Blog Posts

Arthritis: Not Just a Seniors’ Disease

July 12th, 2021

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 in which the body’s own immune system attacks a joint’s cells and tissues, specifically the synovium, the tissue lining the inside of the joint.

In response to the immune system attack, the synovium makes more fluid than needed inside the joint, 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 umbrella. 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 10 to 20 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 is the most common type of arthritis in kids and teens. It 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 is more common in girls than in boys. It may spread to involve more joints and can also cause inflammation of the eyes. Many children outgrow this type by adulthood.

Polyarticular 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 general 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 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 teaches the child ways 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.

Close Up On Cleft and Craniofacial Disorders

July 5th, 2021

July is National Cleft and Craniofacial Disorders Awareness and Prevention Month. This observation was established to educate Americans about the cleft and craniofacial conditions that affect more than 600,000 people in the US.

Cleft and craniofacial disorders are a diverse group of abnormalities in the growth and development of the head and face. Most of these disorders develop during pregnancy and are present at birth.

There are multiple variations of cleft and craniofacial disorders, and they can be mild, moderate or severe. They often affect the physical appearance of the child, but can also impact important functions, including eating, hearing and seeing.

The exact cause of these disorders is unknown. Most physicians believe there is no single cause but multiple factors contribute to their development. These factors include a combination of genes; environmental factors, such as viruses and exposure to dangerous chemicals in the workplace; and a deficiency of the B vitamin folic acid during pregnancy.

The most common of the cleft and craniofacial disorders are cleft lip and cleft palate. These conditions are the most common birth defects in the US. It’s estimated that 2,650 babies are born with a cleft palate each year in the US, and 4,440 are born with a cleft lip with or without a cleft palate.

A cleft lip is a separation of the two sides of the lip. It can range in severity from a small split in the lip to a large opening that goes from the lip up through the nose. A cleft palate is an opening in the roof of the mouth. These disorders occur because the two sides did not fuse during development. The lip and palate develop separately, so children can have a cleft lip, cleft palate or both.

Certain risk factors have been identified that may make you more likely to have a baby with a cleft lip or cleft palate. These include family history; exposure to certain substances during pregnancy, such as cigarettes, alcohol or certain medications; having diabetes; and being obese during pregnancy.

Cleft lip and cleft palate, also called orofacial clefts, are generally diagnosed at birth through a visual assessment and physical examination. In many cases, these defects can be diagnosed during pregnancy using ultrasound. Cleft lip and cleft palate are typically treated with surgery to restore the child’s appearance and function.

Affecting one in every 3.500 to 4,000 births, hemifacial microsomia is the second most common cleft and craniofacial disorder after cleft lip and cleft palate. With hemifacial microsomia, one side of the face is underdeveloped and does not grow properly. Most often, this condition affects the jaw, mouth and ear.

Common signs of hemifacial microsomia include facial asymmetry; reduced size of facial muscles; abnormalities of the outer ear; narrowed jaw or absence of half of the jaw; abnormalities in shape or number of the teeth, or significant delay in the development of the teeth; cleft lip and/or cleft palate; and extremely small eyes.

The cause of hemifacial microsomia is unknown. It is believed that vascular problems in the first trimester of pregnancy result in poor blood flow to the baby’s face during development. Treatment often involves surgery to treat your child’s various facial abnormalities. Speech therapy may also be required.

The spaces between a baby’s skull bones, called sutures, are filled with a flexible material that allow the skull to grow as the baby’s brain grows. A craniofacial anomaly called craniosynostosis results when the sutures close and the skull bones fuse too early. If the brain doesn’t have enough room to grow to its full size, pressure builds up in the skull as well.

Craniosynostosis is common. It occurs in one out of 2,200 live births and affects males slightly more often than females.

The first sign of craniosynostosis is an unusually shaped skull. Other signs include no “soft spot” on the baby’s head, a raised firm edge where the sutures closed and the slow growth or no growth of the baby’s head over time.

Your baby’s doctor can generally diagnose craniosynostosis on a physical exam but may order a CT scan to get a closer look at your baby’s brain as well as the sutures to determine whether or not they are fully closed.

The cause of craniosynostosis is unknown, but most researchers believe it is the result of a combination of genetic and environmental factors. Treatment often involves surgery to relieve the pressure on the brain, correct the deformities of the craniosynostosis and allow the brain to grow properly. In some mild cases, surgery may not be needed. Medical therapies can be used to help mold the skull into a more normal shape.

While most cleft and craniofacial disorders cannot be prevented, you can reduce your risk by quitting smoking, not drinking alcohol while you’re pregnant, maintaining a healthy weight during pregnancy and taking prenatal vitamins containing plenty of folic acid.

Migraine Matters

June 28th, 2021

If you’ve ever had one, you know that a migraine can be a real pain. It’s usually a severe, pulsing pain that concentrates on one side of your head. It gets worse when you do anything physical, but you can barely manage any of your usual everyday activities, either. As the pain intensifies, your eyes start to ache, as well.

Sometimes, the pain makes you sick to your stomach, and you might even throw up. For me, it’s sound I can’t stand, but many people get really sensitive to light. You just want to hide in a dark, quiet room and not come out till it’s over, which could be hours – or days.

A migraine is not just a bad headache. Rather, it’s a disabling neurological disease with different symptoms and different treatment approaches compared to other headache disorders. It’s also a very common condition, affecting 39 million men, women and children in the US and 1 billion worldwide.

Everyone experiences migraine differently. Some people who suffer with migraine, about 30 percent, develop symptoms several hours to up to three days before the headache starts. This stage is called a prodrome. Common symptoms of this stage include anxiety, mood changes, tiredness, increased thirst, food cravings, and neck stiffness and pain.

About 25 to 30 percent of migraine sufferers experience a “warning sign” that a migraine is about to begin called an aura. An aura is typically a disturbance of the senses, such as seeing black dots, wavy lines, flashes of light or objects that aren’t there; experiencing tingling or numbness in your arms and legs; or changes in small, taste or touch.

The exact cause of migraine is unknown, but it’s believed that a migraine starts when overactive nerve cells send out signals that trigger the nerve that provides sensation to your head and face. This in turn causes your body to release chemicals that make your blood vessels swell. Those chemicals cause inflammation and pain..

There are certain risk factors for migraine, including gender; migraine is more common in women. It often starts in people between the ages of 10 and 40, but many women find their migraines get better or go away after age 50. Migraine also runs in families and is more common in people who also have depression, anxiety, bipolar disorder or epilepsy.

The cause of migraine may be unclear, but it is known that certain factors trigger an episode. Many sufferers know their riggers, but some common migraine triggers include: hormonal changes; stress; certain foods, including aged cheese, chocolate and alcohol; caffeine; changes in weather; physical activity; loud noises, bright lights and strong smells; and changes in your sleep, such as getting too much or not enough.

To diagnose migraine, your doctor will conduct a thorough review of your medical history. Your doctor will ask you to describe your symptoms and pain, and how often you get migraines. You will be asked about the activities you were doing that may have brought on the headache and what medications you took to relieve the migraine pain.

Your doctor will also perform a physical examination. Imaging of the brain with an MRI and CT scan or performing a brain wave test (encephalogram [EEG]) isn’t necessary if your physical exam is normal.

Migraine treatment focuses on two therapy strategies, abortive and prophylactic. Abortive simply means stopping or shortening a headache once it has started. Prophylactic means preventing headaches from occurring in the first place. Treatment usually revolves around avoiding triggers, controlling symptoms and taking medications.

There are many different medications, both nonprescription and prescription, that can be used for treating migraines once they have started and for prevention. These medications range from over-the-counter analgesics that contain aspirin and caffeine, often an initial abortive therapy, to antidepressants and anticonvulsants, which have been shown to help prevent migraines when used regularly.

Those who suffer with chronic migraine, who have at least 15 headache days a month, may benefit from BOTOX injections. Doctors believe BOTOX blocks the chemicals that carry pain signals from the brain. It stops the signals before they get to the nerve endings around your face and neck. Alternative routes such as acupuncture and meditation are also treatment options you can try.

Whatever you do to deal with your pain, don’t go it alone. Work closely with your headache specialist to develop a migraine action plan to address those factors that affect you most. Identify your triggers and learn what works best for you when a migraine starts and what you can do to keep headaches from coming back.

Keep control of your migraines and live a happier, healthier life!

Sounding Off On Scoliosis

June 19th, 2021

Scoliosis is a condition that causes the spine to curve sideways and look like an “S” or “C.” Scoliosis curves can occur anywhere on the spine, but most often develop in the spine’s thoracic, or middle, section. In most cases, scoliosis is diagnosed during adolescence, during the growth spurt just before puberty.

Scoliosis affects 2 to 3 percent of the US population, or an estimated six to nine million people. And approximately three million new cases are diagnosed each year.

Scoliosis can develop in infants and young children but primarily affects pre-teens and teens ages 10 to 15. Initially, scoliosis affects boys and girls equally, but girls are eight times more likely to have spinal curves that worsen to the point of requiring treatment.

The most common type of scoliosis is idiopathic scoliosis. “Idiopathic” means the exact cause is unknown. Idiopathic scoliosis accounts for 80 percent of all diagnosed scoliosis cases. While the exact cause of idiopathic scoliosis is not known, research suggests that genetics may play a role in some cases. Approximately 30 percent of adolescents with idiopathic scoliosis have a family history of the condition.

Other types of scoliosis include congenital scoliosis, when problems with the spine form while a baby is developing in the womb, and neuromuscular scoliosis, when medical conditions that affect nerves and muscles, such as muscular dystrophy, cerebral palsy and spina bifida, lead to spinal deformities. Degenerative scoliosis is the result of wear and tear on the discs and joints of the spine and is the most common type of scoliosis affecting adults.

Your child may have scoliosis if his or her: shoulders are uneven (one or both shoulder blades sticks out), head is not centered above the pelvis, one hip looks higher than the other, rib cage sticks out when bending forward, arms hang differently beside the body and entire body leans to one side. About 23 percent of people with idiopathic scoliosis complain of back pain.

In many cases, scoliosis is initially detected during a screening at school or during your child’s annual pediatric check-up. If the screening causes concern, the doctor will perform a full physical exam and get an x-ray of your child’s spine. The doctor may order a CT or MRI scan to get more detailed information about the spine, as well as the muscles, nerves and other structures surrounding it.

The doctor will examine your child with a tool called a scoliometer, which measures the angle of trunk rotation. The spinal curve is typically assessed using a system called the Cobb Method and is diagnosed in terms of severity by number of degrees. Scoliosis is generally diagnosed when the curve is greater than 10 degrees.

Treatment for scoliosis includes observation, bracing and surgery. If your child’s curve is mild, less than 25 degrees, or if your child is almost done growing, the doctor may recommend monitoring the curve to make sure it doesn’t progress. If the curve is under observation, your child will return to the doctor every four to six months for check-ups and follow-up x-rays .

If the curve is between 25 and 45 degrees and your child has not reached skeletal maturity, the doctor may recommend bracing. A brace cannot straighten an existing curve, but it can help prevent the curve from progressing. Large studies show that braces, when used with full compliance, successfully stop curve progression in about 80 percent of children with scoliosis. Braces may need to be worn 16 to 23 hours every day until growth stops.

Surgery may be recommended if your child’s spinal curve is greater than 45 to 50 degrees or if bracing did not stop the curve from progressing. Severe spinal curves may limit space in the chest cavity and interfere with heart and lung function.

The standard surgical procedure for scoliosis is spinal fusion. During this procedure, the surgeon realigns and straightens the spine using rods attached by hooks, screws or wire. The surgeon also places small pieces of bone, called bone grafts, between the affected spinal vertebrae to allow the bones to fuse into one solid unit.

The rods hold the bones in place while they fuse together over time. Only the curved vertebrae are fused. Your child’s remaining vertebrae continue to move freely and assist the body with motion. A large percentage of patients benefit from surgery, but there’s no guarantee it will halt curve progression in every individual.

Your child’s doctor may recommend physical therapy and exercise, which can’t stop scoliosis but can strengthen muscles and improve overall health and wellbeing.

If your child is having difficulty coping with scoliosis, consider joining a support group. Support groups connect you with other parents and kids facing the same challenges. These individuals can provide helpful advice based on their experiences that you can apply to your own situation.

Alzheimer’s and the Brain

June 14th, 2021

The terms “Alzheimer’s disease” and “dementia” are often used interchangeably, but they’re not the same thing. Dementia is a broad term for a group of conditions that negatively affect memory, thinking and behavior. Alzheimer’s disease, or AD, is a progressive type of dementia. According to the Alzheimer’s Association, AD accounts for 60 to 80 percent of dementia cases.

Most of the time, people are diagnosed with AD after age 65, but it can appear in younger people as well. In those cases, it’s called early-onset Alzheimer’s disease. Research has linked early-onset AD to poorer executive and visual/spacial functioning. Early-onset AD is generally diagnosed in people in their 40s and 50s.

In the US, an estimated 5.5 million people have AD. Of those, approximately 5.3 million are 65 years old or older and 200,000 are younger than 65 and have early-onset AD. About two-thirds of Americans with AD, or 3.6 million people, are women ages 65 and older. Two million are men.

The National Institute on Aging reports that the number of Americans with AD doubles
every five years beyond the age of 65. By 2050, the number of people with AD is expected to top 16 million and cost the US as much as $1.4 trillion! AD is the sixth leading cause of death in the US and the fifth leading cause of death for those ages 65 and older.

Generally, the first symptom in people with AD is a loss of memory that can affect daily functioning. You might forget recently learned information, as well as important dates or events. You may begin asking the same questions over and over and relying more heavily on notes or family members to remember how to perform everyday tasks, such as using the microwave.

Other symptoms of Alzheimer’s disease include: difficulty with problem-solving, trouble with speech or writing, disorientation about times or places, decreased or poor judgement, decreased personal hygiene, changes in mood and personality, inability to recognize loved ones, and withdrawal from family, friends and community.

The exact cause of AD is unknown, but age, family history and genetics are believed to play a role in its development. One specific gene, apolipoprotein E, or APOE, has been linked to the onset of AD symptoms in older adults. But keep in mind that you can have this gene and not develop AD, and you can develop AD even if you don’t have this gene.

AD is a degenerative disease that interferes with memory and thinking. It also impairs and eventually destroys brain cells, causing certain changes to your brain. AD can only be definitively diagnosed after you die and doctors can look for these changes in your brain during an autopsy.

With AD, fragments of a protein called beta amyloid form irregular clumps called plaques that interrupt communication between nerve cells in the brain. It’s uncertain whether these plaques cause AD or result from the disease process. It is known that mutations to the precursor protein that forms beta amyloid plaque cause early-onset AD.

Another change with AD involves a protein in brain tissue called tau. Tau stabilizes the microtubules, which are a key part of a brain cell’s structure. In a brain with AD, strands of tau become tangled and interfere with the transportation of nutrients into the brain’s cells. Without nutrients, the cells die.

Memory and thinking depend on the transmission of signals across 100 billion nerve cells in the brain. AD interferes with this transmission of information by affecting the activity of the neurotransmitters, chemicals that assist in carrying the messages from one nerve cell to the next. With AD, these messages become distorted or lost, which impairs your ability to learn, remember and communicate.

AD also affects the microglia, the cells responsible for immune activity in your central nervous system: your brain and spinal cord. With AD, the microglia see the beta amyloid plaques as an injury to the brain and initiate an immune response. This response leads to inflammation that further damages the brain.

Beyond those changes, advanced AD shrinks the surface layer of the cerebrum, the largest part of your brain. This change wreaks havoc on your ability to plan ahead, recall information and concentrate. AD also affects the hippocampus, which plays a role in learning and memory. AD causes this part of your brain to shrivel, impairing your ability to create new memories.

All of these brain changes can be visualized on autopsy.

Doctors make a diagnosis of AD in living people based on multiple factors, including an extensive medical history; a thorough physical exam; tests of memory, problem-solving, attention, counting and language skills; and standard medical tests such as blood and urine tests to identify other possible causes for your symptoms.

Your doctor may also use imaging tests such as MRI, CT and PET scans. These tests can help rule out disorders such as tumors, stroke, Parkinson’s disease and a non-Alzheimer’s dementia, such as vascular dementia. These conditions are treatable, and some of their effects may be reversible.

Treatment cannot strop AD from progressing, but it can temporarily slow down the worsening of symptoms and improve quality of life. AD is typically treated with medication. For mild to moderate AD, medications called cholinesterase inhibitors are most often prescribed.

Cholinesterase inhibitors prevent the breakdown of acetylcholine, a brain chemical believed to play a key role in memory and thinking. These medications include Razadyne®, Exelon® and Aricept®. Unfortunately, as AD progresses, the brain produces less and less acetylcholine, so cholinesterase inhibitors may eventually lose their effectiveness.

Namenda®, an N-methyl D-aspartate (NMDA) agonist, is generally used to treat moderate to severe AD. Namenda is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. The FDA has also approved Namzaric®, a combination of Namenda and Aricept, for the treatment of moderate to severe AD.

Living a healthy lifestyle can help you preserve your brain health. Exercise regularly, eat a balanced diet rich in fruits and vegetables, maintain a healthy body weight, stop smoking and manage your blood pressure and cholesterol at healthy levels. Keep your mind active. Spend quality time with your family and friends, get involved with your community and get help for depression. And if you notice symptoms of AD, see your doctor right away.

Lifting the Veil on PTSD

June 6th, 2021

Post-traumatic stress disorder, or PTSD, is a mental health disorder that can develop after you experience or witness a traumatic or terrifying event. The triggering event may be a natural disaster, serious accident, terrorist act, wartime combat, sexual or physical assault, domestic abuse, even the sudden, unexpected death of a loved one.

While the event is happening, you may believe your life or the life of someone you love is in imminent danger.

Whenever we’re confronted by a traumatic situation, our bodies initiate the “fight or flight” stress response. Our heart rate, blood pressure and breathing increases to prepare us to defend against danger or avoid it. Most people return to normal function once the threat is gone. But if you continue to feel stressed when you’re no longer in danger, you may have PTSD.

Most people who experience a traumatic event don’t develop PTSD, but a small percentage do. According to the National Alliance on Mental Illness (NAMI), PTSD affects 3.6 percent of the adult population in the US – about 9 million individuals.

PTSD is more common in women than men. About 10 of every 100 women (10 percent) develop PTSD sometime in their lives compared to about 4 of every 100 men (4 percent). Why? Women are more likely to experience sexual assault and are more likely to blame themselves for a traumatic event than men.

But PTSD affects children and teens as well. Studies show that about 15 to 43 percent of girls and 14 to 43 percent of boys go through at least one trauma. Of those children and teens who’ve experienced a trauma, 3 to 15 percent of girls and 1 to 6 percent of boys develop PTSD.

Symptoms of PTSD most often begin within three months of the event, but sometimes, they don’t appear until years later. The diagnosis of PTSD should be made by a qualified mental health professional using the criteria set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

According to the DSM-5, to be diagnosed with PTSD, you must have been exposed to death or threatened death, serious injury or sexual violence either directly, through witnessing it, by it happening to a loved one, or during your professional duties.

You must also experience one or more intrusion symptoms, one or more avoidance symptoms, two or more symptoms that affect mood and thinking, and two or more arousal and reactivity symptoms for more than one month.

Intrusion symptoms include nightmares and flashbacks. In addition, you may have vivid, unpleasant memories of the event or feel intense distress when you think about the event. Avoidance symptoms including refusing to discuss the event and avoiding situations that remind you of the event. Arousal and reactivity symptoms include difficulty sleeping, irritability, angry outbursts, being easily startled, and feeling tense and anxious.

Symptoms that affect mood and thinking include an inability to remember key details of the event, feelings of guilt and anger, feeling detached from others and emotionally and mentally numb, having a reduced interest in things you used to enjoy, difficulty concentrating, and experiencing other mental health disorders such as depression and anxiety.

You may experience physical symptoms as well that are not listed in the DSM-5. These include sweating, shaking, headaches, dizziness, upset stomach, various aches and pains, and chest pain. Your immune system is weakened by the stress of PTSD, so you may experience more frequent infections as well. And problems sleeping can cause tiredness that can impair your daily functioning.

Symptoms that are common in children ages 6 and younger include bedwetting after being toilet trained, not being able to speak, acting out the event during play and being clinging with an adult. Children between the ages of 5 and 12 may experience flashbacks. They may have difficulty remembering parts of the event or remember it in a different order. They may have nightmares and be irritable.

Children between the ages of 12 and 18 may display disruptive or disrespectful, impulsive or aggressive behavior. They may feel guilty for not behaving differently during the event and may think about getting revenge for what happened.

The goal of treatment for PTSD is trifold: It aims to reduce the emotional and physical symptoms of PTSD, improve your daily functioning and help you better cope with your triggering event. PTSD treatment generally involves medication, psychotherapy or both. It’s important that you seek treatment from a mental health provider who is experienced in treating PTSD.

Physicians often prescribe antidepressant medications to treat PTSD. Two antidepressants are FDA-approved to treat PTSD: sertraline (Zoloft) and paroxetine (Paxil). These medications are selective serotonin reuptake inhibitors (SSRIs). SSRIs block the resorption of the neurotransmitter serotonin, which stabilizes your mood, feelings of happiness and wellbeing.

Psychotherapy, also called “talk therapy,” is a staple of PTSD treatment. During psychotherapy, the therapist helps you understand your disorder and work through your fears associated with the traumatic event. Psychotherapy teaches skills for managing your symptoms and coping with your disorder. Psychotherapy may be conducted one-on-one, with the family or in a group setting.

Living a healthy lifestyle can also help you cope with your PTSD symptoms, so eat a healthy diet, exercise regularly, get enough sleep and avoid situations that increase stress or anxiety. Also, consider joining a support group. Sharing your feelings with others who understand where you’re coming from can help you feel less alone and isolated.

Recovery from PTSD is a continual process. Generally, symptoms don’t disappear completely, but treatment can help you learn how to manage them more effectively. Often, treatment can result in fewer and less intense symptoms, leading to a better quality of life.

Honing in On Hepatits

May 31st, 2021

May is Hepatitis Awareness Month. Hepatitis is an inflammatory condition of the liver, and when your liver is inflamed, its ability to function can be compromised. Hepatitis is most commonly caused by a viral infection, although there are other causes as well. We’re concentrating on viral hepatitis in this blog.

There are five known types of viral hepatitis classified as hepatitis A, B, C, D and E. In the US, the most frequently diagnosed, affecting an estimated 4.4 million Americans, are hepatitis A, B and C.

Each of these conditions is caused by a different virus: the hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis A. B and C have similar symptoms but are spread in different ways and can affect the liver differently.

The most common symptoms of hepatitis include: dark urine, yellowing of the skin or whites of the eyes (jaundice), clay-colored stool, low-grade fever, loss of appetite, fatigue and aching joints. You may also feel sick to your stomach or have stomach pain. If you experience any or a combination of these symptoms, contact your doctor right away.

To diagnose hepatitis, your doctor will perform a physical exam and review of your symptoms. The doctor will use blood tests to check for the presence of the virus and may also use liver function tests to see how your liver is working, an abdominal ultrasound to look for liver damage or enlargement, or a liver biopsy to sample any abnormal areas of your liver and study them under a microscope.

Hepatitis A is usually a short-term illness that doesn’t lead to a chronic, or long-lasting, infection. The hepatitis A virus is found in the stool and blood of people who are infected. Hepatitis A, which is highly contagious, is commonly spread by eating contaminated food or drink. It can also be spread through close personal contact with someone who is infected, such as during oral-anal sex.

There is no cure for hepatitis A. Treatment typically consists of rest, adequate nutrition and fluids. In rare cases, people with hepatitis A require hospitalization. This type of hepatitis normally resolves within 2 months without having any long-term effects, and you will have lifelong immunity afterward.

Hepatitis B is spread through contact with body fluids such as blood, vaginal secretions and semen containing HBV. Your risk for getting hepatitis B increases if you inject drugs or if you have sex or share razors with someone who has it.

Some people with hepatitis B, particularly those who get infected as adults, are able to clear the virus from their bodies without treatment. For others, short-term hepatitis B progresses into a chronic, lifelong infection that over time can result in serious health problems such as liver damage, cirrhosis, liver cancer and even death.

When treatment for hepatitis B is needed, there are several medications currently available and others in development. However, people who start hepatitis B treatment may need to take medication indefinitely because these medications do not lead to a cure.

Hepatitis C is one of the most common causes of liver disease in the US and used to be the number one reason for liver transplants. The infection is chronic in 75 to 85 percent of people who have it, and 1 to 5 percent experience life-threatening complications, such as liver failure.

Hepatitis C is spread by coming into contact with the blood of a person who is infected with HCV. This can happen if you share drug injection equipment; have sex with someone who is infected; or share personal items such as razors, nail clippers or toothbrushes with an infected person. In addition, about 6 percent of infants born to infected mothers will get hepatitis C.

Treatment is recommended for all people including children three years of age and older and pregnant women with hepatitis C. Currently, treatment involves taking medication for a course of eight to 12 weeks. The cure rate with this therapy is more than 90 percent with few side effects.

To help prevent hepatitis, there are vaccines against hepatitis A and B, but there is no vaccine currently available for hepatitis C.

The Allergy-Asthma Connection

May 24th, 2021

It’s springtime and the trees and flowers are in full bloom. And with that comes an increase in pollen, which can wreak havoc on anyone suffering with allergies. But for some people, the same pollens that triggers an allergic reaction also causes asthma symptoms. This condition is called allergy-induced asthma or allergic asthma.

May is Allergy and Asthma Awareness Month. In this blog, we’ll review the two conditions and explore the connection between them.

An allergy is an overreaction by your immune system to some substance that you inhaled, ate or touched – called an allergen. Allergies can cause a variety of symptoms, depending on how you encountered the allergen, but may include: runny nose, itching, sneezing, congestion, wheezing, shortness of breath, hives, swollen face or tongue, tingly mouth, and swollen throat or lips.

Your immune system responds to an allergen by producing Immunoglobulin E (IgE) antibodies. With IgE antibodies present, any subsequent exposure to the allergen results in an allergic reaction. And when that occurs, your immune system produces histamines, chemicals that expel the allergen from the body and cause the familiar allergy symptoms such as runny nose, sneezing and itching.

Asthma involves inflammation and swelling of the bronchial tubes that carry air to the lungs. In addition, the cells that line the airway in people with asthma produce more mucus, which is thicker than normal, making breathing more difficult. Common symptoms of asthma include: persistent cough, shortness of breath, wheezing and chest tightness, pain or pressure.

It’s estimated that more than 25 million people in the US have asthma, and allergic asthma is the most common type, affecting approximately 60 percent of all people with asthma. With allergic asthma, the same allergens that cause your allergies cause your asthma symptoms. These include pollen, dust mites, pet dander, mold spores and certain foods.

Exactly how the allergic reaction leads to the development of allergic asthma is still being studied. It’s currently believed that IgE and the histamines initiate an inflammatory response in the body, and high levels of these substances, which are present during an allergic reaction, contribute to the inflammation and swelling of the bronchial tubes, triggering asthma symptoms.

Diagnosing allergic asthma generally begins with determining what allergens cause your allergic reactions. A skin prick test is the common way to check for allergies. During this test, your doctor places a small amount of an allergen just under your skin and waits to see if red bumps develop. The red bumps indicate an allergic reaction.

Other tests may be used to diagnose asthma. They include spirometry, which measures the amount of air you inhale and exhale; peak flow test, which measures air pressure as you breathe out; and lung function test, which can show if your breathing improves after you take a certain medication. If your breathing improves, it’s likely you have asthma.

The treatment for allergic asthma can involve treating the allergies, asthma or both. Treating allergies generally includes using antihistamines to deal with the runny nose, sneezing and itching. In more severe cases, immunotherapy may be recommended. Immunotherapy involves getting repeated shots of small amounts of an allergen to build up your tolerance to it.

Asthma is typically treated with inhaled or oral anti-inflammatory medications that help block the allergic response. You may be prescribed a fast-acting inhaler to treat symptoms when they occur or a daily-use inhaler for mild, persistent symptoms. If your asthma symptoms are more severe, your doctor may prescribe an oral medication to use with your inhalers.

There are a few treatments that help with both conditions. One is called a leukotriene modifier, and an example is Montelukast. A daily pill, Montelukast can ease both allergy and asthma symptoms by helping to control immune system chemicals released during an allergic reaction.

Anti-IgE therapy is another treatment that helps with both allergies and asthma. With this therapy, a medication called omalizumab is used. Omalizumab interferes with the function of IgE in the body, helping to prevent the allergic reaction that triggers asthma symptoms.

The most important step you can take to combat allergic asthma symptoms is to avoid the allergens that trigger allergic reactions. Here are a few tips from the American College of Allergy, Asthma and Immunology:

• If pollen is your problem, keep windows closed and avoid going outside when pollen counts are high.

• To reduce mold, use bathroom fans and clean up any standing water immediately. Scrub any visible mold from surfaces with soap and water, and dry completely.

• Ward off dust mites and mold by keeping the humidity in your home below 50 percent and cleaning gutters regularly, Do not use vaporizers or humidifiers.

• Remove pet allergens by vacuuming frequently and cleaning upholstery, including washing your pet’s bed, Keep your pet out of your bedroom to limit symptoms at night.

A Look at Lupus

May 17th, 2021

Lupus is a chronic autoimmune disease in which your body’s immune system, which fights infection from germs such as bacteria and viruses, becomes overactive and attacks normal, healthy tissue instead. It is a complicated disorder that affects different people in different ways. Due to its complex nature, people sometimes call lupus the “disease of 1,000 faces.

There are different types of lupus including systemic lupus erythematosus, or SLE, which is the most common type, SLE causes inflammation of the connective tissues, such as cartilage and the lining of blood vessels, but can involve many organs and systems as well. These include the skin, joints, kidneys, lungs, central nervous system and blood-forming system.

Cutaneous lupus is a form of lupus that is limited to the skin. Drug-induced lupus is a lupus-like disease caused by an overreaction to certain medications, including some drugs used to treat high blood pressure, arrhythmia and tuberculosis. Symptoms typically go away once you stop taking the medication.

Most pregnant women with lupus will have healthy babies. However, around 1 percent of women with autoantibodies related to lupus will have a baby with neonatal lupus. Autoantibodies are immune system proteins that target and react to your own organs and tissues by mistake. Most problems associated with neonatal lupus resolve within six months, but the most serious complication, congenital heart block, requires a pacemaker.

The exact cause of lupus is unclear, but it is more common in people with a family history of the disease. Researchers think it may develop in response to certain hormones, such as estrogen. The fact that nine out of 10 people with lupus are women seems to support that theory, but more research is needed. Most experts believe that lupus is caused by a combination of genetic, hormonal and environmental factors.

Lupus can cause inflammation and pain in many parts of the body and often damages the skin, joints, kidneys, blood, heart and lungs. Because it affects so many areas of the body, lupus can cause a wide range of symptoms.

Common signs and symptoms of lupus include: fatigue; pain or swelling in your joints; swelling in your hands, feet or around your eyes; fever; sensitivity to sunlight or fluorescent light; and chest pain with deep breathing. If your skin and hair are involved, you may have a butterfly-shaped rash on your cheeks and nose, called a malar rash; hair loss; sores in your mouth or nose; and Reynaud’s disease, the discoloration of your fingers and toes in response to stress or cold.

Diagnosing lupus can be challenging because other disorders have similar symptoms. Your doctor will begin with an in-depth medical history and physical examination. There is no single test that can determine if you have lupus, but your doctor may start with blood tests, which can show how your immune system is working and if there’s inflammation in your body. The most useful blood tests look for the autoantibodies that are present in people with lupus.

Urine tests may also be used to see if there’re any problems with your kidneys, and a biopsy may be taken of your skin or kidneys to see if they are damaged, which can be caused by lupus.

Your doctor will look at the entire picture — medical history, symptoms and test results — to determine if you have lupus.

There are potential complications associated with lupus. These include inflammation of the heart (myocarditis and endocarditis) or the membrane that surrounds it (pericarditis). Endocarditis can damage the heart valves and cause heart murmurs. The kidneys can also become inflamed (nephritis), making then unable to effectively rid the body of waste products and toxins.

If you have lupus, you are at high risk for diabetes and pleuritis, an inflammation of the chest cavity lining. You may also be susceptible to pneumonia. Autoimmune disorders such as lupus can contribute to inflammation of the spinal cord (transverse myelitis) and blood vessels (vasculitis). It also increases your risk for atherosclerosis, which contributes to heart attack.

Currently, there is no cure for lupus, but people who have the disease can generally manage their symptoms with treatment, which includes medication. Medications can reduce pain and swelling, regulate immune system activity, balance hormones and reduce or prevent joint and organ damage.

Several types of medications are used to treat lupus. Nonsteroidal anti-inflammatory drugs (NSAIDS) decrease inflammation and are often used to treat joint or chest pain, fever and swelling. Corticosteroids act like the hormone cortisol to help regulate blood pressure and the immune system. Cortisol is also a powerful anti-inflammatory.

Antimalarial medications are often prescribed to treat skin rashes, mouth sores and joint pain. Immunosuppressants are used to control inflammation and an overactive immune system. They are especially useful when corticosteroids have failed to bring symptoms under control. Other drugs are used as well, and clinical trials are ongoing that are studying even more treatments.

The medication therapies that are currently available make it possible for people with lupus to effectively manage their symptoms and live active, healthy lives. Researchers hope that through their work, they’ll be able to identify lupus at an earlier stage, so complications can be prevented before they occur.

Improving Employee Health

May 10th, 2021

In 1979, the President’s Council on Physical Fitness, Sports and Nutrition founded the National Association for Health and Fitness, which in turn created Global Employee Health and Fitness Month. The aim of this annual observance in May is to promote the benefits of a healthy lifestyle to employers and their employees through worksite health promotion activities and environments.

Almost half of all US worksites provide health promotion activities through some type of employee wellness program, an initiative within the organization that fosters healthy lifestyles among its employees. Employee wellness programs vary in the types of services and activities offered, but in the long run, they all appear to benefit the employees – and the employers.

What’s included in a company’s employee wellness program generally depends on the size of the organization, its budget for wellness initiatives and which activities make the most sense for its employee population. The most successful programs address multiple dimensions of employee wellbeing, including their physical, emotional, social, occupational and financial wellbeing.

To help improve employee wellbeing across all dimensions, companies can employ a wide variety of solutions. These may include: health risk assessments, fitness classes or gym reimbursement, health coaching, health education, flu shots, financial counseling/planning, flexible work schedules, free health food, health fairs, on-site/near-site health clinics, telemedicine, tobacco cessation, weight management and wellness challenges.

In many cases, the benefits of providing an employee wellness program outweigh the cost of providing the program. Employees spend most of their time at work, so linking their wellness goals with an overall work-life balance can positively impact the company’s bottom line business outcomes.

For one thing, employee wellness programs lower the employees’ elevated health risks, such as high blood pressure and high cholesterol, which can lead to heart disease and stroke. Managing risk translates into improved overall health. This ultimately reduces use of medical services and lowers medical costs to the employee and employer.

In addition, organizations with good wellness programs can experience reduced absenteeism for a number of reasons. Employees with good general health typically don’t miss work. Employees who can manage stress well have lower absenteeism. Employees with normal blood pressure, cholesterol and glucose are less likely to miss work, and those who are not overweight or obese are less likely to get sick and miss work.

Poor employee productivity at work is called presenteeism. That’s when you’re at work but not really working, and it’s been linked to poor health. Employee wellness programs that impact employee lifestyles and improve health eliminate presenteeism and increase employee productivity. These programs also help to retain and recruit employees to the company, as many workers today look for factors beyond salary when choosing an employer.

Not so fast! Researchers reported conflicting results in a study published in the April 2019 edition of JAMA. In their study, researchers analyzed data from 160 worksites employing nearly 33,000 people. About 10 percent of the employers in the study offered wellness programs that addressed topics such as exercise, nutrition and stress.

The researchers compared employees with and without access to a wellness program over 18 months and discovered that those who had access to a wellness program reported significantly higher rates of exercise and weight management efforts.

BUT, those with and without wellness programs had similar self-reported health behaviors and outcomes; similar results on 10 heath measures, including blood pressure, cholesterol and body mass index; similar use of medical resources; and similar absenteeism and job performance.

So what’s the bottom line when it comes to employee wellness programs? Do they work or don’t they? It’s clear more research is needed to determine the true effectiveness and benefit of these programs. For example, a study lasting longer than 18 months might yield much different results.

If you started exercising more, lost weight, quit smoking and/or began eating healthier because of what you learned though an employee wellness program, you’ll definitely reap benefits that will positively impact your overall health. That’s the true bottom line.

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