Archive For: Medical Conditions

The Age of Anxiety

Higher Anxiety? Our ‘age of anxiety’ began four centuries ago

It can come on suddenly and intensely, causing shaking, confusion and difficulty breathing for no apparent reason…trigger an irrational avoidance of elevators or public transportation…or become a steady drumbeat of worry always in the background. All are known as anxiety disorders, one of the country’s most commonly experienced yet largely untreated mental health issues. Is our era of 24/7 disturbing news, packed schedules and often unrealistic expectations spurring a rise in these disorders, or does it just seem that way?

Modern life can be disquieting, but the truth is that anxiety disorders have always impacted large numbers of people around the world. Consider this description of Hippocrates’ patient in 1621’s The Anatomy of Melancholy: “He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick; he thinks every man observeth him” – a classic case of what would now be diagnosed as social anxiety disorder. Recent research notes that anxiety disorders may be under-recognized and under-treated, but there is no evidence that its prevalence has increased. While the incidence rose from 9 to 15 percent in college students since 2009, according to the Journal of American College Health, the authors attribute the finding to a greater willingness to admit having a mental health issue and increased acceptance of it as a bona fide health problem.

Constant anxiety undeniably takes a toll on health, potentially increasing levels of the stress hormone cortisol and raising blood pressure and may drive inflammation and plaque formation that leads to heart attack and strokes. A reaction to stress that occurs in a region of the brain called the amygdala, anxiety prepares people to confront a crisis by putting the body on alert. The ‘fight or flight’ response serves us well when faced with actual danger but is counter-productive when dealing with worries around work, money, family life or health. However, it’s only when daily function is affected that a disorder is diagnosed, as shown below:

Everyday Anxiety: Worry about finances, health, family or other important life issues
Anxiety Disorder: Constant and unsubstantiated worry that causes significant distress and interferes with daily life

Everyday Anxiety: Embarrassment or self-consciousness in an uncomfortable or awkward social situation
Anxiety Disorder: 
Avoiding social situations for fear of being judged, embarrassed or humiliated

Everyday Anxiety: A case of nerves or sweating before a big test, business presentation, stage performance or other significant event
Anxiety Disorder: 
Seemingly out-of-the-blue panic attacks and preoccupation with the fear of having another one

Everyday Anxiety: Realistic fear of a dangerous object, place or situation
Anxiety Disorder: 
lrrational fear or avoidance of an object, place or situation that poses little or no threat of danger

Everyday Anxiety: Anxiety, sadness or difficulty sleeping immediately after a traumatic event
Anxiety Disorder: Recurring nightmares, flashbacks or emotional numbing related to a traumatic event that occurred several months or years before

The American Psychology Association defines these types of anxiety disorders (obsessive-compulsive disorder and post-traumatic stress disorder are now categorized separately):

  • Generalized anxiety disorder (GAD): the most common, it’s characterized by excessive, long-lasting worries about nonspecific life events, objects and situations.
  • Panic disorder: brief or sudden attacks of intense terror and apprehension, leading to shaking, confusion, dizziness, nausea and breathing difficulties; can occur with or without a particular trigger.
  • Specific phobia: irrational fear of a particular object or situation.
  • Agoraphobia: fear of places, events, or situations, especially open spaces, that may cause you to panic and feel trapped, helpless or embarrassed.
  • Social anxiety disorder: fear of negative judgment from others in social situations or of public embarrassment.
  • Separation anxiety disorder: not exclusive to youngsters, but also experienced by adults who feel disconnected from a person or place that provides feelings of safety or security.

Additionally, anxiety disorders may play a role in exacerbating other conditions such as irritable bowel syndrome (IBS), chronic respiratory disease and heart disease.

Reassuringly, the number of treatment options, both pharmaceutical and non, has grown. Most effective is a combination approach of psychotherapy (cognitive-behavioral therapy, focused talk therapy or exposure therapy), stress management (deep breathing, meditation and yoga) and antidepressant and/or anti-anxiety medications.

Finally, considerable benefits are seen from a healthy lifestyle – reduced intake of caffeine, tea, cola and chocolate, avoidance of recreational drugs and excessive alcohol, and emphasizing exercise, a nutritious diet, and most importantly, a good night’s sleep. According to a recent University of California at Berkley study, the amygdala was particularly stimulated when sleep deprived, mirroring that of anxiety disorders, suggesting that sleep therapy could reduce anxiety in people suffering from panic attacks, GAD and other conditions.


Did You Know?

40 million

People in the U.S. affected by anxiety disorders
Source: NIMH.gov

37%

Percentage of Americans with an anxiety disorder who receive treatment
Source: ADAA.org

The Enemy Within: Autoimmune Disease is on the Rise

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A condition that is thought to have tripled in prevalence over the last 50 years, impacting over 23 million people, could justifiably be seen as an epidemic, or at least, a growing health concern. Autoimmune diseases, though, are not often thought of in that way because they manifest as 80+ different illnesses that nevertheless share the same root cause: a malfunctioning immune system that mistakenly attacks its own tissues. Virtually every human organ system can be impacted: the brain and spinal cord in multiple sclerosis, the skin in psoriasis, the joints in rheumatoid arthritis, the intestines in Crohn’s disease and ulcerative colitis, the insulin-producing cells in the pancreas in Type 1 diabetes, the thyroid in Hashimoto’s disease, among others.

Ironically, 100 years ago, Nobel Prize-winning immunologist Paul Ehrlich, MD, was openly skeptical of a concept in which the body turns on itself, calling it “horror autotoxicus” (literally, the horror of self-toxicity). That set back acceptance of autoimmunity another half century, according to today’s leading neuro-immunologists. Now we are beginning to recognize the pervasiveness of autoimmune disease and develop therapies based on new research into its complex causes.

Notably, the gut, which houses 80 percent of the immune system, has come under increased scrutiny for the role it can play in causing disease. One theory posits that a ‘leaky gut’ may allow undigested food particles, microbes and toxins to enter the blood stream, and trigger inflammation that goes on to
disrupt the proper functioning of the immune system.

There is also a growing consensus that these diseases result from complex interactions between genetic and environmental factors. Autoimmune disease is commonly clustered in families, but may affect different organs. For example, a mother may develop rheumatoid arthritis while her daughter copes with juvenile diabetes, her sister has Hashimoto’s thyroiditis, and her grandmother deals with Graves’ disease. Environment and lifestyle may contribute to the increased incidence of these diseases, including chronic stress.

For the many living with an autoimmune condition, there is hope in the form of new medications, advanced treatments and genuine breakthroughs in the precision medicine approach. Experts predict substantial advances in the next decade, fueled by more than 310 medicines and vaccines for autoimmune diseases already in clinical trials or awaiting review by the Food and Drug Administration (FDA). Options go well beyond simply relieving symptoms or replacing substances destroyed by the disease, including:

  • Therapies to suppress the immune system and preserve organ function, such as methotrexate, used to treat cancer, now also successfully used for rheumatoid arthritis and several other autoimmune diseases.
  • Real progress in biologics, which target specific enzymes and proteins. Monoclonal antibody medicines are being used to block inflammation in rheumatoid arthritis, preventing irreversible joint damage and enabling remission; to inhibit the activity of proteins implicated in Crohn’s and colitis and systemic lupus erythematosus; and are newly approved by the FDA to neutralize inflammatory processes linked to psoriasis.

Running on a parallel and complementary path are natural methods, which continue to gain traction. Areas under investigation include: reducing foods high in sugar and saturated fat, practicing de-stressing techniques, lowering the toxic burden caused by constant exposure to environmental factors and restoring intestinal health with a diet that includes prebiotic and probiotic foods.

Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower

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If you’ve ever wondered why a blood pressure check is part of almost every visit to a doctor’s office, consider what is communicated through the familiar black cuff in just a few seconds. The force of blood pushing against the walls of the arteries as the heart pumps is a critical measure of how well your heart muscle works – systolic blood pressure (SBP, or the top number of a reading) measures the pressure in the arteries when the heart beats; diastolic blood pressure (DBP, or the bottom number) refers to the pressure in the arteries when the heart muscle is resting between beats and refilling with blood.

Readings that exceed the norm, hypertension or high blood pressure, indicate an increased risk of heart attack, stroke and kidney failure. However, exactly what constitutes ‘normal’ blood pressure for optimal health has been debated and tested for decades, and recommendations have fluctuated over time. While the gold standard is under 120 mm Hg/80 mm Hg, the targets for treating hypertension have varied over the years – less than 140/90 in the 1990s, down to 130/80 in 2003, raised to a controversial 150 or less in 2014, and retreating to less than 140 in 2015.

At the end of 2015, a landmark study of more than 9,300 patients, the Systolic Blood Pressure Intervention Trial (SPRINT), moved the needle down even further. Those who were treated most aggressively to drive down blood pressure to 120/80 experienced a significantly lower risk of cardiovascular events, chronic kidney disease, and death. In fact, the outcomes were so convincing that the trial was actually halted after just three years, much sooner than planned, leading the American Society of Hypertension to state: “The early termination of this trial represents an exciting moment in the history of hypertension treatment.” Still, notes of caution were sounded because multiple medications were required, sometimes causing adverse side effects, and experts
agreed more study was needed to justify changes in clinical practice.  Additional evidence followed this year, with an analysis of adults aged 75 years and older who participated in the SPRINT study. The benefits of lowering blood pressure to 120 were even more pronounced, resulting in a one third reduction in risk of cardiovascular events and death, even among the frailest older patients. This finding could benefit almost six million seniors over 75 with elevated blood pressure, according to the Journal of the American College of Cardiology.

While the outcomes are promising, and point in an even more downward direction, experts have not yet reached a consensus on optimal blood pressure targets. For now, hypertension patients should consult with their doctor to determine whether this lower goal is best for their individual care.

Who’s at risk? Virtually everyone

Even those who don’t have high blood pressure by age 55 face a 90 percent chance of developing it during their lifetime, so learning how to identify, prevent and control hypertension can benefit us all.  Consider these best practices:

Identify.

  • Regular checkups are key, as people can live with high blood pressure for years without experiencing any symptoms while internal damage to other parts of the body may be silently occurring.

Prevent.

  • Keep a healthy weight: in an overweight person, every 2 pounds of weight lost can reduce SBP by 1 mm Hg.
  • Eat well: a diet rich in fruits, vegetables, and lowfat dairy products can reduce SBP by 8 to 14 mm Hg.
  • Limit sodium: (see Nutrition Corner, below)
  • Keep active: 30 minutes of aerobic activity most days of the week can reduce SBP by 4 to 9 mm Hg.
  • Moderate alcohol consumption: for women, a single drink a day may lower SBP by 2 to 4 mm Hg.
  • Quit smoking: not only does smoking raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls.

Control.

  • If lifestyle measures alone are insufficient, your physician will determine the appropriate medication, which may include diuretics, beta-blockers or ACE inhibitors.

Joint Assets

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The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered an inexorable result of aging. According to conventional wisdom, cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving, allowing the bones to rub together. When medications and physical therapy no longer provide relief, a costly and time-intensive mechanical joint replacement may be the only solution. However, advances in research and a focus on prevention are providing
a new outlook on an ageold problem…we bring you the latest insights, below.

Prevention

The connection between overweight and OA is even stronger than previously thought. Recent studies show that up to 65 percent of cases of OA of the knee could be avoided if weight was reduced. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably. For women, extra weight is even more of a risk factor than men. In addition, fat tissue produces proteins called cytokines that cause inflammation, and in the joints, this can alter the function of cartilage cells.  Gaining weight results in your body releasing more of  these harmful proteins. However, losing even a few pounds can reduce joint stress and inflammation and decrease by half the risk of OA.

Avoid practicing a sport in an intensive and prolonged way. An injured joint is nearly seven times more likely to develop arthritis than one that was never injured. The condition is now seen more frequently among 30 to 50-year-olds than previously because young athletes or middle-aged ‘weekend warriors’ who tear their anterior cruciate ligament (ACL) or menisci of the knee have a much higher risk of osteoarthritis 10 to 20 years after their injury. Take steps to manage or prevent diabetes, which may be a significant risk factor for OA. Some studies suggest high glucose levels trigger the formation of molecules that make cartilage stiffer and less resistant to stress, and cause inflammation that leads to cartilage loss.

Management

Low impact exercise is key to living well with osteoarthritis. While resting aching joints can bring temporary relief, lack of movement will ultimately lead to more discomfort.
Exercise strengthens the muscles around the joint, acting like a shock absorber, helping to reduce pain. In addition, exercise helps with weight control and is a natural mood elevator. Experts recommend low-impact activities like swimming, walking, biking, and moderate weight lifting. The Arthritis Foundation developed a form of tai chi specifically for people with arthritis,
featuring agile steps and a high stance, that helps increase flexibility and improve muscle strength inthe lower body.

Some new approaches to pain management show promise, but beware of unsubstantiated claims. Platelet-rich plasma (PRP) injections, which involve withdrawing blood, spinning
it to separate the platelets and then injecting the concentrated platelets into a joint, are being studied for long-term effectiveness.  Experts advise against costly supplements such as glucosamine, chondroitin and shark cartilage, all of which have proven of little benefit for people with OA. Some elements of Chinese medicine, including herbs and acupuncture, may help control OA symptoms in some people, but these therapies have not yet been confirmed in large, well-designed clinical studies. Also unproven are low-power laser light, copper bracelets or magnets, chiropractic manipulation and acupressure. The most effective over the counter medication are NSAIDs (non-steroidal anti-inflammatory drugs such as Advil). While Tylenol helps reduce pain and is the safest medicine for older people or those with kidney disease, it does not lower inflammation.

Finally, if you do need an orthopedic implant in the future, take comfort in the fact that development of the next generation of devices is well underway. They will likely be biologic, composed of protein and cells instead of metal and plastic,…functioning as well as a normal joint and created to last a lifetime.

In Our Sights: Sharper Focus on Macular Degeneration Offers New Hope

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In the not so distant past, age-related macular degeneration (AMD), characterized by a loss of central vision, was deemed just another unfortunate consequence of growing older. The gradual breakdown of light-sensing retinal tissue that results in a blind spot directly ahead has caused each generation to struggle with driving a car, reading a printed page or recognizing a friend’s face. As the population ages, the sheer number of people affected grows rapidly. Another case of AMD is diagnosed every three minutes in the U.S. More than 2.1 million Americans with advanced AMD now will grow to 3.7 million by the year 2030, according to the National Eye Institute, who warns the condition will soon take on aspects of an epidemic. A surge of clinical trials and investigative research aims to prevent that from happening, with sights set firmly on restorative, curative solutions.

Scientists exploring the possible causes have made much progress isolating a group of genes that increases the likelihood of an individual developing AMD. Other studies point to inflammation as the trigger. The macula needs a constant, rich blood supply to work correctly, and any interference such as narrowing of the blood vessels, fatty plaque deposits, or a shortage of antioxidants, can cause the macula to malfunction and become diseased.

Treatments have likewise advanced. Last fall, a decades-old drug used to treat HIV/AIDS was reported in Science as unexpectedly exhibiting the capability to halt retinal degeneration. Nucleoside reverse transcriptase inhibitors, known as NRTIs, are already FDA-approved and can be rapidly and inexpensively translated into therapies for both dry and wet AMD (see sidebar), say the study’s authors. At the same time, a nanosecond laser treatment was successfully used to reduce drusen (small fatty deposits beneath the retina) and the thickening of Bruch’s membrane, both hallmark features of early AMD. Importantly, the structure of the retina remained intact, suggesting “this treatment has the potential to reduce AMD progression,” according to Medical News Today. Stem cell transplantation shows enormous promise, as reported in Lancet, with sight restored long-term to a group of patients with severe vision loss. Additionally, injectible drugs and pills that target inflammation associated with AMD are in nationwide trials.

Technological innovations to help AMD patients include the 2013 introduction of a miniature telescope implanted behind the iris to magnify images. Google is moving into the space with a patent for a contact lens containing a built-in camera that will enable audible warnings via a remote device, detect and describe faces, and act as a text reader.

Today’s AMD patients have no shortage of low-vison aids to help them adapt and live well. Google is developing a patent for a contact lens containing a built-in camera that will enable audible warnings via a remote device, detect and describe faces, and act as a text reader. Additional solutions range from ‘smart’ thermostats, watches and remote controls to talking devices.

Finally, understanding who is at risk for developing AMD can be key to prevention. These include: white, female, smoker, family member with AMD, high blood pressure, lighter eye color, obesity, and possibly, over-exposure to sunlight. To minimize risk, follow a healthy diet with plenty of leafy green vegetables and fish high in omega-3 fatty acids, exercise to keep weight and blood pressure under control, eliminate tobacco use, and wear sunglasses to protect from UV rays and high-energy visible (HEV) radiation.

When Dry Becomes Wet

Diagnosis of AMD is first confirmed with a visual acuity exam and testing with an Amsler grid. Those with AMD see the grid’s straight lines as wavy or blurred with dark areas at the center. Additional tests help determine the type of AMD — the dry form affects about 85 percent of AMD patients, and in about 10 to 15 percent of cases, progresses to wet. The difference is significant. The wet form usually leads to more serious vision loss, caused by new blood vessels that leak fluid and blood beneath the retina, resulting in permanent damage. While no treatment currently exists for dry AMD, in the last decade, a number of effective therapies have been implemented for wet AMD. These include monthly, intraocular injections (anti-VEGF) to inhibit a protein that stimulates formulation of new blood vessels, photodynamic or ‘cold’ laser treatment, thermal (heat) laser photocoagulation…and on the horizon are topical eyedrops that may someday replace injections. Nutritional supplements containing antioxidant vitamins, lutein and zeaxanthin are also effective in reducing the chances of dry AMD worsening to wet.

A Quick Spin on Dizziness, Vertigo and Other Balance Disorders

Common, rarely life-threatening, but very unsettling, an attack of dizziness or vertigo can send your world into a spin with simple acts like turning around to back up a car, bending down to tie a shoe or looking up at the sky.

A range of sensations may keep you off balance, from tilting, swaying, whirling and floating, to feeling lightheaded, or conversely, heavy-headed. The swirl of symptoms may seem similar, but there are important differences that define these conditions:

  • Dizziness: lightheadedness, faintness
  • Vertigo: spinning, a sense that the room is moving, akin to the tipsy feeling from too much alcohol
  • Disequilibrium: unsteadiness, a feeling you are about to fall

While dizziness or vertigo represent some of the most frequent reasons people visit their doctors – an estimated one out of four adults has sought treatment for the condition at some point – getting to the root cause can sometimes be a frustrating experience, say experts at the Vestibular Disorders Association. That is because numerous issues can trigger dizziness/ lightheadedness, from cardiovascular concerns such as arrhythmia, atherosclerosis and low blood pressure or conditions such as dehydration, low blood sugar or anemia. Vertigo is caused by head injuries/trauma, disorders of the vestibular system (parts of the inner ear and nervous system that control balance) or rarely, the cerebellum. In addition, aging itself can affect the vestibular system’s function by decreasing the number of nerve cells, and diminishing blood flow to the inner ear.

Lyme Disease: Solving the Puzzle

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Unsurprisingly for an illness known as “The Great Imitator,” the misconceptions surrounding Lyme Disease continue to proliferate. Acute or chronic? Highly treatable or stubbornly resistant? Misdiagnosed because of symptoms that mimic conditions like lupus, multiple sclerosis, Parkinson’s and Lou Gehrig’s disease, or overestimated for the same reason? While television celebrity Yolanda Foster recently gained national attention during her bout with chronic Lyme disease, she also fanned the flames of controversy surrounding this sometimes mystifying condition. A brief overview of current knowledge follows…however experts have not yet reached a consensus on all aspects of this disease.

Research indicates that Lyme disease is transmitted to humans by a bite from a tick infected by the spirochete bacteria, primarily found on the East Coast and in the Midwest. Carried by deer and migratory birds, Lyme disease is on the rise, estimated at 300,000 cases annually in America, considerably larger than the 30,000 cases earlier reported by the Centers for Disease Control (CDC).

The distinctive bull’s eye rash is one identifiable marker of the disease, seen in 70 percent of patients. In the early stages, fatigue and flu-like aches and pains are typical; in later stages, nerve numbness or pain, facial paralysis or weakness, and heart problems are seen; and if not treated, serious and long-term complications that affect the brain, joints, nerves, heart and muscles can occur, according to the Lyme Research Alliance.

Lab tests are generally needed to confirm the diagnosis, followed by a course of oral antibiotics. However, people with early Lyme disease do not develop antibodies for several weeks, resulting in frequent false negatives on the commonly used ELISA or Western Blot antibody tests. For that reason, treating patients based solely on clinical findings, such as a rash and known exposure to ticks, is recommended by some experts, while others advise more aggressive, longer and individualized treatment. All agree, however, that earlier treatment is more effective.

About 20 percent of patients with Lyme disease continue to experience symptoms months and years after treatment ends…and this is where the real debate begins. Muscle and joint pain, cardiac and neurological problems and fatigue have been reported by those with chronic Lyme disease. Some experts believe it indicates an ongoing bacterial infection, while others attribute lingering symptoms to residual damage to tissue and the immune system. Still others, including Dr. Allen Steere, who first recognized Lyme disease back in 1975, say it is being over-diagnosed, mistaken for chronic fatigue or chronic pain.

The continued questioning spurred John Aucott, MD, assistant professor of rheumatology at Johns Hopkins University School of Medicine and founder of the Lyme Disease Research Foundation, to launch the nation’s first controlled study examining long-term health and outcomes of the disease.

“It does no good to keep debating the existence of long-term problems related to Lyme disease while people are suffering a debilitating illness. These patients are lost. No one really knows what to do with them. It’s a challenge, but the first thing we need to do is recognize this is a problem,” he said.

The headwinds have been strong. Lyme disease ranks well below breast cancer and HIV/AIDS for federal funding, despite a significantly higher rate of cases, according to lymedisease.org, but Aucott’s study and others represent hopeful progress.

In the meantime, decrease your risk of contracting Lyme disease by wearing shoes, long pants tucked into your socks, a long-sleeved shirt, hat and gloves when walking in woodsy areas; sticking to trails and avoiding low bushes and long grass; and using insect repellents with a 20 percent or higher concentration of DEET. If you are bitten by a tick, call my office promptly, but do not panic…your chances of acquiring Lyme disease are no more than 1.4 percent.

Medical Mysteries – Sneeze, Shivers, Yawns, Goose Bumps and Hiccups

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The miracles of the human body are on continual display each day. Even involuntary actions, such as sneezing and shivering, help our bodies function optimally.

The big sneeze.

Every time we breathe in foreign particles, sensors in our noses and sinuses detect this, and signal the cilia (hairlike structures that line the nostrils) to sweep mucus and trapped debris upward to be eliminated. We constantly produce mucus – about four cups a day on average. The mucus is either swallowed, pushed out through the lungs, or sneezed out. The sneeze produces a burst of air which neatly clears the nasal passages, almost like pressing the reset button on your computer. For almost 16 million Americans with chronic sinusitis, however, the mucus is the problem. As reported in the Journal of the Federation of American Societies for Experimental Biology, researchers discovered that people with chronic sinus issues are not able to ‘reboot’ and clear the mucus from their nose, causing them to sneeze more often, with ineffective results. Post-nasal drip occurs from the additional mucus, which drips continuously down the nose or throat of sinus sufferers, according to Harvard Health Watch.

Shivers and yawns.

The brain is constantly monitoring, responding and adjusting to stimuli. Shivering and yawning are two automatic and subconscious regulatory body functions controlled by the brain. When the surface of the skin gets chilled, receptors send signals to the brain, which activates the body’s warming reflexes. Shivers occur when the muscles in your arms, legs and jaw contract and expand quickly. As one of nature’s best defenses against hypothermia, shivering is the body’s way of producing heat within the skeletal muscles in order to maintain a core temperature of 98.6°F.

Surprisingly, the true function of yawning might also be to maintain correct temperature in the brain, not to get more oxygen, as previously assumed. The human brain works hard, and tends to heat up more than other organs, according to Smithsonian Magazine. When you yawn, the gulp of air produced travels up to the nasal and oral cavities, and increases the rate of blood flow to the skull; inhaling at the same time brings cooler blood to the brain. This explains why we yawn more frequently at bedtime or upon awakening, as brain temperatures are highest before falling asleep, decline during the night, and rise rapidly in the morning.

Goose bumps.

Triggered by a variety of unrelated events – from the chill you feel after leaving warm water or when entering an overly-air-conditioned restaurant, to watching a horror movie, or even hearing the national anthem – goose bumps are a physiological reaction to both emotion and cold temperature. They result from a contraction of muscles attached to your hair follicles, creating a shallow dimple on the skin surface and making the hair on your head, arms and legs literally stand on end. This gives your skin a strong resemblance to that of plucked poultry. Caused by the subconscious release of the stress hormone, adrenaline, add goose bumps to the sweaty palms, trembling hands and stomach butterflies many experience during strong emotions.

Hiccups.

Hiccups are involuntary contractions of the diaphragm that occur when the vagus nerve, which runs from brain to abdomen, becomes irritated. There are many causes, from digestive disturbances to sudden excitement. As you inhale with each spasm, the opening that permits air to pass through the voice box snaps shut, creating the characteristic “hic.” From the literally hundreds of home remedies suggested for eliminating hiccups, the NY Times recommends: taking a deep breath and holding it, gargling with ice water, putting pressure on the eyeballs, or the tried-and-true method of breathing in and out of a paper bag. Mayo Clinic recommends contacting your physician if you have hiccups consistently for more than 48 hours.

Don’t take them for granted: however common, each yawn, sneeze, shiver, goose bump and hiccup represents a small medical marvel.

Peripheral Neuropathy

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It can start as “pins and needles,” as if your hand or foot has fallen asleep, followed by burning, feelings of electric shock, muscle weakness, or extreme sensitivity to the lightest touch. Peripheral neuropathy (PN) is a chronic and painful condition which involves damage to the nerves outside the brain and spinal cord. This condition is more common among older adults.

There are over 100 known types of neuropathy, a third of them are idiopathic, meaning the cause is unknown. Neuropathy is often difficult to diagnose, is frequently mistaken for other disorders, or even dismissed as something that is imagined. Increased awareness of neuropathy is important, because early diagnosis can result in effective treatment which will allow peripheral nerves to slowly regenerate. Also, pain can be managed, restoring quality of life. If ignored, symptoms may intensify to include loss of sensation, lack of coordination, weakness, dizziness, digestive disorders, unremitting pain and disability.

Who is at the greatest risk of developing peripheral neuropathy? Consider the risk factors which could cause the onset of this disease. They include traumatic injuries, infections, autoimmune disease, repeated nerve pressure, metabolic disorder and exposure to toxins. But by far the greatest risk factor exists for those with diabetes. Approximately 60 to 70 percent of all diabetics develop diabetic peripheral neuropathy (DPN), and that risk rises with age and longer duration of diabetes, reports the National Diabetes Information Clearinghouse.

As a result of the increasing number of diabetics in the United States, as well as chemotherapy survivors, another high risk group, the incidence of peripheral neuropathy continues to climb. Awareness of this disease, however, remains at a very low seven percent. Many more people are affected than the 1-in-15 currently reported, according to Tina Tockarshewsky, president and CEO, The Neuropathy Association. Previously, 20 million Americans were diagnosed with the condition, but another 79 million people with pre-diabetes are also at risk for developing DPN. “We are all gravely underestimating the millions of people struggling and suffering with neuropathies,” contends Tocharshewsky.

The severity of the condition varies depending on the location and type of the affected nerves, according to Medical News Today. Motor nerve damage can leave patients with muscle weakness, cramps, spasms, a loss of balance and coordination, and heaviness of the lower extremities, making it difficult to walk or run. Damage to arm nerves may make it difficult to do routine tasks such as opening jars or turning door knobs. Sensory nerve damage can cause tingling, numbness, pinching and pain, and frequently patients report a sensation of wearing an invisible glove or stocking. Autonomic nerve damage affects internal organs and involuntary functions which can lead to abnormal blood pressure and heart rate, reduced ability to perspire, constipation, bladder dysfunction, diarrhea, incontinence, sexual dysfunction and thinning of the skin. If you experience any of these symptoms, it is of utmost importance to discuss them promptly with your physician. A referral to a neurologist for a complete workup may be indicated.

Even if the underlying cause cannot be identified or corrected, there are fortunately a number of highly effective ways to control pain and restore function. Not surprisingly, one of the top recommendations from Mayo Clinic is a healthy lifestyle: a diet rich in fruits, vegetables, whole grains and lean protein, especially foods with vitamin B-12 (meats, fish, eggs, low-fat dairy foods and fortified cereals), regular exercise, drinking only in moderation, and no smoking at all. For diabetic patients, management of blood glucose levels is essential, along with the same healthy lifestyle choices listed above.

A wide variety of prescription medications have been proven to control pain in neuropathy patients. Additionally, according to a new study from the University of Texas, anti-oxidants appear to offer great potential in the ongoing quest to minimize neuropathy pain and improve quality of life. Antioxidant supplements should not be taken without physician approval.

Current research projects funded by the National Institute of Neurological Disorders and Stroke (NINDS) are exploring the implication of genetics, biological factors in diabetesassociated neuropathies, and how the immune system contributes to peripheral nerve damage. Developing more effective therapies for neuropathic pain is also under the microscope at NINDS.

This new research is encouraging for the millions afflicted with any form of this disease. If you are experiencing symptoms or have questions, please consult your personal physician.

Eyes – In Focus

It is safe to assume that many readers of this newsletter put on their reading glasses first! For most of us, vision changes seem to be noticed in our 40’s. We may have first noticed difficulty reading the fine print on a label or perhaps a restaurant menu, particularly when lights are dim. As we age, our eyes are susceptible to various health issues, some common and others more serious.

Reading with a sense of eye strain in middle age results from presbyobia. This common rite of passage for our eyes occurs when the lens can no longer change shape enough to allow the eye to focus clearly on close objects. (The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye.) Presbyobia is commonly addressed with “cheaters” or reading glasses, and sometimes prescription glasses are needed. The lens power may increase as we age.

Many people experience symptoms of dry eye—the inability to produce sufficient tears to lubricate and nourish the eye. Tears help reduce the risk of eye infections, wash away foreign objects, and keep the surface of the eyes smooth and clear. Over-the-counter eye drops can be effective in replacing natural tears. It is also helpful to keep the humidity level high in your home, stay well hydrated, and wear sunglasses outside to protect against the drying wind and sun. If working at a computer screen for long periods of time, remember to blink regularly.

More than half of people age 65 and older have some form of cataracts, often referred to as an age-related eye disease. Cataracts are formed when the lens of the eye begins to cloud. The lens is composed mainly of water and protein arranged to keep the lens clear and let light pass through it. Cataracts are formed when these proteins cluster together and begin to cloud part of the lens. The cataract can grow larger over time, clouding a larger part of the lens and affecting our vision more seriously. Smoking, diabetes and prolonged exposure to the sun also increases risk for cataracts. In more advanced cases, surgery is required. According to the National Eye Institute (NEI), cataract removal is one of the most common operations performed in the United States, with improved vision seen in 90% of the cases.

Some eye conditions that are considered more serious and may to lead to blindness. These include diabetic retinopathy, age-related macular degeneration (AMD) and glaucoma.

Diabetic retinopathy results from changes in the retina’s blood vessels, which can swell and leak fluid. In some cases, abnormal new blood vessels may grow on the retina’s surface. These changes are only visible through a comprehensive eye exam and early intervention is critical. Once a person is diagnosed with diabetes, a complete eye exam is recommended with annual exams thereafter.

Age-related Macular Degeneration (AMD) is most common in people age 50 and older and gradually causes vision loss in the central field of vision. AMD destroys the macula, located at the center of the retina, making it difficult to recognize faces, close objects or to drive, although peripheral vision may be retained. AMD can result in loss of vision in one or both eyes.

Glaucoma causes damage to the eye’s optic nerve when drainage canals become blocked over time. African-Americans, people over 60 and those with a family history of the disease are at higher risk. Glaucoma can result in blindness. Without treatment, people slowly lose their peripheral vision.

The NEI recommends several steps to help maintain eye health. Schedule a comprehen – sive, dilated eye exam at least once every two years and know your family eye disease history. Many serious as well as common eye problems can only be detected with a thorough exam. Wear protective eyewear when appropriate, such as home improvement projects or if required at work. Protect eyes from ultra violet rays by wearing sunglasses outdoors. Don’t smoke. Finally, eat healthy! A diet that includes fruits and vegetables, as well as fish high in Omega 3 fatty acids, has proven beneficial for our eyes.