Princeton Magazine's Healthy Living, October 2014 by Witherspoon Media Group

OCTOBER 2014

Dr. Aly Cohen

Practicing Rheumatology and “Holistic” Integrative Medicine Donald Parker, CEO of Carrier Clinic Breast Cancer Reconstruction Structural Integration Identifying Gluten-Free Foods Health Issues and Senior Adults Urgent Care Centers Local Gym Facilities Peloton Cycle®

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PRINCETON MAGAZINE OCTOBER 2014

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october 2014

Healthy Living is a special supplement to Princeton Magazine that embraces a proactive approach to better health!

—Lynn Adams Smith (above) Dr. Aly Cohen, Practicing Rheumatology and “Holistic” Integrative Medicine.

fantastic FEATURES!

8 Dr. Aly Cohen

Tackling Toxins Without Tears

by A nne L e vi n

12 Donald J. Parker

CEO of Carrier Clinic by Tayl or S mi th

18 Structural Integration:

A Holistic Approach to Wellness and Healing

by L i nd a A r ntz e ni us

26 From Reconstruction to Renewal

healthy tidbits!

2 YOGA gear 14 Health Issues and Senior Adults 22 Finding Help at Urgent Care Centers b y Ta y l o r Sm i t h

by El l en G i l b er t

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34 New FDA Rule ID’s Gluten-Free Food 32 Choosing Your Next Local Workout 38 Peloton Cycle

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Tackling Toxins Without Tears Advice from Dr. Aly Cohen

by Anne Levin

“ It’s all about learning to limit exposure and making choices to at least cut down exposure in a way that’s reasonable, and creates awareness and empowerment. It’s about looking forward, not back.” 8

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Dr. Cohen and her sons with Dr. Andrew Weil, January 2014

fter graduating from medical school, Aly Cohen got a job with a rheumatology practice in Monroe Township, New Jersey. It was a conventional office, where patients got about 15 minutes of face time with physicians, who prescribed the usual drugs for their problems with arthritis and immune system disorders. Though Cohen loved the work at first, the “in and out” schedule and the lack of focus on factors like diet and stress began to wear on her. “It went against my grain,” she says. “I tried to make the best of it, but I just didn’t like what I was doing.” A few years and two babies later, Cohen, a 1991 graduate of Princeton Day School, decided to take the leap and open her own practice. By integrating the best of her traditional training and experience with a more holistic approach to medical care, and focusing on women’s health, she has created a model that she continues to refine through constant research and education. Her rheumatology, integrative medicine and environmental health practice in Monroe Township examines alternatives to drugs and surgery and explores the root causes of various ailments common to women. At the same time, Cohen has become something of an expert on the effects of environmental chemical exposure. She has worked extensively with Dr. Andrew Weil, known as a pioneer in the field of integrative medicine. Cohen’s book, “The Smart Human’s Essential Guide to Living Healthy in a Chemical World,” is due for release this fall. In November, Cohen will introduce a pilot program at Princeton High School that integrates environmental health information into the health curriculum. Using some contributions of content from the nationally recognized non-profit Environmental Working Group, where she is the medical liaison, Cohen will talk to

students in Chemistry 1 and Human Health about the effects of the environment on well being. She hopes to extend this curriculum to area private schools and public schools nationally. “I thought about who this kind of information could really affect, and I believe one of the most critical age groups to reach out to is young people who may one day have children of their own,” she says. “Pre-teens and teens are also one of the largest consumers of cosmetics and personal care products. When I walk into Sephora and see pregnant women trying out and buying things that might harm them and their babies, I want to start crying.” Growing up in Yardley, Pa., Cohen knew from early childhood that she wanted to be a doctor. “My father, my brother my cousins – everyone in my family is a doctor,” she says. “It was just natural for me.” After PDS, she earned an undergraduate degree at the University of Pennsylvania and then graduated from the Hahnemann University School of Medicine (now Drexel University College of Medicine). Her internship and residency programs were at Beth Israel Medical Center in New York, and a rheumatology/autoimmune disease fellowship was at Montiefiore/Albert Einstein Hospital in the Bronx. Cohen’s husband, by the way, is a physical medicine and rehabilitation physician. Responding to a comment that her father must be proud of her, Cohen smiles. “He is. He’s a bit old school. And I’m not. But I haven’t abandoned my westernscience-based training,” she says. “What I have done is gotten a whole new set of tools to incorporate into what I already knew.” Cohen’s questioning of the conventional medical profession began in her first job. “I had this feeling that we should have been putting more of a focus onto things like diet, exercise, sleeping habits, and stress management,” she says. “A lot of it is

tackling

toxins

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Dr. Cohen celebrating with friends/classmates, The Omega Threes, Arizona Center for Integrative Medicine, January 2014. All fellows receive a ceremonial walking stick made from the light but strong agave plant when they graduate, to send them on their way.

something you’re not trained for in medical school. Everyone wants patients to get well, but the system is set up in such a way that prevention isn’t part of the equation.” Once she started her own office in 2011, Cohen found herself spending up to an hour with each patient. Instead of directing them only toward medications, she incorporated such options as dietary change, exercise, biofeedback, acupuncture, cognitive therapy, environmental toxin counseling, and smoking cessation into her practice. “My office is set up somewhat like a spa, because that goes along with my philosophy,” she says. “When you walk in, you don’t see ‘The View’ playing on a TV screen. Instead, you see beautiful videos of the Great Barrier Reef and Arizona wildlife and things like that.” Cohen’s preoccupation with environmental chemical exposure started with her beloved golden retriever, Truxton. Only a few years old, he came down with autoimmune hepatitis. “It’s very unusual for dogs, let alone golden retrievers. And it’s ironic that I’m an autoimmune specialist. So I was trying to figure out how he got sick. I looked at his environment, his food, and finally at his rubber ‘Kong’ toy, which he never let out of his mouth,” she says. After doing some research, Cohen found some isolated cases of healthy young humans who worked in rubber plants around the world and had come down with autoimmune hepatitis. “Although there is no way to make a link of direct causation between chemicals in the toy and liver disease, it opened my eyes up to chemical laws and regulations in the U.S—or lack thereof—and set me off on a journey which I still continue on today,” she says. Cohen received a scholarship to work with Dr. Andrew Weil and colleagues at the Center for Integrative Medicine in Tucson, Arizona. By the end of the two-year program, she was sold. Since then, she has been lecturing across the country to physicians and health care workers on endocrine-disrupting chemicals and their effects on human health. While she is frequently shocked at what she discovers, she is also a realist. And she doesn’t want to make people panic. “It takes work to take this information and not scare people,” she says. “It’s all about learning to limit exposure and making choices to at least cut down exposure in a way that’s reasonable, and creates awareness and empowerment. It’s about looking forward, not back.”

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Dr. Cohen presenting at Northwestern University Hospital in Chicago, with photo of her golden retriever, Truxton.

Weil has asked Cohen to co-edit an integrative health text in his academic book series for Oxford University Press. She is also putting together a “Smart Human” video blog on environmental health issues such as creating cleaner drinking water, safer choices of cosmetics and personal care products, “topics that will positively effect our everyday lives,” she says. “The idea is to show viewers, in a non-scary, comfortable way, about easy, practical changes they can make.” Cohen says she tries very hard to practice what she preaches. Though she juggles a busy schedule of practicing medicine, lecturing, writing, editing, and research while raising two young boys, she radiates infectious energy and looks younger than her 41 years. “It’s all coming together in a nice way,” she says. “I really feel strongly about doing good medicine.” H E A LT H Y L I V I N G o c t o b e r 2 0 1 4

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Donald J. Parker, CEO of Carrier Clinic Photography by First Looks

Donald J. Parker is the CEO of Carrier Clinic, located in Belle Mead, NJ, at the foot of the Sourland Mountains. In this rural setting, patients are treated for mental illness, behavioral disorders, and addiction. They also maintain a state-approved special education school called the East Mountain School for students in grades 7 through 12. by Tay lo r S m i t h

arrier Clinic operates a very large campus complete with gymnasiums, modern cafeteria, amphitheater, chapel, picnic areas, as well as facilities used for equine and animal therapy. The Active Seniors Program (for adults ages 60 and older) employs a variety of therapeutic techniques to treat mental illness among seniors. In 2009, Carrier Clinic dedicated 15 acres of land for solar panel installation, the largest ground-mount display for any hospital campus in New Jersey at this time. What is your background and where did you work prior to coming to Carrier Clinic? I have been at Carrier for 20 months after a 27-year career at AtlantiCare Health Services in Atlantic County where I served as President. I was responsible for Mental Health and other Health Services including Urgent Care, Home Care, Hospice, a large Day Care and Preschool Education network, multiple outpatient and specialty Physician practices, a Medically Integrated Health & Fitness Center, and a Federally Qualified Health Center. I came to Carrier as the last stop in my career, for the opportunity to lead New Jersey’s largest and oldest private psychiatric hospital. I am a licensed clinical social worker and felt that I could make a contribution in a field where my initial career started and my heart still belonged. What is the Equine Assisted Psychotherapy Program? Carrier has several clinical staff who are certified in Equine Therapy. We have horses brought to our campus weekly for our therapists to engage in a specially

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designed program that engages patients with the horses in an effort to learn about themselves, other people, and interacting with the world. The results are startling. Even adolescents with severe anti-social or aggressive behavior become calmer and more communicative. It’s not about riding or handling horses, it’s about the interaction and learning between the horse and the adolescent. How does East Mountain School help students in grades 7 through 12 dealing with emotional and psychiatric illness? East Mountain School combines academic, behavioral, and counseling services in a nurturing environment, with small class sizes, a 7 to 1 teaching ratio, and a wide array of school subjects to assist disaffected students in achieving success in school. Our focus is to return the students to their home district with the necessary life and academic skills required for them to graduate and pursue their collegiate or vocational goals. What kind of substance abuse and addiction treatment services does Carrier Clinic offer? Carrier’s Blake Recovery Program offers multiple alternatives for reducing dependency including Psychopharmacology as well as therapeutic strategies, both group and individual. We also blend physical exercise, group sports, swimming, and equine therapy into our programs in order to encourage healthier lifestyles.

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Birdseye view sketch of Carrier Clinic’s new building in Belle Mead, New Jersey, completed by NK Architects.

In what ways is Carrier Clinic specifically serving the young adult population (ages 18-25)? Carrier provides a significant array of services for young adults. In our Psychiatric Hospital, we generally have about one-third of our patients in the 18-25 age range with most diagnoses including some type of depressive disorder. We treat the patients with both Group and Individual Psychotherapy, Psychopharmacology, Creative Arts Therapy, and other forms of Mindfulness Training. Our Blake Recovery Program generally has over 50% of the patients in this [young adult] age category. Our program is based on The Twelve Step Process with significant group and one-on-one counseling. Our Detoxification Program employs state of the art medications, which assist us in managing the physical side effects of eliminating substance abuse. A full array of mindfulness activities are used in the treatment programs as well. Are there any programs and support networks at Carrier Clinic that are available to the general public? Carrier operates several support programs including a weekend program for the families of drug and alcohol abusers, which is focused on teaching the members how to assist and support in the recovery process that their loved one is engaged in. We also offer Alcoholics and Narcotics Anonymous Programs on-site throughout the week to introduce patients to available community support. Talk about Carrier Clinic’s plans for the future. Carrier is engaged in the most significant expansion in recent history. A building project, which will add 40 new beds to the Hospital, as well as 10 to the Blake Recovery Program, will be completed in 2015. We will also be building a new Access Center for incoming patients as well as renovate a majority of the space in

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the existing hospital. During our construction we are preserving components of our older buildings in an effort to preserve our heritage. We have secured over 6,000 bricks that will be used to construct pathways throughout our campus, creating a “Path From the Past.” Over 100 double-hung windows will be used as canvases by local artists, creating our “Windows to the Future Project.” We preserved 6 trunks from trees that were being removed during construction and are allowing local artists to carve them into totems for use in our gardens. We have added a significant number of new therapeutic programs focused on the arts. We have established a relationship with the Arts Council of Princeton whose staff are engaged in exposing our adolescents to a wide variety of art forms as a means of managing stress. Our Healing Arts Program has purchased over 80 new pieces of art from local artists that embody healing properties. These new artworks will be placed throughout the hospital. We have launched the first Compassionate Care Index, which will be administered to our patients in order to secure feedback about how compassionate our staff are in delivering care to patients. We will be using the information from the survey to assist in hiring staff who are more compassionate, train the skill of compassion, reward compassion from our staff and prevent compassion fatigue. We submitted a grant application to the Center for Medicare and Medicaid Services to create 6 Behavioral Health Urgent Care Centers that will focus on providing on demand evening, weekend, and holiday services for patients who are experiencing mental health issues that need attention, but don’t qualify for hospitalization.

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(below) Stonebridge at Montgomery.

“NothingChanges, And Yet Everything is Completely Different” * Health issues and senior adults

by ellen gilbert * “The charm of history and its enigmatic lesson consist in the fact that, from age to age, nothing changes and yet everything is completely different.” — Aldous Huxley

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(top right) Buckingham Adult Day Staff: (left to right) Grace Stanley, RN, Barbara Hobson, Evelyn Rivera, Jesse Delvalle. (bottom right) Hula dancing at Greenwood House.

(bottom left) Fiesta at Greenwood House.

that enable aging adults to transition as seamlessly as possible through he very funny journalist Joyce Wadler residences changing circumstances. “I help senior living management during periods of changeis constant in our field,” says Stonebridge at Montgomery Executive Director defines “old age” as the time when -which Jean Brophy. the number of items in your medicine cabinet exceeds the number of hair-care Home Sweet Home products you use. Most people are Most people are inclined to want to live at home for as long as possible as they age. Area agencies like the Princeton Senior Resource familiar with the litany of ills that Center (PSRC) and Buckingham Place Adult Center in Monmouth provide daytime services that can include things like home-delivery senior befall us as we age; if they don’t of groceries and transportation to shops, and medical appointments. Home health aids can be live-in or paid on an hourly basis. While already, it is almost certain that, they offer some measure of companionship, Murray points out that eventually, they will. aids’ “primary role is to ensure safety at home.” This aspect becomes

health

The list varies only slightly from website to website. Federal and State agencies charged with responding to the health care needs of aging Americans more or less agree on the same three or four primary challenges: dealing with Alzheimer’s; chronic disease self-management; fall prevention; and personal emergency response. The buzzwords among are similar, too. Professionals who work with seniors and their families these days are using the words “continuum of care,” and “patientcentered care.” These refer to customized programs implemented at home and in o c t o b e r 2 0 1 4 H E A LT H Y L I V I N G

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especially important when there is cognitive impairment and, says Murray, 75 to 80 percent of our clients have some form of memory loss.” Agencies like Buckingham often offer a home health safety assessments, suggesting that throw rugs be tossed out and introducing clients to medical equipment they might not have known about, like raised toilet seats or “life-line” pendants. “It’s as much for the caregiver is it is for the participant,” observes Murray, noting that it doesn’t have to be everyday. Leaving a stove on when someone isn’t there, though, is a red flag.

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(bottom) Views from Stonebridge at Montgomery. (top right) Pool facility at Stonebridge.

Things Happen At some point “reality intervenes,” and it’s time to rethink the situation, says PSRC Executive Director Susan Hoskins. “Falls are a very big concern,” reports Brophy. However well a home is outfitted with good lights, handrails, and bathtub assists, people fall and, according to Brophy, it’s “a life-changing event.” A broken hip or femur means a degree of immobility and discomfort that often leads to additional health issues and, as a result, depression and a tendency to “give up.” There’s statistical evidence that the elderly death rate rises in the 12 months following a fall. “Everyone wants to stay at home,” agrees Greenwood House Executive Director Richard Goldstein. In Home-centered Health Care: The Populist Transformation of the American Health Care System physician Mike Magee examines “the intersecting megatrends of aging, consumerism, and the Internet, leading those paths to a single common destination - the home.” It’s difficult, though, to stay at home if you don’t have a support system, Goldstein notes. “For people of modest means, help that comes in a few hours a week for bathing and dressing is not enough.” Like Stonebridge, Greenwood House offers home care services as well as assisting living options, as well as hospice care.

Social Studies “Older people want someone who can be there when they have doubts,” suggests Grace Asagra Stanley, a holistic nurse who works at Buckingham Place while also maintaining a private practice. Stanley is a veteran of 20 years as a critical care nurse, but she also describes herself as a “hilot,” a practitioner of the ancient Filipino art of healing. Hilots today typically offer massages and other stress-relievers like the placement of suctioning cups, but sometimes, Stanley says, just “a touch on the head” carries a soothing message. While acknowledging that her practice is only “part of

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the health care mix” and does not preclude getting traditional treatments, Stanley says she’s always interested in the whole person. “Once you’re holistic, you’re always holistic. It influences how you talk, how you communicate, how you listen.” Being seen and heard on a regular basis is no small thing, say experts on aging. The six “points of wellness” that provide the framework for PSRC programs include physical well being, of course, but also social, cognitive, emotional, spiritual, and vocational concerns. Hoskins says that it can be as small as an instructor asking a class “where’s Gloria today?” and thereby reassuring students that they too would be missed if they didn’t show up one day, or, as Brophy points out, the ongoing social engagement provided by residential living. “Neighbors look after neighbors,” she says. The friendliness of the community and formal and informal opportunities to sing and hear or play music all “promote health.”

Alzheimer’s “I entertain fantasies of going out in style, but the fantasy requires that I not lose much more if ‘it’ than I already have.”

—William Ian Miller

A sense of humor always comes in handy—no less so when you are contemplating the possibility (or reality) that you or someone you love may have Alzheimer’s Disease. The Alzheimer’s Organization puts it simply: Alzheimer’s is a disease that attacks the brain and is the most common form of dementia. So what is dementia? “Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.” Goldstein and his colleagues are quick to point out that the fact H E A LT H Y L I V I N G o c t o b e r 2 0 1 4

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that people are living longer these days is increasing the likelihood that they will experience at least some dementia. William Ian Miller is the author of Losing It (in a recent interview he joked that many people bought the book assuming it was a weight-loss guide). The tongue-incheek subtitle of Losing It announces that it is a book “in which an aging professor laments his shrinking brain, which he flatters himself formerly did him Noble Service” (on the book’s cover it shows up, appropriately, in broken, 18th century typeface). “It is,” Miller continues wryly, “a Plaint, tragi-comical, historical, vengeful, sometimes satirical and thankful in six parts, if his Memory does yet serve.” Joking aside, Alzheimer’s is number one on the Administration on Aging’s list of priorities. The Agency’s Alzheimer Disease Supportive Services Program (ADSSP), which was created as a result of the 1965 Older Americans Act, delivers “supportive services and facilitates informal support for persons with Alzheimer’s Disease and Related Disorders (ADRD) and their family caregivers using proven models and innovative practice,” and “advances state initiatives toward coordinated systems of home and community-based care – linking public, private, and non-profit entities that develop and deliver supportive services for individuals with ADRD and their family caregivers.” In practice, area agencies are drawing widely from ADSSP directives as well as from other resources to create programs that address Alzheimer’s and other senior health concerns. Less attention is paid, unfortunately, to the infirmities people are more reluctant to talk about, like urinary and fecal incontinence. “Buried in a new report from the National Center for Health Statistics is an astonishing figure,” a recent New York Times article (“Big Burden, Little Said”) noted “Thirty-seven million older adults who live independently have some type of incontinence.” Not surprisingly, the numbers increase as adults age; the report finds that in nursing homes, 76% of the population is affected.

The Future of

HEALTHCARE is

Shining Brightly

B-Well Rehabilitation Opening Fall 2014

O C T O B E R 2 0 1 4 H E A LT H Y L I V I N G

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Taking the Initiative While many people think that incontinence is a natural outcome of aging and there’s not too much one can do about it, experts report that it can be treated with success through exercise, medicine, or surgical intervention. The same is true for other areas on physical decline. Richard Goldstein counsels people to “see your doctor regularly; deal with issues right away; take your medication; and move around and exercise. “ Healthy eating habits are critical, too; many facilities have dieticians on staff ensuring that residents’ meals are nutritious and, in some cases, customized for those with special diet needs. For non-residents, there are programs offering advice on sensible grocery shopping and healthful cooking. While a number of facilities offer on-site rehabilitation services, Hoskins and her colleagues encourage people to do something before they have that debilitating fall. Starting a program of regular physical exercise is a good idea at any time, and many facilities have health centers—including swimming pools—to ensure that workouts continue even after people leave their former homes. A number of facilities offer regular visits from medical specialists in podiatry, optometry, orthopedics, and dentistry. For some facilities, like Greenwood House, the challenge gets greater as people age. “We see lots of people approaching 90,” says Goldstein, but even then, “the goal is to keep them moving as much as possible.” Sometimes that means simply paying frequent attention to repositioning those who are conﬁned to their beds. The intellectual and cultural institutions that engage Princeton’s younger population are there for seniors to enjoy as well. Visits to the McCarter Theatre, Art Museum, public library, and favorite eating spots enrich the lives of both residential and non-residential seniors, along with opportunities to do volunteer work. “Many people think they’ve earned the right to do nothing as they get older,” observes Hoskins. “People have to choose to take care of themselves.”

B-WELL REHABILITATION COMES TO HAMILTON, NJ B-Well Rehabilitation, located at 3 Hamilton Health Place in Hamilton, New Jersey, will be the only facility in central NJ solely dedicated to post-acute rehabilitation. B-Well Rehabilitation sets itself apart from other post-acute facilities. From the most advanced technologies and equipment such as the HydroWorx 2000 Aquatic Therapy Pool to focusing equally on physical rehabilitation as well as a holistic education component, patients are provided with the opportunity to be better than they’ve ever been.

B-Well Rehabilitation elevation and patient room

For additional information contact Pat Chiorello pat.chiorello@bwellrehabilitation.com TM

(609)-351-0295

9/26/14 3:41:03 PM

Structural Integration:

A Holistic Approach to Wellness and Healing by LINDA ARNTZENIUS p h o t o s b y K R I S G I A C O B B E / LO C U S T A N D H O N E Y P H O T O G R A P H Y

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Anthy Katsiotis moves the fascia of her clients’ shoulders with special manipulation.

any of us turn to massage when injury or the stresses and strains of daily life result in the myriad manifestations of pain—backache, computer neck, carpel tunnel, and those knotted muscles that only deep tissue massage can undo. But while massage soothes and satisfies, its effects are short lived, especially when most of us go right back on doing the activities that caused our problems in the first place. What if there was something that had a more fundamental and long lasting effect? There is. It’s called Structural Integration. When massage therapist and holistic bodyworker Anthy Katsiotis wanted to offer clients at her Pennington practice, a more deeply beneficial treatment, she turned to a technique that she herself had experienced years ago, “rolfing,” as it’s known when practiced by first generation followers of Ida P. Rolf, who invented it in the 1930s, otherwise known as Structural Integration (SI). Being “rolfed” introduced Katsiotis to the world of fascia. “Massage therapists manipulate muscles, tendons and other soft tissue, to open and release muscular tension. Its many positive results include a sense of rejuvenation,” explains Katsiotis. With massage however, there is a shelf life. “Structural Integration focuses on the body’s connective tissue, or fascia, which surrounds muscles, groups of muscles, blood vessels, organs, and nerves, binding

some structures together and permitting others to slide smoothly over each other. Injury, stress, repetitive movements and the effects of aging can cause fascia to adhere and become shorter, tighter, and more dense. Tightened fascia pulls our muscles and skeleton out of proper alignment and posture. And that,” says Katsiotis, “can cause pain, discomfort, and fatigue. When moved and lengthened, however, the fascia, which isn’t as pliable as muscle, holds much longer than muscle. “Hence the ability to re-align the body,” says Katsiotis. SI restores postural balance and ease of movement and often results in a feeling of being more at home in one’s own body. The practice is governed by standards established by the International Association of Structural Integrators (IASI) and is usually delivered in a series of 12 sessions. Plainsboro dentist Joe Delmonico has been receiving SI for the past year. His work necessitates leaning over people all day long and maintaining particular postures for a half hour or an hour at a time. He found temporary relief through chiropractic, acupuncture, and massage before discovering SI. “The first time Anthy worked on my feet, they felt different immediately. It took some getting used to. I had worn custom-made orthotics and now I don’t need them. I’m really impressed. I had thought my problems were in my shoulder or in my back but I wasn’t thinking in terms of my whole body until

holistic

approach

o c t o b e r 2 0 1 4 H E A LT H Y L I V I N G

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“ To be your best you must have a good understanding of and relationship with your own body. My own personal experience of healing/changing my body/mind, soul and spirit, helps me to help others.”

Anthy Katsiotis

Anthy made me aware of the bands of rock-hard muscles in my legs. SI has made me aware of my overall physical well-being. When I get off Anthy’s table, I feel rearranged. So this is something I make time for.” Pain prompted Marsha Fahrer of East Windsor to seek out Katsiotis for massage. “I have a degenerative disease and have had repeated herniated disks since I was about 20, so I’ve always had back issues,” she says. “I had seen an orthopedist and a chiropractor, but Anthy was the only person who was able to make the pain go away. I trust her and I believe that a level of trust is fundamental to this kind of work. When we began SI, I had an idea of what to expect. Even so, I was surprised on one occasion by an overwhelming release of emotion. It was definitely a moment of healing. This treatment is not for the faint of heart. It’s a commitment to oneself to allow for deep emotional as well as physical healing.” Clearly SI is unlike any spa-like treatment in which fragrant fingers flutter over your eyelids and you feel great for half an hour after your session. To be sure, there is that, but much more besides. One does feel restored in mind and body after being on Katsiotis’s table for a full body massage, but more than a feel-good treatment, SI delivers a profound connection to one’s body. There’s a name for this. It’s body/mind awareness. It must also be said that while one receives a massage, one participates in SI, working with the therapist to ensure the desired results. With 35 years of bodywork experience, Katsiotis maintains an on-going interest in understanding the mind, and experiencing spirituality. “To be your best you must have a good understanding of and relationship with your own body. My own personal experience of healing/changing my body/mind, soul and spirit, helps me to help others,” she says.

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Trained in dance and movement education with bachelor’s and master’s degrees from New York and Columbia Universities, Katsiotis began her career as a dancer, choreographer, and educator. Princeton residents may recall her Katsiotis Dance Company. A profound belief in the healing power of touch led her to somatic studies, the special movement sequences that connect body and mind to help change muscles and postural alignment. Having studied Lulu Sweigard’s “Ideokinetics,” the Kinetic Awareness of Elaine Summers, and the techniques of Feldenkrais, among others, and with knowledge of Yoga, Tai Chi and Qi Gong, she undertook a two-year apprenticeship, in 1979, with David Joy in New York City, to learn traditional Swedish massage. A decade later, she worked with Angelo DiMeglio (originally from Ischia, Italy) in Princeton, learning the therapeutic benefits of deep muscle manipulation and nerve work. Her knowledge of fascia comes from working with Dr. Thomas Findley, and Thomas Meyers, whose Maine school of Kinesis Myofascial Integration she attended. Both men were trained by Ida Rolf and are leaders in “Spatial Medicine,” a different way of looking at and treating the body/mind. Besides SI and massage, Katsiotis is experienced in traditional Chinese medicine, Shiatsu and Subtle Energy work. She advocates healing that focuses on the whole person, an important aspect of her SI bodywork treatment. Her clients are of all ages; some seeking stress reduction or relief from pain, some recovering from breast cancer. Many regard SI as preventive medicine. Anne Hitchner, 73, a retired teacher who lives in Hightstown, is dealing with the effects of a car accident that broke her back 32 years ago. She’s been partially paralyzed ever since H E A LT H Y L I V I N G o c t o b e r 2 0 1 4

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(below) Anthy Katsiotis moves the fascia of her clients’ back and shoulders with special manipulation, a method used in Structural Integration.

and has been seeing Katsiotis for a weekly two-hour session for almost three decades. “Anthy is constantly improving her method and learning new techniques; she tailors her work to my needs and of all the therapies she has used on me, I find SI to be most beneficial.” Along with learning new techniques for her clients, Katsiotis also uses these techniques to gain insight into our own body/mind. “Each of us is ultimately responsible for our own health and well being. It is up to us to do whatever we can to have longevity, to preserve our body, mind, soul and spirit. Bodywork, such as SI, is a wonderful avenue to feeling youthful, and just downright great. Personal growth o c t o b e r 2 0 1 4 H E A LT H Y L I V I N G

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comes only if we want it, but change is certain. I see this work as a journey in health, in rejuvenation and longevity.” For more information about Anthy N. Katsiotis MA LMBT (Licensed Massage Bodywork Therapists), 106 Straube Center Boulevard, Pennington, NJ 08534, call 609.937.0446, email anthy@livingbodytherapies.com, or visit: www. livingbodytherapies.com.

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Finding Help at Urgent Care Centers

by tay lo r s m i t h

Urgent Care Centers are a great resource when you don’t want to spend a lot of time waiting in Emergency Rooms. Most Urgent Care Centers provide walk in service where “no appointment is necessary.” They also accept most major insurances and will provide diagnostic care with on-site x-ray and laboratory services. Open 365 days per year, the physicians and nurses are staffed to treat colds, coughs, back pains, allergic reactions, asthma, and much more. The facility may also deliver blood sugar testing, sports physicals, rapid strep tests, rapid flu tests and vaccines. As long as the illness or injury is non-life threatening, an Urgent Care Center will be able to provide the services you need. Find information on local Urgent Care Centers, below.

Princeton Primary and Urgent Care Center

Doctors Express Urgent Care Hamilton

www.ppucc.com 609.919.0009 707 Alexander Road #201 Princeton, N.J.

www.doctorsexpress-hamilton.com 609.297.7520 2222 Route 33 Suite H Hamilton, N.J.

HealthCARE Express Urgent Care & Occupational Medicine

Brunswick Urgent Care

http://mindovermedicine.com 609.297.0546 4065 Quakerbridge Road Princeton Junction, NJ

Saint Peter’s Urgent Care Center www.saintpetershcs.com/urgentcare 609.497.4597 1378 U.S. 206 #11 Skillman, N.J.

InFocus Urgent Care www.infocusurgentcare.com 609.799.7009 64 Princeton Hightstown Road West Windsor Township, N.J.

www.brunswickurgentcare.org 732.955.6765 3185 New Jersey 27 Franklin Park, N.J.

Med Express East Brunswick Urgent Care Center www.medexpress.com 732.613.6168 418 State Route 18 East Brunswick, N.J.

The Doctors Office Urgent Care www.thedoctorsofficeurgentcare.com 732.414.2991 120 Craig Road Manalapan Township, N.J. (Additional locations in West Caldwell, Paramus, and Brick, N.J.)

Images courtesy of Saint Peter’s Urgent Care Center; HealthCARE Express Urgent Care & Occupational Medicine.

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H E A LT H Y L I V I N G o c t o b e r 2 0 1 4

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The New Heart of Princeton Cardiology Associates of New Brunswick has opened a new office! Near University Medical Center of Princeton at Plainsboro Serving central New Jersey for 75 years  Consultations provided by board certified cardiologists  Cardiac disease prevention and management programs  Early disease detection and evaluation  Women’s health issues  Clear communication and coordination with your healthcare providers  On-site testing including: echocardiograms and vascular studies, pacemaker/defibrillator re-programming and evaluation, EKG’s 

Call 732.390.3333 Roger A. Shell, M.D., F.A.C.C. Erwin Mermelstein, M.D., F.A.C.C.  David A. Schaer, M.D., F.A.C.C. Dwayne W. Siu, D.O., F.A.C.C.  John J. Burns, M.D., F.A.C.C.  Dory B. Altmann, M.D., S.M., F.A.C.C. Jeanne L. DeMoss, D.O., F.A.C.C.  Marc A. Scheiner, M.D., F.A.C.C. Anthony Altobelli III, M.D., F.A.C.C.  Amit Kalra, M.D., F.A.C.C. 

10 Forrestal Road South  Princeton, NJ 08540 593 Cranbury Road  East Brunswick, NJ 08816 www.njheartdoctors.com

Eugenie Brunner, M.D. COSMETIC FACIAL PLASTIC SURGERY & SKIN REJUVENATION LASER CENTER COSMETIC FACIAL PLASTIC SURGERY Mini Facelifts I Face & Neck Lifts I Eyelid Lifts Rhinoplasty I Nose Reshaping A Surgeon’s Hands. An Artist’s Eye. A Woman’s Touch in Facial Plastic Surgery.

Eugenie Brunner, MD, FACS

609.921.9497

256 Bunn Drive, Suite 4, Princeton Serving the Princeton Area since 1997

Board Certified in Facial Plastic and Reconstructive Surgery Board Certified in Otolaryngology Head and Neck Surgery Fellowship Trained in Facial Plastic Surgery Fellow, American Academy of Cosmetic Surgery

Top Doctor NYC/NJ 2009-2013 Patients’ Choice Award 2011 & 2012 o c t o b e r 2 0 1 4 H E A LT H Y L I V I N G

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CAPITAL HEALTH CENTER FOR COMPREHENSIVE BREAST CARE Steering Committee Lisa Allen, MD Joseph DellaCroce, MD Kymberly Dietrich, BA, RT (R) (CT) (M) Bernard Grossman, MD Anne Moch, MD Randi Protter, MD Kira Przybylko, MD Rona H. Remstein, RN, MSN Trish Tatrai RN, MS, OCN, CBCN Gary Tuma, MD Shirnett Williamson, MD Robert Wood, MD

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Behind every breast is a heart and a soul. And behind every woman with breast cancer is the Center for Comprehensive Breast Care. Turn here for an array of advanced treatment options. The regionâ&#x20AC;&#x2122;s only molecular breast imaging system. A personal nurse navigator to guide you through every phase of treatment. And a belief that the best outcomes result from treating the whole person, not just the disease. To learn more about our progressive approach, visit our website or call 609.537.6767.

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From Reconstruction K

to Renewal BY ANNE LEVIN

athy Kowalewski had just stopped breast-feeding her toddler son when she noticed her right breast felt different from her left. With no family history of breast cancer, and at 38 still too young to have begun annual mammograms, the Hunterdon County mother of two wasn’t particularly concerned. But she consulted her doctor, who recommended a screening. Seeing the results, the doctor urged Kowalewski to have a biopsy of both breasts right away. It was cancer in her left breast. But the right side looked suspicious, too. Stunned, Kowalewski was referred to a breast surgical oncologist who recommended she have her left breast removed. After recovering from shock and weighing the options, she made the difficult decision to have both breasts removed and undergo reconstructive surgery. “The decision process was so fast,” she recalls. “It was like being on a train and going and going and I couldn’t get off. But I had a two-year-old and a four-year-old, and I wanted to make sure I’d be here for them, for a long time.” Kowalewski dreaded the surgery, a 10-hour process that involved her breast surgeon and a reconstructive surgeon. The recovery wasn’t easy. But a year later, she is swimming almost daily, doing yoga, and running around with her children. Last spring, she biked through Maine’s Acadia National Park. “It was hard in the beginning. It was painful,” Kowalewski says. “But my husband helped me, and step by step, I got back to feeling like myself. Today, I’m so glad I had the surgery at the same time as the mastectomy. I can’t imagine having to wake up from the surgery and not feel anything there, where my breasts had been.” No one wants to hear that they have breast cancer. While some women with early stage tumors can be treated with breast-conserving lumpectomy, it isn’t appropriate for everyone. Treatment for a breast tumor depends on the stage, severity, and type of the cancer. Mastectomy is often the course of treatment. Then there are women who don’t have breast cancer, but are at high risk for developing the disease. An increasing number are choosing to undergo prophylactic mastectomy and reconstructive breast surgery. Actress Angelina Jolie’s choice last year to go public with her decision to do just that brought the prevention and treatment of breast cancer into sharp focus. Jolie’s mother had died of cancer, and she had tested positive for a genetic mutation that put her at high risk for breast and ovarian cancer. Her disclosure was praised by some as a courageous move that would inspire women to take action and consider their own family histories.

Prophylactic mastectomy is not without controversy. It is major surgery, and some experts feel the difficulties associated with it are underestimated. “It’s definitely a hot topic,” says Dr. Brian Buinewicz, a Doylestown, Pa.-based plastic surgeon who is Chief, Plastic & Reconstructive Surgery Division of Abington Memorial Hospital’s Rosenfield Cancer Center. Dr. Buinewicz will be a speaker at the December 6 gathering of the Susan G. Komen Foundation’s annual “Sisters for the Cure” conference at the Philadelphia Marriott Hotel. “There are recent articles out there saying there isn’t an improvement in survival rates for women who have this surgery. But when you’re dealing with one person at a time, with high risk or difficult breasts, statistics can fly out the window,” he says. Breast reconstruction is an increasingly common way for women to deal with the effects of the surgery that can save their lives. “The point is, women with breast cancer have choices,” says Dr. Philip Wey, the reconstructive surgeon who treated Kowalewski. Dr. Wey is with Plastic Surgery Arts of New Jersey, which has offices in New Brunswick and Princeton. “The focus now is beyond survival,” he continues. “It has evolved. It’s about maximizing quality of life. There is always a positive spin on what can be somebody’s worst moment. Not only can you beat this, but you can emerge better than when you started. The goal of reconstruction is not just to rebuild a breast, but to make it as similar to the other as possible. And if women want, we can make their breasts better than they were before.” Continuing advances and new surgical techniques have created a host of options for women considering reconstruction. Each has its own potential benefits and risks. While some reconstructive techniques may be appropriate for one woman, they may not suit another. The first choice, once a patient decides on reconstruction, is whether to make the new breast from muscle or fat taken from elsewhere in the body, or to have implants. Whether silicone or saline, the implant procedure is less expensive than tissue transfer. But implants can be problematic and do not last a lifetime. “Implants last up to 20 years,” says Dr. Wey. “I tell people, that’s a good problem. There’s nothing I’d rather do than see a patient 20 years down the line because they need a new implant. But using body tissue is best.” Another option is to not have reconstruction at all. The decision does not have to be made right away. “It depends. It’s a woman’s choice,” says Dr. Doreen Babott, a medical oncologist at University Medical Center of Princeton at Plainsboro. “Obviously, if you’re younger, it may be more important to you. If you’re 80, you probably don’t care. And younger people heal better, too. Prostheses are better today, but it’s just not the same.” Most women today opt for reconstruction, Dr. Babott says, and do it at the time of their mastectomy.

treatment &

renewal

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“They don’t want to have more surgery, and it’s easier to just do it at the same time. So you have a breast cancer surgeon and a plastic surgeon involved. The women I see who do it are very satisfied with the results. You don’t wake up without a breast. When you recover from surgery, you have something, and that’s very nice.” Breast surgeon Dr. Rachel Dultz, who treated Kowalewski and others interviewed for this article, stresses that reconstructive breast surgery does not impact and negatively affect survival. "That's very important," she says. "There are enough studies that tell us that. The other thing local patients should know is that in this area, we now have such a wide choice of breast surgeons and plastic surgeons that you don't have to go elsewhere to have this done." Dr. Wey has patients from age 25 to 75. “Treatment is customized,” he says. “All cancers, mastectomies, and reconstructions are different. Sometimes women have too many options. It’s our job as doctors to guide them down the right path for them. We’re constantly reinventing ourselves. The technology and the research is constantly getting better.” During her recovery from surgery, Kowalewski had physical therapy sessions with Beth Rothman, who was familiar with the process because she went through it herself. A Princeton-based professor at Union County College and an adjunct in Rutgers University’s physical therapy program, Rothman changed the focus of her practice to helping women recover from mastectomy and reconstructive surgery. Now 56, she was 49 when a mammogram revealed a stage one tumor behind one nipple. She went to Dr. Dultz, who told her she had a choice between a lumpectomy and mastectomy. “I knew I just wouldn’t be comfortable having to check every few months,” Rothman says. “I decided to do the mastectomy.” After consulting with a few plastic surgeons, she chose Dr. Wey. “I saw pictures of the work he had done,” she says. “You want to go to somebody who does the procedure all the time.” He operated on Rothman using latissimus dorsi flap surgery, better known as “lat flap,” taking tissue from her upper back, which is then tunneled under the skin to the breast area, creating a pocket for an implant. The results were “phenomenal,” Rothman says. “I look better than I did before. The nipples look absolutely real. It’s warmer, it’s softer, they just look real. I was unbelievably grateful to wake up with a breast. I wasn’t going to, but my husband said ‘You’ll be sorry if you don’t.’ And he was right. I look better, I feel better, and I can do absolutely everything I could do before.” After the surgery, Rothman was advised to be tested for the gene that predisposes a woman to breast and ovarian cancer. When it came back positive, she immediately elected to have a mastectomy on her other breast. “I didn’t expect it, but once I knew I had the

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gene, I knew I would do it,” she says. “I knew how good it was going to look, because I had already had it on the other breast. It just made sense. So I did it after I finished chemotherapy from the first surgery. I wasn’t scared it was all prophylactic. I went to work with my drains in because I wasn’t worried about it. I think I overdid it because I was kind of cocky, having been through it once already. I hurt my shoulder, but I went for physical therapy and after a week I was fine.” Laura Martin is the program coordinator for the Breast Cancer Resource Center at the YWCA of Princeton. The center offers support groups, exercise and wellness programs, and a free wig and prosthesis boutique in an informal setting at the Y’s Bramwell House. “I wish I’d had a place like this when I had surgery,” says Martin, whose “lat flap” reconstruction was in 2007. Dr. Dultz was Martin’s breast surgeon; Dr. Wey did the reconstruction. “I started on my stomach,” she says matter-of-factly. “He got the muscles out. Then they flipped me over, and Dr. Dultz removed my breasts. She left, he came back, and he put the muscles where he wanted them. Then he put in saline implants. It took about seven hours, so it was all done in one day—one and done.” A few months later, Martin had her nipples reconstructed. “I went on my lunch hour,” she says. “Three little cuts–not a big deal. Then three months after that, they tatooed them. There’s a color chart, like with Benjamin Moore paints. People’s nipples match their lips, apparently.” No one denies that reconstructive breast surgery is major, and it carries risks. Infection, bleeding, scarring, ruptures or leaks, muscle weakness—all of these can happen. And if an implant is being put in, it is a multi-step process. “Until things are really, really done, I usually tell patients, it’s a full year from diagnosis to feeling normal and complete again,” says Dr. Buinewicz. Surgeons agree that the best results are usually when reconstruction is done at the same time as mastectomy. “It’s easier. Everything has been set up,” says Dr. Wey. Then women don’t have to wake up from surgery without a breast. The patient is in control. But you don’t have to do anything. It’s up to you. It’s a very optimistic way of taking on a negative experience.” The loss of a breast is a deeply personal and emotional time for women, says Dr. Gary Tuma, of Plastic Surgery Associates of New Jersey. “From a reconstructive standpoint, reconstructing both breasts at the same time can be more straightforward. Breasts come as a pair and reconstruction is all about symmetry. Trying to create symmetry is much easier to achieve when you are doing it to both breasts.”

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resources

1. Dr. Philip Wey, Plastic Surgery Arts of New Jersey 60 Mount Lucas Road Princeton, NJ 609. 921.2922 78 Easton Avenue New Brunswick, NJ 732.418.0709 www.psanj.com

5. Dr. Gary A. Tuma, Plastic Surgery Associates of NJ Suite 505 2 Capital Way Pennington, NJ 08534 609.537.7000 www.plasticsurgeryofnj.com

9. Capital Health Center for Comprehensive Breast Care Capital Health Medical Center - Hopewell 1 Capital Way Pennington, NJ 08534 609.537.6767 www.capitalbreast.org

6. Dr. Brian Buinewicz Buinewicz Plastic Surgery 10. Breast Plastic Surgery 3655 U.S. 202 Center at NYU Langone Doylestown, PA 2. Breast Cancer Resource Center YWCA Princeton 215.230.4013 Medical Center 59 Paul Robeson Place www.lemedspabucks.com 307 E 33rd Street Princeton, NJ New York, NY 7. Memorial Sloan Kettering 609.497.2100 ext. 349 212.263.5834 www.ywcaprinceton.org/bcrc www.nyumc.org Cancer Center 1275 York Avenue 3. Dr. Rachel Dultz New York, NY 300B Princeton Hightstown Road and suburban locations East Windsor, NJ 800.525.2225 609.688.2729 www.mskcc.org www.racheldultzmd.com 8. Abington Memorial 4. Dr. Doreen Babott Hospital Princeton Healthcare Old York Road 5 Plainsboro Road Abington, PA Ste. 300 215.481.2000 Plainsboro, NJ www.abingtonhealth.org 609.853.7272 www.princetonhcs.org

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Urgent Care Excellence

HealthCARE Express exists to challenge the status quo in healthcare by serving our communities and proving a level of support that is unlike anything you’ve experienced in a healthcare setting.

HealthCARE Express Urgent Care Centers are designed to treat those who need attention quickly but don’t require an emergency room visit. We provide a range of services, including treatment for: Cough, cold, and flu Sore throats and sinus infections Cuts and scratches Broken bones Allergies and asthma Sprains and strains Headaches

Urinary tract infections Ear and eye infections Physical examinations Vaccinations Preventative screenings Lab tests and X-rays Travel health

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WWW.PRINCETONFITNESSANDWELLNESS.COM

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Choosing Your Next Local Workout

by Tay lo r S m i t h

Princeton residents take in pride in their health and many are avid gym members, cross-fitters, and weight lifters. If you are new to the workout scene, Princeton Magazine has gathered together a list of our favorite local spots. Time to sweat!

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Princeton YMCA (princetonymca.org) is community oriented. You will see people of all ages taking swim classes, dance classes, and other group activities. The basketball court is great fun for pick-up games when the weather turns cold. There is also a brand-new health and wellness facility known as The Jim & Nancye Fitzpatrick Wellness Center. A full-facility membership allows for access to all of these separate amenities. CrossFit Nassau (crossfitnassau.com) backs onto the Princeton University Engineering School and is accessible from Nassau Street. CrossFit is a style of workout that incorporates high-intensity interval training, weightlifting, and calisthenics. This particular club offers several unique programs like an Olympic weightlifting club and a running club on Monday and Wednesday nights. All newcomers will be required to complete an “On Ramp” program that serves as an introduction to CrossFit techniques and movements. Squats, deadlifts, and presses are the name of the game.

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Princeton Fitness & Wellness Center

(princetonfitnessandwellness.com), located off of Route 206, has been a favorite of locals for many years. The facilities are spotless and there always seems to be a plethora of trainers to help out anyone who asks. At this gym more than any other, you will notice a lot of personal training. As a member, the wellness center makes it easy to format a workout regime with a personal trainer or to visit with the onstaff nutritionist (Second location at 7 Plainsboro Road, Plainsboro). New York Sports Club (mysportsclubs.com) is a tiny studio at the Princeton Shopping Center. For such a small space, they pack a lot in. Machines are of high-quality and well-maintained. There is a very comfortable weight room that is female friendly and not at all intimidating. Class offerings are minimal but they are popular nonetheless. Due to their location, there is always parking and you can easily swing by one of the many food markets and restaurants for a postworkout pick-me-up. Can Do Fitness Club (candofitness.com) at Princeton Forrestal Village feels luxurious. Besides the indoor lap pool, there are over 100 pieces of cardio equipment and strength training stations. They offer daily fitness classes and personal training. Receive a post-workout massage at the Koi Spa Salon. The café, atrium, and lounge area are perfect for unwinding. You might even want to just hang out here.

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Pennington-Ewing Athletic Club (PEAC)

(www.peachealthfitness.com) boasts two indoor international squash courts, racquetball courts, tennis courts, basketball courts and an indoor track. Their fitness equipment, three exercise studios, wireless entertainment systems, and private stretching areas are first class. Another added bonus is the recently

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expanded Kid Space, which offers an infant crib room, toddler area, and computer/ gaming stations for older children. 2014 marks their 17th anniversary. Pedal Stroke (pedalstrokestudio.liveeditaurora.com) is an indoor spin studio in West Windsor. If you are familiar with the Flywheel or Soul Cycle chains, you will be pleasantly surprised by the similarities. Pedal Stroke is all spin, all the time. The staff is very dedicated and extremely fit. Take a class with any one of the spin instructors and you will find yourself being physically challenged every single time. During each class, the lights go off and the music comes on. Riders can track their â&#x20AC;&#x153;statsâ&#x20AC;? on the viewing board or on the screen of each bike. Classes last 60 minutes, so remember to bring plenty of water. Towels are provided. New barre classes will begin this fall to complement the cycling. Bikram Yoga Plainsboro (www.bikramyogaplainsboro.com) is located at Plainsboro Village Center, only 2 miles from Route 1. Classes are offered throughout the week and are all 90-minutes in length. Conducted in a heated room, Bikram Yoga is designed to work deep into your muscles and tendons. The heat also increases flexibility, improves circulation, and is a great form of stress release. In terms of pricing, the studio offers a New Student Intro Week Special. Guests can also drop-in for a single session or purchase class packages. Locker rooms and showers are available for men and women. o c t o b e r 2 0 1 4 H E A LT H Y L I V I N G

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RWJ Fitness & Wellness Center (rwjhamiltonwellness.com) on Quakerbridge Road in Mercerville is an affiliate of the Robert Wood Johnson University Hospital in New Brunswick. Besides workout classes, RWJ offers frequent free health seminars and screenings. These educational lectures and programs are unique among gyms. There is also an impressive selection of cardio equipment with top name-brands like Woodway, TechnoGym, Cybex, and Nautilus. Newtown Athletic Club (NAC) (newtownathletic.com) is located just off the highway (95 South) in Newtown, Pa. The gym resembles a campus and the first thing you will notice is the sheer size of the place. There is an outdoor pool, indoor pool, outdoor and indoor tracks and green spaces. Inside the main building is a basketball court and several studios where their many classes take place. In fact, there is a class for every taste and they occur all day long (from 5:30AM to 8PM). If you need structure to your workouts, NAC is the place to go. The number of classes will keep you busy all year long. Weight areas are light-filled and open. The main cardio room features extra-large TV screens and a multitude of machines. One of the advantages of belonging to such a large gym is that there are always available machines.

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New FDA Rule ID’s Gluten-Free Food by Ilene Dube

Image courtesy of Condé Nast

Several years ago, a New Yorker cartoon pictured a ponytailed young woman and man in sunglasses cruising past a palm tree in a convertible. “I have no idea what gluten is, either, but I’m avoiding it, just to be safe,” read the caption.

“I have no idea what gluten is, either, but I’m avoiding it, just to be safe.”

hese days, with entire supermarket aisles dedicated to gluten-free products, and asterisked menu items at restaurants denoting gluten-free, most of us know that gluten refers to proteins occurring in wheat, rye and barley and can cause serious health effects in people with celiac disease, gluten intolerance and gluten sensitivity. In fact, the gluten-free food market has become a booming business. Udi’s and Glutino are major gluten-free brands on supermarket shelves, and General Mills has its own gluten-free product line. Food entrepreneurs are opening gluten-free bakeries. Even the Girl Scouts have a gluten-free cookie. Households reporting purchases of gluten-free food products rose to 11 percent last year, according to Nielsen. Makers of products that are naturally gluten-free, such as rice crackers, cranberry juice and popcorn, have hopped on the bandwagon, sporting gluten-free labeling. It is estimated that 3 million people in the United States have celiac disease, an inherited chronic inflammatory auto-immune disorder. For people with celiac disease, consumption of gluten results in the destruction of the lining of the small intestine and the risk of other serious health conditions. Foods that contain gluten trigger production of antibodies that attack and damage the lining of the small intestine. Such damage limits the ability to absorb nutrients and puts celiac sufferers at risk for nutritional deficiencies leading to anemia, osteoporosis, growth retardation, infertility, diabetes, miscarriages, short stature, autoimmune thyroid disease, and intestinal cancers. There is no cure for celiac disease, notes Andrea Levario, executive director of the American Celiac Disease Alliance, and the only way to manage the disease is through diet, by not eating gluten. Without a standardized definition of “gluten-free,” celiac

sufferers could never really be sure if their body would tolerate a food with that label, she adds. Beginning in summer 2013, the FDA issued a rule defining “gluten-free.” The rule also requires foods with the claims “no gluten,” “free of gluten,” and “without gluten” to meet the definition for “gluten-free.” Before the rule there were no federal standards or definitions for the food industry to use in labeling products “gluten-free.” An estimated 5 percent of foods formerly labeled “gluten-free” contained 20 ppm or more of gluten. The requirements apply to packaged foods labeled on or after August 5, 2014. Consumers should be aware that there may be some products still on store shelves that were produced and labeled before the compliance date. The date was established one year earlier to allow food manufacturers sufficient time to make changes needed in the formulation or labeling of foods that bear a gluten-free claim. Gluten-free foods must contain less than 20 parts per million (ppm) gluten. According to the FDA website, epidemiological evidence suggests that most individuals with celiac disease can tolerate variable trace amounts of gluten at levels less than 20 ppm. Foods may be labeled “gluten-free” if they are inherently gluten free, such as eggs, butter and seltzer. Foods imported into the United States must meet the same federal requirements as foods produced domestically. Oats and oatmeal often confuse gluten-free consumers. The grain itself does

Gluten-free section at Whole Foods.

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not contain gluten, but there may be cross contamination with other grains containing gluten. The practice of crop rotation, as well as the shared use of harvesting and transport equipment and storage silos, often results in gluten-containing grains coming into contact with other grains, legumes and seeds that are naturally free of gluten. In addition, manufacturing facilities that use shared production equipment to produce foods both with and without gluten could result in gluten cross-contact. To comply with the new rule, oats labeled gluten-free must contain less than 20 ppm gluten. Neither the final rule nor FDA’s general food labeling regulations prohibit the use of a statement like “made with no gluten-containing ingredients” or “not made with gluten-containing ingredients” on any food products, provided that the statement is truthful and not misleading. However, unless the label of the food including such a statement also bears a gluten-free claim, consumers should not assume that the food meets all FDA requirements for the use of the “gluten-free” claim. The final rule does not prohibit the inclusion of an advisory label statement, such as “made in a facility that also processes wheat,” on foods labeled gluten-free. The FDA will continue to work with, educate and monitor industry on the use of the gluten-free claim. Outreach will be conducted to assist the industry, as needed, to ensure that the provisions of the rule are fully understood. In addition, FDA will use its existing compliance and enforcement tools, such as inspection, laboratory analysis, warning letters, seizure and injunction to ensure that the use of the claim on food packages complies with the definition. Those who dine out would also like to be able to identify gluten-free foods served in restaurants and stores that serve prepared foods. The gluten-free final rule applies to packaged foods, which may be sold in some retail and food-service establishments. The FDA says that restaurants and other establishments making a gluten-free claim on their menus should be consistent with FDA’s definition. State and local governments play an important role in oversight of such businesses, says the FDA website. o c t o b e r 2 0 1 4 H E A LT H Y L I V I N G

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The FDA rule applies to dietary supplements, regulated by the FDA, but excludes foods whose labeling is regulated by the U.S. Department of Agriculture (meats, poultry, and certain egg products) and the Alcohol and Tobacco Tax and Trade Bureau (most alcoholic beverages, including distilled spirits, wines that contain 7 percent or more alcohol by volume, and malted beverages that are made with malted barley and hops). If a person sensitive to gluten eats a product labeled gluten-free and becomes ill or otherwise experiences adverse health effects, they can report their concerns to the FDA by calling 240.402.2405 or e-mailing CAERS@cfsan.fda.gov. According to Felicia Billingslea, director of FDA’s division of food labeling and standards, consumers should know that some foods labeled “gluten free” that are in the marketplace may have been labeled before the rule’s compliance date of August 5, 2014. If consumers have any doubts about a product’s ingredients and whether or not the product is gluten-free, they should contact the manufacturer or check its website for more information.

Whole Earth Center, Princeton, N.J.

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By Tay lo r S m i t h

Peloton ® Cycle Bringing Your Spin Class Home

Peloton Cycle® is bringing the boutique indoor cycling experience into the comfort of your own home. For the cost of the bike ($1,995) and a monthly subscription ($39), users are able to stream an unlimited number of live classes to their living room. These classes are filmed and broadcast from Peloton’s New York studio in Chelsea. From the seat of your bike, you will see the instructor, hear the music, and pedal along to the rhythm of your fellow classmates. And don’t worry about timing; you can live stream any of the classes catalogued on the Peloton server (past and present) at anytime of day.

The Peloton bike is attractive, streamlined, and exceptionally quiet. It is also outfitted with a large touchscreen console that displays class offerings and allows you to select a particular class based on time, intensity level, instructor, etc. The result is a fast-paced, engaging workout that offers an extra dose of fun because you can track your resistance, miles, and calories burned against the other people in the class. This feature keeps the at-home rider engaged and adds a note of competition.

Although the price tag may seem hefty, consider the cost of Flywheel and Soul Cycle classes, which average $32 to $35 for a single class. Even if you bought

several hundred dollars worth of class packages, the Peloton bike would still save you a significant amount of money per month. For those with an indoor cycling addiction, the ability to take an unlimited number of classes per day for no additional cost is extremely appealing.

Peloton Cycle’s geographic reach is expanding rapidly. You will notice riders from Switzerland, Mexico, and Australia

on your touch screen. At any one time, you will be racing against someone in Florida and San Francisco. The company is hopeful that their bikes will soon be selling to an even greater international market, with the intention of streaming classes in more foreign languages (currently offers classes in Spanish). Users can also “follow” one another, adding a social element to the programming.

If you would like to try out the technology inperson, visit their permanent store locations at Short Hills Mall and the Garden State Plaza. In New York, try The Westchester in White Plains, East Hampton or their original Chelsea studio.

Learn more at www.pelotoncycle.com.

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The LYNN Academy of Irish Dance strives to be the premier International Irish dance academy that will strengthen its students’ Irish culture through the instruction of Irish dance and to develop a quality and effective dance school where each student can reach his or her potential.

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