Surprising Physical Signs of Heart Disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Resting Heart Rate for MEN Or WOMEN

Resting Heart Rate for MEN

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

Resting Heart Rate for WOMEN

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

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11 Struggles Every New Runner Understands

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

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

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

Getting winded in the first few minutes.

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

Two words: Sore. Muscles.

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

 

 

Feeling overwhelmed by the copious amount of races.

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

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

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

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

The boredom.

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

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

Trying to find your perfect route.

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

The joy of picking out new workout clothes.

Sleek tanks! Compression pants! Neon shoes!

Running toward (multiple) "finish lines."

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

 

 

Bargaining with yourself on your run.

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

Creating a playlist that will consistently keep you motivated.

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

Eating Well As You Age

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

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

Strategies for Healthy Eating as You Age

Replace old eating habits with these healthy approaches:

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

Overcoming Challenges to Healthy Eating

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

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

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

What You Need to Know About Hyperpigmentation

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

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

Everyday Health: What causes hyperpigmentation?

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

 

 

 

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

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

EH: What steps can you take to treat it?

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

 

 

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

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

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

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

6 Ways to Prep Your Skin for Summer

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

1. Reveal Glowing Skin

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

 

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

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

2. Remove Hair Without Irritation

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

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

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

 

 

3. Fight UV Rays With Food

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

4. Clear Up Body Breakouts

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

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

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

5. Erase Cellulite

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

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

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

6. Treat Your Feet

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

7 Healthy Habits of the 2016 Presidential Candidates

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

What Is Guillain-Barré Syndrome?

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

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

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

GBS Prevalence

Guillain-Barré syndrome is a rare disease.

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

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

Causes and Risk Factors

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

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

Less common triggers for GBS may include:

  • Immunizations
  • Surgery
  • Trauma

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

Types of GBS

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

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

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

Guillain-Barré Syndrome Symptoms

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

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

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

Signs and symptoms of Guillain-Barré syndrome may include:

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

What Is Binge Eating Disorder?

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It's unclear what causes binge eating disorder.

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

Some risk factors for binge eating disorder include:

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

Symptoms of Binge Eating Disorder

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

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

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

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

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

Binge Eating Disorder Treatment

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

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

 

10 Varicose Veins Myths

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

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

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

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

 

 

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

Myth 1: Varicose Veins Are Only a Cosmetic Issue

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

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

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

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

Myth 2: Varicose Veins Are an Inevitable Sign of Aging

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

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

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

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

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

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

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

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

Myth 4: Running Can Cause Varicose Veins

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

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

Myth 5: Varicose Veins Are Always Visible

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

Myth 6: Standing on the Job Causes Varicose Veins

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

RELATED: Steer Clear of These 9 Artery and Vein Diseases

Myth 7: Making Lifestyle Changes Won't Help

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

Myth 8: Surgery Is Your Only Treatment Option

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

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

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

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

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

Myth 9: Recovery After Varicose Vein Treatments Is Difficult

 

 

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

Myth 10: Varicose Veins Can Be Cured

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

10 Essential Facts About Ovarian Cancer

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

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

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

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

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

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

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

 

 

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

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

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

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

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

RELATED: Overcoming Ovarian Cancer, Twice

5. Ovarian cancer has several key risk factorsThese include:

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

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

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

 

 

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

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

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

How to Prevent Hearing Loss

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

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

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

Types and Causes of Hearing Loss

There are three basic types of hearing loss:

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

Hearing Loss Evaluation

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

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

 

 

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

 

 

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

Tips for Hearing Loss Prevention

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

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

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

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

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5 Reasons Why Skin Cancer Surgery Isn’t So Scary

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

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

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

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

Talk Therapy May Help Depressed Teens Who Shun Antidepressants

Cognitive behavioral therapy can help boost mood without drugs.

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

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

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

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

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

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

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

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

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

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

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

RELATED: 7 Antidepressant Side Effects

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

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

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

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

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

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

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

How to 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.

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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!”

Study Finds No Proof of 'Seasonal' Depression

A new study cast doubts on the existence of seasonal depression -- a mood disorder linked to reduced sunlight in the winter months.

This form of depression -- known as seasonal affective disorder (SAD) and recognized by the mental health community for nearly 30 years -- "is not supported by objective data," the new study claims.

Depression comes and goes, said study lead researcher Steven LoBello. If someone experiences depression in the fall and winter, "it doesn't mean that seasonal changes have caused the depression," added LoBello, a professor of psychology at Auburn University at Montgomery, Ala.

For the study, LoBello and colleagues used data from a telephone survey of more than 34,000 U.S. adults asked about depression and then gathered information on time of year, latitude and more when measuring depression.

LoBello noted the study found no evidence that symptoms of depression were season-related and said, "If this seasonal pattern of depression occurs at all, it may be fairly rare."

Dr. Matthew Lorber, acting director of child and adolescent psychiatry at Lenox Hill Hospital in New York City, also said that seasonal affective disorder may not be a "legitimate diagnosis."

Big drug companies, Lorber said, pushed to have SAD recognized as a standard diagnosis. "It then allowed them to market to a new population to use their medications. That was a motivating factor in creating this disorder," said Lorber, who wasn't involved in the new study.

LoBello thinks the seasons have no place in the diagnosis of depression, and he would like to see these criteria discontinued.

His reasoning? Assuming a cause that isn't accurate may lead patients to pursue treatments that won't deliver relief, LoBello said.

According to the new report, published Jan. 20 in Clinical Psychological Science, seasonal affective disorder was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the bible of psychological diagnosis -- in 1987.

RELATED: Why Depression Is Underreported in Men

LoBello isn't the first to explore the validity of this diagnosis.

Kelly Rohan, an associate professor of psychology at the University of Vermont, has done her own research on seasonal depression and found "no season differences in reports of depressive symptoms."

"I certainly did not argue that this means SAD does not exist," she said. "However, only a minority of depression cases are actually SAD."

So, how come other research has found that a significant percentage of the public suffers from this condition? (The American Academy of Family Physicians says up to 6 percent of U.S. adults have winter depression, and as many as one in five have mild SAD symptoms).

It all depends on how the studies are done and how the questions are asked, Rohan said. "Also, SAD depressive symptoms tend to be less severe than in nonseasonal major depression and mood tends to be back to normal in the spring and summer," she said. "So when you take all the depressed people in this sample -- including the minority that claims to be SAD -- and look at seasonal differences in their depression scores, I am not surprised that it is a wash."

For the study, LoBello and colleagues used the 2006 Behavioral Risk Factor Surveillance System. The 34,000-plus respondents had been asked about the number of days they felt depressed in the past two weeks. The researchers matched these responses with the location of each person and the day, month, latitude and amount of sun exposure when interviewed.

People who responded to the survey in the winter months, when sunlight exposure was low, had no greater levels of depressive symptoms than those who responded to the survey at other times, the researchers said.

In addition, the researchers found no evidence for seasonal differences in mood when they zeroed in on more than 1,700 participants with clinical depression.

Serotonin Syndrome: 7 Things You Need to Know

1 / 8   Serotonin Syndrome
Serotonin is a neurotransmitter (a naturally occurring brain chemical) that helps regulate mood and behavior, and increasing serotonin is one way of treating depression.

But if you're taking antidepressant medication that increases serotonin too much, you could be at risk for a dangerous drug reaction called serotonin syndrome.

"Serotonin syndrome usually happens when a doctor prescribes a drug that increases serotonin to a patient already on an antidepressant," said Mark Su, MD, assistant professor of emergency medicine at Hofstra University and director of the Toxicology Fellowship at North Shore University Hospital in Manhasset, N.Y.

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.

8 Healthy Game Day Snacks for Football Season

1 / 9   Skip the Takeout and Whip Up These 8 Winning Snacks

Even if you're not a football fanatic, game day is always an excuse to watch a good matchup, spend time with family and friends, and especially to eat your favorite foods. Nachos, chili, cheese dips — your upcoming game-day gathering will probably boast some of the best non-holiday spreads of the year. Game on! This year, it’s not about what foods you should avoid; instead, we scoured our favorite blogs for healthier game day dishes that score major points for flavor, originality, and nutrition. One look at these winning recipes and you won’t want to order out.

6 Detoxifying Vegetable Soup Recipes for the New Year

Bone broth was the hipster darling of 2015 food trends, but if healthy eating is one of your resolutions, just sipping on broth isn’t going to cut it. It’s a new year, and 2016 is all about doubling down on fruits and veggies in the most delicious way possible. Sure, salads pack in a lot of produce, but broth-based soups may be the most satisfying — and warming! — route to healthy eating this winter. If you’ve been mainlining gingerbread and peppermint bark for the past two weeks, a detoxifying veggie soup is the perfect way to usher in a healthier new year, one satisfying slurp at a time. Here are five recipes that’ll give your resolutions staying power all month long:

Many-Veggie Vegetable Soup

Many-Veggie Vegetable Soup 

We like to think of this dish from Love & Lemons as the “everything but the kitchen sink” of all soup recipes. Here at Everyday Health, we have a strict “no produce left behind” policy, and this is the perfect way to use up all of those death-row veggies in the fridge. Satiating sweet potatoes and carrots pair with lighter veggies like zucchini, tomatoes, and kale to create a hearty, stew-like dish that makes a delicious winter lunch or light supper.

Spiralized Vegan Ramen Soup With Zucchini Noodles

Spiralized Vegan Ramen Soup With Zucchini Noodles

Happiness is when two of your food obsessions (ramen and spiralizing) come together to create a healthy, guilt-free dish. Our friend Ali over at Inspiralized created the ultimate healthy substitute for when you’re jonesing for ramen. This recipe, which swaps noodles for zucchini ribbons, clocks in at 117 calories per serving, which makes it the perfect starter. Or you can make a vegan-friendly meal by adding protein-rich tofu or quinoa — or vegetarian (and a little more authentic!) by serving it with a perfect soft-boiled egg.

 

Spinach Soup With Rosemary Crouton

Spinach Soup With Rosemary Croutons

Here’s another “easy button” recipe that requires just a few essential ingredients that can be swapped in and out depending on what you have in the fridge. Here, cooked spinach, onion, and potatoes are blended with rosemary to create a vegetable-rich savory slurp, but you could use any green you have on hand (think: kale, arugula, mustard greens) and a variety of herbs (thyme, basil, and tarragon would all do the trick!). Eschewing bread this month? Just skip the croutons.

Carrot Apple Ginger Soup

Carrot Apple Ginger Soup

If you haven’t hit the supermarket for your annual “New Year, New You” shopping spree, check the crisper for these holiday holdovers: carrots, onions, apples, and ginger. This bright, sweet, and spicy soup from Joy the Baker keeps in the fridge for up to four days and freezes like a dream. Your first week of January lunch problem? Solved!

Amazon Bean Soup

Amazon Bean Soup With Winter Squash and Greens

If you’re looking for a vegetarian soup that even the most persnickety carnivore will love, look no further. The United Nations has declared 2016 the “International Year of Pulses” (pulses being beans and legumes to me and you), and for good reason: Beans are cheap, healthy, and environmentally-friendly sources of protein that are packed with fiber and nutrients. We love this wintry mix of beans, carrots, squash, and greens, finished with a squirt of lime. You can easily make this a vegan dish by swapping the butter for heart-healthy olive oil and the chicken stock for a veggie version.

No-Bone Broth

No-Bone Broth

Now that you’ve got five delicious soup ideas, you’ll need some broth. Matt Weingarten, culinary director for Dig Inn, created this No-Bone Broth recipe from kitchen scraps, like apple cores, vegetable peels, and the tops and tails of celery, to create a nutrient-rich, vegan stock that’s a perfect base for any soup recipe.

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:

13 Conditions Commonly Mistaken for Multiple Sclerosis

Getting a correct diagnosis of multiple sclerosis (MS) can be a challenge.

No single test can determine a diagnosis conclusively, and not everyone has all of the common symptoms of MS, such as numbness, tingling, pain, fatigue, and heat sensitivity. And to complicate matters, the symptoms you do have may resemble those of some other condition.

To figure out what’s causing possible MS symptoms, doctors look at your medical history, the results of a neurological exam, and an MRI — and sometimes do a spinal tap (also called a lumbar puncture), says Jack Burks, MD, a neurologist and chief medical officer for the Multiple Sclerosis Association of America. "The diagnosis can also require eliminating the possible MS mimicker diseases," he says. That leads to an MS diagnosis by exclusion.

Here are some of the conditions that are sometimes mistaken for multiple sclerosis:

Lyme disease is a bacterial infection transmitted through a tick bite. Early symptoms include fatigue, fever, headaches, and muscle and joint aches. Later symptoms can include numbness and tingling in the hands and feet, as well as cognitive problems such as short-term memory loss and speech issues. If you live in an area that’s known to have Lyme disease or have recently traveled to one, your doctor will want to rule out the possibility, Dr. Burks says.

A migraine is a type of headache that can cause intense pain; throbbing; sensitivity to light, sounds, or smells; nausea and vomiting; blurred vision; and lightheadedness and fainting. A study published online in Neurology in August 2016 found that a migraine was the most common correct diagnosis in study subjects who had definitely or probably been misdiagnosed with MS, occurring in 22 percent of them. That said, headaches — and migraines in particular — do commonly occur with MS, shows a study published in Neurological Sciences in April 2011. And according to a study published in the Journal of Headache Pain in October 2010, they are also significantly associated with other types of pain, as well as with depression.

Migraines can be difficult to diagnose, and doctors use some of the same tools to diagnose the headaches as they do for MS, including taking a medical history and performing a thorough neurological examination.

Conversion and psychogenic disorders are conditions in which psychological stress is converted into a physical problem — such as blindness or paralysis — for which no medical cause can be found. In the Neurology study on MS misdiagnosis, 11 percent of subjects definitely or probably misdiagnosed with MS actually had a conversion or psychogenic disorder.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease that, like multiple sclerosis, attacks the myelin sheaths — the protective covering of the nerve fibers — of the optic nerves and spinal cord. But unlike MS, it usually spares the brain in its early stages. Symptoms of NMOSD — which include sudden vision loss or pain in one or both eyes, numbness or loss of sensation in the arms and legs, difficulty controlling the bladder and bowels, and uncontrollable vomiting and hiccups — tend to be more severe than symptoms of MS. Treatments for MS are ineffective for and can even worsen NMOSD, so getting an accurate diagnosis is extremely important. A blood test known as the NMO IgG antibody test can help to differentiate between MS and NMOSD.

Lupus is a chronic, autoimmune disorder that, like MS, affects more women than men. It can cause muscle pain, joint swelling, fatigue, and headaches. The hallmark symptom of lupus is a butterfly-shaped rash covering the cheeks and bridge of the nose, but only about half of people with lupus develop this rash. There is no single diagnostic test for lupus, and because its symptoms are similar to those of many other conditions, it is sometimes called “the great imitator.”

Rheumatologists (physicians specializing in diseases of the muscles and joints) typically diagnose lupus based on a number of laboratory tests and the number of symptoms characteristic of lupus that a person has.

A stroke occurs when a portion of the brain stops receiving a steady supply of blood, and consequently doesn't get the oxygen and nutrients it needs to survive. Symptoms of a stroke include loss of vision; loss of feeling in the limbs, usually on one side of the body; difficulty walking; and difficulty speaking — all of which can also be signs of an MS flare. The age of the person experiencing the symptoms may help to pin down the correct diagnosis. "While MS can occur in 70-year-olds, if the person is older, you tend to think of stroke, not MS," Burks says. A stroke requires immediate attention; if you think you’re experiencing a stroke, call 911.

Fibromyalgia and MS have some similar symptoms, including headaches, joint and muscle pain, numbness and tingling of extremities, memory problems, and fatigue. Like MS, fibromyalgia is more common in women than in men. But unlike MS, fibromyalgia does not show up as brain lesions on an MRI.

Sjögren’s syndrome is another autoimmune disorder, and the symptoms of many autoimmune disorders overlap, Burks says. Sjögren’s causes fatigue and musculoskeletal pain and is more common in women than in men. But the telltale signs are dry eyes and dry mouth, which are not associated with MS.

RELATED:  The Complex Process of Diagnosing MS

Vasculitis is an inflammation of the blood vessels that can mimic MS, says Kathleen Costello, an adult nurse practitioner and at The Johns Hopkins MS Center in Baltimore and vice president of healthcare access at the National Multiple Sclerosis Society. Depending on the type of vasculitis, symptoms can include joint pain, blurred vision, and numbness, tingling, and weakness in the limbs.

Myasthenia gravis is a chronic autoimmune disease that causes muscle weakness that typically comes and goes, but tends to progress over time. The weakness is caused by a defect in the transmission of nerve impulses to muscles. In many people, the first signs of myasthenia gravis are drooping eyelids and double vision. Like MS, it can also cause difficulty with walking, speaking, chewing, and swallowing. If a doctor suspects myasthenia gravis, a number of tests can help to confirm or rule out the diagnosis.


Sarcoidosis is another inflammatory autoimmune disease that shares some symptoms with MS, including fatigue and decreased vision. But sarcoidosis most commonly affects the lungs, lymph nodes, and skin, causing a cough or wheezing, swollen lymph nodes, and lumps, sores, or areas of discoloration on the skin.

Vitamin B12 deficiency can cause MS-like symptoms such as fatigue, mental confusion, and numbness and tingling in the hands and feet. That's because vitamin B12 plays a role in the metabolism of fatty acids needed to maintain the myelin sheath. Vitamin B12 deficiency can be identified with a simple blood test.

Acute disseminated encephalomyelitis (ADEM) is a severe inflammatory attack affecting the brain and spinal cord. Symptoms include fever, fatigue, headache, nausea, vomiting, vision loss, and difficulty walking. A very rare condition, ADEM typically comes on rapidly, often after a viral or bacterial infection. Children are more likely to have ADEM, while MS is more likely to occur in adults.

Expert Panel Recommends Questionnaire to Help Spot Depression

Part of your next visit to your family doctor's office should be spent filling out a questionnaire to assess whether you're suffering from depression, an influential panel of preventive medicine experts recommends.

What's more, people concerned that they might be depressed could download an appropriate questionnaire online, fill it out ahead of time and hand it over to their doctor for evaluation, the panel added.

In an updated recommendation released Monday, the U.S. Preventive Services Task Force urged that family doctors regularly screen patients for depression, using standardized questionnaires that detect warning signs of the mental disorder.

If a patient shows signs of depression, they would be referred to a specialist for a full-fledged diagnosis and treatment using medication, therapy or a combination of the two, according to the recommendation.

These questionnaires can be self-administered in a matter of minutes, with doctors reviewing the results after patients fill out the forms, said Dr. Kirsten Bibbins-Domingo, vice chair of the task force.

"This could be a checklist that patients fill out in the waiting room, or at home prior to the visit," she said. "The good thing is we have many instruments, measures that have been studied for screening for depression."

About 7 percent of adults in the United States currently suffer from depression, but only half have been diagnosed with the condition, said Bibbins-Domingo, who is a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco.

"We know that depression itself is a source of poor health," she said. "It leads people to miss work, to not function as fully as they might, and we know it is linked and associated with other types of chronic diseases."

It makes sense that family doctors perform front-line screening for depression, since they are more likely than a mental health professional to come across a person with undetected symptoms, said Michael Yapko, a clinical psychologist and internationally recognized depression expert based in Fallbrook, Calif.

"Only about 25 percent of depression sufferers seek out professional help, but more than 90 percent will see a physician and present symptoms and signs that could be diagnosed," said Yapko, who is not on the task force.

The panel has recommended regular depression screening for adults since 2002, but their guidelines currently urge doctors to ask two specific questions that provide a quick evaluation of a person's mood. The questions are, "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"

The updated recommendation expands doctors' options for depression screening, adding commonly used questionnaires like the Patient Health Questionnaire, or PHQ-9.

The PHQ-9 is a list of 10 questions that focus on problems that a person might have experienced during the past two weeks, including poor appetite, low energy, sleep problems and a lack of interest in doing things.

"These are not instruments that diagnose depression," Bibbins-Domingo noted. "They give clinicians the first indication of something that should be followed up on."

RELATED: 10 Drug-Free Therapies for Depression

Yapko said that someone who wanted to could lie on the questionnaires and avoid having their symptoms detected, but he added that in his experience it's not a very likely scenario.

"When you have people who are suffering who genuinely want help, they're happy to give you as accurate a portrayal as they can give you," he said. "Generally speaking, the people seeking help want help and they want to do their best in filling these things out. That's what makes the test worthwhile."

The task force is an independent, volunteer panel of national experts that has been issuing recommendations on preventive medicine since 1984.

Yapko and Bibbins-Domingo said depression screening shouldn't eat into a doctor's time, since patients can fill out and score the questionnaires on their own.

Instead of wasting time reading magazines in the waiting room, patients "could be filling out an inventory that is self-administered, self-scored and wouldn't take any physician time at all," Yapko said.

Patients also could download and fill out a depression questionnaire at home and hand it in when they go to the doctor, but Yapko said patients should make sure they're using the form their doctor prefers.

"Which of the many inventories and questionnaires a doctor might wish to use is a matter of personal and professional judgment," he said. "So, a doctor would need to specify which form to obtain online and the patient would then need to remember to bring it in, not always easy when depression negatively affects your memory. Easier to have the form in the office and have them fill it out in the waiting room."

Yapko added that it's important that doctors who screen for depression follow up by referring patients to a mental health professional, rather than trying to diagnose and treat depression themselves.

"When physicians get a diagnosis of depression, their most immediate thing to do is prescribe an antidepressant," Yapko said, noting that more than 70 percent of antidepressants are prescribed by non-psychiatrists. "Only a minority of people walk out of a doctor's office with a referral to a mental health professional, a fact which drives me a little crazy."

Vitamin D

 

 

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. 

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

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

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

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

 

Local Hepatitis C Screening Success

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

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

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

 

Progress in National Hepatitis C Screening

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

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

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

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

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

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

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

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

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

The three steps to a hepatitis C cure are to:

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

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

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

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

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

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

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

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

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

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

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

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

 

7 Quick Fixes to Look More Attractive

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

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

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.

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.

How to Protect Your Child From an Allergic Reaction While You're Away

You may feel in complete control of your child's allergies — at least when he or she is under your watchful eye. But you can't be with him or her 24/7, and you want her to live as normal a life as possible. What's the balance between letting your child enjoy life and managing your stress in the face of severe childhood allergies? You’ll need to explain to other parents, teachers, and caregivers all they need to know to try to avoid the allergens, recognize allergy symptoms, and treat an allergic reaction so they’ll be as knowledgeable and vigilant as you are. There are steps you can take to clearly convey this potentially life-saving information about your child’s allergies.

Create an Allergy Action Plan

Before a child with severe allergies goes to school, day care, or a babysitter (even a close relative), put an allergy action plan in place to ensure your child’s safety. First, meet with your child’s doctor and ask for a letter that outlines the following:

  • What your child is allergic to as confirmed by allergy testing
  • How to avoid exposure to the allergens, including reducing the risk of cross-contamination in food preparation for food allergies
  • What medications and treatment are needed in case of an allergic reaction, whether mild or severe

This letter is the basis of your written allergy action plan at home, school, and anywhere else your child goes. Send a copy of this letter along with your instructions wherever your child is being watched by others.

Share Your Child’s Allergy Action Plan

Whenever a child with severe allergies is under the care of anyone other than a parent, whether it’s a relative or a babysitter, make sure the caregiver is familiar with your child’s allergy action plan.

However, it's not enough to just hand a written emergency plan to another caregiver, says Scott H. Sicherer, MD, an Elliot and Roslyn Jaffe professor of pediatrics, allergy, and immunology and the chief of the division of allergy and immunology in the department of pediatrics at Mount Sinai Hospital in New York City and author of Food Allergies: A Complete Guide for Eating When Your Life Depends on It. “You should still educate them about avoiding, recognizing, and managing an allergic reaction,” Dr. Sicherer says.

Manage Severe Childhood Allergies at School

Make an appointment to talk with the principal and school nurse before the school year starts, or as soon as you learn of your child's allergy, to discuss the situation and the school’s allergy policy. Take the letter from your child’s doctor along and use the information to work with the school nurse to develop an at-school allergy action plan that meets your child’s specific needs.

Also meet with your child’s teacher and discuss what measures will be taken to prevent an allergic reaction in the classroom, such as regular hand washing, safe foods allowed in the classroom, and allergy-free celebration treats.

"Most schools have allergy policies in place and have had children with allergies before,” Sicherer says. “They may have a variety of approaches for keeping children safe and being ready to recognize and treat reactions." For example, some schools may have special tables in the lunchroom for children with food allergies or offer closer supervision while they’re eating.

Here are three questions to ask about a school’s allergy policy:

  • Where is allergy medication stored?
  • Who is authorized to give allergy medications?
  • What is the allergy emergency plan for field trips and other extracurricular activities?

“Allergy medications at school must be immediately available with clear instructions, and they should not be locked up,” says Robert Wood, MD, a professor of pediatrics and the chief of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore, Md. “Medication needs to be within five minutes of where the child is.”

In October 2013, the Centers for Disease Control and Prevention released its first voluntary guidelines for managing food allergies at school, but there are no mandatory national standards. Some states have their own allergy guidelines in place for schools, which can help you and your school design your own allergy action plan.

Share Information With Your Child About Allergies

How you educate your child to protect him or herself from allergic reactions will depend on his or her age. Preschool and early elementary school kids can’t be expected to speak up for themselves about their allergies and should have close supervision. In the case of a food allergy, there should be very explicit instructions about what they’re allowed to eat, Dr. Wood says.

Young children with severe food allergies may learn that they can’t share food with another child, Sicherer says, or that there are specific people, like Mom, Dad, and their teacher, who know what they're allergic to and what's safe to eat — and that no one else can give them food. But as they get older, they can learn more and take more responsibility for themselves. "They may learn to speak up in restaurants and read food labels to begin to decide what’s safe under supervision," Sicherer says.

Bullied Teens at Risk for Later Depression

Getting picked on at age 13 tied to raised odds of poor mental health at 18, U.K. researchers report.

Young teens who are bullied appear to be at higher risk of depression when they reach early adulthood, according to new research.

"We found that teenagers who reported being frequently bullied were twice as likely to be clinically depressed at 18 years," said Lucy Bowes, a researcher at the University of Oxford in England, who led the research.

The researchers found an association, not a definitive cause-and-effect relationship, Bowes said. "In our type of study, we can never be certain that bullying causes depression," she explained. "However, our evidence suggests that this is the case."

To explore the possible link, the investigators used data on nearly 4,000 teens in the Avon Longitudinal Study of Parents and Children, a community-based group born in the United Kingdom. At age 13, all completed a questionnaire about bullying. At 18, they were assessed for depression.

The study found that nearly 700 teens said they had been bullied "often" -- more than once a week -- at age 13. Of those, nearly 15 percent were depressed at age 18. More than 1,440 other teens reported some bullying -- one to three times over a six-month period -- at age 13. Of these, 7 percent were depressed at age 18. In comparison, only 5.5 percent of teens who weren't bullied were depressed at age 18.

RELATED: Living With the Scars of Bullying

Bowes also found the often-bullied teens tended to stay depressed longer than others. For 10 percent of those often-bullied who became depressed, the depression lasted more than two years. By comparison, only 4 percent of the never-bullied group had long-lasting depression.

Among the bullying tactics, name calling was the most common type, experienced by more than one-third of the teens. About one of four had their belongings taken. About 10 percent were hit or beaten up. Most never told a teacher and up to half didn't tell a parent. But up to three-quarters did tell an adult if the bullying was physical, according to the study published in the June 2 online edition of the BMJ.

Bowes noted that other studies have found the same bullying-depression link. If it does prove to be a causative factor, she added, bullying may account for 30 percent of those who develop depression in early adulthood.

In addition, the link held even when factors such as mental and behavioral problems and stressful live events were taken into account, Bowes said.

The research did not look at why bullying might increase the risk of depression or why some teens appear more vulnerable.

The study findings ring true in practice, said Gilda Moreno, a clinical psychologist at Nicklaus Children's Hospital and Baptist Hospital in Miami, who reviewed the findings.

Children who are bullied over time may develop a ''learned helplessness," she said. "It's not having the skills to stand up to the bullying. That's what may lead to the depression."

Because bullied children often don't tell their parents or teachers, Bowes said that parents need to be aware of potential signs. If a child is reluctant to go to school, parents should talk about why and ask about their relationships with friends, she suggested.

Bowes said parents should also believe their child if he or she complains about bullying, and follow up with the school administrators.

Loners are more likely than others to get picked on, Moreno added. Parents can encourage their kids to develop friendships, she said, to foster a kind of core support group.

Tomato Basil Oatmeal

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

Carbohydrates: Your Diet's Fuel

Before you feast on chicken and boycott carbs, take a closer look at the U.S. Food Pyramid.

Carbohydrates are highlighted as an important part of ahealthy diet, and not banned by any means. Your body needs a wide variety of foods to function and stay healthy.

"Carbohydrate is one of the macronutrients that we need, primarily for energy," says Sandra Meyerowitz, MPH, RD, a nutritionist, online nutrition coach, and owner of Nutrition Works in Louisville, Ky.

While fats and protein are also necessary for energy, they're more of a long-term fuel source, while carbohydrates fulfill the body's most immediate energy needs. "It's your body's first source of energy — that's what it likes to use," adds Meyerowitz.

Could Eating Fish Help Ward Off Depression?

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

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

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

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

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

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

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

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

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

RELATED: 10 Foods I Eat Every Day to Beat Depression

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

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

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

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

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

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

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

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

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

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

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.