BY DR. DELISE DICKARD

“Two roads diverged in a yellow wood…” You probably know the beginning of this century-old poem by Robert Frost.  And you probably know that the traveler was sorry he could not travel both but took the one less traveled “because it was grassy and wanted wear.”

I was reminded of it the other day when someone said to me of a troubled past: “I had to live through it once, and I’ll never waste a moment thinking of it again.” After a decade of specializing in treating trauma, I know that the method of just trying not to think about “it”   rarely works in the long run.

The remark also reminded me of the many myths that people buy into about therapy, and how those who tackle the hard issues in therapy are often taking the road less traveled.  It isn’t always the easiest path.  Sometimes, we may have to whack back some weeds, learn the ivy that is poisonous to us, and find our own way when the path isn’t clear.

Below are some of the biggest myths about therapy—myths people debunk as they begin the journey toward mental wellness.

Myth No. 1:  Traumatic experiences can be locked away and never cause trouble again.

As someone who has treated trauma for a decade, I would love to say this can happen without any work on the part of the victim.  In fact, it may get packed away, but this baggage can fall right back in your lap at the most inconvenient times.  If you’ve experienced trauma, you probably know this already.

Fortunately, we have effective treatment to help the brain process trauma, whether the violation occurred yesterday or many decades ago.

Myth No. 2: Only crazy people need to seek therapy.

I don’t like the word “crazy.” I think in terms of the difficult problems many people experience—sometimes because of life circumstances, and sometimes because of underlying differences in how our brains work.

People need therapy for all sorts of reasons, and those with the most severe problems may  not recognize the need to get help on their own. (So if you are asking yourself “Am I crazy?” then you are probably not.)

Many people who seek therapy simply have some sort of struggle in their lives.  It may be with anxiety, depression, low self-esteem, family dysfunction, trauma, stress, parenting issues or marital problems.  A therapist can help you understand your particular struggles and help you deal with them with tools you learn to incorporate into your life.

If it is discovered that your brain is misbehaving in some way, then that is all the more reason to find the tools to learn about it and move past it so you can lead a rich and more fulfilling life. Therapy is about healing, and not about negative labeling.

Myth No. 3:  People only seek therapy because they don’t have good enough friendships.

While the bond between client and counselor should feel genuinely strong and healthy, like a great friendship, a therapist has something that a friend can’t offer.  Objectivity is present, because the therapist is not involved in the problem personally.  Plus, the time spent together should be all about you.

If you are connected with your therapist, you will care about them, but you don’t have to take care of them as you might need to take care of a friendship.  Your situation, problems and opinion are seen as the most important aspect of the relationship.

Ideally, the therapist’s mental health expertise can help you find patterns that have created despair—and tools to help remedy the psychological wounds.

Myth No. 4:  If you have been to therapy once and it wasn’t helpful, then therapy doesn’t work for you.

The match between client and therapist is very important. This involves not just the therapist’s speciality, but the mix of personality traits and therapeutic approaches he or she uses.

It isn’t one size fits all.  Most therapists know they aren’t the perfect match for every client, and you may have to try one or two therapists before you feel the connection necessary to do good work together. It’s worth the effort.

Myth No. 5: If people know you have been to therapy, then they will see that as a weakness, illness or failure.

Typically, clients get better when they are getting the help they need, and when your true friends notice this improvement, instead of berating you, they might actually ask for a referral.

EXAMINING YOUR LIFE

Socrates’ bold statement that “The unexamined life is not worth living” has gotten much attention over many, many years.   His words may conflict with messages we get from our culture like “in life, the person who accumulates the most stuff wins”  or  “life is a matter of simply maximizing fun.”

But many great thinkers believe that fulfillment comes from examination and learning from—not just  escaping—pain.   It comes in the hard work of finding a sense of purpose in our lives.

Not everyone needs therapy, of course, to lead a life of fulfillment.  But if during self examination you find that you do need some healing or understanding in certain areas, hopefully these myths won’t cause you to shy away from getting the help you need through therapy.

You may know that many people, therapists and clients alike, got together last week to walk for mental wellness.  May is a month when mental wellness will be celebrated all over the country.

In most communities, including ours, clinicians  work together to help clients get back to wellness so that at the end of treatment, they  can say in one way or another:

I took the road less traveled by,
And that has made all the difference.

Dr. Delise Dickard,  a licensed professional counselor, is the director of Riverside Counseling in Fredericksburg. She welcomes reader comments and questions. For contact information, see riversidecounseling.org.

Editor’s note: This story will appear in Healthy Living on Sunday, May 6.

By CATHY DYSON

When Kristie Hurst looks back at the events surrounding her daughter’s birth—and eventual diagnosis with a rare disease—she has to believe there’s a purpose to everything that happens in life.

“I feel like she overcame quite a few obstacles to be here,” Hurst said about her baby girl. “There’s got to be a reason.”

Hurst had her tubes tied after her second child was born, then got the surprise of her life almost eight years later. That’s when she became pregnant with Jacey, who was born on Aug. 27, 2010.

It’s rare but not unheard of for women to conceive after tubal ligation, or having their fallopian tubes tied. Medical websites say the procedure is 99 percent effective in preventing pregnancies, but the effectiveness rate does decline slightly after the first year.

The pregnancy was the first of several shockers for  Hurst and her husband, Johnnie, who live in Unionville in Orange County. Hurst, now 38, learned the day she came home from the hospital with Jacey that she’d lost her job with a community agency.

Soon after Jacey was born, Hurst, who has two older sons, Philip, 18, and Johnnie, 10, noticed that “something wasn’t right” with Jacey, but couldn’t identify the problem. Doctors couldn’t, either, except to say her baby had been born with a heart murmur and eyelids that drooped slightly.

FINALLY, A DIAGNOSIS

The Hursts pushed for more tests, to give a name to the lingering suspicion that something was amiss in Jacey’s actions and appearance.

When Jacey was 14 months old, a cardiologist did a genetic screening that determined she had Williams syndrome. That was the first time her parents had ever heard of the disease, caused when part of a chromosome is deleted during conception.

In most cases, the child with Williams syndrome is the only one in the extended family to have it, according to the Williams Syndrome Association. It causes various types of cardiovascular disease, including some so severe that  open heart surgery is required. It also includes a range of developmental  issues, learning disabilities and problems with eating and hearing, kidneys and hernias.

Now 20 months old, Jacey has pulmonary stenosis, a narrowing of the artery from her heart to her lungs, which causes shortness of breath. She has had surgery to correct the way her eyes turn in, and her mother suspects she has issues with depth perception.

Hurst believes that’s why Jacey cries a lot when she tries to stand by herself. She’s about six months behind the normal age when babies toddle on their own, but she’s plenty active—and flexible—as she crawls and scoots on the floor. Her favorite game is to stand in her mother’s lap. She clasps her mother’s hands and jumps up and down on the balls of her feet.

Williams syndrome affects one in 10,000 people worldwide, or an estimated 20,000 to 30,000 people in the United States, according to the Williams Syndrome Association. Hurst has met many health care providers who are as clueless as she was.

“I feel inadequate trying to explain Williams syndrome because I don’t understand it myself,” the mother said. “But I just have to feel like I’m doing something for her.”

A QUEST FOR KNOWLEDGE

All her life, Hurst has believed in two basic premises: Things happen for a reason, and the more she knows about something, the better she understands it.

Her quest for knowledge about Williams syndrome led to a professor at the University of Kentucky who has studied the disease for 18 years. Dr.  Carolyn Mervis, who couldn’t be reached for this story, wrote the profile commonly accepted for Williams syndrome patients, according to the association’s website.

Hurst takes Jacey to Louisville once a year for an exam. She also talks on the phone with the doctor monthly. She asks if the allergies and acid reflux—which both her sons had—are worse for Jacey because of the syndrome. She wonders how Jacey’s vision problems may interfere with her walking. She asks about weight gain and tells her how Jacey is coping with whole milk.

Sometimes Hurst doesn’t get her questions answered, especially when she wonders what kind of life her child might have as an adult. So Hurst deals with one appointment at a time. She regularly sees specialists at the Lee’s Hill office of Children’s Hospital of Richmond at VCU.

When Mervis said Jacey needed more physical therapy, her  mother scheduled sessions once a week.  She arranged for speech therapy. She consulted with other parents she met through the association’s support group.

“It’s amazing how much information that a Williams syndrome  family has that the doctors don’t have, because they’ve been through it,” said Erin Rupolo, a mother in Rockville, Md., whose 3-year-old daughter has the condition.  “We share triumphs, we share the sad stuff, the medical questions. The support is amazing.”

RAISING AWARENESS

Hurst and her family have always been private people, but she decided it was important to raise awareness of Williams syndrome. She scheduled a walk, picnic and family fun day on Saturday at the Ron Rosner YMCA in Spotsylvania County.

Hurst is hoping at least 50 people will participate in “Jacey’s Walk for Williams,” one of about 100 events during Williams Syndrome Awareness Week.

Lora Schoenberger, who lives in Spotsylvania County, hopes the walk will encourage other parents who feel  something is wrong with their child to press for  a diagnosis as Hurst did.  Schoenberger’s sixth child, Talysa, has Williams syndrome.

Rupolo admires Hurst’s courage in going public with her private battles. “I think she’s amazing,” Rupolo said. “So many people can climb into a hole and just be silent. It’s so important to raise awareness.”

Hurst might call it her reason for being.

ABOUT THE EVENT

This is the third year of Williams Syndrome Association Week, May 5–13. Kristie Hurst of Orange County has organized the first local observation, planned for Saturday, May 12, at the pavilion  at the Ron Rosner YMCA in Spotsylvania County.

The event begins at noon and includes face painting, a picnic lunch, a raffle and a walk.   The Williams Syndrome Association will provide free T–shirts to registered walkers.

 The cost is $15 per person or $40 for a family of four. More information is available at walk4williams.org or 800/806-1871.

A SENSE OF PURPOSE 

When Kristie Hurst ponders the reasons things happen, she thinks about her daughter, Jacey, and her late father, James Cooke. Her father was her best friend. They ate lunch together almost every day and talked regularly until he died of cancer in June 2009.

A few months later, she became pregnant with Jacey—something she thought wasn’t possible because she’d had her tubes tied eight years earlier. Hurst used her father’s initials—J.C.—to form her daughter’s first name.

“When he died, I wondered how in the world I was going to get along without him,” Hurst said. “Sometimes I think that she’s here so that I could get through it.”

ON THE NET: Williams Syndrome Association: williams-syndrome.org.

Cathy Dyson:   540/374-5425
cdyson@freelancestar.com

Editor’s note:  This column will appear in Healthy Living on Sunday, May 6, 2012.

BY JENNIFER MOTL

The basis  of delectable dishes worldwide, onions also have a surprising capacity to shield against cancer.

Often overshadowed by more colorful veggies, humble onions nonetheless play a supporting role in favorite foods around the world, from chili to guacamole and almost all gourmet French and Italian sauces. And caramelized onions are savored in most cuisines.

When measured by how many tons are grown, onions are the second most popular veggie on the planet, surpassed only by tomatoes.

Onions’ versatility may be the reason they are so prized. Ancient people in China, Egypt, Rome and Israel all ate onions. By the Middle Ages, Europeans were using onions not just as food but also as wedding gifts and rent payments, according to the National Onion Association!

PUNGENT AND NUTRITIOUS

Onions are one of the first veggies available in spring—packed with fresh flavor and a good buy at the farmers market right now.

Celebrated for their pungently delicious flavor, onions pack a surprising amount of nutrition per bulb. Onions are a fairly good source of vitamin C for a vegetable—a cup of onions provides about 20 percent of your daily value. A cup also has 3 grams of fiber and 10 percent of your needs for vitamin B6.

Beyond vitamins, onions also provide antioxidants. They are particularly rich in quercetin, also found in tea and apples. Quercetin has been linked to lower risks of heart attacks and several cancers. And red and yellow onions also contain anthocyanins, another protective chemical.

Beyond the nutrients that onions themselves contain, onions actually help the body absorb minerals from other foods. Indian researchers found people absorbed more iron and zinc from grains and beans that were prepared with onions.

ONIONS PROTECT HEALTH

Onion lovers have lower rates of cancers of the stomach, colon and prostate, according to some studies comparing folks who eat the most and least amount of onions.

Like some other seasonings, onions also are mildly antibacterial and antifungal. That means cooking with onions may slightly reduce the risk of food poisoning, though you still need to wash your hands and cook foods properly.

Onions may protect the heart by reducing unwanted blood clots. And Japanese researchers say they’ve found protective compounds from onions in the aorta, the body’s largest artery, like a superhighway from the heart to the rest of the body.

Surprisingly, onions may strengthen bones despite their lack of vitamin D and calcium. Older women who consume onions daily may reduce their risk of hip fracture by more than 20 percent compared to women who avoid onions, according to researchers at Medical University of South Carolina.

HANDLE WITH CARE

Raw onions can make your eyes water, but cooked right, will make your mouth water.

You may wonder how to keep your breath and hands sweet when handling onions. If you’re worried about your breath, choose cooked onions rather than raw ones.

If you can’t resist raw onions, consider freshening your breath afterward by munching on a sprig of parsley or sipping water with a lemon wedge, suggest the experts at the National Onion Association. Lemon juice can also remove onion odor from your hands.

SAVING THE NUTRIENTS

While all fresh onions contain beneficial flavanoids like quercetin, smaller onions were more concentrated sources, according to Korean researchers.

They also found how we cook onions affects flavanoids. Fried onions had 33 percent less. Sautéing, boiling or steaming onions reduced flavanoids by 14 to 21 percent. Microwaving caused a 4 percent loss. Baking was the best method—no flavanoids were lost.

I found a fabulously easy recipe for roasted onions. Here it is, adapted from Cooking in the Moment by Andrea Reusing. Plonk whole, unpeeled onions on a cookie sheet and roast at 425 degrees for an hour or until skins are brown and blistered and inside is tender when poked with a knife. You can slice the tops off onions and serve in their skins if you like. I prefer to slice the tops and bottoms off the onions. Then the skins slip off in one piece.

I tried the recipe last week, and one hour of baking produced juicy, translucent savory-sweet onions. This recipe is by far one of the laziest and best-tasting ways to cook a veggie—a happy combination. Next time, I think I’ll try roasting the onions even longer to see if they caramelize slightly.

Whether you use onions as the basis of a sauce or as a starring dish on their own, they are one of the most savory and nourishing veggies around.

Jennifer Motl is a registered  dietitian. Formerly of Fredericksburg, she now  lives in Wisconsin. She welcomes reader questions via her website, brighteating.com, or by email at healthyliving@freelancestar.com.

Editor’s note:  This story appeared in the Healthy Living section on April 29, 2012.

BY FRANCES WOMBLE

Sharon Westerlund is a big fan of pedicures.  But she doesn’t frequent a salon at the nearest shopping center for her foot needs.  Instead, Westerlund goes to Anh Hastings, a certified medical nail technician who works in the office of Rappahannock Foot and Ankle Specialists.

Hastings provides a level of knowledge and experience that Westerlund said exceeds what she has found at nail salons.

“I’ve been seeing Anh for about two years now,” Westerlund said.  “If something is wrong with my foot, she can tell.  I just like going to the doctor’s office better.”

Hastings worked as a nail technician at salons for years before deciding to pursue certification as a medical nail technician in 2002.

Medical nail technicians are licensed by the state after successfully completing advanced education and training.  They are taught to recognize problems such as fungus, and they learn advanced nail and foot care. An internship with a podiatrist is a standard part of MNT training.

“Many people are surprised to learn I completed internships,” Hastings said. 

Hastings’ work space resembles a typical room at a doctor’s office—except  that a salon chair with a foot bath stands in the middle of the room instead of an examining table.

Working out of a physicians practice gives her clients peace of mind, she said.  It’s what prompted Westerlund, of Fredericksburg, to seek out Hastings for pedicures.

“I know I’m never going to have to worry about my health with Anh,” Westerlund said.

‘THEY ARE SAFE’

The $45 pedicure Hastings provides includes everything people expect from a salon pedicure—nail polishing, callus removal, filing and a foot bath. But there are additional benefits.

Medical nail technicians like Hastings use special cleaning protocols for equipment and tools that aren’t required at all salons. The protocols are in sync with experts’ advice on how to ensure safety during pedicures.

The American Podiatric Medical Association urges people to be aware of the risks involved in getting pedicures. Unsanitary conditions can lead to the spread of foot funguses and bacteria, for example, and sharp tools in inexperienced hands can lead to wounds.

Because of the risk of suffering a cut during a pedicure as the technician tackles calluses and nails, experts say pedicures should be considered surgical procedures, not beauty procedures.

The podiatry association warns that people with diabetes or poor circulation need to be especially careful, as they are more susceptible to  foot infections and complications from wounds.

Pedicures should be scheduled first thing in the morning—whether you’re diabetic or not—because foot baths are cleaner earlier in the day, the APMA says.  The association encourages clients to bring their own pedicure utensils to salons to prevent the transfer of bacteria and funguses. The association also encourages people to be “picky” about whom they trust to give them a pedicure.

Those who see a medical nail technician have less to worry about; Hastings said her training has guided her to go above and beyond state cleaning guidelines.

The guidelines include sanitation procedures to prevent the spread of germs. Fewer than 25 percent of salons follow state disinfection protocols, OSHA reports,  leading many to seek out nail technicians with extra training.

“It doesn’t matter [what time of day] patients come,” Hastings said.  “The water is changed and sterilized between everyone, so it is always clean.”

In addition to changing the water after each client visit, Hastings said that between appointments she uses medical-grade bleach to sterilize everything that comes into contact with patients.

She soaks pedicure utensils in a cleaning solution, similar to what patients see at a dentist’s office.   And Hastings said she goes one step further than the state’s health guidelines: Every month, she sends cultures from pedicure equipment in her office to a laboratory to make sure bacteria are not transferred to patients.

The end result, she said, is that clients can “feel very comfortable.” She said health care professionals including nurses and pharmacists see her for pedicures on a regular basis.

“They like pedicures but know the health risks,” she said.  “Here, they know they are safe.”

‘VERY KNOWLEDGEABLE’

Medical pedicures are ideal for people who want to be pampered but have  health problems such as diabetes or poor circulation, the APMA says. A great number of Hastings’ patients are diabetics and people taking blood thinners.

“Those patients can’t go to salons because of their health, so they come see me,” she said.

Medical nail technicians such as Hastings are trained to know when something is wrong with the foot.  The APMA says lack of visible injury does not necessarily mean the foot is healthy, and a medical nail tech is trained to determine if something is wrong.

“I always begin a pedicure with examining the feet,” Hastings said.  “If something is wrong, the doctor is right here.  It’s easy for patients to get a problem taken care of.”

Barbara Malloy, 90, said her husband first went to see Hastings because of a fungus, and Hastings saw a bigger concern.

“[Hastings] did us a great favor,” Malloy said.  “She noticed a lump on my husband’s foot.  She told us he needed to see the doctor.”

The lump was pre-cancerous and, fortunately, treatable.

“I’m very blessed to catch problems and help people,” Hastings said.

Malloy now regularly visits Hastings for foot care.

“It’s difficult for me to cut my nails, and Anh takes great care of me,” Malloy said. “She is very knowledgeable.”

The Malloys aren’t the only couple to visit Hastings together. Hastings said a large number of men come to her for foot services.

“Women refer their husbands and boyfriends,” she said.  “The men like the privacy of the doctor’s office.  I can close the door, and they don’t have to tell anyone they like pedicures.  It’s much more unisex than a salon.”

MORE INFORMATION
The American Podiatric Medical Association recommends pampering your feet and offers tips for keeping them healthy when getting a pedicure. You can read the advice at apma.org/pedipointers.

To read the government’s recommended disinfecting protocols for nail salons, visit epa.gov/pesticides/factsheets/footspa_disinfection.htm.

Frances Womble: healthyliving@freelancestar.com

Editor’s note:  This column will appear in Healthy Living on Sunday, April 29.

BY DR. PATRICK NEUSTATTER

A report published earlier this month might have caught your attention. It did mine. It lists a whole lot of interventions that doctors order that are very likely a complete waste of time and money—and worse, may be harmful.

The report is titled Choosing Wisely, and it was put together by the American Board of Internal Medicine and nine leading physician specialty societies in combination with Consumer Reports.

Each society came up with five interventions—which is a fancy name for tests or treatments—in its own particular field that are commonly performed but are likely of no value, such as doing Pap smears on women under 21 or giving antibiotics for simple sinus infections lasting fewer than seven days. (See the sidebar and choosingwisely.org for more details.)

The action of the American Board of Internal Medicine was prompted by an editorial in the New England Journal of Medicine written two years ago during the health care reform debate.

Medical ethicist Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas, accused doctors of protecting their income rather than trying to reduce health care costs.

Physicians’ decisions control 80 percent of health care spending, and the claim is that as much as 50 percent of that  spending—representing hundreds of billions of dollars—is being wasted.

WHY THE NEEDLESS TESTS?

“What’s wrong with my doctor that he or she is ordering all these unnecessary tests?” you might ask.

And there’s the rub—and to my mind the key issue of this whole business.

As we spend ourselves into bankruptcy (health care spending is predicted to reach $4.3 trillion by 2019), more and more experts are beginning to look at, and critically question, the status quo. They are looking at the validity of the many established interventions we use whose cost is often more than just money.

There are many coercive factors encouraging doctors to order unneeded tests and treatments:

• Fear of litigation.
• Advertising that promotes tests to some extent  and definitely urges both doctor and patient to want and use specific, expensive name-brand medicines—which are often no better than much cheaper generic drugs.
• Avarice—the doctor might stand to make money from the test. 

Another factor is that doctors and patients feel like tests should be beneficial even if they aren’t—because more information should allay anxieties.

But the principal cause of unneeded testing and treatment is ignorance.

That might sound a bit radical. But too often we follow the “That’s the way it’s always been done” mantra and are too ignorant to know better.

Doctors are “unaware of the negative evidence behind accepted but fruitless health interventions,” noted Dr. David H. Newman, one of those who is skeptical about all the interventions we do, writing in his book “Hippocrates’ Shadow.”

The book is subtitled “What doctor’s don’t know.” In it, Newman—director of clinical research at New York’s Columbia University—knocks many sacred cows, such as antibiotics for strep throat, beta blockers for heart disease, expensive “triptan” medicines for migraines, and the validity of ECGs and mammograms.

GETTING THE FULL PICTURE

This may be making you think your care is in the hands of a lot of ignoramuses, but let me point out that being fully informed is very difficult.

There’s a lot of “lies, damn lies and statistics” about the interventions we use. Mammograms, for example, are commonly accepted as a wonderful, lifesaving intervention. They are recommended by many learned bodies because 75 percent of breast cancers are detected by mammography.

But, as David Newman points out, an in-depth overview of many studies together (a meta analysis), done by the holy of holies in the field of evidence-based medicine—the Cochrane Collaboration—looked at a thing called “number needed to treat.” It notes that you have to do a mammogram every year on 2,000 women for 10 years to save one life.

And in 10 of those 2,000 women, you will detect what appears to be a cancer but isn’t (false positive), or one that would not spread enough to do the woman any harm. This will lead to unnecessary biopsies and possible chemotherapy, radiation, surgery and, unquestionably, a lot of stress and anxiety.

And the radiation from having a mammogram will actually cause a breast cancer in one in every 10,000 women screened.

When it is put like this, many women may have second thoughts. But it very rarely is put like this.

In an article in the Journal of the American Medical Association about the Choosing Wisely program, it’s noted that the doctor discusses the accuracy of a test only 9 percent of the time, and whether it saves lives a mere 1 percent of the time.

BE AN INFORMED PATIENT

I am as guilty as any of telling my patients, blithely, “Oh, it’s time for your mammogram” and not sitting down and presenting the pros and cons in a detailed and understandable way—either because I don’t know them or because it’s so difficult or time-consuming. And this is the case for many, many interventions that we use.

This is where Consumer Reports comes in. Its part in the Choosing Wisely campaign is to work with the medical societies to produce fliers with simply-worded discussions of the pros and cons of the various intervention that are available to patients. The discussions already produced are available at consumerReports.org under “Choosing Wisely.”

So, by doing some reading, you really can have an informed discussion with—and maybe even educate—your doctor.

GROUPS LIST TESTS, TREATMENTS WORTH QUESTIONING

In the Choosing Wisely report, nine medical societies cited five interventions commonly used by those specialties that are often done unnecessarily. Each group then discussed those tests and treatments under the heading, “Five Things Physicians and Patients Should Question.”

The American Academy of Family Physicians came up with:

• Don’t do X–rays or MRI scans for low back pain in the first six weeks unless there are “red flags” suggesting such things as infection, tumors or rapidly progressive nerve damage.
• Don’t use antibiotics for sinus infections lasting less than seven days.
• Don’t do DEXA scans to detect osteoporosis on women under 65 or men under 70 with no risk factors.
• Don’t do Pap smears on women under 21 or women who have had hysterectomies for non-cancer disease.
• Don’t do electrocardiograms or other cardiac screening for low-risk patients without symptoms.

A survey done by Consumer Reports of nearly 1,200 healthy 40- to 60-year-old men and women in 2010 showed that 44 percent had received screening or tests for heart disease which the organization classified as “unlikely to have benefits that outweigh the risks.”

The Congressional Budget Office says 30 percent of care provided in the United States consists of unnecessary tests, treatments, hospital stays and other services that may not improve people’s health. Shannon Brownlee, acting director of the Health Policy Program, claims it is as much as 50  percent.

The JAMA editorial notes that these medical societies are “genuinely protecting patients’ interests and not simply rationing healthcare,” but that implementation may be difficult “when clinicians and consumers are deluged with advertising promotions.”

ON THE NET: choosingwisely.org

Dr. Patrick Neustatter, a longtime family practitioner, is the medical director of the Lloyd F. Moss Free Clinic. He can be reached at healthyliving@freelancestar.com.

Editor’s note: This story will appear in Healthy Living on Sunday, April 29.

BY DONYA CURRIE

On May 5, Lynn DelaMer will be walking for “the one in four.”

The National Institute of Mental Health estimates 26 percent of people, or one in four of us, will suffer a mental health problem in a given year.

“When I’m sitting in a room in a meeting and there are 12 people there, at least three people there have or are going to have a mental health challenge,” said DelaMer, executive director of Mental Health America of Fredericksburg. “One in four people, that’s a huge number. Cancer’s not that high.”

Yet mental health issues still carry a stigma that prevents some from accessing treatment, despite studies that show counseling and medication often can help.

So for the fifth year in a row, the Walk for Mental Wellness — at Hurkamp Park in Fredericksburg — will seek to raise awareness about mental health.

The event also aims to raise money for the local agency that works to link people with treatment and support. That support includes:

• The Senior Visitor Program, which pairs volunteers with elderly residents.
• Support groups for people who have lost a loved one to suicide or who struggle with depression.
• A Mental Health HelpLine. (800/684-MHAF)

The organization also maintains a lending library on mental health topics and advocates for policy change to improve access to mental health care.

“My whole viewpoint is, the more people who know about us, the more people will use our services,” said Cheryle Hodges, a board member of Mental Health America of Fredericksburg and this year’s walk chairperson. “We really need that awareness put out there.”

She pointed out, too, that the yearly walk is the agency’s main fundraiser.

“All the money we raise stays right here in our area, which I think is awesome,” Hodges said. “I would love to see us be able to fill that park with walkers who are raising money for Mental Health America.”

Good mental health is key for overall health and well-being. Researchers are increasingly making the connection between mental health problems and chronic disease.

For example, someone with diabetes or heart disease is more likely to suffer from depression, and the number of people with chronic disease continues to rise both nationally and in Virginia. Treating the depression can help the physical ailment.

A recent book on the link between post-traumatic stress disorder and chronic disease points to a need for family and community support in addition to treatment.

Yet DelaMer often hears of people forgoing mental health care, because of financial strain or the thought that such care is not a priority.

“Mental health seems to keep being put on that back burner,” she said.

Mental Health American of Fredericksburg will continue to work to change that mindset and link people with the support they need. The local agency relies on United Way funding and donations to survive.

“I think until people need our services, they don’t know who we are,” DelaMer said. “But I think when they find us, they’re delighted.”

For more information, call Mental Health America of Fredericksburg at 540/371-2704, email mhafred@mhafred.org or visit mhafred.org.

WEEKEND EVENTS

• The Walk for Mental Wellness starts at 10 a.m.  May 5 at Hurkamp Park in Fredericksburg. Register in advance at mhafred.org, or at the park an hour before the race. Registration fee is $25; prizes are awarded for raising $50, $75 or $100. Other events Saturday include a silent auction and live music.
• On May 4 at 7 p.m., mental health advocates will hold a candlelight vigil at Hurkamp Park. Former state Sen. Edd Houck will speak and be honored for being  “a huge mental health advocate,” said Lynn DelaMer. At 5 p.m. Friday, an exhibit featuring artwork by people with mental health challenges opens at the pawnshop at 712 Caroline St.

Donya Currie is a freelance writer in Stafford County who regularly contributes to Healthy Living and other health-related publications, including the AARP Bulletin. You can write to her at healthyliving@freelancestar .com.

Editor’s note: This column will appear in the Healthy Living section on Sunday, April 22.

BY JENNIFER MOTL

If you’re a faithful reader of my column, you know I think sodas are bad for your health.

While diet sodas may be marginally healthier than sugary ones, they still may be linked to kidney problems and other health issues.

Drinking regular soda may increase the risk of obesity, diabetes and gout, according to several studies. And the phosphate in both regular and diet colas may be linked to kidney failure, although more studies are needed.

Even children can be negatively affected by drinking soda—researchers link it to the rising rate of childhood obesity. Some studies link sodas to infertility as well, but  this is controversial. And some sodas may even contain cancer-causing coloring and flame-retardant chemicals!

The bottom line: Consider drinking more water and less soda. Soda is not evil, but habitual soda drinkers seem to have a lot of health problems.

HARD ON KIDNEYS

While scientists can’t directly prove that soda causes disease, soda is associated with many ailments. For example:

– Drinking just a small, 12-ounce can of a sugary beverage such as soda each day was linked to a 20 percent higher rate of heart attacks. That’s according to research at Winthrop University Hospital in New York released last month.

The research didn’t prove whether  soda actually caused the heart attacks. Still, the American Heart Association recommends limiting soda consumption.

– Soda also slams the kidneys. New evidence suggests that consuming too much phosphorus may strain the kidneys. Japanese researchers have gone so far as to recommend that even healthy people avoid colas.

We know that severe high blood pressure or diabetes can cause kidney failure. And folks who already have kidney failure have long been warned to avoid high-phosphorus foods such as colas. 

And diet sodas, cola or not, may also be a factor. Drinking two or more diet sodas daily was associated with a 200 percent increase in kidney problems, according to researchers at Harvard Medical School.

MORE HEALTH WOES

Regular sodas can increase the risk of gout. This condition causes painful swelling in the toes and other joints in the body. Women who drank two sodas a day had more than double the risk of gout compared with soda avoiders, according to data from the Nurses Health Study of 79,000 American women.

Another area of concern: sleep. Cravings for caffeinated soda may signal sleep apnea or other silent sleep problems that make people feel fatigued. Folks with severe sleep problems consumed nearly twice as much caffeinated soda as folks with normal sleep patterns, according to researchers at the Johns Hopkins University in Baltimore.

WARNING FOR MOMS-TO-BE

For younger women, soda may be linked to reduced fertility. The more soda a woman drank, the lower her chances of conceiving a child, according to one study. Women who drank three sodas daily were half as likely to get pregnant as women who avoided soda, according to American and Danish researchers.

And caffeine from soda and other beverages may be linked to birth defects such as spina bifida, according to the National Birth Defects Prevention Study. More research is needed.

Beyond effects on fertility, the heart, kidneys and joints, drinking sugary sodas has been linked to fatty liver disease, tooth decay and weakened bones.

KIDS AND SODA

American kids are officially consuming too much sugar, according to the Centers for Disease Control and Prevention. The organization says kids are taking in an extra 280 to 360 calories daily from sugar. That’s far beyond government guidelines to limit both added sugars and fats to 15 percent of calories.

The top sources of calories for kids, from toddlers to teens, were “grain desserts” such as cookies and cakes, along with pizza and soda, according to nationwide surveys.

Eating habits started in kindergarten persist into the teen years. One study found that 5-year-olds who drank the most soda ate poorly overall even at age 15. Compared with soda avoiders, soda drinkers consumed more sugar and fewer nutrients such as protein, fiber, vitamin D, calcium, magnesium and potassium.

We know drinking soda is linked to obesity. Some schools have banned sales of soda; but it’s controversial whether this helps, as some kids just buy soda outside school. Policymakers debate whether taxing sodas might help.

A CHEMICAL CONCERN

Many parents have been up in arms about BPA, a chemical found in plastic baby bottles and the lining of canned foods that may cause health problems. Soda may be a source of BPA.

People who drank more soda had higher levels of BPA in their urine, according to the National Health and Nutrition Examination Survey. The survey did not ask about soda containers (plastic bottles, aluminum cans or fountain beverages).

NASTY ADDITIVES

The caramel coloring in Coca–Cola and Pepsi has been linked to cancer, so the soda makers agreed in March to switch to a different version of the caramel color that doesn’t contain the chemical 4–methylimidazole.

And Mountain Dew and Fanta orange sodas contain another chemical, called BVO, that is considered toxic and banned throughout Europe and Japan, according to a report in FoodNavigator.com.

All in all, soda is not a source of nutrients and  has a lot of calories and some potential links to diseases. While an occasional soda is not likely to cause problems, it may be worth cultivating a taste for unsweetened beverages.

Jennifer Motl is a registered  dietitian. Formerly of Fredericksburg, she now  lives in Wisconsin. She welcomes reader questions via her website, brighteating.com, or by email at healthyliving@freelancestar.com.

Editor’s note: This story will appear in Healthy Living on Sunday, April 15, 2012.

BY KRISTIN DAVIS

I am on my way to bed when I remember I forgot to lock the door. I walk briskly up the carpeted hallway to the front of the house. I am steps away, my hand already reaching for the lock, when I see the man—a stranger on the other side of the door.

I am too late.

The stranger steps into the house. I try to scream. Nothing. I try again. This time, sound comes out, low and unnatural.

Then I awake from my dream, and so does my husband, who has shot upright from his sleep, ready to take on whatever has caused me to yell out. 

I have been talking in my sleep again—practically all night, my husband tells me—and my nighttime soliloquy has turned to shouting just as he has fallen back into his own reverie. I am a freak of nature, I think to myself, although it turns out my behavior might actually be normal.

“Everybody sleep-talks sometimes,” said Dr. Maha Alattar, a board-certified sleep expert with Sleep Medicine Specialists in Fredericksburg.  “It doesn’t necessarily indicate a problem.”

A majority of healthy young adults experience some kind of dream-enacting behavior—actually feeling scared after a frightening dream or smiling when they wake up from a happy one, according to a study cited by the American Academy of Sleep Medicine.

Dream-enacting can also include talking, crying or acting out; more than half the nearly 500 who participated in the 2009 study said they’d experienced such a phenomenon.

Even more reported somniloquy:  speaking or making sounds without being able to clearly recall the dream, according to the study.

Sleep talking usually happens in the lighter stages of sleep, Alattar said, and some think it is associated with dreaming. But no one knows for certain what induces these midnight monologues.

PRATTLING ALL NIGHT

Stress and anxiety may have something to do with it, Alattar said. Some sleeping pills can also cause sleep talking. So can post-traumatic stress disorder and narcolepsy.

Doctors can prescribe medicine to make it stop, but the side effects from those are often more troublesome than the sleep talking itself, she said.

Men and children are more apt to sleep talk than others, according to the National Sleep Foundation, although I am neither. It also says sleep talking tends to run in families; my maternal grandfather is known to yell out as he falls asleep and my mother does her share of subconscious mumbling.

And while it usually isn’t a problem for the sleep-talker, it can be a problem for a sleep partner, Alattar said. The dream of the stranger at the door marked at least the third time in the last year or so I have awakened myself —and my husband—with a strange-sounding shout.

I can sleep for weeks in silence. At other times, I prattle unintelligibly all night long and all week long, with no recollection of it in the mornings. And then there are the nights when my words are perfectly clear, so clear that perhaps they wake me. I will instantly remember my diatribe, and who I was talking to, and, more often than not, the four-letter words that laced it.

In real life, I try to watch my tongue.

RADIOACTIVE RHINOS

What people say in their sleep is no indication of who they are, said Alattar, who was once asked by a woman why her otherwise kind husband would say such bad things when he slept.

 “There’s no intention behind it,” Alattar said. “The primitive part of the brain is acting up.”

What someone says while sleeping is also usually not admissible in court because “it is not a product of a conscious or rational mind,” according to the National Sleep Foundation.

A woman in England, struck by the nonsensical things her husband said when he sleep talked, started a blog that became an Internet sensation. She called it “Sleep Talkin’ Man” and decided to start recording his talk of rainbow goats, radioactive rhinos, kidnapped monkeys and chocolate cream cheese.

There are instances where sleep talking should be taken seriously, however—like if it’s accompanied by violent movements such as kicking, punching or thrashing. That could be a sign of a sleep disorder, Alattar said, or an underlying psychiatric problem.

In those cases, it might be worth undergoing a sleep study, she said. “It could be the tip of the iceberg. Or it could be simple. Ninety-nine percent of the time, it’s an island. It stands by itself.”

Kristin Davis  is a freelance writer living in Fredericksburg.

Editor’s note: This column will appear in Healthy Living on Sunday, April 15, 2012.

BY DR. CHRISTOPHER LILLIS

“Can you tell me about your diet?”  It seems like such an innocuous question, and it’s one I find myself asking my patients all the time. Yet it is a remarkably complex question, and cannot be answered   with a nuanced discussion worthy of its importance in a 15-minute office visit.

If you are health conscious and have been paying attention to the news about diets for the last couple of decades, you should be thoroughly confused.  Low-carb? No-carb?  High-protein? Mediterranean?

Why do the experts change their minds all the time, and why can’t you get a straight answer about what to eat to be healthy?

I am a simple primary care physician without a crystal ball, so I will not be able to provide you with an omniscient answer about the diet you must follow.  But I certainly can synthesize some pragmatic tips to help you get and stay healthy, since you are what you eat.

My first tip for you: Ignore the fads. The Atkins Diet, based on a low-carb/no-carb concept, has proved remarkably successful for losing weight quickly. But it wreaks havoc on the cholesterol levels of my patients and has not been studied in regard to its impact on heart disease. It can be very hard to follow, and once you step off the Atkins diet, rapid weight re-gain is very common. The same can be said about Sugar Busters.

The Paleo Diet seems to be the fad du jour, and I was initially intrigued because I find studying our evolutionary history often helps us understand modern-day questions.  However, the Paleo Diet relies much too heavily on animal protein as a source of calories, and I will explain later why this is problematic.

I won’t go into all of the fads out there, but if there is a cleanse involved, a single food item at the center of the diet (the grapefruit diet, the cabbage soup diet) or something that sounds pseudoscientific (the blood type diet, the Candida diet), then you should probably stay away.

Many of the people promoting fad diets are trying to make a buck off insisting that their simplified diet is the “best.” Hogwash!

What you find if you study fad diets is that anecdotal evidence of their success may abound, but scientific evidence is much harder to find.

PRAGMATIC ADVICE

Now that I have told you what not to do, I bet you are hoping I’ll tell you what to do. Well, I can’t.  Not with military precision.  Not with a step-by-step guide or meal plan or commandments.

When I ask my patients about their diets, I want to know what their daily schedule looks like, what foods they prefer, what is possible and sustainable, since we are all different. I prefer to give guiding principles rather than dictates. Here’s my advice.

First: Chose produce over processed foods. If it is not in a box, can or jar  but rather comes from the produce section, it is best. Nothing beats raw, real fruits, nuts, beans and vegetables in the nutrition they deliver.  They will not contain high-fructose corn syrup. You will get some calories but more water, fiber, vitamins and minerals than with that Twinkie you were thinking about.

Second: Avoid fast foods and eat out seldom.  Restaurants pump sugar, salt and fat into everything to increase the pleasurable taste of their foods.  Portion sizes are large to attract customers.  The result is a remarkably toxic mess of too many calories that expand your waistline and clog your arteries.

Third: If you must eat animal protein, try to keep it lean.  Fish seems to be the healthiest animal protein, while poultry, pork and beef are much more apt to cause health problems (I’ll discuss this more later in the column).

Fourth and perhaps most importantly: Avoid  liquid calories.  There is no redeeming quality to sugary soft drinks.  These empty-calorie sources not only are like gasoline on the fire for developing diabetes, but they cause bone mineral loss and tooth decay. Liquid calories—also found in iced tea and even fruit juices—pack on the pounds for most people.  Try your best to stick to water—it’s what nature intended!

LESS MEAT FOR THE DOC

Now you know what I preach. But what do I do in my own life?

Well, that all changed about eight weeks ago.  My brother, Jason Lillis, is an obesity researcher at Brown University in Providence, R.I.  He sent my family an email about eight weeks ago announcing that he and his wife could no longer ignore all the studies they have been exposed to and were becoming vegetarians.

He asked that my family read “The China Study” by  T. Colin Campbell and  Thomas Campbell Thomas M. Campbell II, and watch the documentary “Forks Over Knives.”   I must say, these works are well grounded in science, much more so that 99 percent of the fads out there.  They encourage a mostly plant-based, whole-foods diet—avoiding animal proteins and certainly avoiding processed foods.

These works highlight the dramatically increased rates of many different kinds of cancers found in societies that consume animal meat, compared with those that do not—a research finding that is gaining scientific steam.

As a result of my brother’s encouragement, my wife and I are eating much more vegetarian.  We still have an occasional piece of fish (not fried) and continue to eat some dairy.  But the beef, pork, chicken and turkey are no longer welcome.  The result has been more weight loss for us both, more energy throughout the day, better sleep and a greater general sense of well-being.

My best advice: Do your own research and watch the film my brother recommends. Try to figure out where you can make improvements in your diet.  Don’t beat yourself up over occasional indulgences, but try to do better on a day-by-day basis. You will feel better for it.

ON THE NET: forksoverknives.com, thechinastudy.com

Dr. Christopher Lillis is an internist with Chancellor  Internal Medicine in Fredericksburg. He can be reached  at healthyliving@freelance star.com.

Editor’s note: This column by Dr. Delise Dickard will appear in Healthy Living on Sunday, April 8.

BY DR. DELISE DICKARD

Loneliness sucks (my kids assure me  that’s not a curse word anymore). Some people will do almost anything to avoid it—jump into a bad marriage, stay in a toxic friendship, remain in a bad job. Some continuously try to avoid loneliness with bad habits such as  drinking or shopping.

But loneliness is just a feeling—albeit a horrible one. It may feel like a mental cloud hanging over your head, and it can be coupled with physical symptoms—a burning in your stomach, or the sensation of a slab of concrete pressing on your chest.

Unfortunately, loneliness visits us all from time to time. Sometimes it moves in slowly, like an early morning fog creeping across a landscape. Sometimes it comes on abruptly, like a door slamming in your face.

It can happen during a death, a divorce or  a nasty breakup, when the nest empties or when a loved one suddenly seems to transform into a bully.

Even though there are many painful passages we must go through alone, we are not hostage to the feeling of loneliness. If we refuse to run from it and just sit with it for a while, we can let the feeling inspire us to recover our own sense of self.

We can reflect on who we are—apart from all the others. We can regroup and decide what we believe and what expectations we have for people who  belong in our inner circle of friends.

But first, we have to find our own internal meaning.  I believe that as humans we inherit a kernel of confidence and a natural pursuit for meaning: our own personal meaning. Even if this kernel is malnourished or has taken quite a beating, we need to go find it, bolster it up and maybe redefine it.

Often, when the voices of rejection and criticism subside, we rediscover our sense of self. We become ready to let go of past rejections and loss, and to look forward to nurturing the potential within ourselves.

By refocusing on our sense of purpose, we can shift from loneliness to action and begin  gathering a healthy support system.

But how does a person put together a new inner circle without falling into the trap of creating one that is just as dysfunctional as the one before?

CREATING A CIRCLE

As adults, we choose who gets to be in our inner circle, and it takes strength to choose wisely—rather than staving off loneliness by taking in  the first person who comes along.

We can be very kind acquaintances to many people, but consider the five or six places in your inner circle special spots for those who merit this privilege. It’s fine to leave a few spots open until the right person comes along.

Here are some helpful guidelines for building a healthy support system:

Look for people who validate your purpose and meaning. When people agree on  things or have similar feelings and beliefs, they validate one another. This draws people together, and validation always feels good.

People are never perfect, but your support people should validate you as a person, even if they disagree with your decisions every once in a while. And, of course, you need to validate them in turn and be patient when you disagree with their choices.

Focus on mutual respect. As your sense of meaning in life deepens, you may find you outgrow some friends. Maybe you had a drinking buddy in college who just never grew up. Maybe this buddy doesn’t really “get” your dedication to your family. It doesn’t mean that you can’t be a caring acquaintance, but it may be hard to maintain enough mutual respect to keep this person in your inner circle.

Remember, it isn’t a judgment of him—it’s only that you are exercising your need for mutual respect. The closest people need to support your purpose in life as you journey forward.

Find comfort. Someone once asked me for help getting over her need for friendships. I surprised her by saying we need close friends, and that it wouldn’t be healthy to get over this need. For one thing, when we have those moments of loneliness we are acutely aware of how important it is to have friends for comfort.

Still, we have to be careful about friends who offer comfort at a price. Even unhealthy friends can make us feel comfortable in the short term—and that can draw us back into toxic relationships.

Motivation matters. Good friends motivate you toward your personal best. They “get” you. They respect your purpose, even as it differs from theirs. But  mostly, they motivate you in a healthy direction. And you, in turn, motivate them to be their  best.

Be flexible. If you can, it is best to choose an inner circle whose members will stay committed to one another for the long haul. Circumstances that come along may challenge your relationship, and if it survives the storms, they will typically deepen your bond.

Flexibility is important because your purpose will be ever evolving and your closest friends need to tolerate your phases of change, as you will need to tolerate theirs.

A TEMPORARY SPOT

If you are struggling with loneliness, you might think this all sounds great—but right now your inner circle has many empty chairs. As a counselor, I have had the highest privilege of joining many people as they struggle to re-create a healthier support system. I am often invited to join the inner circle for a while because I can genuinely offer the needed support: validation, respect, motivation, comfort and flexibility.

But in this role, I am simply an honored placeholder—there until  relationships are repaired or good, lifelong support people arrive. The ending, for me, is always bittersweet. I am truly thrilled that the cloud of loneliness has lifted for my client, but it means it is time for me to relinquish my place in the circle to a more carefully chosen friend.
 
Dr. Delise Dickard a licensed professional counselor, is the director of Riverside Counseling in Fredericksburg. She welcomes reader comments and questions. For contact information, see riversidecounseling.org.