MedicaLink June 2015

The University Doctors

MedicaLink Celebrating 15 Years

Ask the University Doctors:

How hot is too hot to exercise outdoors?

Are parked cars a summertime danger for children?

What advice can you give to parents about teenagers and body image?

June 2015

Anesthesia and surgery still safest for necessary procedures, experts say

By TARA HAELLE HealthDay from an overall IQ test. A score of 100 is Having general anesthesia during surgery considered average. at a very young age may be linked to poorer In addition, those with a lower performance brain development, new research suggests.

Children who had received general anesthesia IQ and listening comprehension had slightly less gray matter in two areas at the back of during surgery before they turned four years their brains, the researchers found. of age later scored slightly lower on listening comprehension and parts of an IQ test, compared to children who had never had general anesthesia, the researchers found. The children’s overall IQ scores, however, remained within the normal range.

“It is difficult to see whether this decrease had any functional effect for an individual child,” said study author Dr. Andreas Loepke, a professor of clinical anesthesia and pediatrics at the University of Cincinnati College of Medicine.

But, he added, “these concerns make it obvious that a lot more research is needed to better understand the effects of anesthetics on brain development.”

The findings, published online June 8th and in the July More print issue of the journal evidence “The very receptors that Pediatrics, echo those of that general anesthetics act on to produce earlier studies that have anesthesia may unconsciousness during surgery pointed to a similar link. affect young are also important for stimulating Loepke and his colleagues brains neurons to form proper connections compared 53 children who and to survive,“ Loepke said. “Anesthetic had undergone surgery using hetic exposure may interfere with normal general anesthesia before they were brain development.“ four years old with 53 children who had never all However, one expert cautioned, this small been exposed to general anesthesia. Each ores study only shows a link between lower scores child from the first group was matched to ot and a history of general anesthesia. It cannot a child in the second group according to pment show that anesthesia caused brain development age, sex, socioeconomic status and being iatric problems, said Dr. Raafat Hannallah, a pediatric left- or right-handed. alth anesthesiologist at Children’s National Health All of the children underwent IQ and System in Washington, D.C. language development testing as well as “Studies in children have limitations that imaging with an MRI. The scores for all er prevent experts from understanding whether the children in both groups were within the the harmful effects, if any, were due to the normal range. anesthetic drugs or to other factors, such ass But the children with a history of surgery aid. the surgery or related illness,“ Hannallah said. had listening comprehension and performance at can Loepke also mentioned other factors that IQ scores that averaged three to six points lower nown occur during surgery that might have unknown than the kids without surgery. Performance effects, such as inflammation, pain or the IQ refers to several combined components

underlying medical problem being treated.

“Hence, our study cannot conclusively identify any of these factors to be the cause for the reported findings,“ he said.

In addition, skipping surgery may lead to similar or worse concerns about brain development, Loepke pointed out.

“Surgery is only performed to save lives or to prevent serious health complications,“ Loepke said. “So not performing these crucial surgeries may put the child at greater risk for developmental complications than the theoretical risk linked to the anesthetic exposure.“ The majority of children in this study underwent surgery for ear, nose or throat conditions, especially hearing conditions. General surgery and urology comprised the other two common surgery types.

“Concerns regarding the unknown risk of a surgical procedure and anesthetic exposure to a child’s brain development must be weighed against the potential harm associated with canceling or delaying a needed surgical or diagnostic procedure,“ Hannallah said. “The child’s doctors, including the physician anesthesiologist, are best able to provide this advice.“

ANESTHESIA

101

For those children who need surgical procedures, anesthesia and surgery today are “safer than ever,“ Loepke added. “Survival is much improved even for critically ill babies and procedures that were unthinkable just two or three decades ago,“ he said.

At least two previous studies, one from Australia and the other from the Mayo Clinic, also published in Pediatricsin 2011 and 2012, also found a potential link between anesthesia in young children undergoing surgery and language deficits.

Researchers are continuing to study both animals and children to learn more about whether anesthetics have any effect on brain development, Loepke said, but these findings should not be used to delay a necessary procedure.

“Bottom line, kids do not undergo anesthesia for the fun of it,“ Hannallah said. “They do because they need a surgical or diagnostic procedure to keep them healthy or cure an existing condition. This should not change based on current knowledge.“

MORE INFORMATION

For more on preparing children for anesthesia, visit the American Society of Anesthesiologists at asahq.org.

There are three main categories of anesthesia used in surgery and medical procedures, each having many forms and uses. They are general, regional and local.

• In general anesthesia, you are unconscious and have no awareness or sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein.

• In regional anesthesia, your physician anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake or be given a sedative. Either way, you do not feel the surgery taking place. There are several kinds of regional anesthesia; the two most common are spinal anesthesia and epidural anesthesia.

• In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the location of your body requiring minor surgery or a procedure.

The University Doctors MedicaLink

Are parked cars a summertime danger for children?

By Dr. Jacqueline Kaari, a pediatrician with The University Doctors, responds: No one thinks that it can happen to them, but on average, 37 children die from heatstroke every year after being left behind or becoming trapped in a parked car. Since 1998, more than half of the 640 children who have died this way were simply ‘forgotten’ by their parents or caregivers.

As startling as those statistics are, they don’t tell the whole story. There is no way to know how many ‘close calls’ there were, how many kids were rescued before the temperature inside the car became fatal. It is important to note, too, that it doesn’t require a heat wave for these tragedies to occur.

In one study published in Pediatrics, researchers monitored the temperature increases in a parked car over a 60-minute period on 16 different sunny days. The outside temperature on those days ranged from 72 to 96 degrees. On two of those days, the researchers left the windows opened 1.5 inches.

Regardless of the outside temperature or whether the windows were opened, the researchers found that the internal temperature of the car increased by 19 degrees in

Here are some tips from KidsAndCars.org to help you make sure a similar circumstance never occurs to you: • Put your briefcase, purse or cellphone in the back seat with your child.

• Arrange for your child’s daycare program to call you if your child doesn’t arrive at the usual time.

• Use drive through services at banks or curbside pickup at restaurants whenever your child is with you.

• Place something of your child’s, like a diaper bag, toy or school bag, in the front seat with you.

• Keep vehicles locked when parked and keep keys out of reach of children.

the first 10 minutes and by 29 degrees after 20 minutes. Even on the coolest days, the temperature inside the cars ultimately reached an average of 117 degrees with the majority of that increase occurring during the first 20 to 30 minutes.

The essential point to remember here is that it is dangerous to leave a child in a parked car, even for a few minutes, regardless of the outside temperature. The body of toddlers and infants will warm up several times faster than an adult’s, and their bodies aren’t able to get rid of that added heat through perspiration as well as adults. Because of that, children can experience the devastating effects of heat in a relatively short period of time. Heat stroke can occur when the body temperature reaches 104 degrees, causing symptoms – including dizziness, confusion, seizure and loss of consciousness – that can lead to death.

Sadly, children have died in parked cars or been seriously injured because their parents or caregivers just made a mistake. A change of routine, confusion disembarking after a trip or leaving a car unlocked have all too frequently led to a disastrous outcome.

Much of the heat inside a parked car comes from interior surfaces, such as the dashboard or steering wheel, absorbing heat from the sun’s rays and then releasing that heat to the air inside the car. So, remember to check the surface temperature Primary and preventive care from infancy through adolescence of car seats and buckles before allowing your child to touch them.

• Well baby and child visits • Immunizations If you do accidently leave a child in a parked car and return to find that child • School, camp and sports physicals • Check-ups asleep, don’t assume he or she is taking a nap. You could be seeing signs of heat exhaustion or heat stroke. Remove the child from the car immediately and call for Convenient hours include walk-in morning hours, Saturday morning emergency medical help if the child is unresponsive. At the same time, call 911 to and evening appointments. Most insurances accepted. report any child you see who is left alone in a car seat.

Dr. Jacqueline Kaari is a pediatrician with the University Doctors and chairs the Department of Pediatrics at the Rowan University School of Osteopathic Stratford 856-566-7040 Medicine. To schedule an appointment for your child, please call To schedule an appointment, 856-566-7040 (Stratford) or 856-582-0033 (Washington Township).

Sewell call 856-566-7040 856-582-0033

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Ask The University Doctors

What advice can you give to parents about teenagers and body image?

Dr. Jeffrey Aronowitz, a psychiatrist with The University Doctors, responds:

Negative body image is prevalent normal self-conscious behavior in their children and in our society. Nearly everyone, warning signs that something more serious is happening, regardless of age, has concerns about but one important warning sign to look for is isolation.

A child who doesn’t want to leave the house or participate their appearance. But young children in activities as in the past, may be developing more serious – elementary school children who mental health issues. Although are bullied it may be normal for a young and called “Because of the influence of media “fat” on the images and peer pressure, they see their teenager to feel self-conscious in a bathing suit, not wanting to playground bodies as being ‘wrong’ in shape, size go to the beach with family or or teenagers who are taunted or attractiveness as compared to how only wanting to do so early in the for the way they look – will someone ‘should’ look.” morning or late at night could be often experience a degree of cause for concern. Excessive or negative body image that can extreme dieting or exercise can also be indications of a more grow into larger issues of depression, anxiety or serious mental health issue. eating disorders.

Parents who notice these behaviors should, first, be A lot of the teenagers and children I see in my supportive and talk to their child. Reassure the child or teen practice have issues involving negative body image. that there is nothing wrong with the way he or she looks and Because of the influence of media images and peer pressure, they see their bodies as being ‘wrong’ in shape, that there is no need or reason to respond to peer pressure.

Parents who don’t feel confident in delivering this message size or attractiveness as compared to how someone can turn to role models, like teachers, guidance counselors or ‘should’ look.

According to the National Eating Disorders coaches that the child looks up to.

Association, 30 million Americans have suffered from Parents should also be aware that their own behavior can an eating disorder at some point in their lives and body send the wrong message to their child. Pushing children too dissatisfaction is the best-known contributor to eating hard to be successful – whether that means being popular, disorders. Research published in 2004 examined that athletic or looking a certain way – can instead influence the connection. In the study, researchers looked at body child to look for something he or she can control, which, in image and associated psychological traits in 154 college turn, can lead to the beginnings of an eating disorder. age men and found that the men displayed “substantial Like so much of parenting, understanding when a child’s body dissatisfaction” that was closely associated with body image becomes a reason for concern comes down “depression, measures of eating pathology...and to a judgement call. The important thing for parents to low self-esteem.” recognize, however, is that negative body image is a very real When a child with a negative body issue develops phenomenon, and one that could get worse. If you suspect an eating disorder, the that is happening with your child, ask “..controlling their food intake gives your family physician to recommend a reason isn’t just a desire to lose weight. In fact, them the feeling that they have control therapist who can help. the motivating factor To schedule an appointment with a over their lives.” usually is more about Family Medicine physician, please call control than it is about food or body image. For the the following locations: Forked River (609-756-0000), teenagers with an eating disorder, controlling their food Glassboro (856-256-4333), Hammonton intake gives them the feeling that they have control (609-704-0185), Mount Laurel (856-380-2400), over their lives. The same holds true for children Sewell (856-218-0300), or Stratford (856-566-7020). with difficult family backgrounds involving parental substance abuse. Food intake becomes the one thing the child can control in an unpredictable environment.

It isn’t always easy for parents to distinguish between

The University Doctors MedicaLink Ask The University Doctors

How hot is too hot to exercise outdoors?

Dr. Samantha Plasner, a family physician with The University Doctors, responds: As we approach the first full days of summer, we’ve already seen afternoon temperatures in the mid to upper 80s with a few 90 degree days sprinkled in. Whether it’s to exercise, attend to yardwork or visit an amusement park, warm summer days invite everyone to increase their outdoor activities.

Along with the many benefits of engaging in physical activity out of doors in the summer, ignoring the warning signs of heat related illness could lead to a life threatening event.

The two most important words to keep in mind when working or exercising in warm weather are prevention and hydration.

On most summer days, temperatures begin to climb in the late morning, with the sun’s rays becoming most intense around midday. And even though the intensity of the sunlight slowly fades over the next several hours,

air temperatures will continue to rise as the earth’s surface releases the heat it absorbed earlier in the day.

We’ve all experienced this rise in temperature, yet I always see people out on their Sunday run at 1:00 p.m. This is absolutely the wrong thing to do. Even highly-trained, professional athletes succumb to the heat, and if it can happen to them, it can certainly occur with those of us who are more ‘weekend warrior’ than professional athlete.

So the first rule of thumb when exercising or working outside in summer is to simply avoid doing so in the warmest part of the day. Ideally, you should exercise early in the day or later in the evening when the air and surface temperatures are lower.

Our bodies depend on fluids – primarily water – to remain alive. Through perspiration, exhalation and excretion, adults lose about 10 cups of

two words: prevention and hydration

“Through perspiration, exhalation and excretion, adults lose about 10 cups of moisture every day, and that amount can increase significantly in the summer.” moisture every day, and that amount can increase significantly in the summer. Dehydration occurs when our bodies are losing more water than they take in.

Drinking plenty of fluids before and during exercise is the best way to prevent dehydration.

Water is the best choice for prevention, but once you are dehydrated water really can’t get you ‘caught up.’ If you become dehydrated, you will need to replace what your body has lost with a fluid that has electrolytes in it, such as sodium. Most sports drinks will do that in people who are only mildly dehydrated, but moderate to severe dehydration may require medical attention that includes intravenous (IV) fluids.

If you are thirsty, your body has already started to become dehydrated. Dehydration is also cumulative, meaning that you can become dehydrated slowly as you exercise over a period of days. Individuals with chronic medical conditions like diabetes and heart disease are more prone to dehydration, and certain medications such as those to control high blood pressure can also contribute to dehydration.

When adequately hydrated, our bodies are amazing cooling machines, keeping our internal temperature fairly constant at just below 99 degrees.

Despite that, even individuals who are careful can succumb to heat-related illness caused by

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 dehydration. Knowing these signs of heat illnesses and taking precautions against them could be a life-saver: • Heat exhaustion causes headache, dizziness, weakness and nausea. Treat it with rest, drinks of cool water every 10 - 15 minutes and apply cool, wet cloths directly to the skin. Seek immediate medical help if symptoms don’t improve quickly or suddenly worsen.

• Heat stroke causes all the same symptoms, with little or no perspiration. Other signs include fainting, staggering or acting in a strange or confused manner.

Heat stroke is a life threatening condition. If you suspect heat stroke, call 911 or emergency medical services for immediate help.

• Finally, be sure to check with your physician before beginning any exercise program or significantly increasing the intensity of your exercise.

To schedule an appointment with Dr. Plasner, please call 856-380-2400. The Mount Laurel office is located at 100 Century Parkway, Suite 140, Mount Laurel, NJ 08054.

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Sit back and relax, leave fireworks to the pros With warm weather and family events, the Fourth of July can be a fun time with great memories. But before your family celebrates, make sure everyone knows about fireworks safety.

If not handled properly, fireworks can cause burn and eye injuries in kids and adults. The best way to protect your family is not to use any fireworks at home — period. Attend public fireworks displays, and leave the lighting to the professionals.

Lighting fireworks at home isn't even legal in many areas, so if you still want to use them, be sure to check with your local police department first. If they're legal where you live, keep these safety tips in mind: Kids should never play with fireworks.

Things like firecrackers, rockets, and sparklers are just too dangerous. If you give kids sparklers, make sure they keep them outside and away from the face, clothing, and hair.

Sparklers can reach 1,800°F (982°C) — hot enough to melt gold.

Buy only legal fireworks (legal fireworks have a label with the manufacturer's name and directions; illegal ones are unlabeled),

FIREWORKS

BY THE NUMBERS

and store them in a cool, dry place. Illegal fireworks usually go by the names M-80, M100, blockbuster, or quarterpounder.

These explosives were banned in 1966, but still account for many fireworks injuries.

• Never try to make your own fireworks.

• Always use fireworks outside and have a bucket of water and a hose nearby in case of accidents.

• Steer clear of others — fireworks have been known to backfire or shoot off in the wrong direction. Never throw or point fireworks at someone, even in jest.

• Don't hold fireworks in your hand or have any part of your body over them while lighting. Wear some sort of eye protection, and avoid carrying fireworks in your pocket — the friction could set them off.

• Point fireworks away from homes, and keep away from brush and leaves and

flammable substances. The National Fire Protection Association estimates that local fire departments respond to more 50,000 fires caused by fireworks each year.

(57%) (30%) (74%)

of the 2012 fireworks injuries were burns, while almost one-fifth (18%) were contusions or lacerations.

Source: The Nemours Foundation and The National Council on Fireworks Safety.

In 2012, U.S. hospital emergency rooms saw an estimated 8,700 people for fireworks-related injuries.

The detailed statistics below are based only on injuries seen from June 22-July 22, 2012.

Source: Consumer Product Safety Commission.

Almost three out of five

• Light one firework at a time (not in glass or metal containers), and never relight a dud.

• Don't allow kids to pick up pieces of fireworks after an event. Some may still be ignited and can explode at any time.

• Soak all fireworks in a bucket of water before throwing them in the trash can.

• Think about your pet.

Animals have sensitive ears and can be extremely frightened or stressed on the Fourth of July. Keep pets indoors to reduce the risk that they'll run loose or get injured.

• FAA regulations PROHIBIT the possession and transportation of fireworks in your checked baggage or carry-on luggage.

If a child is injured by fireworks, immediately go to a doctor or hospital. If an eye injury occurs, don't allow your child to touch or rub it, as this may cause even more damage. Also, don't flush the eye out with water or attempt to put any ointment on it.

Instead, cut out the bottom of a paper cup, place it around the eye, and immediately seek medical attention — your child's eyesight may depend on it.

If it's a burn, remove clothing from the burned area and run cool, not cold, water over the burn (do not use ice). Call your doctor immediately.

Fireworks are meant to be enjoyed, but you'll enjoy them much more knowing your family is safe. Take extra precautions this Fourth of July and your holiday will be a blast!

Three out of ten

people injured by fireworks were under the age of 15.

Males accounted for three-quarters of the injuries.

The risk of fireworks injury was highest for young people ages 15-24 followed by children under 10.

(25%)

Sparklers, fountains and novelties alone accounted for one-quarter

of the emergency room fireworks injuries in 2012.

Food safety is key to enjoying summertime cookouts Haul out the barbeque, 'tis the season for outdoor cooking. But warm weather can also provide the ideal climate for germs. Put these food safety tips into practice at your next friendly gathering and avoid getting sick.

FROM THE STORE: HOME FIRST When shopping, buy cold food like meat and poultry last, right before checkout. Separate raw meat and poultry from other food in your shopping cart. To guard against cross-contamination — which can happen when raw meat or poultry juices drip on other food — put packages of raw meat and poultry into plastic bags.

Plan to drive directly home from the grocery store. You may want to take a cooler with ice for perishables. Always refrigerate perishable food within 2 hours. Refrigerate within 1 hour when the temperature is above 90° F. At home, place meat and poultry in the refrigerator immediately. Freeze poultry and ground meat that won't be used in one or two days; freeze other meat within four to five days.

THAW SAFELY Completely thaw meat and poultry before grilling so it cooks more evenly. Use the refrigerator for slow, safe thawing or thaw sealed packages in cold water.

For quicker thawing, you can microwave defrost if the food will be placed immediately on the grill.

MARINATING A marinade is a savory, acidic sauce in which a food is soaked to enrich its flavor or to tenderize it. Marinate food in the refrigerator, not on the counter. Poultry and cubed meat or stew meat can be marinated up to two days. Beef, veal, pork, and lamb roasts, chops, and steaks may be marinated up to five days. If some of the marinade is to be used as a sauce on the cooked food, reserve a portion of the marinade before putting raw meat and poultry in it. However, if the marinade used on raw meat or poultry is to be reused, make sure to let it come to a boil first to destroy any harmful bacteria.

TRANSPORTING When carrying food to another location, keep it cold to minimize bacterial growth. Use an insulated cooler with sufficient ice or ice packs to keep the food at 40° F or below. Pack food right from the refrigerator into the cooler immediately before leaving home.

SERVING THE FOOD When taking food off the grill, use a clean platter. Don't put cooked food on the same platter that held raw meat or poultry. Any harmful bacteria present in the raw meat juices could contaminate safely cooked food.

In hot weather (above 90° F), food should never sit out for more than one hour.

KEEP COLD FOOD COLD Keep meat and poultry refrigerated until ready to use. Only take out the meat and poultry that will immediately be placed on the grill.

When using a cooler, keep it out of the direct sun by placing it in the shade or shelter. Avoid opening the lid too often, which lets cold air out and warm air in. Pack beverages in one cooler and perishables in a separate cooler.

KEEP EVERYTHING CLEAN Be sure there are plenty of clean utensils and platters. To prevent foodborne illness, don't use the same platter and utensils for raw and cooked meat and poultry. Harmful bacteria present in raw meat and poultry and their juices can contaminate safely cooked food.

If you're eating away from home, find out if there's a source of clean water. If not, bring water for preparation and cleaning. Or pack clean cloths, and moist towelettes for cleaning surfaces and hands.

PRECOOKING Precooking food partially in the microwave, oven, or stove is a good way of reducing grilling time. Just make sure that the food goes immediately on the preheated grill to complete cooking.

LEFTOVERS Refrigerate any leftovers promptly in shallow containers. Discard food left out more than two hours (one hour if temperatures are above 90º F).

KEEP HOT FOOD HOT After cooking meat and poultry on the grill, keep it hot until served — at 140° F or warmer.

Keep cooked meats hot by setting them to the side of the grill rack, not directly over the coals where they could overcook. At home, the cooked meat can be kept hot in an oven set at approximately 200º F, in a chafing dish or tray.

HEALTH TIP

Healthy Grilling Options Choose from a variety of meats, veggies and fruit

T

he grill is a great way to cook healthy foods without heating up the kitchen.

Choose lean meats, such as skinless chicken, 96 percent lean ground beef, pork tenderloin, bison, sirloin or flank steak or fish. Vegetarian options may include tofu or black bean burgers.

• Skip oils and marinades in favor of a flavorful dry or low-sodium seasoning rubbed into meat.

• Grill veggies, such as corn on the cob, zucchini, broccoli, yellow squash, asparagus or sweet potato.

• For dessert, grill some fruit, such as sliced pineapple or peaches.

Source: The Academy of Nutrition and Dietetics

COOK THOROUGHLY Cook food to a safe minimum internal temperature to destroy harmful bacteria. Meat and poultry cooked on a grill often browns very fast on the outside. Use a food thermometer to be sure the food has reached a safe minimum internal temperature.

MEATS Cook all raw beef, pork, lamb and veal steaks, chops, and roasts to a minimum internal temperature of 145° F as measured with a food thermometer before removing meat from the heat source. For safety and quality, allow meat to rest for at least three minutes before carving or consuming.

For reasons of personal preference, consumers may choose to cook meat to higher temperatures.

GROUND MEATS Cook all raw ground beef, pork, lamb, and veal to an internal temperature of 160º F as measured with a food thermometer.

POULTRY Cook all poultry to a safe minimum internal temperature of 165° F as measured with a food thermometer.

NEVER partially grill meat or poultry and finish cooking later.

Source: U.S. Food and Agriculture Department, Barbeque and Food Safety.

June is Sickle Cell Anemia Month

Few sickle cell patients getting beneficial drug, study finds

By AMY NORTON HealthDay Few U.S. adults with sickle cell anemia are getting a recommended medication that can help them manage pain, breathing problems and other debilitating symptoms, according to a recent study.

Using a national database, researchers found that less than one-quarter of sickle cell patients who should have been taking a drug called hydroxyurea actually were.

"This is a medication that's highly beneficial and yet most people aren't getting it," said Dr. George Buchanan, a sickle cell expert, and a professor at the University of Texas Southwestern Medical Center at Dallas, who was not involved in the recent study.

Findings from the study were reported in the April issue of the Journal of the American Medical Association.

Sickle cell anemia is an inherited disease that mainly affects people of African, South American or Mediterranean descent. In the United States, about one in 500 African-American children are born with the

MORE INFORMATION

condition, according to the U.S. National Heart, Lung, and Blood Institute (NHLBI).

The central problem in sickle cell is that the body produces red blood cells that are crescent-shaped, rather than disc-shaped. Those abnormal cells tend to be sticky and can block blood flow — causing symptoms such as fatigue and shortness of breath.

Many people with sickle cell also suffer sudden bouts of pain due to poor blood flow. And according to treatment guidelines released last year, adults who have three or more pain 'crises' within a year should be prescribed hydroxyurea.

Hydroxyurea was originally developed as a cancer drug, but it treats sickle cell by prompting the body to make fetal hemoglobin — an oxygen-carrying protein in red blood cells. That, in turn, helps keep red blood cells from becoming stiff, sticky and crescent-shaped, according to the NHLBI. "My own view is, the vast majority of people with sickle cell anemia should be taking hydroxyurea," said Buchanan, who helped develop the latest treatment guidelines.

He added that people who work in the field have long known that hydroxyurea is underused, but this study offers hard numbers.

"The findings are not surprising, but they're very disappointing," Buchanan said.

So why aren't more people who need it getting the drug? There are several issues, said Dr. Michael DeBaun, who directs the sickle cell treatment center at Vanderbilt University in Nashville, TN. For one, DeBaun explained, there are few hematologists who specialize in treating sickle cell patients — especially adults. So people with the disease often see only a primary care doctor.

But because sickle cell is relatively rare, DeBaun said, most primary care doctors have little experience treating it.

Add to that the fact that they may know little about hydroxyurea. "It's a cancer drug," DeBaun said, "and most internists do not go through their training learning how to manage a chemotherapy agent."

Another issue, DeBaun said, is that many sickle cell patients are low-income blacks. Some may be uninsured or "under-insured," and possibly have no consistent health provider. Plus, they often live in areas, whether rural or urban, that lack specialists in the disease, DeBaun explained.

For the study, Dr. Nicolas Stettler and colleagues at the Lewin Group in Falls Church, VA, used a database with information on almost 27 million Americans' health insurance claims.

The researchers identified nearly 700 adults with sickle cell who fit the criteria for taking hydroxyurea.

But based on their records, only 23 percent were using the drug within a year of their last pain crisis.

And that figure, Stettler said, may actually be an underestimate of the problem, because it doesn't account for sickle cell patients on Medicaid or the uninsured.

The results underscore a need for education, for both doctors and patients, according to Stettler.

He suggested that people with sickle cell ask their doctor whether they should be getting hydroxyurea, or any other therapies in the treatment guidelines — which are available online.

Hydroxyurea is not without risks: It can lower the number of white blood cells and platelets in the bloodstream, which could leave people at risk of infections or bleeding. That means patients have to get periodic blood tests, Buchanan said.

But in general, he stressed, hydroxyurea is considered a safe and effective drug.

According to DeBaun, broader efforts are needed to raise awareness of existing sickle cell treatments, and spur more research into new ones. He said sickle cell patients need more-vocal advocacy groups, and more attention from policymakers.

"Care could improve if more health care resources were allocated to sickle cell," DeBaun said.

The U.S. National Heart, Lung, and Blood Institute has the latest sickle cell treatments atwww.nhlbi.nih.gov.

Did you Know It is estimated that between 90 to 100,000 Americans are living with sickle-cell anemia, many of them African-American and people of color. One out of every 500 AfricanAmerican babies is born with sickle cell, one in 12 AfricanAmericans are carriers of the sickle-cell anemia gene.

Symptoms include:

Fatigue Paleness • Rapid heart rate • Shortness of breath • Yellowing of the eyes and skin (jaundice) • Stroke • Swelling of hands and feet • Bacterial infections • Leg ulcers • Eye Damage • Lung and heart injury • •

June is Men’s Health Month

Easy things men can do to improve their health.

There are many easy things men can do every day to improve their health and stay healthy.

GET GOOD SLEEP Insufficient sleep is associated with a number of chronic diseases and conditions, such as diabetes, cardiovascular disease, obesity, and depression. Also, insufficient sleep is responsible for motor vehicle and machineryrelated accidents, causing substantial injury and disability each year. Sleep guidelines from the National Sleep Foundation have noted that sleep needs change as we age. In general, adults need between seven to nine hours of sleep.

Celebrate National Men’s Health by doing some of these things: •

TAKE A BIKE RIDE.

• TOSS

A BALL.

•

EAT LESS SALT.

•

TRY MORE VEGGIES.

chest pain, shortness of breath, excessive thirst, and problems with urination. If you have these or symptoms of any kind, be sure to see your doctor right away. Don’t wait!

HEART DISEASE SIGNS AND SYMPTOMS Keep track of your numbers for blood pressure, blood glucose, cholesterol, body mass index (BMI), or any others you may have. If your numbers are high or low, your doctor or nurse can explain what they mean and suggest how you can get them to a healthier range. Be sure to ask him or her what tests you need and how often you need them.

TOSS OUT THE TOBACCO

GET VACCINATED

It’s never too late to quit. Quitting smoking has immediate and long-term benefits. It improves your health and lowers your risk of heart disease, cancer, lung disease, and other smoking-related illnesses.

Also avoid being around secondhand smoke. Inhaling other people's smoke causes health problems similar to those that smokers have. Babies and kids are still growing, so the poisons in secondhand smoke hurt them more than adults.

Everyone needs immunizations to stay healthy, no matter how old you are. Even if you had vaccines as a child, immunity can fade with time. Vaccine recommendations are based on a variety of factors, including age, overall health, and your medical history.

Vaccines can protect you, your loved ones, and your community from serious diseases like: influenza (flu); shingles; pneumococcal disease; human papillomavirus (HPV) infection; and tetanus, diphtheria, and pertussis (whopping cough) — all three of which the Tdap shot protects against.

Other vaccinations you may need include those that protect against hepatitis A, hepatitis B, chickenpox (varicella), measles, mumps, and rubella. Ask your doctor or nurse which vaccines you need to stay healthy.

MOVE MORE Adults need at least two-and-a-half hours of moderate-intensity aerobic activity (such as brisk walking) every week, and muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) on two or more days a week. You don't have to do it all at once. Spread your activity out during the week, and break it into smaller chunks of time during the day.

TAME STRESS Sometimes stress can be good. However, it can be harmful when it is severe enough to make you feel overwhelmed and out of control. Take care of yourself. Avoid drugs and alcohol. Find support. Connect socially.

Stay active.

EAT HEALTHY

STAY ON TOP OF YOUR GAME

Eat a variety of fruits and vegetables every day. They are sources of many vitamins, minerals, and other natural substances that may help protect you from chronic diseases. Limit foods and drinks high in calories, sugar, salt, fat, and alcohol. Choose healthy snacks.

See your doctor or nurse for regular checkups. Certain diseases and conditions may not have symptoms, so checkups help diagnose issues early or before they can become a problem.

Pay attention to signs and symptoms such as

FIND AFFORDABLE HEALTHCARE Federally funded health centers around the United States provide care, even if you have no health insurance. You can get health care and pay what you can afford, based on your income.

Men& Cancer Every year, more than 300,000 men in America lose their lives to cancer. You can lower your cancer risk in several ways.

What You Can Do: Don’t smoke, and avoid secondhand smoke.

More men in the United States die from lung cancer than any other type of cancer, and cigarette smoking causes most cases.

• If you’re 50 or older, get screened for colorectal cancer. Screening tests can can help prevent colorectal cancer or find it early, when treatment works best.

• Protect your skin from the sun. Skin cancer is the most common cancer in the United States.

Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to ultraviolet (UV) light from the sun and tanning devices. When you’re outside, follow our easy sun safety tips.

• Stay active and keep a healthy weight.

Adopting a lifestyle that includes healthy eating and regular physical activity can help lower your risk for several kinds of cancer.

•

About

VACCINATIONS

Seasonal flu (influenza) vaccine All adults need a flu vaccine every year.

Flu vaccine is especially important for people with chronic health conditions, pregnant women, and older adults.

Td or Tdap vaccine Every adult should get the Tdap vaccine once if they did not receive it as an adolescent to protect against pertussis (whooping cough), and then a Td (tetanus, diphtheria) booster shot every 10 years. In addition, women should get the Tdap vaccine each time they are pregnant, preferably at 27 through 36 weeks.

Talk with your doctor or other health care professional to find out which vaccines are recommended for you at your next medical appointment.

The University Doctors MedicaLink

Make an appointment with one of our ‘Top Docs’ today The University Doctors is a committed team of physicians and health care professionals dedicated to serving the South Jersey community. With expertise in multiple disciplines, we focus on treating all your health care needs at all stages of your life. As faculty members at Rowan University School of Osteopathic Medicine (RowanSOM), we are in tune with the latest treatments and advances in medicine.

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Most insurances accepted.

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Kennedy Health is the principal hospital of the Rowan University School of Osteopathic Medicine. Other affiliated hospitals and health systems include Lourdes Health System, Inspira Health Network, Cooper University Hospital, Meridian Health System, Christ Hospital and Atlantic Health System.