Everything in Moderation

We’ve all heard of the “super foods.” But should your diet be solely made up of those “perfect” health boosting foods?  According to dieticians and nutrition scientists, adhering to a rigid dietary regimen is not a good thing. A 2006 study published in the Journal of Nutrition compared one diet including foods from 18 different botanical families and another covering only 5 families. The researchers concluded that only the diverse diet “induced a significant reduction in DNA oxidation.” Essentially, smaller amounts of many phytochemicals (chemical compounds that occur naturally in plants that may affect health) may have greater beneficial effects than larger amounts of fewer phytochemicals. Researchers say variety gives you wider exposure to beneficial effects scientists may not yet even be aware of and limit your exposure to possible toxins, such as toxins in some mushrooms. So, in the case of your diet, variety truly is the spice of life.

Click here to read the full U.S.News & World Report article: http://www.usnews.com/health/diet-fitness/diet/articles/2010/02/23/why-an-all-superfoods-diet-is-a-mistake.html

Arthritis Risk

Assessing a Higher Arthritis Risk

A new study shows that inactivity and being overweight, particularly in women, may account for the high prevalence of arthritis and arthritis-attributable activity limitations (AALs) in Americans. This study, which was published in the journal Arthritis Care & Research, directly compared health differences associated with the prevalence and risk factors for arthritis and AAL between the United States and Canada. The study used data from a survey in which 3,505 Canadians and 5,138 Americans responded. Results showed that in the United States, the estimated prevalence of arthritis was higher (18.7%) than in Canada (16.8%). And in both countries, those who were physically inactive were more likely to have arthritis and AAL. Results suggest that the higher incidence of arthritis in American women may be due to a higher incidence of obesity and inactivity in those women and that public health messages promoting healthy weight and physical activity should also include messages about the possible risk for arthritis.

Click here to read the full Medscape article: http://www.medscape.com/viewarticle/717668

Mental Health

Could a Hospital Stay Increase Dementia Risk?

A group of researchers from the University of Washington and the Group Health Research Institute in Seattle and the University of North Carolina in Chapel Hill found that elderly people who were hospitalized for a critical illness had a higher risk of dementia. Of the senior citizens who were hospitalized for a noncritical illness, 40% were more likely to develop dementia than their counterparts who were never hospitalized. For those who experienced critical illnesses, that risk was more than double. Researchers aren’t quick to blame the hospital. They say the increased risk may be due to the illness that sent them there. The results of this study are being published in the Journal of the American Medical Association.

Click here to read the full LA Times story: http://latimesblogs.latimes.com/booster_shots/2010/02/hospitalization-cognitive-decline-dementia-risk.html

Breast Health

Breast Cancer Screening Guidelines Result in Less Access to Mammograms

If you recall, those new breast cancer screening guidelines recommended that women at average risk for breast cancer should start having mammograms every two years at age 50 instead of annual screenings starting at age 40. Since those guidelines were published, access to mammograms for women ages 40 to 49 has decreased in some states. A survey conducted by the Avon Foundation for Women has found that respondents from a fourth of the areas surveyed reported changes in their states’ early detection programs for breast and cervical cancer. Respondents said that the guidelines as well as other factors, including budget cuts, have resulted in fewer women having mammograms or the elimination of early breast cancer screening programs for women younger than 50 offered through state-administered breast cancer screening programs. Some of those states that have made changes include California, Florida, Illinois, Michigan, and New York. Some doctors are concerned that some women are using the new guidelines to put off breast cancer screening despite family history or risk factors.Click here to read the full U.S.News & World Report article:  http://www.usnews.com/health/family-health/cancer/articles/2010/02/23/access-to-mammograms-drops-after-guidelines-change.html

Cervical Cancer

Cervical Cancer Vaccine Not So Beneficial for Older Women

According to a new study, women older than 40 are unlikely to see much benefit from a cervical cancer vaccine. The vaccine for HPV is recommended for women aged 9 to 26, and a study was undertaken to see whether older women would be protected as well. The study, which was published in The Journal of the National Cancer Institute, found that the rate of newly detected infections dropped with age — to 13.5% in women 42 and older, from 35% in women 18 to 25. Scientists say that although cervical cancer is more prevalent in older women, it develops decades after the initial infection with a carcinogenic virus. And since older women get fewer infections, the benefit of the vaccine is limited.

Click here to read the full New York Times article: http://www.nytimes.com/2010/03/02/health/research/02prev.html?ref=health

There are some who may consider it to be the adventure of lifetime, while others find that they were not so well prepared as they had imagined. 

Over the past century, life expectancy has increased 30 years. But how do we prepare for all that extra time?

Being Realistic

“There is a gap between what we want retirement to be and what it actually is,” said John T. Cacioppo, Ph.D., and director of the Center for Cognitive and Social Neurosciences at the University of Chicago.  Dr. Cacioppo, an expert in social psychology, is a public speaker and a contributor and blogger for Psychology Today.   

Common problems are:               

• Self-esteem: Self was tied to position and work.
• Isolationism: Loss of social network.
• Ageism: Unexpected age discrimination.
• Disorientation: Loss of structure and purpose.
• Unrealistic goals: Not understanding all sides of questions.
• Family: Increasing demands from family.

Retirees often move to another location, but then may find that their social network is gone and that after six months or so the idyllic retirement setting does not seem so wonderful. Or in starting a second career, the retiree may find he or she is not as respected as at the last job. Without a work schedule, some retirees do not know how to organize their time. And some retirees find that the family expects them to be a baby-sitter or helper now that they “have the time.”

Susan D., a retired health care professional, moved from the suburbs to Chicago, expecting excitement and fun.  What she discovered was that high-rise living was an isolating experience. With the dense population and anonymity, the lakefront view was not enough to offset the lack of companionship.  She eventually transitioned to a smaller city.

“This is not uncommon” said Dr. Cacioppo. “The network we leave took years to build and is not easily replaced. Numbers are not important here, however. A person needs only one or two quality relationships to give life meaning again.”

Dr. Cacioppo said that women generally have an easier time with retirement or being laid off, because they can spend more time with family and friends, specifically female friends. 

The question to ask is, “What exactly do I want in this part of my life?”

Assessment and Experience

Maria Malayter, Ph.D., director of the Center for Positive Aging at National-Louis University in Chicago, wrote a book entitled Boomers: Visions of the New Retirement. From her research, she concluded that three key questions can put a person on the road to a happy retirement.

• What gives your life purpose?  To what are you committed and what do you get excited about?
• Where do you get your mental stimulation? What exactly gets you interested and excited among various types of mental stimulation such as volunteer work, formal education, on-the-job training, teaching, etc.?
• What kind of companionship would you like?  Who are the people with whom you would like to spend time?  What are your networks?

“These three are intricately linked and hard to separate,” said Dr. Malatyer.

“My transition from healthcare required that I look honestly at myself and forced me to discard ideas that no longer worked,” said Susan D. It led me from corporate life, to consulting, and finally to owning my own business.

“The journey was neither easy nor quick,” she said noting she had to be her own cheerleader and just “pushed through” with the help of supportive friends. 

Susan D. also had reared her four children and had been a caretaker for her sister and mother, both of whom recently had died.  She decided she no longer wanted a caretaker role.

“I still babysit occasionally, but I guess I began my businesses to avoid the family calls,” she admitted.

Now, after seven years of owning a business, Susan D. would like to move into something more meaningful that would incorporate her previous healthcare experience. To that end, she now volunteers with a group that serves children who are being raised by their grandparents.

Ageism not only comes from others, but can come from retirees themselves, as when they opt to associate only with others their own age with similar interests. Not only can that result in stagnation and a lack of being open to change, but it also can be depressing as the members of one’s social circle die off.

Dr. Cacioppo suggested socializing, working, and volunteering with younger people. For example, the organization Experiences Corp provides an opportunity for retirees 55 and above to teach children to read. Such activities provide an opportunity to share knowledge with youth, which can be meaningful and rejuvenating, and the mere act of getting involved with an outside organization can keep retirees moving physically.

Nurturing Networks

“Nurturing networks is essential,” said Marci Alboher, senior fellow at  Civic Ventures, a San Francisco-based think tank engaging boomers as a force for social change.  Alboher has written the book, One Person, Multiple Careers, A New Model for Work Life Success. She also created the Shifting Gears column and blog for the New York Times about work/life transitions and career diversity. 

“If there are no support groups, then create them yourself with the people from your employment or friends,” said Alboher, “Cheerleaders are important.”

Alboher offers several strategies for an enjoyable and meaningful retirement:

• Begin research on your interests before you leave your employment.  Ask for a “phased retirement,” although it may not be possible with all employers. This will give you a chance to explore new areas with a bit of structure in place.
• Learn new skills. It isn’t necessary to go back for formal education; there are classes offered through a variety of venues, such as continuing education courses at universities, professional organizations, and aging support centers.
• Volunteer. Volunteer opportunities may provide an idea of where your talents can be used, and also be a good option for learning new skills and providing a sense of purpose.
• Create a day-to-day schedule and long-term plan. Having a plan and strategy from which to work will help you realize what will and will not work. You can even “test drive” a move to a new location as part of your long-term plan by spending time there before you actually retire.
• Stay flexible. Opportunities come from various places and sources, so it is vital to listen and be ready for change.
• Open dialogue.  Look for opportunities to be in and promote dialogue in intergenerational settings.
• Take risks.  Growth comes from moving out of one’s comfort zone.

“It’s not customized,” said Alboher. “You will be finding more and more people identifying new pathways for living”.

When Susan D. asked why some elders are happier than others, she discovered that “the trip depends on you,” she concluded.

–Susan Fong

Resources:

• Marci Alboher: http://www.heyMarci.com
• Alboher, Marci. One Person/Multiple Careers: A New Model for Work/Life Success. Business Plus, 2007: http://www.amazon.com/One-Person-Multiple-Careers-Success/dp/0446696978
• Dr. John Cacioppo: http://psychology.uchicago.edu/people/faculty/cacioppo/index.shtml
• Cacioppo, John; and Patrick, William. Loneliness: Human Nature and the Need for Social Connection. W. W. Norton & Co., 2007: http://scienceofloneliness.com/?q=homepage
• Civic Ventures: http://www.civicventures.org
• The Intergenerational Center at Temple University: http://templecil.org
• Dr. Maria K. Malayter: http://www.docmaria.com
• Stanford Center on Longevity: http://longevity.stanford.edu
• Southern Illinois University Year of the Engaged Older Adult: http://www.law.siu.edu/GenServeGen/home.html
• Mather LifeWays: www.MatherLifeWays.com

The Muscles of the Core

While many of us associate the core with the abdominal muscles alone, it’s actually a complex system of muscles located in the trunk and hips that assist us in practically all movement, from lifting a heavy object to jogging in a straight line on the treadmill. These include muscles in the hip and pelvis like the pubococcygeus (PC or pelvic-floor) muscle, which contracts to control urine flow, as well as the glute medius and minimus, which stabilize the pelvis while walking or jogging and while standing on one foot.

The muscles of the low back are also included in the core musculature; the erector spinae is the best known and is responsible for extending the back, and though it can become very tight is often a weak muscle group. Another back muscle involved in core movement is the multifidus, a deep vertical muscle which stabilizes the vertebrae and helps absorb impact, reducing joint degeneration in the spine. Also of importance is the quadratus lumborum (QL), which is found on either side of the low back and flexes the spine laterally (side-bending); it’s often forced to pick up the slack from weak erector spinae muscles during back extension.

The remaining muscles of the core include the four abdominal muscle groups: the rectus abdominus (or “six-pack”), the external obliques, the internal obliques, and the transverse abdominus. The rectus abdominus flexes the spine forward and is the primary muscle group used to perform crunches. The external obliques, the diagonal muscles to either side of the six-pack, rotate the spine and are used during twisting movements.

Beneath the external obliques lie the internal obliques, which assist in spinal rotation as well as stabilize the core during abdominal exercises; they also function antagonistically to the diaphragm to help us breathe properly. (The diaphragm, while not technically an abdominal muscle, is also considered a core muscle; it contracts to enlarge the thoracic cavity, allowing us to take deep breaths.) Finally, the deepest layer of abdominal muscle is the transverse abdominus. The transverse abdominus draws in the abdominal wall to compress the ribs and stabilize the thoracic spine and pelvis. This muscle helps prevent injury during heavy lifting movements.

Why We Need Core Strength

As we age, the core muscles along with the rest of our muscle groups begin to decrease in mass. Subsequently we lose strength, gain body fat, and develop muscular and postural imbalances. While most of these changes happen over years, postural imbalances can appear relatively quickly and become quite pronounced, especially among women who are sedentary, such as those who sit hunched over a desk all day.  The combination of gravitational forces compressing the spine coupled with weakened postural muscles can result in noticeable changes in alignment, such as a forward head position, rounded shoulders, and a curved upper back.

Training the muscles of the core that are involved in maintaining proper alignment can help resolve these postural issues. Strengthening the muscles of the low back is a good start—exercises like back extensions can help address weak erector spinae muscles, and sitting atop a stability ball can help train the multifidus and transverse abdominus, both of which are heavily involved in maintaining upright posture. Similarly, exercises like the plank hold (see below) recruit the abdominal, back, and hip muscles and teaches them to work together to support the spine in a straight line.

A related issue stemming from core muscle weakness is pain, particularly back, neck, and hip pain (all commonly reported among sedentary populations in the U.S.). In the absence of an injury, most pain in this region is caused by muscle imbalances, imbalances that pull the body out of alignment and force stronger muscle groups to compensate for weaker ones. The good news is that these imbalances are easily (and inexpensively) fixed with core exercise.

By stretching tight muscles and strengthening weak ones, like the abdominals, upper back, low back, and glutes, the muscles will return to their proper lengths. When this happens, regular alignment can resume and pain generally disappears. For example, weak glutes paired with tight hip flexors can cause the pelvis to tilt anteriorly (imagine the back arching slightly and butt sticking out). This places upward pressure on low back muscles, making them tight and painful. Strengthening the glutes and stretching the hip flexors, therefore, can help resolve this imbalance.

A final benefit of core training is that having a strong core makes all demands on the body—whether from exercise or everyday activities like lugging groceries or gardening—easier to handle. When we lift heavy objects, brace ourselves to absorb impact, or are forced to keep our balance, it’s our core muscles that carry the load, draw in to protect us from injury, and prevent us from tipping over. So it only makes sense to keep these muscles working at full strength.

By following the exercises below (which can easily be paired off and distributed among three separate workouts) you’ll be better prepared for all the jobs the core muscles perform: drawing in for good posture and heavy lifting, stabilizing for balance and coordination, and strengthening and stretching for improved alignment. Perform two sets each of these core moves (choose a minimum of two exercises per workout session) three times a week in addition to full-body strength training, cardio, and stretching for optimum results.

Recommended Core Exercises

Opposite-Arm-and-Leg Reach: Get down on all fours with knees directly under hips and hands directly under shoulders. Draw in transverse abdominus muscle (pull belly button toward spine) to keep torso stationary. Slowly reach left arm straight in front of you while simultaneously extending right leg straight behind you (limbs should be parallel to floor). Do not rock side to side or allow low back to dip. Pause at the top, then return to starting position and repeat on other side. Do 8-10 reps each side.

Plank hold/Side plank: Lie face-down on the floor with legs straight and elbows propped directly under shoulders. Lift your weight onto elbows and toes so that your body forms a straight line and is held off the floor. Making sure to keep abs and glutes pulled in, hold this position as long as you can (ideally 30+ seconds). For the side plank, roll onto your side with one elbow propped under shoulder and lift hips off floor so that body forms a straight line; hold as long as you can and repeat on other side.

Stability Ball Crunches: Lie on your back on a stability ball with hips slightly lower than shoulders. Your tailbone should be in contact with the ball and knees bent 90 degrees with feet planted on floor. Place hands behind your head with elbows wide, look straight up at ceiling, and slowly curl shoulder blades off the ball without pulling forward on head or neck. Ball should not move. Exhale as you lift; then inhale and lower until your abs stretch slightly. Perform 15 reps.

Stability Ball Low Back Extensions: Lie face down on a stability ball so that torso is parallel to the floor, chest is just past the front of the ball, and knees are slightly bent (you may want to place feet against a wall). Place hands lightly behind your head just as you would for a crunch. Keeping knees bent and ball stationary, slowly extend the spine so that chest lifts a few inches off the ball (draw abs in to avoid hyperextending). Lower back down and repeat for 10-15 reps.

Supine Knee Twists: Lie on your back on the floor with knees positioned directly above hips so that hips and knees are bent 90 degrees, and spread your arms straight out to either side. Keeping both shoulder blades on the floor, inhale and slowly rotate hips to the right, dropping your knees as far as you can toward the ground. Exhale and slowly bring knees back up; repeat on the left side. Do 8-10 reps each direction.

Heel Touchdowns: Lie on your back with your arms at your sides and your legs lifted above your hips, knees bent 90 degrees. Keep your abs drawn in to maintain contact between your low back and the floor at all times. One at a time, lower your leg from the hip joint, keeping your knee bent, until your heel touches the floor, then exhale and lift your leg back up using your abdominal muscles. Repeat on the other leg, alternating for 10 reps each side.

1. Breaking News on Brittle Bone Disease
   
2. Top Five Misconceptions about Bone Diseases
3. Vitamin D and Osteoporosis: Prevent Bone Disease

Women age 45 and beyond take note: osteoporosis is the most common form of bone disease; it occurs at a rate 60% higher in women than men, leaves bones weak, brittle and at risk of breaking. With knowledge and preventative steps you can hold it at bay.

Here are some of the other types of bone disease that can affect women:

Osteogenesis Imperfecta: This disease, known as brittle bones disease, is passed down from parent to child through genes. It causes bones to be brittle and break under light conditions, such as from the impact of a mild fall. Not only are these people at risk of developing weak, easy-to-break bones, they also are at risk of developing weak muscles, brittle teeth, a bent spine and hearing loss. The disorder causes these effects by limiting the production of collagen, a protein that strengthens bones.

Paget’s Disease: This disease causes bones to grow too large, which makes them weak and brittle. Larger bones require more calcium and collagen to remain strong, and there will be an insufficient supply in the body. The cause of the disease is unknown. People Paget’s disease often experience pain, broken bones or damaged cartilage in the joints. Men are more likely to have Paget’s disease than women, and typically experience symptoms in their legs, pelvis, skull and spine. It occurs most typically in one or a group of bones, but never over the whole skeleton.

Bone Cancer: Because cancer can occur in the bones, it is considered a bone disease. The three types of bone cancers are Osteosarcoma, Chondrosarcoma and Ewing’s Sarcoma. Oseosarcoma starts in the growing bones of young people, mainly ages 10 to 25. Chondrosarcoma is a cancer of the cartilage and doesn’t begin developing until a person has reached age 50. Ewing’s Sarcoma develops in the nerve tissue of the bone marrow. It tends to develop in younger people once chemotherapy treatment for a different type of cancer has occurred.

Good News for Nappers

Preliminary results from a new study show that an afternoon nap can make you smarter. Napping is likened to rebooting a computer to make it work smoother. The study found that after taking part in a memory exercise, the nappers performed 10% better than those who stayed awake. Researchers also found that people’s ability to learn declines about 10% between noon and 6 p.m. normally, but the nappers were able to negate that decline. It’s important to sleep long enough to give the brain an opportunity to go through various cycles of sleep, people in the study napped for 100 minutes. Scientists say napping may be valuable for students and for people struggling with memory issues because of aging. Other recent research has suggested that sleep can help you think more creatively, have better long-term memory, and preserve important memories, so nap on!

Click here to read the full U.S. News and World Report article: http://www.usnews.com/health/family-health/brain-and-behavior/articles/2010/02/21/afternoon-nap-might-make-you-smarter.html

Hypertension

Pay More Attention to High Blood Pressure

According to a new report by the Institute of Medicine, high blood pressure, or hypertension, is not treated aggressively enough and is not enough of a priority for the government. The second leading cause of death, hypertension is relatively simple to treat and prevent, yet one in three adults has it and the numbers are rising. Often called “the silent killer” because of its lack of symptoms, it triggers more than one-third of heart attacks, is a leading cause of strokes and kidney failure, and plays a role in blindness and even dementia. The report mentions simple ways to curb high blood pressure: cut dietary salt, eat more potassium, exercise, and lose 10 pounds. And the institute urged the Centers for Disease Control and Prevention to push doctors to better treat hypertension, and to work with communities to make it easier for people to live the healthy lifestyles that can prevent it.

Click here to read the full USA Today story: http://www.usatoday.com/news/health/2010-02-22-blood-pressure_N.htm

Diabetes

The Avandia Question

With the ongoing debate over the safety of Avandia (a drug for diabetes that may increase the risk for a heart attack), patients are left wondering whether they should keep taking it or not. Physicians urge patients to stay on whatever medicines they are taking until talking things through with their doctors. Skipping or dropping treatment altogether could worsen their diabetes. Dr. Zacharey Bloomgarden, editor of the Journal of Diabetes and a clinical professor at Mount Sinai School of Medicine in New York, says he won’t put new patients on Avandia, given the controversy surrounding the drug, but he has advised patients doing well on the drug to stay on it.

Click here to read the full Wall Street Journal story: http://blogs.wsj.com/health/2010/02/23/avandia-what-should-patients-do/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+wsj%2Fhealth%2Ffeed+%28WSJ.com%3A+Health+Blog%29&mod=smallbusiness

Stroke Prevention

Smoking May Affect the Risk for a Transient Ischemic Attack

Smokers may be at greater risk for a transient ischemic attack (TIA) at a younger age versus nonsmokers. Results of a retrospective study showed that smokers who sought emergency treatment for a TIA were more than a decade younger, on average, than nonsmokers (age 56.7 versus 72.2). A transient ischemic attack is an episode in which a person has stroke -like symptoms for less than 24 hours, usually less than 1-2 hours, and is considered a warning sign that a stroke may occur in the future. It’s caused by a disruption of blood flow to the brain, which is usually caused by a blood clot, or thrombus. According to Bruce Obviagele, MD, of the University of California Los Angeles, the reason smoking appears to be related to age at presentation for TIA and not for stroke might have something to do with the clot. He says that the kind of TIAs you see in smokers might be different from the kind of TIAs or stroke in people who don’t smoke or used to smoke, because those clots are friable, or “crumbly,” and quickly dissolved.

Click here to read the full Medpage Today article: http://www.medpagetoday.com/MeetingCoverage/ASA/18661?utm_content=GroupCL&utm_medium=email&impressionId=1267089776285&utm_campaign= DailyHeadlines&utm_source=mSpoke&userid=220600

Weight Loss

Eat Slowly to Cut Calories

Researchers have found that eating too fast leads to eating more calories. According to a new study, people who took 30 minutes to eat ice cream versus 5 minutes, released more hormones that made them feel full. In a 2008 study in The Journal of the American Dietetic Association, people consumed roughly 10% fewer calories if they slowed down rather than gobbled their food. And in a study in the British Medical Journal, those who ate quickly until full had triple the risk of being overweight. By giving yourself time to feel full, you could end up eating less than if you rush your meals.

Click here to read the full New York Times story: http://www.nytimes.com/2010/02/23/health/23real.html?emc=tnt&tntemail1=y

Weight Loss Is Harder for Middle-Agers

According to USA Today, passing the 10-pound weight loss mark is more difficult for people over 50. Research shows that hitting that wall is common, with most people dropping about 5% to 10% of their starting weight in the first 3 to 6 months. After that initial loss, losing weight takes more sacrifice. Scientists say that one reason it’s difficult to drop more and keep it off is that there’s a cascade of biological responses designed to return dieters to pre-diet levels. A hunger hormone called ghrelin increases, and a fullness hormone called leptin decreases. Essentially, your body is keeping you from losing weight. Other factors may include lower overall levels of physical activity, deeply entrenched poor eating habits, and changes in sex hormones. For women, scientists have found that they have lower metabolisms after menopause than before. And if that weren’t bad enough, there is evidence that a lack of estrogen increases appetite and can cause specific cravings for certain foods, especially carbohydrates and fats. Experts say to lose weight you need to restrict calories, 1,200 to 1,500 a day for women, and exercise. It’s important to keep track of caloric intake, because they say most people are eating much more than they think. They also point out that after you lose weight and become smaller, you need fewer calories to maintain your smaller body. So, if you’re stuck on that plateau, don’t get discouraged. Just try and try again.

Click here to read the full USA Today article: http://www.usatoday.com/news/health/weightloss/2010-03-01-WLCstubbornweightloss01_CV_N.htm

Fitness

Chronic Illness Sufferers May Find Peace in Exercise

Living with a chronic illness brings anxiety and worry, but according to a study in the Archives of Internal Medicine, exercise has been shown to reduce that anxiety. The study looked at 3,000 sedentary people with chronic illnesses, who were still able to exercise for 30 minutes at a time. It found that exercisers were able to reduce their anxiety by 20%. This was true for every health problem, including cancer, depression, heart disease, fibromyalgia, except multiple sclerosis. Previous research has shown exercise effective in lifting depression, but there had been little attention paid to its calming effect.

Click here to read the full LA Times story: http://latimesblogs.latimes.com/booster_shots/2010/02/anxiety-exercise-chronic-conditions.html

Click here to read the full study in the Archives of Internal Medicine: http://archinte.ama-assn.org/cgi/content/full/170/4/321?home

Alzheimer’s disease is the most common type of dementia, accounting for more than 60% of all cases. Individuals in the early stages of Alzheimer’s disease have difficulty thinking clearly and remembering names, events, and new information. In addition, they may suffer from apathy or depression. Progression of the illness impairs a person’s ability to control moods, emotions, language, and physical body functions. Simple daily tasks such as walking to a nearby grocery store, making a cup of tea, or taking a bath become unachievable.

Every 70 Seconds

Every 70 seconds someone develops Alzheimer’s disease in the United States, the Alzheimer’s Association reports. According to the association’s 2009 Alzheimer’s Disease Facts and Figures, more than 5.3 million Americans live with this brain illness, and the number of Alzheimer’s sufferers age 65 and above will reach 7.7 million by 2030. Alzheimer’s is the seventh leading cause of death in the U.S.

Statistics show that a greater number of women than men will develop this form of dementia, because women tend to live longer than men do.

Although in recent decades scientists have made significant strides in the search for causes of the disease and ways to prevent it, there still is no cure or way to slow down the progress of illness once it is diagnosed.

Alzheimer’s Association Chief Medical and Scientific Officer William H. Thies, PhD, listed several risk factors for developing Alzheimer’s Disease over which we have little control: age, family history, and genetics. 

However, there are some risk factors we can affect.

“Other risk factors include lack of physical activity, high blood pressure, isolation, and diet high in saturated fat and low in vegetable matter,” Dr. Thies said.

Larry Sparks, PhD, senior scientist and head of the Laboratory of Neurodegenerative Research at the Banner Sun Health Research Institute in Sun City, AZ, more then 20 years ago decided to look into a possible connection between heart disease and Alzheimer’s disease. Dr. Sparks’ research results indicate that people suffering from high blood pressure and coronary artery disease may be at higher risk for developing Alzheimer’s.

Jeremiah Kelly, MD, associate professor of medicine at Rush Alzheimer’s Disease Center in Chicago, cited a variety of factors.

“Studies show that the presence of vascular risk factors such as diabetes, heart disease, hypertension and smoking, increase the risk of developing Alzheimer’s disease,” Dr. Kelly said. “ Data recently published by the Rush Alzheimer’s Disease Center show that cerebral infarctions (strokes) commonly co-occur with Alzheimer’s Disease and independently contribute to the likelihood of dementia.  These findings make it clear how important it is for health care providers of older adults to carefully identify and actively address vascular risk factors in order to reduce an older person’s risk of developing dementia.”

Cholesterol Link?

Some scientists also have hypothesized that high levels of cholesterol may play some role in Alzheimer’s disease development. However, this question remains highly debatable and requires further research. 

Cholesterol is a fat-like substance produced by the liver and is released to the bloodstream to be “transported” to different organs to make vitamin D and certain hormones, build cell membranes, and help to digest fat. Even though the human body generally produces enough cholesterol, additional cholesterol may be added to the body by eating such common foods such as egg yolks, meat, poultry, shellfish, and milk and other dairy products. An excess of cholesterol may cause atherosclerosis (thickening of artery walls) or coronary or carotid artery disease.

“Data suggest that if a person has an elevated level of cholesterol during midlife years, it increases the risk for developing Alzheimer’s disease,” Dr. Theis said. “But we also have some data showing that cholesterol-lowering medications are not useful for treating people who already have Alzheimer’s disease”—meaning the time to treat for cholesterol is before Alzheimer’s develops, to help head it off. “It looks as though cholesterol may have a long term effect,” he said

The scientist also indicated that numerous studies were conducted linking high levels of cholesterol to heart disease, so this led to clinical trials with the goal of preventing heart disease. No trials have been done to show whether lowering cholesterol can prevent Alzheimer’s disease, but cholesterol lowering treatments can help with other forms of dementia which are often overlapping in the same patient.

Better to Act Than React

Even though the higher risks of getting Alzheimer’s disease begin at age 60, scientists suggest developing healthy lifestyle habits as early as possible.

“Only five percent” of Alzheimer’s sufferers, Dr. Sparks said, “had genetically predetermined conditions. If somebody wants to be healthy in their sixties, they should start taking care of their health earlier”. Although not genetically predetermined, people do carry genes which make them more susceptible to poor lifestyle choices.

The Alzheimer’s experts unanimously spoke about the importance of finding ways to stay physically active such as regular visits to a gym, swimming, hiking, and bike-riding—but noted even less extreme measures can help.

“Physical activity should become a part of life,” Dr. Theis advised. “It does not mean that a person should have to dress up and go to the gym, because if the person does not like going to the gym, he/she is not going to do it on a long term basis. It is perfectly fine if someone would rather take a walk.”

Data also shows the impact of smoking on this disease. An analysis of 19 studies showed that elderly smokers have a significantly increased risk of Alzheimer’s, vascular dementia and any type of dementia.

The another important component of staying healthy and minimizing risks of developing Alzheimer’s disease is to choose a diet low in cholesterol and saturated fat. Foods of animal origin usually are high in saturated fat. Obesity in midlife is a risk factor for Alzheimer’s in late life.

Dr. Kelly suggested focusing on maintaining healthy blood vessels to prevent getting cardiac disease and strokes as a way to head off Alzheimer’s. “We know that atherosclerosis, which causes heart disease, strokes, and peripheral vascular disease, is caused by inflammation,” Dr. Kelly said. “We also know that Alzheimer’s disease is partly caused by inflammation.”

As a way of avoiding Alzheimer’s it is recommended to monitor blood pressure, cholesterol, and sugar levels in the blood. If any of these parameters fall out of the norm, it is best not to ignore it and discuss the situation with your doctor.

Dr. Sparks suggests drinking purified water, as his research indicates a possible link between copper found in drinking water, high cholesterol levels, and increased risk for developing Alzheimer’s disease.

While taking care of the body, it is important not to forget the mind, too. Dr. Thies recommends regularly finding a free hour to learn something new, to tackle a puzzle or a crossword and enjoy time with family members or friends involved in any mind- inspiring activity.

“It is important to stay mentally active in a social environment,” Dr. Thies said. Staying in touch with friends is especially important for patients’ diagnosed as being in the early stages of Alzheimer’s disease–it helps them reduce isolation and avoid depression.

“It is important to realize that Alzheimer’s disease is a chronic illness and people will live with it for a significant amount of time,” Dr. Theis concluded. “All things we have suggested will have a lot of benefits.”

            –Gabija Steponenaite

Resources:

• Alzheimer’s Association: http://www.alz.org
• Alzheimer’s Disease Facts and Figures
• http://www.alz.org/national/documents/report_alzfactsfigures2009.pdf
• Dr. Jeremiah Kelly, http://www.rush.edu
• Dr. Larry Sparks: http://www.bannerhealth.com
• Dr. William H. Thies, http://www.alz.org

Our culture tells us that we should fight hard against age, illness and death: “Do not go gentle into that good night,” the Dylan Thomas poem says. “Rage, rage against the dying of the light.” And holding on to life, to our loved ones, is indeed a basic human instinct. However, as the end of life approaches, “raging against the dying of the light” often begins to lose importance, and “letting go” may instead feel like the right thing to do.

This Fact Sheet discusses the shifting emotions and considerations involved in “holding on” or “letting go.” Addressing these sensitive issues ahead of time will allow a person with a chronic illness to have some choice or control over his or her care, help families with the process of making difficult decisions, and may make this profound transition a little easier for everyone concerned.

The opinions of the dying person are important, and it is often impossible to know what those beliefs are unless we discuss the issues ahead of time. Planning ahead gives the caregiver and loved ones choices in care and is kinder to the person who will have to make decisions. First, this Fact Sheet will present the principal concerns. Then it will discuss planning ahead, and some of the related matters that come up during chronic illness. Finally, it will present some ideas on actually making the decisions when the time has come.

Holding On

As people, we have an instinctive desire to go on living. We experience this as desires for food, activity, learning, etc. We also feel attachments to loved ones, such as family members and friends, and even to pets, and we do not want to leave them. We do not so much decide to go on living, as find ourselves doing it automatically. Robert Frost said once, “In three words I can sum up everything I have learned about life: It goes on.” Even in difficult times, it is our nature to hold on for better times.

When we realize that the end of life may be approaching, other thoughts and feelings arise. The person who is ill will want to be with loved ones, and may also feel a sense of responsibility towards them, not wanting to fail them nor cause them grief. He/she may have unfinished business. For example, the person may want to reconcile with estranged family members or friends and will find it both easier and more important to do. Fears arise, and may be so strong that they are hard to think about or even admit: fear of change, of the dying process, of what happens after death, of losing control, of dependency and so on. Both the person who is ill and the caregiver might also experience resentment, sadness and anger at having to do what neither wants to do, namely face death and dying.

In one way or another, hope remains. The object of hope may change. As death comes closer, the family may hope for a restful night, or another visit with a particular friend, or just a quiet passing from this life to whatever we hope follows it. Often, as the end of life nears, we keep two incompatible ideas in our minds at the same time. The Jewish prayer of the gravely ill puts it well for both the person who is ill and the loved ones caring for him/her: “I do not choose to die. May it come to pass that I may be healed. But if death is my fate, then I accept it with dignity.”

Letting Go

As death nears, most people feel a lessening of their desire to live longer. This is not a matter of depression. Instead, they sense it is time to let go, perhaps as in other times in life when one senses it is time for a major change. Examples might be leaving home, getting married, divorcing or changing jobs. Some people describe a sense of profound tiredness, of a tiredness that no longer goes away with rest. Others, who may have overcome many adversities in their lives, reach a point where they feel they have struggled as much as they have been called upon to do and will struggle no more. Refusing to let go can prolong dying, but it cannot prevent it. Dying, thus prolonged, can become more a time of suffering than of living.

Family members and friends who love the dying person may experience a similar change. At first, one refuses to admit the possibility of a loved one dying. Then one refuses to accept the death happening. Lastly, one may see that dying is the better of two bad choices, and be ready to give the loved one permission to die. As mentioned, the dying are distressed at causing grief for those who love them, and, receiving permission to die can relieve their distress. There is a time for this to happen. Before that, it feels wrong to accept a loss, but after that it can be an act of great kindness to say, “You may go when you feel it is time. I will be okay.”

Other Concerns

Letting go gets mixed up in our minds with a person wanting to die, although these are really separate situations. There are various reasons a person may want to die, reasons quite separate from those for letting go. Depression is one response to finding life too painful in some way. Some people cannot tolerate losing control, so they want to take control of dying. It can be unpleasant to be disabled, or in a place one does not want to be, or isolated from the important people and things in one’s life. Very often, a severely ill person feels like a burden to family and friends, and may wish to die rather than let this continue. Fears of the future, even of dying, may be so great that a person wants to die to get away from that future. Inadequately controlled pain or other symptoms can make life seem unbearable. For many of these problems the right sort of help can make a great improvement, and replace the desire to die with a willingness to live out this last part of one’s life.

Chronic Illness

So far, this Fact Sheet has been about the very end of life. Many, or even most, people go through a period of chronic illness before they die. Along the way there are numerous choices to make. Caregivers and people they care for have to decide whether or not to get a particular treatment or procedure. How long can one keep trying to do usual activities, including work, and when must they admit that that phase of their lives is over? Most of us have things we have dreamed of doing, but never got around to. Now may be the time to do that thing, no matter how difficult, or it may be time to let it be just a beautiful dream. Chronic illness brings up one situation after another where caregivers and care receivers must decide either to hold on or to let go.

Planning Ahead

Planning ahead means thinking about what is important, and what is not. It also means talking about this with those close to us. Even though we think we know what someone else thinks and believes, we really do not know until we ask. You cannot read other people’s minds.

When we think about the last part of our own or someone else’s life, consider these questions: What makes life worth living? What would make it definitely not worth living? What might at first seem like too much to put up with, but then might seem manageable after getting used to the situation and learning how to deal with it? If I knew life was coming to an end, what would be comforting and make dying feel safe? What, in that situation, would I most want to avoid? Some matters to consider would be: being able to talk with people, activity, physical comfort, alertness, the burden of care on others, being at home (or not being there), how much distress it would be worth in order to live another month, what medical procedures are not worth enduring, what I think is the best way for a person to die, how important it is to be in control of how one lives and how one dies, whose opinion should be sought in making choices about end of life care. One especially important matter is to complete the Advance Health Care Directive for both the person who is ill and the caregiver, so that there is an official spokesperson when one is too sick or too confused to speak for him/herself.

If, as caregivers, we haven’t had the necessary conversations—whether due to reluctance, dementia, or a crisis—we might have to think about the issues raised above without a lot of information. Some questions that might help in thinking about this are: What has that person actually told me? How can I find out for sure about her or his wishes? Turning now to myself as the caregiver, what would be important to me? What would I especially like to know about that person’s wishes? What would be the limits of what I could do? Could I take time off work? How much? What physical limitations do I have? What kinds of care would be just too much emotionally for me? Am I willing to accept the responsibility of being someone’s official spokesperson? If that person has relatives who would be especially difficult to deal with, how would I manage being the official maker of decisions?

All of these questions may sound very difficult to discuss now, when the time for decisions is still in the future. However, they are harder to discuss when someone is really sick, emotions are high, and decisions must be made quickly. Dementia soon takes away the ability to discuss complicated issues. The earlier everyone sits down to talk, the better. The best way to start is simply to start. Arrange a time to talk. Someone else’s death or illness may offer a good opportunity to bring up thoughts you had about their choices. Perhaps you could say you want to talk about things that might happen in the future, in case of serious illness. Have some ideas to bring up. Be prepared to listen a lot, and to ask questions. Do your best not to criticize what the other person says. If you know the other person will not want to talk much about this topic, have just one or two important things to say or to ask about. Be prepared to break off the conversation, and to come back to it another time. Write down the important things people say. Eventually, you can use your notes to prepare a statement of wishes and make this statement part of an “advance directive” about health care decisions, whether or not the formal document has been completed.

Making the Decision

Is it time to let go? Or time to give a loved one permission to die? There are three ways to help decide. First, look at the medical situation. Has the illness really reached its final stages? When it has, the body is usually moving on its own toward dying, with strength declining, appetite poor, and often the mind becoming sleepier and more confused. Treatments are no longer working as well as before, and everyday activities are becoming more and more burdensome. In a sense, life is disappearing. Second, talk with people you trust. Discuss the situation with the family members and friends who seem to be able to see things as they are. You might also talk with people who are not personally involved. Choose the people whose judgment you trust, not just those with an official role of giving advice. Most importantly, what does the dying person think? Third, listen to your heart. Try to see beyond your fears and wishes, to what love and caring are saying to you. What is really best for the one who is dying, and for the others around? Given that death is unavoidable, what is the kindest thing to do? It might be holding on. It might be letting go.

Credits

• Albom, Mitch, Tuesdays with Morrie, Doubleday, 1997.
• Byock, Ira, Dying Well, Riverhead Books, 1997.
• Dying Unafraid
  Fran Johns
  Synergistic Press
  3965 Sacramento Street
  San Francisco, CA 94118
  (415) 387-8180
  www.synergisticbooks.com
• Kubler Ross, Elisabeth, Death, The Final Stage of Growth, Prentice Hall, Inc, 1975.
• Levine, Stephen, Who Dies, Anchor Books, 1982.
• Handbook for Mortals
  Joanne Lynn, MD and Joan Harrold, MD
  Americans for Better Care of the Dying
  4200 Wisconsin Ave. NW, Suite 418
  Washington DC, 20016
  (202) 895-2660
  www.abcd-caring.org
• Malcolm, Andrew, This Far and No More, Times Books, 1987.
• Nulland, Sherwin, How We Die, Alfred A. Knopf, 1994.
• Rabbi Nosson Scherman, The Complete Art Scroll Siddur, Mesorah Publications, 2000.
• Shannon, Thomas and Charles Faso, Let Them Go Free, Sheed and Word, 1987.
• Thomas, Dylan, “Do Not Go Gentle Into that Good Night”, The Collected Poems of Dylan Thomas, New Directions, 1957.
• Webb, Marilyn, The Good Death, Bantam Books, 1997.

Resources

Family Caregiver Alliance
180 Montgomery Street, Suite 1100
San Francisco, CA 94104
(415) 434-3388
(800) 445-8106
Web Site: www.caregiver.org
E-mail: info@caregiver.org

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy.

Through its National Center on Caregiving, FCA offers information on current social, public policy and caregiving issues and provides assistance in the development of public and private programs for caregivers.

For residents of the greater San Francisco Bay Area, FCA provides direct family support services for caregivers of those with Alzheimer’s disease, stroke, head injury, Parkinson’s and other debilitating disorders that strike adults.

Compassion & Choices
PO Box 101810
Denver, CO 80250-1810
(800) 247-7421
www.compassionindying.org

Hospice Foundation of America
2001 S St. NW, #300
Washington DC, 20009
(800) 854-3402
www.hospicefoundation.org

National Hospice Foundation
(800) 338-8619
www.hospiceinfo.org

National Hospice and Palliative Care Organization
A Pathway for Patients and Families Facing Terminal Disease
1700 Diagonal Rd. Suite 625
Alexandria, VA 22314
(703) 837-1500
www.nhpco.org

Finding Your Way and Talking it Over
Sacramento Health Care Decisions
10540 White Rock Rd, Suite 135
Rancho Cordova, CA 95670
(916) 851-2828
www.sachealthdecisions.org

Five Wishes
Aging with Dignity
PO Box 1661
Tallahassee, FL 32302
(888) 5-WISHES
www.agingwithdignity.org/5wishes.html

Five Wishes is a document that helps you express how you want to be treated in the event you become seriously ill and unable to speak for yourself.

Prepared by Family Caregiver Alliance. Reviewed by John Neville, MD, Spiritual Care Coordinator, Pathways Hospice. Funding provided by the Older Americans Act, administered by the San Francisco Office on the Aging. ©2003 All Rights Reserved.

We begin mail delivery as we walk down one wing and she tells me anecdotes of the residents.  “She always gets a lot of magazines!” my Mom says, or  “This lady walks up and down the halls all day long”.  We comment on the nice art pieces hanging on the walls and the lovely seating area at the end of the hall, with windows looking out to a scenic view of snow and bare trees, an Indiana winter landscape.  We stop in to visit her friend and my godmother, who can barely see, hear or walk anymore.  Though glad to know I’m there, once I identify myself, Eileen launches into her litany of complaints.  My Mom happily suggests that Eileen could pray while she sits in her darkened room.  That’s it, I thought, Mom has always looked at the bright side of things!   I’m not surprised at all to hear her suggest Eileen might pray for others. That suggestion typifies the strong faith and optimistic view that Mom holds of the world. I recognize those traits in me, learned as a young girl, and smile as I know I have also have passed them on to my children.

Her strong faith and optimistic view, is evident still as she passes out her words of encouragement to all she encounters on her mail route: “How are you doin?” “Glad to see you back (from the hospital)”.  I’m transported back to my youth, as I walk these halls with her, recounting her suggestions to me to “turn it over” when dealing with a difficult situation.  I didn’t understand, then, how you “turned it over” and how doing so would relieve you of the anxiety, pain, or worry of the concern that would be bothering you.  I’ve come to learn, that there is a serenity that follows when one can, indeed, turn over problems to “the Good Lord”, as my Mother refers to Him.

At 92 years of age, we siblings consider Mom to be in fairly good health, all agreeing that we hope to be in as good of shape as she when we reach her age.  She walks slower these days, a broken hip 5 years ago stopped her more vigorous walking with her group of lady friends on Fridays but she continues to exercise on a stationery bicycle in the workout room of the Retirement Center where she lives. 

She is trying out hearing aids this month (surprised at all the sounds she now hears) so she can participate more fully in the conversations in the dining room.  She walks downstairs for dinner and typically sits at a table for four or six.  As she stated, “everybody else has hearing aids too and complains about them.”  At least she recognized, finally, that it wouldn’t be bad to try them out.  I’m convinced it is her positive outlook that will keep her using the hearing aids, even though they bother her, as she must learn to accept hearing different sounds, put them in and out of her ear, and remember to press a button to switch modes when she talks on the phone.

We return to her two-bedroom apartment, after delivering mail, and I look at the wall of Madonna (Mary and baby Jesus) pictures, which I helped her hang after she moved in, on one of my visits home.  “Look Mom, you’ve got all your friends back,” I said to her when the images were all hung.  Mom began collecting Madonna pictures when I was young and her collection spanned two walls in our living room growing up.  They too were a symbol of her strong, Irish Catholic faith that sustained her through the trials and tribulations of marriage, raising five children, living with my Dad after he suffered from heart attacks and watching his descent into dementia then years in a nursing home prior to his death.  All in all, Mom would maintain her deep conviction that “the Good Lord” would provide her with guidance and that Mary too would assist in solving problems of the day.

Though I didn’t stay faithful to my Catholic upbringing, I did stay faithful to living a “spiritual” life.  Mom used to declare that I was the “ecumenical one” because, beginning in high school, I was interested in learning about eastern religions.  I would come to believe more strongly in Angels and all things Spiritual than the Catholic way as the only way but I did, still, maintain a deep faith like my Mom.  My faith also sustained me through my own trials and tribulations of marriage, raising two children plus a divorce, learning to be a single Mom and then remarriage 10 years later.

I’m grateful for Mom’s optimistic view of the world, which my Dad also shared.  Between the two of them, I learned early on to see the cup ½ full as opposed to ½ empty, which would serve me well as I went about my own life.  Mom was thrilled that I was able to pursue both a career and family.  Even though she relinquished her career, working for American Airlines in the 40’s, after getting married, she instilled in me the idea that I could manage both a career and a home.  I never doubted her. 

Thanks Mom for your unwavering faith and support of your career minded, daughter!

Reduce Your Breast Cancer Risk With Exercise

For sedentary postmenopausal women, exercise may reduce the risk for breast cancer. A new study in the Journal of Clinical Oncology has found that moderate to vigorous exercise for a year reduced levels of estradiol (a sex hormone that at increased levels can lead to an increased risk for breast cancer). Critics caution that the modest reductions achieved by exercise can’t come close to those achieved through the use of aromatase inhibitors (drugs used for cancer treatment that lower the estrogen level slowing the growth of cancers). While this may be true, for women who are unwilling, or unable to take the drugs, exercise can be one lifestyle change they can make to help them reduce their risk for breast cancer.

Click here to read the full Medpage Today story: http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/18490 

Study Links Soda to Pancreatic Cancer

Results of a study published in the journal Cancer Epidemiology, Biomarkers & Prevention showed that drinking two or more soft drinks a week had an 87% increased risk of pancreatic cancer compared to those consuming no soft drinks. This study was begun in 1993 and evaluated 60,524 men and women in Singapore for up to 14 years, and looked at their diet and whether they got cancer. Researchers found that those who drank two or more sodas a week, the average number was five, had the 87% increased risk. They think the sugar in the soft drinks is increasing the insulin level in the body, which could contribute to pancreatic cancer cell growth. That increase in insulin is what may be leading to the development of the cancer. While scientists find these results “intriguing,” it’s important to note that these findings were based on a relatively small number of cases and do not prove cause and effect.

Click here to read the full WebMD article: http://www.webmd.com/cancer/pancreatic-cancer/news/20100208/pancreatic-cancer-linked-sodas

Hormone Replacement Therapy May Lead to a Higher Risk for Lung Cancer

A study of peri- and postmenopausal women has found that combined hormone replacement therapy (HRT) (regimens containing estrogen plus a progestin) was associated with as much as a 50% increase in the risk of lung cancer. The study also found that the longer the women were on the therapy, the higher their risk for lung cancer—the highest risk was for those who used estrogen plus progestin for 10 years or more. The use of estrogen without progestin was not associated with an increased risk. Researchers are unclear why this is, but suggest that these results may be helpful for informing women of their risk of developing lung cancer as well as pinpointing the pathways involved in hormone metabolism and lung cancer.

Click here to read the full Medpage Today article: http://www.medpagetoday.com/OBGYN/HRT/18507

Breast Health

Aspirin May Help Breast Cancer Survivors Live Longer

According to a study in the Journal of Clinical Oncology, aspirin appears to substantially reduce breast cancer survivors’ risk of metastasis and death. An aspirin taken at least two days a week reduced breast cancer death risk by 64% to 71%. The risk for distant metastasis (whether the cancer has spread to other parts of body) was also reduced by 43% to 60%. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) nonselectively block Cox-2 overexpression, which has been linked to metastasis of breast cancer, and also lower serum estradiol. (Cyclooxygenase-2, or Cox-2, is an enzyme in the body that becomes more abundant at sites of inflammation and is produced in excess in breast cancer.) The anti-inflammatory effect of aspirin might also hold benefits against cancer; however, these benefits have not been found with acetaminophen (Tylenol). Researchers find these results promising and with further study believe that physicians may be able to recommend aspirin to their breast cancer patients to reduce the risk of cancer spread and mortality.

Click here to read the full Medpage Today story: http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/18489 

Diabetes

Diabetes Drug May Be Harmful to Your Heart

According to reports obtained by the New York Times, if every diabetic now taking Avandia (a drug to treat Type 2 diabetes) took a similar pill called Actos instead, about 500 heart attacks and 300 cases of heart failure would be averted every month. GlaxoSmithKline (GSK), the makers of Avandia say scientific evidence doesn’t establish that it increases the risk of heart attacks. However, an analysis of dozens of studies of Avandia showed in 2006 that Avandia increased the risks of serious heart problems by nearly a third. After this study, negotiations with FDA officials about how and whether to alert the public continued while GSK went on to market and advertise Avandia aggressively. In 2007, a committee of independent experts found that Avandia might increase the risk of heart attack but recommended that it remain on the market, and an FDA oversight board voted 8 to 7 to accept that advice. A Senate investigation has recently criticized GSK for failing to warn patients years earlier that Avandia was potentially deadly. GSK has now been ordered to undertake a new trial comparing how many heart attacks, strokes and heart-related deaths occur among patients given either Avandia, Actos or a placebo, but two doctors from the FDA’s office of surveillance and epidemiology, argue the study is “unethical and exploitative” because patients given Avandia face far greater risks than those given Actos with no promise of any additional benefit.

Click here to read the full New York Times article: http://www.nytimes.com/2010/02/20/health/policy/20avandia.html?pagewanted=1&tntemail1=y&emc=tnt 

Deborah Forbes of Tierra Verde Salon & Spa in Tierra Verde, FL.

Dim lighting. Soothing wall color. The smell of lavender lingering in the air. Warm bed sheets. And most important of all, a massage therapist, like a healer from the mythic past, using skillful hand movements to revitalize a motionless body.

Sound good? Massage therapy can provide a peaceful oasis isolated from the stress of modern society.

“Our current lifestyles have us in a fight-or-flight pattern for much of the day,” said Deborah Forbes, a massage therapist and the owner of Tierra Verde Salon & Spa in Tierra Verde, FL. Forbes noted that in a fight-or-flight stage the body releases adrenaline and cortisol. These hormones are vital when fighting for survival; however, excessive quantities and prolonged presence of adrenalin and cortisol may be poisonous and negatively affect a person’s emotional and physical states. 

“As we continue to create stress on a daily basis, we feel the need to slow things down,” Forbes said. “Massage pulls the mind and body back into one entity, instead of being disassociated.”

An Ancient Art

Massage is one the oldest forms of medicine, and its traditions are found all around the globe. 

In 2100 BC in the Sumer Empire, a healer inscribed a remedy on a clay tablet advising that a diseased body part be healed by “rubbing” it.  The Huangdi Neijing, or Yellow Emperor’s Classic of Internal Medicine, was written in 200 BC in China and is considered the first book of traditional medicine; it recommends massage for certain ailments. The traditional Indian medicine system Ayurveda, the practice of which reaches back as far as the fifth century BC, also prescribes massage to treat numerous illnesses. The ancient Greeks and Romans would not pass on a chance to get a soothing and relaxing massage. Alexander the Great, who otherwise was busy conquering the world, had his personal triptai or massage specialist, who would help the great warrior to relax with massage and calming baths.

Paul Myer, Campus President, Cortiva Institute Chicago

The list of massage therapy benefits is a long one: it helps to enhance immune system; increases blood circulation, thus helping to heal wounds faster; eliminates toxins from the body; improves nutrition distribution to the tissues; has both stimulating and sedative effects on the nervous system; and many others.

For the last couple of decades, massage therapy has experienced a renaissance in the Western world.  “It is a growing industry based on increased consumer requests,” said Paul Myer, president of the massage therapy school the Cortiva Institute in Chicago. “Once consumers experience massage, they incorporate it into their routine to improve their quality of life,”

Robert King, Educational Consultant, Cortiva Institute

Increased interest in a wellness philosophy and alternative medicines has renewed interest in massage therapy. “Western medicine frequently addresses just symptoms of the illness, but not its causes,” said Robert King, author of numerous publications and cofounder and past president of the Chicago School of Massage Therapy. “For example, instead of taking aspirin for headache, people may consider taking a massage, especially if they really have a tight neck, scalp, or upper back muscles, all of which could be a causal factor for the headache.” King serves as an educational consultant for the Cortiva Institute and conducts advanced myofascial training (soft tissue therapy) throughout the country.

In the U.S., people have increasingly become interested in massage therapy as the level of stress in society has increased. “Stress exacerbates every disease,” King said. “If a person has a wound, illness, or psychological disorder, then excessive stress makes the condition worse. Alleviating stress is a very powerful component that helps the person’s health overall.”

Captives of a Stressful Routine

The human body’s response to environmental triggers shifts between two stages: “fight-or-flight” or “rest-and-digest.” When we feel threatened, body systems shift to fight-or-flight mode and prepare to fight for survival. This mode shuts down blood supply to the muscles, and increases blood pressure as well as heart and breathing rates. When there is no potential danger, the nervous system shifts to rest-and-digest mode: the body restores energy, maintains blood pressure at low rate, and ensures proper functioning of the digestive systems.

Bobbe Bermann, Director of Education, Cortiva Institute

During a massage session, the nerve endings in the skin send signals to the brain to relax and release tension. The body increases production of serotonin, a natural mood enhancing chemical, and endorphins, natural pain killers. “Endorphins combat the cortisol that is released in the body due to stress. If the body is less stressed, then its systems are able to work better and an individual experiences a sense of well being,” said Bobbe Bermann, director of education at the Cortiva Institute.

A study done by the American Massage Therapy Association’s Immediate Past- President M.K. Brennan indicates that chair massage reduces stress perception.   “Even the way we view things as being stressful can be changed,” Brennan said. Although more studies need to be done, recent findings indicate that massages enhances stress perception skills, Brennan noted.

M.K. Brennan, Past President, American Massage Therapy Association

“One of the benefits of the massage is taking time for oneself in a quiet environment, where you do not have to do anything and just be,” Brennan said.

Even entering a massage room and just lying with closed eyes, listening to soothing music, and being where everything is designed to be relaxing, sensual, and peaceful helps to calm the nervous system. General relaxation has been proven to help those who feel depressed, anxious, or angry.

Releasing Suppressed Emotions

A good massage therapist may help to release emotions and traumatic memories carried in the body for a long time. The late Austrian-American psychoanalyst and psychiatrist Wilhelm Reich, M.D., stated that the human body, by suppressing negative emotions or defending itself from outside stressors, starts building “neuromuscular armor.”  This “armoring” process can start as early as in childhood.

“Unexpressed anger often causes tension in the muscles of the back and arms that would have been used to strike out,” wrote Patricia J. Benjamin, Ph.D., in explaining Reich’s theories in Tappan’s Handbook of Healing Massage Techniques, based on earlier work by Frances M. Tappan, Ed.D. “Or, unexpressed grief may result in shallow breathing and stiffening of muscles used in crying.”

“Sometimes a trauma lingers in the body for years and people are not even conscious of it,” King explained. “When a massage therapist works on the area which was tight or tense for decades, the area begins to be freed-up and emotions and feelings may be released.”

Miraculous Healing Powers of Touch

It is not surprising that masterly manipulation, rubbing, stroking, and caressing of the skin have always been part of traditional healing methods, since a touch in itself is invaluable to every human being. “In the absence of touching and being touched, people of all ages can sicken and grow touch-starved,” writes naturalist Diane Ackerman, Ph.D., in her book A Natural History of the Senses. “In fetuses, touch is the first sense to develop, and in newborns it’s automatic before the eyes open or the baby begins to make sense of the world. Soon after we’re born, though we can’t see or speak, we instinctively begin touching,”

Numerous studies indicate that babies who are in consistent physical contact with their mothers or caregivers grow and develop faster, their emotions are more controllable, and they are calmer.

“People do not lose the need to be touched when they grow older,” Bermann explained. “A compassionate touch gives a body a sense of belonging, a sense of well-being, and more self-awareness.”

However, hectic daily routines, isolated hours spent in a car stuck in a traffic, friendships created in cyberspace, and rules and regulations defining the amount of touch allowed in a public and/or work environment often push a friendly, caring human touch into peripheral field of human communication. “I feel in this computer age, the interaction we have with other people is cerebral, which makes the human need for touch even more important,” said Forbes.

To benefit most from a massage it is important to have a trusting working relationship with a massage therapist, otherwise the whole potentially healing and relaxing experience may become irritating and stressful. Bermann and Paul Myer of Cortiva suggested verifying a massage therapist’s credentials–see if he or she has a license and liability insurance, belongs to a professional organization, and continues to obtain national certification.

“It is also important to talk to your friends and network to find out whom they would recommend,” Myer said. 

Since every human being is unique and every body responds to massage techniques differently, also it is important to discuss with the massage therapist one’s troublesome body areas and expectations, the Cortiva experts concluded.

–Gabija Steponenaite 

Resources:

• Dr. Diane Ackerman: http://dianeackerman.com
• American Massage Therapy Association: http://www.amtamassage.org/
• Benjamin, Patricia J.. Tappan’s Handbook of Healing Massage Techniques: Classic, Holistic, and Emerging Methods. Upper Saddle River, N.J.: Prentice Hall, 2009.
• Cortiva Institute: http://www.cortiva.com
• Deborah Forbes, Tierra Verde Salon & Spa: http://www.tierraverdesalon.com                                
• Tim Noonan: http://www.timnoonan.com.au/maspap98.htm