About Systemic Lupus Erythematosus (SLE)

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

bhmkclteeodsgq5wrqwaSystemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage to the heart, lungs, kidneys, joints, skin, brain, and blood vessels.   It is characterized by flare-ups, and symptoms, ranging from mild to severe, including extreme fatigue, chest pain, anemia, swelling in legs and near the eyes, painful joints, fever, skin rashes, hair loss, and kidney problems.

At least 1.5 million Americans suffer from lupus.  The ratio of female to male is 9:1 according to the Lupus Foundation of America.   African-American women are far more likely to be affected than are Caucasian women.   Recent research points to a strong genetic role, but environmental and hormonal factors seem to be involved in lupus as well.

Diagnosis can be difficult and may be delayed because the onset of symptoms is hard for patients to pinpoint and because the wide variety of symptoms overlap with many other conditions.  To diagnose lupus, the clinician takes a careful history, performs a physical exam, and orders anti-nuclear antibodies and other laboratory tests.

Although lupus can be life-threatening, some 80 to 90 percent of sufferers can expect to live a normal lifespan if they are carefully monitored and treated.

Management of lupus is directed at preventing flare-ups, treating symptoms, and preventing or slowing damage to organs.  According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the principal medications include:

  • NSAIDs to reduce inflammation.
  • Anti-malarials such as hydroxychloroquine (Plaquenil®) to prevent flare-ups.
  • Corticosteroids such as prednisone (Deltasone®), hydrocortisone, methylprednisolone (Medrol®), and dexamethasone (Decadron®, Hexadrol®) to reduce inflammation.
  • Immunosuppressive agents such as cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) to inhibit an overactive immune system.  Belimumab (Benlysta®) is a B-lymphocyte stimulator protein inhibitor that was approved by FDA 2011 for patients with lupus who are receiving other standard therapies.  It may reduce the number of abnormal B cells thought to be a problem in lupus.
  • Methotrexate (Folex®, Mexate®, Rheumatrex®), a disease-modifying antirheumatic drug, may be used to help control the disease in some patients.

Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin, which may be useful for controlling lupus when other treatments haven’t worked.

A variety of self-care and complementary approaches can be useful, including exercise, diet, the avoidance of sun exposure, and skin protection.  Patients are advised to recognize early signs of a flare-up and get immediate medical attention.

Findings from prospective human studies have strengthened the evidence of a connection between lupus and vitamin D status.  There is evidence that increased vitamin D levels (via supplementation) may help reduce inflammation.  A reasonable dose would be 2000 IU of vitamin D3 on a daily basis.  Vitamin D levels are easily checked.

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Horses as Therapeutic Animals

Posted on Posted in Continuing Education, Elder Care, Homestudy, Psychology, Webinars

horse-1330690_640By Barbara Sternberg, Ph.D.

Hippotherapy is the technical term for therapy with horses. While it has been around for more than a century, hippotherapy came to the fore when a woman named Liz Harwell, whose legs were essentially paralyzed by polio, won the Silver Medal in dressage at the 1952 Helsinki Olympic Games. Today, half a century later, hippotherapy programs are ongoing in multiple countries, and therapeutic riding programs have been developed for people with physical, psychological, cognitive, social, and behavioral problems including cerebral palsy, spina bifida, mental retardation, and depression. The North American Riding for the Handicapped Association makes a distinction between hippotherapy, or horse-based physical therapy under the direction of a licensed therapist, and therapeutic riding, which utilizes different methods to improve strength, muscle control, eye-hand coordination, and social skills.

Riding a horse involves what physical therapists refer to as three-dimensional movement. With each step, the person’s pelvis tilts up, sideways and forward, and back. The horse repeats the sequence and the sensation of these bodily motions for people with physical or neurological handicaps, reacquainting their muscles with how they are supposed to move. The pressure of the horse’s hooves hitting the ground is also three-dimensional, and stimulates the rider’s knees, hips, and spine. It is believed that this movement stimulates the brain, directly affecting the nervous system.

Even speech and language therapy can be enhanced by therapeutic riding programs. Ruth Dismuke-Blakely, a speech therapist from New Mexico, has been working with patients on horseback since 1981. She believes that most speech therapy addresses only the mouth and the brain, disconnected from the rest of the body, but that in fact, the rest of the body is very important for speech. Horses, with their well organized neurological systems, “lend their ordered system to a disordered one.”

Other speech therapists also find horseback riding a therapeutic venue in which to conduct treatment because patients learn more quickly when engaged in real-life settings than when in an office. Hippotherapy is actually approved by the American Speech and Hearing Association as a therapeutic modality.

Psychotherapy takes place in the realm of horses, too, specifically in the stall, along with the horse, the patient, and the therapist. According to psychotherapist Marilyn Sokoloff, PhD the additional aspect of having a horse to touch and interact with speeds up the pace of psychotherapy. The human-horse interaction gives the therapy a here-and-now component to analyze that can cut through resistances that have hindered progress for years. Sokoloff has used horses in group therapy sessions with women, convening the sessions in a horse barn with the women seated in chairs in a circle and the horses in their stalls all around them. Physical contact with the horses is encouraged as a mode of putting the women in touch with their feelings. These women suffer from depression, anxiety, eating disorders, and physical and sexual abuse and are challenged by the horses to find new ways of control. Getting a horse to do what you want raises issues of power and control which are confronted by the women in the group, often to powerful effect.

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Food, Calcium, and Bone Health

Posted on Posted in Continuing Education, Elder Care, Homestudy, Nutrition

CalciumFoods_ML1512_ts481492527By Barbara Boughton

Once a woman hits menopause, getting enough calcium for bone health becomes a major concern. Women over age 60 are prone to osteoporosis — and the spinal, hip, and knee fractures that osteoporosis can bring. Yet adequate dietary calcium can help protect people from osteoporosis.  Taking calcium supplements can help as well.

It’s not just menopausal women who should be concerned about getting enough calcium. As consumption of sugary soft drinks has risen among children and teenagers, intake of milk has also declined. But children and teenagers who are able to eat and drink enough calcium-enriched foods—as well as take in sufficient protein during meals—benefit from improved skeletal growth and bone mass. In fact, studies show that children who avoid, for prolonged periods, drinking calcium-containing milk have an almost three-fold higher risk for fracture than age-matched birth cohorts.

Dairy products are considered to be the easiest and cheapest sources of dietary calcium. Most people should have three to four servings of milk products daily in order to improve bone health and prevent osteoporosis. Studies have estimated that increasing dairy intake to three to four servings per day can reduce osteoporosis-related healthcare costs in the U.S. by $3.5 billion per year.

As well as calcium, it’s important to get enough calcium to enhance calcium absorption. What are your calcium and vitamin D requirements? Adults up to age 50 should get 1,000 mg of calcium and 200 International Units (IUs) of Vitamin D. Those over age 50, should intake at least 1,200 mg of calcium and 400 to 600 IUs of vitamin D each day.

Among foods with calcium, some are better than others for bone health. Yogurt is one of the best. It contains a hefty dose of calcium (415 mg per serving of plain, low-fat or non-fat per eight-ounce serving).  Many varieties of yogurt are also fortified with vitamin D. Some brands of fat-free, plain yogurt contain 30 percent of the adult daily requirements for calcium and 20 percent of the adult daily requirements for vitamin D. Although protein-packed Greek yogurts are popular right now—because of their reputed health benefits—they are less useful than other yogurt types for staving off osteoporosis. Greek yogurts contain less calcium than other types of yogurt and very little vitamin D.

Besides dairy products — such as low-fat and non-fat milk, yogurt, and cheese — there are other foods that are good for your bones. Canned sardines and salmon are rich sources of calcium, and fatty fish such as salmon, mackerel, tuna, and sardines are also replete with vitamin D. Some vegetables contain a generous amount of calcium, including collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens, and broccoli. Foods fortified with calcium and vitamin D—such as some juices, breakfast foods, soy milk, rice milk, cereals, and breads—can also add to the health of your bones.

The foods with the highest amounts of calcium are:  plain low-fat yogurt; calcium-fortified orange juice; low-fat fruit yogurt; skim mozzarella cheese and cheddar cheese; canned sardines; reduced and nonfat milk; tofu made with calcium sulfate; fortified breakfast drinks; and calcium-fortified cereals. Vegetables that are the richest sources of calcium include turnip greens, kale, and Chinese cabbage. For those who are lactose-intolerant, eight ounces of calcium-fortified soy milk can have from 80 mg to 500 mg of calcium.  Rice and almond calcium-fortified beverages can be good sources of calcium, too. To find out how much calcium is in these drinks, check the nutrition label on the back of these products at the grocery store.

If you want to eat for bone health, there are also some foods you should avoid. Heavy alcohol drinking (more than two drinks per day) can lead to bone loss, as can drinking more than three cups of coffee per day. Drinks high in caffeine, including coffee, tea, and caffeinated soft drinks, decrease calcium absorption and contributes to bone loss. Sodas also make it harder for the body to absorb calcium. Salty foods cause your body to lose calcium, too. To reduce the sodium in your diet, limit processed foods, canned foods, and salt added to the foods you eat each day. Aim for 2,400 mg or fewer mg of sodium per day.

Although beans contain calcium, they also are high in substances called phytates that interfere with your ability to absorb calcium. To reduce the phytate level in beans, soak them in water for several hours and cook them in fresh water. Wheat bran also contain high levels of phytates, which prevent your body from absorbing calcium. The phytates in wheat bran not only prevent the absorption of calcium in wheat bran but also prevent the absorption of calcium in foods eaten at the same time. For example, if you have milk and 100 percent wheat bran cereal together, your body can absorb some, but not all, of the calcium from the milk. The wheat bran in other foods like breads, however, is much less concentrated and unlikely to have a noticeable impact on calcium absorption.

Some vegetables with calcium can also contain ingredients called oxalates. Oxalates make it more difficult for you to absorb the calcium in vegetables. Foods with both calcium and oxalates include spinach, rhubarb, and beet greens.

As you can see, getting the right kind of calcium and the right amount of calcium from foods are not a simple matter. Yet it’s well worth the effort, since it will improve your bone health and strength—and may reduce your need for supplements.

  1. Food and Your Bones. Fact sheet. National Osteoporosis Foundation.
  2. Dietary Supplement Fact Sheet: Calcium. National Institutes of Health.
  3. Calcium: An Important Nutrient that Builds Bones. Fact Sheet. Osteoporosis Canada.
  4. Calcium, Nutrition and Bone Health. Fact Sheet. American Academy of Orthopedic Surgeons. aaos.org.
  5. Rizzoli, R. Dairy products, yogurts and bone health. Am J Clin. 2014; 99 (suppl): 1256S-62S.

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Stress: The Silent Stalker of the Heart

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

heart-915562_640Despite the many advantages of today’s technological progress, chronic stress persists as a major problem. Stress is not only uncomfortable, it can cause major damage to the circulatory and immune systems, leading to hypertension, arrhythmias, increased coagulation, and atherosclerosis.

Stress also exacerbates coronary heart disease (CHD), myocardial infarction (MI), and heart failure. Various stressors have been found to raise the risk of heart disease and even increased mortality due to heart disease—especially chronic work-related stress, marital strain, bereavement, and social isolation. Acute emotional stress may trigger myocardial infarction and a phenomenon known as stress myocarditis.

Stress, by virtue of its effects on adrenaline release, triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity. In some individuals, the intrinsic effects of stress include exaggerated heart rates and blood pressure responses. Emotions that often come with stress, namely anger, hostility, anxiety, and depression, bring a heightened risk of cardiovascular disease, coronary heart disease, and cardiac events, and — in those with heart disease — poor prognosis.

Depression is related to greater risk for developing coronary heart disease (CHD), poor prognosis in CHD, and higher mortality in those with CHD. It is also associated with arrhythmias, higher risk of acute coronary syndrome, and poor prognosis after myocardial infarction.

Those who are depressed are less likely to make lifestyle changes important for heart health. Mood disorders such as depression and anxiety may also affect lipid metabolism. Twenty percent of individuals who have cardiovascular disease or a previous history of MI have been found to have major depressive disorder (MDD). Psychosocial stressors can be both a cause and a consequence of cardiovascular disease events. Stress management might reduce future cardiac events in patients with cardiovascular disease.

Unless medications are required, patients can often make lifestyle changes that markedly decrease chronic stress. Some recommended strategies include:

  1. exercising on a regular basis.
  2. meditating for one or two 20- to 30-minute sessions a day. Studies show meditation can have lasting effects on blood pressure and heart rate.
  3. taking a vacation or a long weekend off.
  4. writing about stressful events.
  5. participating in a support group.
  6. regularly doing deep breathing exercises.
  7. using progressive muscle relaxation, which reduces muscle tension by relaxing individual muscle groups.
  8. practicing yoga, tai chi, or qi gong, all forms of exercise and meditation that are effective in reducing stress.
  9. spending more time outdoors.
  10. disconnecting from electronics and social media.
  11. listening to soothing music or silence.
  12. engaging in creative endeavors or hobbies.

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Alzheimer’s Disease

Posted on Posted in Brain Science, Continuing Education, Elder Care, Seminars

constant-63613_640By Dr. Mary O’Brien, MD

Alzheimer’s disease is one of the most dreaded health conditions of our time. There is no cure, and current treatments don’t slow down the disease; they can only alleviate symptoms. As well as avoiding Alzheimer’s disease and age-related cognitive decline, many people want to stay as sharp as possible as they age, and, if possible, delay age-related cognitive decline. Yet are there truly preventive strategies to stave off of Alzheimer’s disease or cognitive problems associated with aging?

While there’s no definitive evidence about what can prevent or reduce the risk of Alzheimer’s disease or dementia, scientific studies have offered clues about strategies that might slow down or prevent cognitive decline. The good news is that research on the prevention and treatment of Alzheimer’s disease—which currently affect about 5.3 million Americans—is now a high priority.

In late 2015, the U.S. Congress approved the largest increase to date in federal spending for Alzheimer’s disease research and care-giver support in the 2016 federal budget—a $350 million increase over 2015. The increase in federal spending came in response to reports and studies documenting the needs and opportunities that lie ahead for Alzheimer’s disease research. By 2050, Medicare spending on Alzheimer’s disease is expected to quadruple to $589 billion annually, but one treatment delaying the onset of the disease could save Medicare $345 billion in the first 10 years of its use, according to a report from the Alzheimer’s Association.

Over the past 30 years, many advances have been made in understanding Alzheimer’s disease and dementia. We now understand the biology of Alzheimer’s disease as never before. The brains of people with Alzheimer’s disease are filled with amyloid plaques—composed of deposits of a toxic protein fragment called beta-amyloid. The brains of Alzheimer’s disease patients also have an abundance of neurofibrillary tangles or abnormal collections of twisted protein threads found inside nerve cells, composed chiefly of a protein called tau.  In Alzheimer’s disease, the amyloid plaques and neurofibrillary tangles damage the brain’s neurons, interfering with their ability to function and communicate with one another. As a result, Alzheimer’s disease causes the brain to shrink and atrophy.

Scientists are now emphasizing research on the development of Alzheimer’s disease and on the symptoms and signs of early Alzheimer’s disease, which is termed mild cognitive impairment. The hope is that learning more about mild cognitive impairment can help identify patients at increased risk for the disease and for disease progression.

The symptoms of mild Alzheimer’s disease include:

  • Memory loss and confusion about once familiar things or places.
  • Difficulty accomplishing daily tasks, especially handling money and paying bills.
  • Poor judgment that leads to bad decisions.
  • Mood and personality changes, such as increased anxiety and aggression.

The symptoms of moderate Alzheimer’s are more serious, and include:

  • Increasing memory loss and confusion, and shortened attention span.
  • Irritability and Inappropriate outbursts of anger.
  • Difficulty with language (in reading and writing) and difficulty in working with numbers.
  • Trouble recognizing friends and family members.
  • Difficulty organizing, planning, and thinking logically.
  • Restlessness, agitation, anxiety, tearfulness, and wandering.
  • Repetitive movements and statements and sometimes muscle twitches.
  • Paranoia, delusions, and hallucinations.
  • Loss of control over impulses.

Age and genetics are the strongest risk factors for dementia and Alzheimer’s disease. However, other risk factors have been linked to Alzheimer’s disease. Research has shown that people with heart disease, stroke, and high blood pressure may be more likely to develop Alzheimer’s disease and to have more severe diseases.  Studies also show that patients with metabolic syndrome, Type 2 diabetes, and sleep apnea are at increased risk for mild cognitive impairment and Alzheimer’s disease. Whether or not successful treatment of hypertension, heart disease, diabetes and sleep apnea can affect cognitive decline is open to question, but is under study. One large trial funded by the National Institutes of Health (NIH) has compared intensive glucose-lowering treatment with standard treatment for Type 2 diabetes, but there were no significant differences between the two groups.

Hormones such as estrogen and progesterone also have effects on the brain. Yet studies on whether menopausal hormone therapy is protective against cognitive decline or Alzheimer’s disease have been conflicting.  Research is continuing on estrogen and progesterone as well as other hormonal therapies that could be preventive, including testosterone, growth hormone-releasing hormone and DHEA (dehydroepiandrosterone).

Many studies have also investigated whether vitamins and dietary supplements can protect against cognitive decline and Alzheimer’s disease. Epidemiological and laboratory studies have suggested that antioxidants from food and supplements can lower the risk of Alzheimer’s disease by preventing oxidative damage from free radicals. Vitamin E, vitamin C, B vitamins, and coenzyme Q10 have been tested as treatments to slow down or prevent Alzheimer’s disease, but none have proved effective. Researchers are also investigating the effect of resveratrol—a compound found in red grapes and red wine.

Research has also revealed that healthy habits can have an important influence on the risk for Alzheimer’s disease and cognitive decline. Studies show that exercise can stimulate the brain and help to make new neuronal connections within the brain that are vital to healthy cognition. Daily aerobic exercise, for instance, can enhance recall and executive function. Research has also found that a diet rich in vegetables is associated with a reduced risk for cognitive decline, and a Mediterranean diet significantly lowers the risk for mild cognitive impairment and Alzheimer’s disease.

Keeping your mind active throughout life may also reduce the risk of Alzheimer’s disease. Large observational and epidemiological studies have associated cognitive health with the maintenance of social relationships at work, volunteering or by living with someone. Mentally stimulating activities such as reading books and magazines, playing game and going to lectures may also keep the mind sharp. Recent large studies have found that people who spend a lot of time in intellectually stimulating activities are significantly less likely to be diagnosed with Alzheimer’s disease.

For healthy people, formal cognitive training sessions also seems to have benefits for the brain. Studies on memory, reasoning, and processing speed training—all aimed at improving mental skills—show that this training can improve cognitive skills for up to 10 years. Other studies are now investigating whether the combination of exercise and cognitive training can delay or prevent age-related cognitive problems.

  1. National Institute on Aging. Alzheimer’s Disease: Unraveling the mystery. nia.nih.gov/
  2. National Institute on Aging. Alzheimer’s Disease Progress Report: Intensifying the Research Effort. nia.nih.gov
  3. Preventing Alzheimer’s Disease: What Do We Know? nia.nih.gov
  4. Alzheimer’s Association. Historic Alzheimer’s funding increase signed into law, answering Alzheimer’s Association call for action. alz.org

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Yoga and Osteoporosis

Posted on Posted in Continuing Education, Elder Care, Homestudy

yoga-876744_640By Barbara Boughton

Yoga practitioners have long touted the health advantages of their practice, including increased flexibility, improved balance and posture, and stress reduction.  Some research studies support these claims although the scientific evidence is far from conclusive.  Now, a new study highlights another possible benefit of yoga:  It may improve bone health — even for those with osteoporosis.

Loren M. Fishman, M.D., a physiatrist at Columbia University and a specialist in rehabilitative medicine, has studied the health benefits of yoga for years.  In 2009, Dr. Fishman and colleagues published a pilot study which showed that 11 subjects who practiced yoga regularly over two years showed significant improvements in bone mineral density (BMD) of the spine and hip when compared to seven controls who did no yoga.  To study the bone benefits of yoga in a larger study, Dr. Fishman invested his own money and solicited participants via the Internet to perform, over 10 years, 12 assigned yoga poses each day or every other day.

The results?  Ten years after beginning the yoga program, 227 of the moderately to fully adherent participants showed significant increases in BMD of the spine and femur, but not significant improvements in BMD of the hip, according to the study, published in the journal Topics in Geriatric Rehabilitation in November 2015.  The study’s results are striking because most participants were elderly, with a mean age of 68.  Moreover, 83% had osteoporosis or osteopenia at baseline.

From a DVD, the participants in the study learned the yoga poses.  The participants were instructed to hold each pose for 30 seconds.  Once the participants learned all the poses, the yoga regimen took just 12 minutes to complete.  During the study, the participants used an online program to record how many poses they did and how often.  The researchers collected data on the participants’ BMD.  The researchers also took X-rays of the spine and hips and took blood and urine chemistry at baseline. Ten years later, the moderately or fully adherent participants underwent repeat measurements of BMD and many also had repeat X-rays.

For the yoga regimen, the researchers selected poses that pitted one group of muscles against another and would be most likely to affect BMD of the femur, hip, and spine.  They also chose poses that would be safe for elderly patients with osteoporosis. Thus, the poses required, with a straight back, leg lifts, lunges, and/or twists.  The poses did not require bending the back.  At the conclusion of the study, the researchers wrote, there were no reported X-ray-detected fractures or serious injuries of any type that stemmed from the practice of yoga.

Yoga has distinct benefits over other treatments for osteoporosis because it is low cost and the “side effects of yoga include better posture, improved balance, enhanced coordination, greater range of motion, higher strength, reduced levels of anxiety and better gait,” the researchers wrote in their paper.  By contrast, elderly women treated with osteoporosis medications frequently suffer gastrointestinal side effects, and these side effects are often barriers to treatment compliance.

In fact, a recent study published in Clinical Interventions in Aging (2015) showed that, among 126,188 elderly female Medicare patients, only 28% had initiated and continued treatment one year after being diagnosed with osteoporosis. Gastrointestinal events affected a significant number of patients, including 69% of those patients that were non-adherent.

Still, the authors of the new study on yoga and bone health caution that their research has important limitations.  Many of the study’s participants had weakened bones at the start and were already performing yoga.  The participants’ behavior may have influenced the results.  Also, the study did not assess BMD in the thoracic spine, the forearm, or ribs — places where many osteoporotic fractures occur.  Most importantly, the design of the study — including the use of the Internet as a recruitment tool and the lack of a control group — may have selected participants likely to benefit from yoga and may have limited the conclusions clinicians can draw from the results.

While yoga may have health benefits for patients — and may even improve bone health — clinicians should also consider the potential for injury among elderly participants, especially those with osteoporosis.  Many orthopedic surgeons report that women who do yoga can suffer agonizing pain and serious wear and tear on the hip that can progress to arthritis, according to an article — by writer and book author William Broad — published as an editorial in The New York Times in 2013.

Among orthopedic surgeons, yoga poses are well known for causing hip injuries. The reason for the injuries — especially among women — is that the extreme leg motions of yoga can cause hip bones to strike one another repeatedly, according to the editorial in The Times.

There is much that is still unknown about the true benefits and risks of yoga. Studies on yoga have documented hip damage from the practice, for instance, but research also shows that yoga can help patients cope with the pain of osteoarthritis and fight joint inflammation.

To obtain health benefits from yoga and avoid injury, it is crucial to practice gentler forms of this exercise and to moderate poses if they are painful. “Better to do yoga in moderation and listen carefully to your body.  That temple, after all, is your best teacher,” wrote author William Broad in the Times’ editorial.

References:

  1. Lu YH, Rosner B, Chang G, et al. Twelve-minute daily yoga regimen reverses osteoporotic bone loss. Topics in Geriatric Rehabilitation. November 2015.
  2. Fishman L Yoga for osteoporosis: A pilot study. Topics in Geriatric Rehabilitation. 2009; 25 (3): 244-50.
  3. Siris ES, Yu J, Bognar K, et al. Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clinical Interventions in Aging. November 5,
  4. Brody JE. Twelve minutes of yoga for bone health. The New York Times. December 21, 2015.
  5. Broad WJ. Women’s flexibility is a liability (in yoga). Editorial, The New York Times. November 2, 2013.

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Menopause and the “Change”

Posted on Posted in Continuing Education, Elder Care, Homestudy, Psychology

flower-428368_640Menopause, long surrounded by misconception and myth, is actually just one of the major transitions in a woman’s life. Most women go through menopause, whether it is secondary to surgery, a specific medical condition, or as part of the natural course of a woman’s life.

Many women dread the thought of menopause—the night sweats, the hot flashes, the weight gain, the mood changes. However, though menopause may mean a few more graying hairs and wrinkles, it is decidedly not a ticket to emotional problems or physical old age. Many women, in fact, find perimenopause and menopause only mildly problematic, and others discover that their symptoms can often be controlled or alleviated.

Though menopause has often been regarded as a medical illness, it is more accurately described as a life change—one that is often accompanied by a complex set of physical and emotional responses. There are health risks that increase after a woman reaches menopause, such as the risk for heart disease and cancer, but these can be cut drastically by preventive medication, diet, or lifestyle.

Menopause can also be a time of new freedom, new beginnings, and second chances. It’s often a time when women begin to reevaluate their lives. Some may decide to embark on bold new paths in their work or personal lives, while others may rededicate themselves to the lives they have already built.

There are many kinds of treatment available to help with perimenopausal and menopausal symptoms, from hormone replacement therapy to nutritional supplements. Physicians can discuss options with their patients, and together they can decide what course would suit them best. An increasing amount of research is available on this phase of life, and better drugs and treatment for menopausal symptoms continue to be discovered.

At one time, menopause was simply referred to as “the change,” a time of life to be dreaded. With an average life expectancy of 79 years of age, most women have at least one third and probably more of their lives ahead of them by the time they reach menopause. And those remaining years are free of menstrual periods, the possibility of pregnancy, and, in most cases, childcare responsibilities.

The “change” can actually be a positive time in a woman’s life. It’s a time when a woman and her partner can recreate their life together, or she can pursue new dreams, and decide how she wants to spend the second half of her life. On the job front, too, it is an ideal time to look at what has been accomplished, and evaluate whether making any changes is desirable. It’s a time to think about where a woman‘s journey in life has taken her, and decide how she wants to spend the years ahead.

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Exploring Parkinson’s Disease

Posted on Posted in Brain Science, Continuing Education, Elder Care, Homestudy

parkinsonBy  James Coggin, M.D.

Every movement of the body requires communication among the central nervous system—especially the brain and spinal cord—and the nerves and muscles. Movement occurs when specialized clusters of neurons in and around the brain stem, called basal ganglia, release neurotransmitters, chiefly dopamine. When there is insufficient formation and action of this neurotransmitter, degenerative disorders can occur, impairing one’s motor skills, speech, and many non-motor skills as well.

Parkinson’s disease (PD) is a chronic, progressive, and degenerative neurological disorder characterized by a loss of dopamine-producing neurons in the substantia nigra (Latin for “black substance”), a small region in the brain stem. The brain stem connects the spinal cord to the brain  and is comprised of the medulla oblongata (myelencephalon), pons (metencephalon), and mid-brain (mesencephalon). Parkinson’s disease or “primary parkinsonism,” results from a neurodegenerative process without any secondary systemic cause. Patients typically experience muscle rigidity, tremors, bradykinesia (slowing of movement), and ataxia (poor balance).

The symptoms of Parkinson’s disease, as well as possible therapies, were discussed in the Ayurveda, the system of medicine that has been practiced in India since 5000 BC, and Nei Jing, the first Chinese medical textbook, published 2,500 years ago. Descriptions of symptoms and treatment of PD date back to medieval times, most notably by Averroes.

Researchers estimate that between 500,000 and one million Americans have Parkinson’s disease, making it one of the most common neurodegenerative disorders in the U.S., second only to Alzheimer’s disease. These statistics are not precise, however, because Parkinson’s is frequently misdiagnosed. The disease occurs in one of two forms:  idiopathic (or sporadic) or — rarely — familial. Most forms of PD are idiopathic  while secondary cases can result from drugs, head trauma, and other medical disorders. Some forms have a genetic or familial basis.

A number of environmental factors has been linked to an increased incidence of Parkinson’s disease. These include:

  • exposure to heavy metals and pesticides.
  • living in a rural area within an industrialized country.
  • exposure to jet fuel.
  • drinking well water.
  • not smoking cigarettes.

The elderly are particularly affected. Parkinson’s is the second-most common neurodegenerative disease of the elderly, and about one percent of Americans over age 65 has been diagnosed with PD. While the average age of onset is about 60 years, the disorder does occur in younger people. In fact, five to 10 percent of cases are diagnosed before age 40. People with early-onset Parkinson’s discover initial symptoms between the ages of 21 and 40. The first symptom in juvenile-onset disease occurs before the age of 20.

People of all ethnic origins can develop Parkinson’s disease although it is slightly more prevalent in Caucasians than in Asians or African-Americans in the United States.

Parkinson’s occurs with slightly greater frequency in men than in women. About 15 percent of sufferers have a first-degree relative who also has the disease although there is typically no clear path of inheritance. Researchers suggest that most cases arise from a combination of factors, including genetic susceptibility, exposure to certain toxins, and aging.

You can learn more about Parkinson’s disease by reading our Parkinson’s Disease & ALS

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Flu Vaccines and How They Work

Posted on Posted in Continuing Education, Elder Care, Seminars, Webinars

Flu SHot, Vaccination

By Dr. Mary O’Brien MD

Composed of two type A viruses and one type B virus, seasonal flu vaccines change annually to reflect the viral types and strains that international surveillance and scientific analysis predict will circulate during a given year. Each vaccine’s protective potential is determined by individual health status and by similarities among the viruses contained in the vaccine and those in circulation. A vaccine that closely matches circulating viruses protects most people from serious flu-related illness.
Even a vaccine that is not a close match affords a degree of protection. Flu vaccines do not protect against flu-like illnesses, which are caused by non-influenza viruses. Also, seasonal flu vaccine does not provide protection against type C influenza.
Seasonal flu vaccine is available in two forms: injected and intranasal routes. Injected vaccine is made from inactivated viruses while the intranasal is an live-attenuated virus.

Live-attenuated influenza vaccine (LAIV) is a flu vaccine in the form of a nasal spray. LAIV is made from live, weakened viruses that do not cause the flu. The Center for Disease Control has approved LAIV for use in people between two years and 49 years of age who are healthy and who are not pregnant. LAIV is also an approved option for people who live with or care for those at high risk for contracting flu. It is not recommended for caregivers of people whose severely compromised immune systems require a protected environment. These healthy individuals should get the flu shot.

Flu vaccinations may be given at the same time that other vaccines are administered. Although vaccination is advisable as soon as seasonal vaccines become available, being vaccinated later in the flu season, like December, still confers benefit in most years. One dose of vaccine a year is sufficient for most people. Children under nine years of age who are being vaccinated against flu for the first time or who were initially vaccinated with a single dose during the previous flu season should receive two doses of vaccine at least four weeks apart.

Side effects associated with flu shots are generally mild, appear shortly after the injection, and persist for a day or two. They include soreness: redness; and swelling at the injection site; low-grade fever; sore or red eyes; and aches. LAIV can cause headache and runny nose. Adults may also develop sore throat or a cough, and children may wheeze, vomit, and have muscle aches or fever.

Symptoms of rare, serious reactions include:

  • high fever
  • behavioral changes
  • breathing difficulties
  • hoarseness or wheezing
  • hives
  • paleness
  • weakness
  • rapid heartbeat
  • dizziness

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 are hospitalized for treatment of flu-related complications. Approximately 36,000 deaths a year result from flu-related causes in the United States. Always check with your doctor before getting a flu vaccination. Also, many local pharmacies offer flu vaccinations in the store to fit your schedule.

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Music As Medicine

Posted on Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars, Webinars

By Barbara Sternberg, Ph.D.

Music has long been recognized as an effective therapy for emotional disorders. But the idea of using music to treat physical ailments is relatively new. The past several years have seen an explosion of research on the uses and benefits of music for both mental and physical health. In a meta-analysis of 400 studies, it was found that music improves the body’s immune-system function and reduces stress. In reducing anxiety prior to surgery, listening to music was also found to be more effective than prescription drugs. In addition, listening to and playing music increased the body’s production of the antibody immunoglobulin-A and natural killer cells. Music also reduced levels of the stress hormone cortisol.

ukulele-516503_640A recent study on the link between music and stress found that music can help calm pediatric emergency-room patients. In a trial with children ages three to 11, University of Alberta researchers found that young patients who listened to relaxing music while having an IV inserted reported significantly less pain, and some showed less distress compared to patients who did not listen to music. Also, for the music-listening group, more than two-thirds of the healthcare providers reported that the IVs were very easy to administer.

Music is also helpful in reducing pain among adult patients as well. In one study, patients in palliative care who participated in live-music therapy sessions reported relief from persistent pain. Music therapists worked closely with the patients to tailor the intervention. Patients sang, played instruments, discussed lyrics, and wrote songs.
Another study evaluated the analgesic effects of music in patients with fibromyalgia pain. Fibromyalgia patients were exposed either to relaxing, pleasant music which they had chosen, or to a control auditory condition (white noise). They rated their pain level, and their functional mobility was evaluated using a standardized measure.
Functional mobility was found to be superior in the patients exposed to music compared to the controls.

In addition, music has been shown to enhance certain quality of life aspects among older adults. A study evaluated the impact of piano training on cognitive function, mood, and quality of life in older adults. Thirteen participants received piano lessons and practiced daily for four months and were compared to an age-matched control group of 16 who participated in other forms of leisure activities such as physical exercise, computer lessons, or painting lessons. In terms of executive function, inhibitory control, and divided attention, significant differences were found for the group that received piano-training. Piano lessons also decreased depression, induced positive mood states, and improved the psychological and physical quality of life of the elderly participants. The researchers concluded that playing piano and learning to read music can be a useful intervention in older adults to promote cognitive reserve and improve subjective well-being.

There is growing evidence that music may be useful in medicine – in areas including reducing stress and pain and improving mood and cognitive function. On word fluency, working memory, and recognition memory, other studies have examined the effects of listening to music. These studies also showed enhanced performance in these cognitive abilities in older adults.

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