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.

For Pain, It Matters Which Doctor You See

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

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

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

The Serious Effects of Pain

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

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

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

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

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

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

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

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

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

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

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

Maria Sharapova’s 5 Best Tips for Glowing Skin and Killer Confidence

Maria Sharapova isn’t just a talented athlete. With supermodel looks, it’s no surprise that the Russian-born blonde has endorsement deals with a slew of beauty and fashion brands and has been photographed for the “Sports Illustrated” Swimsuit Issue. (She even edged out rival Serena Williams to be named the highest paid female athlete in 2014 by “Forbes” magazine.) 

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The five-time Grand Slam winner, who is currently gearing up for this year’s US Open, took time out of her busy schedule to chat with Everyday Health at a recent Supergoop! press event. She reveals her healthy skin habits, how she stays energized during a tough match, and more. 

 

 

1. The most important step in her beauty routine: As one of the best tennis players in the world, Sharapova spends plenty of time out in the sun practicing and playing grueling matches. To ensure her fair skin stays protected, she reaches for SPF almost as soon as she wakes up. And in fact, she says she’s been an avid sunscreen user since her teenage years. 

“It’s important for me to think about sunscreen early in the day, because as you go about your day, you’re thinking about the challenges ahead and the activities you’re doing and [sunscreen] is almost not on your mind anymore,” she says. “I have a bottle of sunscreen next to my shower, so I wake up, take a shower, towel off, and apply.” When she’s playing tennis, Sharapova relies on Supergoop! Everyday Sunscreen Broad Spectrum SPF 50, which she says has a lightweight texture and doesn’t sting her eyes as she sweats. 

RELATED: 10 Best SPFs for Every Skin Concern

2. Her glow-boosting secret: In addition to slathering on SPF in the morning, Sharapova starts her day with a whole lot of water to stay hydrated and keep her skin fresh. “I usually wake up and drink more than a half liter of water, just to get my mind ready and aware that I need to drink [water],” she explains. 

 

 

3. How she relaxes before a big match: For Sharapova, getting enough sleep is one of the keys to her success. “I love to sleep. I love taking naps,” she says. “That’s been part of my regimen since I was a young girl. I used to have a morning and afternoon practice, and I’d come home and have lunch and then take a 45 minute nap. To this day, I enjoy doing that if I have the opportunity.” 

4. Her favorite pre-game meal: When it comes to food, Sharapova keeps it simple. “I’ve learned a lot over the years about how I react to foods and how much energy I have,” she says. “Usually, I eat a little bit of chicken and a lot of green vegetables [before a match].” Sharapova also likes to whip up her own green juices, visiting local stores to pick up veggies and adding lemon and kiwi for sweetness. 

5. How she stays confident: One of the easiest ways Sharapova gives herself a boost is by spritzing on her favorite perfume before walking out the door. And before she steps onto the court, she reminds herself of how lucky she is to be following her dream. 

“I’ve played this sport for a long time and put in a lot of work and effort,” she says. “And that moment when you’re about to go on the court — that’s what you work for, that’s the goal — it’s a privilege. No matter if you win or lose, the opportunity to go out there is pretty special. It’s very powerful.”

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.

Which Gets More TLC: Your Car or Your Body?

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

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

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

Mechanic Vs. Doctor

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

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

RELATED: 5 Worst Celebrity Health Bloopers 

 

 

Engine Health Vs. Heart Health

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

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

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

 

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

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Car Weight Vs. Your Weight

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

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

Changing Your Oil Vs. Checking Your Blood Pressure

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

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

 

 

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

Brake Check Vs. Flu Shot

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

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

Purpose in Life Is Good for Your Health

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

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

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A Healthier Heart

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

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

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

 

 

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

Protect the Brain

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

RELATED: The Life-Saving Power of Purpose

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

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

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

How Purpose Works

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

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

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

Finding Purpose

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

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

 

 

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

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

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

How Trauma Can Lead to Depression

You don't have to have been personally involved in a traumatic experience to suffer the effects.

Over the last few years, a long string of traumatic events have occurred and been widely covered in the news, including movie theater, school, and workplace shootings, as well as natural disasters such as typhoons and earthquakes. These events can be devastating for those personally involved, yet their impact may also be felt by others not directly involved at all.

Many people can go through or hear about such traumatic events and be fine after some time without additional interventions, says Anthony Ng, MD, chief medical officer at Acadia Hospital and chief of the psychiatry service at Eastern Maine Medical Center in Bangor.

But some people who experience such traumatic events — whether personally or just by hearing about them — can become depressed, according to the Depression and Bipolar Support Alliance. Traumatic life events were found to be the biggest single cause of anxiety and depression in a study by researchers at the University of Liverpool published in 2013 in PLoS One. 

RELATED: The Healing Power of Horse Therapy for PTSD

For some, traumatic events such as the Boston Marathon bombing and Sandy Hook Elementary School shooting challenge their basic assumptions about how life works, says Irina Firstein, a licensed therapist who has lived and practiced in New York City for more than 25 years. They can become so scared that they develop a generalized anxiety or panic disorder, which can lead to depression, she says.

Depression and PTSD: What's the Connection?

People who continue to experience extreme symptoms of stress long after a traumatic event may have post-traumatic stress disorder (PTSD), which can also lead to depression — a continued feeling of intense sadness that interferes with a person's ability to function normally.

Depression and PTSD often coexist, and their symptoms may overlap. A study on Vietnam veterans counducted 40 years after the war, published in 2015 JAMA Psychiatry, found that about a third of those who suffered from PTSD also had major depressive symptoms.

Symptoms of depression include sadness, feelings of loss, disillusionment, loss of appetite, and difficulty sleeping, Firstein says.

Symptoms of PTSD include:

Reliving traumatic events through flashbacks or nightmares
Avoiding experiences that remind you of the trauma
Panic attacks
Physical symptoms such as rapid heartbeat, trembling, shortness of breath, or headaches
Symptoms of PTSD and depression that commonly occur together include:

Trouble concentrating
Avoidance of social contacts
Irritability
Abuse of drugs or alcohol
How to Cope With the Effects of Traumatic Events

"Some of these symptoms are normal after such an event," Firstein notes. "However, if they persist, one should try to get professional help.”

Dr. Ng. says red flags that you're not managing well on your own include:

Missing a significant number of days of work or school
Withdrawing from family members or people around you
Experiencing mood swings, such as being irritable and angry to the point that it’s causing problems at home
Not being able to eat and losing weight
Not being able to sleep at night. “As a result, you feel exhausted and can’t function in the daytime,” Ng says.
Having thoughts of hurting yourself or others
Mental health professionals can help. “Psychotherapy; eye movement desensitization and reprocessing, or EMDR therapy (trauma reprocessing using eye movements); and medication are very effective," Firstein says.

In addition to getting professional help, ways to cope with PTSD and depression include:

Spending more time with friends and family
Learning as much as you can about PTSD and depression
Taking part in activities you enjoy
Getting regular exercise
Learning relaxation techniques
Joining a support group
Avoiding drugs and alcohol
The following resources can help you find ways to cope with trauma and depression, as well as help you find therapists in your area: 

Your family doctor. “Tell your doctor, ‘I’ve experienced these symptoms. What can I do?’ Your doctor might treat you or refer you to a psychiatrist or counselor or therapist,” Ng says.
The National Alliance on Mental Illness HelpLine. This organization's staff and volunteers can help you find treatment. Call 800-950-NAMI (6264) or email info@nami.org.
The National Suicide Prevention Lifeline. If you are having suicidal thoughts, call 800-273-TALK (8255). Counselors are available 24/7, and the service is free and confidential.
The American Psychological Association’s psychologist locator.
The PTSD Alliance.
The National Center for PTSD, part of the U.S. Department of Veterans Affairs.  
The Anxiety and Depression Association of America.
Don’t Ignore Symptoms That Persist

Unexplained and unexpected trauma has always been part of the human experience, and depression and PTSD are common results of these events. The best way to deal with them is to know the symptoms and ask for help.

Additional reporting by Beth W. Orenstein.

Can the Anesthetic Ketamine Ease Suicidal Thoughts?

A small study found that the drug worked quickly in people with major depression.

Low doses of the anesthetic ketamine may quickly reduce suicidal thoughts in people with long-standing depression, a small study suggests.

By the end of three weeks of therapy, most of the 14 study volunteers had a decrease in suicidal thoughts and seven ended up not having any such thoughts, the researchers found.

To get into the study, patients had to have had suicidal thoughts for at least three months, plus persistent depression. "So, the fact that they experienced any reduction in suicidal thinking, let alone remission, is very exciting," said lead researcher Dr. Dawn Ionescu, an instructor in psychiatry at Harvard Medical School in Boston.

Despite these results, many mysteries still remain about the drug, Ionescu said. For example, "we don't know yet how the drug works," she said. "In addition, we do not know if the doses of ketamine being used for depression and suicide will lead to addiction -- more research is needed in this area."

The study used only intravenous ketamine, but oral and intranasal doses may also work, she added.

Whether ketamine might ever become a standard therapy for depression and suicidal thoughts is also up in the air. "That is something we need to investigate," Ionescu said.

All of the study volunteers were being treated for major depressive disorder on an outpatient basis. They had all been experiencing suicidal thoughts for three months or more, and were resistant to other treatments, the researchers said. Eleven of the 14 volunteers were female, and their mean age was 50 years.

Ketamine, which is primarily an anesthetic, had been shown in other studies to quickly relieve symptoms of depression, Ionescu said.

For the study, two weekly intravenous infusions of ketamine were given over three weeks. The first three doses of ketamine were five times lower than typically given when the drug is used as an anesthetic. After initial treatment, the dose was increased.

RELATED: How to Create a Depression Treatment Plan

Patients were checked before, during and after treatment, and every other week during three months of follow-up. Assessments included measurement of suicidal thinking, in which patients were asked how frequent and how intense their suicidal thoughts were, the study authors said.

Of the seven patients who stopped having suicidal thoughts, two continued to be free of both thoughts of suicide and symptoms of depression during the three-month follow-up, the findings showed.

No serious side effects from the drug were seen, the researchers said.

"The most common side effects are an increase in heart rate and blood pressure, and changes in the way people perceive their environment. For example, some people will dissociate and feel like their environment looks different or that parts of their body look different. Generally, the side effects are mild and only last for one to two hours," Ionescu said.

Two patients dropped out of the study. One dropped out because of the drug's side effects, and the other had a scheduling conflict, the researchers said.

All of the patients knew they were getting ketamine. The researchers are now finishing up a study in which some patients received the drug and others got a placebo.

Drugs currently used to treat suicidal thinking include lithium and clozapine, but these drugs can have serious side effects requiring careful monitoring of blood levels. Electroconvulsive therapy can also reduce suicidal thoughts, but its availability is limited and it can have serious side effects, such as memory loss, the researchers explained.

Cognitive behavioral therapy, a type of "talk" therapy, can also be an effective treatment for suicidal thinking, but may take weeks to months to be effective, the study authors pointed out.

Dr. Ami Baxi is director of adult inpatient services in the department of psychiatry at Lenox Hill Hospital in New York City. She said, "Ketamine, often used as an anesthetic in medicine, has been recently shown to cause a rapid antidepressant effect and reduce suicidal thoughts in patients with treatment-resistant depression."

However, this study has many limitations, she added. First, it was a very small study and "only two of the 14 patients were able to maintain this reduction three months after the infusion," Baxi said.

Second, patients knew they were receiving ketamine, "leaving them exposed to a possible placebo effect," she explained.

Baxi agreed this is a promising study, but it's too early to know the effects of ketamine on suicidal thinking. "Additional studies remain essential to enhance our knowledge on the psychiatric benefits of ketamine," she said.

The report was published in the May 10 online edition of the Journal of Clinical Psychiatry.

For Pain, It Matters Which Doctor You See

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

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

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

The Serious Effects of Pain

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

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

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

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

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

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

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

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

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

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

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

7 Detox Tips From Scientists Who Actually Tried Them

One of the realities of 2014 is that when a baby is born, he or she has already been exposed to toxic chemicals. The evidence is in umbilical cords, which research has confirmed contain pesticides, waste from burning coal and gasoline, and garbage. Even if you try to do everything right (eat organic, buy natural products, live in a cabin in the middle of the woods, etc.), you can’t avoid all of the chemicals that have become pervasive.

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Bruce Lourie and Rick Smith researched the dominance of these chemicals while writing their first book, Slow Death by Rubber Duck: How the Toxic Chemistry of Everyday Life Affects Our Health (2009), which took a look at everyday items, including canned food, pajamas, Tupperware, and rubber ducks, that put toxins into our bodies. Their readers bombarded them with a simple question: If all this stuff is inside us, how do we get it out?

So the two authors, armed with Smith’s PhD in biology and collective decades working in the environmental field (Smith's the executive director of the Broadbent Institute and Lourie is the president of the Ivey Foundation), went out again to determine what actually worked to get toxins out of the body. Through a series of self-designed experiments on themselves and others, they take readers through their journey in Toxin Toxout: Getting Harmful Chemicals Out of Our Bodies and Our World.

Here are some key facts they learned about what actually matters when it comes to detoxing:

1. Chemicals are everywhere, but you don’t have to worry about all of them.Not all chemicals are actually going to damage us, Laurie said, and people have different tolerance to chemicals (though you may find that out the hard way). Some chemicals are disappearing from our lives (DDT, dioxin, lead) because of awareness of their dangers. “I joke sometimes that I’m a worrier, and I carry around a worry list with me,” Smith said. “In the book, we tried to come up with a short worry list.” The list included phthalates, BPA, pesticides, methyl paraben, triclosan, sodium lauryl sulphatel, and metals that can be harmful when they accumulate, such as aluminum, tin, and mercury. Yes, that’s still a long (and confusing) list, but there are some simple ways to avoid or eliminate them.

 

 

2. Avoid some toxins by shopping natural. Chemicals don’t just get into our bodies through what we eat — they come in through what we slather on our skin, what furniture we sit on, and what we breathe. While reporting for the book, Smith measured his urine before and after simply sitting and breathing in a new Chevy Tahoe for eight hours, and found that doing so had elevated his body's levels of four chemicals from the worry list. So shop smart (and roll down the windows when driving). “When you’re making a purchase, be it a cosmetic, a shampoo, or a new sofa, ask ‘Is this the most natural thing I could buy?’” Lourie said. Read ingredient labels and look up the ones you can’t pronounce. Do your research and check out eco-certifications before making big purchases like sofas or cars to see which, like the Tahoe, are made with dangerous chemicals. 

RELATED: 6 Easy Green Beauty Swaps

3. Organic is actually better, if you want to avoid pesticides. Recent research — particularly one study from Stanford that concluded organic produce doesn’t have more nutrients — has ignored the intended benefit of going organic, Smith and Lourie argue. Organic farming isn’t necessarily meant to yield more nutrient-dense food. It’s meant to make food that won’t contain excessive pesticides. (Yes, it may have traces of pesticides, because almost everything does. Remember the umbilical cords?) Smith and Laurie asked nine kids who hadn’t eaten organic before to eat an all-organic diet for five days while giving urine samples. The urine samples showed the switch yielded a big drop in pesticide levels. “Once people start eating organic food, pesticide reduction occurs in a matter of hours,” Smith said.

 

 

4. It’s better to adjust your habits than to go through a cleanse.  One of the most basic things you can do to get toxins out of your body is to drink more water. Another is to eat less animal fat and more (preferably organic) fruits and vegetables. But is the best way to do that a four-day juice cleanse? Probably not, say Smith and Laurie. "'Cleanse' makes it sound like it’s a special thing,” Lourie said. “If you’re eating more vegetables and drinking plenty of water, and you want to put the vegetables in the water, that’s a good thing to do. Just don’t be mistaken that if you do that for four days out of the year, you’re going to be detoxing your body — it doesn’t work that way.” It’s much better to incorporate fruits, veggies, and water into your daily diet.

5. Embrace sweat — and saunas. Toxins enter your body through what you eat, breathe and touch, and they go out the same way, through breath, digested food and drink, and sweat. While exhaling and urinating are pretty non-negotiable, a lot of us are engaged in a war against sweat. “We’re really confused as to what clean smells like,” Jessa Blades, an eco-blogger, tells the authors in the book.Antiperspirants and some deodorants prevent us from sweating out toxins while using toxic metals to keep the sweat in, a “double toxic whammy” Smith said. Lourie even admitted that he’s stopped using deodorant. Even if you change or quit your antiperspirant, you should try to sweat more, too. You can do this by exercising more or by using saunas to “detox through heavy sweating,” Lourie said. You’ll also end up drinking more water, which is good for eliminating toxins.

6. Be wary of fat. Fat holds on to toxins, which is part of the reason chemicals like DDT still hang around our systems. So if you’re eating lots of animal fat, you’re also eating the chemicals that the animal fat is holding. Then, you’re probably also putting on weight and thus adding fat to your body, which will hold on to those chemicals. “It’s a positive feedback loop,” Lourie said. In fact, if you’re worried about toxins and you’re overweight, losing that extra body fat should be the first step toward reducing the toxins in your body.

7. Push companies to do the right thing, and support regulation of toxins.“Only part of the solution to this problem is being a more careful consumer,” Smith said. ‘The other part is to be a more engaged citizen.” Remember when people learned that Subway bread contained a yoga mat chemical, and took to social media to demand that change? “Never has a company capitulated so quickly,” Smith said. It’s easier than ever to make your voice heard. 

All Diet and Nutrition Articles

All Diet and Nutrition Articles

 

Eating Carbs and Fats Before a Workout? Read This

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

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

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

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

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

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

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.

12 Ways to Ease Seasonal Depression

1 / 13   Seasonal Depression: Common But Treatable
If shorter days and shifts in weather zap your energy and make you feel blue, you’ve got classic symptoms of a seasonal mood disorder. Seasonal affective disorder (SAD) is a form of seasonal depression triggered by the change in seasons that occurs primarily in winter. Why do some people get SAD? Experts aren’t certain, but some think that seasonal changes disrupt the circadian rhythm: the 24-hour clock that regulates how we function during sleeping and waking hours, causing us to feel energized and alert sometimes and drowsy at other times.

Another theory is that the changing seasons disrupt hormones such as serotonin and melatonin, which regulate sleep, mood, and feelings of well-being. About 4 to 6 percent of U.S. residents suffer from SAD, according to the American Academy of Family Physicians, and as many as 20 percent may have a mild form of it that starts when days get shorter and colder. Women and young people are more likely to experience SAD, as are those who live farther away from the equator. People with a family history or diagnosis of depression or bipolar disorder may be particularly susceptible.

"It is important to treat SAD, because all forms of depression limit people's ability to live their lives to the fullest, to enjoy their families, and to function well at work," says Deborah Pierce, MD, MPH, clinical associate professor of family medicine at the University of Rochester School of Medicine and Dentistry in Rochester, New York. Here are a few SAD treatment options you might want to consider.

diabetes type 2

There is a problem about diabetes type 2

 

 

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bad habit or not nutration food is a cause of diabetes

 

   
   

 

 

What to Expect Before and After Bariatric Surgery

Bariatric surgery isn't a spur-of-the-moment operation. In fact, preparing for the procedure may begin a year or more before your surgery date, and lifestyle changes continue well after the surgery has been performed. Be prepared by knowing what will be asked of you every step of the process.

The Year Before Surgery

Leading up to the procedure, your surgical team will likely recommend becoming more informed about diet and exercise.The amount of time you spend in this stage depends on several factors, including your insurance and your team’s recommendations, says bariatric surgeon Ann Rogers, MD, director of the Penn State Hershey Surgical Weight Loss Program in Hershey, Pennsylvania.

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“There’s always some component of nutritional education and some expectation that patients will lose some weight in that program,” explains Dr. Rogers. The dietitians and others who work with you during this stage will send reports on your progress to your surgical team before you schedule your surgery date.

In this phase, you may need to make additional lifestyle changes as well depending on the program. Rogers’ program, for instance, requires smoking cessation, though other weight-loss surgery clinics do not.

The Week Before Surgery

The final days before your surgery can be extremely emotional, filled with excitement, nervousness, and anxiety. Taking these steps as you prepare for your surgery will ease tension and ensure that everything goes smoothly the day of your procedure:

• Read the materials from your clinic.

• Eat and drink as directed. “We have a preoperative diet for eight days, which consists of bariatric-friendly protein shakes,” Rogers says. “They are high in protein, and they do not have sugar.” Most programs have a preoperative diet, although the duration varies, she says. Make sure you understand how long that diet lasts and exactly what you can eat.

• Adjust medications as needed. Discuss how to manage any other conditions you might have, such as diabetes, with your weight-loss surgery team and your primary care physician.

 Meet with the anesthesiologist. Once your surgery date is scheduled, you'll also meet with the anesthesiologist, who will ask about your health history. Although patients will have lots of tests done and medical information detailed during the months before surgery, the anesthesiologist might ask for more tests, advises Rogers.

 Take a blood thinner. Clotting is a risk associated with surgery, says Rogers. Your doctor might recommend taking a blood-thinning medication before and after the surgery.

What to Pack

Rogers suggests taking the following items with you to the hospital:

 Instructions. Bring the manual or other instructions you’ve been given, as well as any preoperative paperwork.

• Identification. You’ll need it to check in.

• CPAP (continuous positive airway pressure) machine. If you've been using one for sleep, take it with you.

• Laptop and cellphone.

• Pajamas and toiletries.

• Pillow and blanket.  

The Day of the Surgery

What your weight-loss surgery will entail varies depending on the specific type of surgery you'll be having.

• Roux-en-Y: This procedure is also known as “gastric bypass.” Your stomach will be divided into a small top pouch and a larger lower pouch. Your small intestine will also be divided and the lower part raised up to attach to your new, smaller stomach. This procedure reduces the quantity of food you can eat at any given time.

• Sleeve gastrectomy: In this procedure, the majority of your stomach will be removed, creating a banana-shaped stomach.

• Biliopancreatic diversion with duodenal switch: In this procedure, a portion of your stomach is removed. The remaining portion is then attached to a lower segment of your small intestine.

 Banding: In this procedure, an inflatable band is wrapped around the upper part of your stomach, creating a small stomach pouch. The band can be adjusted as needed. 

9 Things You’ll Have to Do After Surgery

• Have a ride home in place. Expect to spend at least one night in the hospital, Rogers says. When you're discharged, you'll need to have someone drive you home.

• Prevent blood clots. You will need to adhere to strategies to prevent blood clots from developing. These include taking blood thinners and getting up and walking around while in the hospital and at home.

• Take pain medication. You'll probably get a prescription for pain medication. Laparoscopic surgery reduces pain and hospital stays, but you still may need prescription pain medication for a day or two after discharge, Rogers says.

• Anticipate constipation, as it's a byproduct of the pain medications and the surgery itself. Be sure to talk with your doctor or nurse about how to prevent constipation.

• Eat a restricted diet. Your diet will be restricted to liquid protein shakes for a week or so after the procedure, and then soft foods following that period. Most people can transition to eating food with texture after their one-month follow-up appointment. By three months you should be able to eat fruits and vegetables, Rogers says. The ASMBS recommends cutting down on carbohydrates and increasing protein.

• Drink lots of fluids. The ASMBS recommends at least 64 ounces, or 8 cups, of fluids daily.

• You may need to take supplements. Calcium, vitamin D, and B vitamins are among those your doctor might recommend.

 Exercise – but nothing too strenuous. Walking daily, starting the day you get home, is good for you, says Rogers. However, skip the gym until you have your doctor’s permission. You should be able to lift small weights, she says, but avoid heavy items.

• Plan on missing work for a while. People with desk jobs usually can go back to work in about three weeks, Rogers says. Those with physical jobs or jobs that require extended periods of sitting, such as driving trucks, will have to wait a longer period of time.

Breast Cancer Awareness Month 2017

October is Breast Cancer Awareness Month, an annual campaign to raise awareness of breast cancer risks, the value of screening and early detection, and treatment options available to women and men who are diagnosed with one of the many forms of breast cancer. More than 249,000 people in the United States are diagnosed with invasive breast cancer every year, and nearly 41,000 die from the disease.

Over the years, a loop of pink ribbon has come to symbolize breast cancer awareness, and today the image of a pink ribbon can be found emblazoned on thousands of products, from apparel to dishware to office supplies. But there's more to awareness than just wearing pink.

8 Reasons You Have No Energy

You’d be hard-pressed to find someone who doesn’t hit snooze or experience the midafternoon slump every once in a while, but if you constantly feel like you’re dragging it may be time to take a closer look at your routine. If you don’t have a related health condition and are getting enough shuteye each night, you may be to blame for the constant fatigue. Here are 8 energy-zapping habits that you can change today.  

1. You’re eating too much sugar. While the candy jar is an obvious culprit, refined carbohydrates like white bread and rice, chips, and cereal are a major source of sugar,too. This type of simple sugar is digested quickly by the body, leading to a dip in blood sugar levels that leaves you feeling fatigued. Be sure to replace refined carbs with whole grain varieties for a lasting energy boost.

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2. You aren’t exercising enough. It may seem counterintuitive that exerting energy will actually increase it, but adding a workout to your daily routine will give you a short-term energy boost. Plus, regular exercise improves sleep quality, which will ultimately leave you feeling more well rested.

3.  You’re skipping breakfast. "Skipping breakfast can definitely contribute to low energy in the morning," says Johannah Sakimura, MS and Everyday Health blogger. "It's important to give your body good fuel to start the day after an extended period of fasting." Without this fuel, your body is running on empty – leaving you famished by lunchtime and more likely to make unhealthy choices that will cause that midafternoon dip in blood sugar. "Try to combine healthy carbohydrates, like fruit, veggies, and whole grains, with a protein source, such as eggs, nuts, or dairy. The carbs give you an initial boost, and the protein helps sustain you until your next meal," says Sakimura.

4. You’re sitting too much. Not only is sitting for prolonged periods of time harmful to your health (just one hour of sitting affects your heart!), but it’s a major energy zapper as well. Standing up and moving for even a few minutes helps get your blood circulating through your body and increases the oxygen in your blood, ultimately sending more oxygen to your brain which increases alertness. If you work a desk job, try this move more plan to keep your blood pumping.

5. You’re drinking too much caffeine. Whether it’s a can of soda or constant refills of your coffee mug, many of the beverages we reach for when we feel tired are packed with caffeine – a stimulant that will give you a quick jolt, but can also leave you crashing soon after if you ingest too much. Plus, if you’re drinking caffeinated beverages into the afternoon, they may start to have an effect on your sleep quality. If you’re a coffee drinker, switch to water late-morning and replace soda with seltzer for a bubbly afternoon pick-me-up without the crash.

6. You’re dehydrated. We all know the importance of drinking enough water – and even mild dehydration can have adverse effects on your energy level, mood, and concentration. Aim for at least one glass of water per hour while sitting at your desk, and be sure to fill your bottle up even more if you’re doing strenuous activity or are outdoors in high temperatures. 

7. You have poor posture. A study found that slouched walking decreased energy levels while exacerbating symptoms of depression. The good news: Simply altering body posture to a more upright position instantly boosted mood and energy, while enabling participants to more easily come up with positive thoughts. So sit up straight! Set reminders on your phone or calendar throughout the day to remind yourself to check in with your posture and straighten up. 

8. You’re not snacking smart. If you’re running to the vending machine for a quick afternoon snack, your selection – most likely high in simple carbs and sugar – will take your energy levels in the wrong direction. Instead choose a snack that has a combo of protein and complex carbs for an energy boost that will last throughout the afternoon. Think trail mix, veggies and hummus, or peanut butter on whole wheat toast.

5 Reasons Why Skin Cancer Surgery Isn’t So Scary

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

While Vesper’s story is unusual, skin cancer is the most common cancer in the United States. In fact, it’s currently estimated that one in five Americans will get skin cancer in his or her lifetime.  

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

The buildup of sun exposure over your lifetime puts you at greater risk for developing basal and squamous cell skin carcinomas as you age. Both Vesper and Davis had Mohs surgery, the most effective and precise way to remove the two most common types of skin cancer. 

How to Get Glowing Skin When You Have Psoriasis

Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology, doesn’t just treat patients with psoriasis — she manages her own. Dr. Jacob has been living with psoriasis since she was 14 years old.

Jacob’s psoriasis primarily affects her scalp and nails, both of which can be tough to hide. “I hated it when I had scalp involvement, which would show flakes on my clothing and itch constantly,” Jacob says.

Psoriatic Arthritis Info

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Embarrassed about her nail psoriasis, Jacob used to paint them a color that would mask her symptoms. The National Psoriasis Foundation says that about half of all people with psoriasis will have symptoms affecting the nails, which can include changes in color, thickening of the nails, separation of the nail, and the formation of pits or holes.

An Accessible Skin Care Routine

For healthy skin, Jacob knows she has to keep her skin clear and moisturized as much as possible. She uses CeraVe cleanser, available at many drugstores. “It adds ceramides to the skin, which help to rebalance the natural moisturizing factor in your skin,” she says. She follows that up with CeraVe lotion.

Other daily psoriasis treatment tips that Jacob offers her patients and practices herself include:

  • Cleanse and moisturize your skin just once daily to avoid drying.
  • Use a soft cloth or your hands to lather up with cleanser; never use a loofah on skin that’s actively flaring because the rubbing and scratching could worsen symptoms.
  • If you have psoriasis on your face, Jacob advises against using harsh toners because they can be aggravating.
  • During the frigid Chicago winters, Jacob switches to a cream or moisturizing cream from a lighter lotion because it’s more hydrating for thirsty winter skin.
  • For scalp psoriasis, she recommends over-the-counter favorites like Neutrogena T/Gel, DHS tar shampoos, or those containing salicylic acid (her personal pick is Neutrogena T/Sal.) For something stronger, she likes Clobex, a steroid shampoo that you can get with a prescription from your dermatologist.

When Jacob’s psoriasis flares, she turns to a prescription Avène product called Akérat cream because it contains exfoliators and softeners to soothe the skin.

Daily Psoriasis Treatment Starts from the Inside Out

Jacob knows that psoriasis and its treatments are more than just skin deep. She sticks to a healthy, balanced diet to help keep inflammation down and her symptoms in check. She eats salmon and walnuts for the omega-3 fatty acids, which can help reduce inflammation and promote better heart health. Jacob also takes omega-3 supplements for an extra boost. “They are great for inflammatory conditions, especially psoriasis, and they help balance cholesterol levels and improve your skin texture,” she explains. The heart-healthy supplements can prove particularly beneficial since people with psoriasis have a 58 percent greater chance of suffering a major cardiovascular event like a heart attack, according to the National Psoriasis Foundation.

Stress is also a trigger for psoriasis, so Jacob tries to keep it in check, particularly by exercising. With twin toddlers and a busy schedule, she has to make time to work out. How does she fit it in? “I get up early to exercise so it is done for the day,” she says. It’s a prudent strategy that’s backed by a study from the August 2012 issue of Archives of Dermatology, which found that women who engaged in regular vigorous exercise were less likely to develop psoriasis.

Another of Jacob’s secrets: avoiding alcohol. “It makes stress worse and makes psoriasis worse,” she says. The National Psoriasis Foundation notes that alcohol can interfere with psoriasis treatments and causes side effects when combined with many psoriasis medications. Plus, alcohol can change the way you perceive and manage your stress, according to the National Institute on Alcohol Abuse and Alcoholism.

Find What Works for You

Jacob’s psoriasis is now well controlled with biologic medications, and she says her skin, scalp, and nails stay pretty healthy. Her best advice? Work with your dermatologist to find the right treatment for you.

“The availability of biologic medications was life changing — to not have to deal with other messy medicines that do not work well, to not itch, and to have normal nails is wonderful,” she says. “This type of treatment makes me feel like a normal person again!”

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

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

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

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

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

The Real Monthly Cost of Depression

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

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

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

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

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

Susan Hyatt, 56, Corporate Social Responsibility Advisor

Monthly Medication: $70

Additional Monthly Treatments: $420-$470

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

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

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

RELATED: 5 Things Psychologists Wish Their Patients Would Do

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

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

Kathryn Goetzke, 44, Nonprofit Founder

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

Additional Monthly Treatments: $300-$700

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

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

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

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

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

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

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

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

Maggie White, 34, Stay-At-Home Mom

Monthly Medication: $170

Additional Monthly Treatments: $500-$1,000

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

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

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

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

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

Lisa Keith, PsyD, Assistant Professor of Special Education

Monthly Medication: $80

Additional Monthly Treatments: $105

Net Monthly Out-of-Pocket Costs: $185

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

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

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

9 Surprising Complications of Type 2 Diabetes

Type 2 Diabetes Complications: More Than Just Heart Disease

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

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

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

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

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

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

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

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

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

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

Parent's Depression May Harm Child's Grades, Study Finds

A child's grades in school might suffer if a parent is suffering from depression, according to a new study.

Researchers found that Swedish teens received lower grades during their final year in school if either of their parents had previously been diagnosed with depression.

The difference in grades was noticeable but not huge, said senior author Brian Lee, an associate professor of epidemiology and biostatistics at Drexel University's Dornsife School of Public Health in Philadelphia.

"It's not an entire letter grade drop, but at the same time it might be the difference between a student passing or failing," Lee said.

Parents' depression could affect the children's home lives, causing stress that impacts their academic performance, Lee said.

"Depression is a social disease," he said. "It doesn't just affect you. It affects your relationships as well. If there's strain there, it may affect the child's academic performance."

Since depression can be handed down, it also could be that the children are not doing as well in school because they suffer from undiagnosed mood disorders, he added.

Infants also might receive poorer care during early development if their mothers are depressed -- less breast-feeding or nurturing, for example -- which could have long-term impacts on children's ability to learn and problem-solve, he said.

"There are many different mechanisms to explain what we've found, and those are just a few possibilities," Lee said.

The study, published online Feb. 3 in JAMA Psychiatry, only found an association between parental depression and worse grades, however, not a direct cause-and-effect relationship.

In the study, Lee and his colleagues examined data on more than 1.1 million children born in Sweden between 1984 and 1994.

Compulsory education ends at age 16 in Sweden, and kids leaving school are assigned a final school grade based on how well they did in their last year. The researchers compared the final grades of teens whose mothers and fathers had been diagnosed with depression against those of teens whose parents do not have a mood disorder.

RELATED: Should You Have Kids If You’re Depressed?

They found that maternal and paternal depression affected a teen's performance during that final year in school, even if the depression occurred years earlier.

In general, both maternal and paternal depression in any period of a child's life were associated with worse school performance. Maternal depression was associated with a larger negative effect on school performance for girls compared with boys, according to the results.

The impact of depression is as large as similar effects on grades caused by differences in family income and the level of mom's education, the researchers reported.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., said, "This study provides strong evidence to suggest that children who have a depressed parent are at increased risk for lower academic performance."

Adesman, who was not involved with the research, found it "striking" that parental depression affects learning "regardless of whether the parental depression occurred early in a child's life or later and regardless of whether it is the mother who is depressed or the father."

The findings show that parents suffering from depression need to get help if they want to protect their kids, said Myrna Weissman, chief of epidemiology at the New York State Psychiatric Institute and a professor at Columbia University in New York City.

"We must make sure there's good available treatment for the parent so they stay asymptomatic. That would help a great deal," said Weissman, who wrote an editorial accompanying the study. "We have great data now showing if you treat the parent, the children function better."

Friends of a parent with depression should urge them to seek help, Weissman said.

Schools can offer programs to help children of depressed parents, but Weissman thinks it would be better to get treatment for the adult.

"Depression is highly treatable," she said. "I would certainly begin there."

Hepatitis C FAQs for the Public

Overview

What is hepatitis?

“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?

Hepatitis AHepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

What is Hepatitis C?

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis C can be either “acute” or “chronic.”

Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection.

Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

 

Statistics

How common is acute Hepatitis C in the United States?

In 2014, there were an estimated 30,500 cases of acute hepatitis C virus infections reported in the United States.

How common is chronic Hepatitis C in the United States?

An estimated 2.7-3.9 million people in the United States have chronic hepatitis C.

How likely is it that acute Hepatitis C will become chronic?

Approximately 75%–85% of people who become infected with Hepatitis C virus develop chronic infection.

Transmission / Exposure

How is Hepatitis C spread?

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.

 

People can become infected with the Hepatitis C virus during such activities as

  • Sharing needles, syringes, or other equipment to inject drugs
  • Needlestick injuries in health care settings
  • Being born to a mother who has Hepatitis C

Less commonly, a person can also get Hepatitis C virus infection through

  • Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
  • Having sexual contact with a person infected with the Hepatitis C virus

Can Hepatitis C be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when Hepatitis C can be spread through sexual contact.

Can you get Hepatitis C by getting a tattoo or piercing?

A few major research studies have not shown Hepatitis C to be spread through licensed, commercial tattooing facilities. However, transmission of Hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Body art is becoming increasingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. Further research is needed to determine if these types of settings and exposures are responsible for Hepatitis C virus transmission.

Can Hepatitis C be spread within a household?

Yes, but this does not occur very often. If Hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

How should blood spills be cleaned from surfaces to make sure that Hepatitis C virus is gone?

Any blood spills — including dried blood, which can still be infectious — should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.

How long does the Hepatitis C virus survive outside the body?

The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for up to 3 weeks.

What are ways Hepatitis C is not spread?

Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Who is at risk for Hepatitis C?

Some people are at increased risk for Hepatitis C, including:

  • Current injection drug users (currently the most common way Hepatitis C virus is spread in the United States)
  • Past injection drug users, including those who injected only one time or many years ago
  • Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
  • People who received a blood product for clotting problems made before 1987
  • Hemodialysis patients or persons who spent many years on dialysis for kidney failure
  • People who received body piercing or tattoos done with non-sterile instruments
  • People with known exposures to the Hepatitis C virus, such as
    • Health care workers injured by needlesticks
    • Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus
  • HIV-infected persons
  • Children born to mothers infected with the Hepatitis C virus

Less common risks include:

  • Having sexual contact with a person who is infected with the Hepatitis C virus
  • Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

What is the risk of a pregnant woman passing Hepatitis C to her baby?

Hepatitis C is rarely passed from a pregnant woman to her baby. About 6 of every 100 infants born to mothers with Hepatitis C become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C.

Can a person get Hepatitis C from a mosquito or other insect bite?

Hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.

Can I donate blood, organs, or semen if I have Hepatitis C?

No, if you ever tested positive for the Hepatitis C virus (or Hepatitis B virus), experts recommend never donating blood, organs, or semen because this can spread the infection to the recipient.

 

Symptoms

What are the symptoms of acute Hepatitis C?

Approximately 70%–80% of people with acute Hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice (yellow color in the skin or eyes)

How soon after exposure to Hepatitis C do symptoms appear?

If symptoms occur, the average time is 6–7 weeks after exposure, but this can range from 2 weeks to 6 months. However, many people infected with the Hepatitis C virus do not develop symptoms.

Can a person spread Hepatitis C without having symptoms?

Yes, even if a person with Hepatitis C has no symptoms, he or she can still spread the virus to others.

Is it possible to have Hepatitis C and not know it?

Yes, many people who are infected with the Hepatitis C virus do not know they are infected because they do not look or feel sick.

What are the symptoms of chronic Hepatitis C?

Most people with chronic Hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, Hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.

How serious is chronic Hepatitis C?

Chronic Hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 19,000 people die every year from Hepatitis C related liver disease.

What are the long-term effects of Hepatitis C?

Of every 100 people infected with the Hepatitis C virus, about

  • 75–85 people will develop chronic Hepatitis C virus infection; of those,
    • 60–70 people will go on to develop chronic liver disease
    • 5–20 people will go on to develop cirrhosis over a period of 20–30 years
    • 1–5 people will die from cirrhosis or liver cancer

Tests

Can a person have normal liver enzyme (e.g., ALT) results and still have Hepatitis C?

Yes. It is common for persons with chronic Hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6–12 month period. If the liver enzyme level remains normal, the doctor may check it less frequently, such as once a year.

Who should get tested for Hepatitis C?

Talk to your doctor about being tested for Hepatitis C if any of the following are true:

  • You were born from 1945 through 1965
  • You are a current or former injection drug user, even if you injected only one time or many years ago.
  • You were treated for a blood clotting problem before 1987.
  • You received a blood transfusion or organ transplant before July 1992.
  • You are on long-term hemodialysis treatment.
  • You have abnormal liver tests or liver disease.
  • You work in health care or public safety and were exposed to blood through a needlestick or other sharp object injury.
  • You are infected with HIV.

If you are pregnant, should you be tested for Hepatitis C?

No, getting tested for Hepatitis C is not part of routine prenatal care. However, if a pregnant woman has risk factors for Hepatitis C virus infection, she should speak with her doctor about getting tested.

What blood tests are used to test for Hepatitis C?

Several different blood tests are used to test for Hepatitis C. A doctor may order just one or a combination of these tests. Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person's bloodstream.

Treatment

Can acute Hepatitis C be treated?

Yes, acute hepatitis C can be treated. Acute infection can clear on its own without treatment in about 25% of people. If acute hepatitis C is diagnosed, treatment does reduce the risk that acute hepatitis C will become a chronic infection. Acute hepatitis C is treated with the same medications used to treat chronic Hepatitis C. However, the optimal treatment and when it should be started remains uncertain.

Can chronic Hepatitis C be treated?

Yes. There are several medications available to treat chronic Hepatitis C, including new treatments that appear to be more effective and have fewer side effects than previous options. The Food and Drug Administration (FDA) maintains a complete list of approved treatments for Hepatitis C.

Is it possible to get over Hepatitis C?

Yes, approximately 15%–25% of people who get Hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.

What can a person with chronic Hepatitis C do to take care of his or her liver?

People with chronic Hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and Hepatitis B.

Vaccination

Is there a vaccine that can prevent Hepatitis C?

Not yet. Vaccines are available only for Hepatitis A and Hepatitis B. Research into the development of a vaccine is under way.

Hepatitis C and Employment

Should a person infected with the Hepatitis C virus be restricted from working in certain jobs or settings?

CDC's recommendations for prevention and control of the Hepatitis C virus infection state that people should not be excluded from work, school, play, child care, or other settings because they have Hepatitis C. There is no evidence that people can get Hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact.

Hepatitis C and Co-infection with HIV

What is HIV and Hepatitis C virus coinfection?

HIV and Hepatitis C virus coinfection refers to being infected with both HIV and the Hepatitis C virus. Coinfection is more common in persons who inject drugs. In fact, 50%–90% of HIV-infected persons who use injection drugs are also infected with the Hepatitis C virus. To learn more about coinfection, visithttp://www.cdc.gov/hiv/resources/factsheets/hepatitis.htm.

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 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.

Light Box Might Help Nonseasonal Depression, Too

Light therapy, a treatment for a kind of depression known as seasonal affective disorder (SAD), may also benefit nonseasonal depression, a new study indicates.

"The combination of light and an antidepressant seems to work very well for treating nonseasonal depression," said study leader Dr. Raymond Lam, a professor and head of the Mood and Anxiety Disorders Program at the University of British Columbia in Canada.

Depression, a leading cause of disability worldwide, affects one in 20 people, according to background information with the study. Current treatments include psychotherapy and antidepressant medication, but recurrent episodes are common.

Since bright light treatment is used for people whose seasonal depression occurs in the darker months, the researchers hypothesized it might also lift depression that isn't brought on by light deprivation.

Lam and his team randomly assigned 122 adults with major depression not related to seasonal affective disorder to one of four groups. One group got 30 minutes of bright light treatment a day and took a placebo pill, while another used a device that was not light therapy and took the antidepressant fluoxetine (Prozac). A third group took a placebo pill and used a placebo device, while a fourth took Prozac and got light therapy.

The researchers followed the men and women for eight weeks, looking to see how many went into remission -- defined as having normal scores on a widely used depression scale.

"About 60 percent of the patients who got the combination [Prozac plus light] treatment went into remission with their symptoms compared to about 40 percent on light therapy alone," Lam said.

RESEARCH: 12 Ways to Treat Seasonal Depression

The antidepressant alone was not superior to placebo medication. Only about 30 percent of those on placebo medication and sham light treatment had remission, as did just 20 percent of those on Prozac with sham light treatment.

Light therapy alone was better than placebo, but not from a statistically significant point of view, Lam said.

Experts can't say for sure why light therapy works, but for seasonal affective disorder they think it may help correct disturbances in the body's circadian rhythms, or internal clock.

The same may be true for nonseasonal depression, Lam said. "Another theory is that light affects neurotransmitters in the brain such as serotonin [which affects mood]," he said. Or both could play a role, he added.

One limitation of the study, published online Nov. 18 in JAMA Psychiatry, is that patients' natural light exposure was not measured, the researchers said.

Simon Rego is director of psychology training at Montefiore Medical Center and an associate professor at Albert Einstein College of Medicine in New York City. He said the study is the first well-designed comparison of light therapy and the combination of light therapy and antidepressant medications in adults with nonseasonal major depressive disorder.

"In this case, the authors found that the light treatment, whether delivered alone or particularly when delivered in combination with an antidepressant medication, was efficacious in the treatment of nonseasonal [depression] and, just as important, the treatments were well-tolerated by the subjects," Rego said.

"It appears that light therapy, which is already seen as an effective treatment for seasonal affective disorder, may also be appropriate for nonseasonal [depression]," he added.

However, questions remain, Lam said, such as how long the combination treatment should continue.

Light boxes are sold at drugstores and other locations, Lam said, for less than $100 to $300. Some insurance plans cover them, he said.

Recommended treatment involves sitting in front of the fluorescent light box for a half hour daily as soon as possible after waking up. Lam said this can be done while eating breakfast or working on the computer.

The Canadian Institutes of Health Research funded the study. Lam reports serving as a consultant to or receiving honoraria for speaking from various pharmaceutical companies, including Eli Lilly and Co., which makes Prozac.

Depression Screening Should Include All Pregnant, Postpartum Women

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

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

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

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

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

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

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

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

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

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

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

RELATED: 9 Depression Types to Know

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

7 Dietitian-Approved Pumpkin Spice Foods You'll Love

1 / 8   Healthy Treats to Celebrate the Season

Fall means beautiful foliage, back-to-school time, and, you guessed it, pumpkin spice everything. From lattes to hummus (yes, you read that right), there’s no shortage of pumpkin spice-flavored products on the market. The problem is that many of these foods are laden with fat and sugar. A grande pumpkin spice latte with whipped cream at Starbucks, for example, contains a whopping 50 grams (g) of sugar and 380 calories — enough for a whole meal! Then there’s the pumpkin muffin from Dunkin’ Donuts, which weighs in at 550 calories and 24 g of fat.

The good news is you don’t have to steer clear of foods with pumpkin: They contain even more potassium than bananas, which means they can help lower blood pressure and decrease the risk of stroke and heart disease. Plus, a study published in February 2014 in the International Journal of Clinical Oncology found that consuming foods rich in beta-carotene — like pumpkins — is associated with a decreased risk of colon cancer, and a study published in 2004 showed that it may also reduce risk of prostate cancer.

To help you get into the spirit of the season — without widening your waistline — try these dietitian-approved pumpkin spice treats!

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