Monmouth County's Ask The Doctor September/October 2019

Monmouth County’s Ask The DOCTOR THE HEALTH &WELLNESS MAGAZINE F R YOU ANDYOUR FAMILY FALL ISSUE SEPTEMBER/OCTOBER 2019

Local Physicians Answer Your Health Questions

NEWS YOU CAN USE:

• Kids’ Health • Beauty • Eating Well • Fitness • Aging • ...and more : i ’ l i ll i i ...

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SEPTEMBER/OCTOBER 2019

Allaire Rehab & Nursing, a newly renovated upscale healthcare center in Freehold, delivers unparalleled

subacute rehabilitation & skilled nursing care.

We are the only Special Care Nursing Facility in New Jersey to offer intensive therapy on a long term basis for young adults (18-59) with a Neurological Impairment. Horizon’s at Allaire is centered on nurturing independence and optimizing recovery with many individualized activities and programs.

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KNEE PAIN Dr. Scott Paris

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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SEPTEMBER/OCTOBER 2019

How to Avoid Getting the Flu With the fall season upon us, there’s no better time to understand the scope of the illness and the significance of flu vacci- nations, for everyone. The bottom line is, the flu shot is effective, providing protection against 4 strains of the flu and building the immune system in the event that you do get the flu. What is unpredictable is the timing of flu. It can be found year-round, however, increases in activity typically begin between November and December. The peak of flu activity is between December and February but could last until April or May. So how can you avoid getting the flu this season? Most importantly, get the influenza vaccination. Additionally, practice healthy habits, including: • Frequently washing your hands • Using hand sanitizers • Cleaning and disinfecting communal surfaces • Not sharing foods or beverages • And avoiding contact with people who are sick with the flu. If you do get the flu, know that symptoms could last five to seven days, generally come on suddenly and are more physically debilitating. Symptoms may include weakness, runny nose, cough, sore throat, body aches, chills, vomiting, diarrhea, shortness of breath and a fever of 100.3 and above. For relatively healthy adults, staying home and getting plenty of rest and fluids, and taking over-the-counter medications, like acetaminophen or ibuprofen, can help combat congestion, cough and body aches. When should you seek medical attention for the flu? It is strongly recommended that anyone with the flu who is under age 6, or 65 and older, or has diabetes, high blood pressure, heart disease, cancer, asthma, COPD or other immune conditions or chronic illnesses, go to the doctor immediately. Many people are not aware that the flu can be fatal. If you have concerns about the flu, see your doctor. If you’d like to secure an interview with family medicine physician, Robert Pedowitz, DO, medical director of Family Practice of CentraState, to discuss the flu, its diagnosis, treatment, and prevention, contact Abbey Luterick, director of Public Relations, at 732.294.7082 (office) or 908.415.4193 (cell).

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Can Oolong Tea Extract Fight Breast Cancer? By: Lauren Kolacki

OUR DEPARTMENTS Health Articles and Q&A Pages .......................... 7 Your questions answered from local physicians, medical news and information Kids’ Health & Camp ........................................... 11 Information, news and expert advice to raising healthy children from pregnancy to 18 The Healthy Palate ............................................. 19 Recipes to enjoy and local dining options for eating out Healthy Mind & Soul ..........................................23 Inspirational stories and advice on achieving mental balance and clarity Men’s Health .......................................................26 Expert tips for Men’s health and fitness As We Age .......................................................... 30 Articles and physician information just for seniors Healthy Home .....................................................39 Here you will find expert tips to make your home healthier, safe and fabulous Financial Health ............................................... 49 Information, resources and news related to the health and well-being of your financial future I Am Beautiful .....................................................57

Oolong tea extract has 'great potential' in the prevention of breast cancer, scientists believe because it was shown to stop tumors from growing at a lab at St. Louis University. Laboratory tests showed the Chinese tea, used for centuries for its supposed health benefits, stopped the growth of breast cancer cells. Researchers found the ex- tract hampered the DNA of the cancer cells, inhibiting the growth and progression of tu- mors. Green tea showed similar promise, the scientists said. However, black and dark tea had little effect on the cells. Scientists at St Louis Uni- versity, Missouri, also analyzed the rates of breast cancer and deaths from the disease across China. Their analysis found regions with high oolong tea consump- tion had generally lower rates of the disease. The team now says the tea offers promise as a non-toxic approach to prevent breast can- cer, which one in eight women will develop in their lifetime. Researchers, led by Dr. Chunfa Huang, examined the effect of oolong tea extract on six breast cancer cell lines. “Green and oolong tea extracts prohibited breast cancer cell growth in all six breast cancer cell lines,” Dr. Huang says. The team said, “From our results, oolong tea, much like green tea, plays a role in inhib- iting breast cancer cell growth, proliferation and tumor pro- gression.” Oolong tea originates from China. Any tea that has been oxidized between eight and 85 percent (semi oxidized) can be considered an oolong tea. Tea oxidation is one of many steps in the production of oolong tea. As soon as you pluck a tea- leaf, it starts to oxidize. Black teas are fully oxidized whereas green teas are hardly oxidized

at all. Oolong, also known as 'black dragon tea' falls into the middle. A cup would contain caf- feine, vitamins, minerals, ami- no acids and beneficial tea polyphenol antioxidants, ac- cording to USDA Food Com- position Databases. These properties all have potential for health benefits in- cluding weight loss, brain func- tion, heart health and diabetes prevention. But their efficacy in tea needs more research. Oolong tea is mostly pro- duced in China, where people have been using it for its sup- posed medicinal purposes for a historic period of time. There- fore, the scientists also looked at 2014 data from the Chinese and Fujian province cancer reg- istry annual report. They found that the incidence of breast cancer in the Fujian province was 35 percent lower than the national average. Those who drank the most oolong tea had a 25 percent lower incidence compared to the average Fujian, and 50 per- cent lower than the national average. They also appeared to have a lower mortality rate - the death rate of high consumers of oolong tea in Fijian was 68 per- cent lower than the national average, according to the find- ings published in the journal Anticancer Research. “It is clear that more study is needed,” Dr. Huang said. “The lower incidence and mortality in regions with higher oolong tea consumption indicate that oolong tea has great potential for its anti-cancer properties.” More than 250,000 wom- en in the U.S. were diagnosed with breast cancer in 2018, and around 41,000 die from the illness each year. Prevention and early diagnosis are key to improving future health pros- pects.

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SEPTEMBER/OCTOBER 2019

Print Advertising Tips and Facts By Cami Gunther, Owner Publisher

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

The claims of the death of print media advertising were not only greatly exaggerated – they were dead wrong. Print media advertising isn't just hanging on, either. Now that digital advertising has been around long enough to be evaluated, it's clear that the advantages of print media are many. But the best use of print advertising isn't when it's a substitute for other media. When print is combined with other adver- tising media, it shows its real strength. Here are the facts: • Research shows print allows you to gain deeper understanding and memory because newspapers and magazines are laid out intention- ally for readability and enhanced memory retention. • Print offers unparalleled target marketing by sections and specific editorial topics. When the reader, the business advertiser and the voice of the publication have same “values and goals”, print succeeds in ROI over other media. • Unlike Internet advertising that readers often must click to read, social media that comes and goes, or quick radio or TV ads, print media advertising stays in front of you. • Local news and credible publications give businesses an aura of strength, trust and solidity. People view print advertisers as more trust- worthy than those in digital formats. • All types of advertising require repeat placement to be effective. But it is proven that awareness continues to grow with the frequency of print ads more than other media. • Print is the most budget friendly with greatest impact because look at any print ad's closing paragraph, and you're likely to see a redirect to a website for more information or a special offer. That's because print is exceptionally good at driving readers to wherever you want them to go like the web for your reviews. • For maximum impact, your marketing campaign should be an integrated with editorial that is helpful to the reader, creates your busi- ness as more credible and unique than your competitor. Discounts and coupons can hurt a business. • Local print combined with editorial, branding, repetition and community involvement increases your overall businesses’ ROI in the long run- big picture. Cami Gunther • 732.995.3456 • www.GuntherPublications.com

Q: What is Lichen Sclerosus?

A: (LIE-kun skluh-ROW-sus) is a condition that creates patchy, white skin that appears thinner than normal. It usually affects the genital and anal areas. Anyone can get lichen sclerosus but postmenopausal women are at higher risk. An overactive immune system or an imbalance of hormones may play a role. Symptoms vary person to person, but they generally include:

If you have lichen sclerosus on or around your genitals or anus or have a more advanced case on other parts of your body, your doctor will recommend treatment. Treatment helps reduce itching, improve your skin's appearance and decrease further scarring. I diagnose and treat this in my office and am available for consultations. For more information feel free to contact: Dr. Helen Simigiannis, MD, FACOG Antheia Gynecology 375 US Highway 130, Suite 103 East Windsor, NJ 08520 Next to the Americana Diner 609.448.7800 www.antheiagyn.com Adolescent & Routine Gynecology Menopause Urinary Incontinence Endometrial Ablation Birth Control

Dr. Helen Simigiannis, MD, FACOG

• Itching, irritation, or burning sensations in the skin. • Dry skin that looks like white, patchy marks on your vulva. • Bruising and tearing, which appears when the skin has thinned and become fragile. • White scar tissue, a symptom that, along with itching and burn- ing, can seem really alarming (though white spots are often su- per treatable). One of the most telling signs of lichen sclerosus is white scar tissue in the shape of a figure-8 around the edges of your vulva and anus. • Pain during sex, usually a sign that your skin has thinned and/or a buildup of scar tissue has made your vaginal opening tighter and painfully taut.

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Chris Smith’s Lyme Disease Amendment Passes House, Tells DOD IG to Investigate ‘Weaponization’ of Ticks The full House of Representatives passed an amendment offered by Rep. Chris Smith (R-NJ) which directs the Inspector General (IG) of the Department of Defense to investigate the “possible involvement of DOD biowarfare labs in the weap- onization of Lyme disease in ticks and other insects” from 1950-1975. According to Smith, he was “inspired to write the amendment”—now part of the House-passed 2020 National Defense Authorization Act (NDAA)—by “a number of books and articles suggesting that significant research had been done at U.S. government facilities including Fort Detrick, Maryland and Plum Island, New York to turn ticks and other insects into bioweapons.” During debate on the floor, Smith said that, “The most recent book—Bitten: The Secret History of Lyme Disease and Biological Weapons—includes interviews with Dr. Willy Burgdorfer—the researcher who is credited with discovering Lyme disease. The book reveals that Dr. Burgdorfer was a bioweapons specialist. Those interviews combined with access to Dr. Burgdorfer’s lab files suggest that he and other bioweapons specialists stuffed ticks with pathogens to cause severe disability, disease—even death—to potential enemies.” “With Lyme disease and other tick-borne diseases exploding in the United States—with an estimated 300,000 to 437,000 new cases diagnosed each year and 10-20 percent of all patients suffering from chronic Lyme disease—Americans have a right to know whether any of this is true. And have these experiments caused Lyme disease and other tick-borne disease to mutate and to spread?” Smith asked. “My amendment tasks the DOD Inspector General to ask the hard questions and report back,” he said. During debate on his amendment, Smith said the investigation would explore such questions as: • What were the parameters of the program? • Who ordered it? • Was there ever any accidental release anywhere or at any time of any diseased ticks? • Were any ticks released by design? • Did the program contribute to the disease burden? • Can any of this information help current-day researchers find a way to mitigate these diseases?” Smith has a long record of fighting for people suffering from Lyme disease. He is the author of the pending bipartisan, bicameral TICK Act introduced earlier this year to create a whole-of-government national strategy to aggressively fight Lyme disease. The TICK Act (Ticks: Identify, Control, Knockout Act) (HR 3073) authorizes an additional $180 million to boost funding for Lyme research, prevention and treatment programs. Smith—who is the founding co-chair of the House Lyme Disease Caucus along with Rep. Collin Peterson (D-MN)— said the bill provides $60 million over five years to reauthorize the Regional Centers of Excellence in Vector Borne Disease which have led the scientific response against tick-borne diseases. And the bill authorizes new CDC grants for a total of $120 million over six years, to build a public health infrastructure for Lyme and other tick-borne diseases. The legislation is supported by more than 25 non-government organizations dedicated to combating Lyme. In June, the House of Representatives adopted two other Smith amendments to boost funding for combating Lyme disease. One amendment, (Division C of H.R. 2740, adopted June 18th), adds $2 million to the DOD’s Congressionally Directed Medical Research Program (CDMRP) for Tick-Borne Disease Research which primarily helps service personnel and their families exposed to Lyme. The program is currently funded at $5 million. On June 12th, the House adopted Smith’s amendment to add $1 million for Lyme disease research at the Centers for Disease Control and Prevention (CDC). The CDC currently spends $11 million on Lyme research. This spring, Smith hosted a Congressional town meeting on Lyme disease in Wall Township, NJ, featuring a panel of national experts including Dr. Ben Beard, Deputy Director of the Division on Vector-Borne Diseases at the U.S. Centers for Disease Control; Pat Smith, President of the Lyme Disease Association; and Dr. Richard Horowitz, an Internist and expert in treating patients with Lyme and other tick-borne diseases.

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

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ASK THE DOCTOR

SEPTEMBER/OCTOBER 2019

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

Did you know that falls are the most common cause of fatal and non-fatal injuries in the elderly? And colder weather brings sluggish joints and less blood flow to the body and the brain. This leads to slower reaction times and more unsteadiness. 1 out of 4 people aged over 65 falls every year. Over 3 million injuries are treated annually in the ER. Over 55 billion dollars are spent on treating the elderly due to falls, of which Medicare and Medicaid shoulder 75% of the cost. Not only is the fall a disastrous event, the after effects of depression, physical decline, feeling of helplessness, and isolation all are very common. This also leads to increased stress for the family or immediate caretaker.

Your podiatrist, Dr. Sanjay Gandhi , is an active participant in the National Fall Prevention Program. This includes a podiatric and gait examination to check for risk factors of falling. If you qualify, you are entitled to balance braces that keep your legs from “wobbling” or “teetering”. You also may be able to get free shoes that provide the proper support and grip to maintain ground reactivity. Preventing falls is essential to keeping those minor bumps and bruises away, but also to preventing major head injuries that can cause bleeding and sometimes permanent damage. If you are over 65, and feeling even the slightest bit unsteady, get screened properly today! You have nothing to lose and everything to gain. A Step Up Podiatry

Dr. Sanjay Gandhi, DPM Our Specialty Services For Adults, Children & Seniors Bunions Children Corns & Callouses Diabetic Foot Care Flatfeet Fungus HammerToeTreatment Heel Pain InGrownToeNails Plantar FasciitisTreatment Plantar Warts Orthotics and Surgery

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Landmark Autism CARES Act Passes House Smith’s Bill Provides over $1.8B for NIH, CDC & HRSA autism programs

Bipartisan, bicameral legislation to powerfully support and aggressively pursue durable remedies and effective interven- tions for the 1.5 million children with autism was approved unanimously by the U.S. House of Representatives. Authored by Rep. Chris Smith (NJ-04), with chief Demo- crat cosponsor, Rep. Mike Doyle (PA-14), The Autism CARES Act of 2019 provides slightly more than $1.8 billion over five years “for America’s whole-of-government Autism Spectrum Disorder (ASD) initiative” lead by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA).

Smith’s bill also helps adults with autism who he said are “are often misdiagnosed, underdiagnosed and overlooked. Lan- guage throughout the bill emphasizes that causes, diagnosis, detection, prevention and treatment of autism spectrum dis- order (ASD) must be throughout the lifespan of a person. According to Drexel University’s AJ Drexel Autism Center, about fifty to sixty thousand children “age out” to adulthood each year creating challenges for education, housing, employment and access to health care,” he said. Smith thanked the more than 35 non-governmental organizations that have endorsed his legislation and called on the Senate for speedy passage.

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Dong QuaI: The Benefits of an Ancient Chinese Remedy By Pam T el

Angelica Sinensis, a type of herb, also known as Dong Quai, is a female ginseng belonging to the Apiaceae family of plants, which includes parsley, carrots, celery, and coriander. It thrives in cooler temperatures and is typically found in the mountainous regions of China, Japan, and Korea. The plant has been a prime ingredient in Chinese medicine for centuries and was used for everything from relieving depression, to healing constipation, to increasing ones libido. Today, a major use for Dong Quai is to help balance hormones and reduce symptoms of menopause. Many of the health promoting properties of this herb come from the presence of coumarin, which is a naturally occurring compound present in many plants. It also contains ferulic acid and phytosterols. The root is often brewed into an herbal tea and has a taste similar to anise. Some benefits of Dong Quai include: to strengthen bones, along with eating calcium enriched foods, regular physical ac- tivity, and spending some time outdoors to get a good healthy dose of Vitamin D from the Sun. It can also help in reducing Blood Sugar and promote normal blood sugar levels. It may promote heart health by decreasing your cholesterol levels and reducing the risk for heart disease. It also decreases inflammation- It has powerful properties that help reduce inflammation and reduce the risk of chronic inflammation. It helps alleviate the symptoms of Menopause, which is a natural decline in the amount of hormones produced by the ovaries as women age. It may help with depression and have an anti depressant effect when it comes to your mood. Dong Quai has also been used by the Native Americans, the Ayorvedic, and Kampa, in medicines as a cure for anemia, heart disease and high blood sugar. Dong Quai supposedly means “The husband returns back to the wife.” Its roots are harvested and dried and turned into a powder. The root can also be simmered, steamed, slow cooked and infused into soups and broths but it’s much easier to get it in supplement forms, sliced roots or in an extract. It does have some side effects that you should be aware of. Since it contains Coumarin, which is used in blood thinning medications like warfarin, it can increase your risk of bleeding. You also have to be careful about combining it with oth- er natural blood thinners such as ginger, ginko and garlic. Pregnant women are not advised to take this especially when breastfeeding or taking oral birth control pills. It could cause a miscarriage. Always read up on the product first and when in doubt, ask a doctor.

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

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SEPTEMBER/OCTOBER 2019

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School Bus Safety Nothing says school is back in session like seeing the bright yellow buses out and about in your town.

The American School Bus Council estimates that 480,000 buses provide transportation for children every school year. A new re- port shows that from 2004 to 2013, 327 school-age children were killed in school transportation-related crashes. Of those, 54 were occupants of school transportation vehicles, 147 were occupants of other vehicles, 116 were pedestrians, nine were pedal-cyclists and one was classified as an “other non-occupant.” The report also puts the school transportation-related crash data in the context of overall vehicle crashes: From 2004 to 2013, there were 340,039 fatal motor vehicle traffic crashes. Of those, 1,214 (0.36%) were classified as school transportation-related. Safety Tips The National Safety Council recommends students and parents follow the following precautions when heading out for the bus stop: •Children should always board and exit the bus at locations that provide safe access to the bus or to the school building; •Remind your child to wait for the bus to completely stop be- fore approaching it from the curb; •Make sure your child walks where she can see the bus driver; • If your child’s school bus has lap or shoulder seat belts, make sure your child uses one at all times. Share the Road Remember that school buses stop at all railroad tracks. They do this for the safety of your children, so give them the space to do so. Also, when you see a school bus approaching you from the op-

posite lane, be on the lookout for flashing lights and extending stop sign, which mean the bus is slowing for a student drop-off. Be sure to come to a complete stop in your lane and don’t hit the gas until the bus has disengaged the stop sign and turned off the flashing lights. Bullying Behavior The school bus is a prime spot for bullying because of the limited view the driver has of all the passengers. Here are some signs of bullying, from The U.S. Department of Health and Human Ser- vices and what the department recommends doing about them. Signs to Look For • Unexplained injuries; • Changes in eating habits; • Frequent nightmares; • Frequent stomach aches or headaches; and • Declining grades or interest in school. Actions to Take • Encourage open, honest discussions with your child about the subject; • Set a meeting with your child’s teacher or principal; • Offer your child actions to take that are an alternative to fighting or verbal abuse; • Give your child positive and affectionate attention; and • Keep a close eye out for injuries or worsening atti- tudes toward school.

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A Psychiatrist Reflects on 20 Years of Treating Children with Autism By Ankur Desai, MD

The number of people diagnosed with autism has grown in the 20 years that I’ve been a child and adoles- cent psychiatrist, and so has my understanding of the disorder. I first learned about autism in my Growth and Development Course when I was a medical student 20 years ago. The classic presentation of the disorder was described then as “an individual with pervasive social and communication skills deficits and a history of lim- ited, circumscribed interests and repetitive, stereotypical mannerisms.” I’ll admit: Back then, I was uncertain how to interact with patients with autism and didn’t understand how they would be able to grow and thrive in society. How- ever, I had the opportunity to work with children with

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autism as a medical student, psychiatry resident, and in more depth as a child and adolescent psychiatry fellow. During those six years of training, I learned more about the subtle nuances of autism. I realized that the disorder wasn’t the narrow outlook described above. Instead, I saw first-hand that the autism community encompasses a broad variety of individuals from different walks of life, each with their own strengths and challenges; a true spectrum of abilities and deficits. The Number of Patients Diagnosed with Autism Is Growing The prevalence of autism over the last 15 to 20 years has grown exponentially. When I started medical school, about 1 in 1,000 people were diagnosed with the disorder, and it affected four times as many males than females. In 2000 when I was a resident, autism affected about 1 in 155. Now, the condition affects 1 in 59 children, according to the Centers for Disease Control and Prevention (CDC). Startlingly, in New Jersey, autism affects 1 in 34 children, and more specifically, 1 in 22 boys. I’m frequently asked why the number of children diagnosed with autism continues to increase. The answer is complex. There are multiple reasons for this increase: • Our awareness of autism and our ability to identify its signs and symptoms has improved, leading to a higher rate of diagnosis • It’s likely that people with milder forms of autism who weren’t diagnosed had children of their own who meet the cur- rent definition • Environmental factors, such as exposure to chemicals, medications, alcohol, and other substances and conditions that we only partially understand Redefining Autism In 2015, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the standard reference guide that health care providers use to diagnose mental and behavioral conditions, including autism. In this updated version of the manual, the condition Asperger’s syndrome was removed, and its symptoms were folded into a broader category of autism spectrum disorders (ASD). To be diagnosed with autism spec- trum disorder, patients must have three symptoms (called criteria) regarding socialization and communication and two symptoms of restrictive or repetitive behaviors. With improved awareness of the diagnostic criteria and assessment tools that can identify potential signs of autism at younger ages, children can be referred to the appropriate therapeutic services at earlier stages of their development. This enables us to improve the overall trajectory of their development and progress Over the last 15 to 20 years, there’s been a concerted effort nationwide to integrate behavioral health services to address treatment needs related to ASD and other intellectual and developmental disabilities. There is a growing focus on linking children who exhibit developmental delays involving social skills and speech and language skills with early intervention services and, if appropriate, transition them to specialized preschool programs. These services can provide critical, evi- denced-based services, such as social skills training, applied behavioral analysis, and speech and language therapy, which are important for optimizing their progress in school and in the community. As a parent, it’s only natural to want the best for your child, and it can sometimes be difficult to understand the recom- mendations and “take home” points from an autism evaluation. If your medical provider indicates that your child may meet in school and their long-term prognosis for life. More Services for Better Treatment

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the criteria for autism, you may want to get a goal-standard evaluation, such as an Autism Diagnostic Inventory or Autism Diagnosis Observation Schedule, as the next step in the assessment process. These are assessments that are used to deter- mine if someone meets diagnostic criteria for ASD. You also can request a child study team evaluation from your child’s school. If the child study team agrees to do an assessment for individualized education program (IEP) services as part of their comprehensive evaluation, an autism evaluation could be included. In addition to getting the right diagnosis and the right treatment services in place, talk with your provider about your fears and concerns and identify key members of your support system. Some helpful interventions include looking for support groups in your area or tapping into the SPAN Parent Advocacy Network for help.

Resources for children with autism are expanding and access is improving. You can improve your child’s overall prognosis by getting services in place as early as possible. With the right interventions, children with autism can enjoy a great quality of life and develop the tools they need to achieve their goals. Looking Back—And Ahead My perspective on autism has changed dramatically over the past two decades. My understanding of autism spectrum disorder is far deeper, and I’m optimistic that patients on the spectrum will live positive, productive lives. In my practice, I have seen patients with autism successfully graduate high school and go on to earn college degrees. I’ve seen patients secure jobs through educational and vocational training programs, and I look forward to seeing these patients get married and start families of their own. In fact, the tenacity and intensity that’s inherent in many individuals with autism is one of the most positive aspects of the disorder. With increasing awareness and ongoing development of behavioral health programs for children with autism, there are more options for these individuals to learn, earn, build relationships, and become positive, admirable role models. Ankur Desai, MD, is a board-certified child and adolescent psychiatrist on staff at CentraState Medical Center in Freehold, N.J. He also maintains a private where he provides outpatient medication management and psychotherapy services for children and adults. Dr. Desai can be reached by calling 866-CENTRA7.

QUESTION: Many of my teeth are not in good condition for various reasons. What are some of my options to allow me to smile and eat with no difficulty?

In my practice I place a minimum of six implants for better stability. After the implants are in their prescribed position, the prosthesis is retro-fitted onto the implants and verification of alignment is made. Most patients are both pleased and amazed with the results they see.

It is important to keep in mind that teeth can become non- restorable for various reasons. Initially, one thinks of decay and periodontal (gum disease) issues as the cause. In many cases, these two issues can effect teeth that are natural, with or without fillings / crowns on them. Trauma or grinding of teeth can also cause potential loss of teeth. Regardless of the reason, loosing teeth can create many esthetic and functional problems for most people. For the purpose of this article, I will focus on complete loss of teeth in either the entire upper or lower arch. When someone looses all the teeth in an arch, several treatment options are now available. Many people think that dentures are the necessary treatment, but today that is not the case. Dental implants can be utilized in many combinations. The most discussed treatment option for complete arch restorations involve immediate implant placement and insertion of teeth in one day. This technique requires the placement of four to six implants followed by a single unit set of teeth.

David P. Young, DMD, DICOI

It is important to keep in mind, the clinical treatment can take place in one visit, but there needs to be a few appointments prior to the surgical day to take the necessary impressions and gather all the necessary clinical date. Each patient’s pre-treament condition will determine the number of presurgical appointments. For the next few months a modified diet is followed since the implants can not be placed under heavy chewing function. The details of the diet will be discussed prior to treatment. After about 4-5 months the final prosthesis is fabricated to give you your new beautiful smile and wonderful chewing ability. If you have any questions regarding full arch dental treatment, feel free to contact my office for a complementary consultation and CT scan.

4432 Route 27, CN-201, Kingston, NJ 08528 Phone: 609.497.0808 www.David YoungDMD.com

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Women Who Can’t Say No to Their Children By Pam Teel

Come on now, you all know one or two of them. They could be your friend, a sibling, an in-law, or even a neighbor. They are the ones who usually have the unruly demanding child who wants it their way or no way at all. Their parents, rather than disciplining them the old fashioned way, have opted to try a different approach to their children’s demands. It’s known as “Permissive Parenting,” which can be de- scribed as giving in to your child so you don’t have to put up with his/her ranting and ravings. Permissive parenting is a type of parenting style characterized by low demands with high responsiveness. Permissive parents tend to be very loving, yet provide few guidelines and rules. These parents do not expect mature behavior from their children and often seem more like a friend than a parental figure. These par- ents tend to be the polar opposite of the so-called "helicopter parents." Instead of hovering over their children's every move, permissive parents are incredibly lax and rarely make or enforce any type of rules or structure. Their motto is often simply that "kids will be kids." While they are usually warm and loving, they make little or no attempt to control or discipline their kids. Because there are few rules, expec- tations, and demands, children raised by permissive parents tend to struggle with self-regulation and self-control. Another words, they grow up, spoiled, demanding, and wanting everything their way.

Gentle Parenting is another new philosophy that actually doesn’t rely on punishments at all, because parents feel that’s not what dis- cipline is about, and although it may help to get immediate obedience from your child, it does not cultivate a heartfelt willingness to do what’s right. Gentle parenters feel that when they discipline their children they are teaching them how to conduct themselves in this big world around them but they don’t get there by punishing children, which can leave them feeling ashamed of their mistakes. Instead they give children the freedom to make mistakes and they help them overcome those mistakes together. Gentle Parenting helps the child fix the problem with a capable adult by their side, thus teaching their children to obey authority not out of fear of punishment or desire for reward, but out of respect. The new generation of gentle parenting never use words like, “No’ or “Naughty,” even if their kids are out of control, for fear of dam- aging their confidence. Gentle parenting means a partnership with your kids where they want to do the right thing for the sake of doing the right thing. And by “no punishments” they don’t use time-outs, smacking, shaming or yelling. They use gentle or positive discipline, which aims to teach children empathy, self-control and calmness. They argue that to offer rewards and punishments overrides a child’s natural inclination to try. It teaches them to behave in certain ways for a reward, or to avoid punishment. Many new generation parents are bypassing the good talking too and the time out in a corner for bad behavior. Instead they opt to explain to their child the consequences of their actions rather than raising their voice, saying no, or punishing them. After the tantrums have resolved and the problems settle down, they try to engage in a constructive discussion on the negative impact of their tantrums and how it affects everyone else around them. That is if the parent ever makes it to that stage. Throwing discipline out the window for a discussion with a young child most often is a mute point. Young children have the capacity for only simple discipline. Parents will need a lot of patience trying to explain their children’s bad behavior with a lengthy discussion when something is not okay. Trying to treat your child as you would an adult just isn’t going to work. Children need boundaries, not negotiations. According to the gentle parent approach, the word no doesn’t teach children anything. If a parent labels their kids as naughty, they say it’s all about them not knowing how to channel their emotions. Does a parent really need to explain why they said no to their child? In today’s world, erasing no from a child’s vocabulary will lead to children who feel they can do and say anything they want whenever they want. They need to learn what’s right and what’s wrong. It’s up to the parents to discipline their children at home so they don’t’ think it’s acceptable to carry on with the same behavior patterns in school, church, or with their peers. They need to learn at an early age what’s acceptable and what’s not. Learning how to say, “No” is part of an essential toolkit that all children need to help them make good deci- sions, not just in the now but in the future. At some point in time in their life, someone is going to tell them no. How are they going to handle it once they are adults and on their own? Children need to know that behaving badly will lead to a consequence. Gentle parenters will tell you their kids are never naughty, even if they really are. A parent’s job is to create independent, capable children and the training starts at a young age. Your job is to set the limit, not to con- trol how your child feels about it or reacts to it. Parents can get stuck in a pattern of giving even though they want to set limits. It’s not too late to take back your authority so you can help your child develop skills they will need to cope in the real world. Parents become too focused on the short term goal, which is to make it go away quickly so they can get some of their own down time or just to keep the peace. If this sound like you and you’re doing a good job avoiding the situation, it’s time to focus on the bigger picture. You need to adhere to constant limit setting. Don’t be influenced by outside sources like family members, friends and neighbors. You know your child the best. No matter the reason, giving in on a quick fix will always guarantee problems later. Ask yourself what’s the best thing to do for my child right now? Set Limits and don’t be afraid to give consequences in order to teach them an important lesson about their unacceptable behavior. Always keep these questions in the back of your mind, “What do I want them to learn here? How do I want my child to act as they grow older?” Focus on what you yourself can control. Let them know the negative way they act is not going to get them what they want and then just walk away. Call a friend, work on a craft, do something to alleviate your frustration from the situation. The times you don’t follow through and you do give in will be the ones your child will remember.

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