Nurse Tips: Double-Check Your Medications

Americans are taking more medications than ever before. Most of these meds allow us to live healthier (and longer), but it’s important to make sure that they are taken correctly.

Over the next few months, the Nurse Tip of the Month will give you some helpful hints about your medications and how to make sure they work best for you.

The most important thing to make sure of when you pick up your prescriptions is that you receive the correct medication in the correct dosage. Before you walk out of the store or drive away from the drive-thru lane, open up the bag and check that the medication and dosage written on the label is what your doctor specifically prescribed to you.

Pharmacies do their best to fill prescriptions correctly, but mistakes do happen and they can result in severe consequences, such as overdoses or negative interactions, so make sure you make a habit of checking every single time you pick up your drugs.

You can follow Everybody Needs A Nurse on Twitter @ENANurse1

image by beigeinside via flickr

Exercise & The Brain: New Benefits

Mike Clark is an Exercise Physiologist and Personal Trainer at the Duke Center for Living at Fearrington. He received his BA in Exercise and Sports Science from UNC.

It is well established that a structured exercise program can help prevent heart disease, stroke, cancer, and obesity. But what about the brain? When I was in the exercise science program at UNC we talked about endorphins, and how they increase with exercise to provide that “runner’s high” after a vigorous exercise session. But that was about it. Today there is a lot of research into how physical activity benefits the brain, which goes well beyond helping you feel better a couple of hours after the exercise session. Currently, there are three emerging benefits for the brain that scientists are currently studying.

To begin, the brain can be likened to a computer, with both hardware and software. The brain’s “hardware” consists of the actual cells and structures that form the brain, like cells called neurons, gray and white matter, and different sections to carry out clear-cut functions within the body, much like the medulla oblongata regulates heart rate and breathing rate. The “software” consists of cognition, moods, mental states, memories, and other less tangible qualities. You will be happy to see that physical activity and exercise can aid both the brain’s software and hardware.

The first notable benefit is software related, in that cardiovascular fitness levels have been shown to affect the symptoms of depression in both depressed and non-depressed people. Depression, 1 of the 4 recognized mood disorders, affects roughly 1 in 10 Americans each year. In a twelve-year follow up study published in 2009, researchers measured the depressive symptoms and cardiovascular fitness of eleven thousand men and three thousand women. The results showed that as fitness levels increase, depressive symptoms (i.e. feelings of hopelessness) decreased. The researchers concluded that men and women with the lowest level of cardiovascular fitness were at the highest risk of experiencing depressive symptoms. Additionally, over 25 previous studies show that physically active individuals have a 33% reduction in depressive symptoms, regardless of race, age, or medical condition. Additionally, if depression is already present in a sedentary individual, exercise can be a valuable therapy for decreasing the symptoms, much like antidepressants and talk therapy.

The next benefit is both software and hardware related, in that studies show that physical activity reduces the risk of cognitive decline in adults and older adults. Cognitive decline comes in the form of Alzheimer’s disease and other dementias, which can decrease brain cell number and brain mass, along with negatively impacting thought processes, memories and even moods. While the mechanisms that provide the exercise benefit are still unclear, studies show that cognitive function increases when individuals exercise, with the largest increases coming by way of executive function (i.e. decision making, etc). Dr. Bonita L. Marks, an exercise researcher and neuroscientist at UNC-Chapel Hill and Duke University writes about exercise and the brain: “it seems that physical exercise helps to maintain/preserve the structural integrity of the brain, presumably by facilitating better delivery and uptake of needed hormones, which are responsible for maintaining the existing brain cells and creating new ones. When we have healthy brain cells able to transmit thoughts effectively, we have better memory processes and can remember all the important things, like where you parked your car or where you last put your keys.” Multiple research studies are finding the same effect as Dr. Marks’.

The final benefit to mention is hardware in nature. Neurogenesis is defined as the development of new nervous tissue, and in the case of exercise training, new brain cells. While it was once thought that brain cells could not be replaced once destroyed, MRI and other advanced imaging techniques have proven otherwise. Surprisingly, neurogenesis is a process that takes place throughout life; though the rate slows as age increases. In studies of active and sedentary mice, researchers observed that the sedentary mice experienced normal decreases in neurogenesis and brain size. Exercising mice, however, maintained higher levels of neurogenesis and higher brain sizes, in spite of increasing age. What is also interesting is that there seemed to be higher brain volumes in the mice who exercised early in life, suggesting that the aerobic training may have had an accumulative effect on the brain. Exercise induced neurogenesis has also been observed in humans, and more studies are being conducted on if the new brain cells actually aid in learning, memory, daily function, and the prevention of cognitive decline.

The amount of exercise needed to provide the brain benefit is still under scrutiny. The current exercise recommendation calls for jogging, or an equivalent activity, twenty minutes, 3 days a week, or brisk walking for thirty minutes, 5 days per week. While these recommendations are based primarily on heart health and the prevention of chronic disease, Dr. Marks and other researchers believe this amount of exercise will also apply to brain health.

Fitness Myths Debunked

My apologies for being the bearer of bad news, but we have all been fooled in the world of fitness. Even the most discerning consumer of wellness tips, trends and products has been duped into believing both intentional and innocent lies in the industry. There is no need for bitterness toward the professionals in the field, however, as this is only to be expected when research and education have been limited in past years. The great news is, research has increased at an incredible rate and our questions are getting answered.

The following are what I consider to be the most commonly believed myths that somehow, despite already being debunked rather publicly, are still lurking in the minds of gym members everywhere.

  1. Spot reduction. You know all those inner thigh squeezes you’ve been doing? The countless crunches? The endless triceps extensions, pushdowns and presses? They’re great! But they’re not going to give you a chiseled look. Consider this fact: every single person has a 6-pack of abs. We all have the same set of muscles, special cases aside, so if the muscles are in an anatomy textbook, they are present in your body. The problem is the fat we store between our skin and muscles. This subcutaneous fat, a direct result of more calories in than out, can only be burned by changing to a caloric deficit of more calories out than in. This is not done with 600 crunches, 500 inner thigh squeezes and 300 triceps extensions. This is done with exercises that burn fat, including cardiovascular exercise like running and high-intensity exercise like a kettlebell class, and eating an appropriate number of calories in your day.
  2. Exercising turns fat to muscle. Muscle is muscle, fat is fat. They are completely different tissues that serve completely different roles and functions and they are named differently because, well, they’re different! In a deconditioned individual who is leading a primarily sedentary life, their muscles, including that 6-pack that really does exist, are weak and have possibly even atrophied, meaning wasted away. But the muscle tissue did not turn into the fat that lies between the muscles and skin. What happens is muscle becomes weak due to a lack of adequate use while fat develops due to an excess in calories that were not used for energy so they were stored away by the body. To reverse this occurrence, activity must be increased to address both the weak muscles and the excess fat. By increasing activity, you can rebuild your muscles as well as burn the excess fat.
  3. Resistance training will make me (a female) bulk up. Sure it will… if you’re maxing out the weight and repetitions every time you lift. The principle of Specific Adaptations to Imposed Demands (SAID) can confirm that if you train a particular way, your body will adapt accordingly. Lifting heavy weights will require your body to build larger muscles to accommodate lifting that kind of load. With every increase, as your body adapts, you will experience muscle hypertrophy, or growth. However, you have to impose a demand high enough for that adaptation to take place. Applying sufficient demands, not an overload of demands, on your muscles with resistance, cardiovascular, flexibility and balance exercises, you will provide the appropriate variety for your body to improve your heart’s efficiency, strengthen your muscles and burn excess fat. For specific recommendations on how much of each type of exercise you should be achieving each week, check out the American College of Sports Medicine (

Remember to be a discerning consumer of wellness tips and products because being safe and smart will allow your workout efforts to be more efficient and effective. My best to you as you get and stay on track to your wellness goals this year!

Ellen Thornburg is an Exercise Physiologist and Personal Trainer at the Duke Center for Living at Fearrington. She received her BA in Exercise and Sports Science and Psychology from UNC.

image by aktivioslo via flickr

Headaches: When It's Time To See The Doctor

Headaches are, sadly, fairly common occurrences for most people. Generally, we take an aspirin or ibuprofen and it goes away. But when is it time to seek treatment for a headache?

Plan a visit to your doctor if:

  • your headaches require you to take pain medication frequently or in high doses
  • your headaches are getting progressively worse over time
  • your headache prevents you from performing your usual daily activities

Go to the emergency room immediately if:

  • your headaches are accompanied by seizures, weakness, blurred vision, difficulty with speech or other neurological problems
  • you feel acute, severe pain, particularly with sudden onset
  • your headache is accompanied by severe nausea
  • your headache is the result or an injury, such as a car crash or fall

For more information, check out the National Headache Foundation at

You can follow Everybody Needs A Nurse on Twitter @ENANurse1

image by TheGiantVermon via flickr

Surgery for Back Pain? Think Twice

Back pain can be an enormous obstacle to your daily life. Our spines are so central to every movement we make that any discomfort or pain can make ordinary activities unbearable.

There are numerous causes of back pain, from muscle spasm to disc problems to bone deformities. And there are almost as many kinds of treatments, from massage and acupuncture to steroid injections to surgery.

Our little Nurse Tip page is not big enough to provide an overview of all the treatments for back pain, but it’s important to know that according to the Mayo Clinic and recent studies, surgery helps in only a small percentage of cases and can create complications that can be even worse than the original problem.

Our advice is not to rule out surgery altogether, but to think of it as a last resort after trying every other treatment, starting with the least invasive. New studies have shown that acupuncture is very effective for treating back pain.

 For more information about treatments for back pain, check out these websites: Mayo Clinic webpage & Web MD on acupuncture for back pain 

You can follow Everybody Needs A Nurse on Twitter @ENANurse1

image by ginchyqueendangle via flickr

A Brief History of the Exercise Recommendation

It’s interesting how we take health information for granted. Anecdotes are everywhere, most with little to no science backing them. Take water consumption for example; the long-standing recommendation is 8 eight-ounce glasses per day. Many, including some health practitioners, believe this recommendation is totally accurate. While I am sure it is/was well intended, the daily eight is anecdotal; handed down from who knows where. Currently, the Institute of Medicine (IOM) and the only institution with an actual dietary recommendation for water suggest that men consume the equivalent of 13 eight-ounce glasses a day, or roughly 40% more than the daily eight. For women, the IOM suggests the equivalent of 9 glasses or 15% more than the old standard. And while this article is not about water consumption, the above example does illustrate how health myths can become public fact.

I think the everyday exercise recommendation, classically described as thirty minutes, five days a week, is a lot like the water recommendation concerning its presence in everyday life. It’s the “go to” for CNN’s chief medical correspondent Sanjay Gupta, first lady Michelle Obama, and others who try to promote exercise as part of a healthy lifestyle. But where does it come from, and why does it exist in the first place? And is it, like the old “Daily Eight,” based on nothing? Fortunately for us, the past and current exercise recommendation is based on six decades of observation and research, rather than anecdote.

To go back a bit, the first serious notions of exercise for health in America began in the late 19th and early 20th centuries, when it was a topic of conversation among physicians and health educators. During the early nineteen hundreds, physical hygiene, as it was called at the time, was promoted for performance in prestigious University settings and the military, with no regard to health or the public’s welfare. But Later, in a 1952 landmark study, researchers (Morris et al) showed that when male workers become more sedentary, their risks of heart disease and death increased in a predictable way. From that point the scientific evidence began to emerge, indicating that exercise and fitness had much more to offer than performance.

However, there were some problems associated with telling everyone to exercise in the late 1950’s and 1960’s. Despite emerging benefits, many physicians worried that physical exertion above the normal daily activities may make those with heart disease worse, so they often advised rest rather than exercise. What’s more, cardiovascular disease was still on the rise during the middle of the 20th century, and many health professionals felt that formal exercise may actually cause heart attacks in men above the age of 45. But, at that time there was an incomplete picture of what causes heart disease, as well as a lack of consensus on the finer points of the exercise prescription, namely how difficult an exercise should feel while it’s being performed.

In the early seventies studies began to show that structured exercise programs lead to better outcomes in many patient groups, primarily those with a history of heart disease. Since that time thirty plus health and fitness related recommendations have been issued. Most of them issued by organizations like the American Heart Association, the American College of Sports Medicine, and the YMCA. Surprisingly, today’s recommendation has not changed all that much from earlier editions, and for good reason. Put simply, as an individual goes from being sedentary to active the risk of death and disease drop in a predictable manner. Remember 1952?

The graph to the right represents why the physical activity recommendation came into existence, and why it really hasn’t changed too much in the last 50 years. Looking closely, you will see that as minutes of moderate physical activity increase (walking at three to four miles per hour), health risks, namely death and disease decrease.

So, in a world of advertisements, expert opinion, vitamins and supplements, you can rest assured that not everything you hear is taken from anecdote. Being physically active 30 minutes a day, five days a week at a pace that makes you breath harder, has been shown time and again to prolong life and reduce disease. And the best part; it does not have to cost anything.

Mike Clark is an Exercise Physiologist and Personal Trainer at Duke Center For Living’s Health and Fitness Center. He received his BA in Exercise and Sports Science from UNC.

United Way Cutbacks

The United Way of the Greater Triangle supports a plethora of worthwhile non-profit charitable organizations in Orange and Durham Counties. But its decision to pull the rug out from funding of the Seymour Senior Center wellness program was both unwise and misguided.

Regrettably, it will result in unintended consequences and cause needless hardship to the older adults of our community.

The United Way’s decision comes as a shock to the many senior citizens of Chapel Hill and Carrboro who have relied upon free access to the use the fitness facility. In addition, the machines used by seniors to monitor their blood pressure also may be eliminated.

For more than a decade, the United Way has seen fit to fund the vital Chapel Hill Senior Center wellness program. Why then has the United Way suddenly turned its back on the senior citizens of our community?

In its letter of rejection, the United Way suggested the Seymour Center should focus more on other services to help seniors live independently, rather than fitness alone. Perhaps there’s something missing here in their understanding of just what programs are offered at the senior center.

What better way to help seniors live more independently than to keep them physically fit? In addition to the wellness programs, the Seymour Center offers a wide variety of services to enable seniors to stay healthy and mentally alert.

To mention just a few of these activities, the Seymour Center provides classes on mobility, balance and falls prevention , diabetes management, hearing screenings, aerobics, resistance exercises, personal trainer sessions, strength training, tai chi, nutrition, physical function screening , and more — much more. The Friends of the Robert and Pearl Seymour Center is grateful for the United Way’s support of the Center’s Wellness programs over more than a decade, but we can’t help but feel they have let down the older adults of our community in 2013.

The Skinny on Obesity: Part III

Low carb and high fat diets, high carb low fat diets, exercise programs named with mental illness monikers, shoes designed to tone and firm the bottom, pillows designed to keep us cool while we sleep… What’s next for a nation of consumers who got into trouble consuming too much in the first place?

In the second of this four part obesity series, my friend and coworker Ellen Thornburg identified and discussed increases in portion sizes, decreases in physical activity, and faulty sleeping patterns as causes for obesity. And while obesity, like other chronic diseases, is complex in its nature, it is hard for any expert to argue that eating less, moving more, and sleeping better would not remedy the problem for most Americans.

As the first paragraph suggests, finding our way out of this massive problem can seem complicated, though it need not be this way. Now, I know the mind loves novelty, but all the fads in the world can’t replace a healthy lifestyle that includes a nutrient rich diet, physically active lifestyle, and adequate time to rest.

To discuss how exercise and diet can influence weight, we must discuss the concept of energy balance. This concept is governed by the Law of Conservation of Energy/Mass (given that Einstein is right), and thus weight loss, weight gain, and weight maintenance are governed by how many calories we consume and how many calories we burn. Simply put, you can lose weight on a cheesecake diet, as long as you burn more calories than you consume. To elaborate, think of your adipose tissue (fat cells) as a bank account. If we want a big bank account we spend less and save more. The opposite occurs when we go broke; we spend more money than we put in. This same intuition applies to our bodies. If we want to lose weight we must expend more calories than we take in.

On to some application. To find out how many calories you body needs daily go to this calculator and enter the required information. This tool will give you two numbers, the Basal Metabolic Rate (BMR), which is about how many calories your body would consume during the day if you were at rest, and a daily energy expenditure estimate, which will be the higher of the two numbers and takes into account the caloric cost of your physical activity plus your BMR. To lose weight, eat enough calories to match the BMR number, and let the energy for physical activity come from your adipose tissue.

For example, a sedentary 6 foot 175 lbs male would need roughly 1842 calories to meet the BMR, and 2579 to meet the energy needs for physical activity. Instead of eating 2579 calories per day, eat enough calories to match the BMR of 1842. Doing this will create a caloric deficit that will lead to losing weight at about 1.5 pounds per week. Numbers will vary for different body sizes and ages, but the most important thing to remember about losing weight is to burn more calories than we take in. This method is safe, effective, and ensures that your body is getting enough calories to function properly, unlike many low calorie diets. For the best result, pack in those BMR calories with whole foods, such as fruits, vegetables, whole grains, and lean meats. In doing this you will find that you can eat higher volumes of food, which can lead to satisfaction and fullness.

Adding formal exercise into the equation will lead to a greater caloric deficit at the end of the day. The American College of Sports Medicine recommends 150 minutes per week of moderate aerobic activity. This time must be thought of as extra physical activity done with the intention of improving your health, thus gardening, house cleaning, and running back and forth to the copier does not count. If all we need is 150 minutes per week of extra physical activity, dividing 150 by 7 days per week equals roughly 20 minutes of brisk walking per day. Additionally, these 20 minutes can be broken into five or 10-minute segments, so working in your daily exercise does not have to be the time drain you think.

You can expect to burn anywhere from 100 to 200 calories per day by doing the extra time. Though the numbers seem small compared to eating less, they add up over time and contribute to your calorie deficit. What’s more, exercise leads to a longer healthier life, lower blood pressure, better cholesterol, and feeling of well-being. In short, it’s free medicine.

According to the National Sleep Foundation, exercise, diet, and sleep are interrelated. Thus, not catching you Zz’s can feed into the downward spiral of obesity. For instance, a tired person is less likely to eat well and exercise, although these are the key ingredients to a better night’s sleep. In turn, being overweight or obese can increase the risk of sleep apnea, or the temporary cessation of breathing while sleeping, which, in and of itself makes weight loss more difficult. Visit this site to read more about how exercise, sleep, and diet are interrelated, and to learn more tips that will help you get a better night’s sleep.

In short, remember that weight loss is not rocket science, yet popular media complicates the issue to make money. Eating less, moving more, and getting adequate rest works for weight loss and will prevent and cure obesity. Stay tuned for the fourth and final installment of this series by Ellen Thornburg.

Mike Clark is an Exercise Physiologist and Personal Trainer at Duke Center For Living’s Health and Fitness Center. He received his BA in Exercise and Sports Science from UNC.

image by Filimonas via flickr

The Skinny on Obesity: Part II

How did we get here?

Reports on the ever-increasing obesity epidemic in our country are running rampant, so we should all know that the issue is a reality and is crippling us. In the first part of this series, my colleague Mike Clark defined what obesity is and how it can be measured. After acknowledging what obesity is, the next step is to clarify how we got here.

Why are Americans packing on the pounds? What decisions are we continuing to make that increase the likelihood of so many health risks and diseases? There are three categories to explore this week, including a lack of general movement and physical activity, poor diet choices and inadequate sleep.

Lack of movement

Our society has become sedentary. There is no question or denial of this statement. The latest report from the American College of Sports Medicine (ACSM) recommends at least 150 minutes of cardiovascular exercise each week, both resistance training and flexibility to include exercises for all major muscle groups two to three times per week and neuromotor exercises to maintain or improve balance, agility and the likes at least twice per week. Not only has the Centers for Disease Control and Prevention (CDC) indicated that only 20% of American adults are actually meeting these recommendations, ACSM has indicated that the failure to meet these recommendations is not the entire problem. Most Americans live such a sedentary lifestyle, defined as sitting at desks, in the car or in front of a television frequently and for long periods of time, even the 20% who are making a point to fit physical activity into their weekly routine may still be at risk for heart disease, diabetes and other complications.

Poor diet choices

There is also no question or denial that we eat far more than we used to. The National Heart, Lung and Blood Institute (NHLBI) issued some staggering comparisons of how our portion sizes have changed over the years. In the 1970’s, two slices of pizza totaled 500 calories whereas now two slices would pack 350 extra calories for a whopping total of 850 calories. A standard cup of coffee was 8 ounces and your additive choices were milk and sugar. The norm for a purchased cup of coffee now is at least 16 ounces with milk, sugar and whipped topping for a total of 330 calories. Bagels have gone from a 3-inch diameter with 140 calories to 5- or 6-inch diameter with 350 calories. And another unfortunate truth to our portion woes is that dinner plates have gone from a 10-inch standard diameter to 12 inches. Americans are simply sitting too long and eating far too much.

Inadequate sleep

Sleep is a critical component to overall health and wellbeing. Your brain is able to process information and store memories, cells can recover and regenerate, to name a few theories. Based on sleep research, adults require seven to nine hours of sleep every night, yet the CDC says one in three adults are sleeping less than five hours. The School of Public Health at Harvard University claims that so few hours of sleep results in a 15% increased risk of being obese. This link between lack of sleep and obesity may be due to altered hormones that regulate hunger, more hours awake to eat extra calories, decreased ability to make good decisions regarding food choice, and lack of energy for adequate exercise.

In summary, this sounds like an article from Negative Nancy herself. The sky may be falling over the USA to some degree, but there are answers and there is hope! Stay tuned for Mike Clark’s next article in this series that addresses why we need to correct our patterns and exactly how to do so.

Ellen Thornburg is an Exercise Physiologist and Personal Trainer at Duke Center For Living’s Health and Fitness Center. She received her BA in Exercise and Sports Science and Psychology from UNC.

image by Filimonas via flickr

Help For Alzheimer’s Caregivers, From Home Instead Senior Care

CHAPEL HILL – According to a recent survey, nearly two-thirds of Americans have had a personal experience with Alzheimer’s disease—and more than 60 percent of Americans say they feel unprepared to care for a loved one who’s diagnosed with Alzheimer’s.

“I just don’t know that you’re ever really prepared, unless you’ve walked through it before and seen the toll that it takes,” says Stephen Lair, the franchise owner of Home Instead Senior Care in Chapel Hill. “It affects the whole family.”

This week, Home Instead is offering a series of classes designed for family caregivers to help cope with the disease while keeping their loved ones as comfortable and safe as possible.

“What we’re trying to do with our Alzheimer’s program is give family members the tools to be able to engage their family members all throughout the process (of the disease),” Lair says.

The program is called Alzheimer’s CARE, or Changing Aging through Research and Education.  The classes are free; they begin this week Tuesday in Chapel Hill and continue on Thursday, from 6:00-8:30 p.m.

Lair says the time commitment is worth it, because these classes speak directly to what caregivers need to know to cope on a day-to-day basis.

“A lot of training (tends to be) very cerebral,” Lair says. “It talks about how the disease progresses and what the stages are. But what we find is that family members want to know, ‘okay, that’s great, I know how the disease works, but how do I get my dad to take a bath? How do I manage those behaviors that become difficult as the disease progresses? How do I continue to connect with him once he starts losing such large chunks of his memory–and losing chunks of who he is?'”

The training sessions are designed to walk people through the various stages of caring for someone with Alzheimer’s. Lair says the best approach, at any stage, is simply to try to engage the patient “in their world.”

“I think a lot of people, when they’re dealing with Alzheimer’s, they’re consistently trying to bring people back,” Lair says. “(They say) ‘if I play a certain music or say a certain word, something that’s familiar, then there’ll be a moment of clarity’–and that may sometimes exist…(but) rather than (trying to) bring them back, you (should) just accept the reality of, ‘where they are in time is not where I am in time. Even though he may be 85 right now, he’s remembering things (from) when he was 60, 65 years old. And that’s what his world looks like.'”

Lair says the “Alzheimer’s CARE” classes are designed to teach people how to engage Alzheimer’s patients in that way. He says one of the most effective tools is something called a “life journal.”

“(It’s) something where, throughout the early stages of Alzheimer’s, you begin to gather information about who the person is at all the different stages of life,” he says. “So as they regress through Alzheimer’s and they lose more current memories, you can still engage them in their world, in their reality.”

Classes run from 6:00-8:30 Tuesday and Thursday at the Chapel Hill-Carrboro Chamber of Commerce office on Estes Drive. If you’d like to sign up for the free workshops,, or call Home Instead Senior Care at 919-933-3300.