Dr. Jeffrey Klugman hails from Philly.  Our mild winters coupled with Atlanta’s friendly people caught his attention and The Hand and Upper Extremity Center, where his medical practice is based, sealed the deal. Although he has yet to switch his love for the Philadelphia Eagles to the Atlanta Falcons, we are honored and thankful that Dr. Klugman calls Atlanta home. Always up for a challenge — when he’s not teeing up on the golf course or building LEGOS with his beloved son Harris or his enjoying a tea party with his cherished daughter Samantha — he’s conferring with his patients and executing incredibly skillful procedures for both children and adults in the operating room. 

     A surgeon’s life is intense and when it’s time to relax, he loves to travel and high on his list of favorites are African safaris, journeys to Israel and beach getaways, all together with his incredible wife Robyn. His family’s favorite destination is Margate City on the Jersey shore; he’s been vacationing there since he was a child. One of Atlanta’s and the Southeast’s foremost experts in hand surgery, known for his acumen with both children and adults, his services are in very high demand. He’s the crème de la crème, one of the most sought after and specialized hand surgeons in the South; we are lucky he made Atlanta his home.

     Dr. Klugman’s prestigious resume includes graduating from Tufts University School of Medicine in Boston where he  was selected for the Alpha Omega Alpha Medical Honor Society; a residency in orthopedic surgery at the world-renowned NYU/Hospital for Joint Diseases Orthopedic Institute and a distinguished Harvard University Hand Fellowship at Brigham and Women’s Hospital, Boston Children’s Hospital and Massachusetts General Hospital.

    Dr. Klugman has authored multiple publications and is active in training residents and fellows. He holds a Certificate of Added Qualification in Hand Surgery and is a member of the American Society for Surgery of the Hand and the American Academy of Orthopedic Surgeons. 

TG: Dr. Klugman, you treat both adults and children. How can you help newborn infants with congenital deformities? 

JK: My partners and I have a special interest in pediatric hand surgery and we are often asked to see children with congenital differences. These patients require specialized care and attention as these often are unique problems. Time must be spent in discussion with the family so they can understand the medical issues, treatment options to improve function and cosmesis (preservation of bodily beauty), timing of treatments, and long-term prognosis.

    Congenital issues affect the child but also have an impact on families. Treatments can include therapy, splints, comprehensive medical work-ups, and surgical intervention. Our practice supports a Pediatric Hand Fellowship through the Children’s Healthcare of Atlanta System to hopefully educate future clinicians in how to manage these difficult problems. 

TG: What other pediatric hand problems do you commonly treat?

JK: There are a wide variety of pediatric hand issues. Trauma, such as fractures of the wrist, hand, and fingers, are the most common. I see a large volume of wounds and lacerations often involving tendon and nerve injuries. Masses and cysts are also frequent problems. We care for recreational to high-performance athletes with traumatic injuries, sprains and overuse problems. Crush injuries, finger tip injuries, congenital trigger thumbs/fingers and inflammatory problems, are also quite common.

TG: Let’s talk about your life-changing work with adults. How soon do you like to see a patient after their initial injury?

JK: Often after an acute injury people are seen at an ER or an urgent care. Other times, injuries may be less severe. I believe with injuries of the hand/wrist/forearm it is best to be seen early. Problems are easier to treat when they are more acute. Fractures may heal with malalignment or displacement if not treated properly, and tendon injuries often have a strict time line associated with repairs that dramatically affects outcomes.

    In addition, ER and urgent care MDs are not specialists so it is not uncommon for them to not fully appreciate the severity of an injury or miss subtle issues. Coming for an evaluation early allows for a more accurate and effective treatment with improved outcomes. If the injury is not severe, then patients can be reassured and encouraged to progress with motion and functional activities to prevent stiffness and other complications.  

TG: Arthritis is a common problem. I can remember my mother suffering with arthritis both via pain and the shape of her fingers. Are there any new solutions? 

JK: There are multiple types of arthritis such as osteo, rheumatoid, post traumatic, septic, etc. It sounds like your mother had osteoarthritis. This is a very common problem affecting the hands more so in women than men. It is typically a genetically pre-programed process, meaning it affected your grandmother, mother and will likely affect you. Arthritis of the hand can result in deformity, stiffness and pain.

    Unfortunately, there is no way to prevent this process from occurring or progressing in patients with a pre-disposition. There are options to help with function and cosmesis. Arthritis of the thumb base is a particularly common problem we see that can be painful and functionally limiting.  Fortunately, there are good options available to treat this issue and dramatically improve both pain and function. Non-surgical treatments can include steroid injections, a variety of splits, and nonsteroidal anti-inflammatory medications.  Outpatient surgical treatments can often provide a more permanent solution.  

TG: Is there a treatment for carpel tunnel syndrome? Many people, especially in our computer age, suffer from this malady. Please also tell us about Trigger Finger — what is it and can it be treated?

JK: Carpal Tunnel Syndrome is among the most common problems I see. Carpal Tunnel is compression of the median nerve as it traverses from the forearm into the hand. The carpal tunnel is a defined space with three side bones and a dense ligament forming the roof of the tunnel. When pressure increases in the space it causes the nerve to become compromised and this results in numbness to the thumb, index, middle and part of the ring finger. It can also cause weakness to the muscles at the base of the thumb, which significantly affects fine motor function.

    Patients with Carpal Tunnel Syndrome often require an EMG/Nerve conduction study to objectively evaluate their complaints. Treatment can include a variety of non-operative measures as well as carpal tunnel release surgery, which has a very high success rate in improving symptoms and preventing them from worsening or recurring over time.     

Trigger finger is another common problem I often treat in my office. Trigger finger results from inflammation and catching as the flexor tendon glides through the sheath and first pulley that keeps the tendons adjacent to the bone. In a trigger finger, the tendon becomes inflamed and catches at the first pulley creating a mechanical block, like a truck that’s too big to fit through a tunnel. The solution is to make the truck smaller with a steroid injection or, if that does not solve the problem, I can permanently make the tunnel bigger with a small outpatient procedure to release just the first pulley. Trigger finger release surgery is very effective with high patient satisfaction and minimal down time.  

TG: What separates a hand surgeon from an orthopedic surgeon or plastic surgeon? 

JK: Hand surgeons are typically orthopedic or plastic surgeons who do additional fellowship training specifically in hand surgery. The hand is an extremely complex area anatomically. I tell patients the hand is like Manhattan, lots of expensive real estate in a small area. I believe subspecialization allows for more accurate diagnosis, improved treatment options, more effective therapy and overall improved outcomes.

Renowned in his field, the extraordinarily gifted Dr. David Brothers has one of the premier plastic surgery practices in the country.  He was born in New York City but came to Atlanta and completed his undergraduate degree from Emory University where he graduated Phi Beta Kappa. He received his medical degree from the University of Miami School of Medicine where he was elected to the Alpha Omega Alpha national medical honor society.

    Dr. Brothers is certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgeons and is a Fellow of the American College of Surgeons. He is the founder of the Plastic Surgery Centre of Atlanta, P.C. and has served as the chief of plastic surgery at Saint Joseph’s Hospital of Atlanta, Northside Hospital and Perimeter Surgery Center of Atlanta. The former secretary of the Georgia Society of Plastic Surgeons, Dr. Brothers has been published in the field of reconstructive and cosmetic surgery and is a frequent guest lecturer. 

    He’s an avid traveler and a family man; his three beloved children, Danielle, Amanda and Samantha, accompany him almost everywhere he goes.  Whether he’s relaxing in a villa in the Caribbean or trekking through Europe, his focus is always his family and his patients.  Blessed with hands of gold, this premier plastic surgeon has changed the faces and lives of both men and women throughout the U.S. and Canada.  People come from far and wide to seek his skill and advice.  Dr. Brothers says he enjoys growing older with his patients, but “unfortunately, they are looking younger while I am looking older.”

TG: Twenty years ago, a face lift seemed the best answer to look younger. Today, are there alternatives to a full facelift?

DB: Yes, people can turn back the clock and rejuvenate their faces with non-surgical techniques. We offer many. A good solution for some patients who want to soften fine lines and wrinkles can be to start with injectables such as Botox, which paralyzes the muscles that create wrinkles and lines between the eyebrows and in the forehead. There are also volumizing fillers that allow for a fuller more youthful appearance through the mid-face area. We also offer stimulators like Sculptra, that help replace lost collagen. In combination these fillers and injectables, sometimes known as a “Liquid Lift,” can be a great start into the cosmetic world of rewinding time without having surgery.

    We have laser treatments, such as Fractional C02 laser treatments that help rejuvenate the skin and give it a revitalized appearance. We also offer Venus Viva and Legacy treatments, which are radio frequency treatments that can help with acne scars, rosacea, stretch marks, fine lines, wrinkles and cellulite. All these treatments can be done in the office with little or no downtime in some cases.

TG: You mean someone can visit your office and leave looking younger?

DB: Absolutely. When I came out of my residency none of these products were available. We were trained as surgeons and therefore we were trained to focus on areas that we could only improve surgically. Now, when I examine people, I not only look at things that I can correct surgically, but I also observe  the person’s pattern of aging, where they are losing fat and how it is being redistributed throughout the face.

    The trend in plastic surgery today is no longer to just do a facelift and pull people as tight as you can but rather to turn back the clock and restore the lost volume of youth. A lot of aging is simply lost volume. Our job is no longer simply a matter of examining someone’s face and deciding what surgery you can do for them. Instead, it is evaluating a patient’s face in three dimensions, noting their pattern of aging and why they are aging. Today we have so many more tools to non-surgically rejuvenate the aging face.

TG:  There is a myriad of topical products available, some expensive, that promise a youthful appearance. Are they worth the cost?

DB: Unfortunately, I don’t believe that anything sold over-the-counter will really have any positive effect on your skin. The FDA is a strict regulating organization and anything that has a tremendous impact on the skin or potentially changes the skin significantly would need FDA approval. When people purchase these over-the-counter products very often they are paying for name, packaging and nice smells.  Unfortunately, most of these products are not going to do very much.

     In my office we offer Alchemy SkinCare, a private label made exclusively for us. We also offer Revision Skincare and Venus Skin products. It is best to make an appointment with one of our expert medical aestheticians with Alchemy Aesthetics who will carefully evaluate your skin, customize your regimen and teach you how to use the products.

TG: Let’s talk about Botox. Is it safe?

DB: Botox is very safe. The only complications I have ever had from Botox would be a little bruising; rarely it can drift and just touch a small muscle in the upper eyelid, causing it to droop slightly. If this happens, and again it is quite rare, it usually goes away within a week or two. Ideally, you would repeat Botox three to four times a year. It beautifully and naturally relaxes someone’s facial expressions, and done correctly, it does not give a surprised or frozen look. Botox relaxes the area between the eyebrows where people tend to look very severe. I can inject Botox to relax transverse lines in the forehead. We can also place it under the eyebrow to give a very natural lift to the lateral or outer eyebrow.

TG: What about Sculptra?

DB: Sculptra is a fascinating product and the only product in its class. I am a master trainer for Sanofi-Aventis-Dermik, the pharmaceutical company that manufactures Sculptra. It is a collagen stimulator, a naturally derived product that we inject over a few months that causes a gradual correction of lost volume. And, as the body degrades or breaks it down, eventually into carbon dioxide and water, Sculptra stimulates new collagen production. The actual correction that you get is from your body’s production of natural type 1 collagen. Once corrected, the results last no less than 25 months. I have patients whom we brought to full correction years ago and I have not yet had to re-treat. The product is amazing!

    There is no product out there that can do what Sculptra can do. Sculptra can replace lost volume in the temporal regions, the cheeks and close to the jowls. Even if you tighten the skin surgically you are still not restoring the lost volume. Sculptra, whether it is done without or after a facelift, will restore a youthful fullness to someone’s face.

TG: Can you talk about Restylane and collagen, which are also fillers. Is one product better than the other?

DB: There are many intradermal fillers on the market. I have narrowed the list down to the Juvederm and Restylane family of products. I use the products for the nasolabial folds (the lines from the nose to the mouth), for deep lines around the eyes and for cheek augmentation. These products give the best and longest lasting correction for the volume injected. Juvederm and Juvederm Ultra Plus are mostly used in the lips and some facial lines. Juvederm Ultra Plus is a very good product for natural lip augmentation that is soft and long lasting.

Dr. Stephen A. Rosenberg is one of Atlanta’s preeminent OB/GYN physicians. He’s the go to expert for women: guiding them with skilled care and concern through pregnancy and giving  birth, to helping women navigate the life-changing issues of menopause. Dr. Rosenberg says it is a privilege to be a help to so many wonderful people. He’s the consummate professional, an avid traveler and a loving husband to his wife Eliane and dad to his two beloved children. His daughter Talia and son Lucas are his pride and joy and no vacation is complete unless he has them aboard. He is the gold standard in women’s healthcare, providing his patients with expertise coupled with kindness and concern.

    Dr. Rosenberg received his undergraduate and medical degrees from Emory University.  Already a fan of Atlanta, he then completed his residency at the Emory University School of Medicine. Dr. Rosenberg is certified by the American Board of Obstetrics and Gynecology and he is a Fellow in the American College of Obstetrics and Gynecology.

TG: Dr. Rosenberg, please tell us a little about yourself, your education, and how you ended up in Atlanta involved in women’s healthcare.

SR: I grew up in Virginia and came to Atlanta to attend Emory University School of Medicine.  I did my residency at Grady Memorial Hospital, which is a large inner city hospital in Atlanta. Once I completed my four years of residency in obstetrics and gynecology, I joined North Atlanta OB/GYN some 30 years ago, and I am still delivering babies at Northside Hospital. 

TG: Did you know at an early age that you wanted to go into women’s healthcare?

SR: I think I knew in my early teens that I wanted to be a doctor, but I was uncertain what field of medicine I would go into. At one point I wanted to be a heart surgeon and then a psychiatrist. However, in my third year of medical school, I had the opportunity and responsibility to deliver five to 10 babies during my OB rotation.

   For some doctors in training, delivering a baby can be a life-altering experience, and it was for me! I knew this was what I wanted to do with my professional life. Caring for a woman throughout her pregnancy and then delivering her baby is an awesome responsibility and privilege. There is an intimacy that is unique to this process that is different from any other found in medicine. Women who have a positive obstetric experience often remember their doctor for the rest of their life. 

   Now that I have been in practice for more than 30 years, I have had two very special experiences recently. First, I have now taken care of and delivered a baby for a patient whom I actually delivered myself, during the first year I was in practice, 30 years ago. The second experience involved being invited to the wedding of a gentleman whom I delivered early in my career. How many people can go up to the bride at her wedding and say that they knew the groom before he was born and then delivered him? Needless to say, she, the bride, was at first confused and then shocked. These are the things that make what I do so interesting and exciting.

TG: How has your practice evolved as you have moved through your career?

SR: One of the most wonderful things about being an OB/GYN is that you age with your patients. I see patients when they are having their families, and then every year they come in for their annual exam and I get to keep up with the babies I delivered as they grow up and go off to college. The patients whom I delivered years ago are now approaching the perimenopausal and menopausal phases of their lives, which is typically the mid-40s and on. Of course, this brings on different challenges for women as their hormonal milieu evolves. The good news is that there are new treatment modalities to help women with problems specific to this transitional life phase.

TG:  Can you share with us some of these new treatment options?

SR: Of course. The first thing I would like to discuss is hormone replacement therapy. As you know, much has been written over the years about giving women estrogen and progesterone to help with menopausal symptoms. Suffice it to say that the earlier studies conducted to look at the safety of this therapy were done at a time when women were being given synthetic hormones. The estrogen came from the urine of pregnant horses and was therefore equine estrogens. The progesterone was completely synthetic.

   I have long been a believer in hormone replacement therapy using bio-identical plant-derived hormones, which are identical to the molecules the body naturally makes. I have recently started offering a new hormone regimen called BioTE hormonal pellet therapy.

   I am very excited about this therapy choice because it focuses on not only estrogen but also testosterone. Before menopause, the ovary makes testosterone which is, in part, responsible for libido. I cannot tell you how many menopausal women I see who are very frustrated with their loss of sex drive. Studies have shown that some menopausal symptoms including night sweats, loss of libido, and a general lack of energy may be related more to low testosterone than estrogen. Many women on hormone replacement are not having their testosterone replaced and therefore find the treatment less than satisfactory.

   I am not going to suggest that replacing testosterone is a panacea, curing every menopausal symptom, but a large percentage of my patients receiving this therapy are definitely noticing a marked improvement in how they feel. The other advantage of this therapy model is that the estrogen and testosterone are administered as pellets under the skin in the buttock region. This allows for an even distribution of hormones over a four to six month time frame. It is interesting that when I started my career a few older physicians were doing pellet therapy and then it went away. I guess everything that’s old…

TG: Are there any other treatment options you are using specifically for menopausal women?

SR: Yes. Actually, the other therapy I am now offering in the office addresses a real problem I hear very often, which is pain with intimacy. We all know that 60 is the new 40 but sometimes the body doesn’t quite go along. As women enter menopause and the estrogen levels wane, the vaginal lining can become thinner and less resilient. This can lead to significant pain with intercourse. Who wants to do something when they know it is going to hurt? This can have a very significant impact on a marriage or relationship. I am now offering the Mona Lisa Touch laser therapy in the office. It involves three treatments performed six weeks apart. Although the thought of this treatment might be a little frightening, the treatments are virtually painless.

   The science behind the therapy is that using laser energy on these tissues stimulates more blood flow to the tissues and more glycogen formation, which makes the tissues healthier.  Before I committed to this therapy, I performed a study with several test patients and 98 percent had a very favorable response. Those that did not, needed one extra treatment. I have been told by more than one patient that bringing intimacy back into a relationship is life altering.

Want to Lose Weight and Get Fit? There’s an App for That!

Is there anything worse than discovering you can’t squeeze into your favorite walking shorts or swim suit? These 13 apps make getting fit a cinch whether you want to run, walk, cycle or work out excess pounds or use customized strength training program to shape your legs, sculpt your tush and tone and firm those flabby abs!

Get moving with Fitbit. Whether you choose the wrist-mounted Flex, the clip-on One or slip the Zip in your pocket, the apps work with your smartphhone to track steps taken, calories burned, food consumed and how many zzzs you get in 24 hours. As you change your habits and get healthier and morefit, the Fitbit monitors your progress.

Dump pounds and get fit with Lose It! It takes your profile and goal weight and puts together your personal daily budget. Set that goal, follow the budget, and start losing it now! Lose It! has a large, verified food database that makes counting and tracking calories easy. You can log past meals, input custom foods or search by brands.

Get a nudge with Human. If you’re new to fitness, this app will be the fitness coach you’ve been looking for. It encourages you to get off the coach and get moving outdoors. Whether you walk run or cycle, it will track your progress and let you brag about it on the social media of your choice.

Take a hike (and lose weight, too!) with MapMyHike. This app uses your phone’s GPS to track your moves. Map out a hike before leaving home, start hiking and the app will track your speed, pace, calories burned and what you eat en route.  With 70 million-plus routes, you’ll never be at a loss for somewhere to walk or hike and you’ll never have to worry about getting lost again! Or be brave and create your own route. The app also tracks what you eat so you can lose weight faster.

Turn fitness into a fun video game with Fitocracy. Bored to death with your fitness regimen? Fitocracy is sheer genius at getting you motivated. The app takes the addictive qualities of games like Pokemon and combines it with your workout.. As you complete your workout, you’ll receive “quests” tailored to your preferred activities, earn experience points, progress to new fitness levels and slay the laziness dragon. You can also make friends with other Fitocrats and participate in a fitness social network to increase your motivation and become more awesome. Named An App of the Year by Men’s Journal magazine.

Get a monster workout with Gorilla Workout, an app that helps you lose weight, build muscle, increase agility, and gain energy on a tight budget. It has 175 different bodyweight workouts with 40-plus unique exercises. Choose from four different fitness levels and signature workouts to get fit. Every exercise also has real-life video and text descriptions. No wonder Gorilla was named the Ipad app of the year in 2013 by Apple.

Walk your way to fitness with Accupedo, which measure distance, steps, minutes, calories or laps around a standard track and tracks your progress over time

Kick butt with the Boot Camp Challenge. Get lean, strong and fit with an app that features more than 200 exercises and beginner to advanced routes using beat-sync technology that matches the tempo of your music to your workout.

Count calories and lose weight with My Fitness Buddy, an app that tracks your moves and caloric intake. You may be shocked to discover you’re eating a lot more than you think! The food diary measures ever bite, gram of carbs, fat and protein you eat with no fuss or hassle and takes the mystery out of weight loss. It also gives you access to 1 million food items. Or add your own foods and recipes and access them from anywhere.

Get fit with Fitness Builder. With one of the most comprehensive fitness databases on the planet, this app lets you access a huge library of fitness images and videos, challenging workouts of all varieties, live personal trainers and also lets you track your workouts and progress.

Take a run with Nike+ Running and RunKeeper. If your exercise regimen revolves around running or jogging, these two apps let you map out runs, track your speed, distance and calories burned and  track your location using GPS. RunKeeper lets you keep and track your running stats and set goals, and has customized training plans and voice coaching.

Keep a personal trainer at your fingertips with Endomondo Sports Tracker. This app does all the usual stuff (tracks your heart rate, calories, speed and distance) and more: Enter your fitness goals and an audio coach will provide feedback while you exercise to keep you moving and motivated.

Be Your own Gym with You are Your Own Gym, which provides 200-plus video demonstrations and workout options. Create your own individualized workout for your fitness level with workouts that offer 81 different combinations per fitness level.

Whether you’re a “Road Warrior” who has piled up thousands of Frequent Flier Miles, or someone who is planning a vacation to a distant locale, you’re likely to experience “jet lag,” which can have a profound effect on your sleep and alertness.

For years, jet lag was considered merely a state of mind. Now, studies have shown that the condition actually results from an imbalance in our body’s natural “biological clock” caused by traveling to different time zones.

Basically, our bodies work on a 24-hour cycle called “circadian rhythms .” These rhythms are measured by the distinct rise and fall of body temperature, plasma levels of certain hormones and other biological conditions. All of these are influenced by our exposure to sunlight and help determine when we sleep and when we wake.

When traveling to a new time zone, our circadian rhythms are slow to adjust and remain on their original biological schedule for several days. This results in our bodies telling us it is time to sleep, when it’s actually the middle of the afternoon, or it makes us want to stay awake when it is late at night. This experience is known as jet lag.

Also, altitude plays a role in how get lagged we feel after a long flight. In general, the higher the altitude, the greater the sleep disruption and jet lag. Generally, sleep disturbance becomes greater at altitudes of 13,200 feet or more. The disturbance is thought to be caused by lower oxygen levels and accompanying changes in respiration. Most people adjust to new altitudes in two to three weeks.

Steps to avoid jet lag

Some simple tweaks before, during and after your flight can help lessen the side effects of jet lag. Book a flight that gets you to your destination in early evening.

• Try to stay awake until about 10 pm local time. If you feel sleepy during the day, take a short nap (no more than two hours) and set an alarm to make sure you don’t overdo it.
• Plan ahead for time changes by getting up and going to bed earlier several days prior to an eastward trip and later for a westward trip.
• Upon boarding the plane, change your watch to local time at your final destination
  Steer clear of booze and caffeine at least three to four hours before bedtime. Both are stimulants that prevent sleep.
• When you reach your destination, avoid heavy meals. A light snack (as long as it’s not caffeine or alcohol) is fine.
• Don’t work out or engage in strenuous exercise too close to bedtime (running, vigorous walking, hardcore cycling, spinning, etc.) Yoga, Pilates and stretching is fine and will help relax you while light exercise is fine in the daytime and may help set your internal clock for better sleep.
• When you start getting sleepy on the plane, wear earplugs and blindfolds to block out unwanted noise and light and tell the stewardess not to disturb you for meals and snacks served during the night.
• When you reach your destination or between flights, get some sun. Daylight helps regulate your biological clock while indoor air (airports, airplanes, restaurants, subways and trains) only worsens it.
• Don’t worry about what you eat before a flight. Contrary to popular belief, specific foods have no effect on preventing or minimizing jet lag.

Handling travel related stress conditions

Two common travel related stress conditions are the “First Night Effect” and the “On-Call Effect.” The first condition occurs when trying to sleep in a new or unfamiliar environment like the middle seat of an airplane or a new bed in a hotel room. The second is caused by the nagging fear that something you’re not expecting (an airline stewardess serving you an unwanted meal or a fellow passenger stumbling over you to get to the restroom) might wake you up. To avoid them, try these tips:

• Bring something from home to make you feel more comfy in a new environment; for instance, a photo of you and your significant or a piece of jewelry that reminds you of home.
• Find out if your hotel has voice mail service. If they do, have them handle your calls.
• Check your room for things that could wake you up prematurely, such as light shining through drapes or unwanted maid service. That “Do Not Disturb” card is there for a reason, so use it!
• Don’t rely on your cell phone or wrist watch to wake you up. Ask for two wake-up calls five or ten minutes apart from each other in case the first call doesn’t wake you up or you drift back to sleep.

How to avoid jet lag

The most common environmental elements affecting sleep are noise, sleep surface, temperature or climate, and altitude. Your age and gender also play a part in determining the level of sleep disturbance caused by these factors.

One study found that women are more easily awakened than men by sonic booms and aircraft noise, while other research indicates that men may be more noise sensitive. Children are generally insensitive to extreme noise levels. However, this high threshold declines with age.

Stop the noise

The most common environmental elements affecting sleep are noise, sleep surface, temperature or climate, and altitude. Your age and gender also play a part in determining the level of sleep disturbance caused by these factors. One study found that women are more easily awakened than men by sonic booms and aircraft noise, while other research indicates that men may be more noise sensitive. Children are generally insensitive to extreme noise levels. However, this high threshold declines with age.

Noises at levels as low as 40 decibels or as high as 70 decibels generally keep us awake. Interestingly, however, the absence of a familiar noise can also disrupt sleep. City dwellers may have trouble falling asleep without the familiar sounds of traffic. Or a traveler may find it difficult to sleep without the familiar tick, tick, tick of the alarm clock at home.

Some noises, although annoying at first, can gradually be ignored, allowing sleep to follow. Studies show people can get used to noises such as city traffic in about one week. However, important noises, like a parent’s baby crying, a smoke alarm or even one’s own name being called, are not easily assimilated and generally snap us awake.

Experts are also studying the ability of certain sounds to induce sleep. “White noise,” such as caused by a fan, air conditioner, or radio static, can often block out unwanted noise and encourage sleep.

Mind your sleep surface

Little research is available and not surprisingly on how much sleeping surfaces affect our slumber. For the most part, we know people sleep better when horizontal and not cramped by space. As with noise, however, women and more mature people appear more sensitive to variations in sleep surfaces.

Find your personal temperature for good sleep

The point at which sleep is disturbed due to temperature or climate conditions varies from person to person. Generally, temperatures above 75 degrees Fahrenheit and below 54 degrees will awaken people.

Coping with jet lag

Modifying your behavior and taking sleeping pills are both commonly accepted measures used to minimize certain sleep disorders. As mentioned, certain behaviors can help your body better adjust to new time zones and surroundings. Although there are no guarantees to a fast and sound sleep, simple adjustments in your behavior when traveling may help you get the quality of rest needed to start the day refreshed.

• Sleep Aids: According to NSF’s 2002 Sleep in America  poll, 15% of the respondents reported using either a prescription sleep medication (8%) and/ or an over- the- counter (OTC) sleep aid (10%) to help them sleep at least a few nights a month. While pills do not resolve the biological imbalance caused by jet lag, they may help manage short-term insomnia brought on by travel. Be sure to discuss the use of sleeping pills with your doctor before you try them. Sleep medication can cause side effects.
• Melatonin: One OTC product receiving a lot of attention lately is melatonin. Melatonin is a naturally secreted hormone in humans that affects the body’s circadian rhythms. There is some evidence that when administered during the day, melatonin increases the tendency to sleep, but at night, the amount of sleep is unaffected. Currently, melatonin is largely available only in health food stores and is not regulated. Therefore, melatonin is, at present, an experimental approach to sleep problems and travelers should consult their physicians before using it.
• Behavioral: Modifying your behavior and taking sleeping pills are both commonly accepted measures used to minimize certain sleep disorders.

Back from a trip? How to get over jet lag

Traveling for work or pleasure can be fun and interesting, but traveling to a new time zone can result in jet lag. This condition occurs when your circadian rhythms are slow to adjust to the new time zone and remain on their original biological schedule for several days. This results in your body telling you it is time to sleep, when it’s actually the middle of the afternoon, or it makes you want to stay awake when it is late at night.
Here are some tips for minimizing the occurrence of jet lag :

• Select a flight that allows early evening arrival and stay up until 10 p.m. local time. (If you must sleep during the day, take a short nap in the early afternoon, but no longer than two hours. Set an alarm to be sure not to over sleep.)
• Avoid alcohol or caffeine at least three to four hours before bedtime. Both act as “stimulants” and prevent sleep.
• Try to get outside in the sunlight whenever possible. Daylight is a powerful stimulant for regulating the biological clock. (Staying indoors worsens jet lag.)
• Modifying your behavior can help your body cope and overcome jet lag. Melatonin is an over the counter product that can also help. Learn more about how to cope with jet lag  by creating a sleep friendly environment .

There’s something about this time of year that makes people want to hit the restart button and recharge their health and fitness. But what’s the best way to do it if you can’t even afford to buy healthy groceries?

“Healthy groceries aren’t as pricey as you might think,” says Andrea Worich, a nationally-recognized consumer and money-saving expert, who appears on Fox News, MSNBC and in many other media outlets. “A recent study from the Economic Research Center of the USDA found that the average consumer on a 2,000-calorie diet could meet all their fruit and vegetable requirements for just $2.60 per day,” she says.

Woroch offers 10 healthy ways to spring-clean your diet and learn how to fit nutritious food into your budget — no matter how small it is!

Shop in season.

Americans are blessed to have access to just about any fruit or vegetable year-round. However, it’s best from a flavor and budgetary standpoint to buy produce according to its season: Strawberries are best purchased in summer while citrus is a better winter buy. Holidays also offer better prices on produce popular for entertaining. For example, yams and sweet potatoes are always on sale in November before Thanksgiving. Look for recipes that use the current season’s fruit and vegetables to save on family meals.

Choose organic produce wisely.

Another misconception about healthy eating is that you must buy organic. However, not every fruit and vegetable you purchase needs to be organic. Coined the “clean fifteen,” produce with outer skins that you peel away like pineapple, avocado, onion and sweet corn aren’t affected by pesticides. Produce you eat directly, skin and all, is better purchased organic if your goal is to avoid chemicals.

Find freshness in the frozen aisle.

Frozen fruits and vegetables may seem like a less-healthy choice compared to fresh, but they’re actually just as nutritious and much cheaper. That’s because produce is flash frozen at peak ripeness, retaining optimal flavor and nutrients. When buying frozen produce, don’t assume brand-names are superior to lesser-cost generic or store brands; after all, frozen peas are frozen peas! If you have room in your freezer, stock up during sale time when you can purchase frozen produce for as little as $1 per bag.

Compare store sales.

While shopping in season guarantees lower prices on select fruits and vegetables, stores don’t always offer the same low prices, It’s important to compare prices among stores to ensure you’re getting the best deal. For example, a store might be selling your favorite variety of apples for $1.29 per pound, down from $1.99 per pound. However, another store might have the same variety on sale for $0.88 per pound, a far better sale price. Consult Flipp.com to access store circulars online and instantly compare store prices for specific products.

Print coupons.

Think coupons only exist for processed food? Think again. Whole Foods just released a mobile app featuring in-store deals on everything from quinoa to black beans to whole-grain bread. If you live along the East Coast and shop at an independent grocer, you’ll soon have access to dCoupon, a mobile couponing platform that offers manufacturer’s coupons via smartphone. You can even find coupons for produce: deals’ site www.CouponSherpa.com has a healthy offer discount available every week for 20% off a rotating list of fresh produce, including bananas, pears, broccoli and more.

Try the store’s organic brand.

More private label and generic brands are offering organic food at an average of 30% savings. In fact, the national grocery chain Kroger released their own brand of organic foods two years ago and has since grown to offer 35,000 items in this category. Walmart’s partnership with Wild Oats has yielded affordable options on everything from canned beans to chicken broth to fruit preserves. Ultimately, the steady flow of new organic products and companies has led to lower prices across a range of food categories, including cereals, breads, dairy, condiments and canned goods.

Look out for manager markdowns.

Lean protein and fish are among the most expensive health foods on your grocery list. The key to saving on these is to search for manager markdowns. Meats, chicken or fish nearing the sell-by date are often marked down but perfectly safe to consume. Pick up several packages then freeze what you don’t cook right away for safe consumption later on.

Plant a garden.

Why waste time and money at the grocery store when you can grow your own vegetable garden? Start small by planting just a couple of your favorite herbs like rosemary, sage or dill and study up on gardening tips for optimal conditions. Apartment dwellers don’t  have to dismiss this tip, either; vegetables like lettuce, tomatoes, summer squash, eggplant and peppers can be grown in containers on window sills.

Consider joining a CSA group.

If you enjoy cooking and are not intimidated by uncommon fruits and vegetables, consider joining a Community Supported Agriculture (CSA) group in your area. Consumers pay upfront for a membership to receive weekly boxes of fresh-grown produce, and in some cases, members help with deliveries or with small tasks on the farm. To learn more about CSAs and pricing in your community, consult LocalHarvest.org.

Buy in bulk, selectively.

While bulk shopping can help you save 30 to 40% on your grocery bill, not everything is a smart buy when it comes to health foods. For instance, bulk containers or large bags of produce may lead to food waste if you can’t finish the fruits or veggies before they spoil. Focus your warehouse purchases on non-perishable health foods like quinoa, brown rice, almond butter and olive oil. Quinoa, touted as today’s leading super food and cleanest carb to eat, has a relatively long shelf life (2 to 3 years dry) so you don’t have to worry about it going bad.