In This Issue

• Speaking To The Hearing Impaired
• Root Canals
• New Blood Pressure Guidelines
• Do You Hab a Code?
• Equilibrium / Coordination Problem
• Exercise For Arthritis
• Exercise Corner -- Squats
• Swan Song

• Make sure you have the person's attention -- saying his/her name, speaking face-to-face, and from a distance of four feet or less can help immensely. Visual cues often help comprehension.

• By reducing background noise, hearing comprehension may be greatly enhanced.

• Speak distinctly (i.e., enunciate)

• Avoid quick subject changes. Make subject transitions obvious.

• Consider lighting -- adequate lighting improves hearing comprehension.

Root canals are a subject not previously mentioned in this newsletter, but I will overcome my prejudices against them, and break new ground. I've never had root canal work done, but I've known some people who have, and they have, to a person, not enjoyed the experience.

I didn't even know exactly what a root canal was. Now that I know I will share that information with you. It might motivate you to do what you can to avoid this particular type of dental work.

A little tooth anatomy: above the gum you see the crown, filled with dentin, a bone-like substance that is harder than bone, but softer than the thin hard layer of enamel. that covers it, and contains no blood vessels

Below the gumline is a root system for each tooth. The roots are covered by cementum, a bone-like substance that is softer than enamel.

It should be noted that dentin is the primary "stuff" of both the crown and root. And that a narrow pulp cavity runs through most of a tooth. Pulp fills the cavity and consists of a loose connective tissue that contains blood vessels and nerves.

The health of a tooth may be compromised by untreated cavities or trauma (a chip or crack). Infection, or pulp death may result. Bacteria in dentin or pulp can lead to infection or inflammation of a tooth, and possible destruction of surrounding bone.

Visit a dentist if you experience any of the following conditions:

• Tooth sensitivity to cold or hot food or liquid.

• Tooth pain that lasts for several minutes after contact to cold.

• Pain that occurs in a tooth for no obvious reason.

• Pain caused by the pressure of clamping your teeth together.

• Continuous, severe pain.

The first step, and there are several, is to drill through the crown into the pulp chamber, where the pulp is removed from both the pulp chamber and root canals. Usually a medication (an oral antibiotic) is applied to kill off the bacteria. A temporary filling is then applied to block the hole that was just made in the crown.

During a second visit, the temporary filling is removed, and the root canals are filled with a rubber-like substance called gutta-percha and sealed, and another temporary filling is applied. Once the restoration work is completed, the temporary filling is replaced by a permanent crown. In some cases the tooth's structure is left so weak that a metal or plastic post is inserted in the tooth before application of the crown. Be sure to notify your dentist of any residual pain in the restored tooth.

Normally you can expect your 'new' tooth to last as long as your other natural teeth as long as you follow proper oral hygiene-- regular brushing and flossing, and dental checkups. Regular checkups are important because your restored tooth now has no nerves to signal a problem.

Blood pressure guidelines, what's normal and what's not, have been given a new look by the National Heart , lung, and Blood Institute , and some changes have been made as a result

Previously, 140/90 was considered to be, essentially, the borderline between normal and high blood pressure. At 140/90 your blood pressure would likely be monitored by your doctor, although he/she wouldn't likely take any aggressive action unless the numbers rose significantly more than normal daily vicissitudes. But you would probably get a lecture on diet and exercise.

Now, however, the numbers have been reassessed as shown in Table 1. Research has shown that under the old guidelines, some people in the "normal" range were susceptible to cardiovascular disease; hence, the new guidelines.

It has also been reported that with aging, it is important to be cognizant of blood pressure values, which may increase even after years of being "normal."

Blood pressure represents the force applied to the blood coming out of the heart though the aorta to the rest of the body. High blood pressure (hypertension) over time can cause damage to arteries and the heart -- the extra work can lead to atherosclerosis or arteriosclerosis (arterial blockage or hardening of the arteries, respectively).The heart itself may lose its ability to effectively pump out blood -- heart failure. Another potential problem is left ventricle hypertrophy, a condition characterized by an enlarged left ventricular wall -- once referred to as "athlete's heart." An athlete's heart may become larger, but also stronger --usually with a slower heart rate so more blood is pumped with less effort. Left ventricular hypertrophy, however, is a thickening of the wall of the left ventricle, effectively reducing its capacity, allowing less blood to be pumped out. Remember that fresh (oxygenated) blood is pumped out to the body from the left ventricle.

You should note that "prehypertensive" is a new category (see Table 1) that is a kind of wake-up call. If you fall in this category, it is time for some changes. If applicable, the following lifestyle issues need to be addressed to help keep you from moving on to the next stage of hypertension:

• Weight control

• Healthy diet

• Reduce salt intake

• Exercise (get more active)

• Reduce alcohol intake

• Stop smoking

I hab a code. Help! Once you get a cold, here are some suggestions for mitigating the symptoms, or shortening the time of infection.

• Antibiotics are ineffective since a cold is caused by a virus, and they may make you vulnerable to later infections.

• Vitamin C is controversial -- not since Linus Pauling has anyone shown vitamin C to relieve or stop colds, although a huge number of people still take megadoses and swear by it for effectiveness. Placebo or not, if it works for you, take it.

• Antihistamines, in the opinion of Dr. Isadore Rosenfeld, are not effective against colds, and can cause urinary problems in men with enlarged prostates.

• Expectorants are thought by some doctors to be a waste of money.

• Echinacea is another controversial conundrum for colds. Some consider it to be a placebo, while others claim it improves the immune system. It may or may not help your condition, but seemingly won't hurt it either.

• Aspirin can cause the neurological disorder Reye's Syndrom in children -- use Tylenol instead.

• Chicken soup may actually work, but if it doesn't, at least it tastes good.

• Zinc lozenges have been shown to be effective if taken from the beginning of cold symptoms, but they don't work for everyone; and they may cause mouth irritation, leave an unpleasant aftertaste, and maybe nausea. It may be best not to give these lozenges to kids; a study of first to 12th graders showed them to be ineffective and to cause several side-effects including diarrhea.

• Drink plenty of liquids.

• Get plenty of rest.

• Gargle with warm salt water.

• My own experience is that Contact, or similar brands, effectively plugs a runny nose so you can at least sleep better at night.

• Lots of hand washing

• Avoid people with colds, as much as you can.

• Don't touch your eyes or nose after contact with someone who has a cold or with an object (door handle, dumbbell, ??) touched by that someone.

Kids get more colds than adults because their immune systems are immature, that is, they haven't yet built necessary antibodies; but for adults, they have a mature immune system, but it simply gets overpowered from time-to-time by various viral onslaughts.

Ok, so how do I know whether I have the flu or a cold? Generally speaking, colds come on more gradually than the flu, whose symptoms come on fast. And flu brings a fever (102( or higher) with it, but a cold doesn't. This isn't very specific, but you just tend to feel sicker all over when the flu hits.

To avoid the flu, get a flu shot, especialy the elderly and chronically ill. Live viruses aren't used anymore so the shot won't give you the flu, as it once did. The viruses are different each year, so you have to get a shot each year in October or November.

If you do get the flu, the do's and don'ts are pretty much the same as for colds, plus there are some specific flu medications for you to take -- see a doctor.

I have a friend who has some significant equilibrium and coordination problems walks funny -- wide gait, and staggers a lot, has a lot of falls, can't walk a straight line for more than about 10 steps (on a good day), movements of his left arm and hand are pretty unpredictable, and his speech is slightly slurred. Frequently people stop him and ask if he's alright. His answer is that he's alright for the condition he's in. A major concern of his is being stopped for some traffic violation. The cop would surely think he is drunk, but at least he could easily pass a breathalyzer test.

What would you guess his problem is? Knowing something about brain anatomy would help you come up with the right answer. In the rear, lower part of the brain is the cerebellum, a two-lobe area of the brain that controls balance (helps maintain posture and equiligrium) and coordination (smoothes out body movements) -- the right lobe controls the right side of the body, and the left lobe controls the left side (see Note 1).

One guess as to the problem would be an inner ear malfunction since that is the location of sensors for equilibrium, but the correct answer is a condition called ataxia, which is damage to the cerebellum, where equilibrium information is processed, and commands for corrections are normally made (interpretive/corrective apparatus).

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Note 1 - Technically called ipsilateral, where nerve fibers entering or exiting the cerebellum affect the side from which they enter or exit; as opposed to other brain areas that are contralateral (i. e., right lobe affects the left side the left lobe affects and right side).

Today's medical advice for those with arthritis is to keep moving -- do what you can do. You need rest, but be active when you can.

People with painful arthritis may think that advice makes no sense, but exercise has become a significant part of any treatment plan for the majority of arthritis sufferers.

We are talking gentle exercise here, and there are many options, from walking to weight training, but one of the very best options is water exercise.

Some benefits of exercise for those with arthritis include:

• Helps prevent cardiovascular disease

• Weight-bearing exercise helps slow down bone loss and potentially prevents osteoporosis

• Strengthens muscles that stabilize joints -- this is an example of functional fitness, which everyone should strive to achieve

• Can improve mobility

• Improves balance, which can prevent falls

• Can be a form of weight control, which is important for relieving excessive stress on joints

Water exercise is excellent for anyone, especially those with arthritis. Water is the perfect medium. It allows you to move against resistance, but with little joint stress due to buoyancy of the water; not to mention that warm water (83(F to 88(F is ideal) relaxes your muscles, allowing increased blood circulation providing good flexibility. But be sure to check with your physician before starting any exercise program if you have had joint damage or replacement, or any significant health problem (such as heart abnormalities), for that matter.

If you are experiencing any inflammation, it should be brought under control with medication before exercising, especially in the case of rheumatoid arthritis. You don't want to risk further aggravation to an existing inflamed joint.

There are several exercise options to choose from: water aerobics, running in water while wearing a flotation device of some sort -- a buoyancy vest, for example, or strength training against water resistance.

Before you start your program, here are some guidelines to follow:

• Start easy -- learn how to properly do each step in your program before even thinking about increasing intensity.

• A reasonable goal is 20-40 minutes of exercise three or four times a week; and each session can actually be comprised of several shorter sessions.

• Work through as full a range of motion as you can, but don't strain.

• Repeat movements, ultimately, up to 10-20 times, but start from where you are.

• If your initial session leaves you with aches or pain, reduce your intensity.

• Begin and end each session with some gentle movements -- this functions as a warm-up and cool-down.

Exercise Corner -- squats, with a difference. Squats were featured in an earlier Exercise Corner (September/October 2002). This visitation to the world of squats focuses on "sliding wall squats" using a stability ball (a.k.a. Swiss ball, exercise ball, or balance ball). Find a wall somewhere that you can lean against and slide up-and-down with a small to medium size (16-20 inch diameter) stability ball between your lower back and the wall. Position your feet far enough forward of the wall so that as you squat, your knees are roughly over your ankles (i.e., don't project them past your toes).

Start in a standing position with your toes pointed very slightly outward.. As you squat, knees should be in line with your toes -- your arms should be crossed over your chest, and your face should be looking forward. If you have arthritis or other problems with your knees (and your doctor doesn't object to this exercise) go only as low as is comfortable, but not lower than thighs parallel to the floor, and always use slow and controlled movements As you progress with this exercise, you can add resistance by using dumbbells, but don't go too heavy -- keep ego out of it.

The ball helps you make smooth movements with perfect form -- fairly erect trunk, .knees over your ankles, shoulders back, and knees in proper alignment.

Swan Song. After several years of producing the MAF FITNESS NEWSLETTER, this issue will be the last. The first issue appeared in 1994, in a very primitive form, and has evolved over the years into a more-or-less respectable publication, but everything has to come to an end sometime. I started out with a lot of enthusiasm for the subject, FITNESS, and it remains a very important subject to me, but the enthusiasm has waned, and the newsletter has become more of a burden than a source of pleasure and excitement. It has been fun, and I have learned a lot, and I have enjoyed hearing from people from around the world with questions and comments, but it really is time to go.

I want to thank those of you who have supported my efforts by subscribing to the newsletter -- my mom and dad, Bob and Kitty Weber, and the rest of you. And I thank Magdalena Fenner for supplying me with so many interesting subjects to research. And I especially thank Dick Fulton for encouraging me to publish the newsletter in the first place, and for his technical support (he has solved all of my many computer problems.) and for spending the time and effort to create and maintain the website where all issues since 1994 have been archived.

Namaste,

Michael Fenner

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