Health Beat, August 2013

Health Beat MAGAZINE

AUGUST 2013

A PUBLICATION OF THE RICHMOND REGISTER

Want to age gracefully?

Slather on the sunscreen!

Back-to-school preparations should include an eye exam Not everyone poops: Constipation in children

New treatment options for MS Habits that make you fat The lesser known benefits of cardiovascular exercise

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HEALTH BEAT

MOM’S OBESITY SURGERY MAY HELP BREAK CYCLE IN KIDS The Associated Press

WASHINGTON — Obese mothers tend to have kids who become obese. Now provocative research suggests weight-loss surgery may help break that unhealthy cycle in an unexpected way — by affecting how their children’s genes behave.

In a first-of-a-kind study, Canadian researchers tested children born to obese women, plus their brothers and sisters who were conceived after the mother had obesity surgery. Youngsters born after mom lost lots of weight were slimmer than their siblings.

They also had fewer risk factors for diabetes or heart disease later in life.

More intriguing, the researchers discovered that numerous genes linked to obesityrelated health problems worked differently in the younger siblings than in their older brothers and sisters.

Clearly diet and exercise play a huge role in how fit the younger siblings will continue to be, and it’s a small study. But the findings suggest the children born after mom’s surgery might have an advantage.

“The impact on the genes, you will see the impact for the rest of your life,” predicted Dr.

Marie-Claude Vohl of Laval University in Quebec City. She helped lead the work reported in the journal Proceedings of the National Academy of Sciences.

Why would there be a difference? It’s not that mom passed on different genes, but how those genes operate in her child’s body. The idea: Factors inside the womb seem to affect the dimmer switches that develop on a fetus’ genes — chemical changes that make genes speed up or slow down or switch on and off. That in turn can greatly influence health.

The sibling study is “a very clever way of looking at this,” said Dr. Susan Murphy of Duke University. She wasn’t involved in the research but studies uterine effects on later health. She says it makes biological sense that the earliest nutritional environment could affect a developing metabolism, although she cautions that healthier family habits after mom’s surgery may play a role, too.

It’s the latest evidence that the environment — in this case the womb — can alter how our genes work.

And the research has implications far beyond the relatively few women who take the drastic step of gastric bypass surgery before having a baby. Increasingly, scientists

are hunting other ways to tackle obesity before or during pregnancy in hopes of a lasting benefit for both mother and baby.

What’s clear is that obesity is “not just impacting your life, it’s impacting your child,” Duke’s Murphy said.

More than half of pregnant women are overweight or obese, according to the American College of Obstetricians and Gynecologists. But it’s not just a matter of how much moms weigh when they conceive — doctors also are trying to stamp out the idea of eating for two. Gaining too much weight during pregnancy increases the child’s risk of eventually developing obesity and diabetes, too.

What’s too much? Women who are normal weight at the start of pregnancy are supposed to gain 25 to 35 pounds. Those who already are obese should gain no more than 11 to 20 pounds. Overweight mothers-to-be fall in the middle.

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AUGUST 2013

HEALTH BEAT

Habits that make you fat A few small fixes can significantly lower the number on the scale.

PAGES 8-9

Richmond Register 3

Want to age gracefully?

Slather on the sunscreen!

Sun exposure happens every day, even in winter. Using sunscreen daily can improve our long-term skin health, reduce the appearance of wrinkles and sun spots, and reduce risks for skin cancers. READ MORE PAGE 12

FOCUS: Back-to-school preparations should include eye exam . . . . . . . . . . .page 4 STUDY: Nation’s kids need to get more physical . . . . . . . . . . . . . . . . . . . . .page 5 GROWING UP: Not everyone poops: Constipation in kids . . . . . . . . . . . .page 4

Hospitals seek high-tech help for hand hygiene . . . . . . . . . . . . . . . . . . . . . . . .page 6 MEDICAL MINUTE: New treatment options for MS . . . . . . . . . . . . . . .page 10 MENTAL MORSELS: Let the emperor have his new clothes . . . . . . . . .page 11 CHIROPRACTIC CORNER: It doesn’t hurt to ask . . . . . . . . . . . . . . .page 13 The lesser known benefits of cardiovascular exercise . . . . . . . . . . . . . . . . . . .page 15

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Health Beat is an official publication of the Richmond Register

Melon growers face new FDA rules after outbreak WASHINGTON, Ind. (AP) — Southwestern Indianas melon growers are facing new federal food-safety regulations following last years salmonella outbreak that killed three people who ate Indiana-grown cantaloupes.

The Food and Drug Administration will be inspecting packing sheds and possibly field conditions as part of that effort.

Samples of the melons will be taken and tested for salmonella and E. coli, among other pathogens.

E. coli and salmonella are the two most common of foodborne illnesses passed from tainted produce onto consumers.

Purdue Extension educator Scott Monroe said the State Department of Health has hired two farm food safety consultants to assist in the farm produce education campaign. Purdue has had food safety teams in place for three years, he said.

Monroe said the two consultants, one based in Oaktown and the other in Fort Wayne, will work directly with farmers.

“If farmers have questions, they will contact the consultants who can guide them,” Monroe told the Washington Times-Herald.

A salmonella outbreak traced to a southwestern Indiana cantaloupe farm killed three Kentucky residents last year. That outbreak followed a 2011 Listeria outbreak that killed 33 people who ate cantaloupes grown on a Colorado farms.

Workshops were recently held in southwestern Indiana — the

center of Indianas cantaloupe and watermelon production — to educate melon farmers and their workers about the FDAs new expectations for protecting consumers from food-borne pathogens.

The rough, pitted surfaces of melons can trap dirt and pathogens, making contaminants harder to remove during the fruit-processing following harvest.

Most large melon growers harvest the fruit from the field, unload and wash it, pack it and then cool the fruit before its shipped to stores.All that moving of the melons and washing can lead to unsanitary conditions in packing houses.

A letter from the FDA released in February states that investigations into both last years salmonella outbreak and the 2011 Listeria outbreak traced to a Colorado farm revealed multiple instances of unsanitary production, handling conditions, and packing house practices that lead to those outbreaks.

Nearly one-third of all cases of food borne illness come from produce. In addition to cantaloupes, leafy greens, green onions, and tomatoes are usually the most susceptible.

Consumer who purchase cantaloupes and other melons are advised to use a vegetable brush to scrub away dirt and other material on the rind. The fruit should then be patted dry with a clean towel and allowed to dry before its sliced or cut up.

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HEALTH BEAT

AUGUST 2013

Back-to-school preparations should include eye exam

State law requires exam for children entering public school

S

hopping for supplies and new clothes aren’t the only preparations that parents should make before school starts. State law requires that children ages 3 through 6 who are entering a public school or preschool program for the first time have a vision exam.

“In studying early childhood development, the Kentucky General Assembly identified problems with vision as one of the major factors in limiting children’s abilities to learn and succeed,” said Dr. Reynolds, an optometrist with the Eye Care Center, which has two offices in Richmond and six other cities. “Having children’s eyes examined is one of the most important things you can do to support their education and good health.”

Up to 13 percent of children age 5 and younger have some type of vision condition. After age 5, that number increases to 25 percent.

“All parents are encouraged to have their children’s eyes examined because many problems may not be obvious to you or your child’s teachers,” Reynolds said. “Young children don’t realize that the way they see the world may not be the way it should be. Early diagnosis and treatment can prevent loss of sight from amblyopia, which is commonly called lazy

eye. Unfortunately, one-half of all cases of amblyopia are not diagnosed until after age 5, when it is difficult to correct.”

Amblyopia is the leading cause of vision loss in people under age 40 -- more than injuries or any other disease.

However, it is almost 100 percent treatable if detected early.

Reynolds also said an eye examination is particularly important if your child exhibits any of these signs of possible eye problems: • Loses place while reading, holds the book closer than normal or uses his finger to maintain his place while reading.

• Avoids close work.

• Tends to rub her eyes.

• Has frequent headaches.

• Turns or tilts his head, or squints, to use only one eye.

• Omits or confuses small words when reading aloud.

• Consistently performs below academic potential.

Financial assistance is available. Medicaid and KCHIP cover these services as well as many private insurance plans. Other private programs are also available to help families meet these expenses, such as the Kentucky Vision Project, which is sponsored by the Kentucky Optometric Association, and has donated an estimated $20 million in vision care; Sight for Students; and the Lion’s Club programs.

AUGUST 2013

HEALTH BEAT

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“We have an obligation to keep kids active. We have research to show that physical activity helps kids perform better in school.

It helps them focus better in the classroom ... and they behave better in school. So there are all kinds of side benefits.”

Report:

— PAUL ROETERT, CEO OF THE AMERICAN ALLIANCE FOR HEALTH, PHYSICAL EDUCATION, RECREATION,AND DANCE

Nation’s kids need to get more physical The Associated Press

Reading, writing, arithmetic — and PE? The prestigious Institute of Medicine is recommending that schools provide opportunities for at least 60 minutes of physical activity each day for students and that PE become a core subject.

The report, released May 2013, says only about half of the nation’s youngsters are getting at least an hour of vigorous or moderate-intensity physical activity every day.

Another concern, the report says, is that 44 percent of school administrators report slashing big chunks of time from physical education, arts and recess since the passage of the No Child Left Behind law in 2001 in order to boost classroom time for reading and math.

With childhood obesity on the rise — about 17 percent of children ages 2 through 19 are obese — and kids spending much of the day in the classroom, the chairman of the committee that wrote the report said schools are the best place to help shape up the nation’s children.

“Schools for years have been responsible for various health programs such as nutrition, breakfast and lunch, immunizations, screenings,” Harold W. Kohl III, a professor of epidemiology at the University of Texas School of Public Health, said in an interview with The Associated Press.

“Physical activity should be placed alongside those programs to make it a priority for us as a society,” he said.

The report calls on the Education Department to recommend that PE be adopted as a core subject.

It says physical education in school is the “only sure opportunity” for youngsters to have

access to activity that will help keep them healthy.

The majority of states, about 75 percent, mandate PE, according to the American Alliance for Health, Physical Education, Recreation, and Dance. But most do not require a specific amount of time for PE in school, and more than half allow exemptions or substitutions, such as marching band, cheerleading and community sports.

Many kids also aren’t going to gym class at school every single day. According to the CDC, only about 30 percent of students nationwide attend PE classes five days a week.

The report recommends:: • All elementary school students should spend an average of 30 minutes each day in PE class.

• Middle and high school students should spend an average of 45 minutes each day in PE class.

• State and local officials should find ways get children more physical activity in the school environment.

PE isn’t the sole solution, though.

The report advocates a “whole-of-school” approach where recess and before-andafter-school activities including sports are made accessible to all students to help achieve the 60minutes-a-day recommendation for physical activity. It could be as simple as having kids walk or bike to school, or finding ways to add a physical component to math and science class lessons.

The report also cautions against taking away recess as a form of punishment, and it urges schools to give students frequent classroom breaks.

Schools can do this if they make it a priority, said Paul Roetert, CEO of the American

Alliance for Health, Physical Education, Recreation, and Dance.

“We have an obligation to keep kids active,” Roetert said in an interview. “We have research to show that physical activity helps kids perform better in school. It helps them focus better in the classroom ... and they behave better in school. So there are all kinds of side benefits.”

Kitty Porterfield, spokeswoman for The School Superintendents Association, said nobody is opposed to physical education.

“Everybody would love to see more of it in schools,” said Porterfield. “Given the testing and academic pressures for excellence on schools, often physical education slides to the bottom of the barrel.”

HEALTH BEAT

Hospitals seek high-tech help for hand hygiene The Associated Press

RICHMOND HEIGHTS, Mo. — Hospitals have fretted for years over how to make sure doctors, nurses and staff keep their hands clean, but with only limited success. Now, some are turning to technology — beepers, buzzers, lights and tracking systems that remind workers to sanitize, and chart those who don’t.

Health experts say poor hand cleanliness is a factor in hospital-borne infections that kill tens of thousands of Americans each year. The U.S. Centers for Disease Control and Prevention in Atlanta estimates that one of every 20 patients in U.S. hospitals gets a hospital-acquired infection

each year.

“We’ve known for over 150 years that good hand hygiene prevents patients from getting infections,” said Dr. John Jernigan, an epidemiologist for the CDC. “However, it’s been a very chronic and difficult problem to get adherence levels up as high as we’d like them to be.”

Hospitals have tried varying ways to promote better hygiene. Signs are posted in restrooms. Some even employ monitors who keep tabs and single out offenders.

Still, experts believe hospital workers wash up, at best, about 50 percent of the time. One St. Louis-area hospital believes it can approach 100 percent adherence.

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Mary’s Health Center in the St. Louis suburb of Richmond Heights, Mo., has been the test site for a system developed by Biovigil Inc., of Ann Arbor, Mich. A flashing light on a badge turns green when hands are clean, red if they’re not. It also tracks each hand-cleaning opportunity — the successes and the failures.

The failures have been few at the two units of St. Mary’s where the system is being tested, the hospital said. One unit had 97 percent hand hygiene success, said Dr. Morey Gardner, the hospital’s director of infection disease and prevention. The other had 99 percent success.

“The holy grail of infection prevention is in our grasp,” Gardner said.

The Biovigil system is among many being tried at hospitals. A method developed

by Arrowsight, based in Mt. Kisco, N.Y., uses video monitoring. It is being used in intensive care units at North Shore University Hospital in Manhasset, N.Y., and the University of California San Francisco Medical Center.

Akron, Ohio-based GOJO Industries, maker of Purell hand sanitizer, has developed an electronic compliance monitoring system using wireless technology to track when soap and hand sanitizer dispensers are used. The SmartLink system gives the hospital data on high- and low-compliance areas. The company said it has installed the system at several hospitals around the country, but didn’t say how many.

HyGreen Inc.’s Hand Hygiene Reminder System was developed by two University of Florida doctors.

The Gainesville, Fla., company now features two systems used in seven hospitals, including Veterans Administration hospitals in Chicago, Wilmington, Del., and Wilkes-Barre, Pa.

Associated Press photo

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One is similar to Biovigil’s green badge method. In HyGreen’s, a wall-mounted hand wash sensor detects alcohol on the hands. The badge includes an active reminding system. Unclean hands create a warning buzz. If the buzz sounds three times, the worker is noted for noncompliance.

HyGreen spokeswoman Elena Fraser said that because some hospitals are moving away from alcohol-based sanitizers, HyGreen offers a second system. A touch of the sanitizer dispenser clears the worker to interact with a patient. If the worker shows up at the patient bed without hand-cleaning, the series of warning buzzes begins.

Fraser said hospital infections have dropped 66 percent at units of Miami Children’s Hospital where the badge system has been implemented.

Nurses using the Biovigil system at St. Mary’s near St. Louis wear a badge with changeable colored lights. A doorway sensor identifies when the nurse enters a patient’s room, and the badge color changes to yellow.

The nurse washes his or her hands and places them close to the badge. A sensor in the badge detects chemical vapors from the alcohol-based solution. If hands are clean, the badge illuminates a bright green hand symbol.

If the nurse fails to sanitize, the badge stays yellow and chirps every 10 seconds for 40 seconds, then flashes red. Once the flashing red starts, the nurse has another 30 seconds to wash up, otherwise the badge turns solid red, denoting non-compliance. Either way, each instance is tracked by a computer. The hospital can track each individual’s compliance.

Turn to HYGIENE, page 14

AUGUST 2013

HEALTH BEAT

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GROWING UP

Not everyone poops: Constipation in kids e has not pooped for three days! I am starting to get really “H worried,” said the mother to her husband.

Her husband replied, “That is a long time. What do you think we should do?”

In the meantime, the child is refusing to go near the toilet and complains, “It hurts too much.”

A little known fact outside of adults who have children is how much attention is paid to a toddler and child’s bowel movements.

While not the typical content of most conversations, parents with infants and young children spend considerable time discussing the subject with other parents. One of the reasons for this is the common occurrence of constipation.

While most people believe constipation is simply not pooping for several days, it is more complicated than that.

Some children can wait two or three days before having a bowel movement and not be constipated, while others can have small bowel movements and be constipated.

For children, the key signs are to look for poop that is hard and compact with three to four days between bowel movements.

Also, constipation often involves painful bowel movements and blood in or outside of the poop. Sometimes children can soil themselves between bowel movements.

There are several possible causes of constipation. Some children withhold their stool which might be due to stress regarding potty training, being particular about what toilet they use or because they are afraid of having a painful bathroom experience.

Another possible cause is a diet that is low in fiber or does not include enough liquids.

Finally, constipation can result as a side effect if the child is on medication.

Treatment for infrequent constipation can occur at home.

Adding fiber and increasing daily water intake to toddlers or children’s diet can help.

This diet includes eating prunes, apricots, plums, peas, beans, and whole grain cereals.

DAN FLORELL, PH.D. AND PRAVEENA SALINS, M.D.

Establishing a regular toiDan Florell, Ph.D., is an leting time, particularly with assistant professor at Eastern younger children, can assist in Kentucky University and has combatting constipation. This a private practice, MindPsi can include having the child use (www.mindpsi.net). Praveena the toilet first thing in the morn- Salins, M.D., is a pediatrician ing and then after every meal or at Madison Pediatric Associates snack. (www.madisonpeds.com).

Make sure to tell the child to go to the toilet and not give them the option of saying no.

If the constipation is more severe and not responsive to the addition of fluids and a high fiber diet, a pediatrician should be consulted.

Often the pediatrician will have children take stool softeners, mild laxatives, or have them given an enema.

However, parents should not try these treatments before consulting with the pediatrician.

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HEALTH BEAT

AUGUST 2013

DR. JACK

ON

H E A LT H & F I T N E S S

Habits that make you fat If losing weight were easy, there wouldn’t be so many weight loss diets, programs and pills out there.

Some of these gimmicks work for a while, but ultimately the secret to successful weight loss lies mainly in your lifestyle.

What you do and eat on a day to day basis will invariably determine whether you’re overweight or not.

The switch to a healthier lifestyle doesn’t require profound changes. A few small fixes can significantly lower the number on the scale. Try these healthier habits for quick and lasting weight loss.

Be prepared The Boy Scouts and healthy eaters have the same motto: Be prepared.

That means having a refrigerator and panty stocked with healthy foods, including lean proteins, whole-grain carbohydrates, fruits and vegetables, and healthy fats.

Lunches can then be made from these healthy choices, shaving calories and fat. Snacks can be natural fruits and vegetables, instead of processed foods with high amounts of sugar, salt and fat.

Drink lots of water Inadequate hydration leads to fatigue which many people misinterpret as hunger.

The impact of hydration on weight loss, however, goes far beyond preventing misinterpreted body messages. A study published in the November, 2008 issue of the journal Obesity found a strong association between increased water intake and increased weight loss. Another study found that dieters who drank two 8-oz. glasses of water before their three daily meals lost 5 lbs. more than dieters who didn’t.

Cut down on liquid calories Most of the calories that enter your body in liquid form are empty calories. They add up but don’t make you feel full and they don’t provide much in the way of nutritional value.

Soft drinks, flavored coffees, imitation fruit juice and other

DR. JACK RUTHERFORD

sweetened drinks make virtually no nutritional contribution to the body.

Even fruit juices and sport drinks should be limited as they contain high amounts of sugar. Replace those with water, tea or coffee without sugar and cream, and low-calorie sodas or powdered flavored beverages.

Get enough protein Unless you get plenty of protein in your diet, you will have trouble losing weight.

Your body uses more energy processing protein than it does fat or carbohydrates. Therefore, when you eat protein, it helps you lose weight.

Be sure it’s low-fat protein sources such as skinless chicken, pork tenderloin, ground turkey, beans and seafood. You can also add eggs, peanut butter, low-fat cheeses, Greek yogurt, or low-fat protein bars.

Don’t skip breakfast It’s easy to rush out the door in the morning without taking time for breakfast, but don’t do it.

Breakfast kick-starts your metabolism, forcing it to begin burning calories. If you’re one of those people who doesn’t have an appetite in the morning, don’t worry, just make sure you eat something within the first two hours of waking.

The perfect breakfast combines complex carbohydrates with protein and a little healthy fat.

An example would be two scrambled eggs with a slice of whole-wheat toast, a cup of Greek yogurt with a handful of berries and chopped nuts stirred in.

Stay out of the center aisles at the grocery store A good rule of thumb is to do most of your grocery shopping near the four walls.

The perimeter of the store is where you find fresh produce, the meats, grains and dairy. In the middle aisles are the processed foods you should avoid.

There are a few exceptions, namely in the freezer section where the frozen vegetables are stored and the cereal aisle where you can find oatmeal and whole-grain cereals.

AUGUST 2013

HEALTH BEAT

Lift weights Of course, you’ve started doing aerobic exercise to burn those extra calories, but don’t forget the weights.

You won’t achieve your weight-loss goals through diet and cardio alone. Adding resistance training to cardiovascular exercise will optimize your ability to shed pounds.

Studies have shown the significant relationship between resistance exercise and weight loss. In particular, weight lifting raises the metabolism both during and after the exercise, creating the “afterburn” effect.

Cardio only raises the metabolism during the exercise and for a short period afterwards.

Get enough sleep Yes, you can sleep your way to weight loss, at least partly.

Getting the right amount of sleep is an important factor in achieving and maintaining a healthy weight.

A 2006 study found that people who slept five hours or less a night weighed an average of 5 lbs. more than those who slept seven hours or more.

The reason has to do with the hormones leptin and ghrelin. Studies have shown that sleep deprivation causes a reduction in leptin levels and a rise in ghrelin levels, both of which affect appetite.

High ghrelin levels stimulate the appetite, while low leptin levels makes you feel unsatisfied after eating, leaving you hungrier during your waking hours.

Keep accurate records If you’re trying to lose weight but the pounds just aren’t coming off, chances are you’re eating more than you think.

Keeping records of everything you eat in the form of a food diary can help. Just the act of record-keeping is effective on many levels.

First, you get a complete picture of your daily caloric intake. Plus, knowing you have to write down everything you eat may make you reconsider that late-night bowl of ice cream.

Richmond Register 9

Also, once you’ve kept your food diary for a while, you’ll begin to notice patterns, like late-night snacking in front of the TV, thereby enabling you to make adjustments.

Plan for relapse Accept that everything won’t go as planned. You will invariably fall victim to temptation sooner or later.

If you blow a meal, don’t worry, it’s alright. But that’s not a free pass to blow the rest of the day.

Get back on track as soon as possible. Remember, the important thing is what you will do tomorrow.

You can change unhealthy habits into healthy ones through repetition and the best time to get started is now.

Start with one habit at a time and work up.

If you shed your unhealthy habits, you’ll find you’ll shed the weight soon after.

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HEALTH BEAT

AUGUST 2013

MEDICAL MINUTE

New treatment options for MS ultiple sclerosis (MS) is such a puzzling disease that our M ancestors looked to the heavens for explanations.

In the 13th century, a young Icelandic woman, apparently suffering from MS, suddenly lost her vision and her ability to walk. When she prayed to the saints, her sight and mobility returned … at least for a time.

Scientists are still searching for answers about MS — particularly regarding what specifically causes the disorder and what can be done to manage the troubling symptoms and effects.

Multiple sclerosis is an autoimmune

DANIEL O. LEE, MD BOARD CERTIFIED IN NEUROLOGY AND SLEEP DISORDERS

BAPTIST HEALTH RICHMOND

disease that frequently strikes young adults in their 20s and 30s.

For some reason, the body’s immune system turns inward and causes damage to the protective myelin sheath that covers nerves throughout the body.

Without this protective coating, what happens might be compared to a short in the electrical system of your car. Messages that travel along nerves become slowed or blocked, usually in an unpredictable pattern.

At first, the patient may notice only numbness, weakness or tingling in her legs that come and go with no ready explanation. Or she may suddenly feel so weak in the legs that it’s hard for her to walk.

Symptoms and even the course of the disease vary so widely that doctors are not always certain of the diagnosis. Patients are often referred to a neurologist to confirm the diagnosis.

Other possible symptoms include tremor, pain, electric shock sensations, slurred speech and dizziness.

In only about 10 to 15 percent of patients do symptoms get gradually and progressively worse. This is known as primary-progressive, the most common type in people who develop the disease after age 40.

The usual course is for symptoms to come and go in a relapsing-remitting pattern. The patient suffers unpredictable attacks when symptoms get worse over a period of several days to several weeks.

This is followed by a period of full or partial recovery of some function. The disease does not worsen and the patient may not even have symptoms during this period of remission, which can last a year or longer.

During relapse periods, one area of a nerve in the brain and spinal cord becomes inflamed as the fatty myelin sheath around the nerve is being destroyed. Plaque is formed that interferes with normal nerve impulses and produces the MS symptoms.

Early, aggressive treatment is needed when symptoms occur in order to limit longterm damage.

Over 10 to 25

years, nerves begin to deteriorate, and relapse periods become less frequent or stop altogether.

At this point, there is no known way of recovering nerve function, and some patients eventually lose the ability to walk or speak clearly.

Treatment generally involves reducing the inflammation, ordinarily with corticosteroids.

Over the past decade or so, new drugs have been introduced and six have been approved by the Food and Drug Administration for the treatment of multiple sclerosis.

Known as disease-modifying drugs, these agents work directly against the immune system, weakening the response that causes the inflammation. They have been shown to be effective in reducing the frequency and severity of attacks. When the immune system is inhibited the body is left vulnerable to outside attacks.

While reducing inflammation has long been a major goal of treatment, doctors are now targeting the degeneration of nerves that takes place in many patients after 10 to 20 years.

This neurodegeneration has long been believed to be a consequence of the longterm inflammation. Some experts now believe it may be the other way around; the disease process involves a gradual deterioration of nerve fibers that causes an inflammatory response from time to time.

These theories have led to consideration of another treatment strategy – neuroprotection, as used for treatment of Alzheimer’s, Parkinson’s and other neurodegenerative diseases. Many of the drugs currently used offer protection of nerves by reducing inflammation and increasing levels of growth factors, which are neuroprotective.

One area deserving of further investigation is the possible role of exercise as an MS disease-modifier. Animal studies have found exercise associated with an increase in production of growth factor.

Although the disease works its way out in varied ways, multiple sclerosis can lead to substantial disability and suffering.

However, with so many new treatments available and others on the way, the future is looking better.

AUGUST 2013

HEALTH BEAT

Richmond Register 11

M E N TA L M O R S E L S

Let the emperor have his new clothes e’ve all heard the Hans W Christian Andersen story of the “Emperor’s New Clothes,” and most of us understand the lesson of the story has to do with being honest and plainspoken in a world where those around you are evasive and self-serving.

Most of us probably identify with the outspoken little boy character in theory, even if not always in day-to-day fact.

He’s the one who points out that the emperor has been taken by hucksters, that he isn’t wearing “invisible material.” He’s just naked in public.

As I’ve moved further into the professional world, though, I’ve come to have more sympathy for the emperor’s ministers and his people, although they do not come across as at all admirable in the course of the folk tale.

After all, we are told the emperor is a vain, possibly meglomaniacal character. Therefore, speaking baldly and plainly may well be grounds for very real retaliation from him. At very least, the unfortunate diplomatic ministers could be dismissed from their positions, and the peasants might be deprived of their lives.

Now, go a step further, and assume that not only their own wellbeing, but that of their families also rests on their behavior toward the emperor. How many of us would let our families suffer privation just to be honest and plainspoken?

In other words, what’s really the “right” thing to do here? Honor a remote moral principle of “honesty,” or do what is best for close, real people in our lives?

At the crux of this kind of question rests an alternative theory of moral reasoning put forth by Carol Gilligan in her 1982 book “In a Different Voice: Psychological Theory and

Women’s Development.”

Although she was initially addressing differences in women’s moral reasoning from the man-centric psychological theories of the day, Gilligan herself eventually acknowledged later that while the “different voice” may often be characteristic of women, it can exist in both sexes.

The “different voice” is reasoning that is more relationship-based and less principle-based.

That is, instead of asking if the boy in the story was right to speak out to the emperor because the principle of honesty and authenticity says he must, one would instead ask who would be influenced for good or ill in speaking out?

From the different voice we might wonder: Who in the story is really being harmed if everyone decides to let the emperor walk around naked? He stays in power. His ministers keep their positions.

The peasants live. The swindlers get their money.

Really, nobody loses here. They just have to live with a bit of absurdity in their lives. We chuckle and roll our eyes at absurdity, but we may not suffer for it.

By contrast, other than one person getting to be smug about living up to the remote moral principle of honesty, what is gained by pointing out the obvious? Other than to embarrass a bunch of people?

Of course, I doubt that Gilligan’s theories about moral reasoning will ever make for as interesting a story as those based on idealistic moral principles.

Still, she brings home that we all live in a webwork of social relation-

Who in the story is really being harmed if everyone decides to let the emperor walk around naked?

He stays in power. His ministers keep their positions.

The peasants live... Really, nobody loses here.

ships, and that any act, even a highminded one, may result in the sacrifice of people we care about on the altar of our consciences. Just THOMAS ask any whistleblower.

T HORNBERRY From “a different voice,” we hear reasons to understand why real people act – or fail to act –as they Thomas W. do in life, even when they may Thornberry, M.A., chastise themselves and history in is a mental health hindsight snarls at them for not professional who has living up to their principles. worked extensively In the end, Gilligan helps to with those suffering contextualize our decisions, and lifestyle stress and make us face our very humble communication human foibles. issues.

His ianterest Sometimes, we all make moral is in language and compromise in the name of those the power of words we hold most dearly. to create change.

Perhaps this theory is more Thomas welcomes about empathy and sympathy your feedback: rather than integrity. Which is sirtomas@gmail.com. more valuable?

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12 Richmond Register

HEALTH BEAT

AUGUST 2013

M A D I S O N C O U N T Y H E A LT H D E P A R T M E N T

Want to age gracefully?

Slather on the sunscreen!

E

very summer, we hear about the importance of protecting ourselves from the harmful rays of the sun.

We talk about avoiding sunburns by wearing hats, protective clothing, and sunscreen.

Do we practice what we preach? Not so much.

The Centers for Disease Control and Prevention report that only about half of adults in the U.S. use sunscreen or other measures to protect themselves.

Skin cancer is the most common form of cancer in the United States. There are several different types of skin cancer, with melanoma being the most invasive and deadly type.

Melanoma is named after the cells where it first starts growing, the melanocytes.

Melanocytes are the skin cells that produce melanin, which is the pigment that colors our skin.

Melanin determines our skin color, but our bodies also produce it as a protective response when we are exposed to ultraviolet (UV) light. In essence, the “healthy” tan that many fair skinned people look forward to each summer is actually a distress signal from the body as it tries to respond to damage from the sun.

As many as 90 percent of melanoma cases are caused by exposure to UV rays, either from the sun or from tanning booths.

According to the Centers for Disease Control and Prevention, over 60,000 people died from melanoma in the United States in 2009 (the most recent year that national data is available).

Kentucky ranks among the top 10 nationally for incidence of melanoma. In Madison County, our mortality (death) rate for melanoma is slightly lower than the state’s. However, our incidence rate, which tracks new cases diagnosed each year, is much higher than Kentucky’s rate.

Turn to SUNSCREEN, page 14

CHRISTIE GREEN, MPH MCHD

PUBLIC

INFORMATION OFFICER

AUGUST 2013

HEALTH BEAT

Richmond Register 13

CHIROPRACTIC CORNER

It doesn’t hurt to ask wanted to relay concerns I Itions seem to have repeat conversaon with our clients. They seemed to be very upset that after changing medical doctors they found they were taking more prescriptions than they needed.

I asked them a simple question, “Did you ever talk to your doctor about your prescriptions?�

They said doctors are supposed to know what they are doing.

I knew the next question might get an even louder response, but had to ask. “When you went to the medical doctor did you ask to get rid of the symptom, or ask what was causing them and what could be done to correct that cause?�

My concern is people today are giving the responsibility for their health to others. Not just medical doctors or doctors of chiropractic, but to the pharmaceutical companies and their boxes and bottles of all sorts of chemical, physiologically changing potions.

The promises of quick fixes and symptom relievers are rampant in all forms of media.

If I love to eat spicy foods and afterward get heartburn, I can give the responsibility to a plethora of antacids.

Remember who is responsible for your health. Don’t take that responsibility and give it to the bottle of “what ever you took� so you can eat what you

want with little regard to what it is doing to your body. Just because your symptoms are gone, don’t think you are well.

If we look deeper into this, we will start to see how we are bombarded into thinking this is OK. If you eat spicy food and your stomach gets irritated, this may be a sign your stomach lining is either producing too much acid or the mucous production is not enough to protect the lining.

So, if we eat enough “irritating� foods and we then take the pill or potion that reduces the symptom, have we fixed the cause of the problem? No. If we you responsibly for our own health, we would change our diet and have our nervous system checked by a doctor of chiropractic to see if it is working correctly.

This is only one of the many examples of how we give others the responsibility for our health and for that matter our lives. We need to set a plan allowing us to be responsible for our own actions.

As I stated in a previous article, lifestyle diseases are by far the leading cause of death in the United States.

Take heart disease. If your cholesterol is high and we didn’t have all of the pills that are advertised to lower it, would you take more interest in exercise and diet? You bet you would.

We do the same thing with our children?

The knowledge that fevers occur as a defense mechanism against viruses and bacteria (raising your core temperature kill bacteria and viruses) doesn’t seem to be well known. I can just imagine the little germs cheering and having a party at the first sign of a medication that will lower the child’s temperature and give them (the germs) a reprieve.

Research continues to key in on poor diet and lack of exercise as major sources of hyperactivity.

Still many turn the responsibility for their child’s health to Ritalin, a Schedule II substance under the Controlled Substances Act, which also includes cocaine and methamphetamine, and has a high potential for abuse.

Abuse of these drugs may lead to severe psychological or physical dependence. We hand the responsibility to a pill instead of

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finding the cause of the problem.

It was interesting to ROBERT see, from the conversation BOARDMAN with my patient, how medical doctors are facing the same kind of problem. Once they act on a symptom, and the patient relinquishes responsibility to the doctor. Once the medical doctor prescribes a pill, the patient switches the responsibility to it.

People need to get back to taking responsibility for their own health.

Start by realizing that medications alter your bodyâ&#x20AC;&#x2122;s physiology to trick it into thinking things are under control.

Do you want to be healthy or just not have symptoms?

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14 Richmond Register

HEALTH BEAT

HYGIENE

Keep foods safe from insects Outdoor entertaining is a great way to spend time with family and friends. Outdoor parties run the gamut from informal barbecues to fancy catered events. Party hosts and hostesses realize they will have to take certain precautions to make food safe and palatable when serving guests outdoors.

In addition to weather that can threaten food, insects are an obstacle when entertaining outdoors. Insects may not only be a nuisance, but also can be a danger when food is involved.

Flies Flies that land on food may seem more of a nuisance than anything, but those same bugs can be carriers of any number of diseases. According to Orkin, the common housefly can carry more than 100 diseases and transport pathogens. Flies feed and lay eggs on waste, including feces. Pathogens can collect on their legs and mouth. These microbial invaders can then be transfered to foods. Flies also need to regurgitate on solid food to turn it into a liquid for consumption.

A fly that lands on food could be leaving behind a lot more than before he landed, and that may be unsafe and unsavory. Move

Continued from page 6

food outdoors only at the last minute and use covers to keep flies out.

Wasps Wasps can sometimes be attracted to food. At certain points in the year, typically spring and early summer, wasps are attracted to meats and other protein-laden foods. As the season shifts, wasps are more attracted to sugary, sweet-smelling items, and they can be very persistent when pursuing such foods and beverages. It is best to keep sweet-smelling foods and beverages covered. Some people also advise keeping a really sweet-smelling beverage, such as fruit punch, in a far corner of the yard to deter wasps from coming near entertaining areas like decks or patios. A person who is allergic to bee stings can become quite sick if they are stung by a wasp.

Ants Ants are attracted to sweet foods as well.

Adult ants can only consume liquid foods and, as a result, are most attracted to sweet beverages or melted foods. Wipe up spills and promptly remove sweet items at the end of the party.

SUNSCREEN Continued from page 12 Currently, our county averages 23 new cases of melanoma each year.

Melanoma is not the only health problem related to sun exposure. There are other forms of cancer, like basal cell carcinoma and squamous cell carcinoma, and a precancerous condition called actinic keratosis, or AK. While the risks are lower for these cancers than for melanoma, they can still be disfiguring and cause significant discomfort.

Less dangerous, but perhaps just as important, are the long-term effects of sun

AUGUST 2013

Registered Nurse Theresa Gratton has helped lead the effort toward hand cleanliness at St. Mary’s. She heard about the Biovigil system in early 2012 and convinced the hospital to give it a try.

Gratton said patients are aware of the risk of infection and frequently inquire about whether caregivers have washed their hands. She said the badge relieves their anxiety.

Bill Rogers, a 65-year-old retiree recuperating at St. Mary’s from back surgery and a heart scare, agreed.

“The first thing I noticed up here was the badges,” Rogers said. “It is comforting for me to know their hands are clean as soon as the badge beeps and it goes from yellow to green.”

St. Mary’s is expanding the Biovigil system later this year to other units of the hospital and to employees other than nurses, though details are still being worked out, Gardner said. Eventually, the system may be expanded to SSM’s seven other St. Louis-area hospitals, he said.

Biovigil’s chief client officer, Brent Nibarger, said customers won’t buy the system but will pay a subscription fee of about $12 a month per badge.

The CDC’s Jernigan said the high-tech systems can only help.

“For a health care worker, keeping their hands clean is the single most important thing they can do to protect their patients,” Jernigan said.

exposure, like age spots and wrinkles.

We all develop wrinkles over time, but sun exposure definitely plays a role in how our skin appears as we age.

Sun exposure is the most important factor in wrinkles, and no type of skin is immune to this damage. UV light damages the fibers in skin called elastin. When elastin fibers break down, the skin starts to sag, stretch and lose its ability to go back in place after stretching.

A study released earlier this year from researchers in Australia confirmed for the first time that sunscreen does in fact reduce the long-term effects of sun exposure.

The researchers followed 900 people ages 25 to 55 for four and a half years.

They found that those who used a minimum SPF 15 broad-spectrum sunscreen daily on their face, neck, arms, and hands were significantly less likely to have signs of skin aging than those who did not use sunscreen daily.

Sun exposure happens every day, even in winter. Using sunscreen daily can improve our long-term skin health, reduce the appearance of wrinkles and sun spots, and reduce risks for skin cancers.

While some of us have many years of damaging sun exposure already behind us, it is never too late to start taking care.

Making skin protection a part of our daily routines will help us look better and stay healthier for the long haul.

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AUGUST 2013

HEALTH BEAT

Richmond Register 15

The lesser known benefits of cardiovascular exercise A

ctive people tend to have varying views on cardiovascular exercise, or cardio. Often done at the end of a workout, cardio rarely evokes a staid response from fitness afficionados asked to share their thoughts on this valuable type of exercise. Fans of cardio will admit they love the feeling they get during and after a rigorous round of this type of exercise, which includes activities like running, cycling and walking. But those men and women who dread their time on the treadmill, elliptical machine or stationary bike are likely to categorize cardio as a boring and uninspiring activity. But regardless of a person’s opinion on cardio, there’s no denying it offers numerous benefits, many of which even avid athletes might be unaware.

• Cardio boosts brain power. Perhaps the least known benefit of cardio is its positive impact on the brain.

During cardiovascular exercise, the brain is being flooded with chemicals that improve decision making, memory and problem

solving. Cardio can also help preserve memory and improve its ability to learn. So while the physical benefits of exercise are widely known and noticeable to the naked eye, cardiovascular exercise can be just as effective at improving cognitive function.

• Cardio can improve your appearance. Improving physical appearance is a motivating factor for many physically active men and women, and cardio can go a long way toward improving physical appearance because it increases lean body tissue while reducing fat.

Cardiovascular exercise is a healthy way to burn calories, and burning calories is a healthy means to losing weight.

• Cardio can help reduce the severity of preexisting conditions. Arthritis sufferers have long looked to cardiovascular exercise as a healthy means to relieving the pain caused by their condition. Water exercises like swimming make for great cardiovascular exercises, especially for those looking to relieve arthritis pain. That’s because an exercise such as swimming keeps joints moving while strengthening muscles surrounding those joints.

Studies have shown that cardiovascular exercise also can lower blood pressure.

• Cardio can improve mood.

Cardiovascular exercise can

benefit men and women suffering from depression or those who are simply having a bad day. That’s because the mood-boosting chemical serotonin is released to the brain during cardio, helping to improve mood and alleviate symptoms of depression or fatigue.

• Cardio can make tomorrow’s workout easier. Recovery time is important to athletes, many of whom want to ensure their bodies are ready for tomorrow’s workout even before they finish today’s. Cardiovascular exercise helps to deliver more oxygen-rich blood to muscle tissue, aiding in tissue repair and recovery. The quicker your body can rebound from today’s workout, the more effective tomorrow’s workout will be.

So even if you don’t enjoy that pit stop at the treadmill before you head home, it’s paying more dividends than you might know.

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