MedicaLink, April 2015

The University Doctors

MedicaLink Celebrating 15 Years

“Why are some health conditions more common among different ethnic groups?

Can probiotics be used to treat irritable bowel syndrome?

Medical students give their Family Medicine professors’ children a check-up

April 2015

Experts issue guidelines for treating irritable bowel syndrome

By RANDY DOTINGA HealthDay An estimated 5 percent to 15 percent of the world’s population has irritable bowel syndrome, a condition that can cause symptoms such as abdominal pain, diarrhea or constipation, cramping and bloating, and gas. It can affect people at any age but is especially common when people are in their 20s and 30s.

The treatment of irritable bowel syndrome and a type of constipation known as chronic idiopathic constipation reveal a number of proven treatments for these two common conditions.

“There’s a greater variety of approaches which reflect a greater understanding of the disorders,” said guidelines co-author Dr. Eamonn Quigley, chief of the division of gastroenterology and hepatology at Houston Methodist Hospital.

“We now have a better opportunity to improve the lives of our patients,” Quigley said.

The condition can be difficult to diagnose because other conditions share the same symptoms. Unlike other conditions, however, there’s no specific diagnostic test for irritable bowel syndrome, he noted. Physicians must rely purely on symptoms to make the diagnosis.

To treat the condition, the American College of Gastroenterology say there’s evidence to support the following treatments for irritable bowel syndrome: • Fiber (psyllium especially when compared to bran) • Probiotics • An antibiotic called rifaximin (Rifagut) • Medications known as linaclotide (Linzess) and lubiprostone (Amitiza) The irritable bowel syndrome guidelines also say that research has boosted the case

MORE INFORMATION

Certain interventions may ease IBS, while others work against chronic constipation for using antidepressant medications and psychological therapy.

Probiotics are a hot topic in medicine.

Quigley said research supports their use, but it’s not clear which ones are best. “We need more studies comparing doses and preparations, and there hasn’t been a lot of that done,” he said. Still, probiotics are safe and patients tolerate them well, he noted.

“In regards to specifics, patients have to talk to their doctor,” Quigley said.

Dr. William Chey, a gastroenterologist and professor of medicine at the University of Michigan, agreed that it’s difficult to decide which probiotic product to recommend. He said one possibility is the product known as Align, which is widely available.

However, the guidelines indicate that there’s not enough evidence to support the use of prebiotics (components of food that can’t be digested and promote healthy bacteria) and synbiotics (products that combine probiotics and prebiotics).

As for diet, Quigley said there’s some evidence that gluten-free diets and so-called “FODMAP” diets can help reduce symptoms of irritable bowel syndrome.

FODMAP diets cut out potentially troublesome foods, such as certain added sugars, and then reintroduce them to the diets of patients to help figure out which ones cause symptoms.

Chey said the guidelines slightly understate the value of treatments that involve changing diet since there’s evidence that “diet plays a role in the development of the condition and has a role in treatment.”

For patients with chronic idiopathic constipation, Quigley said, “there are a lot of relatively simple and relatively inexpensive treatments that work for constipation, and most of them are pretty safe.”

Chronic idiopathic constipation is longterm constipation that doesn’t have a known cause. Approximately 10 percent to 15 percent of the general population suffers from this condition.

The guidelines for chronic idiopathic constipation strongly recommend the use of fiber supplements plus laxatives such as polyethylene glycol (MiraLax), lactulose (Generlac), sodium picosulfate and bisacodyl (Dulcolax).

The guidelines also strongly recommend linaclotide (Linzess) and lubiprostone (Amitiza), which also appear in the recommendations to treat irritable bowel syndrome, and prucalopride (Resolor).

Some of these drugs are available over the counter, Quigley said. Prescription drugs are available for people with more severe cases of constipation, he said.

For more about irritable bowel syndrome, try the U.S. National Institute of Diabetes and Digestive and Kidney Diseases at www.niddk.nih.gov.

HEALTH TIP

What’s Triggering Your IBS?

Irritable bowel syndrome (IBS) may be characterized by symptoms including abdominal discomfort, diarrhea, gas, constipation and bloating.

• Certain foods, particularly dairy, chocolate, cabbage, cauliflower, beans, fruit, broccoli, high-fat foods, alcohol and carbonated beverages.

•E motional stress can worsen IBS symptoms, but may not cause them.

•C hanges in hormone levels, such as during menstruation.

•C onditions such as gastroenteritis, or excess bacteria in the gut.

Source: The Mayo Clinic

HEALTH TIP

Manage IBS With Diet

Irritable bowel syndrome is a collection of symptoms that can be aggravated by the foods you eat and how much you eat.

• Eat at consistent times each day to help regulate bowel function.

• Avoid large, heavy meals in favor of smaller, lighter ones.

• Eat plenty of foods rich in fiber, such as whole grains and produce.

• Drink plenty of water and other fluids. Limit alcohol, caffeine and artificial sweeteners.

• Keep a food diary to help identify problem foods and poor eating habits.

Source: The Academy of Nutrition and Dietetics

National Autism Awareness Month celebrates 45 years

By KATHLENN DOHENY HealthDay Autism is a complex mental condition and developmental disability, characterized by difficulties in the way a person communicates and interacts with other people. Autism can be present from birth or form during early childhood (typically within the first three years). Autism is a lifelong developmental disability with no single known cause.

But it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to neurotypical children. Researchers do not know the exact cause of autism but are investigating a number of theories, including the links among heredity, genetics and medical problems.

In many families, there appears to be a pattern of autism or related disabilities, further supporting the theory that the disorder has a genetic basis. While no one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that children with autism may have inherited. It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single “trigger” that causes autism to develop.

Other researchers are investigating the possibility that under certain conditions, a cluster of unstable genes may interfere with brain development, resulting in autism. Still other researchers are investigating problems during pregnancy or delivery as well as environmental factors such as viral infections, metabolic imbalances and exposure to chemicals.

GENETIC VULNERABILITY

Autism tends to occur more frequently than expected among individuals who have certain medical conditions, including fragile X syndrome, tuberous sclerosis, congenital rubella

syndrome and untreated phenylketonuria (PKU). Some harmful substances ingested during pregnancy also have been associated with an increased risk of autism.

ENVIRONMENTAL FACTORS Research indicates other factors besides the genetic component are contributing to the rise in increasing occurrence of autism —for example, environmental toxins (e.g., heavy metals such as mercury), which are more prevalent than in the past. Those with autism (or those at risk) may be especially vulnerable to such toxins, as their ability to metabolize and detoxify these exposures might be compromised.

People with autism are classed as having Autism Spectrum Disorder (ASD) and the terms autism and ASD are often used interchangeably. A wide spectrum disorder, people with autism have a set of symptoms unique to themselves; no two people with autism are the same.

CHARACTERISTICS OF AUTISM While no two people with autism will have the same set of symptoms, there are common characteristics found in those with this complex disability. Briefly, these characteristics include: Social skills People with autism have problems interacting with others; autistic children do not have adequate playing and talking skills.

Mild symptoms on one end of the spectrum may be displayed through clumsy behavior, being out of sync with those around them and inappropriate or offensive comments being made. At the other end of the spectrum, an autistic person may not be interested in others.

DID YOU KNOW?

APRIL 1970 The first National Autism Awareness Month was declared by the Autism Society

Empathy Empathy is the ability to recognize and understand the feelings of another person. People with autism find it harder to show

empathy to others although they can be taught to acknowledge the feelings of others.

D The Puzzle

Ribbon is the symbol for Autism Awareness and is promoted by the Autism Society.

Physical contact In some cases, autistic people do not like physical contact such as hugs, tickling or physical play with others.

Sudden changes to their environment A sudden change in the surrounding environment may affect a person with autism. It could be a loud noise, a change in intensity of lighting or even a change in smell.

Speech issues Speech can be affected in people with autism. Echolalia is a typical speech symptom in which the person repeats words and phrases that they hear. The speech tone of an autistic person may be monotonous. Where symptoms are more extreme the person may not speak.

Changes to behavior and routine People with autism often display repetitive behavior in which they repeat the same action many times over.

For example, a person with autism may repeatedly pace around a room in a certain direction. Any change to their behavior or routine can be unsettling for them. This could be a reordering of daily activities such as when a person brushes their teeth, takes a shower and has breakfast when they get up in the morning.

Other characteristics of autism include an unpredictable learning rate, obsessions and physical tics.

Source: HealthDay and the Autism Society.

Facts and Statistics • About 1

percent of the world population has autism spectrum disorder.

• Prevalence in the United States is estimated at 1 in 68 births.

• More than 3.5 million Americans live with an autism spectrum disorder.

• Prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68).

• Autism is the fastest-growing developmental disability.

• Prevalence has increased by 6 to15 percent each year from 2002 to 2010.

• Autism services cost U.S. citizens $236 to $262 billion annually.

• A majority of costs in the U.S. are in adult services —$175 to $196 billion, compared to $61 to $66 billion for children.

• In 10 years, the annual cost will be $200 to $400 billion.

• Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention.

• The U.S. cost of autism over a lifespan is about $2.4 million for a person with an intellectual disability, or $1.4 million for a person without intellectual disability.

•3 5 percent of young adults (ages 19 to 23) with autism have not had a job or received postgraduate education after leaving high school.

• It costs more than $8,600 extra per year to educate a student with autism. The average cost of educating a student is about $12,000.

Abused kids not destined to be abusive parents

National Child Abuse Prevention Month

The Child Abuse Prevention and Treatment Act (CAPTA), originally passed in 1974, brought national attention to the need to protect vulnerable children in the United States.

By AMY NORTON HealthDay

Conventional wisdom says that abused children often grow up to be abusive parents, but a 30-year study of American families suggests it's more complicated than that.

In one striking finding, researchers uncovered little evidence that physical abuse is passed from one generation to the next.

"That was extremely surprising," said lead researcher Cathy Spatz Widom, a professor of psychology at John Jay College of Criminal Justice, in New York City. "The theory has been that children of parents who were abused are at increased risk of physical abuse."

That theory has been supported by past research. But, Widom explained, those studies have been hampered by limitations, such as working "backward" — starting with parents accused of abuse, and asking them if they'd been mistreated as kids.

"The problem there is, you miss the parents who were abused but did not go on to have these issues," Widom explained.

Her study, published in the March 27th issue of Science, followed two generations of families, including over 1,100 parents and their kids.

More than half of the parents had been abused or neglected as children, back in the 1960s and 1970s; the rest had no history of abuse, but were from similar backgrounds.

To see whether the children of abused parents were at risk, Widom's team used three sources: Records from child protective services (CPS);

GET HELP:

Childhelp is a national organization that provides crisis assistance and other counseling and referral services. The Childhelp National Child Abuse Hotline is staffed 24 hours a day, 7 days a week, with professional crisis counselors who have access to a database of 55,000 emergency, social service, and support resources. All calls are anonymous. Contact them at 1-800-422-4453. physical abuse, versus just over 5 percent of the comparison group — a difference that was not statistically significant.

In contrast, children of abused parents were at higher risk of sexual abuse or neglect, the finding showed.

There's no clear explanation for the difference between physical abuse and other forms of mistreatment, according to Widom.

"It's really puzzling to us," she said. "We need more research to dig into the reasons."

Dr. Kristine Campbell, a pediatrician who studies child abuse, commended the work.

In one striking finding, researchers uncovered little evidence that physical abuse is passed from one generation to the next. interviews with parents; and interviews with their children once they were young adults.

Overall, the researchers found, children of abused parents were at no greater risk of physical abuse. And that was true whether the information came from parents' or children's reports, or CPS records.

Based on CPS reports, for example, almost 7 percent of kids born to abused parents suffered

"This is a very impressive research effort," said Campbell, an associate professor at the University of Utah, in Salt Lake City.

"There has long been acceptance that abuse is passed down through generations, almost like eye color or skin tone," Campbell said.

In her personal experience, she added, "I've seen this presented as a reason to suspect a parent of abusing a child. I've also seen parents terrified

that they are predestined to abuse their child because of their own histories of maltreatment."

But these findings show that's not the case, Campbell said.

Widom agreed. "Parents shouldn't feel they're doomed to continuing the cycle of abuse," she said.

Her team did, however, find that authorities may have a "bias" toward detecting abuse when parents have a history of child mistreatment.

The researchers looked at the rate of official CPS reports among all parents and kids who reported abuse or neglect: When it came to families where parents had been abused, about 30 percent of abuse cases involved an official CPS report; among other families, CPS picked up only 15 percent of abuse cases.

How would that happen? Widom speculated that parents with a history of child abuse may use more social services in general.

"Each time you're in contact with social services," Widom said, "there's an opportunity to be observed by the people working for those agencies, and they're mandated to report suspected child abuse."

But that does not mean abuse is "overdetected" in those families, Campbell stressed.

Instead, she said, the findings imply that the

system often misses child mistreatment — especially in families where parents have no history of abuse.

Despite that sobering take-away, Campbell also saw "good news" in the findings.

"The substantial majority of parents who have experienced child abuse will never abuse their own children," Campbell said.

And for those struggling to get past their childhood mistreatment, many communities have programs that help young moms and dads build their parenting skills, she added.

According to Widom, future studies should dig for the reasons why some abused kids become abusive parents, while many others do not.

Campbell agreed. “If we want to work on child abuse prevention, we need to better understand the perpetrators of abuse,” she said.

“My experience is that very few parents who abuse their children can simply be dismissed as ‘monsters.’”

MORE INFORMATION

The U.S. Department of Health and Human Services has more on child abuse prevention at www.hhs.gov.

Migraine drug may up risk of eating disorders in some teens

By KATHLEEN DOHENY HealthDay

A new report has linked a migraine medication to increased odds of eating disorders in some teens.

The drug in question is called topiramate (Topamax). It's an established migraine drug for adults that was just approved for use in teens in 2014. Appetite reduction and weight loss are common side effects of the drug, according to the report authors.

"For most kids, it's a great medicine, but for a handful of kids the weight loss can trigger symptoms of an eating disorder," said report author Jocelyn Lebow, a child and adolescent psychologist for the eating disorders treatment program at the University of Miami Miller School of Medicine.

It's important to note that the report only showed an association between taking the drug and eating disorders; it did not prove the drug can actually cause an eating disorder. The report was published online April 6th in the journal Pediatrics.

The report details the case histories of seven young women, aged 13 to 18. The teens developed an eating disorder or had an existing disorder worsen after starting the drug.

Lebow emphasized that the report is not a study, but information on seven case histories. "This isn't a prevalence study," she said. "These are kids who presented to an eating disorders program."

What the report suggests, she said, is that there

are some teens who are especially vulnerable to eating disorders and the drug may increase that risk.

Three of the patients didn't have eating disorder symptoms before starting the drug. Another three said they suspected the eating disorder began before they started the medication. The seventh had an eating disorder that was in remission, but it recurred after starting the drug, the researchers reported.

Four of the teens were diagnosed with an unspecified eating disorder. One teen had bulimia nervosa, which involves binging on food then purging by throwing up or using laxatives. And, the final two were diagnosed with anorexia nervosa — a disorder that causes people to excessively restrict food and leads to extreme, potentially dangerous weight loss.

Lebow said she can't say how the drug may trigger the eating disorder, although "we know in any person the weight loss itself can be the trigger for an eating disorder," she said.

A spokesman for Janssen Pharmaceuticals Inc., which makes and sells topiramate, said the Titusville, N.J.-based company will weigh the findings carefully.

"We are reviewing the article, our database and the medical literature, and will report any findings to the FDA [U.S. Food and Drug Administration] as appropriate," Greg Panico, communications leader of neuroscience at Janssen Research & Development, said in a statement.

The link between the migraine "The mechanism of action of the medicine and eating disorders is not drug affects brain chemistry in a way new, said Dr. Russell Marx, associate that could likely lead to an eating medical director at the Eating disorder," he explained.

Recovery Center in Denver Klamp said he would be and chief science officer at reluctant to use the drug the National Eating Disorders in teens at risk for eating Association. "We see this all disorders. "For adolescents the time, that topiramate with a history of anorexia, it can trigger an eating seems like topiramate simply disorder, both in adults should not be used," he said. and teens," he said.

If teens use topiramate for "It's well known migraines, parents should be that this medicine can aware of warning signs of cause weight loss," eating disorders, the he said. Topiramate in experts agreed. combination with another "If you see some pervasive drug, phentermine, is approved symptoms, like a lot of weight loss, don't by the FDA for chronic weight dismiss it," Lebow said. Another warning management, he added. sign is a change in normal behavior, such However, another expert noted as an outgoing teen suddenly isolating that the report isn't definitive. herself and not engaging in activities with It "does not definitively prove friends, she said. that topiramate can cause eating The report authors also suggested that disorders," said Dr. Douglas Klamp, an expert in doctors screen teen migraine patients for eating treating eating disorders in Scranton, Pa. To do disorders and risk factors for eating disorders before that, he said, a large study would have to be done prescribing topiramate. In addition, weight should that followed those with migraines on and off the be monitored carefully when someone first starts drug to see who developed eating disorders. taking the drug, they suggested.

However, he said, he is "reasonably convinced" by the report that the drug can lead to eating disorders.

MORE INFORMATION To learn more about eating disorders, visit the National Eating Disorders Association at www.nationaleatingdisorders.org.

Eating disorders may start in elementary school E

ating disorders can begin before puberty and may be linked with other mental health issues, a new study shows.

Canadian researchers evaluated 215 children, aged 8 to 12, with eating problems. More than 15 percent of the kids made themselves vomit occasionally, and about 13 percent had bulimic-like behaviors. Fifty-two percent of the children had been hospitalized at least once due to their eating problem, and 48 percent had received outpatient treatment, the researchers said.

Bulimia is an eating disorder characterized by eating and purging, usually by vomiting or using laxatives.

"Many researchers believe that bulimia only appears at adolescence, but our (findings) indicate that the problem can arise much earlier. It is possible that it is currently under-diagnosed due to a lack of awareness and investigation," study leader Dominique Meilleur, a clinical psychologist and professor at the University of Montreal, said.

Psychiatric problems were present in 36 percent of the children's families, and many of the children had mental health issues such as anxiety and mood and attention disorders, the study found.

Nearly 23 percent of the children said they had been mocked or insulted about their appearance, according to the study. "For some

children, bullying can initiate or reinforce body image preoccupations and possibly lead to a change in eating behavior," Meilleur said.

Ninety-five percent of the children in the study had restrictive eating behaviors, 69 percent worried about putting on weight, and nearly 47 percent described themselves as "fat."

"These behaviors reflect the clinical presentations we observe in adolescents and support findings that body image is a preoccupation for some children as early as elementary school," Meilleur said.

The researchers also found that eating disorders are not a "girl problem."

Source: HealthDay

Kids and teens: be smart about sports injuries

By RANDY DOTINGA HealthDay It’s that time of year again. Spring has sprung, and with it comes the start of spring sports: baseball, tennis, lacrosse, soccer and track and field.

Time for kids to dust off baseball gloves, clean off their cleats, dig out that tennis racket and get outside!

Unfortunately, injuries are inevitable, but there are preventive measures kids can take to reduce the risk of being permanently sidelined. Children’s doctors and athletic trainers remind kids to know their body and their limits.

But before they hit the pitch, field or track here are a few tips to keep kids in the game and injury-free.

Sports concussions can be a serious health problem. They require early identification, careful evaluation and specialized management before a child or teen can return to play.

WHAT DO WE KNOW ABOUT ACL INJURIES? Although concussions have seen the most media coverage lately, another common sports injury is ACL injuries.

ACL injuries are damage to the anterior cruciate ligament (ACL) in the knee. The ACL is one of four ligaments that keep the knee from wobbling or giving out when you move.

For junior high to college students, ACL injuries are more common in girls than boys. Young women are two to eight times more likely to tear their ACLs than boys of the same age, though doctors aren’t sure why. Some studies suggest that the problem may be related to hormones, quad and hamstring strength, coordination or anatomy.

What is clear is the mechanics involved: When the knee is forced into an unusual position, the ACL and other ligaments can tear, partially or all the way.

ACL tears often occur when children: • Stop or change direction suddenly.

• Twist their knees.

• Bend their knees sideways.

Orthopedic and Sports Medicine doctors are experts in treating growing athletes. Athletic trainers and physical therapists often work with student athletes to increase their relative core and hamstring strength and practice jumping and landing mechanics to help decrease the likelihood of an ACL injury.

AFTER AN INJURY, WHAT NEXT? Unfortunately, injuries do occur.

Taking the proper steps to reduce the risk of injury is important, but sometimes things happen unexpectedly.

• Seek early medical evaluation for diagnosis and to begin a treatment plan.

• Physical therapy will likely be an important component of a complete recovery. It is important to follow through with a rehabilitation program to make sure the injury has not just recovered from pain, but that your body is back to functioning at full strength. The goal is to avoid recurrent pain, further injury and to get athletes back in the game, safely.

• A safe and gradual progression is important to prevent recurrent injury.

SOME COMMON SPRING SPORTS INJURIES Remember, sports are fun and injuries Because of the wide array of sports can be prevented. Take the time to warm played throughout spring, injuries up properly, listen to your body and if can vary. something happens unexpectedly, seek • Common injuries from throwing and early medical evaluation. racquet sports include shoulder and elbow injuries—tennis, baseball etc.

• Knee injuries, ankle injuries and shin splints are commonly seen in sports that involve a lot of running—track, soccer, lacrosse.

• It is important for kids to pay attention to cues of persistent pain— knees, hip, shoulder etc.

• Concussions can occur in any sport, if forceful contact to the head or body occurs. Always report symptoms of a concussion to a coach or athletic trainer. Symptoms can include: • Confusion • Headache • Upset stomach • Blurry vision • Sensitivity to light or sound • Feeling sluggish, hazy, foggy MORE INFORMATION or groggy The U.S. National Library of Medicine • Memory problems offers sports safety resources at www.nlm.nih.gov.

10

sports tips for children and teens

Before your child or teen goes out for spring sports this year, review these ten tips from orthopedic and sports medicine experts: 1. Get plenty of sleep.

2. Avoid skipping meals.

3. Have a pre-practice/game snack and re-fuel afterwards.

4. Stay hydrated. It’s important to make sure you are hydrated going into practice/game and staying hydrated during activity, especially with warmer weather.

5. Complete a proper warm-up and cool down with stretching.

6. Listen to your body and know when to stop. If you are tired, feeling ill or something is hurting, listen to your body to prevent a more serious problem from developing.

7. S tay conditioned throughout the year. It is a good idea to maintain some level of physical activity throughout the year. Too much, too fast, can lead to an injury.

8. Take breaks from year-round sports.

To avoid burnout and overuse, it is also a good idea to vary physical activity throughout the year and take a break from a year-long sport. You can still be active, but give your body parts a break—overuse of the same body part can be bad. Avoid repetitive overuse and possible injury.

9. See a health care provider if you experience early signs of an injury. Seeking medical care early can help avoid injuries from becoming more serious.

Seeking care early can lead to less time missed.

10. Most importantly, have fun! Sports should be fun and enjoyable. If sports become a source of frustration, stress or injury, it may be time to take a break or explore a different activity.

Source: HealthDay and Seattle Children’s Hospital

The University Doctors MedicaLink Ask The University Doctors

Can probiotics be used to treat irritable bowel syndrome?

Dr. Richard Walters, a gastroenterologist with The University Doctors, responds: of serotonin, a neurotransmitter that is produced in Before answering, a little background both the brain and the colon. on irritable bowel syndrome and ‘Antibiotic’ and ‘bacteria’ are terms you have probiotics may be helpful. heard throughout your life and both are important Irritable bowel syndrome (IBS) refers to understanding the potential connection between to a group of symptoms affecting the probiotics and IBS. function of the nerves and muscles of Our bodies are immersed – both inside and out the colon (large intestine). With IBS, – in bacteria. These organisms aren’t part of your hypersensitivity to these nerves and body, but instead live on or in it, and we most likely subsequent abnormal peristalsis (the would not survive long without them. muscle contractions that move bowel contents) in the Your digestive tract alone is loaded with more colon results in food moving too quickly through the than 1,000 different types of bacteria. In fact, the digestive system (causing diarrhea), too slowly (causing number of bacteria in your intestines is about ten constipation), or spasms that can cause pain times greater than the number of cells that make and cramping. the entire rest of your body.

These bacteria serve IBS is a functional disorder and not a disease, so a number of beneficial functions in digestion, there are a number of theories as to its cause, including including producing some essential vitamins. Some stress, lactose intolerance, a virus, or fluctuating levels bacteria, however, are not beneficial and can cause illness. When beneficial and bad bacteria are in balance, you feel well, but if the bad bacteria outnumber the good, an illness can result.

Antibiotics do one thing very well – they kill bacteria.

Although antibiotics can cure a number of infections caused by bacteria, they will sometimes kill off good bacteria, too, which can contribute to Let us help treat your digestive health issues!

IBS symptoms.

Probiotics can be John C. Chiesa, DO, FACOI Drew Chiesa, DO beneficial bacteria.

Donald McMahon, DO Richard Walters, DO Organisms such as yeasts can also help to increase Call for an appointment: 856.566.6853 or 856.218.0300 (Option 6) the number of good bacteria in the body. Adding We offer G.I Services at these locations: probiotics to your diet may Marlton • Mt. Laurel • Sewell • Stratford • West Deptford help restore or maintain the balance between good theuniversitydoctors.com and bad bacteria in your digestive system, relieving some of the symptoms associated with IBS.

We Trust our Gut Instinct

Although products ranging from capsules to chocolate now advertise their probiotic content, these organisms have been available for years.

Some types of yogurt, for example, have long contained ‘live active cultures’ of probiotic bacteria.

Not all probiotics are created equal, and research suggests that some strains may be more effective than others for treating certain conditions. For probiotics that may support the immune or digestive system, look for probiotics that mention Lactobacillus or Bifidobacterium.

It is important to note, however, that probiotics marketed as ‘dietary supplements’ are not subject to the same government regulations as prescription or over-the-counter medications.

The same type of probiotic can differ significantly depending on the company that is making it or including it in food.

Probiotics can also cause side effects. The most common of these are temporary gas and bloating, but allergic reactions are also possible. It is also important to note that people with some medical situations – such as those who are severely immunocompromised – should avoid taking probiotics.

Research has still not determined which specific types of probiotics will work best with a condition like IBS. But, if you have been diagnosed with IBS, experience regular episodes of diarrhea, abdominal pain or indigestion, or if you notice a change in your bowel habits, adding probiotics to your diet could help ease those symptoms.

Please remember to let your health care provider know if you begin using probiotics, or any type of dietary supplement. Even though your symptoms may ease, letting your physician know about them is vital to your overall health and will help to diagnose any underlying medical causes.

To schedule an appointment with Dr. Walters, please call 856.566.6853 for the Stratford Office located at 42 East Laurel Road, Stratford, NJ 08084, Suite3500.

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Contact us to schedule an appointment: OMMclinic@rowan.edu 856.258.0905 Powered by: DISCLAIMER: There is no obligation to use any doctor affiliated with Rowan University School of Osteopathic Medicine or any other OMM doctor after being treated at the OMM Clinic. The OMM clinic is not an alternative to long-term management of an issue. The Clinic can deny treatment to any patient for any reason.

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Medical students give their Family Medicine professors’ children a check-up Dr. Aubrey Olson, a family physician with The University Doctors, responds: Four family medicine physicians from Rowan University School of Osteopathic Medicine (RowanSOM) recently decided to send their own children for a doctor’s check-up – not because their children were sniffling, sneezing or even sick – but because they knew the children would be the perfect patients for second-year medical students completing the On Doctoring II course. Students enrolled in On Doctoring II learn the ins-and-outs of what goes on during a patient visit- from how to perform a thorough and effective examination, to perfecting their bedside manner.

While mock adult patients have been used in previous classes, this was the first time that children fulfilled the role of patient. The timing of area schools being closed for Spring Break and the number of children available who ranged in age from 20 months to nine years, helped finalize the decision for Dr. Aubrey Olson and Dr. Rebecca Moore, Assistant Professors of Family Medicine and Co-Course Directors of On Doctoring II. “We had enough children between several faculty members, who all had the week off from school, so we decided it would be a great resource to have our children be patients for the students.”

Dr. Olson’s two-year-old son, Graeme, was one of the patients. “He was excited to come and spend the day with me, as he normally doesn’t get to see me during

daytime hours,” she said. “Plus, it was an opportunity to show him what Mommy does as a doctor.”

The student doctors were tasked with examining each child’s head, ears, nose, throat, heart and lungs, as well as a scoliosis screening. Most of the time, the young patients exercised patience while the student doctors performed the exam, but there were a few youngsters who were less than thrilled with being poked and prodded. “That’s part of the experience,” noted Dr. Olson. “The students have to learn that not all patients, and children especially, will comply with a doctor’s requests or exam.”

Communicating with young pediatric patients can also be difficult for physicians. Part of the On Doctoring II course experience involves students practicing effective interview techniques with mock patients. Even with the youngest of patients, doctors need to express the importance of a healthy lifestyle – including eating healthy food and getting in enough physical and mental exercise each day.

“Even with the youngest of patients, doctors need to express the importance of a healthy lifestyle – including eating healthy food and getting in enough physical and mental exercise each day.”

Dr. Danielle Cooley, Assistant Professor of Family Medicine, brought her two children, Madison, age eight, and Chase, age six, to be part of the experience. Madison and Chase were happy to help out, and were eager to share their tips of how they practice good health and maintain wellness at home.

Dr. Cooley mentioned that both of her children stay active in youth sports and fuel their energy with healthy snack choices. Madison rattled off a list of the various sports she plays, including hockey, soccer, basketball, softball and dance. “And don’t forget track and cross country,” she added. And, when she’s not playing on a field, she’s practicing piano, taking lessons every Monday. Kindergartner Chase, on the other hand, enjoys T-ball, soccer, hockey and track, and is sure to eat ‘lots of blueberries and raspberries’ and drink ‘lots of water.’

The University Doctors provides primary and specialty health care for all members of your family from infancy to golden years.

Forked River 609.756.0000 • Glassboro 856.256.4333 • Hammonton 609.704.0185 Mt. Laurel 856.380.2400 • Sewell 856.218.0300 • Stratford 856.566.7020 theuniversitydoctors.com

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The University Doctors MedicaLink Ask The University Doctors

Why are some health conditions more common among different ethnic groups?

Dr. Jennifer Caudle, a family physician with The University Doctors, responds: The more we learn about health, the more we find out about the benefits of prevention. From flu shots to mammograms and colonoscopies, preventing illness or chronic disease is much easier - and much less expensive than curing it.

But, as researchers learn more about disease and how to prevent it, they are often left with even more questions. That is particularly true when it comes to understanding why certain groups of people appear to be “While genetics sometimes more prone to specific plays a role in disease, other, diseases. less easily defined factors, While such as poverty, cultural genetics differences and a lack of sometimes access to care or to knowledge plays a role in disease, about prevention, often play a other, less role and can be difficult easily defined to determine.� factors, such as poverty, cultural differences and a lack of access to care or to knowledge about prevention, often play a role and can be difficult to determine.

Time and again, however, statistics point to a number of disparities that fall along ethnic or racial lines. Here are some examples from statistics compiled by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC): Diabetes African Americans and Hispanic Americans are almost twice as likely to be diagnosed with diabetes as non-Hispanic white Americans. Hispanics are also more than one and one-half times likely to begin treatment for end stage renal disease caused by diabetes, and the incidence of diabetes-related deaths is nearly double among African Americans. At the same time, Asian Americans have a 20 percent higher rate of diabetes diagnosis but have a 10 percent lower death rate from the disease.

Cancer When all types of cancer are combined, the CDC notes that African Americans have the highest mortality rate of any racial and ethnic group.

African American women are 10 percent less likely to have been diagnosed with breast cancer, but their mortality rate is nearly 40 percent higher than non-Hispanic white women. Overall cancer rates among Asian Americans and Hispanics are lower than non-Hispanic whites, but both groups have much higher rates of certain types of cancer, notably stomach and liver cancers.

Obesity A potential underlying cause of heart disease, diabetes and some forms of cancer, obesity is a concern that affects all groups, but is still more prevalent among Hispanics (1.2 times more likely to be obese) and African Americans (1.5 times more likely to be obese).

Immunization rates According to the CDC, immunization rates show mixed results, which may indicate that some health disparity gaps have begun to shrink. On the positive side, Asian American, Hispanic and African American children, aged 19 to 35 months, all have immunization rates that are comparable to non-Hispanic white children.

However, the rates for older adults tell a different story. Minority adults over the age of 65 have significantly lower rates of pneumonia and flu vaccinations. This is noteworthy because both of

these illnesses tend to strike harder among older adults.

Although more research will be needed to understand the causes for these and other health care gaps, knowing that disparities exist provides opportunities to eliminate them. Health care providers and organizations can better target disease prevention efforts to educate specific groups of people.

At the same time, if you are a member of a group that is affected by disparities, make sure to see your doctor regularly, know your family history and discuss your specific health risks with your physician. Finally, make sure to get the screenings and immunizations you need to protect your health.

To schedule an appointment with Dr. Jennifer Caudle, please call 856.218.0300.

The Sewell office is located at Harbor Pavilions, 570 Egg Harbor Road, Suite C2, Sewell, NJ 08080.

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

Research Study

Are you married?

Do you have Type II diabetes?

Do you manually self-inject or use an auto-injector??

Rowan University is studying the effects of spousal support in diabetes management.

To learn more or see if you qualify for the study, please call 856.566.6141 or email jungkj@rowan.edu.

If so you may qualify for a research study.

If you are interested in finding out more information, please contact: Office of Clinical Trials Management Rowan University School of Osteopathic Medicine

856.566.6474

“Know Your Numbers’ Community Health Fair presented by the Bethany Baptist Church and Rowan University School of Osteopathic Medicine Student National Medical Association April 18th - 8 am to 2 pm Health information and free rapid screenings for: • Hepatitis • Glucose

Donald A. Barone, DO, Chief, Division of Neurology 42 East Laurel Road, Suite 3500, PO Box 1011, Stratford, NJ 08084

• HIV • Hepatitis

• Blood Pressure • Cholesterol

Bethany Baptist Church 1115 East Gibbsboro Road, Lindenwold, NJ Call 800.524.6274 for more information

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ALZHEIMER’S AND THE BLACK COMMUNITY

Alzheimer’s Association Afri Forum

Education and Tools to Meet the Challenges Saturday, May 16, 2015 • 9:30 am to 12:30 pm Rowan University School of Osteopathic Medicine Academic Center, Multipurpose Room One Medical Center Drive, Stratford, NJ 08084

African-Americans are twice as likely as whites to have Alzheimer’s or another dementia and less likely to have a diagnosis. Come to hear: • About

Offered in collaboration with the New Jersey Institute for Successful Aging of Rowan University School of Osteopathic Medicine

Continental breakfast Registration required by May 11, 2015 (800.272.3900 8Sharon.Jarnette@alz.org 24/7 800.272.3900

•

your brain and Alzheimer’s • About memory assessment programs • The importance of legal planning • How to access programs and services • A caregiver’s story

alz.org/delval

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.