ANNOUNCER: Funding for HealthWeek is provided by the Howard Heinz Endowment and the Teresa and H. John Heinz III Foundation.

SHARYL ATTKISSON: Today on HealthWeek... noise. There's no escaping it. What the din may be doing to your ears, and what you can do about it.

He lives in Boston, and she lives hundreds of miles away. So what could this man do when his mother needed help?

RICHARD GILMAN: "It's very frightening all the way around. It's frightening for her and it's frightening for you as a child to see that."

SHARYL ATTKISSON: Meeting the challenge of long-distance care.

And... giddy-up! How horses are taking some people on a ride to recovery.

Hello. I'm Sharyl Attkisson. Welcome to HealthWeek.

LOW-FAT DIETS
We begin with news about eating for a healthy heart. There's no question that with all the pizza, burgers and ice cream out there, the average American diet is too high in artery-clogging fat. A lot of us are trying to resist temptation and cut down on the fat. But how low should we go?

In our Behind the Headlines segment, we look at a surprising new study provoking debate over whether drastic reductions in fat are really necessary to protect your heart. HealthWeek's Andrew Holtz has more from San Francisco.

MRS. REITERMAN: "We're having some fat-free black bean chili."

ANDREW HOLTZ: After three heart operations, Milt Reiterman, with his wife's help, is on the warpath against fat.

Along with other lifestyle changes, he's adopted a radically low-fat diet: no meat, no chicken, no nuts. Only 10% of calories from fat. He's lost more than 40 pounds.

MILT REITERMAN: I've never looked at this in terms of a weight reduction program. It's a program so that I can live better and feel better.

ANDREW HOLTZ: The force behind the program is Dr. Dean Ornish, a best selling author who preaches that radical fat restrictions help heal diseased hearts.

DEAN ORNISH, MD, UNIV OF CALIFORNIA SAN FRANCISCO: This ancient intervention could stop, and in many cases even reverse, the progression of disease.

ANDREW HOLTZ: It's not always easy sticking to a diet with only 10% fat, especially if you're going to eat out. Now the latest study on diet and cholesterol suggests going to low-fat extremes may do more harm than good.

ROBERT KNOPP, MD: The main point is that people don't have to go to all that effort.

ANDREW HOLTZ: The study's lead author, Dr. Robert Knopp, speaking this week at a meeting of the American Heart Association, says low fat is good, but too low may be unnecessary.

ROBERT KNOPP, MD, UNIV OF WASHINGTON SCHOOL OF MEDICINE: If people will simply undertake a moderate fat restriction, a moderate saturated fat restriction in their diet, they will get as much benefit as a more extreme diet.

ANDREW HOLTZ: The study in the current Journal of the American Medical Association, involved more than 400 men with high cholesterol.

One fourth of the men ate a 30% fat diet, the type recommended by most health experts. The rest were put on more restrictive diets.

The researchers found that men on the lowest fat diets fared no better in terms of weight or cholesterol than those on the 30% fat diet.

What's more, the men who ate the least fat showed changes in cholesterol and blood fats that could signal an increased risk of heart disease.

Dr. Ornish, whose program also includes meditation and exercise, rejects the study's conclusions, in part because it didn't look at whether the patients actually developed heart disease.

DEAN ORNISH, MD: I feel profoundly disturbed by the article, because I think it sends all the wrong messages to people.

ANDREW HOLTZ: One message Ornish and Knopp agree on is that for most Americans the problem is still too much fat, not too little.

SHARYL ATTKISSON: There have been a lot of stories about heart disease in the news this week, all coming from that meeting of the American Heart Association in Florida. Doctor David Meyerson of the Heart Association is here to talk about some of them.

We heard about fat and the controversy about that. What about exercise? There's some new findings in that area regarding exercise and the heart.

DAVID MEYERSON, MD, AMERICAN HEART ASSOCIATION: Well, there is no controversy that all exercise is good. But we're finding now that the frequency of activity is a little bit more important than how intense and how long you exercise. The best benefit came in men who exercised between 11 and 24 minutes each session, but if they did it four or five times a week, they had a 45 or 50 percent reduction in heart disease. So, exercise often, exercise and enjoy it. Do something happy. Do something that make

SHARYL ATTKISSON: If all you can manage is to muster up short amounts of exercise, but frequently, that's good.

DAVID MEYERSON, MD: It's wonderful.

SHARYL ATTKISSON: Okay. Another item in the news was about a cholesterol-lowering drug, and that that may help even people who are healthy and don't have high cholesterol. That seemed to imply that those of us that don't have a cholesterol problem should consider taking the drug anyway as a safety. Is that true?

DAVID MEYERSON, MD: Ten times more women die of heart disease than do of breast cancer. Half the people in our population will die of heart and blood vessel disease. So, this is really serious business. If you are at high risk, if your doctor, if you're diabetic, if you have a positive family history, if you've had heart disease, if you've had bypass, if you have a high predilection in your family for having this, do not look away from these drugs called the Statins. They're a wonderful group of medic

SHARYL ATTKISSON: Okay, for those of us who have no indicators that we are especially high risk and we're just thinking about it, is this something we should consider?

DAVID MEYERSON, MD: If you're not diabetic and have no family history and you're a young person, allow your doctor to help get you to the point whether or not you're at high risk. If you think you're at high risk, talk to your doctor. You should not be starting these medicines by yourself if you can get them or for no reason at all.

SHARYL ATTKISSON: Dr. David Meyerson, thanks so much.

DAVID MEYERSON, MD: Thanks, Sharyl.

HEALTHFUL HINTS

NANCY SNYDERMAN, MD: Hello, I'm Doctor Nancy Snyderman with this week's Healthful Hint.

Your mother probably warned you that you'd ruin your eyesight if you read in the dark. While Mom was wrong about dim light permanently hurting your vision, it is one of the things that can lead to temporary eyestrain.

Besides finding a good lamp, keep your reading material at least 12 inches away from your eyes. And take a break from reading every 20 minutes or so to give your eyes a rest.

Simply blinking keeps your eyes wet and clears away dust. Try to blink more often when you feel your eyes getting tired.

And if you want to help your eyes and beautify your home at the same time, try adding a few house plants. Plants increase the air's humidity which is good for your eyes.

You can also use warm tea made from the flowers of the Eyebright plant to banish eyestrain. You don't drink this herbal tea, but soak a towel in it and then place the towel over your eyes for ten minutes.

Finally, poor eyesight can also lead to eyestrain. So, if you have glasses, remember to wear them.

With Healthful Hints, I'm Doctor Nancy Snyderman.

HEARING LOSS

SHARYL ATTKISSON: It could be loud fireworks on the Fourth of July or a screaming crowd at a football game. All that noise could be taking a toll on your hearing without you even noticing until it's too late. You'll want to listen, as HealthWeek's Pat Anson tells what too much noise can do to your ears.

PAT ANSON: The sights and sounds of a city... San Francisco, in this case, but it could be anywhere. Wherever people go, there's bound to be noise. Noise is so pervasive, we often lose track of how much there is, and how loud it gets.

AUDIOLOGIST: "How's the level of that?

GREG HOLM: "I can't understand a word they're saying."

PAT ANSON: Over 20 million Americans suffer some degree of hearing loss. Many don't even realize they have a hearing problem.

ROBERT SWEETOW, PhD: Very common will we get somebody coming in and they'll say to us, well, I hear great, everyone around me is mumbling.

PAT ANSON: Audiologist Robert Sweetow says too many people take their hearing for granted, putting their ears through a daily obstacle course that often leads to trouble.

ROBERT SWEETOW, PhD, UNIV OF CALIFORNIA SAN FRANCISCO: You can either lose hearing because of an explosion or some kind of an acoustic trauma, a single incident. Or the more common is that you're going to lose hearing over a long period of exposure to noise.

PAT ANSON: Hearing occurs when sound waves pass through the outer and middle ear to the inner ear or cochlea.

Inside the cochlea, sound waves cause tiny hair cells to move, triggering electrical impulses to the brain.

Sudden or prolonged loud noise can damage these delicate hairs, disrupting electrical impulses and causing hearing loss.

Environmental hearing loss usually isn't noticed until we reach our fifties, but it can strike at any age.

Seventeen-year-old Willie Gregory learned that the hard way. At age 13, just a year after he started playing bass guitar in a band, Willie noticed loud music hurt his ears.

WILLIE GREGORY: We'd stop playing and it was just the ringing sometimes would be so loud that it would like drown out other noises.

PAT ANSON: Willie now has trouble hearing high frequency sounds -- the most common type of hearing loss.

WILLIE GREGORY: If someone whispers, I can hear the whisper itself, but I can't understand what they're saying.

PAT ANSON: Someone who suffers a high frequency hearing loss often has trouble hearing speech in crowded, noisy environments. It sounds a little like this. Low frequency sounds become dominant and speech distorted. Consonants are especially hard to hear.

GREG HOLM: I still hear the noise of the person speaking, I just don't understand what the word is.

PAT ANSON: As a fire fighter, Greg Holm is exposed to loud noise on almost a daily basis.

Years before hearing protection was required in the fire service, Greg would race to emergency scenes with air horns and sirens blasting in his ears.

All that noise ruined his hearing, but it took a long time for Greg to admit he had a serious problem.

GREG HOLM: It was extremely scary. I was afraid, number one, to admit that I had something wrong with me. Number two, I thought hearing loss might jeopardize my career.

PAT ANSON: Such fears often stop people from wearing a hearing aid.

ROBERT SWEETOW, PhD: There's just a stigma about aging and hearing loss is often the gold standard for aging.

PAT ANSON: Doctors are hoping much of that stigma will fade now that President Clinton has been fitted with a hearing aid.

RODNEY PERKINS, MD, STANFORD UNIV SCHOOL OF MEDICINE: The baby boomers are hitting 51, the vanguard first ones this year, and I think that this bulge in the population over the next decade will mean a lot larger numbers of hearing devices that will be dispensed.

PAT ANSON: Doctor Rodney Perkins heads the California Ear Institute, which has pioneered the development of hearing aid technology.

Perkins says high-tech digital devices will revolutionize an industry long dominated by analog hearing aids.

RODNEY PERKINS, MD: An analog device is a device that has a rather continuous wave function to it. And a digital device is one that takes that wave, breaks it up into individual bits of information and then puts those bits of information back together.

PAT ANSON: Greg Holm recently switched to a digitally programmed hearing aid.

GREG HOLM: All of a sudden, clarity improved. It just improved and it was adjustable to my hearing loss and programmed for that loss.

PAT ANSON: The downside to digital hearing aids is that they're more expensive, about $2,000 a piece, twice the cost of many analog devices.

AUDIOLOGIST: "You can understand him now?"

GREG HOLM: "Yeah."

PAT ANSON: Greg's career as a fire fighter was saved -- not ruined -- by his decision to wear a hearing aid.

CONDUCTOR: "Ready, play."

PAT ANSON: As for Willie Gregory, now he wears ear plugs to protect his hearing. He also considers himself lucky to have learned an important lesson at an early age.

WILLIE GREGORY: Music is good, and music is good loud. But if you don't have your ears to hear it, I mean music does you no good at all.

SHARYL ATTKISSON: It's better to start young, but it's never too late to take steps to protect your hearing. Audiologist Richard Israel has this advice.

RICHARD ISRAEL, PhD, AUDIOLOGIST: If you have to run a very noisy piece of equipment, if you have a very large lawn that you've got to run your tractor over, break it up. Maybe do it in 20 minute pieces, then take a break, get away from the noise, then go back rather than be in that noise on a continuous basis.

Wear ear protection. It's very inexpensive to buy ear protection. A set of ear muffs, the kind that go over your ears such as you see in the airports, they're around $10 a pair. And ear plugs maybe are 25 or 50 cents for a pair of those foam ear plugs. And they, properly used, can put off developing a hearing loss and cut down those dangerous sound levels.

SHARYL ATTKISSON: And another word of caution, watch the volume on your Walkman. You may like to crank up your music while you clean the house or exercise. But if you can't hear someone talking to you, it's probably turned up too loud.

HEALTH NOTE
Cotton balls provide little protection against noise.

LONG DISTANCE CARE
It's never easy to care for an aging parent. But it's doubly hard if your parent happens to live far away. HealthWeek's Nancy Olson shows us how one family is dealing with the demands of long-distance care.

NANCY OLSON: Seventy-four-year-old Barbara Gilman can't remember when she didn't love to paint.

BARBARA GILMAN: It's always been a mainstay for my being, and I'm not an outstanding artist by any stretch of the imagination, but I do love to do it.

ART TEACHER: "Now we're going to take some blue..."

NANCY OLSON: But there was a time, a few years back, when Barbara stopped painting. She stopped doing most everything. Her family says she became confused, disoriented and delusional.

RICHARD GILMAN: It's very frightening all the way around. It's frightening for her and it's frightening for you as a child to see that.

NANCY OLSON: Her son Richard says changes needed to be made in his mother's life. She could no longer take care of herself. She could no longer live alone.

For Richard and his family, distance makes the situation even more difficult.

DRAMA STUDENT: "What studied torments tyrant has for me..."

NANCY OLSON: He teaches drama at a college in Boston. His brother and sister live in California. And Barbara lives in the Washington D.C. area.

RICHARD GILMAN: It's very hard in any relationship to feel someone's in need and not be able to help them. That's for me one of the most desperate feelings.

NANCY OLSON: Americans are living longer, and moving more frequently, so more and more people are facing this difficult challenge of caring for someone from afar. A recent study by the National Council on Aging estimates that about 7 million Americans are caring for a parent or family member who lives at a distance. Researchers say that's about three times the number 10 years ago.

Dr. Donna Wagner authored the study, the first of its kind to look at this growing number of people like Richard known as a long distance care givers.

DONNA WAGNER, PhD, NATIONAL COUNCIL ON THE AGING: I think there's a lot of guilt that people have about living apart from their parents. If you're not living in the same community you can't just drop by and say I'm taking you to lunch, Mom, I'm doing this. You need to figure out another way to do it and it's not an easy thing to do.

GRACE LEBOW: "Boy, your writing is great."

NANCY OLSON: Enter Grace Lebow. She's a geriatric care manager, the solution many families are finding to their long distance care dilemma.

Today, she's visiting Helen Cutler, who lives in a nursing home. Sitting down with Helen's nurse, physical therapist, and dietician is a weekly routine.

DIETICIAN: "She is eating well and she's taking her supplements."

GRACE LEBOW: "Great. Does she seem to like it?"

DIETICIAN: "Oh, yes, she eats everything."

GRACE LEBOW: "Ha! Okay."

NANCY OLSON: And as the eyes and the ears of the family, she also spends time observing Helen's progress first hand.

NURSE: "Do you have any pain?"

HELEN CUTLER: "No, not really."

NURSE: "Okay."

NANCY OLSON: Once Grace makes her evaluation, she reports back to the family.

GRACE LEBOW, GERIATRIC CARE MANAGER: We get tied in with the whole family in a very emotional way. I would describe myself as a counselor, a consultant, a psychotherapist, a care manager.

NANCY OLSON: These are the skills that prompted Richard to turn to Grace and her staff when he saw his mom's condition deteriorate.

RICHARD GILMAN: We really felt there was a need to have somebody who would have a regular process of making personal contact with my mother and then could share that contact with us, so that we could have at least a weekly feeling for what was going on in her life.

NANCY OLSON: In the last year, Grace has helped Barbara feel less isolated by finding a retirement home she liked, and a doctor who was able to prescribe the right medication.

GRACE LEBOW: When I first met her, she was pretty withdrawn and into herself, it was as though there was a wall between her and anybody else. Now she's out and about, she's vital, she's vigorous.

NANCY OLSON: Barbara's children are once again receiving weekly letters from her.

RICHARD GILMAN: Her regaining her sense of self and being able to get her independence back is largely responsible for a lot of the care that she received over the past year.

BARBARA GILMAN: I know that there is somebody always that I can call on for help. We all need a kind of support from someone.

SHARYL ATTKISSON: Joining us from Boston to discuss long-distance care is Claudia Kalb, a Newsweek reporter who has covered the issue.

Help us with some practical information. Say I decide I need a qualified geriatric care manager. Is it as easy as looking in the phone book?

CLAUDIA KALB, NEWSWEEK: Well, Sharyl, it's not quite that easy, because this is still an emerging field. One of the best ways is word of mouth. You can also check social service agencies in the phone book, as well as call the National Association of Geriatric Care Managers who can help you with referrals.

SHARYL ATTKISSON: Is this an expensive service?

CLAUDIA KALB: It is expensive. The average cost is about $75 an hour, but managers can go as high as $150.

SHARYL ATTKISSON: And how many hours would one need typically?

CLAUDIA KALB: Usually in the beginning there's a large number of hours needed when crisis happens and people need help, and then it goes probably to about five or six hours a week of commitment.

SHARYL ATTKISSON: A lot of people are thinking this is a great idea, but they're having a hard enough time thinking how to pay for the long-term care period, let alone for a manager. What for people who can't afford it?

CLAUDIA KALB: There are other options. Every state has at least one area Agency on Aging. There are about 700 across the country. And if you call a national service called the Elder Care Locator, they can help you get one in your area, which will give you local referrals that are not going to be as high priced.

SHARYL ATTKISSON: And what if there's, are there things that we can do without calling in a professional if we don't think our relative is quite at the state where they need that outside help? What can we do ourselves?

CLAUDIA KALB: There are lots of things you can do. You can be very creative. I talked to one woman who lives in California who has a phone book for her mom who lives in Boston. She's then able to look for local numbers. She visited, checked out neighbors and friends, got their numbers, was able to have those in a book she carries around in California, so she's able to keep in constant contact that way.

SHARYL ATTKISSON: So is it basically just trying to keep in touch as well as you can with a long distance relative?

CLAUDIA KALB: Yes. Just being in touch. Daily phone calls seem to help very much. Also, little tips like if you're looking for clothing for your mother and you live across the country, order two catalogues. Have one sent to you, one to your mom. The two of you can do shopping over the phone.

SHARYL ATTKISSON: Good advice. Claudia Kalb from Newsweek, thanks so much.

CLAUDIA KALB: Thank you, Sharyl.

For more information on long-distance care, or any other HealthWeek story, you can call our toll-free number shown at the end of the program.

ASK THE DOCTOR

WOMAN: "I just want to ask the doctor how do you get the most amount of calcium when you're lactose intolerant and can't have all the dairy products for the osteoporosis?"

BRUCE DAN, MD: First, check with your doctor to make sure you really are lactose intolerant. That is, unable to digest lactose, the main sugar in milk. One study found that many adults who thought they were lactose intolerant could drink eight ounces of milk a day without any problems.

Some lactose-intolerant people can still stomach hard cheese or fermented dairy products such as yogurt. You could also eat special lactose-reduced dairy foods or take tablets containing an enzyme that helps you digest lactose.

And there are many sources of calcium besides dairy products. Foods that have no lactose but lots of calcium include sardines and calcium-fortified tofu.

Also high on the list are calcium-fortified orange juice, collard greens and salmon, canned with the bones.

If you're still not getting enough calcium, about 1,000 to 1,200 milligrams a day for adults, you could take calcium supplements.

Just be sure to check the label because the filler used in many calcium tablets is actually lactose. With Ask the Doctor, I'm Doctor Bruce Dan.

SHARYL ATTKISSON: If you've ever ridden a horse, you know it can be a real workout, leaving your muscles tired and sore. But for some people struggling with serious disabilities, horseback riding may also have the power to "heal." HealthWeek's Bettina Gregory has more from the horse country of northern Virginia.

HORSE THERAPY

BETTINA GREGORY: You don't expect to see a child with cerebral palsy mounting a horse...

JOANNE HART: "There you go."

BETTINA GREGORY:... but Cookie is actually part of 12-year-old Susie Dieter's therapy. Her teacher says they work on the same riding skills that any rider needs.

JOANNE HART, RIDING INSTRUCTOR: Guiding the horse around cones or around standards, making circles and turns and things so they work on actual riding skills.

BETTINA GREGORY: Riding therapy improves balance, posture, mobility and muscle tone, but one of the biggest benefits is the horse's walk mimics normal human walking.

DIANA LARSON, PHYSICAL THERAPIST: On a horse, the way you have to spread your legs and turn your knees out is exactly a pattern opposite of what cerebral palsy and a lot of these other diagnoses, their body does without them thinking about it. Their brain is sending incorrect signals. They're doing odd things with their legs. When you put them on the horse, they're turned out. They're in an exact position that allows them to relax.

BETTINA GREGORY: Susie gets much more than physical therapy from riding Cookie.

SUSIE DIETER: What I get out of it is friendship with him and enjoyment also. Because I really like to trot with him and we work as a team, so that's the way I like it.

GLENDA MOYER: "Okay, Winston, we're going to stretch."

BETTINA GREGORY: The Therapeutic Riding Program in Loudon County, Virginia is not just for kids. Now in her Thirties, Glenda Moyer suffers from multiple sclerosis. She can only ride Winston for a few minutes at a time even with frequent stops.

GLENDA MOYER: "All right, Winston. We're ready to walk on."

BETTINA GREGORY: She still loves it.

GLENDA MOYER: I was almost bed-bound when I started this program. So between the people, the horses and the physical attributes, that's all I can say. It's wonderful!

DIANA LARSON: They may have been walking in a very odd pattern for years. Now they have underneath them what a normal movement would be and thus their body can build upon that.

BETTINA GREGORY: Susie says riding has helped her to get in and out of her wheelchair more easily.

JOANNE HART: "Good job."

BETTINA GREGORY: But equally important is the boost in confidence and self-esteem these riders experience...

GLENDA MOYER: "Goodbye, Winston!"

BETTINA GREGORY:...and the loving bond that develops between horse and rider.

SHARYL ATTKISSON: And that's all for this week. Remember, you can visit us throughout the week at our site on the World Wide Web. To reach the HealthWeek home page, go to PBS ONLINE at the Internet address on your screen. That address is www.pbs.org

Next time on HealthWeek... What's the big attraction? We'll look at the positives and negatives of using magnets to treat illness. We'll also give you some practical advice on choosing a doctor and introduce you to a group of grannies who've found a fun way to "tap" into good health.

Until then, I'm Sharyl Attkisson. Be well.

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