January 2024 OutreachNC by OutreachNC

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J A N U A R Y 2 0 2 4

Precision Nutrition: Medical Nutrition Therapy for Individual Wellness Last month, a friend of mine went to visit his father for a pre-holiday celebration. He said to me, “Dad loves his treats, so I took him some cookies from the kids’ cookie decorating party. Most of the time, he can’t eat sweets, but we make an exception at Christmas.” My friend’s dad is prediabetic, so watching his sugar intake is an important part of preventing diabetes and making sure he lives a long, healthy life, avoiding too many health complications. Many American families and seniors struggle with similar food choices because of health conditions. In fact, millions of American seniors manage chronic health conditions. According to the Centers for Disease Control and Prevention (CDC), 78% of Americans 55 years of age and older live with at least one chronic health condition. The percentage of people with two chronic conditions is 47%, and 19% of Americans 55+ have three or more chronic health conditions. The CDC lists six chronic health conditions including diabetes, cardiovascular disease, Chronic Obstructive Pulmonary Disease (COPD), asthma, cancer and arthritis.

continued on page 6 ASK THE EXPERT: DIETARY ISSUES IN AGING FEATURE: PRECISION NUTRITION: MEDICAL NUTRITION THERAPY FOR INDIVIDUAL WELLNESS MENTAL HEALTH MATTERS: THE MINDBODY CONNECTION

LETTER FROM THE EDITOR

Welcome to 2024!

Well, it’s official: fall is here. I had my first pumpkin-spiced latte just ture dipped low enough to merit a fleece. elimination diet. Helping our parents navigate their own

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

health can be challenging. Don’t worry. It was decaf. Seace offers expert advice for OCTOBER 2022arbitrary -2 We enter another 365 days to meet what can be supportive rather than intrusive. our goals,Well, improve our lives, and survive, it’s official: fallthrive is here. I had my first pumpkin-spiced latte justThere two days ago, as the evening temperaOctober is a gentle month. are constant reminders of change all in a series months, days and a fleece. Amytoward Pharisseach (yes…that’s begins a newconversations o ture of dipped lowweeks, enough to merit weFinally, are lucky, other. Weme) have lingering hours. Sometimes, it really is hour-by-hour. monthly Mentaldances Healtharound Matters…because the flames column: flicker. Smoke us in a circle.it We zip our ja Don’t worry. It was fly decaf. And sometimes, the months by; we look does! This month we explore the connection between back in amazement that another 30 days have Inphysical pain and mental health. We dig how mental this month’s feature, we’re starting aninto important conversation October is a gentle month. There are constant reminders of change. We turn inward, toward warmth and i passed us by. Before we know it, December health therapies for canourselves help with or chronic physical pain.Hollow If care community a loved one? Fox Senio we are lucky, each other. We have lingering conversations over tea. burn fires and sit silence rolls around again, andtoward we’re baking Christmas you or someone you love livesperspective withWe pain, you’ll want to Robin Hutchings offers inside for making thisindecision. the flames flicker. Smoke dances around us in a circle. We zip our jackets and consider hats. cookies and planning for another 12 months. read about possible options for easing that pain. In Ask the Expert, Amy Natt answers a reader’s question regarding In get thisahead month’s feature, we’re starting an conversation: howyear, do we proper senio But let’s not of ourselves. Let’s sit for away As important we roll right along a new let’schoose it with without any estateinto planning. Without adowill orthe access to impo care community for ourselves or a loved one? Fox Hollow Senior Living’s Sales and Marketing Directo a moment and let the new year simmer. some zest and as much positive momentum as we can Robin Hutchings offers inside perspective for making decision. Physical therapist Dr. Sara Morrison of Total Body Therapy and We muster. In thethis words of Willie Nelson: We’re starting 2024 off with a bang and potential diagnostic tools used in physical therapy to help diagnose In on Askgetting the Expert, Amyout Natt answers a these reader’s question regarding do when a loved passes going all-in the most of our tools differ from what what otherto doctor’s offices mayone offer. away without any estate planning. Without a will or access to important accounts, what does a family do? medical care. Pinehurst Medical Clinic’s Callie going to agree with Nathaniel Hawthorne this month, who wro Huneycutt answerstherapist all of ourDr. questions about of I’m Physical Sara Morrison Total Body Therapy and Wellness helps readers understand a therapypotential many of us are unfamiliar with:in physical diagnostic tools used therapy to helptodiagnose and treat You’llaswant to learn how I cannot endure waste anything sopain. precious autumnal sunsh Medical Nutrition Therapy (MNT). What And if we can’t enjoy a year starting off with a Willie these tools differ from what other doctor’s offices mayalloffer. spent almost the daylight hours in the open air. is it? Who needs it? And where can we get it? Nelson quote, what can we enjoy? I’m going to with Nathaniel this month,the who wrote: sunshine, falling leaves and daylight Here’s to enjoying October Huneycutt answers all agree of these questions andHawthorne more. If you’ve ever thought this might be the I cannot endure to waste anything so precious as autumnal sunshine by staying in the house. So I have time to live a healthier life and manage your spent almost all the daylight hours in the open air. facebook.com/ag health in a more positive way, MNT might be just what Here’s you need! to enjoying the October sunshine, falling leaves and daylight hours. instagram.com/ag

LETTER FROM THE EDITOR

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

LETTER FROM THE EDITOR

2 - JANUARY 2024

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

OCTOBER 2022 - 2

Positive anything is better than negative nothing.

AOS Care Manager Ashley Seace answers a reader’s question about his mom’s diet and how he can support her as she embarks on an

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ASK PT:THE WHERE EXPERT: DO DIETARY SYMPTOMS ISSUES COME IN AGING FROM?

4 OCTOBER - JANUARY 2022 2024 - 10 No one likes to be in pain. In fact, I have Question: spent the past 20+ years helping people get My mom has started an elimination diet to out of pain. The most common question I feel better. She’s avoiding gluten, dairy and hear is “How can I get this pain to go away?” some fruits and vegetables. I want her to feel The answer to this is simple. We first need good and to be healthy, but I’m worried she’s to know Why you are hurting. Then we can not getting enough nutrients or calories. figure out how to stop the pain. So, why are And I’m also worried this diet is causing her you hurting? There are many different reasons more anxiety. Should I say something to her for pain to occur in our bodies. Pain can or just stay out of it? be due to a problem in the Muscles, Joints, Tendons, Answer: Organs or Nerves. It can also be due Psychological reasons, or ThistoisMedication, a fantastic question! Dietary concerns Nutrition and the anxiety that surrounds not feeling well because of your diet are very common in Many health care professionals diagnose pain the aging population. And as an adult child, by Special Tests. During these tests, your you want to do what is best for your parents, practitioner will use their hands to push, but you also want to respect their space and pull and twist the areas that are causing you boundaries. pain. These tests are very useful to find what structure is causing If you place My first question foryou youpain. to consider is the stress on a structure it increases yourAre relationship you haveand with your parents. pain, it is involved likely thatinstructure is contributing you very their care? If you are, I to youritsymptoms. Although helpful, many think is completely appropriate for you to of these special tests are only 60-80% accurate. get involved with their diets and make sure While this may looksmoothly good at first, changing everything is going for them. If you the way the question is framed will show are not very involved with their care, theythat this also means they are 20-40% inaccurate. might show some resistance to you getting Misdiagnosis of pain can be very costly. involved with their diets and what your At best itparents keeps you in painonlonger, while inbasis. other cases are doing a day-to-day it can allow symptoms to intensify. When you If you’re concerned with the amount of are dealing with pain, missing your favorite nutrients or calories your parents are getting, activities and sleepless nights… you want to be it would beas beneficial as accurate possible!to consult with their primary care physician. Their primary care The addition Diagnostic Imaging in physician canofmake appropriate suggestions Physical Therapy has revolutionized way for supplemental calories. There are the options pain is addressed. By utilizing Diagnostic Imaging, PT’s are now able to look inside you

and diagnose your pain with over 98% accuracy. out there to increase the number of calories someone That means that we can find the real problem, or is getting every day, such as Boost or Ensure, but problems, and address them from the beginning. it is important to consult with a medical provider No more trial and error. No more “try this for a before you start drinking them. I also think it would few months and if it doesn’t get any better we will be a good idea for your parents to speak with a try to get an MRI”. With the addition of Diagnostic nutritionist because they can help them create a imaging, your Physical Therapist can now say “From meal plan that is best suited to their dietary needs. my evaluation it looks like you have a problem in A nutritionist will look at foods that trigger dietary ____. We are going to do a Diagnostic Ultrasound problems, and they can discuss healthy ways for your and confirm this and fully check your joint.” parents to get the right nutrients and calories every In a matter of a few days, we can have your test day. It can be hard doing an elimination diet and performed, results given to you and a new, more finding foods that are both good tasting and have comprehensive plan to improve your pain. good nutritional value sometimes. Diagnostic imaging in physical therapy includes: If you and your parents have a close relationship, it might be worth mentioning to them that they can 1. Musculoskeletal Ultrasound (MSKUS) always speak with a mental health provider as well. If their diet is making them anxious, it doesn’t hurt to talk to someone and make sure there aren’t any other factors playing into their anxiety. Taking care of yourself involves both caring for your physical needs and your emotional needs, so sometimes talking to an unbiased third party can be helpful. If their anxiety is caused by more than just the diet, then they can always try counseling or anxiety medication to address those feelings. It doesn’t hurt to bring up your concerns to your parents if you think it will be received well by them. MSKUS is a might safe, non-invasive, painlesselse to In fact, they be waiting forand someone diagnostic is used to diagnose step in and tool. assist Itthem because they arestructures anxious and such as tendons, muscles, bursas, nerve overwhelmed trying to find foods ligaments, that are safe for entrapment/pinching and joint structure changes. them to eat right now! Like a video, MSKUS captures real-time images of body structures and can assess a joint/area while it moves. This feature is especially useful as many times pain does not occur at rest, only with movement.

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Reduces breast and prostate cancer risk; boosts, heart, brain, eye and bone health.

Fights cancer, reduces inﬂammation, supports immune system and boosts vision.

Inhibit tumor cell growth, detoxify harmful substances, boosts immune system, reduce inﬂammation and boost heart health.

Builds healthy cells and genetic material and boosts heart health. Calcium strengthens bones, muscles and heart health.

Indoles and lutein

Anthocyanins

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Eliminate excess estrogen and carcinogens and support eye health.

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May decrease estrogen production, boosts heart and brain health.

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ESSENTIAL FOR

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6 - JANUARY 2024

PRECISION NUTRITION: Medical Nutrition Therapy for Individual Wellness by Amy Phariss

The National Council on Aging (NCOA) includes several other conditions such as hypertension, depression, chronic kidney disease, Alzheimer’s Disease and dementia and high cholesterol. In fact, the NCOA estimates 60% of Americans 65+ years of age live with hypertension, and 51% must manage high cholesterol. A key component in managing chronic health conditions is diet and nutrition. According to the CDC, “Most people in the United States don’t eat a healthy diet and consume too much sodium, saturated fat, and sugar, increasing their risk of chronic diseases.” In fact, 9 out of 10 Americans consume too much salt, and more than $170 billion is spent annually on health care for obesity. But diet doesn’t just affect weight and health conditions we associate with obesity. Nutrition

is an important part of managing depression, for example. According to Harvard Health (2022), “Studies have compared “traditional” diets, like the Mediterranean diet and the traditional Japanese diet, to a typical “Western” diet and have shown that the risk of depression is 25% to 35% lower in those who eat a traditional diet.” Also, eating less salt and lower-sodium foods helps manage chronic kidney disease, heart disease and high blood pressure. Lowering sugar intake doesn’t just help manage diabetes; reducing sugar may also decrease inflammation, which contributes to such conditions such as rheumatoid arthritis (RA). In fact, high sugar intake has been linked to an elevated risk of heart disease and stroke, and fiber intake has been associated with lower risks of cardiovascular disease (CVD).

JANUARY 2024 - 7

No matter which chronic health condition we’re managing, diet and nutrition matter. Many doctors and medical offices offer support for patients managing health conditions affected by diet or patients who want to prevent health conditions from developing or worsening. One type of support is Medical Nutrition Therapy (MNT). We reached out to Pinehurst Medical Clinic’s Callie Huneycutt, a Registered Dietitian (RD) and Licensed Dietitian Nutritionist (LDN) to find out how patients can receive help and guidance with their nutrition while managing chronic health conditions. Huneycutt answers all of our questions about what Medical Nutrition Therapy is, who provides it, who qualifies for MNT and how patients can make the most of this individualized service for better overall health and wellness. Question: What is Medical Nutrition Therapy (MNT)? Answer: MNT is a nutrition-based treatment/ service provided by a Registered Dietitian. It consists of a nutrition assessment and individualized nutrition plan to assist in treating certain conditions. Q: Who may benefit from MNT? A: Anyone who has a condition that is affected by their daily nutrition OR anyone with a goal to prevent certain chronic diseases like diabetes, heart disease, and obesity. Q: Are there any downsides to engaging in MNT? Are there any patients who may not be a good fit or may not benefit from MNT? A: Not really. MNT can be utilized for both therapeutic and preventative purposes. Ideally, the participant is at least in the contemplative stage of change (Stage where people are aware that a problem exists and are seriously

thinking about overcoming it but have not yet made a commitment to take action). RDs will assess what stage of change a person is in and tailor the plan to meet them where they are. Q: Which conditions are most often addressed using MNT?

A: Diabetes, Chronic Kidney Disease, Hypertension, High Cholesterol, Overweight/Obesity, and Malnutrition are the most common conditions we address with MNT. Q: Who provides MNT? A: Only licensed Registered Dietitians. Q: What is an RDN? A: Registered Dietitian Nutritionist (Several years ago they added the “N” for Nutritionist for those who wanted to include that term in their credential. RD and RDN are used interchangeably.) RDNs are licensed health professionals that have completed a 4-year degree (plus often a Master of Science degree), at least 1200 hours of supervised practice in a Dietetic Internship, and have passed a national credentialing exam. Q: How is MNT different from following a diet such as the Mediterranean Diet or the SMART diet? A: MNT is truly individualized according to the person’s health needs as well as personal and cultural preferences. A plan is formed after a comprehensive assessment. While components of certain eating patterns, like the Mediterranean Diet, may be incorporated into the MNT plan, it is a much more tailored approach. The follow up visits patients receive as part of MNT are also just as important as the initial plan. In follow-up visits, we work on overcoming barriers to behavior and lifestyle change.

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JANUARY 2024 - 9 Q: According to a study published in 2023, referrals for MNT remain low. Why are more patients not referred for MNT? What are the obstacles to receiving a referral or therapy? A: I think awareness of the MNT service is low in general (so huge thanks for this feature!!!). Patients and referring providers may not be aware of where to find or refer to RDs in their community.

Also, historically, insurance coverage may have been a barrier to seeing a RD. We are now finding that the majority of insurances include coverage for MNT. Q: Medical Nutrition Therapy is often described as an “evidence-based application of the Nutrition Care Process (NCP).” What is the Nutrition Care Process? A: The NCP is the framework RDs follow when providing MNT. It includes four components: nutrition assessment, nutrition diagnosis, nutrition intervention/prescription, and nutrition monitoring and evaluation. It was created to help standardize nutrition care and ensure that patients are always receiving evidence-based treatment. Q: Do dieticians work with any other healthcare providers in helping address health issues using MNT? A: Yes, absolutely. This depends on the setting. In outpatient care, the RD would work closely with the referring provider, typically the PCP or a specialist, like Endocrinology. At PMC, we also work closely with our LCSWs for emotional health concerns, PharmD for medication concerns, and nurses for a variety of clinical concerns. In the long-term care or hospital setting, RDs would also work with the foodservice staff (in addition to the clinical staff listed above) to ensure the patient’s nutrition needs are met.

Q: What can a patient expect during an initial visit with an RDN providing MNT? A: Firstly, they can expect to have a conversation with the RD about their concerns and goals. We value building rapport in initial visits. Through this discussion, along with some questions along the way, a nutrition assessment is completed. Nutrition education may be provided to help explain nutrition’s role in the patient’s health condition. Then a joint discussion is had to develop an action plan to help meet the patient’s goals. A followup is scheduled to monitor progress.

The RD’s role is to help facilitate behavior and lifestyle changes related to nutrition. Contrary to popular belief, RDs are not the food police! Q: What benefits have you personally seen in working with patients using MNT? A: Clinical benefits include weight loss/ weight gain, decrease in A1C/BP/cholesterol, reduced medication burden, prevention of the progression of chronic disease (ex. Prediabetes to diabetes). Others include improved relationship with food and reduced guilt/stress related to food. Q: What advice would you give to a patient who is curious about MNT and wondering if they might be a good candidate for working with an RDN? A: Everyone has to eat to live, so food and nutrition apply to everyone. Even if someone doesn’t have a specific health condition, proactively improving your nutrition is also reason to see a RD. The classic example we often give is – “Don’t wait until your car isn’t working to get it serviced regularly. Staying on top of regular check-ups may prevent something unwanted from happening.” Just ask for a referral or self-refer!

MENTAL HEALTH MATTERS: THE MIND-BODY CONNECTION

Amy Phariss, LCMHCA, Clarity Counseling, NC | amy@claritycounselingnc.com

10 - JANUARY 2024 As a psychotherapist, I see clients each week living with chronic pain. This pain might be a result of a chronic health condition such as arthritis or fibromyalgia, or it might be pain related to an injury, like a fall or car accident. Whatever the cause, living with chronic pain is physically and emotionally draining. Clients report feeling angry that the pain restricts their lives and limits their activities. Some clients feel guilty that the pain they experience limits their ability to engage with grandchildren or travel. Many clients say they feel guilty for often being grumpy or short-tempered due to being in pain. More than one has told me, “I stay in my room most of the day because I know nobody wants to hear about my pain. I’m exhausted all the time. I know my family doesn’t want to be around that.” The pain experienced by those living with the pain and their loved ones isn’t just physical; it’s also emotional. There is a great deal of shame and guilt in chronic pain. The fact is, our mental health affects our physical health and vice versa.

How we feel about our bodies affects how our bodies feel, so treating the mental aspects of chronic pain is just as important as the physical parts. According to the American Psychiatric Association, “An estimated 35%-45% of people with chronic pain experience depression.” In fact, fMRI scans indicate that mental health disorders and chronic pain disorders actually share the same biological mechanisms, linking the two together. For example, depression can make a client more sensitive to pain, heightening their physical experience of pain. In fact, researchers write, “Depression commonly occurs as a result of chronic pain and needs treating to improve outcome measures and quality of life” (Woo, 2010). In fact, nearly one-third of patients with chronic musculoskeletal pain have major depression. Anxiety is another mental health condition often linked with chronic pain. Anxiety can cause chronic pain, and chronic pain can cause anxiety, creating a chicken-andegg loop of mental and physical pain.

There is, however, good news. Many mental health treatments address chronic pain and complement medication, physical therapy and other therapies. You don’t have to suffer, mentally or physically, in silence. From traditional talk therapy to newer treatments like EMDR and biofeedback, the mental health field has a lot to offer patients whose physical pain is creating mental and emotional suffering. Three treatment options stand out in the mental health field for treating chronic pain: 1. Eye Movement Desensitization Reprocessing (EMDR) Eye Movement Desensitization Reprocessing (EMDR) is a relatively new therapy originally developed for the treatment of trauma. In the 40 years since its inception, EMDR therapy has been used to treat multiple mental health issues such as eating disorders, anxiety, depression, OCD and chronic pain. I have worked in my practice with several clients whose lives have been affected by pain. From unexpected injuries to long-term chronic conditions, the pain my clients live with creates mental and emotional pain. They struggle with depression (often linked to anger and isolation), anxiety (will I reinjure myself? Is my family struggling with my condition?) and substance use disorder (SUD). What starts as a regular evening glass of wine becomes a coping mechanism for dealing with pain, and over time, some clients begin to abuse substances as a way to manage the physical and emotional suffering of chronic pain.

JANUARY 2024 - 11 EMDR is a structured, 8-phase treatment that includes bilateral stimulation (usually eye movement) to help clients process distressing memories and events. EMDR helps clients process the emotions and feelings related to an experience and put the events of the past where they belong: in the past.

EMDR targets the root cause of pain, which is often associated with a traumatic event (such as a car accident or unexpected injury), changes, enhances, and helps clients integrate the mind and body responses together. Instead of ignoring the emotions related to pain, EMDR helps clients identify, process and store those emotions in a healthy, adaptive way so they can focus on improving their overall wellbeing. 2. Mindfulness-Based Stress Reduction (MBSR) Mindfulness-Based Stress Reduction (MBSR) is another structured program incorporating mindfulness meditation and awareness to help clients manage pain and the stress often associated with chronic pain. Originally developed by Dr. Jon Kabbit-Zin in the 1970s, MBSR has been adapted for various conditions including chronic pain. MBSR is a structured 8-week program including various techniques and skills used to help clients reduce their overall pain and increase acceptance, awareness and healing. Skills developed through MBSR include mindfulness meditation, body scan,

movement, breath work, cognitive restructuring (re-thinking what you think about pain) and group support. Much of what clients learn in this 8-week program is applied and used at home, giving clients healthy coping skills for pain they can use throughout their lives. Researchers Zeidan and Vago (2017) write, “…mindfulness meditation significantly attenuates pain through multiple, unique mechanisms—an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.” For many clients, the idea of treating pain with fewer narcotic medications is especially appealing. 3. Biofeedback Biofeedback is a therapeutic technique utilizing electronic monitoring to provide clients with real-time information about physiological processes such as muscle tension, skin temperature and heart rate. During biofeedback, you are connected to electrical pads that help you get information about your body and your body’s response to pain. You might learn, for example, that when you have a migraine headache, your jaw tightens or clenches. Once you’re aware of this connection, you can learn to relax this tight muscle and reduce your overall pain. With a reduction in tension, patients often find they experience fewer or less intense headaches. Clients can actually learn to change or affect these variables to help modulate the body’s response to pain.

12 - JANUARY 2024

Biofeedback can measure the following: •

Brain waves using electroencephalography (EEG)

•

Breathing using respiratory biofeedback

•

Heart rate using electrocardiography (ECG)

•

Muscle contractions using electromyography (EMG)

•

Sweat gland activity using electrodermography (EDG)

•

Body temperature using sensors

Through biofeedback training, often conducted in a physical therapy and medical offices, clients learn to respond to their pain instead of reacting to it. Clients also feel a sense of empowerment once they have a sense of control and understanding when it comes to chronic pain. Each of these treatment options empowers clients by helping people understand their pain, acknowledge and accept the pain and develop skills and strategies to cope with and reduce pain.

Chronic pain is never simple; it’s a layered experience affecting all areas of our wellness, from our spiritual health to our professional performance and emotional wellbeing. When we’re hurt and in pain, we don’t work as well. We tend to become socially isolated and often experience depression as a result of this isolation. We take more time off work, have less capacity for engaging with loved ones and often question why we’re suffering and when it will stop….if ever. These therapies, and many others, can help bridge the gap between surviving with pain and thriving in all areas of life. References: American Psychiatric Association (2020). “Chronic Pain and Mental Health Often Interconnected.” https://www.psychiatry.org/news-room/ apa-blogs/chronic-pain-and-mental-healthinterconnected#:~:text=An%20 estimated%2035%25%20to%2045,with%20chronic%20pain%20 experience%20depression.&text=Pain%20can%20also%20be%20 a,Association%20of%20America%20(ADAA). Grant, M. and Threlfo, C. (2002). EMDR in the treatment of chronic pain. Journal of Clinical Psychology. 2002 Dec; 58(12):1505-20. doi: 10.1002/ jclp.10101. Woo, A.K.M. (2010). Depression and anxiety in pain. Rev Pain. 2010 Mar; 4(1): 8–12. doi: 10.1177/204946371000400103 Zeidan, F. and Vago, D. (2016). Ann NY Acad Sci. 2016 Jun; 1373(1): 114127. doi: 10.1111/nyas.13153.

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38)Chew the fat 39) Swarm 41)Key West shows? JANUARY 2024 - 13 45) Collection of sacred songs 48) Bring together 49) Second Amendment words 50)James Bond's depressing drink? 53)_Van Dyke 54)Like many teenagers' rooms 55)Haitian's head 58) Dueling sword 59) One of classic TV's Huxtables 60)"Terrible" czar 61)Loch _monster 62) First vertebra 63)Transmit, as a text

GRAY MATTER GAMES

ACROSS 1) Struggle for air 5) It goes through the roof 10) Pierce with a knife 14) Chip in a pot? 15) Holiday pie ingredient 16) Call to mind 17) Small biter 18) Absinthe flavoring 19) God of love 20) Brought up pickled fish? 23) Thaws a freezer 25) For this reason 26) Batters in Baltimore 27) Amount in grandma's recipe 29) Acknowledge the villain's entrance 30) It's guaranteed to remove wrinkles 31) Guevara grills Kasparov's equipment? 38) Chew the fat 39) Swarm 41) Key West shows? 45) Collection of sacred songs 48) Bring together 49) Second Amendment words 50) James Bond's depressing drink? 53)_Van Dyke 54) Like many teenagers' rooms 55) Haitian's head 58) Dueling sword 59) One of classic TV's Hux tables 60) "Terrible" czar 61) Loch _ monster 62) First vertebra 63) Transmit, as a text

DOWN 1) Prevent from speaking 2) Massachusetts cape 3) Celebrities' favorite seafood? 4) He broke Ty Cobb's record 5) Thinly distributed 6) Dogmata 7) They turn litmus paper red 8) Charge alternative 9) Reflex-testing site 10) Like a Stephen King reader, often 11) Comic actor's asset 12) Immediately 13) He wasn't the dummy of the act 21) "You've got mail" co. 22) Thick-skinned jungle beast 23) Play-_ 24) Rocker Clapton 27) They're ahead of jrs. 28) Organized criminals

56) Convert into leather 57) Author's last word?

NOW EAR THIS 7

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50 53

58 61

1) P 2) M 3) C 4) H 5) T 6) D 7) T 8) C 9) R 10) L 11) C 12) I 13) H 21) " 22)T 23) P 24) R 27)T 28)O 30)M 32)M 33) S 34) F 35)M 36) W 37) H 40) B 41) L 42) N 43) S 44) V 45) O 46) G 47) F F 49) M 51) U 52) L 56) C 57)A

14 - JANUARY 2024

18) Absinthe flavoring 19) God of love 20) Brought up pickled fish? 23)Thaws a freezer 25) For this reason 26)Batters in Baltimore 27)Amount in grandma's recipe 29)Acknowledge the villain's entrance 30)It's guaranteed to remove wrinkles 31)Guevara grills Kasparov's equipment?

Gray Matter Games Solutions

drink? 53)_Van Dyke 54)Like many teenagers' rooms 55)Haitian's head 58) Dueling sword 59) One of classic TV's Huxtables 60)"Terrible" czar 61)Loch _monster 62) First vertebra 63)Transmit, as a text

NOW EAR THIS

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8) Charge alternative 9) Reflex-testing site 10) Like a Stephen Kin 11) Comic actor's asse 12) Immediately 13) He wasn't the dum 21) "You've got mail" 22)Thick-skinned jung 23)Play-_ 24)Rocker Clapton 27)They're ahead of jr 28)Organized crimina 30)Make angry 32)Male bovine 33) Stuff one's face 34)Franken and Capon 35)Mythical island 36)What hunting dogs 37)Have an opinion 40) Bride's title 41) Like a sneak attack 42) Needing more time 43) Sister's daughters 44) Vampires may take 45)Old Iran 46)Greek woodland d 47) Former White Hou Fleischer 49) Metabolism type 51) Urban organization 52)Leave a solid state 56)Convert into leathe 57)Author's last word?

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Accessible Communication with Captions!

T L A 5

V A N E N D

Support groups build a network of trusted friends who understand the challenges you face.

Caregiver

Alzheimer’s

Open to anyone in a caregiver role including family & professional caregivers.

Open to caregivers of those diagnosed with dementia.

1st Tuesday

2nd Wednesday 11:30a.m. - TerraBella

11:00a.m. - Fox Hollow

Relay Conference Captioning Relay Conference Captioning (RCC) service is available for individuals who have a hearing loss or a speech disability to actively participate in teleconference calls or webinars by reading live captions on their laptop, mobile device or tablet. To inquire, contact kim.m.calabretta@t-mobile.com or visit relaync.com/rcc

190 Fox Hollow Rd | Pinehurst

101 Brucewood Rd | Southern Pines

3rd Tuesday

3rd Thursday

5:30p.m. - Fox Hollow

5:00p.m. - TerraBella

190 Fox Hollow Rd | Pinehurst

101 Brucewood Rd | Southern Pines

Ashley Seace & Stephanie Blue, facilitators AOS Care Management

910.692.0683 AOSNC.com

All information shared within a support group is confidential.

Exceptional

ASSISTED LIVING and MEMORY CARE

JANUARY 2024 - 15

At TerraBella Southern Pines, thoughtfully designed interiors and amenity spaces, tasty homestyle dining, and exceptional lifestyle programs come together to create Southern Pines’ best option for Assisted Living & Memory Care. Plus, with 24-hour support from our experienced team of professional caretakers, you or your loved one can enjoy peace of mind knowing we’re here for you every step of the way!

Come See What Makes Us Different

Homestyle Dining with Tableside Service

Tenured Team Members

Recently Renovated

910.216.4537 TerraBellaSouthernPines.com 101 Brucewood Road, Southern Pines, NC 28387 Assisted Living I Memory Care ©2023 TerraBella Senior Living. All Rights Reserved. Prices, plans and programs are subject to change or withdrawal without notice. Void where prohibited by law. Managed and Operated by TerraBella Senior Living. TBSP-0024 7/23

Best Wishes for a Happy, Healthy New Year from Dr. Wellener & Her Team!

JANUARY IS GLAUCOMA AWARENESS MONTH Glaucoma is a disease that damages the optic nerve of the eye and can lead to blindness if left untreated. Specialists at Carolina Eye Associates can help manage and limit glaucoma-related vision loss.

FrontOffice@WellenerDental.com

CAROLINAEYE.COM 910.295.2100 DO YOU KNOW SOMEONE WITH

16 OCTOBER - JANUARY 2022 2024 - 16

Make Every Day Five Star

At Fox Hollow Senior Living, our residents have the opportunity to do everything they’ve always loved. With Five Star Dining, days filled with friends and adventures, you can be yourself again – while we take care of the rest. FOX HOLLOW SENIOR LIVING COMMUNITY 190 Fox Hollow Road • Pinehurst, NC 28374 910-695-0011 • www.FoxHollowSeniorLiving.com ASSISTED LIVING • MEMORY CARE RESPITE/SHORT-TERM STAYS ©2021 Five Star Senior Living

Call to visit and explore our community.