Vol. 2 Issue 6 August/September 2017
Children, Headaches and Strokes ANTIBIOTICS ARE NOT ALWAYS THE ANSWER WHAT IS…? — GROUP B STREP
UNDERSTANDING HEMOCHROMATOSIS www.awellnessupdate.com
Update from Dr. Porter
OVER THE YEARS MANY PEOPLE HAVE HEARD ME SAY: “The brilliance in any solution is making something complicated appear so simple.” I think that saying holds so much truth in medicine and our health. Every month we try to provide a diverse offering of health care topics that simplify the information. We cover advancements in care, cures, and educate our readers about a disease or malady that may affect them, their loved ones or someone they know. Through time, certain diseases or health issues float to the top and become “the disease of the month”. It doesn’t seem that long ago that AIDS was on everyone’s minds. To this day millions of research dollars continually go into “finding a cure”. Some of the diseases that have grabbed headlines headlines in the past have been malaria, polio, ZIka and so on. However, while many of these diseases caused panic, they actually affected a select portion of the population, but had the ability to affect us all. Today’s “disease of the month” is a combination that affects us all: diabetes, weight control and cancer. A Wellness Update has addressed these issues – and potential cures – in past issues. But, as the numbers climb and because diabetes and weight loss have reached a crisis level, you will see more features on lifestyle changes and potential cures. Bear in mind, more and more research is pointing to diet as a direct correlation to cancer. More importantly, more and more research is pointing to diets with little or no sugars and carbs as a cure. We will keep you posted through our feature selections on the progress science has made. And have no fear. We will continue providing varied and interesting features for every reader’s interest. I hope you enjoy this month’s issue. As always, I welcome your feedback. Until next time. Dr. Steven A. Porter Publisher and Chairman
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CONTENT Published by Novomedici, LLC Publisher and Chairman Steve Porter, MD Editorial and Design Director Bonnie Jean Thomas
IN EVERY ISSUE 2 Update from Dr. Porter 4 Cleveland Clinic Health Essentials 24 What Is…? — Group B strep 34 Wellness Update Now
Editorial Content Director Larry Myers
CLEVELAND CLINIC HEALTH ESSENTIALS 4 Pulmonary Fibrosis: How Doctors Treat You When Cause Is Unknown 6 Turned Down for LASIK? Consider SMILE for Nearsightedness 7 Harnessing Your Immune System to Treat Advanced Bladder Cancer
Design Gergana Ilieva
9 Achalasia: Are You at Risk for This Rare Swallowing Disorder?
Corporate Office Novomedici 4403 Harrison Blvd. Suite 2855 Ogden, UT 84403
11 Recipe: Sauteed Spinach and Tomatoes Over Roasted Spaghetti Squash
Contributors:
WELLNESS UPDATE NOW 34 Does Daily Exercise Cut Back On Older Adults’ Sedentary Life? Study: Not So Much
Copyright and Disclaimer Copyright 2016 by Novomedici, LLC. All rights reserved. Reproduction of this magazine, in whole or part is prohibited unless authorized by the publisher or its advertisers. The advertising space provided in A Wellness Update is purchased and paid for by the advertisers. Products and services are not necessarily endorsed by A Wellness Update.
The information contained within A Wellness Update is intended to provide a broad understanding and knowledge of healthcare topics. This information should not be used for self-diagnosis or in place of a visit, call, consultation, or advice from your physician or healthcare provider. We recommend you consult your physician when considering any changes to your healthcare regimen.
34 One in Five Surgical Weight-loss Patients Take Prescription Opioids Seven Years After Surgery
FEATURED ARTICLES
36 Whether It’s Caffeinated or Decaffeinated, Coffee is Associated with Lower Mortality, Which
12 Dealing with Drug Problems
37 For White Middle Class, Moderate Drinking is Linked to Cognitive Health in Old Age 38 Teens May Be Missing Vaccines Because Parents Aren’t Aware They Need One46 Exercise Is Good For Hearing
16 Understanding Hemochromatosis 22 Seeing Eye to Eye 26 Children, Headaches and Strokes 29 CDC Vital Signs: Native Americans with Diabetes
38 Antibiotics Are Not Always the Answer 40 MD Anderson Celebrates the Mission of Kick Butts Day 41 Study Finds Aspirin May Help Prevent Barrett’s Esophagus
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Pulmonary Fibrosis: How Doctors Treat You When Cause Is Unknown 5 possible treatments + risk factors By Lungs, Breathing and Allergy Team
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very day, the air you breathe contains smoke, dust and chemicals that can irritate and damage your lungs. For most people, the lungs do a good job of filtering out toxins and repairing themselves. But if you have idiopathic pulmonary fibrosis (IPF), your lungs don’t heal. Instead, they form scar tissue. Over time, the scar tissue builds up and makes breathing very difficult. IPF is a chronic, progressing lung disease. But you should know that you and your doctor can slow the disease down. Pulmonologist Daniel Culver, DO, discusses
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the basics of IPF, steps you can take to protect your lungs and your best treatment options.
What are risk factors of IPF?
Shortness of breath and a dry cough that lingers are the main symptoms of idiopathic pulmonary fibrosis, Dr. Culver says. The cause of the disease is unknown (idiopathic), but certain risk factors make the disease more likely in some people. You are at greater risk for this disease if you:
l Are (or were) a smoker l Have worked in a dusty environment l Are Caucasian l Are male l Are over age 40
“Most commonly we see idiopathic pulmonary fibrosis in the seventh and eighth decades of life,” Dr. Culver says. Viruses and acid reflux can also trigger the disease once it is present.
How can you slow disease progression?
IPF gets worse over time in at least 90 percent of patients, and there is no cure. However, there are steps you can take to slow things down. The best approaches to treating the disease focus on protecting your lungs against further damage and lightening their load, Dr. Culver says. Try these tips to help protect your lungs and slow disease progression: l If you smoke, do everything possible to
quit. l Avoid dusty environments. l If you have acid reflux, work to get it under control. l Take steps to avoid getting respiratory viruses.
What are possible treatments?
These four treatment options can help lighten the load on your lungs. Your doctor can help decide which are right for you.
1. 2.
Breathe easier with oxygen therapy. A mask or similar device delivers oxygen to your lungs. Treat your sleep apnea. If you have sleep apnea it hampers your breathing while you sleep. It can make your IPF worse.
3.
Take anti-scarring medications. These
drugs can help slow down the rate at which your lungs form scar tissue by about half.
4.
Try pulmonary rehabilitation. The goal of a rehabilitation program is to help you learn to breathe and function as well as possible with IPF and other chronic lung diseases. The program likely will focus on diet, exercise and education. If your doctor recommends pulmonary rehabilitation, make sure those who run the program have a lot of experience in treating lung diseases. Look for a program that treats a high volume of pulmonary patients, Dr. Culver says. For best results, choose a rehabilitation program that has educational and strength training components, too, he says.
Is a lung transplant a good option?
While it’s true that IPF is one of the main reasons for a lung transplant, it’s not an easy fix, Dr. Culver says. It’s difficult to go through a lung transplant. And you often end up trading one set of problems for another. “We only consider lung transplantation in cases of extremely advanced disease that is not responding well to other treatments,” he says. A good candidate for a transplant must: l Have good heart and kidney function l Not be obese l Not have underlying connective tissue
disease l Have a good social support system
If you have an IPF diagnosis, it’s important to take steps from now on to protect your lungs against further damage. Avoid smoke and other lung irritants as much as possible. Focus on protecting your lungs and work with your doctor to find the treatment options that are best for you. If you do that, you will be well on your way to breathing easier and enjoying a better quality of life.
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Turned Down for LASIK? Consider SMILE for Nearsightedness Learn about small-incision lenticular extraction
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By Family Health Team ost people have heard of LASIK, one of the most popular forms of laser vision correction. But have you heard about SMILE?
This procedure is similar to LASIK but also holds some distinct advantages — especially if you’re very nearsighted and need a high correction. Some people who aren’t candidates for LASIK can undergo SMILE.
SMILE vs. LASIK
SMILE stands for Small-Incision Lenticular Extraction. SMILE is similar to LASIK, or Laser-Assisted In Situ Keratomileusis. They both involve the use of a femtosecond laser (which does its work with ultrashort pulses), but SMILE creates a much smaller incision. During a SMILE procedure, the laser is used to create a lenticule, a disc-shaped piece of corneal tissue. The surgeon then removes this corneal tissue through a small incision using a special tool. Once this tissue is removed, it changes the curvature of the cornea to improve your vision. This method differs from LASIK, which involves creating a corneal flap that exposes the cornea so that the surgeon can reshape it with 6 www.awellnessupdate.com
the laser. Afterwards, the flap is put back into place to heal.
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Some of the most ideal SMILE candidates are the ones that require high nearsighted correction and have little or no astigmatism,” says ophthalmologist Ronald Krueger, MD.
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Changes in the cornea that might make someone a poor candidate for LASIK won’t prevent someone from having SMILE, he says. Dr. Krueger identifies a number of benefits of SMILE when compared with LASIK: l SMILE cuts fewer nerves on the surface of
the eye, which may reduce problems with dry eye after the procedure.
l The smaller incision makes the eye less
vulnerable to trauma.
l The procedure tends to involve faster
healing and less discomfort.
l SMILE can produce more accurate results
than LASIK for patients who need a high level of correction.
What happens during and after the procedure? SMILE starts with a local anesthetic, which the surgeon uses to numb the eye. “We couple a small suction ring to the surface of the eye, and then we link it to the laser. The suction holds the eye still during laser treatment,” explains Dr. Krueger. The surgeon then applies it to the cornea of the eye for about 30 seconds. “Once we remove the suction ring from the eye, we use a small instrument that allows us to separate the layers that we created and remove them through the incision,” he says. The procedure typically takes 20 to 30 minutes for each eye. LASIK tends to result in more immediate vision correction, but SMILE generally creates less discomfort and faster healing, given the smaller size of the incision. Most patients are able to resume all normal activities five days after the procedure.
Is SMILE a new procedure? It is relatively new in the United States.
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SMILE has been around since 2009 and has grown exponentially since then,” says Dr. Krueger. “It’s become very popular in Asia and in some places is becoming the preferred procedure.” Physicians have performed approximately 750,000 SMILE procedures worldwide so far, he says.
Harnessing Your Immune System to Treat Advanced Bladder Cancer Drug approval provides another tool if chemotherapy fails By Cancer Care Team
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our immune system helps you to fight off all kinds of ailments, including the common cold and the flu. But in recent years, immunotherapy — drugs that use your body’s immune system to kill diseases — has become an important tool for treating some types of cancer. And now, people with advanced bladder cancer have an immunotherapy option. Earlier this year, the Food and Drug Administration (FDA) approved a drug called atezolizumab, which is sold under the brand name Tecentriq, to treat the most common type of bladder cancer, called urothelial carcinoma. Atezolizumab is the first product in its class to receive FDA approval to treat this type of cancer, the FDA says.
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The drug targets a protein found on the body’s immune cells and some cancer cells. By blocking interactions between this and another protein, the drug may help the body’s immune system fight cancer cells.
Studies show that SMILE is just as safe as LASIK, Dr. Kreuger says. Talk to your doctor to learn about any possible risks associated with your particular vision problems, and to make sure the SMILE procedure is right for you.
A study of the drug showed that up to 28 percent of patients who received atezolizumab experienced complete or partial shrinking of their tumor. Response rates were greater in those who had a certain protein on their immune cells called PD-L1.
Is it safe?
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New paradigm
Urothelial carcinoma is the most common type of bladder cancer and occurs in the urinary tract system, and involves the bladder and related organs. Urothelial carcinoma can spread during or after certain chemotherapy treatments. Bladder cancer is the fourth most common cancer in men, and fifth most common overall. The National Cancer Institute (NCI) estimates 77,000 new cases of bladder cancer and 16,000 deaths from the disease in 2016. “This is definitely a breakthrough and it’s a new paradigm of treatment, particularly in the area of urothelial cancer,” says oncologist Petros Grivas, MD, PhD. Dr. Grivas is a paid consultant for the parent company of the drug.
A new tool
Until recently, there had been no treatment options for people with advanced bladder cancer if standard chemotherapy fails. The drug, which is given through an intravenous infusion every three weeks, gives doctors another tool and is changing the way advanced bladder cancer is treated, the FDA says. Doctors hope that the drug will help prolong life, delay cancer growth and contribute to an overall better quality of life. “This is not a cure or a panacea for bladder cancer, but it definitely adds significantly to the therapeutic medicines, techniques and equipment to treat the disease,” Dr. Grivas says. Other immunotherapy drugs such as pembrolizumab, nivolumab, durvalumab and avelumab are being tested in clinical trials, Dr. Grivas says, who is a paid consultant for most of the companies that produce these drugs. 8 www.awellnessupdate.com
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These drugs work in a similar way with what seems to be so far comparable effectiveness and tolerability that also may contribute to our treatment armamentarium for this challenging cancer,” Dr. Grivas says.
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For example, a clinical trial showed that pembrolizumab prolonged the lives of patients with advanced urothelial cancer when compared to second-line chemotherapy after disease progression on prior chemotherapy. Additional research is necessary to identify who will benefit most from the new treatments and to see if they work in earlier disease settings, Dr. Grivas says.
Achalasia: Are You at Risk for This Rare Swallowing Disorder? Trouble swallowing can have various causes By Heart and Vascular Team
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o you sometimes struggle to swallow your food when you eat? Does it feel like it just gets stuck on the way down? If this happens more than occasionally, you should talk to your doctor. Instead, they form scar tissue. Over time, the scar tissue builds up and makes breathing very difficult. IPF is a chronic, progressing lung disease. But you should know that you and your doctor can slow the disease down. Trouble swallowing can be related to common problems, such as gastroesophageal reflux disease (GERD). Or it can be related to a rare, but more serious swallowing disorder called achalasia. The first symptoms of achalasia are often subtle. Maybe you’re chewing a piece of bread and you find that you need a gulp or two of water to get the food down. You might dismiss the problem at first. But then it becomes increasingly difficult to swallow food and even to drink liquids.
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Patients often feel as if it is a sudden onset. But achalasia is a slow and progressive swallowing disorder that patients only recognize at later stages,” says Sudish Murthy, MD, Section Head of Thoracic Surgery and Surgical Director of the Center of Major Airway Disease at Cleveland Clinic.
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The problem is with your esophagus, the muscular tube that connects your throat to your stomach. Dr. Murthy answers four
questions to explain what you need to know about achalasia.
What’s happening in your body if you have achalasia? Achalasia occurs when the muscle at the lower end of the esophagus (the lower esophageal sphincter) fails to relax when you swallow. This prevents the food from entering your stomach. The food then backs up, and you begin to notice symptoms such as: l Difficulty swallowing l Vomiting undigested food l Chest pain l Heartburn l Weight loss
Who is at risk?
It’s difficult to predict who is at risk for achalasia. It’s a relatively rare condition. It affects about 3,000 adults and children in the United
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States each year. It seems to occur randomly across races and ethnic groups, and does not run in families.
“
It cuts across the spectrum of ages, with a concentration in middle-age people,” Dr. Murthy says.
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What causes this problem?
“This is one of those diseases for which the cause is largely unknown, with significant conjecture and hypothesis,” Dr. Murthy says. One theory is that the disease relates to a viral infection. The infection may damage the nerves that allow the lower esophageal sphincter to relax. The immune system may attack these nerves, which then slowly degenerate.
How do doctors treat achalasia?
food to pass through. This technique, which requires only five small incisions, is often the best option, he says. l Peroral endoscopic myotomy (POEM).
This innovative procedure involves cutting the muscles from inside the esophagus. It takes between one and three hours, Dr. Murthy says l Botulinum toxin (Botox®) injections.
These are often used to treat older patients or those who shouldn’t risk surgery. The injections can relax the lower esophageal muscles and keep them from contracting. They offer a temporary fix, and are sometimes repeated. l Endoscopic balloon dilation. This is a
temporary treatment which disrupts the muscles and widens the opening to allow food to enter the stomach. Whatever your treatment, you should follow up with your doctor at least once each year, Dr. Murthy says.
We can’t cure achalasia, but we can control its symptoms, Dr. Murthy says. There are several treatment options.
“Often these interventions can palliate the disease for a lengthy amount of time, but the view needs to be long-term,” he says.
Medication can help relax the lower esophageal sphincter, but this treatment has only marginal success, he says.
Can achalasia cause cancer?
Most patients with achalasia undergo a procedure or surgery. The most common options include: l Heller myotomy. In this minimally
invasive operation, the surgeon cuts the muscles of the valve between the esophagus and the stomach. This allows 10 www.awellnessupdate.com
People with achalasia have a slight increased risk of developing esophageal cancer, particularly if the obstruction has been a problem for a long time. Difficulty swallowing is a symptom of both achalasia and esophageal cancer, so your doctor will rule out cancer before treating your achalasia, Dr. Murthy says.
RECIPE:
Sautéed Spinach and Tomatoes Over Roasted Spaghetti Squash
Skip the pasta and enjoy this tasty, gluten-free dish By Mark Hyman, MD
Spaghetti squash is a great option to satisfy cravings for pasta without sabotaging your health goals. This crunchy, pasta-like vegetable paired with spinach, tomatoes and pine nuts is a wonderful, comforting meal that is sure to please any crowd. INGREDIENTS
INSTRUCTIONS
1 large spaghetti squash, halved and seeded
1. Preheat the oven to 350°F.
1 tablespoon extra-virgin olive oil, divided Sea salt and freshly ground black pepper, to taste 1/2 cup pine nuts 8 garlic cloves, finely chopped 1 pound grape tomatoes, halved 8 ounces baby spinach 10 fresh basil leaves, finely sliced
2. Brush each half of the squash with 1 teaspoon of the oil and season generously with salt and black pepper. Place the squash, cut sides down, on a baking sheet and roast for 30 to 40 minutes. The squash is cooked when a knife easily pierces through the skin and flesh. Remove from oven and let cool enough to handle, shred the flesh with a fork into spaghetti-like threads and set aside. 3. Turn the oven up to 400°F. 4. Spread the pine nuts on a small baking sheet and place them in the oven to toast until golden brown, 3 to 5 minutes, checking often to prevent browning.
5. Heat the remaining 2 teaspoons of oil in a large sauté pan over medium heat. When the oil shimmers, add the garlic to the pan and cook, stirring constantly, for 2 to 3 minutes. 6. Add the tomatoes to the pan, season to taste with salt and black pepper and cook until the tomatoes begin to burst, 5 to 6 minutes. 7. Add the spinach to the pan and season to taste with salt and black pepper. Cook, stirring until the spinach wilts, 3 to 4 minutes. 8. Divide the spaghetti squash among 4 plates and top with the sautéed spinach and tomatoes. Sprinkle on the pine nuts and fresh basil. Serve immediately. Any leftovers can be covered in an air-tight container and refrigerated for up to 4 days.
NUTRITION INFORMATION Calories 254 Fat 17 g Saturated fat 2 g Cholesterol 0 mg Fiber 5 g Protein 8 g Carbohydrate 25 g Sodium 128 mg
DEALING with Drug Problems Preventing and Treating Drug Abuse
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rug abuse can be a painful experience—for the person who has the problem, and for family and friends who may feel helpless in the face of the disease. But there are things you can do if you know or suspect that someone close to you has a drug problem. Certain drugs can change the structure and inner workings of the brain. With repeated use, they affect a person’s self-control and interfere with the ability to resist the urge to take the drug. Not being able to stop taking a drug even though you know it’s harmful is the hallmark of addiction. A drug doesn’t have to be illegal to cause this effect. People can become addicted to alcohol, nicotine, or even prescription drugs when they use them in ways other than prescribed or use someone else’s prescription. People are particularly vulnerable to using drugs when going through major life transitions. For adults, this might mean during a divorce or after losing a job. For children and teens, this can mean changing schools or other major upheavals in their lives. But kids may experiment with drug use for many different reasons. “It could be a greater availability of drugs in a school with older students, or it could be that social activities are changing, or that they are trying to deal with stress,” says Dr. Bethany Deeds, an NIH expert on drug abuse prevention. Parents may need
to pay more attention to their children during these periods. The teenage years are a critical time to prevent drug use. Trying drugs as a teenager increases your chance of developing substance use disorders. The earlier the age of first use, the higher the risk of later addiction. But addiction also happens to adults. Adults are at increased risk of addiction when they encounter prescription pain-relieving drugs after a surgery or because of a chronic pain problem. People with a history of addiction should be particularly careful with opioid pain relievers and make sure to tell their doctors about past drug use. There are many signs that may indicate a loved one is having a problem with drugs. They might lose interest in things that they used to enjoy or start to isolate themselves. Teens’ grades may drop. They may start skipping classes.
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They may violate curfew or appear irritable, sedated, or disheveled,” says child psychiatrist Dr. Geetha Subramaniam, an NIH expert on substance use. Parents may also come across drug paraphernalia, such as water pipes or needles, or notice a strange smell. “Once drug use progresses, it becomes less of a social thing and more of a compulsive thing—which means the person spends a lot of time using drugs,” Subramaniam says.
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If a loved one is using drugs, encourage them to talk to their primary care doctor. It can be easier to have this conversation with a doctor than a family member. Not all drug treatment requires long stays in residential treatment centers. For someone in the early stages of a substance use problem, a conversation with a doctor or another professional may be enough to get them the help they need. Doctors can help the person think about their drug use, understand the risk for addiction, and come up with a plan for change. Substance use disorder can often be treated on an outpatient basis. But that doesn’t mean it’s easy to treat. Substance use disorder is a complicated disease. Drugs can cause changes in the brain that make it extremely difficult to quit without medical help. For certain substances, it can be dangerous to stop the drug without medical intervention. Some people may need to be in a hospital for a short time for detoxification, when the drug leaves their body. This can help keep them as safe and comfortable as possible. Patients should talk with their doctors about medications that treat addiction to alcohol or opioids, such as heroin and prescription pain relievers. Recovering from a substance use disorder requires retraining the brain. A person who’s been addicted to drugs will have to relearn all sorts of things, from what to do when they’re bored to who to hang out with. NIH has developed a customizable wallet card to help people identify and learn to avoid their triggers, the things that make them feel like using drugs. You can order the card for free at https://drugpubs.drugabuse. gov/publications/drugs-brain-wallet-card.
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You have to learn ways to deal with triggers, learn about negative peers, learn about relapse, [and] learn coping skills,” Subramaniam says.
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NIH-funded scientists are studying ways to stop addiction long before it starts—in childhood. Dr. Daniel Shaw at the University of Pittsburgh is looking at whether teaching healthy caregiving strategies to parents can help promote self-regulation skills in children and prevent substance abuse later on. Starting when children are two years old, Shaw’s study enrolls families at risk of substance use problems in a program called the Family Check-Up. It’s one of several parenting programs that have been studied by NIH-funded researchers. During the program, a parenting consultant visits the home to observe the parents’ relationship with their child. Parents complete several questionnaires about their own and their family’s well-being. This includes any behavior problems they are experiencing with their child. Parents learn which of their children’s problem behaviors might lead to more serious issues, such as substance abuse, down the road. The consultant also talks with the parents about possible ways to change how they interact with their child. Many parents then meet with the consultants for follow-up sessions about how to improve their parenting skills. Children whose parents are in the program have fewer behavioral problems and do better when they get to school. Shaw and his colleagues are now following these children through their teenage years to see how the program affects their chances of developing a substance abuse problem. You can find video clips explaining different ways parents can respond to their teens on the NIH Family Checkup website athttps://www.drugabuse. gov/family-checkup. Even if their teen has already started using drugs, parents can still step in. They can keep closer tabs on who their children’s friends are and what they’re doing. Parents can also help by finding new activities that will introduce
their children to new friends and fill up the after-school hours—prime time for getting into trouble. “They don’t like it at first,” Shaw says. But finding other teens with similar interests can help teens form new habits and put them on a healthier path.
pressure. Even relapse can be a normal part of the process—not a sign of failure, but a sign that the treatment needs to be adjusted. With good care, people who have substance use disorders can live healthy, productive lives. —Source: NIH News in Health, June 2017, published by
A substance use problem is a chronic disease that requires lifestyle adjustments and longterm treatment, like diabetes or high blood
the National Institutes of Health and the Department of Health and Human Services. For more information go to www.newsinhealth.nih.gov
WISE CHOICES SIGNS TO LOOK FOR
People with drug problems may act differently than they used to. They might:
l spend a lot of time alone l lose interest in their favorite things l get messy—for instance, not bathe, change clothes, or brush their teeth
l be really tired and sad l be very energetic, talk fast, or say things that don’t make sense
l be nervous or cranky (in a bad mood) l quickly change between feeling bad and feeling good l sleep at strange hours l miss important appointments l have problems at work l eat a lot more or a lot less than usual
Ask Your Doctor
Questions to ask when choosing a treatment program: l Does the program use treatments backed by scientific evidence? Effective programs usually combine medical and behavioral treatments. l Does the program tailor treatment to the needs of each patient? No single treatment is right for everyone. l Does the program adapt treatment as the patient’s needs change? A person in treatment may need different services at different times. l Is the length of treatment sufficient? Most addicted people need at least three months in treatment.
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Understanding Hemochromatosis WHAT IS HEMOCHROMATOSIS? Hemochromatosis is the most common form of iron overload disease. Too much iron in the body causes hemochromatosis. Iron is important because it is part of hemoglobin, a molecule in the blood that transports oxygen from the lungs to all body tissues. However, too much iron in the body leads to iron overload—a buildup of extra iron that, without treatment, can damage organs such as the liver, heart, and pancreas; endocrine glands; and joints. The three types of hemochromatosis are primary hemochromatosis, also called hereditary hemochromatosis; secondary hemochromatosis; and neonatal hemochromatosis. 16 www.awellnessupdate.com
WHAT CAUSES HEMOCHROMATOSIS? Primary Hemochromatosis
Inherited genetic defects cause primary hemochromatosis, and mutations in the HFE gene are associated with up to 90 percent of cases.1 The HFE gene helps regulate the amount of iron absorbed from food. The two known mutations of HFE are C282Y and H63D. C282Y defects are the most common cause of primary hemochromatosis. People inherit two copies of the HFE gene— one copy from each parent. Most people who inherit two copies of the HFE gene with the C282Y defect will have higher-than-average iron absorption. However, not all of these people will develop health problems associated with
hemochromatosis. One recent study found that 31 percent of people with two copies of the C282Y defect developed health problems by their early fifties.2 Men who develop health problems from HFE defects typically develop them after age 40.1 Women who develop health problems from HFE defects typically develop them after menopause.1 People who inherit two H63D defects or one C282Y and one H63D defect may have higher-than-average iron absorption.3 However, they are unlikely to develop iron overload and organ damage. Rare defects in other genes may also cause primary hemochromatosis. Mutations in the hemojuvelin or hepcidin genes cause juvenile hemochromatosis, a type of primary hemochromatosis. People with juvenile hemochromatosis typically develop severe iron overload and liver and heart damage between ages 15 and 30.
Secondary Hemochromatosis
Hemochromatosis that is not inherited is called secondary hemochromatosis. The most common cause of secondary hemochromatosis is frequent blood transfusions in people with severe anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which means they carry less oxygen to the body’s cells. Types of anemia that may require frequent blood transfusions include:
l congenital, or inherited, anemias such as sickle cell disease, thalassemia, and Fanconi’s syndrome l severe acquired anemias, which are not inherited, such as aplastic anemia and autoimmune hemolytic anemia Liver diseases—such as alcoholic liver disease, nonalcoholic steatohepatitis, and chronic hepatitis C infection—may cause mild iron overload. However, this iron overload causes much less liver damage than the underlying liver disease causes.
Neonatal Hemochromatosis
Neonatal hemochromatosis is a rare disease characterized by liver failure and death in fetuses and newborns. Researchers are studying the causes of neonatal hemochromatosis and believe more than one factor may lead to the disease. Experts previously considered neonatal hemochromatosis a type of primary hemochromatosis. However, recent studies suggest genetic defects that increase iron absorption do not cause this disease. Instead, the mother’s immune system may produce antibodies—proteins made by the immune system to protect the body from foreign substances such as bacteria or viruses— that damage the liver of the fetus. Women who have had one child with neonatal hemochromatosis are at risk for having more children with the disease.4 Treating these women during pregnancy with intravenous (IV) immunoglobulin—a solution of antibodies from healthy people—can prevent fetal liver damage.4 Researchers supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recently found that a combination of exchange transfusion—removing blood and replacing it with donor blood—and IV immunoglobulin is an effective treatment for babies born with neonatal hemochromatosis.5
WHO IS MORE LIKELY TO DEVELOP HEMOCHROMATOSIS? Primary hemochromatosis mainly affects Caucasians of Northern European descent. This disease is one of the most common genetic disorders in the United States. About four to five out of every 1,000 Caucasians carry two copies of the C282Y mutation of the HFE gene and are susceptible to developing hemochromatosis.1 About one out of every 10 Caucasians carries one copy of C282Y.1 Hemochromatosis is extremely rare in African Americans, Asian Americans, Hispanics/
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Latinos, and American Indians. HFE mutations are usually not the cause of hemochromatosis in these populations. Both men and women can inherit the gene defects for hemochromatosis; however, not all will develop the symptoms of hemochromatosis. Men usually develop symptoms at a younger age than women. Women lose blood—which contains iron— regularly during menstruation; therefore, women with the gene defects that cause hemochromatosis may not develop iron overload and related symptoms and complications until after menopause.
WHO IS MORE LIKELY TO DEVELOP HEMOCHROMATOSIS? A person with hemochromatosis may notice one or more of the following symptoms: l joint pain l fatigue, or feeling tired l unexplained weight loss 18 www.awellnessupdate.com
l abnormal bronze or gray skin color l abdominal pain l loss of sex drive Not everyone with hemochromatosis will develop these symptoms.
WHAT ARE THE COMPLICATIONS OF HEMOCHROMATOSIS? Without treatment, iron may build up in the organs and cause complications, including: l cirrhosis, or scarring of liver tissue l diabetes l irregular heart rhythms or weakening of the heart muscle l arthritis l erectile dysfunction The complication most often associated with hemochromatosis is liver damage. Iron buildup in the liver causes cirrhosis, which increases the chance of developing liver cancer.
For some people, complications may be the first sign of hemochromatosis. However, not everyone with hemochromatosis will develop complications.
HOW IS HEMOCHROMATOSIS DIAGNOSED? Health care providers use medical and family history, a physical exam, and routine blood tests to diagnose hemochromatosis or other conditions that could cause the same symptoms or complications.
l Medical and family history. Taking a medical and family history is one of the first things a health care provider may do to help diagnose hemochromatosis. The health care provider will look for clues that may indicate hemochromatosis, such as a family history of arthritis or unexplained liver disease.
l Physical exam. After taking a medical history, a health care provider will perform a physical exam, which may help diagnose hemochromatosis. During a physical exam, a health care provider usually l examines a patient’s body l uses a stethoscope to listen to bodily sounds l taps on specific areas of the patient’s body
l Blood tests. A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. Blood tests can determine whether the amount of iron stored in the body is higher than normal: l The transferrin saturation test shows how much iron is bound to the protein that carries iron in the blood. Transferrin saturation values above or equal to 45 percent are considered abnormal.
l The serum ferritin test detects the amount of ferritin—a protein that stores iron—in the blood. Levels above 300 μg/L in men and 200 μg/L in women are considered abnormal. Levels above 1,000 μg/L in men or women indicate a high chance of iron overload and organ damage. If either test shows higher-than-average levels of iron in the body, health care providers can order a special blood test that can detect two copies of the C282Y mutation to confirm the diagnosis. If the mutation is not present, health care providers will look for other causes.
l Liver biopsy. Health care providers may perform a liver biopsy, a procedure that involves taking a piece of liver tissue for examination with a microscope for signs of damage or disease. The health care provider may ask the patient to temporarily stop taking certain medications before the liver biopsy. The health care provider may ask the patient to fast for 8 hours before the procedure. During the procedure, the patient lies on a table, right hand resting above the head. The health care provider applies a local anesthetic to the area where he or she will insert the biopsy needle. If needed, a health care provider will also give sedatives and pain medication. The health care provider uses a needle to take a small piece of liver tissue. He or she may use ultrasound, computerized tomography scans, or other imaging techniques to guide the needle. After the biopsy, the patient must lie on the right side for up to 2 hours and is monitored an additional 2 to 4 hours before being sent home. A health care provider performs a liver biopsy at a hospital or an outpatient center. The health care provider sends the liver sample to a pathology lab where the pathologist—a doctor who specializes in diagnosing dis-
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ease—looks at the tissue with a microscope and sends a report to the patient’s health care provider. The biopsy shows how much iron has accumulated in the liver and whether the patient has liver damage. Hemochromatosis is rare, and health care providers may not think to test for this disease. Thus, the disease is often not diagnosed or treated. The initial symptoms can be diverse, vague, and similar to the symptoms of many other diseases. Health care providers may focus on the symptoms and complications caused by hemochromatosis rather than on the underlying iron overload. However, if a health care provider diagnoses and treats the iron overload caused by hemochromatosis before organ damage has occurred, a person can live a normal, healthy life.
WHO SHOULD BE TESTED FOR HEMOCHROMATOSIS? Experts recommend testing for hemochromatosis in people who have symptoms, complications, or a family history of the disease. Some researchers have suggested widespread screening for the C282Y mutation in the general population. However, screening is not cost-effective. Although the C282Y mutation occurs quite frequently, the disease caused by the mutation is rare, and many people with two copies of the mutation never develop iron overload or organ damage. Researchers and public health officials suggest the following:
l Siblings of people who have hemochromatosis should have their blood tested to see if they have the C282Y mutation. l Parents, children, and other close relatives of people who have hemochromatosis should consider being tested. l Health care providers should consider testing people who have severe and 20 www.awellnessupdate.com
continuing fatigue, unexplained cirrhosis, joint pain or arthritis, heart problems, erectile dysfunction, or diabetes because these health issues may result from hemochromatosis.
HOW IS HEMOCHROMATOSIS TREATED? Health care providers treat hemochromatosis by drawing blood. This process is called phlebotomy. Phlebotomy rids the body of extra iron. This treatment is simple, inexpensive, and safe. Based on the severity of the iron overload, a patient will have phlebotomy to remove a pint of blood once or twice a week for several months to a year, and occasionally longer. Health care providers will test serum ferritin levels periodically to monitor iron levels. The goal is to bring serum ferritin levels to the low end of the average range and keep them there. Depending on the lab, the level is 25 to 50 μg/L. After phlebotomy reduces serum ferritin levels to the desired level, patients may need maintenance phlebotomy treatment every few months. Some patients may need phlebotomies more often. Serum ferritin tests every 6 months or once a year will help determine how often a patient should have blood drawn. Many blood donation centers provide free phlebotomy treatment for people with hemochromatosis. Treating hemochromatosis before organs are damaged can prevent complications such as cirrhosis, heart problems, arthritis, and diabetes. Treatment cannot cure these conditions in patients who already have them at diagnosis. However, treatment will help most of these conditions improve. The treatment’s effectiveness depends on the degree of organ damage. For example, treating hemochromatosis can stop the progression of liver damage in its early stages and lead to a normal life expectancy. However, if a patient develops cirrhosis, his or
her chance of developing liver cancer increases, even with phlebotomy treatment. Arthritis usually does not improve even after phlebotomy removes extra iron.
l A person with
hemochromatosis may notice one or more of the following symptoms: joint pain; fatigue, or feeling tired; unexplained weight loss; abnormal bronze or gray skin color; abdominal pain; and loss of sex drive. Not everyone with hemochromatosis will develop these symptoms.
EATING, DIET, AND NUTRITION Iron is an essential nutrient found in many foods. People with hemochromatosis absorb much more iron from the food they eat compared with healthy people. People with hemochromatosis can help prevent iron overload by:
l eating only moderate amounts of iron-rich foods, such as red meat and organ meat
l avoiding supplements that contain iron l avoiding supplements that contain
l Without treatment, iron may build up
in the organs and cause complications, including cirrhosis, diabetes, irregular heart rhythms or weakening of the heart muscle, arthritis, and erectile dysfunction.
vitamin C, which increases iron absorption People with hemochromatosis can take steps to help prevent liver damage, including:
l If a health care provider diagnoses and
treats the iron overload caused by hemochromatosis before organ damage has occurred, a person can live a normal, healthy life.
l limiting the amount of alcoholic beverages they drink because alcohol increases their chance of cirrhosis and liver cancer l avoiding alcoholic beverages entirely if they already have cirrhosis
POINTS TO REMEMBER l Hemochromatosis is the most common
l Experts recommend testing for hemochromatosis in people who have symptoms, complications, or a family history of the disease.
l Health care providers treat hemochro-
matosis by drawing blood. This process is called phlebotomy.
form of iron overload disease. Too much iron in the body causes hemochromatosis.
l Inherited genetic defects cause primary hemochromatosis.
l Primary hemochromatosis mainly affects
Caucasians of Northern European descent.
—This information provided courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.
REFERENCES
[1] Bacon BR, Adams PC, Kowdley KV, Powell LW, Tavill AS. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54(1):328–343.
[2] Aguilar-Martinez P, Bismuth M, Blanc F, et al. The Southern French registry of genetic hemochromatosis: a tool for determining clinical prevalence of the disorder and genotype penetrance. Haematologica. 2010;95(4):551–556. [3] Aranda N, Viteri FE, Montserrat C, Arija V. Effects of C282Y, H63D, and S65C HFE gene mutations, diet, and life-style factors on iron status in the general Mediterranean population from Tarragona, Spain. Annals of Hematology. 2010;89(8):767–773.
[4] Whitington PF, Kelly S. Outcome of pregnancies at risk for neonatal hemochromatosis is improved by treatment with high-dose intravenous immunoglobulin. Pediatrics. 2008;121(6):e1615–e1621.
[5] Rand EB, Karpen SJ, Kelly S, et al. Treatment of neonatal hemochromatosis with exchange transfusion and intravenous immunoglobulin. The Journal of Pediatrics. 2009;155(4):566–571.
THE NIDDK WOULD LIKE TO THANK:
Bruce R. Bacon, M.D., St. Louis University School of Medicine, Anthony Tavill, M.D., Case Western Reserve University School of Medicine; Kris Kowdley, M.D., Virginia Mason Medical Center
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SEEING EYE TO EYE Clear doctor-patient communication leads to better eye care
C
ompare a patient’s self-reported eye symptoms with his or her electronic medical record, and clear discrepancies can be seen.
A study from the University of Michigan Kellogg Eye Center revealed wide disparities in the content of pre-appointment patient questionnaires and what a clinician wrote down to document the visit. “We found pretty noticeable differences between the two,” says Maria Woodward, M.D., M.S., an assistant professor of ophthalmology and visual sciences at U-M. “I think certainly the biggest takeaway is when people are presented things in different ways, they tell you different things.”
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The study, published Jan. 26 in JAMA Ophthalmology, analyzed the symptoms of 162 Kellogg patients. Each completed a 10-point survey while waiting to see a physician; questions came from sources including the National Institutes of Health Toolbox. The doctors treating these patients weren’t told about the surveys, or that their recordkeeping would be reviewed for comparison. The contrast was stark: Of the study’s group, “exact agreement” between an individual’s survey and what appeared on his or her medical record occurred in only 38 patients. “The concern highlighted by this research is
that important symptoms may be overlooked. If a patient has severe symptoms, all of those symptoms should be documented and addressed.”
A NEED FOR FOCUS Symptom reporting drove the inconsistencies between surveys and medical records, the study found. The top discordant issue: glare. Of patients reporting concern about glare on their surveys, 91 percent didn’t have it on their medical records. Eye redness was second-most common (80 percent had no medical record mention), followed by eye pain (74.4 percent). Blurry vision was the only symptom to tilt the scales — with more instances of inclusion in medical records than in questionnaires. As a result, other doctors treating the same patient in future visits could have an incomplete picture of the patient’s symptoms. Perhaps riskier: Because digital medical records are increasingly used to guide clinical practice and research, the collective data may be shortsighted or misleading in some scenarios, Woodward says.
“
Many parties in health care use the electronic health records now, and they expect the data to accurately reflect the interaction with the doctor,” says Woodward, also a member of the Institute for Healthcare Policy and Innovation(link is external).
_____
Explanations for the doctor-patient disconnect on medical records are understandable, she adds, with neither party at fault. The doctor-patient relationship is more nuanced than what is reflected in the medical record. Patients might not choose to mention all of their symp-
toms. Doctor dialogue may follow a conversational path versus a point-by-point checklist. Time constraints of record-keeping in the electronic chart can also be an issue. And not every detail of an appointment — particularly minor concerns — is necessarily worth documenting. Still, notes Woodward: “The concern highlighted by this research is that important symptoms may be overlooked. If a patient has severe symptoms, all of those symptoms should be documented and addressed.”
GAINING GREATER CLARITY The study highlights an opportunity to improve lines of communication between patients and doctors. For example, implementing pre-appointment eye symptom questionnaires similar to those in the study could be simple and effective, Woodward says. A similar pilot program is underway in her clinic. “This is definitely a pathway I see as very feasible to resolving this disconnect in the near future; the infrastructure is already there,” she says. The concept also could help bring more clarity to what ends up on a patient’s medical record. Because the surveys Woodward and her team used asked participants to assess the severity of their conditions on a numeric scale, results could help practitioners better evaluate the depth of a patient’s symptoms — and even identify concerns that might have gone unnoticed. The use of a self-report system before seeing the doctor could “really change the conversation between the doctor and the patient,” says Woodward. Rather than spending time to identify symptoms, doctors and patients could be talking about how to manage severe symptoms. —This information provided courtesy of the University of Michigan Medicine
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WHAT IS... Picture this...you’re sitting on the couch, watching TV or looking through a magazine when you come across an advertisement touting the latest and greatest medication or product that will help you combat some illness or disease you’ve never heard of. This leads to questions you can’t answer. Should I be taking this medication? What are the symptoms? Do I need to talk to my doctor? What exactly is this illness? Welcome to our latest column. In our quest to keep you, our readers, informed and educated we look to answer common questions to the not so common issues in the medical community. Here you will find basic insight to some of those nagging questions you have in your pursuit of a healthy lifestyle. This month we will discuss…
Group B strep
Group B strep (streptococcus) is a common type of bacterium is carried in the intestinal or genital tract. This bacteria can cause serious illness in newborns. While usually harmless in healthy adults, it can be dangerous in adults who are older, immunocompromised, or have chronic conditions like liver disease or diabetes.
Many healthy people carry group B strep bacteria in their bodies. Group B strep bacteria are not sexually transmitted, and does not spread through food or water. Group B strep can be carried in your body for just a short period of time, it may come and go, or you may always have it. Illness caused by group B strep in infants usually have symptoms that include fever, trouble feeding and lethargy. Adults who are at risk may get a urinary tract 24 www.awellnessupdate.com
or blood infection, or pneumonia. Diagnosis of group B strep infection and group B strep disease occur when the bacteria are grown from cultures of fluid samples. These cultures can take several days to grow. Common treatment for group B strep is antibiotics. If you have tested positive during pregnancy, intravenous (IV) antibiotics will be given when labor begins. A baby which tests positive for group B strep, will be given IV antibiotics. Sometimes, IV fluids, oxygen or other medications, may be needed as well. Antibiotics are also an effective treatment for group B strep infection in adults.
l In the United States, group B strep bacteria are the leading cause of meningitis (infection of the fluid and lining around the brain) and sepsis (the body’s life-threatening response to infection) in a newborn’s first week of life (early-onset disease).
l About 1 out of every 4 pregnant women carry group B strep bacteria in the rectum or vagina. Group B strep bacteria may come and go in people’s bodies without symptoms.
l Pregnant woman should be tested for group B strep bacteria when they are 35 to 37 weeks pregnant.
l A pregnant woman who tests positive for group B strep bacteria and gets antibiotics during labor has only a 1 in 4,000 chance of delivering a baby who will develop group B strep disease, compared to a 1 in 200 chance if she does not.
l Any pregnant woman who had a baby
with group B strep disease in the past, or who has had group B strep in their urine during this pregnancy caused by group B strep should get antibiotics during labor.
l Most early-onset group B strep disease in newborns can be prevented by giving pregnant women antibiotics (medicine that kills bacteria in the body) through the vein (IV) during labor.
l Newborns are at increased risk for a group B strep disease if their mother tests positive for group B strep bacteria during pregnancy.
l The antibiotics used to prevent early-onset group B strep disease in newborns only help during labor — they can’t be taken before labor, because the bacteria can grow back quickly.
l The rate of serious group B strep disease increases with age; average age of cases in non-pregnant adults is about 60 years old.
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CHILDREN, Headaches and Strokes Children are far more likely than adults to get headaches when having a stroke, a new study suggests.
26 www.awellnessupdate.com
T
he findings, presented Wednesday at the American Stroke Association’s International Stroke Conference 2017, showed that 6 percent of children under age 3 and 46 percent of those 3 or older reported headaches — far higher than the estimated percent of adults who experience headache with an ischemic stroke.
“
Stroke should be considered as a possible diagnosis in any child with a headache and additional symptoms of weakness or numbness (in the face, arm or leg) or changes in walking, talking or vision,” said Lori L. Billinghurst, M.D., M.Sc., clinical assistant professor of neurology at the University of Pennsylvania in Philadelphia. “Urgent brain imaging may be required to distinguish a migraine with aura from a stroke.”
_____
Researchers examined whether headache was documented at the onset of clot-caused ischemic stroke in 355 children 29 days to 18 years old enrolled in the multi-center Vascular Effects of Infection in Pediatric Stroke. Younger children may not have been able to communicate if they were having a headache, researchers noted. Abnormalities in the blood vessel walls are a major reason for stroke in children, but the presence of headache didn’t distinguish between children with strokes related to artery abnormalities from others.
stroke, there were significant differences depending on the type of abnormality. Headache occurred in 70 percent of children with stroke caused by a blood vessel tear (dissection); 70 percent of those with nonprogressive narrowing of the blood vessels (transient arteriopathy of childhood); 12 percent of children with moyamoya disease, a rare cause of progressive blood vessel blockage at the base of the brain; and 43 percent of those with inflammation in blood vessel walls occurring after infection, cancer or other medical conditions. “It is possible that younger brains have blood vessels that are more easily distended and more likely to activate pain sensors that trigger headache,” Billinghurst said. “It is also possible that inflammation — a powerful activator of pain sensors — may be more important in the processes underlying stroke in children than in adults. “We will be doing further work to see if there are differences in blood markers of inflammation in those with and without headache at time of stroke.” Although headache was most common in stroke related to blood vessel tears or narrowing, the numbers in the study were too small to suggest that doctors use the presence of headache to determine the stroke cause, Billinghurst said.
Among children 3 years or older, 50 percent of those with definite artery abnormalities related ischemic stroke had headaches; 3 percent of those with possible artery abnormalities related ischemic stroke; and 51 percent with no artery abnormalities related ischemic stroke.
“We would like to conduct a study of children who enter hospital emergency rooms with headache and suspected stroke to see whether there are characteristics of the headache or other neurologic symptoms that predict whether a stroke will be confirmed on imaging,” she said. “We would like to develop a predictive formula that can help physicians diagnose stroke more rapidly and enable earlier, perhaps lifesaving stroke treatments.”
However, of the 92 strokes in children with definite artery abnormalities related ischemic
—This information provided courtesy of AMERICAN HEART ASSOCIATION NEWS
www.awellnessupdate.com 27
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Native Americans with diabetes
Better diabetes care can decrease kidney failure Native Americans (American Indians and Alaska Natives) have a greater chance of having diabetes than any other US racial group. Diabetes is the leading cause of kidney failure, a costly condition that requires dialysis or kidney transplant for survival. Kidney failure can be delayed or prevented by controlling blood pressure and blood sugar and by taking medicines that protect the kidneys. Good diabetes care includes regular kidney testing and education about kidney disease and treatment. Kidney failure from diabetes among Native Americans was the highest of any race. However, this has declined the fastest since the Indian Health Service (IHS) began using population health and team-based approaches to diabetes and kidney care, a potential model for other populations.
Health care systems can: â– Use population health approaches to diabetes care. Assess long-term outcomes and address disparities. Promote wellness of the entire community and connect people to local resources, including healthy food, transportation, housing, and mental health care. â– Develop a coordinated team approach to diabetes care. Team based-care should include patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.
2X
Native Americans are twice as likely as whites to have diabetes.
2 in 3
In about 2 out of 3 Native Americans with kidney failure, diabetes is the cause.
54%
Kidney failure from diabetes dropped by 54% in Native Americans between 1996 and 2013.
â– Integrate kidney disease prevention and education into routine diabetes care. Screen people with diabetes for kidney disease and make sure that kidney disease is routinely addressed as part of diabetes care.
Want to learn more? www.cdc.gov/vitalsigns/aian-diabetes
www.awellnessupdate.com 29
Problem: Kidney failure from diabetes was highest among Native Americans. Native Americans are more likely to have diabetes.
■ Native Americans with diabetes have had important improvements:
■ Native Americans are twice as likely as whites to have been diagnosed with diabetes.
`` Use of medicines to protect kidneys increased from
Native Americans were more likely to have kidney failure from diabetes than other races until recently.
`` Average blood pressure in those with hypertension was
■ Native Americans were nearly 5 times more likely than whites to have kidney failure from diabetes in 1996.
`` Blood sugar control improved by 10%.
■ Reasons include: high blood sugar, high blood pressure, and significant barriers to health care.
Diabetes-related kidney failure among Native Americans decreased by 54% from 1996 to 2013. ■ The Indian Health Service uses population health and team-based approaches to diabetes and kidney care.
42% to 74% in 5 years. well-controlled (133/76 mmHg). `` Kidney testing in those 65 and older was 50% higher compared
to the Medicare diabetes population.
Kidney failure is a disabling and expensive complication of diabetes throughout the US. ■ Medical costs for kidney failure from diabetes were about $82,000 per person in 2013. ■ Medicare spent $14 billion to treat people with kidney failure from diabetes in 2013.
Team-based and population approaches reduce kidney failure from diabetes in Native Americans: can be a model for other groups. Native American adults have more diabetes than any other race or ethnicity.
Kidney failure from diabetes in Native Americans has dropped more than any other race or ethnicity. 70
Asian Americans Hispanics Blacks
60
8%
Per 100,000 people
Whites
9% 13% 13%
50 40 30 20 10 0
Native Americans
16%
1996 Native Americans
2
30 National www.awellnessupdate.com SOURCE: Health Interview Survey and Indian Health Service, 2010-2012.
2013 Blacks
Hispanics
Asians
Whites
SOURCE: United States Renal Data System (USRDS), 1996-2013, adults 18 and older.
A Model for Diabetes Care 1
Public Public health health and and population population management: management:
Joe Joe is is 58 58 years years old old with with diabetes diabetes and and kidney kidney disease. disease.
Assess communities communities for for poverty, poverty, access access to to •• Assess healthy healthy food, food, housing, housing, jobs, jobs, transportation, transportation, and and places places to to exercise. exercise. Work Work with with local local government government and and other other organizations organizations to to make make improvements. improvements. Care managers managers use use clinical clinical data data to to identify identify •• Care people people who who need need to to be be linked linked to to health health care. care.
2
Care Care manager manager calls calls Joe Joe because because of of missed missed doctor doctor appointments. appointments.
3 4
During During aa home home visit, visit, nurse nurse brings brings Joe Joe his his medicine, medicine, checks checks his his blood blood pressure, pressure, and and draws draws blood blood for for lab lab tests. tests.
5
6
7
At At the the clinic, clinic, Joe’s Joe’s doctor doctor adjusts adjusts his his medicine. medicine. Joe Joe meets meets with with aa nutritionist nutritionist and and diabetes diabetes educator. educator.
Pharmacist Pharmacist helps helps make make sure sure Joe Joe gets gets his his medicine medicine on on time time and and is is taking taking itit correctly. correctly.
8
Joe Joe has has no no sick sick leave leave at at work work or or transportation transportation to to make make itit to to appointments appointments or or pick pick up up his his medicine. medicine. He He also also has has trouble trouble getting getting healthy healthy food. food.
Nurse Nurse connects connects Joe Joe to to community community food food and and transportation transportation resources. resources. She She schedules schedules aa clinic clinic visit visit for for his his next next day day off. off.
CCLINIC LINIC
PPHHAARRM MAACCYY
Over Over time, time, Joe’s Joe’s blood blood pressure pressure and and blood blood sugar sugar are are controlled controlled and and his his kidney kidney function function remains remains okay. okay.
Team-based Team-based Patient Patient Care Care The The diabetes diabetes care care team team helps helps patients patients avoid avoid kidney kidney failure failure by: by: Controlling blood blood pressure pressure and and •• Controlling blood blood sugar. sugar. Using medicines medicines to to protect protect kidneys. kidneys. •• Using •• Checking Checking kidney kidney lab lab tests tests regularly. regularly.
www.awellnessupdate.com 31
SOURCE: CDC Vital Signs, January 2017
3
What Can Be Done? The Federal government is: ■ Funding diabetes treatment and prevention services in Native American communities through the Special Diabetes Program for Indians. https://www.ihs.gov/sdpi
■ Improving diabetes outcomes for populations who receive direct health care from federal agencies, including Native Americans, veterans, and others.
Health care policy leaders and insurers can: ■ Set standards and track performance measures requiring health plans to assess the health of all members of their population with diabetes, including those who don’t regularly visit their healthcare provider. http://bit.ly/2hquJUW
■ Assisting community health centers throughout the US to provide comprehensive diabetes care.
■ Promote CKD screening and monitoring and appropriate use of medicines that protect the kidneys in people with diabetes and CKD.
■ Developing a comprehensive system for tracking chronic kidney disease (CKD).
■ Support team-based care, care management, patient education, home visits, and community outreach.
http://bit.ly/2hw2WlV
https://nccd.cdc.gov/CKD/default.aspx
Health care systems can: ■ Use population health approaches to diabetes care. Assess long-term outcomes and address disparities. Promote wellness of the entire community and connect people to local resources, including healthy food, transportation, housing, and mental health care. ■ Develop a coordinated team approach to diabetes care. Team based-care should include patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.
Patients with diabetes and their families can: ■ Ask about being tested for kidney disease. ■ Check their blood pressure and blood sugar regularly; talk with their healthcare provider about goals. ■ Talk with their healthcare provider if they are having problems getting or taking their medicines. ■ Reduce salt intake to lower blood pressure and protect their kidneys. https://www.cdc.gov/salt/index.htm
■ Integrate kidney disease prevention and education into routine diabetes care. Screen people with diabetes for kidney disease and make sure that kidney disease is routinely addressed as part of diabetes care. 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov
Centers for Disease Control and Prevention CS271046A
32 www.awellnessupdate.com
1600 Clifton Road NE, Atlanta, GA 30329 Publication date: 1/10/2017
Older kids (adolescents, preteens, tweens, and teens) need vaccinations too, including Tdap, Meningococcal, HPV, and flu. Ask your child’s doctor or nurse if your child needs immunizations to protect against serious diseases. http://www.cdc.gov/vaccines/teens
CS223139-E
WELLNESS UPDATE
NOW “Their message is to get out more and move more. And that’s a good message. We’re not saying you shouldn’t do that,’’ Manini said. “But we have to recognize that going out and exercising doesn’t necessarily budge the amount of time people are going to be sedentary in the entire day. You are not necessarily taking away from the sedentary bucket and putting it into the exercise bucket.”
Does daily exercise cut back on older adults’ sedentary life? Study: not so much. GAINESVILLE, Fla - It looks like it might be tougher than anyone thought to lure older adults away from binge-watching TV shows and other sedentary activities. Advances in technology have increased automation, convenience, communication and travel promote sedentary lifestyles and have practically erased the need to engage in physical activity on a daily basis. Increasing moderate-intensity exercise in older adults led to little reduction in the overall time they spent in potentially unhealthy sedentary activity, according to a study led by University of Florida Health researchers and published in the July 18 issue of the Journal of the American Medical Association. The findings are a surprise to researchers who thought that increasing exercise would lead to overall lifestyle changes that would cut back on time spent sitting or otherwise being inactive. “A lot of practitioners have finally accepted the fact that exercise has all these health benefits,” said the study’s senior author Todd Manini, Ph.D., an associate professor in the UF College of Medicine’s department of aging and geriatric research and a member of the UF Institute on Aging.
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Adults who were inactive for periods lasting less than 60 minutes, like sitting to watch television or browsing the internet, and who engaged in moderate-intensity exercise like walking and strength, balance and flexibility training reduced daily sedentary time no more than 12 minutes when compared with a non-exercising group, the study found. For bouts of inactivity lasting an hour or more — bingewatching territory — researchers found no benefit to exercise. Manini said the study may point to a need for strategies beyond exercise for doctors and practitioners trying to motivate patients into more active and healthier lives. Those strategies may include convincing patients to cut back on their television time and, for younger people, getting them to get up from their desk regularly rather than sit in front of a computer all day. The conveniences of modern life are a resilient foe in the battle to stay healthy.
One in Five Surgical Weight-loss Patients Take Prescription Opioids Seven Years After Surgery PITTSBURGH, Pa. – While the proportion of adults with severe obesity using prescription opioids initially declines in the months after bariatric surgery, it increases within a matter of years, eventually surpassing presurgery rates of patients using the potentially addictive pain medications, according to new research led by the University of Pittsburgh Graduate School of Public Health.
The findings—which come from one of the largest, longestrunning studies of adults who underwent weight-loss surgery—indicate that improvements in obesity-related pain gained through bariatric surgery are not sufficient to counter the need for pain relief in the years following the procedure. “Almost half of patients reporting opioid use at the time of surgery reported no such use following surgery. However, among the much larger group of patients who did not report opioid use pre-surgery, opioid use gradually increased throughout seven years of follow-up,” said lead author Wendy C. King, Ph.D., associate professor of epidemiology at Pitt Public Health. The U.S. Centers for Disease Control and Prevention recently presented an evidence-based guideline stating that opioids should not routinely be used to manage chronic pain.
the amount of food the stomach can hold. Before surgery, 14.7 percent of the participants reported regularly taking a prescription opioid. Six months after surgery the prevalence decreased to 12.9 percent, but then it rebounded, progressing to 20.3 percent of participants regularly taking opioids seven years after surgery. Among participants who were not taking opioids at the time of surgery, rates increased from 5.8 percent six months after surgery to 14.2 percent seven years later. Hydrocodone was by far the most commonly reported opioid medication, followed by Tramadol and Oxycodone. There also was an increase over time in the use of medications typically prescribed for opioid dependence, although use of such medications remained rare, with less than 2 percent of patients using them through the years of follow-up.
“Our nation is in an epidemic of opioid abuse, addiction and overdose. Recent reports have suggested that bariatric surgery patients are at elevated risk of chronic opioid use,” said co-author Anita P. Courcoulas, M.D., M.P.H., chief of minimally invasive bariatric and general surgery at UPMC. “Our study does not prove that bariatric surgery causes an increase in opioid use. However, it does demonstrate the widespread use of opioids among post-surgical patients, thereby highlighting the need for alternative pain management approaches in this population.”
Most factors related to substance use disorder that were examined—such as gender, age, income, social support, mental health, smoking, alcohol consumption and illicit drug use—were not related to continued or post-surgery opioid use. However, more pain before surgery, worsening or less of an improvement in pain following surgery, and starting or continuing non-opioid pain-killers were each associated with a higher risk of continuing or starting opioid use after surgery.
Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the NIH-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.
Some researchers have hypothesized that opioid use increases following bariatric surgery due to discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which are contraindicated post-surgery. However, King and her colleagues found that starting NSAIDs post-surgery was associated with a higher risk of also starting to take opioids, while stopping NSAIDs was associated with lower risk of taking opioids.
About 70 percent of the patients underwent Roux-en-Y gastric bypass (RYGB), a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine. The majority of the remaining participants had a less invasive procedure, laparoscopic adjustable gastric banding, where the surgeon inserts an adjustable band around the patient’s stomach, lessening
“This likely reflects that opioid and non-opioid painrelief medications often are used in tandem, versus as alternatives to each other,” said King. “There is an urgent need for research into adequate alternatives to opioids for the long-term management of chronic pain following weight-loss surgery.”
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WELLNESS UPDATE
NOW to drink coffee, drink up! If you’re not a coffee drinker, then you need to consider if you should start.” The study, published in the July 11 issue of Annals of Internal Medicine, used data from the Multiethnic Cohort Study, a collaborative effort between the University of Hawaii Cancer Center and the Keck School of Medicine. The ongoing Multiethnic Cohort Study has more than 215,000 participants and bills itself as the most ethnically diverse study examining lifestyle risk factors that may lead to cancer.
Whether it’s caffeinated or decaffeinated, coffee is associated with lower mortality, which suggests the association is not tied to caffeine. LOS ANGELES –Here’s another reason to start the day with a cup of joe: Scientists have found that people who drink coffee appear to live longer. Drinking coffee was associated with a lower risk of death due to heart disease, cancer, stroke, diabetes, and respiratory and kidney disease for African-Americans, Japanese-Americans, Latinos and whites. People who consumed one cup of coffee a day were 12 percent less likely to die compared to those who didn’t drink coffee. Coffee lovers who drank two to three cups a day reduced their chances of death by 18 percent. The effects were present whether people drank regular or decaffeinated coffee, suggesting that caffeine is not the cause, said Veronica W. Setiawan, lead author of the study and an associate professor of preventive medicine at the Keck School of Medicine of USC. “We cannot say drinking coffee will prolong your life, but we see an association,” Setiawan said. “If you like 36 www.awellnessupdate.com
Since the association was seen in four different ethnicities, Setiawan said it is safe to say the results apply to other ethnic groups. “This study is the largest of its kind and includes minorities who have very different lifestyles,” Setiawan said. “Seeing a similar pattern across different populations gives stronger biological backing to the argument that coffee is good for you whether you are white, African-American, Latino or Asian.”
Benefits of drinking coffee Previous research by USC and others have indicated that drinking coffee is associated with reduced risk of several types of cancer, diabetes, liver disease, Parkinson’s disease, Type 2 diabetes and other chronic diseases. As a research institution, USC has scientists from across disciplines working to find a cure for cancer and better ways for people to manage the disease. The Keck School of Medicine and USC Norris Comprehensive Cancer Center manage a statemandated database called the Los Angeles Cancer Surveillance Program, which provides scientists with essential statistics on cancer for a diverse population. Researchers from the USC Norris Comprehensive
Cancer Center have found that drinking coffee lowers the risk of colorectal cancer. Be careful, though — drinking piping hot coffee or beverages probably causes cancer in the esophagus, according to a World Health Organization panel of scientists that included Mariana Stern from the Keck School of Medicine.
For White Middle Class, Moderate Drinking Is Linked to Cognitive Health in Old Age SAN DIEGO – Older adults who consume alcohol moderately on a regular basis are more likely to live to the age of 85 without dementia or other cognitive impairments than non-drinkers, according to a University of California San Diego School of Medicine-led study. “This study is unique because we considered men and women’s cognitive health at late age and found that alcohol consumption is not only associated with reduced mortality, but with greater chances of remaining cognitively healthy into older age,” said senior author Linda McEvoy, PhD, an associate professor at UC San Diego School of Medicine. In particular, the researchers found that among men and women 85 and older, individuals who consumed “moderate to heavy” amounts of alcohol five to seven days a week were twice as likely to be cognitively healthy than non-drinkers. Cognitive health was assessed every four years over the course of the 29-year study, using a standard dementia screening test known as the Mini Mental State Examination. Drinking was categorized as moderate, heavy or excessive using gender and age-specific guidelines established by the National Institute on Alcohol Abuse and Alcoholism. By its definition, moderate drinking involves consuming up to one alcoholic beverage a day for adult women of any age and men aged 65 and
older; and up to two drinks a day for adult men under age 65. Heavy drinking is defined as up to three alcoholic beverages per day for women of any adult age and men 65 and older; and four drinks a day for adult men under 65. Drinking more than these amounts is categorized as excessive. “It is important to point out that there were very few individuals in our study who drank to excess, so our study does not show how excessive or bingetype drinking may affect longevity and cognitive health in aging,” McEvoy said. Long-term excessive alcohol intake is known to cause alcohol-related dementia. The researchers said the study does not suggest drinking is responsible for increased longevity and cognitive health. Alcohol consumption, particularly of wine, is associated with higher incomes and education levels, which in turn are associated with lower rates of smoking, lower rates of mental illness and better access to health care. The UC San Diego School of Medicine research team adjusted the statistical analyses to remove confounding variables, such as smoking or obesity, but noted the study is based only on statistical relationships between different demographic factors, behaviors and health outcomes. There remain on-going debates about whether and how alcohol impacts lifespan or potentially protects against cognitive impairments with age. “This study shows that moderate drinking may be part of a healthy lifestyle to maintain cognitive fitness in aging,” said lead author Erin Richard, a graduate student in the Joint San Diego State University/UC San Diego Doctoral Program in Public Health. “However, it is not a recommendation for everyone to drink. Some people have health problems that are made worse by alcohol, and others cannot limit their drinking to only a glass or two per day. For these people, drinking can have negative consequences.”
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WELLNESS UPDATE
NOW than half of adolescents receive an annual flu shot. Despite the low vaccination numbers nationwide, more than 90 percent of parents polled thought their teen had received all vaccines recommended for their age. “Our poll found a significant gap between national data on teen vaccination rates and what parents report,” Clark says. “This indicates that many parents are unclear about the additional vaccines their teen may need.”
Teens may be missing vaccines because parents aren’t aware they need one ANN ARBOR, Mich. - Parents may be up to speed on what vaccines their children need for kindergarten, but may be less sure during high school years, a new national poll suggests. More than a third of parents of teens didn’t know when their child’s next vaccine was due and half of parents incorrectly assumed that their doctor would initiate an appointment when the time came, according to a report from the C.S. Mott Children’s Hospital National Poll on Children’s Health(link is external) at the University of Michigan. “When kids are little, their pediatricians usually schedule visits to coincide with the timing of recommended vaccinations,” says poll co-director Sarah Clark M.P.H. “As children get older, well-child appointments occur less often and health providers may not address vaccines during brief visits for sickness or injury. Many teens may be missing out on important vaccines simply because families aren’t aware it’s time for one.” National vaccination rates are well below public health targets for certain adolescent vaccines, particularly those that require more than one dose. According to the Centers for Disease Control and Prevention (CDC), only one third of teens have received the second dose of meningitis vaccine by age 17. Similarly, less than half of boys age 13-17 have completed the HPV vaccine series, and less
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The lack of awareness of the need for vaccines may reflect changes in the recommended schedule for adolescent vaccinations over the years, Clark notes. For example, a recent change in the schedule emphasizes the recommendation to give the meningitis vaccine at age 16. Parents may also be less informed about recommended vaccinations for teens because few states have vaccine requirements for high schoolers. Many states do, however, have vaccination requirements for students to enter elementary and middle school. The doctor’s office was the primary way parents said they knew when their teen was due for another vaccine either because their provider scheduled an appointment for vaccination (44 percent), the doctor or nurse mentioned vaccination during an office visit (40 percent), or the doctor’s office sent families reminders (11 percent). Parents less frequently received a notice from their teen’s school, health plan, or the public health department. “Parents rely on child health providers to guide them on vaccines – in early childhood and during the teen years,” Clark says. “Given the general lack of awareness about adolescent vaccines shown in this poll, there is a clear need for providers to be more proactive for their teen patients.”
Antibiotics are not always the answer HERSHEY, Pa. – The discovery of penicillin in 1928 was heralded as a medical miracle. As one of the first antibiotics, it could cure patients of potentially deadly
bacterial illnesses, such as scarlet fever, typhoid and pneumonia. Unfortunately, overuse of penicillin and other antibiotics can cause other problems for both individual patients and the general population. That’s why it’s important to take antibiotics only for true bacterial infections, including whooping cough, strep throat and urinary tract infections.
Antibiotics don’t kill viruses According to the U.S. Centers for Disease Control and Prevention, up to one-third of antibiotic use in humans is either unnecessary or inappropriate. Antibiotics do not fight viral infections such as colds, flu, bronchitis and most sore throats. Still, many patients expect health care professionals to prescribe antibiotics to “cure” minor illnesses. “Some parents who hate to see their child suffer will contact the doctor’s office at the first sign of an ear infection, hoping for a prescription for antibiotics to quickly end the child’s suffering,” said Barbara Cole, a nurse practitioner with Penn State Medical Group. “But the painful condition is usually caused by a virus.” Although antibiotics kill most bacteria at first, some of the microbes survive and eventually become resistant to that particular drug. As a result, new, stronger antibiotics are developed to fight the resistant bacteria, and then the bacteria become resistant to them, as well. The CDC says virtually all bacterial infections have become resistant to the antibiotic treatment of choice. Bacteria also become resistant when antibiotics are overused in food production and by farmers, as in with cows and chickens. “Just as in humans, antibiotics are essential in treating some diseases in animals, but using antibiotics just to promote the animal’s growth leads to resistance,” Cole said. When a person is infected with an antibiotic-resistant infection, medical professionals must resort to
stronger, more toxic antibiotics to fight it and help that individual get well again. Illnesses last longer and, in more cases, lead to death. According to the CDC, every year more than 23,000 people in the United States die from bacterial infections that are resistant to antibiotics. Relieve symptoms without antibiotics l Cold or flu: drink fluids, get plenty of rest l Comfort for a sick young child: Simply sit and rock him or her l Ear infections: Apply warm compresses l Runny nose: Use saline drops or sprays, run a cool-mist vaporizer, elevate the head, such as by putting an infant in a car seat l Sore throat: Soothe with cool drinks, cough drops (for older children), or honey (for children at least 1 year old) When an antibiotic is prescribed, patients should be sure to take it correctly: l Take each dose at the appropriate time to maximize the effectiveness of the drug. l Take the antibiotic for as long as prescribed, even if symptoms are gone. Otherwise, some bacteria can survive and become resistant. l Don’t take “leftover” antibiotics or those prescribed for someone else. They might not be appropriate for current symptoms and could allow bacteria to multiply. “Remember, don’t demand antibiotics when a health care professional says they’re not necessary. An antibiotic offers no benefits in treating a viral infection,” Cole said. “Taking an unnecessary antibiotic increases the chances that a resistant infection will arise later.” Moreover, an antibiotic can kill the “good” bacteria in the human body, causing intestinal and other problems. Antibiotics can save lives. Anyone with a bacterial infection should take the prescribed antibiotic. On the other hand, when an illness is mild and probably caused by a virus, it’s better to treat the symptoms and let time be the cure.
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WELLNESS UPDATE
NOW MD Anderson celebrates the mission of Kick Butts Day
HOUSTON – As an institution devoted to eliminating cancer, The University of Texas MD Anderson Cancer Center proudly supports the mission of Kick Butts Day to prevent tobacco use in our nation’s children. Organized by the Campaign for TobaccoFree Kids (CTFK), Kick Butts Day is a national day of awareness focused on educating and empowering youth to choose tobacco-free lifestyles. Through several evidence-based programs, MD Anderson has committed to educating youth about the dangers of tobacco use and its effects on their future health. According to the Centers for Disease Control and Prevention (CDC), tobacco use claims an estimated 480,000 lives each year and remains the single largest preventable cause of death in the United States. Tobacco use causes roughly one-third of all cancers, including 90 percent of lung cancers, as well as heart disease, lung disease, diabetes and stroke, among other health conditions. “We welcome any opportunities to raise awareness of the devastating effects of tobacco use,” said Ernest Hawk, M.D., vice president and head, Division of Cancer Prevention and Population Sciences. “Knowing most people develop their nicotine addiction at a young age, tobacco prevention relies on youth education to encourage healthy lifestyle choices and tobacco-free environments to limit youth exposure.” The CDC reports that more than 3,200 children aged 18 or younger smoke their first cigarette each day in the U.S., and an estimated 2,100 become daily smokers. In fact, nearly 90 percent of current smokers first tried a cigarette before age 18. In Texas, approximately 19,000 children become daily smokers each year.
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In an effort to counter these trends, MD Anderson has a variety of programs designed to educate youth and prevent tobacco initiation. In 2001, researchers led by Alex Prokhorov, M.D., Ph.D., professor of Behavioral Science, developed A Smoking Prevention Interactive Experience (ASPIRE), a youth-oriented tobacco prevention and cessation curriculum. The online program is designed to provide an engaging way for teens to learn about the dangers of tobacco use. ASPIRE has been adopted by schools across 33 states in the U.S. as well as more than 6 countries. Recently, MD Anderson and the Houston Independent School District (HISD) reached a first-of-its-kind agreement to provide access to ASPIRE for the roughly 100,000 HISD middle and high school students. Further, as founding partners of the CATCH Global Foundation, MD Anderson and The University of Texas Health Science Center at Houston support distribution of a youth e-cigarette prevention curriculum, CATCH My Breath, to middle schools across the country. “With a wide variety of new and emerging tobacco products, there is an increasing need to design and implement programs such as these,” said Prokhorov. “Our goal is to educate youth about the harms of tobacco use and nicotine addiction, encouraging them to quit smoking or, better yet, never start.” In observance of Kick Butts Day, MD Anderson sponsored a week of awareness and education events at Houston-area KIPP schools, in partnership with CTFK, the Texas Department of State Health Services and Tobacco Free Ft. Bend. Some activities included a pledge wall, cups in a fence with antitobacco messages, daily announcements for tobacco education and a puppet show for K-1 students. MD Anderson also has served as a resource for statewide tobacco control policies that will serve to protect the health of future generations. Collaborations between The University of Texas System and MD Anderson led to development of the system-wide Eliminate Tobacco Use Initiative in 2016.
A recently published impact report highlights progress of the first year, including the establishment of tobaccofree policies across all 14 institutions of the UT System, which includes more than 228,000 students and 100,000 faculty and staff. “We are motivated by tobacco-related suffering we witness in the lives of our patients and their families each day,” said Hawk. “Therefore, MD Anderson has prioritized evidence-based tobacco prevention, cessation and control measures wherever possible. No other single action has as great a potential to advance our mission of eliminating cancer in Texas, the nation and the world.”
Study Finds Aspirin May Help Prevent Barrett’s Esophagus DALLAS – Aspirin has long been used to help prevent and manage heart disease. However, researchers at Baylor Scott & White Research Institute have discovered another potential benefit –protection against Barrett’s esophagus, a disorder that causes damage to the esophagus from long-term acid reflux disease, and can help lower associated cancer risk. “If you are predisposed to developing Barrett’s esophagus, our research suggests that taking aspirin on a regular basis might prevent the condition from developing and the cancers that go along with it,” said senior author Rhonda Souza, MD, co-director of the Center for Esophageal Research at Baylor Scott & White Research Institute. Barrett’s esophagus is a serious complication of chronic gastroesophageal reflux disease (GERD), a common condition where acid and other stomach enzymes reflux into the esophagus, causing damage. Some GERD patients develop Barrett’s esophagus, in which the normal tissue lining of the esophagus changes to tissue that resembles the lining of the intestine. This can predispose people with Barrett’s esophagus to a rare serious cancer called esophageal adenocarcinoma.
“We’ve seen a seven-fold increase in the frequency of esophageal adenocarcinoma in the last 40 years. It is relatively uncommon, but with its increasing frequency, it may not remain that way for long,” said author Stuart Spechler, MD, co-director of the Center for Esophageal Research at Baylor Scott & White Research Institute. Researchers haven’t been able to pinpoint why certain GERD patients develop Barrett’s esophagus while others do not, until now. To understand the mechanisms of the disease, the researchers examined the cells of GERD patients with and without Barrett’s esophagus and treated the samples with acid and bile, common components that reflux up to the esophagus. When treated with these components, the researchers found differences in the molecular pathways of Barrett’s esophagus patients, which could lead to the induction of CDX2, a gene associated with esophageal cancer. While previous data associated NSAIDs, particularly aspirin, with certain GERD protections, the current study was the first to confirm that aspirin alone could inhibit the NF-κB pathway that promotes inflammation and CDX2 expression, which can lead to protection against Barrett’s esophagus. The researchers also discovered that aspirin could augment radiofrequency ablation (RFA), a new endoscopic procedure that burns away abnormal tissue associated with Barrett’s esophagus and is offered through the Center for Esophageal Diseases at Baylor Scott & White Health. When treated with aspirin before and following the procedure, the researchers believe the drug could inhibit the regrowth of abnormal tissue in the esophagus, thereby preventing the condition from returning. “For patients who have been shown to develop Barrett’s, this research suggests that putting them on aspirin following the RFA procedure may delay or prevent the intestinal lining from returning,” Dr. Souza said.
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“Mom, I miss you so much…” Type 2 diabetes steals the lives we cherish most. Nearly a quarter million a year. But it can be prevented. Nearly 80 million Americans have prediabetes. But because prediabetes doesn’t always have symptoms, nine out of ten people who have it don’t even know it. Know your risk before it’s too late. Especially if you’re over 45 or overweight. More importantly, do something about it. Eat better, stay active and lose weight. ®
generated at BeQRious.com
You have a lot to live for. Stop Diabetes. For yourself, and the people you love.
Learn how you can help Stop Diabetes. Visit checkupamerica.org or call 1-800-DIABETES (342-2383).