Get healthy

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bag it up Dietitians serve up tips for healthy and fun school lunches

AND GO

Far from finite, personal energy increases with exercise — including golf

Drill instruction Proper dental care is vital to maintaining overall wellness

late summer 2017

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GET HEALTHY

late summer 2017

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contents

late summer 2017

notes 4 editors’ topics 6 hot 8 your health

Senior health: Physical and mental fitness is only a workout— or two—away

11 the medical report

Methodist Hospitals cardiology specialist dances to the music of the heart

13 sound mind

A new take on an old standard: Worry, be happy

on the go 15 families

Read to your children, early and often, to promote brain development

18 the fit life

There’s nothing finite about human energy as long as it’s fueled by appropriate exercise — and yes, golf does count

22 on the table

2418 10

feature package Good health, it turns out, starts with proper dental care

School lunches: It’s not your dad’s bologna sandwich anymore

26 your best friend How to keep your pet cool, calm and collected in the dog days of summer

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GOLF AND EXERCISE PHOTOS BY TONY V. MARTIN, THE TIMES; DENTAL PHOTO COURTESY OF GETTYIMAGES

Women’s health: Females experience pain differently and therein lies a problem with treatment

Work

Dance

Play

EXPERTS IN MOTION

Orthopedic & Spine Specialists Close to Home The right doctors make all the difference.

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Now Welcoming New Patients To learn more about our Orthopedic and Spine Specialists, call 219-738-6670, or visit MethodistPhysicianGroup.org

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editors’ notes

T

The U.S. health care system keeps medical and dental treatment in different silos, separated by location and payers. Maybe it shouldn’t.

As we report in this issue, researchers are increasingly proving the link between oral and overall health. Studies have found connections between poor oral health and chronic conditions such as diabetes and heart disease.

In the face of this evidence, medical and dental providers in the state and Region are joining forces. In Northwest Indiana, some federally qualified health centers offer mental and dental care under the same roof. And Indiana recently became the last state to approve reimbursement for pediatricians who provide fluoride varnish.

“If we’re going to reduce costs for patients and give them a better experience ... we all need to work together,” said Dr. Isaac Zeckel, chief dental officer for HealthLinc.

-Giles Bruce, Get Healthy co-editor

T

That winning smile is only the beginning of sound health, as Region dentists and internists explain. The mouth is the gateway to overall well-being, making a more integrated approach to health care a must. Worry, if done right, also figures into the equation.

Of course, physical fitness is also important. Humans, it turns out, do not have a finite amount of energy to be saved and savored.

Exercise is vital, and we offer tips and programs for everyone on up to seniors. Golf, by the way, does count, Mr. President.

It’s back-to-school time, so we look at establishing good eating habits — in the lunch bag and cafeteria. Think whole grains, lean protein and lots of fruit and veggies.

Equally important is reading to your children — from birth if not before. Anything will do: books, packages, road signs.

So remember, brush, floss, exercise and read to your kids. You can start with this issue of Get Healthy.

-Mary Jane Grandinetti, Get Healthy co-editor

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ON THE COVER Healthy lunches are where it’s at with fresh fruit and veggies, lean meats and cheeses, whole-grain flat breads and crackers and hummus.

Photo by Tony V. Martin

Drill instruction Proper dental care is vital to maintaining overall wellness

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VOLUME 11, ISSUE 12 PUBLISHER

Christopher T. White CO-EDITORS

Giles Bruce Mary Jane Grandinetti DESIGN DIRECTOR

Mary Garrison DESIGNER

April Burford CONTRIBUTING EDITORS

Jane Ammeson, Karyn Brodsky, Christine Bryant, Julie Dean Kessler, Mark Loehrke, Bob Mouslesong, Carrie Steinweg, VICE PRESIDENT OF SALES

Joe Battistoni ADVERTISING OPERATIONS MANAGER

Eric Horon SALES LEAD

Andrea Walczak PUBLISHED BY LEE ENTERPRISES The Times of Northwest Indiana Niche Productions Division 601 W 45th Ave, Munster, Indiana 46321 219.933.3200 2080 N Main St, Crown Point, Indiana 46307 219.662.5300

Far from finite, personal energy increases with exercise — including golf

Dietitians serve up tips for healthy and fun school lunches

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1111 Glendale Blvd, Valparaiso, Indiana 46383 219.462.5151 Copyright, Reprints and Permissions: You must have permission before reproducing material from Get Healthy magazine.

Get Healthy magazine is published six times each year by Lee Enterprises, The Times of Northwest Indiana, Niche Division, 601 W 45th Ave, Munster, IN 46321.

Follow Get Healthy on Facebook facebook.com/GetHealthyNWI) and on Twitter at @GetHealthyNWI.

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topics

CHRISTINE BRYANT

Heavier birth weight linked to obesity risk

Nurses have stress-related disorders

Babies who are large at birth may have an increased risk of becoming obese in kindergarten through second grade.

A recent study showed at each grade level for preterm and term children, those who were heavy as infants remained heavier than children born at normal birth weights. The findings suggest counseling may be appropriate early in life for families of large infants to help prevent obesity.

Nurses with high stress and poor coping mechanisms may have difficulty with patients, working in teams and communicating with co-workers — to the nurses’ physical detriment.

That’s according to a Ball State University study of nurses that shows:

92

percent had moderate-to-very high stress levels.

78 69 63

percent slept less than eight hours per night. percent did not exercise regularly.

Source: Pediatric Obesity

percent consumed fewer than five servings of fruits and vegetables per day.

22

percent were classified as binge drinkers.

Source: Nursing Research and Practice

A toast to after-dinner drinks Enjoy a glass of wine or pint of beer with and after dinner? That indulgence may come with a benefit — a lower risk of type 2 diabetes.

A new Danish study shows men who had 14 drinks each week and women who had nine appeared to have the lowest risk of type 2 diabetes compared to nondrinkers or those who drank more heavily.

People received the most benefit if they spread those drinks out during the week, rather than binging. The protective effect appeared to be limited to wine and beer, not hard liquor.

Source: Diabetologia

JOB INSECURITY MALADIES

D

espite recent low unemployment rates, workers still worry about losing their jobs — and it’s making the average American sick.

New research from Ball State University’s College of Health shows job insecurity may cause physical and psychological problems, from heart disease to loss of sleep.

The study found that over a 12-month period: • About 33 percent of respondents reported job insecurity, with males 14 percent more likely to do so than females.

• Those reporting job insecurity were more likely to be obese and smoke, have short sleep duration and not engage in regular physical activity.

• Females experienced higher rates of asthma, diabetes, work-life imbalance and worsening general health in the past year.

• Men who were job insecure were more likely to miss more than two weeks of work in the past year.

Source: The Journal of Community Health

Artificial sweeteners = weight gain

T

hough artificial sweeteners often are associated with weight loss, a new study says the opposite.

Researchers analyzed 37 studies on artificial sweeteners, following 400,000 people for about 10 years. Instead of helping people lose weight, artificial sweeteners were linked to a higher risk for health issues such as weight gain and diabetes in those who consumed them regularly, the research found.

Some researchers speculate sweeteners interfere with a person’s microbiome, a collection of gut bacteria that helps the body absorb nutrients, while others say sugar substitutes may cause people to crave sweeter foods more often.

Source: Canadian Medical Association Journal

Diabetes linked to erectile dysfunction Though diabetes has long been considered a risk factor for erectile dysfunction, a new analysis of past research finds the sexual disorder is much more prevalent in men with diabetes than once thought.

In fact, researchers say it can affect up to 53 percent of men with diabetes, according to a study of nearly 90,000 men. Men with diabetes are 3.5 times more likely to have erectile dysfunction than men without diabetes.

MOVEMENT TO COMBAT ALZHEIMER’S Regular exercise may offer some protection against Alzheimer’s disease, according to recent research.

People who did more moderate-intensity physical activity were more likely to have healthy patterns of glucose metabolism in their brains — a sign of healthy brain activity — than those who did less. Light-intensity physical activity was not associated with similar benefits.

Source: Journal of Alzheimer’s Disease

Source: Diabetic Medicine nwi.com/gethealthy

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WOMEN’S HEALTH

Where does it hurt?

Differences in how women experience pain only one roadblock to their treatment JANE AMMESON

S

tudies show that men and women experience pain differently, with some types of pain being unique to women.

“The differences in how women and men feel pain is a very complicated topic,” said Dr. Tarek H. Shahbandar, a Methodist Hospitals-affiliated anesthesiologist who is fellowship-trained and board certified in interventional pain medicine and frequently lectures on pain management.

“One thing I emphasize in my talks is that I think women are better at explaining their pain to their doctors, but unfortunately doctors often ignore or minimize what they say.”

Shahbandar, of Pain Physicians of Indiana in Merrillville, pointed to research indicating that Dr. Tarek women are less likely to Shahbandar have knee surgery than men. That’s not because they don’t need the surgery — it often isn’t offered or discussed.

In one study, doctors were less likely to share information about knee replacements and ask about treatment preferences with women than with men. But when women are given adequate information, they had a better, more accurate understanding of the topic than their male counterparts.

“That’s why women need

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to be their own advocates,” said Shahbandar, who recommends women make sure their doctors understand what they’re saying even if it means asking them to repeat it.

When it comes to treating pain in women, Shahbandar said it’s important to coordinate with all the patient’s physicians, including her family doctor and gynecologist, to formulate a complete medical workup.

“Pain treatment is most effective when all aspects of a patient’s health are taken into consideration,” he said. “Sometimes the source of the pain is very straightforward,

such as when a person has a broken arm which results in pain in that spot.”

Other times the source is not as clear.

“A person can experience pain in one part of the body that is coming from another area — a referred pain,” he said. “By using a selective nerve block — a little bit of anesthesia to block a specific nerve root — we can determine the specific source and proceed accordingly.”

Saying he should be the last person a patient sees, Shahbandar will do specific minimally invasive procedures such as hypogastric block to treat pelvic and genital pain if referred by a woman’s gynecologist.

He noted that fibromyalgia, a chronic pain syndrome, affects women more frequently than men, and that he has had treatment success with hyperbaric oxygen chambers.

According to a Rice University study, researchers studying brain scans of women before and after hyperbaric oxygen treatment support a theory that abnormal conditions in pain-related areas of the brain may be responsible for fibromyalgia.

A stellate ganglion block, an injection of local anesthetic in the neck, has been found to be useful in mitigating the symptoms of postmenopausal women.

Using image guidance, minimally invasive procedures such as these allow for quicker healing time and a quick return — usually within a day — to work.

“Before medicating or surgery, there are all sorts of modalities to try including physical therapy,” Shahbandar said. “Many people believe the goal of pain management is to dull the pain.

But it’s important to know what is causing the pain and to treat it, not just mask it.” nwi.com/gethealthy

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Sharon Carlotta stretches her hands and fingers at the Southlake YMCA.

SENIOR HEALTH

Bend stretch

E

KARYN BRODSKY

ver wonder how some people remain active and sharp well into their 80s, 90s and above?

Though heredity plays a major role, there are ways to take the health of your body and mind into your own hands, including exercising for longevity.

Exercise benefits people of any age; for seniors, it’s crucial. Regular exercise can help

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control body weight, blood pressure and cholesterol levels, may reduce hardening of the arteries, and lower the risk of heart attack and stroke. To help fight osteoporosis, exercise strengthens muscles, tendons, ligaments and bones. A strong and limber body may help increase balance, prevent injury, foster a more active lifestyle and preserve independence, according to AARP. Lifting items, climbing stairs and something as routine as rising out of a chair all require muscle strength; even small increases in that

strength can enhance day-to-day activities. The Centers for Disease Control and Prevention recommend that people older than 65 participate in activities that work all major muscle groups two or more days a week.

Local seniors can join a program designed for them through their local park district. The Munster Parks and Recreation Department, for example, offers a dues-based Keen-Ager membership that offers programs for those CONTINUED ON PAGE 12

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PHOTOS BY TONY V. MARTIN, THE TIMES

Fitness programs help seniors reach for the stars physically, mentally

THE MEDICAL REPORT

Listen to the rhythm of the beating heart

E

lectrophysiology is concerned with the “electrical wiring” of the heart, working in partnership with the arteries of the heart, or the “plumbing.”

The electrical system is responsible for the rhythmic and coordinated beating of the heart. Thus blood is pumped in a coordinated manner, in the right direction.

If the system malfunctions, blood flow is Dr. M. Kamran compromised, leading to lethal conditions.

Aslam Electrophysiology is often called the study of cardiac rhythm.

Unfortunately, the symptoms of electrical malfunction can be very subtle and not as dramatic as a painful heart attack.

Most commonly, symptoms are palpitations, passing out or fatigue. Sometimes there are no symptoms. To document a rhythm disturbance, a physician has to obtain an electrocardiogram while the patient is experiencing symptoms, not at a later date.

This is not always logistically possible. So cardiac monitors are often worn for various time periods for screening purposes. In some cases, monitors the size of a mini paper clip can be implanted under the skin for extended monitoring.

There are many rhythm disturbances affecting patients, from newborns to the elderly. You can be born with a problem or develop one due to age.

However, the most common rhythm disturbance is called atrial fibrillation.

This is the second most common cause of stroke in the United States. Stroke is a leading cause of disability in the U.S. Atrial fibrillation can also contribute to heart failure or dementia. It generally affects patients in their 60s but can occur earlier in life.

Medical options for treatment include blood thinners, and minimally invasive procedures called catheter ablation can reduce the burden of the disease. Catheter ablation targets and eliminates the abnormal circuitry of the heart that lead to rhythm disturbances. These options can be best discussed with an electrophysiologist.

This is only the tip of the iceberg. There are other troublesome rhythms that can arise, at any age, which can be treated with medications or catheter ablation. In addition, there is another world of implantable cardiac devices such as pacemakers and defibrillators that electrophysiologists are trained to manage under the umbrella of cardiac rhythm.

This is an important layer of cardiology subspecialty that should be sought if you suspect cardiac rhythm disturbances.

#

1

Dr. M. Kamran Aslam is a cardiac electrophysiologist affiliated with Methodist Hospitals’ Heart & Vascular Institute and Heart Rhythm Clinic. For more information, call 219-738-5330. nwi.com/gethealthy

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50 and older. Recreation supervisor Danielle Volk said the Keen-Ager program offers chair yoga sessions that focus on breath and body awareness and invokes Qigong (pronounced “chee gong”), ancient Chinese healing exercises and techniques.

Munster Parks also partners with Community Hospital Fitness Pointe in Munster for aqua boot camp and aqua Pilates classes. “Chair yoga is good for limited mobility and balance,” Volk said. “Aqua boot camp focuses on aerobics and toning, and aqua Pilates are low impact, take pressure off the joints and increase core strength.”

For more information, call From left, Mary Ann Schultz, Helen 219-836-7275 (PARK) or Czernoch and Bruno Czernoch do stretches at the Southlake YMCA. visit munster.org.

The Southlake YMCA in Crown Point serves more than 200 active adult members. Active Older Adults Director Deb Kolloway runs senior exercise classes on Mondays, Wednesdays and Fridays, including Senior Boot Camp at 7:30 a.m., the Joyful Joints aqua class at 8 a.m. and Slimnastics at 10:30 a.m. “Cross-training is important: We offer gentle yoga two days a week, and we incorporate balance exercises in all of our classes. On Fridays, we do ‘Dancing with Debbie’ and the class loves it!” Kolloway said. “Exercise keeps the mind clear, keeps joints flexible and keeps everyday tasks manageable.”

She has been working with the seniors for 29 years, and some have attended that long. “They’re like family to me,” she said. “I tell them the reason they are still able to come is that the exercise has kept them young and healthy.” Get more information at 219-663-5810 or visit slymca.org.

Fitness Pointe also offers Functional Living Exercises for Everyone, designed to develop the muscles of older adults so they can more easily and safely perform everyday tasks. “There are more than 80 million adults in the U.S. age 55 and over who are interested in working out for their health and keeping fit,” said program supervisor Nikki Sarkisian. “These aging adults have specialized needs and require specific training, coaching and conditioning to ensure that they achieve results without increased risk of injury.”

The FLEE class is free to Fitness Pointe members and available to nonmembers through the Class Pass program.

Call Fitness Pointe at 219-924-5348 or visit comhs.org.

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MIND GAMES Research suggests that combining good nutrition with mental, social and physical activities may provide the most benefit in maintaining or improving brain health and slowing cognitive decline.

the rest got six minutes of sleep. In a word-recall exercise afterward, those who slept outperformed those who did not, and those who napped for only six minutes scored as well as those who snoozed longer.

Try these tips from Prevention to keep your mind fit as you age:

READ DAILY Reading is an easy way to increase cognitive function and is one of the most effective methods of keeping the brain young. Focusing on a specific task such as reading helps create logical connections and teaches the meanings of new words. Reading is a great stress buster, as it relaxes the mind, body and spirit and can even mentally transport the reader to another time or place.

GO FISHING According to research conducted by Martha Clare Morris, an epidemiologist and associate professor of internal medicine at Rush University Medical Center in Chicago, people who eat fish once a week lower their risk of developing Alzheimer’s disease by 60 percent. That’s attributed to DHA, an omega-3 fatty acid found in large quantities in the brain and in cold water species of fish, such as salmon, tuna and cod. Morris’ research revealed that eating a seafood-based meal each week may slow cognitive decline by 10 percent a year, which is like turning the clock back three to four years.

PHYSICAL EXERCISE Regular exercise preserves brain health and offers long-term benefits.

Thomas Crook, an expert on cognitive development and memory disorders, notes that cardiovascular activity pumps more oxygen-rich blood to fuel brain cells. It also strengthens blood vessels and helps prevent illnesses such as stroke, which can impair cognitive function.

MENTAL EXERCISE Break away from usual habits, vary activities and disrupt routines.

The brain “prefers” and positively responds to fresh, unexpected events.

Regularly play crossword puzzles, Sudoku, solitaire, Mah Jongg and even computer apps that offer a variety of activities and brain teasers. This helps maintain intellect and can reduce the risk of age-related memory loss.

CATCH ENOUGH “ZZZS” Get at least seven to eight hours of sleep per night. No matter your age, proper sleep restores the body and the mind. While asleep the brain processes information accumulated in the day and makes new connections. Lack of sleep can hurt the aging brain. Sleep quality also is important; avoid heavy meals and using technology right before bed and open your windows for bit to take advantage of some fresh air.

GRAB A NAP German researchers reported that naps as short as six minutes can recharge and improve memory.

During a 60-minute test, some subjects stayed awake for the entire time, some slept for 30 to 45 minutes and

KEEP LEARNING Invoke that curiosity craving from childhood and the brain will benefit.

Think outside the box and move out of the comfort zone to process new ideas and enjoy new experiences to form new synapses in the brain, even as an adult.

BE POSITIVE Positive emotions can enhance the ability to process information and are linked to better long-term brain health.

A 2007 study revealed that individuals were 60 percent less likely to develop mild cognitive impairment if they were often happy. More research resulted in higher scores on memory tests for older adults with lower levels of chronic stress.

HAVE A LAUGH Laughing brings a sensation of pleasure, releasing serotonin and dopamine, the happiness hormones, and the more laughter the better the brain performance. In addition to improving cognitive function, laughing helps reduce stress and the risk of anxiety and depression.

STAY SOCIAL Maintaining relationships and getting together with friends and family regularly keeps the brain nimble by reducing cortisol, a hormone vital to regulating bodily systems but produced in abundance in response to stress.

Oscar Ybarra, associate psychology professor at the University of Michigan, notes that interaction with other people likely stimulates structures in the frontal lobe that are responsible for planning, decision making and response control.

DON’T SWEAT THE SMALL STUFF Occasionally, people are forgetful. Don’t be alarmed. Very often in today’s hightech environment, daily information overload can clog our brain. The simple fix for this is to know what and when to forget. A fit brain screens out and discards worthless or meaningless data so it can remember what’s important. nwi.com/gethealthy

CARRY THAT WEIGHT How constructive worrying can be a positive response to stressful situations

‘W

MARK LOEHRKE

hat, me worry?”

That catchphrase of indifference, popularized in the pages of Mad magazine by the gap-toothed Alfred E. Neuman, has long been the general reaction to stressful situations by those who consider themselves well-composed and above such concerns.

But recent research suggests that a little bit of worrying actually may be a better way to deal with stress and fear than simply playing it cool.

Among this wave of support for the notion of “constructive worrying” is a study by the psychology department at the University of California at Riverside, which found that law students awaiting the results of their state bar exams who worked through feelings of anxiety, rumination and pessimism responded more productively to bad news and more joyfully to good news than those who were stoic during the wait.

Further, those students who tried to alleviate worry through coping strategies like distraction and feigned indifference found many of these methods to be ineffective, often experiencing more distress than the people who embraced their worrying.

In other words, the study suggests, while giving in to worry may not lessen the difficulty of a stressful waiting period, that difficulty may pay off once the trial ends.

At least two local mental health experts see the value of the conclusions reached in CONTINUED ON PAGE 14

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time is also not healthy,” said Jake Messing, program director of behavioral health services at St. Catherine Hospital in Jake Messing East Chicago.

“A moderate amount of worry can lead to constructive action and prepare the person for the next step.”

To limit how much time one spends worrying, Rathburn and Messing say it can be helpful to set aside specific “worry times,” perhaps 30 minutes a day.

“One of the keys with worry is to contain it,” Messing said. “‘Worry times’ are based on the idea that, outside of these times, one would say, ‘I need to wait until my scheduled worrying time.’ This prevents worry from being allconsuming but still gets the worrying job done.”

While the research surrounding the benefits of worrying is still fairly new, Rathburn said the notion of engaging in some healthy worrying without letting it become overwhelming is rooted in the much more weathered life lesson of “hope for the best but prepare for the worst.”

“Take the example of a young father who is awaiting news on a promotion he hopes to achieve,” she explained. “He needs the money for his family, and he would view this accomplishment with a sense of pride. He might consider developing a ‘plan B,’ assuming he doesn’t get good news, assessing the family income and expenses and planning accordingly. He would also benefit from looking at the positives in his life, even without the promotion, and understanding that he has much to be proud of in his life, including his loving and supportive family. This would serve to put the promotion in perspective.” nwi.com/gethealthy

PHOTO BY TONY V. MARTIN, THE TIMES‌

“Selfie”

SEE YOUR

the UC Riverside study and agree that there can be certain benefits to worrying, as long as it’s managed properly.

Liz Rathburn, a clinical therapist at Franciscan Behavioral Health Center in Crown Point, stresses that the key to unlocking the potential benefits centers on how one defines “worry.”

“If it’s defined as ruminating on a problem without problem solving, it is nonproductive and can definitely increase stress,” she said. “Think of it this way — if you worry about a negative outcome and it doesn’t happen, you’ve worried needlessly and are experiencing the negative outcome before it even happens.

If you worry about a negative outcome and it does happen, you’ve experienced the negative outcome twice.

“On the other hand, worrying can serve as a motivator to avoid unpleasant feelings associated with a potentially unpleasant event.

For example, worrying about an upcoming deadline can motivate you to take steps to chip away at what you need to do. Worrying about your health can lead you to eat healthier. So it’s important to remember to ‘worry’ constructively.”

Most people, of course, don’t often take the time to think deeply about the concept of worrying, much less to consider ways to worry constructively — they simply worry.

But Rathburn said the positives associated with worrying are only as good as the way in which a person chooses to worry and, specifically, the time devoted to it.

“Worrying nonstop with no movement toward a resolution to your problem is not productive at all,” she explained. “You can worry constructively by limiting the time you worry about something, coupling it with problem solving and making a plan to move toward resolution.”

“Having zero worries is not healthy (and impossible), but worry that is all-consuming and all of the

Reading to children even before birth expands

D

JULIE DEAN KESSLER

uring story time there’s more happening in children’s brains than you might think. And it’s so important that a Northwest Indiana pediatrician provides books in his office for parents, kids and even infants.

“Reading can affect cognition even in newborns, because children can retain what they’re hearing and learning,” said Dr. Usama Moustafa at LaPorte Physician Network Pediatric Care. And when those young children start talking, they have a more advanced vocabulary for their age. A grant from the Healthcare Foundation of LaPorte funds a program providing books for preschool-age kids. “We give the books to them,” said Moustafa.

Studies support this advocacy. Research

nwi.com/gethealthy

intellect, forms bonds

presented at a 2015 Pediatric Academic Societies meeting showed that reading to young children prompts brain activity that supports early reading skills and oral language. Joann Zona, a speech language pathologist at Ingalls Health System in Harvey, Illinois, said early oral language exposure has lasting effect. “The child begins to recognize the written word … and that promotes language,” she said.

Beth Heise, a speech pathologist at Ingalls, began reading to her daughter, Cassady, while she was pregnant with her.

Moustafa is all for it. “I think it’s a good idea. There might be some benefits to the fetus, though currently we have no way to measure that,” he said.

Zona notes that babies hear their mom’s voice before they’re born, and

Heise said, “Reading out loud to children is essential to their development of vocabulary, language, imagination, all of that.” The report to Pediatric Academic Societies noted that imagination is important as children switch to books without pictures.

Stacy Gordenier, of LaPorte, reads to her 1-year-old son, Eli. “I saw how my sister read to her kids,” she said. “And now that they love to read, I want (Eli) to do the same.”

Every day they choose a book to read aloud from Eli’s bookshelf, and Eli is pointing out animals in pictures and elsewhere. He watches while a babysitter uses flash cards for older kids; Gordenier hopes he’ll look forward to that concept for reading.

Zona also points out that reading goes beyond books. “If we focus only on books, people who don’t or can’t read CONTINUED ON PAGE 16

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Speech pathologist Joann Zona (left) with Abril Hall and her son, Jah-ani Hall, at Ingalls Memorial Hospital.

TOP 10 CHILDREN’S BOOKS According to Good Reads, a website launched in 2007 to help people find and share books they love, these are the 10 best children’s books: 1. “Where the Wild Things Are,” Maurice Sendak, 1963 2. “Very Hungry Caterpillar” board book, Eric Carle, 1994 3. “The Giving Tree,” Shel Silverstein, 1964 4. “Green Eggs and Ham,” Dr. Seuss, 1960 5. “Goodnight Moon,” Marcia Wise Brown, 1947 6. “Charlotte’s Web,” E.B. White, 1952

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7. “Where the Sidewalk Ends,” Shel Silverstein, 1974 8. “The Cat in the Hat,” Dr. Seuss, 1957 9. “If You Give a Mouse a Cookie,” Laura Joffe Numeroff, 1985 10. “Love You Forever,” Robert Munsch, 1987

RESOURCES FOR PARENTS • Healthychildren. org. Dr. Pamela High of the American Academy of Pediatrics offers guidelines on what children can do with books at specific ages and how parents can help.

• “The Big Book of Exclamations!,” by speech pathologist Teri K. Peterson.

Joann Zona, speech language pathologist at Ingalls Health System, recommends it for its pictures of babies saying very simple words: “uh-oh,” “wow” and more.

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PHOTO BY ITONY V. MARTIN, THE TIMES

may shy away,” she said. “Look at your T-shirt; you know what those words are.

If you’re in the car with your kid, you know the word ‘stop.’ Read aloud from cereal boxes, baseball cards, a coffee mug.”

She said new initiatives are helping less-verbal families use more words with their infants. That helps close the “word gap” seen between some higher- and lower-income children entering school. “And low-income families may not have books, but do have a cellphone, so they can access apps promoting language interactions, including reading,” she said. Moustafa said studies show reading can increase a child’s IQ. Heise’s daughter is 8 now. “It’s still important to read aloud with her, even though she reads herself,” Heise said, adding that children discern emotions and intonations that way.

“Sometimes when she reads to me out loud it may be pretty flat, and I’ll ask, ‘Did you understand what that was about?’

“But also it was such precious bonding time. There’s a closeness and social aspect to reading to your child.”

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Physical activity trumps leisure in maintaining healthy vigor

energy

CRISIS? Tracy Oedzes shows a pregame warmup by placing the club behind her back and rotating the upper torso to increase flexibility and range of motion.

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n their recent book titled “Trump Revealed,” Washington Post writers Michael Kranish and Marc Fisher detailed President Donald Trump’s view of exercise.

“After Trump mostly gave up his personal athletic interests, he came to view time spent playing sports as time wasted,” they wrote.

“Trump believed the human body was like a battery, with a finite amount of energy, which exercise only depleted. So, he didn’t work out.”

The book further states that when Trump learned that John O’Donnell, one of his top casino executives, was training for an Ironman triathlon, he warned, “You are going to die young because of this.”

Though there is some curious logic to this thinking, evidence points to the opposite.

Kelly Devine Rickert, a Franciscan WellCare health coach and registered dietitian with the Franciscan Health system, explained that energy is derived from our eating and exercise regimens.

“Eating healthy foods, such as whole grains, fruits and vegetables and lean proteins help to increase your energy levels in many ways,” she explained.

“First, eating healthy foods can help prevent your blood sugars from spiking and falling throughout the day, which leads to more consistent energy levels as the day progresses. Second, a diet high in fiber with a mix of healthy fats and protein can increase fullness in between meals so you are not as hungry and tired.”

Franciscan Health follows a dietary guideline provided by the Office of Disease Prevention and Health Promotion when advising a client on a healthy lifestyle that includes diet and nwi.com/gethealthy

PHOTOGRAPHY BY TONY V. MARTIN

I

BOB MOULESONG

exercise, according to Devine Rickert. She pointed to the office’s web page at health. gov that lists the many benefits of physical activity, including increased energy levels.

“The major research findings summarized that physical activity reduces the risk of many adverse health outcomes,” she said.

And it can be fun.

Golf, the one physical pursuit the president maintains, is a prime example. Golfers who walk an 18-hole course can cover as much as five miles and burn 2,000-plus calories.

“Walking, whether it’s a golf course or a treadmill, is a great aerobic activity,” Devine Rickert said.

Roger Vogie, director of Community Hospital Fitness Pointe, points to position statements from the American College of Sports Medicine for hard data related to the benefits of physical activity.

“The medical research that is used by the ACSM is solid data on the benefits of exercise for the body,” he said. “One of my

favorites that we refer to Kelly Devine is their recommendation Rickert, a Franciscan on weekly amounts of WellCare health coach physical activity.” and registered dietitian, The ACSM points out that physical energy derives from recommends that healthy eating and most adults engage in exercise. a moderate intensity level of cardiorespiratory exercise training. They recommend 30 minutes of exercise, five times per week, for a total of 150 minutes.

According to a 2016 article by Tom Spring of the ACSM: “The human body is made to move. There are documented exerciserelated benefits to practically every system in the body. The benefits to the cardiovascular system, muscle and bone may receive the most attention, but other systems also respond favorably to exercise. For example, CONTINUED ON PAGE 21

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the immune system of a trained person works better to fight both chronic and acute disease than the immune system of a sedentary person.”

Though Vogie dismisses the notion that people have finite amounts of energy and finite number of heartbeats as scientifically unproven, he emphasized that a person’s physical condition must be considered when determining the amount and intensity of physical activity.

“We have members who need to start at a much lower rate of time and intensity,” he explained. “But regardless of their current physical condition, we can help them design a program that will improve their endurance, energy levels and overall health.”

Vogie stressed that Fitness Pointe is equipped to deal with this as a health facility whose programs and services adhere to medical guidelines.

“Exercise is a form of medicine,” he said.

“People of all ages and all levels of physical condition can benefit from physical activity.”

He pointed to the famous Farmingham

A HEALTHY ROUND OF GOLF Tracy Oedzes, certified personal trainer and certified golf fitness conditioner at Community Hospital Fitness Pointe, offers these tips to get the most exercise out of a round of golf.

Warmup: Place a club behind your back, and/or the crook of your arms, and rotate your upper torso. Slowly work up the intensity to simulate your golf swing. This increases flexibility and range of motion.

Walk: A golfer who walks 18-hole course logs five miles and burns up to 2,500 calories.

Rotation: Rotate your arms overhead with small, slow circles, gradually increasing the size of the circle, speed, and intensity.

Utilize downtime: While other members of your foursome are teeing it up, use the nearby bench to stretch the hamstrings. Also, perform calf raises and hip flexors, using the bench as needed. Improve your balance by standing on one foot at a time.

Lifting: Using a pull cart and carrying your golf bag are great ways to get your upper body strength training.

Heart Study, first undertaken in 1948 by what’s now known as the National Heart, Lung and Blood Institute.

“That data of their study showed how physical activity could significantly reduce risk factors for cardiovascular disease, diabetes and stroke,” he said.

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lunch?

A

CARRIE STEINWEG

s schools get back into session, parents are faced with helping children adjust to new classrooms and sometimes new schools, getting all the supplies they’ll need and making decisions about how they will be eating.

The midday meal is an important one: Consuming the right things can give kids the boost of energy they need to concentrate for the afternoon, while the wrong things can leave them sluggish and unable to tackle those lessons toward the end of the day.

CAFETERIA OFFERINGS Cafeteria food has gotten a bad rap, though there was a time that was deserved.

Parents of today’s kids can probably recall mystery meat, questionable-looking gelatin or greasy pizza. Today, Salads, school lunches veggies, fruit and bottled have undergone water are among a huge overhaul. the options at They feature Hammond more lean meats schools. and foods with less sodium and fewer calories and more scratchmade items instead of processed choices.

Christine Clarahan is a registered dietitian and director of food and nutrition for the School City of Hammond. “In Hammond we really pride ourselves on nourishing our

kids’ minds so they can concentrate in the classroom,” she said.

Each day the Hammond schools, which offers a free lunch to all students, serve a “Healthy Hoosier” meal. An example would be Italian chicken with mashed potatoes, gravy, green beans, a fluffy roll, diced peaches and milk. Sometimes the Healthy Hoosier meal includes hummus made from scratch along with fresh vegetables. The schools try to source fruit and vegetables locally as much as possible.

Kay Nallenweg, director of food service with Duneland School Corp., said cafeterias have seen big changes in recent years, under new U.S. Department of Agriculture guidelines, and have had to strike a balance between providing healthy foods and serving items kids will actually eat.

DIETARY RESTRICTIONS? A homemade Lunchable with lean deli meat, lowfat cheese wrapped in a whole-grain tortilla with fruit, vegetables and hummus.

If your child has food allergies, Alison Forajter, registered dietitian with Community Healthcare System, recommends teaching them to read food labels so they can spot items that would cause adverse reactions and discuss how to recognize their symptoms and reactions so they can alert school staff.

Involve them in planning, shopping and preparation of allergy-free foods.

FoodAllergy.org is a good source of information for those dealing with food allergies.

If your child follows a gluten-free diet, look for substitutions in kid-friendly foods. Forajter suggests using gluten-free breads on sandwiches, rice crackers in place of whole-grain crackers and corn tortillas instead of flour. Celiac.org has pediatric menus to help with ideas.

FOOD PHOTOGRAPHY BY TONY V. MARTIN, THE TIMES ; HAMMOND SCHOOLS PHOTOS PROVIDED

Tips to fill school lunches — brown bag or cafeteria bought — with healthy options

“Gone are the days of planning a menu with just the five components of a meat or meat alternative, fruit, vegetable, grains and milk with no limitations on fat or calories,” she said.

“There are now strict guidelines for calories, fat content, sodium and what started out as maximum limits on grains and proteins, which eventually was lifted temporarily for one more year, that put a strain on making decisions about what to serve students that they would actually like and eat.”

However, she noted that change was needed in a time when childhood obesity was at an all-time high. “We have more fresh fruits and vegetables being offered and have eliminated sugary drinks and snacks,” she said.

Lunchrooms also are incorporating educational components, too, such as a USDA classroom program that the Hammond Schools have instituted. “It’s a fresh fruit and vegetable program to help expose kids to new healthy foods,” Clarahan said. “They get to try blood oranges, pummelo, dragon fruit, yellow watermelon, jicama, ugly fruit. We prepare it and send in into classrooms in baggies, and they get

to see a whole version of it and we give teachers talking points on each item.”

BROWN-BAGGING IT If you’re packing a lunch, Alison Forajter, registered dietitian with Community Healthcare System, recommends pairing hummus or nut butter with veggie sticks for dipping or whole grain crackers or pita.

Forajter also suggests a twist on a kid favorite: Make your own Lunchables. “Choose whole grain crackers, lean deli meat such as ham, roast beef or turkey, fruit and vegetables and a low-fat cheese, like Swiss,” she said. “Or switch out the bread with a whole grain tortilla to make a wrap instead of a sandwich.”

Getting creative and having a theme related to a holiday or color also can make lunch more appealing to kids. “For example for St. Patrick’s Day, it could be all green and have a turkey avocado spinach wrap, celery sticks and green apples,” Forajter said. Adding vibrant colors in general makes food more appetizing to youngsters, so Forajter encourages parents to pack lunches that allow kids to “eat the rainbow.”

INVOLVING KIDS Giving kids some input into their food makes it more likely it will be eaten.

“If your child brings a lunch, you can collaborate with your child to bring something he or she likes to ensure they will eat a balanced meal,” said Alison Forajter, registered dietitian with Community Healthcare System.

“I suggest sitting down with your child to plan lunches together.

From there have them participate in packing their lunch, as well. This active participation in their meals will give them some ownership and interest in their lunch. Be sure to include a fruit and vegetables and focus on whole grains, lean protein and low-fat dairy.”

Christine Clarahan, a registered dietitian and director of food and nutrition for the School City of Hammond, suggests involving kids who get lunch from the school cafeteria in meal planning.

“It’s a four-week cycle menu, so children can plan with parents since they know what the options will be,” she said.

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root matter OF THE

L

GILES BRUCE

inda Vogedes can smile again. And eat steak.

And vegetables.

About a decade ago, one of her front teeth cracked. She was so busy taking care of her sick parents she didn’t bother having it fixed.

It got infected, as did, subsequently, several more of her teeth, causing them to fall out. At one point, her face swelled to the point it affected her sight and hearing.

She couldn’t eat the food she wanted. She hid her smile. Her confidence was shot.

“I put myself in a shell after that for about a year,” said Vogedes, 49, of Chesterton. “Then my daughter took me to the doctor and said, ‘Fix her. She’s not herself.’”

Vogedes was outfitted with dentures. Almost immediately, her mood improved. She expanded her diet beyond pudding, applesauce and cottage cheese.

“It totally changed my life,” she said.

Her story is an example of the impact good dental health can have on your overall well-being.

“We’re appreciating more and more the effects that oral health has on the rest of the body,” said Dr. Isaac Zeckel, chief Dr. Isaac Zeckel dental officer for HealthLinc, a federally qualified health center in East Chicago, Valparaiso and Michigan City.

He noted that the research connecting oral and overall health has been growing in recent years.

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Sound dental health is key to overall well-being

Poor oral health has been tied to heart disease, diabetes and poor pregnancy outcomes, he said. “Inflammation in one part of the body can affect other areas as well,” he said.

A 2017 study in the journal Health Economics found that newly diagnosed diabetes patients treated for periodontal disease had, on average, lower diabetes-related and medical costs over time. Similar research, published in the American Journal of Preventive Medicine in 2014, determined that treating gum disease correlated with lower spending on diabetes, stroke, heart disease and pregnancy and fewer hospital admissions for diabetes, stroke and heart disease.

There’s also the effect on quality of life. Oral diseases have been found to cause disturbed sleep, stunted growth and poor school performance in children, and limit dietary intake and social functioning in adults, according to a review of literature published in the Journal of the American Dental Association in 2015.

“We’re just discovering all the links between oral health and overall health,” said Dr. Brian Douts, a dentist with NorthShore Health Centers, a federally qualified health center with clinics in Portage, Chesterton, Hammond, Lake Station and Merrillville.

“In the future, no one is going to deny the fact that oral health is an indicator of how your overall health is.”

INFECTIONS CAN SPREAD Dr. Rishi Sukhija, an interventional cardiologist with the LaPorte Physician Network, noted that people with unhealthy teeth have a high risk of developing heart disease or blockage in the arteries. He said it’s either because inflammation in the mouth causes plaque buildup in the heart vessels or individuals with poor oral hygiene are less likely to practice heart healthy behaviors, like eating a nutritious diet or exercising.

Either way, he said, “Dental health is important, and people should take care of their teeth, and they should start early.”

Dr. Kaveh Rahmani, a family doctor with Ingalls Health System, said endocarditis, an infection that travels from the mouth to the heart, is the most dangerous condition that can result from poor oral health. nwi.com/gethealthy

“If you have a longstanding infection in a tooth, bacteria goes from the mouth to the bloodstream and attaches to the heart valve,” said Rahmani, who practices in Crestwood, Flossmoor and Tinley Park. “You Dr. Kaveh might not know about it Rahmani till it’s too late.”

Dental infections can also spread to the neck and chest, causing abscesses that land patients in the emergency room, said Dr. Kedar Kakodkar, an ear, nose and throat physician affiliated with St. Catherine Hospital in Dr. Kedar Kakodkar East Chicago.

“The oral cavity is very important to maintain adequate health,” he said. “It’s a gateway, where we ingest our food.

There are a lot of areas that can be infected.”

Every year, more than 2 million Americans visit the ER for a dental condition, according to the American Dental Association, costing the U.S. health care system about $1.6 billion.

Part of the reason is that many low-income people lack access to dental care. In Northwest Indiana, East Chicago is designated by the federal government as a dental professional shortage area.

A potential solution is for pediatricians to apply fluoride varnish, an inexpensive way to prevent tooth decay in children. This year, Indiana became the last state to approve reimbursement for this service.

MORE INTEGRATION Research has found that dentists are becoming increasingly willing to screen patients for medical conditions—and vice versa. Zeckel said that, during a recent appointment, one of his dentists noticed bruising on a patient’s arms. The patient said she had them all over her body. The dentist referred her to a doctor, who diagnosed the woman with thrombocytopenia, or a lack of blood platelets.

Referring to doctors may be easier to do

at places such as HealthLinc or NorthShore Health Centers, which have medical, dental and vision care under one roof. Many federally qualified health centers have similar arrangements, in part because Medicaid often covers medical and dental. However, on the private side, medical and dental care — and their respective insurances — are more siloed.

“If we’re going to reduce costs for patients and give them a better experience ... we all need to work together,” Zeckel said.

As for Vogedes, she said she feels like a new person, physically and emotionally, since she got her new teeth.

“I can actually go meet friends for lunch because I can eat anything,” she said. “I can eat corn, broccoli, cauliflower. I couldn’t eat green beans very well because they were stringy. I couldn’t eat anything that had skin on it, like tomatoes. I’ve got a whole garden growing this year. My everything has changed.”

And she’s showing off those new teeth.

“I didn’t smile for, what, 10 years,” she said.

“You can see any of my pictures on Facebook — there’s no smile until the day I got my teeth.

I’ve got my smile back. I can chase the world.”

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dog days

CHRISTINE BRYANT

A

s summer winds down, all members of the family are making the most of their time outdoors.

However, with warm weather comes hazards to pets. Local veterinarians offer tips on how to protect pets from overheating, exposure to harmful chemicals and other dangers lurking in the sunshine.

OVERHEATING When it’s time for outdoor fun, Dr. Darlene Finley says one of the most important acts pet owners should take is to provide fresh water.

“Obvious things like keeping the bowl out of the sun will help with keeping it fresh,” said the

veterinarian at Humane Society Calumet Area’s Estelle Marcus Animal Clinic. “A fun thing to keep a pet cool in the heat is to freeze a bowl of water and offer a nice, big ice cube as enrichment.”

Kiddie pools with fresh water are also a great way to keep a pet cool, she said. It’s important to remember that pets are wearing a fur coat, so any behaviors out of the normal on a hot day warrant a trip to the vet.

Dog breeds with flat faces, such as pugs, bulldogs and boxers, are especially susceptible to the heat, and pet owners should use extra caution when they’re outside, Finley said.

“Make sure your pet has the opportunity to get out of the sun,” she said. “Keeping pets hydrated is critical.”

Tips for helping your pet beat end-of-summer heat and other outdoor hazards

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COMMON POISONS Pesticides, herbicides, and fertilizer are in widespread use during the summer months to ward off insects and promote growth of lawns and gardens.

However, some are toxic to animals and, if ingested, may cause vomiting, seizures and death.

“Try to be careful because your pet could be sensitive, even if a product is labeled pet-friendly,” said Dr. Kerri Katsalis at Ridge Animal Clinic in Lansing.

Finley also advises vigilance when barbecuing so pets don’t get into things they shouldn’t be eating, including bones and corncobs, which can cause choking.

HOT PAVEMENT Many surfaces can become painfully hot for pets, Finley said. Darker surfaces are typically hotter than lighter ones.

“Walking in parks with shaded areas and grass is a great alternative to asphalt or cement paths,” she said. “Dogs don’t sweat, so they will eliminate heat by panting and sometimes through their foot pads, so that

should be kept in mind as well.”

BEE STINGS Just like humans, pets may have a bad reaction to bee stings.

Most of the time, a dog or cat will experience mild swelling or tenderness in the location of the sting. However, it’s a good idea to give your vet a call when a sting occurs, Katsalis said.

Depending on its reaction, a pet may need an antiinflammatory or antihistamine.

HOT CARS Even on relatively mild days, a car can heat up quickly. “Just like with babies, don’t leave your pet in a hot car,” Katsalis said.

Don’t assume a pet will be fine for a quick trip in the store.

According to the American Veterinary Medical Association, a vehicle’s temperature can rise almost 20 degrees in 10 minutes and almost 30 degrees in 20 minutes.

Even on a 70-degree day, that’s 100 degrees inside a vehicle in just 20 minutes.

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