& WELLNESS
Yoga for Back Pain ◊ Smoothie Recipes ◊ Coping with Loss
HEALTH
Fall Edition
2010
Workin’? Workout! How to Exercise & Eat Healthy While on the Clock
Sleep On It How 8 Hours of Sleep Can Change Your Life
Sweet Proposal Celebrate National Diabetes Month Around the Holiday Dinner Table
www.HealthyinHR.com
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HEALTH
WELLNESS
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November is national diabetes month, which makes Thanksgiving the perfect time to ask relatives about your family’s medical history.
BON APPÉTIT
8
OUNCE OF PREVENTION
4 IN THE NEWS
From proton therapy to drug costs, get up to date on the nation’s latest health news.
10 DAILY DOSE
LIFESTYLES There’s a lot of truth to be found in the old adage, “early to bed and early to rise makes a man healthy, wealthy and wise.”
Smooth things out with one of nature’s healthiest (and unhealthiest) beverages.
Why work at your desk when you can workout at your desk?
12 YOGA
Relieve low back pain with a few simple poses as described by certified yoga instructor, Cheryl LeClair.
13 Physical therapy
Coming out of the “coma” after surgery.
14 MIND MATTERS
16 FA L L 2 0 1 0
There’s no right way to help a friend cope with loss but there are ways to make it a little easier.
Cover Photo by Mimi G. Davis
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HEALTH
WELLNESS
)F YOU CAN T TOLERATE THIS
Vol. 1, Issue #3 Fall 2010
Published by Pilot Media Cos.
Graphics Manager Kim Moore
Phone 757.222.5350
Design/Layout Mimi G. Davis
Mail 150 W. Brambleton Ave. Norfolk, VA 23510 www.healthyinhr.com
Hampton Roads Business Manager Debbi Wilson (757.222.5341) Hampton Roads Health & Wellness is a quarterly distributed throughout Hampton Roads in high-traffic locations including many doctors’ offices. Entire contents, ad and graphic design and www.healthyinhr.com copyright 2010 by Pilot Media Cos. Reproduction of any portion of this publication or its website without the publisher’s written consent is strictly prohibited. Information found herein is as accurate as possible at press time but should be solely used as a guide. For more specific advice, please consult your family physician.
Sales Manager Bill Blake (757.222.3165) (sales@healthyinhr.com) Hampton Roads Editor Mary Flachsenhaar (757.222.5350) (editor@healthyinhr.com) Managing Editor Craig Ramey (editor@nccoast.com)
THEN HERE IS VERY EXCITING NEWS FOR YOU ,OUD PERSISTENT SNORING CAN BE ANNOYING FOR YOU AND YOUR PARTNER !VOID HEALTH RELATED PROBLEMS DUE TO SLEEP APNEA
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In the News cases, was to cover the mouth with the hands. “The study showed a low prevalence of recommended respiratory hygiene behaviors suggesting that hygiene messages promoted in mass media campaigns have not been seen and/or have not been readily adopted by the public.”
Finding Health Insurance The US Dept. of Health and Human Services has launched a new website in hopes of simplifying the search for health insurance options. “Healthcare.gov is a valuable resource for small businesses, consumers and their families to search for coverage options and understand the new benefits under the Affordable Care Act,” HHS Secretary Kathleen Sebelius said. “By putting the power of information at your fingertips, Healthcare.gov is helping American families everywhere to take control over their health care and make the choices that are right for them.” The site allows consumers to search for both public and private health coverage options through an easy to use health insurance finder tool. Based on answers to a series of questions, the coverage finder produces a menu of potential coverage choices personalized for each user.
To Catch a Cough Germaphobes beware! A study released in July claims approximately one in four people fail to cover their mouth when they cough or sneeze. The findings, which were presented during the International Conference on Emerging Infectious Diseases, come on the heels of a study which found medical students observing people and literally counting respiratory events. “We were surprised to find that this was the first study of directly observed respiratory hygiene behavior that we could identify,” said Nicky Wilson of Otago University Wellington, New Zealand, one of the authors of the study. In the midst of the H1N1 flu pandemic, public health officials around the world were urging individuals to take action to avoid spreading infection. One of the simplest actions recommended was that individuals cover their mouth when they cough or sneeze, preferably with a tissue or into their elbow, to avoid getting the virus on their hands and spreading it to nearby surfaces. Wilson and his colleagues observed 5.5 coughs and sneezes per hour, 26.7 percent of which went uncovered and only 4.7 percent of which were covered by a tissue, handkerchief or elbow. The most common behavior, observed in 64.4 percent of
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Drug Prices on the Rise While generic drug prices have remained stable or declined, brand name medications most used by the country’s aging population increased by 8 percent in 2009. That’s the word from the AARP, which is officially asking for measures to keep prices in check. The study, which is released annually by the senior lobbying/membership organization, looked at 217 products. Incontinence drug Flomax had the highest increase at 24.8 percent, to $4.09 per pill. Nexium rose 6 percent, to $5.40 a day; Plavix, rose 8.8 percent, to $5.06 a day and Lipitor rose 4.1 percent, to $4.03 a day. Drug industry officials are questioning the findings, pointing out that brand name prices are not the most used forms of medications, with a higher percentage of the public using lower priced generic forms of popular drugs.
Hampton’s Now Home to Cutting-edge Cancer Treatment Story and Photos by Bill Cresenzo
T
he largest freestanding proton therapy cancer treatment center in the world has begun treating patients in Hampton. Hampton University officially unveiled its Proton Therapy Institute last week, a mammoth complex that will eventually treat up to 2,000 patients annually, using a proton laser that kills cancerous tumors without hurting the healthy tissue that surrounds them. That reduces the risk that healthy tissue could become cancerous, and reduces the horrible side effects that traditional radiation often brings, said Srivdya S. Duvvuri, a medical physicist at the 98,000-square-foot facility on Enterprise Parkway, the eighth proton therapy center in the country. At the heart of the center is the cyclotron, a 200-ton machine that spins protons at 60 percent of the speed of light, then beams to the center’s gantries, which are three stories tall and weigh 90 tons. They sit mostly unseen just behind the walls where patients are treated. Proton Radiation Therapy delivers radiation with a precision absent in traditional radiation therapy. The proton beams enter the patient’s body, but only at the extremely specific spots where the cancer cells are located. While conventional radiation therapy deposits energy not just on the tumor, but on surrounding tissue, proton therapy deposits radiation only on the tumor and there is no exit dose, meaning that protons give up all of their energy at one spot, then stop, according to center literature. Duvvuri said patients come for the therapy once a day for an average of 29 days. A typical session in one of five treatment rooms from start to finish lasts about 25 minutes, although the center is working to reduce that time. The $225 million center has been years in the making. It is the only one in the mid-Atlantic region and will employ a staff of up to 127. Officials expect cancer patients from all over the country to come there. The facility will treat patients with prostate, lung, breast, ocular and pediatric cancers. Officials expect it to bring at least $1 million per year for the city of Hampton, through taxes and revenue. The center sits on 5.5 acres that the city of Hampton gave the university. Behind a pond is another 5.5 acres where the university eventually plans to build a hotel for patients and their families. The building is filled with light, large windows that look onto gardens in the rear of the center that patients can use before or after their treatments. The university tried to make the center look as far from a stark, sterile hospital as it could, with gardens and earth tones that cover the floors and walls. “They didn’t want to make it seem like a hospital,” Duvvuri said. “We want the kind of environment for our patients so that when they are here, it is a relief for them.”
The institute has a healing garden where patients can relax.
Srivdya S. Duvvuri, a medical physicist, stands in front of one of the proton machines.
David Dandrea, a proton therapy systems engineer, monitors the proton beams used to kill cancer cells.
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Ounce of Prevention
Holiday Heart-to-Heart Look to Your Family’s Past to Prevent Type-2 Diabetes in Your Future
T
he holidays are known as a time for family gatherings, catching up with relatives, and sometimes even the occasional family conflict. Like drama at the holiday dinner table, in many ways your health – for better or for worse – is influenced by your family. This year, why not start a conversation that benefits everyone? Gather your family health history. Why it’s Important Family history of disease is an important part of understanding your risk for developing a number of serious diseases, including type-2 diabetes. Diabetes is a serious disease that, if left untreated, can lead to serious health problems including blindness, loss of limb, kidney failure, heart disease and early death. In fact, most people with type-2 diabetes have a family member – such as a mother, father, brother, or sister – with the disease. November is national diabetes month and the National Diabetes Education Program (NDEP) encourages all families to gather their family health history this holiday season to help prevent or delay type-2 diabetes in future generations. “Type-2 diabetes is passed on genetically. If one parent has diabetes, the child has a 50 percent chance of getting diabetes. If both parents have diabetes, the child has a 90 percent chance of getting type-2 diabetes,” said Dr. Jean Lucas of Diabetes and Endocrinology Consultants of Morehead City, N.C. If you’re looking for telltale signs of diabetes around the holiday table, Dr. Lucas said it is all in the waist band. “If you are looking at family members for potential diabetes, look at their waist. If their waist is overlapping their belt, they have a higher incidence of diabetes,” she said. “A man’s waist of over 40 inches and a female’s waist of over 35 inches puts them at risk for diabetes in addition to heart disease.” By knowing your family health history at an early age, sharing it with your health care team and taking important steps such as maintaining a healthy weight or losing a small amount of weight if you are overweight, making healthy food choices, and being physically active, you can prevent or delay type-2 diabetes (as well as other serious diseases) and help ensure that you will be enjoying holiday family gatherings for years to come.
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Four Questions You Should Ask The answers to these key questions could help you prevent type2 diabetes in your future. • Does anyone in the family have type-2 diabetes? Who has type-2 diabetes? • Has anyone in the family been told they might get diabetes? • Has anyone in the family been told they need to lower their weight or increase their physical activity to prevent type-2 diabetes? • Did your mother get diabetes when she was pregnant? This is also known as gestational diabetes (GDM). If the answer to any of these is yes, or you have a mother, father, brother or sister with type-2 diabetes, you may be at an increased risk for developing type-2 diabetes. Talk to your doctor and visit yourdiabetesinfo.org to learn more about managing your risk and preventing or delaying type-2 diabetes. Your History Affects Your Child’s Future While you’re gathering your family’s history, you need to take your own into consideration as well. Gestational diabetes mellitus, or GDM, is a type of diabetes that occurs during pregnancy and affects about 7 percent of all US pregnancies – or about 200,000 pregnancies each year. If you had gestational diabetes when you were pregnant, you and your child have a lifelong risk for getting diabetes. • Women with a history of gestational diabetes have a 40 to 60 percent chance of developing diabetes in the 5 to 10 years after delivery. • The children of pregnancies where the mother had gestational diabetes are also at increased risk for obesity and type-2 diabetes. • Women who have had gestational diabetes should be tested for diabetes six to 12 weeks after their baby is born, and at least every three years after that. Mothers should let their child’s doctor know that they had gestational diabetes. • Women with a history of gestational diabetes can lower their risk for developing diabetes by making an effort to reach and maintain a healthy weight, making healthy food choices, and being active for at least 30 minutes, five days a week. Keeping a healthy lifestyle helps mother and child lower their risk for getting diabetes in the future. • For a free tip sheet on gestational diabetes, including steps to reduce the risk of developing diabetes, call the National Diabetes Education Program (NDEP) at 1-888-693-NDEP (6337) or visit its website yourdiabetesinfo.org.
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4IDEWATER .EPHROLOGY ,TD Type-2 Diabetes Risk Factors In addition to family history and gestational diabetes, there are other factors that increase your risk for developing type-2 diabetes. If one or more of the following items apply to you, be sure to talk with your health care team about your risk for developing type-2 diabetes and whether you should be tested. • I am 45 years of age or older. • I have been told by my doctor to lose weight. • My family background is African American, Hispanic/ Latino, American Indian, Asian American or Pacific Islander. • I have been told that my blood glucose (blood sugar) levels are higher than normal. • My blood pressure is 140/90 or higher or I have been told that I have high blood pressure. • My cholesterol (lipid) levels are not normal. My HDL cholesterol (“goodâ€? cholesterol) is less than 35 or my triglyceride level is higher than 250. • I am physically active less than three times a week. • I have been told that I have polycystic ovary syndrome (PCOS). • The skin around my neck or in my armpits appears dirty no matter how much I scrub it. The skin appears dark, thick, and velvety. • I have been told that I have blood vessel problems affecting my heart, brain or legs. ď Ž
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Bon Appétit
Smooth Move Finding the Perfect Breakfast Blend
W
hat do McDonald’s and Oprah’s medical guru Dr. Oz have in common? They’re both serving smoothies for breakfast. While Dr. Oz tends to add soy protein, psyllium hulls and flaxseeds (a great source of heart healthy omega-3’s) to his morning beverage, we can feel assured that the only thing fast food restaurants will be quick to include is an extra helping of good, old-fashioned sugar. One thing is certain, however, the fact that McDonald’s has jumped on board is a great indication that smoothies, these
milkshakey blends of fruit and juice or yogurt, have indeed arrived. There’s little to be found on the origin of the beverage, but most point fingers at the health-conscious 20-somethings who made a haven out of southern California beach towns during the 1970s. “The word natural was the marketing battle cry of many national brands of foods, from breakfast cereals to carbonated soda drinks,” said Dan Titus, director of the Juice and Smoothie Association in The History of Smoothies. “Along with the long hair and earthshoes, came the proliferation of health restaurants. I can remember Main Street, Huntington Beach, California, with the head shops and the tofu and smoothie bars. There is one still there FA L L 2 0 1 0
to this day, serving avocado, alfalfa sprout sandwiches and fresh squeezed carrot juice, and of course, fruit juice smoothies.” As is the American way – we can eek the goodness out of just about everything – and the same can be said for these refreshing, and yes, healthy, fruit blends. You add enough sugar, enough juice with added sugar, enough whole milk or honey, and the health benefits are quickly overridden by the fat and calories. While they should certainly be applauded for their efforts, fast food chains simply can’t make it as healthy as you can at home. Filling, good for you and healthy, smoothies can also claim just about the quickest preparation time, short of grabbing a package of toaster pastries out of the vending machine. You need fruit first and foremost – fresh, not canned. If frozen fruit is used
Recipes Creamsicle
to help thicken the end result, make sure no sugar is added. You’ll also need a little liquid to help give your blend a nice consistency. Some people like to add lowfat yogurt for a nice creamy taste, others use ice cubes to make it nice and thick, while some folks do both. The key is that it doesn’t really matter. As long as you’re adding fresh, low-fat ingredients you can mix and match until you come up with your own personal favorite. Of course if all else fails, you can certainly pick up a copy of the Idiot’s Guide to Smoothies – yes, it really exists. We’ll count this as another sign that smoothies are coming into their own. Keep in mind that like Dr. Oz recommends, soy protein, flaxseeds, fiber and other important supplements can easily be blended away and masked by the flavors of the fruit, not only getting your day off to a great start, but setting the cornerstone for a healthier diet. Here are a few recipes to get you started. For each, combine the ingredients in a blender, using pulse until the ice is broken down and then whipping until smooth. ď Ž
1 navel orange, peeled Âź cup lowfat or fat-free vanilla yogurt 2 tablespoons frozen orange juice concentrate Âź teaspoon vanilla extract 4 ice cubes
Strawberry Banana
1 Ÿ cups cold apple juice 1 ripe banana, sliced 1 kiwi, sliced 5 frozen strawberries 1 ½ teaspoons honey
Pina Colada
1 cup lowfat or fat-free vanilla yogurt 1 cup pineapple chunks 6 ice cubes
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8 lg. strawberries 1 cup sparkling mineral water 1 tbsp honey 4-6 lg. fresh mint leaves 2 tbsp. lemon juice
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• Spine & Pelvic Rehabilitation • Acute & Chronic Back Pain • Systemic Disease • Neurological Disorders • Sports Related Injuries • Men & Women’s Health • Headaches • Extremity/Shoulder Pain • Respiratory Dysfunction • Pre/Postnatal Care • Chronic Pain • Gastrointestinal dysfunction • Pre/Post Surgical
757.842.6562 516 Innovation Dr., Ste. 100 Chesapeake, VA 23320 fluidityphysicaltherapy.com
Daily Dose
Office Pace Breaking Up the Workday with Exercise and Healthy Eating By Matthew Adkins
I
t’s no secret that sitting around all day isn’t exactly the best way to lose weight. For those with an office job, however, sometimes you don’t always have an option. As a result of this relatively sedentary lifestyle, weight gain is a real concern. Those extra pounds can add up and may eventually be the cause of a variety of health problems, such as high blood pressure, diabetes and high cholesterol. The blueprint for preventing these health problems is to eat correctly (stay away from trans fats and instead embrace monounsaturated fats, like those found in avocados) and exercise (at least 15 to 20 minutes a day of vigorous activity is recommended). As long as you are conscious of what you put in your
body and you try to balance it out with physical activity, you should be fine. That’s easier said than done for those trapped in an office all day, where it’s easy to roll your chair to the printer instead of walking, or spend lunch in line at the nearest fast food restaurant instead of bringing a healthier option from home. Movement is important to metabolism and if you stay glued in a single place all day, your body’s natural functions tend to slow down. Make it a habit to get up and walk around every hour or so. This will give your eyes and neck a break from the computer and relieve stress. Additionally, it also gives your mind a break from monotony, which will help your creativity and focus when you return to your desk. Sitting in your chair and staring at the same thing for hours on end can cause a great amount of chronic stress, which can eventually affect your neuroendocrine system. This directly results in an increase in abdominal fat, and can also possibly decrease sex hormones, which may also lead to weight gain. If you find yourself in a rut, take some time to stretch and move around. Looking for something a little more regimented? Try this:
1. Bicep Curls
For this you may use any object that is around, such as a water bottle. Because even full water bottles are rather light, the key to this exercise is repetition and speed. Do 20 sets of 5 reps on each arm and try to go as slow as possible.
2. Leg Extensions
Extend one leg until it is level with your hip. Hold it in place for 5 seconds, then slowly lower it. Be sure not to drop the leg all the way to the floor, though. Repeat the extension 15 times and switch legs. 10
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3. Chair Lifts
Using the arms of your chair, lift yourself slowly as high as you can then lower yourself, but not all the way. You want to keep the tension in your arms. Hold yourself in that low position for a few seconds, and repeat. Try doing it 15 times then add more if you’re able.
4. Chair Dips
While seated, place your hands next to your hips and slide forward, off the chair. Once you are off, dip down as close to the floor as you can get until your arms are at 90 degree angles. Then slowly raise yourself up and repeat. It is important you have a stable chair for this, though, so be careful if you are on wheels.
5. Squats
Stand with your feet roughly shoulder length apart. Imagine a chair is behind you and carefully “sit” on it while keeping your balance on your heels. Hold it for a few seconds and then stand back up. Repeat 15 times.
6. Calf Raises
While standing, raise yourself all the way up on your toes and slowly lower yourself back down, but not completely. Try to get your heels as close to the ground as possible without touching, then raise yourself up as high as you can again. After a couple of reps, you should feel the burn in your calves. For a tougher workout, try to stand with your toes on an elevated surface, such as a step or a large book. Let your heels go below your toes, giving you that extra bit of stretch.
7. Lunges
Begin standing. Take a step forward until your front leg is at a 90-degree angle. Once your back knee is almost touching the ground, return to the starting position by driving the front leg back to its original position. Do 10 reps on a leg, then switch.
8. Chair Twirls
A fun way to destress as well as burn some calories is to simply twirl around in your chair. For every 60 rotations, you will burn roughly 50 calories.
By the Water Cooler
In many offices, food is commonly available and it’s not always the healthiest of options. Employees often bring in snacks, birthday cakes and leftovers (especially around holiday season) to share with coworkers. While it is perfectly fine to enjoy a couple of doughnuts or a slice of cake from time to time, try not to overindulge. Make an effort to stay within your recommended caloric intake for the day, even if that means you have to skip dessert after dinner.
It should be noted, though, that eating every morning is very important. Recent research by the American Public Health Association has shown that skipping breakfast greatly decreases metabolism. It also shows that eating anything, even a sugary doughnut, in the morning is better than totally skipping the meal. Breakfast can also curb those hunger pangs that may have been previously relieved with snacking or soda. Vending machines have never really been known for their healthy benefits. Recent studies have shown that repeated vending machine use is directly linked to diabetes, coronary artery disease and other chronic conditions. If a mid-day snack is absolutely necessary, try packing something healthy for yourself rather than relying on junk or fast food.
And finally, be careful what you drink! You may not realize it, but we face liquid temptation just as often as food temptation. According to Terese Scollard, MBA, R.D., L.D., regional clinical nutrition manager for Providence Nutrition Services of Portland, Ore., regional beverages currently account for 21 percent of our daily caloric intake. She encourages people to try not to drink more than 10 percent; the rest of it should come from food. Water is the best, naturally. However, if you must have a soda, zero calorie drinks are recommended. Green tea is also very healthy. The compound ECGC in green tea makes it easier for your body to process fat. You may be able to drop as many as three pounds simply by drinking three cups a day. ď Ž
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Yoga
By Cheryl LeClair
A Guide to Stretching Away Lower Back Pain
B
ack pain is the second most common neurological ailment in the United States — only headaches are more common. Americans spend at least $50 billion each year on low back pain, which is the most common cause of jobrelated disability and a leading contributor to missed work. There are many causes of back pain: arthritis, strained muscles and ligaments, bulging or ruptured discs to name just a few. In a study funded by National Institutes of Health National Center for Complementary and Alternative Medicine, researchers found Iyengar yoga significantly reduced functional disability, pain intensity and depression in adults with chronic low back pain. Another important finding was there appeared to be a trend toward decreased use of pain medication in the yoga group.
How Does it Work? • • • • •
Builds core strength and teaches us to become mindful of our posture and holding patterns in our bodies. Increases flexibility and relieves the stress and tension that contribute to back pain. Musculoskeletal imbalances often result in back pain and yoga strengthens core muscles that are crucial to good spinal support and balance. Brings balance to muscular imbalances that result in poor posture and the subsequent pain. Helps develop mindfulness and self-awareness of unhealthy holding patterns and postures. Proper posture ensures the effective use of muscles and energy, helps prevent arthritis by protecting the joints that arthritis frequently attacks and reduces stress on the ligaments.
Above all, when practiced regularly, yoga increases flexibility. Sitting for long periods can result in tight hip and hamstring muscles that can create pressure on the vertebral discs. Increasing flexibility in these muscles, combined with the development of postural awareness may eliminate pain related to these conditions. A tight piriformis muscle can press on the sciatic nerve resulting in pain radiating down the leg. Hip opening poses stretch the piriformis and relieve pain related to this condition. Yoga also teaches us to relax. Yoga breathing, called pranayama, and postures, called asana, relieve stress and tension that can contribute to back pain. Deep breathing activates the parasympathetic nervous system; the “rest and digest” response. In the rest and digest mode the blood pressure and heart rate decrease. When our attention is directed inward and we feel secure and at ease, muscle tension is released and immunity is enhanced. Our body is able to begin the work of healing itself. Remember that it’s crucial that you seek the care from your health care professional and get a medical evaluation and your physician’s approval before undertaking a yoga program. Physical therapy is often prescribed for back pain and is an excellent foundation on which to build a yoga practice. Seek a yoga instructor that has training and experience in working with clients with back pain and speak with the instructor about your condition and concerns prior to taking a class. A reputable yoga instructor will let you know if they feel your condition is within their scope of training. When you find a qualified instructor you may want to schedule a private session and learn what asana, or poses, are safe for you to perform and learn modifications to these poses that allow you to perform them. Cheryl LeClair is a yoga and iRest yoga nidra instructor. windroseyoga.com
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Help Lift the Fog After Surgery
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ith fall sports injuries, “use it or lose it� vacation hours and high insurance deductibles kicking in at the beginning of the year, people are lining up to go under the knife before they make their first toast to the new year. Having worked for 11 years with patients with a variety of diagnoses, I continue to be amazed on how resilient the human body is and the power it has to heal. Although surgery may be necessary at times, you may not realize the impact it has on the body and the enormous amount of work the body must complete to recover. The obvious recovery is recovery of tissue damaged (such as muscle, bone, nerve, etc.) as a result of surgery. The less obvious is recovery from the general anesthesia used to put and keep you asleep. Remember, general anesthesia puts you into a coma-like state where all systems of the body are slowed down. This is traumatic on the body, whose greatest desire is to provide homeostasis, with all body systems running optimally. Coming out of the coma state completely can be challenging for the patient. This can often present as brain fog and lethargy. Untreated, these results may linger for a long time or indefinitely. Why some people react more significantly to medication like this remains unclear but an individual’s unique body physiology, other medications being taken and past medical history all are possible hypotheses. Nevertheless, there are many ways to help facilitate the clearing out of the medication from your system. Physical therapists may implement shock protocol postoperatively to help improve waste/medication elimination and aid in healing. This protocol involves the practitioner using his or her hands, in direct contact with the client’s body, to engage dysfunctional tissue such as muscle or scar tissue as well as to facilitate the body’s systems (the lymph, nervous, digestive and vascular systems) involved in eliminating medication/anesthesia. This can be helpful no matter how far out of surgery you are. The protocol is one of many we utilize under the umbrella of integrative manual therapy or IMT to address and aid in healing of all systems of the body. Of course, drinking plenty of water, higher intakes of protein for tissue healing, and physical activity, once OKed by your physician, can be helpful too. And don’t forget, postoperatively your immune system is being challenged. You are more prone to infections at this time, so resting and practicing universal health care precautions such as hand-washing are very important. Remember too, postoperative recovery can take some time, so be patient and kind to yourself. Think of this as a forced break. Forced breaks allow us to self-reflect, focus on what is really important and optimize healing. Your body is an amazing machine. You can heal, you can be well and you can be “fog free.�
Jennifer Watson, MPT, IMT Jennifer Watson, MPT, IMT, is the owner and primary therapist of Fluidity Physical Therapy in Chesapeake. She received an undergraduate degree in kinesiology and a master of physical therapy from the University of Wisconsin – Madison. She also has a certification in IMT from the Connecticut School of Integrative Manual Therapy. She can be reached through fluiditypt.com and at 842-6562. ď Ž
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Mind Matters
At a Loss … Coping with the Cycle of Grief By Amanda Dagnino
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ereavement coordinator Heather Brower with Hospice of Carteret County always tells her clients one important thing: she cannot take their pain away, but she can validate it. “You’ve lost your husband and I cannot relate to that. When I go home tonight, my husband is going to be there. But I can relate to that gut-wrenching pain that turns your stomach and squeezes your heart.” Brower did not lose a husband – she lost a child. The death of someone close to us is one of the most difficult things we deal with as humans, Brower said. “No matter how much you want them to, nobody can take the pain away. And it’s hard.” In the US, death is somewhat shrouded in mystery. It’s the end – the stopping point. And for many of us, if we don’t openly address the topic, we may harbor a perverse belief that somehow we can be the lucky one who avoids it. “In our country we don’t want to talk about it, we don’t want to smell it, we don’t want to taste it – we just don’t want 14
anything to do with it. We’re the only culture so afraid of death,” Brower said. “But we can’t avoid it. As soon as we’re born we begin to die.” A healthy attitude toward death and dying is certainly the first step toward better understanding its role in our life cycle – and easing the shock and disappointment when it occurs. And while it can lessen the pain that follows for those left behind, it can’t take it away. The only way to begin making headway, Brower said, is to face it head on. “I personally believe that you can’t dodge the grief – you have to open yourself up to it – you have to feel it,” she said. “And then you have to feel comfortable telling the story.” For Brower that story includes the loss of a child and while the pain is similar to the loss of a husband or father, it is not identical. She doesn’t want anyone to feel like she is devaluating their loss because she has had one of her own. One of the worst things we can say to someone dealing with a loss is that we completely understand. Just because someone lost a father last year doesn’t mean they understand what it means to lose a husband. The loss is so completely different. On the contrary, the best thing we can do is listen, Brower said. Share stories and look back on amusing moments. Listen, FA L L 2 0 1 0
she advises, and really hear what they’re saying. But don’t turn the conversation to yourself and losses you’ve experienced. “It’s so important to the person coping with grief to know that other people miss their loved one, too; that others have stories and anecdotes and silly things that they remember about them.” Brower said instead of focusing on the loss and how terrible everything is – share experiences. Talk about the time your dad advised you to get gas before you left the house and you wound up running out on your way to school and he made you walk the rest of the way, just to learn a lesson. Let those who are most intimately affected by the loss know that you miss them, too. Sharing that those quirky little moments had an impact on your life validates their grief. It lets those coping with the loss know that yes, this was an important person to many and it’s OK to grieve the loss. Often, said Brower, finding a platform in which to share those stories can be a challenge in today’s society, as death is a topic few people are interested in discussing. In the past, when a woman lost her husband she wore black for a year as a sign that she was in mourning. In today’s society, there are no symbolic cues for the public and no way for those who are grieving to express their situation. But that, too, Brower said, is an important step in the healing process.
For men, she said, it can be even more difficult as most men are adverse to discussing and sharing their feelings. In the six years that she has been in her role with Hospice, she has yet to have a man attend the 13-week bereavement counseling offered. “You can get the nail out and get the hammer and then you can hit the nail on the head and it’s fixed,� Brower said. “That’s how men like to approach things. They want to fix things. But you can’t fix a broken heart.� Triggers can come from anywhere – a song filled with memories, a car ride down a long-forgotten road or the aromas of a favorite dinner. The important thing, said Brower, is to not ignore them when they arise, but rather address them and share the memory. For decades, the grief has been broken down into cycles. The most popular of which, made famous by the late Dr. Elisabeth Kubler-Ross, includes denial, anger, bargaining, depression and acceptance, weren’t designed to deal with grief originally, Brower said, but were rather created to describe death and dying. According to the counselor, the doctor later said that the stages had become so widely adopted that she wished she hadn’t written them. With all she knew about death, and more importantly coping with grief, she felt it would be impossible to create a guide every person would follow. There’s simply no sequential order, Brower points out. Things don’t necessarily follow a pattern. It’s much more personal than that. “There’s no time table. It doesn’t go in an orderly fashion,� Brower said. “It’s far too personal of an experience.� As we cope with the loss, she added, it’s important to note that we also have to adapt to our life without that person. We so often identify ourselves as being John’s wife or Lisa’s sister or Cathy’s mother, that it becomes difficult to reintegrate ourselves into society as something else. “We grieve that loss but we have to grieve the changes that happen in our life as well,� said Brower. “How do I integrate myself back into my church group? What about the couples’ supper
club? And we grieve for the pain of other involved. Do something that shows your people, too. My mother, for example, respect of the things they cared about.â€? had to cope with the loss of her first As birthdays, holidays and grandson, but she also had to face the anniversaries roll around, Brower suggests pain her daughter was going through. planning ahead. Plan to spend the day Grief takes many forms.â€? with people so it’s not just gloom and It is important for those who are doom all day. Have folks on standby who grieving to know that it’s normal to are ready to offer a pick-me-up if needed. feel sad. It’s normal to feel mad. All the Do something special for yourself. things we feel are understandable, anger, There are many grief support groups depression, withdrawal, Brower said. But in South Hampton Roads. To locate be weary if someone completely shuts one, a good place to start is through The themselves off from those who love them, Planning Council in Norfolk, which has begins self-medicating with alcohol or a database of support groups of all kinds. drugs, including those prescribed by a The council’s offices can be reached at doctor. 622-9268; its consumer hotline number “While it may momentarily ease the can be accessed by dialing 2-1-1. Susan pain, these things are really depressants Thompson, a palliative care social worker and they’re only magnifying the issue in at Sentara, leads a group; her phone the long run,â€? said Brower. number is 388-2631. Bon Secours To help those coping with loss, Brower Hospice offers grief support; for details, recommends an outlet for their feelings. call Beth Pile, bereavement coordinator, In her group at Hospice, she gives each at 737-2287. ď Ž member a journal so they can let go of the feelings. “Journaling doesn’t have to be page after page after page of written text. It can include pictures, poems, quotes, jokes or just a few lines that sum up exactly how you feel at any given moment,â€? she said. Planting something in the person’s honor is also a great way
to remember someone, she said, ! ! whether on an " ! anniversary or just ! ! after the death. ! “Make a ! contribution to a charity that the deceased appreciated,� she offered. “Volunteer
for Boy Scouts if they were actively w w w. H e a l t h y i n H R . c o m
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Lifestyles
Sleep on This How 8 Hours a Day Can Keep the Doctor Away By Amanda Dagnino
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n our fast-paced, deadline-driven society people are pushed to their limits daily. We manage our homes, our families and our careers with little or no concern about a good night’s sleep. That is, of course, until 3pm rolls around and you find yourself dragging at work with a glazed look on your face. We’re all action and little rest – there will be plenty of time for that in retirement, right? Perhaps. But those of us who think they can run full throttle for too long without any health repercussions are sadly mistaken. “The bottom line is that the average 30- to 40-year-old person needs eight hours of sleep – anything less than that on a chronic basis and you’re going to be chronically sleepy – you’re going to have repercussions,” said Dr. William Hall of Carteret Sleep Diagnostics of Morehead City, N.C . “A lot of people are in bed around 11pm and then up at 6 and they’re just chronically sleep deprived.” And it shows. Symptoms include irritability, difficulty concentrating, memory loss, appetite changes, difficulty handling stressful situations and more. The symptoms, in turn, cause more stress, which may make it more difficult to sleep and a vicious cycle is born. Dr. Hall estimates that around 30 percent of the population has some sort of sleep disturbance. For most it comes 16
and goes, but for others it takes on a more consistent path. “It’s often underestimated, but we need sleep to survive,” the doctor said. “When you sleep your body regenerates, it rejuvenates. There’s a lot that goes on while we’re asleep. It’s 1/3 of your life – it’s a big deal. People say that after a good night’s sleep they feel so much better – well they are. They have a better outlook, they’re less depressed, they have more energy. A good night’s sleep cures a lot of ills. So many of those old adages we’ve heard are based in fact.” We tell people, Dr. Hall reminds, to “sleep on it” before making a major purchase or decision – and there has actually been a scientific study that shows that when people do that they usually do come up with the correct decision, adds Dr. Hall. We all have an internal clock that is set by our genes so some variation in the sleep pattern is normal. There are the larks, or morning people who jump out of bed as chipper as the bright shining sun, and the night owls who prefer to stay up into the wee hours of the morning. The most important thing about our natural cycle, Dr. Hall said, is that we must make sure that we compensate by maintaining eight hours of contiguous sleep each day. “If not – it catches up to you,” said Dr. Hall. “A chronic reduction in the number of hours you sleep can have dangerous affects. And it ages you.” According to Dr. Hall there are two things that should be associated with bed - sleep and sex. Nothing else, he said, belongs in the bedroom, including work, TV watching and worrying about what you’re going to have to face tomorrow. “These are the only two things that should be associated with bed and if
other things are part of the equation then you need to relearn the behavior.” Babies for example, learn how to sleep in their cribs through the patterns established by their parents. At night, he has a bath, perhaps a bottle, then he is placed in the crib and the light is turned out and that process ingrains in the child that this is the time for sleep. He begins to connect being placed in the crib and the lights going out with bedtime. “Just like a baby, adults can relearn that process,” said Dr. Hall. “You have to reprogram what going to sleep means and what it involves. Like most bad habits we change, it’s not something that is going to change overnight. It takes some self-discipline and some people are just harder to teach. But it’s a necessary lesson for our good health.” There are multiple factors that affect the way we sleep – including sleep apnea and other full-fledged sleep disorders – however, stress, lack of exercise and diet are common factors that people have full control over. “These days everyone has economic worries and stress. There is no way to avoid it,” said Dr. Hall. “The important note is that everyone has these worries. Nobody has a stress-free life. How you handle it, your response, is the one thing you can control and is what can ultimately disrupt your sleep cycle.” Exercise, said Dr. Hall, is also a huge factor. As a society, we have become increasingly sedentary with each passing year. Our parents, for example, rarely had sleep disturbances because they were more physically active. Technology and transportation options have made it easier for us to sit in one place and accomplish everything we need. We’re no longer running memo’s up three
flight of stairs – we’re sending an e-mail or interoffice chat. No longer do people walk down to the corner store or stroll over to a friend’s house to ask a question. What’s the point in going outside when you can text, email or call. “We go to work, we eat, then we sit in front of the boob tube,” Dr. Hall said. “And they should have had some level of exercise in there to maintain a healthy sleep pattern. Computers are good for a lot of things but they’re not good for our health. We were built to be busy. We’re the worker bees. And being busy is an important part of getting a healthy night’s sleep. We’ve invented all this technology to make our lives easier but we fail to make time to get up and exercise.” Along with exercise, a healthy diet is necessary to fuel our bodies and keep us moving throughout the course of the day. Clinical dietician Susan Fetzer, MS, RD, LDN reiterates the rule we’ve been told since childhood – breakfast is the most important meal of the day. “Having breakfast definitely helps you feel perkier. We know that children who are in school who skip breakfast are more sluggish,” she said. “It’s not that important that it be breakfast food. It can be a bowl of cereal, a granola bar and yogurt or peanut butter on a piece of toast. We want some sort of healthy carb because they’re easily metabolized to glucose which gives us our energy.” Eating a big heavy meal at any point in the day will make you feel sleepy, she reminds, but a diet rich in fruits, vegetables and dietary fibers as opposed to heavy fats and fried foods can provide our body with the energy it needs. “We don’t want to go have too large of a lunch either, but a nice mix of
carbs, proteins and healthy fats to get us through the afternoon,” Fetzer said. Throughout the day, Fetzer said it’s also important to stay hydrated to maintain a high level of energy and that caffeine should be eliminated after lunch. “Some people are just less affected by caffeine than others, so they may want to experiment a little bit with their caffeine usage and see how it affects their sleep
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patterns,” she said. “But for most people, caffeine should be eliminated in the afternoon and evening because it’s going to affect your ability to sleep at night. “When we hit a rough patch in the middle of the day, the natural response is to go get some coffee or maybe a soda from the machine in the break room – just something to get you through – but really we’re making ourselves more tired the next day by doing so because we’re setting ourselves up for a bad night’s sleep.” And that, said Dr. Hall, is the best method to feeling better during the day. “People who habitually sleep less or more than the average have a lower life expectancy. It’s that simple,” said Dr. Hall. “We’re a society where normal is good – normal heart rate, normal blood glucose and normal sleep patterns.”
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Tips for a better sleep provided by the Carteret Sleep Diagnostic Center 1. Cut down on your time in bed. The longer a
person stays in bed beyond the time that is actually required for sleeping, the more shallow and unsatisfactory sleep gets. It may be difficult in the beginning to cut down on your time in bed to no more than 8-9 hours per 24-hour period because your body gets used to more time in bed. In a few weeks, however, it will adjust.
2. Establish a regular wake up time. Even after
nights when you slept very little or not at all, it is still important to get up at the same time as if you had slept well to keep the 24-hour rhythm.
3. Avoid trying to sleep. The more you try to sleep, the more awake you will become. Lying in bed frustrated and unable to sleep needs to be avoided. As long as you lay in bed comfortable and relaxed, continue to do so. But if you find yourself getting tense, irritated or full of worries you can distract your mind by reading.
4. Avoid the bedroom clock. It is very difficult to relax and fall asleep when you see how time is slipping away. When you go to bed, set the alarm for the next morning.
metabolism and temperature do not drop as much during the night as they do in people who sleep well. If exercise is done intensively for about 20 minutes, body metabolism and temperature rises, and five to six hours later, it decreases much more than if you had not exercised.
6. Take a hot bath 2-4 hours before bed. The idea
is to increase your body temperature and metabolism, which will drop 2-3 hours later.
7. Avoid snacking. Eating stimulates the metabolism. 8. Avoid alcohol. Although alcohol helps many people fall asleep more easily, it then wakes them up more during the night.
9. Avoid caffeine after lunch. 10. Avoid tobacco. Schedule “thinking” time in the early evening to avoid late-day stress. 11.
12. Relaxation training like yoga, biofeedback and 5. Try to exercise in late afternoon/evening. During meditation may be helpful to ease you into sleep. the day, body temperature and metabolism increase, during the night, they decrease. In people with problems sleeping,
At the beginning, practice relaxation only during the day and when you are good at it, integrate it into your bedtime routine. 13. Try counseling. Although it is often very difficult for people with sleep problems to engage in counseling, patients with too much stress will continue to have sleep problems. 14. Medication. While taking a sleeping pill every night is not usually recommended because your body can become dependent upon it, very low doses of sedative antidepressants have shown success in people who have not been successful with a more natural approach. 15. Bright light therapy. Bright light activates the brain and stimulates alertness and can be helpful in shaping the sleep pattern.
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