A Very Long Reception Line

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By Mary O’Brien, M.D.

He was a bright light shining in the darkness.  Billy Graham changed the lives of hundreds of millions of people.  His message was simple and consistent:  God loves you.  He wasn’t concerned about denomination or fine points of theology even though he knew the Bible about as well as anyone.  He was a bold but humble force for good in the world.

In an age when being snide and snarky is considered “cool,” Billy Graham’s sincerity, honor, and compassion provided a beacon of hope.  Today, few things come more easily than cynicism.  I struggle with it every hour of the day.  But Billy Graham managed to rise above that temptation throughout his long life.  He never worried that someone might ridicule, criticize, or dismiss him because he never worried about himself.  Few people manage to subdue their egos the way Billy Graham did.  His lifelong focus was to share God’s love with as many people as possible.

Living a faith-filled life is very difficult.  Mother Teresa understood that. Pope John Paul II knew it.  Brave souls like these never agonize over focus groups, polls, or surveys.  Political correctness and fence-straddling, psycho-babble have no place in their lives.  They really do answer to a Higher Power.

Billy Graham gave spiritual counsel to 12 presidents regardless of their political party or religious affiliation.  He didn’t need to play games, massage egos, or create clever sound bites.  He said what he meant and he meant what he said. He had a clear understanding of right and wrong, and he wasn’t embarrassed by it.

Status had no claim on him. He lived a simple, scandal-free life.  For decades he showed as much attention and kindness to orphans in huts as he did to heads of state in palaces.

Finally, Billy Graham gave us all a noble example of how to endure the ravages of illness and old age with grace and dignity.  As we have seen with other saintly individuals, his patience, courage, and good humor endured until the very end. Protracted illness, pain, and suffering could not conquer the Spirit that worked within him.

I’ve heard it said that when you die, all the souls you’ve helped along the way are there in heaven to greet you.  In Billy Graham’s case, it must have been a very long reception line.

Arthritis and Diet

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

older-black-woman-rubbing-her-hands-arthritisThere are more than 100 different types of arthritis, and, therefore, no single diet will work for every person with arthritis.  However, studies have found that green tea, green leafy vegetables, dried plums, and kiwi fruit are all vitamin-rich and have powerful antioxidant properties.  Diets which include large quantities of fruits and cruciferous vegetables have been shown to have a beneficial effect on preventing the development of rheumatoid arthritis.  In addition, it is clear that carrying extra weight can put significant stress on the joints, and even a small reduction in weight can have an effect on the severity of arthritis symptoms.  Studies have shown that losing weight can significantly ameliorate the effects of osteoarthritis.  Significant weight gain prior to age 35 — as well as excessive alcohol consumption — has been linked to the development of gout.

Other contributing factors are certain foods and nutritional supplements (vitamins, minerals, and omega-3 fatty acids) which may play a role in preventing and reducing symptoms in some types of arthritis, such as gout, osteoporosis, osteoarthritis, rheumatoid arthritis (RA), and reactive arthritis.  Fish oil, particularly when ingested in conjunction with a diet low in arachidonic acid, reduces inflammation in some patients with rheumatoid arthritis.   Regular intake of fish has been shown to have a beneficial effect.  Consumption of excessive dietary fat, however, appears to exacerbate arthritis symptoms.

WEIGHT LOSS AND THE ARTHRITIS PATIENT

Weight loss for overweight arthritis patients is very important for several reasons.  First, as mentioned previously, loss of even a few pounds can significantly reduce stress on weight-bearing joints.   Research demonstrates that exercise and combined weight loss — as well as exercise regimens — result in decreased pain and disability and increased performance levels in patients with osteoarthritis.  Biomechanical data suggest that exercise in combination with diet may also result in improved gait when compared with exercise alone. Secondly, patients of all ages who have arthritis are much healthier, have an improved sense of well-being, and are less likely to suffer arthritis-related depression when they follow a nutritious, well-balanced diet.  The Arthritis Foundation recommends following a balanced diet that includes plenty of fruit, vegetables, and whole-grain products, while limiting consumption of sugar, salt, and saturated fat (i.e., a diet low in fat, high in fiber, and low in sugar).

By Mary O’Brien, MD

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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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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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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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The Case of the Common Cold

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

The most prevalent of all human illnesses, the common cold, is a minor infection of the upper respiratory tract. It mainly involves the nose and throat but can extend to the sinuses, ears, and bronchial tubes. As a general rule, cold symptoms are milder than flu symptoms and most people recover in seven to ten days. Some signs of the common cold are:cold-treatment

  • low grade fever
  • sore throat
  • coughing and/or sneezing
  • nasal congestion or runny nose
  • slight muscle aches
  • mild headaches
  • watery eyes

Cold symptoms generally emerge between one and three days after a cold virus enters the body and resolve in a week — with or without medication. One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health. Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than 5 percent of colds lead to such complications as bronchitis, middle-ear infection, or sinusitis accompanied by a prolonged cough, but between 5 and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum. A cold can produce wheezing, even in children who do not have asthma, and symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks. Symptoms that persist for more than two weeks or that recur might be more allergy than infection related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician. Medical attention is indicated if symptoms progress to:

  • sinusitis
  • ear pain
  • high fever
  • a cough that worsens as other symptoms abate
  • a flare-up of asthma or of another chronic lung problem
  • significantly swollen glands
  • strep throat
  • bronchiolitis
  • pneumonia
  • croup

Beginning in late August or early September, the incidence of infection rises gradually for a few weeks and remains elevated until declining in March or April. Seasonal variations in susceptibility may be related to cold weather or to months when school is in session―times when people spend more hours indoors and chances of interpersonal transmission are enhanced. Changes in relative humidity may also have an effect. Cold temperatures dry the lining of nasal passages and increase vulnerability to infection by common cold-causing viruses that thrive in such weather.

Over the course of a lifetime, a person has been estimated to spend the equivalent of five years suffering from the common cold. One-fifth of that time, cold symptoms are severe enough to require bed rest. Women get more colds than men―especially women between 20 and 30 years of age―and adults over 60 years of age get less than one cold a year on average.

Learn more about the common cold and influenza through our homestudy courses.

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The Importance of Sleep

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

sleeping-child-812181_640When you’re scrambling to meet the countless demands in life, cutting back on sleep might seem like the only answer. Although you realize that getting a good night’s sleep is important, you might not realize the vital role sleep plays in our physical and emotional health. Not getting enough shuteye can have serious and even devastating consequences.

Unfortunately, sleep problems are quite common, and over 60% of Americans report having trouble getting to sleep or staying asleep at least a few nights a week. More troubling is the fact that over 40% of American adults report daytime sleepiness severe enough, at least a few days each month, to interfere with their daily activities.

During sleep, the brain is preparing itself for the next day—and even forming new neural pathways that help with learning, memory, and problem-solving. For teenagers and children, deep sleep actually stimulates the production of growth hormone which supports normal growth and development.

Sleep is also important in maintaining a healthy functioning heart, blood vessels, kidneys, and immune system. Emotional well-being—especially during times of stress—is also tied to getting enough sleep. The ability to react to stress without mood swings and undue anger, as well as the ability to get along with others, is affected by whether or not one gets enough sleep.

Lack of sleep causes not only fatigue, but also a wide range of health problems and disease. Chronic sleep deficiency can causes immune system dysfunction, making it difficult to fight infections. Insomnia can also lead to problematic changes in the endocrine system, which may exacerbate diseases such as diabetes. And sleep problems can lead to abnormalities in the central nervous system and cardiovascular system. Children and adults who don’t get enough sleep, for instance, are at increased risk for a host of emotional ailments, including depression, mood swings, impulsivity, and anxiety.

Below are just a few of the health problems that can result from lack of sleep:

  • Obesity
  • Kidney disease
  • Hypertension
  • Stroke
  • Depression
  • Chronic Pain

Many people think they can function well even with sleep deficits. But scientific research reveals that the opposite is true. After just several nights of not getting enough sleep—with a loss of 1 to 2 hours of sleep per night—your ability to function declines as much as if you hadn’t slept for a day or two.

Research has also shown that people who don’t get enough sleep take longer to finish tasks, have a slower reaction time, and are more likely to make mistakes. They also have difficulty making decisions, are less creative than those who get enough sleep, have a hard time controlling emotions and behavior, and suffer declines in their problem-solving abilities. So not only does lack of sleep compromise alertness and physical health, it can also reduce productivity at work and decrease one’s ability to weather life’s stresses.

When sleep is compromised, the body’s ability to heal, repair, and restore itself can be impaired. Blood pressure fluctuations, adrenaline production, and hormone synthesis are affected —and impede our ability to bounce back from the physical stresses of normal life. When sleep deficits persist for an extended length of time, these disruptions in normal bodily function can push a vulnerable organ system from health into disease.

The bottom line is that we live in a sleep deprived world. Sleep is good for your mind, body, and spirit. In the words of Homer — “There is a time for many words, and there is also a time for sleep.”

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