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How do the holidays affect a person with Alzheimer’s disease? Can someone who exercises and is of normal weight have prediabetes? I often have ‘digestive problems’ following a big meal. Should I be worried?
November 2014
Kids’ diabetes rates up dramatically By STEVEN REINBERG HealthDay Rates of diabetes in U.S. children have jumped sharply in just eight years, according to new research. The prevalence of type 1 diabetes increased 21 percent between 2001 and 2009. At the same time, rates of type 2 diabetes rose 30.5 percent, the study found. These increases affected both boys and girls, and nearly all racial groups, the researchers noted. The reasons behind the increases aren’t entirely clear, said lead researcher Dr. Dana Dabelea, the associate dean for faculty at the Colorado School of Public Health in Aurora. “While we do not completely understand the reasons for this increase, since the causes of type 1 diabetes are still unclear, it is likely that something has changed in our environment, both in the U.S. and elsewhere in the world, causing more youth to develop the disease, maybe at increasingly younger ages,” she said. Several reasons for the increase in type 2 diabetes are possible, Dabelea said. “Most likely is the obesity epidemic, but also the long-term effects of diabetes and obesity during pregnancy, which have also increased over time,” she noted. This report shows the increasingly important public health burden that pediatric diabetes represents, Dabelea pointed out. “It also highlights the facts that all racial/ethnic groups are affected by both major forms of diabetes,” she said. In type 1 diabetes, the body does not produce insulin, the hormone needed to convert sugar, starches and other food into energy. In type 2 diabetes, the body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But over time, it isn’t able to keep up and can’t make enough insulin to keep blood sugar at normal levels. For the study, Dabelea’s team collected data on more than 3 million children and adolescents. When looking for type 1 diabetes, the researchers included people aged 19 years and younger. For type 2, the researchers limited the age range to 10 through 19 years. The incidence of type 2 in children younger than 10 was too low to provide statistically significant numbers, according to the report. The data came from five centers located in California, Colorado, Ohio, South Carolina, and Washington state, as well as from some American Indian reservations in Arizona and New Mexico. In 2001, type 1 diabetes had been diagnosed in just under 5,000 youngsters from a group of more than 3 million youth. By 2009, that number rose to almost 6,700, an increase of 21 percent, according to the study authors. The only groups that didn’t see an increase in type 1 diabetes were children
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from 0 to 4 years old, and American Indian children, the study revealed. For type 2, the researchers looked at a group of almost 2 million children. In 2001, 588 children and teens had been diagnosed with type 2 diabetes. By 2009, 819 kids and teens had type 2, a jump of 30.5 percent, the researchers found. The only ethnic groups that didn’t see an increase in type 2 were American Indians and Asian Pacific Islanders. “Historically, type 1 diabetes has been considered a disease that affects primarily white youth; however, our findings highlight the increasing burden of type 1 diabetes experienced by youth of minority racial/ethnic groups as well,” the authors wrote. The increase for both types of diabetes was seen among boys and girls and among whites, blacks and Hispanics. The biggest increase in both types of diabetes was among those 15 through 19 years of age, the researchers noted. Of the study, Dr. Robert Ratner, chief medical and scientific officer for the American Diabetes Association, said, “The overall prevalence of diabetes is going to grow progressively, because we’ve done so much better in keeping these people alive, they are going to live longer. We also know they are going to continue to incur costs for complications.” Diabetes will be a major health care problem over the next two decades, he predicted. “There is a need to pay more attention to the prevention of diabetes, because we are not going to be able to care for all of these people,” Ratner said. Ratner was perplexed by the increase in type 1 diabetes.
“Whether it’s an interaction between genetics and environment that’s increasing autoimmunity — we really don’t know,” he said. “It’s a major question that needs to be answered.” Dr. Luis Gonzalez-Mendoza, director of pediatric endocrinology at Miami Children’s Hospital, was also concerned by the increase in type 1 diabetes. “Type 1 diabetes seems to be on the rise among teens, almost double what it used to be,” he said. “There is something that is acting as a trigger for the immune system to go crazy, because type 1 diabetes is an autoimmune disorder.” Source: HealthDay
More information The American Diabetes Association provides more information on type 1 diabetes at www.diabetes.org.
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Can someone who exercises and is of normal weight have prediabetes? Dr. Elizabeth Helfer, an endocrinologist with The University Doctors, responds: Diabetes, the seventh leading cause of death in America, may be the premier health care crisis facing our country. According to a report from the Centers for Disease Control and Prevention (CDC), more than 29 million Americans have diabetes, including nearly eight million who are unaware of their disease. Perhaps even more alarming, the CDC estimates that 86 million adults – one out of every three people over the age of 20 – have prediabetes. Without interventions to halt the progression of their disease, it is estimated that 15 to 30 percent of those individuals will develop diabetes within five years. Type 2 diabetes is, by far, the most common form of the disease, accounting for nearly 90 percent of all cases. With type 2, the “Diabetes, the seventh body either can’t make the right amount of leading cause of death insulin or is unable in America” to use its insulin well enough to prevent excess glucose from accumulating in the blood. Over time, these elevated blood sugar levels can damage the blood vessels throughout the body. Being overweight or having a sedentary lifestyle is associated with more than 80 percent of the cases of type 2 diabetes, but that still leaves a significant number of normal weight people who also develop the disease. For those normal weight people, diabetes may pose an even greater risk. A study published in the Journal of the (JAMA) in August 2012 found that normal weight people who were diagnosed with diabetes had a mortality rate that was approximately twice that of diabetics who were overweight or obese. Other factors that increase the risk for diabetes include: age (most cases occur in people older than 45); a family history of diabetes; high blood pressure or elevated levels of LDL (“bad”) cholesterol or triglycerides; and carrying any excess weight around the midsection. If you are a woman, your diabetes risk increases if you have a history of gestational (pregnancyassociated) diabetes or if you have given birth to a baby who weighed over nine pounds. Additionally, African Americans, Hispanics, American Indians and
Asian Americans all tend to be more prone to some lifestyle changes to stop the progression of develop diabetes. the disease. Your physician can help you find the Diagnosing diabetes requires one of several types appropriate changes, including eating a better of blood tests. The fasting plasma glucose (FPG) diet, exercising more and reducing stress. test is the one that may be most familiar. This test Even if you are just slightly overweight, draws a blood sample from individuals who have dropping some of those excess pounds will help. had nothing to eat or drink Studies have “the CDC estimates that 86 million adults – shown that (except water) for at least one out of every three people over the age of eight hours. The test people with 20 – have prediabetes.” measures the amount of pre-diabetes glucose in micrograms (mg) who lose per deciliter (dl) of blood. A normal FPG level will weight and who engage in some modest form be less than 100 mg/dl. People with prediabetes will of exercise (30-60 minutes per day, 5-7 days per have an FPG score between 100 and 125 mg/dl with week) can prevent or delay the development of higher results indicating the presence of diabetes. type 2 diabetes by up to 58 percent. Even if you don’t have any of the risk factors To schedule an appointment with Dr. Helfer, mentioned here, ask your physician if you should please call 856.770.1305. The office is located be tested for diabetes. This is especially important at Pavilions, 2301 Evesham Road, Suite 202, if you have any symptoms – such as excessive thirst, Voorhees, NJ 08043. frequent urination and blurred vision – that are classic signs of the disease. If your test indicates that you have prediabetes, consider it a loud warning that you need to make
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I often have ‘digestive problems’ following a big meal. Should I be worried? Dr. Drew Chiesa, a gastroenterologist with The University Doctors, responds: Thanksgiving Day kicks off a monthlong celebration that has great tasting food and drink lurking at the edge of every gathering, tempting us to either over-indulge or eat the kinds of high-fat or spicy foods that don’t always digest easily. The resulting digestive flare-ups can range from relatively mild to potentially worrisome symptoms of a chronic disease. Gas. Everybody – and every body – produces gas, up to a half gallon per day. Your body produces some of it as it digests food and drink. The majority, however, results from swallowing air while eating and drinking. Surprisingly, most of the gas that comes out of your body is odorless. Any odors result from trace amounts of gas given off during the digestive process. Beans, broccoli, cauliflower and cabbage contain indigestible sugars that produce gas as they are broken down in the colon. High-fat foods move slowly through the digestive process and can cause gas to build up behind them. Some individuals will also experience gas because their bodies are unable to adequately process artificial sweeteners or high fructose corn syrup (a common food additive). Others lack the enzyme needed to digest the sugars found in dairy products, causing the sugars to ferment in the colon and give off gas. Occasional bouts of excessive gas are usually nothing to worry about, but talk to your physician if it happens often or interferes with your ability to enjoy normal activities. Heartburn. The burning sensation of heartburn has nothing to do with the heart, except, perhaps, your love of the foods that may be causing it. Heartburn is caused by acids that have backed up from the stomach, irritating the lining of the esophagus. Heartburn isn’t unusual – nearly half of all Americans report heartburn at least once per month – but it can be a symptom of a disorder called gastro-esophageal reflux disease (GERD). If heartburn occurs more than twice per week, usually follows meals, and over-the-counter antacids only provide temporary relief, talk to your physician. Left untreated, GERD can progress to more serious complications, especially
among older adults. Unfortunately, many tempting of this intestinal distress. If you are sensitive to holiday foods - chocolates, alcohol, fatty foods, caffeine, be aware that, aside from coffee, tea and carbonated beverages, red wine, nuts, acidic fruits espresso, caffeine is also an ingredient in many and vegetables, and peppermint – can all aggravate soft drinks and in some chocolates and candies. GERD symptoms. Stress, alone, won’t cause Let your doctor know if you frequently symptoms to flare, but stress can cause you to eat experience diarrhea after eating, especially too quickly or to eat or drink too many “comfort if the episodes tend to occur suddenly or are foods” that, in turn, lead to heartburn. accompanied by fever or nausea. Diarrhea after Successful GERD treatment usually involves eating could be a symptom of several disorders, lifestyle and you will need a physician who is experienced “..stress can cause you to modifications with these disorders to determine an accurate that include: eat too quickly or to eat or diagnosis. drink too many “comfort avoiding To schedule an appointment with lying down foods” that, in turn, lead to Dr. Drew Chiesa, please call 856.218.0300. for at least heartburn.” The office is located in Washington Township at three hours Harbor Pavilions, 570 Egg Harbor Road, Suite following C-2 Sewell, NJ 08080. a meal; raising the head of the bed by at least six inches; and sleeping on your left side. If those prove unsuccessful, your physician can recommend over-the-counter or prescription medications that are safe and effective. Diarrhea. Highfat foods – buttery desserts, fried foods, fatty meats and foods Let us help treat your digestive health issues! enveloped in thick, creamy sauces – can John C. Chiesa, DO, FACOI all lead to diarrhea Drew Chiesa, DO because undigested Donald McMahon, DO fat can cause the Richard Walters, DO intestines to secrete more water. Food Call for an appointment: 856.566.6853 or 856.218.0300 (Option 6) sweetened with high fructose corn syrup, We offer G.I Services at these locations: the sugar substitute Marlton • Mt. Laurel • Stratford • Washington Twp. • West Deptford sorbitol, and caffeine theuniversitydoctors.com can also be culprits
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Alzheimer’s or Typical Age-related Change?
How do the holidays affect a person with Alzheimer’s disease? Dr. Christian White, a geriatric psychiatrist with the New Jersey Institute for Successful Aging, responds: The decorations, changing locations and large family gatherings that are often part of the year-end holiday season can be confusing and even a bit frightening for people with Alzheimer’s disease. The holidays also add a layer of stress to the already heavy burden of family caregivers. You probably know at least one person who is affected by Alzheimer’s disease. More than five million Americans are living with the disease and 15 million family caregivers combine to provide over 80 percent of the athome care for people with Alzheimer’s. If you are one of those caregivers, you are probably already familiar with some of the concerns and pitfalls of the holiday season. If you are new to the role, there are a few things to keep in have a quiet, separate room available greeting cards together and look at photos mind that will help you and your loved where he or she can rest. that arrive in the mail. one navigate the season. When visiting a person with If you and the person with dementia are First, plan to modify your Alzheimer’s, remember to be sensitive to visiting another person’s home, keep in expectations and your activities. the needs of that person’s caregiver. Offer mind that the change in scenery could be Instead of hosting a large gathering of to do some of the shopping ahead of any disorienting. If the person family and friends, celebration or to prepare and bring part of with dementia is better at consider a more “Introduce changes the meal with you. If it has been a while certain times of the day, intimate event gradually with reminders try to schedule your visit since your last visit let your children know or one hosted by about the time of year.” that the person they are visiting may look during those hours, even if another family and act differently than before. Keep in it means you won’t get to member. That will mind, too, that a person with dementia see everyone who attends. help ease your stress and that of the may have trouble following a conversation During the gathering, avoid questions individual for whom you provide care. or may repeat himself often. Be patient that could cause frustration for the person If you do host the gathering, involve and avoid the urge to correct or cut that with Alzheimer’s. Instead of asking, “Do your loved one in some of the activities person off when he or she is talking. you know who this is?” say something along leading up to it. Introduce changes Selecting an appropriate gift for a person the lines of “Dad, you remember your gradually with reminders about the with Alzheimer’s isn’t as difficult as it nephew Joey.” time of year and mentions that people may seem. Loose, comfortable clothing, The noise and confusion of overlapping will be visiting. Allow the person with favorite music, illustrated books, family conversations during a crowded gathering Alzheimer’s to help with preparing videos and photo albums with labels could cause agitation for your family foods, and with decorating and identifying the people, dates and places are member. To avoid this, try to arrange to wrapping gifts. Take the time to read
Memory loss that disrupts daily life may be a symptom of Alzheimer’s or another dementia. Alzheimer’s is a brain disease that causes a slow decline in memory, thinking and reasoning skills. There are 10 warning signs and symptoms . Every individual may experience one or more of these signs in different degrees. If you notice any of them, please see a doctor.
all good gift choices. And don’t forget to offer the gift of your time to the family caregiver. Stress, anxiety and burnout, which are never far from their doorsteps, will creep even closer during the hectic holiday season. For a variety of reasons, caregivers will often decline offers to help, but the holidays are a great time for some gentle but persistent pressure. Instead of generally asking, “What can I do?” make specific offers to grocery shop, go to the post office, do laundry or bring over a meal that you have cooked. If you are able, plan to stay while the caregiver takes a few hours to get away, run errands or just relax. To schedule an appointment with Dr. Christian White, please call 856.566.6843. The office is located at 42 East Laurel Road, Suite 2100, Stratford, NJ 08084.
Alzheimer’s warning sign
Typical age-related change
Memory loss that disrupts daily life
Sometimes forgetting names or appointments, but remembering them later
Challenges in planning or solving problems
Making occasional errors when balancing a checkbook
Difficulty completing familiar tasks at home, at work, or at leisure
Occasionally needing help to use the settings on a microwave or to record a television show
Confusion with time or place
Getting confused about the day of the week but figuring it out later
Trouble understanding visual images and spatial relationships
Vision changes related to cataracts
New problems with words in speaking or writing
Sometimes having trouble finding the right word
Misplacing things and losing the ability to retrace steps
Misplacing things from time to time and retracing steps to find them
Decreased poor judgment
Making a bad decision once in a while
Withdrawal from work or social activities
Sometimes feeling weary of work, family, and social obligations
Change in mood and personality
Developing very specific way of doing things and becoming irritable when a routine is disrupted
*Source: Alzheimer’s Association (www.alz.org)
For when it becomes more than just misplacing keys Our Memory Assessment Program (MAP) is specially designed to identify the possible causes of memory loss. Our team evaluates physical and medical conditions, mood, thinking and memory, and will make recommendations for an ongoing plan of care. Call to make an appointment today 856.566.6843 New Jersey Institute for Successful Aging University Doctors Pavilion 42 East Laurel Road, Suite 1800 Stratford, NJ 08084 rowan.edu/som/njisa/ facebook.com/theuniversitydoctors • twitter.com/universitydocs
The University Doctors MedicaLink is an Advertorial Supplement published by Rowan University School of Osteopathic Medicine (RowanSOM). RowanSOM staff: Mary Louise Bianco-Smith (editor), Julia Swope, Gerald Carey, Lynne Yarnell, Lucy McGorry, Bernardine Jones. Please send inquiries via email to: sominfo@rowan.edu or RowanSOM Marketing Department, University Doctors Pavilion, Suite 1300, 42 East Laurel Road, Stratford, NJ 08084, 856.566.6191.
The University Doctors MedicaLink Ask The University Doctors
Alzheimer’s or Typical Age-related Change?
How do the holidays affect a person with Alzheimer’s disease? Dr. Christian White, a geriatric psychiatrist with the New Jersey Institute for Successful Aging, responds: The decorations, changing locations and large family gatherings that are often part of the year-end holiday season can be confusing and even a bit frightening for people with Alzheimer’s disease. The holidays also add a layer of stress to the already heavy burden of family caregivers. You probably know at least one person who is affected by Alzheimer’s disease. More than five million Americans are living with the disease and 15 million family caregivers combine to provide over 80 percent of the athome care for people with Alzheimer’s. If you are one of those caregivers, you are probably already familiar with some of the concerns and pitfalls of the holiday season. If you are new to the role, there are a few things to keep in have a quiet, separate room available greeting cards together and look at photos mind that will help you and your loved where he or she can rest. that arrive in the mail. one navigate the season. When visiting a person with If you and the person with dementia are First, plan to modify your Alzheimer’s, remember to be sensitive to visiting another person’s home, keep in expectations and your activities. the needs of that person’s caregiver. Offer mind that the change in scenery could be Instead of hosting a large gathering of to do some of the shopping ahead of any disorienting. If the person family and friends, celebration or to prepare and bring part of with dementia is better at consider a more “Introduce changes the meal with you. If it has been a while certain times of the day, intimate event gradually with reminders try to schedule your visit since your last visit let your children know or one hosted by about the time of year.” that the person they are visiting may look during those hours, even if another family and act differently than before. Keep in it means you won’t get to member. That will mind, too, that a person with dementia see everyone who attends. help ease your stress and that of the may have trouble following a conversation During the gathering, avoid questions individual for whom you provide care. or may repeat himself often. Be patient that could cause frustration for the person If you do host the gathering, involve and avoid the urge to correct or cut that with Alzheimer’s. Instead of asking, “Do your loved one in some of the activities person off when he or she is talking. you know who this is?” say something along leading up to it. Introduce changes Selecting an appropriate gift for a person the lines of “Dad, you remember your gradually with reminders about the with Alzheimer’s isn’t as difficult as it nephew Joey.” time of year and mentions that people may seem. Loose, comfortable clothing, The noise and confusion of overlapping will be visiting. Allow the person with favorite music, illustrated books, family conversations during a crowded gathering Alzheimer’s to help with preparing videos and photo albums with labels could cause agitation for your family foods, and with decorating and identifying the people, dates and places are member. To avoid this, try to arrange to wrapping gifts. Take the time to read
Memory loss that disrupts daily life may be a symptom of Alzheimer’s or another dementia. Alzheimer’s is a brain disease that causes a slow decline in memory, thinking and reasoning skills. There are 10 warning signs and symptoms . Every individual may experience one or more of these signs in different degrees. If you notice any of them, please see a doctor.
all good gift choices. And don’t forget to offer the gift of your time to the family caregiver. Stress, anxiety and burnout, which are never far from their doorsteps, will creep even closer during the hectic holiday season. For a variety of reasons, caregivers will often decline offers to help, but the holidays are a great time for some gentle but persistent pressure. Instead of generally asking, “What can I do?” make specific offers to grocery shop, go to the post office, do laundry or bring over a meal that you have cooked. If you are able, plan to stay while the caregiver takes a few hours to get away, run errands or just relax. To schedule an appointment with Dr. Christian White, please call 856.566.6843. The office is located at 42 East Laurel Road, Suite 2100, Stratford, NJ 08084.
Alzheimer’s warning sign
Typical age-related change
Memory loss that disrupts daily life
Sometimes forgetting names or appointments, but remembering them later
Challenges in planning or solving problems
Making occasional errors when balancing a checkbook
Difficulty completing familiar tasks at home, at work, or at leisure
Occasionally needing help to use the settings on a microwave or to record a television show
Confusion with time or place
Getting confused about the day of the week but figuring it out later
Trouble understanding visual images and spatial relationships
Vision changes related to cataracts
New problems with words in speaking or writing
Sometimes having trouble finding the right word
Misplacing things and losing the ability to retrace steps
Misplacing things from time to time and retracing steps to find them
Decreased poor judgment
Making a bad decision once in a while
Withdrawal from work or social activities
Sometimes feeling weary of work, family, and social obligations
Change in mood and personality
Developing very specific way of doing things and becoming irritable when a routine is disrupted
*Source: Alzheimer’s Association (www.alz.org)
For when it becomes more than just misplacing keys Our Memory Assessment Program (MAP) is specially designed to identify the possible causes of memory loss. Our team evaluates physical and medical conditions, mood, thinking and memory, and will make recommendations for an ongoing plan of care. Call to make an appointment today 856.566.6843 New Jersey Institute for Successful Aging University Doctors Pavilion 42 East Laurel Road, Suite 1800 Stratford, NJ 08084 rowan.edu/som/njisa/ facebook.com/theuniversitydoctors • twitter.com/universitydocs
The University Doctors MedicaLink is an Advertorial Supplement published by Rowan University School of Osteopathic Medicine (RowanSOM). RowanSOM staff: Mary Louise Bianco-Smith (editor), Julia Swope, Gerald Carey, Lynne Yarnell, Lucy McGorry, Bernardine Jones. Please send inquiries via email to: sominfo@rowan.edu or RowanSOM Marketing Department, University Doctors Pavilion, Suite 1300, 42 East Laurel Road, Stratford, NJ 08084, 856.566.6191.
’Tis the season to be stressed and depressed
T
he holiday season often brings unwelcome guests — stress and depression. And it’s no wonder. The holidays present a dizzying array of demands — parties, shopping, baking, cleaning and entertaining, to name just a few. But with some practical tips, you can minimize the stress that accompanies the holidays. You may even end up enjoying the holidays more than you thought you would. When stress is at its peak, it’s hard to stop and regroup. Try to prevent stress and depression in the first place, especially if the holidays have taken an emotional toll on you in the past, Try these tips: Acknowledge your feelings If someone close to you has recently died or you can’t be with loved ones, realize that it’s normal to feel sadness and grief. It’s OK to take time to cry or express your feelings. You can’t force yourself to be happy just because it’s the holiday season. Reach out If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships. Be realistic The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can’t come to your house, find new ways to celebrate together, such as sharing pictures, emails or videos. Set aside differences Try to accept family members and friends as they are, even if they don’t live up to all of your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression, too. Stick to a budget Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don’t try to buy happiness with an avalanche of gifts. Try these alternatives:
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• Donate to a charity in someone’s name • Give homemade gifts • Start a family gift exchange Plan ahead Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That’ll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup. Learn to say no Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can’t participate in every project or activity. If it’s not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.
Don’t abandon healthy habits Don’t let the holidays become a free-forall. Overindulgence only adds to your stress and guilt. Try these suggestions: • Have a healthy snack before holiday parties so that you don’t go overboard on sweets, cheese or drinks • Get plenty of sleep • Incorporate regular physical activity into each day Take a breather Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm. Some options may include:
• Taking a walk at night and stargazing • Listening to soothing music • Getting a massage • Reading a book Seek professional help Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional. Source: HealthDay
Teen conflicts complicate home, school lives
H
ome troubles affect school life, school issues affect home, researchers report Teens’ conflicts at home increase the risk of problems at school for up to two days, according to a new study. The research also found that the reverse is true: school problems can create issues at home.
The study included more than 100 teens, ages 13 to 17, and their parents. The participants completed questionnaires at the end of each day for 14 days. The findings appear in the journal Child Development. Additionally, the study found that bad mood and mental health symptoms such as depression and anxiety are important factors in what’s referred to as “spillover effect.” Problems that can spill over between home and school include arguments between teens and their parents, skipping class, not completing assignments, difficulty understanding school work, and doing poorly on a quiz or test, the University of Southern California researchers explained. For example, failing a test could cause a teen to be irritable, which in turn could lead to an argument with parents. The researchers also found that teens with more symptoms of anxiety and depression were more likely to be in a bad mood after arguing with their parents. The study included more than 100 teens, ages 13 to 17, and their parents. The participants completed questionnaires at the end of each day for 14 days. The findings appear in the journal Child Development.
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“Spillover processes have been recognized, but are not well understood,” Adela Timmons, a doctoral student, and Gayla Margolin, professor of psychology, wrote. “Evidence of spillover for as long as two days suggests that some teens get caught in a reverberating cycle of negative events.” They said their findings could be used to find ways to help teens better handle bad moods and to improve their family relationships and how they do in school. A person with generalized anxiety disorder describes someone who worries excessively, often making it difficult to get through the day.
The Womenshealth.gov website says physical symptoms of generalized anxiety disorder include: • • • • • • • • • •
Significant and unexplained fatigue Aches, pains and tension in the muscles Headaches Twitching or trembling Irritability Difficulty swallowing Sweating excessively Hot flashes Nausea, lightheadedness or shortness of breath Going to the bathroom more frequently Source: HealthDay
More information
The American Academy of Family Physicians has more about teens’ emotional health at www.aafp.org
Even normal-weight teens can have dangerous eating disorders By tara haelle HealthDay Teenagers do not need to be rail thin to be practicing the dangerous eating behaviors associated with anorexia, a new study suggests. Rather, the true measure of trouble may be significant weight loss, and the Australian researchers noted that a drastic drop in weight carries the same risk for life-threatening medical problems even if the patient is a normal weight. Even more concerning, the scientists saw a nearly sixfold increase in this type of patient during the six-year study period. Anorexia nervosa is a mental illness characterized by excessive weight loss and psychological symptoms that include a distorted self-image and fear of weight gain. In some patients, this can also include depression and anxiety. Those who have these symptoms but are not underweight enough to qualify for the definition of anorexia fall under a different diagnosis, known as Eating Disorder Not Otherwise Specified (EDNOS-Wt). “Emaciated bodies are the typical image portrayed in the media of patients with restricting eating disorders such as anorexia nervosa,” said lead researcher Melissa Whitelaw, a clinical specialist dietitian at The Royal Children’s Hospital in Melbourne, Australia. “This paper highlights that it is not so much about the weight but the weight loss that can lead to a serious eating disorder. The complications of malnutrition can occur at any weight.” In her study, which included 99 teens aged 12 to 19, Whitelaw found only 8 percent of the patients had EDNOS-Wt in 2005, but more than 47 percent of the patients had it in 2009. “I was surprised to see how much it increased,” Whitelaw said. “I was also surprised at how similar they were not only physically but also psychologically. Everything about them was anorexia except that they don’t look really skinny.” Both groups had even lost a similar amount of weight: a median 28 pounds for those with anorexia and 29 pounds for those with EDNOS-Wt. Other experts noted that it can be difficult
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to spot this less obvious eating disorder. “We are conditioned to think that the key feature of anorexia nervosa is low body mass index [BMI],” said Cynthia Bulik, director of the Center of Excellence for Eating Disorders at the University of North Carolina at Chapel Hill. BMI measures whether a person is a healthy weight for their height. “In fact, we miss a lot of eating disorders when focusing primarily on weight,” Bulik added. Leslie Sim, an assistant professor of psychology at Mayo Clinic Children’s Center in Rochester, Minn., said, “People are calling it atypical anorexia, but we see it every day. We see people who have all the psychological, behavioral, cognitive and physical symptoms of anorexia nervosa, but the only difference is their weight.” In this study, the side effects of having an eating disorder were also very similar. Dangerously low phosphate levels occurred in 41 percent of anorexia patients and 39 percent of EDNOS-Wt patients. The lowest pulse for the teens was 45 beats per minute (bpm) for those with anorexia and 47 bpm for the other
group. Meanwhile, 38 percent of the EDNOSpatients and 30 percent of the anorexia patients required tube feeding. “Normal-weight patients with anorexia symptoms were becoming medically unstable, despite the fact that they had what you would call a normal body weight,” Whitelaw said. The reasons for the apparent increase in these patients is less clear, but both Sim and Whitelaw said it is likely a combination of increased awareness of the problem and an increased focus on obesity. One tricky aspect of identifying these patients, Sim said, is that the weight loss appears at first to be a positive development. “These patients just fly under the radar and when they’re in that earlier stage, it’s harder for people to see it,” Sim said. “Parents say to me every day, ‘I thought my daughter was doing something good and making healthy choices until it got out of control. We didn’t know it was a problem until she couldn’t eat the cake at her birthday party.” The experts emphasized that eating disorders are not parents’ fault. Instead, parents can play an important role in identifying the symptoms of an eating disorder, especially in its early stages, said Jessica Feldman, a licensed social worker and site director of The Renfrew Center in Radnor, Pa. Symptoms include significant changes in eating patterns, excessive exercising, a teen’s negative statements about their body image, an increase in depression or anxiety, and a loss of interest in previously enjoyable activities. Bulik stressed the importance of recognizing that both conditions are illnesses. “No one chooses to have an illness. We would never tell someone with allergies to ‘just stop sneezing,’ ” Bulik said. “Although dieting might be a first step, the illness takes over and develops a life of its own — sufferers often cannot eat, even if they want to. Source: HealthDay
What is Body Image?
Body image is how you see yourself when you look in the mirror or when you picture yourself in your mind. It encompasses: • What you believe about your own appearance (including your memories, assumptions, and generalizations) • How you feel about your body, including your height, shape, and weight • How you sense and control your body as you move • How you feel in your body, not just about your body
Negative Body Image
• A distorted perception of your shape — you perceive parts of your body unlike they really are • You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure • You feel ashamed, self-conscious, and anxious about your body • You feel uncomfortable and awkward in your body
Positive Body Image
• A clear, true perception of your shape — you see the various parts of your body as they really are • You celebrate and appreciate your natural body shape and you understand that a person’s physical appearance says very little about their character and value as a person • You feel proud and accepting of your unique body and refuse to spend an unreasonable amount of time worrying about food, weight and calories • You feel comfortable and confident in your body
More information Visit the National Eating Disorders Association for more on anorexia at www. nationaleatingdisorders.org.
Combo therapy best for COPD By dennis thompson HealthDay A combination drug therapy aimed at opening the airways and reducing inflammation appears to be the best treatment for older adults with chronic obstructive pulmonary disease (COPD), especially those with asthma, a new study finds. COPD patients who received a combination of long-acting beta agonists and inhaled corticosteroids were less likely to die or require hospitalization because of their breathing disorder, compared to people receiving only one of the two medications, Canadian researchers report. The study findings were published in the September 17th issue of the Journal of the American Medical Association. The findings go against the official guidelines for treating COPD, but actually support what most chest physicians are doing in the clinic, said lead author Dr. Andrea Gershon, a scientist with the Sunnybrook Health Sciences Center and the Institute for Clinical Evaluative Sciences in Toronto. Current treatment guidelines call for COPD patients to first receive a long-acting beta agonist, which relaxes the muscles of the airways and widens them, resulting in easier breathing. If that doesn’t work, physicians then can add an inhaled corticosteroid, which reduces inflammation. “We found the combination therapy appeared to be more effective, and we found that a lot of people are being started on this combination therapy straight away,” Gershon said. “Maybe doctors have had an intuitive sense of these benefits, or maybe drug companies had really good marketing.” Further, researchers found that the combination therapy did not compound a person’s risk of side effects from either drug, most notably osteoporosis and pneumonia. “I suspect when doctors read this, they are going to skip that first step and go straight to combination drug therapy,” said Dr. Norman Edelman, senior medical advisor to the American Lung Association. COPD is the third leading cause of death worldwide, researchers said in
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background information. The disease makes it progressively more difficult for patients to draw a breath, with symptoms slowly worsening over time. The study involved government health data in Ontario on almost 12,000 people with COPD between 2003 and 2011, including 8,712 patients newly placed on combination therapy and 3,160 new users of long-acting beta agonists. The records involved real-world situations, with doctors treating patients according to their best judgment, Edelman noted. “It’s one thing to perform a drug trial and
select patients very carefully and see how your drugs perform, and another to look back and see how people have done in the real world with real doctors,” he said. Researchers found that about 37.3 percent of people died while using beta agonists alone, compared with 36.4 percent of people using the combination therapy. Similar results occurred for hospitalizations caused by COPD — about 30.1 percent for people on the single drug, versus 27.8 percent for people taking the combination. Overall, the use of combination therapy
reduced risk of death or hospitalization by 3.7 percent, compared with beta agonists alone, the study found. The greatest difference was among COPD patients who had also been diagnosed with asthma. Overall, those on combination therapy had a 6.5 percent reduced risk of either death or hospitalization compared with those taking a single drug. The researchers noted, however, that the combination therapy appeared to be less effective for people who are using inhaled long-acting anticholinergic medication, a different class of COPD medication that works by inhibiting the transmission of certain nerve impulses to help reverse airway resistance. Those who received the combination therapy and had never taken a long-acting anticholinergic had an 8.4 percent reduced risk of death or hospitalization. The findings are likely to reassure most physicians that they already are doing the right thing, given that many already are prescribing combination therapy, said Dr. Darcy Marciniuk, the immediate past president of the American College of Chest Physicians and head of the division of respirology, critical care and sleep medicine at the University of Saskatchewan in Saskatoon, Canada. Before paring down their patient sample for research purposes, the Canadian researchers determined that doctors had started 34,289 new patients on combination therapy during the period in question, compared with 3,258 who were prescribed beta agonists alone. “About 10 times more people were started on combination therapy than were started on the single therapy,” Marciniuk said. “That speaks for itself.” Source: HealthDay
More information The National Heart, Lung, and Blood Institute has more on COPD at www.nhlbi.nih.gov.
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