Healthy Living

The medicinal effect of plants containing aspirin-like compounds has been known since the days of the ancient Greek physician Hippocrates.

But it was in 1899 that a Bayer chemist purified the chemical known as acetylsalicylic acid. This new acid was given the medicinal name Aspirin and the “wonder drug” was born.

Despite the amazing medical advances in the last 100+ years, no drug has been proven better at preventing strokes and heart attacks.

Along with reducing pain, fever, and inflammation, aspirin has proven effective at preventing certain types of blood clots that can be caused by platelets, which are small cell fractions that float around in our blood stream ready to activate whenever damage occurs to a blood vessel.

When activated they stick together to form a plug, or clot, which stops the bleeding that occurs when you get a cut. A heart attack or stroke can occur when the cholesterol plaques inside the arteries that supply the brain and heart muscle rupture and activate any platelets floating by. The platelets then form a plug inside the artery and further reduce or completely block blood flow causing tissue damage.

Aspirin decreases the stickiness of platelets so they cannot clump together as easily to form a clot. How powerful is aspirin? If given as soon as a heart attack is suspected it can reduce the risk of death by as much as 23%. In people with cardiovascular disease, aspirin can reduce the risk of stroke and heart attack by as much as 30%. It may be old, but it’s still the best.

The power of aspirin also extends to its side effects; aspirin is one of the leading causes of gastrointestinal bleeds. Even though it is available over the counter, it still must be used with caution. Enteric coated or buffered aspirin may protect you from an upset stomach that some people experience shortly after taking aspirin, but the special coatings do not decrease the risk of a serious bleed in any way.

Aspirin therapy is the mainstay of drug treatment to prevent stroke and heart attacks, but many life-style changes are effective as well. A diet rich in fruits, vegetables and fiber, regular exercise, control of high blood pressure and diabetes all have beneficial effects at preventing many diseases. If you smoke cigarettes, quitting may be the best possible change you can do for your health. Within only a few years after quitting, your risk of many diseases drops to those who have never smoked.

Aspirin therapy usual consists of taking one or two baby-aspirins (80 or 81mg) or a full strength aspirin (325 mg) once a day. This simple regimen along with the very low-cost of aspirin helps make it the drug of choice to prevent strokes and heart attacks. If you are allergic to aspirin or have a history of stomach ulcers or bleeds, other anti-platelet medications are available that can be just as effective.

If you believe you could benefit from an aspirin a day you should talk to your doctor first. A cardiovascular risk assessment that includes weight, blood pressure, and cholesterol levels will guide the physician in deciding if aspirin is right for you. Your individual risk for stomach ulcers and bleeding also need to be assessed to determine if stomach protective agents are needed along with aspirin therapy.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, go to the Healthy Living blog at www.backushospital.org or E-mail Smith and all of the Healthy Living columnists at healthyliving.org.

Stroke is the leading cause of long-term disability in the United States and the number three killer of Americans.

Every year 700,000 people nationwide will suffer a stroke and 160,000 will die from that stroke. It is because of these sobering facts that The American Academy of Neurology, The American Society of Emergency Physicians and the American Stroke Association have come together to form the Brain Attack Coalition.

May is “Stroke Awareness Month” and coalition members are emphasizing the need for early recognition of a stroke. Once recognized, intervention can begin and there is greater chance of full recovery.

In today’s column, we will review some ways to identify a stroke-in-progress, as well as early treatment. Tomorrow’s Healthy Sports column will describe the brain attack and rehabilitation of a famous athlete who suffered a stroke.

Up until now, public awareness efforts have centered on three signs of stroke. This has now been expanded into a campaign called “Give Me 5 for Stroke.” There are five questions if a stroke is suspected:

• Walk: Ask the person to take several steps. Is their balance off? Are they slumping to one side? Are they dragging one leg?

• Talk: Ask them to repeat a phrase such as “You can’t teach an old dog new tricks.” Is their speech slurred? Are the words used appropriately?

• Reach: Have the person extend both arms in front of them. Can they raise both arms? Does one arm drift downward?

• See: Is their vision clear or blurred? Do they have double vision?
• Feel: Ask the person if they are in any pain. Specifically, do they have a headache? Is it the worst headache of their lives?

If any of these warning signs exist, there is a high probability the person is suffering a stroke. Emergency services should be called immediately.

Now that there are new treatments for acute stroke, recovery and survival are measured in minutes. Prompt action is imperative.

If you’d like more information about stroke, view my video at backushospital.org or contact the American Stroke Association at www.strokeassociation.org.

nthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

In our part of the country the onset of spring is a great time of year. It brings flowers, green trees, warm weather, and – for an estimated 36 million Americans – allergies.

Seasonal allergic rhinitis (SAR) is a predictable group of symptoms that include nasal congestion, sneezing, postnasal drip and watery, itchy eyes. The most common cause of seasonal allergies is pollen.

Seasonal allergies can be very troublesome for many individuals, but rarely does it cause serious medical problems. Because it is a self-limiting condition, many people can safely manage their allergy symptoms using medications available over the counter. The anti-allergy medications generally fall into one of two categories: antihistamines and decongestants.

Antihistamines are considered first-line treatment for SAR. Over the counter preparations include tablets, capsules, liquids, and thin strips. Older antihistamines such as diphenhydramine (sold as Benadryl and other generic versions) and chlorpheniramine (sold as Chlor-Trimeton and other generic versions) are very effective at treating and preventing sneezing, itching, and a runny nose.

But these medications also cause drowsiness in most people who take them.

Newer “non-sedating” antihistamines are also available over the counter and tend to cost a bit more. Non-sedating antihistamines include Zyrtec (cetirizine) and Alavert and Claritin (loratadine). Be aware that even the non-sedating antihistamines may make some people drowsy.

Whenever taking an antihistamine for the first time, be sure to not drive or perform any activities that need you to be highly alert until you know how the new medications will affect you.

Decongestants include phenylephrine and pseudoephedrine (now kept behind the counter) and the nasal spray oxymetazoline (sold as Afrin and other generic versions).

Decongestants can ease coughing due to postnasal drip as well as that “stuffy” feeling many allergic people experience. Decongestants must be used with caution because they can worsen common medical conditions such as high blood pressure, diabetes, and glaucoma. The nasal spray should not be used for more than 3-5 days or rebound congestion can occur.

Pharmacy shelves are also stocked with many combination products. Combination products can make allergy treatment more convenient but need to be chosen wisely. Combinations of medications you don’t need only increase your risk of medication side effects with out adding any additional symptom relief.

Treatment can begin a week or more before you expect the pollen count to rise in order to prevent symptoms from occurring.

Seasonal allergies can often be managed by the use of over the counter medications alone without the need for a physician office visit. But to do so safely requires you to follow a few guidelines:

 Be sure to read the labels closely and take as directed without exceeding the recommended doses.

 Check with your pharmacist to make sure your allergy medications do not interact with other prescription or OTC medications you may be taking.

 People with pre-existing medical conditions should speak to their doctor before choosing a decongestant.

 If you find the OTC medications do not provide you with relief, seek your physician to discuss prescription medications that are available to treat SAR.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, go to the Healthy Living blog at backushospital.org or E-mail Smith and all of the Healthy Living columnists at healthyliving@wwbh.org.

If pulling a slot machine handle or throwing dice is your sport, rest assured there is an experienced group of medical professionals ready to help if you “go down.”

Thousands of patrons travel long distances to Connecticut’s casinos each year. Many are sleep deprived from their journey. On arriving they subject themselves to the stress of gambling and sometimes the excitement of winning. Some elderly folks may become disoriented while being in unfamiliar surroundings. Fortunately, the medical care at both the Foxwoods and Mohegan Sun casinos is outstanding.

Video surveillance at casinos may be rivaled only by Fort Knox. Aside from security, these systems are important in locating an injured or lost patron. Emergency Medical Services (EMS) staff are stationed in key locations throughout the casinos so that there is no delay in administering first aid to an injured party. If necessary, EMTs and paramedics can initiate treatment protocols and transport to the Backus Hospital emergency department via one of the ambulances which are always onsite.

Over the course of the past fifteen years, Backus Hospital has provided emergency care for both casinos. This experience has resulted in a wealth of information, resulting in more effective care.

Drs. Fred Fenton and Kyle McClain are staff physicians at the Backus Emergency Department. They report that approximately 15 of the 180 daily ED visits are casino patrons. Many of these are related to heart and brain disorders including stroke, heart attack, and seizures. Approximately one quarter are linked to missed doses of medication.

Both physicians advise all travelers to carry a list of medications, medical conditions, and information to contact their physicians. In an emergency, this can be lifesaving.

Some helpful hints to make a casino visit safer:
• Take all prescribed medications on schedule
• Get plenty of rest before your visit
• Moderation is key; don’t try to pack too much activity into one visit
• Always carry a list containing vital health information

If you are not in good health and still want to enjoy a trip to the casino, rest assured there is an excellent medical network covering you at all times.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

Caffeine seems to be in everything these days, not just the usual sodas and coffee, but sneaking into candy bars, jelly beans and gum.

Energy drinks advertised as containing vitamins and herbs are mostly packing a wallop of caffeine and sugar. Labels unfortunately do not reveal caffeine contents and often give no clue that caffeine is an ingredient, except for on the ingredient list in very small print.

Caffeine acts by displacing a brain chemical called adenosine that helps prepare the body for sleep. This makes the brain more alert. Blood vessels constrict providing relief from headache and mild pain. This is why caffeine is added to some pain relievers.

One 8 ounce cup of coffee contains between 50 and 56 mg of caffeine. A cup of tea will supply 40-50 milligrams. Energy drinks contain between 80 and 240 mg in 16 ounces; soft drinks such as Coke, Pepsi, or Dr. Pepper contain 35-55 mg per 12 ounce serving. Check soft drink labels for caffeine as it can be found in drinks that might not be expected, such as Mountain Dew and Sunkist.

Coffee brands served by national chains often contain more caffeine than coffee brewed at home. A 16 ounce Starbucks coffee contains 330 mg of caffeine.

Caffeine is also showing up in foods. Ice creams containing coffee can supply up to 45 mg per ½ cup serving. A Snickers Charged Bar will contain 60 mg of caffeine.

Caffeine will give some people increased mental or physical performance or an improved mood, however there are some negative effects of consuming more than 200 mg of caffeine such as insomnia, jitters and irritability.

We all know that caffeine can affect sleep, keeping us up at night or waking early. We wake up tired, drink a caffeine laced beverage and start the cycle over again.

Caffeine has been shown to affect fertility, increase risk of miscarriage and increase risk of birth defects. Health professionals recommend that women who are pregnant or trying to become pregnant avoid caffeine containing foods.

Contrary to popular belief, caffeine does not stunt growth and caffeine does not help counteract the effects of alcohol. People who drink caffeinated beverages after drinking may think that they are all right, but judgment is still impaired making them more prone to having accidents.

Another belief is that caffeine acts as a diuretic and that caffeinated beverages do not count toward fluid intake. There is no evidence that caffeine in moderate amounts will cause heart problems or cancer. Studies have been done recently that show that caffeine only acts as a diuretic only for new caffeine users or if taken in excess.

Caffeine in moderation and consumed early in the day, does not seem to pose any health problems. Over consumption of caffeine, more that 300 mg per day, does appear to be a concern, especially for women who have or are trying to conceive.

Parents need to be aware of foods and drinks containing caffeine consumed by their children.

Mary Beth Dahlstrom Green is a dietitian at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. If you would like to comment on this column or others, go to the Healthy Living blog at www.healthydocs.blogspot.com or e-mail Green and all of the Healthy Living columnists at healthyliving@wwbh.org.

Sometimes it seems like we are all searching for the proverbial “pot of gold” at the end of the rainbow.

Happiness is put on hold, forever waiting for the better job, bigger house, or shinier car. Why is it so hard to permit a little celebration for the accomplishments thus far instead of instantly reaching for the next goal? How can we lead a happier life right now, and simply enjoy the rainbow for what it is?

The first step to finding inner peace and leading a fulfilling life is practicing living in the present. Living mindfully helps to acknowledge the delight in everyday experiences and encourages a life of tremendous joy. Recognize that this very moment is a gift.

My daughter’s wedding was an event I wanted to enjoy to the fullest. I remembered my own mother warning me not to “wish my life away,” and at the reception, I invited everyone to share in our joy by savoring every moment of the day.

I asked my daughter’s guests to enjoy the aroma, texture, and taste of the wonderful feast that was offered to them. I invited them to soak in the beauty of the venue and to take the time to speak with someone they did not know. By treasuring the details of a day, happiness is extended beyond the moment. We all have so much to be grateful for; by simply focusing on the positive, we can significantly improve our lives.

One way to center on the positive is to think grateful thoughts. Initially, it might be difficult to change the pattern of negative thinking, but with practice it will become a natural habit. Pick one small thing and focus on it every day. It might be as simple as being grateful for a good cup of coffee in the morning. It’s easy to be grateful for the big things, like a wedding celebration; remember to be grateful for the smaller things as well, such as the smell of a good meal.

Feeling grateful for the many little things that are a part of everyday life is an empowering practice. Remember too, that we all make mistakes. If you find yourself thinking negatively, forgive yourself and move on.

Achieving inner peace is an ongoing experience that takes practice, resilience and forgiveness. By focusing on the positive and making inner peace your first priority, you may find the effects of stress lessened. As you are able to build your feelings of everyday contentment, you will experience an open heart, and your best self. And that rainbow will be even more beautiful than before.

Paula Novak, a registered nurse and certified Healing Touch practitioner, is the Clinical Coordinator for Healing Touch and Integrative Care at William. W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Ms. Novak and all of the Healthy Living columnists at healthyliving@wwbh.org.

March was Deep Vein Thrombosis Awareness Month, and many are not aware of how prevalent this condition is.

Nearly 300,000 people in the United States die each year from blood clots –more then automobile accidents, breast cancer, and AIDS combined. Yet a national survey indicates that 60% of Americans have little or no awareness of Deep Vein Thrombosis (DVT) and the potentially fatal complication, Pulmonary Embolism (PE).

DVT occurs when a blood clot forms in one of the deep veins of the body, most often in the legs. The typical symptoms include pain, redness, and swelling of the lower leg.

Occasionally a piece of the clot will break off and travel through the blood stream and cause a blockage in the smaller vessels of the lungs. When this occurs it is termed a PE. A PE can cause shortness of breath and a sharp pain when breathing deeply and may lead to death.

When diagnosed early, DVT/PE is often easy to treat. But not everyone who develops a DVT or PE will experience those symptoms, making it hard to diagnose, which is why PE is often referred to as a “silent killer” and is the number one cause of death in hospitalized patients.

Even when treated successfully, patients may develop a long–term and often painful condition known as Postphlebitic Syndrome (PTS) and are at a greater risk for having a DVT again.

Prevention is the key.

The Agency for Healthcare Research and Quality (AHRQ) has ranked DVT prevention as the number one patient safety initiative American hospitals can undertake.

The William W. Backus Hospital has responded by marking Deep Vein Thrombosis Awareness Month with a number of programs aimed at educating patients, staff, and physicians.

Prevention of DVT and PE in hospitalized patients begins with a comprehensive assessment of a patient’s risk for developing a clot. Backus’ physicians now have a new risk assessment tool that aids in identifying those patients at risk for a clot.

Once identified, patients can be protected with injectable medications or special stockings depending on other conditions they may have.

But everyone should be aware of their own risk for a blood clot. Whether you are in the hospital or at home, you can be proactive to determine your own risk for developing blood clots, and then speak to your healthcare providers about your concerns.

Risks include certain medical and surgical conditions as well as family history and lifestyle. Major risks include heart failure, cancer, lung disease, recent surgery, and severe infections. Prior history of a DVT, smoking, birth control pills, and obesity all increase your risk as well.

These risks can even be higher if you are off your feet for extended periods of time due to illness or injury. You can protect yourself by discussing these issues with your doctors and keeping yourself informed. Do not hesitate to speak up if you feel you are at risk or are experiencing any signs and symptoms that concern you.

Internet sources such as http://www.preventdvt.org and www.dvt.net are filled with information that will keep you updated about this preventable, yet too often occurring disease.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Smith and all of the Healthy Living columnists at healthyliving@wwbh.org.

When a 2-year-old with severe asthma symptoms was recently released from the hospital, one of the things I discussed with his mother was the dangers of a second hand smoke.

General warnings from the surgeon general and the media mainly focus on smokers themselves. Enactment of laws in recent years banning smoking from restaurants and bars were done to prevent exposure to smoke by the general public. However, there is still no major initiative to educate people about the hazards of smoking for household members, especially children.

What is second hand smoke?

Smoke inhaled by non-smokers is referred to as second hand smoke. At present, 1.1 billion adults worldwide are smokers, making it inevitable that children and the two-thirds of adults who do not smoke are being exposed in some fashion.

Second hand smoke is a mixture of side stream smoke given off by the smoldering cigarette (or pipe or cigar) and of the mainstream smoke that is blown out in to the air by active smokers. Side stream smoke generated under the lower temperature conditions in the smoldering cigarette has a higher concentration of many of the toxic compounds, including nicotine and carbon monoxide. Effects can be much worse in the winter months because of indoor environments and cars with closed windows.

What are the consequences of second hand smoke?

There have been multiple public health reports in the United States and worldwide identifying the specific health risks associated with second hand smoke in children as well as in adults.

Risks for children include:
• Premature births and deaths among newborns
• Reduced birth weight
• Sudden infant syndrome (SIDS)
• Multiple chest infections
• Long lasting colds and chest infections
• Worsening of asthma and other chest conditions and poor lung function
• Multiple ear infections

Exposure to second hand smoke is a significant public health issue and affects both quality of life and healthcare costs.

On average, studies have shown that children exposed to smoke are more likely to be sick and miss school compared to children of non-smoking parents. Adverse effects of smoking by pregnant mothers and to mothers that are exposed to second hand smoking include reduced birth weights, more birth defects as well as an estimated 20-40% increase in sudden infant death syndrome, to name a few. The risk of Sudden Infant Death Syndrome increases with the number of cigarettes smoked per day.

There is increased incidence of cough, phlegm, and wheezing in the children of smokers. The risk of developing chest infection is as high as 50 % if either parent smokes compared to children of non-smoking parents. Those children who have asthma suffer from many more exacerbations (asthma attacks). Their asthma is much more severe and they end up having many more emergency room visits, hospital admissions and missed school days.

Other effects of the second hand smoke include increased incidence of dental problems and childhood cancers including leukemia, lymphoma and brain tumors.

What needs to be done?

Parents should consult their doctors and get help to quit smoking. Partners of pregnant women should avoid smoking around them, especially those with children with asthmas and allergies.

I cannot stress enough that the bad effects of exposure to smoke begin inside the uterus and continue throughout childhood. Avoid smoking at all costs -- your children’s health depends on it.

Ravi Prakash, MD, is a pediatrician on the Backus Hospital Medical Staff with a private practice in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Prakash and all of the Healthy Living columnists at healthyliving@wwbh.org.

Last year more than two million poisonings were reported to poison control centers around the country.

Accidental poisoning is the second-leading cause of home-injury death, and the risk is not just in homes with young children. Although children under the age of five have the highest rate of poisonings, adults account for 35% of all poisonings. The most common substances involved are medications.

Young children are naturally curious and often explore their environment by placing things in their mouth. Make-up, household cleaners and medications (including vitamins and herbal products) are common items in all homes that can be dangerous when ingested. Older children who cannot yet read labels will often mistake medicine for candy and bright colored cleaning agents for juice.

If left in an accessible area to little hands, disaster can occur.

Using child-resistant containers and keeping medicines and cleaners locked-up are important steps to take to keep little ones safe.

When struggling to get a young child to take their medicine, never refer to it as “candy”. Young children need to be taught that medicine is important and should only be used when given by an adult.

It also is not enough to just child-proof your own home; neighbors’ and grandparents’ homes, any home were the child spends time, needs to be safe. If you are a woman and keep medication in your purse, be especially cautious around toddlers. They love to search through bags looking for goodies and may find a non-child resistant pill box.

Older adults, especially those taking multiple medications, are also at a high risk for poisoning. Accidently taking the wrong medication, taking someone else’s medication, and taking a medication twice are common reasons for adult poisonings. Multiple distractions, poor lighting and hard to read prescription labels are often the cause.

Many seniors also save unused medications thinking they may be able to use them again in the future. This leads to overflowing medicine cabinets and pill bottle confusion. Not to mention the poisonous drug interactions that can occur when searching for old medications that may not safely mix with new ones you now have.

Using a pill box to keep track of medications, communicating with your doctor and pharmacist about over the counter and herbal medications you use, and properly disposing of unneeded medications are key steps in preventing medication poisonings in adults.

Only take medications in well lit areas and decrease the number of distractions that can occur. Never share your medications with friends; what works for your headache could be deadly for your friend.

Backus Hospital will host a poison prevention seminar in honor of Poison Prevention Week on March 26 at 6 p.m. in the hospital auditorium. “Poison Prevention for the Whole Family” will offer tips for both young and old, the family pet too, as well as suggestions for safe and proper medication disposal. To register, call 823-6374.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Smith and all of the Healthy Living columnists at healthyliving@wwbh.org.

Being part Irish I grew up celebrating St. Patrick’s Day with the traditional feast of corned beef and cabbage. The enticing aromas and flavors from this dish made it a holiday favorite in my family. Many restaurants, no doubt, will offer this dish as a special on March 17.

But before you place that order, consider what the term “corned” really means. It has nothing to do with the vegetable you can eat on or off the cob, but everything to do with salt.

Back in Anglo-Saxon times meat was preserved by dry curing it with coarse “corns” of salt. Pellets of salt (some as large as corn kernels) were rubbed into beef to keep it from spoiling. Dry-curing has now been replaced with the process of “brining” or using a salt-water bath to flavor and preserve meat.

In practice I have had patients ask me if they should avoid corned beef on a low salt diet.

I think this is best answered by providing some basic facts: According to the U.S. Dietary Guidelines (2005), individuals with hypertension, African Americans, and middle aged and older adults may be more “salt sensitive” than others and should aim to consume less than 1500 mg of sodium per day. For younger individuals and those without hypertension, consume less than 2300 mg per day. Consider that a 3 oz piece of cured, cooked corned beef brisket contains 964 mg of sodium. If you go for seconds on the corned beef and you have high blood pressure you could easily exceed your recommended sodium allowance for the day.

What to do?
 Look for lower sodium brands of corned beef; have a small portion (2 oz) and forego adding additional salt in cooking, at the table, or in the form of condiments (like relish and mustard).
 Think beyond corned beef and cabbage and celebrate St. Patrick’s Day by eating vegetables in shades of green. Green veggies will not only help you get in the spirit, they’ll provide color, texture and flavor to your meals. Low in calories, green vegetables can be a good source of nutrients like Vitamin C, folate, potassium and Vitamin K, to name a few. Protective compounds found in green vegetables may promote eye health and lower your risk of heart disease and some cancers, too.

There are many ways to incorporate more green vegetables into your St. Patrick’s Day feast, or any other meal for that matter:
 Serve grilled or roasted fish, chicken or meat on a bed of wilted greens like
spinach.
 Snack on raw broccoli spears or green peppers.
 Experiment by adding different lettuces to sandwiches i.e., romaine, green-leaf, baby spinach.
 Add broccoli slaw to salads, sandwiches or stir-fries.
 Enjoy sides of steamed asparagus, crisp snow-peas, or sautéed collard greens.
 Add chopped broccoli or spinach to lasagna or manicotti fillings.

However you celebrate St. Patrick’s Day, keep your healthy eating goals in sight and you just may find good luck at the end of the rainbow.

Catherine Schneider is a Registered Dietitian in the Food and Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Ms. Schneider and all of the Healthy Living columnists at healthyliving@wwbh.org.

The term “Parkinson’s disease” elicits images of old, feeble patients unable to move enough to care for themselves. When Michael J. Fox became afflicted with Parkinson’s disease, that image changed.

Parkinson’s disease is part of a broad category of neurological illnesses termed neuro-degenerative diseases. Sadly, they are chronic and slowly progressive. Neuro-degenerative diseases are primarily seen in the elderly. As longevity increases, the numbers of those afflicted will continue to rise. Parkinson’s disease specifically affects motor function and is classified as a movement disorder. Over one million people in the United States alone suffer from Parkinson’s disease.

Cells deep in the brain produce a neurotransmitter called dopamine. They are the principal targets in Parkinson’s disease and become either lost or blocked. Dopamine is crucial for motor nerves to coordinate muscle movement. A lack of dopamine results in uncontrollable shaking (tremors), slowed movements (bradykinesia), and joint stiffness (rigidity). Dopamine replacement with a drug called L-DOPA has been the basis for treatment during the past 50 years. Over time, L-DOPA becomes ineffective.

In 1982, Parkinson’s research changed dramatically. Until then, there were no models for testing new treatments. It was in 1982 that a chemical called MPPP was manufactured in primitive home laboratories and sold on the streets of San Francisco as synthetic heroine. MPPP was easily contaminated and could become MPTP. When MPTP is injected, it immediately destroys the cells which produce dopamine. Hospitals began admitting young people with severe, advanced Parkinsonian symptoms. This created that needed model and an urgency for the development of new treatments.

Today, there are many drugs that are used in various combinations to improve motor function in patients with Parkinson’s disease:

• Carbidopa/Levodopa boosts the level of dopamine in the brain.
• Rasagiline slows the enzymes which breakdown dopamine in the brain.
• Ropinirole increases the sensitivity of dopamine receptors.

“This is a very exciting and encouraging time to be involved in treating Parkinson’s disease,” said Dr. Maria L. Moro-de-Casillas, a neurologist who specializes in the treatment of Parkinson’s disease. “Over 70 percent of my patients are able to function independently.”

In addition to a vast armamentarium of medications, surgical treatments including deep brain stimulation hold great promise.

In tomorrow’s Healthy Sports column, some unconventional treatments for Parkinson’s disease will be discussed.

Anthony G. Alessi, MD, is a neurologist on The William W. Backus Hospital Medical Staff in private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi, or any of the Healthy Living columnists at healthyliving@wwbh.org.

With the death of actor Heath Ledger in February due to a cocktail of pain killers, sleeping pills and anti-anxiety medications, the topic of medication interactions is on many minds.

And we see its implications at Backus Hospital all the time.

About 28 percent of all emergency department visits and 10 percent of all hospitalizations are due to problems with medications.

It is also estimated that 1 in 4 hospitalizations of senior citizens are related to medication issues. The culprit is often multiple drugs prescribed by multiple physicians who are unaware of a patient’s other medications.

Ledger’s autopsy revealed the actor was taking six drugs that all could suppress the respiratory system. The cocktail of drugs created a perfect storm to kill the 28-year-old, the autopsy showed.

It is unclear if Ledger used more then one pharmacy for his prescriptions, which can be a problem. A pharmacy can only check for drug interactions between the prescriptions they fill. There is no way to track a patient’s prescriptions outside their own store or chain.

Even when the same pharmacy is used, patients often forget to tell the pharmacist of any over-the-counter drugs or supplements they are taking. A lot of people think because it’s a natural supplement it’s completely safe and it’s the same thing with over-the-counter drugs.

That is not the case. The two most popular over-the-counter drugs, acetaminophen and ibuprofen, can cause serious problems, such as liver failure with acetaminophen and intestinal bleeding with ibuprofen, if taken inappropriately. Many natural or herbal products have powerful drug interactions.

Patients should also never assume because medications are for very different ailments that they cannot affect one another. Drug interactions occur between all kinds of medications. It is not just side effects and drug interactions that cause trouble, taking multiple drugs without alerting a pharmacist can cause other problems, too.

There can be a lot of waste and duplication of therapies. Having multiple doctors prescribe multiple drugs for the same conditions can lead to wasted money and an increased risk of problems. Having all your prescriptions filled at a single pharmacy allows the pharmacist to evaluate all your prescriptions and supplements for duplication of therapy and drug interactions.

People who are on multiple medications should carry a list with them of what medications they are on, the dosage, how many times a day they take it and why they were prescribed it. This list should be shared with all healthcare providers whenever a medication is prescribed or filled.

Backus Hospital offers a pocket medication card you can use to help you with this at backushospital.org. Simply scroll down the left side of the page and click on “personal pocket medication card.”

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Smith and all of the Healthy Living columnists at healthyliving@wwbh.org.

The word “obese” is an uncomfortable word to hear.

It often carries with it the connotation of being lazy, sloppy, or unhealthy. While these characterizations may be untrue, obesity has definitely been linked to heart disease, stroke, diabetes, and a variety of orthopedic problems. A study published this week in the British medical journal, The Lancet, associates obesity with many common and rare malignancies.

Previously, there was a connection between obesity and cancers of the breast and colon. This more recent study demonstrates an association between excessive weight and tumors of the kidney, esophagus, thyroid, uterus and gall bladder.

Body mass index (BMI) was the measurement used to evaluate almost 300,000 patients used in this study. BMI is based on height and weight with a BMI above 30 considered obese. This is the equivalent of a five foot ten inch person weighing 210 pounds. A BMI of 25 (five foot ten inch person weighing 178 pounds) is considered overweight.

It is believed that half the adult population in all developed nations is overweight or obese. This study should serve as a call to action.

In the current presidential race, each candidate has touted the “best program” for a more effective health care system. By addressing the obesity problem, we will also be reducing the frequency and severity of many other health conditions.

Some basic ways to tackle this problem:

1. Keep it simple. Body weight is based on calories taken in and calories expended. If more calories are taken in than expended, weight gain occurs.

2. Moderation not deprivation. While some people don’t mind measuring, counting, and weighing what they eat, many don’t have the time or inclination. Make an effort to eat from a plate, not a container. Eat reasonable portions of protein, starch, and vegetable, then stop. No second portions.

3. Exercise. This is where you burn the calories. Even moderate exercise can burn significant calories. Poor health is not an excuse. Consult your physician; even those who are disabled can have an exercise regimen developed.

Despite this national debate over what has become an international problem, all health care is local and any effective national health policy will have to begin in our homes and communities.

Let’s get the conversation started about how we can change the health of our community. You can comment and discuss the matter with me on our Healthy Living blog at healthydocs.blogspot.com.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. You can email Alessi and all the Healthy Living columnists at healthyliving@wwbh.org.

Since 1963, February has been appointed National Heart Month. This month has been designated to urge Americans to join in on the battle against the No. 1 killer, heart disease. By now, most us know that not smoking, maintaining a healthy weight, exercising regularly, as well as reducing the saturated and trans fatty acids in our diet can help reduce the risk of heart disease.

More recently, the American Heart Association has updated recommendations for consumption of omega-3 fatty acids for further prevention of heart disease. Omega -3 fatty acids in the diet include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Recommendations specifically include 1 gm of EPA and DHA per day, preferably from fish oil. Currently there are no exact recommendations for ALA for heart disease prevention, although the heart association suggests that intake is beneficial.

Flaxseed is a very rich plant source of alpha-linolenic acid. We should be encouraged to replace oils such as corn oil and safflower oils with canola soybean or flaxseed as well as incorporating flaxseed and walnuts into our diets.

Flaxseed has been used in the diets of humans for thousands of years. The Babylonians cultivated flaxseed as early as 3,000 BC., and millennia later, in 650 BC., Hippocrates used flaxseed for the relief of intestinal discomfort.
Flaxseed can be purchased at many supermarkets.

Ground flaxseed provides more nutritional benefits than whole seed. That’s because the seeds are hard, making them difficult to crack, even with careful chewing, therefore they may pass undigested through the body, reducing the nutritional advantage of eating it in the first place. Ground seeds are available as well as the whole seed. The seed is easy to grind at home by using a coffee grinder, food processor or blender. Like coffee beans, you can grind flaxseed coarsely or fine, but generally recipes call for finely ground seeds.

Once the flaxseed is ground, there is greater risk of it developing an off flavor taste. That is why it is best to grind whole flaxseed as you need it. This ensures its freshness. Either after grinding or purchasing already ground, the flaxseed should be refrigerated or freezed in an airtight container and will keep for up to 90days.

Add flaxseed to your baking for a pleasant nutty taste. It not only adds flavor, it adds extra texture and good nutrition to your breads and other baked goods. Try sampling flaxseed in everything from bread, waffle, muffin and cookie recipes. Sprinkle it into your cereal or on top of yogurt or salads. You can use flaxseed as a replacement for some or all of the oil, butter, margarine or shortening in a recipe. Recommendations include 3:1 substitution ratio. For example, 3 Tbsp. of ground flaxseed added to a recipe can replace 1 Tbsp. of the fat. When flaxseed is used instead of oil, the baked good will tend to brown more rapidly.

So during this month of February, as we are reminded to be good to our heart, go ahead and indulge in some flaxseed and you can say you had a dose of alpha-linolenic acid for the day and feel good about it.

Sarah Hospod is a registered dietitian in the Food and Nutrition Department at The William W. Backus Hospital in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Hospod and all of the Healthy Living columnists at healthyliving@wwbh.org.

Every February, it seems like we are bombarded with candy hearts, roses and visions of cupid. From elaborate greeting cards to children’s’ homemade Valentines, we receive constant reminders that February is the month of love.

Despite this, many don’t feel worthy of love. As we prepare to show our love for others, what better time to start learning to love ourselves first. By identifying the impediments on our path to the spiritual enlightenment of self-love, we can begin to heal our past pains.

Why is it easier to open our hearts to everyone except ourselves? Children are continually bombarded with messages from parents, teachers, peers, the media, and others telling them how to look and act in order to measure up to others’ expectations. Even on Valentine’s Day, the simple act of sharing Valentines can become a stressful test of popularity. As children try to sort through these mixed messages, the relentless cycle of self-judgment begins. As feelings of self-doubt are instilled, many have trouble breaking the cycle even as adults.

Each of us embarks on a different journey. As a child, I found great joy in creation through painting and drawing. Yet my enjoyment and confidence waned because I allowed myself to take to heart any “less than stellar” comments about my finished piece, which eventually led me to participate in my own cycle of self-judgment. The more I continued to allow myself to hear the voices of others through my own inner criticism, the less my goal of validation seemed attainable. Now, as I focus my healing on generating a love for myself, I am able to find love for my artwork. The happiness I feel in creating art helps me to create new cycle of self-appreciation.

So, how do we revive a wounded heart? We restore our love for ourselves by constantly recognizing the good and forgiving the past. Each time a step is taken towards self reconciliation, it helps release the vitality which we need for creative living. Finding love for oneself, in spite of, or perhaps because of the past, will initiate healing and help to release the ties that bind our hearts.
We can continue to nourish our hearts by spending time in meditative silence, in nature, and with positive people. When we can identify something that gives us a sense of joy and allow ourselves to dedicate time for that joy, our hearts will sing.
Nurture your self-healing by attending the “Renewing the Spirit for Women” workshop on April 12, or the “Renewal of a Man’s Soul” workshop on April 25, at the Backus Outpatient Care Center. For more information about these events, call 889-8331, ext. 2483.

Paula Novak, a registered nurse and certified Healing Touch practitioner, is the Clinical Coordinator for Healing Touch and Integrative Care at William. W. Backus Hospital. This column should not replace advise or instruction from your personal physician. E-mail Ms. Novak and all of the Healthy Living columnists at healthyliving@wwbh.org

Medications are powerful things. When used properly they cure diseases, heal wounds, prevent heart attacks and strokes, and prolong life. When misused they can cause injury, disease and even become lethal.

Medication safety is much more then just taking your medications as prescribed, it’s about getting the maximum benefit from them with the least amount of risk. Many people are surprised to know this, but you have more control over medication safety then even your doctor.

In order to get the maximum benefit from the medications that you are prescribed, you need to understand many things beyond what dose to take and how many times a day to take it. When is the best time of the day to take your medication? Can I take some of these medications at the same time? What should you do if you forget a dose? What side effects go away after a short time and which side effects do I need to call my doctor about? When should I start to feel better? What if I don’t feel better? What over-the-counter medications should I now avoid?

Although that sounds like a lot of information, it is really only the basics that everyone should know about all of the medications they take. You should also know why you are taking each medication and how it works. Many medications can be used for different conditions; your pharmacist will need to know why you are taking the prescribed medication so they can properly counsel you. Knowing how a medication works will help you understand the side effects that may occur and how to best manage them before you can get in touch with your doctor.

Did you know that medication safety also includes saving money? Mistakes can be costly. Missing just a few doses of an antibiotic can lead to a treatment failure which may need even more costly medications to treat. Improperly taking your cholesterol medication will decrease its effectiveness and may lead to needing two drugs instead of one to control it.

All of the above may seem to be an overwhelming amount of information to learn, but you don’t have to memorize it all. In fact the best thing to do is to keep a small notebook or file with this information. When your physician gives you a new prescription, ask him or her the above questions and write them down. When you get the drug information printout from the pharmacy, ask the pharmacist to highlight the important information and keep the printouts in a small file. Finally, always keep an updated and detailed list of your medications with you that can be given to all your healthcare providers so they are aware of exactly what you are taking and why.

A detailed list including the drug name, dose, how many times a day you take it, and the reason why. A list is the best way to ensure this information is safely and correctly communicated -- especially if you are out of town and need medical assistance or are being admitted to a hospital.

If you would like some help preparing a list or getting answers to the above questions, Backus Hospital will be hosting a “Brown-Bag” program on Wednesday, Feb. 20 from 7:30-11:15 a.m. in its entry level conference rooms. You can bring all of your medications and herbal products with you and sit with a pharmacist to discuss any questions or issues you have. They will also help you fill out a detailed medication list. To schedule a time, call 823-6374.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Smith and all of the Healthy Living columnists at healthyliving@wwbh.org

After all the holiday eating, most people are willing to scale down their calorie rich diets come January for foods that are more nutritious and contain less fat and sugar. So, what foods are both seasonal and are good choices to incorporate into your New Year’s Resolution Diet?

 The United States is one of the biggest producers of oranges in the world, despite the fact that their origin is South East Asia. There are three varieties of oranges: sweet, loose-skinned, and bitter. The sweet variety is best suited for eating and includes naval, Valencia, and blood oranges.

Many people have realized for years that oranges contain high levels of vitamin C (as much as 98 mg per large orange), which has been shown to protect against cancer and reduce the risk of cataracts based on some controlled studies (although more research is needed).

Eating oranges for their vitamin C content to treat the common cold has conflicting controlled studies, but oranges remain a healthy food nonetheless. They contain about 4 grams of fiber, over 300mg of potassium, and even have about 70mg of calcium (adults should consume 1,000 to 1,300 mg of calcium per day depending upon sex and age).

 Pears are cultivated and thrive in the northwestern United States, mainly Oregon and Washington, and were brought there by colonists in the 1800’s. Some varieties include Anjou, Red and Yellow Bartlett, and Bosc (the latter better for baking or cooking). Although pears do not contain as much vitamin C as oranges, they are still a good source of fiber (4 grams) and potassium (207mg), and have less than 100 calories per serving, making it an excellent snack choice.

 Carrots are particularly nutritious and can be excellent this time of year. Carrots are known predominantly for containing large amounts of vitamin A, and are subject to the folklore that the British Royal Air Force ate enormous amounts of these vegetables to avoid radar in World War II. While this tale cannot be validated, it does hold true in studies that vitamin A improves vision (if deficient in vitamin A) and can help fight certain skin disorders. Not enough research has been done to confirm that this micronutrient has anti-aging benefits.

 Leeks are another good January vegetable choice, this one belonging to the onion family. Speaking of folklore, Nero supposedly ate leeks to improve the quality of his singing voice (I tried this and it doesn’t work). Leeks have been called scallions on steroids, and are easily located in supermarkets between September and April. They should be stored in refrigeration and wrapped loosely in plastic wrap. Leeks do not have nearly the vitamin content of carrots, oranges, or pears – but they are low calorie and contain some fiber.

Filling up on seasonal fruits and vegetables are far more healthful choices ringing in the New Year, especially when compared to the foods some of us indulged in throughout the holidays.

Whitney Bundy is a registered dietitian and Director of the Food & Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Bundy and all of the Healthy Living columnists at healthyliving@wwbh.org.

If you develop aching and stiffness around the upper arms, neck, lower back and thighs, the cause might be polymyalgia rheumatica (PMR), which rheumatologists commonly diagnose in patients over the age of 50.

Thee symptoms tend to develop quickly, over a period of few days or week and occasionally overnight. Involvement of the upper arms, and difficulty raising them above the shoulders is common. Aching and stiffness are worse in the morning, and tend to improve gradually as the day goes by. Occasionally this aching occurs in joints such as those of the hand and feet.

Causes unknown
The cause is unknown. “Myalgia” is a term for “muscle pain,” but tests for muscle damage are not elevated. We now know that PMR is an arthritis that has a tendency to involve the shoulder and hip joints and the bursae around these joints. The pain in the arms and things comes from the nearby shoulder and hip joints.

Who gets PMR?
It occurs in older adults, and rarely in people younger than 50. Average age is greater than 60. Women are affected somewhat more than men, and the disease is more frequent in whites than non-whites.
PMR is not unusual – it is diagnosed more frequently than Rheumatoid arthritis in older adults.

Diagnosis and treatment
Blood tests that detect inflammation are helpful. These include ESR (sedimentation rate) and C-reactive protein tests. Both tests are elevated in most patients, but a small proportion of patients can have these tests normal.
When a physician strongly suspects PMR, a trial of Prednisone is given daily. If patients have PMR they have a response in a matter of few day s– and the response is dramatic. Ibuprofen, naproxen and Tylenol are only minimally helpful at best.
The Prednisone dose is gradually reduced over a period of 12- 18 months. The goal is to find the lowest helpful dose that keeps the patients comfortable. Clinicians monitor lab results on a regular basis while tapering the prednisone. Also, side-effects of chronic prednisone therapy are monitored, like increasing blood sugar, weight gain and osteoporosis.

A cautionary note
PMR can be associated with a more serious condition, giant cell arteritis (GCA). We advise all our patients with PMR to look for temporal headache, change in vision, and jaw pain. If any of this happens they are told to report to us right away or if they are having visual symptoms they should go to the Emergency Department to prevent blindness.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org

We usually never know the ripple effects of our choices but this time it made the news. It happened at a Starbucks drive-through in Florida in early December.

The chain of events began with an angry outburst of yelling and honking by an impatient customer. The man in the car in front, who happened to be a Tai Chi master, responded rather than reacted. Instead of the usual knee jerk reaction of “you push, I’ll push back,” he paid for the coffee of the man behind him. The miracle of the story is that the man who had been so impatient and enraged paid for the person’s coffee behind him; and so it went for the next 17 customers.

The Tai Chi master said “it wasn’t an idea to pay anything forward, nor was it even a random act of kindness, it was a change of consciousness,” he said. “Take this negative and change it into something positive.” Practicing Tai Chi had taught him how to step back and respond to the moment thoughtfully.

Learning to step back and pause so that we are responding to our lives takes practice, and silence and stillness are our best teachers. We have however become so addicted to noise and busyness that stepping back and being in silence for even a few moments may be unsettling.

At a retreat some years ago, after being given the instruction to go off and be alone I was paralyzed. I didn’t know how, had never taken the time, and felt afraid. I would now describe my morning meditation experience as a cross between peace and the seven dwarfs; sometimes sleepy, happy, dopey, or grumpy, and sometimes restless or bored.

The learning is to be with whatever comes up, without judgment or manipulation. Over and over surrendering to the moment as it is and learning to be present in the midst of it. Little by little there is a subtle and deep shift with glimpses of connection to what is true beneath and beyond the surface of appearances. “There is no substitute for the creative inspiration, knowledge and stability that come from knowing how to contact your core of inner silence,” said teacher and author Deepak Chopra.

We can begin by making a quiet space in our day, a space in our home, a space in our mind to step back and begin to observe rather than identify with our thoughts, feelings and moods. Committing just five minutes each day will begin a life-changing momentum.

Practices like Tai Chi, Yoga, meditation and prayer may be helpful in teaching us to quiet ourselves, step back and be more fully present. The Sufi poet Rumi said: “Only let the moving waters calm down, and the sun and moon will be reflected on the surface of your being.”

Become the change you want to see.

Amy Dunion, a registered nurse and licensed massage therapist, is Coordinator of The William W. Backus Hospital’s Center for Healthcare Integration. This column should not replace advice or instruction from your personal physician. E-mail Dunion and all of the Healthy Living columnists at healthyliving@wwbh.org

Now that the New Year has arrived, there is an overwhelming amount of advice on how to improve health. The standard formula for reducing heart disease, stroke, and other chronic illnesses always includes eating a better diet, exercising regularly, cessation of smoking, and scheduling an annual physical.

One area of medicine often overlooked is the need for sufficient sleep. Life has become an endless stream of commitments, both social and occupational. Many people now work more than one job in addition to being available for family obligations. Often these activities come at the cost of sufficient sleep.

The issue of what constitutes adequate sleep is variable and depends on each individual’s age and health status. “Basal sleep” describes the amount of sleep the human body needs on a regular basis to perform optimally. “Sleep debt” is sleep lost due to variations in the sleep schedule. It is believed that the average, healthy adult requires between seven and eight hours of sleep each night. When this amount is not reached, sleep debt accumulates until an opportunity occurs to make up those hours and get back on a schedule.

Sleep requirements change at different stages of life. Infants and young children require much more sleep than the average adult. Teenagers typically have a sleep schedule that runs contrary to most daily routines. Teens may not become sleepy until late at night and then need to sleep later in the morning. Sleep deprivation often causes teens to perform poorly during early morning classes. College schedules offer more flexibility with late morning and evening courses. The elderly also have increased basal sleep demands and it is often difficult for them to initiate or maintain sleep. This is overcome by napping during the day.

Chronically, inadequate sleep results in serious health problems including obesity, diabetes, heart disease and depression. Sleep deprivation is also associated with an increase in serious motor vehicle accidents.

Adequate sleep recommendations include:
• Establish consistent sleep patterns, even on weekends
• Create a sleep environment that is dark, quiet, and comfortable
• Do not eat or exercise for two hours prior to going to bed
• Avoid caffeine, alcohol, and nicotine before attempting sleep

Consultation with your physician or a sleep medicine specialist may be necessary.
Unfortunately, society associates people who sleep or nap a lot with being lazy, while those who sleep very little are considered hard working. Sleep medicine has now determined these thoughts to be incorrect.

It is believed that the best way to start a diet and exercise program is by “shocking” your body. What better way to shock your system this New Year than by sleeping more.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

We are moving into the coldest time of the year in New England. Although snow lovers might welcome the usual arctic blast, it can cause problems for those suffering from Raynaud phenomenon, which is a condition in which some of the body's blood vessels (commonly in the fingers and toes) constrict in an exaggerated way in response to cold or emotional stress.

Normally, blood vessels supplying the skin constrict or narrow in response to cold temperatures, decreasing blood flow to the skin, which helps to minimize heat loss. In people with Raynaud, the vessels constrict in an exaggerated way in response to cold and stress, causing the skin to change to a white color. The skin may then become purplish-blue, caused by low oxygen levels in the blood. When the vessel recovers, it dilates, allowing blood flow to resume; the skin may become red. Approximately 3-5 percent of people are affected by this condition.
According to uptodate.org and raynauds.org:

 There are two kinds of Raynaud – primary and secondary. Patients with primary Raynaud – most common in women, younger age groups and people with family history of the disease -- don’t have a related disease causing it. The underlying relation to cold is uncertain. Fortunately, most patients with primary RP are not significantly disabled by the condition and respond well to treatment. Some patients with secondary Raynaud have an illness, such as scleroderma or SLE, that injures or alters the blood vessels and impacts how they react to cold and stress. Secondary RP can be more difficult to manage because the underlying condition can physically damage the blood vessel.

 A Raynaud attack can be triggered by exposure to cold temperature or even by a shift in temperature from warm to cool. As a result, even mildly cold exposures, like air-conditioning or by the cold of the refrigerated food section in a grocery store, can cause a RP attack. Emotional stress and being startled can cause an attack as well.

 Most often, an attack affects the blood vessels in the fingers. The fingers or toes become suddenly cold as the blood vessels constrict. The skin color changes markedly, and may become pale (called a "white attack") or a purple or blue color (called a "blue attack"). Usually, the symptoms begin in a single finger and then spread to other fingers in both hands. The index, middle, and ring fingers are most commonly involved, while the thumb is often not affected. Symptoms subside as the provoking factor (cold or stress) is removed. After leaving the cold area and warming up, the discoloration resolves after 15 to 20 minutes and, as normal blood flow resumes, the skin "blushes" or becomes pink. Patients with severe secondary Raynaud can sometimes experience a serious decrease in blood flow that does not resolve even after the provoking factor is removed. Pain and ulceration of the skin (tips of the fingers and toes) can result.

 Raynaud is diagnosed based on the patient's description of typical symptoms following cold exposure. Through the history, a healthcare provider can usually distinguish Raynaud from more common complaints of cold hands or feet. Often, the clinician will witness the symptoms during the physical examination. Laboratory tests may be performed to determine whether any conditions that contribute to Raynaud are present. In addition, the small blood vessels (capillaries) around the nail beds may be examined.

Raynaud patients usually benefit from:

 Avoid sudden cold exposure by dressing warmly, wearing layered clothing, and using mittens or gloves.
 To end an attack —placing the hands under warm water or area, or rotating the arms in a whirling windmill pattern.
 Avoid smoking — the nicotine and other chemicals in cigarettes cause the blood vessels to constrict.
 Avoid medications - include decongestants, diet pills, some migraine remedies (ergotamine), and herbs containing ephedra.
 Reduce stress and use relaxation techniques to reduce anxiety.
 While the tips mentioned above are generally enough for patients with primary Raynaud (medication might be needed for cold exposure), patients with secondary Raynaud may require more aggressive treatment. Medications are usually needed to reduce the frequency of attacks and prevent ulceration of the skin of fingers and toes.

 Hospitalization can result if blood flow to a finger or toe is seriously restricted. Treatment then requires additional medications to dilate the blood vessels and to prevent blood clots. Medication or surgery may be used to block the nerves that trigger vasoconstriction in the affected area.

To avoid hospitalization or the worst case scenario, amputation, it is important that if you experience these symptoms you are examined by a healthcare provider. If this is something that you have been putting off or avoiding, put it at the top of your list for the New Year.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org

There is probably a reason why this time of year is loaded with holidays and activities. The days are shorter, it gets darker earlier and every one is just a little bit cranky. Looking forward to Thanksgiving, Christmas, Hanukkah, New Years and even Valentines Day gives us a reason to get up on a cold dark morning.

Because of the shorter periods of sunlight in New England and colder weather keeping some of us inside more, we are also producing less Vitamin D. Vitamin D is a fat soluble vitamin that is produced when our skin is exposed to ultraviolet light (sunshine). It is also found in fortified foods, such as milk, orange juice, soymilk and breakfast cereals. Fatty fish, egg yolk and mushrooms are also sources of the vitamin.

Vitamin D is most well known for promoting bone health by increasing the body’s ability to absorb calcium and phosphorous. It also helps to promote bone formation. Low amounts of Vitamin D in the diet increases risk of the bone disease, Osteoporosis. Prior to the 1930’s, rickets was a major public health problem for children, until milk began to be fortified with Vitamin D. Low blood levels of Vitamin D are also associated with high blood pressure, some types of cancer (skin and colon), depression and autoimmune diseases.

Recommended Daily Intake (RDI) for Vitamin D is 200 International Units (IU) for children and for men and women under 50 years of age. Recommendations go up for people over 50 to 400 IU daily and to 600 IU for those over age 70. Needs increase with aging because the skin makes less pre-vitamin D as it ages and the liver and kidney convert less pre-vitamin D to the active, useful form of the vitamin. An 8-ouce glass of fortified milk contains 100 IU of vitamin D, and 3 ½ ounces of cooked salmon provides 360 IUs. Mushrooms are an excellent source for vegans.

During the months of November through February, the New England sun is an insufficient source of Vitamin D. If outdoor exposure to sunlight is limited and getting away to southern climates is not an option, it becomes important to obtain Vitamin D through foods or supplements. Using sunscreen, which is recommended to prevent skin cancers, also limits ultraviolet light exposure, reducing the production of Vitamin D. During the spring and summer months adequate Vitamin D can be obtained by exposure to sunlight for 10-15 minutes daily.

As I write this column, the view out my window is dreary, with a few snow flurries. A little salmon for dinner and some mushrooms in the salad might be a good idea. Then I think I’ll book a little Island getaway. All for the sake of my bones, of course.

Mary Beth Dahlstrom Green is a dietitian at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Green and all of the Healthy Living columnists at healthyliving@wwbh.org

Bleeding anywhere in the brain is life threatening. Physics dictates that adding volume to a closed container will result in increased pressure. When blood accumulates in the skull, it puts pressure on the brain causing severe damage.

The location of the blood within the brain is often an indication of the source of hemorrhage and the cause of bleeding.

An intracerebral hemorrhage occurs when a blood vessel in the brain ruptures, resulting in bleeding within the substance of the brain. This type of brain hemorrhage is most commonly seen and causes a hemorrhagic stroke. This differs from an ischemic stroke, which is typically caused by a blocked blood vessel as opposed to leakage. It is often the result of chronic high blood pressure, malformed blood vessels, or both. A substance known as beta-amyloid is deposited in the walls of blood vessels during the normal aging process. The accumulation of beta-amyloid weakens the vessel walls, thus making intracerebral hemorrhage more likely in older people.

Sub-arachnoid hemorrhage occurs as the result of a ruptured aneurysm beneath the arachnoid tissue surrounding the brain. An aneurysm is a weakening of an arterial wall resulting in the formation of a berry-like deformity. It is very similar to a bulging bubble seen on the inner tube of a bicycle tire. Aneurysms are usually present at birth and are commonly seen as a family trait.

Subdural hemorrhage occurs beneath the dura mater or the outermost covering of the brain. It typically results from trauma to the veins bridging the subdural space.
Epidural hemorrhage occurs outside the dura mater. This type of hemorrhage is caused by trauma to the middle meningeal artery. Since it is arterial in nature, it produces a large amount of blood very quickly and many times results in sudden death.
There are different treatments for brain hemorrhage. The type of treatment depends on the location of the bleeding and the amount of blood that accumulates.

Neurosurgeons often open the skull and mechanically stop the bleeding and repair the damaged blood vessel. Recent studies have shown that in smaller hemorrhages, the risk of further injury is greater with surgery and it is best to medically support the patient. Medications lower blood pressure, shrink brain swelling, and prevent seizures. Rehabilitation in the form of intense physical, occupational, and speech therapy can lead to a full recovery for many patients.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

The holidays are upon us, which means fun, family, friends and food…lots of it.
Caloric temptations are everywhere, which can make it difficult to stick to healthy habits. In fact, it is estimated that we put on 5-10 pounds between Thanksgiving and New Years.
This comes as no surprise when you consider all the opportunities to “overindulge” during the holidays–the large holiday meals with all the trimmings, the deliveries of goodies to your workplace from grateful customers/co-workers, the holiday parties, just to name a few.
So, trying to lose weight during the holidays may be an unrealistic goal. Instead, aim to maintain your weight during this time. Consider that it takes 3500 calories to gain one pound. This may seem like an awful lot of calories but over the course of a week, it really is not. If you consume 500 more calories per day than you expend, this can result in a 1-pound weight gain per week. So you might ask yourself – what does 500 calories look like? Here’s a glimpse:
 1 cup of egg nog and 1 Lindt chocolate truffle ball
 1 slice of pecan pie
 1 slice of fruit cake w/8 oz Irish coffee
 1 slice of pumpkin pie w/whipped cream
 6 oz roasted turkey (light and dark meat, skin-on), ½ cup stuffing
¾ cup candied sweet potatoes, 1 roll with butter
 1 slice apple pie, 1/4 cup vanilla ice cream
 1 cup of mashed potatoes w/1/2 cup turkey gravy
 1 (3.5 oz) serving of peanut brittle
 5 small shortbread cookies, 8 oz hot chocolate w/whipped cream
 ½ cup crème brulee, 4 oz champagne
 6 soda crackers, 3 Tbsps Wis-pride Port Wine Cheese Ball
Now that you have an idea of what 500 calories could equal in holiday foods, how can you try to avoid gaining weight during the holidays?
Try these tips:
1) Have a healthy snack before you go to a party. If you’re not starving when you arrive you will be less likely to overeat.
2) At buffets, survey what’s available before you start piling food on your plate. Knowing ahead of time what is available may prompt you to choose smaller portions or choose only your favorite foods.
3) Limit calorie-laden beverages like mixed drinks, punch and Eggnog; choose low calorie drinks the majority of the time (i.e., sparkling water w/lemon)
4) Limit gravies and cream sauces or foods prepared in a cream sauce and deep fried foods
5) Look for: skinless turkey or chicken breast, grilled fish, steamed vegetables, tossed salad or fresh fruit.
6) Eat whole grains when possible – if whole wheat pasta, bread or brown rice are available choose these over regular pasta or white rice. The fiber in them will help you to feel fuller longer.
7) Have a small portion of your favorite dessert or share it with a friend
8) Bring a healthy dish if you’re invited to a party.
9) Eat only foods you like. Just because cranberry sauce is traditionally served with turkey does not mean you must have some if you would rather not.
10) Once you have chosen your food-step away from the food table! Remove yourself from temptation-concentrate on mingling with friends or family instead.
11) Eat slowly and savor each bite.
12) Make physical activity a priority! Take a walk after a big meal, take your kids ice-skating or skiing, dance to your favorite music, do laps around a mall before you do your shopping-find excuses to move more and limit sedentary activities like television watching or sitting at the computer.
Happy Holidays!
Catherine Schneider is a Registered Dietitian in the Food and Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Ms. Schneider and all of the Healthy Living columnists at healthyliving@wwbh.org

“We’re not exactly the Waltons,” said a friend commenting on Thanksgiving with her family. In truth none of us are. Yet giving thanks and true gratitude are not about having material wealth or achieving the perfect moment.
Feeling a sense of emotional wealth and gratitude comes from a deep abiding acknowledgement of being with life as it is; noticing what touches our hearts in the midst of each ordinary day with its small inconveniences and sometimes overwhelming difficulties. At times it takes a great deal of courage and a sense of surrender to what life is presenting to have a grateful heart.
Kelly and Pete were two of the 16 people whose lives were devastated last week by the fire that burned down their Washington Street apartment, taking along with it all of their possessions and beloved pets. Several days after the fire, with no home to go to and feeling physically weak, Kelly said, “When everything is taken away, your health and all your possessions, what’s left is your life and your friends so I’m just focusing on being grateful to be alive.”
Gratitude is not cheery optimism or the power of positive thinking. These can seem hollow in the midst of some of life’s experiences. Gratitude is a way of seeing and a way of feeling that affects our emotional as well as physical heart. It’s not surprising that research supports that cardiovascular health is improved and the immune system strengthened by feeling thankful.
Taking a minute or two each night to ask ourselves what touched us today and what we feel grateful for will likely reveal many small and unexpected things, like simple moments of connection with another or with nature, that we may have otherwise forgotten. Last night, I remembered the kindness of the person I stopped to ask for directions when I was lost. He happened to live in the town I was looking for and as I followed, he drove down the most beautiful country road that crossed over a river and was lined with sun-dappled foliage. It was breath-taking.
Gratitude is a simple yet radical act because it will profoundly transform how we see and experience the world, creating and magnifying a momentum of generosity. When we gratefully acknowledge what it feels like to have someone extend a kind and tender hand when we need it, we’ll want to extend our hand to someone else. When we are thankful for a moment in nature, we are more likely to treat the earth with care. Thanks and giving are inextricably woven into a grateful heart.
Author Anais Nin wrote: “we don’t see the world as it is, we see the world as we are”.
Happy Thanksgiving!
– Amy Dunion, a registered nurse and licensed massage therapist, is Coordinator of The William W. Backus Hospital’s Center for Healthcare Integration. This column should not replace advice or instruction from your personal physician. E-mail Dunion and all of the Healthy Living columnists at healthyliving@wwbh.org

Epilepsy is among the most serious, life threatening illnesses neurologists must treat. Epileptic seizures are even described in the early writings of Hippocrates in 480 BC. He was the first to use the term aura (the Greek word for breeze) to describe the feeling that often precedes an epileptic seizure.
Epilepsy is a disorder of the central nervous system in which seizures are the main symptom. Seizures can be epileptic or non-epileptic in origin. Some epileptic seizures are provoked by fever, sleep deprivation, or alcohol withdrawal. Others are the result of a physiological abnormality in the brain which causes an electrical “short-circuit” that can last from seconds to minutes. Partial seizures begin in a specific area of the brain before spreading. Generalized seizures begin diffusely without a focal origin.
Neurologists take a detailed history and perform a neurological examination when they suspect a patient has epilepsy. The examination is supplemented with an MRI or other imaging study of the brain and an electroencephalogram (EEG). An EEG evaluates normal and abnormal electrical discharges in the brain circuitry.
The most effective way of controlling epileptic seizures is with anticonvulsant medications. They work by suppressing abnormal electrical discharges. The earliest anticonvulsants were used in the late 19th century with side effects of sedation and slowed mentation giving the impression that people with epilepsy were mentally deficient. The advent of newer anticonvulsant drugs that did not produce sedation showed the world that those with epilepsy could lead normal, successful lives.
Violent movements, along with loud vocalizations, led many to believe these people were possessed by the devil. When someone does suffer a generalized seizure, it is frightening for the patient as well as for those who witness the event. Preventing harmful injury rather than uselessly attempting to abort the seizure is the principal rule. Some helpful first-aid tips to assist someone having a generalized tonic-clonic (grand mal) seizure are:
1. Help the person into a prone position, cushioning the head and face
2. Remove eyeglasses
3. Clear area of harmful objects
4. Loosen tight clothing around the neck
5. Do not restrain the person
6. Do not force any object into the person’s mouth, especially a finger

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

Pasta with butternut squash and shallots. Grilled portabella mushroom sandwiches. Black bean burritos. Barley and roasted vegetable soup. Lentil curry. Tofu kabobs.
Today’s markets, cookbooks and restaurant selections offer many vegetarian dishes created with flavorful food combinations. Whether you choose a vegetarian eating style or not, these dishes can add food variety and taste experiences to smart eating.
A plant-based diet is nothing new. The term vegetarian was not coined until with late 1800’s although the concept dates back at least to the sixth century B.C. when the Greek Philosopher, Pythagoras, encouraged meatless eating. Many centuries later in the Western world meatless eating was church-related. Harvey Kellogg, a vegetarian, not only developed breakfast cereals; he also invented nuttose, the first meat analog made from peanuts and flour; the first peanut butter.
Vegetarian eating styles differ, as do the reasons why people choose to become vegetarians. With today’s focus on fitness, many cite health reasons. Others express concerns about the environment, compassion for animals, or religious reasons. Others simply prefer the flavors and food mixtures of vegetarian dishes, and many recognize that a plant-based diet often costs less.
Studies show a positive link between vegetarian eating and health. In general, the evidence of some health related problems – heart disease, high blood pressure, type 2 diabetes, and some forms of cancer - tends to be lower among vegetarians.
In a broad definition, being vegetarian means avoiding foods from animal origin and replacing them with plant sources. If you are a vegetarian, you may describe yourself in one of these ways:
• Lacto-ovo vegetarian: choose an eating approach with eggs and dairy products but no meats, poultry and fish.
• Lacto vegetarian: avoid meat, poultry and fish and eggs but eat dairy products.
• Vegan: choose no meat, poultry, fish, eggs or dairy.
• Semi vegetarian: usually follow a vegetarian eating pattern but occasionally eats meat, poultry or fish.
Can vegetarian eating supply your body with sufficient nutrients? Yes. As with any eating style, you need to choose foods carefully and consume the right amount of overall calories to support a healthy weight.
Healthy eating guidelines still apply: go easy on the saturated fat, transaturated fat, cholesterol as well as total fat. Added sugars and added salt should be minimal along with aiming for whole grains, adequate fruits and vegetables. For vegetarians who eat dairy products and perhaps eggs, nutrition issues are not much different from those of non vegetarians: For vegans, the nutrition issues differ somewhat. Without any foods from animal origin, getting enough calories to maintain a healthy weight can be a challenge, especially for growing children and teens. Nutrients that may come up short need special attention: vitamin B12, vitamin D, calcium, iron and zinc. Nonetheless, planned wisely, a vegan diet can provide enough nutrients for overall good health.
Not up to giving up your animal products? A great place to start is to add a meatless meal to your weekly menu. It can be a simple switch from a pasta dish with meat sauce to a vegetable topping, tomato sauce with beans or with olives and capers. Or perhaps it can be as simple as cutting the animal protein in half in your chili or other Mexican-type recipes and replace with kidney, black or pink beans. Not only will these suggestions potentially cost less, they will be much healthier and they will be tasty as well.

Sarah Hospod is a registered dietitian in the Food and Nutrition Department at The William W. Backus Hospital in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Hospod and all of the Healthy Living columnists at healthyliving@wwbh.org.

Physical pain may be the body’s way of protectively warning us that something needs our attention. It may be harder to understand and accept that there may be an essential purpose for the pain felt deeply in the heart or spirit.

As much as we all try to avoid pain and sorrow, they are inextricably part of all of our lives.

As one teacher offered “no matter how we try to change the odds, life is a 50/50 split of pain and pleasure, by the very nature of being human and the impermanence of all life.” He added that we are all here for one reason…to cultivate our capacity for compassion… to grow our hearts.

When we are in a pit of sadness or grief some wisdom suggests getting out as soon as possible for fear of furnishing the pit and moving in. We all have our favorite ways of avoiding difficult feelings. However, the willingness to feel the depth of loss, although one of the most challenging human experiences, promotes the growth of our compassion.
Two poets share their wisdom about the importance of feeling grief. Naomi Shihab Nye’s poem Kindness reminds us, “Before you know kindness as the deepest thing inside, you must know sorrow as the other deepest thing. You must wake with sorrow. You must speak to it till your voice catches the thread of all sorrows and you see the size of the cloth.”

And David Whyte, in his poem The Well of Grief, writes, “Those who will not slip beneath the still surface on the well of grief, turning downward through its black water to the place we cannot breathe, will never know the source from which we drink, the secret water clear and cold.”

The loss of people we love, our work, relationships, or health can feel devastating. The fear of staying trapped in grief can keep us from seeking the silence, space and support we may need to fully experience our loss and eventual healing. Yet holding our pain with love will keep our hearts open through it, no matter how long it takes.
Each event in our lives -- especially the most heart-wrenching ones -- are reshaping us and transforming us into more compassionate human beings. Our choice is only how we respond to this most difficult invitation to live a more authentic life.

Amy Dunion, a registered nurse and licensed massage therapist, is Coordinator of The William W. Backus Hospital’s Center for Healthcare Integration. This column should not replace advice or instruction from your personal physician. E-mail Dunion and all of the Healthy Living columnists at healthyliving@wwbh.org

The Greeks and Romans frequently identified barbarians as “milk drinkers.” The question is, are you?

With an annual milk production per dairy cow in the United States averaging 12,000 pounds per year and a world record milk production of 55,660 pounds for a single cow, it is evident that dairy is popular and being consumed in some fashion. So what’s the craze?

Milk offers a variety of health benefits, including playing a role in reducing the risk of obesity, heart disease and stroke, and insulin resistance with type 2 diabetes.

In addition, according to the National Dairy Council, three or more servings of fat-free or lowfat milk per day is shown to significantly reduce bone loss in older adults. There is evidence that substantiates increasing your consumption of dairy foods or calcium in order to lower the risk of hypertension or reduce blood pressure. Drinking milk is one form of carbohydrate that does not cause dental problems, and actually helps to protect teeth when certain types of cheese are consumed.

Some other benefits of dairy is the fact that it is fortified with vitamin D (mainly because most foods do not naturally contain it) and vitamin A (because vitamin A is removed with the milk fat when it is homogenized). Milk also naturally contains calcium, and Americans ages 19 or older require 1000 mg of calcium per day while Americans ages 51 or older require 1300 mg of calcium per day.

So, what if I don’t like dairy? Calcium has been added to some products such as orange juice for some time now, and there is always the option of taking a calcium supplement or Tums (which contains calcium) before you go to bed at night (studies indicate calcium is best absorbed by bone overnight). For non-milk drinkers who want to increase their calcium intake, try spinach, broccoli, tofu (if you can hack it), salmon, a