Side Effects of Multiple Sclerosis Medications

Twelve disease-modifying medications are FDA-approved to treat relapsing forms of multiple sclerosis (MS). Specifically, these drugs help prevent relapses and slow progression of the disease.

The newest disease-modifying medications are called “immunomodulators” because they affect the functioning of your immune system. 

“All these therapies highlight the increased choices and options for patients living with MS, and the ability of physicians to select a therapy based on individual characteristics,” says Ari Green, MD, assistant clinical director of the UCSF Multiple Sclerosis Center and director of the UCSF Neurodiagnostics Center in San Francisco.

But all drugs can have adverse side effects, and those associated with MS medications range from mild (such as flu-like symptoms or irritation at an injection site) to serious (such as progressive multifocal leukoencephalopathy [PML], a viral disease in the brain).

One of the challenges of MS treatment is balancing risk and benefit, says Dr. Green. Stronger medications might be more effective at slowing progression of the disease, but they may also be associated with more risks.

Discussing Medication Side Effects With Your Doctor

"A doctor has to have a frank and open discussion to find out what is tolerable for patients," says Green. "Some side effects go away as the body gets used to MS medications, but others, such as irritation where the injection takes place, do not."

Because people experience side effects differently, each individual has to decide which side effects he or she can live with, he adds.

In some cases, what are thought to be drug side effects may actually be MS symptoms. Fatigue and headache, for example, may be either.

Keeping a detailed log of your symptoms can help your doctor determine whether you are experiencing a symptom of multiple sclerosis or a medication side effect.

Make a note of when your symptom began, how long it lasted, what might have triggered it, and whether anything you did eased the symptom.

“The more patients are engaged in keeping track of things, the more they can be positively and appropriately engaged in directing their own care,” says Green. This information can also help your provider select appropriate therapies in the future.

Managing MS Medication Side Effects

Some simple steps can often help you manage the most common side effects of MS medications:

Infection risk Some of the immunomodulatory medications increase your risk of common infections, so it’s important to practice prevention strategies such as washing your hands frequently and limiting your contact with people who are ill.

Flu-like symptoms Fever, chills, achiness, and feeling generally under the weather are not uncommon following interferon beta injections, leading some users to stop the medication. Interferon beta medications include Betaseron, Extavia, Avonex, Rebif, and Plegridy.

According to nurses with expertise in MS care, the following steps can help to manage these side effects:

Staying hydrated
Eating healthfully
Taking medications before sleep
Warming injectable medicines up to body temperature before injecting
You can also take a small dose of Advil, Motrin, or Nuprin (ibuprofen) an hour before and an hour after your injection. Tylenol (acetaminophen), Aleve (naproxen), or Benadryl (diphenhydramine) may also help ease these side effects, Green says.

RELATED: 7 Side Effects of MS Steroid Treatment

Injection-site irritation Applying ice to your injection sites before injections, and a warm compress afterward, can help ease any irritation.

Some people may also benefit from some retraining on the finer points of giving themselves injections, notes Green. This is especially true because most people learn how to give self-injections right after their diagnosis — a period when they’re undoubtedly absorbing lots of information about the disease.

If you’re having trouble injecting your MS medication, speak to your healthcare provider about working with an MS nurse for training in self-injections.

Heart health The medication Gilenya (fingolimod) is known to slow some users’ heart rate within the first six hours after the first dose. Because of this, your doctor may advise you to have your first dose in a clinical setting, where your pulse and blood pressure can be monitored.

Distinguishing Side Effects From Symptoms

The immediate side effects of MS medications may be more apparent once you experience them. Immediate side effects, such as flu-like symptoms and chills, are easy to discern, says Green. Even the muscle aches and pains that can occur immediately after taking disease-modifying MS medications differ from the pain associated with multiple sclerosis.

The one rare medication side effect that might be hard to distinguish from an MS symptom is PML, which has been related to use of the drug Tysabri (natalizumab). PML, however, will progress much more quickly than multiple sclerosis — a good reason to stay on top of your medical checkups.


Ongoing Medication Monitoring

Most of the medications prescribed for MS require regular blood tests to keep track of the treatment’s effect on your body, including your liver.

The drug Lemtrada (alemtuzumab) requires blood and urine monitoring before, during, and for four years after treatment is given to watch for serious autoimmune conditions associated with the drug.

In addition to monitoring for side effects, you and your doctor should monitor for positive effects of drugs as well. Green says that a change in therapy is needed if you are having more than one MS relapse a year, if multiple new brain lesions are seen on your MRI, or if your symptoms are progressing despite treatment. Switching medications is a decision you and your doctor should make together.

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.

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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.

9 Allergy Safe Beauty Products

For a hypoallergenic beauty product to plump up your lashes, Van Dyke suggests Almay Thickening Mascara. It's affordable, available at mass-market stores, and a great beauty product to avoid skin allergy reactions. Almay products go through rigorous testing to avoid allergens and irritants and maintain the brand's reputation for hypoallergenic beauty products, says Van Dyke. "It is hard to beat Almay for dermatologist-approved makeup, particularly around the eye," she adds.

Electric Brain Stimulation No Better Than Meds For Depression: Study

For people who battle depression and can't find relief, stimulating the brain with electric impulses may help. But a new study by Brazilian researchers says it's still no better than antidepressant medication.

In a trial that pitted transcranial, direct-current stimulation (tDCS) against the antidepressant escitalopram (Lexapro), researchers found that lessening of depression was about the same for either treatment.

"We found that antidepressants are better than tDCS and should be the treatment of choice," said lead researcher Dr. Andre Brunoni. He's director of the Service of Interdisciplinary Neuromodulation at the University of Sao Paulo.

"In circumstances that antidepressant drugs cannot be used, tDCS can be considered, as it was more effective than placebo," he said.

The researchers used the Hamilton Depression Rating Scale. This test has a score range of zero to 52, with higher scores indicating more depression.

People who received brain stimulation lowered their depression score by 9 points. Those taking Lexapro had depression scores drop by 11 points. Patients receiving placebo experienced a drop of 6 points in their depression score, the researchers found.

RELATED: Depression May Hasten Death in Years After Heart Diagnosis

"tDCS has been increasingly used as an off-label treatment by physicians," Brunoni said. "Our study revealed that it cannot be recommended as a first-line therapy yet and should be investigated further."

The report was published June 29 in the New England Journal of Medicine.

Dr. Sarah Lisanby is director of the Division of Translational Research at the U.S. National Institute of Mental Health. "When you consider if this treatment adds anything to the ways we have to treat depression, you want to know that a new treatment is better than or at least as good as what's available today," she said.

"But this study failed to show that tDCS was better than medication," said Lisanby, who wrote an accompanying journal editorial.

Lisanby pointed out that unapproved tDCS units are being sold on the internet. She cautioned that trying brain stimulation at home to relieve depression or enhance brain function is risky business, because side effects can include mania.

"There are people who are doing do-it-yourself tDCS," she said. "People are trying to find ways to treat depression, but it's important for them to know that tDCS is experimental and not proven to be as effective or more effective than antidepressant medications."

To get a better idea of how well brain stimulation worked for depression, Brunoni and colleagues randomly assigned 245 patients suffering from depression to one of four groups. One group had brain stimulation plus a placebo pill, another had fake brain stimulation plus Lexapro. The third group had brain stimulation plus Lexapro, and the final group had fake brain stimulation plus a placebo.

Brain stimulation involved wearing sponge-covered electrodes on the head. The treatment was given for 15 consecutive days at 30 minutes each, then once a week for seven weeks.

Lexapro was taken daily for three weeks, after which the daily dose was increased from 10 milligrams (mg) to 20 mg for the next seven weeks.

After 10 weeks, patients receiving brain stimulation fared no better than those taking Lexapro. Patients receiving brain stimulation, however, suffered from more side effects, the researchers found.

Specifically, patients receiving brain stimulation had higher rates of skin redness, ringing in the ears and nervousness than those receiving fake brain stimulation.

In addition, two patients receiving brain stimulation developed new cases of mania. That condition can include elevated mood, inflated self-esteem, decreased need for sleep, racing thoughts, difficulty maintaining attention and excessive involvement in pleasurable activities.

Patients taking Lexapro reported more frequent sleepiness and constipation.

Brunoni, however, is not ready to write off brain stimulation as a treatment for depression based on this study.

"We did not test, in this study, the combined effects of tDCS with other techniques, such as cognitive behavior therapy and other antidepressant drugs," he said.

"Previous findings from our group showed that tDCS increases the efficacy of antidepressant drugs, however, it should not be used alone, and its use must be supervised by physicians due to the side effects," Brunoni said.

Lisanby said the tDCS dose in the study may be in question. She said it may have to be adjusted to each individual patient in terms of how strong the electrical stimulation should be. The treatment length also needs to be individualized, as does what part of the brain it should be directed toward.

Also, "we need larger studies to give us the definitive answer about whether tDCS is better than the treatments we have today," Lisanby said.

8 Things Your Dentist Knows About You Just By Looking In Your Mouth

You flossed right before your appointment—and that’s the only time.

Sorry, but you can’t fool your dentist into thinking you floss daily by doing it the night before or morning of your visit. 

“The gums of people who only floss right before a visit are bleeding or look damaged,” says Timothy Stirneman, D.D.S., of All Smiles Dental in Algonquin, Illinois. “Healthy gums are nice and tight and pink.”

Santa Monica-based dentist Kenneth Wong, D.D.S., is on to you, too. “When patients floss right before coming in for a cleaning, I can see the slices where the floss cut at the gum because they were overzealous,” he says. 

Psoriasis Linked to Higher Risk of Depression

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

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

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

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

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

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

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

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

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

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

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

RELATED: 7 Hidden Dangers of Psoriasis

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

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

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

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

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

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

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

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

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

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

DIY Beauty Treatments for Every Skin Problem

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

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

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.

18 Ways to Make This Your Healthiest Summer Ever

I don’t know about you, but I’m tired of summer always being linked to the dread of bathing suit season when there are so many healthy aspects to celebrate this time of year. Fresh produce is abundant, beautiful, and more affordable. The weather (at least in most parts of the country) is perfect for outdoor walking, biking, hiking, and swimming, and the days are longer so you have more time to fit in physical activity. Vacations allow you time to relax, de-stress, and get active with friends and family, and your schedule may be more flexible, allowing you more time to focus on healthy habits.

With summer upon us, it’s the perfect time to set some health goals and embrace new opportunities to eat smart and get fit. Here are 18 ideas to motivate and inspire you throughout the sunny months ahead:

Head to the Farmer’s Market

Loading up on summer’s best and freshest produce, including leafy greens, tomatoes, corn, zucchini, green beans, berries, and stone fruits will make it easier to gobble up more vegetable and fruit servings.

Make salad your main course a few times a week. Take advantage of farm-fresh lettuce and the bounty of seasonal produce to concoct creative salad bowls. For a quintessential summer meal, top your greens with sweet corn, diced tomato, avocado, and crumbled feta.
Swap sugary desserts for delicious seasonal fruits. Instead of reaching for cookies, pastries, or chocolate after dinner, dig into a bowl of naturally sweet, ripe fruit. Best bets include berries, watermelon, cantaloupe, apricots, peaches, and plums.
Lay out a healthy, no-cook summer spread. If it’s too hot to cook, throw together a picnic-style meal of sliced raw veggies (carrots, cherry tomatoes, zucchini, cucumber, etc.) with hummus, sliced whole-grain bread or crackers, cheeses, olives, fruit, nuts, hard-boiled eggs, and other tasty nibbles.
Get grilling. It’s a terrific way to infuse flavor into lean proteins like skinless chicken breasts and thighs, turkey burgers, fish, shrimp, and pork tenderloin, especially if you start with a tasty spice rub or marinade. If you cook extra, you’ll have ready-to-eat proteins to add to leafy green or grain-based salads for simple meals later in the week.
And don’t forget the grilled veggies. Whenever you fire up the grill, toss on some sliced zucchini, summer squash, eggplant, bell peppers, and/or mushrooms. Chop them up and toss with pasta or cooked whole grains like brown rice, farro, and quinoa for a simple meal. Or, layer grilled vegetables on whole-grain bread spread with goat cheese or hummus for a tasty vegetarian sandwich.
Cool down with fruit smoothies. Blend your favorite summer fruits — and veggies like carrots, spinach, and beets — with yogurt and your milk of a choice for a hydrating breakfast or snack. The fruit will add plenty of sweetness, so you can skip added sugars like maple syrup and honey. Make extra and pour into ice pop molds or small paper cups with popsicle sticks for a fun frozen dessert.
Start your day with a hearty, refreshing breakfast. Overnight oats are a great choice this time of year (they’re the more seasonally appropriate counterpart to a hearty bowl of hot oatmeal). Or, top fresh fruit with a dollop of protein-rich yogurt or part-skim ricotta cheese and optional chopped nuts. I can’t wait to dig into my first bowl of fresh cherries, peaches, or nectarines with ricotta!
Go skinny-dipping. Whip up a tasty new dip each week to enjoy with all of the deliciously dunkable summer produce. Try Greek yogurt with mixed fresh herbs, artichoke pesto (you have to try this recipe!), or any number of unique hummus variations, including roasted red pepper, beet, edamame, and carrot-based blends.
Start spiralizing. I don’t endorse a lot of single-use kitchen gadgets, but I’m pretty fond of the vegetable spiral slicers that are all the rage right now. The price is right at about $15 to $25 per machine, and you can use it to make low-cal veggie pastas and salads out of all of the inexpensive summer bumper crops like zucchini, summer squash, cucumbers, carrots, and even beets. Check out this recipe for zesty Carrot Noodle Stir Fry from the blog Inspiralized.
Sip on iced tea. To help you stay hydrated in the hot weather, I suggest keeping a pitcher or two of unsweetened iced tea in the fridge at all times. Switching up the flavor from week to week will prevent you from getting bored in the beverage department. Mint green tea is a classic summertime brew, but I also love fruity combos like pomegranate and raspberry.
Plant something … anything! Never grown anything edible before? Don’t let that stop you; starting a simple garden in pots or other containers is actually really easy. Go to the nearest hardware store and pick up a large planter, a bag of potting soil, and a small potted plant, like any fresh herb or one of the vegetables listed here. Consider starting with basil or a cherry tomato varietal; they’re both easy to grow and versatile in the kitchen.
Go on a pick-your-own adventure! Don’t wait for apple picking in the fall. Make a date with family or friends to harvest summer produce at a local orchard or farm (visit pickyourown.org to find a site near you). If you’re willing to put in the labor, you can buy buckets of berries, stone fruit, and other seasonal items at a great price.
Sit down and enjoy meals outdoors. So many people I know own lovely patio sets but rarely use them. Make a plan to sit down to a family meal in your backyard once a week. You’ll likely eat more slowly and mindfully when you’re dining al fresco. If you don’t have access to an outdoor eating space, plan a fun picnic at a local park.
Master a few healthy recipes for summer cookouts. Finding lighter fare at barbecues can be a challenge, but if you volunteer to bring a healthy dish, you know you’ll have at least one good option to pile onto your plate and dilute some of the heavier entrees and sides. To keep things simple, bring a big bowl of fruit salad or pick up a crudite platter from the grocery store. If you don’t mind doing a bit more prep, I recommend throwing together a pasta salad with lots of veggies, like this colorful soba noodle salad with edamame, red pepper, and purple cabbage.
Go for a daily walk. Now that the days are longer, it’s easier to squeeze in a short walk at the start or end of your day. Aim for at least 30 minutes most days of the week (but if you can only commit to 15 or 20, that’s still well worth the effort). When things start to heat up, schedule an early morning or late evening walk when temps are cooler.
Hit the trail. For a change of scenery, seek out some local walking and hiking trails in your area using sites like alltrails.com and traillink.com. Pack a healthy lunch or snacks and make a day of it!
Take a hiatus from TV. With all the network hit shows on summer break, it’s the perfect time to reduce your screen time. Cut down on evening television viewing and spend that time outdoors walking, biking, doing yardwork, or playing with the kids or grandkids.

9 Surprising Complications of Type 2 Diabetes

Type 2 Diabetes Complications: More Than Just Heart Disease

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

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

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

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

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

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

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

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

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

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

5 Cooking Tips to Spice Up Your Heart-Healthy Diet

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

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

Recognizing an Addiction Relapse

Treatment and recovery from an addiction to drugs or alcohol are steps in a lifelong journey. Unfortunately, 40 to 60 percent of drug addicts and almost half of all alcoholics will eventually go through a substance abuse relapse.

If someone dear to you has been in addiction treatment, it is important for you to be able to recognize if that person is relapsing as early as possible. This way, the problem can be addressed before it spirals out of control. Just because your loved one relapses does not mean that their addiction treatment has failed, however; it just means that the current treatment regimen probably needs to be reevaluated.

Addiction Relapse: Obvious Signs

"Most of the time the signs are so obvious," says Thomas Kosten, MD, Jay H. Waggoner chair and founder of the division of substance abuse at Baylor College of Medicine in Houston.

According to Dr. Kosten, the following are common indicators of a drug or alcohol addiction relapse:

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  • Alcohol is missing from the house.
  • Bottles of alcohol are found around the home.
  • Your loved one comes home obviously intoxicated.
  • Money is missing from bank accounts or stolen from friends or family member.
  • Medicine is missing from the house.

 

 

Addiction Relapse: Early Indicators

 

 

There are also signals from the addict that a relapse is just around the corner, when steps can be taken to prevent the relapse or at least address it in its earliest stages. Your loved one may exhibit the following emotions and behaviors:

  • Anxiety
  • Anger
  • Impatience
  • Extreme sensitivity
  • Moodiness
  • Not wanting to be around people
  • Refusing help
  • Not complying with treatment recommendations
  • Problems with sleeping
  • Appetite changes
  • Reminiscing about the past
  • Lying
  • Seeing friends that they've used drugs or alcohol with in the past
  • Talking about relapse

Addiction Relapse: Stepping in

When you suspect that your loved one has relapsed, Kosten says the best thing to do is tackle the issue head-on. He suggests that you start the conversation in the following way:

  • First, say to your loved one, “I think you’re using.”
  • If the person admits he is using again, then say, “We need to do something about this."
  • Kosten suggests that at this point you start setting limits by saying something such as, "Unless you get help, you will have to leave the house."

If your loved one is showing signs of an impending relapse but hasn’t yet relapsed, Kosten says that it is important to confront him first. Otherwise it is very unlikely that you are going to be able to convince him to get back into addiction treatment. Then you should encourage him to continue with treatment, talk to an addiction counselor or sponsor, and practice good self-care — that is, get enough sleep, eat well, and take steps to relieve stress.

If the addict refuses to talk with a professional or you feel that you need anaddiction expert to help you learn how to confront him, contact your local Council for Alcoholism and Drug Abuse. Or if you have access to the person’s doctor, addiction counselor, or sponsor, speak to that person about how you might deal with the situation.

Statins May Boost Survival Odds After Cardiac Arrest

The odds of surviving cardiac arrest seem higher for patients who've been taking cholesterol-lowering statins, a new study shows.

Researchers in Taiwan studied the medical records of nearly 138,000 cardiac arrest patients. Those already using statins such as Lipitor (atorvastatin) or Crestor (rosuvastatin) were about 19 percent more likely to survive to hospital admission and 47 percent more likely to be discharged. Also, they were 50 percent more likely to be alive a year later, the study found.

"When considering statin use for patients with high cholesterol, the benefit of surviving sudden cardiac arrest should also be considered, as statin use before cardiac arrest might improve outcomes of those patients," said study author Dr. Ping-Hsun Yu.

Yu is a researcher from the National Taiwan University Hospital and College of Medicine in New Taipei City.

The greatest survival benefit from statins was seen in patients with type 2 diabetes, Yu's team said.

Cardiac arrest is the abrupt loss of heart function. Death often occurs instantly or shortly after symptoms appear, according to the American Heart Association.

"We know that a large proportion of cardiac arrests occur due to coronary plaque rupture," said Dr. Puneet Gandotra, director of the cardiac catheterization laboratories at Northwell Health Southside Hospital in Bay Shore, N.Y.

RELATED: Bystander CPR Doubles Cardiac Arrest Survival Rates

"This rupture leads to a snowball effect in arteries and can cause arteries to get blocked, resulting in a heart attack or cardiac arrest," he explained.

So how might statins help?

"I feel that due to statin therapy, there is significant plaque stability and the effects of rupture are not as significant. Thus, an improvement in survival is noticed with patients on statin therapy who have cardiac arrests," Gandotra said.

Statins are often prescribed for patients after a heart attack or stroke as a way to prevent a second cardiovascular event. However, "this does not mean that everyone should be on statin therapy," Gandotra said.

These drugs can have side effects, such as muscle pain and weakness and higher blood sugar levels. In addition, the value of statins for preventing a first cardiac arrest or stroke is not clear, the researchers added.

Dr. Suzanne Steinbaum, director of Women's Heart Health at Lenox Hill Hospital in New York City, said, "What we learn from studies like this is that [statins] have other benefits.

"A study like this gives me a reason to say, 'There are more reasons for you to take a statin than just to lower your cholesterol,' " Steinbaum said.

For the study, Yu and colleagues divided the medical records of almost 138,000 patients according to whether they had used statins for 90 days within the year before their cardiac arrest. The researchers also accounted for gender, age, other medical problems, number of hospitalizations, post-resuscitation and other variables.

Because more than 95 percent of the patients in the study were Asian, these results might not apply to other groups or ethnic populations, Yu said.

The findings were to be presented on Sunday at the American Heart Association annual meeting, in New Orleans. Data and conclusions presented at medical meetings are usually considered preliminary until published in a peer-reviewed medical journal.

diabetes type 2

There is a problem about diabetes type 2

 

 

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8 Things You Can Start Doing Now to Look Younger


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

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

 

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.

The Calming Power of Nature

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

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

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

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

RELATED: How to Create a Depression Treatment Plan

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

What Nature-Depression Research Shows

Among the studies finding nature helps with depression:

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

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

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

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

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

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

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

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

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

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

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

 

Local Hepatitis C Screening Success

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

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

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

 

Progress in National Hepatitis C Screening

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

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

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

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

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

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

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

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

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

The three steps to a hepatitis C cure are to:

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

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

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

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

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

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

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

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

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

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

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

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

 

Talk Therapy May Help Depressed Teens Who Shun Antidepressants

Cognitive behavioral therapy can help boost mood without drugs.

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

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

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

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

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

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

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

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

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

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

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

RELATED: 7 Antidepressant Side Effects

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

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

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

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

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

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

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

Surprising Physical Signs of Heart Disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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News From AAN: Correction on Tysabri/PML Blog (last of paper)

Last week we posted a blog about the risks of PML for patients taking Tysabri, based on news from the American Academy of Neurology (AAN) meetings which took place earlier this month. In the comments section, Chris asked that we check our facts and report back.

Well, once again, your commitment to the Life With MS Blog community has paid off.

I jotted off a quick e-mail to the Public Affairs department for Biogen/Idec and waited… and waited… and got nothing. Because, however, of the active participation of our community the conversation was noted and I got an e-mail asking if we needed any assistance directly from the senior manager for international public affairs.

I am not happy that I was wrong, but I am happy to know that we can get the correct information out to you today.

I had reported that Alfred Sandrock, MD, PhD, of Biogen/Idec, presented findings from the company’s study on progressive multifocal leukoencephalopathy (PML) in patients using Biogen/Idec’s MS drug, Tysabri. I was mistaken in my assessment of “immunosuppressive” (IS) therapy in the list of risk factors for PML.

Risk factors for PML include:

More than two years on Tysabri
Prior immunosuppressant therapy
Positive serology for JC virus infection
According to Biogen, immunosuppessants, in the context used by Dr Sandrock are limited as:

“A prior IS would be considered mitoxantrone, azathioprine, methotrexate, cyclophosphamide, mycophenolate, cladribine, rituximab, and chemotherapy (not otherwise specified).”

Not included, as you can see, are any of the other MS disease modifying therapies (DMT) or even corticosteroids like Solu-Medral or Prednisone — which is normally considered an IS drug, but not for the case of the PML warning.

The original press release that I received on the topic was incomplete and I apologize for the misunderstanding.

As a side note, I took advantage of the conversation to request more information on the companies rational in keeping the patent on the JC Virus assay test that I also mentioned in that same blog post. I’ll update you on that conversation as soon as it happens.

Once again, your voice was heard by the people who have the answers and I think we’ve cleared up the misunderstanding. Thank you all for your continued involvement in our community. It makes a big difference in the lives of so many!

Wishing you and your family the best of health

 

All Diet and Nutrition Articles

All Diet and Nutrition Articles