Blog Posts

Learn About Low Vision

February 10th, 2019

Do you worry about your vision? Many of us do. Vision loss is a common condition in the United States. It’s estimated that 25 million Americans are blind or visually impaired. One in 28 Americans ages 40 and older have low vision. Since low vision is so prevalent, I thought we ought to learn more about it.

First of all, let’s define low vision. It’s a significant visual impairment that can’t be corrected by any type of prescription lenses, or by medication or surgery. Low vision can make it difficult to perform your daily activities, as well as to read, use a computer, drive and watch TV. This can make you feel cut off from the world around you.

Low vision can also affect your mobility. It can interfere with your ability to get around independently. When mobility and communication are hampered, it can lead to feelings of anxiety and depression, and quality of life can be negatively affected in some people.

Eye disorders and injuries to the eye are the primary causes of low vision. These include diseases like macular degeneration, glaucoma and diabetic retinopathy, and genetic conditions like retinitis pigmentosa, as well as conditions like cataracts and traumatic brain injury, including head injuries, brain tumors and stroke.

There are a few common types of low vision. The first is the loss of central vision in which there’s a blur or blind spot in the middle of your vision, but your peripheral, or side, vision remains intact. This can occur with macular degeneration because the macula is responsible for central vision.

Low Vision Chart

  • 20/30 to 20/60, this is considered mild vision loss, or near-normal vision.

  • 20/70 to 20/160, this is considered moderate visual impairment, or moderate low vision.

  • 20/200 to 20/400, this is considered severe visual impairment, or severe low vision.

  • 20/500 to 20/1,000, this is considered profound visual impairment, or profound low vision.

  • less than 20/1,000, this is considered near-total visual impairment, or near-total blindness.

  • no light perception, this is considered total visual impairment, or total blindness.

 

Other types of low vision include loss of peripheral vision. With this, you won’t be able to distinguish anything at one or both sides, or anything directly above and/or below eye level. Loss of peripheral vision can happen with glaucoma and stroke. With blurred vision, both your near and far vision is out of focus. Cataracts can cause this.

There’s also a condition called generalized haze, when it seems like there’s a film covering everything you look at. Extreme light sensitivity is another common type of low vision. This is when regular amounts of light feel overwhelming. With night blindness, another type, you cannot see outside at night or in dimly-lit places indoors. Various eye disorders can cause these conditions.

Anyone can be affected by low vision, but it’s more common as we get older. That’s true, in part, because conditions that often cause low vision, such as macular degeneration and glaucoma, most commonly develop as people age.

Low vision is more frequently seen in people over age 45 and even more frequently seen in people over age 75. In fact, one in six adults over age 45 has low vision, and one in four adults over 75 has it.

The best way to catch and control the diseases and conditions that lead to low vision is by having regular eye exams by an eye care specialist. But if you notice any changes in your vision, contact your eye doctor right away.

Your eye doctor will perform a complete eye exam to diagnose low vision, including tests designed to check your vision and look for eye diseases. Your doctor will test your eyes for visual acuity or how well you see. He or she may use different instruments and lights when testing your vision.

If your eye doctor diagnoses low vision, he or she may refer you to a low vision specialist. A low vision specialist will help you learn new ways to use your remaining vision, modify your home and teach you how to use devices to aid your vision. Visual rehabilitation is part of this process.

Visual rehabilitation begins by recognizing the challenges of vision loss and making adjustments to maximize what vision you have left. It’s a process of learning how to do tasks, such as reading and writing, in news ways.

For example, if you have a blind spot, you may be asked to imagine the object you want to see is in the center of a large clock. You’ll be told to move your eyes along the clock numbers and note when you see the object most clearly. The doctor will tell you to use the same viewing direction when you look at other objects to see them as clearly as possible.

There are also many low vision aids that can help you see when doing your everyday activities. These includes a variety of optical magnifiers, including those that attach to your glasses, those that are handheld and those that stand on their own hands-free.

Telescopes can help you see things that are far away. They can be handheld or attached to your glasses. Non-optical aids that are available include everyday devices that talk. Some examples are watches, timers and blood sugar monitors that have an audio component.

There are also electronic devices such as video magnifies in portable and desktop formats. These devices combine a camera and a screen to make objects, like printed pages, forms and pictures, look larger.

Also helpful to those with low vision are audio books and electronic books that allow you to increase word size and contrast. The latest technology in smartphones, tablets and computers can read aloud or magnify what’s on the screen.

Low vision may be preventable in people with diabetes if they maintain healthy blood glucose levels. The best way to prevent the progression of low vision is by getting your eyes examined regularly so your doctor can catch and manage the eye disorders that can contribute to low vision. Do your eyes a favor, keep an eye on them!

Skin Tightening Technology

January 29th, 2019

If you think about it, your skin is pretty amazing. It’s your body’s largest organ, and it serves a bunch of functions. For example, it protects you from the outside elements, regulates your body temperature, and detects sensations such as heat, cold, pain and pressure. And it regenerates itself about every 27 days.

A drawback of skin, though, is it tends to wrinkle as we get older. The fine lines and wrinkles you can get on your face can make you look older than you really are or feel, and that can affect your self-confidence. There’s always BOTOX, fillers and even facelifts to get rid of the wrinkles and give you a more youthful appearance.

Now, there’s also TempSure Envi. Approved by the FDA about a year ago, TempSure Envi is becoming a staple in most dermatologists’ offices in this country. It’s a different way to reduced wrinkles and tighten up sagging skin, and it’s safe and painless.

TempSure Envi is actually an advanced version of existing technology that uses radiofrequency energy to stimulate the production of collagen in the middle layer of the skin, the dermis. Collagen is a protein fiber that, along with elastin, makes up the supporting structure of the skin.

Collagen gives skin its firmness, and there’s a natural slowdown of collagen production in the skin as we age. TempSure Envi jumpstarts this process by stimulating the cells that make collagen using heat. The new collagen then works to smooth fine lines and wrinkles, and tighten skin.

Radiofrequency energy is not new to dermatology practice, but TempSure Envi’s enhancements make using it safer and more comfortable. In the past, the use of radiofrequency energy on the face and body always came with the risk of skin burns from the heat it generated. TempSure Envi reduces this risk to almost nothing.

That’s because TempSure Envi is completely temperature controlled. It has a system built in that provides heat at a precise, therapeutic temperature consistently during treatment so it doesn’t damage the top layer of skin.

TempSure Envi’s safety controls automatically cease radiofrequency energy delivery once the selected temperature is reached. Energy delivery is resumed when the temperature falls below the selected mark.

Maintaining a precise temperature throughout treatment adds significantly to safety and enables the treatment to be performed more accurately, allowing for effective, consistent results. It also makes the treatment more comfortable for the patients. In one study, 99 percent of patients described the TempSure Envi procedure as pain free.

It takes less than an hour to get a TempSure Envi treatment, so it’s something you can have done over lunch time. There’s no downtime, so you can go back to work and your other activities immediately. You might see a little redness on your face after treatment, but that will go away pretty quickly.

From what I’ve read, you’ll likely notice some difference in your skin right away after your first treatment session, but the full results of the TempSure Envi aren’t’ seen until a few weeks later. That’s because it takes a little time for collagen production to take place and for the collagen to then tighten your skin.

TempSure Envi is effective beyond the face as well. It comes with massage heads that work to reduce the appearance of cellulite. TempSure Envi can be used to treat most areas on the body that need tightening, including your abdomen, arms, legs and buttocks.

TempSure Envi doesn’t hurt, but you can feel the radiofrequency energy at work. During a facial treatment, you’ll likely feel it as a gentle warming sensation around the area being treated. During a body treatment to reduce cellulite, you’ll feel a massaging sensation as well as the warmth.

There are a few drawbacks of TempSure Envi. For one, it takes more than one treatment session to get the full benefit. Dermatologists generally recommend three to four sessions, depending on the area treated and the goal of treatment, to achieve optimal results.

In addition, dermatologists also suggest maintenance treatments every six months to a year to keep your results intact. Of course, you don’t have to do this. It’s totally your choice, but it’s recommended for best results. Cost of the procedure varies per physician and location, but TempSure Envi can also be pricey.

Like any procedure you might be considering, take the time to weigh all the pros and cons before you decide to go with TempSure Envi. Be honest with your doctor – and yourself – about what you hope to achieve with it or any cosmetic procedure.

TempSure Envi may help make your skin look more youthful, but you still have to live a healthy life to look your very best.

Another BC Breakthrough

January 20th, 2019

A couple of months ago, we looked at some of the research being done on breast cancer and learned about some of the breast cancer breakthroughs that’ve been made. Since then, a study’s results were released regarding another potential treatment for an aggressive form of breast cancer. I thought I’d end the year with some good news about a deadly disease.

The study’s findings were reported in The New England Journal of Medicine and presented at a meeting of the European Society for Medical Oncology in Munich, Germany in October. The study looked at the effect of adding an immunotherapy drug to chemotherapy for women with advanced cases of triple-negative breast cancer.

This cancer is called “triple-negative” because it doesn’t have docking points for the hormones estrogen and progesterone, and it’s lacking human epidermal growth factor receptor 2 (HER 2). These are proteins that anti-cancer medications can latch onto to kill tumor cells.1 Without these proteins, the medications have little effect on the tumors.

About ten to twenty percent of breast cancers are triple negative. Triple-negative breast cancer is diagnosed in nearly 40,000 American women each year. It is twice as common in African-American women than in white women, and more likely to occur in younger women.

Triple-negative cancer often resists standard cancer therapies, so survival rates are poor. It’s a deadly form of breast cancer. It accounts for 30 percent to 40 percent of all invasive breast cancer deaths. The October study looked at the effectiveness of Tecentriq (atezolizumab) when taken along with the chemotherapy drug Abraxane (nab-paclitaxel).

In the past, immunotherapy alone had little effect on any form of breast cancer. It’s believed to be because breast cancer cells don’t have as many genetic abnormalities than other cancers that the immune system can recognize as foreign and attack.

Combining immunotherapy with chemotherapy, however, was found to overcome this problem. The right chemotherapy, given at the right dose, the study discovered, ignites the immune system by killing cancer cells that then leave substances behind that the immune system’s cells can detect and attack.

The results of the recent study were that the combination of Tecentriq and Abraxane made both drugs more effective in battling triple-negative breast cancer. The study showed that adding the immunotherapy drug to the chemotherapy helped lower the risk of disease progression, and of death, by 20 percent compared to treatment with chemotherapy alone, which is the standard treatment.

Researchers agree that more work is needed to study potential side effects of Tecentriq. The drug also has to be approved by the US Food and Drug Administration before it becomes widely available in this country.

If you’d like to be part of the process to study an investigational drug like Tecentriq or any new procedure or device to treat breast cancer, consider participating in a clinical trial. Clinical trials are research studies to test the safety and effectiveness of these treatments before they can become standard treatments.

There are four phases of clinical trials. After a treatments has been carefully studied in a lab, clinical trial can start. Phase 1clinical trials help determine if a treatment is safe for human use. During this phase, a small group of volunteers are monitored for side effects. Different doses of the medication are usually also tested.

Phase 2 trials concentrate on whether the treatment is effective against the cancer using the dose or method determined during phase 1. Phase 3 trials focus on whether the treatment being studied is better than the current standard treatment. If the new treatment is determined to be safer or more effective, it is sent to the FDA for approval.

Phase 4 clinical trials include long-term follow-up and monitoring to study the effects of the treatment once it’s been FDA approved. If you’d like to find out more about clinical trials on breast cancer treatments, check out these websites:

With today’s screening tools and advanced treatments, a breast cancer diagnosis isn’t a certain death sentence. But you have to be an active partner with your doctor in helping to detect the cancer early so treatment can be started when it’s most effective.

It’s your job to perform routine breast exams to feel for lumps and look for any changes in your breasts. Get regular physical breast checks from your doctor as well. Follow your doctor’s recommendations about how often to get mammograms for a closer look inside your breasts. Breast cancer is most survivable when found and treated early.

Is It Crohn’s Disease or Ulcerative Colitis?

January 14th, 2019

Both Crohn’s disease and ulcerative colitis (UC) are types of inflammatory bowel disease (IBD). Crohn’s and UC have many things in common: they both cause inflammation, swelling and sores in the lining of the digestive tract, and they’ve got many symptoms in common. Yet, they’re distinct disorders that affect different areas of the GI tract.

It’s estimated that 1.6 million Americans suffer with IBD. It occurs in men and women equally, but is more common in Caucasians than in other ethnic groups. Crohn’s and UC can occur at any age, but are most often diagnosed before age 30, especially Crohn’s, which is most common between the ages of 15 and 30.

There are a couple of factors that differentiate Crohn’s and UC. For one, Crohn’s can develop anywhere in the digestive tract, from the mouth to the rectum, while UC is confined to the large intestine (colon). In addition, Crohn’s can penetrate into the deep layers of the lining of the digestive tract, while UC stays in the top layers.

There’s another difference between Crohn’s and UC. In Crohn’s, the inflammation can “skip” portions of the intestine. It can affect two separate sections and leave areas of normal tissue in between diseased portions. UC doesn’t do that. It affects a continuous portion of the large intestine.

Both types of IBD have similar symptoms, which can be aggravated by outside factors such as diet and stress. Those factors can trigger flare-ups of Crohn’s and UC. Symptoms of these disorders include:

  • Abdominal pain
  • Cramping
  • Persistent diarrhea
  • Constipation
  • Bloody stools
  • Urgency to have bowel movements
  • Fever
  • Fatigue
  • Loss of appetite
  • Weight loss

Doctors don’t know the exact cause of Crohn’s disease and UC, but they run in families so researchers suspect genetics are a factor. Both Crohn’s and UC are disorders of the immune system, which is the body’s natural defense system. The immune system releases defensive substances in response to foreign or invading cells it detects in the body.

It’s believed that in Crohn’s and UC, something triggers the immune system to mistakenly recognize cells of the lining of the GI tract as “foreign” and attack them, causing inflammation. Inflammation comes from the Greek work for “flame”. It literally means, “to be set on fire.” That explains most of the IBD symptoms.

Because the symptoms of Crohn’s and UCs are similar, your doctor will need to use tests to diagnose which disorder you have. Proper diagnosis is critical because treatment is based on the type of IBD you have.

While Crohn’s and UC both have abdominal pain as a symptom, the pain of UC is typically found in the lower left side of the abdomen. Knowing this may help your doctor determine which set of tests to order for you, because tests differ for the diagnosis of Crohn’s and UC.

If your doctor suspects Crohn’s, he or she may order certain endoscopy tests to get a better look at your digestive tract. Endoscopy is a minor procedure during which a small instrument with a camera and light on its end is threaded through your GI tract to look for abnormalities.

For Crohn’s disease, your doctor might use an instrument that is inserted into your rectum to look at the bottom half  of your digestive system. This is a colonoscopy. Your doctor also might use a scope that is inserted into your mouth to examine the upper part of your digestive system. This is an upper endoscopy.

For UC, doctors often use a test with an instrument inserted into the rectum that examines the rectum and lower colon. This type of endoscopy is a sigmoidoscopy. Your doctor may also suggest you get a total colonoscopy, which examines the entire colon.

If you’re diagnosed with Crohn’s or UC, your doctor may prescribe certain medications. He or she may start you on a course of corticosteroids or other anti-inflammatory medicines. A medication to suppress your immune system may also be prescribed. Later, your doctor may add a biologic, such as STELARA® or ENTYVIO®, as a combination therapy.

You may be asked to keep a diary to try to uncover foods or situations, such as those that are especially stressful, that trigger flare-ups of these disorders. Once you identify your triggers, you can work to decrease or eliminate them with diet and lifestyle changes.

Medical treatments are the mainstay for Crohn’s and UC, but in severe cases, surgery may be necessary. Surgery is generally used in cases where there are complications from the disorders. These complications may include bowel perforation, excessive bleeding, development of a cancerous growth or severe, uncontrollable inflammation.

For Crohn’s, surgery may involve removing diseased sections of the digestive tract. In severe cases of UC, the surgical removal of the entire large intestine and rectum may be required.

Whatever you do, don’t self-diagnose. If you’re suffering any of the symptoms of IBD, see your doctor and let him or her diagnose Crohn’s or UC the right way!

 

Think About Your Thyroid

January 7th, 2019

Happy New Year! I hope your holidays were joyful – and safe. January is generally the time when we set our priorities for the year. Many of us make resolutions to improve our bodies on the outside, such as losing weight. But here, we’re going to take a closer look at our bodies on the inside. Today, we’re going to think about our thyroids.

The thyroid is a gland that’s part of the body’s endocrine system. It’s responsible for making and releasing a steady amount of thyroid hormones into the bloodstream. These hormones regulate metabolism, the process of breaking down the food you eat into energy. Your metabolism affects how fast your body performs its daily functions.

Thyroid hormones regulate many body processes. These include your breathing, heart rate, body weight, temperature, cholesterol level, muscle strength and even women’s menstrual cycles. It’s important that these hormones stay at a consistent level in your bloodstream.

The thyroid is shaped a little like a butterfly and sits at the base of your throat just below your voice box. It’s about two inches long and has two lobes that lie on either side of your windpipe. The lobes are connected by a small strip of tissue called an isthmus.

The main hormones produced by the thyroid are triiodothyronine or T3 and thyroxine or T4. T3 and T4 are made by special cells called follicular epithelial cells. The thyroid also makes calcitonin in its C-cells.  Calcitonin regulates the amount of calcium and phosphorus in your blood and inhibits the breakdown of your bones.

The amount of T3 and T4 in your blood is controlled by two other glands, the pituitary in the center of the skull below the brain, and the hypothalamus in the brain. The hypothalamus produces a hormone that signals the pituitary to release its thyroid stimulating hormone (TSH). TSH tells the thyroid to release more or less T3 and T4 to maintain a balance.

When there’s an imbalance, too much or too little T3 and T4 in your blood, your body reacts. Too little thyroid hormone is a condition called hypothyroidism. It occurs when your thyroid doesn’t make enough of its hormones. Too much thyroid hormone is called hyperthyroidism.

With hypothyroidism, your metabolism slows down. Common symptoms include weight gain, sluggishness, fatigue, dry skin and hair, intolerance to cold, and depression. With hyperthyroidism, your metabolism speeds up. Symptoms include irritability, racing heartbeat, muscle weakness, weight loss and sleep problems.

There are multiple causes of thyroid disorders like hypothyroidism and hyperthyroidism. Hypothyroidism may be caused by inflammation of the thyroid gland that can lower the amount of hormones produced or by a hereditary disease of the immune system called Hashimoto’s thyroiditis. An iodine deficiency can affect the production of thyroid hormone as well.3 Removal of the thyroid also gives you hypothyroidism.

Causes of hyperthyroidism include Grave’s disease, a condition in which the entire thyroid is overactive. Sometimes, just one or a few nodules inside the thyroid produce too much hormone. Too much iodine can cause some people to have too much thyroid hormone and some to have too little.

Treatment of these disorders focuses on restoring normal blood levels of the thyroid hormones. Treatment for hypothyroidism is hormone replacement with a synthetic version in pill form. Your doctor will monitor your hormone levels with periodic blood tests and adjust your dose accordingly.

Treatment for hyperthyroidism is a little trickier. To normalize hormone levels, your doctor may use medications to block hormone production or radioactive iodine to disable your thyroid. Another treatment option is removal of the thyroid. This will give you hypothyroidism, as can the radioactive iodine. Then, you’ll have to take the hormone replacement therapy.

Thyroid disorders, including hypothyroidism, are lifelong conditions. But by following your doctor’s instructions and having your hormone levels monitored regularly, you can still live a normal, healthy life.

A Letter to FCS

December 16th, 2018

Image from Rare DR - Rare Disease ReportIt took Tampa local Charles “Alvin” Middleton more than 10 years to receive an accurate diagnosis of familial chylomicronemia syndrome (FCS), a rare genetic lipid disorder that causes fat buildup in the body and often leads to unpredictable and potentially fatal attacks of pancreatitis. Alvin has been in and out of the hospital for more than a decade, and once was put into a medically induced coma for more than 40 days. His husband and family were told at the time that he had a 5% chance of survival. Alvin still suffers from daily symptoms including severe fatigue, abdominal pain and brain fog, and recently had to leave his job. His only option is to adopt a lifelong extremely restrictive low-fat diet (10-12 grams of fat per day), but even that is not often not prevent his symptoms.

Alvin decided to write a letter to his disease, looking back on his journey and voicing his frustrations as well as his hope for a treatment for this devastating disorder. There are no approved treatments available for FCS, which is why Alvin and the entire FCS community as part of a new national campaign are urging the FDA and pharma industry to approve a treatment currently in development – you can learn more via this recent press release.

Here is Alvin’s “Dear FCS” letter:

Dear FCS,

Looking back 11 years ago, I considered myself normal. Someone who had a job, hung out with friends and family, and was in relatively good health. But then our journey together started when I experienced my first symptom because of you, severe stomach pain while on a flight home to Tampa Bay. An ambulance was my welcome home vehicle as I was immediately brought to the emergency room, where I was diagnosed with acute pancreatitis. The doctor said that my case was so bad there was only a 5% chance I would survive. I didn’t know it at the time, but because of you I would eventually undergo seven surgeries, have my gallbladder and spleen removed, be in and out of the hospital with pancreatitis, and see doctors every other week. I am grateful that after a decade a young hospitalist finally figured out that you are the cause of my constant pain and frequent hospitalizations – but I am writing this letter to tell you I want nothing to do with you!

You have caused me, my husband, family and friends tremendous pain over the years. Not only have you caused a significant decline in my physical health but now I am also often emotionally and spiritually withdrawn. Life with you can be a lonely experience. I try to be strong for my friends and family, and especially my husband who has been my rock throughout this journey. You also cost me thousands of dollars that I could have used to help others and now I have accumulated $2 million in medical debt. You even tried to kill me 10 years ago, forcing me into the ICU for more than 40 days in a medically induced coma, but God had a different plan for me.

I feel like I try to please you, but nothing works. I follow the strict low-fat, no carbohydrates, and no sugars diet and exercise regularly as directed by my doctor. I take my prescribed medication. Yes, I sometimes cheat and eat food I’m not supposed to, but generally I do everything I am told — and yet you still cause me pain. Doctors who didn’t know about you would tell me I must not be maintaining the suggested diet, exercising enough, or taking care of myself. Every time I was hospitalized with severe vomiting and pain, doctors would accuse me of drinking alcohol or not following my strict diet. Sometimes I thought I was crazy or a hypochondriac, but it was all you. I was so discouraged and frustrated by many doctors’ responses that I disconnected from the conversation and gave up all hope that I would ever find the cause of my pancreatitis attacks and other symptoms.

I have known for years that something was seriously wrong with me. There have been times when I have been so fatigued from the constant pain that I just wanted to give up on life. You took away my love of gardening, cooking, socializing with my friends, being able to go someone’s house and eat without getting sick, and most recently you forced me to leave my job. You are the reason for my constant fear, anxiety and stress about my health which, combined with feeling out of control and powerless, can be overwhelming. Often, I forget that feeling terrible every day isn’t normal.

Life with you can be a lonely experience. It has ended my career and changed me forever in many ways. Despite the many challenges I’ve faced, the most rewarding experience of my journey has been meeting other FCS patients and knowing that I’m not alone. By sharing our stories with one another and how you have impacted our lives, we are encouraged and hopeful that someone is going to find a treatment to beat you. Together we are building a stronger community of support and sharing information that can help improve our quality of life and educate others who might not know about you. If one person sees my story and learns about you, then all my efforts are worthwhile.

Charles “Alvin” Middleton

Hope For Hypothyroidism

December 11th, 2018

Hypothyroidism is a big word for underactive thyroid.Hypo” means “beneath” or “below.” “Thyroidism” refers to the function of the thyroid. Hypothyroidism, then, means “beneath function” of the thyroid.

Created for the National Cancer Institute, http://www.cancer.gov

Hypothyroidism is a common condition. Estimates vary because millions of people have the disorder and don’t know it, but approximately 10 million Americans have the condition.

Look at it another way. About 4.6 percent of the population of the US ages 12 and older has hypothyroidism. Fortunately, most of those cases are mild. Still, that’s nearly five people out of every 100 people. Women are more likely than men to develop the disorder, and it’s more likely to occur in people age 60 and older.

Let’s learn a little more about hypothyroidism. We’ll start with the basics. The thyroid is an endocrine gland, which means it secretes its hormone directly into the blood instead of through a duct. The thyroid looks a little bit like a butterfly, and it sits in the lower front part of the neck. It produces and secretes thyroid hormones.

The thyroid controls metabolism, the process by which your body uses food for energy. If your thyroid hormone levels are lower than they need to be, which is the result of an underactive thyroid, that process can’t happen efficiently. Your body produces less energy, and your metabolism slows down.

When your metabolism slows, you may notice some changes in how you feel and function. Symptoms of hypothyroidism can be vague and are common to many other disorders, so you may not initially attribute them to hypothyroidism, but tell your doctor about them anyway. Symptoms to look out for include:

  • Fatigue
  • Weight gain
  • Constipation
  • Depression
  • Dry skin
  • Greater sensitivity to cold temperatures
  • Muscle and joint pain
  • Slower heart rate
  • Swelling of the thyroid gland (goiter)

If you experience any of these symptoms, your doctor will perform a complete medical history and physical exam. If your doctor suspects hypothyroidism, he or she will order blood tests to checks hormone levels. They may include tests to measure your levels of thyroid-stimulation hormone (TSH) and T4 (thyroxine).

T4 is the main hormone made by the thyroid. TSH is made by the pituitary gland, the “master gland” in the body. TSH controls when and how much T4 the thyroid produces and releases. Lower than normal T4 levels in your blood usually mean you have hypothyroidism. People can have increased TSH with normal T4. This is called subclinical, or mild, hypothyroidism.

There are many potential causes of hypothyroidism. One is an autoimmune disorder, when the immune system mistakenly thinks the thyroid gland cells are foreign invaders and attacks them. Then there aren’t enough cells remaining to make the hormones.. The most common autoimmune disorder is Hashimoto’s thyroiditis.

Other causes of hypothyroidism include radiation treatment of the thyroid or head and neck region for cancer; inflammation of the thyroid gland; certain medications including amiodarone, lithium, interferon alpha and interleukin-2; congenital defects; surgical removal of all or part of the thyroid; too much or too little iodine, which is necessary to make thyroid hormone; and damage to the pituitary gland.

Hypothyroidism can’t be cured, but in almost all cases, it can be controlled. To treat your low thyroid hormone level, your doctor will replace what your thyroid can no longer make with a synthetic hormone, generally levothyroxine. The levothyroxine pills contain a hormone exactly like the T4  your thyroid produces on its own, so your body can function normally. Your doctor will order regular blood tests to monitor your hormone levels while on the medication.

Some people with hypothyroidism continue to have symptoms while on T4 hormone replacement therapy. They may be give a preparation with the addition of another thyroid hormone called T3. There are challenges, however, to administering T3 so that it is used efficiently and provides its full benefit. A new study out of Rush University Medical Center may have this problem solved.

The study, published in the journal Thyroid in October, offers hope to the 10 to 15 percent of hypothyroidism patients who respond poorly to standard T4 hormone replacement treatment. The study looked at a metal-coordinated molecule to assist in the absorption and metabolism of thyroid hormones.

T3 is necessary to normalize  functional hormone levels in the blood. Unfortunately, T3 metabolizes very quickly, and the body often does not get its full benefits. The goal of the study was to find a way to sustain the level of T3 in the blood so patients benefitted from the additional hormone.

A new drug was studied called poly-zinc-liothyronine (PZL); liothyronine is T3. In the study, researchers successfully treated laboratory rats that had been made hypothyroid with a tablet containing PZL. PZL is a compound made of zinc bound to three L-T3 molecules. The study showed that when researchers took T3 alone, it was immediately absorbed. PZL was not.

More research needs to be conducted before PZL is ready for widespread use. Research includes safety tests in animals and clinical trials in humans. But if you’ve got hypothyroidism that’s not responding to levothyroxine, this study offers hope. You may have a new treatment for your condition in just a few years.

Prostate Cancer Prospects

December 3rd, 2018

In October, we got a glimpse of what was happening in research on breast cancer. This week, I thought I’d give you an update on what’s being studied in prostate cancer. Prostate cancer, as we learned recently, is the second most common cancer in men behind skin cancer and the second leading cancer killer in men, behind lung cancer.

Studies are ongoing as researchers look for the causes and new treatments for prostate cancer, as well as for more effective ways to detect and prevent it. Research is being done in universities and medical centers all over the world. The American Cancer Society breaks down some of the work currently underway. Here’re are a few examples.

On the genetics front, research into the link between gene changes and prostate cancer is helping scientists better understand how this cancer develops. Knowing this might help other scientists design medications that target those changes. It also might help develop tests to detect abnormal genes that can then help identify men at high risk for prostate cancer.

The use of the PSA test is also being studied. Researchers are looking at better ways to measure the total amount of PSA in your blood. They’ve suggested using newer tests that are more accurate than the PSA test. The newer tests include the phi, which combines the results of total PSA, free PSA and proPSA.

In most cases today, doctors use transrectal ultrasound (TRUS) to guide the needle during a biopsy. A newer technique making biopsies more accurate is the color Doppler ultrasound. An even newer approach being studied enhances the Doppler technique by injecting a contrast agent with microbubbles that helps improve the images.

New treatments for early-stage prostate cancer are also being studied. One is high-intensity focused ultrasound (HIFU). HIFU kills prostate cancer cells by heating them with highly focused ultrasonic beams. HIFU has been used in other countries for a while, but is just now being studied for use in the US. It’s being looked at for safety and effectiveness.

There have been some breakthroughs in prostate cancer research in the news recently, and I thought I’d share a few I found with you. These are the reported results of specific research studies recently concluded. These studies offer good news for some men with prostate cancer.

One article reported on a clinical trial on a new technique for radiation therapy. This innovative form of treatment delivers the radiation in only five treatment sessions. A typical course of radiation treatment is 37 sessions.

This clinical trial looked at the effects of stereotactic ablative radiotherapy, which is a highly targeted form of radiation therapy that uses several beams of radiation at one time. The multiple beams intersect at the tumor and deliver a high dose of radiation to the cancer. At the same time, the surrounding, healthy tissue receives only a very low dose.

Another study looked at the effectiveness of immunotherapy on an especially aggressive form of prostate cancer. Men with this form have a much worse survival rate than men with other forms of prostate cancer. Researchers found these men may respond unusually well to this type of therapy, giving them the possibility of an effective form of treatment.

The research found that men with this form of prostate cancer have specific faults in their tumors that make their DNA error prone and unstable, so their survival is half as long as other men with advanced prostate cancer. However, their unstable tumors are more likely to trigger an immune response, which makes them good candidate for immunotherapy.

More good news for men with aggressive prostate cancer, this one a non-metastatic, castrate resistant form with a quickly rising PSA level. Castrate resistant means your cancer no longer responds to the treatments to reduce testosterone, on which your cancer feeds. This form of cancer has not had an effective treatment to date.

Now, a study out of Northwestern University Medicine may have a treatment. The study showed that a medicine currently used to treat men with advanced metastatic prostate cancer significantly lowered the risk of metastasis or death when used in men with this aggressive form of prostate cancer.

The results, the researchers noted, showed several benefits for patients, including a decline in PSA levels and less need for additional anticancer treatments, which can have a negative impact on your quality of life. The lead researcher stated that more study is needed to determine if long-term survival is impacted.

These are just a few examples of the research being done to get a better understanding of prostate cancer and its treatment. If you’re a man at risk for prostate cancer or if you’ve already been diagnosed with it, take heart. Much is being done to get you through it successfully.

Pondering Prostate Cancer

November 26th, 2018

In October, we got an education on breast cancer. Now, in November, it’s time to take a look at the second most common cancer affecting American men, behind skin cancer: prostate cancer. The American Cancer Society estimates there’ll be close to 164,690 new cases of prostate cancer diagnosed in the US in 2018, and more than 29,000 deaths.

ACS also says about one man in nine will be diagnosed with prostate cancer during his lifetime, and about one in 41 will die from it. In fact, prostate cancer is the second leading cause of death in American men, trailing only lung cancer. The good news is that more than 2.9 million men in the US who’ve been diagnosed with prostate cancer at some point are still alive today.

The prostate is part of the male reproductive system. It’s a gland that produces some of the fluid in semen that nourishes and transports sperm. It also contracts and forces this fluid out through the penis during orgasm.

The prostate sits below the urinary bladder and in front of the rectum. The urethra, the tube that carries urine and semen out of the body through the penis, runs through the middle of the prostate, so the prostate also plays a role in urine control in men.

Prostate cancer begins when cells in the prostate gland start to grow out of control. If it’s diagnosed early, prostate cancer is very treatable. However, prostate cancer develops slowly, and there may be no symptoms in the early stages. Often, symptoms only become noticeable when your prostate has become large enough to affect function. Common symptoms include:

  • Frequent need to urinate, especially at night
  • Difficulty beginning or maintaining a urine stream
  • Painful urination
  • Blood in the urine
  • Painful ejaculation
  • Difficulty achieving or maintaining an erection2

On the simplest level, prostate cancer is the result of changes in the DNA of normal prostate cells. These changes can be inherited or acquired during your lifetime. We don’t know exactly what causes the acquired DNA changes, but researchers have discovered some risk factors that may contribute.

Problems can happen anytime a prostate cell divides into two new cells because when it divides, it has to copy its DNA, and that’s an opportunity for errors to occur. The more often and quickly prostate cells divide and grow, the more chances for errors. Therefore, anything that speeds up the process of dividing cells increases the likelihood cancer will develop.

Androgens, or the male hormones such as testosterone, promote prostate cell growth. A higher level of androgens in your body might contribute to an increased risk for prostate cancer in some men. Other risk factors for prostate cancer include age, diet, race (it’s more common in African American men), geography (it’s more prevalent in developed nations) and chemical exposure.

Screening is a way to look for signs of a disease before symptoms appear. There are two common screening tests for prostate cancer, the digital rectal examination (DRE) and the prostate-specific antigen (PSA) blood test. PSA is a protein excreted by the prostate that helps semen remain a fluid. An excess of this protein in the blood, however, is one of the initial signs of prostate cancer.

The ACS and other leading authorities recommend that men discus with their doctors the risks and benefits of these tests before choosing if, when and how often to have them done.

Your doctor will use these tests to help diagnose prostate cancer, along with a complete medical history and physical examination. If the test results are abnormal, your doctor may order other tests such as a biomarker test, a PCA3 test and a transrectal ultrasound. He or she may recommend a biopsy to take samples of prostate tissue to look for cancer cells under a microscope.

If your cancer is in an early stage and is only in your prostate gland, your doctor may suggest watchful waiting or active surveillance. This approach involves carefully monitoring this slow-growing cancer without beginning active treatment.

Treatment for prostate cancer may include one or a combination of surgery, radiation therapy, chemotherapy, hormonal therapy and vaccine therapy. Surgery involves removing the entire prostate gland and, if necessary, some nearby lymph nodes. Surgery can be performed using an open or laparoscopic technique.

Radiation therapy uses high-energy x-rays or particles to kill prostate cancer cells. It can be accomplished by using an external machine with its beams aimed at your prostate gland or by placing radioactive seeds directly on your prostate.

Chemotherapy uses powerful medications given by mouth or through a vein to kill cancer cells. Chemotherapy drugs pass through the entire body, so they’re a good option when your prostate cancer has spread beyond your prostate to other areas of your body.

The aim of hormonal therapy is to reduce the level of male hormones in your body or stop those hormones from affecting the prostate cancer cells. Male hormones stimulate these cancer cells to grow, so hormonal therapy uses surgery or medications to stop the testicles from making these hormones.

Unlike vaccines for viral infections, which boost your body’s immune system to fight the infection, the prostate cancer vaccine charges up the immune system to fight prostate cancer cells. The vaccine hasn’t been shown to stop prostate cancer from progressing, but it has been shown to help men with this cancer live a little longer.

There’s more good news from the American Cancer Society. Prostate cancer is very survivable. ACS put together the relative survival rates of men with prostate cancer according to the most recent data and including all stages of the cancer. The results: The five-year relative survival rate is 99 percent. The ten-year relative survival rate is 98 percent, and the 15-year relative survival rate is 96 percent.

Men, don’t wait till you’re experiencing symptoms. Talk with your doctor and see of prostate cancer screening is right for you. It might catch a cancer when it’s most treatable and survivable.

COPD Uncovered

November 20th, 2018

Someone I know and love was a smoker for most of her life. A few years ago, after a very difficult struggle, she finally quit. Unfortunately, the years of smoking had already done some damage to her lungs, and now she’s suffering from COPD. The weirdest part is she doesn’t seem to understand how she got the disorder. She doesn’t get the connection.

She should have. In the United States, the single biggest cause of COPD is cigarette smoking. In fact, about 90 percent of those who have the disorder are smokers or former smokers. Among people who smoke, 20 percent to 30 percent of them develop COPD. Smoking’s not the only cause, just the most common.

Other causes of COPD include long-term exposure to lung irritants including air pollution and breathing in chemical fumes, dust or toxic substances at home or at work. In rare cases, COPD can be caused by a genetic mutation. Some people have a defect causing a deficiency in the protein alpha-1 antitrypsin, which protects the lungs from damage.

COPD, or chronic obstructive pulmonary disease, actually refers to a group of progressive lung diseases that, over time, make it harder for you to breathe and perform your activities. The two most common diseases and those usually associated with COPD are chronic bronchitis and emphysema.

Most people who have COPD have both chronic bronchitis and emphysema, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate.

In its early stages, you may not notice the symptoms of COPD or may chalk up the changes to “getting older.” But catching COPD early is imperative to effective treatment and management, so contact your doctor if you notice any of the following symptoms:

  • Persistent coughing, especially with a lot of mucus
  • Wheezing or noisy breathing
  • Difficulty breathing or increasing shortness of breath
  • Chest tightness
  • Frequent respiratory infections
  • Fatigue
  • Bluish fingernails or lips

To diagnose COPD, your doctor will evaluate your symptoms, take your complete health and family history, perform a physical examination and review test results. The test most commonly used to diagnose COPD is spirometry, a simple test of how well your lungs work.

National Heart, Blood and lun institute

The image shows how spirometry is done. The patient takes a deep breath and blows as hard as possible into a tube connected to a spirometer. The spirometer measures the amount of air breathed out. It also measures how fast the air was blown out.

During a spirometry test, you blow air into a mouthpiece that is attached to a small machine. This machine then measures the amount of air you blow out as well as how fast you blow it. This test can find COPD in its earliest stages and can be used to determine how severe it is. Your doctor will likely use the spirometry results to guide his or her treatment planning.

Your doctor may also order other tests including a chest x-ray or chest CT or to more closely examine your lungs. These tests can also help rule out other disorders as the cause of your symptoms. Through a blood sample, an arterial blood gas test can show how well your lungs are moving oxygen into your blood and removing carbon dioxide from it.

Because every person with COPD has different degrees of chronic bronchitis and emphysema, treatment is tailored to the patient’s unique situation. Treatment is designed to ease symptoms, prevent complications and slow disease progression. It may include medications, oxygen therapy, pulmonary rehabilitation, surgery, and lifestyle changes.

Medications called bronchodilators to help relax the muscles of the airway, which opens the airway so you can breathe easier. Sometimes, glucocorticosteroids, which help reduce inflammation, are added. These medications are generally inhaled through an inhaler or nebulizer. Your doctor may also recommend you get yearly flu and pneumonia shots to reduce your risk of getting those infections, which can harm your lungs.

If your oxygen level gets low, you may be prescribed oxygen therapy to improve that and help you breathe better. With this, you inhale fresh oxygen through prongs in your nose or a mask. Pulmonary rehabilitation may include an exercise program, disease management training, nutrition advice, and counseling. The goal is to help you stay active and able to perform your daily activities.

In severe cases of COPD, surgery may be needed when other treatments have failed. Surgery may be done to remove large air sacs from the lungs or to remove damaged lung tissue. As a final resort, lung transplantation may become necessary. During a transplant, your diseased lungs are removed and replaced with healthy lungs from a donor.

Lifestyle changes can help to both manage the symptoms of COPD you already have and prevent progression of the disease. The first thing you need to do is quit smoking if you do. There are tons of resources on the internet and in your community to help you do this. Also, take steps to protect yourself from exposure to secondhand smoke and chemical fumes.

There’s no specific diet recommended for people with COPD, but a healthy diet is important for maintaining overall health and strength. For your meals, chose a variety of nutritious vegetables, fruits, grains, proteins, and dairy. Drink plenty of non-caffeinated fluids to help keep mucus on the thin side.

Ask your doctor about how much activity you should get and for suggestions for exercise that will be good for you. Maintain a healthy weight because being overweight makes your heart and lungs work harder.

The National Heart, Lung and Blood Institute estimates that 12 million American adults currently have COPD and another 12 million are undiagnosed or are developing the disease. The World Health Organization chimes in with its estimate that 210 million people worldwide have COPD. They go further to say they expect total deaths to increase more than 30 percent in the next ten years.  COPD is already the third leading cause of death in the US.

COPD has no known cure, but treatments and lifestyle changes can help you manage the disease, slow its progression, and most importantly, feel better and remain more active. If you notice any of the symptoms of COPD, don’t wait. See your doctor and get treatment started as soon as possible.

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