Looking in the mirror What you need to know about dermatology and cosmetic surgery INSIDE Skin Care:
A healthy glow for the winter season
8 Tips
For eating well when eating out
January/February 2011 A Publication of the
Anti-Aging Diet
Healthy meal patterns for looking younger longer
January/February 2011 ~ livingwell
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publisher Stacey Mueller
A Publication of the People in Missoula and Western Montana want to feel good, look good and live well. Available in more than 150 newsstand locations throughout the area, Western Montana Livingwell is well suited for over 30,000 readers monthly who want health tips on fitness, nutrition, family, financial advice, wellness, therapy and beauty.
The opinions, beliefs and viewpoints expressed by the various authors and forum participants in this publication do not necessarily reflect the opinions, beliefs and viewpoints of the Missoulian or Lee Enterprises. The author of each article published in this publication owns his or her own words. No part of the publication may be reprinted without permission. ©2010 Lee Enterprises, all rights reserved. Printed in the USA.
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sales & marketing director Jim McGowan art director & editor Kate Murphy graphic design Andrew Henderson Diann Kelly Mike Lake Megan Richter
advertising sales Holly Kuehlwein 406-523-5223 contributors Carl Ammons Haley Bradley Jennifer Helmer Robert Korenberg Heidi Moretti Jeannette Noble Debby Randall Bonnie Miller Rubin
january/february 2011 VOL.1
IN THIS ISSUE Looking in the mirror
What you need to know about dermatology and cosmetic surgery
Skin care A healthy glow for the winter season
Page 4
ALSO IN THIS ISSUE
Looking for an edge
Anti-aging diet
arthritis
Older job-seekers update their looks
Healthy meal patterns for looking younger longer
Page 8
Page 16
Page 26
Q&A
Health Tip Page 32
Also
Dermatology ~ everyone needs it. Page 11 The recipe ~ for beautiful healthy skin Page 12 8 tips ~ for eating well when dining out Page 20 After 50 ~ Maintaining an active, healthy life Page 24
Serving Missoula since 1922
westernmontanaclinic.com
C. MCHOOD R. HOOVER E. KRESS
C. SMITH L. LOVEJOY
L. AUTIO
J. VISSCHER
S. MCNERNEY
H. MADDOX K. LONG
R. WOLFE
Main Clinic, Broadway Building, 500 W. Broadway, Missoula • 406.721.5600 • 1.800.525.5688 LAR K. AUTIO, MD • KENDRA B. LONG, MD • LISA B. LOVEJOY, MD • HEATHER E. MADDOX, MD • CRAIG H. MCHOOD, MD • CHRISTOPHER B. SMITH, MD • JUDITH K. VISSCHER, MD
Community Medical Center, Physician Center #3, 2835 Ft. Missoula Rd, Missoula • 406.721.5600 REBECCA HOOVER, MD • ERIC J. KRESS, MD • ROCHELLE WOLFE, MD • SARAH MCNERNEY, FNP-BC
Lolo Family Practice,11350 Hwy 93 S, Lolo • 406.273.0045
(NOT PICTURED) ELENA FURROW, MD • NED VASQUEZ, MD • LEAH SCHINDLER, FNP-BC January/February 2011 ~ livingwell
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Skin care during the winter season By Carl Ammons, RN
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inter season is one of the most challenging for your skin. Exposed skin suffers from exposure to wind, snow, frost and heating of your home or workplace. Your skin can become dry, sensitive and irritated. So, what is the best way to protect your skin and keep it healthy? The single most important thing is to keep the skin moisturized. This is especially true when you are having a bath. Don’t forget to
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The single most important thing is to keep the skin moisturized. keep the water temperature low– it can’t be too hot. Also avoid washing your face with hot water as well. The warmer the water, the greater the loss of surface water and the quicker it dries out. The best water temperature is tepid or cold , especially in the morning. Use of water-based moisturizers can lead to a see-saw struggle to keep your skin healthy. These lotions have a lot of water in them, which increases the risk of freezing when you are outside in subzero temperatures. That’s why you should use an oilbased moisturizer, which tends to be more retentive and protective. The fact that it can’t dissolve in water will help prevent frostbite. Scent free soaps and washes help prevent irritation. It is important to remember that application of any chemicals for improving scent and color can irritate our skin and contribute to overall dryness. It is best to apply a moisturizing cream immediately after you wash, while skin is still moist and warm. Try to use a facial cream that contains neutral but moisture retentive base as this will improve dryness and reduce potential for damage. Undoubtedly, the best way to hydrate your skin is to drink plenty of water. Don’t forget to protect your skin when you are outside. It is common to think the sun is dangerous only in summer. However, because snow reflects the sunlight, wearing sunscreen is vitally important in the winter. Remember that sun exposure ages your skin and increases the risk of further damage. One reason for this is, as we age, the layers of the skin tend to flatten and become thinner, and damage from the sun is more common. Use a moisturizer with SPF 15 or even SPF 30 to improve protection from harmful ultraviolet sun rays. Any makeup used should have sun protection also. Protect your lips, as they are one of the most sensitive areas on the face. If you want to avoid chapped lips and sunburn, don’t lick them and use lip balm or lipstick with at least SPF 15-30. Protect any exposed skin this winter season; always wear lip balm and sunscreen. Carl Ammons, RN, is the wound/ostomy care nurse at Community Medical Center. January/February 2011 ~ livingwell
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Looking for an edge Older job-seekers update their looks. By Bonnie Miller Rubin, Chicago Tribune
C
harlotte Doyle hit the gym two hours a day, embraced the latest fashions and made sure that
not a strand of gray peeked through her thick blond hair. But at age 61, she got pink-slipped from her job in pharmaceutical sales. So, in 2009, shortly after she was laid off after 29 years, Doyle decided to take an unorthodox step in a cutthroat job climate and get her teeth straightened. “I need to do everything I can to be competitive,” said the Homewood, Ill., resident, flashing a gleaming mouth of metal. “I desperately want to work.” While most older job-seekers know the importance of keeping their skills current, some are applying that same advice to their faces. From orthodontics to eyelifts — and everything in between — they are turning to such enhancements to gain an edge in the workplace.
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Looks matter. In a quarter-century of
research, Nancy Etcoff, a psychology professor at Harvard Medical School, has found that attractive people are more likely to be hired and promoted, earn higher salaries and be perceived as more intelligent and creative than their less fetching peers. Not that plastic surgery, cosmetic dentistry or other elective treatments have escaped the recession. In 2009, doctors performed 12.5 million cosmetic procedures, a figure that has steadily decreased during the previous two years, according to the American Society of Plastic Surgeons. The only gains were in the minimally invasive categories — such as injectables like Botox and dermal fillers — that are less expensive and have scant recovery time. It’s another tool, though perhaps an extreme one, for aging baby boomers, many of whom are counting on working past conventional retirement age as a hedge against longer life spans and shrinking nest eggs. Teeth whitening? Laser peels? Even “hair systems”? Check, check and check. No group keeps data on why people take such steps to improve their appearance, but anecdotally, employment is often cited as the primary motivation — a change from earlier decades, when social status and romantic viability topped the list, experts say.
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“Patients are saying it’s a matter of staying competitive,” said Dr. Loren Schechter, a Morton Grove, Ill., plastic surgeon. “Even surgery — facelifts, eyelifts — is coming back to pre-2008 levels. That wasn’t there a year ago.” Those older than 55 are among the hardest-hit by unemployment, with nearly 30 percent out of work for a year or longer, said a July poll by Pew Research Center. Companies sometimes insist that appearance is key to conveying a certain image — whether a TV anchor or a hostess at a hot new club.
“
Patients are saying it’s a matter of staying competitive
”
Dermatology
Everyone needs it!
I
n the past only those with a unique skin problem sought the help of the dermatologist. Perhaps if you had a severe rash, an ongoing skin condition, a serious tendency for skin cancer, or a problem that caused discomfort or intense itching. It was the rare person that visited the dermatology office. In recent years that has all changed. Most people can benefit from and understand the value of specialist dermatologic care. We live in a world with an epidemic of skin cancer, both the most consequential and life disrupting, and the less severe forms. These growths are extremely prevalent, and pose a threat to health and well being. Dermatology providers are experts at identifying these problems, and preventing and treating them. These issues are extremely common in people over the age of fifty, and now all too significant in some younger patients. The diagnosis of acne is almost synonymous with dermatology. These doctors can offer the widest array of treatments, the most effective and the broadest care. From prescriptions to prevention, from cleansers and other overthe-counter recommendations, to office techniques and procedures – the largest selection of therapies are known in this field. Dermatologists can help people clear their acne problem, whether it is the teenager, the youngster, or the sufferer of the very common adult acne. For those with itchy conditions and hard to treat rashes, dermatologist s provide guidance and relief. For children with eczema, those with sensitive skin, people with frequent and ongoing rashes and eruptions, help is available. And so many people desire cosmetic suggestions for improvement of their appearance that dermatologists need to stay up to date in this field. Dermatologists, as the medical specialists with the knowledge and treatments for the skin, can offer the finest science in the methods of rejuvenation, coupled with the artistry of skin aesthetics. Whatever your age, whatever your needs or desires,
whether for specific problems or a general check-up, dermatologists are skilled in providing care. So join the ever expanding club, and learn what dermatology has to offer you. Robert Korenberg, MD is a board certified dermatologist in Missoula who has practiced dermatology since 1986.
Skin Care Center • Offering non-invasive skin treatments since 1998 • Most experienced laser staff in Western MT Fraxel Laser facial rejuvenation, loose neck skin, acne scarring Laser Hair Removal Diolite Laser facial veins & redness Medical Microdermabrasion no aluminum crystals Glycolic Acid Peels Botox & Restylane General Dermatology Epicuren Skin Treatments & Products
Combining the science of skin with aesthetics & beauty.
Robert Korenberg, M.D. Board Certified Dermatologist
Frank McCann, PA-C Dermatology Physician Assistant
Sandy Acord Laser Technician
543-8512 1821 South Ave, Ste. 402, Missoula January/February 2011 ~ livingwell
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Vit A Vit C Vit E Vit B Vit B2 Omega 3 Exercise Less Stress
livingwell ~ January/February 2011
The Recipe for Beautiful Healthy Skin by Debby Randall
That old adage “you are what you eat� not only applies to our overall health and nutrition, but how our skin looks and feels as well. As the largest organ in our body, our skin can benefit from the same nutrition we get from foods that have a positive effect on our heart and other major organs. Good nutrition is essential to maintain the inner health of the skin. Most experts agree that eating a balanced diet is the best way to feed your skin. So what is a balanced diet? The healthiest diet is one with adequate lean protein, healthy fats that are high in omega-3 fatty acids, healthy carbohydrates such as whole grains that are high in fiber and a large amount of fruits and vegetables. The latter provides the source for antioxidants and phytonutrients that not only protect the skin but that provide its healthy glow. Certain specific nutrients play an even more vital role in healthy skin production. Vitamin A, found in low-fat dairy
products and beta carotene, the plant form of Vitamin A, is in dark green and yellow-orange fruits and vegetables. It plays a significant role in maintenance and repair of skin tissue. Vitamin C, found in citrus fruits, melons, berries, broccoli, pepper and tomatoes reduces oxidation and damage from free radicals. Most importantly, vitamin C has collagen-stimulating properties that make the skin firm and give it tone. Vitamin E, found in nuts, seeds, healthy oils, wheat germ, whole grain products and spinach has the same anti-aging factor. Omega-3’s healthy fatty acids are found in salmon, sardines, trout, flax, canola oil, olive oil and walnuts. These acids decrease inflammation throughout the body and may help prevent white- and black- heads as well as dry skin. Dietary supplements, such as probiotics can rebalance bacteria in the stomach, and since acne is partially caused by an overgrowth of bacteria, probiotics work in treating blemish-prone skin. Another group of vitamins that are essential for strengthening our immune system are the B vitamins. Vitamin B is necessary January/February 2011 ~ livingwell
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Overall, wellness is the recipe for beautiful, healthy skin.
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for a healthy complexion and the antioxidant property of vitamin B1 is capable of eliminating the free radicals in our body. B1 along with Vitamin B3 also improves blood circulation. Vitamin B2 is capable of preventing acne. The stress-relieving property of B5 can prevent several skin diseases. A healthy immune system is essential for good health. Vitamin B6 aids in strengthening our immune system. Another factor involved with wellness and the skin care picture is a regular exercise routine. It doesn’t have to be extreme, just 30 minutes at least 3 times per week of aerobic exercise will improve blood circulation and promote healthy skin by flushing toxins from the body. Being conditioned and physically fit will help you understand and appreciate the relationship between sound nutrition and how your body performs. The physical benefits of looking good and feeling terrific most often lead to enhanced self-esteem. A very important piece of wellness and the skin care picture is stress, or more importantly, reducing stress. It has been proven that stress can trigger skin breakouts, eczema, hives and other skin diseases. Regular exercise combined with stress reduction techniques such as a relaxing facial or body wrap are helpful for inducing emotional well being, which is known to affect the physical appearance of skin. Yet, all the good nutrition, the steady exercise, the destressing techniques are all for naught if you don’t include the final piece of the wellness and skin care picture, a good night’s sleep. It’s during our sleep cycle that cell renewal occurs and blood flow is elevated, leading some experts to believe that active ingredients are better absorbed into the skin at that time and continue to work long after they’ve penetrated. Sleep is essential for skin renewal and proper skin function. When there is increased circulation and greater oxygen and nutritional exchange and lymphatic circulation, metabolic waste is cleared away, and the skin will look and feel healthier and younger. Overall, wellness is the recipe for beautiful, healthy skin. Make sure you are eating a balanced diet with a high level of fruits and vegetables and omega-3 fatty acids. The antioxidant and anti-inflammatory protection that comes from a healthy diet is the most important aspect for healthy skin. Maintaining a regular exercise routine, keeping stress in check and getting at least 7-8 hours of sleep a night are all factors that contribute to your well being. I would be remiss if I didn’t encourage everyone to drink plenty of liquids, use sunscreen and augment with good skin care products!
Exclusively Dedicated to Skin Care Education.
650 Hour Skin Care Program
Licensed by the State of Montana
Student Clinic
Offers low price facials, waxing, back treatments and makeup applications
800 Kensington, Ste100 • (406) 830-3261 • Missoula
www.MontanaAcademyofSkinCare.com
At the Montana Academy of Skin Care , our skin care therapists learn that ingredients and facial treatments are only a part of the skin care picture. Beautiful, healthy skin requires a healthy lifestyle. Our student clinic offers many types skin care treatments. Call 406-830-3261 for an appointment. For additional information about the academy, visit our website www.MontanaAcademyofSkinCare.com . January/February 2011 ~ livingwell
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Anti-Aging D i e t By Heidi Moretti, MS, a Registered Dietitian at St. Patrick Hospital and Health Sciences Center
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e all age, but some seem to do it with beauty, grace, and remain active, both physically and mentally throughout their lifespan. In order to find out how some seem to stay young, we need
to take a look at cultures that seem to defy the odds of getting cancer, heart disease, diabetes, Alzheimer’s disease and other debilitating illnesses. The residents of Okinawa, Japan, seemed to have mastered the ability to delay aging, with a high number of people living full lives well over 100 years of age. Healthy diet is a large part of their culture, but so is physical activity, spirituality and a culture of congeniality and respect for others. The Mediterranean people also seem to have secrets of staying healthy and avoiding disease into old age as well. The Lyon Heart Study found that following a Mediterranean-style diet may reduce chances of early death. If we look to these cultures, we may even be able to slow the aging process of our skin, the largest and most visible part of the body. Healthy meal patterns of all kinds tend to be anti-inflammatory, and this balance against inflammation may be part of their protective effect. Let’s take a closer look at some of the components of these diets and the key benefits of them.
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Anti-Aging Diet
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High amounts of herbs and spices: Turmeric is a key part of the diet in Okinawa, and is also used as medicine to protect the liver. It is used in soups, curries, and sauces. Other important spices include mugwort, fennel, and Okinawa hot peppers. In the Mediterranean, people generously use garlic and onions. Such spices as saffron, nutmeg, cinnamon, ginger, rosemary, thyme, basil, bay laurel, parsley and sage and cloves are a common part of the cuisine. Dill, mint, sumac and allspice are popular in the Eastern Mediterranean. All herbs and spices tend to have very high levels of antioxidants, and are often anti-inflammatory as well. Science is only beginning to unravel the mysteries of these complicated foods.
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Rich in vitamins/minerals: Okinawa is located in the Southern tip of Japan, with increased UV radiation from the sun due to proximity to the equator. This probably contributes to the nutritional quality and density of the vegetables grown in this region, as well as the total antioxidant content, and possibly the assimilation of vitamins and minerals in these foods.
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Higher percentage of omega 3 fatty acids: Although both Okinawans and Mediterranean people eat mostly plant-based foods, they both consume fish, which are abundant sources of omega 3 fatty acids. Omega 3 fats help counteract inflammation, may help maintain brain function, and reduce chances of cardiovascular diseases. Foods rich in omega 3 fats like fish also tend to be rich in the antioxidant mineral selenium. Seaweed is abundant in the diet in Okinawa, and consumption of it may also increase production of active omega 3 by the liver.
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High amounts and variety of produce: In the Mediterranean, vegetables are the feature item at meals, and range from tomatoes and artichokes to green beans and olives. People adhering to the traditional Mediterranean style diet have low rates of melanoma despite their abundance of sun, and experts believe that their antioxidant-rich diet may be protective for the skin. Okinawa diets often feature goya (bitter melon), shiitake mushrooms, burdock root, seaweed, konnyaku (from a yamlike tuber) and hechima, part of the gourd family. The vast array of produce in these diets may function to boost immunity and protect from cancer and heart disease.
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Low consumption of meat and dairy: The Okinawans diet is primarily vegetarian, and 80% of the food consumed is plant-based. Mediterranean diets are similar in proportion, and often use meat and dairy as a condiment rather than a feature in entrees. Many meat and dairy foods are thought to be proinflammatory.
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Healthy carbohydrates: Sweet potatoes make up a large portion of the diets in Okinawa, as well as low glycemic index grains. This “super food� contains many nutrients that Americans lack, such as potassium, magnesium, fiber, vitamin C and carotenoids. Legumes, such as soybeans, served as miso and often tofu appear on the menu daily. In the Mediterranean region, legumes such as dried peas, garbanzo beans, and cannelini are a key protein source as well as antioxidants, magnesium, potassium and fiber.
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Low consumption of sugar and processed “junk foods�: Most long-lived individuals in these regions eat minimal sugar in their diets, and most foods are fresh, not processed. Sugar and junk foods tend to cause a spike in insulin, which is thought to trigger and speed aging. Low total calories: Scientists are able to show that caloric restriction in animals will increase longevity and increase levels of sex hormones as well as dehydroepiandrosterone (DHEA), a precursor hormone. High levels of DHEA are found in the blood of elder Okinawans as well. Okinawans tend to have relatively low body mass index (BMI), ranging from 18 to 22.
In summary, maintaining a healthy body weight by eating a wide variety of plant-based foods may delay aging and keep our body and minds active as we mature.
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8 Tips for Eating Well when Dining Out
By Haley Bradley, a Registered Dietitian with St. Patrick Hospital and Health Sciences Cent er The frequency of choosing to dine out rather than eating at home continues to grow for many American s. The reason for this trend varies and includes convenience, work obligations, social commitments, or just personal choice. However, the sad truth is that frequently eating out seems to be directly associated with the grow ing American waist-line. Dining out often means consumin g more pre-packaged foods, high-fat meals, and large r portions, thus, increasing one’s intake of fat, calories and sodium. But there is good news, and that is you can eat out and eat healthfully too. By being pro-active, you can take charge of your weight and your health.
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1 Don’t be shy; ask how your food is prepared. Most of the whole food items in dishes fit into a healthy diet, but how they are prepared is often the problem. Ask the server if the kitchen can prepare foods to meet your needs. Be wary of hidden fats termed as creamed, béarnaise, Alfredo or hollandaise sauces. Ask your server to place rich sauces, gravies or dressings on the side so you can control how much you eat or ask if they have low fat options. Request tub margarine rather than butter with bread or potatoes and low fat or fat free milk instead of whole fat milk or cream.
2 Think lean if you want to be lean. Look at protein options including fish, skinless chicken, lean meats (round, loin, and wild game), white meat turkey or cottage cheese. If a menu item you want includes the words fried, breaded or au gratin in its description, request an alternative preparation such as baked, steamed, roasted or broiled. By doing so the scale, as well as your heart, will thank you!
3 Watch your portions. The fact is that people tend to eat more when served larger portions. Learn to fight the “clean your plate” mentality and you may drastically reduce your calorie intake when dining out. Request a to-go box when the entrée arrives and portion out the serving size you want to eat first. The added benefit is that you can enjoy the meal a second, or even third, time. Consider ordering two starter salads but sharing a main course with your dinner partner or order a side salad and appetizer for a meal. Look for restaurants that offer smaller options or meals a la carte, as this can benefit both your waist and wallet.
4 Indulge your inner child. Ordering child sized meals can drastically decrease portion intake. Additionally, many fast food chains are feeling the demand to offer more health conscious options with their “kid’s meal.” Look for baked chips, fruit or vegetable options, or soups as substitutes for fries; opt for low fat milk or water rather than soda; and consider fruit or light yogurt instead of pastries as a sweet treat to end the meal.
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5 Fiber up your meal. Try to pack fruit, vegetables and whole grains into every meal out because fiber and fluid provide the feeling of fullness without weighing you down. Order sides of steamed or grilled vegetables, have fruit for dessert, start the meal with a vegetable-based soup or salad, and look for whole wheat bread, pasta or rice options.
6 Do not arrive famished. Within a few hours of dining out, have a balanced snack that contains fiber and protein to allow you to make better choices at the restaurant. Pre-dining out snacks could include peanut butter on apple slices, cottage cheese with fruit or low fat string cheese with whole grain crackers.
7 Re-think your drink. Soda, juices and energy drinks can be a huge source of hidden calories. Many restaurants offer free refills or super sized soda options which can tack on hundreds of additional calories to a meal. Ask for lemon in your water, low fat milk or unsweetened ice tea instead of sugar-laden beverages.
8 Do your research. Many restaurants have their menus and nutritional information posted on the internet, so go online before you dine and choose a few healthy options ahead of time. Also, if a menu is not available online, call the restaurant ahead of time and see if they will accommodate your needs.
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Maintaining an active, By Jeannette Noble, FNP
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hy should life change after the age of 50? With ever expanding life expectancies, it really seems more like middle age. If you are going to enjoy this time of your life, then you should take some proactive steps to help manage your health. Regular, yearly check-ups and preventive care from your healthcare provider are a great place to start. Recommended screenings at this age include annual blood work including a cholesterol panel, annual eye exams, and a colonoscopy every 10 years. Women should get annual mammograms and depending on their history, PAP tests every 1-3 years. Men can discuss the current recommendations for prostate screening with their medical provider. Key reasons for these screening are early detection and prevention. Colonoscopies allow early recognition of
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polyps and removal before they can progress into cancer. Eye exams are instrumental in diagnosing and being able to treat glaucoma, the leading cause of preventable blindness. Most illnesses are much easier to treat and prevent progression with early diagnosis. What you do not know, CAN sometimes hurt you. Even more important is what you do throughout the year to maintain and improve your health. Strength training can be an excellent way to build lean muscle and increase your metabolism. It is estimated that an extra ten pounds of lean muscle can burn up to an extra 350-500 calories per day. This in turn can be instrumental in maintaining optimum weight, which frequently gets more difficult as we age and lose lean muscle, thereby decreasing our basal metabolism. Even for those who want to avoid building bulky muscles,
healthy life after 50 strength training can help sculpt and tone. By combining a strength training and cardio routine into your active life, you can improve your mood, fitness, sense of well being, and even your cholesterol, among other things. By eating a healthy diet full of complex grains, fruits, and vegetables along with sufficient, lean protein, we give our bodies the fuel they need. Weight management often gets more difficult with age. By eating balanced, frequent, smaller meals, you can help keep your hunger at bay, your blood sugars level, and avoid the slump often caused by dropping blood sugars. Too much caffeine and simple sugars cause a short burst of energy that is often followed by a rapid crash, causing you to eat more as your blood sugars begin to yo-yo up and down. This often leads to a cycle of cravings and increased caloric intake that causes
excessive weight gain. With today’s active lifestyle, it may take some planning ahead and keeping some healthy, balanced snacks handy, but you will feel better for doing it. There are entire books and classes on living healthy; it is impossible to succinctly give you all the keys to healthy living. You are the most important link to deciding how happy and healthy your life will be. After all, you are not getting older or aging – your youth is simply receding a little farther. Take control of your life and live happy and healthy. Jeannette Noble is a nurse practitioner with Community Physician Group at Community Medical Center. January/February 2011 ~ livingwell
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Arthritis
Q&A by Jennifer Helmer, PT
A
new year has arrived and your knee pain persists. Fortunately, the new year is a time for new beginnings and new resolutions. Most people consider a weight loss resolution at this time of year. The appropriate weight loss resolution can also relieve knee pain. However, the confusing media blizzard of competing weight loss programs and introductory gym memberships make it difficult to determine what plan will best fit your needs and your current physical condition. This issue is further complicated by nagging knee joint pain which worsens with increased activity. It can be easy to blame knee joint pain on changes in the weather. However, it is more likely your knees are in some stage of arthritic decline or are muscularly de-conditioned. For your overall health and to reduce your knee joint pain, make the resolution to lose weight. A consult with a health care professional is a must if knee pain is persistent. In my practice, patients ask many questions about arthritis, how it affects them, and how to tackle the task of reducing their body mass. What follows are several commonly asked questions (in bold for easy reference) and their respective answers.
What is arthritis? Osteoarthritis (OA) is defined by Webster’s Dictionary as “degenerative joint disease.”1 “Osteoarthritis causes pain, stiffness, swelling, joint instability and muscle weakness” (Bennell and Hinman, 2010). 2 Simply put, the
cartilage protecting the surfaces of the bones is wearing down. The wearing of articular cartilage is graded 1-4.3 4 Well, what do the grades mean? The higher the number, the worse the articular wear. At grade 4, articular cartilage has become so worn away that the underlying bone is now exposed. Pain ensues with bone rubbing on bone. How do I know if I have osteoarthritis? The most inexpensive diagnosis tool is x-ray, interpreted by a physician. 5 6 How did I get osteoarthritis? The cause of OA is attributed to a combination of factors. “Old age, female gender, being overweight or obese, knee injury, repetitive use of joints, bone density, muscle weakness, and joint laxity all play roles in the development of joint OA, particularly in the weight-bearing joint” (Zhang and Jordan, 2010). 7 Can I reverse osteoarthritis? No, OA cannot be reversed. Once a patient learns that they have OA, they must process how this condition applies to them, and their lifestyle, both now and in the future. Fortunately, methods for prolonging the life of the degenerative knee are available, and discussed below.
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What can I do to diminish the pain? Weight loss is a crucial element in decreasing the pain of OA,8 9 and this ties in nicely with any New Year’s resolution. “Each pound of weight lost will result in a 4-fold reduction in the load exerted on the knee per step” (Messier et al, 2005).10 When considering weight loss, the bottom line is to expend more calories than you are taking in. Most can utilize the pairing of proper reduction of caloric intake and exercise to obtain the caloric burn necessary for weight reduction.11 Will exercising wear down the joint surfaces faster? 12 Exercise to reduce weight seems counterintuitive to some. After all, you gained weight because it hurts to move. This falsehood is commonly expressed by patients in the clinic. However, exercise modification, which includes both aerobic and strengthening components, is suggested both for weight loss and those with arthritic conditions.13 I don’t want activity to make my knee pain worse. What exercises should I do? What exercises should I avoid? Generally, I recommend low-impact exercise such as swimming, or cycling. To improve strength, participate in a modified resistance training program with instruction by a health care provider. I advise patients to refrain from high impact activities, such as jogging and basketball. Can I avoid pharmaceutical management of my osteoarthritis? Knee bracing assists in unloading an arthritic knee compartment, thus reducing pain and stiffness.14 The beneficial effects of bracing can allow individuals to return to an increased frequency in activities such as skiing, hiking, golfing, stairs and prolonged stance. Increasing activity level increases caloric burn. This promotes weight loss. 15 If I brace my knee, will it become weak(er)? My experience is bracing will frequently allow patients to participate in pain-free strengthening. Increased strength of the musculature surrounding the arthritic joint can allow for less painful impact when the lower extremity contacts the ground.11 The progression of the degenerative arthritic process is unpredictable. However, exercise and bracing are non-surgical interventions with few side-effects to reduce weight and help you achieve that New Year’s goal. Do not let misconceptions about arthritis and your activity level steer you away from making a lifealtering change for the better. Physical Therapists are trained, licensed medical professionals. They can evaluate and design an individual exercise-based weight loss program with your resolution and OA in mind.16 Go ahead, commit to the resolution and “Get Back Out There.” Your knees will thank you! Jennifer Helmer is a Physical Therapist, Certified Hand Therapist, and co-owner of Northern Rockies Physical Therapy. Please view www.NorthernRockiesPT for referenced footnotes. January/February 2011 ~ livingwell
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Valley View Estates
A skilled nursing facility in Hamilton providing 24 hour care, full rehabilitation services and a light care wing for those with minor health issues. The only limited memory program with a secured unit offered in the Bitterroot Valley. Complete with Pearls of Life Signature Memory Care Program. 225 North 8th, Hamilton • 363-1144
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livingwell ~ January/February 2011
Northern Rockies Physical Therapy
Live an active life? So do we. We want to work with you, so you can get back out there. Northern Rockies Physical Therapy is owned by a team of physical therapists who have the background, experience and continuing education to work with athletes and active individuals of any level. Whether you have experienced a sports or work-related injury, have undergone surgery or are recovering from an illness, Northern Rockies Physical Therapy can create a program that suits your rehabilitation needs. 2831 Fort Missoula Rd, Suite 200 - Physician Center #2 Community Medical Center - Missoula MT www.NorthernRockiesPT.com Tel: (406)543-0617 - Hours: Mon- Fri 7 am – 6 pm
Rocky Mountain Surgical Solutions
Valley View Estates
A skilled nursing facility in Hamilton providing 24 hour care, full rehabilitation services and a light care wing for those with minor health issues. The only limited memory program with a secured unit offered in the Bitterroot Valley. Complete with Pearls of Life Signature Memory Care Program. 225 North 8th, Hamilton • 363-1144
Dr. Timothy B. Richards. Providing all your general surgery needs for Intra-Abdominal Problems: Gallbladder, Cancer, Breast Conditions, Hemorroids and Hernia. 2831 Ft Missoula Rd, Suite 104, Bldg 2, Missoula, MT 59804. 406-728-0285. www.RMSSMontana.com
Rocky Mountain Surgical Solutions Dr. Timothy B. Richards. Regional leader in comprehensive vein care. Board certified surgeon specializing in vein treatment. Offering both VenaCure laser and VNUS RF - Radio Frequency closure treatments for varicose vein conditions. 2831 Ft Missoula Rd, Suite 104, Bldg 2, Missoula, MT 59804. 406-728-0285. www.RMSSMontana.com
January/February 2011 ~ livingwell
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Only the Best Care!
Also available for complimentary inpatient hospital or in-home consultations.
Olive Our Love By Jeff Schnaufer, CTW Features While olive oil has long been known for its ability to lower bad LDL cholesterol that can lead to heart attack or stroke, recent medical studies have pointed attention to olive oil’s other medicinal values. A study by U.S. scientists published in the October 2009 issue of the Journal of Toxicology and Applied Pharmacology indicates that Oleocanthal, a natural component of extra virgin olive oil that can prevent damage to brain cells, could help prevent Alzheimer’s disease. Also in October, the Archives of General Psychiatry published a Spanish study reporting that people who regularly followed a Mediterranean diet, which includes olive oil, fruits, nuts and whole grains, were less likely to develop depression. Olive oil, again as part of the Mediterranean diet, may also help people with Type 2 diabetes stay off of medications to lower blood sugar, according to Italian research published in the September issue of the Annals of Internal Medicine. “In general, olive oil is an extremely healthy fat,” says Patricia Darragh, executive director of the California Olive Oil Council, Berkeley, Calif. “There have been very highly regarded scientific reports that consumption of extra virgin olive oil has been linked to cardiovascular health and lower risk of breast and colon cancer.” Elisa Zied, a New York City-based registered dietitian and author of the book, says a recent review of several studies also showed that a diet rich in monounsaturated fats (like those found in olive oil) lowered total cholesterol and blood triglyceride levels more than a low fat high carbohydrate diet. “Olive oil is also a good source of vitamin E, a fat soluble vitamin that acts as an antioxidant and fights damage caused by harmful free radicals in the body and in the environment that can contribute to the development of disease,” Zied says.
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livingwell ~ January/February 2011
541-1800
www.HomeHealthofMontana.com
Lifeline is a simple, wireless device worn as a pendant or wristband that allows the wearer to summon help with the push of a button from anywhere in their home, any time of day or night. For the price of a daily cup of coffee, Philips Lifeline can help you maintain your independence, and also give your family peace of mind.
1-800-357-4799
Looking in the mirror What you need to know about dermatology and cosmetic surgery INSIDE Skin Care:
A healthy glow for the winter season
8 Tips
For eating well when eating out
January/February 2011 A Publication of the
Anti-Aging Diet
Healthy meal patterns for looking younger longer