Health Beat, 2014

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HealthBeat

2014

Are You Eating

CLEAN? Kids and Television Wash Your

HANDS! Dealing with

Animal Bites A Publication of the Lewiston Tribune and the Moscow-Pullman Daily News


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MONDAY, JULY 21, 2014

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Table of Contents

Page 2 .... Opthamology .......................................... Moscow Family Eye Care Page 3 .... Hospital .........Tri State Memorial Hospital & Medical Campus Page 4 .... Table of Contents Page 5 Acupuncturist .................................................................Healing Point Assisted Living ................................................Wedgewood Terrace Page 6.....Blood Center .............. Inland Northwest Blood Center Page 7....Chiropractor ......................Elm View Chiropractic Clinic Page 8...Dentists ......................... Maplewood Dental Dr. Bill Perez Meyers-Folsom Dental Clinic Page 9...Dentists cont. ................Studio Smiles Northwest Dr. Robin Henderson Page 10... Ears, Nose & Throat .....................Valley Facial Plastics & ENT Page 11... Family Medicine ...................................Moscow Family Medicine Page 14 .. Free Health Clinic ....................... Snake River Community Clinic Page 15 .. Home Care ....................................... Seubert’s Quality Home Care Page 16 .. Home Health............................Alternative Nursing Services, Inc. Page 17 .. Home Health cont................ A Compassionate Care Company Page 18 .. Hospital ...............................Whitman Hospital & Medical Center Page 18 .. Pharmacy ..............................................................Rosauers Pharmacy Page 19 .. Progressive Care ..................................... Avalon Progressive Care Page 19 .. Rehabilitation .................................Kindred Transitional Care and Rehabilitation Lewiston Page 20 .. Retirement Living ............................... Bishop Place Senior Living Page 21 .. Retirement Living cont.......Whitman Senior Living/Lifestyles Page 22 .. Sport/Physical Therapy ...................................Moscow Mountain Physical Therapy Page 23 .. Surgeons ..................................................................Palouse Surgeons Page 24 .. Medical Center ...................St. Joseph Regional Medical Center 4

HEALTH BEAT

MONDAY, JULY 21, 2014


Optimism Helps Your Heart Smiling, laughing and simply being happy can make all the difference for our hearts. In fact, new research shows that people with higher levels of optimism may be less at risk for heart failure than those who are more pessimistic. And with the breadth of heart failure’s effect on the nation – about 5.1 million Americans are afflicted ever year according to the Centers for Disease Control and Prevention – a little extra optimism is surely needed. HEART FAILURE STATISTICS Other eye-opening statistics from the CDC include: • One in nine deaths include heart failure as a contributing cause. • About half those who develop heart failure die within five years of diagnosis.

diagnoses in older adults, since statistics show that people ages 65 years and older are most prone to heart failure diagnoses. Researchers gathered, analyzed and translated data of more than 6,800 older adults, including health history, background information and psychological data over the course of four years. They also took into account factors that could affect heart failure risk, such as chronic illnesses and demographic factors.

The findings, published in the journal Heart failure costs the nation about $32 billion worth of health “Circulation: Heart care services, medications and missed days of work annually. Failure,” showed that the THE MAIN BEHAVIORS THAT CAN INCREASE YOUR RISK adults who had higher FOR HEART FAILURE ARE, THE CDC REPORTS: levels of optimism reduced their risk of heart • Smoking tobacco. failure by 73 percent. • Eating foods high in fat, cholesterol and sodium. Researchers deduced that staying positive • Not getting enough physical activity. may lead people to • Being obese. making healthier lifestyle choices, POSITIVITY STUDY therefore reducIn the study linking happiness to heart health, optimism was ing their risk for defined as “an expectation that positive things will happen.” heart failure. Researchers from the University of Michigan and Harvard University analyzed the linkage between optimism and heart failure

ACUPUNCTURIST

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Don’t Cheat Your Feet Most Americans log 75,000 miles on their feet by the time they reach age 50, according to the American Podiatric Medical Association (APMA). And much like you would maintain the tires of a car with that many miles, it is crucial to keep up on the general health of your feet. Regular foot care can lead to prevention, detection, intervention and treatment of foot and ankle problems, which can be downright debilitating to everyday life.

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GENERAL INJURIES & CONDITIONS Each foot has 33 joints that can be affected with arthritis, says the APMA. Fluid buildup in the joints couples with inflammation and swelling of the cartilage and lining of the joints to cause arthritis. Other common foot issues include sprains, strains and fractures. A sprain is a soft tissue injury, while a fracture is an actual break in the bone. People who are on their feet for extended periods of time for work or athletics may be more susceptible to both gradual conditions and sudden injuries that may require rest, surgery or both. SHOE INSERTS Shoe inserts, both pre-packaged and customfit, can be very helpful additions to your footcare strategy. They cushion your feet, provide HEALTH BEAT

MONDAY, JULY 21, 2014


lasting comfort and support your arches. The most common types of inserts are heel liners, arch supports, insoles or foot cushions. While helpful in mitigating less serious foot aches and pains, the APMA does not recommend inserts for correcting biomechanical or long-standing foot issues. FOOT HEALTH TIPS Foot care should be a part of your everyday routine. Half of all Americans report experiencing foot pain at some point in their lives, according to an APMA study. The organization recommends a bevy of foot-care tactics in an effort to reduce this substantial number. - Moisturize feet daily to help avoid dry, cracked and irritated skin. - Stretch and exercise your feet and toes to avoid muscle cramps. - Raise your legs often to reduce swelling cause by sitting too long in one position. - Wear the right kind of shoes for optimum comfort, support and padding.

CHIROPRACTOR

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Healthy Mouth: The Early Years Caring for your teeth and gums is a lifelong journey that begins shortly after birth. Dental professionals urge parents to bring their child in for a visit whenever the first primary tooth is visible. This recommendation, which used to define 3 as the starting age, has shifted over the years as the science related to oral hygiene has improved. What’s behind the change? The importance of baby teeth now carries more weight than ever before. The DENTISTS American Dental Association says that properly caring for those miniWe O Off ffer pearly Complete whites that

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A child’s first trip to the dentist can be an educational experience for parents. Dental professionals will show you how to properly clean your baby’s teeth and recognize trouble signs in the mouth, which are critical health tips not usually doled out during pregnancy or within parenting magazines. Dentists can also explain babyspecific concerns regarding dental health, which include baby bottle tooth decay. Avoiding this potentially damaging issue is simple:

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PARENT EDUCATION

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begin popping up through the gums at around 6 months is crucial in keeping space in the jaw for adult teeth.

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The ADA recommends wiping your baby’s mouth with a clean gauze pad to help remove plaque that can harm erupting teeth. Gentle brushing with a toothbrush and water should begin as soon as you start seeing teeth. DENTAL EMERGENCIES Once more teeth start showing up, the risk for dental emergencies increases. Accidents happen, but knowing how to react in such situations can be the key to retaining your child’s oral health. Here is how the ADA recommends you act in a dental emergency:

• Keep a knocked-out tooth moist at all times. If you can, place the tooth back in the socket without touching the root and call your dentist right away. • For a cracked tooth, immediately rinse the mouth with warm water to clean the affected area. Look out for facial swelling and treat appropriately with cold compresses.

DENTISTS

MONDAY, JULY 21, 2014

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Preventive Tests for Men The words “men� and “doctor� don’t always fit in the same sentence, but they should. Screening tests can find potentially harmful diseases early on, when they’re easiest to treat. This can mean more years of enjoying time with your family and friends, as opposed to fighting illness or worse.

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The U.S. Department of Health BLOOD PRESSURE and Human Services recommends High blood pressure increases the following screenings for men: your chance of getting heart or kidney disease, and is recomBODY MASS INDEX mended to be checked every two BMI is a measure of your body fat years. based on your height and weight. It is used to screen for obesity and CARDIOVASCULAR DISEASE Beginning at age 45, you should can serve as a helpful measureask your doctor about incorporatment to keep you on track with ing a daily aspirin to help reduce your diet and exercise plan. your risk of a heart attack. A speCHOLESTEROL cial screening will help your doctor Once you turn 35 years old, have make the decision. your cholesterol checked reguCANCERS larly. High blood cholesterol is one Men ages 50 and above should be of the major risk factors for heart tested for colorectal cancer. How disease. Catching it early can lead often you are screened depends to effective treatment and better on your risk factors, and you may heart health. need to be checked before age

50. Also ask your physician about testing for other cancers, including prostate, lung, oral or skin. DEPRESSION If you have felt “in the dumps” during the past couple of weeks, you may need to speak with your doctor about depression. It is a treatable illness, and keeping it in check can help you maintain interest in the hobbies and activities that you enjoy. DIABETES If your blood pressure is higher than 135/80, ask your doctor to test you for diabetes. High blood sugar can cause problems with your heart, eyes, feet, kidneys, nerves and other body parts.

FAMILY MEDICINE

Five Wishes: Living Will Workshop

your personal, emotional and spiritual needs as well as your medical wishes. It lets you choose the person you want to make health care decisions for you if you are not able to make them for yourself. Five Wishes lets you say exactly how you wish to be Who you want to make health care decisions for you when you can’t make them. The kind of medical treatment you want or don’t want. How comfortable you want to be. How you want people to treat you. What you want your loved ones to know.

Have you heard about the new H M The federal centers for Medicare & Medicade Services (CMS) is implementing a NEW Annual Wellness Visit for Seniors! This visit at Moscow Family Medicine focuses on interviewing you and updating portions of your medical history in order to help identify any risk you have for serious health issues.

What to Expect?

At your Annual Wellness Visit, by CMS as screening instruments. These questions will assess: Your risk for depression; Your memory and cognition; Your risks for falls or injury; Weight and nutritional status; and Determine and recommend the preventative health services that are due. “This visit will be like no other you’ve had before.” -Carrie Barron, R.N.

August 11, 9-11am & September 15, 6-8pm . The Gritman Center Call 208-882-2011 to RSVP for this FREE workshop.

Call Moscow Family Medicine TODAY to set up your appointment!

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MONDAY, JULY 21, 2014

HEALTH BEAT

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Kids and Television How much daily tube time do you give your kids? Two hours? Four? Six? The amount of time children spend watching television can have a direct impact on their sleeping habits, according to new research. The researchers, from Massachusetts General Hospital for Children and the Harvard School of Public Health, followed 1,800 children from infancy to almost 8 eight years old. The team asked their parents how much TV the kids watched when they were 6 months old, then every year after.

so important to children? Sleep deprivation in children is linked to worse performance in school, along with depression, injury, and obesity, according to the sleep study authors. By cutting down on TV and spending more time enjoying other pastimes, children can improve their sleep quality.

The result was clear: The more TV the kids watched, the less they slept. Children with a TV in the bedroom also lost sleep – sometimes up to half an hour less than those in TV-less rooms.

FAMILY MEDIA PLAN

TV-SLEEP CONNECTION One of the main reasons TV can shift sleep patterns is its ability to stimulate a delay in the onset of sleep. Watching violent TV might also lead to interrupted sleep, according to the American Academy of Pediatrics, since it might create anxiety that could prevent sleep if awakened in the middle of the night.

TV remains the most popular medium for children and adolescents, but these other options are providing more “screen time” across the board. The AAP encourages parents to establish and enforce family media plans that spell out clear guidelines for when and how often children can have access to media.

So why is sleep 12

The AAP is concerned not only about children and TV, but also what it describes as new media spanning cell phones, social media, iPads and other devices capable of connecting online.

HEALTH BEAT

MONDAY, JULY 21, 2014


Turning Off Technology Sometimes it’s best to slow life down a bit. And with the powerful impact of technology on our daily lives, that can mean turning off and tuning out from our devices. A one-day – or even onehour – purge from our smartphones, tablets, laptops and flat-screens can help restore

our connection with the people and places around us. And that can have lasting positive effects on our health, according to multiple studies, including one by the National Sleep Foundation that found too much technology may interfere with healthy sleeping patterns. SET SOME LIMITS Track how many times you check your email, Facebook account or Twitter feed each day. Also track how many times you have a meaningful conversation with your spouse, family member or friend. MONDAY, JULY 21, 2014

Write down the total numbers, compare them and prepare to be

amazed. Is the technology-related number double the meaningful conversation one? Triple? It may be time to set limits on your technology use. You can choose to check email only after a certain time in the morning or only after a certain time at night. Set your smartphone’s do-not-disturb setting and handle all of your emails and messages at one time. RECONNECT WITH NATURE Getting reconnected with Mother Nature can be a great way of unplugging from your technology-filled life. Leave the tablet and laptop at home and head out on a camping trip. Or spend the afternoon hiking – without your favorite HEALTH BEAT

device attached to your fingertips. It is still a good idea to bring your phone along on camping or hiking trips in case of emergencies, but

leave them in your backpack and reclaim your relationship with nature, friends and family members. SOCIAL NETWORKING STRESS A study by Utah Valley University found that too much time spent on social networks such as Facebook and Twitter can cause user envy and stress. People may see their friends or family members posting mainly positive messages and updates, and become jealous of their lives. This can be a potentially damaging reaction, especially for people who may be dealing with negative life issues, according to the study.

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Wash Your Hands! Quick, when’s the last time you washed your hands? Right before you picked up this section? Thirty minutes ago? Two hours ago? Gulp, six hours ago? out of three young children who get sick with diarrhea and about one out of six young children with infections like pneumonia.

Maintaining clean hands is one of the most important deterrents to sickness and the spreading of harmful germs. Many diseases and conditions are attributed to people not washing their hands with running water and soap for the proper amount of time. The Centers for Disease Control and Prevention recommends a very specific method for washing hands, one that is backed by data from numerous studies and research projects. More on that below, but first check out some of the CDC’s most striking numbers related to hand-washing.

- Proper hand-washing could reduce respiratory illnesses, like colds, in the general population by about 21 percent. - It could also lead to a 58-percent reduction in the number of diarrheal illnesses in people with weakened immune systems. HOW TO WASH YOUR HANDS Wet: Use clean, running water to wet your hands. The CDC says temperature of the water does not appear to affect microbe removal.

Lather: Create friction by lathering and scrubbing your hands together. And don’t forget those fin- About 2.2 million children under the age of five die gernails. The highest concentration of microbes is each year from diarrheal diseases and pneumonia. generally present there, according to the CDC. Hand-washing with soap could protect about one Scrub: Rub and scrub those hands together for at least 20 seconds – a time equivalent of humming the “Happy Birthday� song twice from beginning to end.

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Rinse: Soap and friction help lift the dirt, grime and germs from your hands, but rinsing sends them down the drain. Always use clean, running water to rinse, as using standing water that has been contaminated through previous use can re-contaminate the hands. Dry: The CDC says germs can be transferred more easily to and from wet hands, so drying your hands immediately after washing is crucial.

HEALTH BEAT

MONDAY, JULY 21, 2014


Cervical Cancer: Reducing the Risk The National Cancer Institute estimates that more than 12,000 new cases of cervical cancer and 4,000 deaths from the disease will be reported in the U.S. this year. cancer early.

The United States Preventive Services Task Force recommends screening begin at age 21, regardless of when a woman becomes sexually Cervical cancer is almost alactive. As a result of the Pap ways caused by human papil- test, cervical cancer rates lomavirus (HPV) infection, have declined dramatically: according to the National U.S. cervical cancer incidence Cancer Institute. And while and death rates were rethese types of cancers start duced by more than 60 from pre-cancerous cells, percent between 1955 and only some women with pre- 1992. cancers will actually develop TREATMENT & COPING cancer. Cervical cancer treatment opThe change from cervical tions include surgery, chemopre-cancer to cervical cancer therapy, radiation therapy, usually takes several years, immunotherapy and vaccine but it can happen in less therapy. Depending on a than a year, according to the patient’s specific needs, treatAmerican Cancer Society. ment may need to employ EARLY DETECTION only one of these treatment plans. Others strategies may The Papanicolaou (Pap) test was introduced in the 1950s contain a combination of options. and still serves as the most crucial screening to identify cervical cancer. The test – named after the doctor who invented it – examines a sample of cervical cells under a microscope to identify any problems and detect cervical MONDAY, JULY 21, 2014

their quality of life. From physical to emotional hardships, patients are urged to reach out to their local physicians or support groups to find ways to cope.

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Cervical cancer forms in tissues of the cervix, which is the organ connecting the uterus and vagina. It is usually a slow-growing cancer that may not have symptoms.

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Are You Eating Clean? It’s a health industry buzz phrase that has helped promote the effort of consuming healthier, more natural foods. But “eating clean” is anything but a passing trend.

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etables.

The United States Department of Agriculture urges adults to consume about three cups of fruits and vegetables per day. The specific amount of fruits and vegetables your body requires to remain at optimal health depends on your age, sex and level of physical activity.

cereals, candy, yogurt and baked goods. Always read the nutritional information of the products you are considering buying. If the sugar content of a potential purchase makes up a large percentage of your daily intake, consider swapping it out for a fruit or vegetable.

By making half of your plate fruits and vegetables at each meal, you can easily meet your body’s needs. And your body will thank you for the extra vitamins, antioxidants and hearthealthy fiber found in most all fruits and veg-

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Cooking clean doesn’t have to translate to you spending hours upon hours in the kitchen. In fact, by simply doubling your favorite clean recipe, you can have plenty to portion and

store in the freezer for future meals. This strategy can help arm you in your fight against the urge to splurge on takeout. Instead, you can choose the easy and affordable option of reheating and enjoying your clean meal.

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Dealing with Animal Bites An animal bite can be both painful and dangerous, depending upon the situation. If you or someone you’re with is bitten by an animal, it is crucial to assess the situation within the first few minutes to determine if medical treatment is necessary. If out in nature, this can obviously be a more difficult task. Bites from snakes or bats, for example can be more alarming than a bite from a domestic animal. Every situation is unique, so always have a first-aid kit handy, and use your common sense to guide your decisions on seeking medical assistance. COMMON BITES

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WHAT TO DO - Minor wounds: Wash the wound as thoroughly as possible with soap and water. Also apply an antibiotic cream and a clean bandage to protect the wound from infection. - Deep wounds: Stop the bleeding by applying pressure with a clean, dry cloth. Depending upon your location and severity of the wound, you should either be driven to your local health care professional or call 9-1-1 for emergency situations. - For infection: Swelling, redness, increased pain and oozing – these are all signs of infection and should be checked by your doctor immediately. TETANUS SHOTS The Centers for Disease Control and Prevention recommends getting a tetanus shot every 10

years. In the case of a deep or dirty bite wound, your doctor may suggest a booster, especially if your last tetanus shot was more than five years ago. The CDC also recommends that children or adults exposed to bats, or who are sleeping and discover bats present, seek medical advice. Even if you don’t think you’ve been bitten, it is important to be checked out because bat bite marks can be very difficult to spot.

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Teen Mental Health The teenage years can be a tough transition – for both parents and children. Physical, mental and emotional changes come on quickly during the teenage years. Throw in the pressures from friends to fit in, from teachers to perform and from parents to live up to their expectations, and being a teen is no easy task. Parents play a vital role in ensuring smooth transitions, both entering, during and exiting the teenage years. And according the American Academy of Family Physicians (AAFP), communication is the greatest tool that

parents have at their disposal.

- Lack of motivation or empathy.

WARNING SIGNS

- Fatigue or loss of energy.

Teens are at risk for a multitude of self-destructive behaviors, according to the AAFP, and there are certain signs that may signal that your child is having an issue:

- Low self-esteem.

- Agitated behavior. - Rapid weight loss or gain. - Drop in school grades.

- Trouble falling and staying asleep/ COMMUNICATION IS BEST Take any of the aforementioned warning signs seriously. Ignoring them can only accelerate a negative behavior, and it is easier to deal with problems before they

RETIREMENT LIVING

HOME IS WHERE YOU FEEL IT Having fun is more than a Bingo game. At home you follow your own interests, hobbies and entertainments. At Bishop Place, our Life Enrichment program lets you do just that, from water aerobics to scrapbooking to morning coee talk to book club, the choice is yours.

Our home, your home. Come feel it.

815 SE Klemgard, Pullman (509) 334-9488 www.BishopPlace.net 20

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spiral out of control. Talking through a potential issue can help you and your teen discover what may be sparking his or her decisions. Be understanding of what your teen is going through and simply listen, stay positive and help your child feel good about him or herself. The AAFP reminds parents that teens are reactionary by nature and decide how they feel about themselves in large part by how their parents react to them.

- National Institute on Drug Abuse (888-NIH-NIDA). - National Institute of Mental Health (800-421-4211).

HELP The AAFP urges you to reach out to your family doctor if you are concerned about any potential warning signs from your teen. There are also numerous national hotlines for information, reference and advice, including: - American Academy of Child and Adolescent Psychiatry (202-966-7300).

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Training Tips for a 5K

Youth Sport Injuries

Every year in the USA, more than 3.5 million children under the age of 15 require medical treatment for sports injuries. On average, the rate and severity of injury increases with a child’s age. For example, during a single youth baseball season, 20% of children ages 8 to 12 and 45% of those ages 13 to 14 will have arm pain. According to the U.S. Centers for Disease Control (CDC), more than half of all sports injuries in children are preventable. Since the passage of Title IX in 1972, girls’ participation in sports has increased dramatically (up to 900%). Studies have proven that participation in athletics leads to better self-esteem, better grades and higher aspirations when it comes to education and career choices. The speed, power and intensity displayed by female athletes have dramatically increased over the past decade. One downfall of this change is a significant increase in female knee injuries - particularly anterior cruciate ligament (ACL) tears – in girls post-puberty. Recent studies have shown that female athletes are up to 8x more likely than boys to suffer a serious non-contact ACL injury. Although there are many factors which may contribute to this difference, some of the latest research indicates that neuromuscular control is one of the biggest factors. Up until puberty, both boys and girls land similarly in a flexed position with good mechanics. After puberty, girls seem to lose these characteristics - they tend to land upright with more impact and their knees collapse together. The good news is that the rate of ACL injury among females can be significantly reduced (up to 88%) by following a neuromuscular training and strengthening program. The CDC estimates that anywhere from 1.6 to 3.8 million sports and recreation-related concussions occur each year in the US. Athletes (particularly young athletes) who are not properly evaluated by medical professionals are even more susceptible to further injury such as second impact syndrome. Second impact syndrome occurs when the brain suffers a second concussion while still recovering from the first. More fluid rushes to the injured area, putting increased pressure on the skull – this can result in permanent damage and death. Studies have shown that individuals with stronger neck and core musculature have a lower rate of concussions. Teaching youth how to land properly may also help reduce their risk of concussions. Both Kelly Isakson and Brenda Boyko, the co-owners of Moscow Mountain Sport and Physical Therapy (MMSPT), have worked with athletes from elementary school age to Olympians. Injury prevention is a big reason why they became physical therapists – they both suffered ACL tears as teenage girls who played sports. The new location of MMSPT includes a 2200 square foot gymnasium space which is equipped to host youth sport training classes – our staff of Physical Therapists and trainers have been working together to help develop these classes. The goal of these classes is not only injury prevention, but also speed, agility and strength training. Team or group training is also available by request.

By now you’ve likely seen a 5K race pop up in your neck of the woods. Often created as a fundraiser, 5Ks are a great way to support a local cause while getting into shape at the same time. The distance of a 5K – 3.1 miles (5 kilometers) – is challenging but manageable for new runners, and can also generally be walked in under an hour. The courses are also usually set to a backdrop of beautiful scenery like cityscapes or wooded areas so you can enjoy your workout while taking in some stunning sights.

run regularly? Can you comfortably run one mile? Two? Let your answers to these questions guide your training regimen. For beginners, training should start a couple of months in advance. Start by mixing in running and walking for 30-minute intervals every day. Once you build your endurance to handle one mile, add a second mile to your routine and so on. TRAINING The goal is to make 3.1 SCHEDULE miles a consistently atHow you train for a 5K is tainable goal without the dependent upon your run- threat of injury or overexning expertise. Do ertion. you already

Summer Class schedule: Athletes ages 7-11: Mon, Wed 9-10am, Ages 12-18: Tues, Thurs 12-1pm. Fall schedule, general information and registration at www.moscowpt.com or contact 208-882-1426 22

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MONDAY, JULY 21, 2014


TRACK YOUR WORKOUTS

DURING THE RUN

There are a few tactics you can use to stay motivated and track your progress during your runs. Put together a playlist of your favorite songs on your phone or mp3 player. You can use certain songs as a reference point to let you know when you’ve hit those first and second mile marks. Using a GPS-powered run tracker on your smart phone is also a great way to monitor your time, distance and calories burned. Many free apps are available for this purpose.

As with any competitive sporting event, you will likely be dealing with a bit of adrenaline as you wait for the 5K start gun to fire. Remember your training. You are simply translating all of your hard work onto the 5K course. If you listen to a certain playlist during your training, don’t change it up for the big race. If you stick to a specific stretch ing routine before you run, do it the same way on race day. And don’t forget to take a minute dur ing your 5K run to slow down and realize all of the good you are doing both for your body and the charitable cause you are helping.

SURGEONS

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MONDAY, JULY 21, 2014


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