"You have a pretty good constitution,
but take it easy with the pursuit of happiness."
from Nov/Dec 1996

"Sorry about my handwriting, Mrs. Trumbull.
That should read ‘topical,’ not ‘tropical,’ application."
from Jul/Aug 2008

"Herbert, you should have been suspicious when they
said it was a big semi-private room."
from Mar/Apr 1997

"Good heavens, nurse,
I wonder how long this has been here! This isn’t my diploma
—it’s the guarantee on my wife’s vacuum cleaner!"
from July/Aug 2005

"This sort of thing can become a real problem
if it’s not treated in time."
from Mar/Apr 1998

"Heart Research Center."
from Sept/Oct 2010

"Mr. Peabody is here for his annual exam."
from Jan/Feb 98

Cartoons: Medical Merriment The Saturday Evening Post

Post: Is CFS a “real” disease?

Vernon: There are more than 4,500 papers in the medical literature that describe disturbed or altered biology in people with CFS, so, yes, the disease is very real. The U.S. Centers for Disease Control & Prevention estimates that at least one million American men, women, and children have CFS. But its devastating effects are sometimes hard to see; people with CFS can look relatively well, especially to those who see them only on a relatively “good” day. Confusion also stems from the possibility that the disease may have several causes, and the fact that it has been described by different names at different times, such as post-viral fatigue syndrome, myalgic encephalomyelitis (ME), chronic fatigue and immune dysfunction syndrome (CFIDS), and ME/CFS.

Post: Is there a specific test or symptom that signals CFS?

Vernon: None have yet been identified, and CFS remains a diagnosis of exclusion. This means doctors diagnose CFS by ruling out other medical and psychiatric diseases that could explain a patient’s symptoms. The medical definition of CFS crafted in the late 1980s is woefully nonspecific. Today, we are addressing the need for better diagnostics and treatment through strategically guided research based on knowledge gained over the past 25 years of CFS research and from other areas of science and medicine.

Post: Are researchers making strides in finding the cause or causes of the disease?

Vernon: There is a great deal of published evidence that acute infection with a variety of different pathogens can lead to CFS in about 10 percent of the cases. So, infection is a plausible cause, possibly in combination with an underlying immune system vulnerability. Understanding who is at greatest risk for severe infection, detecting these infections early, and learning more about the immune response are important approaches to preventing CFS in the future.

Keep in mind that we don’t know the cause of most chronic diseases, yet progress is possible. For example, the “War on Cancer” signed into law by President Richard Nixon in 1971 was aimed at improving cancer treatment and finding cures by increasing research. Indeed, there has been important progress, especially in cancer screening and treatment, even though we still don’t know the cause of most cancers.

Likewise, important findings from more than two decades of CFS research gives me hope that effective treatments will be identified. Currently the handful of physicians in the U.S. who have dedicated their medical careers to caring for CFS patients use a combination of treatment strategies to help patients improve function and quality of life. It requires a partnership and a trial-and-error approach that can be time-consuming and frustrating to both patient and physician. In the future, chemical biomarkers identified by CFIDS Association-funded researchers could help guide treatment using more objective and targeted approaches.

Post: What are biomarkers?

Vernon: Biomarkers can be thought of as indicators not only of disease, but also of response to treatment or even good health. Think of cholesterol, for example. Cholesterol is vital for life, but high levels of bad cholesterol are a biomarker indicating increased risk of cardiovascular illnesses. Biomarker research has found certain molecules on blood cells that occur at different levels in CFS patients compared to healthy people and people with other diagnoses. Other studies on CFS biomarkers may help identify characteristics of people who do not recover from an acute infection and why that might happen.  In addition, we are finding that differences between CFS patients and other groups often show up more clearly when the subjects are studied after a short exercise challenge. Post-exertional relapse is one of the hallmarks of CFS, and it seems to provoke a different biological response than testing patients at rest.

Post: What do people struggling with CFS need to know?

Vernon: There is hope. Right now, awareness about and interest in CFS are at an all-time high and there is tremendous urgency within the scientific community to address the need for better diagnostics and treatment through strategically guided research based on knowledge gained over the past 25 years of CFS research and from other areas of science and medicine.  While some research is not panning out, other areas are heating up. There are new technologies such as genomics, proteomics, and imaging that give us new tools to understand biological abnormalities at the molecular, cellular, and clinical level. The CFIDS Association is laser-focused on making CFS widely understood, diagnosable, treatable, and preventable, and we are making faster progress than ever before.

Quick Guide to Chronic Fatigue Syndrome (CFS)

* People of every age have CFS, but the illness is most common in those ages 40 to 59.

* More than 80 percent of CFS patients in the U.S. don’t know they have it.

* CFS includes four or more of the following characteristics (in addition to fatigue): symptoms that relapse after physical or mental exertion; unrefreshing sleep; substantial memory or concentration problems; muscle pain; pain in multiple joints; headaches of a new type, pattern, or severity; sore throat; and tender neck or armpit lymph nodes.

* CFS is not caused by depression, although the two illnesses often coexist. Many patients with CFS don’t have any psychiatric disorder.

–CFIDS Association of America

RESOURCES: www.cfids.org

www.research1st.com

Fast-Track Research on Conquering Chronic Fatigue The Saturday Evening Post

In their book Top Screwups Doctors Make and How to Avoid Them, the Graedons discuss potentially fatal medical errors that occur in hospitals, doctors’ offices, pharmacies, and elsewhere. The book includes ways that patients can be on the alert to make sure nothing happens to them—including what questions they should ask, how to ensure they’re getting the right medications, and so on. The authors also note that having a friend or family member come with you to the doctor to act as a note-taker and an advocate is always a good idea.

The Graedons have been involved with patient advocacy for more than 25 years, and this book is the culmination of their long experience. However, even though the statistics they quote are scary, there’s no reason to panic. The authors are quick to point out that if you have any questions or concerns about your treatment, you should speak to your doctor first. The book isn’t about making people distrust doctors; it’s about making sure patients are armed with the knowledge they need to significantly reduce the chance of mistakes. Remember: Although you need to be careful and alert, you should still trust the medical professionals who treat you.

In addition to their own experience, the Graedons consulted Dr. Peter Pronovost, M.D., Ph.D., who created a five-step checklist to increase safety at hospitals. For more on Dr. Pronovost’s work, check out his profile in the Post.

Top Screwups Doctors Make and How to Avoid Them is an easy-to-read book with an important message. As the Graedons point out, taking charge of your health and safety by asking questions and making sure you know what’s going on is one of the best way to reduce potential mistakes. If you or a relative is often in and out of the hospital or has a revolving carousel of medications, you should read the Graedons’ book. Forewarned is forearmed, and having this knowledge could stop a potentially fatal error.

Top Screwups Doctors Make and How to Avoid Them will be available from Crown Archetype on October 4, 2011, at a list price of $26.

Top Screwups Doctors Make and How to Avoid Them The Saturday Evening Post

“I have a few questions,” Susana interjected, stopping the pediatrician in her tracks. “What do I do for her?”

“Give her some Tylenol,” she advised. “She’ll be fine.”

“How much Tylenol do I give her?” the new mother asked.

“What is her body weight?” the doctor said, scanning Sofia’s chart.

“I don’t know—no one in 
your office weighed her or took her temperature,” she replied. “Will you please pay more attention to this situation and tell me what’s wrong with my daughter? I need information.”

Because Susana spoke up, her daughter got the attention she needed, and Susana got the information and guidance that she, as a paying customer and concerned mother, had a right to expect from the doctor. But not everyone feels comfortable doing that, even if they should.

Being wise medical consumers means choosing medical partners we can communicate with effectively and trust. When it comes to protecting our health, we have to be sure that we are getting what we pay for. An engaged, concerned, and skilled doctor is the best health care investment we can hope to find.

Illustrated by Pablo Bernasconi

Let’s Talk

Perhaps the most important step to becoming a smart medical consumer is the process of finding and choosing the right GP or family physician. That person will be your closest medical partner and will play an important role in helping you make other decisions about your health care management and practitioners. If 
you are in the market for a new physician, ask your friends and co-workers for recommendations, and go online to find out what doctors within that specialty are located in your area. When you’ve found one you want to “interview,” call the office and schedule an introductory appointment, so you can go 
in, share your medical history, and get a sense of the doctor’s attitudes and approach to medicine. (Tell the scheduling assistant specifically what 
you want to do during the appointment so you have adequate time.)

As with any interview, little things count: The office workers, nurses, and med techs should be friendly and helpful; the office should be clean; the doctor should be open and willing to talk with you about your concerns and interests. Keep it relatively simple, but use your time to determine how well this physician’s working approach suits your own. Does he or she communicate with patients via e-mail when appropriate? Is this doctor comfortable discussing information you’ve gathered? What hospital affiliations does the practice maintain? What regular screening tests does he recommend for someone of your age group? Talk about your major health concerns and listen closely to the answers you receive. If you’re comfortable with the initial meeting, schedule a full physical and use that experience to cement or break the deal with this doc.

Partner with Your Physician

Doctors are not infallible, nor should we expect them to be. Like the rest of us, they occasionally will be distracted and disengaged, and they won’t always seek our active collaboration in the doctor-patient relationship. It is therefore our responsibility to speak up, ask questions, and insist that our voices are heard when we have concerns about our treatment.

We don’t need a degree in medicine to partner with our doctors. We can start with some very simple steps. First, we should realize that our medical history is our business, not just our doctors’ “property.” Most of us know that we should maintain a list of our medications, including dosages and directions for use, along with any alternative health practices and supplements. In addition, many patient advocates advise that we keep track of our medical records, requesting copies from our doctors for our own safekeeping. That way, we know exactly what information is available to new physicians and consulting specialists—and we have the important information we need if we want to do our own research. Further, with copies of our test results in hand, we can be sure that the correct name appears on them and that there wasn’t a mix-up at the lab.

Be Your Own Records Keeper

Illustrated by Pablo Bernasconi

Every time you visit a new doctor, you’re asked to complete a personal health information form that lists family medical history, your history of diseases, illnesses, injuries, hospitalizations, allergies, and so on. You’re also asked to complete a “release of information” form, which enables your previous doctor to release health records to the new doctor’s office. With all this information floating around, you might wonder why anyone would need to keep his or her own personal health record. But, according to the American Health Information Management Association (AHIMA), everyone should do so. That way, no matter when or where we need health care, the medical provider we consult has access to a full and detailed medical history.

These records can be in written or electronic form, stored in a file folder, on a computer hard drive or disk, on a portable USB removable flash drive, or through an online service. The AHIMA maintains a Web site (My Personal Health Record, myphr.com) that offers full information about the benefits of maintaining a personal health record, along with free downloadable electronic forms for compiling one. The site has a search feature to find forms, tools, and software for storing records. Online services typically have access codes and other measures devised to keep information secure and accessible only by those you’ve authorized. Some online storage services are free, while others charge a monthly fee; check each service carefully when making your choice.

Asking Questions, Getting Answers

At some point, most of us will need a medical advocate—a friend or relative who can accompany us to our appointment or examination to help take notes, ask questions, and listen to information. If 
our doctor wants to send us on our way with a prescription, we first should ask for the drug’s name, its purpose, side effects, potential negative interaction, and so on. Then, when we fill the prescription, we need to check its accuracy before we leave the pharmacy. And we should always feel free to ask “why”: Why do I need this drug, treatment, or surgery? How else could we tackle this problem? What benefits will I get 
from this treatment plan, and what risks am I taking?

Some doctors can be prickly when they sense that their authority is 
being challenged. So how do we help make sure that our physician isn’t misdiagnosing our condition? Jerome Groopman, M.D., recommends that patients or their advocates describe to their doctors exactly what worries them most about their symptoms or condition. And ask early—don’t leave important details until the doctor is leaving the room. Groopman also suggests that patients ask questions 
to make their doctors think more deeply about their diagnosis, such as “What else could this be?”

We shouldn’t hesitate to speak up about sloppy practices, either. We can—and need to—ask whether all medical instruments, including stethoscopes and blood pressure armbands, 
have been sterilized, 
and whether we should be started on antibiotics before surgery, to help ward off post-surgical infections.

Illustrated by Pablo Bernasconi

Patient-Physician Compatibility?

Through the years, my expectations for physicians have changed. If you’re going to need ongoing service, such 
as from a cardiologist, dermatologist, internist, or gynecologist, then compatibility is much more important. On the other hand, if you’re seeing a specialist for a (hopefully) one-time treatment, such as an oncologist or surgeon, personality is not as important. What you really want to know is, “How good is the doctor for this type of treatment?” A good question to ask in the first meeting is, “What is your success rate?”

I firmly believe it’s important for patients to be accountable for their bodies and health. We are in a professional relationship with our physicians. We may form close bonds with the health care teams that tend to us or our loved ones, but we can’t afford to overlook potential warning signs simply because we like and trust them. Mistakes happen all the time. Better that we ask why an order has been changed, why a vital sign has been altered, why a medication has been dropped or started, than to have a simple slip-up go unchecked and develop into a fatal error.

Primary Concerns The Saturday Evening Post

As uninsured ranks grow and insured employees cope with complex health plans with varying copays and coverage options, people struggle with understanding their bills and detecting potential errors. But help is available from a growing cottage industry of health advocates and firms specializing in reviewing medical bills; discovering mistakes; and negotiating with health care providers, insurers, and collection agencies, reports Barb Berggoetz in her Sep/Oct 2010 Saturday Evening Post article “Decoding Your Medical Bills.”

Here’s how to contact the medical billing companies mentioned in her article and take control of your health care costs:

1. Medical Billing Advocates of America

PO Box 1705
Salem, Virginia 24153
billadvocates.com
540-387-5870

2. MedReview Solutions, Inc.

4840 Willow Ridge Court
Zionsville, Indiana 46077
medreviewsolutions.com
317-873-4872

3. Chapman Consulting and Hospital Bill Review

14604 Mansfield Dam Ct Unit #1
Austin, Texas 78734
hospitalbillreview.com
800-906-8085

4. Health Advocate, Inc.

3043 Walton Road, Suite 150
Plymouth Meeting, Pennsylvania 19462
healthadvocate.com
610-825-1222

Decoding Your Medical Bills The Saturday Evening Post

“It ruined everything—career, social life, relationships, because I was tired all the time,” Rotherham recalls. With lab results in hand and determined to find an answer, he began researching the Internet for clues. “One thing that kept surfacing was hormone imbalance,” Rotherham found.

The search also introduced him to an Indianapolis physician, noted for success in treating “difficult” cases, who conducted more extensive lab tests that finally revealed a diagnosis—underactive thyroid. Immediately placed on thyroid supplements, Rotherham soon noticed a difference.

“Within a couple of weeks, I felt worlds better,” says Rotherham, now 49, who recently launched his own business. “I went from being literally flat on my back, achy and tired, to being highly functional.”

Rotherham is among the approximately 27 million Americans living with overactive or underactive thyroid, according to the American Academy of Clinical Endocrinologists (AACE). Unfortunately, like Mark Rotherham, many go undiagnosed until something goes terribly awry, at times wreaking havoc on one’s quality of life.

Think of the thyroid as your body’s thermostat. Functioning normally, this butterfly-shaped gland, which sits just below your voice box, releases just the right amount of hormones to regulate your body’s metabolism and keep things running smoothly. However, if the thermostat is turned up too high, the thyroid becomes overactive—a condition called hyperthyroidism. You may feel revved up, overheated, and anxious and notice unexplained weight loss. In contrast, if the thermostat is turned down too low, the thyroid becomes underactive—a disorder called hypothyroidism—and fails to provide enough hormones to meet the body’s demands. As a result, your body slows down, leading to a wide range of ubiquitous symptoms. Of the two, hypothyroidism is the more common—and the more insidious.

Dialing down

The reason hypothyroidism is missed so often is threefold: Doctors don’t always screen for thyroid dysfunction; patients may not know to ask about it; and the symptoms are common to many other conditions.

While some people with hypothyroidism note changes, others overlook symptoms, because they seldom develop overnight and are often subtle. Hypothyroidism is notorious for mimicking changes often associated with aging, such as fatigue and intolerance to cold.

Over time, people may discover that the gland swells 
(see Neck Check) and their eyebrows begin to disappear. Additionally, hypothyroidism decreases sweating and causes slowing of your most vital systems: the heart, the lungs, and the gastrointestinal tract. Patients may experience shortness of breath when exercising, and many develop sleep apnea. Worst of all, hypothyroidism can cause high blood pressure and raise blood levels of cholesterol, two of the biggest aging culprits in America. Identifying the thyroid disorder is crucial, because in rare cases, hypothyroidism can lead to coma or even death. For all of these reasons, I encourage both 
patients and their doctors to have a conversation about hypothyroidism. When left untreated, the complications 
can shave years off your life.

Gauging your risk

Women are especially vulnerable: According to the AACE, hypothyroidism is up to 8 times more common in women than men. But all of us need to pay attention to our thyroids as we age, because underactive thyroid becomes much more common in older adults. By age 60, as many as 17 percent of women and 9 percent of men have an underactive thyroid.

Smoking; exposure to secondhand smoke or large amounts of radiation during childhood or cancer treatments of the head, neck or chest; and some prescription medications (such as the heart drug amiodarone and long-term use of mood-stabilizing lithium) can cause hypothyroidism.

However, the most common culprit in the U.S. is autoimmune dysfunction, when the body’s immune cells start to attack thyroid tissue like it’s a foreign invader. As 
a result, the thyroid gland stops producing hormones the 
way it’s supposed to. Genetics likely play a role; we know 
that people with a personal or family history of autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, 
and psoriasis, among others are at higher risk for hypothyroidism. Researchers are close to discovering which gene types might make us more susceptible to autoimmune thyroid problems. In those who are genetically susceptible, certain environmental factors, such as iodine in our diet, are thought to trigger the autoimmune attack on the thyroid.

Thyroid checkup

If you are worried about your thyroid hormone levels, a simple blood test can help you and your doctor reach a diagnosis. The American Thyroid Association recommends that all adults over the age of 35 undergo thyroid screening; however, there is no firm consensus on mass screening. It’s especially important for people with high cholesterol to ask about having their thyroid levels checked: Many people aren’t screened for thyroid levels and could potentially have hypothyroidism. The good news is that doctors now have a very sensitive “thyroid stimulating hormone” (TSH) test that allows us to diagnose thyroid disorders much earlier—even before symptoms appear. Higher than normal TSH levels can reveal whether your thyroid function is in danger, even if your actual thyroid hormone levels are normal.

If your thyroid blood tests come back sub-par or abnormal, the most common treatment option for hypothyroidism is synthetic thyroid hormone replacements. These oral medications help restore hormone levels that shift your internal thermostat and metabolism back to normal. Evidence suggests that people who take thyroid hormone replacements should do so on an empty stomach. Additionally, certain medications, supplements, and foods may affect your ability to absorb thyroid pills. Talk to your doctor about your present medication regimen to gauge if there is an interaction. For example, generally it’s best to wait about four hours after taking thyroid medication to consume soy and high-fiber products, iron and calcium supplements, antacids that contain aluminium or magnesium, and certain prescription medications such as cholestyramine (Questran). Ultimately, monitoring thyroid hormone levels will determine if there is an absorption problem.

The role of prevention

Even if you’re not a candidate for thyroid hormone medications, dietary changes may help you protect the health of your thyroid. Because both too much and too little iodine can cause hypothyroidism, it’s important to be aware of foods that contain iodine and how they may affect your thyroid. Iodine deficiency is rare in the U.S. because it is added to our table salt. Eating excessive amounts of certain raw vegetables such as brussels sprouts, cabbage, cauliflower, corn, and kale should be avoided because they contain enzymes that can drive down thyroid function. But don’t think I’m telling you not to eat your vegetables—cooking them for just a few minutes deactivates those enzymes and makes them nutritious for your whole body.

In general, to protect the cells in your thyroid and your entire body, I recommend foods rich in:


• Antioxidants (blueberries, cherries, tomatoes, squash,
 bell peppers)

• Omega-3 fatty acids (walnuts, salmon)

• B vitamins (whole grains, fresh vegetables)

Vitamin D is another critical micronutrient that is 
getting a lot of attention for its role in autoimmune disease. We know that up to 70 percent of Americans aren’t getting enough vitamin D and that inadequate levels could put you at higher risk for autoimmune disorders, such as rheumatoid arthritis and multiple sclerosis. Vitamin D also plays a supportive role for the parathyroid glands, four smaller glands located on the larger thyroid, that closely monitor and regulate calcium levels in our blood and bones. One of the best ways to get your daily dose of D is just 10-20 minutes of sunshine each day. Sardines, dark leafy greens, and fortified dairy products are also important sources. I recommend at least 800 international units (IUs) daily for most adults and 1000 IUs for adults over 70.

In addition to warding off problems within the thyroid and autoimmune disease, keeping your vitamin D levels up will also help fight off flu and several forms of cancer.

The key to keeping the thyroid healthy is paying attention to your own body. All too often, we accept that certain changes, such as sluggishness and depression, are just a natural part of the aging process. But hypothyroidism is the secret culprit behind these unexplained symptoms for millions of Americans. When we simply accept weight gain, low exercise tolerance, and mental cloudiness without questioning the cause, we’re risking serious harm to our bodies.

After his hypothyroidism went undiagnosed for a decade, Mark Rotherham is back on his feet.

You can find more information on diagnosing and treating thyroid disease from our exclusive interview with Dr. Jeffrey R. Garber.

Post Investigates: Thyroid Disease The Saturday Evening Post

But with so many choices, which treatments actually improve and protect the skin’s appearance, and which ones simply add a new wrinkle to the budget? The best way to answer that question is to look first at what it is you’re saving your skin from:

When outdoors, wear a wide-brimmed hat and tightly woven clothing that covers your body.

Block the Sun

Protecting your skin from ultraviolet (UVA/UVB) radiation exposure (including indoor tanning), extremes of heat and cold, and air pollution can significantly reduce your risk of wrinkles and skin cancer.

“Baby boomers didn’t know better and received a great deal of harmful sun exposure before sunscreens were available,” says Dr. C. William Hanke, an eminent dermatologist and past president of the American Academy of Dermatology. “Ultraviolet light causes malignant melanoma, as well as basal cell and squamous cell carcinomas, which are much more common skin cancers.”

Thankfully, broad-spectrum sunscreens protect against both UVA and UVB rays and are widely available today. They’re crucial for skin protection, and not just in the summer. While the sun’s UVB rays are strongest in the northern hemisphere May through September, UVA rays are present year round, penetrating windshields, light clothing, and office windows.

However, comparing the ingredients of one sunscreen to another can leave one bleary-eyed and confused.

“Check the product label,” advises Dr. Hanke. “Good broad-spectrum sunscreens have an SPF of 30 or greater and contain protective ingredients that include: avobenzone, ecamsule, oxybenzone, titanium dioxide, and zinc oxide.”

Choose a sunscreen that works best for you. People with oily skin may prefer an alcohol-based gel. Individuals with dry skin want a cream for moisture.

When applying sunscreen, don’t forget less obvious, but vulnerable areas, such as the ears, neck, and face—anywhere that is exposed.

“We see golfers in my clinical practice all the time,” says Dr. Hanke, who reports an increasing number of cancers on the lips, ears, and eyelids of outdoor enthusiasts who fail to adequately protect sensitive areas. “They golf for five or six hours at a time and need to wear sunscreens. The same advice applies to winter skiers as well.”

Clothing also adds an extra layer of protection. “Wear a hat,” stresses Dr. Hanke. “Men with hereditary hair loss who don’t wear hats are at higher risk for premalignant lesions and skin cancers—mostly squamous cell carcinomas—on their scalps. It can be a huge problem.”

When choosing sun-protective clothing, opt for dense, tightly woven fabrics.

“If you hold the hat or shirt up to the light and can see through it, so can the sun,” Dr. Hanke adds. “The hat should have a tight weave to protect the scalp.”

Today, most sporting goods companies, apparel stores, and online outlets sell sun-protective clothing.

Snuff Out Smoke

Aside from the serious health consequences, smoking and secondhand exposure is also bad for your skin—next in line to the sun in causing wrinkles. Nicotine impairs blood flow to the skin, accelerating the normal aging of epidermal tissue.

Keep It Clean

Science of Skin
Older skin is thinner and more fragile, and the deep layers 
contain less elastic tissue. Blood vessels are also less elastic, so that even minor injuries can cause bruising. The skin may be mottled with small, flat brown areas called lentigines (from the Latin word for lentils).

Young Skin: A thick outer layer and a large number of elastic fibers in the deeper layers help maintain the smoothness of young skin.

Older Skin: A thinner outer layer and fewer elastic fibers in the deeper layers result in skin that appears loose, with deeper creases and wrinkles.

Images reprinted from The Human Body, ©1995 Dorling Kindersley Ltd.

Facial hygiene is also critical. One of the first steps is choosing the right cleanser.

“If you have oily skin, you can use any soap you want, and it will probably not be irritating,” Dr. Hanke says. “The soap that I recommend for most people and use myself is plain white Dove. People with dry or oily skin can use it.”

For people with rough and scaly skin, occasionally using an exfoliant makes skin appear smoother and feel softer.

“As you age, dead cells build up on the skin surface,” Dr. Hanke explains. “Exfoliation removes the dead surface layer, and moisturizing helps keep skin soft.”

Cleanse your face twice a day—once in the morning and again at bedtime, then apply a moisturizer based on your skin type. For dry skin, opt for an occlusive moisturizer that covers the skin with a waterproof film through which water cannot evaporate or escape. For sensitive skin, some experts recommend applying a moisturizer containing soothing ingredients, such as bisabolol, a chamomile extract.

“As we get older, our skin is not the barrier that it once was,” says Dr. Hanke. “It dries out more easily. As a result, people need to moisturize their skin more frequently.”

Do high-end products equate with higher quality?

“Some inexpensive moisturizers such as Neutrogena and Oil of Olay are very good, as are some very expensive ones, such as La Prairie and LaMer,” notes the dermatologist. “Find one that works for you and does not irritate your skin.”

A word of caution: Don’t introduce too many products at the same time.

“Stick with one product line,” advises Dr. Hanke. “Different products can inactivate each other through chemical reactions and potentially irritate the skin surface.”

Rejuvenating Aging Skin

Innovations in anti-aging skin care are on the fast track to meet the growing demand of baby boomers (and their parents). From nonprescription “cosmeceuticals” to laser treatments, therapies are available that improve the skin’s surface texture, reduce irregular pigmentation, and help reverse the effects of sun damage.

Topicals: Typically used to address milder signs of aging. For example, retinol, a vitamin A compound, is the first antioxidant topical widely used in nonprescription creams and is the less potent cousin of tretinoin (Retin-A, Avage, Renova), a prescription-strength treatment for acne and fine wrinkles.The fastest growing segment of topical skin care, cosmeceuticals combine aspects of the cosmetic and pharmaceutical industries. Cosmeceuticals influence the function of the skin with biologically active compounds (vitamins, oils, herbs, and botanical extracts). Botanicals, for example, contain antioxidants that protect the skin’s surface. William Beeson, M.D., clinical professor in dermatology at Indiana University School of Medicine and noted facial plastic surgeon, has researched a cornucopia of compounds that rejuvenate skin tissues. His research led to the discovery of unique properties in rosemary, an herb that contains a potent antioxidant called carnosic acid. After demonstrating clinical efficacy, Dr. Beeson and colleagues developed a formulation called Effulgere (effulgere.com) that penetrates the skin surface more deeply and helps “protect the skin from further damage by enhancing the skin’s lipid barrier, brightening the skin, and improving its texture and tone.”

Chemical Peels: A chemical solution—such as phenol, tricholoacetic acid (TCA), or alpha hydroxy acids (AHAs)—that removes damaged outer layers of the skin, revealing the healthier layers below. Wrinkles from sun damage, aging, and heredity can be significantly reduced by undergoing a series of peels that also improve irregular skin pigmentation and remove early skin cancers (actinic keratoses).

Lasers: Many laser treatments are now used to minimize wrinkles, scars, skin discolorations (freckles or “age spots”), and blemishes on the face, neck, chest, and back of hands by removing the outer layer of skin (epidermis). The treatment simultaneously heats underlying tissues (dermis), stimulating the growth of new collagen fibers that form smoother, firmer skin. One of the more popular areas in minimally invasive cosmetic surgery, fractionated carbon dioxide (CO2) laser treatment is performed under topical anesthesia on select areas of damaged skin. The outpatient procedure creates microscopic holes in the skin, which then heal with new collagen that tightens skin and evens tone. Newer technologies offer surgeons a greater level of control in laser surfacing, permitting extreme precision, particularly in delicate areas.

Fillers: These reduce the appearance of facial lines and wrinkles by “plumping” furrows and hollows in the face, giving the skin a more youthful-looking appearance. Fillers (Juvaderm, Restylane, Gore-Tex) are very effective at contouring specific areas on the face, such as around the lips, including long, vertical “marionette” lines that start at the corners of the mouth and extend down the chin. Botulinum toxin type A (Botox, Dysport) injections also diminish lines and wrinkles associated with facial expression, including vertical lines between the eyebrows and on the bridge of the nose, forehead lines and furrows, and crow’s feet.

Saving Face: Skin Care Tips The Saturday Evening Post

For the nearly 50,000 Americans seeking relief each 
year for debilitating bone-on-bone ankle pain and disability, there’s good news. Recent advances in arguably the 
most intriguing area of orthopedic surgery—total ankle replacement—are making strides in restoring mobility and quality of life to patients.

Today, four total ankle replacements are used in the U.S.: the Agility, the Inbone, the Salto Talaris Anatomic Ankle, and the Scandinavian Total Ankle Replacement (STAR).

“The technology is light years ahead of where it was a decade ago,” says Dr. Robert Anderson, an orthopedic surgeon in Charlotte, North Carolina, who performed more than 40 Inbone procedures in the past two years and is part of a design team working on a second-generation device.

Hi-tech artificial ankles provide a new alternative to surgery, which permanently fuses worn-out joints. That procedure reduces ankle pain but often limits mobility, causes a limp, and can lead to arthritis in nearby foot joints. An estimated 25,000 Americans underwent ankle fusions in 2009; others considered even more drastic measures.

Reasons for needing an ankle replacement include wear-and-tear over time, accidents, sports injuries, and bone diseases that lead to severe and life-limiting arthritis.

Four years ago, Jeanne St. John’s ankle problems led her to the brink of a difficult decision.

“I was born with deformed ankles and, eventually, was 
so immobilized by arthritis that I considered a double amputation,” recalls St. John, who lives in Oregon. “Then a friend heard about the Inbone. It’s been life-changing for me.”

As with hip and knee replacements, the history of total ankles dates back to the 1970s. Healthy ankles can withstand 1.5 times one’s body weight while walking, but early devices didn’t hold up. Then, Dr. Mark Reiley—who performed St. John’s surgeries in the San Francisco Bay Area—devised a new way to replace the complex joint.

“Dr. Reiley took the proven technology of knee replacements and basically flipped it upside down to be used in the ankle,” Dr. Anderson describes. “The device, now called the Inbone, has very good mechanical advantages and can be used for primary replacements, as well as revisions of failed or previously placed devices. We believe it will be successful 
for a long time.”

Orthopedic surgeons select the specific ankle replacements depending on patient age, anatomy, bone quality, and goals. Long-term success rates on Inbone are not yet available; European data show that 85 percent of modified Salto and STAR devices are functioning well after 10 years.

But Jeanne St. John, now age 67, prefers to focus on how far her new ankles take her.

“I think in terms of steps rather than years,” she says. “I save my steps for selected activities and for travel. Some of my friends are slowing down, but I have this ‘reverse aging’ thing going on, and I’m so thankful.”

Good News for Bad Ankles The Saturday Evening Post

Mark McEwen, former TV weatherman for The Early Show on CBS, found out during a flight to Orlando in 2005. He had been dozing, then woke up, feeling odd. “It was like being underwater and trying to swim to the surface,” says McEwen, now 55. “You’re just trying to survive, to make sense of something that is senseless.” He had no clue it was a stroke. Nor apparently did the attendant who helped him off the plane—or the skycap who left McEwen sitting curbside in a wheelchair. McEwen could barely talk, but he did manage to ring his wife’s cell phone and convey a basic message. “Help me. Not good.”

If someone near you, like McEwen, were having a stroke, would you recognize it? Would you know what to do? Stroke is the third leading cause of death in this country—and every 40 seconds on average, someone in the United States suffers one. About 30 percent of strokes 
are mild, resulting in no disability. But the 20 percent that are severe, yet survivable, can be crippling.

“A major stroke can change everything—the ability to speak, to move, to work,” says Dr. Walter Kernan, professor of medicine at Yale University School of Medicine. “It may seem to rob a person of his life without actually taking it.” Fortunately, new therapies are in the works that may help improve outcomes.

Striking Out Against Stroke

The most significant advance is the clot-busting drug, known as tissue plasminogen activator, or tPA, which can help the 85 percent of patients whose strokes are caused by clots in the brain. “Sadly,” says Dr. Ralph Sacco, a neurologist and president-elect of the American Heart Association (of which the American Stroke Association is a division), “only about 5 percent of patients actually get it because they don’t reach the hospital in time or they don’t go to a [hospital certified as a] primary stroke center, which can give it rapidly.” Administered intravenously, it takes time to dissolve a clot, particularly a large one and as neurologists say, “time is brain.” Last year, the AHA revised its guidelines, saying that tPA could be given up to four hours and 30 minutes after the onset of stroke—a significant increase over the previous three-hour window. But sooner remains better.

“The best outcomes are still in patients with small clots who receive tPA in less than 90 minutes,” says Dr. Rishi Gupta of Vanderbilt University Medical Center.

Other technologies are already available at comprehensive stroke centers (a notch above primary stroke centers, which are mainly geared to giving tPA). At the Cleveland Clinic, doctors are using stents to prop open blocked blood vessels during a stroke, as well as two FDA-approved devices to help remove clots. One, the Merci Retriever, works like a miniature corkscrew to pull the clot out. The other, the Penumbra, breaks up a clot with microjets of water, then suctions out the pieces. Both devices require highly skilled specialists, and not every patient is a candidate. “You have to image the brain first to see if functional tissue remains that could benefit from restored blood flow,” says Dr. Irene Katzan, medical director of the stroke program at the Cleveland Clinic.

Refining Recovery

Acute treatment is only the first step in stroke recovery. Fortunately, therapists are getting better results with post-stroke rehabilitation than ever. “We used to say to patients, ‘you have three to six months to improve, and after that you can’t expect a whole lot,’ ” says Dr. Richard Zorowitz, chair of physical medicine and rehabilitation at Johns Hopkins Bayview Medical Center. Now, knowledge about the brain’s ability to rewire itself—a concept called neuroplasticity—has encouraged therapists (and patients) to try longer and harder.

“Thanks to the neuroplasticity of the brain—the ability of the brain cells to rearrange their connections, our brain has more capacity than we ever imagined to rewire itself for greater levels of recovery,” says researcher and stroke survivor Dr. Jill Bolte Taylor (read “Life After Stroke”).

Dr. Steven C. Cramer at the University of California, Irvine, is working with robotic therapy to help restore function as well as investigating two hormones that may encourage stem cells to develop into new neurons, key cells that transmit nerve signals to and from the brain. So far, early results look promising. Meanwhile, Dr. David Simpson at Mount Sinai School of Medicine in New York is using botulinum toxin (Botox) to help reduce the spasms that lead to twisted limbs and abnormal gaits, a frequent result of stroke.

For the most part, rehab consists of hard work—and lots of it. Three hours a day is the rule of thumb. But technologies like Nintendo’s Wii video game console keeps exercises interesting—engaging stroke patients in games such as bowling or tennis to improve balance and shifting of weight.

As for McEwen, he’s back on his feet after 14 months of rehab. Today the former weatherman, who described his experiences in his 2008 book Change in the Weather, is a motivational speaker and spokesperson for the American Stroke Association. The organization’s latest campaign (PowerToEndStroke.org) is directed at people with risk factors for stroke—high blood pressure, diabetes, excess weight, and a history of heart disease. “There are lots of things you can do to lower your risk for stroke,” says McEwen. “Knowledge
 is power.” And it could just save your life.

The Post Investigates: Stroke Advances The Saturday Evening Post