September 2007 - Health and Wellness
Dry eyes can be problem, especially in the elderly
By Ann L. Rappoport
If you’ve ever suffered from dry eyes, you can appreciate Shakespeare’s comparison of tears to pearls.
Dry eyes and related conditions account for at least one in five patient visits, notes Dr. Robert S. Bailey, instructor of ophthalmology at Jefferson Medical College and director of cataract and primary eye care at Wills Eye Institute.
“Practically everybody over 40 has some dry eye condition,” says Dr. William Kellogg, an ophthalmologist at Progressive Vision Institute in Northeast Philadelphia and other sites.
“But there are different degrees of severity,” he points out.
Maybe itching and burning in your eyes is driving you crazy. Perhaps you have the annoying feeling that something is in your eyes you can’t get out. Maybe you are experiencing some blurring. Or maybe you’re in pain. If any of these symptoms persist or recur, you’ll need a professional eye exam.
Three levels of tears
The normal eye has three layers of tear film to lubricate and protect it — the mucin, aqueous and lipid layers. A system of tear secretion glands and drainage ducts works with the eyelids so the tears clean and support eye function. Defects in any of these layers or systems can cause dry eyes and interfere with clear vision.
For instance, the lacrimal gland supplies tears to the tear film. Bailey says this is the main culprit of dry eyes as we age — there’s simply not enough tear production. Why does the body cease producing enough of this vital lubricant? Kellogg responds, “Why do our lips, skin and elbows dry out? The difference is that we don’t depend on our elbows to see!”
Many factors can decrease tear production, thereby irritating eyes. Medicines for high blood pressure and allergies (both decongestants and antihistamines) can cause or worsen dry eyes, the physicians explain.
Environmental irritants, like forced air (heat or cooling) and wind, tend to dry out the eyes. Contact lenses and LASIK surgery may exacerbate the problem.
Prevention and treatment
Preventive steps include humidifying the air, repositioning air vents to avoid strong currents, and wearing sunglasses to block wind outdoors. Adjust your computer screen or reading material downward so your eyelids cover your eyes more than when you have to look upward, advises Bailey. Drink plenty of water, they agree. Kellogg emphasizes a healthy diet and says supplemental omega-3 fatty acids support corneal health and reduce dry eyes, and some allergy drugs can be applied topically as eye drops to avoid the drying caused by common allergy medicines.
The many brands and types of over-the-counter ocular lubricants (artificial tears) include solutions with or without preservatives, and liquids or gels. Your choice depends on the sensitivity of your eyes and how frequently you need to lubricate. Gels work longer, but because they temporarily goop up your vision, patients generally use them at night. Liquid drops can be applied any time of the day.
Another way to treat dry eyes is to decrease drainage, so tears remain in the eye longer. Inserting a tiny “punctual plug” into outflow passages in the corner of the eyelids is a short office procedure, reportedly painless. Dr. Kellogg performs about 10 of these procedures a week.
Restasis can help
In many patients, inflammation is the cause of dry eye syndrome. Steroid drops have been used as a short-term measure, but another medication, cyclosporine, has been introduced in lower dosage as a topical drop (brand name: Restasis). This prescription drop has fewer side effects than steroids, according to the doctors, but it is not cheap, and must be used consistently for a long time.
Some eyelid, skin and gland conditions contribute to dry eye, and can be successfully managed. A combination of particular cleansing regimens and prescribed drops usually keeps the irritating effects under control.
Increased awareness of the causes of dry eye, along with improved treatments, equals relief and reassurance to millions. The rare situations when eyelid surgery is required or when dry eye can cause severe pain or harm to the cornea can generally be prevented or avoided by prompt examination and treatment.
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By Cathy Green
Most people know the College of Physicians of Philadelphia as the home of the somewhat creepy Mütter Museum of medical oddities and the Benjamin Rush Medicinal Plant Garden at 19 S. 22nd St.
But the nation’s oldest professional medical organization, founded in 1787, is more about the future than the past. Its website, www.philly
healthinfo.org is a comprehensive source of information.
The site is well organized and easy to navigate.
Main categories are:
• Health Topics, an alphabetical listing from Abortion to Youth Violence (there is no Z subject). If you’re not sure of the designation, you’ll be guided to the right place. For example, Advance Directives will lead you to End of Life Care.
• Local Health Services, with a map of the five-county area. Click on a county and choose a health topic from an alphabetical list; then choose the type of service dealing with that topic. The list includes clinics, support groups and specialty medicine.
• Local Health Events, a monthly calendar — click on a date and a listing of that day’s events will appear.
A recent version of the site also included summer-related articles on healthy swimming, sunscreen and beating the heat. There was also a list of farmers’ markets in the five-county area, giving dates and times of operation.
Phillyhealthinfo.org was founded by the late Dr. Thomas Langfitt, a past president and board member of the college.
For health-related information, this website looks like a good place to start.
Sometimes ‘reverse’ procedure better,
orthopedist suggests
This is another in the “Focus on Wellness” series, in which medical specialists write about matters of concern to older Philadelphians. The views expressed do not necessarily represent those of Milestones or Philadelphia Corporation for Aging.
By Dr. Gerald Williams Jr.
By the time we reach our 60s and 70s — after years of throwing, lifting, reaching and twisting — our shoulders can ache. Like knees and hips, shoulder joints sustain so much wear and tear over time that arthritis can strike, cartilage can tear and active lifestyles can be significantly affected.
Shoulder pain can sideline seniors from their favorite activities, forcing them to alter their active lifestyles. Tennis, gardening and golf, for example, can become unbearable because of shoulder pain.
Moreover, shoulder pain disrupts routine activities, making eating, dressing and combing hair burdensome.
While shoulder pain, in many cases, can be treated with conservative care — such as exercise, cortisone injections and medication — the more severe injuries, like a torn rotator cuff, often require surgery. Fortunately, one of the latest breakthroughs in orthopedic medicine is a new surgical technique for shoulder repair.
Less painful alternative
Reverse shoulder replacement surgery is an alternative to traditional shoulder replacement surgery. It is often the best option for treating pain and disability associated with a completely torn rotator cuff, severe osteoarthritis or a previously failed shoulder replacement.
Meeting Food and Drug Administration approval in 2004, reverse shoulder replacement surgery entails reversing the ball-and-socket device that is used in traditional shoulder replacement surgery. Changing the anatomy of the shoulder, this can relieve pain, increase stability and drastically improve range of motion.
Reverse shoulder replacement surgery has helped 75-year-old Charles Tourtellotte of Haddonfield, N.J., resume a pain-free active lifestyle.
Prior surgery fell short
Tourtellotte, who is a retired physician, suffered severe rotator cuff damage over time, caused by golf, tennis, skiing and fishing.
He first underwent traditional replacement surgery to repair his left shoulder, but the pain persisted and his shoulder would often dislocate.
After undergoing reverse shoulder replacement surgery last November, followed by physical therapy, Tourtellotte has restored motion and strength in his new shoulder and little pain.
If you have shoulder pain, visit an orthopedic surgeon for an evaluation. It’s likely you will not need surgery to treat the pain, but if you do, take comfort in knowing that advanced treatment options, like reverse shoulder replacement surgery, are available.
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Fewer than half taking advantage
of the services
Medicare has been adding preventive and screening services, but it hasn’t been easy getting people to use them.
Fewer than half of Medicare’s 43 million beneficiaries have been taking advantage of the flu shots, physical exams, mammograms, smoking cessation counseling and other services.
“There’s not a real understanding that these benefits are available,” said Herb Kuhn, Medicare’s acting deputy administrator. “We want to get the word out.”
That’s why Kuhn and other Medicare officials have been on tour, meeting with doctors, hospital and medical school representatives, and state and local health personnel, drumming up interest in prevention.
Many Medicare beneficiaries suffer several chronic illnesses that could be avoided or better managed through preventive care. So, Medicare says it’s changing the way doctors are paid, to give a financial incentive to shift from treatment of diseases to prevention.
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To guide older patients in speaking with their doctors, National Institutes of Health (NIH) are offering “Talking With Your Doctor” on http://www.nihseniorhealth.gov, a website NIH has developed with older people’s needs in mind.
“Communicating with your doctor is important to your healthcare, especially as you age and are more likely to have health conditions and treatments to discuss,” pointed out Dr. Judith A. Salerno, National Institute of Aging (NIA) deputy director. “The key is to know how to have that conversation.” NIA is a component of NIH.
The website features tips on, among other things, how to prepare for a doctor visit, what to ask, what information to provide and how to understand what the doctor says.
If you’re “cognitively active” (that means you engage in mentally stimulating activities, such as reading, chess, etc.), you’re less likely to develop Alzheimer’s disease.
That’s the conclusion reached by Chicago researchers reporting their findings in the online edition of Neurology, the medical journal of the American Academy of Neurology.
In the Rush Memory and Aging Project, a study involving more than 1,200 older people, it was concluded that a person who is cognitively active was 2.6 times less likely to develop dementia than one who is not.
Dr. Robert S. Wilson, study author, suggested the findings may be used to help prevent Alzheimer’s disease.
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“Comfort Touch Massage” has been introduced at Life Choice Care and Comfort, a hospice in Fort Washington. It’s a massage technique tailored to the elderly and ill.
Nurses, certified nursing assistants and volunteers have been learning the new technique in an in-service workshop for caregivers developed by Marytheresa Vogler, the hospice’s director of volunteer services.
Its primary intention is to provide comfort to patients through deep relaxation and pain relief.
For information or to volunteer, you may contact Vogler at 800-557-7570 or
www.lifechoicehospice.com.
Makes her feel ‘brand new,’ says
oldest student, 87
By Joe Clark
Kind Essence (“it’s my spiritual name”) is a woman of many bonnets - which she identifies as “caregiver, healer, writer, teacher, performer.”
She’s also a “born clairvoyant,” she says, but she didn’t foresee the most recent bonnet she’s donned — teaching “Gentle Chair Yoga” to seniors in North Philadelphia.
For just about a year, this one-of-a-kind 57-year-old Wynnefield grandmother has been conducting yoga classes on Fridays at Tioga Senior Center for men and women whose average age is the mid-70s.
Wheelchairs, canes and walkers are common sights in her classroom.
“The biggest effect is the improvement in their agility, balance and confidence,” says Kind Essence. “They also breathe and move better. I get them to walk, not shuffle. Most important, they’re doing something.”
Crash ended career
“The beginning was rough,” added Kind Essence. “Most were not familiar with yoga.”
Kind Essence herself was not too familiar with yoga, until an auto accident put an end to a promising dancing career, when her interest “really kicked in.”
A native of Camden and graduate of Glassboro State College (now Rowan University), the former Karen Thompson settled in New York and taught elementary school. She also pursued a singing, dancing and acting career, performing in off-Broadway musicals with an eye on Hollywood.
But in 1994, she recalls, “Boom, I was in a car crash. It took me a year to learn to walk again.”
Caregiver for two
Part of her therapy was taking classes in yoga. It was her first experience with the mental-spiritual-physical healthcare system. It would not be her last.
Three years ago, she returned to New Jersey to visit her mother, 80, who, she was shocked to learn, had Alzheimer’s disease. Although they often spoke on the phone, she says, her mother had been “able to cover it up.”
Kind Essence returned to care for her mother and an 82-year-old aunt in Wynnefield, who also has Alzheimer’s.
Traveling back and forth between South Jersey and Wynnefield began taking its toll on her. She enrolled in a yoga class to “relieve the stress. I needed to do something to save my sanity and health.”
Finding “peace in this confusing time,” she became a certified instructor. Applying the technique to her mother and aunt, she says she “immediately saw results.”
Class makes senior ‘feel new’
She contacted senior centers in Philadelphia, inquiring whether they were interested in her innovative yoga classes. A handful were started, but over the years, her classes have been reduced to just the Tioga Senior Center.
For her classes, she says, Tioga’s sewing room has been transformed into a “place of peace,” where class members move toward “wellness and healing.” Using props like neckties and Styrofoam blocks, Kind Essence’s “yoginis” begin class sitting in a chair raising their arms and moving their feet.
“You don’t know how hard that is for some of them,” said Kind Essence, “but this is the beginning of their empowerment.”
Mamie Whitefield, 87, is Essence’s oldest student.
“Before I started, I just sat around thinking I couldn’t do anything,” said Whitefield. “I’ve never participated in anything like this before. It makes me feel stronger and better. When I leave class, I feel brand new.”
2 classes every Friday
Friday classes in “Gentle Chair Yoga” are taught at 1 p.m., and “Yoga Soul” at 3 p.m., at Tioga Senior Center, 1531 W. Tioga St. For information, you may call the center at 215-227-9999 and ask for Benita.
Kind Essence is available for private and public classes and public speaking at 856-287-7070 or 215-877-3681.
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For one day (Sept. 9), some major arteries
will be auto-less
By Linda L. Riley
“The car is no longer king,” says 64-year-old Hans van Naerssen,
board president of the Bicycle Coalition of Philadelphia and co-chair of “BikePhilly.”
“BikePhilly,” Sunday, Sept. 9, will open up some of the city’s major arteries to bike traffic only, offering easy and challenging routes for a recreational ride, and culminating with a Finish Line Festival. Designed to promote biking, the event will raise funds to support better trails and biking safety.
Van Naerssen’s cycling advocacy started in 2004 when he retired as a partner at Unisys Corporation. At about the same time, a massive expansion of Route 202 blocked both foot traffic and bicycle access to a shopping area near his home. He went to a Tredyffrin Township meeting to complain, and was told by one of the supervisors, “We will never build a sidewalk.”
He set out to prove that statement wrong by initiating a 10-year plan, which is well under way, to interconnect the township’s parks, schools and shopping with sidewalks and trails.
A 13-mile bike commute
Van Naerssen’s love of biking had its roots when he was in graduate school, and took a summer job leading teens across Canada and Switzerland on bike trips. The experience started to heal the disillusionment he had experienced while serving in Vietnam; “it rejuvenated my faith in humanity,” he said.
Over the years, his interest waned, but was rekindled in the 1990s, when he started to gain weight and began biking to stay fit. That turned into commuting to and from work by bike, 13 miles each way, between Wayne and Blue Bell.
Since then, he has branched out.
“I’ve biked the Canadian Rockies, the Florida Keys,” he said. One of the best rides was Cycle Zydeco in Louisiana, because “the first thing you do is learn to dance the Zydeco two-step.”
Wants to ‘make a difference’
In 2004, van Naerssen and five friends, ranging in age from 40 to 65, made a 4,200-mile cross-country bike trip from Avalon, N.J., to Astoria, Ore, The credo for that trip: “We’re not going to cook; whiners will be left behind; and we finish every day with time to have a beer, dinner and a shower.”
The exhilaration of the ride is only part of what motivates him; activism and advocacy are also key.
“Life is short, and I want to be remembered for more than just having kids, or having worked at a job for so many years, or even making X dollars for my ego,” van Naerssen said. “I want to be remembered as making a difference. I want to help improve conditions — in my case bicycling, pedestrian, environmental and political — in my little corner of the world.”
To register for BikePhilly: http://www.bikephilly2007.com or 215-242-9253.
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