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.

 

Hepatitis C FAQs for the Public

Overview

What is hepatitis?

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

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

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

What is Hepatitis C?

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

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

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

 

Statistics

How common is acute Hepatitis C in the United States?

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

How common is chronic Hepatitis C in the United States?

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

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

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

Transmission / Exposure

How is Hepatitis C spread?

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

 

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

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

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

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

Can Hepatitis C be spread through sexual contact?

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

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

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

Can Hepatitis C be spread within a household?

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

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

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

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

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

What are ways Hepatitis C is not spread?

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

Who is at risk for Hepatitis C?

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

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

Less common risks include:

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

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

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

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

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

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

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

 

Symptoms

What are the symptoms of acute Hepatitis C?

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

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

How soon after exposure to Hepatitis C do symptoms appear?

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

Can a person spread Hepatitis C without having symptoms?

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

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

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

What are the symptoms of chronic Hepatitis C?

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

How serious is chronic Hepatitis C?

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

What are the long-term effects of Hepatitis C?

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

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

Tests

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

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

Who should get tested for Hepatitis C?

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

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

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

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

What blood tests are used to test for Hepatitis C?

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

Treatment

Can acute Hepatitis C be treated?

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

Can chronic Hepatitis C be treated?

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

Is it possible to get over Hepatitis C?

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

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

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

Vaccination

Is there a vaccine that can prevent Hepatitis C?

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

Hepatitis C and Employment

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

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

Hepatitis C and Co-infection with HIV

What is HIV and Hepatitis C virus coinfection?

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

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.

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.

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.

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.

DIY Beauty Treatments for Every Skin Problem

  • 1 / 7   DIY Beauty Solutions

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

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

  • 2 / 7   Problem: Hyperpigmentation and dark spots

    Solution: Fresh lemon juice and a red onion


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

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

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

    Solution: Almond milk and coffee grounds


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

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

  • 4 / 7   Problem: Dull skin

    Solution: Peppermint tea


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

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

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

    Solution: Strawberries and honey


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

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

  • 6 / 7   Problem: Dry, frizzy hair

    Solution: Coconut oil


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

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

  • 7 / 7   Problem: Product buildup

    Solution: Apple cider vinegar

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

    “Apple cider vinegar is an effective clarifying

5 Reasons Why Skin Cancer Surgery Isn’t So Scary

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

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

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

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

How to 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.

Essential Facts About Antidepressants

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

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

The Use of Antidepressants Is on the Rise

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

How Antidepressants May Help

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

RELATED: 6 Need-to-Know Antidepressant Facts

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

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

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

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

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

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

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

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

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

Depression Medications and Government Warnings

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

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

Antidepressants Are Not Magic Bullets

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

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

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

Best Ways to Beat Dry Skin

Dry, itchy skin is no joke. Because skin is the body's largest organ (weighing about nine pounds), the frustration and discomfort that go along with dehydration can affect your daily existence, from your wardrobe to your social life. And if you happen to have a skin condition like eczema, you know from experience that flaky skin is no laughing matter.

However, you can fight flakiness and itchiness with a few important tips. Here, skin experts share their best advice for keeping your skin soft and supple.

Find the Right Exfoliator

Exfoliating can be beneficial for those who have dry skin because it helps the dead surface layers of skin cells to be shed, layers that can prevent moisturizers from being absorbed, says Doris Day, MD, a clinical assistant professor of dermatology at New York University Medical Center.

The key is to find the exfoliator that works best for your skin. Scrubs and alpha-hydroxy and beta-hydroxy acids are best for those who don't have sensitive skin. Those with sensitive skin can exfoliate with a home remedy that consists of a paste made from baking soda and water. “It’s great for your face or for rough patches like your heels, and nobody breaks out from it,” says Mona Gohara, MD, an assistant clinical professor of dermatology at Yale University.

Note that if you have any skin conditions, it’s best to check with a dermatologist before trying anything new. And beware of exfoliating too often because it can cause irritation.

Don’t Wash Too Often

 

 

Like exfoliating too much, washing too often can lead to dryness. “I usually tell people to use soap only where they need it — underarms, groin, hands and feet,” says Rebecca Baxt, MD, a dermatologist in Paramus, New Jersey.

Take a Lukewarm Shower

 

 

“Hot showers can strip the skin of oil and leave skin dry,” says Joshua Zeichner, MD, the director of cosmetic and clinical research in the department of dermatology at Mount Sinai Hospital in New York City. Although hot showers are relaxing, fight the urge to parboil yourself and use lukewarm water instead. Also, limit the length of your showers to 10 minutes or less.

Moisturize Every Day

Using a moisturizer daily is crucial to combating dry, flaky skin. “When the skin is dry, it needs to be hydrated from the outside in — drinking eight glasses of water is not enough,” says Dr. Day.

For the most effective moisturizer, look for ingredients, including ceramides, that help support and replenish lipids in the skin. Hyaluronic acid and glycerin, both humectants, help the skin attract water and hold in moisture. Additionally, Dr. Zeichner recommends that, to help seal in moisture, you apply moisturizer to damp skin after showering.

8 Things You Can Start Doing Now to Look Younger


1 / 9   Who Says You Have to Look Your Age?

When it comes to how old you are, age really is just a number. In 2014, researchers at the International Institute for Applied Systems Analysis published a study stating that there are a lot more factors that should go into determining age than how long you’ve been alive. There are plenty of super-simple things you can do to keep your complexion healthy and radiant regardless of what birthday you most recently celebrated. Andrea Robinson, the former head of beauty for Ralph Lauren and Tom Ford and the author of “Toss the Gloss: Beauty Tips and Tricks for Women 50+”, shares her insider knowledge on what anti-aging products really work, makeup tips that are guaranteed to make you look younger, and more.

 

New Cholesterol Drugs Vastly Overpriced, Study Contends

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

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

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

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

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

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

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

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

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

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

RELATED: 8 Foods That Can Cause High Cholesterol

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Psoriasis Linked to Higher Risk of Depression

People with psoriasis may be twice as likely to experience depression as those without the common skin condition, regardless of its severity, a new study suggests.

"Psoriasis in general is a pretty visible disease," said study author Dr. Roger Ho, an assistant professor of dermatology at New York University School of Medicine in New York City. "Psoriasis patients are fearful of the public's stigmatization of this visible disease and are worried about how people who are unfamiliar with the disease may perceive them or interact with them."

Genetic or biologic factors may also play a role in the link between depression and psoriasis, which requires more research, he said. Either way, the findings mean that all individuals with psoriasis could benefit from screening for depression, Ho said, and their friends and family members should be aware of the connection as well.

The findings were scheduled for presentation Thursday at an American Academy of Dermatology meeting in New York City. They have not yet been published in a peer-reviewed journal and should be considered preliminary.

Most people with psoriasis have red, raised patches of skin covered with silvery-white scales, the researchers noted. These patches usually appear on the scalp, elbows, knees, lower back, hands and feet.

The researchers analyzed the responses of more than 12,000 U.S. adults in the 2009-2012 National Health and Nutrition Examination Survey conducted by the U.S. Centers for Disease Control and Prevention.

Overall, nearly 3 percent of responders reported that they had psoriasis, and about 8 percent had major depression based on their answers to a depression screening assessment. Among those with psoriasis, 16.5 percent had sufficient symptoms for a diagnosis of major depression.

Those with any degree of psoriasis had double the odds of having depression even after taking into account their age, sex, race, weight, physical activity level, alcohol use and history of heart attack, stroke, diabetes and smoking, the researchers said.

Depression is one of several concerns that someone with psoriasis should look out for, said Dr. Delphine Lee, a dermatologist at John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, Calif.

"Patients with psoriasis should be aware that there are several other health issues associated with this condition, including cardiovascular and metabolic diseases, such as diabetes, as well as psychological or psychiatric disorders," Lee said. "To address your health beyond your skin is critical to maximizing a person's quality of life."

Several aspects of dealing with psoriasis may contribute to depression, said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City.

RELATED: 7 Hidden Dangers of Psoriasis

What matters more than its severity is the location of flare-ups, she said. Some of her patients won't wear shorts if it's on their legs or won't go on dates because they're embarrassed about red spots on their skin, she added.

"Also, because it's a chronic illness, you don't know if it's going to get worse and you don't get to take a vacation from it either," Day said. "You're using topical treatments all year long, and as soon as you stop, it comes right back. It's very depressing, and it can affect your self-esteem and your quality of life."

Anxiety about how psoriasis and its treatment may affect your future health might also contribute to depression, Day explained.

"It's unsightly, it can be itchy, people are worried about it spreading to other parts of their body, they worry about the side effects of medication, they worry about psoriatic arthritis, they worry about taking medications when they're pregnant, and they worry about passing it along to their children," she said.

Day recommended that people with psoriasis seek mental health treatment to get to the bottom of their depression.

"It's about that emotional connection and finding out what about this condition is affecting someone in the way that it is," Day explained.

Not seeking help can make matters worse, said Dr. Tien Nguyen, a dermatologist at Orange Coast Memorial Medical Center in Fountain Valley, Calif.

"Psoriasis can cause severe emotional distress," he said, noting some patients may have suicidal thoughts or attempt suicide. "Stress is a known cause of exacerbation of psoriasis, so this will lead to a vicious cycle."

Day added that it's critically important to continue seeing a dermatologist to learn about new medications that become available.

"There are some really amazing new treatments that have a great safety profile that can have excellent clearance with lasting results," Day said.

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7 Detox Tips From Scientists Who Actually Tried Them

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

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

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

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

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

 

 

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

RELATED: 6 Easy Green Beauty Swaps

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

 

 

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

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

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

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

The Calming Power of Nature

Spending time in nature eases depression, and could be a good supplement to medicine and therapy.

Remedies for depression abound, from medications to psychotherapy, or talk therapy. Having a range of treatment options is a good idea because no single treatment works equally well for each of the millions of U.S. adults with depression. Now researchers say a new therapy, proven to relieve depression, should be added to the mix as a supplement to established treatments. It's called nature.

Interacting with nature can have replenishing effects for those with depression, says Ethan Kross, PhD, associate professor of psychology at the University of Michigan and one of many experts who has studied the nature-depression link.

A little dose of nature helps us all recharge, but it may have special benefit for those who are depressed. "It seems that, from our work, the restorative effect of nature seems to be stronger for individuals diagnosed with depression," says Marc Berman, PhD, assistant professor of psychology at the University of Chicago. That might be because they feel mentally fatigued, and being in nature re-energizes them. However, Dr. Berman has a strong caveat: "We're not arguing that interacting with nature should replace clinically proven therapies for depression," he says. Nor should those with clinical depression try to treat themselves.

RELATED: How to Create a Depression Treatment Plan

However, Berman and others say, interactions with nature could serve as a very effective supplemental treatment.

What Nature-Depression Research Shows

Among the studies finding nature helps with depression:

Adults with depression who took a 50-minute walk in a natural setting for one research session and then a 50-minute walk in an urban setting for another research session were less depressed and had better memory skills after they took the nature walk.
Adults who moved to greener urban areas, compared to less green, had better mental health during follow-up three years after the move.
Those who took group nature walks reported less depression, less stress, and a better sense of well-being than those who didn't take nature walks, according to a study that looked at more than 1,500 people in a walking program.
Being outdoors and in nature boosts vitality, which experts define as having physical and mental energy. Those with depression often report fatigue and decreased energy. Researchers found the energy-boosting effect of nature was independent of the physical activity or social interaction experienced while outdoors.
How Nature Works Its Magic

The phenomenon of how nature helps improve depression is still being analyzed fully, Dr. Kross says.

One possibility, Berman says, is that interacting with nature helps due to the attention-restoration theory. "We have two kinds of attention," he says. "One is top-down (also called directed), the kind we use at work." Directed attention can be depleted fairly quickly, as you can only focus and concentrate for so long.

Another type of attention is bottom-up, or involuntary. "That's the kind automatically captured by things in the environment, such as lights or music." Involuntary attention is less susceptible to depletion. "You don't often hear people say, 'I can't look at this waterfall any longer,'" Berman says.

Why does nature hold this special effect? In a natural environment, we can choose to think or not, Berman says, and this choice is believed to help us rest our brains. You can then pay attention later, when you need to. "It is giving people more ability to concentrate, which is a big problem for those with depression," Berman says. Nature provides an effective setting for resting our brains, unlike urban settings. Even in the most peaceful urban environment, you have to pay attention to such things as traffic and stoplights.

Nature's replenishing effect is fairly instantaneous, Berman says. So if you're depressed and having an especially bad day, a quick dose of nature might help.

However, Berman cautions that anyone with clinical depression needs to be under a doctor's care, with supervision of all their treatments.

U.S. Cancer Death Rate Continues to Fall

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Purpose in Life Is Good for Your Health

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

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

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A Healthier Heart

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

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

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

 

 

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

Protect the Brain

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

RELATED: The Life-Saving Power of Purpose

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

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

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

How Purpose Works

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

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

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

Finding Purpose

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

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

 

 

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

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

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

Breast Cancer Awareness Month 2017

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

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

Sleep Apnea May Raise Risk of Depression

People with sleep apnea are at increased risk for depression, but continuous positive airway pressure (CPAP) therapy for their apnea may ease their depression, a new study suggests.

The Australian study included 293 men and women who were newly diagnosed with sleep apnea. Nearly 73 percent had depression when the study began. The worse their apnea, the more severe their depression.

However, after three months, only 4 percent of the 228 apnea patients who used CPAP for an average of at least five hours a night still had clinically significant symptoms of depression.

At the start of the study, 41 patients reported thinking about harming themselves or feeling they would be better off dead. After three months of CPAP therapy, none of them had persistent suicidal thoughts.

The study appears in the September issue of the Journal of Clinical Sleep Medicine.

"Effective treatment of obstructive sleep apnea resulted in substantial improvement in depressive symptoms," including suicidal thoughts, senior study author Dr. David Hillman said in a journal news release. Hillman is a clinical professor at the University of Western Australia and a sleep physician at the Sir Charles Gairdner Hospital in Perth.

RELATED: 6 Things People With Sleep Apnea Wish You Knew

"The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression," he added.

People with symptoms of depression should be screened for sleep apnea by being asked about symptoms such as snoring, breathing pauses while sleeping, disrupted sleep and excessive daytime sleepiness, the researchers said.

Sleep apnea affects at least 25 million American adults. Untreated sleep apnea increases the risk of high blood pressure, heart disease, stroke, type 2 diabetes and depression, according to the American Academy of Sleep Medicine.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An Expert's Guide to Sneezin' Season

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

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

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

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

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

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

 

 

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

RELATED: 9 Seasonal Allergy Signs You May Be Overlooking

 

 

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

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

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

10 Winter Foods for Depression

1 / 11   Boost Your Mood With Seasonal Bounty
It’s winter, and depending on where you live, it could be very cold and gray, with sunshine in short supply. The winter doldrums plus holiday high anxiety make this season especially stressful and depressing for many people. But you might be able to eat your way to a better mood. Load your plate with these winter foods for depression to lift your spirits.