August is Psoriasis Awareness Month Psoriasis is an immune-mediated disease that causes raised, red, scaly patches to appear on the skin. Psoriasis typically affects the outside of the elbows, knees or scalp, though it can appear on any location. Some people report that psoriasis is itchy, burns and stings. Psoriasis is associated with other serious health conditions, such as diabetes, heart disease & depres-sion. If you develop a rash that doesn't go away with an over-the-counter medication, you should consider contact-ing your doctor. How do I get psoriasis? While scientists do not know what exactly causes pso-riasis, we do know that the immune sys-tem & genetics play major roles in its development. Usually, something triggers psoriasis to flare. The skin cells in people with psoriasis grow at an abnormally fast rate, which causes the buildup of psoriasis lesions. Men & women develop psoriasis at equal rates. Psoriasis also occurs in all racial groups, but at varying rates. About 1.9% of African-Americans have psoriasis, compared to 3.6% of Caucasians. According to current studies, more than 8 million Americans have psoriasis. Psoriasis often develops between the ages of 15 & 35, but it can develop at any age. About 10-15% of those with psoriasis get it before age 10. Some infants have psoriasis, although this is considered rare. Psoriasis is not contagious. It is not something you can "catch" or that others can catch from you. Psoria-sis lesions are not infectious. How is psoriasis diagnosed? A dermatologist or other health care provider usually examines the affected skin and determines if it is psoriasis. Your doctor may take a piece of the affected skin & examine it under the microscope. When biopsied, psoriasis skin looks thicker & inflamed when compared to skin with eczema. Your doctor also will want to learn about your family history. About 1/3 of people with psoriasis have a family member with the disease, according to dermatologist Dr. Paul Yamauchi with the Dermatology & Skin Care Institute in Santa Monica, Calif. Where does psoriasis show up? Psoriasis can show up anywhere—on the eyelids, ears, mouth & lips, skin folds, hands & feet, & nails. The skin at each of these sites is different & requires different treatments. Light therapy or topical treatments are often used when psoriasis is limited to a specific part of the body. However, doctors may prescribe oral or injectable drugs if the psoriasis is widespread or greatly affects your quality of life. Will I develop psoriatic arthritis? About 11 percent of those diagnosed with psoriasis have also been diagnosed with psoriatic arthritis. However, approximately 30 percent of people with psoriasis will eventually develop psoriatic arthritis. Psoriatic arthritis often may go undiagnosed, particularly in its milder forms. However, it's important to treat psoriatic arthritis early on to help avoid permanent joint damage.—Psoriasis.org

The Altoona Arthritis & Osteoporosis Center (AAOC) was founded by Dr. Alan Kivitz in

1982. Our physicians at AAOC include Dr. Kivitz, Dr. Murphy and Dr. Lavelle. Our doctors are sup-

ported by a talented group of four Physician Assistants (Angela Braatz, PA-C, Victoria Regan, PA-C,

Alison Munchak, PA-C and Michael Zumer, PA-C) and Jerica Wills, CRNP, our Nurse Practitioner.

Together our team of physicians have over 50 years of experience in treating rheumatic conditions and

have participated in over 1000 clinical research studies.

AAOC works with patients to help diagnose and treat rheumatic conditions and other related

disorders that affect the bones, muscles and joints, including:

Rheumatoid Arthritis

Osteoarthritis

Psoriatic Arthritis

Psoriasis

Polymyalgia Rheumatica

Chronic Low Back Pain (Ankylosing Spondylitis)

Osteoporosis

Joint and Muscle Pain

We here at AAOC understand the fear and anxiety that often accompanies the pain of a rheu-

matic disease. Our staff truly enjoys helping patients achieve a higher quality of living through treat-

ment. Our physicians and staff set themselves to the standard of providing the highest quality of care

and we hold ourselves to the highest standards of honesty and integrity.

Our involvement with clinical

research trials helps us to provide our

patients with the most advanced rheu-

matology care. By working with

pharmaceutical companies and the

clinical trials for their investigational

medications we are able to provide

our patients with more treatment op-

tions for a longer amount of time and

to help them “make strides in their

arthritis care”.

By Emily Delzell All mind-body practices aim for the same goal: the cultivation of mindfulness, which experts often define as “paying attention on purpose.” As the term “mind-body” suggests, the pay-off of this pur-poseful attention is twofold. Practices like yoga and tai chi can create many positive physical effects, including improved balance, strength and flexibility. Yet, for people with chronic pain conditions like rheumatoid arthritis (RA), the biggest benefits seem to come from the mind component, specifically a shift in how they perceive themselves and their symptoms, says Heather M. Greysen, RN, NP, PhD, a nurse practitioner at the VA Medical Center in Philadelphia. “Training the mind to pay attention to certain things – and to not pay attention to certain things – helps people cope with pain and other symptoms,” she says. “Processing symptoms and our thoughts about them with acceptance and less judgment puts you in control of your feelings and increases the confi-dence that one can cope with those experiences.” Here’s the low down on four mind-body exercises that can quiet pain, build strength and improve your confidence to manage the ups and downs of living with arthritis. Yoga What it is: Yoga combines standing, sitting and reclined postures with breathing and meditation tech-niques. There are hundreds of postures and dozens of styles, from super-gentle restorative yoga to challenging types such as hot yoga and ashtanga that emphasize strength and endurance. Most involve holding a series of still postures, though in some styles, like vinyasa, practitioners flow from pose to pose. What the science says: Yoga is one of the best-researched mind-body exercise for arthritis, though many studies are small and participants are often practicing different yoga styles. Results show yoga reduces pain, stress, disability, fatigue and depression; lowers disease activity and markers of inflam-mation; and improves grip strength, sleep, mood and general health. Yoga may also help stave off disability that interferes with steady employment. Greysen’s most recent study on yoga and RA, published in 2019 in Holistic Nursing Practice, found that people who prac-ticed various styles of yoga had better overall physical function and were more likely to work full-time compared with their non-yogi peers. Tai Chi What it is: Tai chi combines deep breathing with gentle, slow-flowing postures that relax the mind and strengthen and stretch muscles and ligaments. Like yoga, there are different styles that can be practiced while walking, standing or sitting. What the science says: The handful of studies of tai chi that involve people with arthritis show a host of benefits. These include increased range of motion, improved muscle strength, flexibility, balance, cardiovascular fitness and quality of life as well as reduced pain, stress, inflammatory markers and disease activity.

Tai chi may help people with arthritis by “decreasing stress and causing the release of endorphins (‘feel good’ hormones that reduce pain and boost feelings of euphoria) that decrease perceptions of pain and create a sense of well-being,” says Gülseren Akyüz, MD, professor of medicine in the De-partment of Physical Medicine and Rehabilita-tion at Marmara University School of Medicine in Istanbul, Turkey. Qigong What it is: Qigong (pronounced “chee gong”) originated about 2,000 years ago in China, where it is prescribed by physicians to ease the symptoms of arthritis, high blood pressure, and insomnia. Its many styles integrate breathing exercises, meditation, visualization and gentle body movements. “Qigong exercises are safe even for those who are frail or confined to bed with appropriate modifications. They reduce fatigue and height-en energy, and are non-strenuous, self-paced and designed to protect internal organs and joints,” says Ray Marks, EdD, clinical professor and director of the Center for Health Promotion in the Department of Health and Human Performance at the City University of New York. What the science says: Marks, whose research focuses on the use of safe physical modalities for alle-viating arthritis pain and disability, published a review in Medicines in 2017 of 16 studies of qigong for arthritis. “A major benefit of the consistent practice of qigong is pain reduction,” she says. “Another is its posi-tive effect on reducing stress, depression, anxiety and low personal confidence. Additional observed benefits in people with various forms of arthritis are improved immune system health, sleep quality, balance and agility and interest in life – all possible factors that can impact pain positively.” She also found data showing regularly practicing qigong enhances posture, joint alignment, bone health, endurance, strength and walking ability. Walking Meditation What it is: Sometimes called contemplative walking, walking meditation involves slow, deliberate walking while noticing the components of each step and focusing your attention on your breath and other bodily sensations normally taken for granted. Ideally, it’s done in a quiet, natural environment like a wooded trail or an enclosed area. What the science says: Walking meditation is part of a program called Mindfulness-Based Stress Re-duction (MBSR) developed at the University of Massachusetts and offered at many hospitals. More than 20 studies show the eight-week MBSR program, which includes at least 10 minutes of daily walking meditation, improves physical symptoms, including pain, as well as psychological well-being in people with physical and emotional conditions.—Arthritis.org

By Jennifer Cuthbertson Osteoarthritis (OA) is the most common form of arthritis that affects the back. It can occur anywhere along the spine. Usually the low back and sometimes the neck are affected. In OA, the cartilage that pads the ends of the bones wears down. In spinal OA, this occurs in the facet joints – small joints located between and behind vertebrae. When you move, the bones rub together painfully. Bony growths (called spurs) form in the joints. These spurs can press on nerves, causing more pain. Causes of Back/Spine OA The cause of OA is unknown. Some common factors that play a role in OA include:

Age: The older you are the greater your chance of having OA.

Weight: People who are overweight are more likely to have OA.

Stress: Repeated joint stress from work or sports can increase your risk.

Injury: A back injury can lead to OA.

Genetics: Some people have a family history of OA. Symptoms of Back/Spine OA Symptoms usually start slowly and get worse as time goes by. Pain and stiffness may be worst when you first wake up or after sitting for a long time. Pain can also get bad after being very active.

Stiffness and a loss of flexibility: Turning your neck or straightening your back may be tough.

Pain: Your low back is the most common site of pain.

Crepitus: You may have a feeling of grinding when moving.

Tenderness and swelling: Your back along the affected joints may be sore to the touch. Diagnosing Back/Spine OA To find out of you have OA in your back, your doctor will talk with you and examine your body. They will probably order an X-ray to look for damage to the joints in your spine. They may also order blood tests to rule out other diseases. Treatments for Back/Spine OA The damage caused by OA cannot be reversed. Treatment is focused on easing pain and keeping you mobile. Non-Drug Treatments Lose weight (if needed) to take pressure off your back. Change activities to ones that don’t put as much stress on your back. Go to physical therapy to improve your muscle strength and ability to move your spine.

Try acupuncture or massage for pain relief. Drug Treatments Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can control pain. Steroids (glucocorticoids) may be injected into the back for short-term relief. Surgical Treatments If nothing else helps your pain, your doctor may recommend surgery. Surgery might be used to take pressure off the spinal cord and free nerve roots from bone spurs that are pressing on them or to fuse several segments of the spine together to stabilize it.– Arthritis.org

August 21st is National Senior Citizens Day. The holiday was established in 1988 as a day to recog-nize the wisdom, leadership, and achievements of our senior citizens. Of course, we don’t need a na-tional holiday for an excuse to show appreciation to the seniors in our lives. But if you’re looking for a way to do something special for your loved one to celebrate National Senior Citizen’s Day, we have a few ideas.

1. Have a conversation.

It sounds small, but simply taking the time to sit down and have a real conversation with your loved one can mean the world. So many of our interactions with loved ones become centered around logis-tics and planning, it can be easy to forget to simply ask how someone is doing. Visit in person if possi-ble, or hop on the phone or Skype if you live farther away. Give your loved one an uninterrupted hour of your time and attention.

2. Start a family history project.

The seniors in our lives all have fascinating stories to share, but most of them have never written any-thing down. Remind your loved one how much they’ve seen, experienced, and accomplished by start-ing a family history project. Ask them to tell you stories while you transcribe or simply record on your phone. It gives them an opportunity to revisit share wisdom and you a chance to preserve family sto-ries.

3. Make a photo album.

The older we get, the more we treasure our memories. Consolidate your loved one’s memories all in one place by creating a memory photo album for them. Fill it with photos from throughout their life—starting as far back as you can find photos for. They will love being able to flip through the album whenever they’re in the mood for a walk down memory lane.

4. Cook them dinner.

Sharing a meal together is one of the best ways to show someone you care. Whip up one of your loved one’s favorite dishes and have a family dinner in their apartment or home. To make it really special, finish the meal off with a cake or another favorite treat.

5. Spend an afternoon playing games.

If you have young children, playing games can be a good way for them to bond with their grandparents by doing an activity they can both enjoy. Playing games is also good for seniors, since it helps keep their mind engaged and sharp. Pack up a few games that are favorites in your family and bring them over to your loved one’s for an afternoon of fam-ily fun.—vistaprairie.org

I N G R E D I E N T S

2 tblsp. minced fresh parsley

1 tsp. salt

3/4 tsp. paprika

1/2 tsp. dried thyme

1/2 tsp. dried oregano

1/2 tsp. dried basil

1/2 tsp. ground black pepper

4 whole catfish fillets

Juice of one lemon

2 tblsp. melted butter

1/4 tsp. garlic powder

Non-stick cooking spray

I N S T R U C T I O N S

1. Preheat the oven to 350 degrees.

2. Combine the parsley, salt, paprika, thyme, orega-no, basil and pepper in a small bowl.

3. Sprinkle over both sides of catfish fillets.

4. Place the fillets in a 9x13 baking pan that has been coated with non-stick cooking spray.

5. Add the melted butter, lemon juice and garlic powder to a small bowl. Mix well to combine.

6. Drizzle the butter-lemon-garlic mixture over the fillets.

7. Bake uncovered for 15-20 minutes or until the fish flakes easily.- https://www.lanascooking.com/baked-catfish/

Rena, Medical Assistant

Rena has worked for the Altoona Arthritis & Osteoporosis Center for

the past 16 years. The bulk of what she does in an average day encompasses

authorization and billing of infusion medication for our office. She also

works directly with patients who receive injectable medications for a variety

of diagnoses. Not only does she handle all of that, but she also must ensure

that the medications are on site by overseeing the medication pricing and or-

dering for our office.

In the work that she does, Rena feels helping patients get the treatment that they need has been

truly fulfilling.. This is the overriding factor of her job that she takes immense pride in. But even on a

personal level, Rena states that has had the opportunity to develop some wonderful friends through her

16 year tenure with AAOC.

Through it all Rena has enjoyed learning and developing her knowledge base on rheumatic

medications and the billing process surrounding them. She also has a great appreciation for the leader-

ship of the office and how family-oriented

they are. She could not ask for more with the

grace that this job has allowed for her to

raise her young children and all the extra-

curricular activities that come with being a

parent.