Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

Influenza, a viral infection, illness that can range from mild to life-threatening

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

11 Struggles Every New Runner Understands

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

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

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

Getting winded in the first few minutes.

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

Two words: Sore. Muscles.

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

 

 

Feeling overwhelmed by the copious amount of races.

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

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

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

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

The boredom.

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

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

Trying to find your perfect route.

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

The joy of picking out new workout clothes.

Sleek tanks! Compression pants! Neon shoes!

Running toward (multiple) "finish lines."

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

 

 

Bargaining with yourself on your run.

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

Creating a playlist that will consistently keep you motivated.

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

Eating Well As You Age

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

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

Strategies for Healthy Eating as You Age

Replace old eating habits with these healthy approaches:

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

Overcoming Challenges to Healthy Eating

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

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

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

What You Need to Know About Hyperpigmentation

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

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

Everyday Health: What causes hyperpigmentation?

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

 

 

 

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

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

EH: What steps can you take to treat it?

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

 

 

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

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

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

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

6 Ways to Prep Your Skin for Summer

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

1. Reveal Glowing Skin

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

 

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

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

2. Remove Hair Without Irritation

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

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

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

 

 

3. Fight UV Rays With Food

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

4. Clear Up Body Breakouts

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

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

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

5. Erase Cellulite

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

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

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

6. Treat Your Feet

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

7 Healthy Habits of the 2016 Presidential Candidates

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

What Is Guillain-Barré Syndrome?

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

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

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

GBS Prevalence

Guillain-Barré syndrome is a rare disease.

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

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

Causes and Risk Factors

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

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

Less common triggers for GBS may include:

  • Immunizations
  • Surgery
  • Trauma

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

Types of GBS

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

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

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

Guillain-Barré Syndrome Symptoms

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

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

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

Signs and symptoms of Guillain-Barré syndrome may include:

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

What Is Binge Eating Disorder?

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It's unclear what causes binge eating disorder.

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

Some risk factors for binge eating disorder include:

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

Symptoms of Binge Eating Disorder

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

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

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

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

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

Binge Eating Disorder Treatment

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

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

 

10 Varicose Veins Myths

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

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

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

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

 

 

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

Myth 1: Varicose Veins Are Only a Cosmetic Issue

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

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

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

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

Myth 2: Varicose Veins Are an Inevitable Sign of Aging

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

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

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

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

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

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

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

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

Myth 4: Running Can Cause Varicose Veins

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

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

Myth 5: Varicose Veins Are Always Visible

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

Myth 6: Standing on the Job Causes Varicose Veins

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

RELATED: Steer Clear of These 9 Artery and Vein Diseases

Myth 7: Making Lifestyle Changes Won't Help

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

Myth 8: Surgery Is Your Only Treatment Option

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

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

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

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

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

Myth 9: Recovery After Varicose Vein Treatments Is Difficult

 

 

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

Myth 10: Varicose Veins Can Be Cured

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

10 Essential Facts About Ovarian Cancer

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

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

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

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

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

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

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

 

 

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

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

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

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

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

RELATED: Overcoming Ovarian Cancer, Twice

5. Ovarian cancer has several key risk factorsThese include:

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

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

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

 

 

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

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

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

How to Prevent Hearing Loss

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

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

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

Types and Causes of Hearing Loss

There are three basic types of hearing loss:

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

Hearing Loss Evaluation

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

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

 

 

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

 

 

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

Tips for Hearing Loss Prevention

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

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

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

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

How to Get Glowing Skin When You Have Psoriasis

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

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

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

An Accessible Skin Care Routine

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

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

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

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

Daily Psoriasis Treatment Starts from the Inside Out

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

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

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

Find What Works for You

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

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

8 Things You Can Start Doing Now to Look Younger

2 / 9   Use the Right Skin Care Products

When shopping for skin care products, there are three powerful ingredients you should look for to maintain youthful-looking skin, says Robinson. One, check the label for a serum containing antioxidants like vitamin C (Robinson likes Elizabeth Arden Prevage Anti-Aging Daily Serum), which will help brighten your skin; two, add retinoids, which increase cell turnover and stimulate collagen renewal, to your routine; and three, start using an alpha hydroxy acid exfoliator to remove the top layer of dead skin cells (Robinson is a fan of Peter Thomas Roth Un-Wrinkle Peel Pads, which are gentle enough to be used daily). 

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

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

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

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

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

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

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

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

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

RELATED: 9 Natural Therapies for Bipolar Depression

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

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

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

How might the drug work to ease depression?

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

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

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

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

Another mental health expert agreed.

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

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

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

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

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

Fewer Diabetes Cases Being Missed

Although the number of people diagnosed with diabetes is still on the rise, the good news is that most people with the disease know they have it, a new study shows.

The research suggests that over the past two and a half decades, the percentage of undiagnosed cases has dropped significantly.

"If you're going to your doctor, you probably don't have to worry about undiagnosed diabetes," said study author Elizabeth Selvin, a professor of epidemiology at Johns Hopkins University's Bloomberg School of Public Health.

Selvin explained that previous estimates suggested that over a quarter to 30 percent of people with diabetes probably didn't know it. But those estimates assumed that doctors were only doing one test for diabetes and not following up with a confirmatory second test, as the American Diabetes Association recommends.

However, "we found that's not consistent with how diabetes is diagnosed in clinical practice. In practice, an abnormal finding is confirmed with a second test for the diagnosis. When you use two tests, we see that we're doing a good job with screening and diagnosing diabetes," Selvin said.

In fact, the two-test method seems to capture about 90 percent of all diabetes cases, the researchers noted.

Selvin and her colleagues used data from U.S. National Health and Nutrition Examination Surveys done from 1988 to 1994 and from 1999 to 2014.

RELATED: 9 Types of Medication That Help Control Type 2 Diabetes

The surveys showed that when the research began in 1988 to 1994, there were about 10 million adults with diabetes and confirmed undiagnosed diabetes (that means people who just had one test and didn't get a follow-up test). By 1999 to 2014, there were 25.5 million adults with diabetes or undiagnosed diabetes.

The new research revealed that the number of undiagnosed cases as a percentage of all diabetes dropped from more than 16 percent to slightly less than 11 percent over 26 years.

People who were undiagnosed were more likely to be overweight or obese, older, or a racial or ethnic minority. They were also less likely to have health insurance or access to health care, the study found.

"What we need to figure out is how to target our screening and prevention efforts to the group that actually is undiagnosed. Some of the people being missed have very high [blood sugar levels] and the efforts should be concentrated on getting those people to the clinic," Selvin said.

The findings were published Oct. 23 in the Annals of Internal Medicine.

Dr. Anne Peters is director of the clinical diabetes program at the University of Southern California Keck School of Medicine in Los Angeles. She wrote an editorial that accompanied the study.

"I think there are fewer undiagnosed cases than we used to think, but there are still a lot of people who are undiagnosed," Peters said.

"People with risk factors need to get tested. But people get afraid of the stigma. They get afraid of the disease. But diabetes doesn't have to be awful. People don't have to give up. We need a lot more public awareness and a lot more prevention," she said.

And that doesn't mean you have to lose 100 pounds. "Losing 15 pounds can make a big difference. Just walking 30 minutes a day, five days a week is incredibly beneficial. Take diabetes on in bite-sized pieces," Peters advised.

"There are so many new ways to treat diabetes. Almost everything has changed in the past 30 years. But the earlier you start treatment, the better. Some things are better to face," she said.

Expert Panel Recommends Questionnaire to Help Spot Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

RELATED: 10 Drug-Free Therapies for Depression

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

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

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

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

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

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

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

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

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

6 Things I Didn't Know About Depression Until It Happened to Me

If you or a loved one has been diagnosed with depression, these insights from people who are successfully managing their own depression may help you.

Depression can make you feel alone and isolated, but in reality you aren't. Many other people live with depression every day, and you can learn a lot from them. Here, three people diagnosed with depression share insights they’ve gained along the way.

1. It's Not Your Fault

For the longest time, "I felt like something was wrong with me," says Marisa McPeck-Stringham, 37, a social worker in Ogden, Utah, who blogs about her life, including her depression, as Iron Daisy. She first noticed as a teen that she was sometimes down in the dumps, but she wasn't diagnosed until age 20, she says. Before the diagnosis, she would ask herself: What's wrong with me? She knew she had a good family, a good home, and great parents. "I didn't know it was a mental illness," she says. "I didn't know it was a problem with my brain chemistry."

That reaction is a common one, says Michelle B. Riba, MD, associate director of the University of Michigan Comprehensive Depression Center in Ann Arbor and past president of the American Psychiatric Association. Patients often tell her they think they did something to bring on the depression, and that they could have been stronger.

Dr. Riba tells her patients, "It's a medical condition and has to be treated like a medical condition." Anyone diagnosed with depression must be evaluated to see which treatment or combination might work for them, Riba says.

2. Being Depressed Takes a Lot of Energy

Elizabeth Moon, 70, of Austin, who wrote Crown of Renewal and other books, was diagnosed in the early 1980s. She didn't understand until after she got a diagnosis and was treated how exhausted she had been from trying to keep up with her life. "I didn't realize how long I had been depressed," she says.

"I was active, very physically active," says Moon. "I didn't think of myself as depressed; I didn't realize I was sliding into depression."

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“Not everyone fits the stereotype of sitting on the couch," unable to do anything, she says. "If you’re feeling worthless, like you have no future — even if you appear to be healthy and holding down a full-time job, get checked out.”

"People may not pinpoint [depression symptoms] right away," Riba says of those who get depressed. They may think they’re sleep deprived, for instance, or just have some temporary issues balancing responsibilities.

3. Exercise Has Been Proven to Help With Symptoms

Often, the last thing you want to do if you’re depressed is go out and get some exercise. But those who’ve been there understand the value of exercise, and say it often helps. "If I don't get out and exercise, I have to really watch myself and make sure I’m not sliding," Moon says. "I do much better if I’m active. I have much less chance of sliding into another episode."

RELATED: The Real Monthly Cost of Depression

Exercise ''readjusts our brain chemistry," says McPeck-Stringham. She includes exercise as part of her "self-care" routine. Her workouts also become valuable "me" time, she finds.

And there is good evidence that exercise improves your mental health. A study published in 2014 in JAMA Psychiatry found that exercise does lower your chance of becoming depressed. And in people who already have depression, exercise helps lift depressive symptoms.

4. Writing Helps You Sort Out Your Emotions

Keola Birano, 33, of Hilo, Hawaii, is a full-time writer who also works for his wife's clothing business. Diagnosed at age 19, he soon learned the power of writing — not for his livelihood, but for his depression. First, he wrote a letter to his father and ''without giving it to him," burned it. "It released whatever [negative] feeling I may have held onto," he says.

He has continued writing, both for his blog, Keola Birano Reimagined, and for personal growth. "When you write, it opens up parts of your brain you didn't know were there,'' he says. "I try to do 10 minutes a day on autopilot, to let the feelings out."

5. Managing Depression Is an Ongoing Effort

"It takes a lot of significant work to keep yourself strong," Birano says. "You have to keep working on it. Once you start thinking you have it beat, you set yourself up for failure."

Moon agrees. "I can go downhill in 30 seconds,'' she says. "I've learned to have a plan in place when that happens," she says. Part of her plan is to keep tabs on her mental health before that slide downhill. "At least five times a year, I take the Beck Depression Inventory [a tool used by mental health experts] and see where I am. If I’m coming up [on the score], I need to be very careful. If the score doesn't go back down, I may need meds."

RELATED: 10 Foods I Eat Every Day to Beat Depression

For her, the best approach has been to take medications when needed and then taper off them, she says, but she doesn’t claim this is best for everyone. It’s important to remember that decisions to stop or start medications should always be done in conjunction with your physician.

6. Having a Depression Relapse Doesn’t Mean You Failed

"Right now, I’m in between episodes," Moon says. "I know another one may come and it isn't a disaster when it does come. It doesn't mean you’ll end up committing suicide either."

Figuring out what works for you to stay on an even keel is critical, Moon says. The most important thing for anyone who's depressed? "Recognize when you’re falling off the cliff," she says. Then go get the help you need and deserve.

Serotonin Syndrome: 7 Things You Need to Know

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

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

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

8 Healthy Game Day Snacks for Football Season

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

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

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.

CBT Beats Light Therapy for Seasonal Depression

Cognitive therapy was aimed at 'getting people out of hibernation mode.'

Individuals with seasonal affective disorder (SAD) who participated in 6 weeks of daily cognitive-behavioral therapy (CBT) saw more improvement than those who used light therapy, with the advantage for CBT becoming apparent two winters post-intervention, researchers reported in AJP In Advance.

Two winters after receiving either CBT or light therapy, researchers found that those who received CBT experienced a smaller proportion of recurrence as measured the SIGH-SAD, a primary measure of SAD symptoms, as compared with those who received the light therapy (27.3 percent versus 45.6 percent, respectively), and larger proportion of remissions from SAD as defined by a score of  less then 8 on the Beck Depression Inventory-II (68.3 percent  versus 44.5 percent, respectively), according to Kelly Rohan, PhD, and colleagues from the University of Vermont.

For the study, Rohan and colleagues randomized 177 patients to receive either light therapy on a daily basis for 30 minutes upon waking or to receive CBT-SAD, a type of intervention that delivered psychoeducation, behavioral activation, and cognitive restructuring specifically targeting winter depression symptoms in group therapy sessions twice per week for 6 weeks.

Rohan told MedPage Today that CBT-SAD therapy involved "getting people out of hibernation mode so they approach rather than avoid winter... the activities do not necessarily need to be outdoors or involve communing with snow. They involve anything the person finds enjoyable that can be done in the winter to experience pleasure, rather than withdrawing and socially isolating oneself, which breeds depression." This could involve staying active in one's routines, such as going to the gym, maintaining hobbies, or developing new hobbies to take the place of summer-specific hobbies, or seeing people socially, for instance.

The following winter, researchers contacted study participants in both groups, asking them to resume the treatment they received during the previous winter under their own volition.

Those who received light therapy the previous winter received a letter asking them to resume the daily light therapy upon the onset of the first depressive symptom and those who received CBT-SAD were encouraged to use the skills taught to them the previous winter. Researchers instructed participants in both groups that if recommended strategies were insufficient to relieve symptoms of depression, they should pursue formal treatment, and included contact information for local mental health centers.

RELATED: How to Survive Daylight Saving Time and Shorter Days

Researchers conducted in-person visits in January or February of the first winter following the initial intervention as well as the second winter.

Responses to CBT the first winter after the intervention strongly predicted its effectiveness the following winter. Those who were depression-free the first winter following the intervention were markedly more likely to be depression-free during the second winter compared with those had still shown depression symptoms during the first winter.

In contrast, those who received light therapy who remained depression-free the winter following the intervention were only twice as likely to avoid recurrence during the second winter compared with those without a substantial initial response.

Light therapy has long been used as a treatment for SAD, but one major obstacle to success in treatment includes lack of compliance. In the study, only about a third of subjects reported continuing light therapy at each follow-up, which may have been in part due to study design, according to the authors.

Said Rohan, "In practice, these data indicate that there are options for treating SAD. If someone is willing not only to use light therapy to alleviate current symptoms, but also to keep using daily light therapy until spring and resume using it each fall/winter season, that is a viable option -- however, if someone is willing to work on their thoughts and behaviors in CBT-SAD over 12 sessions in a winter, that is also an option. Better yet, CBT-SAD is a treatment that might have longer-lasting benefits than light therapy in terms of lower risk for SAD recurrence and less severe symptoms two winters later."

Rohan said she hopes to get rates of depression recurrence even lower following SAD treatment in her next study. "This may involve early fall booster sessions to reinforce use of CBT-SAD skills as the seasons change," she noted, or for those who receive light therapy, a conversation regarding increasing compliance with the daily regimen to offset depression recurrence.

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Depression and Substance Abuse

Depression often feeds a substance abuse problem, but the opposite may also be true. Find out just how intertwined these two conditions are.

Mood disorders, like depression, and substance abuse go together so frequently that doctors have coined a term for it: dual diagnosis. The link between these conditions is a two-way street. They feed each other. One problem will often make the other worse, according to the Anxiety and Depression Association of America (ADAA).

About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder, the ADAA reports.

Compared with the general population, people addicted to drugs are roughly twice as likely to have mood and anxiety disorders, and vice versa, according to the National Institute on Drug Abuse (NIDA).

The Shared Triggers of Depression and Substance Abuse

When it comes to substance abuse and depression, it isn't always clear which one came first, although depression may help predict first-time alcohol dependence, according to a study published in 2013 in the Journal of Clinical Psychiatry.

The conditions share certain triggers. Possible connections between depression and substance abuse include:

The brain. Similar parts of the brain are affected by both substance abuse and depression. For example, substance abuse affects brain areas that handle stress responses, and those same areas are affected by some mental disorders.
Genetics. Your DNA can make you more likely to develop a mental disorder or addiction, according to research published in 2012 in Disease Markers. Genetic factors also make it more likely that one condition will occur once the other has appeared, NIDA reports.
Developmental problems. Early drug use is known to harm brain development and make later mental illness more likely. The reverse also is true: Early mental health problems can increase the chances of later drug or alcohol abuse.
The Role of Environment

Environmental factors such as stress or trauma are known to prompt both depression and substance abuse.

Family history is another factor. A study published in the Journal of Affective Disorders in 2014 found that a family history of substance abuse is a significant risk factor for attempted suicide among people with depression and substance abuse.

These types of dual diagnosis may also be traced back to a time in early life when children are in a constant process of discovery and in search of gratification, according to David MacIsaac, PhD, a licensed psychologist in New York and New Jersey and president of the New York Institute for Psychoanalytic Self Psychology.

RELATED: 6 Depression Symptoms You Shouldn’t Ignore

Any interruption or denial of this natural discovery process can manifest clinically and lead people to believe that everything they feel and think is wrong, he explains.

This idea, which Dr. MacIsaac says is based on the work of Crayton Rowe, author of the book Empathic Attunement: The 'Technique' of Psychoanalytic Self Psychology, challenges the idea that people dealing with depression try to self-medicate using drugs or alcohol. In fact, people with a dual diagnosis may be doing just the opposite, MacIsaac suggests.

"Individuals who are severely depressed drink to feed this negativity," he explains. "Initially it's soothing, but only for about 15 minutes. After that individuals sink deeper and deeper and feel worse than they did before."

For these people, MacIsaac points out, negativity is "where they get their oxygen." Any inclination that treatment is working will trigger a need to go back into the black hole of negative discovery, and alcohol will intensify their depression, he adds.

Why Simultaneous Treatment Is Important

Successful recovery involves treatment for both depression and substance abuse. If people are treated for only one condition, they are less likely to get well until they follow up with treatment for the other.

If they are told they need to abruptly stop drinking, however, depressed people with a substance abuse problem may be reluctant to undergo treatment, MacIsaac cautions. "They cling to drinking because they are terrified of losing that negativity," he says.

People with dual diagnoses must understand the root of their issues on a profound level, MacIsaac says. Once they understand, he says, they may have the ability to change. Treatment for depression and substance abuse could involve therapy, antidepressants, and interaction with a support group.

If you think you need treatment but are unsure where to start, the American Psychological Association provides the following suggestions:

Ask close friends and relatives whether they have recommendations for qualified psychologists, psychiatrists, or other mental health counselors.
Find out whether your state psychological association has a referral service for licensed mental health professionals.

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."

A Diet for Better Energy

Complex carbs are key for sustained energy throughout the day, while too many sugary snacks can lead to energy crashes. Find out which foods you need for round-the-clock energy.

 

Juggling the responsibilities of work, life, and family can cause too little sleep, too much stress, and too little time.

Yet even when you're at your busiest, you should never cut corners when it comes to maintaining a healthy diet. Your body needs food to function at its best and to fight the daily stress and fatigue of life.

Energy and Diet: How The Body Turns Food Into Fuel

Our energy comes from the foods we eat and the liquids we drink. The three main nutrients used for energy are carbohydrates, protein, and fats, with carbohydrates being the most important source.

Your body can also use protein and fats for energy when carbs have been depleted. When you eat, your body breaks down nutrients into smaller components and absorbs them to use as fuel. This process is known as metabolism.

Carbohydrates come in two types, simple and complex, and both are converted to sugar (glucose). “The body breaks the sugar down in the blood and the blood cells use the glucose to provide energy,” says Melissa Rifkin, RD, a registered dietitian at the Montefiore Medical Center in the Bronx, N.Y.

Energy and Diet: Best Foods for Sustained Energy

Complex carbohydrates such as high-fiber cereals, whole-grain breads and pastas, dried beans, and starchy vegetables are the best type of foods for prolonged energy because they are digested at a slow, consistent rate. “Complex carbohydrates contain fiber, which takes a longer time to digest in the body as it is absorbed slowly," says Rifkin. Complex carbs also stabilize your body’s sugar level, which in turn causes the pancreas to produce less insulin. This gives you a feeling of satiety and you are less hungry.”

Also important in a healthy, energy-producing diet is protein (preferably chicken, turkey, pork tenderloin, and fish), legumes (lentils and beans), and a moderate amount of healthy monounsaturated and polyunsaturated fats (avocados, seeds, nuts, and certain oils).

“Adequate fluids are also essential for sustaining energy,” says Suzanne Lugerner, RN, director of clinical nutrition at the Washington Hospital Center in Washington, D.C. “Water is necessary for digestion, absorption, and the transport of nutrients for energy. Dehydration can cause a lack of energy. The average person needs to drink six to eight 8-ounce glasses of water each day.”

Energy and Diet: Foods to Avoid

 

Simple carbohydrates, on the other hand, should be limited. Ranging from candy and cookies to sugary beverages and juices, simple carbs are broken down and absorbed quickly by the body. They provide an initial burst of energy for 30 to 60 minutes, but are digested so quickly they can result in a slump afterward.

You should also avoid alcohol and caffeine. Alcohol is a depressant and can reduce your energy levels, while caffeine usually provides an initial two-hour energy burst, followed by a crash.

Energy and Diet: Scheduling Meals for Sustained Energy

 

“I always recommend three meals and three snacks a day and to never go over three to four hours without eating something,” says Tara Harwood, RD, a registered dietitian at the Cleveland Clinic in Ohio. “If you become too hungry, this can cause you to overeat.”

Also, try to include something from each food group at every meal, remembering that foods high in fiber, protein, and fat take a longer time to digest.

Even if life is hectic, it’s important to make wise food choices that provide energy throughout the day. Your body will thank you.

 

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.

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."

potting Between Periods: Should You Worry?

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

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

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

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

 

 

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

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

Spotting in the Early Years

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

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

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

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

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

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

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

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

Bleeding Between Periods in the Middle Years

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

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

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

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

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

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

 

 

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

8 Ways to Squeeze Fitness Into Your Day

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

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

 

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

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

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

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Why Some Seniors Lose Their Hearing

Do you have difficulty hearing conversations held in a noisy room? Do you have a harder time picking up women’s voices than men’s? Do you constantly ask others to repeat what they just said? If you answered ‘yes’ to these questions, you may be experiencing hearing loss — especially if you are 65 or older.

About 8.5 percent of adults between the ages of 55 and 64 suffer from hearing loss, according to the National Institute on Deafness and Other Communication Disorders. That number jumps to 25 percent for those 65 to 74, and it doubles to 50 percent for ages 75 and older. After high blood pressure and arthritis, hearing loss is the most common chronic condition affecting senior health.

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What Causes Hearing Loss?

As you age, you are at risk for two types of hearing loss. The most common type of hearing loss in seniors is presbycusis, or age-related hearing loss. A gradual loss of hearing that affects both ears, presbycusis occurs when tiny hairs in the ear, which are necessary for converting sound waves to sound, become damaged or die. Hearing loss from presbycusis is permanent because once these hairs are damaged or die, they are not replaced with new growth.

Related: 11 Early Signs of Dementia

The other type of hearing loss that seniors experience is tinnitus, or ringing in the ears. Tinnitus can be either permanent or temporary.

Risk Factors Related to Hearing Loss

A lifetime of exposure to loud noises such as music, motorcycles, or firecrackers can cause hearing loss in seniors. Noise-related hearing loss often results in tinnitus. Other causes of and risk factors for hearing loss experienced by seniors include:

  • Smoking
  • Allergies, high blood pressure, tumors, or stroke
  • Medications
  • A punctured eardrum
  • Viruses or bacteria
  • Earwax buildup

Your genes may also play a role in presbycusis, as it tends to run in families. Environmental factors like loud music and smoking make it difficult to determine the effect of genetics on age-related hearing loss; however, according to American Family Physician, an estimated 50 percent of age-related hearing loss is inherited.

Men are also more likely than women to develop hearing loss, and they’re more likely to develop it at an earlier age, says American Family Physician.

The Consequences of Hearing Loss

Losing hearing can have a significant effect on other aspects of your wellbeing. Researchers in a 2014 survey of 18,300 adults found that about 12 percent of participants with hearing loss had moderate to severe depression compared with about 5 percent of those with excellent hearing. The survey, which was published in JAMA Otolaryngology Head and Neck Surgery, also noted that women were particularly susceptible to depression related to hearing loss.

Hearing loss also appears to worsen cognitive functioning, according to a study published in the February 2013 issue of JAMA Internal Medicine. Among the nearly 2,000 seniors studied, hearing loss lowered cognitive functioning on some assessments as much as 41 percent more than it did among those without hearing loss.

Hearing Aids and Other Treatment Options

Though you can’t always fully prevent hearing loss, you can take steps to minimize or overcome it. Age-related hearing loss may be prevented or at least lessened by avoiding loud noises.

Because there is no known cure for age-related hearing loss, treatment is generally focused on improving your ability to function day to day. Your doctor may treat you or refer you to a hearing specialist such an otolaryngologist (or ENT, a medical doctor who specializes in the ear, nose, and throat) or an audiologist (a licensed professional who diagnoses and helps manage hearing problems). The cause and extent of your hearing loss will determine the course of treatment.

hearing aid may be one recommendation from your doctor or audiologist. Hearing aids can be beneficial for many, but according to the National Institute on Deafness and Other Communication Disorders, fewer than 30 percent of adults older than 70 who could benefit from a hearing aid have one. Hearing aids have come a long way over the years and are available in a variety of styles. A hearing aid and its battery will either fit behind the ear, on the ear, just inside the ear, or in the ear canal.

Types of hearing aids include:

  • Analog hearing aids that increase the volume of some sounds while lowering the volume of others
  • Digital hearing aids that allow you to determine which sounds to make louder or lower

Using assistive listening devices also can help compensate for hearing loss. These products either amplify sound, such as sound from telephones, televisions, and radio listening systems, or alert the user visually, such as with smoke detectors or alarm clocks.

 

 

Surgery may be another consideration. Cochlear implants are electronic devices with one part surgically implanted in the skin and the other part worn behind or in the ear. Used only for severe hearing loss, implants will not restore normal hearing, but they can make sounds louder. Because of the nature of the implants, they are not without risks — they pose the potential for infection, damage to the facial nerve, and tinnitus.

Speech or lip reading and sign language may be an answer for some seniors with hearing loss. Both of these techniques require training and practice and are generally recommended for those with severe hearing loss.

See your doctor as soon as you think you have a hearing problem. The loss of hearing could be a symptom of another medical condition. Seniors with untreated hearing loss are also more likely to suffer emotionally and socially when they areunable to interact with friends and family members. Left untreated, hearing loss could lead to deafness, and seniors who do not address their hearing loss put their lives at risk if they are unable to hear emergency warnings such as car horns or smoke alarms.

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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!