Pain 101Understanding and finding relief for body pains

Eye healthYour eyes can get sunburned, too

2014 hEALTh CARE GUIDE

How’s it taste?Our sense of taste and smell might let us down

A SUPPLEMENT OF SUBURBAN NEWSPAPERS INC. ∕∕∕ JULY 30, 2014

By Nicholas Bakalar

The New York Times

Staples are faster, but sutures are safer, researchers concluded in a new study of how incisions are closed after a cesarean section.

The scientists randomly assigned 746 women having a C-section to have sutures or staples. They excluded women with dia-betes; those with chronic steroid use; lupus or HIV infection; a history of radiation to the abdomen or pelvis; and those with sensitivity to the materials used in closing the incision.

The study, which received funding from Ethicon, a maker of sutures, was published in the June issue of Obstetrics & Gynecol-ogy. It found that 10.6 percent of women in the staples group had wound complica-tions, mostly infections and separations, compared with 4.9 percent of those with stitches.

After controlling for age, race, number of previous C-sections and other factors, they found that sewing was associated with a 57 percent reduced risk of wound complica-tions.

“A woman undergoing a C-section should ask the doctor what they’re going to use,” said one of the authors, Dr. Vincenzo Berghella, a professor of obstetrics and gynecology at the Sidney Kimmel Medi-cal College in Philadelphia. “If they hear ‘staples,’ they should question that. It’s clear that sutures are going to cause fewer wound complications.”

Your back can’t tell it’s raining

Many people think the weather affects their back pain, but a new study shows they are probably wrong.

Australian researchers studied 993 cases of sudden, acute back pain in primary care clinics in 2011 and 2012. They gathered weather information from Australia’s Bu-reau of Meteorology. Then they compared the weather when each patient first noticed back pain to the weather one week before and one month before.

The study found no association of tem-perature, relative humidity, barometric pressure or precipitation with episodes of pain. Wind speed and gusts were associ-ated with a slight increase in the risk of back pain, but the effect was not clinically significant.

The findings apply only to back pain, and the authors drew no conclusions about the effect of weather on pain from arthritis, fibromyalgia or other diseases.

“There are things you can do about back pain,” said the senior author, Chris Maher, a professor at the George Institute for Global Health at the University of Sydney in Australia, “like being careful when you lift, avoiding long standing, maintaining healthy physical activity and weight range, and avoiding a stressful work environment. Rather than worry about the weather,” he added, “worry about these other things, which you can change.”

Stroke rates are declining

The incidence of stroke in the United States has declined significantly in the past two decades, a study has found.

The decreases were apparent in people older than 65, the most common age group for stroke, and were similar in men and women and in blacks and whites. There were decreases in stroke deaths as well, but they were concentrated in the young-er study subjects. The report appeared in JAMA.

Researchers followed 14,357 people, ages 45 to 64 at the start of the study, from 1987 to 2011. After accounting for heart disease, hypertension, diabetes, smoking, statin use and other factors, they found that the incidence of stroke decreased by about 50 percent over the period of the study, and stroke deaths by about 40 percent.

Smoking cessation and better treatment of hypertension and high cholesterol prob-ably accounted for part of the decrease, according to the senior author, Dr. Josef Coresh, a professor of epidemiology at Johns Hopkins, and improved medical care and more rigorous control of risk factors probably helped as well. Increased diabetes prevalence contributed to higher risk.

“The decrease in stroke also suggests that there’s a decrease in smaller strokes that we may not detect,” Coresh said, “and that would bode well for overall brain health and the potential for decreasing the risk of dementia with aging.”

health briefs

Researchers: Stitches safer for C-sections

m e t R o C R e a t i v e C o n n e C t i o n

“A woman undergoing a C-section should ask the doctor what they’re going to use. If they hear ‘staples,’ they should question that.”

Dr. Vincenzo Berghella

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2014 health Care GUiDespecial sections editor: Shelley Larsen section editor and designer: Tom Knox Copy editor: Melinda Keenan special projects manager: Paul Swanson retail advertising manager: Dan Matuella Cover images: CTW and Metro Creative Connections

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FamilY FeaTures

Whether it’s sharp or dull, off and on or constant, pain can be a real pain at times. With the ability to interrupt time with fam-ily, lessen productivity at work and create many sleepless nights, understanding the source of your pain is essential for relief.

The ache and its sources

As a source of discomfort, it may be hard to view pain in a positive light. But this natural, protective tool is used by the body as an alert of present or potential harm to tissues. While pain usually ceases once the stimulus has been removed and the damage to tissue has healed, there are many differ-ent factors involved for the amount of time the process takes. One thing is certain — whether it takes an hour or several months, relief is the main focus for those who suffer from any type of pain.

According to the Institute of Medicine of the National Academies, about 100 million Americans deal with chronic pain, which is classified as discomfort lasting six months or longer. While this type of pain can range from minor to debilitating, it can disrupt the social and physical aspects of life in a major way. Those that suffer from this condition often experience headaches, backaches and neck pain, though it can aggravate other areas within the body. Due to its lengthy nature, chronic pain can often lead to emo-

tional issues, such as depression and stress, which can exacerbate the healing process.

The best way to identify chronic pain is to be aware of its symptoms. This pain is persistent and can often be described as aching, burning or shooting. The area where the pain is located is often defined by patients as sore, tight or stiff. Because this type of pain can affect so many areas of life, many in the health community rec-ommend a comprehensive mind and body approach for its management. This can include medication, injections, acupuncture and other holistic treatments.

Here are some of the common types of chronic pain and a few ways to end the discomfort, so you can get back to enjoying life.

Back and neck pain

What causes nearly 40 percent of missed work days in the U.S. and is the fifth most common cause for doctor visits? Running from the top of the neck to the bottom of the spine, back pain is a common complaint among many people. While back pain is typically divided into the most common areas of neck, middle back, lower back and tailbone, its symptoms can also be felt in other parts of the body, including arms, hands, legs and feet.

Some of the common remedies for back and neck pain include everything from mas-

sage therapy, acupressure, acupuncture, back conditioning exercises and medication. Due to the controversy surrounding the last remedy, many patients prefer a more natural way to ease back pain with hot and cold therapy, such as Thermal-Aid Large Sectional Pack, which helps eliminate swell-ing and eases pain on any area of the back.

Headache pain

Though there are many factors that can trigger its unpleasant feeling; headaches can range from a minor sinus headache to a severe migraine. Though it may feel that your brain is the source for the pain, the discomfort is actually caused by a distur-bance to the structures surrounding it, and not within the tissue itself.

Some headache symptoms can be as minor as sensitivity to light or noise to the extreme conditions of fever and vomiting. While most physicians typically recommend

the use of over-the-counter medications, there are also new natural treatments avail-able. One natural product, the Thermal-Aid Headache Relief System provides fast, safe pain relief and is clinically proven to relieve headache pain in more than 90 percent of sufferers.

If you suffer from persistent body and head pains, it’s important to understand the source of the pain.

Important questions to consider

When consulting your medical profes-sional about pain, he or she will likely ask you a set of questions similar to those listed below. It is essential to prepare before you visit the doctor so you can help pinpoint the pain for the best diagnosis and treatment:

• Where is the location of the pain? • When did it start?• What kind of pain is it? (Some descrip-

tions include burning, dull, sharp, etc.)• Do certain activities alleviate or worsen

the feeling?• What treatments have you used? Have

you experienced any side effects?

Helping children get through pain

Whether they’re visiting a physician to receive a routine shot or undergoing treat-ment, it can be difficult for parents to watch their children experience pain. Here are some tips from the American Medical Asso-ciation for helping your little ones cope:

• Stay close during the pain. Regardless of their age, your presence is comforting to your child.

• Make contact with your child. If you can, hold or touch your child throughout the process.

• Take notes from nature: Some animals, such as kangaroo mothers, carry their young close to them. If you have an infant in pain, hold your baby close to your chest wearing only a diaper. This tactic is used worldwide and research shows that it can reduce pain during a procedure.

• Offer distractions. Focus the attention on things your child enjoys to help them re-lax. Some helpful diversions include singing a song together, reading a book out loud or telling their favorite story. Or, give them a playful stuffed toy that also helps ease pain, such as the Thermal-Aid Zoo animals, which offers a 100 percent natural, therapeutic heating and cooling treatment.

• Be truthful. Tell your child up front the procedure will cause discomfort but you will be there for support.

m e t R o C R e a t i v e C o n n e C t i o n S

Understanding and finding relief for body pains

Pain 101

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FamilY FeaTures

For women today, a yearly check-up with your health care provider is an essential part of maintaining your fertility health at every age. The maker of First Response brand of pregnancy tests has asked their panel of experts to share tips every wom-an should take to her doctor to maintain optimal fertility health at every age.

Understand your ovulation cycle

Understanding your ovulation cycle is a simple and basic step in maintaining good overall repro-ductive health, especially for women who are trying to get preg-nant. A recent study conducted by the maker of First Response and researchers from Yale School of Medicine revealed that 40 percent of women were not aware of the timing of ovulation in relation to their period, and 60 percent incor-rectly believed that intercourse should be timed after ovulation to maximize chance of conception. A smartphone app is available to alleviate the guesswork and stress around a woman’s cycle, the First Response Tracker. The app not only keeps track of a woman’s pe-riod and ovulation cycles, but also calculates her most fertile days

and, if pregnant, will estimate how far along she is and predict her due date.

Your sexual history will impact your future fertility

Knowing your sexual history and having an open line of commu-nication with your doctor can help improve your ability to conceive. Dr. Mary Jane Minkin, clinical professor of Obstetrics and Gyne-cology at Yale University School of Medicine, said, “Whether or not you’re trying to get pregnant, it is important to know your body and to have a good relationship with your OB/GYN — you should never feel intimidated or embarrassed to talk about your sexual activity, menstrual cycle and health. If you are trying to get pregnant, know-ing your history will help your doctor discuss a specific fertility plan, and help you make any life-style changes that will best condi-tion your body and overall health for your pregnancy journey.”

Know the risks before you begin trying

Be aware of potential risk factors and take action before you and your partner begin trying to get pregnant. Unless you and your partner are paying for lengthy medical tests and procedures,

there is no way to know whether you will struggle to conceive. But before running to your doctor, be aware of a few important factors that may affect your ability to conceive. As Barbara Collura, president and CEO of RESOLVE: The National Infertility Associ-ation, said, “The guidelines state that you should seek the advice of a fertility specialist if you are under 35 and have been trying to get pregnant for 12 months or over 35 and have been trying for 6 months, but factors such as being overweight or underweight, tobacco and alcohol use, and prior health issues such as surgeries can all impact your fertility and chances of conception.”

A healthy combination of good medical, mental and financial health is the cornerstone to a positive family planning experience

When it comes to trying to get pregnant, being in good health is not just physical — it’s mental and financial, too. “Planning to start your family is an important conversation for both partners to have so they can get on the same page about the major issues and responsibilities of raising a child. Seeking the counsel of your physician for preconception care

and taking folic acid before you are pregnant are important early steps to take,” said Diane Ashton, vice president for health equity and deputy medical director of medical affairs at the March of Dimes. “In addition to going to the doctor and making important life-style changes, budgeting for baby, and making sure you are both emotionally ready to balance your careers and free time with having a family is also very important.”

Talk to your health care provider, at least once a year

Your health care provider plays an important role in your journey,

from pre-conception through pregnancy and birth. Surprising-ly, the Yale study revealed that 50 percent of women had never discussed their reproductive health with their medical provid-er, showcasing the need for more conversations between doctors and patients. Dr. Elizabeth Yepez, a board certified OB/GYN and clinical instructor of obstetrics and gynecology at the Universi-ty of Illinois at Chicago School of Medicine, said, “Our role as medical professionals is to provide an open forum for women to communicate and be engaged and informed about their health and lifestyle choices, and to ultimately empower them to make decisions about their health and well-being.”

Know sooner

When it comes to fertility and conception, it’s more important than ever to know the facts and the risks sooner for a less stress-ful conception journey. Confirming pregnancy as soon as possible is important for women to make life-style changes and initiate prenatal care as close to conception as pos-sible. To best help women get the answers they need sooner, at-home pregnancy tests are available that will show test results with 99 percent accuracy.

Family planning: Six tips every woman should take to the doctor

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Doctor tips for being sun-wise with your eyes

The gentle breezes and bright sunshine of spring and summer entice people young and old to enjoy more time outdoors.

Whether you’re spending the day at the beach or just relaxing on the patio with a good book, sunscreen is a necessity when you’re outside.

While it’s always important to protect the skin, there’s another sun-sensitive organ that too often gets ignored: the eyes.

“Eye health is important all year long, but spring and summer months can be particu-larly harsh on eyes,” said Dr. Justin Bazan, optometrist. “A few simple proactive steps today can have a dramatic effect on eye health for decades to come.”

Here are simple tips from Bazan that anyone can take to improve eye health and protect eyes from sun and other outdoor elements:

Throw on that hat

Head gear isn’t just fashionable during warm weather months; it’s also extremely functional when it comes to protecting eyes from the harsh sun.

Wide-brimmed hats are best, especially if you’re planning to spend a lot of time outdoors, such as a day boating or afternoon gardening.

The wider the brim, the more the hat will deflect sunshine overhead and from the

sides.“Keep in mind, the sun’s UV rays are

typically the strongest between 10 a.m. and 2 p.m., so be sure to wear your favorite hat during peak hour. But, don’t forget about times when the sun is along the horizon between the times of 8 a.m. to 10 a.m. and 2 p.m. to 4 p.m. which is in our direct line of site. This gives our eyes tremendous UV exposure. Prime times for when people are outside exercising,” Bazan said.

Sunglasses are a must

Like SPF for the eyes, sunglasses are essential during sunny and warm weather months.

When shopping, look for lenses with both 100 percent UVA/UVB protection, which will help to reduce the risk of burning your retina, cornea or the delicate skin around the eyes.

Want even more UV protection? Look for products that offer an EPF (eye protection factor) certified rating. It’s the lens plus the frame that can make the difference.

Solar Comfort sportwrap sunglasses and Solar Shield fits-over sunglasses for eye-glass wearers are now lab-tested for maxi-mum UV protection and recently received the EPF Certified Seal, which provides more than 95 percent total frame and lens eye protection from the sun’s damaging rays.

“Remember, cloudy days can be decep-tive,” Bazan said. “Even when the sky is overcast, UV rays still pass through and can damage eyes, so always keep quality sunglasses handy.”

Moisture is key

Dry air, bright skies, wind, air-condition-ing and the high levels of microscopic aller-gens associated with warm weather months can dry out your eyes quickly.

If it feels like your eyes are dryer than usual, try blinking a few times and make a habit of doing so more frequently.

If that doesn’t help, a few drops of an over-the-counter eye lubricant can help. Also, be aware of fans and air-conditioners blowing directly in your face, which can quickly dry out eyes.

“If chronic dry-eye conditions persist, it’s important to visit your eye care provider for an eye exam,” Bazan said.

Don’t forget about food

The fresh fare of the season is not only bursting with flavor, it’s also packed with nutrients good for the eyes.

Next time you visit the grocery store or farmers market, keep an eye out for some vitamin-packed foods that provide key nutrients for eye health.

Fill your plate with some of these flavor-ful foods:

• Vitamin C: oranges, strawberries, papa-ya and green peppers.

• Beta-carotene: yellow and deep orange produce like mangos, peaches, sweet pota-toes and carrots.

• Zinc: beef, pork, lamb, eggs, milk and whole grains.

• Omega-3s: leafy green vegetables, nuts, fish and fish-oil supplements.

“A few simple steps can help anyone maintain eye health and ensure you not only enjoy time outdoors now, but can do so with healthy eyes for many years to come,” Bazan said.

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URGEN CARECLINIC

By Peter aNdrey smith

The New York Times

Sweet, salty, sour and bitter — every schoolchild knows these are the build-ing blocks of taste. Our delight in every scrumptious bonbon, every sizzling hot dog, derives in part from the tongue’s ability to recognize and signal just four types of taste.

But are there really just four? Over the last decade, research challenging the notion has been piling up.

Today, savory, also called umami, is widely recognized as a basic taste, the fifth. And now other candidates, perhaps as many as 10 or 20, are jockeying for entry into this exclusive club.

“What started off as a challenge to the pantheon of basic tastes has now opened up, so that the whole question is whether taste is even limited to a very small number of primaries,” said Richard D. Mattes, a professor of nutrition science at Purdue University.

Taste plays an intrinsic role as a chemi-cal-sensing system for helping us find what is nutritious (stimulatory) and as a defense against what is poison (aversive). When we put food in our mouths, chemicals slip over taste buds planted into the tongue and palate. As they respond, we are thrilled or repulsed by what’s in our mouths.

But the body’s reaction may not always be a conscious one. In the late 1980s, in a windowless laboratory at Brooklyn College, the psychologist Anthony Sclafani was in-vestigating the attractive power of sweets. His lab rats loved Polycose, a maltodextrin

powder, even preferring it to sugar.That was puzzling for two reasons: Malto-

dextrin is rarely found in plants that rats might feed on naturally, and when human subjects tried it, the stuff had no obvious

taste.More than a decade later, a team of exer-

cise scientists discovered that maltodextrin improved athletic performance — even when the tasteless additive was swished around in the mouth and spit back out. Our tongues report nothing; our brains, it seems, sense the incoming energy.

“Maybe people have a taste for Polycose,” Sclafani said. “They just don’t recognize it consciously, which is quite an intriguing possibility.”

Sclafani and others are finding evidence that taste receptors on the tongue are also present throughout the intestine, perhaps serving as a kind of unconscious guide to our behavior. These receptors influence the release of hormones that help regulate food intake, and may offer new targets for diabetes treatments, Sclafani said.

Many tastes are consciously recognized, however, and they are distinguished by hav-ing dedicated sets of receptor cells. Fifteen years ago, molecular biologists began fig-uring out which of these cells in the mouth elicit bitter and sweet tastes.

By “knocking out” the genes that encode for sweet receptors, they produced mice that appeared less likely to lap from sweet-tasting bottles. Eventually, the puta-tive receptors for salty and sour also were identified.

In 2002, though, as taste receptors were identified, the evidence largely confirmed the existence of one that scientist had been arguing about for years: savory.

Umami is subtle, but it is generally described as the rich, meaty taste associ-ated with chicken broth, cured meats, fish, cheeses, mushrooms, cooked tomatoes and seaweed. Some experts believe it may have evolved as an imperfect surrogate for detecting protein.

Since then, researchers have proposed new receptor cells on the tongue for detect-ing calcium, water and carbonation. The growing list of putative tastes now includes soapiness, lysine, electric, alkaline, hydrox-ide and metallic.

“The taste field has been absolutely revo-lutionized,” said Michael Tordoff, a biolo-gist at the Monell Chemical Senses Center. “We’ve made more progress in the last 15 years than in the previous 100.”

One candidate for the next basic taste appears to have emerged as the front-run-ner: fattiness. The idea has been around for a while, and many scientists thought it was not a specific taste, more like a texture or an aroma.

But researchers recently identified two taste receptors for unsaturated fats on the tongue. And fat evokes a physiologi-cal response. Mattes has found that blood levels of fat rise when we put dietary fat in our mouths, even without swallowing or digesting it.

Hours after a meal, the taste of fatty acids alone can elevate triglyceride levels, even when the nose is plugged. But fat, like umami, does not have a clear, perceptible sensation, and it is hard to distinguish a texture from a taste.

Mattes says fat may have a texture that we like (rich and gooey) and a taste that we don’t (rancid).

If so, the taste may serve as part of our sensory warning system. When food spoils, he notes, it often contains high levels of fatty acids, and the taste of them may be “a warning signal.”

Although there is still no consensus beyond sweet, salty, sour, bitter and savory, the research makes clear there is more to taste than a handful of discrete sensations on the tongue. Before long, scientists may have to give up altogether on the idea that there are just a few basic tastes.

“If you’re talking three, four, five, six, you can still call it a pretty exclusive club,” Mattes said. “If you start getting beyond that, is the concept really useful?”

the subtleties of taste are more than the basics

m e t R o C R e a t i v e C o n n e C t i o n S

although there is still no consensus beyond sweet, salty, sour, bitter and savory, the research makes clear there is more to taste than a handful of discrete sensations on the tongue.

“What started off as a challenge to the pantheon of basic tastes has now opened up, so that the whole question is whether taste is even limited to a very small number of primaries.”

richard D. mattes

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By stacey BurliNg

The PhilaDelPhia iNquirer

Food can be one of those unexpected flash points of late life.

Grandma may say she’s never hungry or that the only things that taste good are salty foods such as French fries. Grandpa may lose control over his sweet tooth, living on Tastykakes and ice cream.

The rest of the family worries that poor nutrition will make their elders’ already tenuous health even worse and hasten death. So, in frustration and fear, they chide or tempt loved ones to change their habits. Often, they learn what stubborn means.

“It is extremely distressing,” said Louisa Miceli, a nurse with the Visiting Nurse Association of Greater Philadelphia who has heard about eating problems in many a home. “Eating is such an emotional thing.”

Because metabolism slows and activity declines, it’s normal for elderly people to want less food. What families may not know is that, as people get older, the way food tastes changes — and not in a good way.

While our taste buds are one of the few things that hold up fairly well as we age, our sense of smell is what contributes most of what we think of as flavor — herbs and spic-es, chocolate, vanilla, strawberry, coffee, wine. And that sense falls apart.

According to research by Richard Doty, director of the University of Pennsylvania’s Smell and Taste Center, ability to smell peaks by age 40. It’s all downhill from there, with the slope growing sharply steeper after 60. Sixty percent of people between

65 and 80 have major olfactory impairment. More than 80 percent do after 80.

Men are more impaired than women, and smokers fare worse than nonsmokers. Alzheimer’s and Parkinson’s diseases are also associated with problems with sense of smell. Some medications cause trouble, too.

Older people can also have distortions of taste that make everything — even water — taste salty or give foods a sour or bitter taste, Doty said. In cacosmia, one of the more alarming problems, foods take on a fecal flavor.

In younger people, the sense of smell can be impaired by viruses, head injury, or chemotherapy.

Not being able to smell well can be a serious problem, said Ronald DeVere, a neurologist who directs the Smell and Taste Center in Austin, Texas. People may not smell smoke, leaking gas, or spoiled food. If they lose interest in food, they may lose weight, a risk factor for other health prob-lems in the elderly.

Smell loss may also contribute to depres-sion if older people curtail social activities that involve food.

Many retirement communities are upgrading food to make it fresher, tastier, trendier and more attractive.

But, during interviews with representa-tives from several companies that house and feed the elderly, officials often seemed only vaguely aware of sensory issues that might affect how residents perceive food.

Chris Loss, a professor in the department of culinary science at the Culinary Institute of America, said the school recently began

working on a project to improve food for cancer patients.

He expects the impending wave of aging baby boomers to inspire the food industry to do more research on the special needs of the elderly.

DeVere, who has treated several chefs with smell loss in his practice, said he has tried to educate the culinary industry, with-out much success. “Most people don’t think it’s a big deal,” he said.

What you’re able to “taste” when your sense of smell goes are only the five basic flavors: salty, sweet, bitter, sour, and umami, a savory meaty taste. But subtle differences are gone. This explains the attraction of salt and sugar to the elderly.

“They pour salt and they pour sweet,” De-vere said. He said many older people don’t even realize they have a problem. Others complain that food is tasteless.

“Sweet is probably the thing that is best maintained,” said Marcia Pelchat, an expert in sensory psychology at the Monell Chemi-cal Senses Center.

How much to restrict salt and sugar in the elderly is a question for a person’s doctor.

Some doctors and nursing homes have loosened restrictions, especially for the oldest patients. They have concluded that weight loss in this population is a bigger danger than ice cream and cookies.

“At that point in your life, I’m about saying ‘yes’ more than I say ‘no,’ ” said Elizabeth Kautz, a registered dietitian at Kendal-Crosslands Communities in Kennett Square.

Sense of smell fades with age, might impact overall health

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