Special Issue - Issue 123.1 by topdoctormagazine

SPECIAL ISSUE

May 2021

Pain Management: It's More Than Medicating Pg 01

What's the Impact of Social Media and Misinformation on Medical Procedures? Pg 06

Empowering People to be Healthy and Happy

Pg 10

Why People with COVID Lose Their Sense of Smell

Pg 13

Contents

01 06

01 13 01

Pain Management: It's More Than Medicating

06 What's the Impact of Social Media and

Why People with COVID

Ushering in Natural Medicine:

Misinformation on Medical Procedures?

Empowering People to be Healthy and Happy: An Interview with Eva Vennari

WHAT'S INSIDE?

Lose Their Sense of Smell

An Interview with Charlie Piermarini

5 Reasons You Might Be Feeling Cold All the Time

Pain Management: It's More Than By Yuko Tabasa By Kayla Schleining Medicating Chronic

pain

isn't

just

about

diagnosis

and

medication. Dr. Tania Faruque, MD, knows this well, and she puts it into practice every day at Palomar Spine & Pain in California, where she serves as Medical Director. Her job is no walk in the park: "Being in pain management is a difficult field, of course… it affects pretty much every aspect of people's lives." The job includes more than doing spine injections, joint injections, and neurological work. Dr. Faruque also gets to know her patients on a deeper level and often finds that their pain isn't only physical. One case that stands out to Dr. Faruque was when an older gentleman came to her for chronic back and

joint

pain

treatment.

While

she

was

administering help, she realized there was more going on than just the diagnosis. "[Other than the pain], in his life, his wife had just recently passed away." Dr. Faruque described. "And you see that a lot of these men who've been married for so long… their wives had been taking care of them." She describes how she sees that a lot of older men who lose their wives tend to lose sight of their own wellbeing due to grief, which often accumulates into greater pain. Dr. Faruque said she noticed how "his will of life, his joy was really just gone after his wife passed."

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During every visit, she would talk to him during his clinic visit. “It took time, but I would always talk to him, talk to him about his kids… [even though] he did want to move to Arizona to be with his kids but for the longest time didn't want to actually go… and each visit I would want to be like, Look, you should move, go be with family, it will make a difference." Days passed, months passed, and the gentleman didn't return. One day, Dr. Faruque describes how he showed up at her office out of the blue: "When I saw him again, he did end up moving to Arizona. And he came just to thank me for that." Dr. Faruque tells the story with fondness, the smile practically audible in her voice. "My day is good when I've made a difference in a patient's quality of life." And for this gentleman, the help she provided was more than just providing physical pain relief. Dr. Faruque's journey in the medical field began ever since she was a little girl. Being the daughter of immigrants, she described how her parents never wanted her to take for granted living in America. They instilled in her the values of helping others and giving back: "I know that's a cliché answer, but it's the truth, that's what got me into the field." Plus, the skill set needed to be a doctor came naturally to her: "In school, I really enjoyed science a lot, so this is really the perfect career for me." But Dr. Faruque's interest in science and heart for people as a child was only the beginning. The rest of her quickly-growing career exemplified her intelligence,

ingenuity,

compassion,

and

entrepreneurship on a whole new level. Not only is Dr. Faruque a double-board certified interventional pain management specialist and anesthesiologist, but she's also a graduate of the world-renowned Cleveland Clinic.

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There, she did her residency in Anesthesiology and rotated through the Chronic Pain Rehab Program – a

program

that

treats

some

the

most

complicated chronic pain cases in the medical community. She became the first female pain medicine fellow at Cedars Sinai Medical Center and continues to be one of the few female pain physicians in San Diego, treating patients with interventional

management,

cognitive-behavioral

therapy,

physical and

therapy,

biofeedback

/relaxation training. As the entire world now knows, all the training, skill, and experience in the world couldn't

have

prepared

anyone

for

such

unprecedented times. "My previous job, COVID affected it significantly," Dr. Faruque recounts. "Our clientele went down by 75% in the Pasadena area in California. Unfortunately, the practice never really fully recovered… even when things were getting a little bit better." Dr. Faruque didn't let COVID stop her from giving back to her community. Another doctor reached out to Dr. Faruque, sharing that he was planning to retire and have someone take over his practice. The opportunity couldn't have been more perfect. "It was a great undertaking," Dr. Faruque said, "Really scary, but great." She officially started at Palomar this January. But even with a new year, old challenges still presented themselves. "We were considered non-essential so that unfortunately hindered [things]. Patients were afraid to come to our clinic; pain procedures weren't needed." But when patients started to trickle in, the treatments that had been put off for so long were manifesting in unpleasant ways: "When patients did finally come in, they were in an extreme amount of pain and wanted immediate

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treatment, but that can't be the case." As if things couldn't get any more complicated, patients who had difficulty breathing in masks still had to wear them, and patients eager to get treatments were faced with COVID questions. "A lot of it seemed to be a big nuisance for the patients, but it's all for safety." Aside from the complications that COVID brings, there are also controversies, politicization, and those who don't follow guidelines. Instead of being frustrated, Dr. Faruque realized something: "What I found interesting was that there was a lot of misinformation." She explained, "A lot of us in the medical field take for granted what we know about [COVID], but most patients don't really know anything about COVID." She says she would do her best to answer the many questions patients had about the pandemic. She was surprised to find that many who didn't want to wear masks or follow the guidelines didn't do it out of rebellion – but just because they genuinely didn't understand why. This was especially true with her older patients. "That was one of the biggest surprises for me. We assume that patients know what's happening, but a lot of the time, they don't." For Dr. Faruque, getting patients to come in-person for a check-up is very high on her priority list. Unfortunately, unlike other fields of care, pain treatments can't benefit from telemedicine. "To be realistic, it's difficult in pain management because you really need that physical exam. And if you're giving prescriptions like opioids, you don't want to be doing that over the phone." But even still, Dr. Faruque clarifies that pain treatment isn't only about narcotics and medications.

PAGE

While opioids and narcotics are sometimes necessary, that isn't the whole picture. "Our role is to provide alternatives to avoid long-term medication and surgery." She explains. "I want to be a voice for people understanding what pain management is, that it's not just opioids. It's really other forms of treatment like neuromodulation and regenerative medicine." This is just one of the reasons why a face-to-face appointment is critical for pain management treatments – it's not just about stopping the pain; it's about solving the root issue and improving lifestyle. Dr. Faruque is still early in her career, but she has already made massive waves in her community. "I never choose to settle in my career. I had a dream when I first became a doctor to have my own practice. And not only be a doctor, but also an entrepreneur. I'm proud that I never gave up on that, and now I have that opportunity. It's a big goal that I accomplished." And the race isn't over yet. As the vaccine is being distributed, cases are going down, and life is gradually starting to return to normal, Dr. Faruque and Palomar Spine & Pain look forward to the future. "I really want to make this clinic successful and be a good source, a good doctor, and have a good reputation out there and help people. And right now, it's all about pain and wellness. I truly love helping people."

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What's the Impact of Social Media and Misinformation on Medical Procedures? Social media has revolutionized the way information reaches people. The rise of platforms like Facebook, Twitter, Reddit, and other similar websites has allowed millions of people access to knowledge in a matter of minutes. This increased accessibility has sparked debates within the medical community because of the lack of a consistent fact-checking mechanism on these online spaces. However, articles shared on these platforms have exposed people to more science-based reporting. Medical professionals themselves have also used these websites to share valuable information in a digital setting, free of the barriers in a conventional clinic or hospital. PAGE

Medical Information in Social Media The increased role of social media in the way people communicate has affected both the personal and professional aspects of medicine. In 2015, a study with 4,000 participants showed that 90% of physicians spent time on these platforms for personal use, but 65% also used them for professional reasons. Many Facebook pages exist for disseminating health-related information, and discussions about diseases and disorders are frequent on Twitter. This trend shows an emerging change in the way healthcare professionals interact with patients. Journal articles have been online for years, but social media platforms have allowed facts in more straightforward language to circulate faster. For example, Facebook pages can post infographics condensing a lengthy research paper on a promising HIV drug. Friends can share Instagram collages showing tips on self-checking for signs of breast cancer. However, this conversion of information into bite-size pieces is also seen as harmful by medical professionals. Important details may get lost in trying to fit in information to a character limit, possibly causing misinformation. There is also the threat of frauds and unverified alternative therapies. In recent years, Facebook has become a breeding ground for articles challenging the medical field. This has amplified anti-vaccine campaigns and other harmful beliefs. Fake news purveyors routinely challenge the reputation of many physicians on the platform and the efficacy of drugs proven to combat certain diseases. Unverified alternative therapies masquerading as "cheaper" cures have also become rampant. Efforts to combat these problems exist, with the Food and Drug Administration also drafting guidelines for online fact-checking information about prescription drugs and medical equipment. Professional organizations have issued recommendations on how health care providers should share information on social media. To date, however, there are no clear protocols regarding social media etiquette for medical professionals. It is up to the doctors, nurses, pharmacists, and other providers to come up with ways to ensure that they uphold the rights of their patients, even in an online setting. PAGE

Patient attitudes to health-related information on social media With most people owning a social media account, it is no surprise that posts regarding health attract solid readership. This boosts the reach of information regarding specific conditions and empowers patients to be more involved in communicating with their doctors. Personal research conducted by individuals will allow them to be more proactive in asking for lifestyle and dietary adjustments to complement treatment. Unfortunately, there is also a dark side to people having increased access to health-related information. The advertisement of "alternative" therapies that may be harmful is another threat. Although physicians can support or reject this information, many clients choose not to disclose their newfound remedies due to fear or intimidation. The prospect of "miracle cures" and lesser costs can be lucrative for people desperate to achieve a healthier state, with the FDA also warning the public about health fraud scams. A 2019 study also looked into the relationship between social media and the desire to undergo cosmetic surgery. Results showed that individuals with low selfesteem are exposed to content about these procedures and become more inclined to undergo surgery. This is motivated by their negative sense of self, and watching videos or reading articles related to the subject may amplify their sense of inadequacy. While the operation is a personal decision by the client, it exposes another potential harm to medical content shared online without a filter. There is an increased risk of amplifying a negative outlook on health, with patients making hasty decisions without increased communication with their provider.

The role of the medical community in correcting misinformation The risks associated with health-related information on social media are a pressing problem. Thus, healthcare providers must promote reliable sources of information to their clients. Advisories and infographics that correct fake news regarding harmful substances can do a lot of good to patients. The accessibility of social media is also an avenue for physicians to be more communicative with their patients. The clinical setting comes with a level of intimidation that is less emphasized in an online setting, which can correct misinformation. Leaning into this convenience can positively PAGE

impact a patient's outlook and dialogue with their doctors, preventing them from getting intimidated. Social media may also serve as a tool to lobby for policies that support a patient-centric approach within the medical community. However, this will need support from academic institutions and research bodies. There is an existing communication gap between academics, health care providers, and policymakers. Bridging this can increase opportunities that emphasize the quality of science-based treatments to the public. A 2014 study on big data advocates for increased funding and support for social media integration with medicine to maximize its benefits to the community. The results indicate that online platforms can help communicate verified medical information to the public. Collaborating with websites to implement stricter fact-checking policies is also imperative, as these possess the power to warn the public of fake articles immediately. That way, science-backed information becomes the utmost priority when talking about health. Communication is a crucial aspect of preserving the patient-provider relationship, which is why compassion and support must be present on social media. This allows medical procedures to continue being a collaborative effort between the patient and their health care provider, even with the addition of technology to the mix. Those lured by cheap alternatives promoted on social media are most vulnerable. It is essential to hammer that engaging in unverified methods can cause more harm than good. In the end, patients may cause more harm to themselves and leave themselves vulnerable to higher medical costs. The bitterness of poor quality remains long after the sweetness of low cost is forgotten. Using social media's strengths to combat its harms, the medical community can protect its patients against misinformation.

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Life Style

Empowering People to be Healthy and Happy: An Interview with Eva Vennari By Victoria Cook

Eva Vennari is no stranger to ongoing health problems. As a little girl, she went to various doctors who would attempt to diagnose her properly, but to no avail. After experiencing a draining career that led to burnout, Vennari realized that she wanted no - needed real change. That place of burnout propelled Vennari to where she is today: a CEO and founder of The Elevate Institute,LLC, an organization focused on health and energization. Vennari is a certified Nutritional Counselor in Mineral Balancing and Hair Mineral Analysis

and

has

certifications

for

Personal

Nutrition, Chakra Healing, and Akashic Record Reading. Vennari's enlightenment came at 3 a.m. as she was fighting insomnia. She decided to look online for any illnesses that met her symptoms and came across an article on mineral balancing. Mineral balancing is about utilizing nutrition (minerals) to remove toxins from the body. On further research, Vennari decided to try mineral balancing on herself, and her symptoms were alleviated entirely. For the first time in a while, she felt better. PAGE

A Practitioner in Nutritional Health Her physical change inspired Vennari to become a practitioner in nutritional health. At first, she intended to provide help to herself and family, but the loss of someone close made her realize she could help people beyond her family. She began her business, The Elevate Institute, shortly after. Elevate offers education and a program for those wanting to pinpoint their nutritional imbalances. Different from bloodwork, Vennari

takes

hair

samples

analyze

the

relationships between minerals.

"I affectionately call the hair analysis report the trash report because it captures what is leftover at the end of the body's rejuvenation process," Vennari said. "We're just tapping into the body's natural healing processes by watching how it prioritizes what you eat, drink, and breathe in. And then it makes more you and spits out the rest into soft tissue, which is your hair." This analysis balanced with a holistic approach to pinpointing stresses helps Vennari walk her clients through a path of regaining their energy and living life to their fullest. PAGE

Lasting Change and Real Empowerment One such client was a father depressed, unable to work and be a partner in h is marriage. He was unable to eat, or enjoy anything and had severe anxiety. With the help of Vennari's program, he gradually came to a healthy place emotionally and physically. The change to his nutrition ultimately boosted his energy and restored his confidence along with establishing new boundaries. His wife and some of his children then also went through the program to reach a place of wellness. "When you start taking supplements, and you're paying attention to yourself, that is a form of self-love. Sometimes that's the only first step a person can afford to make in their emotional place," Vennari said. "When you give your body more energy, it frees your mind and emotional space to open up, and you're allowed to process things that you haven't been able to." Stress is one of the biggest inhibitors to people absorbing the minerals they need, so Vennari works with her clients to set healthy boundaries and meditative practices that help with mental and emotional health. Helping each client be aligned holistically is how Vennari empowers people to be happy and healthy. But Vennari recognizes that there is no cure-all for each person. Health, in many ways, is a process, and she, above all, encourages discernment and discipline in pursuing the answer to a healthy life. "The answer is unique to each of us just as our thumbprints," Eva Vennari said. "The foundation to knowing the secret of your life is that you have to put the work in to find out what makes you happy and then make sure you do it."

Want to know more about Eva Vennari? You can find The Elevate Institute and you can listen to her podcast "When Doctors Say 'We Don't Know'" using the QR code.

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Why People with COVID Lose Their Sense of Smell By Odessa Kramer There are now over 29 million coronavirus cases in the U.S. From body malaise to shortness of breath, the virus presents itself in different ways. One of the most common and interesting symptoms is anosmia or smell blindness. An NIH review studied a total of 11,054 COVID-19 patients and found that this loss of smell often precedes the other, more severe symptoms of the virus. This loss of smell can suddenly occur in people infected with COVID-19 and is often associated with loss of taste, too. Loss of smell in COVID-positive patients may happen with or without a stuffy or runny nose; in some cases, this may even be permanent. PAGE

Even though buying a piano is a significant investment for parents with a young child, after much begging on Dr. Roy's part and seeing her dedication, she would receive her first piano at 8. For the next twenty years, she took lessons, performed in recitals, and competed across her hometown of Toronto, Canada. She would even become a student at the Royal Conservatory of Music. Her love for music and piano would continue to be a balm as she transitioned into medical school. "Fast forward to when I was doing my residency in North Carolina at Duke Medical Center. I would work 12-14 hour days. I would be exhausted when I got home, but when I got home, I would look at my piano and go 'alright Lip, just 15 minutes'," said Dr. Roy. "Then I would play classical, I would play Simon and Garfunkel, whatever I wanted to, and I would just feel calm. Soon, I'd look up at the clock, and two hours would have passed."

Inflammation and Loss of Smell C.T. scans of people with COVID-19 who have reported anosmia reveal a cleft syndrome – this happens when swollen soft tissue and mucus block the olfactory cleft, the part within the nose responsible for smelling. The novel coronavirus makes its way into the body by attaching to cells in the upper respiratory tract. Once the virus permeates these cells, with the help of the TMPRSS2 protein and replicates, the inflammatory response is then activated. Inflammation is the immune system's response when it detects foreign and possibly harmful bodies. A column by University of London consultant rhinologist and ENT surgeon, Simon Gane, and University of Reading associate professor, Jane Parker, attributes anosmia to this inflammation and swelling phenomenon. They believe that when the immune system can rid the body of the virus, the swelling subsides, and the sense of smell returns to normal. However, the loss of smell persists even after the person tests negative for the virus in numerous recorded cases. Dr. Gane and Professor Parker present a theoretical explanation based on inflammation physiology: inflammation could trigger the release of chemicals from other systems that may damage tissues and possibly olfactory neurons– the receptors of the sense of smell – in the process. Luckily, olfactory neurons are regenerative.

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Issue 123.1.1

Post-Hospitalization Care and "Smell Therapy" The onslaught of the pandemic overwhelmed the healthcare system. Patients who were lucky enough to make it out of the hospital and "recover" often don't get the necessary post-discharge care they need, as hospitals around the country don't have enough resources and staff. Those who are declared "COVID-free" but are still showing mild symptoms must stay home and wait out these symptoms. The lack of extensive and long-term recovery treatment plans for patients is by no means hospitals' fault. The pandemic nearly paralyzed the entire healthcare system, and it doesn't help that physicians and nurses have been in short supply even before this major health crisis. The spike further exacerbates this shortage in demands for COVID-19 care professionals. Fortunately, the rise of telemedicine and remote learning is helping address this need. These strategies allow healthcare workers to care for more patients through online consultations and virtual health monitoring. More importantly, they provide training to a broader population to prepare for today's healthcare workforce demands. The pandemic has also lead to a new way in which nurses can learn new skills. For qualified nurses who want to learn new skills, there are online R.N. to BSN programs that can give them the necessary abilities to provide specialized care for patients, especially in rehabilitation. These online programs have helped ensure that today's nurses can keep up with the modern demands of COVID-19, such as loss of smell, although the pandemic has made inclassroom learning very difficult. While nurses and physicians are battling the pandemic in hospitals, other organizations take the reins during recovery. Aiding them in post-discharge care are charities and other organizations offering "smell therapy" and other services to help manage lingering effects from COVID-19. These services can last up to four months per individual and can be safely done at home.

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Ushering in Natural Medicine: An Interview with Charlie Piermarini By Victoria Cook and Brianna Connors

Devil's lettuce, weed, pot - all of these names are associated with recreational marijuana and often carry unhelpful negative stigmas associated

with

medical

cannabis.

Enter

Charlie Piermarini . Piermarini

actively

promotes

holistic

education and healthcare utilizing natural medicine,

focusing

medical

CBD

(cannabidiol). He is a PA, co-founder of The Healing Joint and Integrative Medicine, and founder of Restorative CBD. He has three Masters in Physiology, Public Health, and Physician Assistant Sciences. Piermarini remembers what he first thought of

marijuana

medicinal

before

benefits

learning

about

marijuana's

the

cousin,

hemp. "I thought people were just trying to get high," he said. "They [medical schools] don't

teach

anything

about

the

endocannabinoid system, so I researched it and started learning what I could."

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Integrative Medicine The Western approach to medicine, Piermarini found, was limiting. It focused on solving a specific problem instead of looking at the body and its issues as interconnected and fluid. His research, coupled with mentorship from Dr. Jyotiy Patel, inspired Piermarini to expand into integrative medicine. "She instilled in me that you have to look at the patient as a whole. For example, you can't just give diabetic people Metformin and talk about glipizide and send them on their way," Piermarini said. Instead of just prescribing medicine for an ailment, he also talks with his patients about their lifestyle choices what they are eating, how they are exercising, and other related questions.

"We've talked about high dose, 20,000-milligram vitamin C IVs and supplements, doing micronutrient testing

and

testing

functional

pathways

for

deficiencies in vitamins and micronutrients, and keeping you on a good regimen," he said. "People are searching these things out. So I kind of want to meet patients where, you know, where they needed to be met." Piermarini pointed out that some medications may not work on a patient because they are vitamin and nutrient deficient. Focusing on the health of their gut and that they are synthesizing their intake properly, Piermarini believes, gets to the root of many patients' health problems.

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Improving Health with CBD Cannabis and CBD provide unique opportunities for improving patients' health because they can act as stimulants to the brain. "We have a whole system in our body that is made to just respond to plant-like molecules like cannabis," Piermarini said. "There's a lot of healing properties behind cannabis." According to Piermarini, cannabis has zero overdose deaths. "There are no receptors on your brain stem that will suppress your breathing, unlike opioids," he explained. Cannabis affects the brain and helps increase energy production. It also has shown to be a suitable replacement for opioids because it helps rewire the brain's neural pathways and doesn't pose the overdose risk.

Piermarini also offers a more controlled environment for patients to try cannabis as a natural alternative to their ailments. In integrative medicine, medications and dosages are tailored to the patient's needs and then tailored again after monitoring the first-round results. This involved process can reap better results, as all of a person's health variables are considered. "It's

collaborative

authoritative one," he said.

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effort

than

Starting the Conversation Piermarini is a vocal advocate for CBD and natural medicine. He is a speaker for the USA CBD expo, Lucky Leaf Expo, and The CBD Expo and would have spoken at the World CBD Expo if not for CV-19. He continues to write and create resources for patients and doctors. He co-authored a review paper about how CBD works for pain management and was a lead author for a letter to the editor calling for more legitimate CBD products. He also finished his first book titled, "CBD Education From A Medical Professional”, to continue to help educate patients and other medical professionals about CBD. His book is available on Amazon and Kindle. When CV-19 affected his clinic, Piermarini took the opportunity to create an online course for medical professionals and laypeople to educate them about CBD, the endocannabinoid system, and the difference between cannabis and hemp. "I think it's a great place to at least get people up to speed and understand the vernacular and what the endocannabinoid system is," he said. Piermarini wants to educate people properly, especially since other resources on marijuana can fall to the extreme. "CBD is not a cure-all for everything," Piermarini stated. Currently, Piermarini is working with the Arizona state legislature to allow physician assistants to prescribe medical marijuana. "I'm working closely with a few legislators, and they just floated a bill right now for me to give all PAs and NPs the ability to recommend medical marijuana to our patients." The work has just begun for PA Charlie Piermarini, but he has a balanced view of the situation. More people are seeking natural alternatives to their medicine, and that's encouraging.

"Vaccines are great antibody therapies, but all these other medications we're doing are like Hail Mary's," Piermarini said. "If we were a society that prioritized primary prevention of disease, such as activity, eating a well-balanced diet, good supplements, getting good rest, I think we would have been in a little bit better of a situation." You can learn more about CBD and Piermarini's work here.

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5 Reasons You Might Be Feeling Cold All the Time By Joseph P. Smalley

To feel cold when out in the cold is one thing, but feeling icy when other people nearby feel rather toasty hot is another. For women, the condition is not uncommon - partly due to physiology and partly due to susceptibility to factors promoting coldness. Concerning medical causes, it is not safe to be just

guessing.

Medical

conditions

need

checking and confirmation by a specialist. To unravel the cause of the problem, the specialist needs to know the patient's history and have him/her undergo a physical exam. Laboratory and imaging works are helpful as well. Reasons why some people constantly feel cold include (but not limited to):

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#1: Hypothyroidism Always being cold can be a telltale sign of slow metabolism due to a thyroid malfunction. In hypothyroidism, the malfunction is about this gland being unable to secrete enough thyroid hormone. Such a condition prevents the body from generating an adequate amount of heat. Accompanying signs include fatigue, dry skin, thinning hair, and cold hands and feet. About 4.5% of Americans suffer from this condition, which is more prevalent among women who have been pregnant recently and are 60 years old and above. A suspected thyroid problem needs checking by a physician to confirm a diagnosis using a blood test.

Hypothyroidism symptoms are not exclusive to this condition. Other conditions with the same symptoms include anemia and inefficient circulation. These conditions generally result in a low body temperature.

#2: Anemia Not having adequate levels of iron is another reason for being always cold. Iron helps the red blood cells carry oxygen throughout the body. Heat and energy production requires a sufficient supply of oxygen all the time. In some cases, it is not a deficiency in iron that is the culprit for developing anemia. The American Society of Hematology (ASH) explains that the condition may also result from the body's inability to produce enough red blood cells. It may also be that the body is destroying too many red blood cells or losing blood due to some conditions.

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Any of these causes lead to a lack of oxygen supply and poor circulation. In such a case, the patient receives less circulation to the limbs and feels cold in these parts, particularly in the hands and feet. Anemia's symptoms include: Chest pain Awareness of the heart beating Headache Dizziness Lack of energy Shortness of breath

#3: Too Low Body Mass Index (BMI) The healthy BMI range is between 18.5 and 24.9. A person who has a BMI of less than 18.5 falls within the underweight range. This low level of BMI can make that person feel chilly even in normal conditions. Being too underweight can mean a person is too thin and has not enough body fat to provide enough insulation against cold temperatures. Some people intentionally maintain a low BMI, and for them to do that, they reduce their food intake. It is worse if they are not eating much at all. Skimping on calories pushes the brake against metabolism, which reduces efficiency in producing enough energy and heat.

Also, if the weight loss stems from a lack of caloric consumption, it can cause a slowing down of metabolism and reduced efficiency in temperature regulation. Increasing healthy foods with lots of protein, carbohydrates, and fats may be the best solution to this problem.

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#4: Lack of Sleep Proper temperature regulation also relates to getting enough sleep. A person that does not get enough sleep may feel being constantly on ice. The reason has something to do with a mess that happens with the person's circadian rhythm due to disturbance in sleep patterns. As part of the system's normal processes during sleep, the body temperature drops while melatonin production increases. The circadian melatonin rhythm is associated with sleep rhythm. Aging, certain diseases (diabetic neuropathy, degeneration of the autonomic nervous system, Alzheimer's diseases, etc.), and drugs such as anti-inflammatory agents and beta-blockers eliminate melatonin production. If you suspect one of these conditions affects your sleep, talk to your doctor. He may consider prescribing a melatonin treatment. Melatonin is not a sedating substance. It has sleep-promoting effects similar to the natural physiological sequence people experience at night. Under the condition of insufficient sleep, the body thinks that there is a need to doze off. In such a condition, the circadian rhythm naturally lowers the body temperature, and the person can feel colder. Nonetheless, talk to your doctor to establish the root cause of why you do not get enough sleep. Getting enough sleep will help restore your body's natural thermostat to the right setting.

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#5: Being a Woman Being a woman makes a person also susceptible to the condition. Experts call it "the gendered condition." It means that the female body conserves heat better than the male body. The female body does it by directing and maintaining more blood flow to the larger organs (heart, brain, kidney, etc.). This tendency causes less blood flow to smaller and more distant organs such as the feet and the hands, leaving these parts in a woman feel colder than in a man. Other reasons to check for why you are feeling cold include: Dehydration: the water level in the plasma is low Lack of vitamin B12: like iron, vitamin B12 keeps the red blood cells healthy Diabetes: Diabetes can cause circulation issues Anxiety and panic attacks: cold sensations are common symptoms of anxiety Raynaud's disease: this disease makes blood flow go into a temporary spasm

Conclusion When feeling cold all the time, there is no reason to panic. Get to the root cause of the problem and remember: the usual cause of feeling cold all the time is just poor circulation. Feeling cold all the time is not something that should affect your general well-being. Nonetheless, your condition needs an assessment by an expert to know the root cause of your problem. Make sure that you consult your physician. He will run tests to determine whether it is anemia or a thyroid issue causing you to feel cold all the time. Get enough sleep and exercise to improve your circulation. Walking at any pace is a good form of exercise for people with such a problem. Walking, as a form of exercise, increases blood flow throughout the body. Massaging your fingers and toes can increase your body temperature as well.

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Brianna Connors

Justin Miller

Derek Archer

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Top Doctor Awards with Richard MacDonald Our annual Top Doctors Awards recognize and reward doctors who are outstanding in their field. To participate, you must be nominated in your category.

Why the Blind Faith Statue? Richard MacDonald's statues are known around the world for their elegance and craftsmanship. We've chosen his Blind Faith Statue to represent our prestigious awards given to Top Doctors around the nation each year to capture the delicate and heroic juggling act our doctors face each day to save lives and deliver better health and wellness.

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