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. 

Why Drinking Tea May Help Prevent and Manage Type 2 Diabetes

Drinking Tea for Diabetes: Green Tea or Black Tea?

When it comes to drinking tea for diabetes, Steinbaum says benefits are tied to all teas, but that green tea is the clear winner. "For one, when you drink green tea for diabetes, you will get a higher level of polyphenols than you would get in black,” she explains. It’s the polyphenols in fruits and vegetables that give them their bright colors. So, having more color means that green tea is richer in polyphenols. “Of the black teas, the more orange the color, the higher the polyphenols,” she adds.

    "Green tea is good for people with diabetes because it helps the metabolic system function better."

Suzanne Steinbaum, DO

Besides its color, green tea also contains higher polyphenol levels because it's prepared from unfermented leaves, "so it is really pure,” Steinbaum says. Black tea, on the other hand, is made from leaves that are fully fermented, which robs it of some nutrients. “Plus, some black tea varieties can have two to three times more caffeine than green, which isn’t good in excess,” she says.

Polyphenols: Beyond Drinking Tea for Diabetes

The benefits of tea are clear. But besides tea, a number of foods high in polyphenols also can help prevent and manage type 2 diabetes. “The fruits highest in polyphenols are berries, grapes, apples, and pomegranates — because of their rich color,” Steinbaum says. Broccoli, onions, garlic, tomatoes, eggplant, and spinach are also good sources, as are cranberries, blood oranges, blackberries, blueberries, raspberries, strawberries, rhubarb, lemons, limes, and kiwis. “We know red wine contains resveratrol, which is a polyphenol — the highest concentration is in Bordeaux,” Steinbaum says.

8 Ways to Squeeze Fitness Into Your Day

While I aim for 20 or 30 minutes of daily exercise, I never miss an opportunity to sneak in extra movement throughout the day. After all, your muscles have no idea if you’re in a fancy gym or in your kitchen — as long as you’re working them, they’ll get toned!

By doing little exercises throughout the day wherever you can — in the kitchen, in your car, while you brush your teeth, or while you're sitting at your computer — you’ll keep the oxygen flowing and stretch and tone your muscles.

 

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You’ll also boost your metabolism: Did you know you can burn up to 500 calories per day just by fidgeting? It’s true! I like to call these little movements "fidget-cizes." They take only one minute or less and they really do work! Fidget-cizes don't replace your regular workouts, but when life gets too hectic, use these moves as a way to squeeze in a little extra fitness all day long. Here are a few of my favorites. Give them a try!

  • Squeeze that butt: Do it in the elevator, as you're walking down the aisles of a grocery store, and while you're waiting in line at the bank. No one will know — and it's so effective!
  • Work those legs: Try doing leg lifts at your desk or squats while you brush your teeth at night.
  • Add some steps to your day: Whenever you can, sneak in extra walking. Park your car far away from the store, take the stairs instead of the elevator at work, or do a few laps of the mall before you shop this weekend. Every step counts!
  • Tuck that tummy: If you're relaxing in the living room in front of the TV, try lying on the floor or on a blanket and doing crunches. Make a deal with yourself that you'll do them throughout each commercial break. Easy!
  • Take a “dip” on the couch: Sit at the edge of the couch and place your palms down on each side of you. Move forward so that your body is off the couch, bend your elbows behind you, and lower your body toward the floor with your knees bent and feet together. Bend and extend your arms multiple times as you watch TV — you’ll lose that arm jiggle in no time!
  • Stretch it out: Tension can build up in the neck and shoulders simply from sitting at your desk, and it gets even worse as the long work day drags on. Stretching encourages those tense muscles to relax and counteracts any tightness from poor posture and tired muscles. Try doing my Shoulder and Chest Relaxer, One-Arm Reach, and Neck and Shoulder Release at your desk — you'll probably start an office trend!
  • Get firm on the phone: If you spend a lot of time on the phone like I do, don't just sit there — make it a workout by "pretending" to sit! Press your back flat against a wall and lower your body by bending your knees to a 45- to 90-degree angle. Hold the position for as long as you can.
  • Get lean while you clean: Did you know that by doing household chores — carrying laundry upstairs, vacuuming, making your bed, dusting — you can burn up to 400 calories an hour? You’ve got to do these tasks anyway, so you might as well turn on some music and think of it as exercise!

Go ahead: Turn idle time into exercise time and look for every opportunity to move your body. All of those little moments will add up to major health benefits — you’ll see!

Recognizing an Addiction Relapse

Treatment and recovery from an addiction to drugs or alcohol are steps in a lifelong journey. Unfortunately, 40 to 60 percent of drug addicts and almost half of all alcoholics will eventually go through a substance abuse relapse.

If someone dear to you has been in addiction treatment, it is important for you to be able to recognize if that person is relapsing as early as possible. This way, the problem can be addressed before it spirals out of control. Just because your loved one relapses does not mean that their addiction treatment has failed, however; it just means that the current treatment regimen probably needs to be reevaluated.

Addiction Relapse: Obvious Signs

"Most of the time the signs are so obvious," says Thomas Kosten, MD, Jay H. Waggoner chair and founder of the division of substance abuse at Baylor College of Medicine in Houston.

According to Dr. Kosten, the following are common indicators of a drug or alcohol addiction relapse:

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  • Alcohol is missing from the house.
  • Bottles of alcohol are found around the home.
  • Your loved one comes home obviously intoxicated.
  • Money is missing from bank accounts or stolen from friends or family member.
  • Medicine is missing from the house.

 

 

Addiction Relapse: Early Indicators

 

 

There are also signals from the addict that a relapse is just around the corner, when steps can be taken to prevent the relapse or at least address it in its earliest stages. Your loved one may exhibit the following emotions and behaviors:

  • Anxiety
  • Anger
  • Impatience
  • Extreme sensitivity
  • Moodiness
  • Not wanting to be around people
  • Refusing help
  • Not complying with treatment recommendations
  • Problems with sleeping
  • Appetite changes
  • Reminiscing about the past
  • Lying
  • Seeing friends that they've used drugs or alcohol with in the past
  • Talking about relapse

Addiction Relapse: Stepping in

When you suspect that your loved one has relapsed, Kosten says the best thing to do is tackle the issue head-on. He suggests that you start the conversation in the following way:

  • First, say to your loved one, “I think you’re using.”
  • If the person admits he is using again, then say, “We need to do something about this."
  • Kosten suggests that at this point you start setting limits by saying something such as, "Unless you get help, you will have to leave the house."

If your loved one is showing signs of an impending relapse but hasn’t yet relapsed, Kosten says that it is important to confront him first. Otherwise it is very unlikely that you are going to be able to convince him to get back into addiction treatment. Then you should encourage him to continue with treatment, talk to an addiction counselor or sponsor, and practice good self-care — that is, get enough sleep, eat well, and take steps to relieve stress.

If the addict refuses to talk with a professional or you feel that you need anaddiction expert to help you learn how to confront him, contact your local Council for Alcoholism and Drug Abuse. Or if you have access to the person’s doctor, addiction counselor, or sponsor, speak to that person about how you might deal with the situation.

diabetes type 2

There is a problem about diabetes type 2

 

 

many topic

 

bad habit or not nutration food is a cause of diabetes

 

   
   

 

 

Teens and E-cigarettes

In Figure 2 Teen e-cig users are more likely to start smoking.
30.7 percent of e-cig users started smoking within 6 months while 8.1 percent of non users started smoking. Smoking includes combustible tobacco products (cigarettes, cigars, and hookahs).

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.

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.

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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

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Moving Just 1 Hour a Week May Curb Depression Risk

Career couch potatoes, take heart: Just one hour a week of any kind of exercise may lower your long-term risk for depression, new research suggests.

The finding comes from a fresh analysis of a Norwegian survey that tracked exercise habits, along with depression and anxiety risk, among nearly 34,000 adults.

After a closer look at the data, a team of British, Australian and Norwegian analysts determined that people who engage in just an hour of exercise per week -- regardless of intensity level -- face a 44 percent lower risk for developing depression over the course of a decade than those who never exercise at all.

"The key finding from this study is that doing even a small amount of regular exercise seems to protect adults against future depression," said study author Samuel Harvey.

"This was not a case of more is better; the vast majority of the mental health benefits of exercise was realized when individuals moved from doing no regular activity to 1 or 2 hours per week," Harvey explained.

"Also, the mental health benefits were there regardless of the intensity of the physical activity," he added. "There is great evidence that there are many physical health benefits to more regular exercise, but the mental health benefits leveled out after 2 hours."

RELATED: 7 Common Myths About Depression

Harvey is an associate professor with the School of Psychiatry at the University of New South Wales, in Sydney, Australia. "The important point here is that any type of physical activity -- even just walking -- had similar levels of mental health benefits," he concluded.

The original survey was launched between 1984 and 1986. In that timeframe, participants (who were about 45 years old, on average) underwent physical exams, and filled out lifestyle and medical questionnaires. Mental health assessments were also completed.

The Norwegian pollsters conducted a follow-up survey between 1995 and 1997 among roughly two-thirds of the original participants.

About 7 percent of those tracked through 1997 had developed depression, while about 9 percent had developed clinical levels of anxiety, the findings showed.

Exercise did not appear to have any impact on anxiety risk. But investigators found that, regardless of gender or activity intensity, regular exercise lasting at least an hour per week was linked to a lower risk for developing depression over time.

The study authors calculated that roughly 12 percent of the depression cases might have been prevented if those who had become depressed had previously routinely engaged in one hour of low-intensity activity a week.

Exercising more than one hour per week did not, however, appear to substantially decrease depression risk even further; the lion's share of the protective impact appeared to max out at the one-hour mark.

But as to how and why such a minimal amount of regular exercise might help stave off depression, the study team wrote that "the bulk of the observed protective effect remains unexplained." And the study did not prove a cause-and-effect relationship between exercise and lower risk of depression.

Harvey and his colleagues reported their observations in the Oct. 3 issue of the American Journal of Psychiatry.

Simon Rego, chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said that "there are probably many mechanisms at play that could explain how this works. But it doesn't have the same effect on anxiety, so we just don't know yet exactly what's happening."

However, Rego added, "What we do know is that what they've identified is a very low bar of entry. We're talking about just an hour of activity a week. And it doesn't have to be vigorous or intense. You don't need to go out to a spin class or sign up for a running club. This could just be getting people who aren't moving much to just increase their daily walking habit. That's all."

So, he explained, "while we don't have all the definitive answers yet, this is a very promising finding because this is something many people may find easy to do."

Which Gets More TLC: Your Car or Your Body?

The mass production of the Ford Model T sparked a new love affair – one between people and their cars. We carve out time to wash them, cringe at the sight of a dent or scratch, and even name them (although, the nameChristine for a car has yet to make a comeback).

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Our car–caregiver behavior is strange, especially when you consider that a 2011 study found that 40 percent of men said they’re more likely to resolve car problems than their own health problems. Where does your health rank? Are you taking better care of your car than your health? 

Check out our article to see which gets more TLC – your car or your body.

Mechanic Vs. Doctor

If you have a trusted mechanic but not a trusted doctor, you may care more about your car than your health. Choosing a doctor you trust and feel comfortable asking questions fills a critical piece of the health puzzle. In fact, a 2012 study showed that people spend more time researching car purchases than they do selecting a physician

Maybe you're new to insurance because you've just signed up for Obamacare. While insurance plans can limit which primary care providers you can choose, there are other factors to consider when picking a PCP. For example: Is the office staff friendly and helpful, is the doctor easy to talk to, and does the doctor’s approach to testing and treatment suit you? Still unsure which PCP to pick? Ask co-workers, friends and family members for their recommendations.

RELATED: 5 Worst Celebrity Health Bloopers 

 

 

Engine Health Vs. Heart Health

It’s a familiar situation. Your check engine-light pops up and you call your mechanic or hightail it to your nearest car dealership. But can you spot symptoms of heart disease — the No. 1 killer of both men and women in the United States — when they strike?

In addition to having regular cholesterol and blood pressure tests, look for these check-engine lights for your heart, and see your doctor promptly if you have any of them:

  • Shortness of breath
  • Chest pain
  • Swelling of your feet and lower legs, also known as peripheral edema
  • Yellow bumps on the skin called xanthomas
  • Swollen, sore or bleeding gums

 

Americans spend more time researching car purchases than they do selecting a physician.

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Car Weight Vs. Your Weight

Packing your car to the gills with stuff isn’t the best idea. Extra weight kills your gas mileage, makes your car work harder, and causes premature wear and tear. 

The same concept applies to your own body! If you’re still carrying extra pounds around your waist, you’re at greater risk for health conditions like stroke,hypertension, diabetes, cancer, sleep apnea, gout,depression, and even fatty liver disease. The extra weight also puts stress on your joints and can lead to arthritis.

Changing Your Oil Vs. Checking Your Blood Pressure

You should probably get an oil change every 3,000 to 5,000 miles, depending on the make and model of your car. But how often do you get your blood pressure checked?

High blood pressure is a serious health condition that can put you at risk for heart attack, stroke and other illnesses, and every healthcare visit should include a blood pressure reading. But if you're dodging the doctor altogether you're missing out on this vital checkpoint. The American Heart Association recommends that you get your blood pressure checked at least every two years if your blood pressure stays below the healthy standard 120/80 mm Hg — more often if it's inching up.

 

 

RELATED: The Hurt Blogger: How I Became a Runner With RA 

Brake Check Vs. Flu Shot

If you get your brakes checked at least once a year, but don’t get a flu shot every year, you're putting yourself at risk for infections caused by particular flu season's bugs. For the 2012-2013 flu season, the flu vaccine prevented an estimated 6.6 million flu-associated illnesses and 3.2 million flu-associated medical visits,according to the Centers for Disease Control and Prevention.

Still, more than half of Americans didn’t get a vaccination for the most recent season. Make the flu shot a yearly habit and you'll not only cut your risk of getting the flu, you'll also lower your risk of death if you have heart disease, according to research conducted by Jacob Udell, MD, and colleagues at the University of Toronto, published in JAMA

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). 

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

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.
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.

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.

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.

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.

 

Herbal remedy isn't regulated, and can have side effects and serious drug interactions.

Herbal remedy isn't regulated, and can have side effects and serious drug interactions.

St. John's wort is a popular herbal therapy for depression, but a new Australian study highlights the fact that "natural" does not always equal "safe."

Using reports filed with Australia's drug safety agency, the researchers found that adverse reactions to St. John's wort were similar to those reported for the antidepressant fluoxetine -- better known by the brand name Prozac.

Those side effects included anxiety, panic attacks, dizziness, nausea and spikes in blood pressure, the researchers reported in the July issue of Clinical and Experimental Pharmacology and Physiology.

"It's concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk," lead researcher Claire Hoban, of the University of Adelaide, said in a university news release.

Research has shown that St. John's wort can help ease mild to moderate depression. But the fact that it works also means there is a risk of side effects, said Dr. Samar McCutcheon, a psychiatrist at Ohio State University Wexner Medical Center in Columbus.

"Even if the bottle says 'natural' or 'herbal,' it still has ingredients that are active in your body," said McCutcheon, who was not involved in the study.

It has long been recognized that St. John's wort can have significant side effects and interact with certain medications, McCutcheon pointed out.

But many consumers may not know that, she noted, largely because dietary supplements are not regulated in the way that drugs are.

"I definitely think this [lack of awareness] is still an issue," McCutcheon said. "People think St. John's wort is safe because they can buy it at a health food store."

In the United States, dietary supplements do not have to be studied for safety and effectiveness before they reach the market.

"Plus," McCutcheon said, "you're relying on companies to make sure these products include the ingredients they're supposed to, and keep out ingredients that they shouldn't."

The situation is similar in Australia, and many consumers there are unaware that supplements are largely unregulated, according to Hoban's team.

RELATED: 7 Supplement Risks Every Woman Should Know About

The researchers based their findings on doctors' reports to Australia's national agency on drug safety. Between 2000 and 2013, there were 84 reports of adverse reactions to St. John's wort, and 447 reports on Prozac.

But since those are voluntary reports, they do not reflect the actual rate of side effects from either therapy, according to the researchers. And, Hoban said, bad reactions to St. John's wort are particularly likely to go unreported, since the herb is often not even considered a drug.

According to McCutcheon, it's important for people with depression symptoms to see a health professional before self-medicating with St. John's wort. "That will help ensure you have the right diagnosis," she said.

If your symptoms are actually part of a different disorder, St. John's wort may be ineffective -- or possibly even risky. For example, McCutcheon said that in people with bipolar disorder, the herb might fuel a manic episode.

But possibly the biggest concern, she said, is the potential for St. John's wort to interact with commonly used medications.

The herb can dampen the effectiveness of birth control pills, blood thinners and heart disease drugs, along with some HIV and cancer drugs, according to the U.S. National Center for Complementary and Integrative Health.

What's more, it can interact with antidepressants. It's not clear exactly how St. John's wort works, McCutcheon said, but it's thought to boost levels of the brain chemical serotonin -- which is how the most commonly used antidepressants work.

"If you use the two together, you run the risk of having too much serotonin," she said. And that raises the risk of a potentially fatal condition called serotonin syndrome, whose symptoms include confusion, tremors, diarrhea and a drop in body temperature.

Some side effects of St. John's wort are caused by the herb itself, such as skin rash that's worsened by sunlight, said Dr. John Reed, director of inpatient services at the University of Maryland's Center for Integrative Medicine in Baltimore.

But the main concern is still its potential for interacting with other medications, he said. "Compared with other herbs, St. John's has more drug interactions," Reed explained. "So if you're using it, don't take other medications unless it's under medical supervision."

He added that anyone on any medication should do some homework before starting an herbal product. "Go online and do a search for drug interactions. Ask your pharmacist or doctor," Reed advised.

"Unfortunately," he said, "this type of information [on drug interactions] doesn't have to be printed on product labels."

The bottom line, according to McCutcheon, is that people with depression should talk to their providers about any supplements they take, or want to take. And those providers, she said, should be willing to have nonjudgmental discussions.

"I want all my patients to be comfortable enough to bring up anything with me," McCutcheon said.

6 Ways To Tone Your Entire Bod Using Just A Resistance Band

Not only are resistance bands a great toning tool, but you can take them anywhere because they're light and super compact. They're also a smart transition to using weights.

For this workout, try to do 10-12 repetitions of each move using a band that challenges you. (Try this Adjustable Resistance Tube, $8, ) Bands usually come with a light, medium, and heavy option, so choose the best match for your fitness level (and switch to a heavier one as you get stronger). Try to flow from one exercise to the next without taking a break.

(The Slim, Sexy, Strong Workout DVD is the fast, flexible workout you've been waiting for!)​

To start, step on the center of the band with one leg and then step forward with your other leg. Lean your torso forward and keep reaching out through the top of your head all the way down to your tailbone. Try not to hunch over, and make sure to keep tension on your band the whole time. This will be your base posture throughout all six of these moves:

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6 Depression Symptoms You Shouldn’t Ignore

Major depression isn’t always so easy to spot in yourself or someone you love. Use these clues to determine when treatment is needed.

Everyone feels a little down in the dumps now and then. But sadness and withdrawal can become crippling, putting you at risk for a number of serious conditions and consequences, including suicide.

Depression symptoms aren't always as obvious as frequent crying and overwhelming despair. “Oftentimes the changes are subtle, and the person may not notice, but their friends and loved ones may,” says Boadie W. Dunlop, MD, director of the mood and anxiety disorders program in the psychiatry department at Emory University School of Medicine in Atlanta.

There's no one pattern. Depression symptoms may gradually progress from the mild, such as choosing to stay home to watch TV instead of going out with friends, to the more severe, such as thoughts of suicide. Or someone may go from seeming perfectly happy to being totally depressed in a matter of days or weeks. The progression varies from person to person.

“Depression symptoms are particularly troubling if someone displays more than one, or if they persist for more than two weeks,” says Simon Rego, PsyD, associate professor of clinical psychiatry and behavioral sciences at Albert Einstein School of Medicine and director of psychology training at Montefiore Medical Center in the Bronx, New York.

RELATED: 10 Drug-Free Therapies for Depression

To help you recognize depression that warrants concern, whether in yourself or a loved one, here are six depression symptoms — some of which you might even find surprising — that you shouldn’t ignore:

1. Trouble Sleeping Despite being slower in demeanor and motivation, depressed people often lie awake at night, unable to sleep, says Sarah Altman, PhD, a clinical psychologist in the department of psychiatry and behavioral health at The Ohio State University Wexner Medical Center in Columbus. On the other hand, some depressed people may find it difficult to get out of bed and may sleep for long periods during the day.

2. Loss of Interest in Favorite Activities Some people turn to hobbies they enjoy when they feel blue, but people with major depression tend to avoid them. “So if a person who loved spending time with her grandchildren suddenly doesn’t want to see them, or a guy who loves to fish suddenly hangs up his rods, it’s a red flag,” says Tina Walch, MD, psychiatrist and medical director of Northwell Health's South Oaks Hospital in Amityville, New York.

3. Increase in Energy Ironically, when depressed people have made a decision to do something drastic, such as killing themselves, they may go from lackadaisical and slowed to more energetic. That's because they feel a sense of relief in having come to a resolution, Dr. Walch says, "so if you notice a drastic switch like this, you should be very concerned."

4. Change in Appetite Some people overeat when they're depressed or anxious, but in people with severe depression, the opposite is usually true. “A depressed person may stop eating because he or she is no longer concerned with physical well-being,” says John Whyte, MD, MPH, a board-certified internist in Washington, DC and author of Is This Normal?: The Essential Guide to Middle Age and Beyond. “Disregard for personal hygiene is also cause for concern,” Dr. Whyte adds.

5. Touchiness “In some people, depression manifests as more irritability and impatience than feeling down,” Dr. Dunlop says.

6. An Emerging Dark Side “A person who is severely depressed may become preoccupied with death and other morose topics,” Walch says. For example, he or she may talk about what things will be like “after I am gone,” and may also become more likely to take uncalculated risks.

The Next Step: Getting Help

If you notice any of these serious depression symptoms in yourself or someone you love, reach out and get help. “In most people, depression, even major depression, is a very treatable disorder," Walch says. "There is a wide range of medications and therapies that have been proven to work." Specifically, here's what you should do:

Assess the severity. If you or a loved one is considering harming himself or herself, or is having other dark thoughts, immediate treatment is critical. “Go to the nearest emergency room or contact your local or a private mental health provider,” Walch says. Or contact the National Suicide Prevention Lifeline at 800-273-8255 (TALK).
Create a safe environment. “If the person expresses suicidal thoughts, remove any potentially lethal items from the home, such as guns,” Dunlop says.
See a mental health professional. “It doesn’t have to be a psychiatrist — it can also be a psychologist or therapist,” Whyte says.
Be kind. “Blaming or chastising depressed people for feeling low or unmotivated is not helpful and typically serves to reinforce negative feelings they already have,” Dunlop says. “Instead, open the discussion in a nonjudgmental way and encourage the person to seek help.”
Ignore the stigma. “The recent story of the [suicidal] German copilot [Andreas Lubitz] has not been helpful in terms of the stigma surrounding depression,” Walch says. “Depressed people who are suicidal are not murderers. Suicidal thinking can be a depression symptom, but homicidal thinking is not.”
Look to resources. “There are many organizations that have online resources about depression,” Dr. Altman says. They include the National Institute of Mental Health, the National Alliance on Mental Illness, and the American Psychological Association.

Depression Screening Should Include All Pregnant, Postpartum Women

All U.S. adults, including pregnant and postpartum women, should be screened for depression by their family doctor, the nation's leading preventive medicine panel recommends.

Further, doctors need to follow through and get treatment for anyone who tests positive for depression, the U.S. Preventive Services Task Force concluded in an update of its depression screening guidelines.

This is the first time the panel has specifically advocated depression screening in pregnancy and shortly after giving birth. It cited a U.S. study that found that 9 percent of pregnant women and more than 10 percent of postpartum women exhibited signs of major depression.

The American College of Obstetricians and Gynecologists (ACOG) applauded the recommendation.

"Because fewer than 20 percent of women in whom perinatal depression is diagnosed self-report their symptoms, routine screening by physicians is important for ensuring appropriate follow-up and treatment," said ACOG president Dr. Mark DeFrancesco in a statement.

Depression can harm both the child and mother, interfering with their interactions and affecting social relationships and school performance, the panel noted. Risk factors during pregnancy and after delivery include poor self-esteem, child-care stress, prenatal anxiety and decreased social support, the report said.

The new report -- published Jan. 26 in the Journal of the American Medical Association -- updates a similar recommendation the panel issued in 2009 that called for routine screening of adults.

In general, primary care physicians should be able to treat most cases of uncomplicated depression, and refer more complex cases to a psychiatrist, said Dr. Michael Pignone, a member of the task force and director of the University of North Carolina's Institute for Healthcare Quality Improvement.

"That's part of our job," Pignone said.

Options for treatment include therapy with a psychologist or licensed clinical social worker or antidepressant medications.

The task force is an independent, volunteer panel of national experts in preventive medicine. It issues recommendations, and revisits them on a regular basis to make sure that medical evidence still supports the guidelines.

RELATED: 9 Depression Types to Know

Depression is among the leading causes of disability in persons 15 years and older, the panel noted.

Millions of adults suffer from depression and don't know it, said Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.

At any given time, between 5 percent and 10 percent of U.S. adults suffer from a depressive disorder, but half receive no treatment for their depression, Thase said.

The task force's depression guidelines are aimed at detecting and helping those adults who unknowingly have depression, Pignone said.

"This is about screening, not about diagnosing people who come to a doctor's office saying, 'I feel depressed.' The potential value of screening is in those people who would not be found as part of regular clinical care," he said.

Some people may not want to acknowledge they are depressed because there is a stigma around mental illness, Pignone said. Others might just think they are feeling blue, and will get over it.

"In some people, their symptoms may seem more physical to them," he added. For example, depression might cause stomach pain, headaches or sleeping problems.

The task force did not recommend any particular questionnaire for depression screening, because "there are many good tools and there's no single tool that should be recommended above others," Pignone said.

The most common screening tool, the Patient Health Questionnaire, consists of 10 simple questions that can be answered in minutes, according to the U.S. Department of Health and Human Services.

The task force also could not recommend how regularly people should be screened, because not enough research has been done in that area, Pignone said.

"The task force recommendation is that people should be screened at least once," he said. "For the meantime, clinicians should use their judgment about the risk of depression in their patients, in deciding how often to screen."

However, the task force did emphasize the need to follow up a positive screening with treatment.

Dr. Michelle Riba, a former president of the American Psychiatric Association, agreed that primary care doctors should be able to treat most patients with depression.

However, Riba added that doctors should develop a relationship with a psychiatrist they can consult on cases of depression. The psychiatrist could talk with the practitioner on the phone, review patient charts, and help decide the best course of action.

Doctors also should be open to other forms of treatment for depression, such as cognitive-behavioral therapy or light therapy, said Elizabeth Saenger, a psychologist in private practice in New York City.

Light therapy affects the body's production of the hormone serotonin, and studies have shown it can help alleviate depression symptoms, Saenger said.

It makes sense for primary care doctors to lead the way on depression screening because they see patients most often, said Dr. Alan Manevitz, a psychiatrist with Lenox Hill Hospital in New York City.

Treating depression can help patients face other health problems with which they are struggling. "As depression gets worse, so many other chronic illnesses also get worse," Manevitz said. "People don't take care of their health as well when they are depressed."

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

 

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.

 

Scientists Test 'Magic Mushroom' Chemical for Tough-to-Treat Depression

Study of only 12 people suggests it may help some, but more and better research is needed.

A hallucinogenic compound found in "magic mushrooms" shows promise in treating depression, a small, preliminary study found.

"Depression continues to affect a large proportion of the population, many of whom do not respond to conventional treatments," said Dr. Scott Krakower, a psychiatrist who reviewed the study.

"Although this was a small study, it does offer hope for new, unconventional treatments, to help those who are battling with severe depression," said Krakower, who is chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y.

The new trial included 12 people with moderate to severe depression who had been resistant to standard treatment. All of the patients were given the compound psilocybin, found in hallucinogenic mushrooms.

Three months after treatment, seven patients had reduced symptoms of depression, according to a team led by Dr. Robin Carhart-Harris of Imperial College London, in England.

There were no serious side effects, the study authors said in the report published May 17 inThe Lancet Psychiatry.

Carhart-Harris' team stressed that no strong conclusions can be made from the findings -- only that further research is warranted.

RELATED: 9 Natural Therapies for Bipolar Depression

About 1 in 5 patients with depression does not respond to treatments such as antidepressants or cognitive behavioral therapy, the study authors noted.

"This is the first time that psilocybin has been investigated as a potential treatment for major depression," Carhart-Harris said in a journal news release.

"The results are encouraging, and we now need larger trials to understand whether the effects we saw in this study translate into long-term benefits, and to study how psilocybin compares to other current treatments," he said.

How might the drug work to ease depression?

"Previous animal and human brain imaging studies have suggested that psilocybin may have effects similar to other antidepressant treatments," explained study senior author David Nutt, also of Imperial College London.

"Psilocybin targets the serotonin receptors in the brain," he said, "just as most antidepressants do, but it has a very different chemical structure to currently available antidepressants and acts faster than traditional antidepressants."

However, Krakower stressed that caution must be taken with such a powerful drug.

"Psilocybin is still a potent psychedelic compound and can have unwanted side effects," he said. "Patients should interpret these results with caution until more studies are conducted."

Another mental health expert agreed.

"Anyone reading of this study should be cautioned to not use this drug on themselves," said Dr. Alan Manevitz, a clinical psychiatrist with Lenox Hill Hospital in New York City.

He said the study also had some flaws, most notably its small size and the fact that patients had "expectations" of benefit that might have skewed the results.

Furthermore, the need to watch over the patient, "for hours after treatment may make this an impractical drug to clinically use and further research into dosages is required," Manevitz said.

But he noted that this isn't the first time psilocybin has been thought of as medicine.

"Psilocybin has been considered for the use for easing the psychological suffering associated with end-stage cancer," he explained. "Preliminary results indicate that low doses of psilocybin can improve the mood and anxiety of patients with advanced cancer, with the effects lasting two weeks to six months."
 

10 Ways to Fight Chronic RA Pain

The aches and pains of rheumatoid arthritis can be hard to overcome, but these strategies may help in treating chronic pain.

From fatigue to loss of appetite, rheumatoid arthritis (RA) can impact your life in a number of ways, but the most limiting symptom for many people is pain. Because that pain comes in different forms, you may need more than one strategy to relieve it.

“The primary cause of rheumatoid arthritis pain is inflammation that swells joint capsules," says Yousaf Ali, bachelor of medicine and bachelor of surgery, an associate professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai West Hospital in New York City. Joint capsules are thin sacs of fluid that surround a joint, providing lubrication for bone movement. In RA, the body's immune system attacks those capsules.

The first goal of pain relief is the control of inflammation, Dr. Ali explains. “Inflammation can cause acute (short-term) pain or longer-lasting smoldering pain," he says. "Chronic erosion of joint tissues over time is another cause of chronic pain. But there are many options for pain relief.”

Getting RA pain under control may take some work. You may find that you'll need to take several drugs — some to slow the joint damage and some to alleviate joint pain. Alternative therapies, like acupuncture, combined with drugs may help you to feel stronger. It may take some time, too. Try the following strategies — with your doctor's supervision — to discover which are most effective for you:

Treatments and Strategies to Help Relieve Chronic RA Pain

1. Inflammation Medication "In the case of RA, all other pain-relief strategies are secondary to controlling inflammation," Ali says. The No. 1 option in the pain relief arsenal is to control inflammation with disease-modifying anti-rheumatic drugs, called DMARDs. These drugs, which work to suppress the body's overactive immune system response, are also used to prevent joint damage and slow the progression of the disease. DMARDs are often prescribed shortly after a diagnosis in order to prevent as much joint damage as possible.

"The most commonly used is the drug methotrexate," he says. It's administered both orally and through injections. Digestive issues, such as nausea and diarrhea, are the most common side effect of DMARDs, and of methotrexate in particular, if taken by mouth. Hair loss, mouth sores, and drowsiness are other potential side effects. Methotrexate, which is taken once a week, can take about five or six weeks to start working, and it may be three to six months before the full effects of the drug are felt; doctors may also combine it with other drugs, including other DMARDs.

"Steroids may be used to bridge the gap during an acute flare," adds Ali. "If flares continue, we can go to triple-drug therapy, or use newer biologic drugs that are more expensive but also effective.” The most common side effect of biologics are infections that may result from their effect on the immune system.

The next tier of pain relief includes these additional approaches:

2. Pain Medication The best drugs for acute pain, Ali says, are nonsteroidal anti-inflammatory drugs, called NSAIDs. Aspirin and ibuprofen belong to this class of drugs, as does a newer type of NSAID called celecoxib. While NSAIDs treat joint pain, research has shown that they don't prevent joint damage. In addition, NSAIDs may irritate the stomach lining and cause kidney damage when used over a long period of time.

"Stronger pain relievers, calledopioids, may be used for severe pain, but we try to avoid them if possible," says Ali. "These drugs must be used cautiously because of the potential to build up tolerance, which can lead to abuse."

3. Diet Although some diets may be touted to help RA symptoms, they aren’t backed by the medical community. “There is no evidence that any special diet will reduce RA pain," Ali says. But there is some evidence that omega-3 fatty acids can help reduce inflammation — and the joint pain that results from it. Omega-3s can be found in cold-water fish and in fish oil supplements. A study published in November 2015 in the Global Journal of Health Sciences found that people who took fish oil supplements were able to reduce the amount of pain medication they needed.

4. Weight Management Maintaining a healthy weight may help you better manage joint pain. A study published in November 2015 in the journal Arthritis Care & Research suggested that significant weight loss can lower the need for medication in people with RA. Among the study participants, 93 percent were using DMARDs before they underwent bariatric surgery, but that dropped to 59 percent a year after surgery.

5. Massage A massage from a therapist (or even one you give yourself) can be a soothing complementary treatment to help reduce muscle and joint pain. A study published in May 2013 in the journal Complementary Therapies in Clinical Practice involved 42 people with RA in their arms who received either light massage or medium massage from a massage therapist once a week for a month. The participants were also taught to do self-massage at home. After a month of treatment, the moderate-pressure massage group had less pain and greater range of motion than the others.

6. Exercise Although you may not feel like being active when you have RA, and it might seem that being active could put stress on your body, gentle exercises can actually help reduce muscle and joint pain, too. “Non-impact or low-impact exercise is a proven way to reduce pain," Ali says. "We recommend walking, swimming, and cycling.” In fact, one of the best exercises you can do for RA is water aerobics in a warm pool because the water buoys your body.

The Arthritis Foundation also notes that yoga is another option to help reduce RA pain, and traditional yoga poses can be modified to your abilities. Yoga may also help improve the coordination and balance that is sometimes impaired when you have the disease. When it comes to exercise, though, it’s also wise to use caution. Talk with your doctor if any workouts are making your pain worse, and, in general, put any exercise plan on hold during an acute flare.

7. Orthoses These are mechanical aids that can help support and protect your joints. Examples include padded insoles for your shoes and splints or braces that keep your joints in proper alignment. You can even get special gloves for hand and finger RA. A physical therapist can help you determine the best orthoses options for you.

8. Heat and Cold Heat helps to relax muscles, while cold helps to dull the sensation of pain. You might find that applying hot packs or ice packs, or alternating between hot and cold, helps reduce your joint pain. Relaxing in a hot bath can also bring relief, as can exercising in a warm pool.

9. Acupuncture This Eastern medicine practice, which has been around for centuries, is thought to work by stimulating the body's natural painkillers through the use of fine needles gently placed near nerve endings. “I have found acupuncture to be helpful for some patients, but the pain relief is usually not long-lasting,” says Ali.

10. Transcutaneous Electrical Nerve Stimulation (TENS) TENS is a form of therapy that uses low-voltage electric currents to stimulate nerves and interfere with pain pathways. “TENS is usually used for stubborn, chronic pain and not as a first-line treatment for RA,” Ali says. One of the benefits of this treatment is the low occurrence of side effects. If you're interested in trying it for pain relief, talk with your physical therapist.

Remember, you’re not alone — your doctor and specialists can help you find relief from chronic pain. If you’re experiencing more pain than before, or if pain is interfering with your ability to get things done, don’t hesitate to talk to your doctor. Ask your rheumatologist about pain relief options, like exercise, massage, yoga, and acupuncture, but remember that the first priority on your pain relief list should be to get RA inflammation under control.

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