Getting that fire of motivation is important to help put goals for the new year within reach

By Kaye Spector

Plain Dealer Health and Medical Reporter

Why is it that every January, people are eager to make a change, but by Valentine's Day, the urge has evaporated?

It's not unusual for Jazzercise classes, for example, to double in size after Jan. 1. "They usually come after the first of the year because everybody feels that finally, this is the year we are going to do it," says Judy Saletel, a Jazzercise instructor in Mentor for 23 years.

But after six weeks, most people's drive to change is gone, along with any hope to get in shape, slim down, stop puffing on cigarettes or change bad habits.

What can you do to keep the fires of motivation lit?

Psychologist Jeffrey Janata, division chief, psychology, at University Hospitals Case Medical Center, offers some perspective.

In general, motivation can either be positively or negatively reinforced: We go toward the positive -- such as fitting into a fabulous dress for your class reunion -- and away from the negative -- like hating how your thighs look.

What seems to predict success in behavior change is the immediacy of that reinforcement, Janata says.

"If the reward or punishment is coming right now, we're more likely to be motivated than if it's in the distant future," he says.

That's why your goal of a significant weight loss by June is trumped by the New Year's Eve buffet table: Good-tasting food is an immediate reward.

So the trick, Janata says, is to turn those long-term goals into smaller, short-term goals with either immediate consequences or positive reinforcement.

week and be disappointed with a one-pound loss -- even though that's a completely reasonable amount to lose in seven days.

Rather than quit, "focus on the one pound to get there, not on the 30," Janata says. "Make your [short-term] goal to lose a pound a week with reasonable calorie intake and exercise. It's the immediacy that counts for most people."

With that overall approach in mind, Janata offers these six strategies that can keep you moving toward your objective:

Set attainable goals

The first and most important step -- and it might be worthwhile to get some professional advice on what is realistic.

Weight loss and fitness are two classic examples where people often set high goals, then give up after being unable, predictably, to achieve them in an impossibly short time.

"Most people, when they join a fitness center, they want it now. We say, 'Let's just stretch this out for the entire year,' " says Rich Zatta, fitness and personal training manager at Mandel JCC. "We don't want you to feel so overburdened that you don't come back."

About 80 percent of newcomers to the JCC who meet with a professional, set specific goals and have a custom program become longtime users and achieve their results, Zatta says.

"Shape" your behavior Many parents and, yes, animal trainers are familiar with this technique. It rewards attempts, even if they are not right on the mark initially. The idea is that your continued efforts will hone your habits until you achieve your goal.

Say you want to work out every day. Your initial action should be to simply get yourself to the gym, even if you don't do much once there. After you reliably achieve that baby step, then you can further shape your habit by focusing on your workout -- which you also could break down into smaller goals.

The important thing is that lots of little changes can eventually add up to something bigger.

"If our goal is to reduce portion size, we don't want to only give ourselves credit if we get to the nutrition size," Janata says. "If we cut back only a little bit, that's a good thing."

Reward yourself

When you achieve a short-term objective, reinforce that victory with a goodie -- particularly if the behavior you're trying to eliminate, like overeating, is something you enjoy.

Important: The reward should be as valued as the behavior you're trying to abolish.

"We must be careful not to eliminate pleasure without introducing an alternative," Janata says. "That treat is a way of maintaining the same level of reward/pleasure."

Monitor yourself

We engage in much behavior, like overeating, automatically.

Using this technique, you try to pin down and understand the conditions under which you engage in the behavior you're trying to eliminate: When do I tend to light up? In the car? After a meal? When I'm drinking beer?

Once you've figured out your cues and habits, "Now you can set up a plan to overcome the obstacles," Janata says.

Monitoring also leads to insight into internal and external cues, which helps us to change behavior.

And then there's the "reactive effect" -- we can change our behavior merely by becoming aware of exactly how many cookies we are eating at the party, rather than mindlessly munching away.

"Just the act of writing it down, merely the act of paying attention, will accomplish some behavior change," Janata says. "After a while, it takes on a rewarding context."

Disrupt learning chains

Typically, our actions have triggers, either internal, such as thoughts or emotions, or external, such as times of day.

A sample chain: Boredom as a trigger to overeat, which causes you to gain weight.

Find ways to create a new association to that triggering event that will result in a healthier response: When you're bored, go for a walk instead of eating, which will help you to lose weight. Shape in the new association and then reinforce it with rewards.

Proximity of distress

One way to motivate yourself is to use stress: Stay focused on the behavior you are trying to eliminate -- especially if it makes you feel bad.

So put that unattractive photo of you in a bathing suit on your refrigerator door to remind you of why you want to slim down. Or tape stories about lung cancer around your favorite smoking spot.

"If we put it out of our minds, we won't change behavior," Janata says. "If we know that stress is one of the things motivating people to actions, then one tool is to keep stress fresh. Then you are more likely to finish your pills, go to the gym or lose those last five pounds."

Need to de-stress? Turn off the technology and tune out

By Kaye Spector

Plain Dealer Health & Medical Reporter

Feel the need to de-stress? Try turning off your CrackBerry for a few days -- or even a few hours.

Yes, technology is great, but laptops and smart phones are turning many of us into giant knots of stress, says Dr. Ned Hallowell, a psychiatrist, former Harvard professor and author of 16 books, including "CrazyBusy: Overstretched, Overbooked and About to Snap!"

With such devices making us available 24 hours a day, we lose control of our lives, Hallowell says. That ratchets up stress, making us distracted, impulsive, restless and hyperactive.

In fact, Hallowell believes that many of us, who are living overloaded lives through technology, show symptoms of attention deficit hyperactivity disorder.

"When you become crazy busy, you become distracted, you become impulsive, you become restless and hyperactive," he says.

Hallowell recently spoke to Cleveland Clinic employees about how to manage the chaos of modern life. Bottom line: Put on the brakes. And reconstruct the boundaries that technology has broken down.

That means no texting while the family is having dinner. No cell-phone calls while driving. And no obsessive e-mail checking when you have a few minutes of downtime.

Hallowell tells the story of one patient who asked if it was weird that her husband set his BlackBerry down next to them when they made love. Hallowell says he didn't know which was more odd: that the husband felt the need to have his phone nearby at such an intimate moment or that the wife was unsure whether it was appropriate.

"Good people, smart people, enthusiastic people, talented people become victims of their own enthusiasm . . . [and] their own desire to serve. You don't have to be," Hallowell says. "This is the grand seduction of modern life."

His advice is to choose three things every day to accomplish. Then focus laserlike on getting them done. Resist the distractions of interruptions such as visitors, e-mail and phone calls as much as possible.

"As you make yourself too available, you don't have time to think," he says. "Ask someone where they do their best thinking. Rarely do they say 'at work.' You think when you have a block of uninterrupted time. If you're like most people, it's not very often."

Studies show that nearly 20 minutes of every hour at work is spent dealing with interruptions.

"The more you allow yourself to have the world have at you, the more vulnerable you become to stress," Hallowell says. "You're running ragged and overcommitted, plus you're unhappy, plus you'll get sick."

You may have to have a talk with your boss if you're expected to always be available, Hallowell says. But start off with the affirmation that you both have the same goal -- you doing the best work possible. Then say there's a price to pay for being available 24 hours a day -- is it worth what you have to give up healthwise? Most bosses will say no, Hallowell says.

"Run your day knowing your priorities and what you need to get done. Create boundaries according to your desires," he says. "It's up to you to decide what matters."

Registered nurses in high demand as well-paying field continues to grow

By Kaye Spector

Plain Dealer Health and Medical Reporter

 

What's the prescription to recession-proof your employability? Get a nursing degree.

As baby boomers age and the need for health care grows, and with the nationwide nurse shortage, registered nurse jobs are projected to increase nationally by 500,000 by 2016, according to the federal Bureau of Labor Statistics. The bureau counted about 2.5 million RNs across the country in May.

Nursing is a good choice, too, for wages.

Not counting doctors and dentists, nursing salaries typically are among the highest in any large occupational field. Average annual RN wages are $65,130.

Although the job pays well, the nursing shortage is going to get worse, predicts Gingy Harshey-Meade, chief executive officer of Ohio Nurses Association.

The national RN shortage is expected to grow from 8 percent in 2009 to 12 percent in 2010 and to 29 percent by 2020, says the U.S. Department of Health and Human Services.

That's equal to having more than 808,000 too few RNs by 2020.

The problem isn't a lack of people wanting to go into nursing. Rather, it's the lack of nursing educators.

A university teaching job typically pays significantly less than a position in a hospital. So -- particularly when economic times are tough -- many nurses with the advanced education necessary to teach choose to keep working in hospitals.

With the average age of those teaching in nursing programs now 55, the need for educators becomes even more acute in the face of anticipated retirements.

A recent survey by the American Association of Colleges of Nursing found that 62.8 percent of all responding nursing schools had faculty vacancies that they needed to fill, translating into an overall 7.6 percent faculty vacancy rate.

"Salary in higher education is a more pervasive issue and one that can't be solved for a given profession," says Patricia Underwood, associate dean for academic programs and associate professor at Frances Payne Bolton School of Nursing at Case Western Reserve University.

Tuition is another obstacle to luring nurses into becoming educators.

CWRU this year received a large federal grant for student loans that covers tuition and obligates students to pay back only 15 percent if they take nursing-educator courses and work as a nurse faculty member for four years.

This fall's federal stimulus funding broadened the eligibility pool from doctoral students to master's students. CWRU also offers nursing-education fellowships.

"If we are going to address the larger issue of the nursing shortage, we have to address, first and foremost, the faculty shortage," Underwood says. "Starting more programs is not the answer. We have to increase the capacity of existing programs."

The field of pharmacy -- the other high-paying health care occupation, aside from doctors and dentists -- has a little different story.

Pharmacists earn an average of $104,260 a year, says the Bureau of Labor Statistics. But growth in jobs will be much smaller, with projections for 2016 only 30,000 more than this year. The bureau counted 266,000 U.S. pharmacists in May.

More pharmacy schools have opened in the past decade, increasing from 80 to 110, reports the American Association of Colleges of Pharmacy. The number of colleges in Ohio alone doubled from four to eight in the past eight years or so.

"The combination of having more pharmacy schools mixed with more female pharmacists coming back into the job market -- now we're beginning to see the shortage decline," says Ernest Boyd, executive director of the Ohio Pharmacists Association.

"For the moment, pharmacists are paid well in the jobs that they have."

Few studies back promises made by makers of so-called 'functional footwear'

By Kaye Spector

Health and Medical Reporter, The Plain Dealer

It sounds so easy.

All you have to do is put on a pair of shoes, and by simply going about your daily business -- grocery shopping, standing in line at the bank or picking up the dry cleaning -- you get great-looking legs.

That's the promise of "functional footwear" such as MBTs, FitFlops, Reebok's EasyTone sneakers and Skechers' Shape Up shoes.

The manufacturers claim that instability built into the shoes makes it harder to maintain balance and stand erect, forcing the wearer to use and develop muscles that aren't engaged with regular shoes. The footwear also is supposed to reduce stress on the joints and the back.

MBTs, the granddaddy of functional shoes, are made by Switzerland-based Masai Group International Ltd. and have been available in the United States since 2005.

This year, Reebok and Skechers came out with their own less-expensive versions, promising shapelier calves and a tighter rear end without the wearer going anywhere near a gym.

(MBTs cost from $240 to $390, while Reebok and Skechers cost around $100.)

So are the claims all marketing? Or do they work?

In theory, they could work, says Dr. Amanda Weiss Kelly, director of pediatric sports medicine at Rainbow Babies & Children's Hospitals.

But there are few rigorous, peer-reviewed scientific studies to prove it, she says.

One such study shows the MBTs can improve function and reduce knee and lower back pain for patients with knee osteoarthritis.

"For someone with arthritis, these shoes might be worth a try," Weiss Kelly says. "Some research supports this. But you have to be up and moving."

Another showed that developmentally delayed children with motor difficulties who wore the MBTs for two hours a day improved their balance.

"Theoretically speaking, by activating different muscles, you could end up firming and toning the muscles," Weiss Kelly says. "But nobody has done a controlled medical study on it."

The most important thing the shoes might do, Weiss Kelly says, is encourage their owners to walk more.

"Wearing these while sitting at a desk is not going to expand your calorie expenditure," she says. "I don't care what kind of shoes you wear, you have to exercise. I would just be thrilled if we could get people up and walking."

With nod from FDA, stevia finds sweet success in market for 'natural' products

By Kaye Spector

Health and Medical Reporter, The Plain Dealer

Wary of the pink, blue and yellow packets to sweeten your coffee, but trying to avoid the white and brown stuff too?

Check out the newest sweetener on the block, stevia extract.

Leaves from the stevia plant, an herb native to South America and Central America, have been used as a sweetener for centuries. But stevia extract could not be sold as a sweetener in the United States until late last year. That's when the U.S. Food and Drug Administration declared a highly purified extract of the herb, called rebaudioside A, safe for use in foods and beverages.

The Plain DealerStevia, a natural substitute for sugar that is an extract of a plant native to Central and South America. is shown here in powder and plant form. The FDA had been hesitant to approve stevia, in part because an early study showed that some forms of the extract had negative health effects under certain conditions when consumed in large quantities.

With the nod from the FDA, a barrage of products featuring the zero-calorie sweetener hit the U.S. store shelves this year, aimed at those who want to consume less sugar but avoid made-in-the-lab artificial sweeteners.

The big players in the stevia market are food producers Cargill Inc. and Merisant Co. Both make stevia-based tabletop sweeteners, and both have partnerships with soft-drink manufacturers.

Coca-Cola is sweetening its Sprite Green and Odwalla juice drinks with Cargill's Truvia, while Pepsi is adding Merisant's PureVia to its SoBe Lifewater fruit-flavored water.

The rush to market is coming from consumers' hunger for "natural" goods, says Valerie Myers, medical nutrition therapist at Kaiser Permanente in Bedford.

Labeling for both tabletop sweeteners prominently features green plants and the word "natural."

Consumers "like to hear that, rather than it's an amino acid or it's a chemical," Myers says. "We're in a 'green' state right now."

With many health experts blaming sugar-sweetened beverages, at least in part, for the U.S. obesity epidemic, stevia-based beverages might be a good choice for someone trying to cut calories or sugar, says registered dietitian Tammy Randall, director of education at the Diabetes Association of Greater Cleveland. A 12-ounce can of soda has about 150 calories and up to 10 teaspoons of sugar.

Stevia has seen success in other countries. In Japan, where stevia has been used since the 1970s, it accounts for 40 percent of the sweetener market.

Until the FDA's recent approval, stevia could be sold only as a dietary supplement and could not be labeled as a sweetener or added to food products. Stevia remained unknown to most consumers and relegated to health food stores.

As far as Randall is concerned, one calorie-free sweetener --natural or not -- is as good as another. It all comes down to individual taste, she says.

"Many people are leaning toward stevia because of the older myths about sweeteners," she says. "Pretty much all of those have been debunked. They're all pretty safe. Some of it is more personal preference and philosophy rather than a health decision."

But that "all-natural" label on your packet of stevia sweetener might be subject to interpretation.

Stevia extract is up to 300 times sweeter than sugar. So manufacturers mix the extract with other ingredients, like dextrose, to "fill the envelope," Randall says. Truvia and Pure- Via both contain sugar alcohol and other sweeteners, in addition to rebaudioside A.

The display rooms at the American Dietetic Association's recent nutrition conference in Denver were jammed with stevia-sweetened products, Randall says.

Myers also thinks stevia sweeteners could be a good choice for people trying to control their sugar intake. She has grown the herb in her own garden to sweeten her tea.

But she worries that artificial sweeteners merely encourage America's sweet tooth. She'd like to see us all eat fewer sweet things in general.

"There's a time and a use for artificial sweeteners," Myers says. "It's just heightening our desire for sugar."

Scrubs made by Mom add soft touch to Rainbow ER

By Kaye Spector
Health and Medical Reporter, The Plain Dealer 

You can buy scrubs at lots of places: uniform stores, discount stores, on the Web.

But nurses at Rainbow Babies & Children's Hospital have a source for custom-made, child-friendly scrub tops: Dorothy Riedel.

Riedel, who lives in South Euclid, is the mother of Rainbow emergency-room nurse Kristine Vehar.

Riedel began sewing and selling holiday and seasonal-themed scrubs to the Rainbow ER nurses about five years ago, after the ones she made for her daughter generated admiration from Vehar's co-workers and the question: Will your mom make me one?

So now there's a plastic tub in the Rainbow ER nurses' lounge, piled high with fabric. Nurses pick out the fabric, pay $15, and receive their custom-made scrub top in a few weeks. Riedel charges $25 for two, or $10 if the nurse supplies the fabric.

Riedel estimates she's made about 400 scrub tops over the years for the Rainbow nurses. She recently filled orders for 19 tops with holiday prints, such as snowmen or Peanuts characters.

Riedel thinks the kid-friendly prints help the ER's scared children connect with their caregivers.

"When a child is in the ER, there's a lot of strangers in there with them. If they see a nurse with a Charlie Brown top on, they'll feel more relaxed," Riedel says. "It gives me pleasure to do that."

My daughter, my co-author

When Dr. Tommaso Falcone decided to include a section about nutrition in the second edition of his book on infertility, he only had to look across the dining room table for help.

The chairman of the Cleveland Clinic's Ob/Gyn & Women's Health Institute turned to his daughter, Tanya Falcone, a graduate student in nutrition and dietetics at Kent State University.

Father and daughter spent about a year going through the concepts for the book. Then the young woman wrote a chapter on nutrition and supplied menus for the appendices.

Falcone says he learned a little bit about his daughter as the two worked together.

"She is the type of person who has her own ideas," about the medical part of the book, Falcone says. When he would raise questions about some of her ideas, "she was quite firm."

Falcone describes his book, "The Cleveland Clinic Guide to Infertility," as an expanded version of information he would tell patients during their first office consultation.

Nutrition is "a very important part of fertility enhancement," he says, particularly because excessive weight is one of the four main causes of infertility. Eating well also is something the patient has direct control over, he says.

"With most other things, I am controlling the most intimate aspects of their lives," Falcone says. "This is something that they can do."

Tell me about it

It's National Hospice Awareness Month, and Hospice of the Western Reserve is marking the observance by telling stories about hospice and inviting others to share their own.

Every day in November, the hospice is posting a new story on its Web site.

There, you also can download brochures about hospice's services and planning for end-of-life, and find links to information about advocacy at the state and national levels.

The hospice stories reflect the experiences of the staff and volunteers.

Like the story about an information-services worker who spent half a workday and a Friday night to help a dying patient set up Skype, an Internet communication service that allowed the patient to talk to his loved ones all over the country. It was the young patient's final wish.

To read the stories -- or tell one of your own -- go to the Web site and click on the large brown box at the bottom of the page.

Hospitals in the news

High-profile patients who have been treated at Cleveland's big hospitals have been grabbing the national television spotlight in recent weeks.

On Nov. 11, talk-show host Oprah Winfrey broadcast her interview with Charla Nash, the Connecticut woman hospitalized at the Cleveland Clinic after being mauled by a chimp. Nash arrived at the Clinic in February, three days after a friend's 200-pound chimp tore off much of her face and hands.

That same day, ABC's Nightline program broadcast a story reported at University Hospitals Case Medical Center on adults developing serious cases of H1N1, or swine, flu.

On Nov. 13, ABC's 20/20 featured a story on Johanna Orozco, the Cleveland teen who was shot in the face by her ex-boyfriend, with video and interviews of the trauma doctors who treated her at MetroHealth Medical Center.

Doctors concerned about obesity irked by physician group's grant from Coca-Cola

Dr. Caldwell Esselstyn Jr.

 By Kaye Spector

Health and Medical Writer, The Plain Dealer

CLEVELAND -- Caldwell B. Esselstyn Jr., the longtime Cleveland Clinic surgeon who lectures around the world and counsels people regarding the health benefits of a plant-based diet, was among 22 U.S. scientists and physicians who recently signed an open letter of opposition to the American Academy of Family Physicians.

Their beef? The AAFP announced in October that it accepted a six-figure grant from the Coca-Cola Co. to create content about beverages and sweeteners for the academy's consumer Web site, FamilyDoctor.org.

The AAFP said its first-ever "consumer alliance" would enable the academy to develop educational materials and "incorporate the products [consumers] love into a balanced diet and a healthy lifestyle." The new content is expected to launch in January.

The partnership created a stir among some physicians, nutritionists and health experts. Many saw the arrangement as a threat to the 62-year-old academy's commitment to science and family medicine.

Among the critics, in addition to Esselstyn's group, are the Center for Science in the Public Interest and nutrition authority Marion Nestle.

Soda and other sweetened beverages are the No. 1 source of added sugars in the U.S. diet, the American Heart Association says, and many health experts blame the drinks, at least in part, for the soaring U.S. obesity rate. A 12-ounce can of soda can contain up to 10 teaspoons of sugar.

"The AAFP's Web site should be criticizing sugar-sweetened beverages in the strongest language and providing candid, objective advice about the health and safety questions related to diet drinks," the letter sent by Esselstyn's group says. "But with Coca-Cola providing the funding, the AAFP simply cannot do that."