Blog Posts

Highlighting Health Literacy

October 5th, 2020

One of the biggest problems that health care providers have to deal with pertains to health literacy, which is a person’s ability to understand health care information and navigate the health care system. Currently, health literacy in the United States is woefully deficient.

So what exactly is health literacy?

There are many definitions out there, but the concept behind them is essentially the same. An example comes from the American Medical Association Foundation, which defines health literacy as: “the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment.

The Center for Health Care Strategies puts it more simply. In their definition, health literacy refers to “the skills necessary for an individual to participate in the health care system and maintain good health.” The skills they identify are reading and writing, calculating numbers, communicating with health care professionals, and using health technology such as electronic diabetes monitors.

The Network for the National Library of Medicine agrees that health literacy involves using a certain set of skills. The network suggests that “health literacy requires a complex group of reading, listening, analytical and decision-making skills, as well as the ability to apply these skills to health situations.”

According to the US Centers for Disease Control and Prevention (CDC), anyone who needs health information and services also needs health literacy skills. You can use those skills to find appropriate information and services, communicate your needs and preferences, and respond to the information and services.

Health literacy skills also enable you to understand the choices, consequences, and context of the information you receive. With such understanding, you can make decisions based on which information and services match your needs and preferences.

But there’s a big problem. An estimated 90 million Americans, nearly 36 percent, have low health literacy. And it affects certain populations more than others.

For example, Hispanic adults have lower health literacy skills overall than any other ethnic or racial group. Low health literacy is also more common in people who speak another language or speak English as a second language, as well as in older people, people with lower socioeconomic status or education, and people who are uninsured or on Medicare or Medicaid.

It’s imperative that we improve health literacy in this country because low health literacy is having a negative effect on how Americans use the health care system and on overall health outcomes. And as a result of increased use of services and poor outcomes, low health literacy is making an enormous impact on the nation’s health care costs.

The authors of a report titled “Low Health Literacy: Implications for National Health Policy” estimate the impact of low health literacy on the nation’s economy to be between $106 billion and $238 billion annually. That amount, the authors point out, represents between 7 percent and 17 percent of all personal health care expenditures.

To achieve optimal health, you must be an active participant in your health care. But people with low literacy often don’t have the skills necessary to clearly describe their symptoms to their health care provider, or fully understand their diagnosis and follow the instructions for their treatment. Many are simply unable to play an active role in their care.

And that affects the way they use the health care system. Many avoid going to the doctor, and when they have a health concern, they go to the emergency room for care instead. Studies show that people with low health literacy are 2.3 times more likely to visit the emergency room. And with that comes an associated increase in hospital admissions.

Health literacy affects overall health and mortality as well. Low health literacy has been linked to increased frequency of depression, physical limitations, and chronic diseases such as heart disease, stroke, diabetes, and asthma.

Making matters worse, people with low health literacy often have little understanding of their chronic disease. And because they are less engaged in their health care, they are less likely to use preventive services or follow instructions for managing their chronic disease. As a result, people with low health literacy have a much higher risk of complications and death.

Health care providers, health educators, and patients all have roles to play if we’re going to boost health literacy in America. Patients must be willing to engage with their providers and listen to what they say. Providers and educators can do their part by following these Four Simple Strategies for Improving Your Patients’ Health Literacy:

  • Use plain language in both verbal and written communication
  • Use visual aids
  • Recommend and use technology – Research shows that nearly 90 percent of Americans use the internet and 81 percent own a smartphone. Using these technologies can be a good way for providers to get their message to patients.
  • Use effective teaching methods – Some techniques include talking slowly, asking open-ended questions, and asking patients to repeat instructions given to them.

Why is health literacy important? It’s important because it allows you to make good decisions about your health. Health literacy also enables you to get appropriate medical care, take your medications correctly, and manage chronic diseases. And most importantly, it helps you lead a healthy lifestyle so you can live a full and healthy life.

AFib: Hurried Heartbeats

September 21st, 2020

Atrial fibrillation, or AFib, is the most common type of irregular heartbeat, or arrhythmia. With AFib, your heart beats much faster than the normal 60 to 100 beats per minute. To create a normal heart rhythm, or sinus rhythm, your heart’s upper and lower chambers must work in concert. But with AFib, the activity of those chambers is out of sync.

The heart pumps blood to the rest of the body, and the pumping is controlled by the heart’s own electrical system. Each heartbeat is essentially an electrical impulse that navigates through the heart. The impulse is generated by a small mass of specialized tissue in the right upper chamber, or atrium, of the heart called the SA node.

The SA node sends the electrical charge to the AV node, which is located in the wall of tissue that separates the right and left atria called the interatrial septum. The AV node conducts the impulse from the atria to the ventricles, the bottom chambers of the heart. Each impulse moves blood through the atria into the ventricles, from where it is pumped out to the rest of the body.

With AFib, the atria don’t move blood into the ventricles effectively, so the ventricles can’t pump blood to the body efficiently. This can cause your heart to beat irregularly, to be very rapid and feel like quivers or thumps in your chest. AFib can lead to serious heart-related complications including heart failure.

When blood is not pumped efficiently out of the ventricles, it is more likely to clot. If a blood clot leaves the ventricles and enters the bloodstream, it can lodge in an artery going to the brain and cause a stroke. People with atrial fibrillation are 5 to 7 times more likely to have a stroke than the general population. And about 15 to 20 percent of people who have strokes have this heart arrhythmia.

It is estimated that between 2.7 million and 6.1 million people in the United States have AFib. It is more common with age, so as our population gets older, this number will increase. Further, more than 454,000 hospitalizations in which AFib is the primary diagnosis occur each year, and AFib contributes to about 158,000 deaths annually. And that number is expected to rise.

A congenital heart disorder can cause AFib, and certain diseases and conditions that can damage your heart can result in arrhythmia. Possible causes of atrial fibrillation include high blood pressure, heart attack, coronary artery disease, heart valve disease, chronic lung disease, previous heart surgery, an overactive thyroid or metabolic disease, a viral infection, and exposure to stimulants such as caffeine, cocaine, tobacco or alcohol.

Some people have no symptoms and don’t know they have AFib. Their arrhythmia is typically detected during a physical exam when the doctor performs a test called an electrocardiogram, or ECG, which measures heart rhythm. Common symptoms of AFib include the following:

  • Rapid and irregular heartbeat
  • Fluttering or “thumping” in the chest
  • General fatigue
  • Dizziness, faintness or confusion
  • Chest discomfort
  • Shortness of breath
  • Weakness
  • Sweating

In addition to an ECG, your doctor may use other tests to help diagnose AFib. These may include a Holter or portable event monitor, which records your heart’s electrical activity over a period of time. Transesophageal echocardiography, or TEE, uses sound waves to take pictures of your heart through your esophagus. Your doctor uses this test to look for blood clots.

Treating AFib generally includes making certain lifestyle changes, including quitting smoking and limiting your intake of alcohol and caffeine. Also, control your high blood pressure and blood sugar levels, exercise regularly and maintain a healthy weight, and eat a heart-healthy diet that is low in salt, saturated fat, trans fats and cholesterol.

Initially, medications are used to treat atrial fibrillation. These include medications that control heart rhythm, which help return the heart to normal sinus rhythm. Thera are also medications that control heart rate. These work by preventing the ventricles from beating too rapidly. Anticoagulant medications, or blood thinners, which reduce the risk of blood clots and stroke, are also typically prescribed to patients with AFib.

Among the nonsurgical procedures for atrial fibrillation are electrical cardioversion and radiofrequency ablation. With electrical cardioversion, an electrical shock is placed on the outside of the chest to “reset” the heart to normal sinus rhythm.

During radiofrequency ablation, a catheter is inserted through a blood vessel and gently guided into your heart. Your malfunctioning tissue is destroyed using radiofrequency energy delivered through the catheter, and the tissue can no longer send abnormal signals.

Implanted pacemakers are among the surgical procedures for atrial fibrillation. Another is the maze heart surgery. During this procedure, the surgeon cuts small slits in the upper part of your heart. The scar tissue that results interferes with the transmission of electrical impulses that cause AFib, and normal heart rhythm is restored.

Conquering Childhood Cancer

September 15th, 2020

Childhood Cancer Awareness Month is observed every September by cancer organizations around the globe. According to the American Cancer Society, just over 11,000 children under the age of 15 will be diagnosed with cancer in 2020, and about 1,190 children are expected to die from it. After accidents, cancer is the second leading cause of death in children ages 1 to 14.

The most common cancers in children are not the same as the cancers seen most often in adults. When adults get cancer, it often begins in the lungs, breast, colon, prostate or skin. But in children, cancer tends to affect their white blood cells, nervous system, brain, bones, lymphatic system, muscles or kidneys.

How cancer spreads, as well as how it’s treated is typically different for children than adults as well. That’s mostly due to children’s unique responses to treatment. Another difference between childhood cancers and adult cancers is that the recovery rate is higher in children. Most children with cancer can be cured.

Thanks to advances in diagnosis and treatment over the years, 84 percent of children that are diagnosed with cancer now survive five years or longer. In the 1970s, that figure stood at 58 percent, so we’ve come a long way.

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, accounting for approximately 34 percent of all cancers in children. Leukemia is a cancer that begins in the bone marrow and spreads to the blood. From there, it can travel to other parts of the body. Three out of four leukemia cases are ALL.

Tumors of the brain and nervous system are also common in children. In fact, they make up about 27 percent of childhood cancers. Central nervous system tumors are cancers of the brain and spinal cord. They are the most common solid tumors that occur in childhood, and they have the highest mortality rate of childhood cancers.

Lymphoma is a less common childhood cancer that affects special cells called lymphocytes that are part of the body’s immune system. Lymphomas target the lymphatic system, the network of vessels, organs and tissues that carry clear fluid called lymph, which contains disease-fighting white blood cells, through the body.

There are two main types of lymphoma: Hodgkin lymphoma, also called Hodgkin disease, and non-Hodgkin lymphoma. Hodgkin lymphoma is a cancer of the lymph nodes. It can start almost anywhere in the body and then spread to just about any organ or tissue. These often include the liver, bone marrow and spleen.

Non-Hodgkin lymphoma affects the T and B lymphocytes, which are the immune system’s natural killer cells. These cells are produced in the bone marrow then travel to the body’s lymph glands, and to the thymus gland, intestinal tract, tonsils and spleen. Non-Hodgkin lymphoma can start in any of those areas.

Fortunately, childhood lymphoma is rare. Only about 8 percent of childhood cancers are lymphomas: 5 percent of children with cancer will have non-Hodgkin lymphoma while 3 percent will have Hodgkin lymphoma.

Certain cancers in adults and children are hereditary. But in adults, many other factors can contribute to the development of cancer. These include lifestyle and environment influences such as exposure to cigarette smoke, asbestos and ultraviolet radiation from the sun.

But in children, cancer is most often the result of DNA mutations that occur very early in the child’s life or while the child is still developing in the womb. As such, lifestyle and environmental factors play only a minor role in the development of childhood cancers.

There are multiple treatment options for childhood cancer. The treatment options chosen for your child depend on the specific type of cancer and how advanced it is. Among the types of cancer treatment are surgery, chemotherapy, radiation therapy, immunotherapy and stem cell transplants.

Each childhood cancer has its own specific signs and symptoms, but there are some general signs and symptoms. Possible signs and symptoms of cancer in children include the following.

  • An unusual lump or swelling
  • Easy bruising or bleeding
  • Ongoing pain in one area of the body
  • Unexplained fever or illness that doesn’t go away
  • Frequent headaches, often with vomiting
  • Sudden unexplained weight loss

If your child displays any of these signs and symptoms, take him or her to a physician for an evaluation. Early detection helps ensure a positive outcome from childhood cancer.

Raising Voices for MPN Awareness

September 8th, 2020

When asked to name a blood cancer, most people will respond with leukemia, lymphoma or myeloma. That’s not surprising because those are among the most common blood cancers. In fact, new cases of those cancers are expected to account for 9.9 percent of the estimated 1,806,590 new cancer cases diagnosed in the US in 2020.

But for this Blood Cancer Awareness Month, let’s take a closer look at another less common blood cancer called myeloproliferative neoplasms, or MPNs. Like other cancers, MPNs, which are a group of rare, chronic blood cancers, develop when there is uncontrolled cell growth. And the cells, in this case, are blood cells.

Normally, the marrow inside your bones produces cells called blood stem cells. These are immature cells that develop into mature blood cells over time. The mature blood cells include red blood cells, white blood cells and platelets. If you have an MPN, the stem cells in your bone marrow make too many of one of these blood cells.

There are several types of MPNs that are differentiated primarily by the specific blood cell that is affected. Two of the main types are polycythemia vera (PV), which is typified by an excessive amount of red blood cells, and essential thrombocythemia (ET), in which too many platelets are produced.

The third type of  MPN is myelofibrosis, or MF. This type of MPN is characterized by an accumulation of scar tissue in the bone marrow, a process called fibrosis. This fibrosis prevents the bone marrow from making the normal amount of healthy blood cells.

Many people have no symptoms when they are first diagnosed with MPNs. In fact, most MPNs are detected accidentally on routine blood tests that are being performed for other conditions. When symptoms are present, they tend to evolve gradually over time.

When they are noticeable, symptoms of MPNs may include: Pain or feeling of fullness below the ribs (due to an enlarged spleen), blood clots, weight loss, fatigue, pale skin, bone pain, infections and fever, loss of appetite, shortness of breath during exercise, itching and night sweats. Headaches, dizziness, blurred vision and elevated blood pressure are other possible symptoms.

Researchers don’t know what causes MPNs, but they believe there are probably multiple factors that contribute to their development. While the exact cause of MPNs is unknown, several risk factors for the disease have been identified.

One risk factor is exposure to toxins such as benzene and certain solvents or pesticides, as well as exposure to heavy metals such as mercury and lead. This exposure may lead to genetic changes in blood stem cells that can lead to the development of MPNs. Very high doses of ionizing radiation may increase the risk for MF. Around one-third of people with MF had PV or ET first.

Further, a mutation in a gene known as Janus kinase (JAK 2) has been discovered in a high percentage of people with MPNs. But researchers are still exploring the exact role of the JAK 2 mutation in MPN development.

To diagnose MPNs, your doctor will first perform a thorough physical exam and review of your medical history, including a history of your symptoms. Next, your doctor will order blood tests to look for cell abnormalities. These blood tests typically include a complete blood count (CBC), which determines how many of the different types of blood cells are present in your blood.

To confirm a diagnosis of an MPN, a sample of your bone marrow must be removed, or aspirated, and examined under a microscope to look for abnormal cells. This procedure is called bone marrow aspiration and biopsy. A bone marrow biopsy can also detect scar tissue and determine if you have MF.

Treatment for MPNs depends on whether you have PV, ET or MF, but may include: phlebotomy, which is the removal of a controlled amount of blood from your body; chemotherapy; interferon, which is a substance produced by the immune system that helps control the production of blood cells; aspirin therapy to reduce the risk of blood clots; drugs to reduce high platelet counts; and bone marrow transplant to treat MF.

Addiction Recovery Month 2020

August 31st, 2020

National Alcohol & Drug Addiction Recovery Month was created by the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the US Department of Health and Human Services. With SAMHSA, we observe Recovery Month every September to increase awareness of substance use disorders and celebrate individuals in recovery.

Alcohol and drug addiction are also referred to as substance use disorders. Whether the substance is alcohol, opioids, stimulants or sedatives, substance abuse has a widespread impact on life in this country. Research has found that almost 21 million Americans have at least one addiction, and drug overdose deaths have more than tripled since 1990.

What’s more, substance use disorders take an enormous economic toll. One study calculated that drug and alcohol use in the US costs $1.45 trillion in economic loss and societal harm annually. That total includes $578 billion in economic loss and $874 billion in societal harm, which includes quality of life declines and premature death.

For years, many considered addiction to alcohol or drugs to be a moral failing, but that line of thinking has changed. The National Institute on Drug Abuse (NIDA) defines “addiction” as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences.”

Research has discovered that substance use disorders actually change the way the brain works. The substances affect communication pathways in the brain, which changes thought processes, emotions and behaviors. These brain changes can be long-term, lasting well after you stop using drugs or alcohol.

Drugs and alcohol affect the brain by hijacking its reward system. In a healthy brain, positive behaviors such as exercising or spending time with family turn on the brain’s reward system. This system rewards the behavior by making you feel good so you want to repeat the behavior. The brain does this by producing large amounts of the feel-good chemical dopamine.

The brain’s reward system works when you use drugs or alcohol as well. But after repeatedly using the substance, your brain can’t produce normal amounts of dopamine on its own any longer. As a result, you can’t enjoy activities you normally find pleasurable unless you’re using drugs or alcohol.

Further, you develop a tolerance to the number of drugs or alcohol you’re currently using and have to use more to achieve the same reward response.

Addiction can also send your emotional danger-sensing circuits into overdrive. When that occurs, you might become anxious or stressed when you’re not using drugs or alcohol. At that point, you may start using the substance to avoid negative feelings rather than to achieve a “high.”

In addition to changing your brain chemistry, drugs and alcohol can have other negative effects on your life. You can develop an abnormal heart rate and experience heart attacks. Injecting drugs can result in collapsed veins and infections in your heart valves. You can also develop problems with your muscles, kidneys or liver.

When you’re under the influence of drugs or alcohol, you may forget to practice safe sex and become infected with a sexually transmitted disease. Substance use disorders have legal and financial consequences as well if you drive under the influence of drugs or alcohol. Or you may lose your job if your employer requires a drug test and you fail.

Many people with substance use disorders deny that they have a problem with alcohol or drugs. Your doctor uses specific criteria to diagnose addiction. These criteria are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. These criteria include:

  • Lack of control – The substance is used in larger amounts or over a longer time than the person originally intended.
  • Desire to limit use – The person wants to cut back on use but is unable to do so.
  • Time spent — A considerable time is spent trying to acquire the substance.
  • Cravings – The user experiences an intense desire or urges to use their drug.
  • Lack of responsibility – Substance use takes priority over work, school or home obligations.
  • Loss of interest – The user stops engaging in important social or recreational activities in favor of drug use.

If any of these criteria apply to you, consider seeking treatment, which varies by person and substance being abused. There are many types of drug and alcohol rehabilitation, but inpatient rehabilitation programs are typically the most effective.

Some inpatient rehabilitation programs require stays of 30, 60 or 90 days, while other, long-term programs require stays of 120 days or longer. Rehabilitation programs typically include counseling, behavioral therapy and medications to manage cravings and withdrawal symptoms.

If you don’t know where to find treatment, contact SAMHSA’s National Helpline: 1-800-662-HELP (4357). The Helpline is a free, confidential treatment referral and information service for individuals and families facing mental or substance use disorders. Helpline staff can direct you to the help you need. If you suspect you have a problem, call today!

FDA Asks for Plasma Donations to Fight COVID-19

August 24th, 2020

In an effort to further combat the spread of Covid-19, the US Food and Drug Administration is encouraging people who have completely recovered from the virus to donate their plasma to help hospitalized patients who are currently fighting the virus.

The FDA made this request on Sunday, August 23, when it gave emergency approval to the expanded use of antibody-rich convalescent plasma for coronavirus patients.

People who have had COVID-19 and completely recovered from it now have plasma that contains COVID-19 antibodies, the FDA reports. These antibodies can help patients with COVID-19 fight the disease, the FDA says.

“Based on scientific evidence, the FDA concluded that this product may be effective in treating COVID-19 and that the known and potential benefits of the product outweigh the known and potential risks of the product in hospitalized COVID-19 patients,” the FDA says.

The use of convalescent plasma, or plasma collected from people who have recovered from the disease, is not new. It has been used on more than 70,000 COVID-19 patients already, which is why the FDA’s request amounts to an expansion of the therapy.

The FDA cited at least a dozen studies as support for its recommendation, adding that “it is reasonable to believe” that convalescent plasma “may be effective in lessening the severity or shortening the length of COVID-19 illness in some hospitalized patients.”

Adding that early treatment is critical, an FDA official said that in patients 80 years or younger, those who received convalescent plasma within three days of diagnosis were about 35 percent more likely to be alive 30 days later than those who did not received the plasma.

Accounting for more than 55 percent of the blood’s physical makeup, plasma is the largest of the four components in a person’s blood, the part that carries all the other blood components throughout the body.

The FDA is urging recovered COVID-19 patients to donate their plasma because plasma is not like a drug that can be manufactured into millions of doses. It can only be obtained through donations from a small collection of people.

In order to donate plasma, former COVID-19 patients must have received their original diagnosis through a laboratory test, be at least 14 days removed from positive infection of the virus and meet all other donor qualifications.

The spread of COVID-19, which has been cited as the cause of more than 175,000 deaths in the US alone, has “caused unprecedented challenges to the US blood supply,” according to the FDA, which says one plasma donation can save as many as three lives.

“You can help ensure that blood continues to be available for patients by finding a blood donor center near you to schedule your donation,” the FDA concludes.

For further information about donating plasma, the FDA encourages potential donors to visit the following websites:


America’s Blood Centers

American Red Cross

Armed Services Blood Program

Blood Centers of America

Immunization: It’s Not Just For Kids Anymore

August 17th, 2020

Most people think immunization is just for kids. But National Immunization Awareness Month, which is celebrated in August, underscores the importance of vaccination for people of all ages. After all, the old adage that says “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 improved vaccines become available.

For the current guidelines from the US Centers for Disease Control and Prevention, see Recommended Child and Adolescent Immunization Scheduled for Ages 18 and Younger.  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 germs, such as bacteria or viruses, that cause the disease, or materials that resemble those germs. Vaccines work by prompting your body’s own 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 the bacteria 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.

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 all-out outbreak of the disease. The protection that results from community-wide vaccination is called herd immunity.

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

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 and smallpox are near obliteration 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.

Stomach Stillness

August 10th, 2020

How well do you know your digestive system? Your stomach is an important part of it. The stomach is a hollow organ made up mainly of muscle. It takes in food that is eaten, mixes it up and breaks it down into smaller pieces. What’s left is passed from the stomach to the small intestine, where digestion continues.

But sometimes, the muscles in the stomach or the nerves that control those muscles don’t work correctly. That slows the movement of the partially digested food into the small intestine. This condition is called gastroparesis, or delayed gastric emptying, and it can interfere with the entire digestive process, which can lead to symptoms.

It’s uncertain how many Americans actually suffer with gastroparesis. Its symptoms are similar to those of other gastrointestinal disorders such as functional dyspepsia (recurrent indigestion) and chronic nausea. Although it is estimated that up to five million people in the United States have gastroparesis, many remain undiagnosed.

Symptoms of gastroparesis include feeling full shortly after starting a meal, feeling full long after eating, nausea, vomiting, excessive bloating, excessive belching, pain in your upper belly (abdomen), heartburn and poor appetite. Weight loss may occur in severe cases of gastroparesis, and it can promote gastroesophageal reflux disease (GERD) and malnutrition.

Eating greasy, high-fat foods and large amounts of high-fiber foods, such as fruits and vegetables, can make gastroparesis symptoms worse.

The most common cause of gastroparesis is diabetes, which damages the nerves that control the stomach. Certain nervous system diseases, such as Parkinson’s disease and multiple sclerosis, can lead to gastroparesis as well, as can some rheumatologic diseases such as scleroderma. But in most cases, the cause is unknown. In those cases, it is called idiopathic gastroparesis.

If you had surgery on your esophagus, stomach or small intestine, which can result in an injury to your vagus nerve, the main nerve controlling the muscles of the stomach and small intestine, you are at greater risk for gastroparesis. People who have received radiation therapy for cancer are also at greater risk.

Certain medicines, including narcotic pain medicines, some antidepressants and some medicines for treating overactive bladder, can lead to delayed gastric emptying but don’t cause gastroparesis.

If you experience symptoms of gastroparesis, your doctor will perform a thorough physical exam and review of your health history. The doctor may use certain tests to aid in the diagnosis of gastroparesis. These include blood and imaging tests and, most commonly, a gastric emptying study, which determines the time it takes for food to move through your stomach.

For most people, gastroparesis is a chronic health condition in which symptoms come and go over time, so treatment is aimed at easing symptoms and improving your overall quality of life. Treatment options for gastroparesis include diet modification, medication and, in severe cases, enteral nutrition.

Eating small, more frequent meals can improve the movement of food from your stomach into the small intestine because less food is easier to digest. Eating less high-fat and high-fiber food also helps, as does chewing your food thoroughly. It’s also recommended that people with gastroparesis eat their larger meals earlier in the day.

The use of medications that stimulate the stomach muscles to work is another treatment option. These medications include the oral drugs cisapride, domperidone, metoclopramide and erythromycin, which is a type of antibiotic that, in lower doses, also stimulates contraction of the muscles of the stomach and small intestine. In severe cases of gastroparesis, you may receive medications intravenously (IV).

Severe gastroparesis can cause dehydration and malnutrition. When this occurs, your doctor may give you liquid food directly into your small intestine. This is called enteral nutrition. The two most common methods for delivering enteral nutrition are the nasojejunal tube, which is placed through your nose and advanced to your small intestine, and jejunostomy, which is inserted through your abdomen and into your small intestine.

If you have gastroparesis, diet modification and medication will likely be all you need to manage your symptoms and live a higher quality of life.

It’s a SMAall World

August 4th, 2020

August is typically one of the hottest months of the year, so today is an excellent time to stay indoors in the air conditioning and read a blog. The topic of this one is a genetic disorder called spinal muscular atrophy (SMA) that primarily affects infants and children and, more rarely, adults. August is Spinal Muscular Atrophy Awareness Month. 

SMA is a neuromuscular disorder. It is a progressive disease that destroys motor neurons, the nerve cells that control muscle movement. 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 a person’s ability to walk, eat or breathe.

Approximately one in every 6,000 to 10,000 babies worldwide is born with SMA. It is generally believed that as many as 25,000 American children and adults have SMA, which is the leading genetic cause of death in infants and toddlers. It is estimated that more than 75 million Americans are carriers of the mutated gene that leads to SMA. That’s nearly one in every 40 people.

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

In children who have SMA, both of their SMN1 genes are mutated or missing, and their SMN2 genes don’t make enough SMN to compensate. Without adequate SMN, 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 deficiency. These forms of SMA vary greatly in severity and in 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 genes in each cell must be mutated. To inherit SMA, both parents must carry the mutated gene and pass it along to their children. 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 classified into four types. The age at which SMA symptoms begin roughly correlates with the degree to which motor neuron function is affected. The earlier the age of onset, the greater the impact on function.

Type I SMA, also called Werdnig-Hoffmann disease, is a severe form with muscle weakness evident at birth or within the first few months. Most children with type I 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.

Children with type II SMA, also called 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 life expectancy for children with type II SMA can range from early childhood to adulthood, depending on the severity of the patient’s condition.

Type III 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 IV, or adult-onset SMA, is rare and generally does not present until people are in their 20s or 30s. People with this type of SMA can walk throughout life but typically experience mild to moderate muscle weakness, tremors and mild breathing problems. People with type IV SMA have a normal life expectancy.

SMA is typically diagnosed using a blood test that looks for the 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 confirm the SMA diagnosis.

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

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

In December 2016, nusinersen (Spinraza) was approved by the FDA 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. Then in May 2019, the FDA approved Zolgensma, the first gene replacement therapy for a neuromuscular disease. Research on additional treatments for SMA is ongoing.

Iron Overload

July 20th, 2020

Every year, Americans observe Hemochromatosis Screening and Awareness Month in July, and this year is no exception. Hemochromatosis is a big word for a disorder in which you absorb more iron from the food you eat than your body needs for optimal function. It’s essentially iron overload.

Everyone needs some iron. It’s an important nutrient that helps the hemoglobin in your blood carry oxygen to your body’s organs and tissues. But if you absorb too much, it stores up in your joints and organs, particularly your liver, heart and pancreas. If hemochromatosis goes untreated, your organs won’t be able to handle the extra iron. They can become damaged and eventually fail.

There are two types of hemochromatosis: primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron is absorbed from food. Secondary hemochromatosis results from another disease or condition such as thalassemia, an inherited blood disorder, anemia or chronic alcoholism. The primary type is much more common and the focus of this blog.

Hemochromatosis is one of the most common hereditary disorders in the United States, affecting more than one million Americans. It is more common in Caucasians of Northern European descent.

Symptoms typically appear in men between the ages of 30 and 50. They generally do not appear in women until after age 50, or after menopause, because women lose iron from the blood loss of menstruation and childbirth.

Chronic fatigue and joint pain are the most common complaints of people with hemochromatosis. But diagnosis is usually not made right away because these are symptoms of many other disorders as well. Pain in the knuckles and middle finger, referred to as the Iron Fist, is the only symptom specific to hemochromatosis.

Other symptoms of hemochromatosis include lack of energy, abdominal pain, loss of sex drive, heart flutters, weight loss, memory fog, weakness and an abnormal coloring of the skin. It may appear gray or bronzish.

Diagnosis begins with a detailed medical history. Your doctor will ask if anyone in your family has had the disorder or carries the defective genes. A thorough physical examination, including a check of the liver and spleen for swelling, is also completed. Your doctor will likely order blood tests to determine the iron level in your blood. Your doctor may recommend genetic testing to search for the defective genes.

Treatments for hemochromatosis include therapeutic phlebotomy, iron chelation therapy, dietary changes and treatment for complications. Phlebotomy is a procedure that removes blood – and as a result, excess iron – from your body. The process is similar to donating blood, but is typically done at more frequent intervals until your iron level is stabilized. After that, maintenance phlebotomies are completed on a routine basis

Iron chelation therapy uses medication to remove excess iron from your body. This is an excellent option if you’re unable to routinely have your blood removed. The medication can be injected at your doctor’s office or taken orally at home.

Since iron is absorbed from the food you eat, changes in your diet are necessary to limit the amount of iron you consume. Iron-rich foods include red meats such as beef, venison, lamb and buffalo; blue fin tuna; organ meats; and fortified breakfast cereals.

Finally, any complications that result from too much iron in your organs, including liver disease, diabetes and heart problems, can be treated as neededour prognosis depends on the amount of organ damage that occurred by the time you were diagnosed. Early diagnosis and treatment may help prevent or sometimes reverse complications of hemochromatosis. With early intervention, a normal lifespan is possible.

If organ damage has already occurred, treatment may prevent further damage and improve life expectancy, but it may not be able to reverse existing damage. If hemochromatosis is left untreated, it can lead to severe organ damage and even death.

If someone in your family history has hemochromatosis, consider getting a genetic test to screen for the defective genes. Having the genes doesn’t mean you’ll definitely develop the disorder, but at least you’ll know if you can pass on the genes to your children.

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