Balance, Spring 2017

Balance The health magazine for Body, Mind & Motivation

USE IT OR LOSE IT

Regular movement helps with balance, flexibility, strength

CAN YOU HEAR ME NOW?

How smartphones affect your relationships

BEATING THE BLUES

There’s hope for those with seasonal depression

PAIN IN THE FOOT

Weight gain may lead to plantar fasciitis

Volume 9 – Issue 2 – Spring 2017

Spring 2017 1 Published quarterly by the Lewiston Tribune and the Moscow-Pullman Daily News

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*Versus 2D mammography alone Friedewald SM, Raerty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):24992507. 2Rose SL, Tidwell AL, Bujnoch LJ, et al. Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol.

2013;200(6):1401-1408. 3Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a 4 population-based screening program. Radiology. 2013;267(1):47-56. Raerty EA, Niklason LT. FFDM vs FFDM with tomosynthesis for women with radiographically dense breasts: an enriched retrospective reader study. Paper presented at: Annual Radiological Society of North America ScientiďŹ c Assembly and Annual Meeting; November 2011; Chicago, IL. 5Skaane P, Bandos A, Eben E, et al. Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-ďŹ eld digital mammographic images. Radiology. 2014;271(3):655-663. 6Zuley ML, Guo B, Catullo VJ, et al. Comparison of two-dimensional synthesized mammograms versus original digital mammograms alone and in combination with tomosynthesis images.

Radiology. 2014;271(3):664-671. 7FDA PMA submission P080003.

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  Balance

Contents Balance – volume 9, issue 2 – Spring

4

COVER STORY

USE IT OR LOSE IT

Regular movement helps flexibility, strength and more

10

WELLNESS

DEPRESSION

Sufferers should not wait to ask for help

2017

LIFE

CAN YOU HEAR ME?

6

Smartphones and their effects on relationships

14

HEALTH

BACON, SODA - NOT THE WAY TO GO

Sugary drinks and the effect on your health

ALSO | WINTER BLUE 8 | VINEGAR ELIXAR 12 | PLANTAR FASCITIS 16 ADVERTISER INDEX

Allen, Dr. Richard ....................................8 Alternative Nursing Services .................11 Brookside Landing ................................15 Compassionate Care, Inc. ......................18 Dentistry 4 Children ................................9

Electrolysis - Permanent Hair Removal....6 Elmview Chiropractic ..............................9 Dynamic Physical Therapy ....................13 Huckleberrys at Rosauers .....................15 Leavitt DMD, Erin ..................................16

Maplewood Dental .................................5 Ozeran MD, Steven ................................20 St. Joseph Regional Medical Center .......24 Tri-State Memorial Hospital ....................2

Balance is published quarterly by the Lewiston Tribune and Moscow-Pullman Daily News and printed at the Tribune Publishing Co. Inc.’s printing facility at 505 Capital St. in Lewiston. To advertise in Balance, contact the Lewiston Tribune advertising department at (208) 848.2216 or the MoscowPullman Daily News advertising department at (208) 882.5561. Editorial suggestions and ideas can be sent to Tribune City Editor Craig Clohessy at cclohessy@lmtribune.com or Daily News City Editor Devin Rokyta at drokyta@dnews.com.

Spring 2017 3

Use it or lose it Regular movement helps with balance, flexibility, strength

By KERRI SANDAINE Lewiston Tribune

When it comes to flexibility and range of motion, just remember to “use it or lose it.”

Our bodies are not meant to be stagnant, said Amanda Long of Lewiston, a coach and co-owner of CrossFit LC Valley.

“If you don’t move, you lose your mobility and you start to break down. It’s as simple as that.”

People of all ages benefit from regular exercise, stretching and activities that increase mobility, said the 35-year-old mother of two.

And you don’t have to go to the gym or participate in a high-octane sport to gain strength and flexibility, she said. Many online videos provide helpful exercise routines that can be done at home.

In addition, foam rollers, bands and lacrosse balls are inexpensive tools to keep your muscles in tiptop shape. Trainers at area gyms are usually eager to point people in the right direction and answer any questions.

The first step in a fitness program could be as easy as walking around the block and then increasing the distance over time. Regular physical activity is one of the best ways to ward off muscle loss and

Tribune/Barry Kough

It’s all about concentration when Amanda Long is lifting more than her body weight in a few seconds. A workout like this may not be for everybody but some ordinary exercise will make a difference for most people.

Balance

problems with balance and flexibility.

“Your body is a like a door hinge,” Long said. “If you don’t keep it oiled, it can get rusty and creaky.

Movement is vital to maintain range of motion.”

Sitting all day can lead to back pain and other problems, said the longtime coach. Short walks and a simple stretching regime are a good way to combat aches and pains that go along with aging.

“Research shows that healthy joints lead to healthy bodies,” Long said. “Your body is like your car. If you never change your oil, you’re going to have a problem.”

One of her favorite ways to stay active is CrossFit, a high-intensity workout program that involves weight lifting, rowing, kettlebells and a wide variety of sports. She caught the CrossFit bug from her husband, Justin Long, about five years ago and has never looked back.

“I love the CrossFit community and the people, but I also love the challenge, because it’s always changing,” she said. “I’m really passionate about Tribune/Barry Kough Olympic weight lifting. This year I’m trying to Long balances on a bar while training. qualify for the American Open in Reno.”

Long, who is a petite 5 feet 4 inches tall and 120 pounds, can dead lift 300 pounds and “clean and jerk” 160 pounds.

“I never had a desire to lift weights,” she said. “Oh my gosh, now it’s my life. Weight lifting makes me happy and strong.”

CrossFit has become a family activity for the Longs and their two kids, ages 9 and 11, who participate in a MiniFitters program at the gym.

We Off W O ffer Long credits the ever-changing CrossFit routines Complete for reducing her stress, clearing her mind and giving Family Dentistry her time to take a deep breath. Along the way, her • Preventative Care range of motion and flexibility have improved and • Restorative and she’s become an advocate of the “use it or lose it” Experienced, Cosmetic Dentistry motto.

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——— Sandaine may be contacted at kerris@lmtribune.com or (208) 848-2264. Follow her on Twitter @newsfromkerri.

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www.MaplewoodDental.net Spring 2017

Can you hear me now?

How smartphones are affecting your relationships

By Taylor Nadauld

Moscow-Pullman Daily News

For couples wondering how to enhance intimacy, communication and overall relationship satisfaction, they may start by asking themselves one question: When was the last time you picked up your cellphone?

This morning? Five minutes ago? Is it currently in your hand?

With notifications likely to be incoming from iMessage, Facebook, Instagram, Snapchat, daily news apps, game updates, phone calls and emails throughout the day, odds are you could be tempted to check your phone before you finish reading this article.

Those daily updates might seem like a benefit when they’re first received, but the damage they can cause as distractions to a real-life relationship can be brutal.

Can’t look away Josh Misner, a professor of communications at North Idaho College in Coeur d’Alene, has taught and studied the intricacies of human interaction for years. In a social media course he is teaching this semester, Misner asked his students to participate in a weeklong social media fast. Misner participated as

well, since he said he never asks his students to do something he wouldn’t.

A self-proclaimed adorer of social media, Misner found the experiment difficult enough he began deleting social media apps from his smartphone to eliminate temptations.

In the end, he said, the results were both shocking and embarrassing.

“I was absolutely floored by the number of times that I would reach for my phone, just mindlessly,” Misner said. “It honestly made me embarrassed for myself how frequently I did this.”

Misner is no stranger to the addictive tendencies smartphones tend to bring out in their users. For him, the catalyst to what became a cycle of constant screen time was receiving his first Blackberry.

After constantly checking his emails started to get to his wife, Misner said the pair made a pact to ban screens on Saturdays and take a technology holiday, a goal he originally went into kicking and screaming.

“I did not like the idea of it, partly because I experienced some of that fear of missing out,” Misner said. “I thought that it was going to cause all sorts of problems with being able to be responsive to student emails and that I was going to fall behind in my work and stuff.”

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Misner would find himself sneaking in screen time in the bathroom, a behavior similar to that of a smoking or alcohol addict. But those behaviors soon passed and eventually spurned a paradoxically efficient outcome in his screen time.

Rather than working in constant, random intervals throughout the day, Misner said he became significantly more efficient as he began structuring time for work and social media.

Today, Misner continues the tradition and has noticed he uses screens less and less as he becomes more efficient with the time he designates for them.

“My relationship with my wife improved immediately because I was doing what she asked,” Misner said.

problem.

Now, having entered the dating pool again, Harper Bray finds herself confused about dating in a technologically driven world — one powered by smartphone dating apps and textured with complicated rules of etiquette.

She recalled dating four people in one month.

She noticed three out of the four whipped out their phones within five minutes of conversation.

“I just don’t know the rules anymore. I feel like we’re sort of in this time period where we’re trying to restructure the rules of what it means to be on your phone,” Harper Bray said.

And though Harper Bray does not deny she does the same sometimes, it frustrates her to see even her Feeling friends glued ignored to their phones For those during rare who feel their opportunities partner has when they can ignored them all get together.

Daily News/ Geoff Crimmins in favor of a Using a smartphone too much can hurt many relationships.

Misner said one phone, begging thing both sides for more of a relationship need to keep in mind in times of communication can be frustrating. technology-related conflict is awareness. The key to Silas Harper Bray, a 26-year-old Moscow making your partner aware of their phone problem resident, knows the struggle. She recalled a fouris to make them realize it themselves, Misner said. year relationship with her ex-fiance and the daily “When you take that really strong urge and you frustration she felt to gain his attention that was butt it up against somebody who’s saying, ‘Hey, otherwise fixed on a video game or a smartphone.

I think this is a problem, you’re ignoring me,’ the “He’d be playing (a game) on his phone and would potential for conflict is very real and can get out of not have any registration of me or any other part of hand pretty quick,” Misner said. the world,” Harper Bray said. “He was just sort of He advises couples and individuals to make a 24sucked into this technology and I found that really hour log of every time they open their phones and frustrating.” to take their own technology holidays to increase Though Harper Bray said those issues were not self-awareness. necessarily what caused the relationship to fall ...continued on page 11 apart, they were certainly symptoms of a deeper Spring 2017

Throwing light on the winter blues Long, hard season increased reported cases of seasonal affective disorder

By CHELSEA EMBREE Lewiston Tribune

Ask anyone about the long, cold, snowy winter and a likely response includes groans and complaints.

For some people, though, this winter had them bluer than usual.

Mental health care providers have reported increases in diagnosed cases of seasonal affective disorder, as well as symptoms worsening for those suffering from depression. But there are a number Board Certified Diplomate, American Board of Podiatric Surgery

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of steps that everyone can take to feel better as the wait for brighter spring-like conditions continues.

Vanessa Matossian, a licensed professional counselor with Scott Community Care in Moscow, said this winter brought out a seasonal component in clients who have mental health disorders. “Clients that suffer from depression, and anxiety as well — they’ve had a rough time this winter,� she said.

Rhonda Allenger, mental health clinical director for Palouse River Counseling in Pullman, said she’s observed a number of factors that have compounded to make this winter especially hard. People moving from sunnier climates, the tumultuous presidential election and increased access to health care with the Affordable Care Act have resulted in the counseling center’s caseload “busting at the seams,� she said.

Allenger added there’s been a “huge increase� in seasonal affective disorder this year, with the condition nearly identical to depression. Unlike depression, though, seasonal affective disorder occurs only during winter months, usually starting when daylight hours shorten with the autumn equinox.

The symptoms of both depression and seasonal affective disorder include lack of energy and feeling tired, lack of motivation, loss of interest in former pursuits, sleep disturbance and weight gain.

Both Matossian and Allenger noted, though, that everyone experiences some level of decreased activity as daylight hours get shorter. “I think that the amount of light that we receive really has an impact on all of us,� Matossian said.

She and Allenger suggested bright light therapy, which involves sitting in front of a special light for about 20 minutes each morning. Allenger said the light needs to be at a level of 10,000 lux in brightness in order to work effectively, and added such lights are available at Wasem’s in Clarkston.

Any amount of brightness will help, Allenger said.

“Having lights on just in general is going to give you cues about being alert,” she said.

People can also take a vitamin D supplement, determining the right amount by talking with their primary care physician. Additional steps people can take to alleviate seasonal blues include socializing with friends and family, volunteering, exercising and getting outside whenever possible. Allenger also suggests maintaining structure in one’s day, like waking up at the same time daily.

Matossian recommends planning spring and summer camping trips or vacations to look forward to, and said keeping a gratitude journal can also help.

“I tend to think of the mind as kind of like a flashlight, in that you can only focus on one thing at a time,” she said. “So if you can train that focus on ... things that are working well in your life, that takes some thought focus off of the struggles that you’re experiencing.”

In more serious cases, people may consider seeking out a therapist or medication.

“When it becomes really impairing and it impacts your life — you’re not getting out and it’s impactful on your relationships and it’s impactful on your work — those are places where maybe you want to

Tribune/Barry Kough

Many suffer from seasonal depression, especially when indoor light is often brighter than the outdoor light.

see what else is going on,” Allenger said.

If it becomes difficult to keep commitments and get things done, or if there are suicidal thoughts, Matossian said it might then be necessary to talk to a doctor.

For those who have noticed their mood change seasonally, Matossian said now might be a good time to start planning for next winter. She suggested ordering a “happy light” to test out and get used to now, so that it’s ready to go by the time it should start getting use in late August.

“With a little preparation and taking a few simple steps like that, it can make the winter so much easier,” Matossian said.

——— Embree may be contacted at cembree@lmtribune.com or (208) 669-1298. Follow her on Twitter @chelseaembree.

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Spring 2017

W.H.O.: Depression a leading cause of illness, disability worldwide Sufferers should not wait to ask for help

By Shanon Quinn

until it’s really severe,” she said.

Kitzrow said there is no reason for an individual to wait before seeking help for depression symptoms.

The global rate of depression has increased 18 According to W.H.O., those symptoms include percent since 2005, making it the leading cause of persistent sadness, lack of energy, changes in disability and ill health worldwide and the majority appetite or sleep patterns, anxiety, substance abuse, of those suffering from the illness are not receiving a loss of interest in activities that people normally adequate care, according to a enjoy and an inability to carry recent study released by the out daily activities for two World Health Organization. weeks or more.

According to W.H.O., 50 An estimated 16 million percent of those suffering adults — 7 percent of from depression in high the population — have income countries do not experienced at least one major receive adequate care, while depressive episode in the past the percentage increases to 80 12 months, according to the to 90 percent in low income National Institute of Mental countries.

Daily News/ Geoff Crimmins health.

Martha Kitzrow, a The global rate of depression has risen 18 For those struggling with percent since 2005, according to the World licensed psychologist with depression, anxiety or stress Health Organization. the University of Idaho’s in their daily lives, speaking Counseling and Testing Center, to another person, whether friend, family or a said depression, along with anxiety, is one of the professional, is a beneficial first step to take, most common ailments she sees at the center.

Kitzrow said.

Not only is it common, depression remains an “Some people will keep it all inside,” she said. ailment with a stigma attached. The stigma was While turning to friends and family can be helpful, noted by both the W.H.O. and Kitzrow.

Kitzrow said sometimes the people closest to the Kitzrow said that stigma can affect whether sufferer will feel overwhelmed and not know how individuals seek treatment. to react.

“There’s still some hesitation,” she said. “ ‘I She recommended reaching out to organizations should be able to pull out of this myself,’ ‘maybe like the Counseling and Testing Center, which is it’s a weakness.’ ” available to help regardless of the severity of the Sometimes the stigma can affect how long it takes problem. individuals to seek help.

——— “Some people have the feeling they should wait Moscow-Pullman Daily News

Shanon Quinn can be reached at (208) 883-4636, or by email to squinn@dnews.com.

10 Balance

“As soon as people do that, then they become shocked, absolutely shocked at how many times they check in and how much of their time it really kind of drains away from their everyday life,” Misner said.

Not all bad

Of course, for long-distance couples, sometimes smartphones end up becoming the glue that holds a relationship together.

Lyndsie Kiebert, 21, of Moscow, lives hundreds of miles away from her boyfriend, John Onofrey, 21, in Montana. The two have been in a relationship for three years, most of the time separated by state lines.

Onofrey is not one to check his phone every second, Kiebert said. He is an outdoorsy type, preferring to fish and hike rather than scan his smartphone.

Kiebert, on the other hand, is checking social media constantly. That is where her relationship

with Onofrey began — on Instagram, after she commented on one of his photos.

The two had known of each other before through mutual friends, but that simple interaction on Kiebert’s very first smartphone sparked a flame that has been burning since 2014.

“If it weren’t for Instagram, we wouldn’t have started talking,” Kiebert said.

Kiebert said the two used to be in contact constantly — something that made her feel secure.

It was a way to constantly be checking in.

“A smartphone is a way to really drive yourself crazy,” Kiebert said.

That constant need for connection has since cooled down. Now, the days consist of a morning text, perhaps a Snapchat during the day and a text at night. Kiebert and Onofrey have learned to savor conversation time and make it meaningful, rather than constant.

——— Taylor Nadauld can be reached at (208) 883-4630, by email to tnadauld@dnews.com and on Twitter @tnadauldarg.

5 03 9 09 -1 7

Can You Hear Me Now?...continued from page 7

Spring 2017 11

Nothing to sour about More are discovering the health benefits of apple cider vinegar

By ELAINE WILLIAMS Lewiston Tribune

The owner of Lewiston’s Good Health natural foods store points to himself as an example of how drinking apple cider vinegar can make your life better.

Richard Jackson is 70 years old, gets out of bed at 4 a.m. every day to start a daily routine that involves walking 10,000 steps, completing 100 pushups and crunches and teaching three boxing classes at his gym.

His secret to maintaining that level of activity

while eating very little involves consuming apple cider vinegar every day, something he’s done for as long as he can remember.

His store stocks raw, organic unfiltered apple cider vinegar made by Bragg and Spectrum, selling anywhere from two to six cases a week, Jackson said. “It’s not new. I’ve literally sold it in Lewiston since the 1970s.”

The vinegar buzz has become more prevalent recently as the potential health benefits circulate on the internet, Jackson said. “I’m sitting back laughing because it’s not new for me.”

Similar dynamics are in play on the Palouse.

Tribune/Steve Hanks

Bragg Apple Cider Vinegar, local made honey and water make for a sweet and sour elixir to help with troubles.

12 Balance

But other plant-derived foods such as red wine, cider, tea, coffee, berries and red onions, also contain polyphenols, Ewing said.

Studies have indicated that consumption of vinegar in general can reduce blood glucose and insulin levels while increasing the feeling of being full after a meal, Ewing said.

It’s possible that other foods with a high acidic content, such as pickles, have a similar impact, Ewing said.

How much vinegar to use should be considered in a broader context, Ewing said. “It is important to dilute the vinegar, either in water or a food like salad dressing, to protect your teeth, throat and stomach from the high acidity.”

The other thing to remember is that natural doesn’t necessarily equate to harmless, Ewing said. “Your doctor will be able to help you figure out if apple cider vinegar is something that you may want to incorporate into your diet.”

——— Williams may be contacted at ewilliam@lmtribune.com or (208) 848-2261.

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Vinegar sales are steady, but the Moscow Food Co-op is seeing more customers purchase readyto-drink beverages that combine vinegar with fruit flavors such as apple, cherry or lime.

They cost about $3 to $4 for a 12- to 16-ounce serving, compared with less than $4 for Richard Jackson a 16-ounce bottle of the vinegar, said store manager Kerry Morseck.

“Kombucha has opened the pallet to a more sour flavor and folks are really embracing it,” Morseck said. Whether raw, organic, unfiltered apple cider vinegar is good for anything more than cooking is a matter of debate.

The co-op doesn’t make any health claims about foods, but for years vinegar has been considered a folk remedy that can aid with weight loss, address digestive issues or support the immune system, Morseck said.

Personally, she has more energy when she drinks a beverage at lunch that contains vinegar, a small amount of apple juice, cinnamon and stevia, Morseck said. Vinegar is also known for reducing the frequency of needing to urinate, cleaning the toxins out of the lower bowels, stopping leg cramps and putting a quick end to yeast infections by soaking in a tub where a pint of vinegar has been added, Jackson said.

Science suggests some health benefits, but anyone using vinegar for medical reasons should do so only in consultation with a medical professional, partly to guard against side effects, said Brianna Ewing in an email.

She is a clinical assistant professor and food and fermentation specialist at the Washington State University Mount Vernon Northwest Research and Extension Center.

Chlorogenic acid, a natural antioxidant and one of a number of polyphenolic compounds, is found in apples and apple cider vinegar, Ewing said. “An increase in polyphenol consumption has been shown to result in decreased risks of diabetes and obesity.”

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Spring 2017 13

Bacon, soda not the way to go Moscow nutritionist recommends fresh, prepared foods

By Garrett Cabeza

Moscow-Pullman Daily News

Americans are consuming too much bacon and soda and skimping on nuts.

Big surprise.

The result is an increase in deaths from heart disease, strokes and diabetes, according to a recent study published in the Journal of the American Medical Association.

The research is based on U.S. government data showing there were about 700,000 deaths in 2012 from heart disease, strokes and diabetes and on an analysis Americans drink too many sugary drinks. of national health surveys that asked participants about their eating habits.

The study indicated healthy foods that were under-eaten include nuts and seeds, seafood rich in 14 Balance

omega-3 fats such as salmon and sardines; fruits and vegetables; and whole grains.

Unhealthy foods or nutrients that were over-eaten include salt and salty foods; processed meats such as bacon, bologna and hot dogs; red meat including steaks and hamburgers; and sugary drinks.

Mindy Rice, a registered dietician nutritionist at Balanced 360 Nutrition Consulting in Moscow, said the study is “100 percent on the money.”

“It’s just American culture, American diet,” Rice said. “Those are the things we eat.”

Rice said it is simple to fall into unhealthy eating habits.

Daily News/Geoff Crimmins “We eat way too much packaged food, we eat way too much sodium, way too much sugar, and I really just think it goes back to preparing beforehand,” Rice said.

She said people could consume less sodium if they

simply eat fresh foods with a dash of salt at home rather than eating pre-packaged foods.

Rice said it is not necessary to completely cut out unhealthy foods like pizza and french fries, but those foods should be consumed moderately.

And for those looking to shed a few pounds while getting healthier, cutting out sugary drinks could make a huge difference.

Rice said she has seen people lose 20 pounds by simply eliminating soda from their diet. She added some coffee drinks, such as a 20ounce flavored mocha with whip cream, can have 600 to 1,000 calories.

“People don’t realize how many calories they are consuming in pop or even an espresso drink,” Rice said.

She also said bacon has high concentrations of saturated fat and sodium, which is bad for the cardiovascular system. Rice said one piece of bacon has around 5 grams of fat and 75 calories.

Rice said that a key way to help people eat better is to have them think about food in terms of what it can do for their body rather than thinking about the foods that should not be eaten. Rice said some natural high-fat foods, such as avocados and peanuts, have heart-healthy fats. She also recommends the Mediterranean diet, which includes eating large amounts of fruits and vegetables; protein from nuts, seeds, fish and beans; whole grains; and limiting red meat consumption.

Rice also encourages people to drink more water. She said she does not usually recommend fruit juice but if people really enjoy it, then she suggests 100 percent fruit juice and only drinking 6 ounces of it a day. She recommends consuming drinks that are low in calories, including plain coffee, tea and iced tea.

“I just encourage things that have nutrients and give you more bang for the buck,” Rice said.

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15

Pain in the foot Weight gain may lead to plantar fasciitis

By JOEL MILLS

Lewiston Tribune

In his 25 years of healing feet, Dr. Richard Allen has treated a lot of plantar fasciitis. And he believes he knows why.

“It’s gotten more rampant, I think, as people have gotten heavier. You don’t see nearly as much plantar fasciitis in countries where everybody is skinny,” the Lewiston podiatrist said of his theory. “I think it’s the No. 1 problem I see.”

Runners and high-end athletes can also be susceptible to plantar fasciitis due to the extreme stress they put on their feet. But putting extra weight on the plantar fascia — a taut, thick strap

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of tissue that connects the heel to the base of the toes to support the arch — can add enough tension to cause painful inflammation.

Allen said his opinion about obesity contributing to plantar fasciitis is based on his experience, and not any Richard Allen scientific study. But when looking at the foot from a mechanical point of view, it just makes common sense that a heavier person would be more susceptible to the condition.

“The more pressure you put on it from up above, it has to give way,” he said. “And it gives way in the form of inflammation, at the heel mostly.”

In rare cases, the tissue can actually tear away from the bone. Retired NFL quarterback Peyton Manning had perhaps the most famous case of plantar fasciitis in 2015, when just such a tear threatened to end his career.

A more typical case of plantar fasciitis starts with mild discomfort in the sole of the foot, usually around the heel after a period of rest, like a night’s sleep. Most people can walk it off as the plantar fascia stretches But some cases progress into constant pain when putting weight on the foot, or even when resting.

“That’s the time to do something about it, because it’s pretty easily treated,” Allen said.

A trip to the shoe store is frequently enough to avoid a trip to the doctor. Allen recommended simply getting better shoes or insoles that provide full-length arch support to relieve the tension on the plantar fascia.

“Motion-control” or “anti-pronation” shoes and insoles are good terms to remember when shopping

impressions of the patient’s feet.

Those insoles aren’t often covered by insurance, and can cost about $300.

“If they were cheaper and covered by insurance, we’d probably do those first because they work so well,” Allen said.

Less than 5 percent of cases require surgery.

The procedure involves cutting about halfway MedlinePlus.gov through the The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. plantar fascia to create space for better foot support. And staying away from soft, for scar tissue, squishy products like those filled with gel is also a which effectively lengthens it and relieves tension good idea. and inflammation. Recovery can be lengthy, with “Standing in Jell-O might feel good at the store, patients usually taking about six weeks to feel better but it doesn’t last long,” Allen said. “Get something than they did before the surgery. They can return to a little more rigid that can control the way your foot full activity after about three months. moves. That’s what works.”

“So it’s no walk in the park,” Allen said.

If a trip to the doctor becomes necessary, Allen Ironically, he said some of the most severe begins with an X-ray to determine if a bone spur cases can resolve themselves. When the plantar on the heel is present. Spurs can contribute to the fascia tears and then heals, it can have the same condition, but don’t always require surgery to lengthening effect as surgery. correct.

Surgery has a success rate of more than 90 percent, The typical, conservative course of treatment will and Allen said he couldn’t recall a case of plantar then involve a steroid or cortisone injection or the fasciitis that he wasn’t able to eventually correct. use of other anti-inflammatory drugs to ease the pain. If that doesn’t provide sufficient relief, Allen ——— then moves on to custom orthotic insoles that are Mills may be contacted at jmills@lmtribune.com or (208) 848-2266. made in about three weeks by an outside lab using Spring 2017 17

Lung cancer screening Despite prevention guidelines, few smokers seek CT scans to check for lung cancer

By Michelle Andrews Kaiser Health News

Lung cancer screening rates have barely budged in recent years, according to a new study, even though under the health law many people don’t have to pay anything out-of-pocket for them because the test is recommended by a panel of prevention experts.

In 2010, just 3.3 percent of eligible smokers surveyed said they had received a low-dose computed tomography scan in the past year to check for lung cancer. In 2015, the percentage had inched up to 3.9 percent, or 262,700 people out of 6.8 million who were eligible.

The analysis of data from the National Health Interview Survey, a large, ongoing in-person federal

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survey conducted by the National Center for Health Statistics, was performed by researchers at the American Cancer Society and published online in JAMA Oncology.

Despite steady declines in smoking, lung cancer is the No. 1 killer among cancers, accounting for more than 150,000 deaths annually. Smoking is linked to up to 90 percent of lung cancers, according to the Centers for Disease Control and Prevention.

In 2013, the U.S. Preventive Services Task Force, an independent panel of medical experts, recommended annual low-dose CT scans for current or former smokers between the ages of 55 and 80 who smoked for “30 pack years” - the equivalent of a pack a day for 30 years - and currently smoke or quit within the past 15 years. Under the health law, health plans have to cover preventive services that are recommended by the task force without charging consumers for them. Medicare also covers the test for eligible beneficiaries, but coverage for Medicaid enrollees varies by state.

More than half of smokers who met the task force guidelines for screening were uninsured or had Medicaid, the federal/state health program for lower income people, the study found. For these people, the cost of the test, which can run several hundred dollars, could be a deterrent to screening, said Ahmedin Jemal, a vice president at the American Cancer Society and the study’s lead author.

But there are likely other reasons as well, Jemal said. Physicians may also have a knowledge gap. In one study cited in their report, nearly two-thirds of physicians surveyed didn’t know that low-dose CT screening should be done annually in people who are at high risk for lung cancer. In addition, it can be challenging to locate a medical center that has extensive experience with lung cancer.

Epilepsy breakthrough Implant helps stop brain seizures medication only to keep their condition in check.

For others, however, removing the part of the brain that is causing seizures may prove most effective in Imagine a seismograph — the instrument that ridding victims of their attacks. measures and records earthquakes and volcanic But the so-called responsive neurostimulation eruptions — for your brain. system, or RNS for short, developed by Mountain Except this one has a wireless link to a device View-based NeuroPace, treats adults with epilepsy implanted in your head that stops epileptic seizures who don’t at their source, respond to halting the medication or for sudden and whom surgery is violent attacks too risky. before they According to happen. the Institute It’s not science of Medicine, fiction.

800,000 For more than Americans still 1,000 Americans experience with the disorder, seizures like 43-yeardespite taking old Richard anti-seizure Lopez, the medications. system invented Frank Fischer, by a Silicon NeuroPace’s Bay Area News Group/Doug Duran Valley medical Richard Lopez, of Tracy, Calif., who has epilepsy, uses a special wand connected president and technology firm to a computer at his home to collect information from a small neurostimulator CEO, said has given them in his skull. That information is transmitted to his doctor at UC Davis. studies show that back their lives. after a patient tries two anti-seizure medications, Today, 3 million Americans — including 380,000 the chance that a third medication will control Californians — suffer from epilepsy, which is seizures is less than 5 percent. “Your quality of life associated with abnormal electrical activity in the is reduced because of the inability to participate in brain. all of the things we take for granted, like driving,” Experts say the causes of epilepsy are generally Fischer said. unknown, though some cases may be genetic, while With the RNS system, a neurosurgeon positions others can be brought on by head trauma, stroke or the leads of the device at the sources of the seizure central nervous system infection. and places a neurostimulator in the person’s skull.

Most of those who suffer from the disorder require

By Tracy Seipel The Mercury News

Spring 2017 19

Most patients go home the next day.

Dr. Vikram Rao, a neurologist at UC San Francisco’s Epilepsy Center, called the system “a game changer” because it helps a large group of patients who have no other alternative to reduce or end their seizures. He compared the system to cardiac pacemakers that detect abnormal heart rhythms, then deliver electrical stimulation to prompt the heart to beat normally. “That’s an analogy people can relate to,” Rao said.

Lopez still recalls his first grand mal seizure on a sizzling summer day in the mid-1980s, not long after moving to San Jose from Fresno, Calif. He’d gone with friends to Great America and was just stepping off the log flume ride when he began falling backward. He had no memory of losing consciousness or the violent convulsions that followed.

Medics gave his anxious parents some troubling news: It might be epilepsy.

Doctors soon confirmed the diagnosis. And for the past three decades they have prescribed what Lopez calls “the whole poster of epilepsy medications” that has sometimes controlled his chronic seizures — but that “basically wipe you out.”

The litany of drugs and even prior neurological surgery proved mostly ineffective in halting his attacks until Lopez’s yearslong quest for relief led him to Dr. Masud Seyal, director of the UC Davis Comprehensive Epilepsy Program. He recommended trying RNS. Unlike medications and other medical devices that deliver therapy whether or not someone is having a seizure, the implanted RNS system continuously monitors the brain’s activity and is programmed to detect and record specific patterns that can lead to a seizure. The neurostimulator responds with brief pulses of electricity that disrupt the abnormal brain activity before a seizure occurs.

Each patient also receives a 24/7 remote monitor with special software and a handheld wand. The setup wirelessly collects information from the 20 Balance

implanted device and sends it to a database that allows physicians to review seizure activity and manage treatment progress.

At first, however, Lopez said the results were discouraging because the seizures continued, though not as frequently. His doctor was able to fine-tune the device, however, which stemmed the attacks.

Also, like most RNS patients, he must still take his medications.

It’s a similar story for 23-year-old Adison Malkiewicz, a recent San Jose State graduate plagued by epileptic seizures since she was first diagnosed when she was 11.

For years, medications sapped her concentration and energy. And while the drugs thwarted some seizures, she said, they didn’t stop them altogether.

A different nerve stimulation device implanted in her chest wall, with wires leading to a nerve in her neck, didn’t work either. So by March 2015, her doctors recommended giving the RNS system a try, Malkiewicz said.

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Fatal brain disease Discovery could aid in development of treatments for fatal Huntington’s disease of neurodegenerative disease,” said Jonathan Grima, a graduate student in the Johns Hopkins University School of Medicine department of Huntington’s disease is an inherited brain neuroscience whose research was published in the disorder that is uniformly fatal, but researchers journal Neuron. at Johns Hopkins believe they have made a big Grima said it’s not clear if a drug developed discovery about how the disease progresses that to clear these jams could stop cells from dying, could lead to a way to stop it. and thus stop Their progression of findings offer Huntington’s, but hope for a that is the goal. treatment Grima works in to more the lab of Dr. than 30,000 Jeffrey Rothstein, Americans director of who have Hopkins’ Brain Huntington’s Science Institute. symptoms Rothstein, and another who normally 200,000 focuses on ALS, at risk of also known as inheriting the Lou Gehrig’s disease. They disease, has also could pursued similar help scientists cell research better for that disease understand Baltimore Sun/Kenneth K. Lam and a drug that other fatal Jonathan C. Grima, a neuroscience graduate student and fellow at Johns Hopkins and brain diseases Dr. Jeffrey D. Rothstein, professor of neurology, made a significant brain discovery may offer some about Huntington’s disease. treatment is being such as investigated. He amyotrophic lateral sclerosis and a certain type of said the lab is in the early stages of working on its dementia, as well as help researchers learn more own drug for Huntington’s. about normal brain aging.

Rothstein said he expects other scientists to build “We found these kind of traffic jams in cells, on the findings about Huntington’s disease in the and if we can fix the traffic jams we can search for a treatment. potentially provide a new avenue for treatment

By Meredith Cohn The Baltimore Sun

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The Huntington’s researchers, including scientists from other departments at Hopkins, as well as the University of Florida and the University of California, Irvine, have demonstrated how Huntington’s disease disrupts normal cell activity, Rothstein said.

Components of a brain cell, such as salts and proteins, need to move in and out of a cell’s operations center, the nucleus, to keep it functioning properly. In people with Huntington’s disease, proteins produced by the Huntington’srelated gene clump together in the nucleus and can’t pass through special passageways called nuclear pores — every cell has many of these pores — causing the cells to shut down and die.

While scientists have known there was a Huntington’s gene and knew about nuclear pores, they hadn’t been closely studied in the brain. They didn’t know about this clumping and clogging of the pores and breakdown in so-called nuclear transport in Huntington’s sufferers, Rothstein said.

The discovery was met with intense interest by Huntington’s researchers.

“This is very exciting research because we didn’t know what mutant genes or proteins were doing in the body, and this points to new areas to target research,” said George Yohrling, senior director of mission and scientific affairs at the Huntington’s Disease Society of America. “Scientists, biotech companies and pharmaceutical companies could capitalize on this and maybe develop therapies for this biological process.”

Yohrling said there are only two treatments now for Huntington’s disease, one just approved in recent weeks by the U.S. Food and Drug Administration. They both help ease gait and movement problems that are associated with the disease. Other drugs are used to treat depression and anxiety that also normally accompany a Huntington’s diagnosis.

But there is nothing to stop or slow the

progression of the disease, which causes sufferers to lose the ability to reason, speak and walk over a 10- to 25-year period, according to the Huntington’s Disease Society. Symptoms usually appear at age 30 to 50 and sufferers have a 50-50 chance of passing the disease on to their children.

For the Huntington’s research, the scientists used mice as well as human stem cells and human tissue to test their research ideas. Research findings in rodents, typically used as stand-ins for humans, frequently disappoint researchers when they try to reproduce the work in humans. But since this research also involved cells and tissue from humans, Yohrling noted, scientists are more confident in the findings.

For all the optimism about the research — and Yohrling said there was plenty in the Huntington’s research community — he cautioned that the work is early. It’s still not clear if a drug to protect cells would ameliorate symptoms in humans, or how much or for how long it would slow or stop the disease.

The Hopkins researchers and other scientists echoed those warnings.

An effective treatment for Huntington’s likely will require a cocktail of drugs to control symptoms and stall disease progression, said Charbel Moussa, director of the Translational Neurotherapeutics Program at Georgetown University Medical Center.

That’s because the disease is complex and scientist don’t understand all of the affects that Huntington’s has on the brain and why some areas of the brain are unaffected, he said. The new findings nonetheless give researchers a leg up in their search for effective drugs.

“This significantly expands our understanding of Huntington’s disease pathology, and the pathology of diseases that are similar to Huntington’s disease, and even what we see in aging,” Moussa said. “We’re still, unfortunately, far from a cure.”

Spring 2017 22

Crossword

Mental Fitness

name 50. Fast, flightless Aussie 1. Baby’s first words bird 5. Expression of creative skill 51. Jerry, George, Kramer 8. Reddish-brown coating and __ 12. Spanish province 56. Dodger great Hershiser 14. Stinging insect 57. Where wine ferments 15. Greek temple pillars (abbr.)

16. Refurbish 58. Supreme Allied Cmdr.

18. Cave-dwelling amphibian Europe 19. Millisecond 59. Vedic god of fire 20. Removes something 60. Not well 21. Trendy 61. They grow into plants 22. The Buckeye State 62. Variety of pear 23. ‘Taken’ actor 63. Where golfers start 26. Of the skull 64. Posterior 30. Made a mistake 31. Malignant tumor 32. Not night CLUES DOWN 33. German heavyweight 1. Challenge boxer 2. Assert 34. Indicates weight 3. A female operatic star 39. Businessman 4. Expression of sorrow or 42. Charged negatively pity 44. Indian instrument 5. Resistance unit 46. Helps you know where 6. Attached a new backing youÕre going canvas 47. Written works 7. Method painting 49. Kate and Rooney’s last

CLUES ACROSS

8. Branched 9. Barefooted 10. Beer mug 11. Beloved Mexican dish 13. Make better 17. One-time king of Troy 24. Pie _ __ mode 25. St. Anthony’s fire 26. Reciprocal of a sine 27. __-rah skirt 28. Notre Dame coach Parseghian 29. Computer hardware company 35. Policeman 36. Black tropical American cuckoo

Sudoku puzzles are formatted as a 9x9 grid, broken down into nine 3x3 boxes. To solve a sudoku, the numbers 1 through 9 must fill each row, column and box. Each number can appear only once in each row, column and box. You can figure out the order in which the numbers will appear by using the numeric clues already provided in the boxes. The more numbers you name, the easier it gets to solve the puzzle!

Puzzle Answers on p. 15 23

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Sudoku

HOW TO PLAY:

37. Popular basketball player Jeremy 38. Electrocardiogram 40. Cheese dish 41. Prickly shrub 42. Atomic mass unit 43. Nostrils 44. Enchantresses 45. Emphatic typeface 47. One of the Florida Keys 48. Soft, fine material 49. Moutainous tract in Jordan 52. Breezes through 53. Professional assn. for tech pros 54. Class of comb jellies 55. Formerly (archaic)

503561D-17