Family Health & Wellness November/December 2012 by Style Media Group

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health & wellness NOVEMBER/DECEMBER 2012

Stem Cell research Meticulous Work, Miraculous Results

TONED FROM HEAD TO TOE THREE LEAN-BODY WORKOUTS

ADHD

RESOURCES TO HELP

MULTIPLE SCLEROSIS

Early Diagnosis is Key

DYING TO BE THIN

The Art of Real Food Recipes for the Season sacramento

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EATING DISORDERS IN OUR KIDS On the cover:

Roasted Beet Salad with Cucumber from The Art of Real Food. For this recipe and others from the book, turn to page 34.

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Happy Turkey Day!

CERTIFIE

contents

amily

health & wellness NOVEMBER/DECEMBER 2012

familyhw.com

IN THIS ISSUE...

MORE...

6 8 14

Your Child’s Health

Dying to be Thin by Jenn Thornton

Fitness

Toned from Head to Toe

by Kelley Saia

Your Health

Multiple Sclerosis

Six DVD Workouts

by Morgan Cásarez

Stem Cell Research

Meticulous Work, Miraculous Results by Margaret Snider

Your Pet’s Health

Every Pet Deserves a Plan by LeeAnn Dickson |

Family Health & Wellness

November/December 2012 – familyhw.com

Health Happenings SWAG: Products for Your Health & Wellness Your Child’s Health: Full Speed Ahead

29 Your Health:

by Kristen Castillo

Breathing New Life into an Old Trend

Editor’s Note

Touch and Go Nutrition: Eating Right for Your Blood Type

34 Dish: Recipes for Healthy Living

44 Sleep on It:

Get More Zs...

50 Ask the Experts:

Our Advisory Board Answers Your Questions

editor’s note

amily

e live in a time of exciting advancements in the field L EL C of medicine. Researchers EM ST RESEARCH are discovering new and improved ways to treat those with injuries, disease and sickness. One area that is particularly exciting is stem cell research. Though not ADHD without its controversy, researchers believe that stem cell research can lead to major adDYING TO BE THIN vancements in treatment for afflictions that The Art oodf Fo l until now have been considerably less hopea e RRecipes for the Season ful, and the UC Davis Institute for Regenerative Cures is leading the way. In fact, they’re currently conducting, or will be conducting, clinical trials utilizing adult stem cells to treat Huntington’s disease, heart attacks, peripheral vascular disease and bone repair. To find out more about what stem cells are all about and the research and researchers behind the Institute, check out Margaret Snider’s article, “Stem Cell Research: Meticulous Work, Miraculous Results,” starting on page 40. Lately, we’ve been obsessed with “real” food. So when we discovered the recent book, The Art of Real Food, by Joanne Neft and Laura Kenny, we thought we had found food heaven! In this, their follow-up to Placer County Real Food, these local authors present recipes utilizing the freshest produce that’s in season for every week of the year. Turn to page 34 for just a sampling of recipes from the book. Have you always wanted to have a dancer’s body? Yeah, me too. Well, there’s still hope for us, if we’re willing to put in the work—unfortunately just wishing for the body doesn’t make it happen. To help, Kelley Saia has put together ideas for local workouts to help you get the lean body you’ve always wanted. Check out her article starting on page 22. If you are like all of the pet lovers here at Family Health & Wellness, your pets have become integral parts of your family. These “fur children” provide us with the most wonderful greetings when we arrive home, and give us unconditional love day after day. But, if you’re like most of us, you haven’t given much thought to what will happen to your furry friends after you die. In LeeAnn Dickson’s article, “Every Pet Deserves a Plan,” she gives thought to adding a pet provision to your estate plan, or developing a pet trust. Check it out starting on page 48. With every issue of Family Health & Wellness Magazine, it’s our mission to bring you information and resources that you can actually use, and we hope we’ve achieved that mission. And, as always, we love to hear from our readers—tell us what you like and what you want more of... we want to serve it up for you! Feel free to email me directly at wendy@ familyhw.com. Here’s to your health and wellness! health & wellness

MBER 2012 NOVEMBER/DECE

FAMILYHW.CO

Work, Meticulous

Results Miraculous

M TONED FRO TO TOE HEADBODY WORKOUTS

THREE LEAN-

TO HELP RESOURCES

MULTIPLE SCLEROSIS is Key

osis Early Diagn

RDERS EATING DISO KIDS IN OUR

On the cover:

Roasted Beet

r from Salad with Cucumbe Food. The Art of Real and others For this recipe 34. turn to page

from the book,

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NOVEMBER/DECEMBER 2012 ISSUE WENDY SIPPLE Editor/Publisher MEGAN WISKUS Managing Editor Morgan Cásarez, Jamila B. Khan, PARIS ryan, KELLY SODERLUND Editorial Interns DANTE FONTANA Staff Photographer Contributing Writers Morgan Cásarez, Kristen Castillo, LeeAnn Dickson, Jamila B. Kahn, Corrie Pelc, Jacqueline Renfrow, Janice Rosenthal Rock, Kelley Saia, Janet Scherr, Margaret Snider, Jenn Thornton GEORGE KENTON Art Director George Kenton Design | 760-342-3611 | gkenton@verizon.net

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PM 10/15/12 8:30:30

P.S. If you like what you see here in print, check out our Blog. We update it regularly with interesting and helpful health and wellness tips, activities and events. Visit us at familyhw.com. And, be sure to follow us on Facebook: facebook.com/familyhealthwellness.

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GARY ZSIGO Associate Art Director LESLEY MILLER, Aaron Roseli Graphic Designers Debra Linn Advertising Director 916-988-9888 x114 Advertising Sales Representatives tami brown 916-988-9888 x117 RHONDA LOU HAYDEN 916-988-9888 x118 Reg Holliday 916-988-9888 x121 Joanne Kilmartin 916-607-9360 Carrie mccormick 916-988-9888 x112 DEBBIE NEWELL/NEWELL & ASSOCIATES 916-983-9359 Lisa Warner/Warner Enterprises 530-306-2011 Terence P. Carroll CEO/Publisher, Style Media Group Desiree Patterson Editor, Style Group Darren Elms Editorial Director, Luxury Group Aimee Carroll Social Media Maven Kathy Hurt Accounting Manager Cathy Carmichael, Brenna McGowan Office Assistants Jarrod Carroll Customer Service Associate

ADVISORY BOARD MEMBERS CAN BE FOUND ON PAGE 50 Family Health & Wellness is printed on recycled paper. Please recycle this magazine.

P.O. Box 925 • Folsom, CA 95763 Tel 916-988-9888 • Fax 916-596-2100 stylemg.com | familyhw.com © 2012 by Style Media Group. Family Health & Wellness is a bimonthly publication of Style Media Group. All rights reserved. Material in this magazine may not be reproduced in any form without written consent from the publishers. Any and all submissions to Family Health & Wellness become the property of Style Media Group and may be used in any media. We reserve the right to edit. Subscriptions to Family Health & Wellness are available. Contact info@stylemg.com for more information.

health happenings

by corrie pelc and janet scherr

A BOOST FOR BUBBLEBUM

MARSHALL MEDICAL CENTER CELEBRATES NEW WING Marshall Medical Center unveiled its new South Wing in September; thousands turned out to take preview tours and celebrate the long-anticipated new facility which opening this fall. The 88,000-square-foot wing includes a new state-of-the-art Emergency Department, Verified Level III Trauma Center and Birth Center. It took three years to construct, although many more years went into designing and fundraising. “This has been promised for 20 years and the space turned out more beautiful than we could have hoped for,” says James Whipple, CEO of Marshall Medical Center. The Emergency Department is increasing in capacity from 15 to 24 beds and includes many high-tech features, diagnostic imaging capabilities and a trauma/resuscitation room. The new Birth Center offers 12 all-private rooms, an expanded nursery and a family-oriented, inclusive environment. The new building is slated to house more services as funding allows. Whipple praised Marshall’s staff for its enthusiasm in welcoming the new South Wing. “I had someone mention to me that this felt like a wedding,” he says. “First we experienced the build-up and the big celebration of a blessed event. Now we embark on an exciting journey of making a difference in our community, bringing new life into this world and saving lives.” For more information, visit Marshall Medical Center’s Web site: marshallmedical.org.

FRESH LUNCH IDEAS We are now several months into the school year and you’ve probably run out of fresh ideas for your kid’s lunch.

Here are

some to try: Fruit Dunk: Your child will be more likely to eat an orange if you peel and segment it, and seal in a zip-top bag. Throw in a small cup of flavored yogurt and he/she can have fun dunking the orange slices in the yogurt. Keep It Hot: Let’s face it: Cold sandwiches can get really boring. But who said school lunches have to be cold? A hot lunch can be just what your child needs on a chilly winter day. A wide variety of insulated food-storage lunch bags and thermos jars are available to keep soups, stews and entrées hot and safe until lunchtime. Healthy “Hot dogs”: Most kids like hot dogs, but they’re not the healthiest school lunch option. With a little creativity, a fun and nutritious alternative can be packed in the lunch box. Wrap a string cheese stick with one or two slices of lean ham or turkey and place in a hot dog bun. Don’t forget to include a few individual ketchup and mustard packets for this fun “hot dog.”

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Fresh Lunch Ideas photo © Jacek Chabraszewski/fotolia.com, All other photos courtesy of their respective organizations.

BubbleBum—an inflatable, lightweight booster seat that can be deflated and rolled up to be stored in a trunk, locker or backpack until the next car ride—recently received a number of awards, including Mom’s Best HOT Product Winner in the category of Baby Gear. Additionally, it won the 2012 Top Choice of the Year Award in Kids Travel by Creative Child Magazine, and is a winner of both the PTPA (Parent Tested Parent Approved) Media Awards and Juvenile Product Manufacturers Association Awards. BubbleBum also took the Best Bet Award in the Insurance Institute of Highway Safety’s booster seat evaluation report where they reportedly branded BubbleBum as one of the best for safety. Available in bright colors, the booster seat accommodates 4- to 11-year olds, between 40 and 100 pounds. The product retails for $39.99 and is available at bubblebum.us, target.com and babiesrus.com.

by corrie pelc and janet scherr

TURKEY TROT WARM-UP

If your holiday plans include a run for the local food bank on Thanksgiving morning, be sure to warm up first. For many who participate in these seasonal events, it’s easy to overlook the importance of a proper warm-up to increase heart rate, breathing rate and blood flow to the muscles, while reducing the risk of injury. What makes a good warm-up? You should match the level of preparation to the intended effort. For instance, the faster you’ll be running, the longer and more thoroughly you should warm up. Try to arrive at least one hour before the start so you can accomplish everything before the race starts— pick up your number, use the porta potty and chat with friends—then get your body ready for the race. Basic Warm-up: Begin with easy walking or jogging. Add in a few light stretches, and then do several 100-meter strides, accelerating smoothly to race pace. The shorter the race, the longer the warm-up should be, because you’ll need to hit a faster pace right from the start. Here is what many runners recommend for 5K and 10K events: 5K WALK OR JOG: 15-30 minutes STRIDES: 8 x 100 meters 10K WALK OR JOG: 10-15 minutes STRIDES: 6-8 x 100 meters

SAFE WEAR AND CARE OF CONTACT LENSES

Ever wonder what the safest way to wear and care for your contact lenses is? Johnson & Johnson Vision Care, Inc., has recently developed a new educational resource, Healthy Vision & Contact Lenses, available for free at acuvue.com/press. The download offers helpful “Do’s and Don’ts” for handling and wearing contact lenses, and offers easy-to-follow steps on how to reduce the risk of contact lens-related infection through proper use and care, as well as lens-care products.

JUMBO SHRIMP: OXYMORON?

SPARE ONE 4 THE KIDS! What’s better than an evening of bowling? An evening of bowling that benefits foster kids! On Friday, November 2, Lilliput Children’s Services will hold the Spare One 4 the Kids! Bowl-a-Thon Fundraiser from 6-8 p.m. at Country Club Lanes in Sacramento. The event will feature all-you-can-eat pizza and soda, shoe rentals, prizes and raffles. All funds raised will support the Sacramento County Kinship Support Services program, which supports kin—grandparents and other family members—who are raising their relative children when the birth parents aren’t able to do so. To sign up or support a bowler you know, visit lilliput.org.

Family Health & Wellness

November/December 2012 – familyhw.com

The two words together may be contradictory but in reality, shrimp provides jumbo benefits and ranks as a superfood for women. With about 90 calories per three-ounce serving, shrimp has virtually no fat and is packed with protein. It may even help prevent heart disease, thanks to astaxanthin, the antioxidant that gives the shellfish its red tint. “People shy away from shrimp because it’s high in cholesterol, but cholesterol in food is much less likely to raise your blood cholesterol than, say, trans fat,” says Kathy McManus, R.D., director of the Department of Nutrition at Brigham and Women’s Hospital in Boston. Moreover, shrimp is also rich in cancer-fighting selenium and bone-building vitamin D. To see the top 10 superfoods for women, visit shine.yahoo.com and click the Healthy Living tab.

Turkey trot photo © lightpoet/fotolia.com, Contact lens photo © Vladimir Sazonov/fotolia.com, Bowling photo © Alexander Schulz/fotolia.com, Shrimp photo © Anna Kuznetsova/fotolia.com.

health happenings

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health happenings

by corrie pelc and janet scherr

WHY DOES HOLIDAY FRUITCAKE GET A BAD RAP? Word has it that fruitcake’s unfair reputation stems from an old joke on The Johnny Carson Show. While it’s true that some store-bought versions of this Christmas staple may be high in fat and calories, the good news is that there are plenty of ways to prepare your own fresh fruitcake. You can add color to your holiday meals while contributing to your daily requirements of fiber, iron, protein, healthy fats and other nutrients. For example, all-purpose white flour can be combined with whole-wheat flour for added fiber, and molasses can replace sugar for an iron boost. Reduce sugar even further by substituting dried apricots, cherries and pineapple for candied fruits; replace whole eggs with egg whites to reduce cholesterol and fat. So, when faced with a table laden with cakes, cookies and candies this holiday season, a homemade, healthy fruitcake just may be your best choice.

Looking for a way to keep you and your family healthy this winter? You may want to try the Pocket Purifier—a hand-held device that uses UV-C light to literally zap germs from objects and surfaces. Made by Purely Products, the Pocket Purifier reportedly uses the same UV-C light used to sterilize surgical instruments, eliminating 99 percent of germs that cause colds and flu, plus e-coli, salmonella, mold, fungus and MRSA staph (Methicillin-Resistant Staphylococcus Aureus). By holding the device about one inch above a surface for 10-15 seconds, it uses a 4-watt germicidal ultraviolet light that deactivates the DNA of bacteria, viruses and other pathogens destroying their ability to multiply and sanitizes the item you’re trying to clean. The Pocket Purifier retails for $19.99 and is available at purelyproducts.com.

“F” AS IN FAT

According to the report “F as in Fat: How Obesity Threatens America’s Future 2012,” released by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), 13 states are currently on the path to hitting an adult obesity rate of 60 percent by 2030, while 39 states will hit 50 percent and all 50 states could have rates above 44 percent. The report also says that if states’ obesity rates continue on their current course, the number of new cases of type 2 diabetes, coronary heart disease, stroke, hypertension and arthritis could increase 10 times between 2010 and 2020, and then double again by 2030. However, the report says that states could prevent these diseases and dramatically reduce health care costs if they reduced the average body mass index (BMI) of their residents by 5 percent by 2030. To read the report in full, visit healthyamericans.org.

THE PROBLEM WITH PACIFIERS

Pacifiers may stunt the emotional development of baby boys by robbing them of the opportunity to try on facial expressions during infancy, according to a new study conducted by psychologists at the University of Wisconsin-Madison. According to researchers, humans of all ages often mimic the expressions and body language of the people around them, which can be an important learning tool for babies. However, with a pacifier in his mouth, a baby is less able to mirror those expressions and the emotions they represent. Researchers found that 6- and 7-year-old boys who spent more time with pacifiers in their mouths as young children were less likely to mimic the emotional expressions of faces peering out from a video, while college-aged males who reported more pacifier use as a kid scored lower than their peers on common tests of perspective-taking, a component of empathy. University researchers believe that since girls develop earlier in many ways, boys are more susceptible to pacifier use disrupting their use of facial mimicry; more research is reportedly planned to further explain these results.

FOR MORE health happenings, VISIT FAMILY HEALTH & WELLNESS MAGAZINE’S WEB SITE FAMILYHW.COM.

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Fruitcake photo © olyina/fotolia.com, “F as in Fat” illustration © Julia-L/fotolia.com, Pacifier photo © rgbdigital.co.uk/fotolia.com. All other photos courtesy of their respective organizations.

ZAP THOSE GERMS!

swag

KEEN Men’s Targhee II Mid Hiking Boots in Dark Earth/Neutral Gray, $130 at keenfootwear.com.

Capita Indoor Survival FK, $399.95, and Union Binding Company Contact in Blood Splatter, $179.95, at Boards N Motion, 13417 Lincoln Way, Auburn. 530-888-7873, boardsnmotion.com. Nike Flyknit Trainer+, $150, and Soleus Chicked Watch in Pink, $55, at Fleet Feet Sports, 1850 Douglas Boulevard, Roseville. 916-783-4558, fleetfeetsports.com.

Willa Naturals Start Fresh Foaming Facial Wash, $11 at willaskincare.com.

products for your health & wellness by jamila b. khan

Max Muscle Sports Nutrition C.O.M.P. Chocolate (4 pounds), $67.99 at Max Muscle, 2330 Sunset Boulevard, Rocklin, 916-435-0327; 4615 Missouri Flat Road, Suite 4, Placerville, 530-626-0239, maxmusclestoreonline.com.

Pangea Organics Turkish Rose & White Tea Eye Cream, $55, and Pangea Organics Himalayian Geranium & Pomegranate Balancing Oil, $50, at pangeaorganics.com.

FOR MORE swag products, VISIT FAMILY HEALTH & WELLNESS MAGAZINE’S WEB SITE FAMILYHW.COM.

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bobble Water Bottle in Black (Medium, 18.5oz/550mL), $9.99 at GNC, 3450 Palmer Drive, Cameron Park. 530-676-7100, gnc.com.

Photos of products from The Doggie Bag, Boards N Motion and Fleet Feet Sports by Aaron Roseli. All other photos courtesy of their respective organizations.

Quest Nutrition Bars, $2.25 each at The Vitamin Shoppe, 2405 Iron Point Road, Suite 100, Folsom. 916-983-3529, vitaminshoppe.com.

Stella & Chewy’s Dandy Lamb Dinner for Dogs, $29.99, and Pet Naturals of Vermont BoneShaped Chews for Dogs, $11.99, at The Doggie Bag, 6881 Douglas Boulevard, Granite Bay. 916-786-9663, thedoggiebag.com.

S UL OGA N E W

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M E D I TAT I O N AY U RV E DA D O S H A

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your child’s health

Dying to be thin Kids and Eating Disorders BY JeNn Thornton

hildhood is a minefield of growing pains, but add an eating disorder and this carefree stage of life can quickly turn obsessive and extreme. Sadly, the frequency with which eating disorders are affecting the 12-and-under set is alarming. Elizabeth Peterson, M.D., a pediatrician with Marshall Pediatrics, gives parents a glimpse into this complex world.

CATEGORIES The mental health community recognizes four categories of eating disorders. Of these, anorexia nervosa, bulimia nervosa and binge eating disorder are the most common, with a fourth, called eating disorder NOS (or “not otherwise specified”), for afflictions with symptoms that don’t meet the full diagnostic criteria of the above. In self-starvation mode, those with anorexia go to extreme measures—exercising excessively, using laxatives, vomiting and refusing to eat—to lose dramatic amounts of weight (an emaciated appearance is not uncommon). Bulimia sufferers, on the other hand, are often of normal weight, even overweight, complicating identifica-

Family Health & Wellness

November/December 2012 – familyhw.com

tion and diagnosis. After rapid bouts of overeating, bulimics vomit, exercise vigorously or use laxatives to purge. Like bulimics, binge eaters consume vast quantities of food quickly, but they don’t purge. By no means are these conditions mutually exclusive—many kids alternate between them.

CAUSES Eating disorders strike all ethnic groups, socioeconomic levels, ages and genders. “It is estimated that 10 to 15 percent of individuals with eating disorders are boys,” Dr. Peterson notes. While cultural cues stressing unrealistic expectations of thinness—reinforced by scads of positive attention, and more often than not, it seems, multi-milliondollar endorsements and reality TV shows—have and continue to contribute to the rise of eating disorders among youth, there is no smoking gun, per se. A confluence of biological, emotional and social influences all play a role in how they develop. There are, however, commonalities among kids with eating disorders that the medical community identifies as common: perfectionist tendencies, low self-esteem, impulsivity, a lack of coping skills, perceived expectation of high achievement, psychological and emotional problems,

your child’s health are more likely to suffer from anxiety, depression and obsessivecompulsive disorder. Despite some overlap, the signs that a child might have an eating disorder vary depending on the condition, but look for obvious indicators like dramatic weight change over a short period of time, an obsession with food, and rigid diet and exercise routines. Loss of interest and mental clarity, as well as irregular mood, might also indicate cause for concern. Physical manifestations could include dry skin and hair, swollen salivary glands, fatigue and lightheadedness, loss of menstrual cycle, and throat and chest pain.

COPING Hope starts at home. Families who eat together can help protect kids from developing an eating disorder, as can reinforcing healthy attitudes about body image and eating, and modeling behaviors accordingly. “Children learn from watching us,” Dr. Peterson says. “If we are frequently focusing on dieting and body shape, they will too. Encourage healthy nutrition and exercise—not a particular body shape—and being healthy, strong and energetic.” If concerned, consult with a physician and mental health expert specializing in eating disorders to determine the best course of treatment. •

FACILITY FOCUS

familial issues and genetics. “Children whose family members have eating disorders are 6 to 10 times more likely to develop one as well,” Dr. Peterson explains, adding that athletes involved with sports emphasizing body type (think gymnastics, wrestling, bodybuilding, etc.) are also at increased risk for developing an eating disorder.

Photo © Jaimie Duplass/fotolia.com.

COMPLICATIONS These afflictions wreak physical havoc. “There are many shortand long-term dangers of eating disorders in children and teens,” Dr. Peterson says. “The mortality rate for eating disorders is higher than any other mental illness. Eating disorders can negatively impact growth, which affects final adult height. Even worse, related starvation, dehydration and electrolyte balances can damage the heart, brain, liver, kidneys, intestines and muscles. Serious heart arrhythmias, heart failure, osteoporosis and esophageal tears are some of the medical complications associated with eating disorders.” Emotionally, the penalty is equally distressing. Children and teens with eating disorders are in emotional pain and have difficulty negotiating challenges in their own lives. Thus, they

Giving hope to those suffering from eating disorders is the goal of Sacramento-based treatment facility, Summit Eating Disorders and Outreach Programs (sedop.org), which offers intensive outpatient and partial hospitalization options to patients of all ages struggling with anorexia, bulimia or binge eating disorder, while also administering to the needs of their families. “Part of what makes Summit unique is the medical supervision on-site, as well as the collective experience of its diverse staff,” says Executive Director Jennifer Lombardi, M.F.T., who battled and recovered from an eating disorder. “Summit’s multidisciplinary approach includes having a diverse team of medical and psychiatric professionals, as well as dieticians and activity instructors, working collaboratively to provide the best care possible to our patients.” Shockingly, this includes the very young—once, a 7-year-old. For youth, a specifically conceived program incorporates school support services from a credentialed teacher, as well as art, music, movement and cooking, “to ensure that kids and teens have the opportunity to use different mediums to express their thoughts and feelings, as well as to identify new coping strategies,” Lombardi explains. Drawing on her own firsthand experience, Lombardi is in a unique position to share: “I will always remember the sense of shame and fear that accompanied my illness. Imagining the type of care we would want for a loved one motivates us to do whatever necessary to support patients, family members and friends.”

familyhw.com – November/December 2012

Family Health & Wellness

| 17

your childâ&#x20AC;&#x2122;s health

full speed ahead Diagnosing and Dealing with ADHD BY Kelley Saia

Family Health & Wellness

November/December 2012 â&#x20AC;&#x201C; familyhw.com

your child’s health

rom an early age, a child is noticeably active and extroverted. They have one speed: On. They are into everything, it’s difficult for them to focus their attention for a lengthy period of time, and they seem to have “selective hearing.” At what point do parents decide if they just have one active kid or if perhaps there’s something more to the story? Parents may begin to wonder if this child is demonstrating signs of attention deficit hyperactivity disorder (ADHD), but what exactly is ADHD?

Additionally, Linder says, “Despite natural instinct to not want to medicate a child, parents eventually opt for this decision in hopes of a better outcome.” If parents find that the medication doesn’t seem to be working or is causing other issues, they need to know that they are in control and can, and should, advocate to stop the medication and work to find something that does show improvement.

DEFINING ADHD

According to Linder, children with ADHD are very bright, and research shows that there is no correlation between low intelligence and ADHD. However, many parents become confused when they know their child is bright, yet they are failing in school. Diagnosis and treatment can often be delayed in these cases because parents feel their child is, “just not trying hard enough.” Because children with ADHD have difficulty following instructions and sustaining work for long periods of time, they seem to not be listening, which causes frustration among teachers— and often peers—as well as parents and the child himself. Aside from the obvious academic strain, children will also experience stressors in their social life, since they are often ostracized by their peers; their impulsivity can lead to getting in trouble both at home and at school. Diagnosis folchildren with lowed by treatment will certainly help alleviate many ADHD are of these stressors, and when very bright, and schools are informed, they can be research shows instrumental in finding additional strategies to help the child in their that there is no studies. A 504 plan may also be set in place, which is a written, legal correlation document stating the modificabetween low tions and accommodations that must be made for the child; exintelligence amples may include priority seatand ADHD. ing in a classroom, additional test time, or periodic breaks. While there is no known cause for ADHD and no cure, evaluation, diagnosis and treatment are ever improving and can provide children and their families with an overall better quality of life.

Photos © Cheryl Casey/fotolia.com.

DIAGNOSING ADHD If a parent suspects their child may be showing signs of ADHD, they should seek the help of a psychiatrist, psychologist, L.C.S.W., psychiatric nurse practitioner, neurologist, L.M.F.T., or family physician, all of whom can diagnose ADHD. In the past decade, there has been a rise in the number of diagnoses of ADHD in children, teens and adults, due to a number of improvements in the mental health field and among the general public as well. ADHD is diagnosed by completing a comprehensive psychiatric evaluation, including: interviewing, observation and completion of ADHD scales.

“

TREATMENT So, your child has just been diagnosed with ADHD. What now? Linder offers some hopeful advice: “Breathe a sigh of relief, because you and your child are on your way to improving your lives.” She goes on to say it’s important to seek treatment from highly qualified specialists early on and not to give up.

“

According to David Linder, M.D., and Renae Linder, M.S.W., L.C.S.W., of the Linder Psychiatric Group, “Attention deficit hyperactivity disorder (ADHD) consists of a pattern of behavior that is present in multiple settings where it gives rise to social, educational or work performance difficulties. Research findings suggest that these individuals suffer from problems with ‘executive functioning,’ and memory.” ADD is an old term, which is no longer used anymore, but there are three different types of ADHD: inattentive type, hyperactivity type, and combined type (inattentive and hyperactivity). Cindy McCullough, M.A., BCBA, with Get Social! Therapy, says, “It’s safe to say that all children are active, curious and occasionally over-zealous. The difference between a typically developing child and a child with ADHD is truly the frequency and intensity of the behavior.” Typically, it’s in the school setting when symptoms of ADHD become noticeable. According to Linder, a child with ADHD will have impaired functioning in school due to “inability to focus, memory problems, distractibility, difficulty with sustained attention, organizational skill problems, and sometimes hyperactivity and impulsivity.”

AFFECTS ON CHILDREN IN SCHOOL

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your child’s health SIGNS OF ADHD A. INATTENTIVE Signs of inattentive ADHD include six (or more) of the following symptoms that have persisted for at least six months, to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. 1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). 2. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations or reading lengthy writings). 3. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). 4. Often does not follow through on instructions, and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked; fails to finish schoolwork, household chores or tasks in the workplace). 5. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; poor time management; tends to fail to meet deadlines). 6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers). 7. Often loses things necessary for

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tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses or mobile telephones). 8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). 9. Is often forgetful in daily activities (e.g., chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). B. HYPERACTIVITY AND IMPULSIVITY Signs of hyperactivity and impulsivity ADHD include six (or more) of the following symptoms that have persisted for at least six months, to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. 1. Often fidgets with or taps hands or feet or squirms in seat. 2. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, office or other workplace, or in other situations that require remaining seated). 3. Often runs about or climbs in situations where it is inappropriate. (In adolescents or adults, may be limited to feeling restless.) 4. Often unable to play or engage in leisure activities quietly. 5. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable or uncomfortable being still for an extended time, as in restaurants, meetings, etc.; may be experienced by others as being restless and difficult to keep up with). 6. Often talks excessively. 7. Often blurts out an answer be-

November/December 2012 – familyhw.com

fore a question has been completed (e.g., completes people’s sentences and “jumps the gun” in conversations, cannot wait for next turn in conversation). 8. Often has difficulty waiting his or her turn (e.g., while waiting in line). 9. Often interrupts or intrudes on others (e.g., butts into conversations, games or activities; may start using other people’s things without asking or receiving permission; adolescents or adults may intrude into or take over what others are doing). C. SEVERAL INATTENTIVE OR HYPERACTIVE-IMPULSIVE SYMPTOMS WERE PRESENT PRIOR TO AGE 12. D. CRITERIA FOR THE DISORDER ARE MET IN TWO OR MORE SETTINGS (e.g., at home, school or work, with friends or relatives, or in other activities). E. THERE MUST BE CLEAR EVIDENCE THAT THE SYMPTOMS INTERFERE WITH OR REDUCE THE QUALITY OF SOCIAL, ACADEMIC, OR OCCUPATIONAL FUNCTIONING. F. THE SYMPTOMS DO NOT OCCUR EXCLUSIVELY DURING THE COURSE OF SCHIZOPHRENIA OR ANOTHER PSYCHOTIC DISORDER AND ARE NOT BETTER ACCOUNTED FOR BY ANOTHER MENTAL DISORDER (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). •

RESOURCES Get Social! Therapy 408-465-9521 getsocialtherapy.com Linder Psychiatric Group, Inc. 916-780-1070, 916-608-0714 echildpsychiatry.com

MANUAL THERAPY providing FUNCTIONAL Rehabilitation

Insurance Funding for Autism Services Capitol Autism Services is currently partnering with private insurance companies as funding sources for our in-home Applied Behavior Analysis (ABA) programs. If your child has a medical diagnosis of Pervasive Developmental Disorder or Autism Spectrum Disorder, they may be eligible for ABA programs funded through private insurance.

www.HandsOnHealer.net

For more information about our wide range of in-home ABA programs and utilizing private insurance coverage contact us at 916.923.1789 and visit our website.

www.capitolautismservices.com

Michael Cliﬀord • 916-337-6045 Folsom

Foothill Physical Therapy Excellence in Orthopedic and Spine Rehabilitation

Andrew Glidewell, DPT, OCS Kristen Glidewell, MPT Leah Mikla, DPT, OCS, CSCS Greg Stewart, MPT

Standing (left to right) H. Michael Balch, DDS; Michael Gade, DDS; A. Randy Wilkes, DDS; Dwight Miller, DDS, MS ~ orthodontist; Seated (left to right) Jeffrey McClure, DDS; Ronald Milla, DDS; (missing) Gregory Steiner, DDS, MS – periodontist

Blue Oak Dental ~ Roseville 15 Sierra Gate Plaza | Roseville 916-786-6777 www.blueoakdentalroseville.com “Care for a lifetime” is the cornerstone upon which Blue Oak Dental ~ Roseville was founded over 20 years ago. Our friendly staff and dentists provide quality dental care and they are committed to the integrity of their profession and honesty of their treatment recommendations. The office is open extended hours – 7 a.m. to 7 p.m. each weekday, and 7 a.m.

to 1 p.m. on Saturdays to accommodate your busy schedule. The group offers general dentistry, implant dentistry, orthodontics, periodontics and cosmetic dental services. At Blue Oak Dental ~ Roseville, we strive for more than just a beautiful smile. Healthy teeth and gums are essential to good health and that’s why our office features an in-house periodontist, Gregory Steiner, D.D.S., M.S., and an in-house orthodontist, Dwight Miller, D.D.S., M.S. The group offers flexible financing and is currently accepting new patients. Please ask about our $50 new patient certificate.

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(916) 934-0914 www.foothillpt.com

Kristen Glidewell, MPT

Andrew Glidewell, DPT, OCS

Leah Mikla, DPT, OCS, CSCS

Preferred Provider for most insurance Medicare Certified Worker’s compensation/Personal Injury

FITNESS

Toned From Head to Toe Three Lean-Body Workouts

by Kelley Saia // Photography by dante fontana

Kelley (foreground) with Certified Personal Trainer and Pilates Instructor Suzanne Cardenas at California Family Fitness

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November/December 2012 â&#x20AC;&#x201C; familyhw.com

FITNESS

e’ve heard many women—maybe even ourselves—share the desire for a “dancer’s body,” probably not referring to the disturbing images of the Hollywood hit Black Swan, but rather the long, lean muscles of trained dancers. Not 16 years old and not ready to train 40 hours a week with the New York City Ballet to get that body? Luckily, we found some local classes to help women (and men, too!) achieve those sought-after dancer bodies...and don’t worry, rhythm, tutus and tights are not required.

What I enjoyed most about The Dailey Method was the teaching-style. I have taken many classes that promise many of the same things—longer, leaner muscles, better posture, etc.—but the instructors don’t provide any sort of corrections or encouragement, so it’s up to your best guess if you’re doing things correctly. At TDM, the instructors really give you a lot of feedback, easy-to-understand corrections and encouragement, just when you need it. Having so much of my own experience with proper alignment, I’m always leery of programs boasting knowledge in that area; however, TDM is not only based on proper alignment, but the teachers stress it with each and every BACK TO THE BARRE exercise. Most importantly, they really know what they’re talking Ballet dancers are known for their lean bodies honed through about. Practitioners will not only see results more quickly this years of working at “the barre.” It’s no surprise, then, that more way, but will also avoid injury. studios are offering classes that incorporate barre work. One I asked Armijo and fellow instructor and owner of the new such studio is The Dailey Method (TDM). Created by Jill Dailey Folsom location, Sandra Lemos, why they wanted to invest in in the Bay area, TDM is a practice that takes time to master, but this program. Without hesitation, they both chimed in: “Results.” offers an incredibly efficient one-hour workout targeting women’s Both women have children, both have amazing bodies, and both most troublesome areas. Dailey comhave an equal passion for The Dailey bined her study of kinesiology with Method. They encouraged me to The Dailey Method Roseville her early training in ballet and later read through the testimonials they training in Pilates and yoga. have hanging in the lobby. There Having trained as a classical were pages upon pages of women’s dancer myself, I will admit I was incredible stories and appreciation pretty confident before entering my for the program. Armijo and Lemos first TDM class. I was humbled the challenge women to give the class minute the signature Dailey Method a shot, and say that after taking marches began and I broke a sweat; three classes a week for six weeks, I knew this was my kind of class. Ten you’ll not only begin to see and feel minutes in, my thighs were burnyour body change, but you’ll also ing, and after 20 minutes, just about be hooked. every major muscle in my body was With a new location in Folsom shaking. In just one hour, I received and free childcare at both locales, I’ll a full-body workout that reminded certainly be back. It’s perhaps one of me of my years at the ballet barre. As the most efficient workouts I’ve ever I left the beautiful facility and looked received, and as a working mom, down the steps I needed to take to I’m all about efficiency! reach my car, I wondered if my legs PILATES had the strength left to support me. Joseph Pilates designed the Pilates The following day, I couldn’t fully method based on his belief that the straighten my arms without my trimind and body are inter-related. ceps feeling like they were going to Many of his early students were rip. Okay, I may have exaggerated the dancers, which is how Pilates has pain in my body just a bit, but I sure become such a large part of the dance community today. Therewas sore, in a hurts-so-good kind of way. fore, it goes without saying that Pilates can help you achieve the Stacey Armijo, owner of The Dailey Method Roseville and my instructor for day one, suggested that I take three to five longer, leaner muscles that so many of us are after. classes within one week. Despite wanting to soak in a tub the There are different pieces of apparatus used in Pilates, each remainder of the week, I managed to take her advice. I found with its own exercises. California Family Fitness, Spare Time Clubs, Snap Fitness Clubs and other area fitness studios offer that I was able to do a little less the second day because I was so what is considered “mat Pilates” where no apparatus (other than sore, but I finished the class and still felt good. Each time I went, a mat) is needed, although many instructors incorporate some I had a different instructor with different exercises, but one thing remained the same: I got a workout. equipment such as large exercise balls and smaller weighted

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FITNESS balls for variation. These classes are typically open to those in all fitness levels, and the instructors are great at offering modifications for those with injuries or limitations. They also offer options for a great challenge. In fact, Suzanne Cardenas with California Family Fitness is known for her signature phrase: “If you want more...go here...” followed by a challenging add-on to the exercise. Area Spare Time Clubs, Pilates-only studios, and some physical therapy offices offer a larger range of modules including the popular “reformer” classes—the reformer is an apparatus that promotes a greater range of motion and offers more resistance than the basic mat class.

The Dailey Method Roseville

STUDIOS TO TRY: BARRE-FLIES FITNESS STUDIO Granite Bay, 916-791-3543, barreflies.com BARRE BASICS AT FULL THROTTLE FITNESS El Dorado Hills, 916-933-8006, fullthrottlefitness.com California Family Fitness

YOGA Like Pilates, yoga incorporates the mind and body, but it also incorporates spiritual disciplines. However, there are so many variations of yoga, so many studios in our area, and so many classes at gyms, that there really is something for everyone. You don’t have to be spiritual at all to reap the physical benefits of this practice. Yoga classes follow a series of poses and depending on the type of yoga, these poses are either held for a long period of time or flow from one pose to the next, and in some classes there is a combination of the two. Maintaining correct form in these poses is the challenge and promotes strength, flexibility and better posture. Temperature-controlled rooms known as “hot yoga” are very popular and provide added benefits, and certainly challenges. Be prepared to sweat like you never have before if you choose this option. And for those of you thinking: “Yoga is so boring; I will never get a good workout,” I personally challenge you to give it a try. You’ll be surprised at how difficult it really is, and how great you feel when you’re done. Instructors have to undergo pretty significant training to become certified to teach in any of these practices, but no matter the class, students may find that they favor one instructor or practice over another for whatever reason. It’s important to try several classes before deciding if the practice is right for you. Many area studios have introductory rates for new students, so be sure to ask before signing up for classes. •

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BODY CONCEPTS Folsom, 916-939-6800, bodyconceptsinc.com CALIFORNIA FAMILY FITNESS Numerous locations in our area 877-564-6233, californiafamilyfitness.com CORE SOLUTIONS PILATES AND PERSONAL TRAINING Folsom, 916-225-8900, pilateschik.com THE DAILEY METHOD Roseville and Folsom 916-783-8367, thedaileymethod.com ENERGETIC CARE WELLNESS El Dorado Hills, 916-813-7717, energeticcare.com FITNESS SOLUTIONS Diamond Springs, 530-391-9789 ROSEVILLE HEALTH & WELLNESS CENTER Roseville, 916-677-1200, rosevillehwc.com SATTVA PILATES, BARRE & YOGA Rocklin, 916-624-9642, sattvayogaandpilates.com SNAP FITNESS Numerous locations in our area, snapfitness.com SPARE TIME CLUBS Numerous locations in our area 916-859-5910, sparetimeclubs.com

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*Introductory rate valid for Members and first-time Guests only. Actual massage time is 50 Minutes hands-on. Additional local taxes and fees may apply. See Retreat for details. ©2012 Massage Heights. Franchise opportunities available.

YOUR HEALTH

Multiple Sclerosis Early Diagnosis is Key

by Kristen Castillo // photography by Dante Fontana

hink a diagnosis of multiple sclerosis (MS) means you’ll have tingling limbs and chronic pain? Not necessarily. That’s because every case is different. Just ask Folsom resident Jill Bailey who’s had MS for 17 years. Now 53, she was diagnosed after she started having vision problems. “My peripheral vision was so weird,” says Bailey, who thought she needed eyeglasses. She describes her vision problem as similar to “when you’re going through a grove of trees and sunlight is trickling in.” A doctor told her the problem wasn’t her eyes. After an MRI and a spinal tap, doctors determined that it was MS. She received a steroid IV to treat her vision problems, which were corrected with the medication.

Jill Bailey

signs and symptoms MS is thought to be an autoimmune disorder that, according to the National MS Society, “attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves.” John A. Bissell, M.D., chief of the Department of Neurology at Kaiser Permanente South Sacramento Medical Center, says common MS symptoms include, “loss of vision in one eye, double vision, dizziness, loss of balance, weakness and numbness.” Some patients have mild symptoms while other cases are very devastating. “MS is one of the most perplexing conditions we deal

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November/December 2012 – familyhw.com

with in neurology because it affects people in so many different ways,” says John Schafer, M.D., neurologist with the Mercy MS Center in Carmichael.

who it affects About 400,000 Americans have MS and 200 more people are

YOUR HEALTH diagnosed every week. Bailey’s MS was diagnosed when she was 35, which is a typical age range for MS patients. “An important thing about MS is that it’s a disease of young adults,” Dr. Schafer says. “The first symptoms occur in people in their 20s, 30s or early 40s.” Dr. Bissell says a common misconception about MS is, “That it is a ‘crippler of young adults.’ Many patients are diagnosed after age 40, and the disease in younger patients is generally well controlled with medication.” Still, MS does affect more women than men. “It’s much more common in women—maybe three or four times more common in women than men,” Dr. Schafer explains.

types Dr. Schafer says that the most common form is called relapsing/ remitting MS, where symptoms occur in attacks and then get better. Some patients with recurrent attacks have less and less recovery from these attacks over time. Relapsing/remitting MS can be treated with one of about a half dozen medicines. “All of these reduce the chances of having more problems,” Dr. Schafer says. Another form of MS is called secondary progressive. “It gets progressively worse even without new attacks,” Dr. Schafer says. “It may affect people’s abilities to pay attention and absorb materials,” says Dr. Schafer, who adds that there’s no treatment for secondary progressive MS. The primary progressive form of MS is more common in men than women, even though it can affect women too. Patients Bailey with her children: with this type of MS usually have son Brian and problems walking, which slowly daughter Jenn gets worse without any attacks.

the future Early diagnosis is essential. “Treat it before the damage is done,” says Dr. Schafer, who urges people who suspect that they have MS to see their primary care physician, followed by a neurologist. “There were no effective treatments until 1993,” Dr. Bissell says. “Since then, progressively more effective treatments have been available.” With new medicines on the market, “a higher number of people have protection and are getting better,” says Dr. Schafer, who thinks that “there’s hope for new treatments.” Still, there’s the chance that

some of the new medicines could adversely affect the immune system and pose increased risks for patients.

living with ms Nowadays, Bailey’s main MS symptom is a foot drop on her right side. “I’ve got this device called ‘walk aid,’” she says of the band that straps just below the knee, which has nerve conductor electrodes. “It’s the most fabulous device I’ve come across. When I step down, it picks my foot up.” Bailey’s insurance company didn’t want to pay for the walk aid, which cost $5,000. Fortunately, the Northern California Chapter of the National Multiple Sclerosis Society granted her $500 toward the purchase. Bailey pursued the insurance claim and eventually they paid the rest of the bill. Bailey says that her walking gets worse in the heat and when she’s stressed; as well, she has some weakness in her right hand but compensates by using her left. She’s also fallen due to her MS—breaking her collarbone and rupturing her bursa. However, Bailey says that her MS is “very tolerable.” She self-injects a weekly shot of the drug Avonex to slow the progression of the disease. While she can drive, exercise at the gym and do many other things, her children—daughter Jenn, age 28, and son Brian, age 30—help her with house and yard work. And, they do the MS Walk every year in honor of their mother. “I have a really supportive family,” says Bailey. Bailey’s advice to other MS patients? “Stay with a positive attitude,” she says. “I think it helps so much.” •

RESOURCES Kaiser Permanente kp.org Mercy MS Center mercysacramento.org/cm/ content/ms_clinic.asp Multiple Sclerosis Active Source msactivesource.com Multiple Sclerosis Association of America msassociation.org Multiple Sclerosis Foundation msfocus.org National Multiple Sclerosis Society, Northern California Chapter nationalmssociety.org/ chapters/CAN/index.aspx

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Healthcare right where you want it You don’t have to travel far for expert primary and specialty care. Marshall Medical Center provides excellent care for the whole family with convenient locations right here in El Dorado County.

We’re growing to care for you! We’re adding more primary and specialty care physicians to our roster, with offices located conveniently in El Dorado Hills, Cameron Park and Placerville. All of our physicians are board-certified, ensuring high quality care for patients. Marshall Hospital has opened the doors to the area’s newest Emergency Department/Level 3 Trauma Unit and Birth Center, offering the community a higher level of care, service and experience.

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YOUR HEALTH

Touch and Go Body Work to Heal by Corrie Pelc

Photo © Fotowerk/fotolia.com

hether you have an achy shoulder, tight leg muscle, suffer from migraines, or just want to relax, there’s a form of body therapy out there to help. And each type comes with its own technique, certifications, and benefits to your overall wellness. The American Massage Therapy Association (AMTA) estimates that today there are nearly 90,000 nationally certified massage therapists and bodyworkers in the United States. According to a 2011 AMTA consumer survey, an average of 18 percent of adult Americans received at least one massage between July 2010 and July 2011, and an average of 31 percent received a massage in the previous five years. Of those numbers, 40 percent reported they did so for health conditions such as pain management, injury rehabilitation, migraine control, or overall wellness. With so many options, how can you can decide what’s right for you? Here’s a sampling of some of the different body therapies out there and what benefits they offer.

massage uses a very firm pressure to relieve knots in the body. “The therapist will first warm up the body, get the body loose, and then they go in with very intense, deep pressure to get that muscle to release that tightness,” she says.

“m” is for massage

Swedish Massage: Looking for stress relief? That’s what you’ll get, along with mental and physical release, with a Swedish massage, says Breanna Rizzo, junior spa director at Massage Envy Spa in Folsom. This type of massage typically uses long, flowing strokes to gently massage muscles throughout the body. “It allows your body to relax and release all those stressful things that it might be holding on to,” she adds.

With massage, there are still lots of different types to choose from, each with its own techniques and benefits. Deep Tissue Massage: For those who need work done on tight muscles, deep tissue massage is the answer. Noki Ellison, spa director of Atrium Salon Spa in Granite Bay, says deep tissue

Hot Stone Massage: Hot stone massage, which uses basalt stone that retains heat, is beneficial for those with very tight muscles, such as athletes, Ellison says. “The therapist will place the stones on different areas of the body and then use them to massage the legs or arms, almost gliding them along the body,” she explains. “The heat of the stone really releases the muscle so the therapist can get in there and really start that deep tissue release.” Hydrotherapy Massage: This type of massage uses six shower heads that rain down upon the client on the table, and the warm water helps to instantly relax the muscles in the body. Ellison says hydrotherapy massage is used frequently for clients that need lymphatic drainage.

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YOUR HEALTH Trigger Point Therapy: Another massage option is Trigger Point Therapy, which, according to the Massage Envy Spa Web site, is “specifically designed to alleviate the source of the pain through cycles of isolated pressure and release.” Rizzo says that this type of therapy would benefit someone with chronic or acute pain occurring in one specific area, and adds that after a few sessions, the therapy would slowly dull and relieve the pain.

body work to rehab and restore Fortunately for those who suffer from chronic conditions, there are several types of body therapies that focus on pain relief and management as well as rehabilitation and restoration.

Additionally, clients receiving myofascial release also learn what they can do at home to help maintain the work Clifford has done with them. “If they just go back and do the same things over again, it won’t sustain itself,” he says. “The key is to begin to discover what’s creating the issue and then come up with suggestions from experience and talking to the client about what they’re doing ergonomically that might be precipitating the problem.” CranioSacral Therapy: With CranioSacral therapy, Clifford says that therapists work with the cranial structure of the client—aka the bones in their skull—to make sure that they’re in balance. Clifford says that this therapy calls for very subtle pressure, no more than five grams or the weight of a nickel. “That’s the level of pressure you hold to help the bones seek their real position and that helps balance the cranial fluid in the vault of the skull,” he explains. Further, he says that CranioSacral therapy can normally help solve a problem within two to three sessions, and is known to help those with eye and vision issues, hearing issues, jaw problems, headaches and sinus ailments. “(One patient) was having trouble reading and her eyes weren’t tracking correctly,” he recalls. “Within one visit she was able to get her eyes focused and her grades improved.”

Bowen Therapy: A very different type of body treatment is Bowen therapy. Founded by Thomas Bowen of Geelong, Australia in the 1950s, Bowen Therapy is a type of body work that uses thumbs or fingers to apply a “very light stretch, roll and release over specific areas of the body,” alternated with two minute rest periods to allow the body to process the treatment during a 45 to 60 minute session, according to Kathy O’Brien, owner of Fair Oaks Bowen Therapy in Citrus Heights. RESOURCES: O’Brien and her husband, Mike McGee, have worked with everyone—from American Massage babies with colic to people with fibromyTherapy Association algia, back pain, sciatica, digestive probamtamassage.org lems and migraines. O’Brien says that Bowen Therapy is usually a very quick, Atrium Salon Spa effective, and gentle form of pain relief. Granite Bay, 916-791-8585 atriumsalonspa.com “It goes to the core of the problem, so you won’t be coming back forever...99.9 Bowen Therapy percent of the time,” she explains. AddiAcademy of Australia tionally, she says that clients have found bowtech.com Bowen Therapy helps them sleep and gives them more energy. Fair Oaks Bowen Therapy Myofascial Release: According to Michael Clifford, N.M.T., with Hands on Healer in Folsom, myofascial release is a therapy focused on the muscles and nerves that are creating an issue, such as a frozen shoulder, migraine, sciatic, or reduced rate of motion. Clifford, who has been practicing for more than 30 years, says that oftentimes the nerves or muscles have been shortened due to damage. This therapy returns them to their normal elasticity or length, and calms the nerves so they stop firing. “The focus is rehabilitation and restoration,” he adds.

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Citrus Heights, 916-225-3014 fairoaksbowen.com Hands on Healer Folsom, 916-337-6045 handsonhealer.net Massage Envy Spa Locations in Folsom, El Dorado Hills and Roseville massageenvy.com Massage Heights Folsom, 916-790-6938 Roseville, 916-647-5209 massageheightsfolsom.com massageheightsroseville.com

November/December 2012 – familyhw.com

words of wisdom Although all these types of body therapies are different, there is similar advice when looking for a reputable practitioner. Clifford advises first figuring out what type of body therapy you are looking for— one that would be the most beneficial for you—then start contacting practitioners in your area to find out if they offer what you need, and if not, if they can provide a referral. “And always ask for a consultation at no charge,” he adds. If searching for a Bowen Therapy practitioner, O’Brien suggests starting at their Web site which has a lot of information and videos on the therapy. From there, she says to search for certified practitioners on the Web site of the Bowen Therapy Academy of Australia. When looking for a massage therapist, Rizzo advises looking for a certified and licensed therapist; go in, ask questions, and be knowledgeable about what you’re looking for. “If those people can answer your questions and can lead you in the right direction, then it’s a good place for you,” she adds. Finally, Ellison advises always speaking up—don’t be afraid to tell a therapist exactly what your needs are. •

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NUTRITION

eating right for your blood type

Diet Fad or Fiction? by Jacqueline Renfrow

lood typing and treating patients accordingly originates back to the early 1900s. But it was Peter D’Adamo, N.D., MIFHI, who is credited with the theory on eating according to your blood type, after 30 years of working with his own patients. His book, Eat Right 4 Your Type, was published in 1997 and made the association between diseases and the four blood types—A, B, AB and O. Since then, millions have tried it and many have formed strong opinions both for and against this type of eating. While it might not be the “fad” diet of the decade, it seems some naturopathic and alternative health professionals are starting to embrace it more and more.

BASIC PRINCIPLES The basic principles of this diet look at an individual’s blood groups. According to Niki Young, N.D., with Revolutions Natural Medical Solutions in Folsom, “Each of the blood groups is distinct from the others by the simple sugar unit that sticks out from the end of the carbohydrate chain of a glycoprotein or glycolipid.” Lectins—protein-based molecules—cause blood cells to clump.

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NUTRITION Through this process of testing foods with live blood, it was determined that different foods were beneficial, neutral or should be avoided for a specific blood type. Some of the health risks associated to blood cells clumping, or agglutination, include stroke, thrombosis, pulmonary embolism and heart disease. Healthy digestion can play a large part on how well your body destroys these dangerous lectins.

WHAT YOU CAN EAT What does Dr. D’Adamo recommend for all four blood types? Here is the quick down and dirty. Os benefit from meats, poultry and fish, and should avoid grains, breads and legumes. As benefit from vegetarian diets—no meat. Bs can enjoy low-fat dairy, meat and produce but should avoid wheat, corn and lentils. Finally, ABs should avoid chicken, beef and pork but can consume seafood, tofu, dairy and most produce.

Photo © Subbotina Anna/fotolia.com.

THE SKEPTICS

to long-term because of its restrictions. “Many type O patients claim to be happy following a vegetarian diet,” she says. “Like any diet, nutritional adequacy is dependent upon a person’s food choices and having a variety of foods is usually helpful to meet daily nutrient requirements.”

THE SUPPORTERS For every doctor that denounces the validity of the diet, there are some like Priscilla Monroe, R.N., N.D., in private practice in Sacramento, who says that trying the diet would make most people believers. For almost 20 years, the naturopath has recommended eating for your blood type to her clients. Though she herself was for some time a vegetarian and was taught in medical school that more vegetables are better than eating meat, she soon found herself salivating for hamburgers. And quickly discovered that when she ate meat, she felt fabulous. “One man’s medicine is another man’s poison,” she says, quoting the old proverb. Dr. Monroe believes that “we have to practice what we preach to our patients,” which is to be open to new things. Those who have tried eating according to their blood type have reported lowered inflammation, less gastrointestinal distress, decreased constipation, less body pain, clearer skin, weight loss, and improved sleep, memory and mood. Dr. Monroe says to look at D’Amano’s research. There are 12 components if you factor in blood types and race, so it really can speak to most people.

Why do some health care professionals not support this diet? “Some disagree with this diet due to the fact that it stresses that patients with certain blood types require meat,” Dr. Young says. “Vegetarianism is very popular in response to high cholesterol levels, digestive issues, and contamination of the meat with antibiotics and steroids, as well as being more humane.” Tracy Toms, M.S., R.D., with Mercy San Juan Medical Center, says that she would not recommend this diet to her patients. “In the medicine and nutrition sciences, we recommend [diets] based on scientific evidence and this diet doesn’t have any of that,” she EATING FOR says. “People are always looking for a quick YOUR BLOOD fix for aches and pains and weight loss, lookTYPE 101 ing for diets and pills. They don’t want to do the lifestyle route by eating healthier and TYPE O: High-protein meat exercising.” eaters. It’s believed this blood Sheila Leard, R.D., CSSD, C.P.T., with My type originated first and that we Nutrition Zone in El Dorado Hills, agrees, should eat like our primitive ansaying that Dr. D’Adamo’s diet was a fad and cestors. doesn’t know any professional that would recommend this diet, especially with restricTYPE A: Vegetarians. This blood tions so difficult to adhere to. “The weight type should avoid meat, dairy, loss success that one may have when followkidney beans, lima beans and wheat. ing this diet is the outcome of getting rid of processed foods, fast foods and eating with TYPE B: Balanced omnivores. more awareness,” she says. Leard adds that This blood type can include if you’re looking to lose weight, look beyond meat, (no chicken), dairy, eggs, diets, and explore what food means to you. beans, legumes, vegetables, (no Instead of looking at blood type to decide tomatoes) and fruit. what type of diet you should follow, have an assessment through a lab test to determine if TYPE AB: Pescetarians. This you are deficient in vitamins and minerals. blood type should avoid chicken, Sue Hazeghazam, R.D., with Sutter beef and pork but can consume Roseville Medical Center, says that patients seafood, tofu, dairy and most produce. complain that the diet is difficult to adhere

FOOD FOR THOUGHT If you’re going to try the diet, be careful of pitfalls. Dr. Young says that untrained professionals who don’t fully understand the diet may not properly explain it to patients. Also, starting the diet means visiting a doctor for blood work and to make sure that there aren’t any more serious health issues that need to be treated first. “Start slowly,” she says. “Add in more variety of the beneficial foods before eliminating the foods on the avoid list. Keep in mind that even 70 percent adherence to the diet will improve health.” And remember, no two people are exactly alike. “If something doesn’t agree with you on the diet, but your friend with the same blood type has no issues with it, you’re not crazy or imagining it. You are just different from your friend, and that is okay,” Dr. Young says. Dr. Monroe agrees not to take the guidelines of the diet too literally. “If you’re a type A, you don’t have to be a vegetarian. Many people with glucose problems wouldn’t make a good vegetarian...just remember to be openminded. A lot of people don’t want to have to give up their treats, so it’s easier to discount something than give it credibility.” •

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dish...recipes for healthy living

recipes for the season The Art of Real Food

by Joanne Neft and Laura Kenny Photography by Keith Sutter

WALNUT CROSTINI WITH RICOTTA CHEESE AND CHERRIES The Art of Real Food by Joanne Neft and Laura Kenny; Photography by Keith Sutter (In Season Publishing, 2012, $27.95)

• • • • • •

½ loaf walnut bread 1 tablespoon olive oil Salt and pepper to taste 4 ounces ricotta cheese 1 pint cherries, pitted and quartered 2 tablespoons honey

Preheat oven to 375ºF. To make crostini, slice bread in half length-wise, then cut in ¼-inch thick slices and place on a sheet tray. Drizzle with olive oil and season lightly with salt and pepper. Toast in oven until crisp, 7 to 10 minutes. Season ricotta lightly with salt and pepper. Spread generously on crostini. Top each piece with a few cherry quarters and drizzle with honey. Serves 4.

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dish...recipes for healthy living Roasted Beet Salad with Cucumber

seared halibut with garlic and herb compound butter • • • • • • • • • •

1 teaspoon olive oil ½ head red garlic, minced ¼ cup white wine ½ pound butter, room temperature 2 tablespoons parsley, chopped 1 tablespoon dill, chopped 1 Meyer lemon, zested 2 tablespoons grapeseed oil 2 to 3 pounds halibut Salt and pepper to taste

To make garlic and herb compound butter, heat oil in a small sauté pan and cook garlic until fragrant over medium high heat. Add wine and continue cooking until reduced by about 2/3; remove from pan. In a large mixing bowl, combine butter, herbs, lemon zest and garlic. Mix to combine and season to taste with salt and pepper. On a 10-inch square piece of parchment paper, pile butter mixture across the center and bottom quarter of the paper, leaving a 3-inch border around the edge. Roll the butter in the paper, twist the sides to seal. Chill at least 1 hour before using. In a large sauté pan, heat oil. Season fish with salt and pepper, and sear on presentation side until golden brown and cooked about 1/3 of the way through. Flip fish, top with 1 tablespoon compound butter, and turn off pan. Fish will continue to cook. Remove from pan when cooked to medium, or longer if desired. Serves 6.

Roasted beet salad with cucumber • • • • • • • •

1 pound beets 1 tablespoon olive oil Salt and pepper to taste 2 cups Persian cucumbers, sliced ¼-inch thick  2 ounces goat cheese  2 tablespoons red wine vinegar  1 tablespoon olive oil  Dill sprigs for garnish

Preheat oven to 400ºF. Place beets in a roasting pan, coat with oil and season lightly with salt and pepper. Cover with foil and roast 25 to 35 minutes, until fork tender. Let cool slightly and peel off skins, trim ends and slice into wedges. Toss with remaining ingredients and serve. Garnish with dill. Serves 4. Seared Halibut with Garlic and Herb Compound Butter

FOR MORE RECIPES FROM THIS AND OTHER BOOKS, VISIT FAMILY HEALTH & WELLNESS MAGAZINE’S WEB SITE FAMILYHW.COM

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6 DVD

Workouts Breathing New Life Into an Old Trend by Morgan Cásarez

Family Health & Wellness

November/December 2012 – familyhw.com

hen I hear the words “fitness” and “DVD” uttered in the same breath, late-night infomercials, over-the-top aerobics instructors and bad spandex all come to mind. Having grown up in the pre-DVD ‘90s, a time when workouts on tape led by the likes of Jane Fonda, Richard Simmons and Susan “Stop the Insanity!” Powter ruled American living rooms, my perceptions of at-home fitness regimens have always been a bit skewed. Thanks to the power of YouTube, I look back at the way Suzanne Somers hawked the Thighmaster or Oscar De La Hoya powered through the Skip/Fit Workout, and I have to laugh. These techniques seem cheesy at best nowadays, not to mention the fact that most of us wouldn’t be caught dead rocking the hair and fashion trends on display in these hilarious time capsules. Much has changed in the world of health and wellness over the past 20 years, but one thing that always seems to remain is our desire to firm, tone and shed a few extra pounds—with a little help from the pros, that is. According to a survey published in the American College of Sports Medicine’s Health & Fitness Journal last year, educated, certified and experienced fitness professionals took the number one spot on the list of expected worldwide fitness trends in 2012 for the fifth consecutive year. Based on the responses of more than 2,500 fitness professionals, the list of 10 top trends also included strength training, exercise and weight loss, and personal training. The consequences of neglecting balanced meals and exercise are clear—the Centers for Disease Control and Prevention reports that a third of American adults are overweight while another third are obese. Yes, the statistics are startling, but I prefer to keep the following fact in mind when searching for the inspiration to work out: even modest weight loss (as little as five percent of your total body weight) can lead to improvements in blood pressure, blood cholesterol and blood sugars, according to the CDC. That being said, staying in shape never goes out of style, so I recently decided to give the world of at-home exercise a second chance and found that today’s offerings have come a long way from the gimmicks and fads of the past. At under $25 apiece, the following DVDs provide a great, low-cost way to address a myriad of fitness goals.

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Personal Training with Jackie: Xtreme Timesaver Workout $14.95 at jackiewarner.com

• Ideal For: the always on-the-go type • What You’ll Need: hand weights • Total Runtime: 32 minutes Whether you recognize Jackie Warner as the star of Bravo’s Work Out and Thintervention, a successful gym owner, or regular contributor to Fitness Magazine, one thing’s for sure—her rock hard abs are hard to miss and nothing short of enviable. The Xtreme Timesaver DVD is designed to be used three times per week and aims to help you lose weight and achieve a lean, strong and sculpted body like Warner’s. The process begins with a brief warm-up that gets your heart rate up without wearing you down and prepares your body for a range of cardio and strengthening exercises targeting everything from glutes and shoulders to quads and hips. Each compound movement is carried out for just one minute, keeping you (and your muscles) totally boredom-free. The importance of proper breathing is stressed heavily throughout the workout, in addition to the need for control and form over rushed repetitions. I really appreciate that the benefit of each exercise is explained clearly and concisely, and Warner’s time updates and repetition countdowns kept me motivated throughout the process. When she smiles at the camera and says, “Hate me now, love me later,” I’m able to see past the burn and visualize my potential. Looking for a similar workout in a class setting? Try the 30-Minute Express Workout at Roseville Health & Wellness, 1650 Lead Hill Boulevard, Roseville. 916-677-1200, rosevillehwc.com.

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Physique 57 Express 30 Minute Full Body Workout $24.95 at physique57.com

Element: Yoga for Energy & Relaxation

• Used By: Denise Richards, Kelly Ripa, Christy Turlington • What You’ll Need: waist-high sturdy chair or sofa back, exercise mat, playground ball • Total Runtime: 35 minutes Physique 57 creator Tanya Becker lets you know from the get-go that the process of performing her interval overload workout never becomes easier, but rather gets better as you become more familiar with the technique. Designed to deliver a leaner and stronger “dancer’s body,” improve flexibility and cardiovascular health, and increase bone density, the popular program has been receiving massive buzz since 2006 and guarantees you won’t plateau. The Express DVD, which is meant to be used as a once-a-week supplement to the Signature Physique 57 workout, features fast-paced, easy to follow movements based on the Lotte Berk Method (a low-impact combination of yoga, dance and strength training). “Let desire drive you” is just one of many motivational phrases Becker uses that would surely sound ridiculous coming from any other instructor, but her enthusiasm, intensity and energy is contagious. Modifiers are demonstrated throughout the DVD, which is a nice touch since some of the movements can be challenging for first, let alone second and third-timers (I’m looking at you, anatomically correct split). For a little something extra, select Bonus Moves on the main menu for a quick lower body exercise that, over time, can help lift and shape your derriere. Looking for a similar workout in a class setting? Try an Express Class at The Dailey Method, 1611 Lead Hill Boulevard, Roseville. 916-783-8367, thedaileymethod.com/roseville.

• Ideal For: full-body restoration and stress-relief • What You’ll Need: yoga mat • Total Runtime: 75 minutes Tamal Dodge grew up in his family’s Hawaiian yoga ashram and has spent the majority of his life teaching the art of yoga, and his distinguished pedigree is on full display as he guides at-home practitioners through two distinct, yet complimentary sessions. The Energy portion of the DVD promises to “give you a perfect balance of vitality and calm,” while the Relaxation program soothes and relaxes from head to toe. In my experience, at-home workouts are usually filmed on impersonal soundstages, so imagine my delight when Dodge’s calm, smiling face and yoga mat appeared not only outdoors, but also near the ocean. The setting alone, combined with the lightly soothing sounds of spa-esque background music, was almost enough to put me on the path to restoration, but once the process began, I knew I’d unlocked a door to true mind/body renewal. Don’t be fooled by the title, though— this program aids in relaxation, but it does still provide a workout. Dodge’s highly-detailed, step-by-step instructions are enough to aid even a beginner like myself in achieving poses like a seasoned yogi, and his explanations of each movement’s internal effect helped me to work through any initial difficulties. As he says, it isn’t about how far or deep you take each pose; it’s about really feeling the stretches. Looking for a similar workout in a class setting? Try Gentle Hatha Yoga at Serenity Soul Center, 3980 Douglas Boulevard, Suite 120, Roseville. 916-797-8550, soulyogaonline.com.

November/December 2012 – familyhw.com

$14.98 at anchorbayentertainment.com

Tracy Anderson Method Dance Cardio Workout DVD $14.98 at anchorbayentertainment.com

• Used By: Madonna, Gwyneth Paltrow • What You’ll Need: nothin’ but your dancin’ shoes • Total Runtime: 137 minutes Sure, I love to dance as much as the next girl, but I’ll be honest—Tracy Anderson and her moves can be a little intimidating the first time around. Even Gwyneth Paltrow, whose brief testimonial extolling Anderson’s virtues can be found on this DVD, is willing to admit that she felt a bit lost when she first started this particular regimen. Her persistence in mastering the moves obviously paid off as Paltrow has a truly rockin’ body that so belies her 40 years. Anderson recommends using this DVD in combination with either her Mat DVD or Perfect Design Series, but let’s not get ahead of ourselves—the Dance Cardio Workout features a thorough warm-up and two different routines, both of which have their own step-by-step set of instructions that break down each and every bit of fancy footwork. Unless you’re fortunate enough to have a background in dance, one run-through on this portion of the workout probably won’t be enough, but hey, that’s what the rewind button is for, right? Practice, practice, practice until you’ve really got the moves down, otherwise you’ll likely feel left in the dust when it’s time to perform (Anderson really picks up the pace during the actual routines). Once you’ve got it down, the bouncy, music video-ready choreography will have you looking and feeling like a superstar. Looking for a similar workout in a class setting? Try Zumba at Broadstone Racquet Club, 820 Halidon Way, Folsom. 916-983-9180, sparetimeclubs.com.

Billy Blanks: Tae Bo Classic $14.99 at billyblanks.com

• Used By: Wayne Gretzkey, Magic Johnson, Shaquille O’Neil • What You’ll Need: plenty of space to kick and punch • Total Runtime: 63 minutes You probably remember Billy Blanks from (what else?) his ‘90s era infomercial touting the powers of Tae Bo, a fast-paced, high-energy combination of Taekwondo and aerobics. Now that his wildly popular workouts are available on DVD, members of a whole new generation like me can kick, punch and move their feet into a total-body, calorie burning frenzy. According to an article on Livestrong.com by contributor Kristeen Moore, a fitness Web site called Fatburn.com estimates that a 160-pound individual can burn up to 764 calories per hour during a basic Tae Bo workout and up to 878 calories per hour during a more advanced version. It’s an impressive claim, but one thing’s for sure—if you move the way Blanks does for at least an hour, you’re sure to work up a decent sweat at the very least. (I’m sweating just thinking about how hard he pushes himself, not to mention his viewers.) This DVD promises a new spin on the original Tae Bo workout—it takes you through all of the original moves at a breakneck pace, and the energy in the onscreen dojo reaches a near palpable intensity on more than one occasion. Tae Bo definitely isn’t a program for the faint of heart, but Blanks’ positive reinforcement and ever-present eight counts are sure to make you feel like a warrior. Looking for a similar workout in a class setting? Try R.I.P.P.E.D. at California Family Fitness, 700 Oak Avenue Parkway, Folsom. 916-932-0100, californiafamilyfitness.com.

Exhale: Core Fusion Pure Abs & Arms $10.99 at acacialifestyle.com

• Perfect For: anyone short on time and abs • What You’ll Need: hand weights, resistance band (included with DVD) • Total Runtime: 50 minutes Created by husband and wife team and Exhale mind/body spa founders Fred DeVito and Elisabeth Halfpapp, this workout combines elements of Pilates, Lotte Berk Method, yoga and dance to transform flabby arms, nopack abs and undefined backs. My favorite aspect of this program is the fact that it’s conveniently divided into five, 10-minute sessions (upper body weights, upper body, abs, abdominal curl with leg variations, and upper body, back and hip stretches) that can be played together for a complete toning experience, in small groups of my choosing, or individually when I’m really pressed for time. I also enjoyed exploring the disc’s bonus features which includes an additional stretching exercise, as well as portions of two other titles, Exhale: Pilates Plus and Shiva: Creative Core Abs. With more than 50 years of combined experience between them, DeVito and Halfpapp are a fitness force to be reckoned with, but their calm, cheery demeanors helped keep my mind off the intensity of the workout and firmly planted on my goal of achieving a body even half as taut as theirs. Looking for a similar workout in a class setting? Try Hard ABS at El Dorado Hills Sports Club, 530 Post Court, El Dorado Hills. 916-933-4929, sparetimeclubs.com.• NOTE: To avoid injury, it’s always best to consult your doctor before beginning a new fitness routine.

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Stem Cell research

Meticulous Work, Miraculous Results by Margaret Snider 40

Family Health & Wellness

November/December 2012 â&#x20AC;&#x201C; familyhw.com

hen each of us first came into existence, we began as stem cells, which have two key properties: the ability to make copies of themselves, and the ability to differentiate themselves into cells that become the various organs and tissues of our bodies. What are stem cells, and how do they work? These questions are no easier to answer than “How does life begin?” In searching for answers, researchers are asking another question. Stem cells build intricate and perfect human bodies; can they also be used to fix things that have gone wrong?

what is a stem cell? There are many different types of stem cells, with a primary division of embryonic and adult. Embryonic stem cells have not yet differentiated and have the potential of generating all the different types of cells in the body. This type of stem cell can be grown and increased indefinitely in this unspecialized state, and because of this has a multitude of uses in research. Adult stem cells have begun to specialize and now are capable of producing some or all of the mature cell types found within a particular tissue or organ in the body. Possibilities for therapeutic use are varied and promising, and some treatments are tried and in use. However, researchers are quick to point out that our understanding of stem cells is only in the beginning stages.

Above: Jan A. Nolta, Ph.D. Left: Gerhard Bauer. Mr. Bauer is the director of UC Davis Institute for Regenerative Cures’ Good Manufacturing Practice facility. It is a clean facility requiring gowning up. Mr. Bauer and Dr. Nolta have worked together for 20 years.

Jan A. Nolta, Ph.D., with the UC Davis Institute for Regenerative Cures, says that for each of the different diseases, the level of knowledge is different, so it’s hard to make a generalization. “But the ones that are up to clinical trials already, we know a good amount, because we’ve had to prove to the FDA that the use of this type of stem cell in this manner can cure the disease in mice and has the potential to do so in humans, and it is safe,” Dr. Nolta says. “For those, we know a lot about it. For others, it’s really at the beginning.” General knowledge of how and why stem cells do what they do is at an elementary level. “It’s like the wheel. The wheel was a nice round thing you put food on, maybe,” Michael Chez, M.D., with the Sutter Neuroscience Institute, says. “Then you started spinning it and realized you could roll it, then you figured out you could put it to a cart, then a chariot, then a wagon, and eventually you get a car or a plane. We’re kind of at the chariot or cart level.”

uc davis institute for regenerative cures In 2010, the UC Davis Health System opened the Institute for Regenerative Cures—housed in a renovated 109,000-square-foot building on the old California State Fairgrounds. Dr. Nolta is the director of the institute and the stem cell program, with a group of 150 faculty members and their associated labs and clinical personnel. “This building is very special to me,” Dr. Nolta says, “because when I grew up in Willows, which is just north of here, in 4H I showed some corn that I had grown in this building at the State Fair…and now we grow the stem cells here.” Dr. Nolta’s office looks directly out on the Shared Translational Stem Cell Laboratory, a series of bays perpendicular to her office and parallel to each other, with an aisle running down one side. It’s entirely open, with counters, drawers and knee space below and shelves above packed with bottles and supplies. “On this side, we’re getting the stem cells into the clinic,” Dr. Nolta says. “We test the safety of the cells, that’s what the FDA wants to see. We make sure it’s going to be efficacious

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in the particular disease model.” Most of the principal investigators in the translational area are M.D.s from the hospital whose teams work to enable the research to get these projects into clinical trials, and to patients they may be able to help. “This institute gives us a hub for having everyone together to share expertise, equipment, knowledge, techniques, and really get more therapies (or novel treatments) over into the hospital,” Dr. Nolta says. “It’s that jump from the bench and learning all those cool things about the cells, and then going to the bedside. We’re that bridge.” The entire mission is to help patients who don’t have other options. They’ve gotten to the end of what conventional medicine can do for them.

autism treatment clinical trial

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cells and the other 15 will receive a placebo—only the physician who is administering the infusion will know which is which, to avoid influence or bias. After six months of trial, the groups will be reversed, and the subjects who received the placebo will receive the stem cells. Of course, the hope is there will be a distinct improvement seen in the patients receiving the stem cells. “We can honestly say it may not work at all,” Dr. Chez says. “We don’t know. But at least we’re opening the question of how to use these cells.” A significant effect or even clear-cut cases of subgroups that respond in this initial study could open up a new avenue for treatment of autism under certain conditions.

bone regrowth UC Davis Veterinary Medicine Teaching Hospital uses stem cells in the experimental treatment of orthopedic injuries and joint disease in horses and dogs, coordinated with UCD School of Medicine and the department of biomedical engineering. They have successfully treated eight dogs that had a large bone loss.

November/December 2012 – familyhw.com

Above: UC Davis Institute for Regenerative Cures’ Good Manufacturing Practice facility.

Bone was actually regrown in these dogs. The process, Dr. Nolta says, requires taking some of the subject’s bone marrow, processing it through a device to extract stem cells, and mixing it with a bone-forming solution called hydroxyapatite. “So for the dog jawbone, they put that into the mold, and they actually grew the bone back and implanted it,” Dr. Nolta says. “They can implant the teeth of course, with those. Incredible stories. But we’re doing this for humans, too; this is one of our clinical trials.” Dr. Nolta describes the work of Mark Lee, M.D., an orthopedist with UC Davis who works on trauma patients. “Right in the operating room, they take a small amount of the patient’s own bone marrow, separate it, get the stem cells out, mix it with these little bone chips, pack it back in and seal it up, then it forms the bone much more strongly,” Dr. Nolta says. ”This is where there’s been a mangling of the bone, a traumatic crushing.” The implications are significant for gunshot and mortar wounds in the military. The UC Davis team has received some funding from the U.S.

All photos courtesy of UC Davis Health System.

A year ago, Dr. Chez was asked by Cord Blood Registry (CBR), the largest cord blood banking company in the country, to head a study on the use of stem cells in autism, using the subjects’ own cord blood. It has taken a year to get everything in place, and the study is now ready to select subjects. Dr. Chez, author of The Medical Management of Autism: A Guide for Parents and Professionals, has a strong research background, with a 22-year career studying and treating epilepsy, autism, the immune system, and language development in children with neurological disorders. He is the medical director of pediatric neurology at the Sutter Neuroscience Institute, and is an associate professor of neurology at UC Davis. The subjects will be 30 autism patients between the ages of two and seven, whose own cord blood was banked at birth. Some patients of Dr. Chez with cerebral palsy who received infusions of their own cord blood stem cells have made incredible progress, he says. In others, it has not made a difference, but FDA phase 2 studies are underway. He feels it is definitely worth a trial with autism. Of 30 participants in the doubleblind study, 15 will receive the stem

Army in order to learn how to do this best. In some disciplines, treatment has moved past the trial phase and into accepted therapy. As stated in Stem Cell Facts by the International Society for Stem Cell Research (ISSCR): “Blood stem cells are currently the most frequently used stem cells for therapy. For more than 50 years, doctors have been using bone marrow transplants to transfer blood stem cells to patients, and more advanced techniques for collecting blood stem cells are now being used to treat leukemia, lymphoma and several inherited blood disorders. Additionally, some bone, skin and corneal diseases or injuries can be treated by grafting tissues that are derived from or maintained by stem cells. These therapies have also been shown to be safe and effective.”

Controversy Over the years, controversy has surrounded the use of embryonic stem cells, namely religious and political considerations. In addition, the source of the embryonic stem cells and the decision of when life actually begins have also been important issues. “It touches us,” Dr. Nolta says. “We are doing some embryonic stem cell research here, we just aren’t in any clinical trials yet.” Historically, embryonic stem cells used for research have been derived from fertilized eggs that were discarded from in vitro fertilization (IVF) clinics. These were from families who had completed their family planning and no longer wanted those embryos. “Nobody takes cells out of an aborted fetus or an embryo,” Dr. Nolta says. “No scientists do that. Not in America.” The cell line UC Davis uses for its embryonic stem cell research is called the H-9 line, originally made in Korea about 12 years ago. Labs all over the U.S. have used the line that Dr. Nolta calls “the gold standard.” This cell line grows continually in their incubators, and they can take it down the steps of differentiation to become whatever types of cells they need: neurons, liver,

heart, kidney cells, or others. Just that one eight-cell embryo, she says, has repopulated labs all over America. “There are very strict rules about what can and cannot be used, and really if an embryo had a chance at life, even being adopted by the Snowflakes program or something like that, it wouldn’t be used for a cell line,” Dr. Nolta says. “There are mountains of paperwork the family that created the embryo needs to sign to allow it to become a cell line.” A promising new method, still only a possibility, would take a skin sample from a patient and make their own cell line that would be very similar to embryonic stem cells. These are called induced pluripotent stem cells (iPS). “This is a really exciting advancement,” Dr. Nolta says, “because we hope that in the future we can grow people a new piece of their liver or maybe a new kidney some day, in bioreactors, which is very sci-fi, but it’s not too far off.”

misuse and fraud While qualified, ethical and dedicated scientists work to understand processes and solutions that may mean life and death to many people, others simply see the chance for a buck and grab it. Oversight and regulation in the U.S. prevents fraud to the greatest degree possible, and many other countries have their own stringent standards equivalent to the FDA, but patients may be recruited in the U.S. for questionable treatments overseas. “There are some charlatans out there who are using stem cells as snake oil, and they’re bilking the patients for money,” Dr. Nolta says. “They can charge $40,000 for a stem cell infusion and the patient doesn’t even know if they’re getting saline or if they’re actually getting stem cells. And it actually would be better if they were getting saline because if they’re getting stem cells, we don’t know if they’re matched, we don’t know how they’ve been grown, we don’t know if they’re safe.” There are guidelines for people

considering participating in a clinical trial, Dr. Nolta says. Find out if the person who runs the clinic is qualified and legitimate. Also, in the U.S., patients do not pay for clinical trials and they sign paperwork saying they understand that the treatment may or may not help their condition.

Inspiration Regenerative medicine is a field fraught with great potential, science fiction-like expectations and serious ethical considerations. The field and the possibilities are just opening up, and only the future—which comes step by step—will tell what lies ahead. Besides the meticulous work, inspiration can play a part among the scientists and researchers, whose knowledge gives them an inside understanding of the workings of cells. Even young students and newly educated professionals may have a fresh outlook that could trigger an awareness of something that’s been overlooked in the past. However, the ultimate inspiration, Dr. Nolta says, comes from the patients. She points to a framed photo on the shelf of Emily, a Huntington’s patient, who succumbed to her disease a couple of years ago. “Inspiration is from people coming to ask,” Dr. Nolta says, “and then begging and crying, telling us their stories and breaking our hearts.”

•

RESOURCES California Institute for Regenerative Medicine cirm.ca.gov International Society for Stem Cell Research isscr.org Sutter Neuroscience Institute checksutterfirst.org/neuro UC Davis Institute for Regenerative Cures ucdmc.ucdavis.edu/ stemcellresearch

familyhw.com – November/December 2012

Family Health & Wellness

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Sleep

On it

How Lack of Rest Hurts Your Health

by Janice Rosenthal Rock

Getting

enough Zs these days? If not, you’re not alone. With most of us spending nearly one-third of our lives under the covers, you’d think we would have mastered the task of getting a good night’s rest, but think again. The National Institutes of Health (NIH) estimates that 40 million Americans suffer from more than 70 types of sleeprelated problems. If you’re one of those people, you’re not yawning alone.

THE IMPORTANCE OF SLEEP Is sleep overrated? After all, when we were young we learned to get by on little sleep—partying until the wee hours of the morning, pulling allnighters before big exams, or working late to help pay the bills. “Lack of good sleep does affect your health,” says Steven D. Brass, M.D., M.P.H., director of the Neurology Sleep Clinical Program at UC Davis Medical Center. “Research has shown an association between insufficient sleep and serious health conditions, including cardiovascular disease, hypertension, diabetes and mood disorders,” says Dr. Brass. Impaired immune function, reduced memory, increased risk for depression, anxiety, metabolic disorders and obesity, have all been tied to lack of sleep. These are only some of the medical problems that can result from poor sleep. Consider, too, the toll sleep deprivation takes on job function, pro-

Family Health & Wellness

ductivity and workplace accidents, as well as auto accidents. Even occasional sleep problems can increase stress and the risk for car accidents. The National Highway Traffic Safety Administration estimates that, annually, more than 100,000 auto accidents are fatigue related.

November/December 2012 – familyhw.com

BEYOND TIRED There is no research indicating we need a particular amount of sleep. Therefore, whatever makes you feel refreshed and alert when you wake up is considered adequate. Generally, however, adult sleep needs range from 5-6 and up to 9-10 hours, with 7-8 considered the

if your sleep is interrupted repeatedly, this normal cycle is broken, and you may feel tired and have trouble concentrating.

DISORDERS DISRUPTING SLEEP

norm. We all experience both REM (rapid eye movement) and non-REM sleep. Non-REM sleep has 4 stages, with stage 1 being the lightest sleep and stage 4 being the deepest. During normal sleep, you cycle through these necessary types and stages; however,

Insomnia—trouble falling asleep, disrupted sleep, or waking up too early— can last for a few nights, a few weeks or be considered chronic, lasting up to a month or more. Insomnia is a symptom of a larger issue related to lifestyle or physical and psychological health. This may include daily pressures from school or job stress, anxiety, depression, or major life-changing events such as illness, relationship problems, or death of a loved one. Biological changes associated with aging or certain physical diseases, especially those that cause pain, can also trigger sleep disturbances. “Bad” habits such as napping too long or too late, or working the night shift also affect sleep. We live in a 24-hour society, always on the go, and if we’re pushed for time, the first thing that usually goes is sleep. Insomnia that lasts most nights for 2-3 weeks is cause for a visit to your doctor. The other most common sleep disorder is sleep apnea, which is estimated to affect 10-15 million Americans. Narcolepsy (falling asleep uncontrollably during the day), affects at least 120,000 Americans. An unknown number have restless legs syndrome (RLS). “In general, society is not well rested, and looking at these numbers and their causes, you begin to see why,” says James P. Kiley, Ph.D., director of the National Center on Sleep Disorders Research. Snoring, while the brunt of many jokes, can be serious, and a symptom of sleep apnea, the condition of disrupted breathing that occurs during sleep. Sleep apnea is seen twice as often in men as in women, and especially seen in individuals over age 50, overweight people, and individuals with certain physical features, such as a small jaw or a short neck. If you suspect you may have sleep apnea, see your doctor. People with obstructive sleep apnea have an increased risk for

high blood pressure disease, and two new studies show treatment—which ranges from sleeping with a device that delivers a steady flow of air pressure, wearing a dental device while sleeping, to surgical procedures in the throat, including the new and less traumatic radiofrequency ablation—may lower this risk.

GETTING HELP If you’re not getting the rest you need, perhaps a sleep study is in order. Fortunately, most of our area medical centers have sleep labs and conduct sleep studies that are very similar and assure that once sleep problems are diagnosed, they can usually be treated satisfactorily. Sutter Health opened the first sleep center in the Sacramento area in 1984. Sutter Sleep Disorders Centers have helped thousands of adults and children discover the causes and solutions to sleep-related problems. The centers are part of the Sutter Neuroscience Institute, which provides specialty care for a full range of neurological conditions. Mercy Sleep Center, opened in 1986, grew so much that it moved out of Mercy San Juan Hospital to its own location, with the capacity to treat 48-56 patients each week. After an initial consultation, most patients actually spend a night sleeping at the center so their sleep can be monitored and tracked to determine a diagnosis and treatment plan. The Department of Neurology, UC Davis Health System, also has a “sleep lab” at the medical center’s main hospital on Stockton Boulevard. Their Web site explains that during the nightlong diagnostic tests they measure and observe the patient’s sleep, breathing and movement. Another important concern: There are no needles and no pain! Kaiser Permanente has traditional local sleep clinics in Roseville and South Sacramento; as well, Marshall Medical Center has a sleep center on their hospital campus in Placerville. If you’re looking for an alternative

familyhw.com – November/December 2012

Family Health & Wellness

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• Go to bed and wake up at the same time every night and day, including weekends. • Develop a relaxing, nightly routine, such as reading, listening to music or taking a bath. • Create an environment conducive to sleep—quiet, dark and comfortable. • Don’t use bedtime to do work. • Get regular exercise during the day. • Avoid stimulants like caffeine and/or nicotine several hours before bedtime. • Don’t over- or under-eat before bedtime. • Don’t consume alcohol before bedtime. • Avoid daytime naps. • Ask your doctor if any of your medications cause sleep disruption. • Try relaxing all your muscles, head to toe; or think of a repetitive mental routine (yes, counting sheep!). • If you can’t get to sleep, get up and do something relaxing. Reprinted with permission: University Health Services at University of California, Berkeley uhs.berkeley.edu

Family Health & Wellness

option, you might consider Sehatu Sleep in Granite Bay. Instructors here teach individuals how to help the mind and body work in harmony through unique deep relaxation training. The program involves cognitive behavior modification, stretching and breathing exercises, and meditative visual imagery both on site at their studio and online via video conferencing.

SLEEP ISSUES IN CHILDREN It’s also not uncommon for children to have sleep issues—in fact, it’s estimated that one in four families has a child who struggles with sleep issues. Rested Family Child Sleep Consulting in Elk Grove may be the help you need if your child’s sleep has become a family concern. Here, Certified Gentle Sleep Coach Jennifer Denzel offers assistance to families with one or more children who need help with sleep problems. Her services include diagnostic testing for medical issues, counseling in the basics of sleep education, and personalized gentle sleep plans for the entire family.

SLEEP AIDS Most over-the-counter (OTC) sleep aids contain antihistamines, the same ingredients we reach for when we have a cold. Prescription sleeping pills, however, act in areas of the brain to promote sleep. Most doctors warn against the use of sleep aids, especially for the long term. Nevertheless, when taken during rare and very temporary occasions when sleeping is difficult, a sleep-

November/December 2012 – familyhw.com

ing pill can be appropriate when used according to directions. However, they are not a solution to chronic or longterm sleep issues. Everyone has an occasional night of poor sleep, but if you suffer from many nights of poor slumber, talk to your health care provider and get help. Don’t just lie there and take it: Get the Zs you need! •

RESOURCES Kaiser Permanente kp.org Marshall Medical Center Marshallmedical.org Mercy Sleep Center mercysanjuan.org/Medical_Services/ Mercy_Sleep_Center/index.htm National Center on Sleep Disorders Research nhlbi.nih.gov/about/ncsdr/index.htm Pulmonary Medicine Associates Sleep Lab pmamed.com Rested Family Child Sleep Consulting restedfamily.com Sehatu Sleep Sehatusleep.com Sleepmed of California sleepmed.md Sutter Sleep Disorders Centers checksutterfirst.org/sleep UC Davis Medical Center Sleep Disorders Laboratory ucdmc.ucdavis.edu/neurology/clinical_ services/sleep_disorders_lab.html

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HEALTH MATTERS

health & wellness .......................................................

your pet’s health

every pet deserves a plan

Take Care of Your Furry Friends by LeeAnn Dickson

Family Health & Wellness

November/December 2012 – familyhw.com

WHY HAVING AN ESTATE PLAN IS SO IMPORTANT An estate plan is a document executed by a professional in the field of estate law. It details your wishes on the administration and disposition of your property after you die. In this legally binding document, you can decide who will take care of your assets, how your debts will be paid, and who will take in your dependents (if you have any). Who at home unconditionally loves you, happily greets you, and protects and comforts you each and every day? Yes, it’s your dogs, cats or other pets you choose to share your home and life with. In the scheme of things, dogs and cats have relatively short life spans. However, some people have pets that are expected to outlive their owners; certain parrots can live more than 100 years, several reptiles can live 70 to 80 years, and if you happen to have a pet carp, you’re looking at an easy century of care. So, it’s important to make sure someone is going to look after them

ur 16th President Abraham Lincoln once said, “I am in favor of animal rights as well as human rights. That is the way of a whole human being.” His wise words still ring true: Our pets deserve the right to live their lives fully and comfortably...even if their human protectors die or become incapacitated. If you pre-decease or cannot care for your pet, have you made alternative plans? You don’t have to be a seriously silly socialite and leave millions to your cat. Everyone can—and should—plan for the care of a pet. Toby and Thomas, my fur children, are two very spoiled golden retrievers. We have had them since they were pups and plan on having them forever—unless something happens to us and we can’t care for them anymore. We don’t like to think about it, but you never know when your time is up. That’s why we included our “boys” in our estate plan. We know if something unforeseen happens they will be cared for in the manner they’ve been accustomed.

your pet’s health Care for Your Pets—on how to plan for your pet if (and when) you depart. Also available is the Surviving Pets program, which is tailored to the individual needs of the pets and families. “Animals are one of the most precious things in our lives,” Fratis explains. “It is our upmost desire and priority to fulfill the wishes of the owners of the pet.” This successful eight-year program has lessened the stress on many a human and pet. “It is in the best interest of the animal and brings peace of mind to you,” Fratis says. “Once you have enrolled your pets, you don’t have to worry...it is done.”

LESS IS MORE

Photo of Toby and Thomas courtesy of LeeAnn Dickson.

Colleen Watters, attorney-at-law with the Law Offices of Lynn Dean & Associates, advises her clients to keep a pet trust simple. Both Watters and Dean give presentations on a multitude of estate planning and elder law subjects, including planning for your pets. “There are a lot of options, and pet provisions can be part of your existing trust,” Watters explains. “The simpler the trust, the more likely it will be fulfilled.” When interviewing clients, she always asks about pets. “Many folks don’t think of their pets when preparing a will or trust,” Watters says. The estate plan does not have to name a specific animal. It can be worded that any pet you have upon your death will be looked after. It is important to choose a caretaker wisely,” Watters says. “Always make sure that you discuss your wishes with the person you have chosen to care for your pet after you have passed away.” Many breed-specific groups are available to care for your pet when you no longer can. These groups are the experts and have a greater understanding of how to treat your pet. Kim Kuenlen, founder and president of NorCal Aussie Rescue, has helped many families plan for the future of their purebred Australian shepherds. “We get many Aussies because people are no longer able to care for them,” Kuenlen says. “Planning for your pet’s future is important.” By making a provision in your estate plan, your chosen breed-specific group will make sure your beloved furry friend lives a good life in a loving, new home. Take care of business by getting an estate plan and including all of your loved ones—human and animal. You and your pets will be a lot happier for it. •

when you no longer can. What would happen to Toby and Thomas if we had not thought of them? Intended promises from family and friends to take in pets might not RESOURCES happen when they need it most. Individual situations change and although the concern Lynn Dean & Associates is there, the reality can be something differRoseville, 916-786-7515 ent. “Pets are often an afterthought,” says lynndeanlaw.com Leilani Fratis, CEO of Placer SPCA. “Too often pets come to us when their owner has NorCal Aussie Rescue passed away.” The loving and supportive Auburn, 530-268-1600 staff at the shelter has no idea what food norcalaussierescue.com or exercise the pet was accustomed to and if they were taking medications. The nonPlacer SPCA profit, with locations in both Roseville and Roseville, 916-782-7722 Auburn, 530-823-7722 Auburn, hosts a variety of workshops— placerspca.org such as Estate Planning and Ensure Lifetime

familyhw.com – November/December 2012

Toby and Thomas

Family Health & Wellness

| 49

ASK THE EXPERTS

My toddler son has just discovered his “male parts” and seems to be obsessed with them. While I want him to be comfortable with himself, how much playing with his parts is too much, and how do I get him to focus on other things?

My 16-month-old son keeps walking off to the bathroom to squat next to the toilet to “do his business” in his diaper. Should I take this as a cue that he’s ready to start potty training? Doesn’t that seem to be a bit young to start? What’s the “right” age?

No need to worry. Children have been observed under ultrasound “touching” themselves in the womb. It is natural for children to explore their bodies from an early age, and they will find areas that stimulate them and that they may enjoy discovering. For younger children, it is probably best to ignore the behavior. For older children, it is appropriate to suggest that this behavior is okay, but that it should remain private.

Any child that shows interest in the potty may be ready to start training, though 16 months is generally quite young. However, if he has figured out that when he has to “go,” he stops doing what he is doing to go to the appropriate place to do his business, that’s a great start. Other signs of interest may include wanting his diaper changed and wanting to follow adults and sibs into the bathroom or wanting to sit on the toilet.

I don’t want to be the type of parent who calls her child’s doctor for each bump, scratch and cough—what’s a good gauge to help me determine when to call and when to ride it out?

Some simple rules if your child is sick are: If the fever lasts three days or more, they have difficulty breathing, they are not drinking or voiding, they are unable to stop vomiting, or they are lethargic despite adequate fever control, you should call their physician. As for injuries, the head is of concern if there is vomiting or loss of consciousness or a persistent headache following injury. It is especially important to call your physician if your child suffers a head injury during sports before returning to play or school.

My wife and I are expecting a little boy in a few months. She doesn’t want him to be circumcised, but I do. What are the risks and health benefits to both?

The American Academy of Pediatrics just revised its recommendations regarding circumcision and now states that the benefits outweigh the risks of the procedure. Still, this decision of circumcision should ultimately be the parents’ decision, but the benefits include a reduction in urinary tract infections, cancer and sexually transmitted diseases including HIV. —Brett Christiansen, M.D. Brett Christiansen, M.D., is a Marshall Medical Center Provider. Dr. Christiansen is a member of Family Health & Wellness Magazine’s Advisory Board.

FOR MORE Q & As from our advisory board, VISIT FAMILY HEALTH & WELLNESS MAGAZINE’S WEB SITE FAMILYHW.COM.

Family Health & Wellness

November/December 2012 – familyhw.com

There are so many great health and wellness professionals in our region, and several have graciously agreed to be part of Family Health & Wellness Magazine’s Advisory Board. Look for their contributions to this and future issues along with our Web site. We invite you to get to know our Advisory Board Members: Christine Cambridge, M.D. Marshall Medical Center Provider marshallmedical.org Brett Christiansen, M.D. Marshall Medical Center Provider marshallmedical.org Michael Clifford, N.M.T. Hands on Healer handsonhealer.net Timothy E. Phelan, M.D. Creekside OB/GYN of Folsom Medical Corporation creeksideob.com Michele Raithel, N.D., C.M.O. Revolutions Natural Medical Solutions, revolutionsdocs.com Masoud Rashidi, Pharm.D. Innovative Compounding Pharmacy, icpfolsom.com Celia Remy, M.D. Vitality Medical Laser & Skin Clinic vitalitymedicallaserandskin.com Wendy Stedeford, MSAOM, L.Ac. Wendy Stedeford Acupuncture & Oriental Medicine wendystedeford.net Kenneth Sumida, M.D. Nuance Cosmetic Surgery nuancecs.com Monica Tavallaei, D.M.D. Make A Smile, makeasmile.com Tracy Toms, M.S., R.D. Mercy San Juan Medical Center mercysanjuan.org Katharina Truelove, M.D. Marshall Medical Center Provider marshallmedical.org

Photo of Dr. Christiansen courtesy of Marshall Medical Center.

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