New Year’s Resolutions to Exercise Pay Off for Heart Disease Patients

ACSM research links exercise with reduced risk of death in patients with existing heart disease

INDIANAPOLIS – In all parts of the world, the start of a  new year inspires adults to give up junk food, join a gym or make  healthier choices. For one group, the resolution to become more active  could literally be the difference between life and death. Research  released today by the American College of Sports Medicine finds that  being more physically active can help adults suffering from heart  disease keep premature death at bay.

The study, “Physical  Activity and Cardiovascular Mortality Risk: Possible Protective  Mechanisms?” is published in this month’s issue of Medicine & Science in Sports & Exercise_®,  the official journal of ACSM. The research team, which included Lee  Ingle, Ph.D., examined the relationship between moderate-to-vigorous  physical activity and mortality risk in patients with cardiovascular  disease.

“It is well established that regular,  moderate-to-vigorous physical activity reduces the risk of future  cardiac events in healthy individuals and individuals with existing  cardiovascular disease,” said Ingle, an academic with the Carnegie  Research Institute at Leeds Metropolitan University in the United  Kingdom. “What are not well understood are the biological mechanisms  responsible for reducing the burden of risk. We examined the extent to  which changes in typical cardiovascular risk factors explained the  association between physical activity and death in individuals with  cardiovascular disease.”

The study included 1,429 participants,  both male and female, with physician-diagnosed heart disease. At a  baseline visit, participants reported demographic information, health  status, disease history, smoking habits and physical activity levels.  Shortly after the baseline visit, nurses recorded medication and body  mass, collected blood samples, and measured blood pressure and resting  heart rate. Within seven years, 446 of the 1,429 participants died.  Death certificates linked 213 of the deaths to cardiovascular disease.

Participation  in moderate-to-vigorous physical activity at least three times per week  was associated with a much lower risk of cardiovascular-related death.  Physically active participants demonstrated significantly lower levels  of body mass, diabetes and inflammatory risk. Metabolic risk factors  (including body mass index, total-to-HDL cholesterol ratio, and  physician-diagnosed diabetes) and inflammatory markers (including  C-reactive protein) explained an estimated 12.8 percent and 15.4  percent, respectively, of the association between physical activity and  mortality risk.

“The main finding from this study was that  moderate-to-vigorous physical activity reduces the risk of future  cardiac events, in part, by improving metabolic and inflammatory risk  markers in patients with cardiovascular disease,” said Ingle.

According to the U.S. Centers for Disease Control and Prevention, heart diseases is the leading cause of death in the U.S. The Exercise is Medicine^® initiative offers public tools to help adults combat chronic conditions, such as heart disease, with physical activity.

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The  American College of Sports Medicine is the largest sports medicine and  exercise science organization in the world. More than 45,000  international, national and regional members and certified professionals  are dedicated to advancing and integrating scientific research to  provide educational and practical applications of exercise science and  sports medicine.

Medicine & Science in Sports & Exercise_® is the official journal of the American College of Sports Medicine, and  is available from Lippincott Williams & Wilkins at 1-800-638-6423.  For a complete copy of the research paper (Vol. 44, No. 1, pages 84-88)  or to speak with a leading sports medicine expert on the topic, contact  the Department of Communications and Public Information at 317-637-9200  ext. 133 or 127.

The conclusions outlined in this news release  are those of the researchers only, and should not be construed as an  official statement of the American College of Sports Medicine.

For Neck Pain, Chiropractic and Exercise Are Better Than Drugs

Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.

The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.

But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.

“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”

Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.

“There was a void in the scientific literature in terms of what the most helpful treatments are,” he said.

To find out, Dr. Bronfort and his colleagues recruited a large group of adults with neck pain that had no known specific cause. The subjects, 272 in all, were mostly recruited from a large HMO and through advertisements. The researchers then split them into three groups and followed them for about three months.

One group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. A second group was assigned to take common pain relievers like acetaminophen and — in some cases, at the discretion of a doctor — stronger drugs like narcotics and muscle relaxants. The third group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home. They were encouraged to do 5 to 10 repetitions of each exercise up to eight times a day. (A demonstration of the exercises can be found at www.annals.org).

After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the exercises reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.

A year later, when the researchers checked back in, 53 percent of the subjects who had received spinal manipulation still reported at least a 75 percent reduction in pain, similar to the exercise group. That compared to just a 38 percent pain reduction among those who had been taking medication.

Dr. Bronfort said it was a “big surprise” to see that the home exercises were about as effective as the chiropractic sessions. “We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.”

In addition to their limited pain relief, the medications had at least one other downside: people kept taking them. “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later,” Dr. Bronfort said. “If you’re taking medication over a long time, then we’re running into more systemic side effects like gastrointestinal problems.”

He also expressed concern that those on medications were not as empowered or active in their own care as those in the other groups. “We think it’s important that patients are enabled to deal with as much control over their own condition as possible,” he said. “This study shows that they can play a large role in their own care.”

By ANAHAD O’CONNOR of The New York Times

Diet to Prevent & Treat Arthritis

At least one out of five Americans, 46 million, suffer from arthritis, a painful disease that cripples and inflames the joints.

According to a “Today Show” article by nutrition expert Joy Bauer, adopting a proper diet for arthritis can treat and even prevent some symptoms. Besides helping to maintain a healthy weight, Bauer says a nutritious diet may decrease the inflammation of joints:

Because arthritis is a disease of inflammation, the most effective and logical treatment is anything that fights inflammation When it comes to specific foods you should eat, an anti-inflammatory diet involves avoiding foods that make inflammation worse (saturated fat, trans fat and simple refined carbohydrate) and eating plenty of foods that reduce inflammation.

Bauer lists a variety of anti-inflammatory foods, including those rich in omega-3 fatty acids, monounsaturated fats, and most importantly, antioxidants such as vitamin C and carotenes, which may even prevent arthritis by protecting the body from free radicals:

Inflammation produces free radicals, those cell-damaging molecules that are formed in response to toxins or natural body processes. The synovium is just as prone to this kind of damage as the skin, eyes, or any other body tissue. Antioxidants protect the body from the effects of free radicals, and are a critical part of an anti-inflammation diet. Research has demonstrated that certain antioxidants may help prevent arthritis, slow its progression and relieve pain.

Certain spices, such as ginger and turmeric, are also an easy and effective way to adopt an anti-inflammatory diet.

For the complete list of anti-inflammatory foods and the rest of the article, click here.

By http://www.thirdage.com/

Top 10: Holiday Advice for Caregivers and Other Caregiver News

We’ve been reading so much great advice for caregivers this holiday season, we felt it was worth a blog post just to highlight some of these informative articles. If you’re a caregiver to an aging friend or loved one, take a few minutes to read up on some useful tips that can help you travel your caregiving journey with ease.

1. Ryan Malone, of Inside Elder Care, never fails to impress with his expert insights. His latest blog post talks about the recent Gallup poll that really drills down caregiver statistics in the U.S. Some of them are not surprising, but some will be shocked to learn just how many folks are caring for a loved one these days — and the level of sacrifice they make each day in order to do so.
2. Registered nurse, former caregiver (for her father), current long-distance caregiver (for her mother) and our friend (we’re proud to say!), Shelley Webb of Intentional Caregiver, gives us 11 New Year’s resolutions caregivers can make this holiday season in a guest post for Maturity Matters.
3. If you’re planning to move a loved one in the near future, check out these ten tips from AARP. And for more awesomeness from AARP, read this post if you have a caregiver on your shopping list this holiday season for some excellent caregiver gift ideas. Thinking cruises and spa getaways? Think again: an empathetic ear, a little help. You know, those intangibles that are far more valuable than expensive gifts!
4. Montgomery Media offers tips for caregivers to de-stress this holiday season. Top of the list? Don’t forget to take care of yourself, so you can provide better care for your loved one. We’ve heard it many times, but caregivers get so caught up in caring for loved ones they easily forget this very important task.
5. Tax season is rapidly approaching, and Forbes has some information on tax breaks to help caregivers ease the financial burden.
6. American Medical News talks about how technology can connect doctors and caregivers. Easy communication is critical between the two, as caregivers must stay in control of their loved one’s care needs.
7. The San Francisco Chronicle features a press release covering a new approach to caregiving for the Alzheimer’s/dementia patient. The Pines Education Institute of S.W. Florida partnered with Teepa Snow, a nationally-recognized dementia care expert, to produce a series of educational DVDs to aid caregivers.
8. MSN takes a humorous approach to identifying the signs of Alzheimer’s disease with “7 Signs Santa Has Alzheimer’s.” This light-hearted approach excellently conveys critical signs caregivers and loved ones should look out for, especially if visiting a long-distance aging loved one over the holidays.
9. The holidays are supposed to be a joyous time, yet many aging and disabled adults find themselves with a case of the holiday blues. If your loved one is having a difficult time this holiday season, check out these tips from Care.com to help.
10. La Mesa Courier features a great list of tips for making this holiday season a joyous one for your aging loved ones. Try cooking a special meal together, listening to their stories from the past or taking a nostalgic ride around town.

There are so many more to share. What’s your favorite holiday tip for caregivers? Give us some ideas in the comments and we’ll feature your tips in an upcoming blog post!

Understanding Heart Aging and Reversing Heart Disease

Overview:

The heart is an amazing muscle that beats around 100,000 times a day. It is essentially a complex pump that is able to adjust blood pressure, flow, and volume in order to provide your body with all the blood it needs. Your heart is constantly adjusting to what you are doing and the state of your body. As you age, your heart adjusts to the needs of an older body. These adjustments come with trade-offs, leaving the heart more vulnerable to disease and other problems.

Your Heart’s Job:

Everyday your heart must beat more than 100,000 times to pump 1,800 gallons of blood through more than 60,000 miles (if stretched end-to-end) of blood vessels. Your heart also must adjust the rate and force at which it pumps based on your activity level. As we age, changes in the body require that the heart adjusts how it works. For example, the buildup of fat in the arteries, known as atherosclerosis, causes the heart to work harder to pump all that blood through narrower tubes.

The Aging Heart:

Heart disease is a leading cause of death. As we age, our heart compensates for clogged arteries by working harder and raising blood pressure. These changes put the heart at risk and impact our quality of life:

• 40 percent of deaths for people aged 65 to 74 are from heart disease (60 percent for those over 80).
• From age 20 to 80, there is a 50 percent decline in the body’s capacity for vigorous exercise
• In your 20s the maximum heart is between 180 and 200 beats per minute. At 80, it is 145.
• A 20-year-old’s heart can output 3.5 to 4 times the heart’s resting capacity. An 80-year-old can output 2 times resting capacity.

Aging Arteries:

Arteries take oxygen-rich blood away from the heart and deliver it to the body. As we age, our arteries become stiffer and less flexible. This causes our blood pressure to increase. The heart has to adjust to the increase in blood pressure by pumping harder and changing the timing of its valves. These adjustments leave the heart more vulnerable. To stay young at heart, protect your arteries by:

• exercising
• controlling your blood pressure
• watching your cholesterol

Thickening of the Left Ventricle:

Researchers have noted that the wall of the left ventricle of the heart becomes thicker with age. This thickening allows the heart to pump stronger. As our blood vessels age, they become narrower — causing blood pressure to increase. The heart compensates for this by becoming stronger and pumping with more force.

Mitral Valve Closes More Slowly:

The mitral valve closes more slowly with aging. This is because the rate of blood flow from the left ventricle decreases as it relaxes more slowly. It relaxes slower because it grows thicker with age (see above).

Exercise Capacity Shrinks:

As the heart ages, it becomes less able to respond rapidly to chemical messages from the brain. Researchers do not know exactly why the heart does not respond as fast to messages to speed up and adjust to increased activity. The result is the body cannot exercise as long or as intensely as before. This shows up as shortness of breath — a sign that oxygen-rich blood is not moving fast enough through the body because the lungs are trying to breath in more oxygen.

“Sitting” Heart Rate Lowers:

The heart rate of an older person while sitting is slower than a younger person (but the same when lying down). It is thought that this slower rate is from a decline in the heart-brain communication because fibrous tissue and fatty deposits have built up on the on nerves connecting the heart and brain. To compensate, the heart increases the volume of blood in circulation by raising the diastolic blood pressure.

The Heart Can’t Squeeze as Tightly:

Because of the increase in diastolic blood pressure, the heart also stretches larger each beat, giving a stronger pump in order to have a stronger contraction to pump the excess blood volume (called the Frank-Starling mechanism). But because of the greater diastolic pressure, the heart can’t squeeze as tightly.

Heart Enlarges:

The heart of a healthy 70-year-old has 30 percent fewer cells than a 20-year-old’s heart. When heart cells die, the other cells must stretch and grow to stay connected. An older person’s heart cells may be up to 40 percent larger than a younger persons.

Keep Your Heart Healthy and Reverse Heart Disease

Your heart is only as healthy as your arteries. Work hard to keep your arteries healthy by:

• controlling your blood pressure
• improving your cholesterol
• exercising
• relaxing
• learning heart healthy nutrition

Source About.com

Healthy Living: Holiday Stress, Seasonal Depression, Both, or Neither?

To state the obvious, addressing any mental health or psychological problem is easier if you can figure out what is causing the problem. Sometimes you cannot do anything about the cause, but usually understanding the cause helps you figure out the solution.

For people who are struggling with depression, anxiety, or stress during this time of year, it can be difficult to sort out the causes. For some, the onset of late fall and early winter is accompanied by the onset of a seasonal mood disorder, also called seasonal depression. For others, a significant cause of feeling down or overwhelmed is stress associated with the holiday season. In each case, trying to identify the cause can help you figure out what to do to feel better.
Symptoms of Seasonal Mood Disorder: According to the American Psychiatric Association, 10-20% of people in America feel more depressed with the onset of winter. The symptoms for seasonal depression are exactly the same as those for major depression. As the name implies, the only difference with seasonal affective disorder is that the symptoms begin at roughly the same month for one or more consecutive years. Common symptoms include:
• persistently sad or irritable mood ( 2 or more consecutive weeks)
• pronounced changes in sleep, appetite, and energy
• difficulty thinking, concentrating, and remembering
• lack of interest in or pleasure from activities that were once enjoyed
• feelings of guilt, worthlessness, hopelessness, and emptiness
• recurrent thoughts of death or suicide
• persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Symptoms of Acute Stress: People differ in terms of their feelings and behaviors when they are experiencing too much stress, but common signs of excessive stress include:
• Feeling anxious or worried much of the time.
• Feeling irritable or short tempered.
• Muscle tension, back problems, or increase in physical pain (jaws, neck)
• Stomach problems such as heartburn or acid stomach

Coping With Mood Disorder
• Find a way to get out and get going: Staying with your exercise routine, starting a new routine, or finding interesting activities that don’t depend on warm weather is very important. Staying put in your home often increases your depression.
• Exposure to Light: Taking advantage of natural sunlight is important. It may sound odd, but make sure you get outside on sunny days. Some people treat seasonal depression by sitting under bright fluorescent lamps for 30 or more minutes a day.
• Talk to a psychologist or other mental health professional: For both mild and more severe seasonal depression, talk therapy produces great benefits. Often our own patterns of thinking keep the depression going longer than needed. Counseling can help identify and change unhelpful patterns of thinking and behaving.
• Medication: Some anti-depressant medications, such as Wellbutrin XL, have been FDA approved for treatment of seasonal affective disorder. Your psychiatrist or primary care doctor can discuss a range of medical treatment options.

Coping with Holiday Stress
• Set realistic expectations: Sometimes our stress at the holidays is the result of having expectations that are simply unrealistic. Check with someone you trust about whether your expectations of yourself are too lofty.
• Avoid unhealthy coping: If you can’t remove some of your stress, it is helpful not to make things worse. Try to avoid coping by things which are unhealthy such as excessive smoking, use of alcohol, or unhealthy eating.
• Pace Yourself and Take Care of Yourself: Just because you have a lot to do doesn’t mean that you can run at a full sprint for several weeks. Build time, even brief time, into your schedule to relax and rebuild.

For More Information:
American Psychological Association: www.apa.org/helpcenter

By- Dr. David Prescott
Behavioral Medicine Department at Eastern Maine Medical Center

Alzheimer’s Awareness Month

November is Alzheimer’s awareness month. Worldwide it is estimated that about 16 million people have Alzheimer’s disease, 4.5 million of them are Americans. For every person with Alzheimer’s there is often at least one other person who directly cares for them and a host of healthcare & social workers, advocates, volunteers and support workers in the background. With so many people directly or indirectly affected by Alzheimer’s it is good that a time of year is set aside to promote awareness.

It is not known what causes Alzheimer’s disease and at present there is no cure. But there is hope and help for those people with Alzheimer’s. Research into the disease is offering answers to many questions. The pooling of knowledge, the increasing amounts of international funding will one day provide us with the cause, with better ways of treating Alzheimer’s and will hopefully provide a cure for Alzheimer’s.

Until that day this site pays tribute to all the people who have Alzheimer’s disease, to all those who strive to make the lives of people with Alzheimer’s better. To all the caregivers who love and care, who daily give such a lot to help their loved ones we say a special thank you in recognition of your very special contribution.

Easing the Added Stress of Caregiving During the Holidays

For millions of Americans who find themselves in the role of caregiver to an older frail, ill, or disabled relative, the holiday season can add to an already heavy load of responsibilities and cause feelings of stress to soar.

Stress occurs when we work too much, sleep too little, try to cope with difficult or troubling situations, and when we neglect to take good care of ourselves—all of which are typically everyday state of conditions for the millions of Americans who find themselves in the role of caregiver to an older frail, ill, or disabled relative. The added physical and emotional demands that are involved in celebrating the holidays can add to an already heavy load of caregiving responsibilities and cause feelings of stress to soar.

The holidays are traditionally a time when we reflect on past memories. For those who are caring for a frail and elderly family member, these reflections often deepen the awareness of the extent of the older person’s losses (for example, memory loss for those with Alzheimer’s) and how much life has changed for them. Holiday-time reminiscing can also underscore the loss caregivers face in the altered quality of their personal relationship with the older person. The emotional pain of confronting such losses can heighten feelings of stress.

The holidays are also a traditional time for family gatherings. While this can be tremendously enjoyable, when tensions among family members or unresolved conflicts surface, it can become a source of extreme stress. Caregivers too often find themselves in the middle of family discord as they try to mediate the needs of the older person as well as express their own position.

If you are a family caregiver, consider the following suggestions and think about which ones you can put in place during the coming weeks to help ease your feelings of stress during the holidays:

· Set manageable expectations and limits for yourself. Be realistic about what you can and cannot do—as well as what you want to do and don’t want to do.

· Try not to set yourself up for disappointment by comparing this year’s holiday season with the nostalgia of past holidays. Each holiday season is different and can be enjoyed in its own way.

· Ask for and accept help! It’s so often the case that, while people want to be useful, they may not always know what to do. Let other family members and friends know what they can do to share in the responsibility of caregiving. Don’t forget to consider asking people who live at a distance, as well as neighbors and people from faith-based groups or clubs, to pitch in and help.

· Maintain or establish social interaction with friends and other family members. Isolation can further increase feelings of stress. Having the chance to have fun, laugh, and focus on something other than your at-home caregiving responsibilities can help you keep stress at bay and maintain emotional balance.

· Remember the holiday season does not banish reasons for feeling sad or lonely. There’s room for feelings such as sadness, grief and/or loneliness to be present along with other more joyful emotions. If you do feel down, avoid critical self-perceptions, and, instead, try to articulate the understanding you need from those around you. Consider seeking the help of a therapist to help you sort out your feelings and deal with your concerns and troubling issues.

· If the elderly person you are caring for has dementia, avoid overly stimulating environments since that can add to their anxiety and end up increasing your stress level.

· If including the elderly person in large family gatherings creates added work and stress for you, consider alternatives, such as suggesting family members plan to spend individual quality time visiting with their elderly relative.

· Don’t abandon healthful eating and drinking habits. While it’s certainly okay to treat yourself during the holidays, avoid giving in to stress-driven urges for overeating or for overindulging in alcohol.

· Exercise regularly. Even if it means finding someone else to take over your caregiver duties, getting regularly-scheduled exercise—for example, walking, swimming, yoga, biking, or aerobics—can be of tremendous benefit to both your physical and emotional well-being.

· Seek emotional and moral support from other caregivers—there is great strength in knowing you are not alone. Many communities have support groups for family caregivers of elderly persons through local hospitals, churches and/or community centers.

· Use community resources such as meal or shopping services, home-care aides, adult day services, and/or volunteer help from faith-based organizations or civic groups.

· Try to find time for yourself to do something you especially enjoy such as reading, walking, listening to music, gardening and/or visiting with a friend.

· Find ways to ensure you get enough rest. Sleep deprivation can sap your energy, distort your thinking and lead directly to making your mind and your body feel stressed to the maximum.

· If you experience any signs of depression (for example, extreme sadness, trouble concentrating, withdrawal, or hopelessness), don’t delay in getting professional help for yourself. Depression is a serious, but very treatable condition. If left untreated, depression does not “just go away,” instead, the symptoms progressively worsen and can even become debilitating. You can click here for information about depression, including a more detailed list of commonly experienced symptoms and ways to receive help.

Throughout the holiday season (as well as year-round!), remember to be good to yourself. As a family caregiver, you’re doing a very hard job and deserve understanding, support and quality time for yourself to help ensure you meet your own emotional needs. Many caregivers have found that therapy offers life-strengthening help in dealing with the many challenges of caregiving. Therapy can provide a time and place that is devoted exclusively to your feelings, needs, and concerns—and can result in a healthy perspective that allows you to devote your best efforts to your older loved one while also making sure you take the very best care of yourself.

Medications Safety

Learn how you can reduce the risks and get the most out of your medications.

The U.S. Food and Drug Administration (FDA) judges a drug to be safe enough to approve when the benefits of the medicine outweigh the known risks for the labeled use.

Doctors, physician assistants, nurses, pharmacists, and YOU make up your health care team. To reduce the risks from using medicines and to get the most benefit, you need to be an active member of the team.

To make medicine use SAFER:

• Speak up
• Ask questions
• Find the facts
• Evaluate your choices
• Read the label and follow directions

Speak Up

The more information your health care team knows about you, the better the team can plan the care that’s right for you.

The members of your team need to know your medical history, such as illnesses, medical conditions (like high blood pressure or diabetes), and operations you have had.

They also need to know all the medicines and treatments you use, whether all the time or only some of the time. Before you add something new, talk it over with your team. Your team can help you with what mixes well, and what doesn’t.

It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members. Keep a copy of the list for yourself and give a copy to a loved one.

Be sure to include:

• prescription medicines, including any samples your doctor may have given you
• over-the-counter (OTC) medicines, or medicines you can buy without a prescription (such as antacids, laxatives, or pain, fever, and cough/cold medicines)
• dietary supplements, including vitamins and herbs
• any other treatments
• any allergies, and any problems you may have had with a medicine
• anything that could have an effect on your use of medicine, such as pregnancy, breast feeding, trouble swallowing, trouble remembering, or cost

Ask Questions

Your health care team can help you make the best choices, but you have to ask the right questions. When you meet with a team member, have your questions written down and take notes on the answers. You also may want to bring along a friend or relative to help you understand and remember.

Find the Facts

Before you and your team decide on a prescription or OTC medicine, learn and understand as much about it as you can, including:

• brand and generic (chemical) names
• active ingredients — to make sure that you aren’t using more than one medicine with the same active ingredient
• inactive ingredients — if you have any problems with ingredients in medicines, such as colors, flavors, starches, sugars
• uses (“indications” and “contraindications”) — why you will be using it, and when the medicine should/should not be used
• warnings (“precautions”) — safety measures to make sure the medicine is used the right way, and to avoid harm
• possible interactions — substances that should not be used while using the medicine. Find out if other prescription and OTC medicines, food, dietary supplements, or other things (like alcohol and tobacco) could cause problems with the medicine
• side effects (“adverse reactions“) — unwanted effects that the medicine can cause, and what to do if you get them
• possible tolerance, dependence, or addiction – problems that some medicines can cause, and what you can do to avoid them
• overdose — what to do if you use too much
• directions — usual dose; what to do if you miss a dose; special directions on how to use the medicine, such as whether to take it with or without food
• storage instructions — how and where to keep the medicine
• expiration — date after which the medicine may not work, or may be harmful to use

Your pharmacy, the library, the bookstore, the medicine maker, and the Internet have medicine information made for consumers. If you have questions, ask your health care team.

Evaluate your Choices — Weigh the Benefits and Risks

After you have all the information, think carefully about your choices. Think about the helpful effects as well as the possible unwanted effects. Decide which are most important to you. This is how you weigh the benefits and risks. The expert advice from your health care team and the information you give the team can help guide you and your team in making the decision that is right for you.

Read the Label and Follow Directions

Read the label to know what active ingredient(s) is (are) in the medicine. The active ingredient in a prescription or OTC medicine might be in other medicines you use. Using too much of any active ingredient may increase your chance of unwanted side effects.

Read the label each time you buy an OTC medicine or fill your prescription. When buying an OTC, read the “Drug Facts” label carefully to make sure it is the right medicine for you. Prescription and OTC medicines don’t always mix well with each other. Dietary supplements (like vitamins and herbals) and some foods and drinks can cause problems with your medicines too. Ask the pharmacist if you have questions.

Before you leave the pharmacy with your prescription, be sure you have the right medicine, know the right dose to use, and know how to use it. If you’ve bought the medicine before, make sure that this medicine has the same shape, color, size, and packaging. Anything different? Ask your pharmacist. If your medicine tastes different when you use it, tell your health care team.

Read and save all the information you get with your medicine.

Read the label each time before you use the medicine. Be sure it’s right in 5 ways:

1. the right medicine
2. for the right patient
3. in the right amount
4. at the right time
5. in the right way (for example, swallow instead of chew a pill)

Follow directions on the label and from your health care team. When you are ready to use the medicine, make the most of the benefits and lower the risks by following the directions.

If you want to stop a medicine your doctor told you to use or to use it in a different way than directed, talk to a team member. Some medicines take longer to show that they are working. With some medicines, such as antibiotics, it is important to finish the whole prescription, even if you feel better sooner. When you stop using some medicines, you must reduce the dose little by little to prevent unwanted side effects.

by Psych Central Staff

Living Longer Than Predicted

Edie Littlefield Sundby, a cancer “outlier,” gets ready to canoe down the Moose River in Alaska.

In cancer parlance I am known as an “outlier.” What that means is cancer should have ended my life years ago.

I learned I had cancer in March 2007: a Stage IV gastrointestinal cancer that was eventually determined to be gallbladder cancer. It is a deadly and demonic form of the disease, spreading and wreaking havoc with few symptoms until the cancer cells have taken control. As a result, in the past four and a half years I have undergone 65 cancer treatments, every three to four weeks, and my body has ingested and processed more than 500,000 milligrams of chemotherapy.

The cancer quieted down, but in April of this year it came roaring back with a scary diagnosis: inoperable liver cancer. My oncology team delivered five treatments of highly focused and intense radiation to the liver, and began another aggressive round of chemo.

With cancer once again threatening body and spirit, I knew what I needed to do. And that’s why I’m writing this from a serenely quiet campsite beside the Gilahina River in the wilds of Alaska.

With terminal illness there is no time to waste on anger, denial or self-pity. Cancer isn’t personal.

When my cancer was first diagnosed, it was a foregone conclusion by my doctors that I didn’t stand a chance, and words like “palliative” slipped clinically and coldly off tongues. “Summon your family” was the recommendation.

My family rallied — four daughters, including two who were away at college and sacrificed midterm exams, and my husband, who abandoned an entrepreneurial opportunity in Eastern Europe, taking more than 50 sleepless hours to arrive home.

The prognosis was numbing: less than three months to live.

I didn’t buy into it. And equally important, neither did my husband or daughters.

There was no time to waste. And no second chances. Finding the right doctor was the difference between life and imminent death. And fortunately for me and my family, I was enrolled in a health plan that gave me the freedom to choose my doctors.

We found Dr. George Fisher, head of clinical trials at Stanford Cancer Center. When he compassionately put his arm around my shoulder saying he couldn’t cure me but would do his best to treat me, I knew he was the doctor we’d been searching and praying for.

Under his care, I began my life as a chronic cancer patient, undergoing surgery and hours of chemotherapy and enrolling in clinical trials. Our hope was to reach remission and prolong it as long as possible.

Month after month, Dr. Fisher summed up the situation in my medical chart in notes like this one: “Patient continues to do well from the treatment of her incurable cancer and is aware of the high risk of recurrence and progression.” But that’s just what he wrote on paper. Each month, when Dr. Fisher came into the exam room, he reviewed the blood lab results and smiled. “This is remarkable,” he would say, and give me a hug.

Why one patient tolerates and responds to chemotherapy and another patient doesn’t is still a mystery.

For over four years, regardless of what is put into me, or taken out of me, my blood immunity markers are almost always in the normal range. My body can deal with strong chemotherapy, infection and inflammation. Maybe it’s because I spent the first 10 years of my life on an Oklahoma cotton farm, outdoors and mostly barefoot, absorbing bacteria and germs and strengthening my immune system. Maybe not.

Every milestone has been celebrated. After my first 20-week round of chemotherapy, I celebrated by sea kayaking in Fiji with my family. The first anniversary of surviving my terminal diagnosis, I celebrated with a handstand and a return to vigorous yoga and regular weight training. The day after each monthly infusion, I hike four miles into the Torrey Pines Reserve canyon listening to Elvis sing gospel.

I keep my emotional and mental immune system healthy by trying not to take things too personally or too seriously. Ecclesiastes is my single most important self-help source. The sage asks, in essence, what is the point of life? In the end he determines that wisdom suggests living well, keeping to the commandments of God and enjoying every bit of life we have the good fortune to spend.

Whenever my health or spirit takes a dive I flee to a national park, or camp alongside a creek, or hike in a canyon. Our national parks and forests have been called “sanctuaries for spirit.” Indeed, they are healing for me.

I have met other cancer patients with similar stories; some have been in treatment continuously for over eight years. We share many things in common. All of us are grateful for the gift of prolonged life. Our goal is to prolong remission or control tumor growth as long as possible in hopes of a cure.

I am humbled and at a loss to explain why my cancer has been kept under control when others have passed on, or are fighting for a few more weeks of life.

Dr. Fisher told me at our first appointment, more than four years ago, that he has seen even the most loving and positive people succumb to this disease, and even the most negative and sometimes unpleasant people become cured.

I think this was his way of telling me that I wasn’t responsible for the disease, and that I could not assume responsibility for the outcome either.

By EDIE LITTLEFIELD SUNDBY