The sports physical exam is important for adolescents and young athletes to screen for potential health issues before participating in athletics. The exam allows time for further evaluation if any problems are detected from the medical history or physical exam. Only about 10% of sports physicals result in a need for further evaluation, and less than 1% of athletes are denied clearance to play. The primary goals are to identify conditions that could result in injury or illness during sports and to ensure athletes are medically ready for physical activity and training.

2. FITNESS
Before Competing In Athletics
The Sports Physical Is Important
HealthLink by John W. Wilson, M.D. conditioning (deconditioning).
Words From Your
Spring 2005 Certain conditions will
Brown & Toland Doctor
dolescents and young adults
4 Know Your
Cholesterol
Knowledge is power
A are advised to get a sports physical before
they participate in an athletics program at school.
keep the athlete from partic-
ipating. Those with an active
illness that might include
when it comes to your fever or diarrhea should wait
blood lipid levels. While it is not meant to replace a complete physi- until they are better to avoid
cal, it often becomes the only encounter with the dehydration. A rare condi-
6 Women’s Health
What you know about tion called carditis (inflam-
physician that these young athletes may have. mation of the heart) may
heart disease in men may
not apply to women. For this reason, it is help- sports physical several result in sudden death with
8 Men’s Health ful to have the patient’s pri- weeks before the start of exertion. Special care is
Small changes in habits can mary physician conduct the preseason practice. This given when examining
pay big fitness dividends. sports physical. The main allows enough time for A medical history can be the cardiovascular system,
12 Healthy Seniors purpose of the physical is to tests should any problems very helpful for the physi- searching for signs of cardi-
Check out the benefits of screen for problems that turn up. A common prob- cian. Commonly, questions tis or other heart problems.
Medicare Advantage plans. may result in injury, illness lem might be poor flex- will be asked about chronic A new, undiagnosed heart
or even, in rare circum- ibility in the arms and legs, illnesses, medications, sig- murmur often becomes a
Brown & Toland’s HealthLink editor: Richard
Angeloni, Corporate Director, Communications and
stances, death. Statistics which may mean that the nificant allergies, symptoms condition that requires fur-
Public Relations, Brown & Toland Medical Group,
415.972.4307. Brown & Toland’s HealthLink is pub-
show that only about 10 athlete is predisposed to with exercise, previous ther evaluation prior to
lished quarterly and printed in the United States.
Copyright 2005 by Health Ink Communications,
percent of sports physicals injuries. Stretching may heart problems (particularly participation.
780 Township Line Road, Yardley, PA 19067,
267.685.2800. Articles in this newsletter are written
result in a need for further alleviate this problem. heart murmurs), skin Additionally, a condition
by professional journalists or physicians who strive
to present reliable, up-to-date health information.
evaluation, and that less Looseness in certain joints rashes, concussions, heat such as enlarged liver
Our articles are reviewed by medical professionals
for accuracy and appropriateness. No magazine,
than 1 percent of the ath- may mean that an athlete exhaustion problems, or spleen would need
however, can replace the care and advice of medical
professionals, and readers are cautioned to seek
letes are ultimately denied is at higher risk for some wheezing or asthma, vision evaluation and treatment.
such help for personal problems. Some images
in this publication were provided by ©2005
clearance to participate. types of injury and may need problems, weight problems Otherwise, a rupture of
PhotoDisc, Inc. PhotoDisc models used for
illustrative purposes only. (205)
Athletes should get their a brace or some taping. and the loss of physical these organs is possible
NUTRITION Know your fats
All fats are not the same
All Fats Are Not in makeup or in their effect
on the body.
Created Equal Saturated fats
These fats are found
ou need to consume some fat mainly in animal-based
Y to maintain good nutrition. The American
Heart Association (AHA) recommends you should
foods such as red meat,
poultry, lard, butter, cheese,
whole milk and whole milk
consume no more than 30 percent of total calories products, and in palm and
from fat, while the USDA 2005 Dietary Guidelines palm kernel oil, coconut oil,
cocoa butter and partially
recommend a range of 20 to 35 percent. analyses of recipes list the equivalent to one tea- hydrogenated oils. They are
Although fat is not the feel full longer after eating. amount of fat in grams. You spoon. So a serving of solid at room temperature.
body’s preferred fuel You can improve your diet may find it easier to evalu- chips with 12 grams of fat Saturated fats increase the
source, it supplies 9 calo- by putting a little knowledge ate how much fat a food contains almost 2.5 tea- level of LDL (“bad”) choles-
ries for each gram which, of fats and oils into practice. item or recipe contains by spoons of fat and 108 calo- terol in your blood.
in turn, powers physical converting the grams into ries. A bowl of ice cream
activity and many of the A gram of fat teaspoons. with 34 grams of fat con- Polyunsaturated fats
body processes. It also adds Nutrition labels on food Each gram of fat equals 9 tains 6.8 teaspoons of fat Corn, sesame, cottonseed,
satiety to meals — making us products and the nutritional calories. Five grams of fat is and 306 calories. safflower, soybean and
2 Brown & Toland’s HealthLink, Spring 2005 www.brownandtoland.com

3. during contact sports. usually treated and cleared
Other conditions require for full participation. In the TECHNOLOGY
special precautions. An ath- rare instance when some-
lete with one functional eye thing critical is discovered,
should wear eye protection. it may mean the difference Paper Charts and Filing Systems Make Way for
A male with an undescended between life and death. For
or absent testicle may require this reason, the sports physi- Electronic Medical Records
a protective cup in certain cal is supported by the
sports. A wrestler with ring- American Academy of Family n late 2004, Brown & Austin, Brown & Toland’s The EMR, the Touch-
worm may have to cover the
rash while medications are
Physicians, the American
Academy of Pediatrics, the
I Toland Medical Group
launched the first phase
chief executive officer.
“We are particularly
works electronic medical
TM
record system, is part of
used to clear the infection. American Medical Society of an electronic medical proud that we are intro- an overall physician prac-
As athletes become com- for Sports Medicine and the record (EMR), making it ducing an EMR that will tice suite of services,
fortable with their primary American Orthopaedic Society one of the first large inde- including IDX Flowcast ,
TM
physician, they may use this for Sports Medicine. The goal pendent practice associa- new practice management
opportunity to ask about of the sports physical is to tions (IPA) in the nation software that is also part
other health-related issues, allow the athlete to partici- to make such a product of Brown & Toland’s
including such important pate fully and safely. Consider available to its physicians. project.
topics as sexually transmitted scheduling one well before In the first phase of the “The advantages to the
diseases and substance use. the next sports season. ■ project, Brown & Toland San Francisco community
A sports physical can easily launched the clinical lab as a whole are enormous.
become a complete wellness John W. Wilson, M.D., special- results module of the Doctors and patients alike
physical in order to update izes in Family Medicine. He is EMR, which allows physi- benefit from having the
immunizations, order screen- a graduate of the University of cians to access, in real right information available
ing laboratory tests and dis- Texas Southwestern Medical time, results from at the right time. As more
cuss other concerns. Sports School and is currently patients’ lab results. information comes online
physicals that are set up practicing in Daly City. His “This is the first time from more of our net-
through a school usually practice Web site address is that a medical group like benefit the patients of work, it will only get
are focused only on sports- http://jwwilsonmd.family Brown & Toland is mak- San Francisco. Hospitals better,” notes Peter
related concerns. doctors.net. His telephone ing lab results available and physicians will bene- Alperin, M.D., a medical
Most athletes will encounter number is 650.994.9090, for all patients within the fit from the efficiency that director for Brown
no problems at the sports and his e-mail address is community,” says Gloria this service offers.” & Toland. ■
physical. Those who do are JWWilsonMD@aol.com.
sunflower oils contain polyun- Trans-fats
saturated fats. They are liquid Although they are found COOKING WITH OIL AND FAT
at room temperature. They naturally in small amounts in
can reduce total cholesterol some foods, most trans-fats Butter has 108 calories and 12 grams of fat (almost
and lower LDL cholesterol are found in hydrogenated 8 grams of saturated fat) per tablespoon. Because
levels, but they shouldn’t be vegetable oils — such as mar- it’s derived from animal fat, it also contains 33 mg of
consumed in excess because garines and shortenings — cholesterol per tablespoon.
they may also reduce the and in many commercially Margarine contains no cholesterol, up to 2 grams of
level of HDL (“good”) choles- made baked goods and fried saturated fat and 34 to 100 calories per tablespoon.
terol. The fat in seafood is foods. They won’t have to be The softer the margarine, the less saturated it is.
also mainly polyunsaturated. listed on food labels until
Margarine contains trans-fat, so it shouldn’t be used
2006, but you know they’re
in excess. Tub margarines have the least amount of these fats.
Monounsaturated fats present if partially hydro-
These are the primary fats genated vegetable oil or Olive oil has 120 calories and 14 grams of fat per tablespoon. It’s considered one
in olive, peanut and canola margarine is listed among of the most healthful of the fats because 75 percent of its fat is monounsaturated
oils and most other oils made the ingredients. and 13 percent is saturated.
from nuts and seeds. They Trans-fats tend to raise Canola oil, which has the same number of calories and the same amount of fat
raise HDL cholesterol as blood cholesterol levels, as olive oil, is considered the second most healthful. Sixty percent of its fat is
they lower LDL cholesterol. increasing LDL and lowering monounsaturated and 7 percent is saturated.
Monounsaturates are some of HDL cholesterol. They Vegetable oils such as corn or soybean rank third. They also have the same
the most healthful fats you should supply less than number of calories and the same amount of fat, but 20 percent of the fats are
can eat, but even they should 1 percent of your total monounsaturated and 13 percent are saturated.
be consumed in moderation. daily caloric intake. ■
www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2005 3

4. STAYING HEALTHY
For Good Health
Know Your
Cholesterol Level
he amount of cholesterol in your blood has a lot to
T do with your chances of getting heart disease; in fact, it’s one of the
major risk factors for this illness. The higher your blood cholesterol level,
the greater your risk for developing heart disease or having a heart attack.
Cholesterol is a fat-like that their cholesterol level another form of fat in
substance produced by is too high. That’s why it’s your blood your LDL level enough to To reduce your risk
your liver; it is necessary important to find out what If it’s not possible to get a cut your risk of developing for heart disease, it’s also
for building cell walls and your cholesterol level is. If lipoprotein profile done, heart disease or having a important to control your
in the production of hor- your level is high, you can knowing your total choles- heart attack. The higher your blood pressure and to stop
mones. Cholesterol is also take steps to reduce it. terol and HDL cholesterol risk of these illnesses, the smoking.
found in some of the foods can give you a general idea lower your LDL should be. Your doctor may pre-
you eat. about your cholesterol level. You can lower your scribe cholesterol-lowering
When you have too LDL level through lifestyle medication in conjunction
much cholesterol in your Understanding the changes such as a choles- with lifestyle changes.
blood, it builds up in the cholesterol treat- terol-lowering diet, exercise Maintaining your lifestyle
walls of your arteries. Over ment guidelines and weight management. changes will keep your
time, this buildup causes Current guidelines for A low-saturated-fat, low- medication dose as low as
“hardening of the arteries,” treatment of high cholesterol cholesterol diet has less than possible and lower your risk
meaning that the arteries come from the National 7 percent of calories from of heart disease in other
become narrow and that Cholesterol Education saturated fat and less than ways. There are several
blood flow to the heart is Keeping your cholesterol Program III, overseen by the 200 mg of cholesterol. If types of drugs available for
slowed down or blocked. within healthy limits is National Heart, Lung, and this diet doesn’t lower your lowering cholesterol, includ-
important for you no matter Blood Institute. The guide- LDL enough, you can add ing statins, bile acid seques-
what your age or gender, lines are used to determine a soluble fiber to your diet. trants, nicotinic acid and
High blood cholesterol whether you have heart dis- person’s risk of experiencing It’s important to control fibric acids. A new drug
does not cause symp- ease or not. Everyone age a heart attack within 10 years. your weight in order to category called cholesterol
toms. Many people 20 and older should have A person’s cholesterol control your LDL, especially absorption inhibitors was
a blood cholesterol test at level is one part of the if your HDL level is low, recently approved. These
are unaware that their least once every five years. equation for determining your triglycerides are high drugs block cholesterol
cholesterol level is The most accurate test is risk for heart disease. or your waist circumference absorption in the intestine.
the “lipoprotein profile,” Other risks for heart disease is too great (more than
too high. which is done after fasting. include smoking, obesity, 40 inches if you’re a man How statins work
A lipoprotein profile diabetes, high blood pres- or more than 35 inches if By blocking a liver enzyme
Blood carries oxygen to measures: sure, family history of heart you’re a woman). To get that helps to make choles-
your heart and other vital Total cholesterol disease, gender and age enough exercise, aim for terol, statins lower LDL
organs. If enough blood LDL (“bad”) cholesterol, (over 45 for men and over 30 minutes of moderate cholesterol. They may also
and oxygen cannot reach which is the main source 55 for women). physical activity most, if not protect against heart dis-
your heart, you may feel of cholesterol buildup Treatment for high cho- all, days. (In some people, ease by decreasing the for-
chest pain. If the blood and blockage in the lesterol depends on how there are genetic reasons mation of plaque in artery
supply to an area of the arteries many other risk factors are that the LDL level can’t be walls, preventing plaque
heart is completely blocked, HDL (“good”) choles- present. lowered by these methods. from breaking open and by
the result is a heart attack. terol, which helps keep In others, these methods reducing clot formation.
High blood cholesterol LDL cholesterol from Treatment just don’t work well. In both “If you take one of these
does not cause symptoms, building up in the arteries If you have high choles- of these cases, medications drugs, there’s a good
so many people are unaware Triglycerides, which are terol, your goal is to reduce may have to be added.) chance it will lower your
4 Brown & Toland’s HealthLink, Spring 2005 www.brownandtoland.com

5. DIABETES CARE
Dig Into These
you’ll stay on it for the
rest of your life.”
Initially, your doctor
Diabetes Diet Tips
may monitor you for liver
and muscle toxicity, the
most serious side effects
Ndietlong ago, having
strict
ot
diabetes meant a
with limited food
Because you have
diabetes, you are at an
increased risk for heart dis-
If you drink alcohol,
drink in moderation only.
The American Diabetes
of statins. But such side choices and no sugar. Now ease, especially if you have Association (ADA) warns
effects are uncommon, researchers know that the poor eating habits. When that drinking alcohol on
says Dr. Lauer, occurring healthy diet recommended you avoid fatty foods, you an empty stomach can
in only 1 percent to 3 per- for all people meets many can better maintain your cause low blood sugar,
cent of patients. of the dietary goals for weight and blood fat levels. which can be dangerous.
The other potential those with diabetes. Plus, you are less prone to In some cases, low blood
side effects, which are heart disease. sugar can cause fainting or
rare, include constipa- Eat a healthy diet seizures. Consumption of
cholesterol by 20 to tion, headache or nausea. When you have diabetes, alcohol also makes control
30 percent within a few your diet can be similar to of blood sugar erratic and
weeks,” says Michael Maintain a heart- the diet of people without unpredictable.
Lauer, M.D., director of healthy lifestyle diabetes. More than three-
clinical research in the No matter which cho- fourths of your plate should Have smaller, more
department of cardiovas- lesterol-lowering medica- be filled with a combina- frequent meals
cular medicine at the tion you take, it’s impor- tion of these foods: cereal, You may need to eat fre-
Cleveland Clinic Founda- tant to remember that pasta, beans, whole-grain quent small meals through-
tion in Cleveland, Ohio. diet and exercise also bread, vegetables and out the day instead of a few
“They’re taken once a day lower cholesterol and are small amounts of fruits. large meals. This can help
and they’re long-term, a valuable part of your Also eat low-fat sources avoid wide swings in blood
meaning once you’re treatment strategy. Don’t of protein, such as skinless Don’t sabotage sugar with too high or too
prescribed a statin, think you can just take chicken, fish or lean beef. your diet low levels.
there’s a good chance a pill. ■ Based on the average diet, Like everyone, you Your doctor or a dietit-
you need about 50 grams should avoid foods high in ian can help you develop
of protein a day. The num- fat or cholesterol. Eat only a meal plan that’s right for
Alternative Medication ber of protein grams in a small amounts of saturated you. The ADA recommends
serving is listed on food fats such as butter and that all adults with diabetes
If you do experience signs of liver or muscle
toxicity because of statin use, your doctor labels. To keep track of other whole-milk products. see a dietitian every six
may reduce your dose your protein intake, multi- Check food labels for fat months to one year to help
or switch you to a differ- ply the number of grams content. Food labels now with meal plans. ■
ent statin drug. by the number of servings. list the total calories in the
If you have kidney prob- food and the calories from To learn more, visit
Or the doctor may pre-
lems, talk with your doctor fat. Divide the calories from the ADA Web site at
scribe an alternative
cholesterol-lowering about eating less protein. fat by the total calories. If www.diabetes.org.
medication, such as nico- Try cooking with little or the result is more than 30
tinic acid (niacin), a B vitamin that works in the no fat. You can broil, bake, percent, limit how much
liver to affect the production of blood fats, lower roast, poach, steam or of that food you eat.
triglyceride and LDL cholesterol levels and raise microwave without adding Even though sugary foods
HDL cholesterol. Unfortunately, however, “many fat. Before cooking, trim raise blood sugar levels
people don’t tolerate niacin well,” says Dr. Lauer. fat from meat and poultry. more than other foods do,
A class of drugs called fibrates is another Try main dishes with pasta, it is OK to eat them once
option. “They primarily act by reducing triglyc- rice, beans and vegetables in a while. As with total
eride levels,” says Dr. Lauer. “They might be the instead of meat. calories, moderation is key.
better drug to use if someone has more of a
triglyceride disorder than high LDL cholesterol.”
Yet another option is the newest drug category
called cholesterol absorption inhibitors, which
block cholesterol absorption in the intestine.
www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2005 5

6. HEALTHY CHOICES WOMEN’S HEALTH
The Lowdown on
Women and the Risk of
Vitamins Heart Disease
f an older man complains of chest pain, his doctor will
I probably think heart attack. But if an older woman has chest pain, her
doctor may think first of indigestion. And even if a woman is diagnosed
with heart disease, the recommended treatment may be less aggressive
than for a man with the same stage of disease.
Why is there such a dif- risk of developing the dis-
By Peter Alperin, M.D., ference in treating and ease steadily climbs.
Medical Director, Brown & Toland Medical Group diagnosing heart disease The symptoms of heart
in men and women? disease in women are dif-
itamins are a diverse group of naturally “I think there’s a belief ferent from those in men,
V occurring compounds that are required for
proper nutrition. They are commonly divided
held by many men and
women, physicians and lay-
which can make it more dif-
ficult to diagnose. Women’s
into water-soluble (B vitamins, C, folate, biotin, men alike, that heart attacks symptoms include angina
pantothenic acid) and fat-soluble (A, E, D, and K). are solely a man’s problem. (or chest pain), chronic
Importantly, water-soluble vitamins aren’t stored But coronary artery disease breathlessness, chronic
well in our bodies, while we can build up reserves is the leading cause of death fatigue, dizziness, edema,
of fat-soluble compounds. of both men and women rapid heartbeat and nausea.
Over the past 30 years, a tremendous amount of in the United States,” says Men’s symptoms include
research has addressed the benefits of various vitamins. Marianne J. Legato, M.D., sudden pressure, fullness,
Researchers have looked at questions such as the true founder of the Partnership squeezing or pain in the cen-
optimal intake of a vitamin, or whether higher doses for Women’s Health at ter of the chest that lasts for
result in protection from certain diseases. Remarkably, Columbia University. Her Women typically have smaller more than a few minutes or
the sum total of the data has only created more questions. female patients tell her they hearts and narrower arteries goes away and then comes
It does not appear that most people need to take worry more about cancer, than men do, so it takes less back; pain that radiates from
vitamin supplements if they eat a balanced diet with yet 250,000 women die plaque to block a coronary the center of the chest to the
proper amounts of fruits and vegetables. Taking a of heart attacks each year, artery and impair the flow shoulders, neck or arms;
multi-vitamin once a day won’t hurt you, but it is compared with 40,000 who of blood and oxygen to a chest discomfort with light-
likely unnecessary. die of breast cancer. woman’s heart. headedness, fainting, sweat-
Certain groups of people, however, should take The female hormone ing, nausea or shortness of
vitamins. Pregnant women need increased amounts Why women estrogen is believed to breath; and sudden onset
of iron and folate. People subscribing to a vegan diet are at risk provide partial protection of rapid heartbeats.
(no animal products) need vitamin B12 supplements, Although both men and against heart disease. After If a woman has a heart
as this is only found in animal products. Certain women are susceptible to menopause, however, as attack, she is twice as likely
medications may also interfere with proper vitamin heart disease, the reasons the body gradually stops as a man to die within
metabolism, necessitating supplementation. they develop it are different. producing estrogen, the a year, according to the
The research into super doses of various vitamins American Heart Association
is also inconclusive. B vitamins are often touted as (AHA). If she doesn’t die,
“stress protectors” or “anti-oxidants.” While this may she is twice as likely to
be true, no studies have definitively shown that they have a second heart attack.
confer any disease protection. Many people take Besides heart size and
extreme doses of vitamin C, but the data for any the estrogen factor, each
benefit is also lacking. In fact, super doses of water- woman’s risk for heart dis-
soluble vitamins usually pass out of your body ease may be increased by
through your urine very quickly. other factors, including:
Vitamin E also has received significant press over Family history. You’re
the past several years. It falls into the anti-oxidant at greater risk if your
category, and some early evidence suggested that it father had a heart attack
continued on page 10 before age 55 or if your
6 Brown & Toland’s HealthLink, Spring 2005 www.brownandtoland.com

7. five years, especially if
you have diabetes in your
family. Controlling your
blood sugar will decrease
your risk for heart dis-
ease, as well as eye and
kidney disease. All three
of these things — lipid
levels, blood pressure
and blood sugar — may
be checked at more fre-
quent intervals, depend-
ing on your risk factors
Don’t smoke. Becoming
a nonsmoker will reduce
your risk for many
diseases, including
heart disease.
Maintain a healthy
weight. Your body mass
index (BMI) should be
between 18.5 and 24.9.
If you’re overweight,
combining a more
mother had one before secondhand smoke raises recommends that screening (or 21/2 to 61/2 cups per healthful diet with
age 65. Hyperlipidemia the risk of stroke and for heart disease risk factors day) of fruits and vegeta- exercise will help you
(high blood fat) also heart disease and can begin at age 20. Screening bles, depending on your shed excess pounds.
runs in families. cause early onset of meno- includes measuring blood daily calorie needs.
Obesity. Your risk increas- pause, adding to risk. pressure, body mass index, Eat three servings
es if you are 20 percent Sedentary lifestyle. waist circumference and (or about 3 ounces) of
The symptoms of heart
to 30 percent overweight. Women who don’t exer- pulse every two years. For whole grains every day. disease in women are
Where you carry your cise triple their risk. healthy adults, here are ways Limit your daily salt different from those
weight. Fat concentrated Stress. Constant stress to protect heart health: and sodium intake to
around your midsection may increase your risk. Stay active. Exercise at 2300 mg. in men, which can
puts you at greater risk. least 30 to 60 minutes, Have your blood fats make it more difficult
You’re at less risk if fat is preferably every day. checked at least every
on your hips and thighs. Aerobic activities such as five years. If your levels
to diagnose.
Cholesterol. Risk walking, running and are high, you will need
increases with a high swimming provide the to follow a special diet Control stress. Make
overall cholesterol count most cardiovascular ben- to lower them. If diet time for stress-reducing
in which good cholesterol efits. Always check with alone is unsuccessful, activities, such as relax-
(HDL) is low and bad your doctor before lipid-lowering medica- ation exercises.
cholesterol (LDL) is high. increasing your activity. tion may be necessary. Know the danger signs.
Diabetes. Women with Eat a heart-healthy diet. Have your blood pres- Don’t ignore the follow-
diabetes have double Limit your daily fat intake sure checked at least ing signals of heart dis-
the risk of heart attack. Taking care to 20 to 35 percent of every two years. If your tress: intense pressure
High blood pressure. of yourself your total calories. Only pressure is high, and or crushing pain in the
This condition is a major Heart disease doesn’t 10 percent should be sat- your healthy diet and chest; lightheadedness,
risk factor for a heart happen overnight. Years urated fat; the rest should exercise don’t lower it, breathing difficulty or
attack and the most of neglect can create silent be polyunsaturated or you will need medica- shortness of breath; a
important risk factor damage, setting you up for monsaturated fats. tion to bring your blood feeling of severe indiges-
for stroke, according a heart attack. That’s why Limit your daily choles- pressure into normal tion that doesn’t go away
to the AHA. it’s important to practice terol to 300 mg a day. range and keep it there. after taking an antacid;
Smoking. A tobacco prevention, no matter Improve your nutrition Have your blood sugar and a feeling of impend-
habit or exposure to what your age. The AHA by eating 5 to 13 servings checked at least every ing doom. ■
www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2005 7

8. MEN’S HEALTH
Potbellies
A Warning Sign for Later Problems
ou were a pretty good jock in high
Y school, and in your 20s you tried every-
thing from racquetball to running. But in middle
age, even your softball glove is gathering dust. For
recreation, you surf — the Web, not the waves.
Your diet couldn’t be The fact is, you might
more manly: No one’s ever not care as much about
had to ask you “where’s the looks as your wife does,
beef?” And you wouldn’t but that fat around your
be caught dead visiting a abdomen is no laughing
weight-loss center to deal matter. A man’s potbelly
with that thing around often warns of later prob-
your waist you jokingly lems ranging from heart
call a beer belly. disease to cancer, diabetes, the middle-aged male pop- balanced diet and exercise and he was inactive.
arthritis, back pain and ulation between the ages program, they lose inches “All three things put
sleep apnea. of 35 or 40 and 60.” faster than females because you at high risk of a heart
“We can predict with a “We can predict with a Not all of them will have their greater muscle mass attack,” notes Mr. Stetson,
fair degree of accuracy fair degree of accuracy heart attacks, of course, acts as a calorie burner,” whose father died recently
who’s going to have a who’s going to have a heart but it’s still enough to says Ann Louise Gittleman, of a heart attack.
attack,” says Walter R. worry even a manly man author of Super Nutrition Four months after
heart attack.” Thompson, Ph.D., a fellow like you. Fortunately, says for Men. enrolling in the Cooper
— Walter R. Thompson, Ph.D., of the American College Dr. Thompson, you can do Consider Chuck Stetson, Wellness Program in Dallas,
a fellow of the American College of
Sports Medicine and a professor of
of Sports Medicine and a something about it without 56, managing director of a the 6-foot Mr. Stetson had
kinesiology, health and nutrition at professor of kinesiology, running marathons and liv- private equity investment dropped 15 pounds, to
Georgia State University
health and nutrition at ing on bean sprouts. Small firm in Manhattan. A college 210. “I’ve got a lot more
Georgia State University. changes in habits can pay ski team member, he ran energy,” he says. “It’s really
It’s all part of that cava- “It would be those who big dividends. and played squash till about night and day.”
lier male attitude toward don’t have a very healthy five years ago. Last year, his Mr. Stetson increased his
health that also makes men diet, have hypertension or The good news is … doctor gave him a wake-up aerobic workouts from a
less likely than women to are obese — which charac- “The good news is that call: He was obese, his total weekly total of 40 minutes
see a doctor. terizes about 85 percent of when men embark on a cholesterol exceeded 200 to three hours and boosted
REAL MEN, REAL MENUS
“Low-quality, high-fat foods would fatten up any human Switch to lean meats and fish. Experts say
being,” says psychotherapist Connie Tyne. “Treat your- omega-3 fatty acids in fish such as salmon, mack-
self to high-quality foods that nourish your body and erel and sardines protect against heart disease.
help you get from one meal to the next without creat-
Use monounsaturated and polyunsaturated fats.
ing cravings that lead you to eat anything you can find.”
They lower cholesterol and heart disease risk.
Some tips to chew on: You’ll find them in milk, nuts, avocados, olives,
Divide your plate into quarters. Fill one quarter soybeans and vegetable oils made from soy,
with lean meat or fish, another quarter with a flaxseed, corn and canola.
piece of bread and a little pasta, rice or potato, Add fiber, fruits and vegetables. Raw produce
and half the plate with vegetables, salad or fruit. is especially good.
Aim for less saturated fat. It’s found in fatty cuts Cut back on sugars. Avoid foods with lots of
of meat, baked goods and full-fat dairy products. sugar, such as soda, candy and cookies.
8 Brown & Toland’s HealthLink, Spring 2005 www.brownandtoland.com

9. his strength training from director of the Cooper powerful, both physically FAMILY HEALTH
40 minutes to an hour. He Wellness Program, says and mentally,” she says.
went from 10 minutes a men often tell her: “I’m Once skeptical, Mr. Give Immunization
day to half an hour several totally in control of my Stetson agrees. “It doesn’t
times a week on a tread-
mill. And he added a pleas-
environment, I’ve got a fab-
ulous career, but I feel like
take much effort to do it at
all. I’m kicking myself won-
Your Best Shot
ant hour-long weekend jog I’m completely out of con- dering why I didn’t do this
through Central Park.
He’s not eating less,
trol with my body.”
“Making these choices —
five years ago. My family’s a
lot happier, and I also know
H as she’sever hap-On
this
pened to you?
the day supposed
just more healthily, even losing fat and gaining I’ve got a longer life expec- to get her shots, your
in restaurants. Focusing muscle — makes you tancy because of it.” ■ infant wakes up with the
on vegetables and lean sniffles. You or your doc-
meats, he skips butter and tor decides to hold off on
sauces on meats and limits the vaccination. The opportunity slips by and, for
salad dressing, bread and one reason or another, your child never gets that shot.
potatoes. She wouldn’t be the only one. For a variety of rea-
Likewise, in 16 months sons, every year nearly one million children under
5-foot-11 Bob Redden, 54, age 2 aren’t fully immunized against polio, whooping
lost nearly 30 pounds to MEN cough, tetanus, diphtheria or other preventable
fall below 200. He also low-
ered his blood pressure —
ON THE
MOVE diseases, according to the U.S. Centers for Disease
Control and Prevention.
without drugs. How? By Most parents catch up by the time children go
boosting his weekly aerobic You don’t have to run a marathon every day to to school, because most schools require up-to-date
workouts, taking up yoga improve your health. A growing body of evidence immunizations. Still, many children go unprotected
and kayaking, and follow- indicates that just half an hour of moderate physical in their most vulnerable years.
ing the Cooper Wellness activity most days, like walking, can cut your blood
Program’s food principles. pressure and body fat and improve your cardiopul- Overcoming confusion and fear
monary fitness. You don’t even need 30 minutes Some parents slip because they’re confused about
straight. Three 10-minute chunks will work fine. when vaccinations should or should not be given. “Most
Here’s some advice to run with: parents — and many physicians, as well — think that a
Consult your doctor first. Don’t start a fitness baby with the sniffles or a low-grade fever or an ear infec-
program until you do. tion should not get a shot,” says Jerold Aronson, M.D.,
a member of the Pennsylvania chapter of the American
Build activity into your day. Take stairs, not ele-
vators. Park farther away so you’ll walk more. Academy of Pediatrics. “These types of minor illnesses
Trade the riding mower for one you push. aren’t enough reason to delay an immunization.”
Some parents cite fear of side effects for skipping
Consider hiring a trainer. Make sure a reputable
immunizations. The risks of the diseases prevented
group, such as the American College of Sports
Medicine, certifies the trainer. by vaccines are much greater than the risks of immu-
nization, which are minimal.
Find an exercise buddy. Your pal can move you
to exercise when you don’t feel like it.
Working with your doctor
Join a fitness club. The camaraderie and classes Keeping your child’s immunizations up to date
may help keep you on a schedule. requires a partnership between you and your physi-
Find weekend fitness fun. An activity such as cian. Parents should map out immunization sched-
“I learned how to take canoeing, hiking or camping is an incentive to ules with their doctors while their baby is still a new-
responsibility for my work out during the week to get ready. born. Remember that two or more shots can often
health,” says Mr. Redden. If you golf, forget the cart. If carrying a bag is be given at the same time. Your child may require up
The long-time computer too demanding, use a pull-cart or a caddy. to four shots at any given visit
programmer also changed Look for age-specific leagues or outdoor clubs. A few simple suggestions can help you keep up
jobs, becoming a boat Try tennis, golf, basketball, softball, bicycling, with an immunization schedule:
captain in the Florida Keys. hiking — whatever you enjoy. Whenever possible, have immunizations done
“My doctor gave me a Volunteer to coach your children. Don’t watch during well-baby visits and checkups.
choice: I could take more from the bleachers. Get physically involved in Check your child’s immunization status at every
blood pressure medication practices and workouts. visit to your doctor’s office.
or lose weight.” Set a goal. Sign up for a long bike ride, for Keep your own record of immunizations in a
Psychotherapist Connie instance, then use that as a training incentive. handy, secure place. Bring it to your doctor at
Tyne, L.M.S.W., executive every visit so that it can be updated. ■
www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2005 9

10. HEALTHY SENIORS
Brown & Toland Reduces Costs and Improves Care With
Old-Fashioned House Calls
ouse calls are no longer a
H
program will enhance practice efficiency for our physi-
cians and provide better care to our members.”
bygone medical tradition CLM is a national company that specializes in the med-
ical management of high-risk patients. Two full-time board
for many Brown & Toland certified internists, Virginia Scialanca, M.D. and Lola Reis,
Medical Group patients, M.D., will provide care in the San Francisco area. ■
thanks to Health Net’s recent partner-
ship with Care Level Management
(CLM), a national medical manage-
ment company.
The Home Visiting Physician program is available to
qualifying Health Net Seniority Plus members, and will
“We are very encouraged assist Brown & Toland physicians with the management
that this program will of high-risk elderly and homebound patients. Patients
will receive the individual attention of a doctor in the
enhance practice effi- comfort of their own homes, a practice that has been
ciency for our physicians proven to prevent unnecessary hospital admissions and
emergency room visits, better manage expensive pre-
and provide better care scription drugs, and improve coordination of care.
to our members.” Working with the patient’s Brown & Toland primary
— Stan Padilla, M.D., care physician (PCP), the CLM physicians will assess the
vice president of medical group individual’s high-risk status and assist in the provision
services and chief medical officer,
Brown & Toland of needed home-based services, while the PCP will
continue to be responsible for coordinating all other care,
such as specialist referrals and other outpatient care.
“This program provides value to both our physicians
and our patients,” says Stan Padilla, M.D., vice president
of medical group services and chief medical officer for
Brown & Toland. “We are very encouraged that this
Vitamins, continued from page 6
protects against heart the vitamins, the fat-soluble deal. It won’t hurt you, but Peter Alperin, M.D., a
attacks. Recent studies, how- compounds, especially, may it may very well be unnec- medical director at Brown
ever, have shown the exact cause problems because essary. With super doses, & Toland Medical Group,
opposite — high doses may they are stored in fat cells, you may be “flushing” your also is in active practice at
actually increase the risk of making them longer-lasting money away and, in extreme Mills–Peninsula Hospital
heart attack and stroke. and more difficult for the cases, actually causing harm. and is an assistant clinical
Too much of a given vit- body to eliminate. Talk with your doctor. professor of medicine
amin may be toxic. While All in all, taking a single Until next time, stay at the University of
this may occur with any of multi-vitamin a day is no big healthy. ■ California–San Francisco.
www.brownandtoland.com
10 Brown & Toland’s HealthLink, Spring 2005

11. www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2005 11

12. FOR MEDICARE BENEFICIARIES
Medicare Advantage Plans
Offer Ease of Access and
Expanded Benefits
C
onsumers who become eligible informational meetings sponsored by these health plans.
To learn more about these meetings, please fill out the
for Medicare, including those enclosed business reply card and return it to Brown &
Toland Medical Group. We’ll be glad to give you meet-
approaching their 65th birth- ing times and locations, as well as more information
day, have choices available to about these two programs. ■
them beyond traditional Medicare.
Brown & Toland partners with two of the largest health
maintenance organizations (HMOs) in California —
Health Net Security Plus and PacifiCare Secure Horizons —
Medicare beneficia- to give Medicare beneficiaries affordable and compre-
ries will have access hensive coverage. This coverage includes hospitaliza-
tion, emergency care and access to an extensive net-
to benefits that work of private practice physicians.
include doctor’s visits By enrolling in either Health Net’s Seniority Plus
plan or PacifiCare’s Secure Horizons plan, Medicare
and unlimited gen- beneficiaries will have access to a wide range of impor-
eric drug coverage. tant benefits that include doctor visits and unlimited
generic drug coverage.
To find out more about these Medicare Advantage
plans, we encourage you to attend one of the
PRSRT STD
U.S. POSTAGE
The Doctors Behind Every Good Health Plan PAID
Effingham, IL
P.O. Box 640469 Permit No. 148
San Francisco, CA 94164-0469