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Bone Density

The older you get the greater your risk of osteoporosis. Osteoporosis is a bone disease in which bones are brittle, weak and more likely to break. People with osteoporosis most often break bones in the hip, spine, and wrist. There are no signs or symptoms of osteoporosis. You might not know you have the disease until you break a bone. That’s why it’s so important to get a bone density test to measure your bone strength.

A bone mineral density (BMD) test is like an x-ray or scan of your body. A bone density test estimates the true mass of the bone. It doesn’t hurt, and you don’t need to do anything to prepare for it. It only takes about 15 minutes. By measuring BMD, it is possible to predict fracture risk. A BMD test is recommended for all women between the ages of 50 and 65 with risk factors such as family history, bone structure and body weight, and ethnicity, to name a few. The test is recommended for all women over the age of 65. Men and women who take certain medications or have certain diseases should talk to their doctor about having a bone density test, too. Men over 65 who have concerns about osteoporosis, should talk to their doctor about a bone density test.

  • About 40% of postmenopausal women in the U.S. have osteopenia (low bone density). An additional 7% have osteoporosis (substantially low bone density).
  • One in three women and one of five men over the age of 50 will experience a bone fracture related to osteoporosis.
  • About 33% of people who suffer a hip fracture are totally dependent or in a nursing home in the year following the fracture, stressing the importance of early detection and appropriate therapy.
  • Osteoporosis has many available prescription and nonprescription treatment options once the diagnosis is made.

These things can also increase your risk for osteoporosis:

  • Hormone changes (especially for women who have gone through menopause)
  • Not getting enough calcium and Vitamin D
  • Taking certain medicines
  • Smoking cigarettes or drinking too much alcohol
  • Not getting enough physical activity

If you have osteoporosis, you can still slow down bone loss. Finding and treating this disease early can keep you healthier and more active, lowering your chances of breaking a bone.

Get enough calcium.
Calcium helps keep your bones strong. Good sources of calcium include:

  • Low-fat or fat-free milk, cheese, and yogurt
  • Almonds
  • Broccoli and greens
  • Tofu with added calcium
  • Orange juice with added calcium
  • Calcium pills

Get enough vitamin D.
Vitamin D helps your body absorb calcium. Your body makes vitamin D when you are out in the sun. You can also get vitamin D from:

  • Salmon or tuna
  • Fat-free or low-fat milk and yogurt with added vitamin D
  • Breakfast cereals and juices with added vitamin D
  • Vitamin D pills

Get active.
Physical activity can help slow down bone loss. Weight-bearing activities (like running or doing jumping jacks) help keep your bones strong.

  • Aim for 2 hours and 30 minutes a week of moderate aerobic activity. If you are new to exercise, start with 10 minutes of activity at a time.
  • Do strengthening activities at least 2 days a week. These include lifting weights or using resistance bands (long rubber strips that stretch).
  • Find an exercise buddy or go walking with friends. You will be more likely to stick with it if you exercise with other people.

You don’t need special equipment or a gym membership to stay active. Check with your local community center or senior center to find fun, low-cost, or free exercise options.

If you have a health condition or a disability, be as active as you can be. Your doctor can help you choose activities that are right for you.

Stay away from cigarettes and alcohol.

Smoking cigarettes and drinking too much alcohol can weaken your bones. Find ways to stop smoking. If you drink alcohol, drink only in moderation. This means no more than one drink a day for women and no more than two drinks a day for men.

Take steps to prevent falls.

Falls can be especially serious for people with weak bones. You can make small changes to lower your risk of falling, like doing exercises that improve your balance. For example, try walking backwards or standing up from a sitting position without using your hands.

It’s never too late to get on the right track to being and staying healthy!

Time to schedule your check up

How long has it been since you’ve been to the doctor for a wellness checkup. Most of us (mostly men) only go see the doctor if there is something absolutely wrong and we can’t avoid it any longer. But the advantages of seeing the doctor for a checkup when you feel good may help you out in the long-run.

We’re all familiar with the normal questions your doctor will ask about our lifestyle: smoking and drinking habits, caffeine intake, exercise habits, diet, and sexual activity. He will also update your vaccine records and administer those that need updating. A review of your family medical history will also be conducted to see if there is any change in a family member’s health.

If you know we are living a healthy lifestyle, why see your doctor for preventative care?

It’s included in your health insurance. The premium you pay every month for health insurance includes one well check-up per year.

Blood pressure screening. High blood pressure is also known as the silent killer. Even seemingly healthy people can have high blood pressure. Less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.

Heart and respiratory rate: Heart rate values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however. Doctors can also detect an irregular heartbeat, heart murmurs or other indicators of heart disease. An exam will also check your breathing. Twelve to 16 breaths per minute is normal for a healthy adult. But breathing more than 20 times per minute (while resting) can suggest heart or lung problems.

Cholesterol screening. A lipid panel, also known as a cholesterol test is recommended every four – six years, according to the American Heart Association. Your doctor might check more frequently if you have risk factors for heart disease. Abnormal cholesterol level increase the risk for heart attacks and strokes.

HIV screening. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. Learn the risk factors for HIV.

Diabetes (Type 2) Screening. According to the American Diabetes Association, all patients should be screened for diabetes at three-year intervals beginning at age 45, especially people who are overweight or obese. If multiple risk factors are present, screening should be done at an earlier age and more frequently. The U.S. Preventive Services Task Force recommends that adults with high blood pressure or high cholesterol be screened for type 2 diabetes (insulin-resistant diabetes) in an effort to reduce cardiovascular disease.

Obesity Screening. Part of your check up will include getting your height and weight to determine your body mass index (BMI). BMIs of 30 or above are termed obese. A BMI of 25 to 29.9 is overweight. Normal BMIs are 18.5 to 24.9.

Colorectal cancer. At age 50, it’s time to begin regular screening for colorectal cancer. If you have an immediate family member with colorectal cancer or other risk factors you may need to be screened before age 50.

For obvious physiological reasons women and men each have their own unique sets of recommended tests as part of their annual physicals.

For women, breast cancer mammography, cervical cancer screening, and the human Papillomavirus (HPV) DNA Test are recommended.

For some women, age 40 marks the time to begin annual mammography screening for breast cancer. The American Cancer Society recommends that women ages 40 to 44 should have the choice to start mammograms if they wish to do so. Women age 45 to 54 should get mammograms every year, while women 55 and older should switch to mammograms every two years, or can continue yearly screening.

Screening for cervical cancer is recommended for women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval.

The most important risk factor for developing cervical cancer is infection with HPV. Doctors can now test for the HPV (high-risk or carcinogenic types) that are most likely to cause cervical cancer by looking for pieces of their DNA in cervical cells. The test can be done at the same time as the Pap test, with the same swab or a second swab. You won’t notice a difference in your exam if you have both tests.

For men, their annual exam may include testicular exam, a penis and prostate exam,  and a hernia exam.

In a testicular exam, a doctor can check each testicle for lumps, tenderness or changes in size. Most men with testicular cancer notice a growth before seeing their doctor. A doctor will also check a man’s penis for evidence of sexually transmitted infections such as warts or ulcers. The prostate is also examined by feeling the prostate (via the rectum) for its size and any suspicious areas.

During a hernia exam, doctors check for weakness in the abdominal wall between the intestines and scrotum.

During routine exams for both men and women, your doctor can gather information from you based on your general appearance by watching and talking to you. They can assess how healthy your skin appears, how is your memory serving you, and if you can stand and walk easily.

Doctors will also look at your throat, and tonsils, check the quality of your teeth and gums, and your ears, nose, eyes, lymph nodes and thyroid for any unusual signs.

An abdominal exam can detect the size of your liver, presence of abdominal fluid, and listening to bowel sounds. This exam also checks the tenderness of your abdomen.

Reflexes and joint health are also assessed during any annual exam to check for abnormalities.

Want to avoid the doctor for being sick? Healthy behavior like regular exercise, healthy eating and not smoking are the best prescription for preventing illnesses.

What are hernias and what causes them?

In the past two weeks, we’ve heard of two people who need hernia surgery. But what exactly is a hernia and what causes them?

A hernia is a condition in which part of an organ protrudes through the wall of the cavity containing. Oftentimes, it involves the intestine at a weak point in the abdominal wall. While some medical conditions can put pressure on the abdominal wall and cause a hernia, like:

  • Straining on the toilet (due to long-term constipation, for example)
  • Straining to urinate
  • Persistent cough
  • Cystic fibrosis
  • Enlarged prostate
  • Childbirth
  • Abdominal fluid
  • Peritoneal dialysis
  • Undescended testicles

Other times, hernias can be caused by our way of life, such as:

  • Being overweight or obese
  • Lifting heavy items
  • Poor nutrition
  • Smoking
  • Physical exertion

There are several types of hernias and some more severe than others.

Inguinal Hernias is the most common type of hernia and more common in childhood and old age. About two-thirds of people who have a hernia have this type, and it’s more common in men than in women. They occur in part of the abdominal wall called the inguinal canal where a man’s testicles must descend before birth. If the opening does not properly heal, the contents of the abdomen, such as intestine, may protrude through this opening just above the leg crease, near or adjacent to the pubic area. However, in older men, these can occur due to a weakness in the groin area.

Ventral Hernias can occur through the scar due to a past abdominal surgery — weeks, months or years after surgery. They can vary in size from small to very large and complex. If you think you have a ventral hernia, see your doctor immediately as it may widen and become very difficult to repair.

Femoral Hernias are more common in women than men and like inguinal hernias, they appear in the groin area. They are usually the result of pregnancy or childbirth.These hernias are more prone to develop strangulation of the intestines as an early complication. Once diagnosed, it’s important to have surgery to repair it sooner rather than later.

Umbilical Hernias are a bulge in the belly button region, which has a natural weakness from the blood vessels of the umbilical cord. These hernias may occur in infants and may resolve themselves by age three of four. In adults, umbilical hernias will not resolve themselves and may worsen over time. They can be caused by being overweight, excessive coughing, or pregnancy.

Epigastric Hernias occur due to a weakness, gap or opening in the muscles or tendons of the upper abdominal wall, between the breastbone and the navel. These types of hernias are more common in men than in women.

Hiatal Hernias are caused by the upper part of the stomach pushing out of the abdominal cavity and into the chest cavity through an opening in the diaphragm.These types of hernias cause acid reflux which can lead to heartburn, pain, and erosion of the esophagus. Surgery is required for this type of hernia and is more complicated.

Oftentimes hernias do not produce troubling symptoms, but abdominal complaints may mean a more serious problem is progressing.

In some cases, a hernia needs immediate surgery, for instance, when part of the gut becomes obstructed or strangulated by an inguinal hernia. A strangulated hernia happens when part of your intestine or other tissue becomes tightly trapped and the blood supply is cut off. Strangulated hernias can result in gangrene. This condition is considered a medical emergency and requires immediate surgery to undo the blockage and repair the hernia. Immediate medical attention should be sought if an inguinal hernia produces acute abdominal complaints such as:

  • Pain
  • Nausea
  • Vomiting

With the exception of an incisional hernia (a complication of abdominal surgery), in most cases, there is no obvious reason for a hernia to occur.

The risk of hernia increases with age and occurs more commonly in men than in women.

If you do think you have a hernia, seek medical attention. They are usually simple to diagnose, simply by feeling and looking for the bulge. Your doctor will advise you on whether you need surgery or if you should watch and wait for symptoms to persist. Just don’t wait too long, as you may make matters worse.

Group B Strep Awareness Month

Being pregnant is an exciting time, full of expectations of a happy and healthy baby. But for women who may become pregnant or are pregnant it’s important to know the risks and signs for Group B Streptococcus (GBS) and how it can affect your baby.

July is GBS awareness month and we want to do our part to help educate our customers about this potentially deadly infection.

GBS is a type of bacteria that is naturally found in the digestive and lower reproductive tracts of both men and women. About 1 in 4 pregnant women carry GBS.

Carrying GBS does not mean that you are unclean, nor is it considered a sexually transmitted disease or infection. However, like other infections, it can be passed between sexual partners, including through oral contact.

Most women do not have any symptoms of GBS, but it can cause vaginal burning/irritation and/or unusual discharge which may be mistaken for a yeast infection and treated incorrectly. If you have “vaginitis” symptoms, see your care provider promptly for an exam and possible GBS testing.

GBS can also cause bladder infections, with or without symptoms. Your doctor should do a urine culture for GBS and other bacteria at your first prenatal visit. GBS in your urine means that you may be heavily colonized which puts your baby at greater risk. If your urine tests positive, your provider should consider you as “GBS colonized” for this pregnancy so that you receive IV antibiotics for GBS when labor starts or your water breaks.

Call your doctor immediately if you have decreased or no fetal movement after your 20th week or if you have any unexplained fever.

It is now the standard of care in the US and several other countries for all pregnant women to be routinely tested for GBS at 35–37 weeks during each pregnancy unless their urine already cultured positive in the current pregnancy. (Since levels of GBS can change, each pregnancy can be different.) Your doctor will perform a swab test of both your vagina and rectum and receive the test results in 2–3 days. Inform your doctor if you are using antibiotics and/or vaginal medications which may cause false negative results. If you are unsure of what you are taking, bring your prescriptions and other medications with you to your appointment.

If you do test positive for GBS, be sure to keep a copy of all culture test results with you at all times. If you live far away from the hospital, or have a history or short labors, be prepared! The IV antibiotics you receive in labor take about 4 hours to be their most effective. Ask your doctor about a late third-trimester penicillin shot as a possible safeguard. Tell your doctor if you are allergic to penicillin.

Be aware of “alternative medicines”.

Garlic or tea tree oil and other alt medicines have not been proven to prevent babies from becoming infected with GBS. Some are unsafe for babies. One mother (as noted on a GBS website) followed an alternative regimen of acidophilus, echinacea, garlic capsules, vitamin C, grapefruit seed extract, and garlic suppositories to eradicate GBS from her body when pregnant. Her baby was 7 pounds, 20.5 inches and perfect at birth after a normal labor and delivery at home. He died 11 hours later from a group B strep infection in his lungs.

According to the CDC, in the United States, group B strep is the leading cause of meningitis and sepsis in newborns. GBS also causes more than 1,200 babies per year to become infected after the first week of life up to several months of age–sometimes from sources other than the mother.

No one knows how often babies are miscarried or stillborn due to GBS because many parents don’t choose to have autopsies or placental testing done for their deceased babies, and death certificates are rarely updated with the findings so prenatal-onset cases are mostly overlooked for statistical purposes.

Unfortunately, babies can be infected by GBS before birth and up to about 6 months of age due to their underdeveloped immune systems.

  • ​GBS can infect your baby even before your water breaks. GBS infections before birth are called “prenatal-onset.”
  • GBS can cause preterm labor, causing your baby to be born too early.
  • GBS infection can also cause your water to break prematurely without labor starting, causing your baby to lose a significant layer of protection.
  • It is thought that babies are most often infected with GBS as they pass through the birth canal. GBS infections within the first week of life are called “early-onset.”
  • Babies can become infected with GBS by sources other than the mother. GBS infections after the first week of life are called “late-onset.”
  • Be aware that your womb and/or C-section wound can become infected by GBS.

Early-onset neonatal sepsis usually occurs within the first 7 days of life, and is typically caused by infection with group B streptococcus. About 90% of cases present within 24 hours of birth. Of the babies with GBS:

  • 69% present with sepsis
  • 26% present with pneumonia
  • 13% present with respiratory distress
  • 11% present with meningitis

Risk factors for early-onset group B streptococcal infection:

  • Maternal infection (group B strep-positive vaginal culture at delivery)
  • Birth weight of 5.5 pounds or less
  • Gestation 37 weeks or less
  • Prolonged rupture of membranes during birth
  • Intrapartum (during the birth process) fever greater than 99.5 degrees F
  • Chorioamnionitis (inflammation of the fetal membranes due to a bacterial infection, usually occurring during a long labor.)
  • Maternal ethnicity – Black and hispanic women
  • Mothers who smoke
  • Maternal age under 20 years old
  • Frequent (more than 6) vaginal exams during labor and delivery

Late-onset group B streptococcus infection occurs from 7 to 9 days of age, through to the end of the second month of life. Late-onset infection typically presents with:

  • 100% cases of fever
  • 60% cases of meningitis

Call your pediatrician or take your baby to the emergency room immediately if he or she has any of these symptoms:

  • ​High-pitched cry, shrill moaning, whimpering, inconsolable crying, constant grunting as if constipated.
  • Fast, slow, or difficult breathing.
  • Blue, gray, or pale skin, blotchy or red skin, tense or bulging fontanel (soft spot on a baby’s head), infection (pus/red skin) at base of umbilical cord or in puncture on head from internal fetal monitor.
  • Feeding poorly, refusing to eat, not waking for feedings, sleeping too much, difficulty being aroused.
  • Marked irritability, projectile vomiting, reacting as if skin is tender when touched, not moving an arm or leg, listless, floppy, blank stare, body stiffening, uncontrollable jerking.
  • Fever or low or unstable temperature, hands and feet may feel cold even with a fever.

Sources: CDC, NIH, and GBS International.

Newest Drug Approvals

The FDA has recently approved the following medications:

Brineura from BioMarin was approved in April for the treatment of late infantile neuronal ceroid lipofuscinosis type 2 (CLN2). This fatal genetic neurodegenerative disease affects 1 in 12,500 live births and  Brineura is specifically indicated to slow the loss of ambulation in symptomatic pediatric patients 3 years of age and older with with late CLN2 and is indicated to improve the quality of life of the young patients.

For the treatment of adult patients with newly diagnosed acute myeloid leukemia and mastocytosis who are FLT3 positive, Rydapt from Novartis was approved in April 2017. Rydapt is specifically indicated to work in combination with certain chemotherapy for the treatment of adult patients with newly diagnosed acute myeloid leukemia who are FLT3 mutation positive. It is also indicated for the treatment of adult patients with aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated hematological neoplasm (SM-AHN), or mast cell leukemia.

Patients with ocular itching associated allergic conjunctivitis, Zerviate from NicOx was approved by the FDA. This topical antihistamine reduces swelling, itching and, and dilation of blood vessels in the eye.

Kevara from Sanofi was approved in May for the treatment of active rheumatoid arthritis.

Kevzara is specifically indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). Kevzara may be used as monotherapy or in combination with methotrexate (MTX) or other conventional DMARDs. The recommended dosage of Kevzara is 200 mg once every two weeks, administered as a subcutaneous injection.

Postmenopausal women with osteoporosis at a high risk of fracture or have a history of osteoporatic fracture, have a new treatment in Tymlos from Radius Health. Tymols was approved in April and is a human parathyroid hormone related peptide analog. Patients should receive supplemental calcium and vitamin D if dietary intake is inadequate. It is not recommended taking Tymlos and parathyroid hormone analogs for more than two years during a patient’s lifetime.

Austedo from Teva Pharmaceuticals was approved in April for the treatment of chorea associated with Huntington’s disease. Dosage is determined individually for each patient based on the reduction of chorea and their tolerability. Austedo is supplied in pill form and must be swallowed whole and must be taken with food.

For those suffering from tardive dyskinesia, Ingrezza from Neurocrine Biosciences was approved in April. Targive dyskinesia is a chronic disorder of the nervous system characterized by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually developing as a late side effect of prolonged treatment with antipsychotic drugs.

Radicava from Mitsubishi Tanabe Pharma was approved in May for the treatment of amyotrophic lateral sclerosis (ALS). This incurable disease is the progressive degeneration of motor neurons in the brain stem and spinal cord leads to atrophy and eventually complete paralysis of the voluntary muscles.

Alunbrig from Ariad Pharmaceutical was approved in April for the treatment of advanced ALK-positive metastatic non-small cell lung cancer.

Alunbrig is specifically indicated for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) who have progressed on, or are intolerant to, the anti-cancer drug, crizotinib.

For those patients with advanced or metastatic urothelial carcinoma, Imfinzi from AstraZeneca was approved in May. The urothelium is a type of thin tissue that lines much of the urinary tract including the renal pelvis, the ureters, the bladder, and parts of the urethra.

Imfinzi is specifically indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who:

  • have disease progression during or following platinum-containing chemotherapy.
  • have disease progression within 12 months of the first treatment or adjuvant treatment with platinum-containing chemotherapy

As with any medication, there are side-effects. Consult with your doctor about these new treatments to see if they are right for you. Talk to your pharmacist to make sure any new drug that you take does not interfere with your current medications.

Dehydration and Kidney Stones

During the summer months the heat is turned up and your chance of becoming dehydrated is increased. One of the possible side effects of dehydration is the development of kidney stones. When urine is too concentrated from lack of fluids, minerals can build up and form stones.

Stones vary in size from tiny crystals that can only be seen with a microscope to stones over an inch wide. Tiny stones may pass out of your body without your even noticing. With larger stones, you won’t be so lucky. Stones that are larger than a pencil eraser can get stuck in the urinary tract—and some have described the pain as the equivalent to childbirth —causing more than a million people per year to take a trip to the emergency room.

One out of 11 people in the U.S. will be affected by a kidney stone. They can form at any age, but kidney stones usually appear in 40 to 60 year olds. Of those who develop one stone, half of those will develop at least one more at some point in the future.

The best way to prevent kidney stones is to drink more water in the warmer months than you normally drink so you don’t become dehydrated.

If you experience any of these symptoms, seek medical attention:

Frequent & Painful Urination – One of the earliest and most common warning signs that you may have kidney stones is a sudden and unexplained increase in the frequency and urgency of urination. You may feel the need urinate, but are unable to ‘go’.

Spreading Back Pain – Oftentimes patients report pain that begins in their sides and back, just below the rib cage (where the kidneys are located). The pain may travel to the lower abdomen into your groin area and into your lower back.

Blood in Urine –  Rather than being clear or yellow in color, your urine can have a pink tint to even a red or brown color. As the condition worsens, you may notice blood in your urine.

Nausea & Vomiting – Some patients feel nauseated and sometimes it’s so severe that it will cause vomiting. One of the causes of vomiting can also be the intense pain associated with passing a kidney stone. Vomiting can also be caused by the body trying to eliminate toxins and waste, since the kidney stones are impairing the kidneys ability to properly function.

Pungent Smelling Urine – Not only will urine be discolored or cloudy, it may also have a foul odor. Normal urine may have a slightly bitter smell from time to time, but if you have a kidney stone, the urine will have a distinct sharp stench due to the concentration of toxins.

Inability to Sit – Sitting and lying-down can put additional pressure on the affected areas of the body which can make the pain even more intense if you have a larger kidney stone.

Fever & Chills – Most people do not leave kidney stones untreated. However, in a few small cases, the kidney stone remains small and doesn’t cause intense pain and other symptoms. However, the stone can create small internal cuts and scratches along the urinary tract creating small wounds which could become infected.

Kidney & Abdominal Swelling – If kidney stones reach a large size they can block the normal flow of urine, preventing urine from traveling through the urethra on its way out of the body. One of the earliest signs that things are reaching this critical stage is intensely painful swelling of the kidneys. When kidneys swell, you will notice inflammation near your lower back that is painful to the touch. It’s critical that you seek medical attention should you notice these symptoms. If left untreated, your body can go into septic shock as it’s unable to rid itself of toxins.

To detect kidney stones, your doctor may order lab or imaging tests. Lab tests look in urine for blood, signs of infection, minerals (like calcium), and stones. Blood tests can also detect high levels of certain minerals. About 80% of all stones are made of calcium oxalate. Knowing what the stones are made of can help guide treatment.

Treatment also depends on the stone’s size and location. CT scans or plain X-ray imaging can help your doctor pinpoint the location and estimate the size of a kidney stone. Depending on what your doctor finds, you may be prescribed medicine and advised to drink a lot of fluids. Or, you might need a procedure to break up or remove the kidney stone.

There are different procedures for breaking up or removing kidney stones. One method delivers shock waves to the stone from outside of the body. Other strategies involve inserting a tool into the body, either through the urinary tract or directly into the kidney through surgery. After the stone is located, it can be broken up into smaller pieces.

Don’t let the pain of kidney stones send you to the emergency room. Keep hydrated! But if you develop any of the symptoms listed above, call your doctor immediately.

Cataract Awareness Month

Does it feel like when you look at things, they aren’t as crisp, clear or colorful as they used to be? Do things look cloudy or blurry even when you’re wearing glasses? These could be symptoms of cataracts.

Cataracts is one of the leading causes of vision loss in the US and the primary cause of blindness in the world. More than 24 million Americans over 40 are currently living with cataracts. Though rare, children can be affected by cataracts, too.

A cataract is a clouding of the lens in the eyes that affects vision. By the age of 80, more than half of all Americans either have a cataract or have had cataract surgery in one or both eyes.

What causes cataracts?

The lens of your eye lies behind the iris and the pupil and it works much like a camera lens. The lens focuses light onto the retina at the back of the eye and it also adjusts the eye’s focus. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

How do cataracts affect vision?

When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to “grow” slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult and your vision may get duller or blurrier.

The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.

As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.

If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.

Who is at risk for cataract?

The risk of cataract increases as you get older. Other risk factors for cataract include:

  • Certain diseases (for example, diabetes)
  • Personal behavior (smoking, alcohol use)
  • The environment (prolonged exposure to ultraviolet sunlight)

What are the most common symptoms of a cataract?

  • Cloudy or blurry vision.
  • Colors seem faded.
  • Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
  • Poor night vision.
  • Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
  • Frequent prescription changes in your eyeglasses or contact lenses.

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

Are there different types of cataract?

Yes. Although most cataracts are related to aging, there are other types of cataract:

  1. Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
  2. Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
  3. Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
  4. Radiation cataract. Cataracts can develop after exposure to some types of radiation.

How is a cataract detected?

Cataract is detected through a comprehensive eye exam that includes:

  • Visual acuity test. This eye chart test measures how well you see at various distances.
  • Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
  • Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
  • Your eye care professional also may do other tests to learn more about the structure and health of your eye.

How is cataract treated?

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your daily activities, such as driving, reading, or watching TV. Talk to your eye care professional about the benefits and risks of surgery so you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four weeks apart. Cataract removal is very common and is one of the safest and most effective types of surgeries with 90% of people having better vision afterwards.

Make sure your doctor knows of all the medications you are taking prior to cataract surgery as certain medications can increase the risk of bleeding during surgery. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help reduce the risk of infection. Serious infection can result in loss of vision.

What can you do to protect your vision?

  • Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract.
  • If you smoke, stop.
  • Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.
  • If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.


What you should know about Testicular Cancer

It’s rare, but it does happen. A man’s chance of getting testicular cancer is about 1 in 263 which translates to a about 20,000 men every year. Testicular cancer is rare, accounting for about 1% of all male cancers. However,testicular cancer is the most common form of cancer in men ages 15-35. The good news is that with early prevention, the survival rate is 96-99%.

Testicular cancer or cancer of the testis occurs when cancer cells form in one or both testicles. These cells begin to change and grow uncontrollably, forming a mass or tumor. The cells can also invade the bloodstream and lymph system and spread, leading to tumors in other areas of the body.

There are two main types of tumors that account for the majority of testicular cancers:

  • Seminoma: There are two sub-types of seminomas, and the classical (typical) seminomas are more likely to occur in men between ages of 30 and 50. Seminomas are testicular cancers that grow slowly. They’re usually confined to the testes, but the lymph nodes may also be involved.Spermatocytic seminomas are less common and are found more frequently in men 55 years and older. However, both types of seminoma tumors may occur in all age groups.
  • Non-seminoma: There are four main sub-types of non-seminoma tumors: embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma. These types of tumors generally occur between the teen years and early 40s. They also tend to grow and spread rapidly to distant organs in the body including lungs, bones, and the brain.

What are the risk factors for testicular cancer?

The most important risk factor for testicular cancer is undescended testicles. In the womb, the testicles develop in a male baby’s abdomen. They usually move down into the scrotum at birth or in the first year of life. Other risk factors include:

  • Having had abnormal development of the testicles.
  • Having a personal history of testicular cancer.
  • Having a family history of testicular cancer (especially in a father or brother).
  • Being caucasian.

How can I prevent testicular cancer?

  1. Do the exam after a warm shower or bath.
  2. Use both hands to examine each testicle.
  3. As you feel the testicle, you may notice a cord-like structure on top and in back of the testicle.
  4. Feel for any lumps.
  5. You should also get a physical exam once a year.

What are the symptoms of testicular cancer?

  • Swelling or discomfort in the scrotum
  • A painless lump or swelling in either testicle.
  • A change in how the testicle feels.
  • A dull ache in the lower abdomen or groin.
  • A sudden build-up of fluid in the scrotum
  • Pain or discomfort in the testicle or in the scrotum.

If your own exam reveals a change, or any of these symptoms are present, call your doctor for a complete medical exam.

To determine whether a lump is testicular cancer, your doctor may recommend an ultrasound and blood tests. Other tests and scans are required to determine which stage of cancer the man is in. In its final stage, it spreads throughout the body. If the cancer is aggressive and left untreated, it can lead to death. 95% of testicular cancers will spread if left untreated.

Doctors providing your treatment may include:

  • A urologist: a surgeon who specializes in treating diseases of the urinary system and male reproductive system.
  • A radiation oncologist: a doctor who treats cancer with radiation therapy.
  • A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.

Depending on the type of cancer, treatment options can include surgery to remove the testicle, radiation, and chemotherapy. Testicular cancer does not often return as a local recurrence because the entire testicle is removed. For recurrent testicular cancer, treatment usually includes chemotherapy and surgery.

Certain treatments for testicular cancer can cause infertility that may be permanent. Patients who may wish to have children should consider sperm banking before having treatment. Sperm banking is the process of freezing sperm and storing it for later use.


Sources: National Cancer Institute, Cancer.org and WebMD.

Traveling Abroad this Summer?

If you’re like us, you look forward to school being out and spending time together with family on a vacation. If you are lucky enough to take a trip out of the country, the Centers for Disease Control have some specific guidelines for you to ensure you stay healthy wherever your travels take you.

Take note of travel notices. The CDC’s website has country-specific information for travelers about current health issues. These issues could include disease outbreaks, special events or gatherings, natural disasters, or other conditions that may affect your health. Travel categories include:

Watch Level 1: Practice Usual Precautions

This means there is a usual baseline risk or slightly above baseline risk for the specific destination, and limited impact to the traveler.

Watch Level 2: Practice Enhanced Precautions
With watch level two, travelers are at increased risk in defined settings or associated with specific risk factors; certain high-risk populations may wish to delay travel to these destinations.

Watch Level 3: Avoid Nonessential Travel

This level has the highest warnings and travelers are at a high risk if they must travel to the destination.

Aedes mosquitoes spread dengue, chikungunya and Zika viruses. There is a risk to anyone traveling to a tropical or subtropical regions of the world where these viruses are found.

Zika is still a concern among many destinations that American’s frequent including, Costa Rica, Jamaica, and the Dominican Republic, to name a few.

Before Travel

There is no vaccine or medicine for Zika, but you can protect yourself by preventing mosquito bites:

  • Cover exposed skin by wearing long-sleeved shirts and long pants.
  • Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE) and always use as directed.
    • Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.
    • Most repellents, including DEET, can be used on children older than 2 months. (OLE should not be used on children younger than 3 years.)
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
  • Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs to protect them from mosquito bites.

After travel

Many people infected with Zika virus do not feel sick. If a mosquito bites an infected person while the virus is still in that person’s blood, it can spread the virus by biting another person. Be sure to take steps to prevent mosquito bites for 3 weeks after your trip, even if you don’t feel sick, so that you don’t spread Zika to uninfected mosquitoes that can spread the virus to other people.

If you have a pregnant partner, you should either use condoms or not have sex during the pregnancy.

If you are thinking about pregnancy, talk with your healthcare provider about how long to  wait to become pregnant. You also should use condoms after travel to protect your partner from Zika even if you are not pregnant or trying to become pregnant.

No matter where you are traveling, it’s important to be up to date on all routine vaccines. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot.

Ask your doctor what vaccines and medicines you need based on where you are going, how long you are staying, what you will be doing, and if you are traveling from a country other than the US.

Hepatitis A: CDC recommends the hepatitis A vaccine because you can get it through contaminated food regardless of where you are eating or staying.

Hepatitis B: You can get hepatitis B through sexual contact, contaminated needles, and blood products, so CDC recommends this vaccine if you might have sex with a new partner, get a tattoo or piercing, or have any medical procedures.

Malaria: Some travelers to certain areas who are at higher risk for complications from malaria (such as pregnant women) may need to take extra precautions, like antimalarial medicine. Talk to your doctor about how you can prevent malaria while traveling.

Typhoid: You can get typhoid through contaminated food or water. CDC recommends this vaccine for most travelers, especially if you are staying with friends or relatives, visiting smaller cities or rural areas, or if you are an adventurous eater.

Rabies: Rabies can be found in dogs, bats, and other mammals in some countries so CDC recommends this vaccine for the following groups:

  • Travelers involved in outdoor and other activities (such as camping, hiking, biking, adventure travel, and caving) that put them at risk for animal bites.
  • People who will be working with or around animals (such as veterinarians, wildlife professionals, and researchers).
  • People who are taking long trips or moving to certain countries.
  • Children, because they tend to play with animals, might not report bites, and are more likely to have animal bites on their head and neck.

Yellow Fever: Certain governments require proof of yellow fever vaccination only if you are arriving from a country with risk of yellow fever. This does not include the US. If you are traveling from a country other than the US. Your doctor can help you decide if this vaccine is right for you based on your travel plans.

Being proactive and researching the risks with your travel destination, and being safety conscious when abroad are key to staying healthy. Following these simple tips can be the difference in good memories or a bad experience:

  • Get vaccinated
  • Take antimalarial meds
  • Eat and drink safely
  • Prevent bug bites
  • Keep away from animals
  • Reduce your exposure to germs
  • Avoid sharing body fluids
  • Avoid non-sterile medical or cosmetic equipment


Source: CDC

Self Injury and Teenagers

Recent studies have found that one-third to one-half of adolescents in the US have engaged in some type of nonsuicidal self injury (NSSI). Although previously thought to be a characteristic of severe psychopathology, NSSI now appears to be more of a negative coping mechanism associated with anger and depression and mixed emotional states.

Self-injury often begins around the ages of 12 to 14, and it is most commonly the result of feelings of sadness, distress, anxiety, or confusion. Teenagers often use self-injury as a way to cope with these negative emotions.

Social Media and Self-Injury

Social media can both help and hurt when it comes to self-injury behaviors. Many adolescents will turn to social media sites, such as Instagram and Twitter, to find a source of support and to connect with others that are experiencing the same things that they are. However, posts on social media can also encourage self-destructive behavior. Research has shown that viewing content about self-harm, especially on social media, can be a trigger for behavior.

While websites that specifically encourage self-harm or suicide are few in number, and certain social media apps have banned self-injury related content, online communities related to self-harm are still common. Furthermore, research has shown that youth that visit self-harm/suicide websites are 11 times more likely to have thoughts about hurting themselves.

Shaming and Self-Injury

Body shaming, fat shaming, and slut shaming can place teenagers at a higher risk of self-injury. Feelings of shame can cause teenagers to feel heightened levels of distress and anxiety, and teens may resort to cutting and other forms of self-injury in order to relieve these negative feelings.

How Can I Help Myself?

  • Know you are not alone. Because self-injury is relatively common, it’s likely that there are people around who understand and can help. Try talking to a professional person around you, someone like your school psychiatrist, school nurse, or guidance counselor. If you’re not comfortable with that, think about contacting your local MHA Affiliate or checking out the S.A.F.E Alternatives website.
  • Know you can get better. This is a difficult time in your life. However, with help, you can get to the point where you don’t hurt yourself anymore.
  • If cutting or self-injuring is an activity that your friends do, or if you find yourself comparing self-harm behaviors, consider widening your social circle and hanging out with other people. This doesn’t mean you have to abandon your current friends; it just means making new ones who don’t remind you of self-injuring.
  • Figure out what stresses you out and drives you to self-injure. Avoid stressors if they are going to make you cut. Think about other things you could do to manage stress without turning to self-injury.
  • Seek professional help – effective treatment is available for people who injure themselves.  For tips on having a conversation, check out, Time to Talk: Tips for Talking About Your Mental Health and Time to Talk: Talking to Your Parents.
  • It could take some time to see a doctor or other treatment provider. In the meantime, take steps to reduce the harm you are doing to yourself. This could mean hurting yourself fewer times than you normally would, making sure you don’t get infections, or finding alternatives that are less harmful (like holding an ice cube, or snapping yourself with a rubber band).

How Can I Help a Friend who Self-Injures?

  • Ask about it. If your friend is hurting him/herself, they may be glad to have you bring it up so they can talk about it. If someone is not injuring themselves they are not going to start just because you said something about it.
  • Offer options, but don’t tell anyone what they should do, or have to do. If a person is using self-injury as a way to have some control, it won’t help if you try to take control of the situation. Helping your friend see ways to get help – like talking to a mental health professional, parent, teacher, or school counselor – may be the best thing you can do for them.
  • Seek support. Knowing a friend is hurting themself can be frightening and stressful. Consider telling a teacher or other trusted adult. This person could help your friend get the help he or she needs. You may feel that you don’t have the right to tell anyone else, but remember; you can still talk to a mental health professional about how the situation is affecting you, or you can get more information and advice from any number of organizations.
  • Remember you’re not responsible for ending the self-abuse. You can’t make your friend stop hurting themselves or get help from a professional. The only sure thing you can do is keep being a good friend.

Tips for Parents


  • Be patient.
  • Learn about self-injury (like reading this post)
  • Address the issue as soon as possible.
  • Validate your child’s feelings. Remember that this is different from validating the behavior.
  • Speak to your child in calm tones, offer reassurance, and be a respectful listener.
  • Check in on how your child is doing regularly. Ask open ended questions to build healthy communication habits.
  • Ask them what they need for support in order to stop their self-injury.
  • Take your child seriously. It is likely that your child is cutting in order to relieve feelings of stress, and not because they are seeking attention.
  • Give praise for positive change as you see it. When looking for improvement, look back over a six-month period rather than focusing on short periods of time.
  • Focus on your child. It isn’t uncommon for parents to feel overwhelmed or wonder what they did wrong. Find supports to help you work through your own feelings and needs so that you can focus on supporting your child.
  • Take care of yourself. Model what good self-care looks like.
  • Maintain hope. Recovery takes time and feels difficult, but don’t give up.

Do Not

  • Think of ongoing self-injury as failures. Getting better is a process and “relapsing” in self-injury happens. When it does, identify what can change to improve chances for the future.
  • Responding in hurtful ways (yelling, giving harsh and lengthy punishments, threats, insults, etc.) increases stress for everyone and creates barriers to getting better.
  • Fight for power or control. You cannot control another person’s behavior and demanding that your child stop the behavior is generally unproductive.
  • Rationalize the behavior by thinking that your teen is just going through a phase that will be outgrown. The majority of adults who self-injure started their self-injury during adolescence.
  • Minimize the seriousness of this behavior. Cutting is often used to relieve feelings of stress, and reduce negative emotions
  • Isolate your child. Your child needs ongoing support for recovery and this includes staying connected with friends. Find a way to talk about this issue if there are disagreements to find a compromise that doesn’t require isolation.
  • Focus on the self-injury. Concentrate on what is driving the behavior, not the behavior itself.