What’s That on Your Feet?!

It’s summer and many of us are fairly active outside or indoors; walking, jumping, biking, boating, playing sports, jogging, and exercising. Chances are we’re wearing sneakers or athletic shoes while we play or work, those leather, cloth, or mesh multi-colored foot coverings universally popular with children and adults alike. In the United States alone, the market for sneakers and athletic shoes comprises a multibillion-dollar industry that capitalizes on smart marketing, style, star power, peer pressure, practicality, and comfort.  We all wear them, yet how much do we actually know about what’s on our feet, like if they’re suitable for the activities we’re using them for and if they’re good for us?

At one time in the not-too-distant past, everyone wore sneakers when active. Now there are hundreds of athletic shoes to choose from, designed for practically every type of activity, though typically for running, training, and walking.

Court sports include shoes for tennis, basketball, and volleyball. Court sports require the body to move forwards, backwards, and side-to-side. As a result, most athletic shoes used for court sports are subjected to heavy abuse. The key to finding a good court shoe is its sole. Field sports include shoes for soccer, football, and baseball. These shoes often are cleated, studded, or spiked. The spike and stud formations vary from sport to sport, but generally there are replaceable or detachable cleats, spikes, or studs affixed onto nylon soles.

When it comes to track and field, athletic shoe companies produce many models for various foot types. One brand does not meet the needs of everyone, and the latest innovation or most expensive shoe may not be your best choice. However, even the best-designed shoes in the world will not do the job if they do not fit properly. You can avoid foot problems by finding a shoe store that employs a pedorthist or professional shoe fitter who knows about the different shapes and styles of shoes.

Here’s some guidance for choosing the athletic shoe that’s best for you:

Running Shoes:  A good running shoe should have ample cushioning to absorb shock, though there are advocates for minimalist running shoes with almost no cushioning. If you choose a cushioned shoe, look for overall shock absorption for the foot and good heel control. This may help prevent shin splints, tendinitis, heel pain, stress fractures, and other overuse syndromes.

Joggers should wear a shoe with more cushioning for impact. Running shoes are designed to provide maximum overall shock absorption for the foot. Such a shoe should also have good heel control. Together, these attributes help prevent shin splints, tendinitis, heel pain, stress fractures, and other overuse syndromes.

Walking Shoes:  If walking is a major athletic activity for you, wear a lightweight shoe. Look for extra shock absorption in the heel of the shoe,especially under the ball of the foot (the metatarsal area). This will help reduce heel pain (plantar fasciitis and pump bumps) as well as burning and tenderness in the ball of the foot (metatarsalgia). A shoe with a slightly rounded sole or rocker bottom also helps to smoothly shift weight from the heel to the toes while decreasing the forces across the foot. Walking shoes have more rigidity in the front so you can roll off your toes rather than bend through them as you do with running shoes.

Aerobic Shoes:  Shoes for aerobic conditioning should be lightweight to prevent foot fatigue and have extra shock absorption in the sole beneath the ball of the foot (metatarsal area), where the most stress occurs.

Tennis Shoes: Tennis players need a shoe that supports the foot during quick side-to-side movements or shifts in weight. A shoe that provides stability on the inside and outside of the foot is an important choice. Flexibility in the sole beneath the ball of the foot allows repeated, quick forward movements for a fast reaction at the net. You need slightly less shock absorption in the shoe if you’re playing tennis or other racquet sports. On soft courts, wear a softer-soled shoe that allows better traction. On hard courts, you want a sole with greater tread.

Basketball Shoes:  For basketball, choose a shoe with a thick, stiff sole. This gives extra stability when running on the court. A high-top shoe may provide added support but won’t necessarily decrease the risk of ankle sprain or injury.

Cross Trainers:  Cross-training shoes, or cross trainers, combine several of the above features so that you can participate in more than one sport. A good cross trainer should have the flexibility in the forefoot you need for running, combined with the lateral control necessary for aerobics or tennis.

We don’t necessarily need a different pair of shoes for every sport in which we participate. Generally, wear sport-specific shoes for sports you play more than three times a week. If you have worked out for some time injury-free, then stick with the particular shoe you have been wearing. There is really no reason to change.

For special problems, you may need a special shoe. If your ankles turn easily, you may need to wear a shoe with a wide heel. If you have trouble with shin splints, you may need a shoe with better shock absorption.

If the shoe fits, buy it!

Here are some useful guidelines for buying new athletic shoes:

  • If possible, purchase athletic shoes from a specialty store. The staff will provide valuable input on the type of shoe needed for your sport as well as help with proper fitting. This may cost a little more, but is worthwhile, particularly for shoes that are used often.
  • Don’t go just by size. Have your feet measured, and choose shoes that fit the larger foot first.
  • Try on athletic shoes after a workout or run and at the end of the day. Your feet will be at their largest.
  • Wear the same type of sock that you will wear for that sport.
  • When the shoe is on your foot, you should be able to freely wiggle all of your toes.
  • The shoes should be comfortable as soon as you try them on. There is no break-in period.
  • Walk or run a few steps in your shoes. They should be comfortable.
  • Always re-lace the shoes you are trying on. You should begin at the farthest eyelets and apply even pressure as you create a crisscross lacing pattern to the top of the shoe.
  • There should be a firm grip of the shoe to your heel. Your heel should not slip as you walk or run.
  • If you participate in a sport three or more times a week, you need a sport-specific shoe. Remember that after 300 to 500 miles of running or 300 hours of aerobic activity, the cushioning material in a shoe is usually worn down and it’s time to toss the shoes.
  • If you have bunions or hammertoes, find a shoe with a wide toe box. You should be able to fully extend your toes when you’re standing, and shoes should be comfortable from the moment you put them on. They will not stretch out.
  • Women who have big or wide feet should consider buying men’s or boys’ shoes, which are cut wider for the same length.

Finally, if your feet or back hurt, you should get them checked out by a physician. For the best advice, see an orthopedic surgeon, a doctor specializing in diseases of the bones and joints. The orthopedic surgeon is trained to treat problems of the foot and ankle. Pedorthists and orthotists are trained to make and modify arch supports (orthoses) and fulfill the surgeon’s prescription. Working with these professionals will ensure you get the right shoe for the best possible treatment.

Proper-fitting sports shoes can enhance performance and prevent injuries. But whatever you choose to wear on your feet, get out there, have fun, and be healthy!


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Flu Shot Protocols for Employers

The cost of getting sick taxes employers and employees alike. Chronic illness and injuries—though not always anticipated—can be managed, but it’s hard to limit exposure to viruses and bacteria. However, there are steps we can take to mitigate the chances that we and our fellow workers will come down with and share certain contagious illnesses, especially in the workplace.

High on the list of contagions that can be controlled is influenza, or the flu. Every year, millions of Americans contract the flu, losing three to five days of work or more, requiring visits to physicians or walk-in clinics, and for many, a stay in the hospital. It’s also life threatening for seniors, small children and adults with compromised immune or respiratory systems. The annual medical costs run in the billions, as do the costs of lost productivity.

With easy, convenient, and affordable access to safe immunizations for preventing the flu, employers across the country, especially in the healthcare industry, are taking a more proactive stance toward ensuring employee compliance. Some companies are shooting for 100%compliance, launching educational campaigns, team competitions, rallies, and incentive options such as discounts and premiums. Others are taking a carrot and stick approach, linking employer contribution incentives to medical savings accounts. Others are just wielding the stick, insisting that employees receive a flu vaccination as a condition of employment, with exceptions for those who have legitimate religious concerns or allergies to the vaccination.

Recognizing the central role businesses and employers play in protecting the health and safety of their employees, the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) have produced materials intended to guide employers in their planning and preparedness for seasonal and pandemic influenza. The guidance is intended to help employers take actions to decrease influenza spread, maintain business continuity, and secure critical infrastructure. OSHA recommends that employers prioritize vaccination because it is a long-term and effective intervention that reduces reliance on employee behavioral changes such as hand hygiene and respiratory etiquette.

As far back as February of 2010, the Advisory Committee for Immunization Practices (ACIP) released their provisional recommendation that all people six months of age or older receive an annual influenza vaccination, unless contraindicated. The CDC also recommends that employers encourage employees to seek vaccination against both seasonal and pandemic influenza, offer influenza vaccination opportunities at their worksite or consider allowing employees time off from work to seek vaccination.

Despite the potential benefits of vaccination, self-reports within the National Health Interview Survey suggest that vaccine coverage among healthy adults 18 to 49 years is only approximately 20%. Offering vaccination in the workplace could increase coverage by making vaccination more convenient, and reducing or eliminating the associated cost may further improve influenza vaccine participation.

Studies have shown that individuals who received influenza vaccine at work cited convenience as an important factor in the decision to be vaccinated. Following physicians’ offices, workplaces are the most common location to receive an influenza vaccination, with one-third of 18- to 49-year-old vaccine recipients and one-fifth of 50 to 64-year-old vaccine recipients receiving the vaccine at work. The addition of workplace education programs can provide information and alleviate employees’ concerns and misinformation about influenza vaccination.

Compliance and the law

More and more healthcare employers are requiring that all employees get the influenza vaccine in order to help protect patients and coworkers during flu season. This trend has resulted in questions pertaining to the legality of such policies, as well as how to properly implement a mandatory influenza vaccination policy for employees. Employers may adopt mandatory flu shot policies which are drafted and implemented in a legally compliant manner.

As a condition of employment, an employer may require that all employees receive a flu shot. However, an employer’s compulsory flu shot policy must provide for exemptions in order to comply with various laws regulating the employer/employee relationship. For example, if an employee with a physical or mental disability refuses a flu shot, the employer may have to make a reasonable accommodation in order to comply with the federal Americans with Disabilities Act (ADA). A reasonable accommodation could take the form of exempting the employee from the requirement and instead requiring a different protective measure, such as wearing a surgical mask. Similarly, if an employee objects due to a sincerely held religious belief, the employer may also have to provide a reasonable accommodation, unless doing so would impose an undue hardship on the employer.

If an employee refuses to comply with the employer’s policy and/or any reasonable alternative protective measures required by the employer if an exemption is granted, an at-will employer may pursue disciplinary action which could include termination. Employers should consult knowledgeable legal counsel before making employment-based decisions.

Employers wishing to require flu shots should adopt a written flu shot policy so that all employees have reasonable advance notice that receiving an annual influenza vaccination is a condition of employment. The policy should set an annual compliance deadline based on the anticipated start of the flu season and outline consequences for noncompliance. For instance, the policy may list the steps triggered by noncompliance, such as a written warning, suspension, and termination if the noncompliance is not addressed within a certain time frame. The policy should also specify what written documentation the employee must furnish the employer to prove that the employee was vaccinated.

An Employer’s Policy Should Include Exemptions

An employer’s influenza vaccination policy should provide a process for employees to request an exemption from the employer. Additionally, the policy should notify employees that if the employer grants an exemption, employees are required to comply, as a condition of employment, with reasonable alternative protective measures specified by the employer.
Exemptions should be allowed for reasons such as

  • A sincerely held religious belief or creed;
  • A qualifying physical or mental disability;
  • A prior severe allergic reaction to the flu shot;
  • A history of Guillain-Barré Syndrome; or
  • Some other relevant medical reason.

Ultimately, educating employees about the benefits and importance of the flu shot may help maximize employee participation. Just like frequent hand washing, the flu shot is an important protective measure for employees and their families. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza. The CDC has a variety of resources related to influenza vaccination  that may be helpful to employers and employees, especially those in the healthcare field.

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Are You a Candidate for Medical Marijuana?

Though the debate about the use of medical marijuana continues in many states and in Washington, DC, close to half of the country — including Connecticut — has legalized the use of cannabis and its cannabinoids for medicinal purposes for treating a variety of conditions.

Use must be approved by a Connecticut-licensed physician or an Advanced Practice Registered Nurse (APRN), who must write a prescription that only can be filled at a licensed dispensary using products produced locally by a handful of State-approved growers.

To qualify, a patient needs to be diagnosed as having one of the following debilitating medical conditions that is specifically identified in the law, including:  Cancer, glaucoma, HIV, AIDS, Parkinson’s disease, multiple sclerosis, certain types of damage to the nervous tissue of the spinal cord, epilepsy, cachexia, wasting syndrome, Crohn’s disease or post-traumatic stress disorder. Other approved medicinal uses include:

  • Sickle Cell Disease
  • Post Laminectomy Syndrome with Chronic Radiculopathy
  • Severe Psoriasis and Psoriatic Arthritis
  • Amyotrophic Lateral Sclerosis
  • Ulcerative Colitis
  • Complex Regional Pain Syndrome

The laws regarding medical marijuana are fluid and constantly changing, as a board of physicians and legislators reflect on patient needs, other available drugs and therapies, and new research. The following additional medical conditions are now covered for patients over 18 (excluding inmates confined in a correctional institution of facility under the Department of Correction, regardless of their medical condition), although patients under 18 also qualify, with certain restrictions and requirements:

  • Cerebral Palsy
  • Cystic Fibrosis
  • Irreversible Spinal Cord Injury with Objective Neurological Indication of Intractable Spasticity
  • Terminal Illness Requiring End-Of-Life Care
  • Uncontrolled Intractable Seizure Disorder

The first step is to make an appointment with the physician treating you for the debilitating condition for which you seek to use medical marijuana. You will not be able to register in the system until the Department receives a certification from your physician or APRN that you have been diagnosed with a condition that qualifies for the use of medical marijuana and that, in his or her opinion, the potential benefits of the palliative use of marijuana would likely outweigh the health risks.

Patients with a prescription for medical marijuana need to complete an application with the State Department of Consumer Protection, which oversees this program in Connecticut. The process involves providing proof the patient still lives in Connecticut; an updated photograph; certifications that have to be completed online or in writing; and the payment of a program fee. Medical marijuana in Connecticut is not a covered health insurance benefit.

Qualifying patient applications take between two to three weeks to process. Upon approval of the application, a temporary certificate is emailed to the patient. This temporary certificate is valid for 30 days from the approval date of the application. The temporary certificate will allow patients to use their selected dispensary facility while their permanent Medical Marijuana Certificate is being mailed.

Patients must visit their selected dispensary in advance of filling their prescription as part of the screening process. Then, once approved, they can fill their prescription by accessing medical marijuana in a variety of forms and strengths. This includes product for smoking for those who might have trouble ingesting this medicine, or who prefer this delivery method. Prescriptions also cover the use of liquids, lozenges, edibles and other styles.

Though legalized, there are rules restricting use. For example, the law prohibits ingesting marijuana in a bus or any moving vehicle; in the workplace; on any school grounds (public or private), dormitory, college or university property; in any public place; or in the presence of anyone under 18. It also prohibits any use of palliative marijuana that endangers the health or well-being of another person, other than the patient or primary caregiver.

Finally, not every physician or APRN may be willing to write a prescription for medical marijuana, despite legalization. The Department of Consumer Protection does not require physicians or hospitals to recognize marijuana as an appropriate medical treatment in general or for any specific patient. If you believe that your physician is not providing you with the best medical care for your condition, then you may want to consider working with a different physician.

For more information, visit http://www.ct.gov/dcp and look for the section for medical marijuana under Laws & Regulations.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Natural Remedies: Cheap and Accessible

The next time you get too much sun exposure, bitten by a bug, abused by a stinging insect, break out into a rash or burn yourself on a hot pot, consider what remedies might be available to you if you didn’t have access to a medicine cabinet full of salves, creams and potions, or a drug store right down the block. Americans have been practicing home remedies for generations. Many are passed down from grandparents, some brought from Europe or other continents. Families swear by them, even though there’s the risk that future generations won’t remember them by the time they’re adults.

But there’s a treasure trove of natural healing at our fingertips, from toothpaste, apple cider vinegar, wet aspirins and aloe vera on our bee bites, to yogurt on our sunburn, honey on our cuts, and other practical and simple home-healthcare remedies. And in many cases, there’s science to back up what our grandparents already knew:  These things work, they’re cheap and they’re easily accessible.

For example, baking soda is a staple in many homes for baking and cleaning purposes – but there’s a good chance you’re not taking full advantage of all that baking soda has to offer, such as safely removing splinters from our fingers, or brushing your teeth.

In its natural form, baking soda is known as nahcolite, which is part of the mineral natron. It contains large amounts of sodium bicarbonate, which has been used since ancient times. For instance, the Egyptians used natron as a soap for cleansing purposes. Later, anecdotal reports throughout history suggest that many civilizations used forms of baking soda when making bread and other foods that required rising.

Some people believe that when taken internally, baking soda can help maintain the pH balance in our bloodstream. This is likely the basic premise behind its recommended uses against both colds and influenza symptoms. But that’s barely scratching the surface. Baking soda mixed in water helps neutralize stomach acid; soaking a finger or area of your body that has a splinter in the same solution will help raise the splinter to the surface. Adding baking soda to a lukewarm bath is a natural sunburn remedy, or it can be added to a small amount of water and applied directly to the burnt area.

A pinch of baking soda in water makes a paste that’s an effective deodorant, and mixing six parts baking soda to one part sea salt in a blender makes an excellent tooth paste for whitening and fighting plaque. Finally, a similar paste applied to bug bites relieves itching, and it works similarly for itchy rashes and poison ivy. It also is an effective foot soak, exfoliator for face and body, and detox bath for soaking away aches and pains (and it cleans the tub at the same time!).

Honey is another useful home remedy. Some people apply honey directly to the skin for wound healing, burns, sunburn, cataracts, and diabetic foot ulcers. Topical use of honey has a long history. In fact, it is considered one of the oldest-known wound dressings. Honey was used by the ancient Greek physician Dioscorides in 50 A.D. for sunburn and infected wounds. Honey’s healing properties are mentioned in the Bible, Koran, and Torah.

Studies have shown honey to be helpful in healing wounds, and it may be a potent antibiotic.  Honey appears to draw fluid from the underlying circulation, providing both a moist environment and topical nutrition that enhances tissue growth. Honey also may spur debridement — the removal of dead tissue around a wound to make way for healthy tissue. To treat bee stings with honey, apply a small amount to the affected area. Cover with a loose bandage and leave it on for up to an hour.

Honey is used for coughs, asthma, and hay fever. It is a known remedy for treating diarrhea and certain types of stomach ulcers caused by bacterial infection. Honey also is used as a source of carbohydrates during vigorous exercise, and it is added as a fragrance and a moisturizer in soaps and cosmetics.

A cool milk compress is one of the quickest, simplest and lowest-cost ways to treat sunburn. It doesn’t get much easier than just heading to the refrigerator for relief! The initial coolness of the milk will ease the heat, while it also creates a layer of protein to protect your skin, help it heal, and further soothe discomfort. Milk’s cousin, yogurt, is equally effective for treating sunburn. Live cultured plain yogurt contains an abundance of probiotics and enzymes that help heal our skin. Make sure it’s truly plain yogurt, not vanilla, and that it has probiotics, and apply it liberally to the affected area.

Everyone experiences nausea at one point or another. Whether yours is related to pregnancy, acid reflux, a virus or bacterial illness or cancer treatment, natural remedies may provide some relief. Stocking your pantry with natural treatments for nausea can help you get through your discomfort.

Ginger, for example, has a long history of being used to treat nausea, stomachaches, and diarrhea. The Chinese have used ginger to treat a variety of digestive and pain issues for more than 2,000 years. It’s unclear exactly how ginger works to ease nausea, but it’s thought that active components, such as gingerol, directly affect the digestive and central nervous systems.

Another useful home treatment for stomach ailments and nausea is peppermint, which relaxes stomach muscles so that bile can break down fats and food can move through the stomach quickly. Peppermint comes in many forms and treatments, including ointments for skin irritation. Some studies even suggest that the scent of peppermint oil could ease nausea. But if you have gastroesophageal reflux disease (GERD), you should not use peppermint.

Puffiness around the eyes from allergies or rashes can be treated by using home remedies like cucumbers or cold chamomile tea bags to help reduce the inflammation and swelling. Cucumbers have powerful antioxidants and flavinoids that are thought to reduce irritation, and chamomile also has antioxidants and healing properties.

There are many more home remedies that are inexpensive and effective. Take the time to learn what they are and how to use them, and you’ll save money, time and needless trips to the pharmacy!


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Memory loss and aging: What’s “normal?”

Head upstairs for something and come back down without it? Find yourself struggling to remember someone’s last name or phone number? Take a wrong turn going somewhere you’ve been driving to for years? Forget to pay a monthly bill? Forgetfulness may be upsetting, but examples like these are common as we age and nothing to worry about. Yet for many older Americans, forgetting things on an increasingly regular basis may be a sign of oncoming dementia or a form of Alzheimer’s, a degenerative brain disease that affects close to one in four Americans.

Alzheimer’s disease is the sixth-leading cause of death among U.S. adults, and the fifth-leading cause among adults aged 65 to 85. In 2013, an estimated 5 million Americans aged 65 years or older had Alzheimer’s disease. This number may triple by 2050, with the costs of care already projected at over $200 billion per year, and expected to increase to more than $500 billion by 2040.

Alzheimer’s disease causes large numbers of nerve cells in the brain to die. This affects a person’s ability to remember things, think clearly, and use good judgment. It typically involves parts of the brain that control thought, memory, and language. While doctors don’t know what causes the disease, they do know that most of the time it begins after age 60.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life, and Alzheimer’s disease is the most common. It often starts slowly. In fact, some people don’t know they have it and assume their forgetfulness is just a sign of increasing age. However, over time, their memory problems get more serious. People with Alzheimer’s disease have trouble doing everyday things like driving a car, cooking a meal, or shopping or paying bills. They may get lost easily and find even simple things confusing. Some people become worried, angry or violent.

As the illness progresses, people with Alzheimer’s disease need someone to help take care of their daily needs, including feeding and bathing. Some people with Alzheimer’s live at home with a caregiver. Other people with the disease live in a nursing home or in a facility that specializes in dementia-related illnesses.

Though age is the best-known risk factor for Alzheimer’s disease, researchers believe that genetics may play a role. Changes in the brain can begin years before the first symptoms appear, and scientists are studying whether education, diet, exercise and environment play roles in developing Alzheimer’s disease. They also are finding more evidence that some of the risk factors for heart disease and stroke — such as high blood pressure, high cholesterol, and low levels of the vitamin folate — may also increase the risk of Alzheimer’s disease.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by depression, medication side effects, excess use of alcohol, vitamin deficiencies  or thyroid problems may improve when the condition is treated or addressed.

How to recognize signs of early dementia

Alzheimer’s disease is not a normal part of aging. And while memory loss affects all of us as we age, it also is typically one of the first warning signs of cognitive loss.

Different types of dementia are associated with particular types of brain cell damage in specific regions of the brain. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s.

According to the National Institute on Aging, in addition to memory problems, someone with Alzheimer’s disease may experience one or more of the following signs:

  • Gets lost
  • Has trouble handling money and paying bills
  • Repeats questions
  • Takes longer to complete normal daily tasks
  • Displays poor judgment
  • Loses things or misplacing them in odd places
  • Displays mood and personality changes.

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. It’s hard to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose “dementia” and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or gero-psychologist.

Treatment of dementia depends on its cause. In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms, and it’s important to note that other causes of dementia-like behavior – such as from head injuries, alcohol abuse and depression – can be treated.

Protecting our brains

Evidence also is growing for physical, mental, and social activities as protective factors against Alzheimer’s disease. Our brain is nourished by one of our body’s richest networks of blood vessels. Anything that damages blood vessels anywhere in our body can damage blood vessels in our brain, depriving brain cells of vital food and oxygen. Blood vessel changes in the brain are linked to vascular dementia. They often are present along with changes caused by other types of dementia, including Alzheimer’s disease. These changes may interact to cause faster decline or make impairments more severe.

We can help protect our brains with some of the same strategies that protect our heart – don’t smoke; take steps to keep our blood pressure, cholesterol and blood sugar within recommended limits; and maintain a healthy weight.

Regular physical exercise may help lower the risk of some types of dementia. Evidence suggests exercise may directly benefit brain cells by increasing blood and oxygen flow to the brain. And what we eat may have its greatest impact on brain health through its effect on heart health. The best current evidence suggests that heart-healthy eating patterns, such as the Mediterranean diet, also may help protect the brain. A Mediterranean diet includes relatively little red meat and emphasizes whole grains, fruits and vegetables, fish and shellfish, and nuts, olive oil and other healthy fats.

If you or someone you know has several or even some of the signs of increasing forgetfulness, it does not mean that you or they have Alzheimer’s disease. It is important to consult a health care provider regarding concerns about memory loss, thinking skills, or behavioral changes.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Beware hernias masquerading as stomach aches

So when the doctor says “drop your drawers, turn your head, and cough,” he or she obviously isn’t listening to your lungs – typically, it’s a simple way of diagnosing the most typical form of abdominal hernia.

Hernias are very common, and occur in different locations. A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall. Hernias are most likely to occur in the abdomen, but they also can appear in the upper thigh, belly button, and groin areas. Most hernias are not immediately life threatening, but they don’t go away on their own and can require surgery to prevent potentially dangerous complications.

Inguinal hernias, the most common abdominal hernia, make up about 70 percent of all hernias, and are more common in men than in women. This is because a man’s testicles descend through the Inguinal canal shortly after birth, and the canal is supposed to close almost completely behind them. Sometimes, the canal does not close properly and leaves a weakened area prone to hernias.

Hernias are caused by a combination of muscle weakness and strain. Common causes of muscle weakness include failure of the abdominal wall to close properly in the womb, which is a congenital defect; age; chronic coughing; or damage from injury or surgery. Sports-related hernias can be caused by repetitive twisting or turning, especially at high speeds.

The most obvious symptom of a hernia is a bulge or lump in the affected area. In the case of an Inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet. You’re more likely to feel your hernia through touch when you’re standing up.

Other common symptoms of an inguinal hernia include:

  • Pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
  • Weakness, pressure, or a feeling of heaviness in the abdomen
  • A burning, gurgling, or aching sensation at the site of the bulge

In some cases, hernias have no symptoms. You may not know you have a hernia unless it shows up during a routine physical or a medical exam for an unrelated problem.

Depending on its cause, a hernia can develop quickly or over a long period of time. You can’t always prevent the muscle weakness that allows a hernia to occur. However, you can reduce the amount of strain you place on your body. This may help you avoid a hernia or keep an existing hernia from getting worse. Prevention tips include:

  • Not smoking
  • Seeing your doctor when you’re sick to avoid developing a persistent cough
  • Maintaining a healthy body weight
  • Avoiding straining during bowel movements or urination
  • Lifting objects with your knees and not your back
  • Avoiding lifting weights that are too heavy for you

Other types of hernias

Incisional hernias can occur after you’ve had abdominal surgery. Your intestines may push through the incision scar or the surrounding, weakened tissue.

Hiatal hernias occur when part of your stomach protrudes up through the diaphragm into your chest. This type of hernia is most common in patients over 50 years old. If a child has the condition, it’s typically caused by a congenital (birth) defect. Hiatal hernias almost always cause gastro esophageal reflux, which is when the stomach contents leak backward into the esophagus, causing a burning sensation. Symptoms of a hiatal hernia include acid reflux, which is when stomach acid moves backward into the esophagus causing a burning sensation; chest pain; and difficulty swallowing.

Umbilical hernias can occur in children and babies under six months old. This happens when their intestines bulge through their abdominal wall near their bellybutton. You may notice a bulge in or near your child’s bellybutton, especially when they’re crying. An umbilical hernia is the only kind that often goes away on its own, typically by the time the child is one year old. If the hernia has not gone away by this point, surgery may be used to correct it.

Other factors that strain your body and may cause a hernia include being pregnant, which puts pressure on your abdomen, and persistent coughing or sneezing. Other factors include a personal or family history of hernias, being overweight or obese, a chronic cough, chronic constipation, or smoking, which can trigger a chronic cough.

If your hernia is growing larger or causing pain, your doctor may decide that it’s best to operate. Repairing a traditional hernia typically involves sewing or closing the hole in the abdominal wall during surgery. This is most commonly done by patching the hole with surgical mesh, and often can be done through laparoscopic surgery, using a tiny camera and miniaturized surgical tools. Not all hernia surgeries can be conducted this way, however.

If you detect what you believe may be a hernia from straining yourself, exertion or genetics, a quick visit to your physician can help determine the easiest course of action.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Engage Employees in Monthly Health Awareness Activities

Somewhere in Washington, DC, bureaucrats are hard at work reviewing requests for new awareness recognition months, weeks, and days. There already are a slew of these, many designed to raise awareness for serious diseases and illnesses like heart disease, high blood pressure, most types of cancer, diabetes, traumatic brain injury, oral and mental health, and dozens of chronic illnesses.

There also are recognition periods for lesser-known or rare diseases, social causes, and special events like Great Outdoors Month, and Fruit and Vegetables Matter Month. Then, it expands widely from there, with recognition for everything from National Red Meat month, to Don’t Fry Day, Dump your Boyfriend Week, and months dedicated to condoms, grapefruits, biking, and riptide awareness.

The point isn’t to question whether or not these are important and worthwhile tributes, but to acknowledge that there’s something for everyone – and that represents opportunities for small businesses to embrace days, weeks, and months dedicated to loving dogs, drinking wine, eating chocolate, or disease prevention and staying healthy through improved nutrition and exercise.

Employees embrace a wide range of personal interests and activities. If your goal is to help improve workplace health and wellness, enhance teamwork, boost morale, and increase employee involvement, tapping into awareness recognition is an easy, fun, and interactive way to engage employees.

Many organizations create voluntary health and wellness committees tasked with identifying causes that appeal to employees, and then determining how education, outreach, and interactive activities will be coordinated. Some employers tie their activities to local events, charities, and parks. Program suggestions cover the gamut from inviting guest speakers and fitness experts, hosting healthy eating activities, running screening clinics for blood pressure, cholesterol, blood sugar and flu shots, swapping recipes, participating in walks, runs, and bike races, losing weight, quitting smoking, and just about anything creative, enthusiastic people can think about.

This month alone, here are just some of the more serious national health observances taking place:

  • Skin Cancer and UV Awareness Month
  • Mental Health Month
  • National Blood Pressure Awareness Month
  • Healthy Vision Awareness Month
  • Arthritis Awareness Month
  • Lyme Disease Awareness Month
  • Celiac Disease Awareness Month

There are plenty more, too – pick the ones that work for you and your team.

By simply searching on the Internet for “national health awareness months,” you’ll discover a plethora of options. And when companies underwrite group activities, offer incentives, sponsor friendly competitions, and recognize participation, employers can demonstrate leadership, interest in their employees’ wellness, and their commitment to creating and maintaining a healthy workplace.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

The Message Doesn’t Get Old, but Our Skin Does

We love the sun, especially after a dreary winter and rainy spring. Whether working or playing outdoors, attending parties and picnics, enjoying trips to the beach, or just hanging on the deck or in the yard, we soak up those rays, get our vitamin D, and savor our 2017 tans. But this year, as the perennial warnings about sun exposure and the dangers of Ultraviolet (UV) rays hit the air waves, take note: Skin cancer is the most common form of cancer in the United States, and you can help minimize exposure and prevent its onset by taking simple precautions.

Unprotected exposure to UV radiation is the most preventable risk factor for skin cancer. In fact, UV radiation from the sun and tanning beds is classified as a human carcinogen by the U.S. Department of Health and Human Services and the World Health Organization. Each year, more new cases of skin cancer are diagnosed in the U.S. than new cases of breast, prostate, lung, and colon cancer combined. One in five Americans will develop skin cancer in their lifetime, and one American dies from skin cancer every hour.

Chronic exposure to the sun suppresses our natural immune system and also causes premature aging, which over time can make the skin become thick, wrinkled and leathery. Since it occurs gradually, often manifesting itself many years after the majority of a person’s sun exposure, premature aging is often regarded as an unavoidable, normal part of growing older. However, up to 90% of the visible skin changes commonly attributed to aging are caused by the sun. With proper protection from UV radiation, many forms of skin cancer and most premature aging of the skin can be avoided.

Properly protecting ourselves from UV exposure

The best way to lower our risk of skin cancer is to protect our skin from the sun and ultraviolet light. Using sunscreen and avoiding the sun helps reduce the chance of many aging skin changes, including some skin cancers. However, it is important not to rely too much on sunscreen alone. You should also not use sunscreen as an excuse to increase the amount of time you spend in the sun. Even with the use of sunscreen, people should not stay out too long during peak sunlight hours; UV rays can still penetrate our clothes and skin and do harm.

When possible, avoid sun exposure during the peak hours of 10:00 am to 4:00 pm, when UV rays are the strongest. Clouds and haze do not protect you from the sun, so use sun protection even on cloudy days.

Use sunscreens that block out both UVA and UVB radiation. Products that contain either zinc oxide or titanium oxide offer the best protection. Less expensive products that have the same ingredients work as well as expensive ones. Older children and adults (even those with darker skin) benefit from using SPFs (sun protection factor) of 15 and over. Many experts recommend that most people use SPF 30 or higher on the face and 15 or higher on the body, and people who burn easily or have risk factors for skin cancer should use SPF 50+.

Here’s how to use sunscreen to ensure the best possible protection from the sun’s damaging UV rays:

  • Adults and children should wear sunscreen every day, even if they go outdoors for only a short time.
  • Apply 30 minutes before going outdoors for best results. This allows time for the sunscreen to be absorbed.
  • Remember to use sunscreen during the winter when snow and sun are both present.
  • Reapply at least every two hours while you are out in the sunlight.
  • Reapply after swimming or sweating. Waterproof formulas last for about 40 minutes in the water, and water-resistant formulas last half as long.
  • Adults and children should wear hats with wide brims to shield from the sun’s rays.
  • Wear protective clothing. Look for loose-fitting, unbleached, tightly woven fabrics. The tighter the weave, the more protective the garment.
  • Avoid sun lamps, tanning beds, and tanning salons.
  • Buy clothing and swimwear that block out UV rays. This clothing is rated using SPF (as used with sunscreen) or a system called the ultraviolet protection factor (UPF) index.
  • Avoid surfaces that reflect light, such as water, sand, concrete, snow, and white-painted areas.
  • Beware that at higher altitudes we burn more quickly.

The sun’s rays are important to our health, in moderation, but we get more than enough just by being outdoors for normal activities like going to work and to school, and when puttering in the yard or walking the dog. Taking simple, painless steps to help protect ourselves and our children now can make a huge difference later in life.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Achy Knees? Joint Pain? What You Need To Know About Arthritis


Maybe it starts with stiffness in the morning when you wake up, or you notice your hands are aching as the weather turns colder. Knees giving you some trouble, or your shoulder hurting when you lift heavy bags or objects? Age catches up to all of us eventually, but if you’re experiencing stiffness or swelling in your hands and joints, and a decreased range of motion you may be suffering from common arthritis symptoms.

If so, you’re in good company: More than 50 million adults and 300,000 children have some type of arthritis. It is most common among women and occurs more frequently as people get older.

Common arthritis joint symptoms can come and go. They can be mild, moderate, or severe. They may stay about the same for years, or may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities, and make it difficult to walk or climb stairs. Arthritis also can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-rays. Some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin as well as the joints.

Arthritis is not a single disease — it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America.

Every year, arthritis and related conditions account for:

  • More than $156 billion annually in lost wages and medical expenses
  • More than 100 million outpatient visits
  • An estimated 6.7 million hospitalizations

There are different types of arthritis. Osteoarthritis is the most common type of arthritis. When cartilage – the slick, cushioning surface on the ends of bones – wears away, bone rubs against bone, causing pain, swelling, and stiffness.  Over time, joints can lose strength and pain may become chronic. Risk factors include excess weight, family history, age, and previous injury.

Arthritis can also be degenerative. A healthy immune system helps protect us. It generates internal inflammation to get rid of infection and prevent disease. But the immune system can mistakenly attack the joints with uncontrolled inflammation, potentially causing joint erosion, and may damage internal organs, eyes, and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. Researchers believe that a combination of genetics and environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor that can trigger rheumatoid arthritis in people with certain genes.

With autoimmune and inflammatory types of arthritis, early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage. Remission is the goal and may be achieved through the use of one or more medications known as disease-modifying antirheumatic drugs (DMARDs). The goal of treatment is to reduce pain, improve function, and prevent further joint damage.

Other types of arthritis include infectious and metabolic. A bacterium, virus, or fungus can enter the joint and trigger inflammation. Examples of organisms that can infect joints are salmonella and shigella (food poisoning or contamination), chlamydia and gonorrhea (sexually transmitted diseases) and hepatitis C (a blood-to-blood infection, often through shared needles or transfusions). In many cases, timely treatment with antibiotics may clear the joint infection, but sometimes the arthritis becomes chronic.

With metabolic arthritis, uric acid is formed as the body breaks down purines, a substance found in human cells and in many foods. Some people have high levels of uric acid because they naturally produce more than is needed or the body can’t get rid of the uric acid quickly enough. In some people, the uric acid builds up and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain, or a gout attack. Gout can come and go in episodes or, if uric acid levels aren’t reduced, it can become chronic, causing ongoing pain and disability.

Diagnosing and controlling arthritis

Arthritis diagnosis often begins with a primary care physician, who performs a physical exam and may do blood tests and imaging scans to help determine the type of arthritis. An arthritis specialist, or rheumatologist, should be involved if the diagnosis is uncertain or if the arthritis may be inflammatory. Rheumatologists typically manage ongoing treatment for inflammatory arthritis, gout, and other complicated cases. Orthopaedic surgeons do joint surgery, including joint replacements. When the arthritis affects other body systems or parts, other specialists, such as ophthalmologists, dermatologists or dentists, may also be included in the health care team.

When the joint symptoms of osteoarthritis are mild or moderate, they can be managed by:

  • Balancing activity with rest
  • Using hot and cold therapies
  • Regular physical activity
  • Maintaining a healthy weight
  • Strengthening the muscles around the joint for added support
  • Using assistive devices
  • Taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines
  • Avoiding excessive repetitive movements

If joint symptoms are severe, causing limited mobility and affecting quality of life, management strategies may be helpful, but joint replacement may be necessary. Osteoarthritis that isn’t genetic may be reduced or prevented by staying active, maintaining a healthy weight, and avoiding injury and repetitive movements. As a general prescription, focusing on healthy eating and exercise remains the best course for limiting the onset of arthritis and for helping you control symptoms now or down the road.

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Living Life on the Sunny Side of the Street

When people are acting negatively – critical about themselves and others, pessimistic, always seeing the darker side of things, constantly questioning motives, always assuming the worst – it wears on the people around them and on them, as well.  Negative people get sick more often and take longer to recover, while optimistic people tend to be less sick and more resilient.

Research indicates that psychological factors influence cardiovascular disease, morbidity, and mortality. Persistent negative behavior such as depression, anxiety or anger, and cynical, hostile attitudes toward others have been linked as early indicators of future heart disease. On the other hand, dispositional optimism or the general feeling that good things rather than bad will resolve a difficult situation or generally prevail in the future, have been associated with reduced risk of mortality.

Published last year in the American Journal of Epidemiology, researchers found a definitive association between a positive sense of well-being and better health. This study used data from 70,021 women who were part of a long-running nurses’ health study. It gauged their level of optimism through a questionnaire originally conducted in 2004. The average age of respondents was 70 years old.

Then the researchers tracked deaths among the women from 2006 to 2012. They found that after controlling for factors including age, race, educational level, and marital status, the women who were most optimistic were 29% less likely to die during the six-year study follow-up than the least optimistic. That reduced risk was seen in cancer (16% lower), heart disease (38%), stroke (39%), respiratory disease (37%), and infection (52%).

When the researchers ran additional analyses controlling for existing health conditions such as high cholesterol, diabetes, and cancer, the risk of dying was 27% lower among the most optimistic women. When controlling for health behaviors like smoking and exercise, 14% lower. And when controlling for all those factors, the risk of dying was still 9% lower among the most optimistic women.

People who are more optimistic tend to have healthier behaviors when it comes to diet, exercise, and tobacco use. It’s also possible that more optimistic people cope better, create contingency plans, plan for future challenges, and accept what can’t be changed. This optimism may have a direct impact on improved immune function or lower levels of inflammation.

In another study, doctors evaluated 309 middle-aged patients who were scheduled to undergo coronary artery bypass surgery. In addition to a complete pre-operative physical exam, each patient underwent a psychological evaluation designed to measure optimism, depression, neuroticism, and self-esteem. The researchers tracked all the patients for six months after surgery. When they analyzed the data, they found that optimists were only half as likely as pessimists to require re-hospitalization. In a similar study of 298 angioplasty patients, optimism was also protective; over a six-month period, pessimists were three times more likely than optimists to have heart attacks or require repeat angioplasties or bypass operations.

And finally, an American study of 2,564 men and women who were 65 and older also found that optimism is good for blood pressure. People with positive emotions had lower blood pressures than those with a negative outlook. On average, the people with the most positive emotions had the lowest blood pressures.

Can we learn to be positive?

So if having a positive attitude can help reduce illness and prolong life, why aren’t we all happy, and what might we do to become less pessimistic and negative? The first question is the harder to answer. We are complex psychological beings, products of our upbringing, genetics, hardships, and positive and negative experiences. We’ve been shaped and influenced by many people and situations, and we learned good and bad behaviors through the years by observation and reaction, and as protection.

But there are things we can do to help move ourselves into a more positive, optimistic mindset.

For example:

  • Notice negativity. Listen to what you and others say and how negative it is. Track your own thoughts on a daily basis and notice the negative assumptions and conclusions that you draw, because identifying our own negativity is essential to change.
  • When you find yourself saying something negative, think of something positive to say.
  • Search for positive aspects of situations. Most situations can be seen in both a positive and negative light. You just have to find the positive one and keep reminding yourself of it in order to eventually believe it.
  • Think of someone you know who has a positive outlook on life and ask yourself what that person would do or think in particular situations. Then try to think that way too.
  • Give others positive feedback. Even if someone has done something poorly, there has to be some aspect of it that is good. If you can find this, your view will be more positive and the other person may feel encouraged to continue.
  • Give yourself positive feedback and notice when you discount or minimize your successes. Pessimists feel uncomfortable with good things and often fear disappointing others by acknowledging their own strengths. Learn to just say thank you if someone (including yourself) gives you positive feedback.
  • Identify why you feel negative. Does it provide protection against disappointment? Does it help you not to get hurt? Do you think that it helps you to plan for possible challenges? We often think that pessimism and worry are helpful but this is not true. We can learn to handle disappointment, hurt, and challenges if we were not bogged down by anxiety and negativity.
  • Take the risk of being positive and see how it feels. It takes a long time to learn negativity and will take a while to learn optimism.

Positive thinking and being will help you lead a longer, healthier life. It may take practice, but what do you have to lose, other than the negative attitude?

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!