2012 Kingsport Times-News Wedding Planner

Know signs of deadly melanoma. (Page 5)

Volume 10, Number 4, 2012

I think you should know... Marie Browning (Page 12)

Fighting breast cancer.Becky Flora-Waterman (Page 4)

Dental X-rays and you.Kevin Martin (Page 7)

Saveyourskin

2E Kingsport Times-News / Wednesday, April 25, 2012

Adver tisersHealth & Wellness Directory ................... 3Kingsport Hearing Center ........................ 4Mountain Region Family Medicine ......... 6HealthSouth Rehabilitation Hospital ..... 7Indian Path Medical Center .................. 8-9Meadowview Ear, Nose & Throat ........... 10Custom Compounding Centers ............... 11Tri-Cities Gastroenterology .................... 12Guest D.D.S. ............................................. 14Mountain Region Family Medicine ....... 15Kingsport Gastroenterology Associates .16

ContributorsBecky Flora-WatermanFor years, this columnist has written ex-clusively about breastfeeding and its im-portance not only for the health of chil-dren but also for the health of mothers, in-cluding a reduced risk for breast cancer.So, she was stunned, after breastfeedingher own five children, to learn she hadbreast cancer. Page 4.

Kevin MartinNational news media made much of a re-cent report linking dental X-rays to a cer-tain type of benign brain tumor. However,dental X-rays are often safer than X-raysof other parts of the body, and are a greatsource of information for dentists whowant to provide preventative care to theirpatients. Page 7.

James DuncanAfter getting a total knee replacement,folks often ask, “How long will my kneelast?” The answer to that question de-pends on how active you are and want tobe in your later years. Page 10.

Danielle CombsFalls are a significant health risk to olderadults. A recent study shows that thosewith mild hearing loss are at a significant-ly increased risk of falls, and the worsethe hearing loss is, the more likely fallswill occur. Page 11.

Marie BrowningFrom the benefits of dark chocolate, to us-ing fish oil with blood thinners, to a vac-cine for prostate cancer, to the new warn-ings on aspirin use, learn a little about alot this month. Page 12.

Taylor BrownMay is Better Hearing and Speech Month.In honor of that, learn more about all thatspeech-language pathologists have to of-fer their community. They really are morethan a “speech teacher.” Page 15.

Save your skinSabrina Fields tanned the old-fashionedway — by spending hours in the sun —when she was growing up. Later on, shealso used tanning beds. That sun expo-sure led to a bout with melanoma as wellas other skin cancers. Now, she protectsher skin with sunscreen and hats. Page 5.

Got 20?If you can find 20 min-utes in your day whenyou’re not doingsomething important(watching reruns, any-one?), you can fit in anintensive workoutthat will lead to betterhealth. Page 16.

No saltNo-salt pretzels canprovide a deliciouscrunch to chickenpiccata with muchless sodium. Page 11.

Wednesday, April 25, 2012 / Kingsport Times-News 3E

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Reflections on a diagnosis: Breast cancer? Me?Breast cancer. Really? Me?

How?Just about a month ago I re-

ceived a confirmation diagnosisthat the lump in my breast was in-deed cancerous.

Still as a write about this andbeing two weeks into my recoveryfrom a double mastectomy, it al-most seems as if I’m writing aboutsomeone else. Of all the possiblediseases or health-related chal-lenges I would have expected toface as I grew older, breast cancerwas not one of them. It didn’t evenseem a remote possibility.

Still, here I am fighting to be-come a breast cancer survivor.

I had not been doing regularmonthly self-breast exams. In myyounger years I had done thesesporadically, but because I hadbeen pregnant or nursing a childmost of my adult life, self-examswere harder.

The lactating and pregnantbreast often feels lumpy anyway. Ialso have had fibrocystic diseasesince my late teens and thosekinds of breasts always feel lessthan smooth. Additionally, I thinkstressors in my life during thepast several years just made get-ting through some days remark-able. Doing just one more thingeven if it might be good for me wasjust that …one more task to com-plete, and I just didn’t do it.

I had not had a mammogramsince my late teens when a suspi-cious lump was checked out andfound to be fibrocystic in nature.Why wasn’t I having these?

Well, I am just now 45 years oldand have no family history ofbreast cancer. My doctor believedthat regular yearly mammogramswere not necessary until age 50,which is a commonly acceptedrecommendation. I don’t faulthim for not recommending that Ihave one. He was simply follow-ing accepted practice for a reallylow-risk patient. My insurancecompany wouldn’t pay for ascreening mammogram anyway.Thus, it seemed perfectly accept-able to just wait until I turned 50.

So, how did I find it without selfexam or mammogram? Very acci-dentally, yet very much God-led, Ibelieve—while I was showeringand shaving under my arms. Mythumb slipped down a bit as Iheld the razor and I felt some-thing a little different. That was it.Not anything earth-shattering, butlife-changing all the same. Still, Ireally didn’t think this was any-thing to worry about, just differ-ent. It was right before my periodanyway, and so that was probablywhat was going on. When my peri-od started the knot would go away.

However, it didn’t, and so Iwent ahead and made an appoint-ment with my nurse practitionerjust so that I would be doing theresponsible, smart thing, not be-cause I really believed this to beanything like breast cancer. Frommy first appointment with her tothe mammogram with ultrasoundand onto the core needle biopsyfor confirming diagnosis took lessthan 10 days. My surgery tookplace only 10 days after that. It allhappened very quickly.

You might wonder why I havechosen to share this story with youwhen I usually write about breast-feeding matters. Well, for years inthis column, especially in Octoberduring Breast Cancer AwarenessMonth, and for years in my prac-tice, I have preached, yes, proba-bly preached, about how breast-feeding protects against breastcancer. I’ve even expressed frus-tration about breastfeeding notbeing mentioned frequentlyenough in literature that educateswomen about how to lower theirrisk for breast cancer. In an arti-cle I wrote for this column in Oc-tober 2005 I said this:

“Many studies have shown thatwomen who breastfeed have low-er risks of developing breast can-cer. Recently, data from 47 studiesin 30 countries was re-examined.The study group concluded thatthe incidence of breast cancer indeveloped countries could be re-duced by more than half if womenhad the number of births and life-time duration of breastfeedingthat are common in developingcountries. According to the analy-sis, breastfeeding could accountfor almost two-thirds of this esti-mated reduction in breast cancerincidence. The researchers foundif women in developed countriesbreastfed their children just sixmonths longer than they do now,25,000 breast cancers worldwidecould be prevented each year. Ac-cording to the study, a woman’srisk for breast cancer decreasedby about 4.3 percent for every 12

months she breastfed. The riskwent down 7 percent more for ev-ery child born.

“While breastfeeding in and ofitself won’t ensure a woman es-capes breast cancer, it is an im-portant part of the preventionequation along with a well-bal-anced diet that is low in fat, exer-cise, maintenance of a healthyweight, and decreased alcoholconsumption.”

Based upon these statistics Ishould have been the last personto get breast cancer. What do Ibase that on? Well, according tothe information I found using aninteractive tool determiningbreast cancer risk on the NationalCancer Institute website, I onlyhad a 0.8 percent risk of develop-ing breast cancer in the next fiveyears not even taking breastfeed-ing into account.

This was based upon the earlyage at which I started menstruat-ing, nothing more. Adding in thestatistics for breastfeeding andbreast cancer risk given above,that extremely small risk actuallybecomes a negative risk. I havehad five children. That loweredmy risk already by 35 percent. Ihave breastfed for a lifetime totalof approximately 10 years amongall five children, thus loweringthe risk by 43 percent more. Itboggles my mind even now.

I felt a little betrayed when Ilearned about my diagnosis.Hadn’t I done everything possibleto prevent this? Hadn’t I had mychildren at an earlier age? Hadn’tI breastfed every one of them,some with very great challengesto overcome and breastfed themeven for extended periods of time,some even into their toddleryears? Hadn’t I maintained apretty healthy weight, tried towork in exercise, tried to eathealthy most of the time, andlived an overall healthy lifestyle?

Why had breastfeeding let medown? Wasn’t I the lactation con-sultant who proclaimed the bene-fits of breastfeeding over and overagain, much as a mission to get theword out to as many women as Icould? Me? Breast cancer? Real-ly?

I chose to write this columnand share with you about my diag-nosis and my frustrations becausemany of you have entrusted mewith providing you with breast-feeding information for many,many years, and so I feel that Iowe you some sort of addendum.

Let it be made clear. I still be-lieve whole-heartedly in thosestatistics. I still believe thatbreastfeeding plays a role inbreast cancer prevention.

However, I probably found afalse sense of security in it toomuch, almost believing that itmade me immune, and no womanis immune to breast cancer!

Will I change my messageabout breastfeeding’s benefits?No, because even if you don’t ac-count for its breast cancer risk re-duction, breastfeeding’s endlesshealth benefits to both motherand child are well-establishedand well worth it both in theshort-term and in the long-term!

However, I will now add this:Know your breasts. Yes, they areharder to assess when you’repregnant or breastfeeding, butknow them before, during and af-ter. Check them monthly and fol-low-up with your doctor if any-thing feels a little bit odd. Don’twait! Better to overreact thanmiss something that’s a problem.

Ask for a mammogram as soonas you turn 35 or at least at age 40,and if your insurance won’t payfor it because you don’t fall intothe high-risk category, try to workout a way to pay for it out of pock-et. If you have any family historyof breast cancer, you should begetting mammograms way beforethis time!

See your gynecologist or regu-lar doctor/nurse practitioner atleast once a year. Clinical breastexams are as important asself-breast exams. Breastfeed allyour children if possible anddon’t delay childbearing muchpast the middle 20s if at all possi-ble. Studies show that the longer awoman waits to have her firstchild the greater her risk forbreast cancer. Breastfeed as longas you possibly can with eachchild. Every month makes a dif-ference.

Where am I now with all ofthis? As I said earlier, I am at thetwo-week mark following my mas-tectomy and still awaiting the fi-nal word on whether or not

chemotherapy will be recom-mended. The cancer was con-tained within my breast and wasnot in my lymph nodes or any-where else in my body. Praise Godand the power of praying Chris-tians!

This may not have been thecase had I not been “accidental -ly”led to find the lump that dayand sought medical assistance forit, or had my healthcare givers notbeen so prompt in their directionof my care. Reconstruction hasbegun and will be a lengthy pro-cess probably going into the firstof next year.

I am off work for an undeter-mined amount of time for now. AsI contemplated losing my breastsI thought about all my babies whohad been nourished there andfound comfort there. They had in-deed served me and my childrenwell, and I am thankful that I hadthe opportunity to use them fortheir primary purpose before Ihad to let them go.

Sources: Jernstorm, H et al“Breast-feeding and the risk of breast cancerin BRCA1 and BRCA2 mutation carriers.” JNatl Cancer Inst. 2004;96:1094-1098; Lee,SY et al “Effect of lifetime lactation on breastcancer risk: a Korean women’s cohorts t u d y. ” Int J Cancer. 2003;105:390-393;Collaborative Group on Hormonal Factorsin Breast Cancer (2002). “Breast cancer andbreastfeeding: collaborative reanalysis of in-dividual data from 47 epidemiological stud-ies in 30 countries, including 50,302 womenwith breast cancer and 96,973 women with-out the disease.”Lancet 360: 187-95; Zhenget al, “Lactation Reduces Breast CancerRisk in Shandong Province , China ”Am. J.Epidemiol. Dec. 2000, 152 (12): 1129; New-comb PA, Storer BE, Longnecker MP, et al.“Lactation and a reduced risk of pre-menopausal breast cancer.”N Engl J Med.1994;330:81-87; http://www.can-c e r. g o v / b c r i s k t o o l /

Becky Flora-Waterman, RN, BSed, IB-CLC, RLC, is a registered nurse and boardcertified lactation consultant. Email her [email protected]

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Save your skinBy Leigh Ann Laube

Sunless tanning productsweren’t available when SabrinaFields was growing up in Wise,Va., modeling and competing inbeauty pageants. So she tannedthe old-fashioned way —spendinghours in the sun.

When tanning beds becamepopular, Fields used them to keepher dark appearance.

Fast forward to 2005. Fields, 30at time, developed a rash aroundher mouth. When it didn’t go away,she visited a dermatologist. Hecultured the area on her face, butalso found a suspicious place onher thigh.

“It was so tiny you wouldn’thave noticed it unless you knewwhat to look for,”Fields said.

Fields, a respiratory therapist,was convinced she had Methi-cillin-resistant Staphylococcusaureus (MRSA), a type of staphbacteria. She was surprised whenthe dermatologist told her thatshe had stage 2B melanoma andthat if he didn’t operate immedi-ately, she’d live only another sixmonths.

“I didn’t even know whatmelanoma was,”she said.

The surgery left Fields with20-plus stitches in her leg. Subse-quent surgeries to remove basalcell carcinomas and squamouscell carcinomas on her back haveleft her feeling self-consciousabout her appearance.

“My back looks like dot-to-dot,”she said.

Melanoma, the most dangeroustype of skin cancer, is the leadingcause of death from skin disease.A new Mayo Clinic study findsthat since 1970, the rate ofmelanoma today is eight timeshigher in young women, and fourtimes higher in young men.

The study results don’t sur-prise Kingsport dermatologistJoni Sago, who was disappointedthe study didn’t mention the in-creasing risk of melanoma in old-er men.

“If you look at crude incidentrates, men really still have moreof a problem and men die morefrom melanoma. It’s frequently ontheir back where they can’t see it,”she said. “We do see young wom-en, and it’s tragic. We have toleave a large scar and that’saproblem.”

Women tend to check their

bodies more regularly than men,Sago said, and that’s why men old-er than 50 need a baseline screen-ing.

“The rates are higher for menas they get older because they

have cumulative outdoor expo-sure. They have tons of sun ontheir back and, after 50, when youstart getting wisdom spots, you geta lot of scatter and it’s hard toknow what to look for,”she said.

Sago tends to see mostly wom-en, many of whom have used tan-ning beds.

“I see mostly women and a lotof times they may have adult acneor rosacea or want to talk about

anti-aging, and they say, ‘I wouldlike you to look at this spot.’ If it’sayounger women, it’s a place theycan see. At least half of youngerpatients come in because they’veseen a spot and, frankly, most ofthe time they just don’t like theway it looks.”

Because most melanoma iscurable in the early stages, with amore than 90 percent survivalrate, it’s important that it’s caughtand treated early.

Sago said dermatologists re-move suspicious spots, and anyspot bigger than a millimeter issent away for a sentinel lymphnode biopsy.

“If it is less than millimeter, wehave them back to excise the spotand some surrounding skin. Thecure rate is high, but it always ne-cessitates a scar,”she said.

Sago said if she has any suspi-cion of melanoma, the mole is re-moved, which leaves a scar.

“I have so many patients withhundreds of moles, so I’m usingmy naked eye. It’s really the onlything we can do right now. ...It’sashotgun approach to diagnosis.What would be superb is if wecould diagnose without leaving ascar. What we would like to do isnot have to carve on patients andtake off more.”

In November 2011, the U.S.Food and Drug Administrationapproved a new device, calledMelaFind, that makes digital im-ages of skin growths and analyzesthem for signs of cancer.

“It’s the way of the future,”shesaid.“It’s a hand-held device youput it over a mole and it does acomputer algorithm. This willcome up with a number that willsay its likelihood of being some-thing bad. It was approved, andthey are rolling it out to some der-matologists. It takes some train-ing, and insurance probably isn’tgoing to cover it, so it’s got somehurdles.”

The FDA also approved lastyear two drugs to treat advancedmelanoma. Zelboraf attacks thespecific genetic mutation —BRAF—that accelerates tumorgrowth, while Yervoy unleashesthe body’s immune system to fightthe disease. The drugs do not curemelanoma, but may add severalmonths to the expected lifespansof people with advanced

Women and men need to know signs of deadly melanoma

Please see next page

Photo by Ned Jilton II

While growing up, Sabrina Fields prepared for modeling and beauty pageants by tanning through hours spent in the sun. Lat-er, she used tanning beds. That led to a bout with melanoma as well as other skin cancers. Now, when she’s outside, she wearssunscreen and a hat. She avoids going to the beach, she checks her skin regularly and sees a dermatologist every six months.


melanoma.Doctors encourage patients to

check moles for the ABCDEs —asymmetry, borders, color, diame-ter and evolution —but Sago saysthere’s a better way.

“The ugly duckling”mole isone that appears different fromthe rest,”Sago said. Patientsshould know the pattern of moleson their bodies in order to identifyif a mole breaks that pattern.

“Patients need to trust their in-stincts and watch for their uglyduckling,”she said. “It’s so intu-itive. It’s what people do anywayand now we know that actuallyworks. Melanoma is alwayschanging. Melanoma is mutated,so you’re looking at changes overseveral months.”

The best way to prevent skincancer is to protect yourself fromthe sun, and this summer, con-sumers will see changes in theway sunscreens are labeled. Sun-screen labeling for the first timewill be allowed to claim that theproducts protect against skin can-cer and early skin aging. Sun-screens will no longer be able tocarry an SPF value higher than 50,the FDA says, because there isn'tsufficient evidence to show thatan SPF higher than 50 providesgreater protection.

“SPF will be topped out at 50,and it will have a star rating forthe UVA blocking, so I tell my pa-tients make sure you get athree-star. It goes to four, but myunderstanding is that no companyhas earned a four-star rating,”shesaid.

The bottom line, Sago said, isthat melanoma is a disease of allages, and it’s curable if caughtearly enough. Unlike other can-cers, melanoma is visible on theskin, making it easier to detect inthe early stages. The most danger-ous aspect of melanoma is its abil-ity, in later stages, to spread to oth-er parts of the body, most often thebrain, lungs and liver.

“This press about the youngwomen thing was all over thenews, and I’m glad, but I do thinkwe don’t need to neglect men,”she said. “Yo u ’re not out of thewoods if you’re 55 and a guy. Youcan’t underestimate the power ofthe sun in regard to melanoma.”

People at highest risk formelanoma are those with light orred hair, and green or blue eyes.

Although Fields has black hair,she has green eyes. The rash onher face was found to be related tothe melanoma and her compro-mised immune system.

Now, when she’s outside, shewears sunscreen and a hat. Sheavoids going to the beach, she

checks her skin regularly and seesa dermatologist every six months.

“Pretty much he always takessomething off,”she said.

“My skin has changed. I’m veryself-conscious about the way Ilook. I can’t wear strapless oropen-back dresses. It’s just sadthat I let myself do that to try to bep r e t t y. ”

Fields talks to young women,encouraging them to use a spraytan.

“You only have one time withthis skin, and you need to takecare of it,”she said.

Katie Baker used to be a tan-ner. Growing up in Greeneville,she started using tanning beds oc-casionally at age 14. She had herfirst pre-cancerous tumor re-moved at age 22.

Today, Baker is a doctoral can-didate in her fourth year at EastTennessee State University’s Col-lege of Public Health, and a re-search coordinator for Joel Hill-house and the ETSU Skin CancerPrevention Lab.

Her recent research has fo-cused on the tanning trends be-tween mothers and daughters, but

her message remains the same:Skin cancer is the most rapidlygrowing cancer in the nation andis the number one cancer risk inwomen ages 25 to 29.

She and others at the Skin Can-cer Prevention Lab work to edu-cate young people and their par-ents of the dangers associatedwith tanning. They’ve found thatthe message young people aremost receptive too isn’t the threatof cancer.

“The message that most affectsyoung people is that tanning in atanning bed will result in signifi-cant appearance damage. They’regoing to age their skin muchquicker. Your going to lose youryouthful appearance way beforeyour time,”Baker said.

Baker said they are targetingpeople at a younger age, explain-ing that skin damage is cumula-tive.

“Once the burn goes away, thedamage isn’t done. The actualskin cells are damaged in such away that they replicate incorrect-l y, ”she said.

Tanning beds, Baker ex-plained, emit UVA and UVB radi-

ation. The amount of the radiationproduced during indoor tanningis similar to the sun, and in somecases might be stronger.

“Certainly UVA radiation fromthe sun is damaging ... but the in-tensity of the radiation [from tan-ning beds] is so high —seven to 12times the intensity of the sun’srays. Also the radiation makeupfrom the tanning bed is different,”she said.

UVA radiation penetratesdeep into the skin, increasing therisk for melanoma andnon-melanoma skin cancers likesquamous cell carcinoma andbasal cell carcinoma.

Melanoma is increasingly be-ing found in the breast and genitalareas of young women, Bakersaid, a result of nude tanning.

Baker understands the percep-tion that a tan body is a healthybody, as well as the desire ofyoung women to appear tan, butshe encourages people to achievethat glow using self-tanning prod-ucts.

“So far, there are no con-traindications against self-tan-ning products. All they do is dye

the dead skin cells using a plantprotein,”she said.

There have been efforts in sev-eral states to limit indoor tanningfor minors. Minnesota introduceda special tax on tanning and, lastyear, California enacted a lawprohibiting those younger than 18from indoor tanning. Illinois,Utah, Michigan, Arizona, NewJersey, New York and Connecticutare considering similar bans.

SAVE SKINFrom preceding page

After Sabrina Fields hadmelanoma removed fromher thigh — surgery thatleft 20-plus stitches in herleg — she has had subse-quent surgeries to removebasal cell carcinomas andsquamous cell carcino-mas on her back. Thosehave left her feelingself-conscious about herappearance. “My backlooks like dot-to-dot,” shesaid. (contributed photo)

W. Michael Smith, MDIRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) is an increasingly common functional gastrointestinal disorder that is recognized this month for IBS Awareness Month. It is described as a “functional” disorder because it results in functional abnormalities in the gastrointestinal (GI) system, as opposed to structural abnormalities.IBS is diagnosed by your doctor based on certain criteria. There are no lab tests or diagnostic imaging techniques necessary, although your doctor may order labs and imaging to rule out other gastrointestinal conditions that may present like IBS. Patients with IBS often complain of chronic and/or recurrent abdominal pain, which may or may not be associated with eating, stress, alcohol intake and smoking. Changes in bowel habits also are common. While some individuals experience constipation, others experience diarrhea predominantly. Some individuals experience both. One characteristic of IBS is that that abdominal pain is typically improved by bowel movements.Here are a few tips for better managing your IBS symptoms:Stress reduction: Simple stress reduction strategies such as meditation, yoga, breathing techniques and exercise can reduce abdominal pain. This can be especially helpful if your IBS pain is associated with eating. Try taking fi ve minutes before each meal to sit quietly and focus on your breathing. Eat slowly and mindfully.Diet: Consult your doctor if you think there is a connection between particular foods and your symptoms. There may be an underlying food trigger. In general, increasing your fi ber intake by eating fresh fruits and vegetables is a good idea. Not only does fi ber slow down the processing of food, but it also helps to feed the hundreds of different species of benefi cial bacterial living in your gut. This may improve symptoms of IBS, including diarrhea and constipation.Probiotics: These microbes play key roles in our digestion, metabolism and absorption of food particles and nutrients. They also help to maintain the integrity of the walls of our GI tract so that only certain things are absorbed into the body. Supplementing with probiotics can help to restore GI function, reduce gas and improve bowel regularity. You can also get probiotics by eating fermented foods such as yogurt, kefi r, miso and kimchi.Antibiotics: Stay away from antibiotics unless they are truly necessary. In addition to destroying the “bad” bacteria, antibiotics also destroy the “good” bacteria and may worsen GI function. Be sure to take probiotics anytime you take antibiotics; alternate so that you take them a few hours apart.Supplements: Other supplements that have offered IBS patients some relief include peppermint tea or oil (in capsules) and marshmallow root and/or slippery elm bark extracted in room temperature water.

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X-rays help dentists givetheir patients the best care

KevinMA RT I N

Much public attention hasarisen recently over the use andsafety of dental X-rays. A recentstudy in the journal Cancer(April 10, 2012) asserted a poten-tial link between dental X-raysand a benign brain tumor calleda meningioma.

While the authors of the studyadmit it has several flaws andmakes no actual connection be-tween dental X-rays and tumors Ithink the study does serve as aplatform for a discussion aboutdental X-rays today and theirs a f e t y.

Like every other medical tech-nology, dental X-rays have ad-vanced significantly during thepast 50 years. Several decadesago the exposure to radiationfrom dental X-rays was muchhigher. The same goes for chest,abdominal and any other kind ofX-rays.

Today we have digital dentalX-ray sensors that require 75 per-cent to 90 percent less radiationthan previous film-based X-rays.Furthermore, the machines of to-day virtually eliminate scatterradiation, focusing the X-raybeam in just the areas of the con-cern in the mouth.

As X-rays pass through yourmouth, they are mostly absorbedby teeth and bone because thesetissues are denser than cheeksand gums. When X-rays strike thefilm or digital sensor, an imagecalled a radiograph is created.Radiographs allow your dentistto see hidden abnormalities, liketooth decay, infections and signsof gum disease, includingchanges in the bone and liga-ments holding teeth in place.

How often X-rays should betaken depends on your presentoral health, your age, your riskfor disease, and any signs andsymptoms of oral disease youmay be experiencing.

For example, children may re-quire more frequent X-rays thanadults because their teeth andjaws are still developing, andchildren are more prone to cavi-ties than adults. Likewise, pa-tients with a history of rapid de-cay development or periodontaldisease may require X-rays moreoften.

For most areas of the mouth,the only way for the dentist toevaluate a patient for disease isthrough X-rays. X-rays allow den-tist to examine for small areas ofdecay, infections in the bone, pe-riodontal (gum) disease, abscess-

es or cysts, developmental abnor-malities, and some types of tu-mors. In all these cases, the earli-er a problem can be diagnosedthe easier and less expensive it isto treat it.

If recommended X-rays aredelayed, often problems canprogress to the point were eitherteeth are lost or they require ex-tensive, usually expensive treat-ment.

The amount of radiation thatwe are exposed to from dentalX-rays is very small compared toour daily exposure from thingslike cosmic radiation and natu-rally occurring radioactive ele-ments. When compared to medi-cal X-rays (chest, abdominal, ex-tremities, etc.) radiation fromdental X-rays is more than sevento eight times less. Radiation ex-posure from digital dental X-rayswith today’s machines, which vir-tually eliminate scatter radia-tion, is nominal. One source com-pared the amount of radiationexposure from dental X-rays tothe equivalent of one day of natu-ral background radiation, whilean abdominal CT scan is theequivalent of 10 years worth ofnatural background radiation.

The American Dental Associ-ation recommendation for X-rayexams has been misstated (or notclearly stated) in the previouslymentioned study and in severalmedia stories. The ADA recom-mends radiographs be taken de-pending on age and caries (de-cay) risk.

Bitewing radiographs showthe interproximal surface be-tween the teeth and are routinelytaken at recall appointments. Ona child or adult with a high decayrate, the ADA recommends tak-ing bitewing radiographs everysix to 18 months because a per-

son who is susceptible to decaycan go from no decay on a tooth tomassive decay with an abscess inwell under a year. If we postponeX-rays on these individuals, wecan miss decay in the early stageswhen it is easier to fix with asmall filling. On a healthy adultindividual we might take bitew-ing radiographs every 12 to 24months. In addition, anytime wework on a tooth most dentists re-quire a previous radiograph tobe able to visualize the tooth andsurrounding structures.

Dentists also take panoramicX-rays that show us all the struc-tures of the teeth, jaw, joints andsurrounding structures. Onadults we ideally make apanoramic radiograph everythree to five years. Again somepatients, like those with a historyof cysts or periodontal disease,might need panoramic examsmore often. On children we oftentake panoramic radiographsmore often while they are devel-oping. We are checking for per-manent tooth development andpositioning in the jaw, which canonly be done through radio-graphs.

I think most patients today ac-knowledge the need for dentalradiographs during dental ex-ams. They further understandthe attempt by their dentist tofind a balance between keepingtheir mouths healthy and reduc-ing the amount of X-rays they areexposed to.

My hope is when patients seea report of a study or media storywith an obvious attempt to scarepatients, whether it be a medicalor dental report, they will discusstheir concerns with their medi-cal professional. Often the mediagives the sensationalized versioninstead of the unbiased version.These kinds of reports shouldserve as a way to open dialoguebetween patients and doctorsand ultimately lead to betterhealth for the patient.

Sources: “X-Rays.”American DentalAssociation April 11, 2012.http://www.ada.org/3067.aspx?current -Tab=1; “Patient Safety: Radiation Expo-sure in X-ray and CT Examinations.”Radi -ology.org April 13, 2012. http://www.radiol-ogyinfo.org/en/safety/in -dex.cfm?pg=sfty_xray

Kevin Martin, D.D.S., is a family andcosmetic dentist in Kingsport. He practicesat Martin Dentistry with his father, Dr. TimMartin. E-mail questions or topics of inter-est to [email protected], visitwww.martindentistry.net or call 247-8172.

5 symptoms that need actionBy Heidi Stevens

It might be a caffeineheadache, but it might be ananeurysm. Great. Now, at the veryleast, it’s a stress headache.

We asked the experts to tell usfive signs that your body is tellingyou something. And why youshould do something about it.(Namely, call your doctor.)

HEADACHEIf you’re saying the words

“worst headache of my life,” saidCamelia Davtyan, clinical profes-sor of medicine at UCLA, it’s timeto make a call.

“It may be caused by ananeurysm that can burst and leadto sudden death,” said Davtyan.

Or it could be bleeding on thebrain, encephalitis, meningitis orsome other viral or bacterial in-fection within the spinal fluid,said Joshua Miller, medical di-rector at the Cleveland Clinic’sStrongsville Family Health Cen-ter. “The headaches that worry usare ones that start suddenly, likea thunderclap,” Miller said.

CHEST PAINSome chest pain is obvious —

and obviously alarming. “Asqueezing pressure, elephant-sit-ting-on-your-chest feeling,” saidMiller. But some symptoms areless noticeable. Miller said to bemindful of how your body recov-ers from activities you’re used toperforming.

“If you climb a flight of stairsevery day and you usually feelfine, and then one day you get tothe top and feel short of breath,panting, a little pressure in yourchest, you shouldn’t ignore that.”

ABDOMINAL PAIN“It may be attributed to diges-

tion problems and ignored,” saidDavtyan, “But it may be causedby appendicitis or kidney stone,which can get worse quickly ifnot treated.”

Pay particular attention topain that’s accompanied by afever or vomiting.

And be mindful of a recentchange in your bowel move-ments. “If you’re having severediarrhea or black or bloodystools, it can be a warning sign ofan abdominal aneurysm,” saidM i l l e r.

BACK PAINWho among us doesn’t have a

sore back, right? Sit up and takenotice, however, if yours is ac-companied by tingling andnumbness in your feet and toes.

“Tingling and numbness don’thappen with a simple backstrain,” said Davtyan. “It may bea disk herniation that canprogress if not treated.”

UNEXPECTED WEIGHTLOSS

Few of us are going to com-plain if our clothes start fitting alittle looser, particularly in a na-tion with a 26 percent obesityrate. But unintentional weightloss, Miller said, is “very concern-ing.”

“It’s a time to get a really goodhistory of what’s been going on,review your symptoms from headto toe and get some blood workdone,” he said. “Gastrointestinalsymptoms can signal malabsorp-tion issues such as celiac disease,where your body’s not absorbingnutrients properly.

“It can also signal depressionor, often in the case of elderly pa-tients, early signs of dementia.”


How long can I expect my new knee to last?Joint replacements have been

around for many years. Most peo-ple are familiar with some of thejoints replacements such as totalknee and total hip replacements,but there are also partial kneereplacements and shoulder re-placements.

Typically, a joint is replaceddue to end-stage arthritis thatcauses extreme pain, muscleweakness, decreased functionand instability of the joint.

The following information isspecifically related to a totalknee replacement, but may alsoapply to other types of replace-ments.

The surgical procedure of a to-tal knee replacement involveshaving the ends of the femur andtibia bones strategically and pre-cisely removed and replacedwith a metal, alloy and plasticconfiguration-type prosthetic.The prosthetic parts are similarto the portion of the bones re-moved.

This, of course, is a condenseddescription of an intricate pro-cess. If you are interested inlearning more about this process,you may want to check out the In-ternet, which has some good in-formation and videos.

Needless to say, if you are oneof the individuals who has tohave this surgery, you want theprosthesis to last for as long aspossible.

There are a number of factorsthat will determine the longevityof your prosthesis.

These include activity level,type of activity, body weight andfollow-up rehabilitation. Follow-ing are some suggestions to helpincrease the longevity of a totaljoint replacement:

1. Avoid repetitive heavy lift-ing. Increasing load also increas-es the wear and tear on the newjoint structure.

2. Maintain a healthy bodyweight. With each step there is in-creased force on your joints. Theforce at the knee increases threetimes that of your body weight.

3. Be mindful of impact sportssuch as jogging, running and aer-obics, which place more stress onthe joints.

4. Avoid quick stop-start mo-tions, and excessive twisting ac-tions, such as in golf, tennis andracquetball, etc. which placemore torque and force on thejoint.

5. Be aware that activities suchas weight lifting and strengthtraining, that require increasedjoint range of motion while underapplied stress, can also applymore stress on the joints.

6. Follow-up rehabilitationthat focuses on range of motion,flexibility, strength, and goodfunctional outcome can improvethe longevity of all total joint re-placements.

7. Patients taking ownership ofachieving the highest level offunction possible can also im-prove the longevity of a joint re-placement.

Insurance companies contin-ue to scrutinize cost on follow-uprehabilitation.

With good total care, and com-mitment of all parties involved,including physicians, patientsand rehab personnel, a replace-ment can last anywhere from 15to 20 years.

The Knee Society recom-mends avoiding activities such asbaseball, basketball, football,hockey, soccer, high-impact aero-bics, gymnastics, jogging andpower lifting.

In recent years, baby boomershave started increasing the popu-

lation of older and retired indi-viduals in the United States. Dueto this unprecedented genera-tion’s commitment to fitness,health, living longer, being finan-cially savvy, and in many in-stances, staying in the work forcelonger, we are seeing an increasein the number of people electingto have joint replacements.

As of 2005, the estimated num-ber of baby boomers (those bornbetween 1946 and 1964) in theU.S., totaled 78.2 million.

Because this large populationof Americans have had, and con-tinue to have, higher expecta-tions for a good life well intotheir 80s and 90s, we can expectto see more money spent on help-ing them to stay healthy, active,and fit.

Also, as life expectancy con-tinues to increase through ad-vanced technology, better avail-ability of health care, consumereducation and awareness, and in-creased personal income, the ex-pectation for the future appearsto be that we can expect more,not less, people electing to im-prove their quality of life throughjoint replacement.

Since a joint replacement isconsidered an elective surgicalprocedure, it is prudent to look atthe cost of a replacement.

Kneereplacementcost.com hasestimated the cost of a total kneereplacement to range from

$45,000 to $70,000 at a typical hos-pital in the U.S.

Although this may seem like ahuge initial investment, whenlooking at the outcome of in-creased function, in the long runthe benefits far outweigh the neg-atives.

If you take the higher cost of$70,000 and divide by 15 years,the low end of the replacementlife, you get an average cost of$4,666 per year for the replace-ment.

This is a relatively small priceto pay to have a functionallifestyle, and functional is the op-erative word.

If, by having a total joint re-placement, you are able to re-sume walking, going up and downsteps, being able to get up anddown from chairs, in and out of acar, not to mention, possibly thedifference in being able to drivea car or not, and possibly return-ing to play a sport, then the posi-tives are certainly tremendous.

A total joint replacement maynot be right or indicated for ev-eryone.

But for those who need it, it iswonderful to know that the avail-ability of increasing functionalindependence is there.

James Duncan, PT, MS, CSCS, is astaff physical therapist at Holston Valley’sSullivan Center and Johnson City UrgentCare.

JamesDUNCAN

Exercise hard but worth itBy Ellen Warren

The conversation started thisway: “Working out does suck. Andit’s hard work.”

That’s fitness expert ChuckRunyon, whose book title —“Working Out Sucks!” — immedi -ately caught my attention.

Finally, I thought, here’s an ex-perienced trainer (he co-foundedthe huge workout franchise Any-time Fitness) who says whatwe’re all thinking.

Obviously, Runyon doesn’t be-lieve we should stay stuck on thecouch and have another dough-nut. He’s a fitness guru, after all.But he does offer common senseadvice on how to place one footin front of the other on the hard,tough road to feeling and lookingb e t t e r.

And yes, it will require work-ing out. “It may suck, but the al-ternative sucks so much worse.Your fitness level affects everynook and cranny of your life,”Runyon told me.

He says that if you exercise,you think better, have more ener-gy, are more productive at workand feel better about yourself.

OK. Easy to say. Harder to getstarted. “This is a tough journey,”he acknowledges.

Some tips from Runyon andhis book:

• Start moving slowly. “Ifyou’re a sedentary person, ifthat’s one-tenth of a mile, great.It’s like a slow build. You don’tneed to shock your system.”

• “Broadcast your goals. Makesure that people [friends andfamily] know what you’re tryingto accomplish.” Enlist their help.

• “Write down your goals. Ac-countability is the magic ingredi-ent. If you write them down, theyexist.”

• “Find your motivation. It’snot about what the scale says. Is itfor your kids? To be a role mod-el?”

• Build in incentives — oneday to eat a favorite dessert.

• Take a rest day.

Carl Slocum, M.D. • W. Jeffrey Wallace, D.O. • David Osterhus, M.D. • Jennifer Greiner, D.O.Audiologists - Toby Johnson, M.A., CCC-A • Jolene Hoffman, M.A., CCC-A • Pam Babb, M.A., CCC-A

Locations in Kingsport, Bristol, Elizabethton and Big Stone Gap423-246-8155

Comprehensive Ear, Nose and Throat Care, Including Hearing Aids

Meadowview Ear, Nose and Throat SpecialistsMeadowview Ear, Nose and Throat Specialists

DO YOU SUFFER FROM NASAL ALLERGIES?

Pollen, mold, pet dander and weather can be cruel to those who suffer from nasal allergies. If you have symptoms such as sneezing, sniffl ing, running nose and nasal congestion you may have allergic rhinitis. Tens of millions of Americans suffer from these symptoms during certain times of the year.

The physicians at Meadowview Ear, Nose & Throat Specialistscan diagnose and treat your nasal allergies. We offer in-house testing, specialized serum mixing and allergy injection treatments.

Call 423-246-8155 for an appointment withDr. Carl Slocum, Dr. Jeff Wallace, Dr. David Osterhus or Dr.

Jennifer Greiner.

And to HEAR WHAT YOU’VE BEEN MISSING,see if a hearing aid is right for you!

Call for an appointment with any of our audiologistsToby Johnson, MA, CCC-A, Jolene Hoffman, MA, CCC-A

Or Pam Babb, MA, CCC-A


Does hearing lossup risk of falling?

Among adults age 65 or older,falls are a serious health prob-lem, a leading cause of injury anddeath. According to the Centersfor Disease Control (CDC), nearly2,000 older adults died from in-juries from unintentional falls in2009. Also, nearly 2.2 millionnon-fatal injuries from falls weretreated in emergency depart-ments in 2009.

A new study by researchers atJohns Hopkins University andthe National Institute on Agingsuggests that having hearing losscan significantly increase yourrisk of falling. To make the con-nection between hearing loss andrisk of falling, researchers ana-lyzed data from more than 2,000people between the ages of 40and 69. Participants underwentpure tone threshold testing to ex-amine hearing sensitivity,vestibular testing to examine thebalance mechanisms of the innerear, and answered numeroushealth questions includingwhether they had fallen in thepast 12 months.

Of the 2,000 people in thestudy, five in 100 had fallen with-in the past 12 months and 14 in100 had mild hearing loss. Afteradjusting for other factors thatcontribute to the risk of falling,like age, gender or certain medi-cal conditions, hearing loss alonewas found to be a risk factor forincreasing the risk of falling.

Researchers determined thateven a mild hearing loss (definedas 25 decibels) nearly tripled therisk of falling. For every addition-al 10 decibels of hearing loss, therisk of falling increased by an ad-ditional 140 percent. The risk forfalling remained even when peo-ple with vestibular problemswere factored out.

This suggests that somethingother than inner ear problemsmay be causing the increase infalls for people with hearing loss.

The researchers suggest thatpeople with hearing loss havefewer acoustic cues and thus alower awareness of their sur-roundings, putting them more atrisk for tripping and falling. Theresearchers also suggest thatpeople with hearing loss are us-ing more of their brain’s re-sources to compensate for hear-ing sounds that they may be miss-ing. This greatly limits the brain’sresources that can be used for ev-ery day tasks like maintainingproper posture, balance and gaitfor walking.

While hearing loss has beenknown to have social and mentaleffects, physical effects such asfalling had not been studied.

This study once again supportsthe issue of increasing awarenessof hearing loss and its associatedconsequences in our society.

Danielle Combs is a clinical audiologistwho staffs The Hearing Center at HolstonValley Medical Center. E-mail her [email protected]

DanielleCOMBS

No-salt pretzels reducesodium in chicken piccata

By Jill Wendholt SilvaIs a pretzel still a pretzel if

you take away the salt?Pretzels are naturally

fat-free, so it might be temptingto ignore those pesky whiteflakes. Unfortunately, a servingof fat-free pretzels may containup to 400 milligrams of sodium.

The National Institutes ofHealth strongly advises Ameri-cans younger than 50 to reducetheir sodium consumption to2,300 milligrams, or no morethan a teaspoon a day. It all addsup pretty fast, so unsalted pret-zels can be a good option, aslong as you keep in mind thatthey are not actually sodi-um-free. Instead, products la-beled “unsalted” whittle thesodium content down to 75 to 100milligrams per serving.

All this talk of pretzels soonhad us considering how to navi-gate around breading, anotherhigh-sodium product.

This Chicken Pretzel Piccata,a remake of a classic Italiandish, swaps the veal for chickenand coats the meat with thecrumbs of unsalted pretzels. Wealso tweaked the high-caloriesauce made from the pan drip-pings. Instead of using the left-over fat, the sauce incorporatesfat-free evaporated milk,low-sodium chicken broth,lemon juice and white wine.

SHOPPING TIP: Synder’s ofHanover unsalted pretzels con-tain 110 calories per serving and75 milligrams of sodium. We an-alyzed the recipe using both un-salted and salted pretzels; noneof the other nutritional valueschanged, but the amount of sodi-um per serving doubled.

SERVING SUGGESTION:This dish is great served with asmall portion of whole-wheatspaghetti.

Chicken Pretzel Piccata1/2 cup low-fat buttermilk11/2 cups small, unsalted pretzels1 pound boneless, skinless chick-en breasts1 Tbsp. olive oil3/4 cup dry white wine3/4 cup low-sodium chicken broth1/3 cup fresh-squeezed lemonjuice plus a wedge for garnish2 Tbsp. all-purpose flour3/4 cup fat-free evaporated milk1/2 cup minced flat leaf parsleyWhole grain spaghetti, cookedaccording to package directions

Pour buttermilk into a shal-low dish.

Place pretzels in a food pro-

cessor and pulse several timesor until finely crushed. Placepretzel crumbs in another shal-low dish.

Divide chicken into pieces,approximately 4 ounces each,and place between plastic wrap.Pound until very thin.

Heat olive oil in a large non-stick skillet over medium-highheat. Dip each piece of chickeninto buttermilk and then coatevenly with pretzel crumbs.Place chicken in skillet andcook for 2 to 4 minutes or untilgolden. Turn and continue cook-ing for 2 to 4 minutes or untilchicken is cooked through. Re-move chicken to a platter andkeep warm in oven whilepreparing sauce. (If coatingstarts to overbrown while cook-ing chicken, remove chicken

from skillet, place in an oven-proof dish and bake at 350 de-grees F., until chicken is done.)

Add wine, chicken broth andlemon juice to skillet. Bring to aboil; reduce heat to a simmerand simmer, uncovered, for 5minutes. Whisk flour into evap-orated milk. Pour milk mixtureinto lemon juice mixture in skil-let. Cook, stirring constantly un-til sauce bubbles and thickens.

Ladle sauce over chickenand sprinkle with parsley. Servewith spaghetti. Makes 4 serv-ings.

Nutrition information per serving, us-ing unsalted pretzels: 320 calories (17percent from fat), 6 grams total fat (1gram saturated), 69 milligrams choles-terol, 25 grams carbohydrates, 35 gramsprotein, 206 milligrams sodium, 1 gramdietary fiber.

Photo by Tammy Ljungblad

No-salt pretzels and low-sodium broth reduce the sodium when making chickenpretzel piccata.

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I think you should know ...A friend recently asked me if

it was hard to come up with top-ics to write about on a regularbasis. The truth is, I have somany ideas, my problem is com-ing up with a topic than can beaddressed in one short article.

This month, I decided to puttogether a collection ofhealth-related tidbits from the“I Think You Should Know: sec-tion of the full-length newslet-ters I used to offer. (They arenow single topic articles) Youcan access several years’ worthof newsletters at my website,though, if you’d like to readmore like these.

• • •People who regularly eat

dark chocolate decrease theirbody’s levels of C-reactive pro-tein (inflammation markers), re-duce their risk of cardiovasculardisease and diabetes, and showhigher scores of emotionalwell-being. It must be darkchocolate, and one-fourth ounceper day is the ideal amount. (JNutrition, 2008,138:1930-1945)

• • •A congressional sting opera-

tion resulted in the Departmentof Health and Human Servicesapproving a new, fictitious medi-cal review board. The fake pan-el sailed through despite nam-ing Board President TruperDawg (after a deceased pet), andboard members’ names likeApril Phuls and Timothy Witt-less. They also submitted a fakeproposal to an existing board fora clinical trial in which theywould pour a liter (over a quart)of a superglue type liquid intopatient’s stomachs. This was ap-proved. DHHS officials later ac-knowledged that some changesneeded to be made.

• • •Recent research found that

even high-dose fish oil supple-mentation, which improves cog-nitive function and overallhealth, can be used in combina-tion with blood thinners likeclopidogrel (Plavix) and war-farin (Coumadin). (AmJCardiol09;104:1052-1054)

• • •The FDA has approved a vac-

cine from Dendreon, Inc called

Provenge to treat prostate can-cer, shown to increase survivalrates by four months. One infour patients experienced seri-ous side effects, including 3.5percent who suffered strokes.Provenge has a reported cost of$93,000 per patient! Consideringthat the 10-year survival rate isalready more than 90 percent, isadding 4 months to this worthside effects and cost? Dendreonanticipates $1.5 billion per yearin sales.

• • •Studies have found that up to

45 percent of the populationmay be resistant to the benefitsof aspirin, and that aspirin usemay, in fact, be a contributingfactor in the increases in heartattacks, strokes, and macular de-generation. (J Cardiovasc Phar-mocol 06;48(2):1-5) FYI: Excel-lent evidence-based alternativesto consider include ginger, pyc-nogenol, and nattokinase.

• • •Humming for an hour each

day prevents sinus infectionsand eliminates chronic rhinosi-nusitis in four days in most indi-viduals. Try humming at a lowfrequency for an hour beforebedtime. Many people enjoydramatic improvements inbreathing and air flow the veryfirst night. Benefits appear to bedue to increases in nasal nitricoxide induced gas exchange andvibrational frequencies. (MedHypotheses.2006;66(4):851-4)

• • •Multinational food corpora-

tions provide healthier products

when they have to. Artificial col-ors are known to cause seriousproblems, including bladderand liver damage, and behav-ioral and neurological disor-ders. Some are suspected car-cinogens. Most synthetic fooddyes have already been elimi-nated in Europe. The strawber-ry syrup in McDonald’s sundaesis colored with strawberries inEngland, but here in the U.S., ituses 2-naphthalenesulfonicacid, 6-hydroxy-5-((6 metho-cy-4-sulfo-m-tolyl)azo)- disodiumsalt, otherwise known as Reddye No. 40. Which would yourather have?

• • •People who doodle while lis-

tening to a presentation orphone message remember 29percent more information thanpeople who sit still. Apparentlythe “mindless” activity helps re-lax the brain and allow it to bet-ter process and absorb auditoryinformation.

• • •Every time our cells replace

themselves, tiny bits of DNA atthe end of the cell’s chromo-somes called telomeres becomeshorter. The shorter the telom-ere, the more aged the cells.Women who regularly take highquality antioxidants have longer,“younger” telomeres. (Am J ClinNutr. 2009 Jun;89(6):1857-63)

• • •The consumption of four to

five servings per week of beansor lentils lowers the risk ofbreast cancer by as much as 95percent according to severalstudies, including a project atthe Cancer Prevention Labora-tory at Colorado State Universi-ty. (Intl J Cancer 2005;114:628-33)(Crop Sci 2009.49: 179-186)

• • •I hope you found these health

tidbits interesting and useful.Let me know if there is a subjectyou would like to know moreabout.

Marie Browning holds a master’s de-gree in holistic nutrition and is certified innutritional wellness. She offers seminarsand private consultation in the Tri-Citiesarea. Her website is www.healthiersolu-tionsbymarie.com or call her at 367-1396.

MarieBROWNING

CLASSIFIED ADS GET RESULTS

How to feed your teenagersBy Alison Johnson

A good diet is crucial duringadolescence because “it’s a timeof such rapid growth and devel-opment,” says Casey Beeghly, aregistered dietitian with SentaraHealthcare in Norfolk, Va. Sometips:

• Explain nutrition on theirterms. Teens might not care thatunhealthy eating could con-tribute to health problems. Theydo care about having clear skin,thick hair, a good body weight,more energy and brainpower.

• Calcium is key ... Teens needat least two daily servings oflow-fat dairy such as milk, yogurtand cottage cheese to support

bone growth. Other good sources:dark green vegetables, nuts andfortified cereals.

• ... and so is iron. Iron-richfoods include lean red meats,chicken, fish, beans, broccoli,spinach and fortified wholegrains.

• Add in folic acid. This vita-min also helps build lean muscle,and girls need it to guard againstbirth defects in future pregnan-cies. Dark green vegetables, cit-rus fruits and fortified breadsand cereals are good choices.

• Boost fiber intake. Manyteens aren’t great about eatingfruits and vegetables. Keep en-couraging those foods, along withwhole-grain breads and cereals.

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Equal Opportunity?Equal Opportunity?Colorectal cancer is the second leading cause of

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prostate cancer and breast cancer. Fortunately,early detection of polyps or cancer can give you

the best chance for continuing a healthy life!So eat your fruits and veggies, follow a low-fat diet,

exercise regularly… and above all, talk with your provider about scheduling your colorectal screening

depending on your age and family history.Colorectal Cancer:

Prevent it. Detect it. Beat it.


Alternative medicineTai Chi, 3 p.m., May 22, IPMC

Health Resource Center,Kingsport Town Center. $10 perclass or $48 for six weeks. To reg-ister, call 1-800-888-5551.

Ar thritisNatural Health Strategies for

Arthritis, noon, May 24, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

Bone healthBone density screening, 10

a.m. to 2 p.m., May 12, IPMCHealth Resource Center,Kingsport Town Center. $30. Tomake appointment, call1-800-888-5551.

Children/parentingBaby care basics, 6 to 8 p.m.,

May 7, Holston Valley MedicalCenter, Allandale Room. Call Toregister, call 1-877-230-NURSE.

• • •Breastfeeding basics, 6 to 9

p.m., May 8, Holston Valley Medi-cal Center, Allandale Room. Toregister, call 1-877-230-NURSE.

• • •Mommy’s Milk Club, 4 p.m.,

May 10 and May 24, IPMC HealthResource Center, KingsportTown Center. To register, call1-800-888-5551.

• • •Breast Milk Matters, 4 p.m.,

May 15, IPMC Health ResourceCenter, Kingsport Town Center.To register, call 1-800-888-5551.

• • •Infant massage, 11 a.m., May

18, IPMC Health Resource Cen-ter, Kingsport Town Center. Toregister, call 1-800-888-5551.

• • •Regaining Form and Function

after Childbirth, noon, May 18,IPMC Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Childbirth education, 9 a.m. to

4:30 p.m., May 19, Holston ValleyMedical Center, Heritage Room.To register, call 1-877-230-NURSE.

• • •Sibling Class, noon to 2 p.m.,

May 19, Holston Valley MedicalCenter, Birthplace ConferenceRoom. To register, call1-877-230-NURSE.

CPR/first aidAdult and pediatric first

aid/CPR/AED, 9 a.m. to 4 p.m.,May 1, American Red CrossKingsport chapter, 501 S. WilcoxDrive To register, call 1-800-RED-CROSS or visit www.red-cross.org/takeaclass.

• • •Adult and pediatric first

aid/CPR/AED, 5:30 to 8:30 p.m.,May 8 and 5:30 to 9 p.m., May 10,

American Red Cross Kingsportchapter, 501 S. Wilcox Drive Toregister, call 1-800-REDCROSS orvisit www.redcross.org/takea-class.

• • •Cat and dog first aid, 9 a.m. to 4

p.m., May 12, American RedCross Kingsport chapter, 501 S.Wilcox Drive To register, call1-800-REDCROSS or visitw w w. r e d c r o s s . o r g / t a k e a c l a s s .

• • •Adult CPR/AED, 5:30 to 8:30

p.m., May 15, American RedCross Kingsport chapter, 501 S.Wilcox Drive. To register, call1-800-REDCROSS or visitw w w. r e d c r o s s . o r g / t a k e a c l a s s .

• • •Adult first aid/CPR/AED, 9

a.m. to 4 p.m., May 24, AmericanRed Cross Kingsport chapter, 501S. Wilcox Drive. To register, call1-800-REDCROSS or visitw w w. r e d c r o s s . o r g / t a k e a c l a s s .

• • •First aid, 5:30 to 8:30 p.m., May

29, American Red CrossKingsport chapter, 501 S. WilcoxDrive. To register, call 1-800-RED-CROSS or visit www.red-cross.org/takeaclass.

DiabetesDiabetes self-management, 9

a.m. to 12:30 p.m., May 2-3; 9 a.m.to 5 p.m., May 16; Diabetes Treat-ment Center, Kingsport. Physi-cian referral required. To regis-ter, call 224-3575 or 844-2950.

• • •Diabetes self-management, 9

a.m. to 4 p.m., May 7, Lee Region-al Medical Center, PenningtonGap, Va. Physician referral re-quired. To register, call 224-3575or 844-2950.

• • •GOT #’s, noon, May 7, IPMC

Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Advanced nutrition, 4 to 6 p.m.,

May 9, Diabetes Treatment Cen-ter, Kingsport. Physician referralrequired. To register, call224-3575 or 844-2950.

• • •Diabetes self-management, 8

a.m. to noon, May 17; 8 to 10:30a.m., May 18; Hawkins CountyMemorial Hospital. Physician re-ferral required. To register, call224-3575 or 844-2950.

• • •Diabetes Myths, 11 a.m., May

25, IPMC Health Resource Cen-ter, Kingsport Town Center. Toregister, call 1-800-888-5551.

Emotional healthStress Free in a Busy World,

noon, May 14, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

• • •

Hoarding: Strategies for Start-ing to Declutter, 6 p.m., May 17,IPMC Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Parent support group for par-

ents and caregivers of childrenwith autism or Asperger Syn-drome, 6 p.m., first Tuesday,Mountain Region Speech andHearing Center. Call 863-6473 or246-4600 or e-mail [email protected] or [email protected].

• • •Tri-Cities Survivors of Suicide

Support Group, 6 to 8 p.m., fourthMonday, Boones Creek ChristianChurch, Entrance K, Room 403.For those who have lost someoneby suicide, or for those who areinterested in suicide preventionor who might have helpful infor-mation for those who do. Call361-2087.

• • •Alzheimer’s support group

meeting for caregivers, 10 a.m.,first Tuesday, Preston Place II,2303 N. John B. Dennis Hwy.,Kingsport. RSVP by calling378-HOPE.

FibromyalgiaFibromyalgia support group, 2

p.m., May 22, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

FitnessZumba, 10:30 a.m., May 12,

IPMC Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Strength Training for Your

Bones, 6:30 p.m., May 15, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

HeadachesUnderstanding Headaches, 6


Heart healthCoronary risk panel, 7 to 9

a.m., May 15, IPMC Health Re-source Center, Kingsport TownCenter. $15. To register, call1-800-888-5551.

• • •Congestive Heart Failure and

Your Diet, 11 a.m., May 23, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

Mental healthJohnson City National Al-

liance for the Mentally Ill, (NA-MI), 7 p.m., second Thursday,Harrison Christian Church, off

Browns Mill Road, Johnson City.Call 538-4216 or 239-6492.

• • •Kingsport National Alliance

on Mental Illness (NAMI), 7 p.m.first Thursday, First BaptistChurch, Church Circle,Kingsport. Call 234-2516 or866-337-3291.

Nutritional healthKnow Your Nutrition, 1 p.m.,


• • •Fruits, Vegetables and Phyto-

chemicals: The Natural Pharma-cy in Your Ingle’s Produce De-partment, noon, May 12, IPMCHealth Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Adding Color to Your Plate,

12:30 p.m., May 12, IPMC HealthResource Center, KingsportTown Center. To register, call1-800-888-5551.

• • •Tea Party, 3 p.m., May 12, IPMC

Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Healthy Smoothies, 5 p.m.,


• • •Oops! Most Common Nutrition

Mistakes, 2 p.m., May 17, IPMCHealth Resource Center,Kingsport Tow Center. To regis-ter, call 1-800-888-5551.

• • •Life in the Fast (Food) Lane, 4


• • •Easy Ways to Cut 100 Calories,

9 a.m., May 21, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

Parkinson’sParkinson’s support group, 7

p.m., fourth Tuesday, AsburyBaysmont, 100 Netherland Lane,Kingsport. Call 245-0360.

Respiratory healthThe Young and the Breathless,

a support group for pulmonarypatients and their families, 5p.m., fourth Thursday, HeritageRoom, D Building, Holston ValleyMedical Center. Call 224-5800.

Senior healthFall and Injury Prevention, 10

a.m., May 8, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

Special needsSpecial Needs support group,

6 p.m., May 21, IPMC Health Re-source Center, Kingsport TownCenter. To register, call1-800-888-5551.

Visual healthKingsport Association for the

Visually Impaired, a supportgroup for visually impaired per-sons, 7 p.m., first Tuesday, BethelPresbyterian Church, 1593Warpath Drive, Kingsport.

Weight lossExploring the Weight Loss

Surgery Program, 6 p.m., May 3and May 21, Madison House, 2000Greenway St., Kingsport. Formore information and to register,call 1-877-230-NURSE.

• • •Lose it 4Good, 6 p.m., third

Tuesday, HMG Medical Plaza,2nd Floor Conference Room, 105W. Stone Drive. Free and open tothe public. Call 857-2790.

• • •T.O.P.S. (Take Off Pounds Sen-

sibly) Chapter 58 Thursdays, Con-cordia Lutheran Church, 725Truxton Drive, Kingsport.Weigh-in, 10 a.m.; meeting, 10:30a.m. Call (423) 254-0708.

• • •TOPS Tennessee Support

Group Chapter 520, 6 p.m., Mon-days, Bethel PresbyterianChurch, Kingsport. TOPS (TakeOff Pounds Sensibly) is an inter-national non-profit weight losssupport group. Call 245-6496.

Wo m e n ’s healthWo m e n ’s Expo, 10 a.m. to 2


• • •Women and Heart Disease, 1


• • •Abnormal Mammogram: What

Now? noon, May 16, IPMC HealthResource Center, KingsportTown Center. To register, call1-800-888-5551.

• • •Menopause, 5 p.m., May 17,

IPMC Health Resource Center,Kingsport Town Center. To regis-ter, call 1-800-888-5551.

• • •Urinary Incontinence, 1 p.m.,

May 18, IPMC Health ResourceCenter, Kingsport Town Center.Pre-registration is required bycalling 1-800-888-5551.


New way to treat strokes a ‘game-changer’By Patricia Anstett

A new generation of devicescould significantly improve carefor patients who have some of themost devastating types of strokes.

The Solitaire flow-restorationdevice, which gained federal ap-proval last month, is used in thebrains of stroke patients muchlike an artery-opening angioplas-ty procedure for heart blockages.

Robert Lee Burns, 73, of ClayTownship, Mich., credits it withsaving his life.

“I thought it was over,” saidBurns. “Maybe there wasn’tenough room upstairs for meyet.”

A retiree who has worked onoil rigs and automotive assemblylines, Burns was one of the firstfive Michiganders to undergo theprocedure. His surgery was earli-er this month at St. John Hospitaland Medical Center in Detroit.

St. John is the first hospital insoutheast Michigan to use the de-vice. The Detroit Medical Centerand Henry Ford Health System,both based in Detroit; the Oak-wood Healthcare System inDearborn and Beaumont Hospi-tals, Royal Oak, are among thoseplanning to add the technologysoon.

“This is a very promising newt e c h n o l o g y, ” said Dr. SandraNarayanan, a Detroit MedicalCenter interventional neurolo-gist. “I think it’s going to be agame changer.”

Doctors hope the new deviceproves to be more effective andeasier to use than the first gener-ation of products, which workedin a similar way, but weren’t asgood at removing clots.

Studies of the new device inEurope and Canada show that itsignificantly improved strokeoutcomes.

“We hope to replicate some ofthe results,” said Dr. AndrewXavier, director of interventionalneurology at Oakwood.

Just a little more than adecade ago, doctors had few op-tions for patients with the mostdevastating strokes that causeblockages in the brain. The addi-tion of a drug called a tissue plas-minogen activator (tPA) helpedmany people, but doctors say thatas much as 40 percent to 50 per-cent of the time, the clot is too bigto dissolve with the drug, whichideally is given within the firsthour of stroke symptoms and nomore than four and a half hoursl a t e r.

Earlier devices also weretechnically demanding to useand proved a challenge for all

but doctors in high-volume prac-tices who performed the tech-niques often, said Dr. RichardFessler, chief of surgery for theSt. John Providence Health Sys-tem .

The Solitaire device, made byCovidien of Dublin, Ireland, isminimally invasive. Doctorsthread a thin tube through anartery — typically in the top ofthe leg — up to the brain. Then

they advance within that tube an-other instrument with a minia-ture, Slinky-like stent to theblockage. The stent expands andhelps doctors remove the clotmore easily. To be sure the block-age is entirely removed, doctorstake pictures of the arteries.

Burns, known to many in theAlgonac area as Scrapper Bobbecause he salvages yards forscrap, was returning home in histruck one Monday afternoonwhen he felt his right hand andleg go numb. He had not felt wellthat day, he recalled.

“I thought, ‘My God, I’m havinga stroke,’” Burns said.

He pulled over to get hisphone out of his right pocket, buthe was too weak to retrieve it. Aman who saw him outside hishome responded to his call forhelp.

A computer tomography scanat St. John River District Hospitalin East China Township foundthat he had a blockage that wasso big it was unlikely it would behelped by tPA, Fessler said. Anambulance brought Burns to Riv-er District’s bigger sister hospital,St. John in Detroit.

Burns already is taking steps,has slight numbness but no majorparalysis or other stroke compli-cations and most likely will beable to go home soon. He shouldbe able to get back to his life witha few weeks of physical therapy,

Fessler said. “He’s doing beauti-f u l l y. ”

MORE INFORMATION:Details about the recent ap-

proval of the device are on theweb site of Covidien, the devicemanufacturer, athttp://bit.ly/yqeRrX

See a video showing how thesolitaire device works online athttp://bit.ly/Hpbd3k

Photo by Regina H. Boone

Robert Lee Burns, 73, suffered a stroke earlier in the month and received a proce -dure at St. John’s Hospital in Detroit, Mich., that saved his life. The Solitaireflow-restoration device, which gained federal approval last month, is used in thebrains of stroke patients much like an artery-opening angioplasty procedure forheart blockages.

The Solitaire device, madeby Covidien of Dublin,Ireland, is minimally

invasive. Doctors thread athin tube through an artery

— typically in the top ofthe leg — up to the brain.Then they advance within

that tube anotherinstrument with a

miniature, Slinky-like stentto the blockage. The stentexpands and helps doctors

remove the clot moreeasily. To be sure theblockage is entirely

removed, doctors takepictures of the arteries.

‘ This is a very promising newtechnology. I think it’s going

to be a game changer. ’— Dr. Sandra Narayanan

interventional neurologistDetroit Medical Center

2975 Fort Henry Drive Kingsport, Tennessee 423-247-2151

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Raising more awarenessfor better speech, hearing

TaylorBROWN

May is right around the cor-ner, and for some people thatmay mean blooming flowers,Memorial Day barbecues andbaseball, but for speech-lan-guage pathologists and audiolo-gists, May is “Better Hearingand Speech Month.”

It is a time when profession-als in these fields can raiseawareness, increase under-standing and promote possibletreatment options that can im-prove the quality of life for thoseexperiencing speech, language,swallowing, and hearing diffi-culties.

Speech and hearing prob-lems do not discriminate. Theycan affect individuals regardlessof age, ethnic background or so-cioeconomic status. Millions ofindividuals in America sufferfrom a speech-language, hearingor swallowing disorder, andgreater awareness among thegeneral public of the symptomsand treatment options for theseproblems is needed. The publicalso should be aware of whatspeech-language pathologists(SLPs) are capable of doing.

Some people believe that“speech teachers” only help in-dividuals improve their expres-sive language skills. Profession-als in this field are able to domuch more.

In order to work in most pro-fessional settings, SLPs musthold a master’s degree and have(or are currently working to-wards obtaining) a certificate ofclinical competency from theAmerican Speech-Lan-guage-Hearing Association.

SLPs are able to evaluate apatient’s expressive/receptivelanguage skills, articulationskills, swallowing/feeding profi-ciency, fluency and voice. Theyare also able to clinically diag-nose and treat the above aspectsof communication and swallow-ing disorders, as well as screenfor hearing loss.

SLPs can work in a variety ofsettings including schools, hos-pitals, rehabilitation centers,short-term and long-term nurs-ing care facilities, home healthagencies, universities, privatepractice offices, day centers forpersons with disabilities, com-munity clinics, and research fa-cilities. Corporations also mayhire SLPs to work with their em-ployees in effort to improvetheir employees’ abilities tocommunicate with their clients,

both verbally and nonverbally.An increase in demand for

speech-language and swallow-ing services is also expected dueto the aging of baby boomers aswell as improving the survivalrate of premature infants, indi-viduals with cancer, trauma vic-tims and stroke survivors. Due tothese medical improvements,speech-language pathologists(SLPs) are often just one of themany professionals who worktogether to improve or maintainindividuals’ communication im-pairments. Other individualswho work with SLPs may in-clude audiologists, teachers,physicians, psychologists, familymembers, caregivers, socialworkers and rehabilitationcounselors.

These individuals must becomfortable working with eachother and sharing the latest in-formation from their field withthose whom they work with sothat everyone is on the samepage when working with a pa-tient, since something as simpleas a medication change can im-pact speech and hearing abili-ties.

Due to the increase incaseload and changes in theneeds of individuals beingserved, it is important that SLPscontinue to educate themselvesand stay abreast of the latest de-velopments in their fields ofpractice by completing continu-ing education classes and at-tending educational workshops.

SLPs are then able to pass onnew information to their clientsand the public to encourage in-creased awareness. Early detec-tion of hearing-related problemsand speech-language disordersis often key in intervention andtreatment so the more exposurethe general population has to

risk factors and symptoms, thegreater the chance of early de-tection.

If you have any speech-lan-guage, swallowing, or hearingtrouble contact your physician, aspeech-language pathologist oraudiologist to address these con-cerns.

It is best to come preparedwith a written list of questionsand specific concerns to be surethat there is nothing that youleave out. Some individuals be-lieve their communication im-pairments may get better even-tually, but is best to consult withyour physician, SLP or an audi-ologist before deciding whetheror not to take further action.

Remember, the earlier aproblem is detected the morequickly treatment can beginthus maintaining or improvingone’s quality of life.

Taylor Brown, M.A., CCC-SLP is aspeech-language pathologist at MountainRegion Speech and Hearing Center.

Speech and hearingproblems do not

discriminate. They canaffect individuals

regardless of age, ethnicbackground or

socioeconomic status.Millions of individuals in

America suffer from aspeech-language, hearing

or swallowing disorder,and greater awareness

among the general publicof the symptoms and

treatment options for theseproblems is needed. The

public also should beaware of what

speech-languagepathologists (SLPs) arecapable of doing. Some

people believe that“speech teachers” only

help individuals improvetheir expressive languageskills. Professionals in thisfield are able to do much

more.

Fighting the black and blues:What you might wanna

know about bruisingBy Barbara Mahany

A bruise, quite simply, is thebooby prize that comes with life’slumps and bumps.

It’s what you see when bloodleaks out of blood vessels into tis-sues of skin, mucous membranes orother organs, including muscle andbone. Most of the time, it’s nothingto worry about, merely the darkside of bumbling your way throughthe day.

Yo u ’re more likely to bruise ifyou suffer from a vitamin C defi-ciency, underlying genetic disor-ders, alcohol abuse or side effectsof certain medications, says Dr.Javette Orgain, vice speaker of theAmerican Academy of FamilyPhysicians. But anyone who knocksup against an unforgiving force —be it car door or coffee table —isgonna sport that telltale bruise.

If you bruise easily, ask yourdoctor to:

•Conduct a thorough historyand physical exam.

•Determine your standardizedbleeding score (a ranking system toorganize your bleeding history andavoid overlooking common inherit-ed disorders).

•Order blood work, includingcomplete blood count with platelet

count, peripheral blood smear,prothrombin time, partial throm-boplastin time.

If there’s no underlying diseasecausing bruising, consider:

•Boosting your daily vitamin Cintake. Vitamin C, an antioxidant,is known to strengthen and help re-pair cell walls. You don’t needmegadoses, says Orgain, just makesure you’re meeting the minimumdaily requirement —90 mg formen, 75 mg for women.

•Steering clear of medicationsknown to cause easy bruising, suchas Plavix, Coumadin and aspirin(ask your doctor if there are smartsubstitutes).

•Cutting your alcohol consump-tion.

•Clearing the clutter aroundyour house, so you have less to banginto.

•If you’re older or have thin-ning skin, wear thicker clothing.

Can you hasten fading?Try Traumeel, a homeopathic

ointment that lots of folks insistfades the blues. But, fact is, there’slittle that will hasten fading, whichtakes anywhere from two to threeweeks, says Orgain. Hit that bumpwith ice soon as you can after im-pact, but then sit back and watchthe color show.

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Got 20 minutes? Then you have time to exerciseBy Leslie Barker Garcia

Think about your day. Can youunearth a spare 20 minutes? Theymay be masquerading as Inter-net-surfing or lurking within thecommercials-skipped sitcom yourecord and watch every evening.

This search comes with acaveat: When you find those way-ward 1,200 seconds, you lose yourno-time-to-exercise excuse. Be-cause though most health recom-mendations are for a half-hourworkout daily, a concentrated 20minutes can suffice quite nicely.

“Do as much as you can in that20 minutes,”says Jakob Vingren,assistant professor in the depart-ment of kinesiology, health pro-motion and recreation at the Uni-versity of North Texas. “Get asmuch work done as possible inthe allotted time.”

At McMaster University inHamilton, Ontario, researchersstudied the effect that intervals —short bursts of intense exercise —had on various groups of people.They found that a 20-minute work-out consisting of one minute ofstrenuous activity alternated witha minute of easy recovery, had sig-nificant health and fitness effects

on unfit volunteers, cardiac pa-tients and, in later research, dia-betics.

“There’s a lot of benefit in 20minutes if done the right way,”says Bobby Patten, co-founderand head coach of Dallas AquaticMasters.“If you go for a leisurely

walk for 20 minutes, that’s betterthan sitting. If you upped the in-tensity, it’s better than a stroll. Ifyou walked up and down hills,that’s even better.”

The brevity is good from a con-venience standpoint, though, andbreaking the time into pieceshelps it pass even more quickly,says Craig Leverette, academicchair professor of physical educa-tion at Collin College.

The first part of most workoutstends to involve burning carbohy-drates as an energy source, hesays. Most people have a goal ofburning fat, which comes later ina workout. The concentrated in-tensity of a 20-minute workouthelps speed the process a little.

“Everybody has a target zone”for their heart rate, Leverettesays,“based on age, resting heartrate, things like that. You want itto be as high —moderate to vigor-ous—as you can be. It will behard to breathe and talk, not thatyou would want to.”

How to spend those 20 min-utes?

“We can make a simple answer,but it’s not always simple,”saysVingren, who has a doctorate inexercise physiology. “It would be

like going to the doctor and say-ing, ‘I’m sick. I need to take a pill.’It depends on your goal, currentlevel of training, risk factors. Itshould all be done on an individu-al basis.”

He recommends a “s u p e r- s e tworkout”—moving from onestrength-training exercise to thenext without stopping, then re-peating at least one more time.For example, do a set of squats(lower body, abs and core) fol-lowed by bench pressing (armsand chest) and row exercise(back).

“Do larger muscle exercisesbefore smaller muscle exercises,and alternate muscle groups,”Vingren says.

Here’s one idea:CALISTHENICSThe expert: Kristin Moses,

co-owner of the newly openedBody Bar fitness studio in TravisWalk. She’s also raising threeboys, so “totally understands”theno-time-to-exercise crunch.

The advice: Start with a three-to four-minute warm-up by doing30 seconds of jumping jacks, 30seconds of high knees, 30 of glutekicks, 30 of jumping jacks.

“That gets you moving, gets the

oxygen moving,”she says.From there, go into a series of

squats and lunges: 15 squats atmoderate tempo, 15 lunges withyour right leg and 15 with yourleft.

“Come to the floor and do 20 to25 full or modified push-ups.Yo u ’re moving from your legs,big-muscle groups, to upper-bodybig muscles and chest, whichbuilds your heart rate and putsyou into fat-burning zones.”

Next, turn over and sit, handson the floor behind you. Raiseyour hips off the floor for 20 to 25triceps dips.

Repeat the sequence, and thistime“pick up your pace, get yourbutt moving,”Moses says. “Do theleg sequence again. You’re build-ing stamina.”

The third go-round, make it asprint:“Do jumping jacks as fastas you can, high knees as fast.Yo u ’re starting to spike.”

Finish with ab work, she says.Come to the floor and do a plankfor 30 seconds to a minute. Fromthere, turn onto your right sideand do a side plank. Repeat withthe left side.

“Vo i l a ! ”she says. “Yo u ’re done,and you’re in amazing shape.”

Photo by Michael Ainsworth

Kristin Moses, of Body Bar fitness stu-dio, shows the technique for a lunge,part of the routine for a 20-minuteworkout.

WORKING TOGETHER TO PROVIDE OUR PATIENTS WITH THE BEST GASTROINTESTINAL CARE POSSIBLE!

Millions of Americans suffer heartburn every day. Most heartburn sufferers don’t know that what they may view as an unpleasant, but common occurrence can lead to cancer. Persistent heartburn (two or more times per week) or gastroesophageal refl ux disease (GERD) can cause stomach acid to splash into the esophagus, producing cellular changes that can ultimately result in cancer. Heartburn occurs when acid splashes back up from the stomach into the esophagus, the long feeding tube that connects the stomach and throat, causing a burning sensation. Smoking is also a risk factor.

Talk with your doctor if you experience persistent heartburn, swallowing diffi culty or a cough or hoarseness you cannot explain.

KINGSPORT 423-246-6777135 West Ravine Rd. Kingsport, TN 37660

BRISTOL 423-274-6350235 Medical Park Blvd. Bristol, TN 37620

ABINGDON 423-274-6350616 Campus Dr. Abingdon, VA 24210

KINGSPORT 423-246-6777135 West Ravine Rd. Kingsport, TN 37660

BRISTOL 423-274-6350235 Medical Park Blvd. Bristol, TN 37620

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