Health Beat, August 2013

BeatMMAAGGAAZZIINNEE

AUGUST 2013 A PUBLICATION OF THE RICHMOND REGISTER

Health

Want to age gracefully?SSllaatthheerr oonn tthheessuunnssccrreeeenn!Back-to-schoolpreparationsshould includean eye exam

New treatmentoptions for MS

Habits thatmake you fatThe lesser known benefitsof cardiovascular exercise

Not everyone poops:CCoonnssttiippaattiioonniinn cchhiillddrreenn

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WASHINGTON — Obese mothers tend tohave kids who become obese. Now provoca-tive research suggests weight-loss surgerymay help break that unhealthy cycle in anunexpected way — by affecting how their chil-dren’s genes behave.

In a first-of-a-kind study, Canadianresearchers tested children born to obesewomen, plus their brothers and sisters whowere conceived after the mother had obesitysurgery. Youngsters born after mom lost lotsof weight were slimmer than their siblings.They also had fewer risk factors for diabetesor heart disease later in life.

More intriguing, the researchers discov-ered that numerous genes linked to obesity-related health problems worked differently inthe younger siblings than in their older broth-ers and sisters.

Clearly diet and exercise play a huge rolein how fit the younger siblings will continueto be, and it’s a small study. But the findingssuggest the children born after mom’s sur-gery might have an advantage.

“The impact on the genes, you will see theimpact for the rest of your life,” predicted Dr.

Marie-Claude Vohl of Laval University inQuebec City. She helped lead the workreported in the journal Proceedings ofthe National Academy of Sciences.

Why would there be a difference? It’snot that mom passed on different genes,but how those genes operate in her child’sbody. The idea: Factors inside the womb seemto affect the dimmer switches that develop ona fetus’ genes — chemical changes that makegenes speed up or slow down or switch on andoff. That in turn can greatly influence health.

The sibling study is “a very clever way oflooking at this,” said Dr. Susan Murphy ofDuke University. She wasn’t involved in theresearch but studies uterine effects on laterhealth. She says it makes biological sense thatthe earliest nutritional environment couldaffect a developing metabolism, although shecautions that healthier family habits aftermom’s surgery may play a role, too.

It’s the latest evidence that the environ-ment — in this case the womb — can alter howour genes work.

And the research has implications farbeyond the relatively few women who takethe drastic step of gastric bypass surgerybefore having a baby. Increasingly, scientists

are hunting other ways to tackle obesitybefore or during pregnancy in hopes of a last-ing benefit for both mother and baby.

What’s clear is that obesity is “not justimpacting your life, it’s impacting yourchild,” Duke’s Murphy said.

More than half of pregnant women areoverweight or obese, according to theAmerican College of Obstetricians andGynecologists. But it’s not just a matter ofhow much moms weigh when they conceive— doctors also are trying to stamp out the ideaof eating for two. Gaining too much weightduring pregnancy increases the child’s riskof eventually developing obesity and dia-betes, too.

What’s too much? Women who are nor-mal weight at the start of pregnancy are sup-posed to gain 25 to 35 pounds. Those whoalready are obese should gain no more than11 to 20 pounds. Overweight mothers-to-befall in the middle.

MOM’S OBESITY SURGERYMAY HELP BREAK CYCLE IN KIDS

HEALTH BEAT

AUGUST 2013 HEALTH BEAT Richmond Register 3

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FOCUS: Back-to-school preparations should include eye exam . . . . . . . . . . .page 4STUDY: Nation’s kids need to get more physical . . . . . . . . . . . . . . . . . . . . .page 5GROWING UP: Not everyone poops: Constipation in kids . . . . . . . . . . . .page 4Hospitals seek high-tech help for hand hygiene . . . . . . . . . . . . . . . . . . . . . . . .page 6MEDICAL MINUTE: New treatment options for MS . . . . . . . . . . . . . . .page 10MENTAL MORSELS: Let the emperor have his new clothes . . . . . . . . .page 11CHIROPRACTIC CORNER: It doesn’t hurt to ask . . . . . . . . . . . . . . .page 13The lesser known benefits of cardiovascular exercise . . . . . . . . . . . . . . . . . . .page 15

Melon growers face new

FDA rules after outbreakWASHINGTON, Ind. (AP) — Southwestern Indianas melon

growers are facing new federal food-safety regulations followinglast years salmonella outbreak that killed three people who ateIndiana-grown cantaloupes.

The Food and Drug Administration will be inspecting packingsheds and possibly field conditions as part of that effort.Samples of the melons will be taken and tested for salmonellaand E. coli, among other pathogens.

E. coli and salmonella are the two most common of food-borne illnesses passed from tainted produce onto consumers.

Purdue Extension educator Scott Monroe said the StateDepartment of Health has hired two farm food safety consultantsto assist in the farm produce education campaign. Purdue hashad food safety teams in place for three years, he said.

Monroe said the two consultants, one based in Oaktown andthe other in Fort Wayne, will work directly with farmers.

“If farmers have questions, they will contact the consultantswho can guide them,” Monroe told the Washington Times-Herald.

A salmonella outbreak traced to a southwestern Indiana can-taloupe farm killed three Kentucky residents last year. That out-break followed a 2011 Listeria outbreak that killed 33 peoplewho ate cantaloupes grown on a Colorado farms.

Workshops were recently held in southwestern Indiana — the

center of Indianas cantaloupe and watermelon production — toeducate melon farmers and their workers about the FDAs newexpectations for protecting consumers from food-bornepathogens.

The rough, pitted surfaces of melons can trap dirt andpathogens, making contaminants harder to remove during thefruit-processing following harvest.

Most large melon growers harvest the fruit from the field,unload and wash it, pack it and then cool the fruit before itsshipped to stores.All that moving of the melons and washing canlead to unsanitary conditions in packing houses.

A letter from the FDA released in February states that inves-tigations into both last years salmonella outbreak and the 2011Listeria outbreak traced to a Colorado farm revealed multipleinstances of unsanitary production, handling conditions, andpacking house practices that lead to those outbreaks.

Nearly one-third of all cases of food borne illness come fromproduce. In addition to cantaloupes, leafy greens, green onions,and tomatoes are usually the most susceptible.

Consumer who purchase cantaloupes and other melons areadvised to use a vegetable brush to scrub away dirt and othermaterial on the rind. The fruit should then be patted dry with aclean towel and allowed to dry before its sliced or cut up.

Habitsthatmake you fat

PAGES 8-9 READ MORE PAGE 12

A few small fixes can significantly lower the

number on the scale.

Want to age gracefully?

Slather on the

sunscreen!Sun exposure happens every day, even in winter. Usingsunscreen daily can improve our long-term skin health,reduce the appearance of wrinkles and sun spots, andreduce risks for skin cancers.

4 Richmond Register HEALTH BEAT AUGUST 2013

Shopping for supplies andnew clothes aren’t the only

preparations that parentsshould make before schoolstarts. State law requires thatchildren ages 3 through 6 whoare entering a public school orpreschool program for the firsttime have a vision exam.

“In studying early childhooddevelopment, the KentuckyGeneral Assembly identifiedproblems with vision as one ofthe major factors in limitingchildren’s abilities to learn andsucceed,” said Dr. Reynolds, anoptometrist with the Eye CareCenter, which has two officesin Richmond and six othercities. “Having children’s eyesexamined is one of the mostimportant things you can do tosupport their education andgood health.”

Up to 13 percent of childrenage 5 and younger have sometype of vision condition. Afterage 5, that number increases to25 percent.

“All parents are encouragedto have their children’s eyesexamined because many prob-lems may not be obvious to youor your child’s teachers,”Reynolds said. “Young childrendon’t realize that the way theysee the world may not be theway it should be. Early diagno-sis and treatment can preventloss of sight from amblyopia,which is commonly called lazy

eye. Unfortunately, one-half ofall cases of amblyopia are notdiagnosed until after age 5,when it is difficult to correct.”

Amblyopia is the leadingcause of vision loss in peopleunder age 40 -- more thaninjuries or any other disease.However, it is almost 100 per-cent treatable if detected early.

Reynolds also said an eyeexamination is particularlyimportant if your child exhibitsany of these signs of possibleeye problems:

• Loses place while reading,holds the book closer than nor-mal or uses his finger to main-tain his place while reading.

• Avoids close work.• Tends to rub her eyes.• Has frequent headaches.• Turns or tilts his head, or

squints, to use only one eye.• Omits or confuses small

words when reading aloud.• Consistently performs

below academic potential.Financial assistance is avail-

able. Medicaid and KCHIP coverthese services as well as manyprivate insurance plans. Otherprivate programs are also avail-able to help families meet theseexpenses, such as the KentuckyVision Project, which is spon-sored by the KentuckyOptometric Association, and hasdonated an estimated $20 millionin vision care; Sight for Students;and the Lion’s Club programs.

Back-to-school preparationsshould include eye exam

State law requires exam forchildren entering public school


Reading, writing, arithmetic— and PE?

The prestigious Institute ofMedicine is recommending thatschools provide opportunitiesfor at least 60 minutes of physi-cal activity each day for stu-dents and that PE become acore subject.

The report, released May2013, says only about half of thenation’s youngsters are gettingat least an hour of vigorous ormoderate-intensity physicalactivity every day.

Another concern, the reportsays, is that 44 percent of schooladministrators report slashingbig chunks of time from physi-cal education, arts and recesssince the passage of the NoChild Left Behind law in 2001in order to boost classroomtime for reading and math.

With childhood obesity onthe rise — about 17 percent ofchildren ages 2 through 19 areobese — and kids spendingmuch of the day in the class-room, the chairman of the com-mittee that wrote the report saidschools are the best place to helpshape up the nation’s children.

“Schools for years have beenresponsible for various healthprograms such as nutrition,breakfast and lunch, immu-nizations, screenings,” HaroldW. Kohl III, a professor of epi-demiology at the University ofTexas School of Public Health,said in an interview with TheAssociated Press.

“Physical activity should beplaced alongside those pro-grams to make it a priority forus as a society,” he said.

The report calls on theEducation Department to rec-ommend that PE be adopted asa core subject.

It says physical education inschool is the “only sure oppor-tunity” for youngsters to have

access to activity that will helpkeep them healthy.

The majority of states, about75 percent, mandate PE, accord-ing to the American Alliance forHealth, Physical Education,Recreation, and Dance. Butmost do not require a specificamount of time for PE in school,and more than half allowexemptions or substitutions,such as marching band, cheer-leading and community sports.

Many kids also aren’t goingto gym class at school every sin-gle day. According to the CDC,only about 30 percent of stu-dents nationwide attend PEclasses five days a week.

The report recommends::

• All elementary school stu-dents should spend an averageof 30 minutes each day in PEclass.

• Middle and high school stu-dents should spend an averageof 45 minutes each day in PEclass.

• State and local officialsshould find ways get childrenmore physical activity in theschool environment.

PE isn’t the sole solution,though.

The report advocates a“whole-of-school” approachwhere recess and before-and-after-school activities includingsports are made accessible to allstudents to help achieve the 60-minutes-a-day recommenda-tion for physical activity. Itcould be as simple as havingkids walk or bike to school, orfinding ways to add a physicalcomponent to math and scienceclass lessons.

The report also cautionsagainst taking away recess as aform of punishment, and iturges schools to give studentsfrequent classroom breaks.

Schools can do this if theymake it a priority, said PaulRoetert, CEO of the American

Alliance for Health, Physical Edu-cation, Recreation, and Dance.

“We have an obligation tokeep kids active,” Roetert saidin an interview. “We haveresearch to show that physicalactivity helps kids perform bet-ter in school. It helps themfocus better in the classroom ...and they behave better inschool. So there are all kinds ofside benefits.”

Kitty Porterfield, spokes-woman for The School Super-intendents Association, saidnobody is opposed to physicaleducation.

“Everybody would love tosee more of it in schools,” saidPorterfield. “Given the testingand academic pressures forexcellence on schools, oftenphysical education slides to thebottom of the barrel.”


Nation’s kids needto get more physical

“We have an obligation to keep kids active. We have research to show that physical activity helps kids perform better in school.

It helps them focus better in the classroom ... and they behave better in school. So there are all kinds of side benefits.”— PAUL ROETERT, CEO OF THE AMERICAN ALLIANCE FOR HEALTH, PHYSICAL EDUCATION, RECREATION,AND DANCE

Rep

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RICHMOND HEIGHTS, Mo.— Hospitals have fretted foryears over how to make suredoctors, nurses and staff keeptheir hands clean, but with onlylimited success. Now, some areturning to technology — beep-ers, buzzers, lights and track-ing systems that remind work-ers to sanitize, and chart thosewho don’t.

Health experts say poorhand cleanliness is a factor inhospital-borne infections thatkill tens of thousands ofAmericans each year. The U.S.Centers for Disease Controland Prevention in Atlanta esti-mates that one of every 20patients in U.S. hospitals gets ahospital-acquired infection

each year.“We’ve known for over 150

years that good hand hygieneprevents patients from gettinginfections,” said Dr. JohnJernigan, an epidemiologist forthe CDC. “However, it’s been avery chronic and difficult prob-lem to get adherence levels upas high as we’d like them to be.”

Hospitals have tried varyingways to promote betterhygiene. Signs are posted inrestrooms. Some even employmonitors who keep tabs andsingle out offenders.

Still, experts believe hospitalworkers wash up, at best, about50 percent of the time. One St.Louis-area hospital believes itcan approach 100 percentadherence.

Since last year, SSM St.

Mary’s Health Centerin the St. Louis suburb ofRichmond Heights, Mo., hasbeen the test site for a systemdeveloped by Biovigil Inc., ofAnn Arbor, Mich. A flashinglight on a badge turns greenwhen hands are clean, red ifthey’re not. It also tracks eachhand-cleaning opportunity —the successes and the failures.

The failures have been fewat the two units of St. Mary’swhere the system is being test-ed, the hospital said. One unithad 97 percent hand hygienesuccess, said Dr. MoreyGardner, the hospital’s directorof infection disease and pre-vention. The other had 99 per-cent success.

“The holy grail of infectionprevention is in our grasp,”Gardner said.

The Biovigil system isamong many being tried athospitals. A method developedby Arrowsight, based in Mt.Kisco, N.Y., uses video monitor-ing. It is being used in intensivecare units at North ShoreUniversity Hospital inManhasset, N.Y., and theUniversity of California SanFrancisco Medical Center.

Akron, Ohio-based GOJOIndustries, maker of Purellhand sanitizer, has developedan electronic compliance mon-itoring system using wirelesstechnology to track when soapand hand sanitizer dispensersare used. The SmartLink sys-tem gives the hospital data onhigh- and low-complianceareas. The company said it hasinstalled the system at severalhospitals around the country,but didn’t say how many.

HyGreen Inc.’s HandHygiene Reminder System wasdeveloped by two University ofFlorida doctors. TheGainesville, Fla., company nowfeatures two systems used inseven hospitals, includingVeterans Administration hospi-tals in Chicago, Wilmington,Del., and Wilkes-Barre, Pa.

One is similar to Biovigil’sgreen badge method. InHyGreen’s, a wall-mountedhand wash sensor detects alco-hol on the hands. The badgeincludes an active remindingsystem. Unclean hands create awarning buzz. If the buzzsounds three times, the workeris noted for noncompliance.

HyGreen spokeswomanElena Fraser said that becausesome hospitals are movingaway from alcohol-based sani-tizers, HyGreen offers a secondsystem. A touch of the sanitizerdispenser clears the worker tointeract with a patient. If theworker shows up at the patientbed without hand-cleaning, theseries of warning buzzesbegins.

Fraser said hospital infec-tions have dropped 66 percentat units of Miami Children’sHospital where the badge sys-tem has been implemented.

Nurses using the Biovigilsystem at St. Mary’s near St.Louis wear a badge withchangeable colored lights. Adoorway sensor identifieswhen the nurse enters apatient’s room, and the badgecolor changes to yellow.

The nurse washes his or herhands and places them close tothe badge. A sensor in thebadge detects chemical vaporsfrom the alcohol-based solu-tion. If hands are clean, thebadge illuminates a brightgreen hand symbol.

If the nurse fails to sanitize,the badge stays yellow andchirps every 10 seconds for 40seconds, then flashes red. Oncethe flashing red starts, thenurse has another 30 secondsto wash up, otherwise thebadge turns solid red, denotingnon-compliance. Either way,each instance is tracked by acomputer. The hospital cantrack each individual’s compli-ance.

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Hospitals seek high-techhelp for hand hygiene

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Turn to HYGIENE, page 14

“He has not pooped for three days! I am starting to get reallyworried,” said the mother to her husband.

Her husband replied, “That is a long time. What do you thinkwe should do?”

In the meantime, the child is refusing to go near the toiletand complains, “It hurts too much.”

A little known fact outside of adults who have children ishow much attention is paid to a toddler and child’s bowel move-

ments. While not the typ-

ical content of mostconversations, par-ents with infantsand young childrenspend considerabletime discussing thesubject with otherparents. One of thereasons for this isthe common occur-rence of constipa-tion.

While most peo-ple believe constipa-tion is simply notpooping for severaldays, it is more com-plicated than that.

Some childrencan wait two orthree days beforehaving a bowelmovement and not

be constipated, whileothers can have small bowel movements and be constipated.

For children, the key signs are to look for poop that is hardand compact with three to four days between bowel movements.

Also, constipation often involves painful bowel movementsand blood in or outside of the poop. Sometimes children cansoil themselves between bowel movements.

There are several possible causes of constipation. Some chil-dren withhold their stool which might be due to stress regard-ing potty training, being particular about what toilet they use orbecause they are afraid of having a painful bathroom experi-ence.

Another possible cause is a diet that is low in fiber or doesnot include enough liquids.

Finally, constipation can result as a side effect if the child ison medication.

Treatment for infrequent constipation can occur at home.Adding fiber and increasing daily water intake to toddlers orchildren’s diet can help.

This diet includes eating prunes, apricots, plums, peas, beans,and whole grain cereals.

Establishing a regular toi-leting time, particularly withyounger children, can assist incombatting constipation. Thiscan include having the child usethe toilet first thing in the morn-ing and then after every meal orsnack.

Make sure to tell the child togo to the toilet and not givethem the option of saying no.

If the constipation is more severe and not responsive to theaddition of fluids and a high fiber diet, a pediatrician should beconsulted.

Often the pediatrician will have children take stool softeners,mild laxatives, or have them given an enema.

However, parents should not try these treatments before con-sulting with the pediatrician.


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Not everyone poops:Constipation in kids

Dan Florell, Ph.D., is anassistant professor at EasternKentucky University and hasa private practice, MindPsi

(www.mindpsi.net). PraveenaSalins, M.D., is a pediatrician

at Madison Pediatric Associates(www.madisonpeds.com).


If losing weight were easy, there wouldn’t be so many weightloss diets, programs and pills out there.

Some of these gimmicks work for a while, but ultimately thesecret to successful weight loss lies mainly in your lifestyle.

What you do and eat on a day to day basis will invariablydetermine whether you’re overweight or not.

The switch to a healthier lifestyle doesn’t require profoundchanges. A few small fixes can significantly lower the numberon the scale. Try these healthier habitsfor quick and lasting weight loss.

Be preparedThe Boy Scouts and healthy eaters

have the same motto: Be prepared.That means having a refrigerator andpanty stocked with healthy foods,including lean proteins, whole-graincarbohydrates, fruits and vegetables,and healthy fats.

Lunches can then be made fromthese healthy choices, shaving calo-ries and fat. Snacks can be naturalfruits and vegetables, instead ofprocessed foods with high amounts ofsugar, salt and fat.

Drink lots of waterInadequate hydration leads to fatigue which many people

misinterpret as hunger.The impact of hydration on weight loss, however, goes far

beyond preventing misinterpreted bodymessages. A study published in theNovember, 2008 issue of the journalObesity found a strong associationbetween increased water intake andincreased weight loss. Another studyfound that dieters who drank two 8-oz.glasses of water before their threedaily meals lost 5 lbs. more thandieters who didn’t.

Cut down onliquid calories

Most of the calories that enter your body in liquid form areempty calories. They add up but don’t make you feel full andthey don’t provide much in the way of nutritional value.

Soft drinks, flavored coffees, imitation fruit juice and other

sweetened drinks make virtually no nutritional contribution tothe body.

Even fruit juices and sport drinks should be limited as theycontain high amounts of sugar. Replace those with water, tea orcoffee without sugar and cream, and low-calorie sodas or pow-dered flavored beverages.

Get enough proteinUnless you get plenty of protein in your diet, you will

have trouble losing weight.Your body uses more energy processing protein than

it does fat or carbohydrates. Therefore, when you eatprotein, it helps you lose weight.

Be sure it’s low-fat protein sources such as skinlesschicken, pork tenderloin, ground turkey, beans andseafood. You can also add eggs, peanut butter, low-fatcheeses, Greek yogurt, or low-fat protein bars.

Don’t skip breakfastIt’s easy to rush out the door in the morning without

taking time for breakfast, but don’t do it. Breakfast kick-starts your metabolism, forcing it to

begin burning calories. If you’re one of those people whodoesn’t have an appetite inthe morning, don’t worry,just make sure you eat

something within the firsttwo hours of waking.

The perfect breakfast combinescomplex carbohydrates with pro-tein and a little healthy fat.

An example would be twoscrambled eggs with a slice ofwhole-wheat toast, a cup of Greekyogurt with a handful of berriesand chopped nuts stirred in.

Stay out of the centeraisles at the grocery store

A good rule of thumb is to do most of your grocery shoppingnear the four walls.

The perimeter of the store is where you find fresh produce,the meats, grains and dairy. In the middle aisles are theprocessed foods you should avoid.

There are a few exceptions, namely in the freezer sectionwhere the frozen vegetables are stored and the cereal aislewhere you can find oatmeal and whole-grain cereals.

DR. JACKRUTHERFORD

D R . J A C K O N H E A L T H & F I T N E S S

Habits thatmake you fat


Lift weightsOf course, you’ve started doing aerobic exercise to burn

those extra calories, but don’t forget the weights.You won’t achieve your weight-loss goals through diet and

cardio alone. Adding resistance training to cardiovascularexercise will optimize your ability to shed pounds.

Studies have shown the significant relationship betweenresistance exercise and weight loss. In particular, weight lift-ing raises the metabolism both during and after the exercise,creating the “afterburn” effect.

Cardio only raises the metabolism during the exerciseand for a short period afterwards.

Get enough sleepYes, you can sleep your way to weight loss, at least partly.Getting the right amount of sleep is an important factor in

achieving and maintaining a healthy weight.A 2006 study found that people who

slept five hours or less a nightweighed an average of 5 lbs.more than those who sleptseven hours or more.

The reason has to do withthe hormones leptin andghrelin. Studies have shownthat sleep deprivation causesa reduction in leptin levelsand a rise in ghrelin levels,both of which affect appetite.

High ghrelin levels stimulatethe appetite, while low leptinlevels makes you feel unsatisfiedafter eating, leaving you hungri-er during your waking hours.

Keep accuraterecords

If you’re trying to lose weight but thepounds just aren’t coming off, chances areyou’re eating more than you think.

Keeping records of everything you eat inthe form of a food diary can help. Just the actof record-keeping is effective on many levels.

First, you get a complete picture of yourdaily caloric intake. Plus, knowing you have towrite down everything you eat may make youreconsider that late-night bowl of ice cream.

Also, once you’ve kept your food diary for a while, you’llbegin to notice patterns, like late-night snacking in front ofthe TV, thereby enabling you to make adjustments.

Plan for relapseAccept that everything won’t go as planned. You will

invariably fall victim to temptation sooner or later.If you blow a meal, don’t worry, it’s alright. But that’s not a

free pass to blow the rest of the day.Get back on track as soon as possible. Remember, the

important thing is what you will do tomorrow. You can change unhealthy habits into healthy ones

through repetition and the best time to get started is now.Start with one habit at a

time and work up.If you shed

your unhealthyhabits, you’ll findyou’ll shed theweight soonafter.


Multiple sclerosis (MS) is sucha puzzling disease that our

ancestors looked to the heavens forexplanations.

In the 13th century, a young Icelandicwoman, apparently suffering from MS,suddenly lost her vision and her ability towalk. When she prayed to the saints, hersight and mobility returned … at least fora time.

Scientists are still searching for answersabout MS — particularly regarding whatspecifically causes the disorder and whatcan be done to manage the troublingsymptoms and effects.

Multiple sclerosis is an autoimmune

disease that frequently strikes youngadults in their 20s and 30s.

For some reason, the body’s immunesystem turns inward and causes damageto the protective myelin sheath that coversnerves throughout the body.

Without this protective coating, whathappens might be compared to a short inthe electrical system of your car. Messagesthat travel along nerves become slowed orblocked, usually in an unpredictable pat-tern.

At first, the patient may notice onlynumbness, weakness or tingling in herlegs that come and go with no ready expla-nation. Or she may suddenly feel so weakin the legs that it’s hard for her to walk.

Symptoms and even the course of thedisease vary so widely that doctors are notalways certain of the diagnosis. Patientsare often referred to a neurologist to con-firm the diagnosis.

Other possible symptoms includetremor, pain, electric shock sensations,slurred speech and dizziness.

In only about 10 to 15 percent ofpatients do symptoms get gradually andprogressively worse. This is known as pri-mary-progressive, the most common typein people who develop the disease afterage 40.

The usual course is for symptoms tocome and go in a relapsing-remitting pat-tern. The patient suffers unpredictableattacks when symptoms get worse over aperiod of several days to several weeks.This is followed by a period of full or par-tial recovery of some function. The diseasedoes not worsen and the patient may noteven have symptoms during this period ofremission, which can last a year or longer.

During relapse periods, one area of anerve in the brain and spinal cord

becomes inflamed as the fatty myelinsheath around the nerve is being

destroyed. Plaque is formed thatinterferes with normal nerve

impulses and produces theMS symptoms.

Early, aggressive treat-ment is needed when

symptoms occur inorder to limit long-

term damage.Over 10 to 25

years, nerves begin to deteriorate, andrelapse periods become less frequent orstop altogether.

At this point, there is no known way ofrecovering nerve function, and somepatients eventually lose the ability to walkor speak clearly.

Treatment generally involves reducingthe inflammation, ordinarily with corticos-teroids.

Over the past decade or so, new drugshave been introduced and six have beenapproved by the Food and DrugAdministration for the treatment of multi-ple sclerosis.

Known as disease-modifying drugs,these agents work directly against theimmune system, weakening the responsethat causes the inflammation. They havebeen shown to be effective in reducing thefrequency and severity of attacks. Whenthe immune system is inhibited the bodyis left vulnerable to outside attacks.

While reducing inflammation has longbeen a major goal of treatment, doctorsare now targeting the degeneration ofnerves that takes place in many patientsafter 10 to 20 years.

This neurodegeneration has long beenbelieved to be a consequence of the long-term inflammation. Some experts nowbelieve it may be the other way around;the disease process involves a gradualdeterioration of nerve fibers that causes aninflammatory response from time to time.

These theories have led to considera-tion of another treatment strategy – neuro-protection, as used for treatment ofAlzheimer’s, Parkinson’s and other neu-rodegenerative diseases. Many of thedrugs currently used offer protection ofnerves by reducing inflammation andincreasing levels of growth factors, whichare neuroprotective.

One area deserving of further investiga-tion is the possible role of exercise as anMS disease-modifier. Animal studies havefound exercise associated with an increasein production of growth factor.

Although the disease works its way outin varied ways, multiple sclerosis can leadto substantial disability and suffering.However, with so many new treatmentsavailable and others on the way, the futureis looking better.

DANIEL O. LEE, MDBOARD CERTIFIED IN NEUROLOGY

AND SLEEP DISORDERS

BAPTIST HEALTH RICHMOND

M E D I C A L M I N U T E

New treatmentoptions for MS

We’ve all heard the HansChristian Andersen story of

the “Emperor’s New Clothes,” andmost of us understand the lesson ofthe story has to do with being hon-est and plainspoken in a worldwhere those around you are eva-sive and self-serving.

Most of us probably identifywith the outspoken little boy char-acter in theory, even if not always inday-to-day fact.

He’s the one who points out thatthe emperor has been taken byhucksters, that he isn’t wearing“invisible material.” He’s just nakedin public.

As I’ve moved further into theprofessional world, though, I’vecome to have more sympathy forthe emperor’s ministers and hispeople, although they do not comeacross as at all admirable in thecourse of the folk tale.

After all, we are told the emper-or is a vain, possibly meglomania-cal character. Therefore, speakingbaldly and plainly may well begrounds for very real retaliationfrom him. At very least, the unfor-tunate diplomatic ministers couldbe dismissed from their positions,and the peasants might be deprivedof their lives.

Now, go a step further, andassume that not only their own well-being, but that of their families alsorests on their behavior toward theemperor. How many of us would letour families suffer privation just tobe honest and plainspoken?

In other words, what’s really the“right” thing to do here? Honor aremote moral principle of “hon-esty,” or do what is best for close,real people in our lives?

At the crux of this kind of ques-tion rests an alternative theory ofmoral reasoning put forth byCarol Gilligan in her 1982 book“In a Different Voice:Psychological Theory and

Women’s Development.”Although she was initially

addressing differences in women’smoral reasoning from the man-cen-tric psychological theories of theday, Gilligan herself eventuallyacknowledged later that while the“different voice” may often be char-acteristic of women, it can exist inboth sexes.

The “different voice” is reason-ing that is more relationship-basedand less principle-based.

That is, instead of asking if theboy in the story was right to speakout to the emperor because theprinciple of honesty and authentici-ty says he must, one would insteadask who would be influenced forgood or ill in speaking out?

From the different voice wemight wonder: Who in the story isreally being harmed if everyonedecides to let the emperorwalk around naked? Hestays in power. His minis-ters keep their positions.The peasants live. Theswindlers get their money.

Really, nobody loseshere. They just have to livewith a bit of absurdity intheir lives. We chuckle androll our eyes at absurdity,but we may not suffer for it.

By contrast, other thanone person getting to besmug about living up tothe remote moral principleof honesty, what is gainedby pointing out the obvi-ous? Other than to embar-rass a bunch of people?

Of course, I doubt thatGilligan’s theories aboutmoral reasoning will evermake for as interesting astory as those based onidealistic moral principles.

Still, she brings homethat we all live in a web-work of social relation-

ships, and that any act, even a high-minded one, may result in the sac-rifice of people we care about onthe altar of our consciences. Justask any whistleblower.

From “a different voice,” we hearreasons to understand why realpeople act – or fail to act –as theydo in life, even when they maychastise themselves and history inhindsight snarls at them for notliving up to their principles.

In the end, Gilligan helps tocontextualize our decisions, andmake us face our very humblehuman foibles.

Sometimes, we all make moralcompromise in the name of thosewe hold most dearly.

Perhaps this theory is moreabout empathy and sympathyrather than integrity. Which ismore valuable?


Direct Referral Line 859-626-4509

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THOMASTHORNBERRY

Let the emperorhave his new clothes

M E N T A L M O R S E L S

Thomas W.Thornberry, M.A.,is a mental health

professional who hasworked extensively

with those sufferinglifestyle stress and

communicationissues. His ianterest

is in language andthe power of words

to create change.Thomas welcomes

your feedback:[email protected].

Who in the story is really being harmed if everyonedecides to let the emperor walk around naked?

He stays in power. His ministers keep their positions.The peasants live... Really, nobody loses here.


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ssuunnssccrreeeenn!! CHRISTIEGREEN, MPH

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Turn to SUNSCREEN, page 14

Iwanted to relay concerns Iseem to have repeat conversa-

tions on with our clients. Theyseemed to be very upset thatafter changing medical doctorsthey found they were takingmore prescriptions than theyneeded.

I asked them a simple ques-tion, “Did you ever talk to yourdoctor about your prescriptions?”

They said doctors are sup-posed to know what they aredoing.

I knew the next questionmight get an even louderresponse, but had to ask.

“When you went to the med-ical doctor did you ask to get ridof the symptom, or ask what wascausing them and what could bedone to correct that cause?”

My concern is people todayare giving the responsibility fortheir health to others. Not justmedical doctors or doctors ofchiropractic, but to the pharma-ceutical companies and theirboxes and bottles of all sorts ofchemical, physiologicallychanging potions.

The promises of quick fixesand symptom relievers arerampant in all forms of media.

If I love to eat spicy foodsand afterward get heartburn, Ican give the responsibility to aplethora of antacids.

Remember who is responsi-ble for your health. Don’t takethat responsibility and give it tothe bottle of “what ever youtook” so you can eat what you

want with little regard to whatit is doing to your body. Justbecause your symptoms aregone, don’t think you are well.

If we look deeper into this, wewill start to see how we are bom-barded into thinking this is OK.

If you eat spicy food and yourstomach gets irritated, this maybe a sign your stomach lining iseither producing too much acidor the mucous production is notenough to protect the lining.

So, if we eat enough “irritat-ing” foods and we then take thepill or potion that reduces thesymptom, have we fixed thecause of the problem? No.

If we you responsibly for ourown health, we would changeour diet and have our nervoussystem checked by a doctor ofchiropractic to see if it is work-ing correctly.

This is only one of the manyexamples of how we give oth-ers the responsibility for ourhealth and for that matter ourlives. We need to set a planallowing us to be responsiblefor our own actions.

As I stated in a previous arti-cle, lifestyle diseases are by farthe leading cause of death inthe United States.

Take heart disease. If yourcholesterol is high and we didn’thave all of the pills that areadvertised to lower it, would youtake more interest in exerciseand diet? You bet you would.

We do the same thing withour children?

The knowledge that feversoccur as a defense mechanismagainst viruses and bacteria(raising your core temperaturekill bacteria and viruses) does-n’t seem to be well known. Ican just imagine the littlegerms cheering and having aparty at the first sign of a med-ication that will lower thechild’s temperature and givethem (the germs) a reprieve.

Research continues to key inon poor diet and lack of exerciseas major sources of hyperactivity.Still many turn the responsibilityfor their child’s health to Ritalin,a Schedule II substance underthe Controlled Substances Act,which also includes cocaine andmethamphetamine, and has ahigh potential for abuse.

Abuse of these drugs may leadto severe psychological or physi-cal dependence. We hand theresponsibility to a pill instead of

finding thecause of theproblem.

It wasinteresting tosee, from theconversationwith mypatient, howmedical doctors are facing thesame kind of problem. Oncethey act on a symptom, and thepatient relinquishes responsi-bility to the doctor. Once themedical doctor prescribes a pill,the patient switches the respon-sibility to it.

People need to get back totaking responsibility for theirown health.

Start by realizing that med-ications alter your body’s physi-ology to trick it into thinkingthings are under control.

Do you want to be healthy orjust not have symptoms?


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Currently, our county averages 23 newcases of melanoma each year.

Melanoma is not the only health prob-lem related to sun exposure. There areother forms of cancer, like basal cell carci-noma and squamous cell carcinoma, and aprecancerous condition called actinic ker-atosis, or AK. While the risks are lower forthese cancers than for melanoma, theycan still be disfiguring and cause signifi-cant discomfort.

Less dangerous, but perhaps just asimportant, are the long-term effects of sun

exposure, like age spots and wrinkles.We all develop wrinkles over time, but

sun exposure definitely plays a role inhow our skin appears as we age.

Sun exposure is the most important fac-tor in wrinkles, and no type of skin isimmune to this damage. UV light damagesthe fibers in skin called elastin. Whenelastin fibers break down, the skin startsto sag, stretch and lose its ability to goback in place after stretching.

A study released earlier this year fromresearchers in Australia confirmed for thefirst time that sunscreen does in factreduce the long-term effects of sun expo-sure.

The researchers followed 900 peopleages 25 to 55 for four and a half years.

They found that those who used a mini-mum SPF 15 broad-spectrum sunscreendaily on their face, neck, arms, and handswere significantly less likely to have signsof skin aging than those who did not usesunscreen daily.

Sun exposure happens every day, evenin winter. Using sunscreen daily canimprove our long-term skin health,reduce the appearance of wrinkles andsun spots, and reduce risks for skin can-cers.

While some of us have many years ofdamaging sun exposure already behindus, it is never too late to start taking care.Making skin protection a part of our dailyroutines will help us look better and stayhealthier for the long haul.

SUNSCREENContinued from page 12

Outdoor entertaining is a great way tospend time with family and friends. Outdoorparties run the gamut from informal barbe-cues to fancy catered events. Party hosts andhostesses realize they will have to take cer-tain precautions to make food safe andpalatable when serving guests outdoors.

In addition to weather that can threatenfood, insects are an obstacle when entertain-ing outdoors. Insects may not only be a nui-sance, but also can be a danger when food isinvolved.

Flies

Flies that land on food may seem more ofa nuisance than anything, but those samebugs can be carriers of any number of dis-eases. According to Orkin, the commonhousefly can carry more than 100 diseasesand transport pathogens. Flies feed and layeggs on waste, including feces. Pathogenscan collect on their legs and mouth. Thesemicrobial invaders can then be transfered tofoods. Flies also need to regurgitate on solidfood to turn it into a liquid for consumption.A fly that lands on food could be leavingbehind a lot more than before he landed,and that may be unsafe and unsavory. Move

food outdoors only at the last minute anduse covers to keep flies out.

Wasps

Wasps can sometimes be attracted tofood. At certain points in the year, typicallyspring and early summer, wasps are attractedto meats and other protein-laden foods. Asthe season shifts, wasps are more attracted tosugary, sweet-smelling items, and they can bevery persistent when pursuing such foods andbeverages. It is best to keep sweet-smellingfoods and beverages covered. Some peoplealso advise keeping a really sweet-smellingbeverage, such as fruit punch, in a far cornerof the yard to deter wasps from coming nearentertaining areas like decks or patios. A per-son who is allergic to bee stings can becomequite sick if they are stung by a wasp.

Ants

Ants are attracted to sweet foods as well.Adult ants can only consume liquid foodsand, as a result, are most attracted to sweetbeverages or melted foods. Wipe up spillsand promptly remove sweet items at the endof the party.

Keep foods safefrom insects Registered Nurse Theresa Gratton has helped

lead the effort toward hand cleanliness at St.Mary’s. She heard about the Biovigil system inearly 2012 and convinced the hospital to give it atry.

Gratton said patients are aware of the risk ofinfection and frequently inquire about whethercaregivers have washed their hands. She said thebadge relieves their anxiety.

Bill Rogers, a 65-year-old retiree recuperatingat St. Mary’s from back surgery and a heart scare,agreed.

“The first thing I noticed up here was thebadges,” Rogers said. “It is comforting for me toknow their hands are clean as soon as the badgebeeps and it goes from yellow to green.”

St. Mary’s is expanding the Biovigil systemlater this year to other units of the hospital and toemployees other than nurses, though details arestill being worked out, Gardner said. Eventually,the system may be expanded to SSM’s sevenother St. Louis-area hospitals, he said.

Biovigil’s chief client officer, Brent Nibarger,said customers won’t buy the system but will paya subscription fee of about $12 a month perbadge.

The CDC’s Jernigan said the high-tech systemscan only help.

“For a health care worker, keeping their handsclean is the single most important thing they cando to protect their patients,” Jernigan said.

HYGIENEContinued from page 6

AUGUST 2013 Richmond Register 15

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HEALTH BEAT

Active people tend to have varyingviews on cardiovascular exercise,

or cardio. Often done at the end of aworkout, cardio rarely evokes a staidresponse from fitness afficionadosasked to share their thoughts on thisvaluable type of exercise. Fans of car-dio will admit they love the feeling theyget during and after a rigorous roundof this type of exercise, which includesactivities like running, cycling andwalking. But those men and womenwho dread their time on the treadmill,elliptical machine or stationary bikeare likely to categorize cardio as a bor-ing and uninspiring activity. Butregardless of a person’s opinion on car-dio, there’s no denying it offersnumerous benefits, manyof which even avid ath-letes might be unaware.

• Cardio boosts brainpower. Perhaps theleast known bene-fit of cardio is itspositive impacton the brain.During cardio-vascular exer-cise, the brain isbeing flooded withchemicals thatimprove decisionmaking, memoryand problem

solving. Cardio can also help preservememory and improve its ability tolearn. So while the physical benefits ofexercise are widely known and notice-able to the naked eye, cardiovascularexercise can be just as effective atimproving cognitive function.

• Cardio can improve your appear-ance. Improving physical appearance isa motivating factor for many physicallyactive men and women, and cardio cango a long way toward improving physi-cal appearance because it increaseslean body tissue while reducing fat.Cardiovascular exercise is a healthyway to burn calories, and burning calo-ries is a healthy means to losingweight.

• Cardio can help reduce the severityof preexisting conditions. Arthritis suf-ferers have long looked to cardiovascu-

lar exercise as a healthy means torelieving the pain caused by theircondition. Water exercises likeswimming make for great cardio-vascular exercises, especially forthose looking to relieve arthritispain. That’s because an exercisesuch as swimming keeps joints

moving while strengthening mus-cles surrounding those joints.

Studies have shown that cardiovascu-lar exercise also can lower blood pres-sure.

• Cardio can improve mood.Cardiovascular exercise can

benefit men and women suffering fromdepression or those who are simplyhaving a bad day. That’s because themood-boosting chemical serotonin isreleased to the brain during cardio,helping to improve mood and alleviatesymptoms of depression or fatigue.

• Cardio can make tomorrow’s work-out easier. Recovery time is importantto athletes, many of whom want toensure their bodies are ready fortomorrow’s workout even before theyfinish today’s. Cardiovascular exercisehelps to deliver more oxygen-rich blood

to muscle tissue, aiding intissue repair and recov-

ery. The quicker yourbody can reboundfrom today’s work-out, the more effec-

tive tomorrow’sworkout will be.

So even ifyoudon’tenjoythat pitstop atthe

treadmillbefore you

head home, it’spaying moredividends thanyou mightknow.

The lesser known benefitsof cardiovascular exercise

Documents

Health Beat, August 2013