Living Well Sept-Oct

best face forward SEPT/OCT 2015

A Publication of the

you don’t need insurance to see dentist causes of dry eye goes beyond obvious September/October 2015 ~ living well

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living well ~ September/October 2015

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publisher Mark Heintzelman

missoulian.com

A publication of the

People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well suited to more than 30,000 readers monthly who want health tips on fitness, nutrition, family, financial advice, wellness, therapy and beauty.

editor Matt Bunk graphic design Krista Ness Bob Jacobson

advertising sales Rachel Crisp Philips 406-523-5223 contributors David Bellamah Amy Downing Annette Dusseau Kelly Norris Maria Redfern

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. ©2015 Lee Enterprises, all rights reserved. Printed in the USA.

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living well ~ September/October 2015

September/October 2015 VOL. 31

in this issue

dental insurance? pg. 6

dental co-diagnosis pg. 8

best face forward

also inside

healthy mouth pg. 12

causes of dry eye pg. 20

vericose veins pg 16 prioritize mental health pg 26 steps for aging well pg 28

treating facial paralysis pg. 22

prevent hearing loss pg. 32

September/October 2015 ~ living well

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You don’t have to have dental insurance to 6

see a dentist

living well ~ September/October 2015

A

lot of dental patients mistakenly believe that if they lose their dental insurance they can no longer go to the dentist. Of course that isn’t true. What they are probably thinking is that they can no longer afford to go to the dentist if the insurance company isn’t going to pay for it. That is equally false.

About half of dental patients in western Montana no longer use dental insurance to pay for dentistry. Many companies dropped dental insurance during the recession.

Even businesses that have continued to provide this important benefit are growing increasingly frustrated with how little they get for how much they pay. Many insurance companies are increasing restrictions on benefits, imposing higher copays, and adding more severe penalties to force patients to go to network dentists.

Since the vast majority of Montana businesses are small businesses in which the owners have the same benefits as the employees, a lot of small business owners are dropping their dental insurance plans and looking for other options. Since these same small businesses have had to increase their health insurance deductibles due to increased health insurance premiums, they now qualify for Health Savings Accounts (HSA). An HSA is a fantastic tool for paying for prescriptions, dental care, optical, routine medical, chiropractic care or virtually any other legitimate health care expense (see IRS Publication 502 for details).

HSAs are exploding in popularity as a very efficient means to pay for dental expenses. Some employers are contributing the money they spent on insurance premiums to their employees’ HSA accounts. This helps pay higher deductibles for medical expenses, along with a wide variety of other health care expenses. HSA account holders can spend the money they save on health care expenses they really need, not just the ones that are covered. As a bonus, if they don’t spend everything this year it carries over in their HSA for next year (or many years later). The best part is you are absolutely in control of where you spend your money.

Don’t like your dentist? Fire them and find another. Not often an easy option in an insurance network.

Very few people buy dental insurance for themselves because it makes no economic sense. According to

Obamacarefacts.com, “In general dental insurance isn’t a smart buy for individuals simply buying it from an insurer themselves.” Frequently the dental insurance premiums are more than the actual costs of seeing a dentist. Most people with dental insurance get it through their employer with a small monthly premium deducted from their paycheck.

Many employers are forced to increase the portion of the dental insurance premium employees pay so they can pay for rising health insurance costs.

If you are paying more than $30 per month for dental insurance and you are in good dental health, you would probably be better off putting that money in an HSA rather than buying dental insurance. In western Montana most healthy adults can get two cleanings per year, an annual exam and annual x-rays for $300 to $400 annually. If that is all you need and you are paying $360 per year ($30 x 12) in premiums, you could be wasting money. That extra money could go toward glasses, prescription drugs or just save it for a larger medical expense later. You can even earn taxfree interest on many HSA accounts.

Dental insurance has been a very good tool for budgeting for dental care for many years. There are still plans out there that do a good job of earning your premium dollars. If you have a good plan and they still let you see your favorite dentist, stick with it. Even if the numbers don’t always work out in your favor, you are probably better off financially if you continue to see your regular dentist and dental hygienist for preventative care. A lot of people let their preventative care lapse if they change dentists or change insurance plans. That can cost money and have negative health outcomes in the long run.

One thing you can’t afford to do: Stop going to the dentist. According to the Center for Disease Control, nine out of 10 adults over the age of 20 have some degree of tooth-root decay and it is the “the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years.”

The Bottom line: Decide which dentist you like and keep going to them. Do your best to find tax-advantaged ways to pay for dentistry. Don’t let possible short-term savings cause you to make poor decisions that can cost a lot more in the future.

September/October 2015 ~ living well

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Co-diagnosis living well ~ September/October 2015

By Annette Dusseau, DDS, MAGD, ABGD

H

is changing dentistry

ave you ever wondered what your dentist is looking at? More and more dental patients no longer have to wonder.

With the increasing use of new digital technologies, 21st century dental patients have access to much of the same information as their dentist. This new technology sounds intimidating and expensive, but it is really neither. Virtually all of these systems pay for themselves in efficiency. So, in my practice, we haven’t had to charge extra for any of these services. The old saying “A picture is worth a thousand words” is as true today as it was 100 years ago. These pictures save us a great deal of time explaining things to our patients, along with the huge time savings compared with managing physical records and mailing x-rays.

Co-diagnosis sounds like a new innovation, but it is really a very old concept. When the first healer pointed at a rash on a patient’s arm and said “I think this is what it is because…” he (or she) was engaging their patient in co-diagnosis. It is simply having your patient look at what you are looking at and discussing it with them.

Physicians have been doing this for years when they clip an x-ray film up on a light box and go over it with their patient.

Engaging patients in co-diagnosis has been a lot harder for dentists. When we took x-rays using regular film, we were able to produce very clear images that were about the size of a large postage stamp. That was a great medium for me because I look at dental radiographs all day long. My patients struggled with these small images. I spent years pointing at x-ray films with a very sharp pencil trying to explain to my patients what I was seeing. Most would nod politely and their eyes would slowly glaze over as I persisted in trying to help them see the cavity in their tooth or the infection in their bone.

I’ll never forget when we first brought digital radiography (digital x-rays) to our practice in 2005.

We had just installed the system and were doing some training when one of my receptionists told me we had a patient who really needed to see a dentist. She said he appeared to be pretty uncomfortable and asked if there was anything we could do. We rarely shut down our clinic for this very reason. Patients don’t care if you need to train or field new equipment — they need you when they need you. I told the gentleman that if he would agree to help us train on the new system, I’d have my assistant take an x-ray and I’d perform the exam free of charge. He readily agreed since he was obviously in pain.

This worked out great for us because we had some lessthan-perfect teeth to evaluate with the new technology.

I put up the x-ray on a computer monitor right in front of my new patient. He just looked at me and said “Well, anyone can see that tooth needs to go.” He pointed directly at his broken tooth. I was astounded at September/October 2015 ~ living well

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how quickly this patient, who was clearly not a frequent visitor to dental clinics, was able to co-diagnose his problem. Of course, that was a very easy diagnosis to make. Most of my patients are able to recognize the problem once I help them understand what they are looking at. I mostly act as an interpreter to help them understand this foreign language of dentistry and dental radiographs.

These days my patients also have the benefit of intra-oral cameras. These are specially designed cameras that we can use to take a full-color, close-up image of a single tooth or inflamed gums.

Intra-oral cameras are a great complement to digital radiography because some problems don’t show up on X-rays. That is why your dentist is doing a lot of looking and probing when performing a dental examination for you. Often, a dental problem will present clearly to me both clinically and on an x-ray, but the color photo really helps my patient understand some problems that are difficult to see on x-rays. Most dentists have looked at tens of thousands of x-rays so something that is obvious to us may not jump out at someone who doesn’t read x-rays for a living. The intra-oral cameras really help in these situations.

These technologies have really changed my interactions with patients. Instead of “pushing” foreign and intimidating information on them, I spend a lot more time just answering questions. My patients are “pulling” information out of me so they can better understand what they are looking at and what their options are. In most cases, if I can help my patient understand what they are seeing, they come to the same clinical conclusions I do.

It makes my job a lot more fun because I get to have an informed discussion with my patient rather than lecturing to them. It is more like two colleagues discussing treatment options than a doctor just telling a patient what they should do.

Co-diagnosis doesn’t mean we always agree. Sometimes my patients decline my recommendations. This is fine as long as they are making an informed decision. There are risks and rewards associated with any clinical action or inaction. In health care, we are usually balancing the probability of bad things happening if we don’t act versus the limited risks of pursuing treatment. Sometimes I might be recommending a specialist but my patient prefers that I perform the procedure even though they can see it isn’t going to be easy.

I sleep a lot better at night, confident that my patients understand their clinical situation and the balance of risks and benefits. In the past, I often felt that my patients didn’t pursue treatment because they just couldn’t understand what I was talking about. Now, they can clearly see what I’m concerned about and it is real to them. Knowledge is power, and we all feel much more in control when we understand what is going on. Life is better for all of us. I really love my job.

Annette Dusseau is a practicing general dentist and the president of Family Dental Group in Missoula. She has practiced dentistry for 26 years. Dr. Dusseau spent her first 13 years of practice on active duty in the U.S. Army before moving to Missoula to become an independent dentist in private practice. Her credentials include a doctor of dental surgery (D.D.S.) from Indiana University, mastership in the Academy of General Dentistry (M.A.G.D.) and she is also certified by the American Board of General Dentistry (A.B.G.D.).

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living well ~ September/October 2015

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living well ~ September/October 2015

Healthy mouth, healthy you

By Kelly Norris, DDS

D

id you know that the health of your mouth can have a great impact on the health of the rest of your body? Regular dental check-ups, x-rays and cleanings can benefit more than just your teeth and gums. Let’s see why.

In order to understand how our mouth can have such large impact on the rest of our body it is important to understand the environment in our oral cavity and how infections develop.

Our mouths are naturally filled with bacteria which build up on our teeth and gums. Many people do not know that dental decay, otherwise known as a “cavity,” is a type of infection.

If we have diets high in sugar and do not regularly brush and floss, the bacteria in our mouth multiply and feed off of the same sugars we ingest to produce acids which break down tooth structure, leading to decay. If

left untreated the bacteria and decay extends into the nerve of the tooth and travels down to the tip of the roots, causing an abscessed tooth. As a result we feel pain and develop swelling. In extreme cases the infection can travel through our jaw bone to other parts of the body causing severe problems.

Thus, it is important to seek the care of a dental or medical professional as soon as symptoms develop.

In addition to decay and abscessed teeth, the accumulation of bacteria in our mouth can also lead to infections in our gums. Our immune system naturally tries to combat this gum infection by sending inflammatory mediators (part of the body’s natural immune system) to the area, leading to inflammation. This war between our immune system and the bacteria leads to the loss of an innocent bystander, the bone around our teeth.

This is defined as periodontal disease, otherwise known as gum disease.

Untreated periodontal disease leads

to chronic inflammation, which can affect our bodies in numerous ways.

There is strong evidence to support a relationship between periodontal disease and heart disease; in fact, studies show that up to 91 percent of patients with heart disease also have periodontal disease.

Inflammation in the mouth causes inflammation in the blood vessels, which can lead to an increase in the risk for heart attack and stroke (1).

A strong relationship also exists between periodontal disease and diabetes. Inflammation in the mouth inhibits the body’s ability to control blood sugar. Unfortunately, high blood sugar also creates an ideal environment for infection to grow, and thus there is a cyclic pattern between diabetes and periodontal disease, one disease fostering the progression of the other (1, 2).

The relationship between oral health and our overall health goes beyond just heart disease and

In addition to decay and abscessed teeth, the accumulation of bacteria in our mouth can also lead to infections in our gums.

September/October 2015 ~ living well

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At home make sure you are brushing twice daily and flossing once daily.

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living well ~ September/October 2015

diabetes. Researchers are looking into whether expectant mothers with periodontal disease have a higher risk of premature births and low birth rate babies in comparison to those with healthy mouths. One study showed that expectant mothers with periodontal disease using an alcohol-free, antimicrobial mouth rinse had babies with a higher gestational age and birth weight in comparison to mothers who did not treat their periodontal disease with the mouth rinse (3). If you are pregnant or thinking about becoming pregnant, make sure you pay attention to your teeth and gums. Hormonal changes during pregnancy can sometimes worsen some dental problems and good oral health is not only important for you, but also for your baby.

As you can see the health of our mouth can directly influence the health of our body, but beyond that our mouth can actually be a window into our body, showing us problems before we see them any other way. Changes in the color and/or texture of the soft tissue of our mouths, as well as certain patterns of bleeding or wear on the teeth can lead to the diagnosis of diseases and disorders such as anemia, Lupus, Crohn’s Disease, acid reflux, eating disorders and leukemia (4). During your dental exam, your dentist will not only evaluate your teeth, but also your gums, tongue, the roof of your mouth and cheeks to check for any signs of a systemic condition. In addition we can observe oral cancer lesions hopefully before the cancer spreads to other parts of the body.

So, what can you do to help maintain not only a healthy mouth, but a healthy body? Visit your dentist regularly; for most children and adults a visit to the dental office is recommended every six months. These regular visits should include a professional dental cleaning; this is the only way to remove the hard tartar (calculus) which tends to build up at your gumline. This tartar is made up of bacteria and thus removing it is an important part of preventing periodontal disease. At home make sure you are brushing twice daily and flossing once daily. Eat a balanced diet, limiting snacking and intake of sugary food and drink. Take note if your gums bleed during brushing or flossing, if your gums become tender or swollen, if your teeth become loose or are separating, or if there is a change in the way your teeth fit together when you bite. Let your dentist know if you are observing any of these changes, as they may be indicators of periodontal disease or other problems (5).

Lastly, make sure your dentist is aware of any medical problems you may have and what medications you are taking. Always provide an updated medical history so your dentist can advise you of any precautions you should be taking with your dental care. Remember, your dentist cares not only about your teeth but also about your health overall.

Make sure you provide him or her with the most up-to-date medical information and visit regularly so you can work together as partners with the goal of a happy and healthy you.

3. Adams, B. (Fall 2011). Exploring the Link between Oral Health and Systemic Health. Penn Dental Journal.

4. Chi, A.C., Neville, B.W., Krayer, J.W., & Gonsalves, W.C. (Dec 1 2010) Oral Manifestations of Systemic Disease.

American Family Physician, 82(11). Retrieved from http:// aafp.org.

5. American Dental Association. (April 2006) Healthy mouth, healthy body. Journal of the American Dental Assocation, Vol. 137. Retrieved from http://jada.ada. org.

References:

Dr. Kelly Norris is a general dentist practicing at Family Dental Group in Missoula. She graduated from Harvard School of Dental Medicine and completed a General Practice Residency at the Minneapolis Veterans Affairs Medical Center. She has experience treating patients of all ages, including those with significant medical histories.

1. Barker, J. (Jan 4 2012). Oral Health: The MouthBody Connection. Retrieved from http://webmd.com.

2. Mealey, B. (Oct 2006). Periodontal disease and diabetes. A two-way street. Journal of the American Dental Association, Vol. 137. Retrieved from http://jada.ada.org.

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Varicose Veins & Leg Pain 16

May be signs of more serious issue living well ~ September/October 2015

By David Bellamah, MD, FACS

I

t’s back to school time, which tends to be a busy time of year for most people. With more time on the go, busy individuals often “brush off” nagging leg aches and pains as nothing more than a long day on their feet.

But consider this: according to the Millennium Research Group (2011), more than 30 million Americans have varicose veins. This condition happens when the valves in leg veins no longer function, resulting in pooling blood in the legs. People often assume these blue, red or flesh-colored veins are just a cosmetic nuisance, and many individuals mistakenly write them off as an unavoidable reality of aging.

Varicose veins are very often related to a more serious medical condition called chronic venous insufficiency. In addition to causing leg pain and swelling, CVI can result in leg restlessness, skin damage and even ulcers. And, surprisingly, less than 10 percent of people with CVI seek treatment for it (per the Millennium Research Group, 2011).

Varicose veins and CVI are very treatable. At vein centers like ours, we are able to treat, on an outpatient basis, men and women suffering from leg pain and noticeable leg veins of varying sizes - issues that may have long been ignored and could very well be symptoms

of lower extremity venous/vein disease. Treating leg pain and related vein disease is a great example of preventative medicine helping to avoid future problems.

There are many misconceptions about varicose veins and venous disease. Our community can benefit greatly if individuals pay greater attention to their leg pain and noticeable spider and varicose veins, and take action.

Varicose veins myth busters and tips: • Excess weight and unhealthy eating can cause varicose veins. Exercise regularly to increase blood flow to the legs and maintain a healthy weight by combining a healthy diet with physical activity (Dpt. Of Health and Human Services, 2010).

• People who spend a lot of time on their feet (e.g., health care workers, teachers, flight attendants) are at increased risk of developing varicose veins. Rest legs daily by elevating your feet above the heart (Dpt. Of Health and Human Services, 2010).

• Painful vein stripping is a thing of the past. There are now minimally invasive treatment options, which are usually covered by insurance, that allow for a quick return to everyday activities (British Journal of Surgery Society Ltd., Wiley Online Library, March 2011).

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living well ~ September/October 2015

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Causes of dry eye go beyond the obvious

By Brandpoint

B

urning or stinging feeling in your eyes? Do they feel dry and uncomfortable? You may not be alone. Studies suggest that in the United States up to 7.8 percent of women aged 50 or older and 4.34 percent of men over the age of 50 experience symptoms of dry eye, a progressive eye disease.

The symptoms of dry eye vary in severity, but are most commonly described as dryness and overall eye discomfort, and may also include stinging, burning, a gritty feeling or episodes of blurred vision.

“A healthy ocular surface is a critical factor in eye health,” says Marguerite McDonald, MD, of Ophthalmic Consultants, Long Island, New York.

“When that surface becomes irritated or damaged, it activates an inflammatory response that results in the common symptoms of this disease. It’s really not something to be ignored.”

Age is recognized as one of the various risk factors of dry eye, but it’s not the only factor when you consider that dry eye is one of the most common reasons why patients visit their eye doctors.

Risk Factors for Dry Eye

Video displays, including computer screens and other devices, are part of everyday life for many people. But lengthy exposure to these devices may increase the risk of dry eye. For example, continuous work in front of a video display, such as a computer screen, decreases the frequency of blinking and contributes to dryness on the surface of the eye.

“People who spend a lot of time looking at a computer, tablet or smart phone may experience discomfort as a result of this activity and should consider talking to an eye care professional if symptoms continue or worsen,” McDonald says.

As greater numbers of young people choose to use contact lenses to correct vision, the prevalence of dry eye in younger populations may become similar to what’s currently observed in older populations.

Symptoms of dry eye are also common after laser surgery to correct vision impairments, with nearly half of people who had either PRK or LASIK vision surgery reporting symptoms of eye dryness for three months or more, according to a survey.

Certain medications, including antihistamines, benzodiazepine and antidepressants, have all been associated with dry eye.

Diagnosis and Treatment

So what should you do if you’re experiencing these symptoms? An eye care professional can appropriately diagnose dry eye through a comprehensive eye exam, including testing of the ocular surface and tear quality assessment.

Talk to your eye care doctor for more information about the underlying causes of dry eye, as well as the signs and symptoms.

September/October 2015 ~ living well

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The value of a

Therapy can restore facial movement

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living well ~ September/October 2015

By Amy Downing, PT

O

ur face is a window into our soul. It allows for verbal and nonverbal expression often complementing our personality or present mood.

People with long-standing facial paresis experience facial disfigurement and psychological difficulties that does not allow them to convey emotions through facial expression. These people have often been told by health care providers that nothing further can be done to improve their facial movements. However, in many cases this actually is not true, even if the injury or paralysis has occurred 20 years ago. Physical therapists versed in facial rehabilitation can use neuromuscular techniques to improve muscle function and, in return, improve quality of life. Let me explain.

Causes

Facial paralysis or paresis may be caused by several conditions. For example, Bells Palsy is a viral inflammatory immunologic injury to the facial nerve.

It accounts for 57 percent of all facial palsies and occurs mostly in 15-44 year olds. Recovery occurs in approximately 70 percent in 3-8 weeks without intervention. If facial paralysis exists beyond 3 months, then physical therapy may be indicated.

Ramsay Hunt Syndrome – caused by Herpes Zoster oticus – is associated with facial paralysis, hearing loss, vestibular symptoms such as dizziness or loss of balance and pain.

Other causes include acoustic neuroma (a benign tumor on the vestibular nerve), CVA (stroke), head/ neck trauma such as temporal bone fracture or facial nerve branch injuries, posterior fossa tumors or disease, congenital, infections, Guillain Barre or Lyme’s Disease.

How our faces work

smile

after paralysis

Now that we know some of the causes of facial paralysis let’s work to better understand how our facial muscles function. To keep it simple the facial muscles that we use to blink, open and close our eyes, smile, chew, etc. require a nerve to make them move.

This nerve not only produces muscle movement but also produces sensation, such as pain or numbness and tingling. When this nerve, the facial nerve, or cranial nerve VII, is impaired we can end up with facial paralysis.

The facial nerve has 5 branches to the face, innervating various muscles to the following regions: September/October 2015 ~ living well

23

brows, eyes, nasal region, oral commissure and the lips. One part of the branch, or a combination of all the branches may be affected on one side of the face.

The facial nerve innervates 23 paired muscles in the face. It innervates the lacrimal (eye) and salivary (mouth) glands. It supplies special sensory taste to the front 2/3 of the tongue. When impaired the facial nerve can affect our speech. Words that begin with p, d, or b become difficult in addition to ffff, pppp, and ssss sounds. So not only do we have difficulty with facial expression but our eye may excessively water, or we may even drool. We become extremely self-conscious because we cannot form words the way we used to.

For paralysis to the eye muscles we have to add drops or a lubricant due to the eye lid not blinking normally. Some people need to patch their eye at night to protect the cornea. It is wise to seek the advice from an eye doctor if you are experiencing this.

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living well ~ September/October 2015

What does facial paralysis look or feel like?

Facial paralysis could be as simple as one or a combination of the following: Loss of nasolabial (nose and lip) and forehead folds, drooping of mouth and drooling, dry eye or increased tearing, unable to close eyelid tightly or at all, drooping eyebrow, facial asymmetry, and ear, face, or jaw pain.

For those experiencing some sort of paralysis it can be very devastating. People lose their drive to go out for dinner or be seen in public. They make excuses or want to tell

complete strangers their story. It takes away confidences and changes lives forever in many ways, from the way they eat to the way they relate to people. With the help of physical therapy and counseling people with facial paralysis can live happy normal lives.

As the nerve begins to recover we usually see improvement starting at the mouth, with the forehead (frontalis muscle) being last to recover. Problems that can develop during nerve regeneration include simple misdirection. You can get entry of one axon from the nerve into a tubule destined for another muscle. This results in synkinesis, or cross wiring, causing the wrong muscle to contract. An example of this would be when someone is trying to chew food but their eye closes on the affected side with each bite.

Causes of synkinesis include applying electric stimulation or maximal facial expression exercises as the nerve is regenerating. This usually occurs three to four months after injury when regeneration is apparent.

This is exactly what we try to avoid.

Therapy

Physical therapy can be very beneficial for those who are experiencing facial paralysis and still have their facial nerve intact. A physical therapist versed in facial rehabilitation can design a program specific to one’s needs.

Therapy may consist of massaging one’s face and neck daily for 10-15 minutes and/or stretching exercises of the affected side to relieve muscles involved in synkinesis. Patients can be taught to recognize tension and feel the difference between tension and relaxation in general and more specifically in the facial musculature because synkinesis can increase muscle tone which can be exacerbated by stress.

Specific facial exercises are taught to coordinate both the halves of the face. Basic exercises such as forehead wrinkle, eye closure, smile, snarl and lip pucker are performed with variations in amplitude and speed. We can teach exercises for one side of the face to control separate movements, relaxation of the lower jaw, exercises of the mouth (smiling, pouting) and the eye with simultaneous inhibition of synkinesis (slow, small movements and counteraction). A mirror is used for feedback because initially proprioception (the ability to know and feel what our muscles are doing) is limited. We need to learn to self-monitor our face during recovery.

In therapy we progress you to more advanced exercises such as filling the cheeks with varying amounts of air and eating and drinking exercises while keeping the affected eye open (small movements).

Exercises can be performed to increase a patient’s awareness of lip movements and the position of the mouth for various sounds. This is where a speech

therapist may also be helpful.

Last, expression exercises may be taught.

Expression exercises can be taught in two ways; working from the use of certain muscles toward an expression, or working from an expression as a starting point for a movement. For example, one may be asked to raise the forehead or to perform an expression depicting amazement. Other expressions may be evoked by asking one to open their eyes wide (surprise), lift upper lip (disgust) or tighten the lips (anger).

The results of performing physical therapy are long lasting and provide statistically significant improvements. Thus, facial rehabilitation should be offered to people with chronic facial dysfunction to optimize their facial movements, social functioning and their facial expression of emotions.

Consult with your physician to find a therapist who understands neuromuscular facial rehabilitation. After all being able to express oneself through their face will only increase confidence, restore function and help people feel better about themselves.

Amy Downing is a physical therapist at Element Physical Therapy in Missoula. For more information contact the American Physical Therapy Association, www.apta.org.

We are the Balance Experts.

Call Us Today 406.543.7860 2455 Dixon Ave Ste A • Missoula elementpt.com • balanceexpertsmt.com

New Look, Same Expertise!

September/October 2015 ~ living well

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Prioritize your mental health

I

t’s a difficult decision sometimes, to seek help when we are troubled. And even more difficult is the act of walking into a complete stranger’s office, opening our hearts and pouring them all out there on the table. There are many reasons people seek help from a counselor: family problems, substance abuse, sexuality, or even just a mental bump in the emotional journey through life. Whatever the reason, it’s a step in the right direction of putting our best faces forward.

First impressions last forever. This age-old saying rings true in so many situations. Many of us feel this impression has to do with our physical appearance. Isn’t it hard to look 26

living well ~ September/October 2015

good without feeling good? In 2013, the National Institute of Mental Health reported that approximately one quarter of the population suffers from one or more emotional problems. That’s one in four people. So why haven’t we made more of an effort to prioritize the health of our inner selves and allow that healthy feeling to ripple out?

In an effort to be more optimistic, let’s start with how far we’ve come with our mental health wellness. Several centuries ago, stigmatized theories abounded concerning our mental health. Some cultures thought that any sort of “imbalance” with our psyche was caused by demonic possession, magical beings, or loss of status or money. For

many, it was simply easier to institutionalize someone, often in horrific conditions, than treat him or her as a sentient being in need of guidance, advice and ways to connect, or reconnect with the inner self.

Fast forward to 2015, we have made amazing breakthroughs with emotional therapy which helps manage emotions and behaviors. It has even allowed people to manage their mental health without medication. I know, I know, pessimist again, but of those one in four people, less than half, are actively seeking treatment to help them care for their inner self. Can you imagine if that were the same for people who had diabetes or cancer? There would be a complete uproar. Instead, we turn a blind eye and ignore an epidemic that could so easily be addressed with a little mental housekeeping.

Mental health counseling is one such way that we can begin to tackle the issues that have gotten us in the way of ourselves. Whether you seek advice and wisdom for past issues, trauma, fear, sadness, relationships, family, stressors at work, or even just some “maintenance” counseling, the proverbial “therapist” may be just what the doctor ordered.

So when we’re looking in the mirror getting ready for work or school, brushing our hair and teeth, we need to make sure to use our mental brush too. We all can use a little scrubbing on our inner self to make sure that we’re putting our best face forward.

September/October 2015 ~ living well

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Steps for aging

By Maria Redfern, PT

O

ur bodies begin to show signs of aging beginning in our 30’s. The changes are slow and gradual and can sneak up on you. Here are some of the changes and what you can do to age well.

With age the blood vessels and arteries become stiffer and the heart becomes less elastic. This causes your heart to work harder to drive blood to the various organs of the body. This can lead to high blood pressure and other heart-related problems. The amount of muscle mass and strength also begins to decrease due to a decline of growth hormones and testosterone. Muscles and ligaments also begin to become stiff and tight. Estrogen, a hormone in women which protects bone, decreases sharply when women reach menopause. Bones begin to lose their density making them weaker and increasing the risk for fracture. Approximately one in two women over the age of 50 will break a bone due to osteoporosis.

Body weight gain begins to creep up in midlife. We begin to put on an extra 2-3 pounds a year.

Our muscle mass is decreasing and body fat takes it’s place. This extra “few pounds” contributes to a rise in blood sugar levels and the alarming occurrence of Type 2 diabetes in adults. It also increases the levels of HDL, “bad cholesterol”, resulting in heart disease related issues. Our nervous system also changes. Reflexes become slower and you may not feel as coordinated as

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you used to be. Loss of balance occurs more frequently.

Wow, this all seems so bleak. With each birthday all these changes keep marching on. Is there a way to slow the march and bring back our youth? Yes, I think so.

By simply beginning to walk, many of these agerelated changes can be reduced.

Getting Started

Walking is easy to get started. The only equipment required is a good pair of walking shoes, comfortable clothing and the desire to feel better. If you have been sedentary for a long time or have serious health issues, talk with your doctor before you embark on a walking exercise program.

Try to walk five days a week.

The Center for Disease Control and Prevention recommends 150 minutes of moderately intense activity per week. Begin with 15 minutes at a comfortable pace. Do five minutes slower pace warm-up, five minutes brisk pace, and five

well minutes slower pace to cool down. As you become more fit, pick up the pace so you are walking briskly for the majority of the walk. You will be breathing harder, but still should be able to carry on a conversation. Each week add two or three minutes to your walking time until you have built up to five minutes of warm-up, 30 minutes brisk pace, and five minutes of cool down.

Tips for Success

Walk at the same time of day so it becomes a regular part of your day and you develop a habit. Newer studies have found that it takes 66 days to form a new habit, so hang in there. It’s a process. You don’t have to be perfect.

If you get off track, develop a strategy for getting back to walking as quickly as possible.

Walk in pleasant surroundings. If you walk on a treadmill at home, watch TV or listen to music. If you walk outside, find places that are relaxing and enjoyable…trails, quiet neighborhoods.

Make it social. Consider walking with a friend or join a walking group. Socializing and walking are a winning combination for lifting spirits and feeling better.

Stay motivated. There are many devices to help you keep track of steps and mileage. A pedometer or electronic fitness tracker are fun to use. Many smart phones have fitness apps which keep track of mileage and steps for you.

Have a goal.

Sitting and being immobile can be hazardous to your health and shorten your life. To age well, take steps out the door. Walking is a powerful way to slow the march of time.

Get up and keep moving.

Get There.

Maria Redfern is a physical therapist at Valley Physical Therapy in Missoula.

Missoula | 406.721.3096 | 1001 SW Higgins Ste 205 WoMen’s Club | 406.327.0706 | 2105 Bow Street stevensville | 406.777.3523 | 3802 Eastside Highway

ValleyPhysicalTherapyMT.com September/October 2015 ~ living well

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Acupuncture

Acupuncture Clinic of Missoula Safe, gentle and effective healthcare.

Rebecca Sobin,Anna D.A.O.M., L.Ac.L.Ac., Dallas Seaber, L.Ac., Paige Crain, Tonia Janzen, M.Ac.O.M., L.Ac. and Tonia Janzen, L.Ac. Dallas Seaber, M.Ac.O.M., L.Ac.

3031 S Russell St • 728-1600 acupunctureclinicofmissoula.com

Alzheimer’s Care

Assisted Living

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Call for a personal tour.

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Assisted Living

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Assisted Living If you need some help with your daily routine, we are here for you. Pop by or call and see how we can help make Your Life Just a Little Easier Here.

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living well ~ September/October 2015

610 N California St, Missoula, Mt 59802 (406) 721-1646

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September/October 2015 ~ living well

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Hearing loss is preventable

By Brandpoint

delay the onset of hearing loss.

earing loss is common, but the perception that hearing loss is only caused by aging is incorrect.

More than 36 million Americans have hearing loss. It is considered the third most chronic condition among the elderly, according to the Hearing Loss Association of America. Changing lifestyle habits and treating a variety of health conditions can help prevent hearing loss.

Here are seven healthy habits that may help prevent or

Noise

H

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Noise-induced hearing loss is the most common yet preventable cause of hearing loss. Exposure to dangerous levels of noise can occur at work, home and in many recreational activities. Wear ear plugs or muffs when operating loud equipment (i.e. lawn mowers, power saws, leaf blower, etc.) or when using firearms. Buy quieter products (compare dB ratings advertised on the products – the smaller the better).

Your plan: protect her from, well, everything

Your plan: PacificSource

PacificSource is your plan for covering your family.

As an independent, not-for-profit health plan, we strongly believe in providing the best coverage possible for our individual health plans.

That’s why we work hard to provide the finest combination of coverage, service, doctors and price you can find. Because life’s greatest plans deserve a great health plan to match.

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September/October 2015 ~ living well

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iPod/MP3 players

Listening to MP3 players at dangerous levels can cause permanent hearing loss.

You can download apps to ensure noise exposure through your iPod does not exceed dangerous decibel levels. “Volume Limit” is a switch in the “settings” section of your iPhone or iPod to make sure that your hearing is protected. This allows you to set a maximum level for the volume output of the media player and even put a four-digit code on it to keep it fixed.

Diabetes

The National Institute of Health (NIH) found hearing loss is twice as common in people with diabetes. Furthermore, of the 79 million adults with pre-diabetes, the rate of hearing loss is 30 percent higher than in those with normal blood sugar levels.

Moderate weight loss, eating healthy and exercise can delay or prevent Type 2 diabetes among adults at-risk for diabetes.

Smoking

Smoking is a risk factor for hearing loss. Smokers are nearly 70 percent more likely than nonsmokers to suffer hearing loss.

Exposure to secondhand tobacco smoke almost doubles the risk of 34

living well ~ September/October 2015

hearing loss among adolescents. Studies show that smoking, age and noise exposure together increase the risk for hearing loss more than each of these factors alone.

Cardiovascular disease

Not only does exercise help to prevent Type 2 diabetes, but cardiovascular health and hearing health appear to be connected.

Growing evidence suggests a link between hearing loss and poor cardiovascular health.

Earwax (cerumen)

Don’t swab your ear canals. Cerumen cleans and lubricates the skin of the ear canal and provides protection from bacteria, fungi, insects and water.

Attempting to remove cerumen or cleaning the ear canal with a cotton swab tends to push earwax deeper into the ear canal.

Excess or impacted cerumen can press against the eardrum and/or occlude the external auditory canal resulting in hearing loss.

See an audiologist for a base line hearing test

Susceptibility to hearing loss is often undiagnosed and unrecognized. If hearing devices are recommended, wear them.

“There is no reason to miss out on what could be the most important conversation in your life. Stay connected with your friends and family,” says Dr. Kathy Landau Goodman, chair of the Audiology Awareness Campaign. Goodman says to remember every ear is unique, every brain deciphers sound differently, so there is no one size that fits all. What works for a friend may not work for you. It is important to work with a doctor of audiology to help you find the right solution for your individual hearing needs.

The Audiology Awareness Campaign, a non-profit foundation aimed at providing the public with information on hearing loss, is sponsoring the eighth annual “Listen Up America” week, National Hearing Screening week, Oct. 12-16, 2015, where audiologists will offer free hearing screenings nationwide. Call 888-833-EARS (3277) or visit www. audiologyawareness.com, to find an audiologist in your area.

Heal at your own pace.

If it weren’t for the care and expertise that I received from the therapists at The Village Health Care, I would not be walking today!

Pat Swanson

My occupational and physical therapists were instrumental in getting me back on my feet after my hip surgery. I can’t say enough good things about them.

Celia Linsted

Do you need a post-hospital rehabilitation stay?

One of our communities can help.

Surgeries or illness often require more recovery time than is anticipated.

We offer post-hospital supportive services nearby for your recovery.

• Evolutions Therapeutic Recovery Center

• Transitions Sub-Acute Care

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• Physical, Occupational, and Speech Therapy

• Physical, Occupational, and Speech Therapy

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Call for a tour today!

September/October 2015 ~ living well

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“WHEN OUR PLANS CHANGED,

COMMUNITY

D E L I V E R E D.”

NOT ONLY DID COMMUNITY WELCOME THEIR PLANS, THEY HELPED WELCOME THEIR KIDS HOME. WHEN COLIN & LEXIE HICKEY GOT TO COMMUNITY, WE EMBRACED THEIR DESIRE FOR A HOME BIRTH. THEIR TEAM WAS WELCOMED AS A PART OF COMMUNITY. WE MADE SURE THAT THEIR NEEDS WERE MET. HERE AT COMMUNITY, WE BELIEVE THE PARENTS’ CHOICES SHOULD ALWAYS BE HEARD. PLANS MAY CHANGE, BUT AT COMMUNITY, COMPASSIONATE CARE IS ALWAYS OUR PRIORITY.

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living well ~ September/October 2015