Wheels

in motion:
Biking fun
for the family
3 Make the most of your doctor visits 6 Seasonal allergies
May 2008

C
elebrating 30
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recover emotionally after a heart attack
One-third of people whove had a heart attack have feelings of
depression during recovery. If youre one of them, these tips may help:
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Talk with your doctor. He or she will ask questions about your
symptoms and may suggest taking medicines or seeing a counselor.
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Tell your family and friends how youre feeling. Ask for their support.
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Resume your hobbies and other activities as soon as possible, or
try out some new ones.
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With your doctors consent, exercise as appropriate for your condition.
American Academy of Family Physicians
quick takes
Questions are answered by Phyllis D. Cross, M.D., M.P.H., in conjunction
with the Taking Care medical advisory board and medical contributors.
This publication provides general information and isnt a substitute for professional health care.
Be sure to discuss with your doctor any health strategies or medical treatments.
Can cracking my knuckles cause arthritis or other joint problems?
THERE ARE many diferent kinds of arthritis. Osteoarthritis, the most common type,
afects an estimated 21 million Americans.
Among the causes of osteoarthritis is wear and tear on the cartilage that
cushions your joints. When you lose cartilage, your bones can start rubbing
against each other. Tat can lead to pain and stifness.
Tere is no evidence that popping or cracking your knuckles causes
osteoarthritis or any other form of arthritis. Te distinctive sound is
caused by gas bubbles that form in the joint when its stretched. Te
bubbles pop as everything snaps back to its original position. Although
cracking your knuckles might not cause arthritis, it potentially could
worsen a joint problem that already exists.
How to keep
your joints healthy
Ask your doctor about vitamin and mineral
supplements, especially calcium and vitamin D,
that may help strengthen your bones and
joints. Also:
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Maintain a healthy weight. Excess weight
stresses your joints.
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Exercise regularly to strengthen muscles
and bones.
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If you smoke, stop. Smoking weakens bones.
did you know?
Dog owners who walk their dogs are
more active and have less
body fat than people who
dont own or walk dogs.
American College of Sports Medicine
help teens say no
to alcohol, drugs
You may not think your teen
is listening. But, you can
be a powerful deterrent to
alcohol and drug use. Here
are some tips to get the
conversation started:
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Talk candidly about the risks
of drug and alcohol use.
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Be clear about your
expectations, and establish
consequences for breaking
the rules.
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Know how, where and with
whom your teen is spending
unsupervised time.
Partnership for a Drug-Free America
2 MAY 2008
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TAKI NG CARE
youre in charge
MOST DOCTOR visits are brief. But, you still can do a lot
in the time you have. Follow these tips to make the most of
your next appointment:
Plan ahead. What do you want to ask your doctor? Write
down your questions. If the visit is about multiple issues, call
the doctors ofce ahead of time to see if you
need a longer appointment.
Prioritize. Start with the most important
matters in case you run out of time. But,
remember to follow up on other items later.
Be detailed. For example, describe the
symptoms or side efects youre having.
Take notes. Jot down what your doctor
says so you wont forget. Or, bring along your
spouse, a friend or your caregiver to help you
remember things.
Dont be shy. If you dont understand
something, ask questions. Dont hesitate to
bring up such topics as sex or substance abuse. Also, ask when
you should call if symptoms persist or worsen. Your doctor
can help only if he or she knows whats going on.
Follow up. Feel like you didnt have a chance to take care of
everything? Ask if you can call, e-mail or schedule another visit.
Make the most of your doctor visit
WHEN NATURE calls, you know the answer. Your toddler, on the other hand, isnt so
experiencedat least not yet.
Its up to you to teach your child the mechanics of going to the potty, even if, at times, the
task seems to be a losing battle. Ultimately, youll succeed, says Robert Mendelson, M.D.,
spokesperson for the American Academy of Pediatrics.
Its important to remember that toilet training is a natural thing that will happen to all
children when theyre ready, Dr. Mendelson says. Its a learning process that typically takes
about three to six months.
Here are some suggestions on how to make toilet training go as smoothly as possible:
Watch for signs of readiness. Children will let you know when its time to begin training.
You may notice that your child:
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Goes a long time before needing a diaper change or has a dry diaper afer naps
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Asks to wear grown-up underwear
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Tries to hide somewhere when he or she needs to go
Be patient. Urging your child to use the toilet may be counterproductive. If you meet
resistance, wait a bit to train.
Give praise. Reward and encourage successes. But, dont punish your child for having
an accidentthere will be plenty of those. Instead,
keep a positive attitude and clean up messes without
making a big deal out of it.
A fnal hint: When your child is ready to use
the adult potty, try facing him or her toward the
back of the toilet. Your child can hold onto the tank
for support.
Toilet training: Getting down to business
answers for those quick questions
Sometimes, you can talk with a doctor without an appointment.
During your next visit, ask:
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Is it OK to contact you by phone or e-mail?
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Is there a charge for this service?
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Are there certain times or days when its best to call?
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Is there a nurse I can call with questions?
TAKI NG CARE
|
MAY 2008 3
Try bicycling
WHEELS WHIR, ground blurs and a cooling
breeze brushes past your face as you pick up
speed on the downhill slope. Ah, now this is the
lifeespecially afer the rigorous pedaling it took
to reach the top. For the moment, youve recaptured a
childhood joy: bike riding. What a great way to reduce stress,
improve your health and simply have fun.
Body and soul
Fitting exercise into our hectic lives is crucial for mental and physical health.
It can add to an overall sense of well-being and help relieve stress, anxiety and
depression. On the physical side, exercise:
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Reduces the risk of heart disease, high blood pressure, stroke, diabetes, obesity,
colon cancer and other health problems
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Helps control weight
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Keeps joints, tendons and ligaments fexible
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Improves sleep
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Increases energy and endurance
Bike riding in particular exercises your heart and lungs while at the
same time building muscles, mainly those in the thighs, hips and buttocks.
Of course, for safetys sake, talk with your doctor before signifcantly
increasing your activity level. Also, choose safe areas for biking, such as
community bike paths. And, always wear a helmet when riding.
Biking benets
Biking falls in line with other types of
exercise we commonly prescribe,
such as walking, says Barbara
Bushman, Ph.D., a
spokesperson for the
American College of
Sports Medicine.
Wheels in
4 MAY 2008
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TAKI NG CARE
for enjoyment and health
Make your cycling safer
with the right equipment
You dont need a ton of gear to enjoy a great bike
ride, but, in addition to a water bottle, a few things
will make your trip safer and more pleasant.
Start with a properly tting bike helmet. The
National Safety Council says a well-designed helmet
is lightweight and ts comfortably. It should have
a stiff outer shell, a shock-absorbing inner lining
thats at least a half-inch thick, and a chin strap and
fastener to keep it in place.
Use plenty of reectors to make sure its easy
for other people to see you. Your bike should
have reectors on the pedals, as well as a red rear
reector and a white front reector. Its also a good
idea to have spoke reectors on the wheels.
Other safety equipment includes a horn or bell, a
rearview mirror and a bright headlight.
Bring along some tools, such as a pump and a
patch kit, in case your bike breaks down. And, if youll
be leaving your bike unattended, thwart theft with a
hardened-steel U-lock (a lock thats shaped like a U).
Additional equipment can make biking more
comfortable. Bike shorts, for example, add some
padding between you and the seat. Gloves help
prevent numbness and blisters and can protect
your hands in a fall. And, special stiff-soled shoes
can make pedaling easier. Ask for help with these
products at a bike or sporting goods store.
Wheels in
But, cycling, like swimming, has one advantage over
walking. Its not a weight-bearing activity, which makes it
easier on the joints for people with arthritis or other health
conditionsor for those who are overweight.
Of course, cycling isnt just for people with health problems.
Its an activity that nearly everybody can ft into their lives
in some way, Dr. Bushman says. And, theres more than one
way to get the benefts. For example, if cycling outdoors isnt
possible for some reason, consider using a stationary bike.
How much is enough?
Although any amount of exercise is better than none, an
average healthy adult should do at least 30 minutes a day of
moderately intense cardiovascular exercise, such as bike riding,
fve days a week. People who would like to lose weight or
maintain weight loss may need to log 60 to 90 minutes a day.
A moderately intense workout raises your heart rate and
causes you to break a sweat, but youll still be able to carry on
a conversation.
A balanced program
Although bike riding is great on its own, its even better as
part of a balanced workout that focuses on strength training,
fexibility and a mixture of cardiovascular exercises.
Cycling provides cardiovascular benefts, as does walking.
Strength training and fexibility should also be included to
provide a well-rounded ftness program, according
to Dr. Bushman.
If you decide to add biking to your exercise mix,
theres no need to go it alone. Its an activity
that easily can be made into a family
outing, she says. Just enjoy.

For more info
Visit www.bikeleague.org/programs/bikemonth.
Join Bike Month festivities
May is National Bike Montha great time to clean up local bike trails, see
if a bike rack can be installed at work or just show off your spandex!
Its also the perfect time to discover that cycling can be a great way to commute.
To highlight that fact, the League of American Bicyclists has designated Friday,
May 16, as Bike-to-Work Day. Its a special part of Bike-to-Work Week,
which runs from May 12 to 16.
TAKI NG CARE
|
MAY 2008 5
allergies
ITS SUMMERTIME, and the living is
easy. For some of us, though, it might be
sneezyor itchy, stufy and wheezy.
Tese are the joys of seasonal
allergies, also known as hay fever.
A weedy problem
Contrary to the common name,
seasonal allergies arent caused by
hay and they arent accompanied by
fever. Tey happen when people who
are sensitive to pollen breathe in these tiny
grains of plant material. As a result, nasal tissue
becomes infamed.
One of the biggest pollen producers is
ragweed, which grows in nearly every part of the
United States. One ragweed plant can
send out a billion pollen grains
in a seasonusually mid-
August through October.
Other weeds, grasses
and trees produce pollen
in the spring or summer,
so each persons allergy
season may vary. No
matter when it happens,
people with seasonal
allergies can have a runny
nose, itchy eyes, sneezing
and headache.
Allergies also contribute to
more than half of asthma cases. And,
some people with seasonal allergies also
have oral allergy syndrome. For these people,
symptoms worsen when they eat certain fresh
fruits or vegetables. Tey also may have mild
swelling and itchiness of the mouth and throat.
Enjoy your summer
To ease seasonal allergies, try these tips:
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Dont mow lawns, and avoid areas with freshly
cut grass.
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Keep the windows closed in your house and car
to shut out pollen.
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Take a shower and shampoo your hair to wash
of pollen afer spending time outside.
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Use an air conditioner.
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Stay inside when pollen counts are high. You
can fnd the pollen count in your area each
day by visiting the National Allergy Bureau at
www.aaaai.org/nab/index.cfm?p=pollen.
Taking medicine for relief
Medicines ofen help control seasonal allergy
symptoms. One thing to keep in mind is that less
expensive over-the-counter medicines may be
just as efective as prescription ones.
All medicines, however, may have side efects.
Some cause drowsiness and shouldnt be used
if youll be driving, for example. So, talk with
your doctor to determine which medicines
would be best for you and how to use them. Tis
is especially important if you have a medical
condition or if you need to use the medicine for
more than a few days. Also, talk with your doctor
before giving allergy medicines to your child.
Blame the cat
More than half of the 20 million cases of asthma in the United States are due to
allergies. And, who claims the lions share of the blame for those cases? Look no
further than your favorite feline. In a study from the National Institutes of Health,
cats accounted for nearly one-third of allergy-related asthma cases.
That doesnt mean you have to get rid of your pets. Talk with your doctor.
It may be possible to minimize the allergens, keep your asthma under control and
still enjoy your furry friends.
Tiny pollen, big
problems
6 MAY 2008
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TAKI NG CARE
at your best
ONE IN three adults has high blood
pressure, yet nearly a third dont know
it. African Americans are particularly
at risk. High blood pressure sometimes
is called the silent killer because ofen
it has no symptoms at all. Tats why its
important to know your blood pressure.
Inside the body, high blood pressure
is a bully. It forces the heart to work
harder. Blood vessels also take a beating
and can develop small bulges, become
narrow, harden faster, and burst or bleed.
All of this damage can afect blood fow
and lead to kidney failure, heart attack,
stroke, amputation and blindness.
Blood pressure is measured in two
numbers. Both are important.
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Systolic, the top number, refects the
force that occurs in blood vessels when
the heart pumps blood into the body.
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Diastolic, the bottom number, shows
the pressure that remains in the vessels
when the heart rests between beats.
If you have high blood pressure, also
called hypertension, your doctor may
prescribe medicine to control it. He or
she also may suggest that you:
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Lose weight.
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Exercise for at least 30 minutes every day.
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Follow a healthful eating plan, such as
the DASH (Dietary Approaches to
Stop Hypertension) plan, which
emphasizes fruits, vegetables and low-
fat dairy products.
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Choose and prepare foods with less salt
and sodium.
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Quit smoking.
Te goal of treatment is to keep your
blood pressure below 140/90 mm Hg
or even lower if you have diabetes or
kidney disease.
Have your doctor check your blood
pressure at least every two years. Experts
advise more frequent check-ups if
you have prehypertension, high blood
pressure or other health conditions.
Do you know
your blood
pressure?
checking your blood pressure at home
Monitoring your blood pressure at home is easy. There are different types
of monitors, and each has pros and cons. Your doctor or pharmacist can
answer any questions you may have.
As you get started, ask your doctor for your target blood pressure
range, and nd out what numbers are high enough or low enough to
warrant a call. To use your monitor properly:
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Take your pressure every day at about the same time, making sure to
avoid caffeine, smoking and exercise for at least 30 minutes beforehand.
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First, sit quietly for ve minutes with your back supported and your feet
at on the oor. Rest your arm on a table at the level of your heart.
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Then, take two readings at least two minutes apart. Average the results.
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Keep a dated log of your readings. Bring along the logand your
monitor to check its accuracythe next time you visit your doctor.
Although its helpful, home monitoring shouldnt replace periodic
blood pressure monitoring by your health care professional.
What your
numbers mean
Normal. For adults, your
blood pressure is normal if
its less than 120/80 mm Hg.
Prehypertensive. Your top
(systolic) number usually is
between 120 and 139 and/or
your bottom (diastolic) usually
is between 80 and 89. Blood
pressure in this range increases
the risk that youll end up with
high blood pressure unless you
take action to prevent it.
High. Your systolic number
usually is 140 or higher and/or
your diastolic usually is 90
or higher.
TAKI NG CARE
|
MAY 2008 7
Michael W. Rosen, M.D.
National Medical Executive,
Health Solutions Group
Joseph R. Carcione Jr., D.O.,
M.B.A.
Medical Director, Healthcare
Services, Oxford Health Plansa
UnitedHealthcare Company
Gail Borgatti Croall, M.D.
National Medical Director, Health
Care Decision Support, Optum
Phyllis D. Cross, M.D., M.P.H.
Medical Consultant, Optum
Tanise Edwards, M.D.
Medical Consultant, Optum
Cheryl Lewis, R.N.
Medical Consultant, Optum
Virginia Lund, M.A., L.P.,
C.E.A.P.
Mental Health Consultant, Optum
Richard A. Zabinski,
Pharm.D.
Vice President, Pharmaceutical
Solutions, Health Solutions Group
Taking Care adheres to stringent clinical standards and
is reviewed by the following medical professionals:
Taking Care

May 2008 | Vol. 30, No. 5

E-mail: takingcare@uhc.com
If you have an address change, send
it directly to the entity through which
you receive the newslettersuch as
your employer or health plan.
Taking Care is dedicated to helping
people have healthier lives. However,
this publication does not replace
the necessary and individualized
medical care offered by a health
care professional. Not all treatments
mentioned in Taking Care are covered
by your health plan. Please check
with your health plan regarding
covered services.
Unless otherwise noted, all models are
used for illustrative purposes only.
2008 Optum

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Registered nurses are available to answer your health-related
questions 24 hours a day.
Are tanning beds safe?
MANY PEOPLE think a good tan is a sign of good health.
But, actually, its a sign of damaged skin. When youre exposed
to ultraviolet light (UV), your skin tries to protect itself by
producing melanina pigment that causes it to darken.
Unfortunately, excessive UV exposure also may:

Cause skin cancer

Make your skin appear leathery and wrinkled

Weaken your immune system

Damage your eyes and increase the risk of cataracts

Isnt the radiation different?
Tanning beds and lamps emit UV radiation that can be as
strong as, or even stronger than, what comes from the sun. So,
indoor tanning is not a safe alternative to outdoor tanning.
In addition to raising the risk of skin cancer and other
health problems, UV radiation from tanning beds thins your
skin, increasing the likelihood of even more damage.
Some manufacturers claim that their tanning beds use safe
rays. Although this type of UV radiation is less likely to cause
sunburn, it actually penetrates more deeply than the suns rays
and still injures the skin.
Skin damage is cumulativeit builds over time, even if
you dont get sunburns. So, harmful efects may not show
up for years, which is why many people arent aware of the
dangers of tanning.
Want that sun-kissed look?
If you want to tan your skin without the risk of skin cancer,
consider trying sunless tanning products. Tey produce a tanned
look with the active ingredient dihydroxyacetone (DHA), which
darkens the skin by reacting with skin cells. Its for external use
only, so dont get it in your mouth, eyes or nose.
OPTUM

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The truth about tanning beds
Do you have questions?
Optum NurseLine registered nurses are available to
answer your questions and provide health information.
This page of your Taking Care newsletter features
examples of the kinds of questions people askas
well as the kinds of helpful answers they receive.
Taking Care

Helping People Stay Healthy Since 1978