GROWING OLDER IN GOOD HEALTH

Geriactive!

Try this line on your next birthday cake: it is not the years of your life, but the life in your years. And if you intend to do more than sit, recline and repose after age 55, those approaching their golden years need to pursue a notion called “wellness”. The phrase was coined by Dr. Kenneth Cooper at The Aerobics Center in Dallas. Basically, it means being good to your body and taking care of yourself.

Aging is simply not kind to our bodies. Physicians tell us the following things happen to all of us as we get older; some may even occur earlier, if your genes are so predisposed:

Blood pressure and body weight increa

Cardiac output declin

Blood cholesterol levels elevate

Chest wall stiffens

Skeletal muscles decrease in strength and capaci

Bone mass is lost

● Sensory perception and motor responses in the brain and central nervous system are impaired As if that list isn’t depressing enough, other “old age” diseases approach people in their golden years: arthritis; increased risk of developing chronic conditions such as heart disease, diabetes and depression; osteoporosis for women and even some men.

But medical researchers have good news. It is now known that exercise, careful eating and sound health care habits may actually slow the aging process. In fact, exercise appears to have many advantages specific to the golden population segment.

For example, a study examining 30 elderly women concluded older adults with bone loss can actually improve bone mineral content by participating in exercise three days a week. What this means is that women can stop the progression of osteoporosis with exercise, mineral supplements and new estrogen treatments.

And a recent West Coast study concluded that geriatrics who exercise regularly have sharper minds.

Whether its a sharper body or a sharper mind you want, exercise can help you get there. The benefits are numerous: exercise increases caloric expenditure, induces weight loss, lowers blood sugar levels, improves cholesterol levels, and lowers blood pressure. “If the joints are stiffened from non-use, older folks will loosen them as they increase their range of exercise,” says Laura Bitter-mann, owner of Mind Over Body Fitness Experience.

But Bittermann and other trained aerobics teachers warn those who have not exercised in “years” to take it easy. . .real easy.. .at first. Running is probably not a good form of exercise at age 60 if you are overweight and have never run. Try walking. Low-impact aerobics are safer than high impact classes. And, an aquatic exercise such as swimming is ideal.

Bittermann, who plans to start a senior exercise program next year at her studio, says growing older no longer means being “put out to pasture”. But she cautions seniors and anyone who hasn’t exercised vigorously in a number of years to check three points before beginning an exercise program.

“A medical exam is really necessary,” says Bittermann. “Next we customize programs to each participant’s physical activity. Our teachers are taught to be on the lookout for signs of overdoing it: staggering, a white face, loss of vigor, difficulty breathing. Plus they constantly remind folks that they can go at their own pace.”

Bittermann says it is also a good idea to have an individual trained in CPR at every class. Aside from these precautions -which may also apply to younger students – people in the prime of their life can enjoy the same benefits and thrills from exercise that their children do. Best of all, it’s never too late to begin.



Windows To The World



The news is great: growing old no longer means growing blind. Thanks to new technologies and techniques in ophthalmology, all of us can maintain our vision longer and actually improve the eyesight nature gave us. With new surgical microscopes and fine suturing materials, ophthalmologists can perform refractive procedures (refractive means finding vision deficiencies in the eye and correcting them with lenses) to surgically remove cataracts, correct near and far sightedness and reconstruct an eye damaged by trauma or disease.

Ophthalmologists would like to clear the air about a couple of things concerning cataract removal. First of all, most eye surgeons do not use laser technology to remove cataracts. Secondly, cataract surgery can be repeated. Dr. Wesley K. Herman, an ophthalmic microsurgeon in North Dallas, says 20 percent of his practice is spent re-doing cataract surgeries performed in the seventies and early eighties. Lastly, cataracts are not a disease of aging. They are part of the natural aging process. Everyone will develop cataracts if they live long enough. And cataracts can appear in younger people, too.

“Cataracts are actually a hardening of the lens of the eye,” says Dr. Herman. “It becomes opaque and tough like a brittle fingernail.”

The lens is the center eye disk that focuses on objects. As we age the proteins tend to congregate towards the center of this tiny organ. The lens becomes discolored. When it becomes too cloudy or opaque, it’s time to replace the lens. Quite basically, that’s what cataract surgery is all about.

Ten years ago, eye surgeons were removing the entire lens of the eye without a replacement. Patients then had to wear contact lenses or coke-bottle thick eyeglasses to take over for this organ – forever.

Lens implants are a relatively new procedure. Surgeons relax the patient with intravenous medication. (Some patients may prefer general anesthesia, which means surgery should probably be done at the hospital. Most patients prefer the ophthalmologist’s surgical facility.) Working quickly, they cut the tiny bag surrounding the lens, remove the old lens and vacuum out debris. In goes the new, clear plastic lens, the bag is finely sutured, and the operation is complete. The lens will stay in place and remain clear for 15-20 years.

In two hours the patient can go home. Dr. Jeffrey Whitman, an associate of Dr. Charles B. Key at the Cataract Surgery Center, says he’s had patients don glasses and go shopping after leaving the office.

“The surgery is painless, bloodless, and rather like a visit to the dentist,” says Whitman.

Well, then maybe it isn’t like a visit to the dentist. In any case, working in such a minute area requires great surgical skill, years of training and high-powered microscopic equipment.

What’s more, eye surgeons now have the capability to correct vision problems at the same time they remove cataracts.

Dr. Herman tells of a patient with severe myopia, a minus 23 refraction. (Most myopic people are in the minus one-to-five refraction). The patient was severely nearsighted and doomed to a life of thick glasses that could not provide 20/20 vision. Dr. Herman performed an operation called a radial keratotorny. Tiny radial incisions were made into the cornea of the eye, to shorten the cornea and forever alter the way light would refract upon it. The surgery was a complete success. Even though the young man had to still wear glasses, his lenses were much more slender. And his sight with corrective lenses was almost 20/20.

“I remember he told me how amazed he was to see the sky” says Dr. Herman. “Apparently he thought it was always a solid color because he could never make out the distinction between the clouds, the blue and white.”

In the ever-changing world of ophthalmic microsurgery, eye surgeons are making permanent changes in the way people see.

The living contact lens. . .or epikeratophakia. . . is a procedure in which a certain piece of corneal tissue from a donor is cut into the shape of a contact lens. The graft tissue is then sewn into the patient’s own tissue, becoming a permanent part of the eye. (The tissue is frozen until malleable much like a piece of play-doh or plastic). Some surgeons who have the right surgical equipment are even shaving off the patient’s own corneal tissue and reshaping it, then placing it back onto the patient. Using computer equations, the surgeon is able to get the refractory power of the re-molded tissue as close to perfect as possible. Dr. Herman is one of a handful of pioneering, brilliant young American micro-surgeons currently performing this procedure.

Most cataract patients are in their seventies. Dr. Herman estimates he may perform 60 to 90 cataract removals every week. He’s operated on babies and 104 year old patients. The way he sees it, opening up sight is a way to give older people mobility. . . so they can view the world they have been a vital part of for so long.

“When your legs wear out,” says Dr. Herman, “let your eyes do the walking for you.”



Living Fit

You may have been model thin in your teens and twenties, but as the birthdays progress towards middle age, the scales progress to figures you’d prefer seeing in your checkbook, not on your body.

But then, you say, its normal to gain weight at age 50. Certainly by the time you’re 60. Grandparents are supposed to be soft and cuddly. Every matriarch ought to look like Miss Ellie, right?

Not really. As people age, they require less food. They may expend less energy. Middle-aged folks tend to be less physically active than they may have been at 20 and 30. Combine the sitting and overeating and the result may be 60 extra pounds in five years.. .or a slow gain of about one pound a month.

But there may be reasons, even habits that have built up over a lifetime – reasons why you sit and eat, habits that may be difficult to break.

“Lifestyle changes have a lot to do with it,” says Thomas Kozlowski, a bariatric counselor. “The kids go off to college. You’re plugged into a lifestyle of preparing three meals a day for four or five people. You overbuy at the grocery store and prepare too much food.”

What most overweight couples need, says Kozlowski, is a behavioral change in eating habits, more exercise and less eating.

“People can make a behavioral change at any age,” says Kozlowski. “The longer you’ve been practicing it, die more resistant you may be but change is never impossible.”

In his practice, Kozlowski has seen hundreds of middle and golden age people lose large amounts of weight after following his multi-disciplinary approach to weight loss. After a careful medical evaluation, patients are put on a reduced calorie diet. They are also required to attend one group therapy session per week. The multi-disciplinary approach works, according to Kozlowski, because it combines medical treatment with behavior modification.

“Medical treatment alone has a poor success rate,” says Kozlowski, “and group therapy alone has a poor success rate. I’ve seen patients in other practices develop marvelous insight into why they’re overweight-insight, yes, but no weight loss.”

Kozlowski and other weight loss professionals say you cannot ignore the cardinal rule of weight loss: in order to lose weight you must eat less and exercise more.

Enter Maureene Timken and her Live Fit Program. Not only do her clients reduce the amount of food, particularly fats they eat, they walk three-to-four miles a day, four days a week.

You might call it a walking consultation, or a meeting on feet. That’s how Maureene and her clients begin every Live Fit meeting.

“This is a very individualized program,” says Timken. “Some clients cannot walk quickly nor get in three miles. We work up to it.”

The diet portion is a daily allocation of 1200 calories. . .calories carefully selected by Timken’s staff nutritionist.

“I will even make a home visit, taking inventory of a client’s pantry,” she says. “Or I’ll go grocery shopping with a client to teach them how to avoid fats, make substitutes – for example, using yogurt in a recipe instead of sour cream.”

In fact, her 1200 calorie-a-day diet is very low in fats, moderate on the proteins and high in carbohydrates. You can eat bread, pasta, potatoes, oodles of vegetables. Most clients are amazed at the large amount of food they are permitted to eat.

“Weight loss is slow… a pound and a half per week,” says Timken. “But it really helps people who have tried everything, all the diet programs and failed. This is not a short term cure. This is a life-long program. And walking is wonderful – one of the five best aerobic exercises. If you walk a mile in 12 minutes, you can expend more energy than if you run at the same speed (96 calories for running, 106 calories for walking). Yet you are placing only minimal pressure on the joints and lower back.”

Timken is married to a Dallas psychiatrist. Always in good physical shape, the two discovered they were both genetically predestined to high blood cholesterol levels several years ago. By experimenting with diets, she managed to lower both her and her husband’s cholesterol by 50 points. Now, she says, the world appears to be better informed about healthy eating and diet’s role in warding off disease.

Thus losing weight and lowering fats in the diet after age 55 is not just for aesthetics. Weight gain at this time in life can aggravate almost any medical condition. Take arthritis, for example. Extra weight on arthritic knees can cause extra pressure and more pain. Kozlowski likens the extra pounds to carrying a load of dry dog food.

“Next time you’re at the grocery store, pick up a 25 pound bag of dog food,” he says. “On your body the weight is more evenly distributed. But feel how heavy that 25 pounds is. .. and every organ in your body carries the extra burden.”

Consider the wear and tear on the body organs if an individual has been overweight for a number of years, or a lifetime. A thirty-year-old with a weight problem may not have any health problems. But by the time he’s 60, his weight may have induced or aggravated a number of medical symptoms.

“Chances are” says Kozlowski, “If you’ve been thin all your life, barring medications and illness, you won’t become heavy in your senior years. But if you are overweight at 60, unless you’ve been ill, my guess is you were overweight at 40.”

The trick is, then to get the weight off and keep it off before extra fat leads to high blood pressure, diabetes, cardiac disease or any of a number of over-weight-related diseases. Remember that no magic pills or diets will get you there. What you need is a program that will help you find the discipline and self-control you need.

When It Hurts To Move

Arthritis. Even the name has a scratchy consonant rub to it -a grinding of sounds similar to the sound arthritic bones might create as they scratch and tear against each other, producing pain, pain and more pain.

Arthritis sufferers say it hurts when they move and when they don’t move. It is particularly painful in the morning. One 72-year old woman who suffers arthritis in her hands, neck and lower back, says she actually feels better when she sleeps less -say four to five hours a night. Mornings are her worst time. If she has to get anywhere before 11 a.m., she needs a long, hot shower to ease the pain. Then, too, she always fears going to bed at night wondering if the pain will be worse in the morning.

Obviously a crippler to lifestyle, physicians and physical therapists say there are more new ways of dealing with arthritis than ever before.

“There are more than one hundred different types of arthritis, the most common being osteo or wear and tear degenerative arthritis,” says Dr. Roy Fleischmann, associate professor of clinical medicine at the University of Texas Health Science Center and director of the Arthritis Center at St. Paul Medical Center.

“We have a host of new medications, non-steroid anti-inflammatory drugs. Many of them work like aspirin but are much easier to take because the side effects are reduced.”

But Fleischmann says medicine alone will not do the job. He says a team approach is needed for treatment: medication plus occupational therapy, stress management (stress can aggravate arthritis), diet for overweight arthritic patients, and if necessary, surgery to replace joints.

“Osteo, or wear and tear arthritis, happens when cartilage between joints tears away,” says Fleischmann. “Plastic joint replacements are put in to cushion the joints.”

The plastic joints last from 15-20 years, granting relief to those who cannot control pain with medical and physical therapy.

Another form of this disease may begin even earlier in life – rheumatoid arthritis. The body produces antibody chemicals that actually destroy joints and cartilage. Rheumatoid is the crippling arthritis. It can strike women in their 20s and 30s, as well as older men and women. Six new drugs are currently being used to treat this non-curable affliction. The drugs, including oral gold and methotrexate, an anti-cancer drug, halt antibody production in 50-75percent of cases.

“We don’t have drugs that are 100 percent effective yet,” says Fleischmann. “But researchers are studying new drugs as we speak.”

Hopefully, they will progress closer to the 100 percent relief point with few if any side affects, a dream for every victim of arthritis.

The average age for the onslaught of osteo arthritis is 64.2 at St. Paul Medical Center’s Arthritis Center. In general, arthritis begins to affect most people in their sixties. . .about the time they are reaching their prime. The Arthritis Center helps arthritis sufferers deal with their affliction.

The Center has a staff of 12 professionals including dieticians, physical therapists, rheumatolo-gists, social workers and pharmacists. Patients may choose exercise courses designed for the arthritic: water or land exercise; physical therapy; joint protection information and weight reduction.

Weight reduction is vital because every pound of extra weight results in five pounds of pressure on the joints,” says Diana Anderson, Director of the Arthritis Center at St. Paul Hospital. “That’s extra pressure, extra pain.”

The approach is geared to individualized needs. In order to enroll in the program, a patient needs a referral from his or her physician. Based on the patient’s medical history, a custom-tailored program is designed.

Arthritis patients must learn a whole new way of living. Those with neck pain should probably never reach above head level; they cannot lift heavy objects; some cannot even open ajar of food and are instructed not to.

“We had a young chef for a local hotel,” says Anderson. “We told him never to open ajar again with his hands. Then we taught him a new way to open jars with a special device.”

A different lifestyle, but not impossible. Not bedridden or even wheel-chair bound. Exercise is good for arthritis, particularly in the Center’s olympic-sized therapeutic pool. Education in pain and stress management is available at the Center. And, patients may enroll in other St. Paul programs such as Bio-feedback and the Pain Clinic.

“It is also an affordable program,” says Anderson. “The most expensive is our 16-week weight loss and exercise class. Plus, we offer five free support groups, and social interactions that provide another important component.”

For example, last spring’s luncheon for Arthritis Center patients. The guest speaker was a Hall of Fame golfer with arthritis.

Then there is the cruise. Sort of a seminar that sailed away to the Caribbean. Part of the Center’s team of professionals went along to conduct courses – exercise, education, and therapy. But the most important part was fun.

“The age range was 24 to 78 and we had a blast. We had our wheelchair bound people on the beach, in the water, feeling the waves. This is definitely going to be an annual event around here.”



Body Work



It is not that you want a new body. . . maybe just a few parts replaced. The years and gravity have pulled down an inch here and sagged there, not to mention what bearing a child or extra weight can do to the body.

Plastic surgeons say that a growing number of their patients are older. Robert Hamas, a North Dallas plastic surgeon and secretary/treasurer of the Dallas Society of Plastic Surgeons, says about one-third of his practice is over age 55. The majority of his patients are looking for facelifts (rhytidec-tomy), eyelid surgery (blepharo-plasty), breast reconstruction after a mastectomy, or breast reduction, (reduction mammoplasty).

“The two-layer facelift is fairly routine now,” says Dr. Hamas. “Pulling up on the deeper tissues to tighten the face.”

A good facelift performed by a skilled surgeon, should last from 7-10 years. A blepharoplasty, according to Jack Gunter, a board certified plastic surgeon in Dallas, lasts from 10-15 years and can whittle ten years of age from one’s appearance. Small wonder that the public is accepting plastic surgery now more than ever.

“The prevailing notion is that it’s not just for movie stars,” says Dr. Hamas. “It’s for anyone who wants to look younger. A facelift doesn’t stop the clock, it just sets it back.”

Both surgeons have operated on patients past age 70. And they expect to do more surgery on people in their prime, as baby boomers reach their golden years.

They’ve been lifting eyelids and faces for years, but one thing plastic surgeons have not done in the past is suction fat off people much older than 40.

At first, plastic surgeons believed that only youthful skin – skin that still had a lot of tone and resiliancy -could withstand liposuction (localized fat removal). As techniques have improved, lipsuc-tion patients have been creeping up in years. Technology has created a slimmer suction cannula, the tube inserted into the body. And technique brings about better results.

HEALTH NOTES

Remoue WrinklesWithout Surgery

Topical Vitamin A, or Retin-A cream, was introduced several years ago as an acne medication. Now it is coveted as an effective prescription for wrinkles. In fact, it may well be the ONLY cream on the market today that has been scientifically proven to erase wrinkles.

“It will never replace a facelift,” says Dr Jerold Michaelson, a Dallas dermatologist. “But it’s a tremendous drug. It thins off dead cells of the epidermis. Takes away sun damage from years of ultraviolet or sunlight exposure (low-grade damage). It takes several months to work, but Retin changes the texture of the skin, removes tiny, fine wrinkles.”

Dr Michaelson says he receives calls from patients daily-men and women-inquiring about Retin-A as a wrinkle remover Many of these patients are nearing their prime. They see Retin-A as a facelift alternative if their budget is tight, and much less costly than a department store cosmetic regime. Retin-A is available only with a doctor’s prescription.

New Back Procedure Eliminates Pain

Dr. Richard Toranto, a Piano plastic surgeon, is working on an innovative procedure that may make some victims of back pain doubly happy. It’s the WARP abdominal plasty (WARP is the acronym for wide abdominal rectus plication). Working in conjunction with the Department of Orthopedics at the University of Texas/Southwestern Medical School, Dr. Toranto says the procedure trims the waist by 9 to 10 inches and eliminates back pain.

Some back pain is caused by extra strain on the back muscles. This can happen when abdominal muscles have become stretched out and can no longer properly support the vertebrae. Back muscles take over, and the results can be painful.

Dr. Toranto compares the inner layer of stomach muscles to a door spring that has been stretched too far. He shortens the muscles at each end, increasing the amount of pressure they can exert on the vertebrae to push them apart.

He has used the WARP abdominal plasty on approximately 200 patients, most of them women, aged 26 to 68. Done in the hospital under general anesthesia, the procedure is not simple, and carries the same dangers of any surgical procedure. But it also carries a shorter recovery period than most back surgery, usually three weeks. The patient is hospitalized only four days.



Staying on Your Feet



Fact :Falls are the number one cause of serious injury in people over age 65. Most falls, and most accidents, occur in the home. Nationally, the third leading cause of death is from falling. Falling can be fatal to the older person, particularly a woman who suffers from osteoporosis.

Fact: Once you fall, you increase the odds that you will fall again. Elderly people tend to lose confidence in their balance after a fall.

Fact Experts say as many as two-thirds of falls can be prevented with a little know-how.

If you have an elderly parent or friend who has difficulty getting about, refer to this fall-safe check list:

Eliminate slippery floors (tile, terrazo, marble and waxed hardwood floors are treacherous) at hom

Tape or tack a throw rug to a slippery floo

Use a rubber mat. Or wear rubber soled shoes. Or install wall-to-wall carpet. (Here, too, make sure that reducer strips between rooms and in doorways are not inviting trips.)

Clear hallways of debris.

Stairs are particularly dangerous. Keep them uncluttered and well-lit. Make sure a lightswitch is nearby-preferably one that is illuminated in the dark. Make sure there are handrails on both sides of the stairs. Tack down any loose carpetin

Get any and all wires underfoot out of the way.

In the bathroom, install a nightlight. Install toilet and tub bars. Use a rubber shower or tub mat and a thirsty bath mat to help keep the floor dry.

Outside: wobbly stepping stones, cracks in the sidewalk or loose floorboards-fix, remove or avoid them. In icy weather, keep a pail of salt or sand close by for icy steps and walkways. Watch out for slippery sidewalk surfaces in shopping malls, and even outdoors after a rai

Many health problems found in the older population segment can cause or contribute to falls: Parkinson’s disease, pneumonia, and osteoporosis (thinning and weakening of the bones).

Osteoporosis is particularly dangerous because a woman MAY NOT KNOW SHE HAS IT. Hips or limbs can be fractured after a light fall, or even from bumping into the corner of a counter.