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Five-Star Quality Rating Medicare.gov/HospitalCompare “Thank You!” to Our Dedicated Employees and Medical Staff The Centers for Medicare and Medicaid Services recognized Olympic Medical Center with an overall five-star rating in quality, the highest rating awarded in the agency’s latest hospital performance report at Medicare.gov/HospitalCompare. Of the more than 4,000 Medicare-certified hospitals evaluated, only 407 received five-star ratings. This honor would not be possible without our 1,500+ employees and medical staff. Their ongoing commitment to continuous improvement means you can expect quality, patient-centered health care at Olympic Medical Center.
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HEALTHY LIVING Volume 16, Issue 1 · Spring 2020 Produced and published by the PENINSULA DAILY NEWS & SEQUIM GAZETTE Advertising Department 305 W. First St., Port Angeles, WA 98362 360-452-2345 · peninsuladailynews.com 147 W. Washington St., Sequim, WA 98382 360-683-3311 · sequimgazette.com Terry R. Ward, publisher Eran Kennedy, advertising director Shawna Dixson, special sections editor Michelle Lynn, circulation director ARE YOU AN EXPERT IN YOUR FIELD? Share your knowledge with your North Olympic Peninsula community! Health-related professionals are invited to contribute informative and educational articles for consideration in Healthy Living. Contact special sections editor Shawna Dixson at sdixson@peninsuladailynews.com for more information. Submitted articles are the opinions and beliefs of the contributing writer and in no way represent an endorsement by Healthy Living, Peninsula Daily News or Sequim Gazette.
YOGA THERAPY Can an ancient practice help modern back problems? By Renee Klein, madrona mindbody institute Numerous studies by leading organizations like the National Institutes of Health have shown that therapeutic yoga can ease chronic back pain and improve mobility, often while lowering the need for medication. Those results are prompting more physicians to recommend yoga, spurring new people to explore this mind-body practice. DEBUNKING MYTHS Some used to think yoga was exclusively for the young, the super fit or for those who could contort like a pretzel. In fact, yoga is for virtually everybody and every body. Today’s classes include all ages, shapes and sizes, from those who can’t touch their
toes due to tight hamstrings — or who shouldn’t touch their toes because of back concerns — to those who are chair-bound. Nancy Hestbeck, who has a history of back issues, took her first yoga class at age 67. Since then she has learned how hip flexibility influences her lower back mobility, and how maintaining a strong core and strong legs helps protect her back from injury. “Practicing yoga regularly keeps me mindful of how I’m moving and standing, and helps me maintain flexibility and strength in my spine,” Hestbeck said. “Yoga is now a regular and fun part of my life.” YOGA continues on Page 5 >>
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DON’T LET DEPRESSION CONTROL YOU Getting help may let you reclaim your life
Dr. Kristin Puhl, north olympic healthcare network Depression affects millions of Americans. But with the stigma around depression, many people are hesitant to share their struggles with their loved ones. Patients also worry about discussing depression
with their doctors. What will happen at that doctor’s visit? What will their doctor recommend? How will that change their life? Treatment for depression falls into two big categories: behavioral therapy (counseling, often “cognitive behavioral therapy”) and medication. Research studies support the use of both, as they have different benefits and strengths. Behavioral therapy can be difficult for patients because it is timeconsuming. However, brief, targeted therapy, usually a session every week for a couple of months, can be very effective at helping with symptoms of depression. Furthermore, behavioral therapy has the advantage of helping people develop skills and ways of thinking that they can come back to in times of stress and crisis. This effect can be long-lasting and help insulate against future mood disorders.
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Behavioral therapy can be expensive, but doctors often are able to help patients access sliding-scale fee therapy or wrap-around services that are much more affordable, depending on the nature of the primary care clinic and the patient’s insurance. Patients may feel too short on time to take an hour a week for therapy. This has to be balanced against the time that depression costs. It’s not always easy to see the time depression takes away; it steals time in subtle ways, making people too tired or irritable to enjoy being with friends and family, too fatigued for work or just too sad to live a rewarding daily life. Many patients, influenced by messaging with inaccurate information about antidepressants, fear medications for depression — becoming dependent on or “addicted” to medication. One common fear is that patients will lose their personalities and become “happy zombies.” They may also
wonder whether their medications are safe for their bodies long-term. There are different types of medication that can help with depression, and while each has upsides and downsides, some have more side effects to watch out for than others. SSRIs & SNRIs The major classes of first-line antidepressants currently in use are selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). These medications have a lot in common. Serotonin and norepinephrine are neurotransmitters, chemicals that the brain uses to send and receive messages between cells. There is no single simple answer for why or how they work for depression and anxiety; research has illuminated many of their effects, but not all. HELP continues on Page 8 >>
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<<YOGA continued from page 3 AN ALL-TOO-COMMON AILMENT An estimated eight out of 10 Americans will experience back problems. For some it may be a temporary complaint; for example, lifting a too heavy object may require only a few days of rest and/or over-the-counter medications. For others, back pain is a chronic, sometimes lifelong condition. Causes may be congenital (birth) issues, disease, accident or occupational wear and tear. Just think of a long-haul truck driver’s spine and the impact from jockeying a 40-ton, vibrating 18-wheeler year after year.
In sedentary people, the muscles supporting the spine weaken and are more prone to injury. Additionally, sitting puts more pressure on discs and vertebrae than standing or walking.
YOGA THERAPY = “SPINE-TUNING” Frustratingly, as many as 85 percent of back problems are vague and hard to treat. While fractures and herniated discs may be visible on imaging, injuries to muscles, tendons and ligaments are not. A well-balanced yoga for backs session will therapeutically decompress and mobilize the spine to reduce pain and inflammation, increase circulation and improve overall function. Movements should be customized for each individual Back pain is the most common job-related disability and the second into forward bends, back bends and extensions, as well as lateral movements most common reason for primary (spine in a “C” shape) and gentle twists. care visits. A long-standing yoga adage says, “You are only as old as your spine is Additionally, our increasingly inflexible” and, once learned, these sedentary lifestyle has caused a spike in lower back, upper back/shoulder and head concepts around spinal mobilization can and neck complaints. Our bodies were not be applied off the mat. “Yoga enables me to have the life that designed to be folded into chairs for hours I want to live,” said Nancy Powell, 67, on end, let alone hunched forward over who leads a very active life that involves laptops and cellphones; yet, according lots of digging, building, hauling and to the Centers for Disease Control and Prevention (CDC), one in four Americans gardening in Port Townsend’s Eco Village, ptecovillage.org. now spends eight hours a day sitting.
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Top two: Yoga therapist Renee Klein works with “yoga for backs” students at Madrona MindBody Institute Keri French, seen here in Antarctica during an October 2019 trip, says yoga helps provide the strength and movement needed for her sea kayaking adventures.
Improved postural alignment Increased stability Increased range of motion Strengthened muscles Re-balanced muscular asymmetry Release of chronic contraction (upper back, neck, shoulders) Healthier movement patterns
“It’s the combination of core work but also just moving my spine in every direction and working on balance and hip flexibility. I couldn’t do it without yoga.” Another yoga for backs devotee, Keri French, who also is an avid sea kayaker, said yoga has enabled her to develop strength, flexibility and body awareness. “Kayaking is a full body sport where I am asking my lower body to do separate but coordinated dynamic moves with my upper body,” French said. “So much core, balance and flexibility going on in the multidimensions of being on moving water.” YOGA continues on Page 11 >>
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‘SEED’ GOOD HEALTH Vegetable gardening on the North Olympic Peninsula By Jeanette Stehr-Green, clallam county master gardener “Kitchen gardening” — the practice of growing your own vegetables at home — is on the rise. According to the National Gardening Association (NGA), one in three U.S. households grows at least some of their own produce. And interest is increasing, especially among younger Americans. Some have attributed the upswing in food gardening to the “food revolution” and increased interest in where our food comes from.
Others feel we’ve finally wised up to the many benefits of growing our own produce because: ••Nothing tastes as good as homegrown, fresh-picked fruits and vegetables. You can harvest and eat produce at its peak of ripeness. ••Fully ripened produce not only tastes better, but can have a higher content of vitamins and antioxidants. ••A larger variety of produce is available to those who grow their own from seed. Grocery stores typically stock only popular or cost-effective varieties; heirloom and unusual varieties are unlikely to be found in most produce sections. ••When you grow your own, you decide what comes in contact with your produce. You can avoid chemical fertilizers and pesticides based on your gardening philosophies. ••Growing your own produce can save you money. According to NGA estimates, a well-maintained family vegetable garden on average yields a $500 return after adjusting for the gardener’s investment and the market price of produce. Growing your own produce is a great idea. But how can you do it successfully? Here are a few tips for growing vegetables on the North Olympic Peninsula (the Peninsula). RIGHT PLANT, RIGHT PLACE Because of our long, cool springs, moderate temperatures in summer and early arrival of fall-like weather, vegetable gardeners on the Peninsula are wise to focus on crops that can withstand (and even thrive in) cooler temperatures. These cool-weather crops include ••Leafy greens (arugula, Asian greens, chard, lettuce and spinach) ••Members of the cabbage family (broccoli, cabbage, cauliflower and kale) ••Root vegetables (beets, carrots and parsnips) ••Leeks, onions, peas and potatoes That doesn’t mean you can’t grow vegetables that enjoy warmer temperatures, but you likely will have
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FOUR-SEASON VEGETABLE GARDENING With some planning, you can harvest vegetables from your garden year-round. Late winter/early spring From March to May, plant cool-weather crops such as those listed above. Some cool-weather lovers (such as chard, lettuce and spinach) will germinate in relatively cool soil (when soil temperatures reach 35 degrees); these can be direct-seeded into the ground. Other cool-weather lovers (such as members of the cabbage family) will not germinate in cool, wet soil. If you plant these crops before the soil warms sufficiently (45 degrees), use starts (small plants grown in containers for transplanting into the garden). Once soil temperatures rise above 45 degrees, all cool-weather crops can be direct-seeded into the ground. Late spring/early summer In late spring and early summer, move toward crops that enjoy warmer temperatures, such as beans, eggplants, peppers, squash and tomatoes. These plants require soil and air temperatures above 60 degrees to do well.
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to work harder and employ short-season gardening practices, such as starting seeds indoors (while it is still too cool outside to plant) and using covers to protect plants from the elements early in spring and again in fall. Even with these heroics, some vegetables just don’t do well on the Peninsula, including collards, melons, okra and sweet potatoes. Plant these only if you like a challenge. Among the crops that do well here, varieties with certain characteristics perform best — short time to maturation, cold tolerance and/or resistance to diseases. Consult with friends and neighbors for varieties that grow well locally, especially if you live at higher elevations or in more exposed locations. For a chart of recommended planting times and varieties for growing vegetables on the Peninsula, created and provided by Clallam County Master Gardeners, see page 9.
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Because warm-weather crops are planted so late in the growing season (late May or early June for much of the Peninsula), it is best to plant starts when growing those that take longer to harvest (such as peppers and tomatoes). With warm weather lovers, you will be most successful if you focus on varieties with the shortest time to harvest. For example, cherry tomatoes are much more likely to ripen on the vine on the Peninsula (about 55 to 70 days to harvest) than fullsized tomatoes (about 70 to 85 days to harvest). You can continue to plant cool-weather crops in early summer, but they will suffer as temperatures reach 70 degrees. Select heat-tolerant and “slowbolting” varieties and plant them in a spot that gets afternoon shade. Keep them well watered and apply mulch around the plants to cool the soil. Late summer/fall In late summer and early fall, turn your sights back to the cool weather lovers. For them to reach their maximum size before the first frost, you usually have to plant them during the “heat” of summer. The longer a particular crop takes to reach maturity, the earlier it needs to be planted. Members of the cabbage family are typically planted in July, whereas quicker-maturing leafy vegetables and radishes can be planted in August and even early September. Be aware that it may be optimal to use a different variety of a crop than was planted in your spring garden. For example, the spinach varieties Bloomsdale savoy and giant winter are recommended for fall planting whereas Olympia and Seaside are recommended for spring planting. Winter In winter all is not lost. Although few plants grow well during winter, you can continue to harvest cold-tolerant leafy greens from your fall garden throughout the winter (such as arugula, chard, kale, lettuce and spinach).
These cold-tolerant plants often provide a special late winter bonus: if they remain healthy, they will start growing again when warmer temperatures arrive. These overwintered crops will provide some of the earliest harvests of cool-weather crops possible. To keep winter crops healthy, plan on providing some protection from the rain and snow, such as floating row cover or a low tunnel.
LOCAL MASTER GARDENER CONTACTS CLALLAM COUNTY MA STER GARDENERS Coordinator: Laurel Moulton • Submit gardening and plant questions to the Plant Clinic Desk • Phone: 360-417-2514 • Email: mgplantclinic.clallam@gmail.com •
LOCATION, LOCATION, LOCATION For vegetable gardening success, select a garden site that receives at least six hours of direct sun each day. Check potential spots in different seasons to see if the shifting angle of the sun or presence of leaves on deciduous trees affect the amount of sun the site receives. If your yard is heavily shaded, but you have a sunny deck or patio, consider container gardening. Many vegetables, including chard, kale, lettuce (and other greens), peppers, spinach and tomatoes, grow well in large pots. If neither of these options is available to you, consider renting a plot at a community garden. Port Angeles, Sequim, Forks and Port Townsend all have thriving community gardens.
PLANT CLINICS Bring your gardening questions, samples from problem plants and garden pests to the following locations: • Mondays from 9:30 a.m. to 12:30 p.m. (March through mid-October) at the Clallam County Courthouse at 223 E. Fourth St., Port Angeles • Saturdays from 9:30 a.m. to 12:30 p.m. (mid-May through September) at the Master Gardener Demonstration Garden at 2711 Woodcock Road, Sequim
IT’S ALL ABOUT THE SOIL Of course, soil quality also is important, but usually can be amended if you start early enough. Most vegetables enjoy a well-drained, nutrient-rich soil that is slightly acidic. Before planting, have your garden soil tested to see if there is something your soil is lacking. The Clallam Conservation District runs a low-cost soil testing program to help gardeners make informed decisions about the management of soil nutrients. For more information go to clallamcd.org/soil-testing.
PLANT CLINICS Bring your gardening questions, samples from problem plants and garden pests to the following locations: • Mondays from 1 p.m. to 4 p.m. (April through September) at the Jefferson County Community Development Office, 621 Sheridan Street, Port Townsend • Tuesdays from 11 a.m. to 2 p.m. (April through September) at the WSU Jefferson County Extension Office, 121 Oak Bay Road, Port Hadlock
SEED continues on Page 9 >>
JEFFERSON COUNTY MASTER GARDENERS Coordinator: Bridget Gregg • Submit gardening and plant questions online at extension.wsu.edu/jefferson/gardening-2/plant-clinic •
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<<HELP continued from page 4 What the research does show is that these medications work gradually, over the course of weeks to months, to affect brain chemistry in ways that reduce the symptoms of depression. They appear to be safe for long-term use. They work for many patients, but not all, and one key thing to understand with SSRIs/SNRIs is their timeline. Side effects early on for starting SSRI/SNRIs tend to be gastrointestinal. The gut has as many serotonin receptors as the brain, so it’s not surprising that SSRIs/SNRIs can cause nausea and diarrhea. These effects tend to be worst in the first few days of starting. Most SSRIs/SNRIs are started at a lower dose than patients will eventually take and gradually increased to minimize those side effects, and different patients can be affected to very different degrees. Some people have terrible stomach upset and some people never notice any. For most people, the stomach upset goes away within a few days of starting or increasing the dose. Sexual side
effects also are relatively common, most commonly having more difficulty reaching orgasm; some medications have lower risk for that than others, so if it does affect a patient, changing medications may help. Some people also notice changes in their mood that are negative, such as increased thoughts of suicide. These should always be discussed with the doctor who prescribed the medication, and anyone seriously thinking of suicide should call a hotline (the national suicide hotline number is 1-800-273-8255) or go to the emergency room. People who look up these medications will notice a laundry list of possible side effects. Most of these side effects — the vast majority — are very rare and may or may not be truly related to the medication. As part of the medication approval process, all reactions reported by participants in drug trials are included, whether or not there is evidence that the medication causes the side effects. Don’t let those lists be a barrier to treatment. While the unpleasant side effects
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difference before the patient does. Friends or family may remark on greater energy or enthusiasm that the patient is not aware of. The improvement is often gradual and, importantly, can help patients engage more fully in behavioral therapy. It is easier to think when the clouds of depression lift, even a little. Patients who give a medication a full trial of two months and don’t notice any change in their symptoms should not lose hope. There are multiple options at that point. There are medications that can be used to “augment” antidepressants, which seem to help increase the effectiveness of the SSRI/SNRI. There also are many medications within the SSRI/SNRI classes, and patients who are not benefiting from one medication may benefit from another. While it can be draining to try multiple medications, with how long it takes to give each a real trial, it is still worth thinking about planting a new seed.
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appear quickly, the positive effects on mood take weeks to months to appear. This is the hardest part for many patients who try SSRIs/SNRIs. Especially at the beginning, it is easy to see the side effects and impossible to see the benefit, so many patients stop an SSRI/SNRI before a full trial. If patients are able to tolerate the gastrointestinal side effects, it is generally worthwhile to stay on the medication for a full eight weeks, or two months, to see if the positive effects on mood develop. Many patients find that timeline discouraging. People who are depressed are hoping for relief now, not in two months. However, without starting the medication, particularly without trying behavioral therapy, two months may well come and go without relief. Starting an antidepressant is planting a seed of hope. It may not take that long to start working, but most patients will have to wait at least a few weeks for symptoms to improve. It is not uncommon for people around the patient to notice a
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<<SEED continued from page 7 Adding organic matter (such as compost or aged manure) is the best way to improve all kinds of soil. It helps sandy soils retain more moisture and clay soils drain better. It also breaks down naturally to slowly release the nutrients plants need. You’ve just completed “vegetable gardening 101” for the Peninsula. If you feel you need more advice, consult your local Master Gardeners (see sidebar on page 7). We hope that you have the best vegetable garden possible this year. Happy gardening! Jeanette Stehr-Green has been a WSU-certified Clallam County Master Gardener since 2003. Stehr-Green enjoys teaching others about a variety of gardening topics and writes gardening articles for both the Peninsula Daily News and Sequim Gazette. She also participates in a monthly gardening call-in program on KONP.
Recommended vegetable varieties for the North Olympic Peninsula, by Jeanette Stehr-Green, Audreen Williams, Bob Cain and Lois Bellamy (deceased). For a digital (larger) version of this info, go to bit.ly/CCMGvarieties Arugula
March-June (seeds): Astro, Esmee, Red Dragon July-September (seeds) Dragon’s Tongue, Roquette, Speedy, Sylvetta Beans May* (seeds): Blue Lake (pole), Fortex (pole), Provider (bush) Beets March-May (seeds): Bull’s Blood, Detroit Dark Red, Spring Color Beet Blend July-early August (seeds): Chioggia, Detroit Dark Red, Early Wonder Tall Top, Touchstone Gold Broccoli March-May (starts), May (seeds): Di Cicco, Thompson, Waltham 29 Early July (seeds), Late July-August (starts): Thompson; Rudolph and Purple Sprouting for overwintering Cabbage March-May (starts), May (seeds): Caraflex, Golden Acre, Gonzales, Parel Early July (seeds), Late July-August (starts): Early Jersey Wakefield, Golden Acre, Gonzales; Famosa, January King, Storage No. 4 for overwintering Carrots April-May (seeds): Danvers Half Long, Ingot, Mokum, Yaya Early July (seeds): Bolero, Danvers Half Long, Red Core Chantenay Late August-September (seeds): Autumn King, Merida for overwintering Cauliflower March-May (starts), May (seeds): Amazing, Snow Crown Early July (seeds), Late July-August (starts): Amazing, Olympic Chard March-June (seeds) Bright Lights, Golden, Perpetual, Rainbow Blend, Rhubarb Late July-August (starts), September (seeds,
starts if possible): Bright Lights, Fordhook Giant, Perpetual Cucumber May-June* (seeds or starts): Pepinex, Lemon, Marketmore 97 Eggplant May-June (starts): Black King Greens, Asian March-May (seeds): Bok Choi, Ching Chiang, Komatsuna, Pac Choi, Tah Tsai, Wasabina July-September (seeds): Mizuna, Pac Choi, Red Kingdom, Tah Tsai, Wasabina Kale March-May (starts), May (seeds): Beira Tronchuda, Curled Scot, Nero Di Toscana, Improved Dwarf Siberian, Red Russian, Red Ursa, Redbor Early July (seeds), Late July-August (starts): Curled Scot, Nero Di Toscana, Red Russian Leeks March-May (starts): King Richard, Pandora Early July (seeds), Late July-August (starts): Pandora, Giant Musselburgh, Lancelot, Zermatt September (seeds): American Flag for overwintering Lettuce March-June (seeds): Buttercrunch, Continuity, Drunken Woman Frizzy Headed, Little Gem, Merlot, Outredgeous, Parris Island Cos, Red Sails, Salad Bowl July-September (seeds): Arctic Tundra Blend, Continuity, Rouge D’Hiver, Winter Density; Arctic King for overwintering Onions Early July (seeds): Ailsa Craig (bulb), Patterson (bulb) August-September (seeds): Pacific Pearl (bunching), Red Guardsman (bunching), White Bunching (bunching), Walla Walla (bulbing) Peas March-May (seeds), Early July (seeds): Alderman (shelling), Oregon Sugar Pea Pod II
(snow peas), Super Sugar Snap (snap) September (seeds): Alaska (shelling), Avalanche (snow), Canoe (shelling), Cascadia (snap), Green Arrow (shelling) for overwintering Peppers May-June* (starts): California Wonder 300, Wonder Bell Potatoes March-May (seed potatoes): Caribe, French Fingerling, Kennebec, Kerr’s Pink, Ozette, Purple Peruvian, Rose Thumb, Russet Norkotah, Russian Banana Fingerling Radishes March-May (seeds): Cherry Belle, French Breakfast, German Giant, Starburst July-September (seeds): China Rose, Dragon, Runder Schwarzer Winter; Daikon for overwintering Spinach March-June (seeds): Olympia, Palco (slow bolting), Seaside July-September (seeds): Bloomsdale Savoy, Giant Winter, Olympia Squash, Summer May-June* (seeds or starts): Black Beauty Zucchini, Cavili, Latino, Bush Scallop, Round Zucchini, Superpik, Tromboncino Squash, Winter May-June* (seeds or starts): Butterbaby, Honey Boat Delicata, Table King Acorn, Vegetable Spaghetti, Waltham Butternut Tomatoes May-June* (starts): Bloody Butcher, Early Girl, Oregon Spring, Stupice, Sun Gold * Recommendations are based on experiences at Clallam County Master Gardener Demonstration Gardens. Performance of the recommended varieties can vary depending on specific garden conditions such elevation, sun and wind exposure and use of raised beds.
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<<HELP continued from page 8 ADDRESSING CONCERNS Will it make people “happy zombies”? The short answer is no. The long answer is that, although some patients do find that some medications cause a flattening of their emotions, that is neither typical nor the desired result. If a medication causes a patient to feel not like themselves, it is important to talk to the prescribing physician and potentially try a different medication. Antidepressants alone do not make people happy; if they did, they would be drugs of abuse, and people would buy them to get high. They can help to turn down the volume on negative thoughts and let people experience their daily lives without the smokescreen of guilt and sadness that depression creates. What about the fears around becoming dependent on medication? For SSRIs/SNRIs, there is no “abuse potential.” It is impossible to get high on these medications. However, that time patients spend letting
their guts adjust to the medication matters when it comes to going off the medication: Suddenly stopping SSRIs/SNRIs can cause significant gastrointestinal distress, and can also cause a wide variety of psychiatric and physical symptoms, everything from a tingling sensation in the limbs to much worse mood. It is always important to gradually taper off SSRIs/ SNRIs. Suddenly stopping causes “discontinuation syndrome” that varies in severity depending on the medication but is not enjoyable for patients, although rarely truly dangerous. There are medications sometimes used to treat depression or anxiety that do have the potential for both physical dependence and addiction. Benzodiazepines (like Xanax or Valium) are a class of medications that affect the same neurotransmitter receptor group as alcohol. They cause relaxation, which makes them a treatment sometimes used for conditions like panic disorder or specific phobias (like flying). However, like alcohol, people may use them recreationally. Also like alcohol, if people become physically dependent on benzodiazepines and then suddenly stop, the biggest risk is seizures, which can easily be fatal. Benzodiazepines are rarely used for depression and are not a first-line medication for it. Doctors have become much more hesitant to prescribe benzodiazepines since the 1970s, when they were more commonly used. SSRIs/SNRIs are relatively new medications, only in use since the 1990s. Other medication classes that have been used in the treatment of depression include monoamine oxidase inhibitors (MAOIs), which have more interactions with other foods and medications and are no longer firstline depression medications; tricyclic
antidepressants (like amitriptyline or nortriptyline) are sometimes still used, particularly in patients who also struggle with sleep or chronic pain. Another medication in its own class is mirtazapine, which can be used for patients who have difficulty with sleeping or a decrease in appetite. Choice of antidepressant depends on the patient and on the doctor, and while SSRIs/SNRIs are where many physicians start, they are not the only options that may be right for a particular patient. Another drug that is sometimes used for depression has been around for a very long time. Ketamine has been in use as a sedative for decades, and recently, some doctors have begun to prescribe intravenous ketamine to treat depression that has been resistant to other forms of treatment. There is very limited research data on this use of ketamine so far, which means that it is impossible to know whether this will prove to be a safe, effective treatment for depression. Most doctors will not prescribe intravenous ketamine for depression and are not likely to start unless more evidence over time demonstrates a benefit for patients. People often wonder how long they will need to be on antidepressant medications. This is an excellent question, but hard to answer. Patients may only need antidepressant medications for a relatively short period, but for many people, depression is a chronic condition, like high blood pressure, that will need lifelong management. Stigma around treatment and the difficulty of taking daily medication contribute to patients’ desire to stop taking antidepressants. However, caution is always important in tapering off antidepressants, because depression
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can come back if the underlying causes are not addressed. For many people, the underlying causes are simply their unique, individual brain chemistry; even with behavioral therapy, they may benefit most from life-long treatment with antidepressants. Shame and stigma around depression often keep people from getting treatment. Depression, particularly with isolation, can lead to death by suicide or substance use. Taking good care of loved ones means encouraging them to seek help when it seems like they may need it and supporting them when they do start treatments like counseling or medication. Fears around “addiction” to antidepressants are unwarranted, but medications should be tapered to prevent discontinuation syndromes. Antidepressants do not fundamentally change someone’s personality, although some people need to be on antidepressants for the long term in order to lead full, rewarding lives. Counseling is a great option, both on its own and for additional support during treatment with medication. It’s often more accessible than it seems, especially if doctors can help link patients with sliding-scale, reduced fee,or covered providers. Everyone deserves the best possible chance of living a rewarding and meaningful life, and treating depression appropriately can be a part of that. Counseling and medication can support people in their journeys toward better health.
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OTHER BENEFITS Therapeutic yoga provides a range of other benefits, including overall strength, flexibility, mindfulness and stress reduction. Hestbeck, who began practicing for back health, noted, “On my yoga mat I can turn off the noise of the world and let movement and breath heal and energize my body and my soul.” Sea kayaker French agreed. “Of equal value to me is the mindful awareness of body, breath and heart. It is such a powerful but often overlooked dance.” Improved balance is another particularly valuable yoga benefit. Beth Kissinger, 57, began taking
Madrona MindBody Institute’s “yoga for backs” class one year ago and said her balance is noticeably better. “I have vestibular [inner ear] damage, so my balance is compromised. My balance is definitely improved, not only in yoga but throughout my everyday living; what you learn in class you can take and apply into your life.” Improved balance is particularly critical as we age, since every year more than 30 percent of U.S. adults 65 and over will experience a fall, and falls are the most common cause of non-fatal injuries and hospital admissions in people of that age group. NOT ALL YOGA IS CREATED EQUAL Like other movement modalities, yoga has different forms, from vigorous vinyasa yoga where the practitioner moves from one pose to another (often called flow yoga), to “power” forms of yoga that require more strength and arm balances, to more mellow restorative yoga where bodies are propped with bolsters and blocks for longer periods. Each of these styles brings unique benefits. The “Viniyoga” form of yoga is
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particularly therapeutic and has been used frequently in studies demonstrating the benefits of yoga for backs. The American Viniyoga Association describes this yoga lineage as “differentiation, adaptation and appropriate application.” This means that each person’s version of any particular pose may be different, as adapted for his or her own body. Finding a teacher with the right experience is essential, as improper form can place unwanted stress on the spine. Additionally, for anyone with disc issues, osteoporosis or other conditions, certain yoga poses will not be appropriate. It’s worth reading yoga teachers’ bios and getting referrals. A good yoga teacher will always offer options or variations, helping students customize for the cranky hip, the stiff knee or compromised shoulder. Yogi Ann Weston encourages people to try different teachers to find one that is the best fit. “Not every teacher is good for every person. Even more important,” she added, “is to really listen to yourself — don’t necessarily try to do what everyone else is doing. Your body is the smartest thing. Your body will tell you what’s right to do.”
THREE BACK “SINS” TO AVOID 1. Lack of prevention (too little exercise) 2. Inaction (sitting) 3. Lack of attention (improper bending and lifting) Renee Klein tried yoga for strength and flexibility after decades of practicing dance and other forms of exercise. Klein earned her basic and advanced yoga teaching credentials (RYT 500) and went on to become a yoga therapist, certified by the International Association of Yoga Therapy (C-IAYT). She leads classes, workshops and private yoga therapy in Port Townsend at Madrona MindBody Institute, where she is a co-owner. Klein now is deeply indebted to her learned teachers, and to her students, from who she continues to learn.
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Of course, along with the spine, the core of the matter is … the core. The core lets humans bend, twist, rotate and stand upright — it’s like a crane that supports the body’s movement. Often people think their core is just the lower belly, but the core includes abdominal, back, side, pelvic and even buttock muscles. The best prevention for back pain is exercise, which stretches and strengthens the core muscles.
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