**To Your Health Newsletter**

"Promoting Good Health Through Information"

Veterans Affairs Palo Alto Health Care System

Patient Education Newsletter • Spring 2008

**Defrosting Winter's Creaky Joints**

*Ernest H. Winkenwerder, PT*

As winter rains and cold temperatures give way to spring, we start to
think about getting out the patio furniture and wonder why the cold
weather seems to affect our knees and back. Cold weather does tend to
keep people at home more and moving less.

As we get older, muscle mass and strength tend to decrease due to less
activity. Tendons, which connect our bones to muscle, become less
elastic making injury more likely. Joint swelling and cartilage wear and
tear can also occur.

Our bodies are meant to move, remember the saying if you don't use it
you'll loose it? This applies to your bones, joints and muscles.

As we walk the motion of the knee joint increases blood flow which
provides nutrition to the bones, joints and mus­cles and produces
synovial fluid (the body's WD-40). The number one hint on preserving
your joints and bones is to keep moving. A daily walking or biking
routine (as little as 15-30 minutes per day at a comfortable level) will
keep vital fluid moving and the muscles and tendons from tightening up.
This can help to build up bone and muscle, and prevent bone loss (which
your provider may call osteoporosis).

Of course, check with your provider on what is an appropriate activity
for you. Some people who cannot bear much weight can participate in a
swimming program to keep those muscles moving and the blood flowing.

Make sure you warm up slowly and do some light stretching. When starting
a new exercise program, begin little by little. Generally if you sleep
better the night after you exercise and have some SLIGHT muscle
soreness, you chal­lenged the old machine well. Strength training with
light weights (less than 10 pounds) in a comfortable range of motion can
also help build strong bones.

Studies have shown that people into their eighties can safely begin a
light exercise program and improve their health. But because the body
recovers more slowly as we age don't go overboard. Make sure to eat a
balanced diet and you may want to ask your provider about vitamins or
supplements which may help some people with joint problems.

So, "use it or lose it" this spring to help keep the "spring" in your
step!

**Recipe for Health**

Chillin' out pasta salad

**Ingredients:**

2 1/2 cups (8 ounces) medium shell pasta

1 cup (8 ounces) plain nonfat yogurt

2 Tbsp. spicy brown mustard

2 Tbsp. salt-free herb seasoning

1 1/2 cup celery, chopped

1 cup green onion, sliced

1 lb. small shrimp, cooked

3 cup (about 3 large) tomatoes, coarsely chopped

**Directions:**

1\. Cook pasta according to directions -- but do not add salt to the
water. Drain and cool.

2\. In a large bowl, stir together yogurt, mustard and herb seasoning.

3\. Add pasta, celery, and green onion, and mix well. Chill for at least
2 hours.

4\. Just before serving, carefully stir in shrimp and tomatoes.

**Health Information:**

Yields: 6 servings

Serving Size: 1 cup

Each Serving Provides

Calories: 280

Total Fat: 2 grams

Saturated Fat: 1 gram

Cholesterol: 120 mg

Sodium: 270 mg

Total Fiber: 2 grams

Protein: 28 grams

Carbohydrates: 38 grams

Potassium: 590 mg

[*www.nhlbi.nih.gov*](http://www.nhlbi.nih.gov/)

**Because Your Safety is Important to Us!**

Taking an active role in your care can help prevent medication errors!
Carry your medication list with you at all times!

**What is Medication Reconciliation?**

Medication Reconciliation means collecting information about ALL the
medicines that you are taking including prescription medications,
over-the-counter medications, vitamins, and herbal medications.

**Why is Medication Reconciliation important?**

Across the United States, approximately 1.3 million people become ill or
have adverse side effects from medical therapy each year. Medication
reconciliation can help prevent those errors from happening. The
Institute of Safe Medication Practice estimates that 50% of medication
errors and 20% of adverse medical events could be eliminated with proper
medication reconciliation.

**What can I do to help with Medication Reconciliation?**

Keep an updated list of your medicines with you at all times. Tell us at
every clinic visit which medicine you have stopped taking or any new
medications that you have started taking. If you develop an allergy or
adverse effect from a medication, let your provider and pharmacist know.
If you cannot remember what you are taking, bring your cur­rent medicine
bottles with you to your appointment.

Ask for information about your medicine. If you do not understand
something, ask your provider or pharmacist to explain. Always talk to
your provider before taking herbal products or supplements.

**Want to Learn More?**

The Best Care Anywhere: Why VA health care is better than yours by
Phillip Longman (2007) discusses what we can offer as a model for other
healthcare systems.

The Essential Guide to Psychiatric Drugs by Jack Gorman (2007) is up to
date, balanced, and is a strong general guide to symptoms, diagnoses and
drug treatments.

How to Prevent Your Stroke by J. David Spence (2006) has practical,
easy-to-follow advice about prevention and risks, with medical terms,
drugs, and diet issues clearly described.

**Feeling Down? The VA Can Help!**

*Jenny Herschelman, Pharm.D. & Nadine Shirley, LCSW*

Did you know that depression affects about 14.8 million adults in the
United States each year? No one knows exactly what causes depression,
but depression and suicide are closely related. Many of the symptoms of
depression and the warning signs for suicide are the same.

**Symptoms of Depression**

**•** Feeling down

**•** Eating too much, eating too little

**•** Fatigue or lack of energy

**•** No interest in once pleasurable activities

**•** Sleeping too much, sleeping too little

**•** Agitation or slowing of movements

**•** Feelings of worthlessness or guilt

**•** "Can't think straight," or make decisions

**•** Feelings of worthlessness or helplessness

**•** Irritability or restlessness

**•** Persistent aches, pains or headaches

**•** Digestive problems

**Warning Signs for Suicide**

**•** Rage or anger

**•** Increasing alcohol or drug abuse

**•** Withdrawing from friends & family

**•** Sleep problems

**•** Agitation or anxiety

**•** Sense of hopelessness

**•** Feeling trapped

**•** Acting reckless

**•** Thinking about, planning ways to harm oneself.

The good news is there are many effective treatments for depression! The
most common include medications or talk therapy, or both.

Medications for depression, called antidepressants, help balance natural
chemicals in the brain. One important thing to remember is that
antidepressants do not work overnight. They have to be taken everyday,
and it may take as long as four weeks for people to notice an
improvement. That is why it is important to always talk to your provider
before stopping a medication.

Another way to treat depression is through a method called talk therapy.
This helps people think and behave in new ways. Like medications, talk
therapy does not work overnight and people must stick with it for it to
work. For some people, when talk therapy is combined with medications,
treatment is even more successful.

Statistics show that veterans with depression are seven to eight times
more likely to attempt suicide. However, veterans who are treated for
depression are no more likely to attempt suicide than anyone else. The
VA offers many services to veterans who may be depressed or have other
mental health concerns. If you think you may be depressed, please talk
to your provider and he or she will help you get the help you need.

**If you ever have feelings of hurting yourself please call the VA's
Suicide Prevention Hotline immediately at 1-800-273-TALK (8255).**

This hotline is available 24 hours a day and will get you in contact
with a mental health professional that will help you!

**Steps to Reduce Indoor Allergies:\
A Spring Cleaning Checklist**

Use the following checklist to guide your spring cleaning and to rid
your home of indoor allergens:

**•** Get rid of clutter that may be collecting dust.

**•** Clean windows, book shelves and air conditioning vents thoroughly
as they may have collected dust and mold throughout the winter.

**•** Put mattresses, box springs, and pillows in allergy-proof or
\"non-allergenic\" cases.

**•** Vacuum carpeting, or replace it with washable throw rugs.

**•** Wash blankets, sheets, and pillowcases in 130-degree water and dry
in a hot dryer (this should be done every week).

**•** Fix leaks - they leave surfaces wet and allow mold to grow.

**•** Clean moldy surfaces, such as the corners of showers or under
sinks, with a cleaning solution that is 10 parts water to one part
bleach.

**•** Clean under stoves, refrigerators, or toasters where loose crumbs
can accumulate and attract cockroaches.

**•** Block cellar doors, outside drains, and wall, window, or floor
cracks where cockroaches could enter your home.

[*www.aaaai.org*](http://www.aaaai.org/)

**Tips for Healthy Living**

**•** Before going back for seconds, wait 10 or 15 minutes. You might
not want seconds after all.

**•** Order your latte or hot chocolate with fat-free (skim) milk.

[www.smallstep.gov](http://www.smallstep.gov/)

**Questions or Comments?**

If you have any questions or topics you would like

addressed in **To Your Health** feel free to contact:

**Rachel Grande, PharmD**

Pharmacy Practice Resident

VA Palo Alto Health Care System

3801 Miranda Avenue #119 (Pharmacy)

Palo Alto, CA 94304

\(650\) 493-5000 ext. 66573

**To Your Health** is published quarterly for VAPAHCS veterans and their
families.

**Editorial Board:**

Randell K. Miyahara, PharmD

Rosemary Gill, RN, MS

Rachel Grande, PharmD

Kris Morrow

Last Reviewed: April 28, 2007 By: Rosemary Gill