Monmouth Ask The Doctor March-April 2019

Monmouth County’s Ask The DOCTOR THE HEALTH &WELLNESS MAGAZINE F R YOU ANDYOUR FAMILY EARLY SPRING ISSUE MARCH/APRIL 2019

Local Physicians Answer Your Health Questions

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QUESTION: Why should I choose early orthodontic treatment for my child with a palate expander? A s Palatal expanders are often placed while a child

times will eliminate the need for extraction of permanent teeth to create space or invasive jaw surgery to correct the growth discrepancy after the jaws fully develop and often makes the difference between a good orthodontic result and a great orthodontist result. Please contact our office with any questions or to schedule a complimentary first examination to determine if your child would benefit from this type of treatment. Call For A FREE Consultation On Any Service!

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Battling Back: Early Physical Therapy Intervention Improves Low Back Pain—and Reduces Costs By Brian Mason, PT, DPT If you’re suffering from low back pain and are putting off clinical treatment, you may experience more pain—and higher medical costs—in the future. Approximately 80 percent of adults experience low back pain at some point in their lives, according to the National Institute of Neurological Disorders and Stroke. The condition is the most common cause of job-related disability and a leading cause of missed work days. A recent research study found that patients who were referred to a physical therapist within two weeks of seeing their primary care physicians used fewer medical resources and paid lower health care costs than those who delayed treatment. Specifically, those who underwent physical therapy had a reduced risk of needing surgery, injections, additional physician visits, opioids, and advanced imaging studies. In fact, health care costs for patients receiving early care from a physical therapist were significantly lower, on average. In short, the data shows that the sooner a patient starts physical therapy, the faster they recover, which ultimately saves them money. What Causes Low Back Pain? If trauma, such as a car accident, isn’t the cause, low back pain most often develops due to mechanical stresses over a long period of time. This can be from sitting too much, improper lifting techniques, poor posture, poor strength conditioning and/or poor core strength. The condition can occur at any age. While the average age of those needing spine surgery in the United States is age 40, more children are experiencing back pain than in previous generations because they are sitting more and moving less, and many are looking at devices for prolonged periods of time. To determine the cause of pain, a practitioner will look at a patient’s medical history and perform a physical exam, and may order tests. I have found that if I listen to my patients, they will explain what they are experiencing in detail, enabling me to make a more accurate diagnosis. When Should I Seek Treatment? Patients need to start active recovery as soon as possible. This means that after a day or two of limiting your activity, you should take action to return to your previous level of function. If you haven’t returned to normal in two weeks, you should seek clinical intervention. The first step is to find a practitioner like a physical therapist who understands active recovery, bed rest, and modalities such as traction, massage, electrical stimulation, manipulation, and pain medications. These are short-term treatments that can relive pain. In New Jersey, patients can access physical therapy services without a physician referral. How Can Physical Therapy Help? Severe low back pain is very painful, and more importantly, it can be scary for patients. Often, when I see patients in the emergency department, their fears about the condition are nearly as important to address as the physical pain and reduced mobility that they are experiencing. It’s important that I help each patient overcome their fear of physical activity to pre- vent it from impacting the rehabilitation process. The goals of physical therapy are to: • Minimize distress • Restore function quickly • Encourage patients to be active participants in their recovery • Educate patients about their specific injuries and how to avoid reinjury • Develop a recovery program that patients can continue after therapy • Reduce the need for opioid pain medications, which rarely improve healing For example, if I see a patient who has low back pain that’s so severe that they have trouble bending at the waist, I’ll develop a therapy program that’s designed to empower the patient to address underlying factors that contributed to the condition. The most important thing to remember is that if you are experiencing low back pain, the sooner you take steps to recov- er, the quicker you can resume doing the things you love, and avoid more expensive, invasive treatment down the road. Brian Mason, PT, DPT, is the clinical director of Rehabilitation Services at CentraState Medical Center. He can be reached by calling 866-CENTRA7.

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OUR DEPARTMENTS Health Articles and Q&A Pages ............................ 5 Your questions answered from local physicians, medical news and information As We Age ..............................................................12 Articles and physician information just for seniors Kids’ Health & Camp ............................................ 22 Information, news and expert advice to raising healthy children from pregnancy to 18 Men’s Health .........................................................30 Expert tips for Men’s health and fitness The Healthy Palate ............................................... 33 Recipes to enjoy and local dining options for eating out Healthy Home ....................................................... 39 Here you will find expert tips to make your home healthier, safe and fabulous Healthy Mind & Soul ............................................50 Inspirational stories and advice on achieving mental balance and clarity Financial Health .................................................. 53 Information, resources and news related to the health and well-being of your financial future I Am Beautiful ....................................................... 62 Everything from tips to trends Where to go in NJ for specialty services Diet & Fitness ........................................................66

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Synthetic cannabinoids: What are they? What are their effects? By Cassandra Mayall

H E A L T H A R T I C L E S A N D Q & A

Synthetic cannabinoids (“synthetic marijuana,” “Spice,” “K2”) are various manmade chemicals that some people may use as an alternative to marijuana. These seemingly inno- cent little packages of “fake weed” can cause serious side effects that are very different from those of marijuana. Synthetic cannabinoid products can be toxic. As a result, people who smoke these prod- ucts can react with rapid heart rate, vomiting, agitation, confusion, and hallucinations. Some have to get help from emergency medical services or in hospital emergency depart- ments or intensive care units. Synthetic cannabinoids are not one drug. Hundreds of different synthetic cannabinoid chemicals are manufactured and sold. New ones with unknown health risks become avail- able each year. Synthetic cannabinoids are popular because users often believe they are legal and relatively safe. These chemicals are called cannabinoids because they act on the same brain cell recep-

tors as tetrahydrocannabinol (THC), the main active ingredient in marijuana. However, the hundreds of known synthetic cannabinoid chemicals and THC are different chemicals. In fact, synthetic cannabinoids may affect the brain in different and unpredictable ways compared to marijuana. Synthetic cannabinoids are used in a variety of ways: • Sprayed onto plant material and smoked • Mixed into a liquid and vaped in electronic nicotine delivery devices (such as e-cigarettes) • Added to herbal tea or to food and swallowed Consumers can buy synthetic cannabinoids in convenience stores, from individual drug dealers, or online as incense or natural herbal products. They are sold under a number of brand names, including • K2 • Spice • AK-47 • Mr. Happy There are no standards for making, packaging, or selling synthetic cannabinoid chemicals. That means that two packets of a brand-named product may have completely different chemicals. Synthetic cannabinoids can affect brain function. Signs and symptoms and health problems include: • Agitation and irritability • Confusion and concentration problems • Hallucinations, delusions, psychosis, suicidal thoughts, and violent behavior • Seizures • Sleepiness and dizziness • Breathing problems • Gastrointestinal problems • Heart attack, fast heart rate, high blood pressure, and stroke • Kidney failure • Muscle damage These health problems depend on many factors, including the specific synthetic cannabinoid, the dose (how much), and the duration of use (for how long). The long-term effects of long-term synthetic cannabinoid use are unknown. Synthetic cannabinoids may be addictive, since some people have reported withdrawal symptoms after heavy use over a long time. Experts think that the severity of these symptoms is related to how much synthetic cannabinoid is used and for how long. If you or anyone you know becomes sick after using synthetic cannabinoids, seek immediate medical attention. Call 911 or go to the closest emergency room. If you have questions about synthetic cannabinoids, including whether or not to go to the emergency room, please call your healthcare professional or contact your local poison center by calling 1 800 222 1222. • Scooby Snax • Kush • Kronic

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Grieving Elderly and the Immune System By Susan Heckler

Any type of loss or trauma throws your entire life into a tailspin. The loss of a loved one can particularly impact your emotional and physical health. When you are under stress, ever notice a change in your blood pressure? It also throws off your cholester- ol levels, brain chemistry, blood sugar levels, and hor- monal balance. Stress plays a major role in your immune system. Our bodies have a delicate balance of two stress hormones, cortisol and dehydroepiandrosterone sulphate (DHEAS). While the stress hormone cortisol is known to suppress the immune system, DHEAS enhances it, so maintaining a relatively balanced ratio helps to keep your immune system functioning properly. New research shows that the elderly are more prone to a weakened immune system while grieving. They are more likely to develop infections than the younger people due to the hormonal imbalance. Studies noted illness-fighting white blood cells were reduced among the older bereaved study participants. By age 30, the amount of DHEAS we produce starts to decline, with elderly having about 20% of the DHEAS they had in their youth. Grief is also associated with chronic diseases like ulcer- ative colitis, rheumatoid arthritis, asthma, heart disease, and cancer. This is due, at least in part, to chronically ele- vated cortisol. Researchers found that losing a significant person in your life raises your risk of having a heart attack the next day by 21 times, and in the following week by 6 times. "Broken Heart Syndrome" is basically a "tempo- rary" heart attack that occurs due to stress. This diminish- es after about a month. Sedentary behavior is linked to a 25 percent greater probability of being depressed compared to those who are active. This is true whether or not you’re grieving. It is un- certain which comes first, the depression or the inactivity, as one leads to the other in either direction. Activity trig- gers a number of neurotransmitters, such as endorphins, serotonin, dopamine, glutamate, and GABA. These are well-known for their role in mood control. In many cases, being physically active may alleviate the need for anti-de- pressants. During your time of crisis, pay careful attention to the elders and watch for warning signs.

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An aging population, that is augmented by chronic disease, and an increasing physician acceptance of home care is fueling the growth of care for seniors. The key focus is to solve one of the biggest health care and economic challenges of our time “Who will take care of our aging population, and how?” Our answer, we complete the need in the Care Management space by equipping and enabling family members, care givers and health care professionals with the right training and tools, they can dramatically lower the overall cost of care, reduce hospital admissions and re-admissions, and bend the cost curve of aging. Our Solution is on the lines of private duty care management. It is catered to manage “Care in Place” not only for our elderly population, but also any demography with disorder or Chronic Disease that one wants to manage. We provide state of art technical solutions where the heart of processing lies in our proprietary Rule Engine. In the Rule Engine you can define rules for chronic disease like Dementia, Alzheimer’s, etc., or even simple aging issues. You can also set up rules for a Special Child or Special Adult to manage them properly in their surroundings, with care as the focal point. The system is shipped with Activity of Daily Living (ADL and iADL) rules and with basic templates for Dementia, Autism to name a few, that can be extended to suit the need of each individual. Monika Sinha, co-founder of WeCare Health System says, “Our goal is to provide a one stop shop in the Care Management space, specially in the ‘Care-In-Place’ sphere since, it is not only the life expectancy that has increased over the past decade, but also because people prefer to get care in a familiar surrounding.” OUR VISION Our vision is to provide for the “To Be Cared” population, a best in class technical solution that will assist with caring of population who want care in familiar surroundings. OUR MISSION Our mission is to use technology to strengthen the continuum of care, to reduce costs and to improve outcomes by enabling family members, care givers and health care professionals to monitor and manage care that is to be provided. OUR SOLUTION Presenting “myCareportal” - Your In-Home Care Station. Key features are listed below. Let WeCare Health System’s solutions propel your organization above and ahead of the competition by utilizing our easy to use and affordable Technical Solution.

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• Template based Rule engine • The CareGiver Portal can be installed on any portable Android device • Caregiver Clock In/Out

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KNEE PAIN Dr. Scott Paris

H E A L T H A R T I C L E S A N D Q & A

QUESTION: What’s the best way to treat knee arthritis? Consider a non-surgical treatment that really works!

O s teoarthritis of the knee is the #1 leading cause of disability in the U.S. Over 27 million people suffer with knee arthritis and that number continues to grow. With knee arthritis, the cartilage breaks down and wears away, leaving the bones to rub together causing pain swelling stiffness and limited range of motion. As the cartilage breaks down, the knee loses its lubricating fluid. We found that by replacing this lubricating fluid with a natural substance called Hyalgan, the lubrication is restored and many patients experience amazing pain relief.

DOES IT HURT? Many of our patients report that they feel little to no pain at all!We do everything possible to minimize any pain from the procedure, from pain relieving spray and a local anesthetic, to precision guidance that ensures we are always in the right spot. WILL MY INSURANCE COVER HYALGAN? This procedure is covered by most major insurance companies including Medicare. Our insurance department pre-verifies every patient. WHO WILL BE PERFORMING THE HYALGAN PROCEDURE? Dr. Scot Paris is the medical physician who performs the Hyalgan injection. Dr. Paris is trained as a general surgeon and has extensive experience with a variety of surgical procedures. With his conservative approach, he has excelled in the non-surgical treatment of knee pain with the use of fluoroscopy guided Hyalgan injections. SO HOW DO I KNOW IF YOUR KNEE PAIN TREATMENT PROGRAM WILL HELP ME? If you are tired of suffering with painful arthritis of the knee, and you want to see if the latest advances in non-surgical treatment can help, all you have to do is call 732-683-1800 to set up a risk free consultation. During the

WHAT IS HYALGAN AND HOW DOES IT WORK? Hyalgan is a natural lubricating fluid that acts as a lubricant and shock absorber inside the knee joint. The substance in Hyalgan is hyularonic acidwhich is normally found in high levels in healthy joints. Replacing the hyularonic acid with Hyalgan lubricates the joint and reduces pain. Hyalgan has been administered over 40 million times and has been proven to provide long-lasting relief of knee pain from osteoarthritis. WHAT IF YOU ALREADY TRIED KNEE INJECTIONS? If you have had injections like this in the past and experienced poor results, there is still hope! Many doctors in this area offer similar injections, but very few use precision fluoroscopy guidance. Fluoroscopy guidance ensures that the pain relieving Hyalgan reaches the knee capsule where it bonds with the joint fluid to create a lubricating and cushioning layer. Without fluoroscopy, it is estimated that doctors “miss” the capsule over 30%of the time resulting in poor results. We want each and every one of our patients to have the greatest chance of success, so every injection is done with precision fluoroscopy guidance to ensure that the Hyalgan gets into the capsule 100%of the time. Because of this, patientswho previously felt little to no relief with non-flouroscopy guided injection are now getting excellent results. The other “big difference” in our results is the multitude of other supportive care options that we have available to enhance the effectiveness of the Hyalgan procedure. These options include state of the art medical laser treatment, physical therapy, manipulation, corrective osteoarthritis bracing (takes pressure off the damaged section of the knee), and natural anti-inflammatory products. The combination of these treatments offers you what we feel is the most comprehensive non-surgical knee treatment program available.

consultation all of your questions will be answered in a warm and friendly environment. Knee replacement surgery is a very extreme measure to take without considering all of your other options first. Once it’s done there is no turning back. For that reason we encourage you to schedule an appointment to see if you are a candidate for Hyalgan treatment.

We are proud to offer our patients a comprehensive knee pain treatment program that includes the best non- surgical methods to relieve pain all under one roof. We look forward to having the opportunity to help you feel better. Take the first step in ending your knee pain and call to schedule an appointment today!

Dr. Scott Paris using precision fluoroscopy guidance to ensure the best results possible.

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Amazing Grace

By Linda McAndrew RN, BSN • Director of Nursing In both the Christian and Jewish religion, Easter and Passover are considered to be two of the most important holidays of the year. Both of

these holidays signify hope and transformation and both play an important part in family life. How can we help seniors with dementia become more involved in the blessings of the season?

Anyone who has a loved one suffering from dementia or Alzheimer’s knows that the disease can be isolating because of the manifestations of the symptoms. These symptoms include memory loss, anxiety, and a decrease involvement in life in general. How better to help these wonderful seniors than to engage them in the many activities associated with both Easter and Passover. Here are several activities that may help. One activity that can help with both memory and anxiety is to make lavender Easter sachets. The sachet pouches are created by filling premade fabric squares with lavender seeds and then sewing or gluing the open end closed after it is filled. This activity can be easily done with the entire family involved. Lavender can decrease anxiety and also help with memory. Because the aroma or smell of the lavender enters through the nose, it transmits signals to the hippocampus which is closely related to memory and emotions. An Easter egg hunt is another way to help Alzheimer’s or dementia family members enjoy both filling and hiding eggs for younger children to find. Have plastic Easter eggs filled with various fun items including jelly beans candy and other Easter symbols. After the eggs are filled, help the senior hide the eggs in preselected places for the hunt. This activity will serve the purpose of involving everyone in the activity and can help the senior remember family activities from days gone by. An activity that can involve all members of a family for Passover is the creation of a Blessing Bag. With many people standing on street corners and highway exits, the creation of Blessing Bags can be used as an activity for Alzheimer’s seniors and also to help those less fortunate than ourselves. Most Blessing Bags are filled with a variety of helpful things that can be easily gotten at a Dollar store. The following are suggestions for the contents of the Blessing Bag: 24 count zip lock baggies (to be used as the Blessing Bag), Personal Care items such a socks, toothpaste, tissues, lip balm, band aids, a packet of analgesics; Shelf-stable food items such as a protein bar that’s both crunchy and salty, fresh fruit; Printed items such as coupons for free meals, names, addresses, and phone numbers of local food pantries; Seasonal items such as hand warmers. By helping seniors with dementia create Blessing Bags they are helping to create hope for those in need. Easter and Passover helps all of us remember that we all have a place in God’s plan in these seasons of hope and transformation. Happy Easter and Passover to all.

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QUESTION: What is the difference between a Medicare Beneficiaries Hospital Admission and Hospital Observation? ANSWER: Admission vs. observation can have a major impact on the out of pocket cost for care. Prior to the Affordable Care Act hospitals were not held accountable for the number of readmissions that occurred within a 30 day period, which factored in driving up the cost of healthcare. The ACA now emphasizes “performance”, hospitals are now rated by the effectiveness of their treatments and readmissions are considered incompetent. As a result, hospitals are more careful about admitting people.

Valerie Mathis-Leake CLTC, CBC, AHIP Founder, Our Fight For Life

• Medicare beneficiaries are sometime unknowingly entering hospital as observation patients, which is considered outpatient by CMS. • You should receive a Medicare outpatient Observation Notice (MOON) that will inform you if your services are outpatient. • Observation services can be costly. Your total copayment for all outpatient services, under observation, could be more than your inpatient hospital deductible. • Observation services are hospital outpatient services such as testing you receive while your doctor concludes supporting and/ or medically necessary documentation to admit or discharge you. • Observation services can also be facilitated in the emergency room as well as other departments with in a hospital and it could result in an overnight stay. It is important to know, if you are receiving outpatient observation services for more than 24 hours.

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A Summary of Brain Games for the Elderly By Katie Greene Whenever the topic of brain training games comes up, particularly to combat the onset of aging-related dementia, we like to point to this well-researched article. It contains a wealth of information, and a large list of games and activities that are truly beneficial in brain training. However, it is a rather lengthy read, so in this article we are going to summarize its’ more salient points. Brain Training Circumvents, Not Prevents, Dementia

A S W E A G E

It’s well known that there is no known cure for Alzhei- mer’s, but it is entirely possible that dementia symptoms can be circumvented. This is not the same as preven- tion - it is rather a method of redirecting information through your brain, so that information avoids travers- ing damaged neural pathways. Imagine your brain as a map of roads, forming bil- lions of intersections. What dementia does is damage the intersections, preventing information from flow- ing freely throughout the brain. This can affect your speech, memories, and job performance. While seniors were expected to retire by 65 in previous generations, modern lifespan has increased the work and retirement age. What brain training is believed to do is form new intersections (neural synapses), which information can take as alternative routes. As long as you are constantly training your brain and learning new information, you are forming new neural synapses. continued on pg. 15

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continued from pg. 14

New Information Matters Most The important part is learning new information. It’s been proven that memory-based games that rely on recalling pat- terns, or simple mathematics and word problems, don’t form any new neural synapses. Yes, it’s “brain training”, but it's the equivalent of bicep curls with 10lb weights. You do not form new neural synapses by recalling information you already know, just like you don’t build new muscle with weights that are too light for you. Thus, the best type of brain training is when you actively pursue new knowledge. Learning a new language, for exam- ple, has tremendous benefits. You are rewiring your brain in a new way to communicate. Learning history, science, a musical instrument - anything where your brain processes new information is the secret to true brain training. While you don’t necessarily need games to learn history, games make learning more fun. When you’re having fun, you’re more engaged in the activity. That is why brain train- ing games are recommended. So to summarize, things like memory games, Crossword puzzles, and anything that involves information you already know, is not ideal brain training. Those activities may help you awaken your brain for the day, but you must actively pursue new knowledge to truly counter the onset of demen- tia. For a much deeper explanation with plenty of links to proper brain-training games, you can consult the article we linked at the beginning of this one.

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A S W E A G E

ADVICE FOR THE AGING COMMUNITY WHAT IS YOUR DEFINITION OF A FAMILY CAREGIVER? By Sheli Monacchio

Nick was my father’s first cousin and he was kind and he was generous. He would come to my grandmother’s house (his Aunt Laura) in Brooklyn on Sundays when we went to visit. Sometimes his parents would come visit as well. We saw him when we were small through our late teens and maybe even a little longer into our early 20’s. We would see him less and less as I grew older. My grandmother was moved out of Brooklyn and into an Assisted Living near my home. Nick’s parents moved to South Jersey and we had many years of being apart. We would get cards in the

Drs. Segal, Shriver, Rho, Meirowitz, Osias and Bellows provide patients with timely, compassionate, high quality care for their digestive ailments. If you would like to arrange a consultation with one of our physicians, call us at 609-924-1422 Princeton Endoscopy Center provides services (colonoscopy, upper endoscopy) that can detect early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain and bleeding and weight loss. Our goal is to

Nick with the love of his life, Nancy

mail letting us know that he was thinking about us. My grandmother would speak to him on the phone and sometimes I was there when he called, so I would say hello. Nick met the love of his life Nancy who he was married to for 16 years. She passed away after he cared for her while battling breast cancer. He was also the caregiver for his parents who have since passed. His mother, Minnie had Alzheimer’s and was in a nursing home. When Nancy passed away we reconnected and he was coming over for holidays and for my son’s birthday each year. Like no time had passed, he came back to our family and was his same kind, generous and witty self. Just last year, he stopped coming to our family gatherings. Nick was fighting his own battle with cancer and was receiving treatment. But he was losing the battle. Nick had no children and he named my brother and myself his personal representatives. Nick went on hospice as his disease progressed. We were taking turns visiting on the weekends and then it got to the point he could no longer be alone. We got a live in aide to stay with him for safety and we handled some caregiving duties from afar. Managing some finances, ordering groceries, managing calls from the hospice nurse with updates and from the home care companies of this week’s new news. Every other week visits to Mays Landing became normal for us. My brother handled most of the responsibility and went above and beyond for our cousin. Nick spent years being the caregiver for his wife and his parents it took a lot for him to come to grips with the fact that it was time for him to be ok with receiving help. With how independent Nick was, this was no easy task for him. But he eventually became accepting of this. I speak to caregivers all of the time. I assist them on their journeys, giving them resources they need, emotionally being there for them. This whole time since August I had not considered myself a true caregiver for Nick since it was not a full time situation. My boss and I were chatting one day and I told her that I need to get back on track with my clean eating and my exercising like I used to do. I mentioned that I didn’t know where I went off the track. I stressed how much I need to start “taking care of me” again and I think the holidays threw me off track. She said, “You know better than anyone that when you are caregiving, you put yourself last. You are a caregiver. Those things get put aside.” I never considered myself Nick’s caregiver because in my personal experience, caregiving was full time. It was bathing and dressing someone on hospice. I was a caregiver for my mother back in 2007. I made her meals and washed her and cared for her. I realize now that my brother and I were family caregivers for Nick. We were his family. We helped put services in place that he needed. We helped manage his health care needs and his finances. We were in constant communication with the home care and hospice company and we would report these updates with my father. We were his caregivers. A family caregiver does not have to be a full time role to be considered a family caregiver. I learned this lesson this week and wanted to share with the family caregiver who may read this blog. If you are in any way giving any of yourself to help a family member, even if it’s a few times per month, you are a family caregiver and would probably benefit from some self-care initiatives and support. If you are managing someone’s finances because they can no longer manage their own, you are a family caregiver. If you are helping put health and safety solutions in place for your loved one, you are a family caregiver. I suppose I was so close to the situation since August that I wasn’t able to see that very clearly. I am proud to say I was one of Nick’s family caregivers and I wouldn’t have had it any other way.

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