Summer Health & Fitness 2010

Sunday, July 11, 2010

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HEALTH & FITNESS

2F Sunday, July 11, 2010

The Daily Nonpareil

TOO MUCH OF A GOOD THING AMERICANS ARE TREATED – AND OVERTREATED – TO DEATH MARILYNN MARCHIONE AP Medical Writer

The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital.

The little girl climbed up onto her mother’s bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg’s sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

“We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her – not just torture her” in the hospital, Drane said.

Americans increasingly are treated to death, spending more time in hospitals in their final days, trying lastditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.

More than 80 percent of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer’s disease.

More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends.

Yet the numbers show that’s not what is happening: ■ The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late.

In 2008, one-third of people who received hospice care had it for a week or less, said the National Hospice and Palliative Care Organization.

■ Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly onethird of all Medicare dollars.

“People are actually now sicker as they die,” and some find that treatments become a greater burden than the illness was, said Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center. Families may push for treatment, but “there are worse things than having someone you love die,” he said.

Gail Sheehy, author of the “Passages” books, learned that as her husband, New York magazine founder Clay Felker, spent 17 years fighting various cancers. On New Year’s Day 2007, they waited eight hours in an emergency room for yet another CT scan until Felker looked at her and said, “No more hospitals.”

“I just put a cover over him and wheeled him out of there with needles still in his arms,” Sheehy said.

Then she called Dr. R. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine and a doctor at Mount Sinai School of Medicine in New York.

“Nobody had really sat down with them about what his choices are and what the options were,” said Morrison,

AP photos

Above, in this 2008 photo released by Gail Sheehy, Sheehy is shown with her husband, Clay Felker; her daughter, Maura; and grandson, Clay, shortly before Felker died of cancer. A year earlier, he had told Sheehy, “No more hospitals.” Sheehy sought advice from a hospice expert as she and husband coped with his terminal cancer. At right, this undated photo shows Rosaria Vandenberg, right, with her husband, John, and daughter, Alessia. After Roasaria lost her battle with cancer in the hospital in 2004, her sister-in-law, Alexandra Drane, created a website to help support a person’s option to spend their final days at home. who became his doctor.

About a year later, Felker withdrew his own feeding tube, and “it enabled us to go out and have a wonderful evening at a jazz club two nights before he died” in July 2008, Sheehy said.

Doctors can’t predict how soon a patient will die, but they usually know when an illness has become incurable.

Even then, many of them practice “exhaustion medicine” – treating until there are no more options left to try, said Dr. Martha Twaddle, chief medical officer of Midwest Palliative & Hospice Care Center in suburban Chicago.

A stunning number of cancer patients get aggressive care in the last days of their lives, she noted. One large study of Medicare records found that nearly 12 percent of cancer patients who died in 1999 received chemo in the last two weeks of life, up from nearly 10 percent in 1993.

Guidelines from an alliance of leading cancer centers say patients whose cancer has spread should stop getting anti-cancer medicine if sequential attempts with three different drugs fail to shrink their tumors. Yet according to IntrinsiQ, a cancer data analysis company, almost 20 percent of patients with colorectal cancer that has spread are on at least their fourth chemotherapy drug. The same goes for roughly 12 percent of patients with metastatic breast cancer, and for 12 percent of those with lung cancer. The analysis is based on more

than 60,000 cancer patients.

Often, overtreating fatal illnesses happens because patients don’t want to give up.

Saideh Browne said her mother, Khadija AkmalLamb, wanted to fight her advanced ovarian cancer even after learning it had spread to her liver. The 55-year-old Kansas City, Mo., woman had chemo until two weeks before she died last August.

“She kept throwing up, she couldn’t go to the bathroom,” and her body ached, Browne said. The doctors urged hospice care and said, “your mom was stubborn,” Browne recalled. “She wanted her chemo and she wanted to live.”

Browne, who lives in New York, formed a women’s can-

cer foundation in her mother’s honor. She said she would encourage dying cancer patients to choose comfort care over needless medicine that prolongs suffering.

It’s easier said than done.

The American way is “never giving up, hoping for a miracle,” said Dr. Porter Storey, a former hospice medical director who is executive vice president of the hospice group that Morrison heads.

“We use sports metaphors and war metaphors all the time. We talk about never giving up and it’s not over till the fat lady sings .... glorifying people who fought to their very last breath,” when instead we should be helping them accept death as an inevitable part of life, he said.

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when deciding whether to try one of the newer, extremely expensive cancer drugs such as Avastin, Erbitux and Tarceva. Some are touted as

“improving survival by 30 or 50 percent” when that actually might mean living three weeks or months longer instead of two.

“It’s amazing how little benefit those studies show,” Storey said, referring to research on the new drugs.

Dan Waeger tried just about all of them. A nonsmoker, he was diagnosed with lung cancer at age 22, and pursued treatment after treatment before dying nearly four years later, in March 2009.

“He decided if there were odds to be beat, he was going to beat the odds,” said his boss, Ellen Stovall, then-president of the National Coalition for Cancer Survivorship, where Waeger worked as a fundraiser and development manager.

“He received just about every experimental new drug for lung cancer that I’m aware of in his last two years of life. He would get a treatment on a Friday afternoon, be sick all weekend and come to work on Monday,” she recalled.

“He had these horrific rashes. He would get these horrible coughs that were not just the lung cancer. The treatments were making him cough up blood, just horrific side effects – vertigo, numbness, tingling in his hands and feet. He suffered.”

Waeger’s fiancee, Meg Rodgers, said they worried about exceeding the lifetime limits on his insurance, since the care was so expensive.

“I think every time he got a treatment, it was $10,000,” though he paid only a $10 copay, she said.

Yet it was clearly worth any price to him – he died a week before they were to be married, after receiving home hospice care for only two weeks.

“I honestly believe he would have done anything he could to live one more day,” Rodgers said.

Some health policy groups say cancer patients, as well as people with failing hearts or terminal dementia, should get better end-of-life counseling. Last year, a plan that would have let Medicare pay for doctors to talk about things like living wills was labeled “death panels” and was dropped.

Ultimately, how patients and their families make the journey is a matter of personal choice – and there are resources to help them, Stovall said.

“I’ve heard a lot of people over the years say what they would do if they had cancer until it is them. And then they will cling to even the smallest glimmer that something will help,” she said.

“Cancer that can’t be cured is often called daunting but not hopeless. So that’s what patients hear. Hope is the last thing to go. People don’t give that up easily.”

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HEALTH & FITNESS

The Daily Nonpareil

Sunday, July 11, 2010 3F

Orthopedics, chiropractics can co-exist DENNIS FRIEND Staff Writer dennis.friend@nonpareilonline.com (712) 325-5746

Sprains, strains and fractures cause frequent trouble MIKE BROWNLEE Staff Writer mike.brownlee@nonpareilonline.com (712) 325-5732

With summer comes slow-pitch softball, sand volleyball, running and a myriad of other athletic activities, which puts active people at risk for sprains, strains and fractures. But surprisingly enough, summer is actually the slow season for injuries of that sort, according to Mike “Sal” Salerno at Flex Physical Therapy.

“We generally slow down in the summer,” Salerno said. “Because you don’t have as many wintery-condition injuries.”

Salerno said this past winter, which piled snow and ice on the metro area, was rough for injuries.

“A lot of people slipping and falling,” he said.

And fall through spring also has more high school sports, Salerno said, meaning more athletic injuries.

That doesn’t mean the injuries don’t occur in the warm-weather months. Sprained ankles, strained backs, pulled muscles, shoulder trouble … it’s all lurking behind the next swing of the bat, the next golf ball driven, the next jump shot taken.

Salerno said avoiding these

injuries is easy if you follow some common-sense steps.

“Be in good shape for activity,” Salerno said. “Get warmed up before strenuous activity, with a five- to 10minute warm up, then stretch out.

Understand your limits and work within your capacity. A lot of these things happen when people try to do too much. People get tired, and when you’re tired, your muscles don’t fire.

Fatigue sets in and you’re more susceptible to injury.”

But alas, injuries do happen.

Salerno explained that sprains are injuries to ligaments, which are tissue that do not contract. A strain includes muscle tissue, which is contractile.

Treat sprains by employing protection, rest, ice, compression and elevation, or PRICE, according to Salerno.

“That’s first aid for all sprains and strains,” he said. “And, with elevation, it’s best to put it above the heart.”

When PRICE isn’t enough, Salerno and staff at Flex work with patients to improve range of motion and strengthening through isometrics.

Salerno gave an example of isometrics as like a person trying to lift a car.

“You wouldn’t move the car,” Salerno said. “But your muscles would contract. There’s no joint motion – your elbow doesn’t move – but your

muscles contract and build strength.

And there’s not a lot of pressure on the joint.”

With fractures most of the same therapies are used, with range of motion an even greater focus.

“It’s crucial,” Salerno said. “They’ve been immobilized, we get them on an exercise routine.”

The goal is to get things back to normal, he said.

Salerno said 75 percent of the patients at Flex have sprains and strains to varying degrees of severity.

“We see a lot of sprained ankles, a lot of knee trouble. Anterior cruciate ligament tears, knee cap injuries, other anterior knee pain, a lot of shoulder rotator cuff, a lot of lower back strains and sprains.”

Salerno said the injuries come about from a variety of activities.

“We see a lot of workman’s comp, motor vehicle accidents and slips and falls,” he said. “Lot of yard work injuries.”

An orthopedic doctor is a medical professional who treats and diagnoses illnesses and injuries related to the musculoskeletal system.

A chiropractor is a medical professional who treats and diagnoses illnesses and injuries related to the musculoskeletal system.

However, there are significant differences between the two fields of practice, according to Alicia Hamze, marketing director for Miller Orthopaedics in Council Bluffs.

Both are health care practitioners, she said, and practitioners in both areas are legally doctors. They focus on the musculoskeletal system system, which includes bones, joint, ligaments, tendons, muscles and nerves.

“A chiropractor tries to keep people in alignment, treating conditions in which the system is compromised. It’s a non-invasive treatment,” offering alternatives to medication and surgery, Hamze said.

When the problem is more significant, “Orthopedic surgeons know the musculoskeletal system, and orthopedic surgeons may use injections or surgery when necessary,” she said. Chiropractors can treat people through a therapeutic approach involving the movement and manipulation of the spinal column, joints and muscles. Chiropractors are most commonly associated with relieving back pain.

More advanced problems may require orthopedic surgeons and their ability to repair muscles and tendons, replace joints or fuse spines and ankles, Hamze said.

Both fields of medicine can and do co-exist, she said.

“It’s becoming more common to work together. There’s not as large a divide,” Hamze said. “More and more medical doctors see room for other areas or specialties. They both have their place.”

At Miller Orthopaedic, there are five orthopedic surgeons and one podiatrist. Each orthopedic surgeon has a specialty, and the staff has one spine specialist, one total joint specialist and three sports medicine specialists.

“Sports medicine is a relatively new field, but sports have changed and more people are active,” she said. “It’s amazing how many people in their 50s are still active.”

The drawback to someone older trying to participate in sports in the same way they did in high school is “their joints will show the wear and tear.”

The chiropractic approach is complementary to other areas of primary health care. There is a growing trend of cooperation between medical practitioners and chiropractors.

Miller Orthopaedic Affiliates is at 1 Edmundson Place, Suite 500, in Council Bluffs. There are regularly scheduled clinics in Council Bluffs, and outpatient clinics at several locations in throughout southwest Iowa. For appointments, call (712) 232-5333.

Staff photo/Cindy Christensen

Physical Therapist Mike “Sal” Salerno reassesses an old ACL sprain on patient Cory Green at Flex Physical Therapy located at 928 Valley View Drive.

Submitted photo

Bottom photo, Dr. Daniel Larose of Miller Orthopaedics examines Merle Joslin, who had his left rotator cuff repaired in February. He did therapy on his own using the exercises he was shown by a physical therapist.

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HEALTH & FITNESS

4F Sunday, July 11, 2010

The Daily Nonpareil

Boredom, fat busted at AK Peak Fitness CHAD NATION

Husband and wife team to start new gym

Staff Writer cnation@nonpareilonline.com (712) 325-5738

The slogan is “1,350 minutes. 30 days. 1 lifestyle change.”

AK Peak Fitness, 527 S. Main St., has brought a new workout regimen to Council Bluffs. Owners Jim and Courtney Lovely opened the facility on July 1.

Jim Lovely said it has been a goal to open a fitness facility for the past five years.

“I wanted to bring this to Council Bluffs,” Jim Lovely said. “I enjoy and get satisfaction from seeing people leave the gym with a smile after a good workout.”

And Jim Lovely has the credentials to put someone through a “good workout.”

A National Exercise & Sports Trainers Association certified personal trainer, Jim Lovely has been a boot-camp

instructor since 2005. He has also had the opportunity to train some of southwest Iowa’s finest athletes.

Jim Lovely also coaches varsity baseball at St. Albert, where he said he tries to incorporate new training methods to improve the athletes’ performance both on and off the field.

“I’ve been involved in athletics my entire life,” he said.

Jim Lovely said what sets AK Peak Fitness apart from other area gyms is how the workouts are designed. It truly is 1,350 minutes over 30 days.

“We have a five-week session, six days a week,” he said.

Those people working out will spend three days on strength training, including resistance bands, medicine ball work and light hand weights.

The other three days a week will be spent on cardio, but not running in place.

“For cardio, we use kickboxing with freestanding heavy bags,” Lovely said. “It is a workout that most people haven’t experienced.”

The workout is designed to not only lose inches and body fat, but also gain strength, as well as confidence.

Lovely said the workouts also are enjoyable because of the group setting. And no two workouts are the same.

“Our aim is to shock the body,” he said. “But you’re not going to get the same workout twice in five weeks.”

By varying the workout, it also keeps people interested in working out.

“It keeps you coming back

and interested; you don’t get bored with the workout, because you never know what to expect,” he said. “The big thing we want is something that challenges you, but is also really enjoyable.”

Four classes are available, 5 and 6 a.m. and 5:45 and 6:45 p.m. Students will also receive kickboxing gloves, pre- and post-regiment testing, a nutritional seminar and a shirt.

For more information, call (402) 206-7848 or go online to www.cbpeakfitness.com.

Staff photo/Cindy Christensen

At right, Jim Lovely, along with his wife Courtney, is the owner of AK’s Peak Fitness, 527 Main St. The facility has a five-week session, according to Jim. People working out will spend three days on strength training, including resistance bands, medicine ball work and light hand weights.

Dentures require special care TIM ROHWER Staff Writer timothy.rohwer@nonpareilonline.com (712) 325-5752

Stop your period from controlling your life

Believe it or not, dentures have been around hundreds of years, perhaps even a thousand years.

Back in the 1200s, according to a longtime dentist, the Chinese made dentures out of ivory and people in Japan in the 1500s had to wear dentures made of wood.

Needless to say, denture technology has come a long way since then and, in fact, fewer people need dentures than just a few decades ago, said Dr. Sol Kutler, who operates Dr. Sol Kutler’s Dental Health Center in Omaha.

“In the middle of the 20th century, half of the people over 65 needed or wore dentures,” he said. “The percentage of people wearing dentures is lower than it used to be.”

In fact, only 18 percent of older people today do not have their original teeth, Kutler said.

“That’s a big improvement,” he said.

He credits better dental operations like root canals that help save teeth longer, plus more awareness of better teeth care.

“It’s important to go for periodic checkups,” Kutler said.

A major reason for dentures, especially among younger people, is gum disease, he said.

“Bleeding is part of the indication of gum disease,” Kutler said. “Even though gums may be unhealthy, they can be treated. You need to go to the dentist twice a year.”

Daily brushing and flossing is important, but dentists can remove built-up tartar or calcium that can lead to this disease, he said. And, it’s more than just the health of the teeth.

Infections in the mouth can spread to other parts of the body, Kutler said, and constant irritation on the gums can actually lead to cancer.

There are full dentures that replace all of the teeth or partial dentures, which are held in place by the person’s remaining teeth.

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A major reason for dentures, especially among younger people, is gum disease.

With full dentures, Kutler recommends they be taken out at night and wrapped in damp tissue.

“You don’t have to put them in water,” he said. “And, keep them away from the dog.”

Today’s dentures feature a softer, moister base for comfortable wear, he added.

Eventually, dentures should be replaced, Kutler said.

“People tend to wear them too long. I recommend not to go longer than 10 years.”

That’s because the gums continue to shrink with less gum ridge to work with and creating a wrinkled, squashed up look for the mouth. The dentures may also become loose, though a reline can be done to help the problem.

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said, and to practice reading out loud because some words and letters may sound differently now.

When cleaning dentures, a toothbrush with toothpaste is enough. Soaking tablets are OK to use, but not more than 20 minutes at a time. Another alternative that is safe is diluted vinegar in water, he said.

Reaction to their new dentures can vary among wearers, according to Kutler. While some may have reluctant acceptance, others may enjoy relief from the constant pain of their real teeth, and there are those who discover a world of new confidence in smiling and talking directly to people.

Nevertheless, dentures can never really replace the original thing, according to Kutler.

“It’s still an artificial substitute.”

Only women with excessive menstrual bleeding who are finished having children may be candidates for the NovaSure procedure. As with any medical procedure, there are risks to be considered. In a small percentage of patients, side effects of the NovaSure procedure included cramping, nausea/vomiting, discharge, and spotting. Talk to your doctor for further information about the full benefits and risks of the NovaSure procedure. 1. Data on file, Hologic, 2009. 2. Cooper J, Gimpelson R, Laberge P, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc. 2002;9(4):418-428. 3. Laberge PY et al; Assessment and Comparison of Intraoperative and Postoperative Pain Associated with NovaSure and ThermaChoice Endometrial Ablation Systems. J Minim. Invasive Gynecol. 2003; 10(2); 223-232

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HEALTH & FITNESS

The Daily Nonpareil

Task force urges bone-density tests for more women NEW YORK (AP) – Routine screening for osteoporosis should include all younger postmenopausal women who have at least the same chance of a bone break as an older woman, a government task force said Monday.

Also, for the first time, the group weighed whether men should be checked for the bonethinning disease, but it decided there wasn’t enough evidence to recommend for or against the screening.

The U.S. Preventive Services Task Force’s draft guidelines widen its 2002 advice, when it first said that all women over 65, plus those 60 to 64 at higher risk for fractures, should get a bone density test.

The task force now says all younger postmenopausal women should get checked if their risk of a broken bone is the same or greater than the average 65-year-old woman.

Factors that can increase risk include low weight, certain drugs, smoking, heavy alcohol use and a parent who broke a hip.

“The majority of the evidence supports screening and treatment of osteoporosis in postmenopausal women,” the task force wrote. “The evidence for primary prevention in men is lacking and future research is needed.”

In a break from previous practice, the independent, government-appointed panel posted a draft of the guidelines online Monday to allow for public comment. The task force had been considering the move, but the reaction to its controversial mammogram guidelines last fall spurred the group to open the process earlier, said Dr. Ned Calonge, head of the panel.

Also Monday, the Annals of Internal Medicine published a review done for the task force of the latest research on screening methods, bone-building drugs and tools to calculate one’s risk of low bone density and fractures.

Since the 2002 advice, a number of new osteoporosis drugs have been released and heavily advertised, such as Genentech’s Boniva, promoted by actress Sally Field.

Osteoporosis weakens bones and leads to painful and crippling fractures primarily in the hip, spine and wrist. In women, it’s mostly caused by a drop in bone-strengthening estrogen after menopause. The government estimates that 10 million Americans have the disease and half of all women will suffer an osteoporosis bone break in her lifetime.

The task force used a Webbased risk calculator called FRAX – http://www.shef.ac.uk/FRAX – that estimates one’s odds of a fracture within 10 years. It shows women as young as 50 may meet the threshold for a bone test depending on their risk factors, the panel said.

A bone-mineral density Xray is the one most frequently used tests to check for bone loss, and many women start getting the scans once they reach menopause. How frequently the checks are made varies. The task force said there’s not enough evidence to say how often they should be done, but that a couple of years between tests are needed.

One large study found no advantage to repeating the test even after eight years, said Dr. Heidi Nelson, who led the scientific review done at the Oregon Evidence-based Practice Center at the Oregon Health and Science University in Portland.

“So we can really lay off a lot of these repeat screening tests,” she said.

Other medical or advocacy groups support screening women older than 65, and generally advise tests for younger women based on risk factors.

The National Osteoporosis Foundation recommends screening men older than 70; the American College of Physicians says doctors should check older men for risk factors.

Study: Teens benefit from later school day CHICAGO (AP) – Giving teens 30 extra minutes to start their school day leads to more alertness in class, better moods, less tardiness, and even healthier breakfasts, a small study found.

“The results were stunning.

There’s no other word to use,” said Patricia Moss, academic dean at the Rhode Island boarding school where the study was done. “We didn’t think we’d get that much bang for the buck.”

The results appear in July’s Archives of Pediatrics & Adolescent Medicine. The results mirror those at a few schools that have delayed starting times more than half an hour.

Researchers said there’s a reason why even 30 minutes can make a big difference.

Teens tend to be in their deepest sleep around dawn – when they typically need to arise for school. Interrupting that sleep can leave them groggy, especially since they also tend to have trouble falling asleep before 11 p.m.

“There’s biological science to this that I think provides compelling evidence as to why this makes sense,” said Brown University sleep researcher Dr. Judith Owens, the study’s lead author and a pediatrician at Hasbro Children’s Hospital in Providence, R.I. An Archives editorial said the study adds to “a growing body of evidence that changing the start time for high schools is good for adolescents.”

The fact that the study was in the exclusive setting of St. George’s School in Middletown, R.I., doesn’t necessarily weaken the results. Owens acknowledged that there might be more hurdles to overcome at poorer, public schools, including busing

‘The results were stunning. There’s no other word to use.

We didn’t think we’d get that much bang for the buck.’

– Patricia Moss academic dean

schedules, parents’ work hours and daycare for younger siblings. While these issues have killed many proposals elsewhere, some public high schools including those in Minneapolis and West Des Moines have adopted later starting times.

Mel Riddile, an associate director at the National Association of Secondary School Principals, favors later class times for teens but said most districts oppose it.

“It’s about adult convenience, it’s not about learning,” he said. “With budget cuts, it’s going to make it more difficult to get this done.”

Many parents and teachers at St. George’s were opposed but reluctantly agreed to the study after a presentation by Owens, whose daughter was a junior there.

Overall, 201 high school students completed sleep habit surveys before and after the nine-week experiment last year. The results were so impressive that the school made the change permanent, Moss said.

Starting times were shifted from 8 to 8:30. All class times were cut 5 to 10 minutes to avoid a longer school day that would interfere with afterschool activities. Moss said improvements in student alertness made up for that lost instruction time.

Sunday, July 11, 2010

5F

Cancer survivors urged to exercise WASHINGTON (AP) – Cancer survivors, better work up a sweat.

New guidelines are urging survivors to exercise more, even – hard as it may sound – those who haven’t yet finished their treatment.

There’s growing evidence that physical activity improves quality of life and eases some cancer-related fatigue. More, it can help fend off a serious decline in physical function that can last long after therapy is finished.

Consider: In one year, women who needed chemotherapy for their breast cancer can see a swapping of muscle for fat that’s equivalent to 10 years of normal aging, says Dr. Wendy Demark-Wahnefried of the University of Alabama at Birmingham.

In other words, a 45-yearold may find herself with the fatter, weaker body type of a 55-year-old.

Scientists have long advised that being overweight and sedentary increases the risk for various cancers. Among the nation’s nearly 12 million cancer survivors, there are hints – although not yet proof – that people who are more active may lower risk of a recurrence. And like everyone who ages, the longer cancer survivors live, the higher their risk for heart disease that exercise definitely fights.

The American College of Sports Medicine convened a panel of cancer and exercise specialists to evaluate the evidence. Guidelines issued this month advise cancer survivors to aim for the same amount of exercise as recommended for the average person: about 2½ hours a week.

Patients still in treatment may not feel up to that much, the guidelines acknowledge, but should avoid inactivity on their good days.

“You don’t have to be Lance Armstrong,” stresses Dr. Julia Rowland of the

AP

Bobbie Ritt, right, watches as her husband, Ed Ritt, lifts weights at a couples exercise class for cancer patients at Oregon Health and Sciences University in Portland, Ore. National Cancer Institute, speaking from a survivorship meeting this month that highlighted exercise research. “Walk the dog, play a little golf.”

But how much exercise is needed? And what kind?

Innovative new studies are under way to start answering those questions, including: ■ Oregon Health and Science University is training prostate cancer survivors to exercise with their wives.

The study will enroll 66 couples, comparing those given twice-a-week musclestrengthening exercises with pairs who don’t get active.

Researchers think exercising together may help both partners stick with it.

They’re also testing if the shared activity improves

both physical functioning and eases the strain that cancer puts on the caregiver and the marriage.

“It has the potential to have not just physical benefits but emotional benefits, too,” said lead researcher Dr. Kerri Winters-Stone.

■ Demark-Wahnefried led a recent study of 641 overweight breast cancer survivors that found at-home exercises with some musclestrengthening, plus a better diet, could slow physical decline.

■ Duke University is recruiting 160 lung cancer patients to test if threetimes-a-week aerobic exercise, strength training or both could improve their fitness after surgery. Lung cancer has long been thought

Andrew Stanislav, DPM, FACFAS**

beyond the reach of exercise benefits because it’s so often diagnosed at late stages. But Duke’s Dr. Lee Jones notes that thousands who are caught in time to remove the lung tumor do survive about five years, and he suspects that fitness – measured by how well their bodies use oxygen – plays a role.

People with cancer usually get less active as symptoms or treatments make them feel lousy. Plus, certain therapies can weaken muscles, bones, even the heart.

Not that long ago, doctors advised taking it easy.

Not anymore: Be as active as you’re able, said Dr. Kathryn Schmitz of the University of Pennsylvania, lead author of the new guidelines.

“Absolutely it’s as simple as getting up off the couch and walking,” she says.

Exercise programs are beginning to target cancer survivors, like Livestrong at the YMCA, a partnership with cycling great and cancer survivor Lance Armstrong’s foundation. The American College of Sports Medicine now certifies fitness trainers who specialize in cancer survivors.

But anyone starting more vigorous activity for the first time or who has particular risks – like the painful arm swelling called lymphedema that some breast cancer survivors experience – may need more specialized exercise advice, Schmitz said. They should discuss physical therapy with their oncologist, she advises.

Jeffrey Kiley, DPM, FACFAS**

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HEALTH & FITNESS

6F Sunday, July 11, 2010

The Daily Nonpareil

Health insurance in tough times Experts: Routines Practical choices for meeting care and budget needs

Family Features

When evaluating health insurance options, the key is to find the coverage that meets both a family’s health care and budget needs. can help consumers save on both their health insurance premiums and their taxes.

When evaluating health insurance options, the key is to find the coverage that meets both a family’s health care and budget needs.

Golden Rule provides the following tips for individuals and families looking for health insurance today: ■ Do business with a reputable company. Ask a trusted friend or family member, or check companies’ websites for their A.M. Best rating, which indicates financial strength and stability.

■ Understand the plan that is being purchased, what it covers and what it doesn’t. The buyer should know what they are responsible for paying. Ask questions.

■ Find a company with a strong national network of doc-

tors and hospitals. Network discounts might save 30 to 40 percent or more on the cost of medical care. And it’s helpful to know that there are doctors and hospitals one can use wherever one might visit or if you have to relocate to find employment.

■ Consider plans that offer higher deductibles, which generally mean lower premiums for you.

The original minimally invasive treatment

Preserving health insurance coverage is a continuing concern in today’s economy. The lingering recession has cost millions of Americans their jobs – and the health care benefits they have relied on.

While COBRA coverage is a viable option for many workers and families losing their employer-sponsored coverage, it can be costly, even with the government’s 65 percent subsidy.

Fortunately, there are lowercost alternatives available today. According to UnitedHealthcare’s Golden Rule Insurance Company, which has offered health insurance to individuals and families for more than 60 years, short term health plans might be a more affordable option for many laidoff workers and their families.

In fact, short term plans are designed for workers between jobs, new graduates looking for work, students dropping off their parents’ plans, new employees not yet covered by employer plans, early retirees awaiting Medicare eligibility and others whose lives are in time of transition.

Depending on the state, Golden Rule’s short term plans can offer anywhere from one to 12 months of coverage and a wide range of deductibles starting at $250 up to $10,000. The plans are easy to understand, the application process is simple and applicants generally hear back within 24 to 48 hours.

In many states, a person can reapply for consecutive short term plans. Importantly, a person can drop the plans at anytime without penalty.

In addition to short term plans, a wide range of other plans is available to individuals and families not covered by health plans through their employer, including lower-cost high deductible plans and health savings accounts, which

■ Be certain that coveragecan be dropped without penalty if a job with health benefits is found.

■ For more information on short term or other health plans, talk with a local health insurance broker or go online to health insurance company websites such as www.goldenrule.com.

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As summertime workouts heat up, proper post-exercise cool-downs become even more important.

Whether someone is a weekend warrior playing in local summer leagues or a serious runner getting ready for fall marathon season, warmer weather activities increase sweat, break down muscles and deplete the body of electrolytes and other essential nutrients.

“What you do after your workout is just as important as a pre-workout routine, especially during the summer when people tend to be more active,” Fitness expert Lorrie Henry said. Henry has shared some of her post-workout tips to help everyone have a fun and healthy summer season: ■ Cool It: Take the time to cool-down after an intense

workout. Spend the last five to seven minutes of the workout on a lower speed or intensity to return the heart rate to normal, and consider walking the last two minutes on a treadmill.

■ Stretch Out: Avoid next day soreness and stretch your muscles immediately after exercise.

■ Keep Track: Write down what you did during the workout (i.e. miles ran, fitness classes attended, etc.).

■ Refuel Smart: After a tough workout, grab a nutrient-rich drink for maximum benefits.

■ Take A Breath: Take a few minutes to relax.

For more information on the healthy benefits of refueling with chocolate milk, go online to RockinRefuel.com.

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