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A GAZETTE AND GAZETTE-STAR PUBLICATION

A publication of The Gazette and Gazette-Star | Spring 2015 Editor Designer Contributing Writers

Prepress Corporate Advertising Director Advertising Manager Creative Director Creative Services Director

Tiffany Arnold Anna Joyce Karen Finucan Clarkson Scott Harris Kate McDermott Matt Getz Dennis Wilston Chauka Reid Anna Joyce Ellen Pankake

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Content is for informational purposes only and should not be construed as medical advice, nor as a substitute for seeing your own medical professional(s).

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About two-thirds of those over 60 who have high blood pressure have isolated systolic hypertension, in which only the top number, the systolic pressure, is high. –NIH Senior Health

Create a Health

FAMILY TREE T

1/3

of all hip fractures occur in men.

vital screening tests and treatments before any disease is evident. That’s why it’s so important to discuss your family’s health history.

In the future, tests may make it possible to identify and possibly fix the gene glitches that raise a person’s risk for diseases. The National

Institutes of Health is now working on technology that will help doctors quickly create a health plan based on a person’s unique genetic blueprint. In the meantime, family health history is a no-cost way to help doctors personalize your health care.

–NIH News in Health

Down to the Bone

A

s we get older, we begin to lose more bone than we build.

The tiny holes within bones get bigger, and the solid outer layer becomes thinner. In other words, our bones get less dense. Hard bones turn spongy, and spongy bones turn spongier. If this loss of bone density goes too far, it’s called osteoporosis.

More than 10 million people nationwide are esti-

4 Gazette Health | Spring 2015

mated to have osteoporosis.

It’s normal for bones to break in bad accidents. But if your bones are dense enough, they should be able to stand up to most falls. Bones weakened by osteoporosis, though, are more likely to break.

“It’s just like any other engineering material,” said Dr. Joan McGowan, an expert on osteoporosis at the National Institutes of Health. If you fall and slam your weight onto

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Chocolate for the Win W Researchers have been able to reverse age-related memory loss by boosting activity in a region a part of the brain known as the dentate gyrus, according to a study published in Nature Neuroscience.

What led to the boost in activity? A specially formulated drink packed with flavanols, a group of antioxidant compounds found in cocoa beans—yet another reason to be a chocolate lover.

Battling Parkinson’s

a fragile bone, “it reaches a point where the structures aren’t adequate to support the weight you’re putting on them.” If the bone breaks, it’s a major hint that an older person has osteoporosis.

–NIH News in Health

Scientists have identified more than two dozen genetic risk factors involved in Parkinson’s disease, including six that had not been previously reported. They hope such research will one day lead to successful therapies. Parkinson’s disease belongs to a group of motor system disorders, which are the result of the loss of dopamine-producing brain cells.

–National Institutes of Health

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he U.S. Surgeon General has an online tool, My Family Health Portrait at familyhistory.hhs.gov, that can help you gather and record your family health history. The tool lets you save family information to your own computer and share health histories with other family members, and is available in English, Spanish, Italian and Portuguese.

Before you begin using this tool, talk with family members to gather details about their health histories.

Conditions such as cancer, heart disease and diabetes often run in families. Tracing the illnesses of your parents, grandparents and other blood relatives can help your health care practitioner predict your risk for specific disorders. It could suggest

senior FITNESS

Runners live an average of three years longer than non-runners.

–Journal of the American College of Cardiology

Runners chase down life one step at a time ime

M

STORY BY SCOTT HARRIS PHOTOS BY DAN GROSS

aybe there’s no sport as literal in its metaphors as running.

Like life, becoming a runner is not a sprint, but a marathon. And for seasoned athletes as well as those who have never laced a pair of sneakers, it happens one step at a time.

For Deon Merene, 55, a resident of Bowie, completing those 26 marathon miles was the culmination of a lifetime of work. “I had wanted to do a marathon for many years,” she said. “I started running in high school … .

Running a marathon was on my bucket list.”

Running takes a commitment, especially for first-timers and people older than 50.

But competition can be a strong motivator.

According to Running USA, a national nonprofit, more than 19 million people finished a running event in 2013. Running has been shown to prevent obesity and a host of diseases, as well as build strength and elevate mood.

And there are all sorts of race lengths, from the humble 5K all the way up to marathons and ultramarathons, which generally are defined as any run longer than the marathon’s 26 miles. And sometimes being older can actually be helpful, as people find they have more time to spend training. In preparation for her first marathon, Merene ran 40 miles per week, a workload that can be just as taxing mentally as it is physically.

“The kids were a little older and it was easier to commit,” she said. “It gets to be a mental thing. Can I really stick to this thing?”

Merene has completed a handful of marathons. Nick Panebianco, 51, has by his own estimate completed 67. And that doesn’t take ultramarathons into account.

The Beltsville systems engineer once ran 40 miles, which took him about 12 hours.

“It’s hard at first, but it does get easier.

It does feed on itself,” Panebianco said. aid. “I run myself to exhaustion. But I still can’t wait to get back out. I just love to run.” un.”

INJURY RISKS GO UP FOR OLDER PEOPLE, LE,

but perhaps not as much as one mightt think. Mark Peterson, M.D., an n orthopedic surgeon who operates att Adventist HealthCare Shady Grovee Medical Center in Rockville, said the chances of injury—and the path to staying healthy—are generally similar for all runners, regardless of age or experiencee level.

“A lot of it is based on genetics,” Peterson eterson said. “Injuries are usually a matter of overdoing it, whether you’re older or younger ounger … . A 50-year-old may need six months, and a 20-year-old might need six weeks, but either way the risk is there when n you’re getting up to speed.”

Peterson, who identified stress fractures tures in the lower body as the most common injuries for runners, said older people should uld visit their primary care doctor and get theirr hearts checked out before beginning any rigorous igorous program. And while many products, such as different shoes or nutritional supplements, ements, claim to help improve health or strength trength in athletes, nothing has been scientifically tifically proven to prevent injuries or optimize fitness, Peterson said, though he did acknowledge wledge anecdotally hearing from patients that hat certain items can be helpful. | continued ed on 14

“Injuries are usually a matter of OVERDOING IT, whether you’re older or younger.”

Deon Merene, 55, trains along Annapolis Road in Bowie earlier this month.

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Spring 2015 | Gazette Health 5

senior FITNESS

Just 2.5 hours of swimming a week reduces the risk of chronic illness.

Swim for Your Life!

S

BY SHARON NAYLOR

6 Gazette Health | Spring 2015

At a brisk pace, swimmers can burn the same number of calories as a brisk walk, a medium-level intensity aerobics class or a slow run. provides a great cardiovascular workout, provided you’re swimming at a good pace and not just gliding or floating. l Therapeutic effects. If you’ve had a back or other bodily injury, your doctor might suggest swimming as a low-impact workout to help keep you in shape and help rehabilitate your injured body parts. l Stress release. Fitness creates calming hormones and is an important element of a wellness plan. When you’re swimming, you can forget about work, home and money pressures in your daily life.

You may have heard that swimming doesn’t burn many calories compared with running, biking and other exercises. But at a brisk pace, you can often burn the same number of calories as with a brisk walk, a medium-level

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intensity aerobics class or a slow run. Everything you do for your health adds up. You’ll find online calculators projecting how many calories you’ll burn doing specific kinds of exercises, but keep in mind that calculators aren’t always accurate, and the number of calories you burn depends on your weight and gender and the intensity and duration of your workouts.

In addition to lap swimming, you might also want to give these in-water workouts a try: l Water walking. Moving forward, backward or sideways to work your muscles differently. l Water aerobics. If your knees can’t take on-land aerobics, do these fun exercises in water. Water’s buoyancy makes them easier. And some people claim that if no one can see their feet clearly beneath the water, any lack of coordination isn’t noticeable. l Water toning. If you use floatable hand weights and other in-water fitness equipment, muscles get strengthened and firmed. l Flexibility classes. In-water classes led by a trained and licensed instructor can help you improve your flexibility, important as you age, and also help you heal from injuries. l Water yoga. Relaxing yoga classes are now offered at many pools. l Water running. Flotation devices are used to lift you, and you can make running movements with your legs to get in a run without any jarring impact on your legs, knees, feet, hips or back.

Consider pairing your lap swimming with one or more of the above in-water exercises to keep your interest level high, add variety to your workouts and keep your enthusiasm up. Keep a journal of your lap times and other fitness goals to further motivate you to improve your fitness level.

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wimming has numerous health and fitness benefits, especially as you age. The fun of the backstroke, breaststroke, butterfly and freestyle can add a fresh kick to your exercise regimen.

According to the Centers for Disease Control and Prevention, swimming is the fourth-most popular sports activity in the United States, a top way to get regular aerobic exercise. The CDC reported that just two-and-a-half hours of swimming per week can help decrease the risk of chronic illness.

Swimming laps is a low-impact aerobic exercise that works out your heart and puts minimal stress on joints while building endurance and helping to reduce blood pressure and cholesterol levels. Plus, the resistance of the water (12 percent to 14 percent more resistance than air) forces your body to work harder, toning biceps, triceps and back, chest, stomach and leg muscles for all-over toning.

Exercising in the water has several benefits that exercising on land lacks. When you swim, according to the United States Water Fitness Association, 90 percent of your body is buoyant in the water, “so you are not hitting the floor as hard as you would on land.” No pounding or jarring. Also, your flexibility improves, circulation increases, bone strength stays strong (important for post-menopausal women), and your endurance grows. You get the confidence charge of beating your prior lap times as you continue your swimming regimen. Also, the cooling effect of water disperses your body heat more effectively, which can make exercising more comfortable than on land in a hot gym or workout room.

Additional benefits of swimming include: l Fitness. A swimming regimen can help strengthen your body and, of course,

common CONDITIONS

What is Lewy Body Disease?

Understanding the most misdiagnosed type of dementia

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A

BY KATE MCDERMOTT

ggressive public information campaigns over the last 30 years have been highly successful in raising awareness of Alzheimer’s disease, with many Americans now believing the illness is synonymous with what used to be simply known as dementia. Yet neurologists are quick to point out that dementia, like cancer, can take many forms and have many different origins.

In particular, some families of patients who have previously been diagnosed with Alzheimer’s or Parkinson’s diseases are learning that another form of dementia may be the cause of their loved ones’ cognitive decline: Lewy body dementia.

According to the Lewy Body Dementia Association, LBD is the most misdiagnosed form of dementia, affecting nearly 1.4 million Americans. Named after scientist Friedrich H. Lewy who discovered abnormal protein deposits that disrupt the brain’s functioning, LBD remains a difficult condition to diagnose because its symptoms—at least initially—can closely mirror those of Alzheimer’s and Parkinson’s diseases.

“UNFORTUNATELY, NOT MANY CLINICIANS ARE ABLE TO

diagnose this disease because its presentation is subtle,” said Anne E. A. Constantino, M.D., a practicing neurologist with Comprehensive Neurology Services of Silver Spring. Symptoms such as a slowing of cognitive abilities, difficulty assessing spatial relationships and fluctuations in alertness can be present in all three | continued on 13 GAZETTE.NET

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PHOTO BY TRACEY BROWN PHOTOGRAPHY, COURTESY OF WASHINGTON ADVENTIST HOSPITAL

Due to the quick action of his wife, Iris Wilson, George Wilson promptly got the treatment he needed to recover from a stroke two years ago.

common CONDITIONS

Stroke causes 1 out of every 19 deaths in the United States. –CDC

During a Stroke,

‘Minutes are Precious’

B

BY KATE MCDERMOTT

y the time you finish reading this article, nine people in America will have had a stroke and at least one of them will die as a result.

The American Heart Association reports that strokes will kill more than 129,000 people this year, making burst or blocked blood vessels in the brain the fourth leading cause of death in the United States.

Although stroke death rates have dropped nearly 36 percent over the last decade, the sobering fact remains that almost 800,000 people will have a stroke before the year is over and many of those who survive will be left disabled by the interrupted blood supply to their brains.

Given those statistics, George Wilson of Hyattsville knows he’s incredibly lucky to be alive following his stroke in December 2012.

Thanks to the quick decision by his wife, Iris Wilson, to call 911 immediately after he collapsed, he received essential medical treatment within the critical first few hours after his stroke.

That treatment not only saved his life, but also markedly reduced lasting damage to his brain. Today, George Wilson has no significant physical challenges other than some slight speech impairment that he continues to overcome through therapy.

Amir Zangiabadi, M.D., a neurologist at Washington Adventist Hospital in Takoma Park, was waiting for George Wilson when he arrived in the emergency room. Zangiabadi immediately evaluated Wilson’s condition

and ordered a CT scan to determine the location and type of blood vessel injury in his brain.

The scan revealed Wilson had a blocked vessel, so Zangiabadi administered a drug known as recombinant tissue plasminogen activator (tPA) to try to break up the clot that was causing the stroke. “The use of tPA has become more popular over the last 10 years, but timing is everything,” Zangiabadi explained. “It must be administered within four to four and half hours following stroke symptoms’ onset, and sooner for diabetics and those who have suffered stroke before.”

Zangiabadi also cautioned that tPA is not appropriate for everyone who has a stroke. “There is only a 40 percent to 45 percent chance the medicine will work,” he said, noting that patients whose strokes are due to burst blood vessels (hemorrhagic stroke) are not candidates for tPA. Even those whose CT scans reveal blockages are not guaranteed its use either, since factors such as the location of the clot and its thickness play significant roles in how effective tPA will be.

The best thing anyone can do to help a stroke victim is to act FAST (see box on page 12). “If you suspect someoneishavingastroke,youshould not try to transport them to the hospital yourself,”Zangiabadisaid.“Call 911 immediately because if they come by ambulance, they will be seen right away [in the ER] since the paramedics will call us in advance to let us know the situation.” | continued on 12

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commonCONDITIONS

While bone spurs can be found throughout the body, they’re most common in the knees.

Battling

BONE SPURS

Causes and consequences of the body’s response to wear and tear

T

BY KAREN FINUCAN CLARKSON

hey are known to be painful and to interfere with the movement of a joint.

But bone spurs—common in older adults—often are benign. If you are over 60, chances are good that you have a bone spur, though you may not yet realize it, according to local orthopedic surgeons.

A bone spur—the creation of extra bone—is the result of inflammation, stress, pressure or damage.

“It’s the body’s response to wear and tear on the joints,” said Loiy Mustafa, M.D., an orthopedic surgeon at Capital Orthopaedic Specialists, P.A. with privileges at Doctors Community Hospital in Lanham. Bone spurs are found in joints as well as in places where tendons and ligaments attach to bone. In seniors, a bone spur most often occurs when there is degeneration of a joint due to osteoarthritis, Mustafa said.

“What happens is that over time the cartilage breaks down in a joint, and the body deals with that by growing bone in order to provide more stability and surface area,” said Sridhar M. Durbhakula, M.D., an orthopedic surgeon at OrthoBethesda in Bethesda, and co-medical director of the Joint Center at Adventist HealthCare Shady Grove Medical Center.

OSTEOARTHRITIS MAY ACCOUNT FOR THE GREATEST

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numberofbonespurs,butthereareotherfactorsthat contribute to their creation. “Occasionally people get bone spurs from running,” said Anthony S. Unger, M.D., an orthopedic surgeon at Washington Orthopaedics & Sports Medicine in Chevy Chase.

“They also result from pressure, like when a shoe rubs on the side of a foot,” said Unger, who has privileges at Suburban Hospital in Bethesda. Bone spurs have been associated with plantar fasciitis, a condition in which a ligament on the bottom of the foot becomes stressed and inflamed, and Achilles tendonitis, where the tendon in the back of the heel becomes irritated, according to the American Academy of Orthopaedic Surgeons.

If you’re over 60, chances are good you have a bone spur, although you might not realize it.

While bone spurs are found throughout the body—in the feet, hips, spine, neck, shoulder and hands—they are most common in the knees, said Durbhakula. The extra bone can make it painful to move the knee and can interfere with a joint’s range of motion. “The knee is where bone spurs commonly break off and become loose bodies,” he said. As loose bodies float in the knee, they can cause intermittent locking or a sensation that something is preventing the joint from moving properly.

THE GROWTH OF EXTRA BONE IS AN UNCONTROLLABLE

natural response that can have unintended consequences. In the shoulder, for example, bone spurs can pinch rotator cuff tendons. Pain, stiffness and reduced range of motion can occur, said Mustafa, noting that persistent impingement of rotator cuff tendons can lead to tears, which exacerbate the condition.

In the spine, bone spurs can pinch the spinal cord or its nerve roots. “When a bone spur presses on the nerves, which extend into the body, you can get pain running up and down your arms and legs,” said Unger. Weakness or numbness in the extremities also may result.

In seniors, a bone spur most often occurs when there is DEGENERATION OF A JOINT due to osteoarthritis.

An X-ray is most commonly used to diagnose a bone spur, according to Durbhakula. “Because it is bone and calcified, it is readily seen on an X-ray,” he said. Treatment may vary by the location of the bone spur, although there are some approaches that are generally applicable.

“We usually start with conservative measures to reduce pain, such as oral anti-inflammatory medications or cortisone injections into the joint,” said Mustafa. Physical therapy can increase a joint’s range of motion. “When a joint becomes stiff or hard to move, the soft tissue structures around it become tight. Stretching and strengthening exercises can be helpful.” Improved functioning of the joint along with a reduction in pain may delay or eliminate the need for surgery, he said.

According to Durbhakula, other nonsurgical treatments include a supplement known as TripleFlex, which contributes to joint comfort, mobility and flexibility, and Synvisc injections, which supplement fluid in the knee and help lubricate and cushion the joint.

“Synvisc gives the knee more ‘hydraulic suspension’ so that bones are not rubbing against each other as much,” he said. Lifestyle changes, including weight loss and stress reduction, also can be beneficial, relieving pressure and tension on joints and muscles.

“When conservative measures are not successful and a patient’s quality of life is adversely affected, then surgical intervention may be indicated,” said Mustafa. “In the hip and knee, we can do joint replacement surgery. In the spine, we can decompress the pinched nerve. It all depends on the location of the bone spur.”

Early diagnosis of a bone spur is critical to prevent additional damage to a joint and maintaining or regaining one’s quality of life, the orthopedic surgeons said. “The best treatment takes into account many factors and is the one that the physician and patient come up with together,” said Mustafa.

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HOW TO IDENTIFY A STROKE If you notice symptoms such as weakness in extremities, numbness on one side of the body, excruciating headache, sudden dimness or loss of sight or inability to speak, the National Stroke Association says you need to act FAST by asking these questions:

F A S T

FACE – Does the smile droop on one side?

ARMS – Is the person unable to raise both arms?

SPEECH – Is the speech slurred?

TIME – If the answer to any of these is yes, call 911 immediately.

STROKE, from 9 Zangiabadi said that while waiting for the ambulance to arrive, those tending to a stroke victim should help the person lie down. Do not offer medicine, food or liquid, since the person may aspirate given their inability to swallow correctly.

Do not give aspirin since it might cause additional bleeding in those whose strokes are caused by a burst blood vessel.

Zangiabadi said the odds of surviving a stroke and avoiding permanent disability are improving thanks to advances in both public awareness of what to do if stroke is suspected, as well as medical interventions. Aggressive public education campaigns about the risk factors for stroke are also making a difference. He encouraged people to follow the Heart Association’s “Life’s Simple 7” steps to reduce the risk of heart disease and stroke: • Manage your blood pressure • Control cholesterol • Reduce blood sugar • Lose weight • Stop smoking • Eat better • Get active But he also added an eighth step: Reduce alcohol use since some studies indicate that having more than two drinks per day may increase stroke risk by as much as 50 percent.

Although only a small portion of the population is at a higher risk for stroke because of specific genetic diseases, many, many Americans have a genetic tendency for risk factors such as high cholesterol or high blood pressure that put them at higher risk of stroke.

Wilson is one of those people. A

vegetarian for most of his life, he exercised regularly and was in very good health prior to his stroke. But a genetic predisposition for high blood pressure was a risk factor he couldn’t avoid. He is also AfricanAmerican, which almost doubles his risk of stroke as compared to whites.

Atrial fibrillation (irregular heartbeat) also increases the risk of stroke, especially in those over 75, because it can produce what Zangiabadi called “micro-clots” that, although small, can do significant damage. These tiny clots form in the upper chambers of the heart and can travel throughout the body, including to the brain where they can block blood vessels and cause stroke.

Zangiabadi encourages all older patients to maintain a regular relationship with their health care providers—and he encourages those providers to communicate with each other as to the best course of treatment for their patients.

“I especially urge dentists to speak to the patient’s primary care doctor at least three days before performing any treatment,” Zangiabadi said.

He has seen several patients who, under the advice of their dentists, stopped taking their blood pressure and cholesterol medications prior to their dental procedures and subsequently suffered strokes.

Today, Wilson is working hard to return to the radio talk show he has hosted on Sirius XM Radio for many years. And although Iris Wilson doesn’t take to the airwaves like her husband, she is making sure that she broadcasts to anyone who will listen the importance of acting quickly when dealing with stroke.

“Time counts,” she said. “Minutes are precious.”

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• Psychosocial support for patients and families, as well as for the nursing home staff and care givers.

• Spiritual support, as requested, for patients and families.

• Trained volunteers who provide companionship, assistance, and support.

• Bereavement counseling and support for family members and significant others throughout the patient’s illness and for a minimum of 13 months (more, if needed) following the death.

• Consultation and emergency care 24 hours a day, every day of the year.

• Coordination of medical equipment and medications related to the terminal illness for comfort and symptom management.

• Physical, occupational, speech, music, and other therapies as indicated in the plan of care.

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LBD, from 7 diseases, but often what tips practitioners off to a LBD diagnosis is the presence of hallucinations or acting out during sleep.

“If a patient presents with Parkinsonian symptoms and is treated with medications for Parkinson’s disease, they have a lower threshold for developing hallucinations,” Constantino explained. “So if they begin to experience hallucinations, this suggests that it is LBD more than Parkinson’s disease.”

Another clue to a diagnosis of LBD versus Alzheimer’s or Parkinson’s disease is the order in which symptoms begin to present themselves.

“Not everyone who has Parkinson’s disease will get dementia,” said Jim Bicksel, M.D., medical director of Inova Hospital’s Memory Center in Falls Church, Va. “So if movement problems (a slow gait, shuffling of feet, etc.) present themselves first, it could be Parkinson’s. But if dementia occurs first and movement problems ensue, we tend to suspect LBD.” SOME PATIENTS WHO ARE DIAGNOSED

with LBD may live with the condition for some time, and with proper

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WANT TO KNOW MORE? The Lewy Body Dementia Association (lbda.org) offers numerous educational materials as well as information on clinical trials and support forums for patients and families who suffer from the complexities of LBD.

treatment, can manage to cope effectively with the symptoms, even the hallucinations, according to Bicksel.

“Sometimes they simply learn to ignore them,” he said.

Unfortunately, however, LBD is a progressive disorder with no known cure, so over time, the symptoms will get worse.

Doctors often treat it with many of the same medications used for Alzheimer’s and Parkinson’s diseases—including drugs designed to increase the level of chemical messengers in the brain—known under brand names such as Exelon and Aricept. These may help improve memory, but Bicksel pointed out that unlike Alzheimer’s patients, patients with LBD often do not have shortterm memory issues. “If you ask them what month it is, it may take them a long time | continued on 14

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Spring 2015 | Gazette Health 13

LBD, from 13 to respond, but they often are able to give the right answer,” he said.

Carbidopa-levodopa medications such as Sinemet, which are often used to treat Parkinsonian movement symptoms, may also provide some relief. And although anti-psychotic medications, known to many under brand names such as Seroquel or Zyprexa, can help some patients reduce their delusions, other LBD patients may have a severe sensitivity to them that can actually trigger pronounced hallucinations.

AGE AND GENDER SEEM TO PLAY A

significant role in the onset of LBD. Most cases occur after age 60, although some cases have been reported much earlier. A 15-year study funded by the National Institute on Aging published in 2013 revealed that the incidence of LBD was twice as common in men as in women.

There are currently no tests to definitively diagnose LBD. Only

“Anytime you see movement symptoms, things like shuffling of the feet, muscle rigidity, a masked face, et cetera,

YOU SHOULD REQUEST A REFERRAL TO A NEUROLOGIST.” an autopsy of the brain after death can confirm with certainty that a person had the disease. But thanks to patients and families who are willing to donate suspected LBD brains to science after death, Bicksel said researchers are learning that Lewy body proteins are often found in the deep part of the brain that controls movement and that they affect thinking by interfering with the brain’s ability to send signals to different areas involved in cognition.

Armed with this knowledge, researchers can now attempt to answer questions such as how and why the Lewy body proteins deposit in those areas.

Even though we know LBD is the

second most common cause of progressive dementia after Alzheimer’s disease, Constantino said that there is still much to be learned about it.

“There are several papers that suggest a genetic predisposition, but this has never been conclusive,” she said. “Environmental toxins have also been implicated.”

UNTIL A CURE IS FOUND, NEUROLOGISTS

encourage LBD patients to follow many of the same recommendations given to Alzheimer’s and Parkinson’s disease patients.

“It is important to continue to engage in mental, physical and social activities,” Bicksel stressed.

Because of its similarities to

Alzheimer’s and Parkinson’s diseases, families who suspect their loved ones may have LBD should share their concerns with their primary care physicians and request a referral for evaluation by a neurologist who is familiar with the disorder and the subtleties that distinguish it from Alzheimer’s and Parkinson’s diseases.

“Anytime you see movement symptoms, things like the shuffling of feet, muscle rigidity, a masked face, et cetera, you should request referral to a neurologist,” Bicksel said.

Despite uncertainty about how the disease forms or why some medications affect some patients more negatively than others, the experts are sure of one thing: Early identification and early management provide the best hope for patients, since the LBD Association reports that a diagnosis by specialists who are very familiar with the disease can be accurate in 90 percent of cases, leading to more targeted and effective treatment.

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any runner, Peterson said, are “listening to your body” and setting a methodical pace. “Increase your activity by 10 percent a week, be it based on speed or distance. Start off small with walking and then slowly increase … . People get injured when they don’t give themselves enough time to train … . Take it easy.”

While the health benefits might be evident, less so might be the social aspect of the pursuit. “When it’s early in the morning and it’s cold outside, it helps to know there’s someone waiting for you,” Merene said.

Running clubs are a common way to foster community, and these groups exist all around the area.

The Prince George’s Running Club (pgrc.org) offers training and memberships to runners of all experience levels. Panebianco himself helps train runners.

In a nutshell, the key for any beginner, Panebianco said, is to start slow.

“Get out there three times a week and do some walking,” he advised. “Try to cover one mile, then two miles, then three miles.

Then you start to walk and jog at the same time. It’s hard at first, but it gets easier.”

from the EXPERTS

Every day, 60,000 people in the U.S. have surgery under general anesthesia.

Waking Up to Anesthesia

W

hen you face surgery, you might have many concerns. One common worry is about going under anesthesia. Will you lose consciousness? How will you feel afterward?

Is it safe?

Every day about 60,000 people nationwide have surgery under general anesthesia. It’s a combination of drugs that’s made surgery more bearable for patients and doctors alike. General anesthesia dampens pain, knocks you unconscious and keeps you from moving during the operation.

“Prior to general anesthesia, the best ideas for killing pain during surgery were biting on a stick or taking a swig of whiskey,” said Dr. Emery Brown, an anesthesiologist at Massachusetts General Hospital in Boston. Things improved more than 150 years ago, when a dentist in Massachusetts publicly demonstrated that the anesthetic drug ether could block pain during surgery. Within just a few months, anesthesia was being used in Australia, Europe and then around the world.

“General anesthesia changed medicine practically overnight,” said Brown. Life-saving procedures such as open-heart surgery, brain surgery or organ transplantation would be impossible without general anesthesia.

PHOTODISC/THINKSTOCK

GENERAL ANESTHESIA AFFECTS YOUR ENTIRE

body. Other types of anesthesia affect specific regions. Local anesthesia—such as a shot of novocaine from the dentist—numbs only a small part of your body for a short period of time. Regional anesthesia numbs a larger area—such as everything below the waist—for a few hours. Most people are awake during operations with local or regional anesthesia. But general anesthesia is used for major surgery and when it’s important that you be unconscious during a procedure.

General anesthesia has three main stages: going under (induction), staying under (maintenance) and recovery (emergence).

The drugs that help you go under are either breathed in as a gas or delivered directly into your bloodstream. Most of these drugs act quickly and disappear rapidly from your system, so they need to be given throughout the surgery.

A specially trained anesthesiologist or nurse anesthetist gives you the proper doses and continuously monitors your vital signs—such as heart rate, body temperature, blood pressure and breathing.

“WHEN PATIENTS ARE GOING UNDER, THEY

experience a series of deficits,” said Dr. Howard Nash, a scientist at the National Institute of Mental Health. “The first is an inability to remember things. A patient may be able to repeat words you say, but can’t recall them after waking up.”

Next, patients lose the ability to respond.

“They won’t squeeze your fingers or give their name when asked,” Nash said. “Finally, they go into deep sedation.”

Although doctors often say that you’ll be asleep during surgery, research has shown that going under anesthesia is nothing like sleep. “Even in the deepest stages of sleep, with prodding and poking we can wake you up,” said Brown. “But that’s not the case with general anesthesia.

General anesthesia looks more like a coma—a reversible coma.” You lose awareness and the ability to feel pain, form memories and move.

Once you’ve become unconscious, the anesthesiologist uses monitors and medications to keep you that way. In rare cases, though, something can go wrong.

About once in every 1,000 to 2,000 surgeries, patients may gain some awareness when they should be unconscious.

They may hear the doctors talking and remember it afterward. Worse yet, they may feel pain but be unable to move or tell the doctors.

“It’s a real problem, although it’s quite rare,” said Dr. Alex Evers, an anesthesiologist at Washington University in St. Louis.

AFTER SURGERY, WHEN ANESTHESIA WEARS

off, you may feel some pain and discomfort.

How quickly you recover will depend on the medications you received and other factors like your age. About 40 percent of elderly patients have lingering confusion and thinking problems for several days after surgery and anesthesia.

Right now, the best cure for these side effects is time. Brown and his colleagues are working to develop drugs to help patients more quickly emerge and recover from general anesthesia.

Anesthesia is generally considered quite safe for most patients. “Anesthetics have gotten much safer over the years in terms of the things we’re most worried about, like the patient dying or having dangerously low blood pressure,” Evers said. By some estimates, the death rate from general anesthesia is about 1 in 250,000 patients. Side effects have become less common and are usually not as serious as they once were.

–NIH News in Health

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