2021 Nacogdoches Medical Guide

MEDICAL GUIDE

2021

Mohs Surgery | Dermatology | Cosmetics Molly M. Warthan, M.D.

Dr. Molly Warthan, a Board-Certified Dermatologist, has performed over 8,000 skin cancer surgeries in her career. Specializing in Mohs Micrographic surgery, she excises skin cancers mostly from the face and neck, and does frozen tissue sections on the skin cancer to ensure that the cancer is completely removed before suturing the area. Dr. Warthan had the unique opportunity to do her fellowship for Mohs skin cancer surgery with a Mohs surgeon as well as a plastic surgeon who did all the skin cancer surgery repairs. This Mohs procedure allows her to ensure skin cancers are removed prior to patients leaving the office. Dr. Molly Warthan wants all her patients to feel comfortable with the staff and physicians while having surgery.

4730 NE Stallings Dr | Nacogdoches, TX 75965 936.564.6107 | NacDerm.com

Childhood vaccinations during the pandemic

BY MAYO CLINIC NEWS NETWORK DEAR MAYO CLINIC: My son is turning 6 soon, and we usually schedule a well-child visit with his pediatrician around his birthday. I know he needs several vaccinations, but with COVID-19 still being around, I’m wondering if I should postpone the appointment. Is it safe for him to see the doctor and get vaccinated now?

ANSWER: Visiting a health care provider when you are ill may be a necessity, but amid the COVID-19 pandemic, it is understandable that you may have some hesitation.

You’re encouraged to keep the appointment, as a wellchild visit is a valuable opportunity for your son’s health care provider to see him, talk with you about concerns and ensure he is growing appropriately.

Before going to this wellchild visit, reach out to your son’s health care provider to learn about the changes that have been made to his or her office spaces and processes to protect patient safety. Changes may include screening at entrances, requiring everyone to wear a mask, enhanced cleaning standards and limiting the number of people in the building. These changes are made to create safe environments for in-person care while protecting everyone’s safety.

During the COVID-19 pandemic, parents are asked to be thoughtful about bringing children to public spaces, such as retail stores and clinics.

However, families should try to keep their children on the recommended vaccination schedule as much as possible.

Many serious illnesses can not only make you or your child feel terrible, but also they

A girl receives the flu vaccination shot from a nurse at a free clinic held at a local library in Lakewood, California.

Mario Tama/ Getty Images/ TNS

present major risks to health.

Fortunately, vaccines have been proven to be safe and effective in preventing various diseases and conditions. Some diseases may appear to pose a minimal threat, but the recent COVID-19 pandemic has demonstrated the wide-reaching effects of a disease that cannot be easily treated or prevented with a vaccine.

Importance of vaccinations

Vaccinations are important, especially for young children. Infants receive some passive immunity from their mother after birth, according to the Centers for Disease Control and Prevention (CDC). However, this immunity wears off during the child’s first year, with some immunity waning as early as 2 months.

Without vaccinations, children’s bodies often can’t fight diseases. This can lead to serious complications with lifelong effects and even death.

Germs can quickly trav-

el through a community and sicken many people. If enough people are sickened, it can lead to an outbreak or a pandemic. But when enough people are vaccinated against a disease, the germs can’t travel as easily from person to person, and the entire community is less likely to get the disease.

That means even people who can’t be vaccinated, such as those with weak or failing immune systems, will have some protection from getting sick. And if a person gets sick, there’s less chance of an outbreak or pandemic because it’s harder for the disease to spread.

Immunization schedule

The CDC has a recommended immunization schedule based on when your child will get the most protection from a vaccine. In some cases, it is not as simple as catching up the next year because your child will remain unprotected for a year

or there could be other consequences. This is the same schedule recommended by the American Academy of Pediatrics, American Academy of Family Physicians and many other groups.

Your health care provider can answer your questions and help your family determine if vaccinations are needed now or can be postponed. Factors that should be considered include if your area is experiencing an increase in COVID-19 cases, the age of your children, which vaccinations are needed and safety measures implemented by your son’s health care organization.

In a world of uncertainty, protecting yourself and your loved ones is of great importance. Vaccinations are at the front line of disease defense, and are one of the safest, most cost-effective preventive health measures.

— Dr. Jennifer S. Johnson, Family Medicine, Mayo Clinic Health System, Mankato, Minnesota

OUR TEAM IS READY TO SERVE YOU IN NACOGDOCHES

DAVID BOWEN, M.D.

ROBERT DENNIS, M.D.

JAMES HARRIS, M.D.

INTERVENTIONAL PAIN MANAGEMENT SPECIALIST

KNEE & SHOULDER SPECIALIST

HIP & KNEE SPECIALIST

TODD RAABE, M.D.

MICHAEL RUSSELL, M.D.

MARCEL WILEY, M.D.

PATRICK WUPPERMAN, M.D.

SPINE & NECK SPECIALIST

SPINE & NECK SPECIALIST

SPINE & NECK SPECIALIST

KNEE & SHOULDER SPECIALIST

• SPINE & NECK • HIP • KNEE • FOOT & ANKLE

LINDSEY MARKEL, P.A.

• HAND • SHOULDER • ELBOW • INTERVENTIONAL PAIN MANAGEMENT

ORTHOPEDIC EXCELLENCE

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Grief: How to cope with reminders after loss MAYO CLINIC NEWS NETWORK (TNS) — Grief doesn’t magically end at a certain point after a loved one’s death. Reminders often bring back the pain of loss.

When a loved one dies, you might be faced with grief over your loss again and again — sometimes even years later. Feelings of grief might return on the anniversary of your loved one’s death or other special days throughout the year.

These feelings, sometimes called an anniversary reaction, aren’t necessarily a setback in the grieving process. They’re a reflection that your loved one’s life was important to you.

To continue on the path toward healing, know what to expect — and how to cope with reminders of your loss.

Certain reminders of your loved one might be inevitable, such as a visit to the loved one’s grave, the anniversary of the person’s death, holidays, birthdays or new events you know he or she would have enjoyed. Even memorial celebrations for others can trigger the pain of your own loss.

Reminders can also be tied to sights, sounds and smells — and they can be unexpected. You might suddenly be flooded with emotions when you drive

by the restaurant your partner loved or when you hear your child’s favorite song.

The course of grief is unpredictable.

Anniversary reactions can last for days at a time or — in more extreme cases — much longer. During an anniversary reaction you might experience the intense emotions and reactions that you first experienced when you lost your loved one, including: ■ Anger ■ Anxiety ■ Crying spells ■ Depression ■ Fatigue, or lack of energy ■ Guilt ■ Loneliness ■ Pain ■ Sadness ■ Trouble sleeping Anniversary reactions can also evoke powerful memories of the feelings and events surrounding your loved one’s death.

For example, you might remember in great detail where you were and what you were doing when your loved one died.

Even years after a loss, you might continue to feel sadness when you’re confronted with reminders of your loved one’s death.

As you continue healing, take steps to cope with reminders of your loss. For

Dreamstime/TNS

To continue on the path toward healing from the loss of a loved one, know what to expect — and how to cope with reminders of your grief. example: Be prepared. Anniversary reactions are normal.

Knowing that you’re likely to experience anniversary reactions can help you understand them and even turn them into opportunities for healing.

Plan a distraction.

Schedule a gathering or a visit with friends or loved ones during times when you’re likely to feel alone or be reminded of your loved one’s death.

Reminisce about your relationship. Focus on the good things about your relationship with your loved one and the time you had together, rather than the loss. Write a letter to your loved one or a note about some of your good memories. You can add to this note anytime.

Start a new tradition.

Make a donation to a charitable organization in your loved one’s name on birthdays or holidays, or plant a tree in honor of your loved

“

These feelings, sometimes called an anniversary reaction, aren’t necessarily a setback in the grieving process. They’re a reflection that your loved one’s life was important to you. To continue on the path toward healing, know what to expect — and how to cope with reminders of your loss.” one.

Connect with others.

Draw friends and loved ones close to you, including people who were special to your loved one. Find someone who’ll encourage you to talk about your loss.

Stay connected to your usual support systems, such as spiritual leaders and social groups. Consider joining a bereavement support group.

Allow yourself to feel a range of emotions. It’s OK to be sad and feel a sense of loss, but also allow yourself to experience joy and happiness. As you celebrate special times, you might find yourself both laughing and crying.

There’s no time limit for grief, and anniversary reactions can leave you reeling.

Still, the intensity of grief tends to lessen with time.

If your grief gets worse over time instead of better or interferes with your ability to function in daily life, consult a grief counselor or other mental health provider. Unresolved or complicated grief can lead to depression, other mental health problems and other medical conditions. With professional help, however, you can re-establish a sense of control and direction in your life — and return to the path toward healing.

BY MAYO CLINIC NEWS NETWORK

Top10 workout myths

DEAR MAYO CLINIC: I eat fairly healthy, but I want to lose weight and improve my physical wellness in the new year. I’m finding a lot of conflicting information about the best workouts for weight loss, the amount of time I need to work out and what food I should eat. Can you help me make sense of it so I can plan a routine?

ANSWER: Being proactive to achieve long-term health and wellness is important, and you should be proud of your efforts to set fitness goals and develop routines. However, among research, personal opinion and stereotypes, a lot of misinformation can make it hard to know what is accurate.

Here is the truth about the top 10 workout myths that you should consider as you develop your game plan: ■ Myth 1: Stick solely to cardio for weight loss.

While it’s true that you should include 20-30 minutes of cardio in your workout routine, focusing solely on cardio will not transform your body as quickly or as dramatically as you might think.

People perceive cardio as the ultimate solution because their heart rate is up.

But in reality, you need to incorporate both cardio and strength training into your workout. Strength training builds muscles and maximizes your cardio routine.

The more muscle you have, the more calories your body will burn, especially during cardio.

■ Myth 2: Heavy weights will bulk you up.

Some people are con-

Dreamstime/TNS

Consider the top 10 workout maths as you develop your game plan for being healthier. cerned that adding strength training will build muscle bulk to the point that they will look like a bodybuilder.

This is not true. You would have to work out excessively to do so. Start slow and add weight to build muscle, which will maximize the calories your body will burn.

■ Myth 3: If you work out today, you can be lax in your diet.

Working out is important, but so is having good nutrition. You can’t work off a bad diet. Food is fuel, and proper nutrition guarantees results. If you want to lose weight, your calorie output needs to be higher than your calorie input.

■ Myth 4: Stretching helps prevent injuries.

If you grew up playing sports, stretching before a game was a regular routine. However, you might be surprised to learn that while stretching is beneficial — because it prepares the muscles for movement and eases your workout recovery — there is no proven

research that it will reduce your chances of getting an injury. That’s entirely based on your form and movements during a workout.

Use functional, dynamic stretches like lunges and leg swings to help muscle movement during workouts.

■ Myth 5: If the number on the scale isn’t going down, you’re not losing weight.

Many people focus on the number on the scale, but it is not the best representation of body changes.

The number on the scale is a factor of many things, including how much water you’ve consumed, what you ate and when you’re weighing in. Often when a person loses a significant amount of weight, the number on the scale goes up because of building muscle from exercise.

If you want to accurately track your weight loss and muscle development, record measurements of your arms, waist and thighs. And if you’re going to use the

scale, weigh yourself at the same time every day.

■ Myth 6: Cardio machines count burned calories with 100% accuracy.

Some people depend on the treadmill to tell them an exact number of calories burned during a workout. Unfortunately, this metric isn’t 100% accurate.

Many factors determine how many calories your body burns, including your sex, age and current weight. Some machines allow you to enter personalized data in one or two of these factors but rarely all three.

■ Myth 7: Sticking to ab workouts will give you a six-pack.

Abdominal workouts are great for developing core muscles because they benefit your body in many ways, such as improving your balance and stability. However, a person’s overall body fat prevents abs from being seen. If you want six-pack abs, you have to dramatically decrease your body fat to 10%-12% for men or

11%-13% for women. While possible, this requires strict dedication to eating a healthy diet and exercising.

■ Myth 8: Supplements and protein shakes are necessary after workouts.

Supplements and protein shakes are not necessary.

The benefits they offer are available from natural and direct food sources, such as chocolate milk, turkey or a scoop of peanut butter.

The truth is you don’t need supplements and shakes to get proper nutrients. You can get those nutrients from other food sources. If you consume protein-rich foods after a workout, do so within 30 minutes. That’s when your muscles absorb that energy, as they’re still burning and working.

■ Myth 9: If you’re not working up a sweat, you’re not working hard enough.

Sweating is an inaccurate way to measure your workout. Many factors go into the amount a person sweats, such as the temperature, humidity and hydration levels. Your body just could be efficient at cooling itself, as well.

■ Myth 10: No pain, no gain.

While feeling uncomfortable during a workout is normal, feeling pain is not. Many athletes live by the “no pain, no gain” motto, but pain is the way your body tells you that something is wrong. If you start to feel pain during a workout, stop immediately.

If you continue to push through it, you could end up with a serious injury.

— David Webster, Orthopedics, Mayo Clinic Health System

Your Safe Care is Our #1 Priority Here for your emergencies.

Russell Blvd.

Nor th St.

At Nacogdoches Medical Center, your safe care is our #1 priority.

We go above and beyond to help ensure our hospitals is safe for you. When an emergency happens, don’t delay care. We’re here for your emergencies 24/7 with the quality and expertise that makes us A Community Built on Care.

NACOGDOCHES MEDICAL CENTER

NE Stallings Dr.

Social Distancing

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4920 NE Stallings Dr., Nacogdoches, TX 75965

Find a doctor or book an appointment at NacMedicalCenter.com or call 866-697-5864 For life-threatening emergencies, call 9-1-1

‘I don’t want to die in the ER’ One ambulance ride leads to another when hospitals packed

BY SANDY WEST Kaiser Health News Keely Connolly thought she would be safe once the ambulance arrived at Hutchinson Regional Medical Center in Kansas.

She was having difficulty breathing because she’d had to miss a kidney dialysis treatment a few days earlier for lack of child care. Her potassium was dangerously high, putting her at risk of a heart attack.

But she trusted she would be fine once she was admitted and dialysis was begun.

She panicked when a nurse told her that no beds were available and that she would have to be transferred — possibly more than 450 miles away to Denver. She had heard a rumor about a dialysis patient who died waiting for a bed at a hospital in Wichita, about an hour down the road. “‘I don’t want to die in the ER,’” Connolly, 32, recalled thinking. “I just wanted them to fix me, but then the woman came in and said, ‘There are no beds.’ I got really scared and I didn’t know if they had time to get me anywhere else.”

When a bed was finally located 65 miles away in Salina, Connolly, who has kidney failure, was relieved but worried: How long would she be gone?

Who would care for her young daughter? How would she get home? What would it all cost?

Connolly was caught in a situation experts have warned about since the beginning of the coronavirus pandemic: Covid-19 patients are overwhelming hospitals, squeezing space and staff needed to treat emergencies like Connolly’s.

While it has happened in pockets throughout the coun-

try since the spring, the pressure on hospitals is widespread now — reaching into both urban and rural communities at an alarming pace, even as local officials and citizens continue to slam public health departments and pandemic guidelines. Traveling nurses are hard to come by as their services are in high demand nationwide and their pay has escalated beyond the reach of some smaller hospitals.

“This is the first time since I have been here that we’ve had a scenario where multiple hospitals, for longer periods of time, are experiencing some kind of shortages,” said Cindy Samuelson, a senior vice president of the Kansas Hospital Association.

And it got worse after Connolly’s emergency in mid-November. The 14-day rolling average positive test rate in Reno County, where Hutchinson is the county seat, reached 46% on Dec. 22, though it has since come down to 24% as of Jan. 4, said D.J. Gering, data analyst for the Reno County Health Department. The results did not include inmates from the Hutchinson Correctional Center, the local state prison.

By Oct. 1, four covid deaths had been recorded in the county of about 62,000. By Jan. 4, the death toll since the pandemic began had jumped to 105. For comparison, Gering said, Reno County had 19 deaths attributed to pneumonia and influenza combined in all of 2019.

Hospitalizations at the 190-licensed-bed Hutchinson Regional Medical Center increased 800% from mid-October to mid-December then started to temper at the end of the month, said Chuck Welch,

vice president of Hutchinson Regional Medical System.

“I hate to be overly optimistic until we are well past the possible holiday surge from Christmas and New Year’s,” he said in an email.

Operating between 90% and 95% capacity, the hospital is providing care to patients with a multitude of needs and still has room to expand. The problem, Welch said, has been staffing.

Competing for traveling nurses and specialists against larger hospitals to backfill positions open from sick or quarantining staffers has been challenging. When the hospital has been faced with increasing numbers of covid patients seeking emergency care, handling “normal” emergencies like Connolly’s has been much more difficult, Welch said.

While staffers work to transfer patients as close to home as possible, with so many hospitals in Kansas beyond capacity, it has become more common than before to transfer as far away as Colorado and Nebraska. Such transfers require medical flights, which are typically not covered by insurance and can cost patients upward of $50,000, Welch said.

“It is collateral damage,” he said. “It is something that has sort of been lost out of the narrative of these folks where everybody is relieved when we find them a bed. Everybody forgets about the downstream impact of the cost of those transports.”

Connolly recovered after three days in the Salina hospital. But the question still looms about the costs for her emergency care. Connolly had left her job as a corrections officer at the prison in September because coronavirus cases began to spike inside. Without her employer-sponsored health insurance, Connolly now relies on Medicaid and Medicare Part A, which means she is responsible for more out-ofpocket costs for things like pharmaceuticals and ambulance services.

Connolly worries so much about her finances that she’s been too scared to look at her recent ambulance bills. Being a single parent, living with kidney failure and undergoing dialysis during a pandemic are her primary concerns.

As with many underlying conditions, covid-19 appears

Hospitals » 13D

While it has happened in pockets throughout the country since the spring, the pressure on hospitals is widespread now — reaching into both urban and rural communities at an alarming pace.

PBNJ Productions/Getty Images via Kaiser Health News

‘I’m not going to pay for it’ Savvy patient fought for the price she was quoted and didn’t give up

BY ANNA ALMENDRALA Kaiser Health News

When Tiffany Qiu heard how much her surgery was going to cost her, she was sure the hospital’s financial department had made a mistake. Qiu, who already knew from a breast cancer scare earlier that year that her plan required a 30% coinsurance payment on operations, pressed the person on the phone several times to make sure she had heard correctly: Her coinsurance payment would be only 20% if she had the procedure at Palomar Medical Center in Poway, California, about 38 miles south of where Qiu lives.

“I was kind of in doubt, so I called them a second time,” said Qiu. “They gave me the exact same amount.”

Qiu had been diagnosed with uterine polyps, a benign condition that was making her periods heavier and more unpredictable.

Her OB-GYN proposed removing them but said it was safe to wait.

Qiu said that she asked about the possibility of doing it in the doctor’s office under local anesthesia to make the procedure cheaper, but that her doctor rebuffed her suggestion because of her preference for general anesthesia.

Because Qiu thought she was getting a deal on her usual 30% share of the bill, she decided to go ahead with the polyp removal on Nov. 5, 2019. As she sat in the waiting room filling out forms, staffers let her know she needed to pay in full before the surgery.

Unease set in. The hospital asked for the 20% coinsurance — $1,656.10 — that she had been quoted over the phone, but Qiu hadn’t been told she needed to pay on the day of the procedure.

As she handed over her credit card, she confirmed one more time that this would be her total

patient responsibility, barring complications.

The surgery was over in less than 30 minutes, and she walked out of the hospital with her husband, feeling perfectly fine.

Then the bill came.

Patient: Tiffany Qiu is a 49-year-old real estate agent and mother of two who lives in Temecula, California. Her family of four is covered by a Blue Shield of California policy that she and her husband purchased on the marketplace. Last year, they paid a $1,455 monthly premium, with an individual annual $1,850 deductible and an individual out-ofpocket maximum of $7,550.

Total Bill: Palomar Health billed Blue Shield $22,219.64 for the polyp removal, which the insurer negotiated down to $8,576.79. Blue Shield paid $5,769.72 and stated in an explanation of benefits document that Qiu was responsible for a $334.32 deductible and $2,472.75 coinsurance.

Because Qiu had already paid $1,873.20 on the day of surgery, the hospital billed her an additional $933.87, which meant Qiu was on the hook for the remainder of her 30% coinsurance.

These figures don’t include the fees Qiu paid for anesthesia or her doctor’s services.

Service Provider: Palomar Medical Center in Poway is one of three hospitals in the Palomar Health system. Palomar Health is a San Diego County public health care district, which means the health care facilities are nonprofit and receive property taxes as a portion of their revenue stream.

The system is governed by a board of directors elected from within the district’s boundaries.

What Gives: Hospitals and surgery centers sometimes offer discounts if patients are uninsured and able to pay with cash or a

Shelby Knowles for KHN

When Tiffany Qiu found herself on the hook for her usual 30% Blue Shield of California coinsurance after the hospital quoted 20%, she pushed back — and her surgical bill was sent to collections. credit card. Physicians may even offer discounts on a patient’s share of the costs if they know the patient is unemployed or has fallen on hard times. But regularly offering discounts to attract patients is not common, and could even be fraudulent if the patients are insured through Medicare, said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy.

In Qiu’s case, the hospital seemed to be offering a discount on the insurer’s normally required coinsurance.

“The hospital would be in breach of their contract with the insurance if they did not bill her for that amount,” said Martine Brousse, a California-based patient advocate and medical billing consultant for AdvimedPRO. “She owes what the insurance has calculated, and the facility has every right to demand payment.”

Copayments and coinsurance exist, in theory, so patients have “skin in the game.” They have to pay a clearly defined portion of the cost of their care, according to their policy, so they will shop around and use medical care judiciously (though many health experts say coinsurance amounts have gotten so high that many cannot afford them).

Resolution: If she hadn’t been quoted 20%, Qiu said, she would have shopped for a better deal.

She flies to China often to visit her mother and was open to getting the surgery done there.

Qiu called the hospital to ask why she was being billed a second time, despite the lack of complications during the surgery.

She remembers the back-andforth over the remaining bill was exhausting, especially because it happened over the holidays.

“I got tired and said, ‘I don’t want to play this game anymore,’” Qiu recalled. “‘If you want to send it to collections, you can do it, but I’m not going to pay for it.’”

The bill landed at a collection agency called IC System. In a May 23 phone call, Qiu said, a representative offered to slash the remaining bill by 25% if she would just pay that day.

But Qiu refused, though she could easily afford to pay. She’s undaunted by the risk the unpaid bill poses to her credit score, preferring instead to fight the hospital on behalf of other patients who may not have the time or luxury to persist.

The experience left her feeling as if the hospital offered her a

Price » 14D

Medical Directory NURSE PRACTIONER

AUDIOLOGY

Kelly Langston Jobe, Au.D., CCC-A Cole Audiology Lab at SFASU 2100 N. Raguet St. Suite 205 Nacogdoches, TX 75962 936-468-7109 www.coleaudiologylab.com Special Interests/Procedures: Diagnostic testing, hearing aid fitting and repairs for patients of all ages.

Select from a range of products at reduced pricing for your 30 day trial before you buy.

Education: Masters of Science degree in Audiology from University of Texas at Dallas, Doctor of Audiology degree from University of Florida at Gainesville, and certified with the American Speech and Hearing Association.

FAMILY DENTISTRY

Jeffrey B. Hancock, DDS Jeff Hancock Family Dentistry 1125 University Drive Nacogdoches, Texas 75961 (936) 564-2005 Special Interests/Procedures: Services Include Dental Cleaning, Restorative, Crowns, Implants, Root Canals, Extractions, Cosmetic Dentistry.

Most Insurance Plans Accepted. Voted Best of Nac 2012, 2013, 2014, 2016, 2018 and 2020.

GENERAL PRACTICE

NURSE PRACTIONER

Carl Willeford MSN, FNP-C Carl Willeford Jr. MSN,Jr. FNP-C 3226N.North University Drive,300 Suite 300 3226 University Dr., Suite Nacogdoches, Texas Texas 75965 75965 Nacogdoches, (936) 221-5138 936-221-5138 Nacogdochesfamilymedicine.com Nacogdochesfamilymedicine.com 8:00 noon Friday 8:00am-5:00 am-5:00pmpmM-T, M-T,8 am 8:00tillam-Noon Friday

Special Interests/Procedures: Annual wellness exams, health

Special Interests/Procedures: Annualmen’s wellness exams, health scre screenings, lab services, adult medicine, health, women’s health, procedures, COPD & diabetes lab services, adultminor medicine, men’s asthma, health, women’s health, minor proc management, exams, school and sports physicals, asthma, COPDDOT & diabetes management, DOT exams,urgent school and spo care and immunizations. physicals, urgent care and immunizations.

Education: Certified Nurse Education: Practitioner with over 20Nurse yearsPractitioner of clinical medical experience.

Certified with over 20 years of clinical B.S.N. degreeB.S.N. from Stephen F. Austin University in 1996 and M.S.N. from Techfrom Texas Te experience. degree from Stephen F. Austin University in 1996 andTexas M.S.N. School of Nursing in 2005, Post-Graduate Certification as Nurse Practitioner, Texas Tech School of Nursing in 2005, Post-Graduate Certification as Nurse Practitioner, Texas Tech Univer University School of Nursing.

School of Nursing.

OPHTHALMOLOGY

Shannon L. Smith, M.D., F.A.C.S.

Ophthalmology Cataract, Glaucoma, Cornea, & Retina Consultants of East Texas / Medical Arts Surgery Center / Benchmark Optical 3302 N.E. Stallings Dr. Nacogdoches, TX 75965 936-564-3600 • 877-810-3937 Monday - Friday 8:00 a.m. - 5:00 p.m. www.EyesOfTexas.us

Special Interests/Procedures: State of the Art Laser Cataract Surgery, Multifocal and Toric Lens Implants, Glaucoma Surgery and Laser, Diabetic and other Retinal Diagnosis and Management, Dry Eye Specialist, General Eye Care. Certified Ambulatory Surgery Center. Certified, American Board of Ophthalmology; Fellowship Trained in Glaucoma and Ophthalmic Pathology.

PEDIATRICS

Carolyn L Patton, DNP, APRN, FNP-C, AACRN Ryan E. Head, M.D., Scott Nelson, FNP, Brown Family Health Center, Inc. Fran Terno, FNP 1407 E Main St Nacogdoches, TX 75961 936-569-8240

Special Interests/Procedures: Specializing in care for pediatrics and adults, including sport physicals, vaccines for children; DOT physicals, and HIV care.

We accept most insurances, including some HMO plans.

Education: Doctor of Nursing Practice, Certified Family Nurse Practitioner, Certified Advanced AIDS Care Registered Nurse, Certified Department of Transportation Medical Examiner

Pediatrics 625 Russell Blvd Nacogdoches, TX 75965 936-305-5050 F 936-305-5151

Special Interests/Procedures: Specializing in children from birth to 18. Accepting New Patients. We accept Medicaid and most Commercial Insurances.

‘Our new normal’

Baby born with heart defect faces more challenges after having stroke

BY STEFANI KOPENEC American Heart Association News Kayla Scritchfield had a normal pregnancy and delivered her second daughter, Ava, thinking all was well. About six hours later, Ava looked purple. Medical personnel whisked away the newborn.

Kayla and her husband, Garrett, were told that Ava probably had a heart defect.

She needed to be transported from Salina, Kansas, to Kansas City.

Garrett flew with the medical team and his intubated daughter, wondering if she would survive. After they arrived, doctors inserted a stent to open an artery in Ava’s heart, which had a defect known as transposition of the great arteries. The condition results from the two large arteries of the heart (aorta and pulmonary artery) being connected to the wrong heart chamber.

Open-heart surgery could correct the problem. But Ava’s heart wasn’t strong enough. She healed for 10 days.

The night before Ava’s surgery, Kayla and Garrett were headed out of the hospital for a bite to eat when they got a call to come back. No explanation was given.

Doctors and nurses filled Ava’s room. The nurse assigned to Ava for the night was crying in the hallway.

The couple wasn’t allowed in the room. A doctor came out and explained they were trying to start Ava’s heart again because of an error.

“They were changing the IV line, which didn’t get fully locked to keep out all the air, so air slowly filled her IV line when they turned it back on.

Air went to her heart and

Ava Scritchfield at the 2019 Heart Walk.

Photo courtesy of Kayla Scritchfield

caused her heart to stop. And then as it moved up, it went to her brain and caused her to have a massive stroke,” Kayla said.

Doctors got Ava’s heart beating again, then sent her for tests to look for brain damage. Other evidence of the trauma already was evident. Ava was swollen and her face and hands were covered in deep red splotches because as the air embolism traveled through her body, it burst blood vessels.

“They warned us that there could be some major brain damage or that she could possibly be brain-dead based on the amount of air that had traveled to her brain, which was hard to hear,” Kayla said.

Thankfully, Ava’s brain showed activity, even though it also had some dead spots.

She had 20 subclinical seizures, meaning they were experienced but were not visible. Staff took X-rays of Ava’s bowels and intestines to watch the embolism as it

worked its way out of her system, checking to see that it didn’t perforate anything.

A day and a half later, Ava woke up and was alert, promptly getting hiccups at 5 p.m. – the same time of day she did when she was in the womb. It was a soothing, positive sign that things may be improving.

At 20 days old, doctors successfully performed her nine-hour heart surgery. Ava was soon ready to go home to Lindsborg, Kansas. By year’s end, she didn’t need any more seizure medication. She did have lingering effects from the stroke, specifically right-sided deficits that left her with braces on her legs and hand.

Now 3, Ava runs and plays and interacts with other kids as best she can. Twice a week, she goes to preschool, where she gets physical, occupational and speech therapy. She receives additional physical and speech therapy at an infant child development center nearby.

“If you didn’t know the background and her story, without watching her closely, you would never be able to tell that she went through all that,” Kayla said. “I always say she’s very resilient and determined.”

Garrett called her a fighter who makes the family smile.

“She’s one of the happiest kids you’ve ever seen,” he said. “She’s got a laugh that will light up a room real quick.”

Ava’s 7-year-old sister, Maleah, helps the family share Ava’s heart story by raising money as part of the American Heart Association’s Kids Heart Challenge that helps children learn how to have a healthy heart. Kayla and Ava also go to schools to discuss how some children are born with congenital heart defects.

“Before she was born, I had no idea what CHD was,” Kayla said. “It’s our new normal.

We try to stay active and advocate and bring awareness to it.”

Hospitals » From 9D

to pose an extra risk for people with kidney failure and patients undergoing dialysis, said Dr. Alan Kliger, a nephrologist at Yale University and co-chair of the American Society of Nephrology’s COVID-19 Response Team.

Data from New York and Europe early in the pandemic showed that about 1 in 5 dialysis patients who acquired covid died, he said. However, the complication and mortality rates have fallen in recent months, according to unpublished survey data from members of the nephrology society, Kliger said.

“It’s still a high risk,” he said.

For Connolly, the pandemic has also complicated her threetimes-a-week 3½-hour dialysis schedule. For example, when her daughter’s kindergarten

class was told to quarantine for 14 days after an in-class exposure to the virus, she had to scramble to find babysitters so she could attend dialysis.

“I don’t want too many people to watch her because of covid,” Connolly said of her daughter, adding that she is lucky the girl’s father is supportive. But he can’t always step in, which means if Connolly can’t find a sitter, she may have to skip or reschedule dialysis.

Connolly wants to get another job. But living in a county where so many refuse to wear masks and some elected leaders accuse the health department of providing false information about covid testing rates and statistics makes her afraid to be in public more than necessary.

“I want to work,” she said.

“I had a good job. I served my community. The reality of knowing how bad it is at the hospital — I have seen it firsthand. And now I am out and seeing people without masks and I am thinking, ‘If I get this and I have to go back, I may not leave the hospital next time.’”

The reality, said Kliger, Welch and others, is that while the virus runs rampant, hospitals will struggle to keep up, which potentially endangers medical staffers and anyone needing hospital care — and the virus will continue to spread as long as people refuse to wear masks and disregard scientifically sound guidelines.

Connolly said she would love to see more empathy for people who have underlying health concerns like her from those resisting safety measures such as masks.

“Even if they think that it doesn’t work, what if it does?

What if it could? I don’t really understand how wearing a mask is going to take so much out of your day, compared to someone who is immunocompromised and gets sick,” said Connolly. “Or you lose your grandma, or your parent.

That’s going to affect your life a lot longer than wearing a mask for a little while.”

After missing a dialysis appointment, Keely Connolly needed emergency care at a Hutchinson, Kansas, hospital.

But all beds were filled, so she was transferred to Salina — 65 miles away from her home and young daughter.

Keely Connolly via Kaiser Health News

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VI O HA R

AL

BE

fake discount to reel in her business.

“I double-checked and tripledchecked with them,” Qiu said.

“They have financial departments that should be verifying this with my insurance company.”

Another thing to note is how much the hospital billed Qiu for a simple outpatient procedure: $22,219.64. That amount is “totally laughable,” said Dr. Merrit Quarum, founder of WellRithms, a company that works with selffunded employers and other clients to make sense of complex medical claims.

Not only is the charge far out of line with what that procedure typically costs in that region (around $5,500), but Qiu is now stuck paying a larger amount as her share under the terms of her insurance. This is how those “sticker prices” that few people pay still drive up costs for indi-

H

H

EA T L

viduals.

After a reporter’s call, Palomar Health looked back at phone records, confirmed Qiu’s version of events and said a hospital staffer had made a mistake by quoting her a 20% cost-sharing obligation. That percentage then got automatically put into her patient notes and was on the bill of estimated costs she signed and paid on the day of surgery, even though it was incorrect.

They apologized for giving the mistaken impression that Qiu was getting a discount. Staff members are not authorized to offer discounts when providing estimates, said Derryl Acosta, a spokesman for Palomar Health.

Acosta also pointed out other communication breakdowns, like dropping the complaint Qiu phoned in after she received the second bill in late November. Her issue did not get put into the standard customer complaint process, which would have elevated the problem and triggered an

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staffers may be poorly trained or ill informed.

If a patient hears conflicting information about charges before a procedure, they need to approach their insurer to confirm the details of their own policy, said Brousse, the patient advocate.

The simple fact that a hospital staffer misinformed a patient isn’t a legal reason to force a hospital to lower a bill, Brousse said.

Also, get promises in writing — before the day of surgery. Make sure the offer is explicit about which services are included and what might count as a complication. Ask whether you’ll have to pay upfront.

Initial estimated bills can be full of asterisks and “weasel words,” said Akshay Gupta, co-founder of CoPatient, a medical bill review and patient advocacy company.

“Even though she tried to be diligent, obviously she still didn’t know that she would need to get something that was legally enforceable,” said Gupta.

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investigation into the phone records. That’s why Qiu’s bill was sent to the collection agency.

“We definitely admit that the call should have been handled differently,” Acosta said. “We now have a new call center that we believe will handle this type of call better.”

Because Palomar Health was able to see in their phone records that a staffer had confirmed the erroneous 20% coinsurance amount to Qiu, the health system will change her bill to reflect what she was promised. Qiu will get a statement in the mail saying she has a zero balance, Acosta said.

The Takeaway: Multiple medical billing advocates who reviewed Qiu’s case praised her for her tenacity in calling the hospital financial department twice before the procedure. But as she herself acknowledged, most people don’t have the time or spine to fight.

To avoid such situations, experts advised, patients should check in with their insurer about the discounts offered, as hospital

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Man defies doctors’ expectations

BY DIANE DANIEL American Heart Association News

Mark Kincaid greeted spectators coming to the high school football game as he collected donations for his son’s baseball team. His daughter, a cheerleader, was on the field while his wife and one of their three sons watched the game.

As a woman dropped money into Mark’s bucket, his expression went blank. He stumbled backward.

A friend standing nearby caught Mark before he fell. He tried to say something but couldn’t speak.

Paramedics working the game came running. Mark’s wife, Tonya, followed the ambulance to the hospital, only 2 miles away.

“When the doctor came out to talk to me, I knew immediately that it was bad,” Tonya said.

Undetected high blood pressure had caused Mark, then 42, to have a stroke. During the CT scan that detected it, he’d stopped breathing and had to be resuscitated. Now, Mark needed surgery to remove a large blood clot in his brain. Yet this hospital in Whitesburg, Kentucky, wasn’t equipped for such an operation. A helicopter would fly him to a hospital in Bristol, Tennessee, more than two hours by car through the mountains.

As he was being transferred, all his buddies, his daughter and her fellow cheerleaders, his son’s baseball team, other adult friends and their children’s friends formed a line on each side. Everyone prayed.

Doctors in Bristol warned Tonya that Mark was unlikely to survive – and, if he did, his quality of life would be low. He would never have use of the right side of his body and he would likely have major cognitive deficits.

“The morning after the surgery, Mark woke up and immediately recognized me,” Tonya said. “He kept proving doctors wrong, and they kept changing their expectations. But they never gave us an outlook of what he does today.”

The stroke occurred in 2009.

Mark Kincaid survived a stroke at age 42.

While Mark still faces challenges, his progress has far exceeded the grim expectations.

His recovery began with several months of rehabilitation, first in the Bristol hospital, then in a rehab facility in Lexington, Kentucky.

“When they said he had enough for the day, he’d say, ‘No, I want more,’” Tonya said. “He’s a worker.

There’s not a lazy bone in his body.”

Five years after the stroke, Mark met Dr. James Hammock, a rehabilitation specialist in Hazard, Kentucky.

Hammock had Mark do more intense inpatient rehabilitation. He also led him to products that deliver low-level electrical stimulation to activate nerves and muscles.

Since starting to use such units on his right hand, leg and foot, his mobility has vastly improved. He also receives injections of botulinum toxin every three months to help reduce muscle spasms.

His cognitive functioning continues to improve; he especially enjoys playing brain games. However, he was left with aphasia and apraxia, which limit his ability to speak.

“I’m his voice,” Tonya said.

Mark and Tonya live in rural eastern Kentucky. Their three children are now adults, living on their own.

Now 53, Mark walks 3 miles a day, drives his all-terrain vehicle, mows the grass and even cuts down small trees. He and one of his sons are fixing up a 1970 Chevrolet pickup truck that belonged to his father.

When indoors, Mark plays games on his tablet, posts to social media and browses online flea markets.

“I’m not going to have him live in a bubble, because what kind of life is that?” Tonya said.

Five years ago, they joined the first stroke support group in their area.

“We’re like a family,” Tonya said.

Photo courtesy of Tonya Kincaid

“You really bond with people. We clap, cheer and cry together. It’s important to know you don’t have to go through this alone.”

Mark and Tonya also give speeches about stroke education and helping health professionals understand the specific needs of stroke patients, from patient care to how buildings should be designed.

This year, Mark received a Stroke Hero award from the American Stroke Association, a division of the American Heart Association.

“Mark is such an inspiration for the other survivors in our group,” said Keisha Hudson, who leads the support group as part of her work with the University of Kentucky Center of Excellence in Rural Health. “A lot of the research says after five years, stroke survivors are not going to see any improvement, but I’ve seen Mark continually improve. He’s so motivated that he just doesn’t stop.”

For about the first 6 months of life, exclusively feed infants human milk, new dietary guidelines say.

Dreamstime/ TNS

New dietary guidelines

MAYO CLINIC NEWS NETWORK (TNS) — The Dietary Guidelines for Americans have been updated to include, for the first time, recommendations across the lifespan.

Dr. Donald Hensrud, director of the Mayo Clinic Healthy Living Program, says the dietary guidelines, which are updated every five years, are designed to give the best recommendations on what to eat and drink to promote health and prevent disease.

One of the changes for this edition of the guidelines is focused on a lifespan approach from infancy to older adulthood. “We’ve known for quite some time that for the first six months of an infant’s life, they should be fed exclusively human breast milk,” says Dr. Hensrud.

“Another addition that people

may not be aware of is that when foods are introduced to an infant around the age of 4 to 6 months, peanut-containing foods can be added to the diet after checking with the infant’s health care provider. The evidence shows that by adding peanuts early in the diet, it may prevent allergies later on.

Also, under the age of 2 years, no added sugars should be included in the diet of children. Added sugars do not provide any health benefit Key recommendations from the guidelines include: ■ For about the first 6 months of life, exclusively feed infants human milk.

■ At about 6 months, introduce infants to nutrient-dense complementary foods. Introduce infants to potentially allergenic foods along with other complementary foods.

■ From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body weight and reduce the risk of chronic disease.

■ Limit foods and beverages higher in added sugars, saturated fat and sodium, and limit alcoholic beverages.

Dr. Hensrud says that before the guidelines are released, a scientific report on dietary guidelines is published. The dietary guidelines are then derived from this scientific report.

“What many people who work in nutrition would have liked to have seen is a lower limit for added sugars and alcohol. This was included in the scientific report, but did not end up in the Dietary Guidelines,” says Dr. Hensrud.

“For example, the dietary guidelines recommend no more than 10% of calories as added sugars. But the scientific report recommended no more than 6%,” he says. “Similarly, previous guidelines recommended up to no more than an average of two drinks per day for men. The scientific report recommended lowering this to one drink a day on average for both men and women.

The Dietary Guidelines still recommend up to two drinks a day for men.”

Dr. Hensrud says the less added sugars in your diet, the better it will be. “We know that there is very little health benefit and many health risks from including too much added sugars in the diet.

Sugars that are naturally present, such as in fruit, are fine to have in the diet.”

Fresh herbs that can reduce sodium reliance Salt has long been used to add flavor to people’s favorite foods. In fact, the use of salt as a means to preserving foods and adding flavor to recipes dates back to ancient times and has led to countless conflicts ever since.

According to History.com, wars over access to salt reserves in China are believed to have been fought as early as 6,000 B.C. Though that shows just how valuable salt has been throughout much of human history, it doesn’t indicate the negative effects that can result from diets that feature excessive amounts of sodium.

The American Heart Association notes that sodium plays an essential role in the human body by regulating the kidneys and helping to control the body’s fluid balance.

Sodium also helps send nerve impulses and affects muscle function. However, excessive amounts of sodium can compromise heart health. The AHA notes that excessive amounts of sodium in the bloodstream pulls water into the blood vessels, increasing the total volume of blood within them. As more blood flows through blood vessels, blood pressure increases.

Over time, that can adversely affect blood vessels and speed up the build-up of plaque that can block blood flow. Higher blood pressure forces the heart to work harder and increases a person’s risk for heart disease.

So what about sodium, a mineral so valued, and indeed vital to human existence, that it’s led to wars and created countless devotees in kitchens over the centuries? If it’s flavor cooks are aiming for, it’s possible to reduce reliance on sodium and increase the use of fresh herbs without sacrificing flavor. Such a transition can improve heart health and introduce a host of new flavors at meal time.

sweet and fresh flavor profile and is best added to a dish right before serving. Freshly cut basil leaves can be added to any number of dishes, including tomato sauces, pastas, salads, pizzas, and eggs.

Cilantro

Cilantro are the delicate leaves and stems of the coriander plant.

Like basil, cilantro should be added to a dish right before serving and should not be cooked. Cilantro can be paired with beans, tomatoes, corn, and avocados among other foods, and is widely used when preparing Mexican foods at home.

Oregano

The AHA notes that Greek dishes often combine oregano, mint and lemon to create a memorable, delicious flavor profile. If chopping fresh oregano, strip the leaves from the stem and then discard the stem.

Parsley

Parsley isn’t just a garnish used to add aesthetic appeal to plates.

Flat-leaf parsley provides a light and fresh flavor, while the AHA notes that curly parsley offers a slightly peppery profile. Parsley is typically added to a dish during the final minutes of cooking or right before serving, and can be paired with chicken, fish, potatoes, and pasta among countless other foods.

These are just a handful of herbs that can give meals a flavorful punch and help chefs avoid an Basil over-reliance sodium in their reciThe AHA notes that basil has a pes

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5109

How to treat minor burns

Protecting skin pays both shortand long-term dividends. In the short-term, concerted efforts to protect the skin, which can be as simple as applying sunscreen before spending time in the sun, can prevent the pain associated with first-degree burns like sunburns.

And over the long haul, such measures can dramatically reduce a person’s risk for skin cancer, a potentially deadly disease that the World Health Organization reports affects as many as 3.1 million people each year.

Though it’s in everyone’s best interest to prioritize skin protection at all times, burns still happen. Second- and third-degree burns can be severe, and such burns often need to be addressed by medical professionals. But the American Academy of Dermatology notes that most first-degree burns, which can include sunburns, can be treated

“

The AAD notes that most first-degree burns can be treated at home without the need to consult a medical professional. However, the AAD advises the elderly and parents of infants who have suffered first-degree burns, as well as anyone who thinks their burn is severe, to seek immediate medical care.”

at home. Proper treatment of such burns is essential, and the AAD offers these tips to help people treat first-degree burns at home.

■ Cool the burn. First-degree burns should be cooled for about 10 minutes, or however long it takes for the pain to subside. Burns can be immersed in cool tap water, or victims can apply cold, wet compresses to cool the affected area(s).

■ Apply petroleum jelly each day. The AAD notes that it’s important to apply only petroleum jelly to affected areas. Old wives’ tales may suggest that ointments, toothpaste or butter can be applied to burns,

but such substances can cause infection. The AAD advises against applying topical antibiotics as well.

■ Do not pop blisters and cover burns with nonstick, sterile bandages. Areas that have blistered should be allowed to heal on their own but can still be covered. Popping blisters can increase the risk of infection, so avoid the temptation to do so. Use nonstick, sterile bandages that can be easily removed and won’t contribute to infection.

■ Take steps to mitigate pain.

First-degree burns are generally considered minor, but they can still be painful. If the pain is significant,

over-the-counter medications like acetaminophen or ibuprofen can alleviate pain and reduce inflammation.

■ Protect skin from the sun.

Make a concerted effort to protect areas that have healed from firstdegree burns from the sun. Seeking shade, applying a broad-spectrum, water-resistant sunscreen with a minimum sun protection factor (SPF) of 30 and wearing protective clothing can minimize scarring in areas of the skin that have healed from first-degree burns.

The AAD notes that most firstdegree burns can be treated at home without the need to consult a medical professional. However, the AAD advises the elderly and parents of infants who have suffered first-degree burns, as well as anyone who thinks their burn is severe, to seek immediate medical care.

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Health benefits of abstaining from alcohol

After a busy holiday season, the new year presents a great opportunity to renew your commitment to a healthy lifestyle. One increasingly popular health and fitness resolution involves abstaining from alcohol for an entire month. Here are four benefits of having a dry January.

1. You’ll sleep Better Alcohol might help you fall asleep, but it can also disrupt your sleep cycles. This can have a negative effect on your memory, mood and overall health.

2. You’ll get sick less often Alcohol can suppress your immune system. This leaves your body more vulnerable to pathogens and makes it less capable of fighting off an illness or infection.

3. You’ll likely lose weight Alcohol is packed with calories, and you’re more likely to eat junk food when inebriated. Plus, abstain-

Dry January ing can make you feel more energized and motivated to exercise.

4. You’ll have radiant skin Alcohol is a diuretic, which facilitates dehydration and can dry out your skin. Additionally, alcohol increases inflammation and hormone levels, thereby triggering

breakouts.

Keep in mind that you can enjoy the benefits of Dry January even if you slip up. Don’t let one drink undermine your goal to make healthier choices.

Cheers to alcohol

What are the health risks of vaping?

Electronic cigarettes are devices designed to heat a nicotine-based liquid into a vapor, which can then be inhaled. Here’s a look at the known health risks associated with vaping.

Exposure to nicotine

According to the Centers for Disease Control and Prevention, vaping is a less harmful option than smoking if you already smoke.

However, since most e-cigarette liquids contain nicotine, they pose a number of health risks. Among other things, vaping can: ■ Lead to addiction ■ Affect memory and concentration ■ Cause behavioral problems ■ Alter brain development It should be noted that adolescents are particularly susceptible to the dangerous effects of nicotine.

This is why it’s illegal to sell or give

vaping products to anyone under When these substances are heated in a vaping device, they create a the age of 21. carcinogen called formaldehyde.

Exposure to Other toxins that can be found in other chemicals e-cigarette vapor include nickel, tin The main liquids found in vap- and aluminum. ing products are vegetable glycerin, propylene glycol and chemicals Heart and used for flavor such as diacetyl. lung disease

alternatives!

If you still want to raise a glass on special occasions, opt for sparkling water infused with orange and ginger, cucumber and mint or strawberry, basil and lime. Kombucha is also a tasty alternative with a delightful fizz and tangy taste.

Inhaling the harmful chemicals found in e-cigarettes increases the risk of cardiovascular and lung disease. Health experts are also currently investigating the rise of a severe and potentially fatal lung disease referred to as vaping-associated pulmonary injury (VAPI).

While the potential long-term effects of vaping are still unknown, there’s no doubt that the use of ecigarettes is hazardous. The best way to avoid the health risks associated with vaping is to not start or to ask a health-care professional for advice on how to quit.

The hazard of batteries

Vaping devices can be dangerous if they’re not properly used or stored. The lithium-ion batteries in electronic cigarettes can overheat, catch fire or explode in your pocket if they come into contact with metal objects like loose coins or keys.

How to follow the The pegan diet purports to focus on improving health by reducing inflammation and stabilizing blood sugar. Created by American physician Dr. Mark Hyman, it combines certain key principles from veganism and the paleolithic diet. Here’s a look at what the pegan diet entails.

pegan diet

Recommended food

Unlike veganism, this hybrid diet doesn’t prohibit eating meat. However, the pe­gan diet encourages eating grass-fed, pastureraised sources of animal protein and making meat a side dish rather than the main course. Fish and eggs are also permitted.

As for fruits and vegetables, they should make up three-quarters of your diet.

How­ ever, low-sugar fruits and non-starchy ve­geta­bles are preferable. Gluten-free than a vegan or paleo diet, whole grains and sources certain foods are strongly of healthy fats, such as nuts discouraged. These include: and seeds, are allowed in ■ Gluten limited quantities.

■ Sugar ■ Processed foods Restricted food ■ Refined oils ■ Food additives While the pegan diet is ■ Dairy products arguably less restrictive

The diet also discourages fruits, vegetables and fats. eating most grains and le- Eating these foods can help foster good heart health, gumes. prevent disease and reduce Pros and cons inflammation.

The downside is that the On the plus side, the pegan diet focuses on con- diet restricts a number of suming an abundance healthy foods, which can poof healthy, nutrient-rich tentially result in nutrition-

al deficiencies. It can also be an expensive and timeconsuming diet to maintain.

Always keep in mind that before you make a significant change to your diet, you should con­ sult with your do­ ctor, a nutritionist or a dietitian.

Make daikon part of your diet Daikon is a sweet, mildly spicy root vegetable that resembles a plump white carrot.

Also known as a white or Japanese radish, daikon is popular in many types of Asian cuisine and a great addition to your win­ ter meals.

Benefits This crunchy cruciferous vegetable is an excellent source of vitamin C, folate and antioxidants. In addition to being low in calories, some studies indicate that eating daikon: ■ Helps protect against

certain cancers and chronic conditions like heart disease ■ Slows cognitive decline by helping to protect cells against oxidative damage ■ Increases satiety and promotes a healthy body weight

How to eat it

Daikon can be served raw or cooked. Often, it’s thinly sliced for pickling or to be used as a garnish. However, it also makes a tasty addition to a variety of hot and cold dishes and can even be used in baked goods. This winter, try daikon pan fried or roasted. Additionally, the

greens can be used in salads, soups and stir-fries.

How to store it

Keep daikon in a perforated plastic bag or wrapped in a damp towel in the fridge.

It should last for several weeks. Store the greens separately.

Is it OK to exercise when you are sick?

BY GENARO C. ARMAS American Heart Association News

If you are sick and plan to exercise this cold and flu season, experts say to use your head – and recognize the body’s warnings signs.

It’s especially important to take precautions this winter during the COVID-19 pandemic. Consulting a doctor always is a good idea if there are any questions about symptoms or whether to quarantine or isolate.

But in general, physical activity isn’t necessarily a no-no for a milder illness like a simple head cold.

“The typical rule of thumb that a lot of practitioners and exercise physiologists like to stick to is that if symptoms are above the neck, it’s OK to get out there and do some exercise,” said Amanda Paluch, assistant professor at the School of Public Health and Health Sciences at the University of Massachusetts Amherst.

Think a runny nose or light headache, though it might be wise to ease up from the typical routine, she said.

“Maybe just going out for a walk instead of a vigorous run,” Paluch said. “You can still see benefits even with this lower intensity. Just getting out there could actually help you feel a little better.”

Symptoms below the neck like chest congestion or upset stomach typically are signs to avoid exercise.

Never exercise when you have a fever, regardless of whether it’s related to the flu, COVID-19 or another virus, said Dr. Felipe Lobelo, an associate professor at Emory University’s Rollins School of Public Health.

Recently updated guidance from the Centers for Disease Control and Prevention recommend that people diagnosed with COVID-19, with or without symptoms, generally should isolate for at least 10 days after the onset of symptoms or after a positive test.

So, that means no exercising during that time, too, Lobelo said. Even after that 10-day period, he said people should wait another week before resuming exercise.

And the return to exercise after

recovering should be gradual. “You probably will feel deconditioned because of some bed rest and much lower levels of activity, on top of any lingering effects of COVID if you had a cough, fatigue or shortness of breath.”

It’s important, Lobelo added, to notify your doctor if symptoms don’t improve gradually with exercise or if new symptoms like chest pain, shortness of breath or extreme fatigue develop during physical activity.

Finding safe and responsible ways to stay active remains important during the pandemic, whether at home or while outside with social distancing.

According to the CDC, physical activity reduces blood pressure and anxiety, improves mood and energy level, and helps people get better sleep.

However, it’s best to avoid indoor activities at gyms because of the increased potential for coronavirus transmission, Lobelo said. If you do go, wear a face covering, maintain social distancing and wipe down equipment regularly.

“You really want to focus on outdoor activities as much as possible,” Lobelo said. He also encouraged people to take a mask with them outdoors to wear for instances like passing someone on a trail.

Paluch offered tips for those not accustomed to exercising in the cold, including wearing layers of clothing that can be shed if needed. Wearing a mask while exercising has the added benefit of helping to keep your face warm.

A fitness tracker also could be a creative way to stay active and engage virtually with family and friends, said Paluch, who researches the benefits of wearable sensors. For instance, family members might race to see who can accumulate the most steps during a week and compare results online.

“These kinds of things can keep people connected and maybe provide some motivation,” Paluch said. “You can have that social support without direct contact.”

Vitamins play different roles

A nutritious diet is a vital component of a healthy lifestyle. When it’s part of a health regimen that includes routine exercise, a healthy diet that’s rich in fruits and vegetables can help people reduce their risk for various illnesses, including chronic diseases like heart disease, cancer and diabetes.

Many adults have known about the value of fruits and vegetables since they were youngsters and their parents repeatedly told them how important it was to eat healthy foods. Despite those early lessons, the Centers for Disease Control and Prevention reports that less than 10 percent of adults and adolescents eat enough fruits and vegetables.

That’s unfortunate, as fruits and vegetables are loaded with vitamins that benefit the body in myriad ways.

The U.S. National Library of Medicine notes that vitamin deficiency occurs when people do not get enough of certain vitamins.

Recognizing the many functions vitamins serve may compel adults and adolescents to include more fruits and vegetables in their diets.

■ Vitamin A: The USNLM notes that vitamin A helps form and maintain healthy teeth, bones, soft tissue, mucous membranes, and skin. According to the World Health Organization, vitamin A deficiency is the leading cause of preventable blindness in children and increases the risk of disease and death from severe infections.

■ Vitamin B6: Vitamin B6 helps form red blood cells and maintain brain function. Though the National Institutes of Health notes that isolated vitamin B6 deficiency is uncommon, a deficiency has been associated with various conditions, including a weakened immune system and dermatitis cheilitis, a condition marked by scaling on the lips and cracks at the corners of the mouth.

■ Vitamin C: Vitamin C is an antioxidant that promotes healthy

“

Vitamins are crucial to human beings’ overall health. Eating ample amounts of fruits and vegetables is a great and delicious way to avoid vitamin deficiency.”

teeth and gums, helps the body absorb iron and maintains healthy tissue. In addition, vitamin C plays an integral role in helping wounds heal. Vitamin C deficiency impairs bone function, and Merck notes that in children that impairment can cause bone lesions and contribute to poor bone growth.

■ Vitamin D: The USNLM notes that 10 to 15 minutes of sunshine three times per week is enough to produce the body’s vitamin D requirement for people at most latitudes. It’s hard to rely on food to supply ample vitamin D, which helps the body absorb calcium that is necessary for the development and maintenance of healthy teeth and bones.

■ Vitamin E: Vitamin E helps the body form red blood cells and utilize vitamin K. Green, leafy vegetables like spinach and broccoli are good sources of vitamin E. The Office of Dietary Supplements notes that a vitamin E deficiency can cause nerve and muscle damage, potentially leading to muscle weakness and vision problems.

■ Vitamin K: Vitamin K helps to make certain proteins that are needed for blood clotting and the building of bones. The T.H. Chan School of Public Health at Harvard notes that the main type of vitamin K is found in green leafy vegetables like collard greens, kale and spinach. Vitamin K deficiency is rare, but it can lead to bleeding, hemorrhaging or osteoporosis.

Vitamins are crucial to human beings’ overall health. Eating ample amounts of fruits and vegetables is a great and delicious way to avoid vitamin deficiency.

Physical activity guidelines for children, adolescents and adults

Staying healthy is a fulltime job for people of all ages. While it might not always prove so easy to exercise or eat right, the benefits of healthy living are undeniable.

According to the Partnership to Fight Chronic Disease, “prevention” refers to helping people avoid getting sick or identifying diseases early so treatment can begin. Immunizations and disease screenings are two vital components of preventive care, but children, adolescents and adults can take more active roles in preventive care by embracing physical activity.

The Department of Health and Human Services notes that physical activity fosters normal growth and development and can help people feel better, function better, sleep better, and reduce their risk for a large number of chronic diseases.

Reducing risk for chronic

disease keeps people out of the doctor’s office, or even the hospital, and it also can help save considerable amounts of money. One report from the The Milken Institute estimated that high chronic disease and obesity rates are responsible for more than $1 trillion in lost productivity in the workplace every year. In addition, the National Commission on Prevention Priorities notes that increasing the use of five preventive services to 90 percent can save more than 100,000 lives in the United States each year. Such services include advising smokers to quit and offering medication or other assistance to help them and providing flu shots for people age 65 and older.

In recognition of the role exercise plays in preventive care, the DHHS recommends children, adolescents and adults fol-

low these physical activity adolescents should include bone-strengthening physiguidelines. cal activity at least three Children days a week. and adolescents Parents can consult with The DHHS recommends their children’s physicians that children and adoles- to determine age-approcents between the ages of priate muscle- and bonesix and 17 should get 60 min- strengthening activities for utes or more of moderate- their youngsters. to-vigorous physical activAdults ity every day.

■ Aerobic: Most of the The DHHS advises adults 60 minutes or more per day to make a concerted effort should be either moderate- to move more and sit less or vigorous intensity aero- throughout the day. Some bic physical activity and physical activity is better should include vigorous-in- than none. Adults who sit tensity physical activity at less and do any amount of moderate-to-vigorous least three days a week.

■ Muscle-strengthening: physical activity gain some As part of their 60 minutes health benefits.

For substantial health or more of daily physical activity, children and adoles- benefits, adults should get cents should include muscle- at least 150 minutes to 300 strengthening physical activ- minutes of moderate-inity at least three days a week. tensity, or 75 minutes to 150 ■ Bone-strengthening: minutes a week of vigorousAs part of their 60 minutes intensity aerobic physior more of daily physi- cal activity each week. An cal activity, children and equivalent combination of

moderate- and vigorous-intensity aerobic activity can serve as a substitute. Ideally, aerobic activity should be spread throughout the week.

Adults should do musclestrengthening activities of moderate or greater intensity that involve all major muscle groups two or more days a week, as the DHHS notes these activities provide additional health benefits.

These guidelines also apply to older adults, but older adults also should incorporate balance training into their exercise routines. In addition, the DHHS urges older adults to consult with their physicians about the appropriate level of effort for physical activity relative to their level of fitness.

People of all ages should include physical activity in their preventive health care routines. More information about exercise is available at www.health.gov.

Dental hygiene it’s about more than just your teeth

Individuals tend to learn about dental hygiene at an early age. On the recommendation of their children’s pediatricians, parents may begin brushing their youngsters’ teeth the moment the first tooth breaks through the gums.

While proper dental hygiene is vital to oral health, it also can have a profound effect on the rest of the body.

According to the Mayo Clinic, poor oral health might contribute to various diseases and conditions.

Periodontitis is a severe yet preventable gum infection that can lead to tooth loss if left untreated. But the threat of periodontitis doesn’t end in the mouth.

The American Academy of Periodontology notes there’s a connection between periodontitis and several other diseases. While bacteria was long suspected to be the link between peri-

odontitis and other diseases people with diabetes. in the body, the AAP notes that recent research points to inflammation as the cul- Heart disease prit that connects periodonThe AAP notes that titis with diseases such as research indicates peridiabetes and heart disease. odontal disease increases a person’s risk for heart disease, with the inflammaDiabetes tion caused by the former The AAP notes that leading to the latter. People people with diabetes are at with existing heart condiincreased risk for periodon- tions also may find that tal disease, speculating that periodontal disease exacerdiabetes patients’ risk is bates those conditions. The higher because people with Mayo Clinic notes that the diabetes are more vulner- link between heart disease able to infections than those and periodontal disease is without diabetes. While not fully understood, but that suggests periodontal enough studies have been disease is a byproduct of conducted for scientists to diabetes, the AAP notes that support the notion that the research points to the re- two are connected. lationship being a two-way street. Periodontal disease may make it more difficult Can periodontal for people with diabetes to disease be control their blood sugar, prevented? making dental hygiene an especially vital component Periodontal disease is of routine healthcare for preventable. A daily den-

tal hygiene regimen that includes brushing after meals, flossing at least once per day and swishing with mouthwash are some simple, healthy habits that can prevent periodontal disease. In addition, the AAP recommends that people at increased risk for periodontal disease, including the

elderly and smokers, should discuss their risk with their dental professionals.

Dental hygiene can do more for individuals than produce a mouthful of pearly white teeth. In fact, people who prioritize dental hygiene may lower their risks for various diseases.

When can children brush their own teeth?

Parents quickly learn that their children go through a transition marked by a desire to be more independent. They’re picking out their own mismatched clothes and no longer want any help when solving puzzles or complex toys. That newfound independence signals getting older and can be a healthy thing to nourish. But what happens when a youngster suddenly believes he or she is capable of brushing his or her teeth without assistance?

Parents wrestling with their kids’ can-do attitude and if it’s wise to allow them to brush their teeth

unassisted can familiarize themselves with certain guidelines to determine their youngsters’ readiness. According to Scripps Pediatric Dentistry & Orthodontics, most kids are at least six years old before they have developed the finesse and dexterity to handle a toothbrush in a manner that will effectively remove plaque. Dentists also may ask if the child can tie his or her own shoes, which can serve as a barometer of readiness to wield a toothbrush without assistance.

Pediatricians and pediatric dentists recommend that children visit

a dentist as soon as a child’s first tooth starts to appear. This also is when parents should begin to clean their children’s teeth. As a child ages, the natural proclivity to want to take charge of brushing teeth takes hold. The child may not yet have the manual dexterity to brush alone, but parents can encourage the child to brush and then go over the teeth as a “double check.”

This helps foster independence while also ensuring teeth are fully cleaned.

Flossing may require even more dexterity than brushing, but it is

essential for sloughing off plaque that accumulates between teeth and below the gum line, according to Parents magazine. Moms and dads can introduce their children to pre-threaded Y-shaped flossing tools, which are easier to handle than loose floss.

Parents will have to check on children even as they age to be sure they are practicing good oral hygiene. Parents who are in doubt about their children’s readiness can work with dentists or dental hygienists to assess skills and get other pointers.

Guidelines for various cancer screenings

Screenings are vital components of preventive health care. Much like healthy diets and routine exercise can reduce a person’s risk for various diseases, early screenings can reduce the likelihood that diseases like cancer will prove fatal.

The COVID-19 pandemic has affected nearly every aspect of life, including preventive care. Data from the medical records vendor Epic revealed that, between March 2020, when COVID-19 was first declared a pandemic, and early fall 2020 screenings for cancers of the breast, cervix and colon had declined by 86 to 94 percent.

Patients’ hesitation to schedule screenings during the pandemic is understandable. However, medical professionals continue to urge men and women, particularly those who are vulnerable to certain cancers, to schedule screenings. Doctors’ offices and hospitals have adjusted their protocols during the pandemic in an effort to keep patients safe, so adults should not hesitate to

schedule screenings.

The following guidelines can help patients determine if the time is right for them to be screened for various cancers.

■ Breast: Hackensack Meridian Health notes that mammograms have reduced breast cancer mortality in the United States by 40 percent since 1990. The National Comprehensive Cancer Network, Society of Breast Imaging, American Society of Breast Surgeons, and American College of Radiology recommend that women begin receiving annual mammograms at

age 40.

■ Lung: Low-dose computed tomography, often referred to as low-dose CT scans, are noninvasive, simple tests that have helped increase lung cancer survival rates considerably. Hackensack Meridian Health notes that only 15 percent of lung cancers are diagnosed early, so it’s imperative that vulnerable adults prioritize screening (nonsmokers and people who have never smoked are typically not referred for screening). Annual screening is recommended for current smokers or anyone who has smoked in the past 15 years, though doctors may recommend less frequent testing depending on the results of past screenings.

■ Cervical: Cervical cancer screenings, whether it’s a Pap test or an HPV test, can be conducted during women’s health screenings.

Death rates for cervical cancer have dropped considerably thanks to increased screening, so it’s important that women discuss their risk with

their physicians. The American College of Obstetricians and Gynecologists recommends average-risk women between the ages of 21 and 29 have a Pap test every three years, while those between the ages of 30 and 65 have a Pap test and an HPV test every five years.

■ Skin: Skin cancer screenings typically involve doctors examining patients’ skin from head to toe.

If the doctor notices any abnormalities, a biopsy may be taken. People at increased risk of skin cancer, which includes those with fair complexions, a significant history of sun exposure and sunburns and a family history of skin cancer and melanoma should receive full-body screening exams every year. People also can conduct self-examinations and report any abnormalities they find to their physicians immediately.

Cancer screenings are vital components of preventive health care and should remain so even during the pandemic.

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Blood donations are vital to many people’s survival. Whether someone has lost blood after a car accident or as the result of a chronic disease, without the selfless decision by millions of blood donors to donate blood, people in need may not be able to overcome their injuries and illnesses.

Cancer patients may need transfusions for a variety of reasons. Some may have lost a significant amount of blood during surgery, while others may experience a low blood count due to their treatments. Cancers in the blood and bone marrow do not allow the body to produce normal blood-making cells, thereby creating the need for transfusions.

Prospective donors recognize the need for blood, which may be even greater as a result of the COVID-19 pandemic. Though the Centers for Disease Control and Prevention note that it’s safe to donate blood during the pandemic, social distancing guidelines and nervousness about donating adversely affected the blood supply in the United States and other nations in 2020. However, the American Red Cross notes that only a handful of factors may affect prospective donors’ eligibility to donate blood.

Cold, flu and other illnesses

The Red Cross urges prospective donors to wait to donate blood if they: ■ have a fever or a productive cough (one that brings up phlegm) ■ do not feel well on the day of their scheduled donation Donors also are urged to wait to donate until they have completed antibiotic treatment for sinus, throat or lung infections.

Additional requirements regarding donors’ height and weight as well as donation intervals can be found at www.redcrossblood.org.

Medications

The Red Cross says that most medications will not disqualify prospective donors from being able to donate. However, the Red Cross also notes that some medications may require a waiting period after patients take their final dose before they are eligible to donate. Donors can contact their local blood donation center as well as their physicians to determine if any medications they’re currently taking or have taken recently will affect their eligibility to donate.

Low iron

Some donors are ineligible to donate because of low iron.

Donation center staff conduct screening tests to measure the amount of hemoglobin present in potential donors’ blood. Hemoglobin is a protein in the body that contains iron and carries oxygen to the tissues in the body.

If the hemoglobin count is too low, donors will be asked to wait to donate. The body needs iron to make new red blood cells and can help to replace those lost through blood donations. Thankfully, donors whose hemoglobin levels are low can take steps, such as eating foods that are rich in iron, to improve their hemoglobin levels so they can donate blood in the future.

Travel

Potential donors may be ineligible to donate blood if they lived in or traveled to a malaria-risk country in the past three years.

Travel destinations will be reviewed at the time of donation, so donors should be ready to answer questions about their travels during their donation appointment.

Donating blood saves lives. To ensure the safety of donors and donation recipients, prospective donors may need to wait to donate until they meet certain eligibility requirements.

Women’s health Questions to ask your doctor at every age As you get older, your body changes and your health-care needs evolve.

That’s why it’s important to speak with your doctor on a regular basis. Here are a few questions to ask at your next appointment.

In your 20s

■ Which methods of contraception would you recommend for me?

■ How do I know if I’m at risk of developing cervical cancer?

■ Which sexually transmitted and blood-borne infections (STBBIs) should I be tested for?

In your 30s

■ What can I do to increase my chances of having a healthy pregnancy?

■ How can I maintain a healthy weight and blood pressure level?

■ What would you recommend if I’m having trouble sleeping because of stress?

In your 40s

■ Should I be screened for diabetes and high cholesterol?

■ How can I prevent bladder leaks?

■ Am I in perimenopause if my menstrual cycle is irregular and I get hot flashes?

In your 50s

■ How often should I have a mammogram?

■ Should I get the shingles vaccine or any other type of shot?

■ What would you recommend to relieve my menopause symptoms?

In your 60s and older

■ Am I at risk of developing osteoporosis?

■ Should I take calcium or vitamin D supplements?

■ Do I need to get the flu shot if I’m in good health?

Regardless of your age, talking openly and regularly with your doctor is crucial to taking charge of your health.

7 ways to move more every day Many of today’s jobs, hobbies and modes of transportation make it easy to succumb to a sedentary lifestyle. Unfortunately, prolonged periods of inactivity are linked to an increased risk of heart disease, diabetes and obesity. If you find yourself sitting too often, here are seven simple ways to incorporate more movement into your daily routine.

1.

Sit on a stability ball rath­ er than the couch while you watch TV or play video games.

2.

Walk around the room while you’re on the phone. For lon­ ger calls, consider taking a stroll around the block.

3.

Listen to audiobooks or podcasts while you use an elliptical machine, stationary bike or tread­ mill to make your workout more interesting.

4.

Use a standing desk. Do simple exercises, such as calf rai­ ses, while you complete routine basketball game on TV. tasks like checking your email. steps at a time. your previous record.

With a little bit of creativity and 5.

Time how long it takes 7.

Do jumping jacks or run 6.

Take the stairs instead you to do an active chore like vacu­ of the elevator. To really get your in place during the commercial effort, there are plenty of simple uming, and then see if you can beat heart pumping, climb them two breaks while you watch a hockey or and fun ways to be more active.

5

reasons to increase your flexibility Flexibility plays a key role in your overall fitness. In fact, stretching your muscles and joints on a regular basis can make a variety of everyday ac­ tivities easier. Here are the five main benefits of increasing your flexibility.

1. It improves your posture and balance 2. It increases your range of motion 3. It reduces your risk of get­ ting injured 4. It helps your muscles work more effectively 5. It reduces aches, pains and muscle tension Furthermore, stretching after you exercise facilitates muscle

recovery and repair. It also pre­ vents lactic acid from building up and causing muscle soreness.

Keep in mind that stretching shouldn’t be painful. Though it’s normal to feel a pulling sen­ sation, a sharp or stabbing pain means you’ve over­extended your muscles or joints, which can result in injury.

Activities to try

Stretching is just one of many ways to improve your flexibility.

You can also try yoga, tai chi, water aerobics, Pilates, ballet and more. Consider signing up for a beginners’ class in your area.

Many ways walking benefits your body

Life changed dramatically in 2020. When the World Health Organization declared a COVID-19 pandemic in March 2020, hundreds of millions of people across the globe were forced to change how they go about their daily lives, including how they exercise.

Health-conscious adults accustomed to exercising at local gyms had to find new ways to exercise in the wake of the pandemic. Many gyms were forced to close in areas hit hard by COVID-19, and that left many people without access to fitness equipment like weights and cardiovascular machines.

Resilient men and women soon found ways to exercise, and many of them embraced walking.

Though walking might not provide the same level

of intensity that fitness enthusiasts are accustomed to, the Arthritis Foundation notes the various ways walking benefits the body.

■ Walking protects against heart disease and stroke. Walking strengthens the heart and protects it against heart disease. The AF also notes that walking lowers blood pressure.

In fact, post-menopausal women who walk just one to

two miles per day can lower their blood pressure by nearly 11 points in 24 weeks, while women who walk for 30 minutes a day can reduce their risk of stroke by 20 percent.

■ Walking strengthens the bones and can stop the loss of bone mass for people with osteoporosis. In addition, post-menopausal women who incorporate 30 minutes of walking into

their daily fitness regimens can reduce their risk of hip fractures by 40 percent.

■ Walking can extend your life. The AF notes that one study linked walking to longer life expectancy, finding that people who exercise regularly in their fifties and sixties were 35 percent less likely to die over the next eight years than people who never walked.

■ Walking can improve mood. One study from researchers at California State University, Long Beach, found that the more steps people taking during the day, the better their moods were.

■ Walking can lower risk for cognitive decline. Walking also has been linked to a lower risk for age-related cognitive decline. A study from the University of Vir-

ginia Health System found that men between the ages of 71 and 93 who walked more than a quarter of a mile per day had half the incidence of dementia and Alzheimer’s disease compared to men who walked less. In addition, a study from researchers at the University of California, San Francisco, found that age-related memory decline was lower among women ages 65 and older who walked 2.5 miles per day than it was among women who walked less than half a mile per week.

Foot traffic increased as people were forced to find new ways to exercise during the COVID-19 pandemic.

Walking is a great way to stay in shape and even provides some lesser known benefits for people who walk each day.

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Eye exam recommendation schedules Routine eye exams should be a vital component of everyone’s healthcare routine. Such examinations can help people learn if they need prescription eyeglasses and if their existing prescriptions need to be updated, and they also can uncover other serious health issues.

According to the American Academy of Ophthalmology®, a comprehensive eye exam can uncover such problems as aneurysms, brain tumors, diabetes, high blood pressure, and assorted cancers, including those of the blood, tissue or skin. That means routine eye exams can be as effective at safeguarding your overall health as they can at protecting your vision.

The recommended frequency

Prescription eyeglasses help billions of people across the world improve their vision. In fact, when a person’s vision starts to weaken, a new eyeglass prescription is often the solution. However, prescription eyeglasses cannot correct every issue, including low vision.

The National Eye Institute defines low vision as a vision problem that makes it hard for people to perform everyday activities. People with low vision may not see well enough to read, drive, recognize people’s faces, distinguish between colors, or see their television or computer screens clearly.

Though low vision is a serious condition, the Cleveland Clinic notes it does not include complete blindness and can sometimes be improved with the use of visu-

with which people should receive eye exams is based largely on age, though no one should hesitate to schedule an exam if their eyes are bothering them or if they are experiencing any abnormalities with their eyes. In addition, some people may need more frequent eye exams depending on their medical histories, which should be discussed at length with a physician.

Children and adults without preexisting conditions and those not experiencing any abnormal vision problems can adhere to this eye examination schedule, courtesy of the American Optometric Association.

■ Birth to two years: Children in this age group should receive eye

al aids. Understanding low vision and how it can affect a person’s daily life can help patients and their families confront the condition more successfully.

Are all types of low vision the same?

The NEI notes that there are different types of low vision. The four most common types of low vision are: ■ Central vision loss: This is marked by an inability to see things in the center of your vision.

■ Peripheral vision loss: This affects peripheral vision and compromises a person’s ability to see things out of the corners of the eyes.

■ Night blindness: A person diagnosed with night blindness will be unable to see in low light.

■ Blurry or hazy vision:

exams between six to 12 months of age.

■ Age three to five: Children in this age group should receive at least one eye exam between their third and fifth birthdays.

■ Age six to 17 years: Children in this age group should receive one eye exam prior to beginning first grade and then an annual exam thereafter.

■ Age 18 to 64: Adults between

the ages of 18 and 64 should receive an eye exam at least once every two years.

■ Age 65 and older: Annual eye exams are recommended for men and women age 65 and older.

Eye examinations help people preserve and improve their vision while also promoting long-term overall health. These vital components of healthy lifestyles should not be overlooked.

Understanding low vision The Cleveland Clinic notes that objects both near and far will appear out of focus person when a person is dealing blurry vision.

Someone with hazy vision will feel as though his or her entire field of vision is covered with a film or glare.

What causes low vision?

The NEI notes that low vision is not caused by aging alone. However, there is a link between aging and low vision. Many of the diseases that can cause low vision are most common in older adults. In fact, the Cleveland Clinic notes low vision affects one in four adults over age 75 and one in six adults over age 45. The type of low vision a person has will depend on the disease or condition that caused it.

Many different eye condi-

tions can cause low vision, but the NEI says the four most common are: • Age-related macular degeneration (AMD): AMD is a disease of the eye that can blur the vision people need to read and drive. AMD is slow to develop and as it progresses the blurry area near the center of vision may get bigger and things may also seem less bright than before.

■ Cataracts: Cataracts affect more than half of all Americans age 80 or older.

The NEI notes that many people do not notice they have a cataract initially.

But over time, people with a cataract may notice their vision becoming blurry, hazy or less colorful.

■ Diabetic retinopathy: Diabetic retinopathy affects blood vessels in the retina and can cause low vision in

people with diabetes. The NEI urges anyone with diabetes to schedule comprehensive dilated eye exams at least once per year, as finding diabetic retinopathy early, even when no symptoms are present, can help people protect their vision.

■ Glaucoma: Glaucoma is an umbrella term used to describe a group of eye diseases that damage the optic nerve. The NEI notes that half of all people with glaucoma don’t even know they have it, which only underscores the importance of scheduling comprehensive dilated eye exams.

Low vision is a serious condition that can affect people’s ability to perform daily tasks like reading and driving. More information about low vision can be found at www.nei. nih.gov.

Get moving to manage stress MAYO CLINIC NEWS NETWORK (TNS)— Exercise in almost any form can act as a stress reliever. Being active can boost your feel-good endorphins and distract you from daily worries.

You know that exercise does your body good, but you’re too busy and stressed to fit it into your routine.

Hold on a second — there’s good news when it comes to exercise and stress.

Virtually any form of exercise, from aerobics to yoga, can act as a stress reliever. If you’re not an athlete or even if you’re out of shape, you can still make a little exercise go a long way toward stress management. Discover the connection between exercise and stress relief — and why exercise should be part of your stress management plan.

Exercise increases your overall health and your sense of well-being, which puts more pep in your step every day. But exercise also

has some direct stress-busting benefits.

It pumps up your endorphins.

Physical activity helps bump up the production of your brain’s feelgood neurotransmitters, called endorphins. Although this function is often referred to as a runner’s high, a rousing game of tennis or a nature hike also can contribute to this same feeling.

It’s meditation in motion. After a fast-paced game of racquetball or several laps in the pool, you’ll often find that you’ve forgotten the day’s irritations and concentrated only on your body’s movements.

As you begin to regularly shed your daily tensions through movement and physical activity, you may find that this focus on a single task, and the resulting energy and optimism, can help you remain calm and clear in everything you do.

It improves your mood. Regular exercise can increase self-confi-

dence, it can relax you, and it can lower the symptoms associated with mild depression and anxiety.

Exercise can also improve your sleep, which is often disrupted by stress, depression and anxiety. All of these exercise benefits can ease your stress levels and give you a sense of command over your body and • your life.

Marek Uliasz/Dreamstime/TNS

Exercise in almost any form can act as a stress reliever.

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Microgreens rich in vitamins

BY WILL PRY American Heart Association News

As one of the trendiest foods in the produce aisle, microgreens are known for adding a splash of color to a dish, a spicy kick to a salad – and a chunk of change to a grocery bill.

Known for a variety of flavors, textures and aromas, microgreens originated as a product of the California restaurant scene in the 1980s. Smaller than baby greens, they are harvested just one to two weeks after germination – typically later than sprouts, which don’t have leaves. They usually are 1 to 3 inches tall and often are sold with the stems attached.

Most microgreens are rich in concentrated vitamins and antioxidants. A 2012 study in the Journal of Agricultural and Food Chemistry looked at 25 commercially available microgreens

and found they contained nutrient levels up to 40 times higher than more mature leaves. Other research also has shown microgreens contain a wider variety of antioxidants and micronutrients called polyphenols.

Nutrient content aside, microgreens are not a replacement for leafy and other greens in one’s diet, said Christopher Gardner, director of nutrition studies at the Stanford Prevention Research Center in California. Instead, they serve a better purpose as a way to add variety to a regular salad or other healthy meal.

According to the federal dietary guidelines, an adult consuming 2,000 calories a day should eat 2 1/2 cups of vegetables each day, and the key is variety. Yet almost 90% of the U.S. population fall short of that number, the guidelines say.

“I’ve been working more and

more with chefs these days and one of the points that I’ve been trying to help people walk away with is that food really should bring them joy and pleasure,” said Gardner, vice-chair of the American Heart Association’s nutrition committee. Microgreens are “tasty with this sharp spice, that taste in the back of your mouth that you’re not accustomed to.”

Microgreens — sometimes called “vegetable confetti” – are grown from the seeds of a wide array of plant families, with varieties including cauliflower, broccoli, cabbage, arugula, radicchio, carrot, celery, quinoa, spinach, melon, cucumber and squash.

They can be eaten on their own, blended into a smoothie, added to a wrap or salad, or as a garnish on soups and other dishes.

As the COVID-19 pandemic has changed people’s attitudes

about their food shopping habits, do-it-yourself microgreens have offered a sustainable alternative. Growing them at home also may be an antidote to high prices at the grocery store or farmers market. They can be grown yearround, indoors or outdoors, without requiring much time, equipment or expertise.

“Is there something about being in a New York apartment and being able to grow a little backyard tray of microgreens and add it to your food?” Gardner said. “It might not be the meal, it might be just something that you add to what you’re eating for the taste.

“So maybe the actual scale of it makes it more accessible to some people to grow on their own – thereby getting them feeling like they’re a little more in touch with the food that they’re eating because they’re producing it.”

Smoking boosts risk for rare stroke

BY AMERICAN HEART ASSOCIATION NEWS

People who smoke, especially those genetically predisposed to doing so, are at much higher risk for a rare but often fatal type of bleeding stroke, new research shows. And the more you smoke, the higher the risk.

The study, published recentlly in the American Heart Association journal Stroke, provides evidence of a causal link between smoking and subarachnoid hemorrhage, or SAH. That’s when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull. This accounts for 5% of all strokes and affects mainly middle-aged adults; half of the people who have SAH strokes are under age 55. One-third of people who have them die within days or weeks.

Those who survive have a high rate of disability or cognitive impairment.

“Previous studies have shown that smoking is associated with higher risks of SAH, yet it has been unclear if smoking or another confounding condition such as high blood pressure was a cause of the stroke,” Dr. Guido Falcone, the study’s senior author, said in a news release. He is an assistant professor of neurology at Yale School of Medicine in New Haven, Connecticut.

The new study analyzed data for 408,609 people in the United Kingdom between the ages of 40 and 69 who were part of a large cohort that gave researchers access to genetic and other health information. Researchers identified people in the group who smoked, along with those who carried genes associated with a propen-

sity for smoking and those who later experienced SAH strokes.

They found the more a person smoked, the higher their risk of having an SAH. Those who smoked half a pack to 20 packs of cigarettes per year had a 27% higher risk than those who didn’t smoke. Heavy smokers – more than 40 packs per year – were three times more likely than nonsmokers.

People who carried a genetic predisposition for smoking were at 63% greater risk for having an SAH. The results should prompt future studies to explore whether genetic variants leading to smoking can be used to identify people at risk for this type of stroke, lead study author Dr. Julian N. Acosta said in a news release. He is a neurologist and postdoctoral research fellow at Yale School of Medicine.

“

The study, published recently in the American Heart Association journal Stroke, provides evidence of a causal link between smoking and subarachnoid hemorrhage, or SAH. That’s when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.”

“These targeted populations might benefit from aggressive diagnostic interventions that could lead to early identification of the aneurysms that cause this serious type of bleeding stroke.”

Spotting spoiled food beyond the best-by date

Is it safe to eat? While best-by dates are useful indicators, your senses are a much better way to gauge freshness. Here’s how to determine whether food is safe to eat.

■ Dairy. Milk, yogurt, sour cream and other high-humidity dairy products should be chucked if they’ve separated, smell sour, have curdled or are showing even a hint of mold.

■ Cheese. Hard and semi-soft cheeses like Parmesan and cheddar are fairly resistant to mold.

If there’s only a little bit on the surface, you can cut off one inch around the affected area and eat the rest. Moldy soft cheeses should be discarded.

■ Bread. Since mold spores can penetrate the porous surface of bread, a moldy loaf should be thrown out.

■ Potatoes. Throw out any potato with green flesh. This is due to an accumulation of solanine, a toxic chemical naturally produced

by potatoes. If the green coloration doesn’t extend below the skin, the potato is safe to eat once peeled. Make sure to remove eyes and sprouts and to throw out soft, moldy potatoes.

■ Fruits and vegetables. Some fruits and veggies, like carrots and bell peppers, are too dense for mold to penetrate past the surface, so these are safe to eat once the affected spot is removed. Slimy, discolored and thoroughly moldy fruits and veggies should be thrown out.

■ Eggs. Conduct a water test to determine freshness. If the egg sinks, it’s good. If it floats, toss it.

■ Canned food. Throw out rusted or bulging cans, as well as those that have been punctured.

■ Meat and fish. Minor discoloration is nothing to worry about.

However, a slimy texture or an unusual smell are indicators of spoilHowever, if in doubt, it’s always age. The same is true of fresh fish, should also be discarded.

Remember, best-by dates are better to err on the side of cauwhich should never smell fishy.

Deli meats with a slimy coating indicators of freshness, not safety. tion.

5great reasons to eat mushrooms Here are five great reasons why the health-conscious diner should make room on their plate for mushrooms.

1. Vitamin B Most edible mushrooms are rich in vitamins B1, B2, B3, B5 and B9.

These help our bodies metabolize food and contribute to red blood cell formation. These nutrients are also thought to play a role in brain health.

2. Vitamin D Mushrooms are one of the few vegan sources of vitamin D, which is crucial for teeth and bone health.

However, mushrooms only produce vitamin D if exposed to sunlight.

Look for those grown outdoors or that have been irradiated with UV light.

3. Dietary fiber

Most mushrooms are made up of at least 50 percent carbohydrates by weight. However, most of these carbs are insoluble dietary fiber, which plays a crucial role in digestion and helps control cholesterol.

4. Heart health Potassium is found in large quantities in mushrooms and is a key player in regulating blood pressure. In addition, they contain high concentrations of beta-

glucans, a type of fiber that’s been shown to help reduce cholesterol levels. The stem of the shiitake is a particularly good source of betaglucans.

5. Weight management While mushrooms shouldn’t be thought of as a weight loss superfood, they do tend to increase satiety. This means you’ll feel fuller quicker. In conjunction with their low fat and calorie content, this makes them a handy food for weight management.

Mushrooms may also help prevent certain cancers, as well as protect from some types of neurodegenerative diseases. While more research is needed to substantiate these claims, one thing is for sure: eating more mushrooms is a delicious way to stay healthy.

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