Sample Articles: August-October 2003

Tips For Controlling Pain Every Day

Chronic pain is an enormous problem, affecting 50 million Americans every day. Chronic pain affects your ability to work, can put a strain on your relationships, prevent you from getting sleep, and even cause disability.

Two of the most common causes of chronic pain are arthritis and low-back problems. The road to managing pain begins with figuring out what is causing the problem. Then you can learn from your pain and understand what can be done about it. Pain is not something you should simply accept as part of aging. It is a chronic condition that can and should be treated.

A new book, Arthritis Foundation's Guide to Pain Management, provides timely, detailed information about medical advancements in pain management and the importance of a healthy lifestyle for everyone, especially people with chronic pain. The following highlights some quick and easy lifestyle tips for combating pain:

• See a health care provider - Pain is not the problem; it is a symptom of the problem. The earlier it is diagnosed, the more steps can be taken to reduce pain and the potential for disability in the future.
• Explore natural options - Natural or complementary therapies can be very powerful, but are not all created equal. Do your research and check with your doctor before adding an alternative therapy to your treatment program.
• Harness your mindÕs power - Your brain has the power to deal with and even lessen your pain.
• Don't stress out - Learning to relax takes concentration and effort, and can be a natural boost to your pain-control efforts.
Most importantly...
• Exercise - A regular and varied exercise program can ease pain and stiffness, strengthen muscle and bone, burn calories, improve flexibility and may even help to prevent disability. Exercise also boosts your brainÕs natural production of endorphins (or pain fighting hormones), and can result in increased energy, improved sleep and an overall feeling of well-being. All types of exercise serve to reduce stress, so begin with one or two of the following:
A well-rounded exercise program should include:
• Aerobic or endurance exercise - Use large muscles to increase heart rate and strengthen heart and lungs. Dancing, walking, swimming and use of various exercise machines are examples of aerobic exercise.
• Range of motion exercises - Keep the body flexible by bending, stretching or swaying.
• Strengthening exercises - Build the muscles that support the spine and other structures, such as the abdomen. Lift free weights or take a weight training class.
n ItÕs important to learn the difference between exercise-related pain and chronic pain. Signs that you may be doing too much include:
• Increased or unusual pain that lasts for more than one hour after exercise
• Increased feelings of weakness
• Excessive fatigue after exercise
• Decreased range of motion or flexibility

High impact exercises, like jogging, football, snow skiing or in-line skating can exacerbate back pain or joint pain associated with arthritis, and should be avoided unless approved by a health care provider.

Speak to a health care provider, physical therapist, or consider a pain specialist if pain interferes with your exercise routine. Your team of medical advisors may be able to suggest changes in your routine to keep you moving without pain.
Finally...
Read - Arthritis Foundation's Guide to Pain Management provides the answers you have been looking for, so you can feel like yourself again.

Readers also will learn:

• What are the common causes of pain - and why can it keep coming back?
• When is it time to go see a health care provider?
• How is pain diagnosed?
• What treatments - from drugs, to surgery to alternative therapies - can beat the pain?
• What innovative, new treatments can fight pain better than before?
• How can I manage pain in my daily activities?

The Guide to Pain Management is published by the Arthritis Foundation. To order a copy for $24.95, visit www.arthritis.org or call 1-800-477-7679.

A free brochure, Managing Your Pain (covering diagnosis and treatment options for pain), is also is available at 1-800-477-7679 or www.arthritis.org.

The Arthritis Foundation is the only nationwide, nonprofit health organization helping people take greater control of arthritis by leading efforts to prevent, control and cure arthritis and related diseases. For more information call (602) 264-7679.

-------------------------------------------------------------

Financial Question Of The Month

By Nancy Fleming

Question - I decided to convert my traditional IRA to a Roth IRA four years ago and I was able to spread out the tax over four years. The problem is, that I have been paying tax on the higher value from four years ago. I know that when I take money out it will be tax-free. Is there anything I can do about the tax payment?

Answer - A ROTH IRA is an account in which the deposits are paid with after-tax dollars. Anyone, no matter what his or her age, can open and contribute to a ROTH IRA as long as they have earned income. The ROTH has no mandatory minimum distributions during the owner's lifetime. The earnings accumulate tax deferred, and after five years can be withdrawn tax free. People are allowed to convert all or part of an existing IRA to a ROTH. Taxes are due on the monies moved from a traditional IRA to a ROTH. The dollar amount on which taxes have been paid becomes the basis of the ROTH account.

Because you paid tax on a greater amount, you have a basis in the account, which is greater than the account value. Your basis is figured on the amount you paid tax on. Had the account gone up in value, your basis would now be lower than the current value. There is a way to re-capture your tax payment, subject to certain tax rules. Since the ROTH has declined in value, if you are willing to withdraw all of it, you will have a deductible tax loss. You must, however, withdraw the entire value. The IRS does not allow a deduction of the loss until all funds are withdrawn from all accounts. After this, the loss can only be taken as a miscellaneous itemized deduction, subject to the 2% limit on adjusted gross income. For example, if you converted a $100,000 IRA to a ROTH and it is worth $60,000 today (assuming you have no other ROTHs), and you withdrew the entire $60,000, you would have a $40,000 loss. You would have emptied your account and would have received less than your basis; therefore, you have the tax loss.

Being aware of IRA basis can help you take losses and reduce gains when funds in these accounts are withdrawn or sold.
Be sure to see your accountant to verify that your deduction is not further reduced by the overall 3% reduction of itemized deductions and not subject to the Alternative Minimum Tax (AMT).

For information or any questions about this article, you may contact Nancy at (480) 632-8770, or send questions for this column to: Nancy Fleming, CFP at 3651E. Baseline Rd. #E107, Gilbert, AZ 85234. Nancy is a Certified Financial Planner specializing in the concerns of retirees.

-------------------------------------------------------------

Health Care Decisions

By Gillian Hamilton, M.D, Ph.D.

Most people say they want to die peacefully, surrounded by loved ones who will carry out their wishes about end-of-life care. But, less than 25 percent have told family members or health care providers what those wishes are and put them in writing.

As a hospice physician, I have seen the suffering that results when patients are no longer able to communicate their wishes and families don't know what to do. Feeding tube? Ventilator? Dialysis? Hospitalization? The choices are bewildering.

The best time to talk with patients and family members about what kind of medical treatment they want is before a medical crisis occurs. The decisions that emerge from these discussions then are written down on documents known as advance directives, such as living will and medical power of attorney forms.

Planning ahead could spare some families from lifelong guilt, and gives patients more control of their destiny.

Health Care Decisions, a program of Hospice of the Valley, is educating community groups and health-care providers about advance directives. Since its inception in June 2002, the program has reached nearly 50,000 Arizonans.

While many people recognize the need for advance care planning, they often are reluctant to put pen to paper. Denying death is a common reaction, but the issue really is about how people want to live. It's important to complete the documents before the patient becomes incapacitated and it's too late to act. Ideally, the patient's physician should be involved in the conversation.

Let's examine the case of my patient Etta, who was in a care facility for 10 years. She could talk to her grown daughter and son when she was admitted, but dementia's inevitable course robbed her of her ability to do anything but blink and move her head. She was on a feeding tube for eight years, bed-bound and uncommunicative.

Etta's children, both well-educated professionals, considered whether the feedings should be stopped. But they had never talked to their mother about what she would have wanted, and Etta had no living will or medical power of attorney. They had to pursue guardianship to get legal authority in Arizona to stop the artificial feedings. Even then they hesitated, torn by guilt and the fear of "starving" their mother to death.

They didn't understand that a person who stops food and water together dies from renal failure, considered a painless death. It is only when water is continued artificially and food is stopped that starvation occurs.

Advance directives do not mean limiting treatmen, they mean exactly what the person who wrote them says about how they want to live, whether that is aggressively pursuing every treatment available or declining life-prolonging measures.

The issue was the focus of the Arizona Town Hall, a group of citizens from throughout the state that met in Prescott in May (NOTE: 2003). The Town Hall recognized the importance of advance directives, and suggested creating a statewide-computerized registry for people to make directives more readily available.

Health Care Decisions is working with other advocates for better end-of-life care to create such a registry. This would make completing and registering a living will as commonplace as applying for a driver's license or a building permit. It's a natural part of life.

Start the conversation with your family members today, and document that conversation. Make copies of the advance directives and distribute them to relatives and your physicians. We owe it to ourselves and our families to make sure everyone's life story has a meaningful, peaceful ending.

Gillian Hamilton, M.D., Ph.D., is Administrative Medical Director of Hospice of the Valley and Co-Director of Health Care Decisions. She is an internist and geriatrician on the faculty of the University of Arizona College of Medicine. She is listed in Best Docs of America and Best Docs of Phoenix, and has received numerous awards for her work. For more information on Health Care Decisions and to attend or schedule a FREE presentation or consultation, call (602) 222-2229 or consult the Web site: www.hcdecisions.org.

-------------------------------------------------------------

Breast Health: Know Your Body, Get Screened

October is Breast Cancer Awareness Month. As it draws near, women are reminded to take charge of their breast health. In May, the American Cancer Society issued breast cancer screening guidelines that (for the first time) offer specific guidance for older women, women who have serious health problems, and women at increased risk. The new guidelines also offer greater clarification of the role of physical breast exams.

The guidelines represent the most current scientific evidence and expert opinion available. They were developed by an independent panel of 42 medical and scientific experts representing various areas; including breast imaging, epidemiology, family medicine, genetics and risk assessment, geriatrics, medical oncology, nursing, public health, radiology, surgery, consumer issues, and advocacy.

The Society's new guidelines for the early detection of breast cancer are:

•Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
•Clinical breast exams (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over.
•Women should report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
•Women at increased risk (e.g.: family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g.: breast ultrasound or MRI), or having more frequent exams.

"These new guidelines will enable improved discussion between women and their health care providers, helping them make more informed decisions about early detection testing", said Mary A. Simmonds, MD, FACP, the Society's national volunteer president.

"While research related to the ability of CBE or BSE to reduce breast cancer deaths is limited, the exams are still important. When a woman examines her breasts, she becomes more aware of how her breasts normally feel and notices any changes", said Dr. Simmonds. "Having a physical exam by a health care professional is a complement to regular mammography and an opportunity for women and their health care providers to discuss breast changes, risk factors, and early detection testing, she explained".

The American Cancer Society is dedicated to eliminating cancer as a major health problem by saving lives, diminishing suffering and preventing cancer through research, education, advocacy and service. For more information anytime, call toll free 1-800-ACS-2345 or visit www.cancer.org.