July 2012 Health and Wellness

2E Kingsport Times-News / Wednesday, June 27, 2012

ContributorsA. Stephen MayA mild winter and early spring meansticks have arrived in full force muchsooner than in previous years. Al-ready, cases of Rocky Mountain Spot-ted Fever have occurred in the state.Now is the time to take preventativemeasures to ensure that you are notbitten by a tick during the high-risksummer months. Page 4.

Wendy VogelClinical trials help researchers devel-op drugs to fight cancer. However,there is a lot of misunderstandingabout what clinical trials do and whocan participate. Learn what’s mythand what’s truth about participating ina clinical trial while you’re a cancerpatient. Page 5.

Tara LangeA common form of thumb tendinitis,called de Quervain’s, is caused bypinching and gripping in combinationwith wrist sideway motion, which ag-gravate the tendons at the base of thethumb, around the back of the wrist.Physical therapy can help relieve thepain. Page 7

Tim MartinExcessive daytime sleepiness, whichmay result from a wide range of medi-cal disorders and medications, canput us at significant risk for accidentsand have a major impact on ourhealth and sense of well-being. Page10.

Danielle CombsWhen deciding to purchase a hearingaid, there are a number of factors totake into consideration, such as whatyou do and where you go, how mini-mal or severe your hearing loss is, andwhat your expectations are. Page 13.

Marie BrowningAn apple cider vinegar tonic has beenused for thousands of years. It can reg-ulate blood glucose in diabetics, heala sunburn, treat swimmer’s ear infec-tions and ease acid reflux. And this isonly the beginning. Page 15.

Adver tisersHealth & Wellness Directory ............... 3Kingsport Hearing Center ................... 5Meadowview Ear, Nose & Throat ........ 7Health Resources Center ................. 8-9Mountain Region Family Medicine .. 10Custom Compounding Centers .......... 11Tri-Cities Gastroenterology ............... 13Guest, D.D.S. ....................................... 14Mountain Region Family Medicine .. 15

Andy & the BeatsAndy Rogers has battled type 1 dia-betes since he was 15. Now, he has com-bined his dual interests in biochem-istry and performing arts to create amusical dramedy that shows how ayoung boy learns to deal with the chal-lenges of the life-altering disease.Page 6.

MisdiagnosisWhen an older adult begins to expe-rience confusion, forgetfulness andother signs of dementia, many, in-cluding doctors, are quick to jumpto the diagnosis of Alzheimer’s dis-ease. Recent research shows theymay be wrong one-third of the time.Page 16.

Protein powerThe popularity of protein hasnow surpassed the popularityof high fiber and low fat. How-ever, the consumption of highprotein supplements may notdo anymore for a person’s dietthan just eating a healthy bal-ance of foods. Page 14.

Wednesday, June 27, 2012 / Kingsport Times-News 3E

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Rocky Mountain Spotted Fever on rise this yearWith the light winter and ad-

vent of early spring, ticks havecome out early and with them anincrease in the reported cases ofRocky Mountain Spotted Fever(RMSF). RMSF is a disease that isreportable to the Tennessee De-partment of Health (TDH) andthe Centers for Disease Controland Prevention (CDC).

According to TDH statistics,there were 255 cases in the statelast year. Currently, there are 229cases reported in Tennessee withtwo of those cases from SullivanCounty and the summer/peakseason is still ahead of us.

Although RMSF cases havebeen reported throughout mostof the contiguous United States,five states (North Carolina, Okla-homa, Arkansas, Tennessee andMissouri) account for more than60 percent of RMSF cases. Theprimary tick that transmits R.rickettsii in these states is theAmerican dog tick (Dermacentorvariabilis Dermacentor ander-soni).

Although cases of RMSF canoccur during any month of theyear, the majority of cases report-ed to the CDC have an illness on-set during the summer monthswith a peak in cases typically oc-curring in June and July. Thisseasonality varies somewhat fordifferent regions of the countrydue to the climate and the tickvectors involved.

The frequency of reported cas-es of RMSF is highest amongmen, American Indians and peo-ple aged 50 to 69. Individuals withfrequent exposure to dogs andwho reside near wooded areas orareas with high grass may be atincreased risk of infection. Chil-dren from birth through age 9and American Indians have anincreased risk of fatal outcomefrom RMSF.

The first symptoms of RMSFtypically begin two to 14 days af-ter the bite of an infected tick. Atick bite is usually painless, andabout half of the people who de-velop RMSF do not rememberbeing bitten. The disease fre-quently begins as a sudden onsetof fever and headache, and mostpeople visit a healthcareprovider during the first few daysof symptoms. Because earlysymptoms may be non-specific,several visits may occur beforethe diagnosis of RMSF is made,and correct treatment begins.The following is a list of symp-toms commonly seen with thisdisease. However, it is importantto note that few people with thedisease will develop all symp-toms, and the number and combi-nation of symptoms varies greatlyfrom person to person.

Symptoms are fever, rash (oc-curs two to five days after fever,may be absent in some cases; seebelow), headache, nausea, vomit-ing, abdominal pain (may mimicappendicitis or other causes ofacute abdominal pain), musclepain, lack of appetite and con-junctival injection (red eyes).

RMSF is a serious illness that

can be fatal in the first eight daysof symptoms if not treated cor-rectly, even in previously healthypeople. The progression of thedisease varies greatly. Patientswho are treated early may recov-er quickly on outpatient medica-tion, while those who experiencea more severe course may re-quire intravenous antibiotics,prolonged hospitalization or in-tensive care.

While most people with RMSF(90 percent) have some type ofrash during the course of illness,some people do not develop therash until late in the disease pro-cess, after treatment should havealready begun. Approximately 10percent of RMSF patients neverdevelop a rash. It is important forphysicians to consider RMSF ifother signs and symptoms sup-port a diagnosis, even if a rash isnot present.

Doxycycline is the first linetreatment for adults and childrenof all ages and should be initiatedimmediately whenever RMSF issuspected.

Antibiotic treatment followinga tick bite is not recommended asa means to prevent RMSF. Thereis no evidence this practice is ef-fective and may simply delay on-set of disease. Instead, personswho experience a tick bite shouldbe alert for symptoms suggestiveof tick-borne illness and consult aphysician if fever, rash or othersymptoms of concern develop.

The clinical presentation forRMSF can also resemble othertick-borne diseases, such asehrlichiosis and anaplasmosis.Similar to RMSF, these infectionsrespond well to treatment withdoxycycline. For more informa-tion, visit www.cdc.gov orw w w. s u l l i v a n h e a l t h . o r g .

Preventing tick bitesWhile it is a good idea to take

preventive measures againstticks year-round, be extra vigilantin warmer months(April-September) when ticks aremost active. Avoid direct contactwith ticks, avoid wooded andbushy areas with high grass andleaf litter, and walk in the centerof trails.

Repel ticks with DEET orpermethrin

Use repellents that contain 20percent or more DEET (N, N-di-ethyl-m-toluamide) on the ex-posed skin for protection thatlasts up to several hours. Alwaysfollow product instructions. Par-ents should apply this product totheir children, avoiding hands,eyes and mouth.

Use products that contain per-methrin on clothing. Treat cloth-ing and gear, such as boots, pants,socks and tents. It remains pro-tective through several washings.Pre-treated clothing is availableand remains protective for up to70 washings.

Other repellents registered bythe Environmental ProtectionAgency (EPA) may be found athttp://cfpub.epa.gov/oppref/in -sect/.

Find and remove ticksfrom your body

Bathe or shower as soon aspossible after coming indoors(preferably within two hours) towash off and more easily findticks that are crawling on you.

Conduct a full-body tick checkusing a hand-held or full-lengthmirror to view all parts of yourbody upon return from tick-in-

fested areas. Parents shouldcheck their children for ticks un-der the arms, in and around theears, inside the belly button, be-hind the knees, between the legs,around the waist and especiallyin their hair.

Examine gear and pets. Tickscan ride into the home on cloth-ing and pets, then attach to a per-son later, so carefully examinepets, coats and day packs. Tum-ble clothes in a dryer on highheat for an hour to kill remainingticks.

Tick removalIf you find a tick attached to

your skin, there’s no need to pan-ic. There are several tick removaldevices on the market, but a plainset of fine-tipped tweezers willremove a tick quite effectively.

1. Use fine-tipped tweezers tograsp the tick as close to theskin’s surface as possible.

2. Pull upward with steady,even pressure. Don’t twist or jerkthe tick; this can cause themouth-parts to break off and re-main in the skin. If this happens,remove the mouth-parts withtweezers. If you are unable to re-move the mouth easily with cleantweezers, leave it alone and letthe skin heal.

3. After removing the tick,thoroughly clean the bite areaand your hands with rubbing al-cohol, an iodine scrub, or soapand water.

4. If you develop a rash orfever within several weeks of re-moving a tick, see your doctor. Besure to tell the doctor about yourrecent tick bite, when the bite oc-curred, and where you most like-ly acquired the tick.

Andrew Stephen May, M.D., FAAFP,is medical director for the Sullivan CountyRegional Health Department.

A. StephenMAY

Good health key to keeping wealth in retirement yearsBy Donna Gehrke-White

Ruth H. Clark of Pompano Beach, Fla.,is a 95-year-old aerobic wonder, workingout seven days a week.

But Clark is not just flexing her mus-cles, she’s protecting her retirement nestegg by staying healthy.

Economists say health care will becomemore crucial in retirement planning asmedical expenses climb for the elderly.

People on Medicare already spendthree times more as a percent of incomeout-of-pocket for health care compared tonon-Medicare households — 14.7 percentvs. 4.9 percent, according to the NationalCouncil on Aging.

“The financial burden is highest forbeneficiaries who are older, in relativelypoor health, and have low or modest in-comes,” said council spokesman KenSchwartz.

Medicare recipients 85 and older spendan average of 30 percent of their incomefor out-of-pocket medical expenses, or$4,615 a year, according to an analysis onthe website NewRetirement.com.

Many seniors who have higher retire-ment savings and income pay even more:Older clients of Boca Raton financial plan-ner Mari Adam spend about $10,000 to$20,000 per year for medical expenses, sheestimated.

“High dental bills are not uncommon,”

Adam said.The nonprofit Employee Benefit Re-

search Institute estimates a 65-year-oldcouple will need $271,000 to give them-selves a 90 percent chance of havingenough savings to cover their out-of-pocketmedical expenses during retirement.

Clark said she has managed to stay outof the hospital since the mid-1970s, exceptfor a nasty bout with a nose bleed a fewyears ago. She has saved tens of thousandsof dollars in medical costs, from hospitalbills to paying for home healthcare nurses.

Clark, for example, “treats” arthritis bybending, stretching and moving about dur-ing her daily 30-minute workouts in herapartment at the John Knox Village. She

adds two-pound weights to her regimenevery other day.

“Every single joint gets moved,” Clarksaid.

To keep her good health, Clark stoppedbad habits early. She quit smoking in 1960,four years before the U.S. Surgeon Gener-al issued a warning about the dangers ofcigarettes.

The former Connecticut state senatoralso sticks to mostly fruits and vegetables.She has avoided diabetes, heart problemsand other chronic ailments, partly thanksto such a healthy diet. Indeed, Clark thinksher parents’ meat-and-potatoes diet mayhave contributed to their relatively earlydeaths.


Learning myths and truthabout cancer clinical trials

Have you ever wonderedwhat a clinical trial is? Perhapsyou have been asked to partici-pate in a clinical trial and werenot quite sure if it was safe?

Patients with cancer may beasked if they are interested inparticipating in a clinical trial.Some patients will seek out aclinical trial in order to receivea new drug that might not beavailable yet on the market. Un-fortunately there are severalmyths about clinical trials thatmake people hesitate to be apart of this process.

These myths slow down need-ed cancer research. Learningthe truth about clinical trialswill increase participation andfurther the fight against cancer.

Just what are clinical trials?Clinical trials are how we getnew treatment advances on themarket to better fight cancer orother diseases. All our currenttreatments have been throughthis rigorous and time-consum-ing study process. The FDA(Food and Drug Administration)carefully examines the data ob-tained from clinical trials anddetermines if the study drug iseffective and if it is safe to puton the market.

Clinical trials have different“phases” of testing. The drug isfirst tested in the lab — called“pre-clinical” testing before it istried in a human being. TheFDA examines the pre-clinicaldata and decides if the drug canmove into human testing.

Once this permission hasbeen granted, the drug movesinto a phase I trial. In a phase Itrial, the safety of the study drugin human beings is examined.Data is collected from the phaseI trial and again closely studiedby the FDA.

If deemed safe, the drug thenmoves into Phase II and then in-to Phase III studies, then possi-bly Phase IV studies. Phase IIstudies determine if the drug iseffective. Phase III studies com-pares the new drug to currenttreatments. Phase IV studiesmay examine long-term effectsand uses in other diseases.

So what do people believeabout clinical trials, and what isreally true? Here are some com-mon misconceptions about clini-cal trials and the actual facts!

MYTH: I’d just be a guineapig or a lab rat if I am part of aclinical trial.

TRUTH: People who are en-

rolled in a clinical trial are mon-itored very closely by bothphysicians and nursing staff. De-tailed information (such as phys-ical exam findings, lab studiesand more) is required on everypatient on a clinical trial.

Any side effects of the studydrug are carefully managed bythe healthcare team. Patientsare educated thoroughly abouthow the treatment works; anyneeded procedures; risk andbenefits; and any possible sideeffects during the “informedconsent” process prior to clini-cal trial enrollment.

The risks of participation areexplained in detail. If the clini-cal trial team thinks that thetreatment is harming you, theywill stop the study treatment. Ifyou decide to stop the treatment,you may do so at any time. Par-ticipation is always voluntary.

MYTH: My insurance won’tcover clinical trials.

TRUTH: Most insurances cov-er the normal costs of treat-ments in cancer clinical trials.There are some states that re-quire insurances to cover thecosts. Medicare provides cover-age for participation in clinicaltrials. Some clinical trials willprovide the study drug for freeand may pay for tests not cov-ered by insurance.

Your clinical trial coordina-tor will explain this to you in the“informed consent” process pri-or to beginning a clinical trial.

MYTH: I could get a “place -bo” or sugar pill if I participatein a clinical trial.

TRUTH: Most cancer clinicaltrials do not use placebos. Pa-tients will either receive thebest and most current standardtreatment or the study drug.

MYTH: I am too old to partici-

pate in a clinical trial.TRUTH: People older than

age 65 are often underrepre-sented in clinical trials. Onlyabout 25 percent of clinical trialparticipants are older than 65.However, to learn about hownew drugs work in various ages,it is necessary to have an ade-quate number of people in thatage category. Most researchersare seeking participants in allage groups. However, many peo-ple do not even know that a clin-ical trial might be an option —so ask about this — regardless ofyour age.

MYTH: I cannot participatein a clinical trial unless I go to abig cancer center or university.

TRUTH: You can participatein many clinical trials with yourcurrent oncology professionals.Many clinical trials are offeredthrough “cooperative groups”that work with community clini-cal oncology practices. Ask youroncologist if they offer clinicaltrials. There are many differentclinical trials offered here in theEast Tennessee and SouthwestVirginia region.

MYTH: Clinical trials are a“last resort.”

TRUTH: There are many dif-ferent types of clinical trials anddifferent reasons for being partof a clinical trial.

Some people may participatein a clinical trial because thereare no other treatment options.Some people may choose to par-ticipate in order to receive apromising new drug. Others mayparticipate in a clinical trial toprevent a cancer. Some clinicaltrials are “observational” mean -ing that researchers merely ob-serve the treatment and effec-tiveness of a drug already on themarket and collecting dataabout this.

So how do you learn moreabout clinical trials or whatmight be available for a certaincancer? You can go to one of theInternet sites or call the toll-freenumber listed below.

U.S. National Institute ofHealth: http://clinicaltrials.gov/

TrialCheck: http://www.can-certrialshelp.org/ (or call1-877-227-8451)

And if you have more ques-tions …. ask your nurse practi-tioner!

Wendy H. Vogel, M.S.N., F.N.P.,AOCNP, is an oncology nurse practition-er with Kingsport Hematology/OncologyAssociates in Kingsport.

WendyVOGEL

New therapy may lower risk ofdiabetes-related amputation

By Julie DeardorffJim Keenan wasn’t particular-

ly alarmed by a small blister thatdeveloped on his heel. Five dayslater, the 62-year-old’s foot was soseriously infected doctors fearedthey might need to amputate hislower leg.

Keenan, who also has type 2diabetes, instead tried theemerging treatment called hy-perbaric oxygen therapy.

Best known as an antidote forunderwater diving disorders,HBOT involves inhaling pureoxygen while reclining in a pres-surized chamber.

The intense flood of oxygen tothe blood can stimulate cellgrowth, promote the formation ofnew blood vessels and fight cer-tain infections, said Dr. AlanDavis, who directs the Center forWound Care and HBOT at North-west Hospital outside Baltimore.

Swedish researchers haveshown HBOT can help foot ulcersheal in certain patients with dia-betes, according to a 2010 studypublished in the journal Dia-betes Care. A review of other tri-als also found that HBOT seemedto reduce the number of amputa-tions in people with diabetes whohave chronic foot ulcers, accord-ing to a Cochrane Review of theliterature.

But while the data on chronicwound healing are promising, re-search is also sparse and manyphysicians are still skeptical.

The Swedish study appearedto be “well done,” but “it stilldoesn’t tell us which patients willbenefit from this very expensivetreatment,” said Dr. TonyBerendt, an infectious diseasephysician at Oxford and co-au-thor of several clinical guidelineson diabetic foot infection.

Diabetes develops when a per-son’s body can’t make a normalamount of insulin, or uses it in-correctly. “Insulin controls bloodsugar; if the levels are too high,blood vessel and/or nerves can beharmed,” said Davis.

Damage to the blood vessels ornerves can result in a loss of cir-culation or reduced sensation tothe feet. This can make it difficultto detect a sore or injury.

“Those with diabetes lose thegift of pain,” said David Arm-strong, director of the SouthernArizona Limb Salvage Allianceat the University of Arizona de-partment of surgery.

Armstrong’s research hasshown that up to 25 percent ofthose with diabetes will developa foot ulcer. More than half of footulcers become infected; one infive infections require amputa-tion.

HBOT may improve the oxy-gen concentration in the periph-eral tissues, and that increasedoxygen concentration may im-prove healing, Armstrong said.But, he said, if blood isn’t able toflow, due to peripheral vasculardisease, the super oxygenatedblood won’t be able to get to theextremities and HBOT will benearly useless.

Keenan, who lives in Betten-dorf, Iowa, was diagnosed withdiabetes at 58.

At the Genesis Wound and Hy-perbaric Institute in Davenport,he underwent 40 two-hour treat-ments in the pressurized hyper-baric chamber, five days a week,to improve oxygen flow to hisfoot. At the same time, he wastreated with a series of dressings,grafts and vascular surgeries toimprove blood flow to his foot.

The treatment lasted nearlytwo years.

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Andy & The BeatsBy Leigh Ann Laube

When Andy Rogers was diag-nosed with type 1 diabetes at age15, it really wasn’t that big a deal.His older sister had been diag-nosed seven years earlier, andwhen Andy began having someof the same symptoms, he knew.

“I was OK. I thought, ‘Thismakes sense. Game on. Let’s go.’”he said. “I looked up to my sistera lot. I really admire and look upto both my brother and my sister.I'm the youngest in the family. Iwas like, ‘She has it. She can doit. I can be a support for her, andshe can support me.’”

Andy is 23 now and a Decem-ber graduate of the University ofTe n n e s s e e ’s College of Arts andSciences. The son of a doctor, hewas torn during his years at UT— should he choose the arts orthe sciences?

“I fell in love with theater andfell in love with the arts,” hesaid. “I found out I had a talentfor it, and you can’t pursue bothof those at the same time. Itried.”

But diabetes is always on hismind, even when he was prepar-ing for his senior thesis.

“I started thinking aboutthings I would be interested in —diabetes and health. I'm passion-ate about it and interested inlearning more. I was taking a runone day and thought it would befunny to write a musical aboutit,” he said. “It was more of ajoke at first. If diabetes were amusical, what would a song be?Then a story started to develop. Icould be in this show, so I couldshowcase and grow as an artistic,an actor, a singer and dancer. Icould study something that’s im-portant to me and showcase thebiochemistry. ... There are moreeffective ways of teaching thanputting something up on a screenand having me write it down.

“I put together a proposal ande-mailed my adviser. I said, ‘Lis -ten, this is going to sound verycrazy, but this is some thing I re-ally want to do.’ I said I wouldwrite a research paper to backeverything up, so it’s not just myword. So, I wrote a musical thatis backed by a 52-page biochem-istry research paper that acts asa guide to the musical — whycertain characters are in there,why the pancreas would sing acertain song, etc. — and as ahitchhiker’s guide to being a dia-

betic from the perspective of adiabetic.

That musical, “Andy & TheBeats,” was first presented in2011 at the Clarence Brown The-ater on the UT campus. Fourdays ago, the diabetic musicaldramedy was performed at theBijou Theatre in downtownKnoxville.

• • •Andy moved to Kingsport with

his parents, Tom and JennyRogers, and older siblings, Benand Kelli, when he was in theeighth grade. Kelli had been di-agnosed with type 1 diabetes — alifelong disease in which thereare high levels of glucose in theblood — when she was 9.

“We have no family history

that we know of,” Andy said. “It’sjust the two of us. Usually thetrend is it skips a generation, butwe don’t have any family histo-r y. ”

Although both were initiallydiagnosed by their dad, Kelli andAndy got the official word fromdoctors at East Tennessee Chil-dren’s Hospital in Knoxville.

“My symptoms were really ob-vious. I knew something waswrong,” Andy said. “Beingaround the disease so much andhaving it be a pretty prevalentpart of my life, it’s kind of when afamily member gets diagnosed,the whole family gets diagnosed.You understand what it means tobe diabetic.”

Andy quickly learned to man-

age his diabetes, and he’s man-aged it well, though its not with-out thought.

“It’s not a disease you can puton the back burner of yourmind,” he said. “You have makesure you have enough insulinwhen you’re traveling. How do Iadjust my insulin pump when Ihave the flu because it’s makingmy blood sugars go out of whack?Or, there’s a kink in my pumpand I have leave work. What am Igoing to eat for lunch? How manycarbs are in my lunch? It getscumbersome, but it never ends,so it’s not like I can do this forthree months, get my treatmentand I don’t have it any more. It’slike a constant math problemthat you can never get right butyou have to try.”

After graduation fromDobyns-Bennett High School in2007, Andy was set to start UTthat fall. Before school started,he used some of his graduationmoney to fly to New York and seesome professional theater.

He decided to minor in the-ater at UT, but halfway throughhis sophomore year, he droppedout.

“I was only really thinkingabout theater and not organicchemistry, and I was very con-fused about whether to go arts orsciences,” he said.

He took a year off, but wasn’tplanning on ever going back toKnoxville.

”I thought I didn’t need a col-lege education. I needed experi-ence. I did Up With People forsix months and loved it,” he said.

When his stint with Up WithPeople was over, he came back toKingsport to work. But he seizedanother opportunity to go to NewYo r k .

“I had an awful experiencewith auditioning and working. Ihad a wake-up call and realizedI'm not ready to be a professionalactor at age 19,” he said. “I wentback to UT to study biochemistryand theater. I felt like I needed tofinish something that I started.”

• • •It took him about eight months

to get his senior project to thestage.

“Andy & the Beats” is story ofa healthy 12-year-old boy namedAndy who wakes up one morningto find that his immune systemhas been attacked by a virus,which causes him to developtype 1 diabetes.

From the outside, Andy’s fu-ture looks manageable, but onthe inside it’s not. Trapped byfear and confusion, he meets upwith a trio of fantasy friendscalled “the Beats,” who educateand encourage him in his effortsto understand what, why, howand when is the cure.

“I want people to learn some-thing. I want them to learn abouttype 1 diabetes,” Andy said. “Ifyou didn’t know one thing goinginto the show, I want you to knowone thing coming out of it. Themain point is to get people tocare about the disease. This dis-ease gets put on the back burnera lot. This disease causes somany other complications —heart disease, blindness, ampu-tation. I want to get rid of thestereotypes.”

The cast includes a children’sensemble, children who actuallyhave type 1 diabetes.

Although tickets to the perfor-mance at Clarence Brown werefree, donations were encouragedfor Juvenile Diabetes ResearchFoundation. That performanceraised $1,800 for the non-profit.The show at the Bijou was also afund-raiser for the JDRF.

Reaction to the initial perfor-mance was better than Andy ex-pected, he said.

“I was anticipating people tolike it, to enjoy it, but more peo-ple were moved by it than I ex-pected,” he said. “It was a won-derful and terrible experience atthe same time. I felt very vulner-able, but I knew a lot of peoplewere moved by the show. I feltlike I had a lot riding on it. I hadthis baby and I was nurturingthis baby and I worked so hardand I wanted it to reflect who Iwas.”

Andy is working to have theshow fully licensed and copy-righted so other theaters canproduce it and raise money forJDRF in their community.

Since graduation, Andy hadbeen working for the KnoxvilleJDRF in its school program. Thatjob recently ended but he hasother plans.

“I want to perform. I thought Ididn’t want to be a full-time per-former, but I'm going to go backout on the audition route,” hesaid. “I want to pursue acting fulltime.”

For more information, visit“Andy & the Beats” on Face-boook.

Musical dramedy reveals challenges of living with type 1 diabetes

Contributed photo

Andy Rogers was diagnosed with type 1 diabetes when he was 15. Drawn to theperforming arts, Rogers decided to create a musical dramedy, “Andy & TheBeats,” about the challenges of living with the disease. The dramedy premiered in2011 and was performed this week in Knoxville.


Hand therapy may relievecommon thumb tendinitis

If you use your hands for a lotof pinching and gripping and arehaving pain you may be experi-encing a type of thumb tendinitis.

Often pinching and gripping incombination with wrist sidewaymotion can aggravate the tendonsat the base of the thumb, aroundthe back of your wrist. This ten-dinitis is called de Quervain’s,named after a Swiss surgeon whodescribed this condition in 1895.It is a fairly common condition.

Two of the main tendons of thethumb, the abductor pollicislongus and the extensor pollicisbrevis, pass through a tunnel orsheath on the thumb side of thewrist. If there is swelling of thetendons or thickening of thesheaths, it makes it difficult forthe tendons to move easily. Thiscondition may occur gradually orsuddenly. It may be caused byoveruse, can be associated withpregnancy, rheumatoid disease,or can be from an acute injury.

The specific cause of de Quer-vain’s is not known. It remains id-iopathic. Overuse, forceful grip-ping and activities requiring sus-tained or repetitive grasp/pinchwith wrist motion can lead tosymptoms associated with deQuervain’s. Activities such asopening jars, using scissors,wringing things out and repeti-tive grasping/pinching are a fewexamples of activities that mayaggravate the condition.

Acute injuries such as a directblow to the thumb, suddenwrenching of the wrist andthumb while trying to restrain anobject or person, or a fall on anoutstretched hand can be associ-ated with de Quervain’s. Thistype of occurrence is less com-mon.

Often, there may be no knowncause, and your tendons/sheathsmay just not have enough spaceto function properly. Women aremore often affected than men.

Symptoms of de Quervain’s in-clude pain along the back of thethumb. This pain may radiatealong the thumb or forearm andmay be increased with certainthumb motions and/or wrist mo-tions. Some people may have lo-calized swelling and some mayhave tenderness to direct pres-sure of the involved area. Some-times a “catching” sensation isfelt with thumb movement. Occa-sionally numbness may be expe-rienced if a nerve around the ten-don sheath is irritated.

If you feel you are experienc-

ing this type of problem with yourthumb, a visit to your physicianmay be beneficial for diagnosisand treatment. Diagnosis may bemade by physical examination aswell as testing to rule out any oth-er possible sources of thumb sidewrist pain.

Treatment of de Quervain’susually includes wearing athumb/wrist splint or orthosis forfour to six weeks to immobilizethe involved area and preventuse of the thumb/hand in activi-ties which may be aggravatingthe condition. Often ice and an-ti-inflammatory medications maybe recommended. Sometimes asteroid injection may be benefi-cial to decrease pain andswelling.

In some people where the con-dition has developed gradually,de Quervain’s can be more resis-tant to treatment. Surgical re-lease of the covering of the ten-dons may be recommended ifconservative medical treatmentis not effective. The goal ofsurgery is to open the compart-ment to allow more room for thetendons. Surgery is usually anoutpatient procedure, and handtherapy may be recommendedafter surgery.

Hand therapy may be benefi-cial both in conservative treat-ment as well as post-operatively.In conservative treatment, thera-py would address splinting by fit-ting or fabricating a splint, man-aging symptoms with use of ther-mal modalities, instructing inpain-free motion of the wrist andthumb, advising on modificationof activities to allow healing andreduction of symptoms, and pro-gression to strengthening andrestoring functional use of thethumb/hand.

If symptoms persist andsurgery is recommended, therapy

may follow surgery to get you us-ing your hand normally again. Of-ten, just a few sessions may beneeded to get instruction in ahome program.

Sources: www.orthoinfo.aaos.org,www.webMD.com, www.Wikipedia.org, Re-habilitation of the Hand and Upper Extrem-ity, 6th edition, Hand and Upper ExtremityRehabilitation A Practical Guide, 3rd Edi-tion.

Tara Lange, OTR/L, CHT, is a physi-cal therpaist with Wellmont Health Sys-tem.

TaraLANGE

Often pinching andgripping in combination

with wrist sideway motioncan aggravate the tendonsat the base of the thumb,around the back of yourwrist. This tendinitis iscalled de Quervain’s,named after a Swiss

surgeon who described thiscondition in 1895. It is afairly common condition.

Music training improvesthe aging process

By Harry Jackson Jr.Music training has a lifelong

good impact on the aging pro-cess, says a new study out ofNorthwestern University.

Researchers in the AuditoryNeuroscience Laboratory atNorthwestern measured theautomatic brain responses ofyounger and older musiciansand non-musicians to speechsounds.

Researchers discovered thatolder musicians had a distinctneural timing advantage.

Researchers concluded thatage-related delays in neuraltiming are not inevitable andcan be avoided or offset withmusical training.

”The older musicians notonly outperformed their oldernon-musician counterparts,they encoded the sound stimulias quickly and accurately asthe younger non-musicians,”said neuroscientist NinaKraus.

“ This reinforces the ideathat how we actively experi-ence sound over the course ofour lives has a profound effecton how our nervous systemfunctions,” she said.

Kraus, professor of commu-nication sciences in the Schoolof Communication and profes-

sor of neurobiology and physi-ology in the Weinberg Collegeof Arts and Sciences, is co-au-thor of “ Musical experienceoffsets age-related delays inneural timing.”

The data, with recent ani-mal data from other researchcenters suggest that intensivetraining even late in life couldimprove speech processing inolder adults and improve theirability to communicate in com-plex, noisy acoustic environ-ments, said Don Caspary, a re-searcher on age-related hear-ing loss at Southern IllinoisUniversity School of Medicine.

“ They support the idea thatthe brain can be trained toovercome, in part, some age-re-lated hearing loss,” C a s p a r yadded.

Previous studies fromKraus’ Auditory NeuroscienceLaboratory suggest that musi-cal training also offset losses inmemory and difficulties hear-ing speech in noise — two com-mon complaints of olderadults.

The lab has been extensive-ly studying the effects of musi-cal experience on brain plas-ticity across the life span innormal and clinical popula-tions, and in educational set-tings.

Carl Slocum, M.D. • W. Jeffrey Wallace, D.O. • David Osterhus, M.D. • Jennifer Greiner, D.O.Audiologists - Toby Johnson, M.A., CCC-A • Jolene Hoffman, M.A., CCC-A • Pam Babb, M.A., CCC-A

Locations in Kingsport, Bristol, Elizabethton and Big Stone Gap 423-246-8155

Comprehensive Ear, Nose and Throat Care, Including Hearing Aids

Meadowview Ear, Nose and Throat SpecialistsMeadowview Ear, Nose and Throat Specialists

What Will Hearing Aids Do for Me?Perhaps the single most important goal when considering the use of a hearing aid is to improve personal communication and yet maintain independence and freedom to make choices in a world of fast-paced communication. For people with hearing loss, a hearing aid frequently helps achieve this goal. There are three important things to understand about hearing aids:

1. Hearing aids do not restore normal hearing. The most common reason hearing aids are fi tted is to help people hear speech in order to effectively communicate. The hearing loss is generally sensorineural (permanent), and the hearing aid is adjusted mechanically and electronically to help compensate for parts of the ear and central nervous system that are damaged.

2. A hearing aid is a guest in the ear. Hearing aids work well when they are custom made to fi t a person’s

ear. Patients that are fi rst fi tted with a hearing aid generally experience some level of tenderness in the ear. The level of tenderness may be as simple as adjusting to a new pair of shoes or it may be an irritation that requires an audiologist to make adjustments for the hearing aid to feel as natural as possible.

3. Hearing aids require guided practice, patience and persistence. They work best in quiet listening conditions. Adjusting to everyday sounds is challenging and takes practice (e.g. birds, dishes, paper sounds and the sound of one’s own voice).

Patience and realistic expectations are the key ingredients to being a successful hearing aid user. Once you understand this, you are more likely to be successful and satisfi ed with your hearing aid.

Call us at 423-246-8155 to schedule an appointment with one of our certifi ed audiologists and learn how a hearing aid might benefi t you.


Daytime sleepiness accident waiting to happenDo you suffer from excessive

daytime sleepiness? How do weknow when we are too sleepy, forinstance, to safely drive an auto-mobile? Did you know that 20 per-cent of automobile accidents arerelated to being sleepy?

Sleepiness is a common symp-tom noted by as many as one out offive adults and adolescents. Mostof us can relate some instances offalling asleep when we intendedto be awake. Sleepiness is a nor-mal feeling as we approach a typi-cal sleep period or after prolongedwakefulness. However, excessivesleepiness occurs when we entersleep at an inappropriate settingor have episodes of unintentionalsleep. The sleep may be irre-sistible and may intrude on suchactivities as driving, having a con-versation or eating meals. This de-gree of sleepiness may place us atsignificant risk for accidents andhave a major impact on our healthand sense of well-being.

We may not recognize oursleepiness, describing the situa-tion as only a lapse of attention,such as missing an exit on thehighway. Those who are chronical-ly sleep-deprived become accus-tomed to their impairment and are

less likely to recognize their de-gree of sleepiness.

Excessive sleepiness may re-sult from a wide range of medicaldisorders and medications. Pa-tients with heart, kidney or liverfailure, and rheumatologic or en-docrinologic disorders such as hy-pothyroidism and diabetes maynote sleepiness and fatigue. Neu-rologic disorders, such as strokes,tumors, demyelinating diseasesand head trauma, can evoke ex-cessive daytime sleepiness.

Sleepiness is also frequentlythe cardinal symptom of many

sleep disorders. Patients withsleep apnea and narcolepsy, rest-less legs syndrome and periodiclimb movements during sleep maynote excessive daytime sleepinessas their main complaint. Physicalfindings can seem minor to us,such as frequent pauses, slowedresponses, drooping eyelids,repetitive yawning or dark circlesunder the eyes.

The Epworth Sleepiness Scaleis used by sleep specialists to eval-uate a person’s daytime sleepi-ness. Take just a minute to answerthe questions on this short test andsee if you are unusually sleepyduring the day.

The Epworth SleepinessScale

How likely are you to doze off orfall asleep in the following situa-tions? Use the following scale tochoose the most appropriate num-ber for each situation.

0—would never doze1—slight chance of dozing2—moderate chance of dozing3—high chance of dozing

Situation Chance ofdozing

Sitting andreading

Watching TVSitting, inac-

tive in a publicplace (movie ormeeting)

As a passen-ger in a car for anhour without abreak

Lying down torest in the after-noon

Sitting andtalking to some-one

Sitting quietlyafter a lunchwithout alcohol

In a car, whilestopped for a fewminutes in traffic

Total ScoreAdd up your score. If your score

is higher than 9, you have exces-sive daytime sleepiness. You maywant to consider calling for an ap-pointment with your physician orsleep specialist before you be-come one of those 20 percent of au-tomobile accidents caused byfalling asleep at the wheel. Yourfamily will appreciate it, especial-

ly if they are passengers in the carwhile you are driving.

Source. Principles and Practice of SleepMedicine by Meir Kryger, et al. 2011 edition

Dr. Tim Martin practices dentistry inKingsport with his son, Dr. Kevin Martin atMartin Dentistry and The Center for DentalSleep Medicine.

TimMA RT I N

Health, fitness magazines differ in approachesBy Julie Deardorff

I’m one of those women who likes readingmen’s health and fitness magazines. Thoughthey all promise bodies and sex lives that mostof us will never have, I’m drawn to the funny,self-deprecating tone, the functional workouttips and the emphasis on sweat, competitionand strength training.

Yes, women’s magazines have these ele-ments but on a vastly diminished scale.They’re fluffier, in part because beauty prod-ucts and clothes are considered health-relat-ed, but also because women are still plaguedby the irrational fear of “bulking up.”Wewon’t get huge without added testosterone,but some magazines still perpetuate the no-tion that men should build insanely huge mus-cles and women need to lose fat.

A recent Muscle & Fitness magazine cover,for example, promised “75 of the Best MuscleBuilding Exercises.”By contrast, Muscle &Fitness Hers, the female counterpart to thebodybuilder mag, featured thinspiration, in-cluding “The Skinny on Fat Loss”and “TheBest Natural Appetite Suppressants.”Themajority of advertisements touted fat-burningsupplements, stimulants and weight-lossproducts.

Men’s Health and Women’s Health maga-zines have plenty of overlapping content. Bothrecognize that both genders compete inmarathons and triathlons, want great abs in 15minutes and need nutritional guidance. Butthe editors use considerably different voices

to reach their male and female readers.“For Women’s Health, it’s a confiding, chal-

lenging, sisterly thing —equal parts encour-agement, sympathy and advice. It comes froma place of ‘just us girls,’” said David Zinczenko,editor-in-chief of Men’s Health and editorialdirector of Women’s Health.

“Guys tend to be a bit more bracing withtheir counsel, with a healthy dose of humor —plus self-denigration —thrown into the mix,”Zinczenko added. “First we laugh at our-selves, then we laugh at you, then we deliverthe goods straight up, with an expert chaser.”

The direct “male”approach is what I findappealing. Men’s workouts are usually cast asa way to build a stronger body. Women’s exer-cises are given cute, superficial names, suchas “The Wedding Dress Workout”or “TheBikini Body Booty routine.”Rather than send-ing the message that exercise builds muscle,confidence and improves mental health, theemphasis is on looking good. If your workoutgoal is to fit into a swimsuit, you’re using anunsustainable approach to fitness. But if yourgoal is to get healthy —which means incorpo-rating it as a lifestyle —you’ll have a body thatyou want to show off.

Taking cues from the opposite sexWhat women can learn from reading men’s

magazines:1. Worry more about building muscle than

burning fat. Women “focus on working outwith low weights and high repetitions, using

weights that are significantly lighter than ob-jects they lift all day long, such as children,”fitness trainer Tom Holland wrote in his book“Beat the Gym.”This increases the muscles’endurance without making any meaningfulchanges. “It’s a waste of time,”he said.

2. Play games. Men often think of them-selves as athletes; they play pickup basketball,hit the driving range or join a soccer game tokeep workouts fresh and fun. Chose an activityover the elliptical machine or treadmill.

3. Learn from real athletes. Women’s maga-zines often feature workouts from actresseswho have to look good for the camera. Men’smagazines are full of training secrets fromathletes who have to perform.

What men can learn from women’s fitnessmagazines:

1. Join a class. Men were the ones who in-vented Zumba and Pilates; yoga and barre canalso strengthen muscles men didn’t know theyhad, increase flexibility, help prevent injuryand shift the focus from boring gym routines.

2. Lighten up. While women could useheavier weights, men can benefit from lighterones or even body weight exercises. “Wi t hmen, the major problem is ego; they want toimpress the other guys in the gym,”said Hol-land. “It leads to bad form, decreased resultsand inevitable injury.”

3. Balance: Men typically train their mirrormuscles —the chest and biceps. Incorporat-ing a workout from a woman’s magazine couldhelp target other muscle groups and result ina more balanced physique.

Dr. Michael Kauzlarich

Cholesterol and Heart DiseaseCholesterol helps your body build new cells, insulate nerves, and produce hormones. Normally the liver makes all the cholesterol the body needs but cholesterol also enters your body from food, such as animal-based foods like milk, eggs, and meat. Too much cholesterol in your body is a major risk factor for heart disease.When there is too much cholesterol in your blood, it builds up in the walls of your arteries causing a process called atherosclerosis, a form of heart disease. The arteries become narrowed and blood fl ow to the heart muscle is slowed down or blocked. Blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.There are two forms of cholesterol that most Americans are familiar with: Low-density lipoprotein (LDL or “bad” cholesterol) and high-density lipoprotein (HDL or “good” cholesterol.) These are the forms in which cholesterol travels in the blood. LDL is the main source of artery-clogging plaque. HDL actually works to clear cholesterol from the arteries and transports it back to the liver to be eliminated in the stool.Triglycerides are another fat in our bloodstream. Though research is now showing that high levels of triglycerides may also be linked to heart disease, the connection is still controversial.High cholesterol itself does not cause any symptoms so many people are unaware that their cholesterol levels are too high. Talk to your doctor and fi nd out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it.

Mountain Region Family Medicine, P.C.

444 Clinchfi eld Street, Suite 201Kingsport, TN 37660

423-230-2700


Implantable pain disk gives relief to cancer patientsBy Meredith Cohn

An estimated 3.5 million can-cer patients around the globe arein severe pain from their disease,but many get no relief.

In poor countries the cost isconsidered too high for drugs likemorphine when such opioids areoften stolen, abused or not takenaccording to instruction.

But some Johns Hopkins Uni-versity scientists have been work-ing on a solution for those pa-tients, as well as some in theUnited States, that uses a flexiblebutton-sized disk implanted un-der the skin that releases consis-tent doses of painkiller over amonth. No pills, no measuring, notrips to the clinic.

If an upcoming clinical trialfor safety goes well, the devicecould be available next year, doc-tors say. It also could be retooledto treat other diseases and injury,and maybe even some opioid ad-dicts.

“With all the problems, thehealth officials [in developingcountries] would prefer to spendmoney on antibiotics that curediseases, vaccines that preventdiseases or children with a longlife ahead of them rather thanthose with terminal cancer,” saidDr. Stuart A. Grossman, a JohnsHopkins professor of oncology,medicine and neurosurgery anda pain management expert inHopkins’ Sidney Kimmel Com-prehensive Cancer Center.

Grossman grew up overseasbut when he returned to Indiaand other poor countries as anoncologist and worked in cancercenters he saw how hard it wasfor patients with cancer to getopioid pain medications. He andothers began working on a solu-tion about 15 years ago. Theycame up with something thatworks a little like Norplant, therods inserted under the skin thatrelease contraceptives overweeks.

Only this round, plastic diskjust over a centimeter wide deliv-ers hydromorphone, a more po-tent form of morphine, through achannel in its center. The rest ofthe device is sealed to prevent aninitial burst of the drug thatcould kill a patient.

The disk could be made widerto deliver drugs longer, or thickerto deliver higher doses. It eventu-ally could deliver a differentdrug or be used by veterinarianson animals. But for now, the sci-entists are focusing on one devicefor cancer patients that wouldcost about $50 a month, or aboutthe same as the bill for relatively

cheap morphine pills.With Hopkins’ blessing, Gross-

man patented the device andformed a company called Axxia.Dr. Suzanne A. Nesbit, a clinicalpharmacy specialist in pain man-agement and a research associ-ate in the Hopkins oncology de-partment, will run the clinical tri-al, which was delayed a bit whenthe maker of the plastic they pre-ferred decided to stick to produc-ing the soles of shoes.

They’re working with a newplastic that already is approvedfor medical implants by the U.S.Food and Drug Administrationbut requires some fine tuning.

The clinical trial for the diskwill be conducted in the Philip-pines, Singapore and East Balti-more, where Hopkins has a pres-ence.

Grossman said a U.S. manu-facturer would make the drug de-vice and Axxia will rely on phar-maceutical companies aroundthe world to distribute it andtrain doctors unaccustomed toassessing pain, dosing and moni-toring patients.

Some of those who treat painand addiction believe the disk

would serve some populationswell and look forward to havinganother tool for tricky patients,though they also see some chal-lenges.

There are an estimated 5 mil-lion Americans on opioid thera-py for pain, or 2.5 percent of thepopulation, though most take ashort-acting, low-dose Vicodin orsimilar pill and not every day,said Dr. Nathaniel Katz, the di-rector of the nonprofit Programon Opioid Risk Management atthe Tufts Health Care Institute.

Opioids don’t work well man-aging everyone’s pain, and about5 percent of people who takethem become addicted to themedications. Others don’t stick totheir regimen, said Katz, who isalso the CEO of a pain-drug de-velopment company called Anal-gesic Solutions.

There may be a role for Gross-man’s pain disk in addicts andthose who don’t follow their pre-scriptions, he said.

“There are people out therewho would benefit from havingsomething in their body releasingdrugs at all times that doesn’t in-volve the patient and can’t be

changed by them,” he said.“These are people who you fearmight overdose if you give thempills, or there is an abuser in thehousehold, or the person hasmental illness like PTSD, orParkinson’s disease.”

Many don’t have consistentpain, and it would be better ifthey could change their dosage asneeded, Katz said. But whenthat’s not possible, some relief isbetter than none, Katz added.

The disk, he said, may notsolve all illicit use of the drug.Even though they are meant to beimplanted by a doctor, addictsare crafty and will find ways toacquire them, melt them downand ingest them, said Katz,adding many such recipes end upon Internet.

Some addicts have beenknown to eat pain patches eventhough that can be fatal, Katzsaid.

The disks could only be usedto treat addiction if they deliv-ered a different drug than hydro-morphone because that drug isnot approved by the FDA fortreating addiction, only for pain,he said. Only methadone andbuprenorphine currently havethat stamp from the FDA.

There is a growing need fornew treatments for addiction toprescription drugs such as oxy-codone and morphine, said Dr.Michael Fingerhood, an associ-ate professor of medicine at theJohns Hopkins University.

The number of admissions toMaryland Alcohol and DrugAbuse Administration-fundedtreatment programs for prescrip-tion drug addiction doubled to7,000 between 2007 and 2010, ac-cording to the state Departmentof Health and Mental Hygiene.

Others, especially teens, findunused opioids in their parents’medicine cabinets. About 2,500American teens use prescriptiondrugs every day to get high for thefirst time, according to the Part-nership for a Drug Free America.

Maryland joined dozens ofother states this year in creatinga database to track filled pre-scriptions so doctors know whensomeone may be shopping for ex-tra drugs, but the system is notyet up and running.

The trend is likely to continueuntil doctors stop prescribing somany addictive drugs, said Fin-gerhood, who treats addicts.

He said addicts still often havepain, but the pain becomes diffi-cult to treat because they can’t behanded more pills. This is whereDr. Grossman’s disk may come in.

Not for treating the addiction— there already is a similar rodimplant developed by TitanPharmaceuticals Inc. awaitingFDA approval that containsbuprenorphine for that purpose.But to treat the pain, said Finger-hood, who also is the director ofthe division of chemical depen-dence at Hopkins Bayview Medi-cal Center.

“It’s a great option for pain,”he said. “It’s treated poorly nowin this population because theycan’t take traditional pills. ... AndI think implants are going to bethe wave of the future with othermedications as well.”

Photo by Algerina Perna

Dr. Suzanne A. Nesbit and Dr. Stuart A. Grossman of the Sidney Kimmel Compre-hensive Cancer Center at Johns Hopkins, are working on a polymer disk, whichGrossman is holding, that’s inserted under the skin and releases pain medication.The disk would be especially useful in developing countries were opiods are muchharder to get.

‘ There are people out therewho would benefit from hav-

ing something in their body releasingdrugs at all times that doesn’t involvethe patient and can’t be changed bythem. These are people who you fearmight overdose if you give them pills,or there is an abuser in the house-hold. ’

— Dr. Stuart A. Grossman

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AgingAgeless Grace Series, 10:30

a.m., Mondays and Wednesdays,July 9-25, IPMC Health ResourceCenter, Kingsport Town Center.Focusing on different anti-agingtechniques, joint mobility, spinalflexibility, right/left brain coordi-nation, cognitive function, sys-temic stimulation, balance, confi-dence and playfulness. $5 per ses-sion. To register, call1-800-888-5551.

Alternative medicineTai chi, 3 p.m., Tuesdays, July

3-31, IPMC Health Resource Cen-ter, Kingsport Town Center. $40for month. To register, call1-800-888-5551.

CancerAlternative Treatments for the

Side Effects of Cancer-RelatedDisease, noon, July 19, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Survive & Thrive, 6:30 p.m,

Tuesdays, oncology library, thirdfloor, Wilcox Hall, Holston ValleyMedical Center. Call 224-5592.

• • •Sisters, for women who have

been touched by breast cancer,6:30 p.m., first Thursday, oncologylibrary, third floor of Wilcox Hall,Holston Valley Medical Center.Call 224-5592.

Children/parentingImmunizations, Your Child’s

Best Shot, 4 p.m., July 10, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Mommy’s Milk Club, 4 p.m., Ju-

ly 12 and 26, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

• • •Marathon Childbirth Class, 9

a.m. to 4 p.m., July 14, IPMCHealth Resource Center,Kingsport Town Center. $20. Toregister, call 1-800-888-5551.

• • •Childbirth, 10 a.m. to 5:30 p.m.,

July 14, Holston Valley MedicalCenter, Heritage Room. To regis-ter, call 877-230-NURSE.

• • •Sibling Class, noon, July 21,

Holston Valley Medical Center,Birthplace Conference Room. Toregister, call 877-230-NURSE.

• • •Prevention of Sports Injury, 3

p.m., July 23, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

• • •Carseat/Booster Safety Class

and Carseat Check, 3 p.m., July 24,

IPMC Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Breastfeeding Basics, 6:30-9:30

p.m., July 26, Holston Valley Med-ical Center, Allandale Room. Toregister, call 877-230-NURSE.

CPR/first aidAdult first aid/CPR/AED, 9 a.m.

to 4 p.m., July 9, American RedCross, 501 S. Wilcox Drive,Kingsport. To register, call1-800-REDCROSS or visit red-cross.org/takeaclass.

• • •First aid, 5:30-8:30 p.m., July 10,

American Red Cross, 501 S.Wilcox Drive, Kingsport. To regis-ter, call 1-800-REDCROSS or visitredcross.org/takeaclass.

• • •Adult CPR/AED, 5:30-8:30 p.m.,

July 12, American Red Cross, 501S. Wilcox Drive, Kingsport. Toregister, call 1-800-REDCROSS orvisit redcross.org/takeaclass.

• • •Adult first aid/CPR/AED, 9 a.m.

to 4 p.m., July 18, American RedCross, 501 S. Wilcox Drive,Kingsport. To register, call1-800-REDCROSS or visit red-cross.org/takeaclass.

• • •First aid, 5:30-8:30 p.m., July 24,

American Red Cross, 501 S.Wilcox Drive, Kingsport. To regis-ter, call 1-800-REDCROSS or visitredcross.org/takeaclass.

• • •Adult CPR/AED, 5:30-8:30 p.m.,

July 31, American Red Cross, 501S. Wilcox Drive, Kingsport. Toregister, call 1-800-REDCROSS orvisit redcross.org/takeaclass.

DiabetesDiabetes self-management, 9

a.m. to 4 p.m., July 2, Lee RegionalMedical Center, Pennington Gap,Va. Physician referral required.To register, call 224-3575 or844-2950.

• • •Know Your Nutrition, 5 p.m.,

July 10, IPMC Health ResourceCenter, Kingsport Town Center.To register, call 1-800-888-5551.

• • •Advanced nutrition, 9-11 a.m.,

July 11, Diabetes Treatment Cen-ter, Kingsport. Physician referralrequired. To register, call224-3575 or 844-2950.

• • •Diabetes self-management,

1-4:30 p.m., July 11-12; 9 a.m. to 5p.m., July 18, Diabetes TreatmentCenter, Kingsport. Physician re-ferral required. To register, call224-3575 or 844-2950.

• • •Better Blood Sugar in 30 Days,

4 p.m., July 16, IPMC Health Re-source Center, Kingsport TownCenter. To register, call

1-800-888-5551.• • •

Know Your Numbers, 5 p.m.,July 17, IPMC Health ResourceCenter, Kingsport Town Center.To register, call 1-800-888-5551.

• • •Diabetes self-management, 8

a.m. to noon, July 19; 8-10:30 a.m.,July 20, Hawkins County Memori-al Hospital. Physician referral re-quired. To register, call 224-3575or 844-2950.

• • •Know Your Healthy Steps, 5

p.m., July 24, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

• • •Diabetes Self-Management,

8:30 a.m. to 4 p.m., July 26, IPMCHealth Resource Center,Kingsport Town Center. $40. Toregister, call 1-800-888-5551.

• • •Got #’s? noon, July 30, IPMC

Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Kingsport Diabetes Associa-

tion, 7 p.m., second Tuesday, Indi-an Path Hospital Building 2002,Room 203, Kingsport. Helping di-abetics and their families betterdeal with the serious disease ofdiabetes. Call 534-2646.

Emotional healthParent support group for par-

ents and caregivers of childrenwith autism or Asperger Syn-drome, 6 p.m., first Tuesday,Mountain Region Speech andHearing Center. Call MelissaKeeler at 863-6473 or Liz Dotsonat 246-4600 or e-mail [email protected] or [email protected].

• • •Depression and/or anxiety dis-

orders support group, 7 p.m.,Thursdays, at 645 E. Main St.,downtown Kingsport.

• • •Stress, noon, July 26, IPMC

Health Resource Center,Kingsport Town Center. to regis-ter, call 1-800-888-5551.

• • •Tri-Cities Survivors of Suicide

Support Group, 6-8 p.m., fourthMonday, Boones Creek ChristianChurch, Entrance K, Room 403.SOS is for those who have lostsomeone by suicide, are interest-ed in suicide prevention or mighthave helpful information forthose who do. Call Linda PhippsHarold at 361-2087.

• • •Survivors of suicide support

group, 6 p.m., fourth Thursday,Lee Behavioral Health,Jonesville, Va. Call (276) 346-3590or (276) 346-1641.

• • •

Compassionate Friends ofTennVa, 2 p.m., second Sunday,Bristol Public Library, corner ofPiedmont Avenue and GoodStreet, Bristol, Va. Assisting fami-lies toward a positive personalacceptance of grief following thedeath of a child of any age and toprovide information to help oth-ers be supportive.

• • •Alzheimer’s Support Group

Meeting for Caregivers, 10 a.m.,first Tuesday, Preston Place II,2303 N. John B. Dennis Hwy.,Kingsport. RSVP by calling378-HOPE.

FibromyalgiaFibromyalgia Support Group,

2 p.m., July 9, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

Heart healthCoronary Risk Panel, 7 a.m. to

9 a.m. July 10, IPMC Health Re-source Center, Kingsport TownCenter. $15. To register, call1-800-888-5551.

• • •Congestive Heart Failure,

noon, July 31, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

HIV/AIDSPOZ Support Group, for all

those affected by HIV, 6:30 p.m.,first and third Thursdays, HillriseHall conference room. Call439-6006 and 439-6019.

Lar yngectomyNu-Voice Club, support group

for laryngectomy patients, 6 p.m.,fourth Tuesday of each month,Bristol Regional Medical CenterConference Center Elm Room.

Mental healthJohnson City National Al-

liance for the Mentally Ill, (NA-MI), 7 p.m., second Thursday, Har-rison Christian Church, offBrowns Mill Road, Johnson City.Call 538-4216 or 239-6492.

• • •Kingsport National Alliance

on Mental Illness (NAMI), 7 p.m.first Thursday, First BaptistChurch, Church Circle, Kingsport.Call 234-2516 or 866-337-3291.

Nutritional healthBerry Beneficial, noon, July 6,

IPMC Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Cooking for 1 or 2, noon, July

12, IPMC Health Resource Cen-ter, Kingsport Town Center. Toregister, call 1-800-888-5551.

• • •Vegetarian Cooking, 4 p.m., Ju-

ly 30, IPMC Health Resource Cen-ter, Kingsport Town Center. Toregister, call 1-800-888-5551.

Parkinson’sParkinson’s support group, 7

p.m., fourth Tuesday, AsburyBaysmont, 100 Netherland Lane,Kingsport. Call 245-0360.

Respiratory healthHereditary Emphysema:

Could Your Genes Be Responsi-ble? 1 p.m., July 11, IPMC HealthResource Center, Kingsport TownCenter. To register, call1-800-888-5551.

• • •The Young and the Breathless,

a support group for pulmonarypatients and their families, 5 p.m.,fourth Thursday, Heritage Room,D Building, Wellmont HolstonValley Medical Center. Call224-5800.

Skin careSun Exposure: How Much Are

You at Risk? noon, July 18, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Don’t Get Bugged This Sum-

mer, noon, July 25, IPMC HealthResource Center, Kingsport TownCenter. To register, call1-800-888-5551.

• • •Skin Care for Teens, 2 p.m., Ju-

ly 28, IPMC Health Resource Cen-ter, Kingsport Town Center. Toregister, call 1-800-888-5551.

Visual healthKingsport Association for the

Visually Impaired, a supportgroup for visually impaired per-sons, 7 p.m., first Tuesday, BethelPresbyterian Church, 1593Warpath Drive, Kingsport.

Weight lossExploring the Weight Loss

Surgery, 6 p.m., July 5 and 16,Madison House, Kingsport. Toregister, call 877-230-NURSE.

• • •Lose it 4Good, 6 p.m., third

Tuesday, HMG Medical Plaza, 2ndFloor Conference Room, 105 W.Stone Drive. Free and open to thepublic. Call 857-2790.

• • •T.O.P.S. (Take Off Pounds Sen-

sibly) Chapter 58 Thursdays, Con-cordia Lutheran Church, 725Truxton Drive, Kingsport.Weigh-in, 10 a.m.; meeting, 10:30a.m. Call (423) 254-0708.

• • •TOPS Tennessee Support

Group Chapter 520, 6 p.m., Mon-days, Bethel PresbyterianChurch, Kingsport. TOPS (TakeOff Pounds Sensibly) is an inter-national non-profit weight losssupport group. Call 245-6496.


A guide to assist you in buying hearing aidsBefore buying a hearing aid,

there are several aspects that youneed to consider. These can in-clude your medical history, theresults of your hearing evalua-tion, the listening needs for yourlifestyle, as well as hearing aidfeatures and services.

One main objective to consid-er is whether or not you evenneed a hearing aid or if you areeven a candidate for wearing ahearing aid. If you have a mildloss you may or may not need ahearing aid. Each individual isdifferent.

Some people with mild hear-ing loss struggle with communi-cation while others with the samedegree of loss may only have dif-ficulty hearing, if they are sittingfarther away from the source ofthe sound. If you have a very se-vere hearing loss, then you maynot be a candidate for a tradition-al hearing aid or a hearing aidmay be of limited benefit. If you

have a medical condition involv-ing your ear or a history ofsurgery on your ear, then a physi-cian will need to determine if youare able to wear a hearing aid.

Another point to consider ishaving the hearing aid featuresfit your lifestyle needs.

What features do you reallyneed on a hearing aid? Will the

benefit of additional featuresoutweigh the additional cost? Ifyou have a quiet lifestyle you maynot need a hearing aid that is asadvanced as someone who is ac-tively involved in work, meetings,social events and other highlyvaried listening environments. Ifthe size of the hearing aid is notthe main concern to you, then youwill have the benefit of better lis-tening options and longer batterylife of a slightly larger hearingaid.

Other particulars regardinghearing aids, like service, may al-so need to be considered. Mosthearing aids come with a warran-ty, but you will need to know ifthe warranty covers loss anddamage or just repairs, and thelength of the warranty period foreach service.

Also, determine if the warran-ty can be extended and theamount of time it can be extend-ed. In most states, a law requires

that hearing aids come with a tri-al period. You will need to knowthe length of the trial period, andwhether or not the trial periodcan be extended if the hearingaid has to be remade or repaired.

Learn about any up front feesyou pay with the trial period, andwhat fees are refundable if thehearing aid is returned.

Also, what adjustments andservices can be performed in theoffice? How long are these ser-vices provided, and do you needan appointment for these ser-vices?

It may be beneficial to have afriend or family member comewith you to the appointments for

your hearing evaluation, hearingaid assessment and hearing aidfitting. Having someone with youcan help ease anxiety. This per-son can also serve as a secondopinion regarding hearing aidoptions, or help you rememberuseful information later on.

Purchasing hearing aids canseem like a daunting process ifyou do not know what to expect.But if you do your research, askthe right questions and providehonest information, you can soonhave better hearing with ease.

Danielle Combs is a clinical audiologistwho staffs The Hearing Center at HolstonValley Medical Center. E-mail her [email protected]

DanielleCOMBS

Landlines still life lines for manyBy Kim Ode

Dust always needs a place to land. Take therecord turntable, rarely used, but there when youwant to listen to some classic vinyl. Or the transistorradio. The sound quality is awful, but it’ll come inhandy if a storm knocks out the power. The tele-phone? Well, every once in a while, it does ring.

Sometimes you might even see it sporting ablinking light — if you ever looked.

“We got rid of our land line a couple of years agobecause no one would listen to the messages,” saidDeb Balzer, a publicist in Minneapolis. “We actuallywould have disagreements or discord because noone would listen to the messages, let alone pick upthe phone. All of our friends have our cell, so we’dassume if someone was calling the house, it was asolicitor or worse.”

Pity the telephone.More than eight in 10 U.S. adults own a cell-

phone. That proportion likely increased while youread that sentence.

That makes the cellphone the most popular elec-tronic gadget owned by adults in the United States,according to the Pew Research Center’s Internetand American Life Project. No wonder that by De-cember 2010, three of every 10 U.S. homes had onlywireless telephones — an increase of more than 3percent in that year alone, as reported by the Na-tional Center for Health Statistics.

Also: Even in homes that still have a traditionalphone, one in six of them received all or almost allof their calls on wireless phones.

But there are reasons people keep a land line(which is a classic retronym, or term for somethingdevised after a similar, but newer, thing has comeinto use).

Jan Russell of St. Louis Park, Minn., said herhousehold keeps its land line because they havetwo young boys “and we wanted to make sure thatthey could call 911 if something were to happen tous or their 78-year-old grandpa who lives with us.”

Russell raised a common concern: whether inemergencies, a cellphone could provide a location,especially if the caller can’t do so, or if the cell-phone has a different area code than where it’s be-ing used. The good news is that most cell- andsmartphones now have GPS, or global tracking fea-tures. You can be tracked whether you like this“feature” or not.

Still, when time is of the essence, people worrythat a cellphone might not be charged, the callmight get dropped or that they might not even beable to find it. As with TV remotes, a cellphone nev-er seems to be in the same place twice. It may be inthe bottom of a cavernous purse, forgotten in thecar (not that anyone used it there), or simply awaywith its owner, leaving a household incommunica-do.

In this new world, “household” becomes an op-erative term. Back in the day, a phone number con-nected you to everyone who lived under one roof.Now, callers to homes without a land line need todecide whose cellphone is the best way to contact af a m i l y.

In some households, land lines may follow thearrival of children, especially when parents don’twant every homework question or “come out andplay” call coming in through their cellphones.

When Amanda Lancette and her husband set uphousekeeping, each used their own cellphones.“People could contact us directly, and we didn’tmiss having a land line at all,” she said. When theybought a desktop computer in 2000, however, theyneeded a land line for dial-up Internet. With a babyin 2005, it made even more sense to keep the phonefor her mother-in-law, who cared for the baby.

“If we did get rid of our land line again, our [cell]phones would certainly become community proper-t y, ” said Lancette, of Eagan, Minn. “We already havethe issue of missed texts and things because theboys are playing apps on our phones.” Still, oncethe boys are old enough to have cellphones, shesaid they’ll likely drop the land line.

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Beyond meat: Americans preoccupied with proteinBy Michael Hill

Carbs? Calories? Fat? Theyare so very last decade. Dietersand would-be healthy eatersknow the nutrient of the momentbeing tallied, sought and boughtis protein.

Spurred by trainers, diet gu-rus and weight-loss plans, Amer-icans are seeking more— andmore unique — sources of pro-tein, from almonds ground intomilk and soy reshaped as pasta,to peas and whey turned intopowders and shakes. And foodproducers are happy to oblige.

Powders and energy barspacked with 20, 30 or even moregrams of protein per serving areselling briskly. Supermarketshelves once crowded with foodsboasting of being high in fiber orlow in fat now are jammed withclaims of protein content. Yetthis is happening even as Ameri-cans eat less meat, the go-tosource of protein for genera-tions.

“People are getting smarterabout foods in general,” saidPhil Lempert, a food marketingexpert known as The Supermar-ket Guru. He sees higher meatprices driving people to othersources of protein, a movementthat has becoming more pro-nounced this year.

“Longer term, I think you’regoing to see people starting tolook at more vegetables and dif-ferent combinations to createproteins like rice and beans.”

Amanda Perry — an on-the-gomom with two jobs and a1-year-old — is a good example.She counts on lots of protein tokeep her feeling full and full ofenergy. But she needs it to beportable, so she often mixes pro-tein powder with almond milk,maybe a banana and somepeanut butter.

“It’s easily portable, which Ithink is awesome for busy peo-ple because you’re on the run,”said Perry, a 31-year-old personaltrainer who owns a gym inChelmsford, Mass., with her hus-band. “You can’t really take achicken breast or a piece ofsteak with you if you’re going tobe out for several hours.”

Red meat, a rich source ofprotein, is going through an es-pecially bumpy run. Prices areup, and so are health concernsabout beef and its saturated fatcontent. Americans are expectedto consume about 15 percent lessbeef on a per capita basis thisyear compared to 2007, accord-ing to Steiner & Company, aneconomic consultant to the food

industry. Per capita consumptionof all red meat and poultry is ex-pected to be down by 10 percentover the same period.

But if forces are pushing peo-ple away from meat, health con-scious Americans are simultane-ously being lured to othersources of protein, such as nuts,beans, soy and seafood.

Protein has had popularitypeaks before — think of theAtkins diet craze not so manyyears ago — though this timethere are a chorus of voices tout-ing the benefits of protein-heavyregimens like the Paleo Diet,which stresses the lean meatsand wild plants eaten by our an-cestors. And it’s being helpedalong by accumulating evidencethat plant-based protein canlower cholesterol levels andhave other beneficial effects.

A trip down the grocery aisleshows food makers are tuned into this trend and happy to en-gage shoppers about it, fromYoplait Greek yogurts (“2X pro-tein”) to Boca meatless lasagna(“21 g protein”) to Perdue chick-en breast tenders (“excellentsource of protein”).

Like your protein concentrat-ed? Analysts say sales are up forhigh-protein bars.

“As Americans are becomingmore health conscious and busi-er, protein bar sales are increas-ing because they are a conve-nient way to gain protein on thego,” said IBISWorld analyst MaryNanfelt, adding that many pro-tein bars are eaten after a work-out to help the stressed-out mus-cles.

Also popular are the pro-tein-rich powders, often madewith whey, once associated most-ly with weightlifters looking tobulk up. Perry said her proteinpowders — which are vegan be-cause they sit in her stomachbetter — make her feel more en-ergetic.

“I used to be afraid of it. AndI have friends and clients whoare sort of afraid of it. Theythink, ‘Oh, I’m going to gain toomuch weight, it’s too many calo-ries.’ But what they don’t know— and this is common for a lot ofwomen — is that they’re not get-ting enough calories, and they’renot getting enough protein.”

Actually, most Americans eatplenty of protein. The latestavailable federal survey of whatAmericans eat, which covers2007-2008, shows both men andwomen commonly consumingmore protein than needed,sometimes by a third or more.

Of course, the amount of pro-tein needed varies by age,weight and activity level, thoughfederal recommendations sug-gest 56 grams daily for a 154pound man and 46 grams for a126 pound woman. Those levelsare not difficult to achieve if, say,you scramble eggs for breakfast,grab a couple of slices of pep-peroni pizza for lunch and eatchicken and broccoli for dinner.

“There’s this whole idea that Ithink a lot of people are plaguedby that you have to get so muchprotein. And the truth is most ofus do get enough protein andyou don’t have to have as muchas you think,” said Marisa

Moore, an Atlanta-based dieti-tian and spokeswoman for theAcademy of Nutrition and Di-etetics.

People worried about proteinmight do better focusing on ahealthy, diverse diet rather thancounting grams.

Margaret McDowell, a nutri-tionist with the National Insti-tutes of Health’s Division of Nu-trition Research Coordination,notes that lean meats and poul-try, seafood and fat-free dairyproducts are all good ways to getprotein.

“If you can consume yourfoods from a normal diet, thatwould be preferable becausefoods give a lot of other thingsbeside protein and it’s probablymore tasty and enjoyable to eat alean piece of grilled chicken,”McDowell said. “I only eat pro-tein bars if I’m desperate, if I’mrunning for a long time or need aquick snack.”

Photo by Charles Krupa

Amanda Perry, a wife and mom who works two jobs, gets her protein from a shake in which she blends a vegan protein pow-der with almond milk, natural peanut butter, ice and a banana.

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Apple cider vinegar tonicmay cure what ails you

MarieBROWNING

Summer is a great time forbecoming healthier, and thereare many reported health bene-fits of using apple cider vinegar(ACV). Some have clinical sup-port, but the science behind itsefficacy is lacking or poorly un-derstood most of the time.

So far, researchers can onlyagree there is something aboutACV that works for a wide vari-ety of ailments.

It is important to me that anatural remedy be, first andforemost, harmless to the aver-age person. Certainly any prod-uct, natural or synthetic, cancause a problem for someone.However, ACV has at least a3,000 year track record of safetyand efficacy. What modernmedicine can make the sameclaim?

The basic ACV “tonic” con -sists of two or three teaspoons ofACV per cup of water. For opti-mal results, please use a qualityraw ACV such as Bragg’s, Spec-trum or Earth Fare. Adding aspoonful of natural raw honeycreates a more palatable drinkand adds its own health bene-fits.

Cautions: Always rinse yourmouth with water after consum-ing vinegar to avoid damage totooth enamel, and check with ahealthcare professional beforeusing ACV therapeutically if youtake any medications, as somehave the potential to interactwith vinegar.

Here are a few common con-ditions that apple cider vinegarcan help resolve:

• Diabetes: Several studies,including the one below, haveconfirmed that ACV helps regu-late blood glucose. Most studieshave subjects drink ACV in wa-ter just before or during one ortwo meals per day. ACV appearsto interfere with the absorptionof carbohydrates and slows therise of blood sugar. (Johnston C, KimC, Buller A: Vinegar improves insulin sen-sitivity to a high-carbohydrate meal insubjects with insulin resistance or diabetes.Diabetes Care 27:281-282, 2004)

• Sunburn: ACV can speedhealing of sunburned skin, re-ducing pain, redness and peel-ing. It can be sprayed or dabbedon full strength, or diluted witha little water. Several cups canbe added to a tubful of warmwater for full body relief as well.Iced ACV for soaking burnedfeet is nearly miraculous. I rec-

ommend following the ACV withapplication of pure, raw coconutoil to further skin healing.

• Swimmer’s ear infections:Infections like swimmer’s earcan be prevented or managed byirrigating the ear with a 50/50 so-lution of ACV and water. Thiswas first recommended to me bya local physician, and its regularuse put an end to my kids’ prob -lems during swim team and lakeliving years. Since ACV is a nat-ural anti-fungal agent, it has nu-merous related applications.

• Acid reflux: ACV tonichelps regulate acidity and stoppainful reflux for many people.It may sound strange, but youwould be amazed at how wellthis works.

• Sinusitis: The ACV tonic isa natural expectorant and ap-pears helpful in reducing thepain and inflammation associat-ed with sinusitis. Sniffing a 50/50percent mixture of ACV and wa-ter can also help clear out infec-tions. One easy way to do this isby using a clean nasal spray bot-tle to spray into the nose, lettingit run down behind the nasalpassages and down the back ofthe throat.

• Hypertension: Preliminarystudies show ACV to be effectiveat reducing high blood pressure.This does not mean medicationscan be immediately discontin-ued! ACV is merely one of sever-al healthy lifestyle habits thatresult in normal BP.

• Arthritis: Virtually every-one who tries the ACV tonic re-ports significant decrease inarthritis type pain. The usualdosage for this application istwo to three times per day.

• Sleep quality: Drinking asmall glass of the ACV “tonic”helps many people sleep moresoundly with fewer nighttime

bathroom visits.This age-old remedy has been

touted as a cure-all for hundredsof years. It may not cure every-thing, but it sure comes close!I’ve only touched on a handful ofapplications. I’d love to hearhow ACV has helped you. Havea safe Independence Day, every-one!

Marie Browning holds a master’s de-gree in holistic nutrition and is certified innutritional wellness. She offers seminarsand private consultation in the Tri-Citiesarea. Her website is www.healthiersolu-tionsbymarie.com or call her at 367-1396.

So far, researchers canonly agree there is

something about ACVthat works for a wide

variety of ailments. It isimportant to me that anatural remedy be, first

and foremost, harmless tothe average person.

Certainly any product,natural or synthetic, can

cause a problem forsomeone. However, ACVhas at least a 3,000 year

track record of safety andefficacy. What modernmedicine can make thesame claim? The basicACV “tonic” consists oftwo or three teaspoons of

ACV per cup of water.For optimal results, please

use a quality raw ACVsuch as Bragg’s,

Spectrum or Earth Fare.Adding a spoonful of

natural raw honey createsa more palatable drinkand adds its own health

benefits. Cautions: Alwaysrinse your mouth withwater after consuming

vinegar to avoid damageto tooth enamel, and

check with a healthcareprofessional before using

ACV therapeutically.

How to cut back onhigh-calorie juice

By Monica EngMany public health officials

are now warning patients thatfruit juice poses many of thesame health risks as sodawhen it comes to obesity anddiabetes. What concrete ac-tions can consumers take?

Global nutrition professorBarry Popkin and others ad-vise eating whole fruits (whichcontain fiber) instead of drink-ing fruit juices, so that a feel-ing of fullness is deliveredwith the sugars and calories.

Some new, less sugary juiceproducts are on the market, hesaid, but parents also can sim-ply water down juice at home.

Although liquids won’tquell hunger as well as solidfoods, Popkin said a smoothiemade, for example, with ba-nanas, blueberries, ice and nosugar would be “a hell of a lot

better than just blueberryjuice” because the smoothiewould still contain the fruits’f i b e r.

Health advocates also notethat even if a product is la-beled as 100 percent juicewith no added sugar, it cancontain high levels of “natu -ral” sugar. Fruit juice concen-trates also can make a productmuch sweeter than juice ob-tained simply from squeezingfruit.

New York University nutri-tion professor Marion Nestleacknowledges that cuttingjuice out entirely may not berealistic for everyone.

“In theory, it’s absolutelytrue,” Nestle said of the needto avoid juice. “In practice, it’sbest to restrict to 6 or 8 ouncesa day, max. The best advice?Don’t drink your calories!”

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When Alzheimer’s not the real problemBy Robin Erb

His loved ones dreaded whatmight be next: a diagnosis ofAlzheimer’s.

Martin Rosenfeld had calledtoo many times — confused andfrustrated — from a parking lotoutside his synagogue, after driv-ing there in the middle of thenight for services that wouldn’tbegin for hours.

Once a meticulous pat-tern-maker in the clothing indus-try, he now nodded off mid-con-versation. Spilled things. Mum-bled.

“We ’d be getting calls all nightlong. He’d say, ‘What time is it?Can I get up now?’” said hisdaughter, Shelley Rosenberg,whose husband, Don Rosenberg,chairs the Alzheimer’s Associa-tion’s Greater Michigan Chapter.

Rosenfeld’s confusion, whichturned out to be caused partly bysleep apnea, reflects what thehead of Wayne State University’sInstitute of Gerontology worriesis a growing trend in the numberof Americans being wrongfullyassumed — even medically mis-diagnosed — with Alzheimer’s,the most common form of demen-tia and perhaps the most feareddisease of old age.

“It’s a real problem. If you’reolder, and you get a label ofAlzheimer’s — even a hint thatyou have Alzheimer’s — there’sno more critical thinking about it.Yo u ’re written off by a lot of peo-ple,” said Peter Lichtenberg,head of the institute and a clini-cal psychologist who has testifiedin several probate cases in whicha person’s mental capacity was atissue.

Lichtenberg, in a Decemberpaper for the journal ClinicalGerontology, highlighted two casestudies: in one, a man’s bouts ofconfusion and agitation in hislate 70s were caused by illnessand painful cellulitis, notAlzheimer’s; in the other, an87-year-old woman, who seemedsuddenly confused, was sufferingfrom depression.

Lichtenberg’s paper builds onresearch elsewhere that suggeststhat the difficulty in pinningdown Alzheimer’s makes misdi-agnosis too easy. The research isbased mostly on small studies butalso on an ongoing, long-termstudy supported by the NationalInstitute on Aging, which is partof the National Institutes ofHealth. In cases reviewed so far,about one-third of Alzheimer’sdiagnoses were incorrect, saidlead researcher, Lon White.

“The diagnosis was deadwrong one-third of the time, andit was partially wrong a third ofthe time, and it was rightone-third of the time,” Whitesaid.

The project, called the Hon-olulu-Asia Aging Study, has beenunder way since 1991 and fo-cused on the precise brainchanges linked to Alzheimer’sdisease and other types of de-mentia. Pathologists examinedthe brains of 852 men born be-tween 1900 and 1919, about 20percent of whom were diagnosedwith Alzheimer’s.

In the cases carrying anAlzheimer’s diagnosis, two-thirdsof the brains exhibited the typesof lesions closely linked toAlzheimer’s. Half of those fea-tured other problems, as well,such as scarring on the hip-pocampus, the part of the brainresponsible for memory, Whitesaid.

That didn’t mean that thosewithout the Alzheimer’s lesionswere otherwise healthy, “butwhat we’re calling Alzheimer’s isvery often a mixture of differentdisease processes,” White said.

Lichtenberg said his concernsabout misdiagnosis in no waylessen the enormity ofAlzheimer’s impact.

“I don’t know how vast a prob-

lem it is, but I see it too often,”Lichtenberg said.

The Alzheimer’s Associationestimates that 5.4 million Ameri-cans are living with Alzheimer’s.Lichtenberg’s grandmother hadthe disease. A picture of her,dancing, sits in his office atWayne State.

But understanding how oftenAlzheimer’s and other dementiaare misdiagnosed is hard toquantify. Sometimes, that’s be-cause loved ones have not yet no-ticed a decline; sometimes, theydon’t want to face the possibility,Lichtenberg said.

Rosenfeld’s most pressingproblem was severe sleep apneathat had aggravated the moremanageable symptoms of undiag-nosed Lewy-body dementia.Lewy-body dementia causes a vi-sual processing disorder, dis-rupts the ability to organize, planand focus and can causes sleepproblems and hallucinations.

A breathing machine at nightmade a dramatic difference, saidShelley Rosenberg: “I’m thrilled.He is what he used to be. I havemy father back.”

It’s a difficult balance for theAlzheimer’s Association: trying toraise awareness and boost earlyintervention efforts forAlzheimer’s and other demen-tias, while also cautioning fami-

lies and clinicians not to jump toconclusions.

Diagnosing Alzheimer’s istricky and is done, in part, by rul-ing out other health problems,such as an undetected stroke orbrain tumor.

Even well-meaning doctorscan be too quick to judge, espe-cially when confronted by wor-ried loved ones listing Mom’smemory lapses, said JenniferHoward, executive director of theAlzheimer’s Association —Michigan Great Lakes Chapter.

An expert evaluation by an in-terdisciplinary team that in-cludes a geriatrician and neurol-ogist is crucial, she said.

“The brain is not just a physi-cal structure. It’s this incrediblecomputer. It’s constantly comput-ing where resources are neededand redirecting, depending onenergy is coming from and whattask you need to do,” said Rhon-na Shatz, director of BehavioralNeurology at Henry Ford Hospi-tal in Detroit.

For that reason, a commonurinary tract infection, a suddenchange in blood pressure or de-pression are all stresses on anolder brain that, combined withother problems, can quicklyshort-circuit it, Shatz said.

The result is acute confusionor delirium that, to an untrained

eye, may look like Alzheimer’sdisease.

“Pulling these things apartand the need for a real diagnosis— that’s important so people canlive the best quality of life as pos-sible for as long as possible,” saidHoward at the Alzheimer’s Asso-ciation.

In the case of Al Edelson, aformer Wayne State professorand cancer survivor, the confu-sion was really the result of a reg-ular cocktail of 18 medicationsprescribed for a variety of healthissues.

In his mid-’70s, the oncesharp-witted, effervescent profes-sor of instructional technologybegan to withdraw, family mem-bers said. For years, he and hiswife traveled frequently, but hebegan to be more comfortable re-maining near his family’s Hunt-ington Woods, Mich., home.

In the hours before their 5 a.m.departure for a trip to Britainaboard the Queen Mary 2 severalyears ago, Edelson was wideawake, anxious.

“He said, ‘I think I need to can-cel this.’ It was 2 a.m. I said, ‘I willnever forgive you,’” his wife,Joanna Edelson, recalled, chuck-ling.

But the change had becomeundeniable: Usually at easedancing with his wife or leadinggroup conversations, the now-re-tired professor was awkward andwithdrawn on the ship, Edelsonsaid.

Eventually, a doctor gave thediagnosis of Alzheimer’s.

“The problem is that whenyou’re older and you have a lot ofmedical conditions, no doctorspeaks to the other doctor, andthat’s basically what happened,”said Edelson, a retired teacher.

After consulting with otherdoctors, family members scaledback Al Edelson’s drugs. Theywere amazed.

“It was like he came out of acoma,” his wife said.

When he died in December,having just turned 80, the causewas pneumonia, Joanna Edelsonsaid: “Dementia did not kill myhusband.”

Photo by Susan Tusa

Martin Rosenfeld, 90, was originally diagnosed with Alzheimer’s disease when he became confushed and disorganized in histhinking. But further tests showed it was sleep apnea causing symptoms similar to Alzheimer’s. A breathing machine has madea huge difference, returning him to his former self.

‘ The diagnosis was deadwrong one-third of the time,

and it was partially wrong a third ofthe time, and it was right one-third ofthe time. ’

— Lon Whitelead researcher

National Institute of Aging study

July 2012 Health and Wellness

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