Simple Prevention Steps Keep Athletes in Game, Off Bench

When it comes to sports, there’s big pressure on players—even ones who’ve barely just learned to tie their laces—to be bold, play hard, and make bleacher fans proud.

But at what cost? How hard is training too hard? How can you tell when you’re crossing the line, setting yourself up for short- and long-term—maybe even lifelong—pain? Whether you coach a little league team or are gearing up to tackle your first 5K, read on. We’ve talked with sports medicine expert Dr. Mike Maloney on the basics of avoiding athletic injuries, no matter what your sport.

Scripts: When it comes to injury prevention, are there fundamentals that every athlete should perform religiously before training/competing?

Maloney: Recommendations vary dramatically by sport, so I want to point you to really terrific resource—the “Stop Sports Injuries” website, sponsored by the American Orthopaedic Society for Sports Medicine. It’s a goldmine for coaches, trainers and athletes alike, serving up guidelines tailored to your team’s type of play, the unique pitfalls you might meet, and suggested steps you might take to avoid them.

More broadly, though, are basics we all can stick to. Like a proper warm-up and gentle stretching to loosen muscles and get blood flowing. You should also be intentional about taking time to rest—perhaps exercising alternate muscle groups each day, giving your body adequate chance to rebuild and recover.

Investing in the right, properly fitted protective gear—such as pads (neck, shoulder, elbow, etc.), helmets, mouthpieces, face guards, protective cups, eyewear—is important too. So is a supportive shoe, built for the stress inherent in your type of exercise. And of course, you can actively head off heat injury by drinking plenty of fluids before, during and after practice or play, wearing light, breathable clothing, and avoiding outdoor practice during periods of high heat or humidity.

Scripts: How do you know when you’re working too hard?

Maloney: Pain. It’s the body’s built-in alarm system, letting us know to stop and slow down.

Unfortunately, all too often young athletes fear that speaking up about troublesome symptoms might cost them their prized place on the team. There’s heavy social and psychological pressure to “be tough,” hide their injuries, and play through the pain. But that only ultimately makes things worse, and in extreme cases, can damage joints for a lifetime. I’d urge any athlete to keep the big picture—not just the next game—in mind, letting the right coach or trainer know if they’re uncomfortable, are hurting, or sense that their range of mobility is restricted. It takes courage, but it’s essential to voice these concerns.

Scripts: Are there some key injuries that spell death to a sports career?

Again, it depends on the sport. But some of the most devastating injuries we see are torn ACLs (anterior cruciate ligaments), a type of knee injury that can spell trouble (and the bench) for many young athletes—even leading to long-term disability from osteoarthritis (a painful joint condition). More than 50,000 debilitating ACL injuries occur annually in female athletes at the high school and college level. It can take between six to 12 months to return to a sport after ACL reconstruction; some sufferers may experience continuing knee symptoms that limit their participation.

Overuse injuries (in the form of stress fractures, shin splints, and tendonitis ) can develop when athletes boost the frequency, duration, intensity, or resistance of training too quickly—putting undue stress on a particular part of the body. Again, rest is really important. But sometime even that’s not enough; in more serious cases, treatment and medical intervention might be necessary.

Finally, concussions concern us. Research continues to evolve, most recently implicating repeated blows to the head with long-term brain trauma, and even dementia in later life.  We can’t exaggerate the importance of protective helmets and gear.

Scripts: So, what’s the bottom line?

Maloney: I think the overarching message is to train smart, sticking with a conditioning program that emphasizes fitness, strength, flexibility and endurance. Remember, we have one body to age with. It’s so important that we respect it, listen to it. The power of proper nutrition, rest, and prudent training cannot be overstated.

Want To Learn More about Injury Prevention—From a Local Olympian?

On Saturday, March 23, Olympic pole vaulter Jenn Suhr, who brought home the gold medal from the Summer 2012 games in London, will be the featured speaker at a free URMC Orthopaedics and Rehabilitation seminar. A graduate of Roberts Wesleyan College who makes her home in Churchville, Suhr will sign autographs and  share her Olympic experiences—and discuss the steps she takes personally to prevent injuries.

Dr. Michael D. Maloney, chief of URMC Sports Medicine and professor in the Department of Orthopaedics and Rehabilitation, will kick off the activities at 1 p.m. with a discussion about injury prevention and the proper steps that all athletes, whether middle and high school students or adults, should take to avoid injuries. Maloney’s medical practice is broad, including reconstructive surgery of the knee, shoulder, and elbow, and arthroscopy of the knee, shoulder, and elbow for patients of all ages in the Rochester region and beyond. He serves at team physician for the Rochester Red Wings, along with area college sports teams.

For more information on the free community event or to RSVP, please call (585) 275-8762 or e-mail ortho-info@urmc.rochester.edu.

More about URMC Sports Medicine

URMC Sports Medicine, the only medical practice in the nine-county region dedicated solely to sports medicine, offers the latest in medical and surgical care to prevent, evaluate, treat, and rehabilitate injuries for both recreational and competitive athletes of all ages. Its physicians are fellowship-trained sports medicine primary care physicians and orthopaedic surgeons who work together with physical therapists and athletic trainers to give complete medical care. For an appointment, call 585-275-5321.

Colorectal Cancer: Simple Screenings Save Lives

We’ll be blunt. Colorectal cancer is one of the most common cancers, and the second leading cause of cancer deaths in the United States. It will kill more than 50,000 Americans this year – more than die in car crashes.

But it doesn’t have to be so deadly. Ninety percent of colorectal cancers are completely curable, if diagnosed early, but the odds plummet to just 10 percent if tumors are found late. Many are; only about 30 percent of Americans over age 50 have had a simple colonoscopy.

The encouraging news about this lethal cancer is that a little education and adopting a few healthful habits can go a long way in conferring protection. Consider the expert advice below:

• When you turn 50, schedule your first colonoscopy screening and repeat it every five years. If your primary care physician doesn’t suggest it, you should. In this preventive scan, you’ll be sedated while a small, lighted endoscope inspects your colon and rectum for polyps – mushroom-like growths at risk for turning cancerous. If discovered during the scan, the polyps can be removed immediately, greatly diminishing your future risk.
  

  A polyp.

• Eat grilled meats in moderation, and avoid smoking and chewing tobacco. Whether inhaled or swallowed, carcinogens in charred or smoked meats, tobacco smoke and “chew” all eventually pass through the colon, where they can up your risk for cancer.
• Balance your diet between “red” and “green” foods. Over-indulgence in red meats (eating more than a pound a week) has been linked to increased risk for colon cancer; on the contrary, adding more green, leafy vegetables to your diet and reducing your intake of foods with high-carb, high-fat, high-cholesterol content, has been shown to reduce risk.
• Stay active. Incorporating more physical activity – walking a pet, taking the stairs over the elevators, cleaning your house – helps stimulate your body’s waste to keep moving along (the longer stool sits in your rectum or colon, the more time toxic chemicals have to leach out into the surrounding tissues).
• Maintain a healthy weight, and know your shape. Obese men and women are at greater risk for colon cancer; “apple” shapes, which gain weight around the waist and vital organs, tend to be at greater risk than “pear” shapes, which store fat in their thighs and hips.
• Learn the obvious symptoms. Through colorectal cancer is a notoriously “quiet” killer, in the later stages, it can give undeniable clues. If you experience bloody stools, diarrhea, cramping and unexplained weight loss, call your doctor immediately.

Put simply, colorectal screening can save your life. If all Americans were screened regularly, colorectal cancer deaths could be cut in half. March is Colorectal Cancer Awareness Month, so why not schedule your test today?

No health insurance? Learn how we can still help you get screened.

We originally published these tips last year, courtesy of Dr. John Monson, chief of the Division of Colorectal Surgery at URMC. His areas of expertise include minimally invasive technologies for colorectal cancer treatment, in addition to basic research exploring a broad range of cancer-related subjects.

For more information about colon cancer screening, talk to your primary care physician. You can also find doctor videos, patient stories, health facts and more on our colorectal cancer information site.

A Heart-to-Heart on Cardiac Health

February is overrun with the hearts and flowers fanfare of Valentine’s Day. But long after bouquets have wilted and chocolate boxes have been picked over, our hearts should continue a steady beat.

The statistics about heart disease are staggering – it causes more deaths each year than all forms of cancer combined, even though it’s preventable for some people.  Doctors use American Heart Month to remind us to be good to our hearts, so we’ve asked cardiologist Dr. Jeffrey Alexis for some tips.

Scripts:  What’s the best ways we can help prevent problems with our heart?

Alexis:  We can all work to keep our hearts healthy by avoiding tobacco, eating right and getting more exercise.  Smoking damages so many parts of our body; if you’re addicted to tobacco, do whatever it takes to quit.  Miraculously, your body can reverse the damage caused by smoking.   Check out New York State Smokers Quitline for tips and access to resources.

Obesity also contributes to a variety of diseases that can hinder heart functioning. Stay trim, eat a nutritious, plant-based diet – with low-salt and low-calorie foods. Don’t drink too much alcohol.  Make sure you get enough exercise – 30 to 60 minutes per day. This protects against heart disease by:

• helping the heart work more efficiently;
• reducing blood pressure;
• decreasing the tendency of blood to form life-threatening clots;
• moderating stress;
• helping your body use insulin; and,
• helping you maintain a healthy weight.

Scripts:  How do we know if cardiovascular problems are beginning? Are there warning signs?

Alexis:  Pay attention to your blood pressure and cholesterol levels; it’s really important that you know these numbers. 

Regular blood pressure screenings start in childhood. Adults should have their blood pressure checked at least every two years. You may need more-frequent checks if your numbers aren’t ideal, or if you have other risk factors for heart disease. Optimal blood pressure is less than 120/80 millimeters of mercury. There are many inexpensive medications that doctors prescribe to help manage blood pressure or hypertension, and stave off heart disease, if your numbers are high.

Adults should have their cholesterol measured every five years. You may need more frequent testing if your levels are off, or if you have other risk factors for heart disease.  Doctors sometimes even check children’s cholesterol levels if there’s a strong family history of heart disease.  An ounce of prevention goes a long way.

Dr. Jeffrey Alexis is a member of the URMC Program in Heart Failure and Transplantation team, which cares for people with advanced heart disease. 

For more information about heart care, visit URMC’s Heart and Vascular Center or call 275-2877.

Channel Surfers: In Study, TV Time Linked with Lower Sperm Counts

Blustery winter nights, paired with hectic workdays, make a compelling case for sacking out on the couch. But new research cautions that too much TV – and too little exercise – could spell trouble for your fertility.

Known as The Rochester Young Men’s Study, the research draws on semen samples collected by a team from our own University of Rochester Center for Reproductive Epidemiology (based out of URMC’s OB/GYN Department). Young men from all over our city submitted samples and questionnaires probing their level of physical activity, diet, stress, and other lifestyle factors. (Our Rochester team then collaborated with colleagues at Harvard, who ultimately published the findings that are now making headlines nationally.)

To put the insights into perspective, we spoke with Dr. Emily Barrett, a reproductive epidemiologist who works in the research group that conducted the study.

Scripts: Rumor has it sperm counts have been in free-fall for decades. Can you tell us why this might be?

Barrett: There’s actually some controversy as to whether sperm counts truly are declining across the globe. But, if they are, it’s likely linked to a number of underlying factors, not any one particular thing.  It could be that environmental chemicals play a role; we’re starting to realize that diet and lifestyle choices might be important, too.

Scripts: That’s a big theme, apparently, in this study. The results suggest that two modifiable factors – exercise and TV watching – could be tied to sperm count. But the paper throws around some downright impressive stats – for instance, the big-exercisers enjoyed “a 73 percent boost in sperm count.”

Barrett: To put that in context, the average man has 15 to 20 million sperm per milliliter. That’s what’s considered normal. Go lower than that, and successful conception is less likely.

While we don’t know the mechanism behind the relationship found in the study, there are several hypotheses as to why sperm counts might be higher or lower, given these variables. The study authors speculate that increased antioxidant production, which is often linked with exercise, might actually be protective against the routine stress and cell damage that ultimately hinders sperm production. Yet another hypothesis is that the physical act of being scrunched up while sitting on the couch could lead to a higher scrotal temperature – and, consequently, less sperm. But it’s also entirely possible that exercise and TV watching are red herrings, and sperm production is actually associated with other underlying behaviors or factors that the researchers didn’t measure.

Scripts: Good point. What should men take away from this research?

Barrett: We have to be careful not to read too much into these results (this is the first study of its kind). Even so, this is yet another reason for men to get off the couch and exercise.

We know of several other lifestyle factors that are likely to affect sperm quality or quantity. Smoking, being overweight, and prolonged bicycling all may lower sperm counts. Many health conditions can also affect production, so staying in good general health will help to protect men’s fertility as well. It’s really important for men to realize that their lifestyle choices not only affect their general health, but also their fertility.

Emily Barrett, Ph.D., is an assistant professor in the Department of Obstetrics and Gynecology at URMC.

Last fall, we interviewed her for another blog post exploring a potential link between BPA and obesity in kids.

Brrr! Cold Weather Tips for Arthritis Sufferers

‘Tis the season of stress and colder weather. What’s an arthritis sufferer to do? Practicing moderation and common sense (beware of those icy patches when you’re rushing in and out of retail stores!) goes a long way.

But we also thought it was prudent to check in with orthopaedist Dr. Randy Rosier, who’s been treating people with osteoarthritis for nearly 30 years. Below, he offers tips on weather-related flare-ups, supplements, and stem-cell therapy. It’s important to note there are many types of arthritis (inflammation of the joints); in this post, we’re focusing on arthritis resulting from simple wear-and-tear, rather than from autoimmune disease or infection.

Q: Many people believe their symptoms worsen in cold weather, but we’ve also heard that’s just a myth.

Rosier:  I’ve got to say that I believe there’s some truth to it. Over and over, patients report that changes in the weather makes arthritis symptoms worse. This also applies to joint injuries and bone fractures. When it’s cold, our joints do get stiffer. Humidity and other dramatic swings in weather patterns seem to affect joints and mobility as well. My snow-bird patients tell me that when they go to the Southwest or Florida in the winter their symptoms get better. Although no one knows exactly how this works, I think it makes sense that milder climates ease arthritis.

Q: So, other than moving to the South, what other lifestyle changes can Rochesterians make, particularly if pain and stiffness is a daily struggle?

Rosier: Winter is still a great time to exercise. You need to keep moving and keep your weight under control, to keep arthritis symptoms in check. Regular activity also helps lubricate arthritic joints and diminish stiffness.

If you go outside, avoid spending prolonged periods in the cold. And don’t ignore your legs and hips when you’re dressing in layers! So often we think of wearing layers above the waist, but long underwear, socks, and heavier pants that protect your hips, knees, and ankles is equally important.

In terms of types of exercise, make sure it’s low-impact. Swimming is the best thing you can do if you suffer from arthritis. However, I realize that’s not always convenient for many people, so the next best thing is an indoor exercise bike or elliptical machine. You can work up a good sweat with either one, and they’re gentler on the joints than a treadmill.  I urge people with arthritis to avoid running, jumping jacks, squats and lunges. I’ve seen a recent trend where people with mild arthritis or joint discomfort are doing squats and lunges at exercise or zumba classes – and suddenly they’ve got damage to the knees.

Q: What about taking supplements for arthritis? Does science support certain over-the-counter remedies more than others?

Rosier: In general, the evidence supporting supplements for arthritis is weak and controversial. That said, however, I have patients who take glucosamine or fatty acids (omega 3s) and firmly believe it helps. Neither of those supplements will harm you, so I don’t discourage it. Keep in mind, though, that the science is not very strong in this area. The NIH did a large clinical trial testing glucosamine, and the results showed no significant benefit. See, the tricky thing about arthritis is that it’s such a variable disease. I have patients who experience mild symptoms over the course of 40 years and others who progress from almost nothing to severe joint destruction in a short period of time. Symptoms also come and go, from agonizing pain to almost no pain, so it’s difficult to decide whether supplements actually help.

Q: What about other medical interventions, short of surgery? Does anything really help?

Rosier: Yes, we can make several recommendations. Cortisone injections can help in some acute situations, as does ice or cold packs. Heating pads are better for chronic pain. Massage can alleviate symptoms by lessening stiffness. You can’t really massage the hip joints, but for knees, ankles, and shoulders, it can bring some relief. Acupuncture is a pain treatment, and it’s relatively harmless, but I haven’t had any rave reviews from my patients. Finally, a procedure called viscosupplementation, which is an injection of a lubricant similar to the native hyaluronic acid that is in joint fluid, may give relief of symptoms for several months.

Q: Since we’re in the middle of the holiday season, we wondered about some information that popped up on the Internet – that alcohol and caffeine tended to have a damaging or drying impact on cartilage. Is that true? Should we avoid peppermint lattes and the open bar at the office party?

A: Interesting topic, but there’s no convincing evidence to avoid alcohol or caffeine entirely. It’s okay in moderation, and obviously, with alcohol it’s important to limit your intake.  But, having said that, consider the flip side: A compound called resveratrol found in grapes and wine is an anti-inflammatory.  I’m not advocating drinking for those who don’t, but having some red wine with dinner or hors d’oevres won’t hurt and, who knows, it could help.

Q: Finally, what’s the latest news on the horizon in terms of treatment for arthritis?

Rosier: First, it’s important to emphasize that we’re talking about osteoarthritis – which stems from wear on the joints – and not other forms (e.g., rheumatoid, psoriatic, etc.). In that context, we’re writing grants to seeking funding for a clinical trial to test a known drug, Forteo, which has been shown in mice to prevent or retard deterioration of joint cartilage. Other things on the horizon involve stem-cell treatments. But I have to add a big dose of caution here: Patients should beware of clinics that claim to be able to cure arthritis by injecting stem cells into the joints, or enriching plasma with platelet injections. A lot of charlatans exist out there, and none of this is covered by insurers. At this point we don’t have any solid, peer-reviewed, stem-cell therapies to offer.  With further scientific research, however, these directions may hold some future promise.

One last note of caution: Many patients like to take over-the-counter pain relievers for arthritis. In the past we worried about the effects of anti-inflammatory medications on the stomach, but more recent concerns focus on their ability to raise blood pressure and harm the kidneys. We tell patients to limit the use of these medications to a week or two, when they’re experiencing a severe flare-up.

The URMC offers the most advanced arthritis care in the Rochester area, at Clinton Crossings, 4901 Lac de Ville Boulevard, Building D, Rochester, N.Y., 14618. To schedule an appointment call (585) 275-6321. Two new faculty members – Dr. Jennifer Paul and Dr. John Ginetti – are accepting patients. 

Back in Sync: Simple Programming Tweaks Help Defibrillators Work Better

Too many of us take a healthy heartbeat for granted.

But for those living with defibrillators – nearly 200,000 are implanted in Americans each year – abnormal and potentially fatal beating patterns could strike at any moment. Fortunately, a new, world-wide trial led by URMC expert Dr. Arthur Moss shows that slight programming tweaks to these rhythm-resetting devices can help people with heart disease enjoy longer, higher quality lives.

The findings were published last week in the New England Journal of Medicine.

Moss says that implantable defibrillators are commonly programmed to fire when the heart rate exceeds around 170 beats per minute. The problem is, rates of 180 or 190 are not always dangerous, are typically short-lived, and might even be tied to increased activity or exercise. And since defibrillators aren’t always good at differentiating benign from harmful rhythms in this “in-between” range, patients must live against a backdrop of potentially painful, anxiety-provoking shocks.

“There’s also considerable research to suggest that there’s a small amount of damage to the heart muscle with each delivered shock,” added Moss. “If we can eliminate unnecessary ones, this is going to be associated with less heart damage and improved outcomes.”

Indeed, over time, too many false alarms take their toll – and not just on the heart muscle itself. In fact, data from a 2002 trial comparing anti-arrhythmic drugs and defibrillators suggested that shocks are associated with reduced mental well-being. A recent review of more than 45 studies found that such emotional distress isn’t uncommon; between 11 and 28 percent of defibrillator patients had some form of depression and between 11 and 26 percent had an anxiety disorder.

The recent trial Dr. Moss led (the MADIT-RIT trial, or Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy, tapping 1,500 patients in 98 hospital centers in the United States, Canada, Europe, Israel, and Japan), revealed big boons for heart disease patients with defibrillators. The trial showed that setting the device to fire at a slightly higher rate (200 beats per minute) reduced the risk of experiencing a first unnecessary shock by 79 percent, compared to standard programming. Fewer shocks also corresponded with less energy delivered to the heart, which study authors believe ultimately contributed to the reduced risk of death. To their surprise, using this higher threshold for shock delivery also lowered the risk of death by an impressive 55 percent compared to patients whose devices ran on traditional programming.

You can hear Dr. Moss talk about the trial – and what it means people with defibrillators – in the clip below.

Lead investigator, URMC Professor Arthur J. Moss, M.D., is a world-renowned expert in the treatment and prevention of cardiac arrhythmias and sudden cardiac death. Moss’ team found that simply raising the heart rate at which defibrillator devices (ICDs) are set to fire – or deliver shock therapy – makes all the difference.

In 2002, Moss and the MADIT research group showed that ICDs are extremely effective in preventing death in patients at risk of irregular heart rhythms and sudden cardiac death, including individuals who’ve suffered a heart attack. The work changed medical guidelines nationwide, making thousands of heart attack survivors eligible for ICD therapy.

The MADIT-RIT trial is the first large-scale, randomized study designed to evaluate specific programming features to reduce inappropriate (unnecessary) therapy in patients with ICDs. The trial’s sponsor, Boston Scientific, was not involved in data collection or data analysis. Moss, who has led the MADIT trials since their inception in the 1990s, holds no stock in any device company, has never been a member of any corporate speakers bureau, and since Dec. 1, 2008, has chosen not to accept honoraria from Boston Scientific for any professional activity.

More Blame for BPA? Plastics Chemical Found in Heavier Kids

When we think of the drivers behind America’s obesity epidemic, sugar-laden beverages, such as soda and sports drinks, and too little exercise might come to mind. Efforts like First Lady Michelle Obama’s “Let’s Move” campaign are being implemented nationwide to help rein in the childhood obesity rate, which has tripled over the past three decades.

But parents beware – a recent study in the Journal of the American Medical Association adds another potential offender to the list: the chemical Bisphenol A, or BPA, commonly found in canned food, bottled liquids, and other consumer products. Researchers found that children and teens with higher concentrations of BPA in their body were more likely to be obese.

We asked Dr. Emily Barrett, a scientist (and parent!) who studies the influence of various chemicals on development, to shed some light on BPA and what the findings mean for moms and dads trying to raise healthy kids.

Scripts: Studies show that most of kids’ exposure to BPA is through food. Are we exposed mainly through canned goods and other packaged foods?  What about fresh fruits and vegetables?

Barrett: Food does appear to be a main source of exposure to BPA, and several studies have now shown that BPA levels drop when individuals avoid processed foods.  Many studies suggest that cans are a major source; the linings are often made with an epoxy resin containing BPA.

But BPA is probably lurking in a lot of other foods as well, since the food can be exposed to the chemical during processing. And unfortunately, environmental chemicals like BPA might even be found in foods that we typically think of as unprocessed, like fresh meats and dairy. That said, fresh fruits and vegetables are unlikely to be a major source of BPA and remain a smart choice.

Scripts: Why might higher levels of BPA be tied to obesity in kids and teens? And why was a link only found among whites – not blacks or Hispanics?

Barrett: At this point, we don’t understand much about the mechanisms by which current BPA levels might be connected with obesity, as most of the research so far has focused on prenatal exposures. One possibility, though, is that kids who are obese eat greater quantities of foods that are high in BPA, such as fast food, than slimmer kids.

Another possibility is that higher consumption of BPA might actually change metabolism in some way that promotes obesity.

Still, another possibility is that BPA is stored in and released from fat tissue, and since obese kids have more fat, the levels they excrete will be higher.  Further study is needed to better understand these possibilities.

As far as racial differences in the relationship, it may simply be due to different eating patterns and behaviors across cultures. It could also be due to genetic or metabolic differences, but again, more research is needed.

Scripts: What is your advice for parents raising kids and teens? Should they work hard to avoid foods containing BPA? Or should they focus more on common sense recommendations, like eating more fruits and vegetables and getting more exercise?

Barrett: The good news is that by following already tried-and-true recommendations, you’ll likely avoid foods that contain high levels of BPA. We know that highly processed foods tend to be bad for you nutritionally, and those foods are also more likely to have high levels of BPA. So, if you’re encouraging your kids to eat fresh, minimally processed foods, you’re already doing the right thing.

Parents who want to go a step further may think about reducing their use of canned goods – fresh and frozen alternatives are likely to be better for you, plus they taste better, too. They may also want to check their food packaging, plastic food storage containers, and water bottles; those marked with 1, 2, 4, 5, and 6 recycling codes are unlikely to contain BPA. Those marked with 3 and 7 might.  One final tip: Avoid putting plastics in the microwave, as they might release toxins under high heat.

Up to 80 percent of children who are obese remain overweight as adults, according to the National Institutes of Health (NIH). Learn more about child obesity in URMC’s health encyclopedia, linked here.

Emily Barrett, Ph.D., is an assistant professor in the Department of Obstetrics and Gynecology at URMC.

Yawning? Get a Better Night’s Sleep

Is the alarm going off earlier these days? As September ushers in autumn, many people feel a bit sleep-deprived while adjusting to early-morning routines and renewed intensity at school or work.

Teenagers, in particular, are rocked by the reality of a pre-dawn wake-up following a summer of sleeping until noon.  Babies and younger children struggle with going to bed on time. Even for parents, the lack of ZZZs can be truly exhausting.

We spoke with Dr. Heidi Connolly, chief of Pediatric Sleep Medicine at URMC, to get strategies for a good night’s sleep – at least until Halloween and the end of daylight saving time, when the nighttime goblins will surely poke us again.

Scripts: We assume there’s a seasonal aspect to some sleep problems. Can we start with the main hurdles for children and adults in the autumn?

Connolly: A couple of things come into play right now. The start of the new school year obviously presents a challenge. We all kept later schedules in the summer, so we’re feeling a bit tired and out of sorts. Even for children who attended a child care summer camp there is an adjustment. (The camps generally started at 9 a.m., as opposed to many local high schools that have a 7:20 a.m. start time). The earlier wake-up is difficult, particularly for teenagers. Their circadian rhythms are different from adults and younger children, and  biologically, they’re not as tired until late at night. It’s like having perpetual jet lag.

When children have trouble sleeping it can wear on parents. It’s tricky to put kids to bed who aren’t sleepy. A general strategy is to motivate your family by thinking in terms of when you need to wake up, not when you’d like to fall asleep.

Scripts: So,  can you offer some specific tips for getting back on track?

Connolly: Yes, definitely. The goal is to help your body move its circadian rhythm to be in better alignment with your daytime schedule. This is a strategy that business people employ when they frequently move across time zones.

Two of the simplest ways to achieve this: pay attention to light exposure and exercise routines. Avoid exercising too close to bedtime. This includes children rough-housing and adults who hop on the treadmill after 9 p.m.

A better plan is to create a calm, quiet atmosphere during the hour or two before you plan to go to sleep. Calm and darkness lead to production of the sleep-promoting hormone, melatonin. It’s a good idea to confine baths and before-bed stories to the part of the house closest to the bedroom, as well. Even running up and down the stairs at this juncture, say for a snack or another drink of water, can be disruptive to the routine.

I also recommend no video games or any type of screen time one hour before bed. It’s a good idea to avoid putting televisions, laptops, or docking stations for phones in a child’s bedroom. Teenagers often like to take their laptops into their rooms at night for homework and trolling Facebook, but the light exposure on the screens confuses the brain by associating it with awake-time activity. Try to use the bedroom only for sleeping.

School-aged children who are athletes might have games or practices in the evening, but usually they are so tired they can fall asleep pretty quickly. Still, it’s important to be organized and to establish a routine that calmly, quickly and quietly helps them to bed.

Scripts: If we do happen to develop a sleep deficit, how long does it take to regain missed rest?

Connolly: An acute sleep deficit as a result of an all-nighter, for example, this can be replaced with just a few nights of good sleep. A chronic sleep deficit is much harder to resolve. Some people think you can catch up on the weekend, but that never works.  Just think about it: Suppose that each night of the week you sleep only six hours, shorting yourself up to three hours. It’s almost impossible to make up those 12 or 15 hours on the weekend, even if you sleep until noon. And when Sunday night rolls around, you have difficulty falling asleep because you slept late in the morning – so the bad weekly pattern tends to repeat.

It’s important to try and keep the same schedule throughout the week. Get as close to eight or nine hours a night as possible. One of the best ways to know if a child is getting enough sleep is whether they wake on their own at least some mornings.  When they do need to be woken by a parent, they should arouse easily and wake without much effort.

Scripts: Any special advice for parents of infants?

Connolly: Parents with babies or small children face a different challenge – the mismatch of sleep schedules. Babies actually get a lot of sleep, usually 16+ hours a day, but they don’t have a regular circadian rhythm so they sleep almost as much during the day as they do at night. On the other hand, new mothers have a well-established circadian rhythm and cannot always sleep like a baby in the middle of the day to catch up. The remedy is to help babies get into their own rhythms.  We recommend cool, quiet, dark bedrooms, consistency, and allowing babies to learn to sooth themselves while falling asleep. Children who from an early age learn to fall asleep on their own are more likely to fall back asleep without calling for mom if they wake up in the middle of the night. It’s a learned skill that takes practice!

Scripts: That makes a lot of sense. But for children and adults who’re still working on the ability to fall asleep initially, or back to sleep in the middle of the night, what do you recommend?

Connolly:  It’s important to know that insomnia doesn’t get better if you don’t address it. You don’t necessarily need medicines, but learning better sleep skills is vital. We tell children and teenagers that learning to sleep well is like learning good study skills. We try to tailor strategies to each person’s situation. For example, reducing anxiety is important for some people, and we teach guided imagery and logical thinking skills. Many people also benefit from keeping a journal or writing lists. Relaxation techniques can also help when we’re extremely busy or stressed and therefore, having trouble sleeping.

Scripts: Yes, a big project at work or school usually comes with a sleepless night or two. How important is sleep in the context of an upcoming test or presentation?

Connolly: We have plenty of data showing that people who’re sleep deprived perform less well on exams or when giving presentations.  Sleeping involves many stages, including REM or rapid eye movement sleep. REM sleep usually occurs about 90 minutes after we fall asleep and studies show this stage is important for consolidating memories.

If REM sleep is lacking, we have difficulty recalling words or numbers. As children grow up, their job is to retain and push heaps of information into long-term memory stores. So, if you short-circuit yourself on sleep, you’re making it physiologically more difficult for your brain to perform this task.

The consequences of too little sleep are immense. They not only include impaired memory, but depression and a weaker immune system.  There is even new data coming out showing that sleep deprived teens are more likely to be involved in car accidents and sleep deprived children are more likely to be injured as pedestrians.  That’s why we recommend establishing a consistent sleep pattern early in life and to work hard to keep the pattern in place, even when life presents challenges.

For more information about Pediatric Sleep Medicine Services of the Strong Sleep Disorders Center, located at2180 South Clinton Ave., Rochester, NY 14618, please call (585) 340-8949.

Shoulder Pain: Serving Up Advice for Athletes, Weekend Warriors

Overuse or poor mechanics?  Major League Baseball pitchers aren’t the only folks to face this question when shoulder strain shows up, says Dr. Ilya Voloshin, a sports medicine specialist at URMC.

The simple wear-and-tear of aging can produce inflammation, pain and stiffness. Years of vigorous exercise, or even more leisurely activities such as swimming, golf, tennis, gardening, or do-it-yourself house projects, can make some baby boomers feel like they belong on the MLB disabled list.

Recently Dr. Voloshin presented clinical studies at several national meetings (American Orthopaedic Association, Eastern Orthopaedic Association, and American Academy of Orthopaedic Surgeons), on the newest methods for repairing difficult clavicle fractures, re-attaching the bicep tendon in the shoulder, and shoulder replacement.

Long before surgery is necessary, however, don’t overlook warning signs and symptoms, he says. As the physician for the Rochester Knighthawks and Rattlers professional lacrosse teams, he knows what it takes to keep serious athletes and weekend warriors healthy. With summer in full swing, we wanted to learn more.

Scripts: Let’s start with the basics. How common are shoulder injuries and what causes them?

Voloshin: Shoulder pain is the third most common complaint we get in orthopaedics, following back and neck pain. It’s very common.  The shoulder is actually a combination of several joints and tendons that allow you to move your arm. Tears and instability can result from a problem with any of the tissues or bony structures in the shoulder.

Sometimes there is a hereditary component, and sometimes the cause of pain is more obvious, from trauma associated with a motor vehicle accident or extreme overuse.  This last point is important, though:  Even if you don’t play sports, most of us still pick up groceries, small children and heavy packages throughout our lives. Many problems stem from overuse, which results in inflammation. People don’t realize this and just keep working through the pain.

Scripts: A little soreness is easy to ignore, though, especially among those who expect a few aches and pains with aging. Tell us more about the warning signs, and help us to distinguish between what is likely a minor problem and a major one.

Voloshin: Pain when you reach away from your body, or overhead, to grab something from a kitchen cabinet, should not be ignored. Also, when you reach behind yourself — for instance to get something from the back seat of the car – if pain or stiffness occurs you should take notice.  If you’re having pain at night while sleeping it’s very important to see a doctor. That’s a big one. And finally, the most important warning sign is a painful popping that you can feel when you move your arm in a certain direction, or lift a heavy object. 

I’ve also had athletic patients who develop significant shoulder problems without experiencing much pain at all. They learn to compensate for a little soreness, and then one day they’ve torn a muscle or ligament.  If you routinely play contact sports like football or lacrosse, or do anything that involves overhead reaching – like serving a tennis ball – it’s important to pay close attention to any amount of shoulder pain, especially when it persists after athletic activity.

Scripts: You spend a lot of time treating athletes and active people. But do some underlying health conditions also contribute to shoulder injury?

Voloshin:  Yes, definitely. Diabetes makes people prone to what we call “frozen shoulder.”  We’re not sure why it occurs but it’s fairly common. Over a period of days diabetics will experience some chronic pain and then suddenly the shoulder freezes up and they can’t move it. The first line of treatment for that condition is physical therapy.  Also, rheumatoid arthritis causes frequent pain to tendon deterioration, and any connective tissue disorder can lead to ligament or tendon tears.  And finally, it’s important to note that smoking cigarettes negatively impacts the healing of tendon-to-bone.

Scripts: With so many causes of shoulder injury, many treatment options also exist. What is the latest in clinical care?

Voloshin: We do thousands of surgeries a year to repair problems such as rotator cuff issues or wear and tear that’s bad enough to need a complete shoulder replacement. But physical therapy is often the first line of treatment, and rehabilitation of the shoulder is every bit as important as surgery.

The idea behind rehabilitation is to prevent stiffness, maintain the endurance of the muscles around the injury, and improve the motion mechanics of the whole body.

Often you can avoid surgery if you see a doctor when your symptoms are new.  A lot of people decide they’re going to tough it out and work through the pain. This is usually when real tissue breakdown occurs.  These cases lead to surgery with a goal to regain a similar level of activity as before the injury. If surgery is needed, most people have the option of minimally invasive arthroscopy of the shoulder or elbow, which can be done without a hospital stay.

The newest development for young patients with bad shoulder arthritis is minimally invasive shoulder replacement. Obviously, this is a last resort, but it allows them to stay more active during their productive years and leaves good options for the future if revision surgery is needed.  We’ve done several of these procedures on an outpatient basis (patients went home the same day), and the patients are thrilled with their results.

Scripts: Besides not ignoring pain, what is the best thing a person can to do to protect the upper body from injury?

Voloshin:  That’s an interesting question because, as we age, we tend to compensate and change our mechanics for even the most routine activities. So, the key is to keep up good overall body conditioning. It’s not that you have to be super athletic, but remember that a well-toned lower body takes the pressure off the upper body. Think about it. When you serve a tennis ball, throw a football, or toss a softball, your trunk and legs generate more than half of the energy.  That’s why we hear about ankle injuries that impact a baseball player’s pitching, because a sore ankle changes the mechanics. Everyone tries to push the envelope, but really, paying attention to your overall conditioning is the key to staying active.

Dr. Voloshin is chief of the shoulder and elbow division at the URMC Department of Orthopaedics and Rehabilitation. To contact him and for more information, call (585)275-5321 or visit: http://www.urmc.rochester.edu/ortho/shoulder-elbow/

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Cancer Survivors Look to Exercise for Better Life

A morning jog, fast walking, weightlifting and other forms of exercise were off-limits for most cancer patients as recently as 15 years ago.

Fast forward to today, and the latest research suggests that exercise is not only safe for many people with cancer, but might relieve the side effects of cancer treatments—and might even improve survival.

Researcher Karen Mustian, a University of Rochester Medical Center exercise psychologist and physiologist specializing in cancer, designs and studies exercise programs specifically for patients and survivors.

We spoke with her about the evolving story of exercise and cancer.

Scripts: How has the view of exercise for cancer patients changed?

Mustian: It was not that long ago that we were very hesitant to promote exercise for people with cancer, particularly those receiving treatments. We worried they were too sick to work out, and that exercise somehow would make them worse and compromise their ability to complete their treatments and recover.

By 1999, however, almost a dozen small studies suggested exercise might be safe and helpful for cancer patients. Since then, there’s been a dramatic increase in scientific evidence supporting exercise, ranging from simple walking, weightlifting, Tai Chi, yoga and even activities as vigorous as team paddling or dragon boat racing.

Scripts: So, given the changes in thinking, how much exercise do you recommend?

Mustian: Studies have shown exercise to be helpful for a wide variety of debilitating problems. It can improve cancer-related fatigue, sleep problems, depression, anxiety, physical function, immune function and overall quality of life. Experts now suggest that cancer patients and survivors should strive to reach the recommended public health guidelines for physical activity – either moderate-intensity aerobic activity for a minimum of 30 minutes, five days a week, or vigorous-intensity aerobic activity for a minimum of 20 minutes, three days a week.

But the story is not completely done. Some people treated for cancer will need exercise programs that are modified to ensure safety and effectiveness without making cancer-related side effects or other health conditions worse. At this point, scientific evidence does not provide the detailed knowledge to allow us to write explicit exercise “prescriptions” with precise doses, modified for specific cancer-related side effects. Still, we can make broad recommendations.

Scripts: What do you advise for your patients?

Mustian: First, I ask them what they like to do. Do they prefer to be inside or outside? If they like the outdoors, I encourage them to find a physical activity they can do in each season. In Rochester, even in the winter, this might mean cross-country skiing or simply getting outside and playing in the snow. It’s really important to find something you like to do.

I also suggest they work with an exercise professional who has additional training in the unique needs of people treated for cancer. I also encourage them to speak with their oncologist and ask if there are special limitations that they need to consider.

Some cancer patients come through my lab, asking about the amount of exercise they have to do to get rid of their fatigue. Unfortunately, there is no “dose” of exercise specifically designed to reduce fatigue. So, my staff tailors the exercise prescription to each individual, taking into account the baseline level of physical fitness, unique limitations and preferences, along with their goals and whether they’re interested in achieving improvements in mental health, physical health, or some combination.

It’s important to give people a range of options. Cancer patients and survivors have a lot of obligations to manage — jobs, family, and treatments. Asking them simply to add 30 minutes of exercise a day is not always practical or even necessary to achieve significant reductions in cancer-related side effects. For instance, if one person’s main goal is to lift depression or anxiety or fatigue, and they might be able to achieve that with as little as 10 minutes of exercise a day.

Scripts: Do we know exactly how exercise helps cancer patients?

Mustian: It is difficult to say.  To begin with, we don’t know precisely what causes the many side effects of cancer in the first place. We know cancer-related fatigue, neuropathies and cognitive impairments are real, but we can’t articulate a specific cause. We think they are linked to the disease and treatments. We also can’t describe exactly how exercise — either through biological or psychological mechanisms — alleviates these side effects.

It is likely exercise works because it’s what we call a “multi-targeted, multi- system” intervention. Just think: When you do something simple, like standing up from your chair and walking across the room, you activate your entire body from the cellular to the whole organ level, triggering multiple systems, including your muscles, heart, lungs, brain, immune system and more.

Scripts: Your research has shown that yoga can improve sleep and quality of life for cancer survivors. Is that the best exercise?

Mustian: Yoga is a wonderful exercise, but it’s not for everyone. Some people simply don’t enjoy it. For those who do, it helps to reduce several side effects associated with cancer and its treatments. Remember, while some yoga is “gentle,” that does not mean it is easy.

My study and others have shown that yoga works best for cancer patients when it integrates breathing exercises, mindfulness and meditative exercises, and imagery components with yoga postures. Collectively, those components seem to make yoga enjoyable. They’re also what probably make yoga successful.

Again, the people I see in my research studies are interested in living longer, but they also emphasize they want their quality of life to be high. They are not so much looking to exercise to gain extra years, even though they suspect it may help with this, but they are interested in using it to help them maintain their functional independence so they can participate fully in all they want to do. I think that is what most of us, even those of us lucky enough not to have experienced cancer, want for ourselves.

Karen Mustian directs the Physical Exercise Activity Kinesiology Clinical Research Core Laboratory, or PEAK Lab, at the Medical Center. For more information or to contact her, call 585-273-1796 or visit: http://www.urmc.rochester.edu/physiology-exercise-lab/index.cfm