Friday, March 30, 2007


The Neurology of Baseball

The signs of spring are here: the smell of freshly cut grass, longer days and the sound of a bat striking a baseball.

More than eleven years ago, I began an affiliation with the Norwich Navigators and the New York Yankees. Since that time, I have enjoyed spending a week each year at spring training in Tampa, Florida. Growing up in the Bronx, it seemed as if supporting your favorite team was a family obligation. My grandparents emigrated from Italy and yearned to become “Americanized.” What better way than to learn about baseball and cheer for the Yankees, who at the time had so many Italian-American players.

A baseball game is a lot like one of those puzzles where everyone sees something different. Some are watching the base runner, while others may focus attention on the fielder, pitcher or possibly the batter. Excitement builds and the action shifts very quickly.

Neurologically speaking, the act of a batter hitting a ball as it travels 90 miles per hour is an amazing feat. This seemingly simple activity is arguably the most demanding in all of sports. It involves the precise interaction of multiple neurologic functions. The batter must first use visual input to assess the spin of the pitched baseball. He must then anticipate the direction of the ball. Will it be a curve ball, sinker, fastball or maybe a slider? If it is a wild pitch, he may need to swiftly dodge the ball or face serious injury. Subsequent actions involve complex movements and motor functions, enabling a batter to strike the ball with enough force at just the right angle, unable to be caught by a fielder. This whole process is referred to as eye-hand coordination.

These abilities require years of intense training. A concussive head injury can be devastating, wreaking total havoc on neural connections. Most fascinating is how these damaged pathways can be reconditioned after a head injury. I spoke to Mark Littlefield, Head Athletic Trainer for Player Development, who is in charge of rehabilitating injured players for the Yankees in Tampa.

Mr. Littlefield described a tedious two-week batting drill regimen that begins after a player has been cleared by a physician. Swing mechanics that have been carefully chronicled on video during spring training each year can be regained during this time period. Swinging at a tee with no ball (dry swing) is followed by hitting a ball off a tee, then having a ball tossed to the player from about 15 feet. This progresses to hitting in a batting cage, then simulated games and eventually, minor league assignment.

Billy Connors, a former major league player and now a Yankee pitching coach, feels that overcoming the fear of being hit again is the greatest challenge in recovery. The stress caused from this apprehension has ended many baseball careers.
When attending a baseball game this summer, try to remember that there is an intriguing game within a game. The people sitting next to you may be watching a totally different part of the action, especially if they’re neurologists.

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

Monday, March 26, 2007


Common skin disease can develop into arthritis

About 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints.

It can develop at any time, but for most people it appears between the ages of 30-50. In 85 percent of patients, skin disease precedes joint disease.

Therefore, it is important to tell your dermatologist if you have any aches and pains. Psoriatic arthritis seems to affect men at a slightly higher percentage than women.

Both genetic and environmental factors seem to be associated with the development of psoriatic arthritis.

Prompt diagnosis and treatment can relieve pain and inflammation and possibly help prevent progressive joint involvement and damage.

There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans.

Symmetric arthritis is similar to rheumatoid arthritis, but generally milder with less deformity. It usually affects multiple symmetric pairs of joints.

Asymmetric arthritis can involve a few or many joints and does not occur in the same joints on both sides of the body. It can affect any joint, such as the knee, hip, ankle or wrist. The hands and feet may have enlarged "sausage" digits.

Distal interphalangeal predominant (DIP). Although considered the "classic" type, occurs in only about 5 percent of people with psoriatic arthritis. Primarily, it involves the distal joints of the fingers and toes (the joint closest to the nail). Nail changes are usually prominent. 4. Spondylitis is inflammation of the spinal column. In about 5 percent of individuals with psoriatic arthritis, spondylitis is the predominant symptom.

Arthritis mutilans is a severe, deforming and destructive arthritis that affects fewer than 5 percent of people with psoriatic arthritis.
Generally, one or more of the following symptoms appears during the initial onset: Generalized fatigue, tenderness, pain and swelling over tendons, swollen fingers and toes, stiffness, pain, throbbing, swelling and tenderness in one or more joints, reduced range of motion, morning stiffness and tiredness and nail changes.

There is no definitive test for psoriatic arthritis. The diagnosis is made mostly on a clinical basis and by a process of elimination. Medical history, physical examination, blood tests, MRIs and X-rays of the joints that have symptoms may be used to diagnose psoriatic arthritis. It is important to communicate your history of psoriasis to your doctor.

There are multiple treatment options, including anti-inflammatory medications, which help symptoms of inflammation. Then there are disease modifying agents that tend to modify the underlying disease to prevent joint damage or halt the joint damage.

There is also a new set of agents called the Biologics that are also very helpful in management. We now have multiple options to choose from, so it is a very promising time for the patients.

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

Friday, March 16, 2007


Alzheimer’s disease causes safety concerns

A local TV station recently asked me for some comments after a gentleman who suffered from Alzheimer’s disease went missing at a local casino. This incident highlights the difficulties in caring for a loved one with Alzheimer’s disease.

Alzheimer’s disease is the most common type of dementia. There is an inability to absorb new information, despite often having excellent recall of events that occurred many years ago. It is a progressive neurodegenerative disorder for which there is no cure. As we age, the brain gradually becomes smaller. For Alzheimer’s patients, this happens more quickly than in the normal aging process. Recently, we have begun to use medications like Aricept and Namenda that may slow the progression and hopefully improve some of the symptoms.

As many as 4.5 million Americans suffer from Alzheimer’s disease. This number has doubled since 1980. Many people are curious about the increased frequency of Alzheimer’s disease in the population. Fortunately, we now live longer due to technologic advances in the treatment of common illnesses like heart disease, diabetes, and high blood pressure. Unfortunately, we are facing more degenerative diseases as our longevity increases.

Obviously, the inability to recognize new situations presents safety issues. Driving requires good judgment and split-second decision-making. These are both difficult for Alzheimer’s patients and make them unsafe drivers. Some warning signs of dangerous driving habits are:

 frequently getting lost, especially in familiar areas
 failing to observe traffic signals
 making slow or poor decisions
 driving at inappropriate speeds
 confusing the brake and gas pedals

Wandering affects six out of 10 Alzheimer’s patients, and is often the biggest challenge facing caregivers. If not found within 24 hours, up to half will risk serious injury or death.

Darkness always creates an uncertain environment. It is crucial to keep the home well lit, especially at night. Safety gates and childproof locks are essential.
Vigilance is the best protection against wandering. The Alzheimer’s Association sponsors a Safe Return program that provides a national database, 24/7 help line, and training for caregivers and emergency responders.

Fortunately, our casino incident had a happy ending, thanks in part to the extensive video surveillance throughout the casino. I suggest caregivers and families of patients with Alzheimer’s disease contact a local support group or the Alzheimer’s Association at Education is the best tool to prevent serious injury to those suffering from this overwhelming illness.

Anthony G. Alessi, MD, is a neurologist on the Backus Medical Staff 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

Tuesday, March 06, 2007


Simple acts of kindness can go long way for ill

My sister-in-law- Mary recently died of an illness too terrible to imagine. A progressive neurological disease elusively defined not in terms of how to treat it but in what it takes away and how quickly. Her mind was completely spared of deterioration but as the physician in the movie Awakenings said… “we don’t believe the patients are aware because the alternative is unthinkable;” in other words we hope they aren’t fully aware; but she was.

Mary leaves behind two devoted daughters and a radiant and vital spirit that recently managed an out of character obscene hand gesture and a slightly detectable grin in response to a playful prodding from a friend to say something, anything.

I had the privilege of working with oncology patients and their families for 10 years and the lessons were innumerable, but the two that impacted me most were how the people who were ill knew beyond any doubt that very little really mattered beyond love of family and friends. The value placed on job and possessions fell quickly away.

The other profound lesson was how the smallest acts of kindness were often the greatest medicine. When a loved one is sick or in pain we often just want the people caring for them to see the special part of them that we do, and we look for it in the small things. It wasn’t the chemotherapy or blood products that the physicians ordered and the nurses monitored that brought the cards of gratitude but the human-to-human interactions.

In Mary’s case, having the doctor kneel next to her at her last visit and cry with her meant more to her at that point in her illness than a pat on the back or a new prescription.

I was most affected by the patients who were themselves compassionate to others even when their own needs seemed insurmountable. Steve, nearing the end of his own battle with cancer, took a leave from his hospitalization to be at a fund raising event he created to help others with the same disease. His doctor understood that this was a deeply personal mission and supported his choice. Both men seeing beyond themselves and the expected way of doing things.

The acts of kindness may come through in words, in touch, or in taking the extra time to listen to the questions that belie the real fears. We are reminded that we are not only our biology but also our biography. And patients will tell you; I am not just my disease or my disability. Yet in the hurry of the world of hospitals and healthcare we can forget the art of healing, the smaller details that often have the greatest impact.

The science of medicine is essential especially in acute situations when quick medical and surgical interventions are required but chronic, progressive and longstanding illnesses often require something more. Part of that something is made up of the strategies that address the symptoms and part of that something is less technological and more personal. The two combined are good medicine and good medicine affects both the caregiver and patient.

In the words of poet Naomi Shihab Nye: “When we are devoted to the development of kindness…it becomes a movement of the heart so deep and subtle it is like a movement of the sea close to the ocean floor, all but hidden yet affecting absolutely everything that happens above. That’s the force of kindness.”

Amy Dunion, a registered nurse and 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


Make nutrition month 100 percent fad-free

March is National Nutrition Month. It is a time for you to recognize and reinforce the importance of balanced nutrition as a key to good health. This year it is about getting back to the basics. Forget the latest food fad or diet – focus on overall health. Here are five ways to do it:

1. Have a plan. Develop an eating plan. Begin by taking a few minutes today to make a list of some of the current meals you eat now. Think of ways that you can step up the nutritional value of each meal: Ask yourself where you can add whole grains like brown rice, wheat pasta, whole wheat bread or whole wheat English muffins. Next think of were you can add in extra vegetables. How about a sweet potato with lunch? A fresh spinach salad with dinner that includes broccoli or cauliflower. And fruits? Can you sneak sliced banana over a whole grain waffle at breakfast? How about berries with yogurt for a snack. Do you usually have a piece of fruit with lunch? Add one! If not you’ll still have a chance to meet your nutrition goal for mid-afternoon.

2. Look at the Big Picture. All foods can fit into a balanced plan. The key is finding that balance.So know your portion sizes. is a good place to start. Go “Inside the Pyramid” and check out their food galleries within each of the food groups. They give serving sizes specific to every food. For example, the grain group. A 2000 calorie meal plan recommendation includes 6 oz. of grains each day. One ounce is equal to 1 slice of bread, 1 cup of dry cereal, a ½ cup of cook cereal, rice or pasta. 3 cups of popcorn is also considered a one ounce equivalent. Make half of these are whole grains. So this means choosing brown rice, whole wheat pastas and breads.
Look at your food intake over the course of a day. Where can you trim down? Next, let go of the guilt and unrealistic expectations. There is no one perfect meal plan. Change takes time, one step, one meal at a time. Be flexible.

3. Learn to spot a food fad. We have all heard of those popular diet crazes, food fads. The American Dietetic Association (ADA) defines “food fads” as “unreasonable or exaggerated beliefs that eating (or not eating) specific foods, nutrient supplements or combinations of certain foods may cure disease, convey special health benefits or offer quick weight loss.”
Red flags for spotting a food fad include:
 A promise of a quick fix
 Lists of “good” and “bad” foods
 Claims that sound too good to be true
 Diets that tout or ban a specific food or food group

Take a life-style approach not a “diet” one. Time, practice and patience are the keys.

4. Balance food and physical activity. Where do you find your motivation?
If you are thinking about joining a fitness center, look locally at the YMCA, WOW or World Gym. For females only, Curves and Butterfly Life are great options. If you prefer to stick close to home, that’s ok, too. Dose it out: 10 to 20 minutes, 3 times a day can get you there. Walking, gardening, biking, climbing stairs and dancing are all great ways to be active. Ten minutes of the activity at a time is best, shorter bursts of activity may not have the same health benefits.

5. Know the experts. Registered Dietitian’s are well educated and know their stuff. So where do you find these experts? Right here in your community. The Backus Hospital dietitians will be hosting supermarket tours on Wednesday, March 21 from 12-1 p.m. at the Norwich Stop & Shop. This is a great opportunity to learn how to navigate your way through a grocery store and come out with the healthiest choices. You’ll learn tips on reading food labels and ways to master meal planning. To register for this event, call 889-8331 ext. 4319 by Friday, March 16. Space is limited.
Backus Hospital’s Medical Nutrition Therapy (MNT) Outpatient office is an opportunity to meet with a registered dietitian and develop an eating plan that is right for you. Ask you doctor for a referral to this service.

Renee Frechette is a registered dietitian who serves as the outpatient oncology dietitian in the The William W. Backus Hospital’s Radiation Therapy Center. This column should not replace advice or instruction from your personal physician. E-mail Frechette and all of the Healthy Living columnists at

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