Energy Drinks Tied to Inattention, Hyper Behavior in Middle Schoolers

Yale University researchers looked at more than 1,600 students at middle schools in one urban school district in Connecticut. Their average age was around 12 years.

Boys were more likely to consume energy drinks than girls. The researchers also found that among boys, black and Hispanic students were more likely to drink the beverages than white students.

Children who consumed energy drinks were 66 percent more likely to be at risk for hyperactivity and inattention symptoms, according to the study in the current issue of the journal Academic Pediatrics.

RELATED: Energy Drinks Pack a Deadly Punch

Energy drinks have high levels of sugar and also often contain caffeine, the researchers noted. For the study, the investigators took into account the number and type of other sugar-sweetened drinks consumed by the students.

"As the total number of sugar-sweetened beverages increased, so too did risk for hyperactivity and inattention symptoms among our middle-school students. Importantly, it appears that energy drinks are driving this association," study leader Jeannette Ickovics, a professor in the School of Public Health, said in a Yale news release.

"Our results support the American Academy of Pediatrics recommendation that parents should limit consumption of sweetened beverages and that children should not consume any energy drinks," she added.

The students in this study drank an average of two sugary drinks a day. The number of daily sugary drinks ranged from none to as many as seven or more such drinks. Some sugar-sweetened beverages and energy drinks contain up to 40 grams of sugar each. Depending on how old they are, children should only have about 21 to 33 grams of sugar a day, according to the researchers.

Along with causing problems such as hyperactivity and inattention, sugary drinks increase children's risk of obesity, Ickovics noted. About one-third of American children are overweight or obese, according to the latest estimates from the U.S. Centers for Disease Control and Prevention.

Efforts by HealthDay to reach out to the beverage industry for comment were unsuccessful.

News From AAN: Correction on Tysabri/PML Blog (last of paper)

Last week we posted a blog about the risks of PML for patients taking Tysabri, based on news from the American Academy of Neurology (AAN) meetings which took place earlier this month. In the comments section, Chris asked that we check our facts and report back.

Well, once again, your commitment to the Life With MS Blog community has paid off.

I jotted off a quick e-mail to the Public Affairs department for Biogen/Idec and waited… and waited… and got nothing. Because, however, of the active participation of our community the conversation was noted and I got an e-mail asking if we needed any assistance directly from the senior manager for international public affairs.

I am not happy that I was wrong, but I am happy to know that we can get the correct information out to you today.

I had reported that Alfred Sandrock, MD, PhD, of Biogen/Idec, presented findings from the company’s study on progressive multifocal leukoencephalopathy (PML) in patients using Biogen/Idec’s MS drug, Tysabri. I was mistaken in my assessment of “immunosuppressive” (IS) therapy in the list of risk factors for PML.

Risk factors for PML include:

More than two years on Tysabri
Prior immunosuppressant therapy
Positive serology for JC virus infection
According to Biogen, immunosuppessants, in the context used by Dr Sandrock are limited as:

“A prior IS would be considered mitoxantrone, azathioprine, methotrexate, cyclophosphamide, mycophenolate, cladribine, rituximab, and chemotherapy (not otherwise specified).”

Not included, as you can see, are any of the other MS disease modifying therapies (DMT) or even corticosteroids like Solu-Medral or Prednisone — which is normally considered an IS drug, but not for the case of the PML warning.

The original press release that I received on the topic was incomplete and I apologize for the misunderstanding.

As a side note, I took advantage of the conversation to request more information on the companies rational in keeping the patent on the JC Virus assay test that I also mentioned in that same blog post. I’ll update you on that conversation as soon as it happens.

Once again, your voice was heard by the people who have the answers and I think we’ve cleared up the misunderstanding. Thank you all for your continued involvement in our community. It makes a big difference in the lives of so many!

Wishing you and your family the best of health

 

Plastics Chemical Tied to Changes in Boys' Reproductive Development

When expectant mothers are exposed to plastics chemicals called phthalatesduring the first trimester, their male offspring may have a greater risk of infertility later in life, a new study suggests.

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Boys exposed to the chemical diethylhexyl phthalate (DEHP) may be born with a significantly shorter anogenital distance than those not exposed to these chemicals. Anogenital distance is the distance between the anus and the genitals. A shorter anogenital distance has been linked to infertility and low sperm count, the researchers explained.

"We saw these changes even though moms' exposure to DEHP has dropped 50 percent in the past 10 years," said lead researcher Shanna Swan, a professor of preventive medicine and obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City.

"Therefore, we have not found a safe level of phthalate exposure for pregnant women," she contended.

Swan said that this study cannot prove that these boys will have fertility problems as adults or that DEHP causes these problems. However, animal studies have implicated the chemical in male reproductive problems. Based on the data from this study, Swan believes there is a strong association between exposure to DEHP and fertility in human males.

DEHP is used to soften plastics. Most exposure results from eating foods that pick up the chemical during processing, Swan said.

RELATED: 10 Toxic Household Items You Should Throw Away Now

 

 

"Since food is the largest source of DEHP for consumers, it is difficult for pregnant women to minimize exposure," she said. "Eating unprocessed food will likely help. However, eliminating DEHP from food really has to be done by food producers."

The chemical is also found in medical tubing and in a variety of products, including flooring, wallpaper, lacquers and personal care products, Swan said.

The report was published Feb. 19 in the journal Human Reproduction.

For the study, Swan's team collected data on almost 800 pregnant women and their infants.

Specifically, the researchers found that exposure in the womb to three types of DEHP was associated with a significantly shorter anogenital distance in boys, but not in girls.

A group representing the chemical industry took issue with the study, however.

In a statement, the American Chemistry Council (ACC) stressed that the study only examined one type of phthalate, not all versions of the chemical. And it said that phthalates are "one of the most widely studied family of chemicals in use today."

The ACC added that DEHP "is known to break down into its metabolites within minutes after it enters the body. Information collected by the Centers for Disease Control and Prevention over the last 10 years indicates that, despite the fact that phthalates are used in many products, exposure from all sources combined is extremely low -- much lower than the levels established as safe by scientists at regulatory agencies."

 

 

But another expert says phthalate exposure may not be benign. Dr. Kenneth Spaeth, director of the Occupational and Environmental Medicine Center at North Shore University Hospital in Manhasset, N.Y., said, "virtually everyone in the U.S. experiences continual exposure to phthalates."

And, a number of studies have tied the chemicals with changes in developing fetuses. "Phthalates, in particular, have been shown in both human and animal studies to interfere with normal fetal development," he said.

This study supports what has been demonstrated before, that phthalate exposure in the first trimester is linked to male reproductive development, Spaeth said. "This study is an important step forward in establishing this effect because the study included a much larger number of individuals than prior studies and helps identify one particular agent, DEHP, as an important contributor to this effect," he said.

Additionally, this study shows the importance of exposure in the first trimester as a critical window for the effect of phthalates on the male reproductive system. "On the whole, given these features, the authors have contributed important information about the public health risk posed by phthalates," Spaeth suggested.

Purpose in Life Is Good for Your Health

Having a strong sense of purpose in life may not guarantee happiness, but research shows it could promote good health and longevity.  

“There’s no formal definition of having a purpose in life, but the consensus is that it’s a sense of meaning and feeling that life is worth living,” says preventive cardiologist Randy Cohen, MD, medical director of University Medical Practice Associates at Mount Sinai St. Luke’s-Roosevelt Hospital in New York City.

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A Healthier Heart

Reviewing data from ten studies involving 136,000 men and women, Dr. Cohen and his colleagues found that people with a low sense of purpose, as measured by psychological surveys, were more likely to have a stroke, heart attack, or coronary artery disease requiring a stent or bypass surgery.

Individuals with a high sense of purpose had a lower risk of developing the same conditions. “We found a 23 percent reduction in mortality and a 19 percent reduction in cardiovascular events among those people,” Cohen says. That puts living purposefully on a par with other protective things people do, like engaging in exercise.

“What was so remarkable was that regardless of the country where the study was conducted, regardless of how purpose in life was defined, the effect was consistent,” says Cohen, whose findings were published this month inPsychosomatic Medicine: Journal of Biobehavioral Medicine.

 

 

A 2014 study published in The Lancet found that people over age 65 who had a higher personal sense of purpose and well-being were more likely to live longer. Among 9,000 people followed over an 8 ½-year period, 9 percent of those in the highest well-being category died as compared to 29 percent in the lowest category.

Protect the Brain

The benefits of living purposefully may not be limited to heart health. Research conducted at the Rush University Medical Center in Chicago suggests a strong sense of purpose can protect the brain.

RELATED: The Life-Saving Power of Purpose

“Purpose somehow gives your brain resilience,” says Patricia A. Boyle, PhD, a neuropsychologist with the Rush Alzheimer’s Disease Center. “It makes your brain stronger and more resistant to the effects of diseases like Alzheimer’s.”

Participants in the Rush Memory and Aging Project agree to yearly testing and organ donation so that brain tissue can be examined after death. According to four studies published by the research team, subjects who scored higher on the purpose scale were:

  •          29 percent less likely to develop mild cognitive impairment (MCI)
  •          52 percent less likely to develop Alzheimer's Disease (AD)
  •          2 ½ times more likely to be free of dementia
  •          44 percent less likely to have a stroke
  •          52.3 percent less likely to have microscopic blood vessel infarcts that damage brain tissue

How Purpose Works

What it is about a strong sense of purpose that benefits the mind and body is not entirely understood.

Evidence suggests that people who believe their lives have meaning take better care of their health. Psychologists at the University of Michigan and the University of Wisconsin found that the higher men and women scored on a purpose scale, the more likely they were to have routine screenings, such as a colonoscopy, mammogram, prostate exam, Pap smear, and cholesterol test. Higher scores on the purpose scale also translated to fewer days in the hospital.

Dr. Boyle believes a purposeful life has physiologic effects. “There is some evidence that purpose in life protects the brain against the negative effects of stress,” she says. Studies associate a stronger sense of purpose with lower levels of the stress hormone cortisol, which affects a variety of body systems.

Finding Purpose

The question then is: “If someone has a low sense of purpose, are there concrete steps we can recommend to improve that?" asks Cohen.

Mary Jo Kreitzer, RN, PhD, founder and director of the University of Minnesota's Center for Spirituality and Healing, believes the answer is “yes.” She discusses these steps in workshops and on the university’s website.

 

 

Dr. Kreitzer says reflecting on what your individual talents and gifts are is the best place to begin. Next, she says, look at the needs of the world, starting with your loved ones and community: “Ask yourself, ‘Given my unique gifts and talents, how can I make a difference?’”

Dan Buettner, author of The Blue Zones, found that cultures that live longer typically share certain things in common: healthy diet, active lifestyle, and sense of purpose. One of the blue zones Buettner writes about is Okinawa, Japan.

“In the Okinawan language, there is not even a word for retirement,” Buettner said in a speech at a 2010 TED conference. “Instead, there is one word that imbues your entire life, and that word is ‘ikigai.’ And, roughly translated, it means ‘the reason for which you wake up in the morning.’”

Eating Carbs and Fats Before a Workout? Read This

The New York Times published an article “Should Athletes Eat Fat or Carbs?” last week which was based on a study that shows a diet comprised of 85 percent fat can help improve overall performance for ultra-endurance athletes more than the traditional high-carbohydrate diet considered best for athletes. And by fat, they mean good fats that come from foods like nuts, avocados, and extra-virgin olive oil — not your cheeseburgers and French fries. But before you throw all your healthy eating rules out the window, it’s important to note that this recommendation is not for most of us — these recommendations for real athletes. We’re talking about people who exercise for a living — think NBA players, Olympic swimmers, or professional marathoners.

Let’s be honest: Most of us don’t run more than two marathons a week or work out at all hours of the day, so this way of eating is not recommended, even for high school and college players and people who exercise regularly. However, this information certainly brings into question traditional thinking and, as so often with these studies, leaves us wondering if this type of eating could benefit other types of athletes or moderately active people. We’ll need to continue to watch the research for more answers.

It’s important to remember that carbohydrates are an essential part of a healthy, well-balanced diet and provide fuel for your workouts in the form of glycogen, which is stored in the liver and muscles. Fat, however, must be broken down into fatty acids before it can be used as fuel, and only endurance athletes who vigorously exercise throughout the day are able to use up all their glycogen stores before their bodies start using fat. A ketogenic diet, like the ones the article reviews with 85 percent of the diet from fat, forces your body to use fat more readily as an energy source. This is referred to as a ‘ketoadaption’ and takes several weeks to achieve.

Still, it’s not a good idea to overdo it on carbohydrates or fat for all your meals. Fats should only comprise 20 to 30 percent of your total daily calorie intake per meal (think two slices of avocado). Carbohydrates should make up 40 to 50 percent of your meal, and sources of good carbohydrates include vegetables, fruits, legumes, and whole grains. Government experts have offered suggestions for the 2015 Dietary Guidelines, (due to be published in the fall) which encourage Americans to cut down on meat, added sugars, and starchy, high-carb foods and include more fruits, vegetables, whole grains, and healthy fats into their diets.

“The move toward reducing the amount of carbohydrates recommended for the general public is because most of us are not active. We sit too much! When we don’t move, or if we move for only an hour a day, we’re not utilizing all the carbohydrates we are eating, and therefore we continue to gain weight and increase our risk for chronic diseases. For the most part, we are moving too little and eating too much and especially carbohydrates because they are easy, available, and taste good,” says Maureen Namkoong, MS, RD nutrition and fitness director at Everyday Health.

There’s a place for good carbohydrates and fats in a balanced diet. Good carbohydrates and fats give you energy, may help you lose weight, and promote cardiovascular health. But too much of a good thing can be bad — and this is true for fats and carbs, too.

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11 Struggles Every New Runner Understands

I've never been one of those people. You know the kind, the ones who wake up in the morning or lace up in the evening and "go for a run."

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I've always been envious of my roommates, who can sneak in a jog with ease and carry on with their day, as if they had done something casually simple like taking the trash out. So, I made a vow to give running another chance. After all, the exercise has been shown to make you happier, reduce your risk for disease and even increase longevity.

While group classes and long walks will probably always be more my speed, I did find that I was enjoying running more than I ever did in the past. However, that doesn't come without a few hiccups. Below are a handful of struggles all new runners can probably relate to.

Getting winded in the first few minutes.

Probably one of the most discouraging elements of getting into a running routine is realizing that you're not as in shape as you thought you were. I continuously find myself doing more walking or jogging than actual running. But just because you need those intermittent breaks doesn't mean you aren't a runner. In fact, research shows that walking intervals during your run can help you maintain your overall pace.

Two words: Sore. Muscles.

The second-day pain is real. If you're experiencing those achy muscles, try one of these post-run remedies. Just make sure you're checking in with your body as you establish your routine. A little soreness is OK, but if the pain is more intense you may have sustained a running-related injury.

 

 

Feeling overwhelmed by the copious amount of races.

Color runs, beer runs, zombie runs, princess half marathons... the list is seriously endless. However, there are some perks to picking a race. Signing up for one helps you set a goal as you get into a routine, plus there's an opportunity to turn it into a social event by participating with your friends.

If your goal is to become a marathon runner (and props to you!), there are also some benefits there: Research shows consistent long-distance running can improve cardiovascular health and lower the risk for other organ disorders, the Wall Street Journal reported.

The jolting agony of waking up at 6 a.m.

My sleepy brain is constantly telling me my bed feels better than running (and often, the bed wins). If you need a little extra motivation, try one of these hacks to help you jumpstart your morning workout.

The boredom.

Part of the reason I never got into a routine in the first place was because the exercise itself seemed extremely dull to me (the treadmill is my arch-nemesis). Once I discovered more running-path options, I started to have more fun. However, that's not to say that I don't get a little bored sometimes — and that's OK.

Note: If you still just can't get excited by the process most of the time, you may want to try a more entertaining workout option instead. Exercise should be engaging, not mind-numbing.

Trying to find your perfect route.

Finding your favorite place to run is like finding a good apartment: It feels elusive until one day you hit the lottery. Whether you're into lush scenery or a skyline, it's important to find the routes that work for you in order to make the exercise entertaining.

The joy of picking out new workout clothes.

Sleek tanks! Compression pants! Neon shoes!

Running toward (multiple) "finish lines."

If you've ever uttered to yourself just one more pole, you're not alone. In fact, picking out an arbitrary finish line on your run can improve your performance. Research shows those who stare at a target in the distance go faster and feel less exertion than those who don't concentrate on anything, The Atlantic reported.

 

 

Bargaining with yourself on your run.

If you run five more blocks, you can binge-watch Scandal when you get home, I tell myself. Chances are I'd probably do it anyway — but at least it encourages me in the moment.

Creating a playlist that will consistently keep you motivated.

No, a simple music-streaming app won't do when your lungs are on fire and your legs feel weak. You need that one specific song that will inspire you to keep going (shout out to all my Shake It Off comrades). If you're looking for a playlist to spice up your run, check out some of these.

Eating Well As You Age

Looking in the mirror for changes as you age? A healthy diet helps to ensure that you'll like the reflection you see. Good nutrition is linked to healthy aging on many levels: It can keep you energized and active as well as fight against slowing metabolism and digestion and the gradual loss of muscle mass and healthy bone as you age.

Making healthy diet choices can help you prevent or better manage chronic conditions such as high blood pressure, high cholesterol, and diabetes. It's never too late to adopt healthier eating habits.

Strategies for Healthy Eating as You Age

Replace old eating habits with these healthy approaches:

  • Eat every three or four hours. “This keeps energy levels high and keeps appetite hormones in check to avoid overeating,” says Kim Larson, RD, of Total Health in Seattle and a spokesperson for the Academy of Nutrition and Dietetics.
  • Eat protein at each meal. Aim for 20 to 30 grams to help maintain muscle mass. Choose fish at least twice a week as a source of high quality protein. Other good sources of protein include lean meat and poultry, eggs, beans, nuts, and seeds.
  • Choose whole grains. Replace refined flour products with whole grains for more nutrients and fiber.
  • Choose low-fat dairy. Cutting out the saturated fat may help lower your risk for heart disease.
  • Learn about portion sizes. You may need to scale back on the serving sizes of foods to control your weight.
  • Choose nutrient-rich whole foods over empty calories. Whole foods are those closest to their natural state. Empty calories are typically processed foods with added salt, sugar, and fat. For example, snack on whole fruit instead of cookies.
  • Eat a “rainbow” of foods. “Eat five to seven servings of fruits and veggies each day to keep antioxidants like vitamins A, C, and E high,” Larson says. Choosing fruits and vegetables of different colors provides your body with a wide range of nutrients. According to research published in the May 2012 issue of the Journal of the American Geriatric Societyexercise coupled with higher fruit and vegetable intake led to longer lives. Fruits and veggies also fill you up with fiber, which cuts down on snacking and helps control weight, Larson says.
  • Choose healthy cooking techniques. Try steaming, baking, roasting, or sautéing food rather than frying it to cut back on fat.
  • Cut down on salt. If you’re over 51, national recommendations are to eat less than 1,500 milligrams of salt per day. Look for low-sodium foods and season your meals with herbs and spices rather than salt.
  • Stay hydrated. “Dehydration can cause irritability, fatigue, confusion, and urinary tract infections,” Larson says. Be sure to drink plenty of water and other non-caffeinated liquids throughout the day.
  • Ask about supplements. You may have changing nutrient needs as you get older and might benefit from vitamins B12 and D, calcium, and omega-3 fatty acid supplements, Larson says. Ask your doctor or a dietitian for guidance.

Overcoming Challenges to Healthy Eating

Eating a healthy diet can be complicated by changes you may face as you age, such as difficulty eating or a limited budget. There are strategies you can try to solve these common challenges:

  • If you've lost your appetite or sense of taste: Try new recipes and flavors — adding spices, herbs, and lemon juice can make foods more appealing. If you take medication, ask your doctor if appetite or taste changes are side effects and if switching to another drug might help.
  • If you have a hard time swallowing or chewing: Choose foods that are moist and easy to eat, such as nutritious soups made with beans and vegetables, Larson says.
  • If affording groceries is difficult: Shop from a list — careful planning can help you make the healthiest and most cost-effective food choices. Use coupons or shop on days when discounts are offered. Buying fruits and veggies when they’re in season and frozen produce in bulk can also help control expenses.
  • If you have trouble preparing meals: Consider buying healthy prepared or semi-prepared meals or at least pre-cut ingredients to cut down on energy-draining prep time.

Larson believes in the importance of enjoying your food. Make healthy-diet changes step by step and have fun experimenting to find new tastes and cooking styles. Eat slowly and pay attention to the experience. “Create a pleasant eatingenvironment," she says. "Sit by a window and enjoy every bite.”

What You Need to Know About Hyperpigmentation

Even small skin traumas like a pimple or bug bite can leave you with complexion-busting dark spots. “This is one of the most common ailments that patients come to see me about,” explains Jeanine Downie, MD, director of Image Dermatology in Montclair, New Jersey. “It’s an annoying condition that affects all skin types, but the good news is that it’s fairly easy to treat.”

Find out how Dr. Downie helps patients treat and avoid marks on their complexions.

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Jeanine Downie: Any trauma or inflammation to the skin — either from acne, pimples, bug bites, or simply a bump, cut, or scratch — disrupts the surface layers where you have melanin, responsible for skin’s color. As the skin heals, it leaves behind residual pigmentation and dark spots.

 

 

 

EH: Is there anything you can do to prevent it?

JD: Unfortunately, if you’re prone to these dark spots, it’s tough to prevent them. Still, picking or scratching at an irritation will further traumatize the area, so hands off! You’ll also want to be vigilant about wearing sunscreen. As your skin gets darker, so will those hyperpigmented areas — it’s not like a tan is going to even out the color. Obviously, daily sunscreen wear is a must anyway, but this is just one more reason to protect your skin from UV rays.

EH: What steps can you take to treat it?

JD: The sooner you start taking care of your wound, the better it’ll look once healed. I recommend keeping the wound covered, especially if the skin is broken, and applying a topical healing ointment.

 

 

For large cysts or cuts, you may even want to see your dermatologist for a treatment plan. Once the pimple or cut has healed, apply 2% hydroquinone cream, which is available over-the-counter, or 4% hydroquinone, available by prescription from your doctor.

If the topical creams don’t quite do the trick, talk to your dermatologist about chemical peels or laser treatments to completely eliminate more stubborn discoloration.

EH: Is hyperpigmentation more common in people with darker complexions?

JD: No matter your skin color, everyone is susceptible to hyperpigmentation. Still, those with darker complexions seem to hold on to those spots for much longer because they have more melanin in their skin. It also means those hyperpigmented areas are going to be darker and more visible as well. Pregnancy and certain medications can increase your body’s production of melanin, and lead to hyperpigmentation as well.

6 Ways to Prep Your Skin for Summer

Scheduling vacation plans and buying a new swimsuit will mentally prepare you for summer, but your skin may need some help getting ready, too. For gorgeous, smooth skin you'll feel ready to bare, you need to take a few simple steps. Try this head-to-toe refresher to take your skin out of hibernation.

1. Reveal Glowing Skin

Regular exfoliation can be a part of a healthy skin regimen no matter the season; as long as your skin is not sensitive, exfoliation can help you achieve smooth, healthy-looking skin that makes you look more glowing and youthful. “But it must be done with care,” says Doris Day, MD, a dermatologist in New York City. “The goal is to lift off the outer layer of skin cells that are ready to be sloughed off without stripping the skin.”

 

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Brushes, polishing cloths, and scrubs offer easy ways to smooth away rough spots. Rotating cleansing brushes work by physically buffing off the dead skin cells. Exfoliating cloths, microdermabrasion kits, and scrubs with granular ingredients also operate the same way. “For the body, look for a scrub that contains coarse particles that dissolve over time, like sugar, so you don’t irritate the skin,” says Dr. Day.

Products that chemically exfoliate the skin contain ingredients such as glycolic, salicylic, or polyhydroxy acids that cause the skin to shed its outer layer and reveal the newer layer.

2. Remove Hair Without Irritation

If your summer forecast calls for sunny days at the beach or poolside, you may be putting some effort into removing unwanted hair. But once you rip off the wax strip, it’s also important to care for the skin that’s newly exposed to the elements.

Give your skin some time to recover before rolling out your beach towel or getting active outdoors. “I advise clients to stay out of the sun or heat for at least 48 hours after any hair-removal process,” says Cindy Barshop, owner of Completely Bare spas. “Follicles are vulnerable to irritation, and skin may be sensitive due to any heat or friction from lasers, waxing, or shaving.”

Since most of us don’t plan our hair removal that far in advance, buffer your tender skin with an oil-free sunscreen, wait for it to dry (about 5 minutes), and dust on some talc-free baby powder, says Barshop. To prevent ingrown hairs, it’s helpful to wear loose-fitting clothing and use an after-waxing product that contains glycolic and salicylic acids, which team up to prevent dead skin cells from causing bothersome bumps.

 

 

3. Fight UV Rays With Food

All the work you put into making your skin look good won’t be worth it unless you guard it from the sun’s damaging rays, which are strongest during the summer. Surprisingly, you can protect yourself from the inside, too. “In addition to usingsunscreen, eat cooked tomatoes every day if you know you’re going to be in the sun,” says Jessica Wu, MD, assistant clinical professor of dermatology at USC Medical School. According to research, cooked tomatoes are rich in lycopene, an antioxidant that helps fight the effects of UV rays such as redness, swelling, and blistering from sunburn. If you plan to spend a lot of time outdoors, you may benefit from consuming tomato sauce, grilled tomatoes, or even Bloody Marys. “This doesn’t replace sunscreen, but the habit could give you additional protection if you can’t reach your back and miss a spot,” Dr. Wu adds.

4. Clear Up Body Breakouts

It’s no better to have acne on your body than on the face, especially in the heat, when hiding and covering up isn’t an option. The approach to treating acne on the back, chest, and elsewhere on the body is the same as treating facial acne: “Exfoliate regularly, don’t pick, and treat with effective ingredients,” says Day.

Washing with products that contain salicylic acid helps slough off the dead skin cells; a treatment product with micronized benzoyl peroxide can also help by penetrating the skin and killing off the bacteria that cause acne.

If your skin is sensitive, investing in an acne-treating blue light tool may be worth the cost. “You simply wave the light wand over skin for five minutes daily and it helps kill bacteria,” says Leslie Baumann, MD, a dermatologist in Miami. If you have severe body acne, see a dermatologist.

5. Erase Cellulite

First, the good news: Some products may be able to smooth out the undesirable dimples and unevenness of cellulite. The bad news: They won’t get rid of cellulite forever. The smoothing and toning effect, like many good things in life, is fleeting. Still, it may be worth slathering on a toning body lotion to make your skin look and feel tighter for a day at the beach or a special event.

“Products that contain caffeine and theophylline temporarily dehydrate fat cells,” says Dr. Baumann. “However, it’s the massage and the application of the cream that does the work.” The best course of action long-term is to exercise regularly, coupled with targeted massage, suggests Baumann.

Another way to hide cellulite is to apply a fake tan. Take advantage of the newest self-tanners, which have come a long way from the strong-smelling streaky creams or sprays of yesteryear. “There has been so much progress in the formulations — the colors are natural, there’s no streaking, and the scent is so much better,” says Day.

6. Treat Your Feet

If you’ve stuffed your feet inside boots all winter, they probably could use a little TLC for sandal weather. Jump-start your program with a salon pedicure, or if you’re short on time, you can heed Day’s DIY tip, which will help soften feet while you sleep. First, remove thicker skin with a foot file. Apply a rich emollient cream or ointment, then cover the feet in plastic wrap and cotton socks. Leave on overnight. Repeat every day until you achieve smooth skin, then once a week to maintain soft skin.

7 Healthy Habits of the 2016 Presidential Candidates

The New Hampshire primary's in full swing, and if there’s one thing all the presidential hopefuls can agree on, it’s that running for office is the ultimate endurance challenge. They’re canvassing across the country with little time to exercise or sleep, and it doesn’t help that at every stop they’re tempted by unhealthy foods like pizza, pork chops, and pies. So how do the presidential candidates stay healthy and keep their energy levels up during the grueling primary season? Read on to find out!

What Is Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an illness that can result in muscle weakness or loss of muscle function in parts of the body.

In people with Guillain-Barré syndrome (pronounced GHEE-yan ba-RAY), the body's own immune system attacks the peripheral nervous system.

The peripheral nervous system includes the nerves that connect the brain and spinal cord to the limbs. These nerves help control muscle movement.

GBS Prevalence

Guillain-Barré syndrome is a rare disease.

The Centers for Disease Control and Prevention (CDC) estimates that about 1 or 2 out of every 100,000 people develop GBS each year in the United States.

Anyone can get GBS, but the condition is more common in adults than in children, and more men than women are diagnosed with GBS each year.

Causes and Risk Factors

Doctors don't know what causes Guillain-Barré syndrome.

Many people with GBS report a bacterial or viral infection (such as the flu) days or weeks before GBS symptoms start.

Less common triggers for GBS may include:

  • Immunizations
  • Surgery
  • Trauma

Guillain-Barré syndrome is not contagious — it cannot spread from one person to another.

Types of GBS

There are several types of Guillain-Barré syndrome, which are characterized by what part of the nerve cell is damaged.

The most common type of GBS is called acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

In AIDP, the immune system mistakenly attacks the protective nerve covering that helps transmit nerve signals from the brain to other parts of the body.

Guillain-Barré Syndrome Symptoms

The first symptoms of Guillain-Barré syndrome often include feelings of tingling or weakness in the feet and legs. These feelings may spread to the arms and face.

The chest muscles can also be affected. Up to a quarter of people with GBS experience problems breathing.

In very severe cases, people with GBS may lose all muscle function and movement, becoming temporarily paralyzed.

Signs and symptoms of Guillain-Barré syndrome may include:

  • Pricking or tingling "pins and needles" sensations in the fingers, toes, ankles, or wrists
  • Muscle weakness that starts in the legs and spreads to the upper body
  • Unsteady walking
  • Difficulty with eye or facial movements (blinking, chewing, speaking)
  • Difficulty controlling the bowels or bladder
  • Rapid heart rate
  • Difficulty breathing

What Is Binge Eating Disorder?

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It's unclear what causes binge eating disorder.

Like other eating disorders, BED is probably caused by a combination of genetic, psychological, and social factors.

Some risk factors for binge eating disorder include:

  • A history of anxiety or depression
  • A history of dieting (especially in unhealthy ways, such as skipping meals or not eating enough food each day)
  • Painful childhood experiences, such as family problems

Symptoms of Binge Eating Disorder

People with binge eating disorder have frequent bingeing episodes, typically at least once a week over the course of three months or more.

Binge eating episodes are associated with three or more of the following:

  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when you're not feeling hungry
  • Eating alone, because you feel embarrassed about how much you're eating
  • Feeling extremely disgusted, depressed, or guilty after eating

Some people also display behavioral, emotional, or physical characteristics, such as:

  • Secretive food behaviors, including hoarding, hiding, or stealing food
  • Feelings of anger, anxiety, worthlessness, or shame preceding a binge
  • Feeling disgusted with your body size
  • A strong need to be in control, or perfectionist tendencies

Binge Eating Disorder Treatment

If you have binge eating disorder, you should seek help from a specialist in eating disorders, such as a psychiatrist or psychologist.

There are several treatments available for BED. Treatment options may include:

 

10 Varicose Veins Myths

If you have ropy, blue blood vessels in your legs, you may think that they’re unsightly but don't cause any overt symptoms. Yet for some people, varicose veins can cause skin damage and, even worse, lead to dangerous blood clots.

They’re incredibly common: Varicose veins affect about one in four U.S. adults, or about 22 million women and 11 million men between ages 40 and 80.

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Your leg veins face an uphill battle as they carry blood from your toes to your heart. Small flaps, or valves, within these vessels prevent blood from getting backed up on this journey, and the pumping action of your leg muscles helps push the blood along. 

But if these valves weaken, blood can pool — primarily in the veins of your legs — increasing pressure in the veins. As a result of this increased pressure, your body tries to widen the veins to compensate, causing them to bulge and thicken, and leading to the characteristic twisted appearance of varicose veins.

 

 

To help you learn the facts about these enlarged veins, we've set the record straight on 10 sometimes confusing pieces of information, including who gets varicose veins and why, health problems they can cause, and treatment options.

Myth 1: Varicose Veins Are Only a Cosmetic Issue

“A lot of people are told by primary care doctors or others that varicose veins are a cosmetic issue only, when oftentimes they can be much more than that,” saysKathleen D. Gibson, MD, a vascular surgeon practicing in Bellevue, Washington.

“A significant percentage of patients with varicose veins will eventually develop symptoms,” says Pablo Sung Yup Kim, MD, assistant professor of surgery at Mount Sinai's Icahn School of Medicine in New York City. “The most common include dull achiness, heaviness, throbbing, cramping, and swelling of the legs.” Other symptoms include severe dryness and itchiness of the skin near varicose veins. People with varicose veins are also at an increased risk for a dangerous type of blood clot known as deep vein thrombosis.

Other not-so-common signs and symptoms, found in less than 10 percent of patients, include bleeding, skin discoloration, skin thickening, and ulcer formation — all due to varicose veins, says Kim. Unfortunately, once you have skin damage, it’s usually permanent.

“It’s very important to seek medical advice if you have varicose veins and experience symptoms — before changes in the skin are irreversible,” he says.

Myth 2: Varicose Veins Are an Inevitable Sign of Aging

Aging definitely worsens varicose veins, though not everyone gets them. “It's a degenerative process that gets worse and more prominent as we age,” says Dr. Gibson. But young people can get varicose veins, too. While the average age of patients treated in Gibson’s practice is 52, she and her colleagues have treated patients as young as 13.

If you've got varicose veins, it may run in your family. “The cause of varicose veins is primarily genetic,” Gibson explains.

Changes in hormone levels also come into play as a risk factor for varicose veins. “Your risk can be made worse, especially by pregnancy,” she adds.

Myth 3: Varicose Veins Are Strictly a Women’s Issue

While varicose veins are more common in women, men get them, too. About one-quarter of adult women have some visible varicose veins, compared to 10 to 15 percent of men.

Steve Hahn, 51, of Kirkland, Washington, first noticed in his twenties that he had varicose veins in his left leg after he sprained his ankle playing basketball. When he injured his knee about 10 years ago, he noticed that the varicose veins had become more extensive.

“After about five years of thinking about it, I finally had them treated,” he says. “Both of my legs felt very heavy all of the time at this point, as opposed to just after walking a golf course or playing tennis or basketball.”

After treatment, Hahn says, “I feel like I have new legs.” The heaviness is gone, as is the ankle swelling, which he didn't know was related to the varicose veins. And as a side benefit, he adds, he looks better in shorts.

Myth 4: Running Can Cause Varicose Veins

Exercise — including running — is usually a good thing for your veins. “Exercise is always good for the circulation,” Kim says. “Walking or running can lead to more calf-muscle pumping and more blood returning to the heart.”

“Being a runner doesn’t cause varicose veins,” adds Gibson, though there's controversy about whether exercise makes them worse or not.” Compression stockings can help prevent blood from pooling in your lower legs during exercise. “For patients who haven't had their varicose veins treated and are running, I recommend compression. When you’re done running and are cooling off, elevate your legs,” she says.

Myth 5: Varicose Veins Are Always Visible

While the varicose veins you notice are right at the surface of the skin, they occur deeper in the body, too, where you can't see them. “It really depends on the makeup of the leg,” Gibson says. “If you've got a lot of fatty tissue between the muscle and the skin, you may not see them. Sometimes surface veins are the tip of the iceberg and there's a lot going on underneath.”

Myth 6: Standing on the Job Causes Varicose Veins

If you have a job that requires you to be on your feet a lot — as a teacher or flight attendant, for example — you may be more bothered by varicose veins. But the jury's still out on whether prolonged standing actually causes varicose veins. “People tend to notice their varicose vein symptoms more when they’re standing or sitting,” Gibson explains.

RELATED: Steer Clear of These 9 Artery and Vein Diseases

Myth 7: Making Lifestyle Changes Won't Help

Your lifestyle does matter, because obesity can worsen varicose veins, and getting down to a healthy weight can help ease symptoms. Becoming more physically active is also helpful. “Wearing compression stockings, doing calf-strengthening exercises, and elevating your legs can all improve or prevent varicose veins,” saysAndrew F. Alexis, MD, MPH, chairman of the dermatology department at Mount Sinai St. Luke's and Mount Sinai Roosevelt in New York City.

Myth 8: Surgery Is Your Only Treatment Option

The only treatment available for varicose veins used to be a type of surgery called stripping, in which the vein is surgically removed from the body. That’s no longer the case. While this procedure is still the most commonly used varicose vein treatment worldwide, according to Gibson, minimally invasive procedures that don't leave scars have become much more popular in the United States.

Endothermal ablation, for example, involves using a needle to deliver heat to your vein, causing it to close and no longer function. While the procedure doesn't leave a scar, it can be painful, and you may have to undergo sedation before being treated. “You have to have a series of injections along the vein to numb it up; otherwise, you wouldn't be able to tolerate the heat,” Gibson explains. You may need to take a day off from work to recover, as well as a few days off from the gym.

Some medications, called sclerosing agents, close a vein by causing irritation. Others are adhesives that seal a vein shut and don’t require the area to be numbed. Gibson and her colleagues have helped develop some of the new technologies and products used in treating varicose veins, including adhesives.

Milder varicose veins can be treated by dermatologists with non-invasive approaches, such as laser therapy and sclerotherapy, says Dr. Alexis. “For more severe cases where symptoms may be involved, seeing a vascular surgeon for surgical treatment options is advised.”

Although treatment for varicose veins means losing some veins, you have plenty of others in your body that can take up the slack, explains Gibson. “The majority of the blood flow in veins in the leg is not on the surface at all; it's in the deep veins within the muscle,” she says. “Those deep veins … are easily able to take over for any veins that we remove on the surface.”

Myth 9: Recovery After Varicose Vein Treatments Is Difficult

 

 

Newer treatments have quicker recovery times. “These procedures can be performed in an office within 20 to 30 minutes with no recovery time. Patients can usually return to work or daily activities on the same day,” Kim says.

Myth 10: Varicose Veins Can Be Cured

Treatments are effective, but they aren't a cure, Gibson says. Sometimes, varicose veins can make a repeat appearance after treatment. “What I tell my patients is it's kind of like weeding a garden,” she says. “We clear them all out, but that doesn't mean there's never going to be another dandelion popping out.”

10 Essential Facts About Ovarian Cancer

Statistically speaking, ovarian cancer is relatively rare: It represents just 1.3 percent of all new cancer cases in the United States each year, according to the National Cancer Institute (NCI). But although its numbers are small, the fear factor for many women may be disproportionately large.

We spoke to two leading ovarian cancer experts: Robert J. Morgan, Jr., MD, professor, and Mihaela C. Cristea, MD, associate clinical professor, of the medical oncology and therapeutics research department at City of Hope, an NCI-Designated Comprehensive Cancer Center in Duarte, California.

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Here are 10 essential facts about ovarian cancer that you should know:

1. About 20,000 women in the United States are diagnosed with ovarian cancer each year. As a comparison, nearly 250,000 women will be diagnosed with breast cancer this year, according to the American Cancer Society. Of the women diagnosed with ovarian cancer, 90 percent will be older than 40; most ovarian cancers occur in women 60 or older, according to the CDC.

2. You should see your doctor if you experience any of these ovarian cancer symptoms:

  • Vaginal bleeding (especially if you’re past menopause)
  • Abnormal vaginal discharge
  • Pain or pressure in the area below your stomach and between your hip bones
  • Back pain
  • A change in bathroom habits, such as urgently needing to urinate, urinating frequently, or having constipation or diarrhea

It’s important to pay attention to your body and know what’s normal for you. If you have abnormal vaginal bleeding or have any of the other symptoms for two weeks or longer, see your doctor right away.

 

 

These symptoms can be caused by many different problems, but it’s best to have them evaluated, suggests the University of Texas MD Anderson Cancer Center.

3. It’s tricky to pinpoint early, milder symptoms of ovarian cancer. However, the findings of a study published in Cancer in 2007 point to a cluster of vague symptoms that may suggest the need for ovarian cancer testing, says Dr. Morgan. In the study, researchers linked these symptoms to the possibility of ovarian cancer:

  • Pelvic or abdominal pain
  • Strong urge to urinate or frequent urination
  • Bloating or increased abdominal size
  • Difficulty eating or feeling full early

If a woman experiences these symptoms on more than 12 days a month for less than one year, she should insist that her doctor perform a thorough ovarian evaluation, says Morgan. This might include the CA-125 blood test or atransvaginal ultrasound exam.

4. Early detection can mean a better prognosis. When detected early enough, ovarian cancer can be cured. “Stage 1 and stage 2 ovarian cancer is curable about 75 to 95 percent of the time, depending on the tumor grade and cell type,” says Morgan. But because this cancer occurs deep inside the body’s pelvic region, it is often diagnosed in later stages, he says. The cure rate for stage 3 ovarian cancer is about 25 to 30 percent, and for stage 4 it's less than 5 percent, he adds.

RELATED: Overcoming Ovarian Cancer, Twice

5. Ovarian cancer has several key risk factorsThese include:

  • Women with a family history of ovarian cancer may be at higher risk.
  • Women who have never been pregnant and women who have uninterrupted ovulation due to infertility treatments seem to be at higher risk.
  • Early onset of your period, or having a late menopause, seems to increase risk.
  • Using talcum powder in the genital area may increase risk.
  • Smoking is a risk factor for a type of ovarian cancer known as mucinous ovarian cancer. Quitting smoking seems to reverse the risk back to normal, says Morgan.

6. Ovarian cancer is not a single disease. In reality, it’s a diverse group of cancers that respond to different treatments based on their molecular characteristics, says Dr. Cristea. Treatment will also depend on other health conditions, such as diabetes or heart problems, that a woman might have.

7. Ovarian cancer treatments are evolving and improving all the time.Immunotherapy is emerging as a new treatment option for many malignancies, including ovarian cancer,” says Cristea. In another recent development, the firstPARP inhibitor, a DNA-repair drug, has been approved for women with BRCA-mutated ovarian cancer when chemotherapy hasn’t worked. “Women should also ask their doctors about clinical trials that are evaluating immunotherapy as well as other new treatments,” she adds.

 

 

8. Surgery may prevent ovarian cancer in women at very high risk. For women who carry the BRCA or other genes that predispose them to ovarian cancer, doctors often recommend surgery to remove the ovaries and fallopian tubes.Angelina Jolie, the actor and human rights activist, decided to have this surgery in March 2015. “Removing the ovaries can decrease the risk of developing the disease by 98 percent, and can substantially decrease the risk of developing breast cancer,” notes Morgan. Women in this very high-risk group should opt for this surgery after they’ve completed childbearing at around age 35, he notes.

9. Even after remission, ovarian cancer can still respond to treatment. “About 80 to 90 percent of ovarian cancer patients will achieve remission after chemotherapy treatment,” says Morgan. However, many of those women will later experience a recurrence of the cancer. The longer the remission, notes Morgan, the better the chances are for achieving a second remission.

10. It’s best to see an ovarian cancer specialist. When you’ve been diagnosed with ovarian cancer, getting a referral to an ovarian cancer specialist is a wise move, says Cristea. If you’re having surgery, it’s best to have a gynecologic oncologist perform the operation instead of a gynecologist, she adds. And to make sure you’re getting state-of-the-art treatment, consider seeking a second opinion at a NCI-Designated Cancer Center.

Model for a Hepatitis C Cure: Success in the Cherokee Nation

For 9 out of 10 American Indians, treatment led to a hepatitis C cure.

For most of the 3.5 million Americans living with a hepatitis C infection today, the promise of a cure is an empty one unless patients can get proper care. And deaths from hepatitis C keep rising, surpassing deaths from HIV.

Now, in a successful pilot program by the Cherokee Nation Health Services of northeastern Oklahoma, a May 2016 Centers for Disease Control and Prevention (CDC) report shows that curing hepatitis C is possible not only in clinical trials, but also in the larger population — even in remote and impoverished areas.

 

Local Hepatitis C Screening Success

American Indians and Alaska Natives have the highest rates of death from hepatitis C of any group in the United States, and also the highest number of new hepatitis C infections, according to the CDC, says Jorge Mera, MD, lead study author and director of infectious diseases at Cherokee Nation Health Services, though he says it’s not known why. “We made a great effort to detect hepatitis C virus-positive patients," he says. "Hepatitis C virus is known as the invisible epidemic — we tried to make it visible.”

To get more people screened, the health services implemented an electronic health record reminder to target everyone born between 1945 and 1965. The automatic alert prompted medical providers if the patient they were seeing that day was due for a hepatitis C screening test based on the patient's birthdate. This pilot program resulted in a fivefold increase in first-time hepatitis C testing between 2012 and 2015, from 3,337 people to 16,772 and included 131,000 American Indian people, mostly from rural northeastern Oklahoma.

The program educated healthcare providers on how important it is to identify these patients as early as possible, and to offer them treatment. It also informed them about the many ways people are exposed to hepatitis C, including by using or having used IV or intranasal drugs, having been incarcerated, or having received a blood transfusion before 1992. The CDC recommends testing for all people with such histories.

 

Progress in National Hepatitis C Screening

A report on a second, national initiative by the Indian Health Service (IHS) that ramped up hepatitis C testing in a similar way was also published in May 2016 in the CDC's Morbidity and Mortality Weekly Report (MMWR). As of June 2015, the number of people they had screened overall increased from 14,402 to 68,514 over three years, varying by region from 31 to 41 percent of people in the high-risk age group.

“The Indian Health Service’s screening rates for American Indian and Alaska Native patients in the [1945 to 1965] birth cohort have more than tripled since the national recommendations were released, greatly increasing the potential for early detection and follow-up for our patients living with hepatitis C infection,” says Susan Karol, MD, Indian Health Service chief medical officer and member of the Tuscarora Indian Nation in Niagara Falls, New York. The Indian Health Service provides healthcare for 1.9 million American Indian and Alaska Native people, including 566 different recognized tribes.
A Second Test for Active Hepatitis C

“Once patients were detected as HCV-positive, a confirmatory viral blood test was performed to make sure they had an active infection,” says Mera about his hepatitis C program. This test looks for RNA that’s proof of ongoing hepatitis C virus replication in the patient’s blood.

Of the 715 people who tested positive on the first screening test, 68 percent had an active infection. They were referred to one of five hepatitis C virus clinics set up by Cherokee Nation Health Systems, which had primary care providers who were specifically trained through the Extension for Community Healthcare Outcomes (ECHO) program. Outreach also included home visits to people who had hepatitis.
Access to Hepatitis C Drugs That Can Cure

A high proportion of the people who had an active infection — 57 percent — received antiviral drug treatment in this pilot program. Ninety percent were cured of hepatitis C.

“We don’t deny treatment to anybody because they’re depressed or have an alcohol dependence medical problem,” says Mera, though this is often a barrier to getting approvals for antiviral treatment. “We do offer and encourage them to be enrolled in a behavioral health program to address the other medical conditions. As long as they’re following up with the medical appointments and interested in HCV treatment, we will treat their hepatitis C virus.”

David Rein, PhD, program area director of the public health analytics division of NORC, an independent research institution at the University of Chicago, says access to hepatitis C care is improving for some. “In March, the U.S. Veterans Administration dropped all restrictions on treatment and began to provide treatment to any veteran in its system who is infected with the virus, regardless of how far the disease has progressed. Unfortunately, the VA is the exception and not the rule. Many state Medicaid programs and private insurance plans still place unnecessary barriers on treatment access.”   

Coverage to pay for medications is a barrier for many people with hepatitis C, notes a May 2016 editorial in The Journal of the American Medical Association.

The key to success, Mera says, is being relentless. “We have a wonderful group of case managers dedicated to hepatitis C treatment procurement,” he says. “They will work with the third party payers such as Medicaid, Medicare, and private insurance, and also with the patient assistance programs. Our case managers will not take no for an answer very easily, and will exhaust all the possibilities they have to obtain the medications.”
How to Cure Hepatitis C Across the United States

The three steps to a hepatitis C cure are to:

    Get screened to see if you’ve ever been exposed to the hepatitis C virus
    Get tested for active viral infection
    Get effective drug treatment

Yet half of Americans infected with hepatitis C don’t know they have it, while many of those who do know can’t get access to care or can’t pay for the antiviral medication they need.

A plan to cure hepatitis C is important because cases of infection have increased more than 2.5 times from 2010 to 2014, and deaths from hepatitis C are on the rise, exceeding 19,000 per year, according to the CDC's U.S. viral hepatitis surveillance report, published in May 2016.  

“Acute cases, which occur when a patient is first infected with hepatitis C, are increasing at an alarming rate, likely due to higher rates of injection drug use,” says Dr. Rein. But this group of people is not likely to develop symptoms of liver dysfunction for several decades.

“The record number of hepatitis C deaths that the CDC reported for 2014 is almost exclusively related to people who were initially infected with the disease in the 1960s, ‘70s, and ‘80s who developed chronic infections which gradually destroyed their livers over the course of decades,” he explains.

Rein and his colleagues had predicted in 2010 that deaths from hepatitis C would increase to 18,200 annually by the year 2020, peak at 36,000 in 2033, and kill more than one million Americans by the year 2060 if we didn't take action to prevent it. But the sobering reality is that the U.S. case numbers have already exceeded that prediction, with more than 19,000 cases in 2014.

“I still believe that is what will happen if nothing is done to address the epidemic,“ Rein says. “However, I’m both hopeful and confident in our healthcare system, and I believe that we’ll see vastly expanded testing and treatment, which will lead to dramatic reductions in deaths from hepatitis C in the years to come.”

More people, especially those born between 1945 and 1965, need to be tested for the hepatitis C antibody, he says. “Simply disseminating guidelines and providing reimbursement for testing is insufficient to assure that doctors test their patients. Interventions are needed to prioritize testing for hepatitis C.”

The Cherokee Nation group is now working with the CDC on a model that experts hope can be expanded throughout the country to lead people effectively from screening through to a hepatitis C cure.

What can help the model succeed? According to Mera, support, commitment, and trust:

    Political support (in the Cherokee Nation program, from the tribe’s chief and council)
    Commitment and trust from the administration to do the right thing to eliminate hepatitis C
    Dedicated and motivated team members who include primary care providers (nurse practitioners, physicians, pharmacists), lab technicians, nurses, administrators, behavioral health personnel, case managers, and clerks who understand the importance and urgency of hepatitis C screening and a cure

“My wish would be that patients would ask their medical providers to test them for HCV if they think they could have been exposed. This would increase screening, the first step in visualizing the invisible epidemic,” says Mera.

 

Loneliness May Fuel Mental Decline in Old Age

Slower deterioration seen in people with more satisfying relationships, researchers say.

Loneliness and depression are linked to an increased risk of mental decline in the elderly, a new study suggests.

Researchers analyzed data from more than 8,300 American adults aged 65 and older who were assessed every two years between 1998 and 2010. Seventeen percent reported loneliness at the beginning of the study, and half of those who were lonely had depression.

Over the course of the study, mental decline was 20 percent faster among the loneliest people than among those who weren't lonely. People who were depressed at the start of the study also had faster mental decline.

However, lower mental function did not lead to worsening loneliness, according to the study scheduled for presentation Monday at the Alzheimer's Association International Conference in Washington, D.C. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

RELATED: The Health Risks of Loneliness 

"Our study suggests that even one or two depressive symptoms -- particularly loneliness -- is associated with an increased rate of cognitive decline over 12 years," study author Dr. Nancy Donovan said in an association news release. She is a geriatric psychiatrist at Brigham and Women's Hospital in Boston and an instructor in psychiatry at Harvard Medical School.

"We found that lonely people decline cognitively at a faster rate than people who report more satisfying social networks and connections. Although loneliness and depression appear closely linked, loneliness may, by itself, have effects on cognitive decline," she explained.

This is important to know for the development of treatments to enhance mental health and quality of life for older adults, she added.

The new study suggested a link between loneliness, depression and heightened risk of mental decline, but it did not prove cause-and-effect.

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

Eating Well As You Age

Looking in the mirror for changes as you age? A healthy diet helps to ensure that you'll like the reflection you see. Good nutrition is linked to healthy aging on many levels: It can keep you energized and active as well as fight against slowing metabolism and digestion and the gradual loss of muscle mass and healthy bone as you age.

Making healthy diet choices can help you prevent or better manage chronic conditions such as high blood pressure, high cholesterol, and diabetes. It's never too late to adopt healthier eating habits.

Strategies for Healthy Eating as You Age

Replace old eating habits with these healthy approaches:

  • Eat every three or four hours. “This keeps energy levels high and keeps appetite hormones in check to avoid overeating,” says Kim Larson, RD, of Total Health in Seattle and a spokesperson for the Academy of Nutrition and Dietetics.
  • Eat protein at each meal. Aim for 20 to 30 grams to help maintain muscle mass. Choose fish at least twice a week as a source of high quality protein. Other good sources of protein include lean meat and poultry, eggs, beans, nuts, and seeds.
  • Choose whole grains. Replace refined flour products with whole grains for more nutrients and fiber.
  • Choose low-fat dairy. Cutting out the saturated fat may help lower your risk for heart disease.
  • Learn about portion sizes. You may need to scale back on the serving sizes of foods to control your weight.
  • Choose nutrient-rich whole foods over empty calories. Whole foods are those closest to their natural state. Empty calories are typically processed foods with added salt, sugar, and fat. For example, snack on whole fruit instead of cookies.
  • Eat a “rainbow” of foods. “Eat five to seven servings of fruits and veggies each day to keep antioxidants like vitamins A, C, and E high,” Larson says. Choosing fruits and vegetables of different colors provides your body with a wide range of nutrients. According to research published in the May 2012 issue of the Journal of the American Geriatric Societyexercise coupled with higher fruit and vegetable intake led to longer lives. Fruits and veggies also fill you up with fiber, which cuts down on snacking and helps control weight, Larson says.
  • Choose healthy cooking techniques. Try steaming, baking, roasting, or sautéing food rather than frying it to cut back on fat.
  • Cut down on salt. If you’re over 51, national recommendations are to eat less than 1,500 milligrams of salt per day. Look for low-sodium foods and season your meals with herbs and spices rather than salt.
  • Stay hydrated. “Dehydration can cause irritability, fatigue, confusion, and urinary tract infections,” Larson says. Be sure to drink plenty of water and other non-caffeinated liquids throughout the day.
  • Ask about supplements. You may have changing nutrient needs as you get older and might benefit from vitamins B12 and D, calcium, and omega-3 fatty acid supplements, Larson says. Ask your doctor or a dietitian for guidance.

Overcoming Challenges to Healthy Eating

Eating a healthy diet can be complicated by changes you may face as you age, such as difficulty eating or a limited budget. There are strategies you can try to solve these common challenges:

  • If you've lost your appetite or sense of taste: Try new recipes and flavors — adding spices, herbs, and lemon juice can make foods more appealing. If you take medication, ask your doctor if appetite or taste changes are side effects and if switching to another drug might help.
  • If you have a hard time swallowing or chewing: Choose foods that are moist and easy to eat, such as nutritious soups made with beans and vegetables, Larson says.
  • If affording groceries is difficult: Shop from a list — careful planning can help you make the healthiest and most cost-effective food choices. Use coupons or shop on days when discounts are offered. Buying fruits and veggies when they’re in season and frozen produce in bulk can also help control expenses.
  • If you have trouble preparing meals: Consider buying healthy prepared or semi-prepared meals or at least pre-cut ingredients to cut down on energy-draining prep time.

Larson believes in the importance of enjoying your food. Make healthy-diet changes step by step and have fun experimenting to find new tastes and cooking styles. Eat slowly and pay attention to the experience. “Create a pleasant eatingenvironment," she says. "Sit by a window and enjoy every bite.”

What Is Binge Eating Disorder?

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It's unclear what causes binge eating disorder.

Like other eating disorders, BED is probably caused by a combination of genetic, psychological, and social factors.

Some risk factors for binge eating disorder include:

  • A history of anxiety or depression
  • A history of dieting (especially in unhealthy ways, such as skipping meals or not eating enough food each day)
  • Painful childhood experiences, such as family problems

Symptoms of Binge Eating Disorder

People with binge eating disorder have frequent bingeing episodes, typically at least once a week over the course of three months or more.

Binge eating episodes are associated with three or more of the following:

  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when you're not feeling hungry
  • Eating alone, because you feel embarrassed about how much you're eating
  • Feeling extremely disgusted, depressed, or guilty after eating

Some people also display behavioral, emotional, or physical characteristics, such as:

  • Secretive food behaviors, including hoarding, hiding, or stealing food
  • Feelings of anger, anxiety, worthlessness, or shame preceding a binge
  • Feeling disgusted with your body size
  • A strong need to be in control, or perfectionist tendencies

Binge Eating Disorder Treatment

If you have binge eating disorder, you should seek help from a specialist in eating disorders, such as a psychiatrist or psychologist.

There are several treatments available for BED. Treatment options may include:

 

DIY Beauty Treatments for Every Skin Problem

  • 1 / 7   DIY Beauty Solutions

    Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.

    Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.

  • 2 / 7   Problem: Hyperpigmentation and dark spots

    Solution: Fresh lemon juice and a red onion


    Lemon juice and red onions are naturally acidic, and when combined together, they create a gentle-yet-effective at-home alternative to dark spot and hyperpigmentation treatments that are often formulated with harsh chemicals.

    For best results, Michael Lin, MD, a board-certified dermatologist in Beverly Hills, California, suggests blending ¼ of a red onion with freshly squeezed lemon  juice before applying it to the desired area with a Q-tip. After 10 to15 minutes, wash off the homemade treatment with a mild cleanser.

  • 3 / 7   Problem: Dry, calloused hands and feet

    Solution: Almond milk and coffee grounds


    For a smoothing hand and foot scrub, Lin suggests combining almond milk with leftover coffee grounds from your morning roast. Almond milk is rich in antioxidants and vitamin E, which helps protect skin from free radicals that can damage cells and break down collagen. Coffee grounds, on the other hand, offer exfoliating benefits that help reveal radiant skin. “Using a caffeine scrub helps to stimulate cells and elastin, and temporarily firm the skin,” says Lin. 

    Combine 2 cups of almond milk and the coffee grounds in a bowl, then scrub the formula in circular motions on your hands and feet.

  • 4 / 7   Problem: Dull skin

    Solution: Peppermint tea


    Using topical treatments isn’t the only way to achieve gorgeous, glowing skin. In fact, radiant skin can be attained from the inside out by drinking a generous cup of peppermint tea. Dallas-based celebrity aesthetician Renee Rouleau advises her celebrity clients to drink a cup of the minty stuff before red carpet events.  

    “Peppermint tea is known to boost blood circulation, giving skin a vibrant glow,” says Rouleau, adding that peppermint can also help decrease stress. 

  • 5 / 7   Problem: Uneven skin tone and UV damage

    Solution: Strawberries and honey


    Strawberries in particular are jam-packed with vitamin C and are a natural source of salicylic acid, which is often found in anti-acne treatments to help clear skin and keep flare-ups at bay. When paired with honey, which has anti-bacterial benefits, they create a powerful at-home alternative to a store-bought mask. 

    Mash together three strawberries and 1 Tbsp. honey and apply the mixture. Wash off the mask with warm water after 15 minutes.

  • 6 / 7   Problem: Dry, frizzy hair

    Solution: Coconut oil


    As the weather gets warmer, your hair can become dry, frizzy, and completely unmanageable. Because of its moisturizing benefits, coconut oil is highly effective when it comes to nourishing hair and battling frizz. 

    For a hydrating hair treatment, New York City stylist Nunzio Saviano, owner of Nunzio Saviano Salon in New York City, recommends working a tablespoon of liquefied coconut oil through your hair post-shampoo. Leave the oil in for five to 10 minutes and rinse it out with chilly water, which will also help close the hair cuticle and seal in moisture, fighting frizz.

  • 7 / 7   Problem: Product buildup

    Solution: Apple cider vinegar

    Product buildup (sometimes confused for dandruff) is residue left behind on your hair and scalp by shampoo, mousse, hairspray, and other styling products. Additionally, dirt, natural oils, and hard water mineral deposits can build up on your hair shaft, leaving locks dull and weighed down. For a quick at-home fix, celebrity colorist Kyle White recommends a five-minute apple cider vinegar treatment.

    “Apple cider vinegar is an effective clarifying

Teens and E-cigarettes

In picture shows that "Teens are more likely to use e-cigarettes than cigarettes."

Past-month use of cigarettes was 3.6 percent among 8th graders, 6.3 percent among 10th graders, and 11.4 percent among 12th graders. Past-month use of e-cigarettes was 9.5 percent among 8th graders, 14.0 percent among 10th graders, and 16.2 percent among 12 graders.

Two times as many boys use e-cigs as girls.

For Pain, It Matters Which Doctor You See

As a physician anesthesiologist, I know how challenging it can be to treat patients who are in pain. For most people, pain is temporary. But for more than 100 million Americans, there is no end to pain.

Chronic pain can be broad or focused, dull or sharp, distracting or excruciating, and in many cases, debilitating.

Your likelihood of experiencing chronic pain increases with age. Gender can also influence how much pain you have. In general, women report having more pain than men.

The Serious Effects of Pain

Living with chronic pain can affect your life in many ways:

Mental health changes. According to a 2006 survey from the American Academy of Pain Medicine, almost two-thirds of people living with chronic pain have reported a decrease in overall happiness and 77 percent reported feeling depressed.
Increased fatigue. Pain can affect your daily functioning, resulting in decreased concentration, diminished energy levels, and difficulty falling or staying asleep.
Decreased job performance. Chronic pain costs the U.S. more than cancer, heart disease, and diabetes. Health economists estimate that the cost of chronic pain may be as high as $635 billion a year, according to a report published in the Journal of Pain. We can only guess how many people have been limited in their professional advancement because of pain.
Which Doctor Is Best at Treating Pain?

If you  are experiencing pain, your first stop should be to visit your primary care physician. A 2010 analysis of a national medical database found that 13 percent of all doctors visits were to discuss pain. Of these visits, 45 percent were at a primary care physician's office. Less than 1 percent of those surveyed sought help from a specialized pain physician.

Specialized pain physicians are underused by patients, probably because the specialty is relatively new and people don't know about it. These physicians are trained to treat difficult pain conditions using the most advanced treatments.

I like to compare pain physicians to football players. The goal of all of these doctors is the same — to relieve pain — but the role they play varies:

Anesthesiologists spend four years of their training managing anesthesia and pain control in surgical patients. Most pain specialists are anesthesiologists, and they can offer a full array of pain treatments.
Neurologists focus on targeting the neural, or nerve, aspects of pain. Treatments include medications and procedures to treat nerve-related pain.
Physical medicine and rehabilitation physicians focus on relieving pain and improving their patients' day-to-day functioning via physical therapy and physical reconditioning.
The Future of Pain Treatment

Recently, the American Society of Anesthesiologists analyzed dozens of peer-reviewed medical journals from the past year to create its first Women’s Pain Update. Highlights from the report include:

Success with alternative pain-relief methods such as music, yoga, and rose oil.
Breast cancer research that found the type of anesthesia used during breast cancer surgery can affect how quickly and comfortably you recover.
New research has also led to the development of medications that can decrease nerve irritation and depression caused by pain. Similarly, there are several new procedures that can treat pain.

For example, pain specialists can use X-ray or ultrasound imaging guidance to provide relief through steroid injections that target specific nerves and areas of the spinal cord. The procedure is fairly low risk when administered by a physician specifically trained in interventional pain treatments. All three major pain societies, the American Pain Society, the American Society of Interventional Pain Physicians, and the American Academy of Neurology, state that epidural steroid injections are best suited for those with a pinched or inflamed nerve root (also called radiculopathy).

However, we still have a lot to learn about steroid procedures. Studies have shown that any type of epidural injection — including saline — can relieve pain. In fact, such injections provide twice the pain relief of intramuscular steroid injections, without the associated risks.

Don't resign yourself to a life  in pain. If you are one of the millions of people lacking an effective remedy for your pain, a trained pain medicine physician may be able to help you achieve your pain management goals.

The Real Monthly Cost of Depression

Six people reveal how much they spend to treat their depression, how they save money on medications, and more.

With an illness like depression, the cost of treatment often adds up to more than the price of medication alone. Untreated or undertreated depression can break the bank in the form of lost work, lost productivity, and hospital stays.

In fact, depression is estimated to have cost the U.S. economy more than $210 billion in 2010 (including the cost of comorbid, or simultaneously existing, conditions), according to a study published in 2015 in The Journal of Clinical Psychiatry. “The key to managing the cost of depression is managing depression itself,” says health economist Adam Powell, PhD, president of Payer+Provider, a Boston-based consulting firm that works with insurance companies and healthcare providers. “The direct cost American society spends on treating depression is far smaller than the indirect costs spent on its consequences.”

And the personal costs of effectively managing depression can add up, too. In addition to medication, many people with depression pay for therapy, top quality foods, gym memberships, yoga or mindfulness meditation classes, supplements, educational materials, or other goods and services that they feel help them manage the condition.

Here we share what six people with depression spend on the condition — including which costs they must absorb on their own — and how they cut corners to make ends meet.

Susan Hyatt, 56, Corporate Social Responsibility Advisor

Monthly Medication: $70

Additional Monthly Treatments: $420-$470

Net Monthly Out-of-Pocket Costs: $490-$540

Much of what business consultant Susan Hyatt of Denver pays to manage her depression and seasonal affective disorder (SAD) relates to keeping herself productive. And if her strategies to stay productive aren’t effective, she loses income and can’t pay for the things that help her feel and stay better. In addition to her medication — about $70 a month out-of-pocket for Wellbutrin (bupropion) and Oleptro (trazodone) — Hyatt spends about $100 to $150 on supplements and herbs each month, and a little more than $300 for exercise and other lifestyle activities that help keep her motivated to work.

For example, Hyatt, who founded the consulting company Big Purpose Big Impact, walks to Starbucks or another nearby coffee shop every day to work; her tab adds up to $4 to $8 a day. “The noise forces me to have to really concentrate to get anything done, and it works,” Hyatt says. “Once I go home, I can easily slide back into not being very motivated.”

RELATED: 5 Things Psychologists Wish Their Patients Would Do

Too little motivation becomes costly for an entrepreneur. Hyatt’s depression has caused her to miss phone calls about potential work or speaking opportunities on days when she avoids answering her phone. And as she finishes up her long-term contracts, she often finds it exhausting to apply for new ones, costing her potential income. That means she also can’t currently afford massage, acupuncture, and therapy — all of which have helped her manage her illness in the past. “Friends or family who haven’t had issues with depression or SAD may be sympathetic,” she says, “but they often can’t really get their minds around the fact that depression can be debilitating.”

Her best tip: When her Wellbutrin dosage was increased from 300 milligrams (mg) to 450 mg a day, her doctor originally prescribed three 150 mg tablets. But getting one 300 mg bottle and one 150 mg bottle saved her about $35 a month. If your doctor can similarly prescribe a specific dosage that is cheaper, the savings can add up.

Kathryn Goetzke, 44, Nonprofit Founder

Monthly Medication: $0 currently (previously up to $100)

Additional Monthly Treatments: $300-$700

Net Monthly Out-of-Pocket Costs: $300-$700

Kathryn Goetzke, who lives in San Francisco, can easily tick off the ways her depression has cost her: lost productivity, strained relationships, bad decisions, a poorly functioning immune system, and an inability to maintain boundaries. It’s also led to unhealthy habits, such as smoking, alcohol use, and overeating. But after dealing with all these ramifications of the illness, she’s now found that exercise and a healthy diet help her the most in dealing with the condition.

She avoids sugar, eats organic food, makes smoothies, and spends $75 a month on a gym membership, plus another $75 on exercise classes such as Spinning. Not included in her monthly costs is the $600 she paid for a Fisher Wallace Stimulator, an FDA-cleared wearable device that treats anxiety and depression by sending slight electrical pulses to the brain through two nodes that are attached to the temples; Goetzke uses the Stimulator twice a day.

The $150 a month she spends on supplements goes toward 5-HTP, omega-3s, vitamin D, GABA, Dr. Amen’s Serotonin Mood Support, and green powder — a supplement mixture of vitamins, minerals, probiotics, prebiotics, and other ingredients, depending on the manufacturer.

When Goetzke, who is also founder of the International Foundation for Research and Education on Depression (iFred), goes to therapy, it costs about $400 a month.

She emphasizes that depression is treatable, but many people require treatment beyond medication: Therapy is essential, she believes. And while Goetzke no longer needs medication, she would sacrifice anything for it when she did. “There is nothing more important than mental health,” Goetzke says. “I lost my dad to suicide and never want to follow in his footsteps.”

Her best tip: Goetzke has made a lot of changes to cut corners: she finds therapists covered by insurance, does workouts outside instead of taking extra gym classes, borrows books from the library, and quit drinking and smoking. But her biggest tip is to avoid making big decisions while you’re depressed.

“Give it a month to be sure it’s the right decision,” she says. “That’s really helped me avoid making expensive decisions that were more the depression talking than me.”

Maggie White, 34, Stay-At-Home Mom

Monthly Medication: $170

Additional Monthly Treatments: $500-$1,000

Net Monthly Out-of-Pocket Costs: $670-1,700

Although Maggie White, of Downers Grove, Illinois, spends $80 for Pristiq (desvenlafaxine) and $90 for Klonopin (clonazepam) each month, her other costs vary greatly depending on the month. She cares for five young children at home and needs to “keep [herself] as mentally healthy as possible” since her husband travels frequently, and her mental health affects her family, too.

Her therapy adds up to about $50 a month, and the $40 she spends on essential oils is worthwhile because the aromatherapy helps her feel better. When she can afford gym or yoga classes, they’re about $15 each, but most of her additional costs include organic foods and the $175 per month she spends on a range of supplements: vitamin D3, B-complex, B-12, magnesium/calcium, chromium, 80-billion live probiotics, flaxseed oil, potassium, zinc, and vitamin C.

“You cannot put a price on sound mental health,” White says. “If you’re walking around in that black, haunting fog so many of us know, there is no quality of life, no hope, no way to make healthy decisions, or even to know how to surround yourself with healthy people.”

Her best tip: With five kids, planning ahead and trimming the fat are the secrets to White’s household money management. Clothes are hand-me-downs or come from The Salvation Army; for food, she plans meals two weeks out and purchases only the exact groceries needed. Not only does the family skip restaurants, movies, and vacations, but they also don’t have cable TV or personal electronic devices. Instead, they watch old VHS tapes.

Lisa Keith, PsyD, Assistant Professor of Special Education

Monthly Medication: $80

Additional Monthly Treatments: $105

Net Monthly Out-of-Pocket Costs: $185

For Dr. Lisa Keith, of Fresno, California, health insurance helps tremendously with medication costs. The $80 she spends monthly on Cymbalta (duloxetine) and Abilify (aripiprazole) would cost closer to $1,000 per month if not for her insurance. In addition to the $30 she spends each month for a gym membership, $25 in co-pays for her psychiatrist, and $50 for multivitamins, iron, calcium and a few other vitamins, the Fresno Pacific University professor invested $150 in a blue light for light therapy.

“I have it good because I work full-time and have benefits,” Keith says, but those without insurance for medications are less fortunate. “I’ve spent tens of thousands of dollars over the years on medications, doctors, therapy … but the worst thing is that depression cost me a marriage. There’s no price on that.”

Her best tip: Find apps that help manage mental health effectively for you. Keith uses Headspace for meditation, Focus@Will for concentrating, and Spotify for custom music playlists.

Too Soon to Widely Recommend Ketamine for Depression

The drug ketamine -- known as Special K on the party scene -- shows promise as a depression treatment. But researchers aren't ready to recommend it because its long-term effects remain unknown.

That gap in knowledge must be filled before ketamine can be widely used to treat depression, said Colleen Loo, co-author of a new research review. She's a professor at the University of New South Wales in Australia.

Ketamine, an anesthetic drug, is increasingly being used off-label to treat severe and treatment-resistant depression. And some preliminary findings suggest rapid-acting effectiveness, Loo said.

But "this has not been effectively explored over the long term and after repeated dosing," she added in a university news release.

RELATED: 10 Diseases That Make Depression Feel Worse

Loo and her colleagues examined 60 published studies of ketamine treatment for depression, involving a total of nearly 900 patients. The investigators found few studies reported on the safety of repeated doses or sustained use of the drug.

"As ketamine treatment will likely involve multiple and repeated doses over an extended time period, it is crucial to determine whether the potential side effects outweigh the benefits to ensure it is safe for this purpose," she explained.

Past research has linked longer-term ketamine use to bladder inflammation, liver damage, memory loss and addiction. These potential troubles "may limit the safe use of ketamine as a long-term antidepressant treatment," the review authors wrote.

The review was published July 27 in The Lancet Psychiatry.

only am I not alone, but I am connecting in a significant and meaningful way

only am I not alone, but I am connecting in a significant and meaningful way

9 Surprising Complications of Type 2 Diabetes

Type 2 Diabetes Complications: More Than Just Heart Disease

Having diabetes isn’t a death sentence. In fact, an article published in September 2017 in the journal BMJ suggests that, with proper management and weight loss, you can effectively reverse symptoms of the disease. But on the flip side, poorly managed type 2 diabetes can lead to certain complications that can altogether result in increased medical costs, more stress, and potentially a reduced life expectancy. 

If you’ve been diagnosed with diabetes, you likely know the major complications for which having diabetes may leave you at risk: heart disease, kidney disease, neuropathy (or nerve damage), and amputations. But complications associated with poor blood sugar control can affect other parts of the body as well.

"When we talk about diabetes complications, we talk about it from head to toe," says Cathy L. Reeder-McIntosh, RN, MPH, a certified diabetes educator at Wake Forest Baptist Medical Center in Durham, North Carolina. "Even if you don't have perfectly controlled blood sugar, lowering your A1C level — which measures your average blood sugar level over the past two to three months — even a small amount helps reduce your risk of complications."

The A1C test is the most common diagnostic tool for type 2 diabetes, but its function doesn’t end there — for managing diabetes, these test results are crucial, too. The Mayo Clinic recommends getting the A1C test twice per year if you have been diagnosed with type 2 diabetes, don’t use insulin, and your blood sugar is within the goal range that you and your doctor have set.

But if you are on insulin or your blood sugar is poorly controlled, the Mayo Clinic recommends you receive the test four times per year. A normal A1C level is below 5.7 percent, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

To help lower your A1C and reduce your risk for type 2 diabetes complications, you can follow tried-and-true diabetes management advice, like adhering to your medication regimen, practicing portion control while eating a diabetes-friendly diet, and exercising regularly.

But even if you’re meeting your blood sugar level and A1C goals, it’s important to be aware of the potential diabetes complications that may affect you should your situation change. That’s because although taking certain steps to manage diabetes well can potentially lead to reversal, for many people, diabetes remains a progressive disease. Knowing how to spot the signs of all diabetes complications, regardless of their commonality, can be crucial for getting the proper treatment.

For one, your age and ethnicity may play a role in your risk for developing these issues, research suggests. According to a study published in September 2016 in The Journal of Clinical Endocrinology & Metabolism, people diagnosed with diabetes in midlife may be more prone to complications such as vision loss and kidney disease compared with people diagnosed with the disease while they are elderly, as middle-age people have more time to develop these problems than those who are diagnosed later in life.

And a review published in Clinical Orthopaedics and Related Research suggested minorities may be at a greater risk for amputations.

Whether it’s signs of neuropathy, heart disease, kidney disease, or other issues, like digestive problems, skin infections, or the like, some people won't make changes until they see signs of complications caused by years of high blood sugar, Reeder-McIntosh points out. To keep that from happening, you should be aware of all the potential diabetes complications. Following are nine you may not already know. 

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

This week marks the second anniversary of my writing this blog.  It’s a good chance to remember why I write the blog,

This week marks the second anniversary of my writing this blog.  It’s a good chance to remember why I write the blog, what it has meant to me, and to think about what’s ahead.  I originally wanted to write because the original site, HealthTalk.com, helped me immensely with their psoriasis web content.  I especially enjoyed the various topics presented in the monthly webcast.   By writing I believed I could bring my own story and perspective to the discussion of how to live with and treat psoriasis.  At that time I also felt down about many aspects of my life, including psoriasis.  With no end in sight managing this disease I wondered if anything good could be redeemed from the experience.  If I could help one other person feel like they are not alone in battling psoriasis, if anyone could benefit from my trial and errors with medications, or if caregivers could understand the different dimensions of living with psoriasis then writing would be worth it.  Finally, I wanted a community I could share the struggles with and how better to find one than to help create one?

10 Essential Facts About Ovarian Cancer

Statistically speaking, ovarian cancer is relatively rare: It represents just 1.3 percent of all new cancer cases in the United States each year, according to the National Cancer Institute (NCI). But although its numbers are small, the fear factor for many women may be disproportionately large.

We spoke to two leading ovarian cancer experts: Robert J. Morgan, Jr., MD, professor, and Mihaela C. Cristea, MD, associate clinical professor, of the medical oncology and therapeutics research department at City of Hope, an NCI-Designated Comprehensive Cancer Center in Duarte, California.

Psoriatic Arthritis

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Living With PsA Could Mean Living

With Joint Damage. Learn More Now.

 

Here are 10 essential facts about ovarian cancer that you should know:

1. About 20,000 women in the United States are diagnosed with ovarian cancer each year. As a comparison, nearly 250,000 women will be diagnosed with breast cancer this year, according to the American Cancer Society. Of the women diagnosed with ovarian cancer, 90 percent will be older than 40; most ovarian cancers occur in women 60 or older, according to the CDC.

2. You should see your doctor if you experience any of these ovarian cancer symptoms:

  • Vaginal bleeding (especially if you’re past menopause)
  • Abnormal vaginal discharge
  • Pain or pressure in the area below your stomach and between your hip bones
  • Back pain
  • A change in bathroom habits, such as urgently needing to urinate, urinating frequently, or having constipation or diarrhea

It’s important to pay attention to your body and know what’s normal for you. If you have abnormal vaginal bleeding or have any of the other symptoms for two weeks or longer, see your doctor right away.

 

 

These symptoms can be caused by many different problems, but it’s best to have them evaluated, suggests the University of Texas MD Anderson Cancer Center.

3. It’s tricky to pinpoint early, milder symptoms of ovarian cancer. However, the findings of a study published in Cancer in 2007 point to a cluster of vague symptoms that may suggest the need for ovarian cancer testing, says Dr. Morgan. In the study, researchers linked these symptoms to the possibility of ovarian cancer:

  • Pelvic or abdominal pain
  • Strong urge to urinate or frequent urination
  • Bloating or increased abdominal size
  • Difficulty eating or feeling full early

If a woman experiences these symptoms on more than 12 days a month for less than one year, she should insist that her doctor perform a thorough ovarian evaluation, says Morgan. This might include the CA-125 blood test or atransvaginal ultrasound exam.

4. Early detection can mean a better prognosis. When detected early enough, ovarian cancer can be cured. “Stage 1 and stage 2 ovarian cancer is curable about 75 to 95 percent of the time, depending on the tumor grade and cell type,” says Morgan. But because this cancer occurs deep inside the body’s pelvic region, it is often diagnosed in later stages, he says. The cure rate for stage 3 ovarian cancer is about 25 to 30 percent, and for stage 4 it's less than 5 percent, he adds.

RELATED: Overcoming Ovarian Cancer, Twice

5. Ovarian cancer has several key risk factorsThese include:

  • Women with a family history of ovarian cancer may be at higher risk.
  • Women who have never been pregnant and women who have uninterrupted ovulation due to infertility treatments seem to be at higher risk.
  • Early onset of your period, or having a late menopause, seems to increase risk.
  • Using talcum powder in the genital area may increase risk.
  • Smoking is a risk factor for a type of ovarian cancer known as mucinous ovarian cancer. Quitting smoking seems to reverse the risk back to normal, says Morgan.

6. Ovarian cancer is not a single disease. In reality, it’s a diverse group of cancers that respond to different treatments based on their molecular characteristics, says Dr. Cristea. Treatment will also depend on other health conditions, such as diabetes or heart problems, that a woman might have.

7. Ovarian cancer treatments are evolving and improving all the time.Immunotherapy is emerging as a new treatment option for many malignancies, including ovarian cancer,” says Cristea. In another recent development, the firstPARP inhibitor, a DNA-repair drug, has been approved for women with BRCA-mutated ovarian cancer when chemotherapy hasn’t worked. “Women should also ask their doctors about clinical trials that are evaluating immunotherapy as well as other new treatments,” she adds.

 

 

8. Surgery may prevent ovarian cancer in women at very high risk. For women who carry the BRCA or other genes that predispose them to ovarian cancer, doctors often recommend surgery to remove the ovaries and fallopian tubes.Angelina Jolie, the actor and human rights activist, decided to have this surgery in March 2015. “Removing the ovaries can decrease the risk of developing the disease by 98 percent, and can substantially decrease the risk of developing breast cancer,” notes Morgan. Women in this very high-risk group should opt for this surgery after they’ve completed childbearing at around age 35, he notes.

9. Even after remission, ovarian cancer can still respond to treatment. “About 80 to 90 percent of ovarian cancer patients will achieve remission after chemotherapy treatment,” says Morgan. However, many of those women will later experience a recurrence of the cancer. The longer the remission, notes Morgan, the better the chances are for achieving a second remission.

10. It’s best to see an ovarian cancer specialist. When you’ve been diagnosed with ovarian cancer, getting a referral to an ovarian cancer specialist is a wise move, says Cristea. If you’re having surgery, it’s best to have a gynecologic oncologist perform the operation instead of a gynecologist, she adds. And to make sure you’re getting state-of-the-art treatment, consider seeking a second opinion at a NCI-Designated Cancer Center.

Healthy Pizza? It’s Possible With These 5 Recipes.

For many people, pizza tops the list of favorite foods. Not only is the drool-worthy combo of cheese, bread, and sauce satisfying, but it’s one of the easiest meals to pick up (or have delivered) from your local pizzeria. While your favorite slice may be delicious, it can be easy to go overboard on sodium-laden sauce, toppings, and high-calorie crusts. Luckily it’s just as easy — and delicious — to pop a homemade pie into the oven. With a few simple swaps and key ingredients, you can give your favorite comfort food a wholesome makeover without skimping on flavor. So whether you’re craving a fresh-out-of-the-oven slice or just looking for a hassle-free weeknight meal, these five healthy and delicious pies are better than delivery!

11 Struggles Every New Runner Understands

I've never been one of those people. You know the kind, the ones who wake up in the morning or lace up in the evening and "go for a run."

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I've always been envious of my roommates, who can sneak in a jog with ease and carry on with their day, as if they had done something casually simple like taking the trash out. So, I made a vow to give running another chance. After all, the exercise has been shown to make you happier, reduce your risk for disease and even increase longevity.

While group classes and long walks will probably always be more my speed, I did find that I was enjoying running more than I ever did in the past. However, that doesn't come without a few hiccups. Below are a handful of struggles all new runners can probably relate to.

Getting winded in the first few minutes.

Probably one of the most discouraging elements of getting into a running routine is realizing that you're not as in shape as you thought you were. I continuously find myself doing more walking or jogging than actual running. But just because you need those intermittent breaks doesn't mean you aren't a runner. In fact, research shows that walking intervals during your run can help you maintain your overall pace.

Two words: Sore. Muscles.

The second-day pain is real. If you're experiencing those achy muscles, try one of these post-run remedies. Just make sure you're checking in with your body as you establish your routine. A little soreness is OK, but if the pain is more intense you may have sustained a running-related injury.

 

 

Feeling overwhelmed by the copious amount of races.

Color runs, beer runs, zombie runs, princess half marathons... the list is seriously endless. However, there are some perks to picking a race. Signing up for one helps you set a goal as you get into a routine, plus there's an opportunity to turn it into a social event by participating with your friends.

If your goal is to become a marathon runner (and props to you!), there are also some benefits there: Research shows consistent long-distance running can improve cardiovascular health and lower the risk for other organ disorders, the Wall Street Journal reported.

The jolting agony of waking up at 6 a.m.

My sleepy brain is constantly telling me my bed feels better than running (and often, the bed wins). If you need a little extra motivation, try one of these hacks to help you jumpstart your morning workout.

The boredom.

Part of the reason I never got into a routine in the first place was because the exercise itself seemed extremely dull to me (the treadmill is my arch-nemesis). Once I discovered more running-path options, I started to have more fun. However, that's not to say that I don't get a little bored sometimes — and that's OK.

Note: If you still just can't get excited by the process most of the time, you may want to try a more entertaining workout option instead. Exercise should be engaging, not mind-numbing.

Trying to find your perfect route.

Finding your favorite place to run is like finding a good apartment: It feels elusive until one day you hit the lottery. Whether you're into lush scenery or a skyline, it's important to find the routes that work for you in order to make the exercise entertaining.

The joy of picking out new workout clothes.

Sleek tanks! Compression pants! Neon shoes!

Running toward (multiple) "finish lines."

If you've ever uttered to yourself just one more pole, you're not alone. In fact, picking out an arbitrary finish line on your run can improve your performance. Research shows those who stare at a target in the distance go faster and feel less exertion than those who don't concentrate on anything, The Atlantic reported.

 

 

Bargaining with yourself on your run.

If you run five more blocks, you can binge-watch Scandal when you get home, I tell myself. Chances are I'd probably do it anyway — but at least it encourages me in the moment.

Creating a playlist that will consistently keep you motivated.

No, a simple music-streaming app won't do when your lungs are on fire and your legs feel weak. You need that one specific song that will inspire you to keep going (shout out to all my Shake It Off comrades). If you're looking for a playlist to spice up your run, check out some of these.

Type 2 Diabetes Drug Helps Some With Chronic Depression

A new small study is adding evidence to the theory that insulin resistance may play a leading role in some people's depression.

The study found that a medication normally used to boost insulin sensitivity in people with type 2 diabetes appears to help ease the symptoms of chronic depression. And, the effect was strongest in people who were insulin-resistant but didn't have diabetes, the study found.

These findings "add to the neurobiological explanation of what's going on when people are depressed, and it should help de-stigmatize depression. It's a disease of the brain," said the study's lead author, Dr. Natalie Rasgon, a professor of psychiatry and behavioral sciences at Stanford University School of Medicine in California.

"Depression is kind of a catch-all term, like the common cold; it can have more than one cause," Rasgon said. "In this study, we saw two separate effects of the [drug]. In patients with insulin resistance, their insulin resistance improved, and their depression improved."

That may mean that insulin resistance is playing a significant role in the depression of these people, she explained.

But patients who weren't insulin-resistant also saw their depression improve during the trial.

"That speaks to a different mechanism. It could be an anti-inflammatory effect," Rasgon said.

Findings from the study were published Nov. 18 in Psychiatry Research. Funding for the study was provided by the U.S. National Institutes of Health. The researchers received no support from the makers of the drug, pioglitazone (Actos), which has U.S. Food and Drug Administration approval for use as a treatment for type 2 diabetes.

RELATED: Why Sugar Is Poison for Depression

Insulin is a hormone that allows the body and brain to use the sugar from foods as fuel. Someone who is sensitive to insulin uses the hormone effectively. Someone who is insulin-resistant doesn't use insulin well, and sugar is released into the bloodstream instead of being used to power cells in the body and brain. Insulin resistance can be a precursor to type 2 diabetes, the researchers said.

The study included 37 adults -- 29 women and eight men -- recruited at Stanford University. The study volunteers were between 21 and 75 years old. Their weight ranged from underweight to severely obese, the study authors noted. None had diabetes, but some were insulin-resistant or had pre-diabetes, the researchers said.

All of the study volunteers had depression for longer than a year. Despite standard treatments for the mental health disorder, they were still experiencing depression, the study authors said.

Rasgon and her team randomly gave the study volunteers 12 weeks of treatment with pioglitazone or an inactive placebo. People were allowed to stay on their current antidepressant treatment as well. Pioglitazone works by making people more sensitive to insulin, the researchers said.

All of the study participants were tested for depression and insulin resistance at the start of the trial, and again at the end.

People who were insulin-sensitive had improvements in their depression whether they were taking the drug or a placebo. But those who were insulin-resistant only saw improvement in their depression symptoms if they were taking the insulin-sensitizing drug. People who were insulin-resistant who took the placebo didn't get better.

The more insulin-resistant someone was, the better the drug worked on their depression, the study found.

The idea that insulin resistance could cause problems in the brain makes sense, Rasgon said. The brain uses a lot of glucose (sugar), so anything that makes it harder for the brain to get the glucose it needs could affect vital brain functions, such as controlling emotions and thinking, she suggested.

Whether it would be safe for people who don't have type 2 diabetes to take pioglitazone for long periods isn't known. Rasgon pointed out that the study was small and only done for 12 weeks. She hopes to be able to do a longer and larger trial.

"The data in this study is preliminary," said Dr. Eric Hollander, director of the anxiety and depression program at Montefiore Medical Center in New York City. "But it may eventually lead to a new paradigm that could be helpful in reducing the stigma of depression," he added.

"Mood disorders may be part of a systemic illness -- at least in a subgroup of depressed patients," he said.

Hollander suggested that improvements in insulin resistance or decreased inflammation may be what helped ease depressive symptoms.

Both experts said these findings suggest that any of the treatments for type 2 diabetes may also help people with longstanding depression. Treatments include other medications that improve insulin sensitivity, and even lifestyle factors, such as losing weight or exercising. Both of those lifestyle factors increase insulin sensitivity, too.

5 Reasons Why Skin Cancer Surgery Isn’t So Scary

Get the inside scoop on Mohs surgery, the most popular treatment option for basal and squamous cell carcinomas.

Veva Vesper has dealt with more than her fair share of Skin Cancer in the last 25 years. The 69-year-old Ohio resident has had more than 500 squamous cell carcinomas removed since the late 1980s, when the immunosuppressant medication she was taking for a kidney transplant caused her to develop them all over her body — everywhere from the corner of her eye to her legs.

While Vesper’s story is unusual, skin cancer is the most common cancer in the United States. In fact, it’s currently estimated.

Mike Davis, a 65-year-old retired cop, and like Vesper, a patient at The Skin Cancer Center in Cincinnati, Ohio, has a more familiar story. Earlier this year, he had a basal cell carcinoma removed from his left ear — the side of his face most exposed to UV damage when driving on patrol.

All Diet and Nutrition Articles

All Diet and Nutrition Articles

 

7 Quick Fixes to Look More Attractive

One look at the billion dollar anti-aging industry and it's no surprise we find youth beautiful above all else. But skin isn't the only indicator of it — the size of your eyes is, too. "Women with baby-like features such as large, widely-spaced eyes are typically judged to be most attractive," says Viren Swami, PhD, author of The Psychology of Physical Attraction,who cites cross-cultural study data from African-American, Asian, Hispanic, and Taiwanese participants.

The quickest and easiest way to maximize your eyes is to sketch a line on the top lash line using a smoky shade, and then smudge the shadow with a brush or your fingertip to soften and blend, says Tina Turnbow, a celebrity makeup aritst.

Could Eating Fish Help Ward Off Depression?

Consuming more meals from the sea linked to lower risk, study suggests, but cause-and-effect not proven.

Can eating a lot of fish boost your mood? Maybe, say Chinese researchers.

Overall, the researchers found that people who consumed the most fish lowered their risk of depression by 17 percent compared to those who ate the least.

"Studies we reviewed indicated that high fish consumption can reduce the incidence of depression, which may indicate a potential causal relationship between fish consumption and depression," said lead researcher Fang Li, of the department of epidemiology and health statistics at the Medical College of Qingdao University in China.

But this association was only statistically significant for studies done in Europe, the researchers said. They didn't find the same benefit when they looked at studies done in North America, Asia, Australia or South America. The researchers don't know why the association was only significant for fish consumption in Europe.

The study was also only able to show an association between eating fish and the risk for depression, not that eating fish causes a lower risk for depression, Li said.

Still, Li thinks there may be reasons why fish may have an effect on depression.

"Fish is rich in multiple beneficial nutrients, including omega-3 fatty acids, high-quality protein, vitamins and minerals, which were associated with decreased risk of depression from our study," Li said.

The researchers pointed out that it's possible that the omega-3 fatty acids in fish may change the structure of brain membranes, or these acids may alter the way certain neurotransmitters work. Neurotransmitters are the brain's chemical messengers, sending information from brain cell to brain cell. Some neurotransmitters, such as dopamine and serotonin, are thought to be involved in depression, the researchers said.

RELATED: 10 Foods I Eat Every Day to Beat Depression

The report was published Sept. 10 online in the Journal of Epidemiology & Community Health.

Depression affects 350 million people around the globe, according to background information in the study. The mood disorder is the leading cause of disability worldwide, according to the World Health Organization.

Past research has suggested that dietary factors may play a role in depression, the researchers said.

To look at the possible connection between eating fish and depression, Li and colleagues reviewed 26 studies published between 2001 and 2014. The studies included more than 150,000 people. Ten of the studies were done in Europe.

This process, called a meta-analysis, attempts to find consistent patterns across multiple studies.

In addition to an overall benefit from fish in curbing depression, Li's team found a difference between men and women. Specifically, the researchers found a slightly stronger association between eating a lot of fish and lowered depression risk in men by 20 percent. Among women, reduction in risk was 16 percent, the researchers said.

Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said it's "impossible to draw any definitive conclusions about direct cause and effect" due to the study's design.

But, he added, "While the exact way fish may prevent depression is unknown, it's promising to learn that depression may be preventable for some people by making simple modifications to their lifestyle, such as by eating more fish."

Rego said it's especially important to look for novel treatments because depression can have a significant impact on people's lives, and many people don't respond fully to first-line depression treatments.

Future research needs to look into whether the effects of fish on depression vary by the type of fish eaten. In addition, this review didn't look at whether or not fish oil supplements could have the same effect.

Tomato Basil Oatmeal

Sweet oatmeal recipes are easy enough to find, but savory ones? Those are a little harder to pull off. With its tomato puree, pine nuts, fresh herbs, and Parmesan cheese, Oatgasm’s tomato and basil oatmeal reminds us of a lower-carb bowl of pasta — one that you’ll want to eat for breakfast, lunch, and dinner. Mangia!

Side Effects of Multiple Sclerosis Medications

Twelve disease-modifying medications are FDA-approved to treat relapsing forms of multiple sclerosis (MS). Specifically, these drugs help prevent relapses and slow progression of the disease.

The newest disease-modifying medications are called “immunomodulators” because they affect the functioning of your immune system. 

“All these therapies highlight the increased choices and options for patients living with MS, and the ability of physicians to select a therapy based on individual characteristics,” says Ari Green, MD, assistant clinical director of the UCSF Multiple Sclerosis Center and director of the UCSF Neurodiagnostics Center in San Francisco.

But all drugs can have adverse side effects, and those associated with MS medications range from mild (such as flu-like symptoms or irritation at an injection site) to serious (such as progressive multifocal leukoencephalopathy [PML], a viral disease in the brain).

One of the challenges of MS treatment is balancing risk and benefit, says Dr. Green. Stronger medications might be more effective at slowing progression of the disease, but they may also be associated with more risks.

Discussing Medication Side Effects With Your Doctor

"A doctor has to have a frank and open discussion to find out what is tolerable for patients," says Green. "Some side effects go away as the body gets used to MS medications, but others, such as irritation where the injection takes place, do not."

Because people experience side effects differently, each individual has to decide which side effects he or she can live with, he adds.

In some cases, what are thought to be drug side effects may actually be MS symptoms. Fatigue and headache, for example, may be either.

Keeping a detailed log of your symptoms can help your doctor determine whether you are experiencing a symptom of multiple sclerosis or a medication side effect.

Make a note of when your symptom began, how long it lasted, what might have triggered it, and whether anything you did eased the symptom.

“The more patients are engaged in keeping track of things, the more they can be positively and appropriately engaged in directing their own care,” says Green. This information can also help your provider select appropriate therapies in the future.

Managing MS Medication Side Effects

Some simple steps can often help you manage the most common side effects of MS medications:

Infection risk Some of the immunomodulatory medications increase your risk of common infections, so it’s important to practice prevention strategies such as washing your hands frequently and limiting your contact with people who are ill.

Flu-like symptoms Fever, chills, achiness, and feeling generally under the weather are not uncommon following interferon beta injections, leading some users to stop the medication. Interferon beta medications include Betaseron, Extavia, Avonex, Rebif, and Plegridy.

According to nurses with expertise in MS care, the following steps can help to manage these side effects:

Staying hydrated
Eating healthfully
Taking medications before sleep
Warming injectable medicines up to body temperature before injecting
You can also take a small dose of Advil, Motrin, or Nuprin (ibuprofen) an hour before and an hour after your injection. Tylenol (acetaminophen), Aleve (naproxen), or Benadryl (diphenhydramine) may also help ease these side effects, Green says.

RELATED: 7 Side Effects of MS Steroid Treatment

Injection-site irritation Applying ice to your injection sites before injections, and a warm compress afterward, can help ease any irritation.

Some people may also benefit from some retraining on the finer points of giving themselves injections, notes Green. This is especially true because most people learn how to give self-injections right after their diagnosis — a period when they’re undoubtedly absorbing lots of information about the disease.

If you’re having trouble injecting your MS medication, speak to your healthcare provider about working with an MS nurse for training in self-injections.

Heart health The medication Gilenya (fingolimod) is known to slow some users’ heart rate within the first six hours after the first dose. Because of this, your doctor may advise you to have your first dose in a clinical setting, where your pulse and blood pressure can be monitored.

Distinguishing Side Effects From Symptoms

The immediate side effects of MS medications may be more apparent once you experience them. Immediate side effects, such as flu-like symptoms and chills, are easy to discern, says Green. Even the muscle aches and pains that can occur immediately after taking disease-modifying MS medications differ from the pain associated with multiple sclerosis.

The one rare medication side effect that might be hard to distinguish from an MS symptom is PML, which has been related to use of the drug Tysabri (natalizumab). PML, however, will progress much more quickly than multiple sclerosis — a good reason to stay on top of your medical checkups.


Ongoing Medication Monitoring

Most of the medications prescribed for MS require regular blood tests to keep track of the treatment’s effect on your body, including your liver.

The drug Lemtrada (alemtuzumab) requires blood and urine monitoring before, during, and for four years after treatment is given to watch for serious autoimmune conditions associated with the drug.

In addition to monitoring for side effects, you and your doctor should monitor for positive effects of drugs as well. Green says that a change in therapy is needed if you are having more than one MS relapse a year, if multiple new brain lesions are seen on your MRI, or if your symptoms are progressing despite treatment. Switching medications is a decision you and your doctor should make together.

9 Best and Worst Milks for Your Heart

1 / 10   Not All Milks Are Alike

The milk aisle is changing, and has a growing number of options for what to pour on your cereal or drink down as a late-night snack. But what do the newer types of milk mean for your heart health if you have high cholesterol? Old-fashioned cow’s milk, for example, is loaded with calcium and vitamins A and D, which are all good for your heart and overall health. But the saturated fat in whole milk — and even in 2 percent milk — may counteract those health benefits. When you're trying to get to healthy cholesterol levels, you'll want to limit the amount of saturated fat in your diet.

Alternative milks can provide similar nutritional benefits if you're lactose intolerant, allergic to certain proteins in cow’s milk, vegan, or simply prefer something other than cow's milk. “People choose a milk based on tolerability and taste — in addition to health beliefs,” says Deborah Krivitsky, RD, director of nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital in Boston. “Each milk will provide different pluses and minuses.”

Welcome to HealthTalk Blog

For those of you who’ve been with HealthTalk for some time, my name is probably familiar. I’m the founder of this health education company that creates and publishes free audio programming on the latest treatments and quality of life innovations for chronic illnesses such as multiple sclerosis, psoriasis, asthma and various types of cancer.

And also, more recently, I’m a patient treated successfully for chronic lymphocytic leukemia.

Quite frankly, I stumbled into the healthcare arena by accident some 20-plus years ago. And I’m glad I did, because I’ve become fascinated with the improvements to treatment and patient care over the years.

And it may have saved my life.

When I was diagnosed with CLL in 1996, I had been doing this for more than a decade. I carefully researched my options and found a doctor at the M. D. Anderson Cancer Center who recommended what was then an experimental treatment (today, it’s the standard of care). Now I’m in molecular remission.

At HealthTalk, I’m responsible for partnering with advocacy groups and major hospitals (including M. D. Anderson) and I still host many programs, including the upcoming Crohn’s webcast on November 10.

Getting back to my broadcasting roots, I also just launched a radio program called This blog will feature my perspective on the news of the day and other interesting nuggets of useful knowledge that I come across in my work exploring the world of patient empowerment.

This is a very exciting time in medicine. I hope you’ll join me as we travel down the path toward better care together.

How to Protect Yourself During a Mass Shooting

No one thinks they could be in this situation, but here's advice from safety experts if it happens.

Thursday, April 03, 2014

The headlines appear with unnerving frequency about mass shootings somewhere in the United States -- at a movie theater, a shopping mall, a school, a sporting event. Yesterday, a shooting tragedy took place at the Fort Hood military base in Texas, the second at this site since November 2009.

Psoriatic Arthritis

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Precisely how often mass shootings have occurred depends somewhat on interpretation. The Congressional Research Service, which defines a mass shooting as one that takes place in a relatively public place and results in four or more deaths, not including the shooter, identified 78 such shootings in the United States from 1983 to early 2013. A report by researchers at Texas State University, done after the killings at Sandy Hook Elementary School in Connecticut, used different parameters and identified 84 mass shootings from 2000 to 2010 by people whose main motive appears to have been mass murder.

Though the precise number of mass casualty shootings may be hard to determine, there's no disagreement that people today need to think about their safety whenever they go out in public, said Dennis Krebs, a retired captain and paramedic with the Baltimore County Fire Department and author of "When Violence Erupts, A Survival Guide for Emergency Responders" and the "Special Operations Mission Planning Field Guide." 

“If you at least think about what you would do if you were confronted with such a situation, it gives you an edge,” Krebs said. 

Life-Saving Tips in the Event of a Mass Shooting

Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University, said that people don’t need to panic or even fear going to public places to avoid mass casualty shootings. He does agree with Krebs though: In 2014, it’s worth giving some thought to how to protect yourself during a mass shooting. 

 

 

What you can do if faced with a mass shooting depends greatly on the situation and your physique and physical capabilities, Dr. Redlener noted. “If you’re small and alone or with your 1-year-old or your 14-year-old, it’s going to be different,” he said. “Everything about survival guidelines is dependent on the details of the particular situation.” 

However, experts in public safety do have advice on how to protect yourself and your loved ones in the event of a mass shooting.

Pay attention to your surroundings. No matter where you go, "be aware of your environment," Redlener said. "If you see something that looks suspicious or out of place, or you notice an unusual gathering of people, you can begin taking action prior to the event occurring." By being aware, you may be able to avoid the scene and not walk into trouble. “Situational awareness is something that police officers and the military are taught and trained to do,” he said. When you go to a mall or a movie, know where the nearest exits are. 

RELATED: Media Exposure to Traumatic Events Can Be More Stressful Than Being There

Flee if you can. If you’re caught in a mass shooting, “you want to get outside of the building as quickly as you possibly can," Krebs said. A lot of people freeze, but "that's the last thing you want to do,” he said. Urge any people you're with to come with you, but don’t waste precious time trying to persuade them to get out while you can. 

 

"If you see something... suspicious or out of place...you can begin taking action prior to the event."

Irwin Redlener, MDTWEET

 

David Reiss, MD, a San Diego psychiatrist, said that some training in the martial arts can help prepare you to deal with your body’s natural fight-or-flight response and not be paralyzed when faced with traumatic events from which you should flee. “To be aware of that response and have some training in dealing with it can be useful without going overboard,” he said. 

Leave your belongings behind. Drop whatever stuff you have with you -- packages, luggage, purse, or backpack. It will make your exit easier. Nothing is more important than your life, Krebs said. Video of the mass shooting at the Los Angeles airport in November 2013 showed people fleeing with their suitcases, but, as Krebs said, "there's nothing in that piece of Samsonite that’s worth your life." 

If you can’t run, hide. “You want to be in an area that allows you to be protected from the gunman or further mischief by the armed perpetrator,” said Stephen Hargarten, MD, MPH, professor and chairman of emergency medicine and director of the Injury Research Center at the Medical College of Wisconsin. Lock and barricade the doors to your hiding place. In one recent mass shooting at a mall, a store clerk was able to protect some shoppers by hitting the button for a gate in front of the store, sealing everyone inside, Krebs said. 

Once in hiding, be quiet. Shut off your cellphone. Instinct may tell you to keep it on and try to call for help, but a ringing phone could be dangerous if it attracts the shooter's attention, Krebs said. Call 911 for help only if and when it’s safe to do so. 

 

 

Try to avoid confronting the shooter. According to the U.S. Department of Homeland Security, taking any action against the shooter should be a last resort -- something you do only if your life is in imminent danger. But, if there's no other option, yell, act aggressively, or look around for something that might work as a weapon. 

Afterwards, exit carefully. Once the shooting has stopped and you are able to leave the building, go out with your hands up. Drop whatever you are carrying. “Police may not have a description of the suspect they’re after," Krebs said, "and if you come running out the door with something in your hand, you could end up getting hurt." 

Disaster Preparedness With Children 

Parents with young children should follow the same advice that flight attendants give passengers: Take care of yourself first because, if you don’t, you won’t be able to help your children, Dr. Hargarten said.

Before you're faced with a traumatic event, talk with your children about the best ways to handle such situations. What you say will depend on their age, but whatever you say, try not to frighten them unnecessarily. Emphasize that in an emergency situation like that, they would need to follow your directions, no questions asked. If you have to scream at your children, it could attract the attention of the shooter. 

As part of your family's disaster preparedness plan, decide where to meet if you get separated in an emergency -- even if it's a place you've been many times before. 

Dr. Reiss said you can’t anticipate mass casualty shootings and should not spend your days fretting over what you would do if you were caught up in one. “If you expect emergencies every moment of your day, it will ruin your life,” he said. It’s best to give it some thought but not let it overwhelm you

8 Things You Can Start Doing Now to Look Younger

2 / 9   Use the Right Skin Care Products

When shopping for skin care products, there are three powerful ingredients you should look for to maintain youthful-looking skin, says Robinson. One, check the label for a serum containing antioxidants like vitamin C (Robinson likes Elizabeth Arden Prevage Anti-Aging Daily Serum), which will help brighten your skin; two, add retinoids, which increase cell turnover and stimulate collagen renewal, to your routine; and three, start using an alpha hydroxy acid exfoliator to remove the top layer of dead skin cells (Robinson is a fan of Peter Thomas Roth Un-Wrinkle Peel Pads, which are gentle enough to be used daily). 

A Diet for Better Energy

Complex carbs are key for sustained energy throughout the day, while too many sugary snacks can lead to energy crashes. Find out which foods you need for round-the-clock energy.

 

Juggling the responsibilities of work, life, and family can cause too little sleep, too much stress, and too little time.

Yet even when you're at your busiest, you should never cut corners when it comes to maintaining a healthy diet. Your body needs food to function at its best and to fight the daily stress and fatigue of life.

Energy and Diet: How The Body Turns Food Into Fuel

Our energy comes from the foods we eat and the liquids we drink. The three main nutrients used for energy are carbohydrates, protein, and fats, with carbohydrates being the most important source.

Your body can also use protein and fats for energy when carbs have been depleted. When you eat, your body breaks down nutrients into smaller components and absorbs them to use as fuel. This process is known as metabolism.

Carbohydrates come in two types, simple and complex, and both are converted to sugar (glucose). “The body breaks the sugar down in the blood and the blood cells use the glucose to provide energy,” says Melissa Rifkin, RD, a registered dietitian at the Montefiore Medical Center in the Bronx, N.Y.

Energy and Diet: Best Foods for Sustained Energy

Complex carbohydrates such as high-fiber cereals, whole-grain breads and pastas, dried beans, and starchy vegetables are the best type of foods for prolonged energy because they are digested at a slow, consistent rate. “Complex carbohydrates contain fiber, which takes a longer time to digest in the body as it is absorbed slowly," says Rifkin. Complex carbs also stabilize your body’s sugar level, which in turn causes the pancreas to produce less insulin. This gives you a feeling of satiety and you are less hungry.”

Also important in a healthy, energy-producing diet is protein (preferably chicken, turkey, pork tenderloin, and fish), legumes (lentils and beans), and a moderate amount of healthy monounsaturated and polyunsaturated fats (avocados, seeds, nuts, and certain oils).

“Adequate fluids are also essential for sustaining energy,” says Suzanne Lugerner, RN, director of clinical nutrition at the Washington Hospital Center in Washington, D.C. “Water is necessary for digestion, absorption, and the transport of nutrients for energy. Dehydration can cause a lack of energy. The average person needs to drink six to eight 8-ounce glasses of water each day.”

Energy and Diet: Foods to Avoid

 

Simple carbohydrates, on the other hand, should be limited. Ranging from candy and cookies to sugary beverages and juices, simple carbs are broken down and absorbed quickly by the body. They provide an initial burst of energy for 30 to 60 minutes, but are digested so quickly they can result in a slump afterward.

You should also avoid alcohol and caffeine. Alcohol is a depressant and can reduce your energy levels, while caffeine usually provides an initial two-hour energy burst, followed by a crash.

Energy and Diet: Scheduling Meals for Sustained Energy

 

“I always recommend three meals and three snacks a day and to never go over three to four hours without eating something,” says Tara Harwood, RD, a registered dietitian at the Cleveland Clinic in Ohio. “If you become too hungry, this can cause you to overeat.”

Also, try to include something from each food group at every meal, remembering that foods high in fiber, protein, and fat take a longer time to digest.

Even if life is hectic, it’s important to make wise food choices that provide energy throughout the day. Your body will thank you.