What Doctors Know - November 2013

Volume 2, Issue 9 www.whatdoctorsknow.
com
Healthy Way to Grow
Dizziness Can Be a Drag Overcoming Fear: Tough for Teens
www.smokefree.gov
About Smokefree.gov
Smokefree.gov is intended to help you or someone you care about quit smoking. Different people need different resources as they try to quit. The information and professional assistance available on this Web site can help to support both your immediate and long-term needs as you become, and remain, a nonsmoker. Smokefree.gov allows you to choose the help that best fits your needs, including Step-by-step quit smoking guide Information about a wide range of topics related to smoking and quitting Interactive U.S. map highlighting smoking information in your state LiveHelp, National Cancer Institutes instant messaging service National Cancer Institutes telephone quitline, 1-877-44U-QUIT Local and state telephone quitlines, 1-800-QUIT-NOW Publications to download, print, or order
NIH...Turning Discovery into Health

NIH Publication No. 10-7675 Printed May 2012
ON CALL
with
Dr. Porter
ith each What Doctors Know issue, we try to focus on the disease of the month. You can search the internet
and nd all sorts of public awareness campaigns and their corresponding months, weeks or day. Perhaps the most infamous awareness campaign falls in the month of OctoberBreast Cancer Awareness month. You see pink everywhere during that time. You cant watch television without seeing something that brings awareness to breast cancer. The NFL, NCAA and even High Schools wear pink to show their support of breast cancer research. So you might expect a magazine issue totally dedicated to breast cancer. But we wanted to take a slightly different direction for this issue celebrating the months of November and December. Children have settled back in their routine of school, Halloween is over, and most are in eager anticipation of the upcoming holiday season. In this issue, instead of focusing on one or two health issues, we decided to look at a broader scope of health topics. Whether you are just responsible for your own health or the health of many in your family, we hope to touch on a few health issues that might make a difference for you. With all this in mind, we decided to give our readers a well-rounded palate of subjects to read and pardon the pun digest. From Surviving Football Season, to Feeling Awkward? (about prostate health), to A Diet to Prevent Kidney Stones, to a Healthy Way to Grow, staying healthy is a 365-day a year challenge for every member of the family. I hope the content is diverse and interesting enough to help you and your family get through the holidays healthier than ever. Until next issue.
Steve Porter, MD
Publisher and Chairman
W H AT D O C T O R S K N O W. C O M
Published by What Doctors Know, LLC Publisher and Chairman Steve Porter, MD Editorial Advisory Board Vicki J. Lyons, MD, Chairman Editorial and Design Director Bonnie Jean Thomas Design Elevation 43, Ogden, UT Editorial Content Director Larry Myers
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Calling All Doctors. Our readers want to hear from you. What healthcare issues do you want to address? What do you want to tell patients all over the country? Whats new in your practice, in your specialty? Drop us a line and let us know about any healthcare topic you want to address in What Doctors Know. Remember, we want to inform and educate our readers. We know an informed reader has the opportunity to live longer and happier. You can be part of that healing process. Our readers look forward to hearing from you.
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Contents
IN EVERY ISSUE 1 On Call with Dr. Porter 11 ABCs of Vitamins & Supplements 27
Know Your Specialist: Obstetrics & Gynecology
FEATURED ARTICLES 12 Anxiety & your Childs Doctor Visit 14 Hospitalization Risks Tied to Long-Term
Air Pollution Exposure
16 Surviving Football Season 18 Ignoring the Flu Can Be Deadly 20 Overcoming Fear: Tough for Teens 22 Brain Triggers of Obesity 24 Dizziness Can Be a Drag 30 Feeling Awkward? Talk to Your Doc About Prostate Health 33 Breast Cancer Facts 34 Cant Curb the Urge to Move? 36 Find & Banish Those Sneaky Sugars 48 Healthy Way to Grow 50 Are Cigarettes Burning a Hole in Your Pocket? 53 Early Breast Cancer Detection FDA 101 44 Dietary Supplements
HEALTH HUB
FROM CLEVELAND CLINIC
39 Tummy Pain or IBS: Know the Difference

Q & A sheds light on IBS
40 A Diet to Prevent Kidney Stones: Foods Vary 41 Do I Need Surgery for GERD? IN THE NEWS: NOV 2013
UNC School of Medicine ndings challenge assumptions 5 about origins of life
5 Efforts to delay aging are better investment than advances in 42 Dealing With Pink Eye cancer, heart disease 6 Cocaine use can make otherwise resistant immune cells
susceptible to HIV
6 A magnetic crystal ball for coronary artery disease 7 Girls who eat peanut butter may improve breast health
later in life
8 Poor oral health linked to cancer-causing oral HPV infection 8 Unhealthy food marketed to youth through athlete
endorsements
9 Reassuring Findings for Mothers Who Have Inuenza Vaccine

While Pregnant
10 USC study shows large pollution exposure reductions

possible with car ventilation setting choices
In the battle against whooping cough, she needs more than cute.
She needs the safe, proven protection of vaccines. Giving her the recommended immunizations by age two is the best way to protect her from 14 serious childhood diseases, like whooping cough and measles. For more reasons to vaccinate, talk to your childs doctor or go to http://www.cdc.gov/vaccines or call 1-800-CDC-INFO.
Immunization. Power to Protect.
NOV 2013
IN THE
UNC School of Medicine

findings challenge assumptions about origins of life
CHAPEL HILL, N.C.
Efforts to delay aging are better investment than advances in cancer, heart disease
LOS ANGELES
NEWS
esearch from UNC School of Medicine biochemist Charles Carter, PhD, offers
n the heels of an announcement from Google that the companys next startup, Calico, will tackle the
an intriguing new view on how life began. Carters work is based on lab experiments during which his team recreated ancient protein enzymes that likely played a vital role in helping create life on Earth. Carters nding ies in the face of the widely-held theory that Ribonucleic Acid (RNA) self-replicated without the aid of simple proteins and eventually led
science of aging, a new study shows that research to delay aging and the inrmities of old age would have better population health and economic returns than advances in individual fatal diseases such as cancer or heart disease. With even modest gains in our scientic understanding of how to slow the aging process, an additional 5 percent of adults over the age of 65 would be healthy rather than disabled every year from 2030 to 2060. Put another way, an investment in delayed aging would mean 11.7 million more healthy adults over the age of 65 in 2060. The analysis, from top scientists at USC, Harvard, Columbia, the University of Illinois at Chicago and other institutions, assumes research investment leading to a 1.25 percent reduction in the likelihood of age-related diseases. In contrast to treatments for fatal diseases, slowing aging would have no health returns initially, but would have signicant benets over the long term. In the United States, the number of people aged 65 and over is expected to more than double in the next 50 years, from 43 million in 2010 to 106 million in 2060. About 28 percent of the current population over 65 is disabled. In the last half-century, major life expectancy gains were driven by nding ways to reduce mortality from fatal diseases, said lead author Dana Goldman, Leonard D. Schaeffer Directors Chair at the USC Schaeffer Center for Health Policy and Economics. But now disabled life expectancy is rising faster than total life expectancy, leaving the number of years that one can expect to live in good health unchanged or diminished. If we can age more slowly, we can delay the onset and progression of many disabling diseases simultaneously.
to life as we know it. In the early 1980s, researchers found that ribozymes RNA enzymes act as catalysts. It was evidence that RNA can be both the blueprints and the chemical catalysts that put those blueprints into action. This nding led to the RNA World hypothesis, which posits that RNA alone triggered the rise of life from a sea of molecules. The RNA world hypothesis is extremely unlikely, said Carter. It would take forever. Moreover, theres no proof that such ribozymes even existed billions of years ago. To buttress the RNA World hypothesis, scientists use 21st century technology to create ribozymes that serve as catalysts. But most of those synthetic ribozymes, Carter said, bear little resemblance to anything anyone has ever isolated from a living system. Carter, who has been an expert in ancient biochemistry for four decades, took a different approach. His experiments are deeply embedded in consensus biology. Our genetic code is translated by two super-families of modern-day enzymes. Carters research team created and superimposed digital three-dimensional versions of the two super-families to see how their structures aligned. Carter found that all the enzymes have virtually identical cores that can be extracted to produce molecular fossils he calls Urzymes Ur meaning earliest or original. The other parts, he said, are variations that were introduced later, as evolution unfolded. The ndings suggest that Urzymes evolved from even simpler ancestors tiny proteins called peptides. And over time those peptides co-evolved with RNA to give rise to more complex life forms. In this Peptide-RNA World scenario, RNA would have contained the instructions for life while peptides would have accelerated key chemical reactions to carry out those instructions.
NOV 2013
IN THE
NEWS
The next stage in the research will be to closely examine the means by which cocaine makes these once resistant cells susceptible to infection and if the drug does indeed lead to a higher viral reservoir, and to use humanized mouse models to study how drug abuse affects HIV infection as well as the efficacy of Highly Active Antiretroviral Therapy (HAART).
Cocaine use
can make otherwise resistant immune
cells susceptible
to HIV
LOS ANGELES
A magnetic crystal ball for coronary artery disease

CHARLOTTESVILLE, Va.
n imaging test commonly used to diagnose coronary artery disease has an untapped
new UCLA study shows cocaine affects a unique population of immune cells called
potential to predict which patients with the disease are at the greatest risk for heart attacks and other potentially deadly heart problems, researchers at the University of Virginia Health System have determined. Coronary artery disease is the most common form of heart disease and a leading cause of death worldwide. Cardiac Magnetic Resonance Imaging (CMR) is often used to diagnose the condition, but new UVA research shows that CMR stress testing has an underappreciated predictive power -- one that may help doctors determine the best course of treatment and potentially save patients lives. When you perform a stress test, theres two things you want to know: First, does this person have disease that requires an invasive intervention, and, secondly, what is this persons prognosis going to be? said UVAs Michael Salerno, MD, PhD. After reviewing 19 studies and more than 11,000 patients, we were able to show that the data to support the prognostic ability of stress CMR is very robust. RISK OF HEART ATTACK, DEATH The UVA researchers expansive review determined that patients with normal CMR tests had a very low risk of heart attack and death, while patients with positive CMR tests had a risk nearly seven times greater. CMR, the researchers concluded, is as effective at predicting patients risk as other methods already in use, such as nuclear imaging with the added benet of being non-invasive and potentially less expensive. One cannot deny the attractiveness of a test which is free of ionizing radiation, accurate and potentially cost effective, two Harvard doctors state in an editorial saluting the UVA research in the Journal of the American College of Cardiology. There is now ample evidence to support the use of stress CMR as a prognostic tool, accurately differentiating between low risk and high risk patients. It is due time for the cardiology community to trust the magnetic crystal ball!
quiescent CD4 T cells, which are resistant to the virus that causes AIDS. Cocaine makes the cells susceptible to infection with HIV, causing both signicant infection and new production of the virus. In many ways, the spread of HIV has been fueled by substance abuse. Shared needles and drug users highrisk sexual behaviors are just some of the ways that narcotics such as cocaine have played a key role in the AIDS epidemic in much of the world. The surprising result was that the changes cocaine induced on these cells were very minimal, yet they were sufficient to fuel infection, said Dimitrios Vatakis, assistant professor of medicine in the division of hematology/oncology at the David Geffen School of Medicine at UCLA and the studys senior author. We found that cocaine mediates its effects directly, inducing minimal changes in the physiology of these cells and utilizing the same pathways it uses to target the brain. Researchers found a three-day exposure to cocaine made the cells more susceptible to HIV infection by stimulating two receptors in the cells, called 1 and D4. The ndings suggest that cocaine use increases the pool of T cells in the human body that can become infected by the virus.
NOV 2013
IN THE
Girls who eat peanut butter
NEWS
may improve breast health later in life

ST. LOUIS, Mo.
irls who regularly eat peanut butter or nuts could be 39 percent less likely to develop benign breast disease by age 30, according
to a new study. H eres some news worth spreading: Girls who eat more peanut butter could improve their breast health later in life. According to a study from Washington University School of Medicine in St. Louis and Harvard Medical School. Research shows girls ages 9 to 15 who regularly ate peanut butter or nuts were 39 percent less likely to develop benign breast disease by age 30. Benign breast disease, although noncancerous, increases risk of breast cancer later in life. These ndings suggest that peanut butter could help reduce the risk of breast cancer in women, said senior author Graham Colditz, MD, DrPH, associate director for cancer prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Because of the obesity epidemic, Colditz recommended The research was published in the journal Breast Cancer Research and Treatment. Colditz also is the Niess-Gain Professor in Medicine at Washington University School of Medicine. He led the study with Catherine Berkey, MA, ScD, a biostatistician at Harvard Medical School and Brigham and Womens Hospital in Boston. The ndings are based on the health histories of 9,039 U.S. girls enrolled in The Growing Up Today Study from 1996 through 2001. Later, from 2005 through 2010, when the study participants were 18 to 30 years old, they reported whether they had been diagnosed with benign breast disease that had been conrmed by breast biopsy. The researchers found that participants who ate peanut butter or nuts two times each week were 39 percent less likely to have developed benign breast disease than those who never ate them. The studys ndings suggest that beans, lentils, soybeans and corn also may help prevent benign breast disease, but consumption of these foods was much lower in these girls and thus the evidence was weaker.
Past studies have linked peanut butter, nut and vegetable fat consumption to a lower risk for benign breast disease. However, participants in those studies were asked to recall their high school dietary intakes years later. This new study is the rst to use reports made during adolescence, with continued follow-up as cases of benign breast disease are diagnosed in young women.
that girls replace high-calorie junk foods and sugary beverages with peanut butter or nuts.
NOV 2013
IN THE
NEWS
Poor oral health

HOUSTON
linked to cancer-causing oral HPV infection

about 40 percent to 80 percent of oropharyngeal cancers, according to researchers at The University of Texas Health Science Center at Houston (UTHealth). Poor oral health is a new independent risk factor for oral HPV infection and, to our knowledge, this is the first study to examine this association, said Thanh Cong Bui, Dr.P.H., postdoctoral research fellow in the School of Public Health, part of UTHealth. The good news is, this risk factor is modifiable by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers. The researchers found that among the study participants, those who reported poor oral health had a 56 percent higher prevalence of oral HPV infection, and those who had gum disease and dental problems had a 51 percent and 28 percent higher prevalence of oral HPV infection, respectively. In addition, the researchers were able to associate oral HPV infections with number of teeth lost. Similar to genital HPV infection, oral HPV infection can be of two kinds: infection with low-risk HPV types that do not cause cancer, but can cause a variety of benign tumors or warts in the oral cavity, and infection with high-risk HPV types that can cause oropharyngeal cancers. The researchers found that being male, smoking cigarettes, using marijuana, and oral sex habits increased the likelihoaod of oral HPV infection. They also found that selfrated overall oral health was an independent risk factor for oral HPV infection, because this association did not change regardless of whether or not the participants smoked or had multiple oral sex partners. Because HPV needs wounds in the mouth to enter and infect the oral cavity, poor oral health, which may include ulcers, mucosal disruption, or chronic inammation, may create an entry portal for HPV, said Bui. There is, however, currently not enough evidence to support this, and further research is needed to understand this relationship, he said.
oor oral health, including gum disease and dental problems, was found to be associated with oral human papillomavirus (HPV) infection, which causes
NOV 2013
IN THE
Unhealthy food marketed to youth through athlete endorsements

NEW HAVEN, Conn.
Reassuring Findings
SAN DIEGO, Calif.
NEWS
for Mothers Who Have Influenza Vaccine While Pregnant
rofessional athletes are often paid large amounts of money to endorse commercial
esearchers from the University of California, San Diego School of Medicine and Boston University, in collaboration with the American Academy of Allergy
Asthma and Immunology (AAAAI), have found evidence of the H1N1 inuenza vaccines safety during pregnancy. The national study, which was launched shortly after the H1N1 inuenza outbreak of 2009, is summarized in two companion papers published online on September 19 in the journal Vaccine. The overall results of the study were quite reassuring about the safety of the u vaccine formulations that contained the pandemic H1N1 strain, said Christina Chambers, PhD, MPH, Director of the non-prot Organization of Teratology Information Specialists (OTIS) Research Center and lead investigator of UC San Diegos team. We believe our studys results can help women and their doctors become better informed about the benets and risks of u vaccination during pregnancy. Despite federal health authorities recommendations that all pregnant women be vaccinated for inuenza, it is estimated that less than 50 percent of women follow this advice, largely because they are concerned about the effects u vaccines might have on the developing baby. Since it was anticipated that the 2009 H1N1 inuenza season would be severe, a national study was launched by the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), a collaboration between UC San Diego School of Medicine and Boston University and coordinated by AAAAI to gather data on the safety of this vaccine during pregnancy. The team from UC San Diego followed 1,032 pregnant women across the United States and Canada who either chose to receive an inuenza vaccine or were not vaccinated during one of the three seasons from 2009-2012. Women were recruited through MotherToBaby, a service of OTIS. Chambers team found that women vaccinated during pregnancy were no more likely to experience miscarriage, have a baby born with a birth defect or have a baby born smaller than normal compared with those who did not receive a vaccination. Although vaccinated women were more likely to have their babies before term, on average these infants were delivered three days earlier than those born to unvaccinated women.
products. But the majority of the food and beverage brands endorsed by professional athletes are for unhealthy products like sports beverages, soft drinks, and fast food, according to a new study by the Rudd Center for Food Policy and Obesity at Yale. Of the 512 brands associated with these athletes, food and beverage brands were the second largest category of endorsements behind sporting goods. We found that LeBron James (NBA), Peyton Manning (NFL), and Serena Williams (tennis) had more food and beverage endorsements than any of the other athletes examined. Most of the athletes who endorsed food and beverages were from the NBA, followed by the NFL, and MLB, said Marie Bragg, the studys lead author and a doctoral candidate at Yale. Sports beverages were the largest individual category of athlete endorsements, followed by soft drinks, and fast food. Most 93% of the 46 beverages being endorsed by athletes received all of their calories from added sugars. Food and beverage advertisements associated with professional athletes had far-reaching exposure, with ads appearing nationally on television, the Internet, the radio, in newspapers, and magazines. The promotion of energy-dense, nutrient-poor products by some of the worlds most physically t and well-known athletes is an ironic combination that sends mixed messages about diet and health, said Bragg.
Bragg and co-authors assert that professional athletes should be aware of the health value of the products they are endorsing, and should use their status and celebrity to promote healthy messages to youth.
NOV 2013
IN THE
NEWS
USC study shows large pollution exposure reductions possible with car ventilation setting choices
LOS ANGELES
exposure to harmful traffic pollutants: The car ventilation choice you make can be effective in reducing exposure to on-road particle pollution. Scott Fruin, D.Env., assistant professor of preventive medicine, and Neelakshi Hudda, PhD, research associate in the environmental health department of the Keck School of Medicine of USC, recently conducted the rst systematic measurements of invehicle exposure that included a full range of car types and operating conditions, and for all types of particulate pollution. Short of driving less, putting your ventilation to recirculate is the best way to reduce exposure to all types of vehicle-related particulate pollution, said Fruin, senior author on the study. Otherwise, an hour-long commute to work or school can double your daily exposure to traffic-related particulate air pollutants. The scientists found in addition to the benets of recirculation settings, exposures are lower in newer cars, at slower speeds, and on arterial roads, where pollutant concentrations are lower than on freeways. According to the researchers, concentrations of particle pollutants on freeways are often ve to 10 times higher than elsewhere. To put the results in perspective, measurements were turned into predictive models, then the models were applied to the national eet of car models and ages and Los Angeles driving conditions. Drs. Fruin and Hudda found that for a typical car (seven years old, the national average), recirculation settings reduce in-vehicle particle pollution for very small particles from 80 percent (of on-road levels) to 20 percent, and from 70 percent to 30 percent for larger particles, compared to air ventilation settings which bring in outside air. (Windows were always closed in this study. Keeping windows open while driving quickly raises inside pollutant concentrations to the same levels as on-road levels.) Until this comprehensive study, measurements have been based on only a few cars and usually only one pollutant, Hudda said. We showed that recirculation settings produce large exposure reductions across all car types and for all particulate pollutants. The researchers also found that leaving the windows closed over 30-minute or longer drives with several passengers raised carbon dioxide levels in tight new cars to those of stuffy meeting rooms.
10
ased on a new study, environmental health researchers at the University of Southern California have advice for parents who want to reduce their childs
OF VITAMINS & SUPPLEMENTS
VITAMINS
All other vitamins are water soluble, so leave quickly out of your body in your urine if your body doesnt need them. However, it is possible to get too much of a water soluble vitamin, but not very likely. Most people arent getting huge doses of vitamins. But think about it cereal, energy bars, and enriched pasta can all contain vitamins and minerals. Adding multiple vitamins on top of this could push you over the recommended daily limit. How to avoid overdoing it: 1. Think about the supplements you take and the fortied foods or drinks you consume. Write them down and check the dose. 2. Take a multivitamin instead of individual pills because they have such a wide margin of safety that even when combined with fortied foods, they wont cause major issues. 3. Talk with your pharmacist about any supplements youre taking, including vitamins and minerals, and the dose youre taking, too as well as what your diet consists of. That way, they can help you keep doses in a safe range. In addition to vitamins, too much of certain minerals could also be problem. Too much calcium, for example, can cause kidney stones. and dont need to supplement. An in moderation! And remember, most people get enough from their diet
Fortified Foods and Drinks: Are you getting too many
recommended might be causing you harm? These days, everything from bottled water to yogurt seems to have increased levels of vitamins and minerals. Augmenting foods and beverages with vitamins may sound like a great way to cover your bases, especially if sometimes your diet is lacking, but are you in danger of getting too much of these important nutrients? The short answer is -yes. And, how can you determine when too much of a good thing is bad for you? When more and more foods are enriched or augmented in some way, it becomes impossible for shoppers to know what dose theyre getting over the course of a day. There are four specific vitamins that are fat soluble and can accumulate in your body. These include vitamins A, D, E, and K. Although very rare, getting too much of these could be harmful and lead to toxicity. For example, surplus vitamin A causes nausea, blurred vision and dizziness. Other vitamins can cause a variety health concerns everything from palpitations to diarrhea and hair loss.
id you know that taking more vitamins and supplements than is medically
So, as the adage goes everything
added benet of knowing how much youre taking is that you might be able to reduce the number of pills you consume on a daily basis. And this simple step could have a favorable impact on your wallet! Joseph Vande Griend, PharmD, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. Dr. Vande Griend specializes in geriatric pharmacy.
11
Anxiety
COMMON FEARS AND CONCERNS

Separation - Fear of being left in the exam room without a parent Pain - Worry that a part of the exam or a medical procedure will hurt he doctor - Misinterpreting the doctors T speed, efficiency or a detached attitude as sternness, dislike or rejection he unknown - Worry that their problem may be T much worse than their parents are telling them Guilt - Belief that their illness or condition is punishment for something theyve done or neglected to do
& Your Childs
Doctor Visit
HOW DO I PREPARE MY CHILD FOR A DOCTORS VISIT?
When kids anticipate going to the doctor, many become worried and apprehensive about the visit. Whether theyre going for a routine exam or illness, kids are likely to have fears. children can be quite sensitive to their parents emotions. Having a calm, positive, reassuring attitude can reduce your childs anxiety, advises Carlos Lerner M.D., medical director, Childrens Health Center, Mattel Childrens Hospital UCLA. When explaining the purpose of the appointment, talking about the doctor in a positive way helps promote the relationship between your child and the doctor. Explain that the purpose of a regular well-child visit is to see how he is growing and developing and to make sure that his body is healthy. If she is not feeling well, tell her that a doctor can help nd out what is wrong and how best to treat it. When you call to make the appointment, you can ask to speak to the doctor or a nurse to nd out, in a general way, what will take place during the office visit and exam. Then you can explain some of the procedures and their purpose in gentle language. Children can cope with discomfort or pain more easily if theyre forewarned, and theyll learn to trust you if youre honest with them. If you dont know much about the illness or condition, admit that but reassure your child that youll be there and that you will both be able to ask the doctor question. Write down your childs questions to bring with you.
If you detect anxiety from your child about going to the doctor, encourage him or her to to tell you about their fears. Then, address their concerns using age-appropriate language. In the exam room,
4CHOOSING THE RIGHT DOCTOR FOR YOUR CHILD

Because your doctor is your best ally in helping your child cope with health examinations, its important to carefully select a doctor. Of course, you want one whos knowledgeable and competent. However, you also want a doctor who understands kids needs and fears and who communicates easily with them, in a friendly manner. This information provided courtesy of the pediatricians at Mattel Childrens Hospital UCLA
12
Staying healthy isnt easy.
Then again, neither is dying.
When you consider the alternative, eating right and staying active really dont seem so bad. Many of the nearly one million deaths each year from type 2 diabetes, heart disease and stroke could be prevented with a few lifestyle changesincluding regular physical activity, healthier food choices and not smoking. Its not easy. But it is worth it.
Talk to your doctor about your risk for type 2 diabetes and heart disease. Its your life. Listen to your doctor. Eat better. Get moving.
For more information, visit CheckUpAmerica.org, or call 1-800-DIABETES.
ADA 295-09 Hard Ad 7x10 V6.indd 1
5/17/09 7:23:51 PM
Hospitalization Risks Tied to Long-Term
Air Pollution Exposure
14
Our study found that long-term rates of admissions for pneumonia, heart attacks, strokes, and diabetes are higher in locations with higher long-term average particle concentrations
lder adults may be at increased risk of being hospitalized for lung and heart disease,
The results showed an association between long-term exposure to ne air particles for all hospital admissions examined. For example, for every 10-g/m3 increase in long-term PM2.5 exposure, the researchers found a 4.22% increase in respiratory admissions, a 3.12% increase in cardiovascular disease admissions, a 3.49% increase in stroke admissions, and a 6.33% increase in diabetes admissions. Particulate air pollution is one of the largest avoidable
stroke, and diabetes following long-term exposure to ne-particle air pollution, according to a new study by researchers at Harvard School of Public Health (HSPH), published online April 17, 2012 in PLoS ONE. It is the rst study to look at the link between long-term effects of exposure to ne particles in the air and rates of hospital admissions. Prior studies have reported an association between hospitalization and short-term air particle exposure (i.e. exposure to air particles on day of hospital admission or several days before). However, these shortterm studies left unclear how many extra admissions occurred in the long run, and only included people who live near air pollution monitors, typically located in cities. No studies of long-term exposure to ne air particles (over the course of a year or two years) and rates of hospitalizations had been done. Our study found that long-term rates of admissions for pneumonia, heart attacks, strokes, and diabetes are higher in locations with higher long-term average particle concentrations, said lead author Itai Kloog, a research fellow in the Department of Environmental Health at HSPH. Kloog and his colleagues, including senior author Joel Schwartz, professor of environmental epidemiology at HSPH and director of the Harvard Center for Risk Analysis, used novel prediction models, based on satellite observations, emissions, traffic, and weather data to predict levels of ne air particles in the air all over New England, which allowed the researchers to include rural and suburban areas. The researchers compared their ndings with hospital admission records on all Medicare patients, ages 65 and older, admitted to 3,000 hospitals throughout New England from 2000-2006. The researchers estimated zip code concentrations of ne air particles known as PM2.5 air matter with a diameter of 2.5 microns or less and more narrow than the width of a human hair. These particles, such as soot from vehicles, and other particles from power plants, wood burning, and certain industrial processes, are a signicant health risk when they lodge in the lungs, causing inammation there and in the rest of the body, and contributing to lung and heart disease.
causes of death and illness in the United States, and unlike diet and exercise, does not require behavioral change. Off-the-shelf technology can be retrotted onto sources of pollution at modest cost, with a large health benet. This study shows that in addition to avoiding deaths, such measures will reduce chronic disease and medical care costs, said Schwartz.
This information provided courtesy of Harvard School of Public Health
15
Surviving Football Season
How to Make Your
Tailgate Party Healthier

You can estimate how many calories per ounce for a beer by multiplying the amount by volume (the alcoholic percentage) by 2.5 or 3 for heavier beers,
LIGHTENING UP THE GRILL Grilling during football season has no boundaries, whether at the tailgate or at home, the grill is king. However, that does not mean there are not healthy options. Megan Davis, MS, RD, LD, a clinical dietitian with Eat Right, says that eating at mealtimes can help you keep from overeating, while choosing leaner meats to grill will cut out fat. If you and your guests are having burgers, Davis suggests using wheat buns and adding vegetables to your toppings selection to limit calories. Some healthy substitutes for hamburger toppings are avocadoes, tomatoes, and lettuce. Adding vegetables to kabobs is another way to get your daily vegetable servings. Davis says that you can make your favorite recipes healthier by using low-fat products or including more vegetables. For example, instead of using mayonnaise substitute part or all of it with Greek yogurt, use vegetables instead of chips with dip, or make a black bean dip that has less fat. DRINK LESS CALORIES Football season can be challenging with weight gain from alcohol for many of Daviss clients, but a few changes to how you mix your favorite beverages can make a big difference. To cut calories, try mixing wine with Seltzer water to make a wine spritzer, or using diet beverages in mixed drinks. Davis says that keeping alcoholic beverages in a separate cooler than water will also make you less likely to choose alcohol over water and keep hydrating. Davis says that if you do choose to consume alcoholic beverages, to use simple measuring tricks to calculate caloric
16
intake. You can estimate how many calories per ounce for a beer by multiplying the amount by volume (the alcoholic percentage) by 2.5 or 3 for heavier beers, says Davis. When it comes to wine, Davis says that the general rule is to choose a 9 to 12 percent alcohol, which will equal between 110 to 140 calories in a six-ounce glass. The spirit drinks have more calories per ounce depending on the proof, so the rule is to subtract 15 from the proof and that will give you the amount of calories per ounce. GET ACTIVE AT YOUR TAILGATE Football players on the TV screen are not the only movement that can happen at a tailgate. Davis says that she and her team encourage people to incorporate physical activity at their tailgates. Some options are to throw the ball before the game or during halftime, walk around campus, or park further away in order to get more steps in a day. Theres a lot of research that shows you eat 30 percent more if youre distracted watching TV, so keep food away from the TV, says Davis. She says that if someone has to get up to get to the food they are not able to sit mindlessly and eat. Finally, she says that putting all your food on one plate will keep you from grazing throughout the game, which can lead to overeating. This information provided courtesy of the University of Alabama at Birmingham School of Medicine
Surviving Football Season
Your NFL Teams Loss
Can Go Right to Your Gut

Your eating habits may change depending on game results
ROOTING FOR THE WRONG FOOTBALL TEAM MAY MAKE YOU DO BAD THINGS. A recent study by the INSEAD Business School, published in Psychological Science, found people living in cities whose NFL team loses on Sunday tend to eat more calories and fatty foods on the following Monday. Joseph Rock, PsyD, did not take part in the study but is a psychologist at Cleveland Clinic. He says when were uncomfortable we turn to things that will ease that anxiety like comfort food. It doesnt work to x anything, but at least it makes us feel better for a second, says Dr. Rock. When were feeling uncomfortable were not thinking about whats going to happen in a month. Were thinking about Im feeling crummy today and I want that to change. STUDY LOOKS AT WON/LOSS EATING HABITS Researchers looked at the eating habits of people in 30 U.S. cities with teams in the National Football League. They studied them for two seasons, comparing them to cities without NFL teams. THE STUDYS RESULTS SHOWED: People in cities whose team lost on Sunday eat 16 percent more saturated fat and 10 percent more calories People in cities whose team won on Sunday eat 9 percent less saturated fat and 5 percent fewer calories This information provided courtesy of Cleveland Clinic Family Health Team MAKE A GAME PLAN Researchers say fans should shift their focus to and write down what matters most in their lives, like family. This self-affirmation has been shown to be effective in eliminating the effects of defeat. Dr. Rock advises that you put together a practical game plan in the event of a loss. Just realize youre likely to do some things that arent going to be great for you tomorrow if your team loses, he says. Be aware of that. Realize youre going to eat too much, and dont pack some of the unhealthy stuff so you wont have it at your desk tomorrow. WHY PEOPLE EAT MORE IF THEY LOSE, LESS IF THEY WIN Researchers hypothesized that, when their team loses, people feel an identity threat and are more likely to eat more as a coping mechanism. Whereas winning seems to provide a boost to peoples self control. I think whats happening here is that they eat more normally because they dont need to eat unhealthily, adds Dr. Rock. Instead of eating high-caloric, fattening, sweet food in order to feel better they can talk about the game and that makes them feel better.
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Can Be Deadly
related complications in her Beverly Hills, California home. Five months later her husband, Simon Monjack, was found dead in the same home with the same cause of death u related complications. Ignoring the u can certainly be deadly. Far too often, confused with the common cold, the u (inuenza) is a contagious respiratory illness caused by inuenza viruses. They are unique among respiratory viruses because theyre amazingly adaptable and have a history of drifting and shifting into other, sometimes more lethal combinations. Thats why a new inuenza vaccine has to be prepared every year. A u vaccine denitely is the best protection Flu season is from late November through March. Each year 35 to 50 million people are infected with inuenza. Annual deaths from inuenza in the United States have ranged from as few as 3,000 to as high as 49,000. People who develop u may quickly develop inuenza pneumonia. If you begin to have against inuenza. However, those with severe allergy to chicken egg, anyone who has had a severe allergic reaction to the inuenza vaccine in the past, and children younger than six months should see a board certied Allergist and Immunologist for the inuenza vaccine. If you are sick and have a fever, you should wait until you have recovered before getting the u shot. Vicki Lyons, MD and Timothy J. Sullivan, MD Inuenza can be spread to other people beginning one day before any symptoms develop and up to seven days after becoming sick. When people cough, sneeze, or talk, droplets spread the virus. Less often, touching a surface can lead to infection.
Ignoring the Flu
n December 20, 2009, 32-year-old actress Brittany Murphy died of u
a rapid breathing rate, rapid heart rate, lightheadedness, or shortness of breath you should go to the emergency room or call your doctor. The virus also can damage the lungs and set up a pneumonia caused by bacteria. If you develop shaking chills, chest pain or pain when you breathe, or bring up sputum containing blood, you should go to the emergency room or call your doctor.
THERES A LOT YOU CAN DO TO HELP PREVENT THE SPREAD OF GERMS THAT CAUSE RESPIRATORY ILLNESSES LIKE THE FLU. over your nose and mouth with a tissue C when you cough or sneeze. Discard the tissue in the trash. ash your hands often with soap and water. W If soap and water are not available, use an alcohol-based hand rub. void touching your eyes, nose or mouth. A Germs spread this way. ry to avoid close contact with sick people. T If you are sick with u-like illness, the CDC recommends that you stay home for at least 24 hours after your fever is gone. e prepared in case you get sick and need B to stay home for a week or so. Have a supply of over-the-counter medicines, hand sanitizer, tissues and other related items to avoid trips out in public while you are sick and contagious.
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You cant stop time, but you can STOP

You may need one or more vaccines. Ask your doctor whats right for you.
Vaccines can prevent Influenza (flu), shingles, diphtheria/tetanus, pertussis, and pneumococcal diseases.
http://www.cdc.gov/vaccines/adults
serious diseases before they ever start.
W H AT D O C T O R S K N O W. C O CS213468-A M 19
Overcoming Fear:
Tough for Teens

Study shows fear is hard to extinguish from the developing teenage brain, which may explain why anxiety and depression spikes during adolescence
to threat remain high even when the danger is no longer present. According to researchers, once a teenagers brain is triggered by a threat, the ability to suppress an emotional response to the threat is diminished which may explain the peak in anxiety and stress-related disorders during this developmental period. The study, published Sept. 17, 2012 in the early online edition of the Proceedings of the National Academy of Sciences (PNAS), is the rst to decode fear acquisition and fear extinction learning, down to the synaptic level in the brains of mice, which mirror human neuronal networks. Also, through human and rodent experiments, the study nds that acquired fear can be difficult to extinguish in some adolescents. By contrast, the study shows that adults and children do not have the same trouble learning when a threat is no longer present. This is the rst study to show, in an experiment, that adolescent humans have diminished fear extinction learning, says the studys lead author, Dr. Siobhan S. Pattwell, a postdoctoral fellow at the Sackler Institute for Developmental Psychobiology at Weill Cornell. Our ndings are important because they might explain why epidemiologists have found that anxiety disorders seem to spike during adolescence or just before adolescence. It is estimated that over 75 percent of adults with fear-related disorders can trace the roots of their anxiety to earlier ages. The study ndings suggest there is altered plasticity in the prefrontal cortex of the brain during adolescence, with its inability to overcome fear, says the studys senior coinvestigator, Dr. Francis Lee, professor of pharmacology
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study by Weill Cornell Medical College researchers shows that adolescents reactions
and psychiatry at Weill Cornell Medical College, and an attending psychiatrist at NewYork-Presbyterian Hospital/ Weill Cornell Medical Center. This study is the rst to show activity, at the synaptic level, for both fear acquisition and fear extinction and we nd that while these areas function well in both younger and older mice, neurons involved in fear extinction are not as active in adolescent mice, says Dr. Lee. If adolescents have a more difficult time learning that something that once frightened them is no longer a danger, then it is clear that the standard desensitization techniques from fear may not work on them. This new knowledge about the teenage brains synaptic connections not responding optimally will help clinicians understand that the brain region used in fear extinction may not be as efficient during this sensitive developmental period in adolescents. ADOLESCENT MICE NEVER LOSE THEIR FEAR RESPONSE Fear learning is a highly-adaptive, evolutionarily conserved process that allows one to respond appropriately to cues associated with danger. In the case of psychiatric disorders, however, fear may persist long after a threat has passed, and this unremitting and often debilitating form of fear is a core component of many anxiety disorders, including posttraumatic stress disorders (PTSD). Existing treatments, such as exposure therapy, are designed to expose an individual slowly to the cues associated with a perceived threat. This technique is used for a variety of fears, from wartime PTSD to fear of ying, as well as serious adolescent anxiety about school, says Dr. Lee, who treats, among others, patients with PTSD acquired during the World Trade Center collapse on September 11, 2001.
Anxiety disorders are increasingly being diagnosed in children and adolescents, but the success rate of fear extinction-based exposure therapies are currently not known in this population. This study aimed to discover if they could be effective and why or why not. The human experiment was conducted at the Sackler Institute for Developmental Psychobiology at Weill Cornell in collaboration with its director, Dr. B.J. Casey, a study senior co-investigator, who is the Sackler Professor of Developmental Psychobiology and professor of psychology in psychiatry at Weill Cornell. In the experiment, a group of volunteers children, adolescents and adults wore headphones and skin sweat meters and were asked to look at a computer screen with a sequence of blue or yellow square images. One of the squares was paired with a really unpleasant sound. For example, 50 percent of the time the blue square would set off the noise. If the participants acquired a fear of the noise, they showed increased sweat when viewing the image that was paired with it, says Dr. Pattwell. The same group was brought back the next day, and again viewed a sequence of blue or yellow squares, but this time there was no associated noise. But teenagers didnt decrease their fear response, and maintained their fear throughout subsequent trials when no noise was played, she says. However, the researchers documented that, unlike the teens participating in this study aged 12-17, both children and adults quickly learned that neither square was linked to a noxious sound, and this understanding rapidly decreased their fear response. The mouse experiment, which used standard fear conditioning common in these types of animal studies, obtained similar findings. Adolescent mice (29 days old) did not decrease their fear response to stimuli that no longer existed, but younger and older mice did. Interestingly, the adolescent mice never lost their fear response as they aged. The research team then monitored the brains of mice as they participated in the experiment. With the assistance of study senior co-investigator, Dr. Ipe Ninan, an electrophysiologist at NYU Langone Medical Center who is an assistant professor of psychiatry, the research team found that the prelimbic region in the prefrontal cortex, the brain region that processes emotion, is activated during acquisition of fear, and the infralimbic prefrontal cortex is used to extinguish this fear association. While other groups have suggested that the prefrontal cortex plays a role in extinction, no one has shown that this activity is at the level of the synapse the connections between the neurons. In young and old mice, we see plasticity, which is activity in the infralimbic cortex, which helps the animals decrease their fear response
when a threat no longer applies, says Dr. Pattwell. Interestingly, we didnt witness similar activity in adolescent mice. According to researchers there is much more to explore about the fear response and its decoding in human adolescents, such as whether genes contribute to susceptibility to altered fear learning, and most importantly, what can be done to help the adolescent population overcome fear. We need to investigate personalized approaches to treatment of these fear and anxiety disorders in teens, says Dr. Lee. It is essential that we nd a way to help teenagers become more resilient to the fear they experience during adolescence to prevent it from leading to a lifetime of anxiety and depression. This information provided courtesy of Weill Cornell Medical College.
21
Brain Triggers of
Obesity
Stubers work drills down to the precise biological mechanisms that drive binge eating and will lead us away from stigmatizing explanations that invoke blame and a lack of willpower.
ixty years ago scientists could electrically stimulate a region of a mouses brain causing the
Cynthia Bulik, PhD, Distinguished Professor of Eating Disorders at UNC School of Medicine and the Gillings School of Global Public Health, said, Stubers work drills down to the precise biological mechanisms that drive binge eating and will lead us away from stigmatizing explanations that invoke blame and a lack of willpower. Bulik was not part of the research team. Back in the 1950s, when scientists electrically stimulated a region of the brain called the lateral hypothalamus, they knew that they were stimulating many different types of brain cells. Stuber wanted to focus on one cell type gaba neurons in the bed nucleus of the stria terminalis, or BNST. The BNST is an outcropping of the amygdala, the part of the brain associated with emotion. The BNST also forms a bridge between the amygdala and the lateral hypothalamus, the brain region that drives primal functions such as eating, sexual behavior, and aggression.
mouse to eat, whether hungry or not. Now researchers from UNC School of Medicine have pinpointed the precise cellular connections responsible for triggering that behavior. The nding, published September 27, 2013 in the journal Science, lends insight into a cause for obesity and could lead to treatments for anorexia, bulimia nervosa, and binge eating disorder, the most prevalent eating disorder in the United States. The study underscores that obesity and other eating disorders have a neurological basis, said senior study author Garret Stuber, PhD, assistant professor in the department of psychiatry and department of cell biology and physiology. Hes also a member of the UNC Neuroscience Center. With further study, we could gure out how to regulate the activity of cells in a specic region of the brain and develop treatments.
22
The BNST gaba neurons have a cell body and a long strand with branched synapses that transmit electrical signals into the lateral hypothalamus. Stuber and his team wanted to stimulate those synapses by using an optogenetic technique, an involved process that would let him stimulate BNST cells simply by shining light on their synapses.
or to avoid food when they are hungry. Further research is needed to determine whether it would be possible to develop drugs that correct a malfunctioning BNST circuit. We want to actually observe the normal function of these cell types and how they fire electrical signals when the animals are feeding or hungry, Stuber said. We want to understand their genetic characteristics what genes are expressed. For example, if we find cells that become really activated after binge eating, can we look at the gene expression profile to find out what makes those cells unique from other neurons. And that, Stuber said, could lead to potential targets for drugs to treat certain populations of patients with eating disorders. UNC School of Medicine neurobiology graduate student Josh Jennings is the rst author on Stubers paper in Science. Authors also include members of his research team, neurobiology grad student Alice
UNC scientists identify brain circuitry that triggers overeating. The finding shows that certain parts of brain cells could play a critical role in anorexia, bulimia, binge eating disorder, and obesity.
Typically, brain cells dont respond to light. So Stubers team used genetically engineered proteins from algae that are sensitive to light and used genetically engineered viruses to deliver them into the brains of mice. Those proteins then get expressed only in the BNST cells, including in the synapses that connect to the hypothalamus. His team then implanted ber optic cables in the brains of these specially-bred mice, and this allowed the researchers to shine light through the cables and onto BNST synapses. As soon as the light hit BNST synapses the mice began to eat voraciously even though they had already been well fed. Moreover, the mice showed a strong preference for high-fat foods. They would essentially eat up to half their daily caloric intake in about 20 minutes, Stuber said. This suggests that this BNST pathway could play a role in food consumption and pathological conditions such as binge eating. Stimulating the BNST also led the mice to exhibit behaviors associated with reward, suggesting that shining light on BNST cells enhanced the pleasure of eating. On the ip side, shutting down the BNST pathway caused mice to show little interest in eating, even if they had been deprived of food. We were able to really home in on the precise neural circuit connection that was causing this phenomenon thats been observed for more than 50 years, Stuber said. The study, which uses technologies highlighted in the new National Institutes of Health Brain Initiative, suggests that faulty wiring in BNST cells could interfere with hunger or satiety cues and contribute to human eating disorders, leading people to eat even when they are full
Stamatakis, research technician Randall Ung, and Giorgio Rizzo of the University Medical Center Utrecht in the Netherlands. This information provided courtesy of UNC School of Medicine
23
Dizziness
If you think you may have a balance disorder, talk with your health care provider. Your doctor can assess whether your symptoms might be caused by a serious disorder, such as a heart or blood condition.
Can Be a Drag
I
magine reaching for something on a grocery shelf and suddenly feeling unsteady. Or looking over your shoulder to back up the car and having things start whirling around you. Most people feel dizzy now and then. But if that feeling persists or interferes with your daily life, it could be a sign of a balance disorder. A balance disorder makes you feel as if youre moving, spinning or floating, even though youre quite still. More than 4 in 10 Americans will experience an episode of dizziness sometime during their lives thats significant enough to send them to a doctor. Dizziness can range from feeling lightheaded to woozy to disoriented. Feeling that you or your surroundings are spinning is called vertigo. Any of these sensations can be extremely distressing. Balance is a multisystem function, explains NIH hearing and balance expert Dr. Daniel Sklare. It begins with a series of signals within the tiny balance organs of the inner ear. These organs work with your brains visual system to give you a sense of your bodys position. They also keep objects from blurring when your head moves. Sense receptors in skin, joints and muscles also send balance-related signals to the brain. The brain receives and coordinates information from all these different body systems. Balance disorders can arise when any of these signals malfunction. Because balance is so complex, it can be hard to gure out the underlying cause of certain problems. Some balance disorders can begin suddenly. They might arise from an ear infection, a head injury or certain medications. Low blood pressure can lead to dizziness when you stand up quickly. Disorders related to vision, muscles, bones or joints can also contribute to balance problems.
24
Coping with Balance Disorders

As America gets older, many people with imbalance have a collection of these problems, says Dr. Gordon Hughes, NIH clinical trials director for hearing and balance. They might have aging of the ear, aging of vision, cataracts, muscle weakness from losing some muscle mass or arthritis in the hips, plus other problems like diabetes. Researchers have identified more than a dozen different balance disorders. The most common is a sudden, often harmless burst of vertigo that might arise with an abrupt change in the position of the head, like when you bend over to tie your shoes. Technically known as benign paroxysmal positional vertigo (BPPV), this condition can result from a head injury or simply from getting older. BPPV sometimes occurs when tiny calcium crystals in the inner ear become displaced. In that case, your doctor can treat BPPV by carefully moving the head and body to reposition these particles. An NIH-supported clinical trial showed that this treatment works well for BPPV. Another common balance disorder is known as Mnires disease. It can develop at any age, but most often strikes adults between 40 and 60 years of age. Symptoms include intense vertigo, hearing loss, nausea, tinnitus (a ringing or buzzing in the ear) and a feeling of fullness in the ear. Mnires disease usually affects only one ear. Some people with Mnires disease have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some affected people have vertigo so extreme that they lose their balance and fall. These episodes are called drop attacks.
stairwells and grip handles in bathrooms can help make your home safer. Driving a car may be especially hazardous, so ask your doctor if its safe for you to drive. A specialized rehabilitation therapist can give you a set of head, body and eye exercises to help reduce dizziness and nausea. Meanwhile, researchers continue to work to develop new, more effective approaches. In one experimental rehabilitation strategy, now in clinical trials, scientists have created a virtual reality grocery store. It allows people with balance disorders to walk safely on a treadmill through computer-generated store aisles. While holding onto a grocery cart, they can look up and down, turn their heads and reach for items on virtual shelves. By doing this, they safely learn how to navigate an environment that can be challenging for someone with a balance problem. The key for people looking for treatment is to go to the best team of clinical experts that they can gain access to, says Dr. Sklare. Its very important to get that level of assessment. Source: NIH News in Health, August 2012, published by the National An attack of Mnires symptoms, while not life-threatening, can feel completely overwhelming. The symptoms arise because of a change in fluid volume within the inner ear. But its underlying cause remains unknown. Scientists estimate that 6 in 10 people either get better on their own or can control their vertigo with diet, drugs or devices. In severe cases, surgical therapies can end the dizziness but might affect hearing. NIH-funded researchers at the University of Washington are now exploring a new treatment option to stop a Mnires attack. An implant behind the ear is designed to control abnormal electrical activity in the nerve that sends balance information to the brain, bringing the sensation of spinning to a halt. The device is now being tested in clinical trials. If you think you may have a balance disorder, talk with your health care provider. Your doctor can assess whether your symptoms might be caused by a serious disorder, such as a heart or blood condition. If an inner ear balance disorder is likely, you may be referred to a specialist such as an otolaryngologist, a doctor with expertise in the ear, nose and throat. You might receive a hearing test, a balance test and possibly an imaging study of the brain. Work with your doctor to figure out how to cope with your dizziness on a daily basis and reduce your risk of injury. For example, wear low-heeled shoes or walking shoes outdoors. You might decide to try using a cane or walker. Safe, secure handrails in Institutes of Health and the Department of Health and Human Services. For more information go to www.newsinhealth.nih.gov
TELL YOU R DOCTO R

Discuss y our symp toms with You often Y ou feel a s feel unste ady. a health c are provid
er if:
if the roo m is spinn ing aroun Y ou feel a d you. s if youre moving w youre sta hen you k nding or now sitting stil l. Y ou lose your bala nce and fa ll. Y ou feel a s if youre falling. Y ou feel li ghtheade d, or as if you migh Y our visio t faint. n become s blurred. Y ou some times fee l disorien sense of ti ted, losin me, place g your or identity .
25
Phoebes daddy has big dreams for her.
2012 ALSAC/St. Jude Childrens Research Hospital
(10991)
St. Jude patient Phoebe: Daddys Princess
But at this moment, shes fighting cancer.

Thats why St. Jude Childrens Research Hospital spends every moment changing the way the world treats children with pioneering research and exceptional care. And no family ever pays St. Jude for anything. Dont wait. Join St. Jude in finding cures and saving children like Phoebe. Because at this moment, she should be home enjoying story time, hugs from daddy and play dates in the park.
Help them live. Visit stjude.org.
KNOW YOUR SPECIALIST
Oncologist
Oncology is concerned with:
The diagnosis of any cancer in a person herapy (e.g. surgery, chemotherapy, radiotherapy and T other modalities) Follow-up of cancer patients after successful treatment alliative care of patients with terminal P malignancies Ethical questions surrounding cancer care Screening efforts: of populations, or the blood and blood-forming tissues).
Oncology : (from the Ancient Greek onkos (), meaning bulk, mass, or tumor, with cancer. A medical professional who practices oncology is an oncologist.
and the suffix -logy (-), meaning study of) is a branch of medicine that deals
Medical oncology and hematology: The American Board of Internal Medicine (ABIM) examines and certies internists who choose to acquire additional education and training in the dual subspecialty of medical oncology and hematology (the treatment of malignancies of
Pediatric oncology and hematology: The American Board of Pediatrics (ABP) examines and certies pediatricians who choose to acquire additional education and training to subspecialize in the diagnosis and treatment of cancers in children (e.g., leukemia). Radiation oncology: The American Board of Radiology (ABR) examines and certies radiation oncologists, who specialize in radiation treatment of cancers. Surgical oncology: The American Board of Surgery (ABS) examines and certies surgeons who are trained in several types of surgical treatments, including biopsy, tumor staging, and tumor resection (removal).
of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer) To become certied as an oncologist, a candidate must rst graduate from an accredited medical school before entering into training as a specialist (e.g., internist, pediatrician) and sub-specialist (e.g., medical oncologist, pediatric oncologist-hematologist). There are several oncology specialties and subspecialties: Gynecological oncology: The American Board of Obstetrics and Gynecology (ABOG) examines and certies obstetricians and gynecologists who choose to acquire additional education and training to subspecialize in the diagnosis and treatment of cancers of the female reproductive organs (e.g., cervical cancer, breast cancer). Medical oncology: The American Board of Internal Medicine (ABIM) examines and certies internists who choose to acquire additional education and training to subspecialize in medical oncology, the use of medical and chemotherapeutic treatments of cancer.
Oncologist Board Certication

The board certication process includes the following components: EDUCATION Candidates must have graduated from an approved medical school and must have completed an ACGME accredited residency program. Graduate education in a specialty and, if the physician chooses, a subspecialty follows.
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EXAMINATIONS After satisfactory completion of graduate education in a specialty, physicians may apply for certication. Applicants must pass the certifying examination administered by the medical specialty board. If they go on to receive additional education and training in a subspecialty (e.g., pediatric oncology and hematology), they must complete the education and training requirements and then apply for certication and pass the examination administered by the medical specialty board.
DIAGNOSTIC METHODS INCLUDE: Biopsy or Resection; these are methods by which suspicious neoplastic growths can be removed in part or in whole, and evaluated by a pathologist to determine malignancy Endoscopy, either upper or lower gastrointestinal, bronchoscopy, or nasendoscopy; X-rays, CT scanning, MRI scanning, PET scan, ultrasound and other radiological techniques; Scintigraphy, Single Photon Emission Computed Tomography, Positron emission tomography and other methods of nuclear medicine; Blood tests, including tumor markers, which can increase the suspicion of certain types of tumors or even be pathognomonic of a particular disease, as well as CBC counts for White Blood counts and Platelets in the cases of Blood and Bone cancers.
Cancer Diagnosis
The most important screening tool remains the medical history: the character of the complaints and any specic symptoms (fatigue, weight loss, unexplained anemia, fever of unknown origin, paraneoplastic phenomena and other signs). Sometimes a physical examination will reveal the location of a malignancy.
28
KNOW YOUR SPECIALIST
Approximately 50% of all cancer cases in the Western world can be treated to remission with radical treatment
Apart from diagnoses, these modalities (especially imaging by CT scanning) are often used to determine operability, i.e. whether it is surgically possible to remove a tumor in its entirety. Generally, a tissue diagnosis (from a biopsy) is considered essential for the proper identication of cancer. When this is not possible, empirical therapy (without an exact diagnosis) may be given, based on the available evidence (e.g. history, x-rays and scans.) Occasionally, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. This situation is referred to as carcinoma of unknown primary, and again, treatment is empirical based on past experience of the most likely origin.
are commonly used for palliation, where disease is clearly incurable: in this situation the aim is to improve the quality of life and to prolong it
Palliative care
Approximately 50% of all cancer cases in the Western world can be treated to remission with radical treatment. For pediatric patients, that number is much higher. A large number of cancer patients will die from the disease, and a signicant proportion of patients with incurable cancer will die of other causes. There may be ongoing issues with symptom control associated with progressive cancer, and also with the treatment of the disease. These problems may include pain, nausea, anorexia, fatigue, immobility, and depression. Not all issues are strictly physical: personal dignity may be affected.
Therapy
Depending upon the cancer identied, follow-up and palliative care will be administered at that time. Certain disorders (such as ALL or AML) will require immediate admission and chemotherapy, while others will be followed up with regular physical examination and blood tests. Often, surgery is attempted to remove a tumor entirely. This is only feasible when there is some degree of certainty that the tumor can in fact be removed. When it is certain that parts will remain, curative surgery is often impossible, e.g. when there are metastases elsewhere, or when the tumor has invaded a structure that cannot be operated upon without risking the patients life. Occasionally surgery can improve survival even if not all tumor tissue has been removed; the procedure is referred to as debulking (i.e. reducing the overall amount of tumor tissue). Surgery is also used for the palliative treatment of some of cancers, e.g. to relieve biliary obstruction, or to relieve the problems associated with some cerebral tumors. The risks of surgery must be weighed against the benets. Chemotherapy and radiotherapy are used as a rstline radical therapy in a number of malignancies. They are also used for adjuvant therapy, i.e. when the macroscopic tumor has already been completely removed surgically but there is a reasonable statistical risk that it will recur. Chemotherapy and radiotherapy
29
Feeling Awkward?
Talk to Your Doc About Prostate Health
30
Prostate cancer is the second leading cause of cancer death among men, and this year approximately 217,730 men will learn they have prostate cancer and more than 32,050 men will die from the disease
en need to talk to their health care providers about prostate disease and make better informed
According to Dr. Lotan, the potential risks of PSA testing is that it can be falsely elevated leading to an unnecessary prostate biopsy and treatment of prostate cancers in some men who were destined to die of other causes, as well as mild to serious side effects from treatment of prostate cancer. Still, its important for those in high risk categories to get tested and there has been some reduction in prostate cancer mortality since the introduction of prostate cancer screening.
decisions about maintaining their health, according to physicians at Parkland Health & Hospital System. Prostate cancer is the second leading cause of cancer death among men, and this year approximately 217,730 men will learn they have prostate cancer and more than 32,050 men will die from the disease, according to the American Cancer Society. More than 2 million men in the United States who have been diagnosed with prostate cancer are still alive today. When detected at an early stage the five-year survival rate is close to 100 percent. African-American men are disproportionately affected by prostate cancer, having higher rates of prostate diagnosis and death than men of all other racial or ethnic groups in the United States, according to Yair Lotan, MD, Medical Director of the Parkland Urology Clinic and Chief of Urologic Oncology at The University of Texas Southwestern Medical Center. Other risk factors include age and family history, Dr. Lotan said. Men at average risk should start talking to their physicians at age 50. Men at higher risk, including AfricanAmericans, should do so at age 45 and men with a rst degree relative with a diagnosis of prostate cancer should discuss testing at age 40. Symptoms of prostate cancer vary widely and most men do not experience symptoms at all. Those who do may experience difficulty in starting urination, weak or interrupted flow of urine, frequent urination, especially at night, pain or burn during urination, blood in the urine or semen; or pain in the back, hips, or pelvis that doesnt go away. While discussions with your physician are important, Dr. Lotan said not all medical experts agree that the benets of screening for prostate cancer outweigh the risks. The U.S. Preventive Services Task Force recommends against prostate-specic antigen (PSA)-based screening for men unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benet outweighs the known risks, Dr. Lotan said.
Dr. Lotan advises all men of the importance of having an informed discussion with their physician about their risk factors and recommended screenings for prostate cancer. This information provided courtesy of Parkland Health & Hospital System
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A woman tells her support group in California about sharing her MS-related fears with her daughter for the first time.
A group member blogs about it, inspiring a woman in Dallas to reconnect with her own family.
Every Connection Counts at MSconnection.org
Breast Cancer
Facts
The Center for Disease Control estimates that more than 192,370 women are diagnosed with breast cancer each year
The Center for Disease
in women and is second only to lung cancer as the leading cause of cancer deaths among women in the United States. It affects one of every eight American women.
reast cancer is the most common cancer
milk ducts, which carry milk to the nipples. Ductal carcinoma can be invasive with the potential to spread or non-invasive (also called ductal carcinoma in situ or DCIS). About one in five new breast cancer cases are DCIS. The chance for successful treatment of DCIS usually is very high. Lobular carcinoma (cancer) occurs in the lobules, which are the milk-producing glands. Lobular breast cancer can be non-invasive (in situ or LCIS, also called lobular neoplasia) or invasive (have a tendency to spread). About one in 10 breast cancer cases are invasive lobular cancer. LESS COMMON TYPES OF BREAST CANCER Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer that affects the dermal lymphatic system. Rather than forming a lump, IBC tumors grow in flat sheets that cannot be felt in a breast exam. Read more about IBC Triple-negative breast cancer is usually an invasive ductal carcinoma with cells that lack estrogen and progesterone receptors and do not have an excess of HER2 protein on their surfaces. These types of breast cancers tend to spread more quickly and do not respond to hormone therapy or drugs that target HER2. Recurrent breast cancer is cancer that has returned after being undetected for a time. It can occur in the remaining breast tissue or at other sites such as the lungs, liver, bones or brain. Even though these tumors are in new locations, they still are called breast cancer. This information provided courtesy of MD Anderson Cancer Center
Control estimates that more than 192,370 women are diagnosed with breast cancer each year, and the number of new cases has declined over the past decade. More than 40,000 women lose their lives to this disease annually. Men can develop breast cancer, but it happens much less often than in women. Nearly 2,000 men are diagnosed with breast cancer each year. BREAST CANCER TYPES There are two main types of breast cancer. Breast tumors may have a single type of cancer, a combination of types, or a mixture of invasive and noninvasive (in situ) cancer. Ductal carcinoma (cancer) is the most common form of breast cancer. Tumors form in the cells of the
33
Cant Curb the
Urge to Move?
LIVING WITH RESTLESS LEGS SYNDROME
extremes for people with restless legs syndrome. The condition can cause throbbing, pulling or creeping sensations in the legs along with a powerful need to move around for relief. The feelings can range from uncomfortable to agonizing. Once it appears, restless legs syndrome generally People with this condition feel they just absolutely have to move their legs. Their legs feel uncomfortable or even painful unless they move them, says Dr. Richard P. Allen, an expert on restless legs syndrome at Johns Hopkins Bayview Medical Center. When its extreme, patients with this condition can be sittingin a meeting, in a conversation, watching TVand they have to keep moving their legs, which could be very disturbing to themselves and to other people. By some estimates, about 1 in 20 people nationwide has restless legs syndrome. Its about twice as common in women than in men. The disorder can arise at any age, but its generally more serious in middle-age and beyond. Activity relieves the discomfort that people with restless legs syndrome feel, so they often keep their legs in motion. They may pace, jiggle or flex their legs, and toss and turn in bed. This need for movement can make it hard to fall asleep and stay asleep, which can lead to exhaustion. Although theres no cure for restless legs syndrome, medications and lifestyle changes can help minimize symptoms and increase restful sleep. Cutting back on caffeine, alcohol and tobacco may help. Taking a hot bath, massaging the legs or using a heating pad or
34
taying active is usually a good thing. But the motivation to move goes to unwelcome
The irony of restless legs syndrome is that the very act of lying down and trying to relax only activates the symptoms. Symptoms usually arise if youre inactive for extended periods, such as on long ights or car trips. They are often worse at night and gone in the early morning, so some people catch up on sleep at sunrise.
doesnt go away. Symptoms might decrease or disappear for days, weeks or months, but they usually return. The condition can affect one or both legs and even the arms or torso. The cause of restless legs syndrome in most cases is unknown. Research shows that affected people often have too little or malfunctioning iron in the brain. We also know that theres some problem with the dopamine system, and patients often have a good response to dopamine medicine, says Allen. Imaging studies show that people with restless legs syndrome have abnormalities in a movement-related brain region where dopamine is active. Because the disorder tends to run in families, genes likely play a role. Learning more about the underlying genes might lead to improved treatments in the future.
About 1 in 20 people nationwide has restless legs syndrome.
RECOGNIZING RESTLESS LEGS

ice pack can also relieve symptoms. Your doctor might recommend medications that boost dopamine levels or other medicines to address your symptoms. In general it helps to stay active, stay in good health and try to keep good sleep habits, says Allen. If youre concerned about restless legs syndrome, talk with your health care provider. A combination of approaches can usually provide some relief. Source: NIH News in Health, October 2012, published by the National Institutes of Health and the Department of Health and Human Services. For more information go to www.newsinhealth.nih.gov Restless legs syndrome brings all 4 of these characteristics: strong urge to move your legs, often with A unpleasant feelings like tingling, burning or throbbing in the legs. Symptoms that get better with movement. ymptoms that worsen at night and are S mostly gone in the morning. Symptoms triggered by inactivity.
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Find & Banish Those
Sneaky Sugars
As long as youre consuming lots of the sweet stuff, your body has difficulty burning your own body fat for energy.
heres nothing sweet about what sugar when it comes to your weightand health. Rather, sugar
WHERE ADDED SUGARS LURK Practically every item in the center aisles of the supermarket contains added sugar. When they reduce the fat content of foods, manufacturers must find another way to restore flavor, so they often turn to sugar. Learn how to spot it by carefully reading both the Nutrition Facts panel and the list of ingredients on the product label. In addition to the obvious culprits such as soft drinks, baked goods, juice and fruit drinks, desserts, candy and sweetened cereals, youll find added sugars hiding in salad dressings, applesauce, barbecue sauce and even baby food. These empty sugars have been implicated in the epidemic of obesity, as well as in a host of health problems from dental cavities to metabolic syndrome. SPOT THE SUGAR As you prowl the supermarket, be on the alert for these words on packages: agave syrup, brown syrup, cane juice, corn sweetener, corn syrup, crystallized cane juice, date sugar, dextrose, evaporated cane juice, fructose, fruit juice concentrate, fruit syrups, galactose and glucose. Wow! Take a breath and continue on your search for, golden syrup, high-fructose corn syrup (HFSC), honey, invert sugar, lactose, malt, maltose, malt syrup, maple syrup, molasses, raw sugar, rice syrup, sorghum, sucrose, sweetened carob powder, treacle and turbinado. Amazingly, this is not a complete list! WHATS FOR BREAKFAST? Imagine the sort of breakfast many people have each morning: an 8-ounce glass of OJ (21 grams of sugar), a bowl of crunchy bran cereal (21 grams) with half a cup of skim milk (6 grams), and coffee with another ounce of skim milk (1.5 grams). Eat that and youd consume
is sneaky, going by many names and often hiding in plain site in so-called health foods or diet foods. As long as youre consuming lots of the sweet stuff, your body has difficulty burning your own body fat for energy. But once you learn the many aliases for sugar, you can replace foods that pack on the pounds with more nutritious choices that help you slim down. SUGAR COMES IN TWO FORMS There are the naturally occurring sugars such as those found in fruits and vegetables and grains and other whole foods containing carbohydrates. Then there are added sugars, which arent integral to a food. They may be naturalhoney in mustard, for exampleor manufacturedlike corn syrup in a soda. But natural or man made, sugars up both the carb count and the calorie count. Most packaged foods, even ones you dont consider sweet are full of the stuff. One popular brand of marinara sauce contains 11 grams of sugar in a half-cup serving. The tomatoes provide some natural sugar, but most is added. FULL OF CALORIES, BUT LITTLE ELSE A teaspoon of table sugar provides 15 calories. That doesnt sound too bad. But when you realize that the average American consumes 154 pounds of added sugar annually, it translates into almost 750 calories a day. Sugars do provide a source of quick energy, but little or nothing in the way of other nutrients. Eliminate added sugars all together and reduce your intake of all sugars and youre well on your way to controlling your weight and improving your health. Avoiding sugar is a key tenet of a low-carb diet such as Atkins.
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almost 50 grams of sugar! By midmorning, say you had a 6-ounce container of a well-known brand of low-fat lemon yogurt. Katching! Another 31 grams of sugar. HOW ABOUT LUNCH? At lunch, lets say you heat up a cup of tomato soup (10 grams of sugar) to have with a green salad tossed with 2 tablespoons of bottled low-fat honey mustard dressing (5 grams) and half a bottle of sweetened vitamin water (15 grams). Your light lunch leaves you feeling sluggish by late afternoon, so you grab a granola bar for up to 19 grams of sugar. You havent even gotten to dinner and despite having eaten no sweets, youre homing in on 100 grams of sugar. If you had another 30 grams at dinner (assuming no dessert), youll have consumed 520 calories as sugar in a single day. A BETTER WAY Now lets remodel these meals and snacks into low-sugar (and lowcarb) versions. For breakfast, have a couple of eggs with a quartercup of sauted spinach and an ounce of Cheddar cheese. Even with a tablespoon of cream in your coffee, youre looking at 0 grams of sugar. Thats right, nada. Instead of sweetened yogurt, have a half-cup of cottage cheese with a quarter-cup of blueberries for 6 (3 plus 3) sugar grams. A salad topped with sliced chicken and dressed with vinaigrette plus a cup of beef broth makes a lling lunch with only about 1 gram of sugar. In lieu of a granola bar for an afternoon pick-me-up, a low-carb nutrition energy bar packs only 1 gram of sugar. GET THE SUGAR DEMON OFF YOUR BACK But once you focus on eating whole foods, youll find that you dont crave foods with added sugar. Instead, vegetables, berries and other fruits, nuts and whole grains as well as a variety of protein sources and olive oil and other healthy, natural fats leave you satisfied and in control of your appetite. And because your sugar intake is low, youll be more likely to burn your body fat for energy.
BE VIGILANT WHEN EATING OUT When you stop at popular chain eateries, keep your sugar specs on. Here are some of the not-so-sweet surprises in store for you.
CHAIN Starbucks KFC Blimpie McDonalds Arbys Au Bon Pain
FOOD
GRAMS OF SUGAR
Apple Bran Muffin (3.5 oz.). . . . . . . . . . . . . . . . . . . 34 Side of BBQ Baked Beans. . . . . . . . . . . . . . . . . . . . . 19 Chicken Teriyaki Wrap . . . . . . . . . . . . . . . . . . . . . . . . 13 Sausage McGriddles (5 oz.). . . . . . . . . . . . . . . . . . . 15 Vanilla Shake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Cinnamon Crisp Bagel . . . . . . . . . . . . . . . . . . . . . . . 25
Colette Heimowitz, M.Sc., VP of Nutrition & Education at Atkins Nutritionals and author, The New Atkins for a New You Cookbook and The New Atkins for a New You Workbook. Her blog can be found on www.Atkins.com.
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Fighting for:
a day when we can all breathe easier.
The American Lung Association is fighting for a world free of lung disease. Were fighting for healthy lungs, both young and old, and for all the things that make air worth breathing. Join the fight at FightingForAir.org.
H E A LT H H U B
from
Know the Difference

Q & A SHEDS LIGHT ON IBS
Tummy Pain or IBS:
It can be difficult to know the difference between a regular stomach ache and something you should talk about with your doctor. Repeated stomach issues could be a symptom of irritable bowel syndrome (IBS). Read this brief Q&A to learn more.
Q Q
Im having digestive issues. Could it be irritable bowel syndrome?
Q Q
What can I do?
A: Irritable bowel syndrome (IBS) is a problem that affects the large intestine, also known as the bowel, and can cause cramping, bloating, gas, diarrhea and constipation. IBS can be painful, but it does not cause damage. Its cause is unknown.
A: Changes in diet can reduce symptoms of IBS. Avoid caffeine and limit milk products. Eat more ber, drink three to four glasses of water daily, avoid smoking, and get more exercise. Emotional distress also has been known to cause symptoms of IBS.
How do I know I have IBS?
Is there a cure?
A: Your doctor will give you a physical exam and ask for your complete medical history. He or she may want a blood test, stool samples or an X-ray of the bowel, and might also want to perform two procedures that are more complicated: a exible sigmoidoscopy, which examines the large intestines for rectal bleeding or polyps, and a colonoscopy, which looks for abnormalities in the colon.
A: There is no cure for IBS, but avoiding food triggers and managing stress can greatly reduce symptoms.
The Digestive Health Team

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H E A LT H H U B
from
A Diet to Prevent Kidney Stones:
Foods Vary
WHY YOU NEED PERSONALIZED PHYSICIAN ADVICE People who have suffered through the pain of passing a kidney stone might be all too eager to eliminate any and all foods from their diets that have been linked to kidney stones. However, experts say this isnt a good approach. Unless your doctor suggests you should avoid certain foods, your prevention attempts may limit your diet unnecessarily, says urologist Manoj Monga, MD, Director of Cleveland Clinics Center for Endourology and Stone Disease. KIDNEY STONES NOT CREATED EQUAL Dr. Monga says kidney stones are not all the same. There are ve types of kidney stones, all caused by different things in a persons diet, Dr. Monga says. Even the same type of stone can be caused by different foods in different people, he adds. Also, some foods associated with kidney stones are very healthy and shouldnt be restricted unless shown to be a problem. We know certain foods are very good for general health, especially foods that contain oxalates, like spinach, nuts, and strawberries, he says. When people nd out they have kidney stones, sometimes they restrict these foods from their diet without a full evaluation. The moral of the story? Dont restrict your diet until your doctor performs a full evaluation to determine what is causing your kidney stones, Dr. Monga advises. This typically involves collecting an entire days worth of urine, which is then tested for various metabolites. Based on the results, a doctor can then make recommendations about any dietary changes that need to be made. -The Urinary & Kidney Team CHANGES ANYONE CAN MAKE Only your doctor can tell you what is causing your kidney stones. But there are some dietary changes that can reduce your risk and are safe for anyone to make. L imit sodium. The one thing we encourage people to do is limit sodium, says Dr. Monga. Go on a 1,500 mg-per-day diet. This low-sodium diet is healthy for the kidneys as well as the heart. Drink more water. Dehydration increases the risk of kidney stones, so people who sweat a lot or who live in hot climates should be especially careful to drink enough water. Eat more citrus and melon. People can also reduce their risk of developing kidney stones and improve their health in general by increasing their intake of melons and citrus fruits like lemons, limes and oranges, says Dr. Monga. SOME RISK FACTORS INCLUDE: A diet high in protein, sodium and sugar, which can increase your odds of developing some types of kidney stones A family history of kidney stones Certain other medical conditions such as obesity, gout and other systemic diseases Inammatory bowel disease and gastric bypass surgery because they cause changes in the digestive process that affect how your body absorbs calcium and water WHAT CAUSES KIDNEY STONES? Kidney stones are caused by a combination of genetic predisposition and diet, Dr. Monga says.
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Do I Need
H E A LT H H U B
from
Surgery for GERD?

LOTS OF OPTIONS TO TREAT GERD If you have gastroesophageal reux disease (GERD), the valve between your lower esophagus and stomach are weak and sometimes allow food and stomach acids to go back up into your esophagus. The acids cause the burning sensation we call heartburn. But GERD isnt just uncomfortable. If it isnt treated, it can cause longterm problems like sores and scarring in the esophagus that make it hard to swallow. It can even lead to an increased risk of esophageal cancer. Fortunately, there are many different ways to treat GERD. They range from diet and lifestyle changes, all the way up to surgery. So if the rst thing you try doesnt bring you relief, youre sure to nd something that will. LIFESTYLE CHANGES Stop eating at least two hours before bed, so your stomach has a chance to empty before you lie down. This will keep acid from washing into your esophagus. Wear clothes that t well and dont dig into your waist. Anything that puts pressure on your abdomen can force acid from your stomach into your esophagus. Lose weight if you are overweight. Extra fat can also push up on your stomach, forcing acid out. Quit smoking. Nicotine weakens the muscle between your stomach and esophagus. DIET CHANGES Avoid foods that make your heartburn worse. Everyone has certain foods that trigger heartburn symptoms. Chocolate, coffee, citrus fruits, tomatoes, alcohol and fatty foods are common triggers. Keep a food journal for a while if you arent sure which foods are your triggers. Eat small meals. Overeating can force acid out of your stomach. Eat slowly, too. MEDICATION Over-the-counter drugs, like antacids, acid reducers, or combination medicines, can be helpful. If you try them for more than two weeks but they arent helping, talk to your doctor. Prescription drugs work either by making your stomach produce less acid, or by stimulating the muscles between your stomach and esophagus to contract.
SURGERY Medical therapy is still quite effective in treating reux and some complications of reux, says thoracic surgeon Siva Raja, MD, PhD. But in a highly selected group of patients, anti-reux surgery remains an effective option to palliate GERD symptoms. The most common GERD surgery is called a fundoplication. The surgeon wraps the top part of the stomach around the lower part of the esophagus, and sews it in place. This recreates the valve between the stomach and esophagus, so less acid can wash back up. In some people the their GERD is due to a hiatal hernia where part of the stomach has been pulled into the chest. Even in this group, medical treatment to decrease acid can help. If it does not, surgery can be effective. Long-term, surgical treatments are very effective. A recent ve-year study of about 800 people with GERD found that those who had surgery reported better health and quality of life than people who were treated using medication and diet and lifestyle changes. However, because any surgery carries risks, Dr. Raja stresses the importance of working with your doctor to make sure GERD is really the problem, and that youve tried all other treatment options. For the best outcome, he says, make sure you have a thorough work-up by an experienced physician in a center that treats a high volume of patients with GERD. -The Beating Edge Team
41
Pink Eye
A
parents, teachers and students.
Dealing with
7 tips to keep the lid on conjunctivitis

s children are hard at work learning at school, viruses and bacteria are also hard at work, Pink eye, or conjunctivitis, is when the conjunctiva, a very thin membrane that lines the inner surface of the eyelids and white portion of the eye, gets inamed and causes the lining to become red and swollen. Contrary to popular belief, pink eye is not always due to a bacterial infection. It can also be caused by viruses, allergens and irritants. These types of conjunctivitis will typically resolve spontaneously without additional treatment, Babino said. Still, bacteria can be the cause of the infection. Bacterial conjunctivitis is extremely contagious and can quickly spread through a household or classroom. It typically causes eye redness, irritation, pain and/ spreading from one child to another. One of the most contagious ailments is pink eye. Though not life-threatening, the sticky infection is a hassle for
This common medical condition is around all year,
This common medical condition is around all year. Since it can spread so easily, its more common when school is back in session and kids are in close contact and touching similar surfaces.
-Dr. Khalilah Babino
said Khalilah Babino, DO, an Immediate Care physician at Loyola University Health System in Maywood, Ill. Since it can spread so easily, its more common when school is back in session and kids are in close contact and touching similar surfaces.
Dr. Babino gives gives the following tips for dealing with bacterial pink eye:
or thick, discolored drainage initially in one eye. Its common for a persons eyelids to be stuck shut upon awakening due to drainage.
1 Wash your hands frequently for at least

15-20 seconds with warm soapy water.
Bacterial conjunctivitis can be the result of infection from one of several bacterial organisms. Transmission is from person-to-person contact, secretions from an affected person or infected surfaces. If you suspect you have this type of infection, its best to see your medical provider as soon as possible, Babino said. This information provided courtesy of Loyola University Medical Center
2 Use alcohol sanitizer when water and soap

are not available to clean your hands.
3 Avoid eye makeup during an infection

and discard any open eye makeup as it is likely contaminated.
4 Remove contact lenses and wear glasses

until the infection is cleared.
5 Thoroughly clean your contact lens case

and discard disposable contacts.
6 Avoid touching your eyes with your ngers.

Conjunctivitis is commonly transmitted from one eye to the other this way.
7 Avoid school and/or work until you have had

at least 24 hours of antibiotic treatment.
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43
Consumer Health Information Consumer Health Information www.fda.gov/consumer

www.fda.gov/consumer
www.fda.gov/consumer/updates/supplements080408.html
FDA 101 101: : Dietary Dietary Supplements Supplements

T
he law denes dietary supplements in part as products taken by mouth that contain a dietary ingredient. Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet.
enzyme supplementsEnzymes are complex proteins that speed up biochemical reactions. People use dietary supplements for a wide assortment of reasons. Some seek to compensate for diets, medical conditions, or eating habits that limit the intake of essential vitamins and nutrients. Other people look to them to boost energy or to get a good nights sleep. Postmenopausal women consider using them to counter a sudden drop in estrogen levels. a health care professional before using any dietary supplement. Many supplements contain ingredients that have strong biological effects, and such products may not be safe in all people. If you have certain health conditions and take these products, you may be putting yourself at risk. Your health care professional can discuss with you whether it is safe for you to take a particular product and whether the product is appropriate for your needs. Here is some general advice: Dietar y supplements are not intended to treat, diagnose, cure, or alleviate the effects of diseases. They cannot completely prevent
Dietary supplements come in many forms, including tablets, capsules, powders, energy bars, and liquids. These products are available in stores throughout the United States, as well as on the Internet. They are labeled as dietary supplements and include among others vitamin and mineral products botanical or herbal products These come in many forms and may include plant materials, algae, macroscopic fungi, or a combination of these materials. amino acid produc tsA mino acids are known as the building blocks of proteins and play a role in metabolism.
Talk with a Health Care Professional

The Food and Drug Administration (FDA) suggests that you consult with
FDA suggests that you consult with a health care professional before using any dietary supplement.
Photo Illustration: FDA/Michael Ermarth
/ F DA Consumer Health Information / U.S. Food and Drug Administration 44 1 W H AT D O C T O R S K N O W. C O M
AUGUS T 4, 2008
Consumer Health Information

www.fda.gov/consumer/updates/supplements080408.html Consumer Health Information www.fda.gov/consumer
Using supplements improperly can be harmful. Taking a combination of supplements, using these products together with medicine, or substituting them in place of prescribed medicines could lead to harmful, even life-threatening, results.
diseases, as some vaccines can. However, some supplements are useful in reducing the risk of certain diseases and are authorized to make label claims about these uses. For example, folic acid supplements may make a claim about reducing the risk of birth defects of the brain and spinal cord. Using supplements improperly can be harmful. Taking a combination of supplements, using these products together with medicine, or substituting them in place of prescribed medicines could lead to harmful, even life-threatening, results. Some supplements can have unwanted effects before, during, or after surgery. For example, bleeding is a potential side effect risk of garlic, ginkgo biloba, ginseng, and Vitamin E. In addition, kava and valerian act as sedatives and can increase the effects of anesthetics and other medications used during surgery. Before surgery, you should inform your health care professional about all the supplements you use. products dietary ingredient(s) for the word dietary (e.g., herbal supplement or calcium supple ment). Federal law does not require dietary supplements to be proven safe to FDAs satisfaction before they are marketed. For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDAs satisfaction that the claim is accurate or truthful before it appears on the product. In general, FDAs role with a dietary supplement product begins after the product enters the marketplace. That is usually the agencys rst opportunity to take action against a product that presents a signicant or unreasonable risk of illness or injury, or that is otherwise adulterated or misbranded. Dietary supplement advertising, including ads broadcast on radio and television, falls under the jurisdiction of the Federal Trade Commission. Once a dietary supplement is on the market, FDA has certain safety monitoring responsibilities. These include monitoring mandator y reporting of serious adverse events by dietary supplement rms and voluntary adverse event reporting by consumers and health care professionals. As its resources permit, FDA also reviews product labels and other product information, such as package inserts, accompanying literature, and Internet promotion. Dietar y supplement firms must report to FDA any serious adverse events that are reported to them by consumers or health care professionals. Dietary supplement manufacturers do not have to get the agencys approval before producing or selling these products. It is not legal to market a dietary supplement product as a treatment or cure for a specic disease, or to alleviate the symptoms of a disease. There are limitations to FDA oversight of claims in dietary supplement labeling. For example, FDA reviews substantiation for claims as resources permit.
Are Supplements Safe?

Many dietary supplements have clean safety histories. For example, millions of Americans responsibly consume multi-vitamins and experience no ill effects. Some dietary supplements have been shown to be benecial for certain health conditions. For example, the use of folic acid supplements by women of childbearing age who may become pregnant reduces the risk of some birth defects. Another example is the crystalline form of vitamin B12, which is benecial in people over age 50 who often have a reduced ability to absorb naturally occurring vitamin B12. But further study is needed for some other
AUGUS T 4, 2008 4 5
How Are Supplements Regulated?

You should know the following if you are considering using a dietary supplement. Federal law requires that ever y dietary supplement be labeled as such, either with the term dietary supplement or with a term that substitutes a description of the
2 / FDA Consumer Health Information / U.S. Food and Drug Administration
Consumer Health Information Consumer Health Information www.fda.gov/consumer

www.fda.gov/consumer/updates/supplements080408.html
Some ingredients and products can be harmful when consumed in high amounts, when taken for a long time, or when used in combination with certain other drugs, substances, or foods.
dietary supplements. Some supplements have had to be recalled because of proven or potential harmful effects. Reasons for these recalls include microbiological, pesticide, and heavy metal contamination absence of a dietar y ingredient claimed to be in the product the presence of more or less than the amount of the dietary ingredient claimed on the label In addition, unscrupulous manufacturers have tried to sell bogus products that should not be on the market at all. Before taking a dietary supplement, make sure that the supplement is safe for you and appropriate for the intended purpose. professionals to determine how best to achieve optimal health. Do not substitute a dietary supplement for a prescription medicine or therapy, or for the variety of foods important to a healthful diet. Do not assume that the term natural in relation to a product ensures that the product is wholesome or safe. Be wary of hype and headlines. Sound health advice is generally based upon research over time, not a single study. Learn to spot false claims. If something sounds too good to be true, it probably is. This article appears on FDAs Consumer Health Information Web page (www.fda.gov/consumer), which features the latest updates on FDAregulated products. Sign up for free e-mail subscriptions at www.fda.gov/ consumer/consumerenews.html.
For More Information

Protect Your Health Joint FDA/WebMD resource www.webmd.com/fda Fortify Your Knowledge About Vitamins www.fda.gov/consumer/updates/ vitamins111907.html Tips for the Savvy Supplement User: Making Informed Decisions www.fda.gov/fdac/features/2002/202_ supp.html Overview of Dietary Supplements www.cfsan.fda.gov/~dms/ds-oview. html#what Food Labeling and Nutrition www.cfsan.fda.gov/label.html Final Rule Promotes Safe Use of Dietary Supplements www.fda.gov/consumer/updates/ dietarysupps062207.html
Report Problems
A d v e r s e e f f e c t s w it h d ie t a r y supplements should be reported to FDA as soon as possible. If you experience such an adverse effect, contact or see your health care professional immediately. Both of you are then encouraged to report this problem to FDA. For information on how to do this, go to www.cfsan.fda. gov/~dms/ds-rept.html. Adverse effects can also be reported to the products manufacturer or distributor through the address or phone number listed on the products label. Dietary supplement rms are required to forward reports they receive about serious adverse effects to FDA within 15 days. For a general, nonserious complaint or concern about dietar y supplements, contact your local FDA District Ofce (www.cfsan.fda.gov/~dms/ district.html).
Be a Safe and Informed Consumer

Let your health care professional advise you on sorting reliable information from questionable information. Contact t he manufac turer for information about the product you intend to use. Be aware that some supplement ingredients, including nutrients and plant components, can be toxic. Also, some ingredients and products can be harmful when consumed in high amounts, when taken for a long time, or when used in combination with certain other drugs, substances, or foods. Do not self-diagnose any health condition. Work with health care
/ H FD A Consumer Health Information / U.S. Food and Drug Administration 46 3 W AT D O C T O R S K N O W. C O M
AUGUS T 4, 2008
A los 2 aos y medio un trasplante de corazn salv la vida de Priscilla.

Los mdicos le dijeron a su madre que Priscilla no habra vivido un da ms sin un corazn nuevo. Ahora ella puede nadar, saltar la cuerda y jugar con sus amigos. Ella puede hacer todo lo que los otros nios hacen.
Usted puede ayudar a salvar vidas. Hgase donante de rganos y tejidos.

Para ms informacin, visite www.donevida.org o llame al 1-800-485-8432.
Healthy Way to Grow
48
Healthy Way to Grow Aims to Decrease Obesity Among Children Ages Birth to Five. The American Heart Association and Nemours partner to support healthy eating and physical activity in child care settings.
ith inaugural funding provided by The William G. McGowan Charitable Fund, the American
Todays children are tomorrows future, and our collaborative work will help to ensure that the future is a healthy one. Childhood obesity has reached a concerning level in the U.S. with nearly one in three children between ages 2 and 19 being obese. Encouraging an active lifestyle at this critical early age will help prevent health problems later in life and keep kids healthy as they develop, said Dr. Steve Daniels, Professor and Chairman, Department of Pediatrics University of Colorado School of Medicine. Healthy Way to Grow is an exciting opportunity for us
Heart Association and Nemours, a non-prot childrens health system, are launching Healthy Way to Grow, a technical assistance program for child care centers across the country aimed at decreasing obesity among children ages birth to ve years old. The program provides direct, hands-on assistance, customized training, resources and tools to support healthy lifestyles in child care environments. Healthy Way to Grow will launch in fall of 2013. Components of the program include: developing and adopting a center wellness policy, providing training and technical assistance, engaging parents, and encouraging and recognizing progress towards best practices and policies for physical activity, screen time, food and beverage choices, and infant feeding. The program will pilot in six communities in 2013 with the goal of expanding to more communities over the coming years. Pilot locations include: Rochester, N.Y.; Denver, Colo.; Kansas City, Kan.; Northeastern Pa., Chicago, Ill., and Reno, Nev. The need for this program is evident with current national statistics indicating that more than a quarter of U.S. preschool children ages 2-5 is overweight or obese. Obese children as young as age 3 show indicators for developing heart disease later in life. The American Heart Association, Nemours and The McGowan Fund believe getting ahead of the problem is essential. Developmentally, birth to age 5 is an ideal time to impact crucial life-long cognitive and behavioral development, and setting positive patterns for healthy diet and physical activity. With so many American children spending a majority of their day in early care and education centers, improving the healthfulness of childcare environments makes a signicant health impact. This can lead to both a decrease in the number of children under age 5 who are overweight and obese and a decreased risk of developing cardiovascular and other chronic disease over their lifetimes.
to engage early care and education providers in the ght against childhood obesity. Nemours is pleased to be collaborating with the American Heart Association, such a well-respected organization, to ensure that child care providers have what they need to help children in their care grow up healthy, said Debbie Chang, Vice President of Policy and Prevention at Nemours. We are very excited to be partnering with the American Heart Association and Nemours on this important initiative, said Sue Gin-McGowan, president of the McGowan Fund Board of Directors. Our goal in funding Healthy Way to Grow is to give children the opportunity to live healthier, possibility-lled lives, and leverage our inaugural support by demonstrating to other funders the powerful potential of this targeted initiative. For more information on Healthy Way to Grow and availability in your community visit www. healthywaytogrow.org.
49
Are Cigarettes
A
Find more help to quit smoking at www.smokefree.gov
Burning a Hole in Your Pocket?

recent Illinois cigarette tax hike is making smoking dangerous to peoples physical and to do it overnight and you need a team of support around you to cheer you on. That team captain should be your physician, McAndrew said. Nicotine is too strong an opponent for someone to go it alone. You need that team to help keep you on track when everything inside of you wants to go back. nancial health. The additional economic pressures are compelling people to quit smoking. In fact, 70 percent of people who smoke want to quit and 50 percent have tried in the last year, but the pull of nicotine keeps them tethered to the habit. Nicotine really is that addictive. Its a hard battle, but every one that we win, including increasing the cost of cigarettes through taxes, brings individual smokers to the tipping point where the pain of smoking overcomes the joys of nicotine and they quit, said Philip McAndrew, MD, a Loyola University Health system internal medicine physician and an occupational health expert. The tipping point could be a life-altering health experience, but often its the impact on the pocketbook that makes people really consider quitting. In Chicago, alone, it can easily cost a person $300 a month to smoke. This is more than twice as expensive as a monthly prescription of medications to help people stop smoking. Even if a persons insurance wont cover medications, it costs $65 a month for Zyban. The cost of nicotine patches is only $100 a month, McAndrew said. That financial impact can be enough to encourage some to quit. But even when a person has reached that tipping point, its only the beginning. To quit you need the time and a teamwork approach. Dont expect
50
McAndrew gave some tips to help quit:

1 BUILD A TEAM
You cant do this alone. Nicotine releases serotonin and we love that feeling, so you will need people around you to support you. You will need people who are with you in all areas of your life, especially in places that make you think of smoking, McAndrew said. The team should include: Your physician Friends who are supportive of you quitting Co-workers Family
2 SET A SPECIFIC DATE

It is important to be specific on a date you want to quit but also give yourself time to prepare. It is recommended to set a date two to four weeks away so you have time to prepare your environment and your mind to quit.
3 PREPARE FOR QUIT DAY

The moment you decide to quit start thinking about what changes you need to make and take an inventory of what you need to do to limit the temptation of nicotine.
onsider keeping a diary of when you smoke and C where so you know where and when you might struggle the most.
7 CONTINUE TO DO THE THINGS YOU ENJOY

Stopping smoking is not only a physical battle, its psychological as well. People connect smoking with nice things, like taking break or going out with friends. Its important to break that psychological connection, said McAndrew. He recommends: Go ahead and take that smoking break, just dont smoke. Consider going on a walk or spending some time outside. Keep going out with your friends. Since most restaurants and bars dont allow smoking, you wont be as tempted. Why not have that dessert? Just dont have a cigarette at the end of it.
Dont forget about The Great American Smokeout November 21, 2013. Visit cancer.org/smokeout for more tips and resources.
alk to your physician about medications and other T tactics to aid you in the ght. uy gum, carrot sticks or other snacks for the car and B office to help with the oral xation. et rid of all cigarettes, matches, lighters and ashtrays G from your home, car, office, wherever you smoke. lean your clothes, home and car so they dont smell C like smoke. rogram into your phone with resources like the P National Tobacco Quitline, 1-800-QUIT-NOW, to nd support when youve hit a wall.
4 CELEBRATE QUIT DAY

Once the decision is made to quit smoking, start thinking about the Quit Day and get excited. Dont see it as an end to a favorite habit, but a celebration of the beginning of a new, healthier life, McAndrew said. He suggested going out with friends or having a party to mark this special occasion. Just make sure there is no smoking allowed.
8 THINK ABOUT THOSE YOU LOVE

Quitting smoking is about so much more than ourselves. Studies have shown that secondhand smoke can be more devastating than rsthand smoke, especially for children. Children who live in homes where there is a smoker are more prone to allergies and have more colds, upper respiratory infections and ear infections, McAndrew said. Also, research has shown that parents smoking habits greatly increase the risk of their children smoking. Of all the things you pass on to your kids, your smoking habit shouldnt be one of them.
5 NEW MECHANISMS FOR COPING WITH STRESS

Stress is often a trigger for someone to return to old habits. This is where your doctor, a support group and your team can really lend a hand. Find healthier ways to deal with stress such as exercising or deep breathing. Make sure you have those plans in place before your Quit Day.
This information provided courtesy of Loyola University Medicine
6 WATCH OUT FOR BOREDOM,

ESPECIALLY IN THE CAR
Another pothole on the path to quitting is boredom. One of the hardest places to avoid smoking is in the car. McAndrew suggested having gum and carrot sticks or pretzels in the car at all times to help with the desire to have something in your mouth. He also suggested listening to audiobooks while driving to keep your mind active.
51
Early Breast Cancer
Detection
Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.
Current evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has conrmed that mammograms offer substantial benet for women in their 40s. Women can feel condent about the benets associated with regular mammograms for nding cancer early. However, mammograms also have limitations. A mammogram will miss some cancers, and it sometimes leads to follow up of ndings that are not cancer, including biopsies. Women should be told about the benets, limitations, and potential harms linked with regular screening. Mammograms can miss some cancers. But despite their limitations, they remain a very effective and valuable tool for decreasing suffering and death from breast cancer. Mammograms for older women should be based on the individual, her health, and other serious illnesses, such as congestive heart failure, end-stage renal disease, chronic obstructive pulmonary disease, and moderate-tosevere dementia. Age alone should not be the reason to stop having regular mammograms. As long as a woman is in good health and would be a candidate for treatment, she should continue to be screened with a mammogram.
American Cancer Society recommendations for early breast cancer detection
Breast self-exam (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.
Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman. Some women feel very comfortable doing BSE regularly (usually monthly after their period) which involves a systematic step-by-step approach to examining the look and feel of their breasts. Other women are more comfortable simply looking and feeling their breasts in a less systematic approach, such as while showering or getting dressed or doing an occasional thorough exam. Sometimes, women are so concerned about doing it right that they become stressed over the technique. Doing BSE regularly is one way for women to know how their breasts normally look and feel and to notice any changes. The goal, with or without BSE, is to report any breast changes to a doctor or nurse right away. Women who choose to do BSE should have their BSE technique reviewed during their physical exam by a health professional. It is okay for women to choose not to do BSE or not to do it on a regular schedule. However, by doing the exam regularly, you get to know how your breasts normally look and feel and you can more readily detect any signs or symptoms if a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. Should you notice any changes you should see your health care provider as soon as possible for evaluation. Remember that most of the time, however, these breast changes are not cancer.
54
Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, at least every 3 years. After age 40, women should have a breast exam by a health professional every year.
CBE is a complement to mammograms and an opportunity for women and their doctor or nurse to discuss changes in their breasts, early detection testing, and factors in the womans history that might make her more likely to have breast cancer. There may be some benet in having the CBE shortly before the mammogram. The exam should include instruction for the purpose of getting more familiar with your own breasts. Women should also be given information about the benets and limitations of CBE and breast self-exam (BSE). Breast cancer risk is very low for women in their 20s and gradually increases with age. Women should be told to promptly report any new breast symptoms to a health professional.
Women at high risk (greater than 20% lifetime risk) based on certain risk factors should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.
Women at moderately increased risk include those who:

ave a lifetime risk of breast cancer of 15% to 20%, according H to risk assessment tools that are based mainly on family history (see below) ave a personal history of breast cancer, ductal carcinoma in situ H (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH) Have extremely dense breasts or unevenly dense breasts when viewed by mammograms If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because while an MRI is a more sensitive test (its more likely to detect cancer than a mammogram), it may still miss some cancers that a mammogram would detect. For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. But because the evidence is limited about the best age at which to start screening, this decision should be based on shared decision making between patients and their health care providers, taking into account personal circumstances and preferences.
55
Women at high risk include those who:

Have a known BRCA1 or BRCA2 gene mutation ave a rst-degree relative (parent, brother, sister, or child) with a BRCA1 H or BRCA2 gene mutation, but have not had genetic testing themselves ave a lifetime risk of breast cancer of 20% to 25% or greater, H according to risk assessment tools that are based mainly on family history (such as the Claus model - see below) ad radiation therapy to the chest when they were between the H ages of 10 and 30 years ave Li-Fraumeni syndrome, Cowden syndrome, or BannayanH Riley-Ruvalcaba syndrome, or have rst-degree relatives with one of these syndromes
For women at high risk of breast cancer, like those with BRCA gene mutations or a strong family history, both MRI and mammogram exams of the breast are recommended.
Several risk assessment tools, with names like the Gail model, the Claus model, and the Tyrer-Cuzick model, are available to help health professionals estimate a womans breast cancer risk. These tools give approximate, rather than precise, estimates of breast cancer risk based on different combinations of risk factors and different data sets. Because the different tools use different risk factors to estimate risk, they may give different risk estimates for the same woman. For example, the Gail model bases its risk estimates on certain personal risk factors, like current age, age at menarche (first menstrual period) and history of prior breast biopsies, along with any history of breast cancer in first-degree relatives. In contrast, the Claus model estimates risk based only on family history of breast cancer in both first and second-degree relatives. These 2 models could easily give different estimates for the same person. Risk assessment tools (like the Gail model, for example) that are not based mainly on family history are not appropriate to use with the ACS guidelines to decide if a woman should have MRI screening. The use of any of the risk assessment tool and its results should be discussed by a woman and her doctor. It is recommended that women who get screening MRI do so at a facility that can do an MRI-guided breast biopsy at the same time if needed. Otherwise, the woman will have to have a second MRI exam at another facility at the time of biopsy.
reduce their risk of dying from breast cancer. This combined approach is clearly better than any one exam or test alone. Without question, a breast physical exam without a mammogram would miss the opportunity to detect many breast cancers that are too small for a woman or her doctor to feel but can be seen on mammograms.
Although mammograms are a sensitive screening There is no evidence right now that MRI is an effective screening tool for women at average risk. MRI is more sensitive than mammograms, but it also has a higher false-positive rate (it is more likely to nd something that turns out not to be cancer). This would lead to unneeded biopsies and other tests in many of these women, which can lead to a lot of worry and anxiety. This information provided courtesy of the The American Cancer Society believes the use of mammograms, MRI (in women at high risk), clinical breast exams, and finding and reporting breast changes early, according to the recommendations outlined above, offers women the best chance to American Cancer Society method, a small percentage of breast cancers do not show up on mammograms but can be felt by a woman or her doctors. For women at high risk of breast cancer, like those with BRCA gene mutations or a strong family history, both MRI and mammogram exams of the breast are recommended.
56
There are SOME things you simply CAN NOT control.

But there are some really important things you CAN
like keeping your family healthy and safe. The American Diabetes Association has a free booklet that can help you take control. Its called Planning For a Healthy Life and itll help you do just that, with information NG FOR PLANNI on everything from healthier eating choices, choosing a doctor, and managing your nances to planning for a secure retirement.
9-03-08.qxd: Other Pubs Cover for ADA Bklet . 9/3/08 6:20 PM Page 1
This booklet is for everyone who wants to live a long, healthy, happy, active life. Because the American Diabetes Association is concerned about the overall health of all Americans not just people living with diabetes.
A
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Y H E A LT H
f a m i l y h e a l t h
Yo u r
o - u s e e a s y - t
c e r e s o u r
To get your free copy, call 1-800-DIABETES or go to diabetes.org/lifeplanner.

& e i n g w e l l - b
LIFE
Order yours today. And take control of your life.
1-800-DIABETES
diabetes.org/lifeplanner
57
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What Doctors Know - November 2013

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What Doctors Know - November 2013

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Volume 2, Issue 9 www.whatdoctorsknow.

Healthy Way to Grow

Dizziness Can Be a Drag Overcoming Fear: Tough for Teens

NIH...Turning Discovery into Health

Send story ideas to: submit@whatdoctorsknow.com

FROM CLEVELAND CLINIC

39 Tummy Pain or IBS: Know the Difference

9 Reassuring Findings for Mothers Who Have Inuenza Vaccine

10 USC study shows large pollution exposure reductions

Immunization. Power to Protect.

UNC School of Medicine

A magnetic crystal ball for coronary artery disease

Girls who eat peanut butter

may improve breast health later in life

Poor oral health

linked to cancer-causing oral HPV infection

Unhealthy food marketed to youth through athlete endorsements

for Mothers Who Have Influenza Vaccine While Pregnant

OF VITAMINS & SUPPLEMENTS

Fortified Foods and Drinks: Are you getting too many

So, as the adage goes everything

COMMON FEARS AND CONCERNS

& Your Childs

4CHOOSING THE RIGHT DOCTOR FOR YOUR CHILD

Staying healthy isnt easy.

Then again, neither is dying.

For more information, visit CheckUpAmerica.org, or call 1-800-DIABETES.

ADA 295-09 Hard Ad 7x10 V6.indd 1

Hospitalization Risks Tied to Long-Term

Air Pollution Exposure

This information provided courtesy of Harvard School of Public Health

Surviving Football Season

How to Make Your

Tailgate Party Healthier

Surviving Football Season

Your NFL Teams Loss

Can Go Right to Your Gut

Ignoring the Flu

n December 20, 2009, 32-year-old actress Brittany Murphy died of u

You cant stop time, but you can STOP

serious diseases before they ever start.

Tough for Teens

Coping with Balance Disorders

TELL YOU R DOCTO R

Phoebes daddy has big dreams for her.

2012 ALSAC/St. Jude Childrens Research Hospital

St. Jude patient Phoebe: Daddys Princess

But at this moment, shes fighting cancer.

Help them live. Visit stjude.org.

KNOW YOUR SPECIALIST

Oncologist Board Certication

KNOW YOUR SPECIALIST

Every Connection Counts at MSconnection.org

reast cancer is the most common cancer

Cant Curb the

About 1 in 20 people nationwide has restless legs syndrome.

RECOGNIZING RESTLESS LEGS

Find & Banish Those

CHAIN Starbucks KFC Blimpie McDonalds Arbys Au Bon Pain

a day when we can all breathe easier.

Know the Difference

Tummy Pain or IBS:

Im having digestive issues. Could it be irritable bowel syndrome?

What can I do?

39 Tummy Pain or IBS: Know the Difference

9 Reassuring Findings for Mothers Who Have Inuenza Vaccine

10 USC study shows large pollution exposure reductions

1 Wash your hands frequently for at least

2 Use alcohol sanitizer when water and soap

3 Avoid eye makeup during an infection

4 Remove contact lenses and wear glasses

5 Thoroughly clean your contact lens case

6 Avoid touching your eyes with your ngers.

7 Avoid school and/or work until you have had