Tips for Easier and Healthier Travel by Air

Sandwich A study by the National Institutes of Health concluded that during the Holiday season most Americans probably gain only about a pound. That doesn’t sound like much until you consider that this extra weight doesn’t tend to go away after January 1st. It tends to accumulate through the years and a small-yet-sneaky successive holiday weight gain can snowball to become a major contributor to obesity later in life, the study determined. Plus, the one-pound holiday weight gain is an average.

“In my experience, there are plenty of people who gain more like six to eight pounds,” says Linda Spangle, a weight-loss counselor in Boulder, Colorado and author of 100 Days of Weight Loss. If that sounds like you, or you’ve just got some winter weight you want to shed, there’s no time like the New Year to take action. But before you get started, personalize your weight-loss tactics. The key to successful weight-loss lies in discovering the plan that suits your personality.

If you're outgoing and gregarious (think Kirstie Alley), for example, you might benefit from telling everyone you know (not to mention a few million television viewers) that you're trying to shed pounds. A more reserved person, however, might do better with a more mellow approach.

“The key to finding a successful strategy is being honest about your strengths and weaknesses,” says Martin Binks, Ph.D., director of behavioral health at the Duke Diet and Fitness Center in Durham, North Carolina. “To violate your basic nature makes the already challenging process of weight loss more difficult.”

Each of these four plans is targeted to a different personality trait, whether it’s being goal-oriented, extroverted, shy or spiritual. A little of this and a little of that? Combine the techniques to personalize your approach. It’s soul-searching that—bonus!—slims you down.

“I'm Shy”

Even though we live in a tell-all culture, you'd prefer to keep your weight-loss plans to yourself. “Telling friends, family and coworkers invites them to monitor your progress, which feels like added pressure to you,” says Daniel Stettner, Ph.D., a clinical weight-loss psychologist in Berkley, Michigan. In addition, keeping your plans a secret saves you from any potential embarrassment if you fail to reach your goal within a specific time frame. While such self-reliance does provide a safe haven and can help you focus, going it alone isn't easy. “Making weight loss public also tends to increase commitment,” says Daniel Kirschenbaum, Ph.D., director of the Center for Behavioral Medicine in Chicago. In fact, a recent University of Pittsburgh School of Medicine study found that those who involved friends or family in their plans lost more weight and kept it off longer than those who tried to shed pounds solo. Without that public declaration and subsequent affirmation from your peers, you'll have to be more clever at cultivating your own personal support system.

Success Rx:

Find some form of support that feels good to you. That could mean joining an online dieting group, where you can hide behind a user name, or seeking out a registered dietitian in your area for some private one-on-one counseling. If you've got a trusted friend who also wants to lose weight, consider forming an alliance that’s just between the two of you. “Having a select group of supporters can keep you accountable and motivated without making you feel too exposed,” says Kirschenbaum. “If your plan runs into a snag,  your support system can brainstorm about the changes you might make and even reignite your resolve during difficult periods like a plateau.” Implement proven, structured weight-loss techniques that don't depend on other people. Maintain a food and exercise diary. Instead of just re-reading yesterday’s entry, however, write down specific goals for tomorrow. Then chart your progress. You can also wear a pedometer and gradually increase your step requirement each day. “These will help strengthen your sense of personal accountability in the absence of an extensive support system,” says Kirschenbaum.

Set more process-driven goals, such as eating fruit for every snack, instead of end-result goals (like losing 10 pounds by a particular day). “Process-driven goals are usually easier to achieve because they focus on one step toward a result that can take months to achieve,” explains Kirschenbaum. “That gives you many individual opportunities to celebrate personal achievement, which can keep you motivated.”

“I'm outgoing”

When you start a weight-loss plan (or anything, for that matter), your policy is full disclosure to friends, family members and coworkers. (You may even spill the beans to your neighbors, grocer, mailman and anyone who crosses your path for the next few weeks.) You intuitively want and need everyone’s support and encouragement, and you know that being accountable to them will help boost your motivation and keep you on track.

But there’s a catch: “It’s possible to become overly dependent on social support,” says Edward Abramson, Ph.D., a clinical psychologist in Lafayette, California, and author of Body Intelligence (McGraw-Hill, 2005). If your coworkers want to try the latest fad, for example, you can easily get caught up in group-think, which is counterproductive (fad diets tend to produce fleeting results, if any). And when people lose interest in your progress or stop telling you how great you look, your motivation can take a nose dive. Worse, in your quest for listeners, you may stumble on a few people who will try to undermine your success out of jealousy. It’s a sad reality, but “not everybody will be ecstatic to see you reach your goal,” says Stettner.

Success Rx:

Be choosy about whom you tell and what you say. Assess who is likely to be helpful and who might be jealous, resentful or fearful as your waistline grows smaller. “Even your thinner friends might not be as supportive as you think because your weight loss can change the power balance of the relationship,” says Stettner.

Consider joining a group-based weight-loss program, especially one that offers in-person meetings so you can get face time with fellow dieters who are there to offer and receive support themselves. Often, giving support can be just as motivating as getting it.

Ask yourself tough questions, such as: What will I get out of losing weight? What are the possible pros and cons? What are the difficulties going to be? The answers will help you find a more personal source of motivation, so you're not so dependent on others.

“I'm spiritual”

You feel a reverent connection to the universe. Whether or not you belong to any organized religion, you believe that there’s a higher power guiding you through your decisions. “If things don't go your way, you also have a tendency to ask yourself why and really learn from the answer,” says Dorie McCubbrey, Ph.D., an eating and weight-loss specialist in Boulder, Colorado, and author of How Much Does Your Soul Weigh? (Harper Collins, 2003).

Faith can strengthen your commitment and give you the support you need to achieve your weight-loss goals, but relying solely on powers other than your own can be naive. “You can't run a four-minute mile just by praying you can do it,” says Kirschenbaum.

Success Rx:

Weave supportive spiritual habits into your daily routine. Kick off your morning with a prayer or meditation that incorporates positive affirmations, such as “I'm in touch with my body’s true needs today. I can eat slowly and consciously. My workouts are enjoyable and I'm energized.” A “soulful” wake-up routine can reinforce goals and keep them in the forefront of your mind throughout your day. If you sometimes need reminding, carrying a notepad with written affirmations in your purse can help. Pause before each meal or snack to reflect on what you're eating or how you're nourishing your spirit. When you quickly check-in with your spiritual center throughout the day, you're less likely to retreat to autopilot and start snacking out of boredom or some other negative emotion. In addition, by linking your mealtimes with checkpoints, you actually make them more special. “Eating then becomes a means to feed your soul and connect with your higher power, not just satisfy hunger,” says McCubbrey. The more meaningful your mealtimes become, the more respect you're likely to give your food. Bye-bye, takeout: hello, homemade. Mentally replay the day’s events before you drift off to sleep, and try to learn from your mistakes. “If you're spiritually inclined, you're probably really good at learning from parables and other types of lessons,” McCubbrey says. Try to see the day’s experiences objectively, as if you're reading a story, and develop suitable “morals” to help guide you through the following day’s challenges.

“I'm goal-oriented”

You get motivated to lose weight when you've got a big event on the horizon. Weddings and class reunions are perfect (except that they may not occur as often as you'd like). Unfortunately, once the event has passed, your motivation goes up in smoke, and it’s back to your old habits. “Goal-oriented dieters are particularly susceptible to regaining because they tend to lose weight with extreme measures that they can't sustain for the long term,” says Abramson. The result: weight cycling, which may make it harder to lose any weight you regain, according to a University of Pennsylvania study. Research there suggests it could take twice as long with each successive attempt.

Success Rx:

Be realistic. Choose events that are far enough into the future that you don't need to take drastic measures to reach the weight-loss goals you set. Aim to lose no more than two pounds per week, preferably one. The slower your weight loss, the more likely it is to be fat, not water or muscle, you're losing. The more muscle you preserve while you're dieting, the easier it will be to keep the weight off.

Make diet and exercise changes you can sustain long after the event is over. Ask yourself, Will I still want to eat prepackaged frozen meals every day for lunch after I get married? If the answer is probably not, amend your diet to include strategies you can incorporate into your lifestyle forever (or close to it).

Replace every goal you achieve with another one—fast! Goals are the foundation of your motivation, so never be without one. “Event-oriented weight control works as long as there’s always another event on the horizon you can target,” says Kirschenbaum.

Signaling the start of the New Year is the relentless ripple of setting resolu­tions. It seems like everywhere you go, there’s the buzz of becoming-better pledges and promises. For many people, eating smarter, getting healthy and losing weight top their lists of ways in which they’ll improve their well-being in the year to come.

If that rings true for you, you may be interested in some simple substitutions in the kitchen that yield big health ben­efits. While you already might have implemented switches such as eating whole grain bread instead of white bread, sweetening with honey rather than refined white sugar, and serving meals on smaller plates to reduce por­tion sizes, there are many more quick fixes that could make a big difference in your diet.

Like a lot of things in life, banning the baked goods is much harder than it sounds. One way to cut fat and calories when baking is to substitute apple­sauce for the sugar and part of the fat. I did a bit of experimenting when baking with applesauce and came up with a satisfying, though admittedly less sweet, Apple Oat Bran Muffin recipe. The absence of sugar and addi­tion of applesauce achieves a dense structure, pleasing to the palate when served hot from the oven. It’s a recipe worth a try if you’re in search of high­fiber, low-fat baked goods for break­fast.

While salads seem like the way to go for weight loss, a common pitfall lies in the dressing, often laden with fat. One easy solution is to swap salsa for salad dressing. A personal favorite is roasted corn, black bean and red pepper salsa. Loaded with flavor and spice, this salsa gives a kick to mixed greens tossed with olive oil, balsamic vinegar and salt and pepper, without adding any fat.

If you’re steering clear of saturated fats and decreasing the amount of but­ter you cook with, try sauteing in olive oil. Doing so can reduce the risk of heart disease by lowering bad choles­terol levels. The Food and Drug Admini­stration states that consuming as little as 2 tablespoons of olive oil a day can reduce a person’s risk of heart disease. The most beneficial way to incorporate olive oil into your diet is to use it as your healthy fat of choice when cook­ing.

Baby steps like baking with apple­sauce, swapping salsa for salad dress­ing and sauteing with olive oil may seem like simple substitutions. But over time, these smart choices can save calo­ries, cut saturated fat intake and improve cholesterol levels in your body, contributing to a new and better you.

APPLE OAT BRAN MUFFINS

Ingredients

1¼ cups raisin bran cereal
1¼ cups flour
½ cup oatmeal
1 tsp. cinnamon
1 tbsp. baking powder
¼ tsp. salt
1 cup applesauce
¼ cup oil
1 tsp. almond extract
1 apple, finely chopped

Directions

Preheat oven to 375°.

Spray a muffin tin with nonstick spray.

In a medium bowl, combine dry ingredients. Add wet ingredients and stir until well-mixed. Scoop into prepared muffin tin with ice cream scoop to make 10 muffins. Bake for about 25 minutes. Do not overbake.

Serve warm from the oven. Makes 10.

ITALIAN CHICKEN CUTLET MEDALLIONS

Ingredients

2 boneless, skinless chicken breasts
2 cups buttermilk
2 cups Italian bread crumbs
¼-½ cup olive oil
4 lemon slices

Directions

Cut chicken breasts into small medallions, 2-inch square pieces, ½-inch thick. Soak chicken medallions in butter­milk for five to 10 minutes.

Put Italian bread crumbs in large Ziploc bag.

Remove chicken medallions from buttermilk and place in Ziploc bag with bread crumbs. Toss to coat chicken medallions with crumbs.

In a large heavy saucepan over medi­um high heat, heat ¼ cup olive oil to cover bottom of pan, adding more if necessary. Saute chicken medallions and turn to cook other side, browning both sides, cooking for a total of five to six minutes.

Serve Italian Chicken Cutlet Medal­lions over pasta with lemon slices. Serves four.

Sydne George is a food journalist spe­cializing in recipe development, food writing and food photography. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Summer is the time many people break away from their usual routines, but traveling to far-away destinations can wreak havoc on your body.  Sure, it’s fun to visit family and friends or experience new places on vacation, but sitting for long periods of time on an airplane can leave you feeling tired, stiff, and sore—not a good way to start the fun.

Prepare for air travel the same way you’d prepare for an athletic event. Before your trip stretch muscles at home or in an airport--don’t be embarrassed to swing your arms or do a forward bend.  Cool-down with a brisk walk during layovers or after arriving at your destination.

Additionally, summer ushers in a couple of high volume travel times, and travel around holidays such as Memorial Day, Fourth of July, and Labor Day (popular because they allow extra days to visit for most people) brings increased stress when flying to your destination.

Tips for finding the best values with fewest inconveniences, no matter when you travel:

  • Plan ahead. Book your flight as early as possible to get the best rates and times.  You’ll have fewer choices as the holidays get closer.
  • Be flexible. Prices may be lower at alternate airports for both departure and arrival.  If possible, move your travel dates a day or two either way to see if a change affects rates.
  • Fly during the week. Better prices are generally found on weekdays.
  • Check discounters for deals. In addition to checking with a particular airline, go online and look for good deals with consolidators.  Also, consider packaging your flight with hotel and/or car rental for better rates.
  • Ask about special discounts. If you’re over age 60, traveling with young family members, or traveling with a companion, you may qualify for special discounts from the airlines.
  • Fly at night. Taking a red eye or late night flight may mean one less night in a hotel.
  • Arrive at the airport early. On holidays, more people traveling means longer lines and wait times.  Arrive two hours early for a domestic flight and at least two and a half hours for international.
  • Dress comfortably. Wear layers to account for temperature fluctuations.  Avoid tight clothing around upper thighs and torso. Slip-on shoes make security checks go faster.
  • Prepare children. Gradually adjust the child’s sleeping schedule prior to your trip if you’re traveling through several time zones or leaving during normal sleep times.  Pack a bag with plenty of supplies and activities to keep kids occupied and happy.
  • Be courteous with carryon bags. Pack only what you can lift into the overhead bin by yourself—and stick with the allowable type and number of items.

Tips for arriving at your destination feeling energetic instead of worn out.

  • Check bags heavier than 5-10 percent of your body weight.
  • Avoid turning or twisting your head and neck when lifting bags to the overhead bin.
  • Avoid sitting directly under air controls, as this could cause tension in neck and shoulder muscles.
  • If you have food allergies, call ahead to order a special meal, or pack your own “safe” snacks.
  • Use a support behind your back to reduce strain, pain, or injury.  Place pillows or blankets just above the beltline to maintain the normal “S” curve of your spine.
  • Put another pillow in the gap between your neck and the headrest.
  • Vary position frequently while seated to improve circulation and avoid cramps.  Reach arms over the seat back. Do in-seat spinal twists and ear-to-shoulder neck exercises.
  • Exercise your legs by opening toes wide and holding to the count of 10. Tighten calf muscles, hold for five counts, then release.  Do the same for thighs and glutes.  Move knees up and down; massage legs and calves.
  • If prone to blood clots, wear compression hosiery to prevent blood from pooling in legs.
  • Roll shoulders up and back.  Make sure your head isn’t leaning too far forward.
  • Make a fist and then loosen fingers to improve hand circulation and decrease fatigue.
  • On long flights get up and walk the aisles every two to three hours.
  • Drink plenty of fluids, especially water, to stay properly hydrated in dry, re-circulated air.
  • Avoid salty foods, alcohol, tea, and coffee as these can be dehydrating.
  • Moisturize your face and hands as often as possible and use eye drops to reduce wear-and-tear on your body due to dryness.
  • Try not to sleep on daytime flights, as this disrupts your body’s regular sleep rhythm.
  • Don’t skip or delay meals. Eat as close to your normal diet as possible.
  • Wash hands often.

Health items to take on your travels:

  • Prescription medications—Take at least a week’s supply in your carryon in case checked luggage is lost.
  • Over-the-counter anti-diarrheal medication or ginger tablets for a queasy stomach
  • Cold symptom medications including decongestant and throat lozenges
  • OTC pain relievers like acetaminophen, aspirin, or ibuprofen
  • Antifungal and antibacterial ointments
  • Lubricating eye drops
  • Allergy medications, including Epi-pen if a severe reaction is possible
  • Bandages
  • Hand sanitizer
  • Sunscreen, if you’ll be outdoors
  • Mild sleeping medication on overnight flights
  • Extra pair of eye glasses, prescription sunglasses, or contact lenses

Whether you’re 45 or 55, it’s neither too soon—or too late--to start saving your bones.

Skeleton with back pain

Katy Koontz was just 38 and the mother of an active 4-year-old girl when her doctor delivered some upsetting news. The Knoxville, Tennessee, mom--whose period inexplicably never came back after the birth of her daughter--was in early menopause. Concerned about the rapid bone loss that occurs when a woman’s period stops, her doctor referred Koontz for a bone-density test. “I thought it was weird that I was in menopause, but I didn’t expect anything unusual because I had always been healthy,” says Koontz, who regularly walked five miles per day. When she learned a few days later that she had severe osteoporosis—bones so brittle that they could easily fracture—she was horrified. “My doctor said she had last seen bones like mine in an 83-year-old,” recalls Koontz, now 46. Overnight Koontz’s life changed dramatically. A lifelong skier, she had to give up the sport for fear of having a bone-shattering fall. Ditto for ice-skating and sledding with her daughter, Sam. “I suddenly felt old and fragile,” says Koontz.

What happened to Koontz is shocking because she’s so young, but she’s hardly unique. An estimated 15 million American women in their 40s or older have osteoporosis, making them vulnerable to potentially devastating fractures of the hip, spine and wrist. Because we tend to have bones that are smaller and less dense than men’s and lose bone more quickly, 80 percent of the nation’s 10 million osteoporosis sufferers are women. An additional 34 million American women have a serious but less- serious condition called osteopenia: bone mass that’s significantly lower than normal, putting them at high risk for osteoporosis.  It’s never too late to start improving your bones. The steps you take now can pay off for a lifetime.

Why Your Bones Change—and When

Though we think of bones as being static and unchanging, they aren’t. They are composed of living tissue that is constantly in flux. Two types of cells that help with bone formation are osteoblasts, which make new bone tissue, and osteoclasts, which break down current bone tissue in a process known as remodeling. To build and maintain bone, your body needs a steady supply of calcium (along with Vitamin D to maximize calcium absorption) and estrogen. Bones also need weight-bearing exercise, such as walking, strength training or jogging. But exercise alone won’t keep bones healthy, as Koontz learned.

While we’re young, this process ticks along smoothly, with the body building bone more rapidly than it loses it, till we reach our peak bone mass in our mid-20s. Then the scenario changes and we gradually lose bone faster than it can be replaced. When estrogen levels fluctuate during perimenopause (it typically starts between age 45 and 47) then plummet after menopause (about 51), bone loss accelerates.

That’s why we need to be vigilant about keeping the bone we have. Indeed, the only way to prevent osteoporosis is to make bones as strong on possible when we’re young and keep them healthy as we get older, says Bess Dawson-Hughes, M.D., director of the Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, in Medford, Massachusetts. Think of eating well and exercising as making deposits in your bone bank. Surveys show that nine out of 10 women don’t get enough calcium to help maintain bone health. And only 40 percent of Americans exercise regularly.

If you’ve been remiss, you can still start helping yourself now. Case in point:  Katy Koontz began taking a prescription bone-building medication as well as a calcium supplement to slow down her bone loss and strengthen the bone she had while continuing to walk five miles daily. Each year, her bone density improved slightly. Nearly a decade later, though she still has osteopenia, her doctor is so pleased with her results that Koontz has returned to the slopes.

Your age and your estrogen level determine which strategies make the most sense for you. Here’s what you need to know to baby and bolster your bones at each stage of your life.

Ages 40 to 49

What happens: During perimenopause, the transitional years leading to menopause when estrogen fluctuates and your periods become irregular, you can lose bone at a rate of half a percent to three percent per year.

Your Healthy Bone Regimen: It’s too soon to up your calcium intake beyond 1000 mg/day (plus 200 IUs of Vitamin D), but be very sure you get this much, or your bone loss could be even greater. If you don’t get enough calcium and D from food, start taking a supplement. (If you enter menopause in this decade, read the next section.)

Strong Bone Strategies:

Focus on strength training. It’s still important to walk or run, but now the force you exert on bone really has to be greater than what it’s used to in daily life, which is where strength training comes in. Ideally, join a gym: Resistance machines let you lift more weight than you can lift at home, advises Miriam E. Nelson, Ph.D., director of the John Hancock Center for Physical Activity at Tufts University and coauthor of Strong Women, Strong Bones. Studies show that 45 minutes of strength-training twice a week are all it takes to maintain bone mass and slow bone loss. If you can’t afford a gym, consult with a personal trainer who can design an effective at-home strengthening program.

Consider taking an oral contraceptive. Although the pill can be bad for bone in younger women, some studies show it can increase bone density in women who are beginning to lose their body’s natural supply of estrogen. If your period is irregular, the pill can regulate it—and stop hot flashes, which can start now. If you smoke or have high blood pressure, the pill is off-limits.

Ages 50 Plus

What happens: After your period stops, you can lose up to 30 to 50 percent of your bone mass over the next 10 years, says Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation, in Washington, D.C., and author of What Your Doctor May Not Tell You About Osteoporosis Cut bone loss all you can in your crucial 50s 60s.

Your Healthy Bone Regimen: Try to bump up your calcium intake to 1,200 mg per day and be sure to get enough vitamin D. Current guidelines call for 400 IUs of D from age 51 to 70, then 600 IUs thereafter (more may help, in some cases). More than 70 percent of women ages 51 to 70 and nearly 90 percent of older women don’t get sufficient calcium of D. And get enough magnesium, too (women over 30 need 320 mg/day).

Recent research suggests that every 100 mg of magnesium people age 70 and older consume translates into a one percent increase in bone density. For some, bone-building drugs can also help.

Strong Bone Strategies:  Discuss osteoporosis with your doctor. How soon should you have your bones tested? If you have a family history or other risk factors, you may be a candidate for what insurers consider an “early” bone mineral density (BMD) test. DXA, the best type, is essentially a low-dose radiation X-ray of your skeleton to assess the amount of calcium in your bones and gauge their health. Though BMD testing isn’t used as a screening tool for all women until age 65, most insurers will cover a baseline screening at menopause or sooner if you’re at risk for osteoporosis. It may make sense to insist on a DXA soon after 50, even if you’re not in the high-risk group, and pay for it yourself (it about $200). “I believe we really should be testing all women at menopause at the latest because you can have no risk factors yet still have osteoporosis or very low bone mass,” says Dr. Cosman

Calcium supplements: Probably a “must” for most. The higher amount of calcium you need now may be difficult to get from food alone. Getting the amount right can make a difference—especially if you pair it with exercise. A four-year study at the University of Arizona, in Tucson, found that postmenopausal women who did a weight-bearing and strength-training program three times a week for 60 to 75 minutes and took an 800- milligram calcium supplement on top of their usual dietary calcium intake improved their bone mineral density by one to two percent. (Another reason to emphasize strength training now: Strong muscles help balance, which reduces your risk of falls and chances of fractures.)

Boost your B vitamins. Now, more than ever, you need folic acid and vitamins B12 and B6 to lower homocysteine, an amino acid in the blood. Though an elevated homocysteine level is best known as a sign of heart-attack risk, reducing this amino acid also protects your bones. People whose levels are greater than 10 to 12 micrograms per liter are at high risk for hip fracture, reports Katherine Tucker, Ph.D., an epidemiologist at Tufts University’s Human Nutrition Research Center on Aging, in Boston. Sources of homocysteine-lowering B vitamins include green vegetables, such as broccoli and kale, and B-fortified cereal. If your levels are too high (there’s a simple blood test), you may need to take a prescription-strength vitamin B-complex supplement.

Ask your doctor about bone-saving medications. On the basis of your bone density, medical history and other risk factors, you may be a candidate. Even if you’re take one of these drugs, do weight-bearing exercise to improve your strength and balance and make sure you get enough calcium and vitamin D.

 

Are You At Risk for Brittle Bones?

One in two women over age 50 will suffer a fracture caused by osteoporosis. While anyone can develop the disease, you need to be especially vigilant if you have one or more of these risk factors:

  • You have a family history of osteoporosis
  • You’re Caucasian or Asian
  • You weigh less than 127 pounds
  • You had irregular periods or your period stopped in your teens or 20s for three consecutive months or more (not caused by pregnancy or nursing)
  • You have ever taken a steroid medication for a condition such as asthma or lupus
  • You have ever broken a bone as an adult, after low trauma, such as tripping on the curb

 

Which Supplement is Best?

In an ideal world, it’s best to get calcium from food. “Bone health isn’t just a calcium issue,” says Robert P. Heaney, M.D., professor of Medicine at Creighton University in Omaha. “To rebuild themselves, bones also need protein, phosphorous and a whole host of other nutrients that you would best get from food or milk.” Yet many women drink water or diet soda instead of milk at meals and don’t get enough calcium from other sources. If this sounds like you, it’s smart to take a calcium supplement.

Supplements aren’t regulated by the Food and Drug Administration in the same way prescription drugs are, so you need to be scrupulous about choosing a reputable product. While easier said than done (all supplement makers say they’re reputable), experts generally advise choosing a brand that’s nationally known rather than one from a small or obscure manufacturer.

Be sure that you buy a supplement with vitamin D3; bones need D to absorb calcium and D3 is the most potent and effective form. Supplements may contain three forms of calcium (calcium carbonate, calcium citrate or calcium phosphate). Ask your doctor which one is best for you, considering the following:

  • Will you take it regularly? Many calcium supplements resemble horse pills—so if you have trouble swallowing a pill, this may not be the form for you. You may be better off with a supplement that’s chewable, such as a flavored tablet, soft gel, or chewable candy. Or, swallow several smaller pills.
  • How much does it cost? If cost matters, you may prefer calcium carbonate, the least expensive form of calcium. Because it weighs less than other forms, manufacturers can pack more calcium into one pill, so you can end up taking fewer pills each day.
  • Does it have side effects? Calcium carbonate causes gas, nausea and stomach pain in some women. If that’s the case, try other forms of calcium.

Once you decide on a supplement, take it with meals to improve absorption by 10 to 15 percent. Also, spread your dosage equally over the course of the day. For example, if you down a 500-mg supplement every day, take 250 mg at breakfast and another 250 mg at dinner.

If you need an iron supplement, don’t take it at the same time as your calcium pills unless you wash both pills down with orange juice. Calcium (with the exception of calcium citrate) increases with iron absorption. OJ increases iron absorption and overrides calcium’s blocking effect.

 

Side bar: Rate Your Bone Health

The gold standard for measuring bone density is the dual energy X-ray absorptiometry (DXA) test, which measures bone density in the spine, hip or forearm. It’s considered the best test because it uses the least amount of radiation (about one-thirtieth the amount in a chest X-ray) to scan your bones and rate your bones. Cost: around $200.

When you take a DXA test, you’ll get a T-score, a numerical grade for bone health, for the part of your body that’s tested. Each number shows how your BMD (bone mineral density) compares with that of a 30-year-old with optimum bone density—the norm. The difference between your BMD and the norm is called a standard deviation (SD). Normal bone density is within one SD (plus 1 or minus 1) of the 30-year-old. Scores below that are given in negative numbers. What you want is a BMD that’s higher than -1. If you’re -1 to -2.5 SD below the young-adult norm, you have low bone mass, or osteopenia. A score that’s worse than -2.5 signals osteoporosis

 

Bone-Saving Drugs: Do They Work:

Hormone therapy may be the most effective way to actually stop the rapid bone loss associated with menopause. But more and more, other medications can slow bone loss and even help build bone density (without the risks of HT) have become doctors’ treatments of choice for osteopenia and osteoporosis. How long you stay on a medication depends on how well you tolerate it and how your bones fare. Some drugs also have suggested time limits. Here’s a look at common bone savers:

Bisphosphanates: The three main types—alendronate, risedronate and ibandronate—increase bone density in both the hip and spine. Prescribed for both osteopenia and osteoporosis, they’re available in pill or liquid form and can be taken daily, weekly or monthly, depending on the formulation. Some research on alendronate is starting to raise questions about whether these drugs, which increase bone density by inhibiting bone turnover, could make bones more brittle or increase the time it takes fractures to heal. In high doses taken for bone cancer, bisphosphanates have been associated with breakdown of the jawbone in cancer patients. Discuss these issues with your physician.

Calcitonin. This naturally occurring hormone slows bone loss and reduces the risk of spinal fractures. It’s available as a once-a-day nasal spray or as a shot administered either once a day, every other day or three times a week.

Raloxifene. This estrogen-like substance is prescribed for osteoporosis in the spine but is not advised for women with cancer, congestive heart failure, liver disease or a medical history of blood clots. Taken once a day in pill form, it increases bone density and decreases spinal fractures. It may cause hot flashes, sudden sweating or feelings of warmth, especially during the first six months.

Parathyroid hormone. This relatively new treatment for severe osteoporosis stimulates new bone formation and increases bone density. However, you need to give yourself daily injections and are advised to use it for two years at most.

If you love the feel of a good first-thing-in-the-morning stretch, consider the pleasures and benefits of a whole series of stretches added to your daily routine.

You may not have realized that the casual morning stretching that feels so good is actually good for your joints, but doctors and physical therapists have long recommended regular stretching routines to help people with arthritis maintain a good range of motion. When range of motion is lessened by tightening soft tissue surrounding the joint, it can hinder your ability to accomplish day-to-day activities, such as tying your shoes or brushing your hair. The effects of this loss can be devastating to your self-esteem and independence.

But you can improve your range of motion and take back your life by finding time each day to stretch. Stretching is a simple and effective way to keep joints and muscles flexible. A regular stretching routine helps ward off the inevitable joint tightness associated with some forms of arthritis. It’s also valuable for releasing muscle tension and reducing your overall stress level. A good stretching regimen can make a difference in how well you perform everyday activities.

USE IT OR LOSE IT

Although doctors only recently started touting the benefits of aerobic exercise and strength training for people with arthritis, they have always recommended range-of-motion exercises. But exercising with arthritis is not a one-size-fits-all activity. While stretching can help joints and muscles move with ease, it isn't always for everybody. Those in the extreme chronic phase of arthritis, characterized by significant joint deterioration, may find little benefit from stretching. And those in the acute phase of the condition will need to wait until the inflammation subsides before starting a stretching routine. But if you're not experiencing either of these phases, you more than likely will benefit from regular stretching.

As always, before you begin any exercise program, you should check with your doctor or physical therapist to determine which stretches are best for you. Seek guidance on the frequency and intensity recommended. Make sure you understand exactly how to do the stretch, how long to hold each one, how many repetitions you should do and how frequently you should do the series.

Because stretching exercises require no special equipment -- and no cash outlay -- you can begin any time and easily fit the exercises into your schedule. Some people like to stretch as soon as they get up to help get them going in the morning. Others prefer an afternoon stretch to release tension and stress from a long work day. Still others wait until just before bedtime in the hopes of getting a more restful sleep.

Once you have your doctor's OK, you will need to develop a routine that works for you. Start off slowly with some basic moves, illustrated below, and see how they feel to you. Remember, the goal is to gently move and stretch different muscle groups. Everyone, with or without arthritis, has a different "normal" range of motion. It’s important to maintain good posture while you’re stretching even if it means you can't do the whole stretch. Remember to do only what you feel comfortable doing. If any of the stretches is painful, don't do it. It’s possible to overstretch. If you’re experiencing laxity in any of your joints, don’t stretch them.

Exercising just two or three times a week can produce positive results, but many people find that doing a simple stretching routine every day helps them better manage daily tasks.

A physical therapist can help you develop other exercises that address your particular needs, but here we've provided some basic stretches to get you going.

GETTING STARTED

Stretching can be done on its own or as a warm-up for more intense exercise. If your joints are particularly stiff, warm them for a few minutes with a heating pad or take a warm shower before exercising. Start by doing each stretch one to five times, depending on your comfort level. You should expect to feel some resistance, but not pain.

Hold each stretch for 10 to 20 seconds, then relax. Take a short rest between each set of stretches, then repeat the stretch. Slow down or add stretches, depending on how you feel. Remember, breathing is important whenever you exercise. Concentrate on taking deep, regular breaths while stretching. When you inhale, imagine the cleansing oxygen circulating through the muscle group you're stretching and cooling your inflamed joints. When you exhale, imagine you are expelling inflammation, pain and tension from your body.

THE HEAD-TO-TOE STRETCH

This full-body stretch is a good place to begin because it uses every joint and muscle from your toes to the tips of your fingers. Lie face up on the floor or bed with your arms and legs together. Extend your arms and legs as far as you can in either direction, with your toes pointed and your palms facing the ceiling. Tilt your pelvis so your lower back is touching the floor and tuck in your chin. This will gently extend the curve of your back.

Take several deep breaths. Imagine someone is gently pulling your body in opposite directions, and feel your joints loosen. Hold for 10 to 20 seconds, then relax. Repeat five times.

Variation: Stand on tiptoe and reach with your arms for the ceiling.

Cautions: It’s important to keep your lower back flat on the floor during this stretch to prevent injury. Be careful to bend your knees and slowly roll to one side when getting up. Use extra caution with this exercise if you have ankylosing spondylitis, osteoporosis or any other disease affecting the spine.

CALF STRETCH

You probably use your calf muscles more than you realize. Whenever you walk, climb stairs, reach for something on a high shelf, or get out of bed, you depend on these muscles to hold you up. Regular stretching of these muscles keeps them flexible and helps you maintain your balance and sure-footedness. Face a wall (about two to three feet away) with your toes pointed inward slightly and place your palms against the wall. Keeping your knees straight and your feet flat, lean forward onto your hands without bending at the waist. Feel your calf muscles pull and extend. Hold this position for 10 seconds, then gently push away from the wall. Repeat. Variation: If your hands or wrists are sore, lean your forearms, instead of your hands, against the wall.

TRUNK TWIST

This stretch will loosen tight back muscles and improve your flexibility and balance.
Fold your arms in front of your body, forearm to forearm. Gently twist your body at the waist, so you are looking over your right shoulder. Hold this position for 3 seconds. Return to your original position, then twist in the opposite direction, looking over your left shoulder. Again, hold this position for 3 seconds. Return to the original position and repeat the entire sequence.

Variations: You can do this stretch while standing up or sitting on a bed or a chair.

Cautions: While this is a good stretch for the back and spine, it may not be suitable if you have chronic back pain or osteoporosis.

UPPER BODY STRETCH

This stretch eases tension as it helps you to hold your shoulders square and to improve your posture.

Stand with your back straight and your feet together. With both hands, grasp the opposite ends of a bath towel and hold the towel behind your head. Hold for 10 seconds. Feel your chest muscles, shoulders and upper arms stretch and expand. Relax, then repeat.

Variation: If you can't hold the towel behind your head, hold it in front of you or behind your bottom and move the towel from side to side.

Cautions: Don’t do this stretch if you experience shoulder pain due to arthritis.

FOOT STRETCHES

Your feet have a tough job. They are often crammed into ill-fitting shoes yet still carry you everywhere you want to go. Taking the time to stretch these hard-working and often-forgotten joints and muscles feels better than you know.

Sit in a comfortable chair with your right foot off the floor. Point your toes as far as you can without pain, feeling the stretch along the top of your foot. Slowly turn your foot to point your toes inward, stretching the muscles along the outside of your foot. Next, flex your foot, moving your toes back toward your shin, feeling the stretch in the sole of your foot. Finally, turn your foot outward, stretching the inside muscles. Repeat these moves using your left foot.

Cautions: Don't point your toes too intensely and do this exercise slowly to avoid cramping. If you cramp easily, don't do this exercise.

LOWER BACK STRETCH

When your lower back muscles hurt, the pain can make it hard to get out of bed -- much less tackle daily tasks. This stretch will unkink these critical muscles.

Sit on a stool or a chair with a high seat. Gently drop your chest to your lap, letting your arms and head dangle toward the floor. Hold this position for 10 to 20 seconds. Sit up slowly, then repeat.

Variation: Kneel on a padded surface and place your hands on the floor. Straighten your elbows without locking them and keep your back straight. Slowly arch your back and hold for 10 to 20 seconds. Or, lie on a bed with your arms by your sides and your legs together. Slowly bring your knees to your chest. Hold for 10 to 20 seconds. Slowly return your legs to the bed, then repeat.

Cautions: Don't do this exercise if you’re experiencing low back pain that increases when you stretch.

You're at a point in life when you should be getting a good night’s sleep. In fact, you need it to function at work the next day. Nonetheless, its 4 a.m., and you're wide awake--for the umpteenth night in a row. Sound familiar?

Join the sleepless crowd. More than 60 percent of adult Americans experience a sleep problem at least a few nights a week. And it can get worse with each year. After age 50, medical conditions such as back pain, arthritis, and bladder problems begin to take their toll on sleep. Also, specific sleep disorders, such as restless legs and sleep apnea, become more common. But even more fundamental than these physical issues are changes in the very nature of sleep.

Why Do We Sleep?

Scientists are still in the dark about this question, although various theories have held sway over the years, including both the ebb and flow of hormones and a buildup of carbon dioxide in the body. The latest theory is that sleep restores energy to the brain’s nerve cells, according to Andrew A. Monjan, Ph.D., chief of the National Institute on Aging’s Neurobiology of Aging branch. In other words, sleep is hardly a dormant state; while you're snoozing away, your brain is busy recharging.

To give the brain a chance to restore itself, the body’s systems first must get it ready to go to sleep. At about 6 each evening, the pineal gland begins to secrete melatonin, which will gradually build up over the next few hours. At the same time, levels of the molecule adenosine, a breakdown byproduct of normal metabolism, begin to rise. “Once adenosine reaches a certain level, you activate cells that end up producing sleep,” says David White, M.D., professor of sleep medicine at Harvard Medical School.

While the process is more complicated than this, you get the idea. After a round of shuteye, you feel mentally and physically renewed. Skimp on sleep however, and you're likely to drag during the day. Researchers at the University of Pennsylvania in Philadelphia restricted participants in a recent study to four, or six, or eight hours of sleep each night for 14 nights. By the sixth day, those allowed six hours--an average night’s sleep for many people--were roughly as alert as those who had gone without any sleep for one night. And that’s not very alert.

If chronic sleep deficit becomes your norm, you may be able to execute low-level mental chores such as figuring the tip on your lunch bill--but it may take you longer than it would if you were rested. And you may as well say good night to performing several work tasks concurrently, absorbing new information, or making sound judgment calls, especially in a crisis. All told, “Anything that’s not routine becomes difficult if you're tired,” Monjan says.

The Changing Pattern of Sleep

Maybe you've heard that you need less sleep as you get older. That’s just wishful thinking. The need for sleep doesn't diminish in midlife or even in late life. You still require the same amount you did when you were 25 or 30 years old--about eight hours a night.

“Yet the pattern of sleep does change as we age,” says Sonia Ancoli-Israel, Ph.D., director of the sleep disorders clinic at the Veterans Affairs San Diego Healthcare System in California. You may find yourself getting sleepy earlier in the evening, say 8 p.m. instead of 10 p.m., and routinely waking at 4 a.m. instead of 6 a.m. These kinds of changes result from natural shifts in circadian rhythm, the biologic clock all humans carry within themselves that is based on an approximate 24-hour cycle.

However, if you continue to go to bed at 10 p.m., which has been your routine lights-out time for decades, you'll still wake at 4 a.m. “That’s morning to your body,” Ancoli-Israel says. But, unfortunately, you've only slept for six hours.

How we sleep changes in other ways as we age. During sleep, people go through four distinct phases: Stages 1 and 2, the lightest stages, are followed by stages 3 and 4, also called slow-wave sleep, the deepest and perhaps most restorative phases. These latter two stages occur just before REM (rapid eye movement) sleep, when dreaming occurs. For reasons not yet fully understood, getting older brings with it a change in the proportion of various stages of sleep. Infants and children snooze away as much as 20 percent of the night in stages 3 and 4. But studies show that older adults spend most of the night slumbering in the lightest stages; deeper stages 3 and 4 sleep may occupy only 5 percent of the night.

Sleep Stealers

At the same time that sleep patterns change, the incidence of sleep disorders increases. The years after 50 are the prime target for a condition called sleep apnea, a slumber if there ever was one. In sleep apnea, which affects about 4 percent of middle-aged men and 2 percent of middle-aged women, tissue in the esophagus momentarily obstructs the airway, causing breathing to stop--sometimes briefly, sometimes for 10 seconds or longer. When oxygen levels plummet, the person wakes up, but perhaps not sufficiently to realize what has happened. According to the National Institutes of Health, someone with sleep apnea may experience as many as 20 to 30 or more involuntary breathing pauses each hour.

Two additional disorders that can interfere with getting a good night’s sleep are restless leg syndrome (RLS) and periodic limb movement disorder (PLMD). In RLS, unpleasant creeping, crawling, and tingling sensations produce the irresistible urge to move the legs, especially at night when you're lying down waiting to fall asleep. PLMD involves involuntarily kicking several times a night that causes you to hover in lighter stages or wake up. “The majority of patients with RLS also have PLMD,” says Andrew L. Chesson, M.D., Jr., director of the Sleep Disorders Center and professor of neurobiology at Louisiana State University Health Sciences Center in Shreveport.

The exact causes of the two disorders are still unknown. Sometimes RLS is inherited, and some cases have been associated with nerve damage in the legs as the result of diabetes. A number of scientists believe that the mechanism underlying PLMD involves a problem in the nervous system. Both disorders can be treated with drugs. Other sleep robbers include pain from arthritis, heartburn, low back pain, and medications with side effects that interfere with sleep.

“You know you have a problem if you can't sleep when you want to or you're your bedmate tells you your sleep is disrupted,” says David N. Neubauer, M.D., associate director of the Johns Hopkins Sleep Disorders Center in Baltimore.

If any of these symptoms lasts more than a month and interferes with the way you feel and function during the day, seek help from your doctor. The solution may be as simple as switching to a medication that doesn't cause sleeplessness or treating a medical condition that does. For more complex problems, ask your doctor to recommend a sleep specialist. You don't have to put up with sleepless nights because that’s just the way it is. “By itself, getting older is not a cause of insomnia,” Monjan says.

 

Snooze News You Can Use. In addition to consulting your doctor, here are some other strategies that can help put you on the road to dreamland.

Darken your bedroom. Invest in room-darkening bedroom shades that block moonlight and early morning sun. “As much we need light during the day, we need darkness at night,” says Sonia Ancoli-Israel, Ph.D., director of the sleep disorders clinic at the Veterans Affairs San Diego Health Care System in California. If you get up during the night to go to the bathroom, she suggests using a nightlight to show the way rather than turning on a bright overhead light.

Reserve your bed for sleeping. Move the television set into another room and, if possible, limit bedtime reading to a chair next to your bed. Otherwise, you send your body the message that the bed is a place to stay awake. If you can't fall asleep after 15 minutes, leave the bedroom and do something boring until you feel tired.

Avoid caffeine and alcohol. Scientists believe that caffeine blocks the action of adenosine, the organic compound that promotes sleep, and stimulates brain cells to work overtime. If sleep is really a problem, Ancoli-Israel suggests avoiding any caffeine after lunchtime. Besides obvious sources, such as caffeinated coffee (103 mg caffeine in 6 ounces), tea (36 mg in 6 ounces) and cola beverages (49 mg in 12 ounces), try to steer clear of hidden caffeine in foods like coffee-flavored yogurt (44.5 mg in 8 ounces) and chocolate (6 mg in 1 ounce).

As for alcohol, you may be able to get away with having a glass of wine with dinner and still sleep well. But if you're having trouble, do without anything alcoholic for a few weeks to see if it makes a difference. As for nightcaps, forget them. Alcohol will make you drowsy initially, then cause you to wake hours later.

Grab a nap--maybe. For some people, a short mid-afternoon nap can make all the difference to the rest of the day, but for others, it’s the recipe for lost sleep at night. Certainly, people suffering from insomnia should avoid naps. If you're among those who take some time to doze off during the day, don't sleep too long; 15 to 20 minutes should be about enough.

Exercise.  “Exercise helps you sleep longer and fall asleep faster,” says Abby King, Ph.D., of Stanford University School of Medicine in California. King is the lead researcher of a study on the relationship between exercise and sleep. The study randomly assigned 43 men and women over age 50 to exercise moderately (such as a brisk walk before dinner) for 30 to 40 minutes four days a week or to do nothing for four months. At the end of that time, she found that those who exercised generally slept an hour longer each night and also could fall asleep more quickly.

Get some afternoon light. If you don't want to hit the hay just as the dinner dishes have been cleared, spend time outdoors in the afternoon. If you're stuck in your office, take a break by going for a midafternoon walk. This can help turn back your circadian clock and counteract the natural aged-related tendency to fall asleep earlier in the evening and wake up earlier in the morning. If that doesn't work, you might consider a light box. For more information on light boxes, log on the Web site of the Circadian Lighting Association (www.claorg.org). Make a habit of sitting in front of it for a couple of hours in the evening while you read or watch television. Exposure to this kind of light also helps shift your internal clock.

Eat lightly at night. For reasons that are still unclear, a sizable meal an hour or two before bedtime can interfere with sound sleep. So if you eat dinner after 8 p.m., try to make it a light meal.

 

Drugs that Can Sap Your Sleep

If you take any of the following drugs and you have trouble sleeping, your medication may be to blame. Talk to your doctor about switching to another medication or changing the dose.

Beta blockers (to treat high blood pressure and relieve angina)

Thyroid medication (used when the thyroid gland doesn't produce enough hormone)

Bronchodilators (to prevent or treat symptoms of asthma, chronic bronchitis, and emphysema) and corticosteroids (to decrease the number and severity of asthma attacks)

Antidepressants

 

To Sleep Like a Log, Log on to These Sites

For more information on getting a good night’s sleep:

--The National Sleep Foundation at www.sleepfoundation.org.

--American Academy of Sleep Medicine at www.aasmnet.org.

--National Center on Sleep Disorders Research, www.nhlbi.nih.gov/about/ncsdr.

Today, more than two thirds of Americans are enrolled in some form of managed health care. And when the name of the game is cost containment, "quality care" can be tough to get. The squeeze starts with the insurance companies, which are forcing affiliated physicians to see more patients in less time--in some cases, a new patient every seven minutes, while rationing resources such as lab and diagnostic tests. And many managed care doctors are “encouraged” to follow clinical practice guidelines (CPGs), written procedures designed to treat particular diseases for the least amount of money.

HMO doctors can recommend treatment not outlined in the CPGs, and they can spend more time with you during office visits. They can even prescribe brand-name drugs and they can order costly diagnostic tests if they feel you need them. But HMO doctors can't do this for everybody. You have to make yourself stand out.

With this in mind, here's what you can do to increase your chances of receiving the highest-quality service in today's managed-care climate.

BE CHOOSY

Be sure that you pick an HMO that has been awarded a full three-year accreditation status from the National Committee for Quality Assurance (NCQA). This award of three-year accreditation is the NCQA's highest distinction for managed-care organizations who demonstrate excellent programs that promote continuous quality improvement.

Know Your Health Plan. Learn as much as you can about your coverage. “You’re in a better position to navigate the system when you have better information,” says Nick Newsad, a senior analyst at a surgery center in Broomfield, Colorado and author of The Medical Bill Survival Guide (www.medicalbillsurvivalguide.com). Go to your health insurance carrier’s Website and log into its insurance portal with your health insurance card number. There you’ll find your benefit plan, including a list of in-network providers, your deductibles, co-insurance, and co-payments. These tools can help you estimate the cost of your treatment. If you’re not sure about something, call your health insurance company and ask. Get the name of the person you speak to and the date of your conversation in case there’s an issue later.

At your health insurance portal, you’ll also get access to your explanation of benefits (EOB). They’re the documents your insurance company sends your provider, telling them what they were paid and what to bill you. “The bill you get from your provider might not match your EOB. If you get billed for more than you should have, you can ask your insurance company to contact your provider about the discrepancy,” Newsad says.

DOCTOR SHOP

When selecting your primary care physician (PCP), keep in mind that "board certified" (which means that the doctor has passed the Board exam) is better than "board eligible" (the doctor hasn't yet taken this important accreditation test). But even the most credentialed PCP might not be right for you. "Choosing a doctor involves a gut response that starts when you call for an appointment," says James Kvale, MD, professor of family and community medicine at the University of Texas-Houston Medical Center. Clues you're in good hands: The doctor's staff is professional and concerned about your wellbeing. The doctor's office is clean. Your waiting room time is rarely more than 30 minutes. Your doctor listens to your concerns and answers your questions.

SEEK OUT SPECIALISTS

Referrals to specialists are usually authorized by your primary care doctor. But if you want to go to a particular specialist your doctor doesn't know and, for some reason, doesn't want you to see, you can get around it by working backward. Call the specialist and tell her you're interested in becoming her patient, and ask if she has a relationship with other PCPs in your plan. (Offer to fax her the list from your HMO's physician directory.) Then switch to the PCP she suggests. (You can always switch back later.)

SPEAK UP

If you believe that you are not receiving satisfactory care and your physician isn't being helpful, call your HMO's member services department. In many cases, they can help you get the benefit you need. Or you might want to work through the human resources department at your job. You might also consider filing a formal grievance with your HMO (check in your member handbook for the grievance process). Or send a letter directly to the HMO's medical director and the head of its member services department. Ask them to respond to you within a specified time, and tell them you'll seek regulatory or legal help if necessary. If the problem isn't resolved, you can ultimately file a grievance with your state's HMO regulatory agency. Call your HMO's member services department for this agency's address and telephone number. Remember, it's the squeaky wheel that gets the grease.

KNOW YOUR LEGAL LIMITS

If you receive a bill from your doctor for a covered service because your HMO hasn't paid the doctor on time, send the invoice back to your doctor. Include the note, "I'm not responsible for this bill. I'm covered by managed care," advises Harvey Wachsman, JD, MD, an attorney in Great Neck, New York, who specializes in managed care. When your HMO fails to pay your doctor, says Wachsman, it's breaching its contract with the doctor. "Let the doctor go after the HMO," Wachsman advises.

MENTION MONEY

Is this covered?" and "What is this going to cost?" are two relevant questions to ask your doctor, who may recommend a treatment that's not covered by your HMO. If your doctor isn't sure about your coverage, double-check your managed-care contract before consenting to any procedures.

DO YOUR HOMEWORK

To understand your condition and become a decision-maker in your own health care, do your own research online. By being more informed, "you may get better care and you'll feel more in control," says Kvale. If you discover a new treatment your doctor hasn't recommended, there's a good chance it's not yet covered by your HMO. But that doesn't mean it can't be.

Armed with information you provide, your doctor may be able to persuade the HMO to authorize the treatment.

TAKE NOTES

When speaking with HMO customer service representatives, be sure to jot down the date of your call and the name of the representative you speak with. If there's a discrepancy at some point later on, your notes (as in "On April 28 I spoke with representative Jane Doe, who told me this service was covered") may help to resolve the matter in your favor.

QUESTION DENIALS

If your claim is denied because the treatment you received was deemed "not a covered service," "not medically necessary" or generally "unauthorized," ask your doctor to write a letter to the HMO requesting to have the claim reconsidered. Or call your plan's member services department for an explanation. (HMOs have been known to sometimes reverse their determinations.

They've also been known to make mistakes, so it's always worth asking.) If your

HMO refuses to reconsider, file a formal appeal. Check your member handbook for the appeal process. Do research to back up arguments about your care. It's up to you to look out for yourself.

Doctor with stethoscopeOne of the key ways to improve your health and well-being is to have a relationships with a health care provider whom you trust. Often, however, patients don’t know how to have the best possible experience when they visit their doctor’s office.

“Our expectations for medical care can — and should — be higher than any other services we use,” said patient satisfaction expert Steve Feldman, M.D., a dermatologist and founder of DrScore.com, the online physician rating website. “We should expect ‘technically’ great medical care, meaning an accurate diagnosis and proper treatment, but we should also expect to be treated courteously and respectfully by a caring physician. We, as patients, can affect the quality of our experience in the doctor’s office by following these simple tips.”

Tip 1: To avoid a long wait, try scheduling your appointments at the beginning of the day or right after lunch. The doctor’s first appointment of the day is the one most likely to be on time because he or she is less likely to be delayed by an earlier patient’s needs. Other patients prefer the last appointment of the day — the doctor may be running late, but he won’t be rushing to see other patients. “Physicians do try to set reasonable appointment times, but some patients may take longer than expected to see — and you want a physician who will take extra time with you if  you need it,” said Dr. Feldman. “Try setting your appointments when your schedule is flexible and an unexpected wait won’t stress you out.

Tip 2: In case you have a long wait, bring something, such as a book or paperwork, that will allow you to be productive. “I bring my laptop, so I can catch up on e-mails if the office has a wireless connection,” Dr. Feldman said. “Smart phones work, too. You just have to make sure you move to a more private place if you have to return phone calls, so you don’t disturb other patients.

Tip 3: Bring a written list of all your medications, your past illnesses, your current problems and your questions with you to every appointment. “By listing your problems, concerns and questions, you will be that much better prepared and the visit will go much more smoothly,” Dr. Feldman said. “Doctors appreciate organizational skills.”

Tip 4: If you feel unsure about a situation, speak up and ask about it. “In a good medical office, the doctor and staff will keep you informed as to what is happening and what happens next,” Dr. Feldman said. “But doctors get distracted and forget sometimes, so don’t hesitate to ask a question or tell them what is on your mind.”

Tip 5: If you have a negative issue you want to address, try addressing it in a positive, non-threatening way. For example, “you may feel the doctor is not listening to you,” Dr. Feldman said. “Even the smartest, most technically adept doctors do not always have great people skills, and even the ones with the best people skills may not be at the top of their game.  Instead of saying ‘you’re not listening to me,’ which can invite defensiveness, try: ‘Doctor, I know you are listening to me, but when you look down at the floor while I’m speaking, it makes me feel like I’m not being heard.’”

Tip 6: At the end of the visit, make sure you have received written instructions on medications and treatment plans, and you know how and when you will get results from any tests. “The end of the visit is a critical time where the doctor writes prescriptions, gives you the best advice on how to take care of yourself or treat your illness, and talks about test follow-up,” Dr. Feldman said. “The details of medical care are common knowledge for the doctor, but it may be new information for you, so ask for your treatment plan in writing so you don’t forget anything.” Missed test results can cause problems, so make sure you are proactive in finding out how the office will get the results to you.

Tip 7: Give your doctor feedback. Take the time to let your doctor know how the visit went either by telling him or her, communicating to the office staff, writing a letter or participating in an anonymous patient satisfaction survey, such as the one at www.drscore.com.  “Don’t ever be afraid to give your doctor advice on how to be a better doctor,” said Dr. Feldman. “When you give your doctor feedback — whether it is positive or negative — you are giving them a gift.”

Whether it’s kicking that nicotine addiction or trying to pursue hobbies and rituals that bring you happiness and reduce stress, high on your resolution list is become a healthier human being. Here’s 10 ways to improve your health without pain or major money commitment.

1) Quit Smoking-even Social Smoking - Whether you are smoking a pack a day, or only smoke when you are at a party with other closet smokers, or under a bad mood emergency, quitting all cigarettes for good can only benefit your health because each cigarette impacts the future of your lungs. The organization “Ex: Become an Ex-Smoker” offers smokers the support to quit. One of their key strategies is to address “triggers” (Perhaps you have seen the commercial of the secretary who blends a margarita at work before she sneaks off on a smoke break?)  For example, if you have a favorite party jacket that you like to wear when you smoke or a comfy chair you like to smoke and relax in—hide it in storage or give it to charity.  Talk to your doctor about which nicotine aides are best for you.

2) Exercise Your Brain - Maybe you haven’t picked up a clarinet or a flute since your high school marching band days, but a new research shows that learning a new instrument or just practicing music can improve memory and language skills. Recent studies have also shown that playing video games, even a basic one like the popular Tetris can improve cognitive ability and give your brain a boost by challenging it without frustrating it.  So you don’t have to feel so guilty when you while away an hour on Facebook playing Bejeweled.

3) Tackle Stress in Baby Steps - Feeling stressed? “Sometimes vitamin deficiencies can trigger symptoms of stress like having frequent headaches, being overly fatigued, or having chest pains,” says Sharagim Kemp, DO, Health Quest Medical Practice.  Be sure to keep up with yearly physical check-ups to get the right blood work done.  Dr. Kemp also advises patients to take time management seriously by allocating Me Time, saying “No” more often, and making shorter, more realistic to-do lists.

4) Ditch the Yo-Yo dieting - Although you may yearn for your skinny jeans, your body would be better served by vowing to stave off fad diets, liquid diets, and quick weight loss detox programs. Make peace with your scale, and try to remember that slow and steady wins the weight loss race.   You don’t have to say no to apple cider donuts forever. You can limit a dessert indulgence to Saturday night, and enjoy healthier desserts like baked apples with cinnamon and walnuts, suggests, Rufia Payman, on weekdays.  A research study from the Fred Hutchinson Cancer Research Center in Seattle discovered that “Yo-yo dieters” have fewer cancer fighting killer cells in their bodies and therefore weaker immune systems than women who remain at a stable weight.

5) Meditate-Daydream - Studies show that Buddhist monks who meditated thousands of hours had higher brain activity than meditation novices.  If you don’t have 15 minutes to spare, then just take 5 minutes to daydream or tune out the world and your Blackberry.  Dr. Kemp emphasizes that when you are in a situation where stress becomes overwhelming, walking away from the situation and taking that 15 minute quiet time to decompress becomes even more important.

6) Squeeze in fitness - According to the Mayo Clinic, regular physical activity offers multiple benefits including lowering cholesterol, stimulating your metabolism, and reduces the risk of cancer. “If you like to shop, walk in the mall. If you like to do yard work, there are always more leaves to rake or snow to shovel. Make an extra trip up and down stairs whenever possible,” says Dr. Heffernan of Health Quest Medical Practice,Division of Primary Care in Highland .If you prefer to work out in a cozy indoors, then buy rent work-out DVDs, join a gym, or invest in an exercise bike.  Even 15 minutes twice a day is enough to release endorphins that combat stress hormones in the body.

7) Listen to your body - If something is bothering you do more than a Google search.  “Weird symptoms usually are not due to serious problems. However, if you feel that a symptom is weird, it could always be something important. When you are concerned about a problem, having a medical evaluation can only help. If the symptom is due to something simple, then you can be reassured and feel more at ease. If the symptom was due to something more significant then you will be glad you went,” says Dr. Heffernan.

8) Take your sleep seriously - The Center for Disease Control recently announced that getting a good night’s sleep is one of the important things people can do to help in preventing the flu. A Carnegie Mellon study also showed that people who got adequate amounts of sleep (over 7 hours) were less likely to get a cold because their immune systems were stronger.  If you have trouble sleeping, make sure you do not have a medical problem (sleep apnea or restless leg syndrome). If it’s insomnia only, it may be time for some lifestyle modifications.  “What really gives you the rhythm for the sleep wake cycle is the wake up time. The first thing is that you always wake up the same time every morning, because that is going to drive your day. By not getting enough sleep, your appetite hormone balance changes, you crave chocolate and carbohydrates, and your immune system doesn’t work as all,” says  Dr. Barbara Chatr-Aryamontri.

9) Go Mediterranean - “The Mediterranean Diet is high in consumption of fish, olive oil, very little read meat, and nuts. We know that eating the Mediterranean way really reduces cholesterol, Diabetes, and reduces risk of depression, and leads to longer life,” says Rufia Payman, Director of Nutrition and Education at Northern Dutchess Hospital in Rhinebeck.  Use olive oil when cooking instead of butter, and avoid high-fructose corn syrup, and avoid processed food when possible.

10) Lower your cholesterol - “You have to learn to love the food that loves you back and cooking should not be a chore. Cooking should be something you do because you love your self,” says Payman.  Try to resist the lure of the fast-food drive through during the winter. Instead of a fast-food snack, pack a small bag o of your favorite nuts in the car.  According to a recent John Hopkins study, men with lower cholesterol levels were less likely to develop a high-grade deadlier form of prostate cancer.

 

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The idea of an Alzheimer’s disease diagnosis can be scary. Some may even choose to ignore the early signs, hoping to avoid the bleakness an actual diagnosis may bring on, waiting until their families are forced to sort out symptoms that have progressed to the point of being impossible to ignore. These adult children are now not only forced to have a front-row seat to the decline of a loved one, but now must make important decisions for them based on what they think the ill parent would have wanted.

How do you obtain an early diagnosis?

Early Diagnosis in itself can be a tricky journey, but no matter where your journey begins, awareness is the best partner to have along. If you are concerned that you may be demonstrating some symptoms of the disease, the American Alzheimer’s Association provides some tools that can help, including a “Know the 10 Signs” checklist (a link to this can be found on their site at http://www.alz.org/alzheimers_disease_know_the_10_signs.asp). This checklist is a good place to start, so that you have a thorough description of your concerns which you can present to your primary care physician.

Your primary care physician may refer you to a neurologist, psychiatrist or psychologist (or even some combination of the three), who specializes in Alzheimer’s disease and its diagnosis and research. After these medical professionals assess the implications of your testing results, they will be able to determine a diagnosis.

Although it can be overwhelming at first, once an early diagnosis is established, the true journey begins. And there are many emotional and financial benefits and opportunities that come along with it.

Have an early start on taking the best care of yourself.

An early diagnosis can provide you with being with the chance to really put yourself at a mental and physical peak in order to maintain this peak for as long as possible. The more time to prepare and experience life at its fullest, the better off you will be.

By maintaining a peak level of health for as long as possible, you will also be at primed to take advantage of any possible medical breakthroughs doctors may have with the disease.

Spell out what you want.

Something can happen to any one of us, at any moment. Having your will prepared is a good idea, anyway. Doing it while you are on the ball with full-thinking capacity is a great idea.

You will have the benefit of detailing everything you want for yourself medically, leaving no second-guess work for your family and friends. For instance, if you prefer a certain care-giving situation or facility, you have the ability to provide the provisions for this and make certain it happens. Your family will not have to experience the additional pain of determining whether you would want to be revived or not if that question ever comes up. In clearing these matters up for your loved ones, they can focus on enjoying their time with you as much as possible.

You will also have the chance to prepare those close to you in all matters of your estate, including how your house is maintained.

Get support.

Having the support of someone who actually understands is a valuable resource.

You will have time to get in touch with Alzheimer’s groups that can provide this support to you and your family, in order to process what is happening to your mind and body.  There are many places to find this—including your local chapter of the Alzheimer’s Association, who can direct you toward support groups and caregivers who are specialized to direct those affected to the best resources available.

You can also take the time to see a private counselor if you are having emotional difficulty dealing with the diagnosis. They can help bring a sense of peace to you while you are going through the process of planning.

Take time to enjoy yourself.

While there will be extra time to get all of the technical things in order, like estates and finances, it is also important to enjoy yourself. Not everyone has the resources to plan a vacation with their family, but everyone can take small steps to make every day a little more joyful.