor in the country. Less common, though, is the knowledge that Lyme is only one of many tick-borne illnesses in the United States, and some of the others are catching up. Rocky Mountain spotted fever, anaplasmosis, babesiosis and Powassan virus infect people in the northwest through tick bites.

In Westchester County, according to infectious disease specialist Dr. David Goldberg of Scarsdale Medical Group, babesiosis and anaplasmosis (formerly known as ehrlichiosis) are the most common tick-borne ailments after Lyme.

“These latter infections may cause a flulike illness (fever, headache, body aches, malaise) which may be quite severe and, in rare cases, fatal,” Dr. Goldberg said.

“However,” he continued, “unlike Lyme disease, babesiosis and anaplasmosis do not cause long-term chronic symptoms.”

“It’s possible to get all three of these infections from one tick bite” cautioned Dr. Debra Spicehandler, co-chairman of the department of infectious diseases at Northern Westchester Hospital. “Doctors do not routinely test for any of these unless you have symptoms.”

Goldberg reassured, “There are blood tests available for both of these infec-

tions, but, similar to Lyme disease, the tests may not turn positive until weeks after the initial infection. So if a person is seeing his or her doctor for a fever or flulike symptoms occurring after a tick bite, it would be appropriate to test for babesiosis and anaplasmosis, in addition to Lyme.” However, he pointed out, “If the person is being evaluated for chronic fatigue or joint pain, testing for these illnesses is not likely to be helpful.”

Spicehandler noted, “Ehrlichiosis comes on much faster than Lyme. People experience symptoms within three or four days — usually a headache, body aches, and sometimes diarrhea. They’ll have a low white blood count and occasionally elevated liver function. The infection is diagnosed with a blood smear, and the treatment is usually a 10-day course of oral antibiotics.

“Babesiosis infection is less common, though we’re seeing more and more cases in northern Westchester. This is a parasite that invades red blood cells and can cause anemia. The symptoms are similar to malaria, with cycling fevers, headaches, aches and pains. Antibiotics can help treat the infection, but treatment for anemia may be needed as well.”

Dr. Ira Sutton of Scarsdale Family Doctors said they have been seeing more tick-borne illnesses in recent years, though this summer was better.

It is uncommon, but Rocky Mountain Spotted Fever has been reported in New York and Connecticut. Caused by Rickettsia rickettsii bacteria, it is usually transmitted by dog ticks. Initial symptoms include fever of more than 102 degrees Fahrenheit and a severe headache.

Muscle aches, nausea and vomiting often occur. Later, most people develop a rash, usually originating on the wrists and ankles, then spreading to arms, legs and trunk. Some have it on the palms of the hands and soles of the feet as well. In the final stage, there are broken blood vessels and small hemorrhages under the skin. Damage to blood vessels can be one of the most serious results.

Another rare, but locally present virus, Powassan — carried by deer and woodchuck ticks — is important to be aware of because it can enter the blood within 15 minutes of being bitten, and could be deadly. Early treatment is crucial, as the disease can mimic the West Nile Virus — presenting no major symptoms until the sudden onslaught of encephalitis (swelling of the brain). Severe headache and fever should never be ignored, especially when presenting with nausea, vomiting, muscle aches or stiff neck.

No vaccines are available to protect humans against tick-borne illnesses.

That’s why the best way to prevent against these diseases is to “avoid getting bitten,” warned Spicehandler. “Wear long-sleeve, light-colored shirts and long pants when you hike. Limit the exposure of bare skin. Use a repellent that contains DEET — sprays and creams that don’t contain DEET don’t work as well.”

Having more than one tick-borne illness at once can exacerbate the symptoms of each disease, making for the perfect storm inside the body. Even avoiding one of the diseases provides for a better outcome. “The most important underpublicized fact about Lyme disease

is that the tick has to be attached for at least 24 hours or more to transmit the infection,” Goldberg stressed. “So if you do a thorough tick check after you’ve been outdoors (and you need the help of a full-length mirror or another person, in order to see the back) and you remove the tick the same day, it’s virtually impossible to get Lyme disease. The tick should be removed with a pair of tweezers. Grab the tick by the head and remove it in its entirety, gently but firmly.”

To find a host, ticks climb up grasses and branches, then wait for an unsuspecting passer-by to grab onto. Sometimes they make their way inside, hiding in carpet fibers, furniture and crevices until a potential host is near. Ticks take their time, feeding slowly as they remain embedded in skin, usually for several days until they are engorged with blood.

Sunlight, low humidity, well-groomed lawns, gravel and mulch are all turn-offs to ticks. In addition, pest control companies can target tick larvae early in the season to keep people less susceptible in their own yards. Other methods of control include frequent bathing, tick checks, preventative shampoos and conditioner, pretreated clothing and preventative pet treatments.

Prevention is always better than a cure, but everyone should be aware and consult a doctor as soon as symptoms crop up within hours, days or weeks of possible tick exposure.

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Five effective ways to fight seasonal allergies

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utumn is a season filled with crisp air, falling leaves, pumpkin carving and, of course, hay fever symptoms. Hay fever affects 23.6 million American adults and children, according to the American College of Allergy, Asthma and Immunology (ACAAI). Symptoms commonly appear during the spring and fall months.

“Ragweed blooms from August until November, and is unfortunately lasting longer every year,” said Dr. Michael Foggs, an allergist and ACAAI president-elect.

“Research suggests the season lasts up to three weeks longer than it used to, and the further north you live, the longer you have to wait for relief.”

To help sufferers fight fall allergy symptoms, ACAAI offers these tips: • Know the culprits: The most common sneeze and wheeze trigger during the fall hay fever season is ragweed pollen.

Ragweed can begin blooming as early as August in some regions. A single ragweed plant may release 1 million pollen grains in just one day, and one grain can travel up to 100 miles. Mold can also be particularly bothersome this time of year. Unlike pollen, mold doesn’t die with the first frost.

Rather, spores stop growing during this time.

• Avoid triggers: Ragweed pollen and mold spores can float in the air and linger on fallen leaves. After spending time outdoors, shower and change and wash your clothes. Clean your nasal passages, too, by using a salt water rinse. While working outdoors, wear a pollen mask, such as a NIOSH-rated 95 filter mask. Be sure to also

keep your car and home windows closed.

• Find relief: If you wait until the first sneeze to take your medication, you may be too late. Allergists recommend taking your medication two weeks before symptoms begin, and continuing for two weeks after the first frost. Because of the nasal and eye symptoms associated with ragweed allergies, symptoms can linger after the pollen is no longer detected in the air.

• Get tested: While hay fever may not seem serious, self-diagnosis and selftreatment can be. Many popular over-thecounter medications can cause sleep disturbances and mental impairment. If you have symptoms, make an appointment with an allergist for proper testing. Allergy testing can be done as skin tests or as blood tests, with positive results usually appearing in about 20 minutes.

• Arm yourself: Allergy symptoms can be bothersome enough without flu symptoms getting in the way. Because the flu season overlaps with fall allergy season, be sure to get a flu shot. Recent studies have found even those with an egg allergy can safely get a flu shot. An allergist may also prescribe immunotherapy (allergy shots) to provide you with allergy relief during the fall months. While there is no cure for hay fever, this form of therapy can prevent and modify disease progression.

Seasonal allergies and asthma are serious diseases that should be properly treated by a board-certified allergist. More information and free allergy tools, including the My Nasal Allergy Journal, can be found at www.AllergyAndAsthmaRelief.org.

— Brandpoint

Scarsdale Family Doctors Personalized Medical Care for the Entire Family Board CErtiFiEd FaMily PhysiCians

Wednesday, Oct 9: 5:30pm

Love Dance and Fitness Studios, 196 Maple Avenue Put on your pink and join our Zumba-Raiser. $10 per person. All proceeds benefit the White Plains Hospital Making Strides Breast Cancer Walk Team. To register, call 914-681-2328.

What’s New in Breast Cancer Care & Beauty Bar Thursday, Oct 17: 6-8pm

Bloomingdales, 175 Bloomingdale Road An interactive panel discussion with leading breast cancer physicians from White Plains Hospital on the mezzanine level of Bloomingdales. A $25 registration fee is redeemable in the form of a gift card to spend at the Bloomingdale’s Beauty Bar that night. Cocktails and light hors d’oeuvres following the panel. To register, please leave a message at 914-684-6257.

Shining a Light on Breast Cancer Awareness Expo & Survivor Fashion Show Saturday, Oct 19: 11-3pm The Westchester Mall Join us at the Westchester Mall to celebrate survivors! A free health expo will be followed by our not-to-be missed “Walk of Hope” Survivor Fashion Show at 2:00PM.

CANCER AWARENESS

Manhattanville College, 2900 Purchase Street, Purchase Walk with the White Plains Hospital Team.

Please call Una at 914-681-2034 for more information.

ira J. sutton, Md

42 at The Ritz-Carlton, Westchester

2 overhill road, suite 225, scarsdale 636-0077

BREAST ON

Sunday, Oct 20: 9:30am

Oysters and Pink Champagne

Flu shots now available!

SHINE A LIGHT

Making Strides Against Breast Cancer Walk

Marilyn W. sutton, Md Best Doctor, Westchester Magazine (since 1994), & U.S. News & World Report

WHITE PLAINS HOSPITAL

Wednesday, Oct 30: 5-7pm

Come out to 42 at The Ritz-Carlton, Westchester for our Pink Finale event capping off a month of breast cancer awareness with $1 oysters and pink champagne. For more information, please call 914-681-1119.

For more information, please call 914-681-1119.

www.wphospital.org

Page 8A | To Your Health!

Experts weigh in:

Best fitness advice Continued from page 1A

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ncorporate strength training into your workouts. And don’t be afraid of heavier weights (women included).

There are numerous studies showing the benefits of strength training, such as reducing body fat, including visceral fat, staving off osteoporosis and muscle loss, and improving insulin resistance.

Kimberly Holzmann-Krolick, Corelab, Katonah

S

tretching will not only make you feel better, improve posture and help prevent injury, it will make you stronger. When a muscle is tight it doesn’t function as efficiently. Consequently it will fatigue quicker, resulting in less productivity.

When stretching hold for a minimum 3060 seconds. Longer is always better.

Joseph Frisenda Push Personal Training, Irvington

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n integrative approach to wellness is optimal. Severely reduce sugar intake.

Meditate 20 minutes a day. Do a few yoga poses daily.

Susan Kullman Intentional Wellness & Yoga, Katonah

I

f you’re short on time, interval training is the way to go. Pick four exercises; do each for a minute, without resting in between.

After all four are performed, rest a minute and do it all over again. Do this four times and you have yourself a heart pumping workout.

Anne Marie Costanzo Little Black Dress Personal Training, Bronxville

ThE scarsdale INquirer | Friday, October 4, 2013

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ow that fall is in full swing, I’m back to my daily routine of juggling the demands of family and running three Pilates and gyrotonic studios. I find myself getting a bit stressed. Luckily a Pilates and gyrotonic workout always makes me feel stronger, leaner and increases my energy level.

Donna Singer Center for Movement, Scarsdale

H

ow we sit is crucial to our health.

To make sure you are sitting properly, sit on your hands and find your “sit bones.” When you sit your weight should be on those bones. You will sit taller and straighter and will be engaging your abs without even realizing it!

Valeria Barreto Pilates and More, Dobbs Ferry

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articipate in f u nction a l, c o r e-b a s e d exercise regimes with resistance and flexibility training that are safe and challenging, plus cardio. Eat less quantity; no nutritional deprivation. Find a credentialed fitness location/person that is convenient, cares about your success and cultivates commitment resulting in regular attendance.

The most important action!

Gabriela St. Denis, Small Group Fitness, Katonah

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ach and every movement taken in your workout should be done with thought and intent. As with anything, the more focused you are, the greater your achievement.

Ceres Opanowski Rivertown Pilates, Tarrytown — Compiled by Todd Sliss

A daughter’s perspective

Life with advanced breast cancer

C

ate Edwards, daughter of Elizabeth Edwards, became part of the cancer community in 2004 when her mother was first diagnosed with early stage breast cancer. Shocked and defiant, Edwards and her mother assembled the best team of healthcare providers and confronted the cancer with grace, courage and perseverance.

“I moved back in with my family to be with my mom through the early stages of her treatment,” Edwards said.

“I was sure there was an end to cancer in sight and I wanted to see her through it.”

Less than a year later, they were able to breathe a sigh of relief when Elizabeth’s scans came back clear and she appeared to be in remission. Unfortunately, the cancer was not gone for good.

In 2007 the cancer returned. This time, it was metastatic breast cancer that had spread to the bone, which was treatable, but incurable. Advanced breast cancer (ABC) is composed of metastatic breast cancer (stage IV) and locally advanced breast cancer (stage

III), according to the American Cancer Society. Metastatic breast cancer occurs when the cancer has spread beyond the breast to other parts of the body, such as the brain, bones or liver.

Locally advanced breast cancer means the cancer has spread to lymph nodes and/or other tissue in the area of the breast, but not to distant sites in the body.

The advanced breast cancer felt different. The focus turned from becoming a “survivor” to simply surviving, and Edwards and her mom sensed they were part of a new cancer community.

“Before my mom was diagnosed with advanced breast cancer, I assumed breast cancer patients fell into two categories — those who were ‘survivors’ and those who were not,” Edwards said.

“When Mom’s cancer metastasized, I realized this wasn’t the case. There is a community of cancer patients who are challenged by an unpredictable, chronic disease that they could live with for weeks, months or years.”

While there are many resources for early stage breast cancer, information specifically for the ABC community — which includes patients and those who care for them — has been limited. A

2012-13 global survey of nearly 1,300 women in 12 countries, conducted online by Harris Interactive on behalf of Novartis Oncology, showed that 70 percent of U.S. women living with ABC often feel isolated and left out of the broader breast cancer awareness movement. Additionally, 75 percent of women with ABC feel resources to help family and friends cope with and understand the disease would be especially helpful.

To address the unique needs of the ABC community, the “Count Us, Know Us, Join Us” (Count Us) program was developed with guidance from 13 leading cancer advocacy groups. The Count Us program, which is available in English and Spanish at www.advancedbreastcancercommunity.org, provides education and support to patients, caregivers, loved ones and supporters.

In honor of her mother, who passed away in 2010, Edwards has joined Count Us as an ambassador to share her caregiver experience and to help amplify the voice of the ABC community.

“Anyone impacted by this disease — whether a patient, daughter, husband,

friend or colleague — is part of the community,” Edwards said. “”Living with advanced breast cancer means living with uncertainty, but knowing first-hand the struggles this community faces, there is one thing that’s certain: no one should face it alone.”

Rosalie Canosa, MSW, MPA, LCSW-R, program division director for CancerCare, agrees more support is needed for the ABC community, which has different needs than the early stage breast cancer community, especially when it comes to caregivers who need support as well.

“Seventy percent of women with advanced breast cancer have a caregiver, whether it’s a family member who attends every doctor appointment or a neighbor who brings a meal once a week,” Canosa said. “However, caregivers are often so focused on helping that they underestimate support they may need over time.”

For additional information on the Count Us program and resources for ABC support, as well as video messages from Cate Edwards, visit www. advancedbreastcancercommunity.org.

— Brandpoint

Health News Physique 57 opens pop-up in Scarsdale On Sept. 30, Physique 57 launched its first ever pop-up location in Scarsdale.

The studio, located at 1142 Wilmot Road, will be open until spring at which point the company will evaluate a permanent location.

To start, the pop-up will offer three signature Physique 57 classes daily to introduce clients to the Physique 57 method.

Co-founder and SVP of training and programming Tanya Becker will be teaching in addition to Physique 57 instructors from the brand’s Manhattan locations.

While this is a new location for the brand, it is not unfamiliar territory for Physique 57 CEO and co-founder Jennifer Vaughan Maanavi. Scarsdale is Maanavi’s hometown and where her fitness journey began. A cheerleader and avid dancer throughout her time at Scarsdale High School (class of ’89), Maanavi discovered the Lotte Berk Method as a way to both rehabilitate an injured back and get back into shape while working long hours as a finance professional and M.B.A. student in New York City. Soon she was addicted.

Upon learning the only Lotte Berk Method studio in Manhattan was closing, Maanavi was inspired to put her Columbia M.B.A. to work and open up an exercise studio to take over where Lotte Berk Method had left off. She sought out Becker, one of the most adored instructors from her former studio, to act as her cofounder and build an updated and modernized version of the eponymous tech-

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nique. Together they developed a new challenging and comprehensive exercise program that is now the basis for Physique 57’s internationally renowned method.

It is only fitting that Physique 57 open its newest studio in the place where this fitness journey began. “It feels nostalgic bringing Physique 57 to Scarsdale,” Maanavi said. “It has been fulfilling to watch our brand grow on a global scale and a pop-up in my hometown brings the expansion of Physique 57 full circle.”

A fitness phenomenon, Physique 57 sparked a barre studio workout craze with its sold out classes, cult following and celebrity clientele that includes Kelly Ripa, Emmy Rossum, Erin Andrews and many more. It’s their 57-minute workout that has everyone buzzing about rapid, life-

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For more information or to schedule a tour, please call: Doron Kathein at 914-761-8100 x 7151 For more dkathein@esplanadewhiteplains.com information or to schedule a tour, please call: Doron Kathein at 914-761-8100 x 7151 dkathein@esplanadewhiteplains.com

For more information or to schedule a tour, please call: Doron Kathein at 914-761-8100 x 7151 For moredkathein@esplanadewhiteplains.com information or to schedule a tour, please call: Doron Kathein at 914-761-8100 x 7151 dkathein@esplanadewhiteplains.com For more information or to schedule a tour, please call: Doron Kathein at 914-761-8100 x 7151 dkathein@esplanadewhiteplains.com

Innovative Health Systems, Inc. 7 Holland Ave., White Plains, NY 10603 914-683-8050 www.innovativehealthsystems.com

changing results in as few as eight classes, and has received recognition from top publications such as Vogue, Marie Claire, Vanity Fair, The New York Times, The Los Angeles Times, SELF, Shape, Travel + Leisure and InStyle.

Physique 57’s groundbreaking Interval Overload format is a challenging, muscletargeting workout that utilizes intervals of cardio, strength training and stretching.

By overloading muscles to their max, then immediately stretching afterward, muscles are able to fully elongate after every workout, giving clients a long, lean beautiful body in half the time.

Furthermore, Physique 57 offers the most rigorous training and development program in the industry where instructors are trained to teach the method to clients with varied levels and learning styles and continually evaluated to assure quality control. All instructors are dancers and therefore innately attuned to proper alignment, movement, execution and anatomy. This benefit allows for a safer and more effective class.

The launch of the Scarsdale studio brings the Physique 57 brand to a total of seven upscale studios in Los Angeles, New York City, the Hamptons and Dubai.

The studio offerings are complemented by fitness retail boutiques, award-winning DVDs, online workouts and a widely celebrated book, “The Physique 57 Solution,” written by co-founders Becker and Maanavi.

Always welcoming new clients to their fitness community, Physique 57’s supportive instructors and unique fitness program promotes the idea of creating the best version of you through healthy living.

Visit www.physique57.com.

JCC and Camp Zeke host Day of Wellness The JCC of Mid-Westchester and Camp Zeke will co-host an action-packed Day of Wellness community event to promote health and wellness in cooperation with the Westchester Road Runners Club and New Rochelle Parks & Recreation on Sunday, Oct. 20, at 999 Wilmot Road in Scarsdale.

A 5K run for adults and a Family Fun Walk at 9 a.m. (registration begins at 8 a.m.) will kick off the day of activities for all ages, featuring a full schedule of programs in fitness, sports, cooking, nutrition and a wellness-oriented comedy show.

Champion boxers Dmitriy Salita and Yuri Foreman will work out with community participants, pro-basketball player Tamir Goodman (the “Jewish Jordan”) will be on hand to shoot hoops with families in the JCC gym and Kosher by Design author/renowned chef Susie Fishbein will host a cooking lesson (fee: $15 in advance/$20 day of event). In addition, the hilarious Bible Players will provide comic entertainment in the JCC’s Bendheim Performing Arts Center.

The public is invited to join the JCC of Mid-Westchester’s expert instructors for complimentary spin, yoga, zumba and strength-training classes, and a fun family swim in the JCC’s pool. Healthy food will be available at an on-site farmers’ market.

Admission for this community-wide event is free. Advanced registration for the 5K race is $15 or $20 on the event day. For event schedule or more information, contact Elana Rothschild rothschilde@jccmw.org, or visit http://campzeke. org/jccmw to register.

For more information about the JCC, visit www.jccmw.org.

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Friday, October 4, 2013 | ThE scarsdale inquirer

Health Tips Decoding the triggers of your digestive health

of the issues people experience, including: • Heartburn/frequent heartburn • Gas/bloating • Irritable bowel syndrome • Diarrhea • Constipation • Nausea/vomiting.

According to Dr. Lamm, it is also important to know that some digestive health issues can be caused by underlying conditions or even genetics. If digestive health issues are persistent, worsen, or are accompanied by blood, unexplained weight loss or loss of appetite, a physician should be consulted.

For many, navigating the world of digestive health can be overwhelming. How do you determine what your specific problem is and what might be triggering the issues? And how do you figure out which available treatment may help manage the issues?

When trying to understand and seek the best course of action, Lamm suggests keeping in mind the following tips: 1) Be aware of the existence of issues; your digestive health should be seamless.

2) Pay attention to your body and triggers; know how to identify and self-diagnose.

3) Establish an easy fiber routine to help maintain a healthy digestive system.

4) Use appropriate over-the-counter medications to help manage digestive health issues 5) Consult a physician if issues are persistent, worsening or if there is bleeding, unexplained weight loss or loss of appetite.

A family feast for the record books, too much tailgating, a stressful day at the office, an allergic flare-up or just a change in your routine — no matter the cause, you’ve likely had to cope with digestive health issues at some point. For some, they’re an occasional occurrence. For many, they’re a regular or even daily disruption that can be uncomfortable, bothersome and embarrassing.

Digestive health plays a major role in achieving overall health and wellness, and according to digestive health expert and author Dr. Steven Lamm, understanding how to manage digestive health issues is the best way to achieve long-lasting relief and overall health and wellness.

The digestive system, also referred to as the gut, is a unique and perfectly created system that, when impaired, can increase risk of developing infectious, inflammatory and functional G.I. diseases, as well as immune-mediated and metabolic disorders. Good digestive health is also recognized by many as being a requirement for overall good health.

“When we take care of our gut, we take a step toward achieving overall health and wellness,” Dr. Lamm said. “However, many modern day triggers, such as stress, medication and foods low in nutrients, can cause problems that affect our day-today lives.”

These triggers disrupt the balance of the digestive system and manifest as many

For more on Dr. Lamm’s digestive health information and tips, visit www. easiertodigest.com.

— Brandpoint

Don’t give up on skin during colder months During the fall, when temperatures drop, skincare steps that were crucial during the hot summer months can often be overlooked because skin isn’t as exposed. Instead of waiting until skin is uncomfortably dry and itchy, make sure you’re moisturizing every day so skin stays soft, smooth and supple. And with all of the gatherings and parties that happen through fall and winter, you want to feel comfortable and confident in whatever you wear.

So, if you’re the type to hide red, flaky skin under layers of clothing every fall and winter, consider these simple tips that will have you prepared to bare your arms and legs during one of the biggest party seasons: • Stop the scratching: With dry air comes dry skin, which can cause irritating itchy spots. Scratching those spots damages the skin and leaves red welts amongst the white scaly patches. Add a little moisture into the air at home using a humidifier, especially in the bedroom where you sleep at night. Research by the University of Minnesota found that if the outdoor temperature is between zero and 40 degrees F, and the indoor temperature is set at 70 degrees F, the relative humidity level indoors should be

between 30 and 40 percent. Your skin, hair and sinuses will notice the extra humidity indoors, helping you to feel more comfortable in your skin.

• Moisturizer is key: Although a simple step, moisturizing is often overlooked.

But you’d be surprised how applying a layer every day can make you feel more comfortable and confident. Areas to remember moisturizing include the elbows, feet and neck, as these areas build up a tough layer of skin when dried out.

• Add a bit of coloring: Self-tanning product technology has improved greatly over the years, and allows women to give their skin a hint of color without exposing it to any UV rays. After moisturizing, carefully apply a spray or cream tanner to the skin, being sure to thoroughly wash your hands and wrists once finished.

Apply lightly and work in layers, so you don’t overdo it with too much coloring.

• Cater to special features: Lips, eyes and the nose are often affected by the colder temperatures more than the rest of the body. Be sure to give these features of your face loving attention with extra moisturizing products like lip balm and ointment during the winter months.

Also be sure to cover your face while outside with scarves to help prevent additional damage from the cold wind.

By maintaining your skin’s moisture as much as possible, you will feel much more comfortable and know that you can show off your beauty, even as the temperatures drop and the air gets drier.

— Brandpoint

Gluten-free: An alternative for people who really need it Continued

from page

2A

of what foods to buy. This is a step-bystep process. Then she sets them up with a diet. If it doesn’t say gluten-free, she doesn’t recommend they buy it. She recommends that they go organic.

Those with celiac disease can eat rice; quinoa; amaranth (a plant widely valued and used as leaf vegetables and also for cereals); legumes such as beans, peas, lentils (and carob, soybeans and peanuts); and millet which is an allowable grain. “You can make a veggie patty out of it mixed with vegetables,” Arpino said. “Yucca, a vegetable used in South America, is also on the recommended list, along with tapioca and buckwheat and oatmeal, [but] only if it says gluten-free. Obviously anything with wheat, barley and rye are off the list and anything that contains malt.

I do teach people about creative cooking.”

Arpino, who holds an M.A. and is an RDN with the Academy of Nutrition and Dietetics, added, “We have interns who

To Your Health!

create recipes that are very unique. There are tons of other grains that you can substitute for grains on the [off-limits] list.”

Arpino offered this food for thought: “I wonder, and this is a personal feeling, is this problem really celiac disease? There are a whole host of possibilities. It could be genetically modified food and the way it is processed. People should know how their food is processed.”

According to Arpino, a new ruling came out in August that requires new criteria of what manufacturers can say about gluten-free products. If the product fails to meet the gluten-free criteria it will be misbranded. She said there are a lot of products out there that can easily contain gluten, like hot dogs. It’s the way they process certain products that could contain gluten — even licorice.

Arpino emphasized that it is hard to transition to a gluten-free diet and she discourages people from going on one without first being diagnosed. “If they have it [celiac disease] and they’re not diagnosed, they run the risk of colon cancer,” she said.

Arpino is the author of “Eat Fit, Be Fit: Weight Management Solutions,” a lifestyle guide with over 300 recipes. Her multifaceted practice also includes work with overweight children, many who are referred by pediatricians. She is currently teaching high functioning young adults with autism to cook for themselves and eat healthily at the JCC of Mid-Westchester in Scarsdale. Arpino advocates a lifestyle change through diet, exercise and relaxation. Her main focus is weight management, heart disease intervention, lowering cholesterol and eating disorders, and working with cancer patients. She recommends a plant-based diet that not only helps the immune system, but is also nutrient-rich and rich in fiber.

Why fool yourself?

A special section of

The Scarsdale Inquirer P.O. Box 418, Scarsdale, NY 10583 914-725-2500 www.scarsdalenews.com PUBLISHER.................................Deborah G. White SECTION EDITOR....................................Todd Sliss ART DIRECTOR............................ Ann Marie Rezen AD DESIGN....................................Katherine Potter AD SALES.................................Thomas O’Halloran, Barbara Yeaker, Marilyn Petrosa and Francesca Lynch ©2013 S.I. Communications, Inc. All rights reserved.

Reproduction in whole or in part is forbidden without the Publisher’s written permission.

Psychologist Dr. Sharon K. Farber practices psychotherapy in Hastings, with a specialty in children and adolescents, eating disorders and self-injury. Although she doesn’t treat celiacs, she commented that there’s “no good reason to eat glutenfree unless they have celiac disease or gluten sensitivity. People shouldn’t fool themselves in eating a gluten-free diet if they don’t have celiac disease or gluten sensitivity. It becomes a preference.”

Dr. Farber has authored two books, “When the Body is the Target: Self-Harm, Pain and Traumatic Attachments,” and her most recent book, published this year, “Hungry for Ecstasy: Trauma, the Brain

AUTISM:

Result-Oriented Therapy SM

and the Influence of the Sixties.” Farber said that in the field of eating disorders, there are some people who develop an eating disorder by eating the healthiest diet to an extreme.

Striking a balance Allison Cecere is a registered dietician and nutritionist (RD and CDN) in private practice in Bedford Hills and the founder of Nutrition Therapy and Educational Services. When patients come to see her “it’s a mixed bag” of those who have had a clinical workup delineating that they have celiac disease or are celiac sensitive and those who haven’t. Without seeing a doctor first, she would prefer not to waste the consultation. She tells them that eating a gluten-free diet is complicated and explains what’s involved.

“My holistic approach is to get all the facts before the next visit,” Cecere said.

“A comprehensive evaluation is part of what I do. Sometimes they need reassurance. I’m an evidence-based practitioner.

I have to understand the science that supports the diagnosis.”

Cecere needs detailed medical information and blood work. Sometimes she asks for additional testing if they don’t have what she needs for a thorough evaluation. “Bone density is a big problem with celiac patients,” she said. “An untreated celiac patient can have bone mineral malabsorption.”

Cecere might ask to have a bone density test done if the patient has never had one, which will help her plan a vitamin regimen. She reviews their medical histories and has to determine if in fact it’s an allergic reaction or celiac. If they haven’t seen a doctor she has them see one for testing. Often nutrition isn’t the only problem. “I have to have a diagnostic strategy first,” she explained.

Often primary or G.I. doctors, or even allergists, refer their patients to Cecere for meal planning and management, while sometimes it’s a self-referral. Cecere, said it was important that celiacs see a registered dietician who has continuing education and is trained to monitor the inherent nutritional risks in transitioning to a gluten-free diet, which can impact their overall outcome. “It’s always about safety first,” Cecere said.

Vitamins need monitoring since gluten-free diets may be low in zinc, iron, calcium and the B vitamins. In addition to vitamins and minerals and having enough fiber, there are concerns of consuming too much fat.

“All these elements contribute to a

positive outcome,” Cecere said. “It’s a balancing act.”

Planning a gluten-free diet is based on age and gender and their “developmental age,” e.g. women of childbearing age.

After she gets their dietary history and food preferences and asks as many questions as she can, Cecere synthesizes it all and puts together a meal plan for three days and then they repeat it for meals from Day 1. Cecere shows how to alternate items to include other options and then moves into meal planning. “It’s a very collaborative approach,” Cecere said.

Cecere said she often works with motivated clients but sometimes sees people who aren’t motivated, and she can usually get that feeling if they’re not motivated right away. She then has to work with them longer at their comfort level.

With unmotivated clients, Cecere has to take a different road, phasing things in over time — it may take a few extra weeks. She noted that a lot depends on their stress level, possible lack of support at home and their jobs.

Generally Cecere sees clients for four weeks “to roll out the most basic intervention strategy [including what] steps they have to take for meal planning.”

Each consultation can take between 60 and 90 minutes, though some could last as long as two hours, “depending on how much information a person can absorb.”

Cecere teaches her clients how to navigate the world when eating out or on vacation. She noted that there are also Smartphone apps that help with shopping, restaurant ordering, etc. that people can use to help make healthy food choices. She gives them a supermarket shopping list for cooking at home and teaches them how to read labels, because gluten shows up in unexpected places in manufactured foods, including packaged soups, seasoning packets and sauces, any kind of prepared gravy, vegetable sauces that come with frozen vegetables and as additives in other foods.

Knowing what contains gluten is what Cecere calls the “macro” piece and what food contains additives that expose celiacs to gluten as the “micro.” “It’s a very layered intervention,” she said.

Cecere always feels bad about telling people “avoid, avoid, avoid,” but the good news is that they can include lots of fruits and veggies in their diet, as well as protein, fish, eggs, nuts, legumes and a variety of nongluten grains. There are even pastas that are rice- or corn-based.

Cecere recommends that people “experiment with different foods.”

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Page 10A | To Your Health!

ThE scarsdale INquirer | Friday, October 4, 2013

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