Surprising Physical Signs of Heart Disease

Many people associate heart disease with obvious symptoms, like chest pain. But there are some not-so-obvious connections, like swollen feet or bleeding gums, that should also merit a heart check from your doctor.

The classic red flags for a heart attack are familiar to anyone who has watched medical dramas on television. The patient, usually an older man, starts wheezing and gasping for breath. Then he clutches his chest, staggers, and eventually falls over. In real life, the signs and symptoms of heart disease are much more varied and subtle.

Signs Versus Symptoms of Heart Disease
First, some definitions. Heart disease symptoms are indications that you feel or experience, while a sign of heart disease is something your doctor can see or find. Obvious heart disease symptoms include shortness of breath and chest pain. But your doctor will also look for common heart disease signs during an examination or in a patient interview.

Knowing the signs of heart disease is important because you may have them before you have any of the common heart disease symptoms. Letting your doctor know about these warning signs could help you get early treatment for heart disease.

"Signs like ankle swelling or weight gain do not necessarily mean you have heart disease, but taken together with other symptoms of heart disease, laboratory studies, and family history, they are an important part of making a diagnosis of heart disease or heart failure," says Carl E. Orringer, MD, associate professor of medicine and director of the Preventive Cardiovascular Medicine and LDL Apheresis Programs at the University of Miami Miller School of Medicine.

Swelling of the Feet and Lower Legs
Retention of fluid in the feet and legs is known as peripheral edema. Edema may appear as "sock marks" on your legs and ankles at the end of the day, especially if you wear tight socks or hose. Mild peripheral edema is common. Your doctor may check for this sign by pressing a finger against your ankle or shin bone to see if a depression or dent is left behind. This is called "pitting edema” and it could indicate congestive heart failure.

Edema may be a sign of heart failure because when your heart is not pumping well, fluid from inside your blood vessels tends to leak out into surrounding tissues. The legs and ankles are common areas for edema because of the effects of gravity.

"Peripheral edema may be caused by a host of issues,” says Dr. Orringer. “The bottom line is that most people with peripheral edema do not have heart disease, but it could be an important sign if there are other signs and symptoms of heart failure."

Male Pattern Baldness
"If you watched any of the royal wedding, you might have noticed that Prince William is balding on the top of his head. This type of balding of the crown of the head in young men may be a sign of an increased risk for heart disease," says Orringer.

Several large studies have confirmed the link between baldness and heart disease. Compared with men with a full head of hair, men with crown loss have an increased risk of heart disease of about 23 percent. Men with complete loss of hair on the top of their head have an increased risk of 36 percent.

The combination of hair loss, high blood pressure, and high cholesterol pushes the risk even higher. This link may be due to too much of the male hormone testosterone, which interferes with hair growth on the head and causes hardening of the arteries. That doesn't mean you are doomed to heart disease if you are bald, but it does suggest you should be screened more carefully for other signs and symptoms of heart disease.

Yellow Bumps on the Skin
Xanthomas are deposits of fat that build up under the skin. They may appear as small yellow bumps or as flat, wide plaques on your elbows, knees, hands, feet, or buttocks. A type of xanthoma called xanthelasma palpebrarum appears on the eyelids. These yellow, fat deposits can potentially be signs of heart disease because they may indicate high levels of fats in the blood.

"Xanthomas may be a sign of a rare, inherited type of blood disorder in which high levels of triglycerides accumulate in the blood. Xanthomas may also be a sign of increased cholesterol, and they may disappear once cholesterol levels are under control," says Orringer.

Gum Disease
Swollen, sore, or bleeding gums are usually a sign of poor oral hygiene, but may also be an important sign of heart disease. "The association between gum disease and heart disease is the real deal," says Orringer. "There is plenty of research available now that backs up this connection."

Gum disease and heart disease may be linked because they are both signs of poor circulation, or there could be common bacteria that are involved in both gum disease and plaque buildup inside coronary arteries. The link may also have something to do with the body's response to prolonged inflammation. In any case, taking better care of your teeth and gums may be a good way to cut down your risk for heart disease.

Emotional Stress
Weakening of the heart muscle accompanied by extreme emotional stress, grief, or loss, especially in women, is called takotsubo cardiomyopathy, or broken heart syndrome. When this occurs, surging stress hormones, especially adrenaline, trigger cardiac pain that feels a lot like a heart attack, often with heart palpitations, shortness of breath, and flushing. But unlike during a real heart attack, the arteries are not blocked. This potentially serious and often overlooked condition is more common in women than in men; in fact, men make up for only 10 percent of diagnosed cases.

Signs of Heart Failure
Heart failure means the heart is not functioning as well as it should. It doesn't mean the heart has failed. Another term for heart failure is congestive heart failure, or CHF. Heart failure gradually gets worse over time. Some early warning signs may include:

Weight Gain If your heart starts to fail and fluid starts to build up in your tissue, causing edema, you might see a sudden weight gain.

Frequent Urination Heart failure may cause decreased blood flow to the kidneys, which causes you to retain more fluid. One of the signs of this fluid may be frequent urination.

Cataracts Although the exact cause of the relationship between cataracts and heart disease is not known, studies show that people who have cataracts are at higher risk for heart disease, high blood pressure, and high cholesterol. "This link is probably more of an association than a sign of heart disease," says Orringer.

Nighttime Cough "One of the signs of heart failure may be the buildup of fluid in the chest and heart when lying flat at night. This increased fluid can cause a nighttime cough," explains Orringer.

Remember that all these heart disease signs may have many different causes. They do not mean you have or will get heart disease. But combined with other heart disease signs and symptoms, your blood tests, and your family history, they give your doctor the best chance to find heart disease early and keep you in good health.

Resting Heart Rate for MEN Or WOMEN

Resting Heart Rate for MEN

Age 18-25 26-35 36-45 46-55 56-65 65+
Athlete 49-55 49-54 50-56 50-57 51-56 50-55
Excellent 56-61 55-61 57-62 58-63 57-61 56-61
Good 62-65 62-65 63-66 64-67 62-67 62-65
Above Average 66-69 66-70 67-70 68-71 68-71 66-69
Average 70-73 71-74 71-75 72-76 72-75 70-73
Below Average 74-81 75-81 76-82 77-83 76-81 74-79
Poor 82+ 82+ 83+ 84+ 82+ 80+

Resting Heart Rate for WOMEN

Age 18-25 26-35 36-45 46-55 56-65 65+
Athlete 54-60 54-59 54-59 54-60 54-59 54-59
Excellent 61-65 60-64 60-64 61-65 60-64 60-64
Good 66-69 65-68 65-69 66-69 65-68 65-68
Above Average 70-73 69-72 70-73 70-73 69-73 69-72
Average 74-78 73-76 74-78 74-77 74-77 73-76
Below Average 79-84 77-82 79-84 78-83 78-83 77-84
Poor 85+ 83+ 85+ 84+ 84+ 84+

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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.

Everyday Health: What causes hyperpigmentation?

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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.

How to Prevent Hearing Loss

Do you have trouble following a conversation in a noisy room? Do other people complain that you have the television turned up too loud? If the answer to either of those questions is yes, you may already have some degree of hearing loss.

Hearing loss can start at any age. According to the National Academy on Aging and Society, the number of affected Americans between the ages of 45 and 64 has increased significantly since 1971. But it’s much more common in seniors: Some 40 percent of the 20 million Americans who have hearing loss are 65 or older.

Contrary to popular belief, however, hearing loss is not an inevitable part of aging. Some causes of hearing loss can be prevented, and most types of hearing loss can be helped.

Types and Causes of Hearing Loss

There are three basic types of hearing loss:

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  • Sensorineural hearing loss is caused by damage to the inner ear nerves or the nerves that carry sound to the hearing area of the brain. Once you have this type of nerve damage, the only treatment is a hearing aid. Causes of sensorineural hearing loss include injuries, tumors, infection, certain medications, and excessive noise exposure.
  • Conductive hearing loss is caused by a condition that blocks sound waves from being transferred to the nerves involved in the hearing process. Whereas sensorineural hearing loss usually affects both ears, conductive hearing loss may only affect one ear. Common causes include ear infections, ear wax, ear trauma such as a punctured eardrum, and other diseases that affect the ear canal, the eardrum, or the tiny bones in the middle ear. Unlike sensorineural hearing loss, this type of hearing loss can often be corrected and restored.
  • Mixed hearing loss occurs when someone who has nerve type hearing loss from aging or noise trauma then gets an ear infection or develops a wax impaction, causing their hearing to suddenly get much worse. It’s a combination of sensorineural hearing loss and conductive hearing loss.

Hearing Loss Evaluation

If you are having trouble hearing or develop sudden deafness, you need to get your hearing checked as soon as possible. Sudden deafness is a serious symptom and should be treated as a medical emergency. For many people, though, hearing loss may be gradual and not obvious. Here are seven warning signs to watch out for:

  • You have trouble hearing while on the telephone.
  • You can’t seem to follow a conversation if there is background noise.
  • You struggle to understand women’s or children's voices.
  • People complain that you turn up the TV volume too high.
  • You constantly ask people to repeat themselves.
  • You have a long history of working around loud noises.
  • You notice a ringing, hissing, or roaring sound in your ears.

 

 

If you think you have any kind of hearing loss, the place to start is with your doctor. Whether your hearing loss is gradual or sudden, your doctor may refer you to an audiologist (a medical specialist in hearing loss) or an otolaryngologist (a medical doctor specializing in disorders of the ear).

 

 

Depending on the cause and type of your hearing loss, treatment may be as simple as removing ear wax or as complicated as reconstructive ear surgery. Sensorineural hearing loss can't be corrected or reversed, but hearing aids and assistive devices can enhance most people’s hearing. For those with profound hearing loss approaching deafness, an electronic hearing device, called a cochlear implant, can even be implanted in the ear.

Tips for Hearing Loss Prevention

One type of hearing loss is 100 percent preventable: that due to noise exposure. Noise is measured in units called decibels: Normal conversation is about 45 decibels, heavy traffic may be about 85 decibels, and a firecracker may be about 120 decibels. Loud noise — anything at or above 85 decibels — can cause damage to the cells in the inner ear that convert sound into signals to the brain. Here are some tips for avoiding noise-induced hearing loss:

  • Minimize your exposure to loud noises that are persistent.
  • Never listen to music through headphones or ear buds with the volume all the way up.
  • Wear ear plugs or protective earmuffs during any activity that exposes you to noise at or above 85 decibels.
  • See your doctor about a baseline hearing test, called an audiogram, to find out if you already have some early hearing loss.

You should also see your doctor if you have any symptoms of ear pain, fullness, or ringing, or if you experience any sudden change in your hearing. These symptoms could be early warnings of preventable hearing loss.

Hearing loss or deafness can have a serious effect on social well-being. It can cut you off from the world around you. Know the causes of hearing loss, and practice hearing loss prevention to preserve the hearing you still have.

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

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

11 Super Seniors We Admire

1 / 12   Super Seniors We Admire

Senior citizens are having a moment. The U.S. population is getting older — average life expectancy for men and women has reached 76 and 81, respectively, and it’s expected to keep rising, thanks to advances in medicine, nutrition, and safety. In fact, about one in seven adults today is older than 80, and the fastest-growing age group is people over 100. But many of today’s seniors aren’t content to sit still and age quietly. Lately we’ve seen headlines of amazing elders who have completed marathons, graduated college, raced in NASCAR, and more. 

“No matter how old you are, it’s never too late to start living a healthier, more active, more engaging lifestyle,” says Terry Grossman, MD, a physician with an anti-aging and complementary medicine practice in Denver and co-author of Transcend: Nine Steps to Living Well Forever. Even walking an extra 10 minutes a day or taking an adult education class can help keep your body and mind sharp over time, he says. So whether you’re 35, 55, or 75, let these inspiring stories motivate you to cross a life goal off that proverbial bucket list.

Vitamin D

 

 

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.

The Link Between Diet and Eye Disease

Eye disease is one of the most common causes of permanent disability in the United States. More than 20 million Americans age 40 and older have cataracts, and 10 million Americans age 60 and over have age-related macular degeneration (AMD). These eye diseases occur as we grow older, and proper nutrition may have some affect on both of them.

Cataracts develop on the lens of the eye when the proteins in the lens are damaged. These proteins are responsible for keeping the lens clear. When they become damaged, the lens becomes cloudy or opaque, and your vision may become blurry. You may also have poor night vision or double vision with cataracts. Cataract surgery is often necessary to remove and replace the damaged lens with an artificial lens.

AMD occurs when cells in the macula of the eye die. The macula is located in the center of the retina in the back of the eye, and is responsible for your sharp, central vision, which you need for reading and other tasks that require good eyesight. Once the macula is damaged, your vision is no longer clear, and you cannot make out fine details of objects. There is no cure for AMD, but proper nutrition may help prevent it from worsening.

Diet and Eye Disease: What Is a “Healthy Eyes” Diet?

According to Nelson, the nutrients associated with eye health are vitamins C and E; carotenoids, beta carotene, lutein, and zeaxanthin; omega-3 fatty acids; zinc; and vitamins B6, B9 (folic acid or folate), and B12.

“Antioxidants, especially lutein, help deter build-up of waste products in the retina, which in turn helps reduce your risk for AMD,” says Jennifer K. Nelson, MS, RD, director of clinical dietetics and associate professor of nutrition at the Mayo School of Health Sciences in Rochester, Minn. “Folate and vitamin B6 decrease the presence of the blood chemical homocysteine, which lowers your risk for AMD. Antioxidants also help prevent the cross linking of proteins in the lens which can cause cataracts.”


Here's a list of foods containing eye-healthy nutrients:

  • Fruits and vegetables (good sources of vitamins C and E)
  • Dark green vegetables such as kale and spinach (lutein, vitamin E)
  • Yellow and orange fruits and vegetables (beta carotene and zeaxanthin)
  • Anchovies, herring, mackerel, salmon, sardines, trout, tuna, and white fish (omega-3 fatty acids)
  • Beef, eggs, lamb, milk, peanuts, pork, and whole grains (zinc)
  • Bananas, chicken, dried beans, fish, liver, pork, and potatoes (vitamin B6)
  • Citrus fruits, fortified cereals, dried beans, green leafy vegetables, liver, mushrooms, nuts, and peas (folic acid)
  • Dairy products, eggs, meat, poultry, and shellfish (vitamin B12)

A diet high in refined carbohydrates, such as white rice, white bread, and pasta, may actually increase your risk of developing AMD. These foods have a high glycemic index, which means they are broken down rapidly into blood glucose or sugar. Choose breads and pasta made from whole grains and brown rice for your complex carbohydrates.

Diet and Eye Disease: Nutrition Supplements for Eye Health

 

In 2001, the National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific supplement of high doses of vitamin E, beta carotene, zinc, and copper may prevent intermediate AMD from progressing to the advanced stage. AREDS found no evidence that the supplement benefited anyone who showed no signs of AMD or those with early stage AMD. The AREDS-2 clinical trials are currently being conducted to look at the addition of lutein, zeaxanthin, and omega-3 fatty acids to the original AREDS formula.

For those with intermediate AMD who want to try the supplement formula, a discussion with your doctor is a must. “Because the AREDS-recommended supplement contains relatively high doses of antioxidants and zinc, you and your health care provider need to determine if the AREDS supplement is right for you,” cautions Nelson. “It is important that you do not self-medicate any supplements higher than the daily recommended intakes."

“We also need to look at the long-term effects of taking the AREDS supplement,” says Nelson. “For example, the AREDS formula has a very high level of beta carotene, which may increase the risk for lung cancer in smokers.” Nelson adds that eating a diet with plenty of green leafy vegetables, fish, and fortified cereals should make taking supplements for eye health unnecessary for most people.

“We’re only just beginning to look at nutrition and eye health, and it’s an exciting time because we have found such a link,” says Nelson. “A healthy diet is the foundation for healthy eyes.”

Essential Facts About Antidepressants

Newer antidepressants target brain chemicals involved in regulating mood, but they're not magic bullets. Here are the risks and benefits of these commonly prescribed drugs.

Although mild forms of depression are often treated without medication, those with more severe symptoms may benefit from taking antidepressant drugs. These medications, which target brain chemicals involved in mood, may help people with severe depression who do not respond to talk therapy or healthy lifestyle changes alone, according to the National Alliance on Mental Illness (NAMI).

The Use of Antidepressants Is on the Rise

Roughly 67 percent of people living with depression use medication as their primary form of treatment, NAMI reports. Antidepressants are the second most commonly prescribed drugs in the United States, according to a study published in 2013 in the American Journal of Clinical Hypnosis. Overall, use of antidepressants increased from 6.5 percent in 2000 to 10.4 percent by 2010, a study published in 2014 in the Journal of Clinical Psychiatry reveals.

How Antidepressants May Help

There are many theories about what causes depression, according to the National Institute of Mental Health (NIMH). Brain imaging technology shows that parts of the brain involved in mood, thinking, sleep, and behavior look different in people with depression than in those who are not depressed. Genetics, stress, and grief could also trigger depression, according to NIMH.

RELATED: 6 Need-to-Know Antidepressant Facts

Because specific chemicals called neurotransmitters, particularly serotonin and norepinephrine, are involved in regulating mood, medications that target these chemicals are often used to treat depression. Antidepressants work by increasing concentrations of these chemicals. These drugs include:

Selective serotonin reuptake inhibitors (SSRIs): SSRIs work by making more of the neurotransmitter serotonin available to your brain. Some of the drug names you may be familiar with are Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram).

The most common side effects associated with these medications include sexual problems, headache, nausea, dry mouth, and difficulty sleeping. These symptoms often fade over time, NAMI notes.

Atypical antidepressants: This class of drugs includes serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine) and Cymbalta (duloxetine). In addition to serotonin, these antidepressants may target other brain chemicals such as dopamine or norepinephrine.

Side effects of SNRIs are similar to those associated with SSRI drugs. You may also experience, fatigue, weight gain, or blurred vision.

The antidepressant Wellbutrin (bupropion) affects only the levels of norepinephrine and dopamine. This drug, known as a norepinephrine and dopamine reuptake inhibitor (NDRI), has similar side effects as SSRIs and SNRIs, but it is less likely to cause sexual problems. Rarely, seizures may occur.

Tricyclic antidepressants: Tricyclics also affect levels of brain chemicals, but they are no longer commonly used because they have more side effects, including fatigue, dry mouth, blurred vision, urination difficulties, and constipation. If you have glaucoma, you should not take any tricyclic antidepressant. Some tricyclics antidepressants include amitriptyline, amoxapine, and Norpramin (desipramine).

Monoamine oxidase inhibitors (MAOIs): Like tricyclics, MAOIs are now prescribed less often because of their risk for serious side effects. These drugs work by blocking an enzyme called monoamine oxidase, which breaks down the brain chemicals serotonin and norepinephrine. People taking MAOIs can experience dangerous reactions if they eat certain foods, drink alcohol, or take over-the-counter cold medicines.

In 2006, the U.S. Food and Drug Administration (FDA) approved Emsam (selegiline), the first skin patch for treating major depression. At its lowest dose, this once-a-day patch can be used without the dietary restrictions associated with oral MAOIs. Some other MAOIs include Marplan (isocarboxazid) and Nardil (phenelzine).

Depression Medications and Government Warnings

In 2005, the FDA warned that the risk of suicidal thoughts or behavior could be higher in children and adolescents taking depression drugs. In 2007, the warning was expanded to include anyone under age 25 taking antidepressants.

However, to balance the risks and benefits of antidepressants, the FDA’s so-called black box warning also states that depression itself is associated with a greater risk for suicide, notes a 2014 study published in the New England Journal of Medicine. Nevertheless, if you are taking an antidepressant, especially if you are under 25, let your doctor know if your depression seems to be getting worse or if you have any thoughts of hurting yourself.

Antidepressants Are Not Magic Bullets

It's important to remember that simply taking a pill will not cure depression. It may take up to 12 weeks before these drugs have their full effect. Some people need to take various doses or combinations of different medications before they find the treatment strategy that works best for them, according to NAMI.

It’s also important to take antidepressants as prescribed and to follow up with your mental health professional on a regular basis. Some depression drugs must be stopped gradually — if you suddenly stop taking your medication, you could experience withdrawal symptoms or a relapse of your depression.

Often the most effective treatment for depression involves some form of talk therapy, notes NAMI. Discuss with your doctor how exercise and limiting alcohol can also help ease your symptoms.

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.

Nigel Barker: How a Mediterranean Diet Cut My Cholesterol by 88 Points

You may know Nigel Barker as the encouraging yet truthful judge on America's Next Top Model, or as a famed fashion photographer who has shot pictures for GQ, Lucky, and Town & Country, among others — or as the author of a book about connecting with your best self, Beauty Equation.

He's fit and trim and confident, but under that chiseled frame, the now 44-year-old Barker learned a few years ago that he wasn't nearly as healthy as he'd assumed. And he never would have found out — and had the chance to turn his health around — if it weren't for a routine conversation with his insurance company.

In 2011, when Barker asked for an increase in the amount of coverage on his life insurance policy, what he thought would be a no-brainer (pay more to get more) turned out to be a rude awakening.

The company denied the additional coverage because Barker's cholesterol levels were too high.

Food, Family, and High Cholesterol

Barker was shocked: He'd been following a strict low-carb, high-protein diet for the previous two years and had toned his body in the process, which he thought would be good for his heart and health. But his high-protein diet also included saturated fat-heavy red meat, cheese, and butter, which probably contributed to his total cholesterol level of 253 milligrams per deciliter (mg/dL) and an LDL ("bad") cholesterol level of 155 mg/dL.

"I looked great on the outside," says Barker. But inside, potentially dangerous levels of cholesterol were putting him at risk for heart problems.

The optimal level of total cholesterol is less than 200 mg/dL, and LDL should be less than 100 mg/dL, according to the Cleveland Clinic. Barker's total cholesterol level put him at risk for heart disease. On the plus side, Barker's "good" HDL cholesterol was fine, at 63; anything above 60 is considered cardio-protective. Though it's important to aim for these numbers, the American Heart Association (AHA) advocates looking at a person's overall health and lifestyle as risk factors in addition to cholesterol counts.

What you eat is one of these factors, and — bonus! — the perks of a healthy meal plan can extend beyond your heart. A study published in July 2015 in JAMA Internal Medicine found that people who followed a Mediterranean diet rich in heart-healthy foods like whole grains, olive oil, legumes, fish, and fruits and vegetables had better memories and cognition as they aged.

For Barker, even more concerning than just the numbers was his family history of heart disease: His father had his first of several heart attacks at age 45. Having a parent who had a heart attack predicts your heart disease risk more than any other single factor, according to a study published in February 2011 in the Journal of the American College of Cardiology.

"The combination of Nigel's high LDL levels and family history was really scary," says Barker's cardiologist, Suzanne Steinbaum, MD, director of women's heart health at Lenox Hill Hospital in New York City. "When you have a family history of heart disease, you really have to pay attention to your own health."

Because high cholesterol has no symptoms, it can go undiagnosed for years. And people who have a high risk of heart attack due to family history often have no signs or symptoms until they have a heart attack.

While Dr. Steinbaum encourages everyone to have their levels checked regularly, it's especially important if heart disease runs in your family.

The United Stated Preventive Services Task Force recommends getting your cholesterol levels screened at age 35 for men and 45 for women, although if you have increased risk (such as with Barker), you should be screened as early as age 20.

The AHA recommends a more aggressive screening every five years beginning at age 20, but if you have high cholesterol or other heart disease risk factors, your doctor may recommend more frequent testing.

The main priority is to understand your risk and discuss it with your doctor to determine when cholesterol testing is appropriate for you.

How Barker Lowered His Cholesterol Naturally

Steinbaum recommended that Barker first change his diet instead of immediately turn to cholesterol-lowering drugs to lower his total and LDL cholesterol levels.

RELATED: Dr. Dean Ornish Turns Back the Clock on Heart Disease

So Barker traded his low-carb, high-protein eating plan for a Mediterranean-style diet. "Before, Nigel was eating exactly what he shouldn't have been eating for his heart health," Steinbaum says. "But he made the decision to change, and stuck with it."

Within a year, Barker's total cholesterol reading dropped to a much healthier 165, and his LDL was about 100.

"He did it on his own by making healthy choices every day," says Steinbaum.

And Barker remains committed to those heart-healthy habits. "Sometimes you need the drugs," he says, "but we decided to try a little bit of common sense and discipline first."

U.S. Cancer Death Rate Continues to Fall

More Americans are surviving cancer than ever before, but as the population ages, even more will develop the disease.

That's the good and bad news from the 2017 Cancer Progress Report from the American Association for Cancer Research, released Wednesday.

According to the report, the cancer death rate dropped 35 percent among children and 25 percent among adults from 1991 to 2014. That translates to slightly more than 2 million fewer cancer deaths.

On the flip side, new cancer diagnoses are predicted to rise from nearly 1.7 million this year to 2.3 million in 2030, said the association's president, Dr. Michael Caligiuri.

And this year alone, more than 600,000 Americans are predicted to die from cancer, according to the report.

Caligiuri said the increase in cancer cases is simply a consequence of more people living longer. As the report noted, 53 percent of U.S. cancer diagnoses occur among those aged 65 and older, and that population segment is expected to grow from about 49 million in 2016 to just over 74 million in 2030.

"The longer people live, the higher the incidences of cancer are going to be," Caligiuri said.

"The longer you live, the more likely are the chances for serious genetic mutations that cause cancer, and the weaker your system is in repairing your DNA when you do have those genetic changes," he explained.

Dr. Anthony D'Amico is a professor of radiation oncology at Harvard Medical School in Boston. He said, "The most likely explanation for the progress in cancer survival is a combination of advances in cancer treatment coupled with early detection through screening."

The AACR report noted that death rates for many of the most commonly diagnosed cancers in the United States -- including breast, colorectal, lung and prostate cancer -- have been declining for more than a decade. But deaths from other forms of cancer -- brain, liver and uterine cancer -- have been increasing.

RELATED: 'Cancer Pen' Could Help Surgeons Spot Tumor Cells in Seconds

And progress has not benefited every American equally, the researchers noted. Disparities in cancer care continue between whites and blacks, the insured and uninsured, the poor and the elderly.

But there is progress in treatment. Between August 2016 and July 2017, nine new anticancer drugs were approved by the U.S. Food and Drug Administration, the report said. In addition, the FDA approved the use of eight existing drugs for fighting new cancers.

Two of the new drugs are immunotherapeutics, called checkpoint inhibitors. These treatments increase survival and improve the quality of life for patients with many types of cancer.

Progress was also seen in drugs that target specific cancer molecules. In fact, seven of the new drugs do just that, the researchers said.

The FDA also approved a new optical imaging agent to help doctors see brain tumors and more accurately guide their removal.

The keys to more progress in preventing and curing cancer include basic science to understand the biology of cancers, Caligiuri said, then making those findings relevant to cancer treatment through animal and early human trials. Next comes testing on many people to see how safe and effective these new treatments are, he added.

In addition, more studies are needed to better understand the risks for cancer and to develop ways to lower those risks. These include lifestyle changes -- such as not smoking, eating a healthy diet and exercising -- and screening to detect cancer early.

On the cancer prevention side, cigarette smoking declined by nearly 39 percent from 2000 to 2015, which should mean fewer cases of lung cancer in the future, the report said.

The researchers also said that, in the future, nearly all cases of cervical cancer and many cases of oral and anal cancer could be prevented if girls and boys received the human papillomavirus (HPV) vaccine.

Yet, only 63 percent of girls and fewer than 50 percent of boys had received at least one dose of HPV vaccine in 2015, the study reported.

According to D'Amico, "There is still a lot more to do, but we are going in the right direction in terms of discovery, screening and biology."

Cancer is not an inexpensive disease. Direct medical costs in 2014 were nearly $88 billion, the report said. This does not include the indirect costs, such as lost productivity from cancer-related care and death.

Yet the U.S. National Institutes of Health (NIH) received only $30 billion in funding for 2014, Caligiuri said. And of that total, only about $5 billion went to the U.S. National Cancer Institute.

Not surprisingly, Caligiuri believes that both the NIH and the FDA need more money to spend on cancer research and treatment if further progress in the fight against cancer is going to happen.

"The limiting step for more progress against this beast called cancer is funding," Caligiuri said. "The data clearly show that when we have the funding, we can make phenomenal progress."

5 Cooking Tips to Spice Up Your Heart-Healthy Diet

Add Flavor, Texture, and Zest with Heart-Healthy Ingredients

If you have high cholesterol and blood pressure, your doctor has probably advised you to start following a healthy diet as part of your treatment plan. The good news is that delighting your taste buds while sticking to a heart-healthy meal plan is easy — and many of the foods you enjoy most likely aren’t off limits. Healthy herbs and spices lend robust and savory flavor, hearty nuts add texture and a buttery taste, and teas infuse a bright flavor and antioxidants. Michael Fenster, MD (also known as Dr. Mike), a board-certified interventional cardiologist and gourmet chef, shares his cooking tips for preparing delicious meals that will boost your heart health. These choices are part of a healthy lifestyle that may reduce your risk for heart conditions like high blood pressure, heart attack, or stroke down the road.

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

 

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.

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.

Psoriatic Arthritis

www.PsoriaticInfo.com

Living With PsA Could Mean Living

With Joint Damage. Learn More Now.

 

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 Ways to Make Your Treadmill Workout Safer

With the news of SurveyMonkey CEO David Goldberg's accidental death on a treadmill, we are reminded that there are risks to exercise, particularly when using gym equipment. Because a treadmill is powered by a motor, rather than self-propelled, accidents can happen, especially when people lose their balance. Injuries can include bruises, sprains, broken bones, concussions, and sometimes, even death. 

While the Consumer Products Safety Commission reported over 24,000 emergency room visits associated with treadmills in the United States in 2014, deaths are rare. That said, it's important for people to know their physical limits and keep safety in mind when using a treadmill.

The Role of Genetics in Depression

These new genetic discoveries may someday lead to new depression treatments.

 death thoughts, and more — you might ask yourself, "Why me?" Scientists are trying to answer that question.

Researchers know from twin and family studies that genetics does play a role in depression: You don’t actually inherit depression, but you may inherit genes that predispose you to the condition. If you have a parent or sibling with major depressive disorder, you are two to three times more likely to develop depression than someone with no family history. The risk is higher if family members developed depression early in life or experienced recurrent episodes of depression.

Risk Factors for Depression Vary

Having a genetic predisposition doesn’t mean you’ll become depressed. Environmental factors are also very important, says Mary Fristad, PhD, director of research and psychological services in the division of child and adolescent psychiatry at the Ohio State University in Columbus.

“Even if someone is ‘genetically loaded’ because they have multiple relatives with depression — and their partner is equally genetically loaded — raising a child in a calm, predictable, loving, nurturing, limit-setting household with good nutrition, plenty of exercise, adequate sleep, and participation in enjoyable activities might either prevent or delay the onset of depression,” she says.

Dr. Fristad doesn’t recommend genetic testing for depression. “The simplest and least expensive genetic test at present is to ask if anyone on either side of the family has depression,” she says.

But Chris Aiken, MD, director of the Mood Treatment Center and a clinical psychiatry instructor at the Wake Forest University School of Medicine, both in Winston-Salem, North Carolina, says one particular type of gene has been implicated in the development of depression — information that may be helpful to some people. It’s called the serotonin transporter (SERT); serotonin is a neurotransmitter that helps regulate levels of anxiety, depression, and irritability.

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“You can have genes for either a short or long version of SERT,” says Dr. Aiken. “These genes predict whether people will get depressed in the face of stress. For people with the long-arm version of the gene, the risk of depression doesn't rise even after a major life stress, like divorce, grief, or job loss. For those with the short-arm version, the rate of depression goes up with each new stress."

“What's interesting is that people have the same rate of depression when they aren't under any stress — regardless of which version of SERT they have,” Aiken says. “It's only after major stress or childhood trauma that the two groups start to look different.”

Having the long form of the gene raises the risk of experiencing depression after stress, but you won’t automatically become depressed if you have that gene and undergo stress. Similarly, you can still get depressed with the short-arm gene after a stressful life event (i.e., having the gene is not totally protective). In a nutshell, having a particular form of the gene raises the risk of depression after stress but cannot 100 percent predict or prevent it.

According to Aiken, the short-arm SERT isn’t unique to depression: It’s also been linked to post-traumatic stress disorder, fear responses, and alcoholism.

New Genetic Markers for Depression Revealed

In a study published in July 2015 in Nature, scientists reported finding two genetic markers that appear to be clearly linked to major depression. Researchers sequenced DNA from about 10,600 Chinese women, half of whom had depression. Of that half, 85 percent had a severe type of depression called melancholia, described as a gloomy, foreboding feeling that robs people of their joy. They found two genetic sequences that seemed to be linked to depression and confirmed these correlations in an additional 6,000 subjects and controls.

Norman Sussman, MD, a psychiatrist and director of the Treatment Resistant Depression Program at NYU Langone Medical Center in New York City says the results of this study help validate the fact that depression really is an illness, not a psychosomatic disorder or weakness of character.

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“I tell patients, depression is a medical disease," says Dr. Sussman. "Instead of [showing] physical symptoms (which they can also have), it primarily manifests through abnormalities in cognition and mood. You see things in a negative, hopeless way.”

The Nature findings also offer potential opportunity for treatment. Sussman says if we understand the mechanics of depression, it opens new pathways for drug development. Furthermore, says Aiken, knowing your genotype can also help you avoid wasting time with medications that are less likely to work. For example, people with short-arm SERT genes are less likely to respond to selective serotonin reuptake inhibitors, the most common type of antidepressant, but they may respond to other medications.

How You Can Prevent Depression Symptoms

There’s no medical test to diagnose depression, so health professionals rely on patients or family members to report symptoms. The American Psychiatric Association’s diagnostic guidelines say patients should not be diagnosed with depression unless they exhibit a persistently low mood or loss of interest in activities once deemed pleasurable or enjoyable, in addition to four or more symptoms of depression.

Depression symptoms might include loss of interest in activities once deemed pleasurable or enjoyable, significant weight loss or gain, lack of energy, feelings of worthlessness, or repeated thoughts of death or suicide.

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At least 10 percent of Americans will eventually experience an incidence of major depressive disorder, the most serious type of depression. Other people have low-grade, chronic depression. “The difference is severity,” says Sussman. “People with chronic depression know they should be happier than they are.” 

The important thing to keep in mind is that depression is not inevitable — even if you’re genetically predisposed — and it is treatable.

“Studies show that people whose environments are loving, nurturing, structured, physically active, and have good social networks and friendships are protective for children with genetic risks for depression,” says Aiken.

Online screening tools, such as the Depression Wellness Analyzer and the Patient Health Questionnaire (PHQ-9), can help you evaluate whether you may have depression. Discuss the results with your physician so you can seek treatment if appropriate.

Can 'Magic Mushrooms' Kick-Start Depression Treatment?

The active ingredient in "magic mushrooms" may help patients with tough-to-treat depression, a new study suggests.

Twenty patients received psilocybin -- the psychoactive compound in a group of mushrooms that cause hallucinations. Nineteen who completed the study showed improvement in their depression symptoms for up to five weeks after treatment, according to the researchers at Imperial College London.

None had responded to traditional depression treatment, they noted.

"We have shown for the first time clear changes in brain activity in depressed people treated with psilocybin after failing to respond to conventional treatments," said study leader Robin Carhart-Harris, head of psychedelic research at Imperial.

However, his team emphasized that patients with depression should not try to self-medicate with magic mushrooms. While these results are promising, the study was small and did not include a comparison group of patients who did not receive psilocybin, they noted.

Still, brain scans before and after treatment suggest psilocybin may reset the activity of brain circuits that play a role in depression.

"Several of our patients described feeling 'reset' after the treatment and often used computer analogies," Carhart-Harris reported in a college news release. One said he felt like his brain had been "defragged" like a computer hard drive, and another said he felt "rebooted," the researcher added.

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"Psilocybin may be giving these individuals the temporary 'kick-start' they need to break out of their depressive states, and these imaging results do tentatively support a 'reset' analogy. Similar brain effects to these have been seen with electroconvulsive therapy," Carhart-Harris said.

Larger studies are needed to see if this positive effect can be reproduced in more patients, said study senior author David Nutt.

"But these initial findings are exciting and provide another treatment avenue to explore," said Nutt, director of neuropsychopharmacology in the division of brain sciences.

He added that a trial scheduled to start early in 2018 will test the psychedelic drug against a leading antidepressant.

For this latest study, patients received two different doses of psilocybin, one week apart.

In recent years, promising results have emerged from a number of clinical trials testing the safety and effectiveness of psychedelics in patients with conditions such as depression and addiction.

"Psilocybin can be a promising agent for depression," said Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital, in Glen Oaks, N.Y. "For decades, there has been suspected benefit of psychedelic agents for the treatment of psychiatric and neurological disorders."

However, he said, the clinical trials to date have been very small, and without a placebo arm for comparison. He agreed that replication in larger studies is warranted.

The study was published Oct. 13 in the journal Scientific Reports.

Constant Traffic Noise May Boost Depression Risk

People who live with constant road noise may face a higher risk of developing depression, researchers say.

The risk was about 25 percent higher for people living in areas with a lot of traffic, compared to those living in areas with little road noise. However, the risk was largely confined to those who were poor, unemployed, had limited education, smoked or had insomnia, the German study authors found.

"Although we can't say for sure, it has been thought that noise causes stress and annoyance," said lead researcher Ester Orban, of the Center for Urban Epidemiology at University Hospital Essen.

"If this noise persists over a long time and is constant and loud, it may contribute to depression," she said.

Orban cautioned that these findings only show that road noise is associated with depression, not that it causes depression. "Road noise seems to play a role, but I wouldn't talk about causality," she explained.

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Orban said there are some simple things people can do to reduce their exposure to traffic noise, short of moving.

"If you feel annoyed by traffic noise you can use earplugs, and if traffic noise is disturbing your sleep, choose a bedroom away from the busy road," she suggested.

The report was published online Nov. 25 in the journal Environmental Health Perspectives.

For the study, Orban and her colleagues collected data on more than 3,000 people, aged 45 to 75, who took part in the Heinz Nixdorf Recall study. The study participants were followed for an average of five years.

Depressive symptoms include feeling lonely, sad, depressed, having trouble concentrating or feeling like a failure.

Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said this study adds to existing evidence that traffic noise is linked to an increased risk of depressive symptoms.

"This is not surprising, as we already have extensive evidence that noise is associated with both stress and heart disease," he said.

Given that depression is common worldwide and can have a negative effect on individuals and society, and given that its cause is complex, it's important to examine everything that may play a role, including environment and how it interacts with psychological, social and biological factors, Rego said.

Those with a low socioeconomic status and sleep disturbances may be particularly vulnerable to noise effects, he added.

"This suggests that, along with targeting biological factors with medications and psychological factors with treatments such as cognitive behavioral therapy, interventions may also be aimed at targeting environmental factors," Rego said.

Targeting environmental factors includes both individual and societal approaches, he added.

On an individual level, helping patients get a good night's sleep with better sleep practices may help lower the odds of depression, Rego said.

"On a larger scale, communities can work on improving urban planning to address traffic noise in order to help treat depression or perhaps even prevent it," he added.

Talk Therapy May Help Depressed Teens Who Shun Antidepressants

Cognitive behavioral therapy can help boost mood without drugs.

Depressed teens who refuse antidepressants may benefit from counseling, a new study suggests.

The study included more than 200 teens who were unwilling to take medication to treat their depression. The researchers found that those who tried a type of short-term "talk therapy" -- known as cognitive behavioral therapy (CBT) -- were more likely to recover than those who didn't.

"High numbers of adolescents experience depression, as many as 10 to 15 percent each year -- and up to one in five by age 18," said lead researcher Greg Clarke. He is a depression investigator at the Kaiser Permanente Center for Health Research in Portland, Ore.

"Unfortunately, most of these depressed teens are not treated. As few as 30 percent get specific depression care," he said.

In many cases, depressed teens refuse to take antidepressants, "often because of side effect concerns," Clarke said. These include warnings going back to 2004 about suicidal thoughts and behavior related to antidepressant use, the researchers said. Other common side effects from antidepressants include weight gain and fatigue.

"Offering brief cognitive behavioral therapy is an effective alternative," Clarke said. The small to moderate benefits found in this trial may be tied to reduced need for psychiatric hospitalization, the researchers noted.

The report was published online April 20 in the journal Pediatrics.

Simon Rego is director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City. He said that depressed teens can benefit from talk therapy offered by pediatric and family practices.

Teen depression is usually identified in primary care and is increasingly treated there, he said. But as many as 50 percent of teens with depression turn down medications, and of those who start antidepressants, as many as 50 percent fail to keep taking them, Rego said.

"Integrating cognitive behavioral therapy into primary care would present adolescents with depression with a non-medication treatment that would be easily accessible, brief and cost-effective," Rego explained.

According to the Anxiety and Depression Association of America, cognitive behavioral therapy can cost $100 or more per hour. "Some therapists or clinics offer therapy on a sliding scale, which means that charges fluctuate based on income," the association says. Not all insurance plans cover cognitive behavioral therapy.

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For the study, Clarke and his colleagues conducted a five- to nine-week program in which counselors used cognitive behavioral therapy techniques to help teens identify unhelpful or depressive thinking and replace those ideas with more realistic, positive thoughts.

The program also helped patients create a plan to increase pleasant activities, especially social activities, Clarke said.

Between 2006 and 2012, the researchers randomly assigned 212 teens with major depression to receive either the weekly cognitive behavioral therapy or other care for depression, which could have included school counseling or outside therapy. All the teens, who were aged 12 to 18, had either refused antidepressants or stopped taking them, the study authors said.

On average, teens who tried cognitive behavioral therapy recovered seven weeks faster (22.6 weeks versus 30 weeks) than teens who didn't, the investigators found. In addition, the teens who used cognitive behavioral therapy were less likely to require psychiatric hospitalization, the findings showed.

Recovery was defined as having no or minimal symptoms of depression for eight weeks or more. Symptoms included feelings of hopelessness, loss of interest in friends and activities, changes in sleep and appetite, trouble concentrating and feelings of worthlessness or excessive guilt.

After six months, 70 percent of teens in the cognitive behavioral therapy program had recovered, compared with 43 percent of teens not in the program, the researchers reported.

Some benefits were still associated with cognitive behavioral therapy after one year, although the gap between the two groups of teens had tightened, Clarke said.

How to Prevent Hearing Loss

Do you have trouble following a conversation in a noisy room? Do other people complain that you have the television turned up too loud? If the answer to either of those questions is yes, you may already have some degree of hearing loss.

Hearing loss can start at any age. According to the National Academy on Aging and Society, the number of affected Americans between the ages of 45 and 64 has increased significantly since 1971. But it’s much more common in seniors: Some 40 percent of the 20 million Americans who have hearing loss are 65 or older.

Contrary to popular belief, however, hearing loss is not an inevitable part of aging. Some causes of hearing loss can be prevented, and most types of hearing loss can be helped.

Types and Causes of Hearing Loss

There are three basic types of hearing loss:

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  • Sensorineural hearing loss is caused by damage to the inner ear nerves or the nerves that carry sound to the hearing area of the brain. Once you have this type of nerve damage, the only treatment is a hearing aid. Causes of sensorineural hearing loss include injuries, tumors, infection, certain medications, and excessive noise exposure.
  • Conductive hearing loss is caused by a condition that blocks sound waves from being transferred to the nerves involved in the hearing process. Whereas sensorineural hearing loss usually affects both ears, conductive hearing loss may only affect one ear. Common causes include ear infections, ear wax, ear trauma such as a punctured eardrum, and other diseases that affect the ear canal, the eardrum, or the tiny bones in the middle ear. Unlike sensorineural hearing loss, this type of hearing loss can often be corrected and restored.
  • Mixed hearing loss occurs when someone who has nerve type hearing loss from aging or noise trauma then gets an ear infection or develops a wax impaction, causing their hearing to suddenly get much worse. It’s a combination of sensorineural hearing loss and conductive hearing loss.

Hearing Loss Evaluation

If you are having trouble hearing or develop sudden deafness, you need to get your hearing checked as soon as possible. Sudden deafness is a serious symptom and should be treated as a medical emergency. For many people, though, hearing loss may be gradual and not obvious. Here are seven warning signs to watch out for:

  • You have trouble hearing while on the telephone.
  • You can’t seem to follow a conversation if there is background noise.
  • You struggle to understand women’s or children's voices.
  • People complain that you turn up the TV volume too high.
  • You constantly ask people to repeat themselves.
  • You have a long history of working around loud noises.
  • You notice a ringing, hissing, or roaring sound in your ears.

 

 

If you think you have any kind of hearing loss, the place to start is with your doctor. Whether your hearing loss is gradual or sudden, your doctor may refer you to an audiologist (a medical specialist in hearing loss) or an otolaryngologist (a medical doctor specializing in disorders of the ear).

 

 

Depending on the cause and type of your hearing loss, treatment may be as simple as removing ear wax or as complicated as reconstructive ear surgery. Sensorineural hearing loss can't be corrected or reversed, but hearing aids and assistive devices can enhance most people’s hearing. For those with profound hearing loss approaching deafness, an electronic hearing device, called a cochlear implant, can even be implanted in the ear.

Tips for Hearing Loss Prevention

One type of hearing loss is 100 percent preventable: that due to noise exposure. Noise is measured in units called decibels: Normal conversation is about 45 decibels, heavy traffic may be about 85 decibels, and a firecracker may be about 120 decibels. Loud noise — anything at or above 85 decibels — can cause damage to the cells in the inner ear that convert sound into signals to the brain. Here are some tips for avoiding noise-induced hearing loss:

  • Minimize your exposure to loud noises that are persistent.
  • Never listen to music through headphones or ear buds with the volume all the way up.
  • Wear ear plugs or protective earmuffs during any activity that exposes you to noise at or above 85 decibels.
  • See your doctor about a baseline hearing test, called an audiogram, to find out if you already have some early hearing loss.

You should also see your doctor if you have any symptoms of ear pain, fullness, or ringing, or if you experience any sudden change in your hearing. These symptoms could be early warnings of preventable hearing loss.

Hearing loss or deafness can have a serious effect on social well-being. It can cut you off from the world around you. Know the causes of hearing loss, and practice hearing loss prevention to preserve the hearing you still have.

potting Between Periods: Should You Worry?

leeding between your periods, or “spotting,” can occur for many reasons.

The cause is usually benign; for example, hormonal fluctuations that occur at the very beginning of your reproductive life cycle (menarche, the onset of periods) or toward the end (menopause, when periods stop) are often likely culprits.

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But “spotting is never normal," says Joyce Gottesfeld, MD, an ob/gyn at Kaiser Permanente Colorado in Denver. "It doesn't necessarily mean that something bad is going on, but it's not normal.” So if you do notice spotting, it's worth a call to your physician to get it checked out.

When investigating why you’re spotting, healthcare providers consider your age and whether you’re pregnant, have been having unprotected sex, or recently started using a hormonal contraceptive.

 

 

If you’ve started taking the birth control pill or gotten a progesterone implant, it’s not unusual to experience irregular bleeding. If spotting doesn't taper off, talk to your doctor. “You're probably going to want to change birth control pills, because nobody wants to deal with that all the time,” Dr. Gottesfeld says.

Skipping a pill or two may also bring on spotting. “If you're on birth control pills and you missed a pill, that can also make you have bleeding between your cycles, and I wouldn't be so worried,” says Anne C. Ford, MD, associate professor of obstetrics and gynecology at the Duke University School of Medicine in Durham, North Carolina.

Spotting in the Early Years

Spotting can mean different things at early versus later stages of your reproductive cycle.

When you first start having your period, it may be quite irregular for months or even years. This is because your brain, ovaries, and uterus are still working on getting in sync hormonally. Unless your bleeding is excessively heavy or prolonged, it's usually not a problem, according to Dr. Ford.

Once you become sexually active, spotting after intercourse raises a red flag. This is especially true if you’re having unprotected sex or have just started having sex with a new partner.

Bleeding can signal a sexually transmitted infection (STI), such as chlamydia orgonorrhea, that should be treated promptly, Ford says. “Often, the cervix can be very friable [eroded] or just bleed very easily from the infection,” she explains.

Another condition that can lead to post-sex bleeding is cervical entropion, in which the fragile glandular cells lining the cervical opening grow on the surface of the uterus.

Much more rarely, post-sex spotting can be a sign of cervical cancer. Your doctor can take a Pap smear, a sample of cells from your cervix — the opening of the uterus at the top of the vagina — to test for STIs and abnormal precancerous or cancerous cells.

Mid-cycle bleeding could also mean that you’re pregnant and could be miscarrying, although spotting during pregnancy doesn't always mean the pregnancy will be lost. Ectopic pregnancy, in which a fertilized egg grows outside of the uterus (usually within the fallopian tubes), can also cause bleeding, according to the American Congress of Obstetricians and Gynecologists (ACOG). 

Spotting may also be due to vaginal trauma. “The vagina and the cervix are very vascular [they have a lot blood vessels], so they bleed very easily,” says Lisa Dabney, MD, an ob/gyn in the division of urogynecology at Mount Sinai West in New York City. “A scratch in the vagina will always bleed more than a scratch in your regular skin would.”

Bleeding Between Periods in the Middle Years

Once you reach your thirties, the chance that spotting could indicate endometrial cancer, a type of cancer of the uterus, increases. Obesity also boosts your risk of endometrial cancer, even if you’re a younger woman. “We're seeing more and more endometrial pathology like that because of the obesity epidemic. We have to worry about that in very obese women, even if they're younger,” Ford says.

Spotting “definitely becomes more worrisome after the age of 35, because it could be an early sign of endometrial cancer,” Dr. Dabney says. “Hormonal changes, fibroids, and polyps are far more common than endometrial cancer. It's probably one of those things, but unless you have it evaluated, you don't know if you're that one in 1,000 people who has the cancer.”

Fibroids, benign growths that can form in your uterus, are more likely to cause irregular bleeding if they grow into the uterine lining. Polyps, another type of benign growth, can also grow in the uterus or on the cervix and may cause bleeding. Bothfibroids and polyps can be removed surgically.

Endometrial hyperplasia, in which the lining of the uterus grows too thick, can also cause abnormal bleeding. While this condition is benign, it can be a precursor to cancer in some cases, according to ACOG.

If your doctor suspects you may have endometrial cancer, he or she will take a sample of tissue from the endometrium so that the cells can be examined under a microscope. Other tests, such as an ultrasound, may be used to determine if bleeding is related to polyps or fibroids.

The long march toward menopause — which officially occurs when a woman has not menstruated for a full year — begins for most women during their fourth decade. As your ovaries begin winding down egg production, your period is likely to become irregular. You may skip a cycle here or there, have your periods unusually close together, or experience heavy bleeding.

 

 

“As people's ovaries start to age, you can see mid-cycle spotting,” Ford says. “That's very normal and it comes from fluctuating hormone levels.” It can be hard to tell what's normal and what's not during this tricky time of life, according to Ford. “If your normal period was 3 to 5 days and now you're bleeding 7 to 10 days and it's heavy, then it's probably not a normal period.”

New Cholesterol Drugs Vastly Overpriced, Study Contends

The list price of these newer drugs is upwards of $14,000 a year per patient.Getty Images
Are new medicines for people with out-of-control cholesterol wildly overpriced? It's a question that's sparking debate among consumers and providers of care.

Now, researchers at the University of California, San Francisco (UCSF) report that the price of these drugs -- called PCSK9 inhibitors -- would have to be slashed by a whopping 71 percent to be deemed cost-effective.

PCSK9 inhibitors are a relatively new class of medicines for treating patients whose LDL (bad) cholesterol isn't well-controlled on statins or who cannot tolerate statins. Lipitor (atorvastatin) and Crestor (rosuvastatin) are examples of first-line statins doctors typically prescribe to patients with high cholesterol.

The UCSF team didn't question whether these new medicines are effective in reducing heart attacks and strokes.

"These are super awesome drugs, they really work," said study co-author Dr. Kirsten Bibbins-Domingo.

But the price is "far in excess" of what would be considered a reasonable cost for the clinical benefit they provide, added Bibbins-Domingo, a UCSF professor of medicine, epidemiology and biostatistics.

The list price of these newer PCSK9 drugs is upwards of $14,000 a year per patient.

Dr. Kim Allan Williams, who was not involved in the study, is past president of the American College of Cardiology. He said some doctors have a difficult time with such studies because they compare patients' lives and "events" — such as heart attack and stroke — versus dollars spent on these medicines.

The new study doesn't change his view of the value of the PCSK9 inhibitor class.

"No one's giving those drugs unless the patient is incapable of getting to the target [level of LDL cholesterol]," said Williams, who is chief of cardiology at Rush University Medical Center in Chicago. "You're only going to use it for a situation where you have no choice."

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Because the study is based on list prices, not what patients actually pay, it's also "difficult to analyze the cost-effectiveness when [you] don't know exactly what the cost is," Williams added.

He said he's had patients with copays of $380 a month and others who had zero copays because the cost was completely covered by insurance. He worries, though, that poor patients may not be offered the same access to these medicines.

The CSF researchers designed the study to find out how much bang for the buck these drugs actually provide.

Their study updates a prior cost-effectiveness analysis using current list prices as well as results of a recent clinical trial. That trial demonstrated the clinical effectiveness of Repatha (evolocumab), one of two PCSK9 inhibitors approved by the U.S. Food and Drug Administration, in reducing the risk of heart attack and stroke.

Based on a simulation involving 8.9 million adults who would meet trial criteria, adding PCSK9 inhibitors to statins would prevent 2.9 million more heart attacks and strokes compared with adding Zetia (ezetimibe), another type of medication that blocks the production of cholesterol by the liver.

But the PCSK9 inhibitor class is not cost-effective based on a threshold of $100,000 for each life year gained, the study authors contend. They found that you would have to spend $450,000 per year to get one extra year of life per year.

"The price would have to be between $4,000 and $5,000 [per year] for it to be cost-effective," said Bibbins-Domingo. "If you look in other countries, in Europe, for example, that is in fact where this drug is priced."

Dr. Josh Ofman, senior vice president of global value, access and policy at Amgen Inc., the maker of Repatha, took issue with the findings. "We think that their model is deeply flawed," he said.

The study was based a 3 percent per-year rate of heart attacks and strokes, while other studies use much higher rates — more than three times higher — based on "real-world" data, Ofman said. The study is modeling a population that's not having many heart attacks and strokes, he said.

Ofman also questioned the threshold for determining cost-effectiveness that the UCSF researchers used. He said other organizations use a minimum of $150,000 per quality-adjusted life-year saved.

As for the price differential between the United States and Europe, Ofman cited many factors, from government price controls to how those countries price these drugs.

Amgen isn't alone in its criticism of how these medicines are valued. Earlier this month, several national provider and payer groups raised concerns about how the PCSK9 inhibitors are valued in a letter to the nonprofit Institute for Clinical and Economic Review, which assesses the value of new medicines.

More than a dozen organizations, including the National Forum for Heart Disease & Stroke Prevention, the American Pharmacists Association Foundation and the American Society for Preventive Cardiology, signed the letter citing concerns ranging from the types of patients that could benefit from these drugs to the importance of preventing heart attacks and strokes — not just deaths.

"The big controversy about all these types of analyses is what we're willing to value a patient's year of life at," Ofman said.

The new study was published in the Aug. 22/29 issue of the Journal of the American Medical Association.

The 1-Hour Workout That Gets Ciara THIS Bod

The singer — who gave birth to a son in May — recently appeared on MTV’s House of Style and continues to work with Degree Women for the brand’s Do More campaign. Users can search for fitness classes and view behind-the-scenes rehearsal footage on Degree’s web site

“As a hardworking woman, I’m always trying to figure out how I can get better and improve at everything I do," explains Ciara. "I really love being able to share this message with other women and encourage them to keep pursuing their dreams.”

 

 

 

 

At a Degree Women press event, Ciara gave Everyday Health the scoop on how she stays fit, healthy, and gorgeous while trying to juggle a packed schedule. 

On her fitness regimen: “I work out an hour a day. That’s all you need — the rest of it’s all about how you eat,” says Ciara. “When I train with Gunnar [Peterson], we do a mix of plyometric moving and weight training because you want a good balance of cardio, while still maintaining your muscle.”

 

 

 

On eating right: “For breakfast, I love an egg white omelet with spinach and turkey. I’ll also have a side of fruit and wheat toast,” she says. If she gets a late-night craving, Ciara satiates herself with chocolate Ensure protein shakes. “Sometimes I get hungry before I go to bed — I’ll drink one of these and it holds me over until the morning.” 

On how she motivates herself before a performance: “I think about what it is that I want to do onstage and how great I want the show to be,” she says. “I pray, stretch, jump, and move around to get my body warmed up.”

On maintaining her glow: “When I wake up, I wash my face with my dermatologist’s [Dr. Sabena Toor] foaming cleanser, which is made with organic ingredients,” says Ciara. “Then I put vitamin C and Revisions tinted moisturizer all over my face. I do that twice a day.”

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.

An Expert's Guide to Sneezin' Season

Allergy sufferers should prepare for a particularly 'nasty' spring, New York sinus specialist says.

This could be a bad spring allergy season and people with allergies need to be prepared, an expert warns.

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"With the crazy up and down weather, some parts of the country could see worse allergy-provoking conditions. There is likely to be a pollen superburst this season, so sufferers should get ready," Dr. Jordan Josephson, a sinus specialist at Lenox Hill Hospital in New York City, said in a hospital news release.

"It promises to be a nasty spring," he added.

It's crucial to deal with allergy symptoms immediately, according to Josephson.

"Allergies left untreated can cause sinus swelling leading to chronic sinusitis. Allergies can also affect your digestive tract. Gastroesophageal reflux disease (GERD) can be a direct response of the allergic response. So allergies can seriously affect your quality of life. Just ask any allergy or sinus sufferer," he said.

 

 

Dr. Punita Ponda is assistant chief in the division of allergy and immunology at Northwell Health in Great Neck, N.Y. She suggested that if you know you have spring allergies, start taking allergy medication at least one to two weeks before the start of allergy season. Then continue taking it throughout the season, she noted in the news release.

RELATED: 9 Seasonal Allergy Signs You May Be Overlooking

 

 

Josephson outlined a number of other ways to keep your allergy symptoms under control, including: staying indoors as much as possible between 10 a.m. and 4 p.m., when pollen counts are highest; using your air conditioner, which cleans and dries the air; keeping doors and windows closed; and using an air purifier.

After being outdoors, remove your clothes and wash them immediately. Keep pollen-exposed clothes separate from clean clothes. You should also take a shower after being outside in order to remove pollen from your skin and hair, he suggested.

In addition, irrigate your sinuses daily to flush out pollen. And take antihistamines, but try to avoid decongestants.