Health Line May, 2010

May 2010

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Moving off the weight loss plateau HEALTH LINE BRIEFS

Avoiding Summer’s Health Woes

Simple changes you can make today to look better now and in the long term.

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Non-Melanoma Skin Cancers in the Millions and Rising

FDA Is Looking Into Claims About New Genetic Test Kit

Numbers have grown steadily since the 1990s; baby boomer epidemic predicted

• American Kids More Obese Than Previously Thought Mar 19, 2010Extreme obesity in U.S. kids is even worse than previously thought, researchers say.

Kids are at higher risk of serious health problems as a result of being so overweight. The new study found more than 6 percent of kids were obese, while previous federal studies had it at only 3.8 percent. Far more boys than girls were obese, researchers report in the Journal of Pediatrics. The study examined 700,000 children and teens in California, a large study size.

• Smokers Who Quit Show Healthier Arteries Quitting smoking can buy more time against heart disease.A year after kicking the habit, smokers' arteries reversed the early stages of heart disease. The first large study to examine smokers' risk for heart disease was published in the Journal of the American College of Cardiology. Researchers in the study saw an improvement in artery function even though smokers gained an average of 9 pounds after they quit.Often, smokers lose the extra pounds after they get used to not smoking.

The study gave 1,500 smokers five methods to quit and doctors saw a 1 percent improvement in artery function."That may not sound like much," but research shows that translates to a 14 percent lower risk of developing heart disease, Dr. James Stein, lead researcher, said. .

• Expecting? Get Active The American Congress of Obstetricians and Gynecologists recommend that pregnant women exercise for 30 or more minutes at a moderate intensity most days of the week. According to a study by the University of North Carolina at Chapel Hill, fewer than one in four women meet this goal.

For otherwise healthy women, exercise during pregnancy has a number of benefits, including preventing gestational diabetes, helping control weight gain, and improving the expectant mother's mental health.

MATTHEW PERRONE,AP Business Writer WASHINGTON (AP) — The largest U.S. drugstore chain, Walgreen Co., said Wednesday it will hold off selling what was poised to be the first overthe-counter genetic test, after the Food and Drug Administration said the kit has not been proven effective.

Pathway Genomics (HealthDay News) -- The incidence of nonas breast or prostate cancer. More people have announced Tuesday that its melanoma skin cancer has steadily increased had non-melanoma skin cancer than all other saliva swab would be on since the 1990s, making it by far the most cancers combined over the last 31 years, Walgreen's shelves later this common form of cancer, affecting more people according to the study. than all other cancers combined, two new studMost of those who had a non-melanoma skin month, offering millions of Americans the chance peek ies find. cancer had more than one, with the average into their genetic code for More than 2 million Americans on Medicare being 1.6, he noted. signs of inheritable diseases were treated for non-melanoma skin cancer in "This is only going to get worse," said Dr. 2006, up from 1.6 million in 1992, according Suephy Chen, an associate professor of derma- like Alzheimer's.

But within 24 hours the comto one study. The other found that one in five tology at Emory University School of pany's plan was met with stiff 70-year-olds has been Medicine in Atlanta. "Our response from FDA regulators treated for non-melanoma population is aging. Those Researchers called nonwho said the products may run skin cancer. people who grew up in the melanoma skin cancer an 1970s and 1980s when there afoul of federal laws governing Researchers called nonmelanoma skin cancer an "epidemic" that is only going was not a big sun-protection medical tests. On Wednesday, the FDA posted a letter to "epidemic" that is only message out there are now t o g e t w o r s e Pathways online, indicating the going to get worse as all coming into their 50s and San Diego-based company those bathing beauties 60s and are starting to never submitted its product for and sun worshippers from the 1960s, 1970s develop skin cancers." federal review, a requirement and 1980s get older, and their cumulative sun While non-melanoma skin cancers are the for medical devices. exposure racks up. most common, melanoma is a serious worry.

"These kits have not been "We are dealing with a problem that is not Though melanoma accounts for less than 5 proven safe, effective or accugoing away," said Dr. Howard Rogers, a derpercent of all skin cancers, it was expected to rate and patients could be makmatologist in Norwich, Conn., and lead author lead to an estimated 8,650 deaths in 2009, ing medical decisions based on of one of the studies. "The number has kept according to the American Cancer Society. data from a test that hasn't going up and up at a rate of 4.2 percent every In a third paper in the same journal, been validated by the FDA," year, on average, from 1992 to 2006," he said. researchers from the U.S. National Cancer The studies are published in the March issue Institute found survivors of one melanoma are said agency spokeswoman of the Archives of Dermatology. about nine times as likely as the general popu- Erica Jefferson, in an earlier statement Wednesday.

The two types of non-melanoma skin cancer lation to develop a second melanoma.

Walgreen said late are basal cell and squamous cell. While basal Wednesday that the Illinois cell carcinoma is slow-growing and rarely Skin Cancer Facts (skincancer.org) company had decided not to fatal, it can damage the surrounding tissue and • Skin cancer is the most common form of canbone if it's not caught early, causing disfigurecer in the United States. More than 3.5 million stock the tests until it has "further clarity" on the issue. ment when the cancer is removed. cases in two million people are diagnosed Pathway's test would have Squamous cell carcinoma is also rarely fatal, annually. been the first low-cost, massthough it can metastasize and spread to the • Each year there are more new cases of skin lymph nodes and other organs, Rogers said. cancer than the combined incidence of cancers marketed version of kits that screen for genes associated When caught early, squamous cell carcinomas of the breast, prostate, lung and colon. are also highly treatable.

• One in five Americans will develop skin can- with diseases like prostate cancer, cystic fibrosis and diaIn the study by Rogers and colleagues, the cer in the course of a lifetime. researchers analyzed data from two Medicare • Basal cell carcinoma (BCC) is the most com- betes.

A saliva collection kit plus databases and national surveys. They found the mon form of skin cancer; an estimated 2.8 milfull genetic analysis from total number of procedures to treat skin cancer lion BCCs are diagnosed annually in the Pathway was slated to cost in the Medicare population increased by nearly US.38 BCCs are rarely fatal, but can be highly about $275.

77 percent between 1992 and 2006. Between disfiguring if allowed to grow.

Companies like 23andMe and 2002 and 2006 alone, skin cancer procedures • Squamous cell carcinoma (SCC) is the secNavigenics have sold similar increased by 16 percent. ond most common form of skin cancer. An estikits online for years, with In the second study, Dr. Robert Stern of Beth mated 700,000 cases are diagnosed each year prices ranging between $400 Israel Deaconess Medical Center and Harvard in the US,39 resulting in approximately 2,500 and $1,000.

Medical School in Boston, developed a mathe- deaths.

Those products have never matical model to estimate the prevalence of • Basal cell carcinoma and squamous cell carbeen reviewed by the FDA, non-melanoma skin cancer in the United cinoma are the two major forms of nonStates. melanoma skin cancer. Between 40 and 50 per- even though the agency has With about 13 million white non-Hispanic cent of Americans who live to age 65 will have the power to regulate all such laboratory-developed medical U.S. residents having been treated for at least either skin cancer at least once. tests. one non-melanoma skin cancer at the begin• Up to 90 percent of the visible changes comBut agency officials said ning of 2007, that means non-melanoma skin monly attributed to aging are caused by the sun.

Wednesday that Pathway cancers have struck five times as many people Prevention and treatment ... page 2

E. coli Outbreak From Romaine Lettuce Widens

May 12, 2010 -- At least 30 people in four states have been sickened by a rare, virulent strain of E. coli in preshredded Romaine lettuce.

Twelve of the victims have been hospitalized, three with kidney failure. There have

been no deaths to date. Some cases may have gone unreported because many labs do not test for the E. coli strain causing the outbreak.

Michigan, Ohio, New York, and Tennessee have reported cases.

The contaminated Romaine lettuce was sold by restaurants and by grocery/deli salad bars and processed by Freshway Foods in Sidney, Ohio. An unopened bag of Freshway shredded Romaine lettuce was found to carry the E. coli with the same genetic fingerprints as E. coli isolated from patients.

Freshway has recalled all Romaine lettuce with a useby date of May 12 or earlier.

Freshway got the lettuce from a farm in Yuma, Ariz.

Another lettuce distributor, Vaughan Foods, has also recalled lettuce from the same farm. However, no illnesses have yet been traced to lettuce distributed by Vaughan.

Lettuce harvested from other areas does not appear to be associated with the outbreak, the FDA investigation suggests.

The illnesses occurred between April 10 and April 26. Because of a lag time between the last reported illness and testing, it's possible new illnesses may still be occurring.

People with E. coli infection usually get diarrhea and

abdominal cramps for two to eight days after eating a contaminated food. Most people recover within a week, but some cases are much more severe and last much longer.

Some people may develop a form of kidney failure called hemolytic uremic syndrome or HUS. HUS tends to appear just as the diarrhea is getting better. Symptoms may include fever, abdominal pain, pale skin, fatigue, irritability, decreased urine output, unexplained bruises or bleeding from the nose and mouth, and swelling of the face, hands, feet, or body.

Seek immediate medical care if these symptoms appear after several days of

crossed "sanctioned boundaries" for such products by seeking to sell its products in retail pharmacies.

The agency's letter to Pathways, dated May 10, requests a response within 15 days.

"We give them a chance to respond and tell us why do you think that this is, in fact, actually a legal product," said Dr. Alberto Gutierrez, the FDA's director of diagnostic testing.

Pathways said in a statement it is communicating with the FDA and respects Walgreen's decision to hold off stocking the product.

The proliferation of consumer-marketed genetic tests has troubled many public health officials and doctors who worry that the products are built on flimsy data.

"The problem with all of these products is they're based on incomplete, invalidated data and we don't know what the impact on consumers will be," said Dr. Muin Khoury, director of the National Office of Public Health Genomics at the Centers for Disease Control and Prevention.

The biology of how DNA variations actually lead to certain diseases is still poorly understood, although a number of public and private institutions have been racing to find answers.

Khoury said that knowing a patient's medical history — including whether diabetes or heart disease run in their family — is actually more useful than current genetic testing. He and other experts worry that increasing prevalence of genomic tests could pressure doctors to order unnecessary tests and treatment.

"I think it's going to be a headache for both primary care physicians and for consumers themselves who are going to get these reports back and not know what to do with the information," said Dr. Peter Kraft, professor of epidemiology at Harvard School of Public Health.

But the prospect of millions of patients walking into their doctor's office with DNA test results may be unrealistic. A CDC survey found that just 22 percent of Americans were aware of genomic testing.

First lady releases child obesity recommendations page 7

Huntington's Disease Awareness Month recognized in May Seconds Count When Dealing with Stroke page 7

Page 2 • May 2010 • HEALTHLINE

Choosing Sunscreen - Higher SPF Not Necessarily Better There are now several sunscreen brands offering SPF of 50, 60, and even 100. Is there any benefit to these higher SPF (and higher-priced) sunscreens?

SPF, or "sun protection factor", is a measurement of how much the sunscreen shields a person from ultraviolet B rays (UVB). These are the rays that cause sunburn. Sunscreen with an SPF of 30 offers protection from 96.7% of UVB rays, while sunscreen with an SPF of 50 offers protection from 98% of UVB rays. So higher SPFs offer only marginal improvement in protection.

More importantly, SPF does NOT measure the ability of the sunscreen to protect users from ultraviolet A rays (UVA). UVA rays penetrate more deeply into the skin than UVB rays and lead to the premature aging of skin (the early development of wrinkles) and increase the risk of developing skin cancer. It is possible to have a sunscreen with SPF100 and still have little or no protection from UVA rays.

Unfortunately, people who use high-priced sunscreens may not use as much, nor apply it as frequently as they should. And they may be less willing to share it with their family and friends.

“waterproof” may be phased out because it is considered somewhat misleading) • Find a brand that fits your budget.

• Consumer Reports provided high ratings for the following brands: -Blue Lizard Regular -Australian SPF 30+ -Mustella Bébé/Enfant High Protection SPF 50 -Lancôme Paris Sôleil Ultra Expert Sun Care for Sensitive Skin SPF 50 -Fallene Cotz SPF 58 Remember to discard sunscreen that is more than two years old because it might have lost its potency.

Using Sunscreen– Let’s Do Better!

Results of a recent Consumer Reports telephone survey of 1,000 American adults regarding sunscreen use were quite disturbing The most alarming results showed that 31% never wear sunscreen.

And although children are very susceptible to the longterm consequences of sun

• Select a sunscreen with an SPF of 15 and higher. You can ignore SPF values over 50.

• Reapply sunscreen every 2 hours or after swimming or sweating heavily.

• Select a sunscreen with UVA protecting ingredients, such as avobenzone or Mexoryl SX.

“waterproof”. (The term

• Don’t’ skimp on sunscreen!

Most adults need 2 to 3 tablespoons (one ounce) to cover most sun-exposed areas.

• Apply sunscreen 15 to 30 minutes before going out in the sun. It does not have protective effects until it has absorbed and reacted with the skin.

Here are some basic tips on selecting a sunscreen.

• Select a sunscreen labeled “very water resistant” or

dren when they are outside for 2 to 4 hours (14% of parents don’t even apply it to their kids when their children will be outside for more than 4 hours.)

Fortunately, the importance of sunscreen use been has been taken to heart by some, primarily women. When planning to spend 2 to 4 hours in the sun, 48% of women reported being likely to wear sunscreen vs. 27% of men.

Unfortunately, the damaging effects of the sun can be forgotten over time, particularly at the end of a long winter.

48% of sunscreen users who experienced a sunburn in the last 2 years said it happened during their first time out in the sun after months of little or no sun.

A separate study of sunscreen use in Australia showed that most adults used only about ? of the recommended amount of sunscreen on their bodies. If people apply only ? of the sunscreen, they will get only ? of the protection.

So most of us could be doing better. Here are some basic tips on using sunscreen Apply sunscreen regularly

exposure, 27% of parents with kids under 12 years of age never or only sometimes apply sunscreen on their chil-

• Don't rely on sunscreen alone to protect you from skin cancer. Wear tightly woven clothing and a hat, limit sun time, and seek shade during the hottest hours of the day.

…..And Don’t’ Forget the Sunglasses Overexposure to UV rays has been linked to a variety of eye problems, including agerelated cataracts and degeneration of the cornea.

Optometrists recommend wear ing quality sunglasses that offer proper UV protection.

It's also especially important

for young children and teens to have UV-protective eyewear because they typically spend more time in the sun than adults, putting them at greater risk for eye damage.

Look at the label to ensure that the glasses provide UV protection.

Look for sunglasses that are described as blocking 99% or

100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Make sure that sunglass lenses are perfectly matched in color and free of distortions or imperfections.

ARA Content

Treating a Sunburn

The Warning Signs of Skin Cancer

Unfortunately, there's no fast-fix sunburn treatment. Once you have sunburn, the damage is done — although it may take 12 to 24 hours after sun exposure to know the full extent and severity of sunburn, and several days or more for your skin to begin to heal.

Like many cancers, skin cancers -- including melanoma, basal cell carcinoma, and squamous cell carcinoma -start as precancerous lesions.

These precancerous lesions are changes in skin that are not cancer but could become cancer over time. An estimated 40% to 50% of fair-skinned people who live to be 65 will develop at least one skin cancer. Learn to spot the early warning signs. Skin cancer can be cured if it's found and treated early.

mole are ragged, blurred, or irregular, have it checked by a dermatologist. Melanoma lesions often have uneven borders.

Actinic Keratosis (Solar Keratosis) The small, scaly patches caused by too much sun exposure commonly occur on the head, neck, or hands, but can be found elsewhere. They're the early beginnings of skin cancer. Actinic keratosis usually appears on people after age 40, but they can show up in much younger people. Fairskinned, blond, or red-haired people with blue or green eyes are most at risk. Early treatment is advised to stop progression to squamous cell skin cancer.

'D' is for Diameter A mole is suspicious if the diameter is larger than the eraser of a pencil. Benign moles are usually less than 6 millimeters in diameter.

Know Your ABCDEs:

Tips for Screening Moles for Cancer Examine your skin after a shower while skin is wet. A common location for melanoma in men is on the back, and in women, the lower leg. But check your entire body for moles or suspicious spots once a month. Start at your head and work your way down. Check the "hidden" areas: between fingers and toes, the groin, soles of the feet, the backs of the knees.

Check your scalp and neck for moles. Use a handheld mirror or ask a family member to help you look at these areas.

Be especially suspicious of a new mole. Take a photo of moles and date it to help you monitor them for change. Pay special attention to moles if you're a teen, pregnant, or going through menopause,

In the meantime, the most effective sunburn treatment simply helps ease your discomfort: • Keep it cool. Apply cold compresses — such as a towel dampened with cool water — to the affected skin. Or take a cool bath.

• Keep it moist. Apply aloe, moisturizing cream or over-the-counter hydrocortisone cream to the affected skin.

• Beware of sunburn treatment products containing anesthetics, such as benzocaine.

There's little evidence that these products are effective. In some cases, they may even irritate the skin.

• Leave blisters intact. If blisters form, don't break them. You'll only slow the healing process and increase the risk of infection. If needed, lightly cover blisters with gauze.

• Take an over-the-counter pain reliever. If needed, take anti-inflammatory medication — such as aspirin or ibuprofen (Advil, Motrin, others) — according to the label instructions until redness and soreness subside. Don't give children or teenagers aspirin. It may cause Reye's syndrome, a rare but potentially fatal disease.

• Treat peeling skin gently. Within a few days, the affected area may begin to peel. This is

simply your body's way of getting rid of the top layer of damaged skin. While your skin is peeling, continue to use moisturizing cream.

Consult a doctor for sunburn treatment if: • Severe sunburn covers a large portion of your body with blisters • Sunburn is accompanied by a high fever or severe pain • Severe sunburn doesn't begin to improve within a few days To prevent future episodes of sunburn, use sunscreen frequently and liberally. Common sense counts, too. Cover up while you're outdoors, and stay in the shade as much as possible.

'A' is for Asymmetry Asymmetry means one half of a mole does not match the other half. Normal moles are symmetrical. When checking your moles or freckles, draw an imaginary line through the middle and compare the two halves. If they do not look the same on both sides, have it checked by a dermatologist.

'B' is for Border If the border or edges of the

'C' is for Color A mole that does not have the same color throughout or that has shades of tan, brown, black, blue, white, or red is suspicious. Normal moles are usually a single shade of color.

A mole of many shades or that has lightened or darkened should be checked by a doctor.

'E' is for Elevation If a portion of the mole appears elevated, or raised from the skin, have it looked at by a doctor. Melanoma lesions often grow in size or change in height rapidly. A mole that is evolving – shrinking, growing larger, changing color, begins to itch or bleed – should also be checked.

times when your hormones may be surging.

How Are Moles Evaluated?

If you find a mole or spot that has any ABCDE's of melanoma -- or one that's tender, itching, oozing, scaly, doesn't heal or has redness or swelling beyond the mole -see a doctor. Your doctor may want to remove a tissue sample from the mole and biopsy it. If found to be cancerous, the entire mole and a rim of normal skin around it will be removed and the wound stitched closed. Additional treatment may be needed.

Who Gets Skin Cancer, and Why? • Sun exposure is the biggest cause of skin cancer. But it doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight.

• Exposure to environmental hazards, radiation treatment, and even heredity may play a role. Although anyone can get skin cancer, the risk is greatest for people who have: • Fair skin or light-colored eyes • An abundance of large and irregularly-shaped moles A family history of skin cancer • A history of excessive sun exposure or blistering sunburns • Lived at high altitudes or with year-round sunshine Received radiation treatments Source: Webmd

HEALTHLINE • May 2010 • Page 3

Page 4 • May 2010 • HEALTHLINE

DIET & FITNESS

MOVING OFF THE WEIGHT LOSS PLATEAU Add Some Muscle to Your Frame If you're not strength training, now is the time to add some muscle to your frame. It will boost your metabolism and help you change your body composition to lose fat and gain muscle. If you're already lifting, you need to make your strength training more intense. Bump up the frequency of your training from twice to three times a week. Increase the amount of

Homeostasis. That's a fancy way to say equilibrium, and it's what your body craves, even more than salt and vinegar potato chips. We humans are highly adaptive creatures, and our bodies work to maintain homeostasis. This is really no big deal, unless you're trying to lose weight, and then it really just translates into the word the dieter dreads — plateau.

When you hit a plateau, meaning the weight, fat, and inches are no longer coming off, read these tips to see how to revitalize your weight loss efforts. weight you're lifting to challenge your muscles even more or try more challenging exercise. For example, skip the triceps kickback and try triceps push-ups or side planks. Full body exercises give you more bang for your buck.

You Eat It, You Write It Down If you started dieting in back in January as part of a New Year's resolution, kudos to you — you've been at it for almost five months. However, dieting can lose its shine and you can get, well . . . lazy when it comes to food. Food journaling is the best way to keep yourself honest. Those random handfuls of chips or candy Kisses actually do add up. Use the scale not budging as a reminder to track your food intake.

Play With Your Food: Calorie Cycling This technique takes some pre-planning, but it could be just what your body needs. Cycle your calories by toying around with your daily caloric consumption. Maintain the same caloric intake over the course of a week, but eat 100 calories more one day, followed by 200 fewer calories the next day. Some folks call this the "zigzag" method, but no matter what you call it, this method disrupts your body's equilibrium and will rev your weight loss engine.

2-MINUTE DRILL Metabolism sluggish? Extra pounds unforgiving?

Kick your metabolism into gear with this 2-Minute Drill, featured in the new diet and fitness book Belly Off! Diet, written by Jeff Csatari and the editors of Men's Health.

PRISONER SQUATS

Though marketed as a man's read, the principles are applicable for women, too. In particular, the book's 2-Minute Drill - which you do daily is a metabolic booster.

• Crunches • Mountain climbers Bodyweight thrusters Once you get through the drill, if you have time – and energy – repeat it.

WAKE UP AND REV YOUR METABOLISM Research indicates people who work out in the morning work out more often. And that is because you can get it done and out of the way before work, family, and life get in the way. Even better, studies show that exercise in the morning not only stokes your metabolic fires, it also improves your cognitive functions and productivity for the day.

You can also intersperse the 2-Minute Drill into your regular cardio or strength-training workouts to add variety and intensity.

The 2-Minute Drill, designed by fitness expert David Jack, may just be this year’s best kept secret to jump-starting your metabolism. According to Belly Off! Diet author Csatari, starting your day with this series of eight exercises will wake you up, get your body burning fat, trigger endorphins and kick off your day on a positive note.

THE BELLY OFF! 2MINUTE DRILL Eight moves every morning is all you need to boost your metabolism. However, don’t expect this workout alone to give you the body of your dreams. You still need to incorporate healthy eating and regular exercise into your lifestyle.

Perform the following eightcalisthenic circuit at a work effort of 6 to 7 on a 1 to 10 scale. Do each exercise for 15 seconds, moving quickly from one exercise to the next. Complete as many reps as you can of each exercise.

The 8 moves (15 seconds each): Change Your Cardio Routine The body acclimates to repeated challenges, making it necessary to change your cardio routine every four to six weeks. If you run three times a week for 30 minutes, switch it up and take a couple of 60-minute spin classes or hit the rowing machine. Add interval training into your workouts if you're ready — playing with your speed in a workout really unsettles the body's sense of caloric equilibrium. Interval training burns serious calories and boosts your metabolism as well.

Load Up on Fruit, Veggies, and Fiber After looking at your food journal, ask yourself if you're eating enough produce and fiber. Since every calorie counts, you can eat substantially more nutrients with fewer calories with fruits and veggies. Fiber is also filling, so count your grams of this nutrient as well. If you're bored with dieting and counting calories, challenge yourself to eat seven to nine servings of produce — this should help you cut calories without thinking about them.

HEALTHLINE A Special Supplement to the Appalachian News-Express

PUBLISHER Jeff Vanderbeck AVERTISING DIRECTOR Mike Davis SECTION CONTENT AND DESIGN: Tracie Vanderbeck ADVERTISING DESIGN: Jamie Beckett

• Jumping jacks • Prisoner squats* • High knee skips • Side-to-side hops • Pushups

• Prisoner squats: Stand with your fingertips behind your ears, your chest out, elbows back, and feet shoulderwidth apart. Sit back at your hips and bend your knees to lower your body as far as you can without losing the natural arch of your spine.

Keep your head up. Squeeze your gluteals and push yourself back to start position.

Repeat.

• Mountain climbers: Start in a pushup position with your shoulders directly over your hands. Keeping your head in line with your body, bring your right knee to your chest. As you straighten the right leg to start position, bring our left knee to your chest. Keep your weight on the balls of your feet. As quickly as possible, “climb” alternating your legs back and forth.

• Bodyweight thrusters: Keeping your back straight and hands at your shoulders as if you were holding a barbell, bend at the knees into a squat, then explosively drive your legs straight as you extend your arms above your head. Repeat.

MIX IT UP You can do the exercises in the 2-Minute Drill in any order and even add or substitute a few of your own. As you get more fit, increase the time you do each exercise from 15 seconds to 30 seconds or more. Do what works for you – whatever will keep you motivated to get up and get moving.

8 Tips to increase stamina Increasing your stamina is very important for your everyday life. Without having stamina, you will be tired, lazy, and just be sitting at home watching t.v. and just gaining weight. That is an unhealthy lifestyle. Being active in everyday life is the a healthy lifestyle.

Step 1 Before you begin, be sure to set some goals for yourself. Ask yourself a couple of questions such as, Do you want to increase your energy, build muscle mass, increase your strength, or endurance?

Step 2 Create a training method and workout routines that is achievable for you and your goals. When trying to increase your stamina, you have to start from the bottom (small) and work your way up little by little.

Step 3 How to increase stamina? Start off by walking often. When walking, you can improve durability and the air intake in your lungs and make your heart stronger, increase your energy level for a more active lifestyle, give you more leg strength, and give you a better goodnight rest.

Step 4 As you progress from walking, start speed walking or jogging. However, running is also a good way, but some people can't handle that capability because of knee problems and etc.

Step 5 Nest you can to try to ride a bike. It is important to try and find some form of exercise that can be a very productive lifestyle that is active and healthy.

Step 6 If not, try swimming which is a great form of exercise that can contribute to increase stamina. This exercise provides a great cardiovascular workout which can tone your body.

Step 7 Push yourself when you start to give up because then your activity will become easier as time passes.

Never give up because you never know where your capable of going.

Step 8 If walking is the only exercises that is suitable for you, try walking longer.

Don't let you body get used to the activity that you constantly do, so keep it different.

HEALTHLINE • May 2010 • Page 5

Push Ups- Best exercise Apps for for upper body & abs Working Out

•

Whether you like to hit the trail or the gym, iPhone has apps to help you get the most out of your workouts.

If your iPod Touch or iPhone is an essential part of your workout, you've probably scrolled through the endless array of fitness apps available, wondering which ones are worth the time and money.

The right fitness app can give you the boost you need to get through your workouts, but the wrong one can leave you frustrated. I've done a little research and put together a list of my favorite exercise and fitness apps covering everything from strength training and yoga to weight loss and running.

1. iPump & Fitness Builder Price: $19.99 Though expensive, iPump is well worth the price. Stand-out features include:

If you had to pick one exercise to build everything in your upper body, it would be the mighty push-up. There isn’t any gym equipment that can replace the old school push-up.

It works your chest, shoulders, biceps, triceps, back and abdominal muscles.

• A variety of workouts drawing from thousands of unique exercises and equipment such as barbell, exercise ball, dumbbells, kettlebells, BOSU, foam roller and more.

• The ability to search workouts by location (hotel, home, gym, etc.), goal (arms, abs, cardio, etc.) or keyword.

• An exercise database with incredible variety.

Videos of each exercise.

• The ability to edit workouts or create your own.

Done right, it works your whole upper body, including your core. And as a test of fitness, it is probably one of the best exercises out there.

A push-up tests how much strength you have in your upper body, to lift your own weight.

So, how do you correctly perform a pushup?

Kneel on a mat or the floor. Bend over placing your palms on the floor just outside your shoulders. Straighten your legs so the only contact points with the floor are your palms and the front of your soles. Keep your legs straight, and in line with your torso, ensuring your back is also straight. This is your starting position.

Now, slowly lower your body by bending your arms, till you’re almost touching the floor.

Pause for a moment at the bottom, and lift yourself back into the starting position.

If you cannot perform a push-up, then make it easier by supporting yourself at the knees. So, your contact points with the floor are your palms and your lower legs. This is your starting position. Lower yourself in the same manner What Muscles Do Push-Ups Work?

Push-ups are effective in building muscular strength and endurance. In fact, the American College of Sports Medicine (ACSM) recommends a push-up test to evaluate the muscular endurance of the upper body. Due to their accurate assessment of fitness, push-ups are included in the physical training of the military as well as physical education classes throughout the country.

Pectoral Muscles The pectoral muscles of the chest are the primary target of a push-up. The pectoralis minor, the smaller underlying muscle of the

pectoral group, works to stabilize the shoulder joint. The pectoralis major, the larger muscle of the two, works to horizontally extend the flexed arm at the shoulder. This action is observed when you push your body away from the floor.

Deltoid Muscles The shoulder is also used to execute a pushup, specifically the anterior portion of the deltoid muscle. The deltoid works in unison with the pectoral muscles in extending the arm at the shoulder when pushing away from the floor.

Triceps Brachii Muscles The triceps brachii is located on the back of the upper arm. The triceps work to straighten the arm at the elbow as well as extend the arm at the back of the shoulder. The triceps are utilized during both the downward and upward phases of the push-up.

Exercise Plan: 100 Push-Ups in 6 Weeks There's the 8-week Couch to 5K running program and the Zero to a Mile six-week swim program, and now there's a push-up plan for you to follow. It is guaranteed to increase your upper body strength in a month and a half. The goal? One hundred consecutive push-ups!

It doesn't matter how push-up proficient you are right now.

If you follow the six-week program, 100 consecutive push-ups are in your near future. If you're serious about toning your upper body then read more.

The plan requires that you work out three days a week, resting between each day (so Monday, Wednesday, Friday works well). For each workout, you complete five sets of

push-ups at your level, and each day, you progressively increase the number you can accomplish. At the end of the six weeks, you should be strong enough to take on the final test and execute 100 push-ups. To find out more details about this training program, check out the onehundredpushups website. hundredpushups.com

Tips for Beginning an Exercise Program Exercise has several benefits, including weight loss, better sleep, improved mood and self esteem, lower blood pressure and cholesterol, and a decreased risk for developing chronic conditions, such asosteoporosis, diabetes and heart disease, according to the Cleveland Clinic. Remember, though, that building an exercise program takes time, patience, dedication and knowledge of a few free fitness tips that will help you meet your goals and be successful.

vow to walk for 10 minutes three times a week. Gradually build upon that by increasing the time and the number of days you walk.

Begin Slowly If you are new to exercise or it has been a while since your last exercise session, you should gradually integrate a fitness program back into your life by incorporating it into your daily routine, the Cleveland Clinic suggests.

Find an activity that you enjoy such as walking, and

Drink Plenty of Water The more active you are, the more fluids your body needs, according to Northwestern Health Sciences University.

During one hour of exercise, you can lose 1 quart of water, so it is important to drink plenty of water--which is considered the best fluid replacement during exercise--before,

Make Exercise a Priority Just as you would for an important meeting at work, schedule a time each day for your workout and write it on your calendar, the Mayo Clinic suggests. If you make this a habit, you are more likely to make exercise a priority and less likely to skip your workouts.

during and after you work out.

Find Support Surrounding yourself with supportive people will help keep you on track with your exercise routine and ultimately help you reach your goals, suggests the American Heart Association.

Choose the Right Footwear One of the most important aspects of any exercise program is the shoes that you wear, which can either prevent or cause injuries.

According to Strong Health, a website of University of Rochester Medical Center, choose footwear that is specific to the activity you be doing, and make sure the shoes fit snug but not tight.

Make sure that the shoes offer ankle support and provide enough cushion as well as non-skid soles.

2. iFitness Price: $1.99 iFitness offers more than 100 strength and cardio exercises and the ability to create your own workouts.

Stand-out features: • Easy to navigate. You can choose exercises by muscle group, individual muscle or from a full list of exercises.

• With each exercise you can see pictures and descriptions, log the exercise, mark it as a favorite and access a timer for rest periods.

• The database has all the classic exercises (such as bench press, squats, etc.) using a variety of equipment.

• It's easy to create workouts and add new exercises.

3. FitDeck Price: $4.99 FitDeck Bodyweight is based on the FitDeck card game, a deck of cards displaying different exercises. This app offers only bodyweight exercises, so it isn't for everyone. However, it's great for quick, easy workouts when you're short on time. Stand-out features: • A timer is included for the timed exercises.

• Pictures and descriptions of each move.

• No equipment needed.

• Plenty of variety with classic moves (such as pushups) and unusual exercises (such as bear crawls).

• Wild cards (such as 'Repeat Last Card') make things interesting.

• You can edit the deck and choose different elements to include in workouts.

4. Yoga Relax Price: $1.99 Yoga Relax offers a simple and, for the most part, seamless yoga workout.Stand-out features include: • Soothing music and instructions make it easy to flow through the workout without having to look at your iPod. • Poses are simple and great for relaxation.

• You can choose the length of your practice,

from 1 to 36 minutes.

• You can turn off the music and instructions at any time.

5. Lose It! Price: Free As free weight loss apps go, you can't go wrong with Lose It. It's easy to use and offers tons of great feedback for anyone wanting to lose weight. Standout features: • You get an estimate of the calories required to lose weight based on your goal (from 0 to 2 lbs a week).

• The ability to enter foods using a database that includes major brands and common restaurants.

• An exercise database to calculate calories burned.

• A chart that shows your daily calorie budget -- calories eaten, calories burned and a tally of how many more calories you have left.

• You can track nutrients (fat, carbs, fiber, etc.) and add new foods to the database.

• View your progress by the day or week.

Lose It is a great resource and, best of all, it's free.

6. RunKeeper Price: Free Description RunKeeper uses the GPS technology found in the iPhone 3G/3GS to track your fitness activity, giving you comparable results to an expensive GPS watch at a fraction of the cost.

Now, you can also enter your activities manually, including your treadmill runs too! The intuitive and easy-to-use interface of the app makes it easy to track how far you went, how long it took, what your pace/speed was, how many calories you burned, and the path you traveled on a map.

Once your activity is completed, the data is synced to the RunKeeper website (www.runkeeper.com) where you can view a history of all of your activities, and cumulative totals of all of your vital stats. You can also share your progress with friends by posting your activities to Facebook and Twitter, and creating a profile page that allows people to view all of your public activities.

RunKeeper only works on 3G & 3GS iPhones, NOT the iPod Touch*** Features: * Activity Tracking No need for an expensive, standalone fitness tracking device when you can use your iPhone 3G or 3GS to do the same thing. Now you can track how far you went, how long it took you, and the route you traveled right from your iPhone 7. M-Train Price: $1.99 This fitness app offers 4 workouts based on what they call their P.A.S.E. system - power, agility, strength and endurance.

When you buy the app (it's $1.99) you get a strength workout and a power workout, but you'll pay an extra $1.99 each for the agility and endurance workouts. Stand out features: • The workouts are unusual, challenging and fun • All the moves are body weight, so you need no equipment • The moves are tough: mule kicks, plyo pushups, mountain climbers, burpees, long jumps and machine gun squats • Workouts include videos, timers and instructions • You can follow the pre-set workouts or create your own • You can create a playlist to go with your workout

Page 6 • May 2010 • HEALTHLINE

WELLNESS

How to Avoid Summer's Health Woes Experts explain strategies for preventing 6 common maladies from ruining your summer fun.

It's summer, which means the mercury is on the rise, the beach is where it's at, and a cold glass of lemonade is exactly what the doctor ordered.

Learn how to survive the summer season -- from heat waves to poison ivy to bad burgers with these expert tips.

Dehydration and Heatstroke "Dehydration and heatstroke go hand in hand," says Peter Galier, MD, associate professor of medicine at the David Geffen School of Medicine at UCLA. "It happens most commonly in people who are out in the sun."

What happens, explains Galier, is that people sweat and replace their lost electrolyte-packed body fluids with only water. Dehydration can soon follow, and heatstroke can set in if a person becomes so dehydrated they can't sweat enough to cool down, and their body temperature rises.

How to avoid it. "If you are outside and sweating, you should be drinking at least a 50-50 mix of Gatorade and water, which has potassium and sodium," Galier explains.

"You need to be drinking at least one small liter bottle of this mix every hour if you're working or exercising in the sun."

Warning signs. "Symptoms of dehydration can run the gamut from thirst and general fatigue, to headaches, nausea, and confusion," says Galier.

"Heatstroke symptoms are also headache and confusion, but include delirium and even hallucinations."

What to do. While mild dehydration can be treated by rehydrating with fluids, heatstroke is more serious. "If you

have heatstroke, you need to go to the emergency room so you can have intravenous fluids," says Galier. "With really bad heatstroke, your kidneys can shut down."

foods -- that is leaving them in the danger zone, which is anything above 40 and below 140 degrees. In this range, microorganisms that cause food-borne disease can multiply."

Poison Ivy

From the pasta salad left out all afternoon on the Fourth of July, to a turkey and mayo sandwich in your backpack on a 3-mile hike up a mountain on a warm day, to simply driving from the grocery store to your home in the sweltering heat, summertime foods are a breeding ground for trouble -- and bacteria.

The old adage still rings true, explains Galier. "Leaves of three -- let them be," he says.

So when the summer months begin, plan ahead when you know you're going to be trekking through the woods.

How to avoid it. "Poison ivy is a tri-leafed plant, usually with a little yellow and purple, and it tends to be anywhere with shrubbery, hiding out with other vegetation," says Galier. "So stay out of shrub areas or wear high boots or high socks, stay on the path, and don't touch anything you don't recognize."

Warning signs. Poison ivy can creep up on you, even if you wear head-to-toe clothing. "It's the oil of the leaf that's the problem," says Galier. "If you take your clothes off and you touch your clothes, you're going to get it." The "it" he's referring to is the itching and swelling.

What to do. It's time to get out the topical anti-itching cream again, like calamine lotion. "If you can suffer through it and it doesn't get worse, you can ride it out," says Galier. If it gets worse, you'll need to see a doctor for topical steroids or oral steroids."

Food-Borne Illnesses "Food-borne illnesses are more common in summer for a number of reasons," says Linda Harris, PhD, professor in the food science and technology department at University of California Davis. "If the temperature is higher, there is more opportunity for temperature abuse of

How to avoid it. "There are four basic rules for preventing food-borne illness: cook, clean, chill, and separate -and these become important during summer," says Harris, who is a scientific communicator with the Institute of Food Technologists.

First, she recommends, use a thermometer when cooking so you know your food is adequately heated.

Second, "when you are outside, it's always best to wash with soap and water. But if you can't, bring sanitizing handy wipes so you can clean your hands after you handle food," Harris explains.

Warning signs. The warning signs of food-borne illness are the usual suspects, explains Harris: vomiting, stomach cramps, diarrhea, flu-like symptoms, or any combination of these not-sopleasant symptoms.

"One of the mistakes people make is to assume that the last thing they ate is the cause of their symptoms," says Harris. "While some types of food-borne illnesses take two to six hours until symptoms appear, others take one or three days. So the culprit is not always the last thing you had, even though that's probably what came up."

What to do. Despite best efforts, if you fetch up with something you might suspect is food-borne, keep in mind, "Some food-borne illnesses, such as E. coli O157:H7, can be life-threatening, particularly for young children, the elderly, and those with weakened immune systems," according to the FDA's Center for Food Safety and Applied Nutrition.

"Symptoms that are severe or prolonged may need to be treated. People who believe they may have contracted a food-borne illness should call their physician."

Mosquito Bites Third, "if you are going to a picnic, use a cooler where you can maintain food in a cool temperature," says Harris. "Don't use it to make things cold, but to keep things cold. Remember to bring enough ice, as well. If you can't use a cooler, like on a hike, bring foods that don't need refrigeration. Or freeze your foods, so when you are ready to eat them, they're thawed out."

Finally, Harris says, "Keep your utensils and dishes that you use for raw meat separate from those you use to eat."

While mosquito bites used to be little more than annoying and itchy bumps on your arm or behind your ear, now we have even more reason to avoid them with things like West Nile virusand Triple E (Eastern Equine Encephalitis) making headlines.

How to avoid it. Your attack against a mosquito bite is three-pronged, according to the CDC's web site: "Use insect repellent, particularly those with DEET, picaridin, or oil of lemon eucalyptus; wear as much clothing as the warm weather will allow; and avoid the out-

doors during dusk and dawn -- peak biting times."

Warning signs. Mosquito bites will appear as red, raised bumps on your skin.

Worse, they'll itch.

What to do. Mosquito bites usually go away in less than a week, according to the web site of the University of Maryland Medical Center.

In the meantime, you can wash the area and keep it clean, use an ice pack or a cool compress to alleviate itching, take an antihistamine, or use an anti-itching cream, such as calamine lotion.

Nearly 80% of people infected with West Nile virus will not have any symptoms. If you start to experience symptoms like fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach, and back, according to the CDC's web site, see your doctor. There's a chance these could be symptoms of West Nile virus.

finally arrives.

"Just like when your fingers get pruney when you're in the water too long, the same thing happens to your ears," says Galier.

When you swim, or even shower or bathe, water can get trapped in your ear canal, causing the canal to get inflamed and infected.

How to avoid it. Gone are the days of Silly Putty in your ears. Now it's simply wax ear plugs, or custom-fit ear plugs, explains Galier, to prevent swimmer's ear.

Warning signs. "The symptoms of swimmer's ear are ear pain and decreased hearing," says Galier.

You might also experience, according to the web site of the American Academy of Otolaryngology, a sensation that the ear is full, fever, or swollen lymph nodes.

What to do. "Treating swimmer's ear requires a prescription," says Galier. "You need to see your doctor."

Swimmer's Ear Swimmer's ear is a kid's nightmare when summer

What Should Be In Your First Aid Kit? Whether it's for your home, car, or workplace, a properly constructed First Aid Kit is essential for emergencies. According to the American Red Cross, carrying a first aid kit with you or knowing where you can find one is very important. You can purchase a first aid kit or make one yourself. Some kits are specifically designed to fit different activities such as outdoor sports. Whatever your activities consist of, make sure you have the proper items you may need. Aside from the basic first aid essentials, make sure you include any personal items such as medications and emergency phone numbers. Practicing regular upkeep to your First Aid Kit, such as checking expiration dates and replacing any used or outof-date items, is essential. The Red Cross recommends that all first aid kits for a family of four include the following: • 2 absorbent compress dressings (5 x 9 inches) • 25 adhesive bandages (assorted sizes) • 1 adhesive cloth tape (10 yards x 1 inch) • 5 antibiotic ointment packets (approximately 1 gram) • 5 antiseptic wipe packets • 2 packets of aspirin (81 mg each) • 1 blanket (space blanket) • 1 breathing barrier (with one-way valve)

• 1 instant cold compress • 2 pair of non-latex gloves (size: large) • 2 hydrocortisone ointment packets (approximately 1 gram each) • Scissors •1 roller bandage (3 inches wide) •1 roller bandage (4 inches wide) • 5 sterile gauze pads (3 x 3 inches) • 5 sterile gauze pads (4 x 4 inches) • Oral thermometer (non-mercury/nonglass) • 2 triangular bandages • Tweezers • First Aid Instruction booklet Whatever your daily activities include, whether at work or at play, make sure you have a First Aid Kit available and fully stocked to fit your needs.

HEALTHLINE • May 2010 • Page 7

IN THE NEWS

First lady releases child B-Vitamins Help Protect obesity recommendations Against Stroke, Heart Disease People with a diet rich in folate and B-6 are less likely to die from cardiovascular disease, study finds People who eat a diet high in B-vitamins are less likely to die from cardiovascular disease, say Japanese researchers.

They analyzed dietary questionnaires completed by more than 23,000 men and almost 36,000 women who were part of the Japan Collaborative Cohort Study. During a median 14 years of follow-up, 986 of the people died from stroke, 424 from heart disease, and 2,087 from all diseases related to the cardiovascular system.

First lady Michelle Obama speaks at an event at the Eisenhower Executive Office Building, Tuesday, May 11, 2010, in Washington, to discuss the findings of the Childhood Obesity Task Force report. In February, Mrs. Obama launched the Let's Move, a campaign to solve the childhood obesity epidemic within a generation. (AP Photo/Carolyn Kaster)

The study found that women who ate more foods with the B-vitamins folate and B-6 were less likely to die from stroke and heart disease, while men who ate a diet high in these B-vitamins were less likely to die of heart failure.

Vitamin B-12 intake was not

WASHINGTON (AP) — First lady Michelle Obama's campaign against childhood obesity received a boost Tuesday when the government issued its road map for tackling the problem, including encouraging more women to breast-feed.

The report recommends 70 specific steps that all levels of government, the private sector, schools, parents and others can take. Mrs. Obama has said her goal is to solve the problem within a generation so that babies born today can come of age at a healthy weight.

One in three American children is overweight or obese, increasing their risk of developing diabetes, heart disease and other illnesses, and contributing to high health care costs. Some public experts say children today are on track to live shorter lives than their parents.

The recommendations touch on all parts of the "Let's Move" anti-obesity campaign Mrs. Obama launched this year, including giving information to caregivers, serving healthier food in schools, making healthy food cheaper and more available, and getting children to exercise more.

The first lady has spoken publicly about many of the recommendations.

"We know we have the tools.

We know we have the resources to make this happen," she said. "And now ... we have a road map."

The report set 2030 as a benchmark, saying her goal of reversing the epidemic could be achieved if rates fall

back to 5 percent by then.

In emphasizing prenatal care to get children off to a healthy start, the report says a woman's weight before pregnancy and her weight gain while pregnant are important factors that determine childhood obesity. Studies have found that about 1 in 5 children are overweight or obese by age 6, and that more than half of obese children become overweight before age 2.

The report recommends that women be at a healthy weight at conception and that they avoid excess weight gain during pregnancy. The report also stressed the benefits of breast-feeding; studies have found that babies fed this way are 22 percent less likely to become obese.

Other recommendations call for: —Restaurants to consider portion sizes and begin posting calorie information as the new health care law requires.

—Updated federal nutrition standards for meals served at schools and more schoolbased nutrition education.

Congress is working on updating the guidelines.

Legislation that cleared the Senate Agriculture Committee would spend an additional $4.5 billion over 10 years on school nutrition programs; the Obama administration has asked for an additional $10 billion over the period.

—Incentives to lure supermarkets to underserved rural and urban areas.

—Pediatricians to get in the habit of checking their patients' body mass index, a height-weight calculation used to measure body fat.

Kimper

—A standard nutrition label on the front of packaged foods.

—The food industry and beverage industry to limit the marketing of unhealthy products to children, with government regulation as a last resort.

The Grocery Manufacturers Association said in a statement that it has reduced the amount of sugar, fat, calories and sodium in more than 10,000 products and promised further improvement.

A dozen federal agencies, including the departments of Education, Agriculture, Health, Interior and Transportation, participated in the Childhood Obesity Task Force, which President Barack Obama created in February.

The panel had 90 days to issue a report, and it sifted through more than 2,500 suggestions from the public. ___ On the Net: Let's Move: http://www.letsmove.gov

The researchers believe that folate and vitamin B-6 may help protect against cardiovascular disease by lowering levels of homocysteine, an amino acid in the blood that's affected by diet and heredity.

Previous research suggests that too much homocysteine may damage the inner lining of arteries and promote the formation of blood clots.

Fish, liver, meats, whole grains and fortified cereals

are sources of vitamin B-6, while vegetables and fruits, whole or enriched grains, fortified cereals, beans and legumes are sources of folate.

The study appears online April 15 in the journal Stroke.

More information The Office of Dietary Supplement, U.S. National Institutes of Health has more about vitamin B-6.

SOURCE: American Heart Association, news release, April 15, 2010

5 minutes in the green can boost mood Outdoor exercise improves mental health, study finds People should be encouraged to spend time in parks and gardens, researchers say.

LONDON - Just five minutes of exercise a day in the great outdoors can improve mental health, according to a study released on Saturday, and policymakers should encourage more people to spend time in parks and gardens.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Researchers from the Interest, applauded the administration for making childhood obesity a national priority. The report includes benchmarks to help measure progress, and Wootan said her organization will be watching.

"We definitely won't sit back and hope for the best," she said. "We'll keep their feet to the fire."

associated with reduced risk of death from cardiovascular disease.

University of Essex found that as little as five minutes of a "green activity" such as walking, gardening, cycling or farming can boost mood and self esteem.

"We believe that there would be a large potential benefit to individuals, society and to the costs of the health service if all groups of people were to self-medicate more with green exercise," Barton said in a statement about the study, which was published in the journal Environmental Science & Technology.

Page 8 • May 2010 • HEALTHLINE

Seconds count when dealing with stroke

MICHELLE GOFF

By Michelle Goff

According to the Huntington's Disease Society of America, more than a quarter of a million Americans have Huntington's disease or are at risk of inheriting the degenerative brain disorder.

Currently, there is no cure or effective treatment for the disease.

When it comes to strokes, time lost is brain loss.

However, Pikeville neurologist Naveed Ahmed, the medical director of Pikeville Medical Center's Primary Stroke Center, said that if action is taken in time, a patient has a better chance of recovery.

"If a patient meets the criteria and is treated within three and a half to four hours (from the start of symptoms) with TPA, a clot-busting drug called tissue plasminogen activator, the recovery chances are better," Ahmed explained.

He continued, "Patients who receive tPA do better in the recovery process than those who do not receive tPA. There are risks with tPA, but the benefits outweigh the risks."

With time so critical, it's important to identify the warning signs of strokes, which include:

known as warning strokes or mini-strokes. TIAs produce stroke-like symptoms, but no lasting brain damage.

"TIAs should be taken seriously," he noted.

Besides TIAs, other risk factors for strokes include: .Age .Hypertension .Diabetes .Smoking .Obesity .Irregular heartbeat

.Weakness, numbness on one or both sides of the body

.Birth control pills

.Sudden, severe headache with no known cause .Sudden trouble walking, dizziness, loss of balance or coordination Ahmed also stressed the importance of recognizing TIAs (transient ischemic attacks), which are also

States.

Ahmed praised PMC administration, nurses, neurosurgeons and emergency room and ICU specialists as well as his fellow neurologists Sai Gutti and Samrina Hanif for their roles in bringing and sustaining a Primary Stroke Center in Eastern Kentucky.

"I'm happy we have established a Primary Stroke Center," he said. "We're the only JCAHO-approved stroke center east of Lexington in Kentucky."

.Cholesterol

.Vision disturbance

.Speech disturbance, inability to communicate, confusion

Huntington's Disease Awareness Month recognized in May

"There is no way to predict," he said, "but we (the Primary Stroke Center) are screening for diabetes, cholesterol and hypertension.

We have been receiving people with TIAs and we're preventing strokes from happening."

The Primary Stroke Center chose May, which is recognized nationally as Stroke Awareness Month, to hold a Stroke Awareness Day -May 15 -- to educate the public on the third leading cause of death in the United

The center is also acknowledged on the American Stroke Association's Web site, where you can type in your Zip code to locate the closest Primary Stroke Center near you.

Yet, despite the close proximity to a Primary Stroke Center, Ahmed cautioned against treating stroke symptoms causally.

"People should not take symptoms lightly," he advised. "Consider every TIA as a stroke. Things can get rapidly worse, so don't bring yourself to the hospital. Call an ambulance."

Huntington's disease usually affects people between the ages of 30 and 50. However, there is also a juvenile form of the disease. The average lifespan after onset of the disease is 10 to 20 years, and the younger the age of onset, the more rapidly the disease progresses.

Although symptoms vary with individuals, the Huntington's Disease Society of America recog-

nizes the following symptoms: Behavioral/emotional . Irritability . Depression . Anxiety . Aggressive outbursts . Mood swings . Social withdrawal Motor . Fidgety behavior . Uncoordination . Involuntary movements (chorea, dystonia) . Difficulties with speech, swallowing, balance, walking Cognitive . Problems with short-term memory, organizing, coping, concentrating Pikeville neurologist Naveed Ahmed noted that patients with the juvenile form of Huntington's disease

Head injuries DR. BILL WEBB During this time of year of warm weather, kids will be exploring more of the outdoor activities. Biking, ATV riding and playing in playgrounds are all popular activities.

Parents need to be more aware of the potential of head injuries.

Traumatic brain injury is a leading cause of childhood mortality. Head trauma, in children is responsible for over seven thousand deaths, sixty thousand hospitalizations and over six hundred thousand E.R. visits annually.

All types of head injury can be caused by trauma. With children, falls are the most common cause of trauma followed by recreational activities as stated above.

There are several types of

head injury parents should be aware of.

Minor blunt head injury symptoms may include headaches, blurred vision and nausea. Severe blunt head trauma could mean loss of consciousness, seizures and paralysis. The victim may experience trouble speaking, walking or understanding, or experience neurological deficits.

The most severe head trauma can include a penetrating trauma. Symptoms can be minor or severe but the results may be life threatening. Death could be the result from severe head trauma.

Parents should monitor their children after a fall or any type of trauma to the head. While a child who falls may be alert and aware it is always better to err on the

may also have epilepsy.

Ahmed also said that even though no cure exists, "through adequate nutrition, therapy, the support of the family, life planning and medications to prevent anxiety and depression" a Huntington's disease patient can maintain a better quality of life.

You can learn more about the disease at side of caution. A child may develop a lump from a short fall off a bicycle and be completely coherent for several hours after the injury.

The E.R. doctor may go into more detail about the accident and family history. It is common for tests to be preformed and most doctors will check additional motor skills as well as basic nervous system function. It’s always better to get a thorough checkup after a head injury regardless of the severity of the trauma.

Enjoy playtime outside and use caution and follow proper safety procedures when operating machinery and equipment. It’s always a good idea to wear a helmet when riding a bicycle or other motorized vehicles.

Dr. Webb is a graduate of the Pikeville College School of Osteopathic Medicine and practices at St. Joseph Hospital in Martin and at The Wellness Center in Pikevile.

HEALTHLINE • May 2010 • Page 9

AGING

The Sandwich Generation: Taking How to Raise HDL With Supplements care of your parents and your kids Not all types of cholesterol are bad. HDL, or high density lipoprotein, is a type of cholesterol that protects the heart and removes unhealthy cholesterol, called LDL cholesterol. According to the Mayo Clinic, the higher a person's HDL cholesterol is, the lower their unhealthy cholesterol usually isl. The recommendation for reducing the risk of heart disease is 60 mg/dl and above. Increasing HDL cholesterol levels can be done simply by adding in a few healthy supplements.

Tips for Being a Caregiver Michele Borboa, MS If your daily agenda includes taking care of an ailing parent while managing your own household and raising your kids, you are part of the sandwich generation, meaning you are sandwiched in between the needs of your parent and the needs of your spouse and kids. It also means you are probably stretched to your limits. Being a caregiver for your parent and being a parent yourself significantly increases the demands on your time, energy, health, and finances. It can also put a strain on your marriage and relationship with your kids. Fortunately, there are senior caregiving options that can lighten your load and take exceptional care of your parent. Keep reading to learn how to approach your parent about geriatric care and tips for taking care of yourself while being a caregiver.

STEPPING INTO THE CAREGIVER ROLE Most Americans will be caregivers at some point during their lives. In fact, informal caregivers, mostly women, provide 80 percent of the long-term care in the United States. Many caregivers have a family of their own, including children, as well as jobs that are necessary to support their family. The term “sandwich generation” is quite fitting – caregivers are stuck between the needs of their parents and the needs of their nuclear family. It can be exhausting.

“Caring for my mom is stressful, sad and very upsetting,” says Debbie Walden, age 42.

Walden is a mom of two and executive recruiter who is balancing family, caring for her 75 year old mom with Alzheimers, and a full time job.

“The first sign of my mother’s cognitive decline was about 11/2 years ago when we noticed that there were some unpaid bills and some checks that went to the wrong companies,” recalls Walden. “In addition, she was having problems completing sentences. I called my older brother and said, ‘We need to do something.’

THE TOLL OF CAREGIVING When the physical or mental health of a parent (or both parents) starts to fail, it’s a natural instinct to want to come to the rescue. After all, your parents have cared for you throughout your life.

Stepping into that caregiver role, however, often puts your own physical and mental health at risk.

“Women in the sandwich generation often try to do it all,” explains Claudia Fine, LCSW, MPH, CMC, executive vice president and chief professional officer at SeniorBridge, a professional geriatric care management company.

“Juggling working, childcare, marriage and now parent care is usually too much and certainly hard to do well. Then, when you don't do it well, it leaves you with a sense of not feeling good or competent, and perhaps even guilty.”

Fine has worked in the field of eldercare for over 20 years and was a partner with the New York City-based Fine & Newcombe Associates, a pioneering firm in the private eldercare field which was acquired by SeniorBridge.

“We know these kinds of stressors contribute to mental health problems and physical problems, such as hypertension, overeating, being too busy to exercise and simply not attending to your own needs,” the eldercare specialist adds.

In addition to health problems, your marriage can suffer. The level of attention you are now giving to your parent can make your spouse and

children feel abandoned, angry and resentful, even though they love the parent in need of care.

CAREGIVING WITH OUTSIDE HELP Fine suggests that as soon as you start feeling “sandwiched” you should seek the advice of an eldercare professional – and not feel guilty about it. It can reduce a significant amount of stress for everyone involved. She explains, “A geriatric care manager looks at the entire constellation of factors that contribute to problems and stressors and considers each individual’s resources and strengths… and can link you to the right resources, and ultimately partner with you to coordinate them.”

Further, your ailing parent may be able to remain at home with professional geriatric care instead being hospitalized. According to a 2009 AARP study, 90 percent of seniors want to stay in their current home as long as possible, and those that do, actually fare better. “Evidence shows that we can better health outcomes and be more cost efficient with our health spending when we can provide chronic care for the most common conditions in the home, says Eric C. Rackow, MD, a national authority on critical care medicine.

Dr Rackow is president and chief executive officer at SeniorBridge, and chairman of the board of trustees of the Weil Institute of Critical Care Medicine, a well-recognized international center of medical and biomechanical engineering research in critical care and resuscitation medicine.

BE PROACTIVE WITH YOUR PARENT’S CARE Dr Rackow suggests that members of the sandwich generation should think proactively about aging. That means getting professional advice about what to expect with their parents' care before a crisis and need for hospitalization occurs.

Examples of being proactive include: Instead of waiting for your mother to break her hip from a fall, get a professional to conduct a home assessment.

If your parent is having memory lapses and taking more than three medications a day, consider having someone manage their medications before medication errors occur.

When you see cognitive impairment warnings signs, ensure bill pay is overseen before parents becomes victims of financial abuse.

Be aware that as we age we are more susceptible to depression. Support your parents' social activities and make sure they don't become isolated.

“These are the types of services a professional geriatric care management company provides,” the critical care expert adds.

Another way to be proactive is to encourage your parents to take care of their health (and you do the same).

“Clearly it all starts with prevention,” says Dr Rackow. “If people learn how to eat right, exercise, and lead healthy lifestyles, they will be less apt to have chronic illnesses like obesity, diabetes and pulmonary disease.”

APPROACHING YOUR ILL PARENT ABOUT GERIATRIC CARE Even though you are an adult, your mom and dad still see you as their child. Telling them that they need geriatric help can lead to a power struggle and hurt feelings.

Fine says that despite it being hard news to deliver, there are a few effective ways to approach your ailing parent about outside senior care.

1. Put them in the driver's seat. Position the help that

you are introducing in as someone your parent will manage - that they are employing - even if this might not be the case.

Language like "Mom, I'm going to give you a consultant to help you organize the papers piled up in the house" is the kind of message you want to convey as opposed to "you need help."

2. Let them parent you.

Explain to your parents that this kind of help is as much for you as it is for them. Tell them you need to know they are safe in order for you to have peace of mind.

3. Bring in the experts.

Ultimately these approaches may not work and you will need to back away. Consider asking a doctor, lawyer, or financial advisor to recommend or even prescribe that your parent hire a geriatric care manager.

You can approach your parent alone or do it with a sibling or another close loved one – just don’t make it seem that you are “ganging up” on your parent. You may find that your parent is more receptive and that finding care for your parent with another loved one can give you the support that you personally need. Walden teamed up with her brother to care for her ailing mother. “My brother and I are close; the experience of caring for my mom has strengthened our family relationship,” she says. “We found out that we are team players and are giving mom the care she needs now after all the years she took care of us.”

TAKE CARE OF YOURSELF According to WomensHealth.gov, the federal government source for women’s health information, about 75 percent of caregivers who report feeling very strained emotionally, physically, or financially are women. Walden suggests making the time for selfcare, something that has helped her successfully manage her mother’s care, keep her family together, and continue on in her career. “Make time for yourself every day – make it a priority to schedule an hour a day for yourself,” she stresses. “Even if it’s 9pm, I walk outside or go on the treadmill.”

Walden also recommends spending time with friends outside of family, such as a girl’s night out (even if it is only once in a while), and staying proactive about communicating needs to family members. “My kids know that Grandma has memory problems and needs extra help, so if I miss a game because I have to go down to Grandma's, they understand and do not blame me,” she adds.

Dr Rackow can’t emphasize enough that geriatric care management is a crucial step in making sure that everyone involved gets the best care possible. “We don't realize what kind of impact the stress of being responsible for a parent can have on us - and caregiver stress can negatively impact your health,” he explains. “That's why it is important to share the responsibilities and perhaps seek professional help.”

Step 1 Talk to your doctor about the safety of taking niacin and omega 3 fatty acids as well as what doses he recommends.

These two supplements have been found effective in increasing HDL cholesterol levels, but they also have side effects and risks. For example, the Mayo Clinic states that niacin supplements can cause nausea. If your doctor feels that the benefits outweigh the risks of these supplements, then he can tell you what dose to take.

Step 2 Find a slow-release niacin supplement to reduce the risk

of side effects. Niacin is a B vitamin that is normally used by the body to turn carbohydrates into energy. It is available in many foods, but in higher doses in supplements.

The Mayo Clinic states that taking niacin regularly can help to significantly increase HDL levels, from 15 to 35 percent more. Taking a slowrelease niacin decreases the dosage received at once, meaning you have less chance of flushing, nausea or other side effects.

Step 3 Purchase an omega 3 fatty acid supplement that contains EPA and DHA. The University of Maryland Medical Center states that omega 3 fatty acids, found in fish oil or other capsules, can improve HDL levels when

taken regularly. EPA and DHA are two types of fatty acids and because both are healthy, choosing a supplement with both is best. Look for supplements with USP, or United States Pharmacopoeia symbol on the label, as this signifies it has been tested for accuracy of product ingredients and amounts.

Step 4 Eat a healthy, low-fat diet to improve the effectiveness of these supplements.

Supplements can help to boost HDL levels, but eating unsaturated fats such as olive oil, avocados and fish along with taking supplements can do even more. Try replacing butter with olive oil and eating fish instead of beef. source: www.livestrong.com

Avoiding high blood pressure High blood pressure, also called hypertension, occurs when the blood that is being pumped by your heart travels through your arteries at a higher pressure than it should.

Hypertension usually has no symptoms, but can lead to serious illnesses, such as stroke, heart disease, heart attack and kidney disease.

You can generally prevent hypertension and lower blood pressure readings by taking steps toward a healthier lifestyle.

• See your doctor regularly.

Have your blood pressure checked to see if you have hypertension, pre-hypertension or a healthy blood pressure reading. If you have high blood pressure, ask how often you should visit your doctor to best keep your condition under control.

• Quit smoking, if you currently smoke, and don't start smoking if you don't already.

The National Heart, Lung and Blood Institute (NHLBI) states that smoking can cause hardening of the arteries, which leads to high blood pressure.

• Lose weight if you are overweight or obese. If you carry your extra weight around your waistline, you

are at an increased risk of developing hypertension.

According to The Mayo Clinic, losing even a small amount of weight, such as 10 lbs., can lower your blood pressure.

• Cut back on sodium in your diet. To avoid hypertension, consume less than 2,300mg of sodium per day.

If you currently have high blood pressure, cut back to 1,500mg per day.

• Eat mostly fruits, vegetables, whole grains and reduced-fat dairy products.

Avoid foods that are high in saturated fat, trans fats and cholesterol. This is called the DASH diet, which stands for Dietary Approaches to Stop Hypertension. Ask your doctor for more information, or

see Resources.

• Limit the amount of alcohol that your drink.

Drinking up to two alcoholic beverages for men, and one alcoholic beverage for women, per day may protect against heart attacks and high blood pressure. More than that, however, can raise your blood pressure. The Mayo Clinic recommends tapering off slowly if you drink heavily, because stopping suddenly can cause or worsen hypertension for a few days as your body adjusts.

• Reduce the stress in your life. Think about how you can eliminate the things in your life that make you anxious. If this is impossible, consider learning healthy coping skills to handle stress, such as talking to a friend, meditation or getting a massage.

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About Norton Cancer Institute Proceeds from The Ride to Conquer Cancer will help cancer patients through Norton Cancer Institute, the leading provider of cancer care in the Louisville and Southern Indiana region. Our goal is to ensure that we help individuals and families in our region conquer cancer by offering the programs, services and advanced care our entire community deserves.

Page 10 • May 2010 • HEALTHLINE