HEALTH&CARE® Journal Fall/Winter 2023-24 by HEALTH&CARE®Journal

e F E S e Su o r W ! e bs a pa cr ge ip t 4 io n

Fr e

FALL WINTER 2023-24 | ST. LOUIS METRO

Ellen Needs a Kidney Donor

Suddenly, It Looks Like We’re in a

Benef its and Risks of Wegovy and Ozempic

in St. Louis

for Weight Loss Meds That Can Harm Your Driving Skills Many Seniors with

Memory Issues

Aren’t Telling Their Doctors

Golden Age for Medicine

Innovative Liver Transplant

Aging and Stress What You Should Know About

Arthritis

Dancing Helps Parkinson’s

Patients Control Movements

Welcome to the Fall/Winter 2023-24 Issue of HEALTH&CARE® Journal To our Readers: Our mission with this publication is to provide knowledge and health literacy that can help save people from preventable suffering and premature death caused by the leading chronic diseases. The way we seek to do that is to provide helpful, easy-to-understand information from experts that our readers can use for improved health outcomes.

Publisher Editor Todd Abrams Design Art Direction Production Cover Photography Michael Kilfoy Studio X Account Executive Carol Kindinger Printing Walsworth Fulton Advisory Board Dr. Donald Bassman Dr. Joshua Cohen Dr. Shaun Donegan Katy Dowd Robert Fruend Joel Iskiwitch Dr. James Jenkins Dr. Steve Lauter Catina O’Leary, PhD

This issue provides many informative and inspiring examples of the extraordinary progress across medical fields that give us hope that prevention, diagnosis and treatment of even some of the most intractable diseases are showing remarkable progress: The article on page 14, “Suddenly, It Looks Like We’re in a Golden Age for Medicine” talks about the astonishing progress that has happened in just the last few years, including innovations like Crispr gene editing and the miracle of accelerated mRNA vaccine development that bring with them long lists of future life-saving applications. “Innovative Liver Transplant at SSM Health St. Louis University Hospital” on page 16 is a remarkable story of a breakthrough in transplant surgery that makes the procedure possible for a significant additional number of those suffering from severe liver disease. There is great news about medicines and treatments now available or in the pipeline that are found to address the most challenging conditions like Alzheimer’s and brain damage from stroke. And there are also plenty of articles about how modest lifestyle changes can help in effectively preventing or fighting diabetes, heart disease, obesity, high blood pressure and other health- and life-threatening conditions. So, please take time to page through this issue and help yourself to information that can enable you achieve better health outcomes for yourself and your loved ones. This is truly a great time to be alive. We continue to be very interested in hearing from readers about HEALTH& CARE® Journal – content in the magazine, topics you would like to see covered and other information that would be helpful. You can contact us on our website. Todd Abrams

Publisher toddabrams1@gmail.com

Dr. Harvey Serota Mark Tucker Humor Credits:

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Robert Mankoff

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This is what extraordinary looks like. Barnes-Jewish Hospital

St. Louis Children’s Hospital

Missouri Baptist Medical Center

Christian Hospital

Hospitals across BJC HealthCare are recognized among the best in the nation by U.S. News & World Report. From nationally ranked hospitals and specialty services for adults and children, to a variety of common conditions and procedures, BJC hospitals deliver extraordinary care, every day, throughout the region we call home. Discover what health care can be when it comes from people who truly believe that you deserve extraordinary care. Learn more at bjc.org/us-news

Fall/Winter 2023-24 A R T I C L E S

I N

T H I S

10 Health Briefs 12 The Patient’s Advocate 14 Suddenly, It Looks Like We’re in a Golden Age for Medicine

35 Cancer Drug Shortages Persist Across U.S. 36 Anyone Can Get Lung Cancer Detecting It Early Is Crucial

18 Americans Not Sure What’s True in Age of Health Misinformation

Diabetes, Digestive & Kidney Disease

Heart & Vascular Health

40 Cover Story: Ellen Needs a Kidney Donor

22 Job Frustration Can Really Be a Heartbreaker for Men 23 Adding Just 3,000 Steps per Day Could Lower High Blood Pressure 24 Experimental Shot Every Six Months Controlled High Blood Pressure 25 US Heart Deaths Linked to Obesity Have Tripled in 20 Years Neurology & Stroke

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34 Melanoma Is an Even More Deadly Disease in Black Men

16 Innovative Liver Transplant at St. Louis University Hospital

20 What Is Congestive Heart Failure?

I S S U E

38 What Is Chronic Kidney Disease?

41 Nearly 4 in 10 Adults with Type 1 Diabetes Diagnosed After Age 30 42 Moderate Exercise Can Help Shed Dangerous Fat Around the Liver 43 In 22 U.S. States, More Than a Third of Adults Are Now Obese 43 Celiac Disease vs. Gluten Intolerance: What’s the Difference? 44 What You Need to Know about Urinary Incontinence

26 Dancing with Parkinson’s: New Program Helps Patients Control Movements

45 Benefits & Risks of Weight Loss Drugs

28 FDA Gives Full Approval for Alzheimer’s Disease Drug Leqembi

46 The Most Common Asthma Symptoms

29 New Nasal Spray for Migraines Approved by FDA

48 Today's COVID Is Increasingly Looking Like a Cold or Flu

30 Brain ‘Zaps’ Might Limit the Damage from a Stroke

Aches & Pains

Cancer Prevention & Treatment

32 AI Tool ‘Reads’ Brain Tumors During Surgery to Help Guide Decisions

Better Breathing

50 Getting Rid of Neck Pain: Six Ways to Feel Better 52 Ear Pain Relief: Medications, Drops, Surgeries & Self-Care Tips 53 Tips to Prevent Pickleball Injuries

54 Herniated Disk: What It Is, Symptoms and Treatment 56 What You Should Know about Arthritis 57 Suffered Whiplash? Know the Symptoms and Treatments Mental Health

58 Seniors, Here Are the Meds That Can Harm Your Driving Skills 59 Quiz: Do You Know How to Cope with Job Stress? 60 Expressing Yourself Creatively Gives Mental Health Boost 60 Expressing Yourself Creatively Gives Mental Health Boost Women’s Health

62 Menopause & Your Diet: Foods to Choose and Avoid 63 What Every Woman Needs to Know about Breast Cancer Screening 64 Another Possible Exercise Bonus for Women: Preventing Parkinson’s 65 Cranberry Juice Does Help Prevent Urinary Tract Infections Aging & Caregiving

66 Let’s Have an Honest Conversation About What to Expect as You Age

HEALTH&CARE JOURNAL is published twice

a year by HealthCom Network LLC and distributed to Missouri and Illinois homes in the St. Louis Metro area. Article topics are chosen to provide helpful information about health and care topics of interest. Opinions expressed in articles and editorials are those of the authors, and do not necessarily reflect the views of HealthCom Network. While every effort is made to assure accuracy, we are not responsible for how information found in HEALTH&CARE Journal is used. Readers are encouraged to consult with their healthcare providers for advice about their own care. We are very interested in hearing from readers about content in this magazine, and about topics they would like covered. Correspondence should be sent to the address below or to editor@healthandcarestl.com Reproduction of content of this magazine without permission is prohibited. All submitted materials, including images, logos and text for advertising, articles and editorials are assumed to be the property of the contributor, and HealthCom Network does not take responsibility for unintentional copyright infringement. HealthCom Network has the right to refuse advertising and content not deemed appropriate for this publication. For information regarding advertising, call, write or email: HealthCom Network

P.O. Box 411036 St. Louis, MO 63141 Todd Abrams, Publisher toddabrams1@gmail.com 314-443-3024 Carol Kindinger, Account Executive carolkindinger@gmail.com 314-452-3576 HEALTH&CARE is a registered trademark with the US Patent and Trademark Office

68 Alzheimer’s Report: Many Seniors with Memory Issues Aren’t Telling Their Doctors 70 Aging and Stress 72 In Older Adults, a Little Excess Weight Isn’t Such a Bad Thing 74 Book Review 74 Healthy Humor

Association of Health Care Journalists

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12 The Patient’s Advocate

14 Suddenly, It Looks Like We’re in a Golden Age for Medicine 16 Innovative Liver Transplant at SSM Health Saint Louis University Hospital 34 Melanoma Is an Even More Deadly Disease in Black Men 40 Ellen Needs a Kidney Donor

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50 Getting Rid of Neck Pain

WHY JIM EXERCISES In my 20s, I exercised to be competitive in tennis and golf. In my 30s, to keep up with my 3 kids. In my 40s and 50s, so I could stay strong and active. In my 60s, because my sedentary friends started dying. In my 70s, to remain independent. In my 80s, so I can keep doing yardwork and other things I enjoy. As I approach 90, I exercise because I still have more life to live.

Without strength-training, we lose about five to eight pounds of muscle per decade after age 30. The people who train at 20 Minutes to Fitness understand this. Like Jim, each one has a story about their own fitness journey. Jim trains here, he says, because “it’s an order of magnitude greater” than anything he did on his own. He also likes the idea of a medically based workout that he completes with an encouraging coach at his side, making sure he uses proper technique. People of all ages and fitness levels feel welcome at 20 Minutes to Fitness, now in its 21st year. Because workouts are tailored to each person’s needs and limitations, all can achieve their strength-building goals with a once-a-week workout that takes just 20 minutes. JIM HILL | Town & Country, Mo. At age 88, Jim Hill plays 18 holes of golf three times a week, is planning his annual European tour and is a serious piano student. Since 2020, the retired researcher has trained weekly at 20 Minutes to Fitness in Chesterfield.

Your initial consultation and first session are free. Why not give it a try?

For more information on 20 Minutes to Fitness, call its local studios in Clayton (314-863-7836), Chesterfield (636-536-1504), Sarasota or Tampa, or visit 20MinutesToFitness.com.

Just 20 minutes. Just once a week.

Health Briefs Beating ‘Middle-Age Spread’ A diet rich in whole grains, fruits and non-starchy vegetables is the best recipe for middle-aged folks to keep weight under control. Refined grains, sugary beverages or starchy vegetables are likely to fuel an expanding waistline at a time in life when weight gain is common.

Marijuana, meth, cocaine use may trigger dangerous a-fib The heart arrhythmia increases the risk of stroke, heart failure, kidney disease, heart attack and dementia, the authors of a new study noted. European Heart Journal

BMJ Journal

Music lovers’ physiology synchronizes at classical music concerts New research suggests that concert goers may synchronize their heart rate, breathing rate and the electrical conductivity of skin (suggesting excitement) at concerts as they listen to the intricacies of a classical symphony performance. Scientific Reports

Going vegan is healthy for cows, dogs, cats — and the planet 10 H&C

Livestock are responsible for 14.5% of greenhouse gas emissions. Some experts say eating vegan — a nutritionally sound diet without animal proteins or products — for two-thirds of meals could slash food-related emissions by 60%. PLOS ONE

Germs love two skin ‘hot spots’ on your body Grandma knew it all along: wash behind your ears. Skin behind ears and between toes can harbor unhealthy microbes. Analyzing skin from these less-washed areas found microbes that can cause unhealthy conditions like acne and eczema. Frontiers in Microbiology

Mental health decline was greatest in advantaged children during the pandemic Child mental health declined overall during the pandemic, but decline was greatest in children with coupled, highly educated, employed parents and higher household income versus less advantaged groups. Journal of Epidemiology & Community Health

There is a partisan gap in intention to get the new Covid vaccine

AI gets high marks from doctors in answering medical questions ChatGPT’s responses to more than 280 medical questions across diverse specialties averaged between ”mostly” to “almost completely” correct. The program could grow into a source of accurate and comprehensive medical information, but it’s not quite ready for prime time yet.

Fewer than half of Americans (46%) say they will “definitely” or “probably” get the new COVID shot. Interest is highest among those 65 and older (64%) and among Democrats (70%). About 24% of Republicans plan to get the shot. Kaiser Family Foundation

AMA Network Open

Wildfire smoke is reversing recent cleanair gains across the U.S. Since 2000, there’s been enormous progress on improving air quality throughout much of the U.S. However, around 2016 those declines in particulate pollution began to stagnate or even reverse in some states, even in Eastern states not typically affected by wildfires. Nature

More American men are now opting for vasectomy Vasectomies are becoming more common in the United States, with rates surging by more than one-quarter during the past decade. Only 4% of men have undergone vasectomy, but the rate increased by 26% between 2014 and 2021, according to an analysis of commercial health claims data. Urology

Booming sales of legal marijuana linked to more car crashes In October 2018, Canada became the second country to nationally legalize recreational or nonmedical cannabis for adult use. Known cannabis-involved emergency room visits for traffic injuries are still rare, but they grew by 475% over 13 years, with a sharper rise in accidents after legalization, researchers found. JAMA Network Open

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T H E

P A T I E N T ’ S

A D V O C A T E

Hoping My Experience Can Benefit Patients, and Doctors By Jane Tucker

In my last column I wrote about what to do as a patient. Now, I’d like to share some things my experience says you should not do. In February of 1999, I felt a tiny lump on the back of my neck and put it out of my mind as nothing – my first what not to do. I had a routine appointment with a surgeon in May. I kept that appointment but forgot to mention the lump – another no-no. Don’t just count on your memory, keep good notes and refer back to them. It wasn’t until I returned home that I

remembered the lump. I hesitated to do anything. A huge, terrible decision. I thought I didn’t want to bother the doctor and thought maybe a second co-pay wasn’t necessary. You know I could wait a year; it was only the size of a pea. I felt silly about calling back – really, really poor thinking. I changed my mind, called the doctor and made an appointment for the next day. I told the appointment secretary that it was urgent. (I’m finally behaving like a smart patient.) At my appointment the

doctor thought the lump was so small that it couldn’t possibly be malignant, but his good instincts kicked in and he was aware that my sister had lymphoma. He scheduled removal for the next day (Doctor making good decision). Long story short, he called me two weeks later and told me the lump was malignant. Both of us making the right decisions – but mostly my doctor’s decisions saved my life.

Instead of speaking now as The Patient’s Advocate, allow me to speak as A Doctor’s Advocate. doing whatever I could to make sure I made good decisions, even though it took me awhile to figure that out.

A good doctor, even when working with an inexperienced patient (most of us are), can turn things around. The doctor paid attention to me and he saved my life. That story could probably be repeated thousands of times. What it teaches us is how very ordinary my story is.

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Sometimes second guessing is necessary. Trust your instincts, keep good notes and take them with you to your appointments. Don’t think you’re being silly or overreacting, don’t worry about the money and co-pays. Take action as soon as possible. I learned a lot, but my biggest lesson was that I’m not silly and my doctor didn’t think I was. I was not overreacting. I was

That doctor learned something too, even though he had been practicing for many years. After he saw that I went into remission, he called me. It was a heartfelt and sincere call. He was so honest. He said he almost didn’t remove it. It was the smallest malignancy he had ever seen, and he didn’t think it could be malignant. He said that my diagnosis and his actions taught him his greatest doctor lesson. He was a great doctor for listening to me and quite frankly not thinking I was a nervous Nellie and brushing me off. I hope doctors take my story to heart, too, because sometimes, not always, but sometimes the patient’s personality and style of communicating can influence the doctor’s response. I’m sure that can at times be difficult, but it needs to be kept in check. So…it’s a process. Don’t ever think you are bothering the doctor; don’t wait

months to see them. Patients and doctors are a team. No one wins this alone. A good doctor can teach a patient many things. A good patient and even a bad patient can also teach the doctor. I’ve met many doctors over my 24 years under treatment, and if I’ve learned one thing it’s that doctors want their patients to be involved, to be as dedicated to getting them well as the doctor is. You can’t sit back and expect them to just cure you. You need to be fully engaged. It’s difficult at times. You have a huge responsibility being a patient. You need to participate even when it’s hard. Sometimes it might be hard to understand the doctor. If you need a translator, if the doctor has an accent or a speech pattern that makes it difficult to understand, or you have a hearing issue, then speak up. You certainly don’t want to miss anything and neither does your doctor. The doctor will be happy to get you some assistance. I bet you when you turn all the don’t’s into do’s you will see how participation in your recovery is extremely important. Above all…stay well.

Suddenly, It Looks Like We’re in a Golden Age for Medicine By David Wallace-Wells

We may be on the cusp of an era of astonishing innovation — the limits of which aren’t even clear yet.

ype springs eternal in medicine, but lately the horizon of new possibility seems almost blindingly bright. “I’ve been running my research lab for almost 30 years,” says Jennifer Doudna, a biochemist at the University of California, Berkeley. “And I can say that throughout that period of time, I’ve just never experienced what we’re seeing over just the last five years.”

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A Nobel laureate, Doudna is known primarily for Crispr, the gene-editing Swiss Army knife that has been called “a word processor” for the human genome and that she herself describes as “a technology that literally enables the rewriting of the code of life.” The work for which Doudna shared the Nobel Prize was published more than a decade ago, in 2012, opening

up what seemed like an almost limitless horizon for Crispr-powered therapies and cures. But surveying the recent landscape of scientific breakthroughs, she says the last half-decade has been more remarkable still: “I think we’re at an extraordinary time of accelerating discoveries.” The pandemic has exhausted many Americans of medicine, and it has become common to process the last few years as a saga of defeat and failure. And yet these brutal years — which brought more than a million American deaths and probably 20 million deaths worldwide, and seemed to return even the hypermodern citadels of the wealthy West to something like the experience of premodern plague — might also represent an unprecedented watershed of medical innovation.

Beyond Crispr and Covid vaccines, there are countless potential applications of mRNA tools for other diseases; a new frontier for immunotherapy and next-generation cancer treatment; a whole new world of weight-loss drugs; new insights and drug-development pathways to chase with the help of machine learning; and vaccines heralded as game-changing for some of the world’s most intractable infectious diseases. “It’s stunning,” says the immunologist Barney Graham, the former deputy director of the Vaccine Research Center and a central figure in the development of mRNA vaccines, who has lately been writing about a “new era for vaccinology.” “You cannot imagine what you’re going to see over the next 30 years. The pace of advancement is in an exponential phase right now.”

‘World-changing’ innovations It is sometimes hard to see the silver lining for the cloud, particularly when it’s as dark as the last three years have been. But at the very center of the American Covid experience, amid all the death and suffering and despite the dysfunction that midwifed it into being, sits what would have stood out, in any previous era, as an astonishing biomedical miracle: the coronavirus vaccines. Drug-development timelines in previous history had swallowed whole decades; experts warned not to expect a resolution for years. But the mRNA sequence of the first shot was designed in a weekend,

and the finished vaccines arrived within months, an accelerated timeline that saved perhaps several million American lives and tens of millions worldwide — numbers that are probably larger than the cumulative global death toll of the disease. The miracle of the vaccines wasn’t just about lives saved from Covid. As the first of their kind to be approved by the Food and Drug Administration, they brought with them a very long list of potential future mRNA applications: HIV, tuberculosis, Zika, respiratory syncytial virus (RSV), cancers of various and brutal kinds. And the vaccine innovations stretch beyond mRNA: A “world-changing” vaccine for malaria, which kills 600,000 globally each year, is being rolled out in Ghana and Nigeria, and early trials for next-generation dengue vaccines suggest they may reduce symptomatic infection by 80 percent or more.

a range of hard-to-treat addictions. And although the very first person to receive Crispr gene therapy in the United States received it just four years ago, for sickle-cell disease, it has since been rolled out for testing on congenital blindness, heart disease, diabetes, cancer and HIV So far only two applications for such treatments have been submitted to the FDA, but all told, some 400 million people worldwide are afflicted by one or more diseases arising from single-gene mutations that would be theoretically simple for Crispr to fix. And when Doudna allows herself to imagine applications a decade or two down the line, the possibilities sound almost intoxicating: offering single-gene protection against high cholesterol and therefore coronary artery disease, for instance, or, in theory, inserting a kind of genetic prophylaxis against Alzheimer’s or dementia.

Not every innovation arriving now or soon to market comes from U.S. research or shares the same saga of development. But many of their back stories do rhyme, often stretching back several decades through the time of the Human Genome Project, which was completed in 2003, and the near-concurrent near-doubling of the National Institutes of Health’s budget, which helped unleash what Donna Shalala, President Bill Clinton’s secretary for health and human services, last year called “a golden age of biomedical research.”

In January, a much-talked-about paper in Nature suggested that the rate of what the authors called disruptive scientific breakthroughs was steadily declining over time — that, partly as a result of dysfunctional academic pressures, researchers are more narrowly specialized than in the past and often tinkering around the margins of well-understood science.

A couple of decades later, it looks like a golden age for new treatments. New trials of breast-cancer drugs have led to survival rates hailed in The New York Times as “unheard-of,” and a new treatment for postoperative lung-cancer patients may cut mortality by more than half. Another new treatment, for rectal cancer, turned every single member of a small group of cases into cancer-free survivors.

But when it comes to the arrival of new vaccines and treatments, the opposite story seems more true: whole branches of research, cultivated across decades, finally bearing real fruit. Does this mean we are riding an exponential curve upward toward radical life extension and the total elimination of cancer? No. The advances are more piecemeal and scattered than that, and indeed there are those who

Ozempic and Wegovy have already changed the landscape for obesity in America — a breakthrough that has been described and debated so much in terms of cosmetic benefits and medical moral hazard that it can be easy to forget that obesity is among the largest risk factors for preventable death in the United States. Next-generation alternatives may prove even more effective, and there are signs of huge off-label implications: At least anecdotally, in some patients the drugs appear to curb compulsive behavior across

‘Can we actually do it?’

believe that progress should be moving faster still. In the midst of the pandemic, a number of calls for greater acceleration have been issued, some emphasizing the need to reduce costs for drug development, which have doubled every decade since the 1970s, perhaps by redesigning clinical trials or employing what are called human-challenge trials, or by streamlining the drug-approval process. Graham, who is now a senior adviser for global health equity at the Morehouse School of Medicine, emphasizes questions of global distribution and access: Will the new technologies actually get where they are needed most? “The biology and the science that we need is already in place,” he says. “The question now to me is: Can we actually do it?” In 1987, the economist Robert Solow commented that you could see the computer revolution everywhere but the productivity statistics — that despite intuitions about how fully information technology had transformed all forms of work in America, the step-change hadn’t really made a mark on the country’s economy in any obvious statistical way. Until a few years ago, perhaps, you might have said the same about billions of dollars spent researching potential HIV vaccines or the decoding of the human genome, which unleashed a venture-capital-like boom-and-bust biotech hype cycle that sputtered out before most Americans had seen any real gains from it. Sometimes these things just take a little time. David Wallace-Wells is a staff writer at the New York Times magazine and the author of “The Uninhabitable Earth: Life After Warming.” From the New York Times ©2023 The New York Times Company. All rights reserved. Used under license.

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home on maximal oxygen therapy, which enabled him to function, but not with a satisfactory quality of life. He was not nauseous or feeling sick, but the liver disease had clearly begun to affect his lungs. His condition was very precarious, as his liver disease had caused hepatopulmonary syndrome, in which the blood vessels that go through the lungs were dilated and shunting blood in a way that blood could not adequately get oxygen. Had his oxygen mask fallen off during sleep, he might not have survived. Liver transplant was the only option

Innovative Liver Transplant at SSM Health Saint Louis University Hospital Breakthroughs make it possible for those with the most severe liver disease.

ndrew Buxbaum was a very active guy in his late 60s, working as a machinist, and with lots of interests including weekends working with chainsaws and riding motorcycles.

Andrew and his wife Betty were very surprised in the early ‘90s when a routine blood test showed that he had a condition in which his immune system was attacking his liver, because he had no symptoms.

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He was referred by his primary care physician to Dr. Kamran Qureshi, a liver specialist at SSM Health Saint Louis University Hospital (SLU-H), who prescribed medication to reduce the ammonia in his blood. Ammonia is a waste product that’s normally processed in the liver and removed through urine. Several conditions can cause high ammonia levels in the blood, including liver disease.

A severe form of liver disease His condition was manageable until July of 2020, when he developed hyperammonemia, in which the ammonia in his blood built up to such a high level that it caused him to become very confused. The doctor prescribed lactulose, and within 24 hours he was back to his old self. Mr. Buxbaum had one of the most severe forms of liver disease. He had been at

Until 1998, patients with this condition – up to 30% of those with cirrhotic liver disease – were not always considered to be candidates for liver transplantation. Patients with shunting were considered to have too high risk of pulmonary complications and failure to successfully wean from the ventilator after surgery to be able to breathe on their own. The only cure for patients in Mr. Buxbaum’s condition is liver transplantation, one of the most technically challenging and difficult surgeries performed today. With successful transplantation, the physiology of the body changes so that shunting gradually improves, along with the ability to oxygenate the blood as it flows through the lungs. Dr. Govind Rangrass, Associate Professor of Anesthesiology and Critical care and Director of Transplant Anesthesia at SSM Health Saint Louis University Hospital, and his transplant colleagues determined that because of the severity of Mr. Buxbaum’s shunting, placing him on a form of mechanical circulatory support called extracorporeal membrane oxygenation (ECMO) would be the safest way to proceed with liver transplantation.

At left: Dr. Vidya Fleetwood and Dr. Govind Rangrass Above: Andrew and Betty Buxbaum At right: Andrew and Nurse Jackie Photo of Dr. Fleetwood: Michael Kilfoy, Studio X

ECMO is innovative for liver transplantation ECMO is a procedure developed in the late 1970s to take over the function of the lungs. Blood is removed from the body via cannula (similar to a hose) connected to a pump, then oxygenated and returned. It was initially used for premature newborns whose lungs were not yet functioning properly, and was frequently used to support lung function during the COVID-19 pandemic. But ECMO has rarely been performed with liver transplant patients, and very few centers in the world have attempted this combination, especially as a planned approach to transplant. Dr. Rangrass and his colleagues felt that ECMO would decrease the risk of postoperative complications related to low oxygen levels, the time that he would have to be on a ventilator after surgery, and his risk of developing associated complications like pneumonia. ECMO had never been used in liver transplantation before at SLU-H, but they were able to proceed because SLU-H is an ECMO Center where this support can be provided around the clock.

quality. Normally that would mean the patient would go back home only to wait weeks or months for another liver to be procured. But fortunately, a second potential liver donor was identified within a few hours, so Mr. Buxbaum stayed overnight at the hospital for transplantation the next day. Mr. Buxbaum was first brought to the cardiology catheterization lab, where a large cannula was inserted to drain blood from his heart, oxygenated outside the body, and returned to the pulmonary artery. A single hose with two lumens was used, one that drains blood from the right atrium and the other that returns blood to the pulmonary artery. In the past, two separate hoses would be used to perform these functions, one from the neck and one from the groin. The presence of just a single cannula would aid in Mr. Buxbaum’s recovery and mobilization after the surgery.

The transplant surgeon was Dr. Vidya Fleetwood, Assistant Professor of Transplantation and Hepatobiliary at St. Louis University Medical School. She performs liver and kidney transplants, as well as liver and kidney cancer surgery. Dr. Fleetwood agreed that Mr. Buxbaum’s condition was so tenuous that the transplant team was not sure that it was safe to perform the transplant. But with ECMO, it was possible. Planning and executing this procedure brought together teams at the hospital that had never worked together in this way. Coordinated by both Dr. Rangrass and Dr. Fleetwood, the teams included interventional cardiology, liver transplant surgery, liver transplant anesthesia, cardiac surgery, perfusion, and medical and anesthesiology critical care teams for postoperative management. They spent weeks preparing for the procedure, awaiting the arrival of a matching liver. Finding and transplanting the liver

In caring for the donated liver for transplantation, the surgical team utilized an innovative approach. Normally the organ is harvested and immediately put on ice prior to transportation to the surgery site. A recent innovation that has been selectively adopted by the SLU-H Transplant Team is using normothermic machine perfusion to decrease the ischemic insult, or reduced blood flow, to the donor liver. Instead of placing the liver on ice, it is artificially perfused using a special machine.

When a liver was finally found, Mr. Buxbaum was rushed from his home in Fenton to the hospital. But the liver had to be declined because it was not of satisfactory

The hospital was very good about letting Betty Buxbaum stay with Andrew in his intensive care room and recovery room

Post-operative care

the whole time he was there. They always were sure to take care of her as well as him. His nurse, Jackie, had worked in the cardiac ICU for years and brought unique expertise to operating the ECMO machine. Ten days after the successful transplantation surgery, the ECMO device was removed. In preparation for that, Mr. Buxbaum had a planned tracheostomy, which allowed him to be taken off ECMO with fewer complications. From the tracheostomy, Mr. Buxbaum still has some difficulty swallowing. He is working with speech, occupational and physical therapists five hours a day three days a week. He is also working with a transplant coordinator, Brittney Gabris, who monitors his anti-rejection medication, kidney levels and test results. They test his blood every week. It will be less frequent when his numbers even out. Potential for ECMO to expand liver transplantation eligibility While not many centers have offered the transplantation procedure on ECMO up until now, it is possible that this will become more widely embraced. Dr. John Fung is a widely respected transplant surgeon at the University of Chicago who previously mentored Dr. Rangrass. He delivered the keynote address at this year’s International Liver Transplant Society Congress in Amsterdam. In his presentation he identified the preemptive use of ECMO has having the potential to expand liver transplant eligibility for patients who otherwise may not be considered suitable candidates. In reflecting on the procedure, Dr. Rangrass said that this was a very special opportunity to take care of a patient that other transplantation centers might have had to send elsewhere. Such a delay would have made transplantation riskier, all while Mr. Buxbaum’s condition could have deteriorated further. Although it has been a long road to rehabilitation and recovery, Mr. Buxbaum and his wife are thankful to the SLU-H Transplant Team and their colleagues for their care and that their innovative approach to transplantation made this surgery possible.

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data sets, have found lower death rates among recipients of the vaccine than among those who didn’t get the shot.) But nearly half, 47%, thought that claim was definitely false. Nevertheless, said Brendan Nyhan, a professor of government at Dartmouth College who has spent years studying the transmission of false information, the prevalence of vaccine misinformation is “alarming.” And, while not necessarily resulting entirely from misinformation, 30% of respondents thought parents should not be required to vaccinate their children against measles, mumps, and rubella. More than a third of respondents also thought using birth control such as intrauterine devices made it harder for most women to get pregnant once they stopped.

Few Firm Beliefs and Low Trust:

For Lunna Lopes, a senior survey analyst at KFF and one of the poll’s authors, the results show wide exposure, but limited uptake, of false claims. “A lot of people have heard about these health misinformation claims. Just because they’re exposed to it doesn’t mean they’re buying into it,” she said. Still, the din of misinformation might leave the populace unsure what to believe. “You might be less trusting, and less likely to outright reject false information.”

Americans Not Sure What’s True in Age of Health Misinformation Trust in news

media

By Darius Tahir round 3 in 10 Americans still believe ivermectin is an effective treatment for Covid. What’s more, few place significant trust in any form of news media or official institution to accurately convey information about health topics, from Covid treatments and vaccines to reproductive health issues, a new poll from Kaiser Family Foundation shows.

Importance of credible sources 18 H&C

The confusion about what’s true — and who’s telling the truth — is of critical importance to public health, experts in political science said. “Misinformation leads to lives being lost and health problems not being resolved,” Bob Blendon, a professor emeritus of public health at Harvard, said in an interview. Blendon was not associated with the survey.

Such misinformed beliefs are strongly held by only a sliver of the population, according to a recent KFF poll. Nearly a third of the 2,007 respondents said the dewormer ivermectin was definitely or probably an effective treatment for Covid-19. (It’s not: Numerous randomized controlled trials have found otherwise.) A mere 22% thought ivermectin was definitely ineffective. A fifth thought it was definitely or probably true that the Covid-19 vaccine had killed more people than the virus itself. (Multiple studies, examining different

The limited embrace of outright misinformation may be cold comfort for public health advocates. The study also found only grudging trust, at best, for media sources of all kinds and the federal government. The limited trust the survey recorded is colored by wide partisan gaps, noted Nyhan.

Respondents did not have “a lot” of trust in the information relayed by any news media institution. Just over a quarter had this high level of trust for local TV news stations. And that was the highest mark of the institutions tested, which ran the ideological and stylistic gamut from MSNBC to The New York Times to Fox News and Newsmax. More people had “a little” trust in each of these institutions. For Blendon, however, the mild support is a problem. It suggests that “we are short” of trusted sources of news about health. Journalists and editors, he said, should consider there’s “something about the way you’re presenting information that’s not seen as credible by viewers.” Seventy percent of respondents said the news media wasn’t doing enough to limit the spread of health misinformation.

Role of social media The public conversation tends to focus on the often extreme declarations and wild claims featured on social media and on both corporate and government attempts to regulate the medium, Blendon noted.

Sixty-nine percent of respondents said social media companies were not doing enough to limit the spread of false or inaccurate information. But the poll shows that while the public tunes into social media quite frequently, they have very little faith in the health information they see there. No social media outlet enjoyed a double-digit percentage of respondents saying they had “a lot” of trust in it. Even so, said Lopes, a significant slice of the public — about a quarter — turn to these platforms for health information and advice. “That stood out to us,” she said. Latinos and the young are especially likely to use the forums.

Trust in health officials The picture is similarly bleak for official institutions. Around a quarter of respondents had “a great deal” of trust in the Centers for Disease Control and Prevention’s recommendations. That response rate dropped to a fifth when it came to the Food and Drug Administration. The Biden administration, Donald Trump,

and state and local public health officials lagged behind. Those findings, combined with the partisan gaps in trust, were especially discouraging for Nyhan. “They will be essential sources of information in future pandemics despite their errors and misjudgments during the pandemic,” he said of public health institutions. By far the most highly trusted source of health information? One’s own doctor. Forty-eight percent of respondents had a great deal of trust in their recommendations. The survey, the KFF Health Misinformation Tracking Poll Pilot, was conducted May 23 through June 12, online and by telephone among a nationally representative sample of U.S. adults in English and Spanish. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

H E A R T

V A S C U L A R

H E A L T H

What Is Congestive Heart Failure? Plenty of people are affected: Roughly 5.7 million Americans are living with congestive heart failure, with 670,000 new cases diagnosed each year, according to the American Heart Association (AHA). But, in reality, having heart failure doesn’t mean that your heart will never work properly again. Just like there’s more than one reason for heart failure, there are several medical treatments available to help you live well with the condition, according to the National Heart, Lung, and Blood Institute (NHLBI). To better understand how to prevent and manage heart failure, it is important to learn what it is, its stages, symptoms, causes and treatments, and the measures you can take to help lower your risk of developing the condition. What is congestive heart failure? Congestive heart failure occurs when your heart muscle is too stiff, weak or damaged to pump enough blood to meet your body’s needs, according to the NHLBI. The condition can manifest itself in one of two ways. Acute heart failure comes on suddenly, while chronic heart failure develops over time. Both can lead to additional medical conditions, especially if left untreated. These include liver or kidney damage, irregular heartbeat, cardiac arrest and heart valve disease. What are the 4 stages of congestive heart failure?

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According to the National Center for Biotechnology Information, the four stages of congestive heart failure are: Stage A: A high risk for developing

heart failure is present, but there are no symptoms or structural damage to the heart. Stage B: Structural damage to the heart

■ Difficulty sleeping in a horizontal position ■ Blue-tinted fingers and lips ■ Trouble concentrating Right-sided heart failure symptoms include:

is present with no symptoms.

■ Excessive urination

Stage C: Both structural damage and

■ Nausea

symptoms are present. Stage D: This is end-stage heart failure,

which requires advanced treatment interventions such as a heart transplant. What causes congestive heart failure? The causes of heart failure depend on the type that you have. Most typically, the condition occurs on the left side of your heart, which pumps oxygen to the rest of your body. The measure for this pumping efficiency is known as “ejection fraction.” Heart attack, coronary heart disease, heart valve disease, irregular heartbeat and genetically inherited heart conditions can all cause left-sided heart failure because they lower ejection fraction. For those with normal ejection fraction, left-sided heart failure is most typically caused by high blood pressure, obesity, diabetes or other conditions that stiffen the heart chambers. Right-sided heart failure is usually caused by left-sided heart failure. Congestive heart failure symptoms Since symptoms are not yet present in Stages A or B, it may be difficult to know if you have heart failure. For this reason, the AHA recommends having regular screening tests administered by your doctor. These consist of blood pressure readings, cholesterol profiles, blood sugar measurements, and body mass index (a measurement of height and weight) readings. Once symptoms of heart failure appear, they may differ depending on whether you have left-sided or right-sided heart failure Left-sided symptoms include: ■ Shortness of breath ■ Weakness ■ Coughing ■ Extreme tiredness

■ Loss of appetite ■ Weight gain ■ Swelling of the extremities ■ Abdominal pain Congestive heart failure treatments The Cleveland Clinic states that heart failure treatment options depend on the stage you’re experiencing. Typical Stage A and Stage B treatments include diet, exercise and lifestyle changes, such as quitting smoking and drinking. Medications to treat cholesterol, blood pressure, diabetes and certain heart conditions may also be administered. In Stage B, surgical interventions are sometimes recommended, such as removing blockages or repairing heart valves. People in Stage C and Stage D heart failure may be prescribed medications to slow their heart rate, as well as additional dietary and lifestyle restrictions. Sometimes a cardiac defibrillator is surgically implanted to help regulate the heart. How to prevent congestive heart failure A recent study of nearly 9,500 people that was published in the Journal of the American College of Cardiology revealed that those who smoked cigarettes had twice the rate of heart failure as nonsmokers. “We hope our results will encourage current smokers to quit sooner rather than later since the harm of smoking can last for as many as three decades,” senior study author Dr. Kunihiro Matsushita, said in a news release that accompanied the study. In addition to quitting smoking, the U.S. Centers for Disease Control and Prevention also recommends eating a healthy diet, managing your weight, exercising consistently, taking your medications as directed, and getting regular health screenings and medical checkups to help prevent heart failure.

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Employers respond Sanchez, chief medical officer for prevention at the American Heart Association, noted that the group takes workplace stress seriously. Several years ago, the AHA released guidance for employers looking to start resiliency training, as a way to address workers’ stress. The new study, Sanchez said, adds to a pile of evidence that workplaces can, and should, help promote good heart health.

Job Frustrations Can Really Be a Heartbreaker for Men

job that’s demanding but less than rewarding may take a big toll on a man’s heart health, a large new study suggests.

But there are plenty of reasons that stress at work – where adults spend so many of their waking hours – could contribute to heart disease.

The study, of nearly 6,500 white-collar workers, found that men who habitually felt stressed on the job had up to double the risk of developing heart disease as their peers who were more content at work.

For one, chronic stress can directly affect the cardiovascular system, said Mathilde Lavigne-Robichaud, the lead researcher.

Types of job stress In some cases, that stress took the form of “ job strain,” which meant that workers felt pressure to perform but had little power over how to get their work done. In other cases, the central problem was “effort-reward imbalance.” That’s when employees feel their diligence is not winning adequate returns – whether through pay, promotion, recognition or a sense of fulfillment. Men who reported either kind of job stress were about 50% more likely to develop coronary heart disease over the next 18 years, versus men who were happier on the job.

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Then there were the men who cited both types of job stress: Their risk of heart disease was double that of their male counterparts who reported neither work issue. There was no similar effect, however, seen among women. Researchers said the findings do not prove that job stress exacts a toll on men’s hearts, or that it doesn’t harm women.

Physical responses to stress

“Job strain and effort-reward imbalance can directly affect your heart by triggering physical responses that include an increase in heart rate, higher blood pressure and narrowing of blood vessels in the heart,” said Lavigne-Robichaud, a doctoral candidate at CHU de Quebec-University Laval Research Center in Quebec, Canada. “This makes the heart work harder and can lead to problems with blood flow and heart rhythm, ultimately increasing the risk of heart disease,” she said.

The findings are based on nearly 6,500 white-collar workers in Quebec who were part of a long-term health study. At the outset, in 2000, all were free of heart disease and 45 years old, on average. Over the next 18 years, 571 men had a first-time coronary heart disease “event” – such as a heart attack or severe chest pain caused by blocked heart arteries. Among women, 265 suffered a similar heart complication. Overall, the researchers found, the risk of future heart disease rose in tandem with workers’ perceived job stress. That was after accounting for other factors, such as education level, marital status, smoking and drinking habits, and health conditions like diabetes and high blood pressure. The link was only seen among men, however. Why is unclear. And the finding should be taken with a grain of salt, both Lavigne-Robichaud and Sanchez said. They noted that women typically develop heart disease later in life than men, and there were half as many cases among female workers in this study. That could make it harder to see a clear connection between work stress and women’s heart trouble.

“It can interfere with your ability to eat well, exercise regularly and find time to relax,” Lavigne-Robichaud said.

Lavigne-Robichaud said that the AHA and other organizations already encourage employers to have “comprehensive wellness programs” – which may include things like health screenings and nutritious food options.

If it’s hard to have a healthy lifestyle, she added, that would only further any direct effects of stress on the cardiovascular system.

“Our study suggests that incorporating interventions aimed at reducing workplace stress into these programs could help prevent heart disease,” she said.

Dr. Eduardo Sanchez agreed that chronic stress can spell trouble for the cardiovascular system – and is possibly as harmful as obesity or secondhand smoke exposure.

The findings were published Sept. 19 in the journal Circulation: Cardiovascular Quality and Outcomes.

Work stress can also harm the heart in less direct ways.

More information The American Heart Association has advice on stress management.

Adding Just 3,000 Steps Per Day Could Lower High Blood Pressure

bout 80% of older adults in the United States have high blood pressure. Keeping it down can help protect against heart failure, heart attacks and strokes.

“We’ll all get high blood pressure if we live long enough, at least in this country,” Linda Pescatello, professor of kinesiology at the University of Connecticut, said in a university news release. “That’s how prevalent it is.” While her previous research had shown that exercise could have an immediate and long-lasting impact on blood pressure, this new study set out to learn whether moderately increasing walking – popular in this age group – could do the same. The researchers focused on a group of sedentary 68- to 78-year-olds who walked about 4,000 steps per day. By adding in 3,000 steps, they would log 7,000 daily steps, in line with a recommendation of the American College of Sports Medicine.

“It’s exciting that a simple lifestyle intervention can be just as effective as structured exercise and some medications,” said first author Elizabeth Lefferts, of the Department of Kinesiology at Iowa State. Even eight participants who were already taking high blood pressure medication saw improvements in systolic blood pressure from increasing their daily activity. Getting “3,000 steps is large enough but not too challenging to achieve for health benefits,” Lee said in the release. Participants received kits with pedometers, blood pressure monitors and step diaries to track their progress. On average, participants’ systolic and diastolic blood pressure decreased by 7 and 4 points, respectively, after the intervention. Systolic, the top number in a blood pressure reading, is the pressure exerted against artery walls when the heart beats; diastolic is pressure between beats.

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Other studies suggest decreases of these magnitudes correspond to a relative 11% reduction in risk of premature death from all causes and 16% for heart-related causes; an 18% lower risk of heart disease, and a 36% lower risk for stroke.

“In a previous study, we found that when exercise is combined with medication, exercise bolsters the effects of blood pressure medication alone,” Pescatello said. Speed of walking and how long a person walked at a time did not matter as much as simply increasing total steps. The researchers hope to use these data to launch a larger clinical trial. Study findings were recently published in the Journal of Cardiovascular Development and Disease.

Experimental Shot Given Every Six Months Controlled High Blood Pressure in Early Trial

very day, millions of people must take one or more pills to control their blood pressure and reduce their risk for heart attack or stroke, but if new research pans out, some may be able to scrap their pills for a twice-yearly shot with the same benefits. The new shot isn’t ready for prime time yet, but phase 2 trials are underway.

The higher the dose, the greater the effects on blood pressure, with results lasting for up to six months, the study showed. The shot was even more effective when paired with a low-salt diet or another medication. The new trial was funded by Alnylam Pharmaceuticals, the Cambridge, Mass.based maker of zilebesiran.

Given as a shot every six months, zilebesiran suppresses the gene that produces a hormone called angiotensin that causes blood vessels to contract. This contraction causes blood pressure to rise. “This approach offers the potential for sustained reduction in blood pressure that may obviate the need for daily pills in select patients and may help overcome some of the challenges with adherence that compromise our ability to effectively treat high blood pressure,” said lead author Dr. Akshay Suvas Desai, medical director of the Cardiomyopathy and Heart Failure Program at Brigham and Women’s Hospital in Boston. Many people with high blood pressure miss or skip pills because they are overwhelmed and don’t necessarily feel sick, among other reasons. The study

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For the study, 107 people with high blood pressure received either varying doses of zilebesiran as a shot, or a placebo injection, and were then followed for 24 weeks. The researchers also looked at the effect of the 800-mg dose of zilebesiran on blood pressure when people ate a low- or high-salt diet. Another arm of the study looked at how well the shot worked when it was combined with another blood pressure-lowering medication.

“This compound does what we hoped it would do, and blood pressure reduction lasts,” Desai said. “Patients may be able to come into the office quarterly or on a biannual basis to manage blood pressure.” He called the findings exciting but said researchers are eager to learn more. “We need more data to tell us if this approach will reduce rates of heart failure, stroke and heart attacks,” Desai said. Zilebesiran likely won’t be the only blood pressure-lowering medication that people need, he noted. “It may provide a nice background of blood pressure control on which other medications can be layered,” Desai said. The new study assuages concerns that such a long-acting medication might make blood pressure dip too low. Study co-author Dr. George Bakris called the approach “very feasible” for managing high blood pressure.

“The advantages are that it is given as one injection, is good for six months, and you are going to get a substantial drop in blood pressure that would be equivalent to a high dose of a commonly used blood pressure drug,” said Bakris, director of the University of Chicago Comprehensive Hypertension Center. So far, there don’t seem to be many side effects, he said. “It’s not a substitute for pills, but it can reduce pill count and improve adherence,” Bakris said. The study was published July 20 in the New England Journal of Medicine. Diet and lifestyle still fundamental Dr. Maria Carolina Delgado-Lelievre, director of the University of Miami Comprehensive Hypertension Center, said more research is needed before anyone can start to think about downsizing their pill boxes. “Diet and lifestyle changes remain fundamental for managing blood pressure effectively, even with the use of medication like zilebesiran,” said Delgado-Lelievre, who reviewed the findings. Certain poor lifestyle choices, such as consuming too much salt, can reduce the effectiveness of blood pressure medications, she pointed out. “Zilebesiran is not exempt from this phenomenon, as their results indicate that individuals exposed to a high-salt diet saw their blood pressure return to baseline levels,” Delgado-Lelievre said. “Adopting a heart-healthy diet and lifestyle is vital to complement the benefits of medication.” High blood pressure is the No. 1 risk factor for heart disease and stroke. “The concerning issue is that despite various classes of hypertensive medications and advancements in medical technologies, only 1 in 4 adults with hypertension have their condition under control,” Delgado-Lelievre said. “This highlights the critical need to effectively manage blood pressure to reduce the risk of serious complications like heart disease and stroke, ultimately improving overall health and well-being.” Learn how to lower your blood pressure at the American Heart Association.

U.S. Heart Deaths Linked to Obesity Have Tripled in 20 Years

besity taxes many parts of the body, but new research suggests the heart might take the hardest hit of all. Between 1999 and 2020, deaths from heart disease linked to obesity tripled in the United States, and some groups were more vulnerable than others.

Specifically, Black adults had some of the highest rates of obesity-related heart disease deaths, with the highest percentage of deaths seen in Black women. The new study was published in the Journal of the American Heart Association.

Some groups and genders are more vulnerable Obesity-related heart disease deaths were higher among Black people compared with any other racial group, followed by American Indian adults and Alaska Native adults. While Black women had the highest rates of obesity-related heart disease deaths in the study, men in other racial groups experienced more obesity-related heart disease deaths than women.

Heart disease deaths related to obesity tripled “Our study is the first to demonstrate that this increasing burden of obesity is translating into rising heart disease deaths,” study author Dr. Zahra Raisi-Estabragh, a cardiologist and clinical lecturer at the William Harvey Research Institute in London, said in a journal news release. About 42% of Americans are now obese, an increase of almost 10% from the last decade, according to the American Heart Association. For the study, researchers analyzed data on more than 281,000 deaths from 1999 to 2020 in which obesity was listed in a contributing cause of death in a database. They also looked at race, gender and whether people lived in urban or rural areas. Overall, obesity-related heart disease deaths jumped from 2.2 per 100,000 people in 1999 to 6.6 per 100,000 people in 2020, the study showed. The rate of heart disease deaths not related to obesity decreased during the same period. Deaths in obese people were mainly from hardening of the arteries, heart attacks and high blood pressure-related conditions.

Black adults who lived in urban communities experienced more obesity-related heart disease deaths than those living in rural areas, but the reverse was true for all other racial groups. Exactly why such disparities exist is not fully understood, but Black people are known to have higher rates of obesity than folks in other racial groups. In addition, social factors such as unemployment, low income and lack of access to health care may also play a role. Targeted public health programs are needed The new findings reinforce the need for targeted public health programs to help reverse these alarming trends, according to two experts not involved with the study. Heart disease is among the most concerning downstream complication of obesity, and it takes decades to develop, said Dr. Scott Kahan, director of the National Center for Weight and Wellness in Washington, D.C.

“While there has long been high attention to obesity rates and some of the nearer-term risks from obesity, such as diabetes, we should now expect to see greater development of cardiovascular disease complications culminating from increasing numbers of Americans living with obesity for increasing numbers of years and decades,” he said. Several groups of people, including Black Americans and American Indians appear to have even greater risk. “While this is partly driven by higher obesity rates in these groups, other factors are also relevant, including poorer access to medical care and other social determinants of health,” Kahan said. “We need to continue to devote attention and resources to addressing obesity, [including] prevention in those at risk and intervention among those already affected – and this should particularly be focused on those groups at greatest risks.” Calling the findings “concerning though largely consistent with other studies,” Dr. Deepak Bhatt said rising rates of obesity can be attributed to less physical activity and cheaper high-calorie foods. He is the director of Mount Sinai Heart and professor of cardiovascular medicine at the Icahn School of Medicine in New York City. “Obesity-related cardiovascular disease is a major and growing problem in both sexes and all racial groups,” said Bhatt. “The findings are, in part, related to the fact that there is more obesity everywhere and the pandemic helped fuel already rising rates of obesity.” Greater emphasis on public health measures to encourage healthy eating and more physical activity would help turn these statistics around. “Potentially, some newer medications that lead to weight loss but also provide cardiovascular benefit could be useful,” Bhatt added.

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Carly Liegel, community engagement program coordinator with the Joffrey Ballet, leading dance class with Parkinson’s patients. Source: Northwestern Medicine

N E U R O L O G Y

S T R O K E

Dancing With Parkinson’s: New Program Helps Patients Control Movements

very week, a group of dancers meets in Chicago. Together, they follow a series of movements under the guidance of an instructor.

They flex, and reach, and point as Carly Liegel, community engagement program coordinator for the Joffrey Ballet, leads them through a series of movements with their arms and then their legs. But these aren’t professionals, and they aren’t your average dancers. Each one has Parkinson’s disease, a progressive brain disorder with no known cure that can cause uncontrollable movements and balance issues.

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In conjunction with Northwestern Medicine, the Joffrey Ballet started offering “Dancing with Parkinson’s” this summer, exploring ballet, jazz, tap and modern dance, as well as a little improvisation, to tunes played live by a pianist. The five-week program has had a surge of interest, so much so that Northwestern is

planning another session. “We’ve never had a program that filled up as quickly as this one in the 10 years that I’ve been here,” said Dr. Danny Bega, movement disorders specialist at Northwestern. Ginger Hall, who was diagnosed with Parkinson’s disease two years ago, takes the classes. She knows it’s important to stay active to manage her symptoms. “I do believe that the magic bullet for Parkinson’s is exercise. Even though you can’t gain what you’ve lost, you can keep Parkinson’s at bay,” Hall said in a Northwestern news release. “Post-COVID, this program reminds me of how important community is, so, I’ll come back to every class because they’re good people and it’s fun to be out with a group.” Northwestern has long been interested in dance interventions for Parkinson’s patients, Bega said. When the Joffrey Ballet reached out to offer this collaboration, the doctors were very excited about the opportunity, Bega said.

“The fundamental reason for this is that we want people with Parkinson’s to be active,” Bega said. “We’re always coaching them to increase their physical activity. We know that the one thing that can slow down disease and empower people to take control over their own condition is physical activity.” As COVID-19 restrictions have eased, it was the right time for this program to get started, said Liegel. The Joffrey Ballet is interested in offering opportunities for a lot of different ages and to “try to make dance accessible to people in communities in the Chicago city and then suburbs, people who may not have access to it otherwise,” Liegel said. This includes outreach work with children, but the organization was also interested in working with people over age 50. “I’m a big believer that dance is for everybody. And it’s not just about movement and the physicality of it, but it’s about the artistry,” Liegel said. “Sometimes I think people think when they get to a certain age or they haven’t had exposure to arts by a certain age that it’s lost and they’re not able to touch it anymore.” Something else she loves about dance “is that you don’t have to look like the person next to you,” she said. “You can do what you need to do for yourself and just inviting that expression in rather than finding judgment,” Liegel said. Dance is a way to get people with Parkinson’s engaged and motivated, making

it sustainable, Bega said. Benefits include help with the motor symptoms that are the hallmark of the disease, as well as non-motor symptoms. Dance can help with physical issues like mobility, balance and coordination, Bega said, as patients work on their footwork and coordinating movements. But it can also make a difference in fatigue, anxiety and cognitive (mental) issues that people with Parkinson’s face.

Strength in optimism. Hope in progress.

“To have an intervention that can also attack those problems, that can also deal with fatigue and anxiety while helping the motor symptoms is really a particular advantage and one of the reasons that we’re interested in these sorts of mind-body activities,” Bega said.

The APDA Missouri Chapter works tirelessly every day to support and empower those in our community who are impacted by Parkinson’s disease (PD). We promote hope and optimism through innovative services, programs, education, and support, while also funding vital research. We are here to help you and your loved ones every step of the way.

Having to remember different routines and steps uses memory and thinking skills. Partnering with others builds social experiences. There’s a camaraderie from being with others who have the same condition, similar to a support group. Simply getting out of the house is a benefit, he added.

CMY

The program’s popularity may be partly due to recognition of the Joffrey Ballet name. And it might be that dance sounds like fun, like a hobby, rather than exercise. The music itself can also have an impact on people’s quality of life, Bega said.

What participants get from this class is “ just knowing that anybody can dance no matter what your ability is,” Liegel said. She appreciates seeing the joy on a dancer’s face when they master something new.

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“I just love when, even if they mess up, they allow themselves to laugh at themselves and each other in the most lighthearted and fun way,” Liegel said. Northwestern also has collaborations with the theater improv group Second City for patients with Parkinson’s and is developing golf and tennis classes for this patient group, as well. In this class, space is limited to about 30 participants. Each Parkinson’s patient is allowed to bring a caregiver or friend. “Anything we can do to keep them engaged and active and empowered to take control over the disease, I think is going to be beneficial,” Bega said.

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FDA Gives Full Approval to Alzheimer’s Disease Drug Leqembi

his summer, the U.S. Food and Drug Administration gave full approval to the Alzheimer’s disease drug Leqembi (lecanemab-irmb), clearing the way for insurance coverage of the pricey drug.

Leqembi had been approved in January under the Accelerated Approval pathway. This pathway allows the FDA to approve drugs for serious conditions where there is an unmet medical need, based on clinical data demonstrating the drug’s effect on a surrogate endpoint—in the case of Leqembi, reducing amyloid plaques in the brain—that is reasonably likely to predict a clinical benefit to patients.

Alzheimer’s disease is an irreversible, progressive brain disorder affecting more than 6.5 million Americans. The disease slowly destroys memory and thinking skills and eventually, the ability to carry out simple tasks. While the specific causes of Alzheimer’s are not fully known, it is characterized by changes in the brain—including the formation of amyloid beta plaques and neurofibrillary, or tau, tangles—that result in loss of neurons and their connections. FDA approval and Medicare

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“This action is the first verification that a drug targeting the underlying disease process of Alzheimer’s disease has shown clinical benefit in this devastating disease,” Teresa Buracchio, M.D., acting director of the Office of Neuroscience in the FDA Center for Drug Evaluation and Research, said in an agency news release. “This confirmatory study verified that it is a safe and effective treatment for patients with Alzheimer’s disease.” The process of converting a drug to full FDA approval usually attracts little attention. But Alzheimer’s patients and advocates have been lobbying the federal government for months after Medicare

officials announced last year they wouldn’t pay for routine use of Leqembi until it received FDA’s full approval. There were concerns that the cost of new plaque-targeting Alzheimer’s drugs like Leqembi could overwhelm the program’s finances, which provide care for 60 mil-

Assessment Scale Cognitive Subscale 14, and the Alzheimer’s Disease Cooperative Study-Activities of Daily Living Scale for Mild Cognitive Impairment. The most common side effects of Leqembi were headache, infusion-related reactions and amyloid-related imaging abnormalities (ARIA), a side effect known to occur with the class of antibodies targeting amyloid. ARIA most commonly presents as temporary swelling in areas of the brain seen on imaging studies that usually resolves over time and may be accompanied by small spots of bleeding in or on the surface of the brain. Although ARIA is often not associated with any symptoms, symptoms can occur and include headache, confusion, dizziness, vision changes and nausea. Caveat and who qualifies The approval did come with one significant caveat, however: The FDA added a boxed warning to Leqembi’s labeling, cautioning that in rare cases, the medication can trigger “serious and life-threatening events,” including brain bleeds, some of which have proven fatal. The agency also noted that the “prescribing information recommends caution when considering use of Leqembi in patients taking anticoagulants or with other risk factors for intracerebral hemorrhage.”

lion seniors. Leqembi is priced at about $26,500 for a year’s supply of IVs every two weeks. The vast majority of Americans with Alzheimer’s get their health coverage through Medicare. And private insurers have followed its lead by withholding coverage for Leqembi and a similar drug, Aduhelm, until they receive FDA’s full endorsement. The study and side effects The study enrolled 1,795 patients with Alzheimer’s disease. Treatment was initiated in patients with mild cognitive impairment or mild dementia stage of disease and confirmed presence of amyloid beta pathology. Patients received either placebo or Leqembi at a dose of 10 milligrams (mg)/kilograms (kg), once every two weeks. Leqembi demonstrated a statistically significant and clinically meaningful reduction of decline compared to the placebo. Statistically significant differences between treatment groups were also demonstrated on all secondary endpoints, which included the Alzheimer’s Disease

Leqembi will only be available to people in the earliest stages of Alzheimer disease – those with mild dementia or mild cognitive impairment. Labeling will also instruct physicians not to treat patients with Leqembi unless they have already undergone testing to confirm an uptick in levels of amyloid protein in their brain. Amyloid buildup is a key signal of Alzheimer disease, and Leqembi is designed to fight it. The results of the 18-month trial gained wide attention when they were published last December in the New England Journal of Medicine. In the trial, early-stage Alzheimer disease patients who took Leqembi showed a 27 percent reduction in their mental decline compared with patients in the placebo arm of the trial. The drug’s users also showed less evidence of amyloid protein plaques in their brain compared with nonusers. Approval of Leqembi was granted to Japanese manufacturer Eisai.

New Nasal Spray for Migraines Approved by FDA

igraine sufferers will soon have a new treatment option that works more quickly and may be safer for people at risk of heart attack or stroke. The U.S. Food and Drug Administration has approved Pfizer Inc.’s zavegepant (Zavzpret), a nasal spray to treat severe headache pain, the company announced earlier this year. Breakthrough treatment “FDA approval of Zavzpret marks a significant breakthrough for people with migraine who need freedom from pain and prefer alternative options to oral medications,” Angela Hwang, chief commercial officer and president of Pfizer’s global biopharmaceuticals business, said in a company news release. Pfizer expects the nasal spray to be in pharmacies this year,

on a placebo. Side effects reported included an altered sense of taste, nasal discomfort and nausea. How it works Zavzpret blocks the release of calcitonin gene-related peptides, a type of protein. Past research has found these proteins are increased during a migraine, the Times reported.

but it didn’t release pricing information. “We’ve been waiting for this medication to come out,” Dr. Timothy Collins, chief of the headache division at Duke University Medical Center’s neurology department, told the New York Times. “It’s a really helpful addition to migraine management.” FDA approval was based largely on a clinical trial published in Lancet Neurology that found those who took the medication were more likely to return to normal within 30 minutes to two hours. Nasal sprays can be absorbed more quickly than pills. About 40% of the trial participants who took the medication were free of their worst symptoms two hours after using the medication, compared to about 31%

“And I think that discovery has been really groundbreaking in helping us to better understand what happens when someone is having a migraine attack,” Dr. Rashmi Halker Singh, an associate professor of neurology at the Mayo Clinic, told the Times. Other available nasal products target serotonin receptors using triptans. However, they are not indicated for people at risk of heart attack or stroke. “Hopefully this will help us help more people,” Halker Singh said. “That’s the bottom line, right?”

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Brain ‘Zaps’ Might Limit the Damage From a Stroke

ould an electrical zap to the brain limit the damage a stroke inflicts?

Yes, claims a small new study that found this noninvasive procedure increased blood flow to the areas around the clot that caused the stroke, thus protecting them from further damage. “This treatment can be efficiently applied in the emergency setting. It was well tolerated and shows really promising signs of rescuing brain tissue affected by the stroke,” said lead researcher Dr. Mersedeh Bahr-Hosseini, a vascular neurologist at UCLA Health in Los Angeles. “Hopefully, in the not too far future, we will be able to further test the safety and effectiveness of this treatment,” she said. How it works Bahr-Hosseini said the treatment works by boosting blood flow in the brain. “We think it’s not just the brain tissue or brain nerve cells that respond to electrical currents. Blood vessels also respond to the electrical current, usually in the form of vessel dilation,” she said. By expanding the size of the blood vessels in the brain, more blood flows into the brain and protects blood vessels from damage, thus preventing more damage from the stroke. Bahr-Hosseini said that electric stimulation might also protect brain tissue by stopping the extra nerve activity in brain cells as they react to the brain being under attack. Moreover, increasing blood flow and expanding blood vessels may also help to dissolve the clot that caused the stroke, she added.

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Electric brain stimulation has been used to treat psychiatric disorders such as depression, Bahr-Hosseini said. She noted that many patients are not eligible for the two common treatments available for ischemic stroke, namely clot-busting drugs and a device that reaches into the blood vessels and pulls out clots. Among patients who are eligible for those treat-

ments, about 20% to 30% end up with disabilities months after their stroke, Bahr-Hosseini noted. Application is for ischemic strokes Brain stimulation is only appropriate for ischemic strokes, caused by blood clots in the brain’s blood vessels, not strokes caused by bleeding in the brain, called hemorrhagic strokes. For the study, Bahr-Hosseini and her team randomly assigned seven stroke patients to electrical brain stimulation and three to phony stimulation. All 10 patients were treated within 24 hours of the onset of their stroke and were ineligible for other therapies. The treatment involves placing electrodes on the scalp and directing a small electric current to the area of the brain affected by the stroke. Impressive results The researchers found among patients receiving the stimulation, a median of 66% of the penumbra – the brain tissue surrounding the core of the stroke – was saved from damage, compared with 0% among those given the phony treatment. In addition, brain scans showed that the greater the stimulation, the better the

blood flow, while patients who didn’t get the real stimulation experienced a decrease in blood flow, Bahr-Hosseini said. She said this finding might prove that the treatment has a true biological effect. The researchers hope to expand their study by treating more patients to prove that the treatment works. Their hope is that eventually, it will become a standard therapy used along with other treatments. The findings were published in the journal JAMA Network Open. One neurology expert said the study results show promise. “It’s extremely interesting and a possibly promising innovative new treatment for stroke,” said Dr. Richard Libman, vice chair of neurology, stroke and cerebrovascular disease at Long Island Jewish Medical Center in New Hyde Park, N.Y. If this treatment is proven effective, Libman believes it could become a part of standard care. “There’s absolutely no reason why it can’t be used in conjunction with what is now standard of care, which is basically clot-busting drugs given through the vein, or catheter-based techniques which mechanically pull out clots from blocked blood vessels,” he said. Time is critical As with all stroke treatments, time matters, Libman said. The sooner treatment begins after the stroke onset, the better the odds of recovery. “Time is brain is the cliched phrase,” Libman said. “I don’t think that’s ever going to change until we find some magic bullet that can help with brain degeneration or regeneration. “If you get to the hospital quickly we can salvage many brain cells, maybe not all but many,” Libman said. “That has been proven over and over again, to result in better recovery after stroke. To make up the difference between ending up in a nursing home versus ending up at home and requiring help or ending up at home and functioning independently, which is a huge difference in outcome.”

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AI Tool ‘Reads’ Brain Tumors During Surgery to Help Guide Decisions

cientists have developed an artificial intelligence (AI) tool capable of deciphering a brain tumor’s genetic code in real time, during surgery — an advance they say could speed diagnosis and personalize patients’ treatment.

Not all gliomas are the same, however. Most people are diagnosed with one of three subtypes that each have different genetic features — and, critically, different degrees of aggressiveness and treatment options.

Other gliomas, such as glioblastoma, are highly aggressive. So surgeons will try to remove as much of the cancer as possible, and sometimes implant “wafers” of slowly released chemotherapy drugs directly into the brain.

Real-time results in minutes, not days or weeks

“This breakthrough technology has the potential to guide surgical decisions by providing real-time molecular diagnosis during brain tumor surgeries,” said Atique Ahmed, an associate professor of neurological surgery at Northwestern University Feinberg School of Medicine in Chicago.

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The technology, called CHARM, also appears high on the accuracy scale. When Yu’s team put it to the test with glioma samples it had never “seen” before, the AI tool was 93% accurate in distinguishing the three different molecular subtypes. Being able to make such distinctions in the operating room is critical, Yu and other experts said, because it could change how a patient is treated. Some gliomas are less aggressive, and

No one wants to replace doctors, Yu stressed. “We want to use AI as a tool.”

The work, described online in the journal Med, is not the only effort to improve glioma diagnosis using AI. surgeons can be more conservative in removing brain tissue — which can minimize side effects.

In contrast, the AI tool his team is developing can enable molecular diagnosis in 10 to 15 minutes. That means it could be done during surgery, according to Yu, an assistant professor of biomedical informatics at Harvard Medical School, in Boston.

Interest in using AI in medical diagnoses has exploded in recent years. The hope is that AI algorithms will assist specialists in analyzing images — from mammograms or CT scans, for example — to get a faster, more accurate verdict.

CHARM is a much more memorable acronym for Cryosection Histopathology Assessment and Review Machine. Yu’s team developed the tool using more than 2,300 frozen tumor samples from 1,524 patients treated for glioma at various U.S. hospitals.

The researchers trained the AI tool to recognize the different genetic features of gliomas, a group of tumors that constitute the most common form of brain cancer among adults.

Right now, pathologists can analyze gliomas for those genetic markers, in what’s known as molecular diagnosis. But the process takes days to weeks, said Dr. Kun-Hsing Yu, the senior researcher on the new study.

Using AI in medical diagnoses

Improvement and FDA clearance needed Ahmed, who was not involved in the study, called the tool’s 93% accuracy “impressive,” but noted that it can be improved. “It’s important to remember that the 7% inaccuracy is not just a number,” he said. “It represents patients with very aggressive diseases who could benefit greatly from more precise diagnoses.” Yu agreed that the performance can be further refined, and CHARM is not yet ready for prime time. It has to be tested in real-world settings, he said, and cleared by the U.S. Food and Drug Administration. The researchers are working with several hospitals in different areas of the world to put CHARM to that real-world test.

Other tools are under study, including one called DeepGlioma. Dr. Daniel Orringer, a neurosurgeon at NYU Langone’s Perlmutter Cancer Center in New York City, is one of the researchers on that project. Democratizing molecular testing He said that right now, molecular diagnosis of glioma is not only time-consuming and expensive, but not available at all hospitals where patients are treated. AI has the potential to “democratize molecular testing,” Orringer said. CHARM, he said, is “particularly attractive” in that regard, because it could ultimately be used at any hospital that has the capacity to digitize histology slides (microscopic images of patients’ tumor samples). Yu made a similar point. The other AI tools in development for glioma require a special type of microscope that is not available at all hospitals — even in wealthy countries, let alone the developing world, he said. And while the current study focused on glioma, Yu said CHARM could be trained to aid in diagnosing other types of brain tumors, too. Ahmed called that potential “versatility” promising. “The development of CHARM represents a significant leap forward in the quest for precise and rapid molecular diagnosis during brain tumor surgeries,” he said.

Henry (pictured right) History of polyps – Routine screenings No cancer found Colon cancer screening

You’re more important than you know. You touch lives. You give smiles. You are someone’s favorite person. Your health matters. Henry’s wife Maureen is a retired healthcare worker and an advocate for proactive screenings. She convinced Henry to get a routine colonoscopy a few years ago and some non-cancerous polyps were discovered and removed. Knowing he was healthy gave Henry peace of mind and a spirit of freedom to enjoy a carefree life in retirement with his wife and family. It also inspired him to continue his routine screenings to ensure a healthy, happy future.

Four out of 10 adults will develop cancer in their lifetime, but screening tests can catch cancer early and help save lives. Give yourself and those who love you peace of mind, schedule a routine cancer screening and take control of your health today To see Henry’s story and to learn which cancer screenings might be right for you and to schedule an appointment, visit getscreenednow.com or call 314-310-7574. For the lives you touch.

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matology at the University of Mississippi Medical Center, told the Post. “It seems to have a different natural history, and a poorer prognosis, though late diagnosis is a component of that. These cancers can look like a black dot under a fingernail.”

Melanoma Is an Even More Deadly Disease in Black Men

lack men are more likely to die of melanoma, new research shows, and one reason why may be the unusual places where the deadly skin cancer is likely to show up on their bodies. Even though the disease is more common in white men, the new report shows that Black men are 26% more likely to die from it, the Washington Post reported. Differences in location and survival rates “The purpose of our study was to dive deeper into why we are seeing these differences in survival rates and the factors that may be driving this,” study co-author Ashley Wysong, chair of dermatology at the University of Nebraska Medical Center, told the Post.

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The researchers analyzed more than 205,000 cases and discovered that melanoma in Black men is often found in areas that have not had a lot of sun exposure, including the soles of the feet, toes, toenails, fingernails, fingernail beds and palms, the Post reported. About 51% of Black men with melanoma have it on their lower extremities. In white men, only about 10% of those with melanoma have it on their lower extremities, while 35.5% have it on their trunk and nearly 26% have it on their head and neck,

the study found. Only about 13% of cases in Black men were on the trunk and just under 10% were on the head. Later diagnoses Black men also tended to be diagnosed later, with nearly 49% diagnosed at late stages of the disease. Just over 21% of white men are diagnosed with late-stage disease, as are about 40% of Hispanic men, 38% of Asian men and 29% of Native American men, the study found. The five-year survival rate of melanoma is 99% when the cancer is found early, but it’s only 32% after it has spread, the Post reported. The findings were published in the Journal of the American Academy of Dermatology. That plays out in outcomes, with more than 75% of white men living for five years after diagnosis compared to about 52% of Black men, the study found. Deadlier melanoma subtypes are often not found The researchers found that about 20% of Black melanoma patients had a deadlier subtype found on the sole of the foot or palm of the hand that is called Acral lentiginous melanoma. Fewer than 1% of white men had this subtype. “It's not related to sun exposure,” Robert Brodell, a professor of pathology and der-

Dr. Ramona Behshad, Associate Professor of Dermatology at Saint Louis University and Director of Mohs Surgery and Cutaneous Oncology at SSM SLUCare Physician Group, adds “It is a common misconception that people with black, brown, and olive skin are immune to skin cancer. While Blacks have a lower risk of getting skin cancer overall, when a Black man gets melanoma, he is 26% more likely to die than a white man. “This may be related to difficulty in diagnosis, leading to a delayed diagnosis and worse outcome. Because of this, I recommend everyone practice photoprotection and wear sunscreen daily. Also, schedule a skin check if you notice any new or changing skin lesions, regardless of your skin color. Early diagnosis is the key to excellent outcomes.” Wysong noted that melanomas on places like fingers, toes, palms and soles of feet can be mistaken for warts and fungus. “Most people don’t think of skin cancers in their nails or on their hands and feet,” Wysong said. “So we see delays in diagnosis because of the location. It’s hard to see. Most people don’t know what a nail melanoma looks like.” Overall, invasive melanoma cases are up by 27% in 10 years, the Post reported. In 2023, there were over 97,000 cases in the United States, more than 58,000 in men. Nearly 8,000 people are expected to die of melanoma this year. More education is needed for doctors and patients, including in Black patients where it rarely occurs, Jeremy Brauer, a clinical associate professor of dermatology at NYU Langone Health, told the Post. Doctors may not be aware of the differences, Brauer said. “This disproportionate and unfortunate rate of death means we have to try to be much more preventative.”

Cancer Drug Shortages Persist Across U.S.

You are cordially invited to the

cancer centers continue to have shortages of commonly used chemotherapy drugs, a new survey shows, though the medications are not as scarce as they were last June. The National Comprehensive Cancer Network (NCCN), a nonprofit alliance of leading cancer centers, surveyed its network in September.

2023 Annual Men’s Dinner

Drugs in short supply

Cocktails 5:45 Dinner 6:45 The Ritz-Carlton St. Louis

U.S.

In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin. These two platinum-based generic chemotherapy medications are recommended for treating many different cancers. CNN recently reported that two other drugs used for cancer, vinblastine and dacarbazine, went into shortage in September. Overall, 86% of centers surveyed said they were short on at least one type of anti-cancer drug. “Drug shortages aren’t new, but the widespread impact makes this one particularly alarming. It is extremely concerning that this situation continues despite significant attention and effort over the past few months. We need enduring solutions in order to safeguard people with cancer and address any disparities in care,” said Dr. Robert Carlson, chief executive officer for NCCN. Twenty-nine of the NCCN’s member institutions responded to the September survey. They include leading academic centers across the United States. The findings may not reflect additional challenges that smaller community practices serving rural and marginalized patients are experiencing. The centers surveyed were using strict waste management strategies, so nearly all were still able to provide the medications to all patients who needed them. Other medications in short supply included methotrexate, with 66% of centers reporting a shortage; 5-fluorouracil, with 55% falling short; fludarabine at 45%; and hydrocortisone at 41%. Comprehensive solutions are needed “These drug shortages are the result of decades of systemic challenges,” said Alyssa Schatz, NCCN’s senior director of policy and advocacy. “We recognize that comprehensive solutions take time.” “At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today,” Schatz said. “These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency.” The organization is continuing to advocate for more supplies.

Thursday, November 9

Featured Speaker: Former Mizzou Football Coach Gary Pinkel MC: Guy Phillips

The Annual Men’s Dinner raises funds for cancer research, care and prevention for men and women, pediatric to geriatric. Cost: $425 per person Every attendee receives a $150.00 gift certificate to a retail store and enjoys a dinner valued at $200.00. Dress Code: jacket and tie For more information about the St. Louis Men’s Group Against Cancer, visit or call

www.mensgroupagainstcancer.org

314-786-5950

Invitations will be mailed the first week in October and will be available online.

she said. “There has been a fatalistic feeling about lung cancer, but screening is a game changer, and we are going to create an army of survivors like we did with breast cancer through screening.” Lung cancer can often be treated surgically if it is diagnosed at an early stage and hasn’t spread.

Anyone Can Get Lung Cancer. Detecting It Early Is Crucial.

oo few people are getting screened for lung cancer.

This is the message from the American Lung Association’s “State of Lung Cancer” report issued at the end of 2022. Less than 6% of eligible Americans have been screened for lung cancer, and in some states, lung cancer screening rates are as low as 1%. Annual screening recommended for those at high-risk

In 2021, the U.S. Preventive Services Task Force began recommending annual lung cancer screening with low-dose computed tomography (CT) for people aged 50 to 80 who smoked at least one pack of cigarettes a day for 20 years, smoked two packs of cigarettes a day for 10 years, currently smoke, or who have quit in the past 15 years. About 14.2 million Americans meet these guidelines. Medicare and most private insurance plans must pay for the screening test in folks who fall into these high-risk categories.

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“We have such a long way to go with regard to lung cancer screening uptake,” said Dr. Andrea McKee, chairman of radiation oncology at Lahey Hospital & Medical Center in Burlington, Mass. She is also a volunteer spokesperson for the American Lung Association. Denise Lee, who smoked for 40 years, is

a big advocate of early screening. She was not aware of low-dose CT scan screening until she saw a billboard on her way to work. The scan revealed early-stage lung cancer. Lee underwent surgery and chemotherapy. She says early detection saved her life. She also enrolled in a clinical trial testing an immunotherapy drug to prevent recurrence. Part of the reason behind low screening rates is that lung cancer screening is still new. “We have been doing colonoscopies to find colon cancer, Pap testing for cervical cancer, and mammograms to detect breast cancer for decades, but the decision to support lung cancer screening didn't happen until 2021,” McKee said. Screening test is simple, painless and quick The lung cancer screening test is simple and painless, especially compared to some other cancer screening tests that involve prep work like colonoscopies, are invasive like Pap testing, or can be painful such as mammograms, she said. “This is noninvasive and quick. There is no blood draw, just low-dose radiation to create images of the lungs,” she said. A radiologist then looks through images to spot early lung cancers, which are highly curable, McKee said. “Screening-detected stage 1 lung cancer has a 90% cure rate,”

It’s not just smokers who develop lung cancer. Leah Phillips, a mother of three, learned she had advanced lung cancer at the age of 43. An avid runner, she was shocked because she has never smoked. She is currently living with lung cancer and trying to raise awareness that anyone can get lung cancer. Room for improvement The new report did note that people of color who are diagnosed with lung cancer often have lower survival rates, are less likely to be diagnosed early, and less likely to receive surgical treatment. They are more likely to receive no treatment. While most insurers must cover lung cancer screening tests in people who are eligible, fee-for-service state Medicaid programs are not required to do so. Two lung cancer experts from Memorial Sloan Kettering Cancer Center agreed that more people should get screened for lung cancer. “Screening reduces lung cancer deaths, and the benefit outweighs any risk of harm such as overdiagnosis, incidental findings, and invasive procedures,” said Dr. Bernard Park, a surgical oncologist at the cancer center. In addition to the advent of screening, there have been many improvements in treating lung cancer, said Dr. Isabel Preeshagul, a medical oncologist at Sloan Kettering’s center in Montvale, N.J. “Lung cancer has become the poster child for personalized medicine,” she said. “We know so much more now than we did 20 years ago, 10 years ago, one year ago and, even in certain cases, three months ago,” she said. Today, doctors can do genetic testing on lung tumors to see which genes are expressed and better tailor treatment to the specific tumor. “We really focus on tailoring [treatment] to one's tumor,” she said.

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D I A B E T E S ,

D I G E S T I V E

K I D N E Y

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the blood vessels in your kidneys. Almost 1 in 3 people with diabetes has CKD.1 High blood pressure. High blood pressure is the second leading cause of CKD. Like high blood glucose, high blood pressure also can damage the blood vessels in your kidneys. Almost 1 in 5 adults with high blood pressure has CKD.1 Heart disease. Research shows a link

between kidney disease and heart disease. People with heart disease are at higher risk for kidney disease, and people with kidney disease are at higher risk for heart disease. Researchers are working to better understand the relationship between kidney disease and heart disease.

What Is Chronic Kidney Disease?

hronic kidney disease (CKD) means your kidneys are damaged and can’t filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time. This damage can cause wastes to build up in your body. CKD can also cause other health problems. Your kidneys are located in the middle of your back, just below your ribcage.

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The kidneys’ main job is to filter extra water and wastes out of your blood to make urine. To keep your body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium, and potassium—that circulate in the blood. Your kidneys also make hormones that help control blood pressure, make red blood cells, and keep your bones strong. Kidney disease often can get worse over time and may lead to kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to maintain your health. The sooner you know you have kidney

disease, the sooner you can make changes to protect your kidneys. How common is CKD, and who is more likely to develop it? CKD is common among adults in the United States. More than 37 million American adults may have CKD.1 You are at risk for kidney disease if you have: Diabetes. Diabetes is the leading cause of CKD. High blood glucose, also called blood sugar, from diabetes can damage

Family history of kidney failure. If your mother, father, sister, or brother has kidney failure, you are at risk for CKD. Kidney disease tends to run in families. If you have kidney disease, encourage family members to get tested. Use tips from the family health reunion guide from the National Institute of Diabetes and Digestive and Kidney Diseases and speak with your family during special gatherings.

Your chances of having kidney disease increase with age.1 The longer you have had diabetes, high blood pressure, or heart disease, the more likely that you will have kidney disease. African Americans, Hispanics, and Native Americans tend to have a greater risk for CKD.2 The greater risk is due mostly to higher rates of diabetes and high blood pressure among these groups. Scientists are studying other possible reasons for this increased risk.

Symptoms of advanced CKD ■ Chest pain

■ Muscle cramps

■ Dry skin

■ Nausea

■ Itching or numbness

■ Shortness of breath

■ Feeling tired

■ Sleep problems

■ Headaches

■ Trouble concentrating

■ Increased or decreased urination

■ Vomiting

■ Loss of appetite

■ Weight loss

Early CKD may not have any symptoms You may wonder how you can have CKD and feel fine. Our kidneys have a greater capacity to do their job than is needed to keep us healthy. For example, you can donate one kidney and remain healthy. You can also have kidney damage without any symptoms because, despite the damage, your kidneys are still doing enough work to keep you feeling well. For many people, the only way to know if you have kidney disease is to get your kidneys checked with blood and urine tests. As kidney disease gets worse, a person may have swelling, called edema. Edema happens when the kidneys can’t get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles, and less often in the hands or face. People with CKD can also develop anemia, bone disease, and malnutrition. Does CKD cause other health problems? Kidney disease can lead to other health problems, such as heart disease. If you have kidney disease, it increases your

F E A T U R E D

chances of having a stroke or heart attack.

Will my kidneys get better?

High blood pressure can be both a cause and a result of kidney disease. High blood pressure damages your kidneys, and damaged kidneys don’t work as well to help control your blood pressure.

Kidney disease is often “progressive”, which means it gets worse over time. The damage to your kidneys causes scars and is permanent.

If you have CKD, you also have a higher chance of having a sudden change in kidney function caused by illness, injury, or certain medicines. This is called acute kidney injury (AKI). How can CKD affect my dayto-day life?

You can take steps to protect your kidneys, such as managing your blood pressure and your blood glucose, if you have diabetes. What happens if my kidneys fail? Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. If you have kidney failure, you will need treatment to maintain your health. Learn more about what happens if your kidneys fail.

Many people are afraid to learn that they have kidney disease because they think that all kidney disease leads to dialysis. However, most people with kidney disease will not need dialysis. If you have kidney disease, you can continue to live a productive life, work, spend time with friends and family, stay physically active, and do other things you enjoy. You may need to change what you eat and add healthy habits to your daily routine to help you protect your kidneys.

1. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019.

People with kidney disease can continue to work, be active, and enjoy life.

2. Race, ethnicity, and kidney disease. website. www.niddk.nih.gov.

References

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Ellen Needs a Kidney Donor By Todd Abrams

to process, and also salt. Kidney disease causes calcium loss from bones, so she takes calcium and Vitamin D supplements.

llen Langston lives in Clayton and has spent most of her life as a “professional volunteer,” working and tutoring in the Parkway and University City School districts, and as president of Kids’ Place, an organization providing after school care to at risk elementary school students.

Five years ago, Ellen, then a healthy and active 72-year-old, had her regular annual physical. She was surprised, but not completely shocked, to learn that she had reduced kidney function. Her father and his father both had kidney disease. Ellen had no symptoms, like most of those with kidney disease who first discover it through a routine blood test. There is no cure for kidney disease

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When reduced kidney function is discovered, the hope is that it will stabilize or progress very slowly. It is important to stay active and keep blood pressure in check. Ellen is adamant about exercising, walking three days a week and doing strength and balance training two days. She continues to take blood pressure medication, but had to stop other prescriptions for arthritic issues because they are bad for kidneys. She has cut back on beef, since protein is hard for the kidneys

When first diagnosed, Ellen’s measure of kidney function was 38%. It stayed stable for a couple of years, then began to decline. After shoulder surgery, her function went down to 18%, which is considered severely decreased. It then came back up a bit, but is now at just 16%. In April of last year she had a biopsy that showed her kidneys, which normally are as big as fists, were the size of walnuts.

year, if a donor has two healthy kidneys, one kidney will take up the job of its missing counterpart with no ill effects. If Ellen finds one, she can have the transplant right away. Her younger sister was willing to be a donor but was disqualified because she was discovered to be pre-diabetic. A friend in Tampa was also disqualified due to another health condition. Ellen has considered dialysis, which is usually prescribed when kidney function reduces to the 10-15% range, but she prefers the transplant option if she can find a qualified donor. Each year she has to go through the extensive testing again. She continues her exercise, despite feeling fatigued a good deal of the time. Her husband Randy is her “keeper”, having taken over things she used to do, including grocery shopping, meals, taking care of the house and dog.

Consideration of a transplant

The search for a kidney donor

Right after the biopsy, her nephrologist, Dr. Marcos Rothstein, called to tell her how bad her kidney disease was, that she would need a transplant, and should get it before the end of summer. Then her numbers went up a bit and stabilized at 20-21%. There was not a rush, but she needed to get on the list for a transplant.

To try to find a living kidney donor, Ellen is reaching out to the public via Facebook and other social media platforms. “My doctors tell me that other than my declining kidney function I’m an incredibly healthy 76-year-old. I feel like I have so much to live for and want to be able to watch my grandchildren grow up. While I’m embarrassed to be asking strangers to help me search for a kidney, I refuse to give up my fight and want to exhaust every option possible.”

SSM Health St. Louis University Hospital’s renowned Transplant Service Center was highly recommended and able to accept Ellen’s health insurance, so she began working with them. She went through extensive testing that included heart and lung examinations, thoracic MRI, stress test, and thorough blood tests that took 36 tubes - she counted them. Ellen got on the list for a kidney transplant in September of 2022. In January of 2023 she turned 76 years old and was shocked to be told that one year difference disqualified her from receiving a cadaver kidney. She successfully appealed that decision, but because the wait can be 3-5 years, she also began the search for a live donor. As we reported earlier this

If you are interested in learning more about kidney donation, you can reach out to the SSM Health St. Louis University Hospital Transplant Center by contacting Heather Paige via email at Heather. Paige@ssmhealth.com or by phone at 314-257-8334. Tell them you’re calling on behalf of Ellen Langston. Another option is to email ellenskidneysearch@gmail. com for more information. Photo of Ellen: Michael Kilfoy, Studio X

Nearly 4 in 10 Adults with Type 1 Diabetes Weren’t Diagnosed Until After Age 30

ype 1 diabetes has long been viewed as a childhood disease, but a new study suggests it might be time to revise that thinking. Investigators concluded that nearly 4 in 10 Americans with type 1 diabetes aren’t diagnosed with the blood sugar condition until they’re at least 30.

While the consensus has been that type 1 diabetes can develop at any age it typically strikes children, teens and young adults. But the study team points to recent research that more than half of all type 1 diabetes cases (about 62%) develop after the age of 20.

“Our research adds to a growing body of studies showing that adult-onset type 1 diabetes may be as common as childhood-onset type 1 diabetes,” said study author Michael Fang, an assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

That distinguishes it from the much more common type 2 version, in which the pancreas becomes less able to produce insulin, and the body becomes resistant to insulin. Type 2 is more often attributed to lifestyle factors, including being overweight or obese, which can trigger insulin resistance, ultimately leading to dangerously high blood sugar levels. Age of development and diagnosis Identifying clear risk factors for type 1 is tricky, the CDC cautions, though having a family history of the disease is a big warning sign.

Fifty-seven percent of patients did not find out that they had type 1 diabetes until they were 20 or older, while 37% of the patients didn’t find out until they were 30 or older. Another 22% were not diagnosed until they were at least 40. What does this all mean? “While it is commonly believed that type 1 diabetes develops in childhood, our findings suggest it is not that simple,” said Fang. “Type 1 diabetes can develop at all ages.” The CDC notes that type 1 diabetes symptoms are often mild initially, and may go unnoticed for months or even years. On top of that, routine screening is not currently recommended. So, might it be the case that some patients develop the disease while young, yet go undiagnosed well into adulthood? Not according to Fang, who views the findings as more of an indication of “the heterogeneity of the disease,” rather than a sign that type 1 diabetes patients are falling through the cracks.

Type 1 and type 2 diabetes The U.S. Centers for Disease Control and Prevention explains that only about 5% to 10% of all diabetes patients have type 1 diabetes, in which the body’s immune system attacks the islet cells in the pancreas that make insulin, which is needed to help blood sugar enter the body’s cells so it can be used for energy.

from 26 to 30. That compared with 21 among white patients.

To gain more insight into how old type 1 diabetes patients actually are when diagnosed, investigators examined data concerning nearly 950 adults (18 and up) who had previously been confirmed as having the disease. Patient information had been gathered by the U.S. National Health Interview Survey between 2016 and 2022. The pool was almost equally divided between men and women, with an average age of 49 at enrollment. About three-quarters were white. The overall median age at diagnosis was pegged as 24, meaning that half of the patients were diagnosed at a younger age, while the other half was diagnosed when older. Men were more likely to be diagnosed later than women, at 27. Among women, the median age was 22. Racial and ethnic minorities also tended to get diagnosed significantly later in life, the team found, with a median diagnostic age ranging

The bottom line, he said, is that “sometimes it develops in childhood. But often it develops in later ages.” The findings were published Sept. 26 in the Annals of Internal Medicine. Dr. Caroline Sloan, an assistant professor of medicine and population health sciences at the Duke-Margolis Center for Health Policy at Duke University in Durham, N.C, says “if a patient’s diabetes type is misdiagnosed [as type 2 diabetes] it could change a lot about how they’re treated, what doctors they see and their ability to control their blood sugars adequately.” Sloan’s advice: When adults go in for diabetes screening, it’s important to deploy testing “that can help figure out the type of diabetes a person has.” There’s more on type 1 diabetes at the U.S. Centers for Disease Control and Prevention.

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Moderate Exercise Can Help Shed Dangerous Fat Around the Liver

atients with nonalcoholic fatty liver disease are often advised to lose weight, but that can be hard to do and takes precious time. Now, researchers report they have found another strategy can help lower liver fat in people with this condition, which affects nearly 30% of the global population.

Exercise of about 150 minutes each week at a moderate intensity — the exact recommendation from public health experts at the U.S. Department of Health and Human Services — significantly reduced liver fat in patients, the new meta-analysis showed. “I spend a lot of my time trying to help improve the lives of our patients with nonalcoholic fatty liver disease [NAFLD],” said Dr. Jonathan Stine. He is an associate professor of medicine and public health sciences and a hepatologist at Penn State Health Milton S. Hershey Medical Center, in Hershey, Pa. “At this point in time, we still don’t have a regulatory agency-approved drug therapy or even a cure for this condition. And there are roughly a hundred million adults in this country that have this,” Stine noted.

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While research had shown that exercise can improve liver fat, physical fitness, body composition and quality of life, there was no known specific amount of exercise that would do this. For this study, the researchers considered a 30% relative reduction in liver fat — measured by MRI scans — to be meaningful improvement. Then, they reviewed 14 randomized

light cycling. “The great part of moderate-intensity activity, it’s really something anybody can do, even a sedentary population,” Stine said. How long it would take for the exercise regimen to work isn’t totally clear, but the studies in the meta-analysis ranged from four weeks to one year. Stine suggests moving past being fixated on the numbers and toward becoming more physically active. The findings were published online recently in the American Journal of Gastroenterology. Losing weight has been the cornerstone of management for NAFLD for a long time, and exercise along with dietary changes are an important part of that, said Dr. Ani Kardashian, an assistant professor of medicine in the division of gastroenterology and liver diseases at the Keck School of Medicine at the University of Southern California in Los Angeles.

controlled trials with a total of 551 people with NAFLD. Exercise is effective even without weight loss The investigators found that, independent of weight loss, exercise was 3.5 times more likely to achieve this 30% reduction in liver fat compared to standard care. Then they determined the optimal dose of exercise, finding that 39% of patients who were exercising briskly for 150 minutes per week or more achieved a significant treatment response compared to 26% of those who were exercising less than that. “There’s more and more evidence that exercise, even if you don’t lose a single pound, has many beneficial effects,” Stine said. “I would really challenge the thinking that we prescribe exercise as a way for somebody to lose weight, but rather this can be thought of more to improve overall health in the absence of clinically significant weight loss.” What type of exercise? An example of moderate exercise would be a brisk walk in which a person might be starting to get sweaty but can still hold a conversation with a walking partner, Stine said. Another example would be

“But what this is suggestive of is that you can actually have some reversal of fat just with the exercise, even without the weight loss, which is great and it’s actually really great because it’s encouraging for patients,” said Kardashian, who was not involved in the study. Why might exercise reduce liver fat? Kardashian suggests it might be burning the type of fat that builds up around the stomach area, and that is more associated with fat buildup in the liver. NAFLD is quite common, she noted. “And the reason why it’s bad is, in the same way that alcohol can cause damage to the liver through inflammation in the liver, fat can do the same exact thing,” Kardashian said. Kardashian would like to see more research on the impact of exercise on inflammation and scarring of the liver, but said the impact on liver fat would be good information to provide to patients. More information The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on nonalcoholic fatty liver disease.

In 22 U.S. States, More Than a Third of Adults Are Now Obese Obesity is on the rise across the United States. The U.S. Centers for Disease Control and Prevention called the obesity epidemic an “urgent priority.” In 22 states, 35% of adults or more were obese last year, new data from the U.S. Centers for Disease Control and Prevention show. Just 10 years ago, there were no states that had obesity rates at or above 35%. An urgent priority “Our updated maps send a clear message that additional support for obesity prevention and treatment is an urgent priority,” said Dr. Karen Hacker, director

of CDC’s National Center for Chronic Disease Prevention and Health Promotion. The 22 states with an adult obesity prevalence at or above 35% are Alabama, Arkansas, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia and Wisconsin. That’s up from 19 states in 2021. The CDC said the 2022 maps underscore the need to ensure that all people have access to healthy foods, safe places for physical activity and stigma-free obesity prevention and treatment programs. It also called for access to proven medications and weight-loss surgery.

Celiac Disease vs. Gluten Intolerance: What’s the Difference? For most people, there’s no reason to give up gluten for good. But that’s not so easy for folks with two gluten-related medical conditions: celiac disease and gluten intolerance, according to Dr. Sarmed Sami, a gastroenterologist at Mayo Clinic Healthcare in London. He offers some details about this protein and the two health conditions. Gluten is a protein found in grains including wheat, barley and rye. In people with celiac disease, eating it triggers an autoimmune reaction that causes cell damage to the small intestine. That reaction can cause diarrhea, fatigue, weight

loss, bloating, anemia and lead to serious complications, Sami said. Gluten intolerance is more common, he added. “In gluten intolerance, there is no cell damage or inflammation. It’s more of a sensitivity: ‘Gluten doesn't agree with me,’” Sami said in a clinic news release. “If you eat gluten and have an immediate reaction, such as diarrhea, that's more likely to be gluten intolerance than celiac disease, which is a slow process that you don't tend to feel immediately.” A sign of gluten intolerance or celiac disease is having one or more gastrointestinal symptoms such as diarrhea, bloating or heartburn that diminish or disappear if gluten is removed from the diet. These symptoms then return if the person begins eating gluten again.

Demographic differences and health risks Some groups are more likely to be affected than others, the CDC data show. Among groups with enough data for comparison, the number of states with an adult obesity prevalence of 35% or higher was 38 states for Black adults; 33 states for American Indian or Alaska Natives; 14 states for white people, and no states for Asian-American adults. Obesity increases the risk of many serious health conditions, including heart disease, stroke, type 2 diabetes and some cancers, as well as severe outcomes from COVID-19 and poor mental health. It also carries a lot of stigma for people at these higher weights. The CDC’s Division of Nutrition, Physical Activities, and Obesity has a variety of strategies to help improve health and prevent chronic diseases, and to help racial and ethnic populations with the highest risk of chronic disease.

It is important to be tested in case you have the more serious celiac disease, Sami said. Those who have gluten intolerance may be able to cut back on gluten-containing foods rather than having to eliminate them completely, Sami said. “It depends on the intolerance level. Some people may be fine by halving the gluten intake, while others may need to cut down more,” he said. “It’s different from celiac disease, where you have to be strictly, completely gluten-free.” To diagnose celiac disease, doctors start with a blood test to determine whether the body views gluten as an invader and reacts by generating high levels of antibodies. After a positive blood test, an endoscopy can take biopsies to check for damage in the small intestine. For most patients who have celiac disease, eliminating gluten keeps it under control, he said. Without a celiac diagnosis, there is no reason to eliminate gluten, Sami said. The Celiac Disease Foundation has more on celiac disease.

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What You Need to Know About Urinary Incontinence

veryone has had a case of the squirms at some point in their life, fighting the need to urinate as a full bladder presses them to let it all go. But for some, that need occurs far too often. Or, even worse, they go accidentally when they sneeze or laugh.

Dr. Zachary Hamilton, MD FACS, Associate Professor and Division Chief of Urology at Saint Louis University says, “Urinary incontinence is a problem that relates to bladder and sphincter function, leading to the uncontrolled leaking of urine. This problem affects millions of Americans, and it can have substantial effects on quality of life. Urinary incontinence is not a disease but a symptom of a wide range of other health issues, such as infection, medication use, diabetes, stroke, enlarged prostate, or underlying neurologic disease. “Treatment for urinary incontinence depends on the type of leakage and the underlying cause, but it can include dietary changes, physical therapy, medication, or surgery. Hopefully, patients will not be embarrassed to discuss their symptoms with a urologist or primary care doctor, as there are treatment options that can help.” Dr. Konstantin Walmsley, a urologist at Hackensack Meridian Mountainside Medical Center, in Montclair, N.J. adds, “These patients often avoid social gatherings, have a higher likelihood of urinary tract infections and genital skin irritation, and have a higher likelihood of clinical depression.” Types of urinary incontinence

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bladder and occasionally will have urgency urinary incontinence,” Walmsley said. He added that the problem “is also seen in patients with underlying neurological disorders such as stroke or Parkinson's disease. However, the vast majority of patients with urgency urinary incontinence have no identifiable, underlying cause for their condition.” Urgency incontinence also can be caused by constipation or obesity, but these cases can be reversed if treated effectively, Walmsley said.

or acidic foods. ■ Timing your urination. ■ Limiting fluids in the evening before bedtime. Urgency incontinence also can be addressed with Botox injections that help bladder muscles relax, giving sufferers more time to get to the toilet, Walmsley said. Another option is neuromodulation, in which a device or implant sends electrical signals to the location where bladder nerves receive signals from the brain. The electrical stimulation can relax a nervous bladder, causing significant decreases in urinary urgency and frequency, as well as waking up to go to the bathroom, Walmsley said.

“Urinary incontinence is not a disease but a symptom of a wide range of other health issues.”

Surgery also can be used, with doctors implanting slings or bulking agents that give people more control over their urination, Walmsley said.

“I take an individualized approach Stress urinary to each patient incontinence is but tend to favor Dr. Zachary Hamilton, leakage caused by starting therapy MD FACS sneezing or laughwith conservative ing. The muscles approaches such as that hold in your pelvic floor physurine grow so weak they can't handle any ical therapy and behavioral therapies,” added pressure. Walmsley said. “When found in women, it is most comHe has a final piece of advice — don't monly seen in the context of childbirth," suffer in silence. Walmsley said. “With men, the most common cause of stress urinary incontinence are complications from prostate surgery.” Treatment options There are drugs that can help treat urgency incontinence, Walmsley said, but nothing has yet been approved for stress incontinence.

There are two main types of urinary incontinence — urgency incontinence and stress incontinence. Urgency incontinence involves an overactive bladder. Sufferers tend to go more than eight times a day, and often wake at night to relieve themselves.

“The therapies most often used first are behavioral modifications and pelvic floor physical therapy,” Walmsley said. “Pelvic floor physical therapy involves strengthening the Kegel muscles with the assistance of a specially trained physical therapist.”

“About two-thirds of men with an enlarged prostate will have symptoms of overactive

■ Avoiding bladder irritants like caffeine, carbonated beverages, alcohol, and spicy

Behavioral modifications include:

“Don't be afraid or embarrassed to ask for help. You are not alone,” he said. “There are millions of people unnecessarily suffering in silence with incontinence. The diaper and incontinence pad industry is a multibillion dollar per year business, which reflects how common this problem is.” So, talk to your doctor, Walmsley urged. “There are so many different solutions to this problem. Help is just around the corner,” he said. More information The U.S. National Institutes of Health has more about urinary incontinence.

It is Important to Weigh the Benefits and Risks for People Taking Wegovy or Ozempic for Weight Loss

hile many have raved about the powers of popular weight-loss drugs like Wegovy and Ozempic, new research confirms the medications can trigger some nasty gastrointestinal side effects.

Known as GLP-1 agonists, they were originally developed to help manage type 2 diabetes by lowering blood sugar, but they also promote weight loss and have been used off-label for more than a decade. In 2021, some forms of these drugs were approved to treat obesity. However, they may increase the risk of stomach paralysis, pancreatitis and bowel obstruction, scientists found. “Although the incidence of these adverse events are relatively rare, affecting only about 1% of patients, with millions taking these medications, thousands of people are likely to be affected by these adverse events,” said lead researcher Dr. Mohit Sodhi, from the University of British Columbia in Vancouver. “Patients need to weigh the risks and benefits before taking these medications for weight loss,” he said. “We encourage patients who are interested in using these medications to have a lengthy conversation with their physician to see if this medication is appropriate for their goals and what they hope to achieve.” Most patients experience symptoms like constipation and nausea, so the possibility of these more serious side effects is not surprising, said Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York City. “We’re all aware of all these side effects,” Messer said, but the benefit of losing 40

to 50 pounds clearly outweighs the small risk of these side effects. “You decrease your risk of gout, heart disease, strokes, heart attacks and diabetes, so these risks in no way convince me to stop prescribing these medications,” Messer said. For the study, Sodhi and his colleagues examined health insurance claims for approximately 16 million U.S. patients and looked at people prescribed GLP-1 agonists — either semaglutide (Ozempic) or liraglutide (Victoza) — between 2006 and 2020.

for biliary disease, which affects the gallbladder, but this difference was not statistically significant. The report was published online Oct. 5 in the Journal of the American Medical Association. Dr. Jamie Kane, director of the Northwell Health Center for Weight Management in Great Neck, N.Y., said these risks are known and are rare, but patients need to be informed about them before they start one of these medications. “We have to look at risk-benefit ratios and decide whether it makes sense to prescribe them,” Kane said. “It’ll come down to a discussion between physician and patient as to the risk of morbid obesity with chronic conditions and the lifestyle associated with that for pancreatitis and cancer and other disease processes and the slightly increased risk from the drug.” Kane said that patients who shouldn’t be taking these drugs are those with a history of pancreatitis. One expert stressed that while weight-loss drugs can be effective, the best way to maintain a healthy weight is with a healthy lifestyle.

The investigators compared the risks of these drugs with another type of weightloss drug called bupropion-naltrexone (Contrave). Compared to bupropion-naltrexone, GLP1 agonists were associated with: ■ Higher risk of pancreatitis, or inflammation of the pancreas, which can cause severe stomach pain and, in some cases, require hospitalization and surgery. ■ Higher risk of bowel obstruction, where food is prevented from passing through the small or large intestine, resulting in cramping, bloating, nausea and vomiting. Depending on the severity, surgery may be required. ■ Higher risk of gastroparesis, or stomach paralysis, which limits the passage of food from the stomach to the small intestine and results in symptoms like vomiting, nausea and abdominal pain. ■ Researchers also found a higher risk

“GLP-1 agonists appear to be highly effective drugs for both diabetes management and weight loss. But as with all drugs, there are potential side effects, and some of them are severe,” said Dr. David Katz, a specialist in preventive and lifestyle medicine and president of the True Health Initiative. “We don't yet have the long-term experience with these drugs to understand fully the risk/benefit trade-offs with extended use, but the adverse effects chronicled here are a precautionary tale,” he said. This is a good reminder that the first, best and safest approach to managing weight and metabolic health is a healthy diet and lifestyle, Katz said. “Interest in GLP-1s should not distract us from doing all we can to leverage food as medicine, and to ensure everyone’s access to a high-quality diet,” he said. “Drugs, with their attendant costs and inherent risks, should be a last resort.”

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B E T T E R

B R E A T H I N G anything up). An asthma cough often is worse at night due to a variety of reasons, including sinus drainage, increased irritants, changes in air temperature or humidity, and an inability to keep on top of the inflammation while sleeping. Wheezing Wheezing is a high pitched, shrill whistling sound that occurs when the airway is obstructed or narrowed, according to the Cleveland Clinic. Very common in infants and children with asthma, wheezing is a definite sign of an asthma attack in any patient with asthma. If the wheezing is new or occurs with other asthma symptoms, you should see your physician. If the wheezing doesn’t respond to your asthma treatments, you should immediately go to the emergency room for evaluation and treatment.

The Most Common Asthma Symptoms and Treatments You Should Know

sthma can be a tough disease to control, but to control it you first need to know if you have it. A chronic condition, there are telltale symptoms that crop up when an asthma attack strikes and knowing what those are could help you avoid a life-threatening emergency.

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According to the most recent data from the U.S. Centers for Disease Control and Prevention, asthma affects 7.8% of Americans. Asthma occurs when the airways become inflamed and narrow, which hinders airflow. More mucus is produced, which further blocks the air from moving in and out of the lungs. When something in the environment causes irritation, tiny muscles squeeze the airways, narrowing them even more. This is called an asthma attack, according to the Asthma and Allergy Foundation of America. While the effects of asthma vary from minor to severe, here are the most common symptoms of asthma.

Shortness of breath One of the most common asthma symptoms, shortness of breath can be quite frightening, according to the Respiratory Institute at Mount Sinai Hospital. When the airways narrow and more mucus is produced you have trouble pulling enough air in, as well as pushing it out. When this happens, you become short of breath, breathe faster and more shallowly, and use more muscles to get enough air in. This shortness of breath can come on suddenly, with exercise, or even when you are at rest.

As with the other symptoms of asthma, wheezing is set off by irritants in the environment and a narrowing of the airways. Chest tightness or pain Another symptom of asthma is chest tightness or chest pain. According to Mount Sinai, chest tightness without any other symptoms may be an early indicator of an asthma attack. It can feel like you have someone sitting on your chest or you have a band tightening around your chest. Also, with the increased work of breathing and frequent coughing, you may experience chest pain caused by sore muscles. Serious Asthma attack symptoms While all of these are symptoms of asthma, and can be signs of an asthma attack, there are some symptoms that should cause you to seek immediate medical care. These include: ■ Wheezing, coughing, and shortness of breath that become more severe and constant

Coughing

■ Rapid heart rate and respiratory rate

A cough is the body’s way of expelling an irritant, but when it is due to inflammation in the airways, it can be a chronic problem. This common asthma symptom in adults or children occurs because the airways are hyper-responsive to irritants such as dust, cold or dry air, pollen, smoke, and colds or flu. The narrowed and irritable airways cause a cough that is usually nonproductive (you don’t cough

■ Blue-tinged lips or fingers ■ Confusion, drowsiness, exhaustion or dizziness ■ Too short of breath to talk ■ Fainting It is important for patients with asthma to follow their physician’s instructions carefully and make an appointment quickly

if their symptoms become less controlled. Avoid irritants and things that set off your asthma whenever possible, and be diligent to take your medications as prescribed. Having good day-to-day control of asthma is a key to keeping symptoms at bay and preventing asthma attacks, says Dr. John Costello, a pulmonologist at Mayo Clinic Healthcare in London. “The prevention of asthma as a condition is quite difficult,” Costello noted in a recent Mayo Clinic article. “What you can prevent is the frequency and severity of attacks by the use of regular treatment.” Here, experts discuss the most common asthma treatments that physicians use when creating an individualized treatment plan. It is important to follow this plan diligently and check in with your physician regularly.

the CDC says. Losing weight can be an essential part of controlling asthma. Keep a journal: In addition to recording triggers and attacks, keep a record of each time you use your quick relief (rescue) inhaler. One sign of well-controlled asthma is using the rescue inhaler two times a week or less, according to Mount Sinai. If you find your attacks increasing and you are using your quick relief inhaler more often, you should make an appointment with your doctor to review your treatment plan. A peak-flow meter, an instrument that gauges how well you breathe, can also be a valuable tool in controlling asthma. If you

Non-medication treatments for Asthma Avoid triggers: Because asthma is triggered by many things in the environment, one of the most important treatments for asthma does not involve medication, but rather awareness of what those triggers are. It is important for you to keep a journal in which you record when you have an attack and what triggered it. By noticing what your individual triggers are, you are more prepared to avoid them in the future. According to the Allergy & Asthma Network, some common triggers are: ■ Hot or cold air ■ Pet dander, dust, pollen, perfumes, smoke ■ Laughing or crying ■ Stress ■ Exercise ■ Colds or viruses Lifestyle changes: Asthma treatment may also include lifestyle changes. If you smoke, it will be essential for you to quit, according to the American Lung Association. Medications to help with quitting may be part of your treatment plan. In addition, obese patients are more likely to experience asthma symptoms than the general public,

use this regularly and report the results to your physician, it helps the doctor evaluate how well the treatments are working, the Asthma and Allergy Foundation of American says. Asthma medications There are two main categories of medications in the asthma treatment arsenal; long-term (control medications), and quick-acting (rescue medications). Long-term: Long-term medications are ones that are taken every day as a way to control asthma, the Mayo Clinic says. The goal of these medications is to prevent asthma attacks. These reduce airway inflammation and prevent the airways from narrowing. Quick-acting: These quick-acting medications are used in the event of an attack, or when you feel an attack coming on. These include an inhaler that you should carry with you at all times, and can include other medications that may help in the event of an attack. While inhalation therapy is the treatment

of choice, people with severe asthma may need corticosteroids, which can be given either by IV or orally, Costello said. “if the patient’s not responding, then admission to the hospital [is needed] to make sure that these medicines are administered efficiently.” It is very important not to change how you take your medications without checking with your physician first. Surgical treatment for asthma In the case of severe asthma, surgery may be an option. For many with severe asthma, medications don’t work, with research published recently in the journal Science Translational Medicine suggesting that two natural substances that stimulate cell proliferation activate in the airways of severe asthma patients when they inhale corticosteroids and block the medications from working. According to the Mayo Clinic, bronchial thermoplasty, usually done over three sessions, is used in patients with severe asthma who have failed medical treatments. It is not for everyone and is not available everywhere. The physician heats the inside of the lung to destroy the smooth muscles which limits the ability of the lung tissue to tighten. This may make it easier to breathe and decreases the incidence of asthma attacks. Uncontrolled asthma can land you in the hospital, but experts share the various treatments and lifestyle changes you can make to keep yourself out of the ER. While asthma is a chronic illness, you and your physician can create an individualized treatment plan that can give you the best possible control over your asthma. If you experience these asthma symptoms, make an appointment to see your physician as soon as possible. A prompt assessment by a health care provider is needed so a proper diagnosis and treatment plan can be created. For more information, visit the website of the Asthma and Allergy Foundation of America or the Allergy & Asthma Network.

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Today’s COVID Is Increasingly Looking Like a Cold or Flu

ymptoms of COVID-19 have shifted this season, and now are more akin to those of allergies and the common cold, doctors say.

Upper respiratory and fatigue symptoms Many people with COVID-19 now are presenting with upper respiratory symptoms like runny nose, watery eyes and a sore throat, said Dr. Teresa Lovins, an independent family physician in Columbus, Indiana.

“A couple of patients told me ‘this seems like my allergies, but my allergy med isn’t working. And then I start feeling really, really tired and I just can’t get my energy

up and about,’” Lovins recounted. “And I’m like, ‘yeah, we ought to test you for COVID,’ and more times than not it’s positive.”

Other past COVID symptoms less common

Fatigue also continues to plague COVID patients, according to Lovins and Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University in Nashville, Tenn.

Other well-established COVID-19 symptoms — deep cough, a loss of taste or smell, headache, fever — have become much less common or pronounced, Lovins and Schaffner said.

“Fatigue for 24, 48 even 72 hours appears to be really quite common,” Schaffner said. “People just feel puny, as we say here in the South. They don’t all take to their bed, but there’s a fair amount of people taking naps just because they feel wiped out.”

“What I’m hearing from my clinical colleagues, there is indeed a great deal of upper respiratory symptoms. I hear sore throat mentioned very, very prominently,” Schaffner said. “Also, from many quarters, I hear that the loss of taste and smell is less frequent than it was in the early

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Infectious disease experts expected this shift in mild illness, since “virtually everyone has either experienced COVID infection or vaccination or both,” Schaffner said. “We all have a level of immunity, and when we encounter the virus, we’re better prepared to fend it off, and that may alter the clinical presentation,” he continued.

“I know in our community hospitalizations have picked up again,” said Lovins, a board member for the American Academy of Family Physicians. “We’re seeing not anywhere near what we saw last fall, but the numbers are up since May. They went way down, to no patients with COVID in the hospital during the summer, to now back up again.”

People also have benefited from mutation trends in COVID, which have tended to favor the less severe Omicron strain and its descendants, Schaffner said.

COVID-19 remains particularly dangerous for people with existing health problems: older people, those with chronic conditions, the immune-compromised.

COVID is still serious, especially with existing health issues

“Those folks all, when they become infected, still are more likely to get more serious disease, and that results in an increase in hospitalizations,” Schaffner said.

months of the outbreak.”

But Lovins and Schaffner stressed that people should not take COVID lightly, even if milder infections have become more like the common cold. Nationwide, more than 20,500 hospitalizations for severe COVID-19 happened the first week in September, according to the U.S. Centers for Disease Control and Prevention’s data tracker. That is a nearly 8% increase in hospitalizations.

F E A T U R E D

Others also at risk But he added that there’s a reason the CDC recently recommended the new COVID booster for everyone, not just those at high risk. “This emphasis on the high-risk population is true,” Schaffner said. “However, we still occasionally see young, healthy people who get hit with COVID, wind up in the emergency room and have to be

admitted to the hospital. So just because you’re completely healthy and young, robust and physically fit does not mean that you can throw off a COVID infection or treat it as trivial. This virus still compels our respect.” The newest COVID booster specifically targets members of the Omicron XBB variant family, Lovins said. The most common COVID variant, EG.5, belongs to that family. It currently accounts for 1 in 4 COVID infections in the United States, the CDC says. So does the second most common variant, FL.1.5.1, which accounts for 14% of COVID infections. “The vaccine that’s out was planned for an XBB variant,” Lovins said. “So we’ve definitely got coverage with this vaccine for what’s out there right now.” Lovins also urged people to get the appropriate vaccinations for the flu and RSV (respiratory syncytial virus). “I have a feeling that we’re probably going to see the COVID vaccine become something that will be available every year in the fall,” Lovins said.

S E R V I C E

Breathe Easier with Halotherapy at the St. Louis Salt Room Clay Juracsik started The St. Louis Salt Room in 2010 partially as a therapy for his daughter. She had severe asthma, and it was taking a toll on her health. He was looking to help her and make her less dependent on the medications she was taking. Clay studied halotherapy and learned of its benefits, visiting salt spas in Europe and Russia to learn everything he could. Her breathing improved quickly and after several months, she was able to cut her meds by 90%.

“Halotherapy has made her lungs much healthier. It made me more of a believer than I already was,” Clay said. “She hasn't needed medication in a long time.” It was discovered in the mid-1800s that people who worked in salt mines in Poland and surrounding countries had remarkably low rates of respiratory illnesses. Today, spas use a halo-generator to saturate the air with beneficial salt particles and negatively charged ions, clinically proven to deliver the most optimal results.

Salt therapy is recommended for respiratory ailments like asthma, bronchitis, sinusitis, and even allergies. Many people use it to lower stress and relieve fatigue and depression. Athletes use it to optimize breathing and improve circulation. The St. Louis Salt Room was the first Salt Spa in the Midwest and the fifth in the U.S. It has many regular clients, including doctors and nurses.

Clay Juracsik at the Salt Room

To learn more about how the St. Louis Salt Room can help you, visit them for a relaxing halotherapy session at 2739 Sutton Blvd. in Maplewood, 2 blocks south of Manchester or online at www.mysaltspa.com Please call

314-647-2410

to schedule an appointment

A C H E S

P A I N S

Getting Rid of Neck Pain: Six Ways to Feel Better

By Ann Schreiber

he phrase “pain in the neck” is a tongue-in-cheek way to describe annoying situations or people that test our patience, but for those who experience genuine neck pain, it’s no laughing matter.

Neck pain can be a debilitating condition that affects daily life and leaves sufferers longing for relief. This article will explore some practical strategies to alleviate neck pain and provide self-care tips, neck pain exercises and other helpful treatments to try. Neck pain causes Neck pain, also called cervicalgia, is the discomfort experienced in or around the spinal area beneath the head. The Cleveland Clinic says neck pain is common, affecting 10% to 20% of adults. And it should come as no surprise that your neck, medically known as the cervical spine, plays a crucial role in supporting the weight of your head and facilitating its movements. But various injuries and medical conditions can give rise to neck pain. Left untreated, neck pain can become a persistent hindrance, interfering with your daily activities and diminishing your overall quality of life.

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In an article, Dr. Zacharia Isaac, medical director of the Comprehensive Spine Care Center at Brigham and Women’s Hospital in Boston and director of interventional physical medicine and rehabilitation at Harvard Medical School, writes that neck pain usually builds over time. “Neck pain rarely starts overnight,” he writes in a school web page. “It usually evolves over time. And it may be spurred

forcefully jerked backward and forward, straining the neck’s soft tissues. Diseases Certain medical conditions,

such as meningitis, rheumatoid arthritis or cancer, can potentially have neck pain as a symptom. Johns Hopkins Medicine notes that pain that may come on quickly or slowly and that lingers for weeks, three months or more is considered chronic. Chronic neck pain is less common than acute pain. Neck pain symptoms

by arthritis or degenerative disc disease, and accentuated by poor posture, declining muscle strength, stress, and even a lack of sleep.” Fortunately, most neck pain causes are not severe and can be effectively addressed through conservative treatments. The Mayo Clinic provides this list of common neck pain causes: Muscle strain Activities like pro-

longed computer or smartphone use and seemingly minor actions such as reading in bed can strain the neck muscles due to overuse. Worn joints Like other joints, the neck

joints can experience wear and tear over time. This can lead to the development of bone spurs, affecting joint motion and triggering pain. Nerve compression Chronic neck pain can be attributed to the compression of nerves caused by bone spurs or herniated disks within the vertebrae of the neck. As these structures exert pressure on the nerves branching out from the spinal cord, it can lead to persistent discomfort. Injuries Rear-end auto collisions often cause whiplash injuries, where the head is

Recognizing and understanding the symptoms associated with neck pain is essential for effective diagnosis and treatment. By being aware of these telltale signs, you can gain insights into the nature of your discomfort and take appropriate measures to alleviate it. The American Association of Neurological Surgeons says that in addition to neck pain, pressure on a nerve root or the spinal cord by a herniated disc or a bone spur may result in the following neck pain symptoms: ■ Pain in the arm ■ Numbness or weakness in the arm or forearm ■ Tingling in the fingers or hand ■ Difficulty with balance and walking ■ Weakness in the arms or legs Neck pain on the left side commonly stems from non-serious factors like muscle strain due to an uncomfortable sleeping position or inflammation. Occasionally, there may be serious underlying causes such as tumors or arthritis. Similarly, pain on the right side of the neck is typically attributed to causes like muscle strain, poor sleeping posture or improper alignment. If the pain persists for an extended period, it is advisable to consult a doctor for guidance on medical treatments and potential home remedies.

Overall, neck pain is not something to ignore. Keck Medicine of USC says headache, a fever and a stiff neck may be signs of meningitis. How to get rid of neck pain Harvard Health offers these six strategies for neck pain relief: 1. Avoid prolonged static positions: To prevent your neck from getting stuck in an unhealthy position, it’s important to avoid staying in one posture for too long. Regularly moving and changing positions can help alleviate strain. 2. Optimize your workspace ergonomics: Adjust your computer monitor to eye level, use hands-free options for phone calls and consider wearing a headset. When using a tablet, prop it on a pillow at a 45-degree angle instead of keeping it flat on your lap.

promotes proper spinal alignment. 5. Respect your physical limits: Before attempting any strenuous activities that may strain your neck and back, such as moving heavy furniture, consider the potential impact and seek assistance if needed. 6. Make quality sleep a priority: Sleep disturbances have been associated with an increased risk of various conditions, including musculoskeletal pain. Establishing healthy sleep habits can contribute to overall well-being, including neck pain management. Exercises can also help you manage neck pain. Scotland’s NHS Inform recommends movement and stretching exercises. Performing neck stretches involves simple

and controlled movements. One option for a movement exercise is to start by facing forward and gradually turn your head to one side until you feel a gentle stretch on the opposite side of your neck. Hold for two seconds, then return to the starting position before repeating the stretch on the other side. The Mayo Clinic also recommends pain relievers for acute neck pain relief. Pain relievers might include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) or acetaminophen (Tylenol, others). Be sure to follow all dosage recommendations and take only as directed. Neck pain relief is possible Neck muscle pain can be a disruptive force, affecting daily activities and overall well-being. Understanding the causes, symptoms and effective treatments makes it possible to seek relief. Whether through self-care practices, targeted exercises or medical interventions, the path to a pain-free neck is within reach.

3. Keep your eyeglasses updated: “When your eyewear prescription is not up to date, you tend to lean your head back to see better,” Isaac said. 4. Limit pillows while sleeping: Sleeping with excessive pillows under your head can limit your neck’s range of motion. It is advisable to use a supportive pillow that

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Ear Pain Relief: Medications, Drops, Surgeries & Self-Care Tips

f you’re experiencing ear pain, you likely want relief fast.

Learn more about how to get rid of ear pain, including what medications (such as ear drops), self-care tips and surgeries may help, depending on the cause of your ear pain.

Hopkins Medicine: balance problems (rare), drainage (green or yellow liquid that comes out of your ear), fever, muffled hearing or sore throat.

“When a patient with a painful ear also has a fever, that’s a concern something bigger is going on,” Shew said. “Other big red flags that someone should seek What is ear pain? more urgent attention include dizziness, Ear pain can be achy, dull, sharp or tender. headaches, swelling and weakness of the It may be mild or severe, depending on facial muscles. Otherwise, it’s worth going the cause. to an urgent care or seeing your primary care provider if the pain doesn’t get better Ear pain causes within 24 to 48 hours.” “The most common cause of ear pain is an outer or external ear infection, or an otitis media, or middle ear infection, or fluid,” said Dr. Matthew Shew, Assistant Professor of Otolaryngology and Neurotology at the Washington University School of Medicine in St. Louis. Shew explained that sometimes your ear may hurt not because there’s something wrong with the ear itself, but because of referred pain. “Referred pain is from a problem with a nearby part of your body such as your throat, jaw or teeth,” he said. “You should seek further evaluation if your pain persists beyond standard treatment.” Other causes of ear pain, according to the Cleveland Clinic, include: ■ Foreign object (a tiny object like a pebble in your ear) ■ Pressure change (that fullness or pain you might feel when you are scuba diving or on a plane in the air) ■ Sinus or upper respiratory infection

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■ Sore throat ■ Swimmer’s ear ■ TMJ, or temporomandibular joint dysfunction (problems with your jaw joint) Ear pain symptoms If you have ear pain, you may also experience the following symptoms, says Johns

■ Sleeping on the opposite side of the painful ear ■ Sleeping with your ears up higher than the rest of your body To help prevent ear pain in the first place, Shew recommends that you avoid smoking, keep objects out of your ears, keep your ears dry after swimming and bathing, and avoid allergy triggers. Medications/ear drops You may need antibiotics that you swallow and some medications that go inside your ear canal. Your doctor may want you to use ear drops to stop pain, and numbing drops for inflammation (swelling) and pain, the Cleveland Clinic advises. When you use ear drops, make sure you stay positioned with your ear pointed toward the ceiling for about three to five minutes, the American Academy of Family Physicians warns in an article about swimmer’s ear. Move your head gently back and forth to help the ear drops enter and move through your ear canal. Surgery options that may help with ear pain You may need surgery, depending on the cause of your ear pain.

Ear pain treatments: How to get relief When you’re uncomfortable, all you want to know is how to get rid of ear pain. Ear pain relief starts with self-care. You can also try some medications (ear drops). If there is a major issue with your ear, or another part of your body that’s causing referred pain in your ear, you may need surgery. Self-care tips The Cleveland Clinic recommends these self-care options for ear pain: ■ Cold or hot compress ■ Neck stretching, rotating (moving your neck in a circular motion) ■ Over-the-counter pain reliever (acetaminophen or ibuprofen)

Repeated ear infections are one reason for surgery. You may also need surgery, what is known as a tympanoplasty, if you have an ear infection that won’t go away or if there’s a hole in your eardrum. Talk to your doctor about how often you have ear pain, how severe it gets and what causes the problem. They may need to do extra tests to see if you need surgery. Living with ear pain When it’s severe, all you can think about is how to stop ear pain. Fortunately, ear pain is usually temporary. You won’t have to live with it for long. Remember that if your ear pain doesn’t go away after a day or two, see your primary care physician or head to an urgent care clinic. Then, go back if the medications don’t fix your symptoms after a week.

those steps with your other leg. To build coordination, Cole recommends running a few drills that should only take about 15 minutes. First is the side-to-side shuffle. Stand with your feet shoulder-width apart, then quickly move side to side. For the cross-step drill, put your feet shoulder-width apart. Cross one leg in front of the other diagonally. Then quickly move your back leg out from behind the front leg to return to the position you started in. Keep moving side-to-side, crossing and uncrossing your legs in this way.

Pickleball Is All the Rage, Here are Tips on Preventing Injuries

ickleball has become wildly popular, but that may be fueling a rise in pickleball-related injuries.

“It’s quickly becoming a sport of choice for adults over the age of 50,” said Dr. Brian Cole, an orthopedic surgeon and sports medicine specialist at Rush University Medical Center in Chicago. He also plays pickleball.

male,” Cole said. Importantly, many seniors have underlying conditions they don’t know about. “Millions of people walk around with rotator cuff tears but have no pain because they’re well adapted,” Cole said. “But then they go out, adopt this new sport, and they do some funky move that puts them over the edge, and they become symptomatic. And that’s when things kind of spiral.”

“The high injury rate can be attributed to the fact that most players tend to be over Remember to do warmup 50,” Cole said in a hospital news release. exercises “And many of them were largely sedentary “For our older patients, a dynamic warmup before picking up their pickleball paddles.” is pretty important,” Cole said. “Doing Pickleball is like a hybrid of ping-pong some type of exercise prep beforehand and tennis, and attracts many beginners. makes a big difference to prevent injury.” In his practice, Cole often sees strains He recommends starting with a 10-minand sprains, mostly in the legs and ankles. ute warmup that should begin with some Rotator cuff injuries are also common. jogging or jumping jacks. You’ll get your Sometimes he sees more serious injuries, heart rate up and blood flowing to your including fractures and concussions. muscles. Some pointers on avoiding injury

A good first step to avoid injury is to first get an assessment of your health from your primary care physician and possibly also a physical therapist. You may not be as prepared to jump into play as you think if you haven’t been very active in a while. “Patients over 60 account for nearly 80% of pickleball injuries, and most of them are

After that, do some arm circles and shoulder rotations. Hold your arms straight out from your sides and rotate them in small circles, then gradually make bigger circles before rotating in the opposite direction. Put your arms in front of you and rotate your shoulders forward and back. Finish with some leg swings. Stand next to a wall for support, then swing one leg back and forth, then side to side. Repeat

Choose the right gear Select a paddle that is appropriate for your strength level. “Lightweight paddles offer less strain and fatigue in your arms as they weigh 7.5 ounces and less,” Cole said. You may need different shoes for outdoor and indoor play. “Shoes for outdoor games should be durable enough for the surface of the court. They typically have a modified herringbone pattern that optimizes the combination of give and grip. Indoor shoes have softer, thinner, lighter outsoles, so they’re best for hardwood surfaces,” Cole said. Have extra socks on hand to help prevent blisters and foot injuries. Protect yourself from the sun with sunglasses, possibly with a strap or cord that helps keep them in place, and sunscreen of SPF 50 or higher. Getting a lesson can help you learn to play or improve technique. Once you’re on the court, you’ll be boosting your social life, your mental health and promoting healthy aging. “It actually provides a pretty good overall body workout,” Cole says. “It can help with balance, agility, reflexes and handeye coordination, and it doesn’t put excessive strain or stress on our bodies.”

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Herniated Disk: What It Is, Symptoms and Treatment

he pain and discomfort of a herniated disk can significantly impact the quality of your life. Here is what you should know about having a herniated disk, including what it is, its causes, symptoms, diagnosis and treatment.

calf or sole

What is a herniated disk?

Herniated disk diagnosis

The Cleveland Clinic describes a herniated disk as a spinal injury. Your spinal column is made up of bony parts called vertebrae; between the vertebrae are disks that act as cushions. These make it easier to bend and move. When one tears or leaks, it is called a herniated disk. The injury typically occurs in the lower back or neck region. A herniated disk may also be called a slipped disk, a ruptured disk or a bulging disk. Herniated disk causes and risk factors Disk herniation often results from aging; the disks become less flexible over time. The Mayo Clinic lists the following risk factors: ■ Weight: Excess weight puts a strain on the back. ■ Occupation: People with physically demanding jobs that require repetitive lifting, pulling, pushing and bending. ■ Genetics ■ Smoking: It is believed smoking lessens the oxygen supply to the disks and may cause them to break down more quickly. ■ Frequent driving: Sitting for long periods can put pressure on the spine. ■ Sedentary lifestyle

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Herniated disk symptoms Penn Medicine lists the following symptoms of a herniated disk: ■ Pain that occurs on one side of the body ■ Sharp pain in one part of the leg, hip or buttocks ■ Numbness in part of the leg, back of

■ Weakness in one leg ■ Pain when moving your neck ■ Deep pain near or over the shoulder blade ■ Pain that moves along your arm. Your health care provider will examine your pain, muscle reflexes, sensation and strength and may order diagnostic tests, including: ■ Magnetic resonance imaging (MRI): The most common and accurate test. ■ X-rays: These help doctors rule out other causes. ■ Computed tomography (CT): This is to see the bones of your spine. ■ Myelogram: Dye injected into your spinal cord helps locate the herniated disk. ■ Electromyogram (EMG): This is used to evaluate the function of your nerves. Herniated disk treatment “Doctors prefer nonsurgical treatments over surgery whenever possible,” Dr. Mark Wang, an orthopedic spine surgeon at the Desert Institute for Spinal Care in Phoenix, writes. “If surgery is necessary, they will opt for the most minimally invasive option with the highest chance of success, given your condition.” Wang lists several nonsurgical treatment options: ■ Physical therapy ■ Hot and cold therapy: Cold reduces inflammation and pain, while heat promotes circulation and healing. ■ Alternative therapies: Acupuncture and chiropractic care may help. ■ Selective nerve root blocks: A minimally invasive steroid-anesthetic injection interrupts the pain signal between the spinal nerves and the brain. ■ Epidural steroid injections into the spinal column’s epidural space.

The Mayo Clinic lists several medications for herniated disks: ■ Nonprescription pain medications: For mild to moderate pain, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen sodium (Aleve). ■ Neuropathic drugs: These decrease pain by affecting the nerve impulse to the brain, and they include gabapentin (Gralise, Horizant, Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta, Drizalma Sprinkle), venlafaxine (Effexor XR). ■ Muscle relaxers: To reduce spasms. ■ Opioids if other medications do not work, but there is risk of addiction or side effects. There are several types of surgery for herniated disk, Wang noted. They include: ■ Microdiscectomy: A minimally invasive procedure to remove the part of the disk causing the pain; the disk may be repaired. ■ Lumbar laminectomy: A minimally invasive or open surgery that removes a portion of the vertebral bone (lamina) to relieve pressure on the spinal cord or nerve roots. ■ Spinal fusion: Fusing two or more bones in the spine. Can limit mobility but t reduces painful motion of the spine. ■ Artificial disk replacement: The affected disk is replaced with one made of metal or plastic. ■ Endoscopic foraminoplasty: Relieves pain by freeing nerves inside the foramen (the hollow, bony tunnel where your spinal cord nerves exit to your arms or legs). Herniated disk self-care Self-care for a herniated disk includes some lifestyle changes: ■ Maintain a healthy body weight ■ Avoid sitting or standing for long periods ■ Wear flat shoes, not high heels ■ Carry objects close to your body ■ Living with a herniated disk If you have symptoms, seek the advice of a health care provider. Early treatment may prevent more problems. Most people are better in about four weeks, according to the American Academy of Family Physicians.

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Plus, the Joint Replacement Center is the first program in St. Louis to be awarded advanced certification in knee and hip replacement and core certification in shoulder replacement by The Joint Commission.

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What You Should Know about Arthritis

rthritis strikes millions of Americans, leaving them with aching, inflamed joints that make it hard to move around without pain. It is the leading cause of disability and most common in women, but is it the same for everyone? Absolutely not. There are over 100 different forms of arthritis, and they aren’t all treated the same, according to the Arthritis Foundation. Here are the four main types of arthritis, and more about their differing symptoms and treatments: ■ Osteoarthritis ■ Autoimmune inflammatory arthritis ■ Infectious (reactive) arthritis ■ Gout (metabolic arthritis) Osteoarthritis The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) states that osteoarthritis is the most common type of arthritis, especially in older people. The tissues in the joint break down, and as the disease develops, it can damage the entire joint. The joints most commonly affected are hands (ends of fingers and base of the thumb), knees, hips, neck and lower back. Common symptoms of osteoarthritis are in the joints: pain or stiffness, limited range of motion, swelling in and around it, or the feeling that the joint is loose or unstable. Treatments for osteoarthritis According to the Mayo Clinic, the following treatments for osteoarthritis cannot reverse the disease, but they can help reduce pain and improve movement: ■ Acetaminophen (Tylenol).

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■ Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB and others) and naproxen sodium (Aleve). Long-term use can cause bleeding problems or liver and kidney damage. ■ Duloxetine (Cymbalta) is an antidepressant also approved to treat osteoarthritis pain. ■ Physical and occupational therapy.

■ Transcutaneous electrical nerve stimulation (TENS) uses a low dose of electrical current and may provide shortterm relief. ■ Surgery. ■ Cortisone or lubrication injections. ■ Regular exercise can play a vital role in the management of arthritis by keeping muscles around affected joints strong and decreasing bone loss. May help control joint swelling and pain by replenishing lubrication to the cartilage of the joint. Autoimmune inflammatory arthritis According to the Arthritis Foundation, the immune system attacks healthy tissue, including joints in the spine, hands and feet. It can become systemic, affecting eyes, skin, heart and other organs. Rheumatoid arthritis is the most common form; there is also psoriatic arthritis, axial spondyloarthritis and juvenile arthritis. Common symptoms of autoimmune arthritis ■ Rheumatoid arthritis: Joint pain, tenderness, or stiffness that lasts longer than six weeks. Morning stiffness that lasts 30 minutes or longer. More than one joint is affected, and the same joints on both sides of the body are affected. Fatigue is also a symptom. ■ Psoriatic arthritis: Itchy, painful, red patches or a silvery build-up of dead skin cells. Cracking, pitting and white spots on the nail bed. Fatigue, inflammation and swelling where tendons and ligaments connect with a bone. ■ Axial spondyloarthritis: Pain and stiffness starts gradually and lasts three months. The pain improves during exercise and stretching but worsens at rest — morning stiffness. ■ Juvenile rheumatoid arthritis: Swollen, stiff, painful joints, light sensitivity, rash, fatigue, hardened patches of skin. Treatments for autoimmune inflammatory arthritis Treatment options include NSAIDs, corticosteroids, DMARDs — Disease-modifying anti-rheumatic drugs that reduce

inflammation and prevent the worsening of the disease. Biologics and Janus kinase (JAK) inhibitors are special types of DMARDs. Other treatments include surgery, physical and occupational therapy. Infectious (reactive) arthritis Reactive arthritis occurs after a bacterial infection. Symptoms typically begin after recovery from the initial illness. Knee and ankle joints are frequently affected, as well as the lower back. Symptoms include: Joint pain and stiffness, inflamed fingers or toes, pain in the heel or foot; morning stiffness; inflammation of the urinary tract after an infection of the urinary tract or genitals. Also eye inflammation, fatigue, fever, diarrhea and abdominal pain. Other symptoms can be ulcers in the mouth, skin rash and thickened nails. According to the Mayo Clinic, treatment typically includes: NSAIDs, steroid injections, rheumatoid arthritis medications and physical therapy. Gout This is an extremely painful form of arthritis. Uric acid crystals build up in the affected joint, typically affecting one joint at a time, usually the big toe. It can go into remission or flare up. Untreated, it can lead to gouty arthritis. Symptoms of gout in the affected joint are intense pain, swelling, redness and heat. Treatment for gout includes NSAIDs; limiting purine-rich foods (the body breaks them down into uric acid), such as red meat or organ meat; changing or stopping medications associated with hyperuricemia (high blood uric acid levels) and medications to lower uric acid levels, including allopurinol, febuxostat and pegloticase. For more information, visit the websites of the Arthritis Foundation or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Suffered Whiplash? Know the Symptoms and Treatments

for a limited duration under medical supervision. Physical therapy Targeted exercises,

stretching and manual therapy techniques prescribed by a physical therapist can help reduce pain, improve range of motion, and restore muscle strength and function in the neck and surrounding areas.

hiplash — an often underestimated injury that can strike in the aftermath of a collision — inflicts injury and pain on its unsuspecting victims.

Heat and cold therapy An

If you find yourself grappling with the relentless effects of whiplash, you’re not alone. Numerous legal websites estimate that at least 3 million Americans per year sustain whiplash injuries. Here’s what you should know about a whiplash injury, including what it is, and its causes, symptoms and treatments.

some cases, a cervical collar or neck brace may be recommended, to limit neck movement and promote healing.

What is whiplash? “Whiplash is a type of neck injury that occurs when an individual’s head is jerked backward and then forward suddenly, similar to the cracking of a whip. It commonly happens during motor vehicle accidents, particularly rear-end collisions, but it can also occur during sports activities or falls,” said Dr. Jeremy Smith, an orthopedic spine surgeon and director of the spine surgery fellowship at Hoag Orthopedic Institute in Southern California. “This abrupt motion leads to the stretching and tearing of muscles, ligaments and other soft tissues in the neck. The rapid acceleration and deceleration of the head can significantly strain the neck structures.” The unfortunate truth is that whiplash neck is no joke. The Cleveland Clinic indicates that whiplash is often dismissed as fleeting pain, soreness or stiffness. However, the ramifications can be far-reaching, leading to long-term pain and complications. In the most extreme cases, whiplash has the potential to unleash severe spinal injuries, causing permanent disability or even proving fatal. “Whiplash symptoms can vary from person to person, but some common ones include neck pain and stiffness, limited range of motion in the neck, headaches, dizziness, fatigue, shoulder or back pain,

effective approach to whiplash injury self-care includes applying heat or cold packs to the affected area to help alleviate pain, reduce inflammation and promote relaxation of muscles. Neck immobilization In

Injection therapy Cortico-

tingling or numbness in the arms, and sometimes difficulty concentrating or sleeping,” Smith said. “The duration of whiplash symptoms can vary widely, depending on the severity of the injury and individual factors,” said Smith. “In many cases, symptoms improve within a few weeks or months with appropriate treatment and self-care measures. However, some individuals may experience chronic pain or long-lasting symptoms that persist for several months or even years.” The Mayo Clinic concurs that some people continue to have pain for several months or years after the whiplash injury occurred. Whiplash treatments When it comes to the treatment of whiplash, a comprehensive approach is often necessary to address the diverse array of symptoms and promote healing. Health care professionals employ various strategies tailored to each individual’s needs. Let’s explore the range of treatment options available for whiplash, including whiplash injury self-care. Cedars Sinai lists the following treatments for whiplash: Pain management Over-the-counter

pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage mild to moderate pain. In more severe cases, prescription medications, including muscle relaxants or narcotics, may be prescribed

steroid injections may be administered directly into the affected areas to reduce inflammation and ease pain. Alternative therapies Techniques like chiropractic care, acupuncture, massage therapy or transcutaneous electrical nerve stimulation (TENS) may be used as complementary treatments, to manage pain and promote healing. Psychological support Addressing the emotional and psychological impact of whiplash is crucial. Counseling, cognitive behavioral therapy or relaxation techniques can help manage stress, anxiety or depression associated with the injury.

“Whiplash treatment focuses on alleviating pain, reducing inflammation, promoting healing and restoring normal neck function. Initially, conservative measures such as rest, ice or heat therapy, pain medication and gentle neck exercises are typically recommended,” Smith said. “Physical therapy can also be beneficial in restoring strength, flexibility and mobility to the neck,” Smith added. “In more severe cases or when conservative measures fail, interventions like corticosteroid injections or even surgery may be considered, although surgery is generally reserved for rare cases with structural instability or nerve compression. It is crucial for individuals with whiplash to consult with a health care professional, such as a spine surgeon or orthopedic specialist, to determine the most appropriate treatment plan based on their specific condition.”

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M E N T A L

H E A L T H taking their medication on their own,” Carr stressed. “Talk to your health care provider about any changes.” That point was echoed by Jake Nelson, director of traffic safety advocacy and research at the nonprofit AAA. Your doctor might be able to make some changes – like switching to a different medication or adjusting the dose or time of day you take a particular drug.

Seniors, Here Are the Meds That Can Harm Your Driving Skills

ome common medications – including antidepressants, sleep aids and painkillers – may dull the driving skills of seniors, a new study finds.

Classes of medications

Many different medication classes have been linked to the risk of driving impairment. But the new study took a particularly rigorous approach to investigating the issue – following older adults for up to 10 years and testing their driving skills with annual road tests. And it turned out that those using certain classes of medications were at greater risk of failing the road test at some point. When older folks were taking either antidepressants, sedative/hypnotics (sleep medications) or non-steroidal anti-inflammatory drugs (NSAIDs), they were nearly three times more likely to get a failing or “marginal” grade than non-users.

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The findings do not prove the medications are to blame, said lead researcher Dr. David Carr, a specialist in geriatric medicine at Washington University’s School of Medicine in St. Louis. It can be hard, he said, to draw a direct line between a particular medication and diminished driving skills: Is it that drug, another drug, or or the medical condition it’s treating?

In this study, though, Carr and his colleagues were able to account for many factors, including participants’ medical conditions, memory and thinking skills, vision problems and whether they lived in more affluent or disadvantaged neighborhoods. And certain medication groups were still linked to poorer driving performance. Beyond that, Carr said, many of the medications in question are known to act on the central nervous system – with potential side effects, like drowsiness and dizziness, that could affect driving. Patients need to be proactive

“The bottom line is, we need to pay attention to this and advise our patients,” Carr said, adding that he doubts this is happening routinely. Unfortunately, he added, during busy, time-limited doctor visits, discussions of medication side effects may fall by the wayside. So that’s where patients need to be proactive, Carr said: Ask questions about potential side effects when you get a new prescription. And if you’re wondering whether your sluggishness or other symptoms could be due to a medication, talk to your health care provider. “We wouldn’t want anyone to just stop

“Don’t feel like you’re being a burden by asking these questions,” said Nelson, who was not involved in the study. “This is about putting your health and safety first.” He also, however, stressed the role of the pharmaceutical industry in tackling the issue. There are better ways, Nelson said, to alert medication users to the risk of driving impairment – which is typically buried in the “fine print.” The study, published in JAMA Network Open, involved 198 adults who were 73 years old on average at the outset. None had signs of cognitive impairment (problems with memory, judgment or other thinking skills). Study participants had annual check-ups, including a road test with a professional driving instructor, for up to 10 years (about five years, on average). During that period, 35% received a failing and marginal road test grade at some point. Seniors on antidepressants, sleep aids or NSAIDs were at heightened risk. The odds were greatest for those on an antidepressant or sleep medication – with 16% to 17% putting in a poor road performance per year overall. That compared with rates of 6% to 7% of their peers not using those medications. There were a couple of surprises, Carr said. Researchers found no link between antihistamines, which can make users drowsy, or anticholinergic medications, which can cause sedation or blurred vision, and seniors’ driving performance. But, Carr said, it’s possible that older drivers in this study were using newer, non-drowsy antihistamines or there were too few people taking anticholinergics to detect a significant effect. No matter which medications they may be using, Carr said older adults should talk to their doctor about any red flags – like feeling drowsy or slower to react or having a “close call” on the road.

Quiz:

Quiz: Do You Know How to Cope with Job Stress? Whether you’re at the top of the career ladder or a few rungs down, chances are you’ve felt some stress on the job. In a survey reported by the National Institute for Occupational Safety and Health, 40 percent of Americans said their jobs were “very or extremely stressful.” The strain isn’t just aggravating – according to NIOSH, job stress can be hazardous to your health. If you’re gnashing your teeth over a pushy boss, impossible deadlines, or office conflicts, it’s time to take action. How much do you know about coping with job stress? Take this short quiz to find out.

1. Which of these conditions is strongly linked to job stress? a. Back pain b. Heart Disease

2. According to NIOSH, which of these is the most effective long-term solution to on-thejob stress? a. Relaxation exercises

c. Depression

b. Effective time management

d. All of the above

c. Worker-friendly organizational changes

3. According to the American Psychological Association, supervisors and heads of companies are especially vulnerable to job stress. True or False

4. If you feel a lack of control over your job, your only choices are putting up with it or quitting. True or False

5. You have a legal right to a safe working environment. True or False

6. A healthy diet, adequate sleep, and regular exercise can help you deal with on-thejob stress. True or False Answers on the next page

d. Vacations

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Answers 1. Which of these conditions is strongly linked to job stress? The correct answer is: d. All of the above Still think job stress is no big deal? Consider this: After a four-year study of more than 21,000 nurses published in the British Medical Journal, Harvard researchers concluded that job stress can threaten a person’s health just as surely as smoking or a sedentary lifestyle

2. According to NIOSH, which of these is the most effective long-term solution to on-thejob stress? The correct answer is: c. Worker-friendly organizational changes Relaxation exercises, vacations, and better time management can help take the edge off a stressful job. But for dramatic, long-term improvements, the job itself may have to change. According to

Expressing Yourself Creatively Gives Mental Health Boost, Poll Finds One way to get real peace of mind: Start doing something creative.

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Americans who engage in creative activities – from crafting to playing the piano to painting – report better mental health, according to a recent poll from the American Psychiatric Association. “We live in stressful times, and sometimes our jobs and responsibilities can drain our energy and our mental health,” said APA President Dr. Petros Levounis. “Creative activities aren’t just for fun, they can help us take a step back from the daily grind, use our brains differently, and relax.”

About half of American adults say they use creative activities to relieve stress or anxiety. Those who rate their own mental health as “very good” or “excellent” tend to participate in this kind of creative fun more than those who say their mental health is “fair” or “poor,” according to the Healthy Minds Monthly Poll. Of those reporting very good or excellent mental health, about 7 in 10 engaged in creative activities, compared to 50% of adults who reported good mental health and 46% of those citing fair or poor mental health. This poll was conducted in June of this year among 2,202 adults. Things are looking up: About 77% of American adults said their current mental health was good or better, compared to 63% earlier this year.

Of course, the survey can’t prove that tapping into your creative side will improve your mental health. Still, “creative activities are an excellent way to express oneself and to take some time off from the everyday routine,” said APA CEO and Medical Director Dr. Saul Levin. “Creative pastimes that boost our mental health are along the lines of talking to friends, walking in nature and exercising, among other good options. APA is pleased to call attention to these positive actions as part of the public discussion on mental health,” Levin added. When asked what they did creatively to relieve anxiety or stress, 77% said they listened to music, 39% solved puzzles, one-quarter engaged in singing or dancing and about another quarter pursued drawing, painting or sculpting. Crafting, creative writing, playing music and concert-going were other popular stress-relievers.

NIOSH, employers should strive to ensure that their employees have reasonable workloads, clearly defined responsibilities, humane schedules, and a chance to participate in important decisions that affect their jobs.

3. According to the American Psychological Association, supervisors and heads of companies are especially vulnerable to job stress. True or false? The correct answer is: False Those at the top may feel a lot of pressure – and surveys show that they are likely to suffer stress-related ills such as elevated cholesterol and sleep disorders – but they probably wouldn’t want to spend a day in their secretary’s chair. As reported by the American Psychological Association, people who feel powerless in their jobs are prime targets for extreme job stress. Whether you're a waitress, a clerk, or a middle manager, it can be extremely aggravating to

lack any sense of control over your work.

4. If you feel a lack of control over your job, your only choices are putting up with it or quitting. True or false? The correct answer is: False Gaining a little control over your job is one of the most effective ways of preventing stress. You can start by negotiating your job description with your boss. Make sure you both agree on your responsibilities. If you can’t reach an agreement – and your job still seems untenable – then it might be time to look elsewhere for work.

5. You have a legal right to a safe working environment. True or false? The correct answer is: True Hazardous or unsanitary working conditions can be very stressful. If your work environment isn’t up to par, discuss it with your employer

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or workplace representatives. If a dangerous or life-threatening situation still goes uncorrected, contact a labor organization or the local office of the Occupational Safety and Health Administration.

6. A healthy diet, adequate sleep, and regular exercise can help you deal with on-thejob stress. True or false? The correct answer is: True These steps can help you cope with any sort of stress, work-related or otherwise. Whether you love your job or are poring over “Help Wanted” ads, a healthy lifestyle can only help.

References National Institute of Occupational Safety and Health. Stress at work.

W O M E N ’ S

H E A L T H

Menopause & Your Diet: Foods to Choose and Avoid Menopause, a natural stage in a woman’s life, brings a host of changes and challenges. One aspect that is crucial to consider is nutrition. Eating the right foods and avoiding others can help you navigate this change with vitality and optimal health. This article discusses the key foods to eat and those to avoid so you can thrive during menopause and beyond. Diet and menopause During menopause, which is the end of a woman’s menstrual cycles, estrogen levels decrease and may lead to health issues. Rate of bone loss speeds up, increasing your risk of low bone density, osteopenia and osteoporosis, according to the Iowa Clinic. There’s also a higher chance of having a heart attack, stroke or other heart-related issues. Caffeine, sugar, salt, cigarettes and alcohol exacerbate these risks. Body composition also changes during menopause; your lean body mass decreases while your percentage of fat mass increases by 1.7% per year, according to a 2021 article in Nutrition in Menopausal Women: A Narrative Review, by Dr. Poli Mara Spritzer, of Hospital de Clinicas de Porto Alegre in Brazil, and colleagues. Menopause diet

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Fortunately, you’ll find help from a variety of common foods, from veggies to lean meats.

■ Bananas

■ Cabbage

■ Watermelon

■ Bok choy

■ Pears

■ Cauliflower

■ Apples

■ Carrots

■ Eggs

■ Dried figs

■ Nuts and seeds

Foods to avoid during menopause

Fiber will help you maintain your weight. The goal: Aim for 21 grams of fiber per day, according to MedicineNet: ■ Pulses, such as beans, lentils or chickpeas

■ Fresh whole fruit (not juice)

■ Fresh vegetables ■ Whole-grain ce- ■ Brown rice reals, oats or pasta Lean proteins can ease menopausal symptoms and help maintain weight and build mass, so try: ■ Tuna

■ Beans

■ Tofu

■ Lentils

■ Grilled chicken

■ Turkey

■ Lean beef The Cleveland Clinic recommends the following foods to help manage menopausal symptoms: Healthy fats high in omega-3 fatty acids ■ Sardines

■ Chia seeds

■ Salmon

■ Hemp seeds

■ Anchovies

■ Avocados

■ Flaxseeds These soy-based products contain phytoestrogens that help mimic biological estrogen: ■ Tofu

■ Soy milk

■ Soybeans (edamame)

■ Tempeh

Other phytoestrogen-rich foods include: ■ Oats

■ Dried Beans

■ Barley

■ Lentils

For healthy bones, eat foods containing vitamin D and calcium:

■ Carrots

■ Alfalfa

■ Apples

■ Mung beans

■ Rice

■ Wheat germ

■ Brussels sprouts

■ Cucumber

■ Sesame seeds

Foods to eat during menopause

■ Asparagus

■ Romaine lettuce

■ Oily fish

■ Wheat

■ Cauliflower

■ Radish

■ Sage

■ Berries

■ Broccoli

Traditional Chinese medicine says certain cooling foods may help with menopause:

■ Sesame seeds

To help maintain a healthy weight, limit these foods: ■ Pasta (not whole ■ Potatoes grain) ■ White rice ■ White bread ■ Sugary drinks These foods may cause menopausal symptoms to worsen: ■ Alcoholic beverages

■ Highly processed foods

■ Sugar, junk food ■ Caffeine “The Mediterranean diet pattern, along with other healthy habits, may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period,” Spritzer and her team said in the 2021 narrative review. “It consists of the use of healthy foods that have anti-inflammatory and antioxidant properties, and is associated with a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels.” The American Heart Association notes that the Mediterranean-style diet typically includes plenty of fruits and vegetables, bread and other grains. Potatoes, beans, nuts and seeds are also included. Olive oil is the primary source of fat. The diet also includes low to moderate amounts of eggs, fish and poultry. Wine is usually consumed with meals in a low to reasonable amount. Fruit is common for desserts instead of sweets. Listen to your body as you make changes to your diet to see what makes you feel your best. Nourishing your body with healthy foods can make menopause more manageable and make you feel better during this time.

Know your breast cancer risk. Create a plan.

What Every Woman Needs to Know About Breast Cancer Screening

atching breast cancer early is key to making it easier to treat and survive, according to the American Cancer Society (ACS). The organization aims to highlight early detection, noting that screening with mammography has helped breast cancer death rates drop 43% since 1989.

St. Luke’s High-Risk Breast Services

“Breast cancer is the most common cancer in women (after skin cancer) and the second most common cause of cancer mortality. Breast cancer screening with mammography is important because early detection saves lives,” said Robert Smith, senior vice president of early cancer detection science for the cancer society.

Knowing your personal breast cancer risk can help you take steps to reduce your chances of developing it or catch it early, when it is most treatable.

“Research has shown regular mammograms are associated with a substantially reduced risk of dying from breast cancer,” Smith said in an ACS news release. ACS guidelines encourage average-risk women to begin regular screening mammograms — a low-dose X-ray image of the breasts — at age 45. It’s an option to begin screening as early as age 40, according to the guidelines, which were created by a panel of doctors and patient advocates. Annual screening should continue up until age 55 and then can transition to biennial screening, if a woman prefers. Women should also speak with their doctor about family history, genetics and lifestyle choices that can influence risk, as well as familiarize themselves with how their breasts normally look and feel. Those who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year. “Women who receive regular mammograms and are diagnosed with breast cancer are more likely to be diagnosed earlier, less likely to need aggressive treatments and more likely to be cured,” Smith said. “Once a woman begins breast cancer screening, it is important that she commits to regular, on-time examinations. Regular screening, rather than irregular or occasional screening, offers the greatest benefit.”

St. Luke’s Women’s Center offers a comprehensive high-risk program to help you learn your risk and work with our specialists to develop a personalized plan and seamlessly coordinate your care. It begins with a breast risk assessment at your annual mammogram.

Learn more about St. Luke’s High-Risk Breast Services at stlukes-stl.com/BreastHealth, or call 636-530-5512.

More information The U.S. National Cancer Institute has more on mammograms.

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frequency and duration. In other words, it was a complicated measure. Because of that, Elbaz said, it’s not clear whether any particular types of exercise are related to lower Parkinson’s risk. Over three decades, 1,074 study participants developed Parkinson’s. The risk, researchers found, was lowest among women who’d been most physically active in the past 10 years – even with factors like age, weight and diet taken into account. The one-quarter of women who were most active had a 25% lower risk of Parkinson’s compared to the one-quarter who were least active.

Another Possible Exercise Bonus for Women: Preventing Parkinson’s

egular exercise has a long list of health benefits, and a new study suggests another one could be added: a lower risk of Parkinson’s disease.

The study, of nearly 99,000 French women, found that those who were most physically active day to day were 25% less likely to develop Parkinson’s over three decades, versus women who were more sedentary. The study assessed the women’s exercise habits for up to 20 years before their Parkinson’s diagnosis. And since regular exercise clearly has benefits anyway, the findings could be seen as another motivator to get moving, said senior researcher Dr. Alexis Elbaz. “Physical activity has beneficial effects on many body systems, including the bones, heart and lungs,” said Elbaz, a research professor at the French national research institute INSERM in Paris. “And our findings show that physical activity might also contribute to preventing or delaying Parkinson’s disease.”

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About Parkinson’s Parkinson’s disease affects nearly 1 million people in the United States, according to the Parkinson’s Foundation. It is a brain disease that gradually destroys or disables cells that produce dopamine, a chemical that helps regulate movement and emotional responses.

The most visible symptoms of Parkinson’s are movement-related – tremors, stiff limbs and coordination problems – but the effects are wide-ranging and can include depression, irritability and trouble with memory and thinking skills. In general, researchers believe the disease arises from a complex interaction between genetic susceptibility and environmental factors. But only a handful of modifiable risk factors have been linked to Parkinson’s – including a history of head trauma and job exposure to pesticides or heavy metals. If exercise is protective, that would make it one of the few ways to help prevent the disease. “This is important because it represents a possible prevention strategy for a disease that has no cure and has a severe impact on quality of life,” Elbaz said. The study The findings – published in the journal Neurology – are based on just under 99,000 French women who entered a national health study in 1990. At the outset and then every few years, they answered questionnaires on their lifestyle habits and medical history. That included questions gauging vigorous exercise, such as playing sports and running, as well as daily activities like walking, climbing stairs and household chores. The researchers gave each activity a score called a metabolic equivalent (MET), then multiplied each activity’s MET by its

The problem is that Parkinson’s typically has a long “prodromal” phase – a period when people may have certain symptoms, but the disease has not yet fully manifested. So it’s possible that some women in that phase of the illness curtailed their activities. To account for that, the researchers looked back at the participants’ exercise habits for up to 20 years before any Parkinson’s diagnosis. They found that exercise was still tied to a lower risk, though the strength of the connection was less. Protective effect of exercise There is reason to believe exercise could be protective, Elbaz said. Other research has shown, for example, that exercise can help shield brain cells from the ravages of oxidative stress – one of the mechanisms involved in Parkinson’s. Dr. Michael Okun, national medical adviser to the nonprofit Parkinson’s Foundation, called the findings “significant and important.” He noted that a handful of past studies have tied exercise to lower Parkinson’s risk in men only. (Men have a higher rate of Parkinson’s than women do.) Okun said this new, large study suggests that both men and women may want to consider “lifelong” exercise as a way to reduce Parkinson’s risk. That long-term aspect is important, Elbaz said. The women in this study were 49 years old, on average, at the outset, and it was their activity levels in the previous 10 to 20 years that mattered in their Parkinson’s risk. The American Parkinson Disease Association has more on the causes of Parkinson’s disease.

T H E DATA A R E I N :

severe cases may lead to sepsis.

Cranberry Juice Does Help Prevent Urinary Tract Infections

Dr. Johanna Figueroa, a urologist at Northwell Health in Syosset, N.Y., said UTIs often can self-resolve with enough hydration. That means drinking lots of water to flush the bacteria out of your system. Cranberry can be another tool, she said.

It's not just a myth – if you're bothered by UTIs, cranberry products might help. Drinking lots of water and practicing good hygiene are also important.

omen have heard for decades that cranberry products help prevent urinary tract infections. A new study appears to confirm that longstanding advice. About 60% of women over age 18 will suffer one or more urinary tract infections (UTIs) in their lifetime. About 30% will have recurrent UTIs, averaging two to three episodes a year, according to background notes with the study. A review of 50 randomized controlled trials found that taking cranberry supplements or drinking the juice reduced the risk of having repeat symptoms for a UTI by more than 25%. In children, cranberry products reduced these infections by more than 50%. People who were susceptible to a repeat infection after medical treatment such as antibiotics or probiotics saw a 53% reduction. “For the first time, we have consensus that cranberry products (concentrated liquid, capsules or tablets) work for some groups of people; specifically, people who experience recurrent UTI, children and people susceptible to UTI because of medical intervention,” said study author Jacqueline Stephens, senior lecturer in public health in the College of Medicine & Public Health at Flinders University in Australia. Results from around the world This updated review of research from around the world included nearly 9,000 people. Randomized controlled trials are considered the "gold standard" of research studies. “The inclusion of the totality of the global evidence and the rigorous review process

means we are confident of the results, even when the results have changed compared to previous versions of this review,” Stephens said. Lead study author Gabrielle Williams, of the Centre for Kidney Research in Westmead, Australia, recalled that in 1973 her mother was told to drink cranberry juice to prevent “horrible and frequent UTIs.” And that still works for her, Williams said in a Flinders news release. “She's continued to take it daily, first as the nasty sour juice and in recent years, the easy-to-swallow capsules. As soon as she stops, wham the symptoms are back,” Williams said. UTIs especially common in women UTIs can affect anyone, but they're especially common in women because of their anatomy. The infection occurs most commonly in the bladder, the U.S. Centers for Disease Control and Prevention says. It happens when bacteria, typically from the skin or rectum, enter the urethra. This can cause pain, frequent urination and other bothersome symptoms. Infections can move to the kidneys, causing additional pain and complications. Very

“If your symptoms are relieved, it could be that you may not even need to go and seek medical attention because your body itself is able to combat the bacteria that enter the bladder,” said Figueroa, who was not involved in the study. In other cases, doctors often prescribe antibiotics to treat UTIs. While the study review found cranberry to be effective in certain groups, it did not find cranberry products helpful in institutionalized men and women, in pregnant women or in adults with neuromuscular bladder dysfunction and incomplete bladder emptying. Most of the studies reviewed compared use of cranberry products to taking a placebo or getting no treatment. The researchers also analyzed the results of trials comparing cranberry products with probiotics and antibiotics. Why cranberries? Cranberries contain substances known as proanthocyanidins, chemical compounds that can keep bacteria from sticking to the bladder walls, according to the study. Figueroa said the takeaway is that cranberry supplements, can be used if you feel like it's preventing and it's working. The most common side effect of taking cranberry seen in the study was an upset stomach. It’s still important to drink water, she said. Good hygiene also helps to prevent UTIs. The study findings were published in Cochrane Reviews. More information The U.S. Centers for Disease Control and Prevention has more on urinary tract infections.

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A G I N G

C A R E G I V I N G

Let’s Have an Honest Conversation About What to Expect as You Age

By Judith Graham

ow many of us have wanted a reliable, evidence-based guide to aging that explains how our bodies and minds change as we grow older and how to adapt to those differences? Geriatrician Rosanne Leipzig says a lot of health information for older adults isn’t as useful as it should be. No person’s aging process looks exactly like another’s. So she’s written a 400-plus-page guidebook called “Honest Aging: An Insider’s Guide to the Second Half of Life.”

Why call it “Honest Aging”? “Because so much of what’s out there is dishonest, claiming to teach people how to age backwards,” Leipzig said. “I think it’s time we say, ‘This is it; this is who we are,’ and admit how lucky we are to have all these years of extra time.”

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The doctor was referring to extraordinary gains in life expectancy achieved in the modern era. Because of medical advances, people over age 60 live far longer than people at the dawn of the 20th century. Still, most of us lack a good understanding of what happens to our bodies during this extended period after middle age. Several months ago, a medical student asked Leipzig whether references to age should be left out of a patient’s written medical history, as references to race have been eliminated. “I told her no; with medicine, age is always relevant,” Leipzig said. “It gives you a sense of where people are in

their life, what they’ve lived through, and the disorders they might have, which are different than those in younger people.” What questions do older adults tend to ask most often? Leipzig rattled off a list: What can I do about this potbelly? How can I improve my sleep? I’m having trouble remembering names; is this dementia? Do I really need that colonoscopy or mammogram? What should I do to get back into shape? Do I really need to stop driving? Underlying these is a poor understanding of what’s normal in later life and the physical and mental alterations aging brings. Can the stages of aging be broken down, roughly, by decade? No, said Leipzig, noting that people in their 60s and 70s vary significantly in health and functioning. Typically, predictable changes associated with aging “start to happen much more between the ages of 75 and 85,” she told me.

chest pain. Similarly, an older person with pneumonia may fall or have little appetite instead of having a fever and cough. Older adults react differently to medications. Because of changes in

body composition and liver, kidney, and gut function, older adults are more sensitive to medications than younger people and often need lower doses. This includes medications that someone may have taken for years. It also applies to alcohol. Older adults have reduced energy reserves. With advancing age, hearts

become less efficient, lungs transfer less oxygen to the blood, more protein is needed for muscle synthesis, and muscle mass and strength decrease. The result: Older people generate less energy even as they need more energy to perform everyday tasks. Hunger and thirst decline. Peo-

ple’s senses of taste and smell diminish, lessening food’s appeal. Loss of appetite becomes more common, and seniors tend to feel full after eating less food. The risk of dehydration increases. Cognition slows. Older adults process information more slowly and work harder to learn new information. Multitasking becomes more difficult, and reaction times grow slower. Problems finding words, especially nouns, are typical. Cognitive changes related to medications and illness are more frequent.

Here are a few of the agerelated issues she highlights in her book: Older adults often present with different symptoms when they become ill. For

instance, a senior having a heart attack may be short of breath or confused, rather than report

Geriatrician Dr. Rosanne Leipzig

The musculoskeletal system is less flexible. Spines shorten as the discs

that separate the vertebrae become harder and more compressed; older adults typically lose 1 to 3 inches in height as this happens. Balance is compromised because of changes in the inner ear, the brain, and the vestibular system (a complex system that regulates balance and a person’s sense of orientation in space). Muscles weaken in the legs, hips, and buttocks, and range of motion in joints contracts. Tendons and ligaments aren’t as strong, and falls and fractures are more frequent as bones become more brittle. Eyesight and hearing change.

Older adults need much more light to read than younger people. It’s harder for them to see the outlines of objects or distinguish between similar colors as color and contrast perception diminishes. With changes to the cornea, lens, and fluid within the eye, it takes longer to adjust to sunlight as well as darkness. It’s harder to hear, especially at high frequencies. This is because of

accumulated damage to hair cells in the inner ear. It’s also harder to understand

speech that’s rapid and loaded with information or that occurs in noisy environments. Sleep becomes fragmented. It takes longer for older adults to fall asleep, and they sleep more lightly, awakening more in the night.

This is by no means a complete list of physiological changes that occur as we grow older. And it leaves out the many ways people can adapt to their new normal, something Leipzig spends a great deal of time discussing.

A partial list of what Dr. Leipzig suggests, organized roughly by the topics above: Don’t ignore sudden changes in functioning; seek medical attention. At every doctor’s visit, ask why you’re taking medications, whether doses are appropriate, and whether medications can be

stopped. Be physically active. Make sure you eat enough protein. Drink liquids even when you aren’t thirsty. Cut down on multitasking and work at your own pace. Do balance and resistance exercises. Have your eyes checked every year. Get hearing aids. Don’t exercise, drink alcohol, or eat a heavy meal within two to three hours of bedtime. “Never say never,” Leipzig said. “There is almost always something that can be done to improve your situation as you grow older, if you’re willing to do it.” KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews. org/columnists to submit your requests or tips.

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as the medications carry a hefty price tag outside of trials. Aduhelm costs $28,200 a year, while Leqembi carries an annual price tag of $26,500. Early diagnosis is critical Still, early diagnosis of Alzheimer’s is critical for many reasons, she and other experts said. Medicare coverage decisions could change in the near future, for one. But beyond that, “people need care” said Dr. Howard Fillit, chief science officer for the nonprofit Alzheimer’s Drug Discovery Foundation in New York City.

Alzheimer’s Report: Many Seniors with Memory Issues Aren’t Telling Their Doctors

lzheimer’s is one of the most common and serious diseases of aging, yet many older adults with memory issues are not telling their doctors about their struggles. That’s according to a report earlier this year from the Alzheimer’s Association that focuses on whether doctors and patients are discussing early warning signs of the disease. The answer, often, is no. Fears of a diagnosis or treatment

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In focus group discussions, the association found that older adults who’d been noticing problems with their memory and thinking often said they did not want to bring the subject up with their doctor. Some cited fear of getting a wrong diagnosis or being put on unnecessary treatments. At the same time, people often feared a correct diagnosis of dementia. It’s understandable that no one wants to hear that news, said Dr. Nicole Purcell, senior director at the association.

But the reluctance is concerning, she added, because getting to the bottom of people’s thinking and memory problems is essential. In some cases, those issues are not caused by dementia, but by a reversible medical condition such as sleep apnea or a thyroid disorder. Even if a person is in the early stages of Alzheimer’s, Purcell said, new treatments are becoming available that can slow the disease down. New treatment options Within the past two years, the U.S. Food and Drug Administration has approved two drugs that target the underlying biology of the disease: They help clear the brain of abnormal protein clumps called amyloid “plaques” – considered the hallmark of Alzheimer’s. Those medications, aducanumab (Aduhelm) and lecanemab (Leqembi), are not yet widely accessible: Medicare, at least for now, is not paying for them unless the patient is enrolled in a clinical trial. That’s clearly a huge barrier, Purcell said,

Patients, he said, need help with planning for the future, managing coexisting health conditions and medications, and navigating daily challenges. Their family caregivers also need guidance, Fillit pointed out. For all those reasons, he said, an early, accurate diagnosis is “critically important.” The new report, released earlier this year, is part of the Alzheimer’s Association’s annual Facts and Figures update – an overview of how the disease is affecting Americans and the health care system. The report is based on focus group discussions, including with people who had “subjective cognitive decline” – meaning they’d noticed growing problems with their memory or thinking abilities. Many were reluctant to talk to their doctor about it, though. “Often, they said they’d rather talk to a family member or friend, to see what’s ‘normal’ for their age,” Purcell said. In addition, Black, Hispanic, Asian and Native Americans were particularly wary of being put on medications, and preferred a “holistic” approach to their thinking and memory issues. Black and Native American participants also cited racism in the medical field as a concern. Doctors also reluctant to bring it up Doctors, meanwhile, are not broaching the topic, either. Focus groups with primary care doctors revealed that they usually depend on family members to bring any concerns to them.

One reason, Purcell said, is that primary care providers are dealing with so much – seeing older patients who often have multiple physical ailments – that any proactive discussion of brain health falls by the wayside.

early Alzheimer’s, including brain scans and tests of the cerebral spinal fluid that detect amyloid levels. Those tests are, in fact, necessary for people to qualify for the new amyloid-clearing drugs, Sadowski noted.

But doctors also worry that if they do suspect a patient is in early cognitive decline, they will have nowhere to send them: Specialists such as neurologists and geriatricians are in short supply in many areas of the United States, Purcell explained.

The problem, he said, is that even if people can get specialist care, insurance often does not cover those expensive tests.

Difficulties in diagnosis and insurance coverage It all highlights a central issue: While everyone wants people to tell their doctor about any thinking and memory problems, getting a definitive diagnosis can be tough. Diagnosing mild cognitive impairment – early symptoms that may or may not progress to dementia – is challenging, said Dr. Martin Sadowski, a professor of neurology and psychiatry at NYU Grossman School of Medicine in New York City. There are objective tests that can pinpoint whether symptoms are being caused by

The approved amyloid-clearing drugs are by no means the answer to Alzheimer’s. Based on the lecanemab trial, Sadowski said, it slowed patients’ decline by about 30% over 18 months, on average. “We don’t know about the long term,” he noted. Both drugs also carry a risk of brain swelling or bleeding.

That said, Sadowski called himself “a big proponent of early diagnosis.” He noted that, particularly for relatively younger people, a common culprit behind milder impairment is sleep apnea – a highly treatable condition. Fillit added that, even in people with dementia, treating additional conditions like sleep apnea or vitamin B12 deficiency can improve symptoms.

But there are many types of Alzheimer’s treatments in clinical trials right now, Fillit said, and most target underlying processes other than amyloid buildup. It’s thought that taking aim at the disease from multiple angles will ultimately be most effective. “Research into Alzheimer’s disease didn’t start until about 40 years ago,” Fillit said. “And now it’s paying off.”

Plus, Sadowski said, while there are currently barriers to objective tests and new drugs, the situation is evolving. Finally, there are numerous ongoing clinical trials testing new treatments for Alzheimer’s. For anyone who might want to enroll, Fillit said, a definitive diagnosis is a must.

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Aging and Stress

75-year-old heart can be slow to respond to the demands of exercise. And when an 80-year-old walks into a chilly room, it will take an extra-long time for her body temperature to adjust.

Many seniors still manage to sail through their later years. “Successful agers” tend to have a few things in common: They stay connected to friends and family, they exercise and keep active, and, above all, they find ways to both reduce and manage the stress in their lives. The stress alarm

Stress hormones provide energy and focus in the short term, but too much stress over too many years can throw a person’s system off-balance. Overloads of stress hormones have been linked to many health problems, including heart disease, high blood pressure, and weakened immune function. For older people already at heightened risk for these illnesses, managing stress is particularly important.

Stress comes in two basic flavors, physical and emotional – and both can be especially taxing for older people. The impacts of physical stress are clear. As people reach old age, wounds heal more slowly and colds become harder to shake. A

Over time, the brain can slowly lose its skills at regulating hormone levels. As a result, older people who feel worried or anxious tend to produce larger amounts of stress hormones, and the alarm doesn’t shut down as quickly. According to a

t any age, stress is a part of life. Young and old alike have to face difficult situations and overcome obstacles. While young adults struggle to establish a career, achieve financial security, or juggle work and family demands, older people may face failing health or dwindling finances – or simply the challenges of retaining their independence. Unfortunately, the body’s natural defenses against stress gradually break down with age. But you don’t have to give in to stress just because you’re no longer young.

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Emotional stress is more subtle, but if it’s chronic, the eventual consequences can be as harmful. At any age, stressed-out brains sound an alarm that releases potentially harmful hormones such as cortisol and adrenaline. Ideally, the brain turns down the alarm when stress hormones get too high.

study published in the journal Psychoneuroendocrinology, women are especially susceptible to an overload of stress hormones as they age. The study found that the impact of age on cortisol levels is nearly three times stronger for women than for men. The flow of stress hormones can be especially hard on older brains in general. According to a report from the University of California at San Francisco, extra cortisol over the years can damage the hippocampus, a part of the brain that’s crucial for storing and retrieving memories. Several studies have found that high cortisol goes hand in hand with poor memory, so we might be able to chalk up certain “senior moments” to stress. Years of emotional distress may even increase the risk of Alzheimer’s disease. A five-year study of nearly 800 priests and nuns published in the journal Neurology highlighted this potential hazard. The subjects who reported the most stress were twice as likely as the least-stressed subjects to develop the disease. Speeding up the clock Stress doesn’t just make a person feel older. In a very real sense, it can speed up aging. A study published in the Proceedings of the National Academy of Sciences found that stress can add years to the age of individual immune system cells. The

study focused on telomeres, caps on the end of chromosomes. Whenever a cell divides, the telomeres in that cell get a little shorter and a little more time runs off the clock. When the telomere becomes too short, time runs out: The cell can no longer divide or replenish itself. This is a key process of aging, and it’s one of the reasons humans can’t live forever. Researchers checked both the telomeres and the stress levels of 58 healthy premenopausal women. The stunning result: On average, the immune system cells of highly stressed women had aged by an extra 10 years. The study didn’t explain how stress adds years to cells making up the immune system. As the study authors write, “the exact mechanisms that connect the mind to the cell are unknown.” Researchers do have a not-very-surprising theory, though: Stress hormones could be somehow shortening telomeres and cutting the life span of cells.

stress load and you have a better chance to live a long, healthy life. Maintaining a positive outlook is one key – a study by Yale University found that people who feel good about themselves as they get older live about seven and a half years longer than “glass half empty” types. Researchers say the people with more positive attitudes may also deal with stress better and have a stronger will to live.

Stress management: The real fountain of youth?

Staying close to friends and family is an excellent way to cut down on stress. As reported by the American Psychological Association, social support can help prevent stress and stress-related diseases. The benefits of friends and family can be especially striking for seniors. An article published in the American Journal of Health Promotion notes that social support can slow down the flow of stress hormones in seniors and, not coincidentally, increase longevity. Other studies have found that social interactions can help older people stay mentally sharp and may reduce the risk of Alzheimer’s.

The good news is that we can put what we know about stress and aging to work for us. Learn to manage and reduce your

Exercise, a proven stress-buster for people of all ages, may be especially valuable in later years. Regular walks, bike rides, or

water aerobics can do more than keep a person strong and independent; exercise can actually help block the effects of aging on cortisol levels. A recent study published in Psychoneuroendocrinology found that physically fit women in their mid-60s had essentially the same response to stress as a group of unfit women in their late 20s. In contrast, women in their mid-60s who weren’t physically fit released much larger amounts of cortisol in response to stress. In the end, anything that reduces unnecessary stress will make the later years more enjoyable. Some people simply need to stop trying to do too many things at once. Others may want to try breathing exercises or other relaxation techniques. Still others may need to talk to a psychologist to find a new perspective on their lives. Whatever the approach, fighting stress overload is worth the effort. The American Psychological Association reports that reducing stress in later years can help prevent disabilities and trips to the hospital. And if people end up feeling younger, healthier, and happier, that’s OK, too.

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process that starts in our 30s and accelerates in our 60s and beyond — and gain fat. This is true even when our weight remains constant. Also, less fat accumulates under the skin while more is distributed within the middle of the body. This abdominal fat is associated with inflammation and insulin resistance and a higher risk of cardiovascular disease, diabetes, and stroke, among other medical conditions. “The distribution of fat plays a major role in determining how deleterious added weight in the form of fat is,” said Mitchell Lazar, director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania’s Perelman School of Medicine. “It’s visceral [abdominal] fat [around the waist], rather than peripheral fat [in the hips and buttocks] that we’re really concerned about.”

In Older Adults, a Little Excess Weight Isn’t Such a Bad Thing Activity levels

diminish with age

By Judith Graham

M KFF Health News

illions of people enter later life carrying an extra 10 to 15 pounds, weight they’ve gained after having children, developing joint problems, becoming less active, or making meals the center of their social lives. Should they lose this modest extra weight to optimize their health? This question has come to the fore with a new category of diabetes and weight loss drugs giving people hope they can shed excess pounds.

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For years, experts have debated what to advise older adults in this situation. On one hand, weight gain is associated with the accumulation of fat. And that can have serious adverse health consequences, contributing to heart disease, diabetes, arthritis, and a host of other medical conditions. On the other hand, numerous studies suggest that carrying some extra weight can sometimes be protective in later life. For

people who fall, fat can serve as padding, guarding against fractures. And for people who become seriously ill with conditions such as cancer or advanced kidney disease, that padding can be a source of energy, helping them tolerate demanding therapies. Of course, it depends on how heavy someone is to begin with. People who are already obese (with a body mass index of 30 or over) and who put on extra pounds are at greater risk than those who weigh less. And rapid weight gain in later life is always a cause for concern. Making sense of scientific evidence and expert opinion surrounding weight issues in older adults isn’t easy. Here’s what I learned from reviewing dozens of studies and talking with nearly two dozen obesity physicians and researchers.

Also, with advancing age, people tend to become less active. When older adults maintain the same eating habits (energy intake) while cutting back on activity (energy expenditure), they’re going to gain weight. According to the Centers for Disease Control and Prevention, 27% of 65- to 74-year-olds are physically inactive outside of work; that rises to 35% for people 75 or older. For older adults, the health agency recommends at least 150 minutes a week of moderately intense activity, such as brisk walking, as well as muscle-strengthening activities such as lifting weights at least twice weekly. Only 27% to 44% of older adults meet these guidelines, according to various surveys.

Concerns about Our bodies change muscle mass Experts are more concerned about a lack with age of activity in older adults who are overAs we grow older, our body composition changes. We lose muscle mass — a

weight or mildly obese (a body mass index in the low 30s) than about weight loss.

With minimal or no activity, muscle mass deteriorates and strength decreases, which “raises the risk of developing a disability or a functional impairment” that can interfere with independence, said John Batsis, an obesity researcher and associate professor of medicine at the University of North Carolina School of Medicine in Chapel Hill. Weight loss contributes to inadequate muscle mass insofar as muscle is lost along with fat. For every pound shed, 25% comes from muscle and 75% from fat, on average. Since older adults have less muscle to begin with, “if they want to lose weight, they need to be willing at the same time to increase physical activity.” said Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh School of Public Health.

Ideal body weight may be higher Epidemiologic research suggests that the ideal body mass index (BMI) might be higher for older adults than younger adults. (BMI is a measure of a person’s weight, in kilograms or pounds, divided by the square of their height, in meters or feet.) One large, well-regarded study found that older adults at either end of the BMI spectrum — those with low BMIs (under 22) and those with high BMIs (over 33) — were at greater risk of dying earlier than those with BMIs in the middle range (22 to 32.9). Older adults with the lowest risk of earlier deaths had BMIs of 27 to 27.9. According to World Health Organization standards, this falls in the “overweight” range (25 to 29.9) and above the “healthy weight” BMI range (18.5 to 24.9). Also, many older adults whom the study found to be at highest mortality risk — those with BMIs under 22 — would be classified as having “healthy weight” by the WHO. The study’s conclusion: “The WHO healthy weight range may not be suitable for older adults.” Instead, being overweight may be beneficial for older adults, while being notably thin can be problematic, contributing to the potential for frailty.

Indeed, an optimal BMI for older adults may be in the range of 24 to 29, Carl Lavie, a well-known obesity researcher, suggested in a separate study reviewing the evidence surrounding obesity in older adults. Lavie is the medical director of cardiac rehabilitation and prevention at Ochsner Health, a large health care system based in New Orleans, and author of “The Obesity Paradox,” a book that explores weight issues in older adults.

“Maintaining fitness and muscle mass is more important than losing weight for overweight older adults. Is losing a few extra pounds going to dramatically improve their health? I don’t think the evidence shows that.” Carl Lavie, Obesity Researcher

Expert recommendations Obesity physicians and researchers offered several important recommendations during our conversations: ■ Maintaining fitness and muscle mass is more important than losing weight for overweight older adults (those with BMIs of 25 to 29.9). “Is losing a few extra pounds going to dramatically improve their health? I don’t think the evidence shows that,” Lavie said. ■ Unintentional weight loss is associated with several serious illnesses and is a danger signal that should always be attended to. “See your doctor if you’re losing weight without trying to,” said Newman of the University of Pittsburgh. She’s the co-author of a new paper finding that “unan-

ticipated weight loss even among adults with obesity is associated with increased mortality” risk. ■ Ensuring diet quality is essential. “Older adults are at risk for vitamin deficiencies and other nutritional deficits, and if you’re not consuming enough protein, that’s a problem,” said Batsis of the University of North Carolina. “I tell all my older patients to take a multivitamin,” said Dinesh Edem, director of the Medical Weight Management program at the University of Arkansas for Medical Sciences. ■ Losing weight is more important for older adults who have a lot of fat around their middle (an apple shape) than it is for people who are heavier lower down (a pear shape). “For patients with a high waist circumference, we’re more aggressive in reducing calories or increasing exercise,” said Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan. ■ Maintaining weight stability is a good goal for healthy older adults who are carrying extra weight but who don’t have moderate or severe obesity (BMIs of 35 or higher). By definition, “healthy” means people don’t have serious metabolic issues (overly high cholesterol, blood sugar, blood pressure, and triglycerides), obesity-related disabilities (problems with mobility are common), or serious obesity-related illnesses such as diabetes or heart disease. “No great gains and no great losses — that’s what I recommend,” said Katie Dodd, a geriatric dietitian who writes a blog about nutrition. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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B O O K

R E V I E W

Better

A Surgeon’s Notes on Performance

By Dr. Atul Gawande his is not a new book, but it is timeless in what it offers us from the world of medicine that we can apply to all manner of our own endeavors. Atul Gawande is a surgeon, best-selling author and public health leader. Better is organized in three sections, each about one of his three core requirements that drive improved performance in the practice of medicine and apply to other efforts that involve risk and responsibility. Gawande brings these principles to life with fascinating, relatable and inspiring stories from around the world. As in medicine, in our own fields we deal with systems, resources, circumstances and people, as well as our own shortcomings. We face obstacles of all kinds, and new ones keep cropping up. Yet somehow, we must get the job done, figure out new ways to tackle challenges and do better. How this is accomplished and how we can do this in our own lives is the subject of this book.

The first requirement is diligence, the need to give sufficient attention to detail to avoid error and prevail against obstacles. Gawande brings alive in three compelling stories how this principle makes the difference in the performance of medical teams and outcomes for patients. The second challenge is to do right, how to prevent human failings like arrogance, insecurity, greed and misunderstanding from getting in the way of doing what is best for those we serve. This is the “social” dimension of performance, and requires empathy, respect and the ability to see things from others’ perspectives. The third requirement for success is ingenuity, bringing fresh thinking to the tasks at hand. Gawande contends that this is not a matter of superior intelligence, but of character. It requires deliberate, even obsessive reflection on failure and new solutions for improved performance.

Healthy Humor

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Gawande tells the stories of individuals and teams in everyday medicine who have transformed healthcare through each of these principles, sometimes through very simple, but insightful solutions.

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