Blog Posts

The Basics Of Blood Cancers

September 14th, 2022

September is Blood Cancer Awareness Month. Blood cancers affect the production and function of blood cells, of which there are three types. White blood cells are part of the immune system. They help fight infection and disease. Red blood cells transport oxygen from the lungs to the organs and tissues. Platelets help form blood clots to control bleeding.

Most blood cells form from stem cells in the bone marrow, the soft, spongy tissue inside of bones. These cells normally mature into white blood cells, red blood cells or platelets. Hundreds of billions of new blood cells are produced in the bone marrow each day. As a result, the body is provided with a continuous supply of fresh, healthy cells.

With blood cancers, however, this natural blood cell production goes haywire, and abnormal blood cells develop and grow out of control. Excess abnormal cells eventually crowd out the healthy blood cells and prevent them from performing their important functions.

There are three main types of blood cancers: leukemia, lymphoma and myeloma. These cancers affect different types of white blood cells and act in different ways. Each year, these cancers account for approximately 10 percent of cancer diagnoses.

Leukemia involves the overproduction of abnormal white blood cells that — unlike healthy white cells — are unable to fight infection. With the proliferation of these leukemia cells, there’s insufficient room left in the marrow for the production of healthy white blood cells, platelets and red blood cells.

As a result, there aren’t enough red blood cells to provide oxygen to the body’s organs and tissues so they can function properly. There aren’t enough healthy white blood cells to help the body fight off infection, and there aren’t enough platelets to help blood clot.

Lymphoma starts in the infection-fighting cells of the immune system, called lymphocytes. These cells are found in many parts of the lymphatic system, which carries white blood cells throughout the body. The lymphatic system includes the lymph nodes, spleen, thymus gland and tonsils.

There are two main types of lymphoma: non-Hodgkin and Hodgkin, which involve different types of lymphocytes. Most non-Hodgkin lymphomas arise from B cells, a type of white blood cell that makes antibodies. Hodgkin lymphomas begin in special cells called Reed-Sternberg cells, which are abnormal white blood cells that typically contain more than one nucleus.

Myeloma, also called multiple myeloma, is a rare cancer of plasma cells, which, like B cells, are white blood cells that make antibodies. With myeloma, the marrow produces an abundance of abnormal plasma cells, called myeloma cells. These cells crowd out the other healthy cells in the marrow.

The abnormal plasma cells can accumulate in the body and cause health problems that may include weakened bones, anemia (a lack of red blood cells to carry oxygen to your body’s organs and tissues) and abnormal kidney function.

Each blood cancer has its own signs and symptoms. There are, however, some signs and symptoms that are common to the three cancers, including persistent fatigue, swollen lymph nodes, fever, shortness of breath, unexplained weight loss, loss of appetite, abdominal discomfort, bone or joint pain, frequent infections, and easy bruising or bleeding.

Diagnosis begins with a thorough history and physical exam. The doctor will likely order blood tests, such as a complete blood count (CBC), which provides details about white blood cells, red blood cells and platelets. The doctor may also order a blood cell examination to further check blood cells and look for other substances that may be signs of disease.

The doctor may recommend a bone marrow biopsy, also called a bone marrow aspiration, to look for abnormal cells.

There are specific courses of treatment for leukemia, lymphoma and myeloma. In general, however, blood cancers are treated using chemotherapy and radiation therapy. Another treatment often recommended for blood cancer is stem cell transplantation, during which healthy stem cells replace damaged stem cells in the marrow.

With improvements in diagnosing and treating blood cancers, the survival rates have dramatically increased over the past few decades.

Improve the odds even more: If you notice any of the signs and symptoms of blood cancer, visit your doctor right away so you can catch leukemia, lymphoma and myeloma in their early, most treatable stages.

Patti DiPanfilo

Defining DMD, The Most Common Form Of Muscular Dystrophy

September 6th, 2022

September marks National Muscular Dystrophy Awareness Month.

The term “muscular dystrophy” refers to a group of more than 30 genetic diseases characterized by progressive muscle weakness and the degeneration of the skeletal muscles that control movement. The focus of this blog, Duchenne Muscular Dystrophy ( DMD), is the most common and most severe form.

On Wednesday (September 7), people around the world will raise awareness through World Duchenne Awareness Day (WDAD).

For the past six years, Jett Foundation has hosted an annual event in recognition of this day.  This year, the foundation is hosting a virtual event to bring together patients and families, experts and industry partners to celebrate advances made in Duchenne research, acknowledge challenges still to come, and show they are Stronger Than Duchenne. You can participate to learn more about Duchenne throughout the day!

Duchenne affects approximately one out of every 5,000 live male births. About 20,000 children are diagnosed with Duchenne globally each year.

Parent Project Muscular Dystrophy

While DMD primarily affects males, females can also be affected, which is one of the reasons the World Duchenne Organization has deemed this year’s theme as Women in Duchenne.

Signs and symptoms of DMD may vary from person to person and can range from mild to severe. The average age of diagnosis is 4 years. Early signs may include delayed sitting, standing or walking, and trouble learning to talk.

DMD is a progressive disease, so symptoms generally worsen as a child ages.

Other signs and symptoms include weak legs, especially in the thighs and hips; difficulty running or jumping; waddling gait; walking on the toes or balls of the feet; trouble getting up from a sitting or lying position; enlarged calves; difficulty walking stairs; frequent falls; and weakness in the arms or neck.

As a child gets older, he or she may lose the ability to walk and require a wheelchair. The child may experience difficulty breathing and swallowing, and may develop a sideways curve of the spine (scoliosis). About one in three individuals with DMD also exhibit some cognitive impairment or learning disability.

As DMD progresses, it can weaken the heart and respiratory muscles as well. DMD is associated with a heart condition called cardiomyopathy and impaired lung function. People with DMD often die as a result of heart and breathing complications.

DMD is caused by a defect on the gene responsible for producing dystrophin, a protein that keeps muscles strong and protects them from injury as they contract and relax. Without dystrophin, muscle cells are fragile and easily damaged, resulting in a loss of muscle strength and function. The dystrophin gene is located on the X chromosome, one of two sex chromosomes in humans. The other is the Y chromosome.

Females rarely get DMD because they inherit two X chromosomes from their parents. If one has the gene with the defect, the other X chromosome can typically produce enough dystrophin to compensate. Females with a mutation on one X chromosome are considered carriers. Some female carriers are considered manifesting carriers and display a range of physical symptoms. If their X chromosome has the defective gene, they develop DMD. Females with the mutation are carriers and can pass the defect on to their children. However, in some cases, both X chromosomes have a defective dystrophin gene, where a female would be diagnosed with Duchenne.

A doctor may suspect DMD based on family history, symptoms or a thorough physical exam. The doctor will likely use certain tests to assist in making a diagnosis. One is a creatine kinase (CK) blood test. CK is an enzyme inside muscle cells. When these cells are damaged by DMD, they release high levels of CK into the blood.

Another test is a muscle biopsy, in which the doctor removes a tiny sample of muscle tissue and studies it under a microscope to check the level of dystrophin. Absent levels indicate DMD. Doctors can also use genetic tests to look for the defect on the gene that produces dystrophin.

Dystrophic arm muscle
Credit: Alila Medical Media/Shutterstock.com

There’s no cure for DMD, but there are treatments that can ease symptoms and improve quality of life. Treatment typically begins with anti-inflammatory medications called corticosteroids. These medications, which include prednisone and deflazacort (EMFLAZA®), have been found to slow the progression of DMD.

Since 2016, the FDA has approved five new treatments for DMD, including EMFLAZA. The other drugs are “exon-skippers,” which bypass the mutation on the dystrophin gene and allow for the continuation of the process for producing a functioning dystrophin protein. 

Medications that improve heart and respiratory function may also be prescribed, and many of these are being researched in clinical trials.

Physical therapy helps the child maintain motion in the joints and prevent joint deformity and scoliosis. Occupational therapy can help the child manage activities of day-to-day life, such as dressing or using a computer.

In the past, people with DMD often did not live beyond their teens. However, improvements in diagnosis and treatment have increased life expectancy. Today, many people with DMD reach their 30s, and some live into their 40s and 50s. Ongoing research on new treatments is making that possible.

Patti DiPanfilo and Alexa Tinsley

Some Answers About Afib And Your Heart

September 1st, 2022

Your heart pumps blood that has been enriched with oxygen to the rest of your body. The typical heart has two upper chambers, called atria, and two lower chambers, called ventricles. During a normal heartbeat, your heart’s natural electrical system triggers each atrium to contract and push blood into the ventricles. Then, the ventricles contract, which propels the blood out of your heart to your body.

When this process is happening smoothly, you have a normal “sinus rhythm” in which your heart beats between 60 to 100 times per minute.

With atrial fibrillation, or Afib, the atria contract chaotically and unevenly, and are out of sync with the ventricles. As a result, the heart beats irregularly and often very rapidly. Your heart rate may increase to 180 beats per minute or higher.

An irregular heartbeat is called an arrhythmia. Afib is the most common type of arrhythmia. An estimated 3 million to 6 million Americans have Afib. That number is expected to balloon to 12.1 million by 2030 as the population ages.

Let’s observe National Atrial Fibrillation Awareness Month by learning about its symptoms, risk factors, causes and treatments.

Some people with Afib don’t notice any symptoms. Those who do may experience palpitations (sensations of a rapid, fluttering or thumping heartbeat), lightheadedness, extreme fatigue, shortness of breath, faintness or confusion, weakness, dizziness, or chest pain or pressure.

NOTE: Chest pain or pressure may be signs of a heart attack. Call 911 immediately.

Anyone can develop Afib, but some factors put you at a higher risk. These include being older (it’s more common in people age 60 and older); having high blood pressure; having a family history of Afib; drinking alcohol, especially binge drinking; being obese; and having certain health conditions, such as heart disease, thyroid problems, chronic kidney disease, diabetes, asthma, sleep apnea or electrolyte imbalances.

There is no single cause of Afib. In most cases, its development is associated with another medical condition, such as cardiomyopathy, congenital heart disease, coronary artery disease, heart failure, heart valve disease, high blood pressure, pulmonary hypertension or chronic lung disease. It can also develop following heart surgery or after an infection.

In about 10 percent of cases, no underlying heart or lung disease is present. In these instances, the Afib may be caused by excessive alcohol or caffeine intake, stress, certain medications, electrolyte imbalances or genetic factors. Sometimes, no cause can be determined.

To diagnose Afib, your doctor will first ask you about your symptoms and family history. The doctor will likely use certain tests to evaluate the electrical activity in your heart. These tests may include:

• Imaging exams: Your doctor may use x-rays, CT or MRI scans to get clear pictures of your heart and lungs to look for abnormalities.
• Electrocardiogram (EKG): This test records how fast your heart is beating and the timing of the electrical signals as they pass through it.
• Echocardiogram: This test uses sound waves (echoes) to make a video of your heart as it beats.
• Exercise stress test: This test takes EKG measurements while you walk on a treadmill or ride a stationary bike.
• Holter monitor: This is a special machine that you wear for a few days while you engage in your normal activities. The monitor records your heart’s electrical activity 24/7 and captures any occurrences of Afib that your doctor can evaluate.

Treatment for Afib generally begins with medications. Your doctor may prescribe an antiarrythmic drug, which helps return your heart to normal sinus rhythm or maintain normal sinus rhythm. Rate control medications prevent the ventricles from beating too fast, and anticoagulant medications reduce the risk of blood clot formation.

If medication fails to control your Afib, you may need a procedure to treat the abnormal heart rhythm. One is electrical cardioversion, which uses an electrical shock to “reset” your heartbeat.

Ablation is a procedure that uses small burns or freezes to create scar tissue that interferes with the irregular electrical signals in your heart.

If your Afib persists after treatment with medication and ablation, you may be a candidate for surgery, specifically the Maze procedure. During the Maze procedure, your doctor will make a series of incisions or lesions in your right and left atria to confine the electrical signals to defined pathways. This prevents the atria from beating chaotically and causing the symptoms of Afib.

Afib by itself isn’t life-threatening, but it can lead to serious complications, including stroke. Afib is associated with an approximately five-fold increased risk of ischemic stroke. It causes about one in seven strokes. The risk increases because during Afib blood flows through the heart at a slower pace, making it much more likely to clot. If a clot gets pumped out of the heart, it can travel to the brain and cause a stroke.

Don’t take a chance. If you experience symptoms of Afib, see your health care provider and get checked out.

Patti DiPanfilo

What Is Spinal Muscular Atrophy?

August 24th, 2022

August is typically one of the hottest months of the year, so this is an excellent time to stay indoors in the air conditioning and read a blog. The topic of this one is spinal muscular atrophy, or SMA, a genetic disorder that primarily affects infants and children.

August is Spinal Muscular Atrophy Awareness Month.

SMA is a neuromuscular disorder. It’s a progressive disease that destroys the nerve cells that control muscle movement, called motor neurons. With SMA, motor neurons in the spinal cord are affected. As a result, the muscles begin to waste away, or atrophy. Over time, this takes away the ability to walk, eat and breathe.

Approximately one in every 6,000 to 10,000 babies worldwide is born with SMA. Estimates suggest that 10,000 to 25,000 children and adults in the US are living with SMA, making it one of the most common rare diseases. It is estimated that about 6 million Americans are carriers of the mutated gene that leads to SMA. That’s nearly one in every 50 people.

In almost all cases, SMA is caused by the insufficient production of a protein necessary for proper motor neuron function called survival motor neuron (SMN) protein. The SMN protein is primarily produced by the SMN1 gene located on chromosome 5. The SMN2 gene also produces the SMN protein but in smaller quantities.

In children who have SMA, both SMN1 genes are mutated or missing, and their SMN2 genes don’t make enough survival motor neuron to compensate. Without adequate SMN proteins, the motor neurons in the spinal cord begin to wither and die, leading to debilitating and sometimes fatal muscle weakness.

Some forms of SMA are not linked to SMN1, chromosome 5 or SMN protein deficiency. These vary greatly in severity and the muscles affected. SMN-related SMA primarily affects the proximal muscles, those closest to the center of the body. Other forms primarily affect the distal muscles, those farthest away from the body’s center.

SMA is inherited in an autosomal recessive pattern, which means that both copies of the SMN1 gene in each cell must be mutated. To inherit SMA, both parents must carry the mutated gene and pass it along to their child. When both parents are carriers of the mutated gene, a child has a 25 percent chance of being born with SMA.

In SMN-related SMA, there is wide variability in age of onset, symptoms and rate of progression. To account for the differences, SMA is typically classified into four types. The age at which SMA symptoms begin roughly correlates with the degree to which motor neuron function is affected. In general, the earlier the age of onset, the greater the impact on function.

Type 1 SMA, also called Werdnig-Hoffmann disease, affects about 60 percent of people with SMA. It is a severe form with muscle weakness evident at birth or within the first few months. Most children with type 1 SMA cannot control their head movements or sit without help. They often have swallowing problems, which cause feeding difficulties that ultimately impair growth. They also experience breathing problems.

Most children with type I SMA don’t survive past early childhood due to respiratory failure. However, with more proactive care and newer treatments, children with this disorder are living longer and reaching higher milestones, such as sitting up and even walking.

Children with type 2, or Dubowitz disease, develop muscle weakness between the ages of 6 and 12 months. While those with this type can often sit on their own, they typically cannot stand or walk unaided. They often have tremors, scoliosis and respiratory muscle weakness that can be life-threatening. Still, children with type 2 SMA can live into their 30s.

Type 3 SMA, also called Kugelberg-Welander disease, is a mild form of the condition. Symptoms can appear anywhere from 18 months to early adulthood. Those with this type learn to stand and walk, but often lose these abilities later in life. They generally experience mild muscle weakness and are at high risk for respiratory infections. Most people with this type have near normal life expectancies.

Type 4, or adult-onset SMA, is rare, accounting for less that 5 percent of all cases. It generally does not present until people are in their 20s or 30s. People with this type can walk throughout life, but typically experience mild to moderate muscle weakness, tremors and mild breathing problems. People with type 4 SMA have a normal life expectancy.

SMA is typically diagnosed using a blood test that looks for the mutated SMN1 gene. The doctor will recommend this blood test if your child’s symptoms and diagnostic workup suggest SMA. The doctor may also order an electrical study called electromyography (EMG) or a muscle biopsy to rule out other disorders and confirm the SMA diagnosis.

In July 2018, SMA screening was added to the Recommended Uniform Screening Panel for newborns. This helps ensure that every baby is screened, which permits early access to life-changing and even life-saving interventions.

There is no cure for SMA. Treatment focuses on easing symptoms, preventing complications and improving quality of life. Therapies are based on the type of SMA, the severity of the condition and the child’s age. They can range from feeding and breathing tubes to orthopedic braces, wheelchairs, and physical and occupational therapy.

Medications that stimulate the production of the SMN protein are also available to treat SMA. These medications are called disease-modifying therapies.

In December 2016, nusinersen (SPINRAZA®) was approved by the Food and Drug Administration for treating all four types of SMN-related SMA in children and adults. SPINRAZA may be effective at slowing, stopping or possibly reversing SMA symptoms.

In May 2019, the FDA approved ZOLGENSMA®, the first gene replacement therapy for a neuromuscular disease such as SMA.

In August 2020, the FDA approved risdiplam (Evrysdi®) for the treatment of SMA in ages 2 months and older. Evrysdi is an oral medication designed to increase the amount of SMN protein by boosting its production by the SMN2 genes. Research is ongoing for additional disease-modifying therapies for SMA.

Patti DiPanfilo

Save Your Skin From Psoriasis

August 17th, 2022

August marks Psoriasis Awareness Month, a time to learn more about this chronic skin disease and its treatments. It’s also an opportunity to offer support to the more than 8 million Americans who suffer with it.

There are several types of psoriasis. The most common type — plaque psoriasis — affects about 80 to 90 percent of people with the condition. It causes dry, raised, pink or red patches covered with white or silvery scales. These scaly patches, called plaques, are typically found on the elbows, knees, scalp, lower back, face, palms and soles of the feet but can occur elsewhere.

Other symptoms of psoriasis include dry, cracked skin that itches or bleeds, and thick, ridged or pitted nails.

About 25 to 30 percent of people with psoriasis have a related condition called psoriatic arthritis, which causes stiff, swollen, painful joints.

The symptoms of psoriasis typically go through cycles, getting worse for a while (flares) and then getting better (remissions).

While psoriasis can occur at any age, it has two peaks of onset. The first is between ages 20 and 30, and the second between ages 50 and 60. Men and women are at equal risk for developing the disorder.

Psoriasis is an autoimmune disease, a condition in which your body’s protective immune system — which normally guards against germs such as bacteria and viruses — malfunctions and attacks healthy cells by mistake. With psoriasis, white blood cells called T cells mistakenly attack your skin cells, causing the skin cell production process to speed up.

Typically, new skin cells grow every 28 to 30 days. In people with psoriasis, however, the cycle of new cell growth is shortened to every three to four days. The buildup of new skin cells outpaces the sloughing off of old cells. The excess cells are pushed to the skin’s surface, where they pile up and form the scaly patches commonly associated with psoriasis.

Researchers don’t fully understand what causes this to occur, but they believe a mix of genetics and environmental factors are involved in the development of psoriasis. Certain factors have been identified that trigger an outbreak of symptoms.

Common psoriasis triggers include an injury to the skin; stress; infection that affects the immune system; certain medications, including lithium, high blood pressure medications and anti-malarial drugs; smoking; heavy alcohol consumption; rapid withdrawal from oral or systemic corticosteroids; and wintertime, when people are routinely exposed to hot, dry indoor air.

Your doctor can typically diagnose psoriasis based on your history of symptoms and a physical exam. The doctor may take a small sample of skin, which is called a biopsy, to examine it closely under a microscope. This helps your doctor determine the type of psoriasis as well as rule out other disorders as the cause of your symptoms.

There is no cure for psoriasis. The goals of treatment are to reduce inflammation and scales, slow the growth of new skin cells and remove plaques. Treatment for mild to moderate psoriasis often begins with topical creams, ointments or lotions, including topical corticosteroids, retinoids, synthetic vitamin D and coal tar extracts.

Light therapy is a first-line treatment for moderate to severe psoriasis. It may be used alone or in combination with medication. It involves exposing the skin to controlled amounts of natural or artificial light. The light, which may be sunlight, broadband or narrowband UVB light, or an excimer laser, can improve skin affected by psoriasis.

If your psoriasis is moderate to severe and has not responded to other therapies, your doctor may recommend an oral or injected medication. These include steroids, methotrexate and cyclosporine. Drugs called biologics may also be tried. They alter the immune system and disrupt the disease cycle. Common biologics used to treat psoriasis include ENBREL®, HUMIRA®, STELARA® and COSENTYX®.

To live your best life with psoriasis, follow your doctor’s advice carefully. Also try some of these self-care strategies to better manage your condition:

• Use moisturizer regularly, especially after bathing. Avoid harsh soaps.
• Maintain a healthy weight. Obesity makes psoriasis symptoms worse.
• Quit smoking.
• Drink alcohol in moderation.
• Expose your skin to small amounts of sunlight. Limited sunlight can help alleviate psoriasis symptoms, but too much can make symptoms worse. Seek advice from your doctor before doing this.
• Avoid known triggers.
• Lower stress. Try meditation, deep breathing, yoga or tai chi.
• Join a support group to learn more about living and coping with psoriasis.

If you develop a problem with your mental health, such as anxiety and/or depression, as a result of psoriasis, visit a mental health provider for support and treatment. Don’t suffer in silence.

Patti DiPanfilo

Immunization: It’s Not Just For Kids

August 10th, 2022

Most people think immunization is just for kids. But National Immunization Awareness Month, which is recognized each August, underscores the importance of vaccination for all ages. After all, the adage, “An ounce of prevention is worth a pound of cure,” holds true throughout life.

The term immunization refers to the action of making people resistant (immune) to certain infectious diseases, many of which can be very serious or even deadly. Immunization is typically accomplished through inoculation with vaccines.

If you’re like me, you probably received a series of vaccines when you were a child. Over the years, the schedule of vaccines given to children and teens has evolved as doctors have learned more about various infectious diseases and new and/or improved vaccines became available.

For the current guidelines from the Centers for Disease Control and Prevention, see the Child and Adolescent Immunization Schedule for 2022. And here, the American Academy of Family Physicians describes the recommended vaccines in greater detail: Childhood Vaccines: What They Are and Why Your Child Needs Them.

Most vaccines are made using a weakened version of the infectious bacteria or viruses that cause the disease, or materials that resemble those germs. Vaccines work by prompting your body’s defense against disease — your immune system — to produce infection-fighting cells to attack the invading germs.

To better understand how vaccines work, let’s take a closer look at how the immune system fights infection.

When germs invade your body for the first time, your immune system uses certain white blood cells to destroy them. Special white cells called macrophages consume and digest the germs. B-lymphocytes produce disease-fighting antibodies that attack the germs, and T-lymphocytes attack cells in the body that have already been infected by a bacterium or virus.

Once antibodies are created in response to an initial infection, your body keeps them and uses them to fight future infections with the same germ. That’s how vaccines provide protection for the long haul. Many vaccines protect you for years, some for most of your life. But sometimes, a vaccine loses its effectiveness over time. In that case, you may require a booster later in life.

Adults need boosters of certain vaccines they received as children, such as the Tdap, which is the vaccine for tetanus, diphtheria and pertussis (whooping cough), and the vaccine against hepatitis B. People of all ages should get a tetanus booster every 10 years. A booster is recommended any time you’re exposed to the tetanus toxin as well.

It is also recommended that adults receive vaccines for diseases such as influenza, pneumococcal pneumonia and shingles. Here’s a rundown of the recommended vaccines for adults. In addition, vaccination against diseases that are common in other countries is recommended before you travel outside the US. Here’s more information about vaccines for travelers.

There are some people who don’t get vaccinated because they fear side effects. Most vaccines cause only minor side effects such as a mild fever or soreness at the site of the injection. And there is no credible evidence that these vaccines lead to autism, as some opponents suggest.

In 2020, the COVID-19 pandemic brought about the first commercially developed mRNA vaccine, although researchers have been working with the technology for decades. These vaccines don’t work like the others.

Messenger RNA (mRNA) is found in all cells, where it helps create proteins. For these vaccines, scientists design an mRNA that delivers instructions into our cells on how to make a protein that will trigger a specific immune response. These vaccines do not last very long in the body.

Common side effects with mRNA vaccines include headache, fatigue, soreness and nausea that go away within a few days. There have been a few extremely rare, serious side effects such as myocarditis and pericarditis, according to the CDC. Health officials insist mRNA vaccines do not alter DNA.

Immunization is important for two reasons: It protects you from disease and it protects the people around you. How vaccines protect you has already been explored, but how do vaccines protect your community?

If a large number of people in a community are vaccinated and immune to a disease, the germs that cause it can’t spread from person to person as easily. Spreading germs this way can make the people around you sick and lead to an outbreak of the disease. The protection that results from community-wide vaccination is called herd immunity.

All in all, immunization is a safe and effective way to protect against many serious, possibly deadly, infectious diseases. Thanks to immunization, diseases such as polio, rubella and smallpox have been all but eradicated in this country.

Keeping Americans safe from those diseases and many others is why spreading the word about immunization is a priority of National Immunization Awareness Month.

Patti DiPanfilo

Caring For Children’s Eyes

August 3rd, 2022

Your baby’s vision at birth is limited but develops progressively during the growth process. While developing, your child’s vision is vulnerable to eye diseases. Untreated, vision disorders can interfere with your child’s ability to learn and play, and can lead to headaches, eyestrain and fatigue.

August is Children’s Eye Health and Safety Month, a time to concentrate on the well-being of our children’s eyes as they head back to school.

There are many conditions and diseases that can affect a child’s vision.

Refractive errors are among them. The most common are:

Myopia, or nearsightedness, when closer objects are clear but faraway objects are not.
Hyperopia, or farsightedness, which is difficulty seeing close-up objects but faraway objects are clear.
Astigmatism, blurry vision due to an irregular shape of the cornea, the clear, outer layer at the front of the eye.

Eyeglasses are typically prescribed to treat these refractive errors and provide clear vision.

Amblyopia and strabismus are other common eye disorders in children.

Amblyopia, or lazy eye, is characterized by reduced vision from lack of use in one otherwise healthy eye. Treatment typically consists of patching the stronger eye or blurring the vision in the stronger eye with eyedrops. These techniques make the weaker eye work harder and become stronger.

Strabismus, or crossed eyes, is when the eyes are misaligned. One or both eyes may turn inward, outward, up or down. It can be caused by problems with the eye muscles, the nerves that transmit information to the muscles or the control center in the brain responsible for eye movement. Treatment includes glasses, eye patching, muscle surgery to straighten the eyes and eye exercises.

Other nonrefractive conditions include:

Glaucoma, a condition associated with a higher-than-normal fluid pressure inside the eyes.
Cataracts, a clouding of the lens.
Retinoblastoma, a rare cancer of the retina, the light-sensitive layer of nerve tissue lining the back wall of the eye.

Catching and treating eye disorders early will help a child develop healthy vision and avoid learning difficulties at home and in school. Eye care for children begins at birth. A pediatrician will perform a screening eye exam on a baby after birth. This exam can detect abnormalities in the light reflex from the pupil and eye alignment, as well as in external features of the eye.

The pediatrician will continue to check the eyes and vision during routine well-baby visits. There’s disagreement among eye specialists as to when a child should begin seeing an eye doctor for eye exams and how often a child should be examined. Follow doctor’s recommendations, which are based on your child’s specific circumstances.

Here are some things a parent can do to help protect a child’s eyes and developing vision:

Encourage healthy eating. Healthy vision is influenced by the food we eat. Try to incorporate many fruits and vegetables into the child’s diet. Fruits and vegetables contain many of the vitamins and minerals necessary for maintaining healthy eyes and vision.
Spend time outdoors. Playing outside for at least an hour a day, or even just taking a walk outdoors, will help eye muscles relax. It can also help lower the risk of certain eye conditions, including myopia.
Wear sunglasses outdoors. Wearing sunglasses protects eyes from the sun’s harmful ultraviolet rays. Excessive exposure to UV radiation over time has been linked to serious eye diseases later in life.
Wear protective eyewear while playing sports. Avoid serious eye injuries by wearing protective eyewear with shatterproof plastic. Different sports have different eyewear recommendations.
Limit screen time. Prolonged time staring at computer and television screens may cause blurry vision, focusing problems and possibly even increase your the risk for developing myopia. Limit the amount of time on digital devices each day and ensure the child takes frequent breaks to the eyes a rest.

Set a good example for your child. Incorporate these tips into your own life as well.

If you suspect a problem with your child’s eyes or vision, contact a qualified eye doctor who can diagnose and treat the problem.

Patti DiPanfilo

The Scoop On Psoriasis

July 27th, 2022

August marks Psoriasis Awareness Month, a time to learn more about this chronic skin disease and its treatments. It’s also an opportunity to offer support to the more than 8 million people in the US who suffer with it.

There are several types of psoriasis. The most common type — plaque psoriasis — affects about 80 to 90 percent of people with the condition. It causes dry, raised, pink or red patches covered with white or silvery scales. These scaly patches, called plaques, are typically found on the elbows, knees, scalp, lower back, face, palms and soles of the feet but can occur elsewhere.

Other symptoms of psoriasis include dry, cracked skin that itches or bleeds, and thick, ridged or pitted nails. About 25 to 30 percent of people with psoriasis have a related condition called psoriatic arthritis, which causes stiff, swollen, painful joints. The symptoms of psoriasis typically go through cycles, getting worse for a while (flares) and then getting better (remissions).

While psoriasis can occur at any age, it has two peaks of onset. The first is between the ages of 20 and 30, and the second is between the ages of 50 and 60. Men and women are at equal risk for developing the disorder.

Psoriasis is an autoimmune disease, a condition in which your body’s protective immune system — which normally guards against germs such as bacteria and viruses — malfunctions and attacks healthy cells by mistake. With psoriasis, white blood cells called T cells mistakenly attack your skin cells, causing the skin cell production process to speed up.

Typically, new skin cells grow every 28 to 30 days. In people with psoriasis, however, the cycle of new cell growth is shortened to every three to four days. The buildup of new skin cells outpaces the sloughing off of old cells. The excess cells are pushed to the skin’s surface, where they pile up and form the scaly patches commonly associated with psoriasis.

Researchers don’t fully understand what causes this to occur, but they believe a mix of genetics and environmental factors are involved in the development of psoriasis. Certain factors have been identified that trigger an outbreak of symptoms.

Common psoriasis triggers include an injury to the skin; stress; infection that affects the immune system; certain medications, including lithium, high blood pressure medications and anti-malarial drugs; smoking; heavy alcohol consumption; rapid withdrawal from oral or systemic corticosteroids; and cold weather, when people are routinely exposed to hot, dry indoor air.

Your doctor can typically diagnose psoriasis based on your history of symptoms and a physical exam. The doctor may take a small sample of skin, which is called a biopsy, to examine it closely under a microscope. This helps your doctor determine the type of psoriasis as well as rule out other disorders as the cause of your symptoms.

There is no cure for psoriasis. The goals of treatment are to reduce inflammation and scales, slow the growth of new skin cells and remove plaques. Treatment for mild to moderate psoriasis often begins with topical creams, ointments or lotions, including topical corticosteroids, retinoids, synthetic vitamin D and coal tar extracts.

Light therapy is a first-line treatment for moderate to severe psoriasis. It may be used alone or in combination with medication. It involves exposing your skin to controlled amounts of natural or artificial light. The light, which may be sunlight, broadband or narrowband UVB light, or an excimer laser, can improve skin affected by psoriasis.

If your psoriasis is moderate to severe and has not responded to other therapies, your doctor may recommend an oral or injected medication. These include steroids, methotrexate and cyclosporine. Drugs called biologics may also be tried. They alter the immune system and disrupt the disease cycle. Common biologics used to treat psoriasis include ENBREL®, HUMIRA®, STELARA® and COSENTYX®.

To live your best life with psoriasis, follow your doctor’s advice carefully. Also try some of these self-care strategies to better manage your condition:

• Use moisturizer regularly, especially after bathing. Avoid harsh soaps.
• Maintain a healthy weight. Obesity makes psoriasis symptoms worse.
• Quit smoking.
• Drink alcohol in moderation.
• Expose your skin to small amounts of sunlight. Limited sunlight can help alleviate psoriasis symptoms, but too much can make symptoms worse. Seek advice from your doctor before doing this.
• Avoid known triggers.
• Lower your stress. Try meditation, deep breathing, yoga or tai chi.
• Join a support group to learn more about living and coping with psoriasis.

If you develop a problem with your mental health, such as anxiety and/or depression, as a result of your psoriasis, visit a mental health provider for support and treatment. Don’t suffer in silence.

Patti DiPanfilo

Let’s Discuss Cleft And Craniofacial Disorders

July 20th, 2022

Cleft and craniofacial disorders are a diverse group of deformities affecting the face and skull. These disorders are typically present at birth and can range from mild to severe. They can impact your child’s appearance and impede critical functions such as eating and breathing. In the US, approximately 600,000 children have been diagnosed with a cleft or other craniofacial disorder.

In observance of National Cleft and Craniofacial Awareness and Prevention Month, let’s discuss some of the more common disorders in greater detail.

In this image from the National Institutes of Health media library, a child with a cleft lip at age 2 months (left) and at 5 months after reconstruction surgery at the St. Louis Children’s Hospital Cleft Palate and Craniofacial Institute.

Cleft lip and cleft palate are the most common of the cleft and craniofacial disorders. They occur when a baby’s lip or palate doesn’t form properly during pregnancy. About 1 in every 2,800 babies born in the US has a cleft lip; about 1 in every 1,700 babies is born with a cleft palate, and about 1 in every 1,600 babies is born with a cleft lip and cleft palate.

A cleft lip is a separation of the two sides of the lip. The lips form between the fourth and seventh weeks of pregnancy. A cleft occurs if the tissue forming the lip does not fuse completely during fetal development. The result is an opening in the upper lip, which can range from a small slit to a large gap that goes through the lip into the nose.

The palate, or roof of the mouth, forms between the sixth and ninth weeks of pregnancy. A cleft palate results if the tissue that makes up the palate doesn’t join together completely. In some cases, both the front of the mouth (hard palate) and the back part toward the throat (soft palate) are separated. In other cases, only one part of the palate is open.

Other cleft and craniofacial disorders include:

Hemifacial microsomia, also known as Goldenhar syndrome, is a condition in which the tissue on one side of the face is underdeveloped. This disorder typically affects the ear, mouth and jaw. In some cases, both sides of the face are affected. Hemifacial microsomia is the second most common cleft and craniofacial disorder behind cleft lip and cleft palate. It affects 1 in every 3,500 to 4,000 births.

Craniosynostosis is a disorder in which the natural sutures (soft spots) between a infant’s skull bones that enable the skull to expand as your child grows fuse before growth is complete. The result is a skull that’s abnormally shaped and pressure on a growing brain that can lead to developmental delays and learning problems. A baby’s facial bones may also be altered, creating an asymmetrical appearance.

Deformational, or positional, plagiocephaly is a change in head shape due to external pressure on the skull. It can develop if a baby sleeps in the same position most of the time or if problems with the baby’s neck muscles create a preference to turn the head in the same direction.

A vascular malformation is a birthmark or growth composed of blood vessels that can cause functional or aesthetic problems. There are several types of vascular malformations, which are named according to the blood vessel affected. Many of these malformations are apparent at birth. However, some aren’t found until the child is older, sometimes by the teenage years.

Symptoms of cleft and craniofacial disorders vary depending on the disorder and its severity. In general, these disorders are associated with head deformities and difficulties with speech, breathing, hearing and vision. Often, children with these disorders have dental problems and poor self-esteem.

Most medical professionals believe multiple factors combine to cause cleft and craniofacial disorders. Genetics is one factor. An affected child may have received a particular gene or combination of genes from one or both parents.

Environment is another factor. Women who take certain medications, have diabetes, smoke or drink alcohol in excess while pregnant are at a higher risk for having a baby with a cleft or other craniofacial disorder.

Studies have shown that women who don’t get enough folic acid during pregnancy may also be at a higher risk for having a baby with a cleft or other type of craniofacial disorder. Folic acid is a B vitamin found in leafy green vegetables, orange juice, fortified breakfast cereals and enriched grain products.

A cleft or other craniofacial disorder is usually diagnosed within the first few months of life. Many of the disorders, such as cleft lip and hemifacial microsomia, are obvious when looking at the baby. The child’s doctor may use dental or skull x-rays or a CT or MRI scan to aid in the diagnosis. Sometimes, these deformities can be diagnosed before birth using prenatal ultrasound.

Depending on the type and severity of the cleft or other craniofacial disorder, reconstructive surgery may be recommended to improve the child’s physical appearance. Surgery also helps with eating, breathing and speaking, as well as dental problems.

Children born with these disorders often require specialized health care from infancy to young adulthood.
Some research studies suggest that taking folic acid while pregnant may decrease the chances of having a baby with a cleft or other craniofacial disorder. Folic acid can be found in most multivitamins and as a stand-alone supplement.

Patti DiPanfilo

A Juvenile Arthritis Primer

July 13th, 2022

Arthritis, which is inflammation or degeneration of the joints, affects children as well as adults. Arthritis in children is called juvenile arthritis, and July is Juvenile Arthritis Awareness Month.

Juvenile arthritis can cause permanent joint damage and impact the child’s growth and physical development, so early intervention and treatment is imperative. Read on to learn more.

The most common type of childhood arthritis is juvenile idiopathic arthritis (JIA). The term “idiopathic” means the exact cause for the disorder is unknown. We do know that JIA is an autoimmune disease. In this case, the body’s germ-fighting immune system malfunctions and targets the joints’ synovial membrane (tissue lining), causing inflammation.

Researchers don’t know why this happens but believe a combination of genetic and environmental factors may be involved.

In the US, juvenile idiopathic arthritis affects about one of every 1,000 children, or about 300,000 children. There are several types of JIA. The three main types are oligoarticular, polyarticular and systemic.

About 50 percent of children with JIA have the oligoarticular type, which typically affects fewer than five joints, most often the knee, ankle and elbow. In most cases, this type is mild and symptoms may lessen or go away over time. Children with oligoarticular arthritis are at high risk for developing inflammation of the eyes (uveitis). To prevent vision loss, your child should have regular examinations by an eye doctor.

About 30 percent of children with juvenile arthritis have the polyarticular type, which affects five or more joints. It often affects the smaller joints such as those in the hands and feet. It can, however, impact larger joints, including those in the neck and jaw. Typically, polyarticular arthritis affects the same joints on both sides of the body.

Systemic arthritis, also called Still’s disease, occurs in about 10 to 20 percent of children with JIA. It affects the entire body, not just the joints. Systemic JIA typically begins with a fever and rash that come and go. In many cases, it leads to inflammation of internal organs such as the heart, liver, spleen and lymph nodes. If not treated appropriately, children with systemic JIA may develop severe arthritis in their joints that continues into adulthood.

Symptoms of JIA may come and go. Sometimes, symptoms are worse (flares) and sometimes symptoms get better (remission). Symptoms vary depending on the type of JIA and may include joint pain, swelling and tenderness; joint stiffness; limping; difficulty with fine motor activities; persistent fever; rash; weight loss; swollen lymph nodes; fatigue or irritability; growth problems; eye redness or pain; and blurred vision.

To diagnose and treat JIA, your child’s pediatrician may refer you to a pediatric rheumatologist, a specialist in arthritis and related conditions in children. The rheumatologist will perform a physical examination and review of your child’s symptoms. The specialist may order tests on your child’s blood and joint fluid, as well as x-rays or an MRI to help rule out other causes for the symptoms and classify the type of arthritis.

The goals of treatment for JIA are to control symptoms, prevent joint damage and maintain function. Treatment also aims to identify, treat and prevent complications of the disorder.

Treatment for juvenile arthritis generally involves medication and therapy. Medications used include nonsteroidal anti-inflammatory drugs (NSAIDs), which can often quickly reduce inflammation and relieve pain. If NSAIDs don’t relieve symptoms, the next step is disease-modifying anti-rheumatic drugs (DMARDs).

DMARDs suppress the immune system on a broad level, helping to prevent progression of the disease and saving the joints from permanent damage. However, these drugs may take weeks or months to relieve symptoms. Biologic response modifiers are another type of medication that block specific immune signals that cause inflammation. They help to prevent progression of JIA, achieve remission and protect against permanent joint damage.

Corticosteroids are strong inflammation-fighting medications that typically bring fast relief when injected into an affected joint. However, they have many possible side effects, including weakened bones, upset stomach and mood swings, so they are generally only used for short periods.

Physical and occupational therapy play important roles in the treatment of children with arthritis. Physical therapy can help relieve pain, improve and maintain range of motion in the affected joints and strengthen the muscles that support the joints. Occupational therapy teaches how to increase or preserve mobility so the child can more easily perform activities of daily living.

A physical or occupational therapist may recommend your child wear a splint or brace to protect the affected joints to reduce inflammation and prevent contractures, the tightening or shorting of the muscles and joints, which causes a deformity.

With prompt and appropriate treatment, most children with arthritis develop normally and can live active, full lives.

Patti DiPanfilo

Page 3 of 36