To Your Health

To Your Health!

A SPECIAL SECTION OF THE SCARSDALE INQUIRER

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OCTOBER 9, 2015

Apps

FOR FITNESS

How technology is changing the shape of our health

By EVE MARX

W

e are living in the golden age of technological applications. For almost any subject you can think of, there’s probably an app, which is a self-contained program or piece of software that is very special and focused, used primarily on smartphones. Apps are downloaded from the App Store on your smartphone. Each app has an individual icon that is loaded after purchase. To access an app, all you have to do is touch on its icon. There are dozens of apps out now,

most of them free, in fact, that will give you health and nutrition and exercise information and even empathy and encouragement. All things you want from a private nutrition coach or personal trainer.

Jessica Dietz, office manager at NY Health & Wellness, a medical weight loss and health center in Harrison, said, “Technology is useful and convenient.”

She said that Dr. Timothy Morley, a bioidentical hormone expert and the center’s medical director, is currently in project development for his own app that he can offer to his clients to aid and support them through their weight loss.

“It will be journal based, so clients can record their food intake and eating pat-

terns,” Dietz said.

Dietz said she thought apps could be extremely useful and gratifying for users who at the same time under the care of a doctor: “I think there’s a good balance.”

For the curious, even a brief Google search turns up dozens of potentially useful health apps. A few especially noted for their usefulness include: • FitStar Personal Trainer, which is recommended for those just starting out on their fitness journey to fitness fanatics. Created by former NFL star Tony Gonzalez, it’s free on iOS. • Runtastic Six Pack Abs slow motion videos of virtual trainers teaches you how to do a specific exercise correctly the first time around. This will help you

spend 15 to 20 minutes logging in data in an app, I would prefer they spend that 15 minutes going for a walk or preparing meal,” she said. “We are already on technology overload, so let’s try to remove the handheld gadgets.”

One thing Matteao does like about apps is that they often remind users to drink water. “There is a ‘daily water’ app that sends you reminders on a schedule to drink eight cups of water a day,” Matteao said. “Drinking adequate amounts of water is a major struggle for many, and the importance of hydration is poorly understood.”

Matteao likes an app called MyfitContinued on page 4A

By ANTHONY R. MANCINI

H

From understanding to treatments

By JENNIFER LEAVITT

N

INSIDE

Cecilia De Matteao, MS, CNC, CHC at Enhanced Health Coaching, Inc., in Scarsdale, specializing in nutrition education, weight management and health, has reservations about the use of apps.

“The reality is that individuals are constantly on their smartphone devices,” she said, noting that using an app to improve your health just adds to more data processing and minutiae to the day.

“And that’s less incentivizing for many users. Clients have expressed that the process is tedious and frustrating, especially for the average working professional.”

Matteao said she only advises using a nutrition or fitness app as a second or tertiary option. If that. “If a client has to

Breast cancer awareness, options

BRAIN SCANS:

ot so very long ago, mind reading rested squarely in the domain of mysticism, while Alzheimer’s Disease could only be identified postmortem. The past 15 years, though, have seen a surge in neuroimaging advances. Our understanding of what goes on in the human brain has grown by leaps and bounds as sophisticated methods like fMRI (functional magnetic resonance imagin) have taken the field from static snapshots to 3D imagery and even into the realm of real-time videos of neurological activity.

Most of us are familiar with structural imaging, which identifies brain injury, tumors or other physical abnormalities. In functional imaging radiologists explore what the human

avoid injuries, which often occur because you’re doing a movement wrong.

This app is also free on iOS and Android.

• Pump Up is a social platform oriented app that lets you share your workouts and your results (even pictures!) with other fitness enthusiasts. The charm of this app is that you get that whole team spirit thing and support group growing.

It’s free on iOS and Android.

• Map My Fitness is a tracking app with an easy to use interface and super accurate tracking. Use this app to set challenges for yourself and with friends; you can track your gear and the app even tells you when it’s time to purchase a new pair of running shoes — it’s that accurate. Free on iOS and Android.

brain looks like when we’re in love, on drugs, trying to solve a difficult math problem, experiencing depression, anxiety, mania or a wide variety of other states. It is now actually possible to witness information being processed by specific parts of the brain. Activity in an area of the brain leads to faster metabolism and greater blood flow. The areas involved then light up on the scan.

Scientists and physicians are using these technologies in a number

of ways.

Cognitive scientists, for instance, are watching the changes that take place in children’s brains as they learn math. One study involved 27 children and 20 adults, along with 609 scans for each of them, taken as learning was underway. The researchers determined that mature neural patterns in the speech and language-related Broca area were predictive of higher verbal test scores Continued on page 7A

Health news: An alternative to make your vision AOK ........................................ 3A

Treatment-resistant depression: what can you do?..................................... 6A

Harm reduction the key in substance abuse treatment ...................................... 4A

It’s personal: Medicine will soon be all about you .............................................. 8A

Cup of Joe: A harmful vice or health elixir? ............................................................. 5A

Shingles: Knowing early signs may save years of pain ................................... 8A

ealth care professionals in Westchester hospitals are touting recent advances in breast cancer treatment, allowing patients numerous choices in the type of medicine they receive and the amount of surgery they are comfortable with.

“I think it’s important for women to feel empowered and educated about their options,” said Dr. Ranjana Chaterji, a doctor of osteopathic medicine and breast surgeon with The Breast Institute of Northern Westchester Hospital in Mount Kisco. “It’s very scary when you’re diagnosed with breast cancer, but it’s really important to understand what your options are and feel like you’re in control over those options.”

Dr. Chaterji said that around 20 to 30 years ago, if a doctor discovered a malignant lump or abnormality within a breast, a patient going in for surgery would not know how much of her breast would be removed. The patient could potentially be left with disfiguring scars.

“If they had a lump they would go into surgery and then they would not know if they were going to wake up with a breast or not,” she said. “They would be offered no reconstruction. We definitely evolved into treating it a much more humane manner, giving patients a lot of options.”

Treating breast cancer begins at the preventative level, with annual screening recommended once a woman turns 40, unless there is a case of family history where it is recommended that a woman seek screening 10 years before

the earliest case of breast cancer in her family. Women are encouraged to seek screening every year indefinitely as long as they remain in good health.

Dr. Stefanie Zalasin, who performs women’s imaging for Northern Westchester Hospital, said that screening begins with a mammogram searching for potentially abnormal masses within the breast — masses can be quite small — to determine if there is cause for concern.

Dr. Zalasin said that during a mammogram oncologists look for suspicious

masses, such as those that might radiate out throughout the breast, deposits of calcium that look irregular or any other abnormalities. She said that women with dense breast tissue receive higher scrutiny during screening. If any suspicious masses are found, screening leads to ultrasound imaging, which can further determine if a mass is cancerous or benign.

“Our next step really is an ultrasound and an ultrasound is wonderful because Continued on page 9A

Page 2A | To Your Health!

The Scarsdale Inquirer | Friday, October 9, 2015

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To Your Health! | Page 3A

Health News: An alternative to make your vision AOK

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By TODD SLISS

o eyeglasses, no contact lenses during the day, no surgery and there is still a way to see clearly? Yes, thanks to advanced orthokeratology, also known as AOK. With AOK molds or retainers custom made for each patient that are worn like contact lenses overnight, the cornea is reshaped while you sleep, and not only does it give you a full day’s worth of vision by keeping its corrected shape, but it slows down the progression of your nearsightedness (myopia), farsightedness or astigmatism, according to Dr. Abraham Zlatin of Eye Q Optometrist in Scarsdale and Manhattan.

As AOK is not permanent, you can stop using it at any time. You can use the lenses until you are old enough to get LASIK surgery — 18 at the earliest. Once you stop AOK, your myopia will return to it’s normal state. AOK can be used for kids as young as 5 as long as the parents are comfortable with them having what looks like a normal contact lens, though smaller, in their child’s eyes overnight. It is for all ages beyond that and is very popular with athletes who don’t want to wear goggles or can’t wear contacts and can’t get their lenses wet from water and sweat.

You can see well after one or two overnights, but it takes about 10-14 days for the AOK lenses to take full effect. This all follows thorough examination, which includes a study of the topography of the eye by a trained specialist in order to create the perfect custom mold.

Dr. Zlatin has spent over half his career administering AOK since it received FDA approval in 2002 as CRT (corneal refractive therapy), which had already been in use overseas for more than a decade.

There are several types of molds under the AOK umbrella.

Television personality and 1984 White Plains High School graduate A.J. Hammer is a long-time patient of Dr. Zlatin and did a promotional video for him. Hammer uses AOK for many of the same reasons as Zlatin’s other patients: doesn’t want to wear glasses, can’t do everything he needs to do with lenses and didn’t want to get surgery.

Dr. Zlatin shared the ins and outs of AOK: Q: How long have you been practicing and doing this sort of work?

A: I’ve been specializing in contact

that we create with the mold that allow you to see clearly and safely.

Q: How does it work that it last the full day after wearing the molds overnight?

A: The cornea is elastic and it holds its shape. It’s something that once it’s fully shaped it will go back to its natural shape slowly over time. It’s almost like if you take a wedding ring off of your finger and you can see that little indentation there for a minute or two. That’s what we’re doing — we’re reshaping soft tissue and it will go back to its natural state. The collagen in the cornea just holds it much longer.

Q: Do a patient’s molds change over time?

Dr. Abraham Zlatin

lenses since 1993 and AOK was FDA-approved in 2002, which is when I started treating patients with it. Before it was FDA approved I was studying it, but I waited until we got the nod just to make sure the safety level was what we knew it was and was proven. So I’ve been doing it for many years.

Q: What do the molds look like compared to a pair of regular contact lenses?

A: They look very similar to a contact lens. They are just usually a little smaller.

They’re easier to insert, easier to remove, so children actually do better at putting them in and taking them out than contact lenses.

Q: How do the molds function in helping give patients better vision?

A: They do two completely different things. They correct and reverse the current prescription so you can see clearly without glasses, contact lenses or doing any kind of surgery. Also, especially with children, there is another prescription that is designed in the treatment that stops or slows down the progression of nearsightedness, so the children from year to year don’t end up with their eyes getting worse and worse at the same rate as if they wore glasses or traditional contact lenses.

Q: What do the molds actually do to the eye?

A: They gently remold the top surface of the cornea in a way that eliminates their prescription. We’re nearsighted or farsighted or astigmatic because of the shape of the eye. What the molds do is they reshape microns — we’re talking the thickness of a hair — and that can dramatically change a prescription. It’s these small, very tiny little incremental changes

A: A good design on a stable eye does not need to be changed over time. It just needs to be replaced because it’s consumable. Think of it like a windshield wiper — you’re using it, you’re cleaning it, you’re rubbing it. It can develop changes over time, so that mold itself gets replaced, but usually it gets replaced with an identical.

It’s not that the mold has to keep being redesigned. In some cases it does depending on the patient, but that’s not common.

Q: How long will a pair of molds last?

A: A pair of molds generally lasts in really good shape for a full year. It’s not like a disposable contact lens that needs to be changed every two weeks. It will last you easily for the year.

Q: With a patient’s prescription not changing or getting worse with glasses or contacts as the years go on, what are some the health problems that can be avoided by using AOK? A: The problem with becoming nearsighted is the reason the eye becomes more nearsighted every year is because the eye is actually growing longer, stretching. As it stretches it thins out the retina and it starts to create more medical problems related to nearsightedness such as retinal detachment, holes, tears, maculopathy, cataracts and glaucoma. Those are all more common in high nearsighted patients than patients who are not nearsighted or have lower nearsighted prescriptions.

Q: Is there any danger wearing AOK molds overnight?

A: The safety is the same as contact lenses, so if you are comfortable with the safety or the risks of contact lenses, then you should be comfortable with the safety of AOK molds. We need to understand —

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and it’s difficult to convey — that sleeping with an AOK mold is not the same as sleeping with a contact lens. Period. It is not the same. Sleeping with a contact lens is not recommended because the lens is on the eye all day long. The lens gets dirty.

We develop a biofilm on the lens. There are dead cells underneath the lens that become trapped and are more toxic to the cornea. A soft contact lens will absorb everything, so we strongly advise patients to avoid water.

Basically AOK only go in at bedtime and they come out in the morning as soon as you wake up. They are never really on your eye while you are conscious or awake. There is nothing really bothering you. People ask how you feel. They feel great because you don’t feel anything.

When they are on your eye they are on a few minutes before you’re going to sleep.

After you put them on you close your eyes — you’re not blinking, you’re not feeling them. Some patients actually tell me they feel weird if they forget to put them in at night. They feel weird sleeping without them because they get used to it. You feel funny when you sleep without them.

It doesn’t bother people, it doesn’t hurt, it’s not uncomfortable. It’s like anything where maybe the first week or two there’s some discomfort because you’re not used to it. Your eye is a little sensitive, but once you get used to it they’re very comfortable.

Q: What if you don’t wear them for a couple of days or a couple of weeks?

Can you just go back to wearing them at night?

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A: If you regress and then start wearing them again, it begins to treat you again right away. Most patients don’t want their vision to go in and out of focus and we want to maintain myopia control in children, so we don’t want children to wear it sometimes and not other times. You get better consistent clarity if you wear it nightly. If you miss one night once you are fully treated you can still see the following day. It might not be as crisp, but it won’t be as bad as wearing an old pair of glasses usually.

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Q: What is the benefit of offering this to all ages?

A: We do it so there’s freedom, freedom for the children to swim, ski, run around without glasses on. Socially they develop with more confidence because they don’t Continued on page 4A

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Harm reduction the key in substance abuse

By ROSS FISHMAN, Ph.D.

H

arm reduction as a concept has been around for centuries. In its broadest sense, it applies to almost all of human behavior. We all practice harm reduction everyday. Whenever you do something to prevent yourself or another person from getting hurt or to minimize the hurt, you are practicing harm reduction.

Just a few areas to consider are health (annual physicals, vaccines, SPF lotions), children (bumper guards, helmets, training wheels) and automobiles (seat belts, air bags). If you have ever tried to lose weight, eat healthier or cut down on your smoking, you have practiced harm reduction. If you haven’t dropped all the pounds you wanted, started eating more fruits and vegetables or eliminated smoking completely, you can take satisfaction that your effort was an improvement, an important concept too often overlooked.

When it comes to substance use disorders, however, harm reduction and its counterpart, improvement, have been difficult concepts to accept. One the one hand, many in the business of recovery promote the notion of “progress, not perfection,” while on the other hand they demand of substance abusers nothing less than total and immediate abstinence.

Although we easily rationalize the backsliding in ourselves and others when it comes to weight loss, smoking or exercise, as a society, we are incredibly intolerant of slips and relapses among people struggling with their substance use issues.

Our current consideration for harm reduction as appropriate to the field of chemical misuse is not new. The concerns about the excesses of drinking hit a peak in the 1830s when physical injuries, spouse abuse, family neglect and chronic unemployment were rampant. While one group called for total abstinence, another group called for temperance or a reduction of alcohol consumption to reasonable levels.

If treatment programs are to be “successful,” however one might define the term, they need to have patients to treat.

People needing treatment are reluctant to seek treatment for many reasons. They rationalize that they do not have a problem; they tell themselves that their current quandary is temporary; they believe they can handle their problem by themselves; they are not ready to stop using; they believe that they will be judged and labeled;

Continued from page 3A

have the glasses on their faces. They feel more accepted and they can perform better. Adults we do it so they don’t have to use contact lenses or the risky surgeries that don’t always pan out or cause other medical issues. Surgery causes many problems that are irreversible, so a lot of patients don’t want to take those risks so they choose to do AOK. I have patients from the age of 5 to 74.

It’s FDA approved for any age — there are no age restrictions period. You wouldn’t even need to do this earlier than 5. There are alternative for young children, even 5, 6, 7-year-olds that can’t do AOK. There are other forms of myopia control that we practice in our office that do not require molds. They are not as good, but they are better than nothing for the young child to wait until they are old enough for AOK. and/or they are ashamed because of the stigma attached to substance misuse.

The media reports there is a dearth of treatment programs. Perhaps this is true in certain locations. I believe, however, that the shortage is of treatment programs that are ready to meet these users where they are. Too many treatment centers have designed programs that for the most part, though not entirely, are cookie cutters. The staff and the philosophy are already fixed and people in various degrees of difficulty are fitted into that approach. That is not the road to success.

Is it the addiction or the force-feeding of approaches that do not meet the individual’s needs or both that are the cause of relapses after treatment?

Harm reduction started when volunteers went into the streets to offer heroin addicts a safer way of injecting heroin, primarily in order to reduce the likelihood of HIV and other infections that were resulting from dirty needles being shared. The volunteers knew that those users would not seek help because treatment centers would demand abstinence and they were not ready to stop. At first, simple bleach kits were offered to disinfect needles. A second wave of reaching out was to offer syringe exchange so that potentially infected “works” were less likely to be shared.

Many people argued that these attempts were just promoting the continued use of heroin. In a way, that may have been true, but from a public health perspective, bleach kits and needle exchanges were saving lives by reducing the spread of infection — by reducing harm.

Apps for Fitness

Fitbit is an activity tracker device aimed at measuring your exercise, your diet and your sleep. Worn on the wrist just as you would a watch, a Fitbit captures essential data for you. You can track even more if you take the time to enter data about your meals, your weight and other information, including how much water you drink every day.

If you enter your basic stats, like height, weight, your age, within a very short period of time Fitbit will begin telling you how many steps you took in a day, the distance you traveled on foot, how much time you spent being active, how many calories you burned. Tell it what time you went to bed and what time you woke up and the device will use motion to tell you how much time you actually spent asleep and even how restless you were.

Fitbits come in a variety of colors and designs. While almost all the designs will track your steps and how many calories you burned, other models track heart rate and how many floors you climbed. The Surge model, which is the most deluxe, also tracks GPS, continuous heart rate, all-day activity stats and sleep.

It also includes smart notifications and music control.

A random sampling of user satisfaction conducted on the Facebook page Katonah Parents yielded the following (necessarily anonymous)

nesspal that she described as “simple, convenient and flexible for most people to use.”

According to Matteao, apps have their pros and cons: “The pros are they create awareness and short-term accountability and short-term motivation. The cons are they are complex to use and sometimes difficult to interpret results; they are time consuming, tedious, often inaccurate.”

An app can never be a substitute for a personal trainer or private coach. “An app is short-term gratification,” Matteao said. “A health professional’s expertise is to be able to comprehend the complexities of people’s lives and all the challenges and obstacles that are part of their everyday that prohibit them from focusing on their health. Clients become motivated to making changes when they feel that their personal challenges are being heard and understood.”

Matteao said that while Siri is effective helping users of smartphones find answers to questions and an app can show you recorded data, “No technology can ever replace social interaction.

Communication is the missing link. Talk to me and tell me how well or not so well you are doing, what the best part of your process is and what is the worst part, and we will work on it together,” Matteao said. “Showing me data on an app provides little to no benefit in the long-term for attaining optimal health. Technology doesn’t produce change but it helps support it. All this technology is fantastic, but it doesn’t give you long, lasting results.”

responses: • “Satisfied when I hit my 5,000th step!”

• “Both my husband and daughter wear the Fitbit Charge and love it for so many reasons, including the sleep tracking.”

• “Love mine! Very helpful in keeping me active!”

• “I wear mine every day; it’s become part of my wardrobe like a watch. I use mine mostly for sleep tracking and HR. My Fitbit keeps me more active, reminding me of daily steps.”

• “I wear mine every day except the Charge can’t go in the shower so that’s a downside. I use it mostly for sleep tracking, tracking steps, tracking distance and walks.”

• “I use it for all workouts and many days all day. I love it! Make sure to buy the one that tracks heart rate; that’s the most helpful part. In an exercise Facebook accountability group, we all post pictures of our exercise stats.”

• “I just got one and once I got it all set up, i.e. connected to phone and laptop, I started wearing it all the time and tracking steps, heart rate and sleep. It’s a great motivator.

I am loving it!”

• “I think I’m the only person who doesn’t love it. I was sitting at my computer typing and it kept registering as ‘steps.’”

— EVE MARX

Q: What is special about this for children?

A: Once we see a child and we know they are getting worse we are going to try and put the brakes on it any way we can.

You can not under correct nearsightedness because it makes your eyes progress at a faster rate. It’s a big problem. We learn things in school and then we apply them, but you don’t learn everything in school.

You have to learn it in practice. You have to continue studying and there are specialties for certain things. A lot of times today we see doctors under correcting patients that change quickly. All they are doing is putting fuel on the fire and making those children progress faster.

Kids today are 30 percent more nearsighted than the previous generation.

There are doctors out there that just do everything that’s been done the same way for the past hundred and fifty years and say nothing else works. That’s not good either. Slowly over time more doctors are learning about myopia control. It’s fairly new. We didn’t know that we could control nearsightedness this way for many years, but there are many, many, many, many studies out now that show and prove how AOK can stop or slow down progression by at least 50 percent. A child that comes in with a mother who is minus 14 and instead of eventually being a minus 16 the child will only be at worst case scenario a minus 7 if we treat him or her early. That’s worst case scenario.

Q: Why is this such a specialized part of the field?

A: It’s a very different approach. It’s not like fitting contact lenses. You have to think of it almost in an opposite way of fitting contact lenses. It is something that takes many years to study and understand and master. Medical school, optometry school is focused on traditional refractions, contact lenses and medical eye disease. Optometry school today is so focused on eye disease and they only have four years — they don’t have eight years to do everything — so you have to decide you’re going to specialize in contact lenses and then you’re going to have to decide you’re going to specialize in orthokeratology, which is a subspecialty.

It’s something that’s very expensive for doctors to learn to do, it’s very time consuming for doctors to do and they have to do this afterwards in more of a fellowship type of training. Today it’s unfortunate that students, new doctors come out of school with so much debt that they need to start working right away. Once you start working it’s very difficult to go ahead and study something else at the same time.

Q: Do you still do glasses and contacts, or is this your only niche?

A: We still do contact lenses, we specialize in contact lenses and we even custom make contact lenses. Aside from advanced orthokeratology there are patients out there with eye diseases that can not see clearly with any contact lenses or eyeglasses and there are other types of designs that we make called scleral shells and this is a different topic, but scleral shells are the most amazing thing. There are patients that have a disease like keratoconus, for example, that can not see with contacts or glasses and what we do for them is we mold over the entire cornea and create a whole new optical surface for them. We can take them many times to 20/20 where they may legally blind.

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Have you ever heard someone say to another person, “Why don’t you have just two or three beers? Why do you need to drink a whole six-pack?” Harm reduction.

Or, “Please go back to snorting heroin; injecting is just too dangerous?” Harm reduction. Or, “Try to smoke fewer cigarettes in a day or at least try the nicotine patch!” Harm reduction. Every such step is a step in the right direction.

At Innovative Health Systems we ask our patients to give up all mood-altering substances while in treatment unless they are prescribed. We give them some time to achieve this as we know how difficult and dangerous it is to suddenly stop taking in certain substances because of moderate to severe withdrawal symptoms. We make the assumption that our patients were first social users and then problem users. We now want them to experience abstinence while we are helping them learn refusal skills and relapse prevention strategies. Our mission is not necessarily to impose lifetime abstinence on them, but instead when they are ready to move on to have them experience abstinence in addition to the social and problem use they once knew. They are then free to choose which of those three lifestyles they prefer. We know that less is better and none is best. Our hope is that they will find a way to choose abstinence in a world that, for the most part, does not.

Innovative Health Systems is at 7 Holland Ave. in White Plains. Call 683-8050 or visit www.innovativehealthsystems. com.

Fitbit: the latest health tech fad

Continued from page 1A

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Cup of Joe: A harmful vice or health elixir?

T

By JENNIFER LEAVITT

rying to keep up with the latest research on which foods, drinks and supplements we should stock up on, and which ones we should immediately shun, can be downright exhausting. It’s enough to make you want to reach for a double espresso. And that may not be such a bad thing after all.

Coffee is a longtime staple in the western diet, and for most who drink it daily, it’s a habit that dies hard. The good news is, despite its dubious reputation over the decades, that java may actually be good for you.

For decades it seemed to be common knowledge that coffee stressed our cardiovascular systems, led to stomach ulcers and caused dehydration and insomnia. Many Americans perceived it as a necessary evil for making it through life.

Then one day, our morning fuel was redeemed when food chemists announced that it was a good source of antioxidants.

Soon after, a Harvard research study revealed that people who drank as many as six cups of coffee per day were less likely to die during the next five years.

That news was followed by a surge of research into the relationships between coffee and specific diseases, with surprising results. Dozens of long-term studies in the United States, Europe, and Asia have shown not only does coffee not cause heart attacks and strokes, but it actually seems to have a protective effect against these incidents.

One Kaiser Permanente study, en-

dorsed by the American Heart Association, examined the healthcare data of 130,000 members and discovered coffee drinkers were less likely to need hospitalization for heart rhythm disturbances.

One to three cups per day reduced cardiac incidents, regardless of other risk factors.

In Sweden, researchers followed 30,000 women over 10 years and learned that those who drank more than one cup per day appeared to have a 22 to 25 percent lower risk of stroke than non-coffee-drinkers did. They also concluded that low or no consumption of coffee increased the risk of stroke in women.

Habitual coffee drinkers tend to have slightly lower blood pressure than nonconsumers do, and a better chance of avoiding diabetes. Study participants who increased their intake of daily coffee by more than one cup over four years reduced their risks by 11 percent compared to those who made no changes.

Across hundreds of these studies, the group reaping the greatest benefits appeared to be those drinking 2-3 cups of coffee per day, but even at 5 cups, no negative cardiovascular implications were found.

Even the dehydrating myth has been labeled as such. Although coffee does indeed have a diuretic effect, that is apparently offset by the drink’s volume of liquid.

Coffee appears to be protective of our liver, gallbladder, intestines and pancreas as well. Italian researchers learned that taking up the coffee habit lowered liver cancer risks by 40 percent, while drink-

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ing three cups per day could reduce the risk by an additional 10 percent.

Coffee has also been associated with reduced risks of oral, endometrium, brain, colon and rectum cancers, and one study showed strong protection against breast cancer recurrence in women who were taking tamoxifen.

The story doesn’t end there.

Word from the lab is that drinking several cups of coffee per day is associated with reduced rates and later onset of Alzheimer’s disease. Those who indulge in their favorite morning (or anytime) brew are also less likely to develop Parkinson’s.

Researchers were convinced that caffeine was the healing ingredient, until another study called that wisdom into question. While it may be the best known component in our sunrise mugs, it only accounts for 2 percent of the bean. It is highly likely that the polyphenols, chlorogenic acids, phytoestrogens and other micro ingredients contribute to our health. In fact, researchers at the Icahn School of Medicine at Mount Sinai discovered in their study on mice that decaffeinated coffee improved the brain energy metabolism seen in type 2 diabetes, and which happens to be a risk factor for Alzheimer’s disease and other forms of dementia.

An 8 ounce cup of coffee usually contains one to three percent of our daily required folate, thiamin, niacin, manganese, potassium, magnesium and phosphorus; six percent of the pantothenic acid we need; and 11 percent of our daily requirement for riboflavin. It also contains, believe it or not, nearly half a

gram of fiber.

So is this a green light to start drinking coffee by the gallon?

Yes and no, say the experts.

For starters, everyone has different physiology to some extent. What bolsters one person’s health may send another into anaphylactic shock. Pay attention to what your body is telling you.

Then too, the one entirely legitimate warning about coffee is that it can cause sleep disturbances. No one should be using caffeine as a substitute for slumber. And drinking too late in the day can cause serious insomnia that night. Plan accordingly.

Despite all the promising studies, we do know that caffeine increases catecholamines, which are stress hormones, and it can cause anxiety in some people.

Caffeinated coffee is also addictive, so where you once drew on energy from adequate sleep, fresh air and balanced nutrition, you may come to need it just to feel normal, and to avoid brain fog and headaches that can start just 24 hours after your last cup.

One final word of warning is to remember that correlation does not equal causation. This means that, even though we know coffee drinkers have better health outcomes, that could be because coffee drinkers have other healthy habits that were overlooked.

Of course, coffee is not our only source of caffeine. The past decade has seen another favorite bean of ours exonerated as well — the cocoa bean. So have your coffee and eat your chocolate, too. Until they say otherwise, it’s all good.

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Page 6A | To Your Health!

The Scarsdale Inquirer | Friday, October 9, 2015

Treatment-resistant depression: what can you do?

A

By JENNIFER LEAVITT

bout 50 percent of us will experience some form of depression during our lifetimes.

When periods of bereavement are included in those stats, almost no one is spared.

There is no shortage of pharmaceuticals to treat depression. Some people need to try a few different treatments before finding the right fit, but much of the time, something works, at least partially.

Unfortunately, up to 30 percent of those struggling with depression simply don’t respond to the first-line treatments that are available. There is no absolute definition or criteria, but after some time goes by without progress, a provider may label a patient as “treatment resistant,” which is such an unfortunate term because it can lead already-vulnerable patients into a downward spiral of despair.

The most likely explanation for failure to improve is that some less-common factor or combination of factors is driving the depression, and the effective treatment may be just as uncommon.

But that doesn’t mean it isn’t out there.

First thing’s first Primary care doctors often manage antidepressant medications, but if treatment efforts have been for naught, it is wise to visit a specialist. In addition, although they cannot write prescriptions, therapists and social workers often have an abundance of treatment knowledge and referrals to share. Of course, psychotherapy is also beneficial as an adjunct to medication.

Have the most qualified available provider confirm a diagnosis. Sleep or thyroid disorders can mimic depression and comorbid mental illness or personality disorders that have not been addressed can interfere with improvement. When hyper or hypothyroid conditions are affecting mood, extra serotonin may have no effect. If depression is being treated, but anxiety is ignored, the depression may continue.

Remember too that medication cannot always temper unbearable circumstances. If there is an abusive situation, a pill should not take the place of necessary change. Instead, seek personal support and professional help in taking action to change the circumstances. Once diagnosis is certain, doctors also need to know for sure whether the medications themselves are truly to blame for a lack of response. Many experts agree that patients should use at least four

very different treatments for a period of at least one month each before they can be considered resistant. That also means using them correctly and making sure no other substances are interfering.

Take medications at scheduled times, as often as required. Research whether protein, carbohydrates, or other foods might obstruct proper metabolism. Grapefruit juice is the most commonly interfering dietary culprit. (Check for interactions at www.healthline.com/druginteractions or through another reputable service.)

For those who have trouble remembering to take medications, once-weekly remedies might be the perfect choice, or an antidepressant with a very long halflife, such as Prozac, so that early, late or missed doses do not cause extreme mood swings.

The next important question to answer is whether the medication has done anything at all to improve mood. If it has, a stronger dose or the addition of a complementary treatment may be in order.

If, however, unacceptable side effects have continued with equal intensity for two weeks or more, tapered withdrawal is probably a good idea.

Switching and pairing Different classes of antidepressants work in different ways. SSRIs increase the amount of feel-good neurotransmitter serotonin in the brain. Prozac, Celexa, Lexapro, Zoloft and Paxil are all examples of SSRIs. Brintellix and Viibryd also increase serotonin. SNRIs increase norepinephrine as well, and include Effexor, Pristiq and Cymbalta, among others. Wellbutrin is an aminoketone, acting on norepinephrine and dopamine

and is often used in combination with other medications for full effect. The tricyclics, such as Elavil and Adapin, are very effective, but can cause drowsiness. Taking a tricyclic right before bed may be the key to success. Nardil and other MAO inhibitors target enzymes in the brain to boost a variety of neurotransmitters. Often a last resort because there are so many interactions to watch for, some patients may find the higher maintenance of these effective medications entirely worthwhile.

Another alternative is to combine two different classes of antidepressant, or to add a mood stabilizer like lithium, an anticonvulsant, such as carbamazepine, or one of the antipsychotics — Abilify or Seroquel for instance, which are also sometimes prescribed off label for persistent insomnia.

Some effective combinations pair pharmaceuticals with other forms of treatment, such as cognitive or dialectic therapy, music or art therapy, hypnosis, acupuncture, massage and meditation, neurofeedback, brainwave training or a variety of other options. Some of the most promising alternatives come from devices that, in one form or another, stimulate the central nervous system with electricity.

Getting a jump start The oldest, best known and most misunderstood alternative treatment is electroconvulsive therapy, often called “shock therapy.” Despite its Hollywood portrayal as excruciating and terror inducing, ECT is actually very effective and quick acting. Though it does induce controlled seizures, is somewhat un-

comfortable and has the side effect of memory loss, many people with debilitating and seemingly untreatable depression have found the trade off worth it.

It is reserved for the most serious cases, but should not be overlooked as an option if the depression is severe.

A home device based on similar principles, but which is gentler, safer and with far fewer side effects, is the Fisher Wallace Stimulator. It is used at home, without physician supervision, delivering milder electrical signals to stimulate neurotransmitters. It does not cause seizures and those using it have not reported discomfort. Some insurance companies reimburse patients for the FWS, or it can be used on a rent-to-buy basis. As a bonus, the Fisher Wallace is also FDA cleared for the treatment of anxiety, insomnia and chronic pain.

Another option is vagus nerve stimulation, which some refer to as “the yoga of electrical therapies.” Chanting, singing and yogic humming all stimulate the vagus nerve, which tends to make people feel peaceful and content. When those methods just aren’t strong enough, a removable stimulator can be implanted near the collarbone. External devices have also entered the market now, and appear to work in 30 to 50 percent of those who use them, especially when combined with other therapies.

Other non-invasive options are transcranial magnetic and transcranial direct current stimulation, outpatient techniques that are also most successful when used in conjunction with other modes of treatment. Transcranial therapies are safe with few to no side effects.

Light therapy, though not formally part of this group, should not be overlooked as a viable option. Though it does not come in direct contact with the body’s nervous system, it’s an electronic device, one that does stimulate, albeit through the lens of the eye. Blue or green light boxes produce between 2,500 and 10,000 lux, and are most effective for those with seasonal affective disorder.

A growing number of patients have reported, though, that these lights have worked when nothing else did, even for year-round depression.

As frustrating and challenging as depression can be, especially when treatment fails over and over again, we live in a time when there are so many options and a great deal of information at our fingertips. The right answers are out there, waiting to be found. If at first you don’t succeed...well, you know how the saying goes.

Changing lifestyle can help prevent hearing loss Hearing loss is common, but the perception that hearing loss is only caused by aging is incorrect. More than 36 million Americans have hearing loss. It is considered the third most chronic condition among the elderly, according to the Hearing Loss Association of America.

Changing lifestyle habits and treating a variety of health conditions can help prevent hearing loss.

Here are seven healthy habits that may help prevent or delay the onset of hearing loss: 1) Noise: Noise-induced hearing loss is the most common yet preventable cause of hearing loss. Exposure to dangerous levels of noise can occur at work, home and in many recreational activities. Wear ear plugs or muffs when operating loud equipment (i.e. lawn mowers, power saws, leaf blower, etc.) or when using firearms. Buy quieter products (compare dB ratings advertised on the products-the smaller the better).

2) iPod/MP3 players: Listening to MP3 players at dangerous levels can cause permanent hearing loss. You can download apps to ensure noise exposure through your iPod does not exceed dangerous decibel levels. Volume Limit is a switch in the settings section of your iPhone or iPod to make sure that your hearing is protected. This allows you to set a maximum level for the volume output of the media player and even put a

four-digit code on it to keep it fixed.

3) Diabetes: The National Institute of Health (NIH) found hearing loss is twice as common in people with diabetes. Furthermore, of the 79 million adults with pre-diabetes, the rate of hearing loss is 30 percent higher than in those with normal blood sugar levels. Moderate weight loss, eating healthy and exercise can delay or prevent Type 2 diabetes among adults at-risk for diabetes.

4) Smoking: Smoking is a risk factor for hearing loss. Smokers are nearly 70 percent more likely than nonsmokers to suffer hearing loss. Exposure to secondhand tobacco smoke almost doubles the risk of hearing loss among adolescents.

Studies show that smoking, age and noise exposure together increase the risk for hearing loss more than each of these factors alone.

5) Cardiovascular disease: Not only does exercise help to prevent Type 2 diabetes, but cardiovascular health and hearing health appear to be connected.

Growing evidence suggests a link between hearing loss and poor cardiovascular health.

6) Earwax (cerumen): Don’t swab your ear canals. Cerumen cleans and lubricates the skin of the ear canal and provides protection from bacteria, fungi, insects and water. Attempting to remove cerumen or cleaning the ear canal with a

cotton swab tends to push earwax deeper into the ear canal. Excess or impacted cerumen can press against the eardrum and/or occlude the external auditory canal resulting in hearing loss.

7) See an audiologist for a baseline hearing test: Susceptibility to hearing loss is often undiagnosed and unrecognized. If hearing devices are recommended, wear them. “There is no reason to miss out on what could be the most important conversation in your life,” said Dr. Kathy Landau Goodman, chair of the Audiology Awareness Campaign. “Stay connected with your friends and family.”

Goodman says to remember every ear is unique and every brain deciphers sound differently, so there is no one size that fits all. What works for a friend may not work for you. It is important to work with a doctor of audiology to help you find the right solution for your individual hearing needs.

The Audiology Awareness Campaign, a non-profit foundation aimed at providing the public with information on hearing loss, is sponsoring the eighth annual Listen Up America Week/National Hearing Screening Week, Oct. 12-16, where audiologists will offer free hearing screenings nationwide. Call 888833-EARS (3277) or visit www.audiologyawareness.com, to find an audiologist in your area.

— BPT

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NEWS NOTES Pediatric center gets deficiency-free rating Once again, the Elizabeth Seton Pediatric Center was recognized for its delivery of exceptional patient care with a deficiency-free rating from the New York State Department of Health (DOH) during their annual, unannounced Quality Indicator Survey.

This is the center’s sixth deficiencyfree survey since 2004 and the second one since moving into the new facility in March 2012. According to the DOH, the average number of deficiencies cited per facility in the region is eight. The Quality Indicator Survey is a computer assisted long-term care survey process used by selected State Survey Agencies and the DOH to determine if Medicare and Medicaid certified nursing homes meet the federal requirements.

A deficiency-free survey means that the center is in full compliance with the standards required for continued participation in the Medicaid program, according to Lisa Poskanzer, vice president of operations at the pediatric center.

“We embraced the seven surveyors with our ‘All are Welcome’ gusto and four days later were blessed with hearing the coveted words from the team leader, ‘No findings!’” Poskanzer said.

“It was truly a moment of overwhelming joy, tremendous humility and strong validation that we had fulfilled our mission. This accomplishment was the result of hard work, focus to detail and

steadfast leadership that was a combination and melding of our newer and more tenured staff members being open to change, listening attentively to the needs of our children and their families and embracing our mission.”

The Elizabeth Seton Pediatric Center is a not-for-profit pediatric specialty nursing facility, serving the most medically complex children in New York State. The pediatric center, which is a 137-bed, 165,000-square-foot complex in Yonkers, is in its 27th year of service.

The center is rated as a five-star facility in the Best Nursing Homes category of U.S. News & World Report. The stateof-the-art, child-centered building is the only LEED Gold certified green pediatric facility in the country.

Children come to the Elizabeth Seton Pediatric Center with serious medical and neurological challenges. The center provides comprehensive health care, rehabilitation and special education services to all residents. Services include, but are not limited to: medical care; nursing; respiratory therapy; palliative care; pastoral care; social work services; physical, occupational, speech and feeding therapies; music therapy; art therapy; aquatic therapy; and Child Life.

Learn more about the Elizabeth Seton Pediatric Center at www.setonpediatric.org and Facebook at www.facebook.com/setonpediatric.

Busy schedule: 6 tips to eat healthy

By LINDA ARPINO Step 1: Plan ahead by making a menu for the week for all meals. Each meal should include food with protein (nuts, seeds, tofu, beans, fat free dairy, etc.), a fruit or veggie and a high fiber grain (4plus grams/ serving).

Step 2: Create a grocery list with all the foods you need before the week starts and shop during less crowded times.

Step 3: Take short cuts for busy days.

If you don’t have time to cook dried beans or wheat berries, buy canned, frozen or vacuum packed cooked types.

Veggies are available even cut up, but usually cost more for that convenience.

Step 4: As soon as you bring food home, individually package snacks for the week, like 1 ounce nut portions with

dried fruit or cut up raw veggies. Freeze food and veggies for later in week and prepare one or two meals for a busy day.

Marinate foods with herbs for more flavors.

Step 5: Skip foods that are processed.

Eliminate ingredients that add sugar, salt, fat and fillers.

Step 6: Prepare foods with less sugar, fat and salt. Serve raw or bake, roast, steam, grill or slow cook.

Linda Arpino is the founder of the Life Focus Nutrition Centers with offices in Rye Brook, NY, and North Stamford, Conn. She provides individual nutrition counseling to families, adults, children and teens. For more information call (914) WEL-0123 or (203) 321-8454 or visit www.lifefocusnutrition.com.

Pilates benefits both teacher and student You’re a people person, you’re a natural born teacher, you’re interested in helping people improve their well-being.

You enjoy healthy exercise and have good body awareness. You are self-motivated and want to feel good both physically and mentally on the job. There’s a new line of work waiting out there for you: instruction in the Pilates Method.

Now that Pilates has gone mainstream, you or someone you know is probably taking Pilates sessions or classes at a studio or gym near you. But how much do you REALLY understand about the science of this mind-body technique?

The Pilates method of body conditioning is founded on conscious movement of deep muscle and body control. The proven health benefits go beyond the appearance of toning and lengthening the physique — a strong, supple and balanced body and spine are developed.

In Pilates, it’s quality of movement — not quantity — that’s key to improved physical conditioning. In the method, certain basic principles (attention to breath, control from the core and body awareness) must be applied.

Now that you’ve heard all this about the science of the method, do you still think you would like to pursue a career in Pilates? What are some of the things you should consider? First of all, having practiced the method yourself will help you move from student to teacher. “Pilates in your own body” will be your ultimate teaching tool. Most importantly, find a

good Pilates training program which will be essential to kicking your career into high gear. Look for a well-established and reputable Pilates studio that offers a full comprehensive training program and apprenticeship. Having access to various pieces of Pilates equipment and experienced teachers is a must.

Your passion for the philosophies of Pilates conditioning is required; your age, appearance and fitness level are not. The level of your commitment and focus throughout your training will prepare you to be a successful teacher. Although teaching Pilates will require a lot of energy and attention, the rewards of seeing your students achieve life-changing results will make it all worthwhile.

With the immense popularity of Pilates, qualified instructors are always in demand. In addition, your new job will have certain perks: flexible hours, good pay, an easy work environment. But the most important thing is that you will feel good helping others reap the tremendous benefits of Pilates exercise.

So now that you’re on your way to reinventing your new career (and the added bonus of reinventing your new physique), where are you going to find a quality training program? Look no further than in your own backyard. Center for Movement, established in 1998, is located at 846 Scarsdale Ave. in Scarsdale and in has a location in Manhattan. For more information, visit centerformovement.com.

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Friday, October 9, 2015 | The Scarsdale Inquirer

To Your Health! | Page 7A

Strategies to boost weight loss momentum The rules of weight loss are constantly changing — eat this, don’t eat that, take this supplement and do this exercise routine. While eating less and exercising more sounds like a simple formula, finding the right weight loss strategy isn’t always as easy as it seems.

Paul Kriegler, registered dietitian with Life Time: The Healthy Way of Life Company, knows latest trends and one-size fits all approaches are rarely the key to success. “Over the years, I’ve coached many clients who were diligent and focused and who showed up and gave their full effort, but some small aspect of their mindset or lifestyle became a hangup,” he says. “Sometimes an element not even related to their health was holding them back.”

Kriegler notes that getting creative with your weight loss strategy will help you enjoy the full measure of your success and offers six strategies to help drive your weight loss goals and break through those hang-ups: 1) Give the scale a break: Don’t center your weight loss success on a number.

A simple scale doesn’t come close to measuring the significant changes happening in your body during your weight loss journey. Keeping track of your daily weight may complicate your strategy as you experience daily highs and lows.

Instead of focusing on a number each day, notice changes in how your clothes are feeling and how you feel and move overall.

2) Adjust your media intake: Media is one of the biggest sources for weight loss

and health advice, but these messages are typically generalized and based on observational research rather than proven methods and techniques. This can become frustrating and leave a negative impact on your weight loss success. Social media can also leave you feeling defeated. Take a break from the media and pay attention only to what truly inspires you to be your healthiest self.

3) Let your closet be a source of motivation: New clothes are exciting and you almost always want to wear them right away. But if you can’t, allow that wardrobe to fuel the power of your weight loss goals. Additionally, if you have favorite outfits that are a size or two bigger than they should be, consider donating them to nudge yourself in the right direction.

4) Pamper yourself: Whether it’s a manicure or a massage, some type of

weekly or monthly reward for your hard work is well-deserved and also recommended as part of a healthy lifestyle.

Rather than treating yourself with food as a reward, pamper yourself in other ways and reflect on how far you’ve come.

5) Take it one hour at a time: When you’re starting out, losing weight can seem like an overwhelming aspiration.

Breaking it down into smaller increments can make it more manageable.

Start by having one “healthy hour.” Take the stairs, take a lap around the office at work or ask for a salad instead of fries with your meal at lunch. As you spend more and more healthy hours, pretty soon your entire week will become healthier. Focus on improving the present rather than the future.

6) Take pictures to document the process: While it may seem daunting at first, documenting your visual transformation can be a great source of motivation in weight loss. Not only do pictures provide important feedback, but you’ll be able to showcase the fun you’re having while gaining strength and energy living the healthy way of life.

Your individual idiosyncrasies and characteristics make you unique, so not everyone’s weight loss strategy will be the same. Sometimes it’s the unexpected offbeat methods that are key to boosting your weight loss momentum.

— BPT

Discover the dangers of a low sodium diet

Salt, or sodium chloride, is essential for life. In fact, no mineral is more essential to human survival than sodium because it allows nerves to send and receive electrical impulses, helps your muscles stay strong and keeps your cells and brain functioning. However, sodium chloride (salt) is a nutrient that the body cannot produce, and therefore it must be eaten.

The average American eats about 3,400 mg per day of sodium, according to The National Health and Nutrition Examination Survey. You may have heard that this is too much, but according to new research, it may actually be on the low side of the healthy range. A 2014 study, published in the New England Journal of Medicine, tested sodium consumption in more than 100,000 people in 17 countries. The study found that the healthy range for sodium consumption was between 3,000 and 6,000 mg per day. Eating more than 7,000 mg per day of sodium increases your risk of death or cardiovascular incidents, but not as much as eating less than 3,000 mg per day. The low salt diet was significantly more harmful than the high salt diet and salt has many health benefits.

The other component of salt, chloride, is also essential to survival and good health. It preserves acid-base balance in the body, aids potassium absorption, improves the ability of the blood to move harmful carbon dioxide from tissues out to the lungs and,

most importantly, it supplies the crucial stomach acids required to break down and digest all the foods we eat.

Because the level of salt consumption is so stable, it is an ideal medium to use for fortifying other essential nutrients such as iodine. Iodized salt first produced in the U.S. in 1924 is now used by 75 percent of the world’s population to protect against mental retardation due to Iodine Deficiency Disorders (IDD). Iodine is an essential element in healthy human life, enabling the function of thyroid glands to produce needed hormones for proper metabolism.

When children in the womb don’t get enough iodine from their mother, fetal brain development may be impaired.

During pregnancy, iodine deficiency can cause a child to develop learning disabilities and mental retardation as well as developmental problems affecting his speech, hearing and growth.

Salt is also a vital component of hydration. After exercise, it is critical to replace both water and salt lost through perspiration during exercise.

That is why all athletes make sure they are consuming sufficient salt during and after a workout. Expectant mothers and seniors, in particular, need to guard against under-consumption of salt. Higher-salt diets have also been used successfully to combat chronic fatigue syndrome. Asthma sufferers, particularly in Eastern Europe, are often treated by having the person spend time in salt mines or salt caves. This

is because the unique microclimate, containing ultrafine salt particles helps clear the lungs.

Low salt diet myths Low salt diets can be especially harmful for the elderly. In older people, mild hyponatremia (low sodium concentration) is the most common form of electrolyte imbalance in the blood.

Indeed, several recent medical papers found a direct relationship between hyponatremia and unsteadiness, falls, bone fractures and attention deficits.

Elderly people on low salt diets often experience lack of thirst which leads to dehydration and they experience loss of appetite that leads to a host of health problems.

Falls are one of the most serious problems for the elderly and about a third of people older than 65 fall at least once every year. Fall-related injuries in the elderly are associated with numerous psychological and physical consequences and are a leading cause of bone breakage and hip fractures, which can lead to complications and permanent disability or death. More than 5 percent of all hospitalizations in people older than 65 years are due to fall-related injuries. Sadly, the research shows that in assisted living facilities where almost all residents are given low-salt diets, the rate of falls and fractures are three times as great as in the normal home environment.

— BPT

NEWS NOTES Urgent Care Dental…when it just can’t wait Did you know according to the American Academy of Pediatric Dentists, over 2.5 million children under the age of 19 incur sports related injuries? School is in full swing again and so are our beloved after school activities. How many of you have watched your child take a line drive to the face or a soccer ball to the jaw?

To add insult to this very real injury, this usually occurs on evenings or weekends when your dentist is unavailable.

Urgent Care Dental, located at 1088 Central Park Ave. in Scarsdale, can help as they specialize in just these kinds of traumatic mouth injuries. As studies have shown, time is of the essence when dealing with a knocked out or broken tooth. Oftentimes emergency rooms are ill-equipped to handle these situations.

Urgent Care Dental provides emergency dental services for both children

Brain Scans Continued from page 1A

in children. For math, better scores were associated with well-developed transmissions in the intraparietal sulcus region, known for its role in processing numbers. Scientists are learning to identify where the processes falter in children with learning disabilities, so that targeted treatments can be developed.

One example of valuable input that has come from neuroimagery is from the year 2000, when researchers at Yale’s Child Study Center discovered through fMRI that those with autism are unable to process faces in the facial recognition center of the human brain. They use the area of the brain that specializes in object recognition instead, which may explain why autistic children have trouble with facial recognition, do not think it’s important and often have trouble making eye contact. Scientists can now develop therapies that target the involved portions of the brain.

The Amen Clinics, where neuroimagery is the foundation of treatment, were true pioneers in this field when they began 15 years ago. Today, Dr. Daniel Amen can determine whether a patient is experiencing anxiety or, feeling physical pain or even guilt over a failed marriage.

In 2013, researchers learned through neuroimaging that our brains dump toxins out when we are sleeping at night.

Our brain does not use the lymphatic system as all of our other body parts do.

Among the toxins being dumped is beta

and adults seven days a week and can handle broken or knocked out teeth, abscessed teeth, tooth pain, oral or tooth infections, injuries to the mouth and lips, lost fillings or crowns and problems following dental work. Urgent Care Dental is staffed with board certified dentists experienced in emergency dentistry.

Emergencies never happen when it’s convenient. While all children and adults should wear mouth guards and take other preventative measures while participating in sports, injuries may still occur. Urgent Care Dental is proud to offer the support needed to keep smiles safe.

Urgent Care Dental is open MondayFriday from 4-9 p.m. and weekends from 9 a.m.-5 p.m. Call 713-3500, email urgentcaredentalny@yahoo.com or visit www.urgentcaredentalny.com.

amyloid, the protein implicated in Alzheimer’s disease. The very strong implication here is that lack of sleep may be a major contributing factor to this disease.

Neuroimagery is also being used to diagnose and establish the severity of Alzheimer’s disease and other forms of dementia. Doctors are ordering imaging to identify types of headaches so they can prescribe the right treatment. And psychiatric diseases are being diagnosed this way.

Another role of neuroimagery involves pharmaceuticals, and the corresponding neurological activity, as physicians explore the brain to determine, objectively, whether medication is working.

Functional brain imaging can also produce more specific treatment monitoring in people with traumatic brain injury. It can help researchers diagnose schizophrenia, ADHD, bipolar disorder, depression and a staggering variety of other conditions.

Now that we can look inside the brain and literally see what’s going on in there, we can expect continuous, rapid fire progress in this field.

Rarely has a cure been discovered for anything without significant scientific knowledge about the underpinnings of disease. The deep mysteries of the brain had doctors relying on subjective patient feedback and observation of behavior for diagnostics and treatment. Today, neuroimagery is leading the way in biomedicine, taking us into an entirely new world where technology is removing the guesswork and turning mind reading into a legitimate science.

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The Scarsdale Inquirer | Friday, October 9, 2015

IT’S PERSONAL: Medicine will soon be all about you and many other physiological functions.

What’s more, our microbiomes are as individual as a fingerprint. Each one of our 100 million organisms bring their unique DNA and genome to the mix to interact with our genes.

By JENNIFER LEAVITT

M

edical science has increased the average lifespan, improved our quality of life and, in conjunction with technology, has even made it possible to better manage our own health.

Doctors are not magicians though, at least not yet. (Researchers are working on it.)

Often an ailment disappears before we even get to the doctor or there is no appropriate diagnostic test for what ails us. Sometimes our symptoms are just too mysterious or vague to pinpoint. And other times ambiguous treatment guidelines mean that we have to play the trial and error game, hoping that something will agree with our personal biochemistry. And soon.

Even when diagnosis and medical care are quick and straightforward, treatment protocols are usually pretty similar whether it’s great aunt Zelda, us or the newspaper boy who is ill. Most treatment is based on standards of care and statistical outcomes and up until now that has made perfect sense. But modern medicine is on the cusp of a dramatic new age.

The age of ‘omics’ The “omics” suffix refers to a study of molecules within a specific set of cells.

There are many such fields of study, including lipidomics (concerned with all lipids in the human body), proteomics (focused on proteins) and the omics that are literally paving the way to truly personalized medicine — genomics (exploring our genes) and microbiomics (investigating the microbal world within us. With the help of epigenetics, these latter two omics are leading to advances in biomedicine that scientists, doctors and patients could only dream about a decade ago.

The handbook of you Thousands of genes are woven into our DNA. Each one of those genes is a biological blueprint, filled with very specific instructions for the body that houses it. Slight variations in those instructions can make the difference between red hair or blonde, freckles or olive skin, disease or health. The entire collection of our own genes is known as our personal genome, while the study of the overarching human genome is known as genomics. Headed by the National Institute of Health, the Human Genome Project, at www.genome.gov/10001772, identified 20,000 human genes, and has been referred to as “one of the great feats of exploration in history.” This data has given the world significant insight into the physiological human condition, including both

the many similarities we all share, as well as the profound differences that make us each unique well beyond our most obvious traits.

Not your mother’s mail order It isn’t only scientists or physicians who can access this kind of data anymore.

Regular Joes and Janes can have their entire genomes mapped for a mere $99 from services like 23andme.com, a non-prescription genealogical and genomic service. After sending in a swab of DNA, customers receive their raw genetic data and can run it through free, nonprofit sites such as Promethease for interpretation. (Since New York does not allow these tests without a prescription, residents will have to relocate to New Jersey or Connecticut on the days they order, take and mail back DNA tests.)

With genetic data in hand, your average citizen may find out that one of their genes makes cilantro taste like soap to them or that their bodies will be more receptive to a low-fat vs. a low-carb diet. One woman learned that although wine raises HDL levels for most people, it wouldn’t work for her. She also discovered that she has a number of longevity genes. Other data reveals which medications a person will probably respond to, and which they won’t, as well as pharmaceuticals they are overly sensitive to.

During a chronic or acute illness, this

kind of information will soon be helping doctors everywhere skip ineffective treatments, getting right to those that are most likely to work for the specific individual.

Remember though, that we can inherit conflicting genes, such as one that makes us less likely to get a certain disease, and one that does the opposite. Then, too, not all instructions get read or followed and so it is in our microworld as it is in the world at large. Genes and their genetic instructions can be ignored, they can be turned on and off by our physical environment, by love or trauma, by our diets, and by the enormous influences of our personal microbiomes.

The micro world inside you Think of our microbiomes as our second personal genomes, only much bigger. It turns out that the 37 trillion cells that make up a human body are vastly outnumbered by some 100 trillion plus single-celled bacteria that live on and in all of us. These bugs, collectively our microbiome, are not parasites or dangerous intruders. Instead, we enjoy a symbiotic and absolutely necessary relationship with them. Representing over 1,000 different species, the “good guys” (friendly bacteria and other helpful microbes) usually outnumber the “bad guys” (damaging bacteria and other microbes) by 4 to 1. They help us ward off pathogens, retrieve nutrients from food, metabolize fat

Origins of an organ Researchers have determined that a person’s microbiome, if it were gathered all together and compacted into one space, would weigh about as much as the human brain does. Some have even suggested that the microbiome be recognized as a human organ. Your microbiome is well established early in life, but it is also dynamic in nature. Poor dietary habits, stress and antibiotics can eradicate those friendly bacteria, while eating plenty of fiber-rich and fermented foods can help them grow and prosper. There are countless other ways to influence our own health, some of which are being explored through the science of epigenetics. Very similar to the Human Genome Project, NIH has a Human Microbiome Project — https://commonfund. nih.gov/hmp/overview — which relies on public biological samples to study and understand the incredible microscopic worlds within us.

Microscopic Manipulation In epigenetics, scientists and doctors take action based on the information garnered from a person’s individual genome and microbiome. In literal terms, epigenetics means “above genetics” and references those modifications to DNA that turn genes on or off, so to speak, basically determining how cells read and respond to the instructions contained within them. Each of our cells may all contain the same DNA, but they express themselves differently from one another.

In the future, when doctors have a full snapshot of a patient’s genetic and microbal makeup, they will have an incredible depth and breadth of insider information, much like secret codes and passwords that they can use to fine-tune human health, our health, in completely personalized and dramatically more effective ways.

Although mainstream clinical applications are 10 to15 years away, the nation’s top medical schools are already exploring and testing them. The general public can register with clinical trials or get involved with genomic and metabolomic research projects and data banks, becoming part of scientific history while getting an inside look at their own biochemistry and microbiology. Now that’s personal.

Knowing early signs of shingles may save years of pain Did you know almost 1 out of 3 people in America will develop shingles in their lifetime? A whopping 1 million Americans experience the condition each year, according to the Centers for Disease Control and Prevention. Understanding the early signs and symptoms can help you protect yourself and loved ones and may enable you to enroll in a clinical trial of a new drug therapy designed to treat the pain associated with shingles.

“Shingles, also known as herpes zoster, can effect anyone who has recovered from chickenpox at any age, but as you get older you are more likely to get the disease,” said dermatologist and virologist Stephen K. Tyring, M.D., Ph.D. “In fact, the majority of shingles cases occur in people age 50 years or older.”

Dr. Tyring said the first sign of shingles is often pain, burning or tingling on the torso or face. This can occur one to five days before the physical signs of shingles — typically a rash and blisters — appear. This can make early diagnosis difficult.

“Shingles is challenging to identify in its early stage because the pain appears to not be associated with a particular disease,” Tyring said. “Making patients aware of the early symptoms is important because if shingles progresses without treatment the pain may increase and the rash and blistering will become more pronounced.”

Tyring urges everyone to be aware of the early signs of shingles and the importance of seeking treatment immediately. People tend to try to “wait

it out” and visit the doctor only when the symptoms and pain become severe. Visiting a doctor promptly within 72 hours of the first blister can help ensure you get the professional advice necessary to overcome the illness.

The rising incidence of shingles highlights the need for better therapies to help patients, particularly those at increased risk, such as seniors or those with a compromised immune system.

A new clinical trial is seeking participants to test a promising drug therapy that is designed to treat the pain associated with shingles, known as postherpetic neuralgia or PHN. PHN can last for several months or even years after the rash goes away and it occurs in about 20 percent of people who get shingles.

If you or a loved one is diagnosed with shingles, you may be able to participate in this important clinical trial.

Here are some of the criteria patients must meet in order to participate in the study: Be 50 years of age or older, are able to receive your first dose of study medication within 72 hours (three days) of a possible shingles rash appearing and have not received the shingles vaccine.

“Shingles is on the rise and more potent drugs are needed,” Tyring said.

“This clinical trial will help the medical community learn more about how to best treat this disease so everyone can stay as healthy as possible.”

Learn more by visiting: https://www. clinicaltrials.gov/ct2/show/NCT024129 17?term=nct02412917&rank=1.

— BPT

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Friday, October 9, 2015 | The Scarsdale Inquirer

To Your Health! | Page 9A

Breast cancer Continued from page 1A

it can tell you if the mass is just a cyst or not,” Dr. Zalasin said. “It doesn’t increase your risk of developing cancer. Women make cysts, particularly premenopausal women or postmenopausal women who are uncertain medications.”

Dr. Zalasin said that if any mass of concern is found, a patient can undergo further MRI screening. “Once the results come back as a problem cancer or high risk, that’s when they typically see a surgeon,” she said. “At that point, the surgeon would determine if they need to do additional imaging. A lot of surgeons are doing pre-MRIs with patients with newly diagnosed breast cancer because MRI can provide a more accurate assessment of the extent of the disease.”

The next step in determining if a mass is cancerous or at risk of becoming cancerous is a biopsy. Traditionally, biopsies involved removing the entire mass from a breast to test it, however, a technique called fine-needle aspiration now exists that involves taking a sample of an abnormality with a fine needle and syringe, which causes much less potential scarring than the removal of the mass in question.

If the biopsy determines a cancerous or precancerous mass within a breast, then surgery is always recommended.

The type of surgery that a woman might receive depends on the size and shape of the cancer and its location within the breast. Types of surgery range from the removal of the afflicted part of a breast to the full removal of both breasts, known as a bilateral mastectomy. A number of women opt to completely remove both breasts, while others want to preserve theirs.

Dr. Chaterji said that in a case where the partial removal or partial mastectomy of a breast can be performed and where there is no genetic predisposition to breast cancer, it is just as effective with radiation treatment as a bilateral mastectomy.

“Survival studies have shown that there is no difference in overall survival with a mastectomy versus a partial mastectomy with radiation,” she said. “Also, mastectomy does not offer patients 100 percent risk reduction, so there’s no 100 percent guarantee.”

A bilateral mastectomy is not a surefire way to become cured of breast cancer.

Many women choose to undergo the procedure as a way to prevent additional screenings for more cancerous masses and potential additional surgeries for masses that might form later on.

In either case, a patient has a range of cosmetic options. In the case of a partial removal, tissue can be moved around to so that the breasts look similar. Implants are options for those patients who have undergone full or partial mastectomy, as well as using tissue from other parts of the body such as the thigh, abdomen or buttocks. It is possible for women who have undergone even a full mastectomy to have their nipples saved. It is also possible to reconstruct them through plastic surgery.

Dr. Randy Stevens, the director of radiation oncology at White Plains Hospital, said the objective is to leave a breast cancer patient with an end result she can feel comfortable with.

“The goal is to do the right oncologic procedure, but also leave them with a cosmetically acceptable or pleasing result, so they really feel good about themselves in and out of clothes,” she said.

their hair?’ Herceptin is one of the drugs, just as hormonal therapies, where you reYWCA WhitePlains Plains& & Central Westchester ally don’t lose your hair.”

YWCA White Central Westchester YWCA White Plains & Central Westchester Like all drugs, Dr. Stevens said Herceptin has side effects as well: “The bigYWCA White Plains & Central Westchester gest side effect is that it can cause the heart to not function as well. Our doctors will usually do hard specific test every Learn-to-swim classes Learn-to-swim classesfor for three months or so to make sure that the preschoolers, youth, teens patient can handle the medicine. If Learn-to-swim they preschoolers, youth, and classes for teensand adults.

Swim test required for all see any changes they’re picking them up Learn-to-swim classes for adults. Swim testteens required for all preschoolers, youth, and before there’s real damage.” levels above beginner. levels above beginner. preschoolers, youth, teens adults. Swim test required for all and One major side effect of breast cancer Swim test required for all adults. surgery is lymphedema, the characterislevels above beginner.

Gymnastics programs for tic swelling, typically of the arm in breast levels above beginner.

Gymnastics programs cancer patients, due to the removal of boys and girls, tumblingfor lymph nodes. Dr. Stevens tells patients boys and girls, tumbling classes and competitive Gymnastics programs for forteam. lymphedema occurs when lymph nodes Gymnastics programs classes and competitive team. are either damaged from cancer or radiaboys and girls, tumbling boys and girls, tumbling tion treatment and their damage or reKarate program for youth and classesclasses and competitive team. and competitive team. moval results in the body’s natural drainadults, program health andfor wellness Karate youth and age system not functioning correctly. activities and fitness center. adults, health and wellness “There are all kinds of severities,” she program for youth Karate program for youth and said. “In the mildest form the patient Karate may activities and fitness and center. not even be aware of it and it mightadults, just adults, health and wellness health and wellness And, lots more! feel a little swelling or a tight ring, but in activities and fitness center. activities andlots fitness center. a more severe form it limits the quality And, more! of life and activities and potentially they Check our website for have a sense of a heavy arm and difficulty And,more! lots more!

And, lots using their arm.” information and class schedules: Check our website for Dr. Stevens said the key to treating www.ywcawpcw.org lymphedema is to treat it early with physinformation andwebsite class schedules: Check our for (914) 949-6227 x208 ical therapy. Dr. Chaterji said massages Check our website for www.ywcawpcw.org and wearing a compression sleeve are information and class schedules: email: membership@ywcawpcw.org also ways to lessen lymphedema’s symp(914) 949-6227 x208 information and class schedules: www.ywcawpcw.org toms. email: membership@ywcawpcw.org www.ywcawpcw.org Rates of lymphedema are arguably (914) 949-6227 x208 decreasing because now breast surgeons (914) 949-6227 x208 email: membership@ywcawpcw.org are selectively removing afflicted lymph email: membership@ywcawpcw.org nodes and sparing others that would contribute to lymphedema if they are missing Dr. Stevens said. She added transferring lymph nodes to an area where some are missing is also a possibility.

“There are some surgeons doing lymph node transfers, trying to bring fresh lymph nodes into an area where drainage is not good,” Dr. Stevens said. “There is some success it doesn’t work for everybody.”

White Plains Hospital participates in clinical trials and Dr. Stevens said there are a number of potential advancements in treatment being studies, such as experimenting with implementing hormonal 5-STAR Government Rated Four Consecutive Years therapy before surgery.

“Now are we getting hormonal therapy before the surgery and then if they respond, we keep going and if not, we just Skilled Nursing Care on Beautiful Long Island Sound see that the tumor is not changing, we switch,” she said. “This is all now before • Short Term Rehabilitation the surgery because we know exactly • Subacute Care what’s working and what isn’t.”

• Long Term Care Dr. Stevens said the hospital is researching if a shorter course of radiation • Alzheimer/Dementia Care treatment is just as effective as a lon• Respite Services ger course and if 10 years of hormonal therapy is more effective than five years.

The hospital is also looking into whether We invite you to join us for lunch osteoporosis drugs could also help fight and take a tour of our facility breast cancer. “We expect to have a lot more then, but really every couple of months there’s something new in breast cancer,” she said.

Dr. Chaterji said seeking screening, understanding risk and hearing advice from professionals is key for women’s health.

“It’s very scary when you’re diagnosed with breast cancer, but it’s really important to understand what your options are and feel like you’re in control over those options,” she said. “I also think it’s important for women to understand their risk status. A lot of women don’t even know what that is and to make sure that you’re doing breast exams and getting imaging.

It’s really confusing. It can be intimidat490 Pelham Road • New Rochelle, NY 10805 ing to try to make it easily understandwww.gicnr.com • email: infor@gicnr.com able. It’s important for them to go to someone who is practicing breast surgery and knows the latest advances.”

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In addition to surgery, methods such as chemotherapy, radiation treatment, hormone therapy and immunotherapy could be used to further fight breast cancer.

Risks and benefits of chemotherapy are weighed with each individual patient. Dr. Stevens said it is possible to use chemotherapy in advance of surgery to reduce the mass to a more manageable size.

“Sometimes we’ll have those patients see a medical oncologist before surgery and we’ll actually give what we call systemic therapy chemotherapy to shrink the disease and get a heads start on the big picture and do the surgery afterward,” she said. “That’s a bit of a change from before, but it gives the opportunity for some women maybe with a larger size tumor to have their tumor made smaller or downsized and give them the option for a lumpectomy when they wouldn’t have had it originally.”

Regarding radiation treatment, Dr. Stevens said current equipment allows doctors to focus on radiating specific areas of the breast rather than bombarding the entire area with radiation.

“Clearly, the sophistication and the technology has increased, so we’re able to pinpoint targets and customize our treatments to our patients’ individually shaped breasts and to shield the normal tissues far better than we ever could,” she said.

Dr. Stevens said hormonal therapy works to fight tumors by depriving them of estrogen, as many tumors are responsive to the hormone.

“What it does is lowers the estrogen in

a woman’s body to decrease the chance of tumor growth,” she said. “Basically, it’s extremely useful in breast cancer since so many of these breast tumors have this estrogen receptor.”

Dr. Stevens said some hormonal therapy drugs might have side effects that might make patients wary of taking them.

She said the side effects do not happen to all patients and that different hormone drugs could be used to try to avoid them.

“Some of the drugs have a bad rap with women because they have side effects,” she said. “In some cases, some of the drugs can make patients very achy or have creaky joint aches. We tell people to keep an open mind. There’s lots of things we can do if they get the side effects.”

Immunotherapy is also gaining ground as a treatment.

“Immunotherapy is stimulating your immune system to attack cancer cells,” Dr. Stevens said. “It’s also sometimes called biologic therapy, but it’s very important in treating the cancers and we have more and more drugs that are being developed to work in this way.”

One such immunotherapy treatment is Herceptin, or trastuzumab, which Dr. Stevens said helps improve cure rates in addition to being an alternative to chemotherapy that allows patients to keep their hair.

“It’s a targeted therapy directed at a specific protein on the tumor surface,” she said. “It’s not what we call chemotherapy. It’s really more of a targeted antibody therapy. Our patients’ big concern after ‘Will they live?’ is ‘Will they lose

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The Scarsdale Inquirer | Friday, October 9, 2015