Blog Posts

National Diabetes Awareness Month:

November 6th, 2019

Time to turn sugar highs into sugar lows.

It’s fitting that the day after the sugar high of Halloween marks the start of National Diabetes Month.

No doubt the folks who came up with the idea for a low-sugar awareness month figured this to be a good time to start keeping it real before the pumpkin pie, chocolate peppermint brownies and sugar cookies start to derail our diets. And well they should.

According to the U.S. Department of Health and Human Services, diabetes is one of the leading causes of disability and death in the United States. One in 10 Americans have diabetes — that’s more than 30 million people. And another 84 million adults in the United States are at high risk of developing type 2 diabetes.

In Florida, it is estimated that more than 2.4 million people have diabetes and more than 5.8 million have prediabetes. Diabetes is the seventh leading cause of death in Florida, according to the Florida Department of Health.

The numbers are expected to get worse as the population continues to age, with 54.9 million Americans diagnosed in 2030, according to a study by the Institute for Alternative Futures, analyzed by PsyD  Programs. That’s an increase of 38 percent from current rates.

The study estimates that 5,393,800 Floridians will have diabetes in 11 years. That’s 19.8 percent of the state’s population and puts Florida as the second-highest state in the nation for diabetes cases. The top state is expected to be West Virginia, with 20.5 percent. The three states with the lowest percentages are Utah, Alaska and Colorado, each with slightly more than 10 percent.

When broken down by metro area, Miami leads the nation with 18.8 percent of the population projected to be diabetic in 2030. The lowest metro is Minneapolis, with 11.7 percent.

“Diabetes is a very serious disease affecting millions of Americans, but it can be managed with a healthy lifestyle,” says Florida Surgeon General and Secretary Dr. Celeste Philip. “This year, I encourage you to know your risk factors for diabetes and act as a support system for those in your life who may be affected by the disease.”

There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant). Women with diabetes have more difficulty conceiving and may have poor pregnancy outcomes, so it is especially important for women to be aware of their risk factors for developing diabetes, including having a family history of diabetes as well as age, weight, and physical activity level.

The good news, especially for those with prediabetes, is that it can be prevented. A healthy diet, regular exercise and medical monitoring can go a long way toward ensuring that diabetes never gains a foothold.

Some feel smoothies are filled with sugar. It’s true for many store-bought options, but at home you’re in total control.

That’s important because adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes. Over time, high blood sugar from diabetes can damage blood vessels and the nerves that control your heart.

This year, the National Institute of Diabetes and Digestive and Kidney Diseases is emphasizing that tie-in to cardiovascular health.  Here are their tips to take control of your health:

  • Stop smoking or using other tobacco products.
  • Manage your A1C, blood pressure, and cholesterol levels.
  • Develop or maintain healthy lifestyle habits – be more physically active and learn ways to manage stress.
  • Take medicines as prescribed by your doctor.

Yes, that also includes throwing out that bag of candy corn you bought on clearance.  For more information about diabetes and what you can do to prevent, control it or support a loved one, click here.


Simple Technology for Advanced Treatment

November 4th, 2019

The image many people form when thinking of medical researchers at work is one of serious men and women using sophisticated technology to investigate treatments and cures for diseases. But in some cases, these professionals use simple, everyday devices to combat people’s disorders and manage their symptoms.

A recent study, published in Nature Biomedical Engineering on August 5, reported on a new wireless device that regulates neural circuits in the brain using a tiny implant controlled by a simple smartphone. The researchers say this device speeds up efforts to uncover various brain disorders including Parkinson’s disease, Alzheimer’s disease, addiction, depression and pain.

The wireless device enables consistent chemical and optical nerve stimulation, which targets specific brain cells. Previous methods to achieve this effect involved the use of rigid metal tubes and optical fibers to deliver the drugs and light. This method limited the subject’s movement due to the physical connections to bulky equipment. It also often led to lesions in the brain’s soft tissue over time, making that method unsuitable for long-term use.

But this new approach uses large, Lego-like replaceable drug cartridges and powerful Bluetooth-enabled low-energy. This method allows for the targeting of specific nerve cells in the brain for prolonged periods without the limits of a physical connection to equipment or the risk of brain lesions.

Controlled by a simple user interface on a smartphone, researchers using this device can easily trigger any specific combination or the precise sequence of light and drug delivery without being inside a laboratory. And because it can be used for long periods, the device may contribute to uncovering the basis of many neuropsychiatric diseases.

Last year, scientists from the Ulsan National Institute of Science and Technology in South Korea reported on advances in technology using wireless communication and portable devices for diabetes monitoring. Their study results were published in the January 2018 issue of Scientific Advances.

The researchers studied a new technology involving a smart soft contact lens capable of monitoring blood glucose levels in tear fluid, as well as other relevant physiological data in real-time. This data can then be used to facilitate disease management.

Previous attempts at using contact lenses for this purpose came under criticism because the material used was too opaque and rigid, and could potentially damage the eyes. The research team in South Korea addressed these concerns by placing the operational components around the edge of the lens away from the pupil.

The new contact lens that was developed is equipped with sensors that can detect blood glucose changes in the tears, as well as other biomarkers typically found in the blood. These biomarkers include cholesterol, sodium ion and potassium ion levels, offering additional disease monitoring possibilities.

The study researchers note that the contact lens collects tears for measuring glucose changes from those created by normal activities such as blinking. As a result, invasive collection methods, such as finger sticks to collect blood for testing, are avoided. The goal of the new technology is to increase patient compliance with regular blood glucose monitoring.

Other noninvasive methods for measuring blood glucose levels in people with diabetes are also being studied. One study is looking at a technology that measures blood glucose by placing a device near the eye. This technique uses a novel biochemical sensor embedded on a small hydrogel disk. The disk is inserted below the patient’s conjunctiva during a simple, painless procedure performed by an ophthalmologist.

The chemical in the disk reacts with blood glucose in the interstitial fluid below the conjunctiva and emits fluorescent light that is quantified by a special photometer device. This device is placed in front of the person’s eve. It can record blood glucose results in less than 20 seconds.

Another noninvasive device uses occlusion spectroscopy measurements to determine blood glucose measurements. It involves placing a ring-shaped probe around the person’s finger and applying gentle pressure. This pressure temporarily stops blood flow, and optical elements in the device’s sensor perform a sensitive measurement of the light transmitted through the finger.

In one study, measurements taken using this device were compared with measurements taken using invasive methods, and this device proved comparable. Tests showed this device to be a painless and accurate alternative to invasive methods such as finger sticks for continuous glucose monitoring in patients with diabetes.


Superheroes and Supervillains with Mental Disorders

October 30th, 2019

Whether it’s in a comic book or a movie, most everyone has seen a superhero.

Superheroes are different from the rest of us. For example: The Flash is faster than the speed of light, Superman can fly, and Spiderman can shoot webs.

People look at superheroes and see greatness and perfection. In a sense, though, superheroes are just like everyone else. They suffer from some of the same problems many people do.

One such problem is mental illness.

Take Superman, for example. The Man of Steel had to leave his home and family in a different world and learn how to fit into our world. As a result, he suffers from a condition called “Part of Two Worlds Syndrome” and will never feel as if he is truly at home.

Another superhero is Captain America. The poster boy for America could also be a poster boy for depression. He is a soldier who was frozen in the ice after World War II. When he awoke, his life changed dramatically. His family and friends were gone. Dealing with all the death and lost time changes how you see life and makes it hard to move forward.

Captain America probably fears that if he makes new connections and friends, he will lose them too. Everything he faces today is a reminder of what should have been.

Jessica Jones faces many of those same challenges as well. Before she even met The Purple Man, Zebediah Kilgrave, she lost her family in a car crash. That didn’t ruin Jessica completely, but what was left of her life was taken away by the Purple Man.

After coming into contact with experimental chemicals and spending some time in a coma, Jessica emerged with superhuman strength, enough to lift a two-ton police car with little effort, fly and block mind control.

The Purple Man used Jessica’s power to hurt her friends. He would force her to cry and watch disturbing images. The Purple Man nearly killed her friends through her. He gives off pheromones that make people around him bend to his verbal commands.

Jessica, who was known at the time as Jewel to civilians, first meets Kilgrave in a restaurant. Using his own powers, he casually asks her to give up her secret identity, which she does without hesitation and uses her powers for schemes of evil. He induces her to attack the police force outside, which she does – flipping police cruisers with reckless abandon.

Jessica endured Kilgrave’s control for eight months. That’s eight solid months of mental and emotional torture. Afterward, she was little more than a skeleton with skin and hair. A rag doll. She had no control of her own life or mind. And while she eventually escaped from her tormenter, she will never be able to break free from him totally.

The events of what happened to her haunt her in her dreams and in reality. As a result, she suffers from post-traumatic stress disorder (PTSD). Even with her superpowers, she has scars that will never heal.

The same is true of supervillains. They are people too – without a tether to reality. But in all actuality, they are not at fault for their actions, for the most part.

With villains, it is harder to figure out if they are mentally unstable, have a disorder or are just plain out bad. The majority of villains have mental illnesses, which is the main cause of what they do.

Harley Quinn was an innocent victim. She was a therapist of the one and only Joker, which led to her downfall. The Joker abused Harley, putting her through physical, emotional, and psychological pain that caused her to become the villain we all know her to be. As a result, Harley suffers from battered person syndrome and Stockholm syndrome, conditions she cannot escape from.

Two Florida Health Care News employees showing their support for Harley Quinn.

Some supers aren’t villains or heroes but they have mental illnesses as well. Deadpool is one such super. He isn’t classified as a villain or a hero, but Deadpool is the perfect example of a comic book character with psychological disorders.

Deadpool was tortured, physically and emotionally, to the point of death to activate mutant genes. The psychological state of Deadpool reads like a list of psychological disorders.

He mostly suffers from schizophrenia but he also has psychopathic tendencies and has more emotional baggage than any other superhero or villain. With the mental dilemma he faces on a daily basis, he can’t grasp reality.

Thankfully, superheroes and villains are fictional characters who are who they are in part because of these illnesses. We, on the other hand, are real. We live in this world, right now and right here, and just as it is with superheroes and villains, mental illnesses are prevalent.

Approximately one in five adults in the U.S experience mental illness of some kind within a year. But help is available and there are many types of therapies and solutions, including:

  • Psychotherapy – Psychotherapy is the therapeutic treatment of mental illness provided by a trained mental health professional.  Psychotherapy explores thoughts, feelings, and behaviors, and seeks to improve an individual’s well-being.  Psychotherapy paired with medication is the most effective way to promote recovery.  Examples include: Cognitive Behavioral Therapy, Exposure Therapy, Dialectical Behavior Therapy, etc.
  • Medication – Medication does not outright cure mental illness.  However, it may help with the management of symptoms.  Medication paired with psychotherapy is the most effective way to promote recovery.
  • Support Group – A support group is a group meeting where members guide each other towards the shared goal of recovery.  Support groups are often comprised of nonprofessionals, but peers that have suffered from similar experiences.
  • Self Help Plan – A self-help plan is a unique health plan where an individual addresses his or her condition by implementing strategies that promote wellness.  Self-help plans may involve addressing wellness, recovery, triggers or warning signs.
  •  Peer Support – Peer Support refers to receiving help from individuals who have suffered from similar experiences.

Fans of superheroes may not want to know their dark secrets. But superheroes and villains, like many of the people they save, need help. In that way, they are like regular everyday civilians.


Bad News, Good News Regard Breast Cancer

October 27th, 2019
Bad news: More Florida women getting breast cancer.
Good news: Death rate now among nation’s lowest.

When I scanned the first sentence of her Facebook post, I thought at first that it was just another attempt to raise awareness for a worthy cause that would eventually ask me to do my part in the fight by sharing the post with others.

If only it had been.

“I have breast cancer,” it said.

In the paragraphs that followed, my friend explained how she had known for a week that the two-centimeter lump she found last month was malignant. She then talked about the uncertainty, the fear and the battle ahead, and how she planned to kick cancer’s, um, rear end.

It’s an all too familiar post. In the past few months, my pastor’s wife made a similar announcement on Facebook.  Last week, a former colleague who survived breast cancer 12 years ago told me she is having another biopsy.

It’s no wonder we are seeing more of these posts. According to statewide figures from the Florida Department of Health, the breast cancer incident rate increased from 137.6 to 161.7 per 100,000 women between 2006 and 2016.

In 2016 alone, doctors diagnosed 16,721 new cases of breast cancer among women.  Last year, 2,955 women died from breast cancer. That translates to a death rate of 18.5 per 100,000 women.

In 2018, Glades County topped the list with a death rate of 41.9 per 100,000 people, though deaths totaled five. Other counties with high rates included Holmes, Walton, Franklin, Wakulla, Dixie, Gilchrist, Lafayette, Marion, Citrus, Pasco, Nassau, Brevard, Okeechobee and Hendry. Counties reporting the lowest rates were Calhoun, Liberty and Washington, all of which reported no deaths.

Nationally, the good news is that Florida is among the states with the lowest death rates. After peaking in 1999 and 2000 at 24.4 deaths per 100,000, the rate has decreased, with 19.7 in 2016, according to the latest figures from the Centers for Disease Control and Prevention.

Though researchers at the Mayo Clinic in Jacksonville say a vaccine could be available in eight years, the best ways to prevent breast cancer right now is to adopt a healthy lifestyle and get regular screenings to ensure early detection.

So, we’ll continue to wear our pink, participate in three-day walks, and support our friends who make those heartbreaking social media announcements as much as we possibly can.

We’ll also perform regular self exams and screening mammograms as soon as they’re due. No procrastination. Taking care of ourselves is critical, especially if we are taking care of others. Thankfully, we have help in that endeavor.

To make sure every woman is able to get a screening, the Florida Breast and Cervical Cancer Early Detection Program provides free or low-cost mammograms to women who are residents of Florida, 50-64 with no insurance and low income. To see if you qualify, call your county Health Department.


EVALI: A New-Age Killer

October 21st, 2019

In its weekly report released October 11, the US Centers for Disease Control and Prevention (CDC) announced that as of October 15, 2019, 1,479 cases of lung injury associated with the use of e-cigarettes, or vaping, were reported in 49 states, the District of Columbia and the US Virgin Islands. In addition, Thirty-three deaths have been confirmed in 24 states, with more deaths under investigation.

The CDC also announced it gave the mysterious illness a name: EVALI, which stands for “e-cigarette or vaping product use associated lung injury.” The CDC is working closely with the Food and Drug Administration (FDA) as well as state and local health departments to identify patients with EVALI and determine the specific chemical exposure or exposures that led to it.

If you’re not familiar with vaping, it’s the term for using electronic, or e-cigarettes. E-cigarettes work by heating a liquid to produce an aerosol users inhale into their lungs. The liquid can contain nicotine, tetrahydrocannabinol (THC) or cannabinoid (CBD) oils, as well as cutting agents, diluents and other additives. THC is the psychoactive component of marijuana that produces the “high.”

There is a common misperception in this country that vaping is less harmful than smoking. But this recent outbreak of EVALI and the deaths associated with it have triggered an intense debate. So just how popular is vaping? Here are a few facts about the practice in America, according to a July 2019 Gallup poll:

• Nearly one in five 18- to 29-year-olds reports vaping regularly, more than twice the national average.
• Americans with a household income of more than $100,000 per year (5%) are about half as likely to use e-cigarettes as those earning less than $40,000 per year (9%).
• E-cigarette use is lower among those with higher levels of education: College graduates (3%) are three times less likely to vape than those without a college degree (10%).

Most of the patients who suffer with EVALI report a history of using THC-containing products, suggesting THC may be connected to the illness, but research has yet to confirm a clear link. Still, the CDC and FDA recommend people not use e-cigarettes or vaping products that contain THC, especially those obtained off the street or through other illicit sources.

Symptoms of EVALI reported by some patients in the current outbreak include cough, shortness of breath and chest pain. Other patients experienced symptoms such as nausea, vomiting, abdominal pain, diarrhea, fatigue, fever and weight loss. Some patients report their symptoms developed over a few days, but others say their symptoms developed over several weeks.

A study reported in the New England Journal of Medicine earlier in October shed some light on the damage EVALI does to the lungs. Researchers looked at biopsies of 17 patients with the vaping-related lung injury and discovered inflammation suggestive of an inhaled toxic substance. They found the lungs and airways of those patients were damaged in ways similar to those exposed to chemical spills or harmful gasses. The study didn’t suggest what type of chemicals may have caused the damage, however.

Photo courtesy of Sarah Johnson. though most patients with EVALI, as many as 87 percent, have reported using products containing THC, nicotine users aren’t safe, either. Exclusive use of products containing nicotine has been reported by some patients with EVALI, and many people reported combined use of products with THC and nicotine. This suggests nicotine products may play a role in the development of EVALI.

As it stands, the CDC and FDA don’t know for certain what causes EVALI. The only commonality among the EVALI cases in the most recent outbreak is that patients report using e-cigarettes or vaping products. This outbreak may have more than one cause, and the specific chemical or chemicals associated with it are still unknown.

But the CDC has some recommendations for the public to protect itself from EVALI. For one, they suggest people stop using e-cigarettes and vaping, products that contain THC, and they should not use any of these products bought off the street.

The CDC also warns people against modifying or adding any substance to e-cigarettes or vaping products that are not intended by the manufacturer. This includes any products they buy at retail stores. Because they don’t know the role of nicotine, the CDC recommends people refrain from using e-cigarettes and vaping products that contain nicotine.

If you have a problem and can’t stop vaping, there are resources on the national, state and local level to help you quit. Be sure to choose evidence-based treatment options, such as health care provider counseling and FDA-approved medications to help you quit.

If you’ve used e-cigarettes and have symptoms of EVALI, it’s best to visit your health care provider right away. You can also call your local poison control center at 1-800-222-1222.


Arthritis: Not Just a Seniors’ Disease

October 2nd, 2019

It’s probably pretty common for people to equate the term arthritis with osteoarthritis, the wear-and-tear form of arthritis that’s common in adults as we get older. But that’s just one type of arthritis. There are many more, including types that specifically affect children. In general terms, that group of disorders is referred to as childhood arthritis or juvenile arthritis.

The most common type of juvenile arthritis is juvenile idiopathic arthritis or JIA. JIA affects approximately one in 1,000 children under age 16 in the United State or about 300,000 children. JIA is an autoimmune disorder, where the body’s own immune system attacks the joints’ cells and tissues, specifically the synovium, the tissue lining the inside of the joints.

In response to the immune system attack, the synovium makes more fluid than needed inside the joints, and that excess fluid leads to swelling, pain and stiffness. This inflammation can eventually damage cartilage and bone, causing joint dysfunction. Without appropriate treatment, JIA can affect a child’s overall growth and development. JIA can also affect a child’s eyes.

There are several subtypes that fall under the JIA heading. They all involve chronic or long-lasting joint inflammation. To be considered chronic, the inflammation must have been affecting  the joints for more than six weeks. The three main subtypes are characterized by their symptoms and number of joints involved.

Systemic JIA. This type affects about ten percent of children with JIA. It generally begins with a high fever that can be accompanied by a rash. This type may cause inflammation of internal organs such as the heart, liver, spleen and lymph nodes as well as the joints. It affects boys and girls equally and rarely affects the eyes.

Oligoarticular JIA. This types involves fewer than five joints in its first stages, most often the knee, ankle and wrist joints. It affects about 50 percent of children with arthritis, and it’s more common in girls than in boys. It may spread to involve more joints, and it can also cause inflammation of the eyes. Many children outgrow this type by adulthood.

Polyarticulat JIA. About 30 percent of children with JIA have this type. It affects five or more joints, often the same joints on both sides of the body. This type can affect the neck and jaw joints, as well as the small joints of the hands and feet. It can begin at any age and is more common in girls than in boys.

Symptoms vary depending on the type of JIA the child has, but there are some common symptoms, including:

  • Joint stiffness, especially in the morning or after resting
  • Pain or tenderness in the joints
  • Joint swelling
  • Limping
  • Persistent fever
  • Rash
  • Fatigue or reduced activity level
  • Eye redness, eye pain or blurred vision

The exact cause of JIA is unknown. Researchers believe that some children possess certain genes that make them more susceptible to developing the disease, then exposure to something in the environment, such as a virus, triggers the disease to begin. It’s not hereditary, however. It’s rare for more than one child in a family to develop JIA.

Early diagnosis and treatment are key to controlling inflammation, preventing joint damage and keeping the child as healthy and functional as possible. There is no one test for JIA. Doctors diagnose the condition using a variety of methods. They generally begin their assessments by taking a thorough medical history of the patient and performing a full physical examination.

Doctors may also order certain tests. These may include laboratory tests on blood, joint and tissue fluids to rule out other conditions as the cause of the symptoms. X-rays may be taken as well to look for any injuries or unusual development of the bones of the joints.

The goal of treatment for JIA is to reduce swelling, relieve pain, prevent damage and maintain function of the joints. There is typically a team of health care professionals involved in the child’s treatment, including physical and occupational therapists, dietitians, social workers and even school nurses working in concert with the child’s doctor.

Because JIA is an autoimmune disorder, medication is often used in its treatment. If only a few joints are involved, doctors may begin by injecting steroids directly into the affected joints to reduce inflammation and relieve pain. Another option is adding a group of medications called disease modifying drugs or DMARDS.

DMARDS may be used when many joints are involved or when the JIA doesn’t respond to the steroids. DMARDS include drugs such as methotrexate and the more recently developed biologics such as Enbrel, Remicade and Humira. These medications cause side effects and children taking them must be monitored closely.

Physical and occupational therapy also play a role in the treatment of JIA. Physical therapy exercises are important because they help in recovering and preserving range of motion and function of the joints. They also maintain muscle tone, and strong muscles aid smooth joint movement. Occupational therapy shows the child how to perform daily activities with limited joint function.

It’s clear that arthritis is not just for seniors. Many children struggle with painful, swollen and inflamed joints as well. If you know a child struggling with arthritis, be understanding and supportive. Help them if they ask for it, but for the most part, allow them to perform activities on their own. With treatment, children with arthritis can live normal, healthy lives.

Advances, Retreats in the Cancer Battle

September 25th, 2019

At the end of May, the latest Annual Report to the Nation on the Status of Cancer was released, and it offered some encouraging news. The report included cancer statistics from the years 1999 through 2016, the most recent year statistics are available. The report was created by a consortium of the country’s top cancer organizations.

The updated annual report noted that US cancer death rates continued to fall during those years. It stated that overall, cancer death rates decreased 1.8 percent per year in men and 1.4 percent per year in women. This decrease continued am an ongoing trend in declining cancer death rates.

The report also noted that the rate of new cancer cases among men consistently fell between 2011 and 2015, decreasing two percent per year. This is good news after the rate of new cases increased between 1999 and 2008. The rate of new cancer cases in women, however, remained stable from 2011 to 2015.

In addition, the Annual Report to the Nation described progress in the battle against two major cancers, lung cancer and melanoma. Lung cancer gains were attributed to increasing declines in smoking. The reason cited for the improved success against melanoma was the development of new and better treatments for it.

There was some negative news in that report, however. It stated that cancers related to obesity, such as colon cancer, breast cancer in older women and uterine cancer, are on the rise. This should strike a chord in those of us who are struggling with excess weight.

The report also found that the incidence of cancer in women ages 20 to 49 rose an average of 1.3 percent per year. And cancer deaths in this age group were higher for women than for men. Apparently, we’re failing to get the cancer prevention message to these women.  Fortunately, their cancer death rates declined by about 1.7 percent per year from 1999 to 2016.

The American Cancer Society has its own annual report called Cancer Facts & Figures 2019. This report is a companion piece to Cancer Statistics 2019, a scientific paper that was published in January in the American Cancer Society’s CA: A Cancer Journal for Clinicians. In these publications, the Society estimates the numbers of new cancer cases and deaths in 2019.

According to Cancer Facts & Figures 2019, more than 1.7 million new cancer cases are predicted to be diagnosed in the United States in 2019, and approximately 606,880 Americans are expected to die of cancer this year. The number of new cases is the same as last year, but the number of deaths expected in 2019 is slightly lower, down from 609,640 estimated for 2018.

Cancer is the second leading cause of death among children ages 1 to 14 years, second only to accidents. Cancer Facts & Figures 2019 estimates that 11,060 new cases of cancer will be diagnosed in American children ages birth through 14 in 2019, and 1,190 deaths are predicted to occur. The report notes that childhood cancers have increased by 0.6 percent per year since 1975.

Tobacco use remains the most preventable cause of death in the US, despite declines in cigarette smoking. Cancer Facts & Figures 2019 reports that cigarette smoking among American adults ages 18 and older decreased from 42 percent in 1965  to 14 percent in 2017. Among high school students in the US, smoking decreased from 29 percent in 1999 to 8 percent in 2017.

Still, about 30 percent of all cancer deaths are caused by smoking. Cigarette smoking increases the risk of at least 12 types of cancer and may be a factor in two others. Secondhand smoke is also a risk factor for the development of some cancers. In 2014, 5,840 nonsmoking adults in the US were diagnosed with lung cancer as a result of inhaling secondhand smoke.

Most cancers have risk factors. Some are non-controllable, such as age, gender and family history. Other risk factors are controllable, such as smoking, being overweight and having a sedentary lifestyle.

You can reduce your risk of many cancers by modifying your controllable risk factors. This includes stopping smoking, eating a healthy diet, getting regular physical activity and maintaining a healthy weight.

In addition, follow your doctor’s recommendations for getting routine tests and screenings for various cancers. In many cases, uncovering cancer in its early stages means catching it when it’s most treatable and, in some cases, curable.

Gaming: Medical Disorder or Not?

September 15th, 2019

There’s no debate about it. Internet and video games are popular in this country. A Pew survey found that 97 percent of teen boys and 83 percent of teen girls play games on some type of device. And it’s not just kids. A research study estimates that about 160 million American adults play internet-based games.

It’s definitely easy to get caught up in the games, but is playing too much a disease or addiction? That question is up for debate.

In May  2019, the World Health Organization (WHO) officially recognized gaming addiction as a disease. Last year, the organization agreed to include gaming disorder, which includes internet and video gaming, as a condition in its International Classification of Diseases (ICD) 11th Edition.

The ICD serves as the international standard for diagnosing and treating health conditions. It’s used by health care professionals across the globe. The WHO based its decision to include gaming disorder in the ICD on available research and a consensus among a group of international experts in the field.

The ICD describes people with gaming disorder as having a “pattern of gaming behavior characterized by impaired control,” that also involves prioritizing gaming over other daily responsibilities, including school, work and social appointments. If you ignore activities necessary to maintaining good physical and emotional health, you’ve got a problem.

In the US, health care professionals follow the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). That’s the bible for American mental health practitioners.

The DSM-5, published in 2013, doesn’t recognize gaming disorder as a condition, but it did list internet gaming disorder in a section recommending conditions for further research. The DSM-5  notes that internet gaming must cause “significant impairment or distress” in several aspects of a person’s life. It proposes a set of symptoms that includes:

  • Preoccupation with gaming
  • Withdrawal symptoms when gaming is taken away or not available
  • The need to spend more time gaming to satisfy the urge
  • Giving up other activities, loss of interest in activities previously enjoyed
  • Having jeopardized or lost a job or relationship due to gaming
  • Inability to reduce gaming or unsuccessful attempts to quit
  • Deceiving others about the amount of time spent gaming
  • Using gaming to relieve negative moods, such as guilt or hopelessness

According to the DSM-5, a person must have five or more of these symptoms within a year to be diagnosed with internet gaming disorder.

But not all experts agree that gaming, internet or otherwise, should be considered a disorder. Some argue that gaming can’t be separated out from general screen overuse, which includes social media use as well. Others suggest that intense gaming is a symptom of another disorder such as anxiety, depression or ADHD.

There’s research to back that up. One study found that children who had problems with video games were more likely to also have a diagnosis of ADHD or autism spectrum. Those who struggled with social media use often also struggled with depression or anxiety.

One group of specialists recommends referring to problems with gaming as a habit rather than a disorder or addiction. They explain that people feel more empowered to change the behavior of a habit.

These specialists also argue that labeling someone an “addict” and saying they have a chronic disease can have lasting consequences on that person’s life and self-esteem. This is especially true for teens who are in the process of forming their identities.

Whatever you call it, overdoing it on the games to the point of ignoring everything else is not okay. If that’s you and you can’t stop, seek a qualified professional’s help to reduce your urge to play and modify your behavior. Don’t be afraid and don’t wait. Get your life back now!

A Bit About Bleeding Disorders

September 10th, 2019

Normally, if you cut yourself, your body rushes to form a blood clot at the site of the injury to staunch the bleeding. Clots are mostly made of platelets, a type of blood cell, and protein clotting factors that work together to form a fibrin “plug” around the injured area. But if you have a bleeding disorder, this clotting process doesn’t work like it’s supposed to.

Without proper clotting, people with bleeding disorders can bleed excessively. The problem might be too few or abnormal platelets, or low quantities of clotting proteins in the blood. There are different types of bleeding disorders. The most recognized is hemophilia, but the most common is a condition called von Willebrand disease. Both of these disorders occur when the blood lacks certain clotting factors.

The majority of bleeding disorders are inherited, although there are types that form later in life if your body’s immune system rebels against the natural clotting factors. Since there’s a genetic factor involved in most of these disorders, people with a family history of bleeding disorders are at greater risk for having a bleeding disorder themselves.

Some bleeding disorders occur as the result of a medical condition. These include liver disease, a low red blood cell count, a Vitamin K deficiency and as a side effect of certain medications. Medications that interfere with blood clotting are called anticoagulants or blood thinners. Anticoagulants are often used to thin blood to reduce the risk of heart attack and stroke.

While there are different bleeding disorders, they have many symptoms in common. Here are some of the things to look out for. If you notice any of these symptoms, see your doctor for a thorough evaluation. Common symptoms of bleeding disorders include:

  • Easy bruising
  • Bleeding gums
  • Heavy bleeding from small cuts
  • Unexplained nosebleeds
  • Excessive bleeding following surgery or a dental procedure
  • Excessive bleeding during your menstrual periods

While hemophilia is a well-known bleeding disorder, it’s actually rare. It affects approximately one in 10,000 people. The US Centers for Disease Control and Prevention estimate there are 20,000 people with hemophilia in the US. All races and ethnic groups are affected by it. There is currently no cure for hemophilia, but there are effective treatments.

Hemophilia has two classifications, type A and type B, based on which clotting factor is deficient. With type A hemophilia, clotting factor VIII is lacking, and with type B, it’s clotting factor IX. Blood will not clot properly without these clotting factors. Hemophilia type A is the more common type. It’s about four times as common as type B.

Von Willebrand disease (VWD) is caused by a deficient or defective blood clotting protein called von Willebrand factor. VWD is quite common. It affects up to one percent of the US population, which means about 3.2 million people, or one in every 100 Americans, have the disease.

There are several types of VWD. It’s most commonly divided into type 1, type 2 and type 3. Type 1, which is the mildest form, accounts for 70 percent of all cases of the disorder. VWD occurs equally in men and women, although women are more likely to notice symptoms because they may bleed more heavily during their menstrual periods or after childbirth.

In cases of  type 1 VWD, there are lower than normal levels of von Willebrand factor in your blood. With this type, you likely will also have low levels of clotting factor VIII. With type 2 VWD, you have normal levels of von Willebrand factor, but it doesn’t work properly.

People who have type 3 VWD, the most severe form, have extremely low levels or no von Willebrand factor in their blood. They also have low levels of clotting factor VIII. Type 3 VWD is very rare. Only three percent of people with VWD have this type.

VWD is almost always inherited through a mutation to the gene responsible for its development. However, it’s also possible for the gene to spontaneously mutate, so you can get the disease without having a family history of it. You can also get VWD if your immune system overreacts and destroys the von Willebrand factor in your blood.

Treatment for VWD depends on the type and severity. For some mild cases, no treatment may be needed. For other cases, common treatments include desmopressin acetate injections. Desmopressin acetate is a medicine that makes the body release more von Willebrand factor into the blood. It also helps increase the level of factor VIII in the blood.

Another treatment for VWD is factor replacement therapy. During this therapy, medicines rich in von Willebrand factor and factor VIII are injected to replace the missing clotting factors in your blood. This treatment is typically reserved for people with more severe cases of the disease.

Antifibrinolytic drugs, which slow the breakdown of blood clots, and birth control pills, which increase levels of von Willebrand factor and factor VIII, and reduce menstrual blood loss, are other options for treating VWD.

In addition to von Willebrand factor, factor VIII and factor IX, there are many other clotting factors in the blood. Deficiencies in those clotting factors can lead to other, more rare bleeding disorders. Some of these rare disorders have only been discovered during the past 40 years, as more is learned about clotting factors and the blood clotting process.

OTC Considerations

September 3rd, 2019

By now, you know about the drug crisis facing this nation associated with opioid painkillers. You know opioids are overused, and they can lead to abuse, addiction and even death. Maybe you’ve decided to treat your pain, whether it’s a tension headache or back pain, with over-the-counter pain medicines instead. After all, they’re safer, right?pills

Well, not entirely. While OTC pain medicines don’t generally lead to addiction and death, they do have serious risks if you take too much or take them for too long. And that’s actually become a problem. A study by a Boston University School of Health researcher found that Americans are also abusing OTC pain medications, often exceeding the recommended daily dosage.

A problem noted by the Boston University researcher is that OTC pain medications are taken without a physician’s supervision. Drug makers provide directions on product labels, but, in reality, patients choose their dosage. And most have little knowledge of dosing limits and the dangers of exceeding those limits.

When taken as directed, most OTC medications are safe. However, this is not the case for every person, especially when they combine a medicine with other OTC drugs or prescription medications. OTC pain medicines, like any medication, also have risks and side effects.

Acetaminophen, which is found in drugs like Tylenol, Excedrin and Midol, is a common OTC medicine used to treat pain and discomfort. However, acetaminophen can damage liver cells and is, in fact, responsible for 50 percent of acute liver failure cases in the US. It’s also the leading reason for calls to poison control centers and is responsible for 50,000 ER visits each year.

The sneaky thing about acetaminophen is that it’s found in a variety of products, including those for allergies, colds, flu, coughs and insomnia, so you can easily take more than intended. If you’re taking more than one medicine, be sure to check the labels. Don’t take more than 3,000 mg of acetaminophen in one 24-hour period. That’s the maximum recommended by the FDA.

There are other OTC pain relievers called nonsteroidal anti-inflammatory drugs, or NSAIDs, that aren’t so hard on the liver. NSAIDs relieve pain by decreasing inflammation in the target area. They do this by inhibiting two enzymes, COX-1 and COX-2, which produce prostaglandins. Those are hormones that create inflammation, which is responsible for many types of pain.

The problems is prostaglandins also do some good. They protect the lining of the stomach and intestines. When there’s fewer prostaglandins, there’s less protection for the stomach lining, and you can develop stomach problems, including ulcers. NSAIDs also make it harder for your blood to clot, which can make ulcers worse.

OTC NSAIDs include Advil and Motrin. These products contain ibuprofen, which is found in many cold and flu remedies, so you have to pay attention to what you’re taking. The maximum daily dose of these medications is 1200 mg, although it’s strongly recommended this not be taken daily. Naproxen, such as Aleve, is another NSAID that can be bought over the counter.

All of these NSAIDS can cause problems when taken in excess or over long periods of time. These side effects include high blood pressure, damage to the kidneys, ringing in the ears, and an increased risk for heart attack and stroke.

The risk for heart problems is further delineated in a 2016 study published in the British Medical Journal that found the use of NSAIDs was associated with a 20 percent higher risk of being hospitalized with heart failure. Ibuprofen and naproxen were among the NSAIDs called out in that study.

For many of us, OTC pain relievers are a godsend. But we shouldn’t take them lightly just because we can buy them in a store without a doctor’s prescription. They’re still medications and should be taken with caution. Always follow the directions on the package label and your doctor’s recommendations.

In general, don’t take OTC pain medicines for longer than 10 days. If you’re pain persists, see your doctor. He or she can discuss alternatives for managing your pain. These might include courses of heat and ice, physical therapy, steroid injections, radiofrequency ablation, which involves heating up the nerves and destroying their ability to send pain signals to the brain, or even medical marijuana.

You don’t have to be in pain, just take pain medication wisely. It’s smart for your overall health.

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