Image Magazine's Health Watch - 2020 Edition by Mountain View Publishing

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FALL 2020

image/health watch

healthwatch IMAGE MAGAZINEâ&#x20AC;&#x2122;S

lifestyle, fitness & nutrition

FALL 2020

HEART HEALTH STARTS YOUNG TEACH YOUR CHILDREN WELL

TELEHEALTH AT DARTMOUTHHITCHCOCK

HOW PETS IMPROVE WELL-BEING SUPPORT YOUR GUT HEALTHY GUT, HEALTHY LIFE

NEW WAYS TO SERVE PATIENTS

Experience a Place The All-New Sunapee Cove Memory Care Neighborhood is Here! You Can Call Home

We Bring Memories to Life.

Schedule a virtual tour of our community including new memory care apartments!

Call today: 603-763-0566 1250 Route 11, Sunapee, NH 03782 SunapeeCove.com

Call 603-763-0566 for a private tour

I would like to thank my patients for their conďŹ dence in me and the overwhelming community response to my New London "Zeiss" Center of Excellence. We will continue to ensure patients have acc access to state of the art diagnostics and care in the Upper Valley and will be linking our image center to our Boston aďŹ&#x192;liates. I am committed to making sure patients get exceptional care close to home.

Dr. Dorothy L. Hitchmoth, PLLC

CONTENTS FEATURES

DEPARTMENTS

20 THE SOCIAL VALUE OF

14 Word on Health

62 Financial Well-Being

News, tips, and information for your well-being.

Investing and planning in a post-COVID world. by Fred Wainwright, Ledyard Financial Advisors

SENIOR LIVING COMMUNITIES COVID-19 has made personal connections more important than ever. by Cindy Jerome, Executive Director of APD Lifecare

TELEMEDICINE AT DARTMOUTH-HITCHCOCK HEALTH Health care teams are saving lives. by Katherine P. Cox

40 ENCOURAGE HEARTHEALTHY HABITS IN KIDS It’s never too soon to support cardiovascular health. by Mary Gow

48 GUT FEELINGS A healthy gut means a healthy life. by Nancy Fontaine; Amy Tuller, RD, LD, CDE; and Lindsay Smith, Co-op Food Stores

70 BACKCOUNTRY BASICS How to handle emergencies when you’re miles from civilization. by Lisa Ballard

“When the heart is at ease, the body is healthy.”

– Chinese proverb

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18 The Good Life 5 things to do for a better day. by E. Senteio

24 Healthy Habits 5 things to do for better sleep. by E. Senteio

65 Healthy Solutions Helping patients from rehab to wellness. by Maura King Scully

68 Financial Health

34 Best Friends Life is better with a pet. by E. Senteio

Be prepared for the future. by Mike Morin

76 Daily Living

37 Living Well Don’t suffer in silence. by Pamela Brown

58 The Right Balance

Navigating slips, trips, and falls. by Susan Nye

80 Advertisers Index

Dynamic Natural Athletes Wellness Center.

46 Healthy Choices

Throughout the Valley A guide to goods and services in the community.

health watch IMAGE MAGAZINE’S

FALL 2020

lifestyle, fitness & nutrition

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Bob Frisch Cheryl Frisch Executive Editor

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KEEP US POSTED: health watch magazine wants to hear from readers. Correspondence may be addressed to: Letters to the Editor, health watch, 135 Lyme Road, Hanover, NH 03755. Or email us at: dthompson@mount ainviewpublishing.com. Advertising inquiries may be made by email to rcfrisch1@comcast. net. health watch is published annually by Mountain View Publishing, LLC© 2020. All rights reserved. Reproduction in whole or part is strictly prohibited. health watch magazine accepts no responsibility for unsolicited manuscripts, artwork, or photographs.

e d i to r ’s n o te |

BY DEBORAH THOMPSON

To Your Health!

photo by ian r aymond

nce again, we’re bringing you the latest information on a range of topics from the area’s top health experts. From preventing slips and falls to helping our children establish good habits, you’ll find a slew of valuable tips within these pages. All of us have had to make changes to our usual routines since the coronavirus outbreak, and health care facilities are no exception. Find out how DartmouthHitchcock has modified patient care during this period in ways that have been so successful that some programs and platforms will continue, even after things get back to “normal” (page 26). Increased access, efficiency, and teamwork are always good things! The human digestive system is complex, and our feature on gut health outlines how a diet with plenty

of fruits, vegetables, fiber, probiotics, and prebiotics support a healthy gut microbiome (page 48). Every aspect of our health depends on it. The rest of the staff and I appreciate the many health care workers in the area and thank them for always being there when we need them. We’re also grateful for the people who took time to contribute to this issue in order to enlighten us on achieving better health. Enjoy!

Deborah Thompson Executive Editor dthompson@mountainviewpublishing.com

like us www.mountainviewpublishing.com/facebook

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word on health N E W S , T I P S , A N D I N F O R M AT I O N F O R YO U R W E L L - B E I N G

Fall for Seasonal Produce Throughout the autumn months, mix up your diet with the best produce fall has to offer. Enjoy cranberries, beets, pears, apples, sweet potatoes, brussels sprouts, pomegranates, and the wide variety of squash available while they’re at their peak of freshness and flavor.

MORE REASONS TO GET FIT Getting fit in middle age may lead to a healthier brain and heart when you’re in your senior years. A study of nearly 18,000 people finds that the most fit were 16 percent less likely to develop depression and 56 percent less likely to die from heart disease if they developed depression. They were also 61 percent less likely to die from heart disease if they remained free of depression. “There is a well-known connection between depression and cardiovascular disease,” reports lead researcher Dr. Benjamin Willis. Fitness can reduce the risks of both depression and heart disease, even over long periods of time. But only 50 percent of Americans meet the minimum guidelines for physical activity—150 minutes a week. The good news? The benefits of exercise kick in regardless of your age when you start. “It’s never too late to get off the couch,” Dr. Willis says.

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word on health Did You Know? Magnesium is important for many processes in the body, including regulating muscle and nerve function, blood sugar levels, and blood pressure and producing protein, bone, and DNA. Foods that are rich in magnesium include almonds, cashews, and peanuts; spinach and other leafy greens; black beans and edamame; avocados; potatoes; and rice.

Fight Pain with a Good Attitude A recent study finds that optimism may be key to coping with chronic pain. A positive outlook was linked to fewer bouts of back pain, joint pain, and frequent headaches among more than 21,000 veterans. “What was striking was that optimism was associated with less pain even when taking into consideration what the soldiers experienced during deployment, such

GET ON YOUR FEET!

as combat stress and trauma, as well as injury,”

If you sit for six hours a day or

says the study’s lead re-

more, your risk of dying early

searcher. And an upbeat

jumps 19 percent—even if you exercise regularly—compared with people who sit for fewer than three hours. According to the American Cancer Society, sitting too much can kill you in 14 ways,

attitude can have the same power for civilians, say the study authors. Optimistic people tend to be less sensitive to

including cancer, heart disease,

pain and are

diabetes, stroke, lung disease,

able to adjust

digestive disease, Parkinson’s

to pain better

disease, and Alzheimer’s. The

than pessimis-

takeaway is simple: we should all

tic people.

be moving more, and the less sitting we do, the better it is for us. Enjoy our area’s walking, hiking, and biking trails or take a stroll downtown. Just get off the couch and enjoy all our beautiful area has to offer!

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We Get It!

CLEAN YOUR MEDICINE CABINET Do you have small children or grandchildren in the house? It’s critical to clean out your medicine cabinet and lock up any drugs. According to Consumer Reports, only one in five Americans locks up prescription drugs, and about 60,000 preschoolers are rushed to hospitals each year after accidentally swallowing medicine, whether prescription or overthe-counter. Prescription drugs like sedatives and painkillers aren’t the only drugs that can potentially cause harm. Acetaminophen, which is found in Tylenol and hundreds of other products, is the most commonly accidentally ingested over-the-counter drug. A child who takes too much can develop liver damage or even liver failure. To avoid any mishaps, Consumer Reports recommends the following: •R eturn unused medication to your pharmacy, hospital, or narcotic treatment program for disposal. If the pharmacy or hospital won’t take them, ask the local police or fire department if they accept unused medication. • Some pills can be tossed in your household trash—just hide them in coffee grounds, sawdust, or kitty litter and seal in a plastic bag. Ask your local pharmacy how to properly dispose of unwanted medicines. • Do not flush antibiotics or other drugs down the toilet. They may end up contaminating ground or drinking water.

Please call to schedule an individual tour.

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t h e g o o d life |

BY E. SENTEIO

5 THINGS TO DO FOR A BETTER DAY FOLLOW THESE EASY TIPS EVERY MORNING WHEN YOU RISE IN THE MORNING, so do adrenaline and stress hormones, increasing your heart rate and blood pressure—a perfect storm for anxiety and stress to take hold. But your thoughts and actions can make all the difference. These five tips can literally and figuratively brighten your day.

1. Stop. Before jumping out of bed and letting your mind gallop to your to-do list, lie still and take a deep breath. Welcome and be thankful for a new day. You’ve never had this one before. Shift your thoughts away from the mountain of responsibilities and expectations or the monotony of daily tasks. Be grateful you are strong, capable, alive, and able to do them. It might not be your dream job, or your “best” life, or your perfect family, but it is an opportunity to embrace possibility and enact change. Carpe diem with joy and gratitude.

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4. Start the day off right.

2. Open your curtains as soon as you wake up.

Wake up to the scent of citrus: lemons, grapefruit, oranges—like positivity—increase serotonin levels and lift your spirits. Use an aromatherapy diffuser or candle while repeating your morning affirmation and going about your daily routine. Peppermint and rosemary also rev up your brain, stimulating you mentally and physically, so you are ready to embrace the new day.

While you should avoid blue light at night, seek it out first thing in the morning, and the sun is the greatest source. Blue light blocks sleep-inducing melatonin, waking you up and making you feel energized. Before looking for a jolt of caffeine, bask a bit in the early morning sunshine. Pop outside on your lawn or patio and say, “Good morning, world!”

5. Enjoy silence or a song. 3. Don’t underestimate positivity. Replacing negative or neutral thoughts with positive ones increases the production of serotonin, the happy hormone. Hang a poster, quote, or affirmation in your bathroom where you can’t miss it every morning. Keep it simple but meaningful to you. Say it out loud in the mirror. Repeat. This exercises your positivity “muscle,” rewiring your brain to keep negativity at bay. In just a few days, you should notice a difference.

Set the tone for the day on your commute to work or the start of your work-at-home day. Meditate to set your intention for the day; embrace the stillness within you as traffic surrounds you. Or float on the notes of a sound bath, chant, or new-age tune. Or get your heart pumping and mind psyched by blasting music, but not just a random playlist. Find your theme song; let it be what you need at that moment. 

Bonus Weekend Tip Cut out the stress of indecision and hectic preparation. Most people wear the same outfits repeatedly. Use that to your advantage. On the weekend, choose five outfits plus one extra, iron, and organize them in your closet ready to grab and wear each morning.

HAVING A POSITIVE OUTLOOK ENABLES YOU TO COPE BETTER WITH STRESSFUL SITUATIONS, WHICH REDUCES THE HARMFUL EFFECTS OF STRESS ON YOUR BODY.

www.uppervalleyimage.com •

BY CINDY JEROME, EXECUTIVE DIRECTOR OF APD LIFECARE

THE SOCIAL VALUE OF

SENIOR LIVING COMMUNITIES COVID-19 has made personal connections more important than ever

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A senior living community is a home where you can make new friends and bring your own furry friend with you.

www.uppervalleyimage.com â&#x20AC;˘

eing part of any type of social community can offer support in difficult times, but during the COVID-19 pandemic, senior living communities across the country have been able to provide a venue for those essential social connections that are a crucial element of wellness for seniors. Being around other people, especially peers, can help seniors stay intellectually and emotionally engaged, while access to socialization enhances their sense of well-being. Social connections are also critical to helping seniors avoid the inevitable negative effects of social isolation, including anxiety, depression, and immunosuppression. CHALLENGING CHANGES During the State of New Hampshire’s Stay at Home order, the residents of the two senior living communities I oversee as executive director of APD Lifecare were, like all Americans, struggling to adjust to a new way of life defined by social distancing restrictions, both indoors and out; masks and hand sanitizer; telemedicine appointments; and no more face-to-face contact with family. In the early days of the pandemic, residents at the Woodlands, our independent living community, and Harvest Hill, our community for independent living, assisted living, and memory care, were in the same situation as residents of senior living communities across the United States: confined almost entirely to their apartments. Our activities were cancelled, our dining rooms closed, and in-person visits from loved ones were no longer permitted. But as residents in communities everywhere acclimated to these lifestyle changes, staff members were working tirelessly to keep them engaged, whether that meant stopping by for a chat during meal deliveries, dropping off residents’ prescriptions and grocery orders, visiting residents’ apartments for frequent wellness checks, and coming 22 i m a g e h e a l t h w a t c h •

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by to administer medication. For most communities, these changes were challenging, both physically and emotionally. The reality is that, in these perilous times, even while residents of senior living communities like ours were unable to attend social activities or enjoy communal meals, they were still far better off than those living alone at home with no social contact. THE MANY BENEFITS OF SOCIAL INTERACTION Typically, when seniors who live alone join our communities, their mood and activity level improve. This can have a positive impact on cognition. In many cases, new residents are coming from home isolation, where a home health aide or a relative dropping off groceries might be their only visitor for days. When formerly homebound residents move to a senior living community, it is a big change—now they are walking around more, coming down for meals, interacting with their peers, and taking part in stimulating activities that engage and exercise their minds, bodies, and social selves. My colleagues and I have always known that social interaction was extremely important for our residents, but the pandemic has set this fact in stark relief. A great deal of research in geriatric cognition has found that increased social interaction not only improves mood, but also positively impacts cognitive processing. Scientists who study how to prevent or forestall the development of Alzheimer’s disease have come to understand that socialization, along with healthy eating and physical exercise, is essential in combating cognitive decline.

From left: These days, many communities offer socially distanced activities that can be enjoyed with fellow residents, such as lawn games, bingo, fitness classes, and tai chi. Senior living residents value living in a community that provides constant access to support from caring staff. For older adults, frequent peer interaction and close friendships are life-enhancing.

One of the most important kinds of social interaction, scientists have found, is having two or three close friends with whom you maintain regular contact. In addition, face-to-face contact is more powerful than phone calls or Skyping. This is particularly true for seniors with hearing loss or poor vision. In senior living communities, we see the importance of such peer interaction play out firsthand. Sitting in a living room with a couple of friends every afternoon and sharing stories and feelings, thoughts and struggles, as well as a few laughs, has significant value. Although family is important, there is something about spending time with people in the same boat as you, who you can talk to in a way you might not with your children or spouse, that has special power. And it’s not something that seniors can often get living alone. STAYING CONNECTED As COVID cases in Grafton County remain low and restrictions continue to ease, many communities are resuming some regular activities and adding modified ones—in our case, this means hallway bingo and socially distanced outdoor meetings and tai chi classes. We have reopened our dining rooms with

Cindy Jerome is the executive director of APD Lifecare, the Woodlands, and Harvest Hill in Lebanon, New Hampshire. She has an MA in Counseling Psychology and more than 20 years of experience managing senior living communities in New Hampshire and Vermont.

limited seating, and as the weather permits, we are encouraging socially distanced outdoor visits as well as single-person indoor visits. During this pandemic, it has become clearer than ever that peer interaction and social connectedness are one of the greatest benefits for older adults who choose to live in senior living communities. And for all of us, the disruptive events of the last several months have proven something else: that being part of a community has never been more important.  www.uppervalleyimage.com •

h e alt hy h a b its |

BY E. SENTEIO

5 THINGS TO DO FOR BETTER SLEEP FOLLOW THESE EASY TIPS EVERY NIGHT

SLEEP IS AN AFTERTHOUGHT: after the job, after errands, after the family, the pets, the television, and the daily rigmarole. However, a good night’s sleep is vital to a healthy, happy lifestyle. These five tips will improve not only your quality of sleep but also the quality of your life.

1. Not So Sweet Dreams A good night’s sleep begins before you go to bed. You already know to avoid spicy foods, but sugarladen desserts and drinks are also problematic. Sugar signals to your body it is time to be active. Conversely, tryptophan—found in beans, nuts, and whole grains— helps in the production of serotonin and melatonin, which supports sleep. Everyone’s metabolism is different, but the general recommendation is no food or drinks at least two, preferably three, hours before bedtime.

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2. Bask in the Glow

4. Make a List

During the day, expose yourself to as much sunlight as possible—open blinds, go outside at lunchtime, sit by a window, walk the dog (bonus: even 10 minutes of exercise will improve sleep). One study showed that individuals who were exposed to high levels of light throughout the day not only fell asleep more quickly but also experienced less depression, reduced stress, and fewer sleep disturbances. But don’t forget the sunscreen.

Every evening create a list with no more than three “must-do” items for the next day. Choose personal (not job-related) tasks that, once completed, will give you a sense of accomplishment. It can be making a dentist appointment or returning an item to the store. Create the list while waiting for a meeting to start or during commercials. You will sleep better knowing you have a plan of attack for the next day.

3. No Blue Light

5. Breathe, Just Breathe

Blue light radiates from smartphones, laptops, televisions, lightbulbs, and other electronic devices. While offering several daytime benefits, after sunset blue light exposure leads to diminished sleep quality, suppressing melatonin production and altering the body’s circadian rhythms, which can lead to diabetes, heart disease, and obesity. Researchers advise shutting off all electronics two to three hours before bedtime, something most people will not even think about. Consider this: your smartphone and laptop may already have a “night shift” feature that automatically adjusts screen brightness and blue light. If not, download a filter app or buy a pair of blue light blocking glasses.

It’s simple to say that when you go to bed, you should relax. Yet your mind churns through what happened earlier or what’s happening tomorrow. Take a deep breath, fill your lungs, hold it. Know at that moment you are safe; nothing is happening except you are going to sleep. Breathe. Focus on every breath: feel your stomach and chest rise. Breathe out, feel your body deflate, releasing all the tension you’ve been holding inside. Continue along the journey of your breath, in and out, in and out. Repeat. Soon you will find it has led you into a deep and restful sleep. 

Bonus Weekend Tip Change your sheets and plump your pillows. Spritz them with lavender or whatever scent you find relaxing. Clean and comfortable sheets not only help you sleep better, but they may also foster romance.

www.uppervalleyimage.com •

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BY KATHERINE P. COX

TELEMEDICINE A T D A R T M O U T H - H I T C H C O C K H E A LT H

Dr. Julianne Mann, pediatric dermatologist at Dartmouth-Hitchcock. Photo courtesy of DartmouthHitchcock.

H E A LT H C A R E T E A M S A R E S A V I N G L I V E S

s February faded into March, the no-shows and cancellations increased rapidly as anxiety about COVID-19 grew. Dr. Julianne Mann, a pediatric dermatologist at Dartmouth-Hitchcock, and her team realized that outpatient clinics would likely close soon and quickly converted all of their appointments over to telehealth visits. Until then, Dr. Mann had never practiced telemedicine. “Within a week I was doing 20 to 30 visits a day and my patients were extremely grateful. They felt much better about being able to stay in the safety of their own home and not have to travel long distances. By late April I was doing close to 100 visits a week, all virtually,” she says. “I was a bit of a skeptic about telemedicine before this, but I’m a convert now. I’ve loved it.”

www.uppervalleyimage.com •

“We have trained physicians and nurses at our hub at Dartmouth-Hitchcock 24/7 and they provide remote collaboration and consultation to a bedside team in emergency departments in small rural hospitals across our region. They can push a button and get support from the hub team and specialists not only helping clinically but also helping them get the patient to Dartmouth-Hitchcock or another appropriate center for care, if needed,” says Mary.

Mary Oseid, senior vice president for regional strategy and operations. Photo courtesy of Dartmouth-Hitchcock.

PATIENTS IN RURAL AREAS ABOUT 20% OF AMERICANS LIVE IN RURAL AREAS WITHOUT EASY ACCESS TO PRIMARY CARE OR SPECIALIST MEDICAL SERVICES.11

PATIENTS IN RURAL

AREAS HAVE LIMITED ACCESS TO MEDICAL SPECIALISTS; ON AVERAGE, THERE ARE ONLY 40 SPECIALISTS SERVING A 100,000 RURAL POPULATION. 16

ONLY ABOUT

1 IN 10 PHYSICIANS PRACTICE

IN RURAL AREAS IN THE US.16

44.3% OF HEALTH CARE SYSTEM RESPONDENTS SAID THAT PATIENT CARE GAPS DUE TO COMMUNITY REMOTENESS WERE THE MAIN REASON FOR ADOPTING TELEMEDICINE. IN ONE SURVEY,

PROVIDING CARE IN A PANDEMIC Virtual patient visits are among the many telehealth services Dartmouth-Hitchcock provides to its partner facilities. TeleEmergency, TeleICN, TeleICU, TeleNeurology, TelePharmacy, and TelePsychiatry services are all run from the TeleHub at Dartmouth-Hitchcock Medical Center in Lebanon. “The one that’s most talked about coming out of COVID is patient virtual visits,” says Mary Oseid, senior vice president for regional strategy and operations. “Pre-COVID, patients would come in to see their doctors, whether primary care or specialist. We have been working for a long time to develop our systems and processes so that we could eliminate that visit to the office and provide the visit to the patient by video. Pre-COVID we were doing a handful of virtual visits across our system. At the height of it, we were doing 2,500 visits a day. In August, we were running about 1,000 a day,” she says. “Patients are very pleased and report that they would do it again.” Physicians are pleased too. “With children, it’s really nice to have a [virtual] visit where we don’t have to wear masks. They can see my face and I can establish a rapport with them,” says Dr. Mann. “Meeting a patient with a face shield and mask is hard to create that connection. I’ve found that having a face-to-face, uncovered virtual interaction is really nice. It’s less intimidating for the kids but for the parents as well. They can see all my facial expressions.” Post-COVID she sees this continuing. “Some of my patients come from very far away and for things that a physical exam is not vital, I intend to use telehealth. My patients love it and I enjoy it as well. I will absolutely continue to use this platform.”

Source: https://blog.evisit.com/virtual-care-blog/36-telemedicine-statistics-know 11: The Promise of Telehealth For Hospitals, Health Systems and Their Communities,TrendWatch, January 2015. 14: http://www.fiercehealthit.com/story/himss-analytics-most-providers-adopttelemedicine-close-patient-care-gaps/2014-08-14. 16: http://www.ruralhealthweb.org/go/left/ about-rural-health/what-s-different-about-rural-health-care.

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BETTER COLLABORATION MEANS BETTER CARE In many cases, telehealth can be a lifesaver, particularly in remote communities with smaller hospitals that may

Dartmouth-Hitchcock provider-toprovider Connected Care Center for Telehealth serves hospitals in New Hampshire, Vermont, Maine, and New York. Some are constantly hardwired with a monitor, camera, and microphone in their emergency and intensive care units 24/7, 365 days a year.

“TeleEmergency was designed in a way that feels like an extra ED doctor and nurse walked into a local emergency room,” explains Dr. Curtis.

not have the staffing or expertise for some cases. “COVID changed the outpatient virtual visits, but we’ve had a robust program in ICU, neurology, emergency, psychiatry, and TelePharmacy for quite some time,” Mary says. In TeleEmergency, for example, “we have trained physicians and nurses at our hub at Dartmouth-Hitchcock 24/7 and they provide remote collaboration and consultation to a bedside team in emergency departments in small rural hospitals across our region. They can push a button and get support from the hub team and specialists not only helping clinically but also helping them get the patient to Dartmouth-Hitchcock or another appropriate center for care, if needed,” she says. “We do the same thing with our ICU physicians and nurses who support smaller ICUs in more rural communities. We have critical care experts supporting those bedside teams, monitoring, and providing consultation. We do quite a bit of that in neurology and psychiatry too.” With the push of a button, a team at one of the remote hospitals can connect with trained specialists at the hub in Lebanon and get the level of support they may need. Dr. Kevin Curtis, medical director of Connected Care and the Center for Telehealth, is also an emergency department doctor who works in the TeleED hub. “TeleEmergency was designed in a way that feels like an extra ED doctor and nurse walked into a local emergency room,” he explains. In the hub at DHMC, there are three tables each with

Dr. Kevin Curtis, medical director of Connected Care and the Center for Telehealth, is also an emergency department doctor who works in the TeleED hub. Photo courtesy of DartmouthHitchcock.

www.uppervalleyimage.com •

Left: Corey Siegel, MD, conducts an outpatient virtual visit with a patient. Photo courtesy of DartmouthHitchcock. Bottom left: Stephen Surgenor, MD, and Mariel Day, RN, work in the TeleICU hub at Dartmouth-Hitchcock Medical Center. Photo courtesy of Dartmouth-Hitchcock. Bottom right: A family doctor consults with a patient over a video conference.

TELEMED

TELEICU “We embed ourselves with the bedside,” Dr. Curtis says. Often, “we’re a second set of eyes. These local teams are outstanding but with fewer resources. We work as a team.”

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VIRTUAL VISIT

multiple computer screens, a monitor, a camera, a microphone, and a regular telephone. “We serve 11 hospitals in New Hampshire, Vermont, and Maine. Each of those hospitals has two rooms wired for TeleED and are constantly hardwired with a monitor, camera, and microphone 24/7, 365 days a year,” he says. When the ED team wants support from the hub at D-H, they press a dedicated button on the wall. At the hub, a team, consisting of an emergency trained nurse and doctor, responds with “How can we help?” The hospital identifies itself and the hub activates the live interactive audiovisual system. Depending on what’s needed, the medical team at D-H offers collaboration, advice, recommendations, documentation, and monitoring, and, if needed, coordination of transfer and transport to another facility. “We embed ourselves with the bedside,” Dr. Curtis says. “They usually involve us for the sickest or most injured patients, such as cardiac problems, trauma, respiratory distress, or neurological problems.” Often, “we’re a second set of eyes. These local teams are outstanding but with fewer resources. We work as a team.”

Connecting expertise to distant sites via telemedicine improves quality of care and patient outcomes, lowers costs for patients and systems, and improves patient and provider satisfaction. Photo courtesy of DartmouthHitchcock.

HOW PATIENTS FEEL ABOUT TELEMEDICINE ABOUT 74% OF PATIENTS IN THE US WOULD USE TELEHEALTH SERVICES.9

MOST PATIENTS ARE COMFORTABLE WITH HAVING ALL OF THEIR HEALTH RECORDS SECURELY AVAILABLE ON THE CLOUD.10

TeleED allows people to get care locally, but if a transfer is needed, “we can take all that work off the bedside team’s shoulders,” Dr. Curtis says. Sometimes weather can be a factor in the winter and it might be two or three hours before the patient can be transported. “We can assume care so the local team can move on to other patients.” Likewise, if one of the rural hospitals experiences a surge of incoming patients, “we can help. In these situations, the greatest benefit is that after we all work together to get a patient initially stabilized, we can continue to oversee the patient’s management so the local ED team can attend to other patients that just came in.” The D-H team has done more than 2,000 calls so far and “we hear that it’s highly appreciated by the local bedside teams. We get high marks on surveys on how we’re able to work together and be helpful,” Dr. Curtis says. EXTENDING CRITICAL-CARE STAFF AND SPECIALISTS In addition to clinical support and documentation, if the patient needs to be transferred, the emergency team at the hub begins arranging transport so the bedside team doesn’t need to leave the patient. “We send patients where we think it’s most appropriate for them to go, but when they do come to Dartmouth-Hitchcock Medical Center, it goes smoothly because there’s a nice transition of care between our teleteam and the bricks-and-mortar team in the ED,” Mary says. “The benefits are enormous for small rural hospitals that may not see a lot of trauma or get major illnesses. So the opportunity to call in an expert and have them help them with patients is incredible. It’s an opportunity for us to extend the team who’s helping to save lives in really critical situations.”

ABOUT 74% OF PATIENTS ARE COMFORTABLE WITH COMMUNICATING WITH THEIR DOCTORS USING TECHNOLOGY INSTEAD OF SEEING THEM IN PERSON.10

ABOUT 76% OF PATIENTS CARE MORE ABOUT ACCESS TO HEALTH CARE THAN THE NEED FOR HUMAN INTERACTIONS WITH THEIR HEALTH CARE PROVIDERS.11

ONLY 16% OF PATIENTS WOULD PREFER TO GO TO THE EMERGENCY ROOM FOR A MINOR AILMENT IF THEY ALSO COULD ACCESS TELEMEDICINE SERVICES.12

ABOUT 67% OF PATIENTS SAID THAT USING TELEMEDICINE SOMEWHAT OR SIGNIFICANTLY INCREASES THEIR SATISFACTION WITH MEDICAL CARE.12

ABOUT 30% OF PATIENTS ALREADY USE COMPUTERS OR MOBILE DEVICES TO CHECK THEIR MEDICAL OR DIAGNOSTIC INFORMATION.11 Source: https://blog.evisit.com/virtual-care-blog/36-telemedicine-statistics-know 9: http://americas.nttdata.com/Industries/Industries/Healthcare/~/media/Documents/WhitePapers/Trends-in-Telehealth-White-Paper.pdf. 10: http://newsroom.cisco.com/press-release-conten t?type=webcontent&articleId=1148539. 11: The Promise of Telehealth For Hospitals, Health Systems and Their Communities,TrendWatch, January 2015. 12: http://www.softwareadvice.com/medical/ industryview/telemedicine-report-2015/

www.uppervalleyimage.com •

ER surgery medical team collaborates with a neurosurgeon on a patient diagnosis.

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TeleICU works much the same way, Dr. Curtis says, but provides another level of care to the bedside teams in the rural hospitals. In addition to reacting to the critical care of the patient and the needs of the local ICU team on demand, the computer programs and hub team provide predictive analytics and proactive care. They can run analytics based on a patient’s vital signs and labs and can detect any deterioration in their condition often earlier than the bedside team would and alert the local team to pay extra attention. “We may pick up something before even the most experienced bedside team does,” Dr. Curtis says. The ability to have physicians and nurses 24/7 who are critical-care trained is very helpful to these rural teams, Mary says. TeleNeurology was one of the early telehealth care advances, she says. “In rural communities they don’t have neurologists available 24/7 and neurologists on staff often are seeing patients in their clinics, so they can’t run to the ED if someone comes in with a suspected stroke. With our service, they call and get a consult from a neurologist or stroke expert ensuring that they’re getting the expertise of a stroke specialist but also making sure the care is timely, which is crucial in stroke cases. Data suggests we rival stroke centers in responsiveness to strokes with the TeleNeurology service we provide.”

Dr. Curtis sees telemedicine as a way to magnify the impact on patient care. “It’s incredibly satisfying. I enjoy working with the teams and am constantly impressed with the care that they provide. We’ve helped save a fair number of lives. It’s really rewarding.” SAFE AND CONVENIENT Clearly there are many benefits to telehealth, and Dartmouth-Hitchcock is currently averaging 900 appointments a day across the system. In addition to the convenience for patients and their families who don’t have to take time off from work or school and follow the health protocols required for visits, it allows them to see their providers safely. It’s a time saver for medical staff who have to sanitize rooms between visits. It also preserves personal protective equipment (PPE) both with inpatient visits and with hub-based services. The team at the TeleICU and TeleED hubs at Dartmouth-Hitchcock Medical Center, for example, can monitor patients in real time and communicate with the patients’ local care team so they don’t have to enter patients’ rooms as frequently, suiting up and discarding PPE each time they enter and exit the room. Dr. Curtis sees telemedicine as a way to magnify the impact on patient care. “I look forward to the telephone ringing. It’s incredibly satisfying. I enjoy working with the teams and am constantly impressed with the care that they provide. We’ve helped save a fair number of lives. It’s really rewarding.” Dr. Mann agrees. “By necessity the experience of practicing medicine in a pandemic propelled me into learning how to do this. I was initially skeptical about how useful these visits would be and how much I’d enjoy them, but I was pleasantly surprised by how enjoyable the process has been. I’m grateful that Dartmouth-Hitchcock has embraced this new way of providing care. There are just a ton of possibilities for how we can take advantage of giving care in this way.” 

www.uppervalleyimage.com •

b e st f r i e n ds |

BY E. SENTEIO

LIFE IS BETTER WITH A PET BETTER MEANS LONGER, HAPPIER, AND HEALTHIER

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PEOPLE WHO DON’T HAVE PETS often claim it’s because they don’t have the time. Well, having a pet may actually give you more time. Multiple studies conclude that pets can help you live a longer, happier, healthier life. For thousands of years, animals have helped us. Elephants carried logs, oxen plowed, dogs hunted, goats trimmed pastures, cats controlled rodent populations, and birds saved the lives of miners. As the human race evolved, people realized that animals were more than beasts of burden; they were friends and family. Science has proven that animal companionship benefits us in ways we hadn’t imagined.

Never owning a feline means you are 40 percent more likely to die of a heart attack and 30 percent more likely to experience cardiovascular disease. KEEP YOUR PET ACTIVE Autumn is a great time to get outside and take your dog for a long

All Ages Benefit When raised in homes with animals, newborns develop stronger immune systems and have fewer allergies throughout their lives. With few exceptions, children in a cat household are less likely to have asthma. Teens, adults, and the elderly suffer less from depression with a pet in their lives. In a survey by the Human-Animal Bond Research Institute, 74 percent of pet owners said that having a pet improved their mental health. Caring for a pet takes us out of ourselves. If itâ&#x20AC;&#x2122;s feeding, walking, or grooming, an animal depending on you helps individuals feel needed. Almost half of older Americans experience feelings of being alone and isolated. Cigna Insurance reported that 60 percent of adults over 18 say they lack companionship and feel lonely. Loneliness and isolation are associated with poor mental and physical health, increasing the risk of anxiety and depression. Dogs help people form social connections, whether at a dog park or on a neighborhood stroll. Shy people and individuals who have nothing in common strike up conversations about their dogs.

walk. According to the Association for Pet Obesity Prevention, more than half of all dogs are overweight. And a dog that weighs too much is at greater risk for osteoarthritis, high blood pressure, orthopedic problems, ligament injuries, skin disease, heart and respiratory disease, cancer, and a lower life expectancy. Get your dog moving with plenty of walking and playing. Youâ&#x20AC;&#x2122;ll reap the benefits of regular walks as well, including increased heart health, decreased muscle pain and stiffness, stronger bones, and a boost in your energy and mood. www.uppervalleyimage.com â&#x20AC;˘

best friends

“Dogs are not our whole life, but they make our lives whole.” —Roger Caras

But pets are also good companionship: you can tell them anything, talk to them as long as you like, and they never judge or blab your secrets. According to researchers, people who live alone reap the most rewards from sharing their lives with a pet. When emotions are overwhelming, pets are sensitive to moods and the chemicals that accompany them. It’s not only the soft and cuddly creatures that bring comfort and calm, but watching fish, reptiles, or birds is also soothing. Farm animals also offer many of the same benefits as house and couch companions.

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Make a Play Date Animals also bring the fun. Have you ever watched a cat chase a laser or a dog chase its tail? Fun lowers stress levels, decreases blood pressure, and increases the “happy chemical” serotonin. Studies show that just petting a dog, cat, bunny, or horse lowers blood pressure. The mere presence of a loved pet produces physical and mental changes: suppressed stress hormones, lower cortisol levels, and increased feelings of peace and happiness. Exercising with pets offers even more benefits. Dog parents are more likely to work in daily exercise, reach their fitness goals, or lose weight. This helps or prevents chronic disease, leading to a sense of confidence and overall well-being. While dogs keep you active, cats may have more of a calming effect; both are associated with lower cholesterol and triglyceride levels. 

liv ing well |

BY PAMELA BROWN

1 in 3 people over the age of 60 have hearing loss.

According to Cindy Edmondson, the following number of people in United States have hearing loss:

1 in 14 Generation Xers 1 in 6 baby boomers 1 in 5 teenagers

DON’T SUFFER

Fortunately, 90 to 95 percent of people with hearing loss can be treated with hearing instruments.

ADDRESS HEARING LOSS SOONER, NOT LATER

IN SILENCE

Do you ever find yourself struggling to hear? Hearing is one of our most important senses that adds to the quality of our life, and experiencing even a small amount of loss can be problematic. “Hearing health contributes to overall well-being,” says Cindy Edmondson, owner of Powerhouse Hearing Center in Lebanon, New Hampshire, pointing out that hearing loss is the third most common physical condition in older Americans after hypertension and arthritis, and it affects nearly 38 million people in the United States. It’s important to address the issue because letting it go untreated can lead to further hardships. “If a person experiences hearing loss, it can impair brain function by promoting social isolation. It becomes very stressful to be around others. People stop attending functions and gatherings, or they hesitate to make a comment for fear of mishearing information and answering incorrectly,” explains Cindy. Mental issues will also emerge. “The harder the brain has to work to figure out what

Cindy Edmondson, owner Powerhouse Hearing Center

www.uppervalleyimage.com •

l i v i ng we ll Headphones and Hearing Loss About one in five teens has some degree of hearing loss, and experts think many instances could be linked to using headphones. To avoid headphone-induced hearing loss, the American Osteopathic Association suggests listening to music at less than 60 percent maximum volume and for less than 60 minutes. They also recommend using over-the-ear headphones instead of earbuds. Hissing, ringing, or buzzing in the ear are all signs that your teen should visit a doctor immediately.

it is hearing, the more it has to interpret and understand what it hears and then it is incapable of performing other cognitive skills. Memory skills are affected adversely. Information that is not clearly heard is not as easily remembered. As a result, the brain cells atrophy.” Frequent hearing tests and evaluations are just as important as eye exams to obtain a baseline audiogram for future reference and future comparisons. Cindy advises seeking the advice of a hearing professional, and if you suspect something is wrong with your hearing, do some research and find a credited, trained expert and schedule a medical

evaluation. “At Powerhouse we develop a relationship of trust with our customers. We focus on providing a better quality of life based upon the degree of hearing loss, the lifestyle of the individual, and their needs as well as preferences,” says Cindy. Following the belief that “the ear is the boss,” Powerhouse Hearing Center makes specific recommendations relative to the anatomy of the ear, including shape, depth, sensitivity, and limitations due to physical structure. “If the person with hearing loss is fit with the right hearing instrument, their life will be enhanced and enriched. Our products are no longer something that makes you feel old.”

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2020

“If the person with hearing loss is fit with the right hearing instrument, their life will be enhanced and enriched. Our products are no longer something that makes you feel old.” In fact, Powerhouse effectively treats all types of hearing loss with award-winning, state-of-the-art technological devices. “Please note that a hearing instrument is considered a medical device, not a commodity,” says Cindy. “These hearing instruments are next-generation advanced Artificial Intelligence high-technology devices. Starkey’s newest Livio Edge AI hearing instruments are Bluetooth compatible to smartphones, have GPS, and are wireless,” explains Cindy. “This means you can have a phone conversation by streaming the conversation directly to

your hearing devices; listen to music, a book, or a podcast; and even listen to a movie on your paired iPad!” In addition, “The Thrive Hearing Control app allows you to locate your hearing instruments if you misplace them and can be a Fitbit and heart monitor along with many other features.” Don’t settle for less when it comes to caring for your ears. “The future of hearing is available now,” says Cindy. “At Powerhouse, hearing is only our concern; it is all we do and we firmly believe and advocate that to hear better is to live better.” 

The Thrive Hearing Control app.

Powerhouse Hearing Center 23 PowerHouse Mall West Lebanon, NH (603) 298-9775 powerhousehearingcenter.com

www.uppervalleyimage.com •

By learning to love fruits and veggies when theyâ&#x20AC;&#x2122;re young, kids will develop food preferences that will lower their risk of obesity, diabetes, and heart disease later in life.

40 i m a g e h e a l t h w a t c h â&#x20AC;˘

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BY MARY GOW

 ENCOURAGE

HEART-HEALTHY HABITS IN KIDS it’s never too soon to support cardiovascular health

Trails trekked, jump ropes jumped, miles pedaled, soccer balls kicked, laps swum—even short spurts of aerobic exercise every day add up to improved heart health for your child. Combine with a diet rich in fruits, vegetables, and whole grains and you have the building blocks for heart health for the long haul. Research shows that children who grow up with healthy behaviors become adults with a reduced risk of heart disease.

www.uppervalleyimage.com •

Cardiovascular disease is the leading cause of death in the United States, outpacing cancer, respiratory diseases, stroke, and all the others. The US Centers for Disease Control and Prevention (CDC) tabs its annual toll in the US at over 640,000. The good news for children is that in most cases, heart disease doesn’t manifest until adulthood. The bad news is that conditions that can lead to heart disease, like obesity and diabetes, may be laid in childhood and adolescence. Fortunately, lifestyle can reduce many risk factors—and parents play a critical role in modeling and encouraging heart-healthy living. The Major Risk Factors “A child born today is 500 times more likely to die of acquired atherosclerosis [the formation of plaque on artery walls] than of congenital heart disease,” according to Dr. Michele MietusSnyder, a preventive pediatric cardiologist and assistant adjunct professor at the University of California–San Francisco. “It is very important for kids to grow up with the understanding that they are in large measure responsible for their health,” says Dr. Mietus-Snyder. That understanding can be nurtured from an early age in a family’s routines and recreation.

“It is very important for kids to grow up with the understanding that they are in large measure responsible for their health,” says Dr. Mietus-Snyder.

KIDS & SCREEN TIME There’s no doubt that unstructured playtime is more valuable for a child’s developing brain than electronic media—particularly in the early years. According to the Mayo Clinic, kids younger than age two are more likely to learn and remember information presented live than they are from a video. A recent study of 47 preschoolers found that screen time over the American Academy of Pediatrics’ recommendation (an hour a day of high-quality programming for children ages two to five) was associated with differences in brain structure in areas related to language and literacy development. As a child grows, too much screen time has also been linked

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Under the umbrella of heart disease, coronary artery disease caused by atherosclerosis is the most common, afflicting about 18.2 million American adults over age 20 in 2018, and the cause of death for more than 365,000 of them. Leading risk factors include high blood pressure, high cholesterol, smoking, excess alcohol use, diabetes, and obesity. Both diabetes and obesity have been on the rise in the United States in recent decades. In 1960, less than 1 percent of the overall US population was diagnosed with diabetes, a figure that rose to 2 percent in the 1970s and to 7.4 percent in 2015, according to the CDC. Obesity has been on a similar trajectory. Childhood obesity in the 1970s was 5 percent, 13.9 percent in 1999, and 18.5 percent in 2015–2016, as tracked by the CDC. Fortunately, exercise and diet are powerful tools in combating those conditions. Get Kids Moving Exercise has many benefits for the heart: it helps support a normal heart rate, lowers blood pressure, strengthens the heart muscle itself, and helps maintain a healthy weight. For children ages 6 to 17, the American Heart Association recommends 60 minutes of moderate to vigorous exercise daily, noting that it can be broken up into shorter sessions.

DH L I H

OOD OBESI TY

Source: www.researchomatic.com/childhood-obesity-181908.html

to obesity, irregular sleep, behavioral

watching, and how you’re interacting

time in front of screens are more likely

issues, and a lack of social skills.

with them about it.

to develop metabolic syndrome—a

Over the last several months, our

The bottom line: consider what

cluster of conditions that increases

kids have relied on electronic devices

time spent in front of screens is

for learning, communication, and

replacing. Electronic devices are

entertainment more than ever. Should

no substitute for reading together,

for your family. Be aware of what your

we worry about this increased screen

socializing, and playing outdoors.

kids are viewing, talk to them about

time? In March, the AAP published a

Smartphones, tablets, and TVs are

it, and focus on high-quality content.

statement acknowledging that kids’

making kids less active, and seden-

Aside from schoolwork, kids should

screen time will likely increase during

tary behavior is linked to overweight

be engaging in educational content

the coronavirus pandemic, but they

and obesity in young people, putting

as well as media that stimulates their

didn’t offer alternative time limits.

them at risk for heart disease and

imaginations. Experts still recom-

Instead, they encouraged parents to

other chronic health issues. A study

mend that all of us ditch our devices

approach their child’s media use in

by the American Heart Association

at least an hour before bedtime.

terms of who they are, what they’re

reports that teens who spend more

the risk of heart disease and stroke. Set limits on screen time that work

www.uppervalleyimage.com •

Exercising as a family brings the clan together and benefits everyone.

Kids ages 3 to 5 should get three hours of activity a day, including both active play and structured movement. Exercising as a family brings the clan together and benefits everyone, whether it’s a backyard game of Frisbee, hiking the nearby trails, or training together toward a goal like running a 5K Turkey Trot on Thanksgiving. During this time of increased remote learning and home schooling, organized sports may be less available or canceled altogether. The shift in schedules allows for other opportunities. A plethora of fitness, training, and recreational classes are available online, many options tailored to children and adolescents. Young dancers can find everything from hip-hop to Irish step dancing—with some classes taught by kids, for kids. For children who participate in team sports, you can find videos specializing in that interest—from ski conditioning to ball handling and footwork workouts to gymnastics conditioning and workouts. Don’t Forget Diet When it comes to supporting heart health and overall wellness, a wholesome diet goes hand in hand with physical activity. The American Heart Association’s recommendation for children is the same as adults: a heart-healthy diet should be rich in a variety of fresh fruits and vegetables, whole grains, and legumes and low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars. Introduce a wide variety of produce to your children early. By learning to love fruits and veggies when they’re 44 i m a g e h e a l t h w a t c h •

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young, kids will develop food preferences that will lower their risk of obesity, diabetes, and heart disease later in life. Read labels carefully and opt for whole-grain versions of bread, cereal, and snacks. Most fats should come from sources of healthy polyunsaturated and monounsaturated fatty acids, including fish, nuts, and vegetable oils. Choose lean meats like poultry over red meat, which is high in saturated fat. Beyond Exercise and Diet Regular exercise and a nutritious diet go a long way toward supporting your child’s heart health. Beyond these, be sure to let your child’s primary physician know of any history of heart disease in the family, which may indicate the value of cholesterol or other testing or monitoring. It’s crucial to talk to your kids about the dangers of smoking. According to US Department of Health and Human Services, cigarette smoking is the leading preventable cause of death in this country. Never starting is the best way to eliminate this major risk factor for heart disease. Children will benefit from knowing why these behaviors are important. Age-appropriate books about anatomy and the heart will answer questions and spark curiosity. Seeing the heart as a muscle, feeling their heartbeat accelerate with exertion and slow down at rest, and finding their own pulse can all make the heart’s work less abstract. What a gift for a child to understand that each of us has our own heart—and the better we care for it, the healthier we will be throughout our lifetime. 

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www.uppervalleyimage.com •

The GUT IS sometimes called THE SECOND BRAIN because it has the most nervous system cells outside the central nervous system. IT also PRODUCES 90 PERCENT of the BODY’S SEROTONIN, the hormone THAT helps REGULATE EMOTIONS and MOODS.

48 i m a g e h e a l t h w a t c h •

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GUT FEELINGS BY NANCY FONTAINE

a healthy gut means a healthy life

ou know those feelings in your gut—butterflies in your stomach when you’re nervous, growling when you’re hungry, queasy when you see or smell something that disgusts you. But what is the gut when it comes to health? The gut is another word for the middle and end of the gastrointestinal system: the stomach and large and small intestines (the mouth and the esophagus are the beginning). Together these organs allow us to extract nutrients from food and discard elements we cannot use.

www.uppervalleyimage.com •

After the initial breakdown in the mouth, food is swallowed and passed through the esophagus to the stomach. The stomach produces acid and enzymes to break down food, passing the result into the small intestine, where it’s broken down into nutrients we can absorb. The intestine is aided by the pancreas, liver, and gallbladder, which add more enzymes and insulin. When the small intestine et al. are done with their work, the next stop is the large intestine or colon, which absorbs electrolytes and water and passes solid waste to the rectum and out. The gut does not do all that extracting by itself. It has help—lots of help. About 100 trillion bacteria—five pounds’ worth!—call the human gut home, forming what is called the gut microbiome. These bacteria are both good and bad, held in balance. The good guys aid digestion, block bad guys like Salmonella and E. coli, strengthen the immune system, and suppress inflammation when it gets out of control. Gut Concerns The gut is sometimes called the second brain because it has the most nervous system cells outside the central nervous system. It also produces 90 percent of the body’s serotonin, the hormone that helps regulate emotions and moods. Therefore, stress can have a big impact on the gut. As NYU’s Dr. Lisa Ganjhu puts it, stress can “result in adverse effects on the gastrointestinal tract and the whole body. Stress can cause chronic nausea or bloating and can be a trigger for disease flares or exacerbation of symptoms in people who have irritable bowel syndrome, inflammatory bowel syndrome, and other gastrointestinal conditions.”

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What Is Where IN OUR DIGESTIVE SYSTEM From mouth to colon, our digestive system has many parts working toward the same goal—turning food into fuel by extracting the nutrients we need to function. But when any of the system’s components isn’t doing its job, the result may be bloating, indigestion, constipation, and more. Read on to find out how to keep everything running smoothly.

UNDERSTANDING GUT CONDITIONS

FOODS FOR BOWEL HEALTH

Imbalances in intestinal bacteria

Fiber

can contribute to a variety of gut

Fiber

Phytonicides

issues. Studies show that certain strains of probiotics may help alleviate some of the symptoms associated with common conditions and may help reduce flareups. Along with consuming a nutritious diet and managing stress, fostering a healthy gut biome may be helpful if you have

Fiber

a GI condition. Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Symptoms include abdominal pain, gas, bloating, and diarrhea or constipation

Fiber

Pectin Omega 3

(or both). They can typically be controlled by managing diet, lifestyle, and stress.

Prebiotic Fiber

Crohnâ&#x20AC;&#x2122;s disease causes inflammation of the digestive system,

Probiotics are live organisms, usually specific strains of bacteria that directly add to the population of healthy microbes in your gut.

which can lead to abdominal

Prebiotics are specialized plant fibers. They act like fertilizers to stimulate the growth of healthy bacteria in the gut.

different areas of the digestive

pain, severe diarrhea, weight loss, and malnutrition. It can involve tract in different people, but the most common areas affected are the last part of the small intestine

PROBIOTICS vs. PREBIOTICS

Beneficial live bacteria that promote healthy digestive health

Foods that promote the growth of healthy bacteria

Where to find them:

Yogurt Sauerkraut Kefir Pickles Kimchi Tempeh Supplements

Bananas

and the colon. Ulcerative colitis causes longlasting inflammation that leads to ulcers in the lining of the large

Onions Artichokes Garlic Oatmeal Honey Asparagus

intestine and rectum. Symptoms vary depending on the severity of inflammation but can include diarrhea, abdominal pain, rectal pain, bleeding, weight loss, and fevers.

www.uppervalleyimage.com â&#x20AC;˘

Uncomfortable feelings in the gastrointestinal system are common and often result from food or stress. Most pass, but you should contact your doctor if your symptoms include abdominal pain that is steady, severe, or recurring or interferes with your sleep or routines; loss of appetite or unexplained loss of weight; trouble swallowing; fever; or changed bowel habits. Going Pro What you eat has a major effect on your gut. One of the ways you can promote a healthy gut environment is by consuming probiotics. Probiotics are foods that include good bacteria, including particularly fermented foods such as yogurt, kefir, sauerkraut, kombucha, pickles, miso, tempeh, and kimchi. Hard cheeses and sourdough bread also contain probiotics. Another way is to reduce elements of the traditional Western diet that have a negative effect on the gut biome. This means cutting back on, or cutting out, red meat, saturated fats, refined sugar, and processed foods.

WHAT ARE PROBIOTICS AND WHAT DO THEY DO? By Amy Tuller, RD, LD, CDE Probiotics are nonpathogenic bacteria that have a thera-

The most common probiotic bacteria belong to two

peutic benefit to the host. Trillions of microbes, including

groups, Lactobacillus and Bifidobacterium, and one strain

bacteria, fungi (including yeasts), viruses, and protozoa,

of yeast has been found to be an effective probiotic,

live on and in our bodies. This is referred to as the micro-

Saccharomyces boulardii.

biome. Each person’s microbiome is unique and maintain-

One area where probiotics have been found to be effec-

ing an optimal balance within that microbiome helps to

tive is in reducing diarrhea caused by the highly contagious

keep us healthy.

rotavirus in children. Research also shows probiotics to be

Probiotics are found in throughout the body, but the

beneficial for preventing diarrhea associated with antibiot-

most common place linked to beneficial bacteria is the

ics, as well as for eczema, asthma, allergic rhinitis, sinusitis

gut (mostly the large intestine). The probiotics in the gut

and inner ear infections, bacterial vaginosis, colic, constipa-

help to:

tion, Helicobacter pylori infection (the bacteria associated

• Support the immune system

with stomach ulcers), and irritable bowel syndrome.

• Control inflammation • Manufacture vitamins • Aid digestion and nutrient absorption • Prevent bad bacteria from making you sick • Restore healthy balance to the microbiome after a disruption, such as an illness or antibiotic use. 52 i m a g e h e a l t h w a t c h •

When considering a probiotic supplement, talk to your health care provider about what you’re trying to achieve. If

2020

overall wellness is your goal, a supplement may not be necessary. Instead, focus on including probiotic-rich foods in your diet each day to help maintain a healthy microbiome.

The human gut is more complex than previously thought and has a huge impact on whole-body health. A healthy gut contributes to a strong immune system, heart health, brain health, improved mood, healthy sleep, and effective digestion, and it may help prevent some cancers and autoimmune diseases.

MORE ON PROBIOTICS Plain Greek yogurt is a great choice. Adding chopped or pureed fresh fruit adds flavor as well as helpful prebiotics. Most cottage cheese is fermented, and different brands contain different strains of probiotics. Kefir, usually made from cow or goat milk, is like a drinkable yogurt and contains various strains of If you opt for a probiotic supplement, it’s essential not to skimp on quality. A high-quality supplement will contain multiple bacteria strains, and it should state its guarantee of potency and purity on the label. Keep in mind that the bacteria must be live to be of benefit, so some supplements require refrig-

beneficial bacteria. Pickled or fermented vegetables such as pickles, sauerkraut, pickled beets or beans, olives, kimchi, contain beneficial bacteria.

eration. Read the label carefully and look at the CFU

Apple cider vinegar (with the

(colony-forming units) level at the end of the supple-

“mother,” a silty substance at the

ment’s shelf life rather than the level at manufacture,

bottom of the bottle) is a source

as some bacteria die over time.

of probiotics.

Probiotic supplements have a history of safe use, but detailed studies of safety are lacking. The risk

Kombucha is a fermented tea that

of undesirable effects from probiotics is greater

is rich in probiotics.

in people with compromised immune systems and serious illnesses. If you’re considering a probiotic supplement, consult your health care provider first to determine what’s best for you.

Miso can be added to hot water for a tasty soup or drink, and tempeh can be used in place of meat in many dishes. www.uppervalleyimage.com •

Going Pre Another way to help the gut is to consume prebiotics. These are foods that encourage the good bacteria and keep it healthy. Prebiotics are high-fiber, complex carbohydrates such as oatmeal and whole grains. The highest levels of prebiotic materials are found in asparagus, leeks, garlic, Gut-Healing Garlic Asparagus Broccoli Soup.

onions, seaweed, Jerusalem artichokes, bananas, and dandelion greens, but sweet potatoes, corn, and pumpkin as well as beans, lentils, and peas are good sources too. The Gut-Healthy Lifestyle Keeping your gut healthy is essential for keeping yourself healthy overall. Getting enough sleep and exercising regularly help reduce levels of stress and maintain a healthy weight, which the gut likes. Disturbed sleep is also associated with digestive system disturbances from bloating to constipation. If you have regular heartburn, bloating, or constipation, it’s helpful to keep a food diary to determine whether what you’re eating is associated with these issues. Don’t forget that antibiotics kill all bacteria, not just the bad guys, so don’t take them for things like colds and flu, which are caused by viruses. When you eat can also affect how well your gastrointestinal system works. Recent research has found that not all the good bacteria are active at all times of day; like people, they have circadian rhythms. How best to accommodate timing? Dr. Shanthi Parkar from New Zealand’s Plant & Food Research institute advises avoiding eating dense meals rich in fat and sugar in the evening and allowing 12 to 14 hours between the last meal you have before sleeping and breakfast the next morning. As with many health issues, your gastrointestinal health is in your hands. Be kind to your gut bacteria, and they will be kind to you. 

Writer, editor, and librarian Nancy Fontaine works at Norwich Public Library in Norwich, Vermont. She is also a book blogger and website manager and has been writing articles about the Upper Valley for the last several years. She lives in West Lebanon, New Hampshire, with her husband, and her hobbies include reading, quilting, skiing, and snorkeling. 54 i m a g e h e a l t h w a t c h •

2020

BEET, CARROT & GINGER KVASS

BY LINDSAY SMITH COURTESY OF THE CO-OP FOOD STORES

FOR A HAPPY, HEALTHY GUT delicious recipes to support digestion

Beet, Carrot & Ginger Kvass Kvass is an acquired taste, so take it slowly. You might want to add a little raw honey or maple syrup to the finished product. Lacto-fermented foods act as digestive aids but can sometimes taste a bit “funky”—that is natural and not bad for you. It should never taste spoiled. Use your senses! Makes 1 quart 2 cups organic beets (2–4 beets) 1½ cups organic carrots (2–4 carrots) ½ cup fresh organic ginger 1½ Tbsp high-quality sea salt N cup whey Spring water, well water, or filtered treated water 1. Scrub but do not peel the beets and carrots. If yours came with greens, save those for cooking another dish (carrot tops make a great pesto!) or compost them. Roughly chop and smash the ginger. 2. Place the beets, carrots, ginger, salt, and whey into a half-gallon canning jar.

WHOLEGRA AND YOG IN SALAD WITH JAMMY URT SHA EGGS LLOT DR ESSING

www.uppervalleyimage.com •

3. Fill the jar with water, leaving at least one inch of air space from the top of the jar. Cover the jar tightly with a lid. 4. Place the jar in a dark cupboard to ferment at room temperature (70°) for 2 to 3 days. 5. Remove any foam from the top of the kvass. Pour a quart of the kvass into a quart jar, leaving the vegetables behind. The kvass is now ready to drink. 6. Cover the quart jar and transfer it to the refrigerator where it will keep for many weeks. To make a second batch: Add 2 teaspoons of salt to the vegetables in the jar. You can use a little of the previous batch of kvass as a “starter.” Add a quart of water, leaving at least one inch of air space from the top of the jar. Cover the jar tightly with a lid. Again, place the jar in dark cupboard to ferment for 2 days. NOTES: • Red beets or purple carrots will make a red-colored kvass. This a great way to use up older vegetables that are getting soft. • Use whey—not whey protein powder, but the byproduct of soft cheesemaking. You can also use just salt or a bit of starter juice from another fermented product. • Fermenting lids can be used to remove the oxygen from the jar. • If you develop foam or even a little bit of white mold on top, just skim it off. This is from the vegetables coming into contact with oxygen. • The longer you leave it to ferment, the more developed the flavor will be.

Whole-Grain Salad with Jammy Eggs and Yogurt Shallot Dressing

We’re in This Together APD is open, clean, safe, and committed to your child’s health. The American Academy of Pediatrics encourages families to keep seeing their provider during the pandemic to stay on schedule and healthy. Call today.

(603) 448-3122 • AlicePeckDay.org 56 i m a g e h e a l t h w a t c h •

2020

Whole grains not only provide fiber and nutrients, they are also prebiotics. This means they help feed our gut bacteria. Use a selection of lettuces, including bitter ones like arugula or dandelion greens (or many others), which are good for digestion and gut health. They stimulate digestive enzymes and help promote the natural detoxification of the liver. Eggs are a protein and usually easy to digest. Finally, the yogurt and herbs in the dressing also promote digestion.

Serves 4 ½ cup whole rye berries, farro, or wheat berries Kosher salt 1 small shallot, finely chopped O cup whole-milk Greek yogurt 2 Tbsp chopped mint 1 lemon, halved Freshly ground black pepper 6 cups mixed greens (such as arugula, baby mustard, and mizuna) 4 Jammy Soft-Boiled Eggs, halved (recipe follows) 1. Cook the grains in a large saucepan of boiling, salted water until tender. Drain and let cool. 2. Meanwhile, mix shallot, yogurt, mint, and 1 tablespoon of lemon juice in a small bowl; season with salt and pepper. 3. In a medium bowl, toss the greens with a squeeze of lemon juice; season with salt and pepper. 4. Add the grains and toss to combine. 5. Scoop the shallot yogurt onto a plate and top with salad and egg halves. NOTE: Rye berries are sold with their hull intact, which means they’ll take a bit longer to cook than other grains, but they will reward your patience with al-dente chewy nuttiness.

Jammy Soft-Boiled Eggs It’s not necessary to wait for the eggs to come to room temperature. Go ahead and cook them straight out of the fridge. 4–8 large eggs 1. Bring a large saucepan of water to a boil over medium-high heat. Using a slotted spoon, carefully lower the eggs into the water one at a time. Cook 6½ minutes, adjusting the heat to maintain a gentle boil. 2. Transfer the eggs to a bowl of ice water and chill until just slightly warm, about 2 minutes. 3. Gently crack the eggs all over and peel, starting from the wider end, which contains the air pocket. 

www.uppervalleyimage.com •

t h e r ig h t b a lan ce

Our Vision To create a culture of health where everyone’s health is everyone’s priority.

Our Mission To empower individuals to take control of their own health by: • Providing honest and transparent health education/coaching to members of our community. • Providing skills and tools to make healthy behaviors the natural way of life. • Making healthy choices the most logical, most affordable, and most accessible choices to everyone in our community. • Making health a norm, not an exception, a right all humans are born with. Front, from left: Laleh Talebian, Amy Robb, and Karlen Thyne. Back, from left: Sara Lamie, Crystal Sweet, Scott Stone, and Jenna Mangini.

DYNAMIC NATURAL ATHLETES w e l l n e s s • c e n t e r WHERE YOUR HEALTH IS OUR PRIORITY Dynamic Natural Athletes (DNA) in White River Junction, Vermont, was founded in 2018 by co-owners Laleh Talebian, PhD, a research scientist and a certified health coach for patient care, and Karlen Thyne, a certified personal trainer and athletic coach. Their partnership and collaboration started three years before that, when the two met while training at another fitness facility. They immediately connected over their love of natural bodybuilding and strength training and their shared passion for helping others achieve optimal health. Laleh and Karlen started trading expertise—Laleh designed a personalized nutrition plan for Karlen, and Karlen started training Laleh, who was about to com58 i m a g e h e a l t h w a t c h •

2020

pete in a natural, drug-tested, pro-qualifier bodybuilding competition, her tenth amateur competition. They began collaborating, customizing personal training and nutrition for all their clients, which ranged from competitive bodybuilders, triathletes, runners, and obstacle course racers to cancer survivors, people with diabetes, Parkinson’s patients, and more. In February 2019, they were presented with the opportunity to move into the space previously owned by Curves. The decision involved expanding their private studio and transforming it into a full gym. Within a month, they remodeled the space and opened Dynamic Natural Athletes, a full exercise facility and comprehensive wellness center. They immediately took

DON’T FOLLOW YOUR DREAMS –

CHASE THEM

Classes & Training Customized Personal Training Group Training & Exercise Classes Wellness Workshops

Health & Wellness Customized Nutrition Specialized Lab Tests Functional Movement Neuromuscular Therapy Somatic Therapy Integrated Energy Therapy BEMER Therapy

Ask About Our Memberships dynamicnaturalathletes.com facebook.com/DynamicNaturalAthletes 860 Hartford Ave.

White River Junction, VT

(802) 295-9696

t h e r ig h t b a lan ce

MEET THE STAFF Dr. Laleh Talebian Dr. Laleh has a PhD in Molecular and Cell Biology and Immunology and a BS in Genetics/Food Biochemistry. She is a research scientist and health coach for patient care. Her specialties include customized nutrition for disease prevention, athletic performance, and weight management. Karlen Thyne, Certified Personal Trainer Karlen has more than 16 years of experience in basic and advanced customized personal training with an emphasis on body mechanics and injury prevention. Scott Stone, Performance Enhancement Specialist and Holistic Wellness Coach Scott has a BS in Exercise Science–Sports Medicine and more than 20 years of experience in movement enhancement, neuromuscular therapy, somatic therapy, and integrated energy therapy. Crystal Sweet, Certified Personal Trainer and Certified Group Fitness Instructor Crystal specializes in body transformation and weight loss through safe and effective exercise, and she trains clients from beginner to moderate levels. Jenna Mangini, Licensed Massage Therapist and Medical Massage Practitioner Jenna has extensive knowledge and handson experience in physical therapy. She offers customized massage based on the client’s specific needs and has experience with a diverse clientele ranging from senior citizens to professional athletes. Sara Lamie, Doctor of Physical Therapy Sara specializes in running gait assessment, movement screening, back and neck pain management, orthopedics, and postoperative sports rehab. Amy Robb, BEMER Independent Distributor Amy has a BS in Sports, Fitness, and Leisure and an MS in Social Entrepreneurship. She is the former founder and owner of Tip Top Pottery.

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on Crystal Sweet, a former Curves employee and certified personal trainer. In only one year, they have grown their team to include personal trainer Scott Stone, physical therapist Sara Lamie, and massage therapist Jenna Mangini. A Different Kind of Wellness Center DNA is the only wellness center in the Upper Connecticut River Valley where a team of highly qualified professionals collaborate to provide you with the most holistic, comprehensive, and effective care. You’ll start with a health evaluation performed by Dr. Laleh. She will provide you and your DNA trainer with a full report and recommendations for safe and effective training strategies customized for you. Lab tests can be ordered to help shed light on unresolved health concerns to determine whether they can be addressed without pharmaceutical intervention. For example, food sensitivity tests or inflammatory markers can provide Dr. Laleh with critical information to help you resolve issues that may not be detected by routine lab tests. DNA recently added Bio-Electromagnetic-Energy-Regulation (BEMER) technology to its services. BEMER is an adjunct therapy used by hospitals, clinics, universities, and fitness facilities around the world as well as by many individuals in their own homes. BEMER increases blood flow through the microvessels (capillaries), which make up 74 percent of our blood flow. This increases oxygen and nutrient delivery to the organs and tissues and encourages the removal of metabolic waste, which are all fundamental to cellular function. The benefits of BEMER include more energy, pain relief, improved sleep, better elimination, reduced stress, and improved overall wellness. More than 1,000 professional athletes use it for recovery and better performance. Everyone could benefit from more blood flow, and DNA is the only health and fitness facility in the region that offers this therapy. Everyone Is Welcome DNA serves a community of members, clients, and patients of all ages and fitness levels, from 12-year-old youth athletes to 92-year-old members who have one thing in common: to be a healthier, stronger version of themselves. The DNA community includes members who enjoy a small and safe space to exercise on their own and clients who visit once a week for personal training, physical therapy, massage, or a BEMER therapy session. Others may visit Dr. Laleh for a health and nutrition consult, customized health plan, a lab test review, or monthly recommendations. Dynamic Natural Athletes is not a gym, but rather a welcoming, safe, friendly environment where your overall well-being is the most important goal for the team. We collaborate to serve you.  Dynamic Natural Athletes 860 Hartford Avenue White River Junction, VT (802) 295-9696 www.dynamicnaturalathletes.com

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financial well-being |

BY FRED WAINWRIGHT, LEDYARD FINANCIAL ADVISORS

Investing and Planning in a Post-COVID World YOUR FINANCIAL HEALTH CAN REFLECT YOUR PERSONAL VALUES A crucible moment is one that changes you forever. The coronavirus has made it abundantly clear that life is precious and fleeting. A few mornings ago, I woke up my young daughter and told her that she could have the puppy she had been eagerly wanting and I had been resisting. She hugged me tightly and did not let go for what seemed like a very long time. Her hug will be with me for the rest of my life. I have since asked my wife and daughters to think about how we can emerge from this crisis having accomplished something truly meaningful for ourselves, our loved ones, and our community.

Fred Wainwright is Senior Investment Strategist and Head of US Equities at Ledyard Financial Advisors.

What Will Be Your Legacy? Restaurant and airline reservations have ticked up from their lows. Some in the media and in government are saying that the world will go back to normal and COVID-19 will be forgotten as soon as a vaccine is available. There was a post-World War II boom, and the United States economy moved on after the 2009 recession. Today global central banks and legislatures have stepped up to bridge the many gaps in the economy. However, we will continue to live in a world of probabilities. We cannot control a greedy or fearful stock market, but there are actions we can take for ourselves. Keeping in mind just how interconnected we all are, perhaps we should consider a new direction and a more holistic life plan. What quality moments do you envision having with your loved ones? How would you like to be remembered by your friends, your favorite charities, and the world at large?

2 Maple Street Hanover, NH (603) 643-0044 www.ledyardbank.com

Other locations in Concord Hanover Lebanon Lyme New London Norwich, VT West Lebanon

Ledyard Financial Advisors is the wealth management division of Ledyard Bank. We manage over $1.6 billion of client assets. We help individuals, businesses, and institutions make effective decisions about how to save, borrow, and manage their finances. Our unique combination of expert advice, leading-edge financial solutions, and personal attention represent the highest standard of client advocacy and responsiveness.

62 i m a g e h e a l t h w a t c h â&#x20AC;˘

A Transformed Plan A strong legacy is based on a good plan. For example, where would you like to retire and what would you like to do in retirement? How

2020

much will it cost annually? Having visualized your ambitious dreams and achievable goals, consider a comprehensive wealth-management plan. For each item below, score yourself from 1 to 5, with 5 being a strong reflection of your personal values as well as the greater good of your family and society. Investments Insurance Retirement accounts Tax planning Banking Financial planning Business succession Durable power of attorney Family gifting Charitable gifting Titling of assets Executor/trustee Distribution of wealth Alignment with Your Values It can be argued that COVID and other diseases have emerged due to uncontrolled land development and the increasing contacts between humans and wildlife. Smog has cleared in many cities, but as the global economy restarts, the issues of climate change will return. Can your investments reflect your values? Sustainable, socially responsible or ESG (environmental, social, and governance) investing has been gaining momentum. Ethics and innovation are winning. Is your current allocation to stocks keeping you awake at night? If so, consider a modest equity reduction in the account most likely to be used as a savings backup or early in retirement. Accounts dedicated to longer term goals such as providing income or supporting future generations can remain more aggressive. Stay invested and diversified in equities for their

financial well-being dividend payments and to overcome inflation in housing, medical, and other retirement expenses. Post-COVID Strategies Financial planning is evolving. Individuals and businesses will require much more cash in savings for emergencies. Personal and business financial projections will need to be more sophisticated, encompassing a broader range of potential outcomes. The definition of essential and discretionary expenses may need to change for you. Consider a small, permanent budget cut rather than a painfully large change. Will there be a new car or a monthly contribution to your Roth IRA? Lifelong access to quality health care is essential. Do you understand your health savings account or Medicare insurance options? Is your health care proxy form up to date? If you are a business owner, consider how you will systematize resilience. The value of your business will most certainly increase the better its succession plan, its emergency plan, and its employee health plan. Get to know and pronounce EBITDA. You are now a Zoom expert—envision yourself as a valuation expert. Assume you sell your business for that magic multiple. We have read about many acts of bravery, compassion, and community recently. Are there impactful charities that are new to you and deserve your largesse? Building Your Team You are not alone. You can build your team of advisors among accountants, business appraisers, estate attorneys, insurance specialists, and yoga masters (let us slow down the aging process). Your team will help you avoid cognitive and emotional biases and increase the probability of achieving your newly transformed legacy. The puppy’s name will be Vida, which in Spanish means “life.”  Fred Wainwright is Senior Investment Strategist and Head of US Equities at Ledyard Financial Advisors. Fred is a member of the CFA Institute and a graduate of Stanford University and the Tuck School of Business at Dartmouth. He is a member of the Class of 2020 of Leadership New Hampshire. 64 i m a g e h e a l t h w a t c h •

2020

hea lthy solutions |

BY MAURA KING SCULLY

HELPING patients from rehab to wellness SCHMIDT PHYSICAL THERAPY AT EUROPEAN FACE AND BODY STUDIO

Chris and Annemarie Schmidt.

We don’t believe in ‘no pain, no gain’ and will alter the treatment if you feel too much discomfort.” —Chris Schmidt and his team, Schmidt Physical Therapy

Life is full of pain-in-the-neck experiences. When those turn from figures of speech to actual discomfort, however, it’s likely you could benefit from physical therapy. In the Upper Valley, one call to Schmidt Physical Therapy will have you on the road to recovery. With two New Hampshire locations—Claremont and now at the European Face and Body Studio in Hanover—Chris Schmidt and his team make it convenient for patients of all ages to get back to good health. One-on-One Approach Care at Schmidt Physical Therapy focuses on the individual with the goal of treating each patient with the right intervention. This starts with a comprehensive initial assessment. “Not every injury is what it looks

www.uppervalleyimage.com •

h e alt hy s o lu tion s Where Does It Hurt? Chris and his team work with patients to restore function from head to toe. Common complaints include: • • • • •

Neck and low back injuries Sciatica Sports- and work-specific injuries Post-surgical rehabilitation Shoulder, elbow, hand, hip, knee, and foot issues • Headaches and vertigo

Get Moving Schmidt Physical Therapy incorporates a variety of approaches to help patients reduce pain or prevent disability. Services include: • Neuromusculoskeletal assessments • Sports-specific assessments • Orthopedic manual physical therapy • Specific joint mobilizations and manipulations • Exercises utilizing functional and sports-specific protocols • Tai chi for rehabilitation • Soft tissue techniques • Dry needling

No Pain—You Gain Schmidt Physical Therapy incorporates a variety of therapies to address patient concerns, including orthopedic manual physical therapy, medical exercise, and medical massage therapy. “Our goal is to identify and treat the source of your dysfunction with gentle techniques,” he says. “We don’t believe in ‘no pain, no gain’ and will alter the treatment if you feel too much discomfort.” This philosophy is just one aspect that sets Schmidt Physical Therapy apart. Another is the absence of specialized gym equipment. “We use simple hand weights, TheraBands, and patients’ own body weight. The goal is to give you exercises you can perform at home. There’s no need to go to a gym.” Chris notes that the practice also provides the full spectrum of care. “You can come in for rehabilitation and then transition to our wellness program,” he says. “We offer one-on-one personal training and massage therapy in private rooms.” Health and Safety First As a health care provider in the age of COVID-19, Chris and his staff have put all the necessary precautions in place. “All patients are seen in private rooms, which are sanitized after each appointment. All providers wear gloves, face masks, or face shields. We also use a special moveable plexiglass shield between patients and providers,” he says. For those not comfortable with in-person visits, Chris and his staff are available virtually. “Using a secure telehealth connection, we can talk with patients, see how they move, and give them exercises,” he says. In all of these treatments, Chris considers physical therapy as both a helping and problem-solving profession. “I enjoy giving people solutions to function better and longer,” he concludes. 

Schmidt Physical Therapy 3 Dunning Street Claremont, NH (603) 542-9200 www.schmidtphysicaltherapy.com

European Face and Body Studio Schmidt Physical Therapy 70 South Main Street Hanover, NH (603) 277-9075

Maura King Scully is an award-winning freelance writer based in Woodstock, Vermont. You can reach her at www.mkscommunication.com.

DRY NEEDLING 66 i m a g e h e a l t h w a t c h •

like,” says Chris, who brings decades of experience to his practice. “Pain in your foot could be from an issue with your lower back.” Patients are considered a key part of the treatment team. “We encourage feedback and include your input in our approach,” he continues. “And we remain in contact with your doctor for the duration of treatment to facilitate your recovery.”

2020

Gates & Dickson

financial health |

BY MIKE MORIN

Be Prepared for the Future GUARALDI INSURANCE CAN HELP We asked Tim Guaraldi what important points we need to be aware of when it comes to our insurance needs, at any time of life but especially as we age.

Tim Guaraldi Owner, Primary Agent

What types of financial services do you offer, especially for people looking toward retirement and estate planning? We can provide LTC (long-term care) planning, retirement planning, and financial planning. We partner with other professionals from the local area or out of the area. Each client is different and may have different wants and needs—and some clients don’t have any idea. A lot of what we do is educate our clients so they can make informed decisions. LTC in particular is an area that is increasingly missed in the retirement planning process. The clients who get it are the ones who have had to take care of an elderly parent or spouse. It is exhausting to the caregivers, many times on top of their existing jobs. We work with clients to help them understand the importance of having a long-term care policy in place to help with the care and expenses that go along with taking care of a senior parent or spouse. LTC can be an important part of a well-planned retirement. How can families use life insurance as a tool for planning financial security? Life insurance is an important part of any family’s financial security plan, from paying off the mortgage or other long- or short-term debt, extending living-expense coverage, and covering the cost of college to planning for final expenses (funeral) and creating a trust for special-needs children. All these can be protected by purchasing life insurance. It just takes planning, and that’s the hard part for most families—finding the time to sit down and make a plan.

Guaraldi Agency 21 Bank Street Lebanon, NH (603) 448-3250 www.guaraldi.com

68 i m a g e h e a l t h w a t c h •

For those approaching or in the retirement phase of life, explain 401(k) rollovers with an eye toward tax-deferred strategies. Everyone has a different risk tolerance when it comes to investing, especially when you are going into your retirement years. Did I save enough to last through my retirement? Have I been too conservative with investments? What should I do with my 401(k), 403(b), simple IRA, Roth IRA, or traditional IRA? My job is to help you work through those fears and ease you into your retirement. It is also to be honest with you and advise you when you may not have enough to retire and may have to continue to work full or part time. What are your plans and do they fit with your financial situation? 

2020

WHERE LONG-TERM CARE HAPPENS A person at age 65 has a

70% chance

of needing some type of long-term care during retirement. But long-term care doesn’t mean a nursing home.

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Lebanon, New Hampshire

603-448-3250

BY LISA BALLARD

BACKCOUNTRY

BASICS HOW TO HANDLE EMERGENCIES WHEN YOU’RE MILES FROM CIVILIZATION

70 i m a g e h e a l t h w a t c h •

2020

The author pauses near the summit of Mount Major on the southern end of Lake Winnipesaukee, 1.5 miles from the trailhead. Photo courtesy of Lisa Ballard.

www.uppervalleyimage.com â&#x20AC;˘

n experienced hiker sprains an ankle while descending the talus near the

INGS T S T NSEC

summit of Mount Washington. A backcountry skier puts a ski under a hidden log and breaks a leg. A paddler

has a heart attack while portaging his canoe. There are any number of medical emergencies that can happen in the backcountry. Surviving them is a matter of making good decisions given a myriad of variables, including weather conditions, type and severity of the medical situation, number of people with you, whether there’s cell service, and the distance to a doctor.

“What happens anywhere, you bring into the backcountry,” says Redd Brozen, MD, an ER doctor at Dartmouth-Hitchcock Medical Center (DHMC) who is on the faculty of DHMC’s Wilderness/Austere Medicine Program and a member of the Upper Valley Wilderness Response Team. “Heart problems, diabetes, asthma . . . all of your normal medical needs happen in the wilderness too, plus you’re a great distance from help. In a city, it might take six minutes for rescuers to respond, but in the wilderness, it might be hours and hours.” Take hiking, for example. A walk in the woods is a great way to exercise, social distance, and clear one’s head; however, hiking has its risks. You can usually get home with a painful blister on your heel, but what if you sprain your ankle and can’t walk? STOP, which stand for stands for stop, think, observe, and plan. “If you or someone you’re with is injured, assessment is important,” says Dr. Brozen. “If you’re hiking with five friends, you have different options than if you’re solo. Can you use poles as crutches? Can you wrap the ankle? Can you do the three-legged thing with your friends? You need to apply your common sense and figure out your options.” That said, the correct action in a backcountry emergency is not always intuitive. Here are some examples of serious mountain mishaps and what you should do about them before professional help is available.

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INSECT STINGS

FIRST AID AND WHAT TO DO

If the reaction to a sting becomes severe, a dose of Benadryl can curb the symptoms. If the person has trouble breathing, hopefully they are carrying an Epi-pen and know how to use it. If not, Dr. Brozen says keep them calm and concentrating on their breathing.

ANIMAL BITES

DEEP CUT

Few people die from snakebites or other animal bites, though the reaction to a bite can be serious. Keep the victim calm and immobilize the limb. Cover the wound with a bandage or piece of cloth to keep it clean. Remove jewelry or anything that might become restrictive and painful or cut off circulation when the area swells. DO NOT cut around the wound with a knife, suck it, or apply a tourniquet! That only works in the movies.

“Stopping bleeding is always step number one in any backcountry emergency,” says Dr. Brozen. “Then you need to keep the wound clean and dry.” To stop the bleeding, place gauze or any piece of fabric over the wound and apply firm pressure. Don’t peek! If you raise the cloth you might cause the cut to start bleeding again. If blood seeps through, add another cloth on top of it, and keep applying pressure. If the cut is on an arm or leg, keep it as high as possible.

HEART ATTACK

BURNS

STOP, which stand for stands for stop, think, observe, and plan. “If you or someone you’re with is injured, assessment is important,” says Dr. Brozen. BURNS

HEAT STROKE

If your backpacking stove tips over while you’re cooking and the burn is severe, i.e., the skin looks leathery, brown, or black (charred), the area will swell quickly. Remove jewelry, belts, and tight clothing near the burn, then cover it using a cool, moist bandage or cloth. Elevate the injury if you can. DO NOT immerse a serious burn in water.

If your friend acts confused and has trouble breathing, a super-fast heart rate, and red, hot skin, he is suffering from heat stroke. Every minute counts. If you can, immerse the person, except for his head, in a cool stream. Do it until either help arrives or the person starts to recover, but no longer than that. His ability to regulate his body temperature may be compromised, and you can make him hypothermic even on a hot day.

HEAT EXHAUSTION If it’s a hot day and your backcountry buddy feels like throwing up, is dizzy, or complains of muscle cramps and he looks pale with clammy skin, he is likely suffering from heat exhaustion. Have him lie down in the shade as soon as possible. Place a cool, damp cloth on his neck, armpits, and groin, and have him sip fluids, preferably a sports drink or juice and water combo to replace electrolytes.

HYPOTHERMIA

BROKEN BONE

Hypothermia is a sneaky killer. It can happen when the temperature is well above freezing if you get caught in a rainstorm, on a windy day, or you fall into a remote lake or stream. When you shiver uncontrollably, you’ve become mildly hypothermic. If you become disoriented, clumsy, and/ or slur your words, the situation is getting worse and could turn life-threatening. The first step is to take off wet clothing and replace it with dry layers. Build a campfire for a heat source. If that’s not possible, keep moving, which keeps your muscles working, generating body heat.

If the break is on an arm or leg, try to create a splint that immobilizes the joints above and below the break. DO NOT try to push in a bone that’s sticking out or realign a spot that’s crooked. If the person feels cold, faint, or breathes rapidly, they may be going into shock. Cover them with a jacket to keep them warm, and have them lie down, preferably with their feet above their heart. Most people can walk out of the woods with a broken bone above the waist. For a serious break from the pelvis down, the victim will likely need to be air-lifted or taken out on a litter. And if you suspect a back or neck injury, don’t move the person! “You can make it worse,” says Dr. Brozen. “If they have neurological symptoms like numbness but they can move their feet, don’t move them to see what they can do.” www.uppervalleyimage.com •

NJURY

HEAD I HEAD INJURY

According to Dr. Brozen, it’s okay to move someone who falls and bumps their head. He says to get out while you can, perhaps before the person loses consciousness. And while you’re walking, keep their head up.

HEART ATTACK Most first-aid kits contain Tylenol or ibuprofen to reduce pain and swelling, but not aspirin, which is the best backcountry first aid for a heart attack. Dr. Brozen recommends adding it to your kit, especially if you’re middle-aged or older. “The classic symptoms of a heart attack are crushing chest pain and shortness of breath,” says Dr. Brozen. “After giving them an adult aspirin, if they feel up to walking, minimize their effort. Carry their pack. If walking makes it worse, stop! You’re trying to balance their oxygen supply with their body’s demand for it.”

These are only a few of the emergencies that might crop up when you’re away from civilization. The best advice for staying healthy in the great outdoors is being prepared before you leave home, namely carrying whatever supplies you might need in a worst-case scenario and telling someone where you are going and when you plan to be back. That way, if you don’t show up, they’ll know where to look for you.  Lisa Ballard is a former member of the New Hampshire Outdoor Council, which oversees funding for search and rescue throughout the state. She is a life member of the Dartmouth Outing Club and a past president of the Outdoor Writers Association of America. She spends as much of her professional and personal life in the backcountry as she can. To read about her adventures, pick up any issue of image or go to www.LisaBallardOutdoors.com. 74 i m a g e h e a l t h w a t c h •

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Comfortable, Family Centered, Individualized Care. Mertens House is small, with only 14 rooms, but spacious in living, dining and gathering areas. Our staff of 40 attentive, friendly professionals is proud to offer each resident the best of personalized care.

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d a ily liv in g |

BY SUSAN NYE

NAVIGATING

SLIPS, TRIPS, AND FALLS s t ay i n g

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lips, trips and falls happen throughout the year, but a rainy autumn and snowy winter can be particularly hazardous. Although many do not tell their doctor, millions of older people fall every year. The Centers for Disease Control and Prevention estimates that as many as one in three or four seniors experiences one or more falls each year. As baby boomers continue to age, the number of fall-related injuries and their treatment costs are expected to soar.

KEY RISK FACTORS Miranda Albano is a physical therapist assistant and certified occupational therapy assistant licensed at Lake Sunapee Region VNA & Hospice. She helps people avoid falls as well as recover from injuries. Miranda says, “While not every fall can be avoided, if you are aware, a lot is controllable.” Risk factors fall into two categories, personal and environmental.

Personal risk factors include: • Loss of strength, particularly in the lower body • Dizziness or fainting due to a sudden change in blood pressure • Problems with balance • Use of certain medications including tranquilizers, sedatives, or antidepressants

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• I nteractions between some medications • Dehydration • Poor vision • Foot pain or numbness or ill-fitting footwear

Environmental risk factors include: • Moving around in the dark or poorly lit areas • Clutter, scatter rugs, and other obstacles • Wet floors or pavement • Pets underfoot • Broken or uneven steps or stairs • Ice and snow • Uneven ground

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daily living SERIOUS AND COSTLY CONSEQUENCES Approximately one in five falls causes a serious injury, sending roughly three million seniors to the emergency room each year. Head injuries and broken bones, especially hip, wrist, and ankle fractures, are the most frequent issues. Of particular concern, some medications, including blood thinners, can increase the danger. Each year roughly $50 billion is spent

on medical costs related to injuries from nonfatal falls. An additional $754 million is spent on patients who do not recover. Close to 75 percent of these costs is covered by Medicare and Medicaid. The remainder is paid by private insurers or borne by the patients and their families. More often than not, falls are the result of a combination of risk factors. Whether they are personal or environmental,

the more risk factors, the greater the chances of falling. For example, a walk down the hall in the dark in the middle of the night coupled with balance issues and a couple of scatter rugs between the bed and the bathroom are a recipe for disaster. Health care providers can help seniors and their families evaluate their home and medical history and offer recommendations. Something as simple as motion-sensitive night-lights and a sturdy pair of shoes can have a big impact on safety. WHAT CAN HAPPEN AFTER A FALL? Injuries from falls can have a serious, even devastating, impact on an individual. A concussion or a broken hip can lead to days or even weeks of bed rest. That inactivity will cause the patient to lose muscle strength and bone mass as well as reduce flexibility and balance. Depending on the patient’s age and temperament, coming back to full strength and mobility can be extremely difficult. Even falls without serious injury can lead to mobility issues. After a simple slip or trip, some seniors develop a fear of falling. That lack of confidence leads to a reduction in day-to-day activities. Unfortunately, rather than protecting themselves, these seniors quickly lose strength from the reduced activity level. With that loss comes an increased chance of future trips, slips, and falls. RECOVERING FROM A FALL Rebuilding strength and endurance after a fall can feel like an uphill climb. Recovering seniors need to be both patient and persistent. Miranda says, “When progress seems slow, I like to remind patients of how far they’ve come. After all, they woke up in the hospital and now they’re walking—even if it is with a walker or cane.” No one has to do it alone. Seniors should always take advantage of physical therapy after a fall. These exercises

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will help them build back strength, flexibility, and balance. Along with exercise and therapy, seniors should practice good eating habits and a healthy sleep schedule. HOW TO AVOID FALLS Miranda advises everyone to build strength and resilience and create a safe environment. Seniors are encouraged to stay active and exercise regularly. They should not neglect their eyes but schedule regular exams. Medications need to be monitored and checked regularly with their doctor or pharmacist to avoid negative interactions. Seniors should speak with their doctor immediately if they sense any decline in strength or balance. Anyone using a cane or walker should make sure their equipment is properly adjusted. And of course, always drink plenty of water. Just as young couples babyproof their houses, seniors need to fall-proof their homes. That starts with keeping both feet firmly on the floor whenever possible. First, the home should be organized so that the things you use every day are within easy reach, including your favorite coffee mug and winter boots. Avoid step stools if you can, and never climb on anything that shouldn’t be climbed on. Remove the clutter and get a handyman to fix that broken railing or step. Install grab bars in the bathroom and anywhere else they’re needed. 

www.uppervalleyimage.com •

ADVERTISERS INDEX AboutFace Skin Therapy 46

Griff & Company 46

Quail Hollow 17

Alice Peck Day Lifecare 38

Guaraldi Insurance LLC 69

Alice Peck Day Memorial Hospital 56

Hanover Eyecare 13

Randy Schaetzke, Wholistic Health Services of Vermont 47

Amped Fitness 64

Hanover Terrace Health & Rehabilitation Center 57

River Road Veterinary Clinic 47 Robert Alvarenga, DMD 74

Historic Homes of Runnemede 47

Roger A. Phillips, DMD 6

Johnson Audiology 46

Springfield Medical Care Centers Inside Front Cover

Amy Tuller, Registered Dietitician Nutritionist 46 Annemarie Schmidt European Face & Body Studio Back cover

Junction Frame Shop 64

Baker Orthodontics 11

Lake Sunapee Region VNA & Hospice 56

Blue Sparrow Kitchen 47

LaValley Building Supply 39

Brown Furniture 8

Ledyard Financial Advisors 63

ClearChoiceMD Urgent Care 5

Little Istanbul 54

Colonial Pharmacy 47

Love’s Bedding & Furniture 75

Co-op Food Stores 61

Mascoma Dental Associates 12

Counseling Associates 1

Merten’s House 75

Dartmouth-Hitchcock Medical Center 9

Stateline Sports 47 Strong House Spa 46 Sugar River Kitchens, Bath & Flooring 79 Summercrest Senior Community 7 Sunapee Cove 2 The Cabinet en Counter 46 The Gilded Edge Frame Shop & Gallery 47

Mountain Valley Treatment Center 17

The Scotland House 12 The Village at White River Junction 67

Dr. Donna Reed, Optometrist 74

Mt. Ascutney Hospital and Health Center Inside Back Cover

Upper Valley Pediatric Dentistry 57

Dr. Dorothy Hitchmoth 3

Neal Wallace Dental 33

Valley Vision Family Eyecare 46

Dynamic Natural Athletes 59

Neely Orthodontics 4

Vermont Comforts of Home 32

Expectations 47

Northeast Delta Dental 15

WISE 33

Eyeglass Outlet 47

Omer & Bob’s 46

White River Family Eyecare 13

Good Neighbor Health Clinics 46

Powerhouse Hearing Center 45

Windows & Doors by Brownell 36

Doctor Sam’s Eyecare 78

For more information about print and online advertising opportunities, contact Bob Frisch at (603) 643-1830 or email rcfrisch1@comcast.net.

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