Elliptical An elliptical trainer is a stationary exercise machine that simulates walking or running but may exert less pressure on

the leg joints. It offers a minimal-impact, weight-bearing cardiovascular workout that can vary from light to high in-

tensity based on the speed and resistance set by the user. Elliptical trainers use a lot of muscles in the legs, but on some

models you can add upper-body motion as well, creating a full-body workout. To use an elliptical, you stand on top of

the pedals and grab the handles. Move your legs in a gliding back-and-forth motion. Most elliptical machines have an

option to use handles that are in a stable position or handles that move in an opposite arm-and-leg pattern, like cross-

country skiing. Not holding onto the bars will work your core muscles (abdominals, hips and back) and allows you to

exercise your balance. Because the elliptical is low-impact, and the resistance and speed are adjustable, not many

modifications are necessary for people with arthritis.

Modifications

Specific modifications will depend on your joints affected, but you may consider the following.

Wraps or braces can be worn on your affected joints for support and comfort.

You may choose not to hold onto any handles. Not holding on will work your core muscles more because it requires much greater balance.

Tips

Use variety. Go forwards or backwards to emphasize different leg

muscles. Use variable speeds, resistance, incline and programs.

Correct posture and movement will prevent your back from getting sore and your feet from going numb.

Progression

Slowly increase the time, speed and resistance of your workout.

Incorporate interval training: go at a regular pace then add short bursts

of faster speed.—arthritis.org

Raynaud’s is a condition that affects blood flow to the arms and legs, extremities. It occurs when the blood vessels that feed the fin-gers and toes get smaller in reaction to cold or emotional stress (this event is called a vasospastic attack). Diverting blood flow away from the hands and feet to keep the body’s core warm is a normal reaction to extreme cold. However, in Raynaud’s, the body reduces blood flow to the fingers and toes after relatively minor cold temperature exposures, such as holding a glass of ice water or being in an air-conditioned room. Fingers, toes, hands, feet, lips and the tongue are most commonly affected. They may become painfully cold, tingling or numb and become a ghostly shade of white or blue. The same reaction can be triggered by emotional stress or excite-ment. Raynaud’s can occur on its own, primary Raynaud’s. Most people with Raynaud’s have this type. It can occur at any age, but usually begins before age 30. It’s more common in people who live in cold climates. Women are more likely to have primary Raynaud’s. Secondary Raynaud’s is not as common, but it is often more complex and severe. It occurs with other diseases, such as lupus or scle-roderma. It may be linked to certain medicines, such as chemotherapy drugs, or the use of vibrating tools, such as jackhammers, which may cause hand or wrist injuries.

Raynaud’s Phenomenon Causes The causes of primary Raynaud’s are unknown. However, episodes are often triggered by cold temperatures and sometimes emotion-al stress – like if you become nervous or excited. There are many causes of secondary Raynaud’s. These include changes to blood vessels or how the body controls blood flow. These changes can happen if you get another disease or become ill. For example, in scleroderma, the skin and finger blood vessels are nar-rowed by scarring in the blood vessel wall.

Raynaud’s Phenomenon Symptoms The symptoms of Raynaud’s can include: Extreme sensitivity to cold. The body may react to emotional stress as if it were reacting to cold. Skin color changes. Fingers, toes, and/or sometimes the ears, lips and nose turn white due to lack of blood flow (called pallor). The blood that’s left in the tissues loses its oxygen and the affected area turns blue (called cyanosis). As fresh oxygen-rich blood returns to the area, it often turn bright red. Coldness, pain and numbness. A lack of oxygenated blood in the fingers triggers these feelings. Numbness is the sensation that the hands fingers have "fallen asleep." Warmth, tingling and throbbing. The quick return of blood to the fingers triggers these feelings. Skin ulcers and gangrene. For people with severe undiagnosed disease and attacks that last a long time, painful, slow-healing sores may occur in the finger tips. In rare cases, a long-term lack of oxygen to the tissues can result in gangrene (when a body part loses its blood supply).

Raynaud’s Phenomenon Diagnosis A PCP can usually determine if a person has Raynaud’s by getting a medical history and description of an attack and doing a physical examination. He or she may examine the fingers under magnification to look for abnormal blood vessels in the skin. Sometimes, spe-cial blood tests may be needed to distinguish primary from secondary Raynaud’s. These tests look for evidence of an autoimmune or connective tissue disease.

Raynaud’s Phenomenon Treatment The goal of treatment is to keep episodes from happening and make sure they don’t keep the person from doing everyday activities. In secondary Raynaud’s, the goal is to treat the disease responsible for the condition and to prevent ulcers and tissue damage. For most people with Raynaud’s, a conservative approach not using medicines is sufficient to control attacks. For people with more severe attacks, medications may be added. No drugs are approved by the FDA for the treatment of Raynaud’s. However, many drugs that are approved for high blood pressure or chest pain caused by coronary heart disease are used by doctors to treat Raynaud’s, and appear to be effective. The most popular are calcium channel blockers. Some of these can also help heal skin ulcers on the fingers or toes. Other drugs called alpha-receptor blockers that open blood vessels may be used. To help heal skin ulcers, some doctors prescribe a nonspecific vasodilator (drug that relaxes blood vessels), which is applied to the fingers. In severe cases that do not respond to other treatment and threaten to damage tissue, a doctor may recommend surgery.

Raynaud’s Phenomenon Self Care Taking a proactive role in your treatment, a process called self management, is important. To shorten the length of an attack once it has started, try these tips: Keep dry. Sweat that cools on the skin can trigger an attack. Wear socks, gloves, long underwear and exercise gear made from fab-rics that wick moisture away from the skin. Make sure that hair and skin are dry before exiting the gym. Manage hand temperature. Avoid extreme shifts in temperature. Warm hands or feet in warm (not hot) water. Keep your office warm and take frequent breaks to rub hands together. Reduce stress. For some people with Raynaud’s, anxiety and stress – without any drop in temperature -– may provoke an attack. Meditation, yoga and deep breathing are great relaxation techniques. Cognitive behavioral therapy, Tai Chi and aerobic exercise are all great ways to reduce tension. Stop smoking. Smoking narrows blood vessels and makes Raynaud’s worse.—arthritis.org

Vitamin D, a crucial nutrient for strong bones, is more likely to be lacking in people who take oral corticosteroids. A study by researchers at Albert Einstein College of Medicine of Yeshiva University, in New York City, found that those on steroids have a vitamin D deficiency twice as often as people who don’t take one of these medications. Because those with arthritis are often prescribed oral steroids, it is very important to ensure that your vitamin D levels are regularly checked if you’re on these drugs. “Vitamin D can help regulate the immune system, ward off sickness and disease and if you’re taking medication that lowers immune system defenses it can help you from getting sick as often,” says nutritionist Karen Langston, a spokesperson for the National Association of Nutrition Professionals. “Vitamin D maintains blood calcium levels and it regulates calcium and phosphorus, which keep bones and teeth hard. Studies have found that women with the highest levels of vitamin D are 30 percent less likely to develop rheumatoid arthritis than women with lowest level of vitamin D.” What does vitamin D deficiency cause? “The biggest concern is osteomalacia, or the softening of the bones,” says Langston. “In children, it’s called rick-ets. It also can cause brittle bones, weak muscles. Other symptoms are fractures of the hip and pelvis, bone pain and tenderness, tooth decay and hearing loss because the bones in the ear become soft.” Langston says you may have a vitamin D deficiency if you feel pain when you press on your breastbone also called the sternum, located in the middle of your chest. If tests show your body needs additional vitamin D, Langston recommends these painless ways to help get you back in balance: 1) Expose yourself – or even just your hands – to sunlight without sunscreen for just 10 to 15 minutes every other day. Although the amount of sunlight required has been debated, the sun activates vitamin D production in your body. So if you stand in the sunlight, sit on a bench or take a quick stroll, you’ve turned on your vitamin D switch. Keep in mind that if you have darker skin, you need more sunlight to spark vitamin D production because darker skin doesn’t absorb sunlight as well as lighter skin. 2) Open a window. If you can’t get outside, sit by an open window or door for a few minutes, because most win-dows block the part of the sunlight needed to ignite vitamin D production. 3) Go fish. Many types of fish are a good source of vitamin D. Three ounces of wild salmon or Atlantic mackerel can give you the recommended daily amount of vitamin D. 4) Go raw. Raw fish has more vitamin D than its cooked counterparts, so Langston recommends sushi that con-tains Atlantic herring, mackerel and salmon. 5) Go retro. Remember when cod liver oil was in every medicine cabinet? Well it contains lots of vitamin D and it’s new and improved with mint and fruity flavors. One tablespoon contains as much of this strong-bone nutri-ent as three servings of salmon or mackerel. 6) Get fortified foods. Some foods, such as cereals, milk, cheese and soy products, have extra vitamin D added in. Read your labels to find the ones with the biggest vitamin D boost. 7) Step it up in winter. When the weather cools off and the days shorten, many people spend less time outside in the sun. Keep this in mind and try to eat more foods rich in vitamin D to compensate. 8) Get tested. Before the daylight diminishes, have your vitamin D levels checked. Langston says restoring proper vitamin D levels takes several months so it’s best to know where you stand before winter hibernation. 9) Know your meds. Read your medication labels and talk to your doctor or pharmacist, so you’ll know if any of your medicines put you at risk for developing vitamin D deficiency or other nutritional issues.– arthritis.org

For years, I thought my husband’s family served beef tenderloin at Christmas because it’s fancy.

That may be true, but it’s also surprisingly easy. Ask your butcher to do the work for you. (Any good

supermarket butcher will know what “trimmed and tied” means.) You’ll just need to smear it with a

bit of olive oil, season it and pop it into the oven. An instant-read thermometer is a great way to

guarantee a perfect roast.

Tenderloin

2 tsp. kosher salt

1 Tbsp. ground pepper

1 (3½-pound) beef tenderloin roast, trimmed and tied

1 Tbsp. extra-virgin olive oil

Bleu cheese butter

½ cup (1 stick) unsalted butter, softened

5 ounces crumbled bleu cheese

Preheat oven to 450 degrees.

Tenderloin: In a small bowl, blend salt and pepper.

Place tenderloin on a rack in a roasting pan or on a high-sided baking sheet lined with foil. Pat

meat dry and rub on all sides with the olive oil, then pat seasonings on, taking care to get the bot-

tom and sides of the tenderloin. Let sit at room temperature for about 15 minutes.

Bleu cheese butter: While the meat sits, mash butter and bleu cheese together in a bowl. If you’re

making it the day of the meal, serve it from the bowl. If you’re making this in advance, dump the

butter onto one end of a 12-inch-square piece of parchment or waxed paper, then roll it up,

forming a log, and twist the ends to contain the butter. (It should look like a giant Tootsie Roll.)

Wrap in plastic and refrigerate up to one week.

Roast beef for 40 to 50 minutes (timing will depend on the shape of your tenderloin), or until it

reaches 130 degrees for medium-rare. Let the roast rest 10 minutes before slicing into inch-thick

rounds.

Unwrap bleu cheese butter and slice into ½-inch-thick discs. Serve meat warm, and pass butter as

a topping.—arthritis.org

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keting@altoonaresearch.com

Julie, RN, Pharmacy Staff

Julie is a member of our pharmacy staff and has been with us for

the past 19 years. She started her time here as a research study coordinator

and worked in this capacity for 18 years. This past year she moved over to

our pharmacy staff and now helps to prepare study medications for all the

research studies going on at our site.

Many of our studies are what are called “double blind” studies.

This means that a study has an investigational medication provided by a

pharmaceutical company that is looking to become approved by the Food

and Drug Administration for use in treating a specific diagnosis as well as a placebo that does not have

any active ingredients, but looks similar to the investigational medication. The use of the placebo in stud-

ies is to create a control group to compare the study medication to. However, if an effective treatment al-

ready exists for treating a specific diagnosis most trials are set up to have the investigational medication

given to one group and compared to the already effective treatment medication to see which works more

safely and effectively. The pharmacy staff is the only personnel who know whether an individual has re-

ceived the study medication, placebo, or already approved medication being used for comparison.

In her 19 years Julie has found that this job has helped her gain an ability to work in a fast paced

environment. This has given her confidence in her work. She has also developed many lifelong friend-

ships with those she works with. This, she states, is one of the things she enjoys most about working for

the Altoona Arthritis & Osteoporosis Center and the Altoona Center for Clinical Research.